What's in a Name? The Case of Emotional Disclosure of Pain-Related Distress

Recommended approaches to assessing and managing physiotherapy clients experiencing psychological distress: a systematic mapping review

BACKGROUND

Some physiotherapists find assessing and managing clients experiencing psychological distress challenging and are uncertain regarding the boundaries of the profession's scope.

OBJECTIVE

To map the approaches recommended for physiotherapists in scholarly literature, with respect to the assessment and management of clients experiencing psychological distress.

METHODS

A systematic mapping review was conducted. CINAHL, APA PsycINFO, Embase, and Medline ALL databases were systematically searched for secondary and tertiary literature relevant to the research objective. Recommended approaches were extracted from each article and analyzed descriptively and thematically.

RESULTS

3884 records were identified with 40 articles meeting the inclusion/exclusion criteria. Most recommendations related to identifying, assessing, and managing pain-related distress, with depression screening and referral also receiving some attention. Three approaches to detecting and assessing psychological distress were identified: 1) brief depression screen; 2) integrated suicide/nonsuicidal self-harm and depression screen; and 3) multidimensional screen and health-related distress assessment. Regarding the management of psychological distress the main approaches identified were: 1) education and reassurance; 2) cognitive-behavioral approaches; 3) mindfulness; and 4) case management.

CONCLUSION

While assessment and management of health-related distress by physiotherapists is commonly recommended, further guidance is needed to differentiate various forms of distress.

Power of narrative: a case study about documenting private insightful experiences while dealing with pain and associated disability

Objective

People adjusting to living with a chronic disability, such as chronic pain, seek support and resources from societal systems, including health systems, to help them cope with this reality. This case study describes the use of a digital health platform designed to help in that quest.

Method

MyHealthMyRecord (MHMR), is being developed to record, register and curate personal private experiences of a chronic condition. MHMR allows users to record and log short (30-90s) personal and private audio-videos of their accommodation-seeking journey in a way that can be encrypted, registered, curated and shared privately. This case study describes the use of a prototype version of the platform by a participant co-designer who experienced a sudden onset of a chronic pain condition, of undetermined origin. System use began three months after the onset of the condition and just after being discharged from several months of hospitalization without any definitive diagnosis.

Result

During a three-month period, 65 short unstructured contributions were authored and logged. This paper presents a qualitative analysis of that content. The clips used various communication styles that documented experiences, concerns, issues, positive and negative interactions and pain episodes. Using thematic analysis with open coding, three domains (person-facing, accessibility and system-facing) and eight themes (pain, joy, therapy, environmental, recommendations, technical, culture and communication) were identified. Comments about pain, stress, etc., were the most common and occurred in 75% of all videos while technical and therapy/physio related comments were the fewest and occurred in 3 and 9% of the videos, respectively.

Conclusion

We conclude that it is possible to create recordings of events, thoughts, reflections and issues on different aspects affecting an individual's health and well-being impact, including effects of the chronic condition as well as tangential outcomes such as accessibility (or lack of it), using MHMR over a longer period of time. The next steps will be to develop functionality to annotate the recordings, automatically analyze and summarize collections of recordings to make them consumable, useful and understandable to the individual and others, and then to share those analyses and summaries with others. In addition, evaluate this functionality longitudinally with more users.

Is all validation equal? Evaluating sensory- and emotion-focused validation in the context of experimentally induced pain

Validation has been examined in experimental and clinical settings, but examination of whether specific content of validation responses affect pain-related outcomes has not been considered. We examined the impact of sensory- or emotion-focused validation following a pain task. Participants (N = 140) were randomly assigned to one of three validation conditions (i.e. sensory, emotional, or neutral) and completed the cold pressor task (CPT). Participants provided self-report ratings of pain and affective-related variables. Subsequently, a researcher validated emotional, sensory, or no aspects of participants' experience. The CPT was repeated, as were the self-report ratings. No significant differences were observed across conditions in pain or affective outcomes. All conditions reported an increase in pain intensity and pain unpleasantness across CPT trials. These findings suggest validation content may not impact pain outcomes during painful experiences. Future directions to understanding the nuances of validation across interactions and settings are discussed.

