The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative.

Objective: Despite empirical support for interdisciplinary pain rehabilitation programs improving functioning and quality of life, access to this treatment approach has decreased dramatically over the last 20 years within the United States but has grown significantly in the Department of Veterans Affairs (VA). Between 2009 and 2019, VA pain rehabilitation programs accredited by the Commission on Accreditation of Rehabilitation Facilities increased 10-fold in the VA, expanding from two to 20. The aim of this collaborative observational evaluation was to examine patient outcomes across a subset of six programs at five sites.

An Interdisciplinary Pain Rehabilitation Program for Veterans with Chronic Pain: Description and Initial Evaluation of Outcomes.

Objective: Chronic pain conditions are prominent among Veterans. To leverage the biopsychosocial model of pain and comprehensively serve Veterans with chronic pain, the San Francisco Veterans Affairs Healthcare System has implemented the interdisciplinary pain rehabilitation program (IPRP). This study aims to (1) understand initial changes in treatment outcomes following IPRP, (2) investigate relationships between psychological factors and pain outcomes, and (3) explore whether changes in psychological factors predict changes in pain outcomes.

Tele-pain management: use of videoconferencing technology in the delivery of an integrated cognitive-behavioral and physical therapy group intervention.

Chronic pain has been recognized as a highly prevalent problem, and interdisciplinary treatments have been shown to be effective in the treatment of chronic pain. An integrated cognitive-behavioral and physical therapy group protocol has been developed and then implemented at remote sites using videoconferencing technology to provide pain management for veterans. The treatment model is summarized and recommendations are made for addressing challenges in implementing this type of treatment via videoconferencing.

The Driving Behavior Survey: scale construction and validation.

Although long recognized in the clinical literature, problematic behavior characteristic of anxious drivers has received little empirical attention. The current research details development of a measure of anxious driving behavior conducted across three studies. Factor analytic techniques identified three dimensions of maladaptive behaviors across three college samples: anxiety-based performance deficits, exaggerated safety/caution behavior, and anxiety-related hostile/aggressive behavior.

Understanding the interpersonal impact of trauma: contributions of PTSD and depression.

To build on the growing literature on interpersonal relationships among individuals with PTSD, this study examined the separate influences of PTSD symptoms and depression on functioning with friends, romantic partners, and family. To examine the influence of measurement, both interviewer-rated assessment of interpersonal functioning and self-reported assessment of perceived social support were included. The sample included 109 community members who sought help for mental health problems in the aftermath of a serious motor vehicle accident.

The structure of distress following trauma: posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder.

The current report used confirmatory factor analysis to examine the latent structures of both key features and associated symptoms of three disorders that commonly develop following a traumatic event: posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Participants were 228 motor-vehicle accident survivors who sought treatment for emotional difficulties. PTSD, MDD, and GAD were assessed with a combination of self-report and interview-based measures.

Unpacking the relationship between posttraumatic numbing and hyperarousal in a sample of help-seeking motor vehicle accident survivors: replication and extension.

The current study is a replication and extension of previous research that has found support for a relationship between posttraumatic numbing and hyperarousal. This study examined this association while controlling for depression in 345 motor vehicle accident survivors. Additionally, the relationships among specific hyperarousal symptoms and numbing were explored.

An examination of the synergy of pain and PTSD on quality of life: additive or multiplicative effects?

Although models have been proposed to explain common factors that maintain comorbid pain and PTSD [Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev 2001; 21: 857-77], the exact nature of the relationship between these two conditions and their impact on quality of life (QOL) is unknown. The aim of the present investigation was to examine the unique and interactive effects of PTSD and pain on role functioning and life satisfaction--two important domains of QOL.

Development and examination of the social appearance anxiety scale.

The Social Appearance Anxiety Scale (SAAS) was created to measure anxiety about being negatively evaluated by others because of one's overall appearance, including body shape. This study examined the psychometric properties of the SAAS in three large samples of undergraduate students (respective ns = 512, 853, and 541). The SAAS demonstrated a unifactorial structure with high test-retest reliability and internal consistency.

The impact of event scale-revised: psychometric properties in a sample of motor vehicle accident survivors.

