%0 Journal Article %J Clin J Pain %D 2014 %T Cognitive mediators of treatment outcomes in pediatric functional abdominal pain. %A Levy, Rona L %A Langer, Shelby L %A Romano, Joan M %A Labus, Jennifer %A Walker, Lynn S %A Murphy, Tasha B %A Tilburg, Miranda A L van %A Feld, Lauren D %A Christie, Dennis L %A Whitehead, William E %K Abdominal Pain %K Adolescent %K Catastrophization %K Child %K Cognitive Therapy %K Female %K Humans %K Male %K Pain Measurement %K Parents %K Pediatrics %K Treatment Outcome %X

OBJECTIVES: Cognitive-behavioral (CB) interventions improve outcomes for many pediatric health conditions, but little is known about which mechanisms mediate these outcomes. The goal of this study was to identify whether changes in targeted process variables from baseline to 1 week posttreatment mediate improvement in outcomes in a randomized controlled trial of a brief CB intervention for idiopathic childhood abdominal pain.

MATERIALS AND METHODS: Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to 1 of 2 conditions: a 3-session social learning and CB treatment (N=100), or a 3-session educational intervention controlling for time and attention (N=100). Outcomes were assessed at 3-, 6-, and 12-month follow-ups. The intervention focused on altering parental responses to pain and on increasing adaptive cognitions and coping strategies related to pain in both parents and children.

RESULTS: Multiple mediation analyses were applied to examine the extent to which the effects of the social learning and CB treatment condition on child gastrointestinal (GI) symptom severity and pain as reported by children and their parents were mediated by changes in targeted cognitive process variables and parents' solicitous responses to their child's pain symptoms. Reductions in parents' perceived threat regarding their child's pain mediated reductions in both parent-reported and child-reported GI symptom severity and pain. Reductions in children's catastrophic cognitions mediated reductions in child-reported GI symptom severity but no other outcomes. Reductions in parental solicitousness did not mediate outcomes.

DISCUSSION: Results suggest that reductions in reports of children's pain and GI symptoms after a social learning and CB intervention were mediated at least in part by decreasing maladaptive parent and child cognitions.

%B Clin J Pain %V 30 %P 1033-43 %8 2014 Dec %G eng %N 12 %R 10.1097/AJP.0000000000000077 %0 Journal Article %J Brain Behav Immun %D 2013 %T The effect of pre-transplant distress on immune reconstitution among adult autologous hematopoietic cell transplantation patients. %A McGregor, Bonnie A %A Syrjala, Karen L %A Dolan, Emily D %A Langer, Shelby L %A Redman, Mary %K Adolescent %K Adult %K Anxiety %K Depression %K Female %K Hematologic Neoplasms %K Hematopoietic Stem Cell Transplantation %K Humans %K Leukocyte Count %K Longitudinal Studies %K Male %K Middle Aged %K Prospective Studies %K Psychiatric Status Rating Scales %K Self Report %K Sex Factors %K Stress, Psychological %K Treatment Outcome %X

Myeloablative hematopoietic cell transplantation (HCT) is a common treatment for hematological malignancy. Delayed immune reconstitution following HCT is a major impediment to recovery with patients being most vulnerable during the first month after transplant. HCT is a highly stressful process. Because psychological distress has been associated with down regulation of immune function we examined the effect of pre-transplant distress on white blood cell (WBC) count among 70 adult autologous HCT patients during the first 3 weeks after transplant. The participants were on average 38 years old; 93% Caucasian, non-Hispanic and 55% male. Pre-transplant distress was measured 2-14 days before admission using the Cancer and Treatment Distress (CTXD) scale, and the Symptom Checklist-90-R (SCL-90-R) anxiety and depression subscales. WBC count was measured during initial immune recovery on days 5 through 22 post-transplant. Linear mixed model regression analyses controlling for gender and treatment-related variables revealed a significant effect of the mean pre-transplant SCL Anxiety-Depression score on WBC recovery. We found no significant effect of pre-transplant CTXD on WBC recovery. In general, higher levels of pre-treatment anxiety and depression were associated with slower WBC recovery. Psychological modulation of WBC recovery during HCT suggests a unique mechanism by which psychological distress can exert influence over the immune system. Given that WBC recovery is essential to survival for HCT patients, these data provide a rationale for treating anxiety and depression in HCT patients.

