Toby Newton-John is a Clinical Psychologist and Associate Professor at UTS. He completed undergraduate psychology and postgraduate clinical psychology training at University of Sydney before moving to the UK to undertake a PhD in pain psychology at University of London. He has worked in a range of clinical health psychology settings in Australia and the UK, including inpatient and outpatient services, medical centres and private practice. He established a large, multidisciplinary pain management program in Newcastle NSW before moving into academia. He currently maintains a clinical practice on a part time basis as well as being lead for Research and Innovation in the Graduate School of Health at UTS.
Toby’s clinical as well as research interest has been in the social aspects of chronic illness, particularly the reciprocal influences of the primary relationship. He has published numerous articles, book chapters and reviews on the psychology of chronic pain, and has lectured on his work in six countries. He is currently an Associate Editor of Australian Psychologist and a reviewer for a number of specialist journals including Pain, Clinical Journal of Pain and Journal of Orofacial Pain.
Can supervise: YES
Psychological aspects of chronic illness management in adults – psychological assessment, clinical interventions, chronic illness and intimate relationship functioning
Chronic pain and orofacial pain disorders
Non-specific effects of psychological treatments
Inter-professional research within health
Toby has provided research supervision to 4th year Honours, Master of Clinical Psychology and Doctorate of Clinical Psychology students, as well as clinical supervision to postgraduate students as a Psychology Board of Australia approved supervisor. Toby is a member of the Australian Psychological Society, the International Association for the Study of Pain, and the Australian Pain Society.
Rice, ASC, Justins, D, Newton-John, T, Howard, RF & Miaskowski, CA 2008, Series preface.
Shires, A, Sharpe, L & Newton John, T 2019, 'The relative efficacy of mindfulness versus distraction: the moderating role of attentional bias.', European Journal of Pain.View/Download from: Publisher's site
BACKGROUND:This study investigated whether the ability to disengage quickly from pain-related stimuli moderated the relative efficacy of a mindfulness-based intervention versus distraction in response to an experimental pain task. METHODS:Participants (n = 100) completed a dot-probe task with eye-tracking and were then randomized (2:2:1) to receive a mindfulness-based interoceptive exposure task (MIET), distraction instructions or no instructions (control group) before engaging in the cold pressor test. RESULTS:Participants who were allocated to the MIET condition reported a significantly higher pain threshold and distress than the distraction group, although not significantly higher than the control group. Those in the MIET group had improved tolerance compared to both the distraction and control groups. Difficulty disengaging from pain-related stimuli, as measured by the duration of the first fixation on sensory words, was found to moderate the relative efficacy of mindfulness versus distraction in terms of pain threshold and distress, but not tolerance. Those with difficulty disengaging from sensory pain words benefited less from the MIET. Duration of first fixation on sensory and affective pain words were highly correlated, and duration of first fixation on affective pain words also moderated the relative efficacy of MIET and distraction on threshold, but not distress. CONCLUSIONS:These results show that a single brief session of a mindfulness task was sufficient to change an acute pain experience in comparison to a distraction task, and that those who disengaged quickly from pain words benefited most. This article is protected by copyright. All rights reserved.
Crabtree, J & Newton-John, TRO 2019, 'Comparisons and associations between personality, creative potential and achievement in creative, non-creative and early psychosis participants', Psychosis.View/Download from: UTS OPUS or Publisher's site
© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group. Epidemiological evidence supports common genetic determinants between psychosis spectrum populations and creative individuals. Aspects of personality may contribute to protecting the creative artist from psychosis vulnerability. This study examines the similarities and differences in personality within a sample of early psychosis (EP), creative control (CC) and non-creative control (NCC) participants. Findings indicated that the CC group shared closer personality commonalities with the EP group than with NCC participants, on traits such as Neuroticism, Openness and Impulsive Non-Conformity as well as on variables such as Unusual Experiences, Cognitive Disorganisation and Paranoia/Suspiciousness. However, the CC group may better manage their emotional sensitivity and interpersonal suspiciousness than the EP participants. In separate analyses, CC and EP participants recorded higher creative cognition than NCC participants. Unsurprisingly, the CC group reported significantly higher creative achievement than the EP and NCC samples. Of note, the findings indicate that EP participants recorded significantly higher creative achievement than NCC, suggesting that EP patients demonstrate some capacity for creative cognition and creative achievement. These preliminary findings may encourage further research and promote avenues of treatment for at-risk creative individuals and EP individuals.
Cohen, R, Irwin, L, Newton-John, T & Slater, A 2019, '#bodypositivity: A content analysis of body positive accounts on Instagram.', Body Image, vol. 29, pp. 47-57.View/Download from: UTS OPUS or Publisher's site
In the last decade, the body image literature has begun to extend beyond a primary focus on body image disturbances and examine the construct of positive body image. Similarly, "Body positivity" is a growing social media trend that seeks to challenge dominant societal appearance ideals and promote acceptance and appreciation of all bodies and appearances. The present study provides a content analysis of body positive posts on Instagram. A set of 640 Instagram posts sampled from popular body positive accounts were coded for physical appearance-related attributes and central themes featured. Results showed that body positive imagery typically depicted a broad range of body sizes and appearances. Additionally, while a proportion of posts were appearance-focused, the majority of posts conveyed messages aligned with theoretical definitions of positive body image. This study clarifies body positive content on Instagram, as well as highlights points of overlap and distinction from academic principles of positive body image and other appearance-focused social media content. Accordingly, the results offer theoretical and practical implications for future research and prevention efforts.
