The “self” in pain: The role of psychological inflexibility in chronic pain adjustment
Abstract
Self-discrepancy occurs when a person feels the failure to fulfill one's hopes or responsibilities. Although self-discrepancy has been widely examined to elucidate patients' chronic pain adjustment, the underlying mechanism is unclear. The present study proposes that the effect of self-discrepancy on pain outcomes is accounted for by psychological inflexibility, which involves the psychological processes that guide behaviors in the pursuit of goals and values. One-hundred patients with chronic pain were recruited from a public hospital. They were invited to participate in a semi-structured interview regarding their self-discrepancy and complete self-reported questionnaires regarding their psychological inflexibility and pain outcomes. The results confirmed that psychological inflexibility partly accounts for the variance observed between self-discrepancy and pain outcomes. The current study provides additional insight into the mechanism underpinning the impact of self-discrepancy on patients' pain adjustment and offers clinical implications regarding the use of acceptance commitment therapy for chronic pain management.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In chronic pain, low psychological flexibility is linked to higher pain impact and an increased risk of developing emotional disorders.
“In chronic pain, low PF was linked to higher pain impact and an increased risk of developing emotional disorders [32,33].”
From Personality and Pain Outcomes in Rheumatic Disease: The Mediating Role of Psychological Flexibility (2024) · cites this paper as [33]
Cites
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.51.6.1173 · Cited by 91,542 · see citing works
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
(2013) · Cited by 44,563 · see citing works
Preacher, K. J., & Hayes, A. F. (2008) · Behavior Research Methods · doi:10.3758/brm.40.3.879 · Cited by 34,117 · see citing works
Depression and quality of life in older persons: A review
Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A.-S. (2015) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000437299 · Cited by 14,152 · see citing works
Asymptotic Confidence Intervals for Indirect Effects in Structural Equation Models
Sobel, M. E. (1982) · Sociological Methodology · doi:10.2307/270723 · Cited by 12,810 · see citing works
Acceptance and commitment therapy: model, processes and outcomes
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.06.006 · Cited by 6,587 · cited 10× · see citing works
“fusion, (3) attachment to the conceptualized self, (4) dominance of the conceptualized past and feared future, (5) lack of values clarity and (6) inaction, impulsivity, or persistent avoidance (Hayes et al., 2006).”
BackgroundMethodInfluential(1999) · Cited by 5,934 · see citing works
Pain assessment: global use of the Brief Pain Inventory.
Cs, C., & Km, R. (1994) · PubMed · Cited by 5,178 · see citing works
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.03.007 · Cited by 3,950 · see citing works
Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms
Merskey, H. (1994) · Medical Entomology and Zoology · Cited by 3,362 · see citing works
Implementation intentions and goal achievement: a meta-analysis of effects and processes
Gollwitzer, P. M., & Sheeran, P. (2006) · Advances in Experimental Social Psychology · doi:10.1016/s0065-2601(06)38002-1 · Cited by 3,236 · cited 1× · see citing works
“Similarly, a review of chronic pain patients’ goal pursuits indicates that, whether a person initiates a goaldirected behavior is determined by their goal intention as well as their intention realization (Gollwitzer & Sheeran, 2006; Schrooten et al., 2012).”
BackgroundPsychological flexibility as a fundamental aspect of health
Kashdan, T. B., & Rottenberg, J. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.03.001 · Cited by 3,054 · cited 1× · see citing works
“Psychological flexibility emphasizes the flexibility to maintain or modify behaviors according to the situation at hand to pursue central interests and goals rather than narrowly concentrate on achieving happiness or short-term goals (Hayes et al., 1999; Kashdan & Rottenberg, 2010).”
BackgroundThe theory of decision making.
Edwards, W. (1954) · Psychological Bulletin · doi:10.1037/h0053870 · Cited by 2,710 · see citing works
International Association for the Study of Pain
Breivik, H. (2002) · Journal of Pain and Symptom Management · doi:10.1016/s0885-3924(02)00465-7 · Cited by 1,222 · see citing works
Acceptance of chronic pain: component analysis and a revised assessment method
McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004) · Pain · doi:10.1016/j.pain.2003.10.012 · Cited by 1,101 · see citing works
Annals of the Academy of Medicine, Singapore
(2020) · Annals of the Academy of Medicine Singapore · doi:10.47102/annals-acadmedsg · Cited by 742 · see citing works
Higgins, E. T., Klein, R., & Strauman, T. (1985) · Social Cognition · doi:10.1521/soco.1985.3.1.51 · Cited by 721 · see citing works
Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain
McCracken, L. M. (1998) · Pain · doi:10.1016/s0304-3959(97)00146-2 · Cited by 685 · see citing works
Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress.
