Cognitive Behavioral Rehabilitation Research Articles

Cognitive-behavioral rehabilitation in patients with cardiovascular diseases: a randomized controlled trial (CBR-CARDIO, DRKS00029295)

BackgroundDepression, generalized and cardiac anxiety, and posttraumatic stress disorder negatively affect disease severity, participation, and mortality in patients with cardiovascular disease. Psychological treatments within cardiac rehabilitation may improve the outcomes of these patients. We therefore developed a cognitive-behavioral rehabilitation program for patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion. In Germany, similar programs are well established in musculoskeletal rehabilitation and cancer rehabilitation. However, no randomized controlled trials have evaluated if such programs achieve better outcomes in patients with cardiovascular disease compared with standard cardiac rehabilitation.MethodsOur randomized controlled trial compares cognitive-behavioral cardiac rehabilitation with standard cardiac rehabilitation. The cognitive-behavioral program complements standard cardiac rehabilitation with additional psychological and exercise interventions. Both rehabilitation programs last for four weeks. We enroll 410 patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion aged 18 to 65 years. Half of the individuals are randomly assigned to cognitive-behavioral rehabilitation and the other half to standard cardiac rehabilitation. Our primary outcome is cardiac anxiety 12 months after the end of rehabilitation. Cardiac anxiety is assessed with the German 17-item version of the Cardiac Anxiety Questionnaire. Secondary outcomes cover outcomes assessed by clinical examinations and medical assessments and a range of patient-reported outcome measures.DiscussionThis randomized controlled trial is designed to determine the effectiveness of cognitive-behavioral rehabilitation at decreasing cardiac anxiety in patients with cardiovascular disease and mild or moderate mental illness or stress or exhaustion.Trial registrationGerman Clinical Trials Register (DRKS00029295, June 21, 2022).

Tinnitus Treatment

Tinnitus (ringing in the ears) is the perception of sound in the absence of an auditory stimulus. Tinnitus is perceived by about one in 10 adults, and for at least 1 in 100 tinnitus severely affects their quality of life. Objective is to present a review of pathophysiology and treatment approaches for the patients with tinnitus. Currently available options range from medications to the cognitive behavioral rehabilitation and the use of hearing aids. The review provides the overview of the approaches to tinnitus patients, based on national experience and national and international guidelines.

Efficacy of prison-based cognitive behavioral rehabilitation intervention on violent sexual behaviors among sex offenders in Nigerian prisons.

Background/Objective:Evidence showed that reoffending habits are increasing among offenders with violent sexual behaviors. Given the recidivism rates, a psychotherapeutic intervention becomes imperative. This study examined the efficacy of prison-based cognitive behavioral rehabilitation intervention (PCBRI) on violent sexual behaviors among sex offenders in Nigerian prisons.Method:A total of45 participants were the sample size. Compulsive Sexual Behavior Inventory and Hypersexual Behavior Inventory were employed in assessing the participants at 3 points. Using a simple random allocation sequence, 23 participants were exposed to PCBRI programme and 22 participants allocated to control condition. The data obtained were analyzed using repeated measures 2-way analysis of variance.Results:Results indicated a significant effect of the treatment on violent sexual behaviors among sex offenders in Nigerian prisons exposed to the PCBRI programme when compared to the no-intervention group. Result also showed a significant interaction effect of time and group on sex offenders with violent sexual behaviors. Follow-up tests showed significant decrease in violent sexual behaviors after 6 months for the PCBRI group in comparison to the control group.Conclusion:This study concluded that PCBRI approach is a type of psychotherapy that reduces violent sexual behaviors among sex offenders in Southeast Nigeria.

Cognitive behavioral rehabilitation for bipolar disorder patients: A randomized controlled trial.

