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Tabaei-Aghdaei Z, McColl-Kennedy JR, Coote LV. Goal Setting and Health-Related Outcomes in Chronic Diseases: A Systematic Review and Meta-Analysis of the Literature From 2000 to 2020. Med Care Res Rev 2023; 80:145-164. [PMID: 35904147 DOI: 10.1177/10775587221113228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Identifying and synthesizing recent empirical research on goal setting among adults with chronic disease is the focus of this article. The article has two phases: Phase 1, a thematic analysis with machine reading of the data and manual thematic analysis, and Phase 2, a quantitative meta-analysis. Qualitative, quantitative, and mixed-method studies are included in Phase 1 (99 papers). Phase 2 includes only quantitative studies (75 papers). Five main themes are identified: (a) the effect of goal characteristics on health-related outcomes, (b) the effect of goal setting on health-related outcomes, (c) the effect of goal achievement on health-related outcomes, (d) goal alignment between patients and health care service providers, and (e) individual and collaborative goal setting of patients and health care service providers. The meta-analysis reveals considerable evidence of an association between goal setting and health-related outcomes.
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Tito N, Porter E, Castonguay T, Dover G. Longitudinal Validation of a Specific Measure of Fear Avoidance in Athletes: Predicting Time from Injury to Return to Sports Competition. J Pain Res 2023; 16:1103-1114. [PMID: 37020665 PMCID: PMC10069429 DOI: 10.2147/jpr.s396054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/18/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose We developed the Athlete Fear Avoidance Questionnaire (AFAQ) to measure fear avoidance in athletes. Previous fear avoidance scales were developed for the general population and have demonstrated significant predictive capabilities regarding rehabilitation. No research to date has examined the association between athlete fear avoidance as measured by the AFAQ and the rehabilitation time in athletes. Patients and Methods Fifty-nine athletes who were injured during sport season participated in the study (40 males and 19 females). At injury onset, all participants completed self-report functional questionnaires. In addition, we measured multiple aspects of fear avoidance including athlete fear avoidance (AFAQ), kinesiophobia (TSK), and pain catastrophizing (PCS). Finally, we assessed pain severity and interference, as well as depression. Once the athletes were able to return to competition all participants answered the questionnaires again. Pearson correlations and a regression analysis were used to identify relationships between function, psychological variables, pain, and return to competition time. Results The AFAQ yielded the strongest correlation with return to competition time (r=0.544, p<0.001). In addition, function at initial injury time and pain interference were also significantly correlated with return to competition time (r=0.442, p<0.001 and r=0.356, p=0.006 respectively). Athlete fear-avoidance combined with function at the time of injury explained 34% of the variance of return to competition time in the multivariate regression model (p<0.001). Conclusion Athlete fear-avoidance as measured by the AFAQ is associated with rehabilitation time and returning to competition in injured athletes. Psychosocial factors including athlete fear avoidance may explain why some athletes take longer to rehabilitate than others and should be evaluated in athletes who are taking longer than anticipated to complete their rehabilitation. Reducing athlete fear avoidance may facilitate rehabilitation in future studies.
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Affiliation(s)
- Noémie Tito
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Erica Porter
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Tristan Castonguay
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Geoffrey Dover
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
- Correspondence: Geoffrey Dover, Department of Health, Kinesiology, and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, Montreal, QC, Canada, Tel +1 514 848 2424 Ext 3304, Fax +1 514 848 8681, Email
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Gutiérrez L, Écija C, Catalá P, Peñacoba C. Sedentary Behavior and Pain after Physical Activity in Women with Fibromyalgia-The Influence of Pain-Avoidance Goals and Catastrophizing. Biomedicines 2023; 11:biomedicines11010154. [PMID: 36672662 PMCID: PMC9855630 DOI: 10.3390/biomedicines11010154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Fibromyalgia is characterized by chronic pain and fatigue that triggers a functional disability caused by the lack of activity. Pain catastrophizing may contribute to avoiding activity with the intention of managing pain levels. Based on the sedentary behavior with fibromyalgia, the present study assessed the preference of pain-avoidance goals and pain catastrophizing as mediator and moderator variables, respectively, that influence pain perception after a 6-min-walking test. METHODS The sample was composed of 76 women with fibromyalgia (mean age = 55.05, SD = 7.70). Previous sedentary behavior, preference for pain-avoidance goals, and pain catastrophizing were evaluated before starting the walking-test. Subsequently, pain perception was evaluated. RESULTS A significant moderated-mediation model was found in which pain-avoidance goals mediated the relationship between sedentarism and pain after a walking-test, and pain catastrophizing moderated the relationship between the preference for pain-avoidance goals and pain perception. Specifically, high levels of pain catastrophizing contributed to increased pain perceptions after completing the test (B = 0.570, p = 0.03, CI 95% (0.09, 0.11)]. CONCLUSIONS The results suggest that motivational interventions can improve the symptoms because their objectives are focused on managing conflict goals. These interventions should focus on catastrophic cognitions considering that pain catastrophizing is deemed to be one of the major inhibitors of physical activity in fibromyalgia.
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Ruehlman LS, Karoly P. Adherence versus striving to adhere to vegan, vegetarian, or pescatarian diets: Applying a goal-centered, self-regulatory framework. J Health Psychol 2022; 27:2236-2246. [PMID: 35770848 DOI: 10.1177/13591053221111976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adherence to plant-rich diets remains low despite numerous health benefits accruing to such practices. We sought to distinguish college students who report high adherence to a plant-rich diet ("Sustainers") from those who are less successful ("Strivers"). Sustainers more strongly endorsed multiple ethical dietary motives and indicated stronger allegiance to their values compared to Strivers, who rated health reasons more highly. Sustainers scored better on seven factors relating to effective dietary goal pursuit. Results underscore the importance of motivational factors in the maintenance of plant-based eating.
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Affiliation(s)
| | - Paul Karoly
- Goalistics, LLC, USA.,Arizona State University, USA
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Reed DE, Cobos B, Nagpal AS, Eckmann M, McGeary DD. The role of identity in chronic pain cognitions and pain-related disability within a clinical chronic pain population. Int J Psychiatry Med 2022; 57:35-52. [PMID: 33487093 DOI: 10.1177/0091217421989141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Chronic pain has a significant impact on functioning and results in the disruption of one's assumed life trajectory, potentially altering their self-perceived identity. The present research is designed to determine whether identity-related issues are associated with common chronic pain cognitions and pain-related disability, which may help inform understanding of clinical chronic pain populations. METHOD Ninety-eight adult chronic pain patients were assessed at a local pain clinic during a regularly scheduled appointment focusing on pain management. Multivariate hierarchal regression was used to determine whether issues related to identity and death anxiety were associated with pain catastrophizing, pain acceptance, and pain-related disability, above and beyond pain severity, fear-avoidance, and age. RESULTS Self-concept clarity was significantly related to pain catastrophizing and pain acceptance, above and beyond death anxiety, pain severity, fear-avoidance, and age. Death anxiety was associated with pain catastrophizing, pain acceptance, and pain-related disability above and beyond pain severity, fear-avoidance, and age. CONCLUSIONS To the best of our knowledge, the present study is the first examination of self-concept clarity and death anxiety as they relate to pain catastrophizing, pain acceptance, and pain-related disability. These descriptive results support the inclusion of identity and death anxiety within the pain experience and could serve as a foundation for future directions relevant to clinical applications.
