Cognitive-behavioral Strategies Research Articles

Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After a Traumatic Lower-Extremity Injury: The Results of a Randomized Controlled Trial.

Lower-extremity injuries can result in severe impairment and substantial years lived with a disability. Persistent pain and psychological distress are risk factors for poor long-term outcomes and negatively influence the recovery process following a traumatic injury. Cognitive-behavioral therapy (CBT) interventions have the potential to address these risk factors and subsequently improve outcomes. This study aimed to evaluate the effect of a telephone-delivered cognitive-behavioral-based physical therapy (CBPT) program on physical function, pain, and general health at 12 months after hospital discharge following lower-extremity trauma. The CBPT program was hypothesized to improve outcomes compared with an education program. A multicenter, randomized controlled trial was conducted involving 325 patients who were 18 to 60 years of age and had at least 1 acute orthopaedic injury to the lower extremity or to the pelvis or acetabulum requiring operative fixation. Patients were recruited from 6 Level-I trauma centers and were screened and randomized to the CBPT program or the education program early after hospital discharge. The primary outcome was the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) scale. The secondary outcomes were objective physical function tests (4-square step test, timed stair ascent test, sit-to-stand test, and self-selected walking speed test), PROMIS Pain Intensity and Pain Interference, and the Veterans RAND 12-Item Health Survey. Treatment effects were calculated using targeted maximum likelihood estimation, a robust analytical approach appropriate for causal inference with longitudinal data. The mean treatment effect on the 12-month baseline change in PROMIS PF was 0.94 (95% confidence interval, -0.68 to 2.64; p = 0.23). There were also no observed differences in secondary outcomes between the intervention group and the control group. The telephone-delivered CBPT did not appear to yield any benefits for patients with traumatic lower-extremity injuries in terms of physical function, pain intensity, pain interference, or general health. Improvements were observed in both groups, which questions the utility of telephone-delivered cognitive-behavioral strategies over educational programs. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Preparing Nursing Students to Manage Acculturative Stress Experienced During Study Abroad Experiences: Novel Use of Immersive Simulation and Cognitive Behavioral Strategies

Preparing Nursing Students to Manage Acculturative Stress Experienced During Study Abroad Experiences: Novel Use of Immersive Simulation and Cognitive Behavioral Strategies

Types of Medication Non-adherence & Approaches to Enhance Medication Adherence in Mental Health Disorders: A Narrative Review

Background: Medication non-adherence (MNA) presents a significant obstacle that negatively impacts treatment effectiveness in mental health disorders. The objective of this review is to study different types of MNA and interventions designed to enhance medication adherence among individuals with mental health disorders. Methods: We conducted an electronic search on PubMed and Google Scholar using keywords such as adherence, non-adherence, compliance, non-compliance, mental health disorders, psychotropic drugs, major depressive disorder (MDD), schizophrenia, anxiety disorders, and bipolar disorders (BD). From the search results, we selected studies pertinent to the objective of the review. Results: Non-adherence can be categorized into primary nonadherence (not starting medication) and secondary non-adherence (not taking the medication as directed). Generally, we can group the reasons for non-adherence into unintentional and intentional. Unintentional non-adherence (UNA) arises when patients genuinely desire to comply with their prescribed course of therapy but are hindered by factors beyond their control. When addressing UNA, interventions should simplify medication regimens, utilize long-acting injectable (LAIs) medications, offer tools to manage medication and provide follow-up reminders. When a patient deliberately decides not to follow their treatment plan, this is known as intentional non-adherence. To improve intentional non-adherence, the focus should be on patient-centred care and shared decision-making, psychoeducation, effective doctor-patient communication, cognitive-behavioral strategies, and addressing concerns related to the side effects of psychotropic drugs. Conclusion: It is crucial to understand that there is no universal solution to address non-adherence in mental health disorders. Each patient has distinct needs and characteristics, making personalized strategies and interventions of utmost significance.

