DSpace Repository :: Browsing by Author "Thorn, Beverly E."

Browsing by Author "Thorn, Beverly E."

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Associations between sleep disturbances, personality, and trait emotional intelligence
(University of Alabama Libraries, 2016) Emert, Sarah E.; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Insomnia is defined by difficulty falling asleep, staying asleep, or waking earlier than desired with inability to return to sleep. Complaints of nonrestorative sleep (NRS) are often associated with insomnia but can occur independently. Fragmented sleep and NRS have been shown to relate to one’s mood, one’s ability to process their own or others’ emotions, and can lead to changes in cognitions and behaviors. Personality traits related to increases in anxiousness may play a role in the development and maintenance of sleep disorders and associated daytime impairment of NRS. The relations between sleep disturbance, personality traits, and trait emotional intelligence are underrepresented in the current literature and findings have been mixed. This study addressed some inconsistencies by identifying associations between the Big Five personality traits, trait emotional intelligence (TEI), complaints of NRS, and disrupted sleep associated with insomnia. We predicted that neuroticism would relate to poorer sleep and that conscientiousness and TEI would be associated with better sleep. Openness to experience, extraversion, and agreeableness are not often discussed in the literature, but were expected to associate similarly as conscientiousness. Results provided support for the idea that trait characteristics are associated with insomnia severity and restorative sleep quality. These findings indicated that personality and TEI may play a role in development and maintenance of sleep disorders and daytime impairment of NRS; higher conscientiousness, lower neuroticism, and higher TEI possibly demonstrate a protective role to experiencing negative effects of poor sleep.
Attachment Style Is Associated With Perceived Spouse Responses and Pain-Related Outcomes
(American Psychological Association, 2012) Forsythe, Laura P.; Romano, Joan M.; Jensen, Mark P.; Thorn, Beverly E.; University of Alabama Tuscaloosa; University of Washington; University of Washington Seattle
Purpose/Objective: Attachment theory can provide a heuristic model for examining factors that may influence the relationship of social context to adjustment in chronic pain. This study examined the associations of attachment style with self-reported pain behavior, pain intensity, disability, depression, and perceived spouse responses to pain behavior. We also examined whether attachment style moderates associations between perceived spouse responses and self-reported pain behavior and depressive symptoms, as well as perceived spouse responses as a mediator of these associations. Method: Individuals with chronic pain (N = 182) completed measures of self-reported attachment style, perceived spouse responses, and pain-related criterion variables. Results: Secure attachment was inversely associated with self-reported pain behaviors, pain intensity, disability, depressive symptoms, and perceived negative spouse responses; preoccupied and fearful attachment scores were positively associated with these variables. In multivariable regression models, both attachment style and perceived spouse responses were uniquely associated with self-reported pain behavior and depressive symptoms. Attachment style did not moderate associations between perceived spouse responses to self-reported pain behavior and pain criterion variables, but negative spouse responses partially mediated some relationships between attachment styles and pain outcomes. Conclusions/Implications: Findings suggest that attachment style is associated with pain-related outcomes and perceptions of spouse responses. The hypothesized moderation effects for attachment were not found; however, mediation analyses showed that perceived spouse responses may partially explain associations between attachment and adjustment to pain. Future research is needed to clarify how attachment style and the social environment affect the pain experience.
Barriers and facilitators to yoga practice in adults with chronic low back pain
(University of Alabama Libraries, 2015) Combs, Martha Anne; Thorn, Beverly E.; University of Alabama Tuscaloosa
Given the high prevalence of chronic low back pain in the United States and the potential beneficial effects that integrative yoga interventions may have on this condition, the current study sought to examine barriers and facilitators to trying yoga in a population of adults with chronic low back pain. Participants self-reporting chronic low back pain were recruited from community sites in a collegiate town in western Alabama. Primary analyses utilized hierarchical regression and traditional 4-step mediational analyses to examine the predictive influence of catastrophizing and fear of movement on yoga attitudes. Results indicate that fear of movement serves a mediating role between catastrophizing and yoga attitudes. Originally proposed analyses included measurement of "intent to try yoga" as a primary outcome of interest. However, relationships between predictor variables and the unstandardized intent measure were, in general, extremely weak and execution of analyses was not indicated. Measurement of intention is discussed in Appendix A. Participants also responded to items asking them about perceptions of potential barriers and facilitators to trying yoga. Responses were subjected to qualitative thematic analysis and several common themes emerged for both barriers and facilitators: physical issues, cognitive/affective issues, motivational issues, informational issues, practical issues, and social issues. Qualitative analyses are discussed in Appendix B. Identifying cognitive barriers to consideration of yoga as a potential beneficial treatment for chronic low back pain conditions has great importance for clinical treatment of pain, especially as health care focus in the U.S. shifts to be more preventative and emphasizing self-management.
