Cognitive Factors in Fibromyalgia: The Role of Self-Concept and Identity Related Conflicts

Fibromyalgia is a syndrome characterized by the presence of diffuse and chronic musculoskeletal pain of unknown etiology. Clinical diagnosis and the merely palliative treatments considerably affect the patient's experience and the chronic course of the disease. Therefore, several authors have emphasized the need to explore issues related to self in these patients. The repertory grid technique (RGT), derived from personal construct theory, is a method designed to assess the patient's construction of self and others. A group of women with fibromyalgia (n = 30) and a control group (n = 30) were assessed using RGT. Women with fibromyalgia also completed the Fibromyalgia Impact Questionnaire and a visualanalogue scale for pain, and painful tender points were explored. Results suggest that these women had a higher present self-ideal self discrepancy and a lower perceived adequacy of others, and it was more likely to find implicative dilemmas among them compared to controls. These dilemmas are a type of cognitive conflict in which the symptom is construed as "enmeshed" with positive characteristics of the self. Finally, implications of these results for the psychological treatment of fibromyalgia are suggested to give a more central role to self-identity issues and to the related cognitive conflicts.     

Biological and psychological factors associated with memory function in fibromyalgia syndrome.

Fibromyalgia is a stress-related disorder characterized by chronic pain, memory impairment, and neuroendocrine aberrations. With the hypothesis that biological and psychological symptoms may underlie the cognitive problems, the relative influences of neuroendocrine function and psychological factors on declarative memory were examined among 50 women with fibromyalgia. This within-group analysis controlled for age, education, pain, and relevant medications. Neuroendocrine function and depression had significant independent associations with memory function. Higher log-transformed mean salivary cortisol levels were associated with better performance on both immediate and delayed visual recall and with delayed verbal recall. Depressive symptoms were negatively associated with verbal recall. These findings suggest that a basic disorder of endocrine stress responses may contribute to the cognitive symptoms experienced by fibromyalgia patients.     

Viewing Cognitive Conflicts as Dilemmas: Implications for Mental Health

The idea that internal conflicts play a significant role in mental health has been extensively addressed in various psychological traditions, including personal construct theory. In the context of the latter, several measures of conflict have been operationalized using the Repertory Grid Technique (RGT). All of them capture the notion that change, although desirable from the viewpoint of a given set of constructs, becomes undesirable from the perspective of other constructs. The goal of this study is to explore the presence of cognitive conflicts in a clinical sample (n = 284) and compare it to a control sample (n = 322). It is also meant to clarify which among the different types of conflict studied provides a greater clinical value and to investigate its relationship to symptom severity (SCL-90-R). Of the types of cognitive conflict studied, implicative dilemmas were the only ones to discriminate between clinical and nonclinical samples. These dilemmas were found in 34% of the nonclinical sample and in 53% of the clinical sample. Participants with implicative dilemmas showed higher symptom severity, and those from the clinical sample displayed a higher frequency of dilemmas than those from the nonclinical sample.     

Mindfulness Meditation for Symptom Reduction in Fibromyalgia: Psychophysiological Correlates

Objectives Fibromyalgia, a chronic pain syndrome, is often accompanied by psychological distress and increased basal sympathetic tone. In a previous report it was shown that mindfulness-based stress-reduction (MBSR) reduced depressive symptoms in patients with fibromyalgia with gains maintained at two months follow-up (Sephton et al., Arthr Rheum 57:77–85, 2007). This second study explores the effects of MBSR on basal sympathetic (SNS) activation among women with fibromyalgia. Methods Participants (n = 24) responded to a television news appearance, newspaper, and radio advertisements. Effects on anxiety, depressive symptoms, and SNS activation measures were tested before and after MBSR using a within-subjects design. Results The MBSR treatment significantly reduced basal electrodermal (skin conductance level; SCL) activity (t = 3.298, p = .005) and SCL activity during meditation (t = 4.389, p = .001), consistent with reduced SNS activation. Conclusions In this small sample, basal SNS activity was reduced following MBSR treatment. Future studies should assess how MBSR may help reduce negative psychological symptoms and attenuate SNS activation in fibromyalgia. Further clarification of psychological and physiological responses associated with fibromyalgia may lead to more beneficial treatment.     

