Howard Tennen

Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia

&NA; Fifty women with fibromyalgia syndrome (FS) recorded their sleep quality, pain intensity, and attention to pain for 30 days, using palm‐top computers programmed as electronic interviewers. They described their previous nights sleep quality within one‐half hour of awakening each day, and at randomly selected times in the morning, afternoon, and evening rated their present pain in 14 regions and attention to pain during the last 30 min. We analyzed the 30‐day aggregates cross‐sectionally at the across‐persons level and the pooled data set of 1500 person‐days at the within‐persons level after adjusting for between‐persons variation and autocorrelation. Poorer sleepers tended to report significantly more pain. A night of poorer sleep was followed by a significantly more painful day, and a more painful day was followed by a night of poorer sleep. Pain attention and sleep were unrelated at the across‐persons level of analysis. But there was a significant bi‐directional within‐person association between pain attention and sleep quality that was not explained by changes in pain intensity.

A daily process approach to coping: Linking theory, research, and practice.

For decades, coping researchers have used between-person designs to address inherently within-person questions derived from theory and clinical practice. The authors describe recent developments in the use of within-person, process-oriented methods that examine individuals intensively over time. Ongoing studies of stress and alcohol consumption, the effects of depression on adaptational processes, and the temporal dynamics of coping with chronic pain demonstrate that by tracking rapidly fluctuating processes such as mood and coping close to their real-time occurrence, daily process designs offer unique insights into conceptually and clinically challenging questions. Such designs also provide new opportunities to examine the purported mechanisms of therapeutic interventions. Despite its demands on participants and investigators, daily process research offers fresh opportunities to link psychological theory, research, and practice.

Neuroticism and the pain-mood relation in rheumatoid arthritis: Insights from a prospective daily study.

For 75 consecutive days, 54 Ss with rheumatoid arthritis supplied daily reports of their mood and joint pain. After aggregating daily reports, the relation between chronic mood and chronic pain remained statistically significant when controlling for neuroticism, depression, disease activity, disability, and characteristic responses to increasing pain. Findings of a path analysis suggest that (a) individuals higher in neuroticism experience more chronic distress regardless of their responses to pain, their pain intensity, and depressive symptomatology, and (b) the relation between neuroticism and chronic pain is mediated by the propensity of high-neuroticism individuals to catastrophize their pain. Within-subject analyses that controlled for autocorrelation and linear trends in the time series revealed that 40% of the Ss experienced significantly worse moods on more painful days. Although individuals higher in neuroticism reported more intense pain and more negative mood, their daily mood was less strongly linked to their daily pain.

Does Self-Reported Posttraumatic Growth Reflect Genuine Positive Change?

In this study, we evaluated the validity of self-reported posttraumatic growth (PTG) by assessing the relation between perceived growth and actual growth from pre- to posttrauma. Undergraduate students completed measures tapping typical PTG domains at Time 1 and Time 2 (2 months later). We compared change in those measures with scores on the Posttraumatic Growth Inventory (PTGI; Tedeschi & Calhoun, 1996) for those participants who reported a traumatic event between Time 1 and Time 2 (n = 122). PTGI scores generally were unrelated to actual growth in PTG-related domains. Moreover, perceived growth was associated with increased distress from pre- to posttrauma, whereas actual growth was related to decreased distress, a pattern suggesting that perceived and actual growth reflect different processes. Finally, perceived (but not actual) growth was related to positive reinterpretation coping. Thus, the PTGI, and perhaps other retrospective measures, does not appear to measure actual pre- to posttrauma change.

Examinations of chronic pain and affect relationships : Applications of a dynamic model of affect

Two studies of the relationship between pain and negative affect are presented in this article: a study of weekly fluctuations in pain and negative affect among those with arthritis and a study of daily fluctuations in pain and negative affect for participants with fibromyalgia. The roles of positive affect and mood clarity (or the ability to distinguish between different emotions) in modifying the size of the relationship between pain and negative affect were examined in both studies as a means of testing the predictions of a dynamic model of affect regulation. In both studies, the presence of positive affect reduced the size of the relationship between pain and negative affect. Also, for arthritis participants with greater mood clarity, there was less overlap in ratings of negative and positive affective states.