Behavioral cancer pain intervention using videoconferencing and a mobile application for medically underserved patients: Rationale, design, and methods of a prospective multisite randomized controlled trial
(Elsevier, 2021) Kelleher, Sarah A.; Winger, Joseph G.; Fisher, Hannah M.; Miller, Shannon N.; Reed, Shelby D.; Thorn, Beverly E.; Spring, Bonnie; Samsa, Gregory P.; Majestic, Catherine M.; Shelby, Rebecca A.; Sutton, Linda M.; Keefe, Francis J.; Somers, Tamara J.; Duke University; University of Alabama Tuscaloosa; Northwestern University; Feinberg School of Medicine
Background: Women with breast cancer in medically underserved areas are particularly vulnerable to persistent pain and disability. Behavioral pain interventions reduce pain and improve outcomes. Cancer patients in medically underserved areas receive limited adjunctive cancer care, as many lack access to pain therapists trained in behavioral interventions, face travel barriers to regional medical centers, and may have low literacy and limited resources. mHealth technologies have the potential to decrease barriers but must be carefully adapted for, and efficacy-tested with, medically underserved patients. We developed an mHealth behavioral pain coping skills training intervention (mPCST-Community). We now utilize a multisite randomized controlled trial to: 1) test the extent mPCST-Community reduces breast cancer patients' pain severity (primary outcome), pain interference, fatigue, physical disability, and psychological distress; 2) examine potential mediators of inter-vention effects; and 3) evaluate the intervention's cost and cost-effectiveness. Methods/design: Breast cancer patients (N = 180) will be randomized to mPCST-Community or an attention control. mPCST-Community's four-session protocol will be delivered via videoconferencing at an underserved community clinic by a remote pain therapist at a major medical center. Videoconference sessions will be sup-plemented with a mobile application. Participants will complete self-report measures at baseline, post-intervention, and 3-and 6-month follow-ups. Conclusions: mPCST-Community has the potential to reduce pain and disability, and decrease barriers for cancer patients in medically underserved areas. This is one of the first trials to test an mHealth behavioral cancer pain intervention developed specifically for medically underserved communities. If successful, it could lead to widespread implementation and decreased health disparities.
Chronic pain conceptualization within a uniquely marginalized population: exploratory analysis of the relations between biomedical and biopsychosocial perspectives and functioning
(University of Alabama Libraries, 2019) Morais, Calia Arglod; Thorn, Beverly E.; University of Alabama Tuscaloosa
Objective: The goal of the current study was to examine the association of pain beliefs and pain-related outcomes, such as pain interference, physical functioning, depression, and anxiety. The impact of a literacy-adapted psychosocial treatment on the modification of pain beliefs was also explored. Background: Previous research has shown an association between pain beliefs and pain-related outcomes. To date, most studies have found a positive relationship between biomedical pain beliefs and poor psychological and physical outcomes. There is also some evidence to suggest that pain beliefs are a unique predictor for pain outcomes, above and beyond the influence of demographic characteristics. Pain beliefs can be modified through psychosocial treatments for chronic pain, such as Cognitive Behavioral Therapy (CBT). There is a paucity of research examining the biomedical or biopsychosocial pain beliefs of a low-SES population, or whether a psychosocial intervention is effective at changing biomedical or biopsychosocial pain beliefs among this understudied patient population. Method: 290 participants from the Learning About My Pain (LAMP) Study completed questionnaires before starting a 10-week literacy-adapted psychosocial treatment for chronic pain. Participants were randomly assigned to group cognitive-behavioral therapy (CBT), group pain education (EDU) or medical treatment-as-usual (UC). Participants also completed questionnaires at post-treatment. Results: There was a significant positive and weak association between pain beliefs and pain-related outcomes. Regression results revealed that biomedical pain beliefs had a stronger association with physical functioning, while biopsychosocial pain beliefs had a stronger association with psychological functioning. Patient’s biomedical pain beliefs decreased and biopsychosocial pain beliefs increased following participation in a literacy-adapted psychosocial intervention. Conclusions: The findings in this study suggest that certain specific pain beliefs may be more related to particular aspects of physical and psychological functioning. These findings also provide further support for the benefits of literacy-adapted psychosocial treatments and highlight the benefits of providing treatments consistent with a biopsychosocial model of pain. Overall, the results of this study demonstrate the importance of pain belief assessment among an understudied population and its implications to improve our understanding of patient’s pain conceptualization and how it relates to patient outcomes.
