Catastrophizing, pain and traumatic stress symptoms following burns: A prospective study.

BACKGROUND: Pain and posttraumatic stress disorder (PTSD) symptoms are significant problems in the aftermath of a burn injury and they often co-occur. Catastrophizing has been linked to both phenomena. The aim of this study was to investigate the underlying role of catastrophizing in PTSD symptoms and pain following burns. METHODS: This prospective study included 216 patients with burns. PTSD symptoms and pain were measured during hospitalization (T1) and 6 (T2) and 12 months (T3) postburn. The Impact of Event Scale-Revised (IES-R) indexed PTSD symptoms. Acute pain (T1) was the mean pain during the first two weeks of hospitalization measured using an 11-point graphic numeric rating scale. Chronic pain was indexed using the single item 'average' pain from the Brief Pain Inventory (BPI). Catastrophizing was measured at T1 and T2 using the Cognitive Emotion Regulation Questionnaire (CERQ). Data were analysed using structural equation modelling (SEM). RESULTS: The results showed that T2 catastrophizing mediated between acute and chronic PTSD symptoms, and T3 pain. Furthermore, the study revealed significant associations between catastrophizing, PTSD symptoms and pain at the respective measurements, and significant longitudinal associations between the constructs. CONCLUSION: A negative cognitive-affective response to a burn event, such as catastrophizing, mediated the relationship between acute and chronic PTSD symptoms and later chronic pain. Screening for catastrophizing and acute PTSD symptoms is recommended to identify persons at risk for chronic PTSD symptoms and pain. SIGNIFICANCE: The identification of individuals who have the tendency to catastrophize may assist in finding those at risk for development of both chronic PTSD symptoms and chronic pain. Individuals may benefit from early psychological therapy focussing on catastrophizing and acute PTSD symptoms that may ameliorate both chronic PTSD symptoms and pain.

Self-esteem treatment in anxiety: A randomized controlled crossover trial of Eye Movement Desensitization and Reprocessing (EMDR) versus Competitive Memory Training (COMET) in patients with anxiety disorders.

BACKGROUND AND PURPOSE: Little is known about treating low self-esteem in anxiety disorders. This study evaluated two treatments targeting different mechanisms: (1) Eye Movement Desensitization and Reprocessing (EMDR), which aims to desensitize negative memory representations that are proposed to maintain low self-esteem; and (2) Competitive Memory Training (COMET), which aims to activate positive representations for enhancing self-esteem. METHODS: A Randomized Controlled Trial (RCT) was used with a crossover design. Group 1 received six sessions EMDR first and then six sessions COMET; group 2 vice versa. Assessments were made at baseline (T0), end of first treatment (T1), and end of second treatment (T2). Main outcome was self-esteem. We included 47 patients and performed Linear Mixed Models. RESULTS: COMET showed more improvements in self-esteem than EMDR: effect-sizes 1.25 versus 0.46 post-treatment. Unexpectedly, when EMDR was given first, subsequent effects of COMET were significantly reduced in comparison to COMET as the first intervention. For EMDR, sequence made no difference. Reductions in anxiety and depression were mediated by better self-esteem. CONCLUSIONS: COMET was associated with significantly greater improvements in self-esteem than EMDR in patients with anxiety disorders. EMDR treatment reduced the effectiveness of subsequent COMET. Improved self-esteem mediated reductions in anxiety and depression symptoms.

[Relation between neuroticism and low educational level and the risk of post-traumatic stress disorder in women after miscarriage or stillbirth]. / Verband tussen neuroticisme en laag opleidingsniveau en de kans op posttraumatische stressstoornis bij vrouwen na een miskraam of doodgeboorte.

