Our lab has conducted many studies over the years. Many of them are listed here, along with publications stemming from them.
A Emotion-focused Psychodynamic Interview for Chronic Musculoskeletal Pain: A Randomized Clinical Trial
Research demonstrates a link between early life stress and/or trauma and the incidence of pain in adulthood, and traumatic experiences can precipitate, exacerbate, and maintain pain symptoms. Further, evidence from prior studies in our lab and others suggests that engagement in emotional processing of stressful life events can reduce pain symptoms and improve functioning. This randomized clinical trial, which doctoral student Shoshana Krohner conducted for her dissertation in 2021-2022, tested a novel, single-session intervention for individuals with chronic musculoskeletal pain and histories of childhood adversity. The intervention is designed to facilitate emotional processing of past and current relational stressors and was conducted remotely, via Zoom, with 91 adults with chronic pain from around the country. Fellow student Ciara Cannoy also conducted interviews, and an expert in psychodynamic therapy, Dr. Joel Town of Dalhousie University, collaborated and provided supervision. Shoshana published her research:
Krohner, S., Town, J., Cannoy, C.N., Schubiner, H., Rapport, L.J., Grekin, E., & Lumley, M.A. (in press). Emotion-focused psychodynamic interview for people with chronic musculoskeletal pain and childhood adversity: A randomized controlled trial. The Journal of Pain.
Experiential Training in Disclosure Elicitation and Emotional Awareness and Activation: A Randomized Test
Research shows that therapy that activates suppressed emotional experiences leads to better outcomes, but many therapists–and patients–find doing so to be anxiety-provoking and avoid it. For her dissertation, doctoral student, Jolin Yamin, developed a novel training experience to help new mental health trainees (clinical psychology and social work students) develop these skills. The training protocol involves live supervision, deliberate practice, and training video vignettes, and the skills taught are aimed at increasing trainees’ in-session emotional awareness and self-regulation, enhancing their comfort with emotionally challenging therapeutic situations, and enhancing their trauma processing skills. In 2020-2021, Jolin tested in a randomized trial the effects of the new protocol or standard didactic training, which she and a fellow student, Shoshana Krohner, administered remotely to over 100 trainees. Fellow doctoral students, Ciara Cannoy and Katey Gibbins, coded the skills that trainees demonstrated before and after training. Jolin published an article from this work:
Yamin, J.B., Cannoy, C., Gibbins, K., Krohner, S., Rapport, L.J., Trentacosta, C.J., Zeman, L.L., & Lumley, M.A. (in press). Experiential training of mental health graduate students in emotional processing skills: A randomized, controlled trial. Psychotherapy
The impact of Facebook support groups for adults with chronic pain: A randomized clinical trial
People with chronic pain have been turning to the internet for guidance, support, and a sense of community with likeminded peers. Internet-based peer-support groups, in particular, have become increasingly popular among people with chronic conditions. There have been few or no controlled tests of the effects of such groups or whether professional-led groups that include guidance on effective support and communication processes are more effective than patient-led online support groups. Doctoral students Bethany Pester and Hallie Tankha created a novel Facebook-based intervention that incorporates peer support and psychological techniques to target chronic pain. This study, which was conducted in 2020, evaluated the efficacy, social dynamics, and mechanisms of change within this online peer-support intervention among 119 people with chronic musculoskeletal pain. The project was the doctoral dissertations of Bethany and Hallie, both of whom published articles from this research:
Pester, B.D., Tankha, H., Caño, A. Tong, S., Grekin, E., Bruinsma, J., Gootee, J., & Lumley, M.A. (2022). Facing pain together: A randomized controlled trial of the effects of Facebook support groups on adults with chronic pain. The Journal of Pain, 23, 2121-2134.
Tankha, H., Pester, B.D., Brumley, K.M., Cano, A., Grekin, E., Bruinsma, J., Gootee, J., & Lumley, M.A. (2023). A mixed methods investigation into the Us vs. Them mentality in Facebook groups for chronic pain. Health Psychology, 42, 460-471.
