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.     

Social comparison processes and catastrophising in fibromyalgia: A path analysis

Introduction: In addition to coping strategies, social comparison may play a role in illness adjustment. However, little is known about the role of contrast and identification in social comparison in adaptation to fibromyalgia.

Aim: To evaluate through a path analysis in a sample of fibromyalgia patients, the association between identification and contrast in social comparison, catastrophising and specific health outcomes (fibromyalgia illness impact and psychological distress).

Material and Method: 131 Spanish fibromyalgia outpatients (mean age: 50.15, SD = 11.1) filled out a questionnaire.

Results: We present a model that explained 33% of the variance in catastrophising by direct effects of more use of upward contrast and downward identification. In addition, 35% of fibromyalgia illness impact variance was explained by less upward identification, more upward contrast and more catastrophising and 42% of the variance in psychological distress by a direct effect of more use of upward contrast together with higher fibromyalgia illness impact.

Discussion: We suggest that intervention programmes with chronic pain and fibromyalgia patients should focus on enhancing the use of upward identification in social comparison, and on minimising the use of upward contrast and downward identification in social comparison.     

Exploring the associations shared by mood,pain-related attention and pain outcomes related to sleep disturbance in a chronic pain sample

Objective: Sleep disturbance in chronic pain is common, occurring in two-thirds of patients. There is a complex relationship between chronic pain and sleep; pain can disrupt sleep and poor sleep can exaggerate pain intensity. This may have an impact on both depressive symptoms and attention to pain. This study aims to evaluate the relationship between chronic pain and sleep, and the role of mood and attention.

Methods: Chronic pain patients, recruited from a secondary care outpatient clinic, completed self-report measures of pain, sleep, depressive symptoms and attention to pain. Hierarchical regression and structural equation modelling were used to explore the relationships between these measures. Participants (n = 221) were aged between 20 and 84 (mean = 52) years.

Results: The majority of participants were found to be ‘poor sleepers’ (86%) with increased pain severity, depressive symptoms and attention to pain. Both analytical approaches indicated that sleep disturbance is indirectly associated with increased pain severity Instead the relationship shared by sleep disturbance and pain severity was further associated with depressive symptoms and attention to pain.

Conclusions: Our results indicate that sleep disturbance may contribute to clinical pain severity indirectly though changes in mood and attention. Prospective studies exploring lagged associations between these constructs could have critical information relevant to the treatment of chronic pain.     

‘It was all intertwined’: Illness representations and self-management in patients with cancer and anxiety/depression

Objective: Cancer and anxiety/depression frequently co-occur, leading to poorer outcomes for these illnesses. However, the majority of existing research investigates how participants view single illnesses alone. This study aimed to explore the content of individuals’ multimorbid representations and how these relate to their coping behaviours and self-management strategies for cancer and anxiety/depression.

Design: A semi-structured qualitative research design with theoretical thematic analysis.

Main Outcome Measures: Multimorbid illness representations, coping behaviours, and self-management strategies.

Results: In interviews with 21 participants multimorbid representations varied, three participants viewed cancer and anxiety/depression as unrelated, five participants were uncertain about the relationship between cancer and anxiety/depression, and the majority of participants perceived cancer and anxiety/depression as related. This third group of participants often described relationships as causal, with representations having both positive and negative influences on coping behaviours and self-management strategies. Representations were shown to change over the course of the cancer experience, with fear of cancer recurrence and the influence of participants’ most challenging illness also discussed.

Conclusions: People hold multimorbid illness representations that can influence self-management. An awareness of these representations by researchers, health professionals, and patients is important for the creation of future interventions that aim to improve and maintain patient wellbeing.     

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.     

Illness perceptions or recurrence risk perceptions: What comes first? A longitudinal cross-lagged examination among cardiac patients

Objectives: Previous research suggested that illness perceptions provide the basis for illness risk perceptions through an inductive reasoning process. This study aimed to assess the direction of relationships between illness and recurrence risk perceptions over time, among cardiac patients.

