Painful memories: Challenges in trauma-focused therapy for torture survivors with PTSD and chronic pain

Introduction: PTSD and chronic pain are disorders that researchers increasingly acknowledge to be risk factors that overlap and their comorbidity is associated with poorer treatment outcomes. This review focuses on torture survivors due to the high prevalence of comorbidity in this group, as well as how PTSD and chronic pain might develop, interact and mutually maintain each other. Methods: A narrative review of empirical studies and theoretical models regarding chronic pain and PTSD in torture survivors, informed by studies conducted in other contexts. Results and discussion: An overview of PTSD and chronic pain studies of torture survivors is presented. Treatment studies for torture survivors with PTSD are scarce and have been discouraging. Studies in other patient populations and theoretical models of main- taining factors within the cognitive-behavioral paradigm are presented, and focused around how interactions between PTSD and chronic pain might mitigate treatment of both disorders. Mutually maintaining factors between chronic pain and PTSD are presented as potential barriers to healing, and clinical implications involve suggestions for clinicians with intention to overcome these barriers in trauma-focused treatment of torture survivors. The knowledge base on how chronic pain and PTSD interact within the context of torture is still very limited.Torture is a potent risk factor in itself for both chronic pain and PTSD. Studies point to complex interactions between pain and PTSD across different trauma-exposed populations, especially when the trauma includes pain. Moreover, the coping strategies that are available and might function as some form of protection during torture [e.g. dissociation, withdrawal], might conversely function to exacerbate symptoms when the survivor is in a safe rehabilitation context. Observations combined with CPPC literature and recent developments in learning theory challenge clinical practice accordingly. Additionally, the limited knowledge base prevents us from providing clear-cut sugges- tions, particularly as the majority of scientific enquiry regarding chronic pain and PTSD has been conducted in other populations outside of the torture survivors group. Furthermore, cultural factors, specific needs and characteristics in this group, the human rights perspective and the socio-political context all need to be acknowledged. Trauma-focused treatment does not appear to specifically target all the mechanisms that are supposedly interacting in maintaining chronic pain and PTSD. Interdisciplinary rehabilitation and close collaboration between physiotherapists and trauma-focused therapists are warranted.

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Emerging Syndromes

10.1093/oxfordhb/9780190620998.013.24 ◽

2017 ◽

Author(s):

Kelly C. Allison ◽

Jennifer D. Lundgren

Keyword(s):

Empirical Studies ◽

Theoretical Models ◽

Future Research ◽

Night Eating Syndrome ◽

Statistical Manual ◽

Night Eating ◽

Diagnostic And Statistical Manual ◽

Impairment In Functioning ◽

Atypical Anorexia Nervosa ◽

Comorbid Psychopathology

The Diagnostic and Statistical Manual, fifth edition, of the American Psychiatric Association (2013) has designated several disorders under the diagnosis of otherwise specified feeding and eating disorder (OSFED). This chapter evaluates three of these, night eating syndrome (NES), purging disorder (PD), and atypical anorexia nervosa (atypical AN). It also reviews orthorexia nervosa, which has been discussed in the clinical realm as well as the popular press. The history and definition for each is reviewed, relevant theoretical models are presented and compared, and evidence for the usefulness of the models is described. Empirical studies examining the disorders’ independence from other disorders, comorbid psychopathology, and, when available, medical comorbidities, are discussed. Distress and impairment in functioning seem comparable between at least three of these emerging disorders and threshold eating disorders. Finally, remaining questions for future research are summarized.

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Mapping the Landscape and Structure of Research on Education for Sustainable Development: A Bibliometric Review

Sustainability ◽

10.3390/su12051947 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1947 ◽

Cited By ~ 1

Author(s):

Philip Hallinger ◽

Vien-Thong Nguyen

Keyword(s):

