Available via license: CC BY-NC 4.0
Content may be subject to copyright.
REGULAR ARTICLE
Goal Adjustment and Well-Being: The Role of Optimism in Patients
with Chronic Pain
CarmenRamírez-Maestre, PhD1, • RosaEsteve, PhD1, • Alicia E.López-Martínez, PhD1 •
Elena R.Serrano-Ibáñez, PsyD1 • Gema T.Ruiz-Párraga, PhD1 • MadelonPeters, PhD2
Published online: 3 September 2018
© The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Behavioral Medicine. This is an Open Access
article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/
by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly
cited. For commercial re-use, please contact journals.permissions@oup.com
Abstract
Background Chronic pain directly or indirectly interferes
with valued personal goals. Goal adjustment plays a cen-
tral role in patients’ adaptation. Studies on the relation-
ship 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 quality of life.
Purpose The aim of this study was to analyze the rela-
tionship among optimism, goal adjustment, and adapta-
tion in patients with chronic pain.
Methods A sample of 258 patients with chronic muscu-
loskeletal pain completed questionnaires on optimism,
reengagement, disengagement, flexibility, tenacity, ru-
mination, purpose in life, well-being, pain intensity, daily
functioning, and impairment.
Results Structural equation modeling analysis showed
that optimism had a positive association with reengage-
ment, flexibility, and tenacity, and a negative association
with disengagement. Disengagement was positively asso-
ciated with rumination, whereas reengagement, flexi-
bility, and tenacity were associated with higher levels
of purpose in life, which were strongly associated with
adaptation in patients with chronic pain.
Conclusions This study supports the conclusions of pre-
vious research on the role of goal adjustment as a medi-
ator variable between optimism and well-being.
Keywords Optimism • Goal adjustment • Well-being •
Chronic pain
Introduction
Chronic pain interferes with daily activities and goals.
Pain directly or indirectly interferes with valued per-
sonal goals [1, 2]. When there is an increase in pain or
fatigue, the physical and cognitive effort required for
voluntary goal–directed activity may not be available.
Consequently, patients may need to negotiate competi-
tion among their goals for limited physical and cogni-
tive resources. Success in this negotiation is important,
because goals not only make demands but also provide
psychological benefit.
The theoretical literature on goal adjustment strategies
offers three models. On one hand, the dual process model
[3, 4] distinguishes the assimilative mode (tenacious goal
pursuit), which is used to maintain goals, from the ac-
commodative mode (flexible goal adjustment), which is
Carmen Ramírez-Maestre
cramirez@uma.es
Rosa Esteve
zarazaga@uma.es
Alicia E.López-Martínez
aelm@uma.es
Elena R.Serrano-Ibáñez
elenarserrano@uma.es
Gema T.Ruiz-Párraga
gtruizparraga@uma.es
Madelon Peters
madelon.peters@maastrichtuniversity.nl
1 Universidad de Málaga, Andalucía Tech, Instituto de
Investigación Biomédica de Málaga (IBIMA), Facultad de
Psicología, Málaga, Spain
2 Department of Clinical Psychological Science, Faculty of
Psychology and Neuroscience, Maastricht University, 616
6200 MD Maastricht, Netherlands
move "sec[@data-type='conflicthead']" before "ref-list"
move "sec[@data-type='contribution']" after newline "sec[@data-type='conflicthead']"
move "sec[@data-type='funding']" after newline "sec[@data-type='contribution']"
ann. behav. med. (2019) 53:597–607
DOI: 10.1093/abm/kay070
used to promote adjustment of goals to changes in the
individual’s personal situations. Several studies [5, 6]
have found that higher tenacity in goal pursuit and higher
flexibility in goal adjustment predicted improved psycho-
logical functioning and decreased psychological distress
in people affected by neurological injury. On the other
hand, goal adjustment theory [7, 8] suggests that goal ad-
justment entails both disengaging from the unattainable
goal and reengaging in alternative goals. Disengagement
contributes to well-being because it allows individuals
to expend effort on more attainable goals [9]. Successful
disengagement could contribute to quality of life by
preventing the stress of repeated failure and continued
rumination concerning the unattainable goal [8]. Thus,
van Randernborgh et al. [10] concluded that there is a
negative association between rumination and disengage-
ment, because they found that individuals who fail to
disengage from unreachable goals have higher levels of
rumination. It must be emphasized that although goal
disengagement is strongly associated with a reduction in
negative psychological states, goal reengagement is asso-
ciated with positive aspects of subjective well-being [11].
In line with these results, recent empirical studies have
shown that in different samples (young and older adults,
undergraduate students, parents of children with cancer,
and parents of medically healthy children), the capacity
to disengage from the unattainable goal and reengage
in alternative goals is predictive of subjective well-being
and physical health [12–14]. The present study is set
within the framework of a third model: The Integrated
Model of Goal Management [15], which integrates the
dual process model and goal adjustment theory. This
third model includes four strategies: goal maintenance
(tenacious goal pursuit), goal adjustment (comprising
flexible goal adjustment and disengagement), and goal
reengagement. Goal adjustment is a good strategy when
goals are under threat. However, if a goal can still be
attained, goal maintenance is a better strategy. Goal
reengagement is an appropriate strategy to complement
existing goals or to replace unattainable goals. Arends
etal. [15] tested their model in a sample of patients with
arthritis and found that patients who reported a higher
tendency to adjust their goals to changed circumstances
experienced more purpose in life, more positive affect,
and were more satisfied with their participation in daily
life, work, and education. Similarly, Wrosch etal. [16]
examined the association between goal adjustment and
subjective well-being in three samples: students, young
and older adults, and parents of children with cancer
and parents of medically healthy children. The results
showed that goal reengagement was associated with
higher levels of purpose in life. Thus, the tendency to ad-
just threatened goals seemed to be associated with suc-
cessful adaptation. Apart from adjusting personal goals,
the tendency to keep striving for goals also seemed to
benefit adaptation to a chronic disease, because patients
who had a stronger tendency to keep striving for their
goals experienced more purpose in life, positive affect,
and satisfaction with their participation in the setting of
work. In a subsequent study, these authors [17] examined
domain-specific goal management and the preferred
strategies used by patients with arthritis to manage their
goals. The results showed that their strategic preference
was associated with the specific life domain (i.e., family
or work) and that disengagement was the least preferred
strategy by which to managegoals.
