Individual differences and health in chronic pain: are sex-differences relevant?

Background: Because psychological variables are known to intercorrelate, the goal of this investigation was to compare the unique association between several well-established psychological constructs in pain research and pain-related outcomes. Sex differences are considered because pain is experienced differently across sex groups. Methods: Participants were 456 consecutive chronic pain patients attending a tertiary pain clinic (mean age = 58.4 years, SD = 14.8, 63.6% women). The study design was cross-sectional. Psychological constructs included personality (NEO-Five Factor Inventory), irrational thinking (General Attitudes and Beliefs Scale), and coping (Social Problem Solving Inventory). Outcomes were pain severity and interference (Brief Pain Inventory) and physical, general, and mental health status (Short Form-36). To decide whether the bivariate analyses and the two-block, multivariate linear regressions for each study outcome (block 1 = age, sex, and pain severity; block 2 = psychological variables) should be conducted with the whole sample or split by sex, we first explored whether sex moderated the relationship between psychological variables and outcomes. An alpha level of 0.001 was set to reduce the risk of type I errors due to multiple comparisons. Results: The moderation analyses indicated no sex differences in the association between psychological variables and study outcomes (all interaction terms p > .05). Thus, further analyses were calculated with the whole sample. Specifically, the bivariate analyses revealed that psychological constructs were intercorrelated in the expected direction and mostly correlated with mental health and overall perceived health status. In the regressions, when controlling for age, sex, and pain severity, psychological factors as a block significantly increased the explained variance of physical functioning (ΔR2 = .037, p < .001), general health (ΔR2 = .138, p < .001), and mental health (ΔR2 = .362, p < .001). However, unique associations were only obtained for mental health and neuroticism (β = − 0.30, p < .001) and a negative problem orientation (β = − 0.26, p < .001). Conclusions: There is redundancy in the relationship between psychological variables and pain-related outcomes and the strength of this association is highest for mental health status. The association between psychological characteristics and health outcomes was comparable for men and women, which suggests that the same therapeutic targets could be selected in psychological interventions of pain patients irrespective of sex

How Much Support Is There for the Recommendations Made to the General Population during Confinement? A Study during the First Three Days of the COVID-19 Quarantine in Spain

Background: Recommendations on lifestyles during quarantine have been proposed by researchers and institutions since the COVID–19 crisis emerged. However, most of these have never been tested under real quarantine situations or derive from older investigations conducted mostly in China and Canada in the face of infections other than COVID–19. The present study aimed at exploring the relationship between a comprehensive set of recommended lifestyles, socio–demographic, and personality variables and mood during the first stages of quarantine. Methods: A virtual snow–ball recollection technique was used to disseminate the survey across the general population in Spain starting the first day of mandatory quarantine (15 March 2020) until three days later (17 March). In total, 2683 Spanish adults (mean age = 34.86 years, SD = 13.74 years; 77.7% women) from the general population completed measures on socio–demographic, COVID–related, behavioral, personality/cognitive, and mood characteristics. Results: In the present study, depression and anger were higher than levels reported in a previous investigation before the COVID–19 crisis, while vigor, friendliness, and fatigue were lower. Anxiety levels were comparable. The expected direction of associations was confirmed for the majority of predictors. However, effect sizes were generally small and only a subset of them correlated to most outcomes. Intolerance of unpleasant emotions, neuroticism, and, to a lesser extent, agreeableness, sleep quality, young age, and time spent Internet surfing were the most robust and strongest correlates of mood states. Conclusions: Some recommended lifestyles (i.e., maintaining good quality of sleep and reducing Internet surfing) might be more important than others during the first days of quarantine. Promoting tolerance to unpleasant emotions (e.g., through online, self–managed programs) might also be of upmost importance. So far, recommendations have been made in general, but certain subgroups (e.g., certain personality profiles and young adults) might be especially vulnerable and should receive more attention

Pain Catastrophizing and Its Relationship with Health Outcomes: Does Pain Intensity Matter?

