Self-reported Complaints Research Articles

The Influence of Personality on Health Complaints and Quality of Life in Women With Breast Implants.

A causal relation between systemic symptoms and breast implants has not been established. Psychological factors, such as personality and psychological distress, are strongly associated with the development of medically unexplained symptoms. It can be hypothesized that psychological factors may be related to the development of breast implant illness (BII). This study was conducted to evaluate the correlation between self-reported health complaints, health- and breast-related quality of life (QoL), and personality, in women with cosmetic breast implants. Women who attended the plastic surgery outpatient clinic of Maastricht University Medical Center between October 2020 and October 2021 for reasons related to their implants and women recruited for a BII study at the Center during this period were invited to participate in this study. Only women who underwent cosmetic breast augmentation were eligible. Participants completed a physical complaints score form and the BREAST-Q, SF-36, and EPQ-RSS questionnaires via an online survey. In total, 201 women completed the questionnaires. Extroversion and social desirability were predominant personality traits in women with breast implants, followed by neuroticism. Relatively high levels of neuroticism were found compared with normative data. Neuroticism correlated significantly with health status and breast-related QoL. Physical and mental health-related QoL had the strongest correlations with neuroticism (β = -3.94, β = -4.86, P < 0.001). Personality can play a role in the development of complaints. High levels of neuroticism are seen in cosmetic surgery patients and are negatively correlated with subjective health and patient-reported outcomes in women with breast implants. Therefore, neuroticism may be a factor in the development of BII.

Real-World Evidence of Transcutaneous Afferent Patterned Stimulation for Essential Tremor.

Background:Transcutaneous afferent patterned stimulation (TAPS) is a prescription, wrist-worn device-delivered, non-invasive neuromodulation therapy for treatment of hand tremor in patients with essential tremor (ET). This retrospective post-market surveillance study evaluated real-world effectiveness of TAPS from patients using therapy on-demand for at least 90 days between August 2019 through June 2021.Methods:Demographics were summarized from TAPS prescriptions received from the patient’s healthcare provider. Therapy usage and effectiveness were analyzed from device logs, which included tremor measurements from onboard motion sensors. Tremor history and patient-reported outcomes were assessed from a voluntary survey.Results:A total of 321 patients (average age 71 years, 32% female) met the criteria for this analysis, 216 of whom had tremor measurements available for analysis and 69 of whom completed the survey. Total usage period ranged from 90 to 663 days, with 28% of patients using the device for over one year. Patients used therapy 5.4 ± 4.5 (mean ± 1 standard deviation) times per week. TAPS reduced tremor power by 71% (geometric mean) across all sessions, with 59% of patients experiencing >50% tremor reduction after their sessions. Eighty-four percent (84%) of patients who returned the voluntary survey reported improvement in at least one of eating, drinking, or writing, and 65% of patients reported improvement in quality of life. Self-reported device-related safety complaints were consistent with adverse events in prior clinical trials.Discussion:Real-world evidence is consistent with prior clinical trials and confirms TAPS provides safe and effective tremor control for many patients with ET. Future work assessing multi-year safety and effectiveness would be valuable to extend these data.

197P Long-term effects of physical exercise on self-reported cognitive function, fatigue, and quality of life in chemotherapy-treated breast cancer patients

In the randomized controlled Physical Activity and Memory (PAM) study, we found beneficial effects immediately after a 6-month supervised exercise program on self-reported cognitive complaints, fatigue, and quality of life (QoL) in chemotherapy-exposed breast cancer patients with cognitive complaints and tested cognitive problems. The present study assessed whether these effects sustained till one year after study completion.

Clinical utility of self-reported and informant-reported cognitive complaints in older adults.

Clinical utility of self-reported and informant-reported cognitive complaints in older adults.

Cognitive Difficulties, Psychological Symptoms, and Long Lasting Somatic Complaints in Adolescents with Previous SARS-CoV-2 Infection: A Telehealth Cross-Sectional Pilot Study.