Optimism is a personality factor that seems to be
inextricably linked with greater well-being [18–20].
Dispositional optimism is a personality trait that reflects
the extent to which people hold generalized favorable
expectations concerning their future [19, 21]. Therefore,
people high in optimism are inclined to pursue goals
tenaciously [22]. Studies on the relationship between
optimism and self-regulation have shown that people
with high dispositional optimism show more flexible
behavior in the face of changing circumstances, and that
flexible goal adjustment protects people from negative
consequences in stressful circumstances and promotes
quality of life [16, 23–26]. It has also been suggested
that optimists reengage in new attainable goals if they
repeatedly fail to attain certain goals [27–30]. Therefore,
flexible goal adjustment seems to be a mechanism by
which optimism can influence several aspects of well-be-
ing. Recent clinical and experimental evidence suggests
that optimism is an important resilient resource for suc-
cessful adaptation to acute and chronic pain [19, 31–37].
The present study analyzed the role of goal adjustment
strategies as the mechanisms through which optimism is
related to well-being in patients with chronicpain.
To the best of our knowledge, only two studies [15, 17],
which used samples of arthritis patients, have been con-
ducted within the framework of the integrated model of
goal management. The present study investigated the
relationship between dispositional optimism, the four-
goal adjustment strategies proposed by Arends et al.
[15], and well-being in a sample of patients with chronic
musculoskeletal pain. In line with previous evidence, we
designed a hypothetical model that included optimism,
reengagement, disengagement, flexibility, tenacity, ru-
mination, purpose in life, well-being, pain, functioning,
and impairment (Fig.1). It was hypothesized that higher
levels of optimism would be associated with flexible ad-
justment when goals are threatened, striving for goals
when they are still reachable (tenacity), and disengaging
from current ones when they are unreachable and engag-
ing in new ones [15, 17, 23, 27–29]. Therefore, high lev-
els of optimism are expected to be positively associated
with tenacious goal pursuit, flexible goal adjustment
598 ann. behav. med. (2019) 53:597–607
based on the situation, and the use of reengagement and
disengagement.
Regarding the strategies included in the integrated
model of goal management [15], we predicted that reen-
gagement, flexibility, and tenacity would have a positive
association with purpose in life [15], and that disengage-
ment would have an association with lower levels of
rumination [9].
In line with previous studies, we predicted that pur-
pose in life would have a positive association with high
levels of well-being and daily functioning and lower lev-
els of pain intensity and impairment [38]. On the other
hand, we predicted that rumination would have a posi-
tive association with pain intensity and impairment and
a negative association with well-being and functioning.
Methods
Participants were patients with chronic musculoskeletal
pain. All participants were fully informed of the aim of
the study, and given guarantees of personal anonym-
ity and the confidentiality of the survey. Subsequently,
their consent was obtained to voluntarily participate in
thestudy.
Procedure
This study was part of a larger research project which was
approved by the University of Málaga Ethics Committee.
Participants were recruited through two local associa-
tions of patients with fibromyalgia (N=86; 33.3%), one
physiotherapy unit (N=90; 35%), and through doctors
working at the Pain Unit of the Hospital Costa del Sol
in Málaga (N=82; 31.7%). Data were collected between
March 2016 and December 2016. Individuals were con-
sidered eligible for inclusion if they met the following
criteria: At the moment of participation in the study,
they were experiencing musculoskeletal chronic pain, as
defined by experiencing pain for at least the last 6months,
at least 3days per week, at an intensity of 3 or more on a
0 to 10 scale; they were between 18 and 65years old; they
were not being treated for a malignancy, terminal illness,
or psychiatric disorder; they were able to understand the
Spanish language (spoken and written); and they were
able to understand the instructions and questionnaires.
Each participant had a semistructured interview with a
psychologist to obtain demographic, social, and medical
history data. The patients were always assessed in their
usual health center or in the facilities of the associations.
Measures
Dispositional optimism
The Spanish version [39] of the Life Orientation Test-
Revised (LOT-R) [40] was applied. The scale comprises
10 items: six scored items and four filler items. The
response format for each item is a five-point Likert-type
scale ranging from 0 (strongly disagree) to 4 (strongly
agree). In the present study, the LOT-R total score had
a Cronbach’s α of 0.90. High scores reflect greater dis-
positional optimism. The Spanish LOT-R has shown
adequate criteria validity [37].
Goal disengagement and goal reengagement
The goal disengagement and goal reengagement scale
[16] is a 10-item instrument that measures how people
usually react when they have to stop pursuing an impor-
tant goal (responses are scored on a five-point Likert-type
scales ranging from 1=almost never true to 5=almost
always true). Four items measure the tendency to disen-
gage from unattainable goals and six items measure the
tendency to reengage with new goals. The Spanish ver-
sion has adequate criteria validity, internal consistency,
and stability, and its factor structure is in line with the
original structure [41]. In this study, the goal disengage-
ment and the goal reengagement scales had a Cronbach’s
α of 0.70 and 0.94, respectively.
Fig.1. Hypothetical model.
ann. behav. med. (2019) 53:597–607 599
Tenacious goal pursuit and exible goal adjustment
The tenacious goal pursuit and flexible goal adjust-
ment scales [3] assess two distinct modes of coping
with goal disruption, respectively: tenacious goal pur-
suit and flexible goal adjustment. Respondents rate the
degree to which they agree with each statement on a
five-point Likert scale ranging from “fully disagree” to
“fully agree.” The Spanish version of the scales show
good levels of reliability and adequate criteria validity as
demonstrated by correlations with measures of positive
and negative affect and well-being [41]. In this study, the
tenacious goal pursuit and the flexible goal adjustment
scales had a Cronbach’s α of 0.80 and 0.81, respectively.
