Desire for control, felt control, and stress inoculation training during dental treatment.

Coping style research has typically assessed Ss' desire for a coping resource, but ignored whether Ss possess that resource. In this study 110 dental patients were categorized as to their desire for and feelings of control and were randomly assigned, just prior to dental treatment, to a 20 min Stress Inoculation Training (SIT) session or a Filler condition. SIT significantly reduced pain and increased control only for patients who initially reported a high desire for control coupled with low perceived control. This finding supports the view that the discrepancy between high desire for control and low perceived control plays a causal role in the elevated distress and pain initially reported by patients with such control perceptions. These data indicate that consideration of patients' perceived coping resources as well as their coping preferences adds to our ability to predict reactions to stress reduction manipulations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moderating effects of contextual variables on the relationship between hypnotic susceptibility and suggested analgesia.

Assessed 75 undergraduates high, medium, or low on hypnotic susceptibility (the Carleton University Responsiveness to Suggestion Scale) on the cold pressor task before and after 1 of 3 instructional treatments. The treatments were (a) brief instructions to try to reduce pain, (b) the same analgesia instructions preceded by a hypnotic induction procedure, and (c) no hypnotic induction or instructions. In the hypnotic treatment, susceptibility correlated significantly with reductions in reported pain, and high-susceptible Ss reported significantly larger pain reductions than did control Ss. In the instruction-alone treatment, there was no significant relationship between susceptibility and pain reduction, and Ss at all 3 susceptibility levels reduced reported pain significantly more than did controls and as much as did high-susceptible hypnotic Ss. Findings suggest that the correlation between hypnotic susceptibility and hypnotic analgesia is moderated by Ss' attitudes and expectancies concerning their own performance in situations defined as related to hypnosis. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Baseline pain as a moderator of hypnotic analgesia for burn injury treatment.

Sixty-one patients hospitalized for severe burns were randomly assigned to conditions in which they received either hypnosis or a control condition in which they received attention, information, and brief relaxation instructions from a psychologist. The posttreatment pain scores of the 2 groups did not differ significantly when all patients were considered. However, when a subset of patients who reported high levels of baseline pain were examined, it was found that patients in the hypnosis group reported less posttreatment pain than did patients in the control group. The findings are used to replicate earlier studies of burn pain hypnoanalgesia, explain discrepancies in the literature, and highlight the potential importance of motivation with this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral measurement of thermal pain sensitivity in humans: Effects of stimulus intensity and instructions.

This study validated a human behavioral model of thermal nociception analogous to the rodent tail-flick assay. Effects of instructions and stimulus intensity on behavior (i.e., finger withdrawal latency) were evaluated. Using a repeated measures randomized crossover design, the authors exposed 10 volunteers to varying radiant heat intensities (from 42.2 to 52.2 degrees Celsius) during each of 4 sessions. In the different sessions, participants were told to remove their finger when they felt heat, felt unpleasant, felt pain, or could no longer tolerate pain. Withdrawal latencies significantly decreased as stimulus intensity increased and significantly increased for sensory, affective, pain, and intolerance instructions. Instruction set differences were significantly larger at higher stimulus intensities. this technique may be useful in human psychopharmacological research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of two cognitive strategies on pain threshold.

While 1 arm was immersed in ice water, each of 48 female student nurses were asked either to imagine a situation that, if real, would be inconsistent with pain (relevant strategy) or imagine a situation unrelated to pain (irrelevant strategy), or they were not given special instructions (control group). Ss were further divided into those with high and low pain thresholds based on a pretest. The use of strategies (relevant or irrelevant) did not alter the pain thresholds for Ss with low thresholds. Among those Ss with high thresholds, use of a relevant strategy led to a greater increase in threshold than an irrelevant strategy, which, in turn, led to a greater increase than the control condition. Ss who were highly involved in their imaginings showed greater increases in pain threshold than those who were not. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of instructional set on attributions of nonvolition during hypnotic and nonhypnotic analgesia.

Fifty highly hypnotizable subjects were assigned to four treatment groups or a no-treatment control group and then underwent two pain stimulation trials. Half the treated subjects were administered hypnotic analgesia, half waking analgesia. Within hypnotic and nonhypnotic treatments, half the subjects were given actively worded analgesia instructions, half passively worded instructions. Subjects in the four treated groups reported equivalent pain reduction and equivalent use of coping imagery, although hypnotic subjects rated themselves as more deeply hypnotized than did nonhypnotized subjects. Both hypnotic and nonhypnotic subjects given passive instructions rated their pain reduction as occurring involuntarily, whereas those given active instructions reported that their pain was reduced through their active use of coping strategies. These findings support sociocognitive formulations of hypnotic responding that view ratings of involuntariness as reflecting contextually guided interpretations of behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Severity and impact of pain after day-surgery