Design: A longitudinal study was conducted among 138 patients undergoing coronary angioplasty. Self-report questionnaires measured perceived recurrence risk and illness perceptions one day and one month after catheterisation.

Results: Cross-lagged Panel Model Analyses revealed that higher perceptions of timeline, consequences and emotional representations of illness at hospitalisation were associated with higher recurrence risk perceptions one month later. Perceived personal control was the only illness perception with bi-directional associations: higher perceived personal control at hospitalisation was associated with higher recurrence risk perceptions one month later; and higher recurrence risk perceptions at hospitalisation was associated with lower personal control one month later.

Conclusions: The findings suggest that the associations between recurrence risk and illness perceptions can only partly be explained by inductive reasoning. Halo effects and defensive processes are suggested as complementary explanations for the observed associations between risk and illness perceptions.     

How patients’ representations of cystic fibrosis-related diabetes inform their health behaviours

Background: Although diabetes is a frequent complication of cystic fibrosis (CF), patients’ behaviours tend not to comply with best practice recommendations. Using Leventhal’s Common-Sense Model, we address this issue by exploring patients’ representations of CF-related diabetes (CFRD) to better understand the discrepancy between patients’ expected and observed health behaviours.

Methods: Semi-structured individual interviews were conducted with patients (n = 39) in six CF clinics in Quebec, Canada. These interviews were part of a larger research project on screening and management practices for CFRD.

Results: Illness representations differed between two groups of interviewed patients: (1) one group had either CF without dysglycemia or CF with impaired glucose tolerance; and (2) the other group had CFRD. Both representations were internally consistent and encompassed Leventhal’s five dimensions of illness representation: illness identity, cause, timeline, consequences and control.

Conclusions: Patients require specific information on CFRD. The screening phase could be a crucial time to help patients adjust their representations to fit the reality of CFRD.     

Adaptation to an autoimmune disorder: Does mental flexibility impact illness-related self-regulation?

Objective: To examine whether mental flexibility moderates the relationship between illness representations of control and coping behaviour in individuals suffering from rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).

Design: Recently, diagnosed RA (N = 80) and SLE (N = 75) patients completed questionnaires about illness representations of personal and treatment control and four coping behaviours: instrumental coping, adherence to medical advice, palliative coping and wishful thinking. Mental flexibility was assessed with the Trail Making Test Part B (TMT-B), while visuomotor processing speed, as a confounder, was assessed with the Trail Making Test Part A (TMT-A). Moderated mediation models were tested within a bootstrapped multiple regression framework.

Results: TMT-A scores had no statistically significant moderation effects on the relation between representations and coping behaviour. Conversely, in those participants with SLE, TMT-B scores moderated the relation of personal control to wishful thinking and palliative coping, as well as the relation of treatment control to both wishful thinking and palliative coping. All significant effects were restricted to the SLE group.

Conclusion: Interactions between neurocognitive factors and the process of illness adaptation may emerge early during the course of SLE. The present findings highlight the role of cognitive functioning as an integral part of the illness-related self-regulation mechanism.     

Impulse control disorders in Parkinson’s disease: Predominant role of psychological determinants

Objectives: Impulse Control Disorders (ICDs) in Parkinson’s disease (PD) have previously almost exclusively been considered to result from anti-parkinsonian medication. However, this biomedical perspective has failed to achieve a full understanding of the phenomenon and it is argued that a failure to consider psychological factors is a critical omission.

Design: The present study examined the predictive relationship between ICDs in PD and a range of psychological measures, whilst controlling for a number of biomedical determinants.

Main outcome measures: One hundred participants with idiopathic PD completed questionnaires that assessed demographic and clinical characteristics, psychological measures and the presence of ICDs (QUIP-RS).

