Master of Science, The Ohio State University, 2022, Dentistry

Chronic oral and maxillofacial pain conditions represent a diverse group of disorders. Broadly, they can be broken down into temporomandibular disorders (TMDs) and/or orofacial pain disorders. These classifications further detail a series of conditions ranging from joint pains, muscles pains, headaches, to various neuralgias of the head, neck, and face. The presence of depression often complicates these conditions. In addition, chronic noxious stimuli can lead to central sensitization, amplifying and protracting pain. Ketamine, a commonly used general anesthetic agent, has been studied in pre-clinical animal and human clinical trials and has shown great promise for treating chronic pain and depression. It has also been proposed that intravenous ketamine administration plays a role in reversing central sensitization. Albeit simplified, the hypothesized mechanism of action behind ketamine's ability to perform these actions primarily lies within the drug's ability to inhibit N-methyl-D-aspartate receptors (NMDAR) in the central nervous system. However, it is thought that other factors are at play behind ketamine's clinically valuable attributes. Unfortunately, most research in this field has been studied without regard to the head, neck, and face. The following is a systematized review of ketamine therapy to treat such disorders. Regrettably, the results demonstrated the dental profession's lack of pursuit in ketamine therapy when treating chronic oral and maxillofacial pain patients. Nevertheless, there was a meaningful amount of data covering the utility of ketamine therapy. Although most clinical trials present with large degrees of design heterogenicity, the overwhelming conclusion of these publications suggests great promise for the use of intravenous ketamine infusions to treat a multitude of chronic pain conditions. Given these results, the dental profession, with its recent addition of two new specialties (i.e., dental anesthesiology and orofacial pain), alo (open full item for complete abstract)

Committee: Bryant Cornelius (Advisor); Gregory Ness (Committee Member); William Johnston (Committee Member); Erin Gross (Committee Member) Subjects: Dental Care; Dentistry

Specialist in Education (Ed.S.), University of Dayton, 2012, School Psychology

Chronic pain is a widespread and complex concern, which affects students academically, emotionally, and socially. Teachers' knowledge about meeting the academic, emotional, and social needs of children with chronic pain needs is essential. Previous findings indicate that attention and relief from responsibility may reinforce and maintain functional disability; however, teachers may not be properly educated about ways to help students manage chronic pain. This study assessed regular education teachers' understanding of chronic pain. One hundred and five teachers from a midwestern school district completed a survey rating their understanding of chronic pain. The majority of teachers reported no knowledge about chronic pain and had not received any formal training. Most of the teachers, however, indicated that they have previously had a student with chronic pain whose academic, emotional, and social functioning was somewhat affected. Teachers did not vary significantly in their perceptions of impact of pain on functioning based on their school type. Future research should focus on specific chronic pain conditions and the effectiveness of interventions to improve teacher knowledge of working with students with chronic pain. School systems should ensure that teachers understand medical conditions associated with chronic pain in order to provide effective interventions.

Committee: Susan Davies PhD (Committee Chair) Subjects: Educational Psychology

MA, University of Cincinnati, 2024, Arts and Sciences: Psychology

Chronic pain can disrupt adolescents' attention. Such interruptions, in turn, may negatively impact one's overall functioning, causing frustration and distress when trying to engage in important tasks (e.g., schoolwork). This experience has been referred to as cognitive intrusion of pain (Attridge et al., 2015). To date, only one adult self-report measure of cognitive intrusion of pain exists: the Experience of Cognitive Intrusion of Pain Scale (ECIP). This is a critical gap in the literature, as there is currently no known measure of experienced cognitive intrusion of pain for pediatric chronic pain patients. The current study examined the psychometric properties of an adapted version of the ECIP (ECIP-A) among children and adolescents (ages 11-18) with pediatric chronic pain. Data were collected from pediatric chronic pain patients (N = 194) presenting for treatment at a tertiary pain clinic at a large Midwestern children's hospital. Exploratory analyses were conducted for deeper understanding of the current sample, as this is the first study to assess the ECIP-A in pediatric patients with chronic pain. The current sample consisted of 81.9% self-identified as Non-Hispanic White and 77.5% female chronic pain patients. There were no significant differences in ECIP-A scores between males and females, across patient age, or across primary pain condition. ECIP-A scores and Pain Frequency-Severity-Duration composite scores were significantly correlated, indicating that as pain symptoms increase, so does cognitive intrusion of pain (r = 0.23, p = 0.002). Confirmatory factor analysis (CFA) results supported a one-factor model for the ECIP-A, with excellent model fit (?2 = 30.24, df = 23, p = 0.14; CFI = 0.99, TLI = 0.99, RMSEA = .042 (90% CI 0.00 - 0.078), and SRMR = 0.021). Results suggest excellent internal consistency of ECIP-A scores (Cronbach's alpha = 0.94). Pearson correlations indicated good convergent and discriminant validity, as the ECIP-A was moderately and p (open full item for complete abstract)

