Daphne C McKee

Duke University Medical Center, Durham, North Carolina, United States

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Publications (20)67.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Two psychological interventions for rheumatoid arthritis (RA) are cognitive-behavioral coping skills training (CST) and written emotional disclosure (WED). These approaches have developed independently, and their combination may be more effective than either one alone. Furthermore, most studies of each intervention have methodological limitations, and each needs further testing. Method: We randomized 264 adults with RA in a 2 × 2 factorial design to 1 of 2 writing conditions (WED vs. control writing) followed by 1 of 2 training conditions (CST vs. arthritis education control training). Patient-reported pain and functioning, blinded evaluations of disease activity and walking speed, and an inflammatory marker (C-reactive protein) were assessed at baseline and 1-, 4-, and 12-month follow-ups. Results: Completion of each intervention was high (>90% of patients), and attrition was low (10.2% at 12-month follow-up). Hierarchical linear modeling of treatment effects over the follow-up period, and analyses of covariance at each assessment point, revealed no interactions between writing and training; however, both interventions had main effects on outcomes, with small effect sizes. Compared with control training, CST decreased pain and psychological symptoms through 12 months. The effects of WED were mixed: Compared with control writing, WED reduced disease activity and physical disability at 1 month only, but WED had more pain than control writing on 1 of 2 measures at 4 and 12 months. Conclusions: The combination of WED and CST does not improve outcomes, perhaps because each intervention has unique effects at different time points. CST improves health status in RA and is recommended for patients, whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 05/2014; · 4.85 Impact Factor
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    ABSTRACT: A multi-site, randomized, controlled clinical effectiveness trial was conducted for osteoarthritis patients with chronic pain of the knee or hip. Adult health nurse practitioners (NP) provided a 10-session intervention, Pain Coping Skills Training (PCST), in patients' doctors' offices (N=129 patients); the control group received usual care (N=127 patients). Primary outcomes assessed at baseline, post-treatment, 6-month and 12-month follow-up were: pain intensity, physical functioning, psychological distress, self-efficacy, catastrophizing, use of coping strategies, and quality of life. Secondary measures included fatigue, social functioning, health satisfaction, and use of pain medication. Methods favoring external validity, consistent with pragmatic, effectiveness research, were utilized. Primary intent-to-treat (ITT) and secondary per-protocol analyses were conducted. Attrition was within the expected range: 11% at post-treatment and 29% at 12-month follow-up; rates did not differ between groups. Omnibus ITT analyses across all assessment points indicated significant improvement for the PCST group compared to the control group for pain intensity, physical functioning, psychological distress, use of pain coping strategies, and self-efficacy, as well as fatigue, satisfaction with health, and reduced use of pain medication. Treatment effects were robust to covariates (demographics and clinical sites). Trends in the outcomes across the assessments were examined. All outcomes, except for self-efficacy, were maintained through the 12-month follow-up; effects for self-efficacy degraded over time. Per-protocol analyses did not yield greater effect sizes. Comparisons of PCST patients who were more versus less treatment adherent suggested greater effectiveness for patients with high adherence. Results support the effectiveness of NP delivery of PCST for chronic OA pain.
    Pain 05/2014; · 5.64 Impact Factor
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    ABSTRACT: Research examining psychosocial functioning in African American prostate cancer survivors has been limited, in spite of documented higher mortality from prostate cancer and worse long-term physical and emotional outcomes from prostate cancer treatment reported by this group of survivors. In addition, the role of masculinity in psychosocial adjustment among prostate cancer survivors is not well understood. In this study, 59 African American prostate cancer survivors completed a questionnaire assessing masculinity beliefs related to self-reliance, emotional control, and dominance, as well as measures of psychosocial functioning (i.e., symptom distress, negative mood, and functional and social well-being). Results of regression analyses indicated that masculinity beliefs predicted negative mood, functional well-being, and social well-being, controlling for age, income, and medical comorbidities. The findings reported here, although preliminary, suggest that masculinity beliefs could be important therapeutic targets for improving the efficacy of cognitive-behavioral interventions for men adjusting to prostate cancer survivorship.
