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.     

Threat of pain influences social context effects on verbal pain report and facial expression

Current theoretical models of pain catastrophizing have diverging predictions regarding the role of social context and perceived threat on pain expression. The communal coping model of catastrophizing predicts that high pain catastrophizers display more pain expression in the presence of another, regardless of the threat value of the pain, while a cognitive appraisal model predicts high pain catastrophizers to express more pain when pain has increased threat value, regardless of social context. A 2 × 2 factorial design was used to test the validity of both predictions. Healthy participants with varying levels of pain catastrophizing were exposed to a cold pressor task, consisting of a 60 s immersion and 60 s recovery period. Interestingly, the immersion results revealed that beyond and independent from the effects of pain catastrophizing, the effect of threat on verbal pain report and facial expression was dependent on social context and vice versa. In a threatening context, perceived threat of pain mediated the inhibitory effect of social presence on pain expression, suggesting that the observer acted as a safety signal. In the recovery period, social presence enhanced facial expression, but only when no threat was induced. The results are discussed in terms of the dynamic interaction between social context and threat appraisals.     

The Adolescent Religious Coping Scale: Development,Validation, and Cross-Validation

Research literature on adolescent coping is growing, but typically such studies have ignored religious coping strategies and their potential impact on functioning. To address this lack, we developed the Adolescent Religious Coping Scale and used its seven subscales to examine the relationship between religious coping and emotional functioning. A cross-sectional research design was used with both a validation sample of Christian school students (Sample 1, N = 500, ages 12–19) and a cross-validation sample of Christian youth group attenders (Sample 2, N = 62, ages 11–18). Emotional functioning was assessed positively (life satisfaction) and negatively (hopelessness). Factor analyses supported factorial validity, and alpha levels supported reliability of the seven religious coping subscales (Positive God-Focused Coping, Seeking Religious Support, Constructive Distraction, Questioning, Avoidance, Denial, and Deferring). For both samples, religious coping was significantly related (unique variance) to religious support, parental support, and emotional functioning, respectively. In general, positive religious coping strategies were related to more support and better functioning, whereas the reverse was true for negative religious coping strategies. Moreover, many of these results were maintained even after controlling for variance due to age, gender, and religious attendance. As such, clinicians working with religious adolescents should consider encouraging these teens to optimize use of positive religious coping strategies and minimize reliance on negative ones as part of a holistic approach to handling stress. Religious coping findings are discussed regarding their comparison to general adolescent coping and with respect to future research directions.     

Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome

Symptoms of Exhaustion Syndrome (ES) and Chronic Fatigue Syndrome (CFS) are overlapping and create difficulties of differential diagnosis. Empirical studies comparing ES and CFS are scarce. This study aims to investigate if there are any emotional differences between ES and CFS. This cross‐sectional study compared self‐reported alexithymia and observer‐rated emotional awareness in patients with ES (n = 31), CFS (n = 38) and healthy controls (HC) (n = 30). Self‐reported alexithymia was measured with the Toronto Alexithymia Scale‐20 (TAS‐20) and emotional awareness with an observer‐rated performance test, the Level of Emotional Awareness Scale (LEAS). Additionally, depression and anxiety were scored by the Hospital Anxiety and Depression Scale (HADS). Results show that patients with ES expressed higher self‐reported alexithymia in the TAS‐20 compared to HC, but had similar emotional awareness capacity in the observer‐rated performance test, the LEAS. Patients with CFS expressed more difficulties in identifying emotions compared to HCs, and performed significantly worse in the LEAS‐total and spent more time completing the LEAS as compared to HC. Correlation and multiple regressions analyses revealed that depression and anxiety positively correlated with and explained part of the variances in alexithymia scores, while age and group explained the major part of the variance in LEAS. Findings of this study indicate that emotional status is different in patients with ES and CFS with respect to both self‐reported alexithymia and observer‐rated emotional awareness. Emotional parameters should be approached both in clinical investigation and psychotherapy for patients with ES and CFS.     

