Adult attachment insecurity is positively associated with medically unexplained chronic pain.

BACKGROUND: Attachment insecurity (i.e. anxiety in relationships and/or discomfort in close relationships) is associated with self-reports of physical symptoms, medically unexplained symptoms and health conditions involving pain. Medically unexplained chronic pain (MUCP) may represent a particularly severe form of symptom reporting that is also characteristic of individuals with insecure attachment. This study investigated relationships between adult attachment style ratings and past-year MUCP in a sample of the general U.S. population and the ability of attachment style ratings to account for variance in past-year MUCP beyond that accounted for by potential confounders. METHOD: Data from the National Comorbidity Survey Replication (N = 5645) were used. Attachment was assessed with an interview-administered version of a commonly used self-report measure of secure, anxious and avoidant attachment. MUCP was assessed with a brief interview. Depressive and anxiety disorders were included as covariates and were assessed with a fully structured interview based on DSM-IV criteria. RESULTS: The past-year prevalence of MUCP was 2.45% (95% CI = 2.07-2.83). The two insecure attachment styles (i.e. anxious and avoidant) were positively associated with MUCP. These associations remained statistically significant after adjusting for demographic variables and depressive and anxiety disorders. When the two insecure attachment styles were considered together, only avoidant attachment remained significantly associated with MUCP. CONCLUSION: Attachment insecurity ratings were positively associated with past-year MUCP and remained so after statistically adjusting for depressive and anxiety disorders. Further research aimed at understanding the mechanism(s) responsible for the association between attachment insecurity and MUCP is warranted. SIGNIFICANCE: Consistent with earlier research regarding transient physical symptoms, medically unexplained chronic pain was associated with attachment insecurity. Understanding the mechanisms responsible for this association could guide treatment innovations.

Development and evaluation of short forms of the Pain Catastrophizing Scale and the Pain Self-efficacy Questionnaire.

BACKGROUND: To facilitate efficient screening and reduce the length of comprehensive self-report batteries, a four-item short form of the Pain Catastrophizing Scale (PCS) and a two-item short form of the Pain Self-Efficacy Questionnaire (PSEQ) have been developed and evaluated in samples of patients with arm and upper extremity pain. AIMS: The first aim of this study was to evaluate these short forms in a heterogeneous sample of patients seeking treatment for chronic musculoskeletal pain, using a priori criteria for determining adequate internal consistency, construct validity and sensitivity to change. In addition, the findings of past studies were used to identify items suitable for new and potentially stronger short forms of these measures. METHOD: Data were provided by 280 patients who completed the original PCS and PSEQ as part of an interdisciplinary rehabilitation programme. RESULTS: The previously developed four-item PCS and the newly developed six-item short form of the PCS both met the internal consistency and construct validity criteria. They did not meet the criterion regarding sensitivity to change. However, similar to what was obtained using the original PCS, large effect sizes were found when using these short forms to examine pre-treatment to post-treatment changes in catastrophizing. For the PSEQ, the new four-item short form was clearly superior to the other alternatives and met all three criteria. CONCLUSION: The strongest short forms of the PCS and PSEQ could facilitate the assessment of pain catastrophizing and self-efficacy in situations in which the use of the longer original measures is not feasible.

Development and psychometric evaluation of a new measure of pain-related support preferences: the Pain Response Preference Questionnaire.

BACKGROUND: Behavioural conceptualizations of chronic pain posit that solicitous responses to pain behaviours are positively reinforcing and play a role in the development of chronic pain and disability. Recent research suggests that studies investigating this model were likely limited by the use of only a few narrowly defined categories of responses to pain behaviour. A measure of preferences regarding pain-related social support has the potential to improve behavioural models of chronic pain by identifying other potentially reinforcing responses to pain behaviour. OBJECTIVE: The Pain Response Preference Questionnaire (PRPQ) was created to assess preferences regarding pain-related social support. The purpose of the present study was to empirically develop PRPQ scales and examine their psychometric properties. METHODS: A large university student sample (n=487) free of chronic pain completed the 39-item PRPQ. Factor analysis was applied to the data from the present sample to empirically develop PRPQ scales. Using a second student sample (n=87), relationships between the PRPQ scales and theoretically related measures were examined to evaluate the construct validity of the scales. Factor analysis supported four factors that reflected preferences for emotional and instrumental support, assistance in managing pain and emotions, having one's pain ignored, and being encouraged to persist with one's activities. Based on this analysis, scales labelled solicitude, management, suppression and encouragement were created. Correlation analyses supported the construct validity of these scales. CONCLUSIONS: The PRPQ is a psychometrically sound measure of preferences of pain-related social support. Research with clinical samples is needed to further evaluate its psychometric properties and clinical utility.

