Faculty Bibliography

Background: Research based Developmental Theory of Somatoform/Centralized Pain (S/CP) (Landa et al., 2012) suggests that early interpersonal adversity(EIA) interacts with multigenerational factors leading to neural predisposition to S/CP. Interpersonal affect regulation between infant and caregiver is crucial for optimal maturation of nervous system; EIA may impede development of capacities for emotion-somatic sensation differentiation, awareness, expression and regulation of emotions, leading to experiencing distress in somaticaly. These mechanisms of symptom formation suggest that psychotherapies targeting development of these capacities can help treat S/CP; studies show that psychotherapies that focus on emotion expression and working through interpersonal traumas can alleviate S/CP. However, the exact neurophysiologic mechanisms underlying these effects are not yet fully understood. In our previous study, 90% of S/CP patients (vs 10% of controls) presented with the Unmet Need for Closeness with Others (UNCO) as main representation of relationships. We now present the data on autonomic regulation (HRV) and verbally expressed emotions/alexithymia during patient's interviews on interpersonal relationships.
Method(s): Twenty patients with S/CP from Pain, Neurology, and Primary Care clinics, and 20 age-, sex-, ethnicity-, and level of education-matched healthy controls completed the Relationship Anecdotes Paradigm (RAP)-a semi-structured interview coded for representations of relationships (Core Conflictual Relationship Theme method). HRV was measured continuously during RAP. RAP narratives were coded for Verbally Expressed Emotion using coding method adapted from Levels of Emotional Awareness Scale.
Result(s): S/CP patients had higher levels of UNCO and RAP alexithymia, and significant increase in HRV during RAP vs controls. Relationship between these dimensions and history of interpersonal traumas will be explored.
Discussion(s): Talking about interpersonal relationships and expressing UNCO to others was associated with HRV increase among S/CP patients, which has direct implications for psychophysiologic mechanisms underlying change in psychotherapeutic interventions for S/CP, therefore helping reverse effects of EIA suggested by the Developmental Theory of S/CP. Implications for diagnosis and treatment of S/CP will be discussed

ABSTRACT: Somatization syndromes are highly prevalent disorders with unknown etiology and are challenging to treat. Integrating previous findings on alexithymia, attachment, and trauma, we hypothesized that somatization syndromes are associated with a specific internal representation of relationships-the unmet need for closeness with others (desire for interpersonal closeness combined with the fear of being rejected, hurt, or abandoned). Twenty patients with DSM-IV somatization syndromes and 20 well-matched healthy controls completed the Relationship Anecdotes Paradigm/Core Conflictual Relationship Themes interview and measures of interpersonal relatedness, alexithymia, and history of trauma. The results showed that the unmet need for closeness with others was the main internal representation of relationships in 90% of the patients and in only 10% of controls; it was also the strongest predictor of somatization syndrome diagnosis. This suggests that somatization syndromes are strongly associated with the interpersonal representation of the unmet need for closeness with others, which has direct implications for their treatment and future research on their etiology.

Using separate generalized mixed-effects models, we assessed seizure recall and prediction, as well as contributing diagnostic variables, in 83 adult patients with epilepsy undergoing video/EEG monitoring. The model revealed that when participants predicted a seizure, probability equaled 0.320 (95% CI: 0.149-0.558), a significant (P<0.05) increase over negative predictions (0.151, 95% CI: 0.71-0.228]). With no seizure, the rate of remembering was approximately 0.130 (95% CI: 0.73-0.219), increasing significantly to 0.628 (95% CI: 0.439 to 0.784) when a seizure occurred (P<0.001). Of the variables analyzed, only inpatient seizure rate influenced predictability (P<0.001) or recollection (P<0.001). These models reveal that patients were highly aware of their seizures, and in many cases, were able to make accurate predictions, for which seizure rate may be an important factor

BACKGROUND: The working alliance has been shown to be a consistent predictor of patient outcome and satisfaction in psychotherapy. This study examines the role of the working alliance and related behavioral indices in predicting medical outcome. OBJECTIVE: Cognitive and emotional dimensions of the physician-patient relationship were examined in relation to patients' ratings of physician empathy, physician multicultural competence, perceived utility of treatment, and patients' adherence self-efficacy. These factors were then examined as part of a theoretical framework using path analyses to explain patient self-reported adherence to and satisfaction with treatment. DESIGN: The study was based on an ex-post facto field correlation design. PARTICIPANTS: One hundred fifty-two adult outpatients from a neurology clinic at Bellevue Hospital, a large municipal hospital in New York City, participated in the study. INTERVENTIONS: Surveys given to participants. MEASUREMENTS: We used the following measurements: Physician-Patient Working Alliance Scale, Perceived Utility Scale, Treatment Adherence Self-Efficacy Scale, Medical Outcome Study Adherence Scale, Physician Empathy Questionnaire, Physician Multicultural Competence Questionnaire, Medical Patient Satisfaction Questionnaire. MAIN RESULTS: The effect sizes for adherence are between 0.07 and 0.21 and for satisfaction between 0.10 to >0.50. Regression and path analyses showed that ratings of physician multicultural competence and patient adherence self-efficacy beliefs predicted patient adherence (SB = 0.34) and (SB = 0.30) and satisfaction (SB = 0.18) and (SB = 0.12), respectively. Working alliance ratings also predicted patient satisfaction (SB = 0.49). CONCLUSIONS: Psychological and interpersonal dimensions of medical care are related to patient adherence and satisfaction. Medical care providers may be able to use these dimensions to target and improve health care outcomes