Anxiety sensitivity, body vigilance and fear of pain

The aim of the present study was to investigate the role of anxiety sensitivity (AS) as a factor relevant to pain and pain persistence. Two studies were conducted to examine the relationship between AS, body vigilance and the experience of pain in non-clinical samples. Study 1 investigated the relationship between AS and body vigilance that was operationalized by the detection latency for innocuous electrical stimuli; trait anxiety and neuroticism were also included as covariates. Results indicated that the high AS group (N=69) presented shorter detection latency than the low AS group (N=70); neuroticism and trait anxiety did not have significant effects on detection latency. Using another sample, Study 2 investigated the relationship between AS, body vigilance, pain tolerance, catastrophizing, and self-reported distress and pain during a cold pressor task. Neuroticism, trait anxiety and fear of pain were included as covariates. Results showed significant differences between high- (N=66) and low- (N=69) AS groups in body vigilance, catastrophizing and tolerance. The covariates neuroticism, trait anxiety and fear of pain did not have any significant effects. No significant differences were found in pain and distress ratings. Results from both studies support the importance of AS in body vigilance and the experience of pain. The theoretical, preventive and clinical implications of these findings are discussed.     

Is pain sensitivity associated with occupational fears in police recruits?

Gross (Behaviour Research and Therapy, 30, 7-13, 1992a) showed that the fear of pain (pain sensitivity) could be distinguished from dental fears and health concerns. Furthermore, the Pain Sensitivity Index (PSI) correlated significantly with pain expectations, and pain expectations correlated significantly with dental avoidance behaviour. However, Gross noted that the psychometric properties of the PSI had not been fully determined. The present study examined the factor structure of an expanded version of the PSI with a sample of 212 police recruits. A single factor accounted for 52.1% of the variance and the reliability coefficient (alpha = 0.89) indicates that the PSI possesses a high degree of internal reliability. Subsequently, it was hypothesized that pain sensitivity correlates positively with fears relating to police tasks which are characterized by pain expectancies, such as the fear of being assaulted during operational police work. In support of the hypothesis, pain sensitivity correlated highest with situations involving pain. The pain sensitivity construct may help to explain individual differences in fear reactions to situations where pain could be experienced, such as operational police duties or dental attendances.     

Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders

We investigated body vigilance, cardiac anxiety, and the mediating role of interoceptive fear on pain in patients with non-cardiac chest pain (NCCP; a syndrome of chest pain in the absence of identifiable organic etiology). Patients were more attentive to cardiac-congruent sensations than cardiac-incongruent sensations (e.g., gastrointestinal, cognitive dyscontrol; p's < .001). Patients with a DSM-IV Axis I anxiety or mood disorder were more body vigilant compared to patients who did not have a disorder (p's < .05). Patients with anxiety disorders were particularly vigilant to and fearful of cardiac sensations relative to patients without anxiety disorders. Latent variable path models examined the extent that interoceptive fear mediated the association between body vigilance and cardiac anxiety on chest pain. Within each model, diagnostic status, body vigilance, and cardiac anxiety were exogenous and predicted interoceptive fear that in turn predicted pain. Separate models examined body vigilance and cardiac anxiety, and both models fit the data well. Findings showed partial mediation for the body vigilance factor, and full mediation for the cardiac anxiety factor. Interoceptive fear played a mediating role in both models. The syndrome of NCCP may persist partly due to conscious hypervigilance to and fear of cardiac-congruent body sensations, particularly among anxious patients.     

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 development and validation of a Fear of Death Scale based on the cognitive approach of Avicenna

ABSTRACT

The aim of this study was to develop a culturally sensitive approach assessment instrument that measures cognitive beliefs related to Iranian Muslim salient fear of death. This paper discusses the development and validation of Avicenna Fear of Death Scale (AFDS). The results of confirmatory factor analysis resulted in an instrument (AFDS) consisting of five cognitive concerns related to the fear of death including complete annihilation, severe pain of death, consequences of sins, interpersonal attachment, and attachment to estate. Twenty-two statements overall were offered using a Likert scale to measure related cognitive beliefs. Results from a convenience sample of 291 college students, showed the AFDS to have favourable psychometric properties (e.g., adequate reliability and validity). The total alpha coefficient was .85, suggesting that the items have relatively high internal consistency and the item-total correlation between .28 and .63 (p<.001) indicates that the items are discriminating well. Overall, results suggest that cross-cultural differences render a culturally sensitive approach to assessment and diagnosis essential, and therefore a culture-based scale like Avicenna AFDS might be fruitful extensions of the current death anxiety scales like Templer Death Anxiety Scale within the context of Iranian-Islamic culture. This diagnostic tool can help in the cognitive treatment of fear of death.     