Individual experiences of an acceptance-based pain management programme: An interpretative phenomenological analysis

Acceptance of pain has been found to play an important role in adjusting to chronic pain, and the evidence-base is growing with regards to the effectiveness of acceptance-based interventions such as acceptance and commitment therapy, mindfulness and contextual cognitive behavioural therapy within pain management settings. Despite the growing interest in such interventions, previous studies into acceptance-based pain management programmes (PMPs) are quantitative and the exact processes at work during such programmes remain unknown. This study aims to add to previous quantitative research in the area by qualitatively exploring individual experiences of attending an acceptance-based PMP and identifying the key constituents of the programme that participants felt facilitated change. Semi-structured interviews (n = 6) were analysed using interpretative phenomenological analysis, and five themes emerged: I’m not alone, others understand my pain, Freedom from pain taking over, A new self – one with pain, Parts of the programme participants felt facilitated change and Exercise is possible. These findings are then considered in relation to past research and relevant constructs in the literature. Implications for future research and clinical practice are also discussed alongside participant reflections and suggested areas for improvement.     

Living with the unexplained: coping,distress, and depression among women with chronic fatigue syndrome and/or fibromyalgia compared to an autoimmune disorder

Chronic fatigue syndrome (CFS) and fibromyalgia are disabling conditions without objective diagnostic tests, clear-cut treatments, or established etiologies. Those with the disorders are viewed suspiciously, and claims of malingering are common, thus promoting further distress. It was hypothesized in the current study that levels of unsupportive social interactions and the coping styles used among those with CFS/fibromyalgia would be associated with perceived distress and depressive symptoms. Women with CFS/fibromyalgia (n = 39), in fact, reported higher depression scores, greater perceived distress and more frequent unsupportive relationships than healthy women (n = 55), whereas those with a chronic, but medically accepted illness comprising an autoimmune disorder (lupus erythematosus, multiple sclerosis, rheumatoid arthritis; n = 28), displayed intermediate scores. High problem-focused coping was associated with low levels of depression and perceived distress in those with an autoimmune condition. In contrast, although CFS/fibromyalgia was also accompanied by higher depression scores and higher perceived distress, this occurred irrespective of problem-focused coping. It is suggested that because the veracity of ambiguous illnesses is often questioned, this might represent a potent stressor in women with such illnesses, and even coping methods typically thought to be useful in other conditions, are not associated with diminished distress among those with CFS/fibromyalgia.     

Cognitive rigidity in patients with depression and fibromyalgia

Background/ObjectiveThe comorbidity of depression and fibromyalgia chronic syndrome has been well documented in the literature; however, the cognitive structure of these patients has not been assessed. Previous results reported variability in cognitive rigidity in depressive patients, the key for this might be the presence of chronic physical pain such as fibromyalgia. The present study explores and compares the cognitive rigidity and differentiation, between patients with depression with and without fibromyalgia syndrome.MethodThirty one patients with depression and fibromyalgia were matched, considering age, sex and number of depressive episodes, with 31 patients with depression but without fibromyalgia diagnosis. Cognitive rigidity and differentiation were measured with the repertory grid technique.ResultsThe results indicated that depressed patients with fibromyalgia presented higher levels of depressive symptoms, greater cognitive rigidity and lower cognitive differentiation than those without fibromyalgia.ConclusionsThe results might inform future treatments to address the cognitive structure of these patients.     

Cognitive-Behavioral and Personal Construct Therapies for Depression in Women with Fibromyalgia: A Randomized Controlled Trial

Background/ObjectiveFibromyalgia is a chronic pain syndrome that depressive symptoms can aggravate. The aim of the present study was to test the efficacy of Personal Construct Therapy (PCT), an approach that emphasizes identity features and interpersonal meanings as the focus of the treatment of depressive symptoms, in women with fibromyalgia.MethodWe compared PCT with Cognitive Behavioral Therapy (CBT) in a multicenter parallel randomized trial. Women with fibromyalgia and depressive symptoms (n = 106) were randomly allocated to CBT (n = 55) or PCT (n = 51) in individual and modular formats to adjust to their needs. Analysis was by linear mixed-effects models.ResultsParticipants in both conditions had significantly reduced depressive symptoms, and we found no significant difference when comparing groups both post-treatment (β = -0.47, t = -0.49, p = .63) and at follow-up (β = -1.12, t = -1.09, p = .28). Results were similar between conditions for anxiety, fibromyalgia's impact, and the distribution of clinically significant changes in depressive symptoms and pain.ConclusionsPCT and CBT seem to be equally effective in the treatment of depressive symptoms, making PCT a viable alternative treatment.     

