Rosa Esteve

• Dra.
• Professor (Full) at University of Malaga

Psychological inflexibility (PI) and psychological flexibility (PF) are transdiagnostic mechanisms involved in the development, maintenance and treatment of SUDs. Evidence on the relationship between their components and substance abuse has not been investigated using a meta-analytic approach. The aim of this meta-analysis was to quantify the assoc...

The Multidimensional Psychological Flexibility Inventory (MPFI) is a recently developed measure of psychological flexibility and inflexibility (PF and PI) based on the Hexaflex/Inflexahex Model. The aim of this article was to assess the factorial structure, reliability, and convergent and criterion validity of the MPFI-24 in a sample from Spain. Th...

In musculoskeletal pain (MSP), pain duration, disability, and mental health relate to how a person engages in daily activities. The self-reporting questionnaire Activity Patterns Scale (APS) assesses these activity patterns and their subscales: Pacing (Pacing to increase activity levels,Pacing to conserve energy for valued activities,Pacing to redu...

The primary aim was to investigate how respiration rate and inhalation/exhalation ratio influence self‐reported state anxiety during a single slow diaphragmatic breathing exercise session. Eight hundred and twenty‐eight participants completed the study at two separate geographical locations (Poland and Spain). Participants performed a 10‐min online...

Chronic pain conditions are frequently comorbid with anxiety problems. The controlled diaphragmatic breathing technique has been applied in both conditions. However, few studies have examined its efficacy in reducing perceived pain and state anxiety in the population with both pathologies. Thus, the study objective was to investigate the immediate...

Objectives The Pain Responses Scale and its short form (PRS-SF) were recently developed to assess the affective, behavioural, and cognitive responses to pain based on the Behavioural Inhibition and Behavioural Activation Systems (BIS-BAS) model of chronic pain. The purpose of this study was to provide additional tests of the psychometric properties...

This international multicenter randomized controlled trial aimed to compare the effectiveness of virtual reality (VR) distraction with an identical non-VR game in reducing needle-related pain and anxiety in children undergoing venous blood draw. The study involved 304 children aged 5-9 years undergoing a blood draw procedure, randomly allocated to...

Background The negative consequences of prescription opioid misuse and opioid use disorder make it relevant to identify factors associated with this problem in individuals with chronic pain. This cross‐sectional study aimed at identifying subgroups of people with chronic pain based on their psychological profiles, prescription opioid misuse, cravin...

Background Children and adolescents with chronic pain are a vulnerable population who often lack the resources to manage their condition. Due to high personal, social, and economic consequences, proper management in its early stages is key to reducing disability. The aim of this project is to co-develop a digital intervention for pediatric chronic...

Purpose] Non-invasive and drug-free interventions for pain are being developed. One of them is ANF (which stands for “Amino Neuro Frequency”) Therapy®, which consists in the application of carbonized metal devices on a patient’s skin. We aimed to: 1) test perceived changes in pain intensity after ANF application, 2) record frequency and severity of...

Background Opioids are being prescribed widely, and increasingly, for the treatment of chronic non-cancer pain (CNCP). However, several side effects are associated with mid- and long-term opioid use and, for certain patients, with the risk of problematic opioid use. The aim of this study is to know the perception of the physicians about which varia...

Empathy in healthcare professionals is associated with better treatment outcomes and higher satisfaction among patients with chronic pain. Activity patterns play an essential role in the adjustment of these patients and, as a pain behaviour, may have a communicative function and elicit distinct empathic responses. This study investigated whether th...

Objectives: To analyse the empathetic response of future health professionals toward people diagnosed with chronic pain differentiated by the degree of visibility and credibility of symptoms. Methods: A total of 203 undergraduates performed an experimental task using vignettes depicting different diagnoses of chronic pain and completed questionn...

Psychological variables can be used to predict the risk of prescription opioid abuse. The aim of the present study was to analyse the predictive value of a set of these variables. Specifically, we analysed the association between the potential abuse and misuse of opioids and self-affirming mood, neuroticism, extraversion, anxiety and/or depression...

