Thaddeus Pace

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Scholarly Contributions

Chapters

• Badger, T. A., & Pace, T. W. (2017). Depression in families.. In Encyclopedia of Nursing Research, 4th ed.. New York, New York: Springer.

Journals/Publications

• Aguilar-Raab, C., Winter, F., Warth, M., Stoffel, M., Moessner, M., Hernández, C., Pace, T. W., Harrison, T., Negi, L. T., Jarczok, M. N., & Ditzen, B. (2023). A compassion-based treatment for couples with the female partner suffering from current depressive disorder: A randomized-controlled trial. Journal of affective disorders, 342, 127-138.
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  Studies have shown that depression and interpersonal relationships are interdependently connected and that including the intimate partner in treatment for depression has beneficial effects. Given evidence that compassion is both an interpersonal quality and a promising treatment target, the goal of this study was to examine the effects of a compassion-based, contemplative treatment for couples employing a multi-method approach for evaluation.
• Maldonado, A., Villavicencio, E. A., Vogel, R. M., Pace, T. W., Ruiz, J. M., Alkhouri, N., & Garcia, D. O. (2023). The association between perceived stress, acculturation, and non-alcoholic fatty liver disease in Mexican-origin adults in Southern Arizona. Preventive medicine reports, 32, 102147.
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  Although available evidence indicates that Mexican-origin (MO) adults experience unique stressful life events, little is known about how stress may influence risk for developing non-alcoholic fatty liver disease (NAFLD) for this high-risk group. This study investigated the association between perceived stress and NAFLD and explored how this relationship varied by acculturation levels. In a cross-sectional study, a total of 307 MO adults from a community-based sample in the U.S-Mexico Southern Arizona border region completed self-reported measures of perceived stress and acculturation. NAFLD was identified as having a continuous attenuation parameter (CAP) score of ≥ 288 dB/m determined by FibroScan®. Logistic regression models were fitted to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for NAFLD. The prevalence of NAFLD was 50 % (n = 155). Overall, perceived stress was high ( = 15.9) for the total sample. There were no differences by NAFLD status (No NAFLD:  = 16.6; NAFLD:  = 15.3; p = 0.11). Neither perceived stress nor acculturation were associated with NAFLD status. However, the association between perceived stress and NAFLD was moderated by acculturation levels. Specifically with each point increase in perceived stress, the odds of having NAFLD were 5.5 % higher for MO adults with an Anglo orientation and 1.2 % higher for bicultural MO adults. In contrast, the odds of NAFLD for MO adults with a Mexican cultural orientation were 9.3 % lower with each point increase in perceived stress. In conclusion, results highlight the need for additional efforts to fully understand the pathways through which stress and acculturation may influence the prevalence of NAFLD in MO adults.
• Duenas, K. R., Ingram, M., Crocker, R. M., Pace, T. W., de Zapien, J. G., Torres, E., & Carvajal, S. C. (2022). La vida en la frontera: protocol for a prospective study exploring stress and health resiliencies among Mexican-origin individuals living in a US-Mexico border community. BMC public health, 22(1), 2442.
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  Mexican-origin adults living near the U.S.-Mexico border experience unique and pervasive social and ecological stressors, including poverty, perceived discrimination, and environmental hazards, potentially contributing to the high burden of chronic disease. However, there is also evidence that residents in high-density Mexican-origin neighborhoods exhibit lower prevalence rates of disease and related mortality than those living in other areas. Understanding the factors that contribute to health resiliencies at the community scale is essential to informing the effective design of health promotion strategies.
• Merker, J. B., Dixon, H. D., Gluck, R., Kim, Y. J., Powers, A., Schwartz, A. C., Jovanovic, T., Umpierrez, G., Ressler, K. J., Michopoulos, V., Pace, T. W., Gillespie, C. F., & Seligowski, A. V. (2022). Heart rate variability and HbA1c predict plasma interleukin-6 response to psychosocial stress challenge in trauma-exposed women with type 2 diabetes. Brain, behavior, & immunity - health, 19, 100400.
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  Type 2 diabetes mellitus (T2DM) is a major public health problem in the United States. Although cardiovascular autonomic functioning, blood glucose control, and inflammation are known to play a role in T2DM, the interaction between these variables remains largely unexplored, particularly in the context of stress. To address this gap, we examined the relationship between these variables in a sample that is uniquely vulnerable to the health consequences of T2DM.
• Pace, T. W., Zeiders, K. H., Cook, S. H., Sarsar, E. D., Hoyt, L. T., Mirin, N. L., Wood, E. P., Tatar, R., & Davidson, R. J. (2022). Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Meditation Intervention to Decrease Firefighter Psychological Distress and Burnout: A One-Group Pilot Study. JMIR formative research, 6(6), e34951.
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  Firefighters are often exposed to occupational stressors that can result in psychological distress (ie, anxiety and depression) and burnout. These occupational stressors have only intensified with the onset of the COVID-19 pandemic and will likely persist in the postpandemic world.
• Seligowski, A. V., Fonkoue, I. T., Noble, N. C., Dixon, D., Gluck, R., Kim, Y. J., Powers, A., Pace, T. W., Jovanovic, T., Umpierrez, G., Ressler, K. J., Quyyumi, A. A., Michopoulos, V., & Gillespie, C. F. (2022). Vagal control moderates the association between endothelial function and PTSD symptoms in women with T2DM. Brain, behavior, & immunity - health, 26, 100527.
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  Individuals with posttraumatic stress disorder (PTSD) are more likely to present with metabolic diseases such as type-2 diabetes mellitus (T2DM), and cardiovascular dysfunction has been implicated in this link. These diseases disproportionately affect women and individuals exposed to chronic environmental stressors (e.g., community violence, poverty). We examined associations among PTSD, cardiovascular indices, and metabolic function in highly trauma-exposed Black women with T2DM.