‘How can we help when she won't tell us what's wrong?’ Professionals working with South Asian women who have experienced sexual abuse

In this paper, we explore some of the issues facing professionals in the UK currently involved in providing services for South Asian women who have experienced sexual abuse. The study describes part of a wider Economic and Social Research Council funded project, based upon interviews and focus groups with both professionals and women survivors of sexual abuse. Drawing on semi‐structured interviews and two focus groups with 37 professionals including psychological therapists, refuge and project workers, from a range of organisations, our aim in this paper is to provide a discursive analysis of some of the key dilemmas faced by professionals working with sexual abuse in South Asian communities by exploring two central interpretive repertoires: ‘culture not self’ and ‘symptom talk as solution’. The analysis indicates that professionals face a series of dilemmas when working with South Asian women survivors. They highlight the tension between individualised models of personhood in many psychological therapies and the challenge to these by South Asian communities who hold a more relational view of the person. One of the strategies used by professionals to work with the tensions between ‘culture’ and the ‘reality’ of the survivor's pain was the translation of women's distress into symptoms of mental disorder. However, the consequences of this intervention raised some serious issues, including further pathologisation and stigma. The implications of these findings will be discussed in terms of how to understand the experiences of South Asian women from a more socially grounded perspective and to explore the issues they face in accessing and receiving appropriate services to deal with the aftermath of sexually abusive experiences. Copyright © 2006 John Wiley & Sons, Ltd.     

A Quantitative Estimate of Schema Abnormality in Socially Anxious and Non‐Anxious Individuals

Although cognitive theories of anxiety suggest that anxious individuals are characterized by abnormal threat‐relevant schemas, few empirical studies have estimated the nature of these cognitive structures using quantitative methods that lend themselves to inferential statistical analysis. In the present study, socially anxious (n = 55) and non‐anxious (n = 62) participants completed 3 Q‐Sort tasks to assess their knowledge of events that commonly occur in social or evaluative scenarios. Participants either sorted events according to how commonly they personally believe the events occur (i.e. “self” condition), or to how commonly they estimate that most people believe they occur (i.e. “other” condition). Participants' individual Q‐Sorts were correlated with mean sorts obtained from a normative sample to obtain an estimate of schema abnormality, with lower correlations representing greater levels of abnormality. Relative to non‐anxious participants, socially anxious participants' sorts were less strongly associated with sorts of the normative sample, particularly in the “self” condition, although secondary analyses suggest that some significant results might be explained, in part, by depression and experience with the scenarios. These results provide empirical support for the theoretical notion that threat‐relevant self‐schemas of anxious individuals are characterized by some degree of abnormality.     

Attention Modification in Persons with Fibromyalgia: A Double Blind,Randomized Clinical Trial

Contemporary models of chronic musculoskeletal pain emphasize the critical roles of fear, anxiety, and avoidance as well as biases in attention in the development and maintenance of chronic pain disability. Evidence supports the influence of individual difference variables such as anxiety sensitivity, pain-related anxiety, and catastrophizing on the pain experience and on pain-related attentional biases. Changes in attentional biases have been associated with treatment gains in patients with clinically significant anxiety. The Attentional Modification Paradigm (AMP) is a modification of the dot-probe paradigm used to facilitate such changes in attentional biases. Given the relationship between chronic musculoskeletal pain and anxiety, AMP may be effective in reducing pain as well. Participants included persons (n = 17) with fibromyalgia and were randomly assigned to either an AMP condition or a control condition. The participants completed two 15-minute AMP sessions per week for 4 weeks. Those in the AMP condition reported statistically significant and substantial reductions on several individual difference variables relative to those in the control condition, and a greater proportion experienced clinically significant reductions in pain. These preliminary results offer a promising new avenue for treating chronic musculoskeletal pain that warrants additional research. Comprehensive results, limitations, and future directions are discussed.     

