88 results on '"Amy E. Williams"'
Search Results
2. Concurrent and longitudinal associations among insomnia symptoms, internalizing problems, and chronic pain in youth
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Mary K. Lynch Milder, Maureen E. McQuillan, Sarah M. Honaker, Megan M. Miller, James Tolley, Martha A. Michel, Adam T. Hirsh, and Amy E. Williams
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Psychiatry and Mental health ,Applied Psychology - Abstract
Although insomnia symptoms and chronic pain are associated, less is known about the temporal nature of the associations between these variables or the impact of internalizing symptoms on the associations. Concurrent and longitudinal associations were examined among insomnia symptoms, internalizing symptoms, and pain in youth with chronic pain in this retrospective analysis of clinical records. We hypothesized the following: (a) pain, insomnia symptoms, and internalizing symptoms would be significantly interrelated at all waves, (b) insomnia symptoms would more strongly predict future pain than the reverse, and (c) internalizing symptoms would mediate the longitudinal association between insomnia symptoms and pain.Youth (Pain and insomnia symptoms were positively correlated within each wave. We found bidirectional longitudinal associations between insomnia symptoms and pain.Overall, these data demonstrate a bidirectional relationship between insomnia symptoms and pain, as well as weak support for internalizing symptoms mediating the association between pain and insomnia symptoms. Treatment of youth with chronic pain should prioritize concurrent or early treatment of comorbid insomnia symptoms to maximize response to pain treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
- Published
- 2023
3. Anger as a Mechanism of Injustice Appraisals in Pediatric Chronic Pain
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Amy E. Williams, Megan M. Miller, Zina Trost, Eric L. Scott, and Adam T. Hirsh
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Male ,Mediation (statistics) ,Adolescent ,media_common.quotation_subject ,Anger ,behavioral disciplines and activities ,Injustice ,medicine ,Humans ,media_common ,business.industry ,Mechanism (biology) ,Perspective (graphical) ,Chronic pain ,medicine.disease ,Psychosocial Functioning ,Anesthesiology and Pain Medicine ,Pain Clinics ,Neurology ,Adolescent Behavior ,Female ,Neurology (clinical) ,Chronic Pain ,business ,Psychosocial ,Clinical psychology - Abstract
Mechanisms explaining the relationship between pain-related injustice appraisals and functional outcomes in youth with chronic pain have yet to be examined. In studies of adults, greater pain-related injustice is associated with worse depressive symptoms and greater pain through greater anger. No study to date has examined anger expression as a mediator in the relationships between pain-related injustice appraisals and physical and psychosocial functioning in youth with chronic pain. The current sample consisted of 385 youth with varied pain conditions (75% female, 88% White, Mage=14.4 years) presenting to a university-affiliated pain clinic. Patients completed self-report measures assessing anger expression (anger-out and anger-in), pain-related injustice, pain intensity, functional disability, and emotional, social, and school functioning. Bootstrapped mediation analyses indicated that only anger-out (indirect effect= -.12, 95% CI: -.21, -.05) mediated the relationship between pain-related injustice and emotional functioning, whereas both anger-out (indirect effect= -.17, 95% CI: -.27, -.09) and anger-in (indirect effect= -.13, 95% CI: -.09, -.001) mediated the relationship between pain-related injustice and social functioning. Neither mode of anger expression mediated the relationship between pain-related injustice and pain intensity, functional disability, or school functioning. Collectively, these findings implicate anger as one mechanism by which pain-related injustice impacts psychosocial outcomes for youth with chronic pain. Perspective: Anger expression plays a mediating role in the relationship between pain-related injustice appraisals and psychosocial outcomes for youth with chronic pain. Anger represents one target for clinical care to decrease the deleterious impact of pain-related injustice on emotional and social functioning.
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- 2022
4. Clinical Characterization of Juvenile Fibromyalgia in a Multi-Center Cohort of Adolescents Enrolled in the FIT Teens Trial
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Anne M, Lynch-Jordan, Mark, Connelly, Jessica W, Guite, Christopher, King, Alana, Goldstein-Leever, Deirdre E, Logan, Sarah, Nelson, Jennifer N, Stinson, Tracy V, Ting, Emily O, Wakefield, Amy E, Williams, Sara E, Williams, Susmita, Kashikar-Zuck, S, Ardoin, L, Chamberlin, K, Goldschneider, C, Hoffart, R, Ittenbach, M, Lo, J, Peugh, M, Pfeiffer, J, Taylor, and W, Zempsky
- Abstract
Juvenile Fibromyalgia (JFM) is a complex chronic pain condition that remains poorly understood. The study aimed to expand the clinical characterization of JFM in a large representative sample of adolescents with JFM and identify psychological factors that predict pain interference.Participants were 203 adolescents (12-17 years) who completed baseline assessments for the multi-site Fibromyalgia Integrative Training for Teens (FIT Teens) randomized control trial. Participants completed the Pain and Symptom Assessment Tool (PSAT), which includes a Widespread Pain Index (WPI, 0-18 pain locations) and Symptom Severity checklist of associated somatic symptoms (SS; 0-12) based on the 2010 ACR criteria for Fibromyalgia. Participants also completed self-report measures of pain intensity, functional impairment, and psychological functioning.Participants endorsed a median of 11 painful body sites (WPI) and had a median SS score of 9. Fatigue and nonrestorative sleep were prominent features and rated as moderate to severe by 85% of participants. Additionally, neurologic, autonomic, gastroenterological, and psychological symptoms were frequently endorsed. WPI was significantly correlated with pain intensity and catastrophizing, while SS scores were associated with pain intensity and all domains of physical and psychological functioning. Depressive symptoms, fatigue, and pain catastrophizing predicted severity of pain impairment.JFM is characterized by chronic widespread pain with fatigue, nonrestorative sleep, and other somatic symptoms. However, how diffusely pain is distributed appears less important to clinical outcomes and impairment than other somatic and psychological factors highlighting the need for a broader approach to the assessment and treatment of JFM.
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- 2022
5. Retrospective review of opioid use in pediatric patients with chronic pain
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Jackson Griffith-Linsley, Amy E. Williams, James A. Tolley, and Jeffrey S. Raskin
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Ocean Engineering - Abstract
Background and Hypothesis: Demographics and treatment of adult patients with chronic pain have been well characterized. The same has not been done in pediatric patients who are at increased risk of the consequences of opioid use including risk of addiction, truancy, and unemployment. We hypothesize that opioid use in pediatric patients with chronic pain leads to worse functional outcomes due to pain and maladaptive behaviors. Methods: From 2016-2019, 300 new patient consultations to the Riley comprehensive pain clinic were identified. A subpopulation interim analysis of 71 patients was retrospectively evaluated at 6-month intervals for medical, social, pain-related, and questionnaire data. Data was recorded in REDCap by a single researcher. Exported data was analyzed using Microsoft Excel. Results: Seventy-one patients were evaluated and 80% were female. Median age at diagnosis was 14 years (range birth to 18) with average follow-up of 20.5 months. Etiologies varied but contributed to neuropathic (49%), nociceptive (35%), and mixed (11%) pain syndromes. Comorbid psychiatric disorders and sleeping difficulties were present in 69% and 58%, respectively. Sixty-seven percent of age-appropriate patients graduated high school and were in college or employed on final follow-up. Patients managed with opioids did not report a change in visual analog or catastrophizing scales. Conclusion and Potential Impact: The primary demographic of pediatric chronic pain patients is adolescent females. Neuropathic pain syndromes are common, with a majority of patients exhibiting comorbid psychiatric disorders and dysfunctional sleep patterns. Use of opioid medications did not change reported pain scores, and one-third of these chronic pain patients did not attend college or were unemployed. Further analysis of our data set should help better understand the outcomes of pediatric patients with chronic pain.
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- 2022
6. Examination of Family Counseling Coursework and Scope of Practice for Professional Mental Health Counselors
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B. L. Varga, Olivia L. Weinzatl, and Amy E. Williams
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Family therapy ,Medical education ,Scope of practice ,Social Psychology ,Clinical mental health counseling ,Coursework ,education ,Psychology ,Mental health ,Social Sciences (miscellaneous) ,Accreditation - Abstract
This study examined couple and family counseling coursework in the Council for the Accreditation of Counseling and Related Educational Programs (CACREP)–accredited clinical mental health counseling (CMHC) programs and scope of practice related to couple and family counseling based on each state’s licensure regulations for mental health counselors (MHCs). Required and offered courses in couple/family-related content areas for 331 CACREP-accredited CMHC programs were analyzed. In addition, state licensure regulations for all 50 states and Washington, DC, were examined to determine whether MHCs can conduct couple and family counseling based upon licensure regulations. The results of this study indicated a mean of 1.1 couple/family-related courses required and a mean of 2.3 of these courses offered within CMHC programs. All but one of the 51 licensure regulations analyzed either permits or does not specify whether couple/family counseling falls within the scope of practice of MHCs; these 50 state/territory regulations also lack concrete guidelines related to required training or supervised experience in couple and family counseling to provide this service competently as an MHC. Limitations and areas for future research and training opportunities are discussed in light of these results.
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- 2020
7. Spinal Cord Stimulation Improves Functional Outcomes in Children With Complex Regional Pain Syndrome: Case Presentation and Review of the Literature
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James Knight, Sarah K Johnson, Amy E. Williams, Jeffrey S. Raskin, Salma M. Bakr, and James A. Tolley
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Polypharmacy ,Spinal Cord Stimulation ,medicine.medical_specialty ,education.field_of_study ,Adolescent ,business.industry ,Population ,Chronic pain ,Spinal cord stimulation ,Case presentation ,medicine.disease ,Neuromodulation (medicine) ,Treatment Outcome ,Anesthesiology and Pain Medicine ,Complex regional pain syndrome ,medicine ,Humans ,Pain Management ,Female ,Chronic Pain ,Intensive care medicine ,business ,education ,Complex Regional Pain Syndromes ,Pediatric population - Abstract
Background In the pediatric population, complex regional pain syndrome (CRPS) is a debilitating chronic pain syndrome that is classically treated with escalating polypharmacy and physical therapy. Failure of therapy is often encountered in both adult and pediatric patients with CRPS, after which invasive neuromodulatory therapy might be considered. Intrathecal drug delivery systems and spinal cord stimulation (SCS) have been reported in the literature as forms of neuromodulation effective in adult CRPS; however, SCS remains inadequately researched and underreported in the pediatric CRPS population. Owing to the differences in patient population characteristics and the specific vulnerability of adolescents to drugs that might be used to manage refractory cases, including but not limited to opioids, we believe that early effective pain management without the use of chronic pain medications is of paramount importance. Methods Recent evidence suggests that neuromodulation can be useful toward improving function and managing pain, while also reducing medication use in chronic pain patients. A representative case a review of the literature is performed. Results We report the effective treatment of CRPS in a pediatric patient following implantation of an SCS device typifying the improved pain scores, decreased medication use, and substantially improved functional abilities in pediatric patients following SCS. Conclusions The manuscript objective is to stimulate a discussion for SCS use earlier in the therapeutic management of CRPS in children.