Bipolar disorder is frequently associated with cognitive impairment even during euthymia. Previous studies have reported significant impairments in functional and quality of life outcomes and a possible relationship between these variables and cognitive performance. Cognitive rehabilitation interventions have been proposed to address these outcomes but positive results are still scarce. The objective of the present study is to evaluate the efficacy of a new intervention developed to address both cognitive and functional impairment. Thirty-nine individuals were included in this randomized controlled trial. All participants were evaluated by the Cambridge Neuropsychological Test Automated Battery (CANTAB) and completed functional and quality of life (QOL) scales. Patients were randomized to either treatment as usual (TAU) or Cognitive Behavior Rehabilitation (CBR), an add-on treatment delivered in 12 weekly group sessions. All individuals were revaluated after 12weeks. A total of 39 bipolar type I or II patients were included in the analysis, 19 in the TAU group and 20 in the CBR condition. At the entrance of the study, both groups were statistically similar regarding clinical, socio-demographics and cognitive variables. After the end of the intervention, CBR individuals had significantly improved reaction time, visual memory and emotion recognition. In contrast, individuals in the CBR did not present a statistically change in functional and QOL scores after the 12-week intervention. CBR intervention showed promising results in improving some of the commonly impaired cognitive domains in BD. A longer follow-up period may be necessary to detect changes in functional and QOL domains.

Evaluating the Effectiveness of Treatment Options for Pain: Literature Review

This literature review assesses the short and long term effectiveness for chronic pain management of single modality treatment approaches such as opioid use, non-steroidal anti-inflammatory drugs, massage therapy, manual therapy (soft tissue mobilization), instrument assisted soft tissue mobilization, myofascial release, acupuncture, soft tissue release, dry needle, trigger point injection, joint manipulation/joint mobilization, active release technique, strain counter strain, craniosacral therapy, stretching/exercise, McKenzie method, and kinesio taping in comparison to treatment methods that follow the biopsychosocial model such as the multidisciplinary approach, cognitive behavioral rehabilitation and Advanced Soft Tissue Release.

Efficacy of two brief cognitive-behavioral rehabilitation programs for chronic neck pain: results of a randomized controlled pilot study.

Current models of pain behavior suggest that kinesiophobia prevents the reacquisition of normal function, promotes the development of maladaptive coping strategies, and contributes to the disability associated with chronic neck pain (NP). Comparing two brief cognitive-behavioral programs aimed at managing kinesiophobia to understand which one induces better short-term improvements in disability, fear of movement, catastrophizing, adaptive coping strategies, quality of life (QoL), and pain intensity of chronic NP. Pilot, randomized, controlled trial, 3-months follow-up. Outpatients. Subjects with chronic NP. The population was randomized into two groups: group A (N.=15) underwent four sessions of cognitive-behavioral therapy (CBT) based on the NeckPix© (1-week duration); group B (N.=15) received four sessions of CBT based on the Tampa Scale of Kinesiophobia (TSK) (1-week duration). Afterwards, both groups attended 10 sessions of multimodal exercises (5-week duration). Primary measure: Neck Disability Index (NDI). Secondary measures: NeckPix©, TSK, Pain Catastrophizing Scale, Chronic Pain Coping Inventory, EuroQol-Five Dimensions, and pain intensity Numerical Rating Scale. Linear mixed model analyses for repeated measures for each outcome measure to evaluate changes over time and between group. A significant effect of time was found for all outcomes, while no outcomes showed group and/or interaction effects. No changes were found in terms of NDI at the end of CBT, while a significant improvement of about 13 points was found for both groups at the end of the motor training (P=0.001). Similarly, in terms of quality of life there was no change after the CBT program, and a significant change at the end of the motor training, with a partial loss at follow-up. From CBT sessions to follow-up both groups showed a progressive reduction in kinesiophobia, with each group achieving a bigger change in the specific scale used for the CBT program. Two brief cognitive-behavioral rehabilitation programs based on different methodologies of managing fear-avoidance beliefs induced similar short-term improvements in subjects with chronic NP. Clinically significant changes in terms of disability were found in both groups only at the end of a 5-week motor training, regardless of the cognitive-behavioral rehabilitation program previously administrated. Treatment of chronic NP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioral as well as motor lasting changes.

