International Journal of Behavioral Medicine

The ability of three subscales of the Medical Fears Survey (fear of injections and blood draws, fear of blood, fear of mutilated bodies) to predict vasovagal reactions was examined in 364 volunteer blood donors. Participants completed the subscales of the Medical Fears Survey immediately prior to blood donation, and then rated their subjective physiological reactions while seated in a postdonation refreshment area. Correlation analyses indicated that high scores on the fear of injections and blood draws subscale was the best predictor of vasovagal reactions in first-time and experienced female donors (r = .65 and .34, respectively, p < .01). Although the fear of blood subscale was significantly correlated with vasovagal reactions in experienced male donors (r= .45, p < .01), none of the subscales of the Medical Fears Survey was significantly related to subjective physiological reactions in novice male blood donors. Finally, for female donors higher levels of vasovagal reactions to the donation process were associated with decreased intentions to donate blood in the future.

Depression in breast cancer (BCa) patients can reduce quality of life, relationships and treatment compliance, thus constituting a major target for cognitive behavioural (CBT) interventions. Although CBT treatments, which are built upon consideration of the roles of antecedents and consequences for depressive behaviour, are effective, the nature of those antecedents which trigger depression among BCa patients has received relatively little attention. Hypotheses were (1) to determine if BCa patients were experiencing either or both of punishment type I and II and (2) to identify if these aspects of punishment were related to overall depression. Two hundred fifty-three BCa patients completed a standardised depression scale, and data were factor analysed. Components were interpreted for their relationship to punishment type I or II. Two major components emerged: (1) loss of previously available sources of personal or social reinforcement (i.e. punishment type II or negative punishment) and (2) behavioural, emotional and cognitive responses to those losses. These two components represent the total symptomatology of major depressive episode from DSM-IV-TR. These findings support the application of a functional analytic model of depression within CBT assessment and treatment procedures with BCa patients.

Symptom perception in patients with asthma is often inadequate. Patients may fail to perceive serious airway obstruction or suffer from breathlessness without objective cause. These extremes are associated with fatal asthma and excessive use of medicines, respectively. This article covers symptom perception in a multidisciplinary perspective. A presentation of current definitions and methods for studying symptom perception in asthma is followed by a summary of theories on the origin of breathlessness. Next, biomedical and psychological factors influencing symptom perception are exmined. Preliminary biomedical research emphasizes neural pathway impairment, but causal factors remain inconclusive, particularly regarding the overperception of symptoms. Psychological studies suggest that the accuracy of symptom perception is influenced by (a) competition between asthmatic and nonasthmatic sensory information, (b) negative emotions, and (c) acquired response tendencies (e.g. habituation to symptoms, repression of symptoms, selective perception, and false interpretation of symptoms). These factors may favor either blunted perception or overperception. Empirical data in support of psychological factors are still insufficient. Methodological problems and procedures to improve symptom perception are discussed.

A key component to chronic pain management regimens is the use of analgesic medications. Psychological factors, such as mood states, may also affect the use of pain medications for individuals with chronic pain, but few observational studies have examined how these factors may predict pain medication use at the daily level. Daily assessments from 104 individuals with back pain were used to examine fluctuations in daily pain intensity, mood, sleep quality, and physical activity as predictors of the likelihood of pain medication (opioid and non-opioid) use and levels of medication use on the same day. Pain intensity and mood ratings significantly predicted whether participants used pain medication on the same day, while only pain intensity predicted whether participants used more medication than usual. Further, current opioid users were more likely to increase the amount of their medication use on days of higher pain. This article identifies fluctuations in daily pain intensity and mood as salient predictors of daily pain medication use in individuals with recurrent back pain. The current study is among the first to highlight both pain and mood states as predictors of daily pain medication use in individuals with back pain, though future studies may expand on these findings through the use of higher-resolution daily medication use variables.

