Perceived self-efficacy in coping with cognitive stressors and opioid activation.

This experiment tested the hypothesis that perceived self-inefficacy in exercising control over cognitive stressors activates endogenous opioid systems. Subjects performed mathematical operations under conditions in which they could exercise full control over the cognitive task demands or in which the cognitive demands strained or exceeded their cognitive capabilities. Subjects with induced high perceived self-efficacy exhibited little stress, whereas those with induced low perceived self-efficacy experienced a high level of stress and autonomic arousal. Subjects were then administered either an inert saline solution or naloxone, an opiate antagonist that blocks the analgesic effects of endogenous opiates, whereupon their level of pain tolerance was measured. The self-efficacious nonstressed subjects gave no evidence of opioid activation. The self-inefficacious stressed subjects were able to withstand increasing amounts of pain stimulation under saline conditions. However, when endogenous opioid mechanisms that control pain were blocked by naloxone, the subjects were unable to bear much pain stimulation. This pattern of changes suggests that the stress-induced analgesia found under the saline condition was mediated by endogenous opioid mechanisms and counteracted by the opiate antagonist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mechanisms governing empowerment effects: A self-efficacy analysis.

This experiment tested the hypotheses that perceived coping and cognitive control self-efficacy govern the effects of personal empowerment over physical threats. Women participated in a mastery modeling program in which they mastered the physical skills to defend themselves successfully against unarmed sexual assailants. Multifaceted measures of theoretically relevant variables were administered within a staggered intragroup control design to test the immediate and long-term effects of the empowerment program and the mechanisms through which it produced its effects. Mastery modeling enhanced perceived coping and cognitive control efficacy, decreased perceived vulnerability to assault, and reduced the incidence of intrusive negative thinking and anxiety arousal. These changes were accompanied by increased freedom of action and decreased avoidant behavior. Path analyses of causal structures revealed a dual path of regulation of behavior by perceived coping self-efficacy, one mediated through perceived vulnerability and risk discernment and the other through perceived cognitive control self-efficacy and intrusive negative thinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy and safety of nonsteroidal antiinflammatory drugs for cancer pain: a meta-analysis

PURPOSE: To assess the efficacy and safety of nonsteroidal antiinflammatory drugs (NSAIDs) in the treatment of cancer pain by meta-analyses of the published randomized control trials (RCTs). PATIENTS AND METHODS: Twenty-five studies met inclusion criteria for analysis. Of these, 13 tested a single-dose effect, nine multiple-dose effects, and three both single- and multiple-dose effects of 16 different NSAIDs in a total of 1,545 patients. Baseline pain intensity (when provided) of moderate or higher was indicated in 81% of patients. RESULTS: Single-dose NSAID studies found greater analgesic efficacy than placebo, with rough equivalence to 5 to 10 mg of intramuscular morphine. Pain scores differed insignificantly for aspirin versus three other NSAIDs. Analgesic responses to low- and high-dose NSAIDs suggested a dose-response relationship, but this was not statistically significant. Recommended and supramaximal single doses of three NSAIDs produced comparable changes in pain scores, which indicates a ceiling analgesic effect. Common side effects included upper gastrointestinal symptoms, dizziness, and drowsiness. The incidence of side effects showed a trend to increase with dose, without a ceiling effect, and to increase with multiple doses. Single or multiple doses of weak opioids (WO) alone or in combination (WO/C) with nonopioid analgesics did not produce greater analgesia than NSAIDs alone. Single doses of WO/C analgesics produced more side effects than NSAIDs alone, although both side effect incidence and patient dropout rates were equal when multiple doses were administered. CONCLUSION: These findings question whether the traditional World Health Organization (WHO) second analgesic step (addition of a weak opioid when pain is inadequately treated by a nonopioid analgesic alone) is warranted. A lack of comparable studies precluded testing the hypothesis that NSAIDs are particularly effective for malignant bone pain.     

You're changed if you do and changed if you don't: Mechanisms underlying paradoxical interventions.