OBJECTIVE: To determine whether neuroticism and educational level are predictive variables for post-traumatic stress disorder (PTSD) in women following an unsuccessful pregnancy. DESIGN: Prospective. METHOD: In the period June-September 1999, via advertisements in national newspapers, pregnant women with a gestation period shorter than 12 weeks were asked to participate in a study into their perception of the pregnancy. After they had agreed to participate they were given the 'Eysenck personality questionnaire' (EPQ) for neuroticism and other questionnaires, including a scale to determine their highest attained level. Every other month during the pregnancy and one month after the expected date of birth the participants were given brief questionnaires about the pregnancy, in which they were also asked to report miscarriage or stillbirth if such had occurred. Participants in whom the pregnancy had in fact ended unsuccessfully were contacted by telephone and asked to participate in a follow-up study with the 'Post-traumatic symptom scale' (PSS), among others. RESULTS: Of the 1339 women studied, 126 (9%) experienced an unsuccessful pregnancy; 8 of these dropped out of the study (response rate: 94%); one had not indicated her educational level. The remaining 117 women filled out the PSS after about one month. The average age was 31 years (SD: 4). The average duration of gestation at the moment of loss was 12 weeks (SD: 6; range 5-40). The average EPQ-score was 7.3 (SD: 4.6) and the average PSS-score was 18.1 (SD: 9.1). On the basis of the DSM IV, 31 women (26%) fulfilled the criteria for PTSS and 86 women did not. The average PSS-score was 28.2 (SD: 7.0) for the group with PTSS and 14.7 (SD: 6.7) for the group without PTSS. Logistic regression analysis revealed that a later diagnosis of PTSS was significantly associated with a higher score for neuroticism (RR = 4.49; p = 0.004; 95% CI: 1.60-12.60), a lower educational level (RR = 0.65; p = 0.009; 95% CI: 0.48-0.90) and a longer duration of gestation (RR = 2.48; p = 0.001; 95% CI: 1.45-4.25). CONCLUSION: In patients with a high educational level and a low score for neuroticism the risk of developing PTSS was negligible, while with a low educational level and a high score for neuroticism the estimated risk was about 70%. Care and guidance should be concentrated primarily on this group.

The Skin Picking Impact Scale (SPIS): scale development and psychometric analyses.

The Skin Picking Impact Scale (SPIS) is a self-report instrument developed to assess the psychosocial consequences of repetitive skin picking. An initial 28-item scale was administered to 31 individuals with severe self-injurious skin picking and 78 individuals with non-self-injurious skin picking. Item difficulty levels and part-whole correlations resulted in a 10-item scale with good internal consistency. SPIS scores for those with self-injurious skin picking were significantly higher than for those with non-self-injurious skin picking. SPIS scores for those with self-injurious skin picking correlated with duration of daily picking, satisfaction during picking, and shame subsequent to picking, as well as Beck Depression Inventory and Beck Anxiety Inventory scores. Sensitivity and specificity analyses indicate that a scale cutoff score of 7 optimally discriminates individuals with self-injurious skin picking from those with non-self-injurious skin picking.

Emotion- and intrusion-based reasoning in Vietnam veterans with and without chronic posttraumatic stress disorder.

Patients suffering from anxiety disorders other than posttraumatic stress disorder (PTSD) interpret anxiety responses themselves as evidence that threat is impending: "if anxiety, then threat" (Arntz, Rauner, & van den Hout, 1995, Behaviour Research and Therapy, 33, 917-925). This "emotion-based reasoning" (ER) may render a disorder self-perpetuating. Analogous to ER, danger might also be inferred from the presence of intrusions: "intrusion-based reasoning" (IR). The aims of this study were to test whether ER and IR are involved in chronic PTSD. Vietnam combat veterans with or without PTSD or other anxiety disorders rated perceived danger of brief scenarios in which information about objective danger (danger vs safety) and response (anxiety/intrusions vs non-distressing emotion) was systematically varied. Two series were administered: ER-scenarios were non-specific for PTSD and IR-scenarios were specific for PTSD. Relative to control participants, PTSD patients engaged in both ER and IR: whereas veterans without PTSD inferred the danger of scenarios from objective stimulus information, veterans with PTSD also inferred danger from the presence of anxiety or intrusions. Further analyses showed that these effects were largely mediated by perceived uncontrollability.

The Skin Picking Scale: scale construction and psychometric analyses.

