My name is Karlyn (Karly) Edwards, and I am dual research and clinical T32 fellow working with Drs. Beth Darnall and Heather Poupore-King. In my research, I am interested in developing and studying brief digital interventions for chronic pain and opioid misuse/opioid use disorder. I am also interested in characterizing patient factors that facilitate treatment response to OUD medications (buprenorphine, methadone) and psychological interventions. Clinically, I have expertise in delivering acceptance-based interventions (mindfulness, ACT, self-compassion) for chronic pain.

I completed my B.A. in Psychology at the University of Puget Sound in Tacoma, WA in 2014. I then worked as a case manager at a local non-profit mental health agency serving low income communities, and later as a research assistant in Dr. Mark Jensen’s lab at the University of Washington. I completed my Ph.D. in Clinical Psychology at the University of New Mexico under the mentorship of Drs. Kevin Vowles and Katie Witkiewitz, and completed my clinical internship at the Seattle VA. During my PhD, my work focused on characterizing substance use among those with chronic pain, and testing acceptance-based interventions for chronic pain and opioid misuse.

Stanford Advisors

Research Interests

  • Psychology

Current Research and Scholarly Interests

Adapting and testing psychological interventions for chronic pain and opioid misuse, identifying patients factors related to psychological and medication treatment responsiveness, latent variable modeling, brief digital psychological interventions, Acceptance and Commitment Therapy, Mindfulness

Lab Affiliations

All Publications

  • Effects of hypnosis, mindfulness meditation, and education for chronic pain on substance use in veterans: A supplementary analysis of a randomized clinical trial. Rehabilitation psychology Turner, A. P., Edwards, K. A., Jensen, M. P., Ehde, D. M., Day, M. A., Williams, R. M. 2023


    To examine the impact of three behavioral interventions for chronic pain on substance use.Participants were 328 Veterans with chronic pain receiving care at one of two Veterans Affairs Medical Centers in the northwest United States. Participants were randomly assigned to one of three 8-week manualized in-person group treatments: (a) hypnosis (HYP), (b) mindfulness meditation (MM), or (c) active education control (ED). Substance use frequency was assessed using 10 individual items from the WHO-ASSIST, administered at baseline prior to randomization and at 3- and 6-month posttreatment.Baseline substance use (i.e., any use) in the past 3 months was reported by 22% (tobacco), 27% (cannabis), and 61% (alcohol) of participants. Use of all other substances assessed was reported by < 7% of participants. Results showed that MM, as compared to ED, significantly reduced risk of daily cannabis use by 85% and 81% at the 3- and 6-month posttreatment follow-ups, respectively, after adjusting for baseline use. HYP, as compared to ED, significantly reduced risk of daily cannabis use by 82% at the 6-month posttreatment follow-up after adjusting for baseline use. There was no intervention effect on tobacco or alcohol use at either posttreatment follow-up.HYP and MM for chronic pain may facilitate reductions in cannabis use, even when reducing such use is not a focus of treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

    View details for DOI 10.1037/rep0000507

    View details for PubMedID 37289535

  • The Impact Of Single-Session Behavioral Pain Management Class On Next Day Pain Intensity And Opioid Use Among People With Chronic Pain Taking Prescribed Daily Opioids: A Daily Dairy Study Edwards, K., Dildine, T., Herrick, A., You, D. S., Darnall, B., Ziadni, M. S. CHURCHILL LIVINGSTONE. 2023: 96-97
  • Rationale and design of a multisite randomized clinical trial examining an integrated behavioral treatment for veterans with co-occurring chronic pain and opioid use disorder: The pain and opioids integrated treatment in veterans (POSITIVE) trial. Contemporary clinical trials Vowles, K. E., Witkiewitz, K., Clarke, E., Schmidt, Z., Borsari, B., Edwards, K. E., Korecki, J. R., Moniz-Lewis, D. I., Bondzie, J. A., Mullins, C., Thoreson, C. I., Delacruz, J., Wilkins, C. H., Nelson, S., Delventura, J., Henderson, R., Katz, A., Hua, W., Watson, E., Baxley, C., Canlas, B. R., Pendleton, T., Herbst, E., Batki, S. 2023: 107096


