Invited Special Review: Psychological Approaches for Managing Chronic Pain

Psychologists have had an important impact on the conceptualization, assessment, and treatment of chronic pain. Their contributions have been in the areas of emotional distress, behavioral limitations, cognitive mediating events, and psychosocial disruption of chronic pain. These foci have enabled them to clarify the multidimensional nature of chronic pain and to support the biopsychosocial framework as a conceptual guide for research and clinical purposes. Clinically, along with members of an interdisciplinary team, psychologists have a key role in the assessment and treatment of patients with chronic pain. Interdisciplinary collaboration allows the team to recognize important interactions between biomedical and psychosocial dimensions and to appreciate a broader conceptualization of patients' problems. The literature documents strong empirical support for operant-behavioral and cognitive-behavioral therapies for the treatment of chronic pain. On the other hand, although widely accepted from a clinical perspective, the use of motivational interviewing and motivational enhancement therapies is more recent and less well documented for use with patients with chronic pain.     

Flexible and inflexible task sets: asymmetric interference when switching between emotional expression, sex, and age classification of perceived faces

The present study investigated whether the processing characteristics of categorizing emotional facial expressions are different from those of categorizing facial age and sex information. Given that emotions change rapidly, it was hypothesized that processing facial expressions involves a more flexible task set that causes less between-task interference than the task sets involved in processing age or sex of a face. Participants switched between three tasks: categorizing a face as looking happy or angry (emotion task), young or old (age task), and male or female (sex task). Interference between tasks was measured by global interference and response interference. Both measures revealed patterns of asymmetric interference. Global between-task interference was reduced when a task was mixed with the emotion task. Response interference, as measured by congruency effects, was larger for the emotion task than for the nonemotional tasks. The results support the idea that processing emotional facial expression constitutes a more flexible task set that causes less interference (i.e., task-set "inertia") than processing the age or sex of a face.     

Block of glucocorticoid synthesis during re-activation inhibits extinction of an established fear memory

BackgroundThe pharmacology of traumatic memory extinction has not been fully characterized despite its potential as a therapeutic target for established, acquired anxiety disorders, including post-traumatic stress disorder (PTSD). Here we examine the role of endogenous glucocorticoids in traumatic memory extinction.MethodsMale C57BL/6J mice were injected with corticosterone (10 mg/kg, i.p.) or metyrapone (50 mg/kg, s.c.) during re-activation of a contextual fear memory, and compared to vehicle groups (N = 10–12 per group). To ensure that metyrapone was blocking corticosterone synthesis, we measured corticosterone levels following re-activation of a fear memory in metyrapone- and vehicle-treated animals.ResultsCorticosterone administration following extinction trials caused a long-lasting inhibition of the original fear memory trace. In contrast, blockade of corticosteroid synthesis with metyrapone prior to extinction trials enhanced retrieval and prevented extinction of context-dependent fear responses in mice. Further behavioral analysis suggested that the metyrapone enhancement of retrieval and prevention of extinction were not due to non-specific alterations in locomotor or anxiety-like behavior. In addition, the inhibition of extinction by metyrapone was rescued by exogenous administration of corticosterone following extinction trials. Finally, we confirmed that the rise in corticosterone during re-activation of a contextual fear memory was blocked by metyrapone.ConclusionsWe demonstrate that extinction of a classical contextual fear memory is dependent on endogenous glucocorticoid synthesis during re-activation of a fear memory. Our data suggest that decreased glucocorticoids during fear memory re-activation may contribute to the inability to extinguish a fear memory, thus contributing to one of the core symptoms of PTSD.     

Panorama

Panorama

Panorama     

Independence of serial position and response conflict in pre-planned manual response sequences

The present study investigates the effect of spatial stimulus–response correspondence (i.e. Simon effect) in pre-planned manual response sequences. Participants performed pre-cued response sequences consisting of three (Experiment 1) or four (Experiments 2 and 3) key-presses at different locations. Importantly, participants performed each response to a visual go signal, which appeared at a location corresponding to one response in the sequence. This task allowed investigating interference gradients across spatially noncorresponding conditions. We observed a Simon effect at each serial position, that is, RT for the corresponding condition was always shorter than RT for each noncorresponding condition. However, we failed to observe interference gradients from both preceding and subsequent responses in the sequence. These results are inconsistent with (1) a primacy gradient of activations representing serial order and (2) the temporary suppression of an executed response as a mechanism for preventing response repetitions. However, results provide indirect evidence for positional models of serial order.     

Losing the Certainty of Self

In his theory of trauma, Ferenczi points to the disbelief of adults of a child's account of an event as an actual traumatizing factor. Ferenczi also states that of all the consequences of the trauma, which include identification with the aggressor, psychic coma, departure from the possibility of dreams, and a fall to the hell of nightmares, the most important and fundamental is the lack of certainty of self. The disbelief of the adults destroys the certainty of what is perceived and experienced; it has the power of annihilating the child's belief in his own perceptions, his trust in his own senses. The loss of certainty of self appears to be a common characteristic in patients with distinct psychic dynamics. We will analyze the loss of certainty of self in cases of patients of the NEPECC (Núcleo de Estudos em Psicanálise e Clínica da Contemporaneidade) [Center of Studies in Psychoanalysis and Contemporarity Clinic] at the Federal University of Rio de Janeiro.     

Beyond Thinness: The Influence of a Curvaceous Body Ideal on Body Dissatisfaction in Black and White Women

This study examined whether a curvaceous body ideal differentially influenced sources of body dissatisfaction in 116 Black and 222 White women at a northeastern U.S. university. We measured idealization of and dissatisfaction with three components of a curvaceous ideal: breast size, buttock size, and weight. Although most women preferred a curvaceous body shape, more White women preferred this ideal to be slender with medium breasts whereas more Black women preferred this ideal to be curvier with medium breasts and large buttocks. Women discrepant from these ideals reported more dissatisfaction. Dissatisfaction with the curvaceous ideal predicted appearance concerns. Findings highlight the need to consider valued body ideals other than thinness as potential sources of dissatisfaction among women of different racial/ethnic backgrounds.     

Learning as a context for differences and differences as a context for learning

In this paper we describe how we, as two trainers with multiple differences, engaged with a group of trainees in a process of deconstructing the differences between the participants in the training group, using the acronym Social GRRAACCEESS as a heuristic. We will explore how these differences reflexively influenced the process of learning, through teaching, training and supervision, within the group.     

The tell-tale tasks: a review of saccadic research in psychiatric patient populations

This review focuses on saccade research with adult psychiatric patients. It begins with an introduction of the various types of saccades and the tasks used to evoke them. The functional significance of the different types of eye movements is briefly discussed. Research findings regarding the saccadic performance of different adult psychiatric patient populations are discussed in detail, with particular emphasis on findings regarding error rates, response latencies, and any specific task parameters that might affect those variables. Findings regarding the symptom, neurocognitive, and neural correlates of saccadic performance and the functional significance of patients’ saccadic deficits are also discussed. We also discuss the saccadic deficits displayed by various patient groups in terms of circuitry (e.g. cortical/basal ganglia circuits) that may be implicated in the underlying pathophysiology of several of these disorders. Future directions for research in this growing area are offered.