This study examined the relationship between personality traits, cognitive factors, and functional impairment in fibromyalgia patients. 74 fibromyalgia patients completed questionnaires measuring the big five personality traits, pain catastrophizing, pain anxiety, pain vigilance, and functional impairment. Results showed that neuroticism and conscientiousness predicted pain catastrophizing, and neuroticism, openness, and agreeableness predicted pain anxiety. Neuroticism had an indirect effect on pain anxiety through pain catastrophizing. Neuroticism also showed a trend toward moderating the relationship between impairment and pain anxiety. The findings support the fear-avoidance model of pain and provide insight into how personality relates to cognitive and emotional dimensions of pain in fibromyalgia.
This document discusses a study that analyzed accounts from parents caring for individuals with severe myalgic encephalomyelitis (ME) using interpretative phenomenological analysis. The study identified several themes in the parents' experiences, including identity change as parents take on caregiving roles, feelings of guilt, feeling like outsiders who are misunderstood, uncertainty regarding the illness, changing perceptions of time, coping mechanisms, and efforts to manage symptoms and potential improvements. The aims of the study were to give voice to caregivers of ME patients who are often stigmatized and to inform future research supporting these caregivers.
This study compared personality traits in women with fibromyalgia, rheumatoid arthritis, spondyloarthritis, or Sjögren's syndrome using the Big Five Inventory. The researchers found that patients with fibromyalgia scored higher on agreeableness, neuroticism, and openness compared to those with other rheumatic diseases. Specifically, fibromyalgia patients tended to be more compassionate and sympathetic (agreeable), more prone to psychological stress (neurotic), and more open to new ideas and experiences. This highlights some ways personality may differ in fibromyalgia compared to other conditions.
This document summarizes the rationale for the new diagnosis of somatic symptom disorder (SSD) in the DSM-5. The authors explain that SSD represents a consolidation of several previously separate diagnoses from the DSM-IV. It aims to address numerous issues with the previous somatoform disorder categories, such as unclear terminology, overreliance on the concept of "medically unexplained symptoms," overlapping criteria between diagnoses, and low reliability and prevalence rates in clinical practice. The new SSD criteria emphasize persistent somatic symptoms along with disproportionate thoughts, feelings and behaviors related to the symptoms, rather than focusing only on a lack of medical explanation for symptoms.
This study evaluated the discriminant validity of classifying low back pain patients into nociceptive (NP), peripheral neuropathic (PNP), and central sensitization (CSP) pain groups based on mechanisms-based classifications. 464 low back pain patients were classified into these groups and completed questionnaires on pain severity, quality of life, disability, anxiety, and depression. A multivariate analysis found significant differences between groups on the combined measures, with CSP patients reporting more severe and widespread pain and greater impairment/distress than PNP and NP patients. This provides initial evidence that mechanisms-based classifications reflect meaningful differences in patients' multidimensional pain experiences.
Spirituality And Resilience In Trauma VictimsMasa Nakata
1) Spirituality and religious beliefs can help trauma victims build narratives to integrate traumatic experiences and decrease post-traumatic symptoms. Religious frameworks may influence how people interpret and cope with trauma.
2) Positive religious coping is associated with better mental health outcomes for trauma survivors, while negative religious coping is linked to worse outcomes. Religious coping may help reduce feelings of loss of control and helplessness after trauma.
3) Religious beliefs provide a sense of meaning, purpose, and hope that can foster resilience in trauma survivors. Spirituality may be an important but underutilized part of treating conditions like post-traumatic stress disorder.
This study examined the relationships between psychological traits, psychiatric traits, and types of impulsivity. 84 participants completed surveys measuring the Big Five personality traits, personality disorders, and functional and dysfunctional impulsivity. Results showed functional impulsivity was related to aspects of Extraversion and Openness, while dysfunctional impulsivity correlated with Neuroticism and reports of various personality disorders. Aspects of Neuroticism and low Conscientiousness positively correlated with personality disorders, while Extraversion and Openness showed negative correlations. This provides insight into links between normal personality variation and maladaptive traits.
Towards a Critical Health Equity Research Stance: Why Epistemology and Method...Jim Bloyd, DrPH, MPH
Qualitative methods are not intrinsically progressive. Methods are simply tools to conduct research. Epistemology, the justification of knowledge, shapes methodology and methods, and thus is a vital starting point for a critical health equity research stance, regardless of whether the methods are qualitative, quantitative, or mixed. In line with this premise, I address four themes in this commentary. First, I criticize the ubiquitous and uncritical use of the term health disparities in U.S. public health. Next, I advocate for the increased use of qualitative methodologies—namely, photovoice and critical ethnography— that, pursuant to critical approaches, prioritize dismantling social–structural inequities as a prerequisite to health equity. Thereafter, I discuss epistemological stance and its influence on all aspects of the research process. Finally, I highlight my critical discourse analysis HIV prevention research based on individual interviews and focus groups with Black men, as an example of a critical health equity research approach.
This document discusses a study that analyzed accounts from parents caring for individuals with severe myalgic encephalomyelitis (ME) using interpretative phenomenological analysis. The study identified several themes in the parents' experiences, including identity change as parents take on caregiving roles, feelings of guilt, feeling like outsiders who are misunderstood, uncertainty regarding the illness, changing perceptions of time, coping mechanisms, and efforts to manage symptoms and potential improvements. The aims of the study were to give voice to caregivers of ME patients who are often stigmatized and to inform future research supporting these caregivers.
This study compared personality traits in women with fibromyalgia, rheumatoid arthritis, spondyloarthritis, or Sjögren's syndrome using the Big Five Inventory. The researchers found that patients with fibromyalgia scored higher on agreeableness, neuroticism, and openness compared to those with other rheumatic diseases. Specifically, fibromyalgia patients tended to be more compassionate and sympathetic (agreeable), more prone to psychological stress (neurotic), and more open to new ideas and experiences. This highlights some ways personality may differ in fibromyalgia compared to other conditions.
This document summarizes the rationale for the new diagnosis of somatic symptom disorder (SSD) in the DSM-5. The authors explain that SSD represents a consolidation of several previously separate diagnoses from the DSM-IV. It aims to address numerous issues with the previous somatoform disorder categories, such as unclear terminology, overreliance on the concept of "medically unexplained symptoms," overlapping criteria between diagnoses, and low reliability and prevalence rates in clinical practice. The new SSD criteria emphasize persistent somatic symptoms along with disproportionate thoughts, feelings and behaviors related to the symptoms, rather than focusing only on a lack of medical explanation for symptoms.
This study evaluated the discriminant validity of classifying low back pain patients into nociceptive (NP), peripheral neuropathic (PNP), and central sensitization (CSP) pain groups based on mechanisms-based classifications. 464 low back pain patients were classified into these groups and completed questionnaires on pain severity, quality of life, disability, anxiety, and depression. A multivariate analysis found significant differences between groups on the combined measures, with CSP patients reporting more severe and widespread pain and greater impairment/distress than PNP and NP patients. This provides initial evidence that mechanisms-based classifications reflect meaningful differences in patients' multidimensional pain experiences.
Spirituality And Resilience In Trauma VictimsMasa Nakata
1) Spirituality and religious beliefs can help trauma victims build narratives to integrate traumatic experiences and decrease post-traumatic symptoms. Religious frameworks may influence how people interpret and cope with trauma.
2) Positive religious coping is associated with better mental health outcomes for trauma survivors, while negative religious coping is linked to worse outcomes. Religious coping may help reduce feelings of loss of control and helplessness after trauma.
3) Religious beliefs provide a sense of meaning, purpose, and hope that can foster resilience in trauma survivors. Spirituality may be an important but underutilized part of treating conditions like post-traumatic stress disorder.
This study examined the relationships between psychological traits, psychiatric traits, and types of impulsivity. 84 participants completed surveys measuring the Big Five personality traits, personality disorders, and functional and dysfunctional impulsivity. Results showed functional impulsivity was related to aspects of Extraversion and Openness, while dysfunctional impulsivity correlated with Neuroticism and reports of various personality disorders. Aspects of Neuroticism and low Conscientiousness positively correlated with personality disorders, while Extraversion and Openness showed negative correlations. This provides insight into links between normal personality variation and maladaptive traits.
Towards a Critical Health Equity Research Stance: Why Epistemology and Method...Jim Bloyd, DrPH, MPH
Qualitative methods are not intrinsically progressive. Methods are simply tools to conduct research. Epistemology, the justification of knowledge, shapes methodology and methods, and thus is a vital starting point for a critical health equity research stance, regardless of whether the methods are qualitative, quantitative, or mixed. In line with this premise, I address four themes in this commentary. First, I criticize the ubiquitous and uncritical use of the term health disparities in U.S. public health. Next, I advocate for the increased use of qualitative methodologies—namely, photovoice and critical ethnography— that, pursuant to critical approaches, prioritize dismantling social–structural inequities as a prerequisite to health equity. Thereafter, I discuss epistemological stance and its influence on all aspects of the research process. Finally, I highlight my critical discourse analysis HIV prevention research based on individual interviews and focus groups with Black men, as an example of a critical health equity research approach.
How the brain heals emotional wounds the functional neuroanatomy of forgivene...Elsa von Licy
This study used fMRI to examine the brain regions involved in forgiveness. Participants imagined hurtful social scenarios and were instructed to either forgive or harbor a grudge towards the imagined offender. Forgiveness was associated with greater subjective relief and activation in brain regions involved in theory of mind, empathy, and cognitive regulation of emotion, including the precuneus, right inferior parietal lobe, and dorsolateral prefrontal cortex. The results suggest these regions support reappraisal-driven forgiveness by helping to inhibit aggressive reactions and restore emotional balance following an interpersonal offense.
Explanation of how do individuals with multiple sclerosis cope with social is...Liberty University (LU)
Background: Multiple sclerosis (MS) is a progressive neurological disease that can severely affect the psychosocial aspects of primary caregivers of individuals with MS (PCIMS). Objective: This study aimed to explore the process of social isolation among PCIMS in Kerman, Iran. Methods: This study was performed with grounded theory approach through a semi-structured interview with PCIMS (n=15), individuals with MS (n=13), and healthcare providers (n=5) who were selected through purposive and theoretical sampling in Kerman, Iran, during February 2017-April 2018. The data were analyzed through constant comparison method recommended by Corbin and Strauss. Results: Yield of this study was a theory in which "social isolation" was recognized as a core variable. "Lack of awareness and information", "Occupational Difficulties”, " Marital Difficulties, and " Endeavor to Reduce Restrictions" were the other extracted concepts that were related to the core variable which altogether contributed to its exploration. Conclusion: The results of this study showed that social isolation could endanger the well-being of PCIMS. This is the first study which shows to reduce the social isolation of PCIMS it is needed to address both the mutual needs and interests of the caregiver and the care-recipient. Therefore, occupational therapists are advised to design appropriate co-occupations based on the mutual needs and interests of the caregivers and the care-recipients to reduce the social isolation of these caregivers. For an in-depth examination, it is also suggested that studies be conducted discovering relationships between the concepts found in this theory.
The document discusses pain and psychological perspectives in terminal Motor Neurone Disease (MND) sufferers. It defines terminal illness and MND, describing the physical and psychological pain associated with MND. Regarding physical pain, it discusses types, measurement using scales like the SF-36, and pharmacological and non-pharmacological management approaches. For psychological pain, it covers measurement using tools like the BDI and management methods. The document also addresses comorbidities like depression, desire for death, and suicidal thoughts in terminal MND patients. It concludes that managing pain in terminal illness requires a multidisciplinary approach including both medical and psychological support.
Fibromyalgia is a clinical syndrome characterized by widespread pain, fatigue, sleep disturbances, and other somatic and cognitive symptoms. It affects 2-5% of the general population and is more prevalent among women ages 20-50. The cause is unclear but may involve genetic and environmental factors as well as abnormalities in central pain processing and neuroendocrine function. Diagnosis is based on symptoms and involves assessing pain levels and tender points. Treatment focuses on managing symptoms and includes pharmacologic approaches like antidepressants as well as non-pharmacologic options such as exercise, therapy, and acupuncture. Acupuncture is thought to help fibromyalgia by inhibiting pain pathways, stimulating pain modulation pathways, and regulating neuroendocrine function like cortisol and growth hormone levels
Comorbidity of Depression and Insomnia ProposalJennifer Ocasio
This document discusses the comorbidity of insomnia and depression and proposes studying their link using fMRI brain imaging. It notes commonalities in how these disorders affect the HPA axis and cerebral cortex. The author aims to determine if a relationship exists between insomnia and depression by comparing fMRI scans of healthy individuals and those with only one disorder or both. Finding this link could help develop more targeted treatments for the comorbidity.
This document analyzes interview data from cancer patients about their perceptions of good nursing care using Antonovsky's theory of sense of coherence.
The key findings indicate that most patients were able to activate their general resistance resources to cope with the stress of their illness, and that nurses, doctors, family and friends served as vital resources. Good nursing care likely supported the patients' sense of coherence by promoting meaningfulness, comprehensibility, and manageability.
The conclusion is that health personnel can support patients' meaningfulness by listening to their stories, support comprehensibility by providing good information, and promote manageability by alleviating physical suffering, as all three components of sense of coherence are important for caring for cancer patients.
El documento analiza los países de América Latina con mejor dominio del inglés como segundo idioma. Según los datos de una prueba de 910 mil adultos, Argentina obtuvo el puesto número 15 a nivel mundial y es el país latinoamericano con mejor manejo del inglés. La mayoría de los otros 14 países latinoamericanos incluidos en el estudio se encuentran en la franja de bajo dominio del inglés.
This chapter discusses how changes in the international political environment between 1815-1914 contributed to WWI. It outlines how the Congress of Vienna established a balance of power in Europe after Napoleon, with Britain emerging as dominant. Over the century, the map of Europe was redrawn through events like German and Italian unification. This disrupted the balance of power and led to competition between rising nation states. Alliances like the Triple Entente further upset the equilibrium, making war more likely by 1914 as countries struggled to maintain influence in an increasingly multi-polar system without a dominant power to restrain them. Diplomacy had helped manage tensions but could not stop war once it began.
La Web 2.0 o Web Social comprende sitios web que facilitan el compartir información, el diseño centrado en el usuario y la colaboración. Herramientas clave incluyen blogs para compartir artículos de forma cronológica, wikis para que varias personas editen contenido de forma asíncrona, redes sociales para que los usuarios publiquen contenido y se comuniquen, y entornos para compartir recursos como videos, fotos, documentos y presentaciones.
