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The Nature and Extent of Social Anxiety and Avoidance in Patients with Chronic Pain

Published online by Cambridge University Press:  23 February 2012

Renée F. Seebeck ,
Malcolm H. Johnson  and
Ross A. Flett
Renée F. Seebeck
Affiliation:
Massey University, New Zealand
Malcolm H. Johnson
Affiliation:
Massey University, New Zealand
Ross A. Flett
Affiliation:
Massey University, New Zealand
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Abstract

The present study explored the nature and extent of social anxiety and avoidance, anxiety sensitivity, and pain-related anxiety and avoidance in 46 clinic-referred chronic pain patients, compared with a community-based group reporting pain (n = 66) and healthy controls (n = 57). The chronic pain patients consistently reported higher levels of social distress, social avoidance, fear of negative evaluation, anxiety sensitivity, and pain-related anxiety and avoidance as compared with controls. Group differences in social distress, social avoidance, fear of negative evaluation, pain-related cognitive anxiety, and fear of cognitive and emotional dyscontrol, remained stable when pain severity was controlled for. Anxiety sensitivity was strongly related to both social and pain-related fears. The source of these social fears is examined in relation to the elevated pain-related fear and anxiety sensitivity also exhibited by chronic pain patients, and implications for treatment and rehabilitation are discussed.

Type
Articles
Information
The Australian Journal of Rehabilitation Counselling , Volume 9 , Issue 1 , January 2003 , pp. 52 - 72
Copyright
Copyright © Cambridge University Press 2003

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References

Alden, L.E., & Wallace, S.T. (1995). Social phobia and social appraisal in successful and unsuccessful interactions. Behaviour Research and Therapy, 33, 497–506.CrossRefGoogle ScholarPubMed
Amtz, A., Dreessen, L., & de Jong, P. (1994). The influence of anxiety on pain: Attentional and attributional mediators. Pain, 56, 307–314.Google Scholar
Asmundson, G.J.G (1999). Anxiety sensitivity and chronic pain: Empirical findings, clinical implications, and future directions. In Taylor, S. (Ed.), Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety (pp. 269–285). Mahwah, NJ: Erlbaum.Google Scholar
Asmundson, G.J.G, Frombach, I.K., & Hadjistavropoulos, H.D. (1998). Anxiety sensitivity: Assessing factor structure and relationship to multidimensional aspects of pain in injured workers. Journal of Occupational Rehabilitation, 8, 223–234.CrossRefGoogle Scholar
Asmundson, G.J.G, Jacobson, S.J., Allerdings, M.D., & Norton, G.R. (1996a). Social phobia in disabled workers with musculoskeletal pain. Behaviour Research and Therapy, 34, 939–943.CrossRefGoogle ScholarPubMed
Asmundson, G.J.G, Kuperos, J.L., & Norton, G.R. (1997). Do patients with chronic pain selectively attend to pain-related information?: Preliminary evidence for the mediating role of fear. Pain, 72, 27–32.CrossRefGoogle ScholarPubMed
Asmundson, G.J.G, & Norton, G.R. (1995). Anxiety sensitivity in patients with physically unexplained back pain: A preliminary report. Behaviour Research and Therapy, 33, 771–777.CrossRefGoogle ScholarPubMed
Asmundson, G.J.G, Norton, G.R., & Jacobson, S.J. (1996b). Social, blood/injury, and agoraphobic fears in patients with physically unexplained chronic pain: Are they clinically significant? Anxiety, 2, 28–33.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
Asmundson, G.J.G, Norton, P.J., & Veloso, F. (1999). Anxiety sensitivity and fear of pain in patients with recurring headache. Behaviour Research and Therapy, 37, 703–713.CrossRefGoogle Scholar