Pain catastrophizing is known to contribute to physical and mental functioning, even when controlling for the effect of pain intensity. However, research has yet to explore whether the strength of the relationship between pain catastrophizing and painrelated outcomes varies across pain intensity levels (i.e., moderation). If this was the case, it would have important implications for existing models of pain and current interventions. The present investigation explored whether pain intensity moderates the relationship between pain catastrophizing and pain-related outcomes. Participants were 254 patients (62% women) with heterogeneous chronic pain. Patients completed a measure of pain intensity, pain interference, pain catastrophizing, and physical and mental health. Pain intensity moderated the relationship between pain catastrophizing and pain interference and between pain catastrophizing and physical health status. Specifically, the strength of the correlation between pain catastrophizing and these outcomes decreased considerably as pain intensity increased. In contrast, pain intensity did not moderate the relationship between pain catastrophizing and mental health. Study findings provide a new insight into the role of pain intensity (i.e., moderator) in the relationship between pain catastrophizing and various pain-related outcomes, which might help develop existent models of pain. Clinical implications are discussed in the context of personalized therapy

Emotion Network Analysis During COVID-19 Quarantine - A Longitudinal Study

The coronavirus disease 2019 (COVID-19) emergency imposed important challenges in the lives of individuals, particularly since the restriction of free movement and limitation of social contact started. This quarantine strategy has been used for centuries because self-isolation can help contain and control the spread of infectious diseases. However, both isolation per se and its uncontrollability have important negative psychological effects on individuals. Previous pandemics, such as those associated with severe acute respiratory syndrome (SARS), have been described as a mental health catastrophe due to the widespread psychopathology associated with the disease (Gardner and Moallef, 2015). In fact, some people become so anxious, distressed, avoidant, and functionally impaired under pandemics that end up requiring treatment due to the development of an emotional disorder (Wheaton et al., 2012). In this sense, although SARS was dangerous for the elderly and medically fragile, the psychological impact of SARS also inflicted a great deal of suffering in terms of the number of people affected by it and its duration (Chang et al., 2004; Washer, 2004). In another study, respondents who had been quarantined, those who worked in high-risk locations such as SARS wards, or individuals who had close friends or relatives who contracted SARS were 2–3 times more likely to have post-traumatic stress symptoms than people with lower exposure levels (Wu et al., 2009). Thus, it seems clear that mental disorders can be triggered or exacerbated by pandemic-related situational stressors (Wu et al., 2005; Gardner and Moallef, 2015; Shultz et al., 2015). However, as evident as the effects of this quarantine during a pandemic in humans can be, we do not fully understand the psychological dynamics of mood during early quarantine stages and its longitudinal changes over the first 20 days of the COVID-19 quarantine period. Being quarantined is a complex psychological phenomenon that is hard to disentangle because there are numerous interactions between emotions and regulatory mechanisms in order to adapt to this strange and threatening new situation (Pfefferbaum and North, 2020; Suso-Ribera and Martín-Brufau, 2020). Cross-sectional studies fall short to investigate the psychological adaptation to quarantine and even pre-post studies have limitations in understanding what happens during the adaptation process (Brooks et al., 2020; Wang et al., 2020). For these reasons, longitudinal research seems to be the gold standard methodology to monitor these trajectories when attempting to better understand human psychological responses to pandemics. In addition and in contrast to the simplistic view of “one-size-fits-all” stress response to a potential traumatic situation, different trajectories have been proposed during the 2003 SARS outbreak using a latent class approach, namely, recovery, resilient, delayed, and chronic responses (Bonanno et al., 2008). To better understand these responses, a complex longitudinal analysis is needed to understand the variation and mutual influences of emotional network dynamic patterns during the early stages of the adaptation response to quarantine. This requires a new framework different to a latent approach. Following an affective provocation, emotions interact as a dynamic and time-dependent system (Davidson, 2015). This network of emotions changes as a result of internal and external factors (Frijda, 2007). These fluctuations better characterize emotional response than mean levels of emotions (Kuppens et al., 2007; Sperry and Kwapil, 2019) and can be used to predict mood psychopathology (Wichers et al., 