Lachlan McWilliams | University of Saskatchewan (original) (raw)
Papers by Lachlan McWilliams
Rehabilitation Psychology, 2015
Chronic pain has a significant negative impact on the quality of life, including sleep disruption... more Chronic pain has a significant negative impact on the quality of life, including sleep disruption. There is compelling evidence that cognitive-behavioral therapy can be effective in treating sleep disorders. To our knowledge, no research has been carried out on brief cognitive-behavioral educational interventions in individuals with chronic pain. This study was conducted to determine whether a brief education session that incorporates sleep hygiene and cognitive-behavioral strategies would help improve the sleep of individuals with chronic pain. Eighty-five patients from a tertiary care Multidisciplinary Pain Centre completed all aspects of the study. This sample was randomized into 2 groups: a treatment group who received a brief cognitive-behavioral educational session, and a control group who did not. All participants completed a daily sleep diary for 28 days. Measures on sleep quality, beliefs and attitudes about sleep, pain, disability, and mood were recorded at baseline. No significant differences were found between groups on demographic, pain, disability, mood measures, or sleep quality at baseline. Overall, 42% of the individuals who completed this study had depression scores above the clinical cutoff. This sample reported a high level of pain-related disability. Individuals in the treatment group had significantly reduced sleep onset latency compared to controls. No significant differences between groups on the number of times waking or hours slept. Our findings suggest that there is potential for a brief educational intervention to have a positive impact on some aspects of sleep in the chronic pain population. (PsycINFO Database Record
Journal of psychosomatic research, Jan 2, 2015
Recent research with small non-clinical and clinical samples suggests a positive association betw... more Recent research with small non-clinical and clinical samples suggests a positive association between attachment insecurity and sleep disturbances. The present study extends this line of research by exploring this relationship in a large sample of the U.S. population and by statistically adjusting for health conditions and psychiatric disorders as potential confounds. The data used were from the National Comorbidity Survey Replication (N=5692). The main interview consisted of the Composite International Diagnostic Interview used to assess psychiatric diagnoses. Ratings of three adult attachment styles (viz., secure, avoidant, and anxious) were obtained along with self-reports of health conditions and four sleep disturbances (viz., difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and daytime sleepiness). Bivariate logistic regression analyses indicated that ratings of secure attachment were negatively associated with each sleep disturbance and rating...
Journal of Psychopathology and Behavioral Assessment, 2005
- by investigating relations between anxiety sensitivity (AS) and attachment dimensions in a ... more 2002) by investigating relations between anxiety sensitivity (AS) and attachment dimensions in a sample of young adults. Two hundred and twenty-six undergraduate students completed self-report measures including the Anxiety Sensitivity Index and the measure of adult romantic attachment used by C. F. . In order to investigate the association between AS and a different domain of attachment, a measure of adult attachment referring to "close relationships" was included. As defined by both measures, insecurely attached individuals, specifically those classified as preoccupied and fearful (i.e., those with negative Models of Self), reported significantly higher levels of AS than those with secure and dismissing attachment styles (i.e., those with positive Models of Self). Results indicated that across both measures the Model of Self attachment dimension accounted for unique variance in AS levels beyond that contributed by trait anxiety. The Model of Others attachment dimension had a more limited association with AS.
Personality and Individual Differences, 2001
Significant positive correlations between the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson... more Significant positive correlations between the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson, RA, Gursky, DM & McNally, RJ (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8.] and the Trait ...
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
The Pain Response Preference Questionnaire (PRPQ) assesses preferences regarding pain-related soc... more The Pain Response Preference Questionnaire (PRPQ) assesses preferences regarding pain-related social support. The initial factor analytical study of the PRPQ produced four empirically supported scales labelled Solicitude, Management, Encouragement and Suppression. A second study produced similar findings, but suggested that the Management and Encouragement scales be combined into a single scale labelled Activity Direction. To use factor analytical methods to evaluate these competing configurations of the PRPQ (ie, three versus four scales) and to further refine the measure. The ability of the PRPQ scales to account for pain severity and disability ratings was also evaluated. Chronic pain patients (n=201) completed the PRPQ along with the Pain Catastrophizing Scale (PCS) and self-reports of pain severity and disability. Confirmatory factor analysis indicated that both models tested provided a poor fit to the data. A follow-up exploratory factor analysis was used to further refine the...
