Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome

Although separate lines of behaviorally oriented pain research have drawn attention to the importance of pain catastrophizing and trait worry, little is known about how they work together to influence aspects of chronic pain. Integrating pain research with the broader anxiety, cognitive science, and learning literature, we hypothesized that the process (vs. content) of worry influences pain through catastrophizing. One hundred and eighty-six consecutive patients diagnosed (Rome II) with irritable bowel syndrome completed measures of three dimensions of pain (sensory pain, affective pain, long-term suffering), pain intensity, trait anxiety, worry, catastrophizing, and somatization during baseline assessment of an NIH-funded clinical trial of two psychological treatments. Worry was most strongly associated with the emotionally unpleasant aspects of pain, particularly suffering. Multivariate mediational analyses showed that catastrophizing mediated the link between worry and suffering. Worry, catastrophizing and control variables accounted for 46% of the variance in suffering. Chronic pain patients who worry excessively engage in more catastrophic thinking and through this cognitive process experience more intensely the suffering component of pain. Data are consistent with the notion that worry functions as an "experiential avoidance" strategy for aversive features of pain. Findings are discussed with respect to their relevance to behavioral models for understanding and treating anxiety-related chronic pain disorders.     

Everyday worry in adolescents with and without chronic pain: a diary study

Young people report frequent worry, but we know little about the extent, character, or consequence of worry in adolescence, or individual differences associated with worry. Adolescents with chronic pain are one population that are known to have high levels of anxiety, which is associated with higher levels of disability and depression, impairing function. In this study we report a diary study: adolescents (N = 60; aged 16–18) recorded their worry over seven days. Our first aim was to describe the characteristics of adolescent worry and its consequences in a community sample. Our second aim was to compare the experience of girls to boys, and to compare the experience of those with and without chronic pain. Adolescents reported characteristics of each worry they had throughout the week, including content, frequency, strength, interference, emotion, and the strength of emotion associated with worry content. Adolescents reported the consequence for each content and the strength of the consequence. Worry content and consequences were categorised into four categories; health, relationship, personal competence, and other. Adolescents reported 675 unique episodes of worry over the seven-day period that were predominantly about personal competence. The strength of worry content was (M = 6.61, SD = 1.27) and the strength associated with the worry consequence was (M = 5.59, SD = 1.41). Worries were not reported as highly interfering (M = 4.14, SD = 1.61). Contrary to predictions, there were no differences in worry characteristics between adolescents with and without chronic pain. To conclude, worry is a frequent occurrence in older adolescents and the characteristics of worry are discussed. Adolescents worry mostly about personal competence. Adolescents with and without chronic pain reported similar worry characteristics.     

Relationships Among Perceived Racial Stress, Intolerance of Uncertainty, and Worry in a Black Sample

The purpose of this study was to explore the relationships among chronic worry, perceived racial stress, and intolerance of uncertainty in a sample of adults who racially identify as Black. Intolerance of uncertainty has been associated with worry and generalized anxiety disorder in predominantly White samples. Given that racial stress is likely to increase worry, perhaps through the mechanism of intolerance of uncertainty, intolerance of uncertainty was hypothesized to mediate the relationship between perceived racial stress and chronic worry. A nonclinical sample of 77 Black undergraduate students at an urban university completed a series of questionnaires assessing the constructs of interest. Both perceived racial stress and intolerance of uncertainty were significantly correlated with chronic worry in this sample. Moreover, intolerance of uncertainty fully mediated the relationship between perceived racial stress and worry for these Black individuals. These findings are discussed in terms of directions for future research and implications for clinical interventions for Black individuals who are both exposed to racial stress and suffer from chronic worry.     

Does 'mental kinesiophobia' exist?

