CATASTROPHIZING, CHILD PAIN BEHAVIOR, AND PARENTAL RESPONSE

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CATASTROPHIZING, CHILD PAIN BEHAVIOR, AND PARENTAL RESPONSE

TABLE OF CONTENTS

Cover page

Title page

Certification        –       –       –       –       –       –       –       –       i

Dedication –       –       –       –       –       –       –       –       –       ii

Acknowledgement      –       –       –       –       –       –       –       iii

Abstract     –       –       –       –       –       –       –       –       –       v

Table of contents        –       –       –       –       –       –       –       –       vi

CHAPTER ONE: INTRODUCTION

1.1    Background of the Study     –       –       –       –       –       1

1.2    Statement of Problem  –       –       –       –       –       –       7

1.3    Purpose of the study           –       –       –       –       –       8

1.4    Objective of the Study –       –       –       –       –       –       9

1.4    Research Questions    –       –       –       –       –       –       10

1.5    Research Hypothesis   –       –       –       –       –       –       10

1.6    Significance of the Study     –       –       –       –       –       11

1.7    Scope of the study      –       –       –       –       –       –       11

1.8    Limitation of the study         –       –       –       –       –

1.9    Definition of Terms             –       –       –       –       –       12

CHAPTER TWO: REVIEW OF RELATED LITERATURE

2.1    Introduction       –       –       –       –       –       –       –       14

2.2 The Theoretical frame Work –       –       –       –       –       21

2.3 conceptual frame work

2.4 empirical review

CHAPTER THREE: RESEARCH METHODOLOGY

3.1    Introduction       –       –       –       –       –       –       –       82

3.2    Area of the study                –       –       –       –       –       –       82

3.3    Research Design        –       –       –       –       –       –       82

3.4    Sample and sampling techniques –       –       –       –       83

3.5    Population of the study               –       –       –       –       –       84

3.6    Procedure for Data Collection      –       –       –       –       85

3.7    Method of Data Analysis      –       –       –       –       –       85

CHAPTER FOUR: PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

4.1    Introduction       –       –       –       –       –       –       –       87

4.2    Presentation of Data           –       –       –       –       –       87

4.3    Data Analysis     –       –       –       –       –       –       –       88

4.4    Testing of Hypothesis          –       –       –       –       –       91

4.5    Discussion and summary of findings             –       –       94

CHAPTER FIVE:

INTRODUCTION, SUMMARY, RECOMMENDATIONS AND CONCLUSION

5.0    Introduction       –       –       –       –       –       –       –       98

5.1    Summary           –       –       –       –       –       –       –       99

5.2    Conclusion –       –       –       –       –       –       –       –       100

5.3    Recommendations      –       –       –       –       –       –       101

REFERENCES

Abstract

This study sought to model and test the role of parental catastrophizing in relationship to parent-reported child pain behavior and parental protective (solicitous) responses to child pain in a sample of children with Inflammatory Bowel Disease and their parents (n= 184 dyads). Parents completed measures designed to assess cognitions about and responses to their child’s abdominal pain. They also rated their child’s pain behavior. Mediation analyses were performed using regression-based techniques and bootstrapping. Results supported a model treating parent-reported child pain behavior as the predictor, parental catastrophizing as the mediator, and parental protective responses as the outcome. Parent-reported child pain behavior predicted parental protective responses and this association was mediated by parental catastrophizing about child pain: indirect effect (SE) = 2.08 (0.56); 95% CI = 1.09, 3.30. The proportion of the total effect mediated was 68%. Findings suggest that interventions designed to modify maladaptive parental responses to children’s pain behaviors should assess, as well as target, parental catastrophizing cognitions about their child’s pain.

1. Introduction

Catastrophizing cognitions regarding pain have emerged as important predictors of pain-related outcomes [1]. Research spanning both child and adult samples suggests that catastrophizing amplifies pain experience, expressivity, and pain-related dysfunction [2]. For example, catastrophizing among adults has been associated with increased pain intensity, severity and interference, increased pain behavior, decreased pain tolerance, increased depression and distress, and increased disability [310]. Similarly, catastrophizing among children has been associated with increased pain intensity, severity and pain-related attentional avoidance, increased pain anxiety and pain behavior, increased depression and distress, increased functional disability, and decreased health-related quality of life [1120].

