Ida K. Flink

Manipulating optimism: Can imagining a best possible self be used to increase positive future expectancies?

This study tested whether a brief manipulation consisting of positive future thinking can temporarily increase optimism. Participants in the positive future thinking condition (n = 44) wrote about their best possible self (BPS) for 15 min, followed by 5 min of mental imagery. Participants in the control condition (n = 38) wrote about and imagined a typical day in their life. Positive and negative future expectancies and positive and negative affect were measured before and after each manipulation. Compared to the control manipulation, the positive future thinking manipulation led to significantly larger increase in positive affect and positive future expectancies. The increase in positive expectancies was not dependent on the mood effect. The results indicate that imagining a positive future can indeed increase expectancies for a positive future.

Pain in childbirth and postpartum recovery : the role of catastrophizing

This prospective study investigated how pain catastrophizing was related to labor pain intensity and physical recovery after childbirth. Eighty‐eight women giving birth for the first time completed the first questionnaire before delivery. Eighty‐two of those returned the second questionnaire after delivery. Participants were classified as catastrophizers (n=38) or non‐catastrophizers (n=44) based on their scores on the Pain Catastrophizing Scale. Comparison of the groups showed that catastrophizers anticipated and experienced more intense pain (p<.0125) and had poorer physical recovery (p<.0125), measured as the level of self‐reported functioning in activities of daily living, than non‐catastrophizers. These results extend the association between catastrophizing and pain, to pain and recovery in childbirth and provide support for the fear‐avoidance model. It is concluded that pain catastrophizing plays a role in the experience of pain in childbirth and postpartum recovery. Further research is needed to identify appropriate interventions for catastrophizing women during the latter part of pregnancy.

Reducing the threat value of chronic pain : A preliminary replicated single-case study of interoceptive exposure versus distraction in six individuals with chronic back pain

This paper describes a preliminary experimental evaluation of a technique intended to help people suffering from chronic back pain and low pain acceptance to alter the aversiveness or threat value of their persisting pain. Using a multiple baseline cross-over design six individuals with chronic back pain were taught to use a form of interoceptive exposure as well as a relaxation/distraction breathing-based technique in the presence of their pain. Half the participants used one method for three weeks, and then crossed over to the other method for a further three weeks. The other half did the reverse. Assessments were conducted at pre/post treatment and at a three month follow-up. Daily monitoring of pain-related distress was also completed. The results indicated moderately high improvements in pain acceptance across most participants and corresponding declines in pain-related distress. No clear differences occurred between conditions, but the changes on disability and catastrophising scales for most cases were consistent with those reported after more substantial interventions. The study raises some important clinical and methodological issues that could inform future research in this area.

Catastrophizing moderates the effect of exposure in vivo for back pain patients with pain-related fear

This investigation was an initial attempt to explore psychological factors that might help or hinder the effect of exposure in vivo for patients with musculoskeletal pain and pain‐related fear. The study was based on data from a randomized‐controlled trial for patients with non‐specific spinal pain ( Linton et al., 2008 ).

Happy despite pain: Pilot study of a positive psychology intervention for patients with chronic pain

Abstract Background and purpose Dealing with chronic pain is difficult and affects physiological as well as psychological well-being. Patients with chronic pain are often reporting concurrent emotional problems such as low mood and depressive symptoms. Considering this, treatments need to involve strategies for improving mood and promoting well-being in this group of patients. With the rise of the positive psychology movement, relatively simple intervention strategies to increase positive feelings, cognitions, and behaviours have become available. So far, the evidence for positive psychology techniques mainly comes from studies with healthy participants, and from studies with patients expressing emotional problems such as depression or anxiety as their main complaint. This study describes an initial attempt to explore the potential effects of a positive psychology intervention in a small sample of patients suffering from chronic pain. Methods A replicated single case design was employed with five participants. The participants started to fill out daily self-reports and weekly questionnaires two weeks before the intervention started, and continued throughout the intervention. In addition, they filled out a battery of questionnaires at pretest, posttest, and at a three months follow-up. The instruments for assessment were selected to cover areas and constructs which are important for pain problems in general (e.g. disability, life satisfaction, central psychological factors) as well as more specific constructs from positive psychology (e.g. compassion, savoring beliefs). Results The results on pre and post assessments showed an effect on some of the measures. However, according to a more objective measure of reliable change (Reliable Change Index, RCI), the effects were quite modest. On the weekly measures, there was a trend towards improvements for three of the participants, whereas the other two basically did not show any improvement. The daily ratings were rather difficult to interpret because of their large variability, both between and within individuals. For the group of participants as a whole, the largest improvements were on measures of disability and catastrophizing. Conclusions The results of this preliminary study indicate that a positive psychology intervention may have beneficial effects for some chronic pain patients. Although it is not to be expected that a limited positive psychology intervention on its own is sufficient to treat pain-related disability in chronic patients, our findings suggest that for some it may be an advantageous complement to enhance the effects of other interventions. Implications The results of this pilot study about the potential effects of a positive psychology intervention for chronic pain patients may be encouraging, warranting a larger randomized controlled study. Future studies may also concentrate on integrating positive psychology techniques into existing treatments, such as composite CBT-programs for chronic pain patients. Our advice is that positive psychology interventions are not to be regarded as stand-alone treatments for this group of patients, but may potentially enhance the effect of other interventions. However, when and for which patients these techniques may be recommended is to be explored in future research.

