Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Behavioral Medicine
Published in: Annals of Behavioral Medicine 2/2015

01-04-2015 | Original Article

The Role of Experiential Avoidance, Resilience and Pain Acceptance in the Adjustment of Chronic Back Pain Patients Who Have Experienced a Traumatic Event: a Path Analysis

Authors: Gema T. Ruiz-Párraga, Ph.D., Alicia E. López-Martínez, Ph.D.

Published in: Annals of Behavioral Medicine | Issue 2/2015

Login to get access

Abstract

Background

The degree to which shared vulnerability and protective factors for chronic pain and trauma-related symptoms contribute to pain adjustment in chronic pain patients who have experienced a traumatic event remains unclear.

Purpose

The purpose is to test a hypothetical model of the contribution of experiential avoidance, resilience and pain acceptance to pain adjustment in a sample of 229 chronic back pain patients who experienced a traumatic event before the onset of pain.

Methods

Structural equation modelling was used to test the linear relationships between the variables.

Results

The empirical model shows significant relationships between the variables: resilience on pain acceptance and trauma-related symptoms, experiential avoidance on trauma-related symptoms and experiential avoidance, pain acceptance and trauma-related symptoms on pain adjustment.

Conclusions

This study demonstrates the role of a vulnerability pathway (i.e. experiential avoidance) and a protective pathway (i.e. resilience and pain acceptance) in adaptation to pain after a traumatic event.
Appendix
Available only for authorised users
Literature
1.
Casey CY, Greenberg MA, Nicassio PM, Harpin RE, Hubbard D. Transition from acute to chronic pain and disability: A model including cognitive, affective, and trauma factors. Pain. 2008; 134: 69-79.CrossRef
2.
Jones GT, Power C, McFarlane GJ. Adverse events in childhood and chronic widespread pain in adult life: Results from the 1958 British cohort Study. Pain. 2009; 143: 92-96.CrossRefPubMed
3.
Kindler LL, Jones KD, Perrin N, Bennett RM. Risk factors predicting the development of widespread pain from a chronic back or neck pain. J Pain. 2010; 11: 1320-1328.CrossRefPubMedCentralPubMed
4.
Rivara FP, Mackenzie EJ, Jurkovich GJ, et al. Prevalence of pain in patients 1 year alter major trauma. Arch Surv. 2008; 143: 282-287.CrossRef
5.
Sachs-Ericsson N, Kendall-Tackett K, Hernandez A. Childhood abuse, chronic pain, and depression in the National Comorbidity Survey. Child Abuse Negl. 2007; 31: 531-547.CrossRefPubMed
6.
Otis JD, Keane TM, Kerns RD. An examination of the relationship between chronic pain and posttraumatic stress disorder. J Rehabil Res Dev. 2003; 40: 397-405.CrossRefPubMed
7.
Shipherd JC, Keyes M, Jovanovic T, et al. Veterans seeking treatment for posttraumatic stress disorder: What about comorbid chronic pain? J Rehabil Res Dev. 2007; 44: 153-166.CrossRefPubMed
8.
Asmundson GJG, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: Research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry. 2002; 47: 930-937.PubMed
9.
Asmundson GJG, Hadjistavropolous HD. Addressing shared vulnerability for comorbid PTSD and chronic pain: A cognitive-behavioral perspective. Cogn Behav Pract. 2006; 13: 8-16.CrossRef
10.
Martin AL, Halket E, Asmundson GJG, Flora DB, Katz J. Posttraumatic stress symptoms and the diathesis-stress model of chronic pain and disability in patients undergoing major surgery. Clin J Pain. 2010; 26: 518-527.CrossRefPubMed
11.
Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: Mutual maintenance? Clin Psychol Rev. 2001; 21: 857-877.CrossRefPubMed
12.
Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain. 2000; 85: 317-332.CrossRefPubMed
13.
Esteve MR, Ramírez-Maestre C, López-Martínez AE. Experiential avoidance and anxiety sensitivity as dispositional variables and their relationship to the adjustment to chronic pain. Eur J Pain. 2012; 16: 718-726.CrossRefPubMed
