Spousal Expression of Criticism/Hostility and Adjustment among Chronic Pain Patie

描述（由申请人提供）：慢性疼痛的恶化和维持与配偶的批评/敌意有关，但这种联系的性质尚不清楚。这一领域的研究在很大程度上是相关的，导致因果方向不确定，理论模型也没有具体说明配偶批评/敌意与患者痛苦相关的机制。我们提出，配偶批评/敌意与患者对慢性腰痛（CLBP）的适应之间的联系可以通过一个情感表达（EE）模型的综合来阐明，在情感表达（EE）模型中，配偶对患者如何管理他们的病情的批评和配偶对患者的批评/敌意破坏了患者的适应，以及一个人际关系模型。其中，患者持续和夸大的不良适应迹象会引起患者配偶的批评/敌对反应。我们认为慢性疼痛症状引起配偶的负面反应，然后这种反应恶化并维持症状；恶性循环，导致调整不良。与疾病相关的疼痛状况（如癌症）不同，患者和配偶通常对CLBP的病因知之甚少，因此CLBP提供了一个特别合适的模型来测试配偶和患者行为之间的联系。研究1a和1b将测试情感表达和人际关系模型所描述的配偶批评/敌意与患者行为和情绪之间因果关系的有效性。这两项研究都将测试84名CLBP患者及其配偶。在研究1a中，夫妻将进行2次婚姻讨论（中立的；有冲突的），然后患者将在配偶的观察下进行结构化疼痛行为任务（SPBT）。在研究1b中，配偶将观察患者进行2项活动任务（中立；SPBT），然后夫妻将进行有冲突的婚姻讨论。如果这两个模型解释了配偶批评与患者适应之间的联系，那么冲突性讨论中配偶最初批评之间的关系将预测患者在SPBT期间的疼痛行为，而SPBT期间患者最初的疼痛行为将预测冲突性讨论中配偶批评的程度。研究2也将评估情感表达和人际关系模型的有效性，但将使用每日日记法（N=84名患者及其配偶）。患者及其配偶将获得个人资料助理（pda）。在14天的时间里，他们将被提示每天5次回答关于他们自己和他们配偶的情绪和行为的问题，以及在此之前与他们配偶的联系。并发和滞后关联的多层次建模将允许测试配偶内部的个体差异和配偶之间的批评和患者调整的方向性。在时间1中记录高水平冲突的二组中，时间2的患者疼痛行为和时间3的配偶批评之间的滞后二组内关联表明了对螺旋的支持。CLBP是一种常见的致残疾病。更多地了解配偶批评/敌意与患者适应之间的联系，将提供信息，可能导致开发新的、基于夫妻的干预措施，以减少这一人群的痛苦和残疾。

DESCRIPTION (provided by applicant): The exacerbation and maintenance of chronic pain are linked to spousal criticism/hostility, yet the nature of such links is poorly understood. Research in this area is largely correlational, leaving causal directions indeterminate, and theoretical models do not specify mechanisms through which spouse criticism/hostility and patient pain are related. We propose that links between spousal criticism/hostility and patient adjustment to chronic low back pain (CLBP) may be illuminated through a synthesis of an Expressed Emotion (EE) model, in which spousal criticism of how the patient is managing their condition and spousal criticism/hostility toward the patient undermine patient adjustment, and an interpersonal model, in which persistent and exaggerated signs of poor adjustment by patients elicit critical/hostile reactions from patients' spouses. We propose that chronic pain symptoms elicit negative spouse responses and that such responses then worsen and maintain symptoms; a vicious spiral, which leads to poor adjustment. Because the cause of CLBP is often poorly understood by patient and spouse, unlike disease-related pain conditions (eg, cancer), CLBP provides a particularly appropriate model in which to test links between spouse and patient behaviors. Studies 1a and 1b will test the validity of causal pathways linking spousal criticism/hostility with patient behavior and mood described by EE and interpersonal models. Both studies will test 84 CLBP patients and spouses. In Study 1a, couples will engage in 2 marital discussions (neutral; conflictual), and then patients will undergo a Structured Pain Behavior task (SPBT) while the spouse observes. In Study 1b, spouses will observe patients undergo 2 activity tasks (neutral; SPBT), and then couples will engage in a conflictual marital discussion. If the 2 models explain links between spousal criticism and patient adjustment, then the relation between initial spouse criticism during the conflictual discussion will predict later patient pain behavior during the SPBT, and initial patient pain behavior during the SPBT will predict degree of later spouse criticism during the conflictual discussion. Study 2 will also evaluate the validity of the EE and interpersonal models, but a daily diary method will be used (N=84 patients and spouses). Patients and spouses will be given Personal Data Assistants (PDAs). For 14 days they will be prompted 5 times/day to respond to questions about their own and their spouse's mood and behavior, and contacts with their spouse during the preceding interval. Multilevel modeling of concurrent and lagged associations will allow testing within-spouse individual differences and between- spouse directionality of criticism and patient adjustment. Support for the spiral would be indicated by lagged within-dyad associations between patient pain behavior at Time 2 and spouse criticism at Time 3 among dyads who recorded high levels of conflict at Time 1. CLBP is a common and disabling condition. Learning more about links between spousal criticism/hostility and patient adjustment will provide information that could lead to development of novel, couples-based interventions to reduce pain and disability in this population. Public Health Relevance Paragraph: Exacerbation and maintenance of chronic pain are linked to spousal criticism and hostility, yet the nature of such links is poorly understood. We propose that the nature of the relationships between spousal criticism/hostility and patient adjustment to chronic low back pain (CLBP) may be illuminated through a synthesis of an Expressed Emotion (EE) model (spousal criticism of the patient undermines patient adjustment), and an interpersonal model (persistent signs of poor adjustment by patients elicit critical reactions from spouses). With 3 studies, we intend to learn more about links between spousal criticism/hostility and patient adjustment in order to could encourage development of clinical interventions and productive translational efforts targeting this relatively neglected area.