Academic journal article Journal of Cognitive Psychotherapy

Childhood Learning History Origins of Adult Pain Anxiety

Academic journal article Journal of Cognitive Psychotherapy

Childhood Learning History Origins of Adult Pain Anxiety

Article excerpt

Pain anxiety refers to a range of cognitive (catastrophic thinking), behavioral (escape and avoidance), and physiological (heightened arousal) responses to pain (McCracken & Gross). Greater pain anxiety is associated with greater pain severity, disability, and distress. This retrospective study investigated learning history experiences related to the development of pain anxiety in a sample of 198 undergraduates (147 women, 51 men). Childhood instrumental and, to a more limited extent, vicarious learning experiences with pain were positively associated with levels of pain anxiety in adulthood. The physical concerns component of anxiety sensitivity (AS: fear of arousal-related somatic sensations), but not AS-psychological or social concerns or trait anxiety, was found to mediate the relationship between childhood instrumental learning experiences with pain and pain avoidance behavior, cognitive anxiety, and physiological anxiety in adulthood. Both AS physical concerns and, to a lesser extent trait anxiety, mediated the relationship between childhood instrumental learning experiences with pain and fearful thinking about pain in adulthood. Finally, AS physical concerns, but not AS-psychological or social concerns or trait anxiety, also was found to mediate the relationship between childhood observational learning experiences with pain and pain cognitive anxiety and fearful thinking in adulthood.

Keywords : pain anxiety ; anxiety sensitivity ; trait anxiety ; learning

Pain anxiety refers to a range of cognitive (catastrophic thinking), behavioral (escape and avoidance), and physiological (heightened arousal) responses to pain events ( McCracken & Gross, 1998 ). Cognitive-behavioral models of chronic pain ( Asmundson, Norton, & Norton, 1999 ; Lethem, Slade, Troup, & Bentley, 1983 ; Vlaeyen & Linton, 2000 ) consider pain anxiety to be integral to the development and maintenance of chronic pain. Pain anxiety can exacerbate the pain experience by contributing to avoidance of activities expected to promote pain. Avoidance behavior, in turn, can lead to physical deconditioning (e.g., muscle atrophy, decreased mobility), secondary behavioral problems (e.g., weight gain, social withdrawal), disability, and depression ( Hadjistavropoulos & LaChapelle, 2000 ). These consequences can assume a self-perpetuating cycle of responding with pain anxiety and physical deconditioning leading to greater severity of pain, affective distress, behavioral interference, and disability ( Asmundson, 1999 ; McCracken, 1997).

Pain anxiety is an established predictor of adjustment to pain ( Vlaeyen, Kole-Snijders, Boeren, & van Eek, 1995 ). Pain anxiety has been found to be associated with exaggerated perceptions of pain ( McCracken, Gross, Sorg, & Edmunds, 1993 ), reduced range of motion during physical activity ( McCracken, Spertus, Janeck, Sinclair, & Wetzel, 1999 ), more pain behavior and increased help seeking ( McCracken, Gross, Aikens, & Carnrike, 1996 ), greater frequency of days missed from work ( Waddell, Newton, Henderson, Somerville, & Main, 1993 ), increased range of nonspecific physical complaints ( McCracken, Faber, & Janeck, 1998 ), and greater depression and general disability ( McCracken, Zayfert, & Gross, 1992 ).

The most widely used measures for assessing pain anxiety are the original 40-item Pain Anxiety Symptoms Scale (PASS-40; McCracken et al., 1992 ) and its briefer 20-item version ( McCracken & Dhingra, 2002 ). These measures assess four theoretically distinct components of pain anxiety: cognitive anxiety, fearful thinking about pain and anticipated negative consequences related to pain, escape and avoidance behavior, and physiological anxiety. McCracken et al. (1996) found that PASS-40 physiological anxiety scores were the best predictor of the pain severity reported by chronic pain patients and that disability and pain avoidance behaviors were best predicted by PASS-40 escape/avoidance scores. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.