Behavioral Medicine Interventions Research Articles

Behavioral Medicine in Companion Animals

Purpose: The main objective of this study was to investigate behavioural medicine interventions on the behaviour and mental health of companion animals.
 Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library.
 Findings: The findings revealed that there exists a contextual and methodological gap relating to behavioral medicine in companion animals. Preliminary empirical review revealed that it is important to consider the unique needs and circumstances of companion animals when designing and implementing behavioral medicine interventions. Factors such as the animal's history, environment, and the presence of underlying medical conditions must be carefully evaluated to tailor interventions effectively. Additionally, the role of human caregivers, including pet owners, trainers, and veterinary professionals, is paramount in the success of these interventions.
 Unique Contribution to Theory, Practice and Policy: The Social Learning theory, Cognitive Behavioural theory and the Attachment theory may be used to anchor future studies on behavioral medicine in companion animals. The study recommended for promoting early and comprehensive behavioural assessment, increasing awareness and education for pet owners, expanding access to qualified behavioural professionals, incorporating evidence based approaches, fostering collaboration between veterinary and behavioural professions and emphasizing prevention and early intervention.

0913 Evaluation of a Single-Session Sleep Intervention for Air Force Trainees

Abstract Introduction Sleep insufficiency is highly prevalent in military personnel and has detrimental impacts on operational readiness and health. Sleep health across this population does not appear to have improved despite targeted health promotion programs and efforts to bolster evidence-based tertiary care for sleep disorders. There is some evidence that problematic sleep may emerge in early military training environments and persist throughout a service member’s career. Approximately 37,000 personnel complete Air Force (USAF) technical training each year to learn job-specific skills. The purpose of the present study was to assess the effectiveness of a single-session, group-based sleep intervention in USAF Technical Training. Methods A brief (40-min) intervention incorporating behavioral sleep medicine interventions and motivational interviewing was developed and tailored for the target population. Three military units were assigned to receive either the brief sleep intervention (n = 203) or an active control group receiving a brief tobacco intervention (n = 118). Students were queried at two weeks post-intervention to assess their sleep time and quality using the Self-Assessment of Sleep Survey-Split (SASS-Y). Participants included 321 USAF technical school students (Mean age = 21), and the majority identified as male (82%), White (67%), and non-Hispanic (75%). Propensity-score-weighted multivariable logistic regression was utilized to compare the sleep outcomes between intervention and control groups at follow-up. Results At follow-up, students in the sleep intervention were significantly more likely to report sleeping > 6 hours per night on weekdays (OR = 1.49, p < .001) and more likely to endorse “Good” or “Very Good” sleep quality (OR = 1.50, p = .032) as compared to the control group. Follow-up results also showed that 69.2% of students in the sleep intervention group reported having engaged in the self-selected positive sleep ‘Action Step’ they chose and wrote down during the intervention. Conclusion This is, to our knowledge, the first study to design and test a brief motivational interviewing and behavioral sleep intervention in USAF technical training. Results suggest that a single-session, group-level intervention can promote behavioral changes and improve sleep health. Future efforts should consider low-touch additions (e.g., text messaging) to support the durability of intervention effects. Support (if any)

Introduction to the Special Section: Emerging Studies of Sleep as a Critical Target of Behavioral Medicine Intervention.

Introduction to the Special Section: Emerging Studies of Sleep as a Critical Target of Behavioral Medicine Intervention.

Effectiveness of a behavioral medicine intervention in physical therapy on secondary psychological outcomes and health-related quality of life in exercise-based cardiac rehabilitation: a randomized, controlled trial