Pain, 2007
Despite the prominence of fear-avoidance models of chronic pain, there is a paucity of research r... more Despite the prominence of fear-avoidance models of chronic pain, there is a paucity of research regarding the origins of pain-related fear. Based on the premise that insecure attachment could be a developmentally based origin of elevated fear of pain, associations between adult attachment dimensions and constructs included in fear-avoidance models of chronic pain were investigated. Consistent with Bartholomew and Horowitz's [Bartholomew K, Horowitz LM. Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol 1991;61:226-44.] model, attachment was conceptualized as being comprised of a model of self dimension (i.e., degree of anxiety regarding rejection based on beliefs of personal unworthiness) and a model of others dimension (i.e., degree of interpersonal mistrust and discomfort with interpersonal closeness). A large university student sample free of chronic pain (N=278) completed a measure of adult romantic attachment (i.e., Experiences in Clos...
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
Despite the important role positive reinforcement of pain behaviour is believed to play in chroni... more Despite the important role positive reinforcement of pain behaviour is believed to play in chronic pain, there is a paucity of research regarding factors that influence the provision of such reinforcement. Attachment theory suggests that individuals high in attachment avoidance view the pain behaviour of others in a negative manner and would, therefore, provide little reinforcement of pain behaviour. As an initial step in evaluating this model, relationships between attachment dimensions and attitudes toward pain behaviour were examined. Attachment avoidance was hypothesized to be negatively associated with accepting attitudes toward pain behaviour. A sample of undergraduate students (n=160) completed the Relationships Structures Questionnaire, which provides global ratings of adult attachment dimensions (anxiety and avoidance) by assessing attachment across four relationship targets (friend, mother, father and romantic partner). Attitudes regarding the acceptability of pain behavio...
Pain, 2012
Chronic pain is a debilitating condition that can have an impact on various facets of interperson... more Chronic pain is a debilitating condition that can have an impact on various facets of interpersonal functioning. Although some studies have examined the extent to which family members are affected by an individual's chronic pain, none have examined patients' perceptions of feeling that they have become a burden to others. Research on self-perceived burden in different medical populations, such as cancer, amyotrophic lateral sclerosis, and stroke, has shown that it is associated with physical symptoms and, more robustly, with psychological difficulties and concerns. The present study examined the prevalence and predictors of self-perceived burden in a tertiary chronic pain sample. Participants were consecutive patients (N = 238) admitted to an outpatient, interdisciplinary, chronic pain management program at a rehabilitation hospital. At admission, participants completed a battery of psychometric questionnaires assessing self-perceived burden, as well as a number of clinically relevant constructs. Their significant others (n = 80) also completed a measure of caregiver burden. Self-perceived burden was a commonly reported experience among chronic pain patients, with more than 70% of participants endorsing clinically elevated levels. It was significantly correlated with pain intensity ratings, functional limitations, depressive symptoms, attachment anxiety, pain self-efficacy, and caregiver burden. Self-perceived burden was also correlated with an item assessing suicidal ideation. In a hierarchical regression model, depressive symptoms, pain self-efficacy, and adult attachment significantly predicted self-perceived burden after controlling for demographic and pain-related variables. In conclusion, self-perceived burden is a clinically relevant and commonly reported interpersonal experience in patients with longstanding pain.
Spine, 2001
A quasi-experimental design was used to compare the Symptom Checklist 90-Revised profiles (SCL-90... more A quasi-experimental design was used to compare the Symptom Checklist 90-Revised profiles (SCL-90-R) from a group of patients with whiplash injuries (n = 67) and a group with mixed musculoskeletal pain (n = 91). To test the discriminant validity of the characteristic SCL-90-R whiplash profile as proposed by Wallis and Bogduk using a multivariate statistical technique. On the basis of two studies by themselves and their colleagues, Wallis and Bogduk proposed a characteristic SCL-90-R profile evident in samples of patients with whiplash injuries. Their assertion has not been tested empirically in any published studies. The participants in this study consisted of 158 patients at a rehabilitation hospital who completed the SCL-90-R under standard instructions and subsequently were diagnosed by a team comprising a chiropractor, physical therapist, and physician. The participants were categorized as having whiplash-associated disorders or pain caused by other musculoskeletal injuries. A profile analysis following Hotelling's method was used to determine the comparability of SCL-90-R profiles from the two groups. The profile analysis showed no statistically significant differences between the groups with regard to either the shape or the overall elevation of their psychological profiles. The SCL-90-R profiles from both groups were similar to those reported from other chronic pain syndromes, with elevations on the Somatization, Depression, Obsessive-Compulsive, and Psychoticism scales. The current study failed to support the validity of a distinctive SCL-90-R profile for patients with whiplash injuries. Instead, the results suggest that the psychological consequences of experiencing chronic pain from whiplash-associated disorders are similar to the psychological consequences of chronic pain from other musculoskeletal injuries.
