Interpersonal Psychotherapy for Co-occurring Depression and Chronic Pain

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one-fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans and Latinos all report higher rates of pain and depression compared to other groups. This article describes a version of Interpersonal Psychotherapy tailored for patients with comorbid depression and chronic pain, Interpersonal Psychotherapy for Depression and Pain (IPT-P). While IPT-P potentially could be delivered to many different patient populations in a range of clinical settings, this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non-treatment seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option has the potential to improve clinical outcomes for individuals with depression and chronic pain.     

Personal and Situational Variables That Describe Coping With Acute Stress in Competitive Sport

Abstract

The authors examined the degree to which competitive basketball players in Australia were consistent in their cognitive appraisals and coping strategies in response to 4 types of stressful situations that they had experienced during previous basketball games as functions of perceived stress intensity. The authors predicted that both approach and avoidance coping strategies would be dependent on the type of stressful event, in accord with the transactional model. The results supported that prediction: Approach strategies were more prevalent than avoidance strategies following 3 of the 4 events. Cognitive appraisals and perceived stress intensity also strongly influenced the participants' use of coping strategies, accounting for 34% of the variance.     

In Vivo Hippocampal Acetylcholine Release During Exposure to Acute Stress

Hippocampal extracellular acetylcholine (ACh) and choline levels were evaluated using in vivo microdialysis in male Fischer 344 rats before, during, and following an 80-min exposure to two different stress conditions. Measurements were taken in rats restrained and immersed in a water bath containing either 37 degreesC (normothermic-restraint) or 20 degreesC (cold-restraint) water. Results were compared to normothermic-freely-moving rats. Cold-restrained rats displayed decreased ACh levels during cold exposure relative to both normothermic-restrained and normothermic-freely-moving rats. By the end of the cold exposure period and following removal from cold, ACh levels had returned to near-baseline values. Normothermic-restrained rats had levels similar to those of normothermic-freely-moving rats, except for a marked increase in ACh following removal from restraint. Cold-restrained rats displayed a gradual elevation in choline levels during cold stress, followed by a gradual decline after stress termination, whereas both normothermic-restrained and normothermic-freely-moving rats displayed gradual decreases during the microdialysis session. These findings demonstrate that central cholinergic neurotransmission can be altered by the application of, and removal from, acute stressors. In addition, the results suggest a possible relationship between the magnitudes of both the stressor and its cholinergic consequences.     

Personal Standards in Professional Relationships: Limiting Interpersonal Harassment

An attempt is made to define abusive actions by offering criteria against which the behaviour of individuals can be considered. These criteria are based on whether the behaviour is avoidable, the appraisal of an objective observer and the impact of the behaviour on the ‘psychological contract’ between employer and employee. Particular abusive actions, identified by these criteria, are described and are contrasted with what are termed ‘reasonable expectations’ of one person's behaviour towards another. It is argued that only by translating these expectations into personal commitments, against which one's own behaviour can be compared, will interpersonal harassment be limited. It is also proposed that the size of consensus about what constitutes abusive actions measures the integrity of an organization's culture. © 1997 John Wiley & Sons, Ltd.     

Chronic Stress as a Mediator of Acute Stress: The Case of Hurricane Hugo1

This study explored one mechanism through which acute disaster stress (injury, life threat, property damage, loss) may produce lasting psychological distress (depression, anxiety, somatization, hostility). More specifically, the study examined the mediating roles of seven domains of chronic stress (marital, parental, filial, financial, occupational, ecological, physical) within a sample of 930 disaster victims and controls. The results provided strong support for the hypothesis that chronic stress mediates the long-term effects of acute disaster stress on psychological distress. The main effects of loss, though limited in strength, were completely explained by victims’ higher financial, marital, filial, and physical stress. The effects of injury, though quite strong, were largely mediated by these same domains of chronic stress. Likewise, the effects of life threat were largely mediated by all these domains plus ecological stress. A mediational model was not appropriate for understanding the consequences of property damage because it did not exhibit a main effect on psychological distress.     

