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Frisch S, Walter S, Rebhann V, Gruss S, Geisel D, Bär KJ, Gündel H, Lane RD, Smith R. Unconscious Activation of Negative Emotional Memories Increases Pain Unpleasantness. Psychosom Med 2024; 86:580-590. [PMID: 38666650 DOI: 10.1097/psy.0000000000001315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVE The influence of unconscious emotional processes on pain remains poorly understood. The present study tested whether cues to forgotten unpleasant images might amplify pain (i.e., in the absence of conscious recall). METHODS Seventy-two healthy female adults (19 to 34 years) performed an adapted Think/No-think paradigm (T/NT) using 72 combinations of neutral face images (cues) paired with 36 neutral and 36 unpleasant images. After completion of the T/NT task, cues associated with forgotten neutral or unpleasant images were identified. Cues to either neutral or unpleasant images from the NT condition were then presented in randomized order while participants received intermediate-level thermal pain stimulation on the left hand. Ratings of both pain intensity and unpleasantness were acquired after each trial. RESULTS Mean pain unpleasantness ratings were greater during presentation of cues to forgotten negative versus neutral images (5.52 [SD = 2.06] versus 5.23 [SD = 2.10]; p = .02). This pattern was also present when comparing cues to remembered negative versus neutral images (5.62 [SD = 1.94] versus 5.04 [SD = 1.90]; p < .001). Mean pain intensity ratings were higher for cues to negative versus neutral images when remembered (5.48 [SD = 1.79] versus 5.00 [SD = 1.69]; p < .001), but not when forgotten (5.27 [SD = 1.96] versus 5.16 [SD = 1.93]; p = .30). CONCLUSIONS Using an adapted T/NT-Pain paradigm, this study demonstrated that cues to nonrecallable (but potentially unconsciously activated) negative emotional memories amplify pain unpleasantness, similar to known effects of conscious negative emotions.
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Affiliation(s)
- Stephan Frisch
- From the Department of Psychosomatic Medicine and Psychotherapy, Divison Medical Psychology (Frisch, Walter, Rebhann, Gruss, Geisel), and Department of Psychosomatic Medicine and Psychotherapy (Frisch, Gündel), Ulm University Medical Center, Ulm; Department of Psychosomatic Medicine and Psychotherapy (Bär), Jena University Hospital, Jena, Germany; Department of Psychiatry (Lane), University of Arizona, Tucson, Arizona; and Laureate Institute for Brain Research (Smith), Tulsa, Oklahoma
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Segel-Karpas D. Anger and anxiety in older adults: a cross-lagged examination. Aging Ment Health 2024; 28:1209-1215. [PMID: 38516943 DOI: 10.1080/13607863.2024.2320137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Both anger and anxiety are common in older adulthood, with aversive consequences for individuals' physical and mental health. Theory suggests that anger can be an emotional response to the experience of anxiety. Similarly, anger can induce anxiety symptoms. Despite studies documenting the co-occurrence of anger and anxiety and their strong theoretical links, little is known about their temporal relationship. The primary aim of this study was to investigate the longitudinal cross-lagged relationship between anger expression, anger suppression, and anxiety. METHODS A large and representative sample of older adults (N=6,852) was utilized, with data collected in two waves at an interval of four years. All variables were measured using validated self-report scales.Data were analyzed using Structural Equation Modeling. RESULTS Results indicate that both anger suppression and anger expression are significant predictors of anxiety symptoms. Similarly, anxiety is a significant predictor of both anger suppression and anger expression. CONCLUSIONS The effects did not differ in magnitude, suggesting a balanced reciprocity between anger and anxiety. An understanding of this reciprocal association can inform interventions and strategies aimed at promoting emotional well-being in older individuals. By addressing both anger and anxiety concurrently, interventions may have a more comprehensive impact on improving mental health outcomes in this population.
