Bio

Academic Appointments


Professional Education


  • M.S., Drexel University, Psychology (2008)
  • Ph.D., Georgia State University, Clinical Psychology (2014)
  • Clinical Internship, UCLA, Semel Institute for Neuroscience and Human Behavior, Pediatric Psychology (2014)
  • Postdoctoral Fellowship, Stanford University School of Medicine, Pediatric Pain Psychology (2017)

Research & Scholarship

Current Research and Scholarly Interests


Pediatric Pain Management:
-Descriptive cross sectional research utilizing Peds-CHOIR
-Psychosocial interventions within an interdisciplinary outpatient and intensive rehabilitation setting (i.e., Pediatric Rehabilitation Program, PReP)

Risk and Resilience in Pediatric Pain
-Risk factors in pediatric pain including pain catastrophizing, particularly across developmental phases
-Resilience factors in pediatric pain such as acceptance of pain and mindfulness
-Mindfulness-based intervention for youth with pain and their parents/caregivers
-Photovoice with Pediatric Rehabilitation Program

Upcoming projects
-Adolescents and Young Adults (AYA) with chronic pain: exploring the needs of this population, developing and implementing interventions to promote psychosocial functioning and resilience

Publications

All Publications


  • A Pilot Study of Mindfulness Meditation for Pediatric Chronic Pain. Children (Basel, Switzerland) Waelde, L. C., Feinstein, A. B., Bhandari, R., Griffin, A., Yoon, I. A., Golianu, B. 2017; 4 (5)

    Abstract

    Despite advances in psychological interventions for pediatric chronic pain, there has been little research examining mindfulness meditation for these conditions. This study presents data from a pilot clinical trial of a six-week manualized mindfulness meditation intervention offered to 20 adolescents aged 13-17 years. Measures of pain intensity, functional disability, depression and parent worry about their child's pain were obtained at baseline and post-treatment. Results indicated no significant changes in pain or depression, however functional disability and frequency of pain functioning complaints improved with small effect sizes. Parents' worry about child's pain significantly decreased with a large effect size. Participants rated intervention components positively and most teens suggested that the number of sessions be increased. Three case examples illustrate mindfulness meditation effects and precautions. Mindfulness meditation shows promise as a feasible and acceptable intervention for youth with chronic pain. Future research should optimize intervention components and determine treatment efficacy.

    View details for DOI 10.3390/children4050032

    View details for PubMedID 28445406

  • The Effect of Pain Catastrophizing on Outcomes: A Developmental Perspective Across Children, Adolescents, and Young Adults With Chronic Pain. journal of pain Feinstein, A. B., Sturgeon, J. A., Darnall, B. D., Dunn, A. L., Rico, T., Kao, M. C., Bhandari, R. P. 2017; 18 (2): 144-154

    Abstract

    Pain catastrophizing is one of the most powerful predictors of poor outcomes in youth and adults with pain; however, little is known about differential effects of pain catastrophizing on outcomes as a function of age. The current study examined the predictive value of pain catastrophizing on pain interference and pain intensity across children, adolescents, and 2 age groups of young adults with chronic pain. Cross-sectional data are presented from the adult and pediatric Collaborative Health Outcomes Information Registry (CHOIR), including measures of pain catastrophizing, pain intensity, pain interference, and emotional distress from 1,028 individuals with chronic pain. Results revealed that age moderated the relation between pain catastrophizing and pain interference, with the strength of these effects declining with age. The effect of pain catastrophizing on pain interference was strongest in adolescents and relatively weak in all 3 other groups. Emotional distress was the strongest predictor of pain interference for children, whereas pain intensity was the strongest predictor for both adult groups. Pain catastrophizing was found to predict pain intensity and, although age was a significant moderator, statistical findings were weak. Developmental considerations and clinical implications regarding the utility of the construct of pain catastrophizing across age groups are discussed.This article explores differences in pain catastrophizing as predictors of pain interference and pain intensity across cohorts of children, adolescents, and 2 age groups of young adults. This work may stimulate further research on chronic pain from a developmental perceptive and inform developmentally tailored treatment interventions that target catastrophizing, emotional distress, and pain intensity.

    View details for DOI 10.1016/j.jpain.2016.10.009

    View details for PubMedID 27825857

  • Social Risk and Resilience Factors in Adolescent Chronic Pain: Examining the Role of Parents and Peers. Journal of pediatric psychology Ross, A. C., Simons, L. E., Feinstein, A. B., Yoon, I. A., Bhandari, R. P. 2017

