Measuring 'self': preliminary validation of a short form of the Self Experiences Questionnaire in people with chronic pain

Pain acceptance and psychological inflexibility predict pain interference outcomes for persons with chronic pain receiving pain psychology

OBJECTIVES

Awareness (being present), acceptance, and engagement (committed action) are three dimensions of psychological flexibility. Understanding these in the context of chronic pain may identify treatment targets to help refine individual treatment. Our objective was to test the predictive capacity of three dimensions within the psychological flexibility model on the longitudinal trajectory of pain interference.

METHODS

Patients receiving pain psychology treatment at a pain management center participated in this pragmatic clinical longitudinal study (n=86 with at least three assessments; Mean age=51 years; Gender=60 females, 26 males). Measures included the Five Facet Mindfulness Questionnaire (FFMQ-SF); Chronic Pain Acceptance Questionnaire (CPAQ-8); Psychological Inflexibility in Pain Scale (PIPS-12); and Committed Action Questionnaire (CAQ-8). The dependent variable was the Patient Reported Outcomes Information System (PROMIS) Pain Interference (PI). We used latent growth modelling to analyze scores assessed within 180 days of patient care.

RESULTS

Psychological inflexibility (PIPS-12) and pain acceptance (CPAQ-8) measured at baseline predicted PI outcomes (n=86). PIPS-12 showed a direct relationship with pain interference (PI), where higher PIPS-12 scores predicted significantly higher PI mean scores on average across the study period (ρ=0.422, r2=0.382) but also predicted significantly greater decreases in PI across time (ρ=-0.489, r2=0.123). Higher CPAQ-8 scores predicted significantly lower PI mean scores on average across the study period (ρ=-0.478, r2=0.453) but also significantly smaller decreases in PI across time (ρ=0.495, r2=0.076). Awareness (FFMQ-SF) and engagement (CAQ-8) were not predictive of PI outcomes.

CONCLUSIONS

Patients who entered pain psychology treatment with lower pain acceptance and higher psychological inflexibility showed the largest reductions in pain interference across time. These results contribute towards a novel prognostic understanding of the predictive roles of an enhancing dimension and limiting dimension of psychological flexibility.

Predictors of Outcomes Following Interdisciplinary Acceptance and Commitment Therapy for Chronic Pain: Profiling Psychological Flexibility

Background

Growing evidence demonstrates the benefit of acceptance and commitment therapy (ACT) for people with chronic pain. However, there remain people with chronic pain who do not benefit from ACT, and predicting treatment response is difficult.

Aims

This aim of this study was to investigate if baseline psychological flexibility (PF) profiles predict responses to an ACT‐based pain management programme.

Methods

Data from 415 participants attending an interdisciplinary pain management programme were included. Participants completed measures of PF processes and outcomes pre‐ and post‐treatment. Latent profile analysis was used to identify subgroups of participants based on their baseline PF scores. ANOVAs were conducted to compare subgroups of participants on outcome variables at baseline, and changes from pre‐ to post‐treatment.

Results

Three subgroups of participants were identified: (a) low PF, (b) low openness and (c) high awareness and action. The three subgroups significantly differed on all outcome measures at pre‐treatment, supporting the clinical relevance of these PF profiles. However, participants with different baseline PF profiles did not appear to differ in terms of changes in outcome variables.

Conclusions

People with chronic pain demonstrate different PF profiles, but appear to respond to ACT similarly regardless of these profiles. Future studies with a more individualized focus are needed to further understand which components of ACT work for whom on which outcome and how.

Significance

There remain people with chronic pain who do not benefit from acceptance and commitment therapy (ACT), and predicting treatment response is difficult. This is the first study to identify psychological flexibility (PF) profiles along multiple PF processes using latent class analysis, and the first longitudinal study to investigate PF profiles in relation to outcomes in ACT for chronic pain. The findings contribute to the understanding of theoretically consistent predictors of outcomes in ACT, which in turn can inform treatment development.

Examining the association between group context effects and individual outcomes in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy

Background: Although cognitive-behavioural treatments for chronic pain are delivered in groups, there is little research investigating group effects in these treatments. Purpose: The aim of this study was to investigate associations between group composition variables at the start of treatment and individual outcomes following intensive interdisciplinary treatment for pain based on Acceptance and Commitment Therapy. Methods: This was a secondary analysis of routinely collected observational data. Five-hundred and sixteen patients completed a standard set of demographic, pain-related, and psychosocial measures at pre- and post-treatment. Intracluster correlations (ICCs) were computed to examine the clustering of outcomes within groups and multilevel models explored the association between group composition variables and individual level outcomes. Results: The ICCs for pain intensity (0.11) and interference (0.09) suggested that multilevel models were warranted for these outcomes, while a multilevel model for post-treatment depression (ICC=0.04) was not warranted. Group percentage of participants receiving disability 8 benefits and group mean pain intensity at pre-treatment were significantly positively associated with individual level pain intensity at post-treatment, controlling for pre-treatment individual level pain intensity. Group mean pain intensity at pre-treatment was the only group variable that significantly predicted post-treatment pain interference at the individual level. Psychosocial group composition variables were not significantly associated with individual level outcomes. Conclusions: Given the limited predictive utility of group composition variables in the current study, future research should undertake direct assessment of group level therapeutic and counter-therapeutic processes to advance understanding of who benefits from group treatments for pain and how. As the variance in outcomes accounted for by group clustering was relatively small and significant within groups variance remained, research is also needed to further understand individual level factors that influence cognitive-behavioural treatment outcomes for pain.

The Psychological Functioning in the COVID-19 Pandemic and Its Association With Psychological Flexibility and Broader Functioning in People With Chronic Pain

AIMS

People with chronic pain may be particularly vulnerable to the impact of the pandemic COVID-19, and psychological flexibility may protect them. This study investigates psychological functioning in the context of COVID-19, including fear and avoidance in the context of COVID-19, specifically its association with daily functioning, and the role of psychological flexibility, among people with chronic pain.

METHODS

Responses from 555 adults with chronic pain were collected through a cross-sectional online survey and analyzed.

RESULTS

Eight out of 10 participants reported significant depression and nearly 9 out of 10 reported significant functional impairment. COVID-19-related fear and avoidance significantly correlated with pain, pain-related disability, depression, and work and social adjustment (r = 18-.32), as well as psychological flexibility processes, including pain acceptance, self-as-context, and committed action, |r|=.13-.30. COVID-19-related fear and avoidance and COVID-19-related interference were significant predictors of some measures of daily functioning beyond demographics and pain, β = .09-.14. However, these associations weakened when psychological flexibility processes were factored into the models, with fear of COVID-19 no longer being a significant predictor of pain-related disability or depression, and COVID-19 avoidance no longer a significant predictor of depression.

CONCLUSIONS

The psychological functioning in the context of COVID-19 appears to be negatively associated with daily functioning in people with chronic pain, and is statistically significant in this regard. Psychological flexibility may have a role in these associations for people with chronic pain in the pandemic.

PERSPECTIVE

This article demonstrates the psychological implication of COVID-19 and its association with broader emotional and daily functioning in people with chronic pain. It also demonstrates that Psychological flexibility may have a role in these associations for people with chronic pain in the pandemic.