Psychological Inflexibility In Pain Scale Research Articles

Pain acceptance and psychological inflexibility predict pain interference outcomes for persons with chronic pain receiving pain psychology.

Awareness (being present), acceptance, and engagement (committed action) are three dimensions of psychological flexibility. Understanding these in the context of chronic pain may identify treatment targets to help refine individual treatment. Our objective was to test the predictive capacity of three dimensions within the psychological flexibility model on the longitudinal trajectory of pain interference. Patients receiving pain psychology treatment at a pain management center participated in this pragmatic clinical longitudinal study (n=86 with at least three assessments; Mean age=51 years; Gender=60 females, 26 males). Measures included the Five Facet Mindfulness Questionnaire (FFMQ-SF); Chronic Pain Acceptance Questionnaire (CPAQ-8); Psychological Inflexibility in Pain Scale (PIPS-12); and Committed Action Questionnaire (CAQ-8). The dependent variable was the Patient Reported Outcomes Information System (PROMIS) Pain Interference (PI). We used latent growth modelling to analyze scores assessed within 180days of patient care. Psychological inflexibility (PIPS-12) and pain acceptance (CPAQ-8) measured at baseline predicted PI outcomes (n=86). PIPS-12 showed a direct relationship with pain interference (PI), where higher PIPS-12 scores predicted significantly higher PI mean scores on average across the study period (ρ=0.422, r2=0.382) but also predicted significantly greater decreases in PI across time (ρ=-0.489, r2=0.123). Higher CPAQ-8 scores predicted significantly lower PI mean scores on average across the study period (ρ=-0.478, r2=0.453) but also significantly smaller decreases in PI across time (ρ=0.495, r2=0.076). Awareness (FFMQ-SF) and engagement (CAQ-8) were not predictive of PI outcomes. Patients who entered pain psychology treatment with lower pain acceptance and higher psychological inflexibility showed the largest reductions in pain interference across time. These results contribute towards a novel prognostic understanding of the predictive roles of an enhancing dimension and limiting dimension of psychological flexibility.

The Role of Pain Inflexibility and Acceptance among Headache and Temporomandibular Disorders Patients.

Temporomandibular disorders (TMD) and headache are complex. This study aims to assess the association between TMD, headache, and psychological dimensions such as psychological inflexibility and pain acceptance. The sample consisted of 120 participants following a non-probabilistic convenience sampling strategy through a direct invitation to the patients attending our facilities and their relatives (n = 61 diagnosed with headache, n = 34 diagnosed with TMD-headache, n = 25 control group). Diagnostic Criteria for Temporomandibular Disorders (DC-TMD), International Classification of Headache Disorders (ICHD-3 beta version), Chronic Pain Acceptance Questionnaire (CPAQ-8), and Psychological Inflexibility in Pain Scale (PIPS) were used as assessment tools. One-way ANOVA, multiple regression analysis (MRA), and the Johnson-Neyman approach were run by IBM SPSS, version 27 (IBM® Company, Chicago, IL, USA). The significance level was 0.05. One third of our sample presented with headache with TMD. Females were predominant. Males with headache, no systemic disease, less pain severity but higher frequency, living longer with the disease and having sensitive changes, showed higher pain acceptance. When headache occurs with TMD, women with higher education, no headache family history, less pain, and no motor changes showed higher pain acceptance. Patients with both conditions are more liable to have chronic pain and pain inflexibility. Pain intensity and willingness explain 50% of the psychological inflexibility in the headache group. In our sample, individuals suffering from both conditions show greater pain inflexibility, implicating more vivid suffering experiences, leading to altered daily decisions and actions. However, further studies are needed to highlight this possible association.

