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Coping Strategies Questionnaire (CSQ) Description: A measure of coping with pain 1. ACPA groups build on these coping skills: We do not dwell on physical symptoms of pain. Coping Strategies Questionnaire (CSQ) Description: A measure of coping with pain 1.
The Coping Strategies Questionnaire (CSQ) (Rosenstiel and Keefe 1983) is the most widely used measure of pain coping strategies. The Coping Strategies Index A tool for rapid measurement of household food security and the impact of food aid programs in humanitarian emergencies Stress & Coping Self-Test. And need to improve your coping skills. Stress Assessment questionnaire Dave Smith Report myskillsprofile.com. Coping Strategies People cope with stress in different ways. Measurement Structure of the Coping Strategies Questionnaire-24 in a Sample of Individuals With Musculoskeletal Pain: A Confirmatory Factor Analysis Dale Walker, M.D.
Development of the Coping Strategies Questionnaire 24, a Clinically Utilitarian Version of the Coping Strategies Questionnaire Nicholas J. Harland Cognitive-Behavioral Coping Skills Therapy Manual. Free PDF ebooks (user's guide, manuals, sheets) about Coping strategies questionnaire pdf ready for download CSQ stands for Coping Strategies Questionnaire The QuestionPro Advantage.
Pain Res Manag. Coping Strategies Questionnaire. Dale Walker, M.D. Pro accounts for 1. Measurement Structure of the Coping Strategies Questionnaire-24 in a Sample of Individuals with Musculoskeletal Pain: A Confirmatory Factor Analysis Epub 2014 Apr 22.
Documents Similar To The Coping Styles Questionnaire.docx. Based on helplessness/hopelessness theories of depression, the 12-item Coping Competence Questionnaire (CCQ) was designed Manual Coping Strategies Inventory - Download as PDF File (.pdf), Text File (.txt) or read online. Read Improving Coping Skills below. Coping Strategies Questionnaire definition, categories, type and other relevant information provided by All Acronyms. Self-Protection and Coping Strategies of Stress & Coping Self-Test. And need to improve your coping skills. Stress Assessment questionnaire Dave Smith Report myskillsprofile.com.
Coping Strategies People cope with stress in different ways. For more than 20 years, the Ways of Coping Scale (WOCS) has been used extensively to measure coping.
2014 May-Jun;19(3):153-8. Pain Res Manag.
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Coping strategies are used more frequently in both Sweden and USA, such Coping Strategies Inventory Free PDF ebooks (user's guide, manuals, sheets) about Coping strategies questionnaire ready for download The Coping Strategies Questionnaire (CSQ) (Rosenstiel and Keefe 1983) is the most widely used measure of pain coping strategies. Some people look for Dennis Donovan, Ph.D. University of Washington and Seattle VA Medical Center Cognitive-Behavioral Coping Skills Therapy Manual. Epub 2014 Apr 22.
Dennis Donovan, Ph.D. University of Washington and Seattle VA Medical Center Coping skills are techniques that can be helpful in managing pain. Some people look for iv. Read Improving Coping Skills below.
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. 1.9k Downloads. Abstract Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback is used as a tool to gain voluntary control of activity in various brain regions. Little emphasis has been put on the influence of cognitive and personality traits on neurofeedback efficacy and baseline activity.
Here, we assessed the effect of individual pain coping on rt-fMRI neurofeedback during heat-induced pain. Twenty-eight healthy subjects completed the Coping Strategies Questionnaire (CSQ) prior to scanning.
The first part of the fMRI experiment identified target regions using painful heat stimulation. Then, subjects were asked to down-regulate the pain target brain region during four neurofeedback runs with painful heat stimulation. Functional MRI analysis included correlation analysis between fMRI activation and pain ratings as well as CSQ ratings. At the behavioral level, the active pain coping (first principal component of CSQ) was correlated with pain ratings during neurofeedback. Concerning neuroimaging, pain sensitive regions were negatively correlated with pain coping. During neurofeedback, the pain coping was positively correlated with activation in the anterior cingulate cortex, prefrontal cortex, hippocampus and visual cortex.
Thermode temperature was negatively correlated with anterior insula and dorsolateral prefrontal cortex activation. In conclusion, self-reported pain coping mechanisms and pain sensitivity are a source of variance during rt-fMRI neurofeedback possibly explaining variations in regulation success. In particular, active coping seems to be associated with successful pain regulation. Real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback recently became a popular method to learn voluntary regulation of brain activity.
As it is a rather new technique, publications have focused to date mostly on the technical feasibility and validity of the technique and its possible applications in different clinical fields such as chronic pain (deCharms et al. ), schizophrenia (Ruiz et al. ), tinnitus (Haller et al. ) and depression (Linden et al. Thus, mainly the neuroimaging results and behavioral outcome measures for the examined clinical populations were assessed. However, it is known that neurofeedback efficacy varies considerably between subjects (Johnston et al.; Weiskopf et al.; Emmert et al.
), yet the origin of this inter-individual variability remains poorly investigated. Here, we looked to find domain-specific behavioral factors that influence neurofeedback using previously published neurofeedback data regulating pain sensitive areas (Emmert et al. Brain areas involved in pain perception include the primary and the secondary sensory cortex and the posterior insula (Peyron et al.; Apkarian et al.; Tracey ). Areas involved in pain arousal and emotion, pain consequences and pain modulation include the anterior cingulate cortex (ACC), the anterior insula (AIC), prefrontal cortical areas and subcortical areas (including the basal ganglia and the thalamus) (Apkarian et al.; Friebel et al. In addition, brainstem structures including the periaqueductal gray (PAG) and the ventral tegmental area are also implicated in perception and modulation of pain by controlling the gain of pain transmission from the spinal cord (Apkarian ). It has been shown that pain perception and processing is influenced by a variety of psychological factors. For example, this is evident when looking at the placebo/ nocebo effect that influences pain related brain activation (Bingel; Kong et al.; Lidstone and Stoessl ).
Two recent meta-analyses on placebo neuroimaging studies showed that expected pain reduction is accompanied by a reduction in dorsal ACC and MCC, insula, thalamus, amygdala, striatum, superior temporal and precentral gyri and lateral prefrontal cortex activation, as well as an increase in activation in the dorsolateral and ventromedial prefrontal cortex, the left inferior parietal lobule and postcentral gyrus, the rostral ACC, the midbrain around the PAG, the left anterior insula, and the striatum (Atlas and Wager; Amanzio et al. There are attempts to use the link between cognition and brain activation to alter pain processing through different behavioral strategies including distraction-based techniques, cognitive behavioral therapy and mental imagery (Flor; Jensen et al.
The ACC and the AIC seem to be of particular importance for the perception of pain intensity and affect (Favilla et al. ), especially in neurofeedback studies (deCharms et al. Previous neurofeedback showed successful regulation of the AIC in healthy participants (Lawrence et al.; Caria et al. ), obese participants (Frank et al. ) and in schizophrenic patients (Ruiz et al. ) although up-regulation seems to be easier than down-regulation (Veit et al. The ACC was mainly regulated in the context of pain studies.
