The possible selves of international students and their cross‐cultural adjustment in Canada

We assessed 93 international students’ reports of their expected and feared possible selves in terms of their thematic content and configuration, and examined the relations between possible selves and cultural adjustment in Canada. The results showed that international students mostly envisioned possible selves in career, education, intrapersonal, and interpersonal domains, and reported more balanced configurations than matched configurations of possible selves. Balanced possible selves in the educational domain were associated with better psychological well‐being, but balanced selves in the intrapersonal domains were linked with more frequent sociocultural difficulties. The findings suggest that the content of international students’ possible selves reflects not only their academic‐focused and career‐inspired sojourn, but also their intercultural experiences with various ethnic groups in the Canadian multicultural society. As well, they speak to the motivational significance of possible selves, particularly the balanced possible selves, for supporting international students’ motivation to pursue an international education and for facilitating a successful cross‐cultural sojourn.     

Medical help-seeking by different types of chronic pain patients

Abstract

This paper reports on a study of the use of health services by different types of patients with chronic benign pain. The purpose of the study was to identify differences in medical consumption between different types of pain patients. In the course of one year 586 patients were selected by 45 general practitioners: they included patients who had had almost daily chronic pain symptoms for at least six months, without a medical diagnosis (such as cancer or arthritis) to explain the pain. Patients were categorized according to the Multidimensional Pain Inventory which distinguishes four categories: the dysfunctional, who perceive severe pain and gain social support; the interpersonally distressed, who combine pain with affective and relational distress; adaptive copers, who cope with their pain in a number of ways; the average type, with characteristics of all three other types. It was hypothesised that adaptive copers would make less use of health services and would be more involved in self-help activities than dysfunctional or interpersonally distressed patients. Frequent use of psychological services by the interpersonally distressed group was expected. It was predicted that difference in health services use would continue during the subsequent year.

No differences were found between the four groups in location, temporal characteristics, or possible medical causes of the pain symptoms. Dysfunctional patients used more services than the others. Adaptive copers used the least. The four groups did not differ in self-care activities. Group-membership as well as pain severity are related to the use of health services. None of the groups showed a significant decline in the use of health services during the year. It is concluded that chronic pain is invalidating, but that not all patients are equally excessive in their use of medical services.     

The relationship of depression and somatic focus to experimental and clinical pain in chronic pain patients

Abstract

The present study examined Fields' proposal that depression increases the sensory experience of pain in part through greater somatic focus. Experimental and clinical pain measures were compared to self-report of depression and somatic focus in 60 chronic pain patients. Depression scores were unrelated to pain threshold or tolerance on the cold-pressor test. However, as hypothesized by Fields, path analytic models suggested that depression had a direct influence on the evaluative and affective aspects of pain, but the relationship between depression and sensory pain was mediated by somatic focus. These results provide partial support for Fields' neurobiological model of pain and depression.     

Possible Selves in Adolescence: Development and Validation of a Scale for their Assessment

Possible selves (PSs) have a significant role in adolescents' development. For this reason, it is of great importance to have adequate measures to operationalize them. The aim of this work is to present the construction and validation of a scale to assess PSs at the end of high school in multiple domains. Participants were adolescents (n = 320) of both sexes (female = 51.3%) from high-schools in Buenos Aires City, Argentina (age, M = 14.9, SD = 1.5). The scale was developed based on a literature review and a previous qualitative study. Expert judges' assessment revealed that it has good content validity. The scale's structure was studied with exploratory factor analysis and a 5-factor structure with theoretical meaning was found. Spearman's correlations between current and future self-perceptions show evidence of convergent validity. Mann-Whitney U test shows that the scale can discriminate by sex and age. The scale shows adequate to very good internal consistency. These results show that the scale has adequate psychometric properties to assess PSs in Argentine adolescents. The advantages of this scale relative to existing measures of PSs are discussed. Scale development allows us to know more about how adolescents think they will be during a significant life transition such as the end of high school. This is particularly important for planning interventions that focus on motivation and behavior regulation.     

