Fisher, Keren; (1993) Emotion and perceived control as predictors of disability in chronic pain patients. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Early work in behavioural medicine has shown that there is no simple relationship between pain and resulting disability. There are numerous reasons for this which are due both to behavioural factors such as environmental consequences and cognitive ones such as negative beliefs, anxiety and perceived control over the pain problem. A pilot study in the clinical setting which forms the basis of this study, suggested that in a chronic low back pain population, disability measured by a specially designed disability questionnaire reduced as a result of intervention although pain largely remained unchanged. It was therefore necessary to explore the data for possible mediating variables and this lead to the identification of emotional and cognitive factors which contributed to the pain - disability relationship. Two experiments were carried out, one to assess the role of emotional distress and the other the role of perceived control in the modification of disability. The experiments demonstrated that both anxiety and perceived control could be successfully increased or decreased by manipulating patients' cognitive set and that the emotional but not the control manipulations were able to affect activity on a task of daily living (carrying a weight) in the predicted direction relative to baseline. Studies were also undertaken to validate the pain, disability, emotional distress and locus of control measures and it was ascertained that both criterion related and discriminant validity could be established for the disability measure by asking patients to perform sitting, walking and lifting assignments to tolerance and comparing their results with their scores on the relevant sections of the disability questionnaire. Examination of the other measures yielded some validity data. Finally a replication study was carried out to confirm the earlier findings that emotional factors rather than pain itself predict disability and the potential to change limitation of function. This hypothesis was upheld.

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