McCracken, L. M., & Vowles, K. E. (2014) · American Psychologist · doi:10.1037/a0035623 · Cited by 627 · see citing works
Smith, J. A., & Osborn, M. (2007) · Psychology & Health · doi:10.1080/14768320600941756 · Cited by 579 · see citing works
Raes, F. (2010) · Personality and Individual Differences · doi:10.1016/j.paid.2010.01.023 · Cited by 535 · see citing works
McCracken, L. M., Vowles, K. E., & Eccleston, C. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.10.003 · Cited by 466 · cited 2× · see citing works
“…derived from the psychological flexibility model that focuses on observing thoughts and feeling as they are, without trying to change them, and behaving according to the desired values-based goals (Dahl & Lundgren, 2006; Hayes et al., 2006; McCracken & Vowles, 2014; McCracken et al., 2005).”
BackgroundMethodLeung, C. M., Wing, Y. K., Kwong, P. K., & Shum, A. L. K. (1999) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1999.tb10897.x · Cited by 407 · see citing works
Werner, A., Isaksen, L. W., & Malterud, K. (2004) · Social Science & Medicine · doi:10.1016/j.socscimed.2003.12.001 · Cited by 361 · see citing works
Wang, X. S., Mendoza, T. R., Gao, S.-Z., & Cleeland, C. S. (1996) · Pain · doi:10.1016/0304-3959(96)03147-8 · Cited by 308 · see citing works
The role of values in a contextual cognitive-behavioral approach to chronic pain
McCracken, L. M., & Yang, S.-Y. (2006) · Pain · doi:10.1016/j.pain.2006.02.021 · Cited by 260 · see citing works
Hann, K. E. J., & McCracken, L. M. (2014) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.10.001 · Cited by 259 · see citing works
Eccleston, C., Williams, A. C. D. C., & Rogers, W. S. (1997) · Social Science & Medicine · doi:10.1016/s0277-9536(96)00404-2 · Cited by 229 · see citing works
Esteve, R., Ramírez-Maestre, C., & López-Martínez, A. E. (2007) · Annals of Behavioral Medicine · doi:10.1007/bf02879899 · Cited by 226 · see citing works
Risdon, A., Eccleston, C., Crombez, G., & McCracken, L. M. (2002) · Social Science & Medicine · doi:10.1016/s0277-9536(02)00043-6 · Cited by 210 · see citing works
General psychological acceptance and chronic pain: There is more to accept than the pain itself
McCracken, L. M., & Zhao‐O'Brien, J. (2010) · European Journal of Pain · doi:10.1016/j.ejpain.2009.03.004 · Cited by 203 · see citing works
Lundgren, T., Dahl, J., & Hayes, S. C. (2008) · Journal of Behavioral Medicine · doi:10.1007/s10865-008-9151-x · Cited by 199 · see citing works
McCracken, L. M., & Velleman, S. C. (2010) · Pain · doi:10.1016/j.pain.2009.10.034 · Cited by 191 · see citing works
Schmitz, U., Saile, H., & Nilges, P. (1996) · Pain · doi:10.1016/0304-3959(96)03108-9 · Cited by 188 · see citing works
Goal Adjustment Capacities, Subjective Well‐being, and Physical Health
Wrosch, C., Scheier, M. F., & Miller, G. E. (2013) · Social and Personality Psychology Compass · doi:10.1111/spc3.12074 · Cited by 166 · see citing works
Role loss and emotional adjustment in chronic pain
Harris, S., Morley, S., & Barton, S. B. (2003) · Pain · doi:10.1016/s0304-3959(03)00251-3 · Cited by 152 · see citing works
Dezutter, J., Luyckx, K., & Wachholtz, A. (2014) · Journal of Behavioral Medicine · doi:10.1007/s10865-014-9614-1 · Cited by 134 · see citing works
Vowles, K. E., & McCracken, L. M. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.09.011 · Cited by 122 · see citing works
Do chronic pain patients ‘Stroop‘ on pain stimuli?
