Catastrophic Worry Research Articles

Improvements from a small-group multidisciplinary pain self-management intervention for women living with pelvic pain maintained at 12 months.

A small-group multidisciplinary pain self-management program for women living with pelvic pain, with or without endometriosis, was developed to address identified unmet treatment needs. Following completion, over 80% of participants demonstrated clinically significant improvement across a number of domains. There was no clinically significant deterioration on any measure and benefits continued at three months follow-up. This study examines patient-reported outcomes at 12 months following program completion to ascertain maintenance of these improvements. Self-report measures assessed quality of life across the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials domains prior to, at completion and 12 months following participation. At 12 months follow-up, improvement was seen in mean group scores for all baseline measures for 57% of participants who returned valid 12-month follow-up data, with clinically significant improvement seen for within-subject scores for 50% of these participants for pain severity and also for pain-related activity interference. Improvements were also reported in key predictors of long-term outcomes, pain self-efficacy and catastrophic worry, with 92% reporting improvement in each of these two constructs. There were 83% of respondents who reported feeling both improvement in overall sense of wellbeing and improvement in their physical ability compared to before the program. Results suggest that a six-week multidisciplinary small-group intervention increases participants' abilities to self-manage pain and improves quality of life with lasting clinically significant improvements.

The effect of a pain educational video intervention upon child pain-related outcomes: A randomized controlled study.

Pain neuroscience education (PNE) has received increasing research attention demonstrating beneficial effects on pain-related outcomes in adults. Conversely, studies on the effectiveness of PNE in children are scarce. This study investigated the effect of a pain educational video intervention on child pain-related outcomes (i.e. experienced pain intensity, pain-related fear and catastrophic worry about pain, pain threshold and pain knowledge) in healthy children undergoing an experimental pain task. Furthermore, the moderating role of children's demographic (i.e. sex and age) and psychological (i.e. baseline pain knowledge and anticipated pain intensity, pain-related fear and catastrophic worry) characteristics was examined. Participants were 89 children (Mage =11.85, SD=1.78), randomly assigned to either a condition whereby they were instructed to watch a brief pain educational video (i.e. experimental group) or to a control condition whereby they did not watch any video. Study findings revealed that accurate pain knowledge and pain threshold were higher amongst children in the experimental group compared to the control group. In contrast with expectations, no main effects of the video intervention were observed for experienced pain intensity, pain-related fear and catastrophic worry. Moderation analyses indicated that the video intervention contributed, in comparison with the control condition, to higher levels of pain knowledge amongst younger children only and to higher pain thresholds amongst boys only. Further investigation is needed to optimize pain educational video interventions and to determine whether more beneficial outcomes can be found in clinical (i.e. non-experimental) situations and in children with persistent or recurring pain problems. Examining the impact of pain educational interventions within a non-clinical setting is deemed particularly important given that adaptive pain coping strategies likely play an important role in preventing the development and maintenance of future maladaptive pain-related behaviour. Further, study findings provide preliminary evidence of baseline and demographic (i.e. age and sex) characteristics explaining differences in the effect of a pain educational video intervention in pain knowledge and pain-related experiences during experimental pain.

Understanding Pain Catastrophizing: Putting Pieces Together.