P–491 The mediator role of pain-related psychological inflexibility in the relationship between psychopathological symptoms and pain intensity in endometriosis

Abstract Study question Does pain-related psychological inflexibility play a role in the relationship between psychopathological symptoms (depression, anxiety, stress) and pain intensity in women with endometriosis? Summary answer Pain-related psychological inflexibility acts as a mediator exclusively between depressive symptoms and pain intensity. Psychopathological symptoms did not reveal a direct effect on pain intensity. What is known already Endometriosis is a chronic and incapacitating condition frequently involving the experience of pain (e.g., dysmenorrhea, ovulation pain, dyspareunia, chronic pelvic pain). Women dealing with endometriosis may present impaired health-related quality of life and psychological distress, with depressive, anxiety, and stress symptoms being commonly reported. Pain-related psychological inflexibility involves emotion regulation processes, such as avoidance of pain and cognitive fusion with pain. Cognitive and behavioural processes influence the relationship between pain and psychopathological symptoms, and pain-related psychological inflexibility showed to be an underlying mechanism in this relationship. Study design, size, duration Cross-sectional study. Participants’ recruitment was completed through the Associação Portuguesa de Apoio a Mulheres com Endometriose and the Associação Portuguesa de Fertilidade (endometriosis and infertility patients’ associations). Inclusion criteria were age (18 years or older) and an endometriosis medical diagnosis (self-reported). Data collection occurred between February 2018 and May 2018. Participants/materials, setting, methods A sample encompassing 209 women with an endometriosis diagnosis completed online a sociodemographic questionnaire, the Depression, Anxiety and Stress Scales (DASS – 21), the Numeric Pain Rating Scale (NPRS), and the Psychological Inflexibility in Pain Scale (PIPS-PT). Descriptive and correlational analyses were carried out using SPSS v. 26, and path analyses were estimated in AMOS (v. 24) with bootstrap procedures (2000 samples). Main results and the role of chance Participants’ age ranged from 18 to 50 years old with a mean of 34.03 (SD = 6.44) years. The majority of participants were married (n = 112; 53.6%), followed by single (n = 54; 25.8%). Regarding years of education, a mean of 14.62 years (SD = 2.80) was found. Participants reported that their endometriosis diagnosis had been established for 4.55 years (SD = 4.56). Correlation analyses showed that depressive, anxiety and stress symptoms were significantly and positively associated with pain intensity and pain-related psychological inflexibility. A mediation analysis was conducted to examine whether pain-related psychological inflexibility mediated the effect of psychopathological symptoms on pain intensity. Paths showing not to be statistically significant were removed. The final model defining an effect of depressive symptoms on pain intensity mediated by pain-related psychological inflexibility explained 26% of the variance. This model showed a good fit to the empirical data: χ2(5) = 10.75, p = .057, CMIN/DF = 2.15; TLI = .98; CFI = .99; RMSEA = .07, 95% CI = .00 to .14. Depressive symptoms predicted elevated pain intensity fully through higher pain-related psychological inflexibility (b = .05; SEb = .01; Z = 8.45; p < .001; β= .51). Limitations, reasons for caution Although path analysis is a powerful statistical technique, our findings rely on cross-sectional and self-report data. The study was disseminated through patients’ associations, limiting the inclusion of people who do get in touch with such organizations. Moreover, online recruitment tends to recruit participants with more access to online platforms. Wider implications of the findings: Pain-related psychological inflexibility seems to be a relevant construct to be addressed in the psychological assessment of women dealing with endometriosis. Furthermore, results suggest the relevance of targeting emotion regulation processes, and not only focus on reducing pain, in pain management interventions. Trial registration number N/A.

The Psychological Inflexibility in Pain Scale (PIPS): Validity and Reliability of the Japanese Version for Chronic Low Back Pain and Knee Pain.

