Self-system therapy for distress associated with persistent low back pain: A randomized clinical trial.

Abstract

OBJECTIVE: Persistent low back pain (PLBP) is associated with vulnerability to depression. PLBP frequently requires major changes in occupation and lifestyle, which can lead to a sense of failing to attain one's personal goals (self-discrepancy). METHOD: We conducted a clinical trial to examine the efficacy of self-system therapy (SST), a brief structured therapy for depression based on self-discrepancy theory. A total of 101 patients with PLBP and clinically significant depressive symptoms were randomized either to SST, pain education, or standard care. RESULTS: Patients receiving SST showed significantly greater improvement in depressive symptoms. Reduction in self-discrepancy predicted reduction in depressive symptoms only within the SST condition. CONCLUSIONS: Findings support the utility of SST for individuals facing persistent pain and associated depression.

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Citation

Published Version (Please cite this version)

10.1080/10503307.2015.1040485

Publication Info

Waters, Sandra J, Timothy J Strauman, Daphne C McKee, Lisa C Campbell, Rebecca A Shelby, Kim E Dixon, Anne Marie Fras, Francis J Keefe, et al. (2016). Self-system therapy for distress associated with persistent low back pain: A randomized clinical trial. Psychother Res, 26(4). pp. 472–483. 10.1080/10503307.2015.1040485 Retrieved from https://hdl.handle.net/10161/13839.

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Scholars@Duke

Strauman

Timothy J. Strauman

Professor of Psychology and Neuroscience

FOR POTENTIAL STUDENTS (fall 2024 class): 

Dr. Timothy Strauman and Dr. Ann Brewster will be seeking to admit a student for Fall 2024 who will be an important member of their collaborative projects. Dr. Brewster is an intervention scientist and a faculty member in Duke’s Social Science Research Institute. The collaborative projects focus on creating, testing, and implementing school-based therapeutic and preventive interventions for adolescents at risk for negative academic and mental health outcomes. We are partnering with the Durham Public Schools as well as with other local school districts, and Dr. Brewster has extensive experience and expertise in developing the partnerships, working with community members, and the intervention process itself. We are especially interested in applicants with experience in community-based interventions, with interests in adolescence, and with knowledge and experience working with both behavioral and neuroimaging data.



Professor Strauman's research focuses on the psychological and neurobiological processes that enable self-regulation, conceptualized in terms of a cognitive/motivational perspective, as well as the relation between self-regulation and affect. Particular areas of emphasis include: (1) conceptualizing self-regulation in terms of brain/behavior motivational systems; (2) the role of self-regulatory cognitive processes in vulnerability to depression and other disorders; (3) the impact of treatments for depression, such as psychotherapy and medication, on self-regulatory function and dysfunction in depression; (4) how normative and non-normative socialization patterns influence the development of self-regulatory systems; (5) the contributory roles of self-regulation, affect, and psychopathology in determining immunologically-mediated susceptibility to illness; (6) development of novel multi-component treatments for depression targeting self-regulatory dysfunction; (7) utilization of brain imaging techniques to test hypotheses concerning self-regulation, including the nature and function of hypothetical regulatory systems and characterizing the breakdowns in self-regulation that lead to and accompany depression.
Shelby

Rebecca A Shelby

Associate Professor in Psychiatry and Behavioral Sciences

Rebecca Shelby, Ph.D. is an Associate Professor with Tenure in the Department of Psychiatry and Behavioral Sciences at Duke University and the Director of Education and Training for the Duke Cancer Patient Support Program.  Dr. Shelby is a member of the Duke Pain Prevention and Treatment Research Program and the Duke Cancer Control and Population Sciences Program. Dr. Shelby completed her graduate training in clinical psychology at the Ohio State University and her clinical internship and postdoctoral fellowship at Duke University Medical Center.  Her research focuses on developing and evaluating behavioral interventions for cancer patients, management of cancer pain and treatment side effects, and improving adherence to recommended care. Dr. Shelby serves on the Duke clinical psychology internship faculty and supervises clinical psychology fellows, interns, and clinical psychology graduate practicum students completing clinical rotations as part of the Duke Cancer Patient Support Program.   

Keefe

Francis Joseph Keefe

Professor in Psychiatry and Behavioral Sciences

I am Director of the Duke Pain Prevention and Treatment Research Program, an active NIH funded clinical research program focused on developing new and more effective ways of assessing and treating patients having acute and persistent pain.  I have been active in nationally and internationally in shaping the pain research agenda.  For the past 10 years I served as Editor in Chief of PAIN the premier journal in pain research.  I also have served as the Chair of a number of NIH Study Sections.   Finally, I was a member of the Institute of Medicine committee that published a report in 2011 (Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research) that has played a key role in shaping national policies in pain research and pain care.

Over my career, I have played a key role in the development of clinical pain services and pain research programs at Duke Medical Center.  For over 20 years, I directed the Duke Pain Management Program and was a leader in the development of Duke Medical Center's multidisciplinary pain programs (both out-patient and in-patient.)  I collaborate actively with investigators in other countries (e.g. United Kingdom, South Africa, China, and Australia). 

Over the course of my career, I have collaborated closely with investigators both in and outside my lab.  Together we have developed and refined a number of treatment protocols for persistent pain conditions (e.g. pain in patients with advanced cancer; sickle cell disease, and persistent joint pain due to osteo- and rheumatoid arthritis) including partner and caregiver-assisted pain coping skills training interventions.  We have conducted a number of NIH- and foundation- funded randomized clinical trials testing the efficacy of these and other behavioral interventions (e.g. aerobic exercise protocols, yoga based interventions, mindfulness-based interventions, forgiveness-based interventions, loving kindness meditation, and emotional disclosure). 

I currently serve as a Co-Investigator on a number of NIH grants, a number of which are funded by the HEAL Initiative.  Many of these grants are testing novel strategies for delivering training in pain coping skills (e.g. video over internet, web-based training, virtual reality interventions, and apps for mobile devices).  Along these lines, I collaborated with Dr. Chris Rini to develop an internet-based program for training in pain coping skills called painTRAINER (available at mypaintrainer.org). This program is free to any individuals or health professionals who wish to use it.  I have a keen interest in exploring the efficacy of these and other strategies (e.g. training physical therapists, social workers, and nurses) promise to increase access to behavioral pain management interventions making them more widely available to the large population of patients and caregivers who might benefit from them.

I have published over 490 papers on topics ranging from pain coping strategies used during mammography to behavioral approaches to managing acute pain and pain at end of life.  I have a longstanding interest in mentoring students and early career professionals interested in developing, testing, and disseminating novel protocols for managing pain, stress, and medical symptoms.

 


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