BackgroundInterventions promoting adherence to exercise-based cardiac rehabilitation (exCR) are important to achieve positive physical and psychological outcomes, but knowledge of the added value of behavioral medicine interventions for these measures is limited. The aim of the study was to investigate the added value of a behavioral medicine intervention in physical therapy (BMIP) in routine exCR on psychological outcomes and health-related quality of life (HRQoL) versus routine exCR alone (RC).MethodsA total of 170 patients with coronary artery disease (136 men), mean age 62.3 ± 7.9 years, were randomized at a Swedish university hospital to a BMIP plus routine exCR or to RC for four months. The outcome assessments included HRQoL (SF-36, EQ-5D), anxiety and depression (HADS), patient enablement and self-efficacy and was performed at baseline, four and 12 months. Between-group differences were tested with an independent samples t-test and, for comparisons within groups, a paired t-test was used. An intention-to-treat and a per-protocol analysis were performed.ResultsNo significant differences in outcomes between the groups were shown between baseline and four months or between four and 12 months. Both groups improved in most SF-36 domains, EQ-VAS and HADS anxiety at the four-month follow-up and sufficient enablement remained at the 12-months follow-up.ConclusionA BMIP added to routine exCR care had no significant effect on psychological outcomes and HRQoL compared with RC, but significant improvements in several measures were shown in both groups at the four-month follow-up. Since recruited participants showed a better psychological profile than the general coronary artery disease population, further studies on BMIP in exCR, tailored to meet individual needs in broader patient groups, are needed.Trial registration number NCT02895451, 09/09/2016, retrospectively registered.

BEHAVIOURAL MEDICINE: A KEY TO THE MANAGEMENT OF NON-COMMUNICABLE DISEASES IN NIGERIA

Urbanisation and advances in health technology have led to a reduction in communicable diseases. However, poverty, population growth, and the globalisation of unhealthy diets have resulted in a global upsurge of non-communicable diseases (NCD) like cancers, cardiovascular diseases, nutritional and metabolic diseases, endocrine disorders and respiratory diseases. Healthcare for NCDs remains a significant public health challenge. The primary management in Nigeria is currently pharmacological. However, non-pharmacological measures that are cost-effective and safe, with minimal side effects, are available for the prevention (primary and secondary) and treatment of NCDs. The impact of behavioural medicine in Nigeria remains limited despite the potential to significantly reduce the burden of NCDs and improve health and clinical outcomes. This is mainly due to insufficient investment in behavioural medicine research, inferior quality evaluation methods, lack of implementation of research outcomes, and poor interdisciplinary collaboration. Based on insights from the literature, this article discusses the need for behavioural medicine interventions and examines their application, effectiveness, and potential impact on NCDs. It also recommends more consideration of behavioural medicine in preventing and managing NCDs in Nigeria.

Integration of implementation science in cardiovascular behavioral medicine.

Cardiovascular behavioral medicine has significantly advanced the knowledge base regarding the mechanisms by which psychological and behavioral factors can impact cardiovascular function and has developed clear links between these factors and cardiovascular health and disease. More recent work has established numerous behavioral interventions that are efficacious, and in several cases demonstrated to be effective. However, despite these significant advances, translation to broad, real-world uptake and utilization has not been well studied, with consequential profound implications for health equity. The purpose of this article is to review what is known about effective implementation strategies to support the uptake of behavioral medicine interventions to improve cardiovascular health, to underscore the potential for developing additional implementation strategies for wide-scale uptake of effective cardiovascular behavioral medicine interventions, and to discuss the potential for developing additional implementation approaches while conducting early stage efficacy studies in this area. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"My Surgical Success": Feasibility and Impact of a Single-Session Digital Behavioral Pain Medicine Intervention on Pain Intensity, Pain Catastrophizing, and Time to Opioid Cessation After Orthopedic Trauma Surgery-A Randomized Trial.

