Attributions Regarding Unmet Treatment Goals After Interdisciplinary Chronic Pain Rehabilitation

Abstract

The goal violation effect (GVE), a component of the relapse process model, occurs when patients make internal, stable, global, and uncontrollable rather than external, unstable, specific, and controllable attributions about the causes for unmet goals. GVE consistent attributions lead to guilt and self-blame, reduced self-efficacy, and greater probability that a lapse will lead to a full-blown relapse. To determine if chronic pain patients make attributions regarding the causes of unmet goals consistent with the GVE and to determine differences for the GVE and the individual attributions making up the GVE among unmet coping skills, medication, exercise, social, and work goals. In the last week of an interdisciplinary pain program, patients stated 4 to 6 treatment goals. At 6 months follow-up, 100 patients rated the cause for each of their own unmet goals using 7-point scales assessing whether they made internal, stable, global, and uncontrollable attributions. Together, 165 unmet goals were rated and a GVE was calculated for each unmet goal by adding the 4 individual attributions and dividing by 4. The GVE for each of the 5 goal types was above the midpoint toward model consistent attributions. A multivariate analysis of variance was significant for goal type (P<0.0001). No significant differences were found among goal types for the GVE, the stable or global attributions. However, work and social goals were found to have lower internal attributions compared with coping, medication, and exercise goals. Work goals were found to have great uncontrollable attributions compared with coping, medication, and exercise whereas coping was found to be lower than social and exercise goals. Patients made attributions for unmet treatment goals consistent with the GVE component of the relapse process model. Internal and uncontrollable attributions for causes of unmet goals varied with goal type, which has implications for the design of relapse prevention strategies.