Meaningful coping with chronic pain: Exploring the interplay between goal violation,meaningful coping strategies and life satisfaction in chronic pain patients

Trying to cope with chronic pain is a highly demanding and challenging task and pain patients often need to reformulate goals or aspirations due to their pain condition. This goal violation is often related with experienced distress and requires coping processes in order to decrease the distress and stimulate a healthy adaptation. Some scholars, however, argued that in so‐called unsolvable or irreparable stressors such as chronic pain, conventional coping strategies like problem‐focused coping might not be the most adaptive option. In these situations, meaningful coping strategies attempting to transform the meaning of the stressful experience would be more accurate. In this study, we aim to test if goal violation triggers meaningful coping strategies over time and whether engagement in these meaningful coping strategies result in improved life satisfaction, as an indicator of adaptation. A longitudinal three wave study in a sample of paint patients (n = 125) tests whether goal violation triggers positive reappraisal and downward comparison, two possible meaningful coping strategies. The study furthermore tests if engagement in these strategies results in a better adaptation to the pain condition, reflected in higher life satisfaction. Results partially supported our hypotheses by pointing to the benevolent role of downward comparison on life satisfaction via decreased goal violation of pain patients. Our findings however did also show that positive reappraisal predicted lower life satisfaction via increased levels of appraised goal violation which questions the role of positive reappraisal as a genuine meaningful coping strategy. Implications and limitations are discussed.     

Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes

Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal.     

Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis

Pain-related avoidance factors and social resources, as assessed by pain coping and social support, are supposed to have lasting effects on functional disability and pain in chronic pain disorders. As a follow-up to a prospective study demonstrating short-term effects after one year (Behaviour Research and Therapy, 36, 179-193, 1998), the role of pain coping and social support at the time of diagnosis was investigated in relationship to the long-term course of functional disability and pain after three and five years in 78 patients with rheumatoid arthritis (RA), taking into account personality characteristics of neuroticism and extraversion, clinical status and use of medication. In line with findings at the one-year follow-up, results showed that more passive pain coping predicted functional disability at the three-year, but not the five-year follow-up. In addition, low levels of social support at the time of diagnosis consistently predicted both functional disability and pain at the three and five-year follow-ups. Results indicate that pain coping and social support, assessed very early in the disease process, can affect long-term functional disability and pain in RA, and suggest that early interventions focusing on pain-related avoidance factors and social resources for patients at risk may beneficially influence long-term outcomes in RA.     

Emotional congruence in older couples coping with wives' osteoarthritis: exacerbating effects of pain behavior

The authors examined congruence in the negative emotions (depression, anger) of 101 female osteoarthritis patients (M age = 69 years) and their caregiving husbands (M age = 71 years) and the extent to which patients' pain behavior (e.g., limping, rubbing joints) exacerbated linkages between partners' negative emotions. Associations between patients' and husbands' emotions were examined within domains (e.g., depression-depression) and across domains (e.g., depression-anger) over a 6-month interval. Regression analyses revealed that patients' initial levels of depressive symptoms and anger were related to increases in their husbands' anger over time. The associations between patients' depressive symptoms and their husbands' depressive symptoms and anger were conditioned by pain behaviors. Patients who were more depressed and who engaged in high levels of pain behavior had husbands who became more depressed and angry.     

Children's self-reported coping strategies: the role of defensiveness and repressive adaptation

This study examined differences in self-reported coping strategies across children classified according to Weinberger et al.'s (1979) adaptive style paradigm. Consistent with the larger literature, it was hypothesized that repressors (i.e. characterized by high self-reported defensiveness and low self-reported distress) would endorse fewer behaviorally and cognitively avoidant coping strategies than other adaptive style groups. Participants included 134 children, ranging in age from 10 to 13 (M=11.26, sd=.59), who completed measures of defensiveness, trait anxiety, and coping. Consistent with the hypotheses, results indicated significantly lower endorsement of avoidant coping strategies, and significantly higher endorsement of approach-oriented strategies among repressors, but no significant differences across adaptive style groups for other forms of coping. Results indicate that, consistent with other indicators of psychological functioning, the measurement of coping strategies is subject to the effects of socially desirable responding. Further, results provide evidence that measures of coping may be contaminated by items reflecting adjustment problems.     