Social Psychiatry and Psychiatric Epidemiology, 2003
The National Comorbidity Survey (NCS; Kessler et al. 1994) was a nationwide household survey of t... more The National Comorbidity Survey (NCS; Kessler et al. 1994) was a nationwide household survey of the U.S. population designed to produce data on the prevalence and correlates of psychiatric disorders. The NCS dataset is now in public-use format and continues to be widely used for ongoing research efforts. The NCS dataset included a set of 14 items that have face validity as a measure of current emotional distress (depression and anxiety) and could serve as a potentially useful continuous measure of psychological distress. However, there have been no published studies on its psychometric properties and this measure has not yet been utilized by researchers using the NCS dataset. This paper provides an evaluation of the psychometric properties of the NCS Distress Index. The NCS Part II public-use dataset (N = 5877) was used. Detailed diagnostic information was collected along with 14 items assessing current psychological distress and measures of Neuroticism and Openness to Experience. The NCS Distress Index was found to be internally consistent (Alpha = 0.92) and a series of principal-components analyses demonstrated that the measure is most accurately conceptualized as a single-factor measure of general distress. The construct validity of the Distress Index was supported by its associations with the measures of Neuroticism and Openness to Experience. A series of comparisons between diagnostic groups also supported the construct validity of the measure. For example, those with disorders characterized by depressed mood and worry scored higher on the Distress Index than those with disorders characterized by fear and hyperarousal. The NCS Distress Index is a psychometrically sound measure of current emotional distress. Future studies utilizing the NCS public-use dataset could potentially benefit from the inclusion of this measure in addition to more commonly investigated categorical variables such as diagnosable disorders.
Social Psychiatry and Psychiatric Epidemiology, 2006
The present paper investigated the relationships between several personality constructs and the u... more The present paper investigated the relationships between several personality constructs and the use of outpatient mental health services. Respondents were from the National Comorbidity Survey (NCS) Part II data set and included those with a past-year mood, anxiety, alcohol/substance use disorder (n=1750). Bivariate logistic regressions were used to examine associations between participants' self-reports of personality traits and outpatient mental health service utilization. Similar multivariate analyses were used to investigate these associations after adjusting for sociodemographic variables and the presence of psychiatric disorders and their comorbidity. The bivariate and multivariate analyses revealed significant positive associations between outpatient mental health service utilization and both Powerful Others Locus of Control and Self-criticism. These findings suggest that personality traits may play a role in treatment seeking behaviors for mental health problems over and above the presence of psychiatric disorders alone. The assessment of relevant personality constructs has the potential to inform and improve treatment outreach efforts.
Rehabilitation Psychology, 2012
Evaluations of another&am... more Evaluations of another's pain can have important implications in medical, employment, and social settings. Influenced by the Social Communication Model of Pain, this vignette-based study investigated the potential influence of characteristics of the person being evaluated (viz., the coping strategy used by an individual with chronic pain depicted in a vignette) and characteristics of those making evaluations (viz., self-reported attachment anxiety and avoidance of the study participants). The main hypothesis was that participants higher in attachment avoidance would be more critical in their evaluations than those lower in attachment avoidance. Undergraduate students (N = 267) read 1 of 2 vignettes about an individual experiencing chronic pain, provided ratings of this individual, and completed a measure of adult attachment. The vignettes varied in terms of the pain-related coping strategy (catastrophizing vs. distraction) described. Similar to past research, the catastrophizing vignette received more negative ratings than the distraction vignette (e.g., greater disability level), and female participants provided more positive ratings than male participants (e.g., greater deservingness of support). While the attachment variables were unrelated to some dependent variables, consistent with the main hypothesis, attachment avoidance was associated with lower ratings of perceived deservingness of support and desirability as a friend. The current findings suggest that chronic pain patients' coping styles influence evaluations made about them, and that evaluators' gender and attachment characteristics also have important effects on such evaluations.
Psychiatry Research, 2011
Personality and Individual Differences, 2007
Anxiety sensitivity (AS) was originally proposed as a specific vulnerability factor for panic dis... more Anxiety sensitivity (AS) was originally proposed as a specific vulnerability factor for panic disorder and anxiety. The specificity of this relationship has been questioned because AS has also been found to be associated with depressive symptomatology. Data from the Dresden Study of Mental Health, which utilized a large community sample (N = 1867) of young German women, were used to investigate whether AS possesses specificity to anxiety-related psychopathology versus depression-related psychopathology when specific disorders were utilized as dependent variables. Participants completed a diagnostic interview as well as self-report measures of AS and neuroticism. Logistic regression analyses that statistically adjusted for neuroticism indicated that elevated AS had significant positive associations with several anxiety disorders, but was not significantly associated with major depressive disorder or dysthymia. These findings are generally consistent with those of previous studies that utilized self-reports of psychopathology and they support the hypothesis that AS is a specific vulnerability for panic and anxiety. However, when the lower-order components of AS were considered a more complex pattern of findings emerged, including significant positive associations between depression and both the Physical Concerns and Social Concerns components of AS.
