Depression history and coping with chronic pain: a daily process analysis.

This study examined how a previous episode of depression is related to daily pain and reactions to pain among individuals with fibromyalgia, a chronic pain syndrome. Seventy-one women with fibromyalgia (including 30 who were previously depressed) rated their pain and mood 3 times daily for 30 days. Each night, participants rated the extent to which they responded to pain by catastrophizing, how much control they had over that day's pain, their ways of coping with pain that day, and the effectiveness of their coping efforts. Multivariate multilevel regression models revealed that after controlling for neuroticism and current depressive symptoms, formerly depressed and never-depressed individuals differed in how they coped with increased pain and in how they appraised the efficacy of their coping efforts. Formerly depressed participants who also reported more current depressive symptoms showed a greater decline in pleasant mood on more painful days than did formerly depressed participants who were experiencing fewer current depressive symptoms. These findings illustrate how a history of depression can be captured in the dynamics of daily life.     

Gratitude in intermediate affective terrain: links of grateful moods to individual differences and daily emotional experience

Two studies were conducted to explore gratitude in daily mood and the relationships among various affective manifestations of gratitude. In Study 1, spiritual transcendence and a variety of positive affective traits were related to higher mean levels of gratitude across 21 days. Study 2 replicated these findings and revealed that on days when people had more grateful moods than was typical for them, they also reported more frequent daily episodes of grateful emotions, more intense gratitude per episode, and more people to whom they were grateful than was typical for them. In addition, gratitude as an affective trait appeared to render participants' grateful moods somewhat resistant to the effects of discrete emotional episodes of gratitude.     

When hurt will not heal: exploring the capacity to relive social and physical pain

ABSTRACT— Recent discoveries suggest that social pain is as real and intense as physical pain, and that the social-pain system may have piggybacked on the brain structure that had evolved earlier for physical pain. The present study examined an important distinction between social and physical pain: Individuals can relive and reexperience social pain more easily and more intensely than physical pain. Studies 1 and 2 showed that people reported higher levels of pain after reliving a past socially painful event than after reliving a past physically painful event. Studies 3 and 4 found, in addition, that people performed worse on cognitively demanding tasks after they relived social rather than physical pain. Implications for research on social pain and theories about social pain are discussed.     

Assessing self-report of pain: A comparison of two recording procedures

Intensive vs. reduced demand self-monitored pain levels were compared in nine pain patients. Each patient self-monitored pain intensity on a 6-point scale every 2 hr. Overall, daily mean and maximum pain levels were calculated for each patient (1) across all intervals (intensive self-monitoring) and (2) four times per day, at meal times and bedtime (reduced-demand self-monitoring). Differences were found to be negligible. The reduced-demand procedure produced data that were closely representative of pain fluctuations indicated in the more intensive bihourly ratings. Results are discussed in terms of the representativeness and standardization in pain self-monitoring as well as possible enhancement of recording compliance through the use of the less demanding four times per day procedure.Portions of these data were presented at the meeting of the Association for Behavior Analysis, Dearborn, June 1979.     

Follow-up of coping skills training in adults with sickle cell disease: analysis of daily pain and coping practice diaries.

This study examined the 3-month follow-up effects of a pain coping skills intervention in African American adults with sickle cell disease. Sixty-seven participants were randomly assigned to either a coping skills condition or a disease-education control condition. Multivariate analyses applied to summary measures of coping, laboratory pain perception, and clinical measures indicated that participants in the coping intervention reported significantly lower laboratory pain and significantly higher coping attempts at 3-month follow-up in comparison with the control condition. Multilevel random effects models applied to prospective daily diaries of daily pain, health care contacts, and coping practice indicated that on pain days when participants practiced their strategies, they had less major health care contacts in comparison with days when they did not use strategies.     

The daily life of the garden-variety neurotic: reactivity, stressor exposure, mood spillover, and maladaptive coping

This article describes a series of studies using the daily process paradigm to describe and understand the affective dynamics of people who experience frequent and intense bouts of a wide range of negative emotions. In several studies, community residents reported on problem occurrence and affect several times a day or at the end of the day. We found reliable evidence that persons who scored high (vs. low) in Neuroticism reported more daily problems, tended to react with more severe emotions, experienced more mood spillover from prior occasions, and exhibited stronger reactions to recurring problems (the "neurotic cascade"). The susceptibility of neurotics to stress seems to extend to all types of problems while certain other dimensions of personality (e.g., Agreeableness) are associated with hyperreactivity to particular kinds of problems. The research demonstrates how daily process research can provide insight about classic problems in the field of individual differences.     