Committee: Kristen Jastrowski Mano Ph.D. (Committee Chair); Quintino Mano Ph.D. (Committee Member); Cathleen Stough Ph.D. (Committee Member) Subjects: Psychology

Master of Science (MS), Ohio University, 2022, Experimental Psychology (Arts and Sciences)

Chronic low back pain (CLBP) is a burdensome chronic pain condition. Emotion regulation (ER) and insecure adult attachment dimensions are psychosocial variables of great importance to individual differences observed across different chronic pain populations. However, few studies to date have examined ER and insecure adult attachment dimensions in tandem among individuals with CLBP. The aims of the present study are to examine the independent and joint influences of insecure adult attachment dimensions and ER strategies, including emotional expression, cognitive reappraisal, and expressive suppression, on patients' CLBP severity and CLBP interference (N = 242). Results showed that anxious attachment, but not avoidant attachment, positively and significantly correlated with CLBP interference; neither anxious attachment nor avoidant attachment was associated with CLBP severity. Emotional expression and expressive suppression positively and significantly correlated with CLBP severity, but not CLBP interference. Cognitive reappraisal did not correlate with CLBP severity or CLBP interference. Furthermore, emotional expression exacerbated the influence of avoidant attachment on CLBP severity or CLBP interference, while expressive suppression and cognitive reappraisal did not moderate the attachment – CLBP relation. In line with existing research, the present study shows that anxious attachment may be a risk factor related to more CLBP interference. Interestingly, expressing emotions was associated with more CLBP severity or CLBP interference among avoidant people.

Committee: Dominik Mischkowski (Advisor) Subjects: Psychology

PhD, University of Cincinnati, 2021, Arts and Sciences: Psychology

School anxiety is a prevalent and disabling mental health concern among children and adolescents with chronic pain, representing a principal driver of school avoidance and difficulties with academic performance. The only available measure of school anxiety—the School Anxiety Inventory (SAI)—lacks adequate content specificity for measuring school anxiety among youth with chronic pain. The purpose of this study was to inform the development of a modified version of the SAI by exploring the unique school situations that are anxiety-provoking for youth with chronic pain and characterizing the nature of symptoms experienced in these situations. Adolescents with chronic pain (n=16) completed a semi-structured qualitative interview focused on their experiences with anxiety in school-related academic and social contexts. We employed deductive and inductive approaches to thematic analysis to extend the empirical understanding of school anxiety as it is experienced by adolescents with chronic pain. We identified six key themes within the data, each of which informed the generation of a set of new items designed to capture anxiety related to negative interactions with teachers and peers, falling behind with schoolwork, and struggles with concentration and fatigue. These items were refined with feedback from adolescents with chronic pain (n=5) and a team of expert clinicians (n=3), which informed the creation of a modified version of the SAI: School Anxiety Inventory for Chronic Pain (SAI-CP). Results from this study underscore the importance of addressing anxiety early in treatment among youth with chronic pain using tailored approaches that consider their unique sources of anxiety and the symptoms experienced in these situations. Future research is needed to evaluate the psychometric properties of the SAI-CP and to improve the suitability of the measure for use in research and clinical settings.

