On the putative uniqueness of cancer pain: do psychological principles apply?

A large volume of evidence has supported the important role of psychological principles and variables related to the perception of, and response to, nociceptive stimulation. On the basis of this research, a number of psychological interventions have been developed and used successfully with pain patients. Despite the evidence, there has been a tendency for practitioners to neglect the contributing role of cognitive, affective, and behavioral factors in reports of pain by cancer patients. Cancer seems to hold a unique status in medicine and society at large. In this paper, the cancer pain literature is briefly reviewed and evidence is presented for various psychological determinants of the pain report and response that may be extended to pain associated with cancer. The implications of these data for understanding and treatment of cancer patients are described.     

The relationship of appraisal and coping to chronic illness adjustment

There is evidence that adaptation to chronic illness may be affected by psychological factors, especially how patients appraise and cope with the stress of their illness. The purpose of the present study was to examine the relationship of stress appraisal and coping responses to multiple behavioral indices of illness adjustment among patients with diverse chronic medical conditions. One hundred and one patients admitted to a multidisciplinary medicine/psychiatry unit completed measures of functional impairment, depression, symptom severity, and the Ways of Coping Checklist--Revised. Hierarchical regression analyses indicated that emotion-focused coping was positively related to poor psychosocial adjustment and depression after controlling for physician rated disease severity. Appraising chronic illness as holding one back predicted greater emotion-focused coping responses and poorer adjustment to illness. The use of problem-focused coping strategies was generally unrelated to illness adjustment. These findings suggest the presence of an emotion-focused coping triad consisting of wishful thinking, self blame, and avoidance, all of which appear to be maladaptive strategies when coping with chronic medical conditions. Implications for coping skills training and the need for longitudinal research is discussed.     

Pessimistic explanatory style and response to illness

Previous studies have shown that a pessimistic explanatory style is a risk factor for illness, but the factors linking explanatory style and illness are unknown. One's characteristic response to poor health may mediate this relationship. Perhaps pessimistic individuals act helplessly in the face of their symptoms, thereby exacerbating disease. In the present study, we investigated this possibility by asking 96 young adults to complete measures of explanatory style, habitual response to illness, and ways of coping during their most recent episode of illness. Subjects who explain bad events pessimistically (with internal, stable, and global causes) reported more frequent illnesses during the past year and rated their overall health more poorly than those who habitually favor external, unstable, and specific explanations. When ill, the pessimistic subjects were less likely than their optimistic counterparts to take active steps to combat their illness. Our results suggest that one pathway leading from pessimistic explanatory style to poor health is mundane: passivity in the face of disease.     

Additive latency effects of selective and nonselective restricted priming types

The purpose of this investigation was to examine further the contention of Alain et al. (1988) that a third priming type exists, called nonselective restricted (NSR) and controlled by response probability, which is distinct from those types influenced by foreperiod duration (nonselective general priming) and prediction probability (selective priming). In a four-choice reaction time (RT) task, prediction probability (.5, .7, & .9, indicating the likelihood of a particular response) and response probability (.5, .9, denoting the likelihood that a response would be needed at all) exerted significant but noninteractive effects on RTs for prepared responses (most probable), suggesting that each of these probabilities influence different priming types (Sternberg, 1969; selective and NSR, respectively). This was further indicated by the fact that prediction probability, but not response probability, significantly altered RTs for the unprepared (lesser probable) responses. Finally, the hypothesized nonselective character of NSR priming (i.e., all outputs controlled by response probability are equally affected by its value changes) was supported when responses were equiprobable, and, while the null effect of response probability just mentioned seemingly argued against this property when selective priming took place, the interpretation provided herein negated this opposition.     

Overt attempts to change hand preference: a study of group and individual characteristics

Previous work by Porac, Coren, and Searleman (1986) looked at overt attempts to change hand preference from the left to the right side. We extended this research by studying individuals who shifted their handedness from the left to the right side as well as a group who attempted a shift in the opposite direction (right to left). Comparisons of the two shift attempts revealed that the timing, method, and agent of change differed significantly for right versus left shifts. More right than left shifts were successful. Overall, most shift attempts were rated as unsuccessful because they did not result in a handedness classification consistent with the direction of the shift. Individuals classified as successful shifters, whether in the right or left direction, displayed a more ambihanded behavioural pattern than either unsuccessful shifters or the no shift control group. Evidence suggested that left-shift attempts were promoted by original ambihanded tendencies but that ambihandedness in successful right shifts stemmed from the partial success of the switch attempt.     

