Child and Adolescent Psychology
Pediatric Pain Psychology
Instructor, Pediatrics - Gastroenterology
PhD Training:Duke University School of Medicine (2015) NC
Fellowship:Stanford Hospital and Clinics - Pain Mgmt (2016) CA
Internship:Stanford University Clinics and Lucile Packard Children's Hospital (2015) CA
Fellowship, Stanford University School of Medicine, Pain Psychology (2016)
Internship, Lucile Packard Children's Hospital/Children's Health Council, Child Psychology (2015)
PhD, Duke University, Clinical Psychology (2015)
Mind-Body Interventions for Pediatric Inflammatory Bowel Disease.
Children (Basel, Switzerland)
2017; 4 (4)
Pediatric inflammatory bowel disease is an autoimmune disease that causes chronic inflammation of the gastrointestinal mucosa. There is emerging evidence that the brain-gut connection affects inflammatory bowel disease (IBD) patients more than previously thought. This is evidenced by comorbid mood disorders, irritable bowel symptoms concurrent with quiescent IBD, and the potential of psychosocial stressors to trigger IBD flares. Mind-body interventions such as psychotherapy, relaxation, mindfulness, biofeedback, yoga, and clinical hypnosis offer an adjunct to standard medical treatment for IBD. We will review the current evidence base for these mind- body interventions in the treatment of pediatric IBD, illustrate a case study, and offer suggestions for future research for this promising field.
View details for DOI 10.3390/children4040022
View details for PubMedID 28368365
Cognitive problems following hematopoietic stem cell transplant: relationships with sleep, depression and fatigue.
Bone marrow transplantation
2017; 52 (2): 279–84
Cognitive problems are a significant, persistent concern for patients undergoing hematopoietic stem cell transplant (HSCT). Sleep is important for many cognitive tasks; however, the relationship between sleep and cognitive problems for HSCT patients is unknown. This study examined the relationship between sleep and cognitive problems for HSCT patients from pre to post transplant. Patients undergoing HSCT (N=138) completed questionnaires at pre-transplant and during the 12 months following transplant. Questionnaires assessed sleep and cognitive problems as well as commonly co-occurring symptoms: depressive symptoms, fatigue and pain. Post hoc analyses examined the relationship of specific sleep problems with cognitive problems. Sleep problems covaried with cognitive problems even after controlling for depressive symptoms, fatigue and pain. Depressive symptoms and fatigue were also uniquely related to cognitive problems. Post hoc analyses suggest that sleep somnolence, shortness of breath, snoring and perceptions of inadequate sleep may contribute to the association found between sleep and cognitive problems. Findings suggest that sleep problems are associated with and may contribute to cognitive problems for HSCT patients. However, sleep problems are rarely screened for or discussed during clinic visits. Assessing and treating specific sleep problems in addition to depressive symptoms and fatigue may have implications for improving cognitive problems for HSCT patients.
View details for DOI 10.1038/bmt.2016.248
View details for PubMedID 27941775
Imaging-Guided Core-Needle Breast Biopsy: Impact of Meditation and Music Interventions on Patient Anxiety, Pain, and Fatigue
JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY
2016; 13 (5): 526-534
To evaluate the impact of guided meditation and music interventions on patient anxiety, pain, and fatigue during imaging-guided breast biopsy.After giving informed consent, 121 women needing percutaneous imaging-guided breast biopsy were randomized into three groups: (1) guided meditation; (2) music; (3) standard-care control group. During biopsy, the meditation and music groups listened to an audio-recorded, guided, loving-kindness meditation and relaxing music, respectively; the standard-care control group received supportive dialogue from the biopsy team. Immediately before and after biopsy, participants completed questionnaires measuring anxiety (State-Trait Anxiety Inventory Scale), biopsy pain (Brief Pain Inventory), and fatigue (modified Functional Assessment of Chronic Illness Therapy-Fatigue). After biopsy, participants completed questionnaires assessing radiologist-patient communication (modified Questionnaire on the Quality of Physician-Patient Interaction), demographics, and medical history.The meditation and music groups reported significantly greater anxiety reduction (P values < .05) and reduced fatigue after biopsy than the standard-care control group; the standard-care control group reported increased fatigue after biopsy. The meditation group additionally showed significantly lower pain during biopsy, compared with the music group (P = .03). No significant difference in patient-perceived quality of radiologist-patient communication was noted among groups.Listening to guided meditation significantly lowered biopsy pain during imaging-guided breast biopsy; meditation and music reduced patient anxiety and fatigue without compromising radiologist-patient communication. These simple, inexpensive interventions could improve women's experiences during core-needle breast biopsy.
