John T. Sorrell

Anxiety sensitivity in the prediction of pain-related fear and anxiety in a heterogeneous chronic pain population

The present study evaluated anxiety sensitivity, along with depression and pain severity, as predictors of pain-related fear and anxiety in a heterogeneous chronic pain population (n=68). The results indicated that the global anxiety sensitivity factor, as indexed by the Anxiety Sensitivity Index (ASI: Reiss, Peterson, Gursky & McNally, 1986: Reiss, S., Peterson, R. A., Gursky, M. & McNally, R. J. (1986). Anxiety, sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8) total score, was a better predictor of fear of and anxiety about pain relative to the other relevant variables. Additionally, the physical concerns subscale of the ASI was a better predictor of pain-related fear dimensions characterized by high degrees of physiological symptoms and behavioral activation on both the Fear of Pain Questionnaire-III (FPQ-III; McNeil & Rainwater, 1998: McNeil, D. W. & Rainwater, A. J. (1998). Development of the Fear of Pain Questionnaire-III. Journal of Behavioral Medicine.) and Pain Anxiety Symptoms Scale (PASS; McCracken, Zayfert & Gross, 1992: McCracken, L. M., Zayfert, C. & Gross, R. T. (1992). The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain. Pain, 50, 67-73). In a related way, the ASI psychological concerns subscale was a better predictor of pain-related anxiety dimensions characterized by cognitive symptoms of anxiety. Overall, these findings reiterate the importance of anxiety sensitivity in understanding pain-related fear and anxiety, and suggest anxious and fearful responding can be predicted more accurately with higher levels of correspondence between a particular anxiety sensitivity domain and events that closely match that fear.

Predicting work status following interdisciplinary treatment for chronic pain

The effectiveness of interdisciplinary treatments for chronic pain is well established. In general, these treatments decrease psychosocial distress and increase physical abilities. Further, return to work rates following interdisciplinary treatment tend to be quite high. Previous studies have highlighted a number of factors that individually influence return to work rates; however, there is a need for more comprehensive and unified models that allow an evaluation of the inter‐relations among these factors. The present investigation examined how demographic and treatment outcome variables interacted to influence post‐treatment return to work rates in a sample of individuals with chronic pain following interdisciplinary treatment. Results indicated that patient age, lifting ability, pain duration, depression level, and reported disability were individually related to return to work; however, when these variables were evaluated relative to one another, level of depression and patient age had the best ability to predict post‐treatment work status. These results add to the literature by specifically highlighting post‐treatment factors that best discriminate patients who had returned to work from those that had not. Furthermore, they provide evidence that general emotional distress is perhaps the most important predictor of work status following treatment.

Effects of emotion on pain reports, tolerance and physiology

The effects of specific emotional states on a laboratory pain task were tested by examining the behavioural, verbal and psychophysiological responses of 80 student volunteers (50% female). Participants were assigned to one of four Velten-style emotion-induction conditions (ie, anxiety, depression, elation or neutral). The sexes of experimenters were counterbalanced. Overt escape behaviour (ie, pain tolerance), pain threshold and severity ratings, verbal reports of emotion and physiological measures (ie, electrocardiogram, corrugator and trapezium electromyogram) were recorded. A pressure pain task was given before and after the emotion induction. As predicted, those who participated in the anxiety or depression condition showed reduced pain tolerance after induction of these negative emotions; pain severity ratings became most pronounced in the depression condition. Emotion induction did not have a discernable effect on pain tolerance or severity ratings in the elation condition. A pattern of participant and experimenter sex effects, as well as trials effects, was seen in the physiological data. The influence of negative affective states (ie, anxiety and depression) on acute pain are discussed along with the unique contributions of behavioural, verbal and physiological response systems in understanding the interactions of pain and emotions.

Predictors of Self-Reported Anxiety and Panic Symptoms: An Evaluation of Anxiety Sensitivity, Suffocation Fear, Heart-Focused Anxiety, and Breath-Holding Duration

The purpose of this study was to examine the extent to which anxiety-related individual difference variables predict anxious responding when individuals experience aversive bodily sensations. Thus, we explore several psychological and behavioral predictors of response to a single 25-sec inhalation of 20% carbon dioxide-enriched air in 70 nonclinical participants. Predictor variables included anxiety sensitivity, suffocation fear, heart-focused anxiety, and breath-holding duration. Multiple regression analyses indicated that only anxiety sensitivity significantly predicted postchallenge panic symptoms, whereas both anxiety sensitivity and suffocation fear predicted postchallenge anxiety. These data are in accord with current models of panic disorder that emphasize the role of “fear of fear” in producing heightened anxiety and panic symptoms and help clarify specific predictors of anxiety-related responding to biological challenge.

Understanding Manual-Based Behavior Therapy: Some Theoretical Foundations of Parent-Child Interaction Therapy

ABSTRACT Manualized therapy has been criticized as being incompatible with behavior therapy. However, the majority of empirically supported, manual-based therapies utilize basic behavioral principles, such as positive reinforcement, to achieve positive change in the target behavior. Parent-Child Interaction Therapy (PCIT), for example, is a manualized treatment that makes extensive use of the empirically-derived behavioral principles of this paradigm. Understanding how and why these fundamental principles operate is essential when attempting to tailor the program ideographically to meet clients specific needs. The purpose of this article is to provide a model of understanding and evaluating manualized treatments by beginning with a review of the theory and data-driven principles upon which PCIT is based. As a point of illustration, several of the behavioral principles embedded in PCIT, such as reinforcement, punishment, and stimulus control, are highlighted, and clinically relevant examples are presented.

Fear and pain: investigating the interaction between aversive states.

Pain and fear often co-occur and appear to interact, although the nature and direction of their relation is not clearly delineated. The present study investigates how exposure to the experience of one of these states subsequently affects responding to the other. Pressure stimulation and carbon dioxide-enriched air (CO2) were used to induce pain and fear, respectively, in 48 healthy individuals. The order in which the stimuli were introduced was manipulated, as was the CO2 level. Measures of overt behavior, physiological responding, and self-report were obtained; analyses of stimuli effects generally supported their ability to produce pain or fear. Results indicate that the stimulus rated as the most aversive, the higher level of CO2, led to the highest levels of distressed responding across dependent measures. This pattern was replicated for the stimuli found to be less aversive (i.e., pressure stimulation and low-level CO2, respectively). The authors conclude that fear and pain, in and of themselves, do not dictate the nature of their interaction; the most important factor is how aversive they are perceived to be in relation to one another.

Reaching Out to School and Community Stakeholders to Improve Mental Health Services for Youth in an Urban US Community

The article presents the findings from a series of focus groups on youth needs held with adults from an innercity community in the Northeastern United States. The community members who participated in focus groups expressed a range of issues affecting youth health and adjustment, including inadequate housing, childcare, after-school programs, stressed and overcrowded schools, peer pressure for involvement in risky and negative behavior and exposure to high levels of violence and drug activity. Recommendations from these community members focused on building/enhancing programs and supports in schools and neighborhoods to address these issues, and increasing community engagement in the lives of young people. Implications for the development and improvement of school-based mental health programs are discussed.