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Affiliation(s)
- David E Reed
- Department of Psychiatry, University of Texas - Health Science Center at San Antonio, San Antonio, TX, USA
| | - Briana Cobos
- Department of Psychiatry, University of Texas - Health Science Center at San Antonio, San Antonio, TX, USA.,University of Texas at San Antonio, San Antonio, TX, USA
| | - Ameet S Nagpal
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Max Eckmann
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Donald D McGeary
- Department of Psychiatry, University of Texas - Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Peñacoba C, López-Gómez I, Pastor-Mira MA, López-Roig S, Ecija C. Contextualizing goal preferences in fear-avoidance models. Looking at fatigue as a disabling symptom in fibromyalgia patients. PLoS One 2021; 16:e0254200. [PMID: 34237093 PMCID: PMC8266041 DOI: 10.1371/journal.pone.0254200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/23/2021] [Indexed: 01/10/2023] Open
Abstract
The fear-avoidance model provides an explanation for the development of chronic pain, including the role of perception (i.e. pain catastrophism) as an explanatory variable. Recent research has shown that the relationship between pain catastrophism and avoidance is influenced in turn by different psychological and contextual variables, highlighting the affective-motivational ones. From this perspective, the Goal Pursuit Questionnaire (GPQ) was developed to measure the preference for hedonic goals (mood-management or pain-avoidance goals) over achievement goals in musculoskeletal pain patients. Recently, the Spanish version of the GPQ in fibromyalgia patients has been validated. Our aim has been to adapt the Spanish version of GPQ from pain to fatigue symptoms and to validate this new questionnaire (GPQ-F) in fibromyalgia. Despite the recognition of fibromyalgia as a complex disorder and the need for a differential study of its symptoms, fatigue, despite its high prevalence and limiting nature, remains the forgotten symptom. We conducted a cross-sectional study with 231 women with fibromyalgia. Previously, we adapted the Spanish GPQ for fatigue symptoms with three sub-studies (group structured interview, self-administration questionnaire and thinking-aloud; n = 15–27 patients). We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Exploratory factor analysis showed two factors: ‘Fatigue-avoidance goal’ and ‘Mood-management goal’ (39.3% and 13.9% of explained variance, respectively). The activity avoidance pattern fully mediated the relation between both catastrophizing and fatigue-avoidance goals with fatigue. The study shows initial findings about the usefulness of the GPQ-F as a tool to analyze goal preferences related to fatigue in fibromyalgia. The results supported the mediational role of activity avoidance patterns in the relationship between preference for fatigue-avoidance goals and fatigue.
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Affiliation(s)
- Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Irene López-Gómez
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Maria Angeles Pastor-Mira
- Department of Behavioral Sciences and Health, Miguel Hernández University, Campus de Sant Joan, Alicante, Spain
| | - Sofía López-Roig
- Department of Behavioral Sciences and Health, Miguel Hernández University, Campus de Sant Joan, Alicante, Spain
| | - Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Hierarchy of customer goals: conceptual framework and new insights. JOURNAL OF SERVICE MANAGEMENT 2021. [DOI: 10.1108/josm-03-2020-0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to: (1) better understand the structure (hierarchy) of customer goals providing conceptual clarity; and (2) propose a hierarchy of customer goals conceptual framework that explicates how healthcare customer goals are linked to drivers and outcomes, thus building theory and informing practice.Design/methodology/approachThe research draws on 21 in-depth interviews of patients with a chronic disease. Drawing principally on construal-level theory and using manual thematic analysis and Leximancer, this article provides new insights into customer goals.FindingsIn a first, the authors identify a two-dimensional structure for each of the three main goal types, which previously had been viewed as unidimensional. The authors develop a conceptual framework linking drivers of goal setting (promotion/prevention focus world view and perceived role) with goal type (life goals, focal goals and action plan goals and their respective subgoals) and outcomes (four forms of subjective well-being). Visual concept maps illustrate the relative importance of certain health-related goals over others.Research limitations/implicationsThe usefulness of the authors’ conceptual framework is demonstrated through the application of their framework to goal setting among healthcare customers, showing links between the structure of goals (life goals, focal goals and action plan goals) to drivers (promotion/prevention focus world view and perceived role) and outcomes (subjective well-being) and the framework's potential application to other service settings.Originality/valueThis study contributes to healthcare marketing and service management literature by providing new insights into goal setting and proposing a novel hierarchy of customer goals conceptual framework linking drivers, goal types and outcomes.
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Suso-Ribera C, Catalá P, Ecija C, Sanromán L, López-Gómez I, Pastor-Mira Á, Peñacoba-Puente C. Exploring the contextual role of pain severity as a moderator of the relationship between activity patterns and the physical and mental functioning of women with fibromyalgia. Eur J Pain 2020; 25:257-268. [PMID: 32996660 DOI: 10.1002/ejp.1669] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/27/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In past years, and mostly due to contextual psychological therapies, it has been argued that particular behavioural patterns may be useful in certain contexts, but not in others. The goal of this study has been to explore whether pain severity is indeed a contextual factor influencing the relationship between two controversial activity patterns, namely pacing and persistence, and functionality in people with fibromyalgia. METHODS Participants were 231 women diagnosed with fibromyalgia. A multivariate regression was conducted to explore the moderating role of pain severity in the relationship between activity patterns and outcomes (i.e. fibromyalgia impact and depressive symptoms). RESULTS Excessive persistence (interaction: t = -2.45, p = 0.015) and pain-contingent persistence (interaction: t= -2.13, p = 0.034) were more strongly associated with fibromyalgia impact when people experienced less severe pain. Pacing for pain reduction was only significantly related to depressive symptoms at very severe (M = 10) pain levels (interaction: β= -0.18, t= -2.73). CONCLUSIONS The results here reported suggest that the context in which behaviour occurs is relevant when the utility of certain behaviour patterns is considered. The clinical implications of this are clear, as it would justify adapting the recommendations given to patients according to their pain severity status. SIGNIFICANCE This manuscript shows that some activity patterns (i.e. pacing to conserve energy for valued activities) might be advisable regardless of pain levels. Conversely, some patterns might be especially recommended (i.e. pain-reduction pacing) or inadvisable (i.e. excessive and pain-contingent persistence) depending on pain levels (i.e. severe and mild pain, respectively).