Cognitive bias and health-related decision-making
(University of Alabama Libraries, 2016) Fetterman, Zachary James; Tullett, Alexa M.; University of Alabama Tuscaloosa
Extant literature suggests that cognitive bias is a pervasive phenomenon that is present in a variety of domains and is associated with negative consequences related to decision-making and interpersonal interactions (Chambers & Melnyk, 2006; Fischer et al., 2005; Lord et al., 1979; Ross & Ward, 1996). The utility of a brief intervention designed to reduce biases in the understudied domain of health was investigated. The present study extended previous work indicating that completion of a brief bias-reducing intervention was associated with significant reductions in inappropriate confidence in interpersonal judgments (Hart, Tullett, Shreves, & Fetterman, 2015). In the present study, participants completing a bias-reducing intervention did not demonstrate significant differences in confidence bias, selective exposure, and willingness to comply with hypothetical health interventions relative to participants completing a control task. Participants completing a bias-reducing task did, however, demonstrate a greater understanding of cognitive bias and its implications than control participants. Explanations for the present findings including the function of the bias-reducing intervention, measurement of confidence bias and its presumed manifestations, use of Amazon’s Mechanical Turk for recruitment and data collection, and the role of accuracy motivation in the domain of health are discussed. Overall results of the current investigation suggest a need to complete follow-up research in order to clarify present results and to reconcile these results with extant literature.
Cognitive mechanisms in comorbid insomnia and chronic pain
(University of Alabama Libraries, 2011) Dillon, Haley Rebecca; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
The present study examined the relation between pain catastrophizing, pre-sleep arousal (PSA), and insomnia severity in chronic pain patients. Forty-eight outpatients with chronic pain (duration of 6 months or more) completed self-report measures of health, mood, pain, and sleep. A hierarchical regression analysis was conducted to determine the relative contributions of pain catastrophizing, cognitive PSA, and somatic PSA to the prediction of scores on the Insomnia Severity Index, while controlling for age, sex, education level, depression severity, symptoms of Restless Legs Syndrome (RLS), and pain intensity. Results showed that pain catastrophizing accounted for unique variance in insomnia severity, independent of pain intensity and other control variables. However, when cognitive and somatic PSA were taken into account, the significance of cognitive PSA rendered pain catastrophizing non-significant. Research and clinical work should explore how cognitive variables (such as pain catastrophizing) may be linked to the pre-sleep arousal in comorbid insomnia.
A cultural framework for pain management: understanding traditional cultural values in Hispanic patients with chronic pain and limited English proficiency
(University of Alabama Libraries, 2015) Torres, Calia; Thorn, Beverly E.; University of Alabama Tuscaloosa
Objective: In the United States, Hispanics face additional barriers to accurate pain management due to language and cultural differences. One way to address pain disparities among Hispanic patients is to further investigate the role of cultural values that influence chronic pain management. The aim of this study was to to obtain patients’ perspectives and deepen our understanding of the cultural beliefs influencing the pain management decisions of Hispanics with low acculturation and limited English proficiency who turn to Federally Health Qualified Centers (FQHCs) for healthcare services. Methods: The sample included 24 (17 females and 7 males) Spanish-speaking patients with chronic pain. Participants participated in a focus group or key-informant interview and shared about their pain management needs and factors influencing how they experience, report, and treat their chronic pain. Descriptive data on pain and mood variables were also collected to inform how this unique population compares to the original norms reported in the pain literature. Results: Across all interviews, patients’ reported preference for self-care practices, non-invasive medical treatments and reported negative attitudes towards pain medications. Beliefs about pain relief and finding the cure for chronic pain significantly affected their expectations about medical visits. Satisfaction with healthcare providers was highly influenced by patients’ expectations and preference for personal, warm, and friendly interactions. This study also highlights the emphasis of family needs over individual needs and how this prioritization prevented participants from expressing pain behaviors and seeking care. Conclusion: The implications of our findings suggest that patients’ unfamiliarity with mainstream treatment options for chronic pain may shape their expectations and satisfaction with medical visits.
