The role of optimism and pessimism in chronic pain patients adjustment

This study analyses the relationships between patients' dispositional optimism and pessimism and the coping strategies they use. In addition, the coping strategies repercussions on adjustment to chronic pain were studied. Ninety-eight patients with heterogeneous chronic pain participated. The assessment tools were as follows: Life Orientation Test (LOT), the Vanderbilt Pain Management Inventory (VPMI), the McGill Pain Questionnaire (MPQ), Hospital Anxiety and Depression Scale (HADS), and the Impairment and Functioning Inventory for Chronic Pain Patients (IFI). The hypothetical model establishes positive relationships between optimism and the use of active coping strategies, whereas pessimism is related to the use of passive coping. Active coping is associated with low levels of pain, anxiety, depression and impairment and high levels of functioning. However, passive coping is related to high levels of pain, anxiety, depression and impairment and low levels of functioning. The hypothetical model was empirically tested using the LISREL 8.20 software package and the unweighted least squares method. The results support the hypotheses formulated regarding the relations among optimism, pessimism, coping and adjust of chronic pain patients. By analysing optimism among chronic pain patients, clinicians could make better predictions regarding coping and adjustment.     

Testing a model of pain appraisal and coping in children with chronic abdominal pain.

This prospective study of children with recurrent abdominal pain (N=133; ages 8--15 years) used path analysis to examine relations among dispositional pain beliefs and coping styles, cognitions and behavior related to a specific pain episode, and short- and long-term outcomes. Children believing they could not reduce or accept pain appraised their episode-specific coping ability as low and reported passive coping behavior. Dispositional passive coping had direct effects on both episode-specific passive coping and long-term symptoms and disability. Accommodative coping (acceptance and self-encouragement) was associated with reduced episode-specific distress, which itself predicted reduced depressive symptoms 3 months later. Results suggest that coping-skill interventions for children with chronic pain should target reductions in passive coping and consider the potential benefits of accommodative coping strategies.     

How do I cope with pain? Let me count the ways: awareness of pain coping behaviors and relationships with depression and anxiety

Patients with chronic pain are often undertreated with medications alone and need alternative ways of coping. Identifying pain coping skills patients use may be beneficial; however, no research has investigated whether patients are aware of their coping skills. The purpose of this study was to determine whether patients are aware of their pain coping skills, whether certain patient characteristics were related to using coping strategies, and whether coping strategies were related to psychiatric symptoms. Chart reviews were conducted on seventy-eight chronic pain patients who completed a semi-structured psychological interview. Patients endorsed using more coping strategies on the measure compared to the verbal self-report. Identifying with certain patient demographics was related to higher use of some coping strategies. Symptoms of anxiety and depression were also related to the use of some coping strategies. Anxiety was negatively related to ignoring the pain and using self-talk coping statements and positively related to catastrophizing. Depression was negatively related to the use of distraction, ignoring the pain, and using self-talk coping statements. Depression and pain severity were both positively related to catastrophizing and prayer. Results suggest that clinicians may need to help patients become aware of adaptive coping strategies they already use and that the use of certain coping strategies is related to lower levels of depression and anxiety.     

The role of spousal relationships in fibromyalgia patients’ quality of life

Fibromyalgia (FM) is a chronic pain syndrome that includes debilitating symptoms such as widespread pain and tenderness, fatigue, and poor physical functioning. Research has shown FM patients’ choice of coping style and relationship quality with their spouse can impact their mental quality of life (QoL), but no known study has examined the protective nature of relationship quality and coping behaviors on both patient physical and mental QoL in the context of chronic pain. We examined 204 patients with FM on the (a) roles of coping styles and relationship quality on patient quality of life, and (b) moderating effect of relationship quality on the association between negative coping style and patient QoL. A series of multiple regressions found patients’ coping styles were not significantly associated with physical QoL, but were significantly associated with mental QoL. Patients’ relationship quality with their spouse was significantly associated with mental QoL, but not physical QoL and no significant interactions with negative coping style were found. Our results emphasize the importance of coping styles and relationship quality between patients and their spouses in the context of chronic pain. Clinicians can incorporate the patient’s relationship as part of a more holistic approach to care and improving outcomes.     

Biofeedback bei kraniomandibulären Dysfunktionen

Temporomandibular disorders (TMD) are a painful condition present in 3% of the population. The aim of the present study was to develop a biofeedback-based cognitive-behavioral treatment for chronic TMD (BFB-KVT) and to evaluate its effectiveness compared to dental treatment. A total of 26 patients suffering from chronic TMD were randomly assigned to either BFB-KVT (n=15) or occlusal splint treatment (n=11). Preliminary data showed that both treatments reduced pain intensity and jaw disability. Greater improvement of pain-related disability was found for BFB-KVT, and its acceptance by the patients was higher. The proposed protocol appears to be an effective treatment for chronic TMD. The evaluation in a larger sample and of long-term efficacy will follow.     