The present narrative review addresses issues concerning the defining criteria and conceptual underpinnings of pain catastrophizing. To date, the concept of pain catastrophizing has been extensively used in many clinical and experimental contexts and it is considered as one of the most important psychological correlate of pain chronicity and disability. Although its extensive use, we are still facing important problems related to its defining criteria and conceptual understanding. At present, there is no general theoretical agreement of what catastrophizing really is. The lack of a consensus on its definition and conceptual issues has important consequences on the choice of the pain management approaches, defining and identifying problems, and promoting novel research. Clinical and research work in absence of a common theoretical ground is often trivial. It is very surprising that clinical and experimental work has grown extensively in the past years, without a common ground in the form of a clear definition of pain catastrophizing and overview of its conceptual basis. Improving the efficacy and efficiency of pan catastrophizing related treatments requires an understanding of the theoretical construct. So far, most interventions have only demonstrated modest effects in reducing pain catastrophizing. Therefore, clarifying the construct may be an important precursor for developing more targeted and effective interventions, thereby easing some of the burden related to this aspect of pain. In our review, we have extracted and de-constructed common elements that emerge from different theoretical models with the aim to understand the concept of catastrophizing, which components can be modulated by psychological interventions, and the general role in pain processing. The analysis of the literature has indicated essential key elements to explain pain catastrophizing: emotional regulation, catastrophic worry (as repetitive negative thinking), rumination, behavioral inhibition and behavioral activation (BIS/BAS) systems, and interoceptive sensitivity. The present paper attempts to integrate these key elements with the aim to re-compose and unify the concept within a modern biopsychosocial interpretation of catastrophizing.

Internet-Based Extinction Therapy for Worry: A Randomized Controlled Trial

Worry is a common phenotype in both psychiatric patients and the normal population. Worry can be seen as a covert behavior with primary function to avoid aversive emotional experiences. Our research group has developed a treatment protocol based on an operant model of worry, where we use exposure-based strategies to extinguish the catastrophic worry thoughts. The aim of this study was to test this treatment delivered via the Internet in a large-scale randomized controlled trial. We randomized 140 high-worriers (defined as > 56 on the Penn State Worry Questionnaire [PSWQ]) to either Internet-based extinction therapy (IbET) or to a waiting-list condition (WL). Results showed that IbET was superior to WL with an overall large between-group effect size of d = 1.39 (95% confidence interval [1.04,1.73]) on the PSWQ. In the IbET group, 58% were classified as responders. The corresponding figure for WL participants was 7%. IbET was also superior to the WL on secondary outcome measures of anxiety, depression, meta-cognitions, cognitive avoidance, and quality of life. Overall treatment results were maintained for the IbET group at 4- and 12-month follow-up. The results from this trial are encouraging as they indicate that worry can be targeted with an accessible and novel intervention for worry. Replication trials with active control group are needed.

Exposure-based cognitive behavioral therapy for irritable bowel syndrome. A single-case experimental design across 13 subjects

Irritable bowel syndrome (IBS) is a highly prevalent disorder with a significant impact on quality of life. The presence of psychological symptoms in IBS patients such as catastrophic worry and behavioral avoidance suggests the possible efficacy of cognitive behavioral interventions. Exposure-based cognitive behavioral therapy (CBT) has proven to be a promising approach but has only been investigated in a few studies and mainly via the Internet. Therefore, the aims of this study were to extend and replicate previous findings and to evaluate whether an individual, face-to-face, exposure-based CBT leads to improvement in gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life in IBS patients. Thirteen patients with IBS according to Rome III criteria participated in a single-case experimental study using a five-week baseline and a subsequent twelve-session intervention phase focusing on psycho-education, mindfulness and in vivo exposure. Standardized measurement of gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life was conducted weekly during baseline as well as intervention phase and at six-month follow-up. Results showed that over 70% of patients improved significantly on gastrointestinal symptoms, pain catastrophizing, and quality of life. Effects on avoidance behavior were modest. These results strengthen and extend earlier findings and provide further support for the efficacy of exposure-based strategies for IBS.