14.
Zettle RD, Hocker TR, Mick KA, Scofield BE. Differential strategies in coping with pain as a function of level of experiential avoidance. Psychol Rec. 2005; 55: 511-524.
15.
Marx BP, Sloan DM. Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behav Res Ther. 2005; 43: 569-583.CrossRefPubMed
16.
Tull MT, Gratz KL, Salters K, Roemer L. The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety and somatization. J Nerv Ment Dis. 2004; 192: 754-761.CrossRefPubMed
17.
Hayes SC, Wilson KG, Gifford E, Follette VM, Strosahl KD. Emotional avoidance and behaviour disorders: A functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol. 1996; 64: 1152-1168.CrossRefPubMed
18.
Kashdan TB, Barrios V, Forsyth JP, Steger MF. Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behav Res Ther. 2006; 44: 1301-1320.CrossRefPubMed
19.
Costa J, Pinto-Gouveia JP. Experiential avoidance and self-compassion in chronic pain. J Appl Soc Psychol. 2013; 43: 1578-1591.CrossRef
20.
Costa J, Pinto-Gouveia JP. The mediation effect of experiential avoidance between coping and psychopathology in chronic pain. Clin Psychol Psychother. 2011; 18: 34-47.CrossRefPubMed
21.
Esteve R, Ramírez-Maestre C. Pain fear avoidance and pain acceptance: A cross-sectional study comparing their influence on adjustment to chronic pain across three samples of patients. Ann Behav Med. 2013; 46: 169-180.CrossRefPubMed
22.
Orsillo SM, Batten SV. Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behav Modif. 2005; 29: 95-129.CrossRefPubMed
23.
Morina N, Stangier U, Risch AK. Experiential avoidance in civilian war survivors with current versus recovered posttraumatic stress disorder: A pilot study. Behav Change. 2008; 25: 15-22.CrossRef
24.
Thompson RW, Arnkoff DB, Glass CR. Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma. Traum Violence Abuse. 2011; 12: 220-235.CrossRef
25.
Kashdan TB, Morina N, Priebe S. Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: Experiential avoidance as a contributor to distress and quality of life. J Anxiety Disord. 2009; 23: 185-196.CrossRefPubMedCentralPubMed
26.
Gómez-Pérez L, López-Martínez AE. Association of trauma, posttraumatic stress disorder and experimental pain response in healthy young women. Clin J Pain. 2013; 29: 425-434.CrossRefPubMed
27.
Kashdan TB, Breen WE. Social anxiety and positive emotions: A prospective examination of a self-regulatory model with tendencies to suppress or express emotions as moderating variables. Behav Ther. 2008; 39: 1-12.CrossRefPubMed
28.
Orsillo SM, Roemer L, Barlow DH. Integrating acceptance and mindfulness into existing cognitive-behavioral treatment for GAD: A case study. Cogn Behav Pract. 2003; 10: 222-230.CrossRef
29.
McCracken LM. Learning to live with pain: Acceptance of pain predicts adjustment in persons with chronic pain. Pain. 1998; 74: 21-27.CrossRefPubMed
30.
McCracken LM, Vowles KE, Eccleston C. Acceptance of chronic pain: Component analysis and a revised assessment method. Pain. 2004; 107: 159-166.CrossRefPubMed
31.
McCracken LM, Zhao-O’Brien J. General psychological acceptance and chronic pain: There is more to accept than the pain itself. Eur J Pain. 2010; 14: 170-175.CrossRefPubMed
32.
McCracken LM, Samuel VM. The role of avoidance, pacing, and other activity patterns in chronic pain. Pain. 2007; 130: 119-125.CrossRefPubMed
33.
McCracken LM, Eccleston C. A prospective study of acceptance and patient functioning with chronic pain. Pain. 2005; 118: 164-169.CrossRefPubMed
34.
Bensimon M. Elaboration on the association between trauma, PTSD and posttraumatic growth: The role of trait resilience. Personal Individ Differ. 2012; 52: 782-787.CrossRef
35.
Kashdan TB, Kane JQ. Post-traumatic distress and the presence of post-traumatic growth and meaning in life: Experiential avoidance as moderator. Personal Individ Differ. 2011; 50: 84-89.CrossRef
36.
Fincham DS, Altes LK, Stein DJ, Seedat S. Posttraumatic stress disorder symptoms in adolescents: Risk factors versus resilience moderation. Compr Psychol. 2009; 50: 193-199.CrossRef