Este documento presenta un algoritmo para calcular e imprimir la cantidad de alumnos aprobados y reprobados en una asignatura, así como los promedios de notas de los alumnos aprobados, reprobados y en total. El algoritmo recibe como entrada el número de alumnos y la nota final de cada uno, suma las notas de aprobados y reprobados, calcula los promedios y los imprime junto con los conteos de aprobados y reprobados.
Wolfe (2011) fibromyalgia criteria and severity scales for clinical and epide...Paul Coelho, MD
This document describes modifications made to the 2010 American College of Rheumatology (ACR) preliminary diagnostic criteria for fibromyalgia. The modified criteria allow for self-administration in surveys and clinical studies without an examiner. Key changes include replacing a physician assessment of somatic symptoms with a self-reported sum of headaches, abdominal pain/cramps, and depression in the past 6 months. The criteria were tested on over 7000 patients with prior diagnoses of fibromyalgia, osteoarthritis, systemic lupus erythematosus, or rheumatoid arthritis. About 60% of prior fibromyalgia patients met the modified criteria, compared to 16-36% of other groups. A new Fibromyalgia Symptom scale combining widespread pain and symptoms showed good ability
Este documento trata sobre la gerencia de proyectos de tecnología educativa. Explica que la gerencia de proyectos implica liderar esfuerzos y administrar recursos dentro de plazos establecidos para alcanzar los objetivos. Luego, hace tres preguntas clave sobre el rol del profesional en el desarrollo de proyectos, los elementos necesarios para garantizar el ciclo de vida completo de un proyecto y quiénes son los principales responsables de establecer adecuadamente el ciclo de vida. Finalmente, cita dos refer
El documento habla sobre la botadura de un barco. Se menciona que es la cuarta parte de la historia sobre el lanzamiento del barco al agua. Se da continuidad a la narrativa sobre el proceso de botadura.
Este documento describe el trabajo en equipo, incluyendo su definición, aspectos necesarios, ventajas y desventajas, cómo prevenir problemas, técnicas y normas. Explica que el trabajo en equipo involucra a personas asignadas para cumplir metas bajo un coordinador, requiriendo metas claras, habilidades adecuadas, comunicación, liderazgo y apoyo.
Customer support is no longer seen as a cost center. Successful businesses realize the value and return on investment that comes from great customer service. Check out this infographic to understand the ROI of customer support.
Los estudiantes llevaron órganos a la escuela para que otros estudiantes pudieran observarlos y aprender sobre las funciones de cada órgano en el cuerpo humano. También aprendieron técnicas de reanimación cardiopulmonar.
How the brain heals emotional wounds the functional neuroanatomy of forgivene...Elsa von Licy
This study used fMRI to examine the brain regions involved in forgiveness. Participants imagined hurtful social scenarios and were instructed to either forgive or harbor a grudge towards the imagined offender. Forgiveness was associated with greater subjective relief and activation in brain regions involved in theory of mind, empathy, and cognitive regulation of emotion, including the precuneus, right inferior parietal lobe, and dorsolateral prefrontal cortex. The results suggest these regions support reappraisal-driven forgiveness by helping to inhibit aggressive reactions and restore emotional balance following an interpersonal offense.
Explanation of how do individuals with multiple sclerosis cope with social is...Liberty University (LU)
Background: Multiple sclerosis (MS) is a progressive neurological disease that can severely affect the psychosocial aspects of primary caregivers of individuals with MS (PCIMS). Objective: This study aimed to explore the process of social isolation among PCIMS in Kerman, Iran. Methods: This study was performed with grounded theory approach through a semi-structured interview with PCIMS (n=15), individuals with MS (n=13), and healthcare providers (n=5) who were selected through purposive and theoretical sampling in Kerman, Iran, during February 2017-April 2018. The data were analyzed through constant comparison method recommended by Corbin and Strauss. Results: Yield of this study was a theory in which "social isolation" was recognized as a core variable. "Lack of awareness and information", "Occupational Difficulties”, " Marital Difficulties, and " Endeavor to Reduce Restrictions" were the other extracted concepts that were related to the core variable which altogether contributed to its exploration. Conclusion: The results of this study showed that social isolation could endanger the well-being of PCIMS. This is the first study which shows to reduce the social isolation of PCIMS it is needed to address both the mutual needs and interests of the caregiver and the care-recipient. Therefore, occupational therapists are advised to design appropriate co-occupations based on the mutual needs and interests of the caregivers and the care-recipients to reduce the social isolation of these caregivers. For an in-depth examination, it is also suggested that studies be conducted discovering relationships between the concepts found in this theory.
The document discusses pain and psychological perspectives in terminal Motor Neurone Disease (MND) sufferers. It defines terminal illness and MND, describing the physical and psychological pain associated with MND. Regarding physical pain, it discusses types, measurement using scales like the SF-36, and pharmacological and non-pharmacological management approaches. For psychological pain, it covers measurement using tools like the BDI and management methods. The document also addresses comorbidities like depression, desire for death, and suicidal thoughts in terminal MND patients. It concludes that managing pain in terminal illness requires a multidisciplinary approach including both medical and psychological support.
Fibromyalgia is a clinical syndrome characterized by widespread pain, fatigue, sleep disturbances, and other somatic and cognitive symptoms. It affects 2-5% of the general population and is more prevalent among women ages 20-50. The cause is unclear but may involve genetic and environmental factors as well as abnormalities in central pain processing and neuroendocrine function. Diagnosis is based on symptoms and involves assessing pain levels and tender points. Treatment focuses on managing symptoms and includes pharmacologic approaches like antidepressants as well as non-pharmacologic options such as exercise, therapy, and acupuncture. Acupuncture is thought to help fibromyalgia by inhibiting pain pathways, stimulating pain modulation pathways, and regulating neuroendocrine function like cortisol and growth hormone levels
Comorbidity of Depression and Insomnia ProposalJennifer Ocasio
This document discusses the comorbidity of insomnia and depression and proposes studying their link using fMRI brain imaging. It notes commonalities in how these disorders affect the HPA axis and cerebral cortex. The author aims to determine if a relationship exists between insomnia and depression by comparing fMRI scans of healthy individuals and those with only one disorder or both. Finding this link could help develop more targeted treatments for the comorbidity.
This document analyzes interview data from cancer patients about their perceptions of good nursing care using Antonovsky's theory of sense of coherence.
The key findings indicate that most patients were able to activate their general resistance resources to cope with the stress of their illness, and that nurses, doctors, family and friends served as vital resources. Good nursing care likely supported the patients' sense of coherence by promoting meaningfulness, comprehensibility, and manageability.
The conclusion is that health personnel can support patients' meaningfulness by listening to their stories, support comprehensibility by providing good information, and promote manageability by alleviating physical suffering, as all three components of sense of coherence are important for caring for cancer patients.
El documento analiza los países de América Latina con mejor dominio del inglés como segundo idioma. Según los datos de una prueba de 910 mil adultos, Argentina obtuvo el puesto número 15 a nivel mundial y es el país latinoamericano con mejor manejo del inglés. La mayoría de los otros 14 países latinoamericanos incluidos en el estudio se encuentran en la franja de bajo dominio del inglés.
This chapter discusses how changes in the international political environment between 1815-1914 contributed to WWI. It outlines how the Congress of Vienna established a balance of power in Europe after Napoleon, with Britain emerging as dominant. Over the century, the map of Europe was redrawn through events like German and Italian unification. This disrupted the balance of power and led to competition between rising nation states. Alliances like the Triple Entente further upset the equilibrium, making war more likely by 1914 as countries struggled to maintain influence in an increasingly multi-polar system without a dominant power to restrain them. Diplomacy had helped manage tensions but could not stop war once it began.
La Web 2.0 o Web Social comprende sitios web que facilitan el compartir información, el diseño centrado en el usuario y la colaboración. Herramientas clave incluyen blogs para compartir artículos de forma cronológica, wikis para que varias personas editen contenido de forma asíncrona, redes sociales para que los usuarios publiquen contenido y se comuniquen, y entornos para compartir recursos como videos, fotos, documentos y presentaciones.
Este documento presenta un algoritmo para calcular e imprimir la cantidad de alumnos aprobados y reprobados en una asignatura, así como los promedios de notas de los alumnos aprobados, reprobados y en total. El algoritmo recibe como entrada el número de alumnos y la nota final de cada uno, suma las notas de aprobados y reprobados, calcula los promedios y los imprime junto con los conteos de aprobados y reprobados.
Wolfe (2011) fibromyalgia criteria and severity scales for clinical and epide...Paul Coelho, MD
This document describes modifications made to the 2010 American College of Rheumatology (ACR) preliminary diagnostic criteria for fibromyalgia. The modified criteria allow for self-administration in surveys and clinical studies without an examiner. Key changes include replacing a physician assessment of somatic symptoms with a self-reported sum of headaches, abdominal pain/cramps, and depression in the past 6 months. The criteria were tested on over 7000 patients with prior diagnoses of fibromyalgia, osteoarthritis, systemic lupus erythematosus, or rheumatoid arthritis. About 60% of prior fibromyalgia patients met the modified criteria, compared to 16-36% of other groups. A new Fibromyalgia Symptom scale combining widespread pain and symptoms showed good ability
Este documento trata sobre la gerencia de proyectos de tecnología educativa. Explica que la gerencia de proyectos implica liderar esfuerzos y administrar recursos dentro de plazos establecidos para alcanzar los objetivos. Luego, hace tres preguntas clave sobre el rol del profesional en el desarrollo de proyectos, los elementos necesarios para garantizar el ciclo de vida completo de un proyecto y quiénes son los principales responsables de establecer adecuadamente el ciclo de vida. Finalmente, cita dos refer
El documento habla sobre la botadura de un barco. Se menciona que es la cuarta parte de la historia sobre el lanzamiento del barco al agua. Se da continuidad a la narrativa sobre el proceso de botadura.
Este documento describe el trabajo en equipo, incluyendo su definición, aspectos necesarios, ventajas y desventajas, cómo prevenir problemas, técnicas y normas. Explica que el trabajo en equipo involucra a personas asignadas para cumplir metas bajo un coordinador, requiriendo metas claras, habilidades adecuadas, comunicación, liderazgo y apoyo.
Customer support is no longer seen as a cost center. Successful businesses realize the value and return on investment that comes from great customer service. Check out this infographic to understand the ROI of customer support.
Los estudiantes llevaron órganos a la escuela para que otros estudiantes pudieran observarlos y aprender sobre las funciones de cada órgano en el cuerpo humano. También aprendieron técnicas de reanimación cardiopulmonar.
La navidad es una época para reunirse con la familia y seres queridos, disfrutar de su compañía y amor, y sentir la emoción de un niño al abrir regalos. El documento comparte un enlace de video que explora este tema.
El documento discute el modo pedagógico de proceder ignaciano y cómo se refleja en la labor educativa. Describe elementos clave como el contexto, la experiencia vivencial, la reflexión y la acción consecuente. También destaca la importancia de buscar el mayor servicio a Dios ("magis") al servicio de los demás y de la sociedad.
This document provides an overview of customer relationship marketing (CRM). It defines CRM as a business process focused on building customer loyalty and brand value through marketing strategies. The document outlines the evolution of CRM from a transactional focus in earlier periods to a relationship focus today. It discusses frameworks for implementing CRM, including segmenting customers, developing relationship marketing strategies and programs, and measuring customer satisfaction and retention. The document also provides case studies on CRM practices of Volkswagen India and relationship marketing benefits for the Sheraton Suites hotel.
This document discusses somatization disorder and somatoform disorders. It provides definitions and criteria for somatization disorder according to the DSM-IV-TR. Key points include: Somatization disorder is characterized by physical symptoms that cannot be fully explained by medical issues. It is relatively uncommon compared to other somatoform disorders. Patients experience significant distress and impairment. Somatization disorder results in high personal and societal costs due to impairment and overuse of medical resources. Theories about the causes include inherited traits like emotional reactivity and negative affect, as well as deficient emotion regulation skills and maladaptive coping behaviors.
This document reviews literature on the impact of adverse childhood experiences (ACEs). It finds that ACEs are linked to negative health outcomes later in life through their effects on stress response systems and brain development. ACEs are common, affecting up to 67% of the population, and disproportionately impact low-income communities. The impacts of ACEs are cyclical as they increase risks for future generations. While ACEs have lasting biological and behavioral effects, perception of stress may influence outcomes. More research is needed to understand impacts, develop treatments, and engage communities to address this major public health issue.
Health Psychology Psychological Adjustment to the Disease, Disability and Lossijtsrd
This article discusses the psychological adjustment of adults to severe or incurable diseases or other loss. The stress that results from a diagnosis of illness or loss depends on many factors, such as the beliefs of each individual and the social context. Considering the diversity of human perceptions, feelings and behaviors, it was considered important for the present study to include a theory of stress and treatment related to physical illness. At the center of attention are end stage individuals, not their organic problems but mainly their psychological state and that of their families. Reference is then made to the loss of loved one and the period of mourning. As regards the disease response, there is a difference between the immediate reaction to loss, what we call mourning, and the adaptation to a new way of life without the loved one. Finally, the role of therapeutic communication between patients and their families and mental health professionals, as well as the need to maintain psychological balance, is also described. Agathi Argyriadi | Alexandros Argyriadis ""Health Psychology: Psychological Adjustment to the Disease, Disability and Loss"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23200.pdf
Paper URL: https://www.ijtsrd.com/humanities-and-the-arts/psychology/23200/health-psychology-psychological-adjustment-to-the-disease-disability-and-loss/agathi-argyriadi
1) The study examined the association between adverse childhood experiences (ACEs) like abuse and household dysfunction, and painful medical conditions in adulthood.
2) It found that specific ACEs like abuse and parental issues were linked to more reported painful conditions later in life.
3) Anxiety and mood disorders were found to partially explain the relationship, as ACEs increased risks for these disorders, which then increased risks for painful conditions. However, surprisingly the effects of ACEs on painful conditions were stronger in those with lower later-life anxiety/mood issues.
