Depression und chronische Schmerzen: Zur Bedeutung alltäglicher Belastungen und Handlungskontrolle

Luka-Krausgrill, Ursula; Wurmthaler, C.; Wiesheu, M.; Becker, Todd

doi:10.1159/000258300

Cited by 10 publications

(7 citation statements)

References 4 publications

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“…Prior research additionally supports the assumption of an impaired balance between maintenance of and disengagement from intentions in state-oriented patients with distress-avoidance responses: State orientation was shown to be an organismic risk factor that mutually PLOS ONE aggravates deficits in motivation and performance: introjection of social expectations and norms, memory deficits, dissociations between cognitive and emotional preferences, over-activation of intentions, and rigidity against situational changes as well as cognitive and behavioral overactivity [20,22,54,60,68,97,98]. Furthermore, and in line with our results, state orientation was shown to be associated with poor adjustment to chronic pain, helplessness, distress, and depression [20,54,[98][99][100][101][102].…”

Section: Differences Between Pain Response Profiles In Secondary Meassupporting

confidence: 67%

Endurance and avoidance response patterns in pain patients: Application of action control theory in pain research

et al. 2021

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Background Identifying pain-related response patterns and understanding functional mechanisms of symptom formation and recovery are important for improving treatment. Objectives We aimed to replicate pain-related avoidance-endurance response patterns associated with the Fear-Avoidance Model, and its extension, the Avoidance-Endurance Model, and examined their differences in secondary measures of stress, action control (i.e., dispositional action vs. state orientation), coping, and health. Methods Latent profile analysis (LPA) was conducted on self-report data from 536 patients with chronic non-specific low back pain at the beginning of an inpatient rehabilitation program. Measures of stress (i.e., pain, life stress) and action control were analyzed as covariates regarding their influence on the formation of different pain response profiles. Measures of coping and health were examined as dependent variables. Results Partially in line with our assumptions, we found three pain response profiles of distress-avoidance, eustress-endurance, and low-endurance responses that are depending on the level of perceived stress and action control. Distress-avoidance responders emerged as the most burdened, dysfunctional patient group concerning measures of stress, action control, maladaptive coping, and health. Eustress-endurance responders showed one of the highest levels of action versus state orientation, as well as the highest levels of adaptive coping and physical activity. Low-endurance responders reported lower levels of stress as well as equal levels of action versus state orientation, maladaptive coping, and health compared to eustress-endurance responders; however, equally low levels of adaptive coping and physical activity compared to distress-avoidance responders. Conclusions Apart from the partially supported assumptions of the Fear-Avoidance and Avoidance-Endurance Model, perceived stress and dispositional action versus state orientation may play a crucial role in the formation of pain-related avoidance-endurance response patterns that vary in degree of adaptiveness. Results suggest tailoring interventions based on behavioral and functional analysis of pain responses in order to more effectively improve patients quality of life.

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Section: Differences Between Pain Response Profiles In Secondary Meassupporting

confidence: 67%

Endurance and avoidance response patterns in pain patients: Application of action control theory in pain research

et al. 2021

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“…Our study was the first that examined action versus state orientation as a function-focused moderator of the indirect and direct relations of pain-related cognitions to depression in patients with chronic non-specific low back pain. In line with previous studies, we found that state orientation is associated with higher levels of distress and depression in pain patients (Kuhl, 1983;Luka-Krausgrill et al, 1992). In addition, we found significant negative correlations between subjective helplessness and action (versus state) orientation.…”

Section: Discussionsupporting

confidence: 92%

“…In line with prior research, findings indicate that state orientation is an additional function-focused risk factor associated with poor coping, learned helplessness, and/or depression (Beckmann & Kellmann, 2004;Brunstein, 1990;Kuhl, 1981Kuhl, , 1983Kuhl & Beckmann, 1994b;Kuhl & Helle, 1986;Luka-Krausgrill et al, 1992). Hence, in line with Kuhl (1981Kuhl ( , 2000, cognitive-behavioral approaches to depression emphasizing the mediating role of cognitive contents, such as subjective helplessness, may be valid only for state-oriented patients.…”