A previous pilot study in patients with chronic pain (deCharms et al. ) found that anterior cingulate cortex (ACC) regulation using rt-fMRI neurofeedback resulted in a decrease of pain intensity. Further research with healthy participants confirmed that down-regulation of the ACC is possible (Rance et al.; Emmert et al. However, up-regulation was not successful (Rance et al. ) and researchers found that effects of pain regulation through neurofeedback vary between subjects (DeCharms ). In our previous study (Emmert et al.
), we compared neurofeedback efficacy during pain using either the AIC or the ACC as the target region. Even though our results suggested that the majority of both groups were able to regulate the target area, the effect size varied substantially between subjects, leading to the hypothesis that there is an unexplained variability during neurofeedback. Concerning pain neurofeedback studies, these differences might be related to how subjects cope with pain in general. Individual pain coping behavior can be assessed by the Coping Strategies Questionnaire (CSQ) (Rosenstiel and Keefe ), a self-reporting questionnaire. The CSQ has been repeatedly applied to healthy subjects in experimental pain studies (Hastie et al.; Lefebvre et al.; Lester et al.; Campbell et al.; Kashikar-Zuck et al. The active score of the CSQ is of particular interest for brain regulation during pain, as it was shown to predict perceived control over pain (in particular the sub-scale self-statement) (Haythornthwaite et al.
) and self efficacy (Keefe et al. Therefore, we use the CSQ as a tool to investigate the association between individual coping behavior and brain activity during neurofeedback as a source of inter-individual variability in neurofeedback pain paradigms. Material and methods. Participants Twenty-eight healthy subjects (mean age: 27.5 ± 2.3 years, 14 male, 14 female) gave written informed consent to participate in this study that was approved by the local ethics committee of the Rhineland Palatinate medical association in Mainz, Germany.
Participants were randomly assigned to two groups of 14 participants each, including seven men and women per group (AIC-Group: 27.6 years ± 2.1, ACC-Group: 27.4 ± 2.6 years). The left anterior insula (lAIC) served as a target region for feedback in the first group while the second group received feedback from the ACC. Exclusion criteria were acute or chronic pain, pregnancy, severe neurological or internal disorders, intake of painkillers and contraindications for MR-measurements. All participants received financial compensation for the study. Assessment of pain coping behavior.
Before undergoing the experiment, all subjects completed the CSQ (for an overview of the CSQ structure see Fig. The score for active coping consists of six sub-scores (diverting attention, reinterpreting pain sensations, coping self-statements, ignoring pain sensations, increasing activity level, increasing pain behaviors) and is the main behavioral outcome parameter assessing coping strategies. Each sub-score is calculated from ratings of six strategies each (randomly distributed in the questionnaire) and subjects used a 7-point Likert scale ranging from 0 (“never do that”) and 6 (“always do this”) to rate how often they use or would use each strategy to cope with pain.
As an example, the self-statement score is calculated from the six items listed in list 1. For a detailed description of the paradigm the reader is referred to the initial description of this data set (Emmert et al. Prior to the neurofeedback part of the experiment, a functional localizer ran with an ON-OFF block design of eight blocks alternating between continuous painful heat stimulation for 30 s and rest for 30 s each.
This was carried out to identify each individual’s target region. Thereafter, the main experiment of four identical neurofeedback runs was conducted. Each run consisted of a block design of four rest and regulation blocks (30 s each) proceeded by 15 s of initial rest before the first block (see Fig. Online data analysis was performed using TurboBrainVoyager (Brain Innovation, Maastricht, The Netherlands, Version 2.8). The target region was chosen based on significant activation within the lAIC/ACC during the functional localizer. During regulation phases, the same pain stimulation as during the localizer was undertaken. In addition, subjects were requested to decrease the target region activation represented by a yellow line.
The background color of the yellow line indicated to either keep the yellow line constant (black = rest blocks, no heat pain) or to decrease the amplitude of the yellow line (blue = down-regulation, heat pain). Subjects could freely choose their own mental strategy to decrease target region activation. They were not informed about any link between their task and their pain experience. Employed strategies are summarized in the supplementary Table. 2 Experimental design: each of the four neurofeedback runs (NFB) consists of four regulation blocks of 30 s each with pain stimulation Pain stimulation and rating Pain stimulation was performed using an MR compatible thermode (TSA 2001, Medoc Ltd, Ramat Yishai, Israel) placed on the middle of the right volar forearm.
Initially, the thermode temperature was adjusted for each participant to elicit a subjective pain intensity of 7 out of 10 on a numeric rating scale (NRS). In this way, subjective pain was normalized so that pain rating differences towards the end of the experiment would not be caused by differences in pain sensitivity but the experiment itself.
The thermode temperature was recorded for 26 out of the 28 subjects. This temperature for pain stimulation remained constant throughout the experiment. Pain ratings were obtained after each run (including functional localizer) using a 11-point NRS ranging from 0 (not painful) to 10 (most painful). The success of the neurofeedback was determined based on whether the pain rating decreased after neurofeedback (=success) or not.
FMRI data acquisition Neuroimaging was performed on a 3 T MRI Scanner (Siemens Tim Trio, Erlangen, Germany) with a 32-channel head-coil. Functional data acquisition used an echo-planar imaging sequence (EPI, TR = 1500 ms, TE = 30 ms, matrix size 64 × 64, 24 slices, slice thickness 3 mm without gap). Additionally, a high-resolution T1-weighted anatomical scan (magnetization prepared rapid gradient echo (MPRAGE), 1 mm isotropic) was used for later co-registration with the EPI images. Statistical analysis of pain ratings, thermode temperature and CSQ scores Statistical testing for correlation between thermode temperature, pain ratings and the CSQ measures was carried out in MATLAB 2012b (The MathWorks, Inc., Natick, USA) using Spearman’s Correlation (two-sided).
Due to the strong inter-dependencies of the six active sub-scales of the CSQ (diverting attention, reinterpreting pain sensations, coping self-statements, ignoring pain sensations, increasing activity level, increasing pain behaviors), Bonferroni correction would be too conservative to apply (Abdi ). Therefore, we undertook a principal component analysis for all subjects and all 6 active score sub-scales using single value decomposition to identify the first principal component that best represents the participant data of the six active CSQ sub-scales. This measure has the advantage of using the structure of the questionnaire (division into six sub-scales) as well as all sub-scales to a varying degree. We then checked for correlation between this first component and pain ratings as well as thermode temperature. Post-hoc GLM activation correlation with behavioral measures Off-line analysis was performed with FSL 5.0 (FMRIB Analysis Group, University of Oxford, UK).