Background. Few studies have evaluated cognitive functioning and mental health in children and adolescents who contracted the SARS-CoV-2 infection. We investigated the prevalence and association of neuropsychological difficulties, psychological symptoms, and self-reported long-COVID complaints in a sample of adolescents. Methods. Thirty-one adolescents infected by COVID-19 within 3–6 months prior to the assessment were included. Neuropsychological difficulties, psychological symptoms, and self-reported long-COVID complaints were evaluated using a checklist and a battery of multiple standardized measures, using a telehealth procedure. Symptoms during the infection were also detected. Results. We included 31 adolescents (23 girls, 8 boys; mean age 14.1, SD = 2). We found borderline scores in 32.3% and 45.2% of our sample for phonemic and category fluency, respectively. A high percentage of participants showed symptoms of depression (80.6%) and anxiety (61.3%). Fifty-eight percent reported at least one long-COVID symptom. The most common symptoms were headache and attention problems (58%). Subjects presenting numbness/weakness, fatigue, brain fog, or attention problems had higher scores in depression, anxiety, and post-traumatic stress symptoms (p ≤ 0.05). Conclusion. This is a pilot study limited by the lack of control group. However, we found that cognitive, psychological, and physical symptoms were very common among adolescents recovered from COVID-19.

The Prevalence and Development of Neck and Lower Back Pain and Associated Factors in Dentistry Students-A Long-Term Prospective Study.

Musculoskeletal disorders (MSDs) represent a significant occupational burden for dentists and dentistry students. This study aimed to assess the five-year development of most common musculoskeletal complaints among dentistry students during the whole length of their studies and to analyze the impact of some potentially associated risk factors. A longitudinal questionnaire survey regarding the occurrence of MSDs was conducted among a total of 73 dentistry students between 2014 and 2021. The same students enrolled in three consecutive years were monitored throughout their entire studies. Statistical analysis was performed using methods of descriptive statistics, Chi-square test, Fisher’s exact test, McNemar test, and univariate and multivariate logistic regression analyses. The most frequent areas of complaints were neck (61.6%) and lower back (49.3%). The increase in self-reported complaints between the first and the fifth year was statistically significant for neck pain (increase by 15%, p = 0.043) but not for lower back pain (by 6.8%, p = 0.44). According to our data, age, performing top-level sport, and participating in regular sporting activities had a statistically significant influence on neck and/or back pain. The results of this longitudinal prospective study showed that neck, as well as lower back pain, are significant problems for dentistry students.

Prevalence and factors associated with occupational health problems among leather footwear manufacturing workers in Ambur town, Thirupathur district, Tamil Nadu, India

Background: In India, the leather footwear manufacturing sector contributes to a significant segment of leather products, and workers were exposed to a wide range of hazardous substances during the manufacturing process. The present study was conducted to identify the prevalence of various work-related health complaints and the factors associated with occupational health problems among leather footwear workers in Tamil Nadu. &#x0D; Methods: This cross-sectional study was conducted among 275 leather footwear workers in Ambur town, Thirupathur district, Tamil Nadu from June 2019 to July 2019. Data was collected using a semi-structured questionnaire consisting of socio-demographic and workplace characteristics, work-related self-reported health complaints, and use of personal protective equipment (PPE). Descriptive analysis and multivariate analysis were performed to identify factors associated with work-related health problems at a 5% level of significance. &#x0D; Results: The study demonstrated a prevalence of 19.33% respiratory disorders, 16.4% skin ailments, and 37% musculoskeletal complaints. Workers involved in the scouring/finishing process had nearly two times the odds (95% CI: 0.977-3.923); workers who do not use PPE like gloves or masks had two times the odds (95% CI: 1.307-4.346); workers who reported inadequate windows/fans or blowers in their work station had four times the odds (95% CI: 1.421-12.413) and workers who reported lack of regular work training had 3.5 times odds (95% CI: 1.954-6.531) of occupational health problems. &#x0D; Conclusions: Implementation of strict protocols on the use of PPE, periodic monitoring and safety training should be regulated to prevent the workers from these health problems.

Prefrontal Activation During Effortful Processing Differentiates Memory Abilities in Adults with Memory Complaints.

