Leora C. Swartzman

The factor structure of the Coping Strategies Questionnaire.

The Coping Strategies Questionnaire (CSQ) (Rosenstiel and Keefe 1983) is the most widely used measure of pain coping strategies. To date, with one exception (Tuttle et al. 1991), studies examining the factor structure of the CSQ have used the composite scores of its 8 a-priori theoretically derived scales rather than the 48 individual items. An examination of the match between the 8 theoretically derived scales and scales empirically extracted from an item analysis is lacking. Accordingly, the CSQ was administered to 126 chronic pain (whiplash) patients. Factor analyses of the individual items revealed an 8-factor structure to be uninterpretable. Of the 2-9-factor solutions tested, the 5-factor structure was the most interpretable: Factor 1, Distraction; Factor 2, Ignoring Pain Sensations; Factor 3, Reinterpreting Pain Sensations; Factor 4, Catastrophizing; Factor 5, Praying and Hoping. Eighteen Ph.D. or M.D. level clinicians classified items into their corresponding category with a high degree of accuracy (on average, 90.2%), attesting to the face and construct validity of the subscales. Four subscales, Catastrophizing, Reinterpreting Pain Sensations, Praying and Hoping and (to a lesser degree) Ignoring Pain Sensations, correspond with parallel subscales proposed by Rosensteil and Keefe (1983). The fifth subscale, Distraction, is comprised of items from their Diverting Attention and Increasing Activity Level subscales, suggesting that cognitive and behavioural distraction comprise 1 rather than 2 coping strategies. That CSQ items on the original Coping Self-Statements and the Increasing Pain Behaviour subscales failed to load consistently on any factor suggests that they do not reliably measure distinct coping strategies.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of litigation status on adjustment to whiplash injury

Study Design. This retrospective study examined the effect of civil litigation on reports of pain and disability in chronic pain patients who sustained whiplash injuries after a motor vehicle accident. Objectives. To examine the effect of litigation on adjustment to chronic pain. Summary of Background Data. A common methodologic weakness with many studies in this area is the composition of the nonlitigant group, which often includes individuals who have completed litigation as well as those who opted not to litigate. This introduces a confound in that litigant and nonlitigant groups differ not only with respect to litigation status but with respect to any factors that predispose one to litigate. Methods. Questionnaire data were obtained from 41 patients (current litigants) in the process of litigation and 21 patients (postlitigants) who had completed litigation. Subjects completed self‐report measures assessing demographic characteristics, psychological distress, sleep disturbance, employment status, and various pain indices. Results. There were no significant group differences in demographic characteristics, employment status, or psychological distress. Litigants, however, reported more pain than did postlitigants. Group differences in pain reports remained statistically significant even after controlling for length of time since accident and initial severity of the injuries. Conclusions. That litigation status did not predict employment status suggests that secondary gain does not figure prominently in influencing the functionality of these patients. The rather robust effect of litigation status on pain reports is discussed with respect to the potential mediational role of the stress of litigation.

Expectations and the placebo effect in clinical drug trials: Why we should not turn a blind eye to unblinding, and other cautionary notes

Clinical Pharmacology & Therapeutics (1998) 64, 1–7; doi:

Cognitive-emotional decision making (CEDM): A framework of patient medical decision making

OBJECTIVE Assistance for patients faced with medical decisions has largely focussed on the clarification of information and personal values. Our aim is to draw on the decision research describing the role of emotion in combination with health behaviour models to provide a framework for conceptualizing patient decisions. METHODS A review of the psychological and medical decision making literature concerned with the role of emotion/affect in decision making and health behaviours. RESULTS Emotion plays an influential role in decision making. Both current and anticipated emotions play a motivational role in choice. Amalgamating these findings with that of Leventhals (1970) SRM provide a framework for thinking about the influence of emotion on a patient medical decision. CONCLUSION Our framework suggests that a patient must cope with four sets of elements. The first two relate to the need to manage the cognitive and emotional aspects of the health threat. The second set relate to the management of the cognitive and emotional elements of the decision, itself. PRACTICE IMPLICATIONS The framework provides a way for practitioners and researchers to frame thinking about a patient medical decision in order to assist the patient in clarifying decisional priorities.

The menopausal hot flush symptom reports and concomitant physiological changes

Hot flushes are the most frequently reported menopausal symptom. The primary study goal was to develop criteria for the identification of hot flushes that ultimately could be applied independent of symptom report. Twenty-one postmenopausal women each underwent psychophysiological monitoring. Physiological activity accompanying their 93 subjective flush reports was compared with activity during nonflush periods, and a discriminant function analysis was carried out. The Physiological Flush Profile (PFP), developed on the basis of these analyses, consists of peripheral vasodilation plus an increase in skin conductance (sternal and/or palmar), both of a specified magnitude. The PFP was shown to be both a specific and a sensitive measure of hot flushes. Notably, change in sternal skin conductance was highly positively correlated with subjective flush severity ratings. Potential applications of the PFP toward delineating the role of psychological factors in the reporting of menopausal symptomatology are discussed.

What Accounts for the Appeal of Complementary/Alternative Medicine, and What Makes Complementary/Alternative Medicine “Alternative”?

The goal of this study was to elucidate the basis for the appeal of complementary/alternative medicine (CAM) and the basis upon which people distinguish between CAM and conventional medicine. Undergraduates (N = 173) rated 19 approaches to the treatment of chronic back pain on 16 rating scales. Data were analyzed via 3-mode factor analysis, which extracted conceptual dimensions common to both the scales and the treatments. A 5-factor solution was judged to give the best description of the raters’ perceptions. One of these 5 factors clearly reflected the distinction between conventional versus CAM approaches, and a 2nd factor clearly referred to treatment appeal. The other 3 factors were invasiveness, health care professional versus patient effort, and “druglikeness.” To the extent that treatment was seen as a CAM treatment (as opposed to a conventional treatment), it was seen to be more appealing, less invasive, and less druglike. Simple and partial correlations of the dimension weights indicated that both the appealof CAM and the distinction between CAM and conventional medicine were largely driven by the view that CAM is less invasive than conventional medicine.

Health Beliefs and Experiences in Asian Cultures

Publisher Summary Understanding the biological, psychological, and social factors responsible for human health and illness has been an important focus of Asian (particularly Chinese) cultures. Although Asian cultures differ from each other in their emphasis and scope, Confucianism and Taoism play a predominant role in driving the conceptualization of health and medicine, not only in China but also in many other South Asian countries. The chapter outlines the understanding and interpretation of health and illness that stems from these Taoist and Confucist traditions, the way cultural context shapes both collective and individual health behaviors, and health-related experiences in traditional and contemporary Chinese societies. For the increasing number of Asians who immigrate to the West (i.e., North America and Europe), the contrast between the dominant Western models of health and illness (the biomedical model) and their traditional Asian models is a source of confusion. The Western biomedical model focuses on the “objective” biological processes underlying diseases and illness from an analytic perspective. Health problems are often regarded as an episodic deviation caused by micro-level, natural, etiological agents, such as genes, viruses, bacteria, and hormones. The holistic perspective in Chinese culture indicates that health conditions are associated with internal emotional functioning, social relationships, societal norms and values, and ecological factors. Health is achieved and maintained when a person lives in harmony with social and ecological conditions and attains inner psychological balance. According to the collectivistic principles in Chinese and some other Asian cultures, health issues should be viewed in terms of their significance for collective well-being and functioning. The holistic model and the collectivistic orientation are important to understand the health-related experiences and behaviors, such as emotion inhibition, somatization, depression, and underutilization of mental health services in Asian cultures, and to develop culturally sensitive and appropriate health programs for Asian immigrant populations in North America.

The impact of contextual cues on the interpretation of and response to physical symptoms: a vignette approach

This study examined the impact of two contextual cues—stress and aging—on conceptualizations of, and health care responses to, physical symptoms. Eighty-three undergraduates each read four vignettes describing a woman experiencing physical symptoms indicative of either heart attack, depression, ulcer, or flu. Subjects were randomly assigned to one of six age/stress cue combinations. Consistent with predictions, physical symptoms presented with stress cues were less likely to be attributed to acute illness and were seen as more variable. The effect was most pronounced for heart attack symptoms, which, when presented with stress cues, were also less likely (1) to be identified as a heart attack, (2) to be attributed to chronic illness, (3) to elicit recommendations to seek medical care, (4) and to be regarded as serious. The age manipulation did not exert an effect. Implications of these findings and limitations of the vignette approach are discussed.

Cross-Cultural Differences in Illness Models and Expectations for the Health Care Provider-Client/Patient Interaction

Publisher Summary This chapter describes cross-cultural differences in illness models and expectations for the health care provider― patient interaction. Cross-cultural variations in collectivism and individualism can have an impact on the physician– patient interaction. Societies that practice holistic medicine tend to be collectivistic in nature. Interdependent individuals in these societies are defined with respect to specific contexts; they do not exist in isolation. In collectivistic society, the self would involve consideration of many domains outside of the physical entity of the individual such spiritual entities. Mechanistic medical models (e.g., the biomedical model) tend to be practiced by individualistic societies. The individual in these societies has an encapsulated self, that is, other individuals do not enter into the self-concept. Accordingly, in individualistic societies, the treatment of an illness focuses on the physical state of the afflicted individual. A collectivistic patient, with the goal of maintaining harmonious relationships, is likely to give information to the health care provider cautiously and gauge the reaction of the provider before proceeding. This individual would expect the health care provider to move with equal caution and may be offended by a direct questioning manner. In contrast, an individualistic patient is more apt to be direct and to the point, relatively unconcerned with maintaining harmony in the health care provider–patient relationship, and easily frustrated by health communications that are vague or circumspect. Thus, the individualistic–collectivistic distinction and its focus on the self versus the other has been shown to have implications on beliefs about health and illness, expectations for the health care provider–patient relationship, and health communication preferences.

Causal dimensions of college students' perceptions of physical symptoms

According to attribution theory, controllability, locus, and stability are important dimensions underlying causal explanations. The extent to which these theoretical dimensions underlie lay explanations for physical symptoms is unclear. Accordingly, in this study, attributes relevant to the lay public were empirically derived using a multidimensional scaling (MDS) procedure. Undergraduates (N=194) provided similarity judgments for 18 potential causes of physical discomfort. The MDS analysis yielded a three-dimensional solution. The first dimension captured the distinction between “physical” and “nonphysical” causes. The second dimension distinguished either “variable” versus “stable” causes or those that are “controllable” versus “uncontrollable” by health care professionals. The third dimension differentiated causes under “low” versus “high” personal control. These findings empirically confirm the theoretically proposed dimensions of “personal control” and “stability” and suggest the utility of considering the “physical/nonphysical” and “controllability by health care professional” distinctions in future work on attributions in the health domain.