Dr. Audrey Kinzel

Dep’t of Educational Psychology & Special Education

University of Saskatchewan

Presentation to CCPA

Ottawa May 19 2011

To present the findings of research on “The Acceptance of Chronic Pain” with emphasis on the findings which relate most to the choices that characterize the acceptance or process.

Describe how a multi/inter disciplinary treatment approach facilitates acceptance of chronic pain.

Present the parallel between chronic pain and other conditions/situations.

Identity a situation or circumstance which you “accepted” – write this idea on a piece of paper

This might be a situation that: Was unexpected or expected, You asked for or wished for,Was a part of your life plan, or definitely not a

part of your plan,

Keep this paper handy as I will ask you to refer to it later

Reason for studying chronic painIncreasing number of individuals affected:

from 16% in 2007 to 18% in 2009 (CPS, 2009)

Financial cost to society and individualPersonal distress Less than satisfying outcomes despite the

advances in knowledge and treatmentReason for studying acceptanceLearn more about how to learn to ‘live with the

pain’.

Based on Chronic Pain Acceptance Questionnaire (McCracken)

McCracken found 4 factors constitute acceptance:

1. Life Focus2. Acceptance of Chronicity3. Cognitive Control4. (not) Avoiding/Controlling

Living with pain without reaction, disproval, or attempts to avoid or reduce

Acceptance is following what a client wants, ie, less distress so this is following their preference ( Miller)

MethodologyBased in phenomenologyData collection: Active-Indepth Interviews

using Seidman’s process.Data Analysis: Atlas TI and constant

comparative analysis

Current non malignant chronic painPain for a minimum of 6 monthsPain has disrupted lifeNow living a meaningful life with pain Accepted their pain

Ten participants – 7 female, 3 maleFrom 3 provinces including 6 communitiesAge range: Twenties to mid seventiesDuration of pain: 1 to 40 yearsTime to acceptance from pain onset: months to 20

yrsPain diagnosis: dislocated elbow, low back, RSD,

neuropathy, fractures, fasciitis Source of income:- only 1 (of working age) was on full time disability,

1 was part time disability/part time working,- Remainder working, retired (and volunteering).

- The time before acceptance, (nonacceptance) highlighted acceptance

- Meaning of acceptance

- Characteristic attitude and language

- Acceptance is ongoing = Accepting

Support as Strength & ComfortPsychological Support from professionalsEncourage support from others, faith,

workplaceCommunication to Connection

Relates to support but also emotional expression

Momentous Interactions

Shared Experiences- Appropriate disclosure- Group treatment

Being Believed- Believing the client’s level of distress/pain is *- Not believing impacts clients core person

Abandonment or Support: (Professionals) Response to Uncertainty- Relates to the response when a cure is not possible or

not in the near future – requires long term support

- This theme has implications for interdisciplinary treatment/management and you as a counsellor/psychologist

- A personal journey

- Starts with a decision

- Involves a series of steps only the person can take

- Takes time (months or years)

Refer back to the situation you accepted, what did you have/choose to do in this situation to manage it, live with it, accept it . . .?

Keep this in mind . . .

Knowledge and LearningAcquiring knowledge/informationLearning from doing/not doing

Adaptation to LimitationsAcknowledge the need to adapt Action of adapting (avoid some activities,

modify others)Problem focused coping vs emotion focused

coping

Taking (and giving) of Responsibility- Recognize personal responsibility- Others, gave responsibility to higher power

Recognition of ChoicesChange of Focus

- to life- resolution of court cases, insurance claims critical

Relationship with Self- with acceptance of pain came acceptance of the self (less self blame, increased confidence.

Control: Some Giving and Some Taking- realization of what can be controlled and when

Values and Priorities Re-examined- Re-evaluated long standing beliefs and values resulted in letting go of some societal and family expectations.

Which, if any of these choices, did you identify in your acceptance?

Acceptance is not appropriate nor desirable for every person or every condition.

Acceptance may be helpful for individuals for whom:

The present is unsatisfactory. There is a desire for a better future.The path to the better future, acceptance, or

wellness, may/may not involve getting over something – may involve learning to live with.

What are some of the situations acceptance is suited? Not suited for?

Think about your practice, identify conditions or situations in which your client is being managed by more than one type of provider.

(example depression – counsellor/psychologist and family physician)

Identify strategies for assisting clients to realize their choices while keeping a multi/interdisciplinary approach in mind?

As a professional we can help facilitate acceptance of a situation or circumstance to achieve a more satisfying future or wellness

But it is the client who makes the decision to start or move toward (with the help, patience, and support) of the psychologist.

A current client just came to a realization (and acceptance) “I am tired of waiting until I get better to . . . “