A diathesis-stress model of chronic pain and disability following traumatic injury.
A diathesis-stress model of chronic pain and disability following traumatic injury.
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创伤性损伤后慢性疼痛和残疾的素质压力模型。
DOI：
10.1155/2002/252904
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发表时间：
2002
影响因子：
2.9
通讯作者：
Turk,DennisC
中科院分区：
文献类型：
--
作者：
Turk,DennisC
疼痛的一个令人困惑的特征是，患者对表面上相同程度的身体病理的反应存在很大的差异。一系列认知、情感和行为因素与疼痛的感知、疼痛和残疾的维持、疼痛的加剧和对治疗的反应有关。此外，有一些证据表明，个体差异和先前的学习历史也对疼痛和相关残疾的体验有显着影响。这些心理因素在创伤（如机动车事故和工伤）后残疾维持中的作用引起了相当大的兴趣。本文提供了一个简要的概述了一套诱发因素，认知过程和行为原则，似乎是特别重要的，在维护残疾创伤。特别是，焦虑敏感性，预期和避免恐惧或伤害，灾难化的想法，因果归因的症状，自我效能和操作性条件反射进行了讨论。这些因素中的每一个都被整合到一个素质-压力模型中，该模型强调诱发因素与创伤的相互作用，启动一系列解释性认知过程和强化突发事件，这些过程和突发事件在创伤后维持残疾。这个模型提出了一个顺序的过程来解释在相对较小的创伤后人们之间观察到的变化。该模型旨在启发式。这可能是一个有用的概念，可用于指导预防工作和制定治疗干预措施。
One of the perplexing features of pain is the wide variability in patients′ responses to ostensibly the same extent of physical pathology. A range of cognitive, affective and behavioural factors are related to the perception of pain, maintenance of pain and disability, exacerbation of pain and response to treatment. Moreover, there is some evidence that individual differences and prior learning history also have a significant influence on the experience of pain and related disability. The role of these psychological factors in the maintenance of disability following traumas such as motor vehicle accidents and work‐related injuries has generated considerable interest. This paper provides a brief overview of a set of predisposing factors, cognitive processes and behavioural principles that appear to be particularly important in the maintenance of disability following trauma. In particular, anxiety sensitivity, anticipation and avoidance of fear or harm, catastrophizing ideation, causal attributions for symptoms, self‐efficacy and operant conditioning are discussed. Each of these factors is integrated in a diathesis‐stress model that emphasizes the interaction of predisposing factors with a trauma, setting in motion a cascade of interpretive cognitive processes and reinforcement contingencies that maintain disability following the trauma. This model proposes a sequential process to explain the variation observed among people following a relatively minor trauma. The model is intended to be heuristic. It may be a useful conceptualization that can serve to guide prevention efforts and the development of treatment interventions.