Rumination
The pain catastrophizing scale (PCS) is a 13-item meas-
ure in which respondents indicate on a five-point scale
the degree to which they experience various thoughts and
feelings while in pain [42]. Respondents rate the degree
to which they agree with each statement on a four-point
Likert scale ranging from “never” to “always.” The scale
comprises three subscales that assess rumination, magni-
fication, and helplessness, and also provides a total score
on catastrophizing. The rumination score alone was used
in this study. The Spanish version of the scale [43] shows
appropriate reliability and validity. Internal consistency
was high (rumination, α= 0.89; helplessness, α = 0.90;
magnification, α = 0.79; total PCS, α= 0.95). In this
study, the rumination scale had a Cronbach’s α of 0.93.
Purpose in life
The psychological well-being scales (PWBS) were devel-
oped by Ryff [44]. The original version consists of six
dimensions (autonomy, self-acceptance, positive rela-
tionships with others, environmental mastery, personal
growth, and purpose in life), each of which comprises
20 items. We used the Spanish version of the scale [45],
which was derived from the short version proposed by
van Dierendonck [46], and only measured Purpose in
life. As Ryff and Keyes [47] stated, high scores on this
scale mean that the individual has goals that make their
life purposeful. This scale comprises five items which are
scored on a six-point scale ranging from 1 (totally dis-
agree) to 6 (totally agree). The purpose in life subscales
had a Cronbach’s α of 0.70. In this study, the scale had a
Cronbach’s α of 0.89.
Personal well-being
The five-item World Health Organization Well-Being
Index (WHO-5) is a short generic global rating scale that
measures subjective well-being. Respondents rate the
extent to which they agree with a set of statements regard-
ing the frequency of their feelings during the previous 2
weeks on a six-point Likert scale ranging from “never”
to “all the time.” Bech etal. [48] found that the scale had
a Cronbach’s α of 0.84 and good levels of validity. The
Spanish version shows good internal consistency reliabil-
ity (Cronbach’s α =0.86) and good convergent validity.
In this study, the WHO-5 had a Cronbach’s α of 0.89.
Pain intensity
Patients were asked to rate their mildest, average, and
worst pain during the past 2 weeks, as well as their cur-
rent pain, on a scale ranging from 0 to 10, with a “0”
indicating “no pain” and “10” indicating pain as “intense
as you could imagine.” Acomposite pain intensity score
was calculated for each participant by calculating the
mean of the mildest, average, worst, and current pain
[49].
Functioning and impairment
Impairment and functioning were assessed using the
Impairment and Functioning Inventory IFI-R [50], which
consists of 30 items each referring to a specific activity
associated with one of the following areas: household,
autonomous behavior, leisure, and social relationships.
Patients are asked if they performed an activity during
the previous week. If they did not perform the activity,
they are asked if they practiced this activity before the
onset of their pain. The instrument provides an index of
daily functioning, and an index of activity impairment.
Both subscales showed good internal consistency (daily
functioning, α =0.93; impairment, α=0.98) and good
levels of convergent and criterion validity [50]. In this
study, the global scales were both highly reliable (daily
functioning, α=0.87; impairment, α=0.92).
Statistical Analysis
Firstly, we analyzed correlations between the observed
variables included in the model. Then, multiple regres-
sion analyses were performed in order to determine the
possible existence of an interaction between disengage-
ment and reengagement. Thus, the effect of disengage-
ment × reengagement interaction on rumination and
purpose in life (criterion variables) was tested. The pre-
dictor variables were centered prior to entry to avoid the
biasing effects associated with multicollinearity that can
occur when examining interaction terms. All analyses
were conducted using the SPSS version22.0.
Finally, the hypothetical model (Fig.1) was then tested
via structural equation modeling (SEM) using LISREL
8.30 software. We checked the data prior and found that
some variables were not normally distributed. Thus, we
600 ann. behav. med. (2019) 53:597–607
used the maximum likelihood estimation method because
this is effective for any data distribution if the analyses
are performed on covariance matrices, and the matrix of
fourth-order moments is provided [51]. The following
goodness-of-fit indexes were used: the Satorra–Bentler
chi-square, the root mean-square error of approxima-
tion (RMSEA), the comparative fit index (CFI), and the
nonnormed fit index (NNFI). The Satorra–Bentler chi-
square is a chi-square fit index that corrects the statistic
under distributional violations. To reduce the sensitivity
of chi-square to sample size, the index is divided by the
degrees of freedom [52]. Ratios of 2 or less are indicative
of an acceptable fit of the model [53]. The RMSEA is
an absolute misfit index: the closer to zero, the better the
fit. Values less than 0.08 indicate an adequate fit [54, 55].
The CFI and the NNFI range between 0 and 1, where
the closer to 1, the better the fit [55].
Optimism was the exogenous variable in the model
(Fig.1). Endogenous variables were tenacious goal pur-
suit, flexible goal adjustment, goal disengagement, goal
reengagement, rumination, purpose in life, intensity of
pain, well-being, functioning, and impairment.
Results
Participants
A total of 388 patients with chronic musculoskeletal pain
were invited to take part in the study. Of these patients,
98 refused participation, and 32 did not meet the inclu-
sion criteria. The final sample comprised 258 chronic
pain patients (209 women and 49 men). The average age
was 52years (SD=9.75). At the time of the study, 71.30
per cent were married or cohabiting. Regarding employ-
ment, 38.80 per cent were active workers, 24 per cent
were retired, 21.30 per cent were unemployed, and 14.40
per cent were homemakers. Atotal of 13.20 per cent had
completed a college degree, 32.80 per cent had completed
high-school education, and 39.80 per cent had com-
pleted primary education. Generalized pain conditions
were the most frequent (44.52%), and the main pain sites
were the back (26.14%) and knees (14.13%). Mean pain
duration was 12.38years (SD=11.05), and mean pain
intensity was 6.49 (SD = 1.40).
