Nancy A. Hamilton

Fibromyalgia : The Role of Sleep in Affect and in Negative Event Reactivity and Recovery

OBJECTIVE Fibromyalgia (FM) syndrome is a chronic pain condition characterized by diffuse muscle pain, increased negative mood, and sleep disturbance. Until recently, sleep disturbance in persons with FM has been modeled as the result of the disease process or its associated pain. The current study examined sleep disturbance (i.e., sleep duration and sleep quality) as a predictor of daily affect, stress reactivity, and stress recovery. DESIGN AND MEASURES A hybrid of daily diary and ecological momentary assessment methodology was used to evaluate the psychosocial functioning of 89 women with FM. Participants recorded numeric ratings of pain, fatigue, and positive and negative affect 3 times throughout the day for 30 consecutive days. At the end of each day, participants completed daily diary records of positive and negative life events. In addition, participants reported on their sleep duration and sleep quality each morning. RESULTS After accounting for the effects of positive events, negative events, and pain on daily affect scores, it was found that sleep duration and quality were prospectively related to affect and fatigue. Furthermore, the effects of inadequate sleep on negative affect were cumulative. In addition, an inadequate amount of sleep prevented affective recovery from days with a high number of negative events. CONCLUSIONS These results lend support to the hypothesis that sleep is a component of allostatic load and has an upstream role in daily functioning.

Sleep and the affective response to stress and pain.

OBJECTIVE The current study examined sleep disturbance (i.e., sleep duration, sleep quality) as a correlate of stress reactivity and pain reactivity. DESIGN AND OUTCOME MEASURES An ecological momentary assessment design was used to evaluate the psychosocial functioning of men and women with fibromyalgia or rheumatoid arthritis (N=49). Participants recorded numeric ratings of pain, the occurrence of a stressful event, as well as positive and negative affect 7 times throughout the day for 2 consecutive days. In addition, participants reported on their sleep duration and sleep quality each morning. RESULTS Sleep disruption was not found to be an independent predictor of affect. However, sleep was found to buffer the relationship between stress and negative affect and the relationship between pain and both positive and negative affect. CONCLUSION These results are consistent with a model in which good-quality sleep acts as a biobehavioral resource that minimizes allostatic load.

Impact of Two Types of Expectancy on Recovery From Total Knee Replacement Surgery (TKR) in Adults With Osteoarthritis

This study examines the impact of 2 classes of psychological variables—expectancies for the future and self-efficacy—on recovery of function and reduction in symptomatology among individuals seeking total knee replacement surgery (TKR). The authors collected outcome measures (SF-36, WOMAC, Clinician assessments) prior to surgery, 4-6 weeks after surgery, and 6 months postsurgery for surgery patients and controls. Linear trend analyses by group gauged the impact of the surgical intervention on recovery, revealing significant improvements over time on physical health outcomes for the surgery patients not attained by controls. In addition, two classes of psychosocial variables—expectancies and efficacy beliefs—predicted the extent of gains in physical and mental health outcomes among those patients who elected to have surgery. When initial status was controlled, between 9 and 13 percent of the variance in TKR outcomes was due to expectations and efficacy. These results point to the importance of psychosocial variables in recovery of function and reduced symptoms after knee surgery.

The Effectiveness of a Hope Intervention in Coping with Cold Pressor Pain

Hope has been correlated with greater pain tolerance and thresholds and less reported pain severity. The present study investigated the effectiveness of a brief hope-based intervention involving guided imagery and skills instruction aimed at enhancing pain coping skills among university students performing the cold pressor task. The intervention resulted in increased hope among females and increased pain tolerance in all participants. The intervention did not affect pain threshold and resulted in marginally increased pain severity. Thus, this intervention facilitates better pain tolerance without necessarily changing the experience of the pain. Implications for practice and future research are discussed.

Self-Regulation and Chronic Pain:The Role of Emotion

Adjustment to chronic pain is examined within the context of a model that emphasizes goal-centered self-regulatory processing. Individual differences in adjustment to chronic illness have typically been examined from within the framework of stressful person–environment transactions. However, it may be useful to examine a broader array of person–environment transactions encountered in the context of working toward personal goals. Self-regulation may be especially challenging for people with chronic pain because of the link between pain and emotion. Consistent with this perspective, we will focus on the role of emotion as an energizing force in self-regulation and discuss the implications for managing pain. We will suggest that pain and concomitant negative emotion pervasively bias information processing, constrain the selection of goals, and the ongoing process of self-regulation.