BACKGROUND:Behavioral pain treatments may improve postsurgical analgesia and recovery; however, effective and scalable options are not widely available. This study tested a digital perioperative behavioral medicine intervention in orthopedic trauma surgery patients for feasibility and efficacy for reducing pain intensity, pain catastrophizing, and opioid cessation up to 3 months after surgery.METHODS:A randomized controlled clinical trial was conducted at an orthopedic trauma surgery unit at a major academic hospital to compare a digital behavioral pain management intervention (“My Surgical Success” [MSS]) to a digital general health education (HE) intervention (HE; no pain management skills). The enrolled sample included 133 patients; 84 patients were randomized (MSS, n = 37; HE, n = 47) and completed study procedures. Most patients received their assigned intervention within 3 days of surgery (85%). The sample was predominantly male (61.5%), White (61.9%), and partnered (65.5%), with at least a bachelor’s degree (69.0%). Outcomes were collected at 1–3 months after intervention through self-report e-surveys and electronic medical record review; an intention-to-treat analytic framework was applied. Feasibility was dually determined by the proportion of patients engaging in their assigned treatment and an application of an 80% threshold for patient-reported acceptability. We hypothesized that MSS would result in greater reductions in pain intensity and pain catastrophizing after surgery and earlier opioid cessation compared to the digital HE control group.RESULTS:The engagement rate with assigned interventions was 63% and exceeded commonly reported rates for fully automated Internet-based e-health interventions. Feasibility was demonstrated for the MSS engagers, with >80% reporting treatment acceptability. Overall, both groups improved in the postsurgical months across all study variables. A significant interaction effect was found for treatment group over time on pain intensity, such that the MSS group evidenced greater absolute reductions in pain intensity after surgery and up to 3 months later (treatment × time fixed effects; F[215] = 5.23; P = .024). No statistically significant between-group differences were observed for time to opioid cessation or for reductions in pain catastrophizing (F[215] = 0.20; P = .653), although the study sample notably had subclinical baseline pain catastrophizing scores (M = 14.10; 95% confidence interval, 11.70–16.49).CONCLUSIONS:Study findings revealed that a fully automated behavioral pain management skills intervention (MSS) may be useful for motivated orthopedic trauma surgery patients and reduce postsurgical pain up to 3 months. MSS was not associated with reduced time to opioid cessation compared to the HE control intervention.

Relationship of overweight and obesity to insomnia severity, sleep quality, and insomnia improvement in a clinically referred pediatric sample.

Children with overweight or obesity are more likely to experience sleep disorders, although the role of weight in pediatric insomnia treatment has not been examined. The current study examined the relationships of high body mass with pretreatment insomnia severity and global sleep problems and the potential moderating impact of weight on changes in insomnia severity following insomnia treatment. Participants included 1,133 youth ages 2-18 years clinically referred for insomnia treatment. The Pediatric Insomnia Severity Index was collected at the initial assessment and throughout treatment as part of routine clinical care. Treatment status was coded as no treatment, early termination, and completed treatment. Secondary measures of global sleep problems at the initial assessment included the Adolescent Sleep Wake Scale, Adolescent Sleep Hygiene Scale, and Children's Sleep Habits Questionnaire. Medical chart review of visits within ± 3 months of baseline was used to obtain age-adjusted and sex-adjusted body mass index Z-score. Among adolescents, regression analyses found that higher body mass index Z-score modestly predicted baseline insomnia severity (P = .021) and worse sleep hygiene (P < .001). For children, higher body mass index Z-score was modestly associated with baseline total sleep problems (P = .006) but not insomnia severity (P = .792). Across ages, body mass index Z-score predicted neither treatment status nor insomnia improvement (P > .05). Findings were similar in categorical analyses comparing patients with overweight/obesity to healthy weight. Although there is evidence that children of higher body mass present for insomnia treatment with greater sleep concerns, body mass does not predict treatment completion or insomnia improvement. Data suggest insomnia treatment is effective irrespective of weight status. Duraccio KM, Simmons DM, Beebe DW, Byars KC. Relationship of overweight and obesity to insomnia severity, sleep quality, and insomnia improvement in a clinically referred pediatric sample. J Clin Sleep Med. 2022;18(4):1083-1091.