Clinical effectiveness of the psychological therapy Mental Health Intervention for Children with Epilepsy in addition to usual care compared with assessment-enhanced usual care alone: a multicentre, randomised controlled clinical trial in the UK

Mental health difficulties are common in children and young people with chronic health conditions, but many of those in need do not access evidence-based psychological treatments. The study aim was to evaluate the clinical effectiveness of integrated mental health treatment for children and young people with epilepsy, a common chronic health condition known to be associated with a particularly high rate of co-occurring mental health difficulties. We conducted a parallel group, multicentre, open-label, randomised controlled trial of participants aged 3-18 years, attending epilepsy clinics across England and Northern Ireland who met diagnostic criteria for a common mental health disorder. Participants were randomised (1:1; using an independent web-based system) to receive the Mental Health Intervention for Children with Epilepsy (MICE) in addition to usual care, or assessment-enhanced usual care alone (control). Children and young people in both groups received a full diagnostic mental health assessment. MICE was a modular psychological intervention designed to treat common mental health conditions in children and young people using evidence-based approaches such as cognitive behaviour therapy and behavioural parenting strategies. Usual care for mental health disorders varied by site but typically included referral to appropriate services. Participants, along with their caregivers, and clinicians were not masked to treatment allocation but statisticians were masked until the point of analysis. The primary outcome, analysed by modified intention-to-treat, was the parent-report Strengths and Difficulties Questionnaire (SDQ) at 6 months post-randomisation. The study is complete and registered with ISRCTN (57823197). 1401 young people were potentially deemed eligible for study inclusion. Following the exclusion of 531 young people, 870 participants were assessed for eligibility and completed the SDQ, and 480 caregivers provided consent for study inclusion between May 20, 2019, and Jan 31, 2022. Between Aug 28, 2019, and Feb 21, 2022, 334 participants (mean ages 10·5 years [SD 3·6] in the MICE group vs 10·3 [4·0] in control group at baseline) were randomly assigned to an intervention using minimisation balanced by age, primary mental health disorder, diagnosis of intellectual disability, and autistic spectrum disorder at baseline. 168 (50%) of the participants were female and 166 (50%) were male. 166 participants were randomly assigned to the MICE group and 168 were randomly assigned to the control group. At 6 months, the mean SDQ difficulties for the 148 participants in the MICE group was 17·6 (SD 6·3) and 19·6 (6·1) for the 148 participants in the control group. The adjusted effect of MICE was -1·7 (95% CI -2·8 to -0·5; p=0·0040; Cohen's d, 0·3). 14 (8%) patients in the MICE group experienced at least one serious adverse event compared with 24 (14%) in the control group. 68% percent of serious adverse events (50 events) were admission due to seizures. MICE was superior to assessment-enhanced usual care in improving symptoms of emotional and behavioural difficulties in young people with epilepsy and common mental health disorders. The trial therefore shows that mental health comorbidities can be effectively and safely treated by a variety of clinicians, utilising an integrated intervention across ages and in the context of intellectual disability and autism. The evidence from this trial suggests that such a model should be fully embedded in epilepsy services and serves as a model for other chronic health conditions in young people. UK National Institute for Health Research Programme Grants for Applied Research programme and Epilepsy Research UK Endeavour Project Grant.

Social and non-social cognitive behavioural therapy strategies for depression: findings from the MoodMission smartphone application

