恐惧的代价：疼痛恐惧、心理忧虑和躯体化对疼痛感知预测作用的比较

首次在无痛群体中比较疼痛恐惧、心理忧虑和躯体化对疼痛感知的预测作用大小及调节和中介关系。以多个同类量表得分的Z分数加和作为三者的因子分,以冷压痛觉测验（CPT）疼痛指标（阈限、耐受性、强度、不愉快度）为目标变量,通过分层回归及调节和中介作用分析,发现疼痛恐惧对疼痛不愉快度的预测作用最强,心理忧虑对疼痛体验（强度、不愉快度）的预测作用被疼痛恐惧完全中介,躯体化只有在高疼痛恐惧条件下才显著负向预测疼痛不愉快度。综上,疼痛恐惧是三因素中预测CPT疼痛体验的主要因素。     

The role of coping, anxiety, and stress in depression post-acute coronary syndrome

Depressive symptoms are common and can affect prognosis following acute coronary syndromes (ACS). This study examined the psychological factors, coping, anxiety, and perceived stress associated with depression following ACS. Psychological variables were assessed in 15 females and 66 males (M = 57 years, SD = 12). Repeated measures at 2, 12, and 24 weeks post-ACS compared depression, anxiety, perceived stress, and coping resources as determined by the Cardiac Depression Scale, Beck Depression Inventory-II, State Trait Anxiety Inventory, Perceived Stress Scale, and Coping Resources Inventory. Depression, anxiety, and perceived stress remained high in the depressed group across time. Coping scores at 2 weeks post-ACS predicted depression scores at 24 weeks post-ACS. It appears that trait anxiety and coping resources are related to depressive symptoms post-ACS.     

MMPI-2 characteristics in a chronic pain population

This study investigated the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) characteristics of 209 chronic pain patients in an inpatient pain treatment program. Patients completed the MMPI-2, Zung Self-Rating Depression Scale, and Oswestry Low Back Pain Disability Questionnaire. Participants in this sample were matched with comparison participants from the MMPI-2 normative sample on the demographic variables gender, age, and ethnicity. Chronic pain patients reported higher levels of general maladjustment and affective distress than did the normative control group, including more anxiety, depressive symptomatology, and somatic complaints. The MMPI-2 basic scales Hypochondriasis, Depression, and Hysteria were the most useful discriminating factors between chronic pain patients and normal controls, and the content scales Health Concerns and Depression showed significant elevations for the chronic pain group. The 1-3/3-1, 1-2/2-1, and 2-3/3-2 code types accounted for more than two thirds of all two-point classifications for the chronic pain group, and four cluster analysis types classified nearly half of all of these protocols.     

Fear of pain is elevated in adults with co-occurring trauma-related stress and social anxiety symptoms

The aim of this study was to determine whether fear of pain and related fear constructs are elevated in people with co-occurring trauma-related stress and social anxiety symptoms relative to people with 1 or neither of these conditions. Eighty students were selected from a larger sample and divided into 4 equal groups comprising those with both high trauma-related stress and social anxiety symptom scores (TRS/SAS), only high trauma-related stress symptom scores (TRS), only high social anxiety symptom scores (SAS), or neither (N). Results indicated that the TRS/SAS group had significantly higher scores on all fear of pain measures, anxiety sensitivity, and illness/injury sensitivity than any other group, even when level of current pain was included as a covariate. These findings suggest that people with co-occurring trauma-related and social anxiety symptoms are most likely to be fearful of pain and to thereby be at increased risk of developing chronic and disabling pain. Implications for future research and treatment are discussed.     

Fear of Pain is Elevated in Adults with Co‐Occurring Trauma‐Related Stress and Social Anxiety Symptoms

The aim of this study was to determine whether fear of pain and related fear constructs are elevated in people with co‐occurring trauma‐related stress and social anxiety symptoms relative to people with 1 or neither of these conditions. Eighty students were selected from a larger sample and divided into 4 equal groups comprising those with both high trauma‐related stress and social anxiety symptom scores (TRS/SAS), only high trauma‐related stress symptom scores (TRS), only high social anxiety symptom scores (SAS), or neither (N). Results indicated that the TRS/SAS group had significantly higher scores on all fear of pain measures, anxiety sensitivity, and illness/injury sensitivity than any other group, even when level of current pain was included as a covariate. These findings suggest that people with co‐occurring trauma‐related and social anxiety symptoms are most likely to be fearful of pain and to thereby be at increased risk of developing chronic and disabling pain. Implications for future research and treatment are discussed.     

