Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability tha... more Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability than patients who are not overweight. This study examined the long-term efficacy of a combined pain coping skills training (PCST) and lifestyle behavioral weight management (BWM) intervention in overweight and obese OA patients. Patients (N=232) were randomized to a 6month program of: 1) PCST + BWM; 2) PCST-only; 3) BWM-only; or 4) standard care control. Assessments of pain, physical disability (Arthritis Impact Measurement Scales [AIMS] physical disability, stiffness, activity, and gait), psychological disability (AIMS psychological disability, pain catastrophizing, arthritis self-efficacy, weight self-efficacy), and body weight were collected at four time points (pretreatment, post-treatment, and 6 months and 12 months after the completion of treatment). Patients randomized to PCST+ BWM demonstrated significantly better treatment outcomes (average of all three post-treatment values) in terms of pain, physical disability, stiffness, activity, weight self-efficacy, and weight when compared to the other three conditions (p's <.05). PCST+BWM also did significantly better than at least one of the other conditions (i.e., PCST-only, BWM-only, or standard care) in terms of psychological disability, pain catastrophizing, and arthritis self-efficacy. Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long-term benefits.
Emotional disclosure by writing or talking about stressful life experiences improves health statu... more Emotional disclosure by writing or talking about stressful life experiences improves health status in non-clinical populations, but its success in clinical populations, particularly rheumatoid arthritis (RA), has been mixed. In this randomized, controlled trial, we attempted to increase the efficacy of emotional disclosure by having a trained clinician help patients emotionally disclose and process stressful experiences. We randomized 98 adults with RA to one of four conditions: a) private verbal emotional disclosure; b) clinician-assisted verbal emotional disclosure; c) arthritis information control (all of which engaged in four, 30-minute laboratory sessions); or d) no-treatment, standard care only control group. Outcome measures (pain, disability, affect, stress) were assessed at baseline, 2 months following treatment (2-month follow-up), and at 5-month, and 15-month follow-ups. A manipulation check demonstrated that, as expected, both types of emotional disclosure led to immediate (post-session) increases in negative affect compared with arthritis information. Outcome analyses at all three follow-ups revealed no clear pattern of effects for either clinician-assisted or private emotional disclosure compared with the two control groups. There were some benefits in terms of a reduction in pain behavior with private disclosure versus clinician-assisted disclosure at the 2 month follow-up, but no other significant between group differences. We conclude that verbal emotional disclosure about stressful experiences, whether conducted privately or assisted by a clinician, has little or no benefit for people with RA.
Journal of Consulting and Clinical Psychology, 2014
Objective-Two psychological interventions for rheumatoid arthritis (RA) are cognitivebehavioral c... more Objective-Two psychological interventions for rheumatoid arthritis (RA) are cognitivebehavioral coping skills training (CST) and written emotional disclosure (WED). These approaches have developed independently, and their combination may be more effective than either one alone. Furthermore, most studies of each intervention have methodological limitations, and each needs further testing. Method-We randomized 264 adults with RA in a 2 × 2 factorial design to one of two writing conditions (WED vs. control writing) followed by one of two training conditions (CST vs. arthritis education control training). Patient-reported pain and functioning, blinded evaluations of disease activity and walking speed, and an inflammatory marker (C-reactive protein) were assessed at baseline and 1-, 4-, and 12-month follow-ups. Results-Completion of each intervention was high (> 90% of patients), and attrition was low (10.2% at 12-month follow-up). Hierarchical linear modeling of treatment effects over the followup period, and ANCOVAs at each assessment point, found no interactions between writing and training; however, both interventions had main effects on outcomes, with small effect sizes. Compared to control training, CST decreased pain and psychological symptoms through 12 months. The effects of WED were mixed: compared with control writing, WED reduced disease activity and physical disability at 1 month only, but WED had more pain than control writing on one of two measures at 4 and 12 months. Conclusions-The combination of WED and CST does not improve outcomes, perhaps because each intervention has unique effects at different time points. CST improves health status in RA and is recommended for patients, whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients.
This paper explores a discourse of war against HIV/AIDS evident in the Daily Dispatch, a South Af... more This paper explores a discourse of war against HIV/AIDS evident in the Daily Dispatch, a South African daily newspaper, from 1985 to 2000, and discusses the implications of this in terms of the way in which HIV/AIDS is constructed. The discursive framework of the war depends, fundamentally, on the personification of HIV/AIDS, in which agency is accorded to the virus, and which allows for its construction as the enemy. The war discourse positions different groups of subjects (the diseased body, the commanders, the experts, the ordinary citizens) in relations of power. The diseased body, which is the point of transmission, the polluter or infector, is cast as the 'Other', as a dark and threatening force. This takes on racialised overtones. The government takes on the role of commander, directing the war through policy and intervention strategies. Opposition to government is couched in a struggle discourse that dove-tails with the overall framework of war. Medical and scientific understandings pre-dominate in the investigative practices and expert commentary on the war, with alternative voices (such as those of people living with HIV/AIDS) being silenced. The ordinary citizen is incited to take on prevention and caring roles with a strong gendered overlay.
Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability tha... more Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability than patients who are not overweight. This study examined the long-term efficacy of a combined pain coping skills training (PCST) and lifestyle behavioral weight management (BWM) intervention in overweight and obese OA patients. Patients (N=232) were randomized to a 6month program of: 1) PCST + BWM; 2) PCST-only; 3) BWM-only; or 4) standard care control. Assessments of pain, physical disability (Arthritis Impact Measurement Scales [AIMS] physical disability, stiffness, activity, and gait), psychological disability (AIMS psychological disability, pain catastrophizing, arthritis self-efficacy, weight self-efficacy), and body weight were collected at four time points (pretreatment, post-treatment, and 6 months and 12 months after the completion of treatment). Patients randomized to PCST+ BWM demonstrated significantly better treatment outcomes (average of all three post-treatment values) in terms of pain, physical disability, stiffness, activity, weight self-efficacy, and weight when compared to the other three conditions (p's <.05). PCST+BWM also did significantly better than at least one of the other conditions (i.e., PCST-only, BWM-only, or standard care) in terms of psychological disability, pain catastrophizing, and arthritis self-efficacy. Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long-term benefits.
Emotional disclosure by writing or talking about stressful life experiences improves health statu... more Emotional disclosure by writing or talking about stressful life experiences improves health status in non-clinical populations, but its success in clinical populations, particularly rheumatoid arthritis (RA), has been mixed. In this randomized, controlled trial, we attempted to increase the efficacy of emotional disclosure by having a trained clinician help patients emotionally disclose and process stressful experiences. We randomized 98 adults with RA to one of four conditions: a) private verbal emotional disclosure; b) clinician-assisted verbal emotional disclosure; c) arthritis information control (all of which engaged in four, 30-minute laboratory sessions); or d) no-treatment, standard care only control group. Outcome measures (pain, disability, affect, stress) were assessed at baseline, 2 months following treatment (2-month follow-up), and at 5-month, and 15-month follow-ups. A manipulation check demonstrated that, as expected, both types of emotional disclosure led to immediate (post-session) increases in negative affect compared with arthritis information. Outcome analyses at all three follow-ups revealed no clear pattern of effects for either clinician-assisted or private emotional disclosure compared with the two control groups. There were some benefits in terms of a reduction in pain behavior with private disclosure versus clinician-assisted disclosure at the 2 month follow-up, but no other significant between group differences. We conclude that verbal emotional disclosure about stressful experiences, whether conducted privately or assisted by a clinician, has little or no benefit for people with RA.
Journal of Consulting and Clinical Psychology, 2014
Objective-Two psychological interventions for rheumatoid arthritis (RA) are cognitivebehavioral c... more Objective-Two psychological interventions for rheumatoid arthritis (RA) are cognitivebehavioral coping skills training (CST) and written emotional disclosure (WED). These approaches have developed independently, and their combination may be more effective than either one alone. Furthermore, most studies of each intervention have methodological limitations, and each needs further testing. Method-We randomized 264 adults with RA in a 2 × 2 factorial design to one of two writing conditions (WED vs. control writing) followed by one of two training conditions (CST vs. arthritis education control training). Patient-reported pain and functioning, blinded evaluations of disease activity and walking speed, and an inflammatory marker (C-reactive protein) were assessed at baseline and 1-, 4-, and 12-month follow-ups. Results-Completion of each intervention was high (> 90% of patients), and attrition was low (10.2% at 12-month follow-up). Hierarchical linear modeling of treatment effects over the followup period, and ANCOVAs at each assessment point, found no interactions between writing and training; however, both interventions had main effects on outcomes, with small effect sizes. Compared to control training, CST decreased pain and psychological symptoms through 12 months. The effects of WED were mixed: compared with control writing, WED reduced disease activity and physical disability at 1 month only, but WED had more pain than control writing on one of two measures at 4 and 12 months. Conclusions-The combination of WED and CST does not improve outcomes, perhaps because each intervention has unique effects at different time points. CST improves health status in RA and is recommended for patients, whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients.
This paper explores a discourse of war against HIV/AIDS evident in the Daily Dispatch, a South Af... more This paper explores a discourse of war against HIV/AIDS evident in the Daily Dispatch, a South African daily newspaper, from 1985 to 2000, and discusses the implications of this in terms of the way in which HIV/AIDS is constructed. The discursive framework of the war depends, fundamentally, on the personification of HIV/AIDS, in which agency is accorded to the virus, and which allows for its construction as the enemy. The war discourse positions different groups of subjects (the diseased body, the commanders, the experts, the ordinary citizens) in relations of power. The diseased body, which is the point of transmission, the polluter or infector, is cast as the 'Other', as a dark and threatening force. This takes on racialised overtones. The government takes on the role of commander, directing the war through policy and intervention strategies. Opposition to government is couched in a struggle discourse that dove-tails with the overall framework of war. Medical and scientific understandings pre-dominate in the investigative practices and expert commentary on the war, with alternative voices (such as those of people living with HIV/AIDS) being silenced. The ordinary citizen is incited to take on prevention and caring roles with a strong gendered overlay.
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Papers by Mark Connelly