Understanding catastrophizing from a misdirected problem-solving perspective

OBJECTIVES The aim is to explore pain catastrophizing from a problem-solving perspective. The links between catastrophizing, problem framing, and problem-solving behaviour are examined through two possible models of mediation as inferred by two contemporary and complementary theoretical models, the misdirected problem solving model (Eccleston & Crombez, 2007) and the fear-anxiety-avoidance model (Asmundson, Norton, & Vlaeyen, 2004). DESIGN In this prospective study, a general population sample (n= 173) with perceived problems with spinal pain filled out questionnaires twice; catastrophizing and problem framing were assessed on the first occasion and health care seeking (as a proxy for medically oriented problem solving) was assessed 7 months later. METHODS Two different approaches were used to explore whether the data supported any of the proposed models of mediation. First, multiple regressions were used according to traditional recommendations for mediation analyses. Second, a bootstrapping method (n= 1000 bootstrap resamples) was used to explore the significance of the indirect effects in both possible models of mediation. RESULTS The results verified the concepts included in the misdirected problem solving model. However, the direction of the relations was more in line with the fear-anxiety-avoidance model. More specifically, the mediation analyses provided support for viewing catastrophizing as a mediator of the relation between biomedical problem framing and medically oriented problem-solving behaviour. CONCLUSION These findings provide support for viewing catastrophizing from a problem-solving perspective and imply a need to examine and address problem framing and catastrophizing in back pain patients.

Early psychologically informed interventions for workers at risk for pain-related disability: does matching treatment to profile improve outcome?

Purpose This randomized controlled trial had two main aims. The first aim was to investigate the effect of early preventive, psychologically informed, interventions for pain-related disability. The second aim was explore whether people who are matched to an intervention specifically targeting their psychological risk profile had better outcomes than people who were not matched to interventions. Methods A total of 105 participants were recruited from their workplace, screened for psychological risk factors and classified as being at risk for long-term pain-related disability. They were subgrouped into one of three groups based on their psychological profile. Three behaviorally oriented psychological interventions were developed to target each of the three risk profiles. Half of the participants were assigned a matched intervention developed to target their specific profile, and half were assigned an unmatched intervention. After treatment, repeated measure ANOVAs and χ2 tests were used to determine if treatments had an effect on primary and secondary outcomes including perceived disability, sick leave, fear and avoidance, pain catastrophizing and distress, and if matched participants had better outcomes than did unmatched. Results Treatments had effects on all outcome variables (effect sizes d ranging between 0.23 and 0.66), but matched participants did not have better outcomes than unmatched. Conclusions Early, preventive interventions have an impact on a number of outcome variables but it is difficult to realize a matching procedure. More in-depth research of the process of matching is needed.

Understanding Co-occurring Emotion and Pain: The Role of Context Sensitivity from a Transdiagnostic Perspective

Co-occurring emotional distress and chronic pain are a true challenge in the clinic. This combination of symptoms is quite common but associated with poor treatment results, frequent relapses and costly dysfunction. This paper describes a transdiagnostic approach to the problem by focusing on psychological processes that drive both the emotional as well as the pain problem. Avoidance and context (in)sensitivity are suggested as potential transdiagnostic factors that might be targeted in treatment. Since both pain and distress are aversive, they may be avoided. This may be helpful in the short-term, but paradoxically the avoidance maintains the problem in the long-term. Context sensitivity concerns how well our responses are in tune with the changing demands of the environment. We propose that context insensitivity may drive emotional distress and pain problems. We present data that show that disclosure of pain is important emotionally, but that it is also a challenge to respond in manner that is sensitive to the social context. Indeed, disclosing how we feel emotionally or concerning pain might be helpful in some situations, but enhance the problem in others. Finally, we outline a hybrid treatment that combines exposure for pain (feared movements) and emotions (disclosure) with context sensitivity training. While such new treatments are promising, there remains a dire need for more clinical research to test and improve treatments for co-occurring emotional distress and pain.

