McCracken Lance M, Keogh Edmund
Centre for Pain Services, Royal National Hospital for Rheumatic Diseases, and Centre for Pain Research, University of Bath, Bath, United Kingdom.
J Pain. 2009 Apr;10(4):408-15. doi: 10.1016/j.jpain.2008.09.015.
People often respond with distress and avoidance to their own negative experiences, such as the physical, cognitive, and emotional aspects of depression or anxiety. When people with chronic pain respond this way, their overall level of distress may increase, they may struggle to avoid their emotional experiences, and their daily functioning may decrease. The purpose of this study was to examine the role of anxiety sensitivity (AS), or "fear of anxiety," in relation to these processes. It was predicted that those persons with chronic pain who report higher AS will also report higher emotional distress and greater disability caused by chronic pain. A second purpose was to examine whether therapeutic processes designed to reduce emotional avoidance, namely, acceptance, mindfulness, and values, could be demonstrated to reduce the role of AS in relation to this distress and disability based on a statistical model including these variables. Subjects were 125 consecutive adult patients (64.8% women) seeking services from a specialty pain service in the United Kingdom. All patients completed a standard set of measures of AS, acceptance of pain, mindfulness, and values-based action, as well as measures of pain, disability, and emotional functioning, at their initial consultation, and these data formed the basis for the current study. In correlation and regression analyses, AS was associated with greater pain, disability, and distress. In regression analyses, the 3 proposed therapeutic processes reduced the average variance accounted for by AS in patient functioning from DeltaR(2) = .21 to DeltaR(2) = .048. This means that when the 3 therapeutic variables are taken into account statistically, AS alone retained relatively little association with patient functioning. These results suggest that AS may amplify the impact of emotional distress on patient functioning in chronic pain and that processes of acceptance, mindfulness, and values-based action may reduce this effect.
Humans can fear and struggle to avoid their own emotional experiences, even when these cannot harm them. Data presented here show individuals with chronic pain have more distress and disability when they manifest more fear of anxiety symptoms, and behavior patterns of "acceptance" and "mindfulness" may reduce this effect.
人们常常对自身的负面经历产生痛苦和回避反应，比如抑郁或焦虑的身体、认知和情感方面。当慢性疼痛患者以这种方式做出反应时，他们的整体痛苦程度可能会增加，可能会努力回避自己的情感体验，并且日常功能可能会下降。本研究的目的是探讨焦虑敏感性（AS），即“对焦虑的恐惧”，在这些过程中的作用。预计那些报告AS较高的慢性疼痛患者也会报告更高的情绪痛苦以及慢性疼痛导致的更大功能障碍。第二个目的是基于包含这些变量的统计模型，检验旨在减少情绪回避的治疗过程，即接纳、正念和价值观，是否能够证明可减少AS在这种痛苦和功能障碍方面的作用。研究对象为125名连续从英国一家专科疼痛服务机构寻求治疗的成年患者（64.8%为女性）。所有患者在初次咨询时完成了一套关于AS、对疼痛的接纳、正念和基于价值观的行动的标准测量，以及疼痛、功能障碍和情绪功能的测量，这些数据构成了本研究的基础。在相关性和回归分析中，AS与更大的疼痛、功能障碍和痛苦相关。在回归分析中，所提出的三个治疗过程将AS在患者功能中所占的平均方差从ΔR² = 0.21降至ΔR² = 0.048。这意味着当在统计上考虑这三个治疗变量时，仅AS与患者功能的关联相对较小。这些结果表明，AS可能会放大情绪痛苦对慢性疼痛患者功能的影响，而接纳、正念和基于价值观的行动过程可能会减少这种影响。
人类可能会恐惧并努力回避自己的情感体验，即使这些体验不会伤害到他们。此处呈现的数据表明，患有慢性疼痛的个体在表现出对焦虑症状的更多恐惧时会有更多痛苦和功能障碍，而“接纳”和“正念”的行为模式可能会减少这种影响。
