Internet-Delivered Acceptance and Values-Based Exposure Treatment for Fibromyalgia: A Pilot Study

Background: Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM. Methods: This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up. Results: The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohen's d = 0.62–1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion. Conclusions: An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.     

A 9-YEAR-OLD WITH CONVERSION DISORDER, SUCCESSFULLY TREATED WITH PSYCHOANALYSIS

This paper outlines the successful psychoanalytic treatment of a latency-aged boy with severe conversion disorder. Details of clinical treatment are presented. As no tested treatment has yet been found that reliably treats chronic conversion in children, this case is of importance in demonstrating the usefulness of psychoanalysis as treatment for severe psychopathology. The patient's unconscious fantasy constellations that gave rise to this syndrome are highlighted.     

The Adaptation of Patients During the Hospitalization Period of Bone Marrow Transplantation

A longitudinally study was conducted among 42 bone marrow transplantation (BMT) patients to investigate the association between pretransplant psychosocial variables and psychophysiological outcomes during the immediate convalescence period. Family relationships (cohesion, expressiveness, and conflict) and coping resources (cognitive, social, emotional, spiritual/philosophical, and physical resources) were assessed on the admission day (Day –7 Time 1). Data on psychological distress and pain intensity were obtained on Day +7 (Time 2) and Day +14 (Time 3). The average scores at Times 2 and 3 were computed to indicate the overall adjustments of the patients during the hospitalization period after the day of actual transplant (Day 0). It was shown that higher expressiveness family relationships and higher resources to cope effectively with stressful situations were associated with less psychological distress during the above period. Both pretransplant psychosocial variables were not associated with pain intensity during hospitalization. Allogeneic transplant patients reported higher pain intensity than did autologous transplant patients. Psychological distress and pain intensity were positively correlated with each other. Our findings show that pretransplant family relationships and coping resources associate moderately with psychological distress during the immediate convalescent period of BMT. The present findings support the family-centered approach to BMT care and provide a scientific basis for pretransplant psychosocial interventions.     

The Ojibwa Vision Quest

Like other Algonkian-speaking groups, the Ojibwa traditionally sought personal relations with guardian spirits whom they encountered in visions, as a rite of passage into status as adults. Visions were sometimes sought as early as age three or four, and were generally accomplished no later than puberty. The procedures for cultivating visions blended practical and ritual elements. The procedures were both explained informally and portrayed in myths and belief-legends. Roheim interpreted vision quests in keeping with Freud's general theory of religion, as evidence of fixated Oedipus complexes; but a pathologizing interpretation is inappropriate. Detailed analyses of both boys' and girls' self-reports readily support diagnoses of healthy genitality, rather than Oedipal fixation. Vision quests are better regarded as manifestations of ego ideals, leading in most cases to improved ego–superego integration.     

Presurgical MMPI-2 Cluster Profiles Predict 1-Year Low-Back Surgery Outcomes

The primary purpose of this study was to examine whether empirically derived cluster profiles based on scores from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) predicted outcomes of surgery at 1 year for patients with low-back pain. On the basis of hierarchical cluster analysis of presurgery MMPI-2 scores for 60 patients, three interpretable and significant subgroups were formed. These consisted of a pathological/neurotic type, a double V-code type, and a normal type. The patents in the normal type were significantly more likely to report beneficial outcomes of surgery in terms of disability and pain than those in the other 2 types. These findings extend previous research and suggest (1) low-back surgery candidates are heterogeneous in their psychological profiles, and (2) MMPI-2 profiles are predictive of low-back surgery outcome. Future research should focus on identifying physiological substrates for these distinct profiles and investigating the effectiveness of presurgical psychological interventions based on profile type.     