Identifying individuals at increased risks for developing Alzheimer's disease (AD) is crucial for early intervention. Memory complaints are associated with brain abnormalities characteristic of AD in cognitively normal older people. However, the utility of memory complaints for predicting mild cognitive impairment (MCI) or AD onset remains controversial, likely due to the heterogeneous nature of this construct. We investigated whether prefrontal oxygenation changes measured by functional near-infrared spectroscopy (fNIRS) during an arduous cognitive task, previously shown to be associated with the AD syndrome, could differentiate memory abilities among individuals with memory complaints. Episodic memory performance was adopted as a proxy for MCI/AD risks since it has been shown to predict AD progression across stages. Thirty-six adults self-reporting memory complaints in the absence of memory impairment completed a verbal list learning test and underwent a digit n-back paradigm with an easy (0-back) and a difficult (2-back) condition. K-means clustering was applied to empirically derive memory complaint subgroups based on fNIRS-based prefrontal oxygenation changes during the effortful 2-back task. Cluster analysis revealed two subgroups characterized by high (n = 12) and low (n = 24) bilateral prefrontal activation during the 2-back but not a 0-back task. The low activation group was significantly less accurate across the n-back task and recalled significantly fewer words on the verbal memory test compared to the high activation group. fNIRS may have the potential to differentiate verbal memory abilities in individuals with self-reported memory complaints.

Self-Reported Psychosomatic Complaints and Conduct Problems in Swedish Adolescents.

Physical conditions in children and adolescents are often under reported during mainstream school years and may underlie mental health disorders. Additionally, comparisons between younger and older schoolchildren may shed light on developmental differences regarding the way in which physical conditions translate into conduct problems. The aim of the current study was to examine the incidence of psychosomatic complaints (PSC) in young and older adolescent boys and girls who also report conduct problems. A total of 3132 Swedish adolescents (age range 15–18 years, 47% boys) completed the Uppsala Life and Health Cross-Sectional Survey (LHS) at school. The LHS question scores were categorised by two researchers who independently identified questions that aligned with DSM-5 conduct disorder (CD) criteria and PSC. MANOVA assessed the effects of PSC, age, and gender on scores that aligned with the DSM criteria for CD. The main effects of gender, age, and PSC on the conduct problem scores were observed. Adolescents with higher PSC scores had higher conduct problem scores. Boys had higher serious violation of rules scores than girls, particularly older boys with higher PSC scores. Psychosomatic complaints could be a useful objective identifier for children and adolescents at risk of developing conduct disorders. This may be especially relevant when a reliance on a child’s self-reporting of their behavior may not help to prevent a long-term disturbance to their quality of life.

Perceived Physical Discomfort and Its Associations With Home Office Characteristics During the COVID-19 Pandemic.

ObjectiveThe goal of this study was to evaluate the prevalence and change in perception of physical discomfort, including musculoskeletal discomfort, during the COVID-19 pandemic and to determine associations of demographic factors, telework activity, and home office characteristics with the highest prevalence of discomfort.BackgroundThe COVID-19 pandemic forced a substantial increase in telework in many countries. The sudden change from a regular workplace to an improvised “home office” may have an impact on working conditions and physical symptoms of office workers. However, investigations in this area remain limited.MethodA cross-sectional study design was used to compare self-reported complaints of physical discomfort perceived from before with those during the pandemic. Associations between complaints and home office characteristics were investigated from 150 faculty and 51 administrative staff of an academic institution with an age range of 41.16 ± 10.20 (59% female).ResultsA significant increase of physical discomfort was found during the pandemic period for head, eyes, hand, and upper back for both staff and faculty and neck, shoulders, elbows, and lower back for faculty only. Logistic regression analyses point to associations with the lack of a laptop stand, uncomfortable desk, poor lighting, and sitting time, among others.ConclusionA high prevalence of physical discomfort was reported by teleworkers during the COVID-19 pandemic. Some home office characteristics were associated with these discomforts.ApplicationSome telework characteristics seem to be risk factors for physical discomfort. Consideration should be given to teaching best practices for workstation setup and/or conducting other preventive interventions in the work environment.

Clinical and radiographic assessment of peripheral joints in controlled acromegaly