People with chronic pain often change the way they carry out their daily activities according to different patterns, among which are pacing strategies. Cross-sectional studies on the association between pacing and affect show contradictory results. The study aim was to experimentally test whether the induction of positive affect vs negative affect...

Objectives Several studies have demonstrated posttraumatic stress disorder (PTSD) and chronic pain comorbidity. However, there is a lack of research on the psychological variables that might explain their co-occurrence. We investigated the mediating role of distress intolerance and pain catastrophizing in this relationship. Methods A moderated med...

Objectives: The aim of this study was to investigate the consequences of the COVID-19 pandemic in women with non-malignant chronic pain, and to determine whether women exposed to traumatic situations prior to the outbreak would be at a higher risk of negative health impacts. Methods: A total of 365 women were divided into three subgroups according...

Objective: There is an ongoing debate on the use of long-term high-dose medically prescribed opioid analgesics for patients with chronic noncancer pain. Such use is elevated when there is comorbid pain and PTSD, which is quite prevalent. Therefore, it is relevant to investigate the psychological variables that may explain opioid misuse in this pop...

The Current Opioid Misuse Measure (COMM) is a questionnaire used to identify and monitor chronic pain patients on opioid therapy who may be misusing their prescription opioids. The aim of the present study was to adapt the questionnaire for its use in Spanish speaking populations. A total of 171 individuals (131 women and 40 men) with nononcologica...

Objective Substantial empirical evidence has shown that intolerance of uncertainty is a central transdiagnostic feature in psychopathology and it has been suggested to be a pain-related psychological factor contributing to the experience of chronic pain. However, research in this area is virtually nonexistent. The objective of this study was to inv...

Introduction: Accurate assessment of the risk of opioid abuse and misuse in people with noncancer chronic pain is crucial for their prevention. This study aimed to provide preliminary evidence of the diagnostic and predictive capacity of the Spanish versions of the Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients with Pai...

Social support plays a crucial role in the quality of life of people with chronic pain. The Informal Social Support for Autonomy and Dependence in Pain Inventory assesses two functions of received social support: the promotion of autonomy and the promotion of dependence. The aim of this cross‐sectional study was to adapt this instrument for its use...

Purpose Fatigue is known to interfere with function in individuals with physical disabilities. In order to monitor changes in fatigue over time and evaluate the efficacy of treatments, psychometrically sound measures of fatigue are needed. The aim of this work was to evaluate the validity of the Silhouettes Fatigue Scale with English instructions (...

Background In spite of the relevance of daily function in individuals with chronic pain, few questionnaires have been designed to assess this domain in individuals with musculoskeletal pain. In addition, the Impairment and Functioning Inventory (IFI-R) is the only instrument that assesses perceived decreases in levels of daily activity after the on...

Background Opioid therapy is utilized for a broad range of chronic pain conditions. Several studies have highlighted the adverse effects of opioid medication due to the misuse of these drugs. The gradual increase in the use of opioids has become a global phenomenon and is generating social concern. Several treatment guidelines have strongly recomme...

Background: The PASS-20 is a general measure of pain-related anxiety and fear. The aim of the present study was to adapt the questionnaire for use in Spanish-speaking populations. Methods: Sample 1 comprised 216 individuals with chronic spinal pain (114 women and 102 men); sample 2 comprised 85 individuals with acute spinal pain (62 women and 23...

There is solid evidence of an association between several psychological flexibility processes, particularly pain acceptance, and adaptation to chronic pain. However, there are relatively few studies on the relationship between pain acceptance and opioid misuse in chronic pain patients. Thus, the aim of the present study was to test a hypothetical m...

Experiential avoidance, dissociation, and guilt have been shown to be associated with trauma exposure and to play an important role in explaining the development and maintenance of posttraumatic stress symptoms. However, there is a lack of studies that simultaneously address the relationship between these variables, which has never been studied wit...