• Shapira, I., Richman, J., Pace, T. W., Lim, K. O., Polusny, M. A., Hamner, M. B., Bremner, J. D., Mumba, M. N., Jacobs, M. L., Pilkinton, P., & Davis, L. L. (2022). Biomarker Response to Mindfulness Intervention in Veterans Diagnosed with Post-traumatic Stress Disorder. Mindfulness, 13(10), 2448-2460.
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  This study evaluates the effects of treatment with mindfulness-based stress reduction (MBSR) compared to the active control, present-centered group therapy (PCGT), on morning plasma cortisol, interleukin-6 (IL-6), and C-reactive protein (CRP) in veterans diagnosed with post-traumatic stress disorder (PTSD).
• Strauch, K. A., Carrington, J. M., & Pace, T. W. (2022). The current state of patient-to-provider communication of childhood adversity in primary care. Journal of the American Association of Nurse Practitioners.
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  There is a wealth of literature focused on the task of adverse childhood experiences (ACEs) screening; however, little literature exists describing the broader process of ACE-related communication, specifically between nurse practitioners (NPs) and adult primary care patients. Consequently, there is no standardized process for communicating about ACEs in primary care and significant gaps remain related to how, when, and where these conversations occur.
• Crane, T. E., Badger, T. A., O'connor, P. A., Segrin, C., Alvarez, A., Freylersythe, S. J., Penaloza, I., Pace, T. W., & Sikorskii, A. (2021). Lifestyle intervention for Latina cancer survivors and caregivers: the Nuestra Salud randomized pilot trial.. Journal of cancer survivorship : research and practice, 15(4), 607-619. doi:10.1007/s11764-020-00954-z
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  Assess feasibility, acceptability, and preliminary efficacy of an integrated symptom management and lifestyle intervention (SMLI) to improve adherence to the American Cancer Society's (ACS) Guidelines on Nutrition and Physical Activity in Latina cancer survivors and their informal caregivers (dyads)..Forty-five dyads were randomized to a 12-week telephone-delivered intervention or attention control. Intervention effects on nutrition, physical activity, symptom burden, and self-efficacy for symptom management were estimated using Cohen's ds..Mean age was 64 for survivors and 53 for caregivers. Feasibility was demonstrated by the 63% consent rate out of approached dyads. The SMLI was acceptable for 98% of dyads. Among survivors, medium-to-large effect sizes were found for increased servings of total fruits and vegetables (d = 0.55), vegetables (d = 0.72), and decreased sugar intake (d = - 0.51) and medium clinically significant effect sizes for total minutes of physical activity per week (d = 0.42) and grams of fiber intake per day (d = 0.40) for intervention versus attention control. Additionally, medium-to-large intervention effects were found for the reduction of symptom burden (d = 0.74). For caregivers, medium-to-large intervention effects were found for reduced total sugar intake (d = - 0.60) and sugar intake from sugar-sweetened beverages (d = - 0.65); vegetable intake was increased with a medium effect size (d = 0.41)..SMLI was feasible and acceptable for both dyadic members. A larger, well-powered trial is needed to formally evaluate SMLI effectiveness..Integrating symptom management with lifestyle behavior interventions may increase adherence to the ACS guidelines on nutrition and physical activity to prevent new and recurrent cancers.
• Gordon, J. S., Sbarra, D., Armin, J., Pace, T. W., Gniady, C., & Barraza, Y. (2021). Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19-Related Stress: Pilot Feasibility Study. JMIR formative research, 5(10), e32353.
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  The SARS-CoV-2 pandemic has led to concerns about mental health resulting from regional and national lockdowns, social isolation, job loss, and concern about disease exposure.
• McGarrity-Yoder, M. E., Insel, K. C., Crane, T. E., & Pace, T. W. (2021). Diet quality and disease activity in rheumatoid arthritis. Nutrition and health, 2601060211044311.
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  This study examined associations between diet quality and disease activity in adults with rheumatoid arthritis (RA). Perceived stress was also compared to diet and disease activity. In a cross-sectional design, 50 adults with RA were recruited. The Arizona Food Frequency Questionnaire was used to measure dietary intake (four weeks) and diet quality scores were calculated with the Healthy Eating Index - 2015. Perceived stress was measured with the Perceived Stress Scale. Disease activity was measured with the Health Assessment Questionnaire-Disability Index and Pain Scale, erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein, and Disease Activity Score Including 28 Joints-ESR. Diet quality (56;  ± 12) in participants was lower than the national mean (59). Age ( = 0.015) and gender ( = 0.003) were associated with higher diet quality. The belief that diet affects RA disease activity was reported by 44% of the participants, and these participants were significantly more likely to report dietary changes ( 
• McLean, S. A., Ressler, K., Koenen, K. C., Neylan, T., Germine, L., Jovanovic, T., Clifford, G. D., Zeng, D., An, X., Linnstaedt, S., Beaudoin, F., House, S., Bollen, K. A., Musey, P., Hendry, P., Jones, C. W., Lewandowski, C., Swor, R., Datner, E., , Mohiuddin, K., et al. (2021). Correction: The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure. Molecular psychiatry, 26(7), 3658.
• Pace, T. W., Badger, T. A., Segrin, C., Sikorskii, A., & Crane, T. E. (2021). The Relationship Between Health-Related Quality of Life and Saliva C-Reactive Protein and Diurnal Cortisol Rhythm in Latina Breast Cancer Survivors and Their Informal Caregivers: A Pilot Study.. Journal of transcultural nursing : official journal of the Transcultural Nursing Society, 32(4), 326-335. doi:10.1177/1043659620926537
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  Introduction: To date, no study has explored associations between objective stress-related biomarkers (i.e., inflammatory markers, diurnal rhythm of cortisol) and health-related quality of life (HRQOL) in Latina breast cancer survivors and their informal caregivers (i.e., family, friends). Method: This cross-sectional feasibility study assessed saliva C-reactive protein, saliva diurnal cortisol rhythm (cortisol slope), and self-reported HRQOL (psychological, physical, and social domains) in 22 Latina survivor-caregiver dyads. Feasibility was defined as ≥85% samples collected over 2 days (on waking, in afternoon, and in evening). Associations between biomarkers and HRQOL were examined with correlational analyses. Results: Collection of saliva was feasible. Strongest associations were observed between survivor evening cortisol (as well as cortisol slope) and fatigue, a component of physical HRQOL. Discussion: Associations presented may help promote investigations of mechanisms linking stress-related biomarkers and HRQOL in Latina breast cancer survivor-caregiver dyads, which will facilitate development of culturally congruent interventions for this underserved group.
