Self-reported elevated pain levels: A coping strategy used by women undergoing medical abortion procedures

PURPOSE

Epidural analgesia alleviates pain during normal labour but women who undergo medical abortion procedures using epidural analgesia continue to express high pain levels. To understand this we assessed if patients undergoing medical abortions, treated with epidural analgesia, use their pain for psychological benefits.

METHODS

This study comprised 105 patients over 13 weeks of gestational age diagnosed with foetal abnormalities after selecting a medical abortion procedure using epidural analgesia. Three questionnaires were handed-out: 1) 'Need for Affect', assessed the motivation to react to emotions; 2) 'Pain-Levels' 3) PANA- 'Positive Affect' (PA), 'Negative Affect' (NA) assessed emotions pre-abortion and post-abortion.

RESULTS

Patients with a strong Need for Affect and high Pain-Levels expressed a stronger PA post-abortion (b = .69, se = .11, β = .68, p < .001, 95%CI [.48,.90]). Patients with a strong NA pre-abortion and high Pain-Levels expressed a higher NA post-abortion (b = .48, se = .11, β = .53, p < .001, 95%CI [.26, .70]).

CONCLUSION

Patients with a strong Need for Affect who express a strong PA pre-abortion intensify their pain to fulfill their Need for Affect, which then helps recovery. Patients with a strong NA pre-abortion and high Pain-Levels indicate a less favourable outcome.

Negative Emotions Will Be Welcomed: The Effect of Upward Comparison on Counterhedonic Consumption

Upward comparisons are prevalent in life and have a significant influence on consumer psychology and subsequent behavior. Previous research examined the effects of upward comparisons on consumption behavior, mainly focusing on behavior that evokes positive emotions (e.g., donation behavior, sustainable consumption) or behavior that evokes negative emotions (e.g., impulsive consumption, compulsive consumption) and less on behavior that evokes both negative emotions and positive emotions (i.e., counterhedonic consumption). This research examined the effect of upward comparisons on counterhedonic consumption. Five studies (N = 1111) demonstrated that upward comparison (vs. non-upward comparison) leads to counterhedonic consumption, and this effect is mediated by relative deprivation (Studies 2 and 3). In addition, this research showed that the comparison targets moderate the effects of upward comparisons on counterhedonic consumption. Specifically, when the comparison target is a friend, an upward comparison (vs. non-upward comparison) leads to counterhedonic consumption. When the comparison target is a stranger, an upward comparison (vs. non-upward comparison) has no significant influence on counterhedonic consumption (Study 5). Our findings extend the research on upward comparisons, relative deprivation, and counterhedonic consumption.

Neural Reactivity to Social Punishment Predicts Future Engagement in Nonsuicidal Self-injury Among Peer-Rejected Adolescents

BACKGROUND

Rates of nonsuicidal self-injury (NSSI) increase dramatically in adolescence. Affective reactivity and adverse social experiences have been linked to NSSI, but less is known about whether these factors may separately or interactively predict NSSI, especially longitudinally. This study combined functional magnetic resonance imaging and a sociometric measure to test whether a combination of neural (e.g., amygdala) reactivity to social punishment and peer-nominated peer acceptance/rejection predicts NSSI longitudinally in adolescence. Amygdala reactivity was examined as a potential neural marker of affective reactivity to social punishment, which may heighten NSSI risk in contexts of social adversity.

METHODS

One hundred twenty-five adolescents (63 female) completed a social incentive delay task during neuroimaging and school-based peer nominations to measure peer acceptance/rejection. NSSI engagement was assessed at baseline and 1-year follow-up.

RESULTS

Greater amygdala reactivity to social punishment predicted greater NSSI engagement 1 year later among adolescents with high peer rejection. This effect for the amygdala was specific to social punishment (vs. reward) and held when controlling for biological sex and pubertal development. Exploratory analyses found that ventral striatum reactivity to social reward and punishment similarly interacted with peer rejection to predict NSSI but that amygdala connectivity with salience network regions did not.

CONCLUSIONS

Amygdala reactivity to social punishment, in combination with high peer rejection, may increase NSSI risk in adolescence, possibly via heightened affective reactivity to adverse social experiences. Objective measures of neurobiological and social risk factors may improve prediction of NSSI, while therapeutic approaches that target affective reactivity and increase prosocial skills may protect against NSSI in adolescence.

Decreased gray matter volume in regions associated with affective pain processing in unmedicated individuals with nonsuicidal self-injury

Nonsuicidal self-injury (NSSI) has been consistently associated with a reduced aversion to physical pain. Yet, little research has been done to investigate the brain structures related to pain in individuals with NSSI. This study examined gray matter volume patterns of pain processing regions in participants engaging in NSSI (n = 63) and age-, sex-, and handedness-matched healthy controls (n = 63). Voxel-based morphometry was performed to explore gray matter volume in regions of interest (ROIs) and partial correlation analyses were conducted to identify their associations with the frequency, versatility, duration, functions, and pain intensity of self-injury. As a result, significant volume decreases were found in the right anterior insula, bilateral secondary somatosensory cortex (SII), and left inferior frontal gyrus. Moreover, individuals with smaller anterior insula and SII volume showed a higher likelihood of endorsing affect-regulation and sensation-seeking functions of NSSI, as well as engaging in self-injury with a greater perceived intensity of pain. Our results provide the first empirical evidence that individuals with NSSI may exhibit distinct characteristics in brain regions associated with the affective component of pain processing. These neurobiological changes may be associated with their maladaptive response to noxious and painful NSSI experiences.

Is physical pain causally related to suicidal behavior: An experimental test

Existing evidence suggests a link between physical pain and suicide, but the nature of this relationship remains unknown. To address this critical gap in knowledge, the present study leveraged a validated virtual reality (VR) suicide paradigm to experimentally examine the causal effects of physical pain on subsequent virtual suicidal behaviors. Based on previous findings, we hypothesized that physical pain would causally drive virtual suicidal behavior only if suicide was conceptualized as having desirable anticipated consequences (e.g., a means of escaping from current pain; an opportunity to avoid future pain). We tested this by randomizing 326 participants across four different conditions: a physical pain condition, an anticipated escape condition, an anticipated avoidance condition, and a control condition. As predicted, physical pain alone did not result in statistically significant increases in VR suicide rates; however, the anticipation that virtual suicidal behavior would result in the avoidance of future physical pain had a large causal effect on VR suicide rates (B = 1.61, p < .001, IRR = 5.01). We failed to find evidence that anticipating that VR suicide would provide an escape from currently experienced physical pain increases the likelihood of VR suicide. Our findings add to a growing body of evidence suggesting that the anticipated consequences of suicide (e.g., avoidance of future physical pain) may serve as primary causes of suicidal behavior.