In this study the relevance of the concept of mental kinesiophobia (respectively cogniphobia or fear of mental exertion) for clients with chronic stress problems was explored. It was hypothesized that cognitive, chronic stress complaints, such as concentration problems or decreased problem solving abilities, could be catastrophized as signs of heightened personal vulnerability, with a chance of becoming permanent. As a consequence, mental exertion is avoided. This line of reasoning comes from the existing concept of kinesiophobia. This concept describes the avoidance behavior in chronic benign pain patients and refers to their fear of inflicting irreversible bodily damage due to physical exertion.An illustrative case of cogniphobia is presented. In an explorative pilot-study it was demonstrated that chronically stressed clients scored significantly higher on an experimental questionnaire measuring avoidance tendencies for mental exertion, compared with actively working employees. Consequences for treatment and suggestions for further study are discussed.     

Health anxiety moderates the effects of distraction versus attention to pain

Little is known about the relationship between health anxiety and chronic pain. The present study explored whether individual differences in health anxiety would influence the response of chronic pain patients to physical therapy. Furthermore, the interaction of health anxiety with coping strategy usage (distraction versus attention) was studied. Participants were 81 chronic pain patients who were interviewed and completed measures of pain, anxiety and cognition following an active physiotherapy session in which they either: (1) attended to physical sensations; (2) distracted from physical sensations or (3) completed the session as usual. Health anxious, compared to non-health anxious, individuals worried more about their health and injury during the session and attended to and catastrophically misinterpreted sensations more frequently. A complex interaction between health anxiety and coping strategy emerged. Among health anxious patients, attention to sensations resulted in lower anxiety and pain than did distraction. It appears as though attention had a short-term anxiety reducing effect for health anxious patients. Among non-health anxious patients, attention resulted in greater worry about health than distraction. Clinical and theoretical implications are discussed.     

Negative problem orientation (Part II): construct validity and specificity to worry

Negative problem orientation, a dysfunctional set of attitudes related to problem-solving ability, has been implicated as a process variable in several psychological disorders, notably depression and generalized anxiety disorder (GAD). The goal of the present study was two-fold: (1) to further examine the construct validity of a new measure of negative problem orientation, the negative problem orientation questionnaire (NPOQ), through its relationship to conceptually similar variables, and (2) to investigate the specificity of negative problem orientation to worry, the cardinal feature of GAD, compared to depression. The sample consisted of 148 university students who completed six questionnaires, the NPOQ and measures of worry, depression, pessimism, self-mastery, and neuroticism. Multiple hierarchical regressions revealed that when entered in the last step following demographic information and personality variables (pessimism, self-mastery, and neuroticism), the NPOQ accounted for 5.6% of the variance in worry scores compared to 1.6% of the variance in depression scores. It was concluded that the NPOQ shows evidence of construct validity, and that the process variable of negative problem orientation appears to have greater specificity to worry than depression. Implications for the understanding of worry and GAD are discussed.     

Short‐term cognitive‐behavioral treatment in multicultural primary care of patients with longstanding backache

The efficacy of cognitive‐behavioral therapy in multi‐cultural primary care patients with longstanding backache is not evaluated. The purpose of this study was to investigate the outcome of a four weekly‐treatment given by primary care physicians regarding pain‐related worry, depression and severe pain and to determine which social, clinical or gender factors were associated with outcome.The study group consisted of 245 patients in consecutive order from 19 countries, 18 to 45 years, entering rehabilitation program because of longstanding backache. Prevalences of pain‐related worry and depression and severe pain was counted and compared before and after. Logistic regression was used to calculate the odds (OR; 95% CI) for persistent pain‐related worry and/or persistent depression and severe pain (VAS ≥ 50). The prevalences of pain‐related worry and depression were both significantly lower after treatment (pain‐related worry 83% before vs. 38% after; depression 43% before vs. 31% after). Also the number of patients scoring ≥ 50 VAS was a little, but significantly, fewer (68% vs. 61%). Use of interpreter doubled the risk of having persistent pain‐related worry (OR 2.1; 95% CI 1.1–4.1) but the risk was not significant regarding persistent depression (OR 1.8; 0.6‐5.4). The rating of VAS rating ≥ 50 after treatment was twice as high, OR 2.3 (95% CI 1.1–4.6) in the 38–45 year old age group. To conclude, a focus on pain ideas reduced pain‐related worry and depression in these patients with various sociocultural backgrounds and longstanding backache.     

