abstract: An abundance of data has established the links between both pain-related cognitions and relationship attachment qualities in the experience of pain, including long-term functional health in chronic pain patients. However, relatively few studies have explored the dynamic relation between pain and pain-related cognitions within a day, and no studies have tested the moderating role of relationship attachment on the within-day cognition—pain association in chronic pain patients. The objectives of this study were to: 1) assess whether late morning pain flares predicted changes in afternoon positive and negative pain-related cognitive appraisals, and whether these changes in turn predicted end-of-day pain, and 2) explore whether adult attachment anxiety moderated the pain-cognition relation in individuals with chronic pain due to fibromyalgia. One hundred and seventy four partnered individuals with fibromyalgia completed initial assessments of demographics and attachment anxiety, and subsequently completed electronic assessments of pain intensity and positive and negative cognitive pain-related appraisals three times a day for three weeks. Multilevel structural equation modeling established that a latent negative cognitive appraisal factor (encompassing shared variance from catastrophizing, pain irritation, and self-criticism related to pain) mediated the link between late morning and end-of-day pain intensity, in line with the hypothesis. Analyses also provided some support for a mediating role for a positive cognitive appraisal factor (a composite of pain control, pain self-efficacy, and feeling pain without reacting) in the daily course of pain; the mediated effect for positive appraisals was weaker than the mediated effect of negative appraisals, but was sustained in a model that included negative appraisals. Inconsistent with prediction, attachment anxiety did not moderate the within-day links between pain and cognitions. These findings establish the dynamic links within day between pain and pain-related cognitions, and highlight the potential impact of both negative and positive cognitions on daily pain regulation. They point to the value of broadening cognitive-behavioral treatment strategies for chronic pain patients to target not only negative but also positive cognitions. / Dissertation/Thesis / Doctoral Dissertation Psychology 2015

Researchers have examined social relationships as a basic need, showing that being well integrated in a network of social ties is related to various positive health outcomes including reduced mortality and risk behavior (e.g. reduced alcohol consumption). Conversely, a lack of strong social ties is related to negative outcomes including depression, suicide, and substance use (Berkman & Syme, 1979; Durkheim, 1951; Sarason, Sarason, & Gurung, 2001). Loneliness, a negative affective experience resulting from relationship deficits, is related to similar health outcomes as social isolation including depression and problematic alcohol use (Cacioppo, Hawkley, Crawford et al., 2002). However, research to date examining loneliness and health behavior has predominantly employed cross-sectional measures (e.g. UCLA Loneliness Scale; Russell, Peplau, & Cutrona, 1980), therefore failing to capture more fluctuating experiences of and responses to loneliness which may signify maladaptive patterns of coping behavior (Hawkley, Burleson, Bernston, & Cacioppo, 2003; Shankur, McMunn, Banks, & Steptoe, 2011). The purpose of this present study was to examine responses to daily loneliness (i.e. social and solitary alcohol consumption) as a function of social integration and gender, through a secondary analysis of data collected in a larger daily process study. Results indicated that daytime loneliness predicted evening increases in solitary consumption and decreases in social consumption. Further, these within-person effects were influenced by gender and social integration. These findings provide a unique understanding of specific processes by which social relationships, or the perceived lack thereof, influence health and more specifically, mood-related health behavior.

Recent studies have documented an alarming rate of alcohol use in Japan (Eisenback-Stangl et al., 2005; Milne, 2003; Shimizu, 2000). Indeed, permissive social and cultural norms for alcohol use exist within Japanese culture (Shimizu, 1990, 2000). Japanese college-students may be at further risk due to their developmental time period, where increases in alcohol use are typically seen. Furthermore, drinking habits formed during this time period may be difficult to alter later in life (Frone, 2003). Thus, social, developmental, and cultural factors exist to influence drinking among Japanese college students. The purpose of the current study was to investigate the drinking behaviors of Japanese college students and possible proximal predictors of use. Specifically, given the importance of social relationships and interactions to interdependent cultures, such as Japan, the occurrence of negative social interactions may be influential in predicting subsequent drinking, as individuals may increase drinking in order to adhere to the social norms and to make amends. Hypothesis testing confirmed a significant and positive relationship between negative social events and drinking with others. Furthermore, the expected physical, social and emotional outcomes of alcohol consumption (alcohol outcome expectancies) have been shown to predict alcohol use among U.S. samples (e.g., Goldman, 1994), however, daily fluctuations in the desirability of alcohol outcome expectancies has not been previously investigated in a Japanese sample. Given the importance of fluctuations in desirability of alcohol outcome expectancies among U.S. samples (Armeli et al., 2005), this dissertation investigated daily fluctuations in the desirability of expected outcomes and alcohol use. Support for this relationship was found; on days with individuals experienced increases in the desirability of alcohol outcome expectancies, individuals drank more with others. Support for the hypothesis that increases in daily negative social events would predict increases in the desirability of alcohol outcome expectancies was not found. Finally, this dissertation investigated two types of self-efficacy (drinking refusal self-efficacy and social self-efficacy) as stable factors of drinking. Drinking refusal self-efficacy significantly and negatively predicted drinking with others; marginal support for drinking refusal self-efficacy as a moderator of the relationship between negative social events and drinking with others was found. Social self-efficacy significantly and positively predicted drinking with others. No support was found for social self-efficacy as a moderating variable in the relationship between negative social events and drinking with others. In sum, using data that was previously collected via daily process methodology, this dissertation investigated the relationships between daily negative social interactions, daily desirability of alcohol outcome expectancies, and drinking refusal and social self-efficacy as moderators of alcohol consumption. Support was found for five of the seven hypothesized relationships.