Short report: correlates of functional disability with disease activity in elderly patients with rheumatoid arthritis

Rheumatoid arthritis (RA) prevalence increases with age and old people are special patient population. The recognition of functional disability related to RA could be challenging in elderly patients because aging itself and potential co-morbid disease may also cause functional disability. In this study, we aimed to look at the correlation between disease activity and functional disability in elderly RA patients. Elderly RA patients, ≥65 years old at their routine visits were included in the study. The composite ‘disease activity score’ in 28 joints (DAS-28) was used to determine disease activity groups. Health assessment questionnaire (HAQ) scores were calculated to describe the functional disability and compared across the disease activity groups. Two hundred and fifty-eight RA patients with the mean age of 71 ± 5 (65–90) and a total disease duration of 8.4 ± 8.5 (.5–50) years were recruited. The proportion of patients with high and moderate disease activity was 70%. HAQ scores were significantly correlated with disease activity (p < .05). Functional disability estimated by HAQ was correlated with disease activity in elderly patients with RA     

Children's self-reported coping strategies: The role of defensiveness and repressive adaptation

Abstract

This study examined differences in self-reported coping strategies across children classified according to Weinberger et al.'s (1979) adaptive style paradigm. Consistent with the larger literature, it was hypothesized that repressors (i.e. characterized by high self-reported defensiveness and low self-reported distress) would endorse fewer behaviorally and cognitively avoidant coping strategies than other adaptive style groups. Participants included 134 children, ranging in age from 10 to 13 (M=11.26, sd=.59), who completed measures of defensiveness, trait anxiety, and coping. Consistent with the hypotheses, results indicated significantly lower endorsement of avoidant coping strategies, and significantly higher endorsement of approach-oriented strategies among repressors, but no significant differences across adaptive style groups for other forms of coping. Results indicate that, consistent with other indicators of psychological functioning, the measurement of coping strategies is subject to the effects of socially desirable responding. Further, results provide evidence that measures of coping may be contaminated by items reflecting adjustment problems.     

Influence of the social context on use of surgical-lengthening and group-empowering coping strategies among people with dwarfism

Objective: To assess the role that social contextual factors exert on the way people with disproportionate short stature (dwarfism) cope with the negative consequences of discrimination. Method: Using multigroup structural equation modeling, we compare the coping process of people with dwarfism from Spain (N = 63) and the USA (N = 145), two countries that differ in the role played by organizations offering support to people with dwarfism. Results: In Spain, where organizational support is recent, a coping approach aimed at achieving integration with the majority group through limb-lengthening surgery prevails; in the USA, where the long-standing organization of people with dwarfism encourages pride in being a "little person" and positive intragroup contact, a coping strategy based on empowering the minority group dominates. Conclusions: Both strategies, each in its own context, are effective at protecting psychological well-being from the negative consequences of stigmatization; however, they exert their positive effects through different processes. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

A test of the impact of pain on automatic motivational processes in people with knee osteoarthritis

ObjectivePeople with osteoarthritis are likely to be physically inactive and current socio-cognitive approaches to changing physical activity in this patient population are generally ineffective. We assessed prospective associations between physical activity and the automatic processes of habit automaticity, automatic evaluations, and automatic self-schema in people with knee osteoarthritis.DesignOne-week prospective.Method253 adults (aged 46–82 years, 72% female, 28% male) with knee osteoarthritis self-reported their physical activity behaviour of the past week, habit automaticity for physical activity and completed two implicit association tests to assess automatic evaluations of physical activity (relative to sedentary behaviour) and automatic self-schema for physical activity. One week later, participants self-reported physical activity and pain while walking over the prior week. Linear regression models assessed associations of each automatic process with subsequent physical activity and the moderation effect of pain and each automatic process on subsequent physical activity, controlling for covariates.ResultsWe did not find evidence of a statistical relationship between physical activity with automatic evaluations, automatic self-schema, or habit automaticity. The inclusion of pain while walking did not moderate the relationship between any automatic process and physical activity.ConclusionAlthough previous research on healthy, young adults suggests that automatic processes affect physical activity behaviour, we did not find evidence to confirm whether a similar relationship exists for older adults with knee osteoarthritis. Replication and extension work testing these research questions is needed to ensure the findings are not a result of measurement and design features of the study.     

Attachment and behavioral addictions in adolescents: The mediating and moderating role of coping strategies

Gambling, video gaming, and Internet use are typically included as everyday activities that could potentially become behavioral addictions. There is growing evidence that views non‐substance related addictions as coping mechanisms, and considers that attachment styles are likely to play a pivotal role on the development of such addictions, especially on young people. Therefore, the present study aimed to: (1) explore the association between attachment, coping, and behavioral addictions (i.e., gambling disorder, video game addiction, and problematic Internet use); and (2) to analyze the mediating/moderating effect that coping has in the relationship of attachment and these behavioral addictions. A sample consisting of 472 students from secondary education (Mean age = 15.6; SD = 1.33; 51.6% females) was recruited. The findings showed a negative association between attachment and behavioral addictions. Most coping strategies were found to be associated with attachment styles, except for self‐critique and emotional avoidance. In particular, problem avoidance was significantly correlated to all behavioral addictions. In addition, self‐blame and problem solving were significantly correlated to video game addiction and problematic Internet use. Finally, coping was found to act as a mediator and moderator between attachment and video game addiction and problematic Internet use.     