Preference for local or general anesthesia,coping dispositions,learned resourcefulness and coping with surgery

Abstract

People were found to differ in their coping dispositions (as measured with the MBSS, Miller, 1987): those who habitually attend to threatening cues (“monitors”) and those who distract themselves from these cues (“blunters”). However, some people are equally high on both coping dispositions and they were considered to be in a “dispositional conflict”. Furthermore, under certain circumstances people may prefer to act in a way that is inconsistent with their coping disposition; monitors who prefer blunting strategies and blunters who prefer monitoring strategies (labeled here as “disposition-behavior conflict”). Both conflicts were hypothesized to be associated with higher levels of trait anxiety and poorer coping. 59 men scheduled for surgery were assessed as to their coping disposition (monitors or blunters) and their preference for local or general anesthesia, and their learned resourcefulness (selfantrol skills). Monitors who chose general anesthesia (and thus were unable to monitor their own surgery) and blunters who chose local anesthesia (and thus were unable to blunt) were defined as being in a disposition-behavior conflict. Re- and post-surgery measures of anxiety and dysphoria and post-surgery nurses' ratings were used for assessing coping with surgery. Patients who were either high on dispositional conflict or showed a disposition-behavior conflict were higher on trait anxiety and showed poorer post-surgery coping in comparison to patients without such conflicts. Learned resourcefulness was not related to better coping nor to the two conflicts with the exception that patients with a disposition-behavior conflict reported less confidence in their self-control abilities. Overall, preference for local anesthesia predicted better post-surgery coping.     

A comparison of coping strategies in patients with fibromyalgia,chronic neuropathic pain,and pain‐free controls

Patients suffering from chronic pain may benefit from learning adaptive coping strategies. Consensus on efficient strategies for this group of patients is, however, lacking, and previous studies have shown inconsistent results. The present study has examined coping strategies in two distinctly different groups of chronic pain patients and a group of healthy controls. Thirty neuropathic pain (NP) patients, 28 fibromyalgia (FM) patients, and 26 pain‐free healthy controls completed the Coping Strategy Questionnaire (CSQ‐48/27) and rated their daily pain. The results showed that FM and NP patients did not cope differently with pain. The only difference between the groups was that FM patients felt more in control of their pain than NP patients. Both patient groups used more maladaptive/passive coping strategies, but surprisingly also more adaptive/active coping strategies than healthy controls. However, FM patients with high levels of passive strategies felt less in control than FM patients with low levels of passive strategies. This was not seen in NP patients. An important implication for clinical practice is therefore that passive coping strategies should be restructured into active ones, especially for FM patients. Otherwise, the same psychological treatment model can be applied to both groups since they use similar coping styles.     

Coping Styles,Pain Expressiveness,and Implicit Theories of Chronic Pain

Whereas some individuals use active coping strategies and are able to adaptively cope with their pain, others use passive strategies and catastrophic appraisals, which are often associated with increased displays of pain behavior and negative pain-related outcomes. To investigate attribution-based implicit theories as a potential underlying mechanism that might affect coping success, we hypothesized that pain patients with an incremental implicit theory of pain (i.e., view pain as malleable) would have more active coping strategies, lower levels of pain expressiveness, and better pain-related outcomes than those with an entity implicit theory of pain (i.e., view pain as nonmalleable). Patients with chronic back pain undergoing a functional assessment completed a variety of self-report measures and participated in a pain-inducing physiotherapy procedure. The results revealed those with an incremental theory of pain used more active coping strategies, displayed less pain behavior, and reported better pain-related outcomes (e.g., lower levels of depression) than individuals with an entity theory of pain. The findings suggest implicit theories of pain may represent an underlying social-cognitive mechanism linked to important coping, emotional, and expressive reactions to chronic pain. Identifying such a mechanism may provide valuable information for the assessment and treatment of chronic pain.     

Temporomandibular Disorder in Brazilian Patients: A Preliminary Study

The objective of the current study was to evaluate disease-related beliefs, adherence to treatment, quality of life, coping strategies and cognitive status in a group of Brazilian patients with Temporomandibular Disorder (TMD). Thirty patients were evaluated with a semi-directed interview, the Coping Strategies Inventory, and a Mini-Mental State Examination. Although half (50%) of the patients had known their diagnosis long term, 40% of the sample were not correctly following proposed treatment. All patients had a similar pattern of pain behavior related to TMD, while disease-related beliefs, quality of life and coping strategies were variable. Expectations about treatment also had significant association with treatment adherence. The findings of this study suggest that a more thorough understanding of individual differences in TMD is warranted.     