Introducing a Clinical Approach to Diagnosing Primary or Nociplastic Pain
Our long-time physician colleague, Dr. Howard Schubiner, has developing and has been using clinically a diagnostic approach to determining whether or not patients have primary, nociplastic, or neural circuit pain. In this study, he taught the approach to Dr. William Lowry, a physiatrist in a clinical practice in Louisiana, who applied the diagnostic approach to a series of 225 patients with back/neck pain coming to his clinic in 2020-2021. Data on the prevalence of primary pain and its medical and psychosocial correlates was analyzed by graduate student, Marjorie Heule, who co-authored this publication, which also presents Dr. Schubiner’s diagnostic approach.
Schubiner, H., Lowry, W.J., Heule, M., Ashar, Y.K., Lim, M., Mekaru, S., Kitts, T., & Lumley, M.A. (in press). Application of a clinical approach to diagnosing primary pain: Prevalence and correlates of primary back and neck pain in a community physiatry clinic. The Journal of Pain.
Virtual Human Interviewing for Chronic Pain
This research was funded by an R21 grant from the NIH to Doerte Junghaenel, Ph.D. of the University of Southern California and Mark Lumley. The USC has expertise in creating and testing virtual human interviewers, and in this experiment, people with chronic pain were interviewed by a virtual human which provided one of three types of interviews: disclosure and pain psychology/neuroscience, disclosure only, or control. The study was conducted on-line and run from USC in 2021 and resulted in this publication.
Junghaenel, D.U., Schneider, S., Lucas, G., Boberg, J., Weinstein, F.M., Richeimer, S.H., Stone, A.A., & Lumley, M.A. (2023). Virtual human-delivered interviews for patients with chronic pain: Feasibility, acceptability, and a pilot randomized trial of standard medical, psychosocial, and educational interviews. Psychosomatic Medicine, 85, 627-638.
Meta-analyses of Short-term Psychodynamic Psychotherapy on Somatic Symptoms
Dr. Allan Abbass, international expert on short-term dynamic psychotherapy, invited our lab to join him in conducting meta-analyses of the literature on the effects of short-term psychodynamic psychotherapy (STPP) on various functional or somatic symptoms conditions, including pain. Dr. Lumley participated in this as did lab student, Hannah Holmes, who conducted data extraction from the selected articles. We published two articles from this work, one of which presents the “controlled” effects of STPP on outcomes, and the other which presents the “within-treatment” effects, which allowed us to use the many articles on STPP that did not have a randomly assigned control condition.
Abbass, A., Town, J., Holmes, H.J., Luyten, P., Cooper, A., Russell, L., Lumley, M.A., Schubiner, H., Allinson, J., Bernier, D., De Meulemeester, C., Kroenke, K., & Kisely, S. (2020). Short-term psychodynamic psychotherapy for functional somatic disorders: A meta-analysis of randomized controlled trials. Psychotherapy and Psychosomatics, 89, 363-370.
Abbass, A., Lumley, M.A., Town, J., Holmes, H.J., Luyten, P., Cooper, A., Russell, L., Schubiner, H., De Meulemeester, C., & Kisely, S. (2021). Short-term psychodynamic psychotherapy for functional somatic disorders: A systematic review and meta-analysis of within-treatment effects. Journal of Psychosomatic Research, 145, Article 110473.
Pain Psychology and Neuroscience Self-evaluation Intervention: A Randomized Clinical Trial
In this trial, conducted in 2018 and 2019, we developed a brief on-line intervention consisting of a set of exercises that patients with chronic musculoskeletal pain complete to help them understand the role of psychological factors and their brain in causing or contributing to their chronic pain. We recruited 104 adult patients from the University of Michigan Medical Center’s patient registry and randomized them to the new Pain Psychology and Neuroscience intervention or to a control exercise that was comparable in format but focused on health behaviors. Patients were evaluated for pain-related outcomes as well as attitudes and readiness for pain management at baseline and at 1-month and 10-month follow-ups. We found that the novel intervention significantly reduced pain intensity and interference (at 1-month only) and changed several attitudes, particularly in people with back pain, but not in those with fibromyalgia. This study was a collaboration with David Kohns, D.O. and Michael Geisser, Ph.D. of the University of Michigan and Howard Schubiner, MD of Providence Hospital. Graduate student Christopher Urbanik oversaw data collection and analyses and conducted his master’s thesis from this study.