Insomnia and Well-Being

Most Americans have occasional problems with insomnia. The relationship of insomnia to illness is well known. However, insomnia may also relate to lower levels of well-being. Although there are various definitions of well-being, one of the most clearly articulated and comprehensive models identifies 2 overarching constructs, psychological well-being and subjective well-being. The purpose in the present study was to assess the relationship between insomnia symptoms and the dimensions of psychological and subjective well-being, adjusting for the potential confound of comorbid physical and psychological illness. The data for the present study came from the National Survey of Midlife Development in the United States, a survey of community-dwelling adults. After adjustment for demographic characteristics and a wide range of chronic mental and physical health conditions, insomnia symptoms were found to have a significant relationship with both psychological and subjective well-being but a stronger relationship to subjective well-being. These data suggest that insomnia symptoms have a stronger relationship to enjoying life than to the perception that one has a meaningful life.

Insomnia symptoms and well-being: Longitudinal follow-up.

OBJECTIVE Most Americans have occasional problems with symptoms of insomnia. Insomnia symptoms have been linked to psychological distress, but few studies have examined the relationship between insomnia symptoms and well-being. The purpose of the present study was to assess the relationship between insomnia symptoms reported in a 10-year longitudinal study and the dimensions of subjective well-being and eudaimonic well-being, adjusting for the potential confounds of age, gender, and comorbid physical illness. METHOD The data for the present study came from the National Survey of Midlife Development in the United States. Participants were 4,014 community dwelling adults (M age = 56.27 years, SD = 12.4; 55.4% female; 91.6% White). RESULTS After adjusting for demographic characteristics and a wide range of chronic physical health conditions, we found that insomnia symptoms had a significant relationship with both subjective and eudaimonic well-being. Furthermore, the report of insomnia symptoms at 2 time points 10 years apart was found to have an additional impact on subjective and eudaimonic well-being. CONCLUSIONS Results of this study suggest that insomnia symptoms have a strong relationship to individuals enjoying life and perceiving that one has a meaningful life. In addition, these data suggest that the experience of recurrent insomnia symptoms at 2 time points is particularly detrimental to ones well-being.

Individual differences in emotional processing and reactivity to pain among older women with rheumatoid arthritis

The purpose of the current study was to determine whether the relationship between pain and emotion may be better understood by identifying people who are more vulnerable to emotional dysregulation and those who are able to regulate emotion. Data were collected from 81 women diagnosed with rheumatoid arthritis. We assessed affect intensity, emotion regulation, active coping, neuroticism as well as weekly reports of pain, positive affect, and negative affect. Results indicated that the joint effects of emotion regulation and emotional intensity predicted emotional responses to pain. The current study suggests that the emotional impact of pain is related to emotional intensity which can be tempered by the ability to regulate emotion.

Health Goal Cognition and Adjustment in Women with Fibromyalgia

The purpose of this study was to identify individual differences in symptom-specific goal for persons diagnosed with fibromyalgia syndrome (FMS) and to determine whether those differences are related to adjustment outcomes. Women with FMS (N = 71) rank ordered 12 FMS-specific goals and completed a packet of psychosocial outcome measures. Cluster analysis suggested that there were three relatively homogeneous subgroups defined. Cluster 1 ranked goals related to seeking professional care higher than all other groups. Cluster 2 ranked self-sufficiency goals higher than the other two groups. Cluster 3 ranked social-validation goals higher than the other two clusters. Multivariate analyses of variance (MANOVAs) and post-hoc tests showed that goal profiles covaried with differences in pain, negative affect, goal-specific social support, general social support, goal-related interference, and negative life events. Differences between groups are discussed in the context of proposed relations between goals and environmental support.

The Assessment of Emotion Regulation in Cognitive Context: The Emotion Amplification and Reduction Scales

The purpose of this study was to provide initial psychometric evidence for the reliability and validity of The Emotion Amplification and Reduction Scales (TEARS), a questionnaire designed to assess perceived ability to change the trajectory of an emotional response. Items were formulated to assess perceived ability to amplify an emotionally response by either prolonging or intensifying an existing emotion. Additional items were selected to measure processes related to emotion reduction, selecting an emotional response or altering an existing emotion by softening, stopping, or shortening it. Both subscales, Emotion Amplification and Emotion Reduction, were found to have good internal consistency. Confirmatory Factor Analysis was used to document the two-factor structure of the measure and to assess evidence for construct validity. The latent Emotion Reduction variable was found to correlate inversely with negative affect and symptoms of depression. The latent Emotion Amplification variable was found to correlate with higher positive affect and also fatigue. As expected, TEARS is correlated with tonic measures of emotionality.