• Powers, A., Mekawi, Y., Fickenwirth, M., Nugent, N. R., Dixon, H. D., Minton, S., Kim, Y. J., Gluck, R., Carter, S., Fani, N., Schwartz, A. C., Bradley, B., Umpierrez, G. E., Pace, T. W., Jovanovic, T., Michopoulos, V., & Gillespie, C. F. (2021). Emotion dysregulation and dissociation contribute to decreased heart rate variability to an acute psychosocial stressor in trauma-exposed Black women. Journal of psychiatric research, 142, 125-131.
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  Reduced heart rate variability (HRV) in response to stress is a biomarker of emotion dysregulation (ED) and is related to posttraumatic stress disorder (PTSD), yet less is known about its role with dissociation in trauma-exposed adults. The goals of the current study were to examine unique patterns of associations between ED, dissociation, and PTSD with HRV at 15, 30, and 45 min (T1, T2, T3) following an acute psychosocial stressor task in a sample of 49 trauma-exposed, urban-dwelling Black women. Associations with baseline psychophysiology measures were also examined. ED and dissociation were assessed using self-report; PTSD was determined using a semi-structured interview. Heart rate (HR) and HRV, indexed with low frequency/high frequency (LF/HF) ratio and respiratory sinus arrhythmia (RSA), were measured with electrocardiogram recordings. ED and dissociation were positively correlated with LF/HF ratio at T3 (p 
• Titanji, B. K., Tejani, M., Farber, E. W., Mehta, C. C., Pace, T. W., Meagley, K., Gavegnano, C., Harrison, T., Kokubun, C. W., Negi, S. D., Schinazi, R. F., & Marconi, V. C. (2021). Cognitively-Based Compassion Training for HIV Immune Non-responders - An Attention-Placebo Randomized Controlled Trial. Journal of acquired immune deficiency syndromes (1999).
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  Chronic inflammation is associated with increased morbidity and mortality for people with HIV (PWH). Psychological stress is an important contributor to this chronic inflammation. We hypothesized that a Cognitively-Based Compassion Training (CBCT) approach could reduce inflammation and psychological stress in immune non-responder PWH.
• Wyatt, G., Lehto, R., Guha-Niyogi, P., Brewer, S., Victorson, D., Pace, T., Badger, T., & Sikorskii, A. (2021). Reflexology and meditative practices for symptom management among people with cancer: Results from a sequential multiple assignment randomized trial. Research in nursing & health, 44(5), 796-810.
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  Optimal sequencing of complementary therapies can help improve symptom management through nonpharmacological approaches. A 12-week sequential multiple assignment randomized trial comparing home-based reflexology and meditative practices on severity of fatigue and other symptoms was conducted among patients with cancer and their informal caregivers. Dyads were initially randomized to reflexology (N = 150), meditative practices (N = 150), or control (N = 47). If patient's fatigue did not improve (nonresponse) after 4 weeks of reflexology or meditative practices, the dyad was rerandomized to either add the other therapy or continue with the original therapy for weeks 5-8. Four decision rules (DRs) were compared: (1) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, continue with reflexology for another 4 weeks, thus providing a higher dose; (2) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, add meditative practices for the next 4 weeks; (3) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, continue meditative practices for another 4 weeks, thus providing a higher dose; and (4) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, add reflexology for the next 4 weeks. Symptoms were evaluated weekly using the M.D. Anderson Symptom Inventory (MDASI). Clinically, nurses can recommend either therapy since no differences were found among the 4 DRs, with the exception of lower severity for summed MDASI symptoms at week 8 for the use of reflexology only (DR-1) versus DR-2 (sequencing reflexology to meditative practices). Adding the other therapy for nonresponders after 4 weeks may not be warranted.
• Crane, T. E., Badger, T. A., O'Connor, P., Segrin, C., Alvarez, A., Freylersythe, S. J., Penaloza, I., Pace, T. W., & Sikorskii, A. (2020). Lifestyle intervention for Latina cancer survivors and caregivers: the Nuestra Salud randomized pilot trial. Journal of cancer survivorship : research and practice.
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  Assess feasibility, acceptability, and preliminary efficacy of an integrated symptom management and lifestyle intervention (SMLI) to improve adherence to the American Cancer Society's (ACS) Guidelines on Nutrition and Physical Activity in Latina cancer survivors and their informal caregivers (dyads).
• Kessler, R. C., Ressler, K. J., House, S. L., Beaudoin, F. L., An, X., Stevens, J. S., Zeng, D., Neylan, T. C., Linnstaedt, S. D., Germine, L. T., Musey, P. I., Hendry, P. L., Sheikh, S., Storrow, A. B., Jones, C. W., Punches, B. E., Datner, E. M., Mohiuddin, K., Gentile, N. T., , McGrath, M. E., et al. (2020). Socio-demographic and trauma-related predictors of PTSD within 8 weeks of a motor vehicle collision in the AURORA study. Molecular psychiatry.
