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Thesis (Ph.D.)--Massachusetts Institute of Technology, Dept. of Linguistics and Philosophy, 1980. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND HUMANITIES. / Vita. / Bibliography: leaves 231-233. / by Janet Marchel Levin. / Ph.D.

The aim of the study was to investigate the application of aspects of Lazarus and Folkman's theory of Stress, Appraisal and Coping, to the chronic pain experience. In this context, the researcher explored the relationship between pain intensity and stress level. The association between pain intensity and the intensity of negative or positive attitudes towards the pain experience was also investigated. In addition, the relationship between pain intensity and the frequency of employing active, problem focused coping-strategies, or passive, emotion focused strategies, was explored. 105 subjects completed the South African Chronic Pain Questionnaire; an assessment tool based on adapted internationally validated measures. Findings suggest that there is a proportional relationship between pain intensity and stress level in the present chronic pain population. A positive relationship between pain intensity and the intensity of negative attitudes was revealed. A positive relationship was also reflected between pain intensity and the employ of passive, emotion-focused coping-strategies. There is a paucity of research that provides a theoretical framework in which to conceptualize the association between stress, appraisal and coping in chronic pain. To this end, the researcher has employed Lazarus and Folkman's theory in order to conceptualize the relationship between these variables and chronic pain intensity. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2001.

Data from daily diaries were used to examine the relationships between daily pain appraisals (Catastrophizing, Self-Efficacy, and perceived control over pain) and coping strategy use (Distraction, Ignoring Pain, Praying and Hoping, and Reinterpreting Pain Sensation) and nighttime negative mood and pain intensity for 88 women (mean age 46.83 years, SD 11.90) with chronic low back pain who were not attending a specialized pain treatment program. These relationships were examined at two levels using the Hierarchical Linear Modeling program (Bryk & Raudenbush, 1992). The first level of analyses examined whether pain appraisals and coping strategy use during the day predicted levels of nighttime depressed and anxious mood, and pain. This analysis was based on 30 days of monitoring for each participant. The second level of analyses examined whether these daily processes could be predicted by psychosocial and functional variables important to the experience of chronic pain. This analysis was based on the Mutidimensional Pain Inventory (Kerns, Turk, & Rudy, 1985) completed prior to participants beginning the daily monitoring. There were four major findings in this study. First, pain appraisals were more predictive of negative mood and pain intensity than coping strategy use, with Catastrophizing the strongest predictor of depressed and anxious mood, and control the strongest predictor of pain intensity. Second, general affective distress predicted higher levels of negative mood on a daily basis. Third, women who perceived their pain to be interfering a great deal in their lives were more anxious on a daily basis. Fourth, punishing spousal responses predicted nightly negative mood and pain more than solicitous or distracting spousal responses. These results are similar to findings based on patients attending pain treatment programs. This suggests that some of the same processes identified in clinical pain patients may apply to low back pain sufferers in the community who are comparable to study participants. The implications of these findings for pain research and treatment are discussed.

This thesis is a report of a study on patients suffering one of two painful chronic illnesses (rheumatoid arthritis (RA) or migraine), and attempts to discover possible determinants of psychological reactions to long term painful illness. One hundred and sixty chronically ill individuals were interviewed, (80 migraine and 80 RA sufferers). In keeping with other evidence, the extent of psychological disturbance was found to be higher for chronically ill individuals than for general population samples. There were no zero order correlations between reported pain and psychological distress. Age and length of suffering have often been cited as possible factors influencing mood state, but no evidence was found for this in the data gained in this survey. The results provide no evidence for the use of coping strategies as a method of adapting to the demands of the painful chronic illnesses studied here. Beliefs in control over illness have been posited as possible factors that may influence psychological state, and were measured in this research using a health locus of control scale. However locus of control scores were not found to be associated with mood state, although, in keeping with other research, scores were found to be associated with age and social class, with both lower social class and older sufferers scoring higher on externality than those from higher social classes, or whom were younger. The strongest association was found between aspects of subjective health status and mood state. The major finding of this study is that patients assessment of their own health state, in both illnesses, is the major factor associated with psychological state.