Repression in chronic pain: An idea worth recovering

Repression, defined as a process by which threatening information is kept out of conscious awareness, has long been a topic in the chronic pain literature. Emerging in psychodynamic theories, chronic pain is thought to arise from repressed emotions that are converted into physical symptoms; this notion seems to account for much anecdotal evidence and has received empirical support from work with Minnesota Multiphasic Personality Inventory (Hathaway & McKinley, 1943) profiles—particularly the conversion-V. However, the construct validity of this profile among pain patients has been called into question. The emergence of the cognitive-behavioral model of chronic pain ignited a proliferation of research, but because it rejected psychodynamic pain theory, investigation of repression was largely suspended. This lapse leaves unexplained—almost unrecognized—findings that a plurality of chronic pain patients are characterized by constrained emotion, and that repressed, inhibited, and denied negative emotions or traumatic memories have a profound impact on chronic pain. To address these important phenomena and to reinvigorate research, three methods are proposed: (a) expand current empirical clustering procedures, which rely on the Multidimensional Pain Inventory (Kerns, Turk, Rudy, 1985) with measures of defensiveness to isolate patients who report high pain/disability and deny negative affect; (b) employ Weinberger and colleagues' 1979 1990 “repressive style” to examine the responses of repressor pain patients; (c) pursue Pennebaker and colleagues' 1986 1988 theory about disclosure of traumatic events to examine effects of inhibition and disinhibition on persistent pain. Although an integrated model may be premature, it is argued that repression should receive renewed appreciation; it was never really absent, just forgotten.     

Potential Clinical Implications of Implicit and Explicit Attitudes Within Possible Exercise Selves Schemata: A Pilot Study

Our purpose was to explore implicit as well as explicit exercise schemata of 51 inactive to highly active college students. For the implicit measure, a pilot study was used to establish the word set (exercise-related, nonexercise-related, and nonwords) for the lexical decision task. A latency differential was calculated based on reaction times to these word sets. Participants used self-regulatory functions to rate both hoped and feared exercise selves and reported workout hours. An estimate of aerobic fitness was derived. Results showed that implicit exercise attitudes were related to the importance placed on being an exerciser and on avoiding being a nonexerciser. Those who self-identified as an exerciser had higher levels of self-efficacy, workouts, and fitness. In contrast, those who self-identified as a nonexerciser were less active and fit and seemed to dwell on negative thoughts related to self-efficacy. Clinicians might help clients explore these attitudes, especially importance.     

Alexithymia and Early Maladaptive Schemas in chronic pain patients

Psychological factors have an impact on subjective pain experience. The aim of this study was to explore the occurrence of alexithymia and Early Maladaptive Schemas in a sample of 271 first visit chronic pain patients of six pain clinics. The patients completed the study questionnaire consisting of the Toronto Alexithymia Scale‐20, the Finnish version of the Young Schema Questionnaire short form‐extended, the Beck Depression Inventory‐II, and pain variables. Alexithymic patients scored higher on Early Maladaptive Schemas and had more pain intensity, pain disability and depression than nonalexithymic patients. Both alexithymia and depression correlated significantly with most Early Maladaptive Schemas. The co‐occurrence of alexithymia, Early Maladaptive Schemas and depression seems to worsen the pain experience. Screening of alexithymia, depression and Early Maladaptive Schemas may help to plan psychological treatment interventions for chronic pain patients.     

Exposure to physical movement in chronic back pain patients: no evidence for generalization across different movements

This study investigated whether the effects of exposure to one movement generalize towards another dissimilar movement in patients with low back pain. Thirty-nine patients (11 male, 28 female; mean age=43.49 yrs) were requested to perform two movements twice, i.e. bending forward and straight leg raising. During each of the four trials, baseline pain, expected pain and experienced pain were recorded. Analyses revealed that patients initially overpredicted pain, but after exposure the overprediction was readily corrected. This exposure effect did not generalize towards another dissimilar movement. The above pattern of results was only characteristic for patients reporting a high frequency of catastrophic thinking about pain. Low pain catastrophizers did not overpredict pain. The results are discussed in terms of the view that exposure may be better conceived of as the learning of exceptions to a general rule.     

Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes

Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal.     

Trauma symptoms,temperament traits,social support and the intensity of pain in a Polish sample of patients suffering from chronic pain

The aim of the current study was to investigate the relationship between the intensity of pain, treated as the explained variable, and the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), temperament traits postulated by the Regulative Theory of Temperament and aspects of social support among patients suffering from chronic pain (arthritis and low-back pain). To assess the intensity of pain among participants we used the Numerical Rating Scale (NRS-11). The level of trauma symptoms was assessed with the PTSD Factorial Version inventory (PTSD-F). Temperament was measured with the Formal Characteristics of Behaviour – Temperament Inventory (FCB-TI). Social support was tested with the Berlin Social Support Scales (BSSS). The results of our study suggest that significant predictors of pain intensity among chronic pain sufferers were trauma symptoms. We also noticed that some temperament traits (i.e., emotional reactivity) increased the level of global trauma symptoms, which, in turn, intensified the level of pain. In addition, we showed that global trauma symptoms decreased the support participants actually received.     

Sex differences in trauma symptoms,body image and intensity of pain in a Polish sample of patients suffering from chronic pain

The main goal of the current study was to investigate sex differences in the relationship between the level of trauma symptoms appearing in posttraumatic stress disorder (PTSD) and intensity of pain in a sample of 300 Polish patients suffering from chronic pain, specifically rheumatoid arthritis and lower back pain. We also focused on participants’ body image with body esteem as a mediator. To assess the intensity of pain among participants, we used the Numerical Rating Scale. The level of trauma symptoms was assessed with the PTSD Factorial Version Inventory. To measure body image among participants, we used the Body Esteem Scale. The results of our study suggest that trauma symptoms and body image dimensions were significant predictors of pain intensity among men suffering from chronic pain. Moreover, trauma symptoms and age were significant predictors of pain intensity among women suffering from chronic pain. Finally, we demonstrated that sex differentiates the reaction to chronic pain.     

The contribution of recollection and familiarity to recognition memory performance in chronic pain patients

This study examines the selective impact of chronic pain on memory functioning in a recognition task. Thirty chronic pain patients and 30 healthy control subjects performed a yes-no word recognition test. The contribution of recollection and familiarity to both groups' performance was compared by means of the Remember/Know (R/K) procedure, which distinguishes recognition based on the recollection of the encoding episode (R responses) and recognition accompanied by a feeling of familiarity (K responses). Chronic pain patients showed a decrease in recollection together with an increase in familiarity: indeed, they reported less R and more K responses than control subjects. This pattern of performance was not related to the overall recognition ability. These findings are consistent with the hypothesis of the attentional cost of chronic pain, suggesting a selective impact of chronic pain on the most attention-demanding cognitive processes, such as recollection. This study emphasises the relevance of specific procedures distinguishing the underlying components of memory functioning rather than solely global indicators.     

Cognitive factors influence outcome following multidisciplinary chronic pain treatment: a replication and extension of a cross-lagged panel analysis

Reducing maladaptive cognitions is hypothesized to constitute an active therapeutic process in multidisciplinary pain programs featuring cognitive-behavioral interventions. A cross-lagged panel design was used to determine whether: a) early-treatment cognitive changes predicted late-treatment pain, interference, activity and mood changes, but not vice versa; b) three cognitive factors made unique contributions to outcome; c) substantial cognitive changes preceded substantial improvements in outcome. Sixty-five chronic pain patients, participating in a 4-week multidisciplinary program, completed measures of pain helplessness, catastrophizing, pain-related anxiety (process factors), pain severity, interference, activity level and depression (outcomes) at pre-, mid- and posttreatment. Results showed that early-treatment reductions in pain helplessness predicted late-treatment decreases in pain and interference, but not vice versa, and that early-treatment reductions in catastrophizing and pain-related anxiety predicted late-treatment improvements in pain severity, but not vice versa. Findings suggested that the three process factors predicted improvements mostly in common. However, little evidence was found that large early-treatment reductions in process variables preceded extensive improvements in pain. Findings replicate those of a recent report regarding cross-lagged effects, and offer support that cognitive changes may indeed influence late-treatment changes in outcomes.     

