Abstract
Hostility, anger expression, and depression may adversely affect the response of chronic pain patients to pain or functional restoration programs by hampering the development of good working alliances between patients and physical or occupational therapists. Measures of hostility, anger expression, and depression and the Working Alliance Inventory (WAI) were completed by 71 patients with chronic pain (stemming from work-related injuries) prior to starting a “work hardening” program. The physical or occupational therapist acting as any given patient's “program manager” completed the WAI, as well. Hostility and anger expression were correlated negatively only with patient ratings of the working alliance. Therapist ratings were predicted by the interaction of patient anger expression and depression, such that therapists reported their poorest alliances with patients who were both depressed and expressed anger. Results imply that hostility and the propensity to express anger may diminish a pain patient's capacity to foster a collaborative relationship with physical or occupational therapists, while therapists may readily become alienated from depressed and irritable patients.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Wade JB, Price DD, Hamer RM, Schwartz SM, Hart RP: An emotional component analysis of chronic pain.Pain. 1990,40:303–310.
Burns JW, Johnson BJ, Mahoney N, Devine J, Pawl R: Anger management style, hostility, and spouse responses: Gender differences in predictors of adjustment among chronic pain patients.Pain. 1996,64:445–453.
Kerns RD, Rosenberg R, Jacob MC: Anger expression and chronic pain.Journal of Behavioral Medicine. 1994,17:57–67.
Fernandez E, Turk DC: The scope and significance of anger in the experience of chronic pain.Pain. 1995,61:165–175.
Horvath AO: Research on the alliance. In Horvath AO, Greenberg LS (eds).The Working Alliance: Theory, Research, and Practice. New York: Wiley, 1994.
Bordin ES: The generalizability of the psychoanalytic concept of the working alliance.Psychotherapy: Theory, Research, and Practice. 1979,16:252–260.
Horvath AO, Symonds BD: Relations between working alliance and outcome in psychotherapy: A meta-analysis.Journal of Counseling Psychology. 1991,38:139–149.
Priel B, Rabinowitz B, Pels RJ: A semiotic perspective on chronic pain: Implications for the interaction between patient and physican.British Journal of Medical Psychology. 1991,64:65–71.
Sluijs EM, Kok GJ, van der Zee J: Correlates of exercise compliance in physical therapy.Physical Therapy. 1993,73:771–782.
Muran JC, Segal ZV, Samstag LW, Crawford CE: Patient pretreatment, interpersonal problems, and therapeutic alliance in short-term cognitive therapy.Journal of Consulting and Clinical Psychology. 1994,62:185–190.
Smith TW: Hostility and health: Current status of a psychosomatic hypothesis.Health Psychology. 1992,11:139–150.
Smith TW, Sanders JD, Alexander JF: What does the Cook and Medley Hostility Scale measure? Affect, behavior, and attributions in the marital context.Journal of Personality and Social Psychology. 1990,58:699–708.
Smith TW, Brown PC: Cynical hostility, attempts to exert social control, and cardiovascular reactivity in married couples.Journal of Behavioral Medicine. 1991,14:581–592.
Houston BK, Vavak CR: Cynical hostility: Developmental factors, psychosocial correlates, and health behaviors.Health Psychology, 1991,10:9–17.
Smith RC, Zimny GH: Physicians' emotional reactions to patients.Psychosomatics. 1988,29:392–397.
Lane C, Hobfoll SE: How loss affects anger and alienates potential supporters.Journal of Consulting and Clinical Psychology. 1992,60:935–942.
Coyne JC: Depression and the response of others.Journal of Abnormal Psychology. 1976,85:186–193.
Hammen CL, Peters SD: Interpersonal consequences of depression: Responses to men and women enacting a depressed role.Journal of Abnormal Psychology. 1978,87:322–332.
Lechner DE: Work hardening and work conditioning interventions: Do they affect disability?Physical Therapy. 1994,74:471–493.
Gaston L, Marmar CR, Thompson LW, Gallagher D: Relation of patient pretreatment characteristics to the therapeutic alliance in diverse psychotherapies.Journal of Consulting and Clinical Psychology. 1988,56:483–489.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression.Archives of General Psychiatry. 1961,4:561–571.
Kerns RD, Turk DC, Rudy TE: The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).Pain. 1985,23: 345–356.
Cook W, Medley D: Proposed hostility and pharisaic-virtue scales for the MMPI.Journal of Applied Psychology. 1954,238:414–418.
Spielberger CD, Johnson EH, Russell SF, et al: The experience and expression of anger: Construction and validation of an anger expression scale. In Chesney MA, Rosenman RH (eds),Anger and Hostility in Cardiovascular and Behavioral Disorders. Washington, DC: Hemisphere Publishing, 1985.
Beck AT, Steer RA, Garbin MG: Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation.Clinical Psychology Review. 1988,8:77–100.
Smith TW, Frohm KD: What's so unhealthy about hostility? Construct validity and psychosocial correlates of the Cook and Medley Ho scale.Health Psychology. 1985,4:503–520.
Faber SD, Burns JW: Anger management style, degree of expressed anger, and gender influence cardiovascular recovery from interpersonal harassment.Journal of Behavioral Medicine. 1996,19:31–53.
Horvath AO, Greenberg LS: Development and validation of the Working Alliance Inventory.Journal of Counseling Psychology. 1989,36:223–233.
Tracey TJ, Kokotovic AM: Factor structure of the Working Alliance Inventory.Psychological Assesment. 1989,1:207–210.
Horvath AO, Luborsky L: The role of the therapeutic alliance in psychotherapy.Journal of Consulting and Clinical Psychology. 1993,61:561–573.
Krupnick JL, Sotsky SM, Simmens S, et al: The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institutes of Health Treatment of Depression Collaborative Research Program.Journal of Consulting and Clinical Psychology. 1996,64:532–539.
Author information
Authors and Affiliations
Additional information
Center for Medical Psychology
Healthsouth
The authors wish to thank the physical and occupational therapists and staff of the Healthsouth Industrial Rehabilitation Centers at Avondale Avenue in Chicago. IL, and in Oak Lawn. IL, for facilitating the conduct of this study.
About this article
Cite this article
Burns, J.W., Higdon, L.J., Mullen, J.T. et al. Relationships among patient hostility, anger expression, depression, and the working alliance in a work hardening program. ann. behav. med. 21, 77–82 (1999). https://doi.org/10.1007/BF02895037
Issue Date:
DOI: https://doi.org/10.1007/BF02895037