1
|
Cojocaru CM, Popa CO, Schenk A, Marian Ș, Marchean H, Suciu BA, Szasz S, Popoviciu H, Mureșan S. Personality and Pain Outcomes in Rheumatic Disease: The Mediating Role of Psychological Flexibility. Healthcare (Basel) 2024; 12:1087. [PMID: 38891162 PMCID: PMC11171698 DOI: 10.3390/healthcare12111087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Chronic pain is associated with increased disability and vulnerability to emotional disorders. Personality and psychological flexibility (PF) describe interindividual differences that shape the adjustment to chronic pain. Specifically, PF was found to be associated with pain, fatigue, anxiety, and depression intensity. Although previous studies established strong correlations between personality and pain outcomes, evidence on the nature of this relationship is scarce. Therefore, the objective of this study is to explore the mediating effect of PF on the relationship between personality and distress. METHODS This transversal study included 108 participants (age M = 56.7, SD = 11.3) diagnosed with musculoskeletal chronic pain. Self-reported measures were administered by the medical care team. Multiple mediation models were performed for estimating the indirect effects on each outcome variable. RESULTS After controlling for age and gender covariates, we found that PF completely mediated the relationship between personality traits and all pain outcomes and partially mediated the impact of extraversion on anxiety. In addition, emotional stability also had an indirect effect on anxiety through PF. CONCLUSIONS Personality traits and PF are significant predictors of pain outcomes. PF represents a core process mediating the impact of personality traits on the perceived intensity of pain, fatigue, anxiety, and depression in patients with rheumatic disease. These results could facilitate the application of individualized psychological interventions in clinical contexts targeting the reduction of emotional avoidance and in chronic pain patients.
Collapse
Affiliation(s)
- Cristiana-Manuela Cojocaru
- The Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (C.-M.C.); (A.S.); (H.M.)
| | - Cosmin Octavian Popa
- Department of Ethics and Social Sciences, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania
| | - Alina Schenk
- The Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (C.-M.C.); (A.S.); (H.M.)
| | - Ștefan Marian
- Department of Psychology, West University of Timişoara, 300223 Timişoara, Romania;
| | - Horia Marchean
- The Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (C.-M.C.); (A.S.); (H.M.)
| | - Bogdan Andrei Suciu
- Department of Anatomy and Morphological Science, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu-Mures, Romania;
| | - Simona Szasz
- Department of Rheumatology, Physical and Rehabilitation Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (S.S.); (H.P.)
| | - Horațiu Popoviciu
- Department of Rheumatology, Physical and Rehabilitation Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (S.S.); (H.P.)
| | - Simona Mureșan
- Department of Internal Medicine IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania;
| |
Collapse
|
2
|
Cojocaru CM, Popa CO, Schenk A, Jakab Z, Suciu BA, Olah P, Popoviciu H, Szasz S. A Single-Session Process-Based Cognitive-Behavioral Intervention Combined with Multimodal Rehabilitation Treatment for Chronic Pain Associated with Emotional Disorders. Behav Sci (Basel) 2024; 14:327. [PMID: 38667123 PMCID: PMC11047417 DOI: 10.3390/bs14040327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/29/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Defined by chronic pain, rheumatic diseases are often co-occurring with anxiety and depression. Among the available psychological interventions, cognitive-behavioral therapies have an already-proven efficiency in these cases. However, the need to adjust their structure became ubiquitous during the post-pandemic period. Hence, the objective of this study was to investigate the impact of a single-session, process-based cognitive-behavioral intervention for patients with rheumatic conditions within an in-patient setting. MATERIALS AND METHODS A total of 31 participants (mean age 58.9 years) completed the single-session intervention. Assessments were conducted prior to the intervention, post-intervention and after one month. RESULTS Pearson's correlations, paired samples T tests and a covariance analysis based on the Linear Mixed Model were performed for exploring the relations between baseline variables and evaluating the impact of the SSI intervention. Immediately after the intervention, a significant reduction in cognitive fusion (p = 0.001, d = 1.78), experiential avoidance (p = 0.001, d = 1.4) and dysfunctional behavioral processes was observed. At the one-month evaluation, participants reported decreased pain (p = 0.001, d = 1.11), anxiety (p = 0.004, d = 0.55) and depression (p = 0.001, d = 0.72). CONCLUSIONS The single-session, process-based approach represents a promising intervention in healthcare contexts, as an integrative part of a multimodal rehabilitation treatment in patients with rheumatic conditions.