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Affiliation(s)
- Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellon, Spain
| | - Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Lucía Sanromán
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | | | - Ángeles Pastor-Mira
- Department of Behavioral Sciences and Health, Miguel Hernández University, Alicante, Spain
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A goal-systems perspective on plant-based eating: keys to successful adherence in university students. Public Health Nutr 2020; 24:75-83. [PMID: 32515718 DOI: 10.1017/s1368980020000695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore adherence to a plant-based diet from the perspective of goals- and motivations-based systems. DESIGN A cross-sectional, survey-based study was conducted regarding eating patterns, goals and motivations for current eating habits. SETTING Data were collected using an online survey platform, including the Goal Systems Assessment Battery (GSAB) and other survey tools. PARTICIPANTS University students were recruited, including thirty-three students reporting successful maintenance of a plant-based diet (Adherents) and sixty-three students trying to adhere to a plant-based diet (Non-adherents). RESULTS Using GSAB subscale scores, discriminant function analyses significantly differentiated adherents v. non-adherents, accounting for 49·0 % of between-group variance (χ2 (13) = 42·03, P < 0·000). It correctly classified 72·7 % of adherents and 88·9 % of non-adherents. Constructs including value, self-efficacy, planning/stimulus control and positive affect were significant and included in the discriminant function. Logistic regression results suggested that participants who successfully adhered to a plant-based diet were seventeen times more likely to report 'To manage or treat a medical condition' as motivation and almost seven times more likely to report 'To align with my ethical beliefs' as motivation compared with non-adherents. However, these participants were 94 % less likely to report 'To maintain and/or improve my health' as motivation compared with non-adherents. Controlling for motivations, hierarchical logistic regression showed that only planning as part of the GSAB self-regulatory system predicted adherence to a plant-based diet. CONCLUSIONS Values-based approaches to plant-based diets, including consideration for ethical beliefs, self-efficacy and proper planning, may be key for successful maintenance of this diet long-term.
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Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Luque-Suarez A. Pain-Related Fear, Pain Intensity and Function in Individuals With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2019; 20:1394-1415. [DOI: 10.1016/j.jpain.2019.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 04/01/2019] [Accepted: 04/29/2019] [Indexed: 12/26/2022]
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Pain Intensity and Fear Avoidance Explain Disability Related to Chronic Low Back Pain in a Saudi Arabian Population. Spine (Phila Pa 1976) 2019; 44:E889-E898. [PMID: 30817741 DOI: 10.1097/brs.0000000000003002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE The aim of this study was to describe multi-dimensional profiles for people with chronic low back pain (CLBP) and to examine the associations between CLBP-related disability and individual, psychosocial and physical factors in a Saudi population. SUMMARY OF BACKGROUND DATA CLBP-related disability is a multidimensional phenomenon. There is growing interest in exploring factors associated with CLBP-related disability in Saudi Arabia but research is limited in comparison to other countries. METHODS Participants completed questionnaires covering demographics, pain intensity, back beliefs, fear avoidance, psychological distress, and physical activity. Oswestry Disability Index (ODI) was used to measure disability. Participants also performed a standardized sequence of physical performance tests and a Pain Behavior Scale was used to evaluate pain behaviors during performance of these tests. The relationships between disability and all variables were explored using univariate and multivariate regression analyses. RESULTS One hundred and fifteen participants were included, 63% of whom were female. Participants demonstrated moderate disability (mean [SD]: 26.6 [13.5]). The mean (SD) back beliefs score was 28.6 (7.3). Mean depression, anxiety, and stress (DASS 21) scores indicated mild distress; however, 26% to 39% scored in the moderate to severe range for at least one subscale. In univariate analyses, pain intensity and fear avoidance beliefs (physical activity and work) were moderately associated with disability (r = 0.56, 0.49, 0.52, respectively, P < 0.001), with all other factors demonstrating weak association. Multivariate regression revealed that pain intensity, fear avoidance beliefs, psychological distress, and participants' age were all found to be associated with disability, accounting for 52.9% (adjusted R = 0.529) of variability. CONCLUSION This study provides a unique insight into the clinical profile of people with CLBP in a Saudi Arabian population. Pain and psychosocial factors were significantly associated with disability. This study supports the contention that CLBP-related disability is a multifactorial biopsychosocial condition across different cultures. LEVEL OF EVIDENCE 3.
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Knezevic A, Neblett R, Gatchel RJ, Jeremic-Knezevic M, Bugarski-Ignjatovic V, Tomasevic-Todorovic S, Boskovic K, Cuesta-Vargas AI. Psychometric validation of the Serbian version of the Fear Avoidance Component Scale (FACS). PLoS One 2018; 13:e0204311. [PMID: 30248127 PMCID: PMC6152979 DOI: 10.1371/journal.pone.0204311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/05/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The Fear Avoidance Components Scale (FACS) is a new patient-reported outcome (PRO) questionnaire designed to comprehensively evaluate fear avoidance (FA) beliefs and attitudes in persons with painful medical conditions. The original English version has demonstrated acceptable psychometric properties, including concurrent and predictive validity. Two factors have been identified: 1. general fear avoidance; and 2. types of activities that are avoided. METHODS The FACS was first translated into Serbian, and then psychometrically validated. A cohort of 322 chronic musculoskeletal pain subjects completed the FACS-Serb and additional FA-related patient-reported outcome (PRO) measures. Their FACS-Serb scores were then compared to a cohort of 68 acute pain subjects. RESULTS Test-retest reliability (ICC2,1 = 0.928) and internal consistency for both Factors (Cronbach α 0.904 and 0,880 respectively) were very good. An acceptable fit was found with a confirmatory factor analysis of the 2-factor model found with the original English version of the FACS. Strong associations were found among FACS-Serb scores and other PRO measures of pain catastrophizing, depressive/anxiety symptoms, perceived disability, and pain intensity (p<0.001 for all analyses). FACS-Serb total scores, separate Factor scores, and subjective pain ratings were significantly higher in the chronic vs. acute pain cohorts (p<0.001 for all analyses). CONCLUSIONS The FACS-Serb demonstrated strong psychometric properties, including strong reliability and internal consistency, criterion validity (through associations with other FA-related PRO measures), and discriminant validity (through comparisons with a separate acute pain cohort). The FACS-Serb appears to be a potentially useful pain-related assessment tool.
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Affiliation(s)
- Aleksandar Knezevic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia
- * E-mail:
| | - Randy Neblett
- PRIDE Research Foundation, Dallas, Texas, United States of America
| | - Robert J. Gatchel
- Center of Excellence for the Study of Health & Chronic Illnesses, Department of Psychology, College of Science, The University of Texas at Arlington, Arlington, Texas, United States of America
| | | | | | - Snezana Tomasevic-Todorovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Ksenija Boskovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia
| | - Antonio I. Cuesta-Vargas
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, Malaga, Spain
- School of Clinical Science, Faculty of Health at the Queensland University of Technology, Brisbane, Australia
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Psychological Processes in Chronic Pain: Influences of Reward and Fear Learning as Key Mechanisms – Behavioral Evidence, Neural Circuits, and Maladaptive Changes. Neuroscience 2018; 387:72-84. [DOI: 10.1016/j.neuroscience.2017.08.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/22/2017] [Accepted: 08/29/2017] [Indexed: 01/09/2023]
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Claes N, Vlaeyen JWS, Lauwerier E, Meulders M, Crombez G. Goal conflict in chronic pain: day reconstruction method. PeerJ 2018; 6:e5272. [PMID: 30128176 PMCID: PMC6098675 DOI: 10.7717/peerj.5272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/01/2018] [Indexed: 11/20/2022] Open
Abstract
Background When suffering from chronic pain, attempts to control or avoid pain often compete with other daily activities. Engaging in one activity excludes engaging in another, equally valued activity, which is referred to as "goal conflict." As yet, the presence and effects of goal conflicts in patients with chronic pain remain poorly understood. Methods This study systematically mapped the presence and experience of goal conflicts in patients with fibromyalgia compared to healthy controls. A total of 40 patients and 37 controls completed a semi-structured interview in which they first reconstructed the previous day, identified conflicts experienced during that day, and classified each of the conflicting goals in one of nine goal categories. Additionally, they assessed how they experienced the previous day and the reported conflicts. Results Results showed that patients did not experience more goal conflicts than healthy controls, but that they did differ in the type of conflicts experienced. Compared to controls, patients reported more conflicts related to pain, and fewer conflicts involving work-related, social or pleasure-related goals. Moreover, patients experienced conflicts as more aversive and more difficult to resolve than control participants. Discussion This study provides more insight in the dynamics of goal conflict in daily life, and indicates that patients experience conflict as more aversive than controls, and that conflict between pain control (and avoidance) and other valued activities is part of the life of patients.
