Individual experiences of an acceptance-based pain management programme: An interpretative phenomenological analysis

Acceptance of pain has been found to play an important role in adjusting to chronic pain, and the evidence-base is growing with regards to the effectiveness of acceptance-based interventions such as acceptance and commitment therapy, mindfulness and contextual cognitive behavioural therapy within pain management settings. Despite the growing interest in such interventions, previous studies into acceptance-based pain management programmes (PMPs) are quantitative and the exact processes at work during such programmes remain unknown. This study aims to add to previous quantitative research in the area by qualitatively exploring individual experiences of attending an acceptance-based PMP and identifying the key constituents of the programme that participants felt facilitated change. Semi-structured interviews (n = 6) were analysed using interpretative phenomenological analysis, and five themes emerged: I’m not alone, others understand my pain, Freedom from pain taking over, A new self – one with pain, Parts of the programme participants felt facilitated change and Exercise is possible. These findings are then considered in relation to past research and relevant constructs in the literature. Implications for future research and clinical practice are also discussed alongside participant reflections and suggested areas for improvement.     

Quality of life research: a case for combining photo-elicitation with interpretative phenomenological analysis

In this article, we provide practical and theoretical discussion of the use of two complementary research methods to explore quality of life. We present a case example of the use of photo-elicitation alongside interpretative phenomenological analysis and use examples from our research with people living with paraplegia and chronic pain to demonstrate how these methods can be combined to provide a participant-led understanding of quality of life. This discussion includes consideration of practical and ethical issues relevant to others wishing to combine these research methods. Furthermore, we highlight some of the potential practical and therapeutic opportunities provided by the approach through an illustration of how photographs work to enhance self-reflection and promote hermeneutic sense making.     

Picturing ourselves in the world: Drawings,interpretative phenomenological analysis and the relational mapping interview

ABSTRACT

Some aspects of experience can be challenging for research participants to verbalise. Interpretative phenomenological analysis (IPA) researchers need to get experience-near to meet their phenomenological commitments, capturing the “texture” and quality of existence, and placing participants in relation to events, objects, others, and the world. Incorporating drawing into IPA designs provides a vehicle through which participants can better explore and communicate their lifeworlds. IPA researchers also require rich accounts to fulfil their interpretative commitments. Drawing taps into multiple sensory registers simultaneously, providing polysemous data, which in turn lends itself to hermeneutic analysis. This article outlines a multimodal method, the relational mapping interview, which was developed to understand the relational context of various forms of distress and disruption. We illustrate how the approach results in richly nuanced visual and verbal accounts of relational experience. Drawing on an “expanded hermeneutic phenomenology,” we suggest how visual data can be analysed within an IPA framework to offer significant experiential insights.     

Seeking support: An interpretative phenomenological analysis of an Internet message board for people with Complex Regional Pain Syndrome

In this article, we report on the findings of a qualitative inquiry into how an online message board for people who have Complex Regional Pain Syndrome (CRPS) was used by its members. All messages (and responses) posted on the CRPS message board over a 4-month period were collected retrospectively. The data were analysed using the method of Interpretative Phenomenological Analysis. Members used the message board to seek (and provide) support to those with CRPS, and also to express their emotions, feelings and experiences linked to their condition. The message board provided an important source of support for a patient group that can otherwise become isolated as a result of their mobility problems. Furthermore, the analysis revealed the unrealistic hopes that patients can hold concerning the anticipated outcomes of their treatment. This is an important issue for healthcare professionals to explicitly address when interacting with the patient group.     

Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review

The number of acceptance- and mindfulness-based interventions for chronic pain, such as acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), increased in recent years. Therefore an update is warranted of our former systematic review and meta-analysis of studies that reported effects on the mental and physical health of chronic pain patients. Pubmed, EMBASE, PsycInfo and Cochrane were searched for eligible studies. Current meta-analysis only included randomized controlled trials (RCTs). Studies were rated for quality. Mean quality did not improve in recent years. Pooled standardized mean differences using the random-effect model were calculated to represent the average intervention effect and, to perform subgroup analyses. Outcome measures were pain intensity, depression, anxiety, pain interference, disability and quality of life. Included were twenty-five RCTs totaling 1285 patients with chronic pain, in which we compared acceptance- and mindfulness-based interventions to the waitlist, (medical) treatment-as-usual, and education or support control groups. Effect sizes ranged from small (on all outcome measures except anxiety and pain interference) to moderate (on anxiety and pain interference) at post-treatment and from small (on pain intensity and disability) to large (on pain interference) at follow-up. ACT showed significantly higher effects on depression and anxiety than MBSR and MBCT. Studies’ quality, attrition rate, type of pain and control group, did not moderate the effects of acceptance- and mindfulness-based interventions. Current acceptance- and mindfulness-based interventions, while not superior to traditional cognitive behavioral treatments, can be good alternatives.     