Descriptive Statistics
Table1 shows the mean scores, standard deviations, and
correlation coefficients for all measures.
The guidelines proposed by Cohen [56] were used to
assess correlations. Low correlations range from 0.10 to
0.29, moderate correlations from 0.30 to 0.49, and high
correlations from 0.50 to 1.As shown in the table, opti-
mism had high positive correlations with reengagement,
Table1 Descriptive statistics and correlations among measures
MSD Range 1 2 3 4 5 6 7 8 9 10 11
1. Optimism 14.66 5.7 0–24 1
2. Reengagement 17.12 4.0 5–25 0.65** 1
3. Disengagement 9.58 2.7 4–18 −0.54** −0.51** 1
4. Flexibility 24.05 5.4 8–35 0.60** 0.48** −0.31** 1
5. Tenacity 42.68 8.3 21–62 0.55** 0.40** −0.59** 0.54** 1
6. Rumination 11.59 5.8 6–24 −0.60** −0.55** 0.52** −0.37** −0.41** 1
7. Purpose in life 20.21 5.9 5–30 0.67** 0.51** −0.51** 0.52** 0.52** −0.44** 1
8. Well-being 11.04 5.5 0–25 0.65** 0.55** −0.48** 0.48** 0.47** −0.59** 0.71** 1
9. Pain 6.49 1.4 0–10 −0.23** −0.15* −0.02 −0.19** −0.05 0.12 −0.25** −0.32** 1
10. Functioning 47.8 13.9 18–105 0.45** 0.28** −0.30** 0.33** 0.32** −0.25** 0.52** 0.52** 0.12 1
11. Impairment 3.82 3.7 0–16 −0.50** −0.45** 0.42** −0.28** −0.33** 0.59** −0.43** −0.60** 0.29** −0.64** 1
M means; SD standard deviations; range minimum and maximum scores; Pearson’s correlations: *p < .05; **p < .001.
ann. behav. med. (2019) 53:597–607 601
flexibility, purpose in life, and well-being, but negative
correlations with rumination. Reengagement had high
positive correlations with purpose in life and well-being,
and negative correlations with disengagement and ru-
mination. Disengagement had a positive association
with rumination and a negative correlation with purpose
in life and tenacity. Flexibility and tenacity had high
positive correlations with purpose in life. Well-being
had high negative correlations with rumination and
a positive correlation with purpose in life. Daily func-
tioning had a high correlation with purpose in life and
well-being. Finally, impairment had a high positive cor-
relation with rumination and a high negative correlation
with well-being.
Regression Analyses
Disengagement and reengagement should not be under-
stood as opposite poles of a continuum, but as independent
constructs, as research has found small- to moderate-size
correlations between them (r = −0.51 in the current
study). The moderate correlation between disengagement
capacity and reengagement capacity raises the possibility
that the two dimensions might interact [7, 16]. The results
of multiple regression analysis showed that reengagement
and disengagement contributed significantly to the predic-
tion of purpose in life (R2 change=0.34; p=.000; reen-
gagement: β=0.34, p= .000; disengagement: β=−0.34,
p=.000) and rumination (R2 change=0.38; p=.000; reen-
gagement: β=−0.35, p= .000; disengagement: β=0.36,
p=.000). However, disengagement × reengagement inter-
action did not make an additional significant contribution
to the prediction of rumination (β =0.07, p= .19) and
purpose in life (β=0.03, p=.60), being excluded from the
model in both cases.
Structural Equation Modeling
Table2 shows the standardized coefficients of the initial
model. Table3 shows the goodness-of-fit indexes of the
initial and final models.
To obtain a parsimonious model of the relationship
between the variables, and following the recommenda-
tions of the Lagrange multiplier test [51], we deleted all
the nonstatistically significant paths of the initial model.
Thus, paths from rumination to pain and from rumina-
tion to functioning were excluded.
Figure 2 represents the final model. All path coeffi-
cients were statistically significant (p < .05). The good-
ness-of-fit indexes calculated for the SEM indicate
that the estimated model provides a good fit to the
data (χ2(df) = 61.91 (39), p = .08; RMSEA = 0.048;
NNFI =0.99; CFI=0.99). Figure2 shows the stand-
ardized beta (β) and gamma (γ) coefficients. The β and γ
coefficients can be interpreted as follows: β indicates that
a change unit in an endogenous variable is associated
with β-change units in another endogenous variable,
whereas all other variables remain constant. γ indicates
that a change unit in an exogenous variable (optimism)
is associated with γ-change units in an endogenous
variable.
As expected, optimism had a significant positive asso-
ciation with reengagement, tenacity, and flexibility, but,
surprisingly, it had a negative association with disen-
gagement. In addition, the increased use of reengage-
ment, flexibility, and tenacity as strategies to manage
goals was associated with higher levels of purpose in life.
Although a negative association between disengagement
and rumination was expected, the positive association
was found between these variables, with patients charac-
terized by higher levels of disengagement showing higher
Table2 Initial model
Optimism Reengagement Disengagement Flexibility Tenacity Rumination Purpose in life
γ β β β β β β
Reengagement 0.52
Disengagement −0.64
Flexibility 0.63
Tenacity 0.86
Rumination 0.51
Purpose in life 0.29 0.24 0.27
Well-being −0.36 0.59
Pain 0.01 −0.25
Functioning −0.02 0.51
Impairment 0.51 −0.21
Standardized γ and β coefcients.
Empty cells correspond to relationships not included in the hypothetical model.
602 ann. behav. med. (2019) 53:597–607
levels of rumination. Rumination had a negative asso-
ciation with well-being and a positive association with
impairment; thus, patients with higher levels of rumina-
tion reported lower levels of well-being and higher lev-
els of impairment. Finally, purpose in life yielded four
significant path coefficients: two negative paths to pain
intensity and to impairment, and two positive associa-
tions with well-being and daily functioning. Regarding
pain intensity, the participants had high levels of pain
with little difference between levels, which may explain
the low variance accounted for in the pain outcome in
the SEM analyses.
