Abstract The Commission on the Future of Health Care in Canada (CFHCC) is to be congratulated for addressing the tension among various levels of government regarding health-care funding. The CTHCC also took the progressive step of creating the National Health Council, a body charged with ensuring greater accountability in health care. Psychologists have argued for decades that treatment decisions should be guided by a consideration of what works for whom and under what conditions. In our response to Romanow and Marchildon (2003), we argue that funding of health services in Canada has failed to heed this recommendation and the scientific evidence in support of the efficacy of psychological interventions for a wide range of health conditions. Despite remarkable advances in healthcare delivery, Canada's health-care system continues to be funded based on an outdated model of disease and illness. Romanow and Marchildon are to be applauded for their broad conceptualization of health and the role of various health professionals in advancing the health of Canadians. Unfortunately, this recognition did not make its way into the report of the CFHCC to the extent needed to make Canada's health system truly progressive. The Commission on the Future of Health Care in Canada (CFHCC) was a very important social policy initiative. It captured the attention of the public, the health-care sector and governments. The Commission faced formidable challenges with regard to both its objectives and time frame. The focus and attention given the Commission is in no small part an indication of the degree to which support their health-care system and the urgency they feel regarding its current state. Despite the challenges, the CFHCC produced a number of key recommendations that have begun to be implemented. The federal government has made a commitment to establish funding targets so as to ensure predictable and protected revenues for health. This represents a step toward ameliorating the chronic instability and underfunding for health care that has contributed to reduced access and deterioration in the quality of health services. Governance was also addressed through the CFHCC's prescriptions regarding the respective roles of federal and provincial health ministries and the establishment of a National Health Council. The Council has been formed and is expected to hold the health-care system accountable on spending, efficiency, and effectiveness. These are positive steps. The National Health Council in particular holds the promise of serving as a catalyst that can help to transform the way in which we conceptualize and approach health and health-care delivery in Canada. Reconceptualizing Health In describing the work of the CFHCC, Romanow and Marchilclon (2003) state that the extremely short time frame meant that the recommendations could not cover the entire waterfront of longer-term issties, including the role of psychology in the health of Canadians (p. 284). The need to consider the role of a given discipline in health-care delivery is outdated. For years scientific psychology has argued that treatment decisions, and by extension, funding decisions, should be based on a determination of what works for whom under what conditions. Canada's health-care system was built, and continues to revolve, around funding specific providers and services. All too often funding decisions are made independent of scientific evidence regarding efficacy. The exclusion, and more recently the elimination, of psychological services from universal health care is a case in point. To the detriment of Canadians, there exists an artificial chasm between physical and psychological health within Canada's health-care system. Yet, there is broad recognition within the scientific community that health is more than the absence of disease; it is a state of physical, mental, and social well-being (World Health Organization, WHO, 1948). …
Insomnia and depression are common problems for people with chronic pain, and previous research has found that each is correlated with measures of pain and disability. The goal of this study was to examine the combined impact of major depression and insomnia on individuals with chronic pain.The participants were patients with chronic musculoskeletal pain who underwent evaluation at an interdisciplinary treatment center. On the basis of semistructured interviews, participants were classified in three groups depending on whether they: (1) met criteria for major depression with insomnia (n = 38); (2) had insomnia without major depression (n = 58); or (3) had neither insomnia nor major depression (n = 47). The groups were then compared on self-report measures that included the McGill Pain Questionnaire, the Beck Depression Inventory, and the Multidimensional Pain Inventory.Participants with major depression and insomnia reported the most difficulty on measures of affective distress, life control, interference, and pain severity, although the insomniac patients without major depression also had elevated scores on some measures. In regression analyses, insomnia severity ratings did not contribute uniquely to the prediction of psychosocial problems when depression was controlled, but they did contribute to the prediction of pain severity.These results suggest that patients with chronic pain and concurrent major depression and insomnia report the highest levels of pain-related impairment, but insomnia in the absence of major depression is also associated with increased pain and distress.
OBJECTIVE: To examine the test‐retest reliability, construct validity and factor structure of the Pain Beliefs and Perceptions Inventory (PBPI). DESIGN: A sample of 195 individuals attending a chronic pain clinic completed the PBPI along with a preclinic assessment battery. A subset of this sample completed the assessment package two to four weeks and four to six months later in order to examine the test‐retest reliability of the PBPI. RESULTS: Confirmatory factor analysis revealed a four‐factor solution: pain constancy, self‐blame, mystery and understanding of chronicity. Internal consistency estimates ranged from 0.63 to 0.75. Pain constancy and understanding of chronicity had good test‐retest reliability, while test‐retest reliability of the remaining subscales was not adequate. These results differ from those reported in the initial development of the PBPI. Construct validity was determined through examination of correlations between the PBPI and the Beck Depression Inventory, the McGill Pain Questionnaire, the Multidimensional Pain Inventory and a self‐blame questionnaire. CONCLUSIONS: The results of this investigation are consistent with the findings of recent investigations that revealed a four‐factor solution to the PBPI. However, the subscales of this instrument were not found to be uniformly stable over time. These results suggest that further examination and refinement of item content for two of the subscales are required before the instrument is suitable for clinical use.
The interest in treating underlying core vulnerability factors or transdiagnostic processes has been a focus of much attention. In this paper we describe our application of group dynamic-relational psychotherapy to the treatment of perfectionism, a core personality vulnerability factor associated with various forms and types of dysfunction and disorders that have profound costs to the individual both socially and subjectively. Over the course of the past three decades, we developed an evidence-based integrative group treatment that targets the psychodynamic and relational underpinnings of perfectionism. The treatment is based on an integration of psychodynamic and interpersonal perspectives and therapeutic approaches. In this paper we present our model of perfectionism and describe our group dynamic-relational therapy for the treatment of its pernicious outcomes. By drawing on illustrative case material, we describe the approach as applied to one such group as it progresses through four phases of group development that we have termed engagement and pseudo attachment, pattern interruption, self-redefinition/painful authenticity, and termination. Finally, we present some of the accumulating evidence of the effectiveness and efficacy of dynamic-relational therapy.
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