This investigation examined the impact of a potent source of social influence—the placebo—on verbal and nonverbal pain expression. Placebos exert a powerful influence on pain in both clinical and laboratory settings; nevertheless, the placebo remains a poorly understood phenomenon. In the present study the placebo was employed as a social influence designed to alter subjects' expectations or beliefs concerning their response to a noxious event. Furthermore, an attempt was made to classically condition a placebo response in accordance with the conditioning theory of placebo. The pain stimulus consisted of 500-millisecond electrical shocks. The placebo was an inert white cream described as an effective and quick-acting local anaesthetic. To gain a broad assessment of verbal and nonverbal pain expression, two self-report measures and an objective behavioural measure—facial expression—were used. Self-report comprised the "Sensory" and "Unpleasantness" ratio scales (derived from Gracely, McGrath, & Dubner, 1978). Facial expressiveness was coded using the Facial Action Coding System (FACS) developed by Ekman and Friesen (1978). Psychological interventions have been said to primarily alter patients' affective response to pain, thus it was expected that the greatest impact of the placebo would be reflected by the Unpleasantness Scale. The Sensory ratings and facial activity were expected to reflect less of a change. Sex differences were analyzed but were not expected because the pain stimulus intensity was individualized. Anxiety ratings taken before the trials with placebo were expected to be lower than anxiety ratings before the no-placebo trials; this was expected to be positively related to a placebo response (defined as lower pain expression during placebo trials than during no-placebo trials). In the baseline phase, subjects were tested with and without the placebo. They received the expectation manipulation that the analgesic cream would act as a local anaesthetic. Next, to condition a placebo response, in the positive conditioning group shocks administered with placebo cream were surreptitiously decreased; in the negative conditioning group shocks were increased; and in the baseline (control) group shocks remained at baseline levels. A final return-to-baseline phase tested the conditioned placebo response. A significant placebo response was found to be most clearly represented by the self-report measures and less by the facial activity. Control group subjects, who were exposed only to the verbal directive that they were receiving an analgesic cream, demonstrated a clear placebo response on both the Unpleasantness and Sensory self-report scales. Thus both self-report measures reflected a substantial placebo effect. Nonverbal expression reflected an effect only with half of the control group—the males—who exhibited significantly less facial activity during the placebo trials compared to the no-placebo trials. However, neither of the two groups exposed to manipulated shock levels demonstrated a significant conditioned placebo effect on any dependent measure. There was a modest relationship between facial activity and self-report. Self-reported anxiety was somewhat predictive of the degree to which subjects rated placebo trials as less painful than no-placebo trials, but the direction of this relationship was opposite to that hypothesized. In brief, subjects led to expect an analgesic cream, but not exposed to the conditioning manipulation, reliably exhibited a placebo response on both self-report scales; the males in this group also exhibited a placebo response as measured by facial activity. No support was found for the conditioning theory of placebo effects. / Arts, Faculty of / Psychology, Department of / Graduate

No description available.

This study investigated rowers' cognitive pain coping strategies during a 2,000 metre ergometer race. The concepts of association and dissociation were expanded upon by devising five thought categories: performance dissociation (PerfD), pain association (PaA), pain dissociation (PaD), psychological performance association (PsyA), and technical performance association (TechA). Sixteen rowers, five males and eleven females, between the ages of 19 and 27 years, rowed at maximum intensity for four race segments of 500 m, 1,000 m, and 2,000 m on separate occasions. A forty-one item Thoughts During Rowing Questionnaire was administered upon completion of each distance. Subjects' average thought category scores were analyzed by a 4 x 5 (Distance x Thought category) MANOVA. Results indicated significant (p $<$.005) effects for distance and thought category, and an interaction. Results suggest that while racing, rowers rarely dissociate from their performances. As pain awareness rises, rowers dissociate from pain and associate with the psychological or technical aspects of their performances.

