Differential efficacy between cognitive-behavioral therapy and mindfulness-based therapies for chronic pain: Systematic review

Background/Objective: To assess the differential efficacy between mindfulness-based interventions and cognitive-behavioral Therapy (CBT) on chronic pain across medical conditions involving pain. Method: ProQuest, Science Direct, Google Scholar, Pubmed, and Embase databases were searched to identify randomized clinical trials. Measurements of mindfulness, pain, mood, and further miscellaneous measurements were included. Results: 18 studies met the inclusion criteria (fibromyalgia, n = 5; low back pain, n = 5; headache/migraine, n = 4; non-specific chronic pain, n = 4). In fibromyalgia, mindfulness based stress reduction (MBSR) was superior to the usual care and Fibroqol, in impact and symptoms. In low back pain, MBSR was superior to the usual care, but not to CBT, in physical functionality and pain intensity. There were no studies on differential efficacy between mindfulness and CBT for headache and non-specific chronic pain, but Mindfulness interventions were superior to the usual care in these syndromes. Conclusions: Mindfulness interventions are superior to usual cares in all diagnoses, but it is not possible to conclude their superiority over CBT. Comparisons between mindfulness interventions are scarce, with MBSR being the most studied. In central sensitization syndromes, variables associated with pain tend to improve with treatment. More research is needed to differentiate diagnosis and intervention.     

The influence of motivational and mood states on visual attention: A quantification of systematic differences and casual changes in subjects' focus of attention

A great number of studies have shown that different motivational and mood states can influence human attentional processes in a variety of ways. Yet, none of these studies have reliably quantified the exact changes of the attentional focus in order to be able to compare attentional performances based on different motivational and mood influences and, beyond that, to evaluate their effectivity. In two studies, we explored subjects' differences in the breadth and distribution of attention as a function of motivational and mood manipulations. In Study 1, motivational orientation was classified in terms of regulatory focus (promotion vs. prevention) and in Study 2, mood was classified in terms of valence (positive vs. negative). Study 1 found a 10% wider distribution of the visual attention in promotion-oriented subjects compared to prevention-oriented ones. The results in Study 2 reveal a widening of the subjects' visual attentional breadth when listening to happy music by 22% and a narrowing by 36% when listening to melancholic music. In total, the findings show that systematic differences and casual changes in the shape and scope of focused attention may be associated with different motivational and mood states.     

Comparative relationships of the Wechsler Adult Intelligence Scale—Revised (WAIS-R) and the Wechsler Adult Intelligence Scale (WAIS) to the Wechsler Memory Scale (WMS)

This study investigated whether the Wechsler Adult Intelligence Scale — Revised (WAIS-R) and Wechsler Adult Intelligence Scale (WAIS) demonstrate similar patterns of relationship with the Wechsler Memory Scale (WMS). Sixty VA patients were administered the WAIS-R and WMS and 60 completed the WAIS and WMS. The groups were comparable in terms of demographic variables. Pearson correlations were computed between the subtest and IQ scores from the intelligence scales and the scores from the WMS for each group. Comparison of the resulting correlations for the WAIS-R group with those of the WAIS subjects demonstrated only four significant differences, indicating that the WAIS-R and WAIS variables covary in a similar manner with the WMS scores. Following factor analysis of the test data for both groups, coefficients of congruence indicated a high degree of similarity between the two factor solutions. Essentially the same relationships emerged between intelligence variables and the WMS regardless of which scale was administered.     

Estimating rates of chronic fatigue syndrome from a community-based sample: A pilot study

Most of the Chronic Fatigue Syndrome (CFS) epidemiological studies have relied on physicians who refer patients having at least 6 months of chronic fatigue and other symptoms. However, there are a number of potential problems when using this method to derive prevalence statistics. For example, some individuals with CFS might not have the economic resources to access medical care. Other individuals with CFS might be reluctant to use medical personnel, particularly if they have encountered physicians skeptical of the authenticity of their illness. In addition, physicians that are skeptical of the existence of CFS might not identify cases. In the present pilot study, a random community sample (N=1,031) was interviewed by telephone in order to identify and comprehensively evaluate individuals with symptoms of CFS and those who self-report having CFS. Different definitions of CFS were employed, and higher rates (0.2%) of CFS were found than in previous studies. Methodological benefits in using more rigorous epidemiological methods when estimating CFS prevalence rates are discussed. The authors appreciate the generous financial support of the CFIDS Association and Minnan, Inc. We also are grateful for many helpful suggestions provided by Judith A. Richman, William McCready, Wendell Richmond, and Stephen E. Goldston. Finally, we are very thankful to the many undergraduate volunteers who helped us complete this study, and they include Cheryl Stenzel, Georgina DeLa Torre, Vickie Chrisos, Don Banik, Hillary Loeb, Leslie Ramesack, Ellen Diamond, Rob Bleeker, Gib Garza III, Mindy Silverstein, Kadip Sen, Meredith Lombrazo, Brian Miller, Caroline Marsden, Lorraine Whitmore, Stan Gayot, Karen Costakis, and Dave Sobotka.     

Differential validity of the Gottschalk-Gleser Anxiety Scales: is gender a moderator variable?

It can be hypothesized that affects like anxiety can be measured by content analysis of speech due to the phenomenon of mood congruent memory, which is found predominantly in females. To assess the effect of gender on the validity of the Gottschalk-Gleser Anxiety Scales, the standard procedure for obtaining verbal samples was followed and self-report measurements of comparable emotional constructs were applied concurrently. Measures of state and trait emotions were administered to 25 female and 25 male university students. In the female group 18 significant convergent validity coefficients were found. For males, content analytic anxiety scores showed four significant correlations with concurrent self-report scales. These results suggest that content analytic anxiety scores from female subjects may allow a more accurate prediction of state and trait emotions than anxiety scores from male subjects. Thus, gender might have a differential effect on the validity of the Gottschalk-Gleser Anxiety Scales.     