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Affiliation(s)
- Nathalie Claes
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Johan W S Vlaeyen
- Research Group Health Psychology, KU Leuven, Leuven, Belgium.,Department of Clinical Psychological Science, University of Maastricht, Maastricht, the Netherlands
| | - Emelien Lauwerier
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Michel Meulders
- Center for Information Management, Modeling and Simulation, KU Leuven, Leuven, Brussels, Belgium.,Research Group on Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.,Centre for Pain Research, University of Bath, Bath, UK
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Schrooten MG, Van Damme S, Crombez G, Kindermans H, Vlaeyen JW. Winning or not losing? The impact of non-pain goal focus on attentional bias to learned pain signals. Scand J Pain 2018; 18:675-686. [DOI: 10.1515/sjpain-2018-0055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/11/2018] [Indexed: 12/22/2022]
Abstract
Abstract
Background and aims
Insights into the nature of cognitive bias, including attentional bias to threat signals, are considered pivotal to understanding (chronic) pain and related distress. It has been put forward that attention to pain-related threat is normally dynamic and relates to the motivational state of the individual. In this experiment we aimed (i) to replicate the finding that attentional bias for pain signals in healthy participants can be reduced when a non-pain goal is pursued, and (ii) to extend this finding by taking into account the outcome focus of the non-pain goal. We hypothesised that the reduction in attentional bias for pain signals by concurrent non-pain goal pursuit would be stronger with non-pain prevention goals than with promotion goals.
Methods
Healthy university students performed an attentional bias task (i.e. spatial cueing task) containing visual cues that signalled the possible occurrence of a painful stimulus (electrocutaneous stimulus at tolerance level) or its absence, in combination with a non-pain goal task (i.e. digit naming task). The non-pain goal was either related to acquiring a positive outcome (gaining money depending on digit-naming performance; promotion goal group, n=31) or related to avoiding a negative outcome (losing money; prevention goal group, n=31). A standard attentional bias task served as the control condition (control group, n=31).
Results
Spatial cueing effects were larger for pain cues than for no-pain cues, indicating attentional bias for pain signals. The pattern of results suggests that this effect was indeed reduced in the goal groups as compared to the control group, but there was no significant group difference.
Conclusions
We found no statistically-significant evidence for the impact of non-pain goal pursuit or outcome focus on pain-related attentional bias. At best, there were indications of a reduced attentional bias for pain signals with non-pain goal pursuit that was either promotion- or prevention focused.
Implications
These data add to the small but growing body of literature on the assumed relevance of motivational context in explaining variations in attentional bias. The results trigger new questions on the nature and assessment of pain-related attentional bias, and more specifically attentional bias for fear-conditioned pain signals (versus safety signals), from a motivational perspective.
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Affiliation(s)
- Martien G.S. Schrooten
- Örebro University , School of Law, Psychology and Social Work, Center for Health and Medical Psychology (CHAMP) , Box 1252, 70112 Örebro , Sweden
| | - Stefaan Van Damme
- Department of Experimental-Clinical and Health Psychology , Ghent University , Ghent , Belgium
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology , Ghent University , Ghent , Belgium
- Centre for Pain Research , University of Bath , Bath , UK
| | - Hanne Kindermans
- Department of Clinical Psychological Science , Maastricht University , Maastricht , The Netherlands
| | - Johan W.S. Vlaeyen
- Department of Clinical Psychological Science , Maastricht University , Maastricht , The Netherlands
- Research Group on Health Psychology , University of Leuven , Leuven , Belgium
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Emotional and Motivational Pain Processing: Current State of Knowledge and Perspectives in Translational Research. Pain Res Manag 2018; 2018:5457870. [PMID: 30123398 PMCID: PMC6079355 DOI: 10.1155/2018/5457870] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 06/03/2018] [Indexed: 01/13/2023]
Abstract
Pain elicits fear and anxiety and promotes escape, avoidance, and adaptive behaviors that are essential for survival. When pain persists, motivational priority and attention shift to pain-related information. Such a shift often results in impaired functionality, leading to maladaptive pain-related fear and anxiety and escape and avoidance behaviors. Neuroimaging studies in chronic pain patients have established that brain activity, especially in cortical and mesolimbic regions, is different from activity observed during acute pain in control subjects. In this review, we discuss the psychophysiological and neuronal factors that may be associated with the transition to chronic pain. We review information from human studies on neural circuits involved in emotional and motivational pain processing and how these circuits are altered in chronic pain conditions. We then highlight findings from animal research that can increase our understanding of the molecular and cellular mechanisms underlying emotional-motivational pain processing in the brain. Finally, we discuss how translational approaches incorporating results from both human and animal investigations may aid in accelerating the discovery of therapies.
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Rosen NO, Dewitte M, Merwin K, Bergeron S. Interpersonal Goals and Well-Being in Couples Coping with Genito-Pelvic Pain. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2007-2019. [PMID: 28028667 DOI: 10.1007/s10508-016-0877-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 09/22/2016] [Accepted: 10/03/2016] [Indexed: 05/22/2023]
Abstract
In the context of genito-pelvic pain, consideration of interpersonal goals is particularly relevant given that couples' distress is often predicated upon the relational setting. However, relationship goals have not been examined in this population. We investigated (1) the associations between relationship goals and women's pain during intercourse as well as the sexual, relational, and psychological well-being of women with provoked vestibulodynia (PVD) and their partners and (2) the moderating role of sexual goals in these associations. Women with PVD (N = 134) and their partners completed measures of relationship goals, sexual goals, sexual satisfaction, relationship satisfaction, and depressive symptoms. Women also reported on their average pain intensity during intercourse. Women with stronger relationship approach goals reported more sexual satisfaction. When the partner pursued more relationship approach goals, both women and partners reported more sexual and relationship satisfaction and partners reported less depression. Stronger relationship avoidance goals in the partner were associated with less sexual satisfaction in women. Several significant interactions showed that the combination of relationship and sexual approach goals was associated with greater relationship and sexual satisfaction, and fewer depressive symptoms, whereas the combination of relationship and sexual avoidance goals was related to lower relationship satisfaction as well as to greater pain during intercourse for women. Targeting relationship approach and avoidance goals as well as those goals specific to sexual activity may improve the quality and efficacy of couples-based psychological interventions for PVD.