View details for DOI 10.1016/j.jacr.2015.12.004
View details for Web of Science ID 000375357700010
View details for PubMedID 26853501
Positive and negative mood following imaging-guided core needle breast biopsy and receipt of biopsy results.
Psychology, health & medicine
Positive and negative mood are independent psychological responses to stressful events. Negative mood negatively impacts well-being and co-occurring positive mood leads to improved adjustment. Women undergoing core needle breast biopsies (CNB) experience distress during CNB and awaiting results; however, influences of mood are not well known. This longitudinal study examines psychosocial and biopsy- and spirituality-related factors associated with mood in patients day of CNB and one week after receiving results. Ninety women undergoing CNB completed questionnaires on psychosocial factors (chronic stress, social support), biopsy experiences (pain, radiologist communication), and spirituality (peace, meaning, faith) day of CNB. Measures of positive and negative mood were completed day of CNB and one week after receiving results (benign n = 50; abnormal n = 25). Multiple linear regression analyses were conducted. Greater positive mood correlated with greater peace (β = .25, p = .02) day of CNB. Lower negative mood correlated with greater peace (β = -.29, p = .004) and there was a trend for a relationship with less pain during CNB (β = .19, p = .07). For patients with benign results, day of CNB positive mood predicted positive mood post-results (β = .31, p = .03) and only chronic stress predicted negative mood (β = .33, p = .03). For women with abnormal results, greater meaning day of CNB predicted lower negative mood post-results (β = -.45, p = .03). Meaning and peace may be important for women undergoing CNB and receiving abnormal results.
View details for DOI 10.1080/13548506.2016.1271438
View details for PubMedID 28007008
A Pilot Study of a Mobile Health Pain Coping Skills Training Protocol for Patients With Persistent Cancer Pain
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
2015; 50 (4): 553-558
Pain coping skills training (PCST) interventions have shown efficacy for reducing pain and providing other benefits in patients with cancer. However, their reach is often limited because of a variety of barriers (e.g., travel, physical burden, cost, time).This study examined the feasibility and acceptability of a brief PCST intervention delivered to patients in their homes using mobile health (mHealth) technology. Pre-to-post intervention changes in pain, physical functioning, physical symptoms, psychological distress, self-efficacy for pain management, and pain catastrophizing also were examined.Patients with a diagnosis of breast, lung, prostate, or colorectal cancer who reported persistent pain (N = 25) participated in a four-session intervention delivered using mHealth technology (videoconferencing on a tablet computer). Participants completed measures of pain, physical functioning, physical symptoms, psychological distress, self-efficacy for pain management, and pain catastrophizing. We also assessed patient satisfaction.Participants completed an average of 3.36 (SD = 1.11) of the four intervention sessions for an overall session completion rate of 84%. Participants reported that the program was of excellent quality and met their needs. Significant preintervention to postintervention differences were found in pain, physical symptoms, psychological distress, and pain catastrophizing.The use of mHealth technology is a feasible and acceptable option for delivery of PCST for patients with cancer. This delivery mode is likely to dramatically increase intervention access for cancer patients with pain compared to traditional in-person delivery. Preliminary data also suggest that the program is likely to produce pretreatment to post-treatment decreases in pain and other important outcomes.
View details for DOI 10.1016/j.jpainsymman.2015.04.013
View details for Web of Science ID 000362093800018
View details for PubMedID 26025279
Anxiety prior to breast biopsy: Relationships with length of time from breast biopsy recommendation to biopsy procedure and psychosocial factors.
Journal of health psychology
This study investigated how time from breast biopsy recommendation to biopsy procedure affected pre-biopsy anxiety (N = 140 women), and whether the relationship between wait time and anxiety was affected by psychosocial factors (chronic life stress, traumatic events, social support). Analyses showed a significant interaction between wait time and chronic life stress. Increased time from biopsy recommendation was associated with greater anxiety in women with low levels of life stress. Women with high levels of life stress experienced increased anxiety regardless of wait time. These results suggest that women may benefit from shorter wait times and receiving strategies for managing anxiety.