Results: Increased use of a ‘negative’ coping strategy, stronger illness identity, more emotional illness representations and stress were found to be significant predictors of ICDs, and different psychological predictors were associated with different ICDs. Medication was not found to predict ICDs in the presence of psychological factors, either when total treatment levels were considered or when agonist dose was considered alone.

Conclusions: This study provides the first quantitative evidence of a predominant predictive relationship between psychological factors and ICDs in PD. The results suggest that psychological interventions may have useful therapeutic role to play for ICDs in PD.     

Changes over time in head and neck cancer patients’ and caregivers’ illness perceptions and relationships with quality of life

Objective: This study investigated changes in illness perceptions from diagnosis to six months later in patients with head and neck cancer (HNC) and their caregivers. The study also examined whether discrepancy in patient and caregiver perceptions at diagnosis predicted patient health-related quality of life (HRQL) at six months.

Design: Forty-two patient–caregiver dyads completed the Brief Illness Perception Questionnaire (Brief IPQ) at diagnosis and again six months later. Patients also completed a HRQL questionnaire at both time points. Analyses were performed using the Actor–Partner Interdependence Model.

Main Outcome Measure: Total patient HRQL assessed by the Functional Assessment of Cancer Therapy (FACT-H&N).

Results: Perceptions of emotional impact and illness concern reduced over time in patients and caregivers. Perceptions of treatment control and identity increased in caregivers only. After controlling for the effects of baseline HRQL, and the individual contribution of patient and caregiver illness perceptions, greater discrepancy in perceptions of timeline, personal control, and illness identity among dyads at diagnosis predicted lower patient HRQL at six-month follow-up.

Conclusion: Patients’ and their caregivers’ perceptions of HNC are dynamic over time. Greater discrepancy between patients’ and caregivers’ illness perceptions at diagnosis predict poorer subsequent patient HRQL.     

Statistically modelling the relationships between Type D personality and social support,health behaviors and symptom severity in chronic illness groups

Objective: The study aimed to develop a predictive model of how Type D personality influences health behaviours, social support and symptom severity and assess its generalisability to a range of chronic illnesses.

Design: Participants were classified as either healthy (n = 182) or having a chronic illness (n = 207). Participants completed an online survey measuring Type D and a range of health-related variables. Chronic illness participants were classified as having either a functional somatic syndrome (i.e. chronic fatigue syndrome or fibromyalgia), where the underlying pathological processes were unclear, or illnesses such as type 2 diabetes, osteoarthritis or rheumatoid arthritis, where the causes are well understood.

Main Outcome Measures: Outcome measures were health behaviours, social support and both physical and psychological symptoms.

Results: The rate of Type D was higher in chronic illness participants (53%) than in healthy controls (39%). Negative affectivity (NA) and social inhibition (SI) both correlated with outcome measures, although NA was generally the stronger predictor. Using NA and SI as independent subscales led to superior prediction of health outcomes than using categorical or continuous representations.

Conclusion: Findings suggest that the relationship between Type D and health outcomes may generalise across different chronic illnesses.     

Talking about sunbed tanning in online discussion forums: Assertions and arguments

Objective: There is increasing evidence of both health and appearance risks associated with sunbed use. At the same time, the sunbed industry promotes the benefits of using sunbeds, and the image of a tanned skin as attractive and healthy arguably remains embedded within contemporary western culture. These tensions are played out in everyday conversations, and this paper reports a study which explored how sunbed users manage them within online discussion forums.

Design: A total of 556 posts from 13 sunbed-related threads, taken from six different UK-based online forums, were analysed thematically followed by techniques from discourse analysis.

Main outcome measures: Informed by social representations theory and discursive-rhetorical psychology, the way social representations of sunbed use are constructed, debated and disputed in online discussion forums were explored.

Results: Sunbed users drew upon numerous representations to distance and protect themselves from negativity they were confronted with in the forums, utilising a range of rhetorical, discursive strategies to help them.