Acute Stressors and Chronic Response: The Case of Traumatic Stress1

The nature of acute and chronic stress is explored, including analysis of three different ways of categorizing the duration of a stressful episode: the duration of the physical stressor, the duration of threat perception or demand, and the persistence of response. Of particular interest here are situations characterized by brief stressor exposure but long-term threat perception and/ or stress response. Traumatic events are ordinarily very brief but frequently give rise to chronic threat and stubborn response patterns. In many of these cases, distress clearly outlives the event and the “normal” postevent recovery period. Possible mechanisms for such situations are discussed, as are implications for the study of traumatic stress.     

老年慢性疼痛患者疼痛接受与疼痛程度的相关关系

了解老年慢性疼痛患者疼痛接受与疼痛程度,探讨两者的相关关系.采用简易慢性疼痛接受问卷（CPAQ-8）中文版、简化McGill疼痛问卷（SF-MPQ）与一般情况调查表对335例老年疼痛患者进行调查.结果纳入有效样本308例,SF-MPQ总体平均分为（50.24±23.35）分,中文版CPAQ-8总体平均得分（21.74±5.97）分.老年慢性疼痛患者的受教育程度、疼痛期、疼痛部位及疼痛点数目等差异有统计学意义（P＜0.05）.疼痛接受与疼痛程度呈负相关（P＜0.01）,即接受程度越高者,其疼痛程度越低.     

The Construing Of Pain: A Comparison Of Acute And Chronic Low Back Pain Patients Using The Repertory Grid Technique

Hypotheses derived from the literature on pain and on personal construct theory were tested using the repertory grid technique on samples of acute and chronic low back pain patients. Two main differences emerged between these groups: (a) Chronic pain patients showed a small but significant tendency to associate being in pain with being sensitive to others; and (b) chronic pain patients perceived significantly less anger around them. The two groups were then pooled to examine changes in construing with increasing pain duration. Two main trends were noted with increasing chronicity: (a) Pain patients perceived significantly less depression around them, with the construct depressed/not depressed becoming increasingly subordinate, and (b) pain was seen in increasingly less negative terms. The results are discussed with reference to the literature and suggestions are made for future research areas.     

Self-Esteem,Perceived Stress,and Gender During Adolescence: Interactive Links to Different Types of Interpersonal Relationships

The goal of this study was to analyze the relationships between self-esteem, perceived stress, the quality of different types of interpersonal relationships, and gender in adolescents. This study used a sample of 1614 adolescent high school students and robust data analytic techniques to test the proposed relationships. The results partially supported the initial hypothesis in that perceived stress mediated the relationships between self-esteem and four of the types of interpersonal relationships (i.e., same-sex peer relationships, opposite-sex peer relationships, parent–child relationships, and teacher–student relationships) and moderated the relationship between self-esteem and same-sex peer relationships. In addition, a moderated role of gender was also partially supported in that perceived stress mediated the relationships between self-esteem and same-sex peer relationships, opposite-sex peer relationships, and the parent–child relationship for girls, but not boys. On the basis of these findings, it was concluded that perceived stress plays an intervening role in the relationship between self-esteem and different types of interpersonal relationships and that gender seems to be a moderator for some of the patterns of the relationships between these variables. These findings are discussed in light of the possible mechanisms by which the variables could influence each other. Implications for theory and practice as well as some directions for future research were also suggested.     