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Tifft ED, Roberts MZ, Underwood SB, Forsyth JP. Acceptance and Commitment Therapy (ACT) for Problematic Anger: A Case Study. Clin Case Stud 2022. [DOI: 10.1177/15346501221080931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Though anger is a common human emotion, the unfettered behavioral expression of anger is often costly, contributing to a range of functional impairments, poor quality of life, and both physical and mental health problems. The current case illustrates how a third-generation cognitive behavioral therapy, Acceptance and Commitment Therapy (ACT), may be effective in reducing suffering linked with problematic anger. The client (“Robert”), a treatment-naïve man of low socioeconomic status, presented to a university training clinic reporting problematic anger outbursts that interfered with his relationships at work and with his girlfriend. The therapist conceptualized Robert’s problematic anger through the ACT psychological flexibility model, wherein Robert’s anger appeared to function as experiential avoidance to distance him from underlying emotional hurt. The therapist used ACT over 27 sessions to reduce Robert’s psychological inflexibility while promoting more psychological flexibility. Early sessions highlighted the unworkability of Robert’s anger, whereas subsequent sessions focused on clarifying values, loosening cognitive fusion, facilitating present moment awareness, and cultivating mindful acceptance in the service of living a meaningful life. The therapist monitored treatment progress using quantitative measures and qualitative reports. Collectively, the client showed notable gains. The case study adds to the growing body of literature supporting ACT for problematic anger.
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Affiliation(s)
- Eric D. Tifft
- Department of Psychology, University at Albany, Albany, NY, USA
| | - Max Z. Roberts
- Department of Psychology, University at Albany, Albany, NY, USA
| | | | - John P. Forsyth
- Department of Psychology, University at Albany, Albany, NY, USA
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Gentile C, Ditto B, Deschamps A, D'Antono B. Parasympathetic Response Patterns are Associated with Metabolic Syndrome Among Older Women but Not Men. Ann Behav Med 2020; 53:515-526. [PMID: 30113625 PMCID: PMC6499413 DOI: 10.1093/abm/kay063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Little is known about the role of physiological stress responses in metabolic syndrome (MetS). Purpose To examine whether patterns of autonomic response to psychological stress are associated with MetS and whether this association is moderated by sex Methods 1121 men and women (Mage = 65.3 ± 6.77 years) with and without coronary artery disease (CAD) underwent an anger recall stressor task. Heart rate and heart-rate variability (HRV; HF, LF/HF) were assessed. Clusters of participants showing similar patterns of response across baseline, stress, and recovery periods were created using ACECLUS and FASTCLUS in SAS. Logistic regressions included clusters and interaction between clusters and sex as independent variables, controlling for relevant covariates. ANCOVAs were conducted in secondary analyses utilizing a continuous composite representation of MetS. Results Men and women showing greater tonic and phasic HR elevations were more likely to meet MetS criteria (OR = 1.45, [95% CI = 1.02–2.07], p = .037). HF-HRV cluster interacted significantly with sex (p < .001) to predict MetS. In women, those with significant parasympathetic withdrawal to stress and poor recovery were more likely to have MetS than women with a more moderate response (OR = 2.56, [95% CI = 1.23–5.41], p = .013). Women who displayed stress-related parasympathetic activation were also at greater risk of MetS (OR = 2.30, [95% CI = 1.30–4.07], p = .004). Results using a continuous measure of MetS were generally consistent with these findings. Conclusion Among older participants with CAD or other noncardiovascular disease, hyperreactivity to stress was associated with greater prevalence of MetS, particularly in women. Consistent with emerging literature, women who showed blunting or activation of parasympathetic responses to stress were similarly at greater risk.
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Affiliation(s)
- Christina Gentile
- Research Center, Montreal Heart Institute, Montreal, Canada Psychology Department, Université de Montréal, Canada
| | - Blaine Ditto
- Department of Psychology, McGill University, Montreal, Canada
| | - Alain Deschamps
- Chief, Department of Anesthesiology, Montreal Heart Institute, Montreal, Canada
| | - Bianca D'Antono
- Research Center, Montreal Heart Institute, Montreal, Canada Psychology Department, Université de Montréal, Canada
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Dixon-Gordon KL, Berghoff CR, McDermott MJ. Borderline Personality Disorder Symptoms and Pain in College Students: The Role of Emotional Suppression. J Pers Disord 2018; 32:277-288. [PMID: 28604278 DOI: 10.1521/pedi_2017_31_300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is associated with higher rates of pain conditions and greater pain impairment. Past research implicates emotional suppression in acute pain tolerance; thus, emotional suppression may contribute to pain interference among those with high BPD features. Participants were 89 university students who completed measures of BPD features, and complied with 2-week daily diary procedures assessing suppression of emotional thoughts associated with social and nonsocial stressors, distress, pain severity, and interference. Multilevel models revealed a BPD × Suppression × Distress interaction, such that suppression in response to social (but not nonsocial) stressors in the context of high distress was related to pain interference when controlling for pain severity among those with high, but not low, BPD features. These findings suggest. that suppression of emotionally relevant thoughts in response to high distress may contribute to the functional impairment from pain among those with high BPD symptoms.
