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To evaluate a maintenance-tailored therapy (MTT) compared to standard behavior therapy (SBT) for treatment of obesity.change in body weight.A non-blinded, randomized trial comparing effectiveness of MTT and SBT in facilitating sustained weight loss over 18 months; 213 adult volunteersor =18 years participated. SBT had fixed behavioral goals, MTT goals varied over time. Study conducted at the University of Minnesota, School of Public Health, January 2005 through September 2007.Mean (SD) weight losses at 6, 12, and 18 months were 5.7 (5.0) kg, 8.2 (8.6) kg and 8.3 (8.9) kg for MTT and 7.4 (3.9) kg, 10.7 (8.2) kg and 9.3 (8.8) kg for SBT. Total weight loss did not differ by group at 18 months, but the time pattern differed significantly (p0.001). The SBT group lost more weight in the first 6 months. Both groups lost similar amounts between 6 and 12 months; MTT had stable weight between 12 and 18 months, while SBT experienced significant weight gain.The MTT approach produced sustained weight loss for an unusually long period of time and not achieved in previous trials of behavioral treatment for weight loss. The MTT approach, therefore, deserves further study.

Objective: To examine the effects of unilateral stroke patients' neurobehavioral characteristics on spousal psychosocial function. Participants: The sample consisted of twenty unilateral stroke patients and their spousal caregivers. Methods: Patient assessments included mood, affect perception, sensorimotor and cognitive function, marital satisfaction, and activities of daily living. Spousal assessments included mood, marital satisfaction, and perceived stress. Results: To avoid the risk of committing a type I error, the alpha-level of 0.05 was corrected for multiple comparisons involving the three outcome measures, resulting in an adjusted alpha of 0.017 (0.05/3). Using this criterion, the negative correlation between patient depression and spousal marital satisfaction was statistically significant ( rs = �0.585, p = 0.007). There was also a trend for hemispheric side of stroke to correlate with spousal stress (rs = 0.498, p = 0.025), such that strokes in the left hemisphere were associated with greater stress, whereas strokes in the right hemisphere were associated with less stress. Conclusion: These results show that patient depression in particular constitutes a risk factor for marital dissatisfaction in the first few months following stroke. Given that spousal partners provide a large portion of informal support to stroke patients, successful treatment of patient depression may have benefits at the level of the individual, family, and community.

This study examined predictors of maternal responses to children's abdominal pain symptoms. Mothers (N = 450) provided data on psychological distress (self and child), responses to their children's symptoms, and perceived symptom severity. Several demographic factors predicted protectiveness and/or symptom monitoring: younger or male child, maternal non-Caucasian race or less education, and no father in the home. Psychosocial predictors included maternal somatization (related to greater monitoring and less minimization) and child distress (related to greater minimization). A child gender × condition severity interaction indicated greater protection of boys based on perceived severity, but no such discrimination for girls.

Objective: To examine protective buffering and emotional desynchrony among spousal caregivers of cancer survivors. Design: Repeated measures; 42 caregivers engaged in 2 videotaped, oral emotional expression exercises: 1 in the presence of their patient and 1 in the absence of their patient. Main Outcome Measures: Felt emotion (self-report) and expressed emotion (lexical expression or words uttered and coder-derived facial expression). Other measures assessed mental and physical health, dyadic satisfaction, and dispositional emotional inhibition. Results: Protective buffering differed by communicative channel (lexical vs. facial). Caregivers’ facial expressions were more positive when the patient was present versus absent. In contrast, the valence of caregivers’ words did not differ per patient presence. Facial protective buffering was unrelated to health and dyadic outcomes. Lexical protective buffering was inversely related to both caregiver and patient marital satisfaction. Dispositional emotional inhibition was inversely related to caregiver mental health and marital satisfaction. Desynchrony occurred when the patient was present but was counter to prediction; felt emotion was more positive than expressed emotion. Conclusion: Results provide behavioral evidence of facial protective buffering. To the extent that lexical buffering occurs, it poses a dyadic risk, and chronic inhibition poses both psychological and dyadic risks. Future research is needed to refine the operational definition of desynchrony and to examine the biopsychosocial sequelae of buffering.

Objective To examine the sensitivity to change and responsiveness of the Adult Responses to Children's Symptoms (ARCS) among parents of youth with chronic pain. Methods Participants included 330 youth (89 children aged 7-11 years, 241 children aged 12-17 years) and their parents who participated in randomized controlled trials of family-based cognitive-behavioral therapy for chronic pain. Child pain and disability, parental emotional functioning, and parental responses to child pain were assessed at baseline and posttreatment. Results The Protect and Monitor scales of the ARCS were sensitive to change following intervention for both developmental groups, with clinically meaningful reductions in these behaviors, thereby demonstrating responsiveness. Among the adolescent sample, greater change on some ARCS scales was associated with better parental emotional functioning and lower child pain at posttreatment. Conclusions Findings support the sensitivity to change and responsiveness of the Protect and Monitor scales among parents of youth with chronic pain.

