Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes

Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal.     

Toward a Better Understanding of Psychological Well‐Being in Dementia Caregivers: The Link Between Marital Communication and Depression

To read this article's abstract in both Spanish and Mandarin Chinese, please visit the article's full‐text page on Wiley InterScience ( http://interscience.wiley.com/journal/famp ). Dementia research has frequently documented high rates of caregiver depression and distress in spouses providing care for a partner suffering from dementia. However, the role of marital communication in understanding caregiver distress has not been examined sufficiently. Studies with healthy couples demonstrated an association between marital communication and the partners' psychological well‐being, depressiveness, respectively (e.g., Heene, Buysee, & Van Oost, 2005 ). The current study investigates the relationship between caregiver depression and communication in 37 couples in which the wives care for their partners with dementia. Nonsequential and sequential analyses revealed significant correlations between caregiver depression and marital communication quality. Caregivers whose husbands used more positive communication reported less depression and distress. Additionally, caregiver depression was negatively correlated with rates of positive reciprocal communication indicating dependence between the couples' interaction patterns. This study is one of the first to illustrate the relevance of spousal communication in understanding caregiver distress and depression.     

Remarriage Beliefs as Predictors of Marital Quality and Positive Interaction in Stepcouples: An Actor–Partner Interdependence Model

Using an Actor–Partner Interdependence Model, we examined remarriage beliefs as predictors of marital quality and positive interaction in a sample of 179 stepcouples. Three beliefs were measured using subscales from the Remarriage Belief Inventory (RMBI) including success is slim, children are the priority, and finances should be pooled. Several significant actor and partner effects were found for both wives' and husbands' beliefs. Wives' marital quality was positively associated with their own beliefs that finances should be pooled and negatively associated with their own beliefs that success is slim. Wives' reports of their own and spouses' positive interaction were both positively associated with their beliefs that finances should be pooled. Their reports of spouses' positive interaction were also negatively associated with husbands' beliefs that success is slim. Husbands' marital quality was positively associated with wives' beliefs that children are the priority, positively associated with their own beliefs that finances should be pooled, and negatively with success is slim. Positive interaction for husbands was positively associated with wives' beliefs that finances should be pooled and negatively associated with their own beliefs that success is slim. Finally, husbands' reports of positive interaction for their spouses were positively associated with wives' beliefs that finances should be pooled. Implications for future research utilizing dyadic data analysis with stepcouples are addressed.     

Couples Relationship Education and Couples Therapy: Healthy Marriage or Strange Bedfellows?

This paper focuses on issues sparked by the Couples Relationship Education (CRE) field moving toward a more clinical model to meet the needs of an increasing number of distressed couples coming to CRE programs. We review the concerns raised and recommendations made by Bradford, Hawkins, and Acker (2015), most of which push CRE toward a more clinical model. We address these recommendations and make suggestions for best practices that preserve the prevention/education model underlying research‐based CRE. The three main issues are couple screening, leader training, and service delivery models. Our suggested best practices include: conducting minimal screening including the assessment of dangerous levels of couple violence, training leaders with key skills to handle issues raised by distressed couples as well as other couples who may place additional burdens on leaders, providing referrals and choices of programs available to participants at intake and throughout the CRE program, and adding (rather than integrating) clinical services to CRE services for couples who desire additional intervention. Finally, throughout the paper, we review other key issues in the CRE field and make recommendations made for future research and practice.     

Development of Family Functions and Relationship in Families: A Mixed-Design Study

Abstract

This is a mixed-design study that examines the effects of a psychoeducation program on family functioning and the parent-adolescent relationship. The quantitative dimension of the study was quasi-experimental and included the pretest, post-test and follow-up model with control and experiment groups. The data were collected from both parents and adolescents. In the study, there were 32 adolescents in the experiment group (18 male, 14 female), while the control group consisted of 31 adolescents (15 male, 16 female). The results of the study show that the education program decreases the problem behaviors of adolescents while increasing family functions and promoting the adolescent-parent relationship     

An Integrative Model for the Analysis and Treatment of Insomnia

The present paper describes an integrative cognitive-behavioural model for the analysis and treatment of insomnia. According to the theoretical model, insomnia is the result of an interaction between sleep-interfering processes (e.g. various kinds of arousal, and processes whereby various stimuli, behaviours and cognitive activities lead to arousal) and sleep-interpreting processes (sleep-related beliefs, attributions, attitudes, etc.). It is argued that insomnia involves various combinations of such processes, and that treatment should be based on a cognitive-behavioural analysis of how these processes combine in each particular case of insomnia. The treatment model focuses both on a reduction of sleep-interfering arousal processes (e.g. by replacing willful goal-directed control strategies with skills of mindful observation and acceptance) and on a modification of sleep-interpreting processes (by means of behavioural experiments and psychoeducative interventions).     

Attentional Bias,Self-consciousness and Perfectionism in Social Phobia Before and After Cognitive-Behaviour Therapy

Attentional bias for threat words (as measured by the emotional Stroop task), selfconsciousness and perfectionism was studied in 24 patients with social phobia before and after cognitive-behaviour treatment. A total of 18 (75%) of the patients were classified as treatment responders on the basis of reduced scores for social anxiety. The treatment responders showed a significant reduction in attentional bias for social threat words, in public self-consciousness and in perfectionism. The non-responders showed an equal reduction in perfectionism; as they had a much higher level of perfectionism before treatment, however, their change only amounted to a lowering of their level of perfectionism to the level that characterized the treatment responders before treatment. The treatment responders, on the other hand, reduced their level of perfectionism to that of non-clinical samples.     

What is IPT? The Basic Principles and the Inevitability of Change

Interpersonal Psychotherapy (IPT) is an empirically validated treatment for a number of psychiatric disorders. Like all psychotherapies, IPT can be described by its theoretical foundations and its primary targets, tactics, and techniques. The need for continued creativity in IPT and other treatments is reviewed, and several specific proposals for change in IPT based on clinical observations and theoretical considerations are discussed. A paradigm for collaboration between academic research and clinical observation required for continued creativity is offered. Change is inevitable, and the empirically validated therapies such as IPT will be even more effective as they incorporate and test new and creative elements.

En-Gendering the Couple-Deity Relationship: Clinical Implications of Power and Process

Spiritual practices are increasingly accommodated by therapists working with religious couples. While research documents potential benefits, spiritual practices such as prayer may invoke an interpretive couple-God relationship distorted by pathogenic processes in one or both spouses. A survey administered to 78 religious couples examined the influence of power/gender as it relates to couples’ harmful triangulation with Deity. Results suggest that harmful triangulation with Deity does occur to some degree in couple relationships, that there are significant differences by gender, and that spouses’ tendencies to triangulate are correlated with one another. We discuss these results from a systemic-feminist perspective, and offer some clinical applications for working with religious couples.