Development and validation of the attention questionnaire of rehabilitated athletes returning to competition

The present study describes the development and validation of an instrument designed to examine athletes' selective attention returning to competition following a musculoskeletal injury--the attention questionnaire of rehabilitated athletes returning to competition (AQ-RARC). Using a sample of 186 rehabilitated athletes, exploratory factor analysis revealed a 10-item model that examines functional attention and distraction attention. Confirmatory factor analysis further supported the factorial validity of the AQ-RARC with another sample of 184 rehabilitated athletes. The two subscales have good internal consistency and test-retest reliability. The concurrent and discriminant validity of the new instrument were confirmed by examining correlations between the AQ-RARC with other constructs. It is concluded that the AQ-RARC is a valid and reliable instrument that can be used for clinical and research purposes.     

The cardiac anxiety questionnaire: development and preliminary validity

Heart-focused anxiety (HFA) is the fear of cardiac-related stimuli and sensations because of their perceived negative consequences. Although HFA is common to a wide variety of persons who experience chest pain and distress, it often is unrecognized and misdiagnosed, particularly in cardiology and emergency room patients without and with heart disease. To address these concerns, this article reports on the development and preliminary psychometric evaluation of the Cardiac Anxiety Questionnaire (CAQ) designed to measure HFA. In Study 1, 188 cardiology patients completed the CAQ. Item and factor analyses indicated a three-factor solution pertaining to heart-related fear, avoidance, and attention. Reliability analysis of the 18-item CAQ revealed good internal consistency of the total and subscale scores. In Study 2, 42 patients completed the CAQ and several other anxiety-related questionnaires to assess its convergent and divergent properties. Although preliminary validity results are promising, further psychometric study is necessary to cross-validate the CAQ, examine its test-retest reliability, and confirm the stability of the factor structure. Taken together, the CAQ appears to assess HFA, and may therefore be a useful instrument for identifying patients with elevated HFA without and with heart disease.     

Preliminary Validation of a Korean Version of the Acquired Capability for Suicide Scale‐Fearlessness About Death

The interpersonal‐psychological theory of suicide proposes that the desire for suicide must be accompanied by the capability to do so in order for an individual to engage in suicidal behavior. The Acquired Capability for Suicide Scale‐Fearlessness about Death (ACSS ‐FAD ) measures fearlessness about death, a core component of the capability for suicide. This study aimed to validate a Korean version of the ACSS ‐FAD in a college student sample. We administered the ACSS ‐FAD and measures of suicide ideation, fear of suicide, death anxiety, pain anxiety, and depression in a sample of Korean college students (N  = 301) and analyzed its reliability, factor structure, invariance across genders, convergent validity, and discriminant validity. The one‐factor model achieved satisfactory model fit. Across genders, partial metric invariance and partial scalar invariance were established. The results also revealed that the ACSS ‐FAD has good internal consistency, convergent validity (positive correlations with fear of suicide, death anxiety, and pain anxiety), and discriminant validity (no relation with depression). The Korean version of the ACSS ‐FAD presents adequate psychometric properties and may be considered to be a promising instrument for measuring fearlessness about death in college students.     

Relationships Between Physical Symptoms,Emotional Distress,and Pain Appraisal in Fibromyalgia: The Moderator Effect of Alexithymia

Alexithymia is a personality construct that is frequently identified in fibromyalgia (FM). Previous studies have explored the relationship between alexithymia and emotional distress in this disease. Yet, the additional link with factors of pain appraisal is unknown. This study examined the moderating effect of alexithymia in the relationship between emotional distress and pain appraisal in 97 FM women. A control group of 100 healthy women also participated in the study. All participants completed several self-reports about pain experience, sleep quality, impairment, emotional distress, pain appraisal, and alexithymia. FM women showed significantly more difficulty in identifying and describing feelings, but less externally oriented thinking than healthy women. In the clinical group, difficulty in identifying feelings and difficulty in describing feelings significantly correlated with lower sleep quality, higher anxiety and depression, and increased pain catastrophizing and fear of pain. Difficulty in describing feelings significantly correlated with higher pain experience and vigilance to pain. Externally oriented thinking was not correlated with any of the clinical variables. Difficulty in identifying feelings moderated the relationship between anxiety and pain catastrophizing, and difficulty in describing feelings moderated the relationship between anxiety and fear of pain. Implications of the findings for the optimization of care of FM patients are discussed.     