Sleep Characterization of Adolescent and Young Adult Patients with Sickle Cell Disease Using the Pittsburgh Sleep Quality Index

Introduction: Poor sleep quality is common across the lifespan in patients with sickle cell disease (SCD) and has been associated with pain, mood disruption, and fatigue. The Pittsburgh Sleep Quality Index (PSQI) examines sleep quality in both pediatric and adult patients with chronic health conditions, including in adolescents and young adults (AYAs) with SCD. The AYA period is particularly salient for patients with SCD given the potential onset of chronic pain during this developmental period and increased risk for complications during transition. Previous studies have relied on the PSQI total score rather than examining specific domains of sleep quality. In addition, prior studies have mostly focused on either pediatric or adult patients rather than examining AYAs as a group. This study examined specific PSQI sleep domains to identify characteristics that may be impaired in AYAs with SCD. This approach may allow for a multidimensional understanding of sleep in AYAs with SCD and may identify specific targets for intervention.Methods: We performed a retrospective chart review of AYA patients with SCD who completed the PSQI as part of a clinical pilot program. Patients included all types of SCD between 13-25 years. We recorded the PSQI and demographic and medical characteristics (age, sex, SCD type, CBC, and SCD treatments). Descriptive data from PSQI subdomains (sleep duration, latency, efficiency, needing medication to sleep, subjective sleep quality, and mid-sleep time [mid-point between sleep onset and offset]) were examined for adolescents (ages 13 to 18) and young adults (ages 19 to 25) to identify sleep characteristics (table 1). A mean PSQI score > 5 is categorized as having poor sleep quality. Chi-square and Fisher's exact test were used to compare age differences in characteristics for adolescents versus young adults.Results: Eighty-nine AYAs with SCD (mean age: 18.9±3.5 years; 51 female, 38 male) completed the PSQI. Patients were evenly distributed across adolescent (n = 46) and young adult groups (n = 43). SCD genotypes included: HbSS (n = 58), HbSC (n = 15), HbSb + (n = 9), HbSb 0 (n = 3), HbSO-Arab (n = 2), and unknown (n = 2). Adolescents and young adults did not significantly differ for sex, SCD genotype, CBC, or current therapies (all p .3). Average total PSQI scores for adolescents and young adults were 6.26 and 9.02, respectively. Most adolescents (52%) and young adults (84%) reported poor sleep quality (total PSQI score > 5). Thirty nine percent of adolescents rated their sleep duration as less than 7 hours compared to over half of young adults (56%). Many adolescents (59%) and young adults (44%) endorsed a mild to moderate amount of sleep disturbance, with many young adults (47%) also reporting a high amount of sleep disturbance. A large percentage of young adults (68%) and some adolescents (37%) reported prolonged sleep latency and subsequent daytime dysfunction due to sleepiness [adolescents (63.0%) and young adults (77%)]. Sleep efficiency was inadequate in 59% of adolescent and 72% of young adults. More young adults (35%) than adolescents (7%) reported needing medication to sleep. Despite noted sleep deficiencies, subjective sleep quality was frequently rated as “very good” or “fairly good” by adolescents (91%) and young adults (72%). Midsleep time serves as a proxy for chronotype (morning or night person). Mean midsleep time was 4.75 and 4.95 in young adult and adolescent participants, indicating a late chronotype. Among sleep domains, sleep latency, subjective sleep quality, needing medication to sleep, and overall sleep quality were worse among young adults versus adolescents (p = .002 to .012).Conclusion: Adolescents and young adults with SCD had poor sleep quality across multiple PSQI domains. Young adults also reported poorer sleep quality in certain domains versus adolescents, suggesting that some sleep characteristics may worsen during transition. Results highlight the need to be vigilant for sleep problems and the need for sleep education for AYAs with SCD. Future studies focused on the efficacy of behavioral sleep medicine interventions that target sleep deficiencies in AYAs with SCD are also important. This study was limited by using a convenience sample rather than a random sample of patients from the clinic. This study is also cross-sectional and longitudinal efforts are needed to better understand the evolution of sleep difficulties during the AYA developmental period. [Display omitted] DisclosuresLebensburger: Bio Products Laboratory: Consultancy; Novartis: Consultancy. Kanter: Fulcrum Therapeutics, Inc.: Consultancy; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Forma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios: Honoraria, Membership on an entity's Board of Directors or advisory committees; Beam: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Graphite Bio: Consultancy; GuidePoint Global: Honoraria; Fulcrum Tx: Consultancy.

Sleep in a pandemic: Implications of COVID-19 for sleep through the lens of the 3P model of insomnia.