Kohns, D.J., Urbanik, C.P., Geisser, M.E., Schubiner, H., & Lumley, M.A. (2020). The effects of a pain psychology and neuroscience self-evaluation internet intervention: A randomized controlled trial. Clinical Journal of Pain, 36, 683-692. DOI: 10.1097/ajp.0000000000000857
Arab American Women’s Health: Correlational and Experimental Examination of a Sexual Health Interview
The goal of this study was to obtain information about Arab American women’s sexual health and the relationship of sexual health to psychological and physical health more generally. Further, the effects of the interview on health outcomes, including psychological and physical health symptoms, sexual well-being, healthcare utilization, and emotion-related variables, was tested experimentally. In this study, conducted in 2017-2018, a sample of 134 young adult Arab American women were assessed at baseline via questionnaires for various constructs (sexual attitudes, cultural and religious identity, and physical and mental health), and then randomized to either an immediate or delayed sexual health interview. The interview obtained additional information about health, particularly relatively private sexual health-related attitudes and experiences. All participants had a subsequent (5-week delay) re-assessment of the same constructs as assessed at baseline, and the delayed interview participants then had the interview. This study was the doctoral dissertation of Hannah Holmes and was conducted with the help of fellow graduate students Jolin Yamin and Shoshana Krohner. We found that having the interview led to improve sexual attitudes, and that the negative effects of sexual victimization are moderated by several sociocultural variables. Three publications have come from this work:
Holmes, H.J., Yamin, J.B., Krohner, S., Rapport, L.J., Grekin, E.R., Schubiner, H., & Lumley, M.A. (2021). Effects of a sexual health interview among Arab American women: An experimental disclosure study. Archives of Sexual Behavior, 50, 373-384.
Yamin, J.B., Holmes, H.J., Krohner, S., & Lumley, M.A. (2021). Arab American women’s health following sexual victimization: An exploratory study of the moderating effects of bicultural harmony and social constraints. Psychology of Violence, 11, 455-464
Krohner, S., Holmes, H.J., Yamin, J.B., & Lumley, M.A. (2023). Psychological symptoms in Arab American women: Adverse childhood experiences, racism, and the role of religiosity. Psychology of Religion and Spirituality, 15, 68-78.
Rape Aggression Defense (RAD) Program Evaluation
The Rape Aggression Defense (RAD) course is a self-defense course for women, offered by the Wayne State Police Department. The course aims to teach women how to defend themselves against aggressors and promote women’s confidence in their ability to protect themselves, particularly through the use of a live simulation with an aggressor on the last day of class. The goal of the study was to see how mental and physical health change in response to participating in the class, and secondarily to see which background factors of the participants predict responses to the class. This study was conducted from 2016 to 2017 and was led by Hannah Holmes and supported by Kelsey Sala-Hamrick, another clinical psychology doctoral student at Wayne State. A sample of 82 women completed the course and assessments, and analyses showed that post-traumatic stress symptoms, somatic symptoms, and non-assertion improved over the class to 1-month follow-up.
Holmes, H.J., Sala-Hamrick, K.J., Pegram, S.E., Evans, E., Wilton-Martindale, J., & Lumley, M.A. (2021). Rape Aggression Defense course: Physical, psychological, and interpersonal benefits among women with and without interpersonal victimization histories. Journal of Interpersonal Violence, 36(19-20), NP10411-NP10432.
Family Consultation for High-Risk Inpatients with End Stage Renal Disease: A Randomized Trial
End Stage Renal Disease (ESRD) is a life-threatening medical condition that is especially prevalent in low-income populations and has received little attention from health researchers compared to other medical conditions such as cardiovascular disease and cancer. Patients with ESRD have a reputation for being noncompliant and are often labeled as “frequent fliers” in hospitals due to their frequent hospital stays. In this study, which was run from 2015 to 2016, we attempted to improve family knowledge and communication support after discharge by conducting a brief consultation with family members to educate them about cognitive side effects of the illness and barriers to treatment adherence. The intervention reduced 30-day readmission rates from 32% for treatment-as-usual controls to 20% for the family consultation condition. This project was supported by the Blue Cross Blue Shield Foundation of Michigan, and it was the doctoral dissertation of Matthew Jasinski. Co-investigators include Mark Ketterer, Ph.D., Sandeep Soman, M.D., and Jerry Yee, M.D. of Henry Ford Hospital in Detroit.
