Neurocognitive aspects of pain perception

The perception of pain is sensitive to various mental processes such as the feelings and beliefs that someone has about pain. It is therefore not exclusively driven by the noxious input. Attentional modulation involving the descending pain modulatory system has been examined extensively in neuroimaging studies. However, the investigation of neural mechanisms underlying more complex cognitive modulation is an emerging field in pain research. Recent findings indicate an engagement of the ventrolateral prefrontal cortex during more complex modulation, leading to a change or reappraisal of the emotional significance of pain. Taking placebo-induced analgesia as an example, we discuss the contribution of attention, expectation and reappraisal as three basic mechanisms that are important for the cognitive modulation of pain.     

Can CORE assessment data identify those clients less likely to benefit from brief counselling in primary care?

Studies show that counsellors in primary care see many clients with difficulties of a severity similar to those found in secondary care services. Evidence from both RCTs and studies of routinely collected data indicates that many of these ‘clinical’ clients benefit from brief counselling intervention. However, little is known about why some benefit while others fail to do so despite completing their counselling contract. This paper considers client characteristics recorded at assessment and aims, using logistic regression analysis, to identify those characteristics predictive of a poor outcome. Results indicate that a number of characteristics are associated with poor outcome; the most important predictors are economic inactivity and aspects of the patient's condition, particularly continuous/recurrent depression, with some differences between genders. However, the models produced were not acceptable in their predictive power. This may be partly due to data quality issues or important characteristics not being available in the data. The paper concludes that being unemployed or on state benefits may be a proxy measure of severity that has an important impact on outcome for all patients, and particularly for males. Some reasons are suggested and areas of future research are identified.     

Agency and Communion in People with Rheumatoid Arthritis

The purpose of this study was to determine whether the previously found relations among the gender-linked personality orientations of agency, communion, unmitigated agency, and unmitigated communion, and health outcomes existed within a sample of adults with rheumatoid arthritis, a chronic disease that is more prevalent among women than among men. We obtained self-report data from 158 participants on the gender-linked personality orientations, psychological distress, disability, pain, and life satisfaction. As hypothesized, regression analyses indicated that agency was significantly associated with better health outcomes, whereas unmitigated communion was associated with poorer health outcomes. Assessment of these personality variables in people with rheumatoid arthritis may help to identify those at high risk for adverse outcomes.     

Noncompetition Agreements: How Informed Are Counselors?

A noncompetition agreement is a contract between employer and employee prohibiting the practice of a trade or profession for a specified time or within a specified region upon an employee's leaving an employer's hire (A. Valiulis, 1985). The authors assessed American Mental Health Counselor Association members' knowledge of the legal bases for these contracts and their agreement with the legal opinions and also assessed the degree of similarity and dissimilarity between members' knowledge of and agreement with the legal opinions. Results showed that counselors are better prepared to look after the welfare of their clients than their own employment interests. Implications for counselor training are discussed.     

Divine Gifts to the Secular Desert

Being Reconciled: Ontology and Pardon , John Milbank, Routledge 2003 (0-415-30525-x), pp. xiii +242, Pb £17.99, Hb £55     

Type D Personality and Chronic Pain: Construct and Concurrent Validity of the DS14

A body of research has demonstrated that the Type D personality is a risk factor among cardiac patients. Previous studies validating the Type D Scale (DS14) across other clinical groups have not included chronic pain patients in their samples. The purpose of this study was to investigate the construct and concurrent validity of the DS14 using the MMPI-2. The DS14 and its two component subscales demonstrated strong internal consistency among chronic pain patients. The two subscales of the DS14 were found to be related to similar clinical scales on the MMPI-2, and significant differences were found in the MMPI-2 profiles of individuals with and without the Type D personality. Considerations for clinical practice and research are discussed.     

The Definition and Epidemiology of Clusters of Suicidal Behavior: A Systematic Review

Suicide clusters are a rare and underresearched phenomenon which attract wide media attention and result in heightened concern in the communities where they occur. We conducted a systematic literature review covering the definition and epidemiology of the time–space clustering of suicidal behavior. Of the 890 articles identified by electronic searching, 82 were selected for inclusion and the extracted data were analyzed by narrative synthesis. Less than a third of studies included a definition of a suicide cluster, and definitions varied considerably. Clusters occurred in various settings, including psychiatric hospitals, schools, prisons, indigenous communities, and among the general population. Most clusters involved young people. The proportion of all episodes that occurred in clusters varied considerably between studies and partly depended on study methodology (e.g., a larger proportion was found in studies of specific clusters compared with general population studies). Future studies should aim to combine the statistical analysis of time–space clustering with a case study of events, which examines potential links between individuals and the wider environmental context.     

An experimental analysis of aversive imagery versus electrical aversive conditioning in the treatment of chronic alcoholics

A series of three experiments is described comparing an aversive imagery and an electrical escape conditioning procedure in the treatment of chronic alcoholics. Treatment effects were objectively measured by recording subjects' alcohol consumption in a semi-naturalistic laboratory setting. In contrast to conventional group outcome studies, the use of single-subject methodology provided a fine-grained analysis of individual response patterns. The aversive imagery and escape conditioning methods did not differ from each other, and were relatively ineffective in suppressing alcohol intake. In contrast, a punishment procedure in which shock was contingent on drinking did effectively suppress drinking. The data suggest that alcoholics can control their drinking by self-administered shock. The implications for the analysis and treatment of alcoholics are discussed.