Implications of placebo theory for clinical research and practice in pain management

We review three possible theoretical mechanisms for the placebo effect: conditioning, expectancy and endogenous opiates and consider the implications of the first two for clinical research and practice in the area of pain management. Methodological issues in the use of placebos as controls are discussed and include subtractive versus additive expectancy effects, no treatment controls, active placebo controls, the balanced placebo design, between- versus within-group designs, triple blind methodology and the double expectancy design. Therapeutically, the possibility of shaping negative placebo responses through placebo sag, overservicing and the use of placebos on their own are explored. Suggestions for using conditioned placebos strategically in conjunction with nonplacebos are made and ways of maximizing the placebo component of nonplacebo treatments are examined. Finally, the importance of investigating the placebo effect in its own right is advocated in order to better understand the long-neglected psychological aspects of the therapeutic transaction.     

Sex differences in response to physical and nonphysical instigators

One hundred and twenty subjects competed in a reaction-time task similar to that of Taylor (1967). Subjects were randomly assigned to a white noise, fine, or control condition. In the fine and noise conditions programmed opponents administered increasing provocation to subjects over a series of 24 trials. Control subjects were not provoked. As predicted, males retaliated with higher levels of noise than did females, while there were no sex differences in the fine condition. Contrary to prediction, sex of opponent had no effect. Subjects in all conditions tended to view the task as competitive but to devalue their opponent only in the noise condition. The prevalent assumption of female passivity in the face of instigation was rejected. Instead a dichotomy was proposed that while females are less likely than males to reciprocate to physical provocation, they are just as likely to respond to provocation of a nonphysical nature.Parts of this article were presented at the meeting of the American Psychological Association, Chicago, September 1975. Critical comments by Edward Donnerstein and Arnold Kahn on an earlier draft of this article are gratefully acknowledged.     

The Hopelessness Scale for Children: Psychometric properties with normal and emotionally disturbed adolescents

The psychometric properties of the Hopelessness Scale for Children (HSC) were evaluated with a sample of 834 normal adolescents and 93 adolescent suicide attempters. Factor analyses studies revealed two factors with both groups. Internal consistency with item-total score correlations were acceptable, while moderate test-retest reliability was found over a 10-week period with the normal sample. Support for the validity of the HSC was provided via studies with the suicide attempter group in which positive correlations with depression and depressive attributional style were found. Predicted differences between the suicide attempters, an outpatient psychiatric sample, and normal controls were also found. However, some items did not appear to discriminate suicide attempters from controls. Results are discussed in terms of the utility of the HSC with adolescents and adolescent suicide attempters and with regard to differences between child and adult samples in hopelessness.     

CHILD-REARING ATTITUDES OF CHINESE,CHINESE-AMERICAN,AND ANGLO-AMERICAN MOTHERS

Three groups of mothers with different cultural backgrounds, 397 Chinese living in Taiwan, 95 Chinese-Americans immigrated from Taiwan, and 213 Anglo-Americans, were administered the Parental Attitude Research Instrument (PARI). Significant differences were found on all three attitudinal factors and on all 23 attitudinal scales. The results showed that (1) the Chinese mothers were most restrictive, the Anglo-American mothers were least restrictive, and the Chinese-American mothers were intermediate on the continuum of authoritarian-control; (2) the Chinese-American mothers were more likely to approve the expression of hostility or rejection than the Chinese or Anglo-American mothers; (3) the Chinese-American mothers were more democratic than the Chinese mothers, and the Chinese mothers, more democratic than the Anglo-American mothers.     

The role of temporal shifts in turnover processes: it's about time

To better understand the process of organizational withdrawal, a turnover model incorporating dynamic predictors measured at 5 distinct points in time was examined by following a large occupationally and organizationally diverse sample over a 2-year period. Results demonstrated that turnover can be predicted by perceived costs of turnover, organizational commitment, and critical events measured soon after entry into the organization. Occupational unemployment rates, job satisfaction, and search for alternative jobs also become significant predictors when measured over time. Critical events predicted turnover in a manner distinct from the operation of attitudes, consistent with the unfolding model (Lee & Mitchell, 1994). The path to turnover was marked by consistently low perceived costs of turnover and satisfaction, decreases in commitment, and increases in job search over time.     

Job-search persistence during unemployment: a 10-wave longitudinal study

Dynamic predictors of job-search intensity over time are examined in a large 10-wave longitudinal study of unemployed individuals. Two sets of variables relevant to the examination of job search from a dynamic, self-regulatory perspective--core self-evaluations (T. A. Judge, A. Erez, & J. E. Bono, 1998) and the theory of planned behavior (I. Ajzen, 1991)--were used to guide our examination. Results suggest core self-evaluation is related to average levels of job-search intensity over time. Job-search intentions mediated the relationship between subjective norms and job-search self-efficacy in the prediction of job-search intensity in the following 2 weeks. Both Time 1 and cumulative job-search intensity predict reemployment. This repeated-measures study contributes to research on job search that has been primarily cross-sectional or included few time waves.     

Factors Influencing Condom Use Among African American Women: Implications for Risk Reduction Interventions

Examined factors associated with condom use in a community-based sample of 423 sexually active African American women. Measures were selected to reflect the components in prevailing models of health behavior. Condom users were higher on AIDS health priority, prevention attitudes, stage of change, behavioral intentions, reported more frequent and comfortable sexual communication with partners, perceived greater partner and peer approval for condom use, and reported that peers also used condoms. Women in exclusive relationships evidenced earlier stage of change, lower intentions to use condoms, fewer peers who engaged in preventive behaviors, perceived themselves to have lower risk, and had lower rates of condom use, higher education, and family income. Women in fluid relationships were at particularly high risk, with lower rates of condom use relative to women not in a relationship and greater sexual risk for HIV. Implications for HIV-risk reduction interventions with African American women are discussed.     

Do Professional Women Have Lower Job Satisfaction Than Professional Men? Lawyers as a Case Study

A central paradox in studies of gender and jobsatisfaction is why women's job satisfaction is notlower than men's, given that women's jobs are ofteninferior. The explanation most commonly used is that women have lower expectations than men becausethey compare themselves to women while men comparethemselves to men. However, general studies maybemasking a gender difference in higher occupationallevels. The current study explores this possibility byanalyzing the 326 lawyers in the 1990 National Survey ofLawyers' Career Satisfaction. Of the women, 9% wereminorities, and of the men, 3%. It is found that women have significantly lower jobsatisfaction. Women's lower job satisfaction is dueprimarily to their lack of influence and promotionalopportunity. The results support the assertion thatprofessional women have the same expectations asprofessional men, not lower, but because of inequalityin opportunity, the women have lower jobsatisfaction.