Lagad, A, Hodgkinson, K & Newton-John, TRO 2019, 'Is ignorance bliss, or is knowledge power? When cancer healthcare professionals become cancer patients', EUROPEAN JOURNAL OF CANCER CARE, vol. 28, no. 4.View/Download from: Publisher's site
Cohen, R, Fardouly, J, Newton-John, T & Slater, A 2019, '#BoPo on Instagram: An experimental investigation of the effects of viewing body positive content on young women's mood and body image', New Media and Society, vol. 21, no. 7, pp. 1546-1564.View/Download from: UTS OPUS or Publisher's site
© The Author(s) 2019. Body-positive content on social media aims to challenge mainstream beauty ideals and encourage acceptance and appreciation of all body types. The present study aimed to investigate the effect of viewing body-positive Instagram posts on young women's mood and body image. Participants were 195 young women (18–30 years old) who were randomly allocated to view either body-positive, thin-ideal, or appearance-neutral Instagram posts. Results showed that brief exposure to body positive posts was associated with improvements in young women's positive mood, body satisfaction and body appreciation, relative to thin-ideal and appearance-neutral posts. In addition, both thin-ideal and body-positive posts were associated with increased self-objectification relative to appearance-neutral posts. Finally, participants showed favourable attitudes towards the body positive accounts with the majority being willing to follow them in the future. It was concluded that body-positive content may offer a fruitful avenue for improving young women's body image, although further research is necessary to fully understand the effects on self-objectification.
O'Loughlin, I & Newton-John, TRO 2019, ''Dis-comfort eating': An investigation into the use of food as a coping strategy for the management of chronic pain', Appetite, vol. 140, pp. 288-297.View/Download from: UTS OPUS or Publisher's site
© 2019 Objectives: Chronic pain and obesity are major public health concerns. Animal and human models have demonstrated that eating high-sugar nutrient-dense foods confers analgesic effects. Moreover, recent research suggests that people with chronic pain may 'comfort eat' to cope with their pain. Given the harmful impact of obesity on chronic pain, it is critical to determine whether pain elicits comfort eating amongst individuals with chronic pain to ensure that this potentially maladaptive pain coping strategy is not overlooked in chronic pain treatment. Therefore, this study aimed to: determine whether chronic pain intensity predicts pain-induced comfort eating and identify mediators of this relationship; to determine whether pain-induced comfort eating predicts elevated BMI; and to establish whether BMI predicts chronic pain interference. Methods: This study utilised a cross-sectional online survey design and a sample of 151 adults with chronic pain. Results: Over three-quarters of this chronic pain sample reported engaging in pain-induced comfort eating. Chronic pain intensity did not significantly predict pain-induced comfort eating. However, there was a significant indirect effect of chronic pain intensity on pain-induced comfort eating through stress—but not experiential avoidance or pain catastrophising. As predicted, pain-induced comfort eating significantly predicted increased BMI, and BMI in turn significantly predicted greater chronic pain interference. Discussion: This study indicates that pain-induced comfort eating is both common and harmful amongst individuals with chronic pain, across the entire BMI spectrum. Pain-induced comfort eating and stress have emerged as promising chronic pain treatment targets. The findings are discussed and interpreted in light of extant research and theory, as well as limitations of the current study. Future research directions and clinical implications are also considered.
Bulsara, SM, Wainberg, ML, Audet, CM & Newton-John, TRO 2019, 'Retention in HIV Care in Australia: The Perspectives of Clinicians and Clients, and the Impact of Medical and Psychosocial Comorbidity.', AIDS patient care and STDs.View/Download from: Publisher's site
Significant advances in our understanding and treatment of HIV have led to improvements in the medical management of the illness, as HIV infection has evolved from an acute to a chronic illness. Increasing our understanding of the medical and/or psychosocial comorbidities, which can interact to determine "clinical complexity" and impact HIV management, will further strengthen this process. Retention in care is a critical step of the HIV Treatment Cascade, which facilitates effective management of these comorbidities and their impact on HIV medical management. This study sought to build on literature regarding medical and/or psychosocial comorbidity that impacts retention in care, and it often leads to clinically complex presentations, by gaining the perspectives of people living with HIV (PLHIV), and medical and allied health clinicians in the field in Sydney, Australia. A total of 16 clinicians (medical doctors, nurses, clinical psychologists, and social workers) and 14 clients participated in a series of focus groups; they were asked to comment on the perceived barriers to retention and the potential solutions to overcome these. The results indicated a significant degree of overlap between clinician and client perspectives, and they identified "service-specific factors," "logistic/practical factors," "medical/physical factors," and "psychosocial factors" as potential barriers to retention. Results are reviewed in the context of similarities and differences in perspectives between clinicians and PLHIV, and limitations regarding the generalizability of findings are discussed. The broader context of comorbidity and clinical complexity is also examined.
Bulsara, SM, Wainberg, ML & Newton-John, TRO 2018, 'Predictors of Adult Retention in HIV Care: A Systematic Review.', AIDS and Behavior, vol. 22, no. 3, pp. 752-764.View/Download from: UTS OPUS or Publisher's site
A systematic literature review was conducted to identify predictors of poor adult retention in HIV medical care in developed and developing countries. An electronic search was conducted with MEDLINE (OVID), PubMED, EBSCO, SCOPUS, and Cochrane databases, as well as manual searches. Original, quantitative, adult studies in English, published between 1995 and 2015 were included. Only those with a focus on predictors of retention in care were reported on. Of the 345 articles identified, thirty were included following an independent assessment by two raters. In developed countries, the most frequently cited predictors of poor retention were active substance use and demographic factors. In developing countries, physical health factors were most frequently associated with poor retention in care. The results from this review suggests primary concerns for poor retention include substance use and physical health factors. Other psychosocial factors, such as psychiatric illness and social/welfare factors, were also found to be relevant.