PurposeAcromegalic arthropathy is a well-known phenomenon, occurring in most patients regardless of disease status. To date, solely hips, knees, hands, and spinal joints have been radiographically assessed. Therefore, this study aimed to assess the prevalence of joint symptoms and radiographic osteoarthritis (OA) of new, and established peripheral joint sites in well-controlled acromegaly.MethodsFifty-one acromegaly patients (56% female, mean age 64 ± 12 years) in long-term remission for 18.3 years (median, IQR 7.2–25.4) were included. Nineteen patients currently received pharmacological treatment. Self-reported joint complaints were assessed using standardized interviews. Self-reported disability of the upper and lower limbs, and health-related quality of life (HR-QoL) were evaluated using validated questionnaires. Radiographic OA [defined as Kellgren & Lawrence (KL) ≥ 2] was scored using (modified) KL methods.ResultsRadiographic signs of OA were present in 46 patients (90.2%) with ≥ 2 joints affected in virtually all of these patients (N = 44; 95.7%). Radiographic MTP1 OA was as prevalent as radiographic knee OA (N = 26, 51.0%), and radiographic glenohumeral OA was similarly prevalent as hip OA [N = 21 (41.2%) vs. N = 24 (47.1%)]. Risk factors for radiographic glenohumeral OA were higher pre-treatment IGF-1 levels [OR 1.06 (1.01–1.12), P = 0.021], and current pharmacological treatment [OR 5.01 (1.03–24.54), P = 0.047], whereas no risk factors for MTP1 joint OA could be identified.ConclusionSimilar to previously-assessed peripheral joints, clinical and radiographic arthropathy of the shoulder and feet were prevalent in controlled acromegaly. Further studies on adequate management strategies of acromegalic arthropathy are needed.

Vocal outcomes after COVID-19 infection: acoustic voice analyses, durational measurements, self-reported findings, and auditory-perceptual evaluations.

PurposeThe ongoing literature suggests that COVID-19 may have a potential impact on voice characteristics during the infection period. In the current study, we explored how the disease deteriorates different vocal parameters in patients who recovered from COVID-19.MethodsA total of 80 participants, 40 patients with a prior history of COVID-19 (20 male, 20 female) with a mean age of 39.9 ± 8.8 (range, 21–53) and 40 gender and age-matched healthy individuals (mean age, 37.3 ± 8.8; range, 21–54) were included to this study. The data of acoustic voice analyses, durational measurements, patient-reported outcomes, and auditory-perceptual evaluations were compared between the study group and the control group. Correlation analyses were conducted to examine the association between the clinical characteristics of the recovering patients and measured outcomes.ResultsMaximum phonation time (MPT) and the scores of both Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (V-RQOL) questionnaires significantly differed between the groups, which was more evident in female participants. The overall severity score of dysphonia was found to be higher in the study group than the control group (p = 0.023), but gender-based comparisons reached significance only in males (p = 0.032). VHI-10 and V-RQOL revealed significant correlations with the symptom scores of the disease.ConclusionsPatients with a prior history of COVID-19 had significantly lower MPT, increased VHI-10 scores, decreased voice-related quality of life based on the V-RQOL questionnaire, and higher overall severity scores in the auditory-perceptual evaluation. Self-reported voice complaints disclosed close relationships with the symptom scores of COVID-19 disease.

Effects of Galacto-Oligosaccharides Supplementation on Gut Comfort and Fecal Microbiota in Female Adults With Gut Complaints

ObjectivesThe prevalence of gastrointestinal (GI) discomfort is widespread and quality of life is strongly linked to a well-functioning GI tract. Over the years, many (dietary) solutions have been developed but the prevalence remains high. Prebiotic galacto-oligosaccharides (GOS) have been shown to support gut health in various target groups. Therefore, the objective of this study was to investigate the effect of 21 days consumption of 5.5g GOS on gut comfort in women (25–45 years old) with self-reported gut comfort complaints in a double blind randomized placebo controlled trial.MethodsHealthy Dutch women (n = 65) with a self-reported gut comfort component score (consisting of bloating, flatulence, stomach ache, constipation, and diarrhea, range: 0–15) of at least 6 were enrolled. For three weeks, participants received a daily powder with either 5.5g BiotisTM GOS or maltodextrin to be taken during the first meal of the day. Weekly, validated questionnaires were conducted to study the effect on gut comfort score, sleep, stress, and product tolerance. Furthermore, at start and after the intervention, stool samples were taken to study faecal microbiota.ResultsThis study demonstrates that on group average the daily consumption of 5.5g GOS as well as maltodextrin, for 3 weeks in healthy females (average age: 34 yrs) with self-reported gut comfort complaints, improved the gut comfort component score. No differences were found between the two interventions, which indicates that a large placebo-effect was in place. However, the consumption of GOS did result in a 3 times higher odds to improve the gut comfort component score after three weeks. Daily consumption of 5.5g GOS resulted in a shift in the overall microbiota composition, with a clear 85% increase of faecal Bifidobacterium, which was not observed for the control group. Finally, posthoc analysis showed that GOS tends to decrease flatulence and to improve quality of sleep at 21 days of consumption.ConclusionsDaily consumption of 5.5g GOS for 21 days among adult women 25–45 years with non-medical diagnosed gut complaints improved the gut comfort component score, but was not different from the control. However, consumption of GOS resulted in a higher odds to improve this score. Furthermore, the daily intake of 5.5g GOS significantly increased fecal Bifidobacterium.Funding SourcesFrieslandCampina, The Netherlands.