2015; Sperry et al., 2020). In fact, emotion dynamics may be key to understand pathways to psychopathology and well-being (Wichers et al., 2015). For these reasons, to study emotion fluctuations as a dynamic temporal network offers a good opportunity to study the response to stressful situations and increase our understanding of basic emotional responses and could suggest sooner and more successful interventions in the future. The new field of network psychometrics has been used in recent years to investigate the complex structure of various psychiatric disorders (Fried, 2017), including depression (Fried et al., 2016), psychosis (Isvoranu et al., 2016), schizophrenia (Levine and Leucht, 2016), and anxiety (Beard et al., 2016), among others. The network perspective offers a novel way of understanding the dynamics of psychopathology (Borsboom, 2017). In contrast to viewing symptoms as reflective of underlying latent categories or dimensions, network analysis conceptualizes symptoms as constitutive of mental states, not reflective of them (McNally, 2016). At the heart of the theory lies the notion that psychopathological symptoms are causally connected through myriads of biological, psychological, and societal mechanisms. If these causal relations are sufficiently strong, symptoms can generate feedback that maintains symptomatology. In this case, the network can become stuck and develop into a disorder state (Borsboom, 2017). Ultimately, network analysis is a form of time-series analysis that has been recommended for its use in complex models where interactions between system components (e.g., different mood states) need to be modeled. This is done by graphically representing the interactions among system elements by means of edges and nodes (Gao et al., 2016). Thus, mood changes could be studied as networks, and this methodology could detect complex interactions between mood states over time that would be otherwise undetectable using pre–post methodology. Repeated short-term assessments can detect variations in the presence and severity of states and reveal dynamic processes between them (Ebner-Priemer and Trull, 2009; Myin-Germeys et al., 2009; Bolger and Laurenceau, 2013). Network models can be used to investigate such dynamic processes in repeated assessment data from one participant [vector autoregression models (VARs)] or data from multiple participants (multilevel VAR; Epskamp et al., 2016). These models produce temporal networks depicting a directed network of the lagged associations of symptoms from one time point to the next for which Granger causal connections between symptoms are inferred (Schuurman et al., 2016). Temporal networks can then be used to identify symptoms with a high “out-strength,” that is, symptoms that are most predictive of other symptoms at the next time point (Epskamp et al., 2016). The study of mood and its temporal evolution is important for several reasons. Moods, for example, are different to emotions in a number of characteristics, including the fact that they last longer (Ekman and Davidson, 1994). In fact, moods can have an impact on emotions (i.e., they lower the threshold that is required to trigger an emotion) (Thorndike et al., 1991). Therefore, moods can predispose individuals to experience situations in a certain manner, which can ultimately impact the way they cope with stressors (Berrocal and Extremera, 2008), such as being quarantined. Research into the determinants of mood states has been dominated by personality theories. For example, personality models like the five-factor model have shown that individuals high in neuroticism tend to present more unstable mood states (e.g., emotionality) and tend to be dominated by negative mood states (e.g., sadness and anxiety), while extraverted individuals tend to report more positive mood states (e.g., vigor; Garrity and Demick, 2001). The literature has shown, however, that mood states are influenced not only by internal factors (i.e., personality) but also by external elements (e.g., stress; Kudielka et al., 2004). As noted earlier, such changes in mood are important as they can lead to differential adaptation to adverse environments as they predispose to certain emotional states and coping efforts (Catanzaro and Mearns, 1999). During the COVID-19 pandemic, several calls have been made to better understand the impact of the quarantine, an external stressor, on the mood status of individuals across time (Brooks et al., 2020; Lima et al., 2020). To do so, we would need to compare mood during the quarantine with mood prior to the quarantine. In the present study, however, only data after the quarantine were obtained, with the intention to explore how mood states develop over time under such strange situations using complex interaction statistical methods to study the evolution of networks of mood states under a pandemic, which can inform about human adaptation mechanisms under stressful conditions. Thus, the aim of this study was to explore the psychological dynamics of mood changes during the first stages of the COVID-19 quarantine in a sample of Spanish individuals from the general population using longitudinal data in a multilevel framework