Sustainable Development ◽

Knowledge Base ◽

English Language ◽

Current Knowledge ◽

Empirical Studies ◽

Education For Sustainable Development ◽

Intellectual Structure ◽

Geographic Diversification ◽

The Past ◽

K 12

This systematic review of research used science mapping as a means of analyzing the knowledge base on education for sustainable development (ESD) in K-12 schooling. The review documented the size, growth trajectory and geographic distribution of this literature, identified high impact scholars and documents, and visualized the “intellectual structure” of the field. The database examined in this review consisted of 1842 English language, Scopus-indexed documents published between 1990 and 2018. The review found that the knowledge base on ESD has grown dramatically over the past 30 years, with a rapidly accelerating rate of publication in the past decade. Although the field has been dominated by scholarship from Anglo-American_European nations, there is evidence of increasing geographic diversification of the ESD knowledge base over the past 15 years. Citation analyses identified authors who have had a significant influence on the development of this literature. Author co-citation analysis revealed three “schools of thought” that comprise the “intellectual structure” of this knowledge base: Education for Sustainable Development, Developing a Sustainability Mindset, Teaching and Learning for Sustainability. Document content analyses led to the conclusion that the current knowledge base is heavily weighted towards critical, descriptive and prescriptive papers, with an insufficient body of analytical empirical studies. Several recommendations are offered for strengthening this literature.

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A Business Model Framework to Characterize Digital Multisided Platforms

Journal of Open Innovation Technology Market and Complexity ◽

10.3390/joitmc6010010 ◽

2020 ◽

Vol 6 (1) ◽

pp. 10 ◽

Cited By ~ 4

Author(s):

Marco Ardolino ◽

Nicola Saccani ◽

Federico Adrodegari ◽

Marco Perona

Keyword(s):

Information And Communication Technologies ◽

Assessment Tool ◽

Empirical Studies ◽

Communication Technologies ◽

Model Framework ◽

Recent Developments ◽

Information And Communication ◽

Multiple Case ◽

The One

Businesses grounded upon multisided platforms (MSPs) are found in a growing number of industries, thanks to the recent developments in Internet and digital technologies. Digital MSPs enable multiple interactions among users of different sides through information and communication technologies. The understanding of the characteristics and constituents of MSPs is fragmented along different literature streams. Moreover, very few empirical studies have been carried out to date. In order to fill this gap, this paper presents a three-level framework that describes a digital MSP. The proposed framework is based on literature analysis and multiple case study. On the one hand, the framework can be used to describe MSP as it provides an operationalization of the concept through the identification of specific dimensions, variables and items; on the other hand, it can be used as an assessment tool by practitioners, as exemplified by the three empirical applications presented in this paper.

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Dementia grief: A theoretical model of a unique grief experience

Dementia ◽

10.1177/1471301215581081 ◽

2016 ◽

Vol 16 (1) ◽

pp. 67-78 ◽

Cited By ~ 32

Author(s):

Kesstan Blandin ◽

Renee Pepin

Keyword(s):

Applied Research ◽

Theoretical Models ◽

Therapeutic Interventions ◽

Dementia Caregivers ◽

Psychological States ◽

Grief Process ◽

High Prevalence ◽

Research Questions ◽

Stress Burden ◽

Person With Dementia

Previous literature reveals a high prevalence of grief in dementia caregivers before physical death of the person with dementia that is associated with stress, burden, and depression. To date, theoretical models and therapeutic interventions with grief in caregivers have not adequately considered the grief process, but instead have focused on grief as a symptom that manifests within the process of caregiving. The Dementia Grief Model explicates the unique process of pre-death grief in dementia caregivers. In this paper we introduce the Dementia Grief Model, describe the unique characteristics of dementia grief, and present the psychological states associated with the process of dementia grief. The model explicates an iterative grief process involving three states— separation, liminality, and re-emergence—each with a dynamic mechanism that facilitates or hinders movement through the dementia grief process. Finally, we offer potential applied research questions informed by the model.

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The Management of Idiopathic Chronic Pain: A Holistic Approach

The Canadian Journal of Psychiatry ◽

10.1177/070674378102600609 ◽

1981 ◽

Vol 26 (6) ◽

pp. 429-431

Author(s):

H. Brent Richard ◽

Gerald H. Flamm

Keyword(s):

Health Care ◽

Chronic Pain ◽

Psychosomatic Medicine ◽

Health Care Services ◽

Holistic Approach ◽

Secondary Gain ◽

Biopsychosocial Approach ◽

Care Services ◽

Recent Developments ◽

Symptom Formation

The evaluation and treatment of the patient with idiopathic chronic pain traditionally has involved a sequence of studies first by the internist, then the neurologist, and finally the psychiatrist. This has resulted in an overutilization of costly health care services and may paradoxically have helped to promote symptom chronicity. In keeping with recent developments in the field of psychosomatic medicine, a coordinated biopsychosocial approach is advocated with the identification and amelioration of the multiple determinants of symptom formation in each of these interrelated sub-systems. A case is presented in which the application of this holistic approach appeared to help curtail the overuse of health care services and at the same time helped to diminish psychosocial reinforcers in the form of secondary gain.

