Catastrophizing and coping with chronic pain

Abstract

Coping theory based on the Transactional Theory of Folkman and Lazarus (1984) is often applied to the process of psychological adjustment to the experience of chronic pain. In addition, various outcome measurements have been used to conceptualize and quantify adjustment. The results of these investigations have been suggestive of trends, but are not consistent and often are difficult to interpret. In part, these problems could be due to difficulty in defining coping in a meaningful, interpretable manner and to the specified measures of adjustment.;This investigation combined the Transactional Theory with the Dual-Process Model of Brandstadter and Renner (1990). This latter model delineates an end point by which coping efforts can be gauged, i.e., flexible goal achievement. In this manner, one's attempts to cope are judged relative to one's ability to attain a meaningful goal.;In order to obtain information relating to adjustment, a measure of generalized psychological distress was chosen, i.e., MMPI-2, Scale 7, Psychasthenia. This measurement was expected to be sensitive to levels of affective reactivity that might not otherwise be identified by commonly used screening devices.;It was hypothesized that maladaptive coping, i.e., catastrophizing from the Coping Strategies Questionnaire, would be consistently and significantly associated with increased psychological distress and depression. This result was expected due to the negative cognitions that are generated and maintained by catastrophization. These cognitions would then, in turn, influence the individual's ability to attain and maintain meaningful goal-directed behavior.;Coping and affective status were obtained in a correlational study of 135 chronic pain patients. Univariate analyses supported the existence of a strong, positive relationship between maladaptive coping and both indices of psychological distress. Regression analyses indicated a linear relationship between these constructs with maladaptive coping predicting 19.3% of the variance in affective status.;Catastrophizing in response to chronic pain, therefore, appears to uniquely contribute to the individual's level of generalized psychological distress. This appears to be due to its negative influence on perceptions, control expectancies, and hopefulness. The individual's sense of well-being is further compromised by these factors, resulting in significantly diminished resources with which to cope, to adjust, and to self-actualize.