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Symptom & Pain Perception

Q: What 3 factors affect symptom perception? (Kolk et al. 2003)

1. Negative affectivity 2. External information --> when the environment lacks external stimuli attention will focus more internally i.e. distractions like counting the word ‘dog’ means you report less symptoms 3. Selective attention

Q: What are the 3 hypotheses to explain why negative affect and symptom reporting are correlated? Who were they proposed by?

(Watson & Pennebaker, 1989) •The disability hypothesis - people who have a lot of symptoms become more negative because they have a lot of symptoms (i.e. having an illness causes you to become an anxious, jittery, distressed person) •The psychosomatic hypothesis •The symptom perception hypothesis

35 important questions on Symptom & Pain Perception

Which personality trait is related to symptom reporting?

Negative affect
- high levels of negative affect is associated with reporting symptoms more often

Perhaps some people are more predisposed to seek medical attention

Why is symptom/pain perception important?

- Provides a signal of illness
- Affects decision to seek medical attention
- Influences reporting of symptoms to health care providers
- Guides illness-regulation behaviours

What 3 factors affect symptom perception? (Kolk et al. 2003)

1. Negative affectivity
2. External information --> when the environment lacks external stimuli attention will focus more internally i.e. distractions like counting the word ‘dog’ means you report less symptoms
3. Selective attention

What is negative affect? What are related traits?

Distressed; upset; guilty; scared; hostile; irritable; ashamed; nervous; jittery; afraid

Related traits

•Negative emotionality (Tellegen’s MPQ-NEM)
•Neuroticism (EPI-N)
•Type D “distressed” personality (DS14) (negative affect and social inhibition are the 2 sub traits of type D people)

i.e. generally people who have a distressed personality

Negative affect is strongly correlated with...? According to which 2 studies?

Reported symptoms/ health complaints

Watson & Pennebaker (1989) - influential paper
Condenet al. (2013)

What did Watson & Pennebaker (1989) study?

Explored reasons why negative affect is correlated to reported symptoms

The researchers reported a correlation between the negative emotionality intelligence scale (NEM) and the PILL (a measure of symptom reporting - a score of how many symptoms you had over a period of time)

Result: the higher participants were on the NEM scale, the more symptoms they reported (moderate to strong correlation with an effect size of 0.43)

What are the 3 hypotheses to explain why negative affect and symptom reporting are correlated? Who were they proposed by?

(Watson & Pennebaker, 1989)

•The disability hypothesis - people who have a lot of symptoms become more negative because they have a lot of symptoms (i.e. having an illness causes you to become an anxious, jittery, distressed person)

•The psychosomatic hypothesis

•The symptom perception hypothesis

What is the disability hypothesis?

People who are ill have more negative affect because adverse/ chronic health problems heighten feelings of distress and dissatisfaction
Watson & Pennebaker (1989) did not support this hypothesis because there is little evidence that persistent health problems produce high NA

A problem is that there is not enough research on this = it would need a longitudinal approach = you would need to track someone’s medical history and NA over time

What is the Symptom Perception Hypothesis?

High NA Ps more likely to attend to and notice internal physical sensations and interpret somatic changes as signs of illness

What did Kolk et al. (2003) study?

Questionnaire based study
150 patients attended a primary care consultation
Patients reported physical symptoms

Examined whether selective attention mediated the relationship between NA and physical symptoms

Results
- relationship between NA and selective attention: people with higher NA scored higher on the somatic awareness questionnaire (measured attentiveness to common physiological processes e.g. hunger contractions in the stomach)
- Association between selective attention and people’s reporting of physical symptoms
- Connection between NA and symptoms mediated by selective attention

Evidence that people with negative affect are more likely to be aware of symptoms

What did Howren & Suls (2011) study?

They proposed two components to negative affect: anxious and depressed
--> these two components may produce different types of changes within people's cognition

People with anxious negative affect traits = more attentive to somatic changes
People with depressive affect = inflates recall of symptoms experienced in the past

Results

anxious mood reported significantly more symptoms concurrently than other groups (attentional vigilance)
depressed mood reported significantly more symptoms retrospectively (recall bias)

= evidence that the anxiety aspect of NA affect people’s concurrent reporting through attentional vigilance. Depressive mood links to a recall bias – they are more likely to think of past negative symptoms

What is the difference between acute pain and chronic pain?

Acute pain -> pain that lasts for 6 months or less; usually has a definable cause and is mostly treated with painkillers e.g a broken leg or a surgical wound

Chronic pain -> pain that lasts longer than 6 months

(p. 271 textbook)

How might classical conditioning play a role in pain perception?

An individual may associate a particular environment with the experience of pain which can enhance pain when they are in that environment

e.g. if an individual associates the dentist with pain due to past experience, the pain perception may be enhanced when attending the dentist due to this expectation. In addition, because of the association between these two factors, the individual may experience increased anxiety when attending the dentist, which may also increase pain

(p. 276 textbook)

What did Linton et al. (2000) study?

Measured fear avoidance beliefs
--> found that those with higher baseline scores of fear avoidance were twice as likely to report back pain and had a 1.7 times higher risk of lowered physical functioning

(p. 277 textbook)

What did Sullivan et al. (2001) state?