Conclusion: Theoretical contributions and potential practical implications of the findings are discussed. Findings indicate, for example, that those working on campaigns and interventions in this area need to consider the wider negativity and argumentative orientation of sunbed users’ responses.     

Predicting jet lag in long-haul cabin crew: The role of illness cognitions and behaviour

Objective: Established risk factors for jet lag are mostly physiological including circadian preference, age, gender, the number of flight zones crossed and to some extent direction of travel. Some research has also highlighted a role for psychosocial factors including sleep, diet and ‘circadian’ health behaviours and illness cognitions although this remains relatively untested. The aim of this study was to evaluate the role of sleep, diet and illness cognitions in predicting perceived jet lag amongst long-haul crew.

Design: Sixty long-haul crew took part in a longitudinal study. Profile characteristics (including chronotype), preparation strategies (sleep, eating and ‘circadian’ behaviours) and illness cognitions were measured at baseline (before a trip).

Main outcome measures: Subjective jet lag (unidimensional and multidimensional) was measured on the crews’ second day off (post-trip).

Results: Hierarchical regression analyses showed that unidimensional jet lag was predicted by the belief in a cyclical timeline, whereas multidimensional jet lag was predicted by multidimensional jet lag at baseline and to a lesser extent by identity. No role was found for profile characteristics and preparation strategies.

Conclusion: Illness cognitions partly explain the experience of perceived jet lag in long-haul cabin crew indicating that jet lag is in part a psycho-social construct, not just a biological one.     

Influencing health decision-making: A study of colour and message framing

Objective: Previous research has provided evidence that colour associations and frame can influence behavioural intentions to engage in vaccination behaviours. In this study, the extension of these effects to sunscreen application behaviours was investigated. Additional colours and the manner in which colour primes were employed were also explored.

Design: Two hundred and eighty-six college students were primed with either short wavelength colours (blue/purple) or long wavelength colours (red/orange) as part of goal framed sunscreen information pamphlets.

Main outcome measures: Self-reported behavioural intentions to apply sunscreen, immediate affective reaction to stimuli material, anticipated affect towards sunscreen use, and perceived efficacy of preventing skin cancer were measured.

Results: Individuals with no prior intention to use sunscreen expressed greater behavioural intentions to do so after reading a positively framed sunscreen pamphlet that was designed using short wavelength colours. The negatively framed messages and those presented in long wavelength colours did not enhance persuasion.

Conclusions: In accordance with the Unification Theory of Framing, a match between the representations of the target behaviour, the colour prime, and the frame resulted in the greatest amount of persuasion. Creating communications with representations that match the target behaviour could be a powerful tool to increase compliance.     

Book reviews and books received

Helping interventions John Heron: Helping the Client: a Creative Practical Guide. London: Sage, 1990. £9.95.

A person-centred perspective on school counselling John McGuiness: A Whole School Approach to Pastoral Care. London: Kogan Page, 1989. £8.95.

How to relate effectively Richard Nelson-Jones: Human Relationship Skills (2nd edition). London: Cassell, 1990. £11.95.

Ripe for research? Dave Mearns and Windy Dryden: Experiences of Counselling in Action. London: Sage, 1989. £9.95.

Issues in action Windy Dryden (ed.): Key Issues for Counselling in Action. London: Sage, 1989. £7.95.

The meaning of death Rosemary Dinnage: The Ruffian on the Stair: Reflections on Death. London: Viking, 1990. £14.99.

The empty cradle Irving G. Leon: When a Baby Dies: Psychotherapy for Pregnancy and Newborn Loss. London: Yale University Press, 1990. £20.

Children against themselves Israel Orbach: Children Who Don't Want to Live: Understanding and Treating the Suicidal Child. San Francisco: Jossey-Bass, 1988. £17.95.     

Book reviews and books received

Practical help for family therapists John Carpenter and Andy Treacher: Marital and Family Therapy. Oxford: Blackwell, 1989. €29.50 (hardback); €9.95 (paperback).

