The clinical pain acceptance Q-sort: a tool for assessment and facilitation of pain acceptance

The topic of pain acceptance can be clinically difficult to raise in a respectful way. This article introduces a method of managing the topic of pain acceptance in daily clinical practice: The clinical pain acceptance Q-sort. The Q-sort procedure comprises 13 small cards with printed statements concerning pain acceptance on the one side, score numbers on the other side. The procedure involves the patient handling and prioritizing the statements in a personally meaningful order. Both quantitative and qualitative use of the tool is possible. The method has a three-fold outcome: (1) topics of pain acceptance are presented in a multi-faceted way for the chronic pain patient, (2) an approximate assessment of the level of pain acceptance issues is offered to the clinician, and (3) good opportunities for a therapeutic discussion on pain acceptance are made available. The clinical pain acceptance Q-sort procedure may positively contribute to daily clinical work with pain acceptance in a straightforward way. The method provides options for assessment of pain acceptance, for better understanding of the patient, and for clinical training in psychological pain management.     

Inhibition and blindness to response-compatible stimuli: a reappraisal

Recent studies show that the preparation of an action can interfere with the concurrent detection and identification of objects that share features with this action, a phenomenon termed blindness to response-compatible stimuli. In order to account for the blindness effect, an integration mechanism for response features similar to the one suggested for object features has been proposed. In the present article, we propose an alternative explanation, namely an action-effect inhibition mechanism. This mechanism was demonstrated in two versions of a dual-task experiment using a primary stop-signal task. The results showed that when the primary response was withheld (signal-inhibit trials), this resulted in lower identification rates for compatible secondary task stimuli. On the other hand, we did not find any evidence for a blindness effect when the primary response was executed (no-signal trials). Additionally we found that identification rates depended on the time course of the inhibition process as estimated from our data. Consequently, the blindness effect seems to result from the requirement to inhibit the response, perhaps even if only temporary.     

Hypnosis and clinical pain

Hypnosis has been demonstrated to reduce analogue pain, and studies on the mechanisms of laboratory pain reduction have provided useful applications to clinical populations. Studies showing central nervous system activity during hypnotic procedures offer preliminary information concerning possible physiological mechanisms of hypnotic analgesia. Randomized controlled studies with clinical populations indicate that hypnosis has a reliable and significant impact on acute procedural pain and chronic pain conditions. Methodological issues of this body of research are discussed, as are methods to better integrate hypnosis into comprehensive pain treatment.     

Self-monitoring: appraisal and reappraisal

Theory and research on self-monitoring have accumulated into a sizable literature on the impact of variation in the extent to which people cultivate public appearances in diverse domains of social functioning. Yet self-monitoring and its measure, the Self-Monitoring Scale, are surrounded by controversy generated by conflicting answers to the critical question, Is self-monitoring a unitary phenomenon? A primary source of answers to this question has been largely neglected--the Self-Monitoring Scale's relations with external criteria. We propose a quantitative method to examine the self-monitoring literature and thereby address major issues of the controversy. Application of this method reveals that, with important exceptions, a wide range of external criteria tap a dimension directly measured by the Self-Monitoring Scale. We discuss what this appraisal reveals about with self-monitoring is and is not.     

Stiff-person syndrome: autoimmunity and the central nervous system

Stiff-person syndrome (SPS) is a rare disease of severe progressive muscle stiffness in the spine and lower extremities with superimposed muscle spasms triggered by external stimuli. Patients with SPS are often referred for psychiatric evaluation and the psychiatrist may be the first to diagnosis SPS. Psychosocial stressors often precede the first manifestations of the disease; depression, anxiety, and alcohol abuse are comorbid illnesses. The identification of an association with antibodies to glutamic acid decarboxylase (GAD) was invaluable for definitively establishing a pathological basis for the disease; antibodies to amphiphysin and gephyrin are also found in cases of SPS but at much lower frequencies. Whether the antibodies inhibit GAD activity in vivo, target GAD-expressing neurons for immune-mediated destruction, are part of a wider immune process, or are merely a marker for destruction of GAD-expressing neurons by an independent neurodegenerative process is not yet clear. Both electromyography and the detection of GAD antibodies are useful in establishing a diagnosis of SPS. Treatment of SPS includes the use of immunomodulating therapies (plasmapheresis and intravenous immunoglobulins) and symptomatic treatment with benzodiazepines and baclofen. The use of tricyclic antidepressants and rapid withdrawal from therapy should be avoided.     

Emotion regulation in schizophrenia: affective, social, and clinical correlates of suppression and reappraisal

Individuals can exert considerable control over their experience and expression of emotion by applying different regulatory strategies such as reappraisal and suppression. However, although it has been suggested that blunted affect in schizophrenia, characterized by markedly reduced emotion expressivity alongside apparently normal emotion experience, may reflect overuse of suppression, no study to date has assessed self-reported use of these different emotion regulatory strategies in relation to this disorder. In the present study, 41 individuals with schizophrenia and 38 control participants completed a self-report measure that differentiated between use of suppression and reappraisal. Symptom severity and various aspects of cognitive and psychosocial functioning were also assessed. Relative to controls, individuals with schizophrenia did not differ with regard to their reported use of suppression and reappraisal, and reported use of both strategies was unrelated to clinical ratings of blunted affect. However, whereas (lower) use of reappraisal was associated with greater social function impairment for both groups, only for controls was (greater) use of suppression associated with reduced social functioning. Implications for understanding blunted affect and social dysfunction in schizophrenia are discussed.     