Asmundson, G.J.G, & Taylor, S. (1996). Role of anxiety sensitivity in pain-related fear and avoidance. Journal of Behavioral Medicine, 19, 577–586.CrossRefGoogle ScholarPubMed
Averill, PH., Novy, D.M., Nelson, D.V., & Berry, L.A. (1996). Correlates of depression in chronic pain patients: A comprehensive examination. Pain, 65, 93–100.CrossRefGoogle ScholarPubMed
Bacon, N.M.K, Bacon, S.F., Atkinson, J.H., Slater, M.A., Patterson, T.L., Grant, I., et al, (1994). Somatization symptoms in chronic low back pain patients. Psychosomatic Medicine, 56, 118–127.CrossRefGoogle ScholarPubMed
Clark, D.M., & Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R., Liebowitz, M.R., Hope, D.A., & Schneier, ER. (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York: Guilford Press.Google Scholar
Cox, B.J., Borger, S.C., & Enns, M.W. (1999). Anxiety sensitivity and emotional disorders: Psychometric studies and their theoretical implications. In S.Taylor (Ed.), Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety (pp. 115–148). Mahwah, NJ: Erlbaum.Google Scholar
Crombez, G., Vervaet, L, Baeyens, F., Lysens, R., & Eelen, P. (1998). Avoidance and confrontation of painful, back straining movements in chronic back pain patients. Behavior Modification, 22, 62–77.CrossRefGoogle ScholarPubMed
Crombez, G., Vlaeyen, J.W.S, Heuts, P.H.T.G., & Lysens, R. (1999). Pain-related fear is more disabling than pain itself: Evidence on the role of pain-related fear in chronic back pain disability. Pain, 80, 329–339.CrossRefGoogle ScholarPubMed
Dalton, J.A., & Feuerstein, M. (1989). Fear, alexithymia, and cancer pain. Pain, 38, 159–170.CrossRefGoogle ScholarPubMed
Davidson, J.R.T, Hughes, D.L., George, L.K., & Blazer, D.G. (1993). The epidemiology of social phobia: Findings from the Duke Epidemiological Catchment Area Study. Psychological Medidne, 23, 709–718.CrossRefGoogle ScholarPubMed
Devine, D.P., & Spanos, N.P. (1990). Effectiveness of maximally different cognitive strategies and expectancy in attenuation of reported pain. Journal of Personality and Social Psychology, 58, 672–678.CrossRefGoogle ScholarPubMed
Eccleston, C. (1995). The attentional control of pain — Methodological and theoretical concerns. Pain, 63, 3–10.CrossRefGoogle ScholarPubMed
Eccleston, C., Crombez, G., Aldrich, S., & Stannard, C. (1997). Attention and somatic awareness in chronic pain. Pain, 72, 209–215.CrossRefGoogle ScholarPubMed
Fordyce, WE. (1976). Behavioural methods for chronic pain and illness. St. Louis, MO: Mosby.Google Scholar
Girodo, M., Dotzenroth, S.E., & Stein, S.J. (1981). Causal attribution bias in shy males. Cognitive Therapy and Research, 5, 325–338.CrossRefGoogle Scholar
Herman, E.W.M, & Baptiste, S. (1990). Group therapy: A cognitive-behavioural model. In Tunks, E. & Bellissimo, A. (Eds.), Chronic pain: Psychosocial factors in rehabilitation (2nd ed., pp. 212–228). Melbourne: Robert E. Krieger Publishing.Google Scholar
International Association for the Study of Pain. (1986). Classification of chronic pain. Pain (Suppl. 3), S1–S226.Google Scholar
Jensen, M.P., Karoly, P., & Braver, S. (1986). The measurement of clinical pain intensity: A comparison of six methods. Pain, 27, 117–126.CrossRefGoogle ScholarPubMed
Jones, WH., Briggs, S.R., & Smith, T.G. (1986). Shyness: Conceptualisation and measurement. Journal of Personality and Social Psychology, 51, 629–639.CrossRefGoogle ScholarPubMed
Kaplan, H.I., & Sadock, B.J. (1998). Synopsis of psychiatry: Behavioural sciences/clinical psychiatry (8th ed.). New York: Williams & Wilkins.Google Scholar
Kremer, E.F., Atkinson, J.H. Jr., & Ignelzi, R.J. (1981). Pain measurement: The affective dimensional measure of the McGill pain questionnaire with a cancer population. Pain, 12, 153–163.CrossRefGoogle Scholar
Leary, M.R. (1983a). A brief version of the Fear of Negative Evaluation scale. Personality and Social Psychology Bulletin, 9, 371–376.CrossRefGoogle Scholar