A portable practice of repeating a mantram—a sacred word or phrase—has been shown to reduce the severity of posttraumatic stress disorder (PTSD) symptoms in veterans with military trauma. It is thought that the intervention re-directs attention and initiates relaxation to decrease symptom severity, but there may be other mechanisms that may contribute to this improvement. We tested the hypothesis that increases in existential spiritual wellbeing (ESWB) would mediate reductions in self-reported PTSD symptoms following a group mantram intervention. Veterans diagnosed with PTSD from war-related trauma completed 6 weeks of case management plus a group mantram intervention (n = 66) as part of a randomized trial. Measures included PTSD Checklist (PCL) and Functional Assessment of Chronic Illness Therapy–Spiritual Wellbeing. Path analysis was conducted on those who completed treatment to assess ESWB as a possible mediator of change in PCL from baseline to post-treatment. A significant indirect effect, −2.24, 95% CI (−4.17, −1.05) of the mantram intervention on PCL change was found. The path from the mantram intervention to ESWB change was significant and positive (B = 4.89, p < 0.0001), and the path from ESWB change to PCL change was significant and negative (B = −0.46, p = 0.001), thus supporting the hypothesis. Findings suggest that one contributing mechanism that partially explains how the mantram intervention reduces PTSD symptom severity in veterans may be by increasing levels of ESWB.

Subjective disability is considered as the variable that reflects the impact of chronic pain on a patient’s life. This study examines the questions of which syndrome or patient characteristics determine subjective disability and whether there are differences between samples of patients with chronic headaches and low back pain. Direct pain variables and depression, pain coping strategies, and pain-related self-statements (including catastrophizing) are introduced into multivariate regression analyses as potential predictors of disability using a sample of 151 pain patients. Disability is not predicted by pain severity in patients with headaches or back pain. Psychological variables, especially coping strategies, are far more influential. Coping explains more variance in disability in the headache sample than in the chronic low back pain group, whereas depression is more relevant for the degree of disability in the back pain sample.

Aspects of sexual identity development, including integration into gay community, have been found to be associated with sexual risk behavior among men who have sex with men (MSM), but not in the Middle East. Drawing on the minority stress model and integrated theory of health behavior, we examined the relationships between measures of sexual identity development and HIV protective behaviors (condomless anal sex and HIV testing) and the mediating roles of HIV knowledge, peer judgmentalism, and discrimination, in a sample of 226 young MSM in Beirut, Lebanon. A cross-sectional, mediation analysis was conducted using a bootstrapping approach and logistic regression models. Fifteen percent of the sample reported recent condomless anal sex with partners whose HIV status was positive or unknown, and 82.3% had ever been tested for HIV. Multivariate logistic regression analysis showed that greater integration into the gay community was significantly associated with having recent condomless anal sex with positive/unknown HIV status partners and having any history of HIV testing, after controlling for covariates. Knowledge of HIV risk was associated with gay integration as well as both condomless anal sex with positive or unknown HIV status partners and any history of HIV testing, but it only served as a (partial) mediator of HIV testing. Peer judgmental communication about sex and sexuality-related discrimination were related in bivariate analysis to gay integration and condomless anal sex, but they too did not prove to be significant mediators of the relationship between these two constructs. These findings highlight the potential sexual health benefits and vulnerabilities associated with increased integration into the gay community for young MSM in Beirut and the need to better understand how to increase HIV knowledge while limiting its potential to increase sexual risk behavior.

We assessed the association of long-term weight change ≥5 kg with total sleep time (TST), investigating effect modification by sex and overweight/obesity. In a cross-sectional context, we studied 41,610 adults from the general population-based NutriNet-Santé e-cohort. A sleep questionnaire was self-administered in 2014. It included sleep logs for the estimation of average TST at night, and items for the calculation of major weight change as experienced over the previous 5 years. We fit multivariate polytomous logistic regression models. Overall, women with major weight loss had an increased likelihood of short TST (≤6 h) when compared with women with stable weight (OR = 1.15, 95% CI: 1.05–1.25). Individuals with major weight gain had an increased likelihood of short TST compared with their counterparts with stable weight (men: OR = 1.20, 95% CI: 1.05–1.37; women: OR = 1.24, 95% CI: 1.15–1.33). Men with major weight gain were less likely to report long TST compared with men with stable weight (OR = 0.83, 95% CI: 0.70–0.97). Overweight or obesity did not moderate the associations. The study advances knowledge in the fields of public health and nutrition by providing some evidence of a sex-specific association of major weight change with both short and long TST. These associations merit future investigation in a longitudinal context with repeated, objective measures of both weight and sleep time, while applying more stringent interaction test criteria and accounting for changes in health behaviors.