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Affiliation(s)
- Natalie O Rosen
- Department of Psychology and Neuroscience, Dalhousie Univeristy, 1355 Oxford St., P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
- Department of Obstetrics and Gynaecology, IWK Health Centre, Halifax, NS, Canada.
| | - Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Kathleen Merwin
- Department of Psychology and Neuroscience, Dalhousie Univeristy, 1355 Oxford St., P.O. Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Sophie Bergeron
- Department of Psychology, Université de Montréal, Montreal, PQ, Canada
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18
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Ciere Y, Visser A, Jacobs B, Padberg M, Lebbink J, Sanderman R, Fleer J. Living with chronic headache: a qualitative study exploring goal management in chronic headache. Disabil Rehabil 2017; 40:2998-3004. [PMID: 28797176 DOI: 10.1080/09638288.2017.1365381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Effective goal management may potentially prevent or reduce disability in chronic pain. The aim of this study was to gain insight into the nature of goal management in the context of chronic headache (CH). METHODS Interviews with 20 patients were conducted, coded, and analyzed using a combined data-driven and theory-driven approach. The dual process model (DPM) was used as a theoretical framework for this study. RESULTS Participants used a combination of strategies to regain and maintain a balance between personal goals and resources available for goal pursuit. Furthermore, their retrospective reports indicated a development in strategy use of time. Three goal management phases were identified: (1) a "persistence phase," characterized by the use of "resource-depleting" assimilative strategies to remain engaged in goals, (2) a "reorientation phase" in accommodative strategies were used to regain balance, and (3) a "balancing phase" in which a combination of "resource-depleting" and "resource-replenishing" assimilative strategies was used to maintain balance. CONCLUSIONS Goal management is a dynamic process that may contribute to the development of, and recovery from, headache-related disability. Rehabilitation services offered to individuals with CH should target this process to promote optimal functioning. Implications for Rehabilitation Individuals with chronic headache use assimilative and accommodative goal management strategies to be able to pursue personal goals despite the limitations of chronic headache. Before accommodating goals to the limitations of chronic headache, many patients go through a phase of persistence, characterized by the use of resource-depleting assimilative strategies. A reorientation phase, characterized by accommodation of goals to the limitations of chronic headache, allows patients to adopt a more balanced way of pursuing personal goals.
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Affiliation(s)
- Yvette Ciere
- a Department of Health Psychology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Section Health, Medical, and Neuropsychology , Leiden University, Institute of Psychology , Leiden , The Netherlands
| | - Annemieke Visser
- c Department of Applied Health Research , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Bram Jacobs
- d Department of Neurology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Marielle Padberg
- e Department of Neurology , Martini Hospital Groningen , Groningen , The Netherlands
| | - John Lebbink
- f Department of Neurology , AZ Zeno Hospital , Blankenberge , Belgium
| | - Robbert Sanderman
- a Department of Health Psychology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,g Department of Psychology, Health and Technology , University of Twente , Enschede , The Netherlands
| | - Joke Fleer
- a Department of Health Psychology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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19
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20
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Gray JS, Ozer DJ, Rosenthal R. Goal conflict and psychological well-being: A meta-analysis. JOURNAL OF RESEARCH IN PERSONALITY 2017. [DOI: 10.1016/j.jrp.2016.12.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Esteve R, López-Martínez AE, Peters ML, Serrano-Ibáñez ER, Ruíz-Párraga GT, González-Gómez H, Ramírez-Maestre C. Activity Pattern Profiles: Relationship With Affect, Daily Functioning, Impairment, and Variables Related to Life Goals. THE JOURNAL OF PAIN 2017; 18:546-555. [PMID: 28063959 DOI: 10.1016/j.jpain.2016.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/20/2016] [Accepted: 12/18/2016] [Indexed: 02/05/2023]
Abstract
The aim of this cross-sectional study was to identify subgroups of patients on the basis of their activity patterns and to investigate their relationship with life goals, optimism, affect, and functioning. The sample was comprised of 276 patients with chronic musculoskeletal pain. Hierarchical cluster analysis was performed on the activity pattern variables and the resulting clusters were compared using 1-way analysis of variance. The 4-cluster was the optimal solution. The 4 clusters comprised: 1) avoiders: patients with high levels of avoidance and low levels of persistence, who use pacing to reduce pain, 2) doers: patients with high levels of persistence and low levels of pacing and avoidance, 3) extreme cyclers: patients with high levels of avoidance and persistence and low levels of pacing, and 4) medium cyclers: patients with moderately high levels of avoidance and persistence and high levels of pacing. Comparison of the clusters showed that doers had the most adaptive profile, whereas avoiders, followed by extreme cyclers, had unhealthy profiles. Doers showed a high level of optimism and a good balance between goal value, expectancy, and conflict. PERSPECTIVE It is useful to distinguish profiles on the basis of various activity patterns. In contrast to profiles characterized by avoidance, profiles characterized by high persistence and low avoidance were associated with adaptive results. Patients with this profile also showed a high level of optimism and a good balance between goal value, expectancy, and conflict.
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Affiliation(s)
- Rosa Esteve
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain.
| | | | - Madelon L Peters
- Maastricht University, Department of Psychology and Neuroscience, Clinical Psychological Science, Behavioural Medicine, The Netherlands
| | | | - Gema T Ruíz-Párraga
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain
| | - Henar González-Gómez
- Unidad de Rehabilitación de la Unidad de Gestión Clínica Carihuela, Torremolinos, Málaga, Spain
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Goal Pursuit in Youth with Chronic Pain. CHILDREN-BASEL 2016; 3:children3040036. [PMID: 27879686 PMCID: PMC5184811 DOI: 10.3390/children3040036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 01/26/2023]
Abstract
Children and adolescents frequently experience chronic pain that can disrupt their usual activities and lead to poor physical and emotional functioning. The fear avoidance model of pain with an emphasis on the maladaptive behaviors that lead to activity avoidance has guided research and clinical practice. However, this model does not take into consideration variability in responses to pain, in particular the active pursuit of goals despite pain. This review aims to introduce a novel conceptualization of children's activity engagement versus avoidance using the framework of goal pursuit. We propose a new model of Goal Pursuit in Pediatric Chronic Pain, which proposes that the child's experience of pain is modified by child factors (e.g., goal salience, motivation/energy, pain-related anxiety/fear, and self-efficacy) and parent factors (e.g., parent expectations for pain, protectiveness behaviors, and parent anxiety), which lead to specific goal pursuit behaviors. Goal pursuit is framed as engagement or avoidance of valued goals when in pain. Next, we recommend that research in youth with chronic pain should be reframed to account for the pursuit of valued goals within the context of pain and suggest directions for future research.