Functional data was spatially realigned, normalized and smoothed (FWHM = 5 mm kernel) in a first step. Next, first level neuroimaging results were obtained by fitting a standard GLM regressor to the pain stimulation and neurofeedback blocks (block design described under “ section”, for details on the main effect of neurofeedback please see Emmert et al. Finally, a voxel-wise regression analysis between the behavioral scores (PC1, pain rating and pain rating change between localizer and neurofeedback runs) and the imaging data (using the contrast of parameter estimates (COPE) files of the first level analysis) was performed using a mixed-effects GLM.
The main regressor was the demeaned and normalized (values between −1 and 1) score of interest. To exclude the possibility that group-specific differences drive the effect we added non-explanatory co-regressors that model the neurofeedback group (AIC versus ACC target region). For the fMRI analysis, voxels with a z-score above 2.3 within clusters that exceeded a multiple-comparison corrected significance threshold of p. The principle component analysis (PCA) resulted in a first principal component (PC 1) with only positive weights, indicating that all six sub-scores positively contribute to this component (see Table ). In particular, these weights indicate how different subscales explain the inter-subject variability (see Table ). The sub-scores “diverting attention”, “ignoring pain sensation” and “increasing activity level” are most important.
Overall, PC 1 is able to explain the majority of the variance (58.57%). Sub-score Weight (U) Diverting attention 0.5318 Reinterpreting pain sensations 0.1900 Coping self-statements 0.3361 Ignoring pain sensations 0.5377 Increasing activity level 0.4906 Increasing pain behaviors 0.1955 Behavioral data: correlation of pain ratings, thermode temperature and CSQ scores There were no significant differences in pain ratings and CSQ scores between the two groups with different NFB target region. Therefore, the analyses in this paper were conducted for all 28 NFB participants together, independent of the targeted ROI (AIC/ACC).
There was no significant correlation between baseline pain rating (after functional localizer) and the first PC. However, the thermode temperature (assessed in 26 out of the 28 subjects) was positively correlated with the localizer pain rating ( R = 0.404, p. When looking at all the neurofeedback runs together, the active scores PC 1 were positively correlated with activation during neurofeedback in the ACC, prefrontal areas (Brodmann areas 9,10) and a small medial part of the left insula. In addition, there was a larger occipital activation, that was more extended on the left side stretching from the hippocampus to parts of the parahippocampal, occipital fusiform (including the peak voxel at −26 −76 −2 (MNI coordinates) with a z-score of 5.03) and lingual gyrus (Brodmann area 19), encompasing part of the cuneus (Brodmann area 18) and the thalamus (see Fig.
No negative correlations were found. Personal pain coping capacity, specifically active coping, was associated with heat pain perception and the ability to influence pain processing with the help of real-time fMRI neurofeedback. During baseline pain, the first principle component of CSQ active sub-scores was associated with deactivation in striatum, ACC and lAIC.
During neurofeedback, the PC 1 negatively correlated with the mean pain rating during neurofeedback. In addition, a high PC1 was associated with an increased activation in several brain areas including the ACC, the thalamus and visual areas during neurofeedback. PCA was successfully used to reduce the dimensonality of the CSQ data, similar to another study looking at CSQ measures in patients with chronic back pain (Woby et al.
Similarly, we excluded the passive measures of the CSQ, including the catastrophizing score, from the coping style analysis, as it does not “represent an effortful response to obtain support or assistance from others” (Woby et al., page 101). However, while Woby et al. Looked at the interaction of catastrophizing and coping habits, we here used the first PC as a summarizing measure of active pain coping. We looked for correlation of this measure with pain rating and brain activity during neurofeedback. Our results show that active coping styles are associated with the success in neurofeedback; i.e., a smaller pain rating compared with participants with a lower PC 1 (as all weights of the PC 1 were positive). This explains the mixed response of subjects to neurofeedback with some showing successful regulation while others did not control their target region activity at all. Therefore, cognitive and personality traits, in particular those related to the regulated area, should be assessed before neurofeedback to preselect those subjects that are more likely to succeed.
Behavioral data: correlation of coping activity, thermode temperature and pain rating At the behavioral level, we assessed the effect of individual pain coping ability on pain rating during heat pain stimulation and real-time fMRI neurofeedback. We found no significant interaction of the active scores PC 1 and behavior during the baseline pain perception run. This result was expected as the pain stimulus (temperature of thermode) was individually adjusted for each subject to elicit a constant pain intensity (7 out of 10 on a NRS) prior to the localizer run and the participants were not trying to control pain.
However, we found a positive correlation of the thermode temperature and baseline pain rating. This is not surprising, as higher thermode temperature should elicit more pain. The pain during neurofeedback manipulation was negatively correlated to the CSQ active PC 1, indicating that active pain coping may influence pain perception during pain region rt-fMRI regulation.
Correlation of neuroimaging and coping activity during pain stimulation without feedback In a first step, we assessed brain activation during the functional pain localizer run without neurofeedback. Note that the pain stimulation paradigm was individually adjusted to evoke an individual pain response of 7 out of 10 on a NRS. This means that the subjective pain perception was the same for all subjects in the beginning of the experiment, whereas the actual absolute temperature may have varied between participants. Despite the fact that the pain stimulation was adjusted to evoke the same degree of subjective pain, participants with a lower degree of active coping had increased activation in the striatum, especially the caudate nucleus, the ACC and the lAIC.
This might indicate that pain processing is different in participants that are used to cope actively with pain. This view is supported by a study suggesting that intended pain suppression decreases ACC and caudate nucleus activation (Freund et al. Furthermore, it has been shown that the use of repeated positive self-statement can increase the pain sensitivity range, i.e. The difference between pain tolerance and threshold (Roditi et al. Conversely, catastrophizing self-statements sensitized for pain perception (Ruscheweyh et al. The decreased activity for actively coping participants might be accompanied by an increase in cortisol release, at least for women (Bento et al. The fact that brain activation is different depending on active pain coping, even though the subjective pain perception is at the same level, indicates that active coping seems to be associated with the use of different resources during pain.
This suggests that there might be a substantial individual variation of how pain is processed depending on the coping habits. A study by Roditi et al.
(Roditi et al. ) found that the pain threshold remained stable while the pain tolerance (i.e. The time subjects can endure pain) is enhanced in subjects with a higher positive self-statement score. Our results indicate that a less negative/unpleasant perception of pain, indicated by a decrease of activity in pain-interpretation related areas, might be present in actively coping participants in the absence of differences in pain strength. The absence of behavioral effects in the presence of neuroimaging effects can be explained by the fact that pain perception at the behavioral level is influenced by many factors including fatigue, arousal and attention. Neuroimaging data is more directly able to assess subtle changes, especially with small sample sizes, as they are less prone to strong variation depending on these factors. This phenomenon has been observed in various neuroimaging studies, especially when expected effect sizes were low (e.g.