Committee: Kristen Jastrowski Mano Ph.D. (Committee Chair); Jeffery Epstein Ph.D. (Committee Member); Cathleen Stough Ph.D. (Committee Member) Subjects: Psychology

Doctor of Psychology (Psy.D.), Xavier University, 2020, Psychology

The biopsychosocial model argues multiple biological, psychological, and social factors influence the experience, development, and management of chronic pain. The relations between pain intensity, pain interference, substance use, personality, depression, pain attitudes, pain catastrophizing, coping and social support were explored in a sample of 86 new pain treatment patients. An Exploratory Factor Analysis (EFA) revealed four underlying factors that explained 55.55% of the variance: psychological factors (25.34% variance), daily functioning (15.82% variance), control (7.63% variance), and substance use/support (6.57% variance). Logistic regression analyses were conducted to identify the predictive value of the identified factors for current and future chronic pain treatment (0 = noninvasive vs. 1 = invasive). Results indicated no factor was related to current pain treatment; however, control was predictive of future pain treatment (B = -.04, Exp(B) = .97). Formal prediction models were built to identify unique associations to current and future pain treatment. General pain attitudes—including beliefs one should be cared for, negative emotions increase pain, pain can be cured, pain can be controlled, pain causes harm, pain makes one disabled, and medications are the best treatment— was predictive of current pain treatment (B = .80, Exp(B) = 2.22). Pain catastrophizing (B = -.04, Exp(B)= .96) and general pain attitudes (B = 1.01, Exp(B) = 2.75) were predictive of future chronic pain treatment. Our findings suggest that cognitive factors play an important role in chronic pain treatment selection. Future research should use a larger, more diverse sample size to make findings more generalizable.

Committee: Susan Kenford Ph.D. (Committee Chair); Reneé Zucchero Ph.D. (Committee Member); Jennifer Phillips Ph.D. (Committee Member) Subjects: Clinical Psychology

Psy. D., Antioch University, 2016, Antioch Seattle: Clinical Psychology

Negative stereotypes about people with chronic pain pose a barrier in the delivery of care; contribute to worsening symptoms of physical and psychological distress; and play a role in policy decisions that adversely affect patients and providers. Pain-care seekers may be accused of malingering, laziness, mental aberration, attention seeking, and drug seeking. The propagation of stigmatizing attitudes was explored in this Critical Discourse Analysis of online-reader-comments responding to a series of pain-care policy articles published by a large metropolitan newspaper. Results suggest that framing pain patients as legitimate and deserving can inadvertently reproduce the inequities advocates seek to redress. Ascriptions of deservingness were associated with the locus of choice and agency. Assignments of blameworthiness were used to distinguish the legitimate pain patient from the illegitimate care seeker. Motivation for seeking pain care, as much as the effects of opioids, provided crucial determinants in evaluating legitimacy claims and blame ascriptions. Evaluations of deservingness were predicated on the valence of social regard. Compassion, empathy, respect and believability were rewards of positive social regard. The subjects of addiction and drug abuse were maligned to the detriment of people with pain and people with opioid addiction alike. The disease-entity model of chronic pain was associated with psychiatric discourses of mental illness through a narratives inaccurate reality perception. Loss of independence, rationality, and respectability were semantically linked to negative stereotypes of pain patients, drug addicts, and mentally ill groups. Medical discourses drawing on empirical materialist traditions assert taken-for-granted population categories (e.g. chronic noncancer pain patient) with little acknowledgment of confounding variables, lack of evidence, or their social impact. For the benefit of people seeking care, there is a critical need for moral (open full item for complete abstract)

Committee: Mary Wieneke Ph.D. (Committee Chair); Philip Cushman Ph.D. (Committee Member); Elin Björling Ph.D. (Committee Member) Subjects: Health Care; Public Health; Social Research; Sociolinguistics

