Skip to main content

Advertisement

Log in

The “self” in pain: the role of psychological inflexibility in chronic pain adjustment

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Self-discrepancy occurs when a person feels the failure to fulfill one’s hopes or responsibilities. Although self-discrepancy has been widely examined to elucidate patients’ chronic pain adjustment, the underlying mechanism is unclear. The present study proposes that the effect of self-discrepancy on pain outcomes is accounted for by psychological inflexibility, which involves the psychological processes that guide behaviors in the pursuit of goals and values. One-hundred patients with chronic pain were recruited from a public hospital. They were invited to participate in a semi-structured interview regarding their self-discrepancy and complete self-reported questionnaires regarding their psychological inflexibility and pain outcomes. The results confirmed that psychological inflexibility partly accounts for the variance observed between self-discrepancy and pain outcomes. The current study provides additional insight into the mechanism underpinning the impact of self-discrepancy on patients’ pain adjustment and offers clinical implications regarding the use of acceptance commitment therapy for chronic pain management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1182, 1173.

  • Bearden, D. J., Feinstein, A., & Cohen, L. L. (2012). The influence of parent preprocedural anxiety on child procedural pain: Mediation by child procedural anxiety. Journal of Pediatric Psychology, 37, 680–686.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676–688.

    Article  PubMed  Google Scholar 

  • Cao, J., Yang, J., & Zhu, Z.-H. (2013). Reliability and validity of the Chinese version of the Acceptance and Action Questionnaire-Second Edition (AAQ-II) in college students. Chinese Mental Health Journal, 27, 873–877.

    Google Scholar 

  • Cheung, M. N., Wong, T. C. M., Yap, J. C. M., & Chen, P. P. (2008). Validation of the chronic pain acceptance questionnaire (CPAQ) in Cantonese-speaking Chinese patients. The Journal of Pain, 9, 823–832.

    Article  PubMed  Google Scholar 

  • Cleeland, C., & Ryan, K. (1994). Pain assessment: Global use of the brief pain inventory. Annals of the Academy of Medicine, Singapore, 23, 129–138.

    CAS  PubMed  Google Scholar 

  • Dahl, J., & Lundgren, T. (2006). Acceptance and commitment therapy (ACT) in the treatment of chronic pain. In R. A. Baer (Ed.), Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications (pp. 285–306). Oxford: Academic Press.

    Chapter  Google Scholar 

  • Dezutter, J., Luyckx, K., & Wachholtz, A. (2015). Meaning in life in chronic pain patients over time: Associations with pain experience and psychological well-being. Journal of Behavioral Medicine, 38, 384–396.

    Article  PubMed  Google Scholar 

  • Eccleston, C., Williams, A. C. D. C., & Rogers, W. S. (1997). Patients’ and professionals’ understandings of the causes of chronic pain: Blame, responsibility and identity protection. Social Science and Medicine, 45, 699–709.

    Article  CAS  PubMed  Google Scholar 

  • Edwards, W. (1954). The theory of decision making. Psychological Bulletin, 51, 380–417.

    Article  CAS  PubMed  Google Scholar 

  • Esteve, R., Ramírez-Maestre, C., & López-Martínez, A. E. (2007). Adjustment to chronic pain: the role of pain acceptance, coping strategies, and pain-related cognitions. Annals of Behavioral Medicine, 33, 179–188.

    Article  PubMed  Google Scholar 

  • Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69–119.

    Article  Google Scholar 

  • Goossens, M. E., Kindermans, H. P., Morley, S. J., Roelofs, J., Verbunt, J., & Vlaeyen, J. W. (2010). Self-discrepancies in work-related upper extremity pain: Relation to emotions and flexible-goal adjustment. European Journal of Pain, 14, 764–770.

    Article  PubMed  Google Scholar 

  • Hann, K. E., & McCracken, L. M. (2014). A systematic review of randomized controlled trials of acceptance and commitment therapy for adults with chronic pain: Outcome domains, design quality, and efficacy. Journal of Contextual Behavioral Science, 3, 217–227.

