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UK is researching how a mobile application teaches patients diaphragmatic breathing, a technique which may alleviate muscle tension in victims of violence.

UK study looks to mobile app to help victims of abuse manage pain

Women who have suffered from sexual or physical abuse often have residual muscle tension and pain, a symptom of extended stress and activity within the body. Now, two UK researchers are studying how a smartphone app could help these women manage chronic pain.

Charles Carlson, the Robert H. and Anna B. Culton Endowed Professor in the UK Center for Research on Violence Against Women, says a significant portion of the clinic’s female patients have suffered from sexual or physical abuse at some point in their lives, which often results in tension throughout the body that can lead to pain.

Trauma often causes a prolonged state of increased sympathetic tone within the body,” Carlson said. “The chronic hypervigilance may be associated with scanning for danger around every corner. [This can lead] to a state of prolonged and unnecessary muscle tension and eventually, if unchecked, may contribute to muscle-based pain conditions such as myalgia. It is not surprising, therefore, that a significant number of our patients with chronic pain reported experience with physical or sexual abuse.”

Carlson, who is also a professor of psychology in the UK College of Arts and Sciences, and Matt Russell, a doctoral candidate in clinical psychology, want to help patients learn to calm their hypervigilance through strategies that can manage the excessive activation of muscle-based pain. Their previous research shows that patients with chronic pain can find relief through self-regulation strategies that include slow-paced, diaphragmatic breathing – a form of relaxation training.

App teaches self-guided breathing

With the help of a smartphone app that teaches users how to do diaphragmatic breathing, the researchers are currently conducting a clinical trial at the UK Orofacial Pain Clinic, working with patients experiencing myalgia and other chronic pain in the head and neck regions.

Diaphragmatic breathing is a practice most people can learn, so Carlson and Russell are exploring whether patients can help manage their pain by learning to breathe diaphragmatically without the use of a professional therapist. By providing patients with a mobile application that teaches the diaphragmatic breathing approach, the team hypothesizes patients will learn to self-regulate their body’s sympathetic tone to manage their pain.

“We designed the smartphone application to teach patients the basics of paced, diaphragmatic breathing with audio directions only,” Russell said. “Then, we use a visual aid to help pace their breathing, an important piece of strengthening the parasympathetic response.”

The current project will examine the effectiveness of the smartphone health intervention to improve treatment outcomes above standard dental care. The participants recruited through the Orofacial Pain Clinic will receive either standard dental care alone, or standard dental care plus the mobile application on their iPhone/iPad or a provided iPod Touch. Patients using the application will track their daily breathing practices and pain levels, while those receiving standard dental care alone will track only their pain levels. All participants will complete weekly assessments, and at each clinic follow-up visit, participants’ progress will be monitored by collecting measures of their current self-regulation skills.

While a quick iTunes search can result in hundreds of apps that promote breathing strategies to treat various ailments, Carlson emphasizes the importance of empirical evidence.

“To our knowledge, there are no published studies empirically validating that these applications can deliver on their promises,” he said. “As clinical scientists, we believe that before we tell our patients our application will help, we need evidence from a scientific study.”


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sexual violence prevention

Intervention program helps prevent sexual violence in high schools, UK researchers say

University of Kentucky researchers have observed a significant reduction in sexual violence perpetration and victimization among Kentucky high school students, according to a recently published study on the “Green Dot” bystander intervention program.

Led by Ann Coker and Heather Bush of the UK Center for Research on Violence Against Women (CRVAW), the study is the largest and longest randomized controlled trial of bystander intervention programs focusing on sexual violence prevention in high schools. Published this week in the American Journal of Preventive Medicine, the study reveals the implementation of Green Dot in Kentucky high schools decreased not only sexual violence perpetration, but related forms of violence including sexual harassment, stalking and dating violence.

Green Dot, designed by former UK faculty member Dorothy Edwards, has been in use at the university since 2008. It teaches students how to identify situations that could lead to an act of violence (represented on incident maps by a red dot) and shows them how to intervene safely and effectively. A “green dot” represents “any behavior‚ choice‚ word or attitude that promotes safety for all our citizens and communicates utter intolerance for violence.”

“This research is great news for parents, schools, young adults and adolescents across Kentucky and the USA,” said Coker, who is the Verizon Wireless Endowed Chair in CRVAW and professor in the UK College of Medicine. “We found that sexual violence can be prevented  this violence is not inevitable. Adolescents and young adults can learn how to identify risky situations and safely intervene to prevent violence.”

Targeting a serious issue in Kentucky

Sexual violence continues to be a serious problem for Kentucky teens. One in seven high school students in Kentucky experience physical dating violence, and one in 11 have had unwanted sex because they were physically forced or too intoxicated to give consent. Bystander training programs such as Green Dot teach individuals how to recognize situations or behaviors that may become violent and intervene to reduce the likelihood of violence.

Funded by the Centers for Disease Control and Prevention, the study followed 26 Kentucky high schools over the past five years. Half of the schools were assigned to receive the Green Dot intervention, with the others serving as the study’s control group. Interventions were conducted by trained rape crisis educators. The Kentucky Association of Sexual Assault Programs served as a community partner in the trial and covered the cost of Green Dot training for at least one staff person at each regional center across Kentucky. By using these existing resources, the schools encountered no additional costs to implement the program.

The interventions were implemented in two phases. In Phase 1, rape crisis educators delivered Green Dot speeches to all students in the intervention schools. In Phase 2, educators implemented intensive bystander training. This training was conducted in smaller groups by high school students perceived as leaders by their peers (12-15 percent of the student body).

Changing the culture takes time

Each spring from 2010 to 2014, students at each school completed anonymous surveys to measure the frequency of violence they personally experienced, termed “victimization,” as well as the frequency of violence they personally inflicted, termed “perpetration.” All students, in both intervention and control schools, received hotline numbers and website information. Rape crisis staff were also available at each school to talk with any students who needed assistance.

A total of 89,707 surveys were completed over the five-year period, and researchers compared survey-reported data before program implementation with rates from 2010-14. Regarding sexual violence victimization, rates were 12 to 13 percent lower in the intervention versus control schools in years three and four, respectively. This translates to 120 fewer sexually violent events in year three, and 88 fewer in year four, indicating that sufficient time is required to see the ultimate effect of the training on violent behaviors.

“In this study we sought to change the culture that supports violence in high schools, and making these changes requires time,” Coker said. “Fortunately, we had five years to implement and evaluate these changes and we definitely needed all five years. We saw reductions in violence acceptance and increases in bystander actions in the second and third years of the study, but we did not see significant and consistent reductions in sexual violence and other forms of violence until the fourth and fifth years of the study when Green Dot training was fully implemented.”

UK President Eli Capilouto praised the study and the Green Dot program for making both college campuses and high schools safer.

“As educators, we have an obligation to provide our students with a safe place to live and learn,” Capilouto said. “The Green Dot program was ahead of the curve when it was established at the University of Kentucky. Today, it is an effective bystander intervention training tool on college campuses across the country, and the results of the Center for Research on Violence Against Women’s study illustrates its effectiveness in high schools. Providing this important training earlier supports all our efforts to make high schools and college campuses safer for all people.”


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