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  This is the initial report of results from the AURORA multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience. We focus on n = 666 participants presenting to EDs following a motor vehicle collision (MVC) and examine associations of participant socio-demographic and participant-reported MVC characteristics with 8-week posttraumatic stress disorder (PTSD) adjusting for pre-MVC PTSD and mediated by peritraumatic symptoms and 2-week acute stress disorder (ASD). Peritraumatic Symptoms, ASD, and PTSD were assessed with self-report scales. Eight-week PTSD prevalence was relatively high (42.0%) and positively associated with participant sex (female), low socioeconomic status (education and income), and several self-report indicators of MVC severity. Most of these associations were entirely mediated by peritraumatic symptoms and, to a lesser degree, ASD, suggesting that the first 2 weeks after trauma may be a uniquely important time period for intervening to prevent and reduce risk of PTSD. This observation, coupled with substantial variation in the relative strength of mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated with more in-depth analyses of the rich and evolving AURORA data.
• McLean, S. A., Ressler, K., Koenen, K. C., Neylan, T., Germine, L., Jovanovic, T., Clifford, G. D., Zeng, D., An, X., Linnstaedt, S., Beaudoin, F., House, S., Bollen, K. A., Musey, P., Hendry, P., Jones, C. W., Lewandowski, C., Swor, R., Datner, E., , Mohiuddin, K., et al. (2020). The AURORA Study: a longitudinal, multimodal library of brain biology and function after traumatic stress exposure. Molecular psychiatry, 25(2), 283-296.
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  Adverse posttraumatic neuropsychiatric sequelae (APNS) are common among civilian trauma survivors and military veterans. These APNS, as traditionally classified, include posttraumatic stress, postconcussion syndrome, depression, and regional or widespread pain. Traditional classifications have come to hamper scientific progress because they artificially fragment APNS into siloed, syndromic diagnoses unmoored to discrete components of brain functioning and studied in isolation. These limitations in classification and ontology slow the discovery of pathophysiologic mechanisms, biobehavioral markers, risk prediction tools, and preventive/treatment interventions. Progress in overcoming these limitations has been challenging because such progress would require studies that both evaluate a broad spectrum of posttraumatic sequelae (to overcome fragmentation) and also perform in-depth biobehavioral evaluation (to index sequelae to domains of brain function). This article summarizes the methods of the Advancing Understanding of RecOvery afteR traumA (AURORA) Study. AURORA conducts a large-scale (n = 5000 target sample) in-depth assessment of APNS development using a state-of-the-art battery of self-report, neurocognitive, physiologic, digital phenotyping, psychophysical, neuroimaging, and genomic assessments, beginning in the early aftermath of trauma and continuing for 1 year. The goals of AURORA are to achieve improved phenotypes, prediction tools, and understanding of molecular mechanisms to inform the future development and testing of preventive and treatment interventions.
• Pace, T. W., Badger, T. A., Segrin, C., Sikorskii, A., & Crane, T. E. (2020). The Relationship Between Health-Related Quality of Life and Saliva C-Reactive Protein and Diurnal Cortisol Rhythm in Latina Breast Cancer Survivors and Their Informal Caregivers: A Pilot Study. Journal of transcultural nursing : official journal of the Transcultural Nursing Society, 1043659620926537.
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  To date, no study has explored associations between objective stress-related biomarkers (i.e., inflammatory markers, diurnal rhythm of cortisol) and health-related quality of life (HRQOL) in Latina breast cancer survivors and their informal caregivers (i.e., family, friends). This cross-sectional feasibility study assessed saliva C-reactive protein, saliva diurnal cortisol rhythm (cortisol slope), and self-reported HRQOL (psychological, physical, and social domains) in 22 Latina survivor-caregiver dyads. Feasibility was defined as ≥85% samples collected over 2 days (on waking, in afternoon, and in evening). Associations between biomarkers and HRQOL were examined with correlational analyses. Collection of saliva was feasible. Strongest associations were observed between survivor evening cortisol (as well as cortisol slope) and fatigue, a component of physical HRQOL. Associations presented may help promote investigations of mechanisms linking stress-related biomarkers and HRQOL in Latina breast cancer survivor-caregiver dyads, which will facilitate development of culturally congruent interventions for this underserved group.
• Rung, O., Stauber, L., Loescher, L. J., & Pace, T. W. (2021). Alternate Nostril Breathing to Reduce Stress: An Option for Pregnant Women Survivors of Intimate Partner Violence?. Journal of holistic nursing : official journal of the American Holistic Nurses' Association, 898010120983659.
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  Stress resulting from intimate partner violence (IPV) on pregnant women causes and sustains poor health and contributes to poor pregnancy and birth outcomes. Appropriate interventions to reduce stress in this population of women are warranted.
• Umpierrez, G. E., Seligowski, A. V., Ressler, K. J., Phillips, K., Pace, T. W., Michopoulos, V., Gluck, R., Gillespie, C. F., & Dixon, H. D. (2020). Post-Traumatic Stress Disorder Diagnosis and Re-Experiencing Symptom Severity Worsens Glucose Intolerance in African-American Women With Type 2 Diabetes. Biological Psychiatry, 87(9), S429-S430. doi:10.1016/j.biopsych.2020.02.1095
• Zeiders, K. H., Pace, T. W., Nair, R. L., Hoyt, L. T., & Cruze, A. (2020). Latino early adolescents' psychological and physiological responses during the 2016 U.S. presidential election.. Cultural diversity & ethnic minority psychology, 26(2), 169-175. doi:10.1037/cdp0000301
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  Research has documented increased psychological distress among adults during the 2016 U.S. presidential election; however, little is known about how major political events affect adolescents. Despite not actively participating in the election process (e.g., voting), adolescents generally, and Latino youth specifically, may experience a unique stress response during elections, particularly when perceived policy changes center on issues related to their own families' stability and well-being..We examined 42 Latino early adolescents (Mage = 12.50 years, SD = .88; 58% male; 94% immigrant background) living in Arizona and explored their psychological and physiological responses during the 2016 U.S. presidential election. Adolescents self-reported their mood and behaviors for 5 consecutive days across election week (November 6-10, 2016): 2 days before the election, election day, and 2 days after the election. They also completed a saliva sampling protocol at waking and bedtime each day, to capture diurnal cortisol concentrations..Multilevel growth models were utilized to examine intraindividual changes in positive affect, negative affect, and diurnal cortisol patterns across election week. Only 2 of the participants reported supporting the winning candidate. Changes in adolescents' stress hormone concentrations were evident; increases in evening cortisol levels and flatter diurnal cortisol slopes emerged across election week. Negative affect, positive affect, and morning cortisol concentrations did not change..This study provides preliminary evidence that macrolevel factors, such as the recent presidential election, may relate to adolescents' daily stress physiology. Further research is needed to better understand adolescents' responses to sociopolitical change. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
• Pace, T. W., Dodds, S. E., Sikorskii, A., Badger, T. A., Segrin, C., Negi, L. T., Harrison, T., & Crane, T. E. (2019). Cognitively-Based Compassion Training versus cancer health education to improve health-related quality of life in survivors of solid tumor cancers and their informal caregivers: study protocol for a randomized controlled pilot trial. Trials, 20(1), 247.