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Crombez G, Lauwerier E, Goubert L, Van Damme S. Goal Pursuit in Individuals with Chronic Pain: A Personal Project Analysis. Front Psychol 2016; 7:966. [PMID: 27445928 PMCID: PMC4923131 DOI: 10.3389/fpsyg.2016.00966] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 06/10/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent UniversityGent, Belgium
- Center for Pain Research, University of BathBath, UK
- *Correspondence: Geert Crombez,
| | - Emelien Lauwerier
- Department of Health and Well-being, University Colleges Leuven-LimburgLeuven, Belgium
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent UniversityGent, Belgium
| | - Stefaan Van Damme
- Department of Experimental-Clinical and Health Psychology, Ghent UniversityGent, Belgium
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Claes N, Crombez G, Meulders A, Vlaeyen JW. Between the Devil and the Deep Blue Sea: Avoidance-Avoidance Competition Increases Pain-Related Fear and Slows Decision-Making. THE JOURNAL OF PAIN 2016; 17:424-35. [DOI: 10.1016/j.jpain.2015.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/20/2015] [Accepted: 12/10/2015] [Indexed: 02/06/2023]
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Karsdorp PA, Geenen R, Kroese FM, Vlaeyen JWS. Turning Pain Into Cues for Goal-Directed Behavior: Implementation Intentions Reduce Escape-Avoidance Behavior on a Painful Task. THE JOURNAL OF PAIN 2015; 17:499-507. [PMID: 26746152 DOI: 10.1016/j.jpain.2015.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 12/06/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Pain automatically elicits escape-avoidance behavior to avert bodily harm. In patients with chronic pain, long-term escape-avoidance behavior may increase the risk of chronic disability. The aim of the presents study was to examine whether implementation intentions reduce escape-avoidance behavior during painful tasks in healthy individuals. Implementation intentions are "if-then" self-statements associating situational cues with goal-directed behaviors. Seventy healthy participants performed a painful finger pressing task, preceded by either implementation intention instructions with pain or a nonpain cue as a cue for goal-directed behavior, or control instructions. Escape-avoidance behavior was operationalized as task duration and response rate. Inhibitory control was measured using the Stop Signal Task. The pain implementation intentions resulted in the longest task duration (P = .02), and thus less escape-avoidance behavior. Low inhibitory control was associated with shorter task duration (P = .03), and thus more escape-avoidance behavior. The nonpain implementation intentions resulted in the highest response rate, but only when inhibitory control was low (P = .04). Implementation intentions referring to pain or nonpain reduce escape-avoidance behavior on a painful task. It is worthwhile to examine whether individuals in pain and with low inhibitory control benefit from interventions that incorporate implementation intentions. PERSPECTIVE To our knowledge, this study is the first to show that forming implementation intentions reduces escape-avoidance behavior during pain and fosters nonpain goal pursuit. The use of implementation intentions is indicated to be an intervention that could be of use in patients with pain, particularly when inhibitory control is low.
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Affiliation(s)
- Petra A Karsdorp
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands; Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
| | - Rinie Geenen
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Floor M Kroese
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Johan W S Vlaeyen
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands; Research Group Health Psychology, University of Leuven, Leuven, Belgium
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27
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Kelly RE, Mansell W, Wood AM. Goal conflict and well-being: A review and hierarchical model of goal conflict, ambivalence, self-discrepancy and self-concordance. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015. [DOI: 10.1016/j.paid.2015.05.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hasenbring MI, Chehadi O, Titze C, Kreddig N. Fear and anxiety in the transition from acute to chronic pain: there is evidence for endurance besides avoidance. Pain Manag 2015; 4:363-74. [PMID: 25350076 DOI: 10.2217/pmt.14.36] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Substantial evidence reveals that the fear of pain and pain anxiety play a significant role in the development of chronic pain and disability, although underlying mechanisms remain widely unknown. Recent studies indicate that endurance pain responses are important besides avoidance. The purpose of this brief narrative review is to provide an overview of research that argues for the integration of the mechanisms of associative learning, motivation and emotion regulation in order to understand the questions of how and why individuals respond with pain responses, which lead to long-term suffering. By using the avoidance-endurance model of pain, we provide a concept that elucidates a range of responses to pain, fear and anxiety that mediate the transition from acute to chronic pain.
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Affiliation(s)
- Monika I Hasenbring
- Department of Medical Psychology & Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Germany
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Waters SJ, Strauman TJ, McKee DC, Campbell LC, Shelby RA, Dixon KE, Fras AM, Keefe FJ. Self-system therapy for distress associated with persistent low back pain: A randomized clinical trial. Psychother Res 2015; 26:472-83. [PMID: 26079438 DOI: 10.1080/10503307.2015.1040485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Persistent low back pain (PLBP) is associated with vulnerability to depression. PLBP frequently requires major changes in occupation and lifestyle, which can lead to a sense of failing to attain one's personal goals (self-discrepancy). METHOD We conducted a clinical trial to examine the efficacy of self-system therapy (SST), a brief structured therapy for depression based on self-discrepancy theory. A total of 101 patients with PLBP and clinically significant depressive symptoms were randomized either to SST, pain education, or standard care. RESULTS Patients receiving SST showed significantly greater improvement in depressive symptoms. Reduction in self-discrepancy predicted reduction in depressive symptoms only within the SST condition. CONCLUSIONS Findings support the utility of SST for individuals facing persistent pain and associated depression.
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Affiliation(s)
- Sandra J Waters
- a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.,b Department of Psychology , North Carolina Central University , Durham , NC , USA
| | - Timothy J Strauman
- c Department of Psychology and Neuroscience , Duke University , Durham , NC , USA
| | - Daphne C McKee
- a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
| | - Lisa C Campbell
- a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.,d Department of Psychology , East Carolina University , Greenville , NC , USA
| | - Rebecca A Shelby
- a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
| | - Kim E Dixon
- a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.,e Department of Anesthesiology , Duke University Medical Center , Durham , NC , USA.,f Department of Psychology , Tuscaloosa VA Medical Center , Tuscaloosa , AL , USA
| | - Anne Marie Fras
- c Department of Psychology and Neuroscience , Duke University , Durham , NC , USA
| | - Francis J Keefe
- a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA
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How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain. Pain 2015; 156:988-997. [DOI: 10.1097/j.pain.0000000000000146] [Citation(s) in RCA: 265] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Black AK, Fulwiler JC, Smitherman TA. The Role of Fear of Pain in Headache. Headache 2015; 55:669-79. [DOI: 10.1111/head.12561] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/26/2022]
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Avoidance behavior in chronic pain research: A cold case revisited. Behav Res Ther 2015; 64:31-7. [DOI: 10.1016/j.brat.2014.11.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 10/27/2014] [Accepted: 11/04/2014] [Indexed: 11/18/2022]
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Claes N, Karos K, Meulders A, Crombez G, Vlaeyen JW. Competing Goals Attenuate Avoidance Behavior in the Context of Pain. THE JOURNAL OF PAIN 2014; 15:1120-1129. [DOI: 10.1016/j.jpain.2014.08.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/17/2014] [Accepted: 08/06/2014] [Indexed: 01/12/2023]
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Schrooten MGS, Wiech K, Vlaeyen JWS. When pain meets … pain-related choice behavior and pain perception in different goal conflict situations. THE JOURNAL OF PAIN 2014; 15:1166-1178. [PMID: 25218553 DOI: 10.1016/j.jpain.2014.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/19/2014] [Accepted: 08/21/2014] [Indexed: 12/13/2022]
Abstract
UNLABELLED Individuals in pain often face the choice between avoiding pain and pursuing other equally valued goals. However, little is known about pain-related choice behavior and pain perception in goal conflict situations. Seventy-eight healthy volunteers performed a computerized task requiring repeated choices between incompatible options, differing in their effect on probability to receive painful stimulation and money. Depending on group assignment, participants chose between increased pain probability versus decreased money probability (avoidance-avoidance conflict situation); decreased pain probability versus increased money probability (approach-approach conflict situation); or decrease versus increase in both probabilities (double approach/avoidance conflict situation). During the choice task, participants rated painfulness, unpleasantness, threat, and fearfulness associated with the painful stimulation and how they felt. Longer choice latency and more choice switching were associated with higher retrospective ratings of conflict and of decision difficulty, and more equal importance placed on pain avoidance and earning money. Groups did not differ in choice behavior, pain stimulus ratings, or affect. Across groups, longer choice latencies were nonsignificantly associated with higher pain, unpleasantness, threat, and fearfulness. In the avoidance-avoidance group, more choice switching was associated with higher pain-related threat and fearfulness, and with more negative affect. These results of this study suggest that associations between choice behaviors, pain perception, and affect depend on conflict situation. PERSPECTIVE We present a first experimental demonstration of the relationship between pain-related choice behaviors, pain, and affect in different goal conflict situations. This experimental approach allows us to examine these relationships in a controlled fashion. Better understanding of pain-related goal conflicts and their resolution may lead to more effective pain treatment.
