The identification of adaptive and maladaptive coping strategies following traumatic events has been the subject of much scientific inquiry. The current study sought through meta-analysis to evaluate the relationship between the use of approach and avoidance strategies (both problem-focused and emotion/cognitive focused) following trauma and psychological distress. Thirty-nine studies of coping following two types of traumatic events (interpersonal violence and severe injury) were retained in the meta-analysis. There was a consistent association between avoidance coping and distress, overall r = .37, but no association between approach coping and distress, overall r = -.03, but some important moderators existed. Implications of the results for future research regarding coping and trauma recovery are discussed.

Cognitive behavioral therapy (CBT) techniques offer short-term, goal-oriented psychotherapy. In this respect, it differs from classical psychoanalysis in emphasizing changes in thought patterns and behaviors rather than providing 'deep insight'. Importantly, the beneficial effects of CBT can be achieved in 10-20 sessions, compared with the many years required for classical psychoanalysis. Although CBT is often done on a one-to-one basis, it also lends itself to a group therapeutic setting. CBT was initially used in the treatment of mood disorders, but its use has subsequently been expanded to include various other medical conditions, including chronic pain states. Over the past 18 years, several chronic pain treatment programs have used CBT techniques in the management of fibromyalgia. In this review, the results from 13 programs using CBT, alone or in combination with other treatment modalities, are analyzed. In most studies, CBT provided worthwhile improvements in pain-related behavior, self-efficacy, coping strategies and overall physical function. Sustained improvements in pain were most evident when individualized CBT was used to treat patients with juvenile fibromyalgia. The current data indicate that CBT, as a single treatment modality, does not offer any distinct advantage over well-planned group programs of education or exercise, or both. Its role in the management of fibromyalgia patients needs further research.

Thirty patients from a private clinical practice who met the 1990 American College of Rheumatology criteria for fibromyalgia syndrome (FS) were followed prospectively through a brainwave-based intervention known as electroencephalograph (EEG)-driven stimulation or EDS. Patients were initially treated with EDS until they reported noticeable improvements in mental clarity, mood, and sleep. Self-reported pain, then, having changed from vaguely diffuse to more specifically localized, was treated with very modest amounts of physically oriented therapies. Pre- to posttreatment and extended follow-up comparisons of psychological and physical functioning indices, specific FS symptom ratings, and EEG activity revealed statistically significant improvements. EDS appeared to be the prime initiator of therapeutic efficacy. Future research is justified for controlled clinical trials and to better understand disease mechanisms.

The relationship of dispositional optimism, daily life stress, and domestic environment to two types of coping methods was examined in a group of 94 cancer patients. As expected, dispositional optimism and domestic environment made significant contributions to the prediction of avoidance coping. Dispositional optimism contributed significantly to the prediction of active-behavioral coping. Specifically, a significant positive relationship was obtained between active-behavioral coping and optimism. A significant positive relationship also was found between avoidance coping and both daily stress and domestic environment. Avoidance coping was negatively related to dispositional optimism. In multivariate analyses, gender and disease-related variables did not make significant contributions to the prediction of coping method. Suggestions for future research were made.

This study, which was based on 285 Ss who were experiencing stressful and potentially anxiety-producing situations associated with pain, revealed comparable psychometric adequacy in descriptive statistics and estimates of internal consistency for the State-Trait Anxiety Inventory (STAI) Form Y across different ethnic groups and gender, namely, White, Black, and Latino men and women. Examination of item-remainder correlations identifies certain particularly salient screening items for Black men and underscores the importance of individualized item analysis in the interpretation of obtained scale scores. Consistently strong correlations between A-State and A-Trait scale scores with MMPI Depression and Psychasthenia scales and Beck Depression Inventory scores, as well as with scores on the Beck Hopelessness Scale, provided supportive evidence for convergent validity across the Subpopulations. Weaker and more variable correlations obtained with other external measures of psychopathology and psychosocial functioning suggested the possibility of discriminant validity.Although the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970;Spielberger, 1983) has been frequently used to assess anxiety in diverse ethnic groups, the psychometric properties of this inventory have not been carefully and systematically compared for White, Black, and Latino patients. The focus of the present study is the comparison of the psychometric properties of the English version of the STAI Form Y across different ethnic groups and genders (viz., White, Black, and Latino women and men) for an adult sample experiencing stressful and potentially anxiety-producingsituations relevant for all subjects (viz., financial and interpersonal problems associated with physical pain).The STAI comprises two separate 20-item, self-report rating scales for measuring state and trait anxiety. State anxiety (A-State) is conceptualized as a transitory condition of unpleasant, consciously perceived feelings of tension, apprehension, and nervousness that vary in intensity and fluctuate in time as a reaction to circumstances that are perceived as threatening. The items for the A-State scale require a respondent to describe the intensity of a feeling at a particular moment using the following 4-point scale: not at all (1); somewhat (2); moderately so (3); very much so (4). Overall, the scale has been found to be a sensitive indicator of changes in transitory anxiety. Trait anxiety (A-Trait) refers to relatively stable individual differences that

The authors compare theoretical perspectives of chronic pain using a restrictive comprehensive categorization. Four of the perspectives (mind-body dualism, psychological, radical operant--behavioral, and radical cognitive) are categorized as restrictive. The other 4 perspectives (International Association for the Study of Pain, gate control, nonradical operant--behavioral, and cognitive-behavioral) that incorporate multiple facets are categorized as comprehensive. On the basis of empirical support, practical application, and issues concerning potential research design problems, the restrictive perspectives could be rejected for not providing a model in which chronic pain can be thoroughly investigated. The comprehensive perspectives, however, demonstrate greater potential for serving that role. Nonetheless, the need for additional theory development by the comprehensive perspectives is noted.

LENS cannot be recommended as a single modality treatment for FM. However, further study is warranted to investigate the potential of LENS to interact synergistically with other pharmacologic and nonpharmacologic therapies for improving symptoms in FM.

This study examined the relations between depression and demographic, pain-related, and work-related variables in 254 chronic pain patients. Regression analyses were conducted, initially by category (i.e., demographic, pain-related, and work-related), and finally a comprehensive regression analysis was performed, containing the significant independent variables from each category. Among the demographic variables, education level and marital status were related to depression, and an interaction between age and gender was associated with depression, with younger women and older men reporting more depression. Among the pain-related variables, longer duration of pain was associated with increased depression. Among the work-related variables, unemployment was associated with depression, and there was an interaction between work status and litigation status, with working and litigating being associated with depression and not working and not litigating being associated with depression. In the comprehensive analysis, work status, education level, and marital status accounted for a significant amount of the variance in depression scores. These findings, together with future research directions, are discussed.