PurposeThe aim of this study was to translate the Psychological Inflexibility in Pain Scale Japanese version (PIPS-J) and inspect its validity and reliability in older patients with chronic low back pain and knee pain.Materials and MethodsThe PIPS was translated into Japanese by a bilingual linguistic expert and three researchers and administered to 120 outpatients with low back pain and knee pain (61.7% women, age 73.8±7.8 years). Construct validity and criterion validity were evaluated using confirmatory factor analysis and the correlations with the Acceptance and Action Questionnaire-II Japanese version (AAQ-II-J) and the Cognitive Fusion Questionnaire Japanese version (CFQ-J), respectively. Internal consistency using Cronbach’s alpha and test–retest reliability (n=43) were also examined.ResultsOf all, 78.3% had low back pain, 55.6% had knee pain, and 44.2% both. The confirmatory factor analysis reproduced the original PIPS structure with two factors and indicated good model fit (GFI = 0.915, CFI = 0.970, RMSEA = 0.060). All items’ standardized regression weights ranged from 0.35 to 0.80. Criterion validity was shown by correlations of r = 0.58 for PIPS-J pain avoidance with the AAQ-II-J, and r = 0.45 between PIPS-J cognitive fusion and the CFQ-J. Cronbach’s alpha for the PIPS-J total score was α=0.85 (pain avoidance: 0.87; cognitive fusion: 0.68). The test–retest correlation for all 12 items was r = 0.54 (pain avoidance: 0.48; cognitive fusion: 0.54).ConclusionAlthough a less relevant item was found on each of subscales, the PIPS-J appear to be fairly valid and reliable to evaluate psychological inflexibility in chronic pain among Japanese older adults.

Self-reported Fear, Psychological Inflexibility and Opioid Dose in Relation to Pain

Within the past two decades, research on the treatment of chronic pain with opioid medication has attempted to understand the complex relationship between psychological factors, subjective pain experience, and prescription opioid use. Specifically, fear and psychological inflexibility factors have been explored in relation to both pain sensation and opioid dose. The current study aims to explore and enhance the understandings of brief, subjective self-report measures of fear in relation to opioid dose, subjective fear, self-reported pain, and psychological inflexibility processes. This study examined whether (1) a quadratic relationship would exist between pain scores and opioid dose; (2) individuals with higher opioid dosages would have higher psychological inflexibility scores and subjective fear of pain scores; (3) subjective fear scores, in concert with psychological inflexibility pain measures, would be predictive of pain scores, and (4) subjective fear scores would positively correlate to psychological inflexibility pain measures. The final sample consisted of 202 respondents of an online survey for chronic pain. Survey measures included the Chronic Pain Grade questionnaire (CPG), the Psychological Inflexibility in Pain Scale (PIPS), Subjective Fear of Pain when in Low Pain (FlowP), and when in No Pain (FnoP). Opioid dosage for each participant was converted to the standardized Morphine Milligram Equivalent (MME). A significant quadratic relationship between the CPG and MME was found (p=0.016). MME scores were <i>ns</i> in relation to Subjective Fear of Pain scores or PIPS. FlowP and FnoP, however, did predict overall pain scores for participants (p<0.001). Overall pain scores also showed a positive moderate relationship with overall PIPS scores (r(200)=0.673, p<0.001). FlowP and PIPS together explained 45.7% of the variance of pain scores (F(2,199) = 83.640, p=0.003, R=0.676, R²=0.457) with FnoP and PIPS explaining slightly less at 44.8% (F(2,187)=76.002, p<0.001, R=0.670, R²=0.448). FlowP, however, showed slightly stronger correlations to overall PIPS scores (r(200)=0.648, p<0.001) when compared to FnoP (r(188)=0.589, p<0.001). These findings support previous research indicating a quadratic relationship between pain and opioid dose. Higher pain scores were correlated to higher scores on PIPS and subjective fear of pain questions. Of benefit, the subjective fear of pain questions showed some minor predictability when used as a two-question predictor of pain. Our results not only support previous research underlying the relationship between opioid dose and pain but expand on insight into the use of short-form, fear-related questions to predict psychometrics such as psychological inflexibility and pain sensation.

Self-compassion predicting pain, depression and anger in people suffering from chronic pain: A prospective study.