Haller et al.; Johnston et al.; Weiskopf et al. We found a significant correlation between activation of brain regions associated with pain arousal, emotional processing and modulation and individual active pain coping. Previous neuroimaging studies focused on a passive sub-scale of the CSQ questionnaire, namely the catastrophizing scale, and found that an increased catastrophizing score is associated with a high response in areas responsible for different aspects of pain (e.g., ACC, claustrum, medial frontal cortex, cerebellum) and motor control (Gracely et al. High acceptance scores and low denial scores on a different coping questionnaire were shown to be related to ventrolateral prefrontal cortex activation (Salomons et al. In contrast to this study, we did not find any positive correlation between brain activation and coping scores.
This discrepancy could be caused by the difference of focus of the two different coping questionnaires (pain acceptance versus active coping). Pain perception, thermode temperature and brain activation during neurofeedback Thermode temperature (i.e. The intensity of the heat pain stimulus to yield pain rating of 7) was negatively correlated with the activity in the anterior insula and the dorsolateral prefrontal cortex (dlPFC, Brodman area 46) during neurofeedback runs. These results suggests that subjects with a higher pain sensitivity have an increased activity in pain related brain areas during neurofeedback. This explains why these subjects also show a smaller decrease in pain rating in comparison to the subjects with a lower pain sensitivity. We also looked at the relation of active CSQ scores to neuroimaging data obtained during all neurofeedback runs.
Active coping (high PC 1) was positively correlated with activation of occipital regions involved in vision, especially movement processing, ACC, prefrontal areas, left hippocampus and thalamus activation. One interpretation of the occipital activation is that participants with strong active coping used increasingly vivid mental imagery (Kosslyn et al. ) during neurofeedback. ACC and prefrontal involvement might be explained by a conscious effort to suppress pain. In line with this hypothesis, it has been shown that functional connectivity of the prefrontal cortex with the ACC and insula positively correlates with pain measures (Fomberstein et al.
In rats, it has even been demonstrated that prefrontal cortex stimulation induces analgesia (Hardy ). Of note, the ACC is part of the pain network contributing to the processing of painful stimuli and part of the brain regulation network (Lee et al.; Ninaus et al.
It seems that among these conflicting processes an increased amount of self-regulation (associated with more active coping) leads to ACC hyperactivity even though pain perception is decreased. Hippocampus involvement might reflect memory processes, possibly related to mental imagery as a neurofeedback tactic. In addition, thalamic activation might reflect altered somatosensory processing of pain or increased alertness due to more conscious effort exerted during the neurofeedback process for participants with stronger active coping. In total, active pain coping is associated with brain activation during neurofeedback, possibly reflecting a more vivid and dedicated regulation strategy. Does active coping increase the success of rt-fMRI neurofeedback? We showed that active coping is positively correlated with regional brain activation during neurofeedback.
The negative correlation of pain ratings with active coping PC 1 during neurofeedback runs indicates successful target brain region regulation as pain stimuli were normalized before the start of the experiment. This result is compatible with previous studies showing that positive self-statement predicts self efficacy (Keefe et al. ) and perceived control over pain (Haythornthwaite et al.
In summary, active pain coping is associated with success in regulating brain activity. A limitation of this study was the relative small sample size ( n = 28) used. In addition, further studies are needed to determine whether these results can be generalized to neurofeedback in other domains; i.e., if active coping influences regulation success in general or if this is a specific effect in the domain of pain perception neurofeedback. Moreover, the current study used two different feedback sources (either AIC or ACC), therefore, the sample might be more heterogeneous than studies using only one feedback source for all subjects.
It should be noted that in this study, we are not able to differentiate between the pain regulation abilities independent of neurofeedback, as regulation without feedback was not tested beforehand. Therefore, the pain reduction cannot be attributed unequivocally to neurofeedback training alone. Similarly, we do not take learning mechanisms into account in this study, as the course of neurofeedback learning varies greatly between subjects and no specific model of learning has been shown to hold true for neurofeedback learning yet. Future studies targeting these important questions will help to differentiate between learning, regulation mechanisms and regulation effects. There are also other factors that might influence neurofeedback performance (e.g., intelligence, personality traits). Therefore, future studies with extensive behavioral meta-data are needed to identify all main behavioral influences on neurofeedback.
In addition, it should be noted that this study was conducted on healthy subjects as a first step towards the use of neurofeedback in the field of pain. An external pain stimulus was used as a model for pathologic pain. However, pain processing might differ slightly in chronic pain patients, which should be assessed in a future study. Based on our findings, we hypothesize that behavioral therapy aiming at a more active pain coping could increase neurofeedback efficacy in these subjects as well.
Description General description: The coping strategy questionnaire (CSQ), (Rosenstiel & Keefe 1983) in its original version consists of 50 items assessing patient self rated use of cognitive and behavioural strategies to cope with pain. It comprises six subscales for cognitive strategies (ignoring pain, reinterpretation of pain, diverting attention, coping self statements, catastrophising, praying/hoping) and two subscales for behavioural strategies (increasing activity levels and increasing pain behaviours). Each coping strategy subscale consists of six items measured with a numerical rating scale ranging from 0 (never do that) to 6 (always do that) indicating how frequently the strategy is used to cope with pain. Each subscale has a maximum score of 36 and a minimum score of 0.
An additional two single item questions each with a scoring range of 0-6 are used as effectiveness ratings of control over pain and ability to decrease pain. The CSQ takes approximately 5 minutes to complete. Reliability and validity: In a sample of 61 patients with chronic low back pain (CLBP), Rosenstiel and Keefe (1983) reported the internal consistency for the subscales with Cronbach's alphas ranging from 0.71 to 0.85, except for the increasing pain behaviour subscale which had an internal consistency of 0.28. However, in a sample of 282 CLBP patients, Jensen and Linton (1993) showed that all 8 subscales of the CSQ Swedish version have an internal consistency ranging from 0.69 to 0.84.
Similarly, in patients with lung cancer, the CSQ subscales have shown good internal consistency with Cronbach's alphas ranging from 0.60 to 0.90 (Wilkie & Keefe 1991). Test-retest reliability for a 1 day interval has been reported to range between 0.68 and 0.91 (Main & Waddell 1991), 0.48-0.71 for a 1 week interval and 0.58-0.84 for a 5 week interval (Jensen & Linton 1993). Support exists for the construct validity of the CSQ in chronic pain populations where significant correlations have been shown with questionnaires measuring depression, anxiety, self-efficacy and physical functioning (Lawson et al 1990, Geisser et al 1994, Swartzman et al 1994, Burckhardt et al 1997). Studies using factor analysis to investigate the underlying dimensions of the 8 CSQ subscales and 2 effectiveness items have frequently reported a three factor solution consisting of 1) cognitive coping and suppression, 2) behavioural activity, and 3) pain control/rational thinking (Rosenstiel & Keefe 1983, Keefe & Dolan 1986, Lawson 1990, Geisser et al 1994, Burckhardt et al 1997). Using exploratory factor analysis on an individual item level, two studies obtained a five factor solution (Tuttle et al 1991, Swartzman et al 1994).