The coronavirus disease 2019 (COVID-19) pandemic has fundamentally altered daily life across the globe, and the stress associated with these changes is likely to impact sleep. Sleep is critical for physical and mental health; thus, understanding the factors that may contribute to poor sleep during the pandemic represents a first step in identifying behavioral health targets for intervention efforts during and after the pandemic. This review first summarizes the developing research on sleep during the pandemic. The impact of the pandemic on sleep is then examined through the lens of the 3P model of insomnia by proposing pandemic-specific predisposing, precipitating, and perpetuating factors. The potential consequences of sleep disturbance on physical and mental health conditions most relevant to the pandemic are also reviewed. Finally, recommendations for reducing or eliminating pandemic-specific perpetuating factors are detailed, highlighting the potential utility of behavioral sleep medicine interventions in the integration of behavioral health responses and public health initiatives during and after the pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Behavioral Medicine for Sedentary Behavior, Daily Physical Activity, and Exercise to Prevent Cardiovascular Disease: A Review.

Purpose of ReviewBehavioral medicine is a multidisciplinary field that has a key role in reducing risk factors for cardiovascular disease (CVD). The purpose of this review is to describe the role of behavioral medicine for CVD prevention, using physical activity behaviors (e.g., sedentary behavior, daily physical activity, or exercise) as an exemplar. Application of behavioral medicine to improve dietary behaviors is also briefly discussed.Recent FindingsBehavioral medicine interventions that address physical activity behaviors are associated with improved cardiovascular risk factors. Interventions framed in behavior change theory that integrate behavior change techniques to reduce sedentary behavior and promote daily physical activity and exercise have similarly been applied to improve certain dietary behaviors and show promise for reducing CVD risk factors.SummaryBehavioral medicine has an important role in improving various physical activity behaviors for all populations, which is essential for preventing or managing CVD. Further investigation into behavioral medicine interventions that address personal, environmental, and social factors that influence participation in physical activity behaviors, as well as the adoption of a more optimal dietary pattern, is warranted.

581 Impact of Weight on Insomnia Severity, Sleep Quality, and Insomnia Improvement in a Clinically Referred Pediatric Sample

Abstract Introduction Children with overweight/obesity are more likely to have shortened sleep, though little is known about the role of weight status in insomnia severity, sleep quality, and sleep hygiene in clinically referred youth. Methods A total of 1133 children (43.7% female) presented to a Pediatric Behavioral Sleep Medicine Clinic for insomnia. At the initial evaluation, caregivers of children ages 2–10.9 years (N = 744) completed the Pediatric Insomnia Severity Scale (PISI) and the Children’s Sleep Habits Questionnaire (CSHQ); adolescents ages 11–18 years (N = 389) completed the PISI, the Adolescent Sleep Hygiene Scale (ASHS), and the Adolescent Sleep Wake Scale (ASWS). The PISI was completed during at least one Pediatric Behavioral Sleep Medicine visit subsequent to evaluation and initiation of treatment. Patient height and weight, objectively measured within 3 months of the initial evaluation, was used to determine sex-adjusted body mass index z-scores (BMIz). Hierarchal linear regression models were used to determine the impact of BMIz on baseline PISI insomnia severity scores, and CSHQ, ASHS, and ASWS total scores, after covarying for income. Repeated-measures general linear modeling was used to determine whether weight status moderated improvement in insomnia severity over time, covarying for income. Results For children (ages 2–10.9), weight was not associated with baseline insomnia severity (p=.62) or predictive of insomnia improvement following behavioral sleep medicine intervention (p=.71), though higher weight predicted poorer parent-reported sleep quality (p=.006). For adolescents (ages 11–18), higher weight was predictive of higher baseline insomnia severity (p=.026), though did not predict insomnia improvement over time (p = .86); higher weight was also predictive of poorer sleep hygiene (p&amp;lt;.001) and worse sleep quality (p=.03). Conclusion Initial insomnia severity and subjective sleep quality may be worse for youth of higher weight, particularly for adolescents; these findings increase our understanding of how and when overweight/obesity negatively impacts sleep. Fortunately, youth with higher weight respond equally well to pediatric behavioral sleep medicine interventions as their lower-weight peers, suggesting that these interventions need not be modified based on patient weight. Support (if any) Cincinnati Children’s Hospital Medical Center Division of Behavioral Medicine and Clinical Psychology’s Research Funds