37.
López-Martínez AE, Ríos-Velasco L, Ruiz-Párraga GT, Esteve R, Sánchez-Reyna A. The role of resilience and acceptance versus catastrophizing and pain-related fear in chronic pain adjustment. Eur J Pain. 2009; 13(supp): 970.
38.
Ramírez-Maestre C, Esteve R, López-Martínez AE. The path to capacity: Resilience and spinal chronic pain. Spine. 2012; 37: E251-E258.CrossRefPubMed
39.
40.
Ruiz-Párraga GT, López-Martínez AE, Gómez-Pérez L, Ramírez-Maestre C, Barranquero I. Traumatic event stories, PTSD symptoms, resilience, pain acceptance, procedural variables and disability in women with chronic pain. Eur J Pain. 2009; 13(supp): S271.CrossRef
41.
Ruiz-Párraga GT, López-Martínez AE, Gómez-Pérez L. Factor structure and psychometric properties of the Resilience Scale in a chronic musculoskeletal pain sample. J Pain. 2012; 13: 1090-1098.CrossRefPubMed
42.
McFarlane AC, van Hooff M, Goodhew F. Anxiety disorders and PTSD. In: Neria Y, Galea S, Norris FH, eds. Mental Health and Disorders. New York: Cambridge University Publishers; 2009: 47-66.
43.
Whealin JM, Stotzer R, Nelson D, Fengand L, Liu-Tom HT, Pietrzak RH. Evaluating PTSD prevalence and resilience factors in a predominantly Asian American and Pacific Islander sample of Iraq and Afghanistan Veterans. J Affect Dis. 2013; 150: 1062-1068.CrossRefPubMed
44.
Jensen MP, Turner P, Romano JR, Fisher LD. Comparative reliability and validity of chronic pain intensity measures. Pain. 1999; 83: 157-162.CrossRefPubMed
45.
Davidson JRT. Davidson Trauma Scale. Nueva York: Multi-Health Systems, Inc.; 1996.
46.
Green BL, Chung JY, Daroowalla A, Kaltman S, DeBenedictis C. Evaluating the cultural validity of the stressful life events screening questionnaire. Violence Against Women. 2006; 12: 1191-1213.CrossRefPubMed
47.
Goodman L, Corcoran C, Turner K, Yuan N, Green BL. Assessing traumatic event exposure: General issues and preliminary findings for the Stressful Life Events Screening Questionnaire. J Trauma Stress. 1998; 11: 521-542.CrossRefPubMed
48.
Davidson JRT, Book SW, Colket JT, et al. Assessment of a new self-rating scale for posttraumatic stress disorder. Psychol Med. 1997; 27: 153-160.CrossRefPubMed
49.
Davidson JRT, Tharwani HM, Connor KM. Davidson Trauma Scale (DTS): Normative scores in the general population and effect sizes in placebo-controlled SSRI trials. Depress Anxiety. 2002; 15: 75-78.CrossRefPubMed
50.
Bobes J, Calcedo-Barba A, García M, et al. Evaluación de las propiedades psicométricas de la versión española de cinco cuestionarios para la evaluación del trastorno de estrés postraumático. Actas Esp Psiquiatr. 2000; 28: 207-218.PubMed
51.
Wagnild FM, Young HM. Development and psychometric evaluation of the Resilience Scale. J Nurs Meas. 1993; 1: 165-178.PubMed
52.
Hayes SC, Strosahl K, Wilson KG, Bissett RT, Pistorello J, Toarmino D. Measuring experiential avoidance: A preliminary test of a working model. Psychol Rec. 2004; 54: 553-578.
53.
Barraca J. Spanish adaptation of the acceptance and action questionnaire. Int J Psychol Psychol Ther. 2004; 4: 505-515.
54.
Bendayan R, Esteve R, Blanca MJ. New empirical evidence of the validity of the Chronic Pain Acceptance Questionnaire: The differential influence of activity engagement and pain willingness on adjustment to chronic pain. Br J Health Psychol. 2012; 17: 314-326.CrossRefPubMed
55.
Roland MO, Morris RW. A study of the natural history of back pain. Part 1: Development of a reliable and sensitive measure of disability in low back pain. Spine. 1983; 8: 141-144.CrossRefPubMed
56.
Kovacs FM, Llobera J, Gil del Real MT, Abraira V, Gestoso M, Fernández C. Validation of the Spanish version of the Roland Morris Questionnaire. Spine. 2002; 2: 149-151.
57.
Zigmond S, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67: 361-370.CrossRefPubMed
58.