ABSTRACT Objective Cognitive behavioural therapy (CBT) is an evidence-based treatment of depression that can include strategies with a social component. Mental health apps (MHapps) are widely used amongst individuals with depression to access CBT strategies. Despite the research on CBT, it is not clear whether there is a difference in the correlation of CBT strategies for depression with a social component or not. Using MoodMission, an empirically validated MHapp that recommends CBT strategies (termed “Missions”), this study investigated whether social or non-social CBT strategies would correlate with participants’ ratings of helpfulness and distress reduction. Method A total of 4,107 participants who completed at least one social or non-social Mission and baseline 9-item Patient Health Questionnaire (PHQ-9) were included. Multilevel modelling with 2-levels was used, with level 1 entered as the fixed effect between Mission type in predicting subjective helpfulness and distress reduction, and level 2 entered as the random effects of participant covariates of age, gender, and PHQ-9 scores. Results Findings indicated that Missions without a social component was a significant positive predictor in distress reduction, but there was no significant difference in predicting subjective helpfulness. Conclusion These findings suggest that individuals with depression using MHapps could benefit from engaging in non-social CBT strategies for the reduction of subjective distress, more so than social CBT strategies. Study limitations included the self-report study design, subjective outcome measures, and a higher representation of female (80.6%) participants. Further research is required to investigate the clinical significance of these findings with a more representative sample.

Investigating age-related COVID-19 digital health literacy and sense of coherence among adolescents and young adults in schools across Northern Ghana

IntroductionThe empirical link between digital health literacy (DHL) and sense of coherence (SoC) has been extensively discussed in the literature. Yet, there seems to be limited evidence regarding the roles of age and depression status in the link between DHL and SoC of adolescents and young adults (AYAs), especially during the COVID-19 crises. This study investigated the interplay between age, DHL, SoC and psychological distress. Particularly, the study examined the following: (1) relationship between DHL and SoC, (2) moderating role of age in the relationship between DHL and SoC as well as (3) moderating role of depression in the relationship between DHL and SoC.MethodsThe study used a cross-sectional survey to select 998 AYAs in secondary schools in Northern Ghana through questionnaire administration using a stratified sampling procedure.ResultsFindings reveal that age was positively and significantly related to DHL and SoC. However, age failed to moderate the relationship between DHL and SoC. With the same level of DHL, students who exhibited depressive symptoms compared to those without, had lower levels of SoC regardless of their age.ConclusionsAlthough AYAs’ DHL are likely to differ across different age brackets, this gap does not affect their rates of SoC and depression. Nonetheless, there is a need to improve DHL through regular standard training on internet search using basic audio-visual materials like laptops, smart phones, tablets, and lab computers for adolescent and young adult students. Additionally, school authorities, in collaboration with other stakeholders should develop student-centred cognitive-behavioural strategies aimed at reducing depressive symptoms in secondary school students who are at risk of depression in Northern Ghana.

Digital Health Psychosocial Intervention in Adult Patients With Cancer and Their Families: Systematic Review and Meta-Analysis.

Patients with cancer and their families often experience significant distress and deterioration in their quality of life. Psychosocial interventions were used to address patients' and families' psychosocial needs. Digital technology is increasingly being used to deliver psychosocial interventions to patients with cancer and their families. A systematic review and meta-analysis were conducted to review the characteristics and effectiveness of digital health interventions on psychosocial outcomes in adult patients with cancer and their family members. Databases (PubMed, Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, ProQuest Dissertations and Theses Global, and ClinicalTrials.gov) were searched for randomized controlled trials (RCTs) or quasi-experimental studies that tested the effects of a digital intervention on psychosocial outcomes. The Joanna Briggs Institute's critical appraisal checklists for RCTs and quasi-experimental studies were used to assess quality. Standardized mean differences (ie, Hedges g) were calculated to compare intervention effectiveness. Subgroup analysis was planned to examine the effect of delivery mode, duration of the intervention, type of control, and dosage on outcomes using a random-effects modeling approach. A total of 65 studies involving 10,361 patients (mean 159, SD 166; range 9-803 patients per study) and 1045 caregivers or partners (mean 16, SD 54; range 9-244 caregivers or partners per study) were included in the systematic review. Of these, 32 studies were included in a meta-analysis of the effects of digital health interventions on quality of life, anxiety, depression, distress, and self-efficacy. Overall, the RCT studies' general quality was mixed (applicable scores: mean 0.61, SD 0.12; range 0.38-0.91). Quasi-experimental studies were generally of moderate to high quality (applicable scores: mean 0.75, SD 0.08; range 0.63-0.89). Psychoeducation and cognitive-behavioral strategies were commonly used. More than half (n=38, 59%) did not identify a conceptual or theoretical framework. Most interventions were delivered through the internet (n=40, 62%). The median number of intervention sessions was 6 (range 1-56). The frequency of the intervention was highly variable, with self-paced (n=26, 40%) being the most common. The median duration was 8 weeks. The meta-analysis results showed that digital psychosocial interventions were effective in improving patients' quality of life with a small effect size (Hedges g=0.05, 95% CI -0.01 to 0.10; I2=42.7%; P=.01). The interventions effectively reduced anxiety and depression symptoms in patients, as shown by moderate effect sizes on Hospital Anxiety and Depression Scale total scores (Hedges g=-0.72, 95% CI -1.89 to 0.46; I2=97.6%; P<.001). This study demonstrated the effectiveness of digital health interventions on quality of life, anxiety, and depression in patients. Future research with a clear description of the methodology to enhance the ability to perform meta-analysis is needed. Moreover, this study provides preliminary evidence to support the integration of existing digital health psychosocial interventions in clinical practice. PROSPERO CRD42020189698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189698.

