Faculty Bibliography

Fibromyalgia (FM) is a chronic pain condition that typically involves sharp fluctuations in pain intensity over short time periods. Both mental distress and sleep disturbances have been implicated in FM, yet their putative contributions to pain fluctuations have not been fully defined. We assessed simultaneous fluctuations in pain intensity, mental distress and sleep physiology and behavior among FM patients in natural settings. Specifically, seventy-nine adult FM patients reported their current pain and mental distress levels three times a day (morning, afternoon, evening) over two consecutive weeks via a dedicated smartphone app. During this period, sleep physiology (sleep heart rate) and behavior (sleep duration & efficiency) were continuously monitored using a wearable sensor. Mixed model analyses characterized the contribution of mental distress and sleep to daily pain fluctuations. Results revealed that current levels of pain and mental distress both predict subsequent pain levels, yet current pain does not predict subsequent mental distress. These associations were consistent across different daily segments (morning to afternoon, afternoon to evening), but not from evening to following morning. Instead, sleep heart rate emerged as predictor of next day pain, such that nights with lower vs. higher sleep heart rate were associated with pain improvement vs. worsening, respectively, in the subsequent day. These results suggest that both mental distress and sleep play a role in determining pain dynamics in FM. The contribution of sleep heart rate to pain reduction or intensification in the following day highlights the role of sleep physiology in daily pain fluctuations in FM. PERSPECTIVE: This study reveals how mental distress and sleep physiology shape daily pain fluctuations in Fibromyalgia. Using wearable sensors and real-time assessments, we identified sleep heart-rate as a key predictor of next-day pain fluctuations. These findings highlight modifiable, non-invasive targets for improving symptom dynamics and guiding personalized treatment strategies in Fibromyalgia.

Fibromyalgia (FM) is a complex disorder characterized by chronic and widespread musculoskeletal pain. FM and depression are highly comorbid; however, their relationship remains unclear. In line with the hypothesis that there are bidirectional relationships between symptoms of both disorders, a network analysis was conducted. This method is a graphical representation of a partial correlation matrix between individual symptoms, which enables an understanding of how these symptoms relate to one another. Data were pooled from three studies conducted on patients with FM (n = 219). Well-established network analyses methods were used to illustrate the network of FM and depressive symptoms, determine the centrality and bridge strength of each symptom, and identify clusters from within the data. Most clusters detected included both FM and depression symptoms. The most central symptoms that also exhibited high bridge strength were cognitive and psychological: (1) negative affect, and (2) memory problems. Surprisingly, pain did not emerge as central to this network. Utilizing a network analysis approach to examine symptom-to-symptom relationships yielded novel insight into the maintenance of this comorbidity. The research and clinical implications of the findings, such as developing treatments targeting the most central symptoms and avenues for further research, are discussed.