    Chronic pain and opioid use disorder (OUD) individually represent a risk to health and well-being. Concerningly, there is evidence that they are frequently co-morbid. While few treatments exist that simultaneously target both conditions, preliminary work has supported the feasibility of an integrated behavioral treatment targeting pain interference and opioid misuse. This treatment combined Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Relapse Prevention (ACT+MBRP). This paper describes the protocol for the adequately powered efficacy study of this integrated treatment.A multisite randomized controlled trial will examine the efficacy of ACT+MBRP in comparison to a parallel education control condition, focusing on opioid safety and pain education. Participants include veterans (n = 160; 21-75 years old) recruited from three Veterans Administration (VA) Healthcare Systems with chronic pain who are on a stable dose of buprenorphine. Both conditions include twelve weekly 90 min group sessions delivered via telehealth. Primary outcomes include pain interference (Patient Reported Outcome Measurement Information System - Pain Interference) and hazardous opioid use (Current Opioid Misuse Measure), which will be examined at the end of the active treatment phase and through 12 months post-intervention. Secondary analyses will evaluate outcomes including pain intensity, depression, pain-related fear, and substance use, as well as treatment mechanisms.This study will determine the efficacy of an integrated behavioral treatment program for pain interference and hazardous opioid use among veterans with chronic pain and OUD who are prescribed buprenorphine, addressing a critical need for more integrated treatments for chronic pain and Identifier: NCT04648228.

    View details for DOI 10.1016/j.cct.2023.107096

    View details for PubMedID 36693589

  • Opening the Black Box of Psychological Treatments for Chronic Pain: A Clinical Perspective for Medical Providers. PM & R : the journal of injury, function, and rehabilitation Edwards, K. A., Reed, D. E., Anderson, D., Harding, K., Turner, A. P., Soares, B., Suri, P., Williams, R. M. 2023

    View details for DOI 10.1002/pmrj.12912

    View details for PubMedID 36633497

  • Innovative treatment formats, technologies, and clinician trainings that improve access to behavioral pain treatment for youth and adults. Frontiers in pain research (Lausanne, Switzerland) Darnall, B. D., Edwards, K. A., Courtney, R. E., Ziadni, M. S., Simons, L. E., Harrison, L. E. 2023; 4: 1223172


    Chronic pain is prevalent across the life span and associated with significant individual and societal costs. Behavioral interventions are recommended as the gold-standard, evidence-based interventions for chronic pain, but barriers, such as lack of pain-trained clinicians, poor insurance coverage, and high treatment burden, limit patients' ability to access evidenced-based pain education and treatment resources. Recent advances in technology offer new opportunities to leverage innovative digital formats to overcome these barriers and dramatically increase access to high-quality, evidenced-based pain treatments for youth and adults. This scoping review highlights new advances. First, we describe system-level barriers to the broad dissemination of behavioral pain treatment. Next, we review several promising new pediatric and adult pain education and treatment technology innovations to improve access and scalability of evidence-based behavioral pain treatments. Current challenges and future research and clinical recommendations are offered.

    View details for DOI 10.3389/fpain.2023.1223172

    View details for PubMedID 37547824

  • Changes in Pain During Buprenorphine Maintenance Treatment Among Patients With Opioid Use Disorder and Chronic Pain JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Edwards, K. A., Vowles, K. E., McHugh, R., Venner, K. L., Witkiewitz, K. 2022


    Opioid use disorder (OUD) and chronic pain frequently co-occur. Little is known about changes in pain during buprenorphine/naloxone (BUP/NX) maintenance and whether outcomes vary by pain levels. The present study examined changes in pain intensity and pain interference over 12 weeks of BUP/NX maintenance among participants with OUD and chronic pain (N = 194). Differences in outcomes were assessed during BUP/NX maintenance (Week 12) and 2 months following a BUP/NX taper (Week 24).Data from Phase 2 of the Prescription Opioid Addiction Treatment Study (POATS) were used. Two latent transition models were conducted to characterize profiles and transitions between profiles of pain intensity or pain interference (estimated separately).Each model identified a high and low profile. In the pain interference model, the majority were classified in the low profile at baseline. In the pain intensity model, the majority were classified in the high profile at baseline. In both models, patients were more likely to remain in or transition to the low profiles by Week 12. Worse depression was associated with membership in the high pain interference profile at both timepoints. Women were more likely to be in the high pain intensity profile at baseline. Those in the high pain intensity and high pain interference profiles at Week 12 reported worse mental health quality of life (MH-QOL) at Week 12, as well as high pain intensity and high pain interference at Week 24.For a subgroup of patients, high pain intensity and high pain interference remains unchanged during BUP/NX maintenance treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