Day, MA, Ward, LC, Thorn, BE, Lang, CP, Newton-John, TRO, Ehde, DM & Jensen, MP 2018, 'The Pain-Related Cognitive Processes Questionnaire: Development and Validation.', Pain Medicine, vol. 19, pp. 269-283.View/Download from: UTS OPUS or Publisher's site
Objective.: Cognitive processes may be characterized as how individuals think, whereas cognitive content constitutes what individuals think. Both cognitive processes and cognitive content are theorized to play important roles in chronic pain adjustment, and treatments have been developed to target both. However, the evaluation of treatments that target cognitive processes is limited because extant measures do not satisfactorily separate cognitive process from cognitive content. The current study aimed to develop a self-report inventory of potentially adaptive and presumed maladaptive attentional processes that may occur when someone is experiencing pain. Methods.: Scales were derived from a large item pool by successively applying confirmatory factor analysis to item data from two undergraduate samples (N = 393 and 233). Results.: Items, which were generated to avoid confounding of cognitive content with cognitive processes, represented nine constructs: Suppression, Distraction, Enhancement, Dissociation, Reappraisal, Absorption, Rumination, Nonjudgment, and Acceptance. The resulting nine scales formed the Pain-Related Cognitive Process Questionnaire (PCPQ), and scale correlations produced four conceptually distinct composite scales: Pain Diversion, Pain Distancing, Pain Focus, and Pain Openness. Internal consistency reliabilities of the nine scales were adequate (α ≥ 0.70) to good, and the four composite scales had α values of 0.79 or higher. Correlations with pain-related criterion variables were generally consistent with putative constructs. Conclusions.: The developed PCPQ scales offer a comprehensive assessment of important cognitive processes specific to pain. Overall, the findings suggest that the PCPQ scales may prove useful for evaluating the role of pain-related cognitive processes in studies of chronic pain.
Bhattarai, P, Newton-John, TRO & Phillips, JL 2018, 'Quality and Usability of Arthritic Pain Self-Management Apps for Older Adults: A Systematic Review.', Pain Medicine, vol. 19, no. 3, pp. 471-484.View/Download from: UTS OPUS or Publisher's site
To appraise the quality and usability of currently available pain applications that could be used by community-dwelling older adults to self-manage their arthritic pain.A systematic review. Searches were conducted in App Store and Google Play to identify pain self-management apps relevant to arthritic pain management. English language pain management apps providing pain assessment and documentation function and pain management education were considered for inclusion. A quality evaluation audit tool based on the Stanford Arthritis Self-Management Program was developed a priori to evaluate app content quality. The usability of included apps was assessed using an established usability evaluation tool.Out of the 373 apps that were identified, four met the inclusion criteria. The included apps all included a pain assessment and documentation function and instructions on medication use, communication with health professionals, cognitive behavioral therapy-based pain management, and physical exercise. Management of mood, depression, anxiety, and sleep were featured in most apps (N = 3). Three-quarters (N = 3) of the apps fell below the acceptable moderate usability score (≥3), while one app obtained a moderate score (3.2).Few of the currently available pain apps offer a comprehensive pain self-management approach incorporating evidence-based strategies in accordance with the Stanford Arthritis Self-Management Program. The moderate-level usability across the included apps indicates a need to consider the usability needs of the older population in future pain self-management app development endeavors.
Cohen, R, Newton-John, T & Slater, A 2018, ''selfie'-objectification: The role of selfies in self-objectification and disordered eating in young women', Computers in Human Behavior, vol. 79, pp. 68-74.View/Download from: UTS OPUS or Publisher's site
© 2017 Existing research demonstrates a relationship between social networking site (SNS) use and body-related concerns and disordered eating amongst females. Preliminary evidence indicates that SNS photo activities (e.g., taking and sharing 'selfies') may play a particularly important role. The present study aimed to use self-objectification as a framework to examine the relationship between SNS photo activities and body-related and eating concerns in a population of young women. Participants were 259 young women (age 18–29; M = 22.97, SD = 3.25) who completed self-report questionnaires of SNS use and body-related and disordered eating concerns. Results showed that SNS 'selfie' activities, rather than general SNS usage, were associated with body-related and eating concerns. Specifically, greater investment in 'selfie' activities was associated with increased body dissatisfaction and bulimia symptomatology, even after accounting for known risk factors such as thin-ideal internalisation and body mass index (BMI). Moreover, self-objectification was found to moderate the relationship between photo investment and bulimia symptomatology. These findings indicate that active engagement with SNS photo activities, rather than general SNS use, shows an association with body-related and eating concerns. Interventions targeting specific SNS photo activities may be an effective avenue for the prevention and management of body-related concerns and disordered eating in young women.
Day, MA, Lang, CP, Newton-John, T, Ehde, DM & Jensen, MP 2017, 'A content review of cognitive process measures used in painresearch within adult populations', European Journal of Pain, vol. 21, no. 1, pp. 45-60.View/Download from: UTS OPUS or Publisher's site
Background and objective
Previous research suggests that measures of cognitive process may be confounded by the inclusion of items that also assess cognitive content. The primary aims of this content review were to: (1) identify the domains of cognitive processes assessed by measures used in pain research; and (2) determine if pain-specific cognitive process measures with adequate psychometric properties exist.
Databases and data treatment
PsychInfo, CINAHL, PsycArticles, MEDLINE, and Academic Search Complete databases were searched to identify the measures of cognitive process used in pain research. Identified measures were double coded and the measure's items were rated as: (1) cognitive content; (2) cognitive process; (3) behavioural/social; and/or (4) emotional coping/responses to pain.
A total of 319 scales were identified; of these, 29 were coded as providing an un-confounded assessment of cognitive process, and 12 were pain-specific. The cognitive process domains assessed in these measures are Absorption, Dissociation, Reappraisal, Distraction/Suppression, Acceptance, Rumination, Non-Judgment, and Enhancement. Pain-specific, un-confounded measures were identified for: Dissociation, Reappraisal, Distraction/Suppression, and Acceptance. Psychometric properties of all 319 scales are reported in supplementary material.
To understand the importance of cognitive processes in influencing pain outcomes as well as explaining the efficacy of pain treatments, valid and pain-specific cognitive process measures that are not confounded with non-process domains (e.g., cognitive content) are needed. The findings of this content review suggest that future research focused on developing cognitive process measures is critical in order to advance our understanding of the mechanisms that underlie effective pain treatment.