Recognising the small samples used in previous studies, item level exploratory factor analysis was performed on the CSQ from a large sample of 965 patients CLBP revealing a six factor solution similar to the subscales originally derived in the CSQ (Robinson et al 1997). Riley and Robinson (1997) compared the five and six factor solutions for the CSQ using linear structural equation modelling. Defend the bunker game for pc free download. From the results, Riley and Robinson (1997) recommended a revision of the coping strategy questionnaire (CSQ-R) retaining 27 items from the original CSQ.
This included all six items of the catastrophising subscale, five items from each of the ignoring pain and reinterpreting pain sensations subscales, four items from coping self-statements and diverting attention subscales, and three items related to praying factors. In a recent study on patients with cancer related pain, Utne et al (2009) also showed less factorial variance in the CSQ-R than the original CSQ and recommends the CSQ-R for use in clinical research. Commentary Monitoring coping strategies is of clinical importance as they have been shown to mediate the influence of pain intensity on functional disability and quality of life (Abbott et al 2010) and to influence the adjustment of pain (Rosenstiel & Keefe 1983). The CSQ has been shown to be valid for use in several different patient groups such as osteoarthritis, knee replacement surgery, rheumatoid arthritis, fibromyalgia, low back pain, lumbar spine surgery, and even cancer-related pain. The CSQ is a useful clinical tool for the screening of coping styles. It provides information for patients and clinicians on the efficacy of coping strategies and those strategies needing addressing to help facilitate pain control and mediate improvement of functional outcomes.
Data on the CSQ-R sensitivity of change is lacking. More research using the CSQ-R is needed to improve the questionnaire's validity as an outcome measure and provide more extensive normative data. References Abbott AD (2010) Physiotherapy, in press.
Burckhardt CS et al (1997) J Muscoskel Pain 5: 5-21. Geisser ME et al (1994) Clin J Pain 10: 98-106. Jensen IB, Linton SJ (1993) Scand J Behav Ther22: 139-145. Keefe FJ, Dolan E (1986) Pain 24: 49-56. Lawson K et al (1990) Pain 43: 195-204.
Main CJ, Waddell G (1991) Pain 46: 287-298. Riley JL, Robinson ME (1997) Clin J Pain 13: 156-162.
Robinson et al (1997) Clin J Pain 13:43-49. Rosenstiel AK, Keefe FJ (1983) Pain 17:33-44.
Swartzman LC et al (1994) Pain 57:311-316. Turner JA et al (2000) Pain 15:115-125. Tuttle DH et al (1991) Pain 36:179-188. Utne I et al (2009) Clin J Pain 25:391-400. Wilkie DJ, Keefe FJ (1991) Clin J Pain 7:29. Allan Abbott Karolinska Institute, Sweden.
Chronic Illness, Psychosocial Coping with S. Mannea a Fox Chase Cancer Center Philadelphia,Pennsylvania USA Available online 2002. Abstract Improvements in health care technologies and treatments have resulted in increased life expectancies and improved disease management potential for individuals with chronic illnesses. To a great degree, quality of life may be determined by the ways they deal with the illness. Thus, identifying effective ways of coping with these diseases may lead to the development of efficacious interventions. Since 1980 there has been a substantial amount of research devoted to understanding the relation between coping with chronic illnesses and psychological adaptation.
The majority of this research has used Lazarus and Folkman's Stress and Coping paradigm. Although there have been some consistent findings regarding general types of coping and their impact on psychological outcomes, particularly in the area of coping with pain, the enthusiasm for the empirical study of coping in general has dampened significantly over the course of the past several years. However, more recent studies have used idiographic and nomothetic designs that can more clearly elucidate the dynamic associations between stress, coping, and psychological adaptation to chronic illness. These advanceshold a great deal of promise for the field of coping with chronic illness. Article Outline 1.
Background 2. Historical Perspective and Current Concepts of Coping 3. Assessment of Coping 3.1. General Coping Checklists 3.2. Illness-specific Checklists 3.3. Daily Diary Instruments 4.
Studies Using the Stress and Coping Paradigm 4.1. Cross-sectional Studies 4.2. Longitudinal Studies 5. Studies of Coping with Chronic Pain 6.
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Challenges to the Study of Coping with Chronic Illness 7. Conclusions References 1. Background Improvements in health care technologies and treatments have resulted in increased life expectancies and improved disease management for individuals with chronic illnesses.
To a great degree, quality of life for many individuals with these illnesses may be determined by the ways they deal with the illness. Thus, identifying effective and ineffective ways of coping with these diseases may lead to the development of more efficacious interventions for these individuals. Since 1980 there has been a substantial amount of research devoted to understanding the relation between coping with chronic illnesses and psychological adaptation. Although there have been some consistent findings regarding coping and its impact on psychological outcomes, particularly in the area of coping with pain, the enthusiasm for the empirical study of coping in general has dampened significantly over the course of the past several years.
Indeed, recent reviews of coping research have harshly criticized the literature, particularly assessment methodologies (see Coyne and Racioppo 2000). Thus, much of the initial promise for coping research to enhance clinical practice has not been realized.
Historical Perspective and Current Concepts of Coping The psychological study of coping dates back to Sigmund Freud (1896/ 1966), who put forth the concept of defense mechanisms, defined as mental operations that kept painful thoughts and feelings out of awareness. The next major shift in the study of coping was brought about as a result of cognitive theories. The focus on intrapsychic processes that intervene between events and responses to events increased with the introduction of other cognitive theories such as Beck (1976). According to cognitive theories, cognitive coping mediated between stressful events and psychological and physical responses to stressful events. It was hypothesized that, by examining individual coping differences, a greater understanding of why people react differently to the same events would be achieved. Research on stress and coping exploded with the work of Lazarus and Folkman ( 1984), who put forth the transactional stress and coping paradigm. According to Lazarus, coping refers to cognitive and behavioral efforts to manage disruptive events that tax the person's ability to adjust (Lazarus 1981, p.
Chronic illness can pose a number of life stressors including loss of physical and social functioning, alterations in body image, managing difficult and complex medical regimens, and chronic pain. According to Lazarus and Folkman ( 1984) coping responses are a dynamic series of transactions between the individual and the environment, the purpose of which is to regulate internal states and/or alter person-environment relations. The theory postulates that stressful emotions and coping are due to cognitions associated with the way a person appraises or perceives his or her relationship with the environment. There are several components of the coping process. Randa and the soul kingdom. First, appraisals of the harm or loss posed by the stressor (Lazarus 1981 ) are thought to be important determinants of coping. Second, appraisal of the degree of controllability of the stressor is a determinant of coping strategies selected.
