Cognitive features, self-management, and disability level associated with chronic back pain

Scott Allen Johansen, Fordham University


Background. Chronic back pain (CBP) disability results from the complex interaction of psychosocial variables in the presence of back pain. It is believed that personality plays an important role in pain perception; however, the link between personality and chronic pain has been extensively challenged and has received little empirical support. Trait approaches to personality have historically dominated pain research but may not accommodate the multi-level phenomenon that comprises self-regulation (e.g., encodings, expectancies, goals, motives) in response to situational psychological features. Objective. This study hypothesized relationships between action control theory (ACT), a psychological features theory of personality, and CBP measures. Design. One-hundred-twenty CBP patients completed four ACT-related predictor variables representing self (Core Self-Evaluations Scale, a measure of self-worth), self-concept (Conditional Reasoning Test-Relative Motive Strength, a measure of latent achievement motivation), and two forms of rumination (Preoccupation and Hesitation subscales of the Action Control Scale 90). The Work subscale of the Fear Avoidance Beliefs Questionnaire represented pain-related approach/avoidance. Criterion variables included frequency of self-management strategy utilization (Chronic Pain Coping Inventory - 42) and functional disability (Functional Rating Index). Observations. Core self-evaluations were correlated with preoccupation, and hesitation. Latent achievement motivation was related to hesitation. Hesitation and preoccupation were related. The hesitation but not the preoccupation form of rumination was associated with CBP outcomes. Pain-related fear-avoidance beliefs were related to core self-evaluations, hesitation, utilization of illness-focused coping strategies, and functional disability. Illness but not wellness-focused coping was related to education, fear-avoidance beliefs, core self-evaluations, and hesitation. Functional disability was related to education, fear-avoidance, core self-evaluations, latent achievement motivation, hesitation, and illness- and wellness-focused coping. Conclusions. The relationship of stable cognitive structure and mental process variables with CBP approach/avoidance, coping, and disability supports the application of ACT to chronic back pain populations. Support for the self-related central nature of core self-evaluations was observed. Interpretation of findings through the lens of ACT suggests that future research should explore interventions emphasizing the fulfillment of intentions related to approach-oriented self-management featuring wellness-related coping strategies.

Subject Area

Psychotherapy|Personality|Cognitive therapy|Physiological psychology

Recommended Citation

Johansen, Scott Allen, "Cognitive features, self-management, and disability level associated with chronic back pain" (2008). ETD Collection for Fordham University. AAI3302122.