    Abstract

    The current study focuses on social risk and resilience in an adolescent population with chronic pain. Prior research identifies parental cognitions and behaviors as influential in youths' experiences of chronic pain and pain-related disability. Adolescent development is characterized by greater autonomy from parents and an increased emphasis on peer relationships. Study aims explore the potential protective effect of high-quality adolescent peer relationships on associations between parent and adolescent cognitive and behavioral responses to pain.238 adolescents with mixed-etiology chronic pain and their parents completed Pediatric Collaborative Health Outcomes Information Registry (Peds-CHOIR) electronic questionnaires prior to their initial visit to a tertiary pediatric pain clinic. Variables in this study include parent catastrophizing, parent protective behavior, adolescent peer relationship quality, adolescent catastrophizing, adolescent functional impairment, and demographic and pain characteristics.As expected, associations between parent and adolescent cognitive and behavioral pain responses were moderated by peer relationship quality. Contrary to expectations, for adolescents endorsing low-quality peer relationships, maladaptive adolescent outcomes were elevated across levels of parental cognitions and behaviors. For adolescents endorsing high-quality peer relationships, adolescent and parent pain responses were linearly related.This study highlights the salience of both family and peer processes in functional outcomes among adolescents with chronic pain. Results suggest that adolescents' adaptive responses to chronic pain may be best supported by the simultaneous presence of adaptive parenting and high-quality peer relationships. Understanding the larger social context in which an adolescent exists is informative in specifying models that predict adaptive outcomes or magnify risks.

    View details for DOI 10.1093/jpepsy/jsx118

    View details for PubMedID 29048554

  • Pediatric-Collaborative Health Outcomes Information Registry (Peds-CHOIR): a learning health system to guide pediatric pain research and treatment. Pain Bhandari, R. P., Feinstein, A. B., Huestis, S. E., Krane, E. J., Dunn, A. L., Cohen, L. L., Kao, M. C., Darnall, B. D., Mackey, S. C. 2016; 157 (9): 2033-2044

    Abstract

    The pediatric adaptation of the Collaborative Health Outcomes Information Registry (Peds-CHOIR) is a free, open-source, flexible learning health care system (LHS) that meets the call by the Institute of Medicine for the development of national registries to guide research and precision pain medicine. This report is a technical account of the first application of Peds-CHOIR with 3 aims: (1) to describe the design and implementation process of the LHS; (2) to highlight how the clinical system concurrently cultivates a research platform rich in breadth (eg, clinic characteristics) and depth (eg, unique patient- and caregiver-reporting patterns); and (3) to demonstrate the utility of capturing patient-caregiver dyad data in real time, with dynamic outcomes tracking that informs clinical decisions and delivery of treatments. Technical, financial, and systems-based considerations of Peds-CHOIR are discussed. Cross-sectional retrospective data from patients with chronic pain (N = 352; range, 8-17 years; mean, 13.9 years) and their caregivers are reported, including National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) domains (mobility, pain interference, fatigue, peer relations, anxiety, and depression) and the Pain Catastrophizing Scale. Consistent with the literature, analyses of initial visits revealed impairments across physical, psychological, and social domains. Patients and caregivers evidenced agreement in observable variables (mobility); however, caregivers consistently endorsed greater impairment regarding internal experiences (pain interference, fatigue, peer relations, anxiety, and depression) than patients' self-report. A platform like Peds-CHOIR highlights predictors of chronic pain outcomes on a group level and facilitates individually tailored treatment(s). Challenges of implementation and future directions are discussed.

    View details for DOI 10.1097/j.pain.0000000000000609

    View details for PubMedID 27280328

  • Single-Case Research Design in Pediatric Psychology: Considerations Regarding Data Analysis JOURNAL OF PEDIATRIC PSYCHOLOGY Cohen, L. L., Feinstein, A., Masuda, A., Vowles, K. E. 2014; 39 (2): 124-137

    Abstract

    Single-case research allows for an examination of behavior and can demonstrate the functional relation between intervention and outcome in pediatric psychology. This review highlights key assumptions, methodological and design considerations, and options for data analysis.Single-case methodology and guidelines are reviewed with an in-depth focus on visual and statistical analyses.Guidelines allow for the careful evaluation of design quality and visual analysis. A number of statistical techniques have been introduced to supplement visual analysis, but to date, there is no consensus on their recommended use in single-case research design.Single-case methodology is invaluable for advancing pediatric psychology science and practice, and guidelines have been introduced to enhance the consistency, validity, and reliability of these studies. Experts generally agree that visual inspection is the optimal method of analysis in single-case design; however, statistical approaches are becoming increasingly evaluated and used to augment data interpretation.

    View details for DOI 10.1093/jpepsy/jst065

    View details for Web of Science ID 000332344000002

    View details for PubMedID 24003176

  • Ecological system influences in the treatment of pediatric chronic pain PAIN RESEARCH & MANAGEMENT Logan, D. E., Engle, L., Feinstein, A. B., Sieberg, C. B., Sparling, P., Cohen, L. L., Conroy, C., Driesman, D., Masuda, A. 2012; 17 (6): 407-411

    Abstract

    Family, school and the peer network each shape the chronic pain experience of the individual child, and each of these contexts also represents a domain of functioning often impaired by chronic pain. The goal of the present article is to summarize what is known about these bidirectional influences between children with pain and the social systems that surround them. Case reports that illustrate these complex, transactional forces and their ultimate impact on the child's pain-related functioning are included. A case involving siblings participating in an intensive interdisciplinary program for functional restoration and pain rehabilitation highlights how parents change through this treatment approach and how this change is vital to the child's outcomes. Another case involving a child undergoing intensive interdisciplinary treatment illustrates how school avoidance can be treated in the context of pain rehabilitation, resulting in successful return to the regular school environment. Finally, an acceptance and commitment therapy-focused group intervention for children with sickle cell disease and their parents demonstrates the benefits of peer contact as an element of the therapeutic intervention.