Pincus, T., Fraser, L. S. M., & Pearce, S. A. (1998) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.1998.tb01278.x · Cited by 103 · see citing works
McCracken, L. M., & Vowles, K. E. (2007) · The Journal of Pain · doi:10.1016/j.jpain.2007.04.008 · Cited by 103 · see citing works
Acceptance and related processes in adjustment to chronic pain
Thompson, M., & McCracken, L. M. (2011) · Current Pain and Headache Reports · doi:10.1007/s11916-010-0170-2 · Cited by 89 · see citing works
Bearden, D. J., Feinstein, A. B., & Cohen, L. L. (2012) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jss041 · Cited by 81 · see citing works
A Self-Regulation Perspective on Avoidance and Persistence Behavior in Chronic Pain
Damme, S. V., & Kindermans, H. P. J. (2014) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000096 · Cited by 75 · see citing works
Self-discrepancy in chronic low back pain: relation to pain, depression, and psychological distress
Waters, S. J., Keefe, F. J., & Strauman, T. J. (2004) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2003.07.001 · Cited by 73 · see citing works
Kindermans, H. P. J., Huijnen, I. P. J., Goossens, M. E. J. B., Roelofs, J., Verbunt, J., & Vlaeyen, J. W. S. (2011) · Pain · doi:10.1016/j.pain.2010.11.009 · Cited by 65 · see citing works
Hardin, E. E., & Leong, F. T. L. (2005) · Journal of Counseling Psychology · doi:10.1037/0022-0167.52.1.25 · Cited by 61 · see citing works
ACCEPTANCE AND COMMITMENT THERAPY (ACT) IN THE TREATMENT OF CHRONIC PAIN
DAHL, J., & LUNDGREN, T. (2006) · Mindfulness-Based Treatment Approaches · doi:10.1016/b978-012088519-0/50014-9 · Cited by 56 · see citing works
Self-pain enmeshment: Future possible selves, sociotropy, autonomy and adjustment to chronic pain
Sutherland, R., & Morley, S. (2007) · Pain · doi:10.1016/j.pain.2007.09.023 · Cited by 53 · see citing works
Validating measures of psychological flexibility in a population with acquired brain injury
Whiting, D. L., Deane, F. P., Ciarrochi, J., McLeod, H. J., & Simpson, G. K. (2015) · Psychological Assessment · doi:10.1037/pas0000050 · Cited by 45 · cited 2× · see citing works
“Throughout the process of accepting the post-injury self, psychological flexibility is essential to allow malleability in self-concept structure such that behaviors can be changed or redirected according to personal long-term values (Hayes et al., 1999; Whiting et al., 2015).”
BackgroundPsychological Interventions for Chronic Pain: Reviewed within the Context of Goal Pursuit
Schrooten, M. G. S., Vlaeyen, J. W. S., & Morley, S. (2012) · Pain Management · doi:10.2217/pmt.12.2 · Cited by 38 · see citing works
Ning, M. C., Ming, T. W. C., Mae, J. Y. C., & Ping, C. P. (2008) · The Journal of Pain · doi:10.1016/j.jpain.2008.04.005 · Cited by 37 · see citing works
Goossens, M. E. J. B., Kindermans, H. P. J., Morley, S., Roelofs, J., Verbunt, J., & Vlaeyen, J. W. S. (2009) · European Journal of Pain · doi:10.1016/j.ejpain.2009.11.012 · Cited by 37 · see citing works
Huijnen, I. P. J., Kindermans, H. P. J., Seelen, H. A. M., Peters, M. L., Smeets, R., Serroyen, J., Roelofs, J., Goossens, M. E. J. B., & Verbunt, J. (2011) · Pain · doi:10.1016/j.pain.2011.05.028 · Cited by 36 · see citing works
Cao, J. (2013) · Zhongguo xinli weisheng zazhi · Cited by 36 · see citing works
Yu, L., Norton, S., Harrison, A. M., & McCracken, L. M. (2015) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2015.10.003 · Cited by 30 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Hsieh, K.-Y., Hsiao, R. C.-J., Yang, Y., Lee, K., & Yen, C. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16173225 · Cited by 65 · see citing works
Living well with chronic pain: a classical grounded theory
Lennox Thompson, B., Gage, J., & Kirk, R. (2020) · Disability and Rehabilitation · doi:10.1080/09638288.2018.1517195 · Cited by 53 · see citing works
Bi, D., & Li, X. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.01.008 · Cited by 50 · see citing works
Validating measures of psychological flexibility in a population with acquired brain injury
Whiting, D. L., Deane, F. P., Ciarrochi, J., McLeod, H. J., & Simpson, G. K. (2015) · Psychological Assessment · doi:10.1037/pas0000050 · Cited by 45 · see citing works
Fang, S., & Ding, D. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1069748 · Cited by 34 · see citing works
Cognitive Biases in Chronic Illness and Their Impact on Patients' Commitment
Savioni, L., & Triberti, S. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.579455 · Cited by 31 · see citing works
Kato, T. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17207426 · Cited by 22 · see citing works
Akbari, M., Disabato, D. J., Seydavi, M., & Zamani, E. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.09.004 · Cited by 23 · see citing works
Jalali, Z. M., Farghadani, A., & Ejlali-Vardoogh, M. (2019) · Anesthesiology and Pain Medicine · doi:10.5812/aapm.78905 · Cited by 15 · see citing works
Rhodes, A., Marks, D., Block-Lerner, J., & Lomauro, T. (2021) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-020-09729-1 · Cited by 13 · see citing works
Gregory, V. L. (2019) · Springer eBooks · doi:10.1007/978-981-13-0440-8_5-1 · Cited by 9 · see citing works
Vas, S., Povey, R. C., & Clark-Carter, D. D. (2018) · Palliative Medicine · doi:10.1177/0269216318811723 · Cited by 7 · see citing works
Personality and Pain Outcomes in Rheumatic Disease: The Mediating Role of Psychological Flexibility
Cojocaru, C.-M., Popa, C. O., Schenk, A., Marian, Ș., Marchean, H., Suciu, B. A., Szasz, S., Popoviciu, H., & Mureșan, S. (2024) · Healthcare · doi:10.3390/healthcare12111087 · Cited by 6 · see citing works
“In chronic pain, low PF was linked to higher pain impact and an increased risk of developing emotional disorders [32,33].”