Leary, M.R. (1983b). Social anxiousness: The construct and its measurement. Journal of Personality Assessment, 47, 66–75.CrossRefGoogle ScholarPubMed
Leary, M.R. (1988). Socially-based anxiety: A review of measures. In Tardy, C.H. (Ed.), A handbook for the study of human communication: Methods and instruments for observing, measuring, and assessing communication processes. Communication and information science (pp. 365–384). Norwood, NJ: Ablex Publishing Corp.Google Scholar
Leary, M.R., Knight, P.D., & Johnson, D.A. (1987). Social anxiety and dyadic conversation: A verbal response analysis. Journal of Social and Clinical Psychology, 5, 34–50.CrossRefGoogle Scholar
Lethem, J., Slade, P.D., Troup, J.D.G, & Bentley, G. (1983). Outline of a fear/avoidance model of exaggerated pain perception — I. Behaviour Research and Therapy, 21, 401–408.CrossRefGoogle ScholarPubMed
Linton, S.J., Buer, N., Vlaeyen, J.W.S, & Hellsing, A-L. (1999). Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study. Psychology and Health, 14, 1051–1059.CrossRefGoogle Scholar
Maller, R.G., & Reiss, S. (1992). Anxiety sensitivity in 1984 and panic attacks in 1987. Journal of Anxiety Disorders, 6, 241–247.CrossRefGoogle Scholar
Mansell, W., & Clark, D.M. (1999). How do I appear to others? Social anxiety and processing of the observable self. Behaviour Research and Therapy, 37, 419–434.CrossRefGoogle ScholarPubMed
McCracken, L.M. (1997). “Attention” to pain in persons with chronic pain: A behavioural approach. Behavior Therapist, 28, 271–284.Google Scholar
McCracken, L.M., & Gross, R.T. (1995). The Pain Anxiety Symptoms Scale (PASS) and the assessment of emotional responses to pain. In deCreek, L., Knapp, S., & Jackson, T.L. (Eds.), Innovations in clinical practice: A sourcebook (Vol. 14; pp. 309–321). Sarasota, FL: Professional Resources Press.Google Scholar
McCracken, L.M., Zayfert, C. & Gross, R.T. (1992). The pain anxiety symptoms scale: Development and validation of a scale to measure fear of pain. Pain, 50, 67–73.CrossRefGoogle ScholarPubMed
McCracken, L.M., Zayfert, C. & Gross, R.T. (1993). The Pain Anxiety Symptoms Scale (PASS): A multimodal measure of pain-specific anxiety symptoms. Behavior Therapist, 16, 183–184.Google Scholar
McNally, R.J. (1996). Anxiety sensitivity is distinguishable from trait anxiety. In Rapee, R.M. (Ed.), Current controversies in the anxiety disorders (pp. 214–227). New York: Guilford.Google Scholar
McNally, R.J. & Lorenz, M. (1987). Anxiety sensitivity in agoraphobics. Journal of Behavior Therapy and Experimental Psychiatry, 18, 3–11.CrossRefGoogle ScholarPubMed
McWilliams, L.A., Stewart, S.H., & MacPherson, P.S.R (2000). Does the social concerns component of the Anxiety Sensitivity Index belong to the domain of anxiety sensitivity or the domain of negative evaluation sensitivity. Behaviour Research & Therapy, 38, 985–992.CrossRefGoogle ScholarPubMed
Meilings, T. M. B., & Alden, L. E. (2000). Cognitive processes in social anxiety: The effects of self-focus, rumination, and anticipatory processing. Behaviour Research and Therapy, 38, 243–257.CrossRefGoogle Scholar
Murphy, M.A., Tosi, D.J., & Parisen, R.F. (1989). Psychological coping and the management of pain with cognitive restructuring and bio-feedback: A case study and variation of cognitive experiential therapy. Psychological Reports, 64, 1343–1350.CrossRefGoogle Scholar
Osman, A., Barrios, EX., Osman, J.R., Schneekloth, R., & Troutman, J.A. (1994). The Pain Anxiety Symptoms Scale: Psychometric properties in a community sample. Journal of Behavioral Medicine, 17, 511–522.CrossRefGoogle Scholar
Overall, J.E., & Spiegel, D.K. (1969). Concerning least squares of analysis of experimental data. PsycMogcal Bulletin, 72, 311–322.CrossRefGoogle Scholar
