Pain has a significant burden on individuals and society; however challenges remain in the measurement of pain-related utility. Research was conducted to design a measurement framework for valuing pain states, for use in policy making. Within the theoretical framework of utility theory, the bio-psychosocial model of pain was used to select co-variates impacting the pain-utility relationship. The applicability of two utility theories (prospect theory and hedonist theory) to pain was evaluated, with EQ-5D-5L and utility values for scenarios of different pain intensities elicited using time-trade-off (TTO) and willingness-to-pay (WTP). Prospect theory was tested using the pain-utility relationship in 600 members of the general population (‘genpop’) by examining the presence of a reference point and the relationship between pain decreases/increases (gains/losses) and utility. Hedonist theory was tested through examination of predicted, experienced and remembered utilities, and ‘peak-end’ effects, principally using data from 56 university athletes experiencing training pain. Pain intensity had the greatest influence on EQ-5D values, with present and worst pain showing additive effects. Duration of the pain episode, general health, mood, age and gender also had significant impacts. In addition to pain intensity, TTO ‘genpop’ models included age, income, experienced pain and general health; WTP ‘genpop’ models included residual pain, age and income. The TTO and WTP models did not fit the athletes’ data well and alternative models were developed. The data did not confirm prospect theory: a reference point could not be identified (‘genpop’ and athletes) and the shape of the utility curve contradicted theory (athletes). Results for hedonist theory were inconclusive: predicted utility was consistently higher than experienced utility in athletes but the relationship depended on pain levels in ‘genpop’; remembered and experienced utility differed despite being consistent for pain levels; peak-end effects were not found. Further research in controlled environments is recommended for further theory testing.

Thesis (Ph.D.(Psychology))--University of the Witwatersrand, Faculty of Humanities, 2013. / The research entailed a comprehensive study of vicarious trauma in short-term insurance claims workers, compared to trauma counsellors and a control group of holiday booking consultants. A well-known, comprehensive model of compassion fatigue/secondary traumatic stress, developed for therapists formed the basis of the study. The research attempted to determine whether this model can be applied more widely to include administrative populations exposed to traumatised clients on a regular basis. To this end, the model was deconstructed into its eleven constituent parts and each element was investigated in addition to other variables of interest to the study. This was done to determine the importance and applicability of each model element and other selected variables to the administrative context. A mixed methods approach was utilised, which combined quantitative and qualitative data. The results yielded by the study were collectively utilised to construct an etic and an emic voice from the research. At the same time, effects from vicarious trauma were considered from an overarching bio-psychosocial stance, systematically gauging effects on various levels of functioning. Scores from quantitative measures on secondary traumatic stress, negative cognitive schemas, empathy, social support and compassion satisfaction were statistically analysed, which revealed significant differences between the worker groups. Widely accepted relationships between the study variables were tested and found to hold true within and across groups. Regression analysis determined the roles of empathy, social support and compassion satisfaction in vicarious trauma, as measured by secondary traumatic stress and negative cognitive schemas. In addition, constructivist selfdevelopment theory was employed to interpret the negative cognitive effects from vicarious traumatisation. Qualitative data were utilised to further elucidate the role and nature of vicarious trauma in each of the worker groups. The themes of exposure to client suffering, detachment, level of empathic engagement, personal trauma history and difficult life demands were unearthed from the qualitative data, which illuminated the importance and role of each of these elements to claims workers. Other areas of interest, being utilisation of sick-leave as a means to cope, work-related illness, attitudes towards professional counselling, feelings evoked by traumatised clients, and the language utilised by workers in response to client traumata were investigated. Further effects on participants as well iv as effects that reach beyond the person were identified and examined. Effects on the social and work contexts were also elucidated. Finally, interesting themes that emerged spontaneously from the data were considered. The consideration of the various model elements and other areas of interest systematically revealed that administrative workers dealing with traumatised clients are also affected by the process of vicarious trauma. Furthermore, the model was found to be largely suitable to the context of claims workers. However, the model was expanded to augment its usability within the more general administrative domain. Finally, the overarching aim was to enrich, contextualise and elaborate on the experiences of claims workers within their unique work context, to facilitate insight and a deeper understanding of vicarious trauma in more administrative populations that have largely been overlooked in research.