On the interplay between pain observation, guilt and shame proneness and honesty

Seeing others in pain can stimulate powerful socio-emotional responses. Does it also make us more moral? In two laboratory experiments, we examined the interplay between pain observation, self-reported guilt and shame, subjective perceptions of pain intensity, and subsequent honest behavior. Watching a confederate perform a moderately painful (vs. non-painful) task did not affect honest behavior in a subsequent die-roll task. Independent of pain observation, there was a positive relationship between self-reported guilt proneness and shame proneness and honesty. More specifically, individuals who are more prone to feeling guilt -and to a lesser extent shame- behaved more honestly. Furthermore, we found weak support for the hypothesis that greater perceived pain (rather than objective pain) is associated with less cheating. We call for further research in the interconnections between perceived pain, guilt, shame, and moral behavior.

Examining tradeoffs between cognitive effort and relief among adults with self-injurious behavior

BACKGROUND

People engage in nonsuicidal self-injury (NSSI) to reduce negative affect, but it is not clear why they engage in this harmful type of behavior instead of using healthier strategies. The primary goal of this study was to evaluate whether people choose NSSI to reduce negative affect because they perceive it to be less cognitively costly than other available strategies.

METHOD

In experiment one, 43 adults completed a novel, relief-based effort discounting task designed to index preferences about exerting cognitive effort to achieve relief. In experiment two, 149 adults, 52 % with a history of NSSI, completed our effort discounting task.

RESULTS

Our main results suggest that people will accept less relief from an aversive experience if doing so requires expending less effort, i.e. they demonstrate effort discounting in the context of decisions about relief. We also found and that effort discounting is stronger among those with a history of NSSI, but this association became nonsignificant when simultaneously accounting for other conditions associated with aberrant effort tradeoffs.

LIMITATIONS

The use of a control group without NSSI or other potentially harmful relief-seeking behaviors limits our ability to draw specific conclusions about NSSI. The ecological validity of our task was limited by a modestly effective affect manipulation, and because participants made hypothetical choices.

CONCLUSIONS

This study demonstrates that preferences about exerting cognitive effort may be a barrier to using healthier affect regulation strategies. Further, the preference not to exert cognitive effort, though present in NSSI, is likely not unique to NSSI. Instead, effort discounting may be a transdiagnostic mechanism promoting an array of harmful relief-seeking behaviors.

Inter-subject variability of pleasant pain relief using a data-driven approach in healthy volunteers

Background

The offset of a painful and unpleasant sensation can elicit pleasure. This phenomenon, namely pleasant pain relief (PPR), is attracting growing interest in research. While the cold pressor test (CPT) has been frequently used to study the inhibition of pain by the administration of another painful stimulation (inhibitory conditioned pain modulation; ICPM), a preliminary study from our research team has shown that CPT can also elicit a robust and long-lasting PPR. However, its effects on pain relief and inhibition vary greatly between subjects. Although substantial research has been carried out on inter-individual variability in the case of ICPM, the same cannot be said of PPR. Therefore, the current study sought to identify clusters of healthy volunteers with similar dynamic pain responses during the CPT, using a data-driven approach, and to investigate the inter-subject variability for PPR and ICPM.

Methods

One hundred and twenty-two healthy volunteers were recruited. A sequential ICPM paradigm was carried out with CPT (water at 10°C) and a Peltier Thermode to evaluate pain intensity and unpleasantness. Moreover, PPR was measured for four minutes at CPT offset. Statistical analyses were performed using group-based trajectory modelling.

Results

Four trajectories (groups) were identified for CPT pain intensity and unpleasantness ratings with varying levels of tonic pain and pain sensitization (e.g., temporal summation). PPR scores were correlated with both pain ratings trajectories (p &lt; 0.001). On the other hand, no differences were found between groups regarding ICPM efficacy (percentage pain inhibition).

Discussion

This study has provided a first step into the investigation of PPR and ICPM interindividual variability. Using a data-driven approach, it was shown that PPR at CPT offset differs between clusters of participants identified based on dynamic pain intensity and unpleasantness responses from CPT. Thus, it was brought to light that both the levels of tonic pain and pain sensitization underlie individual differences in PPR. The lack of correlation between CPT pain trajectories and ICPM efficacy may be explained by the hypotheses that eliciting ICPM requires only a certain threshold of stimulation which doesn’t need to be noxious. In the future, studies on the inter-subject variability of PPR in large samples of chronic pain patients are warranted.

Beliefs About One's Non-Suicidal Self-Injury: The Experiences of Self-Injury Questionnaire (ESIQ)

OBJECTIVE

The goal of this study was to develop and validate a measure of self-rated positive and negative beliefs about one's non-suicidal self-injury (NSSI), the Experiences of Self-Injury Questionnaire (ESIQ).

METHOD

Psychometric properties and validation against NSSI severity and shame were tested in two U.S. and two U.K. samples of individuals who endorsed a history of NSSI.

RESULTS

Exploratory and confirmatory factor analyses indicated five factors. Subscales were labeled Positive Beliefs, Personal Dislike, Interpersonal Concern, Emotional Suppression, and Emotional Expression. The Positive Beliefs Subscale covers beliefs that NSSI is valuable. Scores on this subscale were associated with endorsement of NSSI frequency, NSSI urges, and perceived likelihood of future NSSI. Other subscales showed validity in that they all showed unique effects on outcome indices of NSSI severity or shame.

CONCLUSION

The ESIQ shows promise as a brief reliable measure of beliefs about and experiences of NSSI.

A multi-measure examination of interoception in people with recent nonsuicidal self-injury

OBJECTIVE

Self-injurious behaviors (SIB) are highly dangerous, yet prediction remains weak. Novel SIB correlates must be identified, such as impaired interoception. This study examined whether two forms of interoceptive processing (accuracy and sensibility) for multiple sensations (general, cardiac, and pain) differed between people with and without recent nonsuicidal self-injury (NSSI).