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Affiliation(s)
- Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Christopher R Berghoff
- Department of Psychiatry and Human Behavior, University of Mississippi, Medical Center, Jackson, Mississippi
| | - Michael J McDermott
- Department of Psychology, University of Louisiana, Lafayette, Lafayette, Louisiana
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Berghoff CR, McDermott MJ, Dixon-Gordon KL. Psychological flexibility moderates the relation between PTSD symptoms and daily pain interference. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2017.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Behavioral, cognitive, and emotional coping strategies of women with endometriosis: a critical narrative review. Arch Womens Ment Health 2018; 21:1-13. [PMID: 28932912 DOI: 10.1007/s00737-017-0779-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
Endometriosis is a disabling and long-term medical condition affecting quality of life and mental health. Behavioral, cognitive, and emotional coping strategies, emotional intelligence, and metacognition could in part explain the link between the disease and impaired psychological and life functioning. This critical narrative review aimed at examining the state of the art of the relationships between endometriosis and these factors. According to PRISMA principles, we performed a systematic search for quantitative and qualitative studies on multiple electronic databases as regards coping strategies, emotional intelligence, and metacognition in women with endometriosis. Studies were subjected to interpretative and critical narrative synthesis. A total of 9 papers were included in the review. Three main categories were identified in thematic analysis and resumed in the manuscript. Findings suggested that (a) pain is considered the major stressor; (b) they usually use both adaptive and maladaptive coping strategies; (c) women with endometriosis and related chronic pain seem to repress emotions more likely than healthy ones; (d) suppressing own emotions, pain catastrophizing, and having a passive coping style are related to higher self-reported pain; and (e) emotional and avoidance coping styles are associated to poor mental status, while positive coping strategies focusing on the problem or on emotions, detached and rational styles are associated to better mental health. Few studies with mixed results and some methodological flaws have focused on coping strategies in women with endometriosis. No studies focusing on metacognition or emotional intelligence were found. Methodological biases, suggestions for future research, and implications for clinical practice were discussed.
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Thakur ER, Holmes HJ, Lockhart NA, Carty JN, Ziadni MS, Doherty HK, Lackner JM, Schubiner H, Lumley MA. Emotional awareness and expression training improves irritable bowel syndrome: A randomized controlled trial. Neurogastroenterol Motil 2017; 29:10.1111/nmo.13143. [PMID: 28643436 PMCID: PMC5690851 DOI: 10.1111/nmo.13143] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 05/29/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Current clinical guidelines identify several psychological treatments for irritable bowel syndrome (IBS). IBS patients, however, have elevated trauma, life stress, relationship conflicts, and emotional avoidance, which few therapies directly target. We tested the effects of emotional awareness and expression training (EAET) compared to an evidence-based comparison condition-relaxation training-and a waitlist control condition. METHODS Adults with IBS (N=106; 80% female, Mean age=36 years) were randomized to EAET, relaxation training, or waitlist control. Both EAET and relaxation training were administered in three, weekly, 50-minute, individual sessions. All patients completed the IBS Symptom Severity Scale (primary outcome), IBS Quality of Life, and Brief Symptom Inventory (anxiety, depressive, and hostility symptoms) at pretreatment and at 2 weeks posttreatment and 10 weeks follow-up (primary endpoint). KEY RESULTS Compared to waitlist controls, EAET, but not relaxation training, significantly reduced IBS symptom severity at 10-week follow-up. Both EAET and relaxation training improved quality of life at follow-up. Finally, EAET did not reduce psychological symptoms, whereas relaxation training reduced depressive symptoms at follow-up (and anxiety symptoms at posttreatment). CONCLUSIONS & INFERENCES Brief emotional awareness and expression training that targeted trauma and emotional conflicts reduced somatic symptoms and improved quality of life in patients with IBS. This emotion-focused approach may be considered an additional treatment option for IBS, although research should compare EAET to a full cognitive-behavioral protocol and determine which patients are best suited for each approach. Registered at clinicaltrials.gov (NCT01886027).