The role of pain anxiety, coping, and pain self-efficacy in rheumatoid arthritis patient functioning

Anxiety about pain is increasingly recognized as one factor contributing to increased pain perception and pain behavior [McCracken, L. M., Faber S. D., & Janeck A. S. (1998) Pain-related anxiety predicts nonspecific physical complaints in persons with chronic pain. Behavior Research and Therapy, 36, 621-630; McCracken L., & Gross R. (1995). The pain anxiety symptoms scale (PASS) and the assessment of emotional responses to pain. Innovations in clinical practice: a source book, 14, 309-321]. To assess this emotional reaction to pain in chronic pain patients, McCracken, Zayfert and Gross [McCracken, L., Zayfert, C., & Gross, R. (1992). The Pain Anxiety Symptom Scale: development and validation of a scale to measure fear of pain. Pain, 50, 67-73] developed the Pain Anxiety Symptom Scale (PASS) composed of four subscales: Cognitive Anxiety, Fearful Appraisal, Escape Avoidance and Physiological Anxiety. The present study extended previous work by examining the relationship among pain anxiety dimensions, use of active and passive coping strategies and arthritis self-efficacy as predictors of functional status in 154 rheumatoid arthritis (RA) patients. Functional status was assessed using the Five-Factor Model of the Arthritis Impact Scale, 2nd ed., (AIMS2): Physical Functioning, Affective Experience, Symptoms, Social Interaction and Role Function. Hierarchical multiple regression analysis on each of the AIMS2 criterion variables showed that pain anxiety, pain and symptom self-efficacy, health status and coping strategies were able to explain between 9 and 38% of the variance in the five AIMS2 variables. The present results support the hypothesized role of pain anxiety along with previously established contributions of self-efficacy and coping strategies, in affecting physical, social, emotional and role functioning in chronic RA patients.     

Coping strategies and perceived social support in fibromyalgia syndrome: Relationship with alexithymia

Fibromyalgia (FM ) is a chronic pain syndrome characterized by high levels of psychological distress and alexithymia, a personality disposition affecting emotional self‐awareness. The main aim of the present study was to investigate for the first time the relationship between alexithymia and coping strategies on the one hand, and alexithymia and perceived social support on the other, in a sample of FM patients. To reach this aim, 153 FM patients completed a battery of tests assessing coping strategies, perceived social support, alexithymia, psychological distress and pain intensity. Four regression analyses were performed to assess whether alexithymia was still a significant predictor of coping strategies and perceived social support, after controlling for psychological distress. High levels of both psychological distress and alexithymia were found in our sample of FM patients. Regarding coping strategies, FM patients reported higher scores on problem‐focused coping, with respect to the other two coping strategies. The regression analyses showed that the externally‐oriented thinking factor of alexithymia significantly explained both problem‐ and emotion‐focused coping, while the difficulty‐describing feelings factor of alexithymia proved to be a significant predictor of perceived social support. Only the variance of dysfunctional coping ceased to be uniquely explained by alexithymia (difficulty identifying feelings factor), after controlling for psychological distress, particularly anxiety. These results highlight a negative relationship between alexithymia and both the use of effective coping strategies and the levels of perceived social support in FM patients. An adequate assessment of both alexithymia and psychological distress should therefore be included in clinical practice with these patients.     

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.     

The Relatives’ Big Five Personality Influences the Trajectories of Recovery of Patients After Severe TBI: A Multilevel Analysis

This study examines the influence of the personality of relatives on the trajectories of recovery of patients with severe traumatic brain injury (TBI). The present subsample (N = 376) of a larger population‐based, prospective, 12‐month multicenter cohort study in Switzerland (2007–2011) consists of patients with severe TBI (age ≥ 16) and their relatives. The predictors are the NEO Five‐Factor Inventory and time (trajectory of functioning of the patient over time). The outcomes are the patients’ (a) neurological functioning; (b) reported emotional, interpersonal, cognitive, and total functioning post‐injury; and (c) health‐related quality of life (HRQoL). The covariates included Abbreviated Injury Scale score of the head region and age. Results for patients > 50 are (a) relatives’ Extraversion influenced patients’ total, interpersonal, and cognitive functioning; (b) relatives’ Agreeableness influenced patients’ interpersonal functioning; and (c) relatives’ Conscientiousness influenced patients’ physical HRQoL (ps < .05). Results for patients ≤ 50 are (a) relatives’ Neuroticism influenced patients’ neurological and emotional functioning, and (b) relatives’ Extraversion influenced patients’ emotional functioning and psychological HRQoL (ps < .05). The personality traits of the relative covary with the functioning of the patient, and psychological adaptation to the loss of function may progress at a later stage after physical health improvements have been achieved. Thus, a biopsychosocial perspective on the rehabilitation process is needed.     