From a theoretical standpoint, catastrophizing has been conceptualized as an appraisal process, a cognitive coping strategy, and a means of coping via elicitation of communal support [2]. In a critical review of the literature on catastrophizing, Quartana and colleagues [2] note that pain catastrophizing in particular is characterized by the tendency to magnify the threat value of a pain stimulus, to feel helpless in the face of pain, and by difficulty inhibiting pain-related thoughts. The assessment of catastrophizing has been conducted primarily through self-report questionnaires such as the Coping Strategies Questionnaire [21] and the Pain Catastrophizing Scale (PCS; [22]). Factors within the larger category of catastrophizing have been derived from the PCS, indicating dimensions of rumination, magnification, and helplessness [22]. More recently, attention to catastrophizing among significant others such as spouses/partners or parents of those with pain has led to the development of instruments such as the PCS-Spouse [23] and PCS-Parent forms [24], designed to assess catastrophizing cognitions in response to a loved one’s pain.

With these measures, researchers have begun to examine effects that the catastrophizing cognitions of significant others may have on patient outcomes. Relatively recent studies have demonstrated that parents’ catastrophic cognitions about their child’s pain are associated with adverse outcomes in the child such as increased pain intensity, increased (parent-perceived) pain behavior, increased pain catastrophizing, increased depressive symptomatology, increased disability, and decreased quality of life [15161925]. Parents’ catastrophizing about their child’s pain has also been associated with the parents’ emotional and behavioral responses to their child’s pain. For example, Hechler and colleagues [25] found that both mothers’ and fathers’ catastrophizing about their child’s chronic pain was associated with self-reported solicitous responding to the child’s pain (responding in ways that reinforce symptomatology and illness behavior). In a laboratory study in which children were asked to undergo a cold-pressor procedure, parents’ catastrophizing about their child’s pain was positively associated with their self-reported distress and tendency to want to stop the procedure [26]. In a third study employing a vignette methodology, mothers’ catastrophizing about their child’s pain was associated with greater endorsement of items reflecting the importance of controlling their child’s pain in a hypothetical pain scenario relative to the importance of having their child engage in everyday activities despite the pain [27]. It should be noted, however, that this association only held for hypothetical scenarios involving acute versus chronic pain [27]. Finally, in a naturalistic study of children with leukemia undergoing lumbar puncture and/or bone aspiration procedures, heightened catastrophic thinking about the child’s procedural pain was associated with greater distress among parents during the procedure. Increased distress among high catastrophizing parents, moreover, predicted greater pain-attending verbal and nonverbal behavior while interacting with their child after the procedure [28].

While parental catastrophizing appears to be an important factor potentially influencing emotional and behavioral responses to pain in children and their parents, the exact nature of its role remains to be clarified. In a cognitive-behavioral model, cognitive appraisals have been viewed as a mediator between events (or perceived events) and emotional and behavioral responses. Thus, appraisals of threat are seen as activating emotional and behavioral responses to perceived stressors [29]. In this framework, child pain behaviors may serve as triggers that increase the likelihood of catastrophizing cognitions on the part of parents, which in turn may prompt responses to protect the child or mitigate threat. This model is illustrated in Figure 1. We have already outlined evidence for Paths a and b. With respect to Path c, the association between child pain behavior and parental protective responses, results from a heat pain induction experiment indicated that parents engaged in more pain-attending talk with their child if the child talked more about his/her pain [30]. This effect was moderated, moreover, by perceived threat. High catastrophizing parents who were led to believe that the heat induction was threatening engaged in more pain-attending talk (e.g., asking their child, “Does it still hurt?”) than did high catastrophizing parents who were led to believe that the heat induction was neutral (nonthreatening). In contrast, pain-attending talk did not differ as a function of perceived threat among low catastrophizing parents [30].

CATASTROPHIZING, CHILD PAIN BEHAVIOR, AND PARENTAL RESPONSE

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