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Affiliation(s)
- Elyse R. Thakur
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center; VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Hannah J. Holmes
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | | | | | - Maisa S. Ziadni
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | | | - Jeffrey M. Lackner
- Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, NY
| | - Howard Schubiner
- Department of Internal Medicine, St. John/Providence Health System, Southfield, MI USA
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA
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Garland EL, Bryan CJ, Nakamura Y, Froeliger B, Howard MO. Deficits in autonomic indices of emotion regulation and reward processing associated with prescription opioid use and misuse. Psychopharmacology (Berl) 2017; 234:621-629. [PMID: 27933366 PMCID: PMC5266620 DOI: 10.1007/s00213-016-4494-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 11/27/2016] [Indexed: 12/16/2022]
Abstract
RATIONALE Prescription opioid misuse and high-dose opioid use may result in allostatic dysregulation of hedonic brain circuitry, leading to reduced emotion regulation capacity. In particular, opioid misuse may blunt the ability to experience and upregulate positive affect from natural rewards. OBJECTIVES The purpose of this study was to examine associations between opioid use/misuse and autonomic indices of emotion regulation capability in a sample of chronic pain patients receiving prescription opioid pharmacotherapy. METHODS Chronic pain patients taking long-term opioid analgesics (N = 40) completed an emotion regulation task while heart rate variability (HRV) was recorded, and also completed self-report measures of opioid misuse, craving, pain severity, and emotional distress. Based on a validated cut-point on the Current Opioid Misuse Measure, participants were grouped as opioid misusers or non-misusers. Opioid misuse status and morphine equivalent daily dose (MEDD) were examined as predictors of HRV and self-reports of emotion regulation. RESULTS Opioid misusers exhibited significantly less HRV during positive and negative emotion regulation, and significantly less positive effect, than non-misusers, after controlling for confounders including pain severity and emotional distress. MEDD was inversely associated with positive emotion regulation efficacy. CONCLUSION Findings implicate the presence of reward processing deficits among chronic pain patients with opioid-misusing behaviors, and opioid dosage was associated with deficient emotion regulation, suggesting the presence of compromised top-down cognitive control over bottom-up hedonic processes. Emotion regulation among opioid misusers may represent an important treatment target.
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Meints SM, Stout M, Abplanalp S, Hirsh AT. Pain-Related Rumination, But Not Magnification or Helplessness, Mediates Race and Sex Differences in Experimental Pain. THE JOURNAL OF PAIN 2016; 18:332-339. [PMID: 27908838 DOI: 10.1016/j.jpain.2016.11.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/18/2016] [Accepted: 11/15/2016] [Indexed: 01/22/2023]
Abstract
Compared with white individuals and men, black individuals and women show a lower tolerance for experimental pain stimuli. Previous studies suggest that pain catastrophizing is important in this context, but little is known about which components of catastrophizing contribute to these race and sex differences. The purpose of the current study was to examine the individual components of catastrophizing (rumination, magnification, and helplessness) as candidate mediators of race and sex differences in experimental pain tolerance. Healthy undergraduates (N = 172, 74% female, 43.2% black) participated in a cold pressor task and completed a situation-specific version of the Pain Catastrophizing Scale. Black and female participants showed a lower pain tolerance than white (P < .01, d = .70) and male (P < .01, d = .55) participants, respectively. Multiple mediation analyses indicated that these race and sex differences were mediated by the rumination component of catastrophizing (indirect effect = -7.13, 95% confidence interval (CI), -16.20 to -1.96, and 5.75, 95% CI, .81-15.57, respectively) but not by the magnification (95% CI, -2.91 to 3.65 and -1.54 to 1.85, respectively) or helplessness (95% CI, -5.53 to 3.31 and -.72 to 5.38, respectively) components. This study provides new information about race and sex differences in pain and suggests that treatments targeting the rumination component of catastrophizing may help mitigate pain-related disparities. PERSPECTIVE This study suggests that differences in pain-related rumination, but not magnification or helplessness, are important contributors to race and sex differences in the pain experience. Interventions that target this maladaptive cognitive style may help reduce disparities in pain.