Modulation of long-term memory by arousal in alexithymia: The role of interpretation

Moderate physiological or emotional arousal induced after learning modulates memory consolidation, helping to distinguish important memories from trivial ones. Yet, the contribution of subjective awareness or interpretation of arousal to this effect is uncertain. Alexithymia, which is an inability to describe or identify one’s emotional and arousal states even though physiological responses to arousal are intact, provides a tool to evaluate the role of arousal interpretation. Participants scoring high and low on alexithymia (N = 30 each) learned a list of 30 words, followed by immediate recall. Participants then saw either an arousing (oral surgery) or neutral video (tooth brushing). Memory was tested 24-h later. Physiological response to arousal was comparable between groups, but subjective response to arousal was impaired in high alexithymia. Yet, delayed word recognition was enhanced by arousal regardless of alexithymia status. Thus, subjective response to arousal, i.e., cognitive appraisal, was not necessary for memory modulation to occur.     

Coping and social support and health related quality of life in women with breast cancer in Turkey

This study aims to investigate the role of social support and coping in explaining health related quality of life (HRQoL) among Turkish breast cancer patients. A cross-sectional sample of 188 women from three hospitals in Turkey completed the Multidimensional Scale of Perceived Social Support, the Ways of Coping Inventory, and the Short Form 36 Health Survey. Socio-demographic and medical information was also collected. Results indicated high HRQoL levels, with 7 of the 10 SF-36 scores being within 1 SD of population mean. Correlations showed that helplessness coping was inversely associated with HRQoL whereas social support, religious coping, optimistic coping and problem focused coping were positively associated with HRQoL. Multiple regressions indicated that time since diagnosis, time since operation, stage of cancer, post-operative treatment, social support and problem solving coping were significant predictors of HRQoL accounting for 54.7% to 46.4% of the variance in physical and emotional HRQoL. Coping and social support have an independent effect on HRQoL over and above sociodemographic and medical variables and should be targeted by appropriate interventions.     

An exploratory analysis of the influence of personality and emotional factors on cerebral blood flow responses during painful stimulation in Fibromyalgia

This study explored the influence of certain personality traits (neuroticism, extraversion, psychoticism, alexithymia), emotional variables (depression, catastrophizing), and insomnia on cerebral blood flow (CBF ) responses to painful stimulation in fibromyalgia, using functional transcranial Doppler sonography. CBF velocities were recorded bilaterally in the anterior cerebral arteries (ACA ) and middle cerebral arteries (MCA ) of 24 fibromyalgia patients during exposure to two painful pressure conditions: (1) fixed pressure (2.4 kg) and (2) an individually calibrated pressure to produce an equal‐moderate subjective pain intensity in all participants (average, 3.5 kg). Psychological factors were assessed by means of questionnaires. Neuroticism, and the externally‐oriented thinking dimension of alexithymia were positively, and extraversion was inversely, associated with specific components of ACA and MCA CBF responses. Regarding catastrophizing and depression, correlations were positive for the fixed pressure condition and negative for the equal subjective intensity condition. The findings suggest that alterations in central nervous pain processing in fibromyalgia vary according to psychological factors. While most of the observed associations reflect a linear increase in nociceptive processing with the magnitude of negative cognitive and emotional states, the inverse associations for catastrophizing and depression during more intense painful stimulation may be ascribed to anti‐nociceptive effects due to activation of the defense reflex.     

Coping with Exposure to Violence: Relations to Emotional Symptoms and Aggression in Three Urban Samples

Relations among exposure to violence, coping, and adjustment were examined in three urban samples. In study 1, which took place in a southeastern city, children ages 6–16 (N = 35; M age = 10.7 years) completed measures of adjustment, exposure to violence, and coping with violence. In study 2, which took place in one southern Midwestern city and one Northeastern city, children ages 8–15 (N = 70; M age = 11.3 years) completed similar measures with the addition of a measure assessing normative beliefs about aggression. Results are in line with the pathologic adaptation model and provide preliminary evidence for two hypothesized pathways explaining the effects of exposure to violence on adjustment: a normalization pathway in which exposure leads to more aggression-supporting beliefs and in turn to greater aggression, and a distress pathway in which exposure leads to avoidant coping and in turn to emotional symptoms.     

