The experience of Rheumatoid Arthritis (RA) includes significant suffering and life disruption. This cross-sectional study examined the associations between pain, catastrophizing, acceptance and physical limitation in 55 individuals (11 males and 44 female; Mean age = 54.37; SD = 18.346), from the Portuguese population with (RA) 2 years after the diagnosis; also explored the role of acceptance as a mediator process between pain, catastrophizing and physical limitation. Results showed positive correlation between pain and catastrophizing (r = .544; p ≤ .001), and also between pain and 2-years’ physical limitation (r = .531; p ≤ .001) Results also showed that acceptance was negatively correlated with physical limitation 2 years after the diagnosis (r = –.476; p ≤ .001). Path-analysis was performed to explore the direct effect of pain (ß = –.393; SD = .044; Z = 3.180; p ≤ .001) and catastrophizing (n.sig.) on physical limitation and also to explore the buffer effect of acceptance in this relationship (indirect effect ß = –.080). Results showed that physical limitation is not necessarily a direct product of pain and catastrophizing but acceptance was also involved. Pain and catastrophizing are associated but the influence of catastrophizing on physical limitation is promoted by low levels of acceptance. Results emphasize the relevance of acceptance as the emotional regulation process by which pain and catastrophizing influence physical functioning and establish the basic mechanism by which pain and catastrophizing operate in a contextual-based perspective. Also the study results offer a novel approach that may help behavioral health and medical providers prevent and treat these conditions.

Background: Health anxiety is common, impairing, and costly. The role of catastrophizing of bodily sensations (i.e. rumination about, overconcern with, and intolerance of bodily sensations) in maintaining health-related anxiety (i.e. anxiety about perceived health problems) is important, but understudied, in the health anxiety literature. Aims: The present study investigates the role of catastrophizing of bodily sensations as a maintenance factor for health-related anxiety over time. Method: Undergraduates (n = 226 women; n = 226 men) completed a baseline assessment, 14-day daily diary study, and 14-day longitudinal follow-up. Results: Path analysis indicated catastrophizing of bodily sensations maintains health-related anxiety from one month to the next in both men and women. Conclusions: The present study bridges an important gap between theory and evidence. Results support cognitive behavioral theories and extend cross-sectional research asserting catastrophizing of bodily sensations maintains health-related anxiety over time. A cyclical, self-perpetuating pattern was observed in the present study wherein catastrophizing of bodily sensations and health-related anxiety contribute to one another over time. Results also suggest targeting catastrophizing of bodily sensations may reduce health-related anxiety.

Objective: This study analyzes the role of a number of cognitive-affective dimensions in the experience and coping of pain in patients with fibromyalgia (FM). Specifically, it was examined whether anxiety, depression, pain catastrophizing and pain-related anxiety predict the pain perception and the self-efficacy expectations in these patients. Method: Seventy-four fibromyalgia patients were asked to complete a questionnaire survey including the Chronic Pain Self-Efficacy Scale, the Hospital Anxiety and Depression Scale, the Pain Anxiety Symptoms Scale-20, the Pain Catastrophizing Scale, and the Short-form McGill Pain Questionnaire. Results: Some relevant correlation and predicting patterns were identified. Physiological anxiety was the best predictor of the sensorial dimension of pain. Pain fear was a significant predictor of the pain intensity. Helplessness was the best predictor of the affective dimension of pain, whereas depression was a significant predicting variable of the self-efficacy expectations. Conclusions: This study shows the relevance of the pain-related anxiety in the pain perception, and of the depression in the self-efficacy expectations in FM patients. Clinical applications of the findings and further research lines in this area are discussed.

Background: Chronic pain patients often describe their pain in ways that suggest vivid mental images, with some reporting images relating to their pain. Despite these clinical observations, there are few studies describing the nature and consequences of these images. This study examined whether mental imagery of pain is associated with levels of reported distress, cognitions, disability or pain severity. Method: In a postal survey, 83 adult chronic pain patients indicated whether or not they experienced mental images of their pain. They also completed standardized measures of depression, anxiety, cognitions, disability and pain severity. Those reporting images were compared to those not reporting images on their responses to the other variables. Results: People with pain imagery reported significantly higher levels of anxiety, depression and catastrophizing than patients who did not report such images. No differences were found on measures of physical disability. Discussion: Mental images of pain appear to be associated with higher levels of anxiety, depression and catastrophizing. It is possible that these images play a role in maintaining such difficulties. For these patients, imagery may provide a route via which clinicians can work with patients to help them reinterpret or respond more flexibly to their pain.

Effects of structured worry interviews were examined among analog-GAD and nonanxious college students. Thirty-four analog-GAD and 29 nonanxious control participants generated sequences of possible catastrophic outcomes for each of six worry topics using the Catastrophizing Interview Technique (Vasey and Borkovec, 1992). Threat ratings for each topic were collected, and ratings of subjective distress, likelihood of the feared outcome, and perceived control over the feared outcome were obtained immediately following each interview. Results indicated that the analog-GAD group rated the worry topics of achievement, social relations, and economics as more threatening than their nonanxious counterparts. The analog-GAD group also generated more catastrophizing steps and reported higher levels of negative mood following the worry interviews. In addition, the eventual fear underlying each worry was determined by coding the content of the final outcome step from each interview. Results from the coded interview responses indicated that fears of negative emotion and of failure were the most frequently coded categories in each of the six topical domains for the analog-GAD group. Although there was no difference in the proportion of negative emotion codes between analog-GAD and nonanxious groups, the analog-GAD group did receive a greater proportion of failure codes than the nonanxious control group. Results largely replicated the findings of Vasey and Borkovec in an analog-GAD sample. In addition, results suggest that fear of negative emotion underlies worry in general, regardless of diagnostic status, while fears of failure or ineffectiveness are more specific to GAD.

Several authors have suggested that threat schemata of high worriers may differ from those of less worried individuals with regards to the manner with which information is structured in the Long Term Memory (LTM) or the content of the information stored in the LTM. The present study tested this hypothesis using the catastrophizing interview technique (c.f., Vasey & Borkovec, 1992). Results revealed that high worriers evaluated the likelihood of the occurrence of feared consequences generated for each worry as more likely to actually happen than low worriers did. Second, the ultimate outcome generated in the catastrophizing sequence for a given worry was more severe for high worriers. Finally, high worriers generated ultimate outcomes that were more similar in content, presumably reflecting tightly organized threat schemata. It is argued that activation of these threat schemata in the LTM contributes to the maintenance of worry and anxiety in anxious individuals.