This study examines the psychometric properties of a measure of distress specific to cancer and its treatment, as tested in patients receiving hematopoietic cell transplantation (HCT).With multicenter enrollment, the Cancer and Treatment Distress (CTXD) measure was administered to adults beginning HCT as part of an assessment that included the Center for Epidemiologic Studies Depression (CESD), Profile of Mood States, and Medical Outcomes Study Short Form 36 (SF-36).From eight transplant centers, 176 of 219 eligible patients completed the assessment. Average age was 46.7 years (SD = 11.9), 59% were male, and the majority were identified as Caucasian (93%). Principal components analysis with the CTXD identified 22 items that loaded onto six factors explaining 69% of the variance: uncertainty, health burden, identity, medical demands, finances, and family strain. Internal consistency reliability for the 22 items was 0.91. The receiver operating characteristic area under the curve was 0.85 (95% CI [0.79, 0.91]), with a cut point of 1.1 resulting in a sensitivity rate of 0.91 and a specificity rate of 0.58. Convergent validity and divergent validity were confirmed with large correlations of the CTXD total score with the CESD, Profile of Mood States, and SF-36 mental health; and a smaller correlation with the SF-36 physical function (r = -0.30).The CTXD is a reliable and valid measure of distress for HCT recipients and captures nearly all cases of depression on the CESD in addition to detecting distress in those who are not depressed. It has potential value as both a research and clinical screening measure for distress.

The role of emotional expression (EE) in the onset and progression of cancer remains equivocal. The purpose of this study was to compare breast cancer patients (n = 25) and matched healthy controls (n = 25) on self-report and behavioral measures of EE and emotional recognition. Based upon Pennebaker's paradigm, participants completed a verbal positive or negative EE behavioral task. Transcripts of participants’ responses were analyzed using the Linguistic Inquiry and Word Count and were coded for emotional valence and intensity by trained raters blind to experimental condition. Breast cancer patients and healthy controls did not differ on self-report, dispositional measures of EE nor on a behavioral measure of emotional recognition. During the behavioral EE task, patients used significantly less inhibition words than controls and were rated as expressing more intense emotion. Results provide some support for the view that cancer diagnosis and treatment can alter emotionally expressive behavior.

Research indicates that myeloablative hematopoietic cell transplantation (HCT) impairs neurocognitive function. However, prospective studies on long-term effects are lacking. This longitudinal study examined neurocognitive changes over the first year in 142 adult recipients of allogeneic HC transplants who received neuropsychologic testing before transplantation and again after 80 days and 1 year. Age-, sex-, and education-adjusted population-based standardized scores were used for normative comparisons. Performance on all tests declined from before transplantation to 80 days (P < .05) and improved by 1 year (P < .05), returning to pretransplantation levels on all tests except for grip strength and motor dexterity. Although verbal fluency and memory recovered by 1 year, both were below norms at all 3 testing times (P < .01). Logistic regressions indicated that patients without chemotherapy, other than hydroxyurea, previous to HCT and patients not receiving chronic graft-versus-host disease (GVHD) medication at 1 year had lower risk of impaired function (P < .05). In conclusion, HCT was associated with significant generalized decline in neurocognitive performance at 80 days, with subsequent recovery to pretransplantation levels by 1 year for most survivors, except on motor tasks. Results indicate that long-term cognitive decrements, as distinct from motor disabilities, infrequently derive directly from HCT. (Blood. 2004;104:3386-3392)

The process of stem cell transplantation (SCT) is both intra and inter dependent; like patients, spousal caregivers (CGs) are affected by the experience. Few empirical investigations have focused on the needs of CGs or dyadic differences over the course of adaptation-the foci of the present study. SCT recipients and spousal CGs (n=131 dyads) completed the Profile of Mood States (POMS) and the Dyadic Adjustment Scale at three time points: pre-transplant, 6 months post-transplant and 1 year post-transplant. A separate, non-medical group completed the POMS as a normative sample. CGs reported higher levels of depression and anxiety as compared to patients and non-medical norms. With respect to marital satisfaction, couples were matched in their perceptions of the relationship prior to transplantation but grew mismatched over time. Six months and 1 year post-transplant, CGs reported lower levels of marital satisfaction relative to their patient counterparts. Counter to prediction, change in CG marital satisfaction (from pre-transplant to 1 year post-transplant) was predicted only by CG gender, not patient physical, nor psychosocial characteristics. Findings offer implications for person-specific and relationship-protective interventions.