The validity of vigilance tasks in differential diagnosis of children referred for attention and learning problems

This study was conducted to evaluate the convergent and discriminant validity of vigilance measures of attention and impulsivity in children. One hundred children referred for evaluation of attention and learning problems were administered a battery of tests including two vigilance tasks, other laboratory measures of inattention and impulsivity, and parent and teacher ratings. It was predicted that vigilance task performance would correlate with teacher ratings and laboratory measures of inattention while correlations with ratings of aggressive behavior were predicted to be lower. Moderate correlations were obtained between the vigilance task scores and other laboratory measures of inattention and impulsivity. However, the vigilance scores did not correlate with teacher or parent ratings of behavior. A factor analysis, conducted to identify underlying dimensions of attention in the battery of tests, revealed strong source effects. The implications for use of vigilance measures in diagnosis are discussed.Portions of this paper were presented at the 1990 Learning Disabilities Association of America International Conference, Anaheim, California.     

Gender orientation and the Bem Sex Role Inventory: A psychological construct revisited

In 1973, Constantinople revolutionized the conceptualization of male and female sex roles when she advanced that masculinity and femininity were not opposite ends of a unidimensional continuum but rather independent constructs. This gave rise to androgyny theory, which advanced that individuals could be both masculine and feminine, and that in fact, the most healthy gender orientation was one containing elements of both. Nearly two decades after the development of the androgyny theory and the Bem Sex Role Inventory (BSRI), one of its most popular measures, it seems prudent to reexamine the androgyny construct and its measurement. This paper does just that. Within the context of a predominantly middle-class, Caucasian population, this study uses factor analysis, reliability estimates, and measures of population agreement to assess the continuing validity and reliability of the BSRI and androgyny theory. While reinforcing the reliability of the BSRI, results raise both methodological and conceptual questions regarding the BSRI and the operationalization of androgyny.     

The development of an instrument to measure teachers' use of fear appeals in the GCSE classroom

Background Previous work has suggested that teachers of General Certificate of Secondary Education classes may use fear appeals as a motivational device but these may have unwanted consequences by increasing examination‐related anxiety in students. Aim To facilitate future work in this area, an instrument was developed to measure teachers' use of fear appeals in the course of normal classroom instruction. Samples Students in their final 2 years of compulsory schooling in England: 192 in Study 1 and 133 in Study 2. Method A construct validity approach was used in the development of this instrument. Study 1 reports the development and piloting of this measure. Study 2 reports refinement of this measure and relations with other constructs. Results A three‐factor structure provided a reasonable model fit and all factors demonstrated acceptable reliability. Factors 1 and 2 described the perceived frequency of fear appeals made in relation to educational/occupational consequences and the third factor described the perceived threat of fear appeals. Conclusion This instrument has demonstrated sufficient convergent and discriminant validity and reliability to be used in subsequent research, although the validation process should continue and it is hoped that the instrument will be adapted for use in other contexts.     

The Role of Anxiety Sensitivity and Mindful Attention in Anxiety and Worry About Bodily Sensations Among Adults Living With HIV/AIDS

The current study examined cognitive factors that may be relevant to understanding anxiety and worry about bodily sensations among an HIV/AIDS population. Specifically, this investigation tested the main and interactive effects of anxiety sensitivity and mindful attention on anxious arousal, bodily vigilance, interoceptive fear, and HIV symptom distress among 164 adults with HIV/AIDS. Results indicated that anxiety sensitivity was positively related to anxious arousal, bodily vigilance, and interoceptive fear, but not HIV symptom distress. Mindful attention was negatively related to anxious arousal, interoceptive fear, and HIV symptom distress, but not bodily vigilance. These main effects for anxiety sensitivity and mindful attention were evident after controlling for disease stage, years with HIV, and demographic variables. There were no interactive effects between anxiety sensitivity and mindful attention. Results are discussed in terms of the clinical implications for identifying and treating anxiety and worry about bodily sensations among adults with HIV/AIDS. Limitations of this study include the use of cross-sectional data and self-report assessments.     

