Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing people's insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.     

The relationship between assessment and psychotherapy

The many arguments, pro and con, about the usefulness and roles of diagnosis in general, and a psychological test battery in particular, can be settled only with reference to particular tests, a particular tester, particular patients, with reference to particular questions, in a particular context. Psychologists need to establish the usefulness of tests in cost-effective ways and demonstrate how tests provide a means of studying the mind. It follows that all psychotherapists should be able to use the tests, as all physiologists should be able to use a microscope. The rule of thumb that therapists should not give tests to their patients is unnecessary, though it is preferable that the tests be given early in the relationship, and that patients have the opportunity to explore their reactions to the procedure. To maximize the usefulness of tests given by someone who is not the patient's therapist, the test report should be designed as a means of persuasion toward therapeutic action more than a passive report of findings. An outline for test report writing is suggested. Finally, the use of tests helps elucidate the many factors that contribute to change through psychotherapy.     

Self-efficacy moderates the relationship between stress appraisal and quality of life among rescue workers

Abstract

Rescue workers are frequently exposed to highly stressful situations during their everyday work activity. Stress and coping theory emphasizes the interaction between primary and secondary appraisal in determining coping responses to stressful events and quality of life. According to Social Cognitive Theory, stress reactions depend on self-appraisal of coping capabilities.

The present study investigated whether self-efficacy moderates the relationship between stress appraisal and professional quality of life. A self-administered questionnaire was submitted to a sample of 451 Italian rescue workers (firefighters, paramedics, and medical technicians), including the Professional Quality of Life Scale, which measures three dimensions of emergency workers' quality of working life: compassion fatigue, burnout, and compassion satisfaction. Multiple regression analyses indicated that the relationship between stress appraisal and professional quality of life was significant only among rescue workers with low levels of self-efficacy but not among those with higher levels of self-efficacy. These results confirmed the expectations based on Social Cognitive Theory that self-efficacy buffers the impact of perceived stressful encounters on professional quality of life. Results suggest the usefulness of interventions aimed at increasing rescue workers' psychosocial skills.     

Cognitive appraisal mediating relationship between social anxiety and internet communication in adolescents

Research suggests that people with high social anxiety trait may be more inclined to interact through computer-mediated communication (CMC). The psychological underpinnings of this inclination however remained unclear. The present research thus examines if cognitive appraisal bias (i.e. heighten estimation of social risk and deflated self-efficacy) would mediate the relationship between social anxiety and one’s perception of CMC attributes, contributing to a differential pattern of responses in CMC use. Four hundred and ten adolescents aged 12-18 years completed a set of self-reported measures tapping social anxiety trait, cognitive appraisals, perception of CMC attributes, and pattern of CMC social responses. Structural equation modeling lent support to the mediating role of the cognitive appraisal factors. Those with higher social anxiety trait would attach higher self-relevance to the CMC attributes, and engage in a more socially-involved pattern of interpersonal responses in CMC. Implications of these findings are discussed.     

Personality disorders and psychosocial changes after intensive psychotherapy: A prospective follow-up study of an outpatient psychotherapy project, 5 years after end of treatment*

This report presents the results of a 7-year prospective outcome study designed to examine the psychosocial changes during and after therapy among 25 outpatients suffering from personality disorders and psychoses. The therapeutic approach was based mainly on object relations theory and psychodynamic self-psychology, and focused in particular on affect consciousness, parental images, self-image and interpersonal relations. Twenty patients completed the form which measured psychosocial changes during therapy, and 21 persons participated at follow-up. The data show statistically significant changes in the capacity to tolerate intimate relationships and actually establish such relationships, improved quality of contact in relationships with friends, a general raising of socioeconomic status and reduced use of ordinary health and social services. Both the global psychosocial outcome at follow-up as measured by HSRS and the general level of symptoms measured by SCL-90 suggest that 76% of the sample had reached a level of psychosocial functioning and adaptation that can be defined as “no-caseness”.     

