Modifying acute pain by matching cognitive style with cognitive treatment

To test whether congruence between cognitive style and cognitive coping would facilitate the attenuation of pressure pain, 30 verbalizers and 30 visualizers were assigned in equal numbers (ns = 10) to pleasant imagery, rational thoughts, and expectancy conditions. Separate 2 X 3 (cognitive style X experimental condition) analyses of covariance on pain tolerance and subjective discomfort indicated that imagery was superior to expectancy in raising tolerance. These findings are discussed in terms of the flexibility of cognitive coping and the content of the images and thoughts which were used.     

Perceived self-efficacy and pain control: opioid and nonopioid mechanisms

In this experiment, we tested for opioid and nonopioid mechanisms of pain control through cognitive means and the relation of opioid involvement to perceived coping efficacy. Subjects were taught cognitive methods of pain control, were administered a placebo, or received no intervention. Their pain tolerance was then measured at periodic intervals after they were administered either a saline solution or naloxone, an opiate antagonist that blocks the effects of endogenous opiates. Training in cognitive control strengthened perceived self-efficacy both to withstand and to reduce pain; placebo medication enhanced perceived efficacy to withstand pain but not reductive efficacy; and neither form of perceived self-efficacy changed without any intervention. Regardless of condition, the stronger the perceived self-efficacy to withstand pain, the longer subjects endured mounting pain stimulation. The findings provide evidence that attenuation of the impact of pain stimulation through cognitive control is mediated by both opioid and nonopioid mechanisms. Cognitive copers administered naloxone were less able to tolerate pain stimulation than were their saline counterparts. The stronger the perceived self-efficacy to reduce pain, the greater was the opioid activation. Cognitive copers were also able to achieve some increase in pain tolerance even when opioid mechanisms were blocked by naloxone, which is in keeping with a nonopioid component in cognitive pain control. We found suggestive evidence that placebo medication may also activate some opioid involvement. Because placebos do not impart pain reduction skills, it was perceived self-efficacy to endure pain that predicted degree of opioid activation.     

Gender Differences in Pain Perception: The Mediating Role of Self-Efficacy Beliefs

The purpose of this study was to assess the extent to which the gender differences in response to the cold pressor test (CPT) are mediated by self-efficacy beliefs. One hundred twelve college undergraduates (69 women and 43 men) engaged in CPT and completed self-report measures of demographic information, physical self-efficacy (i.e., expectations about one's overall physical capabilities), and task-specific self-efficacy (i.e., beliefs about one's ability to cope successfully with the upcoming CPT). In addition, participants provided subjective ratings of pain intensity every 30 s during CPT and were evaluated for tolerance during CPT (up to 4 min). Consistent with past research, men reported lower average subjective ratings of pain intensity and showed higher tolerance for CPT. Path analyses indicated that associations between gender and pain perception were fully mediated by self-efficacy beliefs. Men reported greater physical self-efficacy and task-specific self-efficacy than women did. In turn, higher task-specific self-efficacy ratings predicted increases in tolerance for pain and lower ratings of average pain intensity. Findings indicate that self-efficacy beliefs are one factor that accounts for gender differences in responses to painful stimulation. Future researchers should evaluate conditions under which heightened self-efficacy may be beneficial and harmful, and they should employ experimental designs that incorporate opportunities for use of both communal–interpersonal and individualistic coping strategies in light of possible gender differences in preferred approaches to coping with pain.     

Comparison of three cognitive strategies in altering pain behaviors on a cold pressor task

The efficacy of three cognitive strategies for coping with pain was examined in a cold-water pressor task in a sample of college students. Subjects were pretested and then randomly assigned to one of three treatment conditions (Paradoxical Intention, Rational Self-statement, or Self-observation) or to an expectancy control group. Following training in the respective cognitive strategies, all groups were given a posttest in the cold-water pressor to determine the effectiveness of the treatment. Pain thresholds, tolerances, and discomfort ratings were recorded for subjects in each condition. No differences were found between the Paradoxical Intention or Rational Self-statement groups and the Expectancy Control on any of the pain measures. The Self-observation treatment condition, however, had significantly higher pain tolerance scores than the Expectancy Control group. The findings were attributed to the subjects' dissociating the sensory aspects of the pain experience from the anxiety when focusing upon the coldness and wetness of the cold water.     