Moving From Classical Test Theory to the Evaluation of Usefulness: A Theoretical and Practical Examination of Alternative Approaches to the Development of Career Tools for Job Seekers

This article critiques the common use of principles of classical test theory (CTT) as the key means of assessing the effectiveness of career instruments for employment counseling. The authors argue that excessive reliance on CTT has hindered the development of career assessment tools that better meet the diverse and changing needs of those seeking guidance in their career choice. The authors argue for an alternative paradigm based on notions of usefulness. A computerized career tool is evaluated to illustrate the limitations of CTT and the benefit of alternative methodologies for the assessment of instruments designed to provide effective career guidance.     

Neural basis of affective touch and pain: A novel model suggests possible targets for pain amelioration

Pain is one of the most common health problems and has a severe impact on quality of life. Yet, a suitable and efficient treatment is still not available for all patient populations suffering from pain. Interestingly, recent research shows that low threshold mechanosensory C-tactile (CT) fibres have a modulatory influence on pain. CT-fibres are activated by slow gentle stroking of the hairy skin, providing a pleasant sensation. Consequently, slow gentle stroking is known as affective touch. Currently, a clear overview of the way affective touch modulates pain, at a neural level, is missing. This review aims to present such an overview. To explain the interaction between affective touch and pain, first the neural basis of the affective touch system and the neural processing of pain will be described. To clarify these systems, a schematic illustration will be provided in every section. Hereafter, a novel model of interactions between affective touch and pain systems will be introduced. Finally, since affective touch might be suitable as a new treatment for chronic pain, possible clinical implications will be discussed.     

Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process

Recent developments in CBT emphasize the promotion of psychological flexibility to improve daily functioning for people with a wide range of health conditions. In particular, one of these approaches, Acceptance and Commitment Therapy (ACT), has been studied for treatment of chronic pain. While trials have provided good support for treatment effectiveness through follow-ups of as long as seven months, the longer-term impact is not known. The present study of 108 participants with chronic pain examined outcomes three years after treatment completion and included analyses of two key treatment processes, acceptance of pain and values-based action. Overall, results indicated significant improvements in emotional and physical functioning relative to the start of treatment, as well as good maintenance of treatment gains relative to an earlier follow-up assessment. Effect size statistics were generally medium or large. At the three-year follow-up, 64.8% of patients had reliably improved in at least one key domain. Improvements in acceptance of pain and values-based action were associated with improvements in outcome measures. A “treatment responder” analysis, using variables collected at pre-treatment and shorter term follow-up, failed to identify any salient predictors of response. This study adds to the growing literature supporting the effectiveness of ACT for chronic pain and yields evidence for both statistical and clinical significance of improvements over a three-year period.     

Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase

The concept of acceptance is receiving increased attention as an alternate approach to the suffering that is often associated with persistent and disabling pain. This approach differs from established treatments in that it does not principally focus on reducing pain, but on reducing the distressing and disabling influences of pain as they concern important areas in patients' lives. The present analyses represent a preliminary evaluation of an acceptance-based approach to chronic pain within an interdisciplinary treatment program. One hundred and eight patients with complex chronic pain conditions completed treatment and provided data for the current study. Treatment was conducted in a 3- or 4-week residential or hospital-based format. It included a number of exposure-based, experiential, and other behavior change methods focused on increasing (a) engagement in daily activity regardless of pain and (b) willingness to have pain present without responding to it. Significant improvements in emotional, social, and physical functioning, and healthcare use were demonstrated following treatment. The majority of improvements continued at 3-months post-treatment. Improvements in most outcomes during treatment were correlated with increases in acceptance, supporting the proposed process of treatment.