Claire E. Ashton-James

Pride and Prejudice: How Feelings About the Self Influence Judgments of Others

The present research demonstrates that pride has divergent effects on prejudice, exacerbating or attenuating evaluative biases against stigmatized groups, depending on the form of pride experienced. Specifically, three experiments found that hubristic pride—associated with arrogance and self-aggrandizement—promotes prejudice and discrimination, whereas authentic pride—associated with self-confidence and accomplishment—promotes more positive attitudes toward outgroups and stigmatized individuals. Findings generalized to discriminatory judgments (Experiment 2) and were found to be mediated by empathic concern for the evaluative target. Together, these experiments suggest that pride may be a cause of everyday prejudice and discrimination but that these social consequences depend on whether hubristic or authentic pride is experienced, and the degree to which empathic concern is subsequently aroused.

When the Wolf Wears Sheep’s Clothing Individual Differences in the Desire to be Liked Influence Nonconscious Behavioral Mimicry

Current research into the elicitors of nonconscious behavioral mimicry focuses almost exclusively on prosocial motives. Alternatively, the present research investigates whether the self-centered desire to be liked by others also induces mimicry. We investigate this issue by measuring the mimicry behavior of narcissists—a “dark personality” that is uniquely characterized by a desire to be liked by rather than by genuine liking for people. Narcissists are particularly motivated to form social alliances with high-status others. Hence, it was hypothesized that narcissistic participants would show more mimicry of higher status others (compared to lower status others). Support for this hypothesis was provided by a mixed within- and between-subjects field experiment in which the mimicry behavior of participants identified as being above or below average in subclinical narcissism was observed in a scripted interaction with a higher and lower status other.

Impact of pain behaviors on evaluations of warmth and competence

Summary Using body motion as their only visual cue, participants evaluated a person displaying pain more negatively than a person displaying no pain. ABSTRACT This study investigated the social judgments that are made about people who appear to be in pain. Fifty‐six participants viewed 2 video clips of human figures exercising. The videos were created by a motion tracking system, and showed dots that had been placed at various points on the body, so that body motion was the only visible cue. One of the figures displayed pain behaviors (eg, rubbing, holding, hesitating), while the other did not. Without any other information about the person in each video, participants evaluated each person on a variety of attributes associated with interpersonal warmth, competence, mood, and physical fitness. As well as judging them to be in more pain, participants evaluated the person who displayed pain behavior as less warm and less competent than the person who did not display pain behavior. In addition, the person who displayed pain behavior was perceived to be in a more negative mood and to have poorer physical fitness than the person who did not, and these perceptions contributed to the impact of pain behaviors on evaluations of warmth and competence, respectively. The implications of these negative social evaluations for social relationships, well‐being, and pain assessment in persons in chronic pain are discussed.

Protocols for treating the postoperative pain of fractures in Dutch hospitals

Introduction Every year, over 260,000 patients in the Netherlands are diagnosed with a traumatic fracture. Many patients are treated surgically and need postoperative treatment of pain. Research suggests postoperative pain is often under-treated, leaving a significant proportion of patients in moderate to severe postoperative pain. Specialized, evidence-based pain-management protocols offer patients the best possible pain management, and significantly reduce the risk of pain-related health complications. Objective Our objective was to review the range of postoperative pain protocols that are currently being used to treat postoperative fracture pain within the Netherlands, and investigate whether a specialized, evidence-based protocol for treating postoperative fracture pain exists within this sample. Methods A written request for the protocol currently being used for the treatment of postoperative pain following the surgical treatment of a fracture was sent to 101 Dutch hospital departments. The administration and dosage of pain medications used during postoperative pain management were then identified and summarized. Results Of the contacted hospitals, 57% sent in protocols; 45% of these were eligible for analysis. All of the departments sent a general or acute pain protocol rather than a specialized protocol for the treatment of postoperative pain associated with the surgical treatment of fractures. A total of 22 different analgesics were used for pain management in 135 different administration schemes. Paracetamol, diclofenac, and morphine were used in the majority of protocols. Medication was given via oral, rectal, intravenous, subcutaneous, intramuscular, and epidural routes, amongst others. Conclusion No specialized, evidence-based protocols for the treatment of postoperative fracture pain were found in this Dutch sample. A wide variety of medications, dosages, and administration schemes were used to manage postoperative pain following the surgical treatment of a fracture. The importance of developing a clear, specialized, evidence-based protocol for the treatment of postoperative pain following fracture surgery is discussed.

Can images of pain enhance patient–clinician rapport in pain consultations?