METHOD

Participants were adults with recent (n = 48) NSSI and with no history of SIBs (n = 55). Interoceptive sensibility was assessed with self-reports. Interoceptive accuracy for cardiac sensations was assessed using the heartbeat tracking task. Interoceptive accuracy for pain was assessed with a novel metric that mirrored the heartbeat tracking test.

RESULTS

Participants with recent NSSI reported significantly lower interoceptive sensibility for general sensations relative to people without SIBs. Groups did not differ on interoceptive sensibility for cardiac sensations or pain. Groups also did not differ on interoceptive accuracy for cardiac sensations. The NSSI group exhibited significantly lower interoceptive accuracy for pain compared with the No SIB group.

CONCLUSIONS

Interoceptive impairment in people with NSSI may vary by interoceptive domain and sensation type. Diminished interoceptive accuracy for sensations relevant to the pathophysiology of self-injury may be a novel SIB correlate.

Adolescent girls' stress responses as prospective predictors of self-injurious thoughts and behaviors: A person-centered, multilevel study

Adolescent risk for self-injurious thoughts and behaviors (STBs) involves disturbance across multiple systems (e.g., affective valence, arousal regulatory, cognitive and social processes). However, research integrating information across these systems is lacking. Utilizing a multiple-levels-of-analysis approach, this person-centered study identified psychobiological stress response profiles and linked them to cognitive processes, interpersonal behaviors, and STBs. At baseline, adolescent girls (N = 241, Mage = 14.68 years, Range = 12-17) at risk for STBs completed the Trier Social Stress Test (TSST), questionnaires, and STB interviews. Positive affect (PA), negative affect (NA), and salivary cortisol (SC) were assessed before and after the TSST. STBs were assessed again during 3, 6, and 9 month follow-up interviews. Multitrajectory modeling of girls' PA, NA, and SC revealed four profiles, which were compared on cognitive and behavioral correlates as well as STB outcomes. Relative to normative, girls in the affective distress, hyperresponsive, and hyporesponsive subgroups were more likely to report negative cognitive style (all three groups) and excessive reassurance seeking (hyporesponsive only) at baseline, as well as nonsuicidal self-injury (all three groups) and suicidal ideation and attempt (hyporesponsive only) at follow-up. Girls' close friendship characteristics moderated several profile-STB links. A synthesis of the findings is presented alongside implications for person-centered tailoring of intervention efforts.

[Pain perception and nonsuicidal self-injurious behavior]

This review focuses on studies of pain threshold and tolerance in individuals with nonsuicidal self-injurious (NSSI) behavior. The data on methods of pain sensitivity studies are presented, with issues in animal modeling of NSSI discussed separately. The results of neuroimaging studies on pain sensitivity in individuals with NSSI are described, along with contribution of genetic factors, psychological variables, and disturbances in opioid and hypothalamic-pituitary-adrenal systems. A critical methodological analysis of the studies on pain sensitivity in individuals with NSSI was performed.

Pain sensitivity and plasma beta-endorphin in adolescent non-suicidal self-injury

BACKGROUND

Beta-endorphin (BE) has been suggested to play a central role as to why people engage in NSSI. To our knowledge, no study has systematically assessed this potential relationship in adolescents with NSSI.

METHODS

94 adolescents with NSSI (according to DSM-5 criteria) and 35 healthy controls (HC) were enrolled. All participants received heat pain stimulation, with pain threshold and tolerance measured in °C. Plasma BE levels were assessed. Sociodemographic and clinical characteristics were obtained via semi-structured interviews and self-report questionnaires.

RESULTS

Adolescents with NSSI showed increased pain thresholds (t₍₁₂₇₎=2.071, p=.040), lower pain intensity (t₍₁₁₄₎==2.122, p=.036) and lower plasma BE levels (t₁₂₇==3.182, p=.002) compared to HC. Groups did not differ on pain tolerance (t₍₁₂₇₎=0.911, p=.364). Greater pain threshold correlated positively with borderline personality disorder (BPD) symptoms (r=0.182, p=.039), while pain intensity (r=-0.206, p=.033) and BE levels (r=-0.246, p=.007) correlated negatively with depression severity. No significant relationship was found between pain threshold and plasma BE (r=-0.013, p=.882).

LIMITATIONS

Future studies should implement repeated plasma BE measures to assess BE release in association with pain in NSSI. Validity of plasma BE measures compared to central measures should be considered. Assessing the association between pain sensitivity (PS) and BE in a naturalistic setting presents a promising avenue for future research in NSSI.

CONCLUSIONS

Findings support both reduced PS and basal opioid deficiency as independent biological correlates and potential risk-factors for NSSI. Further longitudinal and experimental studies are needed to investigate the role of BE levels and PS as well as their potential association.

Affect Dysregulation in Context: Implications and Future Directions of Experience Sampling Research on Affect Regulation Models of Loss of Control Eating

Loss of control eating is a core, transdiagnostic eating disorder symptom associated with psychological distress, functional impairment, and reduced quality of life. However, the factors that contribute to persistent loss of control eating despite negative consequences are not fully understood. Understanding the mechanisms that maintain loss of control eating is crucial to advance treatments that interrupt these processes. Affect regulation models of loss of control eating hypothesize that negative emotions trigger loss of control eating, and that loss of control eating is negatively reinforced because it temporarily decreases negative affect. Several variations on this basic affect regulation model have been proposed, including theories suggesting that negative affect decreases during loss of control eating rather than afterwards (escape theory), and that loss of control eating replaces one negative emotion with another that is less aversive (trade-off theory). Experience sampling designs that measure negative affect and eating behavior multiple times per day are optimally suited to examining the nuanced predictions of these affect regulation models in people's everyday lives. This paper critically reviews experience sampling studies examining associations between negative affect and loss of control eating, and discusses the implications for different affect regulation models of loss of control eating. The review concludes by proposing an expanded affect-focused model of loss of control eating that incorporates trait-level individual differences and momentary biological and environmental variables to guide future research. Clinical implications and recommendations are discussed.