We examined 2 mechanisms of change under paradoxical interventions: reactance and increased sense of self-efficacy. Procrastinating college students were randomly assigned to either paradoxical or self-control interventions. Effective study time and perceived self-efficacy were measured before and after treatment. In Study 1 nonverbal measure of initial reactance was employed. In Study 2 reactance was experimentally manipulated. Under paradoxical interventions, Ss higher on initial reactance benefited more from therapy than did Ss with low reactance; nonreactant Ss did not increase their effective study time, but they did improve in perceived efficacy to control their procrastination; increased study time was negatively correlated with increased self-efficacy. In self-control treatment, increased study time was accompanied by increased self-efficacy. Paradoxical interventions seem to reduce procrastination through the mechanism of reactance in some clients, whereas in others they lead to a cognitive change, possibly mediating a subsequent behavior change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of perceived controllability and performance standards on self-regulation of complex decision making.

Tested the hypothesis that perceived controllability and stringency of performance standards would affect self-regulatory mechanisms governing performance attainments of a simulated organization. Ss who managed the simulated organization under a cognitive set that organizations are not easily controllable displayed low perceived self-efficacy, even when standards were within easy reach, and lowered their organizational goals. Ss who operated under a cognitive set that organizations are controllable maintained a strong sense of self-efficacy, set increasingly challenging goals, and exhibited effective analytic thinking. Divergent changes in these self-regulatory factors were accompanied by differences in organizational attainments. Path analyses revealed that perceived self-efficacy, which was affected by prior accomplishments, influenced subsequent organizational performance through its effects on analytic strategies. After further experience, the performance system was regulated more extensively and intricately by Ss' self-conceptions of efficacy. Perceived self-efficacy affected subsequent organizational attainments both through its influence on personal goal challenges. Personal goals, enhanced organizational attainments directly and through mediation of analytic strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger management style and emotional reactivity to noxious stimuli among chronic pain patients and healthy controls: The role of endogenous opioids.

Objective: Previous work suggests that elevated trait anger-out exacerbates pain responses in part through endogenous opioid dysfunction. The authors examined whether this opioid dysfunction affects not only perceived pain intensity, but also emotional responses to being hurt. Design: 79 chronic low back pain (LBP) patients and 46 healthy controls received opioid blockade (8 mg naloxone i.v.) and placebo in randomized, counterbalanced order in separate sessions. During each session, participants sequentially experienced finger pressure pain and ischemic forearm pain tasks, with emotional state assessed at baseline and postpain. Main Outcome Measures: Blockade effects indexing opioid modulation of emotional reactivity were derived by subtracting placebo from blockade condition emotional reactivity. Results: Significant Participant Type × Anger-Out interactions on blockade effects indicated that in LBP participants but not in controls, greater anger-out was associated with deficient opioid modulation of anxiety, anger, and fear reactivity to noxious stimulation. Across participant types, greater anger-in was associated with impaired opioid modulation of anxiety and fear reactivity. Anger-in opioid effects were partially due to overlap with general negative affect. Conclusions: Opioid dysfunction associated with trait anger-out may affect not only perceived pain intensity, but also pain-related suffering in individuals with chronic pain conditions. Implications for understanding the health effects of anger management styles are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The descending cortical control of nociceptive signals: the neurochemical mechanisms and pharmacological control

The purpose of the present study was to determine whether electrical cortical stimulation (as a model of descending inhibitory control) could alter the electrophysiological and behavioral signs of a nociceptive response. The inhibitory cortical influence on the neuronal activity produced by nociceptive stimuli (the tooth pulp, C-fibers of afferent somatic nerves, cardiac afferents) was most marked during electrical stimulation the somatosensory (Sn and St) and fronto-orbital cortices. In chronic experiments, somatosensory cortical stimulation delayed the development of the deafferentation pain syndrome and reduced its intensity. The opioid mu-receptor agonists morphine and fentanyl potentiated the inhibitory action of the cortex on evoked neuronal activity. Pentazocine, a kappa-receptor agonist, was less effective. The opioid receptor blocker naloxone eliminated the effect of both cortical stimulation and opioid analgesics. The serotonin receptor blocker methisergide significantly decreased cortical action. Monoamine reuptake inhibitors (amitriptyline, imipramine, fluoxetine) potentiated the effect of cortical stimulation. Adrenergic, dopaminergic cholinergic, and GABA-ergic substances had a little effect. Among nonopioid analgesics, metamyzol and ketorolak only increased moderately descending cortical control.     