Cohen, R, Newton-John, T & Slater, A 2017, 'The relationship between Facebook and Instagram appearance-focused activities and body image concerns in young women.', Body Image, vol. 23, pp. 183-187.View/Download from: UTS OPUS or Publisher's site
The present study aimed to identify the specific social networking sites (SNS) features that relate to body image concerns in young women. A total of 259 women aged 18-29years completed questionnaire measures of SNS use (Facebook and Instagram) and body image concerns. It was found that appearance-focused SNS use, rather than overall SNS use, was related to body image concerns in young women. Specifically, greater engagement in photo activities on Facebook, but not general Facebook use, was associated with greater thin-ideal internalisation and body surveillance. Similarly, following appearance-focused accounts on Instagram was associated with thin-ideal internalisation, body surveillance, and drive for thinness, whereas following appearance-neutral accounts was not associated with any body image outcomes. Implications for future SNS research, as well as for body image and disordered eating interventions for young women, are discussed.
Newton-John, TR, Ventura, AD, Mosely, K, Browne, JL & Speight, J 2017, ''Are you sure you're going to have another one of those?': A qualitative analysis of the social control and social support models in type 2 diabetes.', Journal of Health Psychology, vol. 22, no. 14, pp. 1819-1829.View/Download from: UTS OPUS or Publisher's site
While there is evidence that spouses can impact the self-management of adults with type 2 diabetes mellitus, less is known about the influence of the wider social network. This qualitative study explored the perceived impact of the family as well as friends and work colleagues on type 2 diabetes mellitus self-management. A total of 25 adults with type 2 diabetes mellitus participated in semi-structured interviews regarding their social experiences of living with diabetes. Deductive thematic analysis was applied to the data. Pre-existing themes of health-related social control and social support were identified in the wider social network, with additional themes of non-involvement and unintentional undermining also emerging.
Dean, S, Peng, W, Zaslawski, C, Elliott, D, Newton-John, T, Campo, M & Pappas, E 2017, 'Mindfulness in Physical and Occupational Therapy Education and Practice: A scoping review', Physical Therapy Reviews, vol. 22, no. 5-6, pp. 221-228.View/Download from: UTS OPUS or Publisher's site
© 2017 Informa UK Limited, trading as Taylor & Francis Group. Background: Mindfulness practices provide numerous benefits for individuals with a variety of health issues. Recent research has highlighted the benefits of mindfulness for health professionals. The potential benefits for physical and occupational therapists or students however, are currently unclear. Objectives: To perform a scoping review on the effects of mindfulness practices among physical (PT) and occupational therapists (OT) and students of those disciplines. Methods: Eligible published articles in English were identified through a literature search of MEDLINE, PsycINFO, Cochrane Library, and AMED from the inception of databases to November 2015. Titles, abstracts, and full-text articles were screened for the selection of relevant papers. Articles identified as editorials, correspondences, commentaries, case reports, abstracts alone, and review papers were excluded. Results: Six studies (two qualitative studies, one quantitative study, one mixed-method study, and two experimental studies) met the inclusion criteria. Three studies focused on PT/OT students, two on clinicians and one on current clinicians who had previously failed a course. These studies highlighted the potential benefits of mindfulness for physical and occupational therapists. They should be interpreted with caution however, due to the small number of relevant studies, high heterogeneity in mindfulness interventions and methodological limitations. Conclusions: There is a paucity of research on the effects of mindfulness among physical and occupational therapists and students of those disciplines. The lack of relevant studies makes a systematic review challenging but the findings of the current studies suggest potentially promising effects.
Dean, SJ, Foureur, M, Zaslawski, C, Newton-John, T, Yu, N & Pappas, E 2017, 'The effects of a structured mindfulness program on the development of empathy in healthcare students', NursingPlus Open, vol. 3, pp. 1-5.View/Download from: UTS OPUS or Publisher's site
Ramke, S, Sharpe, L & Newton-John, T 2016, 'Adjunctive cognitive behavioural treatment for chronic pain couples improves marital satisfaction but not pain management outcomes.', European journal of pain (London, England), vol. 20, no. 10, pp. 1667-1677.View/Download from: UTS OPUS or Publisher's site
Data have consistently shown that patient coping with chronic pain can be affected by various factors associated with the primary relationship, and hence efforts to include the patient's partner in the treatment process have merit. This study evaluated the benefit of adding an adjunctive, couples-based, cognitive behavioural treatment (CBT) for chronic pain to a standard cognitive behavioural pain management programme.Forty-five couples were randomly assigned to either an adjunctive couples intervention (n = 19) or the pain programme only (n = 26). All patient participants completed a 3-week multi-disciplinary pain management programme, to which their partners were invited to attend one full day. In addition, partners in the adjunctive condition received four, one hour treatment sessions focusing on pain education, patient-partner communication, operant behavioural principles and relapse prevention strategies. Partner sessions for the adjunctive intervention were provided over the telephone.By the completion of the pain programme the adjunctive couples intervention demonstrated significant improvements in marital satisfaction for the spouses over and above attendance at the pain management programme alone (p = 0.003). However, spouse involvement did not facilitate any additional response to treatment for pain patients on marital satisfaction, pain, disability or any indices of distress. All treatment gains were maintained at 1 month follow-up.These data demonstrate that a brief CBT intervention can significantly improve marital satisfaction for spouses of chronic pain patients, but the treatment does not translate to improvements in function on any outcomes, including marital satisfaction, for patients of chronic pain. WHAT DOES THIS STUDY ADD?: A brief, telephone-based intervention for couples living with chronic pain is an acceptable format for intervention. This intervention can significantly improve marital satisfaction for partners of chronic pain patients. ...