Pain(less) cleansing: Watching other people in pain reduces guilt and sadness but not shame

Past research has shown that pain experience reduces feelings of guilt for earlier wrongdoings. In this paper, we aim to investigate whether watching other people in pain can reduce feelings of guilt. In Study 1 (N = 60), we found that participants’ levels of guilt and sadness decreased after they watched a one-minute movie clip showing a painful medical procedure. Study 2 (N = 156), eliminated an alternative explanation in which pain observation but not the misattribution of unrelated excitation reduced guilt. Finally, in Study 3 (N = 60), pain observation lowered participants’ feelings of guilt but not their feelings of shame. Overall, these results suggest that the guilt-reducing effect of pain may appear even without the actual experience of physical pain.

Does function predict persistence? Nonsuicidal self-injury among adolescents during and after hospitalization

Nonsuicidal self-injury (NSSI) is a prevalent, concerning behavior among adolescents. Importantly, NSSI can serve a variety of functions. Some adolescents engage in NSSI to fulfill automatic or self-oriented functions (e.g., cutting to avoid internal negative states), whereas others engage in NSSI to serve social functions (e.g., cutting to communicate with others). This study tests whether self-reported reasons for engaging in NSSI, hereafter referred to as NSSI functions, predict NSSI thoughts and behaviors during and after hospitalization among adolescent psychiatric inpatients. Endorsement of both automatic and social NSSI functions, as well as positive and negative reinforcement subtypes, was assessed at hospital admission. Results showed that endorsement of overall automatic function predicted which adolescents engaged in NSSI behavior during hospitalization. Moreover, automatic and social functions showed distinct predictive patterns, such that automatic functions corresponded to greater likelihood of NSSI-related thoughts and behaviors whereas social functions mainly corresponded to reduced likelihood of NSSI-related outcomes. Of note, NSSI functions were less predictive of NSSI-related outcomes after hospital discharge. These findings suggest that identifying adolescent inpatients' reasons for NSSI engagement may meaningfully distinguish those at higher risk (and those at lower risk) of NSSI persistence during their hospital stay.

Potential Mood Variation Following a Behavioral Analogue of Self-Injurious Behavior

Despite increased use of behavioral analogues to identify casual mechanisms of self-injurious behavior (e.g., suicide attempts; non-suicidal self-injury), little is known about the impact on participants. The current study examined the impact of a specific behavior analogue, Self-Aggressive Paradigm (SAP), on participant affect. Community participants (n = 507) reported several affective ratings before and after completing SAP task procedures. Following the SAP, participants reported reductions in nervousness and fear and increases in calmness and anger (d = .21). Participants with a current anxiety disorder reported greater increases in happiness; those with a suicide attempt history reported greater increases in sadness. Findings demonstrate the SAP has no adverse mood effects, supporting its use in experimental research.

Decreased Amygdalar Activation to NSSI-Stimuli in People Who Engage in NSSI: A Neuroimaging Pilot Study

In healthy individuals, stimuli associated with injury (such as those depicting blood or wounds) tend to evoke negative responses on both self-report and psychophysiological measures. Such an instinctive aversion makes sense from an evolutionary perspective. However, to engage in nonsuicidal self-injury (NSSI), this natural barrier must be overcome. The Benefits and Barriers model of NSSI predicts that people who engage in NSSI will show diminished aversion to NSSI-related stimuli compared to controls who do not engage in NSSI. We tested this hypothesis in a pilot study assessing 30 adults, 15 of whom reported current skin cutting and 15 of whom had no history of NSSI. Functional magnetic resonance imaging (fMRI) data were collected while participants viewed neutral, positive, and negative images selected from the International Affective Picture System. Participants also viewed NSSI images depicting razors, scalpels, or wounds caused by cutting. Compared to healthy control (HC) participants, the NSSI group showed decreased amygdala and increased cingulate cortex (CC) and orbitofrontal cortex (OFC) activation to NSSI and negative images. They also showed increased amygdalar and OFC activation to positive images. Neither the control group nor the NSSI group demonstrated significant activation within regions more typically associated with reward during any of the conditions; however, positive and negative affect ratings collected throughout the course of the task suggested that none of the affective conditions were viewed as rewarding. Although preliminary, these findings are suggestive of reduced limbic and greater cortical processing of NSSI stimuli in those with a history of this behavior. This has potentially important implications for current models of NSSI as well as for its treatment.

Feeling Hurt: Revisiting the Relationship Between Social and Physical Pain

Pain overlap theory has generated decades of controversy and still receives considerable research attention. A major advance has been the revelation that social and physical pain activate similar neural regions, providing suggestive evidence of a “piggybacked” alarm system that coevolved to detect social exclusion. Recent developments, however, have brought neural evidence for pain overlap into question. We analyze these developments from a social psychological perspective and identify the need for a reformulated approach. To meet this need, we provide a framework that a priori predicts generalized overlap and specific divergence across a range of biopsychosocial domains. The framework points to a functional pattern for similarities and differences, which can be utilized to generate testable hypotheses so that the field can move forward. To demonstrate the utility and promise of the framework, we identify key hypotheses relating to attention, motivation, and responses to pain, and review research relevant to these hypotheses.

The time course of responding to aversiveness in females with a history of non-suicidal self-injury

Non-suicidal self-injury is a risk factor for suicidal behavior, particularly in females. Two prominent theories of suicide suggest that habituation to the psychophysiological aversiveness of NSSI is a mechanism by which NSSI exposure may lead to increased risk for suicide. Several laboratory studies examining the relationship between physiological habituation and suicide attempt history have yielded mixed results, potentially due to their use of broad measures of physiological arousal and/or focus on specific psychopathologies. However, no studies have examined the association between the time course (e.g., habituation, initial reactivity) of responding to aversiveness and NSSI, which may help to elucidate psychophysiological mechanisms of NSSI. Therefore, we examined habituation and initial reactivity to aversiveness (indexed by the time course of acoustic startle reflex, a well-validated measure of defensive responding) in three groups of young adult females - those with a history of NSSI, psychiatric controls matched on potential confounds (e.g., psychopathology, trauma history, demographics), and healthy controls. Results indicated that individuals with a history of NSSI exhibited blunted initial reactivity and marginally slower habituation to aversiveness relative to the two control groups. The NSSI group's insensitivity to aversiveness may reflect prior psychophysiological habituation, and may be a mechanism through which prior NSSI exposure leads to increased risk for suicidal behavior.

Does nonsuicidal self-injury prospectively predict change in depression and self-criticism?