%B Brain Behav Immun %V 30 Suppl %P S142-8 %8 2013 Mar %G eng %R 10.1016/j.bbi.2012.07.020 %0 Journal Article %J Contemp Clin Trials %D 2013 %T Healthy Homes/Healthy Kids: a randomized trial of a pediatric primary care-based obesity prevention intervention for at-risk 5-10 year olds. %A Sherwood, Nancy E %A Levy, Rona L %A Langer, Shelby L %A Senso, Meghan M %A Crain, A Lauren %A Hayes, Marcia G %A Anderson, Julie D %A Seburg, Elisabeth M %A Jeffery, Robert W %K Accelerometry %K Body Mass Index %K Child %K Child, Preschool %K Cost-Benefit Analysis %K Counseling %K Diet %K Exercise %K Female %K Humans %K Male %K Overweight %K Parent-Child Relations %K Parents %K Pediatric Obesity %K Primary Health Care %K Risk Factors %K Safety %K Sedentary Lifestyle %K Socioeconomic Factors %X

Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5-10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10 year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a Contact Control condition that focuses on safety and injury prevention. The HHHK 5-10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The Contact Control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5-10 trial.

%B Contemp Clin Trials %V 36 %P 228-43 %8 2013 Sep %G eng %N 1 %R 10.1016/j.cct.2013.06.017 %0 Journal Article %J JAMA Pediatr %D 2013 %T Twelve-month follow-up of cognitive behavioral therapy for children with functional abdominal pain. %A Levy, Rona L %A Langer, Shelby L %A Walker, Lynn S %A Romano, Joan M %A Christie, Dennis L %A Youssef, Nader %A DuPen, Melissa M %A Ballard, Sheri A %A Labus, Jennifer %A Welsh, Ericka %A Feld, Lauren D %A Whitehead, William E %K Abdominal Pain %K Adaptation, Psychological %K Adolescent %K Adult %K Child %K Cognitive Therapy %K Female %K Follow-Up Studies %K Gastrointestinal Diseases %K Humans %K Illness Behavior %K Linear Models %K Male %K Middle Aged %K Pain Measurement %K Parent-Child Relations %K Prospective Studies %K Treatment Outcome %X

OBJECTIVE: To determine whether a brief intervention for children with functional abdominal pain and their parents' responses to their child's pain resulted in improved coping 12 months later.

DESIGN: Prospective, randomized, longitudinal study.

SETTING: Families were recruited during a 4-year period in Seattle, Washington, and Morristown, New Jersey.

PARTICIPANTS: Two hundred children with persistent functional abdominal pain and their parents.

INTERVENTIONS: A 3-session social learning and cognitive behavioral therapy intervention or an education and support intervention.

MAIN OUTCOME MEASURES: Child symptoms and pain-coping responses were monitored using standard instruments, as was parental response to child pain behavior. Data were collected at baseline and after treatment (1 week and 3, 6, and 12 months after treatment). This article reports the 12-month data.

RESULTS: Relative to children in the education and support group, children in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month follow-up decreases in gastrointestinal symptom severity (estimated mean difference, -0.36; 95% CI, -0.63 to -0.01) and greater improvements in pain-coping responses (estimated mean difference, 0.61; 95% CI, 0.26 to 1.02). Relative to parents in the education and support group, parents in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month decreases in solicitous responses to their child's symptoms (estimated mean difference, -0.22; 95% CI, -0.42 to -0.03) and greater decreases in maladaptive beliefs regarding their child's pain (estimated mean difference, -0.36; 95% CI, -0.59 to -0.13).

CONCLUSIONS: Results suggest long-term efficacy of a brief intervention to reduce parental solicitousness and increase coping skills. This strategy may be a viable alternative for children with functional abdominal pain.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00494260.

