Nina Kreddig

Fear of movement/(Re)injury in low back pain: confirmatory validation of a German version of the Tampa Scale for Kinesiophobia.

BackgroundThe Tampa Scale for Kinesiophobia (TSK), an instrument for measuring fear of movement/(re)injury, has been confirmed as an important predictor for the persistence of pain-related disability. The aims of this study were to evaluate the psychometric properties of a German version of the TSK (TSK-GV), examining aspects of content validity with special focus on fear-avoidance and endurance, and to confirm criterion-related validity in patients with low back pain (LBP).MethodsA total of 191 patients with LBP were included in this study. Several models with different factor structures from published studies were compared in a confirmatory factor analysis. Internal consistencies of the TSK-GV and its subscales were examined, and correlations with related self-report measures were calculated.ResultsThe internal consistency of the TSK-GV was α = 0.73. A two-factor model with 11 items was found to be the best fit for our data. The two factors were labelled Somatic Focus (SF) and Activity Avoidance (AA). The total score, SF and AA revealed moderate to high correlations with other fear-avoidance variables.ConclusionsThe TSK-GV is a reliable and valid measure for assessing the fear of movement/(re)injury.

Fear and anxiety in the transition from acute to chronic pain: there is evidence for endurance besides avoidance

Substantial evidence reveals that the fear of pain and pain anxiety play a significant role in the development of chronic pain and disability, although underlying mechanisms remain widely unknown. Recent studies indicate that endurance pain responses are important besides avoidance. The purpose of this brief narrative review is to provide an overview of research that argues for the integration of the mechanisms of associative learning, motivation and emotion regulation in order to understand the questions of how and why individuals respond with pain responses, which lead to long-term suffering. By using the avoidance-endurance model of pain, we provide a concept that elucidates a range of responses to pain, fear and anxiety that mediate the transition from acute to chronic pain.

Psychological Impact of Genetic Counseling for Hereditary Nonpolyposis Colorectal Cancer: The Role of Cancer History, Gender, Age, and Psychological Distress

AIMS We prospectively examined the impact of an initial interdisciplinary genetic counseling (human geneticist, oncologist, and psycho-oncologist) on feelings of anxiety with a special focus on subgroups related to personal cancer history, gender, age, and education. RESULTS At baseline, cancer-affected men revealed a significantly higher level of anxiety than unaffected men (p<0.05), whereas history of cancer did not play a role in women. Furthermore, a significant interaction between time, gender, and age was identified for change of anxiety. While women in general and men above 50 years revealed a significant reduction in anxiety, younger men did not show any change over time. A logistic regression indicated that clinical Hospital Anxiety and Depression Scale-A cases can be predicted by general distress (Brief Symptom Inventory) as well as by hereditary nonpolyposis colorectal cancer-related cognitions of intrusion and avoidance (impact of event scale) with a correct classification of 86%. CONCLUSIONS Although initial hereditary nonpolyposis colorectal cancer counseling leads to an overall reduction of anxiety, differential effects of cancer history, gender, and age focus on subgroups of cancer-affected men, who may display unexpectedly high anxiety scores at baseline. Especially younger men do not seem to reduce this high anxiety level. Baseline anxiety was mainly determined by maladaptive situation-specific cognitions. Therefore, consulters should be more aware of anxiety-related cognitions in cancer-affected younger men.

Emotionsregulation und Schmerzen

ZusammenfassungEmotionen und Emotionsregulation sind bei der Wahrnehmung und Modulation von Schmerzen von besonderer Bedeutung, doch die Mechanismen dieser wechselseitigen Beziehung sind noch unklar. Die Transdiagnostik bietet Ansätze, die Verbindung zwischen Emotionen und Schmerzen auf Ebene kognitiver und neuronaler Mechanismen zu untersuchen, mit dem Ziel, gemeinsame Prozesse zu identifizieren, die für beide relevant sind. Studien funktioneller und struktureller Bildgebung weisen auf die Rolle spezifischer kortikaler und subkortikaler Strukturen bei Schmerzen hin, die auch in der Emotionsregulation eine große Rolle spielen. Während bereits zahlreiche Arbeiten zu Strategien der Emotionsregulation und ihren neuronalen Korrelaten bei psychopathologischen Störungen existieren, steht die Forschung zur Emotionsregulation bei Schmerzen noch in den Anfängen. Das vorliegende Review gibt einen Überblick über experimentelle und klinische Studien zur schmerzbezogenen Emotionsregulation und ihren neuronalen und behavioralen Korrelaten. Es werden Schlussfolgerungen für eine Erweiterung der Schmerzpsychotherapie durch einen transdiagnostischen Ansatz gezogen.AbstractEmotions and emotion regulation are of special importance in the perception and modulation of pain but the mechanisms underlying this reciprocal relationship remain unclear. The transdiagnostic model provides an approach to explain the link between pain and emotion regarding cognitive and neuronal mechanisms and aims to identify mutual processes, which are relevant for both. Structural and functional imaging studies of pain indicate the involvement of specific cortical and subcortical structures, which also play an important role in emotion regulation. While numerous studies have investigated emotion regulation and their correlates in the central nervous system in pathological states, the research on emotion regulation in pain is still young. The purpose of this review is to provide an overview of experimental and clinical studies of neuronal and behavioral correlates of pain-related emotion regulation. The current transdiagnostic approach may be able to enhance pain relief in the future.