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- 2020
8. Assessment and Treatment Recommendations for Pediatric Pain: The Influence of Patient Race, Patient Gender, and Provider Pain-Related Attitudes
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Megan M. Miller, Amy E. Williams, Tamika C. B. Zapolski, Kevin L. Rand, and Adam T. Hirsh
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Adult ,Male ,medicine.medical_specialty ,Students, Medical ,Attitude of Health Personnel ,Clinical Decision-Making ,Pain Interference ,Psychological Distress ,Article ,Mean difference ,Young Adult ,03 medical and health sciences ,Race (biology) ,Sex Factors ,0302 clinical medicine ,030202 anesthesiology ,Pain assessment ,medicine ,Humans ,Healthcare Disparities ,Child ,business.industry ,Chronic pain ,Pain Distress ,Implicit-association test ,medicine.disease ,United States ,Abdominal Pain ,Black or African American ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Neurology ,Family medicine ,Pediatric pain ,Female ,Neurology (clinical) ,Chronic Pain ,business ,030217 neurology & neurosurgery - Abstract
Previous studies have documented that racial minorities and women receive poorer pain care than their demographic counterparts. Providers contribute to these disparities when their pain-related decision-making systematically varies across patient groups. Less is known about racial and gender disparities in children with pain or the extent to which providers contribute to these disparities. In a sample of 129 medical students (henceforth referred to as "providers"), Virtual Human methodology and a pain-related version of the Implicit Association Test (IAT) were used to examine the effects of patient race/gender on providers’ pain assessment/treatment decisions for pediatric chronic abdominal pain, as well as the moderating role of provider implicit pain-related race/gender attitudes. Findings indicated that providers rated Black patients as more distressed (mean difference [MD] = 2.33, P < .01, standard error [SE] = .71, 95% confidence interval [CI] = .92, 3.73) and as experiencing more pain-related interference (MD = 3.14, P < .01, SE = .76, 95% CI = 1.63, 4.64) compared to White patients. Providers were more likely to recommend opioids for Black patients than White patients (MD = 2.41, P < .01, SE = .58, 95% CI = 1.05, 3.76). Female patients were perceived to be more distressed by their pain (MD = 2.14, P < .01, SE = .79, 95% CI = .58, 3.70) than male patients, however there were no gender differences in treatment recommendations. IAT results indicated that providers held implicit attitudes that Black Americans (M = .19, standard deviation [SD] = .29) and males (M = .38, SD = .29) were more pain-tolerant than their demographic counterparts; however, these implicit attitudes did not significantly moderate their pain assessment/treatment decisions. Future studies are needed to elucidate specific paths through which the pain experience and care of children differ across racial and gender groups. PERSPECTIVE: Providers’ pain assessment (ie, pain distress/pain interference) and treatment (ie, opioids) of pediatric pain differs across patient race and to a lesser extent, patient gender. This study represents a critical step in research on pain-related disparities in pediatric pain.
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- 2020
9. Drunkorexia: An Exploratory Investigation of College Students With Alcohol‐Related Infractions
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Sterling P. Travis, Eleni Maria Honderich, Amy E. Williams, Sarah E. I. Menefee, Victor E. Tuazon, and Charles F. Gressard
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chemistry.chemical_compound ,Eating disorders ,chemistry ,Incidence (epidemiology) ,medicine ,Alcohol ,Drunkorexia ,medicine.disease ,Psychology ,Education ,Clinical psychology - Published
- 2019
10. Characterizing Juvenile Fibromyalgia in a Large Cohort of Adolescents
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Anne Lynch-Jordan, Mark Connelly, Jessica W. Guite, Christopher King, Alana Goldstein-Leever, Deirdre Logan, Sara Nelson, Tracy V. Ting, Emily Wakefield, Amy E. Williams, Sara E. Williams, and Susmita Kashikar-Zuck
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Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) - Published
- 2022
11. Cross-Sectional Associations among Components of Injustice Appraisals and Functioning in Adolescents With Chronic Pain
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James A. Tolley, Adam T. Hirsh, Mary K Lynch Milder, Amy E. Williams, Eric L. Scott, Megan M. Miller, and Martha A Michel
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Adolescent ,business.industry ,Chronic pain clinic ,media_common.quotation_subject ,Catastrophization ,Emotions ,Chronic pain ,Emotional functioning ,medicine.disease ,Injustice ,Blame ,Cross-Sectional Studies ,Quality of life ,Pediatrics, Perinatology and Child Health ,Developmental and Educational Psychology ,medicine ,Humans ,Chronic Pain ,business ,Child ,Psychosocial ,Social functioning ,Clinical psychology ,media_common ,Pain Measurement - Abstract
Objective Pain-related appraisals, including pain-related injustice, impact the development and maintenance of chronic pain. This cross-sectional study aimed to examine the relationship between the cognitive-emotional components of pain-related injustice—blame/unfairness and severity/irreparability of loss—and functioning in a mixed sample of adolescents with chronic pain. Methods Pediatric patients age 11–18 years (N = 408) completed forms assessing pain-related injustice, pain intensity, and physical and psychosocial functioning as part of their routine assessment in a pediatric chronic pain clinic between January 2014 and January 2019. A series of hierarchical regressions were used to evaluate the relationships among the separate components of pain-related injustice appraisals and functioning. Results Pain intensity and blame/unfairness appraisals were significantly associated with emotional functioning with blame/unfairness being the stronger association (β = −.27). Blame/unfairness appraisals, severity/irreparability appraisals, and pain intensity were significantly associated with physical functioning with pain intensity being the strongest association (β = .36). Pain intensity, blame/unfairness appraisals, and severity/irreparability appraisals were significantly associated with social functioning with blame/unfairness being the strongest association (β = −.34). Pain intensity and severity/irreparability appraisals were significantly associated with school functioning with severity/irreparability being the stronger association (β = −.19). Conclusions These results lend further support to incorporating pain-related injustice appraisals in standard clinical pain assessments. Treatment practices should target the specific injustice appraisals and domains of functioning impacted for each pediatric patient with chronic pain.
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- 2021
12. Battle of the Appraisals: Pain-Related Injustice Versus Catastrophizing as Mediators in the Relationship Between Pain Intensity and 3-Month Outcomes in Adolescents with Chronic Pain
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Eric L. Scott, Zina Trost, Amy E. Williams, Adam T. Hirsh, and Megan M. Miller
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Male ,Mediation (statistics) ,Adolescent ,Injustice ,Quality of life (healthcare) ,Outcome Assessment, Health Care ,medicine ,Humans ,Pain experience ,business.industry ,Catastrophization ,Perspective (graphical) ,Chronic pain ,medicine.disease ,Psychosocial Functioning ,Anesthesiology and Pain Medicine ,Neurology ,Adolescent Behavior ,Quality of Life ,Pain catastrophizing ,Female ,Neurology (clinical) ,Chronic Pain ,business ,Psychosocial ,Clinical psychology ,Follow-Up Studies - Abstract
Pain appraisals are closely tied to pain and functional outcomes. Pain-related injustice and pain catastrophizing appraisals have both been identified as important cognitive-emotional factors in the pain experience of youth. Although pain-related injustice and catastrophizing have been linked to worse pain outcomes – as primary predictors and intermediary variables – little is known about whether they operate as independent or parallel mediators of the relationship between pain and functioning in youth. We tested pain-related injustice and catastrophizing appraisals as candidate mediators of the relationship between baseline pain intensity and 3-month functional outcomes in adolescents. Youth with chronic pain (N = 89, 76% female, 89% White, average age = 15 years) completed measures assessing pain intensity, pain-related injustice, and catastrophizing at baseline, as well as measures assessing functional disability and overall quality of life 3 months later. Multiple mediation analyses indicated that injustice mediated the relationship between pain intensity and 3 month quality of life. Exploratory analyses of specific quality of life domains indicated that injustice mediated the relationship between pain intensity and 3 month emotional functioning, whereas catastrophizing mediated the relationship between pain intensity and 3 month social functioning. The findings suggest these pain-related appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes. Perspective Pain-related injustice and catastrophizing appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes in youth with chronic pain. Treatments targeting pain-related injustice appraisals in pediatric populations are needed to complement existing treatments for catastrophizing.
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- 2020
13. Peer Support in the Treatment of Chronic Pain in Adolescents: A Review of the Literature and Available Resources
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Marti A. Michel, Amy E. Williams, James A. Tolley, and Janelle S Renschler
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media_common.quotation_subject ,education ,Review ,Peer support ,Fibromyalgia ,medicine ,Function (engineering) ,media_common ,Medical education ,support ,Social network ,business.industry ,lcsh:RJ1-570 ,Chronic pain ,complex regional pain syndrome ,lcsh:Pediatrics ,medicine.disease ,Mental health ,peers ,Complex regional pain syndrome ,Pediatrics, Perinatology and Child Health ,The Internet ,social network ,virtual ,fibromyalgia ,internet ,business ,Psychology ,chronic pain - Abstract
Peer support has found applications beyond the mental health field and is useful for managing several chronic disorders and supporting healthy lifestyle choices. Communication through telephone and the Internet allows for greater access to those who cannot meet in person. Adolescent chronic pain would seem ideally suited to benefit from online peer support groups. Research is lacking, however, to characterize benefit in terms of pain and function, despite a clear desire among adolescents for access to such programs. More rapid development of online applications is needed for peer support, and research into the associated outcomes will be necessary to optimally design such programs.
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- 2020
14. The Problem of Pain: Chronic Pain
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Eric L. Scott, Amy E. Williams, and Emily Foxen-Craft
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Biopsychosocial model ,medicine.medical_specialty ,Conceptualization ,Hospital setting ,business.industry ,Chronic pain ,Inpatient setting ,medicine.disease ,Mental health ,Multidisciplinary approach ,Rehabilitative treatment ,medicine ,Physical therapy ,business - Abstract
Youth chronic pain management presents unique challenges to the pediatric psychologist in both inpatient and outpatient settings. This chapter includes specific and practical guidance for working with youth and their families/caregivers presenting to an inpatient setting for treatment of chronic pain. Conceptualization of pediatric chronic pain from a biopsychosocial framework informs the chapter which includes guidance in specific domains to consider within an initial assessment. Practical advice is provided regarding communicating with families about taking a rehabilitative treatment approach in such a way as to increase readiness for treatment of their child’s chronic pain upon discharge from the hospital. The chapter gives clinical pearls for psychologists to make valuable contributions to multidisciplinary treatment teams which seek to incorporate psychological information relevant to the child’s treatment within the hospital setting. Finally, information is offered for referring and coordinating care for patients upon discharge when they have ongoing pain needs including school reentry, effective non-pharmacologic treatment, and prioritizing mental health needs that co-occur with patient’s pain symptoms.
