Personality, Cognitive Appraisal and Adjustment in Chronic Pain Patients

By Herrero, Ana Ma; Ramírez-Maestre, Carmen et al. | The Spanish Journal of Psychology, July 1, 2008 | Go to article overview

Personality, Cognitive Appraisal and Adjustment in Chronic Pain Patients


Herrero, Ana Ma, Ramírez-Maestre, Carmen, González, Vanessa, The Spanish Journal of Psychology


This study investigated the relationship between clinical personality patterns and cognitive appraisal as well as their repercussions on adjustment to chronic pain in a sample of 91 patients. It was predicted that clinical personality patterns would be related to adjustment and cognitive appraisal processes, whereas cognitive appraisals would be related to anxiety, depression and levels of perceived pain. The instruments used were as follows: the Millon Clinical Multiaxial Inventory, the Cognitive Appraisal Questionnaire, the Hospital Anxiety and Depression Scale, and the McGill Pain Questionnaire. Multiple regression analyses, the Kruskal-Wallis test, and the Mann Whitney U-test were used to analyse the data obtained. The results show that certain clinical personality patterns were associated with poor adjustment to chronic pain. The use of cognitive appraisal of harm predicted higher anxiety levels and greater perceived pain in chronic pain patients. The use of cognitive appraisals of challenge predicted lower depression levels.

Keywords: chronic pain, Millon Inventory, cognitive appraisal, anxiety, depression

Este estudio investigó la relación entre los patrones clínicos de personalidad y la evaluatión cognitiva y sus repercusiones sobre la adaptación al dolor crónico en una muestra de 91 pacientes. Se predijo que los patrones de personalidad se relacionarían con los procesos de ajuste y de evaluación cognitiva, mientras que las evaluaciones cognitivas se relacionarían con la ansiedad, la depresión y los niveles de dolor percibido. Se emplearon los siguientes instrumentos: el Inventario Clínico Multiaxial de Millon, el Cuestionario de Evaluación Cognitiva, las Escalas de Ansiedad y Depresión Hospitalarias y el Cuestionario de Dolor de McGill. Se emplearon el análisis de regresión múltiple y los tests de Kruskal-Wallis y de Mann Whitney para analizar los datos obtenidos. Los resultados muestran que ciertos patrones clínicos de personalidad se asociaban con baja adaptación al dolor crónico. El uso de la evaluación cognitiva del daño predijo niveles más altos de ansiedad y mayor dolor percibido en los pacientes de dolor crónico. El uso de la evaluación cognitiva de retos predijo niveles más bajo de depresión.

Palabras clave: dolor crónico, Inventario Millon, evaluación cognitiva, ansiedad, depresión

Pain is currently considered to be a multidimensional phenomenon. Besides being a sensation in a part of the body, pain is also perceived as an unpleasant subjective experience. Therefore, it has an emotional component deriving from a wide range of biological, psychological, and social factors (IASP, 1986). Thus, some psychological factors are central to the pain experience and the way the patient behaves during treatment (Garofalo, 2000). Psychological research has mainly focused on chronic pain. Chronic pain begins as acute pain but persists for 6 months or more despite treatment (Cruzado, Labrador, De la Puente, & Vallejo, 1990).

Transactional models of stress (Lazarus & Folkman, 1984b) suggest that chronic pain may be categorized as a long-lasting stressful situation which patients cannot cope with due to a lack of resources. The cognitive appraisal patients make about pain is conceived of as a process by which the person evaluates the effect a particular encounter with the environment (i.e. the pain) has on his or her wellbeing. There are three kinds of cognitive appraisals: cognitive appraisal of harm or loss, of threat, and of challenge. The type of appraisal influences the coping strategies used and the patients' adjustment to the stressful situation. Several researchers have stated that cognitive appraisal has a strong relationship with the coping strategies chronic pain patients use (Barrowclough, & Parle, 1997; Compas, Worsham, Sydney, & Howell, 1996; Chang, 1998; Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen, 1986; Lazarus, 1966; Lazarus & Folkman, 1984a, 1984b; McCrae, 1984; Mukulincer & Florian, 1995). …

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