Correlates of hypoglycemic fear in type I and type II diabetes mellitus.

We examined whether fear of hypoglycemia in insulin-dependent diabetes mellitus was associated with (a) higher levels of trait anxiety and general fearfulness, (b) difficulty in differentiating symptoms of anxiety and hypoglycemia, and (c) past experience with hypoglycemia. Joslin Diabetes Center outpatients with Type I and Type II diabetes (N = 232), all requiring insulin, were surveyed. Type I patients experienced significantly more fear of hypoglycemia than Type II patients. For the Type I and Type II groups, higher scores on the Worry subscale of the Hypoglycemia Fear Survey (HFS-W) were associated with higher levels of trait anxiety and fear. Higher scores on the Behavior subscale (HFS-B) were associated with higher levels of fear. Among Type I subjects only, HFS-W scores were also positively associated with past hypoglycemic experience and with difficulty in differentiating anxiety and hypoglycemic symptoms. These latter relations remained significant even after the variance resulting from trait anxiety and fear was removed. Other significant associations with HFS-B scores were not observed.     

The contributions of interpersonal attachment and friendship group identification to depressive symptoms in a nonclinical sample

Drawing on previous literature from the separate areas of adult attachment and group processes, we explored attachment and group identification as predictors for depressive symptoms in a nonclinical sample. We found that attachment anxiety and friendship group identification predicted scores on the Beck Depression Inventory, such that higher attachment anxiety resulted in higher depressive symptoms, and greater friendship group identification resulted in lower depressive symptoms. Mediational analysis suggested that group identification partially mediated the effect of attachment avoidance on depressive symptoms, but did not mediate the effect of attachment anxiety on depressive symptoms.     

Correlates of Fear of Falling in Older Adults Who Have Experienced a Fall

Nearly one half of older adults who have experienced a fall report a fear of falling. The present study examined several variables in relation to fear of falling. Thirty community-dwelling older adults, over 60 years of age, who experienced a fall in the previous 12 months participated. Subjects were divided into two groups (low-fear and high-fear) and compared on scores on a Fear of Falling questionnaire, the Falls Efficacy Scale, the Philadelphia Geriatric Center Pain Intensity Scale, the Ways of Coping Checklist-Revised, the Geriatric Depression Scale-15, and the State–Trait Anxiety Inventory for Children. At least a little fear of falling was reported by 25 (83.3%) of the individuals who had fallen. Highly fearful fallers were significantly more likely to endorse higher levels of pain and general anxiety than fallers reporting low levels of fear of falling. Future directions for research were noted.     

Personality antecedents of depressive tendencies in 18-year-olds: a prospective study

Antecedents of depressive tendencies at age 18 were longitudinally evaluated using data from nursery school through high school. Depression was measured by CES-D scores from which the contribution of self-reported anxiety was partialed. As early as age 7, boys who subsequently acknowledged dysthymia were aggressive, self-aggrandizing, and undercontrolled whereas girls with later depressive tendencies were intropunitive, oversocialized, and overcontrolling. Similar gender differences were observed in pre- and early adolescence. At age 14, dysthymic boys were more likely to use both marijuana and harder drugs whereas dysthymic girls showed no tendency to use marijuana but did show a marked tendency to experiment with hard drugs. These girls also displayed low self-esteem. Preschool IQ correlated positively with dysthymia in girls and negatively in boys. The psychodynamics of gender differences in depressive affect were discussed.     

Anxiety sensitivity and fear of pain in patients with recurring headaches.