    View details for DOI 10.1037/ccp0000692

    View details for Web of Science ID 000740011100001

    View details for PubMedID 35007092

  • A Bridge to Nowhere: Resistance to the Possibility of Some Heavy Drinking During Recovery and the Potential Public Health Implications JOURNAL OF ADDICTION MEDICINE Witkiewitz, K., Wilson, A. D., Pearson, M. R., Roos, C. R., Swan, J. E., Votaw, V. R., Stein, E. R., Edwards, K. A., Tonigan, J., Hallgren, K. A., Montes, K. S., Maisto, S. A., Tucker, J. A. 2021; 15 (4): 352-353

    View details for DOI 10.1097/ADM.0000000000000796

    View details for Web of Science ID 000679483100018

    View details for PubMedID 33577228

    View details for PubMedCentralID PMC8352995

  • Can Individuals With Alcohol Use Disorder Sustain Non-abstinent Recovery? Non-abstinent Outcomes 10 Years After Alcohol Use Disorder Treatment JOURNAL OF ADDICTION MEDICINE Witkiewitz, K., Wilson, A. D., Roos, C. R., Swan, J. E., Votaw, V. R., Stein, E. R., Pearson, M. R., Edwards, K. A., Tonigan, J., Hallgren, K. A., Montes, K. S., Maisto, S. A., Tucker, J. A. 2021; 15 (4): 303-310


    Four decades ago, the "controlled drinking" controversy roiled the alcohol field. Data have subsequently accumulated indicating that nonabstinent alcohol use disorder (AUD) recovery is achievable, but questions remain whether it is sustainable long-term. This study examined whether nonabstinent recovery at 3 years after AUD treatment is associated with better functioning at 10 years after treatment.Data were from the 10-year follow-up of Project MATCH (New Mexico site only, n  = 146; 30.1% female, 58.6% non-White). Recovery was defined by latent profile analyses based on psychosocial functioning and alcohol consumption 3 years after treatment. Drinking practices and consequences, depression, purpose in life, and anger were assessed 10 years after treatment. Distal outcome analyses examined differences in drinking and functional outcomes at 10 years as a function of the 3-year latent profiles. Analyses were preregistered at latent profiles identified at 3 years after treatment (ie, low functioning frequent heavy drinkers, low functioning infrequent heavy drinkers, high functioning heavy drinkers, and high functioning infrequent nonheavy drinkers) were significantly associated with outcomes 10 years after treatment. The 2 high functioning profiles at 3 years had the highest level of psychological functioning at 10 years posttreatment, regardless of alcohol consumption level. Abstinence at 3 years did not predict better psychological functioning at 10 years.Nonabstinent AUD recovery is possible and is sustainable for up to 10 years after treatment. The current findings align with recent proposals to move beyond relying on alcohol consumption as a central defining feature of AUD recovery.

    View details for DOI 10.1097/ADM.0000000000000760

    View details for Web of Science ID 000679483100010

    View details for PubMedID 33060466

    View details for PubMedCentralID PMC8044251

  • Associations Among Sleep Disturbance, Pain Catastrophizing, and Pain Intensity for Methadone-maintained Patients With Opioid Use Disorder and Chronic Pain CLINICAL JOURNAL OF PAIN Ponce Martinez, C., Edwards, K. A., Roos, C. R., Beitel, M., Eller, A., Barry, D. T. 2020; 36 (9): 641-647