The role of women's traditional gender beliefs in depression, intimate partner violence and stress: insights from a Spanish abbreviated multicultural measure

Background: Research on traditional gender beliefs has highlighted their psychological impact and social implications for women. The purpose of this study was twofold. First, we aimed to adapt and validate the Spanish version of the Multicultural O’Kelly Women’s Beliefs Scale. Next, we explored its sources of validity evidence in relation to intimate partner violence, stress, and depression. Based on the Rational Emotive Behavior Therapy framework, traditional gender beliefs were expected to be associated with higher levels of intimate partner violence, stress and depression. We also expected to obtain a psychometrically-sound factor structure of the Multicultural O’Kelly Women’s Beliefs Scale. Methods: A sample of Spanish women (N = 322) completed the Multicultural O’Kelly Women’s Beliefs Scale, the Beck’s Depression Inventory II, the Modified Conflict Tactics Scale, and the Stress Perceived Scale. To test the psychometric properties of the Multicultural O’Kelly Women’s Beliefs Scale we implemented exploratory and confirmatory factor analyses and an analysis of the area under the curve. Results: Regarding the psychometric properties of the scale, statistical analysis revealed a one-factor dimensionality (Global traditionalism) and supported a reduction of items in the original instrument. The abbreviated version (eight items) obtained the best fit indices. Considering the association between traditional gender beliefs and psychological outcomes, we found that traditional gender beliefs were associated with increased severity of stress, depressive symptoms and reciprocal verbal aggression. Conclusion: The Spanish adaptation of the Multicultural O’Kelly Women’s Beliefs Scale provided a very short, psychometrically robust and clinically relevant measure of traditional gender beliefs. In addition to the association between traditional gender beliefs and mental health outcomes, an important finding was the relationship between traditional gender beliefs and intimate partner violence. Our scale might be used in clinical settings by helping women to identify their traditional gender beliefs and replace them by healthy and goal-oriented beliefs, which would also contribute in achieving a more egalitarian society

Development and psychometric properties of a new measure of irrational thinking: The Scale of Irrational Contents and Styles-Basics (SICS-B)

Objectives: Analyze the psychometric properties of a new measure for the assessment of the irrational beliefs proposed by Ellis in his model of Rational-Emotive-Behavioral Therapy (REBT): the Scale of Irrational Contents and Styles - Basics (SICS-B). The SICS-B evaluates the 'contents' of the three basic irrational beliefs (Ap: Approval, Pe: Perfectionism, and Co: Comfort) in relation to the four different 'styles' (inferences or processes of thought) in which they can be expressed (DEM: Demandingness, AWF: Awfulizing, FI: Frustration Intolerance, and CON: Condemnation). Methods: Participants: 259 respondents (79.5% women) undergraduates (63%) and (post)graduates (37%) between 18-63 years (M=26.5, SD=10.7). Procedure: A set of 72 statements were drafted (half in a rational way) using a 5-point Likert scale to cover the three areas of content and the four styles of irrational thinking (3x4 subscales), of which to choose the three items of each area with highest psychometric indices and elaborate with them the definitive scale of 36 items. Psychometric Analysis: The reliability and validity study was carried out through a comparative item analysis (average inter-item correlations, item-total correlations) and internal consistency (Ordinal α) of each subscale, and confirmatory factor analyses of several models. Results: The SICS-B presents good indices of internal consistency and content validity. Confirmatory factor analyses validate the 3x4 model in which the three specific contents of the irrational beliefs are integrated with the four main styles of irrational thinking as proposed by the REBT. Conclusions: The SICS-B is a reliable and valid short scale for the assessment of irrational beliefs

A reduction in pain intensity is more strongly associated with improved physical functioning in frustration tolerant individuals: a longitudinal moderation study in chronic pain patients

