Risk-Targeted Behavioral Activation for the Management of Work-Disability Associated with Co-Morbid Pain and Depression: A Feasibility Study

Purpose The purpose of the present study was to conduct a preliminary evaluation the feasibility and impact of a risk-targeted behavioral activation intervention for work-disabled individuals with co-morbid pain and depression. Methods The design of the study was a single arm non-randomized trial. The sample consisted of 66 work-disabled individuals with co-morbid pain and depression. The treatment program consisted of a 10-week standardized behavioral activation intervention supplemented by techniques to target two psychosocial risk-factors for delayed recovery, namely, catastrophic thinking and perceptions of injustice. Measures of pain severity, depression, catastrophic thinking, perceived injustice and self-reported disability were completed pre-, mid-, and post-treatment. Satisfaction with treatment was assessed at post-treatment. Return to work was assessed at 6-month follow-up. Results The drop-out rate was 18%. At treatment termination, 91% of participants indicated that they were ‘very’ or ‘completely’ satisfied with their involvement in the treatment program. Significant reductions in pain (d = .71), depression (d = .86), catastrophic thinking (d = 1.1) and perceived injustice (d = 1.0) were observed through the course of treatment. In multivariate analyses, treatment-related reductions in depression, catastrophic thinking, perceived injustice, but not pain, contributed significant unique variance to the prediction of return-to-work outcomes. Conclusions Risk-targeted behavioral activation was found to be an acceptable and effective intervention for work-disabled individuals with co-morbid pain and depression. The findings suggest that interventions targeting psychosocial risk factors for pain and depression might contribute to more positive recovery outcomes in work-disabled individuals with co-morbid pain and depression.

Privatizations Spark Socialist Backlash: Evidence from East Germany’s Transformation

The fall of the Berlin Wall marks one of the largest transformations of the 20th century. At its core, the year 1990 brought two new systems to Eastern Europe: capitalism and democracy. Yet, to this day, Eastern Europeans show distinctly negative attitudes toward the Western world order, and democratic and market institutions across the region are far from perfect. What explains this unsuccessful transformation? This paper points to the rushed privatization of East European economies as one plausible driver of citizens’ discontent with capitalism and democracy. Using micro-level data from East Germany, we show that firm privatizations led to a marked resurgence of the successor of the former Socialist Unity Party as early as 1994. We argue that this effect is likely due to perceived injustice: Socialist voting thrived whenever firms were sold to Western elites, which local residents took as a sign that capitalism is not meritocratic.

Do disasters trigger protests? A conceptual view and review of the connection between disasters, injustice, and protests – the case of COVID-19

People around the globe were and are affected by the highly contagious virus SARS-CoV-2 (Coronavirus, COVID-19) far beyond the virus itself. Despite the high viral transmission, people did not stop acting collectively. Sometimes these collective actions were against government regulations to health and safety (e.g., anti-lockdown), or to deal with systemic injustice and inequality affecting specific groups (e.g., Black Lives Matter). In this conceptual paper, we discuss the relation between protests and disasters. More specifically we discuss the crucial element of perceived social injustice and inequality for protest to emerge during or in the aftermath of disasters. We review literature related to disasters and protests before moving on to the COVID-19 pandemic to discuss how the context of COVID-19 can have influenced protests as well as protests’ potential impact on viral transmission. We demonstrate that protests during or in the aftermath of disasters are not uncommon. Furthermore, we suggest a direct link between emergent or increased perceived injustice and inequality and protests during/after disasters.

Associations between anger and chronic primary pain: a systematic review and meta-analysis

Objectives Anger is a negative emotion characterized by antagonism toward someone or something, is rooted in an appraisal or attribution of wrongdoing, and is accompanied by an action tendency to undo the wrongdoing. Anger is prevalent in individuals with chronic pain, especially those with chronic primary pain. The associations between anger and pain-related outcomes (e.g., pain intensity, disability) have been examined in previous studies. However, to our knowledge, no systematic review or meta-analysis has summarized the findings of anger-pain associations through a focus on chronic primary pain. Hence, we sought to summarize the findings on the associations of anger-related variables with pain and disability in individuals with chronic primary pain. Methods All studies reporting at least one association between anger-related variables and the two pain-related outcomes in individuals with chronic primary pain were eligible. We searched electronic databases using keywords relevant to anger and chronic primary pain. Multiple reviewers independently screened for study eligibility, data extraction, and methodological quality assessment. Results Thirty-eight studies were included in this systematic review, of which 20 provided data for meta-analyses (2,682 participants with chronic primary pain). Of the included studies, 68.4% had a medium methodological quality. Evidence showed mixed results in the qualitative synthesis. Most anger-related variables had significant positive pooled correlations with small to moderate effect sizes for pain and disability. Conclusions Through a comprehensive search, we identified several key anger-related variables associated with pain-related outcomes. In particular, associations with perceived injustice were substantial.

