State anxiety was assessed in primiparous women at three stages of pregnancy and following childbirth. The sample was divided according to whether or not a complication of pregnancy occurred. Women developing a complication displayed significantly higher levels of state anxiety at each assessment point. Multiple regression analysis was used to examine the relationship between psychosocial parameters and biomedical outcome. No significant association emerged between prenatal assessments of anxiety and outcome measures. State anxiety assessed at 16 weeks was related to anxiety at delivery. The implications of these findings for study design are discussed.

Psychologic issues enter into all aspects of providing infertility services. At the onset the infertile are faced with decisions regarding treatment options. Treatment involves uncertainty and lack of control and exposes the couple to the possibility of failure. The introduction of in vitro fertilization and gamete intrafallopian transfer exposes a proportion of couples to successive experiences of failure. These treatments have implications for emotional processing; some factors can increase the likelihood of impaired coping. Specific ways of dealing with the psychologic needs of infertile couples at all stages of their treatment can be helpful.

The psychological reaction of primiparae to the routine use of ultrasound in prenatal care was studied. Women attending between 10 and 14 weeks menstrual age were assigned at random to 2 conditions of real time ultrasound: (a) high feedback (n = 67) in which the monitor screen was visible and feedback as to fetal size, shape and movement was provided; (b) low feedback (n = 62) in which specific feedback, via the monitor screen, was denied. Assessments were completed pre and post this examination and at 16 and 32 week biphasic scans and following delivery. Women in the high feedback condition showed a uniformly more positive response to the initial real time scan and were more likely following the delivery to nominate this as the most important scan. The implications of providing feedback of this kind are discussed.Key Words: Ultrasound scanningPsychological reactionPrimipara

The performance on the McGill Pain Questionnaire was compared with an alternate version of 16 subcategories of adjectives in distinguishing among three groups of patients with pain. Both versions were administered to (a) primiparae experiencing postepisiotomy pain ( n = 60); (b) outpatients attending a rheumatology clinic ( n = 60); (c) inpatients having undergone wisdom tooth extraction ( n = 60). The order of administration was balanced, so that within each group all 60 patients received both forms of the questionnaire. A number of forms of discriminant function analysis were executed to examine the external validity of the two questionnaire formats in distinguishing among the three patient groups. There were few differences between the two versions, with sensory subcategories loading higher on discriminant functions than affective and evaluative subcategories.

The relationship between labor pain and concomitant psychological state, in terms of prenatal anxiety levels and post-partum mood, has been studied. A consecutive series of primiparae (n = 129) was assessed at intervals over the course of their pregnancy and after delivery. State anxiety was measured at recruitment (10–14 weeks of pregnancy), 10 weeks, 32 weeks and at labor. Labor pain was assessed on the McGill Pain Questionnaire (MPQ) and visual analog rating scales. Pain ratings on the MPQ were found to be high when compared to other clinical pain groups. Drug use in labor emerged as the strongest predictor of pain ratings on the MPQ total, sensory and affective scales, accounting for 11, 9 and 7% of the variance respectively. Anxiety scores at 32 weeks accounted for a further 5% of the variance and emerged as the best predictor of MPQ evaluative scores and visual analog ratings. A significant association was found between pain ratings and ratings of post-partum mood. Neither attendance at preparatory classes nor initial attitudes towards the neonate were related to pain scores.

We evaluated the impact of fetal testing on maternal anxiety. A consecutive series of high-risk women attending during the third trimester for fetal assessment were each randomly assigned to one of four conditions: (1) high-feedback ultrasonography (n = 11), in which the monitor screen was visible; (2) low-feedback ultrasonography (n = 8), in which specific visual and verbal feedback was denied; (3) fetal heart rate monitoring (n = 11); or (4) a video control (n = 7), in which the women viewed a videotape of an ultrasonographic recording. Assessments were conducted before and after each procedure. No change was found in attitude ratings towards the fetus, although there was a significant reduction in state anxiety from before to after, with the reduction most pronounced in women undergoing high-feedback ultrasonography.