Objective: the onset and chronification of pain often has devastating consequences on the physical and mental functioning of individuals. Medical interventions are quite efficacious in reducing pain levels. However, changes in physical and mental health status after medical interventions are not proportional. In the past decades, rational/irrational beliefs, especially catastrophizing, have contributed to a better understanding of the pain experience. This study explores whether pain reduction efforts are more beneficial for individuals scoring high in rational thinking (moderation). Methods: the study design was longitudinal. Patients were assessed twice, 2 weeks prior to the start of medical treatment at the pain clinic and 6 months after. A total of 163 patients with heterogeneous pain (mostly low back and neck pain) participated in the study. Their mean age was 58.74 years (SD = 14.28) and 61.3% were female. Results: Overall, there was a reduction in pain intensity (t = 4.25, p < 0.001, d = 0.32). An improvement in physical functioning (t = 4.02, p < 0.001, d = 0.19), but not mental health (t = -0.66, p = 0.511, d = 0.11) was also observed. In the regression analyses, a decrease in pain intensity was moderately associated with improved physical health (beta = 0.87, t = 4.96, p < 0.001, R-2 change = 0.177). This association was found to be moderated by frustration tolerance (beta = -0.49, t = -2.80, p = 0.006, R-2 change = 0.039). Specifically, post hoc analyses indicated that changes in pain intensity only correlated with changes in physical health when patients reported high frustration tolerance levels (r = 0.47, p = 0.006, M = 7, n = 32), but not when patients were intolerant to frustration (r = 0.28, p = 0.078, M = 17, n = 41). Conclusion: the results suggest that frustration tolerance may render adaptive by facilitating the positive effect that a reduction in pain intensity has on physical health status. The study findings are discussed in the context of personalized therapy with an emphasis on how to maximize the effectiveness of current interventions for pain

The impact of chronic pain on patients and spouses: Consequences on occupational status, distribution of household chores and care‐giving burden.

Background: Informal care-giving by spouses has become frequent in chronic pain settings. However, the impact of pain on occupational, functional and health out-comes in spouses has not been systematically investigated.Aims: The goal of the present study was to examine the impact of pain on both pa-tient and spousal outcomes.Methods: In the present study, the impact of chronic pain on 114 heterosexual dyads was explored (patients: 59% females, average age=57.81years, SD=11.85; spouses: 41% females, average age=57.32years, SD=12.15).Results: Overall, both patients and spouses reported important consequences of pain on outcomes, including occupational status distribution of household chores and marital satisfaction). Almost 52% of spouses indicated a high-to-severe burden. A multivariate model with spouse and patient factors accounted for 37.8% of the vari-ance of this burden. In the model, patient disability (=0.36, p=.002), spouses’ change in occupational status (=0.26, p=.002) and spousal perception of marital adjustment (=−0.36, p<.001) were uniquely associated with burden.Conclusions: The results indicate that the impact of chronic pain should be evalu-ated both for patients and spouses and point to patient and spouse factors that might contribute to spousal burden, which might help guide family interventions in a more effective manner.Significance: Research has shown that chronic pain poses a significant burden on individuals, which increases their reliance on others for assistance. However, the bur-den of informal care-giving assumed by spouses of patients with chronic pain has not been systematically investigated. This study offers new insights into the impact of chronic pain on patients and their spouses, which might provide empirical foundation for the development of new avenues for intervention aimed at promoting adjustment in patients with chronic pain and spouses who act as informal caregivers

Associations of Cognitive Fusion and Pain Catastrophizing with Fibromyalgia Impact through Fatigue, Pain Severity, and Depression: An Exploratory Study Using Structural Equation Modeling

