Cognitive/behavioral approaches: Commonalities among pain scales that assess catastrophizing, anxiety, and depressive thoughts

Abstract

The present research examined the content of several scales measuring thought processes that often accompany the pain experience. Seventy-two items from the Pain Catastrophizing Scale (PCS; Sullivan, Bishop, & Pivik), the Pain Anxiety Symptom Scale (PASS; McCracken, Zayfert, & Gross, 1992), the Catastrophizing subscale of the CCSI (CCSI-CAT; Butler, Damarin, Beaulieu, Schwebel, & Thorn, 1989), the Pain Appraisal Inventory Threat scale (PAI-THRT; Unruh & Ritchie, 1998), and the Inventory of Negative Thoughts in Response to Pain (INTRP; Gil, Williams, Keefe, & Beckham, 1990) were administered to 179 college students. Confoundings of item content with particularities of individual scales (instructions, response format, and separate administration) were eliminated by intermixing items in different orders with common instructions and response format. Exploratory factor analysis (EFA) of item data revealed a strong general factor, but scree test indicated three factors, which after extraction and oblique rotation were labeled: Anxious Ideation, Hypochondriachal Pessimism, and Depressive Ideation. Depressive Ideation was comprised primarily of INTRP items, and three subfactors were apparent: Helplessness, Self-Blame and Alienation. Anxious Ideation contained items from all scales except the INTRP and was dominated by a single factor. Minor factors, related to obsessional preoccupation and disrupted concentration, could be distinguished from the general content. Hypochondriachal Pessimism contained items from all scales except the INTRP, and three subfactors were evident: Pessimism, Hypochondriasis, and Fear of Dying or Disability. Future research will examine the reliability of these factors and subfactors in chronic and acute pain populations. We hypothesize that Depressive Ideation in pain patients will be redundant with depression, and that Anxious Ideation and Hypochondriacal Pessimism will form an improved general measure of catastrophizing reflecting not only magnification, helplessness, and rumination as measured by the PCS, but also worst-case scenario thoughts about the pain experience as suggested by Turner & Aaron (2001).