PURPOSE: To assess the intensity, duration and impact of pain after day-surgery interventions. Predictors of pain severity were also evaluated along with the quality of analgesic practices and patient satisfaction. METHODS: Eighty-nine consecutive day-surgery patients completed self-administered questionnaires before leaving the hospital and at 24, 48 hr and seven days after discharge. The survey instrument was composed of 0-10 pain intensity scales, selected items of the Brief Pain Inventory, of the Patient Outcome Questionnaire and of the Barriers Questionnaire. Analgesic intake in hospital and at home was recorded along with the use of other pain control methods. RESULTS: Forty percent of the patients reported moderate to severe pain during the first 24 hr after hospital discharge. The pain decreased with time but it was severe enough to interfere with daily activities in a substantial number of patients. The best predictor of severe pain at home was inadequate pain control during the first few hours following the surgery. More than 80% of the participants were satisfied with their pain treatment. However, one patient in four (25%) needed contact with a health care provider because of pain at home. Many patients (33% to 51%) reported that instructions about pain control were either unclear or non-existent on several aspects. Medication use was low overall. Thirty-two percent of the patients did not take any pain medication during the first 24 hr after discharge although almost half of them (46%) rated their pain > or = 4. The most common concerns patients had about using pain medication were fear of drug addiction and side effects. CONCLUSION: The severity and duration of pain after day-surgery should not be underestimated. Aggressive analgesic treatment during the hospital stay should be provided along with take-home analgesia protocols and comprehensive patient education programs.     

Instructional demands and ratings of overt and hidden pain during hypnotic analgesia.

16 highly hypnotizable (Carlton University Responsiveness to Suggestion Scale) undergraduates rated the intensity of cold pressor pain during a baseline trial and again during 3 hypnotic analgesia trials. During each analgesia trial, Ss were instructed to give overt reports that reflected consciously experienced pain and covert reports that reflected the intensity of "hidden" pain. Treatment instructions administered before the 1st analgesia trial did not specify the relationship between overt and covert pain. Instructions given before the remaining 2 analgesia trials indicated that hidden pain would be either more or less intense than overt pain. Until they were given explicit information about the relative intensities of the pain, Ss reported no differences in the magnitude of overt and covert pain, contrary to the dissociation hypothesis of hypnotic analgesia. Consistent with social psychological formulations of the hidden observer phenomenon, Ss reported both higher covert than overt pain and lower covert than overt pain, depending on the instructions they were administered. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction, control, and learned helplessness.

Examined the independent effects of perceived control over and perceived predictability of an aversive event on 100 undergraduates' performance on a memory task and depressive affect. All Ss completed the Multiple Affect Adjective Check List and the Desirability of Control Scale. Ss who received noise blasts that were both uncontrollable and unpredictable displayed performance decrements and depressive affect relative to a no-noise group, whereas Ss who were able either to control or to predict the aversive event did not. The perception of control or predictability concerning the aversive event was thus sufficient to mitigate learned helplessness, suggesting the functional equivalence of perceived control and predictability. Finally, results reveal that Ss high in the "desire for control over events" reacted to the aversive noise more than did Ss low in the desire for control. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Desire for control and achievement-related behaviors.

Tested a model that describes the relation between individual differences in the general desire to control events and performance in achievement-related tasks in 6 experiments with 304 undergraduates. All Ss were administered a desirability of control scale and this variable was tested in relationship to achievement-related behavior (aspiration level, response to challenge, persistence, and attributions for success and failure) outlined in the model. Results show that Ss high in the desire for control displayed higher levels of aspiration, had higher expectancies for their performances, and were able to set their expectancies in a more realistic manner than were Ss low in the desire for control. Ss high in desire for control were also found to respond to a challenging task with more effort and to persist longer at a difficult task than were Ss low in desire for control. Finally, a pattern of attributions for success and failure was uncovered for Ss high in desire for control that has been associated with high achievement levels. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotically induced limb anesthesia and adaptation to displacing prisms: A failure to confirm.

Tested 3 groups of 10 undergraduates for accuracy of pointing at a visual target before and after wearing displacing prisms. One group consisted of highly susceptible Ss given a hypnotic suggestion for limb anesthesia following the pretest, and a 2nd group included low susceptible Ss instructed to fake limb anesthesia. A control group unselected on susceptibility received no special instructions. The high susceptibles reported significantly greater felt anesthesia than Ss in the other 2 treatments. Nevertheless, Ss in all 3 groups showed very large displacement errors (i.e., errors in pointing) following prism removal. Results fail to confirm reports that placement errors were eliminated by hypnotic suggestion in highly susceptible Ss. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do patients receive adequate pain control after discharge from the ED?

