There’s More Than Catastrophizing in Chronic Pain: Low Frustration Tolerance and Self-Downing Also Predict Mental Health in Chronic Pain Patients

Among the potential range of irrational beliefs that could be used as predictors of physical and mental health, catastrophizing is the process that has received most attention in chronic pain research. Other irrational processes such as demandingness, low frustration tolerance, and self-downing have rarely been studied. The goal of this study was to explore whether this wider range of beliefs is associated with health in chronic pain patients beyond catastrophizing. A total of 492 chronic pain patients completed a measure of irrational beliefs, a measure of physical and mental health, and a numerical rating scale designed to assess pain intensity and interference. Irrational processes were more strongly associated with mental than with physical health. Low frustration tolerance and self-downing were found to be significantly related to mental health even after controlling for the effect of catastrophizing. Processes other than catastrophizing appear to have potentially important relationships with the mental health of people with chronic pain. These results may offer new intervention targets for practitioners.     

“Ghosts in the Psychoanalytic Nursery”: Response to Lieberman & Harris

In this discussion, I elaborate on the question of why fear, per se, has been relatively absent from psychoanalytic dialogues, and of how to think about the relative primacy of fear, aggression, and infantile sexuality. In response to Harris, I consider some of the ways that contemporary neuroscience and evolutionary theory deepen this discussion. And, following Lieberman, I reflect on why it can be so difficult to hold and process our patients’ fear and trauma.     

Relation between coping and posttrauma cognitions on PTSD in a combat-trauma population

Individual differences in cognitive processes and coping behaviors play a role in the development and maintenance of posttraumatic stress disorder (PTSD). Given the large numbers of combat-exposed service members returning from the Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) conflicts, exploring individual differences in cognitive-affective processes is important for informing our understanding of PTSD etiology and early intervention in military samples. The present study examined the unique main and interactive effects of negative posttrauma cognitions (i.e., negative beliefs about self [NS], the world [NW], and self-blame [SB]) and coping strategies (i.e., positive behavioral, positive cognitive, avoidant coping, and social and emotional coping) on PTSD diagnosis within 155 (M_age = 30.7, SD = 4.48) OEF/OIF/OND combat trauma-exposed Veterans recruited from an ongoing study examining the effects of combat trauma and stress reactivity. In the final, stepwise logistic regression analysis, avoidant coping, but no other coping strategy, was significantly positively related to PTSD diagnosis in the initial step. Higher levels of NS, but not NW, were significantly associated with having a PTSD diagnosis, whereas SB was associated with decreased likelihood of PTSD, above and beyond coping strategies. A significant interaction effect was found between NS and positive cognitive coping, such that greater positive cognitive coping weakened the relationship between NS and PTSD. Examining and addressing coping behaviors and negative thoughts of self jointly may benefit assessment and intervention approaches in a combat-trauma population.     

Review and Comparison of Electronic Patient-Facing Family Health History Tools

Family health history (FHx) is one of the most important pieces of information available to help genetic counselors and other clinicians identify risk and prevent disease. Unfortunately, the collection of FHx from patients is often too time consuming to be done during a clinical visit. Fortunately, there are many electronic FHx tools designed to help patients gather and organize their own FHx information prior to a clinic visit. We conducted a review and analysis of electronic FHx tools to better understand what tools are available, to compare and contrast to each other, to highlight features of various tools, and to provide a foundation for future evaluation and comparisons across FHx tools. Through our analysis, we included and abstracted 17 patient-facing electronic FHx tools and explored these tools around four axes: organization information, family history collection and display, clinical data collected, and clinical workflow integration. We found a large number of differences among FHx tools, with no two the same. This paper provides a useful review for health care providers, researchers, and patient advocates interested in understanding the differences among the available patient-facing electronic FHx tools.     