Jasinski, M.J., Lumley, M.A., Soman, S., Yee, J., & Ketterer, M.W. (2018). Family consultation to reduce early hospital readmissions among patients with end-stage renal disease: A randomized controlled trial. Clinical Journal of the American Society of Nephrology, 13, 850-857. DOI: https://doi.org/10.2215/CJN.08450817
Stress and Health Interview for Primary Care Patients with Medically Unexplained Symptoms: A Randomized Trial
In this study, we tested a novel single-session Emotional Awareness and Expression interview among primary care patients with medically unexplained symptoms. This study was conducted from 2014 to 2015 in the Family Medicine Clinic at Crittenton Hospital. A sample of 75 patients with various “functional” or “medically unexplained symptoms” were randomized to the Interview or a wait-list Control condition. Interviews were conducted with patients during a single 90-minute consultation at the clinic. The interview focused on connecting the patient’s physical symptoms over the life course with stressful events and conflicts they have experienced. The role of emotional suppression and avoidance was explored by having patients experience and express (voice) their feelings about people or relationships that have bothered or hurt them. Changes in patient’s anxiety, physical symptoms, and blood pressure during these exercises were discussed with the goal of helping patients see any links between emotional processes and their symptoms. Feedback from the interviewer was given at the end. Analyses of data collected at 6-week follow-up showed that the interview participants had lower pain and other symptoms than controls. This study was the doctoral dissertation of Maisa Ziadni. It was conducted with the help of fellow graduate student, Heather Doherty along with Dr. John Porcerelli.
Ziadni, M.S., Carty, J.N., Doherty, H.K., Porcerelli, J.H., Rapport, L.J., Schubiner, H., & Lumley, M.A. (2018). A life-stress, emotional awareness and expression interview for primary care patients with medically unexplained symptoms: A randomized controlled trial. Health Psychology, 37, 282-290. http://dx.doi.org/10.1037/hea0000566
Stress and Health Interview for Women with Urogenital Pain: A Randomized Trial
This study was developed and conducted in parallel with the above study, and both studies had the same design, interview, and most of the same measures. This study was conducted among 62 women with urogenital pain at the Women’s Urology Center of Beaumont Hospital. This study also found reduced pain and other symptoms in the interview condition compared to control 6 weeks later. This study was the doctoral dissertation of Jen Carty and conducted with the help of fellow graduate student, Hannah Holmes, along with Dr. Janice Tomakowsky, staff psychologist, and Dr. Ken Peters, Medical Director of the Center.
Carty, J.N., Ziadni, M.S., Holmes, H.J., Tomakowsky, J., Peters, K., Schubiner, H., & Lumley, M.A. (2019). The effects of a life-stress emotional awareness and expression interview for women with chronic urogenital pain: A randomized controlled trial. Pain Medicine, 20, 1321-1329. doi: 10.1093/pm/pny182
Krohner, S., Yamin, J.B., Ziadni, M.S., Carty McIntosh, J.N., Schubiner, H., & Lumley, M.A. (2023). Emotional Awareness and Expression Interview: Examining interview content and patient experiences in two medical samples. Journal of Clinical Psychology in Medical Settings, 30, 520-530.
Stress Management for Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a common, debilitating, and costly disorder driven by stress. This study evaluated two different stress management approaches among 106 people with IBS—relaxation training (RT) and emotional awareness and expression training (EAET)—and how both of these interventions compared to a wait-list control condition. Participants in the two treatment conditions met individually with a therapist for 50 minute sessions with a therapist, once per week over a 3-week period. We found that at 10-week follow-up, only EAET reduced IBS symptoms compared to control, both EAET and RT improved IBS-related quality of life, and only RT improved distress. This project was supported by a grant from the Blue Cross Blue Shield Foundation of Michigan. It was Elyse Thakur’s dissertation, and Jennifer Carty, Maisa Ziadni, Nancy Lockhart, Heather Doherty, and Hannah Holmes helped with data collection.