Few studies have investigated nonsuicidal self-injury (NSSI) as a predictor of outcomes other than suicidal self-injury, severely limiting our understanding of this behavior's full range of consequences. Three independent studies were used to examine the prospective association between NSSI and two outcomes: depressive symptoms and self-criticism. Data were collected from samples of (1) adults with past-month NSSI, (2) adults with lifetime NSSI, and (3) adults with past-year NSSI. Studies included one-month and six-month follow-up periods. Results were tested in an internal meta-analysis. Results suggested that NSSI did not prospectively predict changes in self-criticism. No changes in depressive symptoms were seen over shorter follow-up periods; however, NSSI predicted increases in depressive symptoms at six-month follow-up in one sample. The internal meta-analysis indicated a null relationship between NSSI and prospective internalizing symptoms. Future research should replicate these findings and examine a broader range of outcomes of NSSI to better understand its complex relationship to psychopathology.

Relationship between food perceptions and health-related quality of life in a prospective study with breast cancer patients undergoing chemotherapy

OBJECTIVE

To correlate the perceptions related to dietary intake with the domains and subscales of health-related quality of life (HRQL) in women with breast neoplasms receiving chemotherapy.

METHODS

In this prospective study, 55 women with breast cancer were followed up during chemotherapy at three different times (T0, T1, T2). Before chemotherapy, perceptions related to food consumption were evaluated. HRQL was analyzed with the EORTC QLQ-C30 and Br23 instruments 21 days after each investigated cycle. The differences (T2-T0) in the subscales and HRQL domains were correlated with the differences (T2-T0) in the appetite scores. Spearman's correlation was used to verify a possible correlation between differences in functional and overall HRQL domains (T2-T0) and differences in appetite scores for certain foods and between the differences in some subscales of EORTC QLQ-C30 and Br23 (T2-T0) and differences in appetite scores for certain food groups (T2-T0).

RESULTS

Correlations between pain and appetite for bitter taste and between an increased appetite for juices and pain intensification or fatigue were identified, and pain was correlated with an appetite for starchy foods. An appetite for vegetables, legumes and meat/eggs was correlated with physical function. The only significant correlation with social functions occurred between the appetite for sweet foods and these functions. We found a correlation between overall health, emotional function, social function and physical function and the appetite for juices.

CONCLUSION

Chemotherapy alters the individual's relationship with food and, consequently, the individual's HRQL.

A lab-based study exploring the associations among nonsuicidal self-injury, pain, and emotion among university students

Nonsuicidal self-injury (NSSI; e.g., self-cutting without lethal intent) is a widespread mental health concern among emerging adults in university. Although accumulating evidence suggests that NSSI is primarily an emotion coping behaviour, little is known about variability in emotional response to pain among individuals who self-injure. Recent theory on NSSI suggests that individuals who engage in NSSI to self-punish may experience additional affective gains in response to pain compared to individuals without self-punishment motivations for NSSI and individuals who do not self-injure. To test this hypothesis, 82 undergraduate students (Mage = 21.52 years) were recruited from a mid-sized university, and reported on their emotions three times: at baseline, following a stress-induction task, and after a cold-pressor task. Although all participants showed decreased negative emotions (e.g., hostility, fear) and increased serenity following cold pain, students who engaged in NSSI specifically to self-punish also showed decreased guilt and sadness. The present findings demonstrate that pain may serve to regulate different emotions for students who self-injure depending on their motivations for engaging in NSSI. Additionally, findings suggest that prevention and intervention efforts aimed at reducing the need to self-punish may help to reduce some of the emotionally reinforcing properties of NSSI.

Is the association of deliberate self-harm with emotional relief stable or dependent on emotional context?

BACKGROUND AND OBJECTIVES

Despite strong support for the role of emotional relief in deliberate self-harm (DSH), no research has examined the impact of emotional distress on the strength of the DSH-relief association. Thus, it remains unclear whether the association of DSH with emotional relief is stable across emotional contexts or context-dependent. This study aimed to examine if the implicit DSH-relief association is stronger in the context of emotional distress (relative to a neutral emotional context).

METHODS

Young adult women with (n = 60) and without (n = 60) a history of recent recurrent DSH were randomly assigned to complete a novel version of the Implicit Association Test (IAT) assessing the DSH-relief association at baseline (following an initial neutral emotion induction) and again following either a neutral or negative (i.e., social rejection) emotion induction.

RESULTS

Consistent with hypotheses, the DSH-relief association was stronger among women with recent recurrent DSH (vs. those without DSH) at baseline. Contrary to hypotheses, however, whereas the DSH-relief association remained stable following both the neutral and negative emotion inductions among participants with DSH, it became stronger across both conditions for participants without DSH.

LIMITATIONS

The use of a community sample of young adult women may limit generalizability to other relevant populations (e.g., clinical populations, young men, adolescents). Additionally, the negative emotion induction may not have been powerful enough to affect the strength of the learned DSH-relief association among individuals with a repeated history of DSH.

CONCLUSIONS

Findings suggest that the repeated use of DSH to bring about emotional relief may engender associations of DSH with relief that are relatively insensitive to emotional context.

Role of the mesolimbic dopamine system in relief learning

The relief from an aversive event is rewarding. Since organisms are able to learn which environmental cues can cease an aversive event, relief learning helps to better cope with future aversive events. Literature data suggest that relief learning is affected in various psychopathological conditions, such as anxiety disorders. Here, we investigated the role of the mesolimbic dopamine system in relief learning. Using a relief learning procedure in Sprague Dawley rats, we applied a combination of behavioral experiments with anatomical tracing, c-Fos immunohistochemistry, and local chemogenetic and pharmacological interventions to broadly characterize the role of the mesolimbic dopamine system. The present study shows that a specific part of the mesolimbic dopamine system, the projection from the posterior medial ventral tegmental area (pmVTA) to the nucleus accumbens shell (AcbSh), is activated by aversive electric stimuli. 6-OHDA lesions of the pmVTA blocked relief learning but fear learning and safety learning were not affected. Chemogenetic silencing of the pmVTA-AcbSh projection using the DREADD approach, as well as intra-AcbSh injections of the dopamine D2/3 receptor antagonist raclopride inhibited relief learning. Taken together, the present data demonstrate that the dopaminergic pmVTA-AcbSh projection is critical for relief learning but not for similar learning phenomena. This novel finding may have clinical implications since the processing of signals predicting relief and safety is often impaired in patients suffering from anxiety disorders. Furthermore, it may help to better understand psychological conditions like non-suicidal self-injury, which are associated with pain offset relief.

