Disease controllability moderates the effect of coping efficacy on positive affect

Objective: This study aims to test experimentally whether coping strategies (approach- vs. avoidance-oriented coping) have differential effects under conditions of high or low stressor controllability.

Design: Undergraduates (62 women, 30 men) participated in a 2 × 2 experimental study where they were introduced to a fictitious disease (tisomerase enzyme deficiency) said to be either controllable or uncontrollable and an approach- or avoidance-oriented coping behaviour induction.

Main Outcome Measures: Changes in positive and negative affect.

Results: A significant disease control x coping interaction on positive affect (f² = .07, p = .011) revealed that approach-coping condition participants had higher positive affect than avoidance-coping condition participants when disease control was high (d = .94, p = .003), but not when it was low (d = .11, p = .93). The experimental conditions did not significantly influence negative affect.

Conclusion: Results demonstrate that disease control moderates the salubrious effects of approach-oriented coping on positive affect. For controllable, but not uncontrollable, health stressors, promoting problem-focused approach-oriented coping strategies may be recommended.     

Differences in psychosocial responses to pain between sufficiently and insufficiently active adults with arthritis

Objective: Adults with arthritis struggle to meet the physical activity recommendation for disease self-management. Identifying psychosocial factors that differentiate adults who meet (sufficiently active) or do not meet (insufficiently active) the recommendation is needed. This study sought to examine differences in psychosocial responses to arthritis pain among adults who were sufficiently or insufficiently active.

Design: This prospective study included adults with medically diagnosed arthritis (N = 136, M_age = 49.75 ± 13.88 years) who completed two online surveys: (1) baseline: pain and psychosocial responses to pain and (2) two weeks later: physical activity.

Main outcome measures: Psychosocial responses examined in this study were psychological flexibility in response to pain, pain anxiety and maladaptive responses to pain anxiety.

Results: A between-groups MANCOVA comparing sufficiently active (n = 87) to insufficiently active (n = 49) participants on psychosocial responses, after controlling for pain intensity, was significant (p = .005). Follow-up ANOVA’s revealed that sufficiently active participants reported significantly higher psychological flexibility and used maladaptive responses less often compared to insufficiently active participants (p’s < .05).

Conclusions: These findings provide preliminary insight into the psychosocial profile of adults at risk for nonadherence due to their responses to arthritis pain.     

The Cohen–Hoberman inventory of physical symptoms: Factor structure,and preliminary tests of reliability and validity in the general population

Objective: The present study aimed to investigate the factor structure and psychometric properties of the Cohen–Hoberman inventory of physical symptoms (CHIPS). Construct and discriminant validity were examined by assessing associations between factors and subjective health complaints (SHC) inventory subscales in addition to measures of pain sensitivity, perceived stress and psychological distress.

Design: A cross-sectional online survey was conducted with 535 healthy individuals from the general population (80.6% female, mean age = 29.80).

Main outcome measures: Participants completed CHIPS, SHC, perceived stress scale, pain sensitivity questionnaire, and hospital anxiety and depression scale.

Results: Principal components analysis demonstrated that CHIPS comprised 8 ‘symptoms’ factors as follows; ‘sympathetic/cardiac’ (7 items; α = .827), ‘muscular’ (6 items; α = .752), ‘metabolic’ (5 items; α = .736), ‘gastrointestinal’ (5 items; α = .714), ‘vasovagal’ (4 items; α = .743), ‘cold/flu’ (2 items; α = .837), ‘headache’ (2 items; α = .690) and ‘minor haemorrhagic’ (2 items; α = .309). Significant correlations were observed between factors and SHC subscales (moderate-high), pain sensitivity (negligible-low) and levels of perceived stress and anxiety (low-moderate) indicating good construct, and discriminant validity, respectively.

Conclusions: CHIPS is a multidimensional and internally consistent measurement of physical symptoms. The postulated factor structure may be used for research purposes particularly in health psychology, to consistently differentiate between clusters of self-reported symptoms.     

A meta-analysis of children’s self-reports of dietary intake

Objective: Although research studies increasingly use children as primary reporters in dietary assessments, it is unclear how well children’s self-reported intake correlates with independently validated reports of their intake; this meta-analysis assesses that correlation.