Studies on the effectiveness of pain management have uniformly concluded that health care providers underestimate or undertreat pain. In the emergency department (ED) in which this study was conducted, physicians receive formal didactic and bedside teaching on pain recognition and management in order to heighten the awareness of patients' need for pain control. The purpose of this study was to determine if this outpatient pain management of patients with acute, painful conditions is better than that reported in the medical literature. In this prospective study, 110 adult patients who had an acute, painful diagnosis were telephoned 48 hours after discharge from the ED and asked if they felt their pain at home was well controlled. Patient satisfaction with pain control was higher (91%) than that reported in the medical literature. Also, pain medication was provided more frequently by this study's ED (95%). Education on pain awareness and treatment is a way to improve pain management.     

Sticking together or falling apart: In-group identification as a psychological determinant of group commitment versus individual mobility.

Two experiments investigated how in-group identification, manipulated with a bogus pipeline technique affects group members' desire for individual mobility to another group. In the first experiment (N?=?88), the in-group had low status, and group boundaries were either permeable or impermeable. Low identifiers perceived the group as less homogeneous, were less committed to their group, and more strongly desired individual mobility to a higher status group than did high identifiers. The structural possibility of mobility afforded by permeable group boundaries had no comparable effect. The second experiment (N?=?51) investigated whether in-group identification can produce similar effects when relative group status is unknown. Even in the absence of an identity threat, low identifiers were less likely to see the groups as homogeneous, felt less committed to their group, and more strongly desired individual mobility than did high identifiers. Results are discussed with reference to social identity and self-categorization theories. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Desire for control and conformity to a perceived norm.

The role of individual differences in the general desire for control in conformity situations was examined in three experiments. In Experiment 1, undergraduates low in desire for control were more likely to agree with a persuasive message when survey results were cited indicating public support for the advocated view. Subjects high in desire for control, however, were less persuaded by this message than when the survey information was not included. In Experiment 2, subjects gave humor ratings for cartoons in an Asch conformity paradigm. Subjects with low desire for control were more likely to agree with confederate ratings than were those with high desire for control. Experiment 3 results replicated this effect and ruled out the mere presence of others as an alternate interpretation of it. The findings from all three experiments are interpreted as a demonstration of the motivational component of the desire-for-control construct. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Distal 10q trisomy syndrome with unusual cardiac and pulmonary abnormalities

AIM: To evaluate the use of local transdermic anesthetics in fine needle aspiration biopsy (FNAB) in breast lesions. METHODS: Prospective randomized study of 119 patients having breast lesions, all being indicated for FNAB. The patients were divided into three groups: 40 patients entered in the active group (lidocaine + prilocaine); 40 patients underwent the placebo group (aqueous extract of Triticum vulgaris); and a control group of 39 women in whom FNAB was performed without the administration of any substance. Both the anesthetic and placebo were administered an hour before FNAB. Pain was quantified through a visual analogic scale of pain. The type of pain was also classified in terms of occurrence: only during the puncture, only during the movements and both. RESULTS: The visual linear analogic scale of pain showed an average of 3.3 in the active group, 3.5 in the placebo and 4.0 in the control group (NS). Analysis of the type of pain which was referred by the patient showed that 15% of the patients in the active group, 12.5% of those in the placebo group and 5.1% in the control group did not refer to any sensation of pain. Pain, when felt, was similar in all three groups (p < 0.4). CONCLUSIONS: Both the quantification and the type of pain referred to were similar in all three groups. However, there was a tendency of the patient to refer to less pain when the active substance or the placebo were used, when results were compared to the control group.     

Assisted suicide, depression, and the right to die.

The debate surrounding the legalization of assisted suicide continues despite a limited body of empirical research. Relatively few studies have addressed interest in assisted suicide or the desire for hastened death (rather than approval of legalization) among medically ill patients, and this literature is plagued by methodological limitations. In general, this research has demonstrated a significant association between depression and desire for death; however, the magnitude of this association is unclear. Nevertheless, psychological and social factors have typically appeared more influential in determining patients' desire for death than physical symptoms such as pain. The impact of these findings on future legislative efforts to legalize assisted suicide is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Presurgical anxiety and postsurgical pain and adjustment: Effects of a stress inoculation procedure.