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  Cancer survivors and their informal caregivers (family members, close friends) often experience significant impairments in health-related quality of life (HRQOL), including disruptions in psychological, physical, social, and spiritual well-being both during and after primary cancer treatment. The purpose of this in-progress pilot trial is to determine acceptability and preliminary efficacy (as reflected by effect sizes) of CBCT® (Cognitively-Based Compassion Training) compared with a cancer health education (CHE) attention control to improve the primary outcome of depressive symptoms and secondary outcomes of other HRQOL domains (e.g., anxiety, fatigue), biomarkers of inflammation and diurnal cortisol rhythm, and healthcare utilization-related outcomes in both cancer survivors and informal caregivers.
• Powers, A., Dixon, H. D., Conneely, K., Gluck, R., Munoz, A., Rochat, C., Mendoza, H., Hartzell, G., Ressler, K. J., Bradley, B., Pace, T. W., Umpierrez, G. E., Schwartz, A. C., Michopoulos, V., & Gillespie, C. F. (2019). The differential effects of PTSD, MDD, and dissociation on CRP in trauma-exposed women. Comprehensive psychiatry, 93, 33-40.
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  C-reactive protein (CRP), a marker of systemic inflammation, has been associated with psychiatric disorders including major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Some research suggests that exposure to trauma can trigger increased activity in the inflammatory system. Dissociation is associated with chronic trauma exposure and may be an important factor in understanding the risk for psychiatric outcomes associated with inflammation. The main objective of the current study was to understand how CRP was related to trauma, dissociation, PTSD and MDD in a sample of 55 traumatized African American women with type 2 diabetes mellitus recruited from an urban hospital.
• Zeiders, K. H., Nair, R. L., Hoyt, L. T., Pace, T. W., & Cruze, A. (2019). Latino early adolescents' psychological and physiological responses during the 2016 U.S. presidential election. Cultural diversity & ethnic minority psychology.
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  Research has documented increased psychological distress among adults during the 2016 U.S. presidential election; however, little is known about how major political events affect adolescents. Despite not actively participating in the election process (e.g., voting), adolescents generally, and Latino youth specifically, may experience a unique stress response during elections, particularly when perceived policy changes center on issues related to their own families' stability and well-being.
• Carrington, J. M., Pace, T. W., Sheppard, K. G., Dudding, K. M., & Stratton, D. (2017). Using Twitter to Teach Evidence-Based Practice in Doctor of Nursing Practice Degree Program. Clinical nurse specialist CNS, 31(6), 349-352.
• Mehl, M. R., Raison, C. L., Pace, T. W., Arevalo, J. M., & Cole, S. W. (2017). Natural language indicators of differential gene regulation in the human immune system. Proceedings of the National Academy of Sciences of the United States of America, 114(47), 12554-12559.
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  Adverse social conditions have been linked to a conserved transcriptional response to adversity (CTRA) in circulating leukocytes that may contribute to social gradients in disease. However, the CNS mechanisms involved remain obscure, in part because CTRA gene-expression profiles often track external social-environmental variables more closely than they do self-reported internal affective states such as stress, depression, or anxiety. This study examined the possibility that variations in patterns of natural language use might provide more sensitive indicators of the automatic threat-detection and -response systems that proximally regulate autonomic induction of the CTRA. In 22,627 audio samples of natural speech sampled from the daily interactions of 143 healthy adults, both total language output and patterns of function-word use covaried with CTRA gene expression. These language features predicted CTRA gene expression substantially better than did conventional self-report measures of stress, depression, and anxiety and did so independently of demographic and behavioral factors (age, sex, race, smoking, body mass index) and leukocyte subset distributions. This predictive relationship held when language and gene expression were sampled more than a week apart, suggesting that associations reflect stable individual differences or chronic life circumstances. Given the observed relationship between personal expression and gene expression, patterns of natural language use may provide a useful behavioral indicator of nonconsciously evaluated well-being (implicit safety vs. threat) that is distinct from conscious affective experience and more closely tracks the neurobiological processes involved in peripheral gene regulation.
• Segrin, C., Badger, T. A., Sikorskii, A., Crane, T. E., & Pace, T. W. (2017). A dyadic analysis of stress processes in Latinas with breast cancer and their family caregivers. Psycho-oncology.
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  Breast cancer diagnosis and treatment negatively affect quality of life for survivors and their family caregivers. The stress process model has been useful for describing the cascade of social and psychological experiences that culminate in degraded quality of life for both survivors and their family caregivers. This study is designed to test theoretically specified predictors of negative psychosocial outcomes in a dyadic context.