Doctor of Philosophy, Case Western Reserve University, 1994, Psychology

Chronic pain differs from acute pain in a number of ways. A prominent difference between the two lies in the most beneficial method of treatment. The most effective means of coping with acute pain are passive approaches, based on traditional medical models. The most effective means of coping with chronic pain, when examined in isolation from acute pain, are active approaches in which the individual in pain plays a more aggressive role in the management. Previous research has not addressed the issue of the most effective use of coping style for chronic pain populations, who are faced with managing episodes of both acute and chronic pain. The present study was designed to investigate the coping styles (active vs. passive) which a chronic pain population uses to manage both acute and chronic pain episodes, and to examine the relationship of these coping styles to depression and anxiety. Subjects with chronic pain completed two versions of the Pain Management Inventory (Brown & Nicassio, 1987), one in regard to their chronic pain and the other in regard to acute pain which they experience, indicating the frequency with which they used various active and passive coping strategies. Depression and anxiety were assessed using the Center for Epidemiological Studies Depression Scale (Radloff, 1977) and the trait anxiety scale of the State Trait Personal ity Inventory (Spielberger et al., 1979). Results indicate that chronic pain patients use a mixture of both passive and active strategies, and that they use similar strategies for both acute and chronic pain experiences. The most important predictor of depression and trait anxiety, however, is the use of passive coping in response to chronic pain. Using the current methodology, it was impossible to identify adequately sized groups of subjects who selectively used different coping styles for the two types of pain in order to determine if this selective use of coping styles is beneficial in this population. These results are dis (open full item for complete abstract)

Committee: Dianne Tice (Advisor) Subjects: Psychology, Clinical

Doctor of Psychology (Psy.D.), Xavier University, 2025, Psychology

Chronic pain is a potentially debilitating health condition in which pain lasts beyond normal healing time or for a duration longer than three months. Several psychiatric disorders are comorbid with chronic pain, including mood disorders, anxiety disorders, substance use disorders, suicidal ideation, and post-traumatic stress disorder (PTSD). Chronic pain affects more than one in 10 young adults worldwide. Understanding how chronic pain affects the mental health of individuals in the early stages of adulthood may help clinicians better tailor psychotherapeutic interventions to their needs. Datasets were obtained from 146 participants ages 20-83 (M = 48.67 years) who completed self-report measures related to their psychological functioning. Pearson correlation and a parallel multiple regression mediation analysis were conducted to investigate the relationships between Acceptance and Commitment Therapy (ACT) processes, age, and depressive symptoms. A significant inverse correlation was found between age and depressive symptoms. Younger participants reported significantly lower levels of mindfulness, a weaker sense of "self-as-context," more values discrepancy, and higher levels of cognitive fusion as compared to older participants. Among the ACT processes tested, cognitive fusion was the only one which mediated the relationship between age and depressive symptoms. Psychological inflexibility, chronic pain values discrepancy, and cognitive fusion had a significant direct effect on self-reported symptoms of depression. Younger adults with chronic pain exhibited more depressive symptoms and lower psychological functioning as seen through the lens of the core ACT processes. Understanding the unique psychological challenges of early adulthood may help clinicians to customize psychotherapeutic interventions to help improve psychological functioning in younger adults with chronic pain.

Committee: Jennifer Phillips Ph.D. (Committee Chair); Tammy Sonnentag Ph.D. (Committee Member); Stacey Raj Ph.D. (Committee Member) Subjects: Health; Health Sciences; Psychology; Psychotherapy

Doctor of Philosophy, The Ohio State University, 2025, Health and Rehabilitation Sciences