Traumatic experiences have consistently been linked to poor health and well-being, particularly in women. Psychological factors have been theorized to directly affect the reporting of physical symptoms and perceptions of general health. Posttraumatic stress disorder (PTSD) has been proposed as a major pathway through which trauma affects health and...

Objectives The COVID-19 crisis is a significant stressor worldwide. The physical and emotional condition of individuals with pain sensitization syndromes who are experiencing the pandemic may worsen. This study investigated the contribution of life changes due to the coronavirus to emotional distress in individuals with a diagnosis of chronic centr...

Background: Psychological factors of patients may influence physicians' decisions on prescribing opioid analgesics. However, few studies have sought to identify these factors. The present study had a double objective: (1) To identify the individual factors that differentiate patients who had been prescribed opioids for the management of chronic bac...

PurposeThe quality of life of individuals with chronic musculoskeletal pain partly depends on their capacity to adjust their personal goals. Vignettes have been rarely used to assess this ability. Therefore, this study aimed to test the relationships between vignettes assessing different goal strategies and chronic pain adaptation (i.e., daily func...

Longitudinal research is needed to determine predictive factors of healthcare utilization and medication intake in people with non-specific spinal pain. This study aims to prospectively examine the predictive value of sex, age, work status, pain intensity, pain acceptance, disability, depression, pain anxiety, and catastrophizing in relation to hea...

This longitudinal study explored whether activity patterns change over time in a sample of 56 individuals with chronic musculoskeletal pain over a 15-day period. Once a day, the participants recorded their level of pain intensity and the degree to which they had engaged in several specific activity patterns. Linear mixed models with random coeffici...

Objectives: The identification of psychological markers of the posttraumatic stress reaction after a cardiac event is relevant in the management of cardiovascular risk factors. The aim of the study to test the contribution of experiential avoidance, anxiety sensitivity, and depressive symptoms to acute coronary syndrome posttraumatic stress symptom...

Background Many questions regarding the process by which self‐enhancing humor style has an effect on chronic pain individuals’ adjustment remain unanswered. The aim of the present study was to analyse the association of self‐enhancing humor style with adjustment in a sample of individuals with chronic pain, over and above the role of catastrophizin...

The aim of this study was to validate the Spanish version of the Defensive Pessimism Questionnaire. A sample of undergraduate students (N = 539) was measured on defensive pessimism using the Defensive Pessimism Questionnaire (DPQ), optimism and pessimism using the Life Orientation Test (LOT), positive and negative affect using the Positive and Nega...

Background: The literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder (PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use...

Background: Sleep problems are common for individuals living with physical disabilities and chronic pain. However, the factors that influence the relationship between pain and sleep problems in these populations remain unknown. Objective: The aim of this study was to increase our understanding of the physical, emotional and cognitive factors ass...

Background: The variables that underlie comorbid chronic pain and posttraumatic stress symptoms (PTSS) are not yet clearly established. Objective: The aim of the present study was to analyse the role of the behavioural inhibition system (BIS), behavioural approach system (BAS) and experiential avoidance (EA) in pain adjustment (i.e. pain intensity,...

Background: The behavioral inhibition system (BIS) and behavioral activation system (BAS) are two neu-ropsychological systems hypothesized to underlie response to cues signaling potential reward and punishment, respectively, also in patient responses to chronic pain. Objectives: The aim of this study was to test these hypotheses by evaluating the r...

Gray's Reinforcement Sensitivity Theory postulates two distinct neurophysiological systems that underlie thoughts, emotions, and behavior: the Behavioral Inhibition System (BIS) and the Behavioral Approach System (BAS). Preliminary research suggests that both systems may play relevant roles in the adjustment of individuals with chronic pain. Howeve...

