Volitional Action Control and Depression in Chronic Pain: Does Action versus State Orientation Moderate the Relations of Pain-Related Cognitions to Depression?

Abstract

In this study, we examined the conditional indirect and direct relations of pain-related cognitions to depression. Subjective helplessness was included as presumably mediating the relations of catastrophizing and thought suppression to depression due to motivational deficits. In addition, moderating effects of dispositional action versus state orientation were analyzed, whereby state orientation indicates volitional deficits in coping with distress. The study was based on self-report data from 536 patients with chronic non-specific low back pain at the beginning of inpatient rehabilitation. Moderated mediation analyses were performed. The indirect catastrophizing- and thought suppression-depression relations were (partially) mediated by subjective helplessness; and moderated by failure-related action versus state orientation. Moreover, action versus state orientation moderated the direct relation of thought suppression to depression. Results suggest that catastrophizing, thought suppression, and subjective helplessness do not lead to depression unless associated with self-regulatory inability (i.e., state orientation). In contrast, action-oriented patients more effectively self-regulate pain-related emotions, disengage from rumination, and distract from pain and thus better avoid the debilitating effects of negative pain-related cognitions on depression. Future research and treatment may more strongly focus on the role of motivational and volitional deficits underlying learned helplessness and depression in chronic pain.

From intentions to action: An integrative review of action control theory and research

“…Action-oriented people, compared with state-oriented people, have further been found to display faster stress recovery and fewer adverse effects of stressors (Beckmann & Kellmann, 2004;Gröpel & Kuhl, 2009;Jaramillo & Spector, 2004). Finally, action-oriented people display better mental health than state-oriented people, both on global measures (Kadzikowska-Wrzosek, 2012;Wojdylo et al, 2014) and specific indicators like sleep quality (Kadzikowska-Wrzosek, 2018;Kroese et al, 2014), Facebook addiction (Błachnio & Przepiorka, 2016;Cudo et al, 2020), disordered eating (Blasczyk-Schiep et al, 2019), body image distortions (Kazén et al, 2019) and pain-related experiences (Buchmann et al, 2021).…”