    American journal of men's health 06/2012; 6(5):400-8. · 1.15 Impact Factor
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    ABSTRACT: Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability than patients who are not overweight. This study examined the long-term efficacy of a combined pain coping skills training (PCST) and lifestyle behavioral weight management (BWM) intervention in overweight and obese OA patients. Patients (n=232) were randomized to a 6-month program of: 1) PCST+BWM; 2) PCST-only; 3) BWM-only; or 4) standard care control. Assessments of pain, physical disability (Arthritis Impact Measurement Scales [AIMS] physical disability, stiffness, activity, and gait), psychological disability (AIMS psychological disability, pain catastrophizing, arthritis self-efficacy, weight self-efficacy), and body weight were collected at 4 time points (pretreatment, posttreatment, and 6 months and 12 months after the completion of treatment). Patients randomized to PCST+BWM demonstrated significantly better treatment outcomes (average of all 3 posttreatment values) in terms of pain, physical disability, stiffness, activity, weight self-efficacy, and weight when compared to the other 3 conditions (Ps<0.05). PCST+BWM also did significantly better than at least one of the other conditions (ie, PCST-only, BWM-only, or standard care) in terms of psychological disability, pain catastrophizing, and arthritis self-efficacy. Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long-term benefits.
    Pain 04/2012; 153(6):1199-209. · 5.64 Impact Factor
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    ABSTRACT: To (1) describe a behavioral intervention designed for patients with elevated pain catastrophizing who are scheduled for knee arthroplasty, and (2) use a quasi-experimental design to evaluate the potential efficacy of the intervention on pain severity, catastrophizing cognitions, and disability. Quasi-experimental nonequivalent control group design with a 2-month follow-up. Two university-based orthopedic surgery departments. Adults (N=63) scheduled for knee replacement surgery who reported elevated levels of pain catastrophizing. Patients were recruited from 2 clinics and were assessed prior to surgery and 2 months after surgery. A group of 18 patients received a psychologist-directed pain coping skills training intervention comprising 8 sessions. The other group, a historical cohort of 45 patients, received usual care. Western Ontario and McMaster Universities Arthritis Index Pain and Disability scores, as well as scores on the Pain Catastrophizing Scale. Two months after surgery, the patients who received pain coping skills training reported significantly greater reductions in pain severity and catastrophizing, and greater improvements in function as compared to the usual care cohort. Pain catastrophizing is known to increase risk of poor outcome after knee arthroplasty. The findings provide preliminary evidence that the treatment may be highly efficacious for reducing pain, catastrophizing, and disability, in patients reporting elevated catastrophizing prior to knee arthroplasty. A randomized controlled trial is warranted to confirm these effects.
    Archives of physical medicine and rehabilitation 06/2011; 92(6):859-65. · 2.18 Impact Factor
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    ABSTRACT: Non-cardiac chest pain (NCCP) is a common and distressing condition. Prior studies suggest that psychotropic medication or pain coping skills training (CST) may benefit NCCP patients. To our knowledge, no clinical trials have examined the separate and combined effects of CST and psychotropic medication in the management of NCCP. This randomized clinical trial examined the separate and combined effects of CST and antidepressant medication (sertraline) in participants with non-cardiac chest pain. A sample of individuals diagnosed with NCCP was randomly assigned to one of four treatments: (1) CST plus sertraline (CST+sertraline), (2) CST plus placebo (CST+placebo), (3) sertraline alone, or (4) placebo alone. Assessments of pain intensity, pain unpleasantness, anxiety, pain catastrophizing, depression, and physical disability were collected prior to treatment, and at 10- and 34-weeks following randomization. Data analyses revealed that CST and sertraline either alone or in combination significantly reduced pain intensity and pain unpleasantness. The combination of CST plus sertraline may have the greatest promise in that, when compared to placebo alone, it not only significantly reduced pain but also pain catastrophizing and anxiety. Overall, these findings support the importance of further research on the effects of CST and sertraline for non-cardiac chest pain.
    Pain 02/2011; 152(4):730-41. · 5.64 Impact Factor
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    ABSTRACT: CONTEXT: Lung cancer is one of the most common cancers in the United States and is associated with high levels of symptoms, including pain, fatigue, shortness of breath, and psychological distress. Caregivers and patients are adversely affected. However, previous studies of coping skills training (CST) interventions have not been tested in patients with lung cancer nor have systematically included caregivers. OBJECTIVE: This study tested the efficacy of a caregiver-assisted CST protocol in a sample of patients with lung cancer. METHODS: Two hundred thirty-three lung cancer patients and their caregivers were randomly assigned to receive 14 telephone-based sessions of either caregiver-assisted CST or education/support involving the caregiver. Patients completed measures assessing pain, psychological distress, quality of life (QOL), and self-efficacy for symptom management; caregivers completed measures assessing psychological distress, caregiver strain, and self-efficacy for helping the patient manage symptoms. RESULTS: Patients in both treatment conditions showed improvements in pain, depression, QOL, and self-efficacy, and caregivers in both conditions showed improvements in anxiety and self-efficacy from baseline to four-month follow-up. Results of exploratory analyses suggested that the CST intervention was more beneficial to patients/caregivers with Stage II and III cancers, whereas the education/support intervention was more beneficial to patients/caregivers with Stage I cancer. CONCLUSION: Taken together with the broader literature in this area, results from this study suggest that psychosocial interventions can lead to improvements in a range of outcomes for cancer patients. Suggestions for future studies include the use of three-group designs (e.g., comparing two active interventions with a standard-care control) and examining mechanisms of change.