Peterson, R.A., & Reiss, S. (1992). Anxiety Sensitivity manual (2nd ed.). Worthington, OH: International Diagnostic Systems.Google Scholar
Philips, H.C., & Jahanshahi, M. (1985). Chronic pain: An experimental analysis of the effects of exposure. Behaviour Research and Therapy, 23, 281–290.CrossRefGoogle ScholarPubMed
Philips, H.C., & Jahanshahi, M. (1986). The components of pain behaviour report. Behaviour Research and Therapy, 24, 117–125.CrossRefGoogle ScholarPubMed
Plehn, K., Peterson, R.A., & Williams, D.A. (1998). Anxiety sensitivity: Its relationship to functional status in patients with chronic pain. Journal of Occupational Rehabilitation, 8, 213–222.CrossRefGoogle Scholar
Rachman, S., & Arntz, A. (1991). The overprediction and underproduction of pain. Clinical Psychology Review, 11, 339–355.CrossRefGoogle Scholar
Reiss, S. (1991). Expectancy theory of fear, anxiety, and panic. Clinical Psychology Review, 11, 141–153.CrossRefGoogle Scholar
Reiss, S., & McNally, R.J., (1985). The expectancy model of fear. In Reiss, S. & Bootzin, R. R. (Eds.), Theoretical issues in behavior therapy (pp. 107–122). New York: Academic Press.Google Scholar
Silverman, W.K., Fleisig, W., Rabian, B., & Peterson, R.A. (1991). Childhood Anxiety Sensitivity Index. Journal of Clinical Child Psychology, 20, 162–168.CrossRefGoogle Scholar
Stein, M.B., Housor, J.L., & Uhde, T.W. (1990). Anxiety disorders in patients with Parkinson's Disease. American Journal of Psychiatry, 147, 217–220.Google ScholarPubMed
Sullivan, M.J.L, Bishop, S.R., & Pivik, J. (1995). The Pain Catasttophising Scale: Development and validation. Psychological Assessment, 7, 524–532.CrossRefGoogle Scholar
Tabachnick, B.G., & Fidell, L.S. (2001). Using multivariate statistics (4th ed.). Boston, MA: Allyn and Bacon.Google Scholar
Taylor, S. (1995). Anxiety sensitivity: Theoretical perspectives and recent findings. Behaviour Research and Therapy, 33, 243–258.CrossRefGoogle ScholarPubMed
Taylor, S., Koch, W.J., & McNally, R.J. (1992). How does anxiety sensitivity vary across the anxiety disorders? Journal of Anxiety Disorders, 7, 249–259.CrossRefGoogle Scholar
Turk, D.C., Okifuji, A., & Scharff, L. (1995). Chronic pain and depression — Role of perceived impact and perceived control in different age cohorts. Pain, 61, 93–101.CrossRefGoogle ScholarPubMed
Vlaeyen, J.W.S, de Jong, J., Geilen, M., Heuts, P.H.T.G, & van Breukelen, G. (2001). Graded exposure in vivo in the treatment of pain-related fear: A replicated single-case experimental design in four patients with chronic low back pain. Behaviour Research and Therapy, 39, 151–166.CrossRefGoogle Scholar
Vlaeyen, J.W.S, & Linton, S.J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85, 317–332.CrossRefGoogle ScholarPubMed
Vlaeyen, J.W.S, Kole-Snijders, A.M.J, Boeren, R.G.B, & van Eek, H. (1995a). Fear of movement/(re)injury in chronic low back pain and its relation to behavioural performance. Pain, 62, 363–372.CrossRefGoogle Scholar
Vlaeyen, J.W.S, Kole-Snijders, A.M.J, Rotteveel, A., Ruesink, R., & Heuts, P.H.T.G. (1995b). The role of fear of movement/(re)injury in pain disability. Journal of Occupational Rehabilitation, 5, 235–252.CrossRefGoogle ScholarPubMed
Waddell, G., Newton, M., Henderson, I., Somerville, D. & Main, C.J. (1993). A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain, 52, 157–168.CrossRefGoogle ScholarPubMed
Wall, P.W. (1979). On the relation of injury to pain. Pain, 6, 253–264.CrossRefGoogle ScholarPubMed
Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33, 448–457.CrossRefGoogle ScholarPubMed
Wells, A., & Papageorgiou, C. (2001). Social phobia interoception: Effects of bodily information on anxiety, beliefs, and self-processing. Behaviour Research and Therapy, 39, 1–11.CrossRefGoogle ScholarPubMed