Coping with chronic pain: flexible goal adjustment as an interactive buffer against pain-related distress

Abstract

In the present study, Brandtstädter's (1992) distinction between assimilation and accommodation as two fundamental means of coping is applied to the field of chronic pain. Assimilative coping involves active attempts (e.g. instrumental activities, self-corrective actions, compensatory measures) to alter unsatisfactory life circumstances and situational constraints in accordance with personal preferences. Conversely, accommodative coping (e.g. downgrading of aspirations, positive reappraisal, self-enhancing comparisons) is directed towards a revision of self-evaluative and personal goal standards in accordance with perceived deficits and losses. Our research is based on the assumption that chronic pain can be described as a major source of threat or impediment to personal goals. When goals are no longer perceived to be attainable through active-assimilative coping efforts, accommodative coping should become increasingly important in dealing with chronic pain. In a study of 120 chronic pain patients, dispositional differences in assimilative (tenacious goal pursuit) and accommodative coping tendencies (flexible goal adjustment), as well as measures of pain-related coping and adjustment (depression, pain-related disability, pain intensity) were assessed. The results suggest that accommodative coping functions as a protective resource by preventing global losses in the psychological functioning of chronic pain patients and maintaining a positive life perspective. Most important, the ability to flexibly adjust personal goals attenuated the negative impact of the pain experience (pain intensity, pain-related disability) on psychological well-being (depression). Furthermore, pain-related coping strategies led to a reduction of disability only when accompanied by a high degree of flexible goal adjustment. The theoretical and clinical implications of these findings for coping research and the treatment of chronic pain patients are discussed.

Do Flexible Goal Adjustment and Acceptance Help Preserve Quality of Life in Patients with Multiple Sclerosis?

“…Interestingly, it was also positively correlated with acceptance, suggesting that those patients with a higher ability to flexibly adjust unattainable goals are better in accepting their illness. This is not that surprising, given that there is some conceptual overlap between both constructs [20,24,26]. Nevertheless, the overlap is far from complete, and acceptance uniquely explained QOL on top of goal regulation styles.…”

“…Wrosch and colleagues [21] found that goal disengagement and goal re-engagement tendencies compensate for the distress associated with the occurrence of unattainable goals. In the chronic pain literature, Schmitz and colleagues [24] found a buffering effect of flexible goal adjustment on the correlation between both pain intensity and disability, and depression. We have no direct explanation for the failure to observe any of the hypothesized moderation effects in this sample of MS patients.…”

“…In other words, one may expect that higher flexible goal adjustment and lower tenacious goal pursuit would be associated with better quality of life, and that the negative impact of severe illness on quality of life would be reduced in those who are capable of flexible goal adjustment. Wile the dual process model has been applied to chronic pain [23][24][25], it remains unexplored in MS.…”

Dynamic pain–emotion relations in chronic pain: a theoretical review of moderation studies

“…Schmitz, Saile, & Nilges (1996) reported that low Flexible Goal Adjustment interacted with high pain intensity (and disability) to predict high levels of depression. Also, Kranz, Bollinger, & Nilges (2010) reported that high Flexible Goal Adjustment was associated with increased pain willingness and activity engagement (two complementary aspects of chronic pain acceptance) particularly at high average pain intensity levels.…”

“…Different variables, such as pain (Fifield et al, 1998), negative affect , depression (Schmitz et al, 1996) Third, the models differ in their predictions regarding the intra-or interpersonal level of the relationships they explain. As discussed by Zautra et al (2005), the intrapersonal level answers "when"-questions, while interpersonal differences address "who"-questions.…”