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Affiliation(s)
- Samantha M Meints
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Madison Stout
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Samuel Abplanalp
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
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The effects of emotion regulation strategies on the pain experience: a structured laboratory investigation. Pain 2016; 156:868-879. [PMID: 25734999 DOI: 10.1097/j.pain.0000000000000126] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although emotion regulation modulates the pain experience, inconsistencies have been identified regarding the impact of specific regulation strategies on pain. Our goal was to examine the effects of emotion suppression and cognitive reappraisal on automatic (ie, nonverbal) and cognitively mediated (ie, verbal) pain expressions. Nonclinical participants were randomized into either a suppression (n = 58), reappraisal (n = 51), or monitoring control (n = 42) condition. Upon arrival to the laboratory, participants completed the Emotion Regulation Questionnaire, to quantify self-reported suppression and reappraisal tendencies. Subsequently, they completed a thermal pain threshold and tolerance task. They were then provided with instructions to use, depending on their experimental condition, suppression, reappraisal, or monitoring strategies. Afterward, they were exposed to experimentally induced pain. Self-report measures of pain, anxiety, and tension were administered, and facial expressions, heart rate, and galvanic skin response were recorded. The Facial Action Coding System was used to quantify general and pain-related facial activity (ie, we defined facial actions that occurred during at least 5% of pain stimulation periods as "pain-related actions"). Reappraisal and suppression induction led to reductions in nonverbal and verbal indices of pain. Moreover, self-reported tendencies to use suppression and reappraisal (as measured by the Emotion Regulation Questionnaire) did not interact with experimental condition in the determination of participants' responses. Results suggest that consciously applying emotion regulation strategies during a painful task can moderate both cognitively mediated (e.g., verbal) and automatic (e.g., facial activity) expressions of pain.
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Darnall BD. "Compassion Cultivation in Chronic Pain May Reduce Anger, Pain, and Increase Acceptance: Study Review and Brief Commentary". ACTA ACUST UNITED AC 2015; 3. [PMID: 26985456 DOI: 10.4172/2375-4273.1000142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, USA
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Abstract
BACKGROUND Low back pain (LBP) is a common and costly condition that often becomes chronic if not properly addressed. Recent research has shown that psychosocial symptoms can complicate LBP, necessitating more comprehensive screening measures. AIM The present study investigated the role of psychosocial factors, including anger regulation, in pain and disability using a screening measure designed for LBP treated with physical therapy. METHODS One hundred three LBP patients initiating physical therapy completed an established screening measure to assess risk for developing chronic pain, and psychosocial measures assessing anger, depression, anxiety, fear-avoidance, and pain-catastrophizing before and after 4 weeks of treatment. Dependent variables were pain intensity, physical impairment, and patient-reported disability. Risk subgrouping based on anger and other psychosocial measures was examined using established screening methods and through using an empirical statistical approach. RESULTS Analyses revealed that risk subgroups differed according to corresponding levels of negative affect, as opposed to anger alone. General psychosocial distress also predicted disability posttreatment, but, interestingly, did not have a strong relationship to pain. Subsequent hierarchical agglomerative clustering procedures divided patients into overall high-distress and low-distress groups, with follow-up analyses revealing that the high-distress group had higher baseline measures of pain, disability, and impairment. CONCLUSIONS Findings suggest that anger may be part of a generalized negative affect rather than a unique predictor when assessing risk for pain and disability in LBP treatment. Continued research in the area of screening for psychosocial prognostic indicators in LBP may ultimately guide treatment protocols in physical therapy for more comprehensive patient care.
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Bruns D, Disorbio JM. The Psychological Evaluation of Patients with Chronic Pain: a Review of BHI 2 Clinical and Forensic Interpretive Considerations. PSYCHOLOGICAL INJURY & LAW 2014; 7:335-361. [PMID: 25478059 PMCID: PMC4242977 DOI: 10.1007/s12207-014-9206-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/14/2014] [Indexed: 01/23/2023]
Abstract
Pain is the most common reason why patients see a physician. Within the USA, it has been estimated that at least 116 million US adults suffer from chronic pain, with an estimated annual national economic cost of $560-635 billion. While pain is in part a sensory process, like sight, touch, or smell, pain is also in part an emotional experience, like depression, anxiety, or anger. Thus, chronic pain is arguably the quintessential biopsychosocial condition. Due to the overwhelming evidence of the biopsychosocial nature of pain and the value of psychological assessments, the majority of chronic pain guidelines recommend a psychological evaluation as an integral part of the diagnostic workup. One biopsychosocial inventory designed for the assessment of patients with chronic pain is the Battery for Health Improvement 2 (BHI 2). The BHI 2 is a standardized psychometric measure, with three validity measures, 16 clinical scales, and a multidimensional assessment of pain. This article will review how the BHI 2 was developed, BHI 2 concepts, validation research, and an overview of the description and interpretation of its scales. Like all measures, the BHI 2 has strengths and weaknesses of which the forensic psychologist should be aware, and particular purposes for which it is best suited. Guided by that knowledge, the BHI 2 can play a useful role in the forensic psychologist's toolbox.
