Browsing by Subject "Moderated Mediation"

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    Coping is Complicated: Examining the Roles of Coping Strategies and Pain Self-Efficacy for Black Veterans with Chronic Pain
    (2024-12) Procento, Philip Matthew; Hirsh, Adam T.; Matthias, Marianne S.; Rand, Kevin L.; Stewart, Jesse C.
    Black patients with chronic pain routinely receive insufficient pain management, which contributes to myriad worse outcomes. This inadequate care stems from various factors, including systemic marginalization, provider bias, and patient-level factors. The present study focused on two patient factors: pain self-efficacy and coping strategies. It explored whether the relationship of pain intensity and pain interference was explained by active (less interference) and passive (greater interference) coping strategies, and it investigated if pain self-efficacy strengthened or weakened these mediating relationships. As part of a larger study, Black veterans with chronic pain completed measures assessing pain interference, coping strategies, and self-efficacy. Simple mediation analyses indicated that the relationship between pain intensity and interference was mediated by passive, but not active, coping. Higher pain intensity predicted greater passive coping, which led to worse pain interference. A parallel mediation analysis affirmed this mediating effect when controlling for active coping. Moderated mediation analyses found that pain self-efficacy moderated the mediating effect of passive, but not active, coping. Participants with lower (vs. higher) pain self-efficacy used more passive coping (in absolute terms) across pain intensity levels, but those with higher (vs. lower) self-efficacy experienced greater increases in their passive coping as their pain intensity increased. A parallel moderated mediation analysis affirmed this moderated mediation effect when controlling for active coping. These results suggest that passive coping is a possible mechanism by which pain intensity leads to interference among Black veterans with chronic pain, and that self-efficacy modulates this effect. Future research should replicate these results in other patient samples, investigate other possible moderators (e.g., PTSD), and design interventions to reduce the use of passive coping strategies while simultaneously increasing pain self-efficacy.
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    An Experimental Investigation and Conditional Process Analysis of the Role of Catastrophizing in the Pain — Working Memory Nexus
    (2019-12) Procento, Philip Matthew; Hirsh, Adam T.; Stewart, Jesse C.; Rand, Kevin L.
    There is a well-documented bidirectional relationship between pain and cognitive dysfunction, especially working memory. Despite this extensive body of research, the pain–working memory relationship is poorly understood. Pain catastrophizing – exaggerated negative cognitive and emotional responses towards pain – may contribute to working memory deficits by occupying finite, shared cognitive resources, but this has yet to be investigated. The present study sought to clarify the role of pain catastrophizing (assessed as both a trait-level disposition and state-level process) in working memory dysfunction. Healthy undergraduate participants were randomized to an ischemic pain or control task, during which they completed verbal and non-verbal working memory tests. They also completed measures of state- and trait-level pain catastrophizing. Mediation analyses indicated that state-level pain catastrophizing mediated the relationships of pain group to both verbal and non-verbal working memory, such that participants in the pain group (vs. the control group) catastrophized more about their pain, which then resulted in worse verbal and non-verbal working memory performance. In moderated mediation analyses, trait-level pain catastrophizing moderated this mediation effect for both verbal and non-verbal working memory. Those participants in the pain group who reported greater tendency to catastrophize about pain in general exhibited greater catastrophizing in-the-moment during the pain task, thereby leading to worse verbal and non-verbal working memory performance. These results provide evidence for pain catastrophizing as a putative mechanism and moderating factor of working memory dysfunction in pain. Future research should replicate these results in chronic pain samples, investigate other potential mechanisms (e.g., sleep), and develop interventions to ameliorate cognitive dysfunction by targeting pain catastrophizing.