Predicting preschool motor and cognitive performance in appropriate-for-gestational-age children born at ≤ 32 weeks gestation

Although many follow-up studies have been performed on preterm infants, little attention has been devoted to prediction of motor skills in the preschool or school years. We studied the relationship of performance on the Bayley Scales of Infant Development at a mean corrected age of 21 months to performance on the McCarthy Scales of Children's Abilities at a mean corrected age of 44.7 months for 43 appropriate-for-gestational-age (AGA) children born at ≤ 32 weeks gestation. Motor scores were stable over time with a significant correlation between the Bayley Psychomotor Developmental Index (PDI) and the McCarthy Motor subscale (r = 0.60; p = 0.0001). Scores of cognitive abilities also showed a significant correlation between the Bayley Mental Developmental Index (MDI) and the McCarthy General Cognitive Index (r = 0.42; p = 0.009). Small-for-gestational-age (SGA), very low-birthweight (≤ 1500 grams) children scored lower on the McCarthy General Cognitive Index (p = 0.01) and on the Motor subscale (p = 0.047) than the AGA children. We concluded that motor performance of AGA children born at ≤ 32 weeks gestation is stable from toddlerhood to preschool age. We suggest that SGA children be excluded from studies of motor performance of prematurely born children.     

Chronic pain,compensation and clinical knowledge

The nosological status of the putative clinical entity of compensation neurosis and the relationship of chronic pain complaints to compensation are explored. It is concluded that, using the traditional criteria of diagnostic validity, there is no support for the view that a specific type of psychiatric disorder related to compensation or litigation can be demonstrated. Although it has been generally considered that chronic pain complaints reflect an underlying disease state, recent evidence has shown that in the medico-legal setting the nature of the compensation system and the level of available benefits have a marked influence on both the rate of chronic pain complaints and the duration of pain related work incapacity.     

Coniunctio—in bodily and psychic modes: dissociation, devitalization and integration in a case of chronic fatigue syndrome

Three years of analytical psychotherapy with a professional woman in mid-life, suffering from chronic fatigue syndrome (CFS), is described. Gradual recovery merged into mid-life changes; marriage, along with a new balance of maternal and paternal imagos, enabled her to trust enough to become pregnant— coniunctio in the most primal bodily and psychic modes.
Her life-long, schizoid type pattern, 'the pendulum of closeness and isolation', with its extreme of psycho-physical collapse and devitalization, was replayed in therapy. The analyst's symbolic attitude is emphasized, containing the patient's initial affective explosion and validating the physicality of her condition. Mirroring and steady rhythmic attunement became a new, pre-verbal, source of trust—vitalization; differentiation and separation replaced defensive splitting and dissociation. Then the overwhelmingly powerful bodily/maternal could be counterbalanced by the masculine, and a transitional space emerged for symbolic work.
Both the regressive and the dynamic aspects of CFS are located in the earliest undifferentiated, archetypal, bodily/psychic modes, when the frustration of primary needs evokes the defences of the self. It is argued that our psychodynamic understanding can contribute to the stalemate in seeing chronic fatigue syndrome as either an organic illness or depression, and that a new linking of the somatic and psychic calls for a new professional collaboration.     

Predicting the intensity of losses vs. non-gains and non-losses vs. gains in judging fairness and value: A test of the loss aversion explanation

Three studies examined the predictions that in the context of evaluation of fairness and concessions in negotiations, losses would be perceived as more intensely negative than non-gains, and that non-losses would be perceived as more positive than gains. Extant studies tested only the first of these predictions. These predictions derive from the principle of loss aversion (LA), according to which losses are experienced more intensely than gains of similar objective magnitude. In this view, losses and non-losses are measured against the steep loss part of the value curve, whereas gains and non-gains are measured against the shallow part of the value curve. Our studies replicated extant studies in confirming the first prediction but failed to confirm the second prediction. Specifically, opposite to the prediction of LA, gains were perceived as more intensely positive than non-losses. It seems, therefore, that LA is not a sufficient explanation of why losses are perceived as more averse than gains. Feature positive and regulatory focus effects are discussed as additional potential contributors to the phenomenon.     

Is pain-related fear a predictor of somatosensory hypervigilance in chronic low back pain patients?

Pain-related fear has been found to be associated with increased disability and increased pain perception in patients with chronic low back pain. A possible mechanism by which pain-related fear could lead to increased pain perception is heightened attention to somatosensory sensations. In the present study, chronic pain patients reporting either a high or low level of pain related fear and control participants performed an auditory reaction time task, while occasionally non-painful electrical stimuli--accompanied by threatening instructions--were given to the arm or back. In the primary task condition, participants had to perform the auditory task while ignoring the electrical stimuli. Next, the task was presented under dual task conditions in which participants had to respond both to tones as well as to detection of electrical stimuli. It was hypothesized that for the primary task, high fearful patients would show greater disruption of performance on the auditory task than low fearful patients and controls when stimuli were presented to the back. For the dual task, slower reaction times for the auditory task, in combination with faster detection of electrical stimuli was expected. The hypotheses were not confirmed but patients scoring high on pain-related fear did show an overall increase in reaction time for all conditions of the primary task, with or without simultaneous stimulation. Regression analyses demonstrated that high pain-related fear was associated with increased reaction time to tones both in patients and healthy controls, and that within patients pain-related fear was a better predictor of reaction time to tones than present pain intensity. The findings may be interpreted as showing that patients with elevated levels of pain-related fear habitually attend to somatic sensations, giving less priority to other attention-demanding tasks.