Background: Worry can be conceptualized as a cognitive-affective automatic process initiated in o... more Background: Worry can be conceptualized as a cognitive-affective automatic process initiated in order to address uncertainty and potential personal inadequacies that could result in negative outcomes. The purpose of the current study was to develop a measure of pain-specific worrythe Worry About Pain Questionnaire (WAPQ). Method: In study 1, responses of 335 pain-free participants were used to complete an item analysis and exploratory factors analysis to develop and assess the internal structure of the WAPQ. Study 2 included 224 pain-free participants who completed the WAPQ in order to confirm its factor structure, and to examine its relation to the experience of acute experimental pain. In study 3, 137 individuals with persistent pain were asked to complete the WAPQ as well as measures of pain and depressive symptoms. Results: The resulting 15-item measure assesses uncertainties and potential negative outcomes related to the experience of pain. The results of the exploratory and confirmatory factor analyses showed a two-factor structure. Across all studies, the WAPQ was found to be related to measures of pain in clinical and non-clinical samples, acute experimental pain stimuli, as well as pain anxiety, pain catastrophizing, fear of pain, rumination and depressive symptomatology. Conclusions: The results suggest that the WAPQ is a reliable and valid measure for the assessment of worry about pain that can be used to understand how pain-specific worries are related to the experience and impact of pain across different populations. Significance: Worry has been assessed in pain populations using measures that assess worry in general. The current study shows a relationship between pain-specific worry and the experience of pain. Further, worry about pain is related to but not synonymous with pain catastrophizing.
A growing body of literature supports the association between adverse stress experiences and heal... more A growing body of literature supports the association between adverse stress experiences and health inequities, including obesity, among African American/Black women. Adverse stress experiences can contribute to poor appetite regulation, increased food intake, emotional eating, binge eating, and sedentary behavior, all of which can contribute to weight gain and obesity. Most research studies concerning the effect of psychological stress on eating behaviors have not examined the unique stress experience, body composition, and eating behaviors of African American/Black women. Even fewer studies have examined these constructs among Black female college students, who have an increased prevalence of overweight and obesity compared to their counterparts. Therefore, the aim of the current study is to examine the associations among emotional eating, perceived stress, contextualized stress, and BMI in African American female college students. All participants identified as African American or Black (N = 99). The mean age of the sample was 19.4 years (SD = 1.80). A statistically significant eating behavior patterns × perceived stress interaction was evident for body mass index (BMI) (β = 0.036, S.E. = .0118, p b .01). In addition, a statistically significant eating behavior patterns × contextualized stress interaction was observed for BMI (β = 0.007, S.E. = .0027, p = .015). Findings from this study demonstrate that the stress experience interacts with emotional eating to influence BMI. Based on these findings, culturally relevant interventions that target the unique stress experience and eating behavior patterns of young African American women are warranted.
Depression, a common and disabling problem for low back pain patients, can affect how pain is exp... more Depression, a common and disabling problem for low back pain patients, can affect how pain is expressed. To our knowledge, this is the first study to examine how clinical depression relates to pain self-reports and overt motor pain behaviors. Fifty-eight patients with persistent low back pain participated, all meeting DSM-IV criteria for either major depressive disorder or dysthymia, or scoring an 18 or higher on the Beck Depression Inventory (BDI). Patients rated their usual and worst pain on a 0 to 10 scale (10ϭpain as bad as it can be). A 10-minute sample of patients' motor pain behaviors (viz., guarding, bracing, rubbing, grimacing and sighing) was collected using the Keefe and Block system, and coded by trained observers (inter-observer reliabilityϭ86.0%). The average BDI score was 17.6 (SDϭ7.8). Correlational analyses showed that patients with higher depression scores exhibited significantly higher levels of overall pain behavior (rϭ.44, pϭ.001). In terms of individual pain behaviors coded, patients scoring higher on depression were significantly more likely to exhibit sighing (rϭ.30, pϭ.024) and grimacing (rϭ.46, pϭ.000). Relations between depression and the other pain behaviors failed to meet statistical significance. Although depression selfreports were related to overall pain behavior, they were not related to self-reports of usual pain (rϭ.16, pϭ.239) or worst pain (rϭ.18, pϭ.191). These findings indicate that, in persons with clinical depression, a significant association exists between severity of depression and overt motor pain behaviors but not between depression and self-reports of pain. Clinicians who treat clinically depressed persistent low back pain patients should be aware that depression severity could have an impact on how the patients express their pain. These findings also add to a growing literature that shows that motor pain behaviors and self-reports of pain are not equivalent forms of pain expression and may relate differently to psychosocial factors (e.g. depression).