To examine the relative contributions of disease activity and psychological factors to self-reported symptoms and disability in children with Crohn's disease.Participants (n = 127 children age 8-18 years) completed questionnaires on symptom severity and disability, as well as psychological measures assessing anxiety, depression, pain beliefs and coping. Disease activity was measured by the Pediatric Crohn's Disease Activity Index. Structural equation modeling was used to test the effects of disease activity and psychological factors on symptoms and disability.In the hypothesized model predicting symptoms, psychological factors (β = 0.58; P .001) were significantly associated with disease symptoms but disease activity was not. The model for disability yielded significant associations for both psychological factors (β = 0.75; P .001) and disease activity (β = 0.61, P .05).Crohn's disease symptoms in children and adolescents are not only driven by disease activity. Coping, anxiety, depression, and cognition of illness are important in the patient-reporting of symptom severity and disability. Physicians need to be aware that symptom self-reporting can be driven by psychological factors and may not always be simply an indicator of disease activity.ClinicalTrials.gov: NCT00679003.

OBJECTIVES We evaluated eating behaviors and quality of life (QOL) in preadolescent children at risk for obesity, with and without abdominal pain (AP). METHODS Participants were parent-child dyads enrolled in a randomized, controlled obesity prevention trial. The children were between 5 and 10 years of age and at risk for obesity (70th-95th percentile of body mass index, n = 420). Parents completed measures of their child's eating behaviors, QOL, AP, and bowel function and their own depression status, concern about child weight, and feeding practices. Children's height and weight were also measured. RESULTS Children with frequent AP (≥2/month, n = 103) were compared with children reporting infrequent AP (

Objective To describe the proportion of children adhering to recommended physical activity and dietary guidelines, and examine demographic and household correlates of guideline adherence. Design Cross-sectional (pre-randomization) data from a behavioral intervention trial designed to prevent unhealthy weight gain in children. Participants A total of 421 children (aged 5–10 years) at risk for obesity (body mass index percentile, 70–95). Main Outcomes Measured Physical activity (accelerometry), screen time (parent survey), and fruit and vegetable and sugar-sweetened beverage intake (24-hour dietary recall). Analysis Proportions meeting guidelines were calculated. Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for (1) physical activity (≥ 60 min/d), (2) screen time (≤ 2 h/d), (3) fruit and vegetable intake (≥ 5 servings/d), and (4) sugar-sweetened beverage avoidance. Results Few children met more than 1 guideline. Only 2% met all 4 recommended guidelines and 19% met none. Each guideline had unique sociodemographic and domain-specific household predictors (ie, availability of certain foods and beverages, media, and active play and exercise equipment). Conclusions and Implications Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others. Results have implications for the development of interventions to affect children's weight-related behaviors and growth trajectories.

Objectives Cognitive-behavioral (CB) interventions improve outcomes for many pediatric health conditions, but little is known about which mechanisms mediate these outcomes. The goal of this study was to identify whether changes in targeted process variables from baseline to 1 week posttreatment mediate improvement in outcomes in a randomized controlled trial of a brief CB intervention for idiopathic childhood abdominal pain. Materials and methods Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to 1 of 2 conditions: a 3-session social learning and CB treatment (N=100), or a 3-session educational intervention controlling for time and attention (N=100). Outcomes were assessed at 3-, 6-, and 12-month follow-ups. The intervention focused on altering parental responses to pain and on increasing adaptive cognitions and coping strategies related to pain in both parents and children. Results Multiple mediation analyses were applied to examine the extent to which the effects of the social learning and CB treatment condition on child gastrointestinal (GI) symptom severity and pain as reported by children and their parents were mediated by changes in targeted cognitive process variables and parents' solicitous responses to their child's pain symptoms. Reductions in parents' perceived threat regarding their child's pain mediated reductions in both parent-reported and child-reported GI symptom severity and pain. Reductions in children's catastrophic cognitions mediated reductions in child-reported GI symptom severity but no other outcomes. Reductions in parental solicitousness did not mediate outcomes. Discussion Results suggest that reductions in reports of children's pain and GI symptoms after a social learning and CB intervention were mediated at least in part by decreasing maladaptive parent and child cognitions.

