Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-24T04:51:54.092Z Has data issue: false hasContentIssue false

Efficacy of a Character Strengths and Gratitude Intervention for People with Chronic Back Pain

Published online by Cambridge University Press:  23 November 2012

Heidi J. Baxter
Affiliation:
Department of Psychological Medicine, University of AucklandNew ZealandDiabetes and Renal Services, Division of Medicine, Western Campus, CMDHB, Auckland, New Zealand.
Malcolm H. Johnson*
Affiliation:
Department of Psychological Medicine, University of Auckland, New Zealand.
Debbie Bean
Affiliation:
Department of Psychological Medicine, University of Auckland, New Zealand. The Auckland Regional Pain Service, Auckland, New Zealand
*
Corresponding Author Malcolm H. Johnson, Department of Psychological Medicine, University of Auckland, 85 Park Road, Grafton, Auckland, NZ; Email: mh.johnson@auckland.ac.nz
Get access

Abstract

This study investigated the efficacy of a character strengths and gratitude intervention to reduce pain in people with chronic back pain. Eight participants (males = 4, females = 4) took part in a cross-over multi-baseline study over 5‒7 weeks. Comparisons were made for intervention efficacy effects by contrasting a character strengths approach with a comparison condition premised on positive memories. Daily measures were used to assess mood (happiness, sadness, anger) and pain. In addition, measures of happiness, depression, anxiety, pain catastrophising and pain were collected at each phase. The results indicated improved daily happiness and significantly reduced daily anger following the character strengths and gratitude intervention. This provides preliminary evidence that daily focusing on positive aspects of one's emotional experience benefits those with chronic back pain.