Newton-John, TR, Mason, C & Hunter, M 2014, 'The role of resilience in adjustment and coping with chronic pain.', Rehabilitation Psychology, vol. 59, no. 3, pp. 360-365.View/Download from: UTS OPUS or Publisher's site
PURPOSE: In clinical practice, it is often noted that some individuals struggle with chronic pain, while others find effective means to cope. The purpose of this study was to better understand how resilience fits into coping with persistent pain problems. Of interest was whether measures of resilience add to the prediction of adjustment to chronic pain over and above measures of pain coping as typically used with this patient group. METHOD: Individuals (N = 101) with chronic pain who attended an initial assessment at a pain clinic completed self-report measures of resilience and coping. Pain related outcome data were also collected. RESULTS: Bivariate correlations indicated that higher resilience was associated with significantly less fear avoidance, less pain-related disability, and lower reported pain intensity. Consistent with theoretical propositions, bivariate analyses also indicated that more resilient individuals with chronic pain reported better social support, and were more likely to be working. Higher resilience was also positively correlated with greater pain self-efficacy. However, when hierarchical regression analyses were performed, resilience did not add significantly to the prediction of depression scores and disability scores, over and above the contribution made by existing measures of pain coping. CONCLUSION: These findings suggest that, although the construct of resilience appears to have important relationships with various dimensions of chronic pain, as currently operationalized, it does not add significantly to the understanding of chronic-pain adjustment. Rather than abandoning the resilience construct, our findings suggest that resilience as applied to the problem of chronic pain may require a refinement in measurement with this population.
Newton-John, TRO 2014, 'Negotiating the Maze: Risk Factors for Suicidal Behavior in Chronic Pain Patients', Current Pain and Headache Reports, vol. 18, no. 9.View/Download from: UTS OPUS or Publisher's site
Chronic pain disorders can exert major negative effects on virtually every aspect of an individual's life. It is not surprising then that many chronic pain sufferers find themselves at a point of emotional fragility where they experience thoughts of ending their life. Suicidal behavior encompasses a spectrum of experience, from "life weariness" or passive suicidal ideation, to more active suicidal intent and suicide completion. A range of risk factors for suicidal behavior in the general population have been identified, and these apply equally to the chronic pain population: a family history of mental illness, past history of suicide attempts, and the presence of comorbid depression. With regard specifically to chronic pain patients, elevated suicide risk is also associated with severe or recurrent headache, ambiguous diagnoses (psychogenic pain, abdominal pain), and medicolegal issues related to the pain. A number of suggestions for clinicians managing chronic pain patients with regards to managing suicide risk are given. © 2014 Springer Science+Business Media New York.
SUMMARY While healthcare is most commonly focused at the individual level, considerable research has demonstrated that the presence and nature of the relationship with a significant other can play an important role in both mortality and morbidity. In the case of chronic pain, studies have shown that patient disability, mood and overall adjustment can be strongly influenced by the partner. The partner's responses to patient overt communications of pain have been examined in detail, with support for operant behavioral models of chronic pain generally found. However, more recent studies have extended the behavioral paradigm by exploring issues such as empathy, relationship intimacy and the cognitive patterns of patients and their partners, to better understand dyadic adjustment to chronic pain. Future work will broaden the investigation of the determinants of partner helping behaviors, by looking at pre-illness variables and their expression in a chronic pain relationship.
Newton-John, TRO & McDonald, AJ 2012, 'Pain management in the context of workers compensation: a case study', TRANSLATIONAL BEHAVIORAL MEDICINE, vol. 2, no. 1, pp. 38-46.View/Download from: UTS OPUS or Publisher's site
Newton-John, TR & Geddes, J 2008, 'The non-specific effects of group-based cognitive-behavioural treatment of chronic pain', Chronic Illness, vol. 4, no. 3, pp. 199-208.View/Download from: Publisher's site
Group-based cognitive-behavioural therapy (CBT) for chronic, non-malignant pain is recognized as the treatment of choice for patients with intractable pain problems. The core components of CBT pain treatment have been standardized, and meta-analyses have shown that that this form of intervention is effective. However, the psychotherapy literature points to a range of influences on treatment outcome that arise out of the process of treatment, rather than directly from the active treatment components. These so-called non-specific treatment effects include the composition of the group, the leadership style of the group leader, and the ways in which group dynamics are dealt with. Although CBT pain management programmes are conducted in a group format, and are therefore subject to similar kinds of influences to other forms of group treatment, these issues have not been discussed in detail in any previous literature. The present paper proposes a number of non-specific treatment factors that are likely to be associated with positive outcomes from CBT pain management programmes, and discusses ways in which these factors may be deliberately manipulated in order to maximize treatment effectiveness. © SAGE Publications 2008.
Russo, MA, Newton-John, T & Lo, W 2008, 'Chronic non-malignant pain', Australian Doctor, no. 21/MAR., pp. 25-32.
■Chronic pain affects about 20% of the adult population, with about 10% becoming significantly disabled by it. The social, economic and health care burdens related to chronic pain are enormous. ■CNS plasticity is increasingly recognised as playing a role in the development of persistent pain states. The development of postural abnormalities, physical deconditioning and psychological distress then further add to the maintenance of chronic pain. ■Chronic pain is typically categorised as neuropathic, nociceptive or a mixture of both. ■The use of brief self-report questionnaires can add valuable clinical information regarding pain intensity, mood, pain disability and pain beliefs. ■Opioid prescription should be done with specific pain reduction and functional upgrading goals at the outset. ■Group-based CBT has the strongest empirical basis in terms of increased function and decreased distress.
