Biobehavioral Treatments Research Articles

Heart rate variability may index emotion dysregulation in alcohol-related intimate partner violence.

Intimate partner violence is a serious public health problem that costs the United States more than $4.1 billion in direct medical and mental health costs alone. Furthermore, alcohol use contributes to more frequent and more severe intimate partner violence incidents. Compounding this problem is treatments for intimate partner violence have largely been socially informed and demonstrate poor efficacy. We argue that improvements in intimate partner treatment will be gained through systematic scientific study of mechanisms through which alcohol is related to intimate partner violence. We hypothesize that poor emotional and behavioral regulation as indexed by the respiratory sinus arrythymia measure of heart rate variability is a key mechanism between alcohol use and intimate partner violence. The present study is a placebo-controlled alcohol administration study with an emotion-regulation task that investigated heart rate variability in distressed violent and distressed nonviolent partners. We found a main effect for alcohol on heart rate variability. We also found a four-way interaction whereby distressed violent partners exhibited significant reductions in heart rate variability when acutely intoxicated and attempting to not respond to their partners evocative stimuli. These findings suggest that distressed violent partners may adopt maladaptive emotion regulation strategies such as rumination and suppression when intoxicated and attempting to not respond to partner conflict. Such strategies of emotion regulation have been shown to have many deleterious emotional, cognitive and social consequences for individuals who adopt them, possibly including intimate partner violence. These findings also highlight an important novel treatment target for intimate partner violence and suggest that novel treatments should focus on teaching effective conflict resolution and emotion-regulation strategies that may be augmented by biobehavioral treatments such as heart rate variability biofeedback.

55.2 CBT: BIOBEHAVIORAL TOOLS FOR PEDIATRIC PAIN MANAGEMENT DURING COVID-19

The goal of this session is to outline evidence and tools for a psychologically informed approach to treating pediatric pain during COVID-19. This presentation will highlight recent research on biobehavioral treatments like CBT and offer resources for healthcare professionals working with youth living with pain—particularly critical given that youth are cut off from social support networks, treatment teams, and typical coping strategies during this pandemic. In this session, a pediatric pain psychologist with expertise in biobehavioral treatments will review evidence for youth-centric behavioral interventions that can be used in inpatient and outpatient settings both virtually and in person. We will discuss the biopsychosocial model of pain and health, pain neuroscience, fundamentals of CBT for pediatric chronic pain, and how healthcare providers can best support children in pain during COVID-19. Recent research indicates that youth living with chronic health conditions are at high risk of negative mental and physical health consequences during COVID-19. CBT and other biobehavioral approaches have evidence of effectiveness, can be useful tools for pain management, and can be accessed virtually while families continue to shelter in place. Decades of research confirm that effective pain treatment requires a biopsychosocial approach targeting maladaptive coping behaviors, cognitive processes, emotions, unhealthy family systems, socioeconomic factors, and lifestyle issues like sleep and nutrition. However, pediatric pain continues to be treated primarily—and often exclusively—biomedically, with pills and procedures. Pediatric pain is therefore not being adequately or appropriately managed. This is a particularly difficult time for children living with pain: COVID-19 has cut youth off from peers, social support networks, treatment teams, hobbies, and normal coping mechanisms. CBT has evidence of effectiveness for treating pediatric pain and can be utilized both virtually and in person. It targets brain and body, psychology, and physiology, to change the chronic pain cycle. There are various affordable biopsychosocial resources and tools rooted in science and research that healthcare providers can offer pediatric patients and families.

Assessment and Treatment of the Burden of Migraine

Migraine can take a significant toll on many aspects of sufferers' lives, including occupational, academic, social, and personal functioning. Individuals with migraine experience substantial pain and disability during migraine headaches (the ictal period), and many experience functional impairment and emotional consequences between attacks (the interictal period). The majority of migraine sufferers spend most of their lives in this interictal period; therefore, it is of great importance. Treatment planning must take into account both the ictal and interictal burden. Several tools have been developed to measure the burden of migraine and to assist health care professionals in making management decisions. The Migraine Disability Assessment Scale focuses exclusively on ictal burden. The Migraine Interictal Burden Scale complements the Migraine Disability Assessment Scale by measuring interictal burden. The Migraine Prevention Questionnaire was developed based on clinical guidelines to identify patients who are appropriate candidates for preventive pharmacotherapy for migraine. This article presents 4 cases selected to exemplify the ictal and interictal burden of migraine and the benefits of effective treatment. For each patient, individualized treatment strategies were developed using acute and preventive pharmacotherapy, as well as biobehavioral treatments. Migraine preventive medication and/or biobehavioral intervention may substantially improve patient health-related quality of life by reducing the frequency of migraines and the emotional and lifestyle burden produced by interictal anxiety.