View details for DOI 10.1177/1359105315607828
View details for PubMedID 26424811
Self-efficacy for coping with symptoms moderates the relationship between physical symptoms and well-being in breast cancer survivors taking adjuvant endocrine therapy
SUPPORTIVE CARE IN CANCER
2014; 22 (10): 2851-2859
This study examined the relationships between physical symptoms, self-efficacy for coping with symptoms, and functional, emotional, and social well-being in women who were taking adjuvant endocrine therapy for breast cancer.One hundred and twelve women who were taking adjuvant endocrine therapy (tamoxifen or an aromatase inhibitor) for breast cancer completed measures of physical symptoms, self-efficacy for coping with symptoms, and functional, social, and emotional well-being at the time of routine medical follow-up (women were on average 3.4 years post-surgery; range 3 months to 11 years).Multiple linear regression analyses showed that higher self-efficacy for coping with symptoms was associated with greater functional, emotional, and social well-being after controlling for physical symptoms (p < 0.05). Self-efficacy for coping with symptoms moderated the relationship between physical symptoms and functional (B = 0.05, SE = 0.02, t = 2.67, p = 0.009) and emotional well-being (B = 0.03, SE = 0.01, t = 2.45, p = 0.02). As self-efficacy increased, the relationship between greater physical symptoms and lower well-being became weaker. Among women with high levels of self-efficacy, physical symptoms were not related to functional and emotional well-being.Self-efficacy for coping with symptoms may reduce the negative impact of physical symptoms and contribute to well-being in breast cancer survivors taking adjuvant endocrine therapy. Future studies could examine whether psychosocial interventions aimed at increasing self-efficacy for managing symptoms help women better cope with treatment side effects and improve quality of life.
View details for DOI 10.1007/s00520-014-2269-1
View details for Web of Science ID 000341713400035
View details for PubMedID 24821365
Holding Back Moderates the Association Between Health Symptoms and Social Well-Being in Patients Undergoing Hematopoietic Stem Cell Transplantation
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
2014; 48 (3): 374-384
Holding back, or withholding discussion of disease-related thoughts and emotions, is associated with negative outcomes including lower quality of life, diminished well-being, and relational distress. For patients undergoing hematopoietic stem cell transplantation (HSCT), the degree to which one holds back from discussing illness-related concerns may be an important determinant of social well-being and health; however, this has not been systematically assessed in this population.The purpose of the present study was to assess the moderating effects of holding back discussion of disease-related concerns on the relationship between health-related symptoms and social well-being in adult patients undergoing HSCT.Seventy autologous (n = 55) and allogeneic (n = 15) HSCT patients completed measures of holding back, social well-being, and health symptoms (i.e., pain, fatigue, sleep problems, cognitive problems) both before and after transplantation (i.e., three months after transplantation and six months after transplantation).In patients with average to high levels of holding back, health symptoms were significantly related to lower levels of social well-being; however, for patients with low levels of holding back, the relationship between health symptoms and social well-being was not significant.The results of the present study suggest that the level of holding back may be important in understanding how health-related symptoms relate to social well-being in patients undergoing HSCT. These findings underscore the importance of addressing how patients undergoing HSCT communicate about their disease with others as this may be related to their adjustment to illness and treatment.
View details for DOI 10.1016/j.jpainsymman.2013.09.019
View details for Web of Science ID 000341990700007
View details for PubMedID 24529631
Pain, physical functioning, and overeating in obese rheumatoid arthritis patients: do thoughts about pain and eating matter?
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
2014; 20 (5): 244-250
Obese rheumatoid arthritis (RA) patients have higher levels of pain, disability, and disease activity than do nonobese patients with RA. Patients' health-related thoughts about arthritis and weight may be important to consider in obese patients with RA who face the dual challenge of managing RA and weight.The objective of this study was to examine the relationships of pain catastrophizing, self-efficacy (ie, confidence) for arthritis management and self-efficacy for weight management to important outcomes in obese patients with RA. We expected that after controlling for demographic and medical variables, higher levels of pain catastrophizing and lower levels of confidence would account for significant and unique variance in pain, physical functioning, and overeating.Participants had a diagnosis of RA and a body mass index of 28 kg/m or greater and completed self-report questionnaires assessing pain, physical functioning, overeating, pain catastrophizing, self-efficacy for arthritis management, self-efficacy for weight management, and a 6-minute walk test.Pain catastrophizing, self-efficacy for arthritis, and self-efficacy for weight management were significantly and uniquely related to RA-related outcomes. Pain catastrophizing was a significant independent predictor of pain severity (β = 0.38); self-efficacy for arthritis was a significant independent predictor of self-report physical functioning (β = -0.37) and the 6-minute walk performance (β = 0.44), and self-efficacy for weight management was a significant independent predictor of overeating (β = -0.58).Pain catastrophizing, self-efficacy for arthritis, and self-efficacy for weight management each contributed uniquely to relate to key outcomes in obese patients with RA. Clinicians should consider assessment of thought processes when assessing and intervening with patients who face dual health challenges; unique intervention approaches may be needed for addressing the challenges of arthritis and weight.