Aben I, Verhey F, Lousberg R, Lodder R, Honing G. Validity of the Beck depression inventory, hospital anxiety and depression scale, SCL-90, and Hamilton depression rating scale as screening for depression. Psychosomatics. 2002; 43: 386-393.CrossRefPubMed
59.
Quintana JM, Padierna A, Esteban C, Arostegui I, Bilbao A, Ruiz I. Evaluation of the psychometric characteristics of the Spanish Version of the Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 2003; 107: 216-221.CrossRefPubMed
60.
Byrne BM. Structured Equation Modeling with AMOS. Basic Concepts, Applications, and Programming. 2nd ed. New York: Taylor and Francis; 2010.
61.
Ullman JB. Structural equation modelling. In: Tabachnick BG, Fidell LS, eds. Using Multivariate Statistics. Needham Heights: Allyn and Bacon; 2001: 653-711.
62.
McCracken LM, Eccleston C. Coping or acceptance: What to do about chronic pain? Pain. 2003; 105: 197-204.CrossRefPubMed
63.
Silva AG, Alvarelhão J, Queirós A, Rocha NP. Pain intensity is associated with self-reported disability for several domains of life in a sample of patients with musculoskeletal pain aged 50 or more. Disabil Health J. 2013; 6: 369-376.CrossRefPubMed
64.
Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000; 38: 319-345.CrossRefPubMed
65.
Esteve MR, Ramírez-Maestre C, López-Martínez AE. The role of pain acceptance, coping strategies and pain-related cognitions. Ann Behav Med. 2007; 33: 179-188.CrossRefPubMed
66.
Wetherell JL, Afari N, Rutledge T. A randomized, controlled trial of acceptance and commitment therapy and cognitive behavioural therapy for chronic pain. Pain. 2011; 152: 2098-2107.CrossRefPubMed
67.
Viane I, Crombez G, Eccleston C, Devulder J, De Corte W. Acceptance of the unpleasant reality of chronic pain: Effects upon attention to pain and engagement with daily activities. Pain. 2004; 112: 282-288.CrossRefPubMed
68.
Vowles KE, McNeil DW, Gross RT, McDaniel ML, Mouse A, Bates M. Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain. Behav Ther. 2007; 38: 412-425.CrossRefPubMed
69.
Wicksell RK, Gunnar LO, Hayes SC. Mediators of change in acceptance and commitment therapy for pediatric chronic pain. Pain. 2013; 152: 2792-2801.CrossRef
70.
Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guildford Press; 1999.
71.
Katz J, Asmundson GJ, McRae K, Halket E. Emotional numbing and pain intensity predict the development of pain disability up to one year alter lateral thoracotomy. Eur J Pain. 2009; 13: 870-878.CrossRefPubMed
72.
Moeller-Bertram T, Keltner J, Strigo IA. Pain and post traumatic stress disorder-review of clinical and experimental evidence. Neuropharmacology. 2012; 62: 586-597.CrossRefPubMed
Metadata
Title
The Role of Experiential Avoidance, Resilience and Pain Acceptance in the Adjustment of Chronic Back Pain Patients Who Have Experienced a Traumatic Event: a Path Analysis
Authors
Gema T. Ruiz-Párraga, Ph.D.
Alicia E. López-Martínez, Ph.D.
Publication date
01-04-2015
Publisher
Springer US
Published in
Annals of Behavioral Medicine / Issue 2/2015
Print ISSN: 0883-6612
Electronic ISSN: 1532-4796
DOI
https://doi.org/10.1007/s12160-014-9654-3

Other articles of this Issue 2/2015

Annals of Behavioral Medicine 2/2015 Go to the issue

Original Article

Randomized Controlled Trial of Qigong/Tai Chi Easy on Cancer-Related Fatigue in Breast Cancer Survivors

Invited Commentary

Intimacy, Condom Use, and Pre-Exposure Prophylaxis (PrEP) Acceptability among Men Who Have Sex with Men (MSM) in Primary Partnerships: a Comment on Gamarel and Golub

Original Article

Expectations Are More Predictive of Behavior than Behavioral Intentions: Evidence from Two Prospective Studies

Invited Commentary

Advancing the Science of Mind-Body Interventions: a Comment on Larkey et al.

Original Article

Patient-Perceived Self-Management Tasks and Support Needs of People with Chronic Illness: Generic or Disease Specific?

Original Article

Intimacy Motivations and Pre-exposure Prophylaxis (PrEP) Adoption Intentions Among HIV-Negative Men Who Have Sex with Men (MSM) in Romantic Relationships