    View details for Web of Science ID 000315572000007

    View details for PubMedID 23248814

  • The Influence of Parent Preprocedural Anxiety on Child Procedural Pain: Mediation by Child Procedural Anxiety JOURNAL OF PEDIATRIC PSYCHOLOGY Bearden, D. J., Feinstein, A., Cohen, L. L. 2012; 37 (6): 680-686

    Abstract

    Data suggest parents' preprocedural anxiety is related to children's acute procedural anxiety and pain. This study examined the temporal relations among these constructs to determine whether children's anxiety mediates the relation between parents' anticipatory anxiety and children's procedural pain.A total of 90 preschoolers receiving immunizations, their parents, and the nurses rated children's procedural anxiety and pain. Parents provided ratings of their own preprocedural anxiety.Bootstrapping analyses revealed that children's procedural anxiety mediated the relation between parents' preprocedural anxiety and children's procedural pain according to parents' report and nurses' report but not children's self-report of anxiety and pain.Analyses suggest that children's procedural anxiety mediates the relation between parents' anticipatory anxiety and children's procedural pain. Thus, targeting parents' preprocedural anxiety might be beneficial to the parents as well as the children undergoing a distressing medical procedure.

    View details for DOI 10.1093/jpepsy/jss041

    View details for Web of Science ID 000305827600010

    View details for PubMedID 22623729

  • Pain Intensity, Psychological Inflexibility, and Acceptance of Pain as Predictors of Functioning in Adolescents with Juvenile Idiopathic Arthritis: A Preliminary Investigation JOURNAL OF CLINICAL PSYCHOLOGY IN MEDICAL SETTINGS Feinstein, A. B., Forman, E. M., Masuda, A., Cohen, L. L., Herbert, J. D., Moorthy, L. N., Goldsmith, D. P. 2011; 18 (3): 291-298

    Abstract

    Juvenile Idiopathic Arthritis (JIA) is a chronic rheumatic disease associated with pain and maladjustment. This study investigated whether pain, acceptance of pain, and psychological inflexibility uniquely predicted functional disability, anxiety, general quality of life (QOL), and health-related quality of life (HQOL) among adolescents with JIA. Twenty-three adolescents with JIA and pain were recruited from a pediatric rheumatology clinic. Participants completed self-report measures pertaining to the key study variables. A series of multiple regression analyses demonstrated that higher pain uniquely predicted higher functional disability. Greater psychological inflexibility uniquely predicted higher anxiety, lower general QOL, and lower HQOL. Increases in acceptance of pain were found to be uniquely related to increases in general QOL. These data confirm prior findings that pain impacts functioning, and provide preliminary findings that psychological inflexibility and acceptance may be important targets of psychological intervention for youth with JIA and pain to improve functioning and QOL.

    View details for DOI 10.1007/s10880-011-9243-6

    View details for Web of Science ID 000294361000007

    View details for PubMedID 21630002

  • Cognitive Defusion Versus Thought Distraction: A Clinical Rationale, Training, and Experiential Exercise in Altering Psychological Impacts of Negative Self-Referential Thoughts BEHAVIOR MODIFICATION Masuda, A., Feinstein, A. B., Wendell, J. W., Sheehan, S. T. 2010; 34 (6): 520-538

    Abstract

    Using two modes of intervention delivery, the present study compared the effects of a cognitive defusion strategy with a thought distraction strategy on the emotional discomfort and believability of negative self-referential thoughts. One mode of intervention delivery consisted of a clinical rationale and training (i.e., Partial condition). The other mode contained a condition-specific experiential exercise with the negative self-referential thought in addition to the clinical rationale and training (i.e., Full condition). Nonclinical undergraduates were randomly assigned to one of five protocols: Partial-Defusion, Full-Defusion, Partial-Distraction, Full-Distraction, and a distraction-based experimental control task. The Full-Defusion condition reduced the emotional discomfort and believability of negative self-referential thoughts significantly more than other comparison conditions. The positive results of the Full-Defusion condition were also found among participants with elevated depressive symptoms.

    View details for DOI 10.1177/0145445510379632

    View details for Web of Science ID 000282686100003

    View details for PubMedID 20689153

  • The effects of cognitive defusion and thought distraction on emotional discomfort and believability of negative self-referential thoughts JOURNAL OF BEHAVIOR THERAPY AND EXPERIMENTAL PSYCHIATRY Masud, A., Twohig, M. P., Stormo, A. R., Feinstein, A. B., Chou, Y., Wendell, J. W. 2010; 41 (1): 11-17

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