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Sleep patterns and symptoms of anxiety and depression in patients with chronic pain

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2009000100007 ◽

2009 ◽

Vol 67 (1) ◽

pp. 25-28 ◽

Cited By ~ 28

Author(s):

Martha M.C. Castro ◽

Carla Daltro

Keyword(s):

Chronic Pain ◽

Sleep Disturbances ◽

Myofascial Pain ◽

Depression Scale ◽

Anxiety And Depression ◽

Depression And Anxiety ◽

Sleep Patterns ◽

Symptoms Of Depression ◽

High Prevalence ◽

The Mean

BACKGROUND: Sleep disturbances and symptoms of anxiety and depression have been shown to be involved in the genesis and perpetuation of chronic pain. OBJECTIVE: To evaluate sleep patterns and the prevalence of symptoms of anxiety and depression in patients with chronic pain. METHOD: Four hundred consecutive patients referred to a chronic pain outpatient clinic were investigated using patient charts, the numerical Visual Analogue Scale for the evaluation of pain, the Hospital Anxiety and Depression scale and the Mini-Sleep Questionnaire. RESULTS: The mean age of patients was 45.6±11.4 years. The most frequent medical diagnosis was myofascial pain followed by neuropathic pain. The prevalence of symptoms of anxiety was 72.8%, depression 93% and altered sleep patterns 93%. CONCLUSION: This study revealed a high prevalence of symptoms of depression and anxiety and alterations in sleep patterns in patients with chronic pain, justifying investigation into these disturbances in this group of patients.

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A Systematic Review on Attachment and Sleep at Preschool Age

Children ◽

10.3390/children8100895 ◽

2021 ◽

Vol 8 (10) ◽

pp. 895

Author(s):

Catarina Perpétuo ◽

Eva Diniz ◽

Manuela Veríssimo

Keyword(s):

Systematic Review ◽

Attachment Security ◽

Biological Process ◽

Sleep Problems ◽

Empirical Studies ◽

Theoretical Models ◽

Preschool Age ◽

Future Research ◽

Parent Child Relationships ◽

Present Systematic Review

Sleep is a biological process that impacts nearly every domain of a child’s life. Sleep-wake regulation influences and it is highly influenced by developmental variables related to parent-child relationships, such as attachment. The main goal of the present systematic review is to analyze and integrate the findings of empirical studies investigating the relations between attachment and sleep in preschool age, a period marked by important developmental changes that challenge both attachment system and sleep-wake regulation. A database search was performed using a combination of relevant keywords, leading to the identification of 524 articles, with 19 manuscripts assessed for eligibility; finally, seven studies (2344 children) were included. Overall, the findings were not consistent, with some studies reporting significant associations between attachment security and sleep quality, as well as between attachment insecurity and sleep problems, whereas others did not find significant associations. The results are discussed in light of the available theoretical models and integrated in the context of measurement approaches to attachment and sleep heterogeneity, aiming to guide future research on the topic.

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COVID-19 and anosmia: The story so far

Ear Nose & Throat Journal ◽

10.1177/01455613211048998 ◽

2021 ◽

pp. 014556132110489

Author(s):

Xiangming Meng ◽

Yuandan Pan

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Olfactory Epithelium ◽

Underlying Disease ◽

Predictive Tool ◽

Olfactory Testing ◽

High Prevalence ◽

Smoking Behaviors ◽

Recent Developments ◽

Underlying Diseases

Objectives The pandemic has affected over 182 million coronavirus disease 2019 (COVID-19) cases worldwide. Accumulated evidence indicates that anosmia is one of the significant characteristics of COVID-19 with a high prevalence. However, many aspects of COVID-19-induced anosmia are still far from being fully understood. The purpose of this review is to summarize recent developments in COVID-19-induced anosmia to increase awareness of the condition. Methods A literature search was carried out using the PubMed, Embase, Web of Science, and Scopus. We reviewed the latest literature on COVID-19-induced anosmia, including mechanisms of pathogenesis, olfactory testing, anosmia as predictive tool, pathological examinations, imaging findings, affected factors, co-existing diseases, treatments, prognosis, hypothesis theories, and future directions. Results The possible pathogenesis of COVID-19-induced anosmia may involve inflammation of the olfactory clefts and damage to the olfactory epithelium or olfactory central nervous system by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The D614G spike variant may also play a role in the increased number of anosmia patients. Anosmia may also be an essential indicator of COVID-19 spread and an early indicator of the effectiveness of political decisions. The occurrence and development of COVID-19-induced anosmia may be influenced by smoking behaviors and underlying diseases such as type 2 diabetes, gastroesophageal disorders, and rhinitis. Most patients with COVID-19-induced anosmia can fully or partially recover their olfactory function for varying durations. COVID-19-induced anosmia can be treated with various approaches such as glucocorticoids and olfactory training. Conclusion Anosmia is one of the main features of COVID-19 and the underlying disease of the patient may also influence its occurrence and development. The possible pathogenesis of COVID-19-induced anosmia is very complicated, which may involve inflammation of the olfactory clefts and damage to the olfactory epithelium or olfactory central nervous system.