A variety of treatment outcomes in chronic pain are influenced by patient–clinician rapport. Patients often report finding it difficult to explain their pain, and this potential obstacle to mutual understanding may impede patient–clinician rapport. Previous research has argued that the communication of both patients and clinicians is facilitated by the use of pain-related images in pain assessments. This study investigated whether introducing pain-related images into pain assessments would strengthen various components of patient–clinician rapport, including relative levels of affiliation and dominance, and interpersonal coordination between patient and clinician behaviour. Videos of 35 pain assessments in which pain images were present or absent were used to code behavioural displays of patient and clinician rapport at fixed intervals across the course of the assessment. Mixed modelling was used to examine patterns of patient and clinician affiliation and dominance with consultation type (Image vs Control) as a moderator. When pain images were present, clinicians showed more affiliation behaviour over the course of the consultation and there was greater correspondence between the affiliation behaviour of patient and clinician. However, relative levels of patient and clinician dominance were unaffected by the presence of pain images in consultations. Additional analyses revealed that clinicians responded directly to patients’ use of pain images with displays of affiliation. Based on the results of this study, we recommend further investigation into the utility and feasibility of incorporating pain images into pain assessments to enhance patient–clinician communication.

Appearance of trustworthiness: an implicit source of bias in judgments of patients' pain.

There has long been a concern that superficial, nondiagnostic, patient characteristics can influence clinicians’ evaluation of patients’ pain and their responses to patients’ complaints and requests for help. Studies have shown that the pain judgments of experienced clinicians and health care workers from a variety of disciplines are influenced by matters of appearance—including ethnicity, age, gender, skin colour, socioeconomic status, and attractiveness. Older adults often have their pain underestimated relative to younger adults, the pain reports of ethnic/racial minorities and females are less likely to be believed than their demographic counterparts, and more attractive patients are perceived to be in less pain and to have better physical functioning. One study in Australia found that just changing the name of a patient on a file (from an Anglo to a Latin name) was sufficient to affect the pain assessments of qualified, practicing physiotherapists. Similarly, in a study of nurses in a long-term care setting, Katsma and Souza found the more experienced the nurse, the less likely they were to believe patients’ self-report. This study also found that the nurses doubted the self-report of patients and were more likely to cue into facial expression as the basis of their pain evaluation. Aside from the issue of basic fairness, such biases can have important implications for treatment decisions. Racial and socioeconomic disparities in the prescription of opioids for migraine or low-back pain are well documented, and a recent study fromNorway found that female patientswith chronic painwere less likely to be offered physiotherapy as a treatment strategy thanmale patients. Reiterating the role of appearances in pain management, Turk andOkifuji, for example, found that the prescription of opioids by medical specialists was strongly influenced by their assessment of patients’ pain behaviours. Indeed, only recently Sullivan and Ballantyne published topical review in Pain, warning of the problem of “adverse selection” for the prescription of opioids for patients based on pain report and other pain behaviours rather than more objective criteria. Despite evidence that clinicians’ pain judgments and treatment decisions can be biased by themere appearance of patients, very little research has sought to account for these effects, which is essential if we are to take steps to overcome them. One possibility is that patients’ appearance affects judgments of pain by influencing clinicians’ implicit judgments of patient trustworthiness. Research by Schäfer et al. reported in this issue of Pain supports this idea in a 2 ways: First, the authors provide sound evidence that clinicians make implicit (rapid, nonconscious) judgments of patient trustworthiness on the basis of appearances. Second, they demonstrate that the impact of patient characteristics (in this case, gender and history of depression) on clinicians’ pain assessments is moderated by the appearance of trustworthiness. Each of these processes is considered in turn below, as well as their clinical implications and suggestions for future research.

Are Group Size and Composition Associated with Treatment Outcomes in Group Cognitive Behavioural Therapy for Chronic Pain

Abstract This study explored whether group size and group member characteristics (age, sex, and compensation status) were associated with patient outcomes (changes in pain and disability). Retrospective analyses of outcome data obtained from 2 independently run group cognitive behavioural therapy (CBT) programs for chronic pain (Program A: N = 317 and Program B: N = 693) were conducted. Intracluster correlations were significant in both studies, indicating group-level effects on patient outcomes in both group CBT programs for chronic pain. Mixed modelling revealed that group size and group member characteristics (age, sex, and compensation status) were related to patient outcomes, but not consistently across programs. The results of our analyses confirm the contribution of group composition to individual treatment outcomes in group CBT for chronic pain, and highlight factors that have the potential to contribute to group-level variability in patient outcomes. Further research is needed to identify the mechanisms that account for the impact of group characteristics on the efficacy of CBT for chronic pain.

Parents Reap What They Sow

A controversial feature of modern parenting is “child-centrism,” the tendency for parents to prioritize their children’s well-being above their own. It has been suggested that child-centric parenting in its various forms may undermine parental well-being. Contrary to popular belief, more child-centric parents reported deriving more happiness and meaning from parenthood (Study 1). Study 2 employed the day reconstruction method (Kahneman, Krueger, Schkade, Schwarz, & Stone, 2004) to capture parents’ actual experiences while taking care of their children. Consistent with Study 1, greater child-centrism was associated with the experience of greater positive affect, less negative affect, and greater meaning in life when engaged in child care activities. This link between child-centrism and well-being stands in contrast to recent arguments about the pitfalls of overinvestment in children, while dovetailing with a growing body of evidence that personal well-being is associated with investing in others rather than oneself.