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- 2020
15. Collaborating with Child Psychiatry
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Ann M. Lagges, Amy E. Williams, Julianne M. Giust, and Hillary S. Blake
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medicine.medical_specialty ,Psychotherapist ,Medical terminology ,Conceptualization ,Catatonia ,Child and adolescent psychiatry ,medicine ,Delirium ,Collaborative Care ,medicine.symptom ,Psychology ,medicine.disease ,Patient care - Abstract
Pediatric consultation-liaison (CL) psychologists collaborate with other care providers in the hospital, including psychiatrists. Whether the CL team contains both a psychiatrist and a psychologist or they are separate entities, collaboration between psychiatry and psychology facilitates better patient care. When psychologists and psychiatrists work together, the two disciplines can benefit from the differences in their training. Psychologists benefit from a psychiatrist’s expertise in medication management, diagnostics (e.g., imaging, lab testing, etc.), knowledge of complex clinical presentations (e.g., catatonia, delirium, etc.), and understanding of medical terminology, while a psychiatrist can learn from a psychologist’s knowledge of psychological assessments and more in-depth training in research and psychotherapy. When working together, the psychologist’s and psychiatrist’s conceptualization and treatment of the patient improves. To facilitate effective collaboration, efforts should be made to maximize communication and clarification of roles and responsibilities between psychiatrists and psychologists. Additionally, collaboration between psychiatrists and psychologists is beneficial for trainees, as it broadens their training and facilitates future referrals.
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- 2020
16. Sacred time: Ensuring the provision of excellent supervision
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Amy D. Benton, Katharine Dill, and Amy E. Williams
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050906 social work ,business.industry ,05 social sciences ,Public Health, Environmental and Occupational Health ,Organizational culture ,0501 psychology and cognitive sciences ,0509 other social sciences ,Public relations ,business ,Psychology ,Applied Psychology ,050104 developmental & child psychology ,Qualitative research - Abstract
In this study, the authors explore the beliefs and attitudes regarding what constitutes “excellent supervision” from the perspectives of frontline workers and supervisors employed by one voluntary ...
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- 2017
17. Assessment and Testing
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Amy E. Williams
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Medical education ,Counselor education ,Psychology - Published
- 2019
18. Impairment of Inhibition of Trigeminal Nociception via Conditioned Pain Modulation in Persons with Migraine Headaches
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Kara L. Kerr, K. McCabe, Amy E. Williams, Megan M. Miller, Jamie L. Rhudy, and Emily J. Bartley
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Adult ,Male ,Nociception ,Pain Threshold ,HEADACHE & FACIAL PAIN SECTION ,Adolescent ,Migraine Disorders ,Pain ,Young Adult ,Forearm ,Ischemia ,Threshold of pain ,Conditioning, Psychological ,medicine ,Humans ,Corneal reflex ,Trigeminal Nerve ,Pain Measurement ,Blinking ,business.industry ,Depression ,Catastrophization ,General Medicine ,medicine.disease ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Migraine ,Anesthesia ,Case-Control Studies ,Reflex ,Pain catastrophizing ,Female ,Neurology (clinical) ,Headaches ,medicine.symptom ,business - Abstract
Objective To assess conditioned pain modulation efficiency in persons with and without migraine headaches. Design Cross-sectional assessment of experimental pain. Setting University campus and surrounding community in a large Midwestern US city. Subjects Twenty-three adults with and 32 without a history of migraine headaches participated in the study. Participants were mostly female (N = 40) with an average age of 23 years. Methods Four electrocutaneous stimulations of the supraorbital branch of the left trigeminal nerve were delivered at 150% of an individually determined pain threshold. Conditioned pain modulation was assessed by applying a noxious counterstimulus (forearm ischemia) and delivering four more electrocutaneous stimulations. After each stimulation, pain and the nociceptive blink reflex were assessed. Depression and pain catastrophizing were assessed to control for the potential influence of these variables on pain modulation. Results Participants with and without migraine headaches had similar baseline pain responsivity, without significant differences in pain report or nociceptive blink reflexes. Pain report was inhibited by conditioned pain modulation in both the migraine and control groups. However, unlike nonmigraine controls, participants with migraines did not exhibit an inhibition of nociceptive blink reflexes during the ischemia task. This pattern persisted after controlling for level of pain catastrophizing and depression. Conclusions Migraine sufferers exhibited impaired conditioned pain modulation of the nociceptive blink reflex, suggesting a deficiency in inhibition of trigeminal nociception, which may contribute to the development of migraine headaches.
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- 2019
19. Telling Our Tales: Becoming Art Educators
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Lauren Rouatt, Erika Ogier, Amy E. Williams, and Melanie L. Buffington
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Visual Arts and Performing Arts ,Field (Bourdieu) ,05 social sciences ,050301 education ,Identity (social science) ,Visual arts education ,Education ,Narrative inquiry ,Graduate students ,Pedagogy ,ComputingMilieux_COMPUTERSANDEDUCATION ,0501 psychology and cognitive sciences ,Narrative ,Psychology ,0503 education ,050104 developmental & child psychology - Abstract
This year-long study shares a collaborative narrative inquiry project performed by four graduate students and one faculty member to understand the factors that influenced our paths to art education. We collected data by writing, analyzing, and then reflecting on stories of our experiences. Through careful analysis we identified five different hubs of experience that significantly affected our paths to the field: early experiences and family, school art experiences, mentors, identity, and young adult experiences. By thinking through our experiences, analyzing our narratives, and identifying the hubs, we came to a greater understanding of the influences on our paths to art education. These understandings inform our teaching practices enabling us to support students in meaningful ways.
- Published
- 2016
20. Unfolding Case-Based Practicum Curriculum Infusing Crisis, Trauma, and Disaster Preparation
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Catie A. Greene, Sharon Kim, Sterling P. Travis, Amy E. Williams, and Pamela Nadine Harris
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Self-efficacy ,050103 clinical psychology ,030506 rehabilitation ,medicine.medical_treatment ,education ,05 social sciences ,Practicum ,Crisis management ,Education ,03 medical and health sciences ,Clinical Psychology ,Nursing ,Developmental and Educational Psychology ,medicine ,0501 psychology and cognitive sciences ,0305 other medical science ,Psychology ,Curriculum ,Crisis intervention - Abstract
The authors evaluated an unfolding case-based approach to a practicum in counseling course infusing crisis, trauma, and disaster preparation for changes in students’ crisis self-efficacy across a semester. The course, informed by constructivist-developmental pedagogy and centered on the unfolding case, resulted in significant increases in students’ crisis self-efficacy.
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- 2016
21. The Viability of Structural Family Therapy in the Twenty-first Century: An Analysis of Key Indicators
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Rebecca L. Sheffield, Ramya Avadhanam, Brian A. Kooyman, Victoria A. Foster, Pamela N. Harris, Sharon Kim, Abbas Javaheri, J. Richelle Joe, Amy E. Williams, and Charles R. McAdams
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Cultural Studies ,Family therapy ,050103 clinical psychology ,Social Psychology ,Social work ,business.industry ,education ,05 social sciences ,Twenty-First Century ,Adaptive change ,Proposition ,Public relations ,humanities ,Key (music) ,Clinical Psychology ,Structural family therapy ,050902 family studies ,Medicine ,0501 psychology and cognitive sciences ,sense organs ,Professional literature ,0509 other social sciences ,business ,Social Sciences (miscellaneous) ,Clinical psychology - Abstract
This paper examines the degree to which structural family therapy has adapted effectively to client families and professional demands of the twenty-first century. A review of the current professional literature was conducted to assess the structural model’s continued clinical relevance, how the model has changed in adapting to contemporary social and professional contexts, and whether or not the integrity of the model’s core proposition has been eroded or confounded as a result of adaptive changes.
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- 2016
22. Injustice perceptions about pain: parent-child discordance is associated with worse functional outcomes
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Zina Trost, Eric L. Scott, Adam T. Hirsh, David Wuest, Megan M. Miller, and Amy E. Williams
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Male ,Parents ,Adolescent ,Concordance ,Emotions ,Context (language use) ,Injustice ,03 medical and health sciences ,Disability Evaluation ,0302 clinical medicine ,Quality of life (healthcare) ,Surveys and Questionnaires ,Medicine ,Humans ,030212 general & internal medicine ,Parent-Child Relations ,Child ,Pain Measurement ,Retrospective Studies ,business.industry ,Catastrophization ,Chronic pain ,Age Factors ,Retrospective cohort study ,Pain Perception ,medicine.disease ,Anesthesiology and Pain Medicine ,Pain Clinics ,Neurology ,Child, Preschool ,Quality of Life ,Female ,Neurology (clinical) ,Chronic Pain ,business ,030217 neurology & neurosurgery ,Stress, Psychological ,Clinical psychology ,Dyad - Abstract
Pain is experienced within and influenced by social environments. For children with chronic pain, the child-parent relationship and parental beliefs about pain are particularly important and may influence pain outcomes. Pain-related injustice perceptions have recently been identified as an important cognitive-emotional factor for children with pain. The current study aimed to better understand the pain-related injustice perceptions of children with chronic pain and their parents. The sample consisted of 253 pediatric chronic pain patients (mean age = 14.1 years, 74% female) presenting to a tertiary pain clinic. Patients completed measures of pain intensity, pain-related injustice perceptions, stress, functional disability, and quality of life. Parents completed a measure of pain-related injustice perceptions about their child's pain. Child-parent dyads were categorized into 1 of 4 categories based on the degree of concordance or discordance between their scores on the injustice measures. One-way analysis of variances examined differences in pain intensity, stress, functional disability, and quality of life across the 4 dyad categories. Our findings indicated that both the degree (concordant vs discordant) and direction (discordant low child-high parent vs discordant high child-low parent) of similarity between child and parent injustice perceptions were associated with child-reported pain intensity, stress, functional disability, and quality of life. The poorest outcomes were reported when children considered their pain as highly unjust, but their parents did not. These findings highlight the important role of parents in the context of pain-related injustice perceptions in pediatric chronic pain.