Translation and validation of the Norwegian version of the Injustice Experience Questionnaire

Objectives Perceived injustice is a theoretical construct comprising elements of loss, attribution of blame, and sense of unfairness. Patients with chronic pain often report high levels of perceived injustice, which can have negative impact on physiological and psychosocial aspects and treatment outcome. The Injustice Experience Questionnaire (IEQ) is a self-report 12-item questionnaire that shows good reliability and validity in patients with chronic pain. This study aimed to translate, validate, and expand the use of the Norwegian Injustice Experience Questionnaire (IEQ-N) to a chronic pain population. Methods A mixed-method approach was used to translate and validate the IEQ-N. It was forward-back translated, linguistically validated, and culturally adapted. Individual cognitive debriefing interviews (n=7) and a focus group interview (n=9) was used to explore the patients’ experience with- and understanding of the questionnaire. Statistical descriptive, correlational, factor- and regression analyses were used to investigate the IEQ-N validity, reliability, and factorial structure in a large registry sample (n=3,068) of patients with chronic pain. Results Patients with chronic pain found the IEQ-N relevant. Registry analyses supported that the IEQ-N had a one-factor structure. The internal consistency was high (Chronbach’s alpha=0.92). The construct validity was good, with moderate to strong significant univariate correlation (r=0.29–0.71) (p<0.05) between perceived injustice and related constructs of pain catastrophizing, pain severity, disability, psychological distress, and quality of life. Perceived injustice contributed with significant but small unique variance to pain-related factors (i.e., pain intensity, pain-related disability, psychological distress), but the additional contribution beyond pain catastrophizing was small (0.2–6.7%) (p<0.05). Conclusions Patients in the study found the questionnaire relevant for their situation, and easy to understand. This study provides a reliable and valid Norwegian tool to assess perceived injustice in patients with chronic pain. Ethical committee number REK sør-øst, 2016/1942.

Development of a Questionnaire to Measure the Perceived Injustice of People Who Have Experienced Violence in War and Conflict Areas: Perceived Injustice Questionnaire (PIQ)

Objectives: The primary aim of this research was to develop a questionnaire that assesses perceived injustice among survivors of war and trauma in conflict areas and to evaluate its psychometric properties. This paper presents the first preliminary validation. Furthermore, the assumption that the general perception of injustice correlates with one’s own experiences of injustice and violence was tested. Methods: The 24-item Perceived Injustice Questionnaire (PIQ) was administered partly online and partly in a paper–pencil version to 89 students of the University of Dohuk in Northern Iraq, an area that has been affected by crisis and war for many years. Principal component analysis was used for factor extraction and internal consistency was determined. The Mann–Whitney-U test was used to calculate the group differences between people with and without experience of physical violence and strong experiences of injustice because Kolmogorov–Smirnov tests showed that the data are not normally distributed. Results: Principal component analysis yielded a four-component solution with eigenvalues being the greater one. Cronbach’s alpha for each scale was acceptable to satisfactory. Significant results of the Mann–Whitney U tests supported our assumptions of between-group differences on each of the subscales (emotional and cognitive consequences, injustice perception, injustice experience, revenge, and forgiveness). Discussion: The findings of this study support the construct validity and the reliability of the PIQ. For this reason, it can be seen as a useful addition to the psychological assessment in psychotherapeutic settings of survivors of war and violence. In conclusion, and based on the PIQ, we suggest the development of a new set of therapy modules with worksheets, focusing on the perception, dealing, and understanding of feeling of injustice as an addition to the existing trauma therapy manual for therapy in war and conflict areas.

A network analysis of selected psychosocial factors in Vulvodynia and its subtypes

Objective Psychosocial factors are related to pain and sex-related outcomes in provoked Vulvodynia and possibly, in mixed and spontaneous Vulvodynia. However, a broader behavioural framework, such as the psychological flexibility model, has received limited attention in this context. Recently, additional psychosocial variables have also emerged that appear relevant to Vulvodynia, including perceived injustice, body-exposure anxiety during intercourse, and unmitigated sexual communion. The present study applied network analysis to explore relations between psychological flexibility, newly emerging psychosocial variables relevant to Vulvodynia, and their associations with Vulvodynia outcomes. The study also explored potential differences across Vulvodynia subtypes. Design An online cross-sectional study of 349 participants with Vulvodynia (112 provoked, 237 spontaneous/mixed) was carried out. Methods Participants completed self-report questionnaires, including pain and sexual outcomes, depression, facets of psychological flexibility, body-exposure anxiety during intercourse, unmitigated sexual communion, and perceived injustice. Networks were computed for the total sample and provoked and mixed/spontaneous Vulvodynia subsamples. Results Perceived injustice, pain-acceptance, and depression were “central” factors, among the included variables, in all models. Psychological flexibility processes were relevant for all networks. Depression was more central in the network for mixed/spontaneous Vulvodynia; body-exposure anxiety during intercourse was most central for the provoked subtype. Conclusions Among included variables, perceived injustice, pain-acceptance, depression, and psychological flexibility appear to be important in Vulvodynia. As different factors are significant across subtypes, tailored treatment approaches are suggested.

Perceived injustice, perceived group threat and self-reported right-wing violence: An integrated approach

The present study seeks to explain individual differences in self-reported politically motivated violence and vandalism, and participation within an extreme right-wing group. While violent extremism is highly debated, few criminological studies explicitly test factors that can trigger violent extremism. The present study addresses this gap by integrating two different frameworks: a perceived injustice and group threat-initiated model and an impulsivity-initiated model. We also investigate several intervening mechanisms. We draw on a sample of 705 adolescents and young adults living in Flanders, Belgium to test the strength of direct and intermediary effects of perceived injustice, perceptions of out-group threat from Jewish populations, ethnocentrism, feelings of superiority, moral support for right-wing extremism, and exposure to racist peers on politically motivated violence and vandalism. Results of structural equation models (SEM) indicate various direct and intermediary effects between both perceived injustice and violent extremism, and between impulsivity and violent extremism. Our model reveals the complex and intricate antecedents of violent extremism. Importantly, we find that feelings of injustice and unfair treatment are a major source of extremist violence, as they easily trigger often debated causes such as high in-group identification and ethnocentrism. Implications of these findings for preventing violent extremism are discussed, given the centrality of perceptions of injustice and threat.