Anxiety sensitivity (AS) plays an important role in the cognitive, affective and behavioral profiles of patients with chronic pain related to musculoskeletal injury. However, investigators have not considered whether these findings extend to patients with other classes of chronic pain. The primary purpose of this investigation was to address this issue in 72 patients with recurring headaches who completed a self-report questionnaire inventory during a treatment visit to an outpatient neurology clinic. The mean ASI score for the group (mean = 24; SD = 11) was relatively high. When patients were classified on the basis of ASI scores, 20 (28%) met criteria for high, 41 (57%) for medium and 11 (15%) for low AS. Multivariate analysis of variance confirmed that these groups differed on specific aspects of their cognitive, affective, and behavioral profiles. High AS patients reported greater depression, trait anxiety, pain-related escape/avoidance behavior and fearful appraisals of pain than did patients with medium or low AS. High AS patients also indicated greater cognitive disruption in response to pain than did patients with low AS. Groups did not differ in headache severity, physiological reactivity, change in lifestyle, anger, nor did they differ in use of over-the-counter or prescribed analgesics. Multiple regression analysis identified AS, pain-related cognitive disruption, and sensory pain experience as significant predictors of fear of pain. Lifestyle changes attributed to headache were, on the other hand, predicted by headache severity, physiological and cognitive anxiety and escape/avoidance behavior. These results provide further evidence of the important association between AS and fear responses of patients with chronic pain syndromes. Implications and future directions are discussed.     

Anxiety sensitivity within the anxiety disorders: disorder-specific sensitivities and depression comorbidity

The tendency to perceive anxious states as aversive and harmful is hypothesized to confer vulnerability to the development of anxiety disorders. The most commonly used measure of anxiety sensitivity, the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson, R.A., Gursky, D.M., & McNally R.J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behavior Research and Therapy, 24, 1-8], is composed of multiple lower-order factors, assessing fear of physical symptoms, fear of publicly observable anxious symptoms, and fear of cognitive dyscontrol. This study examined the convergent validity of the lower-order anxiety sensitivity dimensions in DSM-IV diagnosed anxiety disorders. Participants with primary diagnoses of panic disorder with agoraphobia, social phobia, and generalized anxiety disorder (GAD) completed the ASI and measures of anxiety and depression severity. Support was found for the convergent validity of all ASI dimensions in reference to thematically related anxiety disorders and in the identification of patients presenting with and without secondary major depressive disorder (MDD). The ASI-fear of cognitive dyscontrol dimension displayed strong and nonredundant associations with GAD, dimensional depression scores, and secondary diagnoses of MDD. The conceptual implications of the shared importance of fear of cognitive dyscontrol in GAD and MDD are discussed.     

Assessment of fear of fear among Agoraphobic patients: The Agoraphobic Cognitions Scale

A self-report scale for the measurement of fear of fear, the Agoraphobic Cognitions Scale (ACS), was psychometrically evaluated. Two samples of inpatients satisfying DSM-III-R criteria for unipolar depressive and/or anxiety disorder were studied. Intercorrelational and factor analyses indicated that the ACS measured three dimensions of fear of fear: fear of bodily incapacitation, fear of losing control, and fear of acting embarrassingly. Three subscales were constructed to measure these dimensions. The subscales proved to have satisfactory internal consistency and criterion-related validity. However, fear of losing control was related not only to other anxiety symptoms, but also to depressive symptomatology. Agoraphobic patients reported more fear of bodily incapacitation and fear of losing control than social phobic, generally anxious, and nonanxious depressed patients. Fear of embarrassing action was higher among agoraphobic and social phobic patients than among generally anxious and nonanxious depressed patients. These results were obtained after controlling for general anxiety and depression level and, thus, support the validity of the fear of fear construct.     

Anxiety sensitivity and fear of pain in children

Associations among scores on scales of anxiety sensitivity and trait anxiety and a fear of pain questionnaire were examined for 118 children. Analysis showed that anxiety sensitivity was positively and substantially related to fear of pain in the children. Furthermore, the data suggested anxiety sensitivity to be a better predictor of fear of pain than trait anxiety.     