    This study examined the cross-sectional associations among pain intensity, pain catastrophizing, and sleep disturbance among patients receiving methadone maintenance treatment (MMT) for opioid use disorder (OUD) and reporting co-occurring chronic pain.Participants were 89 individuals with OUD and chronic pain drawn from a larger cross-sectional study of 164 MMT patients who completed a battery of self-report measures. The authors conducted 6 mediation models to test all possible pathways (ie, each variable tested as an independent variable, mediator, or dependent variable).The only significant mediation effect was an indirect effect of sleep disturbance on pain intensity through pain catastrophizing. That is, greater sleep disturbance was associated with greater pain catastrophizing, which in turn was associated with greater pain intensity.Altogether, findings suggest that the sleep disturbance to pain catastrophizing to pain intensity pathway may be a key mechanistic pathway exacerbating pain issues among MMT patients with OUD and chronic pain. These results suggest that interventions targeting sleep disturbance may be warranted among MMT patients with OUD and chronic pain. Future work in this area with longitudinal data is warranted.

    View details for DOI 10.1097/AJP.0000000000000848

    View details for Web of Science ID 000570150800001

    View details for PubMedID 32482968

    View details for PubMedCentralID PMC7725378

  • Acceptance and Action Questionnaire - II: Confirmatory factor analysis and measurement invariance between Non-Hispanic White and Hispanic/Latinx undergraduates JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE Edwards, K. A., Vowles, K. E. 2020; 17: 32-38
  • Integrated Behavioral Treatment for Veterans With Co-Morbid Chronic Pain and Hazardous Opioid Use: A Randomized Controlled Pilot Trial JOURNAL OF PAIN Vowles, K. E., Witkiewitz, K., Cusack, K. J., Gilliam, W. P., Cardon, K. E., Bowen, S., Edwards, K. A., McEntee, M. L., Bailey, R. W. 2020; 21 (7-8): 798-807


    Opioid prescription in the treatment of chronic pain is frequent and carries a risk of increased morbidity and mortality in a clinically significant number of patients, particularly those who are using opioids in a hazardous manner. Few treatment options are available that target both pain-related interference and hazardous opioid use among patients with chronic pain. In military Veterans, this issue is of particular importance as numerous reports indicate continued high rates of opioid prescription for chronic pain, as well as significant opioid-related problems. The overall aim of the present study was to determine the feasibility of an integrated psychosocial treatment in Veterans with chronic pain, who also have evidence of hazardous opioid use. To examine this aim, a random design was used to assess the feasibility and initial efficacy of integrating 2 empirically supported interventions: Acceptance and Commitment Therapy for chronic pain and Mindfulness Based Relapse Prevention for opioid misuse. Half of participants were randomized to the integrated treatment group and all participants received usual care through a Veteran's Administration co-occurring disorders medical clinic to treat chronic pain and opioid misuse. In total, 37 participants were randomized and included in intent-to-treat analyses and 32 individuals were included in per protocol analyses with 6-month follow-up serving as the primary study endpoint. Feasibility indicators included recruitment, retention, and treatment completion rates. Recruitment fell short of targeted enrollment, although retention and completion were excellent. Primary outcome measures were opioid misuse, pain interference, and pain behavior. Simultaneous multiple regression analyses controlled for pain duration, baseline opioid dose, and baseline value for outcome measures. Results of both the intent-to-treat and per protocol indicated a significant effect in favor of the integrated intervention for opioid misuse, pain interference, and pain behavior. Results support the feasibility of providing an integrated treatment for both opioid risk and pain interference. PERSPECTIVE: Opioid misuse occurs in some opioid-prescribed individuals with chronic pain. Few treatment options exist that target both pain interference and opioid misuse. This study examined feasibility and initial efficacy of an integrated behavioral treatment for Veterans. Feasibility was supported, except recruitment. Efficacy was supported compared to usual care.