Situational and dispositional coping: an examination of their relation to personality,cognitive appraisals,and psychological distress

Reliable data on the relationships between situational and dispositional coping strategies are sparse. In order to address this gap in the literature, this study examined the determinants and adaptational outcomes of both types of coping. Two hundred and thirty‐three students completed, along with measures of situational and dispositional coping, measures of personality, cognitive appraisals, and psychological distress, the latter variable being evaluated concurrently and prospectively (10 weeks). Results showed that personality shared as much variance with situational as with dispositional coping, but the patterns of relationships were rather different. In addition, cognitive appraisals were found to add significant incremental validity in predicting situational coping beyond trait coping, but primary appraisals were redundant with personality traits, in particular neuroticism. Finally, in spite of the significant amount of variance shared between the two types of coping, they both accounted for individual differences in concomitant and prospective psychological distress, and the relation between dispositional coping and distress was partially mediated by situational coping. The implications of these findings for understanding the relationships between the two types of coping strategy are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

An exploration of the influence of dispositional traits and appraisal on coping strategies in African American college students

This study explored the correlates of self-reported coping strategies from both an appraisal (e.g., severity, impact, desirability of the event, as well as perceived stress) and a dispositional (e.g., preferred/typical coping style, self-concept clarity, self-esteem, emotion regulation, problem-solving style, anxiety) perspective. Participants were 211 African American undergraduate and graduate students from diverse socioeconomic backgrounds. The results indicated that dispositional traits (especially problem-solving style) are associated uniquely with preferred/typical coping styles. The results also provided modest evidence that dispositional traits and subjects' appraisals (e.g., challenge, harm/threat, impact) are predictive of subjects' coping strategies in specific ongoing stressful situations. The general findings from this study appear to mirror research on Caucasian subjects.     

Social support mediating between coping by emotional expression and depression

The present purpose was to investigate the effects of social support on the relationship between coping by expressing emotions and depression in women. Japanese undergraduate students (N = 218) completed four self-report questionnaires: the dispositional and situational versions of the Emotional Coping Questionnaire which measures the mode of expression as being either to self as in a diary or to others as in telling a friend, the Social Support Scale to evaluate received support, and the Center for Epidemiologic Studies-Depression Scale. Analysis showed that expression of emotions to self in both dispositional and situational coping had significant positive correlations with depression, especially for women who scored high on depression, and expression of emotions to others in both dispositional and situational coping were significantly positively correlated with social support. However, no significant mediation effects of social support in emotional expression and depression were found. Limitations and topics for research are discussed.     

Ruminative self-focus and negative affect: an experience sampling study

The authors conducted an experience sampling study to investigate the relationship between momentary ruminative self-focus and negative affect. Ninety-three adults recorded these variables at quasi-random intervals 8 times daily for 1 week. Scores on questionnaire measures of dispositional rumination were associated with mean levels of momentary ruminative self-focus over the experience sampling week. Concurrently, momentary ruminative self-focus was positively associated with negative affect. Cross-lagged analyses revealed that whereas ruminative self-focus predicted negative affect at a subsequent occasion, negative affect also predicted ruminative self-focus at a subsequent occasion. Decomposition of the dispositional rumination measure suggested that brooding, but not reflective pondering, was associated with higher mean levels of negative affect. Though broadly consistent with Nolen-Hoeksema's (1991) response styles theory, these results suggest that a reciprocal relationship exists between ruminative self-focus and negative affect.     

Dispositional and stressor-related emotion regulation in the context of a chronic, life-limiting stressor

In the context of efforts to regulate emotion during chronic stressors, both dispositional response tendencies (affect intensity, negative and positive expressivity) and stressor‐related coping through emotional approach (processing and expressing emotions) are relevant to adjustment. In women with metastatic breast cancer (N = 103), contributions of self‐reported emotional processing and expression related to cancer, as well as dispositional expressivity to adaptive outcomes across 3 months were examined. In the context of high dispositional expressivity, an increase in emotional expression predicted improvements in depressive symptoms and life satisfaction. Emotional processing at study entry predicted increased depressive symptoms and intrusive thoughts, and declining life satisfaction among highly expressive women. Increasing emotional processing predicted improved depressive symptoms in the context of high expressivity. Increases in emotional approach coping were associated with a more arduous cancer experience. Findings highlight the importance of the person‐situation fit in linking emotion‐related constructs to adjustment during unremitting stressors.     

Does trait coping exist? A momentary assessment approach to the evaluation of traits.

