Pain-provoking behaviour as a driven reaction to psychological distress: the bio-psycho-social neurotic loop model

Nursing students' empathic communication: Role in recognizing and treating chronic pain patients

OBJECTIVE

A substantial body of research supports what many nurses know from experience: empathy is at the heart of providing quality care. The major objective of this study was to identify unique mechanisms through which higher empathy translates into greater intentions to treat patients in pain employing novel methodology.

METHODS

Using an ecologically-valid scenario methodology, student nurses (N = 156) reviewed the narrative of a patient in chronic pain. They completed standard, valid measures of empathy toward the patient, perception of the patient's pain, and intention to provide pain-relieving treatment. Nursing student's personality traits were assessed and perception of patients' age and sex were experimentally manipulated.

RESULTS

Empathy was associated with higher intention to treat the patient in chronic pain irrespective of patients' age or sex. A moderated-mediation analysis confirmed that nursing students with higher empathy perceived the patient in the scenario as being in greater pain. This was correspondingly associated with higher intention to provide treatment. Nursing students' trait Extraversion was a moderator.

CONCLUSION

Empathy not only improves rapport between patients and providers but is related to intentions to provide pain-relieving treatment.

PRACTICE IMPLICATIONS

The clinical and educational importance of empathy in patient-provider relationships are discussed.

Evaluating chronic pain impact among patients in primary care: further validation of a brief assessment instrument

OBJECTIVE

To evaluate the psychometric properties of the Profile of Chronic Pain: Screen (PCP:S) in primary care. The PCP:S is a brief assessment device designed to gauge pain severity, interference, and emotional burden.

DESIGN

Questionnaire survey with short-term reliability and validity follow-up.

METHODS

Two hundred and forty-four outpatients (52% female) with chronic pain recruited from five primary care settings completed the 15-item PCP:S at an initial testing session. Approximately 1 week later, two subgroups participated in a retest reliability and validity follow-up. The battery of follow-up questionnaires included a measure of social desirability response bias and several instruments designed to provide convergent validity for the PCP:S.

RESULTS

Retest reliability, internal consistency, factor structure, and social desirability bias were all found to be acceptable. Likewise, preliminary evidence suggests that, by virtue of its correlation with established measures of pain adjustment, the PCP:S is a valid pain assessment device.

CONCLUSIONS

Although the PCP:S was initially developed and validated using a national community sample of adults with chronic pain who provided data via telephone interviews, the present findings support its use as a brief and psychometrically sound paper-and-pencil measure for the assessment of three key components of chronic pain in primary care.

Does neuroscience hold promise for the further development of behavior therapy? The case of emotional change after exposure in anxiety and depression

Over the last few years, the integration of biological and psychological models has become increasingly important in clinical psychology. This paper presents a neurobiological framework for exploring how neuroscience research may be valuable in the context of new developments in behavior therapy. The importance of the cortical-subcortical circuitry of emotion processing for investigating the working mechanisms of exposure therapy is illustrated by current neuroimaging research. The implication is that during exposure therapy the focus of attention must be fully directed towards the emotional content of the threatening situation to facilitate prefrontal control over the amygdala and that new contextual information, of emotional salience, must be added to create inhibitory projections from the hippocampus. In addition, some possible mechanisms of action for different therapeutic approaches to both anxiety and depression and the role of neuroimaging techniques in predicting treatment outcome are discussed.