Daily depression and cognitions about stress: evidence for a traitlike depressogenic cognitive style and the prediction of depressive symptoms in a prospective daily diary study

The authors examined the stability and dynamic structure of negative cognitions made to naturalistic stressors and the prediction of depressive symptoms in a daily diary study. Young adults reported on dispositional depression vulnerabilities at baseline, including a depressogenic cognitive style, dysfunctional attitudes, rumination, neuroticism, and initial depression, and then completed short diaries recording the inferences they made to the most negative event of the day along with their experience of depressive symptoms every day for 35 consecutive days. Daily cognitions about stressors exhibited moderate stability across time. A traitlike model, rather than a contextual one, explained this pattern of stability best. Hierarchical linear modeling analyses showed that individuals' dispositional depressogenic cognitive style, neuroticism, and their daily negative cognitions about stressors predicted fluctuations in daily depressive symptoms. Dispositional neuroticism and negative cognitive style interacted with daily negative cognitions in different ways to predict daily depressive symptoms.     

Individual differences,mood, and coping with Chronic pain in Rheumatoid Arthritis: a daily process analysis

This study examines individual differences in coping and associated health outcomes as they unfold across time. Twice daily for one week, 71 individuals with Rheumatoid Arthritis reported their pain, coping efforts, and negative mood via structured daily records. The five factor model of personality (neuroticism, extraversion, openness to experience, agreeableness, conscientiousness) and disease status were also assessed. Multi-level statistical models examining within and between person variability indicated significant temporal associations from coping to pain and bi-directional associations between mood and pain within days. Furthermore, findings suggest that coping use and coping effectiveness were moderated by personality. Implications for models of coping with chronic pain, as well as clinical applications, are discussed.     

The quantity and quality of marital interaction related to marital satisfaction: A behavioral analysis

An assessment instrument is presented for the evaluation of the quantity and quality of dyadic interaction, as well as for the daily recording of behaviors presented and omitted which influence marital satisfaction. Comparison of data from ten happy couples and from ten couples entering therapy indicated two distinct dysfunctional patterns among distressed couples, with significantly different patterns of time-together and positive/negative ratios differentiating the happy versus therapy groups. Independent behavioral recording for 14 consecutive days significantly increased husband-wife agreement on a traditional adjustment questionnaire without significantly increasing or decreasing the level of satisfaction being assessed. There was no difference between groups as to interspousal agreement on amount of time together. However, the happy couples agreed on daily quality ratings of the 72 15-minute segments significantly more often than did the distressed couples. Couples at the extremes of the happy-distressed continuum reported rewarding and punishing, respectively, in response to the partners presence, regardless of behaviors emitted. Midrange happy couples defined "pleasant" as positive behaviors presented; midrange distressed couples defined "pleasant" as negative behaviors omitted. Theoretical and clinical implications of behavioral analysis of sequential patterns are discussed.     

Predicting and remembering recurrent pain

Two groups of Ss suffering from recurrent episodes of pain (headache or menstrual) were studied over a period of weeks in order to determine if they tend to over-predict aversive events (pain in this instance). The results are consistent with earlier findings on fear pain. Contrary to earlier findings, however, after an under-predicted pain the menstrual Ss decreased their following prediction—suggesting the operation of a superordinate predictive pattern in this group. The Ss in both groups successfully predicted the qualities of their pain episodes, but tended to recall the episodes as being more painful than they had reported at the time of the pain episode. The explanation for the erroneous magnifications of predictions and reports of pain is not obvious. Over-predicting a potential pain, and remembering an episode as having been more painful than it was, may serve a protective function, but if so, these are not the most economical ways of achieving protection. The Ss who used medication expected to obtain moderate relief and they were not disappointed.     