对以边沁、密尔为代表的功利主义的分析批判

边沁的功利主义为苦乐原理、效果论和功利原则这样三个理论基点所构成。这是一个有着内在逻辑困境的三原理。苦乐原理由于没有进行内在的质的区分,为密尔所修正,但密尔的修正突出了苦乐原理与效果论的内在不一致;同时,密尔以自我牺牲来补充功利主义,又暴露了功利主义原则的内在矛盾。还有,密尔以平等权利来为功利主义的最大幸福原理辩护,恰恰表明功利原则并非是可以成为一个理论的基础性原则或终极原则。斯马特的行动功利主义则进一步暴露了功利主义的非正义性特性。功利主义的这样三个典范表明仅仅诉诸功利原则无从走出内在逻辑困境。布兰特援引认知理论以及道义论原则,笔认为这才使功利主义从其困境中走出。     

Psychological Variables Associated with Pain Perceptions Among Individuals with Chronic Spinal Cord Injury Pain

Structural equation modeling was used to examine the relationships between selected psychological variables and pain perceptions in 103 individuals experiencing chronic pain following traumatic spinal cord injury (SCI). Previous studies have suggested strong relationships between psychological variables and chronic SCI pain, but further delineation of such relationships is needed in order ultimately to develop more effective pain management strategies for individuals afflicted with such pain. Anger was found to be significantly related to perceptions of pain (p < .05), but neither guilt nor anger suppression was significantly associated with perceived pain. Internal health locus of control was associated with decreased pain perceptions (p < .05), but there was no significant relationship between internal health locus of control and anger. Punishing responses from significant others to pain complaints were related to feelings of guilt (p < .05) and perceived pain (p < .05), but this relationship was not mediated by guilt.     

Understanding and Treating Pain in Ethnically Diverse Patients

A revolution has taken place during the past 25 years in the understanding and treatment of chronic pain. Psychologists have contributed tremendously to this revolution. However, the primary psychological models of pain treatment have failed to adequately integrate the empirical findings and theoretical understanding of the role of ethnic factors. The goal of this paper is to address this problem by demonstrating the importance of understanding ethnic factors in treating pain, providing an overview of ethnic factors in pain, and proposing guidelines for Clinical Psychologists who treat pain patients from ethnically diverse backgrounds.     

A comparison of coping strategies in patients with fibromyalgia,chronic neuropathic pain,and pain‐free controls

Patients suffering from chronic pain may benefit from learning adaptive coping strategies. Consensus on efficient strategies for this group of patients is, however, lacking, and previous studies have shown inconsistent results. The present study has examined coping strategies in two distinctly different groups of chronic pain patients and a group of healthy controls. Thirty neuropathic pain (NP) patients, 28 fibromyalgia (FM) patients, and 26 pain‐free healthy controls completed the Coping Strategy Questionnaire (CSQ‐48/27) and rated their daily pain. The results showed that FM and NP patients did not cope differently with pain. The only difference between the groups was that FM patients felt more in control of their pain than NP patients. Both patient groups used more maladaptive/passive coping strategies, but surprisingly also more adaptive/active coping strategies than healthy controls. However, FM patients with high levels of passive strategies felt less in control than FM patients with low levels of passive strategies. This was not seen in NP patients. An important implication for clinical practice is therefore that passive coping strategies should be restructured into active ones, especially for FM patients. Otherwise, the same psychological treatment model can be applied to both groups since they use similar coping styles.     

Analgesic effect of Facebook: Priming with online social networking may boost felt relatedness that buffers against physical pain

Social networking sites (SNSs) are extremely popular for providing users with a convenient platform for acquiring social connections and thereby feeling relatedness. Plenty of literature has shown that mental representations of social support can reduce the perception of physical pain. The current study tested whether thinking about SNS would interfere with users’ perceptions of experimentally induced pain. Ninety‐six undergraduate Facebook users were recruited to participate in a priming‐based experiment. They were randomly assigned to one of the three study conditions (SNS prime, neutral prime, or no prime) via rating the aesthetics of logos. The results showed that participants exposed to SNS primes reported less pain of immersion in hot water than did both control groups (neutral‐ and no‐prime). Felt relatedness mediated the link between SNS primes and diminished pain perceptions. This research provides the first demonstration that thinking about SNS can lower experienced physical pain among Facebook users. Online social networking may serve as an analgesic buffer against pain experience than previously thought. The SNS‐enabled analgesia has far reaching implications for pain relief applications and the enhancement of well‐being in human‐interaction techniques.