Masuda, Akihiko; Twohig, M. P.; Stormo, A. R.; Feinstein, A B.; Chou, Y.; and Wendell, J. W., "The effects of cognitive defusion and thought distraction on emotional discomfort and believability of negative self-referential thoughts" (2010 Previous research has shown that rapid vocal repetition of a one-word version of negative self-referential thought reduces the stimulus functions (e.g., emotional discomfort and believability) associated with that thought. The present study compares the effects of that defusion strategy with thought distraction and distraction-based experimental control tasks on a negative self-referential thought. Non-clinical undergraduates were randomly assigned to one of three protocols. The cognitive defusion condition reduced the emotional discomfort and believability of negative self-referential thoughts significantly greater than comparison conditions. Favorable results were also found for the defusion technique with participants with elevated depressive symptoms.

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These findings suggest that guilt may be a mechanism through which abusive violence is related to PTSD and MDD among combat-deployed Veterans. These findings also suggest the importance of assessing abusive-violence related guilt among combat-deployed Veterans and implementing relevant interventions for such guilt whenever indicated.

Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.

The pediatric adaptation of the Collaborative Health Outcomes Information Registry (Peds-CHOIR) is a free, open source, flexible learning health care system (LHS) that meets the call by the Institute of Medicine (IOM) for the development of national registries to guide research and precision pain medicine. This report is a technical account of the first application of Peds-CHOIR with three aims: to 1) describe the design and implementation process of the LHS; 2) highlight how the clinical system concurrently cultivates a research platform rich in breadth (e.g., clinic characteristics) and depth (e.g., unique patient and caregiver reporting patterns); and 3) demonstrate the utility of capturing patient-caregiver dyad data in real time, with dynamic outcomes tracking that informs clinical decisions and delivery of treatments. Technical, financial, and systems-based considerations of Peds-CHOIR are discussed. Cross-sectional, retrospective data from patients with chronic pain (N = 352; 8 – 17 years; M = 13.9 years) and their caregivers are reported, including NIH Patient Reported Outcomes Measurement Information System (PROMIS) domains (mobility, pain interference, fatigue, peer relations, anxiety and depression) and the Pain Catastrophizing Scale. Consistent with the literature, analyses of initial visits revealed impairments across physical, psychological and social domains. Patients and caregivers evidenced agreement in observable variables (mobility); however, caregivers consistently endorsed greater impairment regarding internal experiences (pain interference, fatigue, peer relations, anxiety, depression) than patients’ self-report. A platform like Peds-CHOIR highlights predictors of chronic pain outcomes on a group level and facilitates individually tailored treatment(s). Challenges of implementation and future directions are discussed.