Abstract:This study provides evidence that components of psychological flexibility are associated with a reduced frequency of suicidal thinking in people with chronic pain. Treatments targeting psychological flexibility may help mitigate the impact of chronic pain on suicidal thinking.
“…Psychosocial models of chronic pain, such as the Fear-Avoidance Model 20 , have said little to nothing on the topic of suicide, although recently the Psychological Flexibility model of chronic pain 21 has been specifically applied to the context of suicide in this population 22 . The three predominant, "ideation-toaction" psychological models of suicide, the Interpersonal Psychological Theory 13,14 , the Integrated Motivational-Volitional model 15,16 and the Three Step Theory 17 , have also been relatively silent on the topic of chronic pain.…”
Section: Suicide and Chronic Pain: The Theoretical Contextmentioning
confidence: 99%
“…Recently the first study was conducted to directly investigate the role of psychological flexibility in the suicidal ideation -chronic pain relationship 22 . This study suggested that in multivariable analysis acceptance and committed action (a willingness to be with unwanted experiences such as pain and the capacity to continue to act in accordance with valued life goals, even in their presence) remained significantly associated with suicidal ideation even when controlling for depression, pain interferences and presence of widespread pain.…”
Individuals with chronic pain are at elevated risk of suicide, yet psychosocial factors that may be involved in increasing or decreasing vulnerability for suicidal ideation and behaviour have received little attention. Extant literature on the topic of suicide in individuals with chronic pain only incorporates a limited number of the wide array of known vulnerability and protective factors from the field of suicide research. The current review focuses on transdiagnostic psychological processes, i.e. processes of relevance for both chronic pain and suicide. We synthesize a selection of the previous literature on chronic pain and suicide, concentrating on previously unexplored and underexplored lines of research, including future orientation, mental imagery and psychological flexibility. A far greater degree of cross-pollination between the fields of chronic pain and suicide research is required if we are to progress in our understanding of why some people with chronic pain become suicidal and others do not.
“…Psychosocial models of chronic pain, such as the Fear-Avoidance Model 20 , have said little to nothing on the topic of suicide, although recently the Psychological Flexibility model of chronic pain 21 has been specifically applied to the context of suicide in this population 22 . The three predominant, "ideation-toaction" psychological models of suicide, the Interpersonal Psychological Theory 13,14 , the Integrated Motivational-Volitional model 15,16 and the Three Step Theory 17 , have also been relatively silent on the topic of chronic pain.…”
Section: Suicide and Chronic Pain: The Theoretical Contextmentioning
confidence: 99%
“…Recently the first study was conducted to directly investigate the role of psychological flexibility in the suicidal ideation -chronic pain relationship 22 . This study suggested that in multivariable analysis acceptance and committed action (a willingness to be with unwanted experiences such as pain and the capacity to continue to act in accordance with valued life goals, even in their presence) remained significantly associated with suicidal ideation even when controlling for depression, pain interferences and presence of widespread pain.…”
Individuals with chronic pain are at elevated risk of suicide, yet psychosocial factors that may be involved in increasing or decreasing vulnerability for suicidal ideation and behaviour have received little attention. Extant literature on the topic of suicide in individuals with chronic pain only incorporates a limited number of the wide array of known vulnerability and protective factors from the field of suicide research. The current review focuses on transdiagnostic psychological processes, i.e. processes of relevance for both chronic pain and suicide. We synthesize a selection of the previous literature on chronic pain and suicide, concentrating on previously unexplored and underexplored lines of research, including future orientation, mental imagery and psychological flexibility. A far greater degree of cross-pollination between the fields of chronic pain and suicide research is required if we are to progress in our understanding of why some people with chronic pain become suicidal and others do not.