Regulation of cognitive processes through perceived self-efficacy.

The articles included in the special series in this issue of Developmental Psychology demonstrate that perceived self-efficacy for memory functioning is an important facet of metamemory. Self-beliefs of efficacy can enhance or impair performance through their effects on cognitive, affective, or motivational intervening processes. This commentary addresses a number of issues concerning the extension of self-efficacy theory to memory functioning. These include the following: the multidimensionality and measurement of perceived memory capabilities; the veridicality of memory self-appraisal; the efficacious exercise of personal control over memory functioning; the psychosocial processes by which people preserve a favorable sense of memory self-efficacy over the life span; and strategies for generalizing the impact of training in memory skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive aspects of pain and pain control

The cognitive and cognitive-behavioral approaches have been shown to be very effective in controlling pain and its sequelae both in the laboratory and in the clinical setting. As used in most research and treatment, cognitive approaches are concerned with the way the person perceives, interprets, and relates to his or her pain rather than with the elimination of the pain per se. This article reviews some of the origins of cognitive theory and pain theory, as well as examples of the techniques used and the research support for the approach. Special emphasis is given to self-efficacy, perceived control, and stress inoculation therapy. There is also discussion of some of the limitations of the cognitive approach. The overall conclusion is that the cognitive approach is a powerful and effective one for pain control despite its limitations.     

The estrous cycle and estrogen modulate stress-induced analgesia.

In this article we investigate the impact of estrous cycle, ovariectomy, and estrogen replacement on both opioid and nonopioid stress-induced analgesia. Stage of estrous strongly influenced analgesia. Diestrus females exhibited the typical male pattern produced by the analgesia inducing procedures used—strong nonopioid analgesia following 10–20 tailshocks, and strong opioid analgesia following 80–200 taskshocks. In these experiments the nonopioid analgesia was slightly attenuated during estrus, but the opioid analgesia was markedly reduced. The role of estrogen in producing these changes was studied with estrogen replacement in ovariectomized subjects. Ovariectomy only slightly altered nonopioid analgesia but eliminated opioid analgesia, which suggests that some estrogen might be necessary to maintain the integrity of the system(s) underlying opioid analgesia. Estrogen administration restored opioid analgesia, but further estrogen suppressed opioid analgesia, duplicating the estrus pattern. It did not suppress nonopioid analgesia. Opioid analgesia was enhanced 102 hr after estrogen replacement, thus duplicating the diestrus pattern. Estrogen thus appears to be responsible for the impact of estrous cycle on opioid but not on nonopioid analgesia. These results suggest that ovarian hormones may modulate the impact of stressors on endogenous pain inhibition and other stress-responsive systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing condom use: Evaluation of a theory-based intervention to prevent sexually transmitted diseases in young women.

A multicomponent intervention to increase condom use in sexually active young women was designed, implemented, and evaluated in a randomized experiment. Participants were 198 unmarried female college students (mean age = 18.6 years) who received a 1-session condom promotion intervention or a control (stress management) intervention. The condom promotion intervention led to increased self-reported condom use up to 6 months following intervention as well as positive changes in perceived benefits of condom use, affective attitudes toward condom use and condom users, perceived acceptance of sexuality, control over the sexual encounter, perceived self-efficacy for condom use, and intentions to use condoms. Mediational analysis illustrated the mechanisms of the condom promotion intervention effects, linking psychological constructs affected by the intervention (perceived benefits, acceptance of sexuality, control over the sexual encounter, attitudes toward condoms, and self-efficacy for condom use) to condom use intentions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spinal cord stimulation in chronic intractable angina pectoris: a randomized, controlled efficacy study

