The effect of psychological factors on pain outcomes: lessons learned for the next generation of research.

Big data and machine learning techniques offer opportunities to investigate the effects of psychological factors on pain outcomes. Nevertheless, these advances can only deliver when the quality of the data is high and the underpinning causal assumptions are considered. We argue that there is room for improvement and identify some challenges in the evidence base concerning the effect of psychological factors on the development and maintenance of chronic pain. As a starting point, 3 basic tenets of causality are taken: (1) cause and effect differ from each other, (2) the cause precedes the effect within reasonable time, and (3) alternative explanations are ruled out. Building on these tenets, potential problems and some lessons learned are provided that the next generation of research should take into account. In particular, there is a need to be more explicit and transparent about causal assumptions in research. This will lead to better research designs, more appropriate statistical analyses, and constructive discussions and productive tensions that improve our science.

Assessing Emotional Intelligence Abilities, Acquiescent and Extreme Responding in Situational Judgment Tests Using Principal Component Metrics.

Principal Component Metrics is a novel theoretically-based and data-driven methodology that enables the evaluation of the internal structure at item level of maximum emotional intelligence tests. This method disentangles interindividual differences in emotional ability from acquiescent and extreme responding. Principal Component Metrics are applied to existing (Mayer-Salovey-Caruso Emotional Intelligence Test) and assembled (specifically, the Situational Test of Emotion Understanding, the Situational Test of Emotion Management, and the Geneva Emotion Recognition Test) emotional intelligence test batteries in an analysis of three samples (total N = 2,303 participants). In undertaking these analyses important aspects of the nomological network of emotional intelligence, acquiescent, and extreme responding are investigated. The current study adds a central piece of empirical validity evidence to the emotional intelligence domain. In the three different samples, theoretically predicted internal structures at item level were found using raw item scores. The validity of the indicators for emotional intelligence, acquiescent, and extreme responding was confirmed by their relationships across emotional intelligence tests and by their nomological networks. The current findings contribute to evaluating the efficacy of the emotional intelligence construct as well as the validity evidence surrounding the instruments that are currently designed for its assessment, in the process opening new perspectives for analyzing existing and constructing new emotional intelligence tests.

When, why, and how do People Deviate from Physical Distancing Measures During the COVID-19 Pandemic: A Mixed-Methods Study.

INTRODUCTION: To limit the spread of COVID-19, many countries, including Belgium, have installed physical distancing measures. Yet, adherence to these newly installed behavioral measures has been described as challenging and effortful. Based on the Health Action Process Approach (HAPA) model, this study performed an in-depth evaluation of when, why, and how people deviated from the physical distancing measures. METHODS: An online mixed-method study was conducted among Belgian adults (N = 2055) in the beginning of May 2020. Participants were recruited via an open call through email and social media platforms, using snowball sampling. Conditions wherein people deviated from the physical distancing measures were assessed by means of an open-ended question. HAPA determinants were assessed in a quantitative way. RESULTS: Half of the sample reported to deviate from the measures. Further, deviation from the measures was associated with each determinant outlined by the HAPA. Findings highlight that many people deviated from the measures because of their need for social contact. The majority of the people who deviated from the measures stated that they carefully weighed the risks of their behavior. CONCLUSIONS: Need for social contact pushed people to deviate from physical distancing measures in a deliberate manner. Potential areas for future interventions aimed at promoting adherence to physical distancing measures and enhancing psychosocial well-being are discussed.

What do alexithymia items measure? A discriminant content validity study of the Toronto-alexithymia-scale-20.

BACKGROUND: Questions have been raised about whether items of alexithymia scales assess the construct alexithymia and its key features, and no other related constructs. This study assessed the (discriminant) content validity of the most widely used alexithymia scale, i.e., the Toronto Alexithymia Scale (TAS-20). METHODS: Participants (n = 81) rated to what extent TAS-20 items and items of related constructs were relevant for assessing the constructs 'alexithymia', 'difficulty identifying feelings', 'difficulty describing feelings', 'externally-oriented thinking', 'limited imaginal capacity', 'anxiety', 'depression', and 'health anxiety'. RESULTS: Results revealed that, overall, the TAS-20 did only partly measure 'alexithymia'. Only the subscales 'difficulty identifying feelings' and 'difficulty describing feelings' represented 'alexithymia' and their intended construct, although some content overlap between these subscales was found. In addition, some items assessed (health) anxiety equally well or even better. CONCLUSIONS: Revision of the TAS-20 is recommended to adequately assess all key features of alexithymia. Findings with the TAS-20 need to be interpreted with caution in people suffering from medical conditions.

