A. Corry G. Linssen

Pain coping strategies in a Dutch population of chronic low back pain patients

&NA; The use of strategies for coping with chronic pain was assessed by means of the Coping Strategy Questionnaire (CSQ) in a Dutch sample of 108 chronic low back pain (LBP) patients referred for behavioral treatment. The 3 factors of the CSQ were related to measurements of behavioral and emotional adjustment to LBP above and beyond the effects of demographic and medical status variables. Especially patients high on the factor Helplessness reported higher levels of pain, functional impairment, anxiety, depression and psychoneuroticism, while patients high on the factor Perceived Control reported lower levels of pain, functional impairment and also manifested a higher level of uptime. The causal role of coping strategies in adjustment to pain, the selectivity of focusing on LBP patients selected through referral and implications for pain management are discussed.

Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups

&NA; The aims of this study were to(a) investigate the efficacy of autogenic training (AT) and cognitive self‐hypnosis training (CSH) for the treatment of chronic headaches in comparison with a waiting‐list control (WLC) condition,(b) investigate the influence of subject recruitment on treatment outcome(c) explore whether the level of hypnotizability is related to therapy outcome. Three different subjects groups (group 1, patients (n = 58) who were referred by a neurological outpatient clinic; group 2, members (n = 48) of the community who responded to an advertisement in a newspaper; and group 3, students (n = 40) who responded to an advertisement in a university newspaper) were allocated at random to a therapy or WLC condition. During treatment, there was a significant reduction in the Headache Index scores of the subjects in contrast with the controls. At post‐treatment and follow‐up almost no significant differences were observed between the 2 treatment conditions or the 3 referral sources regarding the Headache Index, psychological distress (SCL‐90) scores and medication use. Follow‐up measurements indicated that therapeutic improvement was maintained. In both treatment conditions, the high‐hypnotizable subjects achieved a greater reduction in headache pain at post‐treatment and follow‐up than did the low‐hypnotizable subjects. It is concluded that a relatively simple and highly structured relaxation technique for the treatment of chronic headache subjects may be preferable to more complex cognitive hypnotherapeutic procedures, irrespective of the source of recruitment. The level of hypnotic susceptibility seems to be a subject characteristic which is associated with a more favourable outcome in subjects treated with AT or CSH.

Behavioral treatment of chronic low back pain. I. Relation of coping strategy use to outcome.

&NA; The clinical relevance of strategies to cope with pain was assessed by means of the Coping Strategy Questionnaire (CSQ). This was presented to a sample of 53 low back pain patients in The Netherlands, who had agreed to participate in a treatment outcome study of a group program consisting of education about pain and a training in relaxation and imaginative pain coping strategies. A baseline period of 10 weeks was followed by 10 weekly therapy sessions. At posttreatment, improvement in measurements of reported pain intensity and behavioral and emotional adjustment to pain correlated significantly with (changes in) coping strategy use. However, at the 6‐month follow‐up, only pain reduction appeared to be significantly related to pretreatment‐follow‐up changes on CSQ scores for Perceived Control. It is concluded that a judgment about ones capability to control pain may be as important as the specific pain coping strategies used.

Cognitive coping and appraisal processes in the treatment of chronic headaches

&NA; The purpose of the present study was to investigate the active cognitive ingredients of change in psychological treatments for long‐term chronic headache complaints. The primary questions this study addressed were: (1) Is a cognitive self‐hypnosis training which explicitly attempts to change appraisal and cognitive coping processes more effective in producing these changes than a relaxation procedure, and (2) are changes in pain appraisal and cognitive coping related to changes in pain and adjustment in the short and long term? A total of 144 patients were assigned at random to a cognitive self‐hypnosis (CSH) treatment or autogenic training (AT) with a duration of 7 weeks. Measures used were: Headache Index (HI), Symptom Checklist‐90 (SCL‐90), Coping Strategy Questionnaire (CSQ), Multidimensional Locus of Pain Control Questionnaire (MLPC) and treatment expectations. The results indicated that patients successfully changed their use of coping strategies and pain appraisals. Cognitive therapy was more effective than relaxation training in changing the use of cognitive coping strategies which were the direct targets of treatment. However, treatment effects were only related with changes in the use of coping strategies and appraisal processes to a limited extent and the mediational role of cognitive processes in pain reduction and better adjustment was inconclusive.

Autogenic training and self-hypnosis in the control of tension headache

This study compares autogenic training and training in multiple self-hypnosis strategies in a sample of 56 patients diagnosed as having chronic tension headache on the basis of medical evaluation by a neurologist. At posttreatment and follow-up, no differences between the two treatment regimens in the reduction of headache and psychological distress were observed. During treatment, patients reduced their headache activity and level of psychological distress significantly in contrast to the waiting-list period (p < 0.05). Follow-up measurements indicated that therapeutic improvement was maintained (p < 0.05). Short-term and long-term pain reduction was accompanied by an increase in perceived pain control (p < 0.003). Moreover, those patients who attributed the pain reduction obtained during therapy to their own efforts manifested long-term pain reduction (p < 0.003).

Autogenic Training and Future Oriented Hypnotic Imagery in the Treatment of Tension Headache: Outcome and Process

The aim of the present study was (a) to investigate the relative efficacy of autogenic training and future oriented hypnotic imagery in the treatment of tension headache and (b) to explore the extent to which therapy factors such as relaxation, imagery skills, and hypnotizability mediate therapy outcome. Patients were randomly assigned to the 2 therapy conditions and therapists. 55 patients (28 in the autogenic therapy condition and 27 in the future oriented hypnotic imagery condition) completed the 4 therapy sessions and 2 assessment sessions. No significant main effect or interaction effects for treatment condition or therapist was revealed. A significant effect for time in analyzing scores for headache pain, pain medication usage, depression, and state anxiety was found. In the self-hypnosis condition, pain reduction proved to be associated with depth of relaxation during home practice (as assessed with diaries) and capacity to involve in imagery (as assessed with the Dutch version [van der Velden & Spinhoven, 1984] of the Creative Imagination Scale [Barber & Wilson, 1978/79; Wilson & Barber, 1978]). After statistically controlling for relaxation and imagery, hypnotizability scores (as assessed with the Dutch version [Oyen & Spinhoven, 1983] of the Stanford Hypnotic Clinical Scale [Morgan & J.R. Hilgard, 1975, 1978/79]) were significantly correlated with ratings of pain reduction. Results are discussed in the context of the neo-dissociation and social-cognitive model of hypnoanalgesia. The clinical relevance and the methodological shortcomings of the present study are also critically assessed.

Responders and Nonresponders to Autogenic Training and Cognitive Self-hypnosis: Prediction of Short- and Long-term Success in Tension-Type Headache Patients

The present study was conducted to determine whether demographic variables, medical status variables, and psychological measures at pretreatment were related to pain reduction immediately following behavioral treatment for headache and at a 6‐month follow‐up. The study sample consisted of 156 subjects, who were selected for participation in a behavioral outcome study on the efficacy of autogenic training and cognitive self‐hypnosis training. A Headache Index based on pain diaries constituted the main outcome measure. Psychological measures included the Symptom Checklist‐90, Dutch Personality Questionnaire, Coping Strategy Questionnaire, Multidimensional Locus of Pain Control Questionnaire, and treatment expectations. Subjects who expected more pain reduction at pretreatment achieved a lower level of pain at posttreatment, independent of pretreatment pain levels. None of the other pretreatment variables were related with pain reduction at posttreatment or at the follow‐up. Finally, at the 6‐month follow‐up, 43 subjects were classified as responders (more than 50% pain reduction) and 113 as nonresponders (less than 50% pain reduction and dropouts). At pretreatment, the responders perceived more pain control than the nonresponders. None of the other pretreatment differences between responders and nonresponders proved to be significant. The main conclusion that could be drawn from this study was that pain reduction, in the short‐ and long‐term, cannot be predicted with any accuracy by demographic and medical status variables or scores for psychological distress, personality traits, coping strategy use, and pain appraisals.

The development of the Multidimensional Locus of Pain Control Questionnaire (MLPC) : factor structure, reliability, and validity

This study was conducted to develop a comprehensive Multidimensional Locus of Pain Control questionnaire (MLPC) and to examine how locus of pain control is related to pain appraisals, pain coping strategies, and adjustment to chronic pain. Subjects were 170 chronic headache patients. By means of factor analysis, four subscales were derived: an Internal, a Chance, a Physician, and a Medication locus of pain control orientation scale. The reliability and validity of the subscales appeared to be satisfactory. The results of the present study indicate that the locus of pain control orientation is significantly related to pain appraisals such as perceived pain control and catastrophizing and, to a lesser degree, to coping strategies as measured by the Coping Strategies Questionnaire (CSQ). However, almost no relationship was observed between locus of pain control and adjustment to pain. Further research with the MLPC in different chronic pain populations is warranted in order to investigate whether the results found in this study can be generalized to chronic pain patients in general.

Assessment of hypnotic processes and responsiveness in a clinical context

The present study was designed to investigate in a clinical situation whether differences in measured hypnotizability validly reflect differences in hypnotic processes and to what extent factors deemed extraneous to hypnosis--such as resistance--influence hypnotic responding. To answer this question, Dutch versions of relevant scales had to first be developed. The factorial validity and reliability of a Dutch translation of the Resistance Toward Hypnosis Scale (DRHS) and a shortened Dutch version of the Phenomenology of Consciousness Inventory (DPCI) were investigated in a sample of 205 psychiatric patients. The DRHS proved to be factorially valid and reliable, and two subscales, Trance and Reality Orientation, derived empirically from the DPCI showed good to satisfactory reliability. In a second study with a subsample of 99 psychiatric patients, hypnotizability as measured by the Stanford Hypnotic Clinical Scale for Adults was strongly and positively related to DPCI Trance scores and moderately and negatively related to DPCI Reality Orientation and DRHS Resistance scores. It is concluded that hypnotizability as measured in a clinical context under standard conditions is strongly related to hypnotic experiences over and above the moderate effects of resistance toward hypnosis and hypnotic suggestions. Standard hypnotizability assessments appear to be similar in their meaning in an experimental and clinical context.