Designed and tested a method for preparing surgical patients to actively cope with the stress of hospitalization and surgery. The effects of a stress inoculation procedure on patients' anxiety, pain, and postoperative adjustment were examined. 24 surgery patients (aged 14–62 yrs) were assigned either to a stress inoculation intervention or to a standard hospital instructions control. Results demonstrate the utility of stress inoculation training in providing surgical patients with a self-regulation technique to reduce their experiences of anxiety and pain and improve their postoperative adjustment, including the reduction of reliance on analgesia and number of postoperative recovery days. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

One-footed and externally disturbed two-footed postural control in patients with chronic low back pain and healthy control subjects. A controlled study with follow-up

STUDY DESIGN: A study of postural control during one-footed and externally disturbed two-footed stance among healthy control subjects and patients with chronic low back pain at the beginning of a functional back restoration program and 6 months later at follow-up examination. OBJECTIVES: To study postural control cross-sectionally among control subjects and patients with low back pain, and to evaluate the effects of functional restoration on the postural control parameters in a follow-up examination. SUMMARY OF BACKGROUND DATA: Deficits of motor skills and coordination have been reported in association with musculoskeletal disorders. It has been found that patients with chronic low back pain have impaired psychomotor control, but the impairment is reversible with successful low back rehabilitation. It is insufficiently known how functional activation and intensive physical training affect postural control. METHODS: Sixty-one healthy volunteers (32 men, 29 women) and altogether 99 patients with low back pain participated in the study. Sixty-eight patients (33 men, 35 women) had moderate and 31 (18 men, 13 women) had severe low back pain. Postural stability was measured with a force platform. In two-footed stance, vibration stimulation on calf and back muscles was used to disturb the balance. Center point of force-velocity (cm/sec), average position shift in anteroposterior direction (cm), and maximal position shift in lateral direction (cm) were used as the parameters. RESULTS: Reliability of all tests was acceptable. Center point of force-velocity was the most sensitive parameter and the one-footed measurement the most sensitivetest for evaluating postural stability. At the beginning, the patients with severe low back pain had poorer one-footed postural control compared with the control subjects (P = 0.0003). The subgroup of patients with moderate low back pain participated in the restoration program. The outcome of the restoration program was considered good if the disability because of low back pain (Oswestry index) decreased during the restoration program and poor if the disability increased or did not change. The one-footed postural stability remained primarily at the same level as the initial results in the control and good outcome groups, but became significantly poorer in the poor outcome group. The difference between poor outcome and control groups was statistically significant (P = 0.04). CONCLUSIONS: Impaired postural stability seems to be one factor in multidimensional symptomatology of patients with chronic low back trouble. Postural stability is easily disturbed in case of impairment in strength, coordination, or effective coupling of muscles in the lumbar and pelvic area. Patients with chronic low back pain seem to experience impairment in these functions, which should be taken into consideration when back rehabilitation programs are planned.     

Patients' perspectives on the management of emotional distress in primary care settings

OBJECTIVE: To investigate how important treatment for emotional distress is to primary care patients in general and to primary care patients with depression, and to evaluate the types of mental health interventions they desire. DESIGN: Patient surveys. SETTING: Five private primary care practices. MEASUREMENTS AND MAIN RESULTS: Patients' desire for treatment of emotional distress and for specific types of mental health interventions were measured, as well as patients' ratings of the impact of emotional distress, the frequency of depressive symptoms, and mental health functioning. Of the 403 patients, 33% felt that it was "somewhat important" and 30% thought it was "extremely important" that their physician tries to help them with their emotional distress. Patient desire for this help was significantly related to a diagnosis of depression (p < .001), perceptions about the impact of emotional distress (p < .001), and mental health functioning (p < .001). Among patients with presumptive diagnoses of major and minor depression, 84% and 79%, respectively, felt that it was at least somewhat important that they receive this help from their physician. Sixty-one percent of all primary care patients surveyed and 69% of depressed patients desired counseling: 23% of all patients and 33% of depressed patients wanted a medication: and 11% of all patients and 5% of depressed patients desired a referral to a mental health specialist. CONCLUSIONS: A majority of these primary care patients and almost all of the depressed patients felt that it was at least somewhat important to receive help from their physician for emotional distress. The desire for this help seems to be related to the severity of the mental health problem. Most of the patients wanted counseling, but relatively few desired a referral to a mental health specialist.     

Vicarious Agency: Experiencing Control Over the Movements of Others.

Participants watched themselves in a mirror while another person behind them, hidden from view, extended hands forward on each side where participants' hands would normally appear. The hands performed a series of movements. When participants could hear instructions previewing each movement, they reported an enhanced feeling of controlling the hands. Hearing instructions for the movements also enhanced skin conductance responses when a rubber band was snapped on the other's wrist after the movements. Such vicarious agency was not felt when the instructions followed the movements, and participants' own covet movement mimicry was not essential to the influence of previews on reported control. (PsycINFO Database Record (c) 2010 APA, all rights reserved)