Coping with painful sex: Development and initial validation of the CHAMP Sexual Pain Coping Scale

Abstract Background and purpose Recurrent vulvar pain is a common and debilitating condition which has received remarkably little attention in pain research. For instance, little is known about how these women cope with sexual activities, and there are no structured assessment tools. The purpose of this study was to explore coping strategies in this group, with a view to develop a measure to assess how women with vulvar pain cope with sexual activities. Methods The current study is based on a subsample from a longitudinal study about vulvar pain in a student sample consisting of women between 18 and 35 years old (N = 964). Only data from the ones reporting recurrent vulvar pain during the last six months (N = 289) were used in the analyses. First, the CHAMP Sexual Pain Coping Scale (CSPCS) was created, with the aim of assessing how women with vulvar pain cope with sexual activities. The scale was inspired by previous research on women with vulvar pain as well as well-known coping strategies in other pain populations. Second, the psychometric properties of the scale were explored by analyzing the factor structure and internal reliability. Third, validity features were examined in terms of criterion validity and construct validity. Results The analyses supported a three-factor solution, embracing the strategies endurance, avoidance and alternative coping. The internal reliability of the subscales turned out to be good, and the criterion validity was supported for all three subscales. The construct validity was clearly supported for the endurance and the avoidance subscales, but not for the alternative coping subscale. Conclusions The findings support the CSPCS as an instrument for assessing how women with vulvar pain cope with sexual activities. The strategies endurance, avoidance and alternative coping correspond with findings from earlier research. Endurance reflects a tendency to engage in and continue with sexual activities despite pain, while attempting to minimize or suppress thoughts of pain. Avoidance, on the other hand, involves efforts to stay away from sexual activities, in particular vaginal penetration, because of fear of pain. Alternative coping refers to endeavours to find alternative sexual activities that do not necessarily involve vaginal penetration. Even though this first study indicates that the CSPCS may be psychometrically sound, more studies are needed to confirm the psychometric properties and clinical application of this instrument. In particular, the construct validity of the alternative coping subscale needs to be further evaluated. Implications A valid instrument for assessing strategies for coping with sexual activities in this population has important clinical implications, since it provides a method that may enhance assessment procedures, be used in research, and stimulate the development of treatment.

Sleep duration and patterns in adolescents: correlates and the role of daily stressors

OBJECTIVES The first aim of this study was to assess the prevalence of sleep deficit in a large sample of adolescents. Second, the study aimed to assess whether short sleep duration in the sample was associated with emotional and behavioral problems. Lastly, the study aimed to investigate the association between daily stressors--bedtime activities and sleep duration. DESIGN Cross-sectional survey. SETTING The questionnaires were completed during school hours in 17 municipal junior high schools in Sweden. PARTICIPANTS A total of 2767 adolescents aged 12 to 16 years, 48% girls. MEASUREMENTS AND RESULTS Sleep measures included total sleep time (TST) for schooldays and weekends, obtained as combined measures of self-reported bed-time, wake-time, and sleep onset latency. We used the new National Sleep Foundations guidelines to operationalize sleep duration. Overall 12% of younger adolescents (age 12-13 years) and 18% of older adolescents (14-16 years) slept less than recommended (TST < 7 hours). Adolescents reporting nonrecommended TST also reported more behavioral (ie, norm-breaking behaviors) and emotional problems (ie, depression, anxiety, and anger), with effects in the small-medium range. Finally, adolescents reporting bedtime arousal and use of information and communication technology in bed were more likely to report TST < 7 hours. Stress at home (for younger adolescents) and stress of school performance (for older adolescents) were also associated with TST less than 7 hours. CONCLUSIONS The new National Sleep Foundations recommendations were informative in this context. Future sleep interventions need to target barriers to good sleep practices, such as use of information and communication technology, stress, and worry that may contribute to arousal at bedtime.