The fear-avoidance model of exaggerated pain perception—II: Preliminary studies of coping strategies for pain

The personal history of pain and personal coping strategies for pain are two of the contributory factors in the Fear-Avoidance Model of exaggerated pain perception proposed by Lethem, Slade, Troup and Bentley (1983, this issue, pp. 401–408). In order to test this aspect of the hypothesis, a questionnaire was designed and has been completed by 165 students (93 female, 72 male) at the University of Liverpool.They were asked about the severity of externally-produced pain (e.g. fracture), of internally-produced pain (e.g. headache) and of back pain; about the strategies they adopted for coping with internallyproduced pain (e.g. did they ignore the pain and carry on—an active strategy—or did they go and rest—a passive strategy); and about the effects of back pain on each of 10 activities or postures (from ‘no effect’ to ‘had to stop completely’) in order to obtain an index of back-pain avoidance.Out of 165, 91 reported previous back pain (Back Pain group) and their average rating for the severity of externally-produced pain was significantly higher than for the No Back Pain group; but there were no differences between these two groups for their coping strategies for internally-produced pain. However, of the Back Pain group with two or more previous attacks, 35 gave a history indicating decreasingly severe attacks and 28, increasingly severe: the coping strategies of the latter group for internally-produced pain were significantly more passive. The ratings for severity of back pain correlated significantly with the indices for back-pain avoidance and with the ratings for severity of internally-produced pain.These findings are in line with the prediction that personal pain history and personal coping strategies are relevant to the Fear-Avoidance Model of exaggerated pain perception and may therefore influence the adoption of an avoidance or a confrontation response by the patient with chronic back pain.     

Bringing a mentalizing framework to understanding mothers with addiction: The groundbreaking work of Nancy E. Suchman

Nancy Suchman is remembered as a pioneer whose mentalization-based intervention—Mothering from the Inside Out (MIO)—transformed the treatment of parents struggling with substance use disorders. Specifically, Suchman's work highlighted the neural mechanisms underlying substance use disorders and identified the promotion of parental mentalizing as a key therapeutic focus in enhancing early parent-child relationships. Her work transformed parenting support models for this population of parents. Several randomized controlled trials (RCT) show the effectiveness of MIO in promoting parental reflective functioning (PRF) and positive relational outcomes in parents with substance use disorders and their children. Suchman's MIO model has since been extended to parenting in many contexts. She is also remembered as a generous colleague, a gifted researcher and clinician, and an inspiration to generations of researchers and practitioners working with parents who aspire to raise healthy, secure children despite multiple challenges and adversities. This special issue compiles the work of researchers inspired by Suchman as they carry on her legacy in examining aspects of parental mentalization. Collectively, the research presented yields confirmation of MIO core assumptions, offers new insights into roles of positive sentiment and savoring in mentalization processes, and presents evaluations of MIO in multiple contexts and with new adaptations.     

Mindfulness and other Buddhist-derived interventions in correctional settings: A systematic review

Interest into the rehabilitative utility of Buddhist-derived interventions (BDIs) for incarcerated populations has been growing. The present paper systematically reviews the evidence for BDIs in correctional settings. Five databases were systematically searched. Controlled intervention studies of BDIs that utilized incarcerated samples were included. Jadad scoring was used to evaluate methodological quality. PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines were followed. The initial search yielded 85 papers, but only eight studies met the inclusion criteria. The eight eligible studies comprised two mindfulness studies, four vipassana meditation studies, and two studies utilizing other BDIs. Intervention participants demonstrated significant improvements across five key criminogenic variables: (i) negative affect, (ii) substance use (and related attitudes), (iii) anger and hostility, (iv) relaxation capacity, and (v) self-esteem and optimism. There were a number of major quality issues. It is concluded that BDIs may be feasible and effective rehabilitative interventions for incarcerated populations. However, if the potential suitability and efficacy of BDIs for prisoner populations is to be evaluated in earnest, it is essential that methodological rigor is substantially improved. Studies that can overcome the ethical issues relating to randomization in correctional settings and employ robust randomized controlled trial designs are favored.     

Holding the Baby in Mind: Discussion of Joseph Lichtenberg's “Communication in Infancy”

Joseph Lichtenberg suggests that infants are held in their caregivers' symbolic world before they create one of their own. This idea is addressed from the perspective of parental reflective functioning. This construct offers a means of further understanding how a caregiver's capacity to elaborate upon the mental life of her child sets the stage for the child's internal experiences becoming known and developed or distorted and stunted within the context of the relationship. These ideas both complement and expand upon the research and theoretical work described by Lichtenberg in his consideration of the development of communication with self and other in infancy.     

Antenatal predictors and use of coping strategies in labour

Abstract

One aim of antenatal preparation is developing coping strategies for use (luring labour. However, the existing literature suggests that attendance at classes is not associated with lower pain or distress, possibly because receiving training cannot be assumed to be associated with subsequent practice.

This study aimed to assess whether attenders at classes actually used their taught strategies in their labours, whether use was associated with psychological benefits and whether antenatal measures could predict subsequent use. Concepts from the theories of planned behaviour and self efficacy were used to attempt to predict use of three types of coping strategy.