Strategic and Automatic Threat Processing in Chronic Musculoskeletal Pain: A Startle Probe Investigation

Attentional bias research with chronic pain samples has yielded conflicting results. In the present investigation the startle paradigm was used to test the postulate that fear‐based mechanisms play an important role in attentional biases for pain‐related threat in chronic pain. Participants, including 31 individuals with chronic musculoskeletal pain and 20 healthy controls, completed a startle task designed to measure attention to different types of words (neutral vs sensory pain vs affective pain vs health catastrophe) presented at different levels of cognitive processing (strategic vs automatic). Measures of fear‐based individual difference variables, including anxiety sensitivity and fear of pain, were also completed. Startle amplitudes and latencies to acoustic startle probes that followed word presentations were recorded. Data were analyzed with repeated measures ANOVAs and correlational analysis. Significant between‐group differences were found indicating that, relative to chronic pain participants, healthy controls had higher startle amplitude index scores for health catastrophe words. There was also a trend among patients with chronic pain for greater startle amplitude index scores for strategic presentations of sensory pain words. In the automatic condition, all participants demonstrated a lower startle latency index for sensory words relative to both affect and health catastrophe words, suggesting participants had more difficulty disengaging from affect and health catastrophe words or were more avoidant of sensory words. Correlational analyses indicated that startle response indices for words related to health catastrophe became more pronounced for chronic pain patients as anxiety sensitivity and fear of pain increased. Implications and directions for future research are discussed.     

The relationship between anxiety sensitivity and fear of pain in healthy adolescents

The present study investigated the relationship between anxiety sensitivity and fear of pain in a large group of healthy adolescents (N=200). Participants completed the childhood anxiety sensitivity index for children-revised, a questionnaire measuring four specific domains of anxiety sensitivity: fear of cardiovascular symptoms, fear of respiratory symptoms, fear of cognitive dyscontrol, and fear of publicly observable anxiety symptoms, and a simplified version of the pain anxiety symptoms scale, a self-report instrument assessing pain-related anxiety and avoidance (i.e. fear of pain). In line with previous research in adult populations, it was found that anxiety sensitivity is substantially and positively related to fear of pain. Even when controlling for other potential predictors of fear of pain (i.e. pain symptoms, other somatization symptoms, trait anxiety, and panic disorder symptoms), anxiety sensitivity appeared to declare a unique proportion of the variance in pain anxiety symptoms.     

疼痛恐惧的形成及其对疼痛知觉的影响

脑岛、杏仁核是疼痛恐惧形成的重要神经网络中心。疼痛恐惧增强了慢性疼痛患者的疼痛知觉体验, 进而加剧抑郁、焦虑情绪和功能损伤程度。脑岛、杏仁核、前额皮层和前扣带回是疼痛恐惧影响疼痛知觉的重要神经基础。通过认知方法干预疼痛恐惧可以改善患者的抑郁、焦虑情绪, 减少功能损伤。未来研究应拓展疼痛恐惧的测量工具, 采用功能磁共振成像技术进一步揭示疼痛恐惧影响慢性疼痛患者疼痛知觉的神经机制。     

Evidence of a disposition toward fearfulness and vulnerability to posttraumatic stress in dysfunctional pain patients

