***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction This study examined the effectiveness of telemedicine in providing psychotherapy to patients with medically unexplained pain ( MUP ) who may not have access to in-person treatment . The impact of Internet-delivered intensive short-term dynamic psychotherapy ( ID-ISTDP ) was investigated for MUP via video teleconferencing ( Skype ™ ) . Methods A r and omized , controlled trial of ISTDP , an evidence -based intervention for MUP , was conducted to compare delivery modalities on variations in MUP symptoms . Eighty-one participants with MUP were r and omized to either ID-ISTDP  ( n = 39 ) or  in-person ISTDP ( n = 42 ) . Outcome variables included the Numeric Pain Rating Scale , Depression Anxiety Stress Scale-21 , Emotion Regulation Question naire , Mindful Attention Awareness Scale and the Quality of Life Inventory . In addition , exploratory analyses were used to examine acceptability , satisfaction and compliance in both conditions . Participants were assessed prior to intervention , immediately following the intervention , and 12 months after . Results In the intention-to-treat analysis , in-person ISTDP participants had significantly lower pain intensity  than ID-ISTDP participants , both immediately following the intervention ( d = 0.97 ) and at the 12-month follow-up ( d = 0.82 ) . Moreover , there were significant decreases in depression , anxiety and stress as well as a greater increase in emotion regulation functioning , mindfulness and quality of life observed in the in-person ISTDP group at the end of the intervention and 12 months after the treatment when compared to the ID-ISTDP group . Participants rated both treatment conditions as equally credible and satisfying . Conclusion ISTDP seems most effective when delivered in person in treating MUP patients with highly comorbid conditions with benefits maintained over 12 months BACKGROUND AND OBJECTIVE Affect and how it is regulated plays a role in pain perception , maintenance of pain , and its resolution . This r and omized , controlled trial evaluated an innovative affective self-awareness ( ASA ) intervention , which was design ed to reduce pain and improve functioning in individuals with fibromyalgia . PARTICIPANTS AND METHODS Forty-five women with fibromyalgia were r and omized to a  manualized ASA intervention ( n = 24 ) or wait-list control ( n = 21 ) . The intervention began with a one-time physician consultation , followed by 3 weekly , 2-h group sessions based upon a mind-body model of pain . Sessions focused on structured written emotional disclosure and emotional awareness exercises . Outcomes in both conditions were measured by a blinded assessor at baseline , post-intervention , and 6-month follow-up . MEASURES The primary outcome was pain severity ( Brief Pain Inventory ) ; secondary outcomes included tender-point threshold and physical function ( SF-36 Physical Component Summary ) . Intent-to-treat analyses compared groups on outcomes using analysis of covariance and on the proportion of patients achieving ≥30 % and ≥50 % pain reduction at 6 months . RESULTS Adjusting for baseline scores , the intervention group had significantly lower pain severity ( p < 0.001 ) , higher self-reported physical function ( p < 0.001 ) , and higher tender-point threshold ( p = 0.02 ) at 6 months compared to the control group . From baseline to 6 months , 45.8 % of the ASA intervention group had ≥30 % reduction in pain severity , compared to none of the controls ( p < 0.001 ) . CONCLUSIONS The affective self-awareness  intervention improved pain , tenderness , and self-reported physical function for at least 6 months in women with fibromyalgia compared to wait-list control . This study suggests the value of interventions targeting emotional processes in fibromyalgia , although further studies should evaluate the efficacy of this intervention relative to active controls OBJECTIVES Although high levels of distress are associated with the onset and severity of Irritable bowel syndrome ( IBS ) , it is unclear how this relates to emotional processing , particularly in relation to maintenance of symptoms and treatment outcome . This qualitative study embedded within a r and omized controlled trial aim ed to explore how individuals with refractory IBS experience , express , and manage their emotions after either therapist-delivered cognitive behavioural therapy ( TCBT ) or Web-based CBT ( WBCBT ) compared  to  treatment as usual ( TAU ) . DESIGN Cross-sectional qualitative study . METHODS Fifty-two semi-structured interviews  were conducted at post-treatment with 17 TCBT , 17 WBCBT , and 18 TAU participants . The transcripts were analysed using inductive thematic analysis with grounded theory elements . NVivo 11 was used to compare themes across groups . RESULTS Across all groups , high expectations of self was a recurring reason for how participants experienced and expressed their emotions . Three themes with subthemes captured how high expectations related to specific aspects of emotional processing : perceived causes of emotions , strategies for coping with emotions ( bottling up , avoiding emotions , and active coping strategies ) , and the perceived interplay between emotions and IBS symptoms . CONCLUSIONS Patients recognized that their IBS symptoms both triggered and were triggered by negative emotions . However , there was a tendency to bottle up or avoid negative emotions for reasons of social desirability regardless of whether patients had CBT for IBS or not . Future psychological interventions in IBS may benefit from addressing negative beliefs about expressing emotions , promoting assertive emotional expression , and encouraging the experience of positive emotions . Statement of contribution What is already known on this subject ? High levels of distress are consistently associated with both the onset and maintenance of IBS symptoms . Little is known about how this relates to the concept of emotional processing . Preliminary findings suggest a positive correlation between poor emotional processing and IBS . However , further studies need to confirm its role in relation to aetiology , maintenance of symptoms , and response to treatment . What does this study add ? High expectations of self and social desirability seem to be important aspects shaping the way individuals with IBS experience , express , and manage their emotions . Emotional avoidance and bottling up were reported as key strategies to cope with negative emotions . The study revealed that bottling up is not perceived as an all-or-nothing strategy but can be applied selectively depending on the context . Psychological interventions in IBS may benefit from addressing not only illness-related causes of negative emotions but also personal and social triggers of distress OBJECTIVE Current psychological and behavioral therapies for chronic musculoskeletal pain only modestly reduce pain , disability , and distress . These limited effects may be due to the failure of current therapies : a ) to help patients learn that their pain is influenced primarily by central nervous system psychological processes ; and b ) to enhance awareness and expression of emotions related to psychological trauma or conflict . METHODS We developed and conducted a preliminary , uncontrolled test of a novel psychological attribution and emotional awareness and expression therapy that involves an initial individual consultation followed by 4 group sessions . A series of 72 patients with chronic musculoskeletal pain had the intervention and were assessed at baseline , post-treatment , and 6-month follow-up . RESULTS Participation and satisfaction were high and attrition was low . Intent-to-treat analyses found significant improvements in hypothesized change processes : psychological attributions for pain , emotional awareness , emotional approach coping , and alexithymia . Pain , interference , depression , and distress showed large effect size improvements at post-treatment , which were maintained or even enhanced at 6 months . Approximately two-thirds of the patients improved at least 30 % in pain and other outcomes , and one-third of the patients improved 70 % . Changes in attribution and emotional processes predicted outcomes . Higher baseline depressive symptoms predicted greater improvements , and outcomes were comparable for patients with widespread vs. localized pain . CONCLUSION This novel intervention may lead to greater benefits than available psychological interventions for patients with chronic musculoskeletal pain , but needs controlled testing Background Fibromyalgia ( FM ) is a syndrome primarily characterised by chronic , widespread musculoskeletal pain . In the aetiology of this syndrome a crucial role is played by complex interactions among biological , genetic , psychological , and socio-cultural factors . Recently , research ers have started to explore emotional functioning in FM , with their attention focused on alexithymia , a personality construct that affects the regulation of a person ’s own emotions . On the other h and , the detection and experience of emotional signals from other people have only been sparsely investigated in FM syndrome and no studies have investigated the ability to represent other people ’s mental states ( i.e. Theory of Mind , ToM ) in these patients . Here we present the first study investigating a large set of social-cognitive abilities , and the possible relationships between these abilities and the performance on executive-function tasks , in a homogenous sample of patients with FM . Methodology Forty women with FM and forty-one healthy women matched for education and age were involved in the study .  Social cognition was assessed with a set of vali date d experimental tasks .  