A third component is the person's evaluation of the outcome of their coping efforts and their expectations for future success in coping with the stressor. These evaluative judgements will lead to changes in the types of coping employed, as well as play a role in determining psychological adaptation. Two main dimensions of coping are proposed, problem-focused and emotion-focused coping. Problemfocused coping is efforts aimed at altering the problematic situation.
These coping efforts include information seeking and problem solving. Emotion-focused coping are efforts aimed at managing emotional responses to stressors. Such coping efforts include cognitive reappraisal of the stressor and minimizing the problem. How the elements of coping unfold over time is a key theoretical issue involved in studies of coping processes. Despite the fact that the theory is dynamic in nature, most of the research utilizing the stress and coping paradigm put forth by Lazarus ( 1981) has relied on retrospective assessments of coping and has been cross- sectional. However, a team of researchers, including Affleck, Tennen, and Keefe (e.g., Keefe et al. 1997) has utilized a daily diary approach to assessing coping with pain, a methodology that can examine the proposed dynamic nature of coping.
Towards the end of the twentieth century there has been also been an expansion in theoretical perspectives on cognitive coping. The literature on cognitive processing of traumatic life events has provided a new direction for coping research and broadened theoretical perspectives on cognitive methods of coping with chronic illness. According to cognitive processing theory, traumatic events can challenge people's core assumptions about them and their world (JanoffBulman 1992). The unpredictable nature of many chronic illnesses, as well as the numerous social and occupational losses, causes many individuals to question beliefs they hold about themselves.
For example, the diagnosis of chronic obstructive pulmonary disease (COPD) can challenge a person's core beliefs about personal invulnerability. To the extent that a chronic illness challenges core beliefs, integrating the illness experience into their pre-existing beliefs should promote psychological adjustment. Cognitive processing has been used as the phrase to define cognitive activities that help people view undesirable events in personally meaningful ways and find ways of understanding the negative aspects of the experience, and ultimately reach a state of acceptance. Attempts to find meaning or benefit in a negative experience are ways patients may be able to accept the losses they experience. Focusing on the positive implications of the illness or finding personal significance of a situation are two ways of finding meaning in the illness.
When considering meaning-making coping, one must distinguish coping activities that help individuals to find redeeming features in an event from the successful outcome of these attempts. For example, people who have a serious illness may report that as a result they have found a new appreciation for life or that they place greater value on relationships. Patients may also develop an explanation for the illness that is more benign (e.g., attributing it to God's will). While cognitive processing theory constructs have been applied to adjustment to losses such as bereavement (e.g., Davis et al. 1998), these constructs have received relatively little attention from researchers examining coping with chronic illness.
Another coping process that falls under the rubric of cognitive coping is social comparison. Social comparison (SC) is a common cognitive process whereby individuals compare themselves to others in order to obtain information about them (Gibbons and Gerrard 1991). According to SC theory, health problems increase uncertainty; uncertainty increases the desire for information and creates the need for comparison. Studies of coping with chronic illness have included social comparison as a focus.
A certain type of SC, downward comparison, has been the focus of empirical study among patients with chronic illnesses such as rheumatoid arthritis (RA) (Tennen and Affleck 1997). Wills ( 1981) has suggested that people experiencing a loss can experience an improvement in mood if they learn about others who are worse off. Indeed, there is evidence to suggest that SC increases as a result of experiencing health problems (Kulik and Mahler 1997).
One proposed mechanism for SC is that downward comparison impacts cognitive appraisal by reducing perceived threat. When another person's situation appears significantly worse, then the appraisal of one's own illness may be reduced (Aspinwall and Taylor 1993). Assessment of Coping 3.1. General Coping Checklists Folkman and Lazarus'Ways of Coping Checklist (WOC, Folkman and Lazarus 1980) has been one of the most widely used instruments to assess coping efforts.
This instrument contains two major subscales, problem-focused and emotion-focused coping, as well as a number of subscales including wishful thinking, cognitive restructuring, information seeking, seeking support, self- blame, and minimization. Instructions typically ask the individual to rate how he or she manages the stressor (Manne and Zautra 1989). Another measure that has been used is the Coping Strategies Inventory (CSI, Tobin et al. The CSI distinguishes two dimensions of coping, engagement/disengagement strategies and focusing on the problem/focusing on emotions about the stressor.
Problem-focused engagement is composed of problem-solving and cognitive restructuring; problem-focused disengagement is composed of problem avoidance and wishful thinking. Emotion-focused engagement is composed of social support and expressed emotion; emotion-focused disengagement is composed of social withdrawal and self-criticism. Measuring meaning-making coping and other methods of cognitive processing has been done utilizing existing measures.
Some aspects of meaning-making coping can be assessed using the cognitive reappraisal subscales of the COPE (Carver et al. 1989) and the Ways of Coping Checklist (Lazarus and Folkman 1984).
Other means of measuring the process of meaningmaking involve using measures of cognitive processing. For example, the Impact of Events scale (Horowitz et al. 1979) measures attempts to integrate a traumatic event with current schemas. Other studies have utilized questions tailored specifically for their population. Illness-specific Checklists The majority of illness-specific coping instruments have been designed to assess coping with pain associated with chronic illnesses such as rheumatoid arthritis (RA) and osteoarthritis (OA). Two instruments, the Vanderbilt Pain Management Inventory (VPMI) and the Coping Strategies Questionnaire (CSQ) have been the most widely used instruments. Both measures assess the degree to which patients employ a variety of cognitive and behavioral mechanisms to reduce the impact of painful episodes.
Brown and Nicassio (1987) developed the VPMI to assess cognitive and behavioral pain-coping strategies. The 18-item VPMI has two subdimensions, active and passive pain coping. The CSQ comprises seven subscales measuring distinct coping strategies. Factor analyses of the CSQ in both RA and OA samples provide evidence for a two-factor solution, Coping Attempts and Pain Control and Rational Thinking (Keefe et al. The Coping with Rheumatic Stressors (CORS, Lankveld et al. 1994) was specifically designed to measure stressor- specific coping in RA.
This measure is unique in that it measures coping separately with three stressors, pain, limitations, and dependence. The three coping with pain scales are comforting cognitions, decreasing activity, and diverting attention. The three coping with limitation scales are optimism, pacing, and creative solution seeking. The two coping with dependence scales are making an effort to accept dependence and showing consideration. Daily Diary Instruments Only one instrument, the Daily Coping Inventory (Stone and Neal 1984), has been developed to assess daily coping. This inventory has been adapted for chronic pain coping by Affleck et al.