Pediatric headache

Headaches occur frequently in the pediatric population and have a significant impact on both the patient and their family. Migraine, the most common headache disorder for which patients see a physician, still remains underdiagnosed and undertreated. Recent studies have revealed the increasing incidence of migraine and chronic migraine in the pediatric population. Limitations of the present diagnostic criteria for migraine are presented, and the proposed modifications to these criteria may assist you with early recognition and ultimate treatment. New acute and preventive migraine treatment data demonstrating statistically significant benefit for the primary endpoints will be reviewed in detail. The clinically relevant impact of migraine on the pediatric patient documented by the use of the Pediatric Migraine Disability Assessment and the Pediatric Quality of Life Inventory will be discussed. A comprehensive management approach blending the most current acute, preventive, and biobehavioral treatments will be reviewed. Further research, with novel study designs, in pediatric headaches is needed to help reveal additional pathophysiological mechanisms, improve diagnostic criteria, and advance optimal treatment. Prospective studies are needed to fully evaluate the efficacy of preventive management in this population and to establish whether early intervention might slow this disease progression.

Integrating Cognitive Neuroscience Research and Cognitive Behavioral Treatment with Neurofeedback Therapy in Drug Addiction Comorbid with Posttraumatic Stress Disorder: A Conceptual Review

ABSTRACT Persons with co-occurring mental and substance use disorders have a more persistent and refractory illness course than those without dual diagnosis. However, few studies have assessed the effects of cognitive-behavioral and biobehavioral treatments on brain function and behavioral indices in people with comorbid drug abuse and posttraumatic stress disorder (PTSD). In this conceptual review, we propose an integrated approach to assessment and treatment utilizing cognitive neuroscience methods, conventional psychotherapeutic treatment and neurofeedback therapy to assess the recovery of cognitive and emotional functions affected by chronic psychostimulant drug abuse co-occurring with PTSD. We review cognitive and motivational factors (e.g., craving, hypersensitivity to drug- and threat-related cues, deficient executive top-down control etc.) involved in addiction and PTSD, and discuss reasons for their persistence and high vulnerability to relapse in cocaine and methamphetamine users with co-morbid ...

Biobehavioral Treatment, Disability, and Psychological Effects of Pediatric Headache

Headache is a common condition among children and adolescents, and it can result in considerable pain, distress, and functional disability. Lacking proper care, many children will continue to experience headaches into adulthood. These considerations point to the importance of prompt, effective, and early intervention for pediatric headache. Biobehavioral treatments are central to such intervention. From promotion of adherence to optimal use of abortive and prophylactic medications to health behaviors that reduce headache activity to biofeedback-assisted relaxation training, the addition of biobehavioral treatment components to a comprehensive pediatric headache care plan can lead to better initial clinical outcomes, may lessen the need for medication, and may help maintain effects over the long term. Attention to the effects of headache and the accompanying psychological distress is an equally important part of treatment. Indeed, outcomes should be measured in terms of pain parameters (headache frequency, duration, severity) and effect on functional disability and quality of life (school absences, mood, satisfaction with pain relief). Optimal care for children and adolescents with headache can be realized with collaboration among primary care practitioners and headache specialists such as child neurologists and pediatric behavioral medicine experts. Biobehavioral treatment is a foundation for provision of such care.

Biobehavioral Factors in Chemotherapy-Induced Nausea and Vomiting

Although emesis can be considered a reflex to clear toxins from the body and involves mostly lower brain structures, nausea's purpose appears to be a warning signal to the individual to not engage in behaviors that he or she was doing at the time. As such, it involves the functioning of cognition and memory from higher developed neural structures. Given this, it should not be surprising that biobehavioral factors are important in predicting and controlling nausea. This article reviews the individual characteristics that are clinically useful in predicting which patients will have an increased probability of experiencing nausea or emesis during chemotherapy treatment, and also briefly review psychologic and biobehavioral treatments that can be useful in managing chemotherapy-related nausea.

