Tine Vervoort

Facing others in pain: the effects of empathy.

Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium Research Institute for Psychology & Health, Utrecht, The Netherlands Department of Psychology, University of British Columbia, Vancouver, BC, Canada Academic Unit of Psychiatry & Behavioural Sciences, University of Leeds, Leeds, UK Department of Psychology, University of Montreal, Quebec, Canada Sub-Department of Clinical Health Psychology, University College London, London, UK Department of Psychology, Wayne State University, Detroit, MI, USA

A Biopsychosocial Formulation of Pain Communication.

We present a detailed framework for understanding the numerous and complicated interactions among psychological and social determinants of pain through examination of the process of pain communication. The focus is on an improved understanding of immediate dyadic transactions during painful events in the context of broader social phenomena. Fine-grain consideration of social transactions during pain leads to an appreciation of sociobehavioral events affecting both suffering persons as well as caregivers. Our examination considers knowledge from a variety of perspectives, including clinical health psychology, social and developmental processes, evolutionary psychology, communication studies, and behavioral neuroscience.

Parental catastrophizing about their child's pain. The parent version of the Pain Catastrophizing Scale (pcs-p) : A preliminary validation

Abstract Numerous studies have found evidence for the role of catastrophizing about pain in adjustment to pain in both adults and children. However, the social context influencing pain and pain behaviour has been largely ignored. Especially in understanding the complexities of childhood pain, family processes may be of major importance. In line with the crucial role of pain catastrophizing in explaining adjustment and disability in adults and children, this study investigates the role of parental catastrophic thinking about their child’s pain in explaining child disability and parental distress. To study parental catastrophizing, a parent version of the Pain Catastrophizing Scale (PCS‐P) was developed. An oblique three‐factor structure emerged to best fit the data in both a sample of parents of schoolchildren (N = 205) and in a sample of parents of children with chronic pain (N = 107). Moreover, this three‐factor structure was found to be invariant across both parent samples. Further, in the clinical sample, parents’ catastrophic thinking about their child’s pain had a significant contribution in explaining (a) childhood illness‐related parenting stress, parental depression and anxiety, and (b) the child’s disability and school attendance, beyond the child’s pain intensity.

Parental catastrophizing about child's pain and its relationship with activity restriction: the mediating role of parental distress

&NA; Recent research has demonstrated that parental behaviors have an important impact upon child and adolescent pain outcomes. At present, however, we do not know which parents engage in particular behaviors and why. In 2 studies, the impact of parental catastrophizing about their childs pain upon parental tendency to stop their childs pain‐inducing activity was investigated. Further, the mediating role of parental distress was explored. In study 1, a sample of schoolchildren (n = 62; M = 12.48 years; SD = 1.72) took part in a cold‐pressor task. In study 2, a clinical sample of adolescents with chronic pain (n = 36; M = 15.68 years; SD = 1.85) performed a 2‐min walking task designed as a pain‐inducing activity. In both studies, the accompanying parent was asked to watch their child performing the pain task. Findings revealed, for both studies, that parents with a high level of catastrophic thinking about their childs pain experienced more distress and a greater behavioral tendency of wanting to stop their childs pain‐inducing activity. Further, parental feelings of distress mediated the relationship between parental catastrophic thinking and parents’ tendency to restrict their childs activity. The findings are discussed in light of an affective‐motivational conceptualization of pain and pain behavior. Parental catastrophizing was associated with parental tendency to restrict their childs engagement in a painful test, and this relationship was mediated by parental distress.

Catastrophizing about their children's pain is related to higher parent-child congruency in pain ratings: an experimental investigation.

Little is known about the variables that account for why parents underestimate the pain of their child. In the present experiment, the joint impact of parental catastrophizing about their childs pain and childrens facial pain expressions was examined upon pain estimates of their child undergoing a pressure pain test. In line with previous research, parents underestimated their childrens pain. Interestingly, it was found that pain was estimated as higher when the child showed more facial pain expressions and when parents catastrophized more about their childs pain. An intriguing finding was that catastrophizing about their childs pain was related to less parent–child incongruence in pain ratings. The discussion addresses the possible functions of catastrophizing of parents about their childrens pain, and delineates avenues for future research.