Positive beliefs about worry: A psychometric evaluation of the Why Worry-II

Positive beliefs about worry are theorized to maintain excessive and uncontrollable worry, the hallmark of generalized anxiety disorder (GAD; American Psychiatric Association, 2013). The Why Worry-II (WW-II) is a 25-item revised questionnaire designed to measure five positive beliefs about worry. These five beliefs are that worry: (1) facilitates problem solving; (2) enhances motivation; (3) protects against negative emotions; (4) prevents negative outcomes; and (5) reflects a positive personality trait. The main goal of this study was to assess the WW-II’s psychometric properties, including its factor structure. Undergraduate participants (N = 309) completed the WW-II, and measures of worry, depression, anxiety, and positive and negative beliefs about worry. Overall, the results suggest that the five-factor model is a good fit to the data. The WW-II demonstrated excellent internal consistency, good test–retest reliability at six weeks, and evidence of convergent and divergent validity. The WW-II also uniquely predicted worry severity. Overall, our findings suggest that the WW-II has a five-factor structure congruent with theoretical predictions, sound psychometric properties, and a unique relationship to excessive worry. The theoretical and clinical implications of these findings are discussed.     

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).     

Age and gender differences in adolescent worry

The purpose of the present study was to explore gender and age differences in adolescent worry. High school students filled out measures of worry, negative problem orientation, intolerance of uncertainty, and general mental health. Girls and boys of different ages were then compared and the relationships between gender, beliefs about worry, intolerance of uncertainty, negative problem orientation and mental health were also examined. Boys reported greater negative problem orientation and intolerance of uncertainty while girls reported more positive beliefs about worry. Findings also revealed certain age trends, indicating that the variables under study may be under the influence of developmental tasks. Regression analysis was performed and positive beliefs about worry emerged as a significant predictor of worry in both sexes. Positive beliefs about worry and negative problem orientation appear to be the key processes in adolescent anxiety and depression.     

Can the components of a cognitive model predict the severity of generalized anxiety disorder?

Over the past decade, a number of well-controlled studies have supported the validity of a cognitive model of generalized anxiety disorder (GAD) that has four main components: intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Although these studies have shown that the model components are associated with high levels of worry in nonclinical samples and with a diagnosis of GAD in clinical samples, they have not addressed the question of whether the model components can predict the severity of GAD. Accordingly, the present study sought to determine if the model components are related to diagnostic severity, worry severity, and somatic symptom severity in a sample of 84 patients with a primary diagnosis of GAD. All model components were related to GAD severity, although positive beliefs about worry and cognitive avoidance were only modestly associated with the severity of the disorder. Intolerance of uncertainty and negative problem orientation had more robust relationships with the severity of GAD (and with worry severity, in particular). When participants were divided into Mild, Moderate, and Severe GAD groups, intolerance of uncertainty and negative problem orientation distinguished the Moderate and Severe GAD groups from the Mild GAD group, even when age, gender, and depressive symptoms were statistically controlled. Overall, the results lend further support to the validity of the model and suggest that intolerance of uncertainty and negative problem orientation are related to the severity of GAD, independently of sociodemographic and associated clinical factors. The theoretical and clinical implications of the findings are discussed.     

Distinguishing obsessive features and worries: the role of thought-action fusion

Obsessions are a key feature of obsessive-compulsive disorder (OCD), and chronic worry is the cardinal feature of generalized anxiety disorder (GAD). However, these two cognitive processes are conceptually very similar, and there is a need to determine how they differ. Recent studies have attempted to identify cognitive processes that may be differentially related to obsessive features and worry. In the current study we proposed that (1) obsessive features and worry could be differentiated and that (2) a measure of the cognitive process thought-action fusion would distinguish between obsessive features and worry, being strongly related to obsessive features after controlling for the effects of worry. These hypotheses were supported in a sample of 173 undergraduate students. Thought-action fusion may be a valuable construct in differentiating between obsessive features and worry.     