Pain anxiety and fear of (re)injury in patients with chronic back pain: Sex as a moderator

Graphical Abstract Abstract Background and aims Anxiety and fear are increasingly seen as related, but distinct concepts, with anxiety describing a reaction to unclear or future threats, and fear to immediate threats. Anxiety and fear both play influential roles in pain. Yet, the two concepts have not been clearly distinguished in pain research. Their reported intensity differs between the sexes, and sex differences in the way pain anxiety and fear of (re)injury relate to pain intensity have been found separately in previous studies. However, they seem to be of a curious nature: In one study, pain anxiety was associated with elevated pain intensity in men, while in another, fear of (re)injury was associated with elevated pain intensity in women. This indicates a moderator effect of sex. The present study is the first to unite previous findings, and to show a more integrative picture, by examining and discussing this moderator effect of sex in a joint study of both pain-related anxiety and fear in both sexes. Methods In 133 patients (mean age 43.6 years, 62% female) with chronic low back pain (mean duration 7.7 years), sex differences were examined with correlations and a multiple linear regression analysis with interaction terms. Differences between subgroups of low and high anxiety/fear were explored via t-tests, following previous studies. Results Sex was supported as a moderator in the association of pain intensity with pain anxiety (PASS-20), and fear of (re)injury (TSK). Higher pain intensity was linked to higher pain anxiety only in men, and to higher fear of (re)injury only in women. A basic regression model with fear, anxiety, sex and disability as predictors (R2 = .14, F(4,123) = 3.24,p = .042) was significantly improved by the addition of the interaction terms Fear×Sex and Anxiety × Sex (R2 = .18, F(2,121) = 4.90, p = .001), which were both shown as significant predictors for pain intensity. Further t-tests revealed a significant difference in pain intensity between high and low anxiety in men (t(47) = −2.34, p = .023,d = −.43), but not in women. Likewise, a significant difference in pain intensity between high and low fear showed in women (t(80) = −2.28, p = .025, d = −.42), but not in men. Conclusions The results support a moderator effect of sex and suggest differential mechanisms between the sexes in pain anxiety and fear in development and maintenance of back pain. The current study is the first to report and analyse this moderator effect. As potential underlying mechanisms, evolution and socialization are discussed, which may elucidate why fear might be more relevant for pain in women, and anxiety more relevant for pain in men. Implications The results indicate the need for a more cautious conceptual separation of fear and anxiety in research. Future studies on fear and anxiety in pain should be aware of the distinction, in order to avoid reporting only half of the picture. The next step would be to solidify the results in different samples, and to examine whether a distinction between anxiety and fear in the sexes could have any benefit in pain treatment.

Emotionsregulation und Schmerzen@@@Emotion regulation and pain: Behaviorale und neuronale Korrelate – ein transdiagnostischer Ansatz@@@Behavioral and neuronal correlates: a transdiagnostic approach

ZusammenfassungEmotionen und Emotionsregulation sind bei der Wahrnehmung und Modulation von Schmerzen von besonderer Bedeutung, doch die Mechanismen dieser wechselseitigen Beziehung sind noch unklar. Die Transdiagnostik bietet Ansätze, die Verbindung zwischen Emotionen und Schmerzen auf Ebene kognitiver und neuronaler Mechanismen zu untersuchen, mit dem Ziel, gemeinsame Prozesse zu identifizieren, die für beide relevant sind. Studien funktioneller und struktureller Bildgebung weisen auf die Rolle spezifischer kortikaler und subkortikaler Strukturen bei Schmerzen hin, die auch in der Emotionsregulation eine große Rolle spielen. Während bereits zahlreiche Arbeiten zu Strategien der Emotionsregulation und ihren neuronalen Korrelaten bei psychopathologischen Störungen existieren, steht die Forschung zur Emotionsregulation bei Schmerzen noch in den Anfängen. Das vorliegende Review gibt einen Überblick über experimentelle und klinische Studien zur schmerzbezogenen Emotionsregulation und ihren neuronalen und behavioralen Korrelaten. Es werden Schlussfolgerungen für eine Erweiterung der Schmerzpsychotherapie durch einen transdiagnostischen Ansatz gezogen.AbstractEmotions and emotion regulation are of special importance in the perception and modulation of pain but the mechanisms underlying this reciprocal relationship remain unclear. The transdiagnostic model provides an approach to explain the link between pain and emotion regarding cognitive and neuronal mechanisms and aims to identify mutual processes, which are relevant for both. Structural and functional imaging studies of pain indicate the involvement of specific cortical and subcortical structures, which also play an important role in emotion regulation. While numerous studies have investigated emotion regulation and their correlates in the central nervous system in pathological states, the research on emotion regulation in pain is still young. The purpose of this review is to provide an overview of experimental and clinical studies of neuronal and behavioral correlates of pain-related emotion regulation. The current transdiagnostic approach may be able to enhance pain relief in the future.