Cognitive-behavioural predictors of children's tolerance of laboratory-induced pain: implications for clinical assessment and future directions

This study sought to investigate cognitive-behavioural predictors of children's tolerance for laboratory-induced cold-pressor pain. It was hypothesised that pain tolerance, as measured by immersion time, would be greater in children who were high in self-efficacy for pain, high in self-reported use of cognitive-coping strategies, and low in emotion-focused coping strategies such as catastrophising. Age and sex differences were also examined in post hoc analyses. Children between the ages of 7 and 14 years (N = 53) participated in the study. Offering partial support for the hypotheses, use of cognitive distraction was found to be associated with greater pain tolerance, while use of internalising/catastrophising was associated with lower pain tolerance. Older boys tended to have greater pain tolerance than younger boys, whereas younger and older girls had intermediate pain tolerance levels. Self-efficacy for pain, in general, was found to be positively correlated with age. The results support efforts to identify children who, because they have lower confidence or lower skills in coping with distress, may need extra support and preparation for painful procedures. Further research is needed to investigate these findings within a clinical pain context.     

Focal changes in cerebral blood flow produced by monetary incentive during a mental mathematics task in normal and depressed subjects

The purpose of this experiment was to determine the effect of incentive-induced arousal on the diffuse and regional cerebral blood flow (rCBF) response during cognitive activation for normal and depressed groups. Two normal rest CBF measurements were followed by two mental mathematics activation CBF measurements. For the first activation measurement, half the subjects in each group were offered monetary incentive for correct performance and half the subjects received no monetary incentive. All subjects were offered monetary incentive on the final activation run. The effect of monetary incentive on the first activation run was to increase CBF activation at four detectors in the left hemisphere. Incentive did not affect the CBF activation response when introduced following practice on the activation task (on the final run). Depressed groups had lower resting blood flow than normals, but the distribution of flow and the CBF response to incentive were almost identical in the two groups.     

Visual and verbal modes of information processing and cognitively-based coping strategies: An extension and replication

This study was designed to investigate the interaction between the use of an imaginallybased vs a verbally-based coping strategy with subjects who were selected on the basis of strong preferences for either visual or verbal modes of information processing. Forty-eight female students were subjected to a cold-pressor task. Measures of pain tolerance, pain threshold and a pain rating were obtained. The findings indicated that there was not a significant relationship between preferred cognitive style and the types of coping strategy provided. However, the treatments combined were found to be significantly more effective than the no-treatment condition on all three dependent measures. A structured debriefing revealed that use of visual vs verbal coping strategies did not differ as a function of treatment type or preferred cognitive style. It was concluded that individuals may demonstrate considerable flexibility in adapting to different types of cognitively-based coping strategies.     

Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress

Wegner's Theory of Ironic Processes has been applied to study the effects of cognitive strategies to control pain. Research suggests that suppression contributes to a more distressing pain experience. Recently, the acceptance-based approach has been proposed as an alternative to cognitive control. This study assessed the tolerance time, the distress and the perceived pain intensity in three groups (suppression, acceptance and spontaneous coping groups) when the participants were exposed to a cold pressor procedure. Two hundred and nineteen undergraduates volunteered to participate. The suppression group showed the shortest tolerance time and the acceptance group showed the longest tolerance time. The acceptance group showed pain and distress immersion ratings that were significantly lower than in the other two groups, between which the differences were not significant. In the first recovery period, the suppression group showed pain and distress ratings that were higher than in the other two groups. In the second recovery period, although the acceptance group showed pain and distress ratings that were significantly lower than in the other two groups, the suppression and the spontaneous coping groups did not differ. The presence of a 'rebound' of physical discomfort and the effects of suppression on behavioural avoidance are discussed. These results support the acceptance approach in the management of pain.     

Cognitive Approaches to Pain Control: Common Factors Underlying Their Effectiveness

The author reviews the cognitive approaches to pain control and discusses how expectancy of success in general and self-efficacy in particular mediate successful outcomes.     

Pain perception as a function of self-focused rumination

Pain sensitivity and tolerance were studied using the cold-pressor technique. A 3 independent groups design was employed using rumination as the independent variable. Group 1 was given a situation in which anger-related self-rumination was introduced. Group 2 was given a self-related rumination task in which anger was not induced. Group 3 received a rumination task not related to the self. In addition, the State-Trait Anger Expression Inventory was given prior to the experiment to test the hypothesis that ratings on the Anger-In subtest would correlate with pain sensitivity. In each group were 6 men and 6 women. Each participant took the anger and another inventory not relevant to the present study before the experiment. An anger measure was taken before and after the experiment for each group to see if the anger induction in Group 1 actually increased anger. There were no differences among the 3 groups on the second anger measure, so differences between Groups 1 and 2 could not be attributed to anger. A 1-way analysis of variance for 3 groups showed a strong main effect on pain tolerance but not pain sensitivity. Groups 1 and 2 were significantly more tolerant of pain than Group 3. The correlation of ratings on the Anger-In (internalized anger) subtest fell short of statistical significance with pain sensitivity and also was not significant for pain tolerance. Results were discussed in terms of the possibility that self-rumination may increase pain tolerance by requiring a greater cognitive load than nonself rumination.     

Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change

The effects of fear appeals on persuasion were investigated in a factorial experiment that was designed to test a combined model of protection motivation theory and self-efficacy theory. As predicted, the probability of a threat's occurrence and the effectiveness of a coping response both had positive main effects on intentions to adopt a recommended preventive health behavior. More importantly, the findings provided support for self-efficacy expectancy as a fourth component of protection motivation theory: Self-efficacy had a direct influence on intentions and interacted with two other variables of protection motivation theory. The interaction effect was interpreted in terms of two new decision-making strategies that people use when confronted with a fear appeal: a precaution strategy and a hyperdefensiveness strategy. In addition, the results replicated previous findings on the relationship between self-efficacy expectancy and outcome expectancy. A model incorporating protection motivation theory and self-efficacy theory is presented as a possible general model of attitude change.     

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.     

Perceived self-efficacy in coping with cognitive stressors and opioid activation

This experiment tested the hypothesis that perceived self-inefficacy in exercising control over cognitive stressors activates endogenous opioid systems. Subjects performed mathematical operations under conditions in which they could exercise full control over the cognitive task demands or in which the cognitive demands strained or exceeded their cognitive capabilities. Subjects with induced high perceived self-efficacy exhibited little stress, whereas those with induced low perceived self-efficacy experienced a high level of stress and autonomic arousal. Subjects were then administered either an inert saline solution or naloxone, an opiate antagonist that blocks the analgesic effects of endogenous opiates, whereupon their level of pain tolerance was measured. The self-efficacious nonstressed subjects gave no evidence of opioid activation. The self-inefficacious stressed subjects were able to withstand increasing amounts of pain stimulation under saline conditions. However, when endogenous opioid mechanisms that control pain were blocked by naloxone, the subjects were unable to bear much pain stimulation. This pattern of changes suggests that the stress-induced analgesia found under the saline condition was mediated by endogenous opioid mechanisms and counteracted by the opiate antagonist.     

Coping self-efficacy mediates the effects of negative cognitions on posttraumatic distress

Although cognitive distortions have predicted posttraumatic distress after various types of traumatic events, the mechanisms through which cognitive distortions influence posttraumatic distress remain unclear. We hypothesized that coping self-efficacy, the belief in one's own ability to manage posttraumatic recovery demands, would operate as a mediator between negative cognitions (about self, about the world, and self-blame beliefs) and posttraumatic distress. In the cross-sectional Study 1, data collected among 66 adult female victims of child sexual abuse indicated that coping self-efficacy mediated the effects of negative cognitions about self and about the world on posttraumatic distress. The same pattern of results was found in a longitudinal Study 2, conducted among 70 survivors of motor vehicle accidents. Coping self-efficacy measured at 1 month after the trauma mediated the effects of 7-day negative cognitions about self and about the world on 3-month posttraumatic distress. In both studies self-blame was not related to posttraumatic distress and the effect of self-blame on posttraumatic distress was not mediated by coping self-efficacy. The results provide insight into a mechanism through which negative cognitions may affect posttraumatic distress and highlight the potential importance of interventions aimed at enhancing coping self-efficacy beliefs.     

Pain sensitivity and coping strategies among dysmenorrheic women: much ado about nothing

Samples of spasmodic, congestive and combined dysmenorrheic women and non-dysmenorrheic women were subjected to an ischemic pain procedure to measure their pain threshold, pain tolerance and self-reported pain. Cognitive and behavioral strategies that subjects had spontaneously used during the pain procedure were later assessed. A classification system was derived for categorizing subjects' responses to the interview and questionnaire used in this assessment. Contrary to previous claims that dysmenorrheic women may be hypersensitive to pain, no differences in pain sensitivity were discovered among the four groups of subjects. A few differences in cognitive and behavioral strategies did emerge, but these were of insufficient magnitude to contend that dysmenorrheic women are disadvantaged in their strategies for coping with pain.     

