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，但对这种联系的性质知之甚少。这方面的研究在很大程度上是相关的，留下因果方向不确定，理论模型没有指定的机制，通过配偶的批评/敌意和病人的痛苦是相关的。我们提出，配偶批评/敌意和患者对慢性腰痛（CLBP）的适应之间的联系可以通过表达情感（EE）模型的综合来阐明，其中配偶批评患者如何管理他们的病情和配偶批评/对患者的敌意破坏了患者的适应，以及人际关系模型，其中，患者的适应不良的持续和夸大的迹象引起患者配偶的批评/敌意反应。我们认为，慢性疼痛症状会引起配偶的消极反应，这种反应会恶化并维持症状;这是一个恶性循环，导致调整不良。由于CLBP的原因往往是由患者和配偶了解甚少，不像疾病相关的疼痛条件（如癌症），CLBP提供了一个特别合适的模型，以测试配偶和患者的行为之间的联系。研究1a和1b将测试因果路径的有效性，将配偶批评/敌意与EE和人际模型描述的患者行为和情绪联系起来。这两项研究将测试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;冲突），然后患者将接受结构化疼痛行为任务（SPBT），同时配偶观察。在研究1b中，配偶将观察患者接受2项活动任务（中性; SPBT），然后夫妻将进行冲突性婚姻讨论。如果这两个模型解释了配偶批评和患者调整之间的联系，那么在冲突讨论期间最初的配偶批评之间的关系将预测后来的患者在SPBT期间的疼痛行为，并且在SPBT期间最初的患者疼痛行为将预测后来的配偶批评在冲突讨论期间的程度。研究2还将评价EE和人际关系模型的有效性，但将使用每日日记法（N=84例患者及其配偶）。患者及其配偶将获得个人数据助理（PDA）。在14天的时间里，他们将每天被提示5次，回答有关他们自己和他们配偶的情绪和行为的问题，以及在前一段时间内与他们配偶的接触。同时和滞后协会的多层次建模将允许测试配偶内的个体差异和配偶之间的批评和患者调整的方向性。支持螺旋将表明在时间2的患者疼痛行为和时间3的配偶的批评之间的二对谁记录在时间1的高水平的冲突的二对之间的滞后二对关联。CLBP是一种常见的致残性疾病。了解更多关于配偶批评/敌意和患者调整之间的联系将提供信息，可能导致开发新的，基于夫妇的干预措施，以减少这一人群的疼痛和残疾。 公共卫生相关性段落：慢性疼痛的恶化和维持与配偶的批评和敌意有关，但这种联系的性质知之甚少。我们建议，配偶的批评/敌意和患者调整慢性腰痛（CLBP）之间的关系的性质，可以照亮通过一个综合的表达情感（EE）模型（配偶批评的患者破坏患者的调整），和一个人际关系模型（持续的迹象，患者调整不良引起配偶的批评反应）。通过3项研究，我们打算更多地了解配偶批评/敌意与患者适应之间的联系，以鼓励针对这一相对被忽视的领域开展临床干预和富有成效的翻译工作。

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.