Self-compassion is associated with disability, pain-related anxiety as well as depression and anger in patients with chronic pain. However, the unique value of self-compassion versus other concepts such as psychological flexibility and self-esteem is unknown. The present study therefore aimed to clarify these relationships. Individuals with chronic pain (NCP=872) and without chronic pain (NNP=356) took part in a longitudinal study. Participants completed self-report instruments: Pain Disability Index (PDI), Pain Catastrophizing Scale (PCS), Pain Anxiety Symptom Scale (PASS-20), Patient Health Questionnaire (PHQ-9), State Trait Anger Expression Inventory (STAXI), Self-Compassion Scale (SCS), Psychological Inflexibility in Pain Scale (PIPS) and Rosenberg Self-Esteem Scale (RSES). Assessments were repeated after 8weeks. We found differences in baseline levels of all relevant variables except for anger-out and anger-control between people with and without chronic pain. Subsequently, we computed a path model analysis regarding individuals suffering from chronic pain (NCP), addressing the predictive value of reduced uncompassionate self-responding (RUS), compassionate self-responding (CS), avoidance (PIPS), cognitive fusion (PIPS) and self-esteem (RSES) regarding pain-related (PDI, PCS, PASS) and emotional variables (PHQ-9, STAXI). Avoidance predicted disability, catastrophizing, anxiety and depression. RUS predicted catastrophizing and pain-related anxiety. Self-esteem predicted depression. CS and cognitive fusion had no unique predictive value. The model explained 65.4%-72.1% of the variance in pain-related variables, 68.7% of the variance in depression and 38.7%-60.7% in the variance of anger-related variables. In conclusion, psychological flexibility, in terms of avoidance, seems to be more relevant for chronic pain than self-compassion. Future research should focus on subgroups and tailored-treatment approaches. SIGNIFICANCE: Applying a longitudinal design, this study examined the predictive value of self-compassion regarding pain, depression and anger. The relevance of self-compassion was compared to psychological flexibility and self-esteem. We can conclude that psychological flexibility, in terms of avoidance behaviour, is the most relevant predictor concerning pain.

The Bed Nucleus of the Stria Terminalis as a Brain Correlate of Psychological Inflexibility in Fibromyalgia

This study explored the brain structural correlates of psychological flexibility (PF) as measured with the Psychological Inflexibility in Pain Scale (PIPS) in patients with fibromyalgia (FM). Structural magnetic resonance imaging data from 47 FM patients were used to identify Gray Matter Volume (GMV) alterations related to PIPS scores. Brain GMV clusters related to PIPS were then correlated with clinical and cognitive variables to further explore how emerged brain clusters were intertwined with FM symptomatology. Longitudinal changes in PIPS-related brain clusters values were assessed by studying pre–post data from 30 patients (15 allocated to a mindfulness-based stress reduction (MBSR) program and 15 to treatment-as-usual). Changes in PIPS-related brain clusters were also explored in participants showing greater/lower longitudinal changes in PIPS scores. PIPS scores were positively associated with GMV in a bilateral cluster in the ventral part of the bed nucleus of the stria terminalis (BNST). Significant associations between BNST cluster with functional impairment, depressive symptomatology, perceived stress and the nonjudging mindfulness facet were observed. Participants reporting greater pre–post increases in PIPS scores showed greater increases in BNST cluster values. These findings contribute to the understanding on the neurobiological bases of PF in FM and encourage further explorations of the role of the BNST in chronic pain.

Psychological Inflexibility in Pain Scale: Greek adaptation, psychometric properties, and invariance testing across three pain samples.