• Sikorskii, A., Wyatt, G., Lehto, R., Victorson, D., Badger, T., & Pace, T. (2017). Using SMART design to improve symptom management among cancer patients: A study protocol. Research in nursing & health, 40(6), 501-511.
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  In this in-progress sequential multiple assignment randomized trial (SMART), dyads of solid tumor cancer patients and their caregivers are initially randomized to 4 weeks of reflexology or meditative (mindfulness) practices provided by/with their caregiver in the patient's home or to a control group. After 4 weeks, intervention group dyads in which patients do not show improvement in fatigue (non-responders) are re-randomized to either receive additional time with the same therapy during weeks 5-8 or to add the other therapy. The aims are (1) to compare reflexology and meditative practices groups during weeks 1-4 on patients' fatigue severity, summed symptom inventory score, depressive symptoms, and anxiety, so as to determine the relative effectiveness of these therapies and the characteristics of responders and non-responders to each therapy. (2) Among reflexology non-responders based on fatigue score at week 4, to determine patient symptom outcomes when meditative practices are added during weeks 5-8, versus continuing with reflexology alone. (3) Among meditative practices non-responders based on fatigue score at week 4, to determine patient symptom outcomes when reflexology is added during weeks 5-8, versus continuing with meditative practices alone. (4) To compare improvements in patient symptom outcomes among the three groups created by the first randomization. (5) To explore which dyadic characteristics are associated with optimal patient symptom outcomes, to determine tailoring variables for decision rules of future interventions. The trial has a target of 331 dyads post-attrition and has 150 dyads enrolled. We are overcoming challenges with dyadic recruitment and retention while maintaining fidelity.
• Powers, A., Michopoulos, V., Conneely, K., Gluck, R., Dixon, H., Wilson, J., Jovanovic, T., Pace, T. W., Umpierrez, G. E., Ressler, K. J., Bradley, B., & Gillespie, C. F. (2016). Emotion Dysregulation and Inflammation in African-American Women with Type 2 Diabetes. Neural plasticity, 2016, 8926840.
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  C-reactive protein (CRP), a marker of systemic inflammation, has been associated with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Emotion dysregulation is a transdiagnostic risk factor for many psychological disorders associated with chronic inflammatory state. The objective of this study was to determine whether inflammation is associated with emotion dysregulation in women with type 2 diabetes mellitus (T2DM). We examined associations between trauma exposure, MDD, PTSD, emotion dysregulation, and CRP among 40 African-American women with T2DM recruited from an urban hospital. Emotion dysregulation was measured using the Difficulties in Emotion Regulation Scale. PTSD and MDD were measured with structured clinical interviews. Child abuse and lifetime trauma load were also assessed. Analyses showed that both emotion dysregulation and current MDD were significantly associated with higher levels of CRP (p < 0.01). Current PTSD was not significantly related to CRP. In a regression model, emotion dysregulation was significantly associated with higher CRP (p < 0.001) independent of body mass index, trauma exposure, and MDD diagnosis. These findings suggest that emotion dysregulation may be an important risk factor for chronic inflammation beyond already known risk factors among women with T2DM, though a causal relationship cannot be determined from this study.
• Reed, R. G., O'Connor, M. F., Pace, T. W., Raison, C. L., & Butler, E. A. (2016). Dyadic Coping and Salivary Interleukin-6 Responses to Interpersonal Stress. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43).
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  Dysregulated immune responses to stress are a potential pathway linking close relationship processes to health, and couples' abilities to cope with stress together (dyadic coping) likely impact such immune responses. Most stress research has focused on immune reactivity, whereas knowledge of immune recovery remains limited. The present study examined how acute interpersonal stress affects immune reactivity and recovery, as well as whether dyadic coping moderates these effects. Healthy couples (N = 24) completed the Dyadic Coping Inventory and provided saliva samples 4 times each day for 5 days, including 2 days before a laboratory dyadic stressor (discussing an area of disagreement), the day of, and 2 days after. Four additional saliva samples were taken throughout the laboratory stressor. Saliva samples were assayed for interleukin (IL)-6. Multilevel models that adjusted for demographic and health variables indicated that partners low in dyadic coping showed immune reactivity to the stressor whereas partners high in dyadic coping did not. Dyadic coping did not moderate immune recovery, which had occurred by 5 hr poststressor across all participants. Results suggest that partners low in dyadic coping show increased reactivity of immune responses to interpersonal stress. Enhancing dyadic coping in couples may impact not only their mental health and relationship quality, but also their risk of stress-related immune disorders. (PsycINFO Database Record

Presentations

• González Hernández, E., & Pace, T. W. (2020, October). Promoting Well-being in Breast Cancer Survivors with CBCT®: Research Findings and Future Directions. Contemplative Science Seminar. online: Center for Contemplative Science and Compassion-Based Ethics, Emory University.
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  Invited talk at Emory, co-presented with Dr. González Hernández about our research on CBCT for breast cancer survivors in Puebla and Arizona.
• Sarsar, E., Pace, T. W., Zeiders, K. H., Cook, S., & Hoyt, L. (2020, November). Pilot Testing an App-Based Meditation Intervention Among Firefighters During the COVID-19 Pandemic. COVID-19 Symposium. online: University of Arizona Health Sciences Center.
• Pace, T. W. (2019, July). Overcoming Distress to Promote Wellness in Cancer Survivorship. University of Illinois College of Medicine - Peoria, Cancer Biology and Pharmacology 2019 Research Seminar Series. University of Illinois - Peoria: UIC College of Medicine, Department of Cancer Biology and Pharmacology.
• Pace, T. W., Dodds, S., Sikorskii, A., Pahlitzsc, K. H., Badger, T. A., Segrin, C. G., Negi, L. T., Harrison, T., & Crane, T. E. (2019, February). Feasibility and Acceptability of Cognitively-Based Compassion Training to Improve Indicators of Distress in Solid Tumor Cancer Survivors and Their Informal Caregivers. American Psychosocial Oncology Society. Atlanta, GA.