The practice and theoretical basis of pain measurement is reviewed and critically examined in the areas of animal research, human subjects laboratory investigation and clinical study. The advantages and limitations of both physiological and behavioral methods are discussed in each area, and subjective report procedures are evaluated in human laboratory and clinical areas. The need for procedures that bridge these areas is emphasized and specific issues are identified. Progress in the technology of pain measurement over recent decades is reviewed and directions for future work are suggested.

Cohen, Robin S.; Ferrer-Brechner, Theresa; Pavlov, Anna; Reading, Anthony E. Author Information

I am grateful to Dr. Fielding for his comments on male sexuality, which our paper (Bulletin, October 1982) prompted. However, I fear his concerns to be as misplaced as his citation ('unpublished observations') will remain elusive. The study cited in the paper will be published in full elsewhere (Journal of Behavioral Assessment). No assumptions were made about the nature of the processes under investigation; we were merely interested in the reliability of different recording methods. Our parameters were defined by previous research carried out by the World Health Organization's Special Program of Research in Human Reproduction (1982), with the relationship of morning erections to bladder distension duly acknowledged. Dr. Fielding's remaining points are equally misleading. Although we may all speculate on the merits or demerits of retarding ejaculation, our preference would be to obtain data, particularly in view of the cross-cultural significance of such information. Similarly, that spermatozoa constitute less than 1% of the total volume of ejaculatory fluid is academic in the absence of precise methods of abolishing spermatogenesis without impairing sexuality or health status. The question as to the potential acceptability of hypothetical methods decreasing volume of ejaculate remain, especially when considering the important distinction between objective and subjective appraisals of change (Marshall, 1977).

The response profiles on the McGill Pain Questionnaire (MPQ) were compared with those obtained from a checklist format, consisting of the 78 MPQ words arranged in random order. Both forms were administered to 3 patient groups: (a) primiparae experiencing post-episiotomy pain (n = 60); (b) outpatients attending a rheumatology clinic wisdom tooth extraction (n = 60); and (c) inpatients having undergone wisdom tooth extraction (n = 60). The order of administration was balanced, so that within each patient group 40 patients received either one of the study forms and 20 both, yielding total sample sizes of 120 and 60 for further statistical analyses. Comparison of numbers of words checked in the two formats showed considerable similarity and so for purposes of further comparison, the MPQ structure was imposed on the checklist. This permitted comparison of summary scores, with no significant differences in mean level, with the sole exception of the evaluative subscale. Comparison of individual subgroup profiles on both forms also showed considerable similarity. A second objective was to compare the format in discriminating between patient groups. It was found that the MPQ offered a higher correct classification rate, although there was little in it, with MPQ subgroup scores rather than subscale scores showing marginally better results.

Summary. In a double‐blind study naproxen sodium (550 mg), or placebo was administered 1 h before Vabra curettage and pain associated with the procedure was assessed immediately after operation and 30, 60 and 120 min later by visual analogue and verbal rating scales, and the McGill pain questionnaire. The pre‐curettage anxiety of the patients was assessed by the Spielberger state anxiety inventory. Of the 58 patients, 51 (87.9%) reported pain during the procedure; there was no relation between the level of pain experienced and the pre‐curettage anxiety score. Compared with the placebo group, the pain experienced by the naproxen group was significantly less as measured by the McGill pain questionnaire immediately after curettage, and by visual analogue scales 30 and 60 min after the procedure. The verbal rating scales showed that naproxen significantly reduced backache 30 min after curettage, and cramp immediately after the procedure and 30 and 60 min later but did not reduce the severity of the pain associated with the procedure.

The EPQ was administered to 43 women attending an artificial insemination by donor (AID) clinic. The results indicated that relative to age-norms, the women were significantly lower on Psychoticism and Neuroticism, and significantly higher on the Lie scale. There were no differences between those women who did, and those who did not, become pregnant over a 6-month period. On the basis of the personality scores obtained, we would describe women attending AID clinics as calm, controlled individuals who have chosen, in conjunction with their partner, what is a socially-acceptable solution to the problem.