The success of acceptance and commitment therapy (ACT) in improving life functioning among chronic pain patients is followed by an interest in investigating mechanisms of action via which it unfolds and validating measures to assess its key constructs. The Psychological Inflexibility in Pain Scale (PIPS-II) assesses pain avoidance and fusion. This is the first study to examine the measurement models of this instrument's Greek adaptation (G-PIPS-II) in patients with different pain localizations (i.e., chronic and headache). A community heterogeneous sample of chronic pain sufferers (N = 156) and two clinical samples comprising treatment-seeking chronic pain patients (N = 149) and treatment-seeking headache patients (N = 89) were recruited from nongovernmental chronic pain support organizations and primary care centers. Exploratory and confirmatory factor analyses demonstrated an acceptable model fit of the G-PIPS-II yielding a two-factor model: avoidance (8 items) and cognitive fusion (4 items). Moderate to high correlations with theoretically related measures supported its construct validity; reliability was high for the total scale and the Avoidance subscale and medium for the Cognitive Fusion subscale. Weak measurement invariance was established across the three pain groups, suggesting that regardless of pain localization, chronic pain and headache patients understand the two latent factors in a similar way. G-PIPS-II is a psychometrically sound instrument assessing two constructs targeted for change within ACT and is deemed a conceptually meaningful scale with items having similar meanings for patients with different pain localization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Supplemental Material for Psychological Inflexibility in Pain Scale: Greek Adaptation, Psychometric Properties, and Invariance Testing Across Three Pain Samples

Supplemental Material for Psychological Inflexibility in Pain Scale: Greek Adaptation, Psychometric Properties, and Invariance Testing Across Three Pain Samples

The Evaluation of the Construct and Convergent Validity and Reliability of Psychological Inflexibility in Pain Scale in Individuals With Migraine Headache

Background: The migraine headache is one of the common chronic pains. Recent psychopathological approaches emphasized more on acceptance than the control of pain. Psychological inflexibility in pain scale (PIPS) is a tool to assess pain acceptance. Objectives: The current study aimed at evaluating the psychometric properties of PIPS. Methods: The study sample comprised of 250 individuals with migraine headache. They were selected from patients admitted to neurological ward of Shahid Beheshti Hospital and private neurology clinics in Kashan, Iran in summer 2015. After preparation of the PIPS (translation and back-translation), participants completed the PIPS and chronic pain acceptance questionnaire (CPAQ). The factor structure and correlation of PIPS with CPAQ were examined. Results: The results of exploratory factor analysis (EFA) showed two factors of pain avoidance (10 items) and cognitive fusion factor (six items) for this scale. The confirmatory factor analysis (CFA) confirmed the obtained model in comparison with the original model (group factor analysis (GFA), CFA, and the Tucker-Lewis index (TLI) ≥ 0.90; the root mean square error of approximation (RMSEA) 90% confidence interval (CI) = 0.03 - 0.06). Also, the convergent validity of this scale was confirmed with CPAQ (r =.66, P < 0.001). The reliability of the scale by internal consistency and test-retest method was good. Conclusions: The Persian version of PIPS has appropriate psychometric features in Iranian society and it can be used to measure this characteristic.

Concept and validation of the German version of the Cognitive Fusion Questionnaire (CFQ-D)

Within the ACT model of psychological flexibility, cognitive fusion (CF) refers to individuals’ attitudes towards their own thoughts and beliefs, more specifically, the extent to which they identify with and are behaviorally regulated by the form and content of their own thoughts and beliefs. This concept is of growing interest for those treating chronic conditions. Evidence supports the relevance of CF in the context of pathological conditions such as chronic pain. Recently developed measures of CF are available in English but so far, have been lacking in German. This study aims to explore the reliability and validity of the German translation of the Cognitive Fusion Questionnaire (CFQ) within a clinical sample (n = 216) of patients suffering from chronic pain at a rehabilitation clinic and a non-clinical sample (n = 166). Participants also completed a set of standard clinical measures as well as the German translation of the Psychological Inflexibility in Pain Scale (PIPS) to assess concurrent and convergent validity. Confirmatory factor analysis (CFA) confirmed a one-factor solution, referred to as CF, which had been identified previously. The scale had good psychometric properties. Furthermore, the CFQ-D total sum score was correlated with measures of psychological inflexibility in pain, pain intensity, self-reported state of health and limitation of physical functioning, functional ability, quality of life, pain related self-instructions and depression. Further analyses indicate that CFQ-D is a reliable and valid instrument for assessing CF in a German-speaking population.