OBJECTIVE:Spouses of military combatants often experience adverse outcomes, including posttraumatic stress symptoms (PTSS) in the event of ambiguous loss (AL). AL refers to an uncertain situation regarding a person's status as alive or as cognitively present. The former ambiguity is categorized by the term physical AL (PAL), which refers to the continued psychological presence of a person, despite their physical absence. The latter ambiguity, categorized by the term psychological AL or ambiguous presence, refers to when a person is emotionally absent, despite their physical presence. Though AL has been widely researched, there are still gaps around the AL-posttraumatic stress disorder (PTSD) relationship, especially regarding dyadic variables that can moderate this relationship. Also, most of the AL military-related studies are qualitative, with only a few that combine qualitative and quantitative research methods. We address these gaps in an innovative mixed-methods study examining the emotional experience of Israeli veterans' spouses with a focus on the relationship between AL, PTSS, and dyadic adjustment (DA). METHOD/METHODS:) and a semistructured narrative interview. RESULTS:Our results revealed positive correlations between AL-PTSS and PAL-PTSS. Also, an interaction effect was found in which the lower the DA level, the stronger the PAL-PTSS correlation. Conversely, the higher the DA level, the stronger the ambiguous presence-PTSS correlation. Qualitative findings identified themes in the experience of these situations, including uncertainty and ambivalence. CONCLUSIONS:Our qualitative and quantitative results combined suggest that the way military couples deal with AL may be an important emotional experience requiring specific attention from mental health professionals. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Complex Posttraumatic Stress Disorder (CPTSD) is a condition resulting from exposure to chronic, interpersonal traumatic events, in which some form of control or power dynamics existed. Its clinical picture includes the main symptom clusters of posttraumatic stress disorder, accompanied by dysregulated emotion, problems in interpersonal relationships, and difficulties in identity integration. In addition, both clinical work and research have shown CPTSD to include highly distressing and complicated psychological phenomena, such as identification with the aggressor, various forms of dissociation, self-harm and self-destructive behaviors, and more. Due to this highly complex and multilayered clinical picture, the treatment of CPTSD poses a significant clinical challenge to therapists. In this special issue of In Session, we present a series of case studies, each representing a different therapeutic approach to CPTSD (e.g., skills training for affective and interpersonal regulation, Eye Movement Desensitization and Reprocessing, psychodynamic, integrative psychotherapy). These cases also represent a wide variety of patient populations, as well as different types of underlying traumatic events. Together, they reveal the breadth of clinical possibilities currently available to trauma therapists encountering cases of CPTSD. They also highlight the challenges and dilemmas that clinicians often face when treating this condition, as well as ways to overcome those.

Negative birth experiences are common. It is yet unclear which women may be most at risk already before pregnancy. Childhood trauma and non-autonoumous/unresolved attachment state of mind may affect how women experience giving birth. This study used longitudinal data to test childhood trauma and attachment state of mind as predictors of birth experience in at-risk sample of primipara women (N = 193). The Adverse Childhood Experiences questionnaire and the Adult Attachment interview were administered during pregnancy, and women reported about their birth experience three months postpartum. Partial Least Square Structural Equation Modelling was applied to answer the research questions. Childhood physical neglect and parental substance abuse were predictive of a more negative birth experience, while attachment state of mind was not associated with how women experienced giving birth. Cross-validation suggests that these findings may be considered externally valid. Further research using validated measures on birth experience are needed.

OBJECTIVE:Quantitative studies examining the occurrence of childbirth-related posttraumatic stress disorder (CB-PTSD) following severe perineal rupture are lacking. The objective of this population-based study was to investigate the prospective associations between the degree of perineal tear during childbirth and CB-PTSD symptoms, when adjusting for known covariates (maternal age, years of school education, premature birth, and parity). We hypothesized that women with different degrees of perineal tear will differ regarding (1) the level of CB-PTSD symptoms at 8 weeks and 2 years postpartum and (2) the rate of change in CB-PTSD symptoms from 8 weeks to 2 years postpartum. METHOD/METHODS:Secondary data analysis from the Akershus Birth Cohort, a large population-based prospective cohort study using self-report questionnaires and hospital record data. RESULTS:The degree of perineal tear was significantly associated with CB-PTSD symptoms at 8 weeks and 2 years postpartum. However, the degree of perineal tear was not significantly associated with the change in CB-PTSD symptoms over time. Similar patterns were found for both total CB-PTSD symptoms as well as for avoidance and intrusion symptoms only. CONCLUSION/CONCLUSIONS:Results seem to support a dose-response model, suggesting that the higher the severity of the perineal tear, the higher the posttraumatic morbidity.

