The authors investigated the relations of coping with psychological adjustment and functional status in 46 adults with systemic lupus erythematosus (SLE). The participants completed questionnaires that measured coping with SLE, depression, and functional impairment. A subgroup (n = 22) completed the same questionnaires an average of 7.7 months later. Correlational and regression analyses revealed that, at Time 1, passive coping strategies (eg, avoidance, wishful thinking, blaming self) were significantly related to poorer psychological adjustment and functional status. Problem-focused coping was significantly associated with less depression. Longitudinal analyses showed that using wishful thinking and seeking social support at Time 1 were significant predictors of adjustment at Time 2. These findings are compared with findings from studies of other population groups with chronic illnesses.

Cluster analysis was used to validate headache diagnostic criteria of the International Headache Society (IHS). Structured diagnostic interviews were conducted on 443 headache sufferers from a community sample, which was randomly split to allow replication. Hierarchical cluster analysis of symptoms in both subsamples revealed two distinct (P<.001) clusters: (1) unilateral pulsating pain, pain aggravated by activity, and photophobia and phonophobia, and (2) bilateral pressing/tightening pain, mild to moderate intensity, and absence of nausea/vomiting. These clusters were consistent with IHS migraine and tension-type classifications, respectively. Replication using a non-hierarchical clustering technique, k-means cluster analysis, revealed a migrainelike patient cluster, reflecting more frequent pulsating, unilateral pain; more severe pain; and pain aggravated by activity; nausea, vomiting, photophobia, and phonophobia. A tensionlike patient cluster was also identified, reflecting more frequent pressing/tightening pain, mild to moderate pain, bilateral location, and absence of nausea/vomiting. These patient clusters were consistent across subsamples. International Headache Society diagnoses corresponded with classification based upon statistically derived clusters (P<.001). These results indicate that headache symptoms cluster empirically in a manner consistent with IHS criteria for migraine and tension-type headaches. Criterion overlap problems regarding pain intensity and duration were identified. Overall, these data support migraine and tension-type headache as distinct entities, and provide support for the IHS diagnostic criteria with minor modifications.

These results support the hypothesis that individuals with migraine respond physiologically to stress differently than control individuals.

Laboratory investigations of cardiovascular reactivity to mental stress often ignore concomitant differences in cognitive, affective, and behavioral responses that are commonly observed among study participants. To provide a more systematic laboratory methodology to examine relations among cardiovascular, behavioral, and self-report measures of cognitive and affective responses to stress, we developed and tested a social confrontation procedure involving standardized interactions during two scenes. Results of three investigations are presented to illustrate the utility of the social confrontation procedure. In the first two studies, this multidimensional assessment strategy produced results which may foster research projects that bridge separate areas of psychological inquiry. In one application, persons with hypertensive parents, in contrast to persons with normotensive parents, exhibited characteristic negative behavioral responses during both interactions as well as the more commonly-observed exaggerated blood pressure reactions. In the other study, students from less functional families (regarding cohesion and adaptability) were shown to exhibit exaggerated blood pressure reactions in addition to their commonly-reported negative cognitive and behavioral coping styles. Finally, a third study examined how a simple instructional set regarding the expression or suppression of anger influenced participants' responses. Significant differences were observed across response domains, with anger expression resulting in a more intense response than anger suppression. In sum, the social confrontation procedure represents an important methodological development for exploring the relation between response domains, the relation between cardiovascular response to stress and psychosocial risk for cardiovascular disease, and the physiological and behavioral distinction between anger expression and anger suppression.

Behavioral, cardiovascular, and self-report of cognitive and affective responses to 2 interpersonal challenges were examined among 20 men with a positive (FH+) and 20 with a negative (FH-) family history of hypertension. Heart rate (HR) and blood pressure (BP) were measured throughout the laboratory session; Ss were requested to self-report positive and negative cognitions, state anger, and state anxiety that occurred during interactions with a male and female confederate. Behavioral responses to interpersonal tasks were videotaped, coded, and categorized into 4 major groupings (positive verbal, positive nonverbal, negative verbal, and negative nonverbal). FH+ individuals exhibited significantly higher resting HR and systolic BP (SBP) reactivity to both interactions than FH- counterparts. Analyses of behavioral responses for both interactions revealed significantly more negative verbal and nonverbal behavior and less positive nonverbal behavior among FH+ as compared with FH-Ss.

Coping with chronic pain during exposure to pain produced by activity was examined in 30 patients with chronic low back pain referred to a university pain management center. Patients' range of motion, autonomic responses, and anticipatory anxiety ratings before exposure and ratings of pain and anxiety after exposure were assessed, and the number of repetitions of the activities that produced the pain was recorded. Analyses showed that using coping self-statement was associated with lower skin conductance during anticipation and greater range of motion. Praying, hoping, and catastrophizing were associated with greater anticipatory anxiety, greater anxiety during the painful activity, and less range of motion from the onset of increased pain to the point of pain tolerance. Praying and hoping were associated with higher pain ratings and fewer repetitions of the activity. Assessment of coping during an incident of pain and multiple methods to measure pain and distress provided convincing evidence that patients' self-management responses influence the consequences of pain exposure.

No abstract

The validity of the International Headache Society (IHS) classification system for college-aged students with headache was examined using cluster analysis. Undergraduate college student volunteers (N = 369) underwent a structured diagnostic interview for headaches, and the sample was divided into two subsamples for purposes of replication. A hierarchical cluster analysis (Ward's method) of the headache characteristics reported by the first subsample suggested a statistically distinct three-cluster solution, and the solution was replicated using the second subsample. It appeared that one cluster was tensionlike, while the other two were migrainelike. Nonhierarchical cluster analyses (K-means) of the cases from each subsample revealed a similar pattern of a tensionlike and two migrainelike clusters. Identical three-cluster solutions were found for the second subsample both by using cluster centers from the first subsample and by clustering the cases independently, suggesting that the cluster solution was not a random finding. The IHS classification system appears to lack adequate specificity and sensitivity for college-aged students with headache who report migrainelike symptoms. Thus, the generalizability of research results using college-aged students with headache to the adult population may be questionable.