Measures of executive function were used to test the correlations between this dimension and the social-cognitive profile of patients with FM . Relationships between social-cognitive abilities and demographic , clinical and psychological variables were also investigated . Principal Findings Patients with FM have impairments both in the regulation of their own affect and in the recognition of other ’s emotions , as well as in representing other people ’s mental states . No significant correlations were found between social cognition tasks and the subcomponents of the executive function that were analysed . Conclusions The results show the presence of several impairments in social cognition skills in patients with FM , which are largely independent of both executive function deficits and symptoms of psychological distress . The impairments reported highlight the importance of adequately assessing ToM and emotional functioning in clinical practice OBJECTIVE The present study examines the possibility that a chronic pain condition , such as fibromyalgia , was associated with deficits in decision making and associative learning . METHODS Fifteen patients with fibromyalgia ( aged 42 - 59 years ) and 15 healthy controls ( aged 39 - 61 years ) participated in the experiment . Subjects completed  anxiety ( STAI ) and depression ( BDI )  question naires , as well as st and ardized neuropsychological tests ( Stroop and WAIS subscales ) . In addition , an emotional decision-making task ( Iowa Gambling Task ) and a conditional associative learning task ( CALT ) were administered to all participants . RESULTS Results indicated that fibromyalgia had a poorer performance than healthy controls in both tasks , showing more perseveration errors in the learning task , and more disadvantageous decisions , as well as a more r and om behavior in the gambling task . Moreover , we observed that poor performance on the associative learning task  was mediated by depression , whereas performance on the gambling task was not influenced by depression . No group differences were found on the st and ardized neuropsychological tests . CONCLUSION These findings indicate that pain and depressive symptoms in fibromyalgia might lead to significant deficits in emotionally charged cognitive tasks . Furthermore , it suggests that chronic pain might impose a high cost on executive control , undermining mainly affective processes involved in learning , memory , attention , and decision-making Summary Within‐day associations between behavioral anger expression and momentary chronic pain intensity show significant lagged effects , with elevated behavioral anger expression linked to greater subsequent pain intensity . ABSTRACT Links between elevated trait anger expressiveness ( anger‐out ) and greater chronic pain intensity are well documented , but pain‐related effects of expressive behaviors actually used to regulate anger when it is experienced have been little explored . This study used ecological momentary assessment methods to explore prospect i ve associations between daily behavioral anger expression and daily chronic pain intensity .  Forty‐eight chronic low back pain ( LBP ) patients and 36 healthy controls completed electronic diary ratings of momentary pain and behavioral anger expression in response to r and om prompts 4 times daily for 7 days . Across groups , greater trait anger‐out was associated with greater daily behavioral anger expression ( P < 0.001 ) . LBP participants showed higher levels of daily anger expression than controls ( P < 0.001 ) . Generalized estimating equation analyses in the LBP group revealed a lagged main effect of greater behavioral anger expression on increased chronic pain intensity in the subsequent assessment period ( P < 0.05 ) . Examination of a trait × situation model for anger‐out revealed prospect i ve associations between elevated chronic pain intensity and later increases in behavioral anger expression that were restricted largely to individuals low in trait anger‐out ( P < 0.001 ) . Trait × situation interactions for trait anger suppression ( anger‐in ) indicated similar influences of pain intensity on subsequent behavioral anger expression occurring among low anger‐in persons ( P < 0.001 ) . Overlap with trait and state negative affect did not account for study findings . This study for the first time documents lagged within‐day influences of behavioral anger expression on subsequent chronic pain intensity . Trait anger regulation style may moderate associations between behavioral anger expression and chronic pain intensity It is now widely accepted that individuals with autism have a Theory of Mind ( ToM ) or mentalizing deficit . This has traditionally been assessed with false‐belief tasks and , more recently , with silent geometric animations , an on‐line ToM task . In adults with milder forms of autism st and ard false‐belief tests , originally devised for children , often prove insensitive , while the Frith‐Happé animations have had rather better success at capturing the on‐line ToM deficit in this population . However , analysis of participants ' verbal descriptions of these animations , which span scenarios from “ R and om ” to “ Goal ‐Directed ” and “ ToM , ” is time consuming and subjective . In this study , we developed and established the feasibility of an objective method of response through a series of multiple‐choice questions .  Sixteen adults with aut 
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The results indicate that patients show a reduced engagement with cognitive content of emotions .
On the other h and , bodily constituents of ER seem to depict an over-reactive pattern .
Similarly , the patients tend to encounter difficulties in flexibly disengaging their ( spontaneous ) attention from emotional material .