Individual differences in the regulation of affect are known to impact pain and other symptoms in... more Individual differences in the regulation of affect are known to impact pain and other symptoms in rheumatoid arthritis. However, no studies have yet used a rigorous daily diary methodology to address the question of whether current pain is reduced when positive or negative affects are effectively regulated. We used a prospective, repeated daily sampling design to infer the regulation of affect from day-to-day changes in affect intensity and examined how these changes in affect were prospectively related to pain from rheumatoid arthritis. Ninety-four adult patients diagnosed with rheumatoid arthritis completed daily measures of pain and positive and negative affect over a period of 30 days. Information on demographic and disease status variables was collected during a medical evaluation. Results of hierarchical linear model analyses indicated that the regulation of both positive and negative affect from the prior day to the current day predicted significantly greater decreases in pai...
This study examined gender differences in prospective within-day assessments of pain, pain coping... more This study examined gender differences in prospective within-day assessments of pain, pain coping, and mood in men and women having OA, and analyzed gender differences in dynamic relations between pain, mood, and pain coping. A sample of 64 women and 36 men diagnosed as having pain due to osteoarthritis of the knee(s) rated their pain, pain coping, and mood two times each day (once in the afternoon and once in the evening) for 30 days using a booklet format. Two gender differences were found in between person-analyses: women used more problem focused coping than men, and women who catastrophized were less likely than men to report negative mood. Several within-day and across-day gender differences were noted. First, women were much more likely to show a significant increase in pain over the day. Second, men were more likely than women to experience an increase in coping efficacy over the day. Third, men were more likely than women to use emotion-focused coping when their mood was more negative. Finally, men were more likely than women to experience an increase in negative mood and a decrease in positive mood in the morning after an evening of increased pain. Taken together, these findings underscore the importance of obtaining multiple daily assessments when studying gender differences in the pain experience.
The present study examined relationships between pain coping, hormone replacement therapy, and la... more The present study examined relationships between pain coping, hormone replacement therapy, and laboratory and clinical pain reports in post-menopausal women and age-matched men with osteoarthritis. Assessment of nociceptive flexion reflex threshold was followed by an assessment of electrocutaneous pain threshold and tolerance. Participants rated their arthritis pain using the Arthritis Impact Measurement Scales. To assess pain coping, participants completed measures of emotion-focused coping, problem-focused coping, and pain catastrophizing. Results indicated that women were more likely than men to report using emotion-focused pain strategies, and that emotion-focused coping was associated with more arthritic pain and lower electrocutaneous pain tolerance. Correlations between coping measures and pain reports revealed that catastrophizing was associated with greater arthritis pain and lower pain threshold and tolerance levels. However, catastrophizing was not related to nociceptive flexion reflex threshold, suggesting that the observed relationship between catastrophizing and subjective pain does not rely on elevated nociceptive input. A comparison of men (n=58), post-menopausal women receiving hormone replacement therapy (n=32), and post-menopausal women not receiving hormone replacement therapy (n=42) revealed no significant group differences in arthritis pain, electrocutaneous pain threshold or tolerance, or nociceptive flexion reflex threshold. Thus, older adults with osteoarthritis do not exhibit the pattern of sex differences in response to experimental pain procedures observed in prior studies, possibly due to the development of disease-related changes in pain coping strategies. Accordingly, individual differences in clinical and experimental pain may be better predicted by pain coping than by sex or hormonal differences.
Studies have documented the efficacy of coping skills training (CST) for managing pain, distress,... more Studies have documented the efficacy of coping skills training (CST) for managing pain, distress, and disability in persons with arthritis. However, no laboratory studies have examined the effects of CST on descending modulation of nociception. This study used the nociceptive flexion reflex (NFR) to document pain and nociceptive responding among 62 men and women with osteoarthritis of the knee (mean age ¼ 63.3 AE 7.5 years). Before and after a 45-minute CST session, participants completed laboratory assessments of NFR threshold and questionnaires evaluating pain and state anxiety. Results indicated significantly increased NFR thresholds and decreased pain ratings following CST for men and women. A significant time by sex interaction was observed for state anxiety, with women reporting greater decreases in anxiety following CST than men. This is the first study to demonstrate effects of a CST protocol on a measure of descending inhibition of nociception among patients with osteoarthritic knee pain.