Thakur, E.R., Holmes, H.J., Lockhart, N.A., Carty, J.N., Ziadni, M.S., Doherty, H.K., Lackner, J.M., Schubiner, H., & Lumley, M.A. (2017). Emotional awareness and expression training improves irritable bowel syndrome: A randomized controlled trial. Neurogastroenterology and Motility, 29:e13143. DOI: 10.1111/nmo.13143
Holmes, H.J., Thakur, E.R., Carty, J.N., Ziadni, M., Doherty, H., Lockhart, N., Schubiner, H., & Lumley, M.A. (2018). Ambivalence over emotional expression and perceived social constraints as moderators of relaxation training and emotional awareness and expression training for irritable bowel syndrome. General Hospital Psychiatry, 53, 38-43. https://doi.org/10.1016/j.genhosppsych.2018.05.002
Pain and Stress Management for Fibromyalgia
This five-year large-scale clinical trial compared Emotional Awareness and Expression Therapy (EAET), Cognitive-Behavioral Therapy (CBT), and Education control among 230 patients with fibromyalgia. The study was conducted jointly between Wayne State University and the University of Michigan Medical Center. Patients were put into clusters of 5 to 7 patients, and clusters were randomized to one of the three conditions. Patients met in groups for 8 weekly sessions of 90 minutes each, led by therapists trained specifically for that condition. Assessment at post-treatment and 6-month follow-up showed that EAET had better outcomes than education on most measures, and surpassed CBT on several measures (pain widespreadness, prevalence of 50% or more pain reduction). CBT was slightly better than control, but significant only on anxiety reduction. This project is supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a part of the National Institutes of Health (NIH). The study’s co-investigators are David A. Williams, Ph.D. and Daniel J. Clauw, M.D., of the University of Michigan Medical Center in Ann Arbor, and Howard Schubiner, M.D., of St. John Health / Providence Hospital in Southfield.
Lumley, M.A., Schubiner, H., Lockhart, N.A., Kidwell, K.M., Harte, S., Clauw, D.J., & Williams, D.A. (2017). Emotional awareness and expression therapy, cognitive-behavioral therapy, and education for fibromyalgia: A cluster-randomized controlled trial. PAIN, 158, 2354-2363. doi: 10.1097/j.pain.0000000000001036
Studies below need updating with findings and references. But the reader will at least see some of the projects that we have conducted.
The Effects of Anger Suppression and Expression on Chronic Low Back Pain
This experimental laboratory study evaluates how stress and emotion regulation influence chronic low back pain. Patients with low back pain engage in a computer-based stress task followed by various coping exercises, and pain responses—both self-reported and behavior—are assessed. We are also recording physiological reactions (blood pressure, heart rate, muscle tension), and individual differences in how people deal with emotions. This study is funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and is being conducted both at Wayne State University in Detroit as well as at Rush University Medical Center in Chicago, where Dr. John Burns is the grant PI.
Narrative Exposure Therapy to Treat Traumatic Stress in Arab Refugees: A Clinical Trial
This project is evaluating whether a brief psychological intervention can help traumatized Middle Eastern Refugees in the Detroit metro area reduce their physical and emotional symptoms. The intervention consists of three session of a treatment called Narrative Exposure Therapy. The treatment involves two components: constructing a narrative of the person’s overall life, which provides context for the traumatic event, as well as an exposure element which involves helping the person process and work through painful details, emotions, memories, and perceptions of the traumatic event. We will be looking at whether people in the group that receives the treatment improve their mood, trauma symptoms, sleep, physical health, and overall well being compared to a control group. This project was Alaa Hijazi’s dissertation project.
Study of Headaches and Relaxation and Emotional Skills
In this project, we are evaluating two different treatments for individuals with chronic headaches. Both treatments are done through three group sessions. One focuses on teaching relaxation skills and the other focuses on teaching participants how to identify and express their emotions. Relaxation skills are a commonly used treatment for chronic pain; for this study, we have developed a novel treatment based in emotional awareness and assertiveness skills. We hope to investigate the effects of this treatment as compared to the standard relaxation treatment, as well as a no-treatment control. We will determine which of these treatments might be better at decreasing the frequency and severity of chronic headaches, and which of these treatments might work better for individuals with certain personality characteristics or traits. Olga Slavin-Spenny and Elyse Sklar are directing this study, and Dana Nevedal is helping with data collection.