Rehabilitation in Autism. Pilot Project on the Health Centre-Based Primary Care Model within the National Health Plan Implementation Projects

Background: In Italy, there is a lack of reliable data on the epidemiology of Autism Spectrum Disorder (ASD) on a national scale. The exact etiopathogenesis of ASDs is still largely unknown, with autism representing the final common pathway of different pathological conditions. Aim of the Study: Assessment of the effects produced by the individualised, intensive and holistic rehabilitation programme used by the Il Cireneo Foundation on the daily living skills of people diagnosed with ASD. Materials and Methods: Out of the eighty-seven (n = 87) enrolees, seventy-nine (n = 79), of whom 19 were females (24.1%) and 60 were males (75.9%), with a mean age of 13.41 years (SD = 6.93 years; range = 2 - 33 years) terminated the three-year study. The enrolees were evaluated two times: at the beginning of the rehabilitation programme and at the end of the three-year goal-oriented project. Results: Statistically significant results between T0 and T1 were recorded for CARS (t-4.221; p < 0.05) and for the domains of Communication (t-2.750; p < 0.05), Daily Living Skills (t-6.526; p < 0.05) and Motor Skills (t-3.524; p < 0.05) of the VABS. Conclusions: People diagnosed with autism can be helped to become more autonomous and independent in carrying out activities of daily living thanks to an intensive psycho-educational and cognitive-behavioural rehabilitation programme, of which the Il Cireneo Foundation is the only expression in the Abruzzo region.

Cognitive-behavioral rehabilitation vs. treatment as usual for bipolar patients: study protocol for a randomized controlled trial

BackgroundBipolar disorder (BD) is commonly associated with cognitive and functional impairments even during remission periods, and although a growing number of studies have demonstrated the benefits of psychotherapy as an add-on to pharmacological treatment, its effectiveness appears to be less compelling in severe presentations of the disorder. New interventions have attempted to improve cognitive functioning in BD patients, but results have been mixed.MethodsThe study consists of a clinical trial comparing a new structured group intervention, called “Cognitive-Behavioral Rehabilitation,” with treatment as usual (TAU) for bipolar patients. The new approach is a combination of cognitive behavioral strategies and cognitive remediation exercises, consisting of 12 weekly group sessions of 90 min each. To be included in the study, patients must be diagnosed with BD type I or II, aged 18–55 years, in full or partial remission, and have an IQ of at least 80. A comprehensive neuropsychological battery, followed by mood, social functioning, and quality of life assessments will occur in three moments: pre and post intervention and 12 months later. The primary outcome of the study is to compare the time, in weeks, that the first full mood episode appears in patients who participated in either group of the study. Secondary outcome will include improvement in cognitive functions.DiscussionThis is the first controlled trial assessing the validity and effectiveness of the new “Cognitive-Behavioral Rehabilitation” intervention in preventing new mood episodes and improving cognitive and functional impairments.Trial registrationClinicaltrial.gov, NCT02766361. Registered on 2 May 2016.

Responsiveness and minimal clinically important changes for the Tampa Scale of Kinesiophobia after lumbar fusion during cognitive behavioral rehabilitation.