Purpose: Patellofemoral pain (PFP) is a prevalent condition with high recurrence that limits mobility and reduces quality of life. The lateral step-down test (LSDT) is used to assess lower extremity movement quality in individuals with PFP with an emphasis on frontal plane movement. Knee valgus, the frontal plane movement of the knee medially, during weight bearing lower extremity tasks increases patellofemoral joint forces. Rehabilitation professionals appraise movement quality with the goal of reducing knee valgus during activity to reduce patellofemoral joint forces and pain. It is unclear if experienced and novice physical therapists can measure movement quality by identifying the same number of movement deviations and measure knee valgus between each other. Alterations in movement occur in individuals with PFP with various step-down and single leg squat tasks. Understanding how fear of movement, as measured by the Tampa Scale of Kinesiophobia (TSK-17), and PFP, may relate to movement is a research priority in the field. The relationship of the TSK-17 and the frontal plane projection angle (FPPA), a 2-dimensional (2D) measure of knee valgus, during the LSDT remains relatively unexplored. Also, the temporal demands of the LSDT are unknown. The primary purpose of this dissertation was to 1) Examine if there is a difference between expert and novice physical therapists appraising quality movement and establish the reliability of physical therapists measuring the 2D measurement of the FPPA of individuals with chronic PFP during LSDT, 2) Investigate the relationship of kinesiophobia as measured by the TSK-17 on the average FPPA when measured at the lowest point of descent during the LSDT while controlling for key covariates, and 3) Explore the interlimb temporal performance of individuals with unilateral PFP during the different phases of the LSDT, and overall time to complete the test. Methods: This dissertation used baseline data from an ongoing registered ra (open full item for complete abstract)

Committee: James Onate (Advisor); Laura Schmitt (Committee Member); Matthew Briggs (Committee Member); Laura Boucher (Committee Member); Brittany Hand (Committee Member) Subjects: Kinesiology; Physical Therapy; Rehabilitation; Sports Medicine

Master of Science (MS), Wright State University, 2024, Computer Science

Sickle Cell Disease (SCD) is one of the most prevalent genetic blood disorders affecting millions of people worldwide. It is often accompanied by acute and/or chronic pain leading to increased healthcare costs and adverse outcomes. Effective management of SCD requires an understanding of the diverse physiological profiles. This study employs unsupervised machine learning, specifically K-means clustering to categorize the patients suffering with SCD into different clusters based on their vital signs. The main aim is to identify the groups that reflect similarities in physiological and pain profiles, allowing an in-depth analysis to reveal distinctive features distinguishing patient clusters. The project pipeline involved data collection, preprocessing, clustering, cluster validation and statistical analysis of clusters. Following this we found the choice of four clusters to be the best fit for the patient cohort using cluster validity measures with the following physiological behavior: (i) a combination of low blood pressure, high respiration, and elevated heart rates; (ii) low blood pressure and slightly high oxygen saturation; (iii) high blood pressure; and (iv) elevated heart rates. Statistical methods ANOVA (Analysis of Variance) and effect size calculations were performed to validate the obtained clusters and assess the importance and amplitude of feature differences across the clusters. The findings demonstrate the effectiveness of unsupervised learning in revealing patient heterogeneity within SCD population. The study concludes that clustering can play a vital role in enabling healthcare providers with a better understanding of patient-specific needs.

Committee: Tanvi Banerjee Ph.D. (Advisor); Michael L. Raymer Ph.D. (Committee Member); Wen Zhang Ph.D. (Committee Member) Subjects: Computer Science

Master of Public Health, The Ohio State University, 2005, Graduate School

Committee: Not Provided (Other) Subjects:

PhD, University of Cincinnati, 2024, Arts and Sciences: Psychology

Background: Chronic pain and eating disorders are two prevalent and disabling pediatric health concerns, with serious, potentially life-threatening consequences. These conditions can co-occur, yet little is known about best practices for identifying and treating co-morbid pain and eating disorders. Further, disordered eating behaviors may be overlooked when pain, particularly abdominal pain, is the primary presenting problem. Delayed intervention for eating disorders may have grave implications, as eating disorders have one of the highest mortality rates among psychological disorders. This study aimed to understand pediatric clinicians' experiences with adolescents who present with chronic pain and eating disorders. Method: Semi-structured interviews were conducted with hospital-based physicians (N = 10; 70% female; M years of experience = 15.3) and psychologists (N = 10; 80% female; M years of experience = 10.2) across the United States. Audio transcripts were coded and thematic analysis was used to identify key themes. Results: Three main themes emerged: clinical practice, clinician training, and collaboration and consultation. Clinicians described frequently encountering adolescents with chronic pain and eating disorders. Comorbid chronic functional abdominal pain and avoidant and restrictive food intake disorder (ARFID) were the most common clinical presentation noted. Clinicians expressed concern regarding lack of confidence in diagnosing comorbid eating disorders and chronic pain which they attributed to lack of screening tools as well as limited training in identifying these conditions. Clinicians identified collaboration and consultation with clinicians who have experience with adolescents with chronic pain and/or eating disorders as a helpful method for meeting the needs of adolescents with comorbid chronic pain and eating disorders. Discussion: In the current sample, clinicians describe encountering adolescents with comorbid pain and eat (open full item for complete abstract)

