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BACKGROUND: Although mindfulness-based interventions (MBIs) are widely used in clinical and nonclinical settings, there has been little systematic study of their potential risks. To address this gap, we examined differences in psychological and physical worsening among participants in the usual care and intervention conditions of a 3-group, randomized pragmatic trial (Learning to Apply Mindfulness to Pain [LAMP]) that tested the effectiveness of 2 approaches to delivering MBIs to patients with chronic pain. METHODS: The sample consisted of 374 male and 334 female patients with chronic pain enrolled in the LAMP trial who completed a 10-week follow-up survey, 61% of whom had a mental health diagnosis. Psychological and physical worsening was assessed by a checklist asking whether participants experienced specific symptoms since beginning the study. We used multivariable logistic regression models with imputed data to determine whether predicted probabilities of increased symptoms differed between usual care and the 2 MBIs. RESULTS: Participants in usual care were more likely to report experiencing increased psychological and physical worsening than were those in the MBIs, including an increase in disturbing memories; sadness, anxiousness, and fatigue; isolation and loneliness; and feeling more upset than usual when something reminded them of the past. CONCLUSIONS: MBIs do not appear to cause harm, in terms of increased symptoms, for this population of patients with chronic pain and high levels of mental health comorbidities. CLINICAL TRIAL REGISTRATION: Preregistration with an analysis plan at www.ClinicalTrials.gov: NCT04526158. Patient enrollment began December 4, 2020.

BACKGROUND: Although studies have documented higher rates of chronic pain among women Veterans compared to men Veterans, there remains a lack of comprehensive information about potential contributors to these disparities. MATERIALS AND METHODS: This study examined gender differences in chronic pain and its contributors among 419 men and 392 women Veterans, enrolled in a mindfulness trial for chronic pain. We conducted descriptive analyses summarizing distributions of baseline measures, obtained by survey and through the electronic health record. Comparisons between genders were conducted using chi-square tests for categorical variables and t-tests for continuous measures. RESULTS: Compared to men, women Veterans were more likely to have chronic overlapping pain conditions and had higher levels of pain interference and intensity. Women had higher prevalence of psychiatric and sleep disorder diagnoses, greater levels of depression, anxiety, post-traumatic stress disorder, fatigue, sleep disturbance, stress and pain catastrophizing, and lower levels of pain self-efficacy and participation in social roles and activities. However, women were less likely to smoke or have a substance abuse disorder and used more nonpharmacological pain treatment modalities. CONCLUSION: Among Veterans seeking treatment for chronic pain, women differed from men in their type of pain, had greater pain intensity and interference, and had greater prevalence and higher levels of many known biopsychosocial contributors to pain. Results point to the need for pain treatment that addresses the comprehensive needs of women Veterans. UNLABELLED: Clinical Trial Registration Number: NCT04526158. Patient enrollment began on December 4, 2020.

BackgroundMindfulness-based interventions (MBIs) are evidence-based nonpharmacological treatments for treating chronic pain. However, the predominant MBI, mindfulness-based stress reduction, has features that pose significant implementation barriers.ObjectivesThis study will test two approaches to delivering MBIs for improving Veterans' chronic pain and mental health comorbidities. These two approaches address key implementation barriers.MethodsWe will conduct a four-site, three-arm pragmatic randomized controlled trial, Learning to Apply Mindfulness to Pain (LAMP), to test the effectiveness of two MBIs at improving pain and mental health comorbidities. Mobile+Group LAMP consists of prerecorded modules presented by a mindfulness instructor that are viewed in an online group setting and interspersed with discussions led by a facilitator. Mobile LAMP consists of the same prerecorded modules but does not include a group component. We will test whether either of these MBIs will be more effective than usual care at improving chronic pain and whether the Mobile+Group LAMP will be more effective than Mobile LAMP at improving chronic pain. Comparisons for the primary hypotheses will be conducted with continuous outcomes (Brief Pain Inventory interference score) repeated at 10 weeks, 6 months, and 12 months. The secondary hypotheses are that Mobile+Group LAMP and Mobile LAMP will be more effective than usual care at improving secondary outcomes (e.g., post-traumatic stress disorder, depression). We will also confirm the comparisons for the primary and secondary hypotheses in gender-specific strata.ImplicationsThis trial is expected to result in two approaches for delivering MBIs that will optimize engagement, adherence, and sustainability and be able to reach large numbers of Veterans.