Gray's Reinforcement Sensitivity Theory postulates two distinct neurophysiological systems that underlie thoughts, emotions, and behavior: the Behavioral Inhibition System (BIS) and the Behavioral Approach System (BAS). Preliminary research suggests that both systems may play relevant roles in the adjustment of individuals with chronic pain. Howeve...

Background Chronic pain directly or indirectly interferes with valued personal goals. Goal adjustment plays a central role in patients’ adaptation. Studies on the relationship between optimism and goal regulation have shown that people with high dispositional optimism adjust their goals in a flexible way, and that flexible goal adjustment promotes...

Interpersonal forms of trauma are among the most commonly reported traumas. These types of traumas are more damaging to well-being than noninterpersonal forms. They have also been strongly associated with somatic symptoms and more general physical health problems. Nevertheless, the results of trauma studies are mixed and suggest that pathways may v...

Background: Current literature shows that posttraumatic stress disorder and complex posttraumatic stress disorder symptoms differ. Although the psychological treatments available for posttraumatic disorder are well established, little is known about the effectiveness of those aimed at the treatment of complex posttraumatic stress. Objective: To ev...

Objective Activity patterns are the product of pain and of the self-regulation of current goals in the context of pain. The aim of this study was to investigate the association between goal management strategies and activity patterns while taking into account the role of optimism/pessimism and positive/negative affect. Methods Two hundred and thir...

Background: One of the most frequently used instruments to assess posttraumatic stress in children and adolescents is the Child PTSD Symptom Scale. However, there has been limited evaluation of its construct validity in the Spanish language despite Spanish being one of the most widely spoken languages in the world. Objective: To provide data on the...

The Flourishing Scale was developed by Diener based on recent theories of psychological wellbeing. This article tested some of the psychometric properties of the Spanish version of the Flourishing Scale (FS-SV). Participants were 545 university students (Sample 1) and 111 patients with chronic back pain (Sample 2). Participants completed a battery...

El objetivo de este estudio es realizar la adaptación y validación al castellano de las escalas “Tenacious Goal Pursuit and Flexible Goal Adjustment” y “Goal Disengagement and Goal Reengagement”. La muestra se compone de 681 estudiantes de la Facultad de Psicología de Málaga. El análisis factorial exploratorio muestra el mismo número de factores a...

The aim of this study was to adapt the "Tenacious Goal Pursuit and Flexible Goal Adjustment" and "Goal Disengagement and Goal Reengagement" scales into Spanish and validate them. The sample comprised 681 students from the Faculty of Psychology at Malaga University (Spain). Exploratory factor analysis showed the same number of factors as the origina...

Objective.: To investigate the predictive power of resilience and vulnerability factors in relation to pain-related disability. Design.: A two-year prospective study investigated whether back pain-related disability was predicted by the following variables, measured when pain was acute: 1) pain-related disability, 2) pain intensity, 3) depressio...

Background/aims: This longitudinal study investigated the pattern of change in pain intensity, disability, and depression in 232 chronic pain patients who were followed up for 2 years since pain onset. Most studies that have investigated changes in these variables over time have used participants who had already been in pain for more than 3 months...

Perspective: It is useful to distinguish profiles on the basis of various activity patterns. In contrast to profiles characterized by avoidance, profiles characterized by high persistence and low avoidance were associated with adaptive results. Patients with this profile also showed a high level of optimism and a good balance between goal value, e...

Flourishing (plenitud in Spanish) is a concept related to psychological well-being. This study aimed to know on flourishment and resilience role in patients' wellbeing and adjustment to their chronic pain. Participants were 111 patients with chronic musculoskeletal pain. Correlation analyses showed that flourishing had a significant relationship wi...

PurposeThis study investigated the role of anxiety sensitivity, resilience, pain catastrophizing, depression, pain fear-avoidance beliefs, and pain intensity in patients with acute back pain-related disability. Method Two hundred and thirty-two patients with acute back pain completed questionnaires on anxiety sensitivity, resilience, pain catastrop...