Journal Of Pain & Palliative Care Pharmacotherapy, 2004
This study describes patterns of opioid analgesic prescription during a one-year period among a s... more This study describes patterns of opioid analgesic prescription during a one-year period among a sample of patients with
This article describes a study to construct and validate a rating scale to assess appropriateness... more This article describes a study to construct and validate a rating scale to assess appropriateness of career choices of 143 high school students. Test-retest reliability coefficients for the rating scale scores were in the .80s and .90s. Intercorrelations of teacher and counselor ratings were in the .50s and .60s. Rating scale scores correlated mostly in the .30s with an objective
Non-cardiac chest pain (NCCP) is a common and distressing condition. Prior studies suggest that p... more Non-cardiac chest pain (NCCP) is a common and distressing condition. Prior studies suggest that psychotropic medication or pain coping skills training (CST) may benefit NCCP patients. To our knowledge, no clinical trials have examined the separate and combined effects of CST and psychotropic medication in the management of NCCP. This randomized clinical trial examined the separate and combined effects of CST and antidepressant medication (sertraline) in participants with non-cardiac chest pain. A sample of individuals diagnosed with NCCP was randomly assigned to one of four treatments: (1) CST plus sertraline (CST+sertraline), (2) CST plus placebo (CST+placebo), (3) sertraline alone, or (4) placebo alone. Assessments of pain intensity, pain unpleasantness, anxiety, pain catastrophizing, depression, and physical disability were collected prior to treatment, and at 10- and 34-weeks following randomization. Data analyses revealed that CST and sertraline either alone or in combination s...
Research examining psychosocial functioning in African American prostate cancer survivors has bee... more Research examining psychosocial functioning in African American prostate cancer survivors has been limited, in spite of documented higher mortality from prostate cancer and worse long-term physical and emotional outcomes from prostate cancer treatment reported by this group of survivors. In addition, the role of masculinity in psychosocial adjustment among prostate cancer survivors is not well understood. In this study, 59 African American prostate cancer survivors completed a questionnaire assessing masculinity beliefs related to self-reliance, emotional control, and dominance, as well as measures of psychosocial functioning (i.e., symptom distress, negative mood, and functional and social well-being). Results of regression analyses indicated that masculinity beliefs predicted negative mood, functional well-being, and social well-being, controlling for age, income, and medical comorbidities. The findings reported here, although preliminary, suggest that masculinity beliefs could be...
How can cognitive-behavioral therapy benefit patients with persistent pain? The purpose of this r... more How can cognitive-behavioral therapy benefit patients with persistent pain? The purpose of this review is to provide an overview of cognitive-behavioral treatment approaches to persistent pain. The review is divided into four sections. In the first section, we describe the conceptual back ground for cognitive-behavioral approaches to pain. In the second section, we describe the basic elements of a typical cognitive-behavioral treatment protocol used in pain management. In the third section, we address questions that health care professionals frequently ask about cognitive - behavioral treatment. In the fourth section, we discuss new clinical applications of cognitive-behavioral treatment.
How can cognitive-behavioral therapy benefit patients with persistent pain? The purpose of this r... more How can cognitive-behavioral therapy benefit patients with persistent pain? The purpose of this review is to provide an overview of cognitive-behavioral treatment approaches to persistent pain. The review is divided into four sections. In the first section, we describe the conceptual back ground for cognitive-behavioral approaches to pain. In the second section, we describe the basic elements of a typical cognitive-behavioral treatment protocol used in pain management. In the third section, we address questions that health care professionals frequently ask about cognitive - behavioral treatment. In the fourth section, we discuss new clinical applications of cognitive-behavioral treatment.
Although several studies have shown that enhanced cardiovascular reactivity can predict hypertens... more Although several studies have shown that enhanced cardiovascular reactivity can predict hypertension development in African Americans, these findings have not been consistent among all studies examining reactivity and hypertension susceptibility. This inconsistency may be explained by the influence of anxiety (state and trait) on the blood pressure response to stress. Therefore, this study sought to determine whether anxiety is associated with blood pressure response to cold pressor (CP) and anger recall (AR) stress tests in young healthy African Americans. Modeling using state and trait anxiety revealed that state anxiety predicts systolic (SBP) and diastolic blood pressure DBP response to CP and AR (P≤0.02). Interestingly, state anxiety predicted heart rate changes only to CP (P<0.01;P=0.3for AR). Although trait anxiety was associated with SBP response to AR and not CP, it was not a significant predictor of reactivity in our models. We conclude that anxiety levels may contribut...