    View details for DOI 10.1016/j.jpain.2019.11.007

    View details for Web of Science ID 000582483300005

    View details for PubMedID 31760109

    View details for PubMedCentralID PMC7542006

  • A Comparative Meta-Analysis of Unidisciplinary Psychology and Interdisciplinary Treatment Outcomes Following Acceptance and Commitment Therapy for Adults with Chronic Pain JOURNAL OF PAIN Vowles, K. E., Pielech, M., Edwards, K. A., McEntee, M. L., Bailey, R. W. 2020; 21 (5-6): 529-545


    While much of the literature provides positive support for psychological interventions for chronic pain, 2 recent meta-analyses indicate small to moderate benefits only. This inconsistency in findings suggests that there are other treatment-related variables to consider. One possible consideration pertains to treatment format, as psychological models form the basis for both unidisciplinary psychology and integrated interdisciplinary treatments for chronic pain. Therefore, a comparative meta-analysis of unidisciplinary and interdisciplinary treatments was performed to determine whether there were differences in treatment effect size (ES) at post-treatment and follow-ups of up to 1 year. One specific treatment model, Acceptance and Commitment Therapy (ACT), was investigated as it was felt that this literature was extensive enough to perform the planned analysis, while also being circumscribed enough in size to make it feasible. In total, 29 articles met inclusion criteria, 13 reported outcomes for unidisciplinary ACT, and 15 for interdisciplinary ACT. At both post-treatment and follow-up, interdisciplinary ACT had a greater ES for physical disability, psychosocial impact, and depression compared to unidisciplinary ACT. No differences in ES were observed for pain intensity, pain-related anxiety, or pain acceptance. Findings remained the same when study heterogeneity was considered. There was a significant difference observed between treatment format and treatment duration-on average, unidisciplinary interventions were of shorter duration than interdisciplinary interventions. Moderation analyses examining the relation between total treatment duration and ES generally indicated a moderate positive relation between treatment length and ES. This relation was strong for psychosocial impact. PERSPECTIVE: A comparative meta-analysis examined the relative ES of unidisciplinary (ie, clinical psychology only) and interdisciplinary ACT for chronic pain in 29 studies. The ES for interdisciplinary ACT was larger than unidisciplinary ACT for physical disability, psychosocial impact, and depression. No differences were present for pain intensity, anxiety, and acceptance.

    View details for DOI 10.1016/j.jpain.2019.10.004

    View details for Web of Science ID 000574819200003

    View details for PubMedID 31683020

    View details for PubMedCentralID PMC7477894

  • Demographic differences in perceived social norms of drug and alcohol use among Hispanic/Latinx and non-Hispanic White college students ADDICTIVE BEHAVIORS Edwards, K. A., Witkiewitz, K., Vowles, K. E. 2019; 98: 106060


    Social norms are a modifiable treatment target that can decrease problematic alcohol use among college students. However, little is known about how social norms may be related to cannabis, opioid, and stimulant use. Further, it is not known how these relations might differ by gender and race/ethnicity. This study sought to examine the role of descriptive social norms of two peer reference groups (close friend and acquaintance) in relation to personal substance use among four substances (opioids, alcohol, cannabis, and stimulants), and if these relations may be moderated by gender or race/ethnicity in a sample of Hispanic/Latinx (H/L) and Non-Hispanic White (NHW) students. Participants were primarily H/L (58%), women (70%), and freshman (47%). Findings indicated that higher perceived peer substance use was associated with higher personal use for alcohol and cannabis. Higher perceived close friend stimulant use was associated with higher personal stimulant use, although perceived acquaintance stimulant use was not associated with personal stimulant use. There was no association between perceived peer opioid use and personal opioid use. Men had a stronger positive association between perceived peer cannabis use and personal use. Women had a stronger positive association between perceived acquaintance stimulant use and personal use. H/L students had a stronger positive association between perceived peer cannabis use and personal use. NHW had no significant association between perceived peer opioid use and personal use. Findings suggest that men and H/L students may be more susceptible to peer influences on cannabis and opioid use.