Measuring clinical pain

There are two goals in attempts to measure, the intention to describe and the intention to compare. These two functions work hand in hand and are brought to fruition in psychological and educational testing only by psychometrics that can produce person-free item calibrations and item-free person measures. The only such psychometrics that currently exist is that based on George Rasch's work. One of the consequences of using the tools Rasch left us is the Pain Scale, a rating scale that asks the person in pain to compare the intensityof his/her own pain with that he/she imagines is described by some 25 adjectives. Analyses of the responses of 53 people with chronic lower back pain to the Pain Scale using the Rasch partial-credit latent-trait model show that they were very much in agreement about the amount of hurt implied by each of the adjectives. An examination of person fit to the partial-credit model gave no hint of a response set in the data but two people did differ very much from their peers in their operational definitions of back pain and were studied separately. The evidence from these two people suggested that they either could not understand the task before them or could not get enough perspective on their pain to describe its intensity.I would like to thank Benjamin Wright and Geoff Masters for their help with this research. Drs. David J. Smith and James B. Boscardin were the first to bring my attention to the problem of measuring pain and were generous in their financial support of this work.     

Delirium and isolated angiitis of the central nervous system: a case report and review

Central nervous system (CNS) vasculitis is a rare entity, especially when it occurs in isolation; it is seen more commonly as part of a multisystem vasculitis. Common presenting symptoms include persistent headache, encephalopathy, and multifocal signs. We discuss the case of a 68-year-old female who presented twice in 1 month with confusion and choreaform movements. Extensive workup was negative for a connective tissue disease or other conditions in the differential, including neurosarcoidosis, Creutzfeldt-Jakob disease, and neurosyphilis. The only significant findings were elevated erythrocyte sedimentation rate, inflammatory signs in the CNS, and diffuse slowing of the electroencephalogram. A presumptive diagnosis of isolated angiitis of the central nervous system (IACNS) was made and the patient was successfully treated with steroids. She recovered fully with no residual symptoms. The diagnosis of IACNS is often difficult given there are no definitive laboratory investigations or pathognomonic presentation. However, a series of signs, symptoms, and laboratory findings have been proposed that are helpful in making the diagnosis. To our knowledge, IACNS presenting primarily with delirium has not been previously reported in the literature. The diagnosis of IACNS is purely speculative for this case, as the gold standard for diagnosis, a leptomeningeal cortical biopsy, was not performed.     

Uneasiness with facet analysis: time for a reappraisal

Although already several decades old, the facet analysis (also called facet theory) has not been able to assert itself in the field of psychology. Here the reasons for the widespread uneasiness with the facet analysis will be presented starting with an outline of the approach. This will make it clear that the facet analysis does not represent a research method in the narrower sense and definitely not a "theory" but a method with the status of a logical principle of thought. In experimental psychology this principle has been used successfully for a long time in the form of multifactorial experimental designs. However, multifactorial measurement designs are still few and far between in differential and diagnostic psychology. This can be explained especially by the fact that an important aspect of validity--the validity of construct differentiations--has been ignored. Because of a principle rejection of factor analytic methods, even the proponents of the facet analysis have overlooked the central contribution of their approach with respect to the validity of measurement methods.     

Acute pain in a clinical setting: Effects of cognitive-behavioural skills training

The present study evaluated the efficacy of cognitive-behavioural skills training, patterned after stress-inoculation training, as a preventive intervention for the attenuation of acute clinical pain during a noxious X-ray procedure—the knee arthrogram. Thirty-six adult male outpatients were randomly assigned to one of three groups: Skills Training. Attention-Placebo, and No-Treatment Control. An experimental pain test was administered before and after the interventions, as a generalization measure. Arthrogram pain was assessed by three dependent measures: patient's ratings, radiologist's ratings and videotape ratings completed by two‘blind’ raters. The results failed to support the efficacy of skills training for the attenuation of acute clinical pain, or its generalization to the experimental pain test. Although Skills Training subjects reported using significantly more coping strategies during the arthrogram. many subjects in the two control groups also reported using their own spontaneous strategies. Equivocal data were obtained on the role of ‘self-efficacy’ expectancies in mediating pain behaviour and experience. Experimental pain threshold but not pain tolerance was significantly related to acute clinical pain experienced during the arthrogram.     

Strength of the nervous system and augmenting-reducing: Paradox lost

Two conflicting viewpoints were identified regarding the relationship between sensation seeking and subjective response to stimulation: (a) that sensory augmenters are high sensation seekers compared with sensory reducers (the view of Zuckerman and Buchsbaum); and (b) that it is the reducer rather than the augmenter who is the high sensation seeker (the view of Petrie and Vando). Proponents of the first approach measure Augmenting-Reducing through the use of the average cortical-evoked response, while advocates of the second position use Petrie's version of the Kinaesthetic Figural Aftereffects Test or Vando's Reducer-Augmenter Scale. It is argued that the disagreement is semantic and results from the differences in method of measurement. It is further argued that most, if not all, of the research findings may be accommodated within the framework of strength-of-the-nervous-system theory which distinguishes between two dimensions,sensitivity andfunctional endurance. The implications for future research are pointed out.