Reinforcement signaling of punishment versus relief in fruit flies

Painful events establish opponent memories: cues that precede pain are remembered negatively, whereas cues that follow pain, thus coinciding with relief are recalled positively. How do individual reinforcement-signaling neurons contribute to this “timing-dependent valence-reversal?” We addressed this question using an optogenetic approach in the fruit fly. Two types of fly dopaminergic neuron, each comprising just one paired cell, indeed established learned avoidance of odors that preceded their photostimulation during training, and learned approach to odors that followed the photostimulation. This is in striking parallel to punishment versus relief memories reinforced by a real noxious event. For only one of these neuron types, both effects were strong enough for further analyses. Notably, interfering with dopamine biosynthesis in these neurons partially impaired the punishing effect, but not the relieving after-effect of their photostimulation. We discuss how this finding constraints existing computational models of punishment versus relief memories and introduce a new model, which also incorporates findings from mammals. Furthermore, whether using dopaminergic neuron photostimulation or a real noxious event, more prolonged punishment led to stronger relief. This parametric feature of relief may also apply to other animals and may explain particular aspects of related behavioral dysfunction in humans.

Being right, but losing money: the role of striatum in joint decision making

Joint decision-making entails that you sometimes have to go along with the other's choice even though you disagree. In this situation, a resulting negative outcome may, however, elicit a feeling of satisfaction and an impulse to say "I told you so". Using fMRI, we investigated the neural correlates of this complex process comprised of both positive and negative outcomes. During a social visual search task, 19 participants gave their advice to a co-actor who then made the decision resulting in a mutual loss or gain. This design allowed direct comparisons of situations that resulted in the same monetary outcome but that differed with respect to the correctness of the initial advice of the participant. Increased striatal activations were found for gains compared to losses and for correct compared to incorrect advice. Importantly, ROI analyses also showed enhanced striatum activation for monetary losses that were preceded by correct compared to incorrect advices. The current study therefore suggests that reward-related neural mechanisms may be involved when being right even in situations that end in monetary losses.

Assessing Non-Suicidal Self-Injury in the Laboratory

The majority of non-suicidal self-injury (NSSI) research has used self- or clinician-rated measures of behavior which (a) are subject to reporting biases, or (b) have limited use in experimental designs that could illuminate causal relationships. Laboratory-based behavioral tasks have therefore been developed to assess NSSI-related behaviors more directly. We reviewed the behavioral methods that have been developed to assess NSSI tendencies or behaviors over the past 30 years. Several categories of laboratory analogues were identified: NSSI-related stimuli (e.g., NSSI pictures, implicit association tasks, guided imagery), experimenter administered pain stimuli (e.g., cold, heat, pressure, shock, and blade), and self-selected pain stimuli (e.g., cold and shock). These behavioral methods assess various aspects of NSSI and all have distinct advantages and shortcomings. Overall, these approaches have made significant contributions to the field complementing self- and clinician-ratings.

Social exposure and emotion dysregulation: Main effects in relation to nonsuicidal self-injury

We examined the relation of interpersonal and media exposure to nonsuicidal self-injury (NSSI) among 340 university students in the southeastern United States (73.5% female, M age = 19.38 years, SD = 1.15). We also assessed interactions and main effects of each exposure and emotion dysregulation in relation to NSSI, testing the social learning hypothesis of NSSI. Most participants endorsed medium to high levels of exposure to NSSI via media sources. More than one-third of participants were somewhat or very familiar with someone who engaged in NSSI. Almost half reported occasional or frequent conversations about NSSI. Both exposure forms were significantly related to NSSI history. However, hurdle regression analyses revealed that interpersonal exposure and emotion dysregulation, but not media exposure, were significantly associated with NSSI history and frequency. We did not find evidence for an emotion dysregulation-by-interpersonal-exposure interaction. We discuss implications for theoretical models of NSSI, limitations, and future directions.

Characterizing the course of non-suicidal self-injury: A cognitive neuroscience perspective

Non-suicidal self-injury (NSSI) has received increasing recognition as a clinically significant phenomenon. Although in most individuals who engage in NSSI, this behavior is short-lived, for a significant proportion of these individuals, NSSI follows a chronic course. There is a need for research advancing our understanding of the mechanisms of risk for NSSI, and how these mechanisms may change over time to account for the persistence of this behavior. In the current paper, a conceptual framework is proposed for characterizing the processes underlying the transition from initial engagement in NSSI to a chronic trajectory of this behavior. In particular, a case is made for conceptualizing NSSI as a habitual behavior as defined within a cognitive neuroscience perspective, with support from the existing theoretical and empirical literature. Finally, potential mechanisms are articulated for the development of chronic NSSI within this conceptual framework and recommendations presented for empirically evaluating this conceptualization of NSSI in future research in this area.

Understanding Mixed Emotions: Paradigms and Measures

In this review, we examine the paradigms and measures available for experimentally studying mixed emotions in the laboratory. For eliciting mixed emotions, we describe a mixed emotions film library that allows for the repeated elicitation of a specific homogeneous mixed emotional state and appropriately matched pure positive, pure negative, and neutral emotional states. For assessing mixed emotions, we consider subjective and objective measures that fall into univariate, bivariate, and multivariate measurement categories. As paradigms and measures for objectively studying mixed emotions are still in their early stages, we conclude by outlining future directions that focus on the reliability, temporal dynamics, and response coherence of mixed emotions paradigms and measures. This research will build a strong foundation for future studies and significantly advance our understanding of mixed emotions.

