McCracken, L. M., & Vowles, K. E. (2007). Psychological flexibility and traditional pain management strategies in relation to patient functioning with chronic pain: An examination of a revised instrument. Journal of Pain, 8, 339-349.
Recent developments in the cognitive behavioral treatments emphasize the role of psychological flexibility in adaptive functioning. Within chronic pain, data are available supporting four processes involved in psychological flexibility: Acceptance, moment to moment awareness, values-based action, and separation of problematic thoughts and beliefs from the behavior that follows them. The present study was intended to investigate the relations patient functioning and behaviors demonstrating psychological flexibility, as compared to traditionally conceived pain coping strategies, such as activity pacing, relaxation, and positive self-statements. Two hundred-sixty treatment-seeking chronic pain patients completed a battery of measures, including a clinical instrument assessing a range of responses to pain. After initial psychometric evaluation of the instrument, two subscales were identified, one labeled “Psychological Flexibility” and the other “Pain Management”. Both subscales were related to emotional functioning and psychosocial disability, although Psychological Flexibility achieved larger correlations and was associated with additional indices of distress, physical functioning, healthcare use and work status. Regression analyses indicated that Psychological Flexibility accounted for significant variability in eight of ten measures of functioning, after controlling for pain and demographic variables, whereas Pain Management did not achieve significance for any measure. These results suggest that psychological flexibility, defined by its constituent processes, is relevant to the study of chronic pain and may be a powerful predictor of patient functioning, whereas the utility of more traditionally-conceived pain management strategies may benefit from a reappraisal.