2004 — 2008 |
Lumley, Mark A |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Disclosure and Skills Training For Rheumatoid Arthritis
DESCRIPTION (provided by applicant): Two self-management interventions have promise for improving the health and adjustment of people with rheumatoid arthritis (RA): written emotional disclosure (ED) and coping skills training (CST). These approaches have evolved separately and not been compared, and an intervention that integrates ED with CST may be more effective than either one alone. The proposed study combines the expertise of two research teams to conduct a randomized, controlled trial of the integrated and separate effects of ED and CST for people with RA. Adults with RA (N = 280) will be randomized to one of four treatment groups in a 2 X 2 factorial design. One factor is six sessions of either ED (writing about stress, RA, and coping options) or its matched control, neutral writing. The second factor is 6 sessions of therapist-provided CST (teaching six pain and stress coping skills) or its matched control, nurse-provided arthritis education. Thus, the 4 treatments are: a) integrated ED / CST; b) ED (+ arthritis education); c) CST (+ neutral writing); and d) Control (neutral writing + arthritis education). A comprehensive battery of measures (pain, physical disability, psychological impairment, disease activity, physician ratings, C-reactive protein) will be assessed at baseline and 1-month, 3-month, and 12-month follow-ups, and potential mediators (self-efficacy, coping skill use, emotional approach coping) will be assessed via 30-day daily diary recordings prior to each assessment. Analyses will a) test whether the integrated treatment leads to better outcomes than either ED or CST alone; b) directly compare the efficacy of ED alone and CST alone; and c) compare each treatment with a control condition. Process measures will determine whether the integrated treatment enhances the content of patients' emotional disclosure and their participation in CST, and analyses of mediators will indicate whether the interventions have unique or common pathways. This research is key to the goal of developing theoretically-grounded, highly efficacious, and easily implemented self-management strategies to improve adjustment of people with RA and other pain conditions.
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1 |
2005 — 2007 |
Lumley, Mark A |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Cognitive-Emotional Integration in Adulthood and Aging
This longitudinal-sequential study continues to examine the principle of dynamic integration that underlies affect-cognition relations throughout the adult life span and further elaborates it by interfacing relatively macrolevel, psychometric/personological evidence with more micro-level and process-oriented analyses. Rather than defining success in emotion regulation as the maximization of positive and minimization of negative affect, or affect optimization, optimal regulation is characterized as a dynamic coordination of affect optimization with cognitive-affective complexity, or a concern with a complex and objective description of emotion-relevant issues. Deviations from such dynamic integration can occur when processing resources are restricted either as a result of normative cognitive changes related to age, or of socio-emotional restrictions such a poor regulation styles. Under such restrictions, individuals will opt for one of the modes to the exclusion of the other, resulting in less well-regulated behavior. A total of 337 European Americans and African Americans aged 20 to 98 will undergo an extensive battery of measures related to affect, cognition, social context, well-being, and health in Phase 1 of the study. This Phase extends the core longitudinal study and examines the developmental course of the modes, their stability over time, and their antecedents and adaptive outcomes on a relatively macro-analytical level. Phase 2 and 3 add to Phase 1 a more micro-analytical and experimental examination of how individuals organize representations about self and other, and how these representations are affected by exposure to threatening emotions. In Phase 3, finally, 120 individuals from the total population will be selected to participate in an experience sampling study examining variability and covariation of emotions across a relatively short time interval of 1 week. Phase 1 longitudinal analyses using multi-group hierarchical linear modeling will focus on analyzing patterns of change in the regulation modes as well as identifying sources of individual differences in change. For Parts 2 and 3, parameters derived from these analyses will be interfaced with evidence about specific mechanisms gleaned from more micro-level process study and sampling of daily affective experience. Overall, this study will make a significant contribution towards examining linkages between emotion regulation and patterns of psychological and physical aging, as well as identifying social and psychological mechanisms that are involved in individual differences in rates of aging.