Event representation in Pavlovian conditioning: image and action

In a typical Pavlovian conditioning experiment, a relatively insignificant event, the conditioned stimulus (CS), is paired with a biologically more meaningful event, the unconditioned stimulus (US). As a consequence of those pairings, the CS is thought to acquire response characteristics of the US. In this article I describe experiments with rats that suggest that under some circumstances, the CS acquires control of perceptual processing of the US, in the absence of that US itself. I present three kinds of evidence for this surrogate processing, which I liken to imagery or hallucination: (1) CSs come to control specific, sensory-evaluative responses normally evoked only by the USs; (2) CSs can substitute for USs in the establishment of new learning about those USs themselves; (3) CSs can substitute for USs in the modulation of conditioning to other events, either overshadowing (interfering) or potentiating learning, in the same manner as the USs themselves. Finally, I compare these data with evidence for conditioned sensation and imagery in humans, and suggest that imagery may be a very basic process, evolutionarily derived from perceptual and conditioning processes adapted to deal with remote or absent objects.     

CONCEPTUALIZATIONS OF WORK,FAMILY AND LEISURE BY MANAGERS OF INFORMATION TECHNOLOGY*

This study analysed the way 20 managers in the information technology industry in Australia viewed their lives, and identified two dimensions of central importance cutting across the work, family and leisure spheres encompassed by them. One dimension was positively loaded towards activities which were challenging, creative and under the individual's control. These activities were enjoyable, and included examples such as consulting with clients, creating new business, and communicating and dealing with others, whether at work or at home. The opposite pole of this dimension involved activities such as completing paperwork, general administration, doing the shopping, and disciplining the children. Such activities were seen as necessary, routine or stressful, and were generally disliked. The other dimension dealt with activities which, at one pole, were emotionally involving or involved moral standards, and included examples such as attending meetings, doing things as a family, and settling disputes, either at work or at home. At the other pole were activities which were usually done alone and involved no sense of social or moral obligation. Leisure activities typically fell into this category. The results indicated that these managers generally pursued a lifestyle which was seen to be non-stressful, and one valued for the challenge, enjoyment, freedom of choice and personal control which it offered.     

Congruence of personality and life events in depression

Consistent with the personality-event congruence hypothesis, highly sociotropic depressed patients (n = 19) reported more recent negative interpersonal events than negative autonomy events and more negative interpersonal events than did highly autonomous depressed patients (n = 22), for whom the hypothesis was not supported. There was no evidence of such congruence among nondepressed schizophrenic patients (n = 44). In a second study, there was significant personality-event congruence in dysphoric students (n = 26) but not in nondysphoric students (n = 56). Both the high-sociotropy and high-autonomy dysphoric groups separately yielded nonsignificant trends consistent with congruence. These findings add to the growing support for the importance of the sociotropy construct in depression and weaker support for the autonomy construct or its measurement, and they suggest that the congruence effect does not generalize to all psychopathologies.     

The two faces of alcohol myopia: attentional mediation of psychological stress

Two studies provided evidence that alcohol's relationship to psychological stress is indirect and is mediated by the allocation of attention. Study 1 found that, as the attentional demands of a distracting activity increased, so did alcohol's reduction of anxiety. Study 2 replicated this effect and found that a highly demanding activity could reduce anxiety even without alcohol. This study further implicated the role of attention in anxiety reduction by demonstrating a relationship between changes in anxiety and response latency to a secondary monitoring task. Finally, in both experiments, intoxicated subjects who did not perform any activity showed an increase in anxiety. From these data, we argue that alcohol affects psychological stress, to an important degree, through its ability, in conjunction with ongoing activity, to affect the amount of attention paid to stressful thoughts.     

Peer-group association and adolescent tobacco use

Mosbach & Leventhal (1988) examined the relation of cigarette smoking to peer-group identification in rural Wisconsin adolescents. They found that among dirts (problem-prone youth), regulars (average youth), hot-shots (good social or academic performers), and jocks (athletes), youth most likely to smoke were dirts and hot-shots. We performed a replication with a Southern California cohort and also for use of smokeless tobacco. We hypothesized that jocks would be the main users of smokeless tobacco. We identified the same groups and an additional one, skaters (skateboarders or surfers). As Mosbach & Leventhal found, cigarettes were used most by dirts. Contrary to their results, but consistent with other research, we found that hot-shots were least likely to smoke. Contrary to our prediction, we found that skaters and dirts were more likely to use smokeless tobacco than were jocks. Our data show that both tobacco forms are used by problem-prone youth.