BACKGROUND: Spinal cord stimulation is known to be a successful treatment for chronic intractable angina pectoris. Its effect may be anti-ischemic. It is uncertain if the clinical effect is partly caused by a placebo effect of surgery for implantation of a stimulator. In this study, clinical efficacy is investigated, together with a possible placebo effect. METHODS AND RESULTS: Efficacy of spinal cord stimulation as a treatment for chronic intractable angina pectoris was studied for 6 weeks in 13 treated patients and 12 control patients with chronic angina. Assessments were exercise capacity and ischemia, daily frequency of anginal attacks and nitrate tablet consumption, and quality of life (perceived quality of life and pain). Compared with control, exercise duration (P =.03) and time to angina (P =.01) increased; anginal attacks and sublingual nitrate consumption (P =.01) and ischemic episodes on 48-hour electrocardiogram (P =.04) decreased. ST-segment depression on the exercise electrocardiogram decreased at comparable workload (P =.01). Anginal attacks and consumption of sublingual nitrates decreased (P =.01), perceived quality of life increased (P =.03), and pain decreased (P =.01). CONCLUSIONS: Spinal cord stimulation is effective in chronic intractable angina pectoris, and its effect is exerted through anti-ischemic action. Efficacy is unlikely to be explained as a placebo effect from surgery.     

Effects of time of testing, stress level, and number of conditioning days on naloxone sensitivity of conditioned stress-induced analgesia in rats.

In 2 experiments, an anticipatory conditioned stimulus/stimuli (CS) and a shock-associated CS were used. Duration of exposure to the anticipatory CS was long, as in studies reporting opioid conditioned stress-induced analgesia (CSIA), whereas duration of shock-associated CS was short, as in nonopioid CSIA. Effects of unconditioned stimulus/stimuli (UCS) strength were investigated by using 3 levels of footshock, and the development of CSIA was monitored by using different levels of training (1–6 days). CSIA, measured in both anticipatory and postexposure test periods, was found to be relatively stable across tail-flick trials within days and insensitive to strength of shock. As training progressed, CSIA increased with repeated CS–UCS pairings. We tested for opioid involvement using naloxone and found opioid and nonopioid mechanisms underlying CSIA; these mechanisms combined to form a stable level of analgesia. Data suggest that stress level and amount of training interact to activate opioid and nonopioid mechanisms of CSIA. Discrepancies in previous studies regarding naloxone sensitivity may be attributable to differences in stress levels, test periods, and durations of exposure to shock-related cues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-evaluative and self-efficacy mechanisms governing the motivational effects of goal systems.

Tested the hypothesis that self-evaluative and self-efficacy mechanisms mediate the effects of goal systems on performance motivation. These self-reactive influences are activated through cognitive comparison requiring both personal standards and knowledge of performance. 45 male and 45 female undergraduates performed a strenuous activity with either goals and performance feedback, goals alone, feedback alone, or without either factor. The condition combining performance information and a standard had a strong motivational impact, whereas neither goals alone nor feedback alone effected changes in motivation. When both comparative factors were present, the evaluative and efficacy self-reactive influences predicted the magnitude of motivation enhancement. The higher the self-dissatisfaction with substandard performance and the stronger the perceived self-efficacy for goal attainment, the greater was the subsequent intensification of effort. When one comparative factor was lacking, the self-reactive influences were differentially related to performance motivation, depending on the nature of the partial information and on the type of subjective comparative structure imposed on the activity. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Generalization of therapeutic changes in agoraphobia: The role of perceived self-efficacy.

Investigated the extent and mechanisms of therapeutic generalization across distinct areas of agoraphobic dysfunction. Twenty-seven severe agoraphobics were each given performance-based treatment for some phobic areas while leaving their other phobias untreated. Behavioral tests revealed that (a) the treated phobias improved significantly more than the untreated (transfer) phobias, (b) the transfer phobias improved significantly more than control phobias, and (c) the transfer benefits were highly variable within and between subjects. Analyses of possible cognitive mechanisms revealed that perceived self-efficacy accurately predicted treatment and transfer effects even when alternative factors such as previous behavior, anticipated anxiety, anticipated panic, perceived danger, and subjective anxiety were held constant. In contrast, these alternative factors lost most or all predictive value when self-efficacy was held constant. Agoraphobia thus appears to be neither a unitary entity nor a mere collection of independent phobias, but a complexly patterned problem governed largely by self-perceptions of coping efficacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of teacher self-efficacy and relations with strain factors, perceived collective teacher efficacy, and teacher burnout.

