Maladaptive responses to pain-related distress, such as pain catastrophizing, amplify the impairments associated with chronic pain. Many of these aspects of chronic pain are similar to affective distress in clinical anxiety disorders. In light of the role of the amygdala in pain and affective distress, disruption of amygdalar functional connectivity in anxiety states, and its implication in the response to noxious stimuli, we investigated amygdala functional connectivity in 17 patients with chronic low back pain and 17 healthy comparison subjects, with respect to normal targets of amygdala subregions (basolateral vs centromedial nuclei), and connectivity to large-scale cognitive-emotional networks, including the default mode network, central executive network, and salience network. We found that patients with chronic pain had exaggerated and abnormal amygdala connectivity with central executive network, which was most exaggerated in patients with the greatest pain catastrophizing. We also found that the normally basolateral-predominant amygdala connectivity to the default mode network was blunted in patients with chronic pain. Our results therefore highlight the importance of the amygdala and its network-level interaction with large-scale cognitive/affective cortical networks in chronic pain, and help link the neurobiological mechanisms of cognitive theories for pain with other clinical states of affective distress.

Systematic Treatment Selection (STS) is a form of technical eclectism that develops and plans treatments using empirically founded principles of psychotherapy. It is a model that provides systematic guidelines for the utilization of different psychotherapeutic strategies based on patient qualities and problem characteristics. Historically, it stems from accumulating evidence that no single theory is effective in treating all patients and common characteristics shared among different theoretical philosophies. A review of the literature and further research resulted in the extraction of four main decisional domains that are involved in determining effective treatment strategies. These domains include: (1) patient predisposing qualities, (2) treatment context, (3) relationship variables, and (4) intervention selection. These main principles provide the basis for which guidelines have been developed to systematically individualize treatment plans. The next step in the process is to effectively disseminate and implement this model, in which students and clinicians are taught to operate from a patient based rather than a theory based perspective.

This study examines point of entry, functional impairment, comorbid diagnosis, and demographic variables as predictors of treatment amount and cost for patients with mental illness and substance abuse disorders in Santa Barbara County Mental Health Services. Overall, significant results were found for point of entry, with higher costs associated with mental health than chemical abuse point of entry. Furthermore, amount, modality, and cost of service varied widely across such variables as functional impairment with those rated as least impaired receiving the greatest amount of services at the greatest cost. Additional significant findings in treatment amount and cost are reported for variables such as homelessness, ethnicity, and age.