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  Background: Cancer survivors and their informal caregivers (ICs)(family members or friends) often experience higher depression, anxiety, and fatigue both during and after primary cancer treatment. Our prior work suggests these impairments are interdependent between survivors and ICs. The goal of this trial is to promote well-being in dyads consisting of solid tumor cancer survivors and ICs with an 8-week compassion meditation-based intervention called CBCT® (Cognitively-Based Compassion Training). We expect that CBCT® will leverage emotional contagion to promote sharing of positive affect and well-being within dyads, potentially dismantling the possibility of shared negative affect.Methods: Dyads include survivors within 10 years of completing primary treatments (chemotherapy, radiation, surgery) and at least one member with mild depression or anxiety symptoms (determined by Patient Reported Outcomes Measurement Information System [PROMIS] 4a short forms). Dyads are randomized to either CBCT® or an 8-week active attention control (cancer health education, CHE). Feasibility was measured by retention, and acceptability by CBCT® and CHE intervention attendance and at-home practice (CBCT® only). We used PROMIS 8a forms to assess depression and anxiety, and PROMIS 7a to assess fatigue, before and after the 8-week interventions.Results: To date 16 individuals have been enrolled in the study. The retention rate is 88%. Participants randomized to CBCT and CHE attended 75% and 87.5% of classes, respectively. At-home practice of CBCT® averaged 4.90 (SD=1.92) sessions per week, with an average of 18.44 (SD=1.97) minutes per session. Baseline PROMIS depression, anxiety, and fatigue scores were 54.02 (SD=10.29), 61.59 (SD=3.53), and 56.49 (SD=5.82) for survivors and 51.44 (SD=6.56), 53.06 (SD=9.01), and 54.24 (SD=7.76) for caregivers, respectively.Conclusions: Intervention attendance and adherence were good, and better than prior studies involving CBCT® including with breast cancer survivors. Both CBCT® and CHE are feasible and acceptable in survivor-IC dyads experiencing mild-moderate depression, anxiety, and fatigue.Acknowledgement of funding: Jack Challem Trust
• Cruze, A., Cruze, A., Pace, T. W., Pace, T. W., Hoyth, L., Hoyth, L., Nair, R. L., Nair, R. L., Zeiders, K. H., & Zeiders, K. H. (2018, September). Latino adolescents’ psychological and physiological response to the 2016 U.S. presidential election. International Society of Psychoneuroendocrinology Annual Conference. Newport Beach, CA.
• Pace, T. W., Badger, T. A., Segrin, C. G., Sikorskii, A., & Crane, T. E. (2018, April / Spring). Saliva C-reactive Protein and Diurnal Cortisol Rhythm in Hispanic Breast Cancer Survivors and Their Informal Caregivers: Relationship with Cancer Treatments and Health-Related Quality of Life. Western Institute of Nursing Annual Conference. Spokane, WA, United States: Western Institute of Nursing.
• Pace, T. W., Sikorskii, A., Segrin, C. G., Badger, T. A., & Crane, T. E. (2018, Fall). Personalizing Symptom Management Interventions: Symptom Burden among Latinas with Breast Cancer and Their Informal Caregivers. State of the Science Congress. Washington DC: American Academy of Nursing.
• Pace, T. W., Sikorskii, A., Segrin, C. G., Badger, T. A., & Crane, T. E. (2018, Spring). Body Mass Index and Depression among Latina Breast Cancer Survivors. American Psycosocial Oncology Society Annual Meeting. Tucson, AZ: American Psycosocial Oncology Society.
• Pace, T. W., Sikorskii, A., Segrin, C. G., Badger, T. A., & Crane, T. E. (2018, Spring). Depression and Anxiety is Associated with Body Mass Index, but not Fatigue among Latina Breast Cancer Survivors. Western Institute of Nursing Annual Meeting. Spokane, WA: Western Institute of Nursing.
• Pace, T. W. (2017, August). Overcoming Stress to Promote Wellness in Survivorship. Kellman Beat Cancer Boot Camp monthly meeting. Udall Park, Tucson, AZ: Kellman Beat Cancer Boot Camp.
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  I presented my research and spoke about the mechanisms of wellness interventions in front of a sizable group of cancer survivors and their families at this event in Tucson.
• Sikorskii, A., Wyatt, G., Pace, T. W., Badger, T. A., & Victorson, D. (2016, December). Using SMART design to improve symptom management among cancer patients.. Cancer Prevention and Control Seminar. University of Arizona Cancer Center.
• Weihs, K. L., Raison, C. L., Pace, T. W., Dodds, S., Bell, M., Eparvier, L., & Fiero, M. (2015, July). Feasibility and Effects of Cognitively-Based Compassion Training (CBCT) on Psychological Well-Being in Breast Cancer Survivors: A Randomized, Wait List Controlled Pilot Study. 2015 World Congress of Psycho-Oncology. Washington, D.C.: American PsychoOncology Society.

Poster Presentations

• Pace, T. W., Dodds, S., Sikorskii, A., Badger, T. A., Segrin, C. G., Negi, L. T., Harrison, T., & Crane, T. E. (2020, April). Cognitively-Based Compassion Training to Improve Health-Related Quality of Life in Solid Tumor Cancer Survivors and Their Informal Caregivers: Findings from a Pilot Randomized Trial. American Society of Preventive Oncology. online.
• Pace, T. W., Dodds, S., Sikorskii, A., Badger, T. A., Segrin, C. G., Negi, L. T., Harrison, T., & Crane, T. E. (2020, March). Cognitively-Based Compassion Training to Improve Health-Related Quality of Life in Solid Tumor Cancer Survivors and Their Informal Caregivers: Findings from a Pilot Randomized Trial. American Psychosocial Oncology Society. online.
