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This study aimed to examine the temporal patterning of pain acceptance-based coping, activity, and mood in patients with complex regional pain syndrome Type I (CRPS-I), by using a daily diary method. A total of 30 patients with CRPS-I seeking treatment in a tertiary pain management center located in Seoul, Korea participated in the study. Multilevel random effects analyses indicated that (a) engagement in pain acceptance-based coping was significantly associated with lower same-day pain and negative mood and greater same-day activity and positive mood; (b) pain acceptance-based coping predicted increases in activity on the following day; (c) greater pain intensity was significantly associated with lower same-day pain acceptance-based coping and activity and greater same-day negative mood; and (d) pain intensity did not predict pain acceptance-based coping, activity, or mood on the following day. These findings suggest that patients with CRPS-I may benefit from responding to pain with acceptance. Further study and eventual application of this process in CRPS-I may improve upon the success of current approaches to this problem.

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BACKGROUND: Preference of types of social support may vary across recipients, and social support that is less than the amount preferred may be associated with depressed mood. PURPOSE: This study aimed to investigate the interaction effects between pain controllability and discrepancy in social support and the additive utility of discrepancy in social support over perceived social support in predicting depressed mood among patients with chronic pain. METHOD: A total of 173 patients seeking treatment at two outpatient pain management clinics in Hawaii participated. RESULTS: The results indicated that (1) patients with low pain controllability preferred significantly more social support than those with high pain controllability, for all types of social support; (2) patients preferred significantly more informational and emotional support than instrumental support for both pain controllability levels; (3) discrepancy in informational or instrumental support was not associated with depressed mood, whereas discrepancy in emotional support was significantly associated with more depressed mood for low pain controllability, but not for high pain controllability; and (4) discrepancy in emotional support added a significant increment of variance in predicting depressed mood over and above perceived emotional support, whereas discrepancy in informational or instrumental support did not. CONCLUSION: Findings suggest the relative importance of discrepancy in emotional support from a significant other, especially for patients with low pain controllability.

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Sixty-seven clients with severe and persistent mental illnesses (SPMI) recruited from community mental health centers were interviewed to assess their subjective quality of life, self-efficacy, importance of ethnic matching and level of working alliance (WA) with their clinicians. Results revealed that clients in the ethnically matched group reported significantly higher WA compared to the non-matched group. Clients who reported a higher level of WA also reported better recovery status. Results suggest that, in a multicultural community, ethnic matching may help augment WA and address potential barriers to treatment engagement, and identifying strategies to promote WA may enhance treatment effectiveness in programs for SPMI.

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PURPOSE: Accepting pain rather than trying to control it has been the focus of recent pain management research. Pain acceptance often has been assessed using the chronic pain acceptance questionnaire (CPAQ). This study aimed to evaluate the factor structure and other psychometric properties of a Korean language version of the CPAQ (KCPAQ). METHODS: This study used two archival data sets collected over two different time periods at the same site in Korea, generating two samples (Total N = 361). RESULTS: Exploratory factor analysis using sample 1 (N = 182) provided support for the same two-factor structure as the original English CPAQ. Confirmatory factor analysis using sample 2 (N = 179) demonstrated the adequacy of the two-factor model obtained from sample 1. Samples 1 and 2 were combined for the reliability and validity analyses. The results indicated that the KCPAQ has good internal consistency and test-retest stability. The KCPAQ was significantly correlated with pain intensity, pain-related anxiety, depressive symptoms, physical adjustment, and psychosocial adjustment. CONCLUSION: The KCPAQ has reliability and construct validity support for the measurement of pain acceptance in a Korean patient sample with chronic pain.

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BACKGROUND: This study aimed to evaluate processes from the mutual maintenance model in relation to daily functioning in patients with both chronic pain and a history of a traumatic experience. The mechanism illustrated the structural relations for daily functioning among pain intensity, hyperarousal, re-experiencing, trauma avoidance, and pain avoidance. METHODS: Archival data (N = 214) was used for this study and data were analyzed for 142 chronic pain patients reporting a traumatic experience and seeking treatment at a tertiary pain clinic in Korea. RESULTS: The results indicated that pain intensity, hyperarousal, and pain avoidance had significant direct effects on daily functioning. Also, pain intensity showed significant indirect effects on daily functioning through hyperarousal and pain avoidance; and hyperarousal through pain avoidance. CONCLUSIONS: Results suggest a direct contribution of high levels of pain, hyperarousal symptoms of PTSD, and pain avoidance behaviors to reduced daily functioning. Also, elevated pain as reminders of the trauma may trigger high levels of hyperarousal symptoms of PTSD. Subsequently, avoidant coping strategies may be used to minimize pain so that the trauma would not be re-experienced, thus inhibiting the activation of hyperarousal symptoms of PTSD. However, prolonged use of such strategies may contribute to decline in daily functioning.