This study sought to model and test the role of parental catastrophizing in relationship to parent-reported child pain behavior and parental protective (solicitous) responses to child pain in a sample of children with Inflammatory Bowel Disease and their parents (n=184 dyads). Parents completed measures designed to assess cognitions about and responses to their child’s abdominal pain. They also rated their child’s pain behavior. Mediation analyses were performed using regression-based techniques and bootstrapping. Results supported a model treating parent-reported child pain behavior as the predictor, parental catastrophizing as the mediator, and parental protective responses as the outcome. Parent-reported child pain behavior predicted parental protective responses and this association was mediated by parental catastrophizing about child pain: indirect effect (SE) = 2.08 (0.56); 95% CI = 1.09, 3.30. The proportion of the total effect mediated was 68%. Findings suggest that interventions designed to modify maladaptive parental responses to children’s pain behaviors should assess, as well as target, parental catastrophizing cognitions about their child’s pain.

To assess differences in weight regain one year after an 18-month obesity treatment with standard behavior therapy (SBT) or maintenance-tailored therapy for obesity (MTT).213 obese adult volunteers were treated for 18 months using SBT with fixed behavioral prescriptions or MTT that employed varied behavioral prescriptions with treatment breaks. Follow-up analysis focused on weight maintenance after a year of no contact. The trial was conducted at the University of Minnesota between 2005 and 2009.Mean (SD) weight change between 18 and 30 months for participants in the SBT group was +4.1 kg (4.4) compared to +2.8 kg (4.5) in the MTT group. This is a 31% reduction in weight regain in MTT relative to SBT (p=0.078). This trend toward better maintenance in MTT versus SBT was due primarily to superior differential maintenance in MTT participants in the highest tertile of total weight loss at 18 months, i.e. MTT participants in this tertile regained 4 kg less than SBT participants between 18 and 30 months.The MTT approach with varied content and timing produced more desirable patterns of weight loss maintenance than the traditional SBT approach, especially among individuals who had achieved greater initial weight loss.

A metaperception is an individual's perception of another's perception of him or her. Symbolic interactionists posit that metaperceptions are based on social feedback, while social cognitivists posit that metaperceptions are formed via an inward turn to self-perception. We hypothesized that a situational factor, clarity of feedback, moderates whether individuals will tune into the message itself versus to self-perception: unambiguous feedback may elicit metaperceptions based on the feedback, while ambiguous feedback may elicit metaperceptions based on self-perception. To test this, 157 undergraduates selected as low or high in self-esteem were randomly assigned to receive either clear, channel-consistent (e.g., positive verbal/positive nonverbal) feedback or unclear, channel-inconsistent (e.g., positive verbal/negative nonverbal) feedback from a confederate. Results indicated independent effects of both self-esteem and verbal feedback. In addition, counter to prediction, metaperceptions formed in response to channel-consistent feedback were more in line with the self; metaperceptions formed in response to channel-inconsistent feedback were more in line with the verbal element of the message. Possible explanations and implications are discussed.

Research indicates that spirituality/religion is important to many patients and they want this to be an integrated component of their care. This study's aim was to better understand doctors' attentiveness to patients'/families' spiritual/religious concerns and the contributing factors for this in the Northwest USA as well as doctor's attitudes about referrals to chaplains. Study participants included 108 pediatricians and oncologists who completed an online self-report questionnaire regarding their beliefs about the health relevance of patients' spirituality/religion and their attentiveness to this. Few doctors routinely addressed this concern. Doctors who were Christian, did not expect negative reactions to inquiring, and were knowledgeable regarding chaplains were more likely to address spirituality/religion. Doctors who felt less adequate in addressing spirituality/religion and were concerned about patients negative reactions were less likely to value referral to chaplains. On the other hand, those who had an understanding regarding chaplains were more likely to support referral.

Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5–10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a Contact Control condition that focuses on safety and injury prevention. The HHHK 5–10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The Contact Control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5–10 trial.

Objective To determine whether a brief intervention for children with functional abdominal pain and their parents' responses to their child's pain resulted in improved coping 12 months later. Design Prospective, randomized, longitudinal study. Setting Families were recruited during a 4-year period in Seattle, Washington, and Morristown, New Jersey. Participants Two hundred children with persistent functional abdominal pain and their parents. Interventions A 3-session social learning and cognitive behavioral therapy intervention or an education and support intervention. Main Outcome Measures Child symptoms and pain-coping responses were monitored using standard instruments, as was parental response to child pain behavior. Data were collected at baseline and after treatment (1 week and 3, 6, and 12 months after treatment). This article reports the 12-month data. Results Relative to children in the education and support group, children in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month follow-up decreases in gastrointestinal symptom severity (estimated mean difference, −0.36; 95% CI, −0.63 to −0.01) and greater improvements in pain-coping responses (estimated mean difference, 0.61; 95% CI, 0.26 to 1.02). Relative to parents in the education and support group, parents in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month decreases in solicitous responses to their child's symptoms (estimated mean difference, −0.22; 95% CI, −0.42 to −0.03) and greater decreases in maladaptive beliefs regarding their child's pain (estimated mean difference, −0.36; 95% CI, −0.59 to −0.13). Conclusions Results suggest long-term efficacy of a brief intervention to reduce parental solicitousness and increase coping skills. This strategy may be a viable alternative for children with functional abdominal pain. Trial Registration clinicaltrials.gov Identifier:NCT00494260

