Clinical assessment of behavioral coping responses: preliminary results from a brief inventory

Abstract

Patients and clinicians sometimes take coping with chronic pain primarily as a process of gaining more control over pain. An alternate approach might include helping the pain sufferer to discriminate parts of their situation that can be effectively controlled from those that cannot. When faced with situations that do not yield to attempts at direct control patients may gain better results from leaving those situations as they are and investing their efforts elsewhere. This study was designed to examine this type of expanded view of coping with pain, a view that includes both attempts at control and acceptance. 200 adults seeking treatment for chronic pain were the subjects of this investigation. They completed a number of self-report inventories including a measure called the Brief Pain Coping Inventory, an inventory assessing accepting responses to pain as well as pain management responses standardly targeted by cognitive-behavioral treatment methods. Preliminary results showed that the BPCI yields scores with adequate temporal consistency and validity. Further results showed that a number of the responses assessed by the BPCI were reliable predictors of patient functioning. In general less frequent struggling to control pain, fewer palliative and avoidant coping responses, and more explicit persistence with activity despite acknowledged pain were associated with less depression and anxiety and greater life functioning. These results demonstrate that, in some instances, attempts at avoidance and control of chronic pain may be less helpful compared with a willingness to experience pain and focus on functioning.

Acceptance of chronic pain

“…In fact, acceptance clearly is not the same as diverting attention from pain or ignoring pain, nor is it the same as increasing behavioral activity for purposes of pain management [13]. It shares more in common with such strategies as "carrying on with an activity with pain present" and "realizing that pain does not need to lead an activity to stop" [15]. When a measure of six coping strategies was compared with a single measure of acceptance of pain, the acceptance score clearly performed as a stronger predictor of pain, disability, depression, pain-related anxiety, and work status in a large sample of chronic pain sufferers [13].…”

Psychological Flexibility and Traditional Pain Management Strategies in Relation to Patient Functioning With Chronic Pain: An Examination of a Revised Instrument

“…Previous data demonstrate adequate item intercorrelations and correlations with measures of acceptance of pain and patient functioning to support validity of the BPCI items as a measure of acceptance-oriented and traditional cognitive-behavioral coping responses. 22 The purpose of the additional 11 items added to form the BPCI-2 was an attempt to derive multiitem summary scores from the inventory, as the original single item format was open to criticism regarding inadequate reliability and stability. The items were written by 1 of the authors (LM), in consultation with 3 other clinical psychologists working in pain management, and designed to encompass psychological flexibility, including acceptance, mindfulness, values-based action, and cognitive defusion; or a traditional CBT approach, including activity pacing, exercise, relaxation, positive self-statements, distraction, and pain coping.…”

“…The BPCI-2 was administered as a pool of 29 items, including the 18 original items of the BPCI, 22 with the intent to further develop the measure based on the current analyses. The BPCI was designed as a brief clinical instrument to assess a range of responses to pain including acceptance-based (eg, "realized that pain does not prevent activity," or "struggled to get control of the pain," which is negatively keyed) and typical cognitivebehaviorally based ("used a relaxation strategy to reduce feelings of pain," or "changed my activity to keep myself focused on something other than pain"), each assessed by individual item responses.…”

“…23 The purpose of the present study was to further investigate the role of psychological flexibility in patients with chronic pain. For this study, the content of a previously designed measure of pain coping, the Brief Pain Coping Inventory (BPCI), 22 was expanded to include additional items related to acceptance, mindfulness, values-based action, and cognitive defusion. A preliminary aim was to demonstrate adequate reliability and validity for this expanded measure.…”

Att leva med en kropp som värker : samtal med fysioterapeuten

“…paradoxal förändring då sker (76). Utan denna acceptans kan uppmärksamheten inte riktas mot icke-smärtande aspekter av livet, en insikt som också är kärnan i Acceptance and Commitment Therapy (ACT) (77,78). Denna centrala roll av accepterandet får också stöd i studier av långvarig sjukdom.…”