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Childhood Learning History Origins of Adult Pain Anxiety

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Pain anxiety refers to a range of cognitive (catastrophic thinking), behavioral (escape and avoidance), and physiological (heightened arousal) responses to pain (McCracken & Gross). Greater pain anxiety is associated with greater pain severity, disability, and distress. This retrospective study investigated learning history experiences related to the development of pain anxiety in a sample of 198 undergraduates (147 women, 51 men). Childhood instrumental and, to a more limited extent, vicarious learning experiences with pain were positively associated with levels of pain anxiety in adulthood. The physical concerns component of anxiety sensitivity (AS: fear of arousal-related somatic sensations), but not AS-psychological or social concerns or trait anxiety, was found to mediate the relationship between childhood instrumental learning experiences with pain and pain avoidance behavior, cognitive anxiety, and physiological anxiety in adulthood. Both AS physical concerns and, to a lesser extent trait anxiety, mediated the relationship between childhood instrumental learning experiences with pain and fearful thinking about pain in adulthood. Finally, AS physical concerns, but not AS-psychological or social concerns or trait anxiety, also was found to mediate the relationship between childhood observational learning experiences with pain and pain cognitive anxiety and fearful thinking in adulthood.
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... Beyond physical outcomes, solicitous parenting may influence patient beliefs about and approaches to managing pain that are carried on into adulthood (Watt et al., 2010). Specifically, patients reinforced in response to general pain experienced during their childhood reported greater avoidance and negative views of pain in adulthood (Watt et al., 2010). ...
... Beyond physical outcomes, solicitous parenting may influence patient beliefs about and approaches to managing pain that are carried on into adulthood (Watt et al., 2010). Specifically, patients reinforced in response to general pain experienced during their childhood reported greater avoidance and negative views of pain in adulthood (Watt et al., 2010). As 41% of pediatric patients with chronic abdominal pain will continue to experience symptoms as adults (Horst et al., 2014), having a fuller understanding of pain-related beliefs and behaviors influenced by solicitous parenting is crucial to inform treatment and disrupt this trajectory. ...
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Objective The current study sought to explore how solicitous parenting predicts patient engagement in valued activities (i.e., activity engagement) and prioritization of controlling pain (i.e., pain willingness), two factors of pain acceptance. We also examined how solicitous parenting and abdominal pain severity interact to predict these two factors. Method Participants were 119 pediatric patients seen for an initial evaluation in a multidisciplinary abdominal pain clinic. Patients met criteria for a Rome functional gastrointestinal disorder, and, as part of standard care, patients and their caregivers completed questionnaires assessing solicitous parenting, pain acceptance, and abdominal pain severity. Results Greater negatively reinforcing solicitous parenting predicted lower activity engagement and pain willingness. Further, positively reinforcing solicitous parenting did not add significant variance in predicting activity engagement or pain willingness after accounting for variance predicted by negatively reinforcing solicitous parenting. Last, while negatively reinforcing solicitous parenting and abdominal pain severity did not interact to predict activity engagement or pain willingness, abdominal pain severity predicted significant variance in each facet of pain acceptance even after accounting for negatively reinforcing solicitous parenting. Conclusions Results suggest that patients experiencing negatively reinforcing solicitous parenting may engage in valued activities less and be less willing to tolerate pain while prioritizing other life goals. Findings highlight the importance of monitoring parenting behavior and identifying goals that will encourage patient action in the face of increased pain severity. Implications for Impact Statement This study suggests that how parents respond to their child’s abdominal pain relates to how the child views pain and acts while in pain.
... Finally, as the effect of maternal modelling of bingeing behaviors is not the focus of our study, the covariance in the model between mothers' and daughters' binge eating or drinking is etiologically neutral with respect to direction of influence. Future studies, using learning experience self-reports (e.g., Watt et al., 2010), might consider a maternal influence of binge eating or drinking through modelling (e.g., the daughters' observations of their mothers' eating/drinking behaviors and attitudes influencing daughters' bingeing; Cooley et al., 2008). ...