On the protective role of identification with a stigmatized identity: Promoting engagement and discouraging disengagement coping strategies

We examined the mechanisms by which ingroup identification impacts well-being in stigmatized groups. Studies 1–3a were conducted among gay people in Europe and North America. Among gay people, the results suggest identification with homosexuals protected well-being via a decrease in self-group distancing (Studies 1–3a, N = 1,055). Other coping strategies were associated with identification but had no relationship with well-being. Identification was positively related to engagement coping strategies (i.e., collective action, group affirmation and ingroup support), and negatively related to disengagement strategies (i.e., ingroup blaming and avoidance of discrimination). Study 3b examined these mechanisms among Black Americans (N = 203). Again, identification was positively related to engagement coping, and negatively to disengagement; however, only collective action (positively) predicted well-being. Results are discussed in terms of how the effectiveness of different strategies for coping with stigma will differ depending on features of the intergroup context, such as the level of permeability of intergroup boundaries.     

Stress and coping in the elderly

Changing demographics indicate a significant increase in the number of surviving elderly, a decrease in the number of children in each family, and an increase in the number of surviving generations. Four guidelines are offered for minimizing the stress and maximizing the coping strategies of the elderly and their families: a) aging must be viewed as a life-span developmental experience, b) aging is a biopsychosocial phenomenon, c) supportive others can occupy critical positive or negative roles in the adaptation process, and d) the elderly and their families must develop proactive, anticipatory strategies for coping with the exigencies of age. These guidelines are offered to help the elderly face the challenge of aging successfully.     

The role of pain anxiety, coping, and pain self-efficacy in rheumatoid arthritis patient functioning

Anxiety about pain is increasingly recognized as one factor contributing to increased pain perception and pain behavior [McCracken, L. M., Faber S. D., & Janeck A. S. (1998) Pain-related anxiety predicts nonspecific physical complaints in persons with chronic pain. Behavior Research and Therapy, 36, 621-630; McCracken L., & Gross R. (1995). The pain anxiety symptoms scale (PASS) and the assessment of emotional responses to pain. Innovations in clinical practice: a source book, 14, 309-321]. To assess this emotional reaction to pain in chronic pain patients, McCracken, Zayfert and Gross [McCracken, L., Zayfert, C., & Gross, R. (1992). The Pain Anxiety Symptom Scale: development and validation of a scale to measure fear of pain. Pain, 50, 67-73] developed the Pain Anxiety Symptom Scale (PASS) composed of four subscales: Cognitive Anxiety, Fearful Appraisal, Escape Avoidance and Physiological Anxiety. The present study extended previous work by examining the relationship among pain anxiety dimensions, use of active and passive coping strategies and arthritis self-efficacy as predictors of functional status in 154 rheumatoid arthritis (RA) patients. Functional status was assessed using the Five-Factor Model of the Arthritis Impact Scale, 2nd ed., (AIMS2): Physical Functioning, Affective Experience, Symptoms, Social Interaction and Role Function. Hierarchical multiple regression analysis on each of the AIMS2 criterion variables showed that pain anxiety, pain and symptom self-efficacy, health status and coping strategies were able to explain between 9 and 38% of the variance in the five AIMS2 variables. The present results support the hypothesized role of pain anxiety along with previously established contributions of self-efficacy and coping strategies, in affecting physical, social, emotional and role functioning in chronic RA patients.     

Children's strategies for coping with stress: Blunting and monitoring

The present study examined children's suggestions for coping with uncontrollable stress, from the perspective of the monitoring/blunting distinction proposed by Miller (1987). Children in the first through sixth grades heard stories depicting four stressful situations that afforded little opportunity for control. Children's coping suggestions were classified as blunting (including reappraisal, cognitive distraction, and behavioral distraction), monitoring, or seeking support. Overall, blunting strategies were mentioned most often, followed by monitoring, and seeking support. A grade-level increase in blunting suggestions was found, and this developmental pattern was identical for reappraisal, cognitive distraction, and behavioral distraction. No grade-level differences were observed for monitoring or support. Situational differences in coping suggestions were explored, and there was mixed evidence of cross-situational consistency in coping style.The author would like to thank the staff and students of the Bell Top Child Care Centers and Kinder-Care Learning Center, Bloomington-Normal, Illinois. Thanks are also due to Cricket Blassage and Latoria Carroll for their help with the coding. This research was partially supported by a small grant from Illinois State University. An earlier version of this paper was presented at the meeting of the Society for Research in Child Development, Seattle, Washington, April, 1991.