Design: Moderators of the correlation between self-reported and independently validated intake were predicted a priori: type of dietary intake assessment (24 h recall, food diary and food frequency questionnaires), validation measures, parental assistance and age. Online databases were searched for articles published from 1990 to 2014 that compared children’s self-reports of dietary intake to validated observations of food intake in children age 4–16.

Main outcome measures: Summary effect size Pearson r between children’s self-reported dietary intake and independently validated dietary intake were calculated.

Results: In k = 32 samples from 23 studies, a statistically significant correlation (r = .48, Z = 7.26, p < .001) was found between children’s self-reported dietary intake and independently validated reports of dietary intake. Validation method (Q = 17.49, df = 2, p < .001) and parental assistance (Z = 2.03, p = .042) were significant moderators of this correlation. Self-report methodology (Q = 3.95, df = 2, p = .139) and age (Q = .02, p = .879) were not significant moderators of the distribution of effect sizes.

Conclusion: Together, these results provide baseline information about children’s recall in dietary intake assessments conducted with children as primary reporters.     

Can self-affirmation exacerbate adverse reactions to stress under certain conditions?

Objective: Self-affirmation has repeatedly been shown to reduce adverse psychological and physiological responses to stress. However, it is plausible that self-affirmation could exacerbate negative reactions to stress under certain conditions. The current research explored whether self-affirmation would increase negative psychological responses to a stressor occurring in a central life domain characterised by low levels of control.

Design: Female participants (Study 1 N = 132; Study 2 N = 141) completed baseline measures of anxiety and mood. They were then randomly allocated to complete a self-affirmation or control task, before reading a narrative documenting a stressful birth and imagining themselves in the place of the woman giving birth. After completing this task, participants again reported their levels of anxiety and positive mood.

Main outcome measures: Anxiety and positive mood assessed at follow-up.

Results: Study 1 demonstrated that self-affirmed women experienced increased anxiety and less positive mood at follow-up, compared both to baseline and to women in the control condition. Study 2 revealed that the effect of self-affirmation on outcomes was moderated by fear of childbirth.

Conclusion: These results provide preliminary evidence that self-affirmation may worsen negative responses to stressors under certain conditions and for certain individuals.     

Motivational interviewing or reminders for glaucoma medication adherence: Results of a multi-site randomised controlled trial

Objective: Nonadherence reduces glaucoma treatment efficacy. Motivational interviewing (MI) is a well-studied adherence intervention, but has not been tested in glaucoma. Reminder interventions also may improve adherence.

Design: 201 patients with glaucoma or ocular hypertension were urn-randomised to receive MI delivered by an ophthalmic technician (OT), usual care or a minimal behavioural intervention (reminder calls).

Main Outcome Measures: Outcomes included electronic monitoring with Medication Event Monitoring System (MEMS) bottles, two self-report adherence measures, patient satisfaction and clinical outcomes. Multilevel modelling was used to test differences in MEMS results by group over time; ANCOVA was used to compare groups on other measures.

Results: Reminder calls increased adherence compared to usual care based on MEMS, p = .005, and self-report, p = .04. MI had a nonsignificant effect but produced higher satisfaction than reminder calls, p = .007. Treatment fidelity was high on most measures, with observable differences in behaviour between groups. All groups had high baseline adherence that limited opportunities for change.

Conclusion: Reminder calls, but not MI, led to better adherence than usual care. Although a large literature supports MI, reminder calls might be a cost-effective intervention for patients with high baseline adherence. Replication is needed with less adherent participants.     

Subjective age and sleep in middle-aged and older adults

Objective: Chronological age is commonly used to explain change in sleep. The present study examines whether subjective age is associated with change in sleep difficulties across middle adulthood and old age.

Design: Participants were drawn from the second (2004–2005) and third (2013–2014) waves of the Midlife in the United States Survey (MIDUS, N = 2350; Mean Age: 55.54 years), the 2008 and 2014 waves of the Health and Retirement Study (HRS, N = 4066; Mean Age: 67.59 years) and the first (2011) and fourth (2014) waves of the National Health and Aging Trends Survey (NHATS, N = 3541; Mean Age: 76.46). In each sample, subjective age, sleep difficulties, depressive symptoms, anxiety and chronic conditions were assessed at baseline. Sleep difficulties was assessed again at follow-up.

Main outcome measures: Sleep difficulties.