Fibromyalgia: the role of sleep in affect and in negative event reactivity and recovery

OBJECTIVE: Fibromyalgia (FM) syndrome is a chronic pain condition characterized by diffuse muscle pain, increased negative mood, and sleep disturbance. Until recently, sleep disturbance in persons with FM has been modeled as the result of the disease process or its associated pain. The current study examined sleep disturbance (i.e., sleep duration and sleep quality) as a predictor of daily affect, stress reactivity, and stress recovery. DESIGN AND MEASURES: A hybrid of daily diary and ecological momentary assessment methodology was used to evaluate the psychosocial functioning of 89 women with FM. Participants recorded numeric ratings of pain, fatigue, and positive and negative affect 3 times throughout the day for 30 consecutive days. At the end of each day, participants completed daily diary records of positive and negative life events. In addition, participants reported on their sleep duration and sleep quality each morning. RESULTS: After accounting for the effects of positive events, negative events, and pain on daily affect scores, it was found that sleep duration and quality were prospectively related to affect and fatigue. Furthermore, the effects of inadequate sleep on negative affect were cumulative. In addition, an inadequate amount of sleep prevented affective recovery from days with a high number of negative events. CONCLUSIONS: These results lend support to the hypothesis that sleep is a component of allostatic load and has an upstream role in daily functioning.     

Affective deficits and pain insensitivity in schizophrenia

Affective deficits have long been considered a prominent feature of schizophrenia and play a central role in recent theory and research on the pathophysiology of this disorder. However, it has recently been argued that current approaches to the conceptualization and assessment of affective flattening in schizophrenia are confounded by the social and neuromotor deficits that are also prevalent in this disorder. Insensitivity to pain in individuals with schizophrenia — a phenomenon that has been reported frequently but never systematically investigated — provides one approach to examining affective flattening unconfounded by social and neuromotor deficits. Two studies are described in which signal detection theory measures of thermal pain sensitivity were examined in patients with schizophrenia, mood disorder, and normal controls; in addition, in the patients with schizophrenia, the relationships between these measures and measures of affective deficits were examined. Patients with schizophrenia had significantly poorer sensory discrimination of painful thermal stimuli than control subjects, but did not differ from controls with respect to their response criterion for reports of pain; patients with mood disorder had a significantly higher (i.e., more stoical) criterion for reports of pain than controls. As predicted, among the patients with schizophrenia, higher response criterion was significantly correlated with greater affective flattening and less intense affective experience (as well as with fewer positive symptoms and poorer premorbid adjustment). The results of these studies suggest that pain insensitivity in schizophrenia may reflect affective as well as sensory abnormalities, and that pain insensitivity in schizophrenia may provide a method for studying affective flattening in this disorder that is relatively independent of the social and neuromotor deficits that confound existing measures of this symptom. Continued examination of the relationship between pain insensitivity and affective deficits in schizophrenia is also important because numerous clinical reports have suggested that pain insensitivity is detrimental to health and can have life-threatening consequences in individuals with this disorder.This research was supported, in part, by research grants from the National Institute of Neurological Disorders and Stroke to Robert H. Dworkin (NS-30714) and W. Crawford Clark (NS-09263, NS-20248).     

Longitudinal Assessment of Pain, Coping, and Daily Functioning in Children with Sickle Cell Disease Receiving Pain Management Skills Training

Objective. To conduct intensive pain management skills training (IST) in children with sickle cell disease (SCD) and their parents and to comprehensively evaluate pain, coping, and daily functioning in children pre, immediately post, and 3 months following treatment. Methods. Three children who received IST in nonpharmacological and pharmacological pain management strategies completed a Coping Strategies Questionnaire (CSQ) at pre, post, and follow-up assessments, and daily pain and activity diaries for 18 weeks, spanning from 1 week pretreatment to 11 weeks posttreatment. Results. From pre- to posttreatment, 1 child receiving IST indicated increased report of active coping attempts and all 3 children indicated decreased report of negative thinking on the CSQ. Participants in IST used coping skills on 90% of days with pain and reported the skills to be moderately helpful on the daily diaries. For daily activities such as eating dinner, playing with friends, and hours slept, children participated similarly on days with pain and days without pain during the posttreatment period. Given the small number of participants in this study, individual cases are discussed to highlight similarities and differences in how participants responded to the treatment and during the 3-month follow-up period. Conclusions. In this pilot study, each participant showed improvement in coping and daily functioning after completing the IST program. Individual differences in response to treatment indicate the need for more targeted intervention programs that incorporate pharmacological and nonpharmacological components. The results of this study highlight both the promise and the complications of conducting comprehensive pain intervention and functional outcome studies in children with SCD.     

Sex differences in pain indices, exercise, and use of analgesics

To understand better reported sex differences in sensitivity to pain, this study examined daily pain frequency and intensity, use of analgesics, physical activity, and both subjective and physiological response to acute pain in 18 men and 24 women, healthy people who provided information about their daily pain symptoms and physical activity before completing a cold pressor task. Compared to men, women reported more frequent and intense pain symptoms, as well as more frequent use of analgesics and lower physical activity. Women evinced higher physiological arousal during the cold pressor task but similar subjective pain. The findings highlight the different ways men and women cope with pain and the effect on their responses to acute pain.     