The association between a history of lifetime traumatic events and pain sever...Paul Coelho, MD
This study examined the associations between a history of lifetime abuse and affective distress, fibromyalgia symptoms, pain severity, interference, and physical functioning in 3,081 chronic pain patients. The study found that those with a history of abuse had greater depression, anxiety, worse physical functioning, greater pain severity, worse pain interference, higher catastrophizing, and higher scores on the 2011 Fibromyalgia Survey criteria. Mediation models showed that fibromyalgia survey scores and affective distress independently mediated the relationship between abuse history and pain severity and physical functioning. The findings support a biopsychosocial model where affective distress and fibromyalgia symptoms interact to play roles in how abuse relates to increased pain morbidity.
The Suicide (SPI) and Violence Potential Indices (VPI)from t.docxarnoldmeredith47041
This study evaluated the validity of the Suicide Potential Index (SPI) and Violence Potential Index (VPI) from the Personality Assessment Inventory (PAI) in assessing risk of harm to self and others. The study compared SPI and VPI scores between 158 psychiatric outpatients with and without histories of suicide attempts, violence, and psychiatric diagnoses. Results supported the validity of the SPI in differentiating groups with and without suicide histories. The VPI differentiated groups with and without violence histories. Both the SPI and VPI scores varied significantly across psychiatric groups and were elevated for patients with executive dysfunction, supporting their use in risk assessment.
Anorexia Nervosa Valued And Visible. A Cognitive-Interpersonal Maintenance M...Sophia Diaz
1) The document proposes a cognitive-interpersonal maintenance model of anorexia nervosa that combines intra-personal and inter-personal maintaining factors.
2) The four main maintaining factors suggested are perfectionism/cognitive rigidity, experiential avoidance, pro-anorectic beliefs, and responses of close others.
3) The model departs from others by not emphasizing weight and shape factors and suggests anorectic symptoms have adaptive functions in reducing social threats through complex defensive functions.
174 Journal of EMDR Practice and Research, Volume 9, Number 4,.docxaulasnilda
This document summarizes a case study that examined the effects of EMDR therapy on the neurocognitive and physiological outcomes of an 18-year-old female diagnosed with PTSD and major depressive disorder due to childhood sexual abuse. Pre- and post-treatment assessments found improvements in attention, memory, information processing speed, and working memory, as well as decreases in heart rate, depression, dissociation, and PTSD symptoms. At a 1-year follow-up, treatment gains were maintained, suggesting EMDR therapy ameliorated PTSD symptoms and improved neurocognitive functioning.
The document discusses functional somatic syndromes, which are conditions characterized more by symptoms and suffering than identifiable tissue abnormalities. These syndromes include chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and others. While the causes are not fully understood, these syndromes are thought to involve biological, psychological, and social factors and often involve high rates of psychiatric comorbidity, symptom overlap between syndromes, and refractoriness to standard medical treatments.
This document discusses a proposed study analyzing temporal choice and amygdala activity in patients with depression or bipolar disorder using fMRI imaging during a monetary choice questionnaire. The study aims to investigate if bipolar patients discount rewards more heavily than depressed patients and connect this with greater amygdala activation. Previous research found both groups made riskier decisions than controls in gambling tasks. Studies also linked impulsivity and suicide attempts, indicating bipolar patients may discount more due to amygdala structural differences found in prior imaging research. The proposed study would test these hypotheses by comparing discount rates and amygdala activity between depressed and bipolar young adult patients.
Journal of Traumatic StressApril 2013, 26, 266–273Public.docxtawnyataylor528
Journal of Traumatic Stress
April 2013, 26, 266–273
Public Mental Health Clients with Severe Mental Illness and
Probable Posttraumatic Stress Disorder: Trauma Exposure and
Correlates of Symptom Severity
Weili Lu,1 Philip T. Yanos,2 Steven M. Silverstein,3 Kim T. Mueser,4 Stanley D. Rosenberg,4
Jennifer D. Gottlieb,4 Stephanie Marcello Duva,5 Thanuja Kularatne,1 Stephanie Dove-Williams,5
Danielle Paterno,5 Danielle Hawthorne,5 and Giovanna Giacobbe5
1Department of Psychiatric Rehabilitation and Counseling Professions, University of Medicine and Dentistry of New Jersey,
Scotch Plains, New Jersey, USA
2John Jay College of Criminal Justice, Department of Psychology, CUNY, New York, New York, USA
3Division of Schizophrenia Research, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New
Jersey, Piscataway, New Jersey, USA
4Department of Psychiatry, Dartmouth Medical School, Concord, New Hampshire, USA
5University Behavioral Health Care, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA
Individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure and for the development of posttraumatic
stress disorder (PTSD). This study reports findings from a large, comprehensive screening of trauma and PTSD symptoms among public
mental health clients in a statewide community mental health system. In 851 individuals with SMI and probable PTSD, childhood sexual
abuse was the most commonly endorsed index trauma, followed closely by the sudden death of a loved one. Participants had typically
experienced an average of 7 types of traumatic events in their lifetime. The number of types of traumatic events experienced and Hispanic
ethnicity were significantly associated with PTSD symptom severity. Clients reported experiencing PTSD in relation to events that occurred
on average 20 years earlier, suggesting the clinical need to address trauma and loss throughout the lifespan, including their prolonged
after-effects.
Over the past two decades, a growing body of research has
shown that individuals with severe mental illness (SMI) are
at greatly increased risk for trauma exposure (see Grubaugh,
Zinzow, Paul, Egede, & Frueh, 2011, for a review). Although
national surveys indicate that more than half of people in the
general population report exposure to at least one event that
according to the Diagnostic and Statistical Manual of Mental
Disorders (4th ed., DSM-IV; American Psychiatric Associa-
tion, 1994) meets criteria for trauma (Kessler, Sonnega, Bromet,
Hughes, & Nelson, 1995), studies of people with a SMI (such as
This research was supported by National Institute of Mental Health grant R01
MH064662. We wish to thank the following individuals for their assistance
with this project: Edward Kim, Lee Hyer, Rachael Fite, Kenneth Gill, Rose-
marie Rosati, Christopher Kosseff, Karen Somers, John Swanson, Avis Scott,
Rena Gitlitz, John Markey, Zygmond Gray, Marilyn Green, Alex Sh ...
The document discusses functional somatic syndromes, which are characterized more by symptoms, suffering, and disability than by demonstrable tissue abnormalities. These syndromes include conditions like chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome. They share similarities in phenomenology, high rates of co-occurrence between syndromes, and higher than expected rates of psychiatric comorbidity. While discrete causes may be found for some patients, psychosocial factors like the belief of having a serious disease, expectations that the condition will worsen, the "sick role", and alarming media portrayals perpetuate the distress of these patients.
Common Brain Mechanisms Between Pain & AddictionPaul Coelho, MD
This document summarizes a perspective on common brain mechanisms of chronic pain and addiction. It proposes that chronic pain involves neuroadaptations similar to those seen in addiction, including reward deficiency, impaired inhibitory control, incentive sensitization, aberrant learning, and anti-reward allostatic neuroadaptations. The document provides epidemiological context on the prevalence and costs of chronic pain. It then reviews models of reward and addiction neurobiology and discusses how chronic pain may disrupt normal hedonic homeostasis in a manner analogous to addiction through an allostatic load. The perspective aims to inform improved chronic pain treatment by drawing parallels to addiction theories and interventions.
Running head LITERATURE REVIEW-POST TRAUMATIC STRESS DISORDER .docxwlynn1
Running head: LITERATURE REVIEW-POST TRAUMATIC STRESS DISORDER 1
LITERATURE REVIEW-POST TRAUMATIC STRESS DISORDER 8
Literature Review-Post Traumatic Stress Disorder
Amber Hope
Argosy University
Literature Review-Post Traumatic Stress Disorder
Introduction
Using Abraham Maslow’s Hierarchy of Needs theory in this situation creates relevance towards approaches employed to manage post-traumatic stress disorder. The theory is a framework and approach that looks into satisfying needs for positive mental and physical development. The steps are met before one move to above steps. The needs include physiological, self-esteem, love & belonging, safety & security, love & belonging, and self-actualization. The above factors are considered critical for the methods employed in dealing with Post-Traumatic Stress Disorder (PTSD) (Brummelte & Galea, 2016). The model is essential in identifying the effects of PTSD on battered women, parenting of youths, the mental status of pregnant mothers, and factors that lead to future criminality among youths.
The Jungian theory is also being looked at in dealing with PTSD because of its capacity, just like the Hierarchy of Needs theory, in bridging the relationship between the mind and social developments. The situation discusses PTSD as a problem in limiting positivity in mental and physical health (Brown, 2017). The society may not work without a stable mental status. Therefore, it is essential to study the relationship between PTSD and health. This is with a focus on mood, behavioral traits, health, and another health status.
Literature Review of Post-Traumatic Stress Disorder (PTSD)
Baumeister, Vohs, Aaker, & Garbinsky (2013) argue that an organism possesses a positive life depending on its capacity to maintain an internal milieu amidst challenges in its environment. Brummelte & Galea, (2016) supports the above factor by calling it homeostasis. Stress is seen as a factor that changes the homeostasis of organisms negatively. Adamsons & Johnson (2013) presents the various stakeholders who are affected by PTSD. Among them include women, children, and male adults. However, women, children, and youths are the ones that experience the problem the most. Adamsons & Johnson (2013) shows that a stressor derived from the PTSD condition acts as a threat to the life of anyone in the world. PTSD has evolved for many decades depending on the changing nature of society and modern society. Stress response also continues to undergo evolution to acquire its adaptive processes.
Dziwota, Stepulak, Włoszczak-Szubzda, & Olajossy (2018) presents data relating to prolonged response towards stress. The situation appears as the one which influences the development of tissue damages and the occurrence of illnesses. The situation is seen to invoke coping mechanisms and responses between human and animals depending on the nature of the threats they perceive to affect their liv.
This document summarizes a research study that surveyed 837 mental health professionals to determine their views on various models of mental illness. It found that professionals' endorsement of models differed depending on the specific illness. For schizophrenia, they most endorsed a biological model followed by cognitive and behavioral aspects. For depression, a social model was most endorsed followed by cognitive and behavioral aspects, with biological being least endorsed. For antisocial personality disorder, professionals most endorsed social constructionist and nihilist models, suggesting lack of interest in viewing it as a mental illness. The implications of professionals' endorsed models are discussed, such as impacts on treatment approaches, responsibility attribution, stigma, and access to social benefits.
ALCohoL ReSeARCh C u r r e n t R e v i e w s506 Alcohol .docxADDY50
ALCohoL ReSeARCh: C u r r e n t R e v i e w s
506 Alcohol Research: C u r r e n t R e v i e w s
Resilience to Meet the
Challenge of Addiction
Psychobiology and Clinical Considerations
Tanja N. Alim, M.D.; William B. Lawson, M.D.; Adriana Feder, M.D.; Brian M.
Iacoviello, Ph.D.; Shireen Saxena, M.S.; Christopher R. Bailey; Allison M.
Greene, M.S.; and Alexander Neumeister, M.D.
Tanja N. Alim, M.D., is an assis-
tant professor and William B.
Lawson, M.D., is a professor
and chair of the Department
of Psychiatry, both at the
Department of Psychiatry and
Behavioral Sciences, Howard
University, Washington, DC.
Adriana Feder, M.D., is an assistant
professor; Brian M. Iacoviello,
Ph.D., is a postdoctoral fellow;
and Shireen Saxena, M.S.,
Christopher R. Bailey, and
Allison M. Greene, M.S., are
research associates; all at the
Mood and Anxiety Disorders
Program, Department of Psychiatry,
Mount Sinai School of Medicine,
New York, New York.
Alexander Neumeister, M.D., is
a professor in the Department of
Psychiatry and Radiology, New
York University Langone Medical
Center, New York, New York.
Acute and chronic stress–related mechanisms play an important role in the
development of addiction and its chronic, relapsing nature. Multisystem adaptations in
brain, body, behavioral, and social function may contribute to a dysregulated
physiological state that is maintained beyond the homeostatic range. In addition,
chronic abuse of substances leads to an altered set point across multiple systems.
Resilience can be defined as the absence of psychopathology despite exposure to
high stress and reflects a person’s ability to cope successfully in the face of adversity,
demonstrating adaptive psychological and physiological stress responses. The study of
resilience can be approached by examining interindividual stress responsibility at
multiple phenotypic levels, ranging from psychological differences in the way people
cope with stress to differences in neurochemical or neural circuitry function. The
ultimate goal of such research is the development of strategies and interventions to
enhance resilience and coping in the face of stress and prevent the onset of addiction
problems or relapse. Key WoRDS: Addiction; substance abuse; stress; acute stress
reaction; chronic stress reaction; biological adaptation to stress; psychological
response to stress; physiological response to stress; resilience; relapse; coping
skills; psychobiology
evidence from different disciplinessuggests that acute and chronicstress–related mechanisms play
an important role in both the develop-
ment and the chronic, relapsing nature
of addiction (Baumeister 2003; Baumeister
et al. 1994; Brady and Sinha 2005).
Stress is defined as the physiological
and psychological process resulting from
a challenge to homeostasis by any real
or perceived demand on the body
(Lazarus and Fokman 1984; McEwen
2000; Selye 1976). Stress often induces
multisystem adaptations that occur in
the brain and .
ALCohoL ReSeARCh C u r r e n t R e v i e w s506 Alcohol .docxSHIVA101531
ALCohoL ReSeARCh: C u r r e n t R e v i e w s
506 Alcohol Research: C u r r e n t R e v i e w s
Resilience to Meet the
Challenge of Addiction
Psychobiology and Clinical Considerations
Tanja N. Alim, M.D.; William B. Lawson, M.D.; Adriana Feder, M.D.; Brian M.
Iacoviello, Ph.D.; Shireen Saxena, M.S.; Christopher R. Bailey; Allison M.
Greene, M.S.; and Alexander Neumeister, M.D.
Tanja N. Alim, M.D., is an assis-
tant professor and William B.
Lawson, M.D., is a professor
and chair of the Department
of Psychiatry, both at the
Department of Psychiatry and
Behavioral Sciences, Howard
University, Washington, DC.
Adriana Feder, M.D., is an assistant
professor; Brian M. Iacoviello,
Ph.D., is a postdoctoral fellow;
and Shireen Saxena, M.S.,
Christopher R. Bailey, and
Allison M. Greene, M.S., are
research associates; all at the
Mood and Anxiety Disorders
Program, Department of Psychiatry,
Mount Sinai School of Medicine,
New York, New York.