Altered regulation of negative affect in patients with fibromyalgia: A diary study.

BACKGROUND: Fibromyalgia is characterized by widespread musculoskeletal pain and often accompanied by cognitive and emotional problems. Adaptation to fibromyalgia may therefore also rely on one's ability to regulate emotional problems. In this study, we examined two indices of emotion regulation, that is, (a) affective instability, involving frequent large fluctuations in self-reported affect, and (b) resting heart rate variability (HRV). METHODS: Participants were 46 patients with fibromyalgia (Mage  = 45.4 years; 39 females) and 46 matched healthy controls (Mage  = 44.9 years; 37 females). Heart rate was monitored under resting conditions to derive HRV. Subsequently, participants completed an electronic end-of-day diary for 14 consecutive days assessing daily levels of pain, disability, negative affect (NA) and positive affect (PA). Affective instability was operationalized as the mean square of successive differences in daily mood. RESULTS: Results indicate increased levels of NA instability and reduced levels of HRV in patients with fibromyalgia in comparison with healthy controls. Furthermore, HRV and NA instability were inversely related. Finally, in patients, higher NA instability was related to increased pain disability. CONCLUSIONS: Current findings support the idea that patients with fibromyalgia are confronted with fluctuating emotions. These results may have important implications for treatment as they provide support for the use of emotion regulation skills training in patients with fibromyalgia to impact upon NA instability. SIGNIFICANCE: This study provides novel insight in the link between emotion regulation indices,that is, heart-rate variability and negative affective (NA) instability, in patients with fibromyalgia, and presents evidence for differences in both emotion regulation indices between patients with fibromyalgia and healthy people. Furthermore, results link increased NA instability with increased levels of daily disability in patients with fibromyalgia. Together, these findings offer support for a key role of emotion regulation in fibromyalgia outcomes, providing pathways for clinical practice.

Adherence to the Physical Distancing Measures during the COVID-19 Pandemic: A HAPA-Based Perspective.

BACKGROUND: The COVID-19 pandemic requires massive and rapid behavior change. The Health Action Process Approach (HAPA) describes personal determinants that play a key role in behavior change. This study investigated whether these determinants are associated with adherence to physical distancing measures to prevent the spread of COVID-19 (i.e. keeping 1.5 m physical distance and staying at home). Decreased psychosocial well-being and lack of social support were explored as barriers to adherence. METHODS: Two cross-sectional surveys were conducted among adults in Belgium. The first survey (N = 2,379; March 2020) focused on adherence to physical distancing measures. The second survey (N = 805; April 2020) focused on difficulty with, and perseverance in, adhering to these measures. Linear regression models were fitted to examine associations with HAPA determinants, psychosocial well-being, and social support. RESULTS: Self-efficacy, outcome expectancies, intention, action planning, and coping planning were related to adhering to, difficulty with, and perseverance in, adhering to physical distancing measures. Decreased psychosocial well-being and lack of social support were related to more difficulties with adhering to physical distancing and lower perseverance. CONCLUSIONS: Health action process approach determinants are associated with adherence to physical distancing measures. Future work could design HAPA-based interventions to support people in adhering to these measures.

Let's talk about pain catastrophizing measures: an item content analysis.

