Thesis (Ph. D.)--University of Virginia, 1998. / Includes bibliographical references (p. 122-133). Also available online through Digital Dissertations.

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Objectives: This thesis aims to explore evidence for the effectiveness of cognitive behavioural therapy (CBT) for non-cardiac chest pain (NCCP). Design: The systematic review aimed to evaluate evidence for CBT as an effective intervention for anxiety in the NCCP population. Study one describes the chest pain characteristics, illness beliefs and prevalence of anxiety in a NCCP sample in a cross-sectional design. Study two explores the acceptability and clinical effectiveness of a CBT-based self-help intervention for NCCP patients, using a between subjects, repeated measures design. Methods: A systematic review was completed via a comprehensive literature search for comparative studies examining CBT-based interventions for NCCP including a measure of anxiety. In the empirical study, participants completed measures of anxiety, illness beliefs and indices of chest pain (self-reported frequency, severity and impact on activities) at baseline. Comparisons between illness beliefs and anxiety were undertaken using descriptive statistics and Pearson correlations. Participants were randomised to receive a CBT-based self-help intervention booklet or treatment as usual, with questionnaires re-administered at three-month follow-up. ANOVAs were used to evaluate whether the intervention led to improvements in anxiety levels, or increased belief in participants’ personal control of symptoms. Results: Ten studies met inclusion criteria for the systematic review, with four studies showing evidence regarding the effectiveness of CBT for anxiety. Approximately two thirds of the thesis research sample reported on-going pain following clinic attendance, for the majority this was ‘very mild’ or ‘mild’ pain. Almost half (47%) reported experiencing clinically significant anxiety. Stress was the most common causal attribution advocated by the sample to explain their chest pain. Anxiety scores were significantly associated with psychological attribution scores, but not with personal control or illness coherence beliefs. In study two, 87 participants completed the study and ITT analyses were completed on 119. There were no significant differences between the groups in terms of reduced anxiety or self-reported belief in personal control of symptoms. The intervention booklet was evaluated largely positively by those who reported reading it. Conclusions: CBT-based self-help appears an acceptable intervention for those diagnosed with NCCP. Further research is needed to identify those who are most likely to benefit from such self-help intervention.

The present investigation sought to explore the efficacy of stress inoculation in the management of pain with severely burned adults. Subjects were 16 adult burn patients randomly assigned to either the stress-inoculation or no-treatment comparison group. The focus of the analysis was the amount of change or improvement from pretreatment to posttreatment periods. The stress-inoculation group showed significant improvement on all nine dependent measures, while the no-treatment group improved significantly on only two (physical and emotional self-ratings). The overall comparison of the amount of change between groups revealed that the stress-inoculation group showed significantly greater improvement in pain management than the no-treatment group during this time. It was concluded that stress inoculation, as a flexible treatment package, was efficacious in the management of pain experience of burn patients.

This thesis focuses on the psychological factors that play a role in the development and maintenance of chronic postsurgical pain in patients after cardiac surgery. The literature review deals with the mechanisms of chronic postsurgical pain, its risk factors, the process of the transformartion of acute pain into chronic pain, and the psychological management of chronic pain after surgery, specifically in the field of cardiosurgery. The thesis focuses in particular on patient-related factors in terms of anxiety or depression before or after the surgery, coping strategies, fear of pain, attachment styles, and how are these factors involved in the development nad maintenance of chronic pain. The empirical part consists of a research of quantitative design conducted at the Department of Cardiac Surgery of the 3rd Faculty of Medicine and FN KV in Prague, which monitors the development of pain in patients after cardiac surgery at the time of discharge, 3 months after the surgery and after 1 year after the surgery, and focuses on the assessment of preoperative and postoperative patient-related factors that contribute to the development and maintenance of chronic pain. The main aim of the research is to identify these psychological factors.