Alexander Neumeister, M.D., is
a professor in the Department of
Psychiatry and Radiology, New
York University Langone Medical
Center, New York, New York.
Acute and chronic stress–related mechanisms play an important role in the
development of addiction and its chronic, relapsing nature. Multisystem adaptations in
brain, body, behavioral, and social function may contribute to a dysregulated
physiological state that is maintained beyond the homeostatic range. In addition,
chronic abuse of substances leads to an altered set point across multiple systems.
Resilience can be defined as the absence of psychopathology despite exposure to
high stress and reflects a person’s ability to cope successfully in the face of adversity,
demonstrating adaptive psychological and physiological stress responses. The study of
resilience can be approached by examining interindividual stress responsibility at
multiple phenotypic levels, ranging from psychological differences in the way people
cope with stress to differences in neurochemical or neural circuitry function. The
ultimate goal of such research is the development of strategies and interventions to
enhance resilience and coping in the face of stress and prevent the onset of addiction
problems or relapse. Key WoRDS: Addiction; substance abuse; stress; acute stress
reaction; chronic stress reaction; biological adaptation to stress; psychological
response to stress; physiological response to stress; resilience; relapse; coping
skills; psychobiology
evidence from different disciplinessuggests that acute and chronicstress–related mechanisms play
an important role in both the develop-
ment and the chronic, relapsing nature
of addiction (Baumeister 2003; Baumeister
et al. 1994; Brady and Sinha 2005).
Stress is defined as the physiological
and psychological process resulting from
a challenge to homeostasis by any real
or perceived demand on the body
(Lazarus and Fokman 1984; McEwen
2000; Selye 1976). Stress often induces
multisystem adaptations that occur in
the brain and .
This document contains summaries of several research papers on topics related to chronic pain, suicide risk, and bipolar disorder:
1) One study found that tapering opioid doses for chronic pain patients was associated with increased risks of overdose and mental health crisis compared to patients who did not taper. Higher tapering speeds were linked to even greater risks.
2) Another study observed chronic pain patients undergoing opioid tapering or transition to buprenorphine treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine use predicted dropout. Pain levels varied after treatment.
3) Research on combat veterans found that those exposed to combat had higher rates of PTSD, suicide attempts, strokes and chronic pain
Labeling Woefulness: The Social Construction of FibromyalgiaPaul Coelho, MD
This document discusses the social construction of fibromyalgia and how it has been established as a legitimate disease label despite a lack of clear biological or clinical evidence. It argues that fibromyalgia serves social and economic purposes for various groups, including patients, doctors, pharmaceutical companies, and the media, but poses risks by medicalizing psychosocial problems. The document proposes that widespread pain is a normal human experience for some that is best addressed by exploring psychosocial factors rather than believing the solution lies in neurobiology. Examining fibromyalgia as a social construct may be more helpful for patients than continuing to medicalize their experiences.
Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrosp...Paul Coelho, MD
This study analyzed outcomes for 240 patients with chronic pain who were prescribed long-term opioid therapy above 90 mg morphine-equivalent daily doses. Patients were offered an outpatient opioid taper or transition to buprenorphine if taper was not tolerated. 44.6% successfully tapered, 18.8% transitioned to buprenorphine, and 36.6% dropped out of treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine/z-drug use predicted greater dropout. Pain intensity changes after treatment were mixed, with over half of tapered patients reporting increased pain and about half of transitioned patients reporting decreased pain.
This document appears to be a questionnaire assessing symptoms of widespread pain and calculating a WPI (Widespread Pain Index) score and SS (Symptom Severity) score. It asks the respondent to indicate areas of pain on a diagram and rate the severity of symptoms like fatigue, thinking difficulties, and unrefreshed sleep. It also inquires about additional symptoms like abdominal pain, depression, and headaches. The final section rates pain-related worry and fear on a scale. Additional questions determine if the respondent has a workers compensation or disability claim related to their pain complaint.
Fibromyalgia is a condition that causes chronic aches and pains all over the body, fatigue, and often a sleep disorder. The doctor diagnosed the patient with fibromyalgia based on a score of 13 or more on the fibromyalgia questionnaire from the American College of Rheumatology, which is consistent with the syndrome. By focusing on and managing the diagnosis of fibromyalgia, the patient's other pain symptoms can decrease.
This document contains two studies related to psychological treatments for chronic conditions:
1) A study of chronic fatigue syndrome patients found that poorer outcomes were predicted by membership in a self-help group, receiving sickness benefits, and symptoms of dysphoria. Severity and duration of symptoms did not predict response.
2) A randomized controlled trial of 125 fibromyalgia patients compared operant behavioral therapy, cognitive behavioral therapy, and attention placebo. Both behavioral therapies significantly reduced pain intensity while cognitive therapy improved cognitive and affective variables and operant therapy improved physical functioning and behaviors. The attention placebo resulted in no improvement or deterioration.
This document summarizes three studies on the risks and efficacy of opioids for chronic non-cancer pain (CNP). The first study finds that while opioids were associated with small improvements in pain and physical functioning compared to placebo, they also increased the risk of vomiting. Comparisons to other medications found similar benefits to pain and functioning. The second study finds no difference in pain-related function between opioid and non-opioid groups over 12 months, and higher rates of adverse effects and pain intensity in the opioid group. The third study finds limited effectiveness of opioids for CNP, as opioid users did not report improvements in outcomes after 2 years. Regarding risks, higher opioid doses are associated with increased overdose risk across several patient groups in
1) This randomized clinical trial compared opioid vs nonopioid medication therapy over 12 months for patients with chronic back, hip, or knee pain.
2) It found no significant difference in pain-related function between the two groups, but pain intensity was significantly better in the nonopioid group. Adverse effects were significantly more common in the opioid group.
3) The study concludes that opioid therapy was not superior to nonopioid medications for improving pain-related function over 12 months, and the results do not support initiating opioids for moderate to severe chronic musculoskeletal pain.
Mortality quadrupled among opioid-driven hospitalizations notably within lowe...Paul Coelho, MD
This study analyzed national hospitalization data from 1993-2014 to examine trends in mortality and characteristics of hospitalizations related to opioids compared to other drug and non-drug hospitalizations. The key findings were:
1) Mortality among opioid-related hospitalizations quadrupled from 0.43% before 2000 to 2.02% in 2014, increasing 0.12 percentage points per year relative to other drug hospitalizations.
2) While total opioid-related hospitalizations remained stable, diagnoses shifted from opioid dependence/abuse to opioid/heroin poisoning, which have higher mortality rates. Hospitalizations for poisoning grew by 0.01 per 1,000 people annually after 2000.
3) Patients hospitalized for opioid/
Prescriptions filled following an opioid-related hospitalization.Paul Coelho, MD
This study analyzed prescription drug fills within 30 days of discharge for 36,719 patients hospitalized for opioid misuse. Only 16.7% received medications approved for opioid dependence, while 40.3% filled antidepressant prescriptions and 22.4% filled opioid pain medication prescriptions. Concurrently, 13.9% filled benzodiazepine prescriptions and 7.4% filled both benzodiazepine and opioid prescriptions, indicating a need for improved education on risks. Overall, more effort is required to ensure patients receive recommended post-hospitalization treatment and support services.
This study examined the risk of psychiatric hospitalization in the offspring (second generation) of Finns who were evacuated to Sweden without parents during World War II (first generation), compared to offspring of Finns who were not evacuated. The study found that daughters of mothers who were evacuated during childhood had an elevated risk of psychiatric hospitalization, especially for mood disorders. However, there was no increased risk found for offspring of evacuated fathers or for male offspring of evacuated mothers. This suggests that early childhood adversity experienced by the first generation, such as war-related trauma, may be associated with mental health problems that persist into the second generation.
Correlation of opioid mortality with prescriptions and social determinants -a...Paul Coelho, MD
This study analyzed Medicare Part D data from 2013-2014 to examine the relationship between opioid prescription rates, socioeconomic factors, and opioid-related mortality rates at the county level in the United States. The results showed that higher county-level opioid prescription rates, especially those from emergency medicine, family medicine, internal medicine, and physician assistants, were associated with higher opioid-related mortality rates. Higher poverty levels and proportions of white populations in counties also correlated with increased mortality. Additionally, prescribers in the highest quartile of opioid prescription rates had a disproportionate impact on mortality compared to the remaining 75% of prescribers.
This report examines CMS's oversight of Medicare Part D beneficiaries who receive opioid prescriptions and providers who prescribe opioids to these beneficiaries. It finds that while CMS provides guidance to Part D plan sponsors on monitoring beneficiaries at high risk of opioid overuse, it lacks complete data on the full population of beneficiaries at risk. It also finds that CMS oversees prescribing through its contractor NBI MEDIC but does not specifically analyze opioid prescription data or require reporting on actions taken regarding inappropriate opioid prescribing. The report concludes that CMS needs more comprehensive oversight to reduce the risks of opioid misuse, overdose, and inappropriate prescribing among Medicare beneficiaries.
This study analyzed opioid prescription trends among medical specialties in the U.S. from 2007-2012 using a national prescription database. The key findings were:
- Primary care specialties (family practice, internal medicine, general practice) accounted for nearly half of all dispensed opioid prescriptions in 2012.
- Specialties treating pain conditions like pain medicine, surgery, and physical medicine had the highest rates of opioid prescribing.
- Overall opioid prescribing rates increased from 2007-2010 but stabilized from 2010-2012 as most specialties reduced rates.
- The greatest increase in opioid prescribing was among physical medicine specialists, while the largest decreases were in emergency medicine and dentistry.
The place-of-antipsychotics-in-the-therapy-of-anxiety-disorders-and-obsessive...Paul Coelho, MD
This document summarizes a research article about the use of antipsychotic drugs in the treatment of anxiety disorders and obsessive-compulsive disorders. The review finds evidence that certain second-generation antipsychotics (SGAPs), like quetiapine, risperidone, and aripiprazole, can be effective for generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). Quetiapine in particular receives a recommendation as a first-line treatment for GAD. However, the review finds insufficient evidence for SGAPs in the treatment of social anxiety disorder and panic disorder. First-generation antipsychotics are not recommended for any anxiety disorders based on their side effect profiles
Structured opioid refill clinic epic smartphrases Paul Coelho, MD
#*** I explained to the patient the risks of combining opioids and benzodiazepines based on medical literature. We agreed to slowly taper the patient off benzodiazepines and trial safer alternatives for sleep and anxiety issues.
#*** I showed the patient their fibromyalgia screening questionnaire results, which were consistent with a fibromyalgia diagnosis. Fibromyalgia can amplify other painful conditions and is often the primary source of morbidity when present with other chronic pain diagnoses.
#*** We discussed the patient's high risk opioid regimen based on their dose exceeding CDC guidelines. While willing to work on a harm reduction plan, it will require a taper or switching to buprenorphine due to safety concerns.
Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, an...Paul Coelho, MD
This document summarizes the key issues regarding the use of opioids for chronic pain treatment:
1) An overreliance on opioids to treat chronic pain has contributed to the prescription opioid abuse epidemic in the US, as outpatient use allows for abuse and diversion of these addictive drugs.
2) While clinical trials show opioids effectively treat acute pain and are initially effective for chronic pain, real-world use reveals increased risks of abuse, addiction, and poor functional outcomes over the long-term.
3) The evidence supporting chronic opioid therapy was limited and observational in nature, yet convinced the medical community until larger population studies showed increased abuse rates contrary to initial assumptions.
The potential adverse influence of physicians’ words.Paul Coelho, MD
The physician's words can inadvertently amplify patients' symptoms and increase somatic distress if not carefully considered. Learning about potential side effects from medications, procedures, or test results can lead patients to experience and report those effects more frequently through psychological mechanisms like misattribution and increased attention to bodily sensations. Discussing concepts like nocebo and viscerosomatic amplification with patients can help provide reassuring explanations for symptoms and make them feel less intrusive. Physicians should thoughtfully consider their word choices and focus on benefits as well as side effects to minimize undue distress.
This document is an evidence report published by the Institute for Clinical and Economic Review (ICER) that evaluates the comparative clinical effectiveness and value of cognitive and mind-body therapies for chronic low back and neck pain. It was authored by Jeffrey Tice and others from ICER. The report assesses the clinical evidence on therapies such as cognitive behavioral therapy and mindfulness-based stress reduction and presents economic analyses of the long-term cost-effectiveness and potential budget impact of these therapies. It also incorporates input from clinical experts and stakeholders.
The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
English Drug and Alcohol Commissioners June 2024.pptxMatSouthwell1
Presentation made by Mat Southwell to the Harm Reduction Working Group of the English Drug and Alcohol Commissioners. Discuss stimulants, OAMT, NSP coverage and community-led approach to DCRs. Focussing on active drug user perspectives and interests
Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
End-tidal carbon dioxide (ETCO2) is the level of carbon dioxide that is released at the end of an exhaled breath. ETCO2 levels reflect the adequacy with which carbon dioxide (CO2) is carried in the blood back to the lungs and exhaled.
Non-invasive methods for ETCO2 measurement include capnometry and capnography. Capnometry provides a numerical value for ETCO2. In contrast, capnography delivers a more comprehensive measurement that is displayed in both graphical (waveform) and numerical form.
Sidestream devices can monitor both intubated and non-intubated patients, while mainstream devices are most often limited to intubated patients.
As Mumbai's premier kidney transplant and donation center, L H Hiranandani Hospital Powai is not just a medical facility; it's a beacon of hope where cutting-edge science meets compassionate care, transforming lives and redefining the standards of kidney health in India.
Joker Wigs has been a one-stop-shop for hair products for over 26 years. We provide high-quality hair wigs, hair extensions, hair toppers, hair patch, and more for both men and women.
About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
Sectional dentures for microstomia patients.pptxSatvikaPrasad
Microstomia, characterized by an abnormally small oral aperture, presents significant challenges in prosthodontic treatment, including limited access for examination, difficulties in impression making, and challenges with prosthesis insertion and removal. To manage these issues, customized impression techniques using sectional trays and elastomeric materials are employed. Prostheses may be designed in segments or with flexible materials to facilitate handling. Minimally invasive procedures and the use of digital technologies can enhance patient comfort. Education and training for patients on prosthesis care and maintenance are crucial for compliance. Regular follow-up and a multidisciplinary approach, involving collaboration with other specialists, ensure comprehensive care and improved quality of life for microstomia patients.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
The facial nerve, also known as cranial nerve VII, is one of the 12 cranial nerves originating from the brain. It's a mixed nerve, meaning it contains both sensory and motor fibres, and it plays a crucial role in controlling various facial muscles, as well as conveying sensory information from the taste buds on the anterior two-thirds of the tongue.