The present study examined the nature of and relationship between attributions, just world beliefs (JWB) and adjustment in a sample of 62 community pain sufferers. This was exploratory because it accounted for shortcomings of these concepts, meaning they have not been investigated like this in pain. Specifically, it accounted for the scarcity of research distinguishing between cause, responsibility and blame; allowing the self-definition of responsibility, blame and adjustment; examining changes in attributions and adjustment, and considering just world beliefs. The importance of investigating these issues in pain was detailed. The research was conducted in two phases. The first, brief phase piloted a measure to account for these shortcomings. The second phase used the piloted measure to investigate the shortcomings in a series of five aims. Descriptive analyses indicated that most participants made causal attributions for their pain, with around half attributing responsibility and blame. Although similar in the types of attributions made, cause was distinguished from responsibility and blame, which were indistinguishable from each other. Attributions did not change. Additionally, JWB were weakly correlated with pain intensity, and analyses of variance techniques found JWB to interact with pain duration, such that those with 1 month-2.5 years' duration had stronger JWB than those in the 3-9 years' duration. JWB did not interact with attributions or adjustment, but chi-square analyses found attributions interacted with adjustment, such that attributions to the self were adaptive, while attributions to others resulted in poor adjustment to pain. Stepwise multiple regression analyses suggested that these latter attributions predicted pain intensity, as did pain treatments. Additionally, individual differences in attributions, adjustment and pain intensity emerged in chi-square analyses, although none were found on JWB. Full interpretations were made of these findings, and their implications for future research discussed.

This research investigated the role of coping strategies in reducing the pain experience of rheumatoid arthritis (RA) patients over a seven-day period. Sixty-three patients completed a twice-daily structured dairy consisting of an eight scale revision of the Ways of Coping (WOC), the depression subscale of the Affects Balance Scale (ABS), and a pain visual analogue scale (VAS). Multivariate analyses for repeated measures identified two coping strategies, Self-Care and Positive Reappraisal, as significantly effective in pain reduction. Self-Care includes behavioral attempts to manage the symptoms of RA. Positive Reappraisal involves cognitive efforts to redefine pain experience in positive terms. The other six coping strategies also demonstrated a trend to increased use on days when pain decreased. These data imply that intraindividual approaches in examining the coping/pain association have potential benefit for determining a causal relation between coping and pain. / Medicine, Faculty of / Cellular and Physiological Sciences, Department of / Graduate

Very few good empirical investigations of pain and coping in children and adolescents currently appear in the published literature. In contrast to the adult literature, for ethical reasons, a foundation of basic research using experimentally-induced pain does not exist in the pediatric literature (McGrath, in press). This remaining deficiency in knowledge about children's spontaneous abilities to cope with pain is particularly harmful because it means that clinicians must base their assessment and treatment of pain in children on their knowledge of adults (Jeans, 1983). The need to consider cognitive-developmental issues has been emphasized in several recent papers (Lavigne, Schulein, & Hahn, 1986; Maddux, Roberts, Sledden, & Wright, 1986; Thompson & Varni, 1986). The present investigation evaluated the pain experienced and spontaneous coping strategies used by 39 children and adolescents with various forms of arthritis, during a painful joint-measuring task which is typically part of physiotherapy treatments for this illness. The two purposes of the study were: 1) to assess age/cognitive-developmental differences and 2) to compare "effective copers" versus children who were having some difficulties coping with pain (i.e. pain was interfering with their activities of daily living). Three age groups (5-7 years, 8-10 years, and 11-18 years), corresponding to the Piagetian stages of preoperational, concrete operational and formal operational thought, were compared. Subjects were videotaped while the range of motion in their joints was measured by the physiotherapist. Videotapes were subsequently coded for behavioral coping strategy use. Immediately following the joint measurement task, subjects were interviewed regarding thoughts they recalled experiencing. Transcribed interviews were subsequently coded for cognitive coping strategies reportedly used and catastrophizing cognitions reportedly experienced. In addition, parents completed two questionnaires rating the degree to which pain interferes with their child's activities of daily living, and the physiotherapist made a global rating of each child's functional capacity. The overall MANOVA using age group as a between groups factor, with self-reported pain variables entered as dependent measures was nonsignificant. A significant multivariate effect did emerge, however, when the coping variables were entered as dependent measures in a second overall MANOVA. Follow up univariate analyses revealed an age/cognitive-developmental trend in behavioral and cognitive coping strategy use. Children in the youngest group (preoperational) used primarily behavioral strategies to cope with pain elicited by the physiotherapy joint-measuring task, whereas slightly older children (concrete operational) began to supplement their repertoire of behavioral coping strategies with some cognitive coping strategies. A significant rise in reported cognitive coping strategy use was observed in the oldest group (formal operational). In addition, a discriminant function revealed that the two most important discriminators between "effective copers" versus children having some difficulties coping with pain were the amount of pain expression (vocal or nonvocal) coded and the amount of catastrophizing thoughts reportedly experienced during the physiotherapy task. Implications of these results for the treatment of children having difficulties coping with arthritic pain are discussed. / Arts, Faculty of / Psychology, Department of / Graduate