Committee: Kristen Jastrowski Mano Ph.D. (Committee Chair); Cathleen Stough Ph.D. (Committee Member); Claire Aarnio-Peterson Ph.D. (Committee Member) Subjects: Psychology

Doctor of Philosophy (PhD), Ohio University, 2024, Clinical Psychology (Arts and Sciences)

Transcranial alternating current stimulation (tACS) is non-invasive brain stimulation technique optimal for targeting specific neural frequencies associated with various aspects of cognition and behavior. Emerging evidence from clinical and experimental studies suggests that tACS applied at alpha range (α-tACS) may reduce pain experience in the context of elevated anxiety or uncertainty. The current study employed a randomized crossover double-blinded design to deliver α-tACS and sham stimulation to 28 participants (13 healthy, 15 with chronic low back pain) while they received mechanical pressure and muscular ischemia pain stimulation. Mechanical pain ratings were found to be higher during tRNS compared to α-tACS. Conversely, ischemic pain ratings were found to be higher during α-tACS compared to tRNS. Further, individuals high in trait anxiety (intolerance of uncertainty) evidenced significantly lower ischemic pain report following α-tACS (M = 35.6, SD = 30.6) compared to sham (M = 46.9, SD = 23.9), t(26) = -3.17, p < 0.001. There were no significant effects of interest found for low back pain ratings among the back pain subsample (assessed at baseline, post-stimulation, and 24-hour follow-up). Pre-post stimulation EEG indicated limited support for higher alpha and broad support for higher theta activity following α-tACS compared to sham. Additionally, increases in alpha and theta at certain sites were associated with lower mechanical pain and low back pain report, respectively. Future research in more representative clinical pain samples is needed to validate and extend this emerging body of research.

Committee: Christopher France (Committee Chair) Subjects: Behavioral Sciences; Clinical Psychology; Medicine

PHD, Kent State University, 2025, College of Arts and Sciences / Department of Psychological Sciences

Introduction: Over 80% of patients with Chiari Malformation (CM: a chronic health condition characterized by brain and spinal malformations and displacements) struggle with moderate to severe disability due to neck pain and headaches. Acceptance and Commitment Therapy (ACT) has been shown to be efficacious in addressing chronic pain when administered as a self-guided online intervention. However, it is unclear if adjunctive weekly phone coaching is necessary for retention, satisfaction, engagement, and treatment efficacy. Method: This study randomized 112 participants with CM to ACT+ Coaching, ACT-Only, or a waitlist control group. Participants completed a baseline survey, nine weekly assessments, eight weeks of online intervention modules, and a one- and three-month follow-up survey. Primary outcomes were psychological flexibility (PF) and chronic pain acceptance; secondary outcomes included pain intensity, pain interference, depression, and anxiety. Treatment groups were also compared on treatment retention, satisfaction, and engagement with the online intervention. Results: Participants were mostly female (92%), averaged 43 years old, and primarily had CM type 1 (91%). There were no differences between the ACT+ Coaching and ACT-Only groups on PF, chronic pain acceptance, pain interference, or anxiety. There were very small differences between the treatment groups on depression and ratings of pain intensity. Compared to the waitlist control, both the ACT+ Coaching and ACT-Only groups had significant improvement in activity engagement subscale and anxiety scores. Compared to the control group, the ACT+ Coaching group had significant improvement in PF and chronic pain acceptance while the difference between controls and the ACT-Only group was approaching significance. While participants in the coaching group reported that coaching sessions were helpful and important to the intervention, there were no significant differences in intervention satisfaction between (open full item for complete abstract)