• Rung, O., Stauber, L. S., Loescher, L. J., & Pace, T. W. (2020, Spring). Intimate partner violence in pregnant women: Reducing stress with yogic breathing. Western Institute of Nursing Annual Meetings.
• Gallegos Jr., J. L., Ritter, L. S., Gallek, M., Taylor-Piliae, R. E., Pace, T. W., Pace, T. W., Gallek, M., Taylor-Piliae, R. E., Gallegos Jr., J. L., & Ritter, L. S. (2019, March). Hidden Risks: Relationship among visceral adipose tissue, interleukin - 18, and adiponectin in the development of type 2 diabetes in Filipino Americans. American Heart Association's 2019 EPI/Lifestyle Scientific Sessions. Houston, TX: American Heart Association.
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  accepted for presentation
• Pace, T. W., Dodds, S., Badger, T. A., Sikorskii, A., Negi, L. T., Segrin, C. G., Harrison, T., & Crane, T. E. (2019, April). FEASIBILITY AND ACCEPTABLITY OF COGNITIVELY-BASED COMPASSION TRAINING FOR SOLID TUMOR CANCER SURVIVORS AND THEIR INFORMAL CAREGIVERS. Western Institute of Nursing 2019 Conference. San Diego, CA.
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  Purpose/Aims: The purpose of this study was to determine the feasibility and acceptability of an 8-week compassion meditation-based intervention called CBCT® (Cognitively-Based Compassion Training) for survivors of solid tumor cancers and their informal caregivers (ICs) (i.e. family members or friends). We also worked to demonstrate feasibility of measuring features of depression, anxiety, and fatigue in survivor-IC dyads taking part in the intervention.Rationale/Conceptual Basis/Background: Cancer survivors and their ICs often experience higher depression, anxiety, and fatigue both during and after primary cancer treatment. Our prior work suggests these impairments are interdependent between survivors and ICs. The goal of this trial was to assess feasibility and acceptability of CBCT for survivor-IC dyads, with the longer-term goal of establishing CBCT in order to promote well-being in survivor-IC dyads. We expect that CBCT will leverage “emotional contagion” within survivor-IC dyads to promote sharing of positive affect and well-being for both dyad members, potentially dismantling the possibility of shared negative affect.Methods: Dyads included survivors within 10 years of completing primary treatments (chemotherapy, radiation, surgery) and at least one member with mild depression or anxiety symptoms (determined by Patient Reported Outcomes Measurement Information System [PROMIS] 4a short forms). Dyads were randomized to either CBCT or an 8-week active attention control (cancer health education, CHE). Both the CBCT and CHE groups met for 90 minutes each week, for 8 continuous weeks. At-home meditation practice was encouraged in the CBCT group. Feasibility was measured by retention, and acceptability by CBCT and CHE intervention attendance and at-home practice (CBCT only). We used PROMIS 8a forms to assess depression and anxiety, and the PROMIS 7a to assess fatigue.Results: Thirty-two individuals were enrolled in the study with a retention rate of 88%. Participants randomized to CBCT and CHE attended 75% and 87.5% of classes, respectively. At-home practice of CBCT averaged 4.90 (SD=1.92) sessions per week, with an average of 18.44 (SD=1.97) minutes per session. Baseline PROMIS depression, anxiety, and fatigue scores were 53.29 (SD=7.49), 58.19 (SD=5.35), and 55.83 (SD=4.86) for survivors and 52.55 (SD=5.21), 53.58 (SD=7.37), and 54.98 (SD=5.88) for caregivers, respectively.Conclusions: Intervention attendance and adherence was good, and better than prior studies involving CBCT including a study by us with breast cancer survivors. Both CBCT and CHE are feasible and acceptable in survivor-IC dyads experiencing mild-moderate depression, anxiety, and fatigue. The results of this trial are an important step toward exploring the benefits of CBCT for both survivors of solid tumor cancers and their informal caregivers.Acknowledgement of funding: Jack Challem Trust
• Pace, T. W., Loescher, L. J., Stauber, L. S., & Rung, O. (2020, Spring). Intimate partner violence in pregnant women: Reducing stress with yogic breathing. Western Institute of Nursing Annual Meetings.
• Gillespie, C. C., Dickson, D., Gluck, R., Munhoz, A., Mendoza, H., Rochat, C., Carter, S., Jovanovic, T., Fani, N., Lott, A., Bradley, B., Ressler, K., Umpierrez, G., Schwartz, A., Pace, T. W., & Michopoulos, V. (2017, December). Alterations in Glucocorticoid, Immune, and Metabolic Regulation are Associated with Post-Traumatic Stress Disorder in African-American Women with Type II Diabetes Mellitus. American College of Neuropsychopharmacology 56th Annual Meeting. Palm Spring, CA: American College of Neuropsychopharmacology.
• Pace, T. W., DeBlois, M., Walsh, M. E., Toomey, R. B., & Hernandez-Ainza, A. (2017, Spring). Depression, anxiety, and perceived social support as potential mediators for disparities in stress-hormonal regulation in transgender youth.. Mindfulness Research Conference. Seattle, WA.
• Pace, T. W., Pace, T. W., Rosenfeld, A. G., McEwen, M. M., McEwen, M. M., & Rosenfeld, A. G. (2016, April). Symptom biomarkers in Mexican American women with diabetes & heart disease.. Western Institute of Nursing Communicating Nursing Research Conference. Anaheim CA: Western Institute of Nursing.
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  This was work from our Emmons grant.

Others

• McEwen, M. M., Rosenfeld, A. G., & Pace, T. W. (2016, October). Concept Paper: Innovative, biobehavioral, symptom self-management approach to filling the existing gap in knowledge for Mexican-American women with co-occurring T2DM and IHD.. NIMHD program officers meeting.
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  Concept paper: We proposed an innovative, bio-behavioral, symptom self-management approach to filling the existing gap in knowledge for Mexican-American women with co-occurring T2DM and IHD.