Exploring the relationship between facets of mindfulness and eating pathology in women

Although researchers have examined the efficacy of acceptance- and mindfulness-based interventions in the treatment of eating disorders, few studies have explored the association between trait mindfulness and eating pathology. Therefore, the purpose of the current investigation was to examine the unique associations between multiple facets of mindfulness (acting with awareness, nonreactivity, nonjudgment, describing, and observing) and eating pathology. Undergraduate women (N = 276) completed the Eating Attitudes Test-26, the Five Facet Mindfulness Questionnaire, and the 21-item version of the Depression Anxiety Stress Scales. A hierarchical regression analysis revealed that four mindfulness facets (awareness, nonreactivity, nonjudgment, and describing) were uniquely associated with eating pathology above and beyond anxiety and depression symptoms. Results are discussed with regard to the potential role of various facets of trait mindfulness in eating pathology as well as the possible utility of mindfulness-based treatments for eating disorders.     

the relationship between pain and coping styles among hiv-positive men and women

Abstract

Pain in HIV/AIDS patients is associated with compromised quality of life and emotional adjustment. Although previous findings support a relationship between coping styles and subjective pain for various groups of chronically-ill persons, little research has examined the associations between coping and pain in HIV-positive or AIDS patients. The purpose of this study was to explore the relationship between pain and coping styles among 105 HIV-positive participants (32 women and 73 men) in a randomized clinical trial designed to examine the effect of group psychotherapy on quality of life and health behavior. Participants completed the Brief COPE, the pain scale from the Medical Outcomes Study-HIV, and a demographic and medical questionnaire. Multiple regression analysis, with pain as the dependent variable, showed that participants who reported coping through denial reported greater pain severity (p < 0.0001). These results suggest that denial as a coping strategy appears to be signficantly associated with pain for persons with HIV/AIDS. However, further research is necessary to determine the causal relationship between pain and coping through denial. These findings also point to the possibility of psychological intervention in order to modify maladaptive coping styles and to ameliorate pain in this population.     

Forty years of group psychotherapy at the Menninger Clinic

Despite the skepticism and indifference to group psychotherapy that existed in the 1950s and 1960s within the psychoanalytic community in general and among the staff and administration of the Menninger Clinic in Topeka, Kansas in particular, a few clinicians there forged ahead in pursuit of incorporating this modality as an accepted treatment. After gaining some acceptance first in the hospital, we experienced a slow rate of growth, except with our trainees who were generally enthusiastic about group work. Many of them were intrigued first by their exposure to the group dynamics seminars and later by the didactic courses and supervised group work that eventually came to be required by the accrediting body for residency programs of the American Psychiatric Association. Visiting senior consultants and teachers, mainly associated with the American Group Psychotherapy Association, as well as an esteemed clinician from the Tavistock Clinic, also lent credibility and legitimacy to our effort. When group treatment began to be adopted by units of the Menninger Hospital in the early 1970s, there was a significant sea change in the attitude of the organization and group psychotherapy became a well established modality.     

Factors influencing the temporal relationship between alcohol consumption and experiences with aggression among college women.

The authors assessed temporal relationships among alcohol use, aggression, and mood using daily data from 179 college women. Participants called an interactive voice response system over an 8-week period. The odds of experiencing verbal, sexual, and physical aggression (odd ratios = 2.25, 19.44, and 11.84, respectively) were significantly higher on heavy drinking days (M = 7.46 drinks) compared to nondrinking days. Both a history of victimization and greater psychological symptom severity influenced the odds of involvement in verbal aggression. The odds of alcohol consumption were 3 times higher during the 24 hr following verbal aggression compared with days in which verbal aggression did not occur. On the day immediately following involvement in either verbal or physical aggression, positive mood decreased and negative mood increased. During the week (2-7 days) following sexual aggression, women's positive mood was decreased. These findings reinforce the need for interventions aimed at reducing heavy episodic drinking on college campuses.     

The choice of a name: "Dora" and Freud's relationship with Breuer

I have suggested that Freud's choice of the pseudonym Dora for his eighteen-year-old hysterical patient, Ida Bauer, was over-determined. Dora, it seems likely, was named not only after Freud's sister's nursemaid, as Freud himself explained, but also after Dora Breuer, Josef Breuer's youngest daughter. This theory is based on an examination of the similarities in the lives and symptoms of Anna O. (Breuer's famous hysterical patient of 1880-1882) and Dora; on an analysis of the transferences and countertransferences in the cases of these two young women; and on evidences of the persistent significance of Josef Breuer in Freud's life after 1895. These specific inquiries also call attention to the nature of hysteria at the end of the nineteenth century and to the ever-present complexities of the physician-patient relationship.