This study examined the factor structure, internal consistency, concurrent validity, and discriminative validity of the Impact of Event Scale-Revised (IES-R, [Weiss, D. S. & Marmar, C.

Virtual Reality Exposure Therapy for PTSD symptoms after a road accident: an uncontrolled case series.

This report examined whether Virtual Reality Exposure Therapy (VRET) could be used in the treatment of posttraumatic stress disorder (PTSD) symptoms in the aftermath of a serious motor vehicle accident. Six individuals reporting either full or severe subsyndromal PTSD completed 10 sessions of VRET, which was conducted using software designed to create real-time driving scenarios. Results indicated significant reductions in posttrauma symptoms involving reexperiencing, avoidance, and emotional numbing, with effect sizes ranging from d=.

Rebound effects following deliberate thought suppression: does PTSD make a difference?

This study was designed to examine the effects of deliberate suppression of trauma-related thoughts in 44 individuals who were PTSD+ and 26 individuals who were PTSD- following a motor vehicle accident (MVA). In an effort to resolve discrepancies in the literature, the PTSD- group was selected from the same help-seeking population as the patient group. Measures included the percentage of MVA-related thoughts, mood, perceived controllability of thoughts, and physiological arousal (heart rate, skin conductance, and two measures of facial EMG).

Screening for PTSD in motor vehicle accident survivors using the PSS-SR and IES.

The current study compares the total scores of two potential posttraumatic stress disorder (PTSD) screening tools, the Impact of Event Scale (IES) and the PTSD Symptom Scale, Self-Report (PSS-SR), to the Clinician-Administered PTSD Scale (CAPS) in a large sample of motor vehicle accident (MVA) survivors (N = 229, of whom 43% met criteria for PTSD). For the IES using a cutoff score of 27, sensitivity was .91, specificity was .

What factors are associated with the maintenance of PTSD after a motor vehicle accident? The role of sex differences in a help-seeking population.

To investigate potential sex differences in factors that are associated with chronic PTSD, data from 223 participants were examined using logistic regression analyses. Each participant had been involved in a serious motor vehicle accident (MVA), which had occurred at least 6 months earlier (range 6mos-37 years). Although men and women did not differ in the rate of diagnosed PTSD, four variables were found to interact significantly with sex in the prediction of chronic PTSD: peritraumatic experiences of helplessness, danger, and the certainty that one would die during the MVA and lack of employment.

Post-traumatic stress disorder symptoms, pain, and perceived life control: associations with psychosocial and physical functioning.

The symptoms of PTSD and pain frequently co-occur following a traumatic event; however, very little is known about how these two conditions are associated with physical and psychosocial functioning. The current study intended to first examine the differential association of co-occurring pain complaints and PTSD symptoms with disability in the domains of psychosocial and physical functioning, and second, to test whether perceived life control is a mediator of these relationships. All participants experienced a motor vehicle accident (MVA) and reported pain due to accident-related injuries (n=183).

Quality of life and post trauma symptomatology in motor vehicle accident survivors: the mediating effects of depression and anxiety.

We examined the respective contributions of depression, anxiety, and post-trauma symptoms, as these factors reduce quality of life (QOL) in 111 individuals who had experienced a serious motor vehicle accident. Correlations and structural equation modeling were used to evaluate whether the severity of posttraumatic stress disorder symptoms influences QOL directly, and whether depression and anxiety mediated this relationship. Results indicated that post trauma symptomatology has a negative effect on QOL, which is mediated by depression and anxiety.

Is the concept of "repression" useful for the understanding chronic PTSD?

Theories concerning the value of avoiding versus attending to trauma-related thoughts provide mixed support for specific coping strategies such as repression. The goal of this study is to examine the usefulness of the concept of repression in understanding chronic Posttraumatic Stress Disorder (PTSD). One hundred and fifty individuals who had been in a motor vehicle accident were included.

Psychometric Properties of the Posttraumatic Cognitions Inventory (PTCI): a replication with motor vehicle accident survivors.

This study examined the factor structure, internal consistency, concurrent validity, discriminant validity, and discriminative validity of the Posttraumatic Cognitions Inventory (PTCI; E. B. Foa, A.