Development and pilot testing of an mHealth behavioral cancer pain protocol for medically underserved communities
(Routledge, 2019) Dorfman, Caroline S.; Kelleher, Sarah A.; Winger, Joseph G.; Shelby, Rebecca A.; Thorn, Beverly E.; Sutton, Linda M.; Keefe, Francis J.; Gandhi, Vicky; Manohar, Preethi; Somers, Tamara J.; Duke University; University of Alabama Tuscaloosa
The purpose of this study was to refine and test a mobile-health behavioral cancer pain coping skills training protocol for women with breast cancer and pain from medically underserved areas. Three focus groups (Phase 1) were used to refine the initial protocol. A single-arm pilot trial (Phase 2) was conducted to assess feasibility, acceptability, and changes in outcomes. The intervention was delivered at a community-based clinic via videoconferencing technology. Participants were women (N = 19 for Phase 1 and N = 20 for Phase 2) with breast cancer and pain in medically underserved areas. Major themes from focus groups were used to refine the intervention. The refined intervention demonstrated feasibility and acceptability. Participants reported significant improvement in pain severity, pain interference, and self-efficacy for pain management. Our intervention is feasible, acceptable, and likely to lead to improvement in pain-related outcomes for breast cancer patients in medically underserved areas.
Development of the composite catastrophizing measure-short form (CCM-SF)
(University of Alabama Libraries, 2014) Smitherman, Anna; Thorn, Beverly E.; University of Alabama Tuscaloosa
Pain-related cognitions play an important role in the pain experience. Several different pain cognitions are frequently assessed in both research and clinical evaluation. Among them, pain catastrophizing has been shown to be particularly predictive of a number of pain outcomes. The Pain Catastrophizing Scale (PCS) is the most widely used measure of pain catastrophizing and shows good reliability and validity. However, research suggests that catastrophizing may not be fully captured by the three scales comprising the PCS. The goal of this study was to develop and validate a new measure of pain catastrophizing. The new measure, The Composite Catastrophizing Measure - Short Form (CCM-SF), was developed from data collected on 73 items from the PCS and other related measures (N=220). These items were subjected to factor analyses and 14 were selected to represent two scales: pain preoccupation and pain worry. The new measure was administered to 223 undergraduate students prior to and after a cold pressor task (CPT) to assess both dispositional and situational pain cognitions. The CCM-SF showed good internal consistency for both the dispositional (α=.92) and situational (α=.91) administrations. Correlation analyses showed that both administrations of the CCM-SF were predictive of pain outcomes (pain intensity, unpleasantness, and tolerance) from the experimental pain task. Confirmatory factor analysis indicated that its factor structure remained consistent over time. Analyses also revealed that, when evaluated individually, the pain preoccupation subscale was a better predictor than the pain worry subscale of pain outcomes related to the CPT. It is hypothesized that the pain worry subscale will contribute more to the assessment of clinical pain samples than experimental pain samples. The CCM-SF seems to be psychometrically comparable to current gold standard measurements of pain catastrophizing. Beyond this, the CCM-SF offers unique subscales that allow for the versatile assessment of pain across domains (e.g. experimental, chronic, and acute). Future research should explore the summative and subscale scores from the CCM-SF in clinical samples.