Communicating the experience of living with chronic pain: The role of non-verbal communication and the power of lessons learned

Background: Chronic pain is hard to communicate due to its invisible, inaudible, and imprecise nature. Outside of pain scales that try to quantify pain, individuals with chronic pain have a hard time expressing it, yet pain management relies on effective communication. This study explores how women with chronic pain enrolled in an online therapeutic writing workshop communicate the experience of living with chronic pain to fellow sufferers. Methods: A six-week online therapeutic writing workshop was conducted with individuals with chronic pain who responded to weekly creative writing prompts that focused on mindfulness and cognitive behavioral therapy strategies including attention, emotional regulation, and examining thoughts and attitudes. Participants were recruited by their primary care provider; seven participants enrolled. All posts were aggregated and analyzed using thematic analysis. Results: Data analysis from participants’ posts reveal two interpretive repertoires including physical evidence of pain where participants expressed visible impacts of pain occurring in their home environments and communicated non-verbally in gestures and behaviors. Secondly, the theme of lessons learned from living with pain emerged including enhanced empathy, the need for self-care, and sharing coping skills. Conclusion: This study extends our understanding of the experience of living with chronic pain outside of a medical context by providing new insights gained from their creative writing responses. The online therapeutic writing workshop fostered a community of support where participants were empowered to express their pain, identify their pain behaviors, and invite cognitive restructuring to learn from their pain.

Development and Implementation of an Anxiety Management Intervention for Young Children

ABSTRACT Children are facing increasing levels of anxiety in the classroom. Learning anxiety management strategies may prevent worry from interfering in the classroom, thereby improving emotional well-being. We used qualitative analysis of teacher interviews (N = 21) to evaluate an intervention designed to teach children cognitive-behavioral strategies to reduce anxiety. During interviews, teachers discussed their perceptions of child anxiety and whether they thought parents would use the two worry management books (for first through third graders). Results of qualitative analyses indicated teachers thought the books were effective, and they would use the strategies. Teachers indicated children were facing significant worries, such as financial security. Teachers reported using breathing strategies with children. They mentioned that using imagery, with a superhero to fight worries, was a new strategy they could use. Teachers favored implementing strategies they were familiar with, like breathing. They also preferred strategies that were consistent with their curriculum. Teachers thought that parents would need training to use the books with their children. In summary, teachers viewed the intervention as an effective tool for addressing anxiety for young children. Future studies should include information about child and parent perceptions of the intervention and assessment of dissemination of the intervention.

The Effectiveness of Cognitive Behavioral Therapy on Depression and Sleep Problems for Climacteric Women: A Systematic Review and Meta-Analysis.