The Psychological Inflexibility in Pain Scale (PIPS) - validation, factor structure and comparison to the Chronic Pain Acceptance Questionnaire (CPAQ) and other validated measures in German chronic back pain patients.

BackgroundAcceptance and Commitment Therapy (ACT) for pain offers an alternative to traditional Cognitive Behavioural Therapy (CBT) approaches. ACT focuses on the enhancement of ‘psychological flexibility’ that enables individuals to pursue their values and goals despite pain. To assess specific treatment effect or mediators and moderators of change, questionnaires measuring ACT constructs are needed.MethodsThe Psychological Inflexibility in Pain Scale (PIPS) was translated into German and completed by 182 participants with chronic back pain (70.3 % women, age 51.0 ± 10.5 years). Item analyses and a confirmatory factor analysis were computed as well as correlations with the Chronic Pain Acceptance Questionnaire (CPAQ), which measures related, but slightly different ACT-related constructs, and self-reported disability, pain intensity and further pain-related questionnaires.ResultsThe confirmatory factor analysis reproduced the original structure with two subscales and a good fit. The internal consistencies of the subscales were Cronbach’s α = .91 (Avoidance) and α = .26 (Fusion). Average item-whole correlations of the items with the respective subscales were r = .71 (Avoidance) and r = .20 (Fusion). The highest correlations were observed for Avoidance with the CPAQ (r = −.81), the Tampa Scale of Kinesiophobia (r = .58) and the Pain Catastrophizing Scale (r = .56) and for Fusion with the CPAQ subscale Pain willingness (r = −.55). The PIPS subscale Avoidance predicted pain-related disability even after controlling for catastrophizing and fear of movement.ConclusionsThe PIPS subscale Avoidance may be a valuable instrument to assess treatment processes in future RCTs. The PIPS subscale Fusion seemed more problematic in the German sample with chronic back pain. More research on the comparison between PIPS and other questionnaires assessing psychological flexibility and the usefulness of the concept ‘Fusion’ for chronic pain are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0641-z) contains supplementary material, which is available to authorized users.

The Psychological Inflexibility in Pain Scale (PIPS)

Psychological flexibility receives increasing attention as the overarching process in Acceptance and Commitment Therapy (ACT). This study investigates the psychometric properties of the Psychological Inflexibility in Pain Scale (PIPS), measuring “avoidance” and “cognitive fusion” with pain, in a heterogeneous clinical sample of 428 chronic pain patients from four rehabilitation centers. Furthermore, the relationship between the PIPS and mindfulness (Five Facet Mindfulness Questionnaire, FFMQ) as a theoretically related measure within ACT is explored. Confirmatory factor analyses replicated acceptable/good model fit and internal consistencies. In a subsample from two rehabilitation centers (n = 237), the PIPS showed moderate to high relationships with aspects of mindfulness, pain interference in daily life, pain disability and mental health, and small relationships with pain intensity and physical functioning. The avoidance subscale explained additional variance in outcome variables beyond the FFMQ, ranging from 4.5 to 15.8%. Outcomes support the psychometric properties of the PIPS in a heterogeneous chronic pain sample. The PIPS and FFMQ measure slightly overlapping, but distinct constructs, and can be used complementary to assess a broad range of processes within ACT. Potential problems with the cognitive fusion subscale are acknowledged for future research.