This study investigated the extent to which momentary reports of coping are a traitlike phenomenon and the validity of a questionnaire assessment of coping style. Participants (N = 96) completed the questionnaire, then monitored stressful events and coping activities for 2 days using a hand-held computer that administered a brief assessment every 40 min. Momentary reports exhibited a sizable traitlike component: Individual differences accounted for 42% of the variance for 2 coping items and 15-30% of the variance for 15 items. The questionnaire assessment of coping style was a poor predictor of average momentary coping; the coping style measure and the aggregated momentary measure of trait coping shared 23% of their variance for religion and 0-12% for the 16 other coping measures. Self-report assessments of trait coping are poor measures of the trait component of momentary coping and very poor predictors of coping in specific situations.     

Optimism, coping, psychological distress, and high-risk sexual behavior among men at risk for acquired immunodeficiency syndrome (AIDS).

In a cohort of gay men responding to the threat of acquired immunodeficiency syndrome (AIDS), dispositional optimism was associated with less distress, less avoidant coping, positive attitudes as a coping strategy, and fewer AIDS-related concerns. Men who knew they were seropositive for human immunodeficiency virus (HIV) were significantly more optimistic about not developing AIDS than men who knew they were seronegative for HIV. This AIDS-specific optimism was related to higher perceived control over AIDS and to active coping among seropositive men only and to health behaviors in both serostatus groups. There was no relation of optimism to risk-related sexual behavior. It is concluded that optimism is psychologically adaptive without necessarily compromising health behavior. It is also concluded that it is useful to distinguish between event-based optimistic expectations and dispositional optimism.     

Dispositional and situational coping and mental health status of university students

The results of stress coping studies do not clearly demonstrate whether dispositional and situational coping can predict health status or whether dispositional coping can predict situational coping. The present study used structural equation modeling to test proposed directional relationships. 292 Japanese university students completed questionnaires concerning dispositional and situational coping and mental health status. Analysis showed that dispositional coping predicted situational coping for some coping strategies. In women, an increase in dispositional Problem-solving predicted a reduction in mental distress via situational Problem-solving. The results suggest that, only for Problem-solving by women, dispositional coping is related to mental health status, but only through situational coping.     

Spiritual pathology and religious coping as predictors of forgiveness

Spiritual pathology, religious coping, and dispositional forgiveness were investigated in two studies with graduate students at a Christian university-based seminary. Spiritual pathology was operationalised using measures of spiritual instability and spiritual grandiosity. Study 1 (N?=?194) examined patterns of correlation between positive and negative religious coping items, spiritual pathology, and dispositional forgiveness. Spiritual instability correlated with numerous positive and negative religious coping items while spiritual grandiosity did not. Dispositional forgiveness correlated with more positive than negative religious coping items. Study 2 (N?=?214) tested regression models with these variables. Spiritual grandiosity showed a significant quadratic (concave down) effect in predicting dispositional forgiveness while the linear effect was not significant. A hierarchical regression model showed positive religious coping, spiritual instability, and the quadratic effect for spiritual grandiosity each predicted unique variance in dispositional forgiveness after controlling for spiritual impression management. Negative religious coping was not related to dispositional forgiveness when included with these variables.     

A Dispositional and Situational Assessment of Children's Coping: Testing Alternative Models of Coping

ABSTRACT Dispositional and situational measures of children's coping were developed using a theoretically based approach. Two studies ( N 1 = 217; N 2 = 303) assessed the psychometric characteristics of these measures in fourth- through sixth-grade children. Confirmatory factor analyses indicated that a four-factor model of dispositional coping (active, distraction, avoidant, and support seeking) provided a better fit to the data than either the problemversus emotion-focused (Lazarus & Folkman, 1984) or passive versus active (Billings & Moos, 1981) coping models. The four-factor model was largely invariant with respect to age and gender. Moderate to high correlations were found between the parallel subscales of the dispositional and situational measures of coping. Although the four factor structures of the dispositional and situational measures were generally similar, factor loadings and correlations between dimensions were not equivalent.     

Differential effects of avoidant and attentional coping strategies on adaptation to chronic and recent-onset pain

Examined the effectiveness of attentional and avoidant coping strategies for somatic, behavioral, and psychological adaptation to clinical pain. Subjects were 30 chronic and 30 recent-onset pain patients who used either attentional or avoidant coping strategies in response to their pain. Based on a review of the coping literature, it was hypothesized that subjects with recent-onset pain would demonstrate greater adaptation (lower anxiety, depression, lower pain severity and somatization ratings, and higher levels of social activity) when employing avoidant rather than attentional strategies. Chronic pain subjects using attentional strategies were predicted to demonstrate greater adaptation than chronic pain subjects using avoidant strategies. The results supported this "time x strategy" hypothesis. Implications for pain treatment programs are discussed, and suggestions are made for matching pain duration with patient coping style.