The effect of acute physical pain on subsequent negative emotional affect: A meta-analysis

Although it is clear that most people attempt to avoid pain and often find it unpleasant in the moment, research suggests that changes in affect after pain are not universally negative. To help advance our understanding of pain-affect relationships, the goal of the current study was to conduct a meta-analysis of studies examining changes in negative affect, as defined by subjective experience and psychophysiology, after the experience of acute laboratory pain. We identified 22 effect sizes from 17 different studies (N = 1,717). We tested several different hypotheses based primarily on theories of nonsuicidal self-injury (NSSI), with mixed support. Our main findings were that pain had a small to medium effect in reducing negative affect (dav = -0.35, 95% confidence interval [CI] [-0.58, -0.12]), and most robustly regulated negative affect in the context of a negative affect induction (dav = -0.37, 95% CI [-0.73, -0.02]) relative to neutral affect induction (dav = 0.08, 95% CI [-0.09, 0.26]). Similar reductions were also seen after painful and nonpainful stimulation, calling into question whether pain is necessary or whether any stimulation is sufficient. The results lead to several questions to be addressed in future research. (PsycINFO Database Record

Transformative Events: Appraisal Bases of Passion and Mixed Emotions

Mixed emotions are conceptualized as involving the co-occurrence of states opposite in valence. One might expect that combinations of opposites would show diminished overall emotion intensity. But is this always the case? If not, when will mixed emotions be characterized by high intensity, and when by low intensity? In this article, theories of emotion-eliciting appraisal and emotion intensity are employed to understand mixed emotions and phenomena of passion. It is proposed that intense emotions are produced by transformative events: perceived motive-relevant changes that are important, large, and rapid. Transformative events that can move a person between greatly motive-inconsistent and greatly motive-consistent outcomes constitute one potent path to passion. Illustrative phenomena of passion, mixed emotions, and related research are discussed.

Metabotropic Glutamate Receptors 7 within the Nucleus Accumbens are Involved in Relief Learning in Rats

Relief learning is an appetitive association of a formally neutral cue with relief induced by the offset of an aversive stimulus. Since the nucleus accumbens mediates relief learning and accumbal metabotropic glutamate receptors 7 (mGluR7) modulate appetitive-like processes, we hypothesized that accumbal mGluR7 may be involved in the modulation of relief learning. Therefore, we injected the allosteric mGluR7 agonist AMN082 into the nucleus accumbens and tested the effects of these injections on acquisition and expression of relief memory, as well as on the reactivity to electric stimuli. AMN082 injections blocked acquisition but not expression of relief memory. In addition, accumbal AMN082 injections strongly reduced the locomotor reactivity to electric stimuli indicating antinociceptive effects. These antinociceptive effects might be causal for the blockade of relief learning after AMN082 injections. Taken together, the present study indicates that functional activation of accumbal mGluR7 has antinociceptive effects that interfere with relief learning.

Non-suicidal Self-Injury in Adolescence

PURPOSE OF REVIEW

Non-suicidal self-injury (NSSI) is a common mental health threat among adolescents. This review aims to present the current literature on epidemiology, etiology, and therapeutic approaches with a focus on the period of adolescence.

RECENT FINDINGS

NSSI is widespread among adolescents both in community as well as in clinical settings with lifetime prevalence rates between 17 and 60% in recent studies. It is influenced by multiple factors including social contagion, interpersonal stressors, neurobiological background, as well as emotional dysregulation and adverse experiences in childhood. There is still a lack of studies regarding the psychotherapeutic as well as the psychopharmacological treatment of NSSI in adolescence. Furthermore, sufficient evidence for prevention programs is missing.

Reversing Stimulus Timing in Visual Conditioning Leads to Memories with Opposite Valence in Drosophila

Animals need to associate different environmental stimuli with each other regardless of whether they temporally overlap or not. Drosophila melanogaster displays olfactory trace conditioning, where an odor is followed by electric shock reinforcement after a temporal gap, leading to conditioned odor avoidance. Reversing the stimulus timing in olfactory conditioning results in the reversal of memory valence such that an odor that follows shock is later on approached (i.e. relief conditioning). Here, we explored the effects of stimulus timing on memory in another sensory modality, using a visual conditioning paradigm. We found that flies form visual memories of opposite valence depending on stimulus timing and can associate a visual stimulus with reinforcement despite being presented with a temporal gap. These results suggest that associative memories with non-overlapping stimuli and the effect of stimulus timing on memory valence are shared across sensory modalities.

Doubling Your Payoff: Winning Pain Relief Engages Endogenous Pain Inhibition

When in pain, pain relief is much sought after, particularly for individuals with chronic pain. In analogy to augmentation of the hedonic experience (“liking”) of a reward by the motivation to obtain a reward (“wanting”), the seeking of pain relief in a motivated state might increase the experience of pain relief when obtained. We tested this hypothesis in a psychophysical experiment in healthy human subjects, by assessing potential pain-inhibitory effects of pain relief “won” in a wheel of fortune game compared with pain relief without winning, exploiting the fact that the mere chance of winning induces a motivated state. The results show pain-inhibitory effects of pain relief obtained by winning in behaviorally assessed pain perception and ratings of pain intensity. Further, the higher participants scored on the personality trait novelty seeking, the more pain inhibition was induced. These results provide evidence that pain relief, when obtained in a motivated state, engages endogenous pain-inhibitory systems beyond the pain reduction that underlies the relief in the first place. Consequently, such pain relief might be used to improve behavioral pain therapy, inducing a positive, perhaps self-amplifying feedback loop of reduced pain and improved functionality.

Low implicit and explicit aversion toward self-cutting stimuli longitudinally predict nonsuicidal self-injury

There is a pressing need to improve the ability to identify individuals at risk for nonsuicidal self-injury (NSSI; e.g., cutting or burning oneself); unfortunately, beyond prior NSSI, there are few powerful longitudinal predictors of NSSI. The present study addressed this limitation by investigating the ability of a novel factor--low aversion to self-cutting stimuli--to longitudinally predict NSSI in 49 individuals with a history of self-cutting. Results revealed that both low implicit and explicit aversion to self-cutting stimuli were significantly associated with future NSSI (rs = .32-.51), and that these associations were unique from several other theoretically important predictors, including prior NSSI, number of NSSI methods, implicit identification with self-cutting, self-prediction of future NSSI, emotion dysregulation, and therapy status. These findings are consistent with the notion that instinctive barriers (e.g., aversion to NSSI stimuli, pain) dissuade most people from engaging in NSSI, and that the erosion of these barriers may facilitate NSSI.

Predictors of self-injury cessation and subsequent psychological growth: results of a probability sample survey of students in eight universities and colleges

BACKGROUND

Factors affecting non-suicidal self-injury cessation are poorly understood. The aim of this study was to identify differences between individuals with current and past non-suicidal self-injury (NSSI) in a large probability sample of university students using quantitative and qualitative methods. Predictors of psychological growth related following NSSI cessation were also examined.

