Living with chronic pain - a longitudinal study of the interrelations between acceptance, emotions, illness perceptions and health status
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PhDThesis2.zip (4.930Mb)
Date
26/11/2010Author
Dima, Alexandra-Lelia
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Abstract
Psychological adjustment to chronic pain has been recently explored within three
separate frameworks: a behaviour-focused account of chronic pain acceptance within
the broader remit of Acceptance and Commitment Therapy; an emotion-focused
approach with various research programs investigating the role of anger, fear, depression
and also shame and positive emotions in chronic pain; and a cognitionfocused
perspective more recently reframed in terms of illness perceptions as part
of a wider model of response to health threats, the Self-Regulatory Model. Although
these frameworks have broad areas of overlap, limited research has been directed
at integrating acceptance, emotions and illness perceptions into a common, comprehensive
account of psychological adjustment to chronic pain. Such an account
would be beneficial both for providing a parsimonious approach that would guide
further research and for developing pain management interventions that would take
advantage of existing research from all three domains.
The aim of the present thesis was to explore the possibility of integrating these
separate areas by studying the relationships between the main concepts (acceptance,
emotions, and illness perceptions) in the context of chronic pain.
Based on a review of the relevant conceptual and methodological issues of each
domain, a theoretical analysis of the similarities and differences between them was
developed, with particular emphasis on the potential of existing models to support
an integrative account. This analysis provided specific hypotheses regarding
each domain and the interrelationships between them, which were investigated in
a longitudinal study on a heterogeneous sample of 265 chronic pain patients using
the services of the NHS Lothian Pain Clinic and several patient support organisations.
Data were collected via postal and online questionnaires at 3 time points,
at 41/2-month intervals (21% attrition rate). Validated questionnaires were used to
measure the relevant constructs, with additional questions obtaining information
regarding health status, medical history and demographics. The confirmatory analysis (employing a variety of statistical procedures, from correlation
to multiple regression, factor analysis, cluster analysis and structural equation
modeling) largely confirmed the expected relations within and between domains
and was also informative regarding the most suitable data reduction methods. A
detailed psychometric analysis of the questionnaires used offered a complementary
view on the theoretical and methodological issues involved. An additional
exploratory analysis focused on identifying the comparative characteristics of acceptance,
emotions, and illness perceptions in predicting health status indicators,
controlling for contextual factors such as medical history and demographics. Although
no significant longitudinal changes were identified in most parameters (confirming
the clinical observation of chronic pain as a stable condition), the longitudinal
data allowed an analysis of the stability of the concepts and of the magnitude
of their relationships in this patient sample. The analysis of intra- and interpersonal
variation via hierarchical longitudinal modeling confirmed the stability of the
data, highlighted the necessity of studying variation at both levels, and revealed interesting
moderation effects, explained via the proposed concept of ‘discrimination
ability’ and several alternative mechanisms.
These results can be considered as first steps towards an integrative model of psychological
adjustment to chronic pain. It is proposed that the behavioural, cognitive
and emotional aspects need further conceptual clarification and these future efforts
can be supported by the Cognitive-Affective Model of the Interruptive Function of
Pain, within the wider framework of the Self-Regulatory Model.
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