Discrimination, cultural consonance, and cell-medated immunity among college students at the University of Alabama
(University of Alabama Libraries, 2016) Quinn, Edward; DeCaro, Jason A.; University of Alabama Tuscaloosa
Racial-ethnic inequalities in health are a major public health concern in the United States. Biocultural anthropologists approach the question of health using culture theory and are informed by expertise in human biology. The mechanisms by which social inequalities “get under the skin” and are transduced into health inequalities are of interest to both biocultural anthropologists and those directing efforts to reduce health inequalities. Recent evidence showing racial-ethnic differences in cell-mediated immunity was elaborated upon through research conducted with 71 young college students at the University of Alabama. Drawing on prior ethnographic work on understandings of life trajectory among youth, and on the extensive literature demonstrating associations between perceived discrimination and health outcomes, this study tested two mechanisms for the observed racial-ethnic differences in cell-mediated immunity. Cultural consonance, or the degree to which an individual is congruent with locally valued ways of thinking and behaving, and perceived discrimination were tested for associations with cytomegalovirus (CMV). CMV was used as a proxy measure of cell-mediated immune status. Differences by race-ethnicity in CMV were found. Non-White students had higher levels of CMV than White students. No main effects of cultural consonance or perceived discrimination predicted CMV, but an interaction between these two variables did predict CMV. Future research efforts in racial-ethnic health disparities will consider social address and culture as important factors in population health.
Does perceived social support mediate the relationship between catastrophizing and pain response?
(University of Alabama Libraries, 2015) Van Dyke, Benjamin Prime; Thorn, Beverly E.; University of Alabama Tuscaloosa
Objective: The objective of the current investigation was to attempt to contribute to the limited body of literature regarding the role and importance of social context, in particular social support, to the experience of pain. Specifically, the current study proposed that some of the previously observed effects of pain catastrophizing on pain experience operate through a social mechanism of action by reducing available social resources to help people cope with the stress of pain. Thus, it was hypothesized that perceived social support would at least partially mediate the relationship between pain catastrophizing and pain experience or response variables (perceptions of pain intensity and unpleasantness and tolerance time). Method: A sample of 285 college students enrolled in introductory psychology courses answered baseline questionnaires about dispositional variables before completing a fixed-time cold pressor task (60s) followed by an open-ended cold pressor task (to test pain tolerance). Questionnaires assessed perceived general social support (the Social Provisions Scale), dispositional and situational pain catastrophizing (Pain Catastrophizing Scale), and perceptions of pain intensity and unpleasantness (using visual analog scales). Results: The final sample consisted of 285 college students (Age: M = 19.62, SD = 1.73), was primarily White (77.9%) and female (58.2%), and the majority denied having either chronic or recurrent pain (n = 160, 56.1%). Regression and SEM analyses demonstrated that the study mediation hypothesis was not supported. Conclusion: Results of the current study suggest important revisions and considerations for future replications and similar studies.
Effects of a psychosocial intervention on eating behavior compliance in bariatric surgery patients
(University of Alabama Libraries, 2009) Boeka, Abbe; Prentice-Dunn, Steven; Lokken, Kristine L.; University of Alabama Tuscaloosa
Obesity is a leading cause of preventable death in America and its prevalence is increasing at an alarming rate. Given the medical and psychosocial consequences of obesity, surgical intervention for weight loss ("bariatric" surgery) is now considered a viable option. Although the initial success rate of bariatric surgery is high, sustained weight loss requires adherence to strict post-surgical guidelines. There is increasing evidence that a percentage of patients have difficulties adhering to the post-surgical guidelines, with reemergence of poor eating habits (overeating, binge eating) being a major contributing factor. Recurrence of such eating habits can be detrimental to successful weight loss after surgery. Given the difficulties many patients face after surgery, it is possible that the typical post-surgical eating behavior guidelines presented to bariatric surgery patients are ineffective in motivating some individuals to comply. Protection Motivation Theory (PMT), a model that specifies the components of health messages that increase compliance with a health behavior, has been proven to be a reliable model for creating health promotion messages. The present study utilized a PMT-based intervention directed at patients undergoing bariatric surgery. Eighty-two obese individuals seeking surgical treatment of obesity were recruited to participate in this study. Participants were divided into two groups: PMT vs. Control. In addition to routine messages from the bariatric surgeon, participants in the PMT group received an intervention focused on the importance of adhering to post-surgical eating behavior guidelines and how best to adhere to these guidelines. This intervention was in the form of lectures, guided readings, and participant discussion. Participants in the control group received standard of care information from the bariatric surgeon. Those participants who had bariatric surgery during the time frame of the study were followed after surgery to assess post-surgical eating habits and weight loss. Results indicated that overall, the PMT intervention did not have a significant impact. However, follow-up analyses indicated that perceived self-efficacy and perceived threat of not following the guidelines may predict patients' intentions to comply with post-surgical guidelines. In addition, perceived self-efficacy was found to be a significant predictor of post-surgical weight loss. Findings are discussed in terms of the methodological compromises that resulted from the applied research setting as well as promising avenues for future investigation.
