Investigating How Parental Instructions and Protective Responses Mediate the Relationship Between Parental Psychological Flexibility and Pain-Related Behavior in Adolescents With Chronic Pain: A Daily Diary Study.

Melanie Beeckman,Liesbet Goubert,Sean Hughes,Tom Loeys,Laura E Simons

doi:10.3389/fpsyg.2019.02350

Melanie Beeckman, Liesbet Goubert + Show 3 more

Open Access

https://doi.org/10.3389/fpsyg.2019.02350

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Abstract

BackgroundParental behavior can influence how well adolescents cope with chronic pain. Previous research has largely focused on how parents negatively impact adolescent functioning. Yet more recent work suggests that parents – and particularly parental psychological flexibility – can foster better adolescent pain-related functioning. In this study we examined if parental protective responses and instructions to engage in activities in the presence of pain mediate the impact of parental psychological flexibility and acceptance of adolescent pain on adolescents’ daily pain-related behavior.MethodFifty-six adolescents with chronic pain (Mage = 14.5 years, 86% girls) and one of their parents (93% mothers) were recruited at initial evaluation at two pediatric pain clinics in the US. Parents completed baseline questionnaires assessing psychologically flexible parenting and acceptance of adolescent pain. Next, parents and adolescents completed a 14-day self-report diary assessing adolescent activity-avoidance and activity-engagement in the presence of pain (adolescent report), and parental protective responses and instructions for their adolescent to engage in activities (parent report).ResultsPsychologically flexible parenting and acceptance of adolescent pain in parents were indirectly related to lower daily adolescent activity-avoidance, via their negative association with daily parental protective responses. Positive associations also emerged between baseline psychologically flexible parenting and overall levels of adolescent activity-engagement via its negative association with overall levels of parental protectiveness across the 14-day period. Psychologically flexible parenting and parental acceptance of adolescent pain were also indirectly related to daily decreases in adolescent activity-avoidance via their association with daily increases in parental activity-engagement instructions. These baseline parental resilience factors were also positively related to overall levels of parental engagement instructions, a route via which an indirect association with both higher overall activity-engagement as well as higher overall activity-avoidance in the adolescent was observed.ConclusionOur findings suggest an (indirect) adaptive role of parental psychological flexibility on adolescent daily pain-related behavior via its impact on parental protective behavior. If our findings replicate, they would suggest that these parental behaviors could be targeted in pain treatments that include both adolescents and their parents. Future research could further examine the impact of parental instructions on pain-related behavior in adolescents with chronic pain.

Highlights

One in five children and adolescents experience chronic pain (King et al, 2011), which frequently affects their physical, emotional, and social functioning (Palermo, 2000; Hunfeld et al, 2001; Palermo and Eccleston, 2009)
We found an unexpected positive indirect effect of parental psychological flexibility on adolescent activity-avoidance at the between-dyads level, via higher overall levels of parental engagement instructions
The present study further examined whether psychologically flexible parenting and parental acceptance of adolescent pain indirectly predicted daily adolescent pain-related behavior, via their respective impact on daily parental protective responses, and/or daily instructions parents provide to their adolescent

Summary

Introduction

One in five children and adolescents experience chronic pain (King et al, 2011), which frequently affects their physical, emotional, and social functioning (Palermo, 2000; Hunfeld et al, 2001; Palermo and Eccleston, 2009). The first argues that parents tend to emit protective behaviors (e.g., keeping the child home from school) when faced with their adolescent in pain, and that these behaviors directly result in heightened adolescent avoidance of pain-related activities (Palermo and Chambers, 2005; Goubert and Simons, 2013). It is this heightened and persistent avoidance which is assumed to increase risk of disability (Asmundson et al, 2012; Simons and Kaczynski, 2012). In this study we examined if parental protective responses and instructions to engage in activities in the presence of pain mediate the impact of parental psychological flexibility and acceptance of adolescent pain on adolescents’ daily pain-related behavior

Results

Discussion

Conclusion