Exploring predictors of psychological distress in chronic pain
Research type
Research Study
Full title
The relationship between self-compassion, illness perceptions and anxiety and depression in individuals living with chronic pain.
IRAS ID
321236
Contact name
Gemma Cherry
Contact email
Sponsor organisation
University of Liverpool
Duration of Study in the UK
1 years, 4 months, 28 days
Research summary
Summary of Research
This study sets out to understand why some people with chronic pain go onto experience persistent psychological distress (i.e., anxiety and depression) and some individual's do not. To help us understand this, we will examine two models to see which best accounts for distress. These models will include the illness perception model which underpins Cognitive Behavioural Therapy and the self-compassion model underpinning Compassion Focussed Therapy.Summary of Results
Participants:
In total, 157 participants returned full datasets at baseline. A total of 71.3% identified as female and 95.59% White, with an average age of 47.35 years (SD 15.16), and widespread pain (23.9%) reported as the most common pain type. Eighty-seven (55.41%) also completed three-month follow-up questionnaires. At follow-up, the average age was 28.33 years (SD 14.96), 79.31% identified as White, and 56.32% reported widespread pain as their pain type.Results:
This study examined relationships between illness perceptions, compassion, and anxiety and depression in individuals living with chronic pain. The study also sought to investigate how worry and rumination may mediate these relationships over time. Illness perceptions and compassion (i.e., from others, self, for others) were shown to be associated with anxiety, depression, worry, and rumination. Partial support was found for hypothesis iv (illness perceptions and compassion will each account for a significant proportion of variance in anxiety and depression, over and above demographic and clinical variables, at baseline); at baseline, compassion (from others) explained additional variance in anxiety, but illness perceptions did not, whilst illness perceptions and compassion (for others and self) explained additional variance in depression. Partial support was also found for hypothesis v (the relationships between illness perceptions and compassion (measured at baseline), and anxiety (measured three months later), will be mediated by worry); worry partly mediated the relationship between baseline illness perception and subsequent anxiety, but not between baseline compassion (for self, others, from others) and subsequent anxiety. Contrary to hypothesis vi (the relationships between illness perceptions and compassion (measured at baseline), and depression (measured three months later), will be mediated by rumination), rumination did not mediate the relationship between either illness perceptions or compassion and subsequent depression. Findings will be discussed and presented in regard to anxiety and depression in-turn.Anxiety in Chronic Pain
Results indicate that both illness perceptions and compassion are implicated in explaining the development and maintenance of anxiety over time in people with chronic pain, with stronger support found for the fit of Common Sense Model (Leventhal et al., 2016) than for the compassion model. Specifically, illness perceptions and worry were each significantly positively associated with anxiety. Longitudinally, worry partly mediated the relationship between illness perceptions and anxiety. This is in keeping with the thesis of the Common Sense Model (Leventhal et al., 2016) and suggests that drawing on evidence-based approaches such as Cognitive Behavioural Therapy that aim to challenge negative illness perceptions and reduce worry could be effective in helping reduce anxiety in chronic pain (Buhrman et al., 2015; de Williams et al., 2012; Eccleston et al., 2014), as recommended by National Institute of Health Care Excellence (2021b). Findings regarding compassion in the development and maintenance of anxiety over time were less consistent.In summary, the Common Sense Model (Leventhal., 2016) associated with Cognitive Behavioural Therapy and the compassion model associated with Compassion Focused Therapy are implicated in the development and maintenance of anxiety in individuals living with chronic pain. Data from this study suggest that utilising interventions incorporating cognitive and compassion elements may be of benefit in reducing anxiety. However, whilst illness perceptions (Common Sense Model) and compassion hold variance within anxiety, they do not statistically account for all the variance, which may suggest that there may be further psychological processes that may add to current understanding. This warrants further exploration but may indicate that rather than the utility of one modality (i.e., Cognitive Behavioural Therapy or Compassion Focused Therapy), drawing on multiple modalities/psychological processes in an integrated approach for the treatment of anxiety in individuals living with chronic pain, may be effective. This approach may also be helpful for drawing on interventions to target the development and maintenance of depression in chronic pain.
Depression in Chronic Pain
Findings lend partial support for the fit of the Common Sense Model in understanding depression experienced by adults with chronic pain, but limited support was found for the role of compassion. Cross-sectionally, illness perceptions were positively associated with both rumination and depression. Longitudinally, illness perceptions had a direct effect on depression, but unlike the anxiety model, there were no mediating effects of rumination on the relationship between illness perceptions and depression. At a cross-sectional level, lacking compassion for self and for others explained additional variance in depression, supporting the notion that depression is associated with an occupation of a self-critical stance (Zhang et al., 2019). However, compassion (i.e., for self, for others, from others) did not impact levels of depression or rumination over time, when examined concurrently with illness perceptions. This again contrasts with previous findings (Carvalho et al., 2020; Hughes et al., 2021). It is plausible that the differential relationships noted between compassion and anxiety and depression may be because compassion is linked to a fear of how one is perceived and judged by others, which impacts anxiety rather than depression (Clark & McManus, 2002). However, this remains speculative and requires further investigation.REC name
HSC REC A
REC reference
23/NI/0025
Date of REC Opinion
14 Mar 2023
REC opinion
Further Information Favourable Opinion