Personality and Individual Differences, 2001
Recently proposed models [eg Eccleston, C., & Crombez, G. (1999). Pain demands attention: a c... more Recently proposed models [eg Eccleston, C., & Crombez, G. (1999). Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychological Bulletin, 125, 356366; McCracken, LM (1997). Attention to pain in persons with chronic ...
Pain, 2003
Chronic pain and psychiatric disorders frequently co-occur. However, estimates of the magnitude o... more Chronic pain and psychiatric disorders frequently co-occur. However, estimates of the magnitude of these associations have been biased by the use of select clinical samples. The present study utilized the National Comorbidity Survey [Arch. Gen. Psychiatry 51 (1994) 8-19] Part II data set to investigate the associations between a chronic pain condition (i.e. arthritis) and common mood and anxiety disorders in a sample representative of the general US civilian population. Participants (N=5877) completed the Composite International Diagnostic Interview [World Health Organization (1990)], a structured interview for trained non-clinician interviewers based on the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association (1987)], and provided self-reports of pain and disability associated with a variety of medical conditions. Significant positive associations were found between chronic pain and individual 12-month mood and anxiety disorders [odds ratios (OR) ranged from 1.92 to 4.27]. The strongest associations were observed with panic disorder (OR=4.27) and post-traumatic stress disorder (OR=3.69). The presence of one psychiatric disorder was not significantly associated with pain-related disability, but the presence of multiple psychiatric disorders was significantly associated with increased disability. The findings of the present study raise the possibility that improved efforts regarding the detection and treatment of anxiety disorders may be required in pain treatment settings.
PAIN, 2010
A growing body of research indicates that attachment insecurity is associated with pain-related c... more A growing body of research indicates that attachment insecurity is associated with pain-related catastrophizing. Attachment anxiety has consistently been found to be positively associated with pain catastrophizing. In contrast, the relationship between attachment avoidance and pain catastrophizing has been less consistent. The current study was designed to (a) determine whether anxiety accounts for unique variance in catastrophizing beyond that contributed by the overlapping constructs of self-esteem and neuroticism and (b) clarify the relationship between avoidance and catastrophizing by investigating this relationship when controlling for attachment anxiety. The final objective was to investigate whether attachment is also related to catastrophizing about the pain of significant others. A convenient sample of individuals currently in a romantic relationship (N=148) completed self-report measures of attachment anxiety and avoidance, neuroticism, self-esteem, pain catastrophizing, and significant other pain catastrophizing. Multiple regression analyses indicated that attachment anxiety accounted for unique variance in pain catastrophizing and each of its lower-order components (i.e., rumination, magnification, helplessness), beyond that accounted for by the personality variables. Attachment avoidance was negatively associated with the rumination component of catastrophizing, but this association was only found after controlling for attachment anxiety. The attachment dimensions were also associated with some components of significant other pain catastrophizing. Anxiety was positively associated with the helplessness component of significant other pain catastrophizing, and avoidance was negatively associated with the rumination and helplessness components of significant other pain catastrophizing. Future research directions regarding the social context of pain are discussed.
Pain, 2008
McNeil and Rainwater's Fear of Pain Questionnaire III (FPQ-III, 1998) is an empirically derived s... more McNeil and Rainwater's Fear of Pain Questionnaire III (FPQ-III, 1998) is an empirically derived self-report inventory that assesses fear of three broad categories of pain: Severe, Minor, and Medical Pain. Previous exploratory and confirmatory factor analyses suggest that the original 3-factor model of the FPQ-III has a poor fit [Osman A, Breitenstein JL, Barrios FX, Gutierrez PM, Kopper BA. The Fear of Pain Questionnaire-III: further reliability and validity with nonclinical samples. J Behav Med 2002;25:155-73; Albaret MC, Sastre MTM, Cottensin A, Mullet E. The Fear of Pain Questionnaire: factor structure in samples of young, middleaged and elderly European people. Eur J Pain 2004;8:273-81; Roelofs J, Peters ML, Deutz J, Spijker C, Vlaeyen JWS. The Fear of Pain Questionnaire (FPQ): further psychometric examination in a non-clinical sample. Pain 2005;116:339-46.