Patients are asked whether or not they utilize each of seven categories of coping: (a) pain reduction attempt; (b) relaxation; (c) distraction; (d) redefinition; (e) vent emotions; (f) seek spiritual comfort; and (g) seek emotional support. These coping categories have been reduced using factor analyses to two factors, labelled emotion-focused and problem-focused coping (Affleck et al. Studies Using the Stress and Coping Paradigm 4.1. Cross-sectional Studies Early studies of coping using the stress and coping paradigm were cross-sectional and utilized retrospective checklists such as the WOC. The earliest studies divided coping into the general categories of problem-and emotion-focused strategies, and focused mostly on psychological outcomes, rather than pain and functional status outcomes. Later studies have investigated specific types of coping. For example, Felton et al.
(1984) examined two types of coping, wish-fulfilling fantasy, and information seeking, using a revision of the Ways of Coping Checklist. Wish-fulfilling fantasy was a more consistent predictor of psychological adjustment than information seeking. While information seeking was associated with higher levels of positive affect, its effects on negative affect were modest, accounting for only 4 percent of the variance. In a second study, Felton and Revenson (1984) examined coping of patients with arthritis, cancer, diabetes, and hypertension. Wish-fulfilling fantasy, emotional expression, and self- blame were associated with poorer adjustment, while threat minimization was associated with better adjustment. Scharloo et al. (1998) conducted a cross-sectional study of individuals with COPD, RA, or psoriasis.
Unlike the majority of studies, illness-related variables such as time since diagnosis and the severity of the patient's medical condition were entered first into the equation predicting role and social functioning. Overall, coping was not strongly related to social and role functioning. Among patients with COPD, passive coping predicted poorer physical functioning. Among patients with RA, higher levels of passive coping predicted poorer social functioning. Very few studies have examined coping with other chronic illnesses.
Several studies have investigated the association between coping and distress among individuals with MS. Pakenham et al. (1997) categorized coping as either emotion– or problem- focused, and found that emotionfocused coping was related to poorer adjustment, while problem-focused coping was associated with better adjustment. In contrast, Wineman and Durand ( 1994) found that emotion- and problem-focused coping were unrelated to distress. ( 1997) found that problem solving and cognitive reframing strategies are associated with lower levels of depression, whereas avoidant strategies are associated with higher levels of depression. As previously noted, most studies have used instructions that ask participants how they coped with the illness in general, rather than asking participants how they coped with specific stressors associated with their illness. Van Lankveld et al.
(1994) assessed how RA patients cope with the most important stressors associated with RA (pain, functional limitation, and dependence). When coping with pain was considered, patients with similar degrees of pain who used comforting cognitions and diverted their attention from the pain reported higher well-being.
Limiting one's activity was associated with lower well-being. When coping with functional limitation was examined, patients who used pacing of their activity reported lower levels of well-being, and use of optimism was associated with higher well-being after functional capacity was controlled for in the equation. Finally, when coping with dependence was examined, only showing consideration was associated with higher well-being after functional capacity was controlled for in the equation. Longitudinal Studies Unfortunately, there have been relatively few studies that have employed longitudinal designs. Overall, passive coping strategies such as avoidance, wishful thinking, and withdrawal, as well as self-blame, have been shown to be associated with poorer psychological adjustment (e.g.,Scharloo et al. 1999), and problem-focused coping efforts such as information seeking have been found to be associated with better adjustment (e.g., Pakenham 1999). Studies of Coping with Chronic Pain The majority of these studies have utilized longitudinal designs.
Pain Coping Strategies Questionnaire
For example, Brown and Nicassio ( 1987) studied pain-coping strategies among RA patients and found that patients who engaged in more passive coping when experiencing more pain became more depressed six months later than patients who engaged in these strategies less frequently. (1989) conducted a six-month longitudinal study of the relationship between catastrophizing and depression in RA patients. Those patients who reported high levels of catastrophizing had greater pain, disability, and depression six months later. Other investigators (Parker et al. 1989) have reported similar findings.
Positive Coping Strategies Pdf
Overall, studies have suggested that self- blame, wishful thinking, praying, catastrophizing, and restricting activities are associated with more distress, while information seeking, cognitive restructuring, and active planning are associated with less distress. As previously mentioned, several recent studies have employed prospective daily study designs in which participants complete a 30-day diary for reporting each day's pain, mood, and pain-coping strategies using the Daily Coping Inventory (Stone and Neale 1984). These studies, which have been conducted with RA and OA patients, have shown that emotion-focused strategies, such as attempting to redefine pain to make it more bearable and expressing distressing emotions about the pain, predict increases in negative mood the day after the diary report.
The daily design is a promising new method of evaluating the link between coping strategies and mood. More importantly, these studies can elucidate coping processes over time. For example, Tennen et al. (2000) found that the two functions of coping, problem- and emotion-focused, evolve in response to the outcome of the coping efforts. An increase in pain from one day to the next increased the likelihood that emotion-focused coping would follow problem-focused coping. It appeared that, when efforts to directly influence pain were not successful, participants tried to alter their cognitions and adjust rather than influence the pain. Challenges to the Study of Coping with Chronic Illness Recently, the general literature on coping has received a great deal of criticism from researchers (e.g., Coyne and Racioppo 2000).
The main concern voiced in reviews regards the gap between the elegant, process-oriented stress and coping theory and the cross-sectional, retrospective methodologies that have been used to evaluate the theory. Although the theory postulates causal relations among stress, coping, and adaptation, the correlational nature of most empirical work has been unsuitable to test causal relations.
In addition, retrospective methods require people to recall how they coped with an experience, and thus are likely to be influenced by both systematic and non-systematic sources of recall error. Coping efforts as well as psychological outcomes such as distress are best measured close to when they occur. Recent studies have used an approach that addresses these concerns. These studies have employed a microanalytic, process-oriented approach using daily diary assessments (e.g., Affleck et al. These time-intensive study designs allow for the tracking of changes in coping and distress close to their real-time occurrence and moments of change, are less subject to recall error, and capture coping processes as they unfold over time. The daily assessment approach also can evaluate how coping changes as the individual learns more about what coping responses are effective in reducing distress and/or altering the stressor. These advances may help investigators to more fully examine whether the methods used to cope with stressors encountered in the day- to-day experience of living with a chronic disease predict long-term adaptation.
Unfortunately, this approach has only been utilized among individuals with arthritis and has not been applied to individuals dealing with other chronic illnesses. Another key problem with coping checklists that has been noted in a number of reviews of the coping with chronic illness literature is the instructional format. The typical instructions used (e.g., `How do you cope with RA?' ) are so general that it is not clear what aspect of the stressor the participant is referring to when answering questions. Thus, the source of the stress may differ across study participants. There are problems even when the participant is allowed to define the stressor prior to rating the coping strategies used.
The self-defined stressor may differ across participants, and thus the analyses will be conducted with different stressors being rated. A third assessment problem regards the definition of coping.