Background: Recruitment for clinical trials and large-scale studies is challenging, especially for patients with complex conditions like chronic pain. Email recruitment has the potential to increase efficiency, to reduce costs, and to improve access for underrepresented patient populations. The objective of this study was to examine the effectiveness, efficiency, and equitability of email versus postal mail recruitment for the Learning to Apply Mindfulness to Pain (LAMP) study, a three-site clinical trial of mindfulness-based interventions for chronic pain. Methods: Patients with chronic pain diagnoses were recruited from three United States Department of Veterans Affairs (VA) facilities using the VA electronic health record (EHR). Recruitment materials were sent using either postal mail (n = 7986) or email (n = 19,333). Patients in the email recruitment group were also mailed introductory postcards before any emails. Mailing addresses and email addresses were obtained from the EHR. Effectiveness was measured by the response rate of patients who logged into the secure LAMP study website. Efficiency was measured by the number of days from when the recruitment materials were sent to when patients logged into the LAMP portal as well as the estimated costs of each recruitment approach. To assess equitability, we examined whether email recruitment was less effective for underrepresented populations, based on demographic information from the EHR. Results: Effectiveness—unadjusted response rates were greater for email versus postal-mail recruitment (18.9% versus 6.3%), and adjusted response rates were over three times greater for email recruitment (RR = 3.5, 95% CI 3.1–3.8) based on a multivariable analysis controlling for age, gender, race, ethnicity, rurality, and site. Efficiency—email recruitment had a significantly lower mean response time (1 day versus 8 days) and a lower cost. Equity—email recruitment led to higher response rates for all subpopulations, including older, non-White, Hispanic, rural, and female Veterans. Conclusions: Email recruitment is an effective, efficient, and equitable way to recruit VA patients to large-scale, chronic pain clinical trials. Trial registration: Clinical Trial Registration Number: NCT04526158. Patient enrollment began on December 4, 2020. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic stress disorder (PTSD) and chronic pain are highly prevalent comorbid conditions. Veterans dually burdened by PTSD and chronic pain experience more severe outcomes compared to either disorder alone. Few studies have enrolled enough women Veterans to test gender differences in pain outcomes [catastrophizing, intensity, interference] by the severity of PTSD symptoms. Aim: Examine gender differences in the association between PTSD symptoms and pain outcomes among Veterans enrolled in a chronic pain clinical trial. Methods: Participants were 421 men and 386 women Veterans with chronic pain who provided complete data on PTSD symptoms and pain outcomes. We used hierarchical linear regression models to examine gender differences in pain outcomes by PTSD symptoms. Results: Adjusted multivariable models indicated that PTSD symptoms were associated with higher levels of pain catastrophizing (0.57, 95% CI [0.51, 0.63]), pain intensity (0.30, 95% CI [0.24, 0.37]), and pain interference (0.46, 95% CI [0.39, 0.52]). No evidence suggesting gender differences in this association were found in either the crude or adjusted models (all interaction p-values<0.05). Conclusion: These findings may reflect the underlying mutual maintenance of these conditions whereby the sensation of pain could trigger PTSD symptoms, particularly if the trauma and pain are associated with the same event. Clinical implications and opportunities testing relevant treatments that may benefit both chronic pain and PTSD are discussed. [ABSTRACT FROM AUTHOR]