- Published
- 2018
23. A Developmental Approach to Addiction Theory and Treatment
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Amy E. Williams and Charles F. Gressard
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Developmental approach ,Neuroscience - Published
- 2018
24. Maintenance of Pain in Children With Functional Abdominal Pain
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Danita I. Czyzewski, Erica M. Weidler, Mariella M. Self, Amy E. Williams, Robert J. Shulman, and Allison M. Blatz
- Subjects
Persistence (psychology) ,Male ,medicine.medical_specialty ,Abdominal pain ,Psychological intervention ,Article ,Irritable Bowel Syndrome ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Child ,Defecation ,Irritable bowel syndrome ,Pain Measurement ,Referred pain ,business.industry ,Gastroenterology ,Chronic pain ,medicine.disease ,Anxiety Disorders ,Abdominal Pain ,Pediatrics, Perinatology and Child Health ,Physical therapy ,Anxiety ,Female ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Objectives A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdominal pain frequency and compared the predictive value of 3 methods for assessing pain-stooling relations (ie, diary, parent report, child report). Methods Seventy-six children (7-10 years old at baseline) who presented for medical treatment of functional abdominal pain were followed up 18 to 24 months later. Baseline anxiety and abdominal pain-stooling relations based on pain and stooling diaries and child- and parent questionnaires were examined in relationship to the persistence of abdominal pain frequency. Results Children's baseline anxiety was not related to persistence of pain frequency. Children who, however, displayed irritable bowel syndrome (IBS) symptoms at baseline maintained pain frequency at follow-up, whereas in children in whom there was no relationship between pain and stooling, pain frequency decreased. Pain and stool diaries and parent report of pain-stooling relations were predictive of pain persistence but child-report questionnaires were not. Conclusions The presence of IBS symptoms in school-age children with functional abdominal pain appears to predict persistence of abdominal pain over time, whereas anxiety does not. Prospective pain and stooling diaries and parent report of IBS symptoms were predictors of pain maintenance, but child report of symptoms was not.
- Published
- 2017
25. Endogenous Inhibition of Somatic Pain Is Impaired in Girls With Irritable Bowel Syndrome Compared With Healthy Girls
- Author
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Robert J. Shulman, Danita I. Czyzewski, Margaret M. Heitkemper, Mariella M. Self, and Amy E. Williams
- Subjects
Pain Threshold ,medicine.medical_specialty ,Time Factors ,Anxiety ,Article ,Nociceptive Pain ,Irritable Bowel Syndrome ,Physical Stimulation ,Surveys and Questionnaires ,Internal medicine ,Threshold of pain ,Humans ,Medicine ,Child ,Irritable bowel syndrome ,Pain Measurement ,Analysis of Variance ,business.industry ,Chronic pain ,medicine.disease ,Inhibition, Psychological ,Distress ,Anesthesiology and Pain Medicine ,Neurology ,Hyperalgesia ,Physical therapy ,Female ,Pain catastrophizing ,Neurology (clinical) ,medicine.symptom ,business ,Somatization - Abstract
Endogenous pain inhibition is often deficient in adults with chronic pain conditions including irritable bowel syndrome (IBS). It is unclear whether deficiencies in pain inhibition are present in young children with IBS. The present study compared endogenous pain inhibition, somatic pain threshold, and psychosocial distress in young girls with IBS versus controls. Girls with IBS did not show significant endogenous pain inhibition of heat pain threshold during a cold-pressor task in contrast to controls, who had significant pain inhibition. Girls with IBS did not differ from peers on measures of somatic pain but had more symptoms of depression, somatization, and anxiety than controls. When psychological variables were included as covariates, the difference in pain inhibition was no longer significant, although poor achieved power limits interpretation of these results. Higher-order cognitive processes including psychological variables may be contributing to observed pain inhibition. In girls with IBS, pain inhibition was positively related to the number of days without a bowel movement. To our knowledge, this is the first study to demonstrate deficiencies of endogenous pain inhibition in young children with IBS. Findings have implications for better understanding of onset and maintenance of IBS and other chronic pain conditions. Perspective This study found that young girls with IBS have deficient endogenous pain inhibition compared to healthy girls, which is consistent with the literature on adults. This information can facilitate clinicians in identification of risk factors for onset/maintenance of IBS and other chronic pain conditions.
- Published
- 2013
26. Motivational Priming Predicts How Noxious Unconditioned Stimuli Influence Affective Reactions to Emotional Pictures
- Author
-
Jamie L. Rhudy and Amy E. Williams
- Subjects
Noxious stimulus ,General Medicine ,Psychology ,Affect (psychology) ,Priming (psychology) ,Cognitive psychology - Abstract
Motivational priming theory (MPT) and preparedness theory generate competing hypotheses about the impact of an aversive US on responses to an affective foreground. MPT predicts the aversive US will facilitate negative emotional reactions to unpleasant pictures and inhibit positive emotional reactions to pleasant pictures. Preparedness theory predicts an aversive US will increase negative emotional reactions to unpleasant pictures, but will not impact responses to pleasant pictures. The present study (N = 125) compared these competing hypotheses by assessing how noxious shocks and non-noxious noises influence responses to emotional pictures. Following each picture, participants rated how the picture made them feel using the Self Assessment Manikin. Results supported MPT - noxious USs, but not non-noxious USs, facilitated negative emotional reactions to unpleasant pictures and inhibited positive emotional reactions to pleasant pictures.
- Published
- 2012
27. Physiological Predictors of Response to Exposure, Relaxation, and Rescripting Therapy for Chronic Nightmares in a Randomized Clinical Trial
- Author
-
Amy E. Williams, Kristi E. Pruiksma, Jamie L. Rhudy, K. McCabe, Joanne L. Davis, Emily J. Bartley, and Patricia Byrd
- Subjects
Adult ,Sleep Wake Disorders ,Pulmonary and Respiratory Medicine ,Relaxation ,medicine.medical_specialty ,Imagery, Psychotherapy ,medicine.medical_treatment ,Poison control ,Neuropsychological Tests ,Risk Assessment ,Severity of Illness Index ,law.invention ,Stress Disorders, Post-Traumatic ,Young Adult ,Quality of life (healthcare) ,Randomized controlled trial ,Predictive Value of Tests ,Reference Values ,law ,Severity of illness ,medicine ,Humans ,Cognitive Behavioral Therapy ,Relaxation (psychology) ,Electroencephalography ,Middle Aged ,New Research ,Mental health ,Dreams ,Nightmare ,Treatment Outcome ,Neurology ,Chronic Disease ,Cognitive therapy ,Physical therapy ,Female ,Neurology (clinical) ,medicine.symptom ,Psychology ,Follow-Up Studies ,Clinical psychology - Abstract
Study Objectives: Evidence supports the use of cognitive behavioral therapies for nightmares in trauma-exposed individuals. This randomized clinical trial replicated a study of exposure, relaxation, and rescripting therapy (ERRT) and extended prior research by including broad measures of mental health diffi culties, self-reported physical health problems, and quality of life. Additionally, physiological correlates of treatment-related change assessed from a script-driven imagery paradigm were examined. Methods: Forty-seven individuals were randomized to treatment or waitlist control. Results: The treatment group demonstrated improvements relative to the control group at the one-week post-treatment assessment. At the 6-month follow-up assessment, signifi cant improvements were found for frequency and severity of nightmares, posttraumatic stress disorder symptoms, depression, sleep quality and quantity, physical health symptoms, anger, dissociation, and tension reduction behaviors. Participants also reported improved quality of life. Treatment-related decreases in heart rate to nightmare imagery were correlated with improvements in sleep quality and quantity; treatment-related decreases in skin conductance to nightmare imagery were correlated with improvements in nightmare severity, posttraumatic stress disorder symptom severity, sleep quality, and fear of sleep; and treatment-related decreases in corrugator activity to nightmare imagery were correlated with improved physical health. Conclusions: Findings provide additional support for the use of ERRT in treating nightmares and related diffi culties and im
- Published
- 2011
28. Cognitive outcome and reliable change indices two years following bilateral subthalamic nucleus deep brain stimulation
- Author
-
Amy E. Williams, Michele K. York, Adriana M. Strutt, Joseph Jankovic, Richard K. Simpson, and Gladys Marina Arzola
- Subjects
Male ,medicine.medical_specialty ,Parkinson's disease ,Deep brain stimulation ,Deep Brain Stimulation ,medicine.medical_treatment ,Motor Activity ,Neuropsychological Tests ,Audiology ,Article ,Developmental psychology ,Executive Function ,Fluency ,Mental Processes ,Memory ,Subthalamic Nucleus ,medicine ,Humans ,Dementia ,Longitudinal Studies ,Aged ,Language ,Recall ,Neuropsychology ,Parkinson Disease ,Cognition ,Middle Aged ,medicine.disease ,nervous system diseases ,Subthalamic nucleus ,surgical procedures, operative ,nervous system ,Neurology ,Visual Perception ,Female ,Neurology (clinical) ,Geriatrics and Gerontology ,Cognition Disorders ,Psychology ,therapeutics - Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) is currently the treatment of choice for medication-resistant levodopa-related motor complications in patients with Parkinson’s disease (PD). While STN-DBS often results in meaningful motor improvements, consensus regarding long-term neuropsychological outcome continues to be debated. We assessed the cognitive outcomes of 19 STN-DBS patients compared to a group of 18 medically-managed PD patients on a comprehensive neuropsychological battery at baseline and two years post-surgery. Patients did not demonstrate changes in global cognitive functioning on screening measures. However, neuropsychological results revealed impairments in nonverbal recall, oral information processing speed, and lexical and semantic fluency in STN-DBS patients compared to PD controls 2 years post-surgery in these preliminary analyses. Additionally, reliable change indices revealed that approximately 50% of STN-DBS patients demonstrated significant declines in nonverbal memory and oral information processing speed compared to 25–30% of PD controls, and 26% of STN-DBS patients declined on lexical fluency compared to 11% of PD patients. Approximately 30% of both groups declined on semantic fluency. The number of STN-DBS patients who converted to dementia 2 years following surgery was not significantly different from the PD participants (32% versus 16%, respectively). Our results suggest that neuropsychological evaluations may identify possible mild cognitive changes following surgery.