Evans, AW, Leeson, RMA, Newton John, TRO & Petrie, A 2005, 'The influence of self-deception and impression management upon self-assessment in oral surgery', British Dental Journal, vol. 198, no. 12, pp. 765-769.View/Download from: Publisher's site
Objective: To see if poor self-assessment of surgical performance during removal of mandibular third molars is influenced by self-deception (lack of insight) and impression management (trying to convey a favourable impression). Design: A prospective study of 50 surgeons, surgically removing a lower third molar tooth. Setting: One UK dental school over a two year period. Methods: The surgeons' surgical skills were assessed (by two assessors) and self-assessed using check-list and global rating scales. Post-operatively, surgeons completed validated deception questionnaires which measured both self-deception enhancement (lack of insight), and impression management (the tendency to deliberately convey a favourable impression). Main outcome measures: Reliability between assessors, and between assessors' and surgeons' self-assessments were calculated. Discrepancies between assessors' and surgeons' scores were correlated with surgeons' deception scores. Results: Reliability between assessors was excellent for checklist (0.96) and global rating scales (0.89) and better than the reliability between assessors and surgeons (0.51 and 0.49). There was a statistically significant correlation (r=0.45 p=0.001 checklist, r= 0.48 p<0.001 global) between over/ under-rating of their surgical performance by surgeons and their impression management scores. No statistically significant correlation was found between this inaccuracy in self-assessment and surgeons' individual self-deception scores. Conclusion: The majority of surgeons scored themselves higher than their assessors did for surgical skill in removing a single mandibular third molar tooth. Impression management (the tendency to deliberately convey a favourable impression) may contribute to a surgeon's inaccurate self-reporting of performance. Lack of insight appears to be much less important as a contributing factor. The authors speculate that pressure to provide evidence of good performance may be encouraging surgeons to ma...
Feinmann, C & Newton-John, T 2004, 'Psychiatric and psychological management considerations associated with nerve damage and neuropathic trigeminal pain', JOURNAL OF OROFACIAL PAIN, vol. 18, no. 4, pp. 360-365.
Evans, AW, Leeson, RMA & Newton-John, TRO 2002, 'The influence of self-deception and impression management on surgeons' self-assessment scores', MEDICAL EDUCATION, vol. 36, no. 11, pp. 1095-1095.View/Download from: Publisher's site
Newton-John, T, Ashmore, J & McDowell, M 2001, 'Early intervention in acute back pain: Problems with flying the yellow flag', Physiotherapy, vol. 87, no. 8, pp. 397-401.View/Download from: Publisher's site
Disability related to chronic back pain has been identified as one of the major medical and social problems of current times. There is substantial evidence that pain management programmes based on cognitive behavioural principles are effective in terms of improving physical function and psychological well-being for long-term back pain sufferers (Morley et al, 1999). However, few studies have investigated the efficacy of pain management with patients in the early phases of the condition, before many of the problems associated with chronic pain have developed. A project was therefore designed in order to determine whether the provision of a pain management intervention during the acute phase of back pain would help prevent the development of chronic disability. For a variety of reasons this study did not proceed, and the aim of this article is to outline the pitfalls that were encountered in setting up such a study. It is hoped that future clinicians/researchers might benefit from our hindsight.
Newton-John, T, Madland, G & Feinmann, C 2001, 'Chronic idiopathic orofacial pain: II. What can the general dental practitioner do?', BRITISH DENTAL JOURNAL, vol. 191, no. 2, pp. 72-73.View/Download from: Publisher's site
Madland, G, Newton-John, T & Feinmann, C 2001, 'Chronic idiopathic orofacial pain: 1: What is the evidence base?', BRITISH DENTAL JOURNAL, vol. 191, no. 1, pp. 22-24.View/Download from: Publisher's site
Spence, SH, Sharpe, L, Newton-John, T & Champion, D 2001, 'An investigation of symptom-specific muscle hyperreactivity in upper extremity cumulative trauma disorder', CLINICAL JOURNAL OF PAIN, vol. 17, no. 2, pp. 119-128.View/Download from: Publisher's site
Harvey, LA, Newton-John, T, Davis, GM, Smith, MB & Engel, S 1997, 'A comparison of the attitude of paraplegic individuals to the Walkabout Orthosis and the Isocentric Reciprocal Gait Orthosis', Spinal Cord, vol. 35, no. 9, pp. 580-584.View/Download from: Publisher's site
This study compared the attitude of paraplegic individuals to the Isocentric Reciprocal Gait Orthosis (IRGO) and the Walkabout Orthosis (WO), after they had been given the opportunity of using both. Ten complete T9-12 paraplegic patients participated in this randomised cross-over design. Initially the subjects learned to walk with the first orthosis before taking it home for a 14 week home trial period. The same process of training and trialing the orthosis at home was then repeated with the second orthosis. Attitudes to specific aspects of the orthoses were assessed by an 18 point questionnaire and overall attitudes were inferred after determining the amount of time that subjects used the orthoses at home and determining which orthosis the majority of subjects wanted to keep at the end of the study. The main finding was that subjects did not perceive any significant differences between the two orthoses. That is: (i) the questionnaire did not detect significant differences in attitudes to the two orthoses; (ii) there was no significant difference in the number of subjects that preferred one orthosis to the other, at the end of the study, and (iii) subjects did not derive more use from one orthosis than the other over the two 14 week home trial periods. In addition, it was found that few subjects wore either orthosis more than once every 2 weeks and that subjects were primarily using the orthoses for therapeutic purposes. This latter finding was supported by the results of the questionnaire that revealed that subjects found both orthoses to be useful for standing but not useful for performing more purposeful tasks. It was concluded that when subjects are primarily using the WO and IRGO for therapeutic purposes, they do not readily perceive differences between the two.
Newton-John, TRO, Spence, SH & Schotte, D 1995, 'Cognitive-Behavioural Therapy versus EMG Biofeedback in the treatment of chronic low back pain', Behaviour Research and Therapy, vol. 33, no. 6, pp. 691-697.View/Download from: Publisher's site
Forty-four chronic, but relatively well functioning, low back pain patients were assigned to either Cognitive Behaviour Therapy (CBT), Electromyographic Biofeedback (EMGBF) or Wait List Control (WLC). Both treatments were conducted over eight sessions in groups of four subjects. Results at post-treatment indicated significant improvements in functioning on measures of pain intensity, perceived level of disability, adaptive beliefs about pain and the level of depression in both the CBT and EMGBF conditions. These improvements were not evident for the WLC condition. At 6 months follow-up, treatment gains were maintained in the areas of pain intensity, pain beliefs, and depression, for both treatment groups, with further improvements occurring in anxiety and use of active coping skills. No significant differences were found between CBT and EMGBF on any of the outcome measures at either post-treatment or at 6 months follow-up. Further research is required to determine the degree to which these results reflect the mild level of psychological impairment and disability status of patients in the present study. © 1995.
