Despite research suggesting that resident physicians frequently struggle to prioritize their own health and well-being, little is known about their personal healthcare behaviors. This study aims to quantify preventive healthcare utilization and assess the barriers and facilitators to care-seeking among resident physicians. A 22-question survey was electronically distributed to 110 ACGME-accredited residency programs across different specialties across the United States. Quantitative data were analyzed using STATA, and qualitative data were analyzed using inductive qualitative content analysis to identify barriers to healthcare utilization.Of 356 survey respondents, 316 residents (88.8
This study evaluated the feasibility and proof of concept of a structured 4-week acceptance and commitment therapy (ACT) protocol for parents of infants admitted to a Level III neonatal intensive care unit (NICU). This investigation emphasized successful protocol implementation, treatment adherence, and preliminary individual-level clinical outcomes. Participants included volunteer, English-speaking parents aged > 18 years, whose infants were < 35 weeks gestational age and admitted to the NICU with an anticipated stay > 28 days. Senior psychiatric residents delivered the ACT protocol in 4-weekly sessions addressing: (1) values versus goals, (2) avoidance behaviors, (3) acceptance, present-moment awareness, and observing self, and (4) values and committed action. Pre- and post-intervention assessments measured acceptance and action, parental bonding, confidence, post-traumatic stress disorder (PTSD), resiliency, and depression. Feasibility was evaluated through treatment adherence and the proportion of participants demonstrating clinically meaningful change on validated measures. Of 24 enrolled parents, 20 (83
Chronic pain affects millions and is frequently comorbid with disordered eating behaviors; however, standard eating disorder screening tools often fail to capture the full scope of eating-related difficulties in this population. The purpose of this project was to explore the lived experience of eating problems among adults with complex chronic pain. Sixteen participants (15 women, age range 21–69, all White, non-Hispanic, cisgender) were interviewed by a member of the interprofessional research team, and data were analyzed using Reflexive Thematic Analysis. Participants described eating difficulties that extended far beyond traditional eating disorder criteria. Researchers constructed five overarching themes that represented the data: (1) Trapped in a Vicious Cycle (interplay of pain, medication side effects, mood, and maladaptive eating); (2) Living with Unpredictability and Trying to Manage Uncertainty (fear and trial-and-error surrounding food triggers); (3) Embodiment and Identity (profound shifts in body image, self-concept, and life trajectory); (4) Social Isolation (avoidance of social activities and perceived lack of understanding); and (5) Practical Barriers (financial, physical, and logistical obstacles to obtaining and preparing food). Findings show eating problems in chronic pain are complex, biopsychosocial phenomena characterized by fear-avoidance, impossible trade-offs, identity disruption, and systemic barriers rather than solely motivational or weight-related issues.
Multiple Chemical Sensitivity (MCS) is a poorly understood condition characterised by physical symptoms triggered by minimal exposure to odorous or chemical agents, often without identifiable organic pathology. This case study describes cognitive behavioural therapy (CBT) for MCS in an older adult referred to a respiratory team after developing persistent, generalised reactions to odours following an acute toxic inhalation. Symptoms led to severe avoidance, functional impairment and suicidal ideation. Following medical evaluation, psychological assessment did not support the alternative diagnoses considered and informed a working formulation of specific phobia. Treatment comprised 14 sessions, beginning virtually because of avoidance, progressing to in vivo exposure and concluding with relapse-prevention planning. Outcome measures and self-report indicated substantial reductions in anxiety and health-related worry, alongside achievement of all functional goals. Improvements were maintained at 10- and 22-month follow-up, with low anxiety scores and marked reductions in beliefs about harm from previously feared stimuli. This case illustrates how a specific-phobia formulation and phobia-focussed CBT may be applicable to some MCS presentations following appropriate medical evaluation. It also highlights a potential role for clinical psychologists in respiratory settings. As a single case, the findings provide descriptive evidence of improvement but cannot establish a causal treatment effect.