Epidemiology of bedtime, arising time, and time in bed: analysis of age, gender, and ethnicity
(University of Alabama Libraries, 2011) Thomas, Stephen Justin; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
This study investigated the epidemiology of subjective behavioral sleep variables (i.e., bedtime, arising time, and time in bed) as a function of age, gender, and ethnicity. Sleep diaries were analyzed for 756 participants. Regression analysis showed a main effect of age on subjective bedtime, arising time, and time in bed, but not for gender or ethnicity. Younger adults had later bedtimes and arising times than other age groups. Older adults had earlier bedtimes and later arising times, which resulted in greater time spent in bed than any age group. These results suggest that there are distinct behavioral sleep patterns based on age but not gender or ethnicity and may have significant clinical implications, particularly for older adults.
The evolution of secondary insomnia in women with breast cancer
(University of Alabama Libraries, 2012) Vander Wal, Gregory Scott; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Secondary insomnia resulting from the onset of a health problem often persists beyond the course of the instigating stressor, suggesting that secondary insomnia evolves into a self-sustaining primary disorder. However, the course of secondary insomnia and how it relates to a primary medical or psychological disorder is poorly understood. Newly diagnosed breast cancer provides an opportunity to study secondary insomnia at the onset of an instigating stressor. The current study explored the feasibility of a methodology to examine the relationship between insomnia and breast cancer over a 2 month period in 29 women newly diagnosed (< 6 weeks) with breast cancer. Primary analyses included exploratory descriptive techniques. A multilevel modeling framework was also applied to the data to examine changes in sleep and cancer symptoms over time. The results show a significant relationship between insomnia severity and breast cancer symptom severity. Evidence is also presented regarding differences in the experience of this relationship for individuals with primary and secondary insomnia. Further evidence is presented supporting a change in the relationship between sleep and stress over time for individuals with secondary insomnia. Implications for timing of intervention and future research are discussed.
Health care utilization and opioid prescriptions for chronic pain in low-income settings
(University of Alabama Libraries, 2017) Newman, Andrea Kara; Thorn, Beverly E.; University of Alabama Tuscaloosa
Chronic pain is a serious health problem with high rates of health care utilization (HCU) and opioid prescriptions (OP). Many patients become stymied in a perpetual cycle of unsuccessful attempts to find relief from suffering through frequent health care visits and opioid prescriptions. Especially within low-income populations, the burdens of health care services and pain medications are especially unpleasant due to significant financial costs, barriers to transportation, and high levels of stress. Research is currently limited in examining the various factors associated with HCU and OP within low-income settings. The Learning About My Pain (LAMP) trial is a randomized comparative effectiveness study of group-based psychosocial interventions (PCORI Contract #941, Beverly Thorn, PI; clinicaltrials.gov identifier NCT01967342) for patients receiving care for chronic pain at low-income clinics in rural and suburban Alabama. As part of the LAMP study, medical records one-year prior to study onset were retrospectively collected for data analysis on HCU and OP. Sociodemographic traits (age, gender, race, poverty status, primary literacy, and education level), pain related variables (pain severity, pain interference, disability, number of pain sites, number of pain types, and opioid prescriptions), and psychological variables (depressive symptoms and pain catastrophizing) were entered into a hierarchical multiple regression model to predict health care utilization. Results suggested that being Black/African-American, having received an opioid prescription in the year prior to treatment onset, and higher depressive symptoms were associated with increased health care utilization for chronic pain conditions. Study findings suggest the need for a biopsychosocial approach to chronic pain management.