Unlabelled: Several self-report measures were used to identify 6 activity patterns in chronic pain patients: pain avoidance, activity avoidance, task-contingent persistence, excessive persistence, pain-contingent persistence, and pacing. Instruments for assessing pacing should include 3 pacing behaviors (breaking tasks into smaller tasks, taking f...

There are few instruments with adequate psychometric properties for assessing daily functioning in patients with musculoskeletal pain. In addition, none of these instruments assess the perceived decrease in levels of daily activities after pain onset. To review the psychometric qualities of the Impairment and Functioning Inventory (IFI) for chronic...

Purpose: Recent attention has focused on resilience as an important process in the experience and management of chronic pain. In this context, resilience is considered as a psychological factor that promotes adaptive responses to pain and pain-related life adversities. Current research suggests that it is a relevant variable in the prediction of p...

The tendency to respond with fear and avoidance can be seen as a shared vulnerability contributing to the development of post-traumatic stress disorder (PTSD) and chronic pain. Although several studies have examined which specific symptoms of PTSD (re-experiencing, avoidance, emotional numbing and hyperarousal) are associated with chronic pain, non...

The aim of the present study was to analyse differences between men and women in the experience of chronic pain. Resilience, fear-avoidance of pain, and pain acceptance were included in a hypothetical model as variables involved in chronic pain adjustment. A sample of 400 chronic spine pain patients (190 men and 210 women) attending Primary Care Un...

Prior studies found a range of psychological factors related to the perception of pain, maintenance of pain and disability. The aim of this study was to investigate the role of pain fear-avoidance and pain acceptance in chronic pain adjustment. The influence of two diathesis variables (resilience and experiential avoidance) was also analyzed. The s...

Prácticamente todas las personas han sufrido alguna vez un episodio de dolor agudo a lo largo de su vida, pero sólo una minoría acaba padeciendo dolor crónico. Actualmente existe un reconocimiento unánime de que el tránsito del dolor agudo al dolor crónico se explica por la interacción entre las condiciones fisiopatológicas del trastorno y un conju...

This study investigated the association between anxiety sensitivity and pain catastrophizing in children, caregivers' anxiety sensitivity and catastrophizing about children's pain and responses to children's pain, pain intensity reported by children, and pain intensity estimated by caregivers. The participants were 102 children scheduled for outpat...

Background Prior studies found that pain fear avoidance and pain acceptance are significantly associated with adjustment to chronic pain. Purpose The purpose of this study is to compare the influence of pain fear avoidance and pain acceptance on adjustment to chronic pain across three samples: patients with chronic back pain treated at primary care...

Several empirical studies have shown that personal characteristics act as differential variables, which determine how pain is experienced and how the chronic pain patient adjusts to pain. The main aim of the present research is to review the relationships between some dispositional characteristics and pain adjustment. Taking into account the empiri...

Prácticamente todas las personas han sufrido alguna vez un episodio de dolor agudo a lo largo de su vida, pero sólo una minoría acaba padeciendo dolor crónico. Actualmente existe un reconocimiento unánime de que el tránsito del dolor agudo al dolor crónico se explica por la interacción entre las condiciones fisiopatológicas del trastorno y un conju...

Anxiety sensitivity has been included in the fear-avoidance model as a vulnerability factor to explain individual differences in fear of pain. Several studies have suggested that the relationship between anxiety sensitivity and some psychopathological disorders is mediated by experiential avoidance, an affect-related regulatory process that involve...

Previous studies on children's pain perspectives remain limited to English-speaking populations. An exploratory cross-sectional descriptive design was used to investigate the developmental progression of children's pain perspectives, including their pain experience, its definition and attributes, causality and coping. The Children's Pain Perspectiv...

This study analyses the relationships between patients' dispositional optimism and pessimism and the coping strategies they use. In addition, the coping strategies repercussions on adjustment to chronic pain were studied. Ninety-eight patients with heterogeneous chronic pain participated. The assessment tools were as follows: Life Orientation Test...