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1 |
2010 — 2014 |
Lumley, Mark A |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Emotional Exposure and Cognitive Behavioral Therapies For Fibromyalgia
DESCRIPTION (provided by applicant): Fibromyalgia (FM) is a common and disabling pain condition, which is notoriously difficult to treat. Traditional non-pharmacological therapies for pain, such as cognitive behavioral therapy, are of benefit, but their efficacy may be limited by a failure to directly address stress and emotional dysregulation. A substantial literature reveals that many patients with FM have increased lifetime trauma or stress and emotional regulation problems, and the subsequent failure to process difficult emotional experiences appears to contribute to pain and other symptoms in many individuals with FM. Emotional exposure and processing treatments are highly successful with trauma and anxiety problems-which are common co-morbidities in patients with FM and other chronic pain conditions. We have solid preliminary data on the efficacy of emotion regulation-based interventions for FM, and the proposed research will test an innovative and promising emotional awareness and exposure intervention. This application combines the clinical research, chronic pain, and FM expertise of two research teams to conduct a 2-site, randomized controlled trial of emotional exposure therapy (EET) against both a standard cognitive-behavioral therapy (CBT;pain coping skills training) and control condition (FM education) in a design that controls for non-specific factors and experimenter allegiance to the different treatments. Adults with FM (N = 270) will be randomized to 1 of 3 treatment groups, which will receive 1 individual and 8 group-format treatment sessions. A comprehensive battery of outcome measures, including both psychophysical pain and objective activity measures, will be assessed at baseline and two post-treatment evaluations over a 1-year follow-up. We will test whether both active treatments are more efficacious than the control condition, and whether EET surpasses CBT on affective outcomes and CBT surpasses EET on behavioral outcomes. This study also will test whether the effects of the interventions are mediated by treatment-specific or more general change processes, including improved autonomic regulation as indexed by heart rate variability, increased emotional awareness and expression, and improved pain coping. Finally, because FM is increasingly recognized as heterogeneous and only a subset of patients have any given risk factor-including stress and emotional avoidance-we will explore several proposed moderators of the effects of EET and CBT, including trauma history, emotion regulation abilities, depression, and interpersonal difficulties. This research has the potential to greatly advance treatment options and success rates for FM and other conditions that are influenced by stress and emotional regulation problems, and it will illuminate change processes, individual differences, and treatment matching or tailoring. PUBLIC HEALTH RELEVANCE: Fibromyalgia (FM) is a common and disabling pain condition, and currently available medical and behavioral treatments have limited effect, perhaps because they do not address the unresolved stress and emotion regulation problems that are found in many patients with FM. In a large sample of patients with FM, we will test the effects of an innovative emotional exposure and processing treatment that targets stress resolution, by comparing it with cognitive-behavioral therapy and a placebo control condition. We also will test proposed mediators of the interventions, including improved autonomic regulation, and explore which subgroups of patients benefit the most from each approach.