Stigma and the delegitimation experience: An interpretative phenomenological analysis of people living with chronic fatigue syndrome

Individual in-depth interviews with 14 people with chronic fatigue syndrome (CFS) were conducted, focusing on the experience of living with CFS. The interviews were transcribed verbatim and were analysed for recurrent themes using interpretative phenomenological analysis (IPA). Here we present two inter-related themes: “Negotiating a diagnosis” and “Negotiating CFS with loved ones”. Participants reported delay, negotiation and debate over diagnosis: further, they perceived their GPs to be sceptical, disrespectful and to be lacking in knowledge and interpersonal skills. However, participants found delegitimising encounters with their partners more difficult to deal with. Participants viewed such delegitimation as a form of personal rejection; they were hurt by their loved ones’ reactions and subsequently pondered the price of love, respect and friendship. The findings are discussed in relation to extant literature, and recommendations for future research are suggested.     

Bullying as a group process: Participant roles and their relations to social status within the group

Bullying was investigated as a group process, a social phenomenon taking place in a school setting among 573 Finnish sixth-grade children (286 girls, 287 boys) aged 12–13 years. Different Participant Roles taken by individual children in the bullying process were examined and related to a) self-estimated behavior in bullying situations, b) social acceptance and social rejection, and c) belongingness to one of the five sociometric status groups (popular, rejected, neglected, controversial, and average). The Participant Roles assigned to the subject were Victim, Bully, Reinforcer of the bully, Assistant of the bully, Defender of the victim, and Outsider. There were significant sex differences in the distribution of Participant Roles. Boys were more frequently in the roles of Bully, Reinforcer and Assistant, while the most frequent roles of the girls were those of Defender and Outsider. The subjects were moderately well aware of their Participant Roles, although they underestimated their participation in active bullying behavior and emphasized that they acted as Defenders and Outsiders. The sociometric status of the children was found to be connected to their Participant Roles. © 1996 Wiley-Liss, Inc.     

The impact of maternal postnatal depression on men and their ways of fathering: an interpretative phenomenological analysis

Objectives: Postnatal depression affects approximately 15% of women in Western countries. There are conflicting findings about the effects on fathers as well as the extent to which fathers buffer against the negative effects of depression on children. This study sought to understand the ways in which maternal postnatal depression affects men and their ways of fathering.

Design: Narrative interviews were conducted with 14 British fathers (mean age?=?33.9?years) whose (ex)partners had experienced at least one episode of postnatal depression. Interviews explored how their partner’s depression affected them, the partner relationship, their children and their ways of fathering. Data were analysed with interpretative phenomenological analysis.

Results and Conclusions: Men felt that their partner’s depression led to significant physical and/or psychological maternal absence as well as a fracturing of the family unit, which had been an important ideological foundation for men’s fathering. Unequal divisions of labour, unfulfilled expectations, a thwarting of preferred ways of fathering and preoccupation with their partner’s depression took some men away from fathering. Others reported adaptation by accepting the loss of shared parenting and investing in an exclusive father–child relationship. Fathering appears to be particularly affected by the loss of a close adult relationship.     

Hurt feelings and four letter words: Swearing alleviates the pain of social distress

Methods for alleviating physical pain are increasingly found to attenuate social pain. Recent evidence suggests that swearing may attenuate sensitivity to physical pain. This study examined whether swearing similarly attenuates two consequences of social distress: social pain and exclusion‐induced hyperalgesia. Sixty‐two people wrote about an autobiographical experience of exclusion or inclusion. Then they repeated a swear or neutral word for 2 minutes followed by measures of social and physical pain. Excluded non‐swearers reported feeling more social pain and greater sensitivity to physical pain compared with included non‐swearers. Excluded swearers reported less social pain than excluded non‐swearers and no heightened sensitivity to physical pain. The findings suggest that social and physical pain are functionally similar and that swearing attenuates social pain.     

Quality of life and social support of patients being evaluated for bone marrow transplantation

A sample of 437 patients completed self-report measures of quality of life and social support while they were being evaluated for bone marrow transplantation (BMT) at The Johns Hopkins Oncology Center. Generally, the candidates showed reasonably high levels of quality of life (QOL) on the Satisfaction with Life Domains Scale (SLDS), their present ranking on the Cantril Self-Anchoring Ladder of Life, and their scores on the Bradburn Positive Affect Scale. The level of QOL of these candidates for transplant was significantly related to their level of social support. Both availability and adequacy of social support for these transplant candidates were found to be significantly related to QOL as measured by the SLDS. Availability of social support as measured by patient membership in religious and other organizations was significantly related to Positive Affect but not Negative Affect. The Family APGAR and Relational Support Scales measures of social support were significantly correlated with both Positive and Negative Affect.     

Bereavement,received social support,and anxiety in the elderly: A longitudinal analysis

Abstract

Determinants of anxiety and life satisfaction were examined among the elderly. Study I related the experience of stressful loss events, i.e., the death of a friend or family member, as well as received social support, to anxiety. Support buffered the effects of life events: Only those who received no support after loss were highly anxious. Study II explored determinants of anxiety and life satisfaction over a twelvemonth period. About half of the criterion variance could be explained. Perceived health turned out to be an influential predictor, whereas the role of social support remained ambiguous. The results are discussed in terms of social factors and emotions in the life of the elderly.     