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Perfectionism is linked to a range of psychopathology, including binge eating. Our study enhanced understanding of the role maternal perfectionistic concerns play in the maintenance of binge eating in emerging adult daughters. A sample of 73 mother-daughter dyads (mean age = 49.51 years for mothers and 19.89 years for daughters) reported on perfectionistic concerns (composite of doubt about actions and concern over mistakes), binge eating, and binge drinking (composite of frequency, severity, and perceptions). Using actor-partner interdependence modelling, mothers' and daughters' perfectionistic concerns were positively associated with their own binge eating (actor effects). Mothers' perfectionistic concerns were positively associated with daughters' binge eating (partner effect), but not vice versa. Perfectionistic concerns did not show significant actor or partner associations with binge drinking, supporting the specificity of our model. Findings suggest binge eating has characterological and interpersonal antecedents.
... Looking beyond the direct association between AS and pain-related anxiety, research also suggests that AS may play a mediating role in the association of early learning experiences with the development of painrelated anxiety (Watt, Stewart, Moon, & Terry, 2010). Other researchers have found that AS predicted pain-related escape and avoidance indirectly through its impact on pain-related anxiety among chronic pain patients (Asmundson & Taylor, 1996;. ...
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High anxiety sensitivity (AS) has been associated with elevated pain-related anxiety in anxiety and pain samples. The present study investigated (a) the associations among the lower order dimensions of AS and pain-related anxiety, using a robust measure of AS, and (b) the pain-related anxiety outcomes of a telephone-delivered cognitive behavioural treatment (CBT) designed to reduce high AS. Participants were 80 anxiety treatment-seeking participants with high AS (M age = 36 years; 79% women). After providing baseline data on AS and pain-related anxiety, participants were randomly assigned to an eight-week telephone CBT or a waiting list control. At baseline, bivariate correlations showed AS physical and cognitive, but not social, concerns were significantly associated with pain-related fear and arousal but not escape/avoidance behaviours. Multiple regression revealed that after accounting for emotional distress symptoms, AS physical, but not cognitive or social, concerns uniquely predicted pain-related anxiety. Multilevel modelling showed that the AS-targeted CBT reduced pain-related anxiety and treatment-related changes in global AS and AS physical concerns mediated changes in pain-related anxiety. Results suggest that an AS-targeted intervention may have implications for reducing pain-related anxiety. Further research is needed in a chronic pain sample.
... These behaviours are thought to function to amplify children's cognitions about the inherent threat value of pain and reinforce pain behaviours (e.g., escape/avoidance; see Wilson, Lewandowski & Palermo, 2011). These early social learning processes related to somatic symptoms (including pain) in childhood are predictive of high levels of anxiety sensitivity and pain-related anxiety in adulthood (Watt & Stewart, 2000;Stewart et al., 2001;Watt, O'Connor, Stewart, Moon, & Terry, 2008;Watt, Stewart, Moon, & Terry, 2010). Similarly, children's autobiographical memories develop within this familial context and are highly influenced by the quality and content of their verbal interactions with individuals in their social environments, particularly parents (Bauer et al., 2010;Peterson et al., 2007). ...
... Early instrumental (ie, reinforcement for sick role behaviours) and vicarious (ie, parent modelling of sick role behaviours) learning experiences regarding somatic symptoms in childhood are related to high levels of anxiety sensitivity in adulthood (64)(65)(66). Similarly, instrumental and vicarious learning experiences regarding pain in childhood are predictive of pain-related anxiety in adulthood through their influence on the physical concerns component of anxiety sensitivity (67). Importantly, these early learning processes may be affected by the psychological characteristics of the child. ...