Catastrophising has been linked to both the onset of pain and the development of longer-term pain problem

(In an essay catastrophising would go in a paragraph/point about cognition)

(p. 278 textbook)

What did Crombrez et al. (2003)

Explored the relationship between catastrophizing and pain intensity in a sample of children between 8-16 years

Results = catastrohphizing independently predicted both pain intensity and disability regardless of age and gender

(p. 278 textbook)

What is a central principle to Pennebaker’s (1982) psychosocial model of symptom perception?

Competition-of-cues principle
--> competition between the internal environment (i.e. what's going on in your body) verses the external environment

= the more the external environment lacks information, the more we focus internally; the more that is going on in the external environment the less likely you are to notice what's going on in your body

What is meant by selective attention?

Schema-directed monitoring
--> your pre-existing schema/ theory you have about your illness/body can influence how you make sense of bodily sensations

The more the gate is opened, the greater perception of pain. According to Melzack and Wall (1965, 1982) which factors can open the gate?

Physical factors
Emotional factors
Behavioural factors

What are the key assumptions of the gate control theory?

•Pain is a perception and experience rather than just a sensation/stimulus response to a stimulus

•The individual is active not passive in the way in which they process and interpret painful stimuli
•Pain is never totally either organic or psychogenic
•Pain has multiple causes - the GCT suggests that many factors are involved in pain perception, not just a single cause
•Interaction between mind and body
•Pain understood in terms of the degree of opening or closing the gate - therefore there in individual variability in pain perception

(p. 274 textbook)

Regarding the gate control theory, what physical factors open and close the gate?

Open gate:
Injury/ activation of small fibres

Close gate:
Medication/ stimulation of large fibres

Physical factors = degree of injury you have; whether the small fibres/peripheral fibres are activated or not – medication and acupuncture can suppress the pain (in close gate)

What is a problems with the gate-control theory?

1. Although their is plenty of evidence illustrating the mechanisms to increase and decrease pain perception, no one has actually located the gate

(p. 275 textbook)

Regarding the gate control theory, what emotional factors open and close the gate?

Open gate:
Anxiety, fear (of pain), tension

Close gate:
Happiness, optimism,relaxation

Regarding the gate control theory, what behavioural factors open and close the gate?

Open gate:
Attention to pain, boredom - the degree to which your external environment is active --> can link this to the symptom perception hypothesis --> competition-of-cues

Close gate:
Distraction or involvement in other activities i.e. if you are doing other things you are less likely to notice the pain compared to if you are bored and inactive

What emotional factors may affect someone's pain perception?

Anxiety
Fear (in particular, the fear of pain)

What did Crombez et al. (1999) find?

Pain-related fear can be more disabling than the pain itself ---> fear creates a hypervigilance – more attentive to changes in your body

People's fear of pain is more predictive of self-reported disability/how disabling their pain is than the pain itself (the objective levels of pain they are experiencing)

Crombez et al. (1999) shows that the anticipation of the stimulus can have a big effect on perceptual experience and how people manage their pain

What did James & Hardardottir (2002) find?

They looked at the relationship between anxiety levels and

Results = Anxiety can influence pain sensitivity or tolerance

(It is also worth noting that a distractor task increased the tolerance of both high and low anxiety participants --> High anxiety individuals benefited the most from the distractor task than in the control condition (UNDIR) = distractor tasks are useful in pain management)

What did Topcu & Findik (2012) study?

They studied the effects of relaxation exercises on patients following abdominal surgery on their pain levels

Results = significant effect --> 71.7% of the participants said their pain decreased after doing relaxation exercises

What did Pennebaker (1983) argue?

There are individual differences in the amount of attention people pay to their internal states. Whereas some individuals may sometimes be internally focused and more sensitive to symptoms, others may be more externally focused and less sensitive to internal changes

(p. 57 textbook)

What did Cropley & Steptoe (2005) study?

Directly explored the relationship between real recent life stress and general symptom reporting.

Results demonstrated that higher stress was associated with an increased frequency on a range of symptoms

What did Stegen et al. (2001) study?

Stegen et al. (2001) indicated that individuals with high negative affect show a stronger attentional bias to internal sensations. These individuals were also worse than those with lower negative affect at detecting external changes, such as a change in an auditory tone. This study supports Pennebaker (1983) by proving that certain individuals are more internally focused than others. Importantly, this study also demonstrates that mood and cognitions interact to influence symptom perception, the factors are not independent from each other.

What did Ballenger et al. (2001) find?

The International Consensus Group of Depression and Anxiety concluded that there are significant cultural variations in anxiety and depression symptom perception.

What did Minsky et al. (2003) find?

That not only did the diagnosis of major depression and schizophrenic disorders vary by ethnic group, but so did symptom perception, with Latinos reporting a higher frequency of psychotic symptoms

What did Wang et al. (1997) find?

A cross-cultural pattern of symptom perception variation can be found for somatic symptoms with headaches being a more prevalent symptom in USA and Western Europe than in Asia and Africa

What does a cross-cultural variation in symptom perception tell us?

That individuals may model their symptom perception on their culture and the people around them

The question on the page originate from the summary of the following study material:

Psychology of Illness

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