Self-injury and self capacities: assisting an individual in crisis.

This article reports findings of a study on self-injury, childhood abuse, and self capacities that supports a theory for understanding and assisting self-injuring individuals in crisis. In the study, 233 adults from partial hospital settings and an outpatient clinic answered questions concerning self-injury, abuse history, and three self capacities (the ability to tolerate strong affect, the ability to maintain a sense of self-worth, and the ability to maintain a sense of connection to others). More than 60% reported childhood abuse. More than half reported self-injury. Individuals with a history of self-injury showed greater impairment of self capacities than individuals who did not report self-injury. Individuals with a history of childhood abuse showed greater impairment than did individuals who did not report childhood abuse. Greatest impairment was associated with both self-injury and abuse. Implications of the results are explored and the theory for assisting self-injuring individuals in crisis is presented.

An analysis of factors that contribute to the magnitude of placebo analgesia in an experimental paradigm.

Placebo analgesia was produced by conditioning trials wherein heat induced experimental pain was surreptitiously reduced in order to test psychological factors of expectancy and desire for pain reduction as possible mediators of placebo analgesia. The magnitudes of placebo effects were assessed after these conditioning trials and during trials wherein stimulus intensities were reestablished to original baseline levels. In addition, analyses were made of the influence of these psychological factors on concurrently assessed pain and remembered pain intensities. Statistically reliable placebo effects on sensory and affective measures of pain were graded according to the extent of surreptitious lowering of stimulus strength during the manipulation trials, consistent with conditioning. However, all of these effects were strongly associated with expectancy but not desire for relief. These results show that although conditioning may be sufficient for placebo analgesia, it is likely to be mediated by expectancy. The results further demonstrated that placebo effects based on remembered pain were 3 to 4 times greater than those based on concurrently assessed placebo effects, primarily because baseline pain was remembered as being much more intense than it actually was. However, similar to concurrent placebo effects, remembered placebo effects were strongly associated with expected pain levels that occurred just after conditioning. Taken together, these results suggest that magnitudes of placebo effect are dependent on multiple factors, including conditioning, expectancy, and whether analgesia is assessed concurrently or retrospectively.