Trauma can lead to mental illness, but it can also result in positive outcomes known as post-traumatic growth (PTG). Many cancer survivors who experience trauma report experiencing PTG, which is connected to psychological resilience—the ability to adapt and cope with stress. Metacognitive skills, cognitions about cognitions, are critical for managing life challenges. Previous studies assessing metacognition in cancer patients have primarily utilized self-report scales to evaluate metacognitive cognitions. In contrast, the present study is the first to assess metacognitive skills in cancer patients using a semi-structured, interview-based approach with interviewer-administered scoring Metacognition Assessment Scale-Abbreviated (MAS-A). This study investigated the relationship between metacognitive skills with psychological resilience and PTG in cancer survivors. The study included 45 cancer patients in remission. Participants completed assessments: the MAS-A for metacognitive skills, the Post-traumatic Growth Inventory (PTGI) for PTG, the Resilience Scale for Adults (RSA) for resilience, World Health Organization Quality of Life Scale-Brief for life quality. MAS-A is interviewer-rated, while the remaining scales are self-reports. There was no significant relationship between the MAS-A and PTGI scores (p > .05). However, positive correlations were found between the MAS-A and RSA scores (rs = .297 to .454; p = .048–.002). Additionally, higher PTGI- Changes in Philosophy of Life scores were found in those receiving chemotherapy and radiotherapy (p = .008 and .001, respectively). While metacognitive skills do not directly impact PTG, they are related to psychological resilience, a key predictor of PTG. This highlights the importance of further research on metacognitive interventions and their effectiveness in cancer patients.
Nighttime hypoglycemia is a significant concern for caregivers of youth with type 1 diabetes (T1D), often leading to persistent worry and compensatory behaviors that maintain elevated nighttime glucose levels. In the present study, we qualitatively assessed specific fears related to nighttime hypoglycemia and behaviors to avoid nighttime hypoglycemia from caregivers of youth with T1D. In addition, we interviewed diabetes providers to assess if these topics are discussed in diabetes clinic. We completed semi-structured interviews with 10 diabetes providers and 15 caregivers. We used Framework Matrix Analysis theory to assess specific qualitative patterns. We identified 40 a priori codes and uncovered 3 de novo codes, which fit into 18 subthemes across three core themes: (1) specific fears about nighttime hypoglycemia, (2) caregiver behaviors to prevent it, and (3) negative outcomes stemming from these fears and behaviors. Both caregivers and providers acknowledged the prevalence of nighttime hypoglycemia, anxiety, and its potential impact on family well-being. These findings underscore the importance of addressing caregiver fears in clinical care, particularly for families managing frequent hypoglycemia or elevated nighttime glucose levels. Routine screening for fear-driven behaviors may help improve both caregiver and child outcomes.
Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by inadequate or restricted food intake unrelated to body image or weight concerns. ARFID is frequently observed in patients with gastrointestinal disorders. Given the growing clinical interest, we conducted this systematic review to synthesize evidence, assessment approaches regarding ARFID-like symptomatology in adult patients with inflammatory bowel disease (IBD). A systematic search of MEDLINE, Scopus, Web of Science, PsycInfo was conducted in July 2025, yielding seven studies on ARFID in IBD. This review followed the framework outlined by Page (2021). Prevalence rates, assessment tools, associations with clinical, psychological factors were synthesized. Reported prevalence of ARFID-like behaviors ranged from 10.2 to 51.3
Child and adolescent mental health disorders are a significant global health concern, with high rates of treatment dropout adversely affecting long-term outcomes. This retrospective cohort study aimed to identify factors influencing treatment dropout in child and adolescent psychiatric patients. 443 outpatients aged < 15 years who visited a specialized child and adolescent psychiatry outpatient clinic at a national medical center in Japan between April 2022 and March 2023 were followed for 1 year. Dropout was defined as failure to attend scheduled appointments without notice or having no record of visits for more than 6 months after the last visit. Of the 443 patients, 74 (16.7
This study aimed to evaluate the association between anxiety symptom levels and grazing behavior in individuals with type 2 diabetes. It employed a cross-sectional, descriptive, and analytical design, conducted between August 2023 and June 2024 at a public hospital. The sample consisted of 157 individuals with type 2 diabetes, aged 20 to 64 years, of both sexes, who had been receiving care from the hospital’s endocrinology department for at least one year. The Beck Anxiety Inventory was used to assess the severity of anxiety symptoms, while the Repetitive Eating Questionnaire measured the frequency of grazing behavior. In the anthropometric assessment, most participants were classified as overweight; however, arm circumference measurements indicated a higher prevalence of eutrophy. Neck circumference results revealed that the majority of participants were at increased cardiovascular risk. Furthermore, a negative correlation was found between glycated hemoglobin levels and arm circumference values. On average, participants had been living with diabetes for 11± 8.3 years. Most were using insulin and did not have access to ongoing nutritional counseling. The majority had fasting blood glucose levels above the recommended threshold, a pattern also reflected in their glycated hemoglobin levels. A positive correlation was identified between anxiety symptom scores and glycated hemoglobin levels. Although most participants exhibited minimal anxiety symptoms, the total anxiety score showed a statistically significant positive correlation with grazing behavior scores. This study is particularly relevant as it highlights the importance of understanding the relationship between psychological distress and maladaptive eating behaviors, which may compromise effective diabetes management.
