The role of pain anxiety, coping, and pain self-efficacy in rheumatoid arthritis patient functioning

Anxiety about pain is increasingly recognized as one factor contributing to increased pain perception and pain behavior [McCracken, L. M., Faber S. D., & Janeck A. S. (1998) Pain-related anxiety predicts nonspecific physical complaints in persons with chronic pain. Behavior Research and Therapy, 36, 621-630; McCracken L., & Gross R. (1995). The pain anxiety symptoms scale (PASS) and the assessment of emotional responses to pain. Innovations in clinical practice: a source book, 14, 309-321]. To assess this emotional reaction to pain in chronic pain patients, McCracken, Zayfert and Gross [McCracken, L., Zayfert, C., & Gross, R. (1992). The Pain Anxiety Symptom Scale: development and validation of a scale to measure fear of pain. Pain, 50, 67-73] developed the Pain Anxiety Symptom Scale (PASS) composed of four subscales: Cognitive Anxiety, Fearful Appraisal, Escape Avoidance and Physiological Anxiety. The present study extended previous work by examining the relationship among pain anxiety dimensions, use of active and passive coping strategies and arthritis self-efficacy as predictors of functional status in 154 rheumatoid arthritis (RA) patients. Functional status was assessed using the Five-Factor Model of the Arthritis Impact Scale, 2nd ed., (AIMS2): Physical Functioning, Affective Experience, Symptoms, Social Interaction and Role Function. Hierarchical multiple regression analysis on each of the AIMS2 criterion variables showed that pain anxiety, pain and symptom self-efficacy, health status and coping strategies were able to explain between 9 and 38% of the variance in the five AIMS2 variables. The present results support the hypothesized role of pain anxiety along with previously established contributions of self-efficacy and coping strategies, in affecting physical, social, emotional and role functioning in chronic RA patients.     

The role of disgust and fear in blood and injection-related fainting symptoms: A structural equation model

Structural equation models were used to examine the relationship of blood, injection, and injury (BII) fears, disgust sensitivity, and trait anxiety to having experienced fainting-related symptoms in 722 university students. The latent variable representing BII fears was highly positively related to faint symptoms whereas that relating to disgust experiences was inversely related to fainting. A second disgust sensitivity variable was not directly related to fainting. Trait anxiety added nothing directly to the model, although it was related to BII latent variable. Additional analyses included a gender-related cross-validation which showed that models developed on one gender group did not fit well when applied to the other gender group. Blood drawings were the most common faint eliciting situations and were found to be reportedly more likely to elicit faint symptoms than were injections.     

Development and initial validation of the medical fear survey-short version

The present investigation employs item response theory (IRT) to develop an abbreviated medical fear survey (MFS). Application of IRT analyses in study 1 (n = 931) to the original 50-item MFS resulted in a 25-item shortened version. Examination of the location parameters also resulted in a reduction of the Likert-type scaling of the MFS by removing the last response category ("terror"). The five subscales of the original MFS were highly correlated with those of the MFS-short version. The short version also displayed comparable convergent and discriminant validity with the original MFS in relation to measures of fear, disgust, and anxiety. Confirmatory factor analysis in Study 2 revealed that the five-factor structure of the MFS-short form fit the data well in U.S. (n = 283) and Dutch (n = 258) samples. The short form also had comparable convergent and discriminant validity with the original MFS in relation to domains of disgust in both samples. Receiver operating characteristic (ROC) analysis in Study 3 demonstrated that the subscales of the short version were comparable with the original MFS in classifying participants high (n = 40) and low (n = 40) in blood/injection phobia. Last, structural equation modeling in Study 4 (n = 113) revealed that the MFS-short form demonstrated excellent convergent/discriminant validity with strong associations with injection fear and no association with spider fear. These findings suggest that the MFS-short form has considerable strengths, including decreased assessment time, while retaining sound psychometric properties.     

The Mutilation Questionnaire as a predictor of blood/injury fear and fainting

The Mutilation Questionnaire, (MQ) was examined in terms of its psychometric characteristics, its relation to Fear Survey Schedule-II Blood/Injury items, its ability to predict B/I-related fainting, a response common to many B I fearful persons, and its factor structure. In two separate samples of college subjects, females reported greater B/I fear than males, the distributions were positively skewed and negatively kurototic but internal consistency was adequate in both. The MQ correlated 0.75 with five B/I items taken from the FSS-II. While these two scales were comparable in assessing self-reported B/I fear, the MQ was more predictive of fainting. Discriminant analyses of the 30 MQ items in relation to prediction of subjects' faint histories resulted in 77% correct classification of faint history. However, responses to a single question concerning subjects' self assessment of B/I fear was equally as capable of classifying fainting status as the full MQ scale. Responses to the single fear question correlated 0.55 with faint history while MQ scores correlated only 0.45. Factor analyses of the MQ revealed two factors described as 'revulsion of B/I stimuli', accounting for 19% of item variance and 'fear of bodily damage', accounting for 7%. Implications of these results are discussed in terms of the FSS-II, the MQ and alternative means of B/I fear assessment.     

Representations for biased numerical judgments

Models are presented that introduce bias parameters into the numerical representations for ratio and interval judgments. An interval bias model is considered that has the capability of accounting for both interval and ratio judgments. A contrasting ratio bias model—a simple generalization of the classical model that accepts ratio judgments at face value—is also considered, and both models are tested with brightness data. The ratio estimation data lead to the conclusion that the constraints placed on the structure of the data by the classical model are too strong. In terms of goodness-of-fit and certain theoretical criteria, the interval bias model accounts for the ratio estimation data better than the ratio bias model. The interval estimation data are supportive of recent efforts directed toward the development of direct interval scaling theory.     

Beyond fast mapping: young children's extensions of novel words and novel facts

L. Markson and P. Bloom (1997) concluded that there was evidence against a dedicated system for word learning on the basis of their finding that children remembered a novel word and a novel fact equally well. However, a word-learning system involves more than recognition memory; it must also provide a means to guide the extension of words to additional exemplars, and words and facts may differ with regard to extendibility. Two studies are reported in which 2-4-year-old children learned novel words and novel facts for unfamiliar objects and then were asked to extend the words and facts to additional exemplars of the training objects. In both studies, children extended the novel word to significantly more category members than they extended the novel fact. The results show that by 2 years of age, children honor the necessary extendibility of novel count nouns but are uncertain about the extendibility of arbitrary facts.     

Disgust sensitivity and contamination fears in spider and blood-injection-injury phobias

Disgust has been implicated in the onset and maintenance of blood-injection-injury (BII) and animal phobias. Research suggests that people with these phobias are characterized by an elevated sensitivity to disgust-evoking stimuli separate from their phobic concerns. The disgust response has been described as the rejection of potential contaminants. Disgust-motivated avoidance of phobic stimuli may therefore be related to fears of contamination or infection. The present study compared BII phobics, spider phobics and nonphobics on two measures of disgust sensitivity and two measures of contamination fears. Positive correlations were found between disgust sensitivity and contamination fear. Specific phobics scored higher than nonphobics on all scales and BII phobics scored higher than spider phobics on contamination fear measures. Furthermore, the contamination fear scales were correlated with the blood phobia measure, but not correlated with the spider phobia measure. The results suggest that while both phobias are characterized by elevated disgust sensitivity, contamination fear is more prominent in BII than spider phobia.