The fear-avoidance model of exaggerated pain perception—II: Preliminary studies of coping strategies for pain

The personal history of pain and personal coping strategies for pain are two of the contributory factors in the Fear-Avoidance Model of exaggerated pain perception proposed by Lethem, Slade, Troup and Bentley (1983, this issue, pp. 401–408). In order to test this aspect of the hypothesis, a questionnaire was designed and has been completed by 165 students (93 female, 72 male) at the University of Liverpool.They were asked about the severity of externally-produced pain (e.g. fracture), of internally-produced pain (e.g. headache) and of back pain; about the strategies they adopted for coping with internallyproduced pain (e.g. did they ignore the pain and carry on—an active strategy—or did they go and rest—a passive strategy); and about the effects of back pain on each of 10 activities or postures (from ‘no effect’ to ‘had to stop completely’) in order to obtain an index of back-pain avoidance.Out of 165, 91 reported previous back pain (Back Pain group) and their average rating for the severity of externally-produced pain was significantly higher than for the No Back Pain group; but there were no differences between these two groups for their coping strategies for internally-produced pain. However, of the Back Pain group with two or more previous attacks, 35 gave a history indicating decreasingly severe attacks and 28, increasingly severe: the coping strategies of the latter group for internally-produced pain were significantly more passive. The ratings for severity of back pain correlated significantly with the indices for back-pain avoidance and with the ratings for severity of internally-produced pain.These findings are in line with the prediction that personal pain history and personal coping strategies are relevant to the Fear-Avoidance Model of exaggerated pain perception and may therefore influence the adoption of an avoidance or a confrontation response by the patient with chronic back pain.     

年轻男同性恋者自我概念清晰性与生命意义感的关系及作用机制

通过网络抽样法对405名年轻男同性恋者进行问卷调查,考察年轻男同性恋者自我概念清晰性与生命意义感的关系,并探讨内化同性恋嫌恶和应对自我效能感在其间的作用机制。结果表明：（1）年轻男同性恋者自我概念清晰性与生命意义感呈显著正相关。（2）内化同性恋嫌恶、应对自我效能感在自我概念清晰性与生命意义感间起链式中介作用。（3）应对自我效能感在自我概念清晰性与生命意义感间起中介作用。     

The role of risk perception and efficacy cognitions in the prediction of HIV-related preventive behavior and condom use

The salience of the Protection Motivation Theory to HIV preventive behavior was investigated in a sample of 468 heterosexual men 20-45 years of age recruited in Germany and at vacation spots in Spain. This theory conceptualizes self-protective behaviors as a function of the severity of the threat, perceived personal vulnerability to this threat, the availability of coping responses, and the effectiveness of these responses. Cognitive variables measured included perceived severity of the threat of AIDS, sexual self-efficacy expectancy, self-efficacy expectations in terms of sexual communication skills, response efficacy, and attitude toward condom use. On a scale of 1 (low) to 6 (high), perceived severity of the AIDS threat averaged 5.3, individual susceptibility ratings averaged 3.5, and susceptibility of peers had a mean of 4.9. Although 33% of respondents had made behavioral changes in response to the AIDS epidemic, only 15% always used condoms while 12% used them occasionally. Self-efficacy expectancy with regard to assertiveness and use of preventive measures emerged as the most significant predictor of HIV-related behaviors. The causal analyses indicated that high communicative self-efficacy expectancy is associated with high-risk sexual behaviors, while self-efficacy expectancy regarding assertiveness and the use of preventive measures promotes risk reduction. These associations were strongest in men over 26 years of age, singles, and tourists. These findings suggest a need for interventions for couples such as assertiveness training and guidance on communicating about sex and AIDS. Also demonstrated was the need for AIDS education programs to identify where participants are in terms of perceiving the threat of and coping with the AIDS epidemic and promote conditions that will help people advance to the next stage.     

高一学生应对灵活性及其影响因素的研究

本研究采用问卷调查和实验室任务相结合的方法,对59名高一学生进行一个月的跟踪调查,对结果进行聚类分析,旨在探寻高一学生在应对灵活性方面表现出的不同风格,同时从自我效能感、社会支持两方面探讨影响高一学生应对灵活性的主观和客观因素。研究结果表明:(1)聚类分析得到高一学生应对灵活性的四种类型:应对灵活型,积极不灵活型,消极不灵活型和积极不一致型;(2)应对灵活型和积极不灵活型被试的控制感显著高于消极不灵活型和积极不一致型;策略选择方面,积极不灵活型、积极不一致型倾向于使用问题焦点应对,应对灵活型、消极不灵活型倾向于使用情绪焦点应对;(3)自我效能感和社会支持在一定程度上可对应对灵活性类型产生预测作用,应对灵活型学生的自我效能感和对社会支持的利用度明显高于其他三类学生。研究结果有助于我们深入了解高中学生的适应问题。