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UNLABELLED: Mindfulness involves reducing potential influences from aversive cognitions, sensations, and emotions on behavior. Mindfulness may influence the experience of pain-related anxiety, and thereby enhance other aspects of physical and psychosocial functioning. Thus, the purpose of this study was to investigate a potential mediating role of pain-related anxiety between mindfulness and physical and psychosocial functioning in chronic pain patients. This cross-sectional/correlational study used archival data (N = 226) obtained from the larger Korean Pain Study at a university-based pain-management center in Korea. Based on the inclusion criterion for the present study, archival data were analyzed for a final sample of 179 patients with chronic pain. Structural equation analyses showed that both the partial- and full-mediation models had adequate goodness-of-fit indices for physical and psychosocial functioning. Subsequent chi-square tests, however, indicated that the more parsimonious full-mediation model was preferred to the partial-mediation model for physical and psychosocial functioning. Bootstrapping procedures yielded significant mediation effects of pain-related anxiety in the full-mediation models on physical and psychosocial functioning. These findings suggest that being mindful may lead indirectly to a decrease in the disabling influences of pain-related anxiety, thereby contributing to better physical and psychosocial functioning, rather than playing a direct contributing role for better functioning among chronic pain patients in Korea. PERSPECTIVE: This article examines the mediating role of pain-related anxiety between mindfulness and physical/psychosocial functioning. Results suggest that mindfulness methods may benefit patients having pain-related anxiety and consequent disability. These benefits may derive from the way processes of mindfulness interact with processes of avoidance and with cognitive influences on emotional suffering.

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BACKGROUND: The Pain Anxiety Symptoms Scale (PASS-20) consists of 20 items designed to assess four aspects of pain-related anxiety: cognitive anxiety, escape-avoidance behaviors, fear of pain, and physiological symptoms of anxiety. Although the PASS-20 is a well-established measure of pain-related anxiety in Western samples, different cultures may yield a different factor structure or different associations with pain-related outcome variables. PURPOSE: The purposes of this study were (1) to examine the factor structure of a Korean language version of the PASS-20 (KPASS-20); (2) to examine reliability and construct validity of the KPASS-20; and (3) to compare the findings of this study with those of the original psychometric study using a Western sample. METHOD: A total of 166 patients seeking treatment in a university pain management center located in Seoul, Korea participated. RESULTS: Results indicated that the KPASS-20 consists of three factors, "fearful thinking," "physiological response," and "avoidance," and has adequate reliability and construct validity estimates. On the mean total score of the KPASS-20, the Korean sample had a significantly higher score than the original Western sample. In addition, in correlation analyses between the total score of the KPASS-20, physical functioning, and pain severity, the Korean sample had significantly higher coefficients, whereas similar differences were not found in the analyses of psychological functioning and depression. CONCLUSION: The findings provide preliminary support for the reliability and validity of the KPASS-20.

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This Commentary on the Muse and McGrath study (this issue, pp. 96-103) refutes its conclusion that the amount of training for prescription privileges for psychologists (RxP) is equal to or greater than that for psychiatric nurse practitioners and physicians. First, the sample failed to include only training programs for nurses and psychologists that lead to independent prescribing. Second, training was defined by an arbitrary, nonvalidated list of "key content areas" that excluded much of the standard medical curricula for nurses and physicians to prescribe. Third, the levels of training for which the "key content areas" were assessed omitted undergraduate prerequisites, apprenticeships, supervised practice, and residencies that are a standard part of the nursing and physician programs studied. RxP training remains substandard.