This study examined intra- and inter-personal associations between pain catastrophizing and verbal expression in 70 children with recurrent abdominal pain and their mothers. Participants independently completed the Pain Catastrophizing Scale. Mothers and children then talked about the child’s pain. Speech was categorized using a linguistic analysis program. Catastrophizing was positively associated with the use of negative emotion words by both mothers and children. In addition, mothers’ catastrophizing was positively associated with both mothers’ and children’s anger word usage, whereas children’s catastrophizing was inversely associated with mothers’ anger word usage. Findings extend the literature on behavioral and interpersonal aspects of catastrophizing.

Myeloablative hematopoietic cell transplantation (HCT) is a common treatment for hematological malignancy. Delayed immune reconstitution following HCT is a major impediment to recovery with patients being most vulnerable during the first month after transplant. HCT is a highly stressful process. Because psychological distress has been associated with down regulation of immune function we examined the effect of pre-transplant distress on white blood cell (WBC) count among 70 adult autologous HCT patients during the first 3 weeks after transplant. The participants were on average 38 years old; 93% Caucasian, non-Hispanic and 55% male. Pre-transplant distress was measured 2–14 days before admission using the Cancer and Treatment Distress (CTXD) scale, and the Symptom Checklist-90-R (SCL-90-R) anxiety and depression subscales. WBC count was measured during initial immune recovery on days 5 through 22 post-transplant. Linear mixed model regression analyses controlling for gender and treatment-related variables revealed a significant effect of the mean pre-transplant SCL Anxiety-Depression score on WBC recovery. We found no significant effect of pre-transplant CTXD on WBC recovery. In general, higher levels of pre-treatment anxiety and depression were associated with slower WBC recovery. Psychological modulation of WBC recovery during HCT suggests a unique mechanism by which psychological distress can exert influence over the immune system. Given that WBC recovery is essential to survival for HCT patients, these data provide a rationale for treating anxiety and depression in HCT patients.

Objective To investigate whether sex differences exist in the pattern of change in C-reactive protein (CRP) levels during weight loss, and whether the associations between weight change and CRP change differ by the types of anthropometric variables. Design Longitudinal, prospective analysis of subjects participating in an intentional weight loss trial (the Lose It For Ever: LIFE Study) followed-up for 30 months. Subjects 212 healthy, obese men and women (age: 23–77y, BMI: 30–39kg/m2). Measurements Body mass index (BMI), waist and hip circumferences, and waist-to-hip ratio (WHR), CRP, and lifestyle variables repeatedly measured at baseline, 6, 12, 18, and 30-month follow-up. Results Weight change was J-shaped with a nadir at 12-months in both men and women (P for month2

Unexplained abdominal pain in children has been shown to be related to parental responses to symptoms. This randomized controlled trial tested the efficacy of an intervention designed to improve outcomes in idiopathic childhood abdominal pain by altering parental responses to pain and children's ways of coping and thinking about their symptoms.Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to one of two conditions-a three-session intervention of cognitive-behavioral treatment targeting parents' responses to their children's pain complaints and children's coping responses, or a three-session educational intervention that controlled for time and attention. Parents and children were assessed at pretreatment, and 1 week, 3 months, and 6 months post-treatment. Outcome measures were child and parent reports of child pain levels, function, and adjustment. Process measures included parental protective responses to children's symptom reports and child coping methods.Children in the cognitive-behavioral condition showed greater baseline to follow-up decreases in pain and gastrointestinal symptom severity (as reported by parents) than children in the comparison condition (time x treatment interaction, P0.01). Also, parents in the cognitive-behavioral condition reported greater decreases in solicitous responses to their child's symptoms compared with parents in the comparison condition (time x treatment interaction, P0.0001).An intervention aimed at reducing protective parental responses and increasing child coping skills is effective in reducing children's pain and symptom levels compared with an educational control condition.