(1) Background: Women in their middle years undergoing perimenopause encounter a range of physical and psychological alterations attributed to hormonal changes. The prominent symptoms among menopausal women are depressive symptoms and sleep-related problems. The aim of this study was to conduct a meta-analysis examining the effects of Cognitive Behavioral Therapy (CBT) on women going through menopause, specifically focusing on depressive symptoms and sleep problems. We analyzed studies conducted both within the country and across international settings over the last decade. (2) Methods: A search of the literature was conducted-a targeted search, exclusively considering randomized controlled trials (RCTs) that were published within the timeframe spanning from 15 June 2013 to 15 June 2023. (3) Findings: Upon reviewing nine studies that satisfied our inclusion criteria and involved a total of 923 participants, it was noted that four of these studies incorporated diverse cognitive-behavioral strategies. Among the nine studies, a total of four were included in the meta-analysis: two measured depressive symptoms, and two measured sleep quality. The combined effect size for depressive symptoms was found to be 3.55 (95% confidence interval: -5.48, -1.61; p < 0.05), and for sleep quality, it was 0.78 (95% confidence interval: -1.32, -0.25; p = 0.004). (4) Conclusions: Our review emphasizes the necessity for conducting larger-scale studies focused on the application of CBT for women experiencing menopausal symptoms. Additionally, it is recommended to approach the interpretation of these results with caution due to discrepancies in methodology and the overall quality of the studies. Further clinical trials are necessary to establish the ideal number of CBT sessions needed for the effective treatment of depression in menopausal women. Future studies should cover a wider range of geographical locations, including more countries, and focus on various outcomes such as depressive symptoms and sleep quality.

Psychological Challenges Experienced by EFL Students in Learning English

This study aimed to look into the psychological challenges EFL students faced while learning English and the strategies they used. This research was conducted using a quantitative descriptive research design with a questionnaire as the instrument. The respondents of this research were 75 students from one of the public junior high schools in Kota Jambi. The data obtained were analyzed using statistics and descriptive methods. Students face three psychological challenges: self-belief, motivation, and Anxiety. For the learning strategy, there were eight indicators of the learning strategy that students used in learning English; 6 of them were the learning strategy that they used, such as cognitive strategies (underlining and memorizing) and behavioral strategies (test-taking, help-seeking, homework management, and note-taking skills).&#x0D;

Reduction in Feeding Problems and Impact on Family Following a 12-Week Interdisciplinary Group Feeding Intervention for Children With Feeding Problems and Their Caregivers

Caregivers and their children with clinical levels of feeding problems participated in Picnic Group, an outpatient interdisciplinary family group treatment program for children with feeding disorders and their caregivers at a large regional pediatric hospital. The manualized treatment is based on an interdisciplinary systematic approach that draws from sensory integration, communication, and cognitive behavioral strategies (e.g., classical conditioning, systematic desensitization, communication of automatic thoughts) to increase pleasurable interactions with food over a 12-week period and includes caregiver and child intervention components. Escape extinction techniques such as nonremoval of the spoon were not used in treatment. Caregivers completed measures focused on their children’s feeding behaviors and family strain at baseline and at the end of the 12-week intervention. Wilcoxon signed-rank tests compared measures between baseline and the end of treatment. Results indicated that at the 12th week, caregivers generally reported one less feeding problem, fewer specific types of eating and mealtime problematic behaviors, and decreased impact of feeding problems on the family. Children were able to work up a hierarchy of food interactions with more foods per group session than at the first session. Caregivers of children with a developmental diagnosis showed the most decrease in caregiver strain. Outpatient interdisciplinary group treatment can decrease feeding problems and caregiver strain in families with children with feeding disorders.

Understanding School Anxiety in Italian Adolescence through an Artificial Neural Network: Influence of Social Skills and Coping Strategies.