Discussion
The aim of this study was to investigate the relationship
between optimism, goal adjustment, and adaptation
in patients with chronic pain. The results show a posi-
tive and significant association between optimism and
reengagement, flexibility, and tenacity. Therefore, in line
with previous studies [26, 29, 30], patients high in opti-
mism seem to be flexible when negotiating competition
between goals, reengage with new attainable goals, and
behave tenaciously with valuable ones. However, sur-
prisingly, a negative association was found between opti-
mism and disengagement.
This result could be explained by the strong associ-
ation between optimism and tenacity. As Carver et al.
[19, 21] stated, dispositional optimism is a personality
trait that reflects the extent to which people hold gen-
eralized favorable expectations concerning their future.
These positive expectations are associated with pursuing
goals tenaciously, because they can probably be reached.
Therefore, positive expectations about the future could
lead patients high in optimism to reengage in new valu-
able goals without losing hope of reaching other goals
that are more difficult to achieve.
Another unexpected finding was a positive association
between disengagement and rumination. As mentioned,
Arends’ theory [15] states that successful disengagement
could contribute to quality of life by preventing the stress
of repeated failure and continued rumination concerning
the unattainable goal [7–9]. In the present study, it was
found that higher levels of disengagement were associ-
ated with higher levels of rumination; this result is the
opposite of the hypothesis formulated. It could be the
case that patients, who abandon some important goals,
even if they are unreachable, may continue to ruminate
on the issues involved. It is also noteworthy that high
disengagement was not accompanied by reengagement
in alternative goals. Goal adjustment theory [7, 16] pro-
poses that goal adjustment entails both disengaging from
the unattainable goal and reengaging in alternative goals.
Therefore, disengagement may only be beneficial if it is
accompanied by reengagement. However, multiple re-
gression analyses showed that since both disengagement
Table3 Goodness-of-t indexes
χ2 (df) RMSEA NNFI CFI
Initial model 59.08 (37) 0.048 0.99 0.99
Final model 61.91 (39) 0.048 0.99 0.99
RMSEA root mean-square error of approximation; NNFI non-
normed t index; CFI comparative t index.
Fig.2. Final model. Rectangles are observed variables, circles are standardized error variances, straight lines with arrows represent
presumed causal paths, values above the arrows represent standardized γ and β coefcients (p < .05), values in parentheses are standard
errors, and the curved line represents the correlation between the variables. Goodness-of-t indexes of the tested models: χ2(df)=61.91
(39), p =.08; RMSEA=0.04; NNFI=0.99; CFI=0.99.
ann. behav. med. (2019) 53:597–607 603
and reengagement contribute significantly to the predic-
tion of rumination and purpose in life, the interaction
of disengagement and reengagement does not make an
additional significant contribution to the prediction of
those criterion variables. Besides, the present study found
a negative correlation between disengagement and reen-
gagement, which suggests that patients disengaging from
goals were in general not able to reengage in alternative
goals. In the clinical setting, the concept of acceptance is
associated with orientating the patient’s attention toward
positive everyday activities and other rewarding goals [1,
57]. It could also be the case that the beneficial effects
of disengagement may also be dependent on the types
of goals given up. In the case of pain patients, when
pain persists and attempts to resolve it have repeatedly
failed, they may need to give up the goal of pain relief to
achieve adjustment [1]. Nevertheless, it should be borne
in mind that the present study measured disengagement
as the capacity to give up goals in general rather than
to only give up the goal of pain relief. This aspect is
demonstrated by two items on the disengagement sub-
scale: If Ihave to stop pursuing an important goal in my
life: It’s easy for me to reduce my effort toward the goal;
Idon´t stay committed to the goal for a long time; Ican
let it go. On the other hand, as expected, a positive asso-
ciation was found between rumination and impairment
and a negative one between rumination and well-being,
although no association was found among rumination,
functioning, and intensity of pain. We assessed rumin-
ation using the pain catastrophizing scale (rumination
subscale) [42]. Several studies on the role of catastro-
phizing in chronic pain have suggested that there is an
association between rumination and disability [58, 59].
The present study found that rumination, understood as
being an aspect of catastrophizing, seems to play a nega-
tive role in the levels of activity of patients with chronic
pain. In summary, patients with high levels of optimism
have high levels of tenacity and low levels of disengage-
ment. In addition, those who disengage also have higher
levels of rumination, which is associated with poor lev-
els of adaptation. Therefore, these results do not sup-
port Arends’ theory, because the role of disengagement
appears to be very similar to the role of avoidance as
described in the fear-avoidance model of pain [1, 2].
Thus, in patients with chronic pain, rather than disen-
gagement being used as a flexible way to manage goals, it
is used as an avoidance strategy.
In any case, more studies are needed to address
thisissue.
On the other hand, the results of the present path ana-
lysis showed that reengagement, flexibility, and tenacity
were associated with patients’ adaptation through pur-
pose in life. As expected, and in line with several stud-
ies [12, 14–16], patients high in optimism who reported
higher flexibility, tenacity, and reengagement with new
goals also had higher scores on purpose in life. We found
that purpose in life plays a central role between goal
adjustment strategies (reengagement, flexibility, and
tenacity) and multiple aspects of adaptation to chronic
pain: higher levels of well-being and daily functioning,
less impairment, and decreased pain intensity. Purpose
in life addresses the extent to which individuals see their
lives as having meaning, a sense of direction, and goals
to live for [38]. Thus, the effective management of goals
is associated with higher levels of purpose in life which,
in turn, is associated with patients’ adaptation and
well-being.