When does priming justice promote forgiveness? On the importance of distributive and procedural justice for self and others

Two studies show that thinking about justice can both enhance and impede forgiveness, depending on whether thoughts about distributive and procedural justice for self and others are activated. In Study 1 (n = 197), participants expressed more forgiveness towards a prior transgressor when primed to think about justice for self or procedural justice for others, and less forgiveness when primed to think about distributive justice for others. Study 2 (n = 231) used an alternate priming method and replicated these effects by inducing an interpersonal transgression and measuring forgiveness intentions, emotions and behavior. Study 2 also showed that priming justice influences forgiveness especially when the perceived severity of an interpersonal offense is high. The current research shows that activating justice cognitions can enhance or impinge on forgiveness in predictable ways. We discuss contributions to emerging justice theory, potential implications, and future directions.     

The Developing Theory of Mental State Control: Changes in Beliefs about the Controllability of Emotional Experience from Elementary School through Adulthood

ABSTRACT

In everyday life, we use folk theories about the mind and behavior to understand ourselves and others. An important part of our folk theory of mind is our intuitions about the role of the self in mental functioning—namely, whether the self is able to control each mental operation. The current study explored beliefs about the nature of control over emotional aspects of mental experience from middle childhood through adulthood. Elementary school children (n = 46), middle schoolers (n = 46), 18-year-olds (n = 46), and adults (n = 104) were presented with vignettes depicting characters experiencing negative emotions. Participants evaluated the intentionality, changeability, and chronicity of the characters’ responses. Results showed that by elementary school, children share adults’ view that emotions are largely outside of volitional control. However, beliefs about the changeability and chronicity of emotions mature beyond middle childhood. Between elementary school and adulthood, participants decreased their endorsement of the ability to change one’s current negative emotions and increased their beliefs in the chronic, enduring nature of these responses. With age, these changeability and chronicity beliefs also came to differ depending on the emotional response (i.e., feeling grumpy, being nervous, acting mean). Together, these findings suggest that intuitions about the controllability of emotional experience become more differentiated and less optimistic across development.     

How Do Elements of a Reduced Capacity to Withstand Uncertainty Relate to the Severity of Health Anxiety?

Intolerance of uncertainty (IU)—a multidimensional cognitive vulnerability factor—is associated with a variety of anxiety disorders and health anxiety (HA). To date, few studies have assessed whether IU dimensions (prospective and inhibitory IU) are differentially associated with HA and whether their contributions are independent of anxiety sensitivity (AS). This study addressed these issues using independent community (n = 155; 81% women) and undergraduate (n = 560; 86% women) samples. Results indicated that prospective IU, but not inhibitory IU, had significant positive associations with HA in community dwellers and undergraduate students. AS somatic and cognitive concerns were also significant predictors among both samples. In addition, severity of IU dimensions among individuals reporting elevated HA were compared against individuals diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive–compulsive disorder. Results indicated minimal differences between those with elevated HA and each of the anxiety disorder diagnoses. Findings lend support to the unique transdiagnostic nature of IU and support commonalities between HA and anxiety disorders.     

The importance of feeling sexually attractive: Can it predict an individual's experience of their sexuality and sexual relationships across gender and sexual orientation?

Limited research exists on the implications of feeling sexually attractive for various aspects of sexuality and sexual relationships. This article examined associations between self‐perceived sexual attractiveness and sexual esteem, sexual satisfaction and amount of sexual experience, among both men and women who identified as heterosexual (n = 1017), gay or lesbian (n = 1225) or bisexual (n = 651). Results of the study demonstrated that positive self‐perceptions of sexual attractiveness predicted greater sexual esteem, greater sexual satisfaction, a higher frequency of sexual activity with others and a larger number of sexual partners among both men and women who identified as heterosexual, gay, lesbian or bisexual. The findings suggest that feeling sexually attractive may have implications for how an individual experiences their sexuality and sexual relationships regardless of their gender or sexual orientation. The importance of considering an individual's self‐perceptions of sexual attractiveness when they present with concerns related to their sexual experiences or relationships, and the potential benefits of educational and therapeutic interventions designed to enhance self‐perceptions of sexual attractiveness are discussed.     