    Journal of pain and symptom management 09/2010; · 2.42 Impact Factor
  • Osteoarthritis and Cartilage 01/2010; 18. · 4.26 Impact Factor
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    ABSTRACT: To examine the contributions of chest pain, anxiety, and pain catastrophizing to disability in 97 patients with noncardiac chest pain (NCCP) and to test whether chest pain and anxiety were related indirectly to greater disability via pain catastrophizing. Participants completed daily diaries measuring chest pain for 7 days before completing measures of pain catastrophizing, trait anxiety, and disability. Linear path model analyses examined the contributions of chest pain, trait anxiety, and catastrophizing to physical disability, psychosocial disability, and disability in work, home, and recreational activities. Path models accounted for a significant amount of the variability in disability scales (R(2) = 0.35 to 0.52). Chest pain and anxiety accounted for 46% of the variance in pain catastrophizing. Both chest pain (beta = 0.18, Sobel test Z = 2.58, p < .01) and trait anxiety (beta = 0.14, Sobel test Z = 2.11, p < .05) demonstrated significant indirect relationships with physical disability via pain catastrophizing. Chest pain demonstrated a significant indirect relationship with psychosocial disability via pain catastrophizing (beta = 0.12, Sobel test Z = 1.96, p = .05). After controlling for the effects of chest pain and anxiety, pain catastrophizing was no longer related to disability in work, home, and recreational activities. Chest pain and anxiety were directly related to greater disability and indirectly related to physical and psychosocial disability via pain catastrophizing. Efforts to improve functioning in patients with NCCP should consider addressing pain catastrophizing.
    Psychosomatic Medicine 09/2009; 71(8):861-8. · 4.08 Impact Factor
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    ABSTRACT: This study examined the degree to which pain catastrophizing and pain-related fear explain pain, psychological disability, physical disability, and walking speed in patients with osteoarthritis (OA) of the knee. Participants in this study were 106 individuals diagnosed as having OA of at least one knee, who reported knee pain persisting for six months or longer. Results suggest that pain catastrophizing explained a significant proportion (all Ps < or = 0.05) of variance in measures of pain (partial r(2) [pr(2)] = 0.10), psychological disability (pr(2) = 0.20), physical disability (pr(2) = 0.11), and gait velocity at normal (pr(2) = 0.04), fast (pr(2) = 0.04), and intermediate speeds (pr(2) = 0.04). Pain-related fear explained a significant proportion of the variance in measures of psychological disability (pr(2) = 0.07) and walking at a fast speed (pr(2) = 0.05). Pain cognitions, particularly pain catastrophizing, appear to be important variables in understanding pain, disability, and walking at normal, fast, and intermediate speeds in knee OA patients. Clinicians interested in understanding variations in pain and disability in this population may benefit by expanding the focus of their inquiries beyond traditional medical and demographic variables to include an assessment of pain catastrophizing and pain-related fear.
    Journal of pain and symptom management 12/2008; 37(5):863-72. · 2.42 Impact Factor
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    ABSTRACT: Emotional disclosure by writing or talking about stressful life experiences improves health status in non-clinical populations, but its success in clinical populations, particularly rheumatoid arthritis (RA), has been mixed. In this randomized, controlled trial, we attempted to increase the efficacy of emotional disclosure by having a trained clinician help patients emotionally disclose and process stressful experiences. We randomized 98 adults with RA to one of four conditions: (a) private verbal emotional disclosure; (b) clinician-assisted verbal emotional disclosure; (c) arthritis information control (all of which engaged in four, 30-min laboratory sessions); or (d) no-treatment, standard care only control group. Outcome measures (pain, disability, affect, stress) were assessed at baseline, 2 months following treatment (2-month follow-up), and at 5-month, and 15-month follow-ups. A manipulation check demonstrated that, as expected, both types of emotional disclosure led to immediate (post-session) increases in negative affect compared with arthritis information. Outcome analyses at all three follow-ups revealed no clear pattern of effects for either clinician-assisted or private emotional disclosure compared with the two control groups. There were some benefits in terms of a reduction in pain behavior with private disclosure vs. clinician-assisted disclosure at the 2-month follow-up, but no other significant between group differences. We conclude that verbal emotional disclosure about stressful experiences, whether conducted privately or assisted by a clinician, has little or no benefit for people with RA.