Frontal Lobe Function and Pain in the Elderly

We review the literature on pain and aging and conclude that evidence supports a hypothesis that right frontal cortex contributes to the mediation of the chronic pain experience in elderly persons with chronic pain syndromes. Evidence for the right frontal pain hypothesis comes from clinical, neurocognitive, and neuroimaging studies, which implicate right inferior and orbitofrontal cortex in (1) the persistent pain experience, (2) negative emotional states, (3) retrieval of negative emotional and autobiographical memories, (4) regulation of autonomic arousal, and (5) regulation of attentional and pain functions of the anterior cingulate region. Right frontal dysfunction is also implicated in the effects of cognitive aging. If right frontal neurocognitive systems are affected in cognitively impaired elderly, and if (by hypothesis) the right frontal cortex also plays a major role in the experience of chronic pain, then cognitively impaired elderly with right frontal dysfunction should be protected to some extent from persistent pain syndromes. Available evidence supports this proposition.     

Are Women Perceived as Engaging in More Maladaptive Worry Than Men? A Status Interpretation

Studies 1 and 2 addressed people's perceptions of women's and men's overall maladaptive worry. In Study 1, participants rated how they perceive women's and men's worry in general. In Study 2, participants rated the worry of either a woman or a man whom they know well. As expected in both studies, participants perceived women as experiencing more maladaptive worry than men. A second objective was to compare people's perceptions of women's and men's worry to their perceptions of low- and high-status individuals' worry to determine if a status model can account for the perception that women worry more than men. In Study 3, participants were presented a minimal instantiation of status (Conway, Pizzamiglio, & Mount, 1996). As expected, participants perceived low-status individuals as experiencing more maladaptive worry than high-status individuals. Findings are discussed in terms of gender stereotypes and theoretical models of gender.     

Distress intolerance and worry: the mediating role of cognitive variables

Background and Objectives: Distress intolerance (DI) has been identified as a potential risk factor for a variety of maladaptive avoidance behaviors, including worry. However, mechanisms linking DI to specific behaviors remain poorly understood. One hypothesis is that DI is a general vulnerability that confers risk of particular avoidance behaviors via more specific, lower-order vulnerabilities. The current study examined associations between DI and worry-related cognitions. Design: A multiple mediator model tested the hypothesis that worry-related variables (intolerance of uncertainty [IU], cognitive avoidance, beliefs about worry, and negative problem orientation) mediated the association between DI and worry. Methods: An undergraduate student (n = 281) and a clinical (n = 123) sample completed self-report measures. Results: Across samples, worry was associated with higher levels of DI, IU, cognitive avoidance, beliefs about worry, and negative problem orientation. Mediation results differed somewhat between the two samples. In the undergraduate sample, IU, negative beliefs about worry, and positive beliefs about worry mediated the association between DI and worry. In the clinical sample, negative problem orientation and negative beliefs about worry mediated the association between DI and worry. Conclusions: Results provide initial evidence that DI may be associated with worry via unique risk factors.     

Distinguishing rumination from worry in clinical insomnia

Research has found that repetitive thought processes, such as worry and rumination, play an important role in several disorders; however, these cognitive processes have not yet been examined in insomnia. This study explores rumination and worry in insomnia by examining: 1) whether those high and low on rumination and worry differ on subjective sleep measures, and 2) whether rumination and worry are distinct processes in insomnia. Participants (N = 242) were diagnosed with an insomnia disorder by sleep experts. Participants completed measures of worry and rumination and maintained a 2-week daily sleep log. Results of a multivariate analysis of variance found no main effect of worry; although high and low ruminators differed on several sleep log indices, including sleep efficiency, wakefulness after sleep onset and sleep quality. Factor analysis supported the idea that rumination and worry are separate constructs. Whereas previous research has focused on worry in insomnia, these findings suggest that rumination is important for understanding sleep disturbance. Further, although rumination and worry are both repetitive thought processes, these results indicate that they are distinct processes within insomnia and should be treated as such. The results are discussed with respect to treatment implications for Cognitive Behavioural Therapy for Insomnia.     

THE ABSENT AUTHOR: MAURICE BLANCHOT AND INSPIRATION

But when you are handed over, do not worry about how to speak or what to say; what you are to say will be given to you when the time comes, because it is not you who will be speaking; the Spirit of your Father will be speaking in you (Matt 10:19-20).