BACKGROUND: Protective buffering refers to hiding cancer-related thoughts and concerns from one's spouse or partner. In this study, the authors examined the intrapersonal and interpersonal consequences of protective buffering and the motivations for such behavior (desire to shield partner from distress, desire to shield self from distress). METHODS: Eighty hematopoietic stem cell transplantation recipients and their spousal caregivers/partners completed measures that were designed to assess protective buffering and relationship satisfaction at 2 time points: before transplantation (T1) and 50 days after transplantation (T2). Overall mental health also was assessed at T2. RESULTS: There was moderate agreement between 1 dyad member's reported buffering of their partner and the partner's perception of the extent to which they felt buffered. Caregivers buffered patients more than patients buffered caregivers, especially at T2. The more participants buffered their partners at T2 and the more they felt buffered, the lower their concurrent relationship satisfaction and the poorer their mental health. The latter effect was particularly true for patients who buffered and for patients who felt buffered. With respect to motivations, patients who buffered primarily to protect their partner at T1 reported increases in relationship satisfaction over time; however, when they did so at T2, their caregiver reported concurrent decreases in relationship satisfaction. CONCLUSIONS: Protective buffering is costly, in that those who buffer and those who feel buffered report adverse psychosocial outcomes. In addition, buffering enacted by patients with an intention to help may prove counterproductive, ultimately hurting the object of such protection. Cancer 2009;115(18 suppl):4311–25. © 2009 American Cancer Society.

OBJECTIVE: To examine the trajectories of mood, weight and physical activity, and associations between mood, weight, and gender, among 213 obese individuals. METHODS: Prospective, longitudinal design. Assessments at baseline and 6, 12, and 18 months of Profile of Mood States, Paffenbarger Physical Activity Questionnaire, and weight. RESULTS: Total mood disturbance decreased from baseline to 6 months, with no change thereafter. Weight decreased from baseline to 6 to 12 months, and increased from 12 to 18 months. Physical activity increased from baseline to 6 months, and 12 to 18 months. Increased physical activity predicted greater vigor and less fatigue over time. Females high in distress at 6 months lost less weight than females low in distress and at 18 months gained more weight than those low in distress. There were no such associations among males. CONCLUSION: The trajectories of mood, weight and physical activity were synchronous only in the short-term. Distress monitoring, targeted to females who relapse, may be warranted.

This study investigated whether catastrophic thinking about pain by children with functional abdominal pain or by their parents is associated with health outcomes in the child. Subjects were 132 parent-child dyads. Child catastrophizing predicted child depression, anxiety and functional disability. Parents’ catastrophizing cognitions about their own pain predicted self-reported protective responses to their children’s abdominal pain (responding in ways that encourage illness behavior). Protectiveness, in turn, predicted child functional disability. All findings held despite controlling for child age, gender, and symptom severity. These results suggest that catastrophic cognitions play an important role in how children and parents cope and respond to functional abdominal pain, and may have implications for assessment and treatment in the clinical setting.

To examine the effects of unilateral stroke patients' neurobehavioral characteristics on spousal psychosocial function.The sample consisted of twenty unilateral stroke patients and their spousal caregivers.Patient assessments included mood, affect perception, sensorimotor and cognitive function, marital satisfaction, and activities of daily living. Spousal assessments included mood, marital satisfaction, and perceived stress.To avoid the risk of committing a type I error, the alpha-level of 0.05 was corrected for multiple comparisons involving the three outcome measures, resulting in an adjusted alpha of 0.017 (0.05/3). Using this criterion, the negative correlation between patient depression and spousal marital satisfaction was statistically significant (rs=-0.585, p=0.007). There was also a trend for hemispheric side of stroke to correlate with spousal stress (rs=0.498, p=0.025), such that strokes in the left hemisphere were associated with greater stress, whereas strokes in the right hemisphere were associated with less stress.These results show that patient depression in particular constitutes a risk factor for marital dissatisfaction in the first few months following stroke. Given that spousal partners provide a large portion of informal support to stroke patients, successful treatment of patient depression may have benefits at the level of the individual, family, and community.

This paper reviews empirical work on cognitive and social learning contributions to the etiology and treatment of illness behavior associated with functional abdominal pain and inflammatory bowel disease. A particular emphasis is placed on randomized controlled trials, the majority of which are multi-modal in orientation, incorporating elements of cognitive behavioral therapy, social learning, and relaxation. Based on this review, we offer methodological and clinical suggestions: (1) Research investigations should include adequate sample sizes, long-term follow-up assessments, and a credible, active control group. (2) Standard gastrointestinal practice should include, when appropriate, learning opportunities for patients and family members, for example, instruction regarding the encouragement of wellness behavior.