Validation of a Spanish version of the psychological inflexibility in pain scale (PIPS) and an evaluation of its relation with acceptance of pain and mindfulness in sample of persons with fibromyalgia

BackgroundPsychological flexibility has been suggested as a fundamental process in health. The Psychological Inflexibility in Pain Scale (PIPS) is one of the scales employed for assessing psychological inflexibility in pain patients. The aim of this study was to validate the Spanish version of the PIPS and secondly, to compare it to two other psychological constructs, the acceptance of pain and mindfulness scales.MethodsThe PIPS was translated into Spanish by two bilingual linguistic experts, and then, back-translated into English to assess for equivalence. The final Spanish version was administered along with the Pain Visual Analogue Scale, Fibromyalgia Impact Questionnaire, Hospital Anxiety Depression Scale, Pain Catastrophizing Scale, Chronic Pain Acceptance Questionnaire and the Mindful Attention Awareness Scale, to 250 Spanish patients with fibromyalgia. Face validity, construct validity, reliability (internal consistency and test-retest) and convergent validity were tested. Also a multiple regression analysis was carried out.The usual guidelines have been followed for cross-cultural adaptations.ResultsData were very similar to the ones obtained in the original PIPS version. The construct validity confirmed the original two-components solution which explained 61.6% of the variance. The Spanish PIPS had good test-retest reliability (intraclass correlation coefficient 0.97) and internal consistency reliability (Cronbach’s alpha: 0.90). The Spanish PIPS’ score correlated significantly with worse global functioning (r = 0.55), anxiety (r = 0.54), depression (r = 0.66), pain catastrophizing (r = 0.62), pain acceptance (r = −0.72) and mindfulness (r = −0.47), as well as correlating modestly with pain intensity (r = 0.12). The multiple regression analyses showed that psychological inflexibility, acceptance and mindfulness are not overlapped.ConclusionsThe Spanish PIPS scale appears to be a valid and reliable instrument for the evaluation of psychological inflexibility among a sample of fibromyalgia patients. These results ensure the use of this scale in research as well as in clinical practice. Psychological inflexibility measures processes different from other related components such as acceptance and mindfulness.

Psychometric properties of the Spanish version of the mindful attention awareness scale (MAAS) in patients with fibromyalgia

BackgroundMindful-based interventions improve functioning and quality of life in fibromyalgia (FM) patients. The aim of the study is to perform a psychometric analysis of the Spanish version of the Mindful Attention Awareness Scale (MAAS) in a sample of patients diagnosed with FM.MethodsThe following measures were administered to 251 Spanish patients with FM: the Spanish version of MAAS, the Chronic Pain Acceptance Questionnaire, the Pain Catastrophising Scale, the Injustice Experience Questionnaire, the Psychological Inflexibility in Pain Scale, the Fibromyalgia Impact Questionnaire and the Euroqol. Factorial structure was analysed using Confirmatory Factor Analyses (CFA). Cronbach's α coefficient was calculated to examine internal consistency, and the intraclass correlation coefficient (ICC) was calculated to assess the test-retest reliability of the measures. Pearson’s correlation tests were run to evaluate univariate relationships between scores on the MAAS and criterion variables.ResultsThe MAAS scores in our sample were low (M = 56.7; SD = 17.5). CFA confirmed a two-factor structure, with the following fit indices [sbX2 = 172.34 (p < 0.001), CFI = 0.95, GFI = 0.90, SRMR = 0.05, RMSEA = 0.06. MAAS was found to have high internal consistency (Cronbach’s α = 0.90) and adequate test-retest reliability at a 1–2 week interval (ICC = 0.90). It showed significant and expected correlations with the criterion measures with the exception of the Euroqol (Pearson = 0.15).ConclusionPsychometric properties of the Spanish version of the MAAS in patients with FM are adequate. The dimensionality of the MAAS found in this sample and directions for future research are discussed.

