Trait mindfulness and catastrophizing as mediators of the association between pain severity and pain-related impairment
Introduction
The deleterious effects of chronic pain on such diverse indicators of adjustment as effective goal pursuit (Karoly, Okun, Enders, & Tennen, in press), psychological health (e.g., depression and anxiety) (Fishbain et al., 1997, McWilliams et al., 2003), and quality of life (Schlenk et al., 1998) have been widely documented. Further, the mechanisms by which pain may give rise to adjustment problems are gradually becoming better understood. A particularly promising avenue of investigation focuses upon individual differences in the cognitive processing of pain-related experiences (Pincus and Morley, 2001, Roelofs et al., 2005). Specifically, mindfulness and pain catastrophizing have emerged as variables that may clarify the complex relationship between pain experience and disordered adjustment (Grossman et al., 2007, Keefe et al., 1989); and their role as mediators of the relation between chronic pain severity and pain-related impairment is the focus of the present investigation.
Previous research has consistently shown that people with persistent pain are likely to respond to pain reflexively and habitually (see Eccleston and Crombez, 1999, Van Damme et al., 2010 for a review). Hence, we propose that, relative to people reporting low chronic pain severity, people who report high chronic pain severity are likely to be less mindful. Research likewise shows that pain possesses the capacity to disrupt conscious, reflective thinking and to facilitate maladaptive automatic reactions such as passivity and worry (Crombez, Eccleston, Van Damme, Vlaeyen, & Karoly, 2012) that can, over time, precipitate catastrophizing. Pain catastrophizing, in turn, has repeatedly been associated with various dimensions of functional disability (Arnow et al., 2011, Sullivan et al., 1998).
However, as a counterpoint, it has been suggested that mindfulness, defined as the state of being present in the moment with a non-judgmental attitude of acceptance (Kabat-Zinn, 1994, Kabat-Zinn et al., 1985), can reduce catastrophic thinking (see Kang, Gruber, & Gray, 2013 for a review). Moreover, mindfulness-based interventions have demonstrated that trait mindfulness is not a fixed characteristic, but rather can be increased with training (Carmody and Baer, 2008, Collard et al., 2008). Thus, the impact of mindfulness on maladaptive cognitive processing merits careful empirical attention inasmuch as mindfulness may provide the regulatory leverage to mitigate pain catastrophizing and thereby short circuit pain’s deleterious effects on ensuing emotional, social, vocational, and physical functioning.
In view of the above-noted relationships, we hypothesized that pain severity will be negatively related to dispositional mindfulness which, in turn, will be negatively associated with pain catastrophizing. Finally, pain catastrophizing is posited to be the most proximal determinant of pain-related impairment. These hypothesized relations are tested by means of a three-path mediation model (Taylor, MacKinnon, & Tein, 2008) that examines mindfulness and pain catastrophizing as mediators of the relation between pain severity and pain-related impairment.
In evaluating this three-path model, we included pain acceptance as a covariate. Acceptance gauges how much one pursues life activities while in pain and how much one is willing to experience pain without trying to control it (McCracken, Vowles, & Eccleston, 2004). This variable was selected to serve as a covariate because, like mindfulness, it is a resilience-related resource for individuals with chronic pain and may influence pain-related impairment independent of mindfulness.
Section snippets
Procedure
Potential participants (N = 3000) were screened by administering the “Severity” subscale of the “PCP:S” to students enrolled in sections of Introduction to Psychology at a large, southwestern university in the United States. Students scoring in the upper 15% range (n = 450; cutoff score: above 19; M = 20.42, SD = 2.28) of pain severity were categorized as experiencing high pain severity and those who scored in the lower 15% range (n = 450; cutoff score: below 8; M = 5.28 SD = 1.38) of pain severity
Preliminary analyses
Means, standard deviations, Cronbach alphas, and correlations for all the measured variables in the current study are displayed in Table 1. The correlations show that most variables were moderately correlated. The positive relation between pain severity and pain acceptance may reflect a dynamic whereby the adaptive mechanism of accepting pain is more likely to be invoked by individuals who are living with severe pain.
Structural model
Using Mplus, the fit of the hypothesized three-path mediational model to the
Discussion
The present study sought to test a model wherein mindfulness and pain catastrophizing served as mediators of the relation between chronic pain severity and pain-related impairment. Although the full three-path mediated effect was not statistically significant, several meaningful paths were observed in our analyses.
First, people experiencing higher levels of pain severity were found to be less mindful compared to those who report less pain severity. To the best of our knowledge, this link
Conflict of interest statement
The first two authors have no conflict of interest. The third author is a co-developer of the PCP:S.
Acknowledgement
We thank Mirna Hodzic Mun for her comments on a previous version of this paper.
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