Results: An older subjective age at baseline was related to an increase in sleep difficulties over time in the three samples, and was mediated, in part, through more depressive symptoms, anxiety and chronic conditions. Feeling older was associated with an increased likelihood of major sleeping difficulties at follow-up in the three samples.

Conclusion: Subjective age is a salient marker of individuals’ at risk for poor sleep quality, beyond chronological age.     

Psychosocial mediators of a theory-based resistance training maintenance intervention for prediabetic adults

Objective: Examine psychosocial mediators of the effects of high vs. low-dose resistance training (RT) maintenance interventions among older (ages 50–69), overweight and pre-diabetic adults.

Design: Participants (N = 123) completed a three-month supervised RT initiation phase and were subsequently randomised (time 1) to high or low-dose six-month unsupervised RT maintenance interventions (time 2), followed by a six-month no-contact phase (time 3).

Main Outcome Measures: Online measures of putative mediators and RT behaviour.

Results: RT intervention condition (high vs. low dose) had significant effects on change from time 1 to time 2 in behavioural expectation, self-regulation and perceived satisfaction (f² = .04–.08), but not outcome expectancies, RT strategies or behavioural intentions (f² ≤ .02). Change in each of the putative mediators, except for outcome expectancies (f² ≤ .02), had significant effects on RT behaviour at times 2 (f² = .12–.27) and 3 (f² = .23–.40). In a multiple mediation model, behavioural expectation (f² = .11) and self-regulation (f² = .06) mediated the effects of RT intervention condition on time 2 RT behaviour, whereas perceived satisfaction did not (f² = .01). Self-regulation was a significant mediator of intervention effects on time 3 RT behaviour (f² = .11), but behavioural expectation and perceived satisfaction were not (f² = .04).

Conclusions: Findings suggest that behavioural expectation and self-regulation are appropriate targets for RT maintenance interventions among at-risk older adults.     

Self-efficacy and planning strategies can improve physical activity levels in women with a recent history of gestational diabetes mellitus

Introduction: Regular physical activity can reduce the risk of developing diabetes in high risk populations including in women with gestational diabetes mellitus (GDM). This study applied the Health Action Process Approach (HAPA) to determine the motivational and volitional factors important in increasing physical activity among women with previous GDM.

Methods: Women with GDM receiving obstetric care at a teaching hospital in Sri Lanka were invited to participate in a survey 6–36 months post-delivery. At baseline and 8 weeks later, 152 women completed postal and telephone surveys that collected socio-cognitive and physical activity data. The study hypotheses were tested using structural equation modelling.

Results: The modified model fit the data well (CFI = .95, TLI = .94, RMSEA = .057) and explained 11% of the variance in behaviour. Action self-efficacy was the only important predictor of intention to be physically active. Intention as well as maintenance self-efficacy predicted planning, which, in turn, predicted physical activity. Planning mediated the effect of intention and self-efficacy (maintenance and recovery) on physical activity.

Conclusion: This study has identified predictors of physical activity among women with previous GDM that can inform intervention studies. Interventions targeting this population need to include planning strategies and enhance self-efficacy.     

The interplay between feelings and beliefs about condoms as predictors of their use

Objective: Negative feelings about condoms are a key barrier to their use. Using the behavioural affective associations model, we examined the joint effects of affective associations and cognitive beliefs about condoms on condom use.

Design: In Study 1 (N = 97), students completed measures of their affective associations and cognitive beliefs about sex and condoms, sexual activity and condom use. In Study 2 (N = 171), a measure of behavioural intentions and condom selection task were added.

Main outcome measures: Condom use measured in Study 1 as (1) current condom use, and (2) willingness to use condoms; in Study 2 as: (1) behavioural intentions, (2) number of condoms selected.

Results: Affective associations with sex and condoms were behaviour-specific, were directly associated with the respective behaviour, and mediated the relations of cognitive beliefs to behaviour, ps < .05. In Study 2, affective associations were associated with behavioural intentions and the number of condoms selected, ps < .05; cognitive beliefs were indirectly associated with these outcomes through affective associations, indirect effects: ps < .05.

Conclusions: Affective associations are a behaviour-specific and proximal predictor of condom use, mediating the effect of cognitive beliefs, suggesting they may be a particularly viable intervention target.     