Acceptance and commitment therapy for fibromyalgia: A randomized controlled trial

Abstract Background Recent developments within cognitive behavior therapy (CBT) have emphasized the utility of acceptance and mindfulness strategies, contrasting interventions focused on reduction or control of symptoms. A study of fMRI changes after CBT in females with fibromyalgia (FM) has been performed and results are presented elsewhere (under review). The aim of the present study was evaluate the effectiveness of Acceptance and Commitment Therapy (ACT)-based intervention for patient diagnosed with FM in comparison with a wait-list control Method Female patients aged 18–55 years, fulfilling the American College of Rheumatology classification criteria for FM, and with a weekly self-reported average pain intensity of &gt;40 (VAS 0–100) were considered eligible for inclusion. Participants completed a set of questionnaires prior to treatment, immediately following the treatment and at follow 3–4 months post treatment. Primaryoutcome variable was pain disability (PDI). FIQ, SF36, SES, STAI, pain intensity, BDI, PIPS (psychological inflexibility in pain scale) were also used. The ACT-intervention consisted of twelve weekly group sessions, ten with psychologist and two with pain physician. Treatment was evaluated and mediation analyses were performed. Results Primary outcome measure (PDI): A significant improvement in pain disability for ACT in relation to the control condition, p &lt; 0.001. Secondary outcome measures: ACT showed significant improvement in mental health quality of life, self-efficacy, depression, and anxiety. Consistent with hypotheses, ACT did not result in significant changes in either physical quality of life or pain intensity. Mediation analyses: A decrease in psychological inflexibility from pre to post assessments significantly mediated the improvement in pain disability. Conclusion The present study supports the utility of using a relatively brief ACT intervention in a group format for women diagnosed with fibromyalgia, and data suggests a mediating function on improvements in psychological flexibility.

Predicting and Preventing Chronic Postsurgical Pain and Disability

Predicting and Preventing Chronic Postsurgical Pain and Disability

The Psychological Inflexibility in Pain Scale (PIPS) – Statistical properties and model fit of an instrument to assess change processes in pain related disability

Recent developments within CBT have emphasized acceptance rather than control of pain and distress in treatments aimed at improving functioning and life quality, but there is still a lack of reliable and valid instruments to assess relevant processes in such interventions. The Psychological Inflexibility in Pain Scale (PIPS) was developed to assess target variables in exposure and acceptance oriented treatments. A preliminary validation study resulted in a two-factor solution with subscales for avoidance and cognitive fusion related to pain, showing satisfactory psychometric properties. This study sought to evaluate the instrument with 611 participants with whiplash associated disorders. Exploratory and confirmatory factor analyses supported a two-factor solution with 12 items which showed an acceptable model fit, adequate internal consistencies, and strong relations with criteria variables (e.g. disability and life satisfaction). The construct validity of the instrument was supported by high correlations with subscales from the Chronic Pain Acceptance Questionnaire (CPAQ) and the Tampa Scale of Kinesiophobia (TSK). Notably, hierarchical regression analyses illustrated that PIPS explained more variance than TSK in pain, disability, life satisfaction and depression. Furthermore, PIPS was found to mediate the relationship between e.g. pain and disability, suggesting the usefulness of PIPS as a process measure in treatments of people with chronic pain. Thus, it is argued that this 12-item version of PIPS may be used to explore the importance of psychological in/flexibility in chronic pain and to analyse processes of change in exposure based interventions, as well as for clinicians in tailoring interventions for patients with chronic debilitating pain.

Avoidance and cognitive fusion – Central components in pain related disability? Development and preliminary validation of the Psychological Inflexibility in Pain Scale (PIPS)

Acceptance of pain and other associated negative private experiences has received increasing attention in recent years. This approach is in stark contrast to the traditional approach of reducing or controlling symptoms of pain. The empirical support for treatments emphasizing exposure and acceptance, such as Acceptance and Commitment Therapy, is growing. However, to date, few instruments exist to assess the core processes in these types of treatments. This study describes the development and preliminary validation of the Psychological Inflexibility in Pain Scale. Principal components analysis (PCA) suggests a 2-factor solution with a total of 16 items measuring avoidance of pain and cognitive fusion with pain. Results also indicate adequate reliability and validity for the scale. Implications of these findings for clinical assessment, as well as for research on pain related disability, are discussed along with suggestions for further research in this area.