The Pain-Invalidation Scale: Measuring Patient Perceptions of Invalidation Toward Chronic Pain

Increasing evidence reveals the damaging impact of having one's chronic pain symptoms invalidated through disbelief, discrediting, and critical judgement. In other instances, a caregiver's over-attentiveness to the daily tasks of individuals with pain can be problematic, potentially undermining rehabilitation. The aim of this study was to develop an instrument to measure different aspects of invalidation perceived by people with chronic pain. Item generation was informed through literature review and a thematic analysis of narratives from 431 peer-reviewed articles. The crowdsourcing platform Prolific was used to distribute survey items to participants. In Study 1A, Principal Component Analysis was performed on data from 302 respondents, giving rise to 4 subscales, including: Invalidation by the Self, Invalidation by Immediate Others, Invalidation by Healthcare Professionals, and Invalidation by Over-attentive Others. Confirmatory Factor Analysis of data collected from aonther 308 individuals in Study 1B supported the 4-factor model of the Pain-Invalidation Scale (Pain-IS) and identified a best-fit model with 24 items. The Pain-IS was further validated in another 300 individuals in Study 2. The Pain-IS demonstrates sound psychometric properties and may serve as a valuable tool for use by clinicians in the detection of pain-invalidation issues, as a first step in patient pain management. Perspective. Links between pain-invalidation and pain levels, as well as functional detriment, highlight the importance of having one's chronic pain experience heard, believed and accepted. The Pain-Invalidation Scale is designed to identify domains where invalidation of the patient's pain should be addressed to promote emotional processing, treatment adherence and improved outcomes.

Validation of the Structured Interview for the Assessment of Expressed Emotion (E5) in a Sample of Adolescents and Young Adults From the General Population

Expressed emotion (EE) is an index of significant others' attitudes, feelings, and behavior toward an identified patient. EE was originally conceptualized as a dichotomous summary index. Thus, a family member is rated low or high on how much criticism, hostility, and emotional overinvolvement (EOI) s/he expresses toward an identified patient. However, the lack of brief, valid measures is a drawback to assess EE. To cover this gap, the E5 was designed. The objective of this study is to provide psychometric properties of a recent measured in adolescents to be used to tap perceived high levels of EE. The sample was composed by 2,905 adolescents aged from 11-19years; 57% girls. Results demonstrate good factor structure, reliability, construct validity and invariance across gender and age revealed a good fit. As a result, E5 is a brief, valid and reliable measure for assessing expressed emotion in parents of adolescent children.

How Do I Help My Partner in Pain? Partners' Helping Behaviors Are Linked to Lower Pain and Greater Perceived Validation During an Experimental Pain Task

BACKGROUND

Observers' responses to people with illness are important predictors of quality of life, yet findings are mixed regarding the types of responses that affect illness-related suffering.

PURPOSE

The purpose of this study was to examine whether perspective taking positively affects observers' responses to their romantic partner experiencing experimentally induced pain and whether responses based in Self-Determination Theory and communication models of illness are related to perceived validation and pain outcomes.

METHODS

Undergraduate romantic couples (N = 122) completed baseline questionnaires; then one partner was randomly assigned to complete the cold pressor task, whereas the other partner observed. Couples were randomly assigned to one of two groups: a perspective-taking group in which observers were privately instructed to take the perspective of the pain participant or a control group. Afterward, both partners completed surveys, and pain participants completed a video recall task in which they recalled partner behaviors that were coded by trained raters using a theoretically derived manual.

RESULTS

Pain participants in the perspective-taking group identified significantly less invalidating communication from their partners, fewer behaviors that thwarted their competence, and more behaviors that supported their autonomy. Across groups, pain participants who received more normalizing communication that supported their competence felt more validated by their partners, had lower pain intensity, and exhibited greater pain tolerance, whereas those who received more invalidation showed worse outcomes.

CONCLUSIONS

The results from this study suggest that attention to different types of partner behaviors is essential when developing behavioral medicine treatments for pain and illness.

Interpretations of partners' responses to pain behaviours: Perspectives of patients and partners

OBJECTIVES

Partner's responses to pain behaviours play a pivotal role in the patient's adjustment. This study aims to further our knowledge regarding patients' and partners' interpretation of partners' responses to pain behaviours, and the possible discrepancies between patients' and partners' perceptions. Further, this study examines patients' preferred responses to pain behaviours and possible discrepancies between received and preferred responses to pain behaviours.

DESIGN

A qualitative research design based on a semi-structured in-depth interview.

METHODS

Patients with chronic low back pain and their partners (n = 54) were recruited through purposive sampling and interviewed. Data were analysed based on an inductive analytic approach.