Coping and Cognitive factors in adaptation to in vitro fertilization failure

Characteristics were identified that predict adaptation following an unsuccessful attempt at in vitrofertilization (IVF). Forty-one women and their husbands were interviewed and administered questionnaires prior to IVF and 2 weeks after notice of a positive or negative pregnancy test. Of the 36 couples who failed to conceive as a result of IVF, 6 of the women studied developed clinical depressive symptoms. Those women who reported poorest adaptation to IVF failure were more likely to have reported depressive symptoms prior to IVF, were more likely to have reported feeling a general loss of control over their lives as a result of infertility, tended to use escape as a coping strategy, and reported having felt some responsibility for their IVF failure. Dispositional optimism, as well as a sense of being partially responsible for the infertility, was protective of distress following IVF failure.

Depression, self-esteem, and the absence of self-protective attributional biases

Previous research has demonstrated a relation between depression and attributional style. In the present study we evaluated the extent to which self-esteem may be an important determinant of attributional style. Subjects completed measures of self-esteem, depression, and anxiety and responded to the Attributional Style Questionnaire. Maximum R2 analyses revealed that for significant one-variable and multivariable regression models, self-esteem accounted for the variation in attributional style on the majority of outcome measures. Depression and anxiety added little beyond the contribution of self-esteem. These findings were consistent for both positive and negative events. In addition, self-esteem accounted for variation in attributional evenhandedness. Results are discussed in terms of the role of self-esteem maintenance in attributional style.

The relative importance of dispositional optimism and control appraisals in quality of life after coronary artery bypass surgery

Similar mechanisms have been proposed to explain the stress-buffering effects of both dispositional optimism and perceived control. Yet dispositional optimism as a personal resource should function independently of situational control appraisals. To evaluate the unique and additive contributions to adaptation of control appraisals and optimism, we followed 49 individuals scheduled for coronary artery bypass surgery. One month before surgery dispositional optimism was associated with neither health locus of control nor specific expectancies about the outcomes of surgery. Dispositional optimism, however, was associated with perceived control over the course of the illness and with quality of life appraisals. Although presurgery optimism predicted life quality 8 months after surgery, this was not the case when general and specific control appraisals and specific expectancies were included in the prediction. These findings are discussed as they relate to current conceptions of trait optimism.

Personality, temperament, and character dimensions and the DSM-IV personality disorders in substance abusers.

The authors evaluated the relationship between P. T. Costa and R. R. McCraes (1992) NEO 5-factor model, C. R. Cloningers (1993) 7-factor Temperament and Character Inventory (TCI), and the American Psychiatric Associations (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th ed., personality disorders in 370 inpatient and outpatient alcohol, cocaine, and opiate abusers. NEO Neuroticism was associated with many disorders, and different patterns for Agreeableness, Conscientiousness, and Extraversion emerged for the different disorders. Several TCI scales were associated with different personality disorders, although not as strongly as the NEO dimensions. Results did not support most predictions made for the TCI. Normal personality dimensions contributed significantly to the prediction of personality disorder severity above and beyond substance abuse and depression symptoms.

Pain coping strategies and coping efficacy in rheumatoid arthritis: a daily process analysis

Abstract Data from daily diaries were used to analyze pain coping processes in rheumatoid arthritis patients. For 30 consecutive days, 53 individuals described the pain coping strategies they used that day and rated the efficacy of their coping, joint pain, and positive and negative mood. Relations among variables were examined across‐persons and within‐persons over time. At the across‐persons level of analysis, (i) daily coping efficacy was unrelated to pain coping or pain intensity, and (ii) the more frequent daily use of a wide variety of pain coping strategies was correlated with greater pain. Within‐person analyses provided unique information about the relations among coping, pain, and mood not apparent in the across‐persons results. Specifically, these analyses showed that increases in daily coping efficacy were not only related to decreases in pain, but also to decreases in negative mood and increases in positive mood. Time‐lagged effects of coping and coping efficacy were also found. Individuals who reported high levels of coping efficacy on one day had lower levels of pain on the subsequent day. The daily use of pain reduction efforts and relaxation strategies also contributed to an improvement in next‐day pain and an enhancement of positive mood. The implications of these findings for the assessment of pain and coping in rheumatoid arthritis patients are discussed.