In this study, the authors developed and factor analyzed the Norwegian Teacher Self-Efficacy Scale. They also examined relations among teacher self-efficacy, perceived collective teacher efficacy, external control (teachers' general beliefs about limitations to what can be achieved through education), strain factors, and teacher burnout. Participants were 244 elementary and middle school teachers. The analysis supported the conceptualization of teacher self-efficacy as a multidimensional construct. They found strong support for 6 separate but correlated dimensions of teacher self-efficacy, which were included in the following subscales: Instruction, Adapting Education to Individual Students' Needs, Motivating Students, Keeping Discipline, Cooperating With Colleagues and Parents, and Coping With Changes and Challenges. They also found support for a strong 2nd-order self-efficacy factor underlying the 6 dimensions. Teacher self-efficacy was conceptually distinguished from perceived collective teacher efficacy and external control. Teacher self-efficacy was strongly related to collective teacher efficacy and teacher burnout. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Glutamate receptor-mediated hyperexcitability after ethanol exposure in isolated neonatal rat spinal cord

The influence of maternal opioid receptor blockade (50 mg/kg naltrexone, NTX) or saline (controls) throughout pregnancy on nociception and brain opioid receptor characteristics of rat offspring were examined; all animals were crossfostered to untreated mothers at birth. At 21 and 30 days, NTX-exposed pups weighed 8.2-24.3% more than controls, but both NTX and control groups were of similar body weights at 48, 60, and 80 days. Rats in the NTX and control groups displayed comparable baseline reactions to the hotplate. Morphine challenge tests and nociceptive measures revealed that NTX-subjected offspring examined at 21, 30, 48, and 60 days did not react to dosages that invoked 42-132% decreases from baseline levels in controls. Animals exposed prenatally to NTX were analgesic when injected with the opioid butorphanol or the nonopioid xylazine. The binding affinity (Kd) and capacity (Bmax) of delta and kappa opioid receptors were similar in NTX and control groups at 21 and 80 days. However, the Bmax, but not the Kd, of mu opioid receptors was subnormal in NTX offspring by about 20% in contrast to control rats at 21 and 80 days. The results imply that the interactions of some endogenous opioids with opioid receptors during development are determinants of certain aspects of pain sensitivity as well as the density of particular opioid receptors in the postnatal period.     

The formation of 1-hydroxymethylnaphthalene and 6-hydroxymethylquinoline by both oxidative and reductive routes in Cunninghamella elegans

The cold-pressor test is a widely used pain-induction model in humans. This method has been shown to be a sensitive measure for detecting opioid analgesia. However, nonsteroidal anti-inflammatory drugs have not produced consistent analgesic effects with use of this model. The analgesic effect of acetaminophen (INN, paracetamol) on cold pressor-induced pain has not been reported by other investigators. In this study, a double-blind, randomized, placebo-controlled design was used to evaluate the dose-related effects of oral acetaminophen on cold pressor-induced pain in 18 normal healthy human subjects. We observed dose-related analgesic activity of oral acetaminophen using the cold pressor-induced pain model in these subjects. There were statistically significant main effects of both dose and time (pain and bothersomeness ratings decreased with increasing drug dose and increased over time). In pairwise comparisons only the contrast between the highest dose of acetaminophen (1000 mg) and placebo reached statistical significance. Results from our study suggest that the cold-pressor method may have clinical value in evaluating nonopioid analgesic agents.     

A cognitive-behavioral treatment for rheumatoid arthritis.

Tested a cognitive-behavioral rheumatoid arthritis treatment designed to confer skills in managing stress, pain, and other symptoms of the disease. It was hypothesized that the treatment would reduce symptoms and possibly improve both immunologic competence and psychological functioning. 15 22–75 yr old women in the treatment group received instruction in self-relaxation, cognitive pain management, and goal setting. 15 similar controls received a widely available arthritis helpbook. Evidence of an enhancement of perceived self-efficacy, reduced pain and joint inflammation, and improved psychosocial functioning was found in the treated Ss based on their responses to an arthritis self-efficacy scale, the Zung Self-Rating Depression Scale, a perceived stress scale (developed by S. Cohen et al, 1983), and the UCLA Loneliness Scale. Magnitude of improvements was correlated with degree of self-efficacy enhancement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic discontinuation in chronic insomnia: Impact of psychological distress, readiness to change, and self-efficacy.

Objective: To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy. Design: Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia. Main Outcome Measures: Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy. Results: There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change. Conclusions: Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)