International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering
(Oxford University Press, 2019) Darnall, Beth D.; Juurlink, David; Kerns, Robert D.; Mackey, Sean; Van Dorsten, Brent; Humphreys, Keith; Gonzalez-Sotomayor, Julio A.; Furlan, Andrea; Gordon, Adam J.; Gordon, Debra B.; Hoffman, Diane E.; Katz, Joel; Kertesz, Stefan G.; Satel, Sally; Lawhern, Richard A.; Nicholson, Kate M.; Polomano, Rosemary C.; Williamson, Owen D.; McAnally, Heath; Kao, Ming-Chih; Schug, Stephan; Twillman, Robert; Lewis, Terri A.; Stieg, Richard L.; Lorig, Kate; Mallick-Searle, Theresa; West, Robert W.; Gray, Sarah; Ariens, Steven R.; Potter, Jennifer Sharpe; Cowan, Penney; Kollas, Chad D.; Laird, Danial; Ingle, Barby; Grove, J. Julian; Wilson, Marian; Lockman, Kashelle; Hodson, Fiona; Palackdharry, Carol S.; Fillingim, Roger B.; Fudin, Jeffrey; Barnhouse, Jennifer; Manhapra, Ajay; Henson, Steven R.; Singer, Bruce; Ljosenvoor, Marie; Griffith, Marlisa; Doctor, Jason N.; Hardin, Kimeron; London, Cathleen; Mankowski, Jon; Anderson, Andrea; Ellsworth, Linda; Budzinski, Lisa Davis; Brandt, Becky; Hartley, Greg; Heck, Debbie Nickels; Zobrosky, Mark J.; Cheek, Celeste; Wilson, Megan; Laux, Cynthia E.; Datz, Geralyn; Dunaway, Justin; Schonfeld, Eileen; Cady, Melissa; LeDantec-Boswell, Therese; Craigie, Meredith; Sturgeon, John; Flood, Pamela; Giummarra, Melita; Whelan, Jessica; Thorn, Beverly E.; Martin, Richard L.; Schatman, Michael E.; Gregory, Maurice D.; Kirz, Joshua; Robinson, Patti; Marx, James G.; Stewart, Jessica R.; Keck, Phillip S.; Hadland, Scott E.; Murphy, Jennifer L.; Lumley, Mark A.; Brown, Kathleen S.; Leong, Michael S.; Fillman, Mechele; Broatch, James W.; Perez, Aaron; Watford, Kristine; Kruska, Kari; You, Dokyoung Sophia; Ogbeide, Stacy; Kukucka, Amy; Lawson, Susan; Ray, James B.; Martin, T. Wade; Lakehomer, James B.; Burke, Anne; Cohen, Robert I.; Grinspoon, Peter; Rubenstein, Marc S.; Sutherland, Stephani; Walters, Kristie; Lovejoy, Travis; Stanford University; University of Toronto; Hospital for Sick Children (SickKids); Yale University; Oregon Health & Science University; University of Utah; University of Washington; University of Washington Seattle; University of Maryland Baltimore; York University - Canada; University of Alabama Birmingham; US Department of Veterans Affairs; Veterans Health Administration (VHA); Veterans Affairs Medical Center - Birmingham; American Enterprise Institute for Public Policy Research; University of Pennsylvania; Pennsylvania Medicine; University of Western Australia; Royal Perth Hospital; University of Kansas; University of Kansas Medical Center; Southern Illinois University; National Changhua University of Education; State University of New York (SUNY) Upstate Medical Center; Harvard University; Spaulding Rehabilitation Hospital; Massachusetts General Hospital; Harvard Medical School; University of Texas Health Science Center at San Antonio; Washington State University; University of Iowa; John Hunter Hospital; University of Florida; Albany College of Pharmacy & Health Sciences; Western New England University; Eastern Virginia Medical School; Texas Womans University; University of Southern California; University of Miami; Indiana University-Purdue University Indianapolis; Monash University; University of Alabama Tuscaloosa; Tufts University; Massachusetts Department of Public Health; Boston University; James A. Haley Veterans Hospital; Wayne State University; University of Minnesota Twin Cities
An Intersectional Identity Approach to Chronic Pain Disparities Using Latent Class Analysis
(University of Alabama Libraries, 2020) Newman, Andrea K; Thorn, Beverly E.; Allen, Rebecca S.; University of Alabama Tuscaloosa
Chronic pain is a highly prevalent and costly condition with substantial negative effects. However, health care differences exist in prevalence, pain assessment, treatment, and outcomes based on demographic characteristics. There has been a recent increase in health disparity research. Many studies have examined the relationships between independent factors of disparity (e.g., race, sex, income, age, etc.) and health outcomes. Research is limited on the interaction of these independent factors (e.g., female Black/African-American, low-income older adult, etc.). Given the high frequency of individuals with multiple disparity factors, applying an intersectional identity approach to chronic pain disparity research is important. Latent class analysis (LCA) examined chronic pain disparities with an intersectional identity theory approach in the Learning About My Pain (LAMP) trial, a randomized comparative effectiveness study of group-based psychosocial interventions (PCORI Contract #941, Beverly Thorn, PI; clinicaltrials.gov identifier NCT01967342) for patients receiving care for chronic pain at low-income clinics in rural and suburban Alabama. LCA results suggested a 5-class model with meaningful differences in factors related to disparities. Cross-sectional results highlighted the importance of SES, age, and race in the experience of chronic pain. The latent disparity profiles varied by pre-treatment chronic pain functioning and there was some evidence that individuals with moderate disparities (i.e., low literacy/education, older Black/African-American adults, and disability) benefited more from Cognitive-Behavioral Therapy (CBT) than Pain Education (EDU). There were no significant heterogeneity of treatment effects when examining CBT or EDU versus Usual-Care (UC). The intersectional identity theory approach provided an integrated picture of chronic pain disparities and increased information for future treatment adaptations that meet the specific needs of individuals with similar social identities.