Elevated emotional distress is common in patients with type 1 diabetes mellitus (T1DM), and alleviating psychological problems is important as they may interfere with adherence to T1DM treatment regiments and poor glycaemic regulation. One way to understand and treat emotional distress is to formulate them as linked to self-regulatory strategies and their underlying metacognitive beliefs as proposed by the Self-regulatory Executive Functioning (S-REF) model. We aimed to evaluate the role of dysfunctional metacognitions in diabetes-related emotional distress beyond general emotional distress and to test the statistical fit of a metacognitive model in a sample consisting of 218 adults with T1DM. Dysfunctional metacognitive beliefs were significantly and positively associated with emotional distress symptoms. Beliefs about the need to control thoughts and cognitive self-consciousness showed a unique association with diabetes-related emotional distress even when controlling for general emotional distress symptoms. A metacognitive model specified by dysfunctional metacognitive beliefs, metacognitive strategies (brooding), and general and diabetes-related emotional distress fitted the data well. The metacognitive model of psychological disorders is relevant to formulate and possibly treat different types of emotional distress symptoms in patients with T1DM with the implication that a feasibility trial of metacognitive therapy is warranted.
Older Black adults experience disproportionately high rates of chronic pain (CP) and depression, yet inequities in access, recognition, and culturally resonant treatment persist. Mindfulness-based cognitive therapy (MBCT) is an evidence-based group intervention for depression with emerging promise for CP. However, adaptations for older Black adults with comorbid CP-depression remain underexplored. Guided by cultural intervention adaptation and community engagement principles, we conducted four Community Engagement Studios with 20 older Black adults in Boston (ages 51–84), all reporting CP (≥ 3 months) and mild to moderate depressive symptoms (PHQ-9 ≥ 15). Participants reviewed MBCT content and reflected on cultural relevance, barriers, and facilitators. Through thematic analysis of recorded transcripts, we identified themes pertaining to their perceptions of MBCT. Three themes emerged: (1) nuanced acceptance of mindfulness practices when adapted to faith, physical limitations, and language; (2) importance of instructors who are grounded in respect and shared cultural context; and (3) preference for flexible, sustainable delivery (community-based, hybrid options, shorter sessions). Our findings highlight MBCT’s feasibility for older Black adults with the CP-depression comorbidity when adapted for cultural resonance, accessibility, and sustainability. Results will directly inform our adaptation of MBCT for the CP-depression comorbidity among older Black adults.
Fatigue is common in inflammatory bowel disease (IBD) yet firm understanding of its management remains unclear. While psychosocial factors influence fatigue, less is known about how these factors differ among fatigue subtypes. This study examined the contributions of self-reported disease activity and psychosocial factors to five fatigue subtypes. Patients with Crohn's disease or ulcerative colitis were recruited from an academic medical center. Participants completed online surveys including the Multidimensional Fatigue Inventory (MFI-20) and measures of depression, anxiety, pain interference, pain catastrophizing, and insomnia. In 312 participants, depression was most associated with subtypes of fatigue. Percent variance attributable to fatigue subtypes: general (17%), physical (12%), mental (25%), and reduced motivation (17%). Anxiety was most strongly associated with activity avoidance (17% variance). Factors associated to a lesser degree were pain interference and insomnia. The contribution of psychosocial factors to fatigue was as, if not more substantial than patient-reported disease activity. Symptom-level analysis found cognitive and behavioral symptoms of depression to be most associated with fatigue. While subtypes of fatigue differ in their association to psychosocial factors, depression was a consistent and strongly associated factor. Results highlight the importance of screening for depression and point to specific treatments that may be beneficial for fatigue management.