Linkages between Interparental Conflicts and Adjustment of Adolescents in Hong Kong: The Mediating Role of Locus of Control

Journal of Child and Family Studies - Interparental conflicts have long been recognized as a risk factor for maladjustment in adolescents. Many studies have been conducted to examine mediators that...     

predicting job decisions in tomorrow's workforce

The Job Decision Factors Survey used policy capturing to measure the influence of 7 factors on job decisions. Data from 400 undergraduate students at a large university, 88% 18–25 years of age, 12% 25–65 years of age, 82% female, 54% White, 21% Asian, 10% Black, 10% Hispanic, 1% American Indian, were included in a regression analysis. Hypothesis 1, the significance of the 7‐factor model, was supported (R² = .02). Hypothesis 2, opportunities to learn accounting for more variance than compensation, was supported (β = .11, β = .06, respectively). Job counselors should consider highlighting learning opportunities when counseling or interviewing similar populations.     

Psychological Strengths and Cognitive Vulnerabilities: Are They Two Ends of the Same Continuum or Do They Have Independent Relationships with Well-being and Ill-being?

Research programs examining psychological strengths and vulnerabilities have remained largely separate, making it difficult to determine the relative contributions of strengths and vulnerabilities to well-being. Two studies (241 normals, 54 depressed outpatients) compared certain psychological strengths (Transcendence subscales, Values In Action Inventory of Strengths) and cognitive vulnerabilities (Dysfunctional Attitudes Scale). In multiple regression, strengths usually related more to positive well-being—life satisfaction, positive affect, vitality, meaning, elevating experience—though vulnerabilities also related to the first three variables; vulnerabilities related more to illbeing—negative affect, depression—though hope, humor, enthusiasm, and forgiveness sometimes also showed relationships. Pre-treatment strengths (hope, spirituality, appreciation of beauty and excellence) predicted post-treatment recovery from depression; cognitive vulnerabilities did not. Strengths and vulnerabilities sometimes interacted, with strengths weakening the relationship between vulnerabilities and well-being. Our findings indicate that strengths and vulnerabilities are not mere opposites (correlating at most moderately) and deserve study as distinct contributors to well-being.     

Sex Differences in the Presentation of Chronic Low Back Pain

Sex differences in 351 patients with chronic low back pain were examined. Biological, psychological, and psychosocial factors were considered. Sex differences in adaptive functioning were consistent with traditional gender roles. Significant interactions were found for sex and employment status, and sex and marital status. Retired women reported more pain and less activity than retired men. Retired men reported the least pain of any group. Outdoor work and social activities show opposite within–group patterns for men and women when stratified by employment status. Marriage was associated with more household work for women and less for men. The financial and social contexts of employment status and marriage are different for men and women. Results suggest the treatment of women with chronic low back pain requires attention to work in the home and the financial and social context of work outside the home.     

The Family Cycle: Breaking the Intergenerational Transmission of Trauma through Mentalizing

ABSTRACT

In recent years, attachment and mentalization theory have been used to guide and inform clinical work with complex, vulnerable adults and children, who struggle to make sense of their own experience or to understand and reflect upon the thoughts and feelings of others. Traumatized parents often have difficulty reflecting upon their children’s thoughts and feelings, at great cost to the child’s sense of trust and safety in the world. In this paper we describe the use of the Family Cycle a clinical activity designed to promote mentalizing in high-risk parents and children with histories of significant and often chronic developmental trauma – with parents whose children are enrolled in an intensive home visiting program aimed at avoiding psychiatric hospitalization. Our aim is to both help them make meaning of their own histories, and understand how these have, in turn, impacted their children. We first present the Family Cycle activity generally, and then use case material to describe its use with a parent in our program.     

Dating Violence Victimization,Dispositional Aggression,and Nonsuicidal Self‐Injury among Psychiatrically Hospitalized Male and Female Adolescents

The objective of the current study was to characterize the association between dating violence victimization and dispositional aggression in predicting nonsuicidal self‐injury (NSSI) among psychiatrically hospitalized male and female adolescents. One hundred fifty‐five adolescents (ages 13–17) and their parents completed the Schedule for Affective Disorders and Schizophrenia for School‐Age Children clinical interview to assess NSSI and child abuse; adolescents completed self‐report measures of aggression and dating violence victimization (verbal, physical, and sexual). Dating violence victimization and NSSI were found to be highly prevalent among both males and females in this psychiatric inpatient sample. Two moderational models were supported, wherein dating violence was associated with NSSI in the context of elevated trait anger in males and indirect aggression in females. Findings suggest that helping victims of dating violence acquire skills to address certain forms of dispositional aggression may attenuate NSSI.