2. The Relationship Between the Fear-Avoidance Model of Pain
and Personality Traits in Fibromyalgia Patients
Marı´a Pilar Martı´nez • Ana Isabel Sa´nchez •
Elena Miro´ • Ana Medina • Marı´a Jose´ Lami
Ó Springer Science+Business Media, LLC 2011
Abstract This study examined the relationship between
several cognitive-affective factors of the fear-avoidance
model of pain, the big five model of personality, and
functional impairment in fibromyalgia (FM). Seventy-four
FM patients completed the NEO Five-Factor Inventory, the
Pain Catastrophizing Scale, the Pain Anxiety Symptoms
Scale-20, the Pain Vigilance and Awareness Question-
naire, and the Impairment and Functioning Inventory.
Results indicated that the cognitive-affective factors of
pain are differentially associated with personality traits.
Neuroticism and conscientiousness were significant pre-
dictors of pain catastrophizing, and neuroticism, openness,
and agreeableness were significant predictors of pain anx-
iety. Personality traits did not contribute significantly to
vigilance to pain. The effect of neuroticism upon pain
anxiety was mediated by pain catastrophizing, and neu-
roticism showed a trend to moderate the relationship
between impairment and pain anxiety. Results support the
fear-avoidance model of pain. Implications of the findings
for the understanding and management of FM are
discussed.
Keywords Fibromyalgia Á Pain catastrophizing Á
Pain anxiety Á Vigilance to pain Á Neuroticism
Introduction
Fibromyalgia (FM) is a chronic pain syndrome of uncertain
origin that leads to a significant deterioration of patient’s
quality of life. According to the American College of
Rheumatology (ACR; Wolfe et al., 1990), this disease is
characterized by the presence of widespread musculoskel-
etal pain for at least three months in all four quadrants of
the body, as well as pain in digital palpation in at least 11
of the 18 sensitive points of the body. Although FM may
have a very heterogeneous nature, the most important
diagnostic variables are widespread pain, cognitive symp-
toms, unrefreshed sleep, fatigue, and a number of somatic
symptoms (Wolfe et al., 2010). Considerable links between
these variables have been reported (e.g. Miro´ et al., 2011).
According to epidemiological studies, the prevalence of
FM ranges from 10.2 to 15.7% in visits to rheumatologists
(Neumann & Buskila, 2003), and FM is the third most
common rheumatic disorder after low back pain and
osteoarthritis (Lawrence et al., 2008). Aside from personal
discomfort, FM causes a notable economic burden for the
healthcare system. The annual medical costs for FM
patients ($4065) are significantly higher than those for
control patients not diagnosed with FM ($2766) (Lachaine,
Beauchemin, & Landry, 2010).
Although the etiology of FM is not clearly established,
accumulating evidence suggests that patients with FM have
a dysregulation of the hypothalamic–pituitary–adrenal
(HPA) axis that occurs in response to a chronic stressor and
is associated to impaired immunity (Ross et al., 2010).
Bazzichi et al. (2007) found higher levels of cytokines in
FM patients than in controls, which suggests the presence
of an inflammatory response system (for reviews, see
Bazzichi et al., 2007; Nishikai et al., 2001; Pamuk & Cakir,
2007). In fact, some FM symptoms are reminiscent of
M. P. Martı´nez (&) Á A. I. Sa´nchez Á E. Miro´ Á A. Medina Á
M. J. Lami
Departamento de Personalidad, Evaluacio´n y Tratamiento
Psicolo´gico, Universidad de Granada, Facultad de Psicologı´a,
Campus Universitario de Cartuja, 18071 Granada, Spain
e-mail: mnarvaez@ugr.es
123
J Clin Psychol Med Settings
DOI 10.1007/s10880-011-9263-2
3. ‘‘sickness behavior,’’ a syndrome of pain, fatigue, depres-
sion, and impaired cognition caused by the production of
pro-inflammatory cytokines (Ross et al., 2010).
In addition, there is growing acceptance of the role that
psychological factors play in exacerbation of the symptoms
as well as dysfunctional adjustment. These psychological
factors mainly include coping and appraisal styles and
personality traits. Cognitive appraisal is a dual process. In
primary appraisal, individuals assess the significance of a
particular encounter with the environment for their well-
being; in secondary appraisal, individuals assess whether
they can take action to improve their relationship with the
environment, and which coping strategies (cognitive and
behavioral efforts aimed to manage the demand of the
environment) may be useful for this (Lazarus & Folkman,
1984). Personality traits are distinguishing qualities or
characteristics of individuals, that is, a readiness to think or
act in a similar fashion in response to a variety of different
stimuli or situations (Carver & Scheier, 2000).
Several cognitive-affective factors have contributed to
further understanding of FM. A few examples are helpless-
ness (Nicassio, Schuman, Radojevic, & Weisman, 1999),
hypervigilance to pain (Crombez, Eccleston, Van den
Broeck, Goubert, & Van Houdenhove, 2004), fear of pain
(Turk, Robinson, & Burwinkle, 2004), pain catastrophizing
(Hassett, Cone, Patella, & Sigal, 2000), self-efficacy expec-
tancies (Buckelew, Murray, Hewett, Johnson, & Huyser,
1995), and coping strategies (Garcı´a-Campayo, Pascual,
Alda, & Gonza´lez-Ramı´rez, 2007). Strong links between
some of these cognitive-affective factors have been reported
in FM patients (Sa´nchez, Martı´nez, Miro´, & Medina, 2011).
Moreover, a number of reports have indicated that FM is
related to personality traits such as neuroticism (Malt,
Olafsson, Lund, & Ursin, 2002), alexithymia (Brosschot &
Aarsse, 2001), hypochondriasis and hysteria (Trygg,
Lundberg, Rosenlund, Timpka, & Bjorn, 2002), perfection-
ism (Mcallister, 2000), and harm avoidance (Anderberg,
Forsgren, Ekselius, Marteinsdottir, & Hallman, 1999).
Additionally, recent studies suggest that the clinical person-
ality profile of FM patients is mainly oriented to expressing a
great variety of somatic complaints, health problems, and
physical malfunctioning (Pe´rez-Pareja, Sese´, Gonza´lez-Ordi,
& Palmer 2010). Despite previous reports, the role of per-
sonality in the abovementioned cognitive and emotional
dimensions of pain has not been sufficiently explored. It
should be noted that the status of some of the psychological
characteristics mentioned has not definitively established.
For example, there is controversy about whether pain catas-
trophizing should be considered as a personality trait or as a
situation-specific response (for a review, see Quartana,
Campbell, & Edwards, 2009; Turner & Aaron, 2001).
The ‘‘fear-avoidance’’ model (Leeuw et al., 2007;
Vlaeyen & Linton, 2000) is an influential theoretical
approach that addresses chronic pain. It considers the
contribution of personality in the cognitive-affective fac-
tors of pain. The model suggests that negative appraisal of
pain and its consequences (pain catastrophizing) is a
potential precursor to pain-related fear and this fear leads
patients to focus their attention on possible somatic signals
of threat (hypervigilance) and to show avoidance/escape
behaviors. All these factors aggravate the pain problem,
leading to disability, gradual deterioration of the muscular
system, and depression. The latter maintain the pain
experience, thereby contributing to a spiral of increasing
fear and avoidance. According to the model, pain catas-
trophizing is influenced by negative affectivity (neuroti-
cism) and threatening illness information. While this model
has scientific support in chronic musculoskeletal pain prob-
lems (e.g. Cook, Brawer, & Vowles, 2006), its explanatory
value in FM patients is unknown.
Various studies have examined the relationship between
personality traits and pain cognitive-affective factors in
non-clinical samples as well as samples with no FM pain.
In an experimental study of pain among college students,
Thorn et al (2004) found that the tendency to describe
oneself as emotionally vulnerable mediated sex differences
in pain catastrophizing. Muris et al. (2007) observed that
pain catastrophizing in young adolescents was explained
by the behavioral inhibition system, reactive temperament
traits (fear), and perceptual sensitivity. In a study of two
experimental pain models with healthy individuals, Lee
(2009) found that neuroticism was positively correlated
with somatosensory amplification, fear of pain, and pain
catastrophizing; the study found that these cognitive-
affective factors were generally more strongly related to
qualitative and quantitative pain measures than personality
indices. In a clinical sample composed of patients with low
back pain, Goubert, Crombez, and Van Damme (2004)
found that neuroticism moderated the relationship between
pain severity and catastrophic thinking about pain; they
also observed that pain catastrophizing and pain-related
fear mediated the relationship between neuroticism and
vigilance to pain. However, other studies have not identi-
fied a link between personality and appraisal of pain. For
example, in patients with chronic pain, Herrero, Ramı´rez-
Maestre, and Gonza´lez (2008) found that personality
profiles (schizoid-compulsive-dependent, antisocial-com-
pulsive, and compulsive) did not differ in the type of
cognitive appraisal of pain (harm, threat, and challenge
appraisal). The discrepancy observed in these studies
points to the need to collect new evidence on the rela-
tionship between chronic pain and personality.
To the best of our knowledge, current study is the first to
explore the links between personality traits and cognitive-
affective factors of pain in FM patients, according to the
fear-avoidance model. Although neuroticism appears to be
J Clin Psychol Med Settings
123
4. an important factor in the heightened experience of pain,
other personality traits may also play a prominent role. It is
important to take the big five personality model into
account, as it greatly contributes to the understanding of
individual’s physical and emotional well-being. It has been
found that neuroticism and conscientiousness are relevant
to understanding depressive moods (Vearing & Mak,
2007), neuroticism and extraversion have predicted the
severity of bodily anxiety symptoms (Kristensen, Mortensen,
& Mors, 2009), and neuroticism and introversion are linked
to greater pain-related cardiac vagal tone changes (Paine,
Kishor, Worthen, Gregory, & Aziz, 2009). Therefore,
taking into account the fear-avoidance model and previous
findings with other chronic pain conditions, the objectives
of this cross-sectional study in FM patients were the fol-
lowing: (1) analyze the relationships between personality
dimensions and pain catastrophizing, pain anxiety, and
vigilance to pain; (2) determine the contribution of per-
sonality dimensions in these cognitive-affective factors; (3)
explore the mediating role of pain catastrophizing in the
relationship between neuroticism and pain anxiety; and (4)
explore the moderating role of neuroticism in the rela-
tionship between impairment and both pain catastrophizing
and pain anxiety.
Method
Subjects and Procedure
Seventy-four subjects with FM (70 women and four men)
with a mean age of 46.54 years (SD = 8.13, ran-
ge = 24–62 years) recruited from a FM association in
Granada (Spain), participated in this study. All the patients
were diagnosed with FM in a rheumatology clinic
according to the criteria of the American College of
Rheumatology (ACR; Wolfe et al., 1990). The fulfillment
of the following criteria was required: (1) age range from
18 to 65 years; (2) no history of alcoholism or drug
addiction; (3) absence of concomitant major medical con-
ditions (e.g., inflammatory rheumatic diseases, endocrine
disorders), and (4) no presence of major depressive disor-
der with severe symptoms or suicide ideation, or other
major axis I diagnoses of the DSM-IV-TR (APA, 2000).
The patients of the FM association were contacted by
telephone and invited to participate in the study. From a
potential sample of 100 people, 74 participants were
selected as the final clinical group for the study. Of the
sample contacted, 15 patients refused to participate in the
study, four subjects met the criteria of major depressive
disorder with severe symptoms, and seven had comorbidity
with other rheumatic diseases (mainly arthritis). The
remarkable percentage of female patients selected
(70 women vs. 4 men) matches that found in several epi-
demiological studies. For example, the female/male ratio of
patients with FM ranged from 9:1 (Burckhardt, Jones, &
Clark, 1998) to 20:1 (Schneider, 1995). Moreover, a recent
study reported that, in the context of rheumatology, 94% of
patients with FM were women (Branco et al., 2010).
Participants were asked to complete an interview (semi-
structured format) with a duration of approximately one
hour. The interview focused on onset and course of symp-
toms, life history, lifestyle, work, personal relations, the
family and the participant’s attitudes about his/her illness,
and psychological status. After the interview, participants
were given a set of questionnaires to be completed at home.
It was verified that patients had an adequate level of reading
comprehension of the self-report measures. Questionnaires
were delivered in one week at the most. All participants were
informed about the characteristics of the study and informed
consent was obtained. Patients did not receive any incentives
to participate in the study. The study received ethical
approval from the University of Granada ethics committee.
Most of the participants were married (74.3%), had
elementary or secondary education (57.8%), and had an
inactive work situation (59.5%). The mean duration of
the diagnosed disease was 4.11 years (SD = 3.07).
Among participants, 94.6% were receiving current phar-
macological treatment (mainly analgesics, anxiolytics,
anti-inflammatory drugs, skeletal muscle relaxants, and
anti-depressants), and 93.2% of them also received other
treatments (e.g. physical exercise, acupuncture, oxygen
therapy, psychotherapy). At the time of the study, patients
had a stabilized pharmacological pattern and none of them
were receiving structured cognitive-behavioral therapy for
their problem.
Measurements
The Short-Form McGill Pain Questionnaire (SF-MPQ;
Melzack, 1987)
The SF-MPQ assesses pain experience using 15 verbal pain
descriptors, a current pain intensity index, and a visual
analogue scale (VAS) to assess pain intensity during the
previous week, anchored with ‘‘no pain’’ (1) and ‘‘extreme
pain’’ (10). Several studies have reported the reliability and
validity of the Spanish version of the MPQ (e.g. La´zaro
et al., 2001). The internal consistency of the MPQ was .74
(Masedo & Esteve, 2000). The VAS was used in this study.
The Impairment and Functioning Inventory
(IFI; Ramı´rez-Maestre & Valdivia, 2003)
The 19-item IFI evaluates daily functioning and deterio-
ration of patients with chronic pain in several areas of life.
J Clin Psychol Med Settings
123
5. The IFI includes two general indices (Functioning and
Impairment) and four specific dimensions (Household
activity, Independent functioning, Social activities, and
Leisure activities). This inventory has adequate reliability
(.76 in functioning and .72 in impairment) and a factor
analysis confirmed its four-factor structure (Ramı´rez-
Maestre & Valdivia, 2003). The Impairment index was
used in this study.