Illness identity, or how an individual integrates their disease into their sense of self, is an important psychological concept for medical populations. According to one model, there are four proposed dimensions of illness identity: Acceptance, Rejection, Enrichment, and Engulfment. Acceptance and Enrichment describe an individual’s ability to embrace their illness and regard it as a source of positive meaning-making, while Rejection and Engulfment describe an individual’s inclination to disregard or be preoccupied by their illness in unhelpful ways. This study aimed to describe illness identity in a sample of adults with symptomatic sickle cell disease (SCD) and examine how domains of illness identity correlate with physical and mental health variables. Forty-six adults with symptomatic SCD preparing to undergo nonmyeloablative hematopoietic transplants completed a baseline evaluation that included the Illness Identity Questionnaire (IIQ) and measures of depression, anxiety, fatigue, sleep disturbance, physical functioning, and pain. Levels of Enrichment were significantly higher than other dimensions of illness identity (Acceptance, Rejection, and Engulfment). Engulfment scores were positively correlated with sleep disturbance and pain, while Rejection scores were positively correlated with depression and negatively correlated with pain. Results suggest that illness identity is nuanced in adults with SCD. Clinicians and researchers should explore how psychosocial interventions can promote Enrichment and reduce Engulfment.
It is unknown whether youth with abdominal pain-related disorders of gut–brain interaction (AP-DGBI) and clinically elevated pain intensity, functional disability, and anxiety (“high-risk”) respond differentially to the Aim to Decrease Anxiety and Pain Treatment (ADAPT), an evidence-based cognitive behavioral therapy program, compared to youth with fewer risk factors (“low-risk”). This secondary analysis included youth aged 9–14 with AP-DGBI recruited from outpatient gastroenterology clinics and randomized to receive ADAPT plus treatment as usual (TAU) or TAU-alone. Baseline risk status was determined using an established grading system derived from validated measures. Differences in post-treatment ( 8 weeks) pain intensity, functional disability, and anxiety were examined using a multivariate analysis of covariance model with an interaction of risk-status-by-treatment-allocation. Data from 79 youth were analyzed; 29 (36.7
Sickle cell disease (SCD) is a hemoglobin disorder impacting red blood cell and resulting in difficult-to-control pain, which significantly impacts quality of life and psychological wellbeing. There are barriers preventing patients living with SCD from receiving psychological care, and limited work demonstrating best psychological pain care practices. We describe two innovative approaches for incorporating psychological care in two clinics (i.e., pediatric and adult) serving patients living with SCD in a Southeastern United States health system. The first is psychological screening and referral to psychotherapy program. The second is a mindfulness program offering bedside interventions, retreats, and individual sessions. These innovative treatment approaches emphasize adapting psychological care to address care barriers (e.g., access to care, cultural stigma). Adaptable, patient-centered psychological approaches may positively impact pain and decrease healthcare utilization in clinics serving patients managing SCD. Case studies highlight the importance of flexibility and adaptation in service delivery. Both programs are feasible in demonstrating uptake, coordinating across programs, and working with medical providers. Future research and clinical efforts should continue developing adaptable, culturally sensitive psychological approaches to target pain in patients living with SCD, improve quality of life and psychological wellbeing in patients managing SCD, and positively impact health systems.