The Tampa Scale of Kinesiophobia (TSK) is a commonly-used measure for the assessment of fear of movement beliefs in chronic complaints, but its responsiveness in subjects after lumbar fusion has been never reported. Evaluating the responsiveness and minimal clinically important differences (MCIDs) for the TSK and its subscales after lumbar fusion. Population-based cohort study. Secondary care rehabilitation hospital. In-patients undergoing rehabilitation after lumbar fusion. At the beginning and end of a four-week motor and cognitive-behavioral rehabilitation program, 180 patients completed the TSK. After the intervention, the global perceived effect (GPE) was analyzed to produce a dichotomous outcome (improved vs. stable). Responsiveness for the TSK and its subscales were calculated by distribution (effect size [ES], standardized response mean [SRM]) and anchor-based methods (receiver operating characteristics (ROC) curves; correlations between change scores of the TSK and its subscales and GPE). ROC curves were also used to compute MCID values. The ES ranged from 1.63 to 1.77 and the SRM from 1.25 to 1.39 for TSK and its subscales. The ROC analyses revealed a value of area under the curve (0.999 [95% CI: 0.978; 1.000], 0.998 [95% CI: 0.975; 1.000], 0.990 [95% CI: 0.962; 0.999] for the TSK, Harm and Activity Avoidance subscales, respectively). MCID values greater than 6 (95% CI: >5; >6), 4 (95% CI: >3; >5), and 2 (95% CI: >2; >2) were achieved for the TSK, Harm and Activity Avoidance subscales, respectively. Correlations between change scores of the TSK and its subscales and GPE were high (0.786-0.830). The TSK and its subscales were sensitive in detecting clinical changes in subjects undergoing rehabilitation after lumbar fusion. The obtained MCID values will help in the design of future randomized controlled trials and in the interpretation of the clinical impact of a rehabilitation program after lumbar fusion.

Group-based task-oriented exercises aimed at managing kinesiophobia improved disability in chronic low back pain.

There are still doubts concerning the clinical impact of multidisciplinary cognitive behavioural rehabilitation programmes conducted in group-based settings and about their long-term effects on subjects with chronic low back pain (CLBP). This randomized, parallel-group superiority-controlled trial aimed at evaluating the effect of such a programme on disability, kinesiophobia, catastrophizing, pain and quality of life in CLBP. One hundred and fifty patients were randomly assigned to a 5-week group-based multidisciplinary programme of task-oriented exercises integrated with cognitive behavioural therapy mainly aimed at managing kinesiophobia (experimental group, 75 subjects) or group-based traditional exercises (control group, 75 subjects). Before treatment, 5weeks later (post-treatment), 12 and 24months after the end of treatment, the Oswestry Disability Index, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, a pain Numerical Rating Scale and the Short Form Health Survey were assessed. A linear mixed model for repeated measures was used for each outcome measure. Significant group (p<0.001), time (p<0.001) and time-by-group interaction (p<0.001) effects were found on disability, with a between-group difference (95% confidence interval) after training in favour of the experimental group of -10 (-12; -8). Also kinesiophobia, catastrophizing, pain, and quality of life improved to a significantly greater extent in the experimental group. The improvements of the experimental group were maintained at follow-ups. This light group-based multidisciplinary cognitive behavioural rehabilitation programme was superior to traditional exercises in reducing disability, kinesiophobia, catastrophizing, and enhancing the quality of life of subjects with CLBP. The effects lasted for at least 2years after the end of the intervention.

Can rehabilitation in boreal forests help recovery from exhaustion disorder? The randomised clinical trial ForRest

Modern society is faced with increasing incidence of mental and behavioural disorders. The objective of this study was to evaluate whether visits to boreal forests can be utilised for rehabilitation from exhaustion disorder (ED). This randomised controlled trial comprised of a forest rehabilitation group (n = 35) and a waiting list group (control group) (n = 43) with subsequent cognitive behavioural rehabilitation (CBR) for all participants in both groups. The recovery from ED was compared between the forest rehabilitation and the control group at baseline, after the forest rehabilitation (3 months), and at the end of the CBR (1 year). Both groups had enhanced recovery from ED after the 3-month intervention period and at the end of the CBR (1 year), and there were no significant differences between the groups in terms of psychological health measures. Mental state, attention capacity and preferences for different forest environments were studied during the forest visits. Mental state was improved, but it showed some seasonal differences. A significant effect on attention capacity was found for single forest visits, but there was no effect found for the rehabilitation period as a whole. The most popular forest environments contained easily accessible, open and bright settings with visible water and/or shelter. Forest rehabilitation did not enhance the recovery from ED compared to the control group, but the participants’ well-being was improved after single forest visits.