Operational criteria and factors related to recovery from schizophrenia

Schizophrenia is often conceptualized by clinicians and researchers alike as a chronic illness with persisting, relapsing or deteriorating symptoms, and no hope for sustained remission and recovery of functioning. Countering this perspective, retrospective and prospective studies with both chronic and recent onset patients suggest that schizophrenia has a heterogeneous course, which can be favorably influenced by comprehensive and continuous treatment as well as personal factors such as family support and good neurocognitive functioning. The factors influencing recovery are mostly malleable through treatment and may often lead to a sustained remission of symptoms and normal or near-normal levels of functioning.To facilitate future research in this area, an operational definition of recovery from schizophrenia is proposed that includes symptom remission; full- or part-time involvement in work or school; independent living without supervision by family or surrogate caregivers; not fully dependent on financial support from disability insurance; and having friends with whom activities are shared on a regular basis. To satisfy the definition of recovery from the long-term illness of schizophrenia, each of the above criteria should be sustained for at least two consecutive years. For validation, these criteria were submitted to focus groups comprising clients, family members, practitioners, and researchers. Using this operational definition, a pilot study was conducted to identify the self-attributions, clinical characteristics and neurocognitive correlates of 23 individuals who have recovered from schizophrenia. The focus groups endorsed most of the criteria as being relevant to the construct of recovery, although there were differences between research investigators and others. The pilot study generated hypotheses for future testing, suggesting that quality of sustained treatment, near-normal neurocognition, and absence of the deficit syndrome were key factors associated with recovery. With operational definitions and variables identified as possible facilitators of recovery, both hypothesis-generating and testing research can proceed with the aim to identify factors that are malleable and can become targets for therapeutic intervention. There are many extant, evidence-based biobehavioral treatments, as well as mental health service systems for their delivery, that could form the basis for rapid progress in promoting recovery. However, obstacles would have to be overcome to the dissemination, re-invention and utilization of empirically validated treatments, while rigorous, controlled research on determinants of recovery are simultaneously begun.

Behavioral and educational modalities

General agreement has emerged in the scientific literature that behavioral and educational modalities are useful and effective in the management of chronic pain conditions. Behavioral and educational treatment modalities constitute a component of virtually every established chronic pain treatment program. It has been demonstrated that management of temporomandibular disorders has benefited from such behavioral interventions as well. The label “biobehavioral” refers to proven, safe methods that emphasize self-management and acquisition of self-control over not only pain symptoms but also their cognitive attributions or meanings and maintaining a productive level of psychosocial function, even if pain is not totally absent. A large collection of treatment modalities is subsumed under the label of biobehavioral treatments; the most commonly studied of these include biofeedback, stress management, relaxation, hypnosis, and education. An NIH Technology and Assessment Conference held in 1995 comprises the best available summary of the state of the art concerning the suitability of biobehavioral methods as useful approaches to ameliorate chronic pain, including TMD. Educational methods have also been demonstrated to be efficacious in the self-management of headache and back pain, but only limited data are available for TMD. By and large, when biobehavioral treatments are used in the management of TMD, effects are virtually always positive and in the hypothesized beneficial direction. While effects are often moderate in size, these methods show the potential for producing long-lasting benefits when compared with usual clinical treatment for TMD. Research has as yet failed to establish one biobehavioral modality as superior to another. It is important to note that much the same situation is present with regard to the scientifically established validity of many biomedically based TMD treatments.

Nonpharmacologic treatment of hypertension: does it work?

Abundant clinical and epidemiological data suggest that hypertension, or high blood pressure is a disease of high prevalence in industrialized societies, with cardiovascular morbidity and mortality directly related to the level of blood pressure. Although efficacious pharmacologic approaches to the control of high blood pressure are available, concern about risk versus benefit in the use of antihypertensive drug therapy for patients with mild hypertension has led to renewed interest in nonpharmacologic interventions. In the U.S.A. the National High Blood Pressure Education Program, an organization comprised of research scientists and a variety of other professionals concerned with the control of high blood pressure, has through a consensus process, recommended some nonpharmacologic approaches to the treatment of hypertension. The pros and cons of nutritional interventions, exercise and biobehavioral treatments are discussed. Nonpharmacologic recommendations in the treatment of hypertension for which there appear to be sufficient requisite data include weight reduction for the obese, moderate sodium restriction (although this is controversial) and restriction of alcohol consumption to less than 57 g of ethanol daily.