A Prospective Investigation of Acceptance and Control-Oriented Coping with Chronic Pain

Pain Management Unit, Royal National Hospital for Rheumatic Diseases, University of Bath, Bath, BA1 1RL, UK.
Journal of Behavioral Medicine (Impact Factor: 3.1). 09/2007; 30(4):339-49. DOI: 10.1007/s10865-007-9104-9
Source: PubMed


Historically, investigations of coping with chronic pain primarily have sought methods for gaining greater control over pain and pain-related distress. Recently, it has been suggested to expand the framework of coping so that control efforts are redirected from circumstances where they fail, and so that coping can more explicitly incorporate potentially more practical and flexible notions of acceptance. The purpose of the present study was to evaluate the role of control-oriented and acceptance-oriented coping responses for patient functioning using a prospective design. Participants included 120 adult patients with chronic pain who completed measures of coping, pain, disability, depression, and pain-related anxiety at two time points, separated by an average of 3.7 months (SD = 2.6 months). Factor analyses revealed four factors within the coping data: Pain Management, Pain Control, Help Seeking, and Activity Persistence. A series of correlation and linear regression analyses was performed to assess the relations of these factors at initial assessment to functioning later in time. In general, Activity Persistence was associated with better functioning over time while control-oriented responses were associated with greater difficulty. The factor representing more or less traditional pain management methods showed surprisingly limited relations with aspects of patient functioning. Analyses of concurrent change in coping and functioning highlighted a unique, apparently unhelpful, role of Pain Control. These results support the inclusion of contextual acceptance-related processes in current frameworks for understanding adjustment to chronic pain.

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Available from: Kevin Vowles, Sep 11, 2014
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    • "We developed an acceptance-oriented CBT aimed at reducing psychological distress and stimulating cognitive-behavioral change for highly distressed patients with rheumatic diseases to be embedded in a multimodal rehabilitation program [20]. The choice for an acceptance-oriented CBT over traditional CBT or acceptance and commitment therapy (ACT) was theoretically grounded in the dual-process coping model [21] that stresses the fit between characteristics of the situation and the employed coping strategy and it was guided by evidence-based cognitive therapy principles [22] and by empirical evidence on the role of acceptance and coping flexibility in the adjustment to a chronic illness [23] [24] [25] [26] [27]. Patients with rheumatic diseases will need to deal with the adverse consequences of the disease and with a progressive, fluctuating, and often unpredictable disease course. "
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    ABSTRACT: OBJECTIVE: To examine the potential effectiveness of a multimodal rehabilitation program including an acceptance-oriented cognitive-behavioral therapy for highly distressed patients with rheumatic diseases. METHODS: An observational study employing a one-group pre-post test design (N=25). The primary outcome was psychological distress. Secondary outcomes were quality of life, illness acceptance, and coping flexibility. Group pre-to-post and pre-to-12 months follow-up treatment changes were evaluated by paired-samples t-tests and Cohen's effect sizes (d). Individual changes were evaluated by the reliable change index (RCI) and clinically significant change (CSC) parameters. RESULTS: Significant effects were found post-treatment and maintained at 12 months in psychological distress (d>0.80), illness acceptance (d=1.48) and the SF-36 subscales role physical, vitality, and mental health (d≥0.65). No significant effects were found for coping flexibility and the SF-36 subscales physical functioning, bodily pain, social functioning, and role emotional. Both a reliable (RCI) and clinically significant (CSC) improvement was observed for almost half of the highly distressed patients. CONCLUSION: The patients enrolled in the multimodal rehabilitation program showed improved psychological health status from pre to post-treatment. PRACTICE IMPLICATIONS: A randomized clinical trial is needed to confirm or refute the added value of an acceptance-oriented cognitive-behavioral therapy for highly distressed patients in rehabilitation.
    Full-text · Article · Feb 2013 · Patient Education and Counseling
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    • "In conclusion, patients with CRPS-I cope with pain on a daily basis, and they experience fluctuations in their pain, activity and mood across days. Acceptance has been shown to be correlated with positive pain-related outcomes (McCracken et al., 2007 "
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    ABSTRACT: This study aimed to examine the temporal patterning of pain acceptance-based coping, activity, and mood in patients with complex regional pain syndrome Type I (CRPS-I), by using a daily diary method. A total of 30 patients with CRPS-I seeking treatment in a tertiary pain management center located in Seoul, Korea participated in the study. Multilevel random effects analyses indicated that (a) engagement in pain acceptance-based coping was significantly associated with lower same-day pain and negative mood and greater same-day activity and positive mood; (b) pain acceptance-based coping predicted increases in activity on the following day; (c) greater pain intensity was significantly associated with lower same-day pain acceptance-based coping and activity and greater same-day negative mood; and (d) pain intensity did not predict pain acceptance-based coping, activity, or mood on the following day. These findings suggest that patients with CRPS-I may benefit from responding to pain with acceptance. Further study and eventual application of this process in CRPS-I may improve upon the success of current approaches to this problem.
    Full-text · Article · Aug 2012 · Journal of Behavioral Medicine
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    • "L'horizon de notre consultation et celui de leur vie s'enrichira, la douleur sera là, mais il y aura aussi d'autres choses, vers lesquelles se diriger avec eux. C'est cette possibilité de redéploiement vers la vie – alors que la douleur est encore présente et qu'elle nous a mis tous mis en e ´chec quand on ne faisait que s'occuper d'elle – que soulignent les récents travaux [16] [20] qui prônent de s'investir dans ce que l'on peut piloter. Il est intéressant d'entendre les patients qui ont pu « lâcher » une lutte par rapport a ` leur douleur et reprendre le volant de leur vie – il est vrai avec la douleur, mais la douleur n'a plus ce caractère obnubilant d'avant. "
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    ABSTRACT: Most medical doctors close a consultation by a drug prescription, even if some doubts exist about the treatment efficacy. The aim of this paper is to open a discussion on the questions underlying this urge to prescribe and to make some proposals for the clinical practice. Firstly, the psychosocial factors which may question the relevance of the prescription will be discussed. These elements (unrealistic treatment expectancies, distrust or anger against caregivers, multiple earlier treatment failures, or a relatively balanced situation) might threaten potential treatment benefits but may be difficult to identify and take into account. Secondly, some caution has to be made if the clinician decides to prescribe despite these psychosocial contraindications. It is then important to discuss with the patient the meaning of the treatment, its concrete aims and its practical modalities. Finally, observing that concluding a consultation without any prescription might be very uncomfortable for the caregiver, asks questions about the symbolic meaning of the prescription: need for the patient to be mothered, need "to keep up" for the doctor, biomedical reference frame observance. We conclude that, in spite of the anxiety raised when no prescription is made, the absence of prescription might paradoxically reopen the therapeutic process. Observing that pain may resist to the treatments allows a move towards broader objectives than symptom control. Such a change is possible only if it is recognised that the biological and psychosocial conditions of efficacy of the treatment are not, or will never be, optimal.
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