Anxiety at 13 and its effect on pain,pain-related anxiety,and pain-related disability at 17: An ALSPAC cohort longitudinal analysis

The aim of the present study was to investigate the influence of anxiety at 13 years of age on the presence of chronic pain, pain-related anxiety, and pain-related disability at 17 years of age in a large longitudinal cohort. We hypothesized that mother-reported anxiety at 13 would be associated with the presence of chronic pain at 17 and an increase in pain-related anxiety using all available data from the longitudinal cohort. Further, we hypothesized that anxiety at 13 would predict pain-related disability in adolescents who reported chronic pain at 17 years of age. Participants were recruited from the Avon Longitudinal Study of Parents and Children based in the UK who attended a university research clinic at 17. Child anxiety (reported by the mother) was extracted at child age 13, and self-report of the presence of chronic pain, pain-related anxiety, and pain-related disability at 17. Analyses revealed that child anxiety at 13 was not significantly associated with the presence of chronic pain at 17 (n = 842). However, anxiety at 13 was significantly associated with pain-related anxiety at 17 (n = 1831). For the subsample of adolescents who reported chronic pain, anxiety at 13 was associated with pain-related disability at 17 (n = 393). Further analyses revealed that pain-related anxiety at 17 mediated the association between anxiety at 13 and pain-related disability at 17, suggesting that pain-related anxiety should be a target for treatment in adolescents with chronic pain, to reduce the impact of pain in later adolescence. General anxiety at 13 was unrelated to the presence of chronic pain at 17, but should be considered a risk factor for later pain-related anxiety and disability in a subset of adolescents who develop chronic pain.     

Introduction to Group-Analytic Psychotherapy by S. H. Foulkes

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she “understands” because of having also grown up in an alcoholic family); (b) the “will to restore,” which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a “rush to recovery” on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) “countertransference goodness and availability” as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.     

Creativity in Men and Women: Threat,Other-Interest,and Self-Assessment

Previous research into gender and creativity has provided little evidence for consistent differences between men and women in creative performance. This research revisits this topic by proposing a person × situation approach, arguing that gender differences in creative performance only occur in certain contexts, but not others. Based on the assumption that men and women tend to differ in self versus other orientation, experimental instructions varied whether our participants’ (n = 169) creative efforts benefit the self or others, and whether creativity occurred under conditions of threat or not. In the absence of threat, women outperformed men in the originality of their creative efforts when the task was beneficial to others. This effect was eliminated in the presence of competitive threat. In contrast to some previous work, threat also increased creative performance under some circumstances. Results also revealed gender differences in self-assessment of creativity such that women seemed to be somewhat more attuned to the objective level of the originality of their creative performance than men. The discussion focuses on implications for research on gender differences in creativity, arguing that researchers must appreciate that gender differences in creativity, so far as they exist, are likely embedded in specific situational contexts.     

Co-morbid pain conditions and feelings of invalidation and isolation among women with vulvodynia

Many women with vulvodynia also suffer from other chronic co-morbid pain conditions. Alone, these pain conditions are associated with feeling invalidated by others and feeling socially isolated. It is unclear, however, how the presence of additional pain co-morbidities are associated with the psychosocial wellbeing of women with vulvodynia. We used data from a survey administered by the National Vulvodynia Association. Women reported clinician-diagnosed vulvodynia, presence of co-morbid pain, and how often they felt that they felt no one believed their pain existed (invalidated) and isolated. Analyses determined prevalence of feeling invalidated or isolated, and the difference in prevalence when co-morbidities existed. Forty-five percent of these 1847 women with vulvodynia reported having at least one of the following five chronic pain conditions, chronic fatigue syndrome, endometriosis, fibromyalgia, interstitial cystitis, or irritable bowel syndrome. Adjusted baseline prevalence among all women of feeling invalidated was 9% and of feeling isolated was 14%. Having a co-morbid condition with vulvodynia, as well as having an increasing number of co-morbid conditions with vulvodynia, was significantly associated with the presence of feeling both invalidated and isolated. Chronic fatigue syndrome was the co-morbidity most strongly associated with feelings invalidation and isolation. One or more co-morbid pain conditions in addition to vulvodynia were significantly associated with psychosocial wellbeing. However, the temporality of the association could not be elucidated and therefore we cannot conclude that these pain conditions cause poor psychosocial wellbeing. Despite this, future studies should explore the utility of promoting validation of women's pain conditions and reducing social isolation for women with chronic pain.