Dental phobias and anxieties: evidence for conditioning processes in the acquisition and modulation of a learned fear

The present study investigated some of the factors which differentiate individuals with dental anxieties and phobias from those without such fears. In particular, two questions were addressed: (i) What differentiates subjects who have never been anxious about dental treatment from subjects who at some time have been anxious? and (ii) What factors lead to subjects changing their attitudes either from anxious to relaxed or from relaxed to anxious? The results suggest that the factors which influence the acquisition and modulation of dental anxieties are consistent with the associative and representational processes portrayed in contemporary models of human conditioning. Subjects who reported never having had anxieties about dental treatment were less likely to have had a painful dental treatment than subjects who did report an anxiety. Subjects who did report a painful dental experience but did not acquire anxiety reported a history of dental treatment favourable to the operation of latent inhibition. Subjects who reported that they were good at enduring pain were more likely to report a longer interval between their very first dental treatment and their first painful dental treatment. Under some conditions in which latent inhibition should have precluded the acquisition of a dental fear, an anxiety appeared to be acquired because a very painful experience had attenuated the latent inhibition process. Subjects whose dental anxiety did not remit reported significantly more painful and traumatic dental experiences than subjects whose anxiety did remit.     

Suffering for science: the effects of implicit social demands on response to experimentally induced pain

In two experiments subjects rated their pain during baseline trials of cold pressor and finger pressure pain. After various instructional treatments, they were posttested with these same stimuli. As in previous studies, we found in both experiments that coping suggestions significantly reduced reported pain. Experiment 1, however, demonstrated that subjects often refrained from using available cognitive coping strategies to reduce pain unless they had been given explicit permission to do so. Experiment 2 replicated this finding and also showed that explicit permission to "do whatever you can to reduce pain" was as effective as a coping suggestion in decreasing reported pain. These findings indicate that subjects' interpretation of what is appropriate responding in the test situation determines how they choose to cope with the painful stimulation. Thus standard experimental procedures for assessing baseline levels of pain implicitly lead subjects to refrain from coping and thereby tend to underestimate their ability to control pain. Moreover, suggestions and other instructional techniques for coping with pain may produce much of their effect not by teaching subjects new coping skills but instead by giving them permission to use already available coping strategies.     

A novel radiant heat test for assessing pain threshold in human subjects: Measurement stability

New methodologies to assess analgesic response in humans are needed to better integrate preclinical and clinical data. In the present study we examined the test-retest stability of an innovative radiant heat methodology compared with an electrical stimulation methodology. For the radiant heat task, a modified rodent tail flick apparatus was used. The latency for finger withdrawal was recorded. For the electrical stimulation tasks, subjects placed two fingers on two electrodes from which they received a brief series of increasingly intense electrical stimulations. Maximum stimulus intensity (in milliamps) delivered was recorded. On each of 4 test days, the subjects received five test trials with a 10-min interval between trials. All the subjects were tested twice on each apparatus in a counterbalanced design. Finger withdrawal latencies for the radiant heat task did not differ significantly across test trials or test days. Finger withdrawal scores for electrical stimulation increased significantly across test trials as well as test days. These data show that the radiant heat method generates consistent latencies across trials and days, whereas shock produces trends over time. The radiant heat task, which is convenient to operate and inexpensive to build, appears promising as a reliable test of pain threshold in humans.     

The impact of daily stress on health and mood: psychological and social resources as mediators

This study examined daily stress processes among 75 married couples across 20 assessments during a 6-month period. The somatic and psychological effects of common everyday hassles were investigated. Overall, there was a significant relationship between daily stress and the occurrence of both concurrent and subsequent health problems such as flu, sore throat, headaches, and backaches. The relationship of daily stress to mood disturbance was more complex. The negative effects of stress on mood were limited to a single day, with the following day characterized by mood scores that were better than usual. Furthermore, striking individual differences were found in the extent to which daily stress was associated with health and mood across time. Participants with unsupportive social relationships and low self-esteem were more likely to experience an increase in psychological and somatic problems both on and following stressful days than were participants high in self-esteem and social support. These data suggest that persons with low psychosocial resources are vulnerable to illness and mood disturbance when their stress levels increase, even if they generally have little stress in their lives.