A digital media attention diversion improves mood and fear in patients receiving chemotherapy for recurrent gynecologic malignancies: results of a randomized trial

BackgroundRecurrent gynecologic cancer patients experience symptoms that affect psychologic, emotional, social, and physical well-being. Chemotherapy can further exacerbate these symptoms. Poor mood, pain, and fatigue are linked and are detrimental to quality of life. Interventions targeting these symptoms may improve patient-reported outcomes and performance status.ObjectivesTo determine the ability of a humorous digital media attention diversion to improve symptom domains of positive and negative mood during chemotherapy for patients with recurrent gynecologic cancers.Study designThis randomized, crossover clinical trial enrolled women with recurrent gynecologic cancers. Subjects participated over three cycles of chemotherapy. The primary outcome was the change in mood on the validated Positive and Negative Affect Scale-Extended (PANAS-X) instrument, which measures positive and negative affect domains. All subjects completed the PANAS-X after receiving chemotherapy during cycle 1 on study. In atudy arm 1, subjects watched their choice of humorous movies on a digital media device while receiving chemotherapy during cycle 2 on study. They selected from non-humorous movies during cycle 3 on study. In arm 2, the order of movies was reversed. After each cycle, mood, fatigue, and other patient-reported outcomes were assessed for comparison with baseline measurements.ResultsThe target enrollment of 66 subjects was achieved. Subjects watched humorous content for an average of 96.0 min and non-humorous content for an average of 62.5 min. Negative mood improved after exposure to humorous (p=0.017) and non-humorous content (p=0.001). Patient-reported fear also improved after exposure to both humorous (p=0.038) and non-humorous content (p=0.002). Subjects reported higher use of affiliating and self-effacing humor types.ConclusionsOffering patients a choice of digital media during chemotherapy significantly improved negative mood and fear. This was seen with both humorous and non-humorous content. This low-cost and low-risk intervention should be implemented as an attention diversion to improve negative mood and fear for patients receiving chemotherapy.

Olfactory Effects on Attention Allocation and Perception of Exertion

The aim of the current study was to test the effectiveness of pleasant odors on perception of exertion and attention allocation. A secondary purpose was to employ a placebo-control design and measure perceived smell intensity during task performance; methods that have been overlooked in previous olfaction studies in the sport and exercise domain. Seventy-six college students (35 females, 41 males) were recruited to perform a handgrip task. They were randomly assigned to one of 4 groups: control, placebo, lavender odor, and peppermint odor. Adhesive strips were placed under the noses of those in the latter three groups. The placebo group had a strip with no odor. The lavender and peppermint odor groups had a drop of concentration on the strip. After establishing a maximal voluntary contraction (MVC) level, participants performed at 30% of their MVC level for as long as they could tolerate, during which they provided ratings of perceived exertion (or effort; RPE), attention, and smell intensity at 30s intervals, and affect every 60s. MANOVA procedures failed to reveal significant differences among the treatment and nontreatment groups on rate of perceived exertion, attention allocation, and total time duration on the task. However, statistical differences were found between both odor groups and the placebo group on perceived attention diversion. The lavender group reported that the odor diverted attention to a higher degree than both the peppermint and placebo groups. Although nonsignificant, findings revealed a trend suggesting that odors may have an effect on cognitive processes, and on performance. There is a need for additional research to better capture these effects. Directions for further research, with an emphasis on methodological issues are outlined.

Phantom Pain—Psychological Conceptualization and Treatment: A Case Report

This paper describes a case concentrating on the psychological conceptualization and treatment of phantom pain. A single session of cognitive work, teaching an “attention diversion’ strategy, was effectively utilized for the treatment of below knee phantom pain in an elderly lady. A follow-up, approximately one year later, revealed that the treatment gains had been maintained. Although a review of the literature (Sherman, Sherman and Gall, 1980) presents a rather murky picture as regards treatment prospects, the results nevertheless illustrate how a very simple cognitive strategy was successfully employed to alleviate a long standing debilitating phantom pain.