Hybrid emotion-focused exposure treatment for chronic pain

The effectiveness of exposure-based treatments for people with disabling chronic pain iswell-established and often impressive, but patients do not respond equally well, many drop out, and a proportion relapse once treatment is completed. It may just be there are limits to how much treatments for this population can achieve; after all, once pain becomes chronic there are no real cures and the known natural history of chronic pain is that it is likely to wax andwaneovermanyyears. But naturally, researchers and clinicians (and their patients) will always seek better outcomes. While exposure-based treatments in the pain field have typically been based on the idea that people are avoiding movements expected to be painful, in this issue of the Scandinavian Journal of Pain Linton and Fruzetti [1] take up a perspective proposed by Lumley et al. [2] and argue that many chronic pain patients may also have learnt to avoid a variety of personally relevant, emotional stimuli, associatedwith the behaviour, aswell as pain. In this sense, restricting the exposure treatment to movements alone may not be enough, especially if the patients engage in safety behaviours, like cognitive avoidance [3], that may undermine any benefits for behavioural exposure. Recent experimental evidence supporting this position was reported by Volders et al. [4]. One way of resolving the problem of patients presenting with evidence of both behavioural and emotional avoidance might be to address both domains of avoidance simultaneously. Tang et al. [5] recently described a hybrid version of cognitive behavioural therapy for patients reporting both insomnia and chronic pain, especially for patients in whom similar psychological mechanisms (e.g. catastrophic worry) seemed to be contributing to both problems. This work builds on the transdiagnostic perspective enunciated by Harvey et al. [6] and more recently by Linton [7]. Linton and Fruzetti [1] also utilize the transdiagnostic perspective in their study, but in this case they developed a hybrid treatment comprising behavioural exposure and emotion regulation. The behavioural exposure was consistent with the well-known methods previously described by Linton et al. [8] and others (e.g. de Jong et al. [9]). The emotion regulation methods, however, were derived from dialectical behaviour therapy (DBT). DBT was originally described

Pain Catastrophizing as Repetitive Negative Thinking: A Development of the Conceptualization

Pain catastrophizing is a well-known concept in the pain literature and has been recognized as one of the most powerful psychological determinants of negative outcomes for pain problems. However, relatively little effort has been put into developing its theoretical underpinnings. More specifically, the intrinsic function of catastrophizing is not explicitly dealt with in contemporary theoretical models. The aim of this article is to add to existing models by proposing a development of the conceptualization of catastrophizing that stresses its function as an emotion regulator. We argue that catastrophizing can be conceptualized as a form of negative repetitive thinking, which is abstract, intrusive, and difficult to disengage from. It has been argued that repetitive negative thinking is a form of ineffective problem solving that functions to downregulate negative affect and that it can be regarded as an avoidant coping strategy because it impedes processing of emotional and somatic responses. Thus, in our conceptualization, catastrophizing is proposed to be a form of problem-solving behavior that functions to reduce negative emotion triggered by pain, and other related stimuli. Furthermore, we argue that catastrophizing is preferably regarded as a process where cognitions, emotions, and overt behavior are intertwined and not viewed as separate entities. To underscore the latter, we suggest the term catastrophic worry. Our intention with this development of the conceptualization is to give rise to new ideas for research and clinical practice and to revitalize discussions about the theoretical framework around pain-related catastrophizing.

A Transdiagnostic Approach to Pain and Emotion

Emotion and pain are known to be intimately related, but treating co-occurring problems is still in its infancy mainly because we lack a clear theoretical understanding of the underlying mechanisms involved. This lack of understanding is problematic because treatment has proved challenging and co-occurring pain and emotional problems are associated with poor outcome, relapse, and greater sick absenteeism. Transdiagnostics has emerged as one way of focusing on the shared underlying mechanisms that drive comorbid problems. This approach has not been thoroughly examined for pain and emotion. Hence, the purpose of this review is to describe a transdiagnostic approach to pain and emotion and its clinical implications. To this end, the transdiagnostic approach is applied to pain and emotion in a narrative review of the literature. A focus on the function of emotion and pain relative to the context is underscored as a way to understand the relationship better. Avoidance, catastrophic worry, and thought suppression are put forward as three examples of potential transdiagnostic mechanisms that may underlie a co-occurring emotion and pain problem. The approach is readily translated to the clinic where assessment and treatment should focus on identifying transdiagnostic mechanisms. However, additional exploration is needed and therefore suggestions for future research are presented.