How are Consumer Sleep Technology Data Being Used to Deliver Behavioral Sleep Medicine Interventions? A Systematic Review

ABSTRACT Background: The rapid growth of consumer sleep technology demonstrates the population’s interest in measuring sleep. However, the extent to which these devices can be used in the delivery of behavioral sleep interventions is currently unknown. The objectives of this systematic review were to evaluate the use of consumer sleep technology (wearable and mobile) in behavioral sleep medicine interventions, identify gaps in the literature and potential future directions. Methods: We completed a scoping review of studies conducted in adult populations that used consumer sleep tracking technology to deliver sleep-related interventions. Results: Our initial search returned 4,538 articles and 14 articles met our inclusion/exclusion criteria. Results demonstrated that wearable devices are being used for two main purposes: 1. To deliver treatment for insomnia and 2. Sleep monitoring as part of overall wellness programs. Half of the articles reviewed (n = 7) used consumer sleep technology in a cognitive behavioral therapy for insomnia. The majority of the studies reviewed (n = 10) were fully digital, without human intervention, and only two small studies evaluated interventions delivered with and without a sleep tracking device. Conclusions: These studies demonstrate opportunities to utilize consumer sleep trackers in insomnia treatment and wellness programs, but most new and innovative interventions are in the early, feasibility stages. Future research is needed to determine how to leverage wearables to improve existing behavioral sleep treatments and determine how this technology can engage patients and reduce barriers to behavioral sleep medicine interventions.

Common paraverbal errors during hypnosis intervention training

ABSTRACT There is growing literature to support the use of hypnosis as an evidence-based behavioral medicine intervention to manage a wide variety of symptoms and side effects associated with cancer and its treatment (e.g., pain, nausea, fatigue). However, formal training in hypnosis is often lacking among cancer care providers. The purpose of this study is to identify common paraverbal errors among hypnosis trainees in order to inform future training efforts. In a sample of 196 hypnosis trainees, paraverbal errors (i.e., tone, pacing, and phrasing) were tracked across hypnotic intervention components. Results revealed that trainees had most difficulty with hypnotic tone, particularly during the Induction, Deepening, and Alerting components. Individual trainee characteristics were unrelated to paraverbal errors.

The Added Value of a Behavioral Medicine Intervention in Physiotherapy on Adherence and Physical Fitness in Exercise-Based Cardiac Rehabilitation (ECRA): A Randomised, Controlled Trial.

PurposeDespite beneficial effects, adherence to exercise-based cardiac rehabilitation (exCR) is low in patients with coronary artery disease (CAD). The aim of this study was to investigate adherence to and the effects of a behavioral medicine intervention in physiotherapy (BMIP) added to routine exCR care on the primary outcome of physical fitness compared with routine exCR care.Patients and MethodsIn a randomized, controlled trial, 170 patients with CAD (136 men), mean age 62.3 (7.9) years, were included at a Swedish university hospital. Patients were randomized 1:1 to routine exCR care (RC) or to a BMIP added to routine exCR care for four months, with a long-term follow-up at 12 months. The outcome assessment included submaximal aerobic exercise capacity, muscle endurance and self-reported physical activity and physical capacity.ResultsThe four-month follow-up showed improvements in all outcomes for both groups, but changes did not differ significantly between the groups. Patients in the BMIP group were more adherent to exCR recommendations compared with the RC group (31% vs 19%) and a non-significant tendency towards the maintenance of submaximal aerobic exercise capacity over time was seen in the BMIP group, whereas patients in the RC group appeared to deteriorate.ConclusionBoth groups improved significantly at the four-month follow-up, while the 12-month follow-up showed a non-significant tendency towards better long-term effects on submaximal aerobic exercise capacity and exercise adherence for a BMIP compared with RC. In spite of this, a better understanding of the role of a BMIP in enhancing adherence is needed.