- Published
- 2011
29. Experimental Assessment of Affective Processing in Fibromyalgia
- Author
-
Jamie L. Rhudy, Amy E. Williams, and Emily J. Bartley
- Subjects
Adult ,Male ,Reflex, Startle ,Fibromyalgia ,media_common.quotation_subject ,Affective distress ,Disease ,Arousal ,Pleasure ,Developmental psychology ,Young Adult ,Heart Rate ,Surveys and Questionnaires ,medicine ,Humans ,Valence (psychology) ,media_common ,Blinking ,Electromyography ,Chronic pain ,Galvanic Skin Response ,Middle Aged ,medicine.disease ,Affect ,Anesthesiology and Pain Medicine ,Acoustic Stimulation ,Neurology ,Anxiety ,Female ,Neurology (clinical) ,medicine.symptom ,Psychology ,Photic Stimulation ,Clinical psychology - Abstract
Fibromyalgia syndrome (FMS) is a chronic pain disorder associated with widespread musculoskeletal pain, tenderness, and fatigue. Additionally, correlational research suggests negative affect (eg, depression, anxiety) and deficits in positive affect may contribute to FMS symptomatology. However, well-controlled, experimental research is necessary to ascertain whether patients with FMS have problems in affective processing. The present study used a well-validated picture-viewing paradigm to evoke emotional responses in 17 patients with FMS and 17 sex- and age-matched healthy control participants. Each participant viewed pleasant (erotica), neutral, and unpleasant (attack related) pictures, and abrupt white noises were delivered during two-thirds of the pictures to evoke startle eyeblinks. Appetitive and defensive responding was assessed from subjective (valence/pleasure and arousal ratings) and physiological (corrugator EMG, heart rate, skin-conductance response, startle-reflex modulation) reactions to pictures. Results suggested FMS was associated with greater defensive activation (displeasure, subjective arousal, corrugator EMG) to the unpleasant, threat-related pictures, but not deficits in appetitive activation to erotic pictures. Although preliminary, these data suggest individuals with FMS have deficits in affective processing, but this dysregulation may be limited to defensive activation. Implications for treatment and future research are discussed. Perspective Fibromyalgia is a debilitating disease associated with affective distress. Results from the present study suggest that FMS is associated with enhanced defensive activation to nonpainful threat-related stimuli, but not deficits in appetitive reactions to erotic stimuli. These findings have implications for the treatment and study of FMS.
- Published
- 2009
30. Psychophysiological responses to pain: Further validation of the nociceptive flexion reflex (NFR) as a measure of nociception using multilevel modeling
- Author
-
Jamie L. Rhudy, Christopher R. France, Emily J. Bartley, Klanci M. Mccabe, and Amy E. Williams
- Subjects
Adult ,Male ,Reflex, Startle ,medicine.medical_specialty ,genetic structures ,Cognitive Neuroscience ,Individuality ,Pain ,Experimental and Cognitive Psychology ,Models, Psychological ,Audiology ,Nociceptive flexion reflex ,Developmental psychology ,Developmental Neuroscience ,Predictive Value of Tests ,Heart rate ,Noxious stimulus ,medicine ,Humans ,Pain perception ,Corneal reflex ,Biological Psychiatry ,Pain Measurement ,Models, Statistical ,Endocrine and Autonomic Systems ,General Neuroscience ,Multilevel model ,Hemodynamics ,Nociceptors ,Reproducibility of Results ,Electric Stimulation ,Neuropsychology and Physiological Psychology ,Nociception ,Neurology ,Data Interpretation, Statistical ,Female ,Psychology ,Skin conductance ,Algorithms - Abstract
Physiological reactions to noxious stimuli are often used to make inferences about pain, but few studies have thoroughly examined the intra- and interindividual relationships between them. In the present study (N=104), multilevel analyses was used to assess relations between physiological (nociceptive flexion reflex magnitude [NFR], blink reflex magnitude, skin conductance response [SCR], heart rate [HR]) and subjective reactions to electrocutaneous stimuli. All physiological reactions were significant predictors of ratings when entered alone, explaining 1% (SCR) to 29% (NFR) of the variance; but only NFR, blink, and HR were significant in a multivariate predictor model. Significant interindividual variability in slopes was found for blink and HR, but not NFR. A final trimmed model that included NFR, blink, and the blink random slope explained 35% of the variance in ratings.
- Published
- 2009
31. Emotional control of nociceptive reactions (ECON): Do affective valence and arousal play a role?
- Author
-
L. Maynard, Jamie L. Rhudy, J. Russell, Amy E. Williams, and K. McCabe
- Subjects
Adult ,Male ,Pain Threshold ,medicine.medical_specialty ,media_common.quotation_subject ,Emotions ,Stimulation ,Audiology ,Affect (psychology) ,Nociceptive flexion reflex ,Arousal ,Perception ,Heart rate ,medicine ,Humans ,Association (psychology) ,media_common ,Nociceptors ,Biofeedback, Psychology ,Affect ,Anesthesiology and Pain Medicine ,Nociception ,Neurology ,Female ,Neurology (clinical) ,Psychology ,Social psychology - Abstract
Prior research suggests emotional picture-viewing modulates motoric (nociceptive flexion reflex), autonomic (skin conductance response, heart rate acceleration), and subjective (pain rating) reactions to noxious electrodermal stimulation. The present study sought to determine whether emotional valence and arousal contribute to nociception modulation. To do so, pictures varying in emotional content (erotica, food, neutral, loss, attack) were chosen to manipulate emotional valence (pleasant = erotic and food; unpleasant = loss and attack) and arousal (low = food and loss; moderate = erotica and attack). Pictures were presented in pseudorandom order to elicit emotional processing while noxious electric stimulations were delivered to the sural nerve. Nociceptive flexion reflex (NFR) magnitude, skin conductance response (SCR), heart rate (HR) acceleration, and subjective pain ratings to each stimulation were measured, standardized, averaged by picture content, and analyzed. Results suggested that picture-viewing explained 52% of the variance in the multivariate combination of the nociceptive reactions and modulated them in parallel. Pleasant pictures inhibited reactions, whereas unpleasant pictures enhanced them. However, only erotica and attack pictures elicited significant modulation relative to neutral pictures, suggesting arousal also contributed. An exploratory multilevel analysis also supported this conclusion. Together, these data suggest emotional control of nociceptive reactions (ECON) is associated with a valence-byarousal interaction. Implications of these findings for how emotional picture-viewing can be used to study supraspinal modulation are discussed. � 2007 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
- Published
- 2008
32. The Influence of Conditioned Fear on Human Pain Thresholds: Does Preparedness Play a Role?
- Author
-
Jamie L. Rhudy and Amy E. Williams
- Subjects
Adult ,Male ,Pain Threshold ,Conditioned emotional response ,medicine.medical_specialty ,Adolescent ,Emotions ,Pain ,Neuropsychological Tests ,Audiology ,Extinction, Psychological ,Developmental psychology ,Cognition ,Surveys and Questionnaires ,Conditioning, Psychological ,Threshold of pain ,Reaction Time ,medicine ,Humans ,Fear conditioning ,Habituation ,Habituation, Psychophysiologic ,Pain Measurement ,Fear processing in the brain ,Facial expression ,Classical conditioning ,Fear ,Galvanic Skin Response ,Extinction (psychology) ,Anesthesiology and Pain Medicine ,Neurology ,Hyperalgesia ,Female ,Neurology (clinical) ,Psychology ,Photic Stimulation - Abstract
Emotionally charged facial expressions (happy, fear) served as conditioned stimuli in a differential fear conditioning procedure. Expressions were presented in pseudo-random order on a computer monitor. For half of the participants, the fear expression was paired with an aversive electric stimulation (UCS), whereas the happy expression was unpaired. The other participants had the opposite pairing. To assess the influence of conditioned fear on pain, expressions were shown again in the absence of the UCS and pain threshold was assessed during each expression. The latency of finger withdrawal from a radiant heat device was used to index pain threshold. Skin conductance response (SCR) and self-reported emotion were measured to assess fear conditioning. Consistent with preparedness theory, differential fear conditioning was only present when the fear expression was paired with the UCS. Moreover, pain threshold was only influenced by fear conditioning in persons for whom the fear expression was paired with the UCS. Specifically, finger withdrawal latencies were lower (suggesting hyperalgesia) during the fear expression than during the happy expression; an effect that was not present before CSUCS pairing. This work suggests that some stimuli are more readily associated with an aversive event and can lead to pain enhancement. Perspective: Although preliminary, these results suggest that fear-relevant environmental stimuli (including facial expressions) may provide important environmental cues during aversive events that influence the level of pain experienced.
- Published
- 2007
33. Agreement between prospective diary data and retrospective questionnaire report of abdominal pain and stooling symptoms in children with irritable bowel syndrome
- Author
-
Robert J. Shulman, Danita I. Czyzewski, Amy E. Williams, Mariella M. Self, and Erica M. Weidler
- Subjects
Diarrhea ,Male ,Abdominal pain ,medicine.medical_specialty ,Constipation ,Adolescent ,Physiology ,Child age ,Article ,Irritable Bowel Syndrome ,Surveys and Questionnaires ,Medicine ,Humans ,Psychiatry ,Child ,Defecation ,Irritable bowel syndrome ,Recall ,Endocrine and Autonomic Systems ,business.industry ,Pain diary ,Gastroenterology ,Rome iii ,medicine.disease ,Abdominal Pain ,Health Records, Personal ,Mental Recall ,Female ,medicine.symptom ,business ,Clinical psychology - Abstract
Clinical decision-making about diagnosis and treatment is routinely guided by patient report of symptoms, with symptom recall critically influencing medical management particularly for conditions lacking objective indicators such as functional gastrointestinal disorders (FGIDs). In research, patient-reported outcomes are increasingly conceptualized as primary endpoints1, 2, emphasizing patient report in evaluating potential treatments. Health-related information recalled via questionnaire has been questioned as unreliable or subject to bias.3 For example, peak and end effects (i.e., most intense and most recent pain) disproportionately influence pain recall and can undermine validity of retrospective self-reports.3–13 Recalled pain ratings are typically higher than momentary assessments, and lengthening recall interval magnifies bias.4,9, 11,13–19 Despite these limitations, retrospective questionnaires are used routinely and endorsed for assessing symptoms in FGID treatment trials1. Given this endorsement and the burden of diaries20, evaluating if questionnaires are a sufficient proxy is worthwhile. Most literature evaluating correspondence between recalled and recorded symptoms involves non-GI samples, but evidence suggests GI symptoms are subject to recall error, or that recalled and recorded bowel function diverge.21–27 This small literature is often limited by lack of correspondence between questionnaire and diary intervals (e.g., questionnaires preceding diary). This challenges interpretation, but adult IBS literature suggests that subtyping differs based on recalled versus recorded data26,27. Rome III Diagnostic Questionnaires may overestimate the frequency of abnormal stool form26, participants tend to recall more extreme stool forms as representative27,28, and those describing constipation underestimate stool frequency on questionnaire.23,24 Lackner and colleagues recently reported that, though as a group adults with IBS accurately recalled some IBS symptoms, individual correspondence varied with a subset of patients evidencing poor recall accuracy.28 Few studies examine correspondence between recalled and recorded pain in children, particularly in GI samples. Available research employs variable methods and yields variable interpretations concerning children’s recall accuracy. Accuracy usually increases with age, recalled pain ratings tend to be higher than momentary ratings (though pediatric findings are more mixed), and peak- and end-effects similarly bias ratings.14,18,29–32 Even less pediatric research concerns recalled versus recorded stool data, though evidence suggests recalled and recorded defecation frequency do not closely correspond and methodology affects diagnostic classification.33 One study by Chogle and colleagues34 examined correspondence between recalled and recorded pain in pediatric FGIDs, comparing a four-week pain diary to retrospective report of number of pain days. Results reflected a moderate positive correlation (Spearman correlation = 0.4), with 16% of children having perfect agreement. Interestingly, younger children had higher correspondence than adolescents. Group data reflected more pain days via diary than recall, but individual data indicated that 54% of children recalled fewer episodes than reported on diary, whereas 40% recalled more.34 To extend scant and often methodologically limited literature, we evaluated correspondence between retrospective questionnaire and prospective diary in pediatric IBS, evaluating pain and stool variables during the same reporting interval. Given the importance of parent perception in pediatrics and evidence that parent- and child-report differ35, correspondence between parent questionnaire and child diary was also examined. Relationship of child age to correspondence between child diary and questionnaire was also assessed.