The Pain Catastrophizing Scale (PCS; Sullivan, Bishop, &
Pivik, 1995)
The PCS assesses the rumination, magnification, and
helplessness associated with pain. It includes 13 items
measured on a 5-point Likert scale ranging from 0 (not at
all) to 4 (all the time). The PCS shows adequate internal
consistency and concurrent and discriminant validity
(Osman et al., 2000). In the present study, the Cronbach
alpha of the Spanish version of the PCS was .93.
The Pain Anxiety Symptoms Scale-20 (PASS-20;
McCracken & Dhingra, 2002)
The PASS-20 assesses the fear, cognitive anxiety, escape/
avoidance behavior, and physiological anxiety associated
with pain. This is a 20-item scale where subjects respond to
a 6-point Likert scale ranging from 0 (never) to 5 (always).
The PASS-20 has good convergent validity and reliability
(Roelofs et al., 2004). In the present study, the Cronbach
alpha of the Spanish version of the PASS-20 was .88.
The Pain Vigilance and Awareness Questionnaire (PVAQ;
McCracken, 1997)
The PVAQ consists of 16 items that evaluate attention to
pain using a 6-point Likert scale ranging from 0 (never) to
5 (always). The PVAQ shows adequate convergent validity
and internal consistency (Roelofs, Peters, McCracken, &
Vlaeyen, 2003). In the present study, the Cronbach alpha of
the Spanish version of the PVAQ was .79.
The NEO Five-Factor Inventory, NEO-FFI
(Costa & McCrae, 1992)
The NEO-FFI is a well validated self-report inventory
that assesses the big five personality factors: neuroticism,
extraversion, openness, agreeableness, and conscientious-
ness. The inventory includes 60 items measured on a
5-point Likert scale ranging from ‘‘strongly disagree’’ to
‘‘strongly agree.’’ The present study used the Spanish
version by TEA Ediciones. In this version the factors
showed an internal consistency between .82 and .90.
Data Analyses
Statistical analyses were performed with SPSS 15.0 soft-
ware for Windows. The moderational and mediational
effects were performed using MedGraph (Jose, 2003) and
ModGraph (Jose, 2008). All the analyses were two-tailed
and probabilities of less than .05 were taken as significance
levels. The statistical power of the analyses was greater
than .80. The minimum required sample size for the study
was 56 subjects, given an alpha level of .05, seven pre-
dictors, an anticipated effect size of .30 (medium), and a
desired statistical power level of .80.
In order to determine the association between the cog-
nitive-affective factors of pain and personality traits,
Pearson’s correlation coefficient was obtained. A multi-
variate regression analysis was performed to explore the
contribution of personality traits to the prediction of cog-
nitive-affective factors.
The mediator effect of pain catastrophizing in the
relationship between neuroticism and pain anxiety was
analyzed using the criteria developed by Baron and Kenny
(1986). The following conditions had to be met to estab-
lish the mediation: (1) variations in neuroticism (inde-
pendent variable, IV) significantly account for variations
in pain anxiety (dependent variable, DV) (path c); (2)
variations in neuroticism (IV) significantly account for
variations in pain catastrophizing (mediator) (path a); (3)
variations in pain catastrophizing (mediator) significantly
account for variations in pain anxiety (DV) (path b); and
(4) the previous relationship between neuroticism and pain
anxiety is no longer significant once pain catastrophizing
(mediator) is controlled (path c’). Several linear regression
analyses were performed to test these conditions. The
Sobel test was used as a post-hoc analysis of the media-
tion effect.
The moderator effect of neuroticism was also analyzed
using the criteria put forward by Baron and Kenny
(1986): in predicting pain catastrophizing or pain anxiety
(DVs), the model considers the impact of the impairment
(VI), the impact of neuroticism (moderator), and the
interaction of both (VI 9 moderator); the moderator
effect is supported if the interaction is significant. Sev-
eral hierarchical regression analyses were conducted to
test this condition. Following the recommendations of
Aiken and West (1991) to eliminate multicollinearity
effects, the variables were centered (scores are put into
deviation score form by subtracting the sample mean
from all individual scores). Later, the interaction term
was formed by multiplying the centered scales. As a
post-hoc analysis of the moderation effects, several
regression lines were plotted for low, medium and high
levels of neuroticism.
J Clin Psychol Med Settings
123
6. Results
Descriptive Analyses
Descriptive statistics and correlation coefficients for all
measures are shown in Table 1. The mean score in pain
intensity (SF-MPQ) was 7.38. This score is within the
expectations for FM patients and indicates relatively high
levels of pain. The mean score of impairment level (3.76)
in the FM group was very similar to that reported by
patients with musculoskeletal chronic pain (Ramı´rez-
Maestre, Esteve, & Lo´pez, 2008). The mean scores of
patients with FM on the PCS, PASS-20, and PVAQ were
slightly to moderately higher than those reported in pre-
vious studies with FM patients (Roelofs et al., 2003, 2004).
Taking into account the Spanish normative data in the
NEO-FFI (Manga, Ramos, & Mora´n, 2004), the FM group
obtained mean scores corresponding to percentiles 85 in
neuroticism, 15 in extraversion, 30 in openness, 65 in
agreeableness, and 50 in conscientiousness.
Men (n = 4) and women with FM (n = 70) in the
present study did not differ significantly in the following
demographic variables: age (U = 110.00, p = .473), mari-
tal status (v3
2
= .68, p = .877), educational level (v3
2
=
3.05, p = .383) and work status (v4
2
= 6.65, p = .155).
No significant differences were found between men and
women (U values between 74.00, p = .107 and 132.50,
p = .894) or age groups (40.75 years vs. [53.00 years,
groups established considering percentiles 25 and 75) in
the clinical variables analyzed (t35 values between -1.83,
p = .075 and 1.57, p = .125).
Relationship Between Self-Report Variables
Table 1 shows the mean, standard deviation and Pearson
intercorrelations of all the measures. The main results were
the following: (1) significant positive correlations between
neuroticism and pain catastrophizing and pain anxiety, and
between agreeableness and vigilance to pain; (2) significant
negative correlations between extraversion and pain
catastrophizing and between openness and pain intensity as
well as pain anxiety; (3) significant positive correlations
between cognitive-affective factors of pain; (4) significant
positive correlations between pain intensity and both pain
catastrophizing and pain anxiety, and (5) significant posi-
tive correlations between impairment and both pain
catastrophizing and pain anxiety.
Value of Personality Traits in Predicting Cognitive-
Affective Factors of Pain
The multivariate regression analysis that predicted cogni-
tive-affective factors of pain is shown in Table 2. When
pain catastrophizing was considered as the DV, the model
including pain variables (pain intensity and pain duration)
and personality traits (neuroticism, extraversion, openness,
agreeableness, and conscientiousness) as predictors was
significant (F7,63 = 3.43, p .05) and accounted for 20%
of the variance. Neuroticism and conscientiousness made a
significant contribution in predicting pain catastrophizing.
When pain anxiety was the DV, the model composed of
pain variables and personality traits was also significant
(F7,63 = 7.03, p .01) and explained 38% of the variance
in pain anxiety. Pain intensity, neuroticism, openness, and
agreeableness significantly contributed to predicting pain
anxiety. Finally, when vigilance to pain was considered as
the DV, the model including pain variables and personality
traits was not significant. However, agreeableness was
found to make a significant contribution in predicting
vigilance to pain.
Further analyses were only performed with neuroti-
cism because it significantly correlated with both pain
Table 1 Means (M), standard deviations (SD), and correlations among all measures
M (SD) 2 3 4 5 6 7 8 9 10
1. Pain intensity 7.38 (1.65) .19 .28* .43** .18 .09 -.15 -.26* -.06 .06
2. Impairment 3.76 (3.12) – .25* .22* .09 .06 -.01 -.01 .10 .07
3. Pain catastrophizing 25.35 (11.80) – .70** .50** .36** -.23* -.19 .06 .16
4. Pain anxiety 52.42 (17.39) – .34** .39** -.17 -.26* .14 .03
5. Vigilance to pain 48.77 (11.54) – .06 -.15 -.16 .31** -.02
6. Neuroticism 29.01 (9.47) – -.39** -.07 -.17 -.16
7. Extraversion 24.08 (8.75) – .33** -.05 .11
8. Openness 26.93 (8.73) – .15 .11
9. Agreeableness 31.88 (7.36) – -.09
10. Conscientiousness 30.01 (6.98) –
* p .05, ** p .01
J Clin Psychol Med Settings
123
7. catastrophizing and pain anxiety and obtained the highest B
values in predicting these variables. Taking into account
the significant correlation between pain intensity and pain
catastrophizing (potential mediator), pain intensity was
included as a controlled variable in the mediational
analysis.
Pain Catastrophizing as a Mediator Between
Neuroticism and Pain Anxiety
Several regression analyses were performed to explore the
mediation of pain catastrophizing in the relationship
between neuroticism and pain anxiety, controlling for the
effect of pain intensity. In Analysis 1 (path c), both pain
intensity (b = .39, p .001) and neuroticism (b = .36,
p .001) were significant predictors and explained 28% of
the variance in pain anxiety (F2,69 = 15.27, p .001). In
Analysis 2 (path a) in which pain catastrophizing was
entered as the DV, both IVs were significant (pain inten-
sity, b = .23, p .05; and neuroticism, b = .34, p .01)
and explained 16% of the variance (F2,70 = 7.98, p .05).
In Analysis 3 (path b), pain intensity (b = .27, p .001)
and pain catastrophizing (b = .63, p .001) were signifi-
cant predictors and explained 56% of the variance in pain
anxiety (F2,70 = 46.92, p .001). In Analysis 4 (path c’),
pain anxiety was included as the DV (as in Analysis 1), and
pain intensity and pain catastrophizing were entered as
additional IVs with neuroticism. All of them were signifi-
cant predictors (pain intensity, b = .26, p .001; pain
catastrophizing, b = .58, p .001; and neuroticism,
b = .18, p .05) and explained 57% of the variance
(F3,68 = 32.74, p .001). The contribution of neuroticism
to pain anxiety greatly decreased (b from .36 to .18) when
the effect of pain catastrophizing was considered. The
difference between path c and path c’ was significant, as
revealed by the Sobel test (z = 2.86, p .01). The ratio
index (computed by dividing the indirect effect by the total
effect; Jose, 2003) indicated that 53% of the influence of
neuroticism on pain anxiety was mediated by pain
catastrophizing.
Neuroticism as a Moderator Between Impairment
and Pain Catastrophizing
To test for neuroticism as a moderator between impairment
and pain catastrophizing, the cross-product terms neuroti-
cism and impairment were entered in a separate block in a
hierarchical regression analysis, following the entry of
Table 2 Multivariate regression analysis predicting pain catastrophizing, pain anxiety, and vigilance to pain
Dependent variable Independent variable B SEB t Adjusted R2
F
Pain catastrophizing Pain intensity 1.14 .80 1.41 .20 3.43*
Pain duration .18 .41 .44
Neuroticism .49 .15 3.29*
Extraversion -.01 .17 -.11
Openness -.24 .16 -1.53
Agreeableness .33 .17 1.84
Conscientiousness .43 .18 2.38*
Pain anxiety Pain intensity 3.72 1.05 3.53** .38 7.03**
Pain duration .86 .53 1.61
Neuroticism .89 .19 4.55**
Extraversion .22 .22 1.01
Openness -.43 .21 -2.04*
Agreeableness .67 .23 2.85*
Conscientiousness .33 .24 1.40
Vigilance to pain Pain intensity .64 .84 .76 .09 2.01
Pain duration .02 .43 .06
Neuroticism .10 .15 .69
Extraversion -.02 .17 -.11
Openness -.25 .16 -1.47
Agreeableness .60 .18 3.23*
Conscientiousness .06 .19 .35
* p .05, ** p .01
J Clin Psychol Med Settings
123
8. impairment and neuroticism as first-order terms. Signifi-
cant main effects were found for impairment (b = .24,
p .05) and neuroticism (b = .34, p .01). Yet, the
interaction impairment 9 neuroticism was not a significant
predictor of pain catastrophizing (b = .08, p = .449).
Neuroticism did not have a significant moderating effect on
the relationship between impairment and pain
catastrophizing.
Neuroticism as a Moderator Between Impairment
and Pain Anxiety
To explore neuroticism as a moderator, we tested whether
the interaction impairment 9 neuroticism was a signifi-
cant predictor of pain anxiety, after controlling the influ-
ence of impairment and neuroticism. Significant main
effects were observed for impairment (b = .23, p .05)
and neuroticism (b = .39, p .001). An effect close to
statistical significance was observed in the impair-
ment 9 neuroticism interaction (b = .20, p = .06),
revealing that the link between impairment and pain anx-
iety is probably moderated by neuroticism. The overall
model explained 21% of the variance in pain anxiety
(F3,68 = 7.36, p .01).
Figure 1 shows the interaction between impairment and
neuroticism. The low, medium and high levels (for both
impairment and neuroticism) were computed using the
mean as the medium value, considering 1 SD below the
mean as the low value and 1 SD above the mean as the high
value (following Aiken & West, 1991). Simple slopes for
the medium-neuroticism line (t70 = 2.20, p .05) and
high-neuroticism line (t70 = 2.86, p .01) were signifi-
cant. Results suggest that the pain anxiety level remained
stable in the low neuroticism group under low, medium and
high impairment conditions. However, in the medium and
high-neuroticism groups, pain anxiety level increased sig-
nificantly in the medium and high impairment conditions.
Discussion
The present study aimed to clarify the relationship between
pain appraisal (pain catastrophizing, pain anxiety, and
vigilance to pain), personality, and impairment in FM
taking into account the fear-avoidance model of pain and
the big five personality model. A number of interesting
findings were observed. First, there was a strong relation-
ship between cognitive-affective factors of pain and per-
sonality styles. The tendency to make catastrophic
appraisals of pain was positively related to neuroticism and
negatively related to extraversion; the tendency to experi-
ence pain stimuli-related anxiety was positively related to
neuroticism and negatively related to openness; and the
tendency to focus attention on painful sensations was
positively related to agreeableness. Second, personality
traits accounted for a substantial proportion of the variance
in pain catastrophizing and pain anxiety. Neuroticism was
the most important predictor in both cognitive-affective
factors. Third, personality traits did not contribute signifi-
cantly to vigilance to pain. Fourth, the effect of neuroticism
upon pain anxiety was mediated by pain catastrophizing,
and neuroticism showed a trend to moderate the relation-
ship between impairment and pain anxiety.