Background: Spouses of ex-combatants often experience psychological distress due to sharing their lives with a partner who endured traumatic experiences, a phenomenon known as "secondary traumatization". Self-differentiation is the emotional distance one takes, while keeping an amount of togetherness with significant others. The couple's relationship and self-differentiation can impact the manner and expanse of secondary traumatization experienced by the spouse. Objective: This study aimed to examine the role of marital adjustment and self-differentiation (an enmeshed vs detached differentiation style), in secondary traumatization among spouses of ex-combatants. Methods: This study is part of a longitudinal study examining psychological implications of war among Israeli ex-combatants and their spouses. Overall, 267 spouses have been assessed three times (2003;2011;2016). Participants completed self-report questionnaires evaluating secondary PTSD (SPS), general psychiatric distress (GPD), self-differentiation and dyadic adjustment (DAS). Cross-path models were used to assess associations between the variables longitudinally. Results: Associations were found between both self-differentiation and dyadic adjustment and SPS and GPD. Path models showed that fusion\cutoff differentiation predicted more SPS\GPD over time and vice-versa. Furthermore, dyadic adjustment mediated the association between fusion\cutoff differentiation and SPS\GPD. In other words, fusion\cutoff differentiation in time 1 predicted dyadic adjustment in time 2, which in turn predicted SPS\GPD in time 3. Conclusions: Our results can be interpreted in conjunction with original theories about secondary traumatization, emphasizing the importance of keeping a balanced emotional distance in the marital relationship as a way of reducing distress and PTSD symptoms following traumatic events.

BACKGROUND:Fibromyalgia (FM) is a pain condition characterized by physical and psychological difficulties. This randomized controlled trial aimed to evaluate the effects of a mindfulness-based stress reduction (MBSR) on FM patients and identify the role of two pain cognitions: psychological inflexibility in pain (PIPS) and pain catastrophizing (PCS), as mechanisms of change. METHODS:95 FM patients (Mean ± SD: 49.18 ± 13.26 years) were randomly assigned to MBSR group therapy (n = 49) or a waitlist (WL) control group (n = 46). An adapted MBSR protocol for FM was employed. A series of measures were taken, covering FM symptoms, depression, perceived stress (PSS), PIPS and PCS. Three measurements were conducted: pre-intervention, post-intervention and 6-months follow up. RESULTS:Compared to WL controls, the MBSR group showed greater improvements in FM symptoms (F(1,78) = 2.81, p < 0.05), PSS (F(1,78) = 4.38, p < 0.05) and Depression (F(1,78) = 21.12, p < 0.001), with mostly medium effect sizes. Improvements in PSS (F(2,68) = 7.75, p < 0.05) and depression (F(2,68) = 15.68, p < 0.05) remained stable over six months. The effect of MBSR on FM and PSS was mediated by one's reported change in PIPS. The effect of MBSR on depression was mediated by one's reported change in PCS. CONCLUSIONS:These results reveal the significant therapeutic potential of MBSR for FM patients, due to the emphasis on non-judging and acceptance of negative inner states. Furthermore, this research identified two important pain-related cognitions as mechanisms of change, suggesting that MBSR contributes to cognitive change, which enables the reduction of physical and psychological distress. TRIAL REGISTRATION NUMBER/BACKGROUND:NCT04304664.

Complex posttraumatic stress disorder (CPTSD) is a term representing the psychopathological implications of exposure to chronic, inter-personal trauma. These include the main symptoms of PTSD, as well as changes in identity, emotion regulation, and inter-personal relationships. Self-harm and dissociation (i.e., disintegration of mental processes) are also quite common in CPTSD. Considering this complex and often severe clinical picture, mental health professionals often find it difficult to effectively treat CPTSD. In this paper, we present an integrative approach to the treatment of CPTSD based on a combination of techniques from several psychotherapy approaches. The case described here illustrates the need for therapeutic flexibility and eclecticism when treating individuals exposed to chronic trauma. We show the advantages of flexible therapeutic attunement, which enables the therapist to respond to the changing need of the patient, as well as her fluid clinical picture and symptom manifestation. The case also illustrates how interventions taken from psychodynamic therapy, Dialectical behavior therapy, and Eye Movement Desensitization and Reprocessing may be applicable in various stages of treatment, alleviating the patient's distress in several psychological and physical domains.