Illness perceptions and compassion are important psychological processes involved in distress in chronic pain: A longitudinal study

Abstract

Introduction: To develop effective and acceptable interventions for reducing distress in adults living with chronic pain, understanding the psychological processes presumed to underlie therapeutic approaches is needed. This longitudinal study examined the relative contribution of illness perceptions (grounded in the common-sense model informing cognitive behavioural therapy) and compassion (key to compassion-focused therapy) in predicting anxiety and depression in chronic pain, and explored whether effects were mediated by worry and rumination.

Method: Adults with chronic primary pain, recruited through a tertiary pain management service in the United Kingdom, completed pain interference and severity, illness perceptions, compassion, worry, rumination, anxiety, and depression measures at baseline (N = 159), and three months later (N = 96).

Results: At baseline, lower compassion from others and greater worry were associated with greater anxiety, while more negative illness perceptions, lower compassion (for self and others), greater rumination, and greater pain interference were linked to higher depression scores. Longitudinally, there were no significant direct effects of baseline illness perceptions or compassion on anxiety three months later, and no mediating effects of worry when controlling for pain interference and severity. For depression, more negative illness perceptions at baseline directly predicted greater rumination and depression levels three months later, but no mediating effect of rumination on depression was found.

Discussion: Therapeutic approaches grounded in the common-sense model may be useful in understanding depression in individuals living with chronic pain. Further research is needed to explore processes and mechanisms underpinning anxiety.

Keywords: Anxiety; Chronic pain; Compassion; Depression; Illness perceptions; Rumination; Worry.