BackgroundYu, L., & McCracken, L. M. (2024) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2024.101972 · Cited by 6 · see citing works
Gregory, V. L. (2020) · Springer eBooks · doi:10.1007/978-981-13-6975-9_5 · Cited by 4 · see citing works
Moore, E., & Sitron, J. (2024) · Healthcare · doi:10.3390/healthcare12070798 · Cited by 2 · see citing works
Zhao, W. X., Liu, X., Deng, Y., & Wu, A. M. S. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100848 · Cited by 2 · see citing works
Malvini, W., Criddle, J. M., LaCour, M., & Sandoz, E. K. (2025) · Behavioral Sciences · doi:10.3390/bs15070875 · Cited by 2 · see citing works
Concept Analysis of Illness Acceptance in Chronic Disease: Application of Hybrid Model Method
Ko, I. S., Ji, H., Hong, S., & Jung, E. (2021) · Journal of Korean Academy of Fundamentals of Nursing · doi:10.7739/jkafn.2021.28.1.67 · Cited by 2 · see citing works
Age and psychosocial contributors to well-being among older adults living with chronic pain
Kohlert, A., Gallant, N. L., & Hill, T. G. (2024) · Cogent Psychology · doi:10.1080/23311908.2024.2320469 · Cited by 1 · see citing works
Pye, L., Gillett, J. L., Clegg, H., & Tilley, M. (2026) · Women s Reproductive Health · doi:10.1080/23293691.2025.2603689 · Cited by 1 · see citing works
Emotion Regulation Variability and Chronic Pain: An Ecological Momentary Assessment Study
Rogers, A. H., Zvolensky, M., Aaron, R. V., Lackner, J. M., Smit, T., Bakhshaie, J., & Gerhart, J. I. (2026) · Behaviour Research and Therapy · doi:10.1016/j.brat.2026.104977 · Cited by 1 · see citing works
Andonian, C., Beckmann, J., Freiberger, A., & Huber, M. (2024) · Springer eBooks · doi:10.1007/978-3-031-32046-0_7-1
Andonian, C., Beckmann, J., Freiberger, A., & Huber, M. (2025) · Springer eBooks · doi:10.1007/978-3-031-73363-5_7
- Authors
- Kwok, S. S. W., Chan, E. C. C., Chen, P. P., & Lo, B. C. Y.
- Affiliations
- University of Hong Kong (HK)
- Alice Ho Miu Ling Nethersole Hospital (CN)
- Corresponding author
- Lo, Barbara Chuen Yee
- ORCID
- Chen, Phoon Ping
- Venue
- Journal of Behavioral Medicine
- Published
- 2016-06-08
- Volume
- 39
- Issue
- 5
- Pages
- 908-915
- ISSN
- 0160-7715 (ISSN-L)
- 1573-3521
- OpenAlex
- W2413431785
- Cited by
- 24
- References
- 57
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2022: 1 · 2021: 3 · 2020: 4 · 2019: 4 · 2018: 1 · 2014: 1
- FWCI
- 2.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- Digital Commons - Lingnan (Lingnan University) (submittedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- self-discrepancy, psychological inflexibility, chronic pain, acceptance and commitment therapy, pain outcomes, self-regulation, goal pursuit
- MeSH terms
- Adaptation, Psychological, Female, Humans, Male, Pain Measurement, Surveys and Questionnaires, Self Concept, Stress, Psychological, Chronic Pain, Pain Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