Development and validation of the Causes of Re-Injury Worry Questionnaire

Re-injury worry is an important construct in competitive sport that may influence performance and increase the risk of re-injury. However, there are currently no available instruments to measure the causes of re-injury worry. The purpose of this study was to develop the Causes of Re-Injury Worry Questionnaire (CR-IWQ). The study was conducted in three independent research phases to investigate the following: (a) the content relevance, (b) the factor structure and the factorial validity, (c) the concurrent validity, (d) the discriminant validity, and (e) the test-retest reliability (intraclass correlation coefficients; ICC), and the internal consistency of the instrument. Exploratory factor analysis (EFA) was chosen to examine the factor structure of the CR-IWQ. Confirmatory factor analysis (CFA) was used to examine further the factorial validity of the instrument. A number of valid constructs were used to assess the concurrent and discriminant validity of the CR-IWQ. The reliability of the new instrument was examined using Pearson r (ICC) and Cronbach α. Three hundred and seventy athletes with an acute musculoskeletal sport injury in the last year participated in the study. EFA revealed a 12-item model, representing two factors ("Re-injury worry due to rehabilitation" and "Re-injury worry due to opponent's ability"). CFA supported the two-factor model of the CR-IWQ. The concurrent and discriminant validity of the CR-IWQ was confirmed by examining correlations between the CR-IWQ with other constructs. The ICCs and the Cronbach α indices of the CR-IWQ were acceptable. We have demonstrated that the CR-IWQ is a good psychometric instrument that can be used for clinical and research purposes.     

An Examination of the RDoC Negative Valence Systems Domain Constructs and the Self-Reports Unit of Analysis

In response to shortcomings with the current diagnostic classification system for mental health disorders, such as poor validity and reliability of categorical diagnoses, the National Institute of Mental Health proposed the Research Domain Criteria (RDoC) initiative to move towards a dimensional approach using translational research. The current study examined associations between measures of behaviors, cognitions, and mental health symptoms and how they overlap in the Negative Valence Systems (NVS) domain. Specifically, we examined how the Self-Reports unit of analysis reflects the RDoC NVS constructs of acute threat, potential threat, sustained threat, frustrative nonreward, and loss. The overall goal was to identify additional self-report measures that reflect these constructs. Participants, two student samples and two community samples (total N = 1,509), completed online self-reported measures. Questionnaire total and subscale scores were submitted to a principal-axis factor analysis with Promax rotation separately for each sample. For both student samples and one community sample six-factor solutions emerged reflecting major aspects of the RDoC NVS and positive valence systems, particularly acute threat (i.e., fear/panic), potential threat (i.e., inhibition/worry), sustained threat (i.e., chronic stress), loss (i.e., low well-being), frustrative nonreward (i.e., reactive aggression), and reduced behavioral activation. The second community sample differed in that fear/panic and frustration/anger was combined in a general distress factor. Recommendations for additional NVS self-report markers are discussed.     

Prediction of experimental pain sensitivity by attention to pain-related stimuli in healthy individuals

The aim of the present study was to assess the predictive power of the processing of pain-related information, comprising concepts of hypervigilance to pain, pain catastrophizing, and pain-related anxiety (questionnaires) as well as attentional processes related to pain-related stimuli (dot-probe task) in explaining individual differences in experimental pain sensitivity (pressure/thermal pain threshold). In 160 healthy participants (ages 13-61; 80 females), results of hierarchical multiple regression analyses showed that self-reported hypervigilance contributed significantly to the prediction of pain sensitivity, whereas pain catastrophizing and anxiety did not. However, inconsistent with prediction, the effect was in the opposite direction, indicating that vigilance to pain sensations or stimuli is associated with lower pain sensitivity in healthy individuals. Entering the attentional bias indices from the dot-probe task showed that an increased bias to pain words is related to higher experimental pain sensitivity, which confirms the hypothesis.     

Is pain-related fear a predictor of somatosensory hypervigilance in chronic low back pain patients?