Investigating the psychosocial determinants of physical activity in older adults: A qualitative approach

Objective: Despite the benefits of physical activity (PA), only one-third of older adults meet the recommended levels. The present study focused on psychosocial determinants of PA following retirement. Social cognitive theory (SCT) was used to better understand pre- and post-retirement adults’ thoughts about PA, the reasons why some individuals are more active than others, and how PA is incorporated into daily life after retirement.

Design: Seven focus groups of older adults (N = 37, M = 64, SD = 5.20; males = 20) representing a range of PA levels and retirement length participated in one of seven focus groups.

Results: Aligned with SCT, self-efficacy beliefs along with perceptions about barriers and benefits of PA were among the major determinants of PA. Findings highlighted the importance of social support, positive outcome expectations and self-regulatory strategies as motivators. The lack of structure in retirement was a hindrance to incorporating PA into daily routine but, when incorporated, PA provided a sense of purpose in the lives of retired individuals.

Conclusion: It is important to understand the meaning of retirement as a life transition and how it affects beliefs about PA to inform SCT-based health promotion interventions targeting individuals in retirement age.     

The positive eating scale: relationship with objective health parameters and validity in Germany,the USA and India

Objective: The prevailing focus regarding eating behaviour is on restriction, concern, worry and pathology. In contrast, the purpose of the present studies was to focus on a positive relationship with eating in non-clinical samples from Germany, the USA and India.

Design: In Study 1, the Positive Eating Scale (PES) was tested and validated in a large longitudinal sample (T1: N = 772; T2: N = 510). In Study 2, the PES was tested in online samples from the USA, India and Germany (total N = 749).

Main Outcome Measures: Health risk status was measured in Study 1 with objective health parameters (fasting serum glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure, waist circumference, BMI).

Results: Study 1 revealed acceptable psychometric properties of the PES, internal consistency (α = .87), as well as test–retest reliability after six months (r = .67). Importantly, a positive relationship with eating was associated with decreased health risk factors six months later. In Study 2, the structure of the PES was confirmed for German, Indian and US-American adults, suggesting validity across remarkably different eating environments.

Conclusion: A positive relationship with eating might be a fruitful starting point for prevention and intervention programmes promoting physical and psychological health.     

Meta-analysis of psychosocial interventions on survival time in patients with cancer

Objective: This study was to evaluate the effects of psychosocial interventions on survival in adult patients with cancer.

Method: MEDLINE via PubMed, Cochrane Library CENTRAL, CINAHL, and Korean electronic databases (September 2014) were searched. Methodological quality was assessed using Cochrane’s Risk of Bias for randomized studies. The RevMan 5.3 program of the Cochrane library was used for data analysis.

Results: Fifteen randomized controlled trials met the inclusion criteria, with a total of 2940 participants. Overall, psychosocial interventions was not associated with better survival (HR = .83, 95% CI [.68, 1.10], p = .06, I² = 64%). In subgroup analysis, based on six trials with 1448 subjects, psychoeducational interventions for cancer patients with non-metastatic at intervention implementation resulted in a 41% reduction in the risk of dying of cancer (HR = .59, 95% CI [.49, .71], p < .001, I² = 0%). For psychoeducational intervention, significant survival benefit were found when health staff delivered the intervention and at a follow-up time of more than 10 years.

Conclusions: Use of psychoeducational interventions for cancer patients at early stage appeared to have beneficial effects on survival, preferably for delivering of health staff. However, conduct of further psychosocial studies with adequate power will lead to better understanding of the effects of treatments on survival outcome.     

Associations between childhood biomedical factors,maternal smoking,personality traits,Body and Mass Index and the prevalence of asthma in adulthood

Objective: The study set out to investigate socio-economic, biomedical, health and behavioural and psychological factors in childhood and adulthood associated with the prevalence of asthma in adulthood, drawing data from The National Child Development Studies (NCDS), a birth cohort in the UK.

Design: The National Child Development Study, a nationally representative sample of 17,415 babies born in Great Britain in 1958 and followed up at 7, 11, 33 and 50 years was used.

Main Outcome Measure: The prevalence of asthma at age 50 was the outcome measure. The analytic sample consists of 5118 participants with complete data on a set of measures at birth, at ages 7, 11, 33 and 50 years.