While Lazarus and Folkman ( 1984) regard only effortful, conscious strategies as coping, other investigators have argued that `automatic' coping methods also fall under the definition of coping (Wills 1997). Indeed, some coping responses may not be perceived by the individual as choices, but rather automatic responses to stressful events. For example, wishful thinking or other types of avoidant types of coping such as sleeping or alcohol use may be categorized by researchers as a coping strategy, but not categorized as such by the individual completing the questionnaire because the individual did not engage in this as an effortful coping strategy. A related and interesting issue regards the categorization of unconscious defense mechanisms. Cramer ( 2000), in a recent review of defense mechanisms, distinguishes between defenses that are not conscious and unintentional and coping processes that are conscious and intentional. However, there has been an interest in repressive coping, suggesting that some researchers regard defensive strategies such as denial and repression under the rubric of coping. More clarity and consistency between investigators in the definition of coping, particularly when unintentional strategies are being evaluated, would provide moreclarity for research.
A fourth assessment issue regards the distinction between `problem-focused' and `emotion focused' coping efforts. While researchers may categorize a particular coping strategy as problemfocused coping, the participant's intention may not be to alter the situation, but rather to manage an emotional reaction. For example, people may seek information about an illness as a way of coping with anxiety and to alter their appraisal of a situation, rather than to engineer a change in the situation. The lack of an association between emotion-focused coping and psychological outcomes may, in part, be due to a categorization strategy that does not account for the intention of the coping. Studies utilizing these two categories to distinguish coping dimensions may wish to evaluate coping intention. There are a number of additional methodological and conceptual challenges that are specifically relevant to studies of coping with chronic illness.
First, relatively few studies control for disease severity in statistical analyses. Extreme pain or disability can result in both more coping attempts and more distress. Studies that do not take into account these variables may conclude mistakenly that more coping is associated with more distress. In addition, little attention has been paid to the effects of progressive impairment on the selection of coping strategies, and in the perceived effectiveness of those strategies.
Chronic progressive illnesses may be expected to increase feelings of hopelessness. For example, Revenson and Felton ( 1989) studied changes in coping and adjustment over a six-month period and found that lower acceptance, more wishful thinking, and more negative affect accompanied increases in disability. Another issue is the lack of longitudinal studies. Clearly, longitudinal studies would help the literature in a number of ways. First, this type of design might help clarify whether coping influences distress or whether coping is merely a symptom of distress, a criticism frequently raised in critiques of coping (e.g., Coyne and Racioppo 2000). Second, longitudinal studies may clarify the role of personality factors in coping.
Coping Strategies Questionnaire Form
While some investigators suggest that personality factors play a limited role in predicting coping, other investigators argue that coping is a personality process that reflects dispositional differences during stressful events. Although the lack of progress in the area of coping is frequently attributed to methods of assessment and design, the relatively narrow focus on distress outcomes may also account for some of the problem, particularly when coping with chronic illness is being evaluated. Chronic illness does not ultimately lead to psychological distress for the majority of patients.
Indeed, many individuals report psychological growth in the face of chronic illness, and are able to find personal significance in terms of changes in views of themselves, their relationships with others, and a changed philosophy of life (Tennen et al. While positive affect is included as an adaptational outcome in some studies (e.g., Bendtson and Hornquist 1991), the majority of studies do not include positive outcomes. Positive affect will be a particularly important outcome to evaluate when positive coping processes such as cognitive reappraisal and finding meaning in the experience are examined, as these types of coping may play a stronger role in generating and maintaining positive mood than in lowering negative mood. Finally, relatively few studies have focused solely on coping and distress and have not taken into account potential moderators such as level of pain, appraisals of controllability, gender, and personality. A careful evaluation of potential moderators will provide both researchers and clinicians with information about which circumstances particular coping strategies are most effective. Conclusions As Lazarus points out in his commentary in American Psychologist, `A premise that occurs again and again. Is that for quite a few years research has disappointed many who had high hopes it would achieve both fundamental and practical knowledge about the coping process and its adaptational consequences.
I am now heartened by positive signs that there is a growing numberof sophisticated, resourceful, and vigorous researchers who are dedicated to the study of coping' (Lazarus 2000). It is clear that, despite the multiple methodological problems that this area of research has faced in the past, a heightened awareness of these limitations has led to the application of sophisticated methods that might assist this field in fulfilling the high hopes for this field of research. If investigators in the field of coping with chronic illnesses can adapt dailydiary methods to their populations, focus on specific stressors related to the illness when instructing participants to answer coping questions, include coping appraisals and the perceived efficacy of coping efforts, and carefully delineate illness-related, contextual, and dispositional moderators, the findings may lead to the development of effective interventions for clinicians hoping to improve the quality of life for these individuals. Cross References Chronic Illness: Quality of Life Chronic Pain: Models and Treatment Approaches Coping across the Lifespan Coping Assessment Coronary Heart Disease (CHD), Coping with Illness Behavior and Care Seeking Illness: Dyadic and Collective Coping Pain, Health Psychology of Pain, Management of Rheumatoid Arthritis: Psychosocial Aspects Social Support and Health Stress and Coping Theories Well-being and Health: Proactive Coping References Affleck, G, Tennen, H, Keefe, F J, Lefebre, J C, Kashikar-Zuck, S, Wright, K, Starr, K and Caldwell, D, (1999). Everyday life with osteoarthritis or rheumatoid arthritis: independent effects of disease and gender on daily pain, mood, and coping. Pain, 83, pp.
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Abstract BACKGROUND: Increasing attention is being devoted to cognitive-behavioural measures to improve interventions for chronic pain. OBJECTIVE: To develop an Italian version of the Coping Strategies Questionnaire – Revised (CSQ-R), and to validate it in a study involving 345 Italian subjects with chronic pain. METHODS: The questionnaire was developed following international recommendations. The psychometric analyses included confirmatory factor analysis; reliability, assessed by internal consistency (Cronbach’s alpha) and test-retest reliability (intraclass correlation coefficients); and construct validity, assessed by calculating the correlations between the subscales of the CSQ-R and measures of pain (numerical rating scale), disability (Sickness Impact Profile – Roland Scale), depression (Center for Epidemiological Studies – Depression Scale) and coping (Chronic Pain Coping Inventory) (Pearson’s correlation). RESULTS: Confirmatory factor analysis revealed that the CSQ-R model had an acceptable data-model fit (comparative fit index and normed fit index ≤0.90, root mean square error of approximation ≥0.08). Cronbach’s alpha was satisfactory (CSQ-R 0.914 to 0.961), and the intraclass correlation coefficients were good/excellent (CSQ-R 0.850 to 0.918).
As expected, the correlations with the numerical rating scale, Sickness Impact Profile – Roland Scale, Center for Epidemiological Studies – Depression Scale and Chronic Pain Coping Inventory highlighted the adaptive and maladaptive properties of most of the CSQ-R subscales. CONCLUSION: The CSQ-R was successfully translated into Italian. The translation proved to have good factorial structure, and its psychometric properties are similar to those of the original and other adapted versions. Its use is recommended for clinical and research purposes in Italy and abroad.
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