Alexithymia is conceptualized as a personality variable involving profound affective deficits. Individuals with high levels of alexithymia are characterized by difficulty in describing emotions, a preoccupation with somatic symptoms, and an insensitive interpersonal style. Alexithymia is commonly found among chronic pain patients. Despite a burgeoning literature, researchers have not identified either the precise characteristics and source of the poor interpersonal performance associated with alexithymia, or how the presence of alexithymia relates to the phenomenology and conceptualization of pain. The Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia in a sample of 145 female university students who had reported experiencing significant pain during the past year. An exploratory factor analysis was conducted to check the factor structure of the TAS-20 with this sample. A series of three studies was designed to explore the relationship with alexithymia and: 1) reactions to facial expressions of emotion, 2) reactions to others' pain, and 3) conceptualization of own pain. The cleanest factor solution was yielded by a Maximum Likelihood Analysis with oblique rotation. In this sample, the TAS-20 is adequately represented as 4 factors: 1) Difficulty Identifying Bodily Sensations (Body); 2) Confusion about Emotions (Emotions); 3) External Cognitive Style (External), and 4) Interpersonal Awkwardness (Awkward). Study 1 investigated the ability to judge and respond to facial expressions of emotion, as a potential source of interpersonal difficulties. Participants examined slides of adults modeling specific emotions, and attempted to identify the modeled affective states. Alexithymia was expected to be related to difficulty in assessing facial expressions of emotion. As predicted, the ability to identify and appropriately respond to modeled emotional expressions was significantly lower in high-alexithymia participants. Alexithymia scores were related to a tendency to rate various modeled emotions as "pain," providing support for the association with a somatic preoccupation. Study 2 entailed evaluation of interpersonal perception in the context of pain by investigating the relationship between alexithymia and judgement of pain in infants. Participants evaluated two dimensions of pain (sensory discomfort and emotional distress) while watching videotapes of neonates undergoing invasive but routine medical procedures. It was hypothesized that the somatic preoccupation and emotional insensitivity associated with alexithymia would lead high-alexithymia individuals to exaggerate the sensory component of pain in infants and underestimate the affective domain. Predictions were only partially supported. When depressed mood and extent of current pain were controlled, the hypothesized relationship emerged between the TAS-20 External factor and lower ratings of perceived emotional distress, and between the Body factor and higher ratings of perceived sensory discomfort. Contrary to expectations, Body factor scores were related to higher emotional distress ratings. In Study 3, participants assessed retroactively the sensory and affective components of their own painful experiences. There is an increasing trend for multidisciplinary pain clinics to include psychological interventions, treatments whose success is largely dependent upon patients distinguishing the sensory and affective components of pain. It was predicted that high-alexithymia participants would emphasize the sensory rather than the affective dimension, a judgement pattern which could explain the link found between high levels of alexithymia and poorer recovery from chronic pain conditions. Contrary to expectations, it was found that alexithymia scores were unrelated to ratings of sensory intensity. After controlling for depressed mood and extent of current pain, the only significant result to emerge was between the TAS-20 Awkward factor and higher (not lower) ratings of the affective component of participants' own painful experiences. Results suggest that a source of the social awkwardness associated with alexithymia may arise from an insensitivity to facially expressed mood states. There is some evidence that individuals with an external cognitive style pay less attention to the affective distress entailed in infants' pain experiences. The overall pattern of results suggests that alexithymia, as measured by the TAS-20, is best viewed as factorially complex. While the factors display some interdependence, there is greater utility in computing and examining all factor scores rather than describing individuals by a global TAS-20 total score.

The purpose of this investigation was to examine the supposition that chronic pain patients (CPPs) have altered pain perception. Two models were examined that led to opposing predictions as to how CPPs would respond to painful stimuli (i.e., the hypervigilance and adaptation-level models). Both predictions have been supported by past research but because of methodological variation and the type of pain disorder studied, it has remained unclear under what circumstances the predictions of these two models may be met. The responses of pain patients to painful stimuli have been found to vary for patients-with different clinical presentations (i.e. those with and without medically incongruent signs and symptoms). Therefore, the present investigation sought to compare the responses to radiant heat stimuli of sixty CPPs (thirty with and thirty without a medically incongruent pain presentation) to thirty age and sex matched normal control subjects (i.e., pain-tree individuals). Signal detection theory methodology was used in order to separately evaluate sensory sensitivity and the response bias to report sensations as painful. In addition, cognitive and affective factors were assessed in order to identity potential psychological correlates of altered pain perception. The results of this study indicated that the presence of a medically incongruent pain presentation distinguished patients on their subjective report of disability and to a lesser extent cognitive appraisal and affective distress regarding their pain condition. They did not differ in their responses to painful stimuli. In a post hoc analysis where CPPs were classified into 'organic' and 'functional’ diagnostic groups, significant differences in pain threshold and the response bias to report pain were found. Patients classified as 'organic' had significantly higher pain thresholds compared to normal control subjects and patients classified as 'functional'. Differences in pain threshold were primarily represented by the response' bias to report sensations as painful rather than sensory sensitivity to the stimuli. The 'functional' group had a slightly lower pain threshold than the normal control group but this difference was not significant. The results are discussed in light of the two models of pain perception. The two methods used to classify pain patients are discussed according to their orthogonal characteristics on sensory, cognitive, and affective components. / Arts, Faculty of / Psychology, Department of / Graduate