Background: Worry can be conceptualized as a cognitive-affective automatic process initiated in o... more Background: Worry can be conceptualized as a cognitive-affective automatic process initiated in order to address uncertainty and potential personal inadequacies that could result in negative outcomes. The purpose of the current study was to develop a measure of pain-specific worrythe Worry About Pain Questionnaire (WAPQ). Method: In study 1, responses of 335 pain-free participants were used to complete an item analysis and exploratory factors analysis to develop and assess the internal structure of the WAPQ. Study 2 included 224 pain-free participants who completed the WAPQ in order to confirm its factor structure, and to examine its relation to the experience of acute experimental pain. In study 3, 137 individuals with persistent pain were asked to complete the WAPQ as well as measures of pain and depressive symptoms. Results: The resulting 15-item measure assesses uncertainties and potential negative outcomes related to the experience of pain. The results of the exploratory and confirmatory factor analyses showed a two-factor structure. Across all studies, the WAPQ was found to be related to measures of pain in clinical and non-clinical samples, acute experimental pain stimuli, as well as pain anxiety, pain catastrophizing, fear of pain, rumination and depressive symptomatology. Conclusions: The results suggest that the WAPQ is a reliable and valid measure for the assessment of worry about pain that can be used to understand how pain-specific worries are related to the experience and impact of pain across different populations. Significance: Worry has been assessed in pain populations using measures that assess worry in general. The current study shows a relationship between pain-specific worry and the experience of pain. Further, worry about pain is related to but not synonymous with pain catastrophizing.
A growing body of literature supports the association between adverse stress experiences and heal... more A growing body of literature supports the association between adverse stress experiences and health inequities, including obesity, among African American/Black women. Adverse stress experiences can contribute to poor appetite regulation, increased food intake, emotional eating, binge eating, and sedentary behavior, all of which can contribute to weight gain and obesity. Most research studies concerning the effect of psychological stress on eating behaviors have not examined the unique stress experience, body composition, and eating behaviors of African American/Black women. Even fewer studies have examined these constructs among Black female college students, who have an increased prevalence of overweight and obesity compared to their counterparts. Therefore, the aim of the current study is to examine the associations among emotional eating, perceived stress, contextualized stress, and BMI in African American female college students. All participants identified as African American or Black (N = 99). The mean age of the sample was 19.4 years (SD = 1.80). A statistically significant eating behavior patterns × perceived stress interaction was evident for body mass index (BMI) (β = 0.036, S.E. = .0118, p b .01). In addition, a statistically significant eating behavior patterns × contextualized stress interaction was observed for BMI (β = 0.007, S.E. = .0027, p = .015). Findings from this study demonstrate that the stress experience interacts with emotional eating to influence BMI. Based on these findings, culturally relevant interventions that target the unique stress experience and eating behavior patterns of young African American women are warranted.
Depression, a common and disabling problem for low back pain patients, can affect how pain is exp... more Depression, a common and disabling problem for low back pain patients, can affect how pain is expressed. To our knowledge, this is the first study to examine how clinical depression relates to pain self-reports and overt motor pain behaviors. Fifty-eight patients with persistent low back pain participated, all meeting DSM-IV criteria for either major depressive disorder or dysthymia, or scoring an 18 or higher on the Beck Depression Inventory (BDI). Patients rated their usual and worst pain on a 0 to 10 scale (10ϭpain as bad as it can be). A 10-minute sample of patients' motor pain behaviors (viz., guarding, bracing, rubbing, grimacing and sighing) was collected using the Keefe and Block system, and coded by trained observers (inter-observer reliabilityϭ86.0%). The average BDI score was 17.6 (SDϭ7.8). Correlational analyses showed that patients with higher depression scores exhibited significantly higher levels of overall pain behavior (rϭ.44, pϭ.001). In terms of individual pain behaviors coded, patients scoring higher on depression were significantly more likely to exhibit sighing (rϭ.30, pϭ.024) and grimacing (rϭ.46, pϭ.000). Relations between depression and the other pain behaviors failed to meet statistical significance. Although depression selfreports were related to overall pain behavior, they were not related to self-reports of usual pain (rϭ.16, pϭ.239) or worst pain (rϭ.18, pϭ.191). These findings indicate that, in persons with clinical depression, a significant association exists between severity of depression and overt motor pain behaviors but not between depression and self-reports of pain. Clinicians who treat clinically depressed persistent low back pain patients should be aware that depression severity could have an impact on how the patients express their pain. These findings also add to a growing literature that shows that motor pain behaviors and self-reports of pain are not equivalent forms of pain expression and may relate differently to psychosocial factors (e.g. depression).