    Pain 08/2008; 137(1):164-72. · 5.64 Impact Factor
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    ABSTRACT: African American men experience worse prostate cancer outcomes compared with those of Caucasian men, not only in incidence and mortality rates, but also in coping with the side effects of treatment. Unfortunately, African American men have been significantly under-represented in research evaluating the efficacy of psychosocial interventions for improving coping in prostate cancer survivors. This pilot study explored the feasibility and efficacy of coping skills training (CST), an intervention developed to enhance coping with treatment side effects in a sample of African American prostate cancer survivors and their intimate partners. The intervention was delivered in a telephone-based format designed to facilitate research participation. A total of 40 couples were randomized to either 6 sessions of CST or usual care. Survivors completed measures of disease-specific quality of life (QOL) related to urinary, sexual, bowel, and hormonal symptom domains, as well as measures of global QOL (i.e., physical functioning and mental health). Partners completed measures of caregiver strain, mood, and vigor. Analysis of data from 30 couples (12 couples in CST, 18 couples in usual care) indicated that CST produced moderate to large treatment effects for QOL related to bowel, urinary, sexual, and hormonal symptoms. Partners who underwent CST reported less caregiver strain, depression, and fatigue, and more vigor, with moderate effect sizes observed that approached conventional levels of statistical significance. These preliminary findings suggest that telephone-based CST is a feasible approach that can successfully enhance coping inAfrican American prostate cancer survivors and their intimate partners. Cancer 2007. (c) 2006 American Cancer Society.
    Cancer 02/2007; 109(2 Suppl):414-24. · 5.20 Impact Factor
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    Sandra J Waters, Daphne C McKee, Francis J Keefe
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    ABSTRACT: How can cognitive-behavioral therapy benefit patients with persistent pain? The purpose of this review is to provide an overview of cognitive-behavioral treatment approaches to persistent pain. The review is divided into four sections. In the first section, we describe the conceptual back ground for cognitive-behavioral approaches to pain. In the second section, we describe the basic elements of a typical cognitive-behavioral treatment protocol used in pain management. In the third section, we address questions that health care professionals frequently ask about cognitive - behavioral treatment. In the fourth section, we discuss new clinical applications of cognitive-behavioral treatment.
    Psychopharmacology bulletin 02/2007; 40(4):74-88. · 1.35 Impact Factor
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    ABSTRACT: An experiment was conducted to investigate the interaction of task incentive and the Type A behavior pattern in determining psychomotor performance and psychophysiological responses during a verbal problem solving task. Twenty-four Type A and 17 Type B subjects as determined by the structured interview were randomly assigned to a Monetary Incentive condition or a Non-incentive Control condition. Results indicated that the presence or absence of explicit incentives affected task performance for Type As but not for Type Bs. Type As gave more responses more quickly when offered monetary reward. In contrast, the effects of incentive on cardiovascular responses were observed in Type B subjects but not Type As. Type As showed increased systolic blood pressure and heart rate and skeletal muscle vasodilatation in both conditions, while Type Bs showed increased heart rate and systolic blood pressure only when incentives were offered. Type Bs in the Control condition did not change significantly from baseline and actually tended to respond with a deceleration of heart rate and skeletal muscle vasoconstriction. The results are discussed in terms of the need to consider both the interaction of Type A with the nature of the task and the pattern of cardiovascular responses in future studies of psychophysiologic differences between Type A and Type B individuals.
    Psychophysiology 01/2007; 20(1):63 - 70. · 3.29 Impact Factor
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    ABSTRACT: Studies have documented the efficacy of coping skills training (CST) for managing pain, distress, and disability in persons with arthritis. However, no laboratory studies have examined the effects of CST on descending modulation of nociception. This study used the nociceptive flexion reflex (NFR) to document pain and nociceptive responding among 62 men and women with osteoarthritis of the knee (mean age=63.3+/-7.5 years). Before and after a 45-minute CST session, participants completed laboratory assessments of NFR threshold and questionnaires evaluating pain and state anxiety. Results indicated significantly increased NFR thresholds and decreased pain ratings following CST for men and women. A significant time by sex interaction was observed for state anxiety, with women reporting greater decreases in anxiety following CST than men. This is the first study to demonstrate effects of a CST protocol on a measure of descending inhibition of nociception among patients with osteoarthritic knee pain.