Background The Spanish version of the Pain Vigilance and Awareness Questionnaire has not been validated. Purpose The aims of this study were to examine the factor structure of the Spanish version of the Pain Vigilance and Awareness Questionnaire and present empirical evidence regarding its validity. Method A sample of 468 chronic back pain patients...

Background / Purpose: The PASS-20 is the short form version of the Pain Anxiety Symptoms Scale, a self-report measure of pain-related fear. The primary purpose of this study was to determine the psychometric properties of the Spanish version of the PASS-20. Main conclusion: Principal component analysis provided a two-factor solution of the Spa...

Aim of investigation: Recent research indicated wide variability regarding pain-related cognitive/affec-tive and behavioral responses to pain, showing that fear-avoidance responses (FAR) and endurance-responses (ER) play a prominent role in the maintenance of low back pain (LBP). Until now, there is a lack of reliable and valid instruments covering...

A cross-sectional study. To analyze the relationship between resilience, acceptance, coping, and adjustment to spinal chronic pain. Several studies have concluded that resilience is relevant in predicting pain and physical functioning among patients with chronic pain. Although resilience may have a role in preventing or living with chronic pain, th...

The aims of this study were to examine the internal structure of the Spanish version of the Chronic Pain Acceptance Questionnaire and present new empirical evidence regarding its validity. A sample of 315 chronic pain patients attending a pain clinic completed a battery of instruments to assess pain acceptance, general psychological acceptance, dep...

The aim of this study was to investigate whether distraction is less effective when pain is perceived as threatening. Forty-one female undergraduate participants were assigned to distraction and not distraction conditions that consisted in performing a distraction task and the threat value of the pain stimuli was manipulated using instructions. AS,...

Objective: to know and analyze the discomfort level and main causes of suffering in advanced cancer patients from a patient's perspective. Method: in a sample of 132 patients cared for at Cudeca Foundation suffering and its causes were evaluated using a subjective perception scale. Data were analyzed using the SPSS 11. Results: most patients associ...

Este estudio toma como marco teórico el modelo de miedo-evitación del dolor. Su objetivo es determinar, en un grupo de personas en tratamiento por presentar un trastorno de dependencia, si quienes desarrollaron dolor crónico tras el período de abstinencia se diferencian de aquellos en los que el dolor no persistió en un conjunto de variables que, s...

Objective: to examine the role played by disease awareness and emotions in the pain and suffering experience in a sample of patients with advanced Cancer. Material and method: the sample consisted of 89 patients with advanced or terminal Cancer. A semistructured interview was administered to assess their general condition, disease awareness, suffer...

In a sample of patients under treatment for dependence disorder, the fear-avoidance model of pain was used as a theoretical framework to investigate differences between patients who developed chronic pain after the abstinence period and those who did not. In line with the model, a set of variables involved in the chronification process were conside...

This study analyses the relationships between patients' cognitive appraisals concerning their pain and the coping strategies they use. In addition, the way the coping strategy influences the intensity of perceived pain and impairment in these patients was studied. One hundred and twenty two patients with musculoskeletal chronic pain participated. T...

The aim of the present study was to investigate the role of anxiety sensitivity (AS) as a factor relevant to pain and pain persistence. Two studies were conducted to examine the relationship between AS, body vigilance and the experience of pain in non-clinical samples. Study 1 investigated the relationship between AS and body vigilance that was ope...

Unlabelled: The purpose of the present study was to test a hypothetical model of the relationships between perceived social support, coping responses to pain, pain intensity, depressed mood, and functional disability (functional status and functional impairment) in a population of patients with chronic pain in a Spanish Clinical Pain Unit. It was...

In chronic pain context, recent studies have begun to consider the relevance of the patient's cognitive appraisal about their pain. Nevertheless, there are not many instruments that allow us to measure the cognitive appraisal of pain. The main purpose of this study was the development of an instrument to measure cognitive primary appraisal in chron...