Individual differences in the regulation of affect are known to impact pain and other symptoms in... more Individual differences in the regulation of affect are known to impact pain and other symptoms in rheumatoid arthritis. However, no studies have yet used a rigorous daily diary methodology to address the question of whether current pain is reduced when positive or negative affects are effectively regulated. We used a prospective, repeated daily sampling design to infer the regulation of affect from day-to-day changes in affect intensity and examined how these changes in affect were prospectively related to pain from rheumatoid arthritis. Ninety-four adult patients diagnosed with rheumatoid arthritis completed daily measures of pain and positive and negative affect over a period of 30 days. Information on demographic and disease status variables was collected during a medical evaluation. Results of hierarchical linear model analyses indicated that the regulation of both positive and negative affect from the prior day to the current day predicted significantly greater decreases in pai...
This study examined gender differences in prospective within-day assessments of pain, pain coping... more This study examined gender differences in prospective within-day assessments of pain, pain coping, and mood in men and women having OA, and analyzed gender differences in dynamic relations between pain, mood, and pain coping. A sample of 64 women and 36 men diagnosed as having pain due to osteoarthritis of the knee(s) rated their pain, pain coping, and mood two times each day (once in the afternoon and once in the evening) for 30 days using a booklet format. Two gender differences were found in between person-analyses: women used more problem focused coping than men, and women who catastrophized were less likely than men to report negative mood. Several within-day and across-day gender differences were noted. First, women were much more likely to show a significant increase in pain over the day. Second, men were more likely than women to experience an increase in coping efficacy over the day. Third, men were more likely than women to use emotion-focused coping when their mood was more negative. Finally, men were more likely than women to experience an increase in negative mood and a decrease in positive mood in the morning after an evening of increased pain. Taken together, these findings underscore the importance of obtaining multiple daily assessments when studying gender differences in the pain experience.
The present study examined relationships between pain coping, hormone replacement therapy, and la... more The present study examined relationships between pain coping, hormone replacement therapy, and laboratory and clinical pain reports in post-menopausal women and age-matched men with osteoarthritis. Assessment of nociceptive flexion reflex threshold was followed by an assessment of electrocutaneous pain threshold and tolerance. Participants rated their arthritis pain using the Arthritis Impact Measurement Scales. To assess pain coping, participants completed measures of emotion-focused coping, problem-focused coping, and pain catastrophizing. Results indicated that women were more likely than men to report using emotion-focused pain strategies, and that emotion-focused coping was associated with more arthritic pain and lower electrocutaneous pain tolerance. Correlations between coping measures and pain reports revealed that catastrophizing was associated with greater arthritis pain and lower pain threshold and tolerance levels. However, catastrophizing was not related to nociceptive flexion reflex threshold, suggesting that the observed relationship between catastrophizing and subjective pain does not rely on elevated nociceptive input. A comparison of men (n=58), post-menopausal women receiving hormone replacement therapy (n=32), and post-menopausal women not receiving hormone replacement therapy (n=42) revealed no significant group differences in arthritis pain, electrocutaneous pain threshold or tolerance, or nociceptive flexion reflex threshold. Thus, older adults with osteoarthritis do not exhibit the pattern of sex differences in response to experimental pain procedures observed in prior studies, possibly due to the development of disease-related changes in pain coping strategies. Accordingly, individual differences in clinical and experimental pain may be better predicted by pain coping than by sex or hormonal differences.
Studies have documented the efficacy of coping skills training (CST) for managing pain, distress,... more Studies have documented the efficacy of coping skills training (CST) for managing pain, distress, and disability in persons with arthritis. However, no laboratory studies have examined the effects of CST on descending modulation of nociception. This study used the nociceptive flexion reflex (NFR) to document pain and nociceptive responding among 62 men and women with osteoarthritis of the knee (mean age ¼ 63.3 AE 7.5 years). Before and after a 45-minute CST session, participants completed laboratory assessments of NFR threshold and questionnaires evaluating pain and state anxiety. Results indicated significantly increased NFR thresholds and decreased pain ratings following CST for men and women. A significant time by sex interaction was observed for state anxiety, with women reporting greater decreases in anxiety following CST than men. This is the first study to demonstrate effects of a CST protocol on a measure of descending inhibition of nociception among patients with osteoarthritic knee pain.