Type
Articles
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arnold, B. S., Alpers, G. W., Sub, H., Friedel, E., Kosmutzky, G., & Pauli, P. (2008). Affective pain modulation in fibromyalgia, somatoform pain disorder, back pain and healthy controls. European Journal of Pain, 12, 329338. doi: 10.1016/j.ejpain.2007.06.007CrossRefGoogle ScholarPubMed
Barlow, D. H., Nock, M. K., & Hersen, M. (2009). Single Case Experimental Designs: Strategies for studying behavior change (3rd ed.). Boston: Allyn & Bacon.Google Scholar
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52, 6977. doi: 10.1016/S0022-3999%2801%2900296-3CrossRefGoogle ScholarPubMed
Briggs, A. M., & Buchbinder, R. (2009). Back pain: A national health priority area in Australia. Medical Journal of Australia, 190, 499502.CrossRefGoogle ScholarPubMed
Buhrman, M., Faltenhag, S., Strom, L., & Andersson, G. (2004). Controlled trial of Internet-based treatment with telephone support for chronic back pain. Pain, 111, 368377. doi: 10.1016/j.pain.2004.07.021CrossRefGoogle ScholarPubMed
Carson, J. W., Keefe, F., Lynch, T. R., Carson, K. M., Goli, V., Fras, A. M., & Thorp, S. R. (2005). Loving-kindness meditation for chronic low back pain: Results from a pilot trial. Journal of Holistic Nursing, 23, 287304 doi: 10.1177/0898010105277651CrossRefGoogle ScholarPubMed
Cruise, S. M., Lewis, C. A., & Mc Guckin, C. (2006). Internal consistency, reliability, and temporal stability of the Oxford Happiness Questionnaire Short-Form: Test-retest data over two weeks. Social Behavior & Personality, 34, 123126. doi: 10.1097/PSY.0b013e318199d97fCrossRefGoogle Scholar
de Wied, M., & Verbaten, M. N. (2001). Affective pictures processing, attention, and pain tolerance. Pain, 90, 163172. doi: 10.1016/s0304-3959(00)00400-0CrossRefGoogle ScholarPubMed
Dickens, C., Jayson, M., & Creed, F. (2002). Psychological correlates of pain behavior in patients with chronic low back pain. Psychosomatics, 43, 4248.CrossRefGoogle ScholarPubMed
Diener, E., Oishi, S., & Lucas, R. E. (2003). Personality, culture, and subjective well-being: Emotional and cognitive evaluations of life. Annual Review of Psychology, 54, 403425. doi: 10.1146/annurev.psych.54.101601.145056CrossRefGoogle ScholarPubMed
DiGuiseppe, R., & Tafrate, R. C. (2003). Anger treatment for adults: A meta-analytic review. Clinical Psychology: Science and practice, 10, 7084. doi: 10.1093/clipsy.10.1.70Google Scholar
Duckworth, A. L., Steen, T. A., & Seligman, M. E. P. (2005). Positive psychology in clinical practice. Annual Review of Clinical Psychology, 1, 629651. doi: 10.1146/annurev.clinpsy.1.102803.144154CrossRefGoogle ScholarPubMed
Dworkin, R. H., Turk, D. C., Revicki, D. A., Harding, G., Coyne, K. S., Peirce-Sandner, S., . . . Melzack, R. (2009). Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). Pain, 144, 3542. doi: 10.1016/j.pain.2009.02.007CrossRefGoogle ScholarPubMed
Eccleston, C. (2001). Role of psychology in pain management. British Journal of Anaesthesia, 87, 144152. doi: 10.1093/bja/87.1.144CrossRefGoogle ScholarPubMed
Flink, I. K., Nicholas, M. K., Boersma, K., & Linton, S. J. (2009). Reducing the threat value of chronic pain: A preliminary replicated single-case study of interoceptive exposure versus distraction in six individuals with chronic back pain. Behaviour Research and Therapy, 47, 721728. doi: 10.1016/j.brat.2009.05.003CrossRefGoogle ScholarPubMed
Fordyce, M. W. (1977). Development of a program to increase personal happiness. Journal of Counseling Psychology, 24, 511521. doi: 10.1037/0022-0167.24.6.511CrossRefGoogle Scholar
Fordyce, M. W. (1983). A program to increase happiness – further studies. Journal of Counseling Psychology, 30, 483498. doi: 10.1037/0022-0167.30.4.483CrossRefGoogle Scholar
Fredrickson, B. L. (1998). What good are positive emotions? Review of General Psychology, 2, 300319.CrossRefGoogle ScholarPubMed
Fredrickson, B. L., & Branigan, C. (2001). Positive emotions. In Mayne, T. J. & Bonanno, G. A. (Eds.), Emotions: Current issues and future directions. New York: Guilford Press.Google Scholar
Fredrickson, B. L., & Cohn, M. A. (2008). Positive emotions. In Haviland-Jones, J. M. & Feldman Barret, L. (Eds.), The Handbook of Emotions (3rd ed., pp. 777796). New York: Guildford Press.Google Scholar
Fredrickson, B. L., & Joiner, T. (2002). Positive emotions trigger upward spirals toward emotional well-being. Psychological Science, 13, 172175.CrossRefGoogle ScholarPubMed
Fredrickson, B. L., Mancuso, R. A., Branigan, C., & Tugade, M. M. (2000). The undoing effect of positive emotions. Motivation and Emotion, 24, 237258. doi: 10.1023/A:1010796329158CrossRefGoogle ScholarPubMed
Gil, K. M., Carson, J. W., Porter, L. S., Ready, J., Valrie, C., Redding-Lallinger, R., & Daeschner, C. (2003). Daily stress and mood and their association with pain, health-care use, and school acitivity in adolescents with sickle cell disease. Journal of Pediatric Psychology, 28, 363373. doi: 10.1093/jpepsy/jsg026CrossRefGoogle Scholar
Guadagnoli, E., & Mor, V. (1989). Measuring cancer patients’ affect: Revision and psychometric properties of the Profile of Mood States (POMS). Psychological Assessment, 1, 150154.CrossRefGoogle Scholar
Hawkins, N. G., Sanson-Fisher, R. W., Shakeshaft, A., D'Este, C., & Green, L. W. (2007). The multiple baseline design for evaluating population-based research. American Journal of Preventive Medicine, 33, 162168. doi: 10.1016/j.amepre.2007.03.020CrossRefGoogle ScholarPubMed
Herrmann, C. (1997). International experience with the Hospital Anxiety and Depression Scale: A review of validation data and clinical results. Journal of Psychosomatic Research, 42, 1741. doi: 10.1016/S0022-3999(96)00216-4CrossRefGoogle Scholar
Hills, P., & Argyle, M. (2002). The Oxford Happiness Questionnaire: A compact scale for the measurement of psychological well-being. Personality and Individual Differences, 33, 10731082. doi: 10.1016/S0191-8869(01)00213-6CrossRefGoogle Scholar
Kenntner-Mabiala, R., & Pauli, P. (2005). Affective modulation of brain potentials to painful and nonpainful stimuli. Psychophysiology, 42, 559567. doi: 10.1111/j.1469-8986.2005.xx310.xCrossRefGoogle ScholarPubMed
Kimball, M., & Willis, R. (2006). Utility and happiness. University of Michigan. Michigan. Retrieved from http://www.econ.yale.edu/~shiller/behmacro/2006-11/kimball-willis.pdfGoogle Scholar
Loggia, M. L., Mogil, J. S., & Bushnell, M. C. (2008). Experimentally induced mood changes preferentially affect pain unpleasantness. The Journal of Pain, 9, 784791. doi: 10.1016/j.jpain.2008.03.014CrossRefGoogle ScholarPubMed
Lovibond, P. F. (1998). Long-term stability of depression, anxiety, and stress syndromes. Journal of Abnormal Psychology, 107, 520526.CrossRefGoogle ScholarPubMed
Meagher, M. W., Arnaw, R. C., & Rhudy, J. L. (2001). Pain and emotion: Effects of affective picture modulation. Psychosomatic Medicine, 63, 7990. doi: 10.1016/S0304-3959(03)00297-5CrossRefGoogle ScholarPubMed
Mykletun, A., Stordal, E., & Dahl, A. A. (2001). Hospital Anxiety and Depression (HAD) scale: Factor structure, item analyses and internal consistency in a large population. British Journal of Psychiatry, 179, 540544.CrossRefGoogle ScholarPubMed
Osman, A., Barrios, F. X., Gutierrez, P. M., Kopper, B. A., Merrifield, T., & Grittmann, L. (2000). The Pain Catastrophizing Scale: Further psychometric evaluation with adult samples. Journal of Behavioral Medicine, 23, 351365. doi: 10.1023/A:1005548801037CrossRefGoogle ScholarPubMed
Osman, A., Barrios, F. X., Kopper, B. A., Hauptmann, W., Jones, J., & O'Neill, E. (1997). Factor structure, reliability, and validity of the Pain Catastrophizing Scale. Journal of Behavioral Medicine, 20, 589605. doi: 10.1023/A:1025570508954CrossRefGoogle ScholarPubMed
Peterson, C., Park, N., & Seligman, M. E. P. (2005). Assessment of character strengths. In Koocher, G. P., Norcross, S. S. & Hill, S. S. III (Eds.), Psychologists’ Desk Reference (2nd ed., pp. 9398). New York: Oxford University Press.Google Scholar
Peterson, C., & Seligman, M. E. P. (2004). Character Strengths and Virtues: A handbook and classification. New York: Oxford University Press.Google Scholar
Potter, P. T., Zautra, A. J., & Reich, J. W. (2000). Stressful events and information processing dispositions moderate the relationship between positive and negative affect: Implications for pain patients. