Alison M. Radcliffe

Pain and emotion: a biopsychosocial review of recent research.

OBJECTIVE AND METHOD Research on emotion and pain has burgeoned. We review the last decades literature, focusing on links between emotional processes and persistent pain. RESULTS Neurobiological research documents the neural processes that distinguish affective from sensory pain dimensions, link emotion and pain, and generate central nervous system pain sensitization. Psychological research demonstrates that greater pain is related to emotional stress and limited emotional awareness, expression, and processing. Social research shows the potential importance of emotional communication, empathy, attachment, and rejection. CONCLUSIONS Emotions are integral to the conceptualization, assessment, and treatment of persistent pain. Research should clarify when to eliminate or attenuate negative emotions, and when to access, experience, and express them. Theory and practice should integrate emotion into cognitive-behavioral models of persistent pain.

Alexithymia and Physical Health Problems: A Critique of Potential Pathways and a Research Agenda

In the late 1960s and early 1970s, there were reports that patients with various physical illnesses had relatively poor outcomes with psychodynamic psychotherapy (Nemiah & Sifneos, 1970; Sifneos, 1967). Many of these physically ill patients had difficulty reflecting upon, describing, and expressing their emotions; and they struggled to identify connections between psychological or mental processes and their physical symptoms or disease exacerbations. They were described as unproductive, unimaginative, boring, and stiff; and therapists often had difficulty establishing close working alliances with them. The word alexithymia was coined to describe these patients and their primary difficulty—putting feelings into words. These initial observations of alexithymia in patients with health problems undergoing psychotherapy indicated the need for research. But what direction should such research take? In retrospect, at least two research directions could have ensued during the subsequent decades. First, research could have examined the treatment implications of alexithymia, addressing questions such as, “Why do alexithymic patients have difficulty with insight-oriented therapy?” “What alternative treatments might be useful for them?” “Can alexithymia be reduced, and will this lead to improved health?” However, this first research direction was almost completely ignored. Instead, a second direction, based on the observation of elevated alexithymia in physically ill patients, has been diligently pursued—what are the health implications of alexithymia? This second line of research has been dominant in subsequent years as researchers have sought to demonstrate that alexithymia is indeed a risk factor for physical illness. Although research on alexithymia was sporadic during the 1970s and early 1980s, the literature has flourished during the past 20 years. This has been due, in large part, to the development, validation, and promotion of the Toronto Alexithymia Scale (Taylor, Ryan, & Bagby, 1985) and its 20-item revision (Bagby, Parker, & Taylor, 1994; Bagby, Taylor, & Parker, 1994). The TAS-20 provides not only a global alexithymia score but also scores on three dimensions or facets of alexithymia: (a) difficulty identifying one’s feelings, (b) difficulty describing one’s feelings, and (c) an externally oriented mode of cognition. A computer literature search (Medline) revealed that by mid-2003, more than 1,300 research articles had been published on alexithymia. To provide a sense for

Does Emotional Disclosure About Stress Improve Health in Rheumatoid Arthritis? Randomized, Controlled Trials of Written and Spoken Disclosure

&NA; Studies of the effects of disclosing stressful experiences among patients with rheumatoid arthritis (RA) have yielded inconsistent findings, perhaps due to different disclosure methods – writing or speaking – and various methodological limitations. We randomized adults with RA to a writing (n = 88) or speaking (to a recorder) sample (n = 93), and within each sample, to either disclosure or 1 of 2 control groups (positive or neutral events), which conducted four 20‐minute, at‐home sessions. Follow‐up evaluations at 1, 3, and 6 months included self‐reported, behavioral, physiological, and blinded physician‐assessed outcomes. In both writing and speaking samples, the disclosure and control groups were comparably credible, and the linguistic content differed as expected. Covariance analyses at each follow‐up point indicated that written disclosure had minimal effects compared with combined controls – only pain was reduced at 1 and 6 months, but no other outcomes improved. Spoken disclosure led to faster walking speed at 3 months, and reduced pain, swollen joints, and physician‐rated disease activity at 6 months, but there were no effects on other outcomes. Latent growth curve modeling examined differences in the trajectory of change over follow‐up. Written disclosure improved affective pain and walking speed; spoken disclosure showed only a marginal benefit on sensory pain. In both analyses, the few benefits of disclosure occurred relative to both positive and neutral control groups. We conclude that both written and spoken disclosure have modest benefits for patients with RA, particularly at 6 months, but these effects are limited in scope and consistency. Both written and spoken methods of emotional disclosure have some health benefits for patients with rheumatoid arthritis, but the effects are limited.

Computer-based written emotional disclosure: the effects of advance or real-time guidance and moderation by Big 5 personality traits

Standard written emotional disclosure (WED) about stress, which is private and unguided, yields small health benefits. The effect of providing individualized guidance to writers may enhance WED, but has not been tested. This trial of computer-based WED compared two novel therapist-guided forms of WED – advance guidance (before sessions) and real-time guidance (during sessions, through instant messaging) – to both standard WED and control writing; it also tested Big 5 personality traits as moderators of guided WED. Young adult participants (n = 163) with unresolved stressful experiences were randomized to conditions, had three, 30-min computer-based writing sessions, and were reassessed six weeks later. Contrary to hypotheses, real-time guidance WED had poorer outcomes than the other conditions on several measures, and advance guidance WED also showed some poorer outcomes. Moderator analyses revealed that participants with low baseline agreeableness, low extraversion, or high conscientiousness had relatively poor responses to guidance. We conclude that providing guidance for WED, especially in real-time, may interfere with emotional processing of unresolved stress, particularly for people whose personalities have poor fit with this interactive form of WED.

The increasing role of psychology health research and interventions and a vision for the future.

Psychology is on the cusp of becoming a major contributor to the health of the people living in the United States. Over the past 50 years, psychology research and psychologically based interventions and prevention strategies have increasingly influenced the health of people and health care services in the United States. In this article, the authors review briefly the first 40 years of psychology’s development as a health profession. An overview of the accelerating changes for psychological involvement in health since the millennium follows. Then, a vision for the future is presented. This article has as its theoretical base a biopsychosocialcultural model of health that places increasing influence on the role of culture, which includes race, ethnicity, social class, gender, physical ablebodiness, and developmental age.

Does Written Emotional Disclosure about Stress Improve College Students’ Academic Performance? Results from Three Randomized, Controlled Studies

Several early studies and subsequent reviews suggested that written emotional disclosure (WED)—writing repeatedly about personal stressful experiences—leads to improved academic performance of college students. A critical review of available studies casts some doubt on this conclusion, so we conducted three randomized, controlled experiments of the effects of WED versus control writing on grade point average (GPA) of college students. In all three studies, WED writing was implemented effectively—it contained more negative emotion language and generated more negative mood than did control writing. In Study 1, WED did not influence GPA during either the writing semester or subsequent semester among 96 students with headaches. In Study 2, WED had no effect on GPA compared with either control writing or no writing conditions among 124 students with unresolved stress. In Study 3, WED did not influence GPA or retention among 68 academically at-risk ethnic minority students, although secondary analyses suggested some benefits of WED among students who wrote more than once, particularly men. These three studies challenge the belief that WED improves academic performance of college students in general. Future research should examine subgroups of students who might benefit from WED.