%B JAMA Pediatr %V 167 %P 178-84 %8 2013 Feb %G eng %N 2 %R 10.1001/2013.jamapediatrics.282 %0 Journal Article %J J Psychosoc Oncol %D 2012 %T Expressive talking among caregivers of hematopoietic stem cell transplant survivors: acceptability and concurrent subjective, objective, and physiologic indicators of emotion. %A Langer, Shelby L %A Kelly, Thomas H %A Storer, Barry E %A Hall, Suzanne P %A Lucas, Heather G %A Syrjala, Karen L %K Adaptation, Psychological %K Adult %K Caregivers %K Communication %K Expressed Emotion %K Female %K Hematopoietic Stem Cell Transplantation %K Humans %K Male %K Middle Aged %K Patient Satisfaction %K Psychotherapy %K Skin Physiological Phenomena %K Stress, Psychological %K Survivors %X

This study sought to examine the effects of an expressive talking intervention for 58 caregiving partners of hematopoietic stem cell transplant survivors, persons known to experience distress. Caregivers were randomly assigned to a three-session emotional expression (EE) or control condition. Subjective, objective, and physiologic indicators of emotion were assessed. Relative to controls, EE participants experienced more negative emotion, uttered more negative emotion words, and perceived the exercises as more helpful and meaningful. The trajectory of skin conductance and the use of cognitive mechanism words increased across EE sessions, suggesting sustained emotional engagement. Future research is warranted to determine the optimal dose and timing of EE for this population.

%B J Psychosoc Oncol %V 30 %P 294-315 %8 2012 %G eng %N 3 %R 10.1080/07347332.2012.664255 %0 Journal Article %J J Nutr Educ Behav %D 2012 %T Measuring perceived barriers to healthful eating in obese, treatment-seeking adults. %A Welsh, Ericka M %A Jeffery, Robert W %A Levy, Rona L %A Langer, Shelby L %A Flood, Andrew P %A Jaeb, Melanie A %A Laqua, Patricia S %K Body Mass Index %K Diet, Reducing %K Energy Intake %K Factor Analysis, Statistical %K Female %K Health Behavior %K Health Knowledge, Attitudes, Practice %K Humans %K Linear Models %K Male %K Middle Aged %K Obesity %K Perception %K Self Concept %K Self Efficacy %K Surveys and Questionnaires %K Time Factors %K Weight Loss %X

OBJECTIVE: To characterize perceived barriers to healthful eating in a sample of obese, treatment-seeking adults and to examine whether changes in barriers are associated with energy intake and body weight.

DESIGN: Observational study based on findings from a randomized, controlled behavioral weight-loss trial.

PARTICIPANTS: Participants were 113 women and 100 men, mean age 48.8 years, 67% white, and mean body mass index at baseline 34.9 kg/m(2).

VARIABLES MEASURED: Perceived diet barriers were assessed using a 39-item questionnaire. Energy intake was assessed with the Block Food Frequency Questionnaire. Body weight (kg) and height (cm) were measured.

ANALYSIS: Factor-based scales constructed from exploratory factor analysis. Linear regression models regressed 12-month energy intake and body weight on baseline to 12-month factor-based score changes (α = .05).

RESULTS: Exploratory factor analysis yielded 3 factors: lack of knowledge, lack of control, and lack of time. Reported declines in lack of knowledge and lack of control from baseline to 12 months were associated with significantly greater energy restriction over 12 months, whereas reported declines in lack of control and lack of time were associated with significantly greater weight loss.

CONCLUSIONS AND IMPLICATIONS: Results suggest that declines in perceived barriers to healthful eating during treatment are associated with greater energy restriction and weight loss.

