title: Relationships among patient hostility, anger expression, depression, and the working alliance in a work hardening program.
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.
authors.affiliation: Department of Psychology, Finch University of Health Sciences/The Chicago Medical School, North Chicago, IL 60064, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Burns
authors.forename: L J
authors.initials: LJ
authors.lastname: Higdon
authors.forename: J T
authors.initials: JT
authors.lastname: Mullen
authors.forename: D
authors.initials: D
authors.lastname: Lansky
authors.forename: J M
authors.initials: JM
authors.lastname: Wei
mesh_terms: D000328:Adult; D000786:Anger; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D019260:Expressed Emotion; D006791:Hostility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000523:psychology / Q000534:rehabilitation*; D009788:Occupational Therapy / Q000523:psychology*; D010146:Pain / Q000523:psychology / Q000534:rehabilitation*; D010349:Patient Compliance / Q000523:psychology; D010555:Personality Inventory; D010809:Physical Fitness / Q000523:psychology; D026741:Physical Therapy Modalities / Q000523:psychology*; D011369:Professional-Patient Relations; D011379:Prognosis; D011615:Psychotherapy, Group; D016896:Treatment Outcome; D014891:Weight Lifting; D014947:Wounds and Injuries / Q000534:rehabilitation*