Background: Among adults with functional gastrointestinal disorders, psychological distress influences who consults a physician, but little is known about predictors of consultation when the patient is a child. Objective: To determine the relative contributions of psychological symptoms of the mother, psychological symptoms of the child, severity of child abdominal pain, and family stress to consultation. Design: Observational study. Setting: Health maintenance organization. Participants:Twohundredseventy-fivemothersof334 children who had abdominal pain in the past 2 weeks, as per child self-report. Main Outcome Measures: Mothers completed questionnaires about themselves (Symptom Checklist 90– Revised) and their children (school absences, medication use, and the Child Behavior Checklist). Children completed the Pain Beliefs Questionnaire to assess perceived pain severity. Results:Thirty-ninechildrenhadbeentakentotheclinic for abdominal pain symptoms at least once in the past 3 months (consulters), whereas 295 were nonconsulters. Logisticregressionanalysesrevealedthatboththechild’s self-report of perceived pain severity (P.001) and maternal psychological symptoms (P=.006) predicted consultation. Although children who visited physicians had significantly more psychological symptoms, this was not a significant predictor of consultation after adjusting for maternal psychological symptoms. Family stress did not predict consultation. Conclusion: The decision to take a child to the clinic for abdominal pain is best predicted by maternal psychological distress and the child’s perceived pain severity.

Purpose To determine late effects of hematopoietic cell transplantation (HCT) on health problems and health-related quality of life for 10-year survivors. Patients and Methods Four hundred five adults consented to the study before HCT. Medical records and standardized self-report measures were maintained prospectively. After 10 years, 137 survivors and nontransplant controls, case-matched on age, sex, and race, completed self-report of medical problems, symptoms, and health-related quality of life. Results Survivors and controls had similar rates of hospitalization and most diseases, but survivors reported an average of 3.5 medical problems versus 1.7 for controls (P < .001). Survivors reported more musculoskeletal stiffness, cramps, weakness and joint swelling (P < .001), cataract surgery (P < .001), hepatitis C (P = .004), sexual problems for men (P = .01) and women (P < .001), restrictions in social function (P = .002), memory and attention concerns (P = .003), urinary frequency or leaking (P = .006), use of psychotropic medication (P = .009), and denial of life and health insurance (P < .001). Survivors and controls did not differ in self-reported rates of osteoporosis, hypothyroidism, employment, marital satisfaction, divorce, or psychological health. Conclusion Although indistinguishable in many respects, survivors had more medical needs than controls. Health problems were not focused on specific diseases or limited to survivors with readily identifiable risk factors. Musculoskeletal problems require both screening and research into etiologies and effective treatments. Osteoporosis and hypothyroidism may be underdiagnosed. Survivors require screening for sexual problems, urinary frequency, mood and need for antidepressants or benzodiazepines.

ContextHematopoietic cell transplantation (HCT) is an effective and widely used treatment for hematologic malignancies. The rate and predictors of physical and emotional recovery after HCT have not been adequately defined in prospective long-term studies.ObjectiveTo examine the course of recovery and return to work after HCT.Design, Setting, and PatientsProspective, longitudinal cohort study at a US academic center specializing in HCT. Function was assessed from pretransplantation to 5-year follow-up for 319 adults who had myeloablative HCT for treatment of leukemia or lymphoma and spoke English. Of the 99 long-term survivors who had no recurrent malignancy, 94 completed 5-year follow-up.Main Outcome MeasuresPhysical limitations, return to work, depression, and distress related to treatment or disease were evaluated before transplantation, at 90 days, and at 1, 3, and 5 years after HCT.ResultsPhysical recovery occurred earlier than psychological or work recovery. Only 21 patients (19%) recovered on all outcomes at 1 year. The proportion without major limitations increased to 63% (n = 57) by 5 years. Among survivors without recurrent malignancy, 84% (n = 74) returned to full-time work by 5 years. Patients with slower physical recovery had higher medical risk and were more depressed before HCT (P≤.001). Patients with chronic graft-vs-host disease (P = .01), with less social support before HCT (P = .001), and women (P

This article highlights findings from the cancer-specific and other medical caregiving literatures and details a 2-year longitudinal prospective investigation of mood among hematopoietic stem cell transplant (HSCT) patients and spousal caregivers (CGs). Emphases are on gender and role (patient, spouse). Couples (n = 131) completed the Profile of Mood States before HSCT, 6 months, 1 year, and 2 years after HSCT. Data from a nonmedical sample were also collected for normative comparison. Negative affect declined over time for both patients and CGs (P0.05), with gender differences among CGs (P0.01) but not patients (P0.05). Female CGs reported greater depression and anxiety than male CGs. In gender-specific normative comparisons, male and female patients and male CGs showed elevations in negative affect before transplant (P0.01) but not after (P0.05). Female CGs, in contrast, showed elevations at multiple time points (P0.01), suggesting slower resolution of distress over time. These results highlight the need to consider time, gender, and role when addressing emotional, marital, or psychiatric needs in couples. Further investigation is required to identify sources and long-term sequelae of negative affect among female CGs and their partners.