View details for DOI 10.1097/RHU.0000000000000124
View details for PubMedID 25036564
Predictors of Pain Experienced by Women During Percutaneous Imaging-Guided Breast Biopsies
JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY
2014; 11 (7): 709-716
The purpose of this study was to evaluate pain experienced during imaging-guided core-needle breast biopsies and to identify factors that predict increased pain perception during procedures.In this institutional review board-approved, HIPAA-compliant protocol, 136 women undergoing stereotactically or ultrasound-guided breast biopsy or cyst aspiration were recruited and provided written informed consent. Participants filled out questionnaires assessing anticipated biopsy pain, ongoing breast pain, pain experienced during biopsy, catastrophic thoughts about pain during biopsy, anxiety, perceived communication with the radiologist, chronic life stress, and demographic and medical information. Procedure type, experience level of the radiologist performing the biopsy, number of biopsies, breast density, histology, and tumor size were recorded for each patient. Data were analyzed using Spearman's ρ correlations and a probit regression model.No pain (0 out of 10) was reported by 39.7% of women, mild pain (1-3 out of 10) by 48.5%, and moderate to severe pain (≥4 out of 10) by 11.8% (n = 16). Significant (P < .05) predictors of greater biopsy pain in the probit regression model included younger age, greater prebiopsy breast pain, higher anticipated biopsy pain, and undergoing a stereotactic procedure. Anticipated biopsy pain correlated most strongly with biopsy pain (β = .27, P = .004).Most patients report minimal pain during imaging-guided biopsy procedures. Women experiencing greater pain levels tended to report higher anticipated pain before the procedure. Communication with patients before biopsy regarding minimal average pain reported during biopsy and encouragement to make use of coping strategies may reduce patient anxiety and anticipated pain.
View details for DOI 10.1016/j.jacr.2014.01.013
View details for Web of Science ID 000338800500016
View details for PubMedID 24993536
Psychosocial interventions for managing pain in older adults: outcomes and clinical implications
BRITISH JOURNAL OF ANAESTHESIA
2013; 111 (1): 89-94
Interest in the use of psychosocial interventions to help older adults manage pain is growing. In this article, we review this approach. The first section reviews the conceptual background for psychosocial interventions with a special emphasis on the biopsychosocial model of pain. The second section highlights three psychosocial interventions used with older adults: cognitive behavioural therapy, emotional disclosure, and mind-body interventions (specifically mindfulness-based stress reduction and yoga). The final section of the paper highlights important future directions for work in this area.
View details for DOI 10.1093/bja/aet129
View details for Web of Science ID 000321061500015
View details for PubMedID 23794650
- Optimism and pain: A positive move forward PAIN 2013; 154 (1): 7-8
The Context of Pain in Arthritis: Self-efficacy for Managing Pain and Other Symptoms
CURRENT PAIN AND HEADACHE REPORTS
2012; 16 (6): 502-508
Arthritis pain may be best understood in the context of a biospychosocial model of pain. The biopsychosocial model of pain suggests that adjustment to arthritis pain is multifaceted and is influenced by biological, psychological, and social factors. One psychological construct that appears to be particularly helpful in understanding arthritis pain is patients' self-efficacy for managing pain and other symptoms. In recent work, investigators have included self-efficacy for managing pain and other symptoms as key outcome measures in behavioral and psychosocial intervention studies. The goal of this article was to review recent intervention studies that have examined the effect of behavioral and psychosocial interventions on self-efficacy for managing pain and other symptoms. Throughout the article, we make several suggestions for future clinical and research considerations regarding the role of self-efficacy for managing pain and other symptoms in the context of arthritis pain.
