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Stuck in mind: the role of catastrophizing in pain
Örebro University, School of Law, Psychology and Social Work. (Center for Health and Medical Psychology (CHAMP))ORCID iD: 0000-0003-2718-7402
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Pain catastrophizing emerges in the literature as one of the most important psychological determinants of both pain itself and the negative outcomes commonly associated with it. However, despite decades of research confirming the impact of catastrophizing, there are still areas that remain unexplored or in which the surface has only been scratched. The overall aim of this dissertation was to expand existing knowledge about catastrophizing and to advance the theoretical framework around the concept.

The role of catastrophizing was explored in three distinct areas: during pain in childbirth, in exposure treatment for back pain patients, and in a problem solving context. The findings from the three studies confirmed the vital role of catastrophizing in these areas. Firstly, catastrophizing played a critical role in pain in childbirth; women who catastrophized reported labor pain as more intense and the subsequent recovery period as longer than women who did not catastrophize. Secondly, catastrophizing was identified as a moderator of treatment effect in exposure in vivo for back pain patients with pain-related fear; patients who catastrophized were not helped by the exposure. Thirdly, catastrophizing played a role in a problem solving context; although this is in line with contemporary models such as the misdirected problem solving model, the results suggested a somewhat different pathway to this previous model. Taken together, these findings underscore the instrumental role of catastrophizing in diverse areas and imply a need for catastrophzing to be assessed and addressed in clinical contexts. In addition, the findings highlight a need for further development of the theoretical framework around catastrophizing as well as treatment interventions that directly target catastrophizing. Based on these needs, a new model of catastrophizing was proposed – a model of catastrophizing from a process perspective. In this model, the proposed function of catastrophizing is to down-regulate negative affect, as a form of internal avoidance. The model is a complement to existing theoretical models and provides a framework for developing treatment interventions that directly target catastrophizing, for example by problem solving skills training. Successful interventions for people who catastrophize would lead to several gains – for the individual in less suffering and increased ability to handle pain problems, and for society as a whole in reduced costs for health care for these individuals.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2011. , 71 p.
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 21
Keyword [en]
catastrophizing, pain, fear avoidance, problem solving
National Category
Social Sciences Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-19125ISBN: 978-91-7668-826-7 (print)OAI: oai:DiVA.org:oru-19125DiVA: diva2:445438
Public defence
2011-12-02, Hörsal L2, Örebro universitet, Fakultetsgatan 1, Örebro, 13:15
Opponent
Supervisors
Available from: 2011-10-04 Created: 2011-10-04 Last updated: 2016-12-05Bibliographically approved
List of papers
1. Pain in childbirth and postpartum recovery: the role of catastrophizing
Open this publication in new window or tab >>Pain in childbirth and postpartum recovery: the role of catastrophizing
2009 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 13, no 3, 312-316 p.Article in journal (Refereed) Published
Abstract [en]

This prospective study investigated how pain catastrophizing was related to labor pain intensity and physical recovery after childbirth. Eighty-eight women giving birth for the first time completed the first questionnaire before delivery. Eighty-two of those returned the second questionnaire after delivery. Participants were classified as catastrophizers (n=38) or non-catastrophizers (n=44) based on their scores on the Pain Catastrophizing Scale. Comparison of the groups showed that catastrophizers anticipated and experienced more intense pain (p<.0125) and had poorer physical recovery (p<.0125), measured as the level of self-reported functioning in activities of daily living, than non-catastrophizers. These results extend the association between catastrophizing and pain, to pain and recovery in childbirth and provide support for the fear-avoidance model. It is concluded that pain catastrophizing plays a role in the experience of pain in childbirth and postpartum recovery. Further research is needed to identify appropriate interventions for catastrophizing women during the latter part of pregnancy.

Place, publisher, year, edition, pages
Amsterdam: Elsevier, 2009
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-5886 (URN)10.1016/j.ejpain.2008.04.010 (DOI)000264243300013 ()18515162 (PubMedID)
Available from: 2009-03-02 Created: 2009-03-02 Last updated: 2017-03-24Bibliographically approved
2. Catastrophizing moderates the effect of exposure in vivo for back pain patients with pain-related fear
Open this publication in new window or tab >>Catastrophizing moderates the effect of exposure in vivo for back pain patients with pain-related fear
2010 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 8, 887-892 p.Article in journal (Refereed) Published
Abstract [en]

This investigation was an initial attempt to explore psychological factors that might help or hinder the effect of exposure in vivo for patients with musculoskeletal pain and pain-related fear. The study was based on data from a randomized-controlled trial for patients with non-specific spinal pain (Linton et al., 2008).

First, catastrophizing, anxiety, and depression were studied as possible treatment moderators. We found evidence that catastrophizing was a moderator of treatment outcome in exposure. When further exploring the nature of the relationship between catastrophizing and outcome, the results showed that the exposure was effective only for patients with low or moderate levels of catastrophizing. High catastrophizers did not improve from the treatment. On the other hand, anxiety was a general predictor of poor outcome, and not a specific moderator of outcome in exposure. In contrast, depression was not significantly related to outcome.

Next, patients were divided into high change participants and low change participants based on their improvement in disability after treatment in order to investigate the change in psychological variables during treatment. Descriptive data indicated that high change participants had large improvements across treatment on depression, anxiety, catastrophizing, and fear-avoidance beliefs whereas low change participants virtually did not change at all on these variables across treatment.

These findings denote that catastrophizing is a moderator of treatment outcome in exposure whereas several psychological variables might be important for the treatment process

National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-13430 (URN)10.1016/j.ejpain.2010.02.003 (DOI)
Available from: 2011-01-11 Created: 2011-01-11 Last updated: 2016-12-05Bibliographically approved
3. Understanding catastrophizing from a misdirected problem-solving perspective
Open this publication in new window or tab >>Understanding catastrophizing from a misdirected problem-solving perspective
2012 (English)In: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 17, no 2, 408-419 p.Article in journal (Refereed) Published
Abstract [en]

Objectives.  The aim is to explore pain catastrophizing from a problem-solving perspective. The links between catastrophizing, problem framing, and problem-solving behaviour are examined through two possible models of mediation as inferred by two contemporary and complementary theoretical models, the misdirected problem solving model (Eccleston & Crombez, 2007) and the fear-anxiety-avoidance model (Asmundson, Norton, & Vlaeyen, 2004).

Design.  In this prospective study, a general population sample (n= 173) with perceived problems with spinal pain filled out questionnaires twice; catastrophizing and problem framing were assessed on the first occasion and health care seeking (as a proxy for medically oriented problem solving) was assessed 7 months later.

Methods.  Two different approaches were used to explore whether the data supported any of the proposed models of mediation. First, multiple regressions were used according to traditional recommendations for mediation analyses. Second, a bootstrapping method (n= 1000 bootstrap resamples) was used to explore the significance of the indirect effects in both possible models of mediation.

Results.  The results verified the concepts included in the misdirected problem solving model. However, the direction of the relations was more in line with the fear-anxiety-avoidance model. More specifically, the mediation analyses provided support for viewing catastrophizing as a mediator of the relation between biomedical problem framing and medically oriented problem-solving behaviour.

Conclusion.  These findings provide support for viewing catastrophizing from a problem-solving perspective and imply a need to examine and address problem framing and catastrophizing in back pain patients.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-19741 (URN)10.1111/j.2044-8287.2011.02044.x (DOI)000301175800011 ()22106932 (PubMedID)2-s2.0-84858025240 (Scopus ID)
Available from: 2011-10-06 Created: 2011-10-06 Last updated: 2017-02-16Bibliographically approved

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