Panic Attacks in Generalized Anxiety Disorder

Panic attacks have been reported by patients with generalized anxiety disorder (GAD) in response to catastrophic worry. This has not been characterized in the literature. We examined the prevalence of GAD panic attacks in an anxiety disorders clinic sample. Charts of 254 patients with DSM-IV GAD were retrospectively evaluated. The presence and type of panic attacks were examined as well as correlates including comorbidity, baseline symptom severity, demographic variables, and family history. Twenty-one percent had GAD panic attacks, 21.7% had situationally predisposed attacks, 15.6% had situationally bound attacks, and 39.4% had unexpected panic attacks. The individuals who had GAD panic attacks had higher scores on the Anxiety Sensitivity Index compared with those who also had other types of panic attacks. One in five patients with GAD reported GAD panic attacks; however, these individuals did not differ significantly on the correlates that were evaluated. These findings require replication and further evaluation.

Sleep Disturbance and Depressive Symptoms in Adolescence: The Role of Catastrophic Worry

Depression is a common and debilitating disorder in adolescence. Sleep disturbances and depression often co-occur with sleep disturbances frequently preceding depression. The current study investigated whether catastrophic worry, a potential cognitive vulnerability, mediates the relationship between adolescent sleep disturbances and depressive symptoms, as well as whether there are gender differences in this relationship. High school students, ages 16-18, n = 1,760, 49% girls, completed annual health surveys including reports of sleep disturbance, catastrophic worry, and depressive symptoms. Sleep disturbances predicted depressive symptoms 1-year later. Catastrophic worry partially mediated the relationship. Girls reported more sleep disturbances, depressive symptoms, and catastrophic worry relative to boys. The results, however, were similar regardless of gender. Sleep disturbances and catastrophic worry may provide school nurses, psychologists, teachers, and parents with non-gender specific early indicators of risk for depression. Several potentially important practical implications, including suggestions for intervention and prevention programs, are highlighted.

Investigating the effect of intolerance of uncertainty on catastrophic worrying and mood

Intolerance of uncertainty (IU) is a construct known to influence catastrophic worry and is often observed in Generalized Anxiety Disorder (GAD). Research into the psychological manifestations of GAD suggests IU is associated with worry, but has not confirmed a causal link. The current study investigated the relationship between catastrophic worry and IU in a non-clinical undergraduate and postgraduate population (n = 46), with a mean age of 26.8 (SD = 5.52 years), where 71.74% were women. Participants received either a high or low IU manipulation, mood was measured throughout the study on 100 point visual analogue scales (VAS), and worry was measured using the catastrophising interview (CI). The high IU group generated significantly more catastrophising steps than the low IU group. Increased levels of sadness and anxiety were observed in the high as compared to the low IU group post IU manipulation, and this difference was maintained throughout the CI interview. A mediation analysis revealed that sadness and anxiety did not significantly mediate the relationship between IU and number of CI steps. These findings have implications for GAD treatment, as they suggest that manipulating IU affects measures of worry and its associated emotional and behavioural symptoms.

Understanding catastrophic worry in eating disorders: Process and content characteristics

Background and objectivesThe majority of people with eating disorders (ED) experience high levels of comorbid anxiety and depression, yet the maintenance processes of these in ED remain largely unknown. Worry, a defining cognitive feature and important maintenance factor of anxiety, has not been well-studied amongst people with ED. This is the first study to explore both the process and content characteristics of catastrophic worry in ED. MethodsTwenty-nine patients with anorexia nervosa (AN), 15 patients with bulimia nervosa (BN) and 37 healthy controls (HC) completed measures assessing anxiety, depression, worry and eating disorder pathology. Catastrophic worry was assessed using the Catastrophizing Interview and catastrophic worry content was explored using qualitative Thematic Analysis. ResultsCompared to HCs, ED groups had higher levels of anxiety, depression and worry and they generated a greater number of catastrophic worry steps. Worry was further found associated with depressive symptomatology in those with ED. Worry content for the ED groups included ED themes, but also themes reflecting broader inter and intrapersonal concerns. LimitationsThe degree to which worry is driven by depressive versus anxious symptomatology remains unclear. The current study does not include an anxious or depressed control group, and results should be considered in the light of relatively small samples sizes. ConclusionFindings indicate that interventions that target worry processes may be a useful adjunct to treatment for those ED patients with clinical worry levels.

