Abbie O. Beacham, Ph.D. Stacy Lorenz, M.A. Xavier University, Cincinnati, OH USA
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Pain matters! Implications for acceptance-based interventions with women with co-morbid chronic illnesses
Abbie O. Beacham, Ph.D. Stacy Lorenz, M.A.
Xavier University, Cincinnati, OH USA
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Key Collaborators Xavier University ACT Research Team John Forrette, M.A., Desiree Green, B.A., Amy Houston, M.A., Caroline Kelley, M.A., Stacy Lorenz, M.A., Matthew Maley, M.A., Amy Olzmann, M.A. & Stephanie Parazak, M.A.
University of Colorado Denver Dana Brown, M.A. Jessica Geller, M.A., Andrew Herbst, M.A., Carissa Kinman, M.A., & Jessica Payne-Murphy, M.A.
Spalding University Ann Brugh, Psy.D. , Steve Katsikas, Ph.D. , Ken Linfield,Ph.D., Kristen Thacker, Psy.D. & Brooke Threlkeld, Psy.D.
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Agenda• Background & Significance
– Challenges of co-morbid chronic illness and pain presentations
• Method – In depth description of sample
• Results • Discussion
– Connect to clinical and research implications
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Background & Significance • Non-communicable Diseases/Chronic
Illnesses (CI) – including Chronic Pain – majority of health care costs worldwide
• World Health Organization, 2011
• Empirically supported behavioral assessments and interventions for CI management– Modest-to-good outcomes– Most diagnosis specific
• e.g., diabetes & depression
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Background & Significance
• Room for improvement – interventions for chronic illness
management – specialty & primary health care settings
• Acceptance-based interventions – considerable promise in CP populations
• McCracken, Vowles & Eccleston, 2003, 2004, 2005; Vowles, McCracken & Eccleston, 2007; McCracken & Zhao-O’Brien, 2010
– becoming widely applied in patients with co-morbid chronic illnesses
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Perceived Illness-related Disability
Functional & Medical
Outcomes
Perceptions of disability
due to illness and symptoms
*Beyond objective
indicators of disability
*Alschuler, Theisen-Goodvich, Haig & Geisser, 2008
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Conceptual Model of factors related to Perceived Illness-related Disability(Caveat: Not SEM!)
Perceived Disability
Mindfulness
Experiential Avoidance
CI Acceptance
OUTC
OMES
+/- Affect
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“…patients seek care for all of their conditions, not just for a solitary condition. In fact, visits for comorbidities outnumber visits for any single condition…”
– Starfield et al, 2003
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Co-morbid chronic illness presentation
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Study Questions• In a sample of women, does
concomitant pain matter when among myriad CI symptoms?
• When pain is a primary concern for patients with co-morbid CIs, how might patients “differ” on ACT related variables/constructs?
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MethodProcedure: Recruited sample through online CI specific support groups
Yahoo! & Facebook
•“SurveyMonkey” survey •45-60 mins to complete •No incentive for participation
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MeasuresPerceived Illness Disability Index
– Adapted from the Pain Disability Index – Pollard, 1984
Mindful Attention & Awareness Scale – Brown & Ryan, 2003
Chronic Illness Acceptance Q’aire– Two-factor structure: Activity Engagement & Willingness
– Beacham, Linfield, Kinman & Payne-Murphy (Under review)
Acceptance & Action Q’aire-II – Bond et al, 2011
Positive & Negative Affect Schedule– Watson, Clark, & Tellegen, 1988
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• Diabetes• Hypertension• Heart Disease• COPD• Asthma• Arthritis• Rheumatoid
Arthritis• Fibromyalgia• Multiple Sclerosis
Sample: Recruited CI Support Groups(Most frequently endorsed CI’s)
“Chronic Pain” groups not
targeted
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1 Item: “Is chronic/recurring pain a primary concern?”
Yes72%(n=281)
No28%(n=109)
58% of “Yes” Chronic Pain Diagnosis
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“Is chronic/recurring pain a primary concern?”
Yes No p value
Age 51.53 54.89 .028
Education (years) 15.25 15.72 ns
Married/Partnered 64.7 54.6 ns
% Caucasian 90.3 86.7 ns
# Chronic Illnesses 2.71 1.55 .000
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“Overall, how much pain relief have pain treatments or medications provided?”
0 10 20 30 40 50 60 70 80 90 1000
5
10
15
20
25Mean Relief = 45.7, SD= 24.56
Percent Relief
Perc
ent o
f Sam
ple
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Perceived Illness-related Disability “Yes” versus “No”
Total Perceived Disability Score05
10152025303540
p<.001
Yes
No
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The short of it: Overall differences “Yes” versus “No” = Pain Matters
Mean SD CIAQ Activity Engagement No 40.49 12.49
Yes 33.52 11.82
CIAQ Willingness No 25.55 11.12Yes 22.75 7.96
MAAS Total No 4.34 0.955Yes 4.00 0.971
PANAS Positive Affect No 29.52 8.09Yes 26.41 7.97
PANAS Negative Affect No 18.43 7.22Yes 21.51 8.25
NOTE: *All p’s < .05
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“Is chronic/recurring pain a primary concern?
“Yes” versus “No”
ACT related variablesLegend: Higher scores - Positive outcomes Higher scores - Less Positive Outcomes
The long of it: Upon closer examination
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Experiential Avoidance “Yes” versus “No”
AAQ Scores 0
5
10
15
20
25Yes No
p = .007
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Negative Affect “Yes” versus “No”
PANAS Negative0
5
10
15
20
25Yes No
p = .003
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Mindfulness “Yes” versus “No”
MAAS Scores1
1.52
2.53
3.54
4.55
Yes No
p = .001
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Positive Affect “Yes” versus “No”
PANAS Positive0
5
10
15
20
25
30
35Yes No
p = .01
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Levels of CI Acceptance “Yes” versus “No”
Activity Engagement Willingness05
1015202530354045
Yes No
p < .05
p <.001
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Total Disability Scores by CI Acceptance
Activity Engagement Willingness05
101520253035404550
High Medium Low
p<.001 p<.001
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Family/Home Disability Scores by CI Acceptance
Activity Engagement Willingness0123456789
10High Medium Low
p<.001 ns
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Recreation Disability Scores by CI Acceptance
Activity Engagement Willingness0123456789
10High Medium Low
p<.001 p <.005
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Occupation Disability Scores by CI Acceptance
Activity Engagement Willingness0123456789
10High Medium Low
p<.001 p =.003
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% Pain Relief by CI Acceptance
Activity Engagement Willingness0
10
20
30
40
50
60
70High Medium Low
p<.001
ns
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LimitationsSample from online support groups
Although online samples not drastically different from clinical samples characteristics
Replication and extension
Retrospective recall of self-identified support group members
Prospective studies next step
Assess objective (i.e., behavioral) and subjective outcomes in multiple domains
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Discussion• Patients presenting with co-morbid
CIs may also be struggling with concerns about pain in concert with many other symptoms– Pain concerns may not be reflected in
chart diagnoses
• Lack of assessment of whole picture of complexity could make patients SEEM treatment resistant
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Discussion• Transdiagnostic acceptance-
based approaches may have promise for these patients
– Enable a focus on values-based function – committed action within context of the WHOLE symptom picture
– Utility of acceptance subgroups in these approaches?
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