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Affiliation(s)
- Martien G S Schrooten
- Center for Health and Medical Psychology (CHAMP), Örebro University, Örebro, Sweden; Research Group on Health Psychology, University of Leuven, Leuven, Belgium.
| | - Katja Wiech
- Research Group on Health Psychology, University of Leuven, Leuven, Belgium; Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, Nuffield Division Anaesthetics, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Johan W S Vlaeyen
- Research Group on Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
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Gatzounis R, Schrooten MG, Crombez G, Vlaeyen JW. Interrupted by pain: An anatomy of pain-contingent activity interruptions. Pain 2014; 155:1192-1195. [DOI: 10.1016/j.pain.2014.03.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 11/29/2022]
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Hollander MD, de Jong JR, Volders S, Goossens MEJB, Smeets RJEM, Vlaeyen JWS. Fear reduction in patients with chronic pain: a learning theory perspective. Expert Rev Neurother 2014; 10:1733-45. [DOI: 10.1586/ern.10.115] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Karoly P, Ruehlman LS, Okun MA. Psychosocial and demographic correlates of employment vs disability status in a national community sample of adults with chronic pain: toward a psychology of pain presenteeism. PAIN MEDICINE 2013; 14:1698-707. [PMID: 24010682 DOI: 10.1111/pme.12234] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although chronic pain is a source of work-related disability, relatively little research has addressed the psychological factors that differentiate individuals in chronic pain who leave the workforce from those who remain on the job despite their pain. OBJECTIVE The present study examined a small set of attitudinal and coping-related factors as potential correlates of pain-related disability vs continued part- or full-time employment over and above the role of well-known risk factors. METHODS A large sample of adult men and women with chronic pain drawn from across the United States (N = 1,293) by means of random digit dialing was subdivided into two groups: working (N = 859) and on disability (N = 434). Both groups were interviewed (by telephone) to complete a set of instruments (called the Profile of Chronic Pain: Extended Assessment battery) measuring pain attitudes and coping methods. RESULTS Logistic regression analysis revealed that continued employment status was inversely related to pain severity and was positively related to higher education and being Hispanic. After controlling for severity and demographic factors, belief in a medical cure and catastrophizing tendencies were significant inverse predictors, and task persistence was a positive predictor of continued employment. CONCLUSIONS Results revealed both demographic and attitudinal predictors of continued employment and highlight the value of harnessing insights from the psychology of work engagement to better understand the processes underlying pain presenteeism. Interventions designed to keep persons with pain in the active work force should build upon and extend the present findings.
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Affiliation(s)
- Paul Karoly
- Department of Psychology, Arizona State University, Tempe, Arizona, USA; Goalistics LLC, Tempe, Arizona, USA
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Implicit associations between pain and self-schema in patients with chronic pain. Pain 2013; 154:2700-2706. [PMID: 23932910 DOI: 10.1016/j.pain.2013.07.055] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/30/2013] [Accepted: 07/31/2013] [Indexed: 11/23/2022]
Abstract
Chronic pain often interferes with daily functioning, and may become a threat to an individual's sense of self. Despite the development of a recent theoretical account focussing upon the relationship between the presence of chronic pain and a person's self, research investigating this idea is limited. In the present study we aimed to (1) compare the strength of association between self- and pain schema in patients with chronic pain and healthy control subjects and (2) research whether the strength of association between self- and pain-schema is related to particular pain-related outcomes and individual differences of patients with chronic pain. Seventy-three patients with chronic pain (M(age) = 49.95; SD = 9.76) and 53 healthy volunteers (M(age) = 48.53; SD = 10.37) performed an Implicit Association Test (IAT) to assess the strength of association between pain- and self-schema. Patients with chronic pain also filled out self-report measures of pain severity, pain suffering, disability, depression, anxiety, acceptance, and helplessness. Results indicated that the pain- and self-schema were more strongly associated in patients with chronic pain than in healthy control subjects. Second, results indicated that, in patients with chronic pain, a stronger association between self- and pain-schema, as measured with the IAT, is related to a heightened level of pain severity, pain suffering, anxiety, and helplessness. Current findings give first support for the use of an IAT to investigate the strength of association between self- and pain-schema in patients with chronic pain and suggest that pain therapies may incorporate techniques that intervene on the level of self-pain enmeshment.
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Abstract
The present study examined the role of goals in the relation between calling and life satisfaction in a diverse, adult sample. Building off the self-concordance model of goal progress, the current study explored whether career goal self-efficacy (CGSE) mediated the relation between calling and life satisfaction and whether this mediation was moderated by intrinsic, extrinsic, self-transcendence, or physical self goal aspirations. We found CGSE to partially mediate the relation between calling and life satisfaction. Additionally, self-transcendence goals and physical self goals moderated this mediation such that, for people high in calling, the mediation only existed for those with high self-transcendence goals or low physical self goals. These results suggest that people with callings may need to have self-transcendence goals and avoid physical self goals in order for the confidence in their ability to achieve career goals to mediate the relation between their sense of calling and life satisfaction. Limitations and implications for future research are discussed.
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Affiliation(s)
- Blake A. Allan
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Ryan D. Duffy
- Department of Psychology, University of Florida, Gainesville, FL, USA
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Abstract
OBJECTIVE The fear-avoidance (FA) model of chronic pain describes how individuals experiencing acute pain may become trapped into a vicious circle of chronic disability and suffering. We propose to extend the FA model by adopting a motivational perspective on chronic pain and disability. METHODS A narrative review. RESULTS There is ample evidence to support the validity of the FA model as originally formulated. There are, however, some key challenges that call for a next generation of the FA model. First, the FA model has its roots in psychopathology, and investigators will have to find a way to account for findings that do not easily fit within such framework. Second, the FA model needs to address the dynamics and complexities of disability and functional recovery. Third, the FA model should incorporate the idea that pain-related fear and avoidance occurs in a context of multiple and often competing personal goals. DISCUSSION To address these 3 key challenges, we argue that the next generation of the FA model needs to more explicitly adopt a motivational perspective, one that is built around the organizing powers of goals and self-regulatory processes. Using this framework, the FA model is recast as capturing the persistent but futile attempts to solve pain-related problems to protect and restore life goals.