- Published
- 2015
34. Gender differences in pain: Do emotions play a role?
- Author
-
Amy E. Williams and Jamie L. Rhudy
- Subjects
Male ,media_common.quotation_subject ,Emotions ,Pain ,PsycINFO ,Arousal ,Gender Studies ,Manipulation checks ,Perception ,medicine ,Animals ,Humans ,Valence (psychology) ,Pain Measurement ,media_common ,Motivation ,Sex Characteristics ,Brain ,Fear ,General Medicine ,Anxiety ,Female ,medicine.symptom ,Psychology ,High arousal ,Clinical psychology ,Sex characteristics - Abstract
Background: Research suggests that the influence of gender on the processing and experience of pain is a result of several mechanisms. One mediating variable is emotion, which may modulate pain through an interaction of valence (pleasant-unpleasant) and arousal (calm-excited). Objective: This review examines whether gender differences in the experience and processing of emotion contribute to differences in the modulation and perception of pain. Methods: An English-language search of MEDLINE and PsycINFO was conducted from 1887 to May 2005. Additional literature was obtained from reference lists of articles retained in the initial search. Results: Emotion appears to influence pain through a valence-by-arousal interaction. Specifically, negatively valenced emotions with low to moderate arousal (eg, anxiety) enhance pain, whereas negatively valenced emotions with high arousal (eg, fear) reduce pain. In contrast, positively valenced emotions always reduce pain, as long as minimal arousal is achieved. Some evidence suggests that women are more sensitive than men to threat-related stimuli and thus experience more negative affect than men. This would generally lead to enhanced pain perception in women. It is also possible that women are more likely than men to experience negative affect with high arousal (intense fear) and thus pain inhibition. However, the relatively lower base rate of intense negative emotions is not likely to contribute much to gender differences in pain. Evidence also suggests that men may be more sensitive to positive events, particularly sexual/erotic stimuli, which may lead to more positive emotion-induced pain reduction in men, relative to women. Conclusions: This review suggests that gender differences in the experience of pain may arisefrom differences in the experience and processing of emotion that, in turn, differentially alter pain processing. Specifically, the system associated with negative affect may be more attuned to threatening stimuli in women, and the system associated with positive affect may be more attuned to pleasurable stimuli in men. However, there is a paucity of research directly addressing this issue; much of the research on this topic has failed to test a comprehensive model of emotion, failed to use adequate manipulation checks, or failed to use within-subject experimental designs that control for intra- and interindividual differences. Therefore, it is concluded that additional research is warranted.
- Published
- 2005
35. An exploration of substance abuse course offerings for students in counseling and social work programs
- Author
-
Amy E. Williams and Jill L. Russett
- Subjects
Counseling ,Social Work ,Social work ,business.industry ,Substance-Related Disorders ,media_common.quotation_subject ,Counselor education ,Medicine (miscellaneous) ,Military psychiatry ,Bachelor ,medicine.disease ,Mental health ,Substance abuse ,Psychiatry and Mental health ,Nursing ,Education, Professional ,Health care ,Medicine ,Humans ,Curriculum ,Education, Graduate ,Substance use ,business ,media_common - Abstract
Background Counseling and social work programs educate future practitioners who are likely to be engaged in direct practice with individuals impacted by substance use disorders. Recent changes to policy and practice, including the Affordable Health Care Act and DSM-5 ( Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), contribute to the ongoing need to develop substance abuse competencies among mental health professionals at all educational levels and across multiple disciplines. Methods The authors reviewed programs of study and course catalogs identified and accessed online for counselor education, Bachelor of Social Work, and Master of Social Work programs to identify offered and required courses focused on substance abuse, as determined by course title and description. Results Of the 97 master's-level counseling programs reviewed, 67 required at least 1 course in substance abuse and 12 offered at least 1 elective in substance abuse. Of the 89 Bachelor of Social Work programs reviewed, 3 required at least 1 course in substance abuse and 40 offered at least 1 elective in substance abuse. Of the 58 Master of Social Work programs reviewed, 1 program required at least 1 course in substance abuse and 37 offered at least 1 elective. Conclusion The continual need to advocate for education and development of substance abuse practitioners across professions is discussed, and directions for future research are described.
- Published
- 2014
36. Are child anxiety and somatization associated with pain in pain-related functional gastrointestinal disorders?
- Author
-
Danita I. Czyzewski, Robert J. Shulman, Mariella M. Self, and Amy E. Williams
- Subjects
Male ,medicine.medical_specialty ,Abdominal pain ,Gastrointestinal Diseases ,Comorbidity ,Anxiety ,Article ,medicine ,Humans ,Psychiatry ,Child ,Somatoform Disorders ,Applied Psychology ,Inflammation ,medicine.disease ,Abdominal Pain ,Assessing Pain ,Pain frequency ,Pain catastrophizing ,Female ,Pain report ,medicine.symptom ,Psychology ,Somatization ,Clinical psychology - Abstract
This study investigated individual and incremental contributions of somatization and trait anxiety to pain report in children with pain-related functional gastrointestinal disorders. Eighty children (7–10 years) with pain-related functional gastrointestinal disorders completed the State-Trait Anxiety Inventory for Children, the Children’s Somatization Inventory, and 2-week pain diaries (assessing pain frequency and maximum pain). Hierarchical regressions indicated that both trait anxiety and somatization were significantly related to maximum pain and pain frequency, with somatization explaining more variance. Trait anxiety did not significantly add to prediction above somatization. Assessment of somatization may assist with treatment planning for children with functional abdominal pain.
- Published
- 2013
37. Epilepsy and attention-deficit hyperactivity disorder: links, risks, and challenges
- Author
-
David W. Dunn, Amy E. Williams, William G. Kronenberger, and Julianne M. Giust
- Subjects
Pediatrics ,medicine.medical_specialty ,Population ,Prevalence ,Review ,behavioral disciplines and activities ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,children ,mental disorders ,ADHD ,Medicine ,Attention deficit hyperactivity disorder ,0501 psychology and cognitive sciences ,In patient ,Attention deficits ,seizure disorder ,education ,Psychiatry ,Pediatric epilepsy ,education.field_of_study ,business.industry ,05 social sciences ,medicine.disease ,Seizure Disorders ,epilepsy ,business ,030217 neurology & neurosurgery ,050104 developmental & child psychology - Abstract
Attention-deficit hyperactivity disorder (ADHD) has a prevalence rate of 7%–9% in the general population of children. However, in children with epilepsy, ADHD has been found to be present in 20%–50% of patients. This paper provides a review of ADHD prevalence in pediatric epilepsy populations and reviews data on specific symptom presentation and attention deficits in patients with epilepsy. This paper also reviews evidence-based treatments for ADHD and specifically the treatment of ADHD as a comorbid condition in children with epilepsy.
- Published
- 2016
38. Are there sex differences in affective modulation of spinal nociception and pain?
- Author
-
Amy E. Williams, Jamie L. Rhudy, J. Russell, Mary C. Chandler, K. McCabe, Kara L. Kerr, and Emily J. Bartley
- Subjects
Adult ,Male ,Pain Threshold ,medicine.medical_specialty ,Pain tolerance ,Emotions ,Pain ,Audiology ,Stimulus (physiology) ,Nociceptive flexion reflex ,Developmental psychology ,Arousal ,Threshold of pain ,Reflex ,medicine ,Humans ,Sex Characteristics ,Nociceptors ,Electric Stimulation ,Anesthesiology and Pain Medicine ,Nociception ,Neurology ,Nociceptor ,Female ,Neurology (clinical) ,Psychology ,Sex characteristics - Abstract
Sex differences in the processing and experience of emotion exist. The present study examined whether sex differences in emotion lead to sex differences in affective modulation of pain and spinal nociception (assessed by nociceptive flexion reflex, NFR). Participants were healthy men (n = 47) and women (n = 73). Prior to affective modulation testing, electrocutaneous pain sensitivity was assessed (NFR threshold, pain threshold, pain tolerance). Affective modulation of pain and NFR was then assessed by presenting pictures that vary in emotional valence and arousal (mutilation, attack, death, neutral, families, adventure, erotica) during which suprathreshold electrocutaneous stimulations were delivered. Subjective emotional reactions were assessed after every picture, and nociceptive reactions were assessed after every suprathreshold stimulus. Results indicated women had greater pain sensitivity and also responded more negatively to attack pictures and less positively to erotic pictures. But despite these differences, affective modulation of pain/NFR was not moderated by sex: erotic pictures inhibited pain/NFR and mutilation pictures enhanced pain/NFR. Together, this implies subjective emotional experience does not completely mediate picture-evoked modulation of pain/NFR, a supposition that was further supported by exploratory analyses that demonstrated picture-evoked modulation of pain/NFR was present even after controlling for intra- and inter-individual differences in emotional reactions to pictures. Implications and limitations of these findings are discussed. Perspective Evidence suggests that women are more sensitive to experimental and clinical pain, but the mechanisms contributing to these sex differences are poorly understood. Affective processes are known to play a role in regulating pain signaling and pain experience; therefore, the present study examined whether sex differences in affective experience contribute to sex differences in pain. Results indicate that in healthy individuals affective processes may not contribute to sex differences in pain.