Few investigations have addressed whether patient subgroups derived using the Multiaxial Assessment of Pain (MAP) [Turk, D. C., & Rudy, T. E. (1987). Towards a comprehensive assessment of chronic pain patients. Behaviour Research and Therapy, 25, 237-249; Turk, D. C., & Rudy, T. E. (1988). Toward an empirically derived taxonomy of chronic pain patients: integration of psychological assessment data. Journal of Consulting and Clinical Psychology, 56, 233-238.] differ with regard to fear and avoidance. It has, however, been reported that dysfunctional patients exhibit more pain-specific fear and avoidance than patients classified as interpersonally distressed or minimizers/adaptive copers [Asmundson, G. J. G., Norton, G. R., & Allerdings, M. D. (1997). Fear and avoidance in dysfunctional chronic back pain patients. Pain, 69, 231-236.]. We attempted to extend these findings by examining two fear constructs that are receiving increased attention in the chronic pain literature-anxiety sensitivity and PTSD. The sample comprised 115 patients with chronic pain. Of these, 14 (12.2%) were classified as dysfunctional, 21 (18.3%) as interpersonally distressed and 47 (40.8%) as minimizers/adaptive copers. Between-group differences were observed on the fear of cognitive and emotional dyscontrol dimension of anxiety sensitivity, total and symptom cluster scores on the PTSD measure, and depression. No differences were observed for the fear of somatic sensations dimension of anxiety sensitivity or agoraphobia, social phobia, and blood/injury fears. Dysfunctional patients generally exhibited elevated scores relative to one or both of the other MAP subgroups on fear of cognitive and emotional dyscontrol, depressed affect, PTSD symptom total score and PTSD symptom cluster scores. As well, a substantial proportion of dysfunctional and interpersonally distressed patients were classified as having PTSD (71.4 and 42.9%, respectively) when compared to minimizers/adaptive copers (21.3%). These results suggest that MAP subgroups differ with regard to their propensity to be(come) fearful and in their likelihood of having PTSD. Theoretical and clinical implications are discussed.     

Cognitions associated with anxiety and depression

The aim of the study was to examine whether cognitions associated with depression were different from those associated with anxiety. Sixty-four students and clerical staff completed the Beck Depression Inventory, the State-Trait Anxiety Inventory and the Cognitions Questionnaire. Those respondents whose depression scores were above the median were found to have significantly greater scores on one dimension of distortion (i.e. generalisation across situations) than respondents whose depression scores were below the median. There was also a general tendency for depression to be related to levels of overall cognitive distortion. The respondents whose trait anxiety scores were above the median did not show a significantly greater degree of overall cognitive distortion or generalisation across situations than those respondents whose anxiety scores were below the median.     

The origins of height fear: an evaluation of neoconditioning explanations

The present research sought to establish a reliable and valid instrument for assessing the relevance of neoconditioning factors (e.g. latent inhibition, UCS inflation/revaluation, prior fear levels, prior expectancies of harm, fear and pain levels experienced during supposed learning events), in the development of human fear. Fifty-four undergraduate height-fearful students completed the new origins instrument (OQ-II), while 54 matched controls completed a modified version (OQM-II) that examined their prior experiences with heights. In general, few differences between groups were found. Height-fearful and control subjects did not differ on trait anxiety, the frequency of negative encounters with heights, the age at which these events had occurred, prior fear levels, prior expectancies of harm, or reports of UCS inflation/revaluation procedures. However, in a finding directly opposite to that expected from a conditioning account, the mean fear and pain scores reported by subjects who had experienced direct conditioning events were significantly higher in the non-fearful group than in the height-fearful group. These findings are discussed in terms of associative and non-associative models of fear.     

A simultaneous test of the relationship between identified psychosocial risk factors and recurrent events in coronary artery disease patients

Psychosocial factors are increasingly recognized as risk indicators for coronary artery disease (CAD) prognosis and they are likely interrelated. The objective of this study is to simultaneously test the relationship between key psychosocial constructs as independent factor scores and recurrent events in CAD patients. There were 1268 CAD outpatients of 97 cardiologists surveyed at two points. Recurrent events or hospitalization in the intervening nine months were reported. Factor analysis of items from the Hospital Anxiety and Depression Scale, Perceived Stress Scale, the ENRICHD Social Support Inventory, and Hostile Attitudes Scale was performed to generate orthogonal factor scores. With adjustment for prognostic variables, logistic regression analysis was performed to examine the relationship between these factor scores and recurrent events. Factor analysis resulted in a six-factor solution: hostility, stress, anxiety, depressive symptoms, support, and resilience. Logistic regression revealed that functional status and anxiety, with a trend for depressive symptoms, were related to experiencing a recurrent event. In this simultaneous test of psychosocial constructs hypothesized to relate to cardiac prognosis, anxiety may be a particularly hazardous psychosocial factor. While replication is warranted, efforts to investigate the potential benefits of screening and to investigate treatments are needed.