Committee: Douglas Delahanty (Advisor); Joel Hughes (Committee Member); Clare Stacey (Committee Member); Mary Himmelstein (Committee Member); Andrea Warner Stidham (Committee Member); Jeffrey Ciesla (Committee Member) Subjects: Behaviorial Sciences; Clinical Psychology; Psychology

Master of Arts (M.A.), University of Dayton, 2023, Theological Studies

This thesis seeks to engage in an examination of redemptive suffering and Resurrected woundedness, especially for persons with disabilities through the interlocutor of the sixteenth-century saint, St. Teresa of Avila. Teresa of Avila, with her embodiment of suffering, provides a first-hand example of the spiritual tension experienced when living with a disability. From the perspective of Teresa, her body was physically limiting her from fully serving God; "que servia mucho mas a Dios con la salud" ["I would be able to serve God much better if I were in good health"] (Autobiography, VI: 5). Thus, I explore the research question: does disability or woundedness hinder one's relationship with God? Teresa reveals that she wishes her body was healed in order to serve God in a greater way. The main aspect of this project is to present the tension between these two approaches to suffering happening within the same person with special consideration of her early modern European social context. After sharing a bit of my own experience of suffering in the convent, I combine the voice of Teresa of Avila with contemporary disability theologians to arrive at the present conversation in theological disability studies. I further emphasize the embodied limits model of disability, proposed by Deborah Creamer, as a lens to look at Teresa's suffering in a spiritual context. My conclusion hinges on the terminology of redemptive suffering within the church. I suggest a renaming of the term, moving towards a more inclusive spirituality of suffering, especially considering persons with disabilities.

Committee: Jana Bennett (Advisor); Nicholas Rademacher (Committee Member); Sandra Yocum (Committee Member) Subjects: Theology

Doctor of Psychology (PsyD), Wright State University, 2024, School of Professional Psychology

Chronic pain and posttraumatic stress disorder (PTSD) are highly prevalent but lack interventions that address their comorbidity. Written exposure therapy (WET) is an evidenced-based brief intervention designed to focus on PTSD. The intervention that has been developed in this dissertation has been named CronP (chronic pain and PTSD) and delivers a modified digital version of WET in tandem with a clinician. The digital intervention will consist of five modules containing writing prompts to be completed each week prior, during, or after seeing a clinician. The goal in providing the intervention in digital form is to enhance therapeutic efficiency and provide a format of treatment in which the individual can participate in what they may perceive as their safe space (home, etc.). This could include having the individual engage in the writing portions without the clinician present while at the provider's office and reduce the time needed in the clinician's office unlike traditional WET. The two aims of this dissertation are 1) to provide a review of literature investigating the possible usefulness of a digital intervention addressing the comorbidity of chronic pain and PTSD and 2) to present a proposal for a digital intervention that delivers a modified version of WET to reduce both perceived chronic pain intensity and PTSD symptoms. For purposes of this study a digital intervention is operationally defined as follows: A format that can be accessed by any number of electronic devices (e.g., cell phone, tablet, desktop, etc.) through a website portal.

Committee: Julie Williams Psy.D., ABPP. (Committee Chair); Lyndsay Griffin Colvin Psy.D. (Committee Member); Michelle Schultz Psy.D. (Committee Member) Subjects: Clinical Psychology; Cognitive Psychology; Cognitive Therapy; Health; Health Education; Mental Health; Psychology; Psychotherapy; Therapy