Changes in smell and taste perception related to COVID-19 infection: a case–control study

The main aim of the present study was to psychophysically evaluate smell and taste functions in hospitalized COVID-19 patients and to compare those results with a group of healthy subjects. Another aim of the study was to assess the relationship of changes in patients’ smell and taste functions with a number of clinical parameters, symptoms, and other physiological signs as well as with severity of disease. Olfactory and gustatory functions were tested in 61 hospitalized patients positive for SARS-CoV-2 infection and in a control group of 54 healthy individuals. Overall, we found a significant impairment of olfactory and gustatory functions in COVID-19 patients compared with the control group. Indeed, about 45% of patients self-reported complaints about or loss of either olfactory or gustatory functions. These results were confirmed by psychophysical testing, which showed a significantly reduced performance in terms of intensity perception and identification ability for both taste and smell functions in COVID-19 patients. Furthermore, gustatory and olfactory impairments tended to be more evident in male patients suffering from more severe respiratory failure (i.e., pneumonia with need of respiratory support need during hospitalization).

The association between self-reported psychosomatic complaints and bullying victimisation and disability among adolescents in Finland and Sweden

To analyse the associations between bullying victimisation, disability, and self-reported psychosomatic complaints in adolescents, and to investigate the role of support from parents and teachers in such associations. The study was based on Finnish and Swedish data from two waves (2013/2014 and 2017/2018) of the Health Behaviour in School-aged Children survey (n=16,057). Descriptive statistics were produced for four groups of adolescents: (a) bullied with disabilities; (b) not bullied with disabilities; (c) bullied without disabilities; and (d) not bullied without disabilities (reference group). Two multilevel multinomial logistic regression models were performed for the Finnish and Swedish samples separately. The first model analysed associations between psychosomatic complaints and bullying victimisation, controlling for a range of confounders. The second model analysed associations between psychosomatic complaints and social support from parents and teachers. Across both countries, bullied adolescents with disabilities were more likely to self-report psychosomatic complaints than the reference group, even after adjusting for other potential confounders. Teacher support was identified as a potential protective factor as the odds ratio for psychosomatic complaints decreased when including teacher support as a factor in the model. The association with parent support showed mixed findings in Finland and Sweden. Disability in combination with bullying victimisation generated the highest levels of self-reported psychosomatic complaints compared to adolescents that were not bullied nor had disabilities. High teacher support may be a protective factor against psychosomatic complaints for bullied and/or disabled adolescents.

Autoantibodies in Females Exposed to Indoor Air Dampness Microbiota and Complaining of Electromagnetic Hypersensitivity- The Case Control Report

We hypothesized that prolonged or cumulative exposure to indoor air dampness microbiota in moisture-damaged buildings and daily exposure to wireless telecommunication devices would potentiate the risk of electromagnetic hypersensitivity (EHS), which is poorly defined. We performed a nested comparative analysis within an age- and sex-matched study of females who were exposed to dampness microbiota with self-reported complaints compatible with EHS (n=11). Their levels of autoantibodies towards 13 different autoantigens were measured. EHS presented as multiple chemical sensitivity, profound fatigue, memory disturbances in all subjects (11/11), and cognitive impairment in the majority (9/11). When comparing the patients to controls, no difference was detected between the levels of the following autoantibodies: angiotensin II type 1 receptor (AGTR1), endothelin receptor type A (ETAR), adrenergic receptors α1AR, α2AR, β1AR, β2AR and cholinergic muscarinic receptors m1AChR, m2AChR, m3AChR and m5AChR. In contrast, IgG levels towards m4AChR and fibroblast growth factor receptor 3 (FGFR3), and IgM autoantibodies against glycosylated moieties of heparan and heparan sulphate (TS-HDS) were significantly decreased in the study cohort, p=0.008; p=0.032, p&lt;0.001, respectively. This is the first report demonstrating an imbalance in the nervous system autoantibodies in patients with EHS. The clinical significance of these altered responses remains to be clarified.

