Paul D. Rokke

Can anxiety help us tolerate pain

&NA; It was hypothesized that anxiety which is relevant to the source of pain exacerbates pain, whereas anxiety which is irrelevant to the source of pain reduces the experience of pain. Female subjects were given either high or low anxiety provoking information about a cold presser task (relevant anxiety) or high or low anxiety provoking information about a potential shock (irrelevant anxiety). Subjects were then exposed to the cold pressor. The results demonstrated that subjects who were highly anxious about the cold pressor reported experiencing the most pain. Subjects who were highly anxious about the shock reported the least pain and reported significantly less pain than subjects who were highly anxious about the cold pressor. These findings clearly demonstrate that the relationship between anxiety and pain is not always positive or unidirectional.

Cognitive Therapy for Depression: A Comparison of Individual Psychotherapy and Bibliotherapy for Depressed Older Adults

Thirty-one community-residing older adults age 60 or over either received 16 sessions of individual cognitive psychotherapy (Beck, Rush, Shaw, & Emery, 1979) or read Feeling Good (Burns, 1980) for bibliotherapy. Posttreatment comparisons with the delayed-treatment control indicated that both treatments were superior to a delayed-treatment control. Individual psychotherapy was superior to bibliotherapy at posttreatment on self-reported depression, but there were no differences on clinician-rated depression. Further, bibliotherapy participants continued to improve after posttreatment, and there were no differences between treatments at 3-month follow-up. Results suggest that bibliotherapy and that individual psychotherapy are both viable treatment options for depression in older adults.

The role of client choice and target selection in self-management therapy for depression in older adults.

In a study designed to maximize the effectiveness of treatment by allowing participants to select the target of treatment, 40 depressed older adults were randomly assigned to a waiting-list control condition or to conditions in which the target of treatment was either chosen or assigned. All participants received self-management therapy and the choice was between changing behavior or changing cognition. It was found that individually administered self-management therapy was effective in treating depression for older adults. There were no differences in outcome between versions of self-management therapy that targeted behavioral or cognitive change. Among those who completed treatment, there were no differences in outcome between those who received a choice and those who did not. Individuals who were given a choice of treatment options, however, were less likely to drop out of treatment prematurely.

Self-Management Therapy and Educational Group Therapy for Depressed Elders

A final sample of 34 adults, over the age of 60 and meeting DSM-III-R diagnostic criteria for major depression, were randomly assigned to three conditions. Self-management therapy and educational group therapy were compared to a waiting-list control condition. Treated participants improved, relative to controls, on two of four indices of depression, and three of four secondary measures of outcome, including frequency of self-reinforcement, learned resourcefulness, and self-control knowledge. Both treatments showed significant decreases in depression over the course of treatment and maintained these gains over a 1-year follow-up period. Averaged across depression instruments, 71% of self-management participants and 61% of educational group participants showed clinically meaningful improvement. There were no statistically significant differences between these treatments.

Matching Pain Coping Strategies to the Individual: A Prospective Validation of the Cognitive Coping Strategy Inventory

The validity of the Cognitive Coping Strategy Inventory (CCSI; Butler et al., 1989) was tested in a prospective fashion. Subjects were randomly assigned to one of three conditions. Some were “matched” to a strategy for which they received a high CCSI score, some were “mismatched” to a strategy for which they received a low CCSI score, and some were given a choice of strategies. Those subjects using a matched strategy obtained better threshold and tolerance times on the cold pressor than subjects who used a mismatched strategy. Despite clear differences in exposure to the cold pressor these conditions did not differ from each other in self-reported levels of pain. It was concluded that the CCSI appears to be a valid and useful tool for selecting a coping strategy to help particular individuals manage acute pain. Though the CCSI is relatively easy to administer and score, the comparative costs and benefits of using it must be weighed against the somewhat more efficient approach of simply offering the subject a choice of treatments. Subjects given a choice of strategies performed as well as subjects matched to a strategy on the basis of CCSI scores.

When does a choice of coping strategies help? The interaction of choice and locus of control

Undergraduate student volunteers either were given a choice of coping strategies or were assigned to a coping strategy which was used to help them tolerate the cold pressor. Subjects who were given a choice of coping strategies reported their strategy to be more credible and perceived a greater sense of control than subjects who were not given a choice. Improved pain tolerance, however, did not result directly from being given a choice. Increases in pain tolerance depended on locus of control. Subjects who had a high internal health locus of control reported a greater strength of self-efficacy and demonstrated increased pain tolerance following a choice of strategies. In comparison, subjects who reported a more external health locus of control did not benefit from receiving a choice. This study has implications for our understanding of the role of choice in therapy and for improving the effectiveness of our interventions with individuals.

Self-efficacy and choice of coping strategies for tolerating acute pain.

Participants who reported either low or high self-efficacy for tolerating painful stimuli were randomly assigned to conditions, in which they either did or did not have a choice of strategies for coping with arm shock. Choice and self-efficacy were positively associated with increases in perceived control. Being given a choice, in comparison to having no choice, led to increased tolerance of arm shock and lower pain reports for those with high self-efficacy. Providing a choice of strategies did not benefit those with low self-efficacy. This study demonstrates that the benefits of allowing individuals the opportunity of choosing among an array of coping options depend on a prior conviction that one is able to cope.

The role of choice in enhancing tolerance to acute pain

The ability of choice of treatments to enhance tolerance to pain was investigated. Results showed that subjects who were given a choice of coping strategies tolerated the cold pressor for a longer period of time than those not given a choice. The mechanism by which choice exerts its influence, however, remains unknown. In contrast to our predictions, having a choice of treatments did not increase perceptions of treatment credibility or a sense of self-efficacy. Post hoc analyses revealed that subjects who were not given a choice, but who were nevertheless assigned to their preferred treatment, did not differ from subjects given a choice on tolerance time, but reported less pain and found the treatment more credible than subjects given a choice. The mechanisms by which choice influences treatment outcomes, including the nature and role of treatment preferences, require further investigation.

The emotional blink: adult age differences in visual attention to emotional information.

To assess age differences in attention-emotion interactions, the authors asked young adults (ages 18-33 years) and older adults (ages 60-80 years) to identify target words in a rapid serial visual presentation (RSVP) task. The second of two target words was neutral or emotional in content (positive in Experiment 1, negative in Experiment 2). In general, the ability to identify targets from a word stream declined with age. Age differences specific to the attentional blink were greatly reduced when baseline detection accuracy was equated between groups. With regard to emotion effects, older adults showed enhanced identification of both positive and negative words relative to neutral words, whereas young adults showed enhanced identification of positive words and reduced identification of negative words. Together these findings suggest that the nature of attention-emotion interactions changes with age, but there was little support for a motivational shift consistent with emotional regulation goals at an early stage of cognitive processing.

Boredom proneness and emotion regulation predict emotional eating

Emotional eating is considered a risk factor for eating disorders and an important contributor to obesity and its associated health problems. It has been suggested that boredom may be an important contributor to overeating, but has received relatively little attention. A sample of 552 college students was surveyed. Linear regression analyses found that proneness to boredom and difficulties in emotion regulation simultaneously predicted inappropriate eating behavior, including eating in response to boredom, other negative emotions, and external cues. The unique contributions of these variables to emotional eating were discussed. These findings help to further identify which individuals could be at risk for emotional eating and potentially for unhealthy weight gain.