OBJECTIVE: This paper reports on the development of the Skin Picking Scale (SPS), a six-item paper-and-pencil measure for the assessment of skin picking. METHODS: 28 severe self-injurious and 77 non-self-injurious skin pickers initially completed an eight-item severity scale modeled after the Yale--Brown Obsessive--Compulsive Scale (Y-BOCS). RESULTS: Group comparisons and part--whole correlations for individual scale items resulted in a six-item scale with a total score range of 0--24. A Cronbach's alpha coefficient of.80 indicated moderate internal consistency for the scale. Construct validity was demonstrated by significant correlations between SPS total scale scores and self-reported average duration of skin picking episodes. Significant correlations were also reported between SPS total scale scores and both Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scores, as well as self-reported intensity of emotions during the picking process. Lastly, sensitivity and specificity analyses suggest that a SPS cut-off score of 7 differentiates severe self-injurious and non-self-injurious skin pickers. CONCLUSION: The SPS is a valid and reliable self-report scale for the assessment of severity in medical and psychiatric patients who endorse skin picking.

Posttraumatic stress disorder after pregnancy loss.

This prospective longitudinal study investigated the prevalence of posttraumatic stress disorder (PTSD) in response to pregnancy loss. About 1,370 women were recruited in the early stages of pregnancy and 113 of them had a subsequent pregnancy loss. One and four months after pregnancy loss, they were assessed for PTSD with the Posttraumatic Symptom Scale. Depression was also assessed. The majority had an early loss, i.e., within 20 weeks. At one month, the prevalence of PTSD was 25%, and the symptom-severity was similar to other traumatized populations. Women with PTSD had increased risk of depression: 34% of PTSD cases and 5% of non-cases reported depression. At four months, 7% met the criteria for PTSD, of which half were chronic. In contrast, rates for depression had not declined. The results indicate that pregnancy loss is potentially traumatic, putting women at risk of developing PTSD. In most cases, the disorder is immediate and persists for several months.

Does failure hurt? The effects of failure feedback on pain report, pain tolerance and pain avoidance.

In this study an experiment was conducted to examine whether failure experiences have an effect on pain report, pain tolerance and pain avoidance. Furthermore, it was investigated if negative affectivity (NA) affected the impact of failure feedback on pain report, either as a mediator, in the case of negative state affect, or as a moderator when NA as a personality trait was considered. Fifty-four healthy female volunteers were included and randomly assigned to one of three conditions: (1) failure feedback; (2) success feedback; (3) neutral control task. After the manipulation, subjects were given a cold pressor task in order to obtain pain measures. Regarding the effects of failure feedback on pain report, it was found that, in comparison with success feedback, failure feedback led to increased pain report. With regard to pain tolerance, pain was tolerated for longer when preceded by success feedback than when preceded by failure feedback. Differences between failure and control conditions did not reach significance. With regard to pain avoidance, no differences between the conditions were found. The hypothesized mediating role of negative state affect was not found. Though in the hypothesized direction, no significant effect was found for NA-trait moderating the influence of failure on pain. The discussion focuses on a number of research questions that remain to be answered, and the clinical relevance of the effects of failure and success experiences on pain report and pain tolerance.

Self-injurious skin picking: clinical characteristics and comorbidity.

BACKGROUND: Repetitive skin picking, a self-injurious behavior that may cause severe tissue damage, has received scant empirical attention. The authors examined the demographics, phenomenology, and associated psychopathology in a series of 31 subjects with this problem. METHOD: Subjects were administered the Structured Clinical Interview for DSM-IV for Axis I and Axis II disorders. They also completed several mood questionnaires and a new self-report inventory designed to assess phenomenology, triggers, cognitions, emotions, and consequences associated with skin picking. RESULTS: The mean age at onset on self-injurious skin picking was 15 years, and the mean duration of illness was 21 years. All subjects picked at more than one body area, and the most frequent sites of skin picking were pimples and scabs (87%). The most common comorbid Axis I diagnoses were obsessive-compulsive disorder (OCD; 52%), alcohol abuse/dependence (39%), and body dysmorphic disorder (32%). Forty-eight percent (N = 15) of the subjects met criteria for at least one mood disorder, and 65% (N = 20) for at least one anxiety disorder. The most common Axis II disorders were obsessive-compulsive personality disorder (48%) and borderline personality disorder (26%). CONCLUSION: Self-injurious skin picking is a severe and chronic psychiatric and dermatologic problem associated with high rates of psychiatric comorbidity. It may be conceptualized as a variant of OCD or impulse-control disorder with self-injurious features and may, in some cases, represent an attempt to regulate intense emotions.