Abstracts Psychology

Chronic Pain-Related Distress & Disability: An Empirical Investigation of a Modern Behavioral Theory of Acceptance of Chronic Pain

by Elizabeth A. Cascarilla

Chronic pain is a pervasive and often intractable health problem that affects approximately one fifth of the population in the United Sates. Despite the moderate effectiveness of some biomedical and multimodal psychotherapeutic treatments for pain, chronic pain remains highly distressing and disabling for many. A modern behavioral model of chronic pain expands upon earlier operant – behavioral and cognitive – behavioral models of pain (W. E. Fordyce, 1976; D. Turk, D. Meichenbuam, & M. Genest, 1983) by viewing much of the accompanying distress and disability as arising from experiential avoidance (S. C. Hayes, K. D. Strosahl, & K. G. Wilson, 1999) and by asserting the importance of acceptance of pain as a key behavioral process in undermining suffering and promoting adjustment to chronic pain (L. M. McCracken, 2005). Acceptance of chronic pain is conceptualized as the adoption of flexible behavioral response patterns aimed at increasing one’s engagement in meaningful activities and the willingness to experience pain sensations in some circumstances when doing so serves to enhance adaptation and life functioning. Acceptance of chronic pain is emerging as a robust predictor of enhanced psychosocial and physical functioning in patients with chronic pain. Given the prevalence and severity of distress and disability experienced by some treatment-seeking chronic pain patients and the apparent contribution of acceptance to enhanced patient functioning, the current study sought to provide an independent test of the validity of a modern behavioral theory of acceptance of chronic pain by examining whether greater acceptance of pain predicts enhanced patient adjustment to chronic pain. A total of 117 patients seeking treatment at a chronic pain rehabilitation program responded to questionnaires assessing acceptance of pain and other indices of emotional distress, pain intensity, and pain-related disability. Results indicated that greater chronic pain acceptance is related to less emotional distress and pain-related disability independent of pain intensity. Acceptance of chronic pain accounted for incremental variance in measures of depression, anxiety, and pain-related disability above and beyond pain intensity. Implications for the treatment of chronic pain, future research directions, and strengths and limitations of the current study are discussed.