Use was high for breathing strategies but poor for relaxation and posture. Proportion of use of breathing and relaxation showed weak associations with lower fear. Whilst intentions did act as significant predictors for use of posture and relaxation only small proportions of the variance were accounted for and other antenatal measures showed little predictive capacity.

Reasons why women in labour may fail to take behavioural consequences from their antenatal beliefs are considered. Predicting health-related behaviours where maintenance rather than just initiation is involved may require greater consideration of intra-situational and emotional factors. Modifications of antenatal preparation to facilitate use of strategies are discussed.     

The move from categories to process: Attachment phenomena and clinical evaluation

Despite the degree to which attachment theory and research have been embraced by clinicians in recent years, many remain unsure as to what this perspective adds to clinical understanding and psychodynamic thinking about the clinical process. In this article, I outline some ways that developments in the study of attachment have the potential to enrich our clinical work with children and families, and may be particularly illuminating with respect to certain aspects of evaluation, formulation, and diagnosis. This added value comes not from formally assessing patients' attachment classification but from sensitizing clinicians to observing the functioning of the attachment system and to the internal and interpersonal functions of attachment processes. Such awareness on the part of the therapist makes it possible for these dynamic regulatory, defense, and motivational systems to be addressed within the context of evaluation and ongoing psychotherapeutic work. Thinking about attachment processes within the clinical situation does not supplant other aspects of dynamically oriented assessment and evaluation, but rather is theoretically consistent with psychoanalytic models of development and offers new levels of richness and understanding to formulations and treatment planning.     

‘They’ve invited me into their world’: a focus group with clinicians delivering a behaviour change intervention in a UK contraceptive service

Although teenage conceptions rates in the United Kingdom (UK) have seen a downward trend recently, it remains imperative that contraceptive services for young people continue to improve. To ensure that evidence-based interventions are sustained in clinical practice, it is useful to assess the experiences of those delivering them. This study explores the experiences of sexual health clinicians who were trained to deliver a one-to-one behaviour change intervention aiming to improve contraceptive use in young women. The intervention was set in a UK NHS contraceptive and sexual health service and involved clinicians’ facilitating (within one-to-one consultations) the formation of implementation intentions (or ‘if-then’ plans) that specified when, where and how young women would use contraception. A focus group was conducted with seven clinicians who had delivered the intervention. A thematic analysis of the focus group revealed three overall themes: (1) How the intervention worked in practice; (2) barriers and benefits to delivering the intervention; and (3) positive changes to individual consultation style and wider ‘best practice’ within the clinic. Our findings show that, with support, clinical staff would be in favour of incorporating if-then planning as a strategy to help promote contraceptive adherence in young women.     

Assessing Couple Therapy as a Treatment for Individual Distress: When is Referral to Couple Therapy Contraindicated?

In order to better understand the effects of initial level of psychological disturbance on treatment outcome, a retrospective case control study of 95 couples who received couple therapy was conducted by sorting couples into one of four groups based on the degree of distress reported by individuals at intake: Neither distressed; both distressed; male distressed, female not distressed; female distressed, male not distressed. When partners started treatment with similar levels of disturbance both responded well in couple therapy. However, if the female reported clinical levels of disturbance at intake but her partner did not, outcome for the female was especially poor in contrast to outcomes for females receiving individual therapy. Clinically disturbed males showed significant gains in treatment even when their partners were not disturbed. These suggestive results argue for the possible value of conducting controlled studies of treatment assignment decisions that maximize positive outcomes.     

The development and organization of attachment: implications for psychoanalysis

As a result of John Bowlby's breach with the British Psychoanalytic Society nearly forty years ago, his work, specifically the development of attachment theory, was until recently largely expunged from the psychoanalytic record. However, thanks to developments in both psychoanalytic and attachment theories, a rapprochement has been forged, and a number of scholars are now seeking to integrate these two complementary perspectives. In this paper, the fundamental premises of attachment theory are discussed in light of their relation to psychoanalytic theory. In addition, their application to the clinical situation in both adult and child treatment is discussed.     

Hostile/Helpless maternal representations in pregnancy and later child removal: A pilot study

This article presents the results of a small pilot study examining links between Hostile/Helpless (HH) representations of caregiving in pregnancy and later child removal by child protective services. The sample was drawn from a replication study of the Minding the Baby^® attachment‐based home‐visiting intervention conducted in the United Kingdom, serving young first‐time mothers in under resourced communities. The HH classification system (Lyons‐Ruth et al.) was adapted for use with the Pregnancy Interview (PI) (Slade); 26 PIs were assessed (coders blinded) in a sample that included 13 mothers whose infants were removed from custody due to anticipated or documented maltreatment within 2 years of childbirth, and 13 mothers who did not have their infants removed. Mothers whose infants were removed from their custody had significantly higher HH scores than mothers of infants who were not removed from their care (F(1, 24) = 14.500, p < .001), and the relation between overall HH classification and infant removal status was also significant (χ²(1, N = 26) = 12.462, p < .001). Results suggest that prenatal maternal caregiving representations may predict postnatal relationship disruptions, and indicate the need for larger studies further testing this prenatal approach to maltreatment risk assessment in at‐risk populations.