School anxiety depends on multiple factors that occur directly or indirectly in the teaching-learning process, such as going to the blackboard in class or reporting low grades at home. Other factors that influence school climate are social skills and coping strategies. That said, the aim of this research was to analyze the sources of school anxiety, coping strategies, and social skills in Italian secondary school students through an artificial neural network. For this purpose, a quantitative and ex post facto design was used in which the Inventory of School Anxiety (IAES), the Coping Scale for Children (EAN), and the Questionnaire for the Evaluation of Social Skills student version (EHS-A) were administered. The results showed that cognitive avoidance and behavioral avoidance coping strategies, together with the lack of social skills in students, are the variables that contributed the most to school anxiety scores in the artificial neural network. The conclusions revolve around the need to develop primary prevention programs.

Cognitive - Behavioural Coping Strategies as Predictor of Suicide Risk Severity

Background and aim: Cognitive behavioural coping strategies are closely correlated with depression and suicide risk. The aim of this study is to explore the particular features of cognitive-behavioural coping strategies and their impact on depression levels and suicidal ideation. Methods: The study included a total of 131 participants, of whom 65 had a clinical diagnosis of depression and 66 were controls. Psychometric tools were administered to both groups: Montgomery-Asberg Depression Scale (MADRS), Depression Anxiety Stress Scale (DASS21R), Strategic approach to coping scale (SACS), Columbia Suicide Severity Rating Scale (C-SSRS), in order to assess the differences between depressive and non-depressive individuals in relation to cognitive behavioural coping strategies. Results and conclusion: Results based on statistical analysis of scores obtained on various psychometric scales showed significant differences between depressed and non-depressed patients. Also, cognitive-behavioural strategies could represent predictors that can be used in the prevention of suicide risk.

An internet-based behavioral intervention for adults with autism spectrum disorder – A randomized controlled trial and feasibility study

BackgroundThe increased prevalence of Autism Spectrum Disorder (ASD) diagnoses in combination with psychiatric comorbidity, has led to an increased need for effective interventions. The evidence for internet-based interventions for several mental health problems is established but has not been evaluated for adults with ASD. ObjectiveThe aim of this randomized controlled trial is to evaluate the feasibility and effects of an internet-based intervention targeting quality of life and psychiatric symptoms (depression and anxiety) in adults with ASD. Methods84 participants were randomly allocated to intervention (n = 42) or control (n = 42). The 18-week internet-based intervention covered a range of themes related to difficulties common in ASD, and exercises based on cognitive behavioral strategies. Participants were provided with individual feedback following each module and were invited to regular chat sessions with peer participants. The primary outcomes were subjective quality of life and sense of coherence, and secondary outcomes were symptoms of depression and anxiety. All outcomes were measured at five occasions and analysed with linear mixed effect models. Participant satisfaction and adherence was also analysed. ResultsParticipant satisfaction and adherence was satisfactory but no significant interaction between group and time was found for any outcome measure. Autistic traits were negatively related to quality of life and sense of coherence and positively related to anxiety and depressive symptoms. ConclusionsThis internet-based intervention showed feasibility regarding adherence and participant satisfaction. However, no significant effects on quality of life, sense of coherence or psychiatric symptoms were found, likely due to limitations in the design and methodology of this specific trial in combination to the heterogeneity of the group. Individuals with ASD may require interventions that are flexible and individually tailored in regard to both format, content and therapeutic support. The current trial provides useful information and suggestions for the future research on internet-based interventions for ASD.

Stepped collaborative care for pain and posttraumatic stress disorder after major trauma: a randomized controlled feasibility trial