Results: Using logistic regression analyses, results showed that childhood asthma (OR = 6.77: 4.38–10.48, p < .001) and respiratory symptoms (OR = 1.83: 1.18–2.86, p < .01), maternal smoking during pregnancy (OR = 1.26: 1.00–1.59, p < .05), Body and Mass Index (BMI) (OR = 1.03: 1.02–1.05, p < .001), traits Neuroticism (OR = 1.13: 1.01–1.21, p < .05) and Conscientiousness (OR = 0.76: 0.76–0.96, p < .01), as well as sex (OR = 1.49: 1.15–1.94, p < .001) were all significantly associated with the prevalence of asthma in adulthood.

Conclusion: The study shows that both childhood and adulthood psychological and sociological factors are significantly associated with the prevalence of asthma in adulthood, though more work need to be done in this area.     

Religiosity as a predictor of mortality: A retrospective cohort study in 1519 rural citizens in Greece

Objective: Investigating the role of religiosity in mortality.

Design: A retrospective cohort study (mean follow-up period 131.2 ± 30.8 months) in 1519 rural citizens in Greece (57.1% women, mean age 56.9 ± 20.4 years).

Main outcome measures: Measurements included education, disease status, body mass index, lifestyle, sleep-quality and self-rated health (SRH). Religiosity was assessed as composite score of praying and church attendance. Cox proportional hazard models were used to calculate adjusted hazard ratios (aHR) for all-cause and cardiovascular mortality.

Results: A total of 293 deaths were recorded, 59.2% of which had occurred due to cardiovascular diseases, followed by cancer diseases (17%). All-cause mortality was found increased for older people (aHR: 1.10, 95%CI: 1.08–1.11, p < .0001), for males (aHR: 1.44, 95%CI: 1.14–1.83, p = .002), for people reporting good SRH (aHR: .66, 95%CI: .51–.87, p = .003). Moreover, with increasing age the practice of regular exercise decreases all-causes mortality by approximately 3.5% by each year. Participants in the moderate category of religiosity were found to have decreased risk for all-cause mortality (aHR: .61, 95%CI: .46–.83, p = .001) compared to those in the low religiosity category. Cardiovascular mortality was also significantly associated with SRH and religiosity.

Conclusion: Religiosity predicts mortality, in a rural population in Greece. Deciphering the mediators of religiosity and mortality relationship could facilitate future health policies.     

The impact of smoking cues in antismoking messages among intermittent and light smokers

Objective: Based on the Limited Capacity Model of Motivated Mediated Message Processing, this study explored the effects of smoking cues in antismoking Public Service Announcements (PSAs) on message processing among intermittent/light smokers and nonsmokers.

Method: A 2 (smoking cues: present vs. absent) × 2 (smoking status: smokers vs. nonsmokers) mixed experimental design was conducted. Self-report measures and two physiological measures including skin conductance and heart rate were examined.

Results: Messages with smoking cues generated higher levels of arousal (F = 4.57, p = .04), attention (F = 2.51, p = .04), positive message evaluation (F = 28.70, p < .001) and less intent to smoke (F = 26.60, p < .001). Intermittent and light smokers had much stronger reactions to messages containing tobacco-related visuals, including arousal (F = 4.10, p = .04), perceived ad effectiveness (F = 9.24, p = .03) and intent to smoke (F = 22.98, p < .001).

Implication: The antismoking arguments may have suppressed cue-induced smoking urges, which dampened negative persuasion outcomes. Limitations included the restricted generalisability and the focus on short-term effect. Future research may use a random sample of PSAs with a general population.     

3-D bone models to improve treatment initiation among patients with osteoporosis: A randomised controlled pilot trial

Objective: To investigate the efficacy of 3-D printed bone models as a tool to facilitate initiation of bisphosphonate treatment among individuals who were newly diagnosed with osteoporosis.

Design: Fifty eight participants with estimated fracture risk above that at which guidelines recommend pharmacological intervention were randomised to receive either a standard physician interview or an interview augmented by the presentation of 3-D bone models.

Main outcome measures: Participants’ beliefs about osteoporosis and bisphosphonate treatment, initiation of bisphosphonate therapy assessed at two months using self-report and pharmacy dispensing data.