Spence, SH, Sharpe, L, Newton-John, T & Champion, D 1995, 'Effect of EMG biofeedback compared to applied relaxation training with chronic, upper extremity cumulative trauma disorders', Pain, vol. 63, no. 2, pp. 199-206.View/Download from: Publisher's site
This study examined the relative effectiveness of EMG biofeedback, applied relaxation training and a combined procedure in the management of chronic, upper extremity cumulative trauma disorder. Forty-eight patients with a history of about 5-6 years of upper extremity pain were randomly assigned to 1 of 4 treatment conditions, namely applied relaxation training, EMG biofeedback, a combined approach or a wait-list control. Treatments were conducted on an individual basis, twice per week for 4 weeks. Patients in all 3 treatment conditions showed significant short-term reductions in pain and psychopathology in comparison to the wait-list group who showed minimal change. Six-month follow-up data were obtained for patients in the treatment conditions, but not the wait-list group. There was some evidence of relapse on measures Of depression, anxiety and pain beliefs for treated patients during the 6-month follow-up period, although measures remained significantly below pre-treatment levels for most outcome indices. Self-monitored pain continued to decrease for the treatment groups through follow-up. Contrary to predictions, however, the strongest short-term treatment benefits were shown by patients receiving applied relaxation training on measures of pain, distress, interference in daily living, depression and anxiety. By 6-month follow-up, differences between treatment groups were no longer evident. © 1995.
Newton-John, T 2018, 'Multidisciplinary Cognitive Behavioural Treatment for Chronic Pain' in Farquhar-Smith, P, Beaulieu, P & Jagger, S (eds), Landmark Papers in Pain, Oxford University Press.
Dionne, R, Newton-John, T & Zakrzewska, J 2009, 'Overall management of facial pain' in Zakrzewska, J (ed), Orofacial Pain, Oxford University Press, pp. 53-68.
Svensson, P, Baad-Hansen, L, Newton-John, T, Ng, S & Zakrzewska, J 2009, 'Investigations' in Orofacial Pain, Oxford University Press, pp. 25-42.
Newton-John, T & Nandi, P 2008, 'History taking and examination of the patient with chronic pain.' in Justins, D, Newton-John, TRO, Howard, R & Miasowski, C (eds), Clinical Pain Management, Hodder Arnold, London, pp. 3-11.
Newton-John, T 2008, 'Measuring pain and disability in chronic urogenic pain' in Baranowski, AP, Abrams, P & Fall, M (eds), Urogenital Pain in Clinical Practice, Taylor Francis, New York, pp. 103-110.
Baranowski, A, Collett, B, Newton-John, TRO & Wesselmann, U 2006, 'Urogenital pain: taking management forward.' in Flor, H, Kalso, E & Dostrovsky, J (eds), Progress in Pain Research and Management, IASP Press, Seattle, pp. 681-694.
Baranowski, AP, Collett, B, Newton-John, T & Wesselmann, U 2006, 'Urogenital pain: taking management forward', IASP Press, Seattle, pp. 681-694.
© Cambridge University Press 2005 and Cambridge University Press, 2009. Introduction It is axiomatic to state that patients experiencing chronic pain often experience significant psychological dysfunction. Any clinician who has spent any time in a pain clinic will be aware of the high levels of emotional and behavioural disturbance that can occur in this patient group. Depression, anxiety and anger are common emotional states associated with chronic pain. Moreover, pain patients may show unusual gait patterns, with guarding and bracing of affected areas of the body, and other physical behaviours. The psychological perspective from which one addresses these difficulties depends very much upon the model of pain, implicit or explicit, that one holds. The first section of this chapter will therefore discuss pain models and their relationship to treatment. Key psychological theories will then be laid out (as they apply to chronic pain) and the various components of the theories discussed. Finally, a number of relevant issues in the application of psychological treatments for chronic pain will be discussed. Chronic pain and psychology: separation or integration? The publication of the gate control theory of pain in 1965 marked a shift in thinking, in relation to psychological processes in pain. Up to that point, the experience of pain was largely a biomedical phenomenon. How much you were hurt was dependent upon where you were injured, and the extent to which your tissues were damaged.
Newton-John, T 2004, 'Measurement of pain.' in Dolin, S & Padfield, N (eds), Pain Medicine Manual, Butterworth Heinemann, London, pp. 29-36.
Newton-John, T & Feinmann, C 2003, 'The dentist-patient relationship.' in Scully, C (ed), Oxford Handbook of Applied Dental Sciences, Oxford University Press, Oxford, pp. 593-602.
Feinmann, C & Newton-John, TRO 2003, 'Orofacial pain.' in Scully, C (ed), Oxford Handbook of Applied Dental Sciences, Oxford University Press, Oxford, pp. 615-619.
Newton-John, T 2002, 'The psychology of pain.' in Zakrzewska, J & Harrison, S (eds), Assessment and Management of Orofacial Pain. Pain Research and Clinical Management., Elsevier Press, London, pp. 35-52.
Newton-John, T 2002, 'The measurement of pain in adults.' in Zakrzewska, J & Harrison, S (eds), Assessment and Management of Orofacial Pain. Pain Research and Clinical Management., Elsevier Press, London, pp. 87-104.
Newton-John, T 2002, 'Psychological effects of chronic pain and their assessment in adults.' in Jensen, T, Wilson, PR & Rice, ASC (eds), Clinical Pain Management. Chronic Pain., Arnold Press, London, pp. 101-111.