Doctor of Psychology (Psy.D.), Xavier University, 2023, Psychology

Up to 66% of Veterans experience challenging chronic pain conditions within a three-month time frame (Donahue et al., 2020). Although chronic pain has historically been treated with prescription medications, research suggests that an acceptance of one's pain combined with values-based committed action can lead to increased quality of life, and eventually to a decrease in perceived pain (Baranoff et al., 2016; McCracken & Velleman, 2010). In recent years, the Veterans Health Administration has adopted a new, integrated approach to health care, referred to as the Whole Health System of Care. Whole Health emphasizes patient autonomy, assists with values exploration, promotes committed action to those values, and offers a variety of healthy behavior groups. This retrospective chart review aimed to better understand the impact of a Whole Health wellness program for Veterans with chronic pain as it pertained to their health-related quality of life and perceived pain levels. 63 Veterans completed self-report surveys at a Whole Health orientation group and at six-month follow-up for health-related quality of life, life engagement, and perceived pain levels. Results showed that number of wellness classes attended was not significantly associated with quality of life measures. Additionally, life engagement at the time of orientation did not moderate the relationship between class attendance and quality of life measures. Participating Veterans did, however, experience a significant increase in mental health quality of life. Finally, very few Veterans with chronic pain attended pain-specific groups within Whole Health. These results suggest that additional research is needed to assess the Whole Health System of Care and examine Veteran and institutional factors that may be associated with outcomes.

Committee: Jennifer Phillips Ph.D. (Advisor); Stacey Raj Ph.D. (Committee Member); Heather McCarren Ph.D. (Committee Member) Subjects: Psychology

Master of Science (MS), Bowling Green State University, 2022, Biological Sciences

Chronic pain is a poorly understood biological response to acute nerve damage. Chronic pain encompasses both central and peripheral nervous system sensitization, sometimes referred to as long term potentiation. The research community has traditionally focused its studies of these states on mammals, but recent work has shown that Drosophila experience central nervous system modulation which results in chronic pain. Flies also show conserved nociceptive TRP ion channels, which supports the hypothesis that pain is a highly conserved state. As the pain modulatory system must evolve after simple nociceptive systems, a deeper conservation may exist than has previously been thought. Thus we have reason to investigate if the modulation of pain with injury is conserved as well. The present work validates a novel paradigm to measure conditioned place avoidance in Drosophila as a function of stimulus intensity. With the focus on conditioned place avoidance, the present study makes assays on pain avoidance possible. Pain avoidance is a much more complex phenomenon than simple pain reflex, but one which is definitionally included in the pain phenomenon by the International Association for the Study of Pain. Further, pain modulation is widely known to affect pain avoidance behavior, establishing a definitional and biological connection between pain and pain avoidance. The present study inquires if injury can modulate pain avoidance behavior in Drosophila. The present study demonstrates that leg amputation induces quicker aversion to aversive stimuli. Drosophila offers the research community a high-throughput chronic pain model which can provide quantitative characterizations of chronic pain and analgesia in a model that is genetically accessible, with widely understood neuronal circuitry.

Committee: Robert Huber Ph.D. (Committee Chair); Moira van Staaden Ph.D. (Committee Member); Jon Sprague Ph.D. (Committee Member) Subjects: Biology; Neurosciences

MA, University of Cincinnati, 2022, Arts and Sciences: Psychology

Pain captures attention and may reduce the attentional resources needed to perform tasks of working memory, a key component of executive functioning involved in short-term information maintenance and processing. Individuals with chronic pain often report working memory deficits that interfere with daily functioning. Like pain, negative affect—namely, anxiety and pain catastrophizing—are also thought to consume attentional resources, and likely also have deleterious effects on working memory performance. However, a paucity of research exists on the interactive effect of pain and negative affect on working memory performance. The current study utilized two working memory performance measures (digit span and n-back) to evaluate the relationship between experimental pain and negative affect on cognitive performance. Due to limited research on chronic pain in non-clinical samples, relationships among variables and chronic pain status were also explored. Participants were 84 undergraduates aged 18 to 35. Linear mixed modeling failed to find any significant interactions between experimental pain and negative affect on digit span performance or overall n-back performance. However, significant three-way interactions emerged among experimental pain, cognitive load (e.g., difficulty), and negative affect (e.g., anxiety sensitivity, pain catastrophizing) on n-back performance. Findings indicate complex relationships among pain, negative affect, and working memory, likely dependent at least in part on individual differences. There is a need for further study on these nuanced differences, in part, to inform development of tailored interventions for individuals with chronic pain.

Committee: Kristen Jastrowski Mano Ph.D. (Committee Member); Cathleen Stough Ph.D. (Committee Member); Quintino Mano Ph.D. (Committee Member) Subjects: Psychology