To examine the association of physician nonverbal communication with standardized patient (SP) satisfaction in the context of the "quality" of the interview (i.e., information provided and collected, communication skills).Observational.One university-based internal medicine residency program.Fifty-nine internal medicine residents. INTERVIEWING: The 59 residents were recruited to participate in 3 SP encounters. The scenarios included: 1) a straightforward, primarily "medical" problem (chest pain); 2) a patient with more psychosocial overlay (a depressed patient with a history of sexual abuse); and 3) a counseling encounter (HIV risk factor reduction counseling). Trained SPs rated physician nonverbal behaviors (body lean, open versus closed body posture, eye contact, smiling, tone of voice, nod, facial expressivity) in the 3 encounters. Multiple regression approaches were used to investigate the association of physician nonverbal behavior with patient satisfaction in the context of the "quality" of the interview (SP checklist performance, measures of verbal communication skills), controlling for physician characteristics (gender, postgraduate year).Nonverbal communication skills was an independent predictor of standardized patient satisfaction for all 3 patient stations. The effect sizes were substantial, with nonverbal communication predicting 32% of the variance in patient satisfaction for the chest pain station, 23% of the variance for the depression-sexual abuse station, and 19% of the variance for the HIV counseling station.Better nonverbal communication skills are associated with significantly greater patient satisfaction in a variety of different types of clinical encounters with standardized patients. Formal instruction in nonverbal communication may be an important addition to residency.

One way in which the dyadic communicative process can go awry is for one or both parties to send channel-inconsistent communications - communications in which the verbal and nonverbal elements are not matched in emotional valence (e.g., uttering positive words with a frown). We hypothesized that unilateral stroke patients would be likely to send such messages. Given the verbal impairments typically associated with left hemisphere damage (LHD), e.g., agrammatism, and the nonverbal impairments typically associated with right hemisphere damage (RHD), we expected LHD and RHD patients to send messages in which the impaired channel was perceived as inconsistent with the unimpaired channel. Ten LHD, 11 RHD and six normal control patients were videotaped while engaging in social interaction. Observers made judgments about the valence of the patients' (1) words (based on transcripts of the interactions), and (2) facial expressions (based on soundless videos of the interactions). Analysis of word-face difference scores revealed a significant linear trend, with messages of LHD patients judged more positive in facial expression than in verbal content, messages of RHD patients judged more positive in verbal content than in facial expression, and messages of control patients judged channel-consistent (similar in valence across facial and verbal channels).

Neuropsychological research indicates that the left hemisphere plays a dominant role in verbal production and processing, while the right hemisphere plays a dominant role in nonverbal production and processing. This study sought to examine the effects of such differential hemispheric specialization on personality and social competency. Ten left hemisphere damaged (LHD) stroke patients, 11 right hemisphere damaged (RHD) stroke patients, and 7 neurologically normal (NHD) patients were videotaped while engaging in social interaction with their spouse and an interviewer. Segments of the interactions were independently coded by two observers. Patients and spouses were rated with respect to their level of social competency and the extent to which they were characterized by 10 personality adjectives (e.g., outgoing, warm ). Ratings for the personality items were summed to create an aggregate score. Analysis of these scores revealed both LHD and RHD patients to have lower (i.e., more negative) mean scores than NHD patients, suggesting that stroke patients as a whole were seen as socially impaired. Analysis of the socially competent item revealed particular LHD deficits; LHD patients were seen as less socially competent than both RHD and NHD patients. Spouses of LHD, RHD, and NHD patients, in contrast, did not differ in observer-rated social behavior. ( JINS , 1998, 4 , 447–455.)

G A A b st ra ct s preferred causal attribution and the ranking of attributions did not vary over one year. Subjective illness attributions such as “dysfunctional stress regulation” (β = 0.65, P < 0.01) and “interpersonal reasons” (β = 0.58, P < 0.01) aim towards a higher anxiety in patients at T2. Naming “social reasons“ as attribution at T1 was a significant predictor for severity of symptoms at T2 (β = 0.47, P < 0.01). Furthermore, the attributions “dysfunctional stress regulation“ and “fatalism“ at T1 affected physical quality of life at T2. These coherences were independent from variables such as age, sex and IBS subgroup and were still present after controlling for the respective starting level of outcome variables.Conclusions: Subjective theories of illness are of prognostic value for clinical and psychological outcome in IBS patients. The knowledge of content and significance of concepts that patients develop to explain their disease will enable the healthcare professional to better understand patient expectations and improve doctor-patient-relationship as well as treatment approaches in irritable bowel syndrome.