Causal symptom attributions in somatoform disorder and chronic pain

Hiller, Wolfgang; Cebulla, Mario; Korn, Hans-Jürgen; Leibbrand, Rolf; Röers, Bodo; Nilges, P.

doi:10.1016/j.jpsychores.2009.06.011

Cited by 42 publications

(45 citation statements)

References 39 publications

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“…For example, studies assessing causal attributions using both quantitative and qualitative measures found the number of spontaneous mentions to be less than the number of causal attributions endorsed in a questionnaire (Cebulla, 2002;Hiller et al, 2010;Korn, 2003). Further, the dimensions of causal attribution identified seem to vary according to the research instrument used (see Table 2, above).…”

Section: Assessment Of Causal Attributions In Patients With Sfdsmentioning

confidence: 99%

“…While some studies support the notion of a tendency towards somatic illness attributions among SFD patients (Kirmayer & Robbins, 1996;MacLeod et al, 1998;MossMorris & Petrie, 2001;Nimnuan et al, 2001;Rief et al, 2004), more recent studies and reviews (Aiarzaguena et al, 2008;Goldbeck & Bundschuh, 2007;Hiller et al, 2010;Kirmayer et al, 2004;Martin et al, 2007a;Nikendei et al, 2009;Rief & Broadbent, 2007;Risør, 2009;Schröter et al, 2004) and, in particular, qualitative studies on doctor-patient interaction Salmon et al, 2004Salmon et al, , 2009) present more of a mixed picture, with SFD patients being open to both somatic and psychosocial explanations of their symptoms.…”

Section: Causal Attributions and Sfdsmentioning

confidence: 99%

“…A recent semi-structured interview study by Hiller et al (2010) depending on the situation they found themselves in. 'Symptomatic', 'personal', 'social' and 'moral' idioms were used interchangeably and at times concurrently and 'with different emphasis at different times and in different social situations' (p. 518), thus underlining their dynamic nature.…”

Section: Causal Attributions and Sfdsmentioning

confidence: 99%

See 2 more Smart Citations

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

Groben¹,

Hausteiner²

2011

Journal of Psychosomatic Research

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Section: Assessment Of Causal Attributions In Patients With Sfdsmentioning

confidence: 99%

Section: Causal Attributions and Sfdsmentioning

confidence: 99%

Section: Causal Attributions and Sfdsmentioning

confidence: 99%

See 1 more Smart Citation

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

Groben¹,

Hausteiner²

2011

Journal of Psychosomatic Research

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“…These results corroborate estimates of patients' psychological distress observed in other studies [43,44] with approximately 60% of patients expressing psychological attributions for various symptoms. Other studies on causal attributions also emphasized the importance of psychological attributions although multiple causal attributions may coexist [16,19].…”

Section: Discussionmentioning

confidence: 99%

“…Causal attributions are the common-sense explanations people give to account for an event and their own interpretations which will guide future behaviours [7][8][9][10]. Various studies [11][12][13] have highlighted how much causal attributions influence cognitions and symptom experience but also contribute to determine the illness response, help-seeking behaviour, illness-associated disability as well as coping behaviour and adaptive resources in various illnesses, including heart infarction [14], somatoform disorders [15,16], somatoform disorders in patients with suspected allergies [17], orthopaedic surgery [18], chronic pain [19], fatigue [20,21] and fibromyalgia [22,23].…”

Section: Introductionmentioning

confidence: 99%

Primary attributions in women suffering fibromyalgia emphasize the perception of a disruptive onset for a long-lasting pain problem