“…Statistically however, suicidal ideation was only weakly correlated with stress but not with PTS. We suppose that the very low prevalence of suicidal ideation in our sample (6.9%), as compared to 40%–45% in non‐athletic samples with chronic pain (Legarreta et al, ; McCracken et al, ), may be responsible for the negative findings. As athletic participation was reported to be associated with a reduced risk for suicidality (Sabo et al, ) larger sample sizes might be needed.…”
Section: Discussionmentioning
confidence: 56%
“…Recent reviews reported an association between pain and suicidality, both for patients with chronic and acute pain (Fishbain, Lewis, & Gao, 2014;Tang & Crane, 2006), indicating suicidality to be an important issue in athletes with pain. Suicidal ideation in chronic pain is associated with different psychological measures, such as pain-related catastrophizing or helplessness (Breivik et al, 2014;Legarreta et al, 2018;Racine et al, 2014) and is negatively correlated with acceptance and committed action (McCracken et al, 2018), two important aspects of the concept of psychological flexibility (Hayes, Luoma, Bond, Masuda, & Lillis, 2006;McCracken & Morley, 2014). McCracken et al (2018) proposed the model of psychological flexibility as an overarching theoretical approach to comprise these different factors as precursors of suicidality in terms of avoidance of negative experiences.…”
Section: Discussionmentioning
confidence: 99%
“…Suicidal ideation in chronic pain is associated with different psychological measures, such as pain-related catastrophizing or helplessness (Breivik et al, 2014;Legarreta et al, 2018;Racine et al, 2014) and is negatively correlated with acceptance and committed action (McCracken et al, 2018), two important aspects of the concept of psychological flexibility (Hayes, Luoma, Bond, Masuda, & Lillis, 2006;McCracken & Morley, 2014). McCracken et al (2018) proposed the model of psychological flexibility as an overarching theoretical approach to comprise these different factors as precursors of suicidality in terms of avoidance of negative experiences. Indeed, both TS in general and PTS can be conceptualized as a kind of experiential avoidance (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996), as the attempt to "not think" on a specific target implies the avoidance of the cognitive representation of that target.…”
Background
Depression and suicidal ideation are important health problems in athletes suffering from pain. Dysfunctional pain cognitions, that is, pain‐related thought suppression (PTS), may play an important role in their aetiology. Thought suppression was shown to increase depressive mood, particularly in highly stressed individuals. This cross‐sectional study examines the relationship between PTS and stress on depression and suicidal ideation in athletes with pain.
Methods
A total of 159 athletes with non‐specific low back pain completed a set of questionnaires to measure PTS, depression and stress. Participants were split into groups with high and low stress, and high and low PTS. Two‐way ANOVA calculated main effects for PTS, stress and a PTS*stress interaction, with depressive symptoms as dependent. Subsequently, distribution tests were calculated, investigating if the presence of clinically relevant depression and suicidal ideation is dependent of conditions of high/low PTS and stress.
Results
A main effect of stress demonstrated higher depression scores in highly stressed athletes. Further, a significant PTS*stress interaction showed elevated depression scores in athletes with high PTS and high stress. Distribution analysis revealed positive associations between PTS, stress and depression, with depression being most frequent among athletes with high PTS and high stress. Suicidal ideation was not significantly associated with PTS and only weakly correlated with stress.
Conclusions
Our findings show that PTS is the most common pain response in athletes with pain. The results indicate a higher prevalence of depression and elevated depressive symptoms in athletes experiencing high stress, seemingly more pronounced when highly engaging in PTS.
Significance
This study contributes to the understanding of depression in athletes with pain, suggesting stress and pain‐related thought suppression to increase symptoms and prevalence of depression. As athletes often experience acute or chronic pain, understanding the impact of pain cognitions on health outcomes is an important step in the optimization of treatments.
Experiencing chronic pain often leads to changes in the individual's ability to function physically. Three activity patterns are frequently observed in response to ongoing pain, namely avoidance, pacing and persistence (Andrews et al., 2012). Avoidance is defined as an attempt to escape from activities that are anticipated to be unpleasant or pain-eliciting. Pacing
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