Journal of Social and Personal Relationships, 2013
Rehabilitation Psychology, 2015
Chronic pain has a significant negative impact on the quality of life, including sleep disruption... more Chronic pain has a significant negative impact on the quality of life, including sleep disruption. There is compelling evidence that cognitive-behavioral therapy can be effective in treating sleep disorders. To our knowledge, no research has been carried out on brief cognitive-behavioral educational interventions in individuals with chronic pain. This study was conducted to determine whether a brief education session that incorporates sleep hygiene and cognitive-behavioral strategies would help improve the sleep of individuals with chronic pain. Eighty-five patients from a tertiary care Multidisciplinary Pain Centre completed all aspects of the study. This sample was randomized into 2 groups: a treatment group who received a brief cognitive-behavioral educational session, and a control group who did not. All participants completed a daily sleep diary for 28 days. Measures on sleep quality, beliefs and attitudes about sleep, pain, disability, and mood were recorded at baseline. No significant differences were found between groups on demographic, pain, disability, mood measures, or sleep quality at baseline. Overall, 42% of the individuals who completed this study had depression scores above the clinical cutoff. This sample reported a high level of pain-related disability. Individuals in the treatment group had significantly reduced sleep onset latency compared to controls. No significant differences between groups on the number of times waking or hours slept. Our findings suggest that there is potential for a brief educational intervention to have a positive impact on some aspects of sleep in the chronic pain population. (PsycINFO Database Record
Journal of psychosomatic research, Jan 2, 2015
Recent research with small non-clinical and clinical samples suggests a positive association betw... more Recent research with small non-clinical and clinical samples suggests a positive association between attachment insecurity and sleep disturbances. The present study extends this line of research by exploring this relationship in a large sample of the U.S. population and by statistically adjusting for health conditions and psychiatric disorders as potential confounds. The data used were from the National Comorbidity Survey Replication (N=5692). The main interview consisted of the Composite International Diagnostic Interview used to assess psychiatric diagnoses. Ratings of three adult attachment styles (viz., secure, avoidant, and anxious) were obtained along with self-reports of health conditions and four sleep disturbances (viz., difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and daytime sleepiness). Bivariate logistic regression analyses indicated that ratings of secure attachment were negatively associated with each sleep disturbance and rating...
Journal of Psychopathology and Behavioral Assessment, 2005
- by investigating relations between anxiety sensitivity (AS) and attachment dimensions in a ... more 2002) by investigating relations between anxiety sensitivity (AS) and attachment dimensions in a sample of young adults. Two hundred and twenty-six undergraduate students completed self-report measures including the Anxiety Sensitivity Index and the measure of adult romantic attachment used by C. F. . In order to investigate the association between AS and a different domain of attachment, a measure of adult attachment referring to "close relationships" was included. As defined by both measures, insecurely attached individuals, specifically those classified as preoccupied and fearful (i.e., those with negative Models of Self), reported significantly higher levels of AS than those with secure and dismissing attachment styles (i.e., those with positive Models of Self). Results indicated that across both measures the Model of Self attachment dimension accounted for unique variance in AS levels beyond that contributed by trait anxiety. The Model of Others attachment dimension had a more limited association with AS.
Personality and Individual Differences, 2001
Significant positive correlations between the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson... more Significant positive correlations between the Anxiety Sensitivity Index [ASI; Reiss, S., Peterson, RA, Gursky, DM & McNally, RJ (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8.] and the Trait ...
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
The Pain Response Preference Questionnaire (PRPQ) assesses preferences regarding pain-related soc... more The Pain Response Preference Questionnaire (PRPQ) assesses preferences regarding pain-related social support. The initial factor analytical study of the PRPQ produced four empirically supported scales labelled Solicitude, Management, Encouragement and Suppression. A second study produced similar findings, but suggested that the Management and Encouragement scales be combined into a single scale labelled Activity Direction. To use factor analytical methods to evaluate these competing configurations of the PRPQ (ie, three versus four scales) and to further refine the measure. The ability of the PRPQ scales to account for pain severity and disability ratings was also evaluated. Chronic pain patients (n=201) completed the PRPQ along with the Pain Catastrophizing Scale (PCS) and self-reports of pain severity and disability. Confirmatory factor analysis indicated that both models tested provided a poor fit to the data. A follow-up exploratory factor analysis was used to further refine the...