RESULTS

Patients as well as partners indicated a number of different interpretations of partners' responses to pain behaviours, including invalidation, relieving pain, validation, encouragement, caregiving exhaustion, and expressing resentment. Patients and partners revealed similarities in the interpretation of response categories that they associated with validation, invalidation, and expressing resentment. Discrepancies between patients and partners indicated that partners interpreted some responses as caused by caregiving exhaustion while patients did not. Patients perceived partner responses that included the active involvement of the partner (e.g., encouraging pain talk) more positively than responses that showed less active involvement of the partner.

CONCLUSION

Patients and partners are likely to make various interpretations of a certain partner response to pain behaviours. Our findings underscore that patients' interpretation about a certain behaviour might determine whether that behaviour is rated as desirable or aversive.

Why do Patients Engage in Pain Behaviors? A Qualitative Study Examining the Perspective of Patients and Partners

OBJECTIVES

Patients' pain behavior plays an important role in the interaction between patients and their partners, as acknowledged in operant models of pain. However, despite the considerable research attention to pain behaviors, the underlying motives of such behaviors are still unclear. The current study explores the motives to engage in pain behaviors and the possible discrepancies between individuals experiencing pain and partners' perceptions of those motives.

METHODS

A qualitative study was performed, comprising semistructured interviews with 27 patients with chronic low back pain and their partners. They were recruited through purposive sampling at 2 pain clinics located in Tehran, Iran.

RESULTS

Patients and partners mentioned a variety of motives for pain behaviors, including protecting oneself against more pain, regulating negative emotions, informing others about the pain severity, seeking validation or intimacy, gaining advantages from pain, and expressing anger. Patients and partners revealed the most similarities in motives such as protecting oneself against more pain and informing others about the pain severity. However, partners rarely acknowledged patients' motives for seeking validation and they were more likely to mention negative motives (eg, expressing anger).

DISCUSSION

In conclusion, partners are more likely to attribute negative motives to the patient's pain behaviors, which may lead to their hostility toward patients. The findings of this study provide new insights into motives of pain behaviors from the perspective of patients and partners, which can inform couple-based interventions in terms of effective pain communication.

New Model for Couple Therapy for Patients with Chronic Pain and their Caregivers: An Attempt to Improve Quality of Life and Reduce Pain

Background:

Several psychological interventions have been implemented to manage chronic pain. In this study, in addition to the patients, his/her spouses have participated in the program. Besides, this innovative therapy integrates several practical approaches into one comprehensive protocol.

Objective:

This study aimed to analyze the effectiveness of couple therapy (patient/caregiver-oriented) on improving the quality of life and reducing pain among patients with chronic pain.

Methods:

The present study is a quasi-experimental and clinical trial with a control group with pretest and posttest. The authors conducted this study at LABAFINEJAD Hospital in Tehran on 30 patients with chronic pain and their spouses by having a short form of a questionnaire for quality of life and chronic pain score questionnaire to measure the effectiveness of the treatment.

Results:

The results indicated that this treatment increased two aspects of quality of life remarkably, social function and strength for continuing the performance; that help boosts interpersonal relationships as well. Regarding the results, although the couple-based treatment could improve all aspects of pain, the two primary subscales, physical health and mental health, both enhanced. Besides, the treatment reduced the intensity of pain.

Conclusion:

Couple-based intervention through increasing social support, improving the quality of sex, decentralizing of pain, and paying attention to the neglected needs of caregivers and patients with chronic pain can improve quality of life and reduce pain in patients.

A new approach to capturing pain disclosure in daily life in-person and online

This feasibility study employed a new approach to capturing pain disclosure in face-to-face and online interactions, using a newly developed tool. In Study 1, 13 rheumatoid arthritis and 52 breast cancer patients wore the Electronically Activated Recorder to acoustically sample participants' natural conversations. Study 2 obtained data from two publicly available online social networks: fibromyalgia (343,439 posts) and rheumatoid arthritis (12,430 posts). Pain disclosure, versus non-pain disclosure, posts had a greater number of replies, and greater engagement indexed by language style matching. These studies yielded novel, multimethod evidence of how pain disclosure unfolds in naturally occurring social contexts in everyday life.