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Affiliation(s)
- Daniel Bruns
- Health Psychology Associates, 1610 29th Avenue Place Suite 200, Greeley, CO 80634 USA
| | - John Mark Disorbio
- Health Psychology Associates, 1610 29th Avenue Place Suite 200, Greeley, CO 80634 USA
- 113 Blue Grouse Road, Evergreen, CO 80634 USA
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Slavin-Spenny O, Lumley MA, Thakur ER, Nevedal DC, Hijazi AM. Effects of anger awareness and expression training versus relaxation training on headaches: a randomized trial. Ann Behav Med 2014; 46:181-92. [PMID: 23620190 DOI: 10.1007/s12160-013-9500-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Stress contributes to headaches, and effective interventions for headaches routinely include relaxation training (RT) to directly reduce negative emotions and arousal. Yet, suppressing negative emotions, particularly anger, appears to augment pain, and experimental studies suggest that expressing anger may reduce pain. Therefore, we developed and tested anger awareness and expression training (AAET) on people with headaches. METHODS Young adults with headaches (N = 147) were randomized to AAET, RT, or a wait-list control. We assessed affect during sessions, and process and outcome variables at baseline and 4 weeks after treatment. RESULTS On process measures, both interventions increased self-efficacy to manage headaches, but only AAET reduced alexithymia and increased emotional processing and assertiveness. Yet, both interventions were equally effective at improving headache outcomes relative to controls. CONCLUSIONS Enhancing anger awareness and expression may improve chronic headaches, although not more than RT. Researchers should study which patients are most likely to benefit from an emotional expression or emotional reduction approach to chronic pain.
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Affiliation(s)
- Olga Slavin-Spenny
- Department of Psychology, Wayne State University, 5057 Woodward Ave., 7th Floor, Detroit, MI, 48202, USA
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Pirrotta R, Jeanmonod D, McAleese S, Aufenberg C, Opwis K, Jenewein J, Martin-Soelch C. Cognitive functioning, emotional processing, mood, and personality variables before and after stereotactic surgery: a study of 8 cases with chronic neuropathic pain. Neurosurgery 2014; 73:121-8. [PMID: 23778124 DOI: 10.1227/01.neu.0000429845.06955.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stereotactic central lateral thalamotomy (CLT) has been applied as a treatment for chronic intractable neuropathic pain. However, it is not clear whether this intervention influences the emotional and cognitive impairments observed in patients who have chronic neuropathic pain. OBJECTIVE To investigate neuropsychological functions and emotional processing in patients with chronic neuropathic pain compared with healthy volunteers and to explore the neuropsychiatric effect of the CLT. METHODS We investigated pain ratings, cognitive functions, emotional processes, and personality variables before and after surgery in 8 patients with intractable neuropathic pain. Patients were tested before and 3 months after CLT by the use of neuropsychological tests; clinical scales for depression, anxiety, anhedonia, and anger regulation; a personality test; and 2 experimental tasks testing the theory of mind as well as the ability to recognize facial emotional expressions. Nine age- and sex-matched control subjects were tested once using the same procedure. RESULTS The comparison of the patient group before surgery with the control group evidenced significant differences on the cognitive assessments, the depression and anxiety scores, as well as on the somatic complaint subscale of the personality test. Three months after CLT, patients experienced a significant improvement in their depression scores. There were no additional postsurgical cognitive impairments. CONCLUSION For our patients with chronic neuropathic pain, CLT provided pain relief and reduction of their depression scores without causing postsurgical cognitive impairments.
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Affiliation(s)
- Roberto Pirrotta
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich Switzerland
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Yoon KL, Quartana PJ. Post-Evaluative Biases Toward Somatic Stimuli and Cardiovascular Responses in Social Anxiety. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2012. [DOI: 10.1007/s10862-012-9302-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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