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The test-retest reliability and content and construct validity of the Health Behavior Schedule II were examined. The Health Behavior Schedule II is a self-report intended to assess 45 potential predictors of compliance for 12 mainstream health practices: (1) eating a healthy diet, (2) exercising regularly, (3) flossing teeth daily, (4) protecting skin from sun, (5) wearing a seat belt, (6) practicing safe sex, (7) wearing a bike safety helmet, (8) not smoking cigarettes, (9) limiting alcohol consumption, (10) taking medication as prescribed, (11) obtaining cervical cancer screen, and (12) breast self-examination. The predictor items of the Health Behavior Schedule II were rationally derived from the Health Compliance Model-II and independently evaluated by three expert judges for content validity. The psychometric status of the Schedule was assessed using a multiethnic sample of 461 college students. 12 stepwise multiple regression analyses yielded 24 items as significant predictors of compliance. The configuration of predictor items varied across the 12 health behaviors with self-efficacy as the only common predictor. Effect size estimates were greatest for cervical cancer screening (R2 = .65) and least for breast self-exams (R2 = .38). Each predictor has implications for compliance enhancement strategies. These findings provide preliminary support for the utility of the questionnaire in assessing potential improvements in health compliance outcomes among young adults.

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This study compares the psychometric characteristics of four questionnaires designed to assess self-control skills: the Self-Control Questionnaire, the Frequency of Self-Reinforcement Questionnaire, the Cognitive Self-Management Test, and the Lifestyle Approaches Inventory. Content validity was judged to be fairly comparable by three raters in Study 1. In Study 2, convergent and divergent validity support was obtained for all four questionnaires when administered to 369 multiethnic college students, but the relative degree of support varied across constructs. Hence, selection of a self-control instrument may be guided by the target behavior of interest.

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This study inspected the deterministic structure of unipolar depression. Two women self-monitored sadness hourly 10 times a day for 6 months. One woman had a recurrent history of unipolar depression, and the other did not. Data were analyzed by visual inspection, examination of the Fourier transforms of the time plots, and the correlation dimension. Results suggested that in addition to a strong periodic component that existed only within the depressed subject's mood time series, a low-dimensional chaotic process might have been operating. In the nondepressed control subject, no such periodicity or process could be identified. The findings support maladaptive deterministic theories of mood disorders and have implications for the assessment of unipolar depression.

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OBJECTIVES: This study explored the use of complementary and alternative medicine (CAM) by degree of use (nonuse, light, moderate, and heavy) by patients with cancer as it relates to sociodemographic and disease characteristics, subjective well-being, and dissatisfaction with the health care system. DESIGN AND PARTICIPANTS: One hundred and forty-three (143) patients with cancer of Asian, Caucasian, and Pacific Islander ethnicities originally recruited through the state-wide population-based Hawaii Tumor Registry and interviewed approximately 3 years postdiagnosis. OUTCOME MEASURES: This study introduced a multidimensional measure, degree of CAM use, to rank participants by quantity of CAMs used as well as frequency, intensity, and breadth of use. Predictor variables explored were sociodemographic variables, disease site, quality-of-life measures, satisfaction with conventional treatment and physicians, satisfaction with medical information, and perceived severity of illness. RESULTS: Heavier CAM use was related to being female, Caucasian, having more education, having breast cancer, and having greater symptoms of nausea and vomiting. Heavier use was also associated with lower doctor satisfaction and a greater perception of disease severity. Sociodemographic and clinical variables accounted for the largest proportion of the variance in degree of use, but subjective well-being and health care satisfaction provided incremental increases in the variance explained. CONCLUSIONS: This study is one of few studies exploring predictors for the quantity or degree of use of CAM by patients with cancer. Understanding factors related to these patients' heavier or lighter CAM use has implications for health care offerings and cancer treatment decision-making.

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The self-control theory of psychopathology has contributed to the understanding and treatment of unipolar depression. This paper explores the relationship between self-control skills as measured by the Frequency of Self-reinforcement Questionnaire and other negative emotional states, with a focus on hostility. In Study 1, scores on the Brief Symptom Inventory were inversely related to self-control skills among a sample of 53 college students, suggesting potential generalizability of the theory. In Study 2, self-control skills were inversely related to hostility, anger, and aggression among a sample of 68 college students. The role of self-control skills in the regulation of hostility deserves further investigation.

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This article summarizes the six primary arguments for and against prescription privileges for psychologists (PPP or RxP) that were presented in this special issue. Four articles addressed points made in the testimony in favor of PPP by the American Psychological Association. Six articles addressed points in the testimony against PPP by the American Association of Applied and Preventive Psychology. It is concluded that the PPP debate reflects a deep schism in clinical psychology that represents a serious disunity in the field. The disunity is seen as a divide between those trained to be psychotherapists and those trained to be scientist-practitioners. It is argued that the former support PPP and are interested in the survival of professional schools, while the latter oppose PPP and are interested in the survival of university departments of psychology. For the discipline to survive there must be a rapprochement between these factions and alternatives to PPP for the retraining of psychotherapy practitioners.

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