- Published
- 2010
39. Cognitive-behavioral treatment for chronic nightmares in trauma-exposed persons: assessing physiological reactions to nightmare-related fear
- Author
-
Jamie L. Rhudy, Patricia Byrd, Amy E. Williams, Emily J. Bartley, K. McCabe, Joanne L. Davis, and Kristi E. Pruiksma
- Subjects
Adult ,Male ,medicine.medical_specialty ,media_common.quotation_subject ,medicine.medical_treatment ,Anger ,Arousal ,Stress Disorders, Post-Traumatic ,Arts and Humanities (miscellaneous) ,Surveys and Questionnaires ,medicine ,Humans ,Psychiatry ,Monitoring, Physiologic ,media_common ,Analysis of Variance ,Sleep disorder ,Cognitive Behavioral Therapy ,Depression ,Fear ,Middle Aged ,medicine.disease ,Dreams ,Nightmare ,Sadness ,Cognitive behavioral therapy ,Clinical Psychology ,Treatment Outcome ,Psychophysiology ,Chronic Disease ,Cognitive therapy ,Female ,medicine.symptom ,Psychology ,Stress, Psychological - Abstract
Cognitive-behavioral treatments (CBTs) that target nightmares are efficacious for ameliorating self-reported sleep problems and psychological distress. However, it is important to determine whether these treatments influence objective markers of nightmare-related fear, because fear and concomitant physiological responses could promote nightmare chronicity and sleep disturbance. This randomized, controlled study (N=40) assessed physiological (skin conductance, heart rate, facial electromyogram) and subjective (displeasure, fear, anger, sadness, arousal) reactions to personally relevant nightmare imagery intended to evoke nightmare-related fear. Physiological assessments were conducted at pretreatment as well as 1-week, 3-months, and 6-months posttreatment. Results of mixed effects analysis of variance models suggested treatment reduced physiological and subjective reactions to nightmare imagery, gains that were generally maintained at the 6-month follow-up. Potential implications are discussed.
- Published
- 2010
40. Habituation, sensitization, and emotional valence modulation of pain responses
- Author
-
Emily J. Bartley, Amy E. Williams, and Jamie L. Rhudy
- Subjects
Adult ,Male ,Pain Threshold ,medicine.medical_specialty ,Emotions ,Pain ,Stimulus (physiology) ,Audiology ,Nociceptive flexion reflex ,Developmental psychology ,Young Adult ,Surveys and Questionnaires ,Reflex ,medicine ,Noxious stimulus ,Humans ,Valence (psychology) ,Habituation ,Habituation, Psychophysiologic ,Sensitization ,Pain Measurement ,Analysis of Variance ,Electromyography ,Galvanic Skin Response ,Middle Aged ,Electric Stimulation ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Nociception ,Neurology ,Female ,Neurology (clinical) ,Analysis of variance ,Psychology ,Photic Stimulation - Abstract
The Emotional Controls of Nociception (ECON) paradigm involves the presentation of emotionally-charged pictures during which painful stimuli are delivered. Across several ECON studies, unpleasant pictures enhanced pain and nociception, whereas pleasant pictures inhibited pain and nociception. However, at this time it is unknown whether emotional valence (unpleasant, neutral, pleasant) influences the habituation or sensitization of pain responses that occurs within a testing session. Indeed, ECON assumes that emotional valence modulation of pain is consistent throughout testing; otherwise the interpretation of valence modulation (unpleasant > neutral > pleasant) could be threatened. To address this issue, the present study (N = 120) presented 108 pictures that varied in emotional valence. During and in between pictures, 52 suprathreshold electrocutaneous stimuli were delivered to evoke pain, the nociceptive flexion reflex [NFR], and pain-evoked skin conductance response [SCR]. Mixed effects ANOVAs verified that within-subject changes in pain responses were influenced by stimulus repetition (NFR and SCR habituated, pain ratings sensitized) and emotional valence (responses were highest during unpleasant pictures, intermediate during neutral pictures, and lowest during pleasant pictures). However, habituation/sensitization slopes were unaffected by emotional valence, thus indicating emotional valence modulation was consistently observed throughout the testing session. These results provide additional validation for the ECON paradigm and suggest that the circuit responsible for emotional modulation of pain and nociception is less susceptible to habituation or sensitization than the circuits responsible for responses to suprathreshold shocks.
- Published
- 2009
41. Does pain catastrophizing moderate the relationship between spinal nociceptive processes and pain sensitivity?
- Author
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Jamie L. Rhudy, Christopher R. France, Emily J. Bartley, Amy E. Williams, Klanci M. McCabe, and Jennifer L. Russell
- Subjects
Adult ,Male ,Pain Threshold ,medicine.medical_specialty ,Adolescent ,Pain tolerance ,Pain ,Models, Psychological ,Nociceptive flexion reflex ,Young Adult ,Physical medicine and rehabilitation ,Threshold of pain ,Reflex ,medicine ,Noxious stimulus ,Humans ,Aged ,Pain Measurement ,Aged, 80 and over ,Psychological Tests ,Sex Characteristics ,business.industry ,Cognition ,Middle Aged ,Uncorrelated ,Electric Stimulation ,Anesthesiology and Pain Medicine ,Nociception ,Neurology ,Pain catastrophizing ,Female ,Neurology (clinical) ,business - Abstract
Existing evidence indicates that pain catastrophizing is associated with enhanced pain reports and lower pain threshold/tolerance levels, but is not significantly related to nociceptive flexion reflex (NFR) threshold in healthy and clinical pain samples. This suggests pain catastrophizing may modulate pain threshold at a supraspinal level without influencing descending modulation of spinal nociceptive inputs. To examine this issue further, the present study assessed NFR threshold, electrocutaneous pain threshold, and electrocutaneous pain tolerance, as well as subjective ratings of noxious stimuli in a sample of 105 healthy adults. Pain catastrophizing was assessed prior to testing using traditional instructions and after pain testing with instructions to report on cognitions during testing (situation-specific catastrophizing). As expected, NFR threshold was correlated with pain sensitivity measures, but uncorrelated with both measures of catastrophizing. Although situation-specific catastrophizing was correlated with some pain outcomes, neither catastrophizing measure (traditional or situation specific) moderated the relationship between NFR and pain sensitivity. These findings confirm and extend existing evidence that catastrophizing influences pain reports through supraspinal mechanisms (eg, memory, report bias, attention) without altering transmission of spinal nociceptive signals. Perspective Assessing catastrophic thoughts related to a specific painful event (situation-specific catastrophizing) provides important additional information regarding the negative cognitions that influence pain-related processes. However, neither situation-specific nor traditionally measured pain catastrophizing appear to enhance pain by engaging descending controls to influence spinal nociceptive processes.
- Published
- 2008
42. Emotional modulation of autonomic responses to painful trigeminal stimulation
- Author
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Amy E. Williams and Jamie L. Rhudy
- Subjects
Adult ,Male ,Pain Threshold ,medicine.medical_specialty ,Self-Assessment ,Trigeminal stimulation ,Emotions ,Pain ,Stimulation ,Sural nerve ,Audiology ,Autonomic Nervous System ,Electrocardiography ,Young Adult ,Sural Nerve ,Heart Rate ,Physiology (medical) ,Heart rate ,medicine ,Psychophysics ,Humans ,Trigeminal Nerve ,Pain Measurement ,Analysis of Variance ,General Neuroscience ,Chronic pain ,Galvanic Skin Response ,medicine.disease ,Electric Stimulation ,Emotional modulation ,Autonomic nervous system ,Neuropsychology and Physiological Psychology ,Female ,Skin conductance ,Psychology ,Neuroscience ,Photic Stimulation - Abstract
Dysregulation of supraspinal pain modulation may contribute to chronic pain, including head/face pain. Our laboratory has shown that emotional picture-viewing reliably modulates subjective and physiological pain responses to noxious extracranial (sural nerve) stimulation, suggesting this is a valid method of studying supraspinal modulation. However, to study head/face pain, it is important to determine whether responses evoked by trigeminal stimulation are also modulated. In the present study (34 healthy participants), emotionally-charged pictures (unpleasant, neutral, pleasant) were presented during which painful trigeminal stimulations were delivered during and in between pictures. Autonomic responses to each shock (pain-evoked HR acceleration, pain-evoked skin conductance response [SCR]) were recorded. Consistent with research on extracranial pain, autonomic responses were larger during unpleasant pictures and smaller during pleasant pictures, with linear trends explaining 23% of the variance in pain-evoked HR and 35% of the variance in pain-evoked SCR (ps
- Published
- 2008
43. Physiological-emotional reactivity to nightmare-related imagery in trauma-exposed persons with chronic nightmares
- Author
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Patricia Byrd, K. McCabe, Jamie L. Rhudy, Joanne L. Davis, and Amy E. Williams
- Subjects
Adult ,Male ,medicine.medical_specialty ,Neuroscience (miscellaneous) ,Medicine (miscellaneous) ,Facial Muscles ,Stress Disorders, Post-Traumatic ,Health problems ,Heart Rate ,Recurrence ,Surveys and Questionnaires ,Heart rate ,medicine ,Humans ,Psychiatry ,Depressive symptoms ,Sleep disorder ,Cognitive Behavioral Therapy ,Electromyography ,Galvanic Skin Response ,Middle Aged ,medicine.disease ,Mental health ,Nightmare ,Dreams ,Posttraumatic stress ,Imagination ,Female ,Neurology (clinical) ,Psychology (miscellaneous) ,medicine.symptom ,Skin conductance ,Psychology - Abstract
Script-driven imagery was used to assess nightmare imagery-evoked physiological-emotional reactivity (heart rate, skin conductance, facial electromyogram, subjective ratings) in trauma-exposed persons suffering from chronic nightmares. Goals were to determine the efficacy of nightmare imagery to evoke physiological-emotional reactivity, correlates (mental health, nightmare characteristics) of reactivity, and consequences (sleep and health problems) of reactivity. Nightmare imagery resulted in significant reactivity relative to control imagery. No mental health variable (posttraumatic stress disorder status, depressive symptoms, dissociation) or nightmare characteristic (months experienced, frequency, similarity to trauma) was associated with reactivity level. However, nightmare imagery-evoked autonomic responses were associated with greater sleep disturbance and reported health symptoms, even when nightmare frequency was controlled. These results suggest nightmare-related autonomic reactions may contribute to sleep and health disturbance.
