Parental injustice appraisals in the context of child pain: examining the construct and criterion validity of the IEQ-Pc and IEQ-Ps

A growing pediatric and adult literature highlights the role of injustice appraisals in adjustment to pain. However, interpersonal injustice dynamics have remained largely unexplored. The present study investigated the factor structure and criterion validity of parentally adjusted versions of the Injustice Experience Questionnaire, assessing child-oriented (IEQ-Pc) and self-oriented appraisals (IEQ-Ps) in the context of child pain. Participants were triads of healthy children (N = 407, Mage = 12) and both their parents and dyads of children with chronic pain (N = 319, Mage = 14) and 1 parent. In both samples, children completed measures of functional disability and quality of life (physical, emotional, social, and academic); parents completed the IEQ-Pc, IEQ-Ps, and a measure of parental catastrophizing about child pain. Across samples, a confirmatory oblique two-factor model (Severity/Irreparability-Blame/Unfairness) provided a better fit to the data compared to a one-factor model; nevertheless, the two-factor solution was considered suboptimal. A post hoc exploratory factor analysis consistently revealed 1 factor. In terms of criterion validity, the IEQ-Pc and IEQ-Ps demonstrated differential associations depending on the child's pain versus healthy status, independent of parental catastrophizing. Further, findings in the healthy sample indicated that fathers’ self-oriented injustice appraisals related to lower child social function. In the clinical sample, parental child-oriented injustice appraisals related to greater child functional disability and lower physical, emotional, social, and academic function. Current findings support the unique role of parental injustice appraisals, assessed by the IEQ-Pc and IEQ-Ps, in understanding child pain, but also suggest these may only partially capture the phenomenology of parental injustice appraisals in the context of child pain

Interpersonal dynamics and therapeutic relationship in patients with functional somatic syndromes: A metasynthesis of case studies.

Patients with functional somatic syndromes (FSS) often display troubled relationships with health care providers, psychotherapists, and significant others. Research shows that patients' history of trauma, attachment disturbances, and mentalization deficits may result in the emergence of maladaptive interpersonal patterns, which may later contribute to the onset and maintenance of FSS, "doctor hopping." and dropout in psychotherapy. As the nature and therapeutic consequences of such maladaptive interpersonal patterns in FSS cannot be understood sufficiently by quantitative methods alone, there is a need for in-depth qualitative research. To address this issue, we conducted a metasynthesis of 23 published case studies of patients with FSS from various psychotherapeutic orientations. Results show that patients with FSS from our sample perceived others as unreliable, that is. unavailable, overcontrolling, and overprotective. To adapt to such unreliable others. patients attempted to please and to control them. Patients also suppressed their emotional awareness and expression. Although alexithymia could also play a role, the primary reason for emotional avoidance seemed to be interpersonal in nature, that is, patients were avoiding negative emotions in order to please and control the unreliable others. The onset and worsening of FSS were associated with both interpersonal and physical triggers. Showing signs of physical or emotional distress led to more rejection, overcontrol, and overprotection from unreliable others, which could create a "vicious circle." Our results suggest that offering a more interpersonal perspective on emotion regulation difficulties would be beneficial for patients with FSS, counselors, psychotherapists, and other health care professionals

Social integration of adolescents with chronic pain : a social network analysis

Adolescents with chronic pain (ACP) often experience impairments in their social functioning. Little is known about the consequences of these impairments on peer relationships of ACP. This study applied social network analysis to examine whether adolescents with more pain problems are less popular (RQ1), adolescents with similar pain problems name each other more often as being part of the same peer group (RQ2), dyads with an adolescent experiencing more pain problems report less positive (eg, support) and more negative (eg, conflict) friendship qualities (RQ3), and positive and negative friendship qualities moderate the relationship between pain and emotional distress (RQ4). This study used data from the first wave of a longitudinal study (N = 2767) which followed up Swedish adolescents from 19 public schools. For RQ1-3, Multiple Regression Quadratic Assignment Procedure was applied. For RQ4, standard multilevel models with observations of adolescents nested within schools were estimated. Results showed that ACP were not less popular than adolescents without chronic pain. Second, ACP nominated each other more often as being part of the same peer group. Third, results regarding friendship quality showed that adolescents with more pain problems perceived the relationship with their friends as less positive (eg, support) and more negative (eg, conflict) than adolescents with less pain problems. Finally, positive and negative friendship qualities moderated the relationship between pain and emotional distress. This study contributes to the literature on the importance of peer relationships of ACP. Clinical implications and directions for future research are discussed

The impact of maternal child- and self-oriented pain-related injustice appraisals upon maternal attention to child pain, attention to anger, and pain-attending behavior

Objectives The current study investigated the role of maternal child- and self-oriented injustice appraisals about child pain in understanding maternal attention for child pain and adult anger cues and pain-attending behavior. Methods Forty-four children underwent a painful cold pressor task (CPT) while their mother observed. Eye tracking was used to measure maternal attention to child pain and adult anger cues. Initial attention allocation and attentional maintenance were indexed by probability of first fixation and gaze duration, respectively. Maternal pain-attending behaviors toward the child were videotaped and coded after CPT completion. Mothers also rated the intensity of pain and anger cues used in the free-viewing tasks. All analyses controlled for maternal catastrophizing about child pain. Results Neither child-oriented nor self-oriented injustice was associated with maternal attentional bias toward child pain. Regarding attention toward self-relevant anger cues, differential associations were observed for self- and child-oriented injustice appraisals, with maternal self-oriented injustice being associated with a greater probability of first fixating on anger and with higher anger ratings, whereas maternal child-oriented injustice was associated with enhanced attentional maintenance toward anger. Neither type of maternal injustice appraisals was associated with maternal pain-attending behavior, which was only associated with maternal catastrophizing. Conclusions The current study sheds light on potential differential mechanisms through which maternal self- vs. child-oriented injustice appraisals may exert their impact on parent and child pain-related outcomes. Theoretical implications and future directions are discussed

Adherence to the physical distancing measures during the COVID‐19 pandemic : a HAPA‐based perspective

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

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

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