Section: Discussionsupporting

confidence: 71%

“…The prospective dimension captures the ability to up-regulate positive emotions and initiate goal-oriented action and proactive coping strategies under demanding conditions (i.e., state-oriented hesitation vs. action-oriented initiative) (Jostmann et al, 2005;Kuhl & Beckmann, 1994b;Kuhl & Quirin, 2011). Moreover, state orientation was found to be positively associated with distress and depression in pain patients (Kuhl, 1983;Luka-Krausgrill et al, 1992).…”

Section: Action Control Moderating the Relations Of Pain-related Cognitions To Depression?mentioning

confidence: 99%

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Volitional Action Control and Depression in Chronic Pain: Does Action versus State Orientation Moderate the Relations of Pain-Related Cognitions to Depression?

et al. 2021

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In this study, we examined the conditional indirect and direct relations of pain-related cognitions to depression. Subjective helplessness was included as presumably mediating the relations of catastrophizing and thought suppression to depression due to motivational deficits. In addition, moderating effects of dispositional action versus state orientation were analyzed, whereby state orientation indicates volitional deficits in coping with distress. The study was based on self-report data from 536 patients with chronic non-specific low back pain at the beginning of inpatient rehabilitation. Moderated mediation analyses were performed. The indirect catastrophizing- and thought suppression-depression relations were (partially) mediated by subjective helplessness; and moderated by failure-related action versus state orientation. Moreover, action versus state orientation moderated the direct relation of thought suppression to depression. Results suggest that catastrophizing, thought suppression, and subjective helplessness do not lead to depression unless associated with self-regulatory inability (i.e., state orientation). In contrast, action-oriented patients more effectively self-regulate pain-related emotions, disengage from rumination, and distract from pain and thus better avoid the debilitating effects of negative pain-related cognitions on depression. Future research and treatment may more strongly focus on the role of motivational and volitional deficits underlying learned helplessness and depression in chronic pain.

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“…Zwischen 20 und 35% der stationären Patienten mit chronischen Schmerzen haben ernsthafte depressive Beschwerden [29,30]. Für den ambulanten Bereich gibt es kaum Daten über das Ausmaß der Komorbidität von Depression und Schmerz [23].…”

Section: Introductionunclassified

Gesichtsschmerzen in der Psychiatrie

Peschen-Rosin

2002

Schmerz

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Chronic facial pain may cause diagnostic and therapeutic difficulties, thus demanding a complete interdisciplinary consultation. As in 20 to 25% of patients with a nociceptive or primary neuropathic pain a psychiatric comorbidity is expected, it is necessary to include psychiatric and psychosomatic examinations. Every 8th male and every 4th female pain patient has the statistical risk of having a depression at the same time. Depression may develop as a consequence of pain, but may also be the primary basis for a pain syndrome. An independent coincidence is possible as well. Besides affective disorders, persistent somatoform pain syndromes, syndromes of conversion, hypochondriac or artificial disorders and pain in psychosis have to be excluded in patients presenting with chronic facial pain. In depression, persistent somatoform pain syndromes, atypical facial pain but also when dysfunctional illness beliefs and coping mechanisms are present, cognitive-behavioral therapy should be offered to the patient. Motivation to psychotherapy may be difficult, especially in patients relying exclusively on physical illness beliefs. The physician should develop and extend the physical illness beliefs together with the patient to a model that includes biological as well as psychosocial factors. Tricyclic antidepressants may be indicated not only in depression, but also in chronic pain due to the analgetic effects of these drugs. The choice of drug therapy should conform to the main complaints of depression and accompanying illnesses. Indication of antidepressants or neuroleptic drugs in somatoform pain syndromes is still unclear. Their potential slight effect may simply be due to the high comorbidity between somatoform pain syndromes and depression.

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Depression und chronische Schmerzen: Zur Bedeutung alltäglicher Belastungen und Handlungskontrolle

Cited by 10 publications

References 4 publications

Endurance and avoidance response patterns in pain patients: Application of action control theory in pain research

Endurance and avoidance response patterns in pain patients: Application of action control theory in pain research

Volitional Action Control and Depression in Chronic Pain: Does Action versus State Orientation Moderate the Relations of Pain-Related Cognitions to Depression?

Gesichtsschmerzen in der Psychiatrie

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