Is reduction in pain catastrophizing a therapeutic mechanism specific to cognitive-behavioral therapy for chronic pain?
(Oxford University Press, 2012) Burns, John W.; Day, Melissa A.; Thorn, Beverly E.; Rush University; University of Alabama Tuscaloosa
Mechanisms underlying favorable outcomes of psychosocial interventions for chronic pain are unclear. Theory suggests changes in maladaptive cognitions represent therapeutic mechanisms specific to cognitive-behavioral therapy (CBT). We illustrate the importance of examining whether treatments work either uniquely via mechanisms specified by theory or via mechanisms common to different treatments. Secondary data analysis was conducted to examine the effects of reduction in pain catastrophizing on outcomes following CBT and Pain Education. Generally, reductions in pain catastrophizing were significantly related to outcome improvements irrespective of CBT or Pain Education condition. Results underscore the need to assess whether mechanisms presumed to operate specifically in one treatment do indeed predict outcomes and illustrate the importance of broadening the assessment of mechanisms beyond those specified by theory. Theory-specific, competing, and common mechanisms must all be assessed to determine why our treatments work.
Juror perceptions in sexual orientation-based hate crimes
(University of Alabama Libraries, 2010) Gorter, Erin; Salekin, Karen L.; University of Alabama Tuscaloosa
The present study sought to investigate how victim sexual orientation and homonegativity influence the relationship between severity of crime and assignment of punishment to the perpetrator of a sexual orientation-based (SO) hate crime. These differences were examined across three levels of hate crime: misdemeanor assault, felony assault, and attempted murder. In addition, a secondary focus of this study was to examine whether jurors' perceptions of perpetrator and victim blame varied based on the severity of the crime and the victim's sexual orientation. Previous literature has shown that juror sexual prejudice (i.e., homonegativity) influences jurors' perceptions and decision-making processes in similar contexts; therefore, the researchers explored whether homonegativity moderates each of the proposed relations. A total of 238 participants were recruited from jury pools in four counties located in the state of Alabama. Participants completed a series of questionnaires related to a trial vignette, which depicted one of three varying levels of an SO hate crime. Results showed a significant main effect of the severity of crime on sentencing recommendation with the length of punishment increasing with the severity of the crime. No significant main effect of victim sexual orientation and no significant interaction between severity of crime and homonegativity were found on sentencing recommendation. It was also found that more blame was assigned to the perpetrator when the victim was heterosexual and significantly lower levels of victim blame were found when the crime was a misdemeanor assault as opposed to a felony assault or attempted murder. However, both of these relations became non-significant when homonegativity was entered into the model indicating the variables were unable to explain a unique amount of variance in the perceptions of blame. Finally, it was found that participants with higher levels of homonegativity assigned higher amounts of blame to the victim (regardless of the victim's sexual orientation). Theoretical and practical implications of these results are discussed. The results suggest there are some factors which may unduly influence jury members in SO hate crimes and could lead to homosexual victims experiencing additional negative consequences during these trials. The current study also demonstrates the need for additional research on jury decision-making in SO hate crimes to ensure that victims of these crimes are being treated fairly within the justice system.

Browsing by Author "Thorn, Beverly E."

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