Treating Primary Insomnia: Clinical Effectiveness and Predictors of Outcomes on Sleep,Daytime Function and Health-Related Quality of Life

Primary insomnia, as defined by DSM-IV-TR, refers to a persistent sleep disturbance which is not connected to a current psychiatric or physical condition, but significantly impairs social and occupational functioning. This study explored the impact of Cognitive Behavioral Therapy for Insomnia (CBT-i) on sleep, daytime functioning and health-related quality of life (HRQoL). Next, we investigated which factors predicted positive treatment outcome by examining demographics, insomnia characteristics, baseline levels of daytime function, HRQoL, sleep-disruptive beliefs and psychological health on post-treatment sleep quality, daytime function and HRQoL. 138 consecutive primary insomnia patients completed questionnaires pre- and post-treatment and at 6 months follow-up. After CBT-i, robust clinical improvements were observed in sleep, daytime function and HRQoL, regardless of age, gender, type or duration of the complaint. Patients with pre-treatment severe insomnia, pronounced daytime impairment and low psychological well-being benefited most.     

Catastrophizing,locus of control,pain, and disability in chinese chronic low back pain patients

Abstract

The present study examined the associations of locus of control (LOC) and catastrophizing with pain intensity and disability in Chinese chronic low back pain (CLBP) patients. In the study, 56 respondents (21 men and 35 women) with a mean age of 36.98 years (SD= 12.22) completed measures assessing locus of control, catastrophizing tendency, pain intensity, disability, and psychological distress. Results showed that after partialling out the effects of gender, duration of pain, and psychological distress, internal LOC significantly explained the variance of disability. For pain intensity, only catastrophizing accounted for a large portion of the variance. Limitations of the study and suggestions for future work were discussed.     

Mental toughness, stress, stress appraisal, coping and coping effectiveness in sport

The aim of the present study was to investigate the relationship between mental toughness, stressor appraisal, coping strategies and coping effectiveness among a sample of athletes. Participants were 482 athletes (male n = 305; female n = 177), aged between 16 and 45 years (M age = 20.44 years, SD = 3.98). In support of a priori predictions, mental toughness was associated with stress intensity and control appraisal, but not the type of stressor experienced by athletes. Total mental toughness and its six components predicted coping and coping effectiveness in relation to the self-selected stressor. In particular, higher levels of mental toughness were associated with more problem-focused coping, but less emotion-focused and avoidance coping. Coping effectiveness was influenced by the coping strategy employed by the athletes.     

Incremental Validity of Alexithymia, Emotional Coping and Humor Style on Happiness and Psychological Well-Being

This study attempts to ascertain whether alexithymia, suppression and reappraisal coping, and humor styles account for incremental variance in happiness (Lyubomirsky’s scale) and psychological well-being (Ryff’s scale), after controlling for Big Five traits and emotional positivity ratio of previous day’s mood. A total of 355 psychology undergraduates (72 % women) responded to measures of each construct, and two hierarchical multiple regressions were carried out for happiness and psychological well-being. The Big Five were entered in the first regression block, alexithymia was entered in a second block, and affiliative, self-enhancing, aggressive and self-defeating humor style, reappraisal and suppression coping were entered in the third block, and previous day’s mood in the last step. Alexithymia accounted for a small proportion of variance in psychological well-being, controlling for the Big Five traits. Suppression and affiliative, self-enhancing and self-defeating humor explained a complementary amount of variance in happiness and psychological well-being, controlling for the previous day’s mood, confirming the association of emotional regulation and affect with judgments of happiness and well-being. Taking into account humor and suppression, the multivariate association of alexithymia disappears. Results suggest that low suppression, low self-critical use of humor and affiliative humor are correlates of psychological well-being, whereas self-enhancing humor and low suppression are correlates of happiness, playing a mediational role between personality traits and well-being.     