Gendered discourses of facilitation in a probation learning environment: challenging the heteronormative ideal

This article focuses on the cognitive behavioural rehabilitation programmes run by the probation service in the UK. Drawing on Judith Butler's assertion that both sex and gender are discursively produced and Becky Francis' notion of gender monoglossia and heteroglossia, the article seeks to analyse and problematise the gendered discourses of facilitation that were mobilised by policy-makers and practitioners in this setting. The dominant institutional model of heteronormative facilitation promoted the ideal of each programme being delivered by one female and one male facilitator in order to provide a gender ‘balance’. But underpinning this ideal lay the binarised and essentialist notion that ‘masculinity’ arose naturally from the male body and ‘femininity’ from the female body. Female facilitators were positioned as bringing a calming and non-threatening atmosphere to the group and as naturally possessing skills of ‘empathy’ and ‘warmth’. Male facilitators were highly valued by managers, but were also under pressure to perform masculinity in very specific ways that were linked to notions of intellectual, rational, ‘middle-class’ masculinity. Through an analysis of interviews with probation practitioners and session observations, the article highlights that despite these dominant institutional constructions, a variety of complex and contradictory performances of ‘masculinity’ and ‘femininity’ were mobilised in this environment.

Description and design considerations of a randomized clinical trial investigating the effect of a multidisciplinary cognitive-behavioural intervention for patients undergoing lumbar spinal fusion surgery

BackgroundThe ideal rehabilitation strategy following lumbar spinal fusion surgery has not yet been established. This paper is a study protocol, describing the rationale behind and the details of a cognitive-behavioural rehabilitation intervention for lumbar spinal fusion patients based on the best available evidence. Predictors of poor outcome following spine surgery have been identified to provide targets for the intervention, and the components of the intervention were structured in accordance with the cognitive-behavioural model. The study aims to compare the clinical and economical effectiveness of a cognitive-behavioural rehabilitation strategy to that of usual care for patients undergoing lumbar spinal fusion surgery.Methods/DesignThe study is a randomized clinical trial including 96 patients scheduled for lumbar spinal fusion surgery due to degenerative disease or spondylolisthesis. Patients were recruited in the period October 2011 to July 2013, and the follow-up period is one year from date of surgery. Patients are allocated on a 1:2 ratio (control: intervention) to either treatment as usual (control group), which implies surgery and the standard postoperative rehabilitation, or in addition to this, a patient education focusing on pain behaviour and pain coping (intervention group). It takes place in a hospital setting, and consists of six group-based sessions, managed by a multidisciplinary team of health professionals.The primary outcomes are disability (Oswestry Disability Index) and sick leave, while secondary outcomes include coping (Coping Strategies Questionnaire), fear-avoidance belief (Fear Avoidance Belief Questionnaire), pain (Low Back Pain Rating Scale, pain index), mobility during hospitalization (Cumulated Ambulation Score), generic health-related quality of life (EQ-5D) and resource use. Outcomes are measured using self report questionnaires, medical records and national registers.DiscussionIt is expected that the intervention can provide better functional outcome, less pain and earlier return to work after lumbar spinal fusion surgery. By combining knowledge and evidence from different knowledge areas, the project aims to provide new knowledge that can create greater consistency in patient treatment. We expect that the results can make a significant contribution to development of guidelines for good rehabilitation of patients undergoing lumbar spinal fusion.Trial registrationCurrent Controlled Trials ISRCTN42281022.