The evaluation of contraceptive methods raises special methodological problems. These problems are being addressed as a result of an increase in the number of clinical trials of new contraceptive methods for men. The effects of the new methods on male sexual functioning is expected to have a significant impact of method acceptability. In monitoring sexuality to detect medication and trial effects, the accuracy of the report is a legitimate concern. Both interviews and diary cards have been used to monitor sexual functioning. Interviews assure compliance and diary cards allow reporting close in time to the event. Reactivity is a concern in both ongoing and periodic retrospective reporting. Repeated assessments have been shown to both decrease the number of reported symptoms, and in some instances, increase the variety of reported symptoms. Opportunities for verifying the reports are limited. Concordance between partners may be due to corroboration. Systematic distortions due to cultural norms, need states, or memory lapses may impair accuracy. Studies on the accuracy of reporting for different events are being undertaken. For example, monthly reports of frequency of intercourse, masturbation, and average number of sexual thoughts per day are significantly correlated with daily records; but frequency of morning erection is not. Another problem encountered concerns the acceptability of the measures to study the population. Diary cards may not be kept conscientiously in cultural settings where record keeping is not a customary behavior. The intrusiveness of the method is important, for example, 3 out of 29 men attributed potency problems to keeping daily records. A third issue relates to the subjective value attached to changes in sexual functioning due to a mediation or trial effect. Changes need to be evaluated with reference to the base rate in the population as a whole, as sexual difficulties appear to be fairly common. For example, change resulting in early or late ejaculation may be beneficial or detrimental depending on cultural factors, personal needs and so on.

The McGill Pain Questionnaire (MPQ) is widely used in pain research and treatment. The internal structure of the questionnaire has been subjected to empirical investigation, with sensory and reactive factors documented. In the present study, questionnaire responses of 95 women experiencing acute (post episiotomy) pain are analyzed. Episiotomy pain patients utilized sensory subgroups more frequently than comparison groups of women experiencing dysmenorrhea (n = 166) or chronic pelvic pain without obvious pathology (n = 31). Chronic pain patients used affective and reaction subgroups with greater frequency. The episiotomy/MPQ scores were subjected to factor analysis and 6 factors were derived, reflecting specific sensory qualities and combined emotional/sensory dimensions. The factor structure to emerge was less distinctive than previously reported on chronic pain patients. It is suggested that acute pain involves less differentiation of sensory, affective and evaluative language dimensions. Rating scales were also administered. Ratings of labor and episiotomy pain were uncorrelated indicating the importance of distinguishing between these in studying pain in the puerperium.

A treatment approach is presented for the management of fear associated with vaginal examination. A combination of relaxation training, imaginal and in vivo desensitization, and cognitive restructuring exercises, was effective in overcoming the phobic anxiety. After treatment, the patient was able to undergo regular clinic examinations, with progress maintained at 12-month follow up.

The short-term psychological effects on the mother of real-time ultrasound examination early in pregnancy have been evaluated. Primiparae were randomly assigned to one of two groups: a high feedback, where they saw the monitor screen; b low feedback, where the scan was accompanied by a global evaluation of progress. Women were assessed before and after examination. The results confirm the acceptability of scanning, with mothers in both groups displaying more positive attitudes after it. Significant between-group differences emerged with respect to self-reported emotional state and attitudes toward the scanning procedure. The results demonstrate the powerful effect of ultrasound on maternal attitudes. The implications are discussed in terms of studying ‘at risk’ mothers, along with the rationale for enhancing feedback at this stage.

There is currently an expanded interest amongst clinical psychologists in extending their clinical service to other medical specialties in addition to psychiatry. The present paper considers the strategic and methodological implications of this trend. It is suggested that the efficient use of limited resources demands an expanded role, which involves the evaluation of service-related problems in addition to traditional casework. A further departure from the traditional role involves the development and refinement of measures of psychological state in clinical research trials. Examples of the way in which involvement may be exhibited on a methodological level are offered by considering psychological aspects of medication. In order to establish the clinical utility of such collaboration, it is necessary to provide biomedical personnel with empirical documentation of the benefits of attending to the psychological aspects of their clinical practice.