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1 |
2014 |
Arnetz, Bengt Birger Lumley, Mark A |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Mental Health in Iraqi Refugees: Importance of Post-Displacement Social Stressors
DESCRIPTION (provided by applicant): Refugees are at a strikingly elevated risk of suffering from post-displacement mental disorders, with severe implications for social and occupational functioning while increasing the burden and costs of mental health and social services. Studies have identified pre-displacement individuals and socio-environmental risk factors for refugee mental health. These factors, e.g., exposure to war trauma, are largely non-malleable. However, there is increasing scientific evidence of adverse mental health effects from post-displacement trauma, including violence, and marginalization. As a result, there is a need to assess the efficacy of post-displacement institutional resources, such as language and vocational training. Although significant resources are devoted to such post-displacement programs, there is a void of prospective, controlled studies examining their effectiveness in promoting refugees' mental health. The long-term goal of this research is to further our understanding of post-displacement institutional risk and resiliency factors for mental health. The overall objective of this proposal is to compare mental health over time in a random sample of newly arrived Iraqi refugees and legal Middle East immigrant controls. The central hypothesis, based on our pilot data, is that post-displacement institutional resources attenuate mental health consequences of post-displacement stress, controlling for pre-displacement trauma. The primary specific aims are to: 1) Describe the differences in mental health disorders, specifically post-traumatic stress disorder (PTSD) and depression, between newly arrived Iraqi refugees and non-war exposed Arab immigrant to the U.S. and their relationship to pre-displacement trauma; 2: Determine the relationship between pre-displacement trauma and post-displacement stressors as it relates prospectively to mental health over a 2-year period, and whether this relationship differs between refugees and immigrants; and 3: Determine the impact of post-migration institutional services on mental health and whether effects differ by group. This research is innovative in that it uses a random sampling, prospective, controlled design to study important mental health among newly arrived refugees. Our multi-disciplinary team, with excellent relationships to the Arab and Chaldean American community, will thus evaluate multiple levels of predictors of mental health: group (refugee vs. immigrant), pre- and post-displacement trauma, institutional resources (service utilization), and interactions between these factors. The expected outcome is improved understanding of the relationship between trauma, social service utilization and mental health. The project is of
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1 |
2018 — 2019 |
Junghaenel, Doerte Ulrike [⬀] Lumley, Mark A |
R21Activity Code Description: To encourage the development of new research activities in categorical program areas. (Support generally is restricted in level of support and in time.) |
Development and Preliminary Testing of Novel Virtual Human-Assisted Psychosocial Interviews For Patients With Chronic Musculoskeletal Pain @ University of Southern California
Project Summary / Abstract Chronic musculoskeletal pain is associated with significant psychosocial difficulties. Unfortunately, patients and medical providers find it difficult to discuss psychosocial factors, and these often remain unaddressed during the medical visit. The goal of the proposed application is to develop next-generation Virtual Human-assisted therapeutic interviews that can be integrated in current pain practice to engage patients in a conversation about psychosocial problems associated with their chronic pain. Virtual Humans (VHs) are computer-animated characters that mimic the appearance and behavior of a real person and that can be used as virtual interviewers. This novel technology also makes it possible to implement different experimental conditions with a great degree of standardization, thereby enhancing internal validity and reproducibility, while maintaining a high level of authenticity. Our team?s existing VH prototype has been successfully used to elicit self-disclosure. We propose to adapt our VH for use in patients with chronic pain in preparation for a subsequent large-scale clinical trial. In Phase 1 of the application, we will develop VH-assisted psychosocial interviews specifically for chronic pain. They will address two theoretically important yet divergent targets of communication: (1) psychosocial consequences resulting from the experience of chronic pain (e.g., depression, relationship disruption); and (2) possible psychosocial contributors that may trigger, exacerbate, or maintain chronic pain (e.g., background stressful events, pain attributions). Development of the VH-assisted psychosocial interviews will be guided by prior research on emotion-focused treatment, our extensive clinical expertise, and qualitative feedback from patient stakeholders. In Phase 2, we will bring our VH into the clinic and conduct preliminary feasibility and efficacy testing. Patients will be randomly assigned to one of four experimental conditions in a 2 x 2 factorial design, in which the VH will address (a) psychosocial consequences of chronic pain, (b) psychosocial contributors to chronic pain, (c) a combination of both, or (d) neither (attention control group). All patients will engage in a single VH interview session before their initial medical consultation. Feasibility will be established through participation rates, potential patient concerns about discussing psychosocial stressors with the VH, clinic flow, and stakeholder satisfaction. Based on existing theoretical frameworks, we expect that the VH sessions will impact patient outcomes through improved patient emotion regulation, working memory, and patient-provider relations; shifts in pain attitudes, and increased motivation for behavioral pain management. The pilot data collected in this application will provide essential preliminary information on the therapeutic mechanisms and patient health benefits of the VH-assisted communication approaches. This proposal is expected to be impactful because it 1) utilizes novel yet promising next-generation VH methodology; 2) tests theories and advances practice about how patients? psychosocial problems related to pain should be addressed in pain management; and 3) examines the feasibility and clinical utility of integrating VHs into pain care.
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0.943 |