Is there a negative association between anxiety sensitivity and arousal-increasing substances and activities?

Little research has addressed McNally's hypothesis [(1996). Anxiety sensitivity is distinguishable from trait anxiety. In: R. M. Rapee (Ed.), Current controversies in the anxiety disorders (pp. 214-227). New York: The Guilford Press.] that anxiety sensitivity (AS) should be negatively associated with the use of arousal-increasing substances. In the present study, we examined the relationship between AS and the self-reported use of two widely available stimulants--nicotine and caffeine--and exercise frequency in a sample of 256 university students. A measure of trait anxiety was also incorporated within the design. The associations between use of both substances and levels of AS and trait anxiety were weak and nonsignificant. Although inconsistent with McNally's hypothesis, some significant findings were found when the lower-order components of AS (i.e., fears of physical, psychological, and publicly observable symptoms of anxiety) were examined. The associations between exercise frequency and the anxiety measures, indicating a negative relationship, were generally consistent with McNally's hypothesis. Implications of these findings are discussed with reference to future investigation.

A comparison of symptom checklist 90-revised profiles from patients with chronic pain from whiplash and patients with other musculoskeletal injuries.

STUDY DESIGN: A quasi-experimental design was used to compare the Symptom Checklist 90-Revised profiles (SCL-90-R) from a group of patients with whiplash injuries (n = 67) and a group with mixed musculoskeletal pain (n = 91). OBJECTIVES: To test the discriminant validity of the characteristic SCL-90-R whiplash profile as proposed by Wallis and Bogduk using a multivariate statistical technique. SUMMARY OF BACKGROUND DATA: On the basis of two studies by themselves and their colleagues, Wallis and Bogduk proposed a characteristic SCL-90-R profile evident in samples of patients with whiplash injuries. Their assertion has not been tested empirically in any published studies. METHODS: The participants in this study consisted of 158 patients at a rehabilitation hospital who completed the SCL-90-R under standard instructions and subsequently were diagnosed by a team comprising a chiropractor, physical therapist, and physician. The participants were categorized as having whiplash-associated disorders or pain caused by other musculoskeletal injuries. A profile analysis following Hotelling's method was used to determine the comparability of SCL-90-R profiles from the two groups. RESULTS: The profile analysis showed no statistically significant differences between the groups with regard to either the shape or the overall elevation of their psychological profiles. The SCL-90-R profiles from both groups were similar to those reported from other chronic pain syndromes, with elevations on the Somatization, Depression, Obsessive-Compulsive, and Psychoticism scales. CONCLUSIONS: The current study failed to support the validity of a distinctive SCL-90-R profile for patients with whiplash injuries. Instead, the results suggest that the psychological consequences of experiencing chronic pain from whiplash-associated disorders are similar to the psychological consequences of chronic pain from other musculoskeletal injuries.

Parental problem drinking and anxiety disorder symptoms in adult offspring: examining the mediating role of anxiety sensitivity components.

Preliminary studies have implicated childhood exposure to parental problem drinking as a possible factor in the development of anxiety sensitivity (AS). The present retrospective study was designed to examine the role of exposure to distressing parental problem drinking behaviors, over and above the role of parental alcoholism, in the development of various AS components (psychological, physical, and social concerns) in the offspring. We also examined the possible mediating role of AS components in explaining relations between parental drinking problems and anxiety-related symptoms in the adult offspring. A sample of 213 university students provided retrospective reports of both distress related to parental drinking [Children of Alcoholics Screening Test (CAST)] and parental alcoholism [maternal and paternal forms of the Short Michigan Alcoholism Screening Test (SMAST)]. Participants also reported on their own current AS levels [AS Index (ASI)], general anxiety symptoms [State-Trait Anxiety Inventory-Trait subscale (STAI-T)], and lifetime history of uncued panic attacks [Panic Attack Questionnaire-Revised (PAQ-R)]. Scores on the CAST predicted AS psychological and physical concerns (but not social concerns) over and above participant gender and parental alcoholism measured by the SMASTs. Moreover, AS psychological concerns proved a consistent modest mediator of the relations between parental problem drinking on the CAST and both general anxiety and uncued panic outcomes in the offspring. Thus, exposure to distressing parental problem drinking behavior may be one factor that contributes to elevated AS psychological concerns in the child, which in turn may contribute to the development of anxiety disorder symptoms in the offspring.