Differences in fibromyalgia impact on functioning exist and appear to be influenced by numerous factors, including symptomatology severity, as well as the cognitive profile of the individual. The contribution of these elements, however, tends to be explored in a fragmented manner. To address this issue, we tested a comprehensive structural equation model in which associations of cognitive fusion and pain catastrophizing with function limitations are investigated through fibromyalgia symptomatology (i.e., fatigue, pain severity, and depression) in 231 women with fibromyalgia. In the model, cognitive fusion and two catastrophizing components (magnification and helplessness) were associated with poorer functioning indirectly through fibromyalgia symptomatology. Only the rumination component of catastrophizing had a direct association with functional limitations. All fibromyalgia symptoms were linked to increased functional limitations. A parsimonious model with significant associations only obtained an excellent fit (S-B χ2 = 774.191, df = 543, p < 0.001; CFI = 0.943; RMSEA = 0.043; CAIC = −2724.04) and accounted for 50% of the variance of functional limitations. These results suggest that the relationship between psychological cognitive processes, fibromyalgia symptomatology, and functional limitations is complex and support the need for comprehensive models such as the present. The findings are discussed in the context of personalized psychological treatments (i.e., the need to address certain cognitive processes according to the problematic symptomatology or outcome)

Development and validation of the alcohol Expectancy Questionnaire Short Form (EQ-SF)

Las expectativas sobre los efectos del alcohol son una variable proximal al consumo de alcohol. Uno de los instrumentos más usados y recomendados para evaluar este constructo es el Expectancy Questionnaire (EQ; Leigh y Stacy, 1993). El objetivo es desarrollar una versión corta del EQ (EQ-SF) útil para administraciones en las que el tiempo de evaluación es reducido. Dos muestras, una de adolescentes (N = 514, 57,20% mujeres) y una de adultos (N = 548, 61,50% mujeres), completaron el EQ y diversas medidas sobre consumo de alcohol. Se utilizaron diversas estrategias para seleccionar los 24 ítems. Se exploró la estructura del EQ-SF mediante análisis factoriales confirmatorios y la invarianza de medida entre sexos y grupos de edad realizando análisis multigrupo. Se calculó la fiabilidad de las escalas mediante el alfa de Cronbach y el coeficiente omega, y la validez concurrente a través de análisis de regresión. La invariancia entre grupos fue aceptable. Los coeficientes alfa y omega iban de ,77 a ,93. Las expectativas positivas predijeron la cantidad de alcohol consumida y los problemas derivados del consumo, mientras que las negativas predijeron los problemas derivados. Sexo y edad moderaron estas asociaciones. Los hombres con elevadas expectativas positivas bebían más que las mujeres, mientras que los adultos con elevadas expectativas negativas mostraron mayores problemas derivados del consumo que los adolescentes. Las diferentes fuentes de evidencia sobre la validez y fiabilidad del EQ-SF sugieren que es un instrumento adecuado para evaluar las expectativas sobre los efectos del alcohol en población española.Alcohol expectancies are proximal variables to alcohol use and misuse. In recent decades, different measures have been developed to assess this construct. One of the most frequently used and recommended instruments is the Expectancy Questionnaire (EQ; Leigh y Stacy, 1993). Our aim is to develop a short version of the EQ (EQ-SF) for suitable use in time-limited administrations. Two samples, adolescents (N = 514, 57.20% females) and adults (N = 548, 61.50% females), completed the EQ together with alcohol-use measures. Different item selection strategies were applied to select the 24 items. The EQ-SF structure was explored using confirmatory factor analysis, and measurement invariance was tested running a multi-group analysis comparing groups by sex and age. Reliability was tested using Cronbach’s alpha and omega coefficients. Concurrent validity was investigated with regression analyses. The EQ-SF showed acceptable between-groups measurement invariance. Alphas and omegas ranged from .77 to .93. Positive expectancies predicted both alcohol use and alcohol-related problems. Negative expectancies predicted alcohol-related problems. Sex and age moderated these associations. Males with high positive alcohol expectancies showed higher alcohol consumption than females, while adults with high negative alcohol expectancies showed greater alcohol-related problems than adolescents. Different evidence on the validity and reliability of the EQ-SF suggest that it is a suitable instrument to assess alcohol expectancies in the Spanish population