Pain, 2007
Despite the prominence of fear-avoidance models of chronic pain, there is a paucity of research r... more Despite the prominence of fear-avoidance models of chronic pain, there is a paucity of research regarding the origins of pain-related fear. Based on the premise that insecure attachment could be a developmentally based origin of elevated fear of pain, associations between adult attachment dimensions and constructs included in fear-avoidance models of chronic pain were investigated. Consistent with Bartholomew and Horowitz's [Bartholomew K, Horowitz LM. Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol 1991;61:226-44.] model, attachment was conceptualized as being comprised of a model of self dimension (i.e., degree of anxiety regarding rejection based on beliefs of personal unworthiness) and a model of others dimension (i.e., degree of interpersonal mistrust and discomfort with interpersonal closeness). A large university student sample free of chronic pain (N=278) completed a measure of adult romantic attachment (i.e., Experiences in Clos...
Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
Despite the important role positive reinforcement of pain behaviour is believed to play in chroni... more Despite the important role positive reinforcement of pain behaviour is believed to play in chronic pain, there is a paucity of research regarding factors that influence the provision of such reinforcement. Attachment theory suggests that individuals high in attachment avoidance view the pain behaviour of others in a negative manner and would, therefore, provide little reinforcement of pain behaviour. As an initial step in evaluating this model, relationships between attachment dimensions and attitudes toward pain behaviour were examined. Attachment avoidance was hypothesized to be negatively associated with accepting attitudes toward pain behaviour. A sample of undergraduate students (n=160) completed the Relationships Structures Questionnaire, which provides global ratings of adult attachment dimensions (anxiety and avoidance) by assessing attachment across four relationship targets (friend, mother, father and romantic partner). Attitudes regarding the acceptability of pain behavio...
Pain, 2012
Chronic pain is a debilitating condition that can have an impact on various facets of interperson... more Chronic pain is a debilitating condition that can have an impact on various facets of interpersonal functioning. Although some studies have examined the extent to which family members are affected by an individual's chronic pain, none have examined patients' perceptions of feeling that they have become a burden to others. Research on self-perceived burden in different medical populations, such as cancer, amyotrophic lateral sclerosis, and stroke, has shown that it is associated with physical symptoms and, more robustly, with psychological difficulties and concerns. The present study examined the prevalence and predictors of self-perceived burden in a tertiary chronic pain sample. Participants were consecutive patients (N = 238) admitted to an outpatient, interdisciplinary, chronic pain management program at a rehabilitation hospital. At admission, participants completed a battery of psychometric questionnaires assessing self-perceived burden, as well as a number of clinically relevant constructs. Their significant others (n = 80) also completed a measure of caregiver burden. Self-perceived burden was a commonly reported experience among chronic pain patients, with more than 70% of participants endorsing clinically elevated levels. It was significantly correlated with pain intensity ratings, functional limitations, depressive symptoms, attachment anxiety, pain self-efficacy, and caregiver burden. Self-perceived burden was also correlated with an item assessing suicidal ideation. In a hierarchical regression model, depressive symptoms, pain self-efficacy, and adult attachment significantly predicted self-perceived burden after controlling for demographic and pain-related variables. In conclusion, self-perceived burden is a clinically relevant and commonly reported interpersonal experience in patients with longstanding pain.
Spine, 2001
A quasi-experimental design was used to compare the Symptom Checklist 90-Revised profiles (SCL-90... more A quasi-experimental design was used to compare the Symptom Checklist 90-Revised profiles (SCL-90-R) from a group of patients with whiplash injuries (n = 67) and a group with mixed musculoskeletal pain (n = 91). To test the discriminant validity of the characteristic SCL-90-R whiplash profile as proposed by Wallis and Bogduk using a multivariate statistical technique. On the basis of two studies by themselves and their colleagues, Wallis and Bogduk proposed a characteristic SCL-90-R profile evident in samples of patients with whiplash injuries. Their assertion has not been tested empirically in any published studies. The participants in this study consisted of 158 patients at a rehabilitation hospital who completed the SCL-90-R under standard instructions and subsequently were diagnosed by a team comprising a chiropractor, physical therapist, and physician. The participants were categorized as having whiplash-associated disorders or pain caused by other musculoskeletal injuries. A profile analysis following Hotelling's method was used to determine the comparability of SCL-90-R profiles from the two groups. The profile analysis showed no statistically significant differences between the groups with regard to either the shape or the overall elevation of their psychological profiles. The SCL-90-R profiles from both groups were similar to those reported from other chronic pain syndromes, with elevations on the Somatization, Depression, Obsessive-Compulsive, and Psychoticism scales. The current study failed to support the validity of a distinctive SCL-90-R profile for patients with whiplash injuries. Instead, the results suggest that the psychological consequences of experiencing chronic pain from whiplash-associated disorders are similar to the psychological consequences of chronic pain from other musculoskeletal injuries.
Social Psychiatry and Psychiatric Epidemiology, 2003
The National Comorbidity Survey (NCS; Kessler et al. 1994) was a nationwide household survey of t... more The National Comorbidity Survey (NCS; Kessler et al. 1994) was a nationwide household survey of the U.S. population designed to produce data on the prevalence and correlates of psychiatric disorders. The NCS dataset is now in public-use format and continues to be widely used for ongoing research efforts. The NCS dataset included a set of 14 items that have face validity as a measure of current emotional distress (depression and anxiety) and could serve as a potentially useful continuous measure of psychological distress. However, there have been no published studies on its psychometric properties and this measure has not yet been utilized by researchers using the NCS dataset. This paper provides an evaluation of the psychometric properties of the NCS Distress Index. The NCS Part II public-use dataset (N = 5877) was used. Detailed diagnostic information was collected along with 14 items assessing current psychological distress and measures of Neuroticism and Openness to Experience. The NCS Distress Index was found to be internally consistent (Alpha = 0.92) and a series of principal-components analyses demonstrated that the measure is most accurately conceptualized as a single-factor measure of general distress. The construct validity of the Distress Index was supported by its associations with the measures of Neuroticism and Openness to Experience. A series of comparisons between diagnostic groups also supported the construct validity of the measure. For example, those with disorders characterized by depressed mood and worry scored higher on the Distress Index than those with disorders characterized by fear and hyperarousal. The NCS Distress Index is a psychometrically sound measure of current emotional distress. Future studies utilizing the NCS public-use dataset could potentially benefit from the inclusion of this measure in addition to more commonly investigated categorical variables such as diagnosable disorders.
Social Psychiatry and Psychiatric Epidemiology, 2006
The present paper investigated the relationships between several personality constructs and the u... more The present paper investigated the relationships between several personality constructs and the use of outpatient mental health services. Respondents were from the National Comorbidity Survey (NCS) Part II data set and included those with a past-year mood, anxiety, alcohol/substance use disorder (n=1750). Bivariate logistic regressions were used to examine associations between participants' self-reports of personality traits and outpatient mental health service utilization. Similar multivariate analyses were used to investigate these associations after adjusting for sociodemographic variables and the presence of psychiatric disorders and their comorbidity. The bivariate and multivariate analyses revealed significant positive associations between outpatient mental health service utilization and both Powerful Others Locus of Control and Self-criticism. These findings suggest that personality traits may play a role in treatment seeking behaviors for mental health problems over and above the presence of psychiatric disorders alone. The assessment of relevant personality constructs has the potential to inform and improve treatment outreach efforts.
Rehabilitation Psychology, 2012
Evaluations of another&am... more Evaluations of another's pain can have important implications in medical, employment, and social settings. Influenced by the Social Communication Model of Pain, this vignette-based study investigated the potential influence of characteristics of the person being evaluated (viz., the coping strategy used by an individual with chronic pain depicted in a vignette) and characteristics of those making evaluations (viz., self-reported attachment anxiety and avoidance of the study participants). The main hypothesis was that participants higher in attachment avoidance would be more critical in their evaluations than those lower in attachment avoidance. Undergraduate students (N = 267) read 1 of 2 vignettes about an individual experiencing chronic pain, provided ratings of this individual, and completed a measure of adult attachment. The vignettes varied in terms of the pain-related coping strategy (catastrophizing vs. distraction) described. Similar to past research, the catastrophizing vignette received more negative ratings than the distraction vignette (e.g., greater disability level), and female participants provided more positive ratings than male participants (e.g., greater deservingness of support). While the attachment variables were unrelated to some dependent variables, consistent with the main hypothesis, attachment avoidance was associated with lower ratings of perceived deservingness of support and desirability as a friend. The current findings suggest that chronic pain patients' coping styles influence evaluations made about them, and that evaluators' gender and attachment characteristics also have important effects on such evaluations.
Psychiatry Research, 2011
Personality and Individual Differences, 2007
Anxiety sensitivity (AS) was originally proposed as a specific vulnerability factor for panic dis... more Anxiety sensitivity (AS) was originally proposed as a specific vulnerability factor for panic disorder and anxiety. The specificity of this relationship has been questioned because AS has also been found to be associated with depressive symptomatology. Data from the Dresden Study of Mental Health, which utilized a large community sample (N = 1867) of young German women, were used to investigate whether AS possesses specificity to anxiety-related psychopathology versus depression-related psychopathology when specific disorders were utilized as dependent variables. Participants completed a diagnostic interview as well as self-report measures of AS and neuroticism. Logistic regression analyses that statistically adjusted for neuroticism indicated that elevated AS had significant positive associations with several anxiety disorders, but was not significantly associated with major depressive disorder or dysthymia. These findings are generally consistent with those of previous studies that utilized self-reports of psychopathology and they support the hypothesis that AS is a specific vulnerability for panic and anxiety. However, when the lower-order components of AS were considered a more complex pattern of findings emerged, including significant positive associations between depression and both the Physical Concerns and Social Concerns components of AS.