- Published
- 2008
44. Implementing the cities readiness initiative: lessons learned from Boston
- Author
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Christine M. Judge, Howard K. Koh, Amy E. Williams, M. Suzanne Crowther, John P. Jacob, John Auerbach, Richard A. Serino, and Loris J. Elqura
- Subjects
medicine.medical_specialty ,Engineering ,Emergency Medical Services ,Safety Management ,Population ,Poison control ,Disaster Planning ,Plan (drawing) ,Suicide prevention ,Occupational safety and health ,Security Measures ,Anthrax ,Environmental health ,medicine ,Emergency medical services ,Humans ,Program Development ,education ,education.field_of_study ,business.industry ,Public health ,Communication ,Public Health, Environmental and Occupational Health ,Public relations ,Bioterrorism ,Anti-Bacterial Agents ,Preparedness ,Models, Organizational ,Organizational Case Studies ,Public Health ,Public Facilities ,business ,Boston - Abstract
The federally funded Cities Readiness Initiative (CRI) requires seamless federal, state, and local public health coordination to provide antibiotics to an entire city population within 48 hours of an aerosolized release of anthrax. We document practical lessons learned from the development and implementation of the Boston CRI plan. Key themes center on heightened emphasis on security, a new mass protection model of dispensing, neighborhood-centric clinic site selection, online training of Medical Reserve Corps volunteers, and the testing of operations through drills and exercises. Sharing such lessons can build national preparedness. (Disaster Med Public Health Preparedness. 2008;2:40–49)
- Published
- 2008
45. Efficacy of a program to encourage walking in VA elderly primary care patients: the role of pain
- Author
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Patricia M. Dubbert, Amy E. Williams, Jamie L. Rhudy, and Kent Kirchner
- Subjects
Program evaluation ,Male ,medicine.medical_specialty ,Physical activity ,Pain ,Physical exercise ,Primary care ,Walking ,Exercise program ,Medicine ,Humans ,Applied Psychology ,Aged ,Veterans ,Aged, 80 and over ,Motivation ,Primary Health Care ,business.industry ,Telephone call ,Public health ,Social environment ,Psychiatry and Mental health ,Clinical Psychology ,Physical therapy ,business ,human activities ,Program Evaluation - Abstract
Pain may be a barrier or a negative outcome of initiating and maintaining an exercise program in elderly patients. The purpose of this study was to examine the role of pain in a program designed to increase walking for exercise in 181 veteran primary care patients (60 - 80 years). Self-reported physical activity (min-walked per week) and pain were assessed at baseline, 6, and 12 months. Walking for exercise increased over time without significant changes in pain. Analyses suggested that baseline pain was not a barrier to initiating or maintaining a walking exercise program, nor did increased walking influence reports of pain. These results suggest that patients can be encouraged to engage in physical activity, even if they are currently suffering from pain.
- Published
- 2007
46. Affective modulation of eyeblink reactions to noxious sural nerve stimulation: a supraspinal measure of nociceptive reactivity?
- Author
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Amy E. Williams and Jamie L. Rhudy
- Subjects
Adult ,Male ,Time Factors ,Stimulation ,Sural nerve ,Arousal ,Nociceptive flexion reflex ,Sural Nerve ,Physiology (medical) ,Low arousal theory ,Noxious stimulus ,Reaction Time ,Humans ,Pain Measurement ,Skin ,Analysis of Variance ,Blinking ,Electromyography ,General Neuroscience ,Nociceptors ,Electric Stimulation ,Affect ,Neuropsychology and Physiological Psychology ,Nociception ,Reflex ,Female ,Psychology ,Neuroscience ,Photic Stimulation - Abstract
Research suggests affective picture-viewing modulates subjective and physiological reactions to noxious stimulation (pain report, heart rate acceleration, skin conductance response, nociceptive flexion reflex). Because the nociceptive flexion reflex (a spinal reflex) is modulated by picture-viewing, this suggests affective processes are able to modulate afferent nociception at spinal levels. This highlights the importance of assessing nociceptive reactivity from physiological measures mediated at different levels of the neuraxis (spinal vs. supraspinal) to help elucidate the mechanisms associated with pain regulation. The present study examined whether affective pictures modulate eyeblink reactions (a supraspinal reflex) to noxious stimulation. Healthy men and women (N=23) were recruited from the psychology subject pool to participate. Pictures (attack, loss, neutral, food, erotica) that manipulated affective valence and arousal were presented and noxious electrodermal stimulations were delivered to the sural nerve. Picture duration (500-ms vs. 6-s) was also manipulated, balanced across picture content. Results suggested affective valence and arousal contributed to the modulation of eyeblinks. Eyeblinks were larger during highly arousing unpleasant pictures (attack) than highly arousing pleasant pictures (erotica), but low arousal pictures (loss, food) did not lead to significant modulation. Affective modulation was independent of picture duration or the perceived painfulness of noxious stimulation. This study suggests eyeblink reactions can serve as a supraspinal outcome in procedures used to study affective modulation of pain and nociception.
- Published
- 2007
47. Affective modulation of autonomic reactions to noxious stimulation
- Author
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Jamie L. Rhudy, Amy E. Williams, and K. McCabe
- Subjects
Adult ,Male ,Pain Threshold ,medicine.medical_specialty ,Adolescent ,Stimulation ,Sural nerve ,Audiology ,Autonomic Nervous System ,Developmental psychology ,Heart Rate ,Physiology (medical) ,Heart rate ,medicine ,Noxious stimulus ,Reaction Time ,Humans ,Valence (psychology) ,General Neuroscience ,Nociceptors ,Galvanic Skin Response ,Affective modulation ,Electric Stimulation ,Affect ,Neuropsychology and Physiological Psychology ,Nociception ,Multivariate Analysis ,Facilitation ,Female ,Psychology ,Photic Stimulation - Abstract
Research suggests that emotion modulates spinal nociception and pain; however, there is limited evidence that other objective, nociceptive reactions are modulated. This study examined the impact of affective picture-viewing on autonomic reactions (skin conductance response, heart rate acceleration) resulting from noxious electric stimulations to the sural nerve. Pictures varying in affective valence (unpleasant, neutral, pleasant) were presented during which noxious stimulations were delivered. Skin conductance response and short-latency heart rate acceleration following each stimulation was calculated and averaged by picture valence. Results suggested that autonomic reactions were modulated in parallel. Specifically, reactions were smaller during pleasant pictures than unpleasant pictures, although unpleasant pictures did not result in significant facilitation relative to neutral pictures. The valence linear trend explained 26% of the variance in the multivariate combination of the reactions, suggesting emotion does modulate autonomic reactions to nociception. These results suggest that SCR and HR acceleration are outcomes that can be assessed together with NFR and pain report during picture-viewing to study affective modulation of spinal (NFR), supraspinal (SCR, HR acceleration), and subjective (pain report) nociceptive reactions.
- Published
- 2006
48. Emotional modulation of spinal nociception and pain: the impact of predictable noxious stimulation
- Author
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K. McCabe, P. Rambo, J. Russell, Jamie L. Rhudy, and Amy E. Williams
- Subjects
Adult ,Male ,media_common.quotation_subject ,Emotions ,Pain ,Sural nerve ,Affect (psychology) ,Nociceptive flexion reflex ,Sural Nerve ,Perception ,Reflex ,Noxious stimulus ,Humans ,International Affective Picture System ,media_common ,Pain Measurement ,Electroshock ,Nociceptors ,Anesthesiology and Pain Medicine ,Nociception ,Neurology ,Spinal Cord ,Female ,Neurology (clinical) ,Cues ,Psychology ,Neuroscience ,Photic Stimulation - Abstract
Recent evidence suggests that emotional picture-viewing is a reliable method of engaging descending modulation of spinal nociception. The present study attempted to replicate these findings and determine the effect of noxious stimulus predictability. Participants viewed pictures from the International Affective Picture System (IAPS), during which pain and nociceptive flexion reflexes (NFR) were elicited by electric shocks delivered to the sural nerve. For half of the participants ( n = 25) shocks were preceded by a cue (predictable), whereas the other half received no cue (unpredictable). Results suggested emotion was successfully induced by pictures, but the effect of picture-viewing on the NFR was moderated by the predictability of the shocks. When shock was unpredictable, spinal nociception (NFR) and pain ratings were modulated in parallel. Specifically, pain and NFR magnitudes were lower during pleasant emotions and higher during unpleasant emotions. However, when shocks were predictable, only pain was modulated in this way. NFRs from predictable shocks were not altered by pictures. Further, exploratory analyses found that pain ratings, but not NFRs, were lower during predictable shocks. These data suggest emotional picture-viewing is a reliable method of engaging descending modulation of spinal nociception. However, descending modulation could not be detected in NFRs resulting from predictable noxious stimuli. Although preliminary, this study implies that separate mechanisms are responsible for emotional modulation of nociception at spinal vs. supraspinal levels, and that predictable noxious events may disengage modulation at the spinal level. The current paradigm could serve as a useful tool for studying descending modulation.
- Published
- 2006
49. Affective modulation of nociception at spinal and supraspinal levels
- Author
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K. McCabe, Jamie L. Rhudy, Amy E. Williams, P. Rambo, and Mary Anh Thù V. Nguyê˜n
- Subjects
Adult ,Male ,Pain Threshold ,medicine.medical_specialty ,Adolescent ,Cognitive Neuroscience ,Statistics as Topic ,Experimental and Cognitive Psychology ,Electromyography ,Emotional valence ,Audiology ,Pain rating ,Arousal ,Nociceptive flexion reflex ,Developmental Neuroscience ,Escape Reaction ,Reflex ,medicine ,Humans ,Biological Psychiatry ,Motivation ,medicine.diagnostic_test ,Endocrine and Autonomic Systems ,General Neuroscience ,Brain ,Neural Inhibition ,Galvanic Skin Response ,Affective modulation ,Electric Stimulation ,Affect ,Neuropsychology and Physiological Psychology ,Nociception ,Neurology ,Spinal Cord ,Female ,Psychology ,Neuroscience - Abstract
This study was designed to examine the effect of emotion on the nociceptive flexion reflex and pain ratings. To do so, 28 participants viewed pictures varying in emotional valence (unpleasant, neutral, pleasant) and electric stimulations were delivered during and in between pictures. Biceps femoris EMG resulting from the stimulations was used to quantify the nociceptive flexion reflex (spinal nociception), and pain ratings to the stimulations were used as an evaluative measure of supraspinal nociception. Manipulation checks suggested that pictures effectively manipulated emotion. Moreover, nociceptive flexion reflex magnitudes and pain ratings were modulated in a parallel manner. Specifically, viewing unpleasant pictures enhanced the nociceptive flexion reflex and pain, whereas viewing pleasant pictures inhibited the reflex and pain. Analyses suggested that emotional valence, but not arousal, mediated the effects of pictures.
- Published
- 2005
50. 822 Poor Agreement Between Prospective Diary Data and Retrospective Report of Abdominal Pain and Stooling Symptoms in Children With Irritable Bowel Syndrome (IBS)
- Author
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Bruno P. Chumpitazi, Danita I. Czyzewski, Erica M. Weidler, Robert J. Shulman, Mariella M. Self, and Amy E. Williams
- Subjects
medicine.medical_specialty ,Abdominal pain ,Hepatology ,business.industry ,Internal medicine ,Gastroenterology ,Physical therapy ,Medicine ,medicine.symptom ,business ,medicine.disease ,Irritable bowel syndrome - Published
- 2014
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