    View details for DOI 10.1016/j.addbeh.2019.106060

    View details for Web of Science ID 000484648100036

    View details for PubMedID 31376659

  • The relation of self-compassion to functioning among adults with chronic pain EUROPEAN JOURNAL OF PAIN Edwards, K. A., Pielech, M., Hickman, J., Ashworth, J., Sowden, G., Vowles, K. E. 2019; 23 (8): 1538-1547


    Previous research has shown that self-compassion is associated with improved functioning and health outcomes among multiple chronic illnesses. However, the role of self-compassion in chronic pain-related functioning is understudied. The present study sought to understand the association between self-compassion and important measures of functioning within a sample of patients with chronic pain.Treatment-seeking individuals (N = 343 with chronic pain) that were mostly White (97.9%) and female (71%) completed a battery of assessments that included the Self-Compassion Scale (SCS), as well as measures of pain-related fear, depression, disability, pain acceptance, success in valued activity and use of pain coping strategies.Cross-sectional multiple regression analyses that controlled for age, sex, pain intensity and pain duration, revealed that self-compassion accounted for a significant and unique amount of variance in all measures of functioning (r2 range: 0.07-0.32, all p < 0.001). Beta weights indicated that higher self-compassion was associated with lower pain-related fear, depression and disability, as well as greater pain acceptance, success in valued activities and utilization of pain coping strategies.These findings suggest that self-compassion may be a relevant adaptive process in those with chronic pain. Targeted interventions to improve self-compassion in those with chronic pain may be useful.Self-compassion is associated with better functioning across multiple general and pain-specific outcomes, with the strongest associations among measures related to psychological functioning and valued living. These findings indicate that self-compassion may be an adaptive process that could minimize the negative impact of chronic pain on important areas of life.

    View details for DOI 10.1002/ejp.1429

    View details for Web of Science ID 000482925300014

    View details for PubMedID 31115099

  • Alcohol and Opioid Use in Chronic Pain: A Cross-Sectional Examination of Differences in Functioning Based on Misuse Status JOURNAL OF PAIN Vowles, K. E., Witkiewitz, K., Pielech, M., Edwards, K. A., McEntee, M. L., Bailey, R. W., Bolling, L., Sullivan, M. D. 2018; 19 (10): 1181-1188


    Opioid misuse is regularly associated with disrupted functioning in those with chronic pain. Less work has examined whether alcohol misuse may also interfere with functioning. This study examined frequency of opioid and alcohol misuse in 131 individuals (61.1% female) prescribed opioids for the treatment of chronic pain. Participants completed an anonymous survey online, consisting of measures of pain, functioning, and opioid and alcohol misuse. Cut scores were used to categorize individuals according to substance misuse status. Individuals were categorized as follows: 35.9% (n = 47) were not misusing either opioids or alcohol, 22.9% (n = 30) were misusing both opioids and alcohol, 38.2% (n = 50) were misusing opioids alone, and only 3.0% (n = 4) were misusing alcohol alone. A multivariate analysis of variance was performed to examine differences in pain and functioning between groups (after excluding individuals in the alcohol misuse group due to the small sample size). Group comparisons indicated that individuals who were not misusing either substance were less disabled and distressed in comparison to those who were misusing opioids alone or both opioids and alcohol. No differences were indicated between the latter 2 groups. Overall, the observed frequency of opioid misuse was somewhat higher in comparison to previous work (approximately 1 out of every 3 participants), and misuse of both alcohol and opioids was common (approximately 1 out of every 5 participants). While these data are preliminary, they do suggest that issues of substance misuse in those with chronic pain extends beyond opioids alone.Opioid and alcohol misuse was examined in 131 individuals prescribed opioids for chronic pain. In total, 35.9% were not misusing either, 22.9% were misusing both, 38.2% were misusing opioids, and 3.1% were misusing alcohol. Individuals not misusing either were generally less disabled and distressed compared to those misusing opioids or both.

    View details for DOI 10.1016/j.jpain.2018.04.013

    View details for Web of Science ID 000448632600008

    View details for PubMedID 29758355

  • Using Analgesics for Emotional Modulation is Associated With Increased Distress, Depression, and Risk of Opioid and Alcohol Misuse: Initial Evaluation and Component Analysis of the Reasons for Analgesic Use Measure (RAUM) CLINICAL JOURNAL OF PAIN Vowles, K. E., Bailey, R. W., McEntee, M. L., Pielech, M., Edwards, K. A., Bolling, L. A., Rivers, W. 2018; 34 (10): 975-982