Author(s): Adam D. LaMotte [sup.1] , Laura A. Meis [sup.2] , Jamie J. Winters [sup.3] , Robin A. Barry [sup.4] , Christopher M. Murphy [sup.1] Author Affiliations: (1) University of [...], Although the content of relationship problems has received considerable study in research on couple adjustment, little of this work has focused on relationship problems among men who engage in intimate partner violence (IPV). Theory and research on IPV indicate that relationship problems are an important contributing factor, and the assessment of relationship problems may prove clinically useful in IPV treatment. With a sample of 589 men presenting for services at an abuser intervention program (AIP), the current study aimed to (1) provide descriptive information about rates of endorsement and problem severity for 30 relationship problems, (2) identify different areas of relationship problems via principal component analysis, and (3) examine bivariate correlations between relationship problems and use of physical IPV, emotional abuse, and relationship satisfaction. Results indicated that poor communication, difficulties over money, constant bickering, lack of trust between partners, and selfishness/lack of cooperation were the most commonly endorsed relationship problems. Principal component analysis identified seven broad areas of relationship problems, including communication/money management, substance use, sexual difficulties, cultural differences, mistrust/jealousy, togetherness, and shared friends/activities. As predicted, the severity of relationship problems was positively associated with IPV and emotional abuse and negatively associated with relationship satisfaction. These findings provide key preliminary information about relationship problems among men in treatment for partner abuse and highlight directions for future research.

Objective: The purpose of the present study was to examine the role of experiential avoidance (EA) in relationship adjustment, psychological aggression, and physical aggression among military couples. Method: The sample was composed of 49 male soldiers who recently returned from deployment to Iraq and their female partners. As part of a larger study, participants completed self-report measures of emotional avoidance (EA; Acceptance and Action Questionnaire-II), relationship adjustment (Dyadic Adjustment Scale), and conflict (Conflict Tactics Scale-2). Data from men and women were simultaneously modeled with the actor-partner interdependence model. Results: Men's EA was associated with decreases in relationship adjustment and increases in physical aggression perpetration and victimization. For women, relationship adjustment was not associated with EA, but greater EA among women was associated with decreased relationship adjustment for male partners. Associations among EA and psychological aggression were nonsignificant. Conclusions: These data provide evidence that EA may play a critical role in the relationships of couples following deployment and highlight the importance of targeting EA in couple therapy. (Contains 4 tables, 1 figure and 1 footnote.)

Concerns about low motivation to change among perpetrators of intimate partner violence (IPV) have heightened interest employing behavior change models with this population. In the present investigation, a new scale was developed, the Outcome Expectancies for Partner Abuse (OEPA) Scale, assessing the negative and positive outcome expectancies of partner abuse. Items were generated from statements made by IPV offenders during videotaped group therapy sessions. Among a clinical sample of 130 IPV perpetrators, item psychometric properties, factor structure, and subscale validity were examined. Results indicated generally good psychometric properties and a 2-factor solution, with the exception of 4 items subsequently removed from the negative expectancies scale. Significant associations were demonstrated between instrument subscales, readiness to change, and self-reported abusive behavior. Additionally, positive expectancy scores correlated with anger problems and relationship adjustment whereas negative expectancy scores correlated with partner-reported IPV. Potential uses of the OEPA and future directions for psychometric research are discussed. (Contains 2 notes and 5 tables.)

This study examined the role of posttraumatic stress disorder (PTSD) symptoms with respect to dating aggression perpetration among a sample of 199 undergraduates. Almost one-third of the overall sample reported physical dating aggression perpetration in the past year, and approximately 80% reported engaging in psychological dating aggression. Structural equation modeling (SEM) analyses indicated that the effects of trauma exposure on dating aggression were fully indirect via PTSD symptoms. PTSD symptoms were associated with psychological dating aggression in part through its association with anger, and alcohol problems were also directly related to this outcome. Results generalize findings from other populations suggesting the salience of trauma and PTSD symptoms in intimate relationship aggression and point to possible etiological pathways for these associations. Keywords: PTSD: dating aggression; physical aggression: psychological aggression DOI: 10.1891/0886-6708.25.4.456

This article outlines a rationale for investigating the individual (one-on-one) treatment format and individualized (case-tailored) services for partner abuse perpetrators. Many state standards caution against or prohibit individual services in abuser intervention. However, initial research indicates that motivational interviewing, conducted individually, can increase abusive clients' engagement in the change process. Challenges of using the group format in treatment development are discussed along with potential benefits of individual treatment for this population. Notably, individual treatment can be adapted to the client's stage of change, can address a range of presenting concerns (such as substance abuse and mood disorders) that may influence outcome, and can be used to focus clinical attention on case-specific change targets while avoiding potentially negative and antisocial peer influences in the group format. Nevertheless, individual treatment has been almost entirely ignored to date in clinical research with this population. Keywords: therapy; partner violence; abuse; offenders