Maternal Protective Parenting Accounts for the Relationship Between Pain Behaviors and Functional Disability in Adolescents

INTRODUCTION

A variety of factors influence parent responses to pain behaviors they observe in their adolescents with chronic pain. Certain parental responses to pain, such as attention or overprotection, can adversely impact adolescent adaptive functioning and correspond to poor clinical outcomes.

OBJECTIVES

It was hypothesized that the relationship between adolescent pain behaviors and functional disability was mediated by maladaptive parenting (protective, monitoring, solicitousness) responses.

MATERIALS AND METHODS

Participants were 303 adolescents and their mothers presenting to a pain clinic. Adolescents completed measures of functional disability and pain intensity; mothers completed measures assessing adolescent pain behaviors, their own catastrophizing about their adolescent's pain, and responses to pain. A path model tested the direct and indirect associations between pain behaviors and disability via 3 parenting responses, controlling for average pain intensity and parent pain catastrophizing.

RESULTS

Greater pain behavior was associated with increased protective responses (α path, P<0.001); greater protective behavior was associated with increased disability (β path, P=0.002). Including parenting responses in the model, the path between pain behaviors and disability remained significant (c' path, P<0.001). The indirect path between pain behaviors and disability via parenting responses was significant for protective responses (P<0.02), controlling for pain intensity and parent pain catastrophizing. The indirect effect of protective responses explained 18% of the variance between pain behaviors and disability.

DISCUSSION

Observing adolescent pain behaviors may prompt parents to engage in increased protective behavior that negatively impacts adolescents' functioning, even after controlling for the effects of parental pain catastrophizing.

The Impact of Emotional Regulation Strategies on Pain Catastrophizing in the Context of Interpersonal Relationships

OBJECTIVES

The Communal Coping Model suggests that pain catastrophizing may serve to elicit support from others. What is not known is how emotional regulation, namely emotional inhibition, impacts pain catastrophizing within the context of an interpersonal relationship. Individuals who have a greater tendency to emotionally inhibit may have a greater likelihood to use catastrophizing as a means for seeking support, particularly in relationships characterized by satisfaction and emotional validation.

METHODS

Data were collected from 50 undergraduate couples at the University of Michigan-Dearborn. Participants were videotaped during the completion of an acute pain cold pressor task and completed measures involving pain catastrophizing, emotional inhibition, and relationship dynamics (ie, Ambivalence Over Emotional Expressiveness Questionnaire, White Bear Suppression Inventory, Dyadic Adjustment Scale). In addition, the videotaped interactions were coded for both invalidation/validation and overt expressions of pain catastrophizing.

RESULTS

Emotional inhibition, and both validation and invalidation were associated with pain catastrophizing. Observed validation and invalidation were not, however, directly associated with relationship satisfaction. Hierarchical linear regression showed a significant interaction between thought suppression and relationship satisfaction to predict pain catastrophizing.

DISCUSSION

Results show relationship satisfaction moderates the association between pain catastrophizing and thought suppression in a manner in which couples with high levels of relationship satisfaction who also engage in thought suppression are more likely to use pain catastrophizing as a cognitive strategy to elicit support. This study offers direction into treatment and suggests that couples based cognitive-behavioral treatments that aim to utilize adaptive cognitive and behavioral coping strategies, as well as emotional exploration and validation, may be beneficial.

A Couple-Based Psychological Treatment for Chronic Pain and Relationship Distress

Chronic pain impacts individuals with pain as well as their loved ones. Yet, there has been little attention to the social context in individual psychological treatment approaches to chronic pain management. With this need in mind, we developed a couple-based treatment, "Mindful Living and Relating," aimed at alleviating pain and suffering by promoting couples' psychological and relational flexibility skills. Currently, there is no integrative treatment that fully harnesses the power of the couple, treating both the individual with chronic pain and the spouse as two individuals who are each in need of developing greater psychological and relational flexibility to improve their own and their partners' health. Mindfulness, acceptance, and values-based action exercises were used to promote psychological flexibility. The intervention also targets relational flexibility, which we define as the ability to interact with one's partner, fully attending to the present moment, and responding empathically in a way that serves one's own and one's partner's values. To this end, the intervention also included exercises aimed at applying psychological flexibility skills to social interactions as well as emotional disclosure and empathic responding exercises to enhance relational flexibility. The case presented demonstrates that healthy coping with pain and stress may be most successful and sustainable when one is involved in a supportive relationship with someone who also practices psychological flexibility skills and when both partners use relational flexibility skills during their interactions.