Cedraschi¹,

Girard²,

Luthy³

et al. 2013

Journal of Psychosomatic Research

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Objective: Fibromyalgia (FM) is a chronic musculoskeletal pain disorder characterized by widespread pain. This study focuses on patients' attributions of illness and of symptom onset. Methods: Semi-structured interviews were conducted with 56 women to elicit patients' views on what triggered their FM. The transcripts of the interviews were analyzed using a classical indexing technique to identify key themes. Content analysis was performed by two independent coders. Results: Primary causal attributions fell into five categories: psychological problems (28 respondents); somatic concerns (N=12); violence/abuse during childhood (N=7), gynaecological/obstetrical problems (N=6), and fatigue (N=3). Patients' attributions were internal and external in the same proportions, more frequently unstable than stable, and more often described uncontrollable than controllable. Participants expressed decrements in self-esteem and feelings such as self-blame or despair; global perceptions of persistent pain and long-lasting problems, evoking chronicity and hopelessness; and low perceived control over their lives as well as beliefs that nothing can be done, thus increasing a feeling of guilt and vulnerability. Patients' narratives emphasized disruptive circumstances surrounding symptom onset. Conclusion: Attributions often referred to the psychological dimension of the events surrounding FM onset, even though some of them also had a clear somatic dimension. Many narratives mentioned successive disruptive events and suggested an increasing loss of control. Addressing these illness representations may contribute to tailor the treatment and to help patients gain self-coherency by providing means to understand pain onset but also to guide future behaviours, particularly in terms of adjustment and help-seeking.

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Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain

Ashar,

Lumley,

Perlis

et al. 2023

JAMA Netw Open

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ImportanceIn primary chronic back pain (CBP), the belief that pain indicates tissue damage is both inaccurate and unhelpful. Reattributing pain to mind or brain processes may support recovery.ObjectivesTo test whether the reattribution of pain to mind or brain processes was associated with pain relief in pain reprocessing therapy (PRT) and to validate natural language–based tools for measuring patients’ symptom attributions.Design, Setting, and ParticipantsThis secondary analysis of clinical trial data analyzed natural language data from patients with primary CBP randomized to PRT, placebo injection control, or usual care control groups and treated in a US university research setting. Eligible participants were adults aged 21 to 70 years with CBP recruited from the community. Enrollment extended from 2017 to 2018, with the current analyses conducted from 2020 to 2022.InterventionsPRT included cognitive, behavioral, and somatic techniques to support reattributing pain to nondangerous, reversible mind or brain causes. Subcutaneous placebo injection and usual care were hypothesized not to affect pain attributions.Main Outcomes and MeasuresAt pretreatment and posttreatment, participants listed their top 3 perceived causes of pain in their own words (eg, football injury, bad posture, stress); pain intensity was measured as last-week average pain (0 to 10 rating, with 0 indicating no pain and 10 indicating greatest pain). The number of attributions categorized by masked coders as reflecting mind or brain processes were summed to yield mind-brain attribution scores (range, 0-3). An automated scoring algorithm was developed and benchmarked against human coder–derived scores. A data-driven natural language processing (NLP) algorithm identified the dimensional structure of pain attributions.ResultsWe enrolled 151 adults (81 female [54%], 134 White [89%], mean [SD] age, 41.1 [15.6] years) reporting moderate severity CBP (mean [SD] intensity, 4.10 [1.26]; mean [SD] duration, 10.0 [8.9] years). At pretreatment, 41 attributions (10%) were categorized as mind- or brain-related across intervention conditions. PRT led to significant increases in mind- or brain-related attributions, with 71 posttreatment attributions (51%) in the PRT condition categorized as mind- or brain-related, as compared with 22 (8%) in control conditions (mind-brain attribution scores: PRT vs placebo, g = 1.95 [95% CI, 1.45-2.47]; PRT vs usual care, g = 2.06 [95% CI, 1.57-2.60]). Consistent with hypothesized PRT mechanisms, increases in mind-brain attribution score were associated with reductions in pain intensity at posttreatment (standardized β = −0.25; t127 = −2.06; P = .04) and mediated the effects of PRT vs control on 1-year follow-up pain intensity (β = −0.35 [95% CI, −0.07 to −0.63]; P = .05). The automated word-counting algorithm and human coder-derived scores achieved moderate and substantial agreement at pretreatment and posttreatment (Cohen κ = 0.42 and 0.68, respectively). The data-driven NLP algorithm identified a principal dimension of mind and brain vs biomechanical attributions, converging with hypothesis-driven analyses.Conclusions and RelevanceIn this secondary analysis of a randomized trial, PRT increased attribution of primary CBP to mind- or brain-related causes. Increased mind-brain attribution was associated with reductions in pain intensity.

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Causal symptom attributions in somatoform disorder and chronic pain

Cited by 42 publications

References 39 publications

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

Somatoform disorders and causal attributions in patients with suspected allergies: Do somatic causal attributions matter?

Primary attributions in women suffering fibromyalgia emphasize the perception of a disruptive onset for a long-lasting pain problem

Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain

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