An Investigation of Factors Associated with Cognitive Avoidance in Worry

This study is an exploration of factors that may be contributing to cognitive avoidance, a proposed maintaining factor in worry and generalized anxiety disorder (Borkovec et al., in Heimberg et al. (Eds.), Generalized anxiety disorder: Advances in research and practice, 2004; Dugas et al., Behav Res Ther 36: 215–226, 1998). Two sets of worry-related processes, negative beliefs about worry and the fear of anxiety, were postulated to contribute to the use of cognitive avoidance strategies. Questionnaires were completed by 259 undergraduate students (67.1% female; mean age 23.33 years, SD = 5.27). All process measures, including cognitive avoidance, were correlated with generalized and catastrophic worry. Using hierarchical multiple regression analysis, both negative beliefs about worry and the fear of somatic symptoms of anxiety were found to predict cognitive avoidance. Implications for cognitive-behavioral models of generalized anxiety disorder are discussed.

Persecutory delusions and catastrophic worry in psychosis: Developing the understanding of delusion distress and persistence

In a recent theoretical account of persecutory delusions, it is suggested that anxiety and worry are important factors in paranoid experience [Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P. E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41(4), 331–347]. In emotional disorders worry has been understood in terms of catastrophising. In the current study, the concept of catastrophising is applied for the first time with persecutory delusions. Thirty individuals with current persecutory delusions and 30 non-clinical controls participated in a cross-sectional study. The group with persecutory delusions was also followed up at 3 months to assess predictors of delusion persistence. At its most severe, 21% of individuals with persecutory delusions had clinical worry, 68% had levels of worry comparable with treatment seeking GAD patients. Further, high levels of anxiety, worry and catastrophising were associated with high levels of persecutory delusion distress and with the persistence of delusions over 3 months. If future research replicates these findings, worry reduction interventions for individuals with persecutory delusions may be warranted.

Catastrophic worry in primary insomnia

The present study aimed to provide an empirical test of the proposal that catastrophic worry about the consequences of not sleeping is common among patients with primary insomnia and serves to maintain the sleep disturbance. It was predicted that relative to good sleepers, patients with primary insomnia would catastrophize more and that catastrophizing would be associated with increased negative affect and increased perception of threat. A ‘catastrophizing interview’ was administered to 30 patients with primary insomnia and 30 good sleepers. Consistent with the predictions, the insomnia patients generated more catastrophes about the consequences of not sleeping and gave higher likelihood ratings than good sleepers. For the insomnia group, but not the good sleepers, the catastrophizing interview was associated with increased anxiety and discomfort. The limitations of the study, possibilities for future research, and clinical implications of these findings are discussed.

Social problem solving and trait anxiety as predictors of worry in a college student population

This study examined the relations between trait anxiety, social problem-solving ability, and two different measures of worry in a sample of 353 college students. The worry measures were the Penn State Worry Questionnaire (PSWQ), which measures worry frequency, uncontrollability, and distress, and the Catastrophic Worry Questionnaire (CWQ), which assesses extreme negative outcome expectancies associated with worry. Results of hierarchical multiple regression analyses showed that social problem-solving ability accounted for a significant amount of variance in both worry measures even after trait anxiety was controlled. Three different dimensions of social problem-solving ability were found to be significantly associated with worry. Negative problem orientation was positively related to both worry measures after controlling for trait anxiety. In addition, rational problem solving and impulsivity/carelessness style were both positively related to the CWQ after controlling for trait anxiety and problem orientation, which suggests that catastrophic worry has both constructive and dysfunctional problem-solving aspects that cannot be accounted for by the person's problem orientation. The implications of these findings for theory, research, and practice were discussed.