Substance Abuse and Pain
This project is examining predictors of prescription and substance misuse among patients attending a chronic pain clinic, and simultaneously test methods of data collection for obtaining disclosures of substance abuse and trauma history. All participants are being recruited from a local chronic pain clinic for a single session in which they are either interviewed or asked to complete paperwork regarding their emotional styles, their personality, history of trauma, and substance misuse.The theoretical question is whether emotion regulation factors predict substance misuse beyond the effect of more straightforward or routinely obtained variables. We have developed an innovative, interpersonal method to try and improve disclosure. This method was developed based on the facilitation model from the Methods of Disclosure study (described in the “Recent Research” section below). This is Lindsay Oberleitner’s dissertation, and Kathryn Zumberg, Amy Loree, Deb Valentino and Nancy Lockhart are helping with data collection.
Evaluating a Novel Chronic Pain Treatment Program
In this project, we are evaluating a novel, emotion and insight-oriented treatment program for patients with chronic pain. We are collaborating with Howard Schubiner, M.D., an Internal Medicine physician at Providence Hospital (Southfield, MI) who has developed and conducts a group-based intervention for patients with pain problems that are influenced by stress and emotions (e.g., low back pain, fibromyalgia, headaches, etc.). Dr. Schubiner evaluates referred patients and enrolls them into his program, and we are conducting independent patient evaluations before and after the program, and at 3-and 6-month follow-ups. We will determine the overall effects of the program, who benefits, and which components of the program are most important. We also are experimentally testing the effects of an innovative therapeutic assessment procedure—an interpersonal, emotional communication exercise—on patients at pre-treatment. This study is Amanda Burger’s dissertation, and Maren Hyde, Alaa Hijazi, Elyse Sklar, Jen Carty and Deb Valentino are collaborating on the study as well.
Internet Writing for Stress Management
Our prior studies have found that written emotional disclosure has benefits, but they are rather weak. Therefore, we are testing ways to strengthen the effect, particularly by engaging a therapist in the process. In this study, we are recruiting college students who have had unresolved stressful experiences, and comparing four approaches to writing on a secure web-based platform. Participants write for 3 days in the laboratory about time management or about stressful experiences, which can be done without writing feedback, with therapist-provided feedback, or in an instant messaging format with a therapist. Assessments are conducted at baseline and 6 weeks after writing. This is Jon Beyer’s dissertation, Alison Radcliffe helped design the software and is collaborating on the study, and Lindsay Oberleitner is collaborating as well.
Pain and Stress Management for Rheumatoid Arthritis
This 5 year randomized clinical trial (through 2010) which is funded to Wayne State University by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, is a large venture being conducted in collaboration with Dr. Frank Keefe at Duke University Medical Center. In this randomized trial, we are testing whether writing about stress or health behaviors and receiving training in coping skills or arthritis education affects the health of people with rheumatoid arthritis. By combining each technique, we hope to find greater results with which the health and the quality of life is improved and the stress is reduced. In addition, we are testing individual difference variables as moderators of the effects of these interventions.
Migraine Headache Web-based Writing Study
In this project, undergraduates with migraine headaches write for four sessions on a secure website about stress or time management. Some of the stress writers are given feedback about their writing in order to help them write more effectively. Participants are followed-up over several months to see the changes of headache activity. Rebecca Stout and Amanda Burger are directing this study.
Methods of Disclosure Study
This study examines various ways to help people share private stressful experiences. We are testing traditional expressive writing, private talking, talking to a guide and guide –facilitated disclosure. Disclosure takes place during one session, and the immediate and 1-month effects are being tracked. Lindsay Oberleitner and Olga Slavin are directing this study.
Stress Management for International Students
This study is a randomized test of the effects of written emotional disclosure for 3 days, a 2-session assertiveness training course, their combination, and a wait-list control. This study is for international students here at Wayne State because the stress of adjusting not only to a new university but also new culture and separation from home can be very challenging. Shedeh Tavakoli-Moayed and Alaa Hijazi are directing this study and Olga Slavin is contributing as well.
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