[Emotion regulation and pain : Behavioral and neuronal correlates: a transdiagnostic approach].

ZusammenfassungEmotionen und Emotionsregulation sind bei der Wahrnehmung und Modulation von Schmerzen von besonderer Bedeutung, doch die Mechanismen dieser wechselseitigen Beziehung sind noch unklar. Die Transdiagnostik bietet Ansätze, die Verbindung zwischen Emotionen und Schmerzen auf Ebene kognitiver und neuronaler Mechanismen zu untersuchen, mit dem Ziel, gemeinsame Prozesse zu identifizieren, die für beide relevant sind. Studien funktioneller und struktureller Bildgebung weisen auf die Rolle spezifischer kortikaler und subkortikaler Strukturen bei Schmerzen hin, die auch in der Emotionsregulation eine große Rolle spielen. Während bereits zahlreiche Arbeiten zu Strategien der Emotionsregulation und ihren neuronalen Korrelaten bei psychopathologischen Störungen existieren, steht die Forschung zur Emotionsregulation bei Schmerzen noch in den Anfängen. Das vorliegende Review gibt einen Überblick über experimentelle und klinische Studien zur schmerzbezogenen Emotionsregulation und ihren neuronalen und behavioralen Korrelaten. Es werden Schlussfolgerungen für eine Erweiterung der Schmerzpsychotherapie durch einen transdiagnostischen Ansatz gezogen.AbstractEmotions and emotion regulation are of special importance in the perception and modulation of pain but the mechanisms underlying this reciprocal relationship remain unclear. The transdiagnostic model provides an approach to explain the link between pain and emotion regarding cognitive and neuronal mechanisms and aims to identify mutual processes, which are relevant for both. Structural and functional imaging studies of pain indicate the involvement of specific cortical and subcortical structures, which also play an important role in emotion regulation. While numerous studies have investigated emotion regulation and their correlates in the central nervous system in pathological states, the research on emotion regulation in pain is still young. The purpose of this review is to provide an overview of experimental and clinical studies of neuronal and behavioral correlates of pain-related emotion regulation. The current transdiagnostic approach may be able to enhance pain relief in the future.

Gesundheit und Krankheit

In den vorangegangenen Kapiteln haben Sie erfahren, wie der Mensch zu dem wird, was er ist und wie seine Erfahrungen, seine Gedanken und sein Verhalten sich gegenseitig beeinflussen. Dabei wurde die Relevanz dieser Prozesse fur den klinischen Alltag besonders betont, da es im Rahmen der Psychologie im medizinischen Bereich zumeist um psychische Prozesse im Zusammenhang mit korperlichen Erkrankungen geht. In diesem Kapitel sollen die Grundlagen der vorherigen Kapitel auf den Menschen, sowohl gesund als auch krank, bezogen werden und dadurch noch mehr Praxisrelevanz erhalten.

Kommunikation und Interaktion

Ein wesentlicher Bestandteil Ihrer Tatigkeit als Pfleger besteht in der Kommunikation und Interaktion mit Patienten. Das Fuhren von Anamnesegesprachen und die Aufklarung von Patienten z. B. uber ihre Erkrankungen, Behandlungsmoglichkeiten und ihrer Prognose stellen ebenso wie die Forderung ihrer Compliance (siehe Kapitel 5 – Motivation, Abschnitt 5.4.2 – Compliance) der Patienten eine besondere Anforderung an Sie in Ihrem beruflichen Alltag dar. Die Gesprachsdauer zwischen Patient und Arzt beschrankt sich in der Regel auf wenige Minuten. Somit bleiben Fragen seitens der Patienten haufig ungeklart und werden dann nicht zuletzt an das Pflegepersonal gerichtet. Zugunsten einer erfolgreichen Behandlung sollten diese Fragen dann allerdings auch bestmoglich aufgefangen werden.

Sozialpsychologie und Soziologie

Die Sozialpsychologie beschaftigt sich in erster Linie mit den sozialen Beziehungen zwischen Menschen, und wie diese sich gegenseitig beeinflussen. Diese Beziehungen konnen von einer Zweierbeziehung uber Gruppenbeziehungen bis zu den Beziehungen der ganzen Menschheit reichen. Sie werden strukturiert von den Normen und Rollen, die innerhalb einer Gesellschaft gelten. Diese formen und beeinflussen das menschliche Zusammenleben. Dabei gelten in der Pflege besondere Regeln und Normen, die die Zusammenarbeit von Patienten und Pflegenden regeln.