Pain-related fear has been found to be associated with increased disability and increased pain perception in patients with chronic low back pain. A possible mechanism by which pain-related fear could lead to increased pain perception is heightened attention to somatosensory sensations. In the present study, chronic pain patients reporting either a high or low level of pain related fear and control participants performed an auditory reaction time task, while occasionally non-painful electrical stimuli--accompanied by threatening instructions--were given to the arm or back. In the primary task condition, participants had to perform the auditory task while ignoring the electrical stimuli. Next, the task was presented under dual task conditions in which participants had to respond both to tones as well as to detection of electrical stimuli. It was hypothesized that for the primary task, high fearful patients would show greater disruption of performance on the auditory task than low fearful patients and controls when stimuli were presented to the back. For the dual task, slower reaction times for the auditory task, in combination with faster detection of electrical stimuli was expected. The hypotheses were not confirmed but patients scoring high on pain-related fear did show an overall increase in reaction time for all conditions of the primary task, with or without simultaneous stimulation. Regression analyses demonstrated that high pain-related fear was associated with increased reaction time to tones both in patients and healthy controls, and that within patients pain-related fear was a better predictor of reaction time to tones than present pain intensity. The findings may be interpreted as showing that patients with elevated levels of pain-related fear habitually attend to somatic sensations, giving less priority to other attention-demanding tasks.     

Orienting and maintenance of gaze in contamination fear: Biases for disgust and fear cues

The present study examines the extent to which attentional biases in contamination fear commonly observed in obsessive-compulsive disorder (OCD) are specific to disgust or fear cues, as well as the components of attention involved. Eye tracking was used to provide greater sensitivity and specificity than afforded by traditional reaction time measures of attention. Participants high (HCF; n = 23) and low (LCF; n = 25) in contamination fear were presented with disgusted, fearful, or happy faces paired with neutral faces for 3 s trials. Evidence of both vigilance and maintenance-based biases for threat was found. The high group oriented attention to fearful faces but not disgusted faces compared to the low group. However, the high group maintained attention on both disgusted and fearful expressions compared to the low group, a pattern consistent across the 3 s trials. The implications of these findings for conceptualizing emotional factors that moderate attentional biases in contamination-based OCD are discussed.     

Is pain sensitivity associated with dental avoidance?

The present investigation examined whether pain sensitivity is associated with dental avoidance. Whereas the aim of the first study was to determine whether pain sensitivity can be distinguished from dental fears and health concerns, the aim of the second study was to examine the structure of cognitive aspects of pain sensitivity, and the aim of the third study was to examine the relationships of pain sensitivity to anxiety sensitivity, fear, pain, and avoidance. In the first study (n = 222), a factor analysis performed with items from the Dental Phobia and Pain Sensitivity Inventory distinguished a pain sensitivity factor from factors relating to dental phobia and health concerns. The factor structure of the Pain Sensitivity Index was examined in the second study (n = 181), and similarly, a pain sensitivity factor was interpreted in the data. The third study (n = 65) found that although pain sensitivity correlated significantly with anxiety sensitivity, these constructs are not identical to each other. For instance, pain sensitivity but not anxiety sensitivity correlated significantly with blood-injury phobia. Pain sensitivity should be taken into account in future studies of dental phobia as pain sensitivity was found to be predictive of pain intensity, and pain intensity was found to be predictive of dental avoidance.     

Measuring fear of movement/(re)injury in chronic low back pain using implicit measures

Fear of movement/(re)injury is assumed to contribute to the development and maintenance of chronic low back pain (CLBP) in a subgroup of patients. Studying fear of movement/(re)injury with implicit attitude measures, without the awareness of the patient, might be a valuable addition to self-report questionnaires. The aims of the current study were to investigate whether CLBP patients demonstrate more implicit fear of movement/(re)injury than healthy controls, and whether 2 implicit measures are related to each other, and to an explicit self-report measure of fear of movement/(re)injury. A group of 66 CLBP patients and 30 healthy controls took part in this study. In addition to self-report questionnaires, fear of movement/(re)injury was implicitly assessed by the Extrinsic Affective Simon Task (EAST) and the Go-No-Go-Association Task (GNAT) that aimed to determine the association between back-stressing movements and the evaluation "threatening". On both implicit tasks it was found that neither CLBP patients nor healthy controls demonstrated implicit fear of movement/(re)injury, and that CLBP patients did not differ from healthy controls in their level of implicit fear of movement/(re)injury. In general, no associations were found between the EAST and the GNAT, or between implicitly measured and self-reported fear of movement/(re)injury. One major caveat in drawing inferences from these findings is the poor reliability of these implicit measures. Research towards the psychometric properties of these measures should first be expanded before modifying, and applying, them to more complex domains such as fear of movement/(re)injury.