In summary, as Mens etal. [7] suggested, it is relevant
to identify the factors that facilitate goal adjustment pro-
cesses. Although there is considerable evidence linking
optimism and favorable outcomes, additional research is
needed to better understand the mechanisms that explain
how optimism exerts its effects on subjective well-being
and health [60]. The results of the present study suggest
that optimism is associated with the goal adjustment
process, and that the relationship between optimism and
the successful adaptation of patients with chronic pain
could be mediated by the effectiveness of goal adjust-
ment strategies, and levels of purpose in life. However,
in the present study, disengagement appeared to be an
ineffective goal adjustment strategy. In the study partic-
ipants, disengagement from goals was associated with
high levels of pain rumination which is ultimately asso-
ciated with higher levels of impairment and lower levels
of well-being. Based on the perspective of the fear-avoid-
ance model of pain [1, 2], it could be suggested that dis-
engagement is a way to avoid valuable activities that are
associated with impairment and low levels of subjective
well-being due to persistent negative thinking about pain
(pain rumination). Probably, there are functional simi-
larities and differences between healthy disengagement
behavior and unhealthy avoidance behavior. It is proba-
bly difficult for people to distinguish and report on the
differences. Therefore, it could be the case that measures
fail in detecting these differences with precision. Further
research is needed to investigate this aspect.
Given these results, the role of dispositional variables
such as optimism should be taken into account in clinical
contexts. In relation to pain, recent clinical and experi-
mental evidence suggests that positive affect and opti-
mism are two of the most important resilient resources
for successful adaptation to acute and chronic pain
[19, 31–36].. It seems that optimistic expectancies are
quite flexible [16, 23, 25, 26]. This flexibility allows peo-
ple to be realistic when they need to be, but optimistic
when they do not [61]. The positive contribution opti-
mism entailing the clinical setting has led to the devel-
opment of optimism interventions. Peters etal. [62] used
604 ann. behav. med. (2019) 53:597–607
the “Best Possible Self” (BPS) manipulation as a positive
future thinking technique based on the work of King
[63]. According to King, the BPS manipulation helps
people to have a clearer view of the goals they want to
reach. The results of the BPS manipulation in patients
with pain [64] showed that the use of an online positive
psychology intervention increased positive emotions
and optimism in patients with chronic pain, which led
to higher levels of happiness, optimism, positive future
expectancies, positive affect, self-compassion, and the
ability to live the life they wanted despite pain, and lower
scores on pain catastrophizing, depression, and anxiety.
Positive effect may also increase access to memories of
other positive experiences and facilitate the ability to
think creatively and flexibly. Therefore, training in opti-
mism [62] could increase the probability of using effective
goal adjustment strategies, thus leading to improvements
in levels of purpose in life, and ultimately, to improve-
ments in well-being and functioning.
This study has several limitations. Firstly, the par-
ticipants had high levels of pain with little difference
between levels. New studies using participants with dif-
ferent levels of pain would provide more information on
the association between psychological variables and the
intensity of perceived pain. The results of the study are
also limited by its exclusive reliance on self-report meas-
ures. In addition, the cross-sectional study design means
that causal associations cannot be identified and nature
of the data leave open the possibility that directions of
the causal paths could be different from those described.
Longitudinal methods could be used in future studies to
investigate the predictive value of dispositional variables,
as well as the role of goal adjustment in the adaptation
of patients with chronic pain.
Acknowledgements This research was supported by grants
from the Spanish Ministry of Science and Innovation (PSI2013-
42512-P) and the Regional Government of Andalusia (HUM-566;
CTS-278).
Compliance with Ethical Standards
Authors’ Statement of Conflict of Interest and Adherence to Ethical
Standards Authors Carmen Ramírez-Maestre, Rosa Esteve,
Alicia E. López-Martínez, Elena R. Serrano-Ibáñez, Gema
T. Ruiz-Párraga, and Madelon Peters declare that they have no
conflict of interest. All the procedures involving human partici-
pants were conducted 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 compar-
able ethical standards.
Primary Data This study was part of a larger research project
(Esteve, López-Martínez, Peters, Serrano-Ibáñez, Ruíz-Párraga,
González-Gómez, and Ramírez-Maestre, 2017; Esteve, Ramírez-
Maestre, Peters, Serrano, Ruiz-Párraga, and López-Martínez,
2016). This is an original analysis and it was neither published
nor sent anywhere. However, part of the analyses was presented
as a poster in 10th Congress of European Pain Federation
(EFIC), in Copenhagen, September 6–9, 2017. Recently, the Pain
Research and Management journal has accepted another paper title
Optimism, positive and negative affect, and goal adjustment strate-
gies: their relationship to activity patterns in patients with chronic
musculoskeletal pain. This and the current manuscript are both
part of the same research project (PSI2013-42512-P), although the
analyses are different. The authors have full control of all primary
data and that they agree to allow the journal to review their data
if requested.
Authors’ Contributions Authors whose names appear on the sub-
mission have contributed sufficiently to the scientific work and
therefore share collective responsibility and accountability for the
results. Upon request authors should be prepared to send rele-
vant documentation or data in order to verify the validity of the
results. This could be in the form of raw data, samples, records,
etc. Sensitive information in the form of confidential proprietary
data is excluded.
Ethical Approval The Ethics Committee of the University of
Málaga approved this study (CEUMA 2013-0016-H). This article
does not contain any studies with animals performed by any of
the authors. The data were collected in a manner consistent with
ethical standards for the treatment of human subjects, approved by
the University of Málaga Ethics Committee.
Informed Consent All the procedures followed were in accord-
ance with the ethical standards of the committee responsible for
human experimentation (institutional and national) and with
the 1975 Declaration of Helsinki (revised 2000). Informed con-
sent was obtained from all individual participants included in
the study.
References
1. Crombez G, Eccleston C, Van Damme S, Vlaeyen JW, Karoly
P. Fear-avoidance model of chronic pain: the next generation.
Clin J Pain. 2012;28:475–483.
2. Vlaeyen JW, Linton SJ. Fear-avoidance model of chronic
musculoskeletal pain: 12years on. Pain. 2012;153:1144–1147.