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van der Maas LCC, de Vet HCW, Köke A, Bosscher RJ, Peters ML. Psychometric Properties of the Pain Self-Efficacy Questionnaire (PSEQ). EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2012. [DOI: 10.1027/1015-5759/a000092] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Self-efficacy beliefs are an important psychosocial determinant of pain behavior and predict the outcome of pain management programs. Participants in these programs are challenged to live a life as normal as possible despite the pain. In view of the continuous presence of pain, self-efficacy measurement should take this into account. The Pain Self-Efficacy Questionnaire (PSEQ) asks participants to take the pain into account when rating their self-efficacy beliefs. In the present study, this questionnaire is examined on its psychometric qualities. The study also examines self-efficacy as an independent predictor of outcome measures after controlling for pain intensity. 278 chronic pain patients participate in this study, divided into two samples. Exploratory and confirmatory factor analysis supported a 1-factor solution. Internal consistency was excellent, and test-retest reliability was adequate. Regression analysis showed that pain self-efficacy was an independent predictor of disability and quality of life after controlling for pain intensity. Furthermore, the PSEQ discriminated between workers and nonworkers, and between patients who used medication and those who did not.
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Affiliation(s)
- Lia C. C. van der Maas
- University of Applied Sciences Windesheim, Zwolle, The Netherlands
- Reade, Center of Rehabilitation and Rheumatology, Amsterdam, The Netherlands
| | - Henrica C. W. de Vet
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Albère Köke
- Adelante Expertise Center Pain Rehabilitation, Hoensbroek, The Netherlands
| | - Ruud J. Bosscher
- Department of Human Movement Sciences, VU University Amsterdam, The Netherlands
- Department of Human Movement, Health and Well-Being, University of Applied Sciences Windesheim, Zwolle, The Netherlands
| | - Madelon L. Peters
- Department of Clinical Psychological Science, Maastricht University, The Netherlands
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Schrooten MG, Van Damme S, Crombez G, Peters ML, Vogt J, Vlaeyen JW. Nonpain goal pursuit inhibits attentional bias to pain. Pain 2012; 153:1180-1186. [DOI: 10.1016/j.pain.2012.01.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 01/14/2012] [Accepted: 01/26/2012] [Indexed: 11/25/2022]
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Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain 2012; 153:1144-1147. [DOI: 10.1016/j.pain.2011.12.009] [Citation(s) in RCA: 607] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 12/05/2011] [Indexed: 11/17/2022]
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Van Damme S, Van Ryckeghem DM, Wyffels F, Van Hulle L, Crombez G. No pain no gain? Pursuing a competing goal inhibits avoidance behavior. Pain 2012; 153:800-804. [DOI: 10.1016/j.pain.2011.12.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 12/16/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022]
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Van Damme S, Moore DJ. From the clinic to the lab (and back)-a call for laboratory research to optimize cognitive behavioural treatment of pain. Transl Behav Med 2012; 2:102-5. [PMID: 24073100 PMCID: PMC3717810 DOI: 10.1007/s13142-011-0083-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Cognitive behavioural therapy (CBT) is the dominant psychological treatment for chronic pain. CBT covers a mixture of aims and a broad range of techniques, including attentional control, modification of maladaptive beliefs and coping strategies and flexible goal setting and acceptance. Patients are exposed to varying selections of these strategies, and a major challenge for clinical practice is to determine what works for whom in which context. We propose that incorporating laboratory research into translational behaviour medicine is a critical developmental step that will help optimizing CBT and provide examples of representative experimental research programs.
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Affiliation(s)
- Stefaan Van Damme
- />Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - David J Moore
- />Centre for Pain Research, School for Health, The University of Bath, Bath, UK
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Schrooten MGS, Vlaeyen JWS, Morley S. Psychological interventions for chronic pain: reviewed within the context of goal pursuit. Pain Manag 2012; 2:141-50. [DOI: 10.2217/pmt.12.2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
SUMMARY In contemporary psychological interventions for chronic pain, cognitive-behavioral therapy takes a central role, covering a broad range of techniques and aims. To improve the effectiveness of cognitive-behavioral therapy and to refine its components, new theoretical approaches may help understand and arrange the mechanisms underlying pain perception, behavior and suffering. This article reviews processes of change in cognitive-behavioral therapies for chronic pain within the context of goal pursuit. Treatments are viewed from the perspective of the action phase model of goal attainment. With this model in mind, a distinction is made between goal ‘intentions’ and their ‘realization’. In addition, recent research findings on goal pursuit in the context of (chronic) pain are reviewed, with a special emphasis on their implications for clinical practice.
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Affiliation(s)
- Martien GS Schrooten
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Johan WS Vlaeyen
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
- Research Group Health Psychology, University of Leuven, Leuven, Belgium
| | - Stephen Morley
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- St James University Hospital, Leeds, UK
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Karsdorp PA, Vlaeyen JW. Chronic pain: Avoidance or endurance? Eur J Pain 2012; 13:551-3. [DOI: 10.1016/j.ejpain.2009.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 02/04/2009] [Indexed: 11/27/2022]
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Hardy JK, Crofford LJ, Segerstrom SC. Goal conflict, distress, and pain in women with fibromyalgia: a daily diary study. J Psychosom Res 2011; 70:534-40. [PMID: 21624576 DOI: 10.1016/j.jpsychores.2010.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 10/29/2010] [Accepted: 10/31/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES A chronic illness such as fibromyalgia can interfere with daily activities and goals by limiting available resources, including time and energy. This leads to competition between goals, known as goal conflict. The purpose of this study was to determine if goal conflict increases symptoms in women with fibromyalgia and whether symptoms lead to perceptions of goal conflict. METHODS Women with fibromyalgia (N=27) recorded their pain, emotional distress, and fatigue each morning and evening for five consecutive days. Each evening, they listed that day's goals, rating goals on their level of conflict. Goal conflict was also rated by independent raters, and a difference score reflected goal conflict discrepancy. RESULTS On days with higher goal conflict, pain increased more from morning to evening (γ=1.71, 95% confidence interval=0.32-3.09, P<.05). On days with higher morning emotional distress, goal conflict was overestimated (γ=0.075, 95% confidence interval=0.035-0.116, P<.05). Women who had a higher symptom burden also typically overestimated their goal conflict relative to those with fewer symptoms (P<.05 for all). CONCLUSIONS Goal pursuit may deplete psychological and physical resources in this vulnerable population, resulting in higher pain. Conversely, emotional distress may affect perception of goal conflict, resulting in less ambitious goal pursuit. Understanding the dynamic relationship between goal conflict and fibromyalgia symptoms may lead to more effective management of limited resources and pursuit of daily goals with fibromyalgia.
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Affiliation(s)
- Jaime K Hardy
- Department of Psychology, University of Kentucky, Lexington, KY 40506, USA
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Ruehlman LS, Karoly P, Pugliese J. Psychosocial Correlates of Chronic Pain and Depression in Young Adults: Further Evidence of the Utility of the Profile of Chronic Pain: Screen (PCP: S) and the Profile of Chronic Pain: Extended Assessment (PCP: EA) Battery. PAIN MEDICINE 2010; 11:1546-53. [DOI: 10.1111/j.1526-4637.2010.00933.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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