The cognitive-affective factors of pain seem to be dif-
ferentially related to personality. Pain catastrophizing and
pain anxiety are associated with a neurotic personality style
characterized by a tendency to experience more negative
emotions and adhere to dysfunctional beliefs, and less
ability to control impulses and cope with stress. This result
agrees with previous empirical evidence, which suggests
that neuroticism in chronic pain patients is a significant
predictor of maladaptive behavioral manifestations of pain
(Lauver & Johnson, 1997) and is associated to greater use
of passive coping strategies and higher pain intensity
(Ramı´rez-Maestre, Lo´pez-Martı´nez, & Esteve-Zaragoza,
2004). It has also been found that interpersonally distressed
pain patients show higher levels of neuroticism than
adaptive coping pain patients (Nitch & Boone, 2004).
The present findings agree with those reported by
Goubert et al. (2004) and Muris et al. (2007), who revealed
that neuroticism (and similar temperamental traits) are
closely related to the tendency to interpret the meaning of
painful sensations in an extreme and dysfunctional way.
This personality trait may be a significant factor that pre-
disposes individuals to have a worse general health per-
ception and react in an extreme and dysfunctional way to
physical discomfort, including pain. In fact, some authors
Fig. 1 Moderating role of neuroticism in the relationship between
impairment and pain anxiety
J Clin Psychol Med Settings
123
9. have argued that neuroticism may not simply reflect over-
reporting of physical complaints but can also be seen as a
potential vulnerability factor to poor health (Johnson,
2003). This trait has also been found to predispose indi-
viduals to psychological distress and not to show positive
emotions, which in turn may lead to medically unexplained
symptoms (De Gucht, Fischler, & Heiser, 2004).
Interestingly, our findings suggest that neuroticism
(negative affectivity) was the greatest contributor to both
pain catastrophizing and pain anxiety. The present study
also found that 53% of the influence of neuroticism on
pain anxiety was mediated by pain catastrophizing. This
finding is consistent with the ‘‘fear-avoidance’’ model of
pain developed by Leeuw et al. (2007). The present results
agree with previous studies that showed that pain catas-
trophizing and pain-related fear mediated the relationship
between neuroticism and vigilance to pain (Goubert et al.,
2004). However, they differ from those reported by
Asghari and Nicholas (2006), who found, in a prospective
study with chronic pain patients, that neuroticism was not
a significant predictor of residualized change in catastro-
phizing over time. The present data also differ from those
reported by Goubert et al. (2004), who observed that
neuroticism predicted vigilance to pain. It should be noted
that the present study did not analyze exactly the same
paths as those reported by Goubert et al., that it did not
use the prospective design by Asghari and Nicholas, and
that none of these studies included FM patients. Addi-
tionally, we observed that neuroticism is probably a sig-
nificant moderator in the relationship between impairment
in daily functioning and anxiety responses associated to
painful stimuli: pain anxiety tends to be more marked at
higher levels of impairment when neuroticism is high.
This result is in line with the study performed by Goubert
et al. (2004), who found that neuroticism moderated
the relationship between pain severity and pain
catastrophizing.
The fact that neuroticism shows a trend to moderate the
relationship between impairment and pain anxiety but not
between impairment and pain catastrophizing may be
explained considering that pain anxiety involves a more
severe stage than pain catastrophizing in the spiral of fear-
avoidance. The PASS-20 assesses a broad construct that
includes alarmist appraisal of pain (like the PCS), but also
avoidance and escape strategies of coping with pain, and
physiological anxiety responses. Therefore, when faced
with the functional limitations associated with his/her dis-
ease, a FM patient with a neurotic personality style may
tend to respond in a maladaptive way at multiple levels
(cognitive, behavioral, or physiological), reflecting a
greater degree of pain anxiety. Further studies are needed
to explain the hierarchical relationship between the cog-
nitive-affective factors associated with pain.
The present findings indicate maladaptive aspects of
neuroticism, which is consistent with the abovementioned
studies and evidence that show that this personality trait is
associated with many psychological and physical problems
(see review by Lahey, 2009). However, neuroticism as a
strategy may have an adaptive value. According to Watson
and Casillas, (2003), extremely low levels of neuroticism
increase individual’s vulnerability to several types of
threat, so neuroticism may play an active and beneficial
role in health-related awareness.
The present research considers pain catastrophizing as
an appraisal process, however, different theoretical con-
ceptualizations of pain catastrophizing have been proposed.
For example, the communal coping model suggests that
catastrophizing represents an interpersonal strategy to cope
with pain (Sullivan et al., 2001). Catastrophizers may
exaggerate pain expression to obtain proximity, assistance
and support from others, thereby heightening pain experi-
ence and making difficult adaptation to pain. According to
this model, solicitous or reinforcing responses from others
may contribute to maintain the exaggerated pain expression
of catastrophizers.
The present study also highlighted the role of other
personality dimensions such as conscientiousness, open-
ness, and agreeableness in pain appraisal. The findings
show that a high level of conscientiousness (characterized
by a tendency to plan, persistence, control, and motivation
in goal-directed behavior) is a significant predictor of pain
catastrophizing. This finding differs from those reported by
Goubert et al. (2004), who found that conscientiousness
was not a significant predictor of pain catastrophizing but
of vigilance to pain. Some studies have shown that the
relationship between this personality trait and health is
influenced by gender differences. For example, conscien-
tious women report more lumps or growths while consci-
entious men report less depression and constipation as
well as better general health perception and more vitality
(Jerram & Coleman, 1999).
Our study revealed that a low level of openness to
experience is closely related to pain-related anxiety and
predicts a significant proportion of variance in this cogni-
tive-affective factor. Individuals with lower levels of
intellectual curiosity, creativity, and open-mindedness to
fantasy, internal feelings, news activities, values, etc., show
a greater tendency to react anxiously to painful stimuli.
This is in line with some reports that suggest high openness
is associated with positive appraisals to health (Jerram &
Coleman, 1999; Nitch & Boone, 2004).
We observed that a high level of agreeableness (char-
acterized by a tendency to be altruistic, cooperative and
helpful towards others) was a significant predictor of pain
anxiety. Similarly, this personality trait was related to
vigilance to pain, explaining a significant proportion of the
J Clin Psychol Med Settings
123
10. variance. It is necessary to consider that these finding may
be showing the alexithymic trends of FM patients. People
with high levels of agreeableness tend to inhibit commu-
nicating negative emotions to others. Previous studies have
reported that FM subjects scored higher on alexithymia
than healthy controls, even when negative affectivity was
considered as a covariate (Brosschot & Aarsse, 2001) and
difficulty identifying feelings is the dimension of alexi-
thymia most closely associated with FM (Sayar, Gulec, &
Topbas, 2004). This is consistent with the well-known
difficulty of patients with somatoform pain to communicate
their emotions and pain experiences (Cox, Kuch, Parker,
Shulman, & Evans, 1994). It is noteworthy, however, that
findings on agreeableness differ from those obtained in
previous studies (Jerram & Coleman, 1999).
Although several studies have supported the role of
catastrophizing as a cognitive vulnerability-stress factor
related to emotional distress in chronic pain patients (Lee,
Wu, Lee, Cheing, & Chan, 2008), this study suggests that
other more basic personality traits influence the develop-
ment of these dysfunctional cognitive styles that disrupt
mood and adjustment in FM. Personality is probably an
important factor in the pathophysiology of FM. Studies
about the alterations of the autonomic nervous system and
the HPA axis suggest a contribution of these stress-
response systems in vulnerability to FM or in symptom
expression in FM (Dadabhoy, Crofford, Spaeth, Russell, &
Clauw, 2008). Recent research has analyzed the association
between personality traits and the HPA axis, reporting that
high levels of neuroticism were associated with elevated
levels of evening cortisol in subjects under 75 years old
(Gerritsen et al., 2009). In this context, a marked neurotic
style may influence the way individuals cognitively process
pain-related stimuli, reduce their perceived ability to
manage distress, and predispose individuals with limita-
tions in daily functioning to experience pain anxiety. All
this ultimately leads to exacerbation of disease. Much more
research is needed to understand the vulnerability role of
neuroticism and other personality dimensions in FM.
Limitations and Conclusions
The present study has some limitations. All the measures
used were self-reported. Although the VAS of the SF-MPQ
has good sensitivity and specificity, and these values are
considerably similar to those obtained with dolorimetry
(Marques, Assumpc¸a˜o, Matsutani, Pereira, & Lage, 2008),
in future research, it would be advisable to use a pressure
algometer. The algometer may offer complementary
information to that provided by self-report measures.
Another limitation of our study is the small sample, which
we hope to expand in future studies. This is a preliminary
study within broader research we are currently conducting.
The cross-sectional design did not provide knowledge
about the direction of causality of the relationships
explored. In addition, since only one pain sample was used,
it was not possible to determine whether the findings were
specific to FM or would have also been identified in other
chronic pain problems. Patients in this study came from a
FM association and may have different clinical character-
istics (including perception of pain and ability to manage
it) from those observed in patients of rheumatology ser-
vices. In future research, it would be advisable to replicate
the study using a longitudinal design as well as a sample of
patients with different pain conditions from other medical
contexts.
Lastly, the combination of personality traits may explain
some of the differences observed between studies. It would
be useful for future studies to explore in FM patients with
high-neuroticism whether agreeableness, openness, and
conscientiousness are associated with worse perception of
physical health. It would also be important to study whe-
ther the role of these personality traits is due to some
specific facets of the traits and can be modulated by vari-
ables such as sex, health status, pain intensity, and so on.
Additional studies are needed to clarify the conditions
under which the big five factors influence the experience of
pain.
Our findings have relevant practical implications.
Keeping in mind the heterogeneity of FM patients, it
would be very useful to assess personality traits that
predispose individuals to have a greater risk of experi-
encing pain as threatening and fearful. Early identification
of FM patients with high levels of these traits seems
crucial, given that such patients could greatly benefit from
therapies focused on changing dysfunctional attitudes
toward pain. This is relevant to successfully preventing
disability. Several reviews have reported that cognitive-
behavioral interventions are effective in reducing fear-
avoidance beliefs in chronic pain (Lohnberg, 2007) and
catastrophizing in FM (Glombiewski et al., 2010), how-
ever, it is unknown how personality traits influence the
efficacy of this type of intervention. Considering our
findings, neuroticism might modulate the degree of change
in pain anxiety of FM patients and might therefore be a
useful predictor of treatment outcomes. Future research
analyzing the relationship between personality traits and
the fear-avoidance model in greater depth is needed to
improve our understanding of FM and its clinical
management.
Acknowledgments This study is part of a broader research project
financially supported by the Spanish ministry of science and inno-
vation (research project PSI2009-13765PSIC). The authors wish to
thank AGRAFIM (Association of People Affected with FM in Gra-
nada, Spain) for its cooperation in the study.
J Clin Psychol Med Settings
123
11. References
Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and
interpreting interactions. Newbury Park, CA: Sage.
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (4th ed. rev.). Washington, DC: APA
(Spanish translation: Barcelona, Masson, 2002).
Anderberg, U. A., Forsgren, T., Ekselius, L., Marteinsdottir, I., &
Hallman, J. (1999). Personality traits on the basis of the
temperament and character inventory in female fibromyalgia
syndrome patients. Nordic Journal of Psychiatry, 53, 353–359.
Asghari, A., & Nicholas, M. K. (2006). Personality and pain-related
beliefs/coping strategies: A prospective study. Clinical Journal
of Pain, 22, 10–18.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator
variable distinction in social psychology research: Conceptual,
strategic, and statistical considerations. Journal of Personality
and Social Psychology, 51, 1173–1182.
Bazzichi, L., Rossi, A., Massimetti, G., Giannaccini, G., Giuliano, T.,
De Feo, F., et al. (2007). Cytokine patterns in fibromyalgia and
their correlation with clinical manifestations. Clinical Experi-
mental Rheumatology, 25, 225–230.
Branco, J. C., Bannwarth, B., Failde, I., Abello, C. J., Blotman, F.,
Spaeth, M., et al. (2010). Prevalence of fibromyalgia: A survey
in five European countries. Seminars in Arthritis and Rheuma-
tism, 39, 448–453.
Brosschot, J. F., & Aarsse, H. R. (2001). Restricted emotional
processing and somatic attributions in fibromyalgia. Interna-
tional Journal of Psychiatry and Medicine, 31, 127–146.
Buckelew, S. P., Murray, S. E., Hewett, J. E., Johnson, J., & Huyser,
B. (1995). Self-efficacy, pain and physical activity among
fibromyalgia subjects. Arthritis and Rheumatism, 8, 43–50.
Burckhardt, C. S., Jones, K. D., & Clark, S. R. (1998). Soft tissue
problems associated with rheumatic disease. Lippincott’s
Primary Care Practice, 2, 20–29.
Carver, C. S., & Scheier, M. F. (2000). Perspectives on personality
(4th ed.). Needham Heights, MA: Simon & Schuster.
Cook, A. J., Brawer, P. A., & Vowles, K. E. (2006). The fear-
avoidance model of chronic pain: Validation and age analysis
using structural equation modeling. Pain, 121, 195–206.
Costa, P. T., & McCrae, R. R. (1992). NEO-PI-R, Revised NEO
Personality Inventory and NEO Five-Factor Inventory (NEO-
FFI). Psychological Assessment Resources, Inc. Odessa, FL,
(Spanish version: Madrid, TEA Ediciones, 2002).
Cox, B. J., Kuch, K., Parker, J. D., Shulman, I. D., & Evans, R. J.
(1994). Alexithymia in somatoform disorder patients with
chronic pain. Journal of Psychosomatic Research, 38, 523–527.
Crombez, G., Eccleston, C., Van den Broeck, A., Goubert, L., & Van
Houdenhove, B. (2004). Hypervigilance to pain in fibromyalgia:
The mediating role of pain intensity and catastrophic thinking
about pain. Clinical Journal of Pain, 20, 98–102.
Dadabhoy, D., Crofford, L. J., Spaeth, M., Russell, I. J., & Clauw, D.