Despite benefits for patients, families, and healthcare professionals, psychology remains only partially integrated into hospital care. A brief, practical questionnaire for routine use could help understand staff perceptions and support psychologists’ integration. This study aimed to (a) develop and validate the Psychologist in Hospital Questionnaire (PHQ), an 18-item self-administered Italian instrument designed to assess staff perceptions of psychologists’ roles in three domains: support for patients and families, integration into care pathways, and support and training for staff; (b) examine whether domain scores reflect professional and organizational differences. Between December 2024 and May 2025, all healthcare professionals were invited to complete the PHQ in a general hospital in Southern Italy. The instrument’s psychometric structure was tested via confirmatory factor analysis (CFA), and its internal consistency was assessed with Cronbach’s α. Differences in PHQ scores across professional and organizational variables were examined. CFA, performed on a sample of 347 participating staff, supported the three-factor structure with good fit indices and high internal consistency (α = 0.80–0.89). Psychologists were most valued for supporting and training staff, followed by supporting patients and families. Greater awareness of psychologists’ support was observed among staff in units with regular access to psychologists and in medical units, supporting construct validity. The PHQ is a reliable 18-item tool suitable for routine evaluation of staff perceptions of psychologists’ roles. Its use may guide hospital service planning and foster organizational models that strengthen psychologists’ presence in healthcare teams.
Emerging work characterizing youth with chronic pain increasingly recognizes a large cohort of youth with co-occurring chronic pain and autism. This development has prompted questions about how to adapt Intensive Interdisciplinary Pediatric Pain Treatment (IIPTs) and the group-based treatments commonly used in these settings to improve accessibility, acceptability, and utility for autistic participants. There is a need for clinically oriented literature that IIPT programs and clinical trialists can use to guide adaptation efforts. Given long-term risks of inadequately treated pediatric pain, we argue it is clinically and ethically important to identify reasonable autism-informed adjustments within existing IIPT frameworks, even as more empirical work unfolds to inform nuance. In this narrative review, we synthesize evidence from pediatric pain psychology and autism intervention literatures to identify overlapping mechanisms and opportunities for adaptation, with a specific focus on group-based CBT/ACT-oriented treatments delivered in IIPTs. We summarize emerging clinical characteristics of autistic adolescents enrolled in IIPTs, bridge autism and pediatric pain group treatment literature, map that literature onto pediatric pain targets and autism-informed IIPT group design considerations and provide practical examples of IIPT group modifications extended from the existing data and the authors’ clinical experience delivering group-based pain psychology services to autistic youth in IIPTs. We also highlight constraints of group formats for autistic youth and emphasize flexible pathways of care.
Burn patients often experience severe procedural pain throughout hospitalization, and poorly controlled pain is a significant predictor of long-term psychological adjustment post-injury. Virtual Reality (VR) presents a promising adjunctive approach to pharmacological analgesics by redirecting patients’ attention away from painful stimuli using immersive, multidimensional environments. Recent technological advances have made VR more affordable, portable, and hands-free permitting the head-mounted display to be easily transported with minimal set up, particularly conducive to hospital environments. This proof-of-concept randomized pilot trial compared VR-enhanced distraction to treatment as usual (TAU) during painful procedures (e.g., wound dressing changes) in hospitalized burn patients. Of 51 patients approached, 15 adults enrolled and 100
Brief Cognitive Behavioral Therapy for Chronic Pain is an abbreviated treatment designed for use in integrated primary care. This pilot study aimed to assess the feasibility of treatment delivery and study procedures in preparation for conducting a future effectiveness trial. Thirty patients with chronic musculoskeletal pain were recruited from a Veterans Health Administration medical center. Following baseline assessment, patients were randomized to either Brief Cognitive Behavioral Therapy for Chronic Pain plus primary care treatment as usual or primary care treatment as usual alone. Recruitment was completed on time averaging 2.5 patients enrolled per month. Completion of study assessments was high (i.e., 13% missing at 6-week assessment; 10% missing at 12-week assessment). Patients assigned to Brief Cognitive Behavioral Therapy for Chronic Pain averaged 5.6 of 6 possible sessions and reported strong therapeutic relationships with their therapists. Descriptive analyses indicated that clinically significant improvement in pain-related activity interference, pain intensity, and depression symptoms was demonstrated in the treatment group only. This treatment is feasible to deliver in the context of a clinical trial and shows potential as a time-limited approach to impart pain self-management skills among primary care patients. A powered effectiveness trial is warranted. This trial was registered at ClinicalTrials.gov (NCT03490981) on 10/1/2018.