METHOD

The sample included 836 students who participated in a larger online study of well-being at eight U.S. colleges and who reported current or past history of repeated NSSI. The average age of respondents used in analysis was 21.3 years. They were 78.3 % female and 21.7 % male and were 70.7 % Caucasian, 1.4 % African American/Black, 5.5 % Hispanic, 7.8 % Asian/Asian American and 14.7 % other. Analyses tested differences in demographics, NSSI characteristics (e.g. lifetime frequency, number of NSSI functions, NSSI disclosure), formal help-seeking, psychosocial factors, and mental health and trauma histories.

RESULTS

Individuals with current NSSI status were more likely to be female and slightly younger, to report higher NSSI lifetime frequency, more NSSI forms and functions, thinking of themselves as a "self-injurer", and current psychological distress. Individuals with current NSSI status were less likely to report that self-injury interfered with life, that therapy was useful in stopping, perceiving social support, having a sense of meaning in life, access to more emotion regulation strategies, and life satisfaction. Qualitative data suggested that cessation may be attributable to changes in ability to regulate emotion (62.6 %), self-awareness (38.7 %), and important relationships to others (36.0 %). Psychological growth after stopping NSSI was predicted by more severe NSSI (form and perceived NSSI dependence), having talked about NSSI with others and higher numbers of confidantes, perceived life satisfaction, and a history of suicide action.

CONCLUSIONS

These findings add to the still nascent body of literature examining processes related to NSSI cessation. Our results point to the importance of help-seeking and social support, as well as psychosocial processes in stopping NSSI.

Synapsin determines memory strength after punishment- and relief-learning

Adverse life events can induce two kinds of memory with opposite valence, dependent on timing: "negative" memories for stimuli preceding them and "positive" memories for stimuli experienced at the moment of "relief." Such punishment memory and relief memory are found in insects, rats, and man. For example, fruit flies (Drosophila melanogaster) avoid an odor after odor-shock training ("forward conditioning" of the odor), whereas after shock-odor training ("backward conditioning" of the odor) they approach it. Do these timing-dependent associative processes share molecular determinants? We focus on the role of Synapsin, a conserved presynaptic phosphoprotein regulating the balance between the reserve pool and the readily releasable pool of synaptic vesicles. We find that a lack of Synapsin leaves task-relevant sensory and motor faculties unaffected. In contrast, both punishment memory and relief memory scores are reduced. These defects reflect a true lessening of associative memory strength, as distortions in nonassociative processing (e.g., susceptibility to handling, adaptation, habituation, sensitization), discrimination ability, and changes in the time course of coincidence detection can be ruled out as alternative explanations. Reductions in punishment- and relief-memory strength are also observed upon an RNAi-mediated knock-down of Synapsin, and are rescued both by acutely restoring Synapsin and by locally restoring it in the mushroom bodies of mutant flies. Thus, both punishment memory and relief memory require the Synapsin protein and in this sense share genetic and molecular determinants. We note that corresponding molecular commonalities between punishment memory and relief memory in humans would constrain pharmacological attempts to selectively interfere with excessive associative punishment memories, e.g., after traumatic experiences.

Explicating the role of emotion dysregulation in risky behaviors: A review and synthesis of the literature with directions for future research and clinical practice

Extant literature provides support for emotion dysregulation as a transdiagnostic construct with relevance to the pathogenesis and treatment of numerous psychiatric difficulties and maladaptive behaviors, including risky, self-destructive, and health-compromising behaviors (e.g., substance use, risky sexual behavior). The aim of the present review is to synthesize theory and empirical research on the relationship between emotion dysregulation and risky behaviors. In addition, we highlight cutting-edge approaches for investigating the emotion dysregulation-risky behavior, including examination of the role of positive emotional experiences and inclusion of context-dependent and physiological assessments. Finally, we note the relevance of the emotion dysregulation-risky behavior relation to intervention efforts aimed at reducing risky behaviors.

How absent negativity relates to affect and motivation: an integrative relief model

The present paper concerns the motivational underpinnings and behavioral correlates of the prevention or stopping of negative stimulation – a situation referred to as relief. Relief is of great theoretical and applied interest. Theoretically, it is tied to theories linking affect, emotion, and motivational systems. Importantly, these theories make different predictions regarding the association between relief and motivational systems. Moreover, relief is a prototypical antecedent of counterfactual emotions, which involve specific cognitive processes compared to factual or mere anticipatory emotions. Practically, relief may be an important motivator of addictive and phobic behaviors, self destructive behaviors, and social influence. In the present paper, we will first provide a review of conflicting conceptualizations of relief. We will then present an integrative relief model (IRMO) that aims at resolving existing theoretical conflicts. We then review evidence relevant to distinctive predictions regarding the moderating role of various procedural features of relief situations. We conclude that our integrated model results in a better understanding of existing evidence on the affective and motivational underpinnings of relief, but that further evidence is needed to come to a more comprehensive evaluation of the viability of IRMO.

The use of human resources literature regarding the relationship between affect and student academic performance

Orientation: In human resources literature affect, or affectivity, has been identified as contributing, either negatively or positively, to different forms of performance in a range of different contexts.Research purpose: The aim of the study was to empirically test theory that predicts that affect can influence performance; in this case the academic performance of students in the South African higher education context.Motivation for the study: Human resources job performance theory seems to offer important insights when extended into other contexts of individual performance. The specific potential influence of affect on student performance is unclear in this context.Research design, approach and method: A non-probability comprehensive sample of all students registered for first-year accountancy (n = 719) was used. Confirmatory factor analysis, exploratory factor analysis and bivariate tests of association were used to empirically test theory predicting relationships between affect and student academic performance.Main findings: In general the findings support the predications derived from affect theory, that negative affect is negatively associated with student performance and that positive affect is positively associated with student performance. Yet, the results suggest that affect might not, in this context, reflect the two-dimensional theoretical structure. In particular, negative affectivity might better be considered as a three-dimensioned construct.Practical/managerial implications: These results suggest that proactive measures may need to be taken by higher education institutions to support first-year students affectively. Student advisors or counsellors should be appointed, with a specific focus on providing support for student anxiety and other contextual frustrations to which individuals with higher levels of negative affect might be particularly vulnerable.Contribution: These findings provide new insights into the importance of extending human resource theory into different contexts. Knowledge of the specific potential constraints posed by affect to student performance is provided.