Made available in DSpace on 2014-12-17T15:36:42Z (GMT). No. of bitstreams: 1 RodrigoPAF_TESE.pdf: 1146990 bytes, checksum: e87dcca3a2082ed00e0523d76a6a9042 (MD5) Previous issue date: 2013-09-20 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Fibromyalgia (FM) is a non-inflammatory rheumatic syndrome of unknown etiology, with symptoms of diffuse musculoskeletal pain and presence of specific anatomic sites called tender points. The symptoms are often associated with fatigue, sleep disturbances, morning stiffness, alterations in pain perception, anxiety and depression. Fibromyalgia exhibits a correlation between physical and behavioral symptoms, which have a negative influence on the quality of life of patients. Emotional skills are important factors since they are related to subjective well-being, personal productivity, social interaction and interpersonal relationships. We aim to describe the physical and psychosocial interactions in women with FM, showing the association between perceived social support and affect with symptoms of pain, functionality and mood. We will also describe a body representation of pain in women with FM. Data were collected over 3 years and the sample size ranged between studies. This is an exploratory cross-sectional study conducted with a convenience sample of 63 women with FM and 42 healthy women as a control group (CT), aged 20-76 years, recruited through spontaneous demand at Onofre Lopes University Hospital (HUOL) and the Clinical School of Physiotherapy of Universidade Potiguar (UNP). The Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), Social Support Scale (MOS), Hamilton Anxiety Scale and Scale of Positive and Negative Affect Schedule (PANAS), in addition to pressure algometry were used. For data analysis, we used parametric and non-parametric tests and a general linear model with adjustment variables and analysis of variance. A significant difference was found between pain threshold and tolerance, functionality, depression, anxiety, social support, and positive and negative affect between the groups. Affective states and social support were associated with anxiety, depression and functionality. A body was drawn representing pain with higher incidences in trapeze, supraspinatus and second ribs. The reason for studying sensory aspects, affective behavior and social support in FM patients opens perspectives for scientific and clinical research of this syndrome. Women with chronic pain such as FM appear to have altered mood states, less social support and affective dysfunctions, influencing the other symptoms of the syndrome / A fibromialgia (FM) ? uma s?ndrome reum?tica n?o inflamat?ria, de etiologia desconhecida, apresentando sintomas de dor musculoesquel?tica difusa e presen?a de s?tios anat?micos espec?ficos dolorosos ? palpa??o, denominados tender points. Dentre os sintomas frequentemente associados est?o a fadiga, dist?rbios do sono, rigidez matinal, altera??es na percep??o da dor, ansiedade e depress?o. Existe na FM uma correla??o entre os sintomas f?sicos e comportamentais que influenciam negativamente na qualidade de vida dos pacientes. As habilidades emocionais aparecem como fatores importantes por estarem relacionadas com o mecanismo de bem estar subjetivo pessoal, produtividade, intera??o social e de relacionamento interpessoal. Objetivou-se descrever as intera??es f?sicas e psicossociais em mulheres com FM apresentando poss?veis associa??es entre a percep??o de apoio social e afetividade com os sintomas de dor, funcionalidade e estado de humor. Objetivo-se tamb?m, descrever um tipo de representa??o corporal da dor em mulheres com FM. Os dados foram coletados ao longo de 3 anos e o n?mero amostral variou entre os estudos. A partir de um estudo explorat?rio descritivo transversal, foi composta uma amostra por conveni?ncia de 63 mulheres com FM e 42 mulheres saud?veis como grupo controle (CT), com faixa et?ria de 20 a 76 anos, recrutadas mediante demanda espont?nea no setor de Fisioterapia do Hospital Universit?rio Onofre Lopes (HUOL) e na Cl?nica Escola de Fisioterapia da Universidade Potiguar (UNP). Foi aplicado o Question?rio de Impacto da Fibromialgia (FIQ), Invent?rio de Depress?o de Beck (IDB), Escala de Apoio Social (MOS), Escala de Ansiedade de Hamilton e Escala de Afeto Positivo e Negativo (PANAS). A seguir foi realizada a avalia??o da dor atrav?s da algometria de press?o. Para a an?lise dos dados, foram utilizados testes param?tricos e n?o param?tricos e de an?lise de vari?ncia. Foi encontrada diferen?a significativa quanto ao limiar e toler?ncia ? dor, funcionalidade, depress?o, ansiedade, apoio social e afetividade positiva e negativa. Os estados afetivos e o apoio social apresentaram associa??o com ansiedade, depress?o e funcionalidade. Foi elaborada uma representa??o corporal da dor que apresentou maiores incid?ncias em trap?zio, supraespinhal e segunda costela. A raz?o de se estudar a FM integrando os aspectos sensoriais, afetivo-comportamentais e sociais amplia os horizontes para investiga??o cient?fica e cl?nica dessa s?ndrome. Mulheres com FM apresentam estados de humor alterados, menor apoio social e express?o disfun??es de afetividade que influenciam os demais sintomas da s?ndrome