3. Brandtstädter J, Renner G. Tenacious goal pursuit and flex-
ible goal adjustment: Explication and age-related analysis of
assimilative and accommodative strategies of coping. Psychol
Aging. 1990;5:58–67.
4. Brandtstädter J, Rothermund K. The life-course dynamics of
goal pursuit and goal adjustment: a two-process framework.
Dev Rev. 2002;22:117–150.
5. Brands I, Stapert S, Köhler S, Wade D, van Heugten C. Life
goal attainment in the adaptation process after acquired
brain injury: the influence of self-efficacy and of flexibility
and tenacity in goal pursuit. Clin Rehabil. 2015;29:611–622.
6. Van Damme S, De Waegeneer A, Debruyne J. Do flex-
ible goal adjustment and acceptance help preserve quality
of life in patients with multiple sclerosis? Int J Behav Med.
2016;23:333–339.
7. Mens MG, Wrosch C, Scheier MF. Goal adjustment theory.
In: Whitbourne SK, ed. The Wiley-Blackwell Encyclopedia of
Adult Development and Aging. New York: Wiley-Blackwell;
2015.
8. Wrosch C, Scheier MF, Carver CS, Schulz R. The importance
of goal disengagement in adaptive self-regulation: when giv-
ing up is beneficial. Self Identity. 2003;2:1–20.
9. Barber LK, Grawitch MJ, Munz DC. Disengaging from a
task: lower self-control or adaptive self-regulation? J Individ
Dif. 2012;33:76–82.
ann. behav. med. (2019) 53:597–607 605
10. Van Randernborgh A, Hüffmeier J, LeMoult J, Joormann J.
Letting go of unmet goals: does self-focused rumination im-
pair goal disengagement? Motiv Emot. 2010;34:325–332.
11. Wrosch C, Bauer I, Scheier MF. Regret and quality of life
across the adult life span: the influence of disengagement and
available future goals. Psychol Aging. 2005;20:657–670.
12. Jobin J, Wrosch C. Goal disengagement capacities and se-
verity of disease across older adulthood: the sample case of
the common cold. Int J Behav Dev. 2016;40:137–144.
13. North RJ, Holahan CJ, Carlson CL, Pahl SA. From failure to
flourishing: the roles of acceptance and goal reengagement. J
Adult Dev. 2014;21:239–250.
14. Wrosch C, Scheier MF, Miller GE. Goal adjustment capaci-
ties, subjective well-being, and physical health. Soc Personal
Psychol Compass. 2013;7:847–860.
15. Arends RY, Bode C, Taal E, Van de Laar MA. The role of
goal management for successful adaptation to arthritis.
Patient Educ Couns. 2013;93:130–138.
16. Wrosch C, Scheier MF, Miller GE, Schulz R, Carver CS.
Adaptive self-regulation of unattainable goals: goal disen-
gagement, goal reengagement, and subjective well-being. Pers
Soc Psychol Bull. 2003;29:1494–1508.
17. Arends RY, Bode C, Taal E, Van de Laar MA. Exploring pref-
erences for domain-specific goal management in patients with
polyarthritis: what to do when an important goal becomes
threatened? Rheumatol Int. 2015;35:1895–1907.
18. Carver CS, Kus LA, Scheier MF. Effects of good versus
bad mood and optimistic versus pessimistic outlook on
social acceptance versus rejection. J Soc Clin Psychol.
1994;13:138–151.
19. Carver CS, Scheier MF, Segerstrom SC. Optimism. Clin
Psychol Rev. 2010;30:879–889.
20. Rasmussen HN, Scheier MF, Greenhouse JB. Optimism and
physical health: a meta-analytic review. Ann Behav Med.
2009;37:239–256.
21. Carver CS, Scheier MF. Dispositional optimism. Trends Cogn
Sci. 2014;18:293–299.
22. Nes LS, Segerstrom SC. Dispositional optimism and coping: a
meta-analytic review. Pers Soc Psychol Rev. 2006;10:235–251.
23. Hanssen MM, Vancleef LMG, Vlaeyen JWS, Hayes AF,
Schouten EGW, Peters ML. Optimism, motivational coping
and well-being: evidence supporting the importance of flex-
ible goal adjustment. J Happiness Stud. 2014;16:1–13.
24. Pavlova MK, Silbereisen RK. Dispositional optimism fos-
ters opportunity-congruent coping with occupational uncer-
tainty. J Pers. 2013;81:76–86.
25. Schmitz U, Saile H, Nilges P. Coping with chronic pain: flex-
ible goal adjustment as an interactive buffer against pain-re-
lated distress. Pain. 1996;67:41–51.
26. Wrosch C, Scheier MF. Personality and quality of life: the
importance of optimism and goal adjustment. Qual Life Res.
2003;12 (Suppl 1):59–72.
27. Aspinwall LG, Richter L. Optimism and self-mastery predict
more rapid disengagement from unsolvable tasks in the pres-
ence of alternatives. Motiv Emot. 1999;23:221–245.
28. Duke J, Leventhal H, Brownlee S, Leventhal EA. Giving up
and replacing activities in response to illness. J Gerontol B
Psychol Sci Soc Sci. 2002;57:P367–P376.
29. Rasmussen HN, Wrosch C, Scheier MF, Carver CS. Self-
regulation processes and health: the importance of optimism
and goal adjustment. J Pers. 2006;74:1721–1747.
30. Segerstrom SC, Nes LS. When goals conflict but people
prosper: the case of dispositional optimism. J Res Pers.
2006;40:675–693.
31. Geers AL, Wellman JA, Lassiter GD. Dispositional optimism
and engagement: the moderating influence of goal prioritiza-
tion. J Pers Soc Psychol. 2009;96:913–932.
32. Geers AL, Wellman JA, Seligman LD, Wuyek LA, Neff LA.
Dispositional optimism, goals, and engagement in health
treatment programs. J Behav Med. 2010;33:123–134.