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Full text (open access) pdf is available at: http://www.pulsus.com/journals/abstract.jsp?sCurrPg=abstract&jnlKy=7&atlKy=11402&isuKy=1092&isArt=t&fromfold=Current The fear-avoidance model has become an increasingly popular conceptualization of the processes and mechanisms through which an acute pain experience can become chronic. The model itself has its roots in early behavioural and cognitive work, has been amended sev-eral times, and has led to the development and evaluation of conceptually related treatment options. In recent years, there have also been important advances in the evaluation and application of the fear-avoidance model within the context of pediatric pain. The present review has several purposes. First, we will define several constructs that are central to the fear-avoidance model. Second, we will summarize the fear-avoidance model and its various iterations. Third, we will review the growing empirical literature focusing on applications of fear-avoidance constructs in understanding persistent pain in pediatric samples. Fourth, we will propose an empirically-based pediatric fear-avoidance model of chronic pain that may improve its heuristic value in the pediatric milieu. Fifth, we will describe assessment and treatment options for children and adolescents with various types of chronic pain stemming from the model and provide a narrative review of effectiveness and efficacy studies. Finally, we will identify avenues for future investigation
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Presented study provides a brief overview of the knowledge about the specific features of pain experience in children, factors affecting this pain experience and possibilities of pain reduction at the psychosocial level. Pain is a complex perceptual experience which is manifested at the biological, psychological and social level. For the child, pain is a significant source of stress and that is why it is important to reduce pain intensity, using every possible way. Many factors influencing experienced pain intensity in children are discussed in this review. These include developmental level, past experiences with pain, behavioral patterns taken in the family, approach of medical staff and relatives during painful procedures, the attachment between mother and child or perceived painfull procedure-related fear and anxiety. In the last section, methods that are effective in reducing experienced pain are reviewed, as for example explanation, relaxation, conversation, demonstration of procedure, presence and physical contact with a parent or influence of pleasant environment. The review concludes with recommendations for practice.
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Anxiety isn't all in your head. When you feel nervous, symptoms such as chills, sweating, heart palpitations, and shaking can affect your whole body. If you worry that others notice these anxiety symptoms or fear that they could be harmful to your health, you may have anxiety sensitivity. Anxiety sensitivity is the fear of anxiety-related sensations, a condition that affects approximately 16 percent of the population. People with high anxiety sensitivity often fear these bodily sensations even more than the situation that caused their anxiety in the first place. This fear of fear can lead them to avoid activities that might trigger their symptoms, and can cause other mental and physical problems down the road. Overcoming the Fear of Fear provides you with all the tools you need to stop fearing your anxiety symptoms for good. You'll learn to use cognitive behavioral techniques that have been proven effective for people with anxiety sensitivity. These techniques can help you reduce your anxiety sensitivity, prevent recurrence of panic attacks, and start living without fear.
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Anxiety sensitivity (AS) is the fear of anxiety sensations which arises from beliefs that these sensations have harmful somatic, social, or psychological consequences. Over the past decade, AS has attracted a great deal of attention from researchers and clinicians with more than 100 peer-reviewed journal articles published. In addition, AS has been the subject of numerous symposia, papers, and posters at professional conventions.© 1999 by Lawrence Erlbaum Associates, Inc. Why this growing interest? Theory and research suggest that AS plays an important role in the etiology and maintenance of many forms of psychopathology, including anxiety disorders, depression, chronic pain, and substance abuse. Bringing together experts from a variety of different areas, this volume offers the first comprehensive state-of-the-art review of AS--its conceptual foundations, assessment, causes, consequences, and treatment--and points new directions for future work. It will prove to be an invaluable resource for clinicians, researchers, students, and trainees in all mental health professions. © 1999 by Lawrence Erlbaum Associates, Inc. All rights reserved.
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Evaluated a scale for measuring anxiety sensitivity (i.e., the belief that anxiety symptoms have negative consequences), the Child Anxiety Sensitivity Index (CASI), in 76 7th–9th graders and 33 emotionally disturbed children (aged 8–15 yrs). The CASI had sound psychometric properties for both samples. The view that anxiety sensitivity is a separate concept from that of anxiety frequency and that it is a concept applicable with children was supported. The CASI correlated with measures of fear and anxiety and accounted for variance on the Fear Survey Schedule for Children—Revised and the State-Trait Anxiety Inventory for Children (Trait form) that could not be explained by a measure of anxiety frequency. The possible role of anxiety sensitivity as a predisposing factor in the development of anxiety disorder in children is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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