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Pain patients´ experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity and treatment outcome
Örebro University, School of Law, Psychology and Social Work. (Center for Health and Medical Psychology (CHAMP))
Örebro University, School of Law, Psychology and Social Work. (Center for Health and Medical Psychology (CHAMP))ORCID iD: 0000-0002-3887-6281
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Psychiatry.ORCID iD: 0000-0001-9500-7763
Örebro University, School of Law, Psychology and Social Work. (Center for Health and Medical Psychology (CHAMP))ORCID iD: 0000-0001-5359-0452
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2017 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, 77-86 p.Article in journal (Refereed) Published
Abstract [en]

Background and aims: Validating and invalidating responses play an important role in communication with pain patients, for example regarding emotion regulation and adherence to treatment. However, it is unclear how patients’ perceptions of validation and invalidation relate to patient characteristics and treatment outcome. The aim of this study was to investigate the occurrence of subgroups based on pain patients’ perceptions of validation and invalidation from their physicians. The stability of these perceptions and differences between subgroups regarding pain, pain interference, negative affectivity and treatment outcome were also explored.

Methods: A total of 108 pain patients answered questionnaires regarding perceived validation and invalidation, pain severity, pain interference, and negative affectivity before and after pain rehabilitation treatment. Two cluster analyses using perceived validation and invalidation were performed, one on pre-scores and one on post-scores. The stability of patient perceptions from pre- to post-treatment was investigated, and clusters were compared on pain severity, pain interference, and negative affectivity. Finally, the connection between perceived validation and invalidation and treatment outcome was explored.

Results: Three clusters emerged both before and after treatment: (1) low validation and heightened invalidation, (2) moderate validation and invalidation, and (3) high validation and low invalidation. Perceptions of validation and invalidation were generally stable over time, although there were individuals whose perceptions changed. When compared to the other two clusters, the low validation/heightened invalidation cluster displayed significantly higher levels of pain interference and negative affectivity post-treatment but not pre-treatment. The whole sample significantly improved on pain interference and depression, but treatment outcome was independent of cluster. Unexpectedly, differences between clusters on pain interference and negative affectivity were only found post-treatment. This appeared to be due to the pre- and post-heightened invalidation clusters not containing the same individuals. Therefore, additional analyses were conducted to investigate the individuals who changed clusters. Results showed that patients scoring high on negative affectivity ended up in the heightened invalidation cluster post-treatment.

Conclusions: Taken together, most patients felt understood when communicating with their rehabilitation physician. However, a smaller group of patients experienced the opposite: low levels of validation and heightened levels of invalidation. This group stood out as more problematic, reporting greater pain interference and negative affectivity when compared to the other groups after treatment. Patient perceptions were typically stable over time, but some individuals changed cluster, and these movements seemed to be related to negative affectivity and pain interference. These results do not support a connection between perceived validation and invalidation from physicians (meeting the patients pre- and post-treatment) and treatment outcome. Overall, our results suggest that there is a connection between negative affectivity and pain interference in the patients, and perceived validation and invalidation from the physicians. Implications In clinical practice, it is important to pay attention to comorbid psychological problems and level of pain interference, since these factors may negatively influence effective communication. A focus on decreasing invalidating responses and/or increasing validating responses might be particularly important for patients with high levels of psychological problems and pain interference.

Place, publisher, year, edition, pages
Elsevier, 2017. Vol. 17, 77-86 p.
Keyword [en]
Chronic pain; Communication; Validation; Invalidation; Treatment outcome
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-59104DOI: 10.1016/j.sjpain.2017.07.007PubMedID: 28850377Scopus ID: 2-s2.0-85026788123OAI: oai:DiVA.org:oru-59104DiVA: diva2:1133382
Available from: 2017-08-15 Created: 2017-08-15 Last updated: 2017-11-13Bibliographically approved
In thesis
1. Calm down: strategies for emotion regulation in clinical practice
Open this publication in new window or tab >>Calm down: strategies for emotion regulation in clinical practice
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Problems with emotion regulation are common in people who seek help from health care professionals working with problems featuring psychological factors. Two such patient groups, chronic pain patients and patients with severe anxiety, are of interest in this dissertation. Effectively regulating and increasing functional emotion regulation in these patients is often challenging for clinicians, and effective strategies are needed. One treatment that greatly emphasizes the importance of functional emotion regulation is dialectical behavior therapy (DBT). DBT has a strong empirical basis in other patients with severe problems with emotion regulation, raising the question of whether the treatment and its more specific components (e.g., validation, which means communicating understanding and acceptance) could be effec-tive in the groups of patients of interest here.

Accordingly, the overall aim of this dissertation was to expand our knowledge of how to use functional emotion-regulation strategies from DBT to regulate emotions in patients with chronic pain or treatment-resistant anxiety disorders. Study I examined whether brief training was enough to increase validation in partners of people with chronic pain, and whether this was associated with better-regulated emotion in the people with chronic pain. Study II explored patient perceptions of validation and invalidation by the physician in a clinical chronic pain context. Lastly, study III investi-gated whether a more extensive treatment intervention inspired by DBT was feasible and effective in patients suffering from treatment-resistant anxiety disorders.

The findings indicate that emotion-regulation strategies from DBT can be effective in regulating emotions in these patients. The dissertation also illus-trates some of the difficulties in doing this, providing important information for future work, such as suggestions for modifications that might further increase positive outcomes.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. 108 p.
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 38
Keyword
Emotion regulation, validation, invalidation, chronic pain, treatment-resistant anxiety disorders, dialectical behavior therapy, communication
National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:oru:diva-61072 (URN)978-91-7529-216-8 (ISBN)
Public defence
2017-11-21, Örebro universitet, Långhuset, Hörsal 1, Fakultetsgatan 1, Örebro, 13:15 (English)
Opponent
Supervisors
Available from: 2017-09-18 Created: 2017-09-18 Last updated: 2017-10-30Bibliographically approved

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Edlund, SaraWurm, MatildaHolländare, FredrikLinton, Steven J.Tillfors, Maria

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