J. (2008). Biology and therapy of fibromyalgia. Evidence-based
biomarkers for fibromyalgia syndrome. Arthritis Research and
Therapy, 10:211. doi:10.1186/ar2443.
De Gucht, V., Fischler, B., & Heiser, W. (2004). Neuroticism,
alexithymia, negative affect, and positive affect as determinants
of medically unexplained symptoms. Personality and Individual
Differences, 36, 1655–1667.
Garcı´a-Campayo, J., Pascual, A., Alda, M., & Gonza´lez-Ramı´rez, M.
T. (2007). Coping with fibromyalgia: Usefulness of the Chronic
Pain Coping Inventory-42. Pain, 132, S68–S76.
Gerritsen, L., Geerlings, M. I., Bremmer, M. A., Beekman, A. T. F.,
Deeg, D. J. H., Penninx, B. W. J. H., et al. (2009). Personal-
ity characteristics and hypothalamic-pituitary-adrenal axis
regulation in older persons. American Journal of Geriatric
Psychiatry, 17, 1077–1084.
Glombiewski, J. A., Sawyer, A. T., Gutermann, J., Koenig, K., Rief,
W., & Hofmann, S. G. (2010). Psychological treatments for
fibromyalgia: A meta-analysis. Pain, 151, 280–295.
Goubert, L., Crombez, G., & Van Damme, S. (2004). The role of
neuroticism, pain catastrophizing and pain-related fear in
vigilance to pain: A structural equations approach. Pain, 107,
234–241.
Hassett, A. I., Cone, J., Patella, S. J., & Sigal, L. H. (2000). The role of
catastrophizing in the pain and depression of women with
fibromyalgia syndrome. ArthritisandRheumatism,43, 2493–2500.
Herrero, A. M., Ramı´rez-Maestre, C., & Gonza´lez, V. (2008).
Personality, cognitive appraisal and adjustment in chronic pain
patients. Spanish Journal of Psychology, 11, 531–542.
Jerram, K. L., & Coleman, P. G. (1999). The big five personality traits
and reporting of health problems and health behaviour in old age.
British Journal of Health Psychology, 4, 181–192.
Johnson, M. (2003). The vulnerability status of neuroticism: Over-
reporting or genuine complaints? Personality and Individual
Differences, 35, 877–887.
Jose, P. E. (2003). MedGraph-I: A programme to graphically depict
mediation among three variables: The internet version, version
2.0. Victoria University of Wellington, Wellington, New Zea-
land. Retrieved from http://www.victoria.ac.nz/staff/paul-jose-
files/medgraph/medgraph.php.
Jose, P. E. (2008). ModGraph-I: A programme to compute cell means
for the graphical display of moderational analyses: The internet
version, Version 2.0. Victoria University of Wellington, Wel-
lington, New Zealand. Retrieved from: http://www.victoria.ac.
nz/psyc/staff/paul-jose-files/modgraph/modgraph.php.
Kristensen, A. S., Mortensen, E. L., & Mors, O. (2009). The
association between bodily anxiety symptom dimensions and the
scales of the revised NEO Personality Inventory and the
Temperament and Character Inventory. Comprehensive Psychi-
atry, 50, 38–47.
Lachaine, J., Beauchemin, C., & Landry, P.-A. (2010). Clinical and
economic characteristics of patients with fibromyalgia syn-
drome. Clinical Journal of Pain, 26, 284–290.
Lahey, B. B. (2009). Public health significance of neuroticism.
American Psychologist, 64, 241–256.
Lauver, S. C., & Johnson, J. L. (1997). The role of neuroticism and
social support in older adults with chronic pain behavior.
Personality and Individual Differences, 23, 165–167.
Lawrence, R. C., Felson, D. T., Helmick, C. G., Arnold, L. M., Choi,
H., Deyo, R. A., et al. (2008). Estimates of the prevalence of
arthritis and other rheumatic conditions in the United States. Part
II. Arthritis and Rheumatism, 58, 26–35.
La´zaro, C., Caseras, X., Whizar-Lugo, V. M., Wenk, R., Baldioceda,
F., Bernal, R., et al. (2001). Psychometric properties of a Spanish
version of the McGill Pain Questionnaire in several Spanish-
speaking countries. Clinical Journal of Pain, 17, 365–374.
Lazarus, R. S., & Folkman, S. (1984). Stress appraisal and coping.
New York: Springer.
Lee, J. E. (2009). The psychology of pain: The influence of
personality on experimentally-induced pain perception. Disser-
tation Abstracts International: Section B: The Sciences and
Engineering, 70, 1348.
Lee, E.-J., Wu, M.-Y., Lee, G. K., Cheing, G., & Chan, F. (2008).
Catastrophizing as a cognitive vulnerability factor related to
depression in workers’ compensation patients with chronic
musculoskeletal pain. Journal of Clinical Psychology in Medical
Settings, 15, 182–192.
Leeuw, M., Goossens, M. E. J. B., Linton, S. J., Crombez, G.,
Boersma, K., & Vlaeyen, J. W. S. (2007). The fear-avoidance
J Clin Psychol Med Settings
123
12. model of musculoskeletal pain: Current state of scientific
evidence. Journal of Behavioral Medicine, 30, 77–94.
Lohnberg, J. A. (2007). A review of outcome studies on cognitive-
behavioural therapy for reducing fear-avoidance beliefs among
individuals with chronic pain. Journal of Clinical Psychology in
Medical Settings, 14, 113–122.
Malt, E. A., Olafsson, S., Lund, A., & Ursin, H. (2002). Factors
explaining variance in perceived pain in women with fibromy-
algia. BMC Musculoskeletal Disorders, 3, 12. doi:10.1186/14
71-2474-3-12.
Manga, D., Ramos, F., & Mora´n, C. (2004). The Spanish norms of the
NEO five-factor inventory: New data and analyses for its
improvement. International Journal of Psychology and Psycho-
logical Therapy, 4, 639–648.
Marques, A. P., Assumpc¸a˜o, A., Matsutani, L. A., Pereira, C. A. B., &
Lage, L. (2008). Pain in fibromyalgia and discriminative power
of the instruments: Visual analog scale, dolorimetry and the
McGill Pain Questionnaire. Acta Reumatologica Portuguesa, 33,
345–351.
Masedo, A. I., & Esteve, R. (2000). Some empirical evidence
regarding the validity of the Spanish version of the McGill Pain
Questionnaire (MPQ-SV). Pain, 85, 451–456.
Mcallister, M. J. (2000). The unvanquished: Prevalence of moral
masochistic personality characteristics in persons with fibromy-
algia. Dissertation Abstracts International Section B: The
Sciences and Engineering, 61, 540.
McCracken, L. M. (1997). ‘Attention’ to pain in persons with chronic
pain: A behavioural approach. Behaviour Therapy, 28, 271–284.
McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain
Anxiety Symptoms Scale (PASS-20): Preliminary development
and validity. Pain Research and Management, 7, 45–50.
Melzack, R. (1987). The short form McGill Pain Questionnaire. Pain,
30, 191–197.
Miro´, E., Lupia´n˜ez, J., Hita, E., Martı´nez, M. P., Sa´nchez, A. I., &
Buela-Casal, G. (2011). Attentional deficits in fibromyalgia and
its relationships with pain, emotional distress and sleep dys-
function complaints. Psychology and Health, 26, 765–780.
Muris, P., Meesters, C., Van den Hout, A., Wessels, S., Franken, I., &
Rassin, E. (2007). Personality and temperament correlates of
pain catastrophizing in young adolescents. Child Psychiatry and
Human Development, 38, 171–181.
Neumann, L., & Buskila, D. (2003). Epidemiology of fibromyalgia.
Current Pain and Headache Reports, 7, 362–368.
Nicassio, P. M., Schuman, C., Radojevic, V., & Weisman, M. H.
(1999). Helplessness as a mediator of health status in fibromy-
algia. Cognitive, Therapy and Research, 23, 181–196.
Nishikai, M., Tomomatsu, S., Hankins, R. W., Takagi, S., Miyachi,
K., Kosaka, S., et al. (2001). Autoantibodies to a 68/48 kDa
protein in chronic fatigue syndrome and primary fibromyalgia: A
possible marker for hypersomnia and cognitive disorders.
Rheumatology, 40, 806–810.
Nitch, S. R., & Boone, K. B. (2004). Normal personality correlates of
chronic pain subgroups. Journal of Clinical Psychology in
Medical Settings, 11, 203–209.
Osman, A., Barrios, F. X., Gutierrez, P. M., Kopper, B. A., Merrifield,
T., & Grittman, L. (2000). The Pain Catastrophizing Scale:
Further psychometric evaluation with adult samples. Journal of
Behavioral Medicine, 23, 351–365.
Paine, P., Kishor, J., Worthen, S. F., Gregory, L. J., & Aziz, Q.
(2009). Exploring relationships for visceral and somatic pain
with autonomic control and personality. Pain, 144, 236–244.
Pamuk, O. N., & Cakir, N. (2007). The frequency of thyroid
antibodies in fibromyalgia patients and their relationship with
symptoms. Clinical Rheumatology, 26, 55–59.
Pe´rez-Pareja, J., Sese´, A., Gonza´lez-Ordi, H., & Palmer, A. (2010).
Fibromyalgia and chronic pain: Are there discriminating patterns
by using the Minnesota Multiphasic Personality Inventory-2
(MMPI-2)? International Journal of Clinical and Health
Psychology, 10, 41–56.
Quartana, P. J., Campbell, C. M., & Edwards, R. R. (2009). Pain
catastrophizing: A critical review. Expert Review of Neurother-
apeutics, 9, 745–758.
Ramı´rez-Maestre, C., Esteve, R., & Lo´pez, A. E. (2008). Cognitive
appraisal and coping in chronic pain patients. European Journal
of Pain, 12, 749–756.
Ramı´rez-Maestre, C., Lo´pez-Martı´nez, A. E., & Esteve-Zaragoza, R.
(2004). Personality characteristics as differential variables of the
pain experience. Journal of Behavioral Medicine, 27, 147–165.
Ramı´rez-Maestre, C., & Valdivia, Y. (2003). Evaluacio´n del funcio-
namiento diario en pacientes con dolor cro´nico [Evaluation of
daily functioning in patients with chronic pain]. Psicologı´a
Conductual, 11, 283–291.
Roelofs, J., McCracken, L., Peters, M. L., Crombez, G., van
Breukelen, G., & Vlaeyen, J. W. S. (2004). Psychometric
evaluation of the Pain Anxiety Symptoms Scale (PASS) in
chronic pain patients. Journal of Behavioral Medicine, 27,
167–183.
Roelofs, J., Peters, M. L., McCracken, L., & Vlaeyen, J. W. S. (2003).
The Pain Vigilance and Awareness Questionnaire (PVAQ):
Further psychometric evaluation in fibromyalgia and other
chronic pain syndromes. Pain, 101, 299–306.
Ross, R. L., Jones, K. D., Bennett, R. M., Ward, R. L., Druker, B. J.,
& Wood, L. J. (2010). Preliminary evidence of increased pain
and elevated cytokines in fibromyalgia patients with defective
growth hormone response to exercise. Open Immunology
Journal, 3, 9–18.
Sa´nchez, A. I., Martı´nez, M. P., Miro´, E., & Medina, A. (2011).
Predictors of the pain perception and self-efficacy for pain
control in patients with fibromyalgia. Spanish Journal of
Psychology, 14, 366–373.
Sayar, K., Gulec, H., & Topbas, M. (2004). Alexithymia and anger in
patients with fibromyalgia. Clinical Rheumatology, 23, 441–448.
Schneider, M. J. (1995). Tender points/fibromyalgia vs. trigger points/
myofascial pain syndrome: A need for clarity in terminology and
differential diagnosis. Journal of Manipulative and Physiolog-
ical Therapeutics, 18, 398–406.
Sullivan, M. J. L., Bishop, S., & Pivik, J. (1995). The Pain
Catastrophizing Scale: Development and validation. Psycholog-
ical Assessment, 7, 524–532.
Sullivan, M. J. L., Thorn, B., Haythornthwaite, J. A., Keefe, F.,
Martin, M., Bradley, L. A., et al. (2001). Theoretical perspec-
tives on the relation between catastrophizing and pain. Clinical
Journal of Pain, 17, 52–64.
Thorn, B. E., Clements, K. L., Ward, L. C., Dixon, K. E., Kersh, B.
C., Boothby, J. L., et al. (2004). Personality factors in the
explanation of sex differences in pain catastrophizing and
response to experimental pain. Clinical Journal of Pain, 20,
275–282.
Trygg, T., Lundberg, G., Rosenlund, E., Timpka, T., & Bjorn, G.
(2002). Personality characteristics of women with fibromyalgia
and of women with chronic neck, shoulder, or low back
complaints in terms of Minnesota Multiphasic Personality
Inventory and defense mechanisms technique modified. Journal
of Musculoskeletal Pain, 10, 33–55.
Turk, D. C., Robinson, J. P., & Burwinkle, T. (2004). Prevalence of
fear of pain and activity in patients with fibromyalgia syndrome.
Journal of Pain, 5, 483–490.
Turner, J. A., & Aaron, L. A. (2001). Pain-related catastrophizing:
What is it? Clinical Journal of Pain, 17, 65–71.
Vearing, A., & Mak, A. S. (2007). Big five personality and effort-
reward imbalance factors in employee’s depressive symptoms.
Personality and Individual Differences, 43, 1744–1755.
J Clin Psychol Med Settings
123
13. Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its
consequences in chronic musculoskeletal pain: A state of the art.
Pain, 85, 317–332.
Watson, D., & Casillas, A. (2003). Neuroticism: Adaptive and
maladaptive features. In E. C. Chang & L. J. Sanna (Eds.),
Virtue, vice, and personality: The complexity of behavior (pp.
145–161). Washington, DC: American Psychological
Association.
Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Katz,
R. S., Mease, P., et al. (2010). The American College of
Rheumatology preliminary diagnostic criteria for fibromyalgia
and measurement of symptom severity. Arthritis Care and
Research, 62, 600–610.
Wolfe, F., Smythe, H. A., Yunus, M. B., Bennet, R. M., Bombardier,
C., Goldenberg, D. L., et al. (1990). The American College of
Rheumatology 1990 criteria for the classification of fibromyal-
gia. Report of the Multicenter Criteria Committee. Arthritis and
Rheumatism, 33, 160–172.
J Clin Psychol Med Settings
123