Optimal Scoring of the Multidimensional Pain Inventory in a Chronic Pain Sample

The Multidimensional Pain Inventory (MPI) is one of the most commonly used self-report instruments in pain settings. The MPI can be used to classify patients into three clusters or its nine scales can be treated as dimensions in efforts to understand patient heterogeneity. Previous research suggests the existence of a fourth cluster, whose members have been labeled ‘repressors,’ that emerges with the addition of a defensiveness scale to the MPI. The current paper compared the abilities of MPI cluster and dimensional models with and without a measure of defensiveness to capture variability in validating variables related to personality, psychopathology, physical functioning, and treatment outcome in a chronic pain sample. Results suggest that dimensional models consistently outperform cluster models in explaining variance in outcome variables, and that the addition of a measure of defensiveness increments the validity offered by the MPI scales. Implications for the assessment of pain patients are discussed.

Effortful Control and Interpersonal Behavior in Daily Life

The Cognitive-Affective Processing System (CAPS) was used to examine effortful control (EC) as a moderator of daily interpersonal behavior. Participants (N = 240) were nonclinical young adults who completed a 7-day event-contingent experience sampling study of interpersonal perception and affect. Multilevel linear models indicated that EC moderated within-person covariation of interpersonal warmth and affect activation; high EC individuals reported greater momentary warm behaviors when perceiving others as affectively activated. EC also amplified between-person covariation of interpersonal warmth between self and others; high EC individuals generally responded to perceptions of another's warmth with a greater degree of warm behavior. Varying levels of EC predict responses to interpersonal perceptions and affect in daily life, suggesting an important dimension for interpersonal functioning.     

Components of Mindfulness in Patients with Chronic Pain

Methods of mindfulness are gaining increasing popularity within the behavioral and cognitive therapies and appear helpful for a range of clinical problems. The purpose of this study was to examine cognitive and behavioral processes underlying mindfulness. One hundred fifty patients seeking treatment for chronic pain completed a battery of questionnaires, including the 15-item Mindful Attention Awareness Scale (MAAS; Brown and Ryan, J Pers Soc Psychol 84:822–848, 2003). Preliminary analyses supported reliability and validity of the MAAS for patients with chronic pain. A confirmatory factor analysis provided incomplete support for a singe factor structure from the items of the MAAS. In turn, an exploratory factor analysis yielded a four-factor solution: Acting with Awareness, Present Focus, Responsiveness, and Social Awareness. Correlation and regression analyses indicated that the Acting with Awareness and Present Focus subscales were significantly related to measures of patient emotional, physical, and social functioning. Further research that explores and validates models of mindfulness-based processes is recommended.     

Post-Traumatic Stress Disorder Symptoms in United Nations Peacekeepers: An Examination of Factor Structure in Peacekeepers with and without Chronic Pain

Recent factor analytic investigations of post-traumatic stress disorder in military veterans suggest that symptoms are best described by either a hierarchical 2-factor model or a 4-factor inter-correlated model. Other recent evidence suggests that post-traumatic stress disorder and chronic pain are intricately related; however, the nature of this relationship is not well understood. Factor analysis provides one method for clarifying this relationship. In study 1, we compared competing models of post-traumatic stress disorder symptom structure in a sample of 400 male United Nations peacekeepers using confirmatory factor analysis. Results indicated that both the hierarchical 2-factor and the 4-factor inter-correlated models provided good fit to the data. In study 2, the reliability of these models was assessed in 427 male United Nations peacekeepers with chronic back pain and 341 without. Group comparisons of the confirmatory factor analysis results revealed that the structure of the hierarchical 2-factor and 4-factor inter-correlated models both provided good fit to the data in both the chronic back pain and the group without. However, the structure of the models for the group with chronic back pain group differed in significant ways from that of the group without chronic back pain. Post-traumatic stress disorder symptoms in military veterans can be adequately conceptualized using either a hierarchical 2-factor or 4-factor inter-correlated model. Chronic pain has a minimal influence on overall factor structure. The hierarchical 2-factor model, while parsimonious, does not provide the degree of symptom detail provided by the 4-factor inter-correlated model. Implications for conceptualization of post-traumatic stress disorder symptoms for patients with chronic back pain and significant post-traumatic stress disorder symptomatology are discussed.     