Data from daily diaries were used to examine the relationships between daily pain appraisals (Catastrophizing, Self-Efficacy, and perceived control over pain) and coping strategy use (Distraction, Ignoring Pain, Praying and Hoping, and Reinterpreting Pain Sensation) and nighttime negative mood and pain intensity for 88 women (mean age 46.83 years, SD 11.90) with chronic low back pain who were not attending a specialized pain treatment program. These relationships were examined at two levels using the Hierarchical Linear Modeling program (Bryk & Raudenbush, 1992). The first level of analyses examined whether pain appraisals and coping strategy use during the day predicted levels of nighttime depressed and anxious mood, and pain. This analysis was based on 30 days of monitoring for each participant. The second level of analyses examined whether these daily processes could be predicted by psychosocial and functional variables important to the experience of chronic pain. This analysis was based on the Mutidimensional Pain Inventory (Kerns, Turk, & Rudy, 1985) completed prior to participants beginning the daily monitoring. There were four major findings in this study. First, pain appraisals were more predictive of negative mood and pain intensity than coping strategy use, with Catastrophizing the strongest predictor of depressed and anxious mood, and control the strongest predictor of pain intensity. Second, general affective distress predicted higher levels of negative mood on a daily basis. Third, women who perceived their pain to be interfering a great deal in their lives were more anxious on a daily basis. Fourth, punishing spousal responses predicted nightly negative mood and pain more than solicitous or distracting spousal responses. These results are similar to findings based on patients attending pain treatment programs. This suggests that some of the same processes identified in clinical pain patients may apply to low back pain sufferers in the community who are comparable to study participants. The implications of these findings for pain research and treatment are discussed. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

The effects of a computer program (Health Imagery Technology Systems, HITS) designed to promote attitude and cognitive changes through elicitation of evoked response potentials were evaluated with chronic pain patients. A treatment and control group were used for comparison (52 patients, 22 females, 32 males, mean ages 47). Wechsler Adult Intelligence Scale-Revised subtests, a Semantic Differential scale, the Health Attribution Test, an imagery protocol, the McCoy-Lawlis Pain Drawing, and the Zung Depression scale were used at admission and discharge to measure change. A pre- post-mood thermometer was used with the treatment group. The hypotheses that the treatment group would show significant changes on these measures were tested with a two group repeated measures analysis of variance design. No significant changes were noted for either group on the intellectual measures, on health attitudes, or reports of pain. The similarities subscale showed significant within group variance (F = 5.46, p < .023). One bipolar adjective pair indicated significant differences (F = 4.79, p < .035), possibly a result of chance. One of seven imagery measures suggested a significant improvement in strength of imagery for the treatment group (F = 18.2, p < .00008). Both groups showed significantly improved imagery of body defenses (F = 4.58, £ < .037) and significantly reduced depression scores (F = 15.93, p < .000021). A mood thermometer was measured for the treatment group alone and five situational mood changes were significant in predicted directions. Post hoc discriminant analysis showed significant differences only on one adjective pair (F = 9.75, p < .0029). No combination of variables added to the prediction of group membership. Overall, the effects of the HITS program did not seem strong enough to indicate its value as a treatment modality in chronic pain populations beyond current treatment. It did indicate some significant situational mood effects in positive directions.