‘We’re not trying to turn them into middle-class Guardian readers’: constructing the offender in the probation ‘classroom’

Over the past 10 years, cognitive-behavioural programmes have come to be seen as a standard form of rehabilitation for offenders in the United Kingdom. However, the majority of research has tended to evaluate the programmes purely within the evidence-based context of the ‘What Works’ criminal justice agenda. By placing the programmes within their social and political context, this article suggests that they function as neo-liberal regimes of governance that aim to ‘responsibilise’ offenders. Through an analysis of interviews with probation practitioners, the article explores how ‘othering’ discourses relating to offenders intersected with gendered, classed and ‘raced’ social identities. Consequently, young white, working-class masculinities were constructed within this educational environment as impulsive, irresponsible and ‘cognitively deficient’. Thus, the article calls for a discursive shift away from cognitive-behavioural rehabilitation techniques and towards more genuinely inclusive, socially just, and holistic educational programmes for probationers.

Can the quality of high-risk violent prisoners' release plans predict recidivism following intensive rehabilitation? A comparison with risk assessment instruments

Even when motivated to desist from crime, many high-risk offenders fail quickly following release from prison. One cause may be a lack of preparation for release. Recent research with child-sex offenders has demonstrated that men who avoided reconvictions not only had better plans made for life on parole prior to their release, but plan quality also added significant incremental validity to the prediction of recidivism after controlling for both static and dynamic measures of risk. This study examined release planning in high-risk violent prisoners in an intensive cognitive-behavioural rehabilitation programme. We compared the predictive validity of plan quality with three well-validated risk assessment instruments. Men who were reconvicted had significantly higher scores on all three risk instruments and significantly poorer plans, but plan quality did not significantly improve prediction when risk was controlled. Plan quality was also significantly poorer in men who were reimprisoned, and did significantly improve prediction over and above each risk prediction instrument. Findings suggest that higher quality release plans may protect offenders from being quickly reimprisoned, despite high levels of assessed criminal risk, and that enhancing resources put into release planning may lead to improved parole outcomes.

A brief motivational interviewing intervention with prisoners: when you lead a horse to water, can it drink for itself?

Offenders’ readiness to engage in changes that will reduce their risk of reoffending is now recognized to be as important as the design and delivery of programmes that support such change. Interest is growing in both how to increase engagement in change processes, and how to measure any improvements in engagement. This study evaluated the effects of a brief offending-focused motivational interviewing (MI) intervention on reconviction in male prisoners serving sentences for diverse crimes. Men who undertook MI were significantly less likely to be reconvicted than those who did not. The results also served to validate a stage-based measure of readiness to change derived from Prochaska and DiClemente's Transtheoretical Model. Prisoners who were offered MI increased their readiness to change by an average of one stage, while the scores of men who were not remained unchanged. Furthermore – whether men undertook MI or not – change in stage of change predicted reconviction. This was a high-risk sample, making the results intriguing for at least two reasons. First, reductions in recidivism are usually achieved only with much more intensive programmes for high-risk men. Second, according to ‘traditional’ cognitive–behavioural rehabilitation theory, programmes need to target change in dynamic risk factors directly to reduce reconviction risk. That these results were obtained with men whose initial motivation was low, and in the absence of any ‘traditional’ criminogenic rehabilitation, raises questions about whether there is more than one mechanism involved in desistance.

MF.07 Measurement of outcome in cognitive behavioural rehabilitation services: HoNOS-ABI & FIMFAM-UK sensitivity to change and lessons from HoNOS Rasch analysis

AimsTo determine HoNOS-ABI and FIMFAM-UK sensitivity to change following cognitive-behavioural rehabilitation for brain injury, and to examine the psychometric properties of these outcome measures.Methods324 brain injured survivors underwent cognitive-behavioural rehabilitation...