%B J Nutr Educ Behav %V 44 %P 507-12 %8 2012 Nov-Dec %G eng %N 6 %R 10.1016/j.jneb.2010.06.005 %0 Journal Article %J J Clin Oncol %D 2011 %T Prospective neurocognitive function over 5 years after allogeneic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years. %A Syrjala, Karen L %A Artherholt, Samantha B %A Kurland, Brenda F %A Langer, Shelby L %A Roth-Roemer, Sari %A Elrod, JoAnn Broeckel %A Dikmen, Sureyya %K Adult %K Aged %K Cognition Disorders %K Female %K Hematopoietic Stem Cell Transplantation %K Humans %K Male %K Middle Aged %K Neoplasms %K Prospective Studies %K Survivors %K Time Factors %K Transplantation, Homologous %X

PURPOSE: Research has documented cognitive deficits both before and after high-dose treatment followed by allogeneic hematopoietic cell transplantation (HCT), with partial recovery by 1 year. This study prospectively examined the trajectory and extent of long-term cognitive dysfunction, with a focus on 1 to 5 years after treatment.

PATIENTS AND METHODS: Allogeneic HCT recipients completed standardized neuropsychological tests including information processing speed (Trail Making A and Digit Symbol Substitution Test), verbal memory (Hopkins Verbal Learning Test-Revised), executive function (Controlled Oral Word Association Test and Trail Making B), and motor dexterity and speed (Grooved Pegboard). Survivors (n = 92) were retested after 80 days and 1 and 5 years after transplantation. Case-matched controls (n = 66) received testing at the 5-year time point. A Global Deficit Score (GDS) summarized overall impairment. Response profiles were analyzed using linear mixed effects models.

RESULTS: Survivors recovered significant cognitive function from post-transplantation (80 days) to 5 years in all tests (P < .0001) except verbal recall (P > .06). Between 1 and 5 years, verbal fluency improved (P = .0002), as did executive function (P < .01), but motor dexterity did not (P > .15), remaining below controls (P < .0001) and more than 0.5 standard deviation below population norms. In GDS, 41.5% of survivors and 19.7% of controls had mild or greater deficits (NcNemar test = 7.04, P = .007).

CONCLUSION: Although neurocognitive function improved from 1 to 5 years after HCT, deficits remained for more than 40% of survivors. Risk factors, mechanisms and rehabilitation strategies need to be identified for these residual deficits.

%B J Clin Oncol %V 29 %P 2397-404 %8 2011 Jun 10 %G eng %N 17 %R 10.1200/JCO.2010.33.9119 %0 Journal Article %J Obesity (Silver Spring) %D 2011 %T Sex-specific HDL cholesterol changes with weight loss and their association with anthropometric variables: the LIFE study. %A Yatsuya, Hiroshi %A Jeffery, Robert W %A Erickson, Darin J %A Welsh, Ericka M %A Flood, Andrew P %A Jaeb, Melanie A %A Laqua, Patricia S %A Mitchell, Nathan R %A Langer, Shelby L %A Levy, Rona L %K Anthropometry %K Blood Glucose %K Cholesterol, HDL %K Female %K Humans %K Insulin %K Male %K Middle Aged %K Obesity %K Sex Factors %K Subcutaneous Fat %K Triglycerides %K Waist-Hip Ratio %K Weight Loss %X

Decrease in the level of high-density lipoprotein cholesterol (HDLC) has been observed in women who start dieting, but not in men. Patterns of HDLC change during intentional weight loss through 30-months of follow-up, and their association with changes in anthropometric measurements were examined in obese women (N = 112) and men (N = 100). Missing HDLC values at 6-, 12-, 18-, and 30-month follow-up (N = 16, 34, 55, and 50, respectively) due to dropout were imputed by multiple imputation. Mean ages and BMIs of subjects at baseline were 47.2 years and 34.8 kg/m(2) for women, and 50.4 years and 35.0 kg/m(2) for men. On average, participants lost weight steadily for 12 months, followed by slow regain. During the first 6 months, HDLC decreased significantly in women (-4.1 mg/dl, P = 0.0007), but not in men. Significant HDLC increases were observed in both men and women from 6- to 12-month follow-up. HDLC changes in women were positively associated with changes in hip circumference from baseline to 12-month independent of changes in triglycerides (TG), glucose, and insulin. Rapid decrease of predominantly subcutaneous fat in the femoral and gluteal area might be associated with HDLC decrease in women during initial weight loss.

