L. Charles Ward

An evaluation of sex differences in psychological and physiological responses to experimentally-induced pain: a path analytic description

Abstract A cold pressor task (CPT) was used with 203 college students (112 women and 91 men) in a study of sex differences in pain response. Physiological measures were taken before and after pain induction, and sex‐differentiating personality traits were assessed with the Personal Attributes Questionnaire (PAQ). The Pain Catastrophizing Scale (PCS) was given with standard instructions prior to the CPT, and it was re‐administered after the CPT with modified instructions to assess catastrophic thinking during the CPT. Hypotheses were formulated into an explanatory model that was evaluated by path analysis. Pain induction elevated blood pressures and cortisol levels for both sexes, but systolic blood pressure reactivity and cortisol response were greater in men, even with sex differences in CPT tolerance times controlled statistically. Post‐CPT PCS scores were positively related to pain ratings and negatively related to tolerance, but baseline PCS scores did not predict tolerance or pain ratings. Pre‐PCS scores were not well correlated with post‐PCS scores (r=0.46) and underestimated post‐PCS scores, particularly for women. The Sex difference on the post‐CPT PCS was largely attributable to the PAQ personality trait of Emotional Vulnerability. The differential results obtained from assessing catastrophizing before and after the CPT emphasized the importance of specifying the context in which catastrophizing is assessed (both timing and instructions). Theoretical considerations in the construct of catastrophizing are also highlighted, including, but not limited to, the confounding of variables such as pain intensity and unpleasantness.

Catastrophizing and perceived partner responses to pain.

&NA; This study examined the relationship between catastrophizing and patient‐perceived partner responses to pain behaviors. The Catastrophizing subscale of the Cognitive Coping Strategy Inventory and the West Haven–Yale Multidimensional Pain Inventory were completed by 62 adult chronic pain patients. Consistent with past research, catastrophizing and patient‐perceived solicitous partner behaviors were positively correlated with negative pain outcomes. The communal coping theory of catastrophizing suggests that catastrophizing might be undertaken to solicit support and empathy from others. However, catastrophizing was not related to perceived solicitous partner behavior in this study. Rather, catastrophizing was associated with perceived punishing partner responses. Implications are that catastrophizing and perceived solicitous partner behaviors are independently associated with pain and that catastrophizing may not be reinforced by empathy from significant others.

Comparison of factor structure models for the Beck Depression Inventory--II.

Factor analyses of the Beck Depression Inventory--II (A. T. Beck, R. A. Steer, & G. K. Brown, 1996) have frequently produced 2 different 2-factor oblique structures. The author used confirmatory factor analyses to compare these structures with a general-factor model with 2 orthogonal group factors. The general-factor model fit as well as or better than the 2-factor models when applied to item data from previous studies (3 clinical and 2 college samples). Communalities associated with the General Depression factor ranged from 71% to 82%. Cognitive and Somatic group factors were indicative of intropunitiveness and fatigue. It was concluded that the general-factor model gives an acceptable empirical explanation of item covariance structure and offers a conceptual interpretation that is well suited to clinical practice and research.

Personality factors in the explanation of sex differences in pain catastrophizing and response to experimental pain.

Objective:To examine the effects of personality and pain catastrophizing upon pain tolerance and pain ratings and to examine the impact of an experimental pain induction on subsequent ratings of catastrophizing. Method:Two hundred nineteen college students participated in a cold pressor task. Sex-differentiating personality constructs were measured by the Extended Personal Attributes Questionnaire. The Pain Catastrophizing Scale was given before and after the cold pressor task. Results:A path-analytic model fit the data well and permitted tests of explanatory relationships. Mediational analyses demonstrated that sex differences in catastrophizing were explained by the Personal Attributes Questionnaire Masculinity–Femininity and Verbal Passive-Aggressiveness scales. Pain tolerance and pain ratings differed significantly between men and women, but Masculinity–Femininity partially mediated those sex–pain relationships. Additionally, higher pain ratings and lower pain tolerance were independently associated with increased catastrophizing after the cold pressor task. Conclusions:The results suggest that sex differences in catastrophizing and pain responsivity are partially accounted for by the dispositional tendency to describe oneself as emotionally vulnerable. The findings also suggest that pain catastrophizing may be situational as well as dispositional.

Validity, reliability, and standard errors of measurement for two seven-subtest short forms of the Wechsler Adult Intelligence Scale—III.

Validity and reliability coefficients and standard errors of measurement for 2 7-subtest short forms (SF) of the Wechsler Adult Intelligence Scale-III (WAIS-III; D. Wechsler, 1997) are provided. Data for the study were obtained from the WAIS-III-WMS-III Technical Manual and were based on the 2,450 adolescents and adults in the WAIS-III standardization sample. SF1 consists of Information, Digit Span, Arithmetic, Similarities, Picture Completion, Block Design, and Digit Symbol-Coding. SF2 uses the same subtest combination, except Matrix Reasoning is substituted for Block Design. For the 13 age groups in the standardization sample, the 2 short forms have impressively high validity and reliability, and small standard errors of measurement. Whenever a short form IQ is used, it is recommended that the examiner append the abbreviation Est next to the value.

Mindfulness-based cognitive therapy for the treatment of headache pain: a pilot study.

Objective:This pilot study reports the findings of a randomized controlled trial (RCT) investigating the feasibility, tolerability, acceptability, and initial estimates of efficacy of mindfulness-based cognitive therapy (MBCT) compared to a delayed treatment (DT) control for headache pain. It was hypothesized that MBCT would be a viable treatment approach and that compared to DT, would elicit significant improvement in primary headache pain-related outcomes and secondary cognitive-related outcomes. Materials and Methods:RCT methodology was employed and multivariate analysis of variance models were conducted on daily headache diary data and preassessment and postassessment data for the intent-to-treat sample (N=36), and on the completer sample (N=24). Results:Patient flow data and standardized measures found MBCT for headache pain to be feasible, tolerable, and acceptable to participants. Intent-to-treat analyses showed that compared to DT, MBCT patients reported significantly greater improvement in self-efficacy (P=0.02, d=0.82) and pain acceptance (P=0.02, d=0.82). Results of the completer analyses produced a similar pattern of findings; additionally, compared to DT, MBCT completers reported significantly improved pain interference (P<0.01, d=−1.29) and pain catastrophizing (P=0.03, d=−0.94). Change in daily headache diary outcomes was not significantly different between groups (P’s>0.05, d’s⩽−0.24). Discussion:This study empirically examined MBCT for the treatment of headache pain. Results indicated that MBCT is a feasible, tolerable, acceptable, and potentially efficacious intervention for patients with headache pain. This study provides a research base for future RCTs comparing MBCT to attention control, and future comparative effectiveness studies of MBCT and cognitive-behavioral therapy.

Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain.

Summary Cognitive behavioral therapy was compared with pain education within an underserved, low‐socioeconomic status, rural chronic pain population. Both interventions were found to be viable treatment options. ABSTRACT Chronic pain is a common and costly experience. Cognitive behavioral therapies (CBT) are efficacious for an array of chronic pain conditions. However, the literature is based primarily on urban (white) samples. It is unknown whether CBT works in low‐socioeconomic status (SES) minority and nonminority groups. To address this question, we conducted a randomized controlled trial within a low‐SES, rural chronic pain population. Specifically, we examined the feasibility, tolerability, acceptability, and efficacy of group CBT compared with a group education intervention (EDU). We hypothesized that although both interventions would elicit short‐ and long‐term improvement across pain‐related outcomes, the cognitively‐focused CBT protocol would uniquely influence pain catastrophizing. Mixed design analyses of variance were conducted on the sample of eligible participants who did not commence treatment (N = 26), the intention‐to‐treat sample (ITT; N = 83), and the completer sample (N = 61). Factors associated with treatment completion were examined. Results indicated significantly more drop‐outs occurred in CBT. ITT analyses showed that participants in both conditions reported significant improvement across pain‐related outcomes, and a nonsignificant trend was found for depressed mood to improve more in CBT than EDU. Results of the completer analyses produced a similar pattern of findings; however, CBT produced greater gains on cognitive and affect variables than EDU. Treatment gains were maintained at 6‐month follow‐up (N = 54). Clinical significance of the findings and the number of treatment responders is reported. Overall, these findings indicate that CBT and EDU are viable treatment options in low‐SES minority and nonminority groups. Further research should target disseminating and sustaining psychosocial treatment options within underserved populations.

WAIS-IV Subtest Covariance Structure: Conceptual and Statistical Considerations.

D. Wechsler (2008b) reported confirmatory factor analyses (CFAs) with standardization data (ages 16-69 years) for 10 core and 5 supplemental subtests from the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). Analyses of the 15 subtests supported 4 hypothesized oblique factors (Verbal Comprehension, Working Memory, Perceptual Reasoning, and Processing Speed) but also revealed unexplained covariance between Block Design and Visual Puzzles (Perceptual Reasoning subtests). That covariance was not included in the final models. Instead, a path was added from Working Memory to Figure Weights (Perceptual Reasoning subtest) to improve fit and achieve a desired factor pattern. The present research with the same data (N = 1,800) showed that the path from Working Memory to Figure Weights increases the association between Working Memory and Matrix Reasoning. Specifying both paths improves model fit and largely eliminates unexplained covariance between Block Design and Visual Puzzles but with the undesirable consequence that Figure Weights and Matrix Reasoning are equally determined by Perceptual Reasoning and Working Memory. An alternative 4-factor model was proposed that explained theory-implied covariance between Block Design and Visual Puzzles and between Arithmetic and Figure Weights while maintaining compatibility with WAIS-IV Index structure. The proposed model compared favorably with a 5-factor model based on Cattell-Horn-Carroll theory. The present findings emphasize that covariance model comparisons should involve considerations of conceptual coherence and theoretical adherence in addition to statistical fit.

Measurement of agency, communion, and emotional vulnerability with the personal attributes questionnaire

Factor analytic studies of the 24-item Personal Attributes Questionnaire (Spence & Helmreich, 1978) have reported inconsistent results, and a previous confirmatory factor analysis (CFA) indicated inadequate fit for factors corresponding to Masculinity, Femininity, and Masculinity–Femininity scales. In this research, we used CFA in a college sample (N = 382) to evaluate the 3-factor model, and we revised scales by eliminating 6 misspecified items. The revised model fit well in another college sample (N = 230). We renamed the revised scales Agency, Communion, and Emotional Vulnerability. In relation to Five-factor theory, Emotional Vulnerability and Communion correlated well with Neuroticism and Agreeableness, respectively, and Agency had moderate correlations with Neuroticism, Extraversion, and Conscientiousness. Psychometric results in the context of current theory suggest that Agency (Masculinity) may not be a fully adequate measure of the agency construct.

Perceived Spouse Responses to Pain: The Level of Agreement in Couple Dyads and the Role of Catastrophizing, Marital Satisfaction, and Depression

The primary objective of this study was to examine whether individuals with chronic pain (“participants”) and their spouses agree on perceptions of solicitous, distracting, and punishing spouse responses to pain. The second aim was to examine the role of participant catastrophizing (a negative mental set about pain), participant and spouse marital satisfaction, and participant and spouse depression in participant perceptions of spouse responses, spouse perceptions of their responses, and agreement between participants and spouses. Individuals with chronic musculoskeletal pain and their spouses (N=108 couples) completed questionnaire packets. Examination of overall group averages (participants vs. spouses) indicated little or no differences between participant and spouse ratings. Examination of individual agreement in participant and spouse ratings indicated substantial disagreement. The proposed moderators predicted both participant and spouse perceptions and jointly made minor contributions to dyad agreement. Although neither participant nor spouse perceptions of spouse responses are necessarily a reflection of actual behavior, the lack of agreement in this study suggests it may not be valid to use only patient perceptions in research related to spouse responses.