New Research From Clinical Psychological Science

Read about the research published in Clinical Psychological Science:

A Model of the Intersection of Pain and Opioid Misuse in Children and Adolescents

Genevieve F. Dash, Anna C. Wilson, Benjamin J. Morasco, and Sarah W. Feldstein Ewing

This review addresses the role of pain and pediatric opioid prescriptions in potentiating the risk of opioid misuse. In medical settings, youths are not routinely prescribed substances they might abuse, except for opioids: Almost 20% of high school students have received at least one opioid prescription by their senior year. The introduction of opioids via prescription might contribute to the development of opioid-induced hyperalgesia (increased sensitivity to pain), chronic pain, and disability, leading to increased opioid use and opioid-related problems. Youth are at a higher risk for these outcomes if, before the prescription, they already suffered from psychological distress, pain, and disability and were unable to deal with distress. Their peers also use opioids without fully perceiving the risk; their parents suffer from chronic pain, use opioids or other drugs, and show low parental monitoring. Other risk factors include available household and peer opioid prescriptions, higher opioid prescription doses and refills, as well as persistent pain, pain catastrophizing, and a pleasurable “high” from opioids. Pain self-efficacy (confidence in one’s ability to function while in pain), the use of nonpharmacological pain treatments, and non-substance-using friends might be factors protecting against opioid misuse.

Meta-Awareness of Dysregulated Emotional Attention
Liad Ruimi, Yuval Hadash, Ariel Zvielli, Iftach Amir, Pavel Goldstein, and Amit Bernstein

Meta-awareness of attentional biases (MAB) — self-awareness that one’s attentional processing of emotional information is dysregulated – may help individuals regulate attention to emotional stimuli. Ruimi et al. examined cigarette smokers’ attentional biases, asking them to rapidly identify the location of probes on a screen; the researchers manipulated whether the probe appeared in the same location as neutral images (e.g., a pencil) or appetitive images (e.g., a cigarette). During the task, participants responded to questions, reporting whether one of the images in the previous trial attracted their attention and influenced their response. Results revealed individual differences in MAB. When people showed attentional bias on one trial, momentary absence of MAB was associated with subsequent attentional bias in the opposite direction on the following trial, a sign of dysregulation. Momentary presence of MAB reduced this reactivity and was more likely to be followed by balanced attentional allocation. This study introduces a method for objectively estimating MAB and provides evidence for a functional link between MAB and attentional processing of reward cues.

Bereavement Outcomes as Causal Systems: A Network Analysis of the Co-Occurrence of Complicated Grief and Posttraumatic Growth
Benjamin W. Bellet, Payton J. Jones, Robert A. Neimeyer, and Richard J. McNally

The loss of a loved one can lead to complicated grief (CG), a debilitating yearning for the deceased. But mourners who experience CG often also experience posttraumatic growth (PTG). To investigate how CG and PTG are connected, Bellet and colleagues investigated the structure of the network of CG and PTG elements, in which symptoms are represented by nodes, and associations among nodes are represented by links with different thicknesses signifying the strength of the association. The authors surveyed 485 participants who had lost a loved one within the past 2 years and computed CG and PTG networks, identified the central features of each one, and then computed a network of both CG and PTG. The results indicate that challenges to control and identity disturbance are the most central elements of CG, whereas the discovery of a new life path and greater personal strength are the most central elements of PTG. CG and PTG shared positive and negative links, and the most central element that seemed to connect them was the degree of disruption and change in mourner’s world views. These results suggest that being negatively affected by someone’s death may promote personal growth.

Ventrolateral Prefrontal Cortex Activation During Social Exclusion Mediates the Relation Between Intolerance of Uncertainty and Trait Aggression
Stephanie M. Gorka, K. Luan Phan, Bobak Hosseini, Eunice Y. Chen, and Michael S. McCloskey

To test whether intolerance of uncertainty (IU) is associated with aggression as a behavioral trait via the activation of the ventrolateral prefrontal cortex (vlPFC), Gorka and colleagues assessed brain activity in patients with intermittent explosive disorder and in nonpatients during a social-exclusion task. The authors used Cyberball, a virtual game in which participants are instructed to play a ball-tossing game with two other participants; in reality, however, the actions of the other players are computer-controlled and designed to induce social inclusion (the ball is tossed to the participant) or exclusion (the two other players do not toss the ball to the participant). In addition, Gorka et al. collected measures of IU and lifetime history of aggression (LHA). The results indicated that greater LHA was associated with prospective IU (i.e., excessive worry about the future) but not with inhibitory IU (i.e., avoidance behaviors), and greater prospective IU was associated with less vlPFC activation during social exclusion. A mediation model indicated an indirect effect of prospective IU on LHA through vlPFC activation, suggesting that individuals with high IU might have difficulties in neural regulation, which may increase propensity for aggression.

Central Sensitization: Explanation or Phenomenon?
Emanuel N. van den Broeke, Diana M. Torta, and Omer Van den Bergh

Central sensitization (CS) has been used in pain research to explain pain hypersensitivity in conditions such as whiplash and chronic pain; recently, some researchers have applied CS to nonpain symptoms, such as anxiety or depression. In this commentary, van den Broeke and colleagues point out that generalizing CS explanations to nonpain symptoms adds a label without actually explaining those symptoms. As defined by the International Association for the Study of Pain, CS refers to the increased responsiveness of a group of sensory neurons that receives information about potentially damaging stimuli and sends signals resulting in the physical sensation of pain. Therefore, the authors say, CS does not apply to increased responsiveness to stimuli that are not related to physical pain and does not explain enhanced responsiveness to emotionally relevant stimuli. They also suggest that the role of cognitive and emotional factors should be considered as potential explanations for these phenomena.