Self-Report Differentiation of Anxiety and Depression in Chronic Pain

The psychometric distinctiveness of self-reported anxiety and depression in patients with chronic pain was investigated. The item-level responses of 220 patients with heterogeneous pain conditions from the Beck Depression Inventory and State-Trait Anxiety Inventory State-Anxiety scale were submitted to common factor analysis. Three first-order factors were identified: depression, anxiety-absent, and anxiety-present. One second-order factor of negative affect was also identified. Correlations of first-order factor scores with other psychometric measures suggested only minor distinctiveness. The findings indicated that it is possible to distinguish anxiety and depression psychometrically in patients with chronic pain but suggested that negative affect may be the primary underlying construct of the affective experience of these patients.     

Brief Psychological and Hypnotic Interventions in Chronic Pain Management

This article will explore how brief psychological approaches using hypnosis and imagery can be used with patients with chronic pain, predominantly in a Primary Care setting, although much that is discussed here could be applied in the Secondary sector. Chronic pain is defined as pain which endures for more than 6 months and may last for months or years. It serves no physiological purpose and persists after the time that ‘normal’ healing would be supposed to have taken place. Chronic pain may also range from that of cancer or arthritis, to that which seems to have no single or obvious physical causation. Teaching self-hypnosis and use of imagery can give these patients tools that they can use to help themselves, not only with pain, but also with the emotional distress that so often accompanies and exacerbates it. Unlike medication, self-hypnosis has only positive side effects and can give back some measure of control to patients who feel helpless and hopeless.     

Hope in the Face of Chronic Pain and Mortality

Human pain, especially when severe, chronic, and life-threatening, is a distinct challenge to hope. A review of recent research regarding human pain and its effects supports this idea. A pastoral theology that attends to the way of the cross and the hope of the resurrection can guide ministry with persons facing this challenge. The meditations and reflections of John Tully Carmody during his season of suffering with multiple myeloma are illustrative and instructive.     

Domain-Based and Overall Life Satisfaction for Youth with Chronic Conditions: The Role of Personal,Interpersonal, and Environmental Factors Over a One-Year Period

This paper examined the differential influences of personal, interpersonal, and environmental level factors on domain-based and overall life satisfaction over one year for youth with chronic health conditions. Baseline and Time 2 follow-up data were used from a study examining quality of life for a sample of 439 youth with chronic conditions, aged 11 to 17 years. The Brief Multidimensional Students’ Life Satisfaction Scale measured youths’ life satisfaction in five domains (i.e., satisfaction with self, family life, friendships, school experiences, where one lives) and in overall life. Six multivariate linear regression analyses were performed, each exploring relations of the hypothesized correlates at baseline with one aspect of life satisfaction at follow-up controlling for youth gender, age, household income, and the corresponding aspect of life satisfaction at baseline. Factors at all three levels were found to be important to some aspect of life satisfaction. Emotional well-being played a notable role in life satisfaction across multiple domains and in overall life satisfaction. Family-related factors were also significantly related to life satisfaction across several domains. Social support from close friends and teachers and the school environment were important to specific domains of life satisfaction. Classmate social support emerged as a key factor related to overall life satisfaction. Implications for practice and future research are discussed.     

The Accuracy of the DSM-IV Pain Disorder and the ICD-10 Persistent Somatoform Pain Disorder in Chronic Pain Patients

Objectives. In this investigation we studied the relationships between different psychological relevant subgroups and the presence of different psychosomatic symptoms in a sample of chronic pain patients, testing the accuracy of the DSM- and ICD classification systems.Results. We found no evidence for a “pure” pain syndrome according to the DSM- and ICD systems. On the contrary, we found highly significant evidence of a mixed psychosomatic condition.Conclusion. The results suggest a broad somatoform classification, with subgroups based on personality characteristics taking a stress—coping model into account, including interpersonal attachment behaviour. An alternative model of a diagnostic approach is presented.