33. Goodin BR, Kronfli T, King CD, Glover TL, Sibille K,
Fillingim RB. Testing the relation between dispositional opti-
mism and conditioned pain modulation: does ethnicity mat-
ter? J Behav Med. 2013;36:165–174.
34. Hanssen MM, Peters ML, Vlaeyen JW, Meevissen
YM, Vancleef LM. Optimism lowers pain: evidence
of the causal status and underlying mechanisms. Pain.
2013;154:53–58.
35. Hanssen MM, Vancleef LM, Vlaeyen JW, Peters ML.
More optimism, less pain! The influence of generalized and
pain-specific expectations on experienced cold-pressor pain.
J Behav Med. 2014;37:47–58.
36. Ramírez-Maestre C, Esteve R, López AE. The role of op-
timism and pessimism in chronic pain patients adjustment.
Span J Psychol. 2012;15:286–294.
37. Nes LS, Segerstrom SC. Dispositional optimism and coping: a
meta-analytic review. Pers Soc Psychol Rev. 2006;10:235–251.
38. Kim ES, Strecher VJ, Ryff CD. Purpose in life and use of
preventive health care services. Proc Natl Acad Sci USA.
2014;111:16331–16336.
39. Ferrando PJ, Chico-Librán E, Tous JM. Propiedades psi-
cométricas del test de optimismo life orientation test.
Psicothema. 2002;14:673–680.
40. Scheier MF, Carver CS, Bridges MW. Distinguishing opti-
mism from neuroticism (and trait anxiety, self-mastery, and
self-esteem): a reevaluation of the life orientation test. J Pers
Soc Psychol. 1994;67:1063–1078.
41. Soubrier E, Esteve R, Ramírez-Maestre C. Adaptación de las
escalas “Tenacious Goal Pursuit”, “Flexible Goal Adjustment”
y “Goal Disengagement and Goal Reengagement”. Escritos
de Psicología /Psychological Writings. 2017;10:103–115.
42. Sullivan MJL, Bishop SC, Pivik J. The pain catastrophiz-
ing scale: development and validation. Psychol Assess.
1995;7:524–532.
43. Muñoz M, Esteve R. Reports of memory functioning by
patients with chronic pain. Clin J Pain. 2005;21:287–291.
44. Ryff C. Beyond ponce de leon and life satisfaction: new
directions in quest of successful aging. Int J Behav Dev.
1989;12:35–55.
45. Díaz D, Rodríguez-Carvajal R, Blanco A, etal. Adaptación
española de las escalas de bienestar psicológico de Ryff.
Psicothema. 2006;18:572–577.
46. Van Dierendonck D. The construct validity of Ryff ’s scale
of psychological well-being and its extension with spiritual
well-being. Pers Individ Dif. 2004;36:629–644.
47. Ryff CD, Keyes CL. The structure of psychological well-being
revisited. J Pers Soc Psychol. 1995;69:719–727.
48. Bech P, Olsen LR, Kjoller M, Rasmussen NK. Measuring
well-being rather than the absence of distress symptoms:
a comparison of the SF-36 mental health subscale and the
WHO-five well-being scale. Int J Methods Psychiatr Res.
2003;12:85–91.
49. Jensen MP, Turner JA, Romano JM, Fisher LD. Comparative
reliability and validity of chronic pain intensity measures.
Pain. 1999;83:157–162.
50. Ramírez-Maestre C, Esteve R. A new version of the impair-
ment and functioning inventory for patients with chronic
pain (IFI-R). Pm R. 2015;7:455–465.
606 ann. behav. med. (2019) 53:597–607
51. Batista JM, Coenders G. Modelos de Ecuaciones Estructurales.
Madrid: La Muralla; 2000.
52. Bentler PM. Comparative fit indexes in structural models.
Psychol Bull. 1990;107:238–246.
53. Kline RB. Principles and Practice of Structural Equation
Modeling. 3rd ed. New York: Guilford Press; 2005.
54. Hu L, Bentler PM. Fit indices in covariance structure mod-
elling: sensitivity to underparameterized model misspecifica-
tion. Psychol Methods. 1998;3:424–453.
55. Hu L, Bentler PM. Cutoff criteria for fit indexes in covari-
ance structure analysis: conventional criteria versus new
alternatives. Struc Equ Modeling. 1999;6:1–55.
56. Cohen JW. Statistical Power Analysis for the Behavioral Sciences.
2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
57. McCracken LM, Vowles KE, Eccleston C. Acceptance of
chronic pain: Component analysis and a revised assessment
method. Pain. 2004;107:159–166.
58. Ramírez-Maestre C, Esteve R, López-Martínez A. Fear-
avoidance, pain acceptance and adjustment to chronic pain: a
cross-sectional study on a sample of 686 patients with chronic
spinal pain. Ann Behav Med. 2014;48:402–410.
59. Ramírez-Maestre C, Esteve R, Ruiz-Párraga G, Gómez-Pérez
L, López-Martínez AE. The key role of pain catastrophizing
in the disability of patients with acute back pain. Int J Behav
Med. 2017;24:239–248.
60. Forgeard MJC, Seligman MEP. Seeing the glass half full: a
review of the causes and consequences of optimism. Prat
Psychol. 2012;18:107–120.
61. Armor DA, Taylor S. Situated optimism: specific outcome
expectancies and self-regulation. Adv Exp Soc Psychol.
1998;30:309–379.
62. Peters ML, Smeets E, Feijge M, etal. Happy despite pain:
a randomized controlled trial of an 8-week internet-de-
livered positive psychology intervention for enhancing
well-being in patients with chronic pain. Clin J Pain.
2017;33:962–975.
63. King LA. The health benefits of writing about life goals. Pers
Soc Psychol Rev. 2001;27:798–807.
64. Boselie JJLM, Vancleef LMG, Peters ML. Filling the glass:
effects of a positive psychology intervention on execu-
tive task performance in chronic pain patients. Eur J Pain.
2018;22:1268–1280.
ann. behav. med. (2019) 53:597–607 607