Journal Of Pain & Palliative Care Pharmacotherapy, 2004
This study describes patterns of opioid analgesic prescription during a one-year period among a s... more This study describes patterns of opioid analgesic prescription during a one-year period among a sample of patients with
This article describes a study to construct and validate a rating scale to assess appropriateness... more This article describes a study to construct and validate a rating scale to assess appropriateness of career choices of 143 high school students. Test-retest reliability coefficients for the rating scale scores were in the .80s and .90s. Intercorrelations of teacher and counselor ratings were in the .50s and .60s. Rating scale scores correlated mostly in the .30s with an objective
Non-cardiac chest pain (NCCP) is a common and distressing condition. Prior studies suggest that p... more Non-cardiac chest pain (NCCP) is a common and distressing condition. Prior studies suggest that psychotropic medication or pain coping skills training (CST) may benefit NCCP patients. To our knowledge, no clinical trials have examined the separate and combined effects of CST and psychotropic medication in the management of NCCP. This randomized clinical trial examined the separate and combined effects of CST and antidepressant medication (sertraline) in participants with non-cardiac chest pain. A sample of individuals diagnosed with NCCP was randomly assigned to one of four treatments: (1) CST plus sertraline (CST+sertraline), (2) CST plus placebo (CST+placebo), (3) sertraline alone, or (4) placebo alone. Assessments of pain intensity, pain unpleasantness, anxiety, pain catastrophizing, depression, and physical disability were collected prior to treatment, and at 10- and 34-weeks following randomization. Data analyses revealed that CST and sertraline either alone or in combination s...
Research examining psychosocial functioning in African American prostate cancer survivors has bee... more Research examining psychosocial functioning in African American prostate cancer survivors has been limited, in spite of documented higher mortality from prostate cancer and worse long-term physical and emotional outcomes from prostate cancer treatment reported by this group of survivors. In addition, the role of masculinity in psychosocial adjustment among prostate cancer survivors is not well understood. In this study, 59 African American prostate cancer survivors completed a questionnaire assessing masculinity beliefs related to self-reliance, emotional control, and dominance, as well as measures of psychosocial functioning (i.e., symptom distress, negative mood, and functional and social well-being). Results of regression analyses indicated that masculinity beliefs predicted negative mood, functional well-being, and social well-being, controlling for age, income, and medical comorbidities. The findings reported here, although preliminary, suggest that masculinity beliefs could be...
How can cognitive-behavioral therapy benefit patients with persistent pain? The purpose of this r... more How can cognitive-behavioral therapy benefit patients with persistent pain? The purpose of this review is to provide an overview of cognitive-behavioral treatment approaches to persistent pain. The review is divided into four sections. In the first section, we describe the conceptual back ground for cognitive-behavioral approaches to pain. In the second section, we describe the basic elements of a typical cognitive-behavioral treatment protocol used in pain management. In the third section, we address questions that health care professionals frequently ask about cognitive - behavioral treatment. In the fourth section, we discuss new clinical applications of cognitive-behavioral treatment.
How can cognitive-behavioral therapy benefit patients with persistent pain? The purpose of this r... more How can cognitive-behavioral therapy benefit patients with persistent pain? The purpose of this review is to provide an overview of cognitive-behavioral treatment approaches to persistent pain. The review is divided into four sections. In the first section, we describe the conceptual back ground for cognitive-behavioral approaches to pain. In the second section, we describe the basic elements of a typical cognitive-behavioral treatment protocol used in pain management. In the third section, we address questions that health care professionals frequently ask about cognitive - behavioral treatment. In the fourth section, we discuss new clinical applications of cognitive-behavioral treatment.
Although several studies have shown that enhanced cardiovascular reactivity can predict hypertens... more Although several studies have shown that enhanced cardiovascular reactivity can predict hypertension development in African Americans, these findings have not been consistent among all studies examining reactivity and hypertension susceptibility. This inconsistency may be explained by the influence of anxiety (state and trait) on the blood pressure response to stress. Therefore, this study sought to determine whether anxiety is associated with blood pressure response to cold pressor (CP) and anger recall (AR) stress tests in young healthy African Americans. Modeling using state and trait anxiety revealed that state anxiety predicts systolic (SBP) and diastolic blood pressure DBP response to CP and AR (P≤0.02). Interestingly, state anxiety predicted heart rate changes only to CP (P<0.01;P=0.3for AR). Although trait anxiety was associated with SBP response to AR and not CP, it was not a significant predictor of reactivity in our models. We conclude that anxiety levels may contribut...
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