Collapse
Affiliation(s)
- Cristiana-Manuela Cojocaru
- The Doctoral School of George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (C.-M.C.); (A.S.)
| | - Cosmin Octavian Popa
- Department of Ethics and Social Sciences, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania
| | - Alina Schenk
- The Doctoral School of George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (C.-M.C.); (A.S.)
| | - Zsolt Jakab
- Department of Counseling, Career Guidance and Informing Students, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania;
| | - Bogdan Andrei Suciu
- Department of Anatomy and Morphological Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu-Mures, Romania;
| | - Peter Olah
- Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania;
| | - Horațiu Popoviciu
- Department of Rheumatology, Physical and Rehabilitation Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (H.P.); (S.S.)
| | - Simona Szasz
- Department of Rheumatology, Physical and Rehabilitation Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540142 Targu-Mures, Romania; (H.P.); (S.S.)
| |
Collapse
|
3
|
Ecija C, Gutierrez L, Catala P, Peñacoba C. Preference for Hedonic Goals in Fibromyalgia; Is It Always an Avoidance Mechanism? Looking the Relationship with Pain Acceptance from a Positive Psychology Perspective. Pain Manag Nurs 2024; 25:80-87. [PMID: 38129209 DOI: 10.1016/j.pmn.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 12/23/2023]
Abstract
The aim of this study was to analyze the effect of openness to experience on pain acceptance through positive affect (PA) considering the moderating role of preference for mood management goals in women with fibromyalgia (FM). A cross-sectional study (n = 231) was carried out. A simple mediation model and a moderate mediation model were conducted by SPSS macro-PROCESS. Results showed that PA mediated positively the effect of openness to experience on acceptance (B = 0.46, SE = 0.80, t = 5,59; 95% CI = [0.3016, 0.6298], p < .001) and that the contribution of openness to experience to PA varied at different values of mood management goals (medium: - .04; ß = .40, p < .001; high: .95; ß = .61, p<.001). Findings may serve as a foundation for tailored interventions to promote activity through acceptance focusing on PA and mood management goals among women with medium to high level of hedonic goals.
Collapse
Affiliation(s)
- Carmen Ecija
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Lorena Gutierrez
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Patricia Catala
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Cecilia Peñacoba
- From the Department of Psychology, Rey Juan Carlos University, Madrid, Spain.
| |
Collapse
|
4
|
Kleinstäuber M, Garland EL, Sisco-Taylor BL, Sanyer M, Corfe-Tan J, Barke A. Endorsing a Biopsychosocial Perspective of Pain in Individuals With Chronic Pain: Development and Validation of a Scale. Clin J Pain 2024; 40:35-45. [PMID: 37819212 DOI: 10.1097/ajp.0000000000001163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Patients' beliefs about pain play an important role in their readiness to engage with chronic pain self-management. The central aim of this study was to validate a self-report instrument to assess a specific set of pain beliefs, patients' endorsement of a biopsychosocial model of chronic pain Patients' Endorsement of a Biopsychosocial Model of Chronic Pain Scale (PEB). METHODS Interdisciplinary experts in the field of pain were involved in creating an instrument, the PEB Scale, to operationalize patients' endorsement of a biopsychosocial pain model. A sample of 199 patients with chronic pain was recruited to evaluate the factorial structure (principal axis factoring), the internal consistency (Cronbach alpha), the convergent and discriminant validity (correlational analyses), incremental validity (multiple, hierarchical regression analyses), and construct validity (differential population analysis) of the instrument. RESULTS The factor analysis resulted in a unidimensional, 11-item instrument that explained 51.2% of the total variance. Cronbach alpha (=0.92) indicated high internal consistency of the created set of pain-related beliefs. Regression analyses demonstrated that PEB is a strong predictor of patients' engagement with pain self-management ( P < 0.001) after controlling for demographic variables, anxiety, depression, and other pain-related beliefs. DISCUSSION Our results show that the PEB Scale is a highly reliable self-report instrument that has the potential to predict patients' readiness to adopt pain self-management. Future research should focus on revalidating the scale to operationalize PEB. Moreover, the PEB Scale should be implemented in longitudinal study designs to investigate its ability to predict the transition from acute to chronic pain and patients' long-term pain management.