View details for DOI 10.1007/s11916-012-0298-3
View details for Web of Science ID 000310952200003
View details for PubMedID 23054977
Self-Compassion in Patients With Persistent Musculoskeletal Pain: Relationship of Self-Compassion to Adjustment to Persistent Pain
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
2012; 43 (4): 759-770
Self-compassion entails qualities such as kindness and understanding toward oneself in difficult circumstances and may influence adjustment to persistent pain. Self-compassion may be a particularly influential factor in pain adjustment for obese individuals who suffer from persistent pain, as they often experience heightened levels of pain and lower levels of psychological functioning.The purpose of the present study was to examine the relationship of self-compassion to pain, psychological functioning, pain coping, and disability among patients who have persistent musculoskeletal pain and who are obese.Eighty-eight obese patients with persistent pain completed a paper-and-pencil self-report assessment measure before or after their appointment with their anesthesiologist.Hierarchical linear regression analyses demonstrated that even after controlling for important demographic variables, self-compassion was a significant predictor of negative affect (β=-0.48, P<0.001), positive affect (β=0.29, P=0.01), pain catastrophizing (β=-0.32, P=0.003), and pain disability (β=-0.24, P<0.05).The results of this study indicate that self-compassion may be important in explaining the variability in pain adjustment among patients who have persistent musculoskeletal pain and are obese.
View details for DOI 10.1016/j.jpainsymman.2011.04.014
View details for Web of Science ID 000303194400015
View details for PubMedID 22071165
Pain Acceptance, Hope, and Optimism: Relationships to Pain and Adjustment in Patients With Chronic Musculoskeletal Pain
JOURNAL OF PAIN
2011; 12 (11): 1155-1162
There is growing interest in the role that positive aspects of psychological adjustment, such as pain acceptance, hope, and optimism, may play in explaining adjustment in persons suffering from persistent pain. This study conducted in obese patients with persistent musculoskeletal pain (N = 89) examined the degree to which pain acceptance and hope explained pain intensity, pain unpleasantness, psychological distress, and pain-related disability, after controlling for the effects of optimism. In correlational analyses, pain acceptance and optimism were associated with psychological distress and pain disability with hope being related to only psychological distress. Pain acceptance, optimism, and hope were not significantly associated with pain. Hierarchical linear regression (HLR) analyses found that pain acceptance remained a significant predictor of psychological distress and pain disability after controlling for optimism, demographic, and medical variables. HLR analyses found that hope was not a significant predictor of psychological distress after controlling for optimism, pain acceptance, and demographic and medical variables. The results of this study are important because they indicate that pain acceptance, hope, and optimism are all related to pain adjustment. They also highlight the importance of controlling for optimism when examining the effects of pain acceptance and hope on pain adjustment.In a sample of obese patients with persistent musculoskeletal pain, pain acceptance was a significant predictor of psychological distress and pain disability even after controlling for optimism, demographic, and medical variables. These results add to the growing literature on the importance of pain acceptance in understanding adjustment to persistent pain.
View details for DOI 10.1016/j.jpain.2011.06.002
View details for Web of Science ID 000297379800005
View details for PubMedID 21820969
- Yoga for persistent pain: New findings and directions for an ancient practice PAIN 2011; 152 (3): 477-480
- Understanding chronic pain in older adults: Abdominal fat is where it is at PAIN 2011; 152 (1): 8-9
Feasibility and effectiveness of a brief meditation-based stress management intervention for patients diagnosed with or at risk for coronary heart disease: A pilot study
PSYCHOLOGY HEALTH & MEDICINE
2009; 14 (5): 513-523
Extensive research has led to the development of a psychobiological model of cardiovascular disease. This model suggests that psychological factors such as depression, anxiety, hostility, and stress may affect the development and progression of coronary heart disease (CHD). Recent studies have also demonstrated that meditation-based stress reduction programs are useful interventions for patients with various medical and psychological symptoms. The objective of this pilot study was to gather preliminary information regarding the feasibility of implementing a brief meditation-based stress management (MBSM) program for patients with CHD, and those at high risk for CHD, at a major metropolitan hospital that serves a predominately non-local patient population. The secondary aim of this study was to investigate the possibility that such an intervention might reduce depression, as well as perceived stress, anxiety, and hostility, while improving general health scores. The overall feasibility results indicate that this MBSM intervention was highly feasible with regard to both recruitment and retention of participants. In fact, 40% of patients requested further training. In addition, after completion of the 4-week intervention, participants reported significant reductions in depression and perceived stress. In conclusion, the present study demonstrated that the brief meditation-based stress management program was well-received by patients and can successfully be used as a supportive program for patients at risk or diagnosed with CHD.
View details for DOI 10.1080/13548500902890087
View details for Web of Science ID 000271402800001
View details for PubMedID 19844830