Survival for the guidance teacher W.P. Gothard and E. Goodhew: Guidance and the Changing Curriculum. London: Croom Helm, 1987. €22.50.

Second-class male Michael S. Kimmel (ed.): Changing Men: New Directions in Research on Men and Masculinity. London: Sage, 1987. €35 (hardback); €14.50 (paperback).

Analysing the analyst Rosemary Dinnage: One to One: Experiences of Psychotherapy. London: Viking, 1988. €12.95.

Practical counselling skills revisited Richard Nelson-Jones: Practical Counselling and Helping Skills. London: Cassell, 1988. €7.95.

Snakes and pyramids Jocelyn Chaplin: Feminist Counselling in Action. London: Sage, 1988. €7.95.

The person-centred approach: a key text Dave Mearns and Brian Thome: Person-Centred Counselling in Action. London: Sage, 1988. €7.95.     

Book reviews

So you thought you had sorted out a Code of Ethics? Gavin Fairbairn and Susan Fairbaim: Ethical Issues in Caring. Aldershot: Avebury, 1988. £22.50.

The myth of positivism Celia Kitzinger: The Social Construction of Lesbianism. London: Sage, 1987. £8.95.

A family approach to art psychotherapy H. B. Landgarten: Family Art Psychotherapy: a Clinical Guide and Casebook. New York: Brunner/Mazel, 1987. $27.50.

Simple psychodynamics Michael Jacobs: Psychodynamic Counselling in Action. London: Sage, 1988.

Optimistic assumptions T. Haberle: Counselling and Curing. London: SPCK, 1987. £3.50.     

Attachment patterns moderate the relation between coping flexibility and illness acceptance among kidney transplant recipients

Background and Objectives: Post-transplant kidney recipients may experience psychological concerns which have been associated with negative health behaviors. Illness acceptance might have an important role in this process. In line with the Conservation of Resources Theory (COR), the current study aimed to examine the relationship between coping flexibility, attachment patterns and illness acceptance among post-transplant kidney recipients, and to evaluate whether attachment patterns moderate the link between coping flexibility and illness acceptance.

Design: The study employed a cross-sectional design.

Methods: Ninety-four post-transplant kidney recipients completed questionnaires assessing demographic and medical characteristics, illness acceptance, coping flexibility and attachment patterns.

Results: Our results indicated that coping flexibility was positively associated with illness acceptance. Moreover, attachment moderated this link, as high coping flexibility was associated with increased illness acceptance among individuals with low levels of attachment anxiety, a finding which was not significant when high levels of anxiety were reported.

Conclusions: This study highlights the potential importance of building greater flexibility in order to enhance illness acceptance among kidney transplants recipients. Moreover, the role of insecure attachment patterns in health-related outcomes among kidney transplants recipients is emphasized.     

Illness representations,pain and physical function in patients with rheumatic disorders: between- and within-person associations

Objectives: Rehabilitation for patients with rheumatic diseases improves both illness representations (IR) and clinical outcomes such as pain and physical functioning (PF). However, it is unclear whether IR may affect and, in turn, are affected by pain and PF. In this study, we examined both between-person associations and within-person associations between IR and pain/PF over time on three measurement occasions. Furthermore, cross-lagged relationships were examined.

Design and main outcome measures: This secondary analysis is based on data from N?=?186 patients with rheumatic diseases. Data on pain, PF and IR were assessed using self-report questionnaires at the beginning, the end and three months after a 3-week inpatient rehabilitation.

Methods: To separate between- and within-person level, data were analysed using random-intercept cross-lagged panel models.

Results: On both the between-person level (r?=?|0.21|???|0.44|) and the within-person level (r?=?|0.15|???|0.46|), pain and PF were related to cognitive and emotional IR. In addition, we found within-person bidirectional cross-lagged effects between emotional IR and PF.

Conclusion: IR show complex relationships with pain and PF. Improving PF might improve subsequent illness-related emotional distress and vice versa.