BACKGROUND: Concerns have been raised about whether self-report measures of pain catastrophizing reflect the construct as defined in the cognitive-behavioral literature. We investigated the content of these self-report measures; that is, whether items assess the construct 'pain catastrophizing' and not other theoretical constructs (i.e., related constructs or pain outcomes) using the discriminant content validity method. METHOD: Items (n = 58) of six pain catastrophizing measures were complemented with items (n = 34) from questionnaires measuring pain-related worrying, vigilance, pain severity, distress, and disability. Via an online survey, 94 participants rated to what extent each item was relevant for assessing pain catastrophizing, defined as "to view or present pain or pain-related problems as considerably worse than they actually are" and other relevant constructs (pain-related worrying, vigilance, pain severity, distress, and disability). RESULTS: Data were analyzed using Bayesian hierarchical models. The results revealed that the items from pain-related worrying, vigilance, pain severity, distress, and disability questionnaires were distinctively related to their respective constructs. This was not observed for the items from the pain catastrophizing questionnaires. The content of the pain catastrophizing measures was equally well, or even better, captured by pain-related worrying or pain-related distress. CONCLUSION: Based upon current findings, a recommendation may be to develop a novel pain catastrophizing questionnaire. However, we argue that pain catastrophizing cannot be assessed by self-report questionnaires. Pain catastrophizing requires contextual information, and expert judgment, which cannot be provided by self-report questionnaires. We argue for a person-centered approach, and propose to rename 'pain catastrophizing' measures in line with what is better measured: 'pain-related worrying'.

Multidimensional screening for predicting pain problems in adults: a systematic review of screening tools and validation studies.

Screening tools allowing to predict poor pain outcomes are widely used. Often these screening tools contain psychosocial risk factors. This review (1) identifies multidimensional screening tools that include psychosocial risk factors for the development or maintenance of pain, pain-related distress, and pain-related disability across pain problems in adults, (2) evaluates the quality of the validation studies using Prediction model Risk Of Bias ASsessment Tool (PROBAST), and (3) synthesizes methodological concerns. We identified 32 articles, across 42 study samples, validating 7 screening tools. All tools were developed in the context of musculoskeletal pain, most often back pain, and aimed to predict the maintenance of pain or pain-related disability, not pain-related distress. Although more recent studies design, conduct, analyze, and report according to best practices in prognosis research, risk of bias was most often moderate. Common methodological concerns were identified, related to participant selection (eg, mixed populations), predictors (eg, predictors were administered differently to predictors in the development study), outcomes (eg, overlap between predictors and outcomes), sample size and participant flow (eg, unknown or inappropriate handling of missing data), and analysis (eg, wide variety of performance measures). Recommendations for future research are provided.

A componential emotion approach for the assessment of emotional awareness in youth.

The Levels of Emotional Awareness Scale for Children (LEAS-C) is a performance-based instrument that assesses emotional awareness in the structure of written responses to a set of real-life scenarios. While it is theoretically expected that emotional awareness develops with age, virtually no age differences have been established with the LEAS-C. The present study investigated whether an adaptation of the instructions and scoring procedure on the basis of the componential emotion approach could improve the validity of the LEAS-C and reveal the theoretically expected age differences. An adapted LEAS-C was administered to a sample of 574 children and adolescents and scored with the original and a new componential scoring procedure. An acceptable reliability for the original and a good reliability and a high interrater reliability for the componential scoring procedure were observed. Multigroup confirmatory factor analyses showed measurement invariance of factor loadings and intercepts across children (8 to 12 years) and adolescents (13 to 16 years) for all tested models, for both scoring procedures. A one-factor model fitted well for the total scores and self and other scores for both scoring procedures. The pattern of relationships with alexithymia, emotional intelligence, intelligence, personality, and social and emotional impairment as well as gender differences were comparable with prior research. Furthermore, the expected relationship with age was found, with stronger correlations for the componential than the original scoring procedure. In conclusion, analyses of the reliability, internal structure, and nomological network supported the adaptations of the LEAS-C on the basis of the componential emotion approach. (PsycINFO Database Record

Revisiting the dimensional structure of the emotion domain.

Recent research has claimed that a novelty dimension is needed to represent the cognitive emotion structure over and above valence, power and arousal. Novelty emerged when student samples evaluated the meaning of 24 emotion terms on 142 emotion features. This claim is debatable, however, because to date novelty has never been found in similarity sorting studies. It is possible that novelty emerged because sophisticated student samples evaluated emotion terms on emotion features. The current research identified a large, representative set of emotion terms using a free-listing task in a middle childhood up to early adulthood sample (N = 5071). Children, adolescents, students and adults (N = 1184) then evaluated the similarity between these emotion terms using a similarity rating task without priming any emotion feature. Novelty robustly emerged as the fourth dimension. The existence of novelty is thus confirmed with a different method across a wide variety of participants.