Purpose To examine feasibility and acceptability of providing stepped collaborative care case management targeting posttraumatic stress disorder (PTSD) and pain symptoms after major traumatic injury. Materials and methods Participants were major trauma survivors in Victoria, Australia, at risk of persistent pain or PTSD with high baseline symptoms. Participants were block-randomized, stratified by compensation-status, to the usual care (n = 15) or intervention (n = 17) group (46% of eligible patients). The intervention was adapted from existing stepped collaborative care interventions with input from interdisciplinary experts and people with lived experience in trauma and disability. The proactive case management intervention targeted PTSD and pain management for 6-months using motivational interviewing, cognitive behavioral therapy strategies, and collaborative care. Qualitative interviews explored intervention acceptability. Results Intervention participants received a median of 7 h case manager contact and reported that they valued the supportive and non-judgmental listening, and timely access to effective strategies, resources, and treatments post-injury from the case manager. Participants reported few disadvantages from participation, and positive impacts on symptoms and recovery outcomes consistent with the reduction in PTSD and pain symptoms measured at 1-, 3- and 6-months. Conclusions Stepped collaborative care was low-cost, feasible, and acceptable to people at risk of PTSD or pain after major trauma. IMPLICATIONS FOR REHABILITATION After hospitalization for injury, people can experience difficulty accessing timely support to manage posttraumatic stress, pain and other concerns. Stepped case management-based interventions that provide individualized support and collaborative care have reduced posttraumatic stress symptom severity for patients admitted to American trauma centers. We showed that this model of care could be adapted to target pain and mental health in the trauma system in Victoria, Australia. The intervention was low cost, acceptable and highly valued by most participants who perceived that it helped them use strategies to better manage post-traumatic symptoms, and to access clinicians and treatments relevant to their needs.

Effective pain management strategies for common pediatric conditions

Pain management in neonates, infants, and children is a complex and challenging aspect of healthcare, with a high prevalence of undertreatment. Efforts have been made to improve pain assessment and implement effective interventions. Pharmacological approaches include non-opioid analgesics, opioids, and adjuvant analgesics, while non-pharmacological interventions involve physical techniques and cognitive behavioral strategies. Pediatric pain management requires considering developmental stages, individual variability, and emotional factors. Accurate pain assessment, weight-based dosing, and involving parents are crucial. Minimizing procedural pain and addressing psychosocial aspects contribute to better outcomes. Comprehensive pain management is necessary to prevent long-term consequences and enhance recovery. However, there is a persistent gap between evidence-based guidelines and clinical practice, indicating the need for further education and training. Implementation of pain management protocols and multidisciplinary approaches involving healthcare providers, psychologists, physical therapists, and educators are essential. By adopting these strategies, healthcare providers can improve the quality of life for pediatric patients, reduce the burden on the healthcare system, and mitigate the long-term impact of untreated pain.

Multi-disciplinary community-based group intervention for fibromyalgia: a pilot randomized controlled trial.

Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances, mood disturbances, and cognitive impairment. Most individuals with fibromyalgia experience poorly managed symptoms and increased healthcare service use. Multicomponent therapies, with a focus on nonpharmacological modalities, are increasingly supported in the literature. However, given the limited resources available, implementation in smaller communities remains a challenge. This research tested a community-based multidisciplinary group intervention for individuals diagnosed with FM living in a small urban centre. The primary outcome was perceptions of quality of care and secondary outcomes included disease-related functioning, anxious and depressive symptoms, pain beliefs, and health service utilization. A pilot randomized control trial was conducted in which 60 patients diagnosed with fibromyalgia were randomized into a 10-week community-based multidisciplinary group intervention program or usual care. Treatment components included twice-weekly exercise sessions and weekly education sessions (e.g., pain education, cognitive behavioral strategies for stress, nutrition, peer support). The trial (NCT03270449) was registered September 1 2017. Statistically significant post-intervention improvements were found in the primary outcome, perceived quality of care (Cohen's d = 0.61, 0.66 for follow up care and goal setting, respectively). Secondary outcomes showing statistically significant improvements were disease-related daily functioning (Cohen's d = 0.70), depressive symptoms (Cohen's d = 0.87), and pain beliefs (Cohen's d = 0.61, 0.67, 0.82 for harm, disability and control, respectively). No adverse events were reported. Community-based multidisciplinary group interventions for fibromyalgia show promise for improving satisfaction with quality of care, disease-related functioning, and depression, and fostering more adaptive pain beliefs.