Results: Individuals in the 3-D bone model intervention condition were more emotionally affected by osteoporosis immediately after the interview (p = .04) and reported a greater understanding of osteoporosis at follow-up (p = .04), than the control group. While a greater proportion of the intervention group initiated an oral bisphosphonate regimen (alendronate) (52%) in comparison with the control group (21%), the overall initiation of medication for osteoporosis, including infusion (zoledronate), did not differ significantly (intervention group 62%, control group 45%, p = .19).

Conclusion: The presentation of 3-D bone models during a medical consultation can modify cognitive and emotional representations relevant to treatment initiation among people with osteoporosis and might facilitate commencement of bisphosphonate treatment.     

Does self-efficacy mediate the cross-sectional relationship between perceived quality of health care and self-management of diabetes? Results from Diabetes MILES – Australia

Objective: Quality of health care (QoC) and self-efficacy may affect self-management of diabetes, but such effects are not well understood. We examined the indirect role of diabetes-specific self-efficacy (DSE) and generalised self-efficacy (GSE) in mediating the cross-sectional relationship between self-reported QoC and diabetes self-management.

Design: Diabetes MILES–Australia was a national survey of 3,338 adults with diabetes. We analysed data from 1,624 respondents (age: M = 52.1, SD = 13.9) with type 1 (T1D; n = 680) or type 2 diabetes (T2D; n = 944), who responded to a version of the survey containing key measures.

Main Outcome Measures: self-reported healthy eating, physical activity, self-monitoring of blood glucose frequency, HbA_1c, medication/insulin adherence.

Results: We used Preacher and Hayes’ bootstrapping method, controlling for age, gender and diabetes duration, to test mediation of DSE and GSE on the relationship of QoC with each self-management variable. We found statistically significant but trivial mediation effects of DSE and of GSE on most, but not all, variables (all effect sizes < .06).

Conclusion: Support for mediation was weak, suggesting that relationships amongst these variables are small and that future research might explore other aspects of self-management in diabetes.     

Predicting sun-protective intentions and behaviours using the theory of planned behaviour: a systematic review and meta-analysis

Objective: To synthesise theory of planned behaviour (TPB) relationships, using meta-analysis, and test the predictive utility of the model for sun protection behaviour.

Design: Thirty-eight samples were identified via database/manual searches and academic society posts based on the criteria: measuring sun-protective intentions and/or prospective behaviour; using the TPB/theory of reasoned action as a basis of measurement; and providing bivariate correlations for at least one relevant TPB association.

Main outcome measures: Sun-protective intentions and behaviours.

Results: The sample-weighted average effects were moderate-to-strong with attitudes showing the strongest association with intention (r+ = 0.494), followed by perceived behavioural control (PBC; r+ = 0.451), and subjective norm (r+ = 0.419). Intentions showed a stronger association with prospective behaviour (r+ = 0.486) compared to PBC (r+ = 0.314). A total of 39% of variance in intentions and 25% of variance in behaviour were explained. Publication bias was not evident. Moderator analyses showed that TPB associations were stronger when measures specified the Target, Action, Context and Time; in non-student samples; and when follow-up exceeded two weeks.

Conclusion: Despite recent criticism, this review shows that the TPB explains a large amount of variance in sun protection and that TPB associations are robust across different populations.     

The role of pain behaviour and family caregiver responses in the link between pain catastrophising and pain intensity: A moderated mediation model

Objectives: This study investigated the mediating role of pain behaviours in the association between pain catastrophising and pain intensity and explored the moderating role of family caregivers’ responses to pain in the link between pain behaviours and pain intensity.

Methods: The sample consisted of 154 chronic pain patients and their family caregivers. Patients completed questionnaires regarding pain intensity, pain catastrophising, pain behaviours and their caregivers’ responses to their pain. Family caregivers reported their responses to the patients’ pain.

Results: Pain catastrophising was associated with pain intensity (r = 0.37) and pain behaviours partly mediated this association. The positive association between pain behaviours and pain intensity was significant only if patients reported that their family caregivers showed high levels of solicitous (effect = .49) and distracting responses (effect = .58), and if caregivers reported to show high levels of solicitous responses (effect = .51). No support was found for negative responses as a moderator neither based on patients’ perception of negative responses nor based on caregivers’ perception of negative responses.

Conclusions: The findings are in line with the idea that family caregivers’ solicitous and distracting responses convey to patients that their condition is serious, which may reinforce patients’ pain and pain behaviours, especially in those who catastrophise.