Alexithymia is conceptualized as a personality variable involving profound affective deficits. Individuals with high levels of alexithymia are characterized by difficulty in describing emotions, a preoccupation with somatic symptoms, and an insensitive interpersonal style. Alexithymia is commonly found among chronic pain patients. Despite a burgeoning literature, researchers have not identified either the precise characteristics and source of the poor interpersonal performance associated with alexithymia, or how the presence of alexithymia relates to the phenomenology and conceptualization of pain. The Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia in a sample of 145 female university students who had reported experiencing significant pain during the past year. An exploratory factor analysis was conducted to check the factor structure of the TAS-20 with this sample. A series of three studies was designed to explore the relationship with alexithymia and: 1) reactions to facial expressions of emotion, 2) reactions to others' pain, and 3) conceptualization of own pain. The cleanest factor solution was yielded by a Maximum Likelihood Analysis with oblique rotation. In this sample, the TAS-20 is adequately represented as 4 factors: 1) Difficulty Identifying Bodily Sensations (Body); 2) Confusion about Emotions (Emotions); 3) External Cognitive Style (External), and 4) Interpersonal Awkwardness (Awkward). Study 1 investigated the ability to judge and respond to facial expressions of emotion, as a potential source of interpersonal difficulties. Participants examined slides of adults modeling specific emotions, and attempted to identify the modeled affective states. Alexithymia was expected to be related to difficulty in assessing facial expressions of emotion. As predicted, the ability to identify and appropriately respond to modeled emotional expressions was significantly lower in high-alexithymia participants. Alexithymia scores were related to a tendency to rate various modeled emotions as "pain," providing support for the association with a somatic preoccupation. Study 2 entailed evaluation of interpersonal perception in the context of pain by investigating the relationship between alexithymia and judgement of pain in infants. Participants evaluated two dimensions of pain (sensory discomfort and emotional distress) while watching videotapes of neonates undergoing invasive but routine medical procedures. It was hypothesized that the somatic preoccupation and emotional insensitivity associated with alexithymia would lead high-alexithymia individuals to exaggerate the sensory component of pain in infants and underestimate the affective domain. Predictions were only partially supported. When depressed mood and extent of current pain were controlled, the hypothesized relationship emerged between the TAS-20 External factor and lower ratings of perceived emotional distress, and between the Body factor and higher ratings of perceived sensory discomfort. Contrary to expectations, Body factor scores were related to higher emotional distress ratings. In Study 3, participants assessed retroactively the sensory and affective components of their own painful experiences. There is an increasing trend for multidisciplinary pain clinics to include psychological interventions, treatments whose success is largely dependent upon patients distinguishing the sensory and affective components of pain. It was predicted that high-alexithymia participants would emphasize the sensory rather than the affective dimension, a judgement pattern which could explain the link found between high levels of alexithymia and poorer recovery from chronic pain conditions. Contrary to expectations, it was found that alexithymia scores were unrelated to ratings of sensory intensity. After controlling for depressed mood and extent of current pain, the only significant result to emerge was between the TAS-20 Awkward factor and higher (not lower) ratings of the affective component of participants' own painful experiences. Results suggest that a source of the social awkwardness associated with alexithymia may arise from an insensitivity to facially expressed mood states. There is some evidence that individuals with an external cognitive style pay less attention to the affective distress entailed in infants' pain experiences. The overall pattern of results suggests that alexithymia, as measured by the TAS-20, is best viewed as factorially complex. While the factors display some interdependence, there is greater utility in computing and examining all factor scores rather than describing individuals by a global TAS-20 total score. / Arts, Faculty of / Psychology, Department of / Graduate

Note:

No description available.

Pain is a major problem for bum patients, particularly during dressing changes and wound debridement. The bum patients' pain experience, related to resting conditions and procedural dressing changes, was studied. The purpose of this descriptive study was to describe bum patients' pain experience as related to resting and procedural pain and anxiety. Specifically, the research was designed to describe bum patients' pain and anxiety during resting conditions and dressing changes and describe bum patients' responses of their acceptable level of pain. A convenience sample of 23 acutely burned adults over the age of 18 undergoing bum wound care without previous surgical intervention in a southeastern bum unit was recruited to participate in this study. Data were collected using the short-form McGill pain questionnaire, the Visual Analogue Scale-anxiety and the Visual Analogue Scale-pain. Demographics of the sample were collected. The Baseline Assessment Form and the Procedural Assessment Form were used to collect data regarding the setting and medications used prior to each measurement. Descriptive statistics, the Wilcoxon signed-ranks test, and the Friedman test were used to analyze data, describe the sample and report baseline and procedural responses of pain and anxiety. The analysis of data revealed that there was a significant difference found between pain responses during resting conditions and procedures (z = -2.34, p = .02), with procedural pain being greater. There were no significant differences in anxiety between resting conditions and procedures (z = -1.41, p = .16). There was a significant difference between bum patients' acceptable level of pain, resting pain, and procedural pain (x2 = 9.2, p = .01). Resting pain was significantly lower than patients' acceptable level of pain (z = -2.97, p = < .01). Procedural pain was slightly lower than patients' acceptable level of pain but these results were not statistically significant (z = - .90, p = .37). This study demonstrated that there are differences between bum patients' pain at rest and pain during procedures, specifically dressing changes. There are many implications for clinical practice. First, pain assessment must be based on the use of a valid and reliable patient self-report tool. Second, the pain management regimen must be highly individualized and should take into considerations the differences between resting and procedural pain. Third, pain and anxiety management should be studied utilizing multiple methods of pain and anxiety management techniques (i.e. medication, music, humor, and wound care teaching). Fourth, bum patients' acceptable level of pain should be assessed to provide adequate pain management. Lastly, further research is needed in the area of bum pain management. The area of bum pain management requires additional research to develop guidelines encompassing patients' bum experiences and effective outcomes focusing on the utilization of valid and reliable assessment tools.

"December, 2003" / Bibliography: leaves 283-311. / xiv, 311 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, School of Medicine, Dept. of Psychology, 2005