Newton-John, T 2001, 'The psychology of pain.' in McClean, A, Stones, W & Thornton, S (eds), Pain in Obstetrics and Gynaecology., Royal College of Obstetrics and Gynaecology, London, pp. 47-68.
Newton-John, TRO & Williams, ACD 2000, 'Solicitousness revisited: A qualitative analysis of spouse responses to pain behaviors', INT ASSOC STUDY PAIN (IASP) PRESS, pp. 1113-1122.
Hayes, S & Newton-John, T 2018, 'The Role of Conflict Resolution Styles in Couples Coping with Chronic Pain'.
Background and Aims: Relationship satisfaction is known to be an important contributor to better adjustment in chronic pain patients (Cano et al. 2005), however relationships often suffer as a result of chronic pain-related difficulties. This study investigated one aspect of relationship satisfaction - Conflict Resolution Styles (CRS), as proposed by Gottman's (1999) marital interaction model - on adjustment and coping with chronic pain. This model proposes that it is neither the intensity nor frequency of relationship conflict which is most salient, but rather it is the way in which conflicts are resolved which determines relationship satisfaction. The model proposes three regulated CRS – Avoidant, Volatile and Validating – and one dysregulated CRS, termed Hostile. Evidence from the general population has shown that the dysregulated/Hostile CRS leads to poorer relationship outcomes than the regulated CRS (Holman & Jarvis, 2003), however this model has not previously been tested in a chronic pain sample.
Methods: 100 participants with chronic pain were recruited from medical and physiotherapy practices across the Greater Sydney Region, in New South Wales, and from online pain support groups. 65% of the sample were female, with a mean age of 46.9 years (SD=14.9) and a mean pain duration of 9.3 years (SD=8.9). 59% of the sample reported primarily lower back pain, however 70.5% reported pain in three or more sites. 88.6% were married/de facto status, with a mean relationship duration of 12.2 years (SD=8.9). Participants completed the CRS (Conflict Resolution Style Scale) as well as the BPI, DASS, Dyadic Adjustment Scale (assessing relationship satisfaction), the MPI Spouse Response Scale, and the Pain Behavior Checklist.
Results: There were no differences between medical/physiotherapy practice participants (n=52) and online pain support group participants (n=48) on gender, relationship duration, pain duration, or pain intensity and hence data were collapsed for bo...
Donnelly, TJ, Palermo, T & Newton-John, T 2018, 'SYSTEMATIC REVIEW OF PARENT AND FAMILY FACTORS AND THEIR INFLUENCE ON PAEDIATRIC CHRONIC PAIN.'.
Background and Aims: The application of a biopsychosocial framework to the understanding of chronic pain in children and adolescents should include the family system within a comprehensive model of onset, adjustment and maintenance (1). In particular, authors have suggested that the influence of the family on paediatric chronic pain can be conceptualised at three levels: family level variables (e.g., family environment, overall functioning), dyadic variables (e.g., parent-child interactions) and individual parent variables (e.g., parenting style, parental reinforcement/solicitousness) (1). There is some empirical evidence to support each level of this model, with investigations showing that increased parental psychological distress, poorer family functioning and lower levels of age appropriate autonomy, predict increased pain-related disability in children with chronic pain (2). Studies also suggest a more consistent relationship between pain-related disability and family functioning than with reported child pain intensity (3).
The current research aims to provide an update on the literature published in Lewandowski et al.'s 2008 systematic review (3). It also aims to broaden the current understanding of paediatric chronic pain by expanding the focus of the review to each of the three intra-family levels identified: family level variables; dyadic variables; and individual parent variables. It is anticipated that this will provide a comprehensive understanding of family and parent factors that may help to guide future assessment and intervention approaches for children experiencing chronic pain and their families.
Methods: A systematic search of Medline, PubMed, EMBASE, and PsychINFO was conducted on January 8th 2018 to identify studies meeting inclusion and exclusion criteria. Studies included in the review are those that are peer reviewed; focus on chronic pain and functional outcomes for children and adolescents; include a measure of family functioning, or pa...
Background and Aims: Pain is a universal phenomenon, but it is also inherently private and subjective – there is no objective test for its existence. Sufferers rely primarily on language to render their pain public, to describe and qualify their pain experience. It has been suggested that pain language may thus provide the best tool to assess and measure pain (1). The McGill Pain Questionnaire (MPQ; 2) paved the way for incorporating language into pain research. However, more recent research has gone further and explored aspects of pain language such as metaphors (3) and linguistic and grammatical patterns (4). The objective of this study was to explore the ways in which those with chronic pain use language to speak about and describe their pain experience.
Methods: Three focus groups were conducted with a total of 16 participants (age range = 22 – 74 years, mean age = 46.6 years) who were attending an outpatient chronic pain management program (average pain duration = 6.6 years). Participants were asked to describe aspects of their pain experience such as how their pain feels and how pain affects their lives. These focus groups were audiotaped, transcribed verbatim, and analysed via thematic analysis.
Results: The key themes and subthemes identified were: Isolation (Invisibility of Pain, Difficulty of Pain Expression, Suffering Alone, Separation from Others, Shame), Physical Sensations of Pain (Size and Weight, Strange Sensations, Temperature, Piercing, Aching, Making Pain Relatable), Pain Personified (As an Adversary, As External to Self), Pain as Overwhelming (Unrelenting Nature of Pain, Loss and Ruin), and Coping with Pain (Holding on and Moving Forward, Finding Positives). Across themes, participants utilised metaphorical language and spoke of their pain in an externalizing fashion, personifying it as an adversary and as outside of their self. The physical, sensory aspects of pain were subsumed by a personal narrative of pain and its effect on the sufferer...
Toby currently has research collaborations with Relationships Australia, Neuroscience Research Australia, Odyssey House Drug and Alcohol Rehabilitation, and University of London UK.