Efficacy and mechanisms of a single-session behavioral medicine class among patients with chronic pain taking prescription opioids: study protocol for a randomized controlled trial

BackgroundIndependent of pain intensity, pain-specific distress is highly predictive of pain treatment needs, including the need for prescription opioids. Given the inherently distressing nature of chronic pain, there is a need to equip individuals with pain education and self-regulatory skills that are shown to improve adaptation and improve their response to medical treatments. Brief, targeted behavioral medicine interventions may efficiently address the key individual factors, improve self-regulation in the context of pain, and reduce the need for opioid therapy. This highlights the critical need for targeted, cost-effective interventions that efficiently address the key psychological factors that can amplify the need for opioids and increased risk for misuse. In this trial, the primary goal is to test the comparative efficacy of a single-session skills-based pain management class to a health education active control group among patients with chronic pain who are taking opioids.Methods/designOur study is a randomized, double-blind clinical trial testing the superiority of our 2-h, single-session skills-based pain management class against a 2-h health education class. We will enroll 136 adult patients with mixed-etiology chronic pain who are taking opioid prescription medication and randomize 1:1 to one of the two treatment arms. We hypothesize superiority for the skills-based pain class for pain control, self-regulation of pain-specific distress, and reduced opioid use measured by daily morphine equivalent. Team researchers masked to treatment assignment will assess outcomes up to 12 months post treatment.DiscussionThis study aims to test the utility of a single-session, 2-h skills-based pain management class to improve self-regulation of pain and reduce opioid use. Findings from our project have the potential to shift current research and clinical paradigms by testing a brief and scalable intervention that could reduce the need for opioids and prevent misuse effectively, efficiently, and economically. Further, elucidation of the mechanisms of opioid use can facilitate refinement of more targeted future treatments.Trial registrationClinicalTrials.gov, ID: NCT03950791. Registered on 10 May 2019.

0476 Readiness and Stages of Change in a Behavioral Sleep Medicine Clinical Sample: From Pre-Contemplation to Struggling to Maintain Change

Abstract Introduction Stages of change in the transtheoretical model are used to assess a patient’s readiness to change, which may help providers tailor behavioral treatment (BT). As research has focused on substance abuse, there is a significant lack of data in individuals presenting for behavioral sleep medicine (BSM) treatment. Methods 146 consecutive patients (46.1±16.0 years, 61.6% female, 19.9% minority) who were evaluated at the BSM program of Penn State Hershey Sleep Research &amp; Treatment Center completed the University of Rhode Island Change Assessment Scale (URICA) assessing readiness to change (RtC) and pre-contemplation (P), contemplation (C), preparation/action (A) and struggling to maintain (M) stages of change. Subjects also completed the Insomnia Treatment Acceptability Scale (ITAS) and Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS). Results The average RtC score was 9.4, with 21.9% of the sample in stage P, 56.2% in C and 21.9% in A. The average P (53.2±7.6), C (49.1±10.1), A (48.8±12.3) and M (37.7±9.1) scores suggested an overall “contemplation cluster profile”. Higher RtC (r=0.37), C (r=0.31) and A (r=0.24) scores were associated with greater acceptability of BT, while higher P scores were associated with lower acceptability of BT (r=-0.22). In contrast, higher M scores were associated with greater acceptability of pharmacological treatment (r=0.21) as well as higher DBAS scores, including sleep medication expectations (r=0.23). Conclusion Patients attending a BSM program typically present at a contemplation stage, which indicates intention to start changing sleep behaviors within the next few months with some ambivalence in regards to pros/cons of such change. A significant proportion of patients struggle to maintain change and present with higher acceptability for pharmacological interventions, which may hinder the effectiveness of BT and may require specific therapeutic approaches. Support Department of Psychiatry, Penn State College of Medicine

Technological Hindrances of Behavioral Medicine Patient Access: A Literature Review