Personality and Individual Differences, 2001
Recently proposed models [eg Eccleston, C., & Crombez, G. (1999). Pain demands attention: a c... more Recently proposed models [eg Eccleston, C., & Crombez, G. (1999). Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychological Bulletin, 125, 356366; McCracken, LM (1997). Attention to pain in persons with chronic ...
Pain, 2003
Chronic pain and psychiatric disorders frequently co-occur. However, estimates of the magnitude o... more Chronic pain and psychiatric disorders frequently co-occur. However, estimates of the magnitude of these associations have been biased by the use of select clinical samples. The present study utilized the National Comorbidity Survey [Arch. Gen. Psychiatry 51 (1994) 8-19] Part II data set to investigate the associations between a chronic pain condition (i.e. arthritis) and common mood and anxiety disorders in a sample representative of the general US civilian population. Participants (N=5877) completed the Composite International Diagnostic Interview [World Health Organization (1990)], a structured interview for trained non-clinician interviewers based on the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders [American Psychiatric Association (1987)], and provided self-reports of pain and disability associated with a variety of medical conditions. Significant positive associations were found between chronic pain and individual 12-month mood and anxiety disorders [odds ratios (OR) ranged from 1.92 to 4.27]. The strongest associations were observed with panic disorder (OR=4.27) and post-traumatic stress disorder (OR=3.69). The presence of one psychiatric disorder was not significantly associated with pain-related disability, but the presence of multiple psychiatric disorders was significantly associated with increased disability. The findings of the present study raise the possibility that improved efforts regarding the detection and treatment of anxiety disorders may be required in pain treatment settings.
PAIN, 2010
A growing body of research indicates that attachment insecurity is associated with pain-related c... more A growing body of research indicates that attachment insecurity is associated with pain-related catastrophizing. Attachment anxiety has consistently been found to be positively associated with pain catastrophizing. In contrast, the relationship between attachment avoidance and pain catastrophizing has been less consistent. The current study was designed to (a) determine whether anxiety accounts for unique variance in catastrophizing beyond that contributed by the overlapping constructs of self-esteem and neuroticism and (b) clarify the relationship between avoidance and catastrophizing by investigating this relationship when controlling for attachment anxiety. The final objective was to investigate whether attachment is also related to catastrophizing about the pain of significant others. A convenient sample of individuals currently in a romantic relationship (N=148) completed self-report measures of attachment anxiety and avoidance, neuroticism, self-esteem, pain catastrophizing, and significant other pain catastrophizing. Multiple regression analyses indicated that attachment anxiety accounted for unique variance in pain catastrophizing and each of its lower-order components (i.e., rumination, magnification, helplessness), beyond that accounted for by the personality variables. Attachment avoidance was negatively associated with the rumination component of catastrophizing, but this association was only found after controlling for attachment anxiety. The attachment dimensions were also associated with some components of significant other pain catastrophizing. Anxiety was positively associated with the helplessness component of significant other pain catastrophizing, and avoidance was negatively associated with the rumination and helplessness components of significant other pain catastrophizing. Future research directions regarding the social context of pain are discussed.
Pain, 2008
McNeil and Rainwater's Fear of Pain Questionnaire III (FPQ-III, 1998) is an empirically derived s... more McNeil and Rainwater's Fear of Pain Questionnaire III (FPQ-III, 1998) is an empirically derived self-report inventory that assesses fear of three broad categories of pain: Severe, Minor, and Medical Pain. Previous exploratory and confirmatory factor analyses suggest that the original 3-factor model of the FPQ-III has a poor fit [Osman A, Breitenstein JL, Barrios FX, Gutierrez PM, Kopper BA. The Fear of Pain Questionnaire-III: further reliability and validity with nonclinical samples. J Behav Med 2002;25:155-73; Albaret MC, Sastre MTM, Cottensin A, Mullet E. The Fear of Pain Questionnaire: factor structure in samples of young, middleaged and elderly European people. Eur J Pain 2004;8:273-81; Roelofs J, Peters ML, Deutz J, Spijker C, Vlaeyen JWS. The Fear of Pain Questionnaire (FPQ): further psychometric examination in a non-clinical sample. Pain 2005;116:339-46.
Journal of Social and Personal Relationships, 2013