Parents' emotion‐related beliefs and behaviours in relation to children's coping with the 11 September 2001 terrorist attacks

To assess relationships between parental socialization of emotion and children's coping following an intensely emotional event, parents' beliefs and behaviours regarding emotion and children's coping strategies were investigated after a set of terrorist attacks. Parents (n=51) filled out the Parents' Beliefs about Negative Emotions questionnaire and were interviewed within two weeks of the attacks. Their elementary and middle school‐aged children were interviewed eight weeks later. First, parents' beliefs were related to two kinds of parental behaviours. Parents' beliefs about both the value of and the danger of children's emotions were positively related to their discussion with their children. Parents' belief about children's emotions as dangerous was also negatively related to parents' expressiveness with their children. Second, parents' beliefs were related to five kinds of coping strategies reported by their children. Parents' belief about children's emotions as valuable predicted children's problem‐solving, emotion‐oriented, and support‐seeking coping following the terrorist attacks. Parents' belief about children's emotions as dangerous predicted children's avoidance and distraction coping following the attacks. Parents' beliefs about the importance of children's emotions may foster a family atmosphere that facilitates children's coping with intensely emotional events. Results support differentiated, multi‐faceted analysis of the broader construct of parental beliefs. Copyright © 2008 John Wiley & Sons, Ltd.     

Cognitions, metacognitions, and chronic pain

Purpose: Although the content of thoughts has received a considerable amount of attention in pain research, the importance of thought processes (metacognitions) has received less attention. Method: One hundred twenty-nine individuals with muscular dystrophy and chronic pain completed measures assessing metacognitions and frequency of both catastrophizing and pain control beliefs. Results: Greater use of reappraisal and distraction metacognitions were associated with more perceived control over pain, whereas greater use of worry and punishment metacognitions were associated with more catastrophizing. Conclusions/Implications: The current findings indicate that metacognitions are associated with both pain control beliefs and catastrophizing and therefore may play an important role in the development or maintenance of pain-related cognitive content thought to influence patient functioning. Research is needed to determine whether treatments that encourage changes in both metacognitions and cognitive content are more effective than treatments that focus on cognitive content alone. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study

Abstract

Fear-avoidance beliefs and catastrophizing have been implicated in chronic pain and theoretical models have been developed that feature these factor in the transition from acute to chronic pain. However, little has been done to determine whether these factors occur in the general population or whether they arc associated with the inception of an episode of neck or back pain. The aim of this study was to evaluate prospectively the effects of fear-avoidance beliefs and catastrophizing on the development of an episode of self-reported pain and associated physical functioning. To achieve this, we selected a sample of 415 people from the general population who reported no spinal pain during the past year. At the pretest a battery of questionnaires was administered to assess beliefs about pain and activity and it featured the Pain Catastrophizing Scale and a modified version of the Fear-Avoidance Beliefs Questionnaire. One year later outcome was evaluated by self-reports of the occurrence of a pain episode as well as a self-administered physical function test. The results showed that scores on both fear-avoidme and cabstrophizing were quite low. During the one year follow-up, 19% of the sample suffered an episode of back pain. Those with scores above the median on fear-avoidance beliefs at the pretest had twice the risk of suffering an episode of back pain and a 1.7 times higher risk of lowered physical function at the follow-up. Catastrophizing was somewhat less salient, increasing the risk of pain or lowered function by 1.5. but with confidence intervals falling below unity. These data indicate that fear-avoidance beliefs may be involved at a very early pint in the development of pain and associated activity problems in people with back pain. Theoretically. our results support the idea that fear-avoidance beliefs may develop in an interaction with the experience of pain. Clinically, the results suggest that catastrophizing and particularly fear-avoidance beliefs are important in the development of a pain problem and might be of use in screening procedures.     

Alexithymia, Irrational Beliefs, and the Rational-Emotive Explanation of Emotional Disturbance

In recent discussions of Rational-Emotive Behavior Therapy (REBT), Ellis has argued that unconscious processes supplement irrational beliefs in explaining psychopathology. The hypothesis of this investigation was that these unconscious processes reflect alexithymia. University students responded to the three factors from the Toronto Alexithymia Scale, the Malouff and Schutte Belief Scale (MSBS), 5 subscales from the Survey of Personal Beliefs, and instruments recording depression, anxiety, and neuroticism. As hypothesized, alexithymia and irrational beliefs predicted greater emotional disturbance while also displaying some small positive correlations with each other. In multiple regressions, both types of variables combined to predict emotional disturbance, with alexithymia explaining the greater amount of variance. Alexithymic difficulties in identifying emotions had uniquely negative mental health implications. The MSBS and the Low Frustration Tolerance subscale were the most noteworthy measures of a pathogenic irrationality. These data supported the claim that the unconscious processes of REBT could be conceptualized in terms of alexithymia.