Children's catastrophic thinking about their pain predicts pain and disability 6 months later

Catastrophic thinking about pain has been identified as an important determinant of adjustment to pain, in both adults and children. No study has investigated the prospective and unique role of catastrophizing in explaining later pain and disability in children. The aim of the present study was to investigate the prospective roles of catastrophic thinking about pain, pain intensity, and trait anxiety and their putative relationship with pain and disability tested 6 months later. Participants were 323 schoolchildren. Analyses revealed that the childs pain catastrophizing at baseline had a small but unique contribution to the prediction of pain and disability 6 months later, even when controlling for the initial pain and disability levels. In line with expectations, moderation analyses revealed that the effects of catastrophizing upon pain and disability at follow‐up were only true for those children reporting low levels intensity of pain at baseline. The variability in disability and pain complaint could not be explained by trait anxiety. Instead anxious disposition might be best conceived of as a precursor of catastrophizing in children; i.e. children with higher levels of trait anxiety at baseline were more inclined to report higher levels of catastrophizing at follow‐up. The findings are discussed in terms of potential mechanisms through which catastrophizing might exert its negative impact upon pain and disability outcomes in children.

Expressive dimensions of pain catastrophizing: a comparative analysis of school children and children with clinical pain

&NA; We investigated the role of the child’s pain catastrophizing in explaining (1) children’s self‐reported tendency to verbally share their pain experience with others and (2) different dimensions of pain expression, as described by the mother and the father, including non‐verbal and verbal communicative pain behaviour and protective pain behaviour. Participants were school children, children with chronic or recurrent pain, and their parents. The results showed that: (1) Pain catastrophizing was associated with children’s greater self‐acknowledged tendency to verbally share their pain experience with others. (2) Mothers and fathers perceived highly catastrophizing children to be more communicative about their pain. (3) The role of pain catastrophizing in the child’s verbal sharing of pain experiences and in explaining expressive behaviour as rated by parents did not differ between the school children and children with recurrent and chronic pain. (4) Nevertheless, findings indicated marked differences between school children and the clinical sample. Children of the clinical sample experienced more severe pain, more pain catastrophizing, more protective pain behaviour, but less verbal communications about their pain. These results further corroborate the position that catastrophic thoughts about pain have interpersonal consequences. Findings are discussed in terms of the possible functions and effects upon others of pain catastrophizing and associated categories of pain behaviour.

The effects of parental presence upon the facial expression of pain: The moderating role of child pain catastrophizing

&NA; This experiment investigated the effects of child catastrophic thinking and parental presence on the facial expressions of children when experiencing pain. School children experienced pressure pain in either one of two conditions: (1) when observed by a parent (n = 53 children and their parent), or (2) when observed by an adult stranger (n = 31 children). Analyses revealed that children showed more facial pain expression in the presence of their parent than in the presence of the stranger. This effect was, however, only found for children with infrequent catastrophic thoughts about pain. Children who have frequent catastrophic thoughts expressed high pain regardless of who they believed was observing them. Results are discussed in terms of the social consequences of pain catastrophizing, and the variables contributing to the expression or suppression of pain display in children and its impact upon others.

Parental catastrophizing about their child’s chronic pain: Are mothers and fathers different?

Preliminary evidence suggests that parental catastrophizing about their childs pain may be important in understanding both parental responses to their childs pain and the childs pain experience. However, little is known about potential differences between mothers and fathers. There were three aims of the present study addressing this lack of knowledge: (i) to investigate the three‐factor structure of the German version of the Parental Pain Catastrophizing Scale (PCS‐P) ( Goubert et al., 2006 ) in mothers and fathers of children with chronic pain, (ii) to explore differences between mothers and fathers in parental catastrophizing, (iii) to investigate the contribution of parental catastrophizing on the childs chronic pain problem and pain‐related parent behavior.

Threat of pain influences social context effects on verbal pain report and facial expression

Current theoretical models of pain catastrophizing have diverging predictions regarding the role of social context and perceived threat on pain expression. The communal coping model of catastrophizing predicts that high pain catastrophizers display more pain expression in the presence of another, regardless of the threat value of the pain, while a cognitive appraisal model predicts high pain catastrophizers to express more pain when pain has increased threat value, regardless of social context. A 2 x 2 factorial design was used to test the validity of both predictions. Healthy participants with varying levels of pain catastrophizing were exposed to a cold pressor task, consisting of a 60 s immersion and 60 s recovery period. Interestingly, the immersion results revealed that beyond and independent from the effects of pain catastrophizing, the effect of threat on verbal pain report and facial expression was dependent on social context and vice versa. In a threatening context, perceived threat of pain mediated the inhibitory effect of social presence on pain expression, suggesting that the observer acted as a safety signal. In the recovery period, social presence enhanced facial expression, but only when no threat was induced. The results are discussed in terms of the dynamic interaction between social context and threat appraisals.