    Journal of Pain and Symptom Management 04/2006; 31(3):262-9. · 2.60 Impact Factor
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    ABSTRACT: This preliminary study tested the efficacy of a partner-guided cancer pain management protocol for patients who are at the end of life. Seventy-eight advanced cancer patients meeting criteria for hospice eligibility and their partners were randomly assigned to a partner-guided pain management training intervention, or usual care control condition. The partner-guided pain management training protocol was a three-session intervention conducted in patients' homes that integrated educational information about cancer pain with systematic training of patients and partners in cognitive and behavioral pain coping skills. Data analyses revealed that the partner-guided pain management protocol produced significant increases in partners' ratings of their self-efficacy for helping the patient control pain and self-efficacy for controlling other symptoms. Partners receiving this training also showed a trend to report improvements in their levels of caregiver strain. Overall, the results of this preliminary study suggest that a partner-guided pain management protocol may have benefits in the context of cancer pain at the end of life. Given the significance of pain at the end of life, future research in this area appears warranted.
    Journal of Pain and Symptom Management 04/2005; 29(3):263-72. · 2.60 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate whether personality traits, as assessed by the Minnesota Multiphasic Personality Inventory (MMPI), at time of college entry can predict the number of reported pain conditions at an approximate 30-year follow-up for 2332 subjects, 1834 men and 498 women, who were administered the MMPI on entry to the University of North Carolina (Chapel Hill) between 1964 and 1966. In 1997, a follow-up was conducted in which subjects were administered a self-report questionnaire regarding whether they had experienced 1 or more chronic pain conditions. Analyses of the relationship between the MMPI clinical scales at college entrance and the report of number of chronic pain conditions at follow-up were conducted. Among male participants, elevations of Scales 1 (Hypochondriasis), 3 (Hysteria), and 5 (Masculinity/Femininity) predicted increases in number of chronic pain conditions at follow-up. For female participants, elevations in Scales 1, 3, and 6 (Paranoia) predicted increases in number of chronic pain conditions at follow-up. The current study suggests that a statistically significant relationship exists between MMPI responses at college entry and reports of chronic pain conditions at mid-life. PERSPECTIVE: This study found a small, but significant relationship between elevations on MMPI scales measuring hypochondriasis and hysteria and the report of chronic pain conditions at follow-up. The study is important because it is the first to examine how personality assessed in younger adults relates to the number of chronic pain conditions reported 30 years later.
    Journal of Pain 03/2005; 6(2):92-7. · 3.24 Impact Factor
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    ABSTRACT: This study examined the relationship between patient and partner ratings of self-efficacy for symptom control and quality of life (QOL) among 40 African American prostate cancer survivors and their intimate partners. Data analyses revealed that cancer survivors who had rated their self-efficacy for symptom control higher reported better QOL related to urinary, bowel, and hormonal symptoms and better general health QOL (i.e., better physical functioning and better mental health). Data analyses also revealed that partners who rated their self-efficacy for helping the patient manage symptoms as higher reported better QOL (i.e., less negative mood and less caregiver strain). Finally, exploratory analyses indicated that higher self-efficacy in patients was associated with less anxiety and caregiver strain in partners, and higher self-efficacy in partners was associated with better adjustment to bowel and hormonal symptoms and better mental health in patients. The clinical implications of these findings are discussed and future directions for research on self-efficacy in African American prostate cancer survivors are identified.
    Journal of Pain and Symptom Management 12/2004; 28(5):433-44. · 2.60 Impact Factor
  • Francis J Keefe, Daphne McKee, Thomas Lynch
    Spine 07/2002; 27(11):1237. · 2.16 Impact Factor
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    ABSTRACT: A laboratory experiment was conducted to investigate the interaction between task incentives and the Type A behavior pattern in determining performance during a task of verbal problem solving. The results indicated that Type A subjects responded more quickly and more frequently than their Type B counterparts. In addition, evidence suggested that a situational characteristic–whether instructions offered a monetary reward or served as an evaluative stressor–affected subjects differently depending on their behavior pattern classification. These findings suggest that Pattern A behavior occurs as a response to challenges signifying the potential for reward as well as a threat of failure. Implications for future research emphasize the need to investigate the characteristics of the situation and the task, as well as the individual.
    Journal of Applied Social Psychology 03/1980; 10(2):101 - 114. · 0.83 Impact Factor

Publication Stats

330 Citations
67.82 Total Impact Points

Institutions

  • 2014
    • Duke University Medical Center
      • Department of Psychiatry and Behavioral Science
      Durham, North Carolina, United States
  • 2011
    • Duke University
      Durham, North Carolina, United States
  • 1980–2007
    • University of North Carolina at Chapel Hill
      • Department of Medicine
      Chapel Hill, NC, United States