Collapse
Affiliation(s)
- Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, UT
| | - Brittany L Sisco-Taylor
- Data Center Program, Disease Prevention and Response Division, Spokane Regional Health District, Spokane, WA
| | - Mathias Sanyer
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan
| | - Julia Corfe-Tan
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Antonia Barke
- Institute of Psychology, Clinical and Psychological Intervention, University of Duisburg-Essen, Universitaetsstr, Essen, Germany
| |
Collapse
|
5
|
Yao X, Xu X, Chan KL, Chen S, Assink M, Gao S. Associations between psychological inflexibility and mental health problems during the COVID-19 pandemic: A three-level meta-analytic review. J Affect Disord 2023; 320:148-160. [PMID: 36179778 PMCID: PMC9516602 DOI: 10.1016/j.jad.2022.09.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND An increasing number of research has documented the positive associations between psychological inflexibility (PI) and mental health problems (i.e., depressive, anxiety, and stress symptoms) during the COVID-19 pandemic. However, the documented associations have been inconsistent. This review thus aimed to quantitatively summarize primary research to gain better estimates of these associations. METHODS A systematic literature review was conducted in six databases and three-level meta-analytic models were used to statistically synthesize effect sizes and to examine moderators of the associations between PI and depressive, anxiety, and stress symptoms. RESULTS A total of 22 studies yielded 63 effect sizes on associations between PI and depressive, anxiety, or stress symptoms. The results of three separate meta-analyses revealed a large and significant association between PI and depressive (r = 0.580, 95 % CI [0.549; 0.775]), anxiety (r = 0.548, 95 % CI [0.468; 0.761]), and stress symptoms (r = 0.548, 95 % CI [0.506; 0.725]). The association between PI and depressive symptoms is stronger for males than for females, and the association between PI and stress symptoms varies by type of measure that primary studies use to assess PI and stress symptoms. LIMITATIONS Temporal or causal conclusions are not allowed due to cross-sectional nature of the associations included in meta-analyses. Clinical samples with high levels of stress were underrepresented. CONCLUSIONS PI seems an important risk factor for symptoms of depression, anxiety, and stress, and should therefore be targeted in interventions addressing mental health problems during the COVID-19 pandemic and beyond.
Collapse
Affiliation(s)
- Xiaoyu Yao
- School of Sociology and Political Science, Shanghai University, Shanghai, China
| | - Xinhan Xu
- School of Sociology and Political Science, Shanghai University, Shanghai, China
| | - Ko Ling Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Shimin Chen
- School of Public Administration, China University of Mining and Technology, Xuzhou, China
| | - Mark Assink
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Shuling Gao
- School of Sociology and Political Science, Shanghai University, Shanghai, China.
| |
Collapse
|
6
|
Ecija C, Catala P, Velasco L, Pastor-Mira MA, Peñacoba C. When It Hurts, a Positive Attitude May Help. The Moderating Effect of Positive Affect on the Relationship Between Walking, Depression, and Symptoms in Women with Fibromyalgia. Pain Manag Nurs 2022; 23:767-775. [PMID: 35840530 DOI: 10.1016/j.pmn.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/17/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increased exercise is a marker of health in fibromyalgia (FM). However, patients frequently avoid physical activity as a way of minimizing the pain they feel. This deprives them of opportunities to obtain positive reinforcement, increasing functional impact. AIMS This study examines the mediating role of depressive symptoms between walking (as physical exercise), functional impact, and pain, at different levels of positive affect (PA) among women with fibromyalgia. DESIGN Cross-sectional correlational study. SETTINGS Mutual aid associations for fibromyalgia in Spain. PARTICIPANTS 231 women diagnosed with FM. METHODS Moderate mediation analyses were conducted using PROCESS. RESULTS First, a simple mediation model showed that depression mediated the effect of walking on functional impact, but not on pain. Additionally, the moderated mediated model showed that this effect was significant at medium and high levels of PA, but not when levels of PA were low. CONCLUSIONS Provision of resources focused on positive affect seem to increase the positive effects of walking on functional impact through the reduction of depressive symptoms. Nurses can improve adherence of patients with FM to walking behavior through increasing positive affect.
Collapse
Affiliation(s)
- Carmen Ecija
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Lilian Velasco
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Mª Angeles Pastor-Mira
- Department of Behavioral Sciences and Health, Miguel Hernández University, Alicante, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain.
| |
Collapse
|
7
|
Ecija C, Catala P, Gutierrez L, Javier Arrayás-Grajera M, Peñacoba C. The Influence of the Fear of Negative Evaluation on Activity Avoidance in Fibromyalgia: Exploring Pain Acceptance and Positive Affect as Resilience Variables. Clin Nurs Res 2022; 32:902-913. [PMID: 36217962 DOI: 10.1177/10547738221122670] [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]
Abstract
To examine the mediating role of pain acceptance (PAcc) between fear of negative evaluation (FNE) and activity avoidance (AV) at different levels of positive affect (PA) (moderator) among women diagnosed with fibromyalgia (FM) (moderate mediation model). This study was cross-sectional in design. A convenience sample of women with FM (n = 231) completed measures of pain severity, FNE, PAcc, AV, and PA. A simple mediation model and a moderate mediation model was constructed and analyzed using the SPSS macro-PROCESS. First, PAcc mediated the effect of FNE on AV (β = .02, SE = 0.008; [95% CI [0.0075, 0.0394]). Second, a mediated effect of PAcc between FNE and AV moderated by PA at medium and high levels of PA were found (m: 0.23; β = -.22, p = .0006; h: 9.59; β = -.34, p = .0002. Future work should seek to validate study findings in diverse samples of FM patients. Additionally, future work should explore how FM self-management interventions that include PAcc can promote increased activity among women suffering from FM with medium to high levels of PA.
Collapse
|