Living conditions, including life style, in primary-care patients with nonacute, nonspecific spinal pain compared with a population-based sample: a cross-sectional study

BackgroundNonspecific spinal pain (NSP), comprising back and/or neck pain, is one of the leading disorders behind long-term sick-listing, including disability pensions. Early interventions to prevent long-term sick-listing require the identification of patients at risk. The aim of this study was to compare living conditions associated with long-term sick-listing for NSP in patients with nonacute NSP, with a nonpatient population-based sample. Nonacute NSP is pain that leads to full-time sick-listing >3 weeks.MethodsOne hundred and twenty-five patients with nonacute NSP, 2000–2004, were included in a randomized controlled trial in Stockholm County with the objective of comparing cognitive–behavioral rehabilitation with traditional primary care. For these patients, a cross-sectional study was carried out with baseline data. Living conditions were compared between the patients and 338 nonpatients by logistic regression. The conditions from univariate analyses were included in a multivariate analysis. The nonsignificant variables were excluded sequentially to yield a model comprising only the significant factors (P < 0.05). The results are shown as odds ratios (OR) with 95% confidence intervals.ResultsIn the univariate analyses, 13 of the 18 living conditions had higher odds for the patients with a dominance of physical work strains and Indication of alcohol over-consumption, odds ratio (OR) 14.8 (95% confidence interval [CI] 3.2–67.6). Five conditions qualified for the multivariate model: High physical workload, OR 13.7 (CI 5.9–32.2); Hectic work tempo, OR 8.4 (CI 2.5–28.3); Blue-collar job, OR 4.5 (CI 1.8–11.4); Obesity, OR 3.5 (CI 1.2–10.2); and Low education, OR 2.7 (CI 1.1–6.8).ConclusionsAs most of the living conditions have previously been insufficiently studied, our findings might contribute a wider knowledge of risk factors for long-term sick-listing for NSP. As the cross-sectional design makes causal conclusions impossible, our study should be complemented by prospective research.

High-Intensity Rehabilitation for Violent Offenders in New Zealand: Reconviction Outcomes for High- and Medium-Risk Prisoners

As the empirical evidence accumulates, so does confidence that carefully designed and delivered rehabilitation approaches can reduce risk. Yet little is known about how to rehabilitate some specialized groups, such as high-risk violent offenders: career criminals with an extensive history of violent behavior. Since 1998, New Zealand's Rimutaka Violence Prevention Unit (RPVU) has provided intensive cognitive-behavioral rehabilitation to violent men. In this evaluation, 112 medium- and high-risk prisoners who entered the program after 1998 are case matched to 112 untreated men. Reconviction outcome data over an average of 3.5 years postrelease show that 10% to 12% fewer program completers were reconvicted for violence compared to their untreated controls. High-risk completers also are less likely to be reconvicted for any offense. Those men who opted out of the study are a slightly higher-risk group than those who completed it, but noncompletion does not further increase their risk. Given the lack of program theory, and formidable practical challenges involved in working with such a high-risk group, these results are very promising.

Increased mortality among individuals with chronic widespread pain relates to lifestyle factors: A prospective population-based study

Purpose. Widespread chronic pain has been related to disability and loss of quality of life, but in a few epidemiological studies also to increased mortality. The aim of this study was to further investigate the relationship between chronic pain, lifestyle factors and all cause mortality.Methods. A random sample of an adult (age 25–74) Swedish population (n = 1609) responded to a comprehensive questionnaire on pain, other symptoms, lifestyle, work and socioeconomic factors in 1988. Mortality data for this cohort between 1988 and 2002 were analysed. Survival analysis (Kaplan–Meier) and Cox proportional regression were used to study initially reported factors influencing survival.Results. Individuals with widespread chronic pain showed an increased mortality risk (hazard ratio, HR = 1.95, CI: 1.26–3.03) compared to the group without chronic pain. Death due to cardiovascular disease accounted for the increased mortality. Adjustment for lifestyle factors eliminated the excess risk.Conclusions. Increased mortality among individuals with widespread chronic pain is related to factors like smoking, sleep disturbances and low physical activity. The result emphasises the importance of including lifestyle factors in a cognitive-behavioural rehabilitation process. It remains to be shown whether health promotion activities aimed at lifestyle could change mortality among individuals with chronic pain.