Exploring the meaning in meaningful coincidences: An interpretative phenomenological analysis of synchronicity in therapy

Synchronicity experiences (SEs) are defined as psychologically meaningful connections between inner events (e.g. thought, dream or vision) and one or more external events occurring simultaneously or at a future point in time. There has been limited systematic research that has investigated the phenomenology of SEs in therapy. This study aimed to redress this by exploring the process and nature of such experiences from the perspective of the practitioner. Semi-structured face-to-face interviews were conducted with a purposive sample of nine practitioners who reported SEs in their therapeutic sessions (three counsellors, three psychologists and three psychotherapists), and focused on how participants make sense of their experiences of synchronicity in therapy. Interpretative phenomenological analysis was used to identify three superordinate themes: sense of connectedness, therapeutic process, and professional issues. Findings suggest that SEs can serve to strengthen the therapeutic relationship and are perceived as useful harbingers of information about the therapeutic process, as well as being a means of overcoming communication difficulties, as they are seen to provide insights into the client’s experiencing of themselves and others, regardless of whether or not the SE is acknowledged by the client or disclosed by the therapist.     

Trauma symptoms,temperament traits,social support and the intensity of pain in a Polish sample of patients suffering from chronic pain

The aim of the current study was to investigate the relationship between the intensity of pain, treated as the explained variable, and the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), temperament traits postulated by the Regulative Theory of Temperament and aspects of social support among patients suffering from chronic pain (arthritis and low-back pain). To assess the intensity of pain among participants we used the Numerical Rating Scale (NRS-11). The level of trauma symptoms was assessed with the PTSD Factorial Version inventory (PTSD-F). Temperament was measured with the Formal Characteristics of Behaviour – Temperament Inventory (FCB-TI). Social support was tested with the Berlin Social Support Scales (BSSS). The results of our study suggest that significant predictors of pain intensity among chronic pain sufferers were trauma symptoms. We also noticed that some temperament traits (i.e., emotional reactivity) increased the level of global trauma symptoms, which, in turn, intensified the level of pain. In addition, we showed that global trauma symptoms decreased the support participants actually received.     

Spirituality and psychological pain: the mediating role of social support

Spirituality is a multifaceted construct, and often studied as a one- or two-dimensional variable. Recent work has resulted in the development of the RiTE model of spirituality. While preliminarily supported as a useful approach to measuring spirituality, little is known regarding its associations with other outcomes. Past studies have shown inverse associations between spirituality and psychological distress, which appears to be partially a function of social support derived from spiritual beliefs or practices. As such, the present study tested the relationship between the RiTE dimensions and psychache as mediated by multiple types of social support. Parallel mediation results from an undergraduate sample (N?=?1994) showed that all three RiTE dimensions were indirectly associated with psychache via multiple forms of social support. Ritualistic and existential spirituality also displayed direct associations with psychache. Implications of these findings are discussed in the context of past literature, applicable theoretical constructs, and treatment considerations.     

Social integration and social support in a life crisis: Effects of macrosocial change in east Germany

The breakdown of the former communist system in East Germany was a major critical life event for those who left that country as well as for those who stayed behind. When the borders were opened, a longitudinal study was launched to examine the psychological readaptation process. Some indicators of social changes of migrants compared to nonmigrants were available. At three points in time over 2 years, both groups reported on their social bonding and social support. Migrants readjusted well by making new friends. In particular, young men were socially active, and more same-sex than opposite-sex friendships were established. The group of young migrants reported having received the most support, in particular when they had a partner. Anticipated support, in contrast, was highest for young single women who did not migrate. Results contribute to the understanding of social dynamics that occur after a stressful relocation.     

Understanding the impact of HIV diagnosis amongst gay men in Scotland: An interpretative phenomenological analysis

Objectives: Although a wide literature details the psychological impact of human immunodeficiency virus (HIV) diagnosis, it predates the introduction of effective treatment for HIV (i.e. anti-retroviral therapies, ARTs). This article explores the psychological impact of HIV diagnosis in post-ART accounts. This is important, given the recent policy developments which focus upon increasing HIV testing and thus diagnoses.

Design: This study presents a qualitative exploration of the experiential accounts of HIV-positive gay men living in Scotland. A total of 14 HIV-positive gay men took part in open-ended interviews.

Methods: Interpretative phenomenological analysis was employed to identify recurrent themes across the interviews.

Results: Our analysis focuses upon the participants’ struggles in adjusting to their HIV status. Diagnosis was a deeply shocking and unexpected experience. Stigma and fear of prejudice dominated their accounts. HIV was understood, variously, as a shameful, fatal and life-changing condition. Overall, within these accounts there was little sense of HIV normalisation.

Conclusions: In Scotland, where HIV prevalence is low, and where no accessible HIV-positive sub-culture exists, there is on-going psychological distress and morbidity amongst gay men testing HIV positive. As HIV-related policy increasingly focuses on increasing rates of antibody testing, there is a need to reduce the psychosocial costs associated with HIV-positive diagnoses.