Technology is a pervasive tool utilized throughout inpatient and outpatient hospital care. Behavioral medicine has a plethora of technology to integrate and support medical infrastructure and processes. A systematic literature review was performed to classify the technological hinderances that specifically plague behavioral medicine. Researchers examined articles contained within the databases of CORE, Elsevier, PubMed, ResearchGate, and ScienceOpen and pulled all relevant articles. A total of 85 articles were collected after the removal of duplicates. Several themes have been identified in the systematic literature review that negatively affects behavioral medicine treatment at the provider, clinical staff, non-clinical staff, patient, and organizational levels. These themes are a lack of behavioral medicine patient resources, a surfeit of stigmas surrounding treatment, higher levels of comorbidities in these patients as compared to non-behavioral medicine specialties, and a reliance on outdated educational protocols for training staff. The themes significantly affect patients within the behavioral medicine specialty more than other subsectors of medicine due to the unique ailments that behavioral medicine encompasses. The future climate of behavioral medicine treatment could be affected by the aforementioned hinderances. However, evidence in the literature review displays positive findings when employee education and technological integration are combined. Further research should be directed towards the implementation of SBE into clinical and non-clinical behavioral medicine employee training.

Effects on obstructive sleep apnea severity following a tailored behavioral sleep medicine intervention aimed at increased physical activity and sound eating: an 18-month follow-up of a randomized controlled trial.

Positive effects have been reported following a behavioral sleep medicine (BSM) intervention targeting physical activity and eating behavior in addition to continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). Long-term follow-up remains to be explored. The aim was to examine the long-term effects of a tailored BSM intervention addressing physical activity and eating behavior in addition to CPAP treatment in patients with moderate to severe OSA combined with overweight and physical inactivity. Further, the aim was to identify variables at baseline, associated with treatment success regarding OSA severity. Sixty participants (body mass index: 34.5 ± 5.0 kg/m²; apnea-hypopnea index [AHI]: 43.7 ± 21.2 events/h) completed the randomized controlled trial with a follow-up at 18 months. The participants were randomized to either a control group treated with CPAP or an experimental group treated with CPAP and a BSM intervention targeting physical activity and eating behavior changes. OSA was categorized as mild (AHI: 5 to <14.9 events/h), moderate (AHI: 15 to <29.9 events/h), or severe (AHI ≥30 events/h). Being in the experimental group was associated with a larger improvement (B = -9.353, P = .029) in AHI at the 18-month follow-up compared with being in the control group when adjusting for baseline AHI and body mass index. Improvement in OSA category occurred more frequently in the experimental group participants (n = 11; 36.7%) compared with the control group (n = 2; 6.7%). Deterioration in OSA category was found in 1 (3.3%) participant in the experimental group and 3 (10%) in the control group. The importance of a BSM intervention as an adjunct treatment in patients with OSA is emphasized due to its long-term benefits. Registry: ClinicalTrials.gov; Name: Lifestyle changes in obstructive sleep apnea; Identifier: NCT01102920.

Technological Hindrances of Behavioral Medicine Patient Access: A Literature Review

Technology is a pervasive tool utilized throughout inpatient and outpatient hospital care. Behavioral medicine has a plethora of technology to integrate and support medical infrastructure and processes. A systematic literature review was performed to classify the technological hinderances that specifically plague behavioral medicine. Researchers examined articles contained within the databases of CORE, Elsevier, PubMed, ResearchGate, and ScienceOpen and pulled all relevant articles. A total of 85 articles were collected after the removal of duplicates. Several themes have been identified in the systematic literature review that negatively affects behavioral medicine treatment at the provider, clinical staff, non-clinical staff, patient, and organizational levels. These themes are a lack of behavioral medicine patient resources, a surfeit of stigmas surrounding treatment, higher levels of comorbidities in these patients as compared to non-behavioral medicine specialties, and a reliance on outdated educational protocols for training staff. The themes significantly affect patients within the behavioral medicine specialty more than other subsectors of medicine due to the unique ailments that behavioral medicine encompasses. The future climate of behavioral medicine treatment could be affected by the aforementioned hinderances. However, evidence in the literature review displays positive findings when employee education and technological integration are combined. Further research should be directed towards the implementation of SBE into clinical and non-clinical behavioral medicine employee training.