Self-reported psychosomatic complaints and conduct problems 2 in Swedish adolescents

Self-reported psychosomatic complaints and conduct problems 2 in Swedish adolescents

Alleviation of Health Complaints Following Regular Consumption of Filtered Tap Water (AcalaQuell®) Is Independent from Placebo Effects

Recently, it was shown that regular consumption of a standardized amount of filtered tap water improved the self-reported physical complaints. However, since individuals were fully aware of the type of water they consumed it was unclear to what extent this effect was ascribable to placebo effects. This paper tests the effectiveness of an in-home water filter system (AcalaQuell®) which was compared with a sham water filter containing no significant filter ingredients. Both filters were concealed, and participants knew that the probability to receive the clinically proven filter was 50 percent. There were large differences between the two groups (d = 0.7 &amp;lt; d &amp;lt; 2). For individual-specific complaints, the reduction was 38 percent for the filtered water group while the reduction in the placebo group was about 8 percent. Subjective health complaints are considerably reduced after daily intake of AcalaQuell®-filtered tap water during a three-week administration period. This effect is specific and independent from placebo effects.

Self-reported symptoms and health complaints associated with exposure to Ixodes ricinus-borne pathogens

BackgroundThe impact of infections with tick-borne pathogens (TBPs) other than Borrelia burgdorferi (s.l.) and tick-borne encephalitis virus (TBEV) on public health in Europe remains unclear. Our goal is to evaluate whether the presence of these TBPs in ticks can be associated with self-reported health complaints.MethodsWe enrolled individuals who were bitten by I. ricinus between 2012 and 2015 and collected their relevant demographic and clinical information using a self-administered online questionnaire. A total of 4163 I. ricinus ticks sent by the participants were subject to molecular analyses for detection of specific TBPs. Associations between the presence of TBPs in ticks and self-reported complaints and symptoms were evaluated by means of a stepwise approach using a generalized linear model (GLM).ResultsOf 17 self-reported complaints and symptoms significant in the univariate analyses, 3 had a highly significant association (P < 0.01) with at least one TBP in the multivariate analysis. Self-reported Lyme borreliosis was significantly associated (P < 0.001) with B. burgdorferi (s.l.) infection. Facial paralysis was associated (P < 0.01) with infection with B. miyamotoi, N. mikurensis and R. helvetica. Finally, a significant association (P < 0.001) was found between nocturnal sweating and A. phagocytophilum.ConclusionsWe found associations between the presence of TBPs in ticks feeding on humans and self-reported symptoms. Due to the subjective nature of such reports and the fact that infection was determined in the ticks and not in the patient samples, further prospective studies utilizing diagnostic modalities should be performed before any clinical outcome can be causally linked to infection with TBPs.Graphical

Digital Compensatory Cognitive Training for Older Adults with Memory Complaints

ABSTRACT Many older people experience everyday memory complaints which can be a precursor condition to mild cognitive impairment and dementia. Research has consistently shown that compensatory cognitive training (CCT) benefits cognition in older adults. Providing CCT in a computerized format makes it more accessible and reduces its costs. We studied a newly developed digital CCT for older adults with everyday memory complaints that is multi-factorial and based on empirically supported techniques to improve memory. 55 older adults with self-reported everyday memory complaints participated in a study with outcomes assessed at baseline and post-intervention. We found that participants in the experimental condition improved significantly on the main objective outcome measure assessing associative memory compared to participants in a waitlist control condition. Specifically, after correcting for learning effects, 28% of participants in the experimental condition showed a reliable improvement. No effects were found on other objective outcome measures, most notably those assessing transfer to novel tasks. Participants in the experimental condition scored higher on measures of memory satisfaction, use of internal memory strategies, and quality of life. These findings contribute to existing knowledge on CCT by providing partial evidence for the efficacy of a digital CCT for older adults with everyday memory complaints. We recommend the use of digital CCT for older adults who experience memory complaints in their everyday life, but who do not qualify for medical treatment. Particular attention needs to be given to enhancing transfer of the learned strategies to everyday life.