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Correlates To Export Involvement Of Manufacturing Firms In A Less Industrialized Country

Journal of Applied Business Research (JABR) ◽

10.19030/jabr.v8i2.6163 ◽

2011 ◽

Vol 8 (2) ◽

pp. 48

Author(s):

Dimitris Bourantas ◽

John Halikias ◽

Peter Malliaris

Keyword(s):

Empirical Studies ◽

Manufacturing Firms ◽

Fundamental Question ◽

Large Share ◽

Exporting Firms ◽

Domestic Markets ◽

Clear Cut ◽

Export Activity ◽

The Past ◽

And Performance

Over the past twenty years, considerable attention has been paid to the export behavior and performance of firms. A large share of the literature dealing with this matter consists of empirical studies whose purpose has been to identify the profile of exporting firms, in order to estimate the export potential. Although the environment is the same for all firms within a certain country, some distinguish themselves as exporting firms while others, do not. Thus a fundamental question arises: in what ways do exporting firms differ from non-exporting ones? This paper concludes that the distinction between exporting and on-exporting firms as a clear cut dichotomy is insufficient, and that a firms export activity is, to a large extent, related to its international competitiveness. This is especially true for countries such as Greece, where domestic markets are rather limited.

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The Prevalence of Chronic Pain in Canada

Pain Research and Management ◽

10.1155/2011/876306 ◽

2011 ◽

Vol 16 (6) ◽

pp. 445-450 ◽

Cited By ~ 205

Author(s):

Donald Schopflocher ◽

Paul Taenzer ◽

Roman Jovey

Keyword(s):

Chronic Pain ◽

Care Delivery ◽

Case Definitions ◽

Survey Questions ◽

Industrialized Nations ◽

High Prevalence ◽

Prevalence Estimates ◽

Pain Prevalence ◽

Definition Of ◽

Survey Methodologies

Published population estimates of the prevalence of chronic pain have been highly variable due, in part, to differences in definitions and study methodologies. Designing health care delivery models that address chronic pain and reduce its impact, however, require accurate, up-to-date prevalence data. This article first reviews studies that examined the prevalence of chronic pain both internationally and in Canada. The ensuing sections describe a telephone-based survey of a well-defined population of adults using a detailed and sequential definition of chronic pain, and well-validated and reliable data collection tools for establishing the prevalence of chronic pain in Canada.BACKGROUND: While chronic pain appears to be relatively common, published population prevalence estimates have been highly variable, partly due to differences in the definition of chronic pain and in survey methodologies.OBJECTIVES: To estimate the prevalence of chronic pain in Canada using clear case definitions and a validated survey instrument.METHODS: A telephone survey was administered to a representative sample of adults from across Canada using the same screening questionnaire that had been used in a recent large, multicountry study conducted in Europe.RESULTS: The prevalence of chronic pain prevalence for adults older than 18 years of age was 18.9%. This was comparable with the overall mean reported using identical survey questions and criteria for chronic pain used in the European study. Chronic pain prevalence was greater in older adults, and females had a higher prevalence at older ages compared with males. Approximately one-half of those with chronic pain reported suffering for more than 10 years. Approximately one-third of those reporting chronic pain rated the intensity in the very severe range. The lower back was the most common site of chronic pain, and arthritis was the most frequently named cause.CONCLUSIONS: A consensus is developing that there is a high prevalence of chronic pain within adult populations living in industrialized nations. Recent studies have formulated survey questions carefully and have used large samples. Unfortunately, a substantial proportion of Canadian adults continue to live with chronic pain that is longstanding and severe.

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