Does the social concerns component of the anxiety sensitivity index belong to the domain of anxiety sensitivity or the domain of negative evaluation sensitivity?

The present study utilized an exploratory factor-analytic approach (i.e. principal-components analysis; PCA) to investigate whether the Social Concerns component of the Anxiety Sensitivity Index (ASI [Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index manual (2nd ed.). Worthington, OH: International Diagnostic Systems.]) is best conceptualized as belonging to the domain of anxiety sensitivity (AS) and/or the domain of negative evaluation sensitivity (NES). A sample of university students (N = 216) was administered measures of both NES (i.e. Brief Fear of Negative Evaluation scale; Leary, 1983) and AS (i.e. ASI). Participants' responses to the items comprising these measures were subjected to a PCA with oblique rotation. Factors representing the NES construct and the three lower-order AS constructs (i.e. AS Physical, Psychological and Social Concerns) were obtained. Subscales derived from these four factors were positively and significantly correlated with one another and loaded on a single higher-order factor labeled Threat Sensitivity. Thus, the present findings suggest that the AS Social Concerns factor is distinct from NES and the other lower-order components of AS. However, correlational analyses and higher-order PCA indicated that the AS Social Concerns factor taps a blend of AS and NES as well as something unique and distinct from both global AS and NES.

Impact of adult attachment styles on pain and disability associated with arthritis in a nationally representative sample.

OBJECTIVE: The objective of this study was to evaluate Mikail et al.'s hypothesis that adult attachment styles are associated with important pain-related variables such as pain and disability levels. DESIGN: A cross-sectional design was used to examine the relation between measures of adult attachment styles and both pain and disability. SETTING: The data used were obtained from the National Comorbidity Survey, a large and nationally representative sample of community-dwelling individuals aged 15 to 54 years. In the present study, individuals (n = 381) in the National Comorbidity Survey with arthritis or related conditions were included. OUTCOME MEASURES: Ratings regarding three adult attachment styles (secure, anxious, and avoidant) were obtained by administering Hazan and Shaver's attachment self-report in an interview format. Pain and disability were assessed in a similar manner using four-point rating scales. RESULTS: Ratings of insecure attachment were positively and significantly correlated with both pain and disability. A multiple regression analysis revealed that pain severity and the rating of anxious attachment could account for 20.3% of the variance in disability. CONCLUSIONS: The attachment theory holds promise for understanding reactions to pain conditions, and Mikail et al.'s model warrants further investigation.

Alcohol consumption in university women: a second look at the role of anxiety sensitivity.

The study reexamined the relationship between anxiety sensitivity (AS) and drinking behavior in a sample of university women (N = 197) taking into account recent theoretical considerations regarding the possible hierarchical nature of the AS construct. To assess the incremental validity of this construct, the amount of variance in drinking behavior accounted for by measures of AS and trait anxiety was investigated with several multiple regression analyses. Contrary to expectations, measures of both constructs failed to account for significant variance in drinking behavior. McNally's [1996: Rapee RM, editor. Current Controversies in anxiety disorders. p 214-244] hypothesis regarding a trait anxiety by AS interaction received weak support as the combination of these two variables accounted for a small (i.e., 1.6%) portion of variance in one drinking variable (viz., monthly intoxication). Correlational analyses revealed only two small and marginally significant associations between the lower-order components of AS (i.e., fears of physical, cognitive, and publicly observable symptoms of anxiety) and the drinking measures. Potential reasons for the failure to replicate or extend Stewart et al.'s [1995: J Anxiety Disord 9:283-392] findings of significant positive associations between AS and both weekly alcohol consumption and excessive drinking are discussed.