Psychological flexibility and traditional pain management strategies in relation to patient functioning with chronic pain: An examination of a revised instrument
Open accessAbstract
Unlabelled Recent developments in cognitive behavioral theory emphasize the role of "psychological flexibility" in adaptive functioning. Psychological flexibility includes processes of acceptance, mindfulness, values, and cognitive defusion. The present study was intended to investigate aspects of psychological flexibility in relation to the functioning of patients with chronic pain. Two hundred sixty patients seeking treatment for chronic pain completed a battery of measures, including an expanded version of an instrument assessing responses to pain that reflect both psychological flexibility and traditionally conceived "pain management strategies" (ie, pacing, relaxation, positive self-statements). Initial psychometric evaluation of the expanded instrument yielded 2 reliable subscales, as hypothesized. Both subscales were correlated with measures of emotional functioning and psychosocial disability, although psychological flexibility achieved larger correlations and was correlated with additional measures of physical functioning, health care use, and work status. Regression analyses indicated that, after pain and patient background variables were statistically controlled, psychological flexibility accounted for significant variance in eight separate measures of functioning while pain management strategies accounted for significant variance in none. These results may call for a shift in our approaches to chronic pain in line with developments taking place in broader areas of behavioral and cognitive therapy.Perspective This study includes development of an instrument for assessing coping, consisting of traditionally conceived coping strategies and a process that may be unfamiliar to most readers, termed "psychological flexibility." Results demonstrated that this process, a blend of acceptance, values-based action, mindfulness, and cognitive defusion, is significantly related to patient functioning with chronic pain.
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Psychological inflexibility is characterized by rigid behavioral repertoires aimed at avoiding pain and related distress, which may work well in the short term but over time result in a gradual decrease in functioning without any corresponding alleviation of pain or distress.
“Psychological inflexibility is characterized by rigid behavioral repertoires aimed at avoiding pain and related distress [14,15], which may work well in the short term, but over time result in a gradual decrease in functioning without any corresponding alleviation of pain or distress [16].”
From Baseline Pro-Inflammatory Cytokine Levels Moderate Psychological Inflexibility in Behavioral Treatment for Chronic Pain (2022) · cites this paper as [16]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThere is relatively broad support for the relevance of the processes studied here on patient outcomes.
“At the present time, there is relatively broad support for the relevance of the processes studied here on patient outcomes.”
From Acceptance and values-based action in chronic pain: A three-year follow-up analysis of treatment effectiveness and process (2011) · cites this paper as McCracken & Vowles, 2007
The Discussion (page not provided) reports significant associations between a measure of psychological flexibility and several aspects of functioning in patients with chronic pain. But its description of support as relatively broad goes beyond the paper’s qualification: acceptance has a relatively established literature, while mindfulness, values-related processes, and cognitive defusion have not been extensively studied. The paper also found little predictive benefit from traditional pain-management strategies. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThere are data available which parallel these findings in measures of chronic pain 'coping' behaviors and experimental settings with chronic pain patients.
“In particular, there are data available which parallel these findings in measures of chronic pain 'coping' behaviors (McCracken & Vowles, 2007; Vowles & McCracken, 2010) and experimental settings with chronic pain patients (Vowles et al., 2007).”
From Acceptance and values-based action in chronic pain: A three-year follow-up analysis of treatment effectiveness and process (2011) · cites this paper as McCracken & Vowles, 2007
Some of the six constituent processes of psychological flexibility are gaining prominence, especially acceptance and values-based action.
“Some of its six constituent processes of PF, however, are gaining prominence, especially acceptance, 4,10,11,18,26,56,58,69,84,87,97 and values-based action. 55,56,59,67,84”
From The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management (2014) · cites this paper as [58]
There are other trials that are pseudo-randomized, partly controlled, or pilot studies, a partial reanalysis of treatment outcome focused on older adults, and several larger scale effectiveness studies, including a large treatment cohort that showed good outcomes at three years post treatment.
“There are other trials that are pseudo-randomized, partly controlled, or pilot studies, 36,58,87 a partial reanalysis of treatment outcome focused on older adults, 54 and several larger scale effectiveness studies, 52,84 including a large treatment cohort that showed good outcomes at three years post treatment. 86”
From The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management (2014) · cites this paper as [58]
ACT has generated a wide array of applications including several treatment formats for chronic pain: three or four week residential group treatment delivered by an interdisciplinary team, individual treatment, self-administered workbooks with therapist support, via the internet, outpatient group treatment, and one-day workshop-based treatment.
“ACT has generated a wide array of applications including the following treatment formats for chronic pain: three or four week residential group treatment delivered by an interdisciplinary team, 58 individual treatment, 90 self-administered workbooks with therapist support, 75 via the internet, 7 outpatient group treatment, 91 and one-day workshop-based treatment. 16”
From The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management (2014) · cites this paper as [58]
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“These excessive behavioral patterns seem likely to result in significantly decreased adjustment in the long run (McCracken and Vowles 2007), and people who have restricted behavioral repertoire may feel more psychological vulnerability.”
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“Psychological inflexibility is characterized by rigid behavioral repertoires aimed at avoiding pain and related distress [14,15], which may work well in the short term, but over time result in a gradual decrease in functioning without any corresponding alleviation of pain or distress [16].”
Background
- Authors
- McCracken, L. M., & Vowles, K. E.
- Affiliations
- Royal National Hospital for Rheumatic Diseases (GB)
- Corresponding author
- McCracken, Lance M.
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2007-09
- Volume
- 8
- Issue
- 9
- Pages
- 700-707
- ISSN
- 1526-5900 (ISSN-L)
- OpenAlex
- W2165597306
- Cited by
- 103
- References
- 43
- Citations by year
- 2026: 1 · 2025: 7 · 2023: 2 · 2022: 5 · 2021: 2 · 2020: 6 · 2019: 5 · 2018: 4 · 2017: 2 · 2016: 6 · 2015: 10 · 2014: 7 · 2013: 6 · 2012: 9
- FWCI
- 9.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- 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
- psychological flexibility, chronic pain, pain management strategies, coping strategies, acceptance, mindfulness, cognitive defusion, values-based action, psychometric validation, psychosocial disability, physical function, health care utilization, employment status, cognitive behavioral therapy
- MeSH terms
- Activities of Daily Living, Adaptation, Psychological, Adult, Attitude to Health, Behavior, Chronic Disease, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Pain Measurement, Intractable Pain, Regression Analysis, Reproducibility of Results, Cognitive Behavioral Therapy
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