%B Obesity (Silver Spring) %V 19 %P 429-35 %8 2011 Feb %G eng %N 2 %R 10.1038/oby.2010.216 %0 Journal Article %J Am J Gastroenterol %D 2010 %T Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. %A Levy, Rona L %A Langer, Shelby L %A Walker, Lynn S %A Romano, Joan M %A Christie, Dennis L %A Youssef, Nader %A DuPen, Melissa M %A Feld, Andrew D %A Ballard, Sheri A %A Welsh, Ericka M %A Jeffery, Robert W %A Young, Melissa %A Coffey, Melissa J %A Whitehead, William E %K Abdominal Pain %K Adaptation, Psychological %K Adolescent %K Child %K Cognitive Therapy %K Disability Evaluation %K Female %K Humans %K Linear Models %K Male %K Pain Measurement %K Parent-Child Relations %K Parents %K Prospective Studies %K Treatment Outcome %X

OBJECTIVES: Unexplained abdominal pain in children has been shown to be related to parental responses to symptoms. This randomized controlled trial tested the efficacy of an intervention designed to improve outcomes in idiopathic childhood abdominal pain by altering parental responses to pain and children's ways of coping and thinking about their symptoms.

METHODS: Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to one of two conditions-a three-session intervention of cognitive-behavioral treatment targeting parents' responses to their children's pain complaints and children's coping responses, or a three-session educational intervention that controlled for time and attention. Parents and children were assessed at pretreatment, and 1 week, 3 months, and 6 months post-treatment. Outcome measures were child and parent reports of child pain levels, function, and adjustment. Process measures included parental protective responses to children's symptom reports and child coping methods.

RESULTS: Children in the cognitive-behavioral condition showed greater baseline to follow-up decreases in pain and gastrointestinal symptom severity (as reported by parents) than children in the comparison condition (time x treatment interaction, P<0.01). Also, parents in the cognitive-behavioral condition reported greater decreases in solicitous responses to their child's symptoms compared with parents in the comparison condition (time x treatment interaction, P<0.0001).

CONCLUSIONS: An intervention aimed at reducing protective parental responses and increasing child coping skills is effective in reducing children's pain and symptom levels compared with an educational control condition.

%B Am J Gastroenterol %V 105 %P 946-56 %8 2010 Apr %G eng %N 4 %R 10.1038/ajg.2010.106 %0 Journal Article %J Prev Med %D 2010 %T Maintenance-tailored therapy vs. standard behavior therapy for 30-month maintenance of weight loss. %A Levy, Rona L %A Jeffery, Robert W %A Langer, Shelby L %A Graham, Dan J %A Welsh, Ericka M %A Flood, Andrew P %A Jaeb, Melanie A %A Laqua, Patricia S %A Finch, Emily A %A Hotop, Annie M %A Yatsuya, Hiroshi %K Adult %K Behavior Therapy %K Humans %K Male %K Middle Aged %K Obesity %K Weight Gain %K Weight Loss %X

OBJECTIVE: To assess differences in weight regain one year after an 18-month obesity treatment with standard behavior therapy (SBT) or maintenance-tailored therapy for obesity (MTT).

METHOD: 213 obese adult volunteers were treated for 18 months using SBT with fixed behavioral prescriptions or MTT that employed varied behavioral prescriptions with treatment breaks. Follow-up analysis focused on weight maintenance after a year of no contact. The trial was conducted at the University of Minnesota between 2005 and 2009.

RESULTS: Mean (SD) weight change between 18 and 30 months for participants in the SBT group was +4.1 kg (4.4) compared to +2.8 kg (4.5) in the MTT group. This is a 31% reduction in weight regain in MTT relative to SBT (p=0.078). This trend toward better maintenance in MTT versus SBT was due primarily to superior differential maintenance in MTT participants in the highest tertile of total weight loss at 18 months, i.e. MTT participants in this tertile regained 4 kg less than SBT participants between 18 and 30 months.

CONCLUSIONS: The MTT approach with varied content and timing produced more desirable patterns of weight loss maintenance than the traditional SBT approach, especially among individuals who had achieved greater initial weight loss.

%B Prev Med %V 51 %P 457-9 %8 2010 Dec %G eng %N 6 %R 10.1016/j.ypmed.2010.09.010