0149 Emotion Dysregulation and Sleep Disturbances in Trauma-Exposed College Students

Abstract Introduction Trauma-exposed individuals are at risk of developing symptoms of posttraumatic stress disorder (PTSD), which has been linked to both sleep disturbances and sleep-related daytime impairment. A growing body of literature suggests affective processes, such as negative and positive emotion regulation, may influence associations between PTSD and sleep. Therefore, our study aimed to examine if there was a direct effect of negative and positive emotion dysregulation on sleep disturbances and sleep-related impairment above the influence of PTSD symptoms. Methods Participants were 460 trauma-exposed college students (69.8% female; 62.0% White; Mage = 20.13 ± 2.94) recruited from the University of North Texas. Trauma exposure was assessed with the Life Events Checklist for DSM-5. Participants completed demographic questionnaires, the PTSD Checklist for DSM-5 (excluding sleep-related questions), the Difficulties in Emotion Regulation Scale (DERS-16), the Difficulties in Emotion Regulation – Positive (DERS-P), the PROMIS Sleep Disturbance (PROMIS-SD), and Sleep-Related Impairment (PROMIS-SRI) Short Forms. Multiple regression models with robust standard errors were conducted to examine associations between both positive and negative emotion dysregulation on sleep disturbances and sleep-related impairment, covarying for PTSD symptoms, age, gender, race, and ethnicity. Results Greater negative emotion dysregulation was associated with greater sleep disturbances (b = 0.06, SE = 0.03, p = .015, ηp2 = 0.01) above the influence of positive emotion dysregulation, PTSD symptoms, age, gender, race, and ethnicity (R2 = 0.28). Greater negative emotion dysregulation was also associated with greater sleep-related impairments (b = 0.20, SE = 0.03, p &amp;lt; .001, ηp2 = 0.08) above the influence of the same covariates (R2 = 0.31). Positive emotion dysregulation was not associated with sleep disturbances or sleep-related impairments. Conclusion Results suggest that more difficulty regulating negative emotions is linked to disturbed sleep among trauma-exposed individuals. Additional experimental work is needed to understand if regulating negative emotions via cognitive-behavioral strategies (e.g., mindfulness, cognitive restructuring) can lead to downstream improvements in sleep. Support (if any)

Latent profiles of cannabis use, protective behavioral strategies, and health beliefs in college students

College student cannabis use is prevalent and heterogeneous, with some students experiencing cannabis-related problems. Cannabis protective behavioral strategies (PBS) are cognitive-behavioral strategies associated with reduced cannabis use and problems. There is a need for theory-informed and person-centered research to better understand cannabis PBS. The current study applied the health belief model (HBM) and latent profile analysis to discern patterns of cannabis use, PBS, and health beliefs among college students. Students (n = 164; Mage = 18.8; 53% female) who endorsed past-month cannabis use completed an online survey between September and November 2017. The 3-profile model best fit the data. Profile 1 (24.3%) represents the “infrequent use/high protection” profile characterized by using cannabis about 1–9 times, high PBS use, high perceived threat and benefits, and moderate perceived barriers. Profile 2 (38.1%) represents the “occasional use/moderate protection” profile characterized by using cannabis about 20–59 times, moderate PBS use, moderate perceived threat and benefits, and low perceived barriers. Profile 3 (37.6%) represents the “frequent use/low protection” profile characterized by using cannabis about 80 or more times, low PBS use, low perceived threat and benefits, and high perceived barriers. Profiles did not differ by age, ethnicity/race, sex, or college year, though varied significantly by age at first cannabis use, cannabis availability, cannabis problems, use frequency, and use context. Results provide preliminary support for distinct patterns of cannabis use, PBS, and health beliefs that align with the HBM. Results highlight the importance of considering how students perceive cannabis PBS and problems and how those beliefs may influence their PBS and cannabis use.