    It is important to identify aspects of analgesic use that are associated with harm in chronic pain. Historically, the focus has been patterns of use (eg, overuse). This study evaluated another aspect of use-rather than evaluating how analgesics were being used, the primary interest was in why they were being used.In total, 334 analgesic using individuals with chronic pain responded to a pool of items assessing reasons for analgesic use. Measures of pain intensity, distress, depression, and opioid and alcohol misuse were also completed.Exploratory factor analyses indicated 3 overarching reasons for use, including taking analgesics: (1) for pain reduction/functional improvement; (2) for emotional modulation/sedation; and (3) to be compliant with prescriber instructions. Correlation and regression analyses indicated that the second factor had the strongest relations with the other measures used, such that greater endorsement of analgesic use for emotional modulation was associated with greater distress, depression, and opioid and alcohol misuse. Using analgesics for pain reduction/functional improvement was associated with greater pain-related distress and depression. Using analgesics to be compliant was not associated with any measure. This pattern of results was generally replicated when a subsample of 131 individuals taking opioids was examined.Results support the utility of examining reasons for analgesic use; use to achieve emotional modulation/sedation may be particularly associated with risk. The data also provide support for the questionnaire developed, the Reasons for Analgesic Use Measure.

    View details for DOI 10.1097/AJP.0000000000000621

    View details for Web of Science ID 000445767100013

    View details for PubMedID 29697475

    View details for PubMedCentralID PMC6110954



    This pilot study evaluated the possibility that 2 interventions hypothesized to increase slower brain oscillations (e.g., theta) may enhance the efficacy of hypnosis treatment, given evidence that hypnotic responding is associated with slower brain oscillations. Thirty-two individuals with multiple sclerosis and chronic pain, fatigue, or both, were randomly assigned to 1 of 2 interventions thought to increase slow wave activity (mindfulness meditation or neurofeedback training) or no enhancing intervention, and then given 5 sessions of self-hypnosis training targeting their presenting symptoms. The findings supported the potential for both neurofeedback and mindfulness to enhance response to hypnosis treatment. Research using larger sample sizes to determine the generalizability of these findings is warranted.

    View details for DOI 10.1080/00207144.2018.1460546

    View details for Web of Science ID 000434190900002

    View details for PubMedID 29856281

  • Resilience and Function in Adults With Physical Disabilities: An Observational Study ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Battalio, S. L., Silverman, A. M., Ehde, D. M., Amtmann, D., Edwards, K. A., Jensen, M. P. 2017; 98 (6): 1158-1164


    To determine if resilience is uniquely associated with functional outcomes (satisfaction with social roles, physical functioning, and quality of life) in individuals with physical disabilities, after controlling for measures of psychological health (depression and anxiety) and symptom severity (pain, fatigue, and sleep disturbance); and to examine the potential moderating effect of sex, age, and diagnosis on the hypothesized associations between resilience and function.Cross-sectional survey study.Surveys were mailed (81% response rate) to a community sample of 1949 individuals with multiple sclerosis, muscular dystrophy, postpoliomyelitis syndrome, or spinal cord injury. Participants were recruited through the Internet or print advertisement (28%), a registry of previous research participants who indicated interest in future studies (21%), a departmental registry of individuals interested in research (19%), disability-specific registries (18%), word of mouth (10%), or other sources (3%).Convenience sample of community-dwelling adults aging with physical disabilities (N=1574), with a mean Connor-Davidson Resilience Scale (10 items) score of 29.Not applicable.Patient-Reported Outcomes Measurement Information System measures of Satisfaction with Social Roles and Activities and Physical Functioning, the World Health Organization's brief Older People's Quality of Life Questionnaire, and the Connor-Davidson Resilience Scale (10 items).After controlling for age, age squared, sex, diagnosis, psychological health, and symptom severity, resilience was significantly and positively associated with satisfaction with social roles (β=.17, P<.001) and quality of life (β=.39, P<.001), but not physical function (β=.04, P>.05). For every 1-point increase in scores of resilience, there was an increase of .50 in the quality of life score and .20 in the satisfaction with social roles score. Sex also moderated the association between resilience and satisfaction with social roles (F1,1453=4.09, P=.043).The findings extend past research, providing further evidence indicating that resilience plays a unique role in nonphysical functional outcomes among individuals with physical disabilities.

    View details for DOI 10.1016/j.apmr.2016.11.012

    View details for Web of Science ID 000402776600012

    View details for PubMedID 27993585

  • Changes in Resilience Predict Function in Adults With Physical Disabilities: A Longitudinal Study ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Edwards, K. A., Alschuler, K. A., Ehde, D. M., Battalio, S. L., Jensen, M. P. 2017; 98 (2): 329-336


    (1) To determine if resilience exhibits similar stability across time as depression, fatigue, and sleep quality; and (2) to determine if changes in resilience over a period of 1 year are associated with changes in depression, fatigue, sleep quality, and physical function over the same time period.Observational longitudinal survey study with measures administered 2 times, 1 year apart.Community-based population sample.Adults with physical disabilities (N=893).Not applicable.Primary outcomes were measures of resilience (Connor-Davidson Resilience Scale), depression (Patient Health Questionnaire-9), fatigue (Patient-Reported Outcomes Measurement Information System [PROMIS] Fatigue Short Form), sleep quality (PROMIS Sleep Disturbance), and physical function (8-item PROMIS Physical Functioning).Resilience (r=.71, P<.001) exhibited similar stability over 1 year to depression (r=.71, P<.001), fatigue (r=.79, P<.001), and sleep quality (r=.68, P<.001). A decrease in resilience was associated with an increase in depression (F1,885=70.23; P<.001; R2=.54) and fatigue (F1,885=25.66; P<.001; R2=.64), and an increase in resilience was associated with improved sleep quality (F1,885=30.76; P<.001; R2=.48) and physical function (F1,885=16.90; P<.001; R2=.86) over a period of 1 year, while controlling for age, sex, and diagnosis.Resilience exhibits similar test-retest stability as other important domains that are often treatment targets. Changes in resilience were associated with changes in depression, fatigue, sleep quality, and physical functioning over the course of 1 year. Further longitudinal and experimental research is warranted to investigate the potential causal effect of changes in resilience on quality of life in individuals with physical disabilities.

    View details for DOI 10.1016/j.apmr.2016.09.123

    View details for Web of Science ID 000393930100017

    View details for PubMedID 27776921

  • Relative Importance of Baseline Pain, Fatigue, Sleep, and Physical Activity: Predicting Change in Depression in Adults With Multiple Sclerosis ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION Edwards, K. A., Molton, I. R., Smith, A. E., Ehde, D. M., Bombardier, C. H., Battalio, S. L., Jensen, M. P. 2016; 97 (8): 1309-1315


    To determine whether baseline levels of pain, fatigue, sleep disturbance, and physical activity measured at the initial assessment predicted the development of or improvement of depression 3.5 years later, while controlling for sex, age, and disease severity.Observational, longitudinal survey study.A community-based population sample.Adults with multiple sclerosis (MS) (N=489).Not applicable.Primary outcome was classification of depression group measured using a Patient Health Questionnaire-9 cutoff score ≥10, indicating probable major depression.Fatigue severity (odds ratio, 1.19; 95% confidence interval, 1.12-1.26; P<.0001) and sleep disturbance (odds ratio, 1.06; 95% confidence interval, 1.02-1.10; P=.001) predicted probable major depression 3.5 years later among those not depressed at the initial assessment. An effect of age (odds ratio, .96; 95% confidence interval, .92-.99; P=.008) was found among those who developed depression, indicating that younger adults were more likely to develop depression. Pain, fatigue, sleep, and physical activity at baseline were not significantly associated with recovery from depression among those depressed at the initial assessment.Fatigue and sleep may contribute to the development of depression. Clinical trial research targeting these variables to determine their influence on depression is warranted.

    View details for DOI 10.1016/j.apmr.2016.02.025

    View details for Web of Science ID 000381244200013

    View details for PubMedID 27016262

  • Misinterpretation of African American English BIN by adult speakers of Standard American English LANGUAGE & COMMUNICATION Beyer, T., Edwards, K. A., Fuller, C. C. 2015; 45: 59-69