    Article  Google Scholar 

  • Hardin, E. E., & Leong, F. T. L. (2005). Optimism and pessimism as mediators of the relations between self-discrepancies and distress among Asian and European Americans. Journal of Counseling Psychology, 52, 25–35.

    Article  Google Scholar 

  • Harris, S., Morley, S., & Barton, S. B. (2003). Role loss and emotional adjustment in chronic pain. Pain, 105, 363–370.

    Article  PubMed  Google Scholar 

  • Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.

    Google Scholar 

  • Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25.

    Article  PubMed  Google Scholar 

  • Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.

    Google Scholar 

  • Higgins, E. T., Klein, R., & Strauman, T. (1985). Self-concept discrepancy theory: A psychological model for distinguishing among different aspects of depression and anxiety. Social Cognition, 3, 51–76.

    Article  Google Scholar 

  • Huijnen, I. P., Kindermans, H. P., Seelen, H. A., Peters, M. L., Smeets, R. J., Serroyen, J., & Verbunt, J. A. (2011). Effects of self-discrepancies on activity-related behaviour: Explaining disability and quality of life in patients with chronic low back pain. Pain, 152, 2165–2172.

    Article  PubMed  Google Scholar 

  • International Association for the Study of Pain. (1986). Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. Pain Supplement, 3, S1–S226.

    Google Scholar 

  • Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30, 865–878.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kindermans, H. P., Huijnen, I. P., Goossens, M. E., Roelofs, J., Verbunt, J. A., & Vlaeyen, J. W. (2011). “Being” in pain: The role of self-discrepancies in the emotional experience and activity patterns of patients with chronic low back pain. Pain, 152, 403–409.

    Article  PubMed  Google Scholar 

  • Leung, C. M., Wing, Y. K., Kwong, P. K., Shum, A., & Lo, K. (1999). Validation of the Chinese-Cantonese version of the hospital anxiety and depression scale and comparison with the Hamilton rating scale of depression. Acta Psychiatrica Scandinavica, 100, 456–461.

    Article  CAS  PubMed  Google Scholar 

  • Lundgren, T., Dahl, J., & Hayes, S. C. (2008). Evaluation of mediators of change in the treatment of epilepsy with acceptance and commitment therapy. Journal of Behavioral Medicine, 31, 225–235.

    Article  PubMed  Google Scholar 

  • McCracken, L. M. (1998). Learning to live with the pain: Acceptance of pain predicts adjustment in persons with chronic pain. Pain, 74, 21–27.

    Article  CAS  PubMed  Google Scholar 

  • McCracken, L. M., & Velleman, S. C. (2010). Psychological flexibility in adults with chronic pain: A study of acceptance, mindfulness, and values-based action in primary care. Pain, 148, 141–147.

    Article  PubMed  Google Scholar 

  • McCracken, L. M., & Vowles, K. E. (2007). Psychological flexibility and traditional pain management strategies in relation to patient functioning with chronic pain: An examination of a revised instrument. The Journal of Pain, 8, 700–707.

    Article  PubMed  Google Scholar 

  • McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69, 178–189.

    Article  PubMed  Google Scholar 

  • McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159–166.

    Article  PubMed  Google Scholar 

  • McCracken, L. M., Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43, 1335–1346.

    Article  PubMed  Google Scholar 

  • McCracken, L. M., & Yang, S.-Y. (2006). The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain, 123, 137–145.

    Article  PubMed  Google Scholar 

  • McCracken, L. M., & Zhao-O’Brien, J. (2010). General psychological acceptance and chronic pain: There is more to accept than the pain itself. European Journal of Pain, 14, 170–175.

    Article  PubMed  Google Scholar 

  • Pincus, T., Fraser, L., & Pearce, S. (1998). Do chronic pain patients ‘Stroop’ on pain stimuli? British Journal of Clinical Psychology, 37, 49–58.

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.

    Article  PubMed  Google Scholar 

  • Raes, F. (2010). Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety. Personality and Individual Differences, 48, 757–761.

    Article  Google Scholar 

  • Risdon, A., Eccleston, C., Crombez, G., & McCracken, L. (2003). How can we learn to live with pain? A Q-methodological analysis of the diverse understandings of acceptance of chronic pain. Social Science and Medicine, 56, 375–386.

    Article  PubMed  Google Scholar 

  • Schmitz, U., Saile, H., & Nilges, P. (1996). Coping with chronic pain: Flexible goal adjustment as an interactive buffer against pain-related distress. Pain, 67, 41–51.

    Article  CAS  PubMed  Google Scholar 

  • Schrooten, M. G., Vlaeyen, J. W., & Morley, S. (2012). Psychological interventions for chronic pain: reviewed within the context of goal pursuit. Pain Management, 2, 141–150.

    Article  PubMed  Google Scholar 

  • Smith, J. A., & Osborn, M. (2007). Pain as an assault on the self: An interpretative phenomenological analysis of the psychological impact of chronic benign low back pain. Psychology and Health, 22, 517–534.

    Article  Google Scholar 

  • Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. Sociological Methodology, 13, 290–312.

    Article  Google Scholar 

  • Sutherland, R., & Morley, S. (2008). Self-pain enmeshment: Future possible selves, sociotropy, autonomy and adjustment to chronic pain. Pain, 137, 366–377.

    Article  PubMed  Google Scholar 

  • Thompson, M., & McCracken, L. M. (2011). Acceptance and related processes in adjustment to chronic pain. Current Pain and Headache Reports, 15, 144–151.

    Article  PubMed  Google Scholar 

  • Van Damme, S., & Kindermans, H. (2015). A self-regulation perspective on avoidance and persistence behavior in chronic pain: New theories, new challenges? The Clinical Journal of Pain, 31, 115–122.

    Article  PubMed  Google Scholar 

  • Vowles, K. E., & McCracken, L. M. (2010). Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes. Behaviour Research and Therapy, 48, 141–146.

    Article  PubMed  Google Scholar 

  • Wang, X. S., Mendoza, T. R., Gao, S.-Z., & Cleeland, C. S. (1996). The Chinese version of the Brief Pain Inventory (BPI-C): Its development and use in a study of cancer pain. Pain, 67, 407–416.

    Article  CAS  PubMed  Google Scholar 

  • Waters, S. J., Keefe, F. J., & Strauman, T. J. (2004). Self-discrepancy in chronic low back pain: Relation to pain, depression, and psychological distress. Journal of Pain and Symptom Management, 27, 251–259.

    Article  PubMed  Google Scholar 

  • Werner, A., Isaksen, L. W., & Malterud, K. (2004). ‘I am not the kind of woman who complains of everything’: Illness stories on self and shame in women with chronic pain. Social Science and Medicine, 59, 1035–1045.

    Article  PubMed  Google Scholar 

  • Whiting, D. L., Deane, F. P., Ciarrochi, J., McLeod, H. J., & Simpson, G. K. (2015). Validating measures of psychological flexibility in a population with acquired brain injury. Psychological Assessment, 27, 415–423.

    Article  PubMed  Google Scholar 

  • Wrosch, C., Scheier, M. F., & Miller, G. E. (2013). Goal adjustment capacities, subjective well-being, and physical health. Social and Personality Psychology Compass, 7, 847–860.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yu, L., Norton, S., Harrison, A., & McCraken, L. M. (2015). In search of the person in pain: A systematic review of conceptualization, assessment methods, and evidence for self and identity in chronic pain. Journal of Contextual Behavioral Science, 4(4), 246–262.

    Article  Google Scholar 

  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Barbara Chuen Yee Lo.

Ethics declarations

Conflict of interest

Silvia Sze Wai Kwok, Esther Chin Chi Chan, Phoon Ping Chen and Barbara Chuen Yee Lo declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kwok, S.S.W., Chan, E.C.C., Chen, P.P. et al. The “self” in pain: the role of psychological inflexibility in chronic pain adjustment. J Behav Med 39, 908–915 (2016). https://doi.org/10.1007/s10865-016-9750-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-016-9750-x

Keywords

Navigation