Matilda Wurm

A psychometric evaluation of the Swedish version of the Responses to Positive Affect questionnaire

Abstract Background: Previous research mainly focused on responses to negative affect in relation to depression, and less on responses to positive affect. Cognitive responses to positive affect are interesting in the context of emotion regulation and emotion disorders: positive rumination is associated to hypomania risk and bipolar disorder. There is to date no questionnaire in Swedish that captures the phenomena of cognitive response styles. Aims: The aim of this study was to investigate the replicability of the Responses to Positive Affect questionnaire (RPA) in a newly translated Swedish version and to test its psychometric properties. Methods: Swedish undergraduates (n = 111) completed a set of self-report questionnaires in a fixed order. Results: The hypothesized three-factor model was largely replicated in the subscales Self-focused positive rumination, Emotion-focused positive rumination and Dampening. The two positive rumination subscales were strongly associated with each other and current positive affect. The subscales showed acceptable convergent and incremental validity with concurrent measures of depression, hypomania, anxiety, repetitive negative thinking, and positive and negative affect. The model explained 25% of the variance in hypomania, but fell short in the explanation of depression. Conclusions: The Swedish version of the RPA shows satisfactory reliability and initial findings from a student sample indicate that it is a valid measure comparable with the original RPA questionnaire. Results give emphasis to the importance of further exploration of cognitive response styles in relation to psychopathology.

Characteristics and consequences of the co-occurrence between social anxiety and pain-related fear in chronic pain patients receiving multimodal pain rehabilitation treatment

Abstract Background and aims Chronic pain problems are related to specific pain related fears and maladaptive pain-coping but also commonly co-occur with other anxiety problems. Shared emotional vulnerability factors may explain this comorbidity and may influence treatment outcome. Indeed, pain patients going through multimodal pain treatment are a heterogeneous group and treatment results vary. One understudied anxiety disorder co-occurring with pain is social anxiety. This may be relevant as many pain-related challenges are situated in social contexts. The aim of this study is to investigate the occurrence of subgroups with differential patterns of social anxiety and pain related fear in a sample of chronic pain patients who receive multimodal pain treatment. The aim is also to study the characteristics of these potential subgroups and the consequences of different patterns of social anxiety and pain related fear. Methods 180 patients with chronic musculoskeletal pain answered questionnaires before and after a multimodal pain treatment in a hospital rehabilitation setting in middle Sweden. A cluster analysis using pre-treatment scores on the Social Phobia Screening Questionnaire and the Tampa Scale of Kinesiophobia was performed. Subgroups were thereafter validated and compared on impairment due to social anxiety, pain catastrophizing, anxiety, and depression. Moreover, subgroups were described and compared on vulnerability factors (anxiety sensitivity, negative affect) and outcome factors (pain intensity, pain interference, and return to work self-efficacy). Results Four distinct clusters emerged: (1) low scores, (2) pain-related fear only, (3) social concern only, and (4) high social anxiety and pain-related fear. Patients high on social anxiety and pain-related fear had significantly higher levels of anxiety sensitivity, negative affect, and higher general emotional symptomatology. They also had remaining problems posttreatment. Conclusions A subgroup of patients with clinical levels of social anxiety has suboptimal rehabilitation results, with residual emotional problems and high levels of emotional vulnerability. Implications These patients may be in need of additional treatment efforts that are not being met today. To prevent insufficient treatment results and prolonged work disability, these patients need to be detected during screening and may benefit from pain treatment that takes their emotional problems into account.

Pain patients’ experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity, and treatment outcome

Abstract Background and aims Validating and invalidating responses play an important role in communication with pain patients, for example regarding emotion regulation and adherence to treatment. However, it is unclear how patients’ perceptions of validation and invalidation relate to patient characteristics and treatment outcome. The aim of this study was to investigate the occurrence of subgroups based on pain patients’ perceptions of validation and invalidation from their physicians. The stability of these perceptions and differences between subgroups regarding pain, pain interference, negative affectivity and treatment outcome were also explored. Methods A total of 108 pain patients answered questionnaires regarding perceived validation and invalidation, pain severity, pain interference, and negative affectivity before and after pain rehabilitation treatment. Two cluster analyses using perceived validation and invalidation were performed, one on pre-scores and one on post-scores. The stability of patient perceptions from pre- to post-treatment was investigated, and clusters were compared on pain severity, pain interference, and negative affectivity. Finally, the connection between perceived validation and invalidation and treatment outcome was explored. Results Three clusters emerged both before and after treatment: (1) low validation and heightened invalidation, (2) moderate validation and invalidation, and (3) high validation and low invalidation. Perceptions of validation and invalidation were generally stable over time, although there were individuals whose perceptions changed. When compared to the other two clusters, the low validation/heightened invalidation cluster displayed significantly higher levels of pain interference and negative affectivity post-treatment but not pre-treatment. The whole sample significantly improved on pain interference and depression, but treatment outcome was independent of cluster. Unexpectedly, differences between clusters on pain interference and negative affectivity were only found post-treatment. This appeared to be due to the pre- and post-heightened invalidation clusters not containing the same individuals. Therefore, additional analyses were conducted to investigate the individuals who changed clusters. Results showed that patients scoring high on negative affectivity ended up in the heightened invalidation cluster post-treatment. Conclusions Taken together, most patients felt understood when communicating with their rehabilitation physician. However, a smaller group of patients experienced the opposite: low levels of validation and heightened levels of invalidation. This group stood out as more problematic, reporting greater pain interference and negative affectivity when compared to the other groups after treatment. Patient perceptions were typically stable over time, but some individuals changed cluster, and these movements seemed to be related to negative affectivity and pain interference. These results do not support a connection between perceived validation and invalidation from physicians (meeting the patients pre- and post-treatment) and treatment outcome. Overall, our results suggest that there is a connection between negative affectivity and pain interference in the patients, and perceived validation and invalidation from the physicians. Implications In clinical practice, it is important to pay attention to comorbid psychological problems and level of pain interference, since these factors may negatively influence effective communication. A focus on decreasing invalidating responses and/or increasing validating responses might be particularly important for patients with high levels of psychological problems and pain interference.

Musculoskeletal pain in early adolescence: A longitudinal examination of pain prevalence and the role of peer-related stress, worry, and gender

OBJECTIVE Adolescence is a time of change during which several health problems, such as pain problems, increase. Psychosocial mechanisms involved in this development, such as interpersonal stressors and worry, are still understudied, especially longitudinally. The first aim of this study was to investigate the prevalence of musculoskeletal pain in Swedish adolescents between the ages 13 and 15 using pain grades. The second aim was to study the role of peer-related stress, worry, and gender in the development of musculoskeletal pain problems over time. METHODS Adolescents in 18 public schools were followed from 7th to 9th grade (N = 1181) and answered self-report questionnaires at three time points. Prevalence was assessed at all three time points and a moderated mediation analysis investigated if peer-related stress in 7th grade predicted musculoskeletal pain two years later and if this relationship was mediated by worry in 8th grade. Gender was entered as a moderator. RESULTS In 7th grade, 8.4% of adolescents reported musculoskeletal pain with some functional impairment. In 8th and 9th grade around 10% of adolescents reported musculoskeletal pain problems, with girls reporting a higher prevalence than boys. Peer-related stress in 7th grade predicted musculoskeletal pain problems in 9th grade, mediated by worry in 8th grade. The mediation was moderated by gender: peer-related stress predicted worry for girls, but not for boys. CONCLUSION Peer-related stress and worry seem to be involved in the development of pain over time. These factors should therefore be targeted in preventative interventions and during treatment.

Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study

In pain patients, comorbid emotional problems have been linked to negative outcomes, including suboptimal treatment gains. Developing parsimonious and accessible treatment options is therefore important. The overarching aim of this study was to test an internet delivered therapist guided transdiagnostic treatment with telephone support. An adapted version of the Unified Protocol for Transdiagnostic Treatments of Emotional Disorders was used as an intervention for pain patients with residual pain problems and comorbid emotional problems after having received a multimodal pain rehabilitation. The study used a replicated AB single case experimental design (N = 5; 3 females). Outcome measures were depressive and general anxiety symptoms, pain intensity, pain coping problems, and diagnostic status. Feasibility measures (completion and compliance) and patient satisfaction were also assessed. Scores on Nonoverlap of All Pairs (NAP) indicate a decrease of anxiety for three participants and a decrease of depression for four participants. Decreases were small and did not always reach statistical significance. Also, Tau-U scores could only confirm a reliable trend for one participant. Two out of four patients who were diagnosed with psychiatric disorders before treatment did no longer fulfill diagnostic criteria posttreatment. No improvements could be seen on pain problems. The treatment was feasible and patient satisfaction was high. Hence, while an internet delivered transdiagnostic treatment with telephone support may be a feasible and accepted secondary intervention for pain patients with comorbid emotional problems, the effects are unclear. The gap between high patient satisfaction and small changes in symptomatology should be explored further.

Do responses to Positive Affect Influence Mood Reactivity? Exploring Cognitive Response Styles through a Mood Induction Procedure

Abstract Cognitive responses to positive affect (PA) are interesting in the context of emotion dysregulation and emotion disorders. Previous research mainly focused on ruminative responses to negative affect in relation to psychopathology. The aim of this study was to explore the interaction between cognitive response styles as measured with the Responses to Positive Affect questionnaire (RPA) and changes in emotional state during an experimental manipulation in a non-clinical sample. Using a pre-test post-test design, Swedish undergraduate students (n = 60) were randomized into either a mood induction procedure designed to evoke positive mood or a control condition. Results revealed that the two positive rumination subscales of the RPA were associated with each other and with PA. However, none of the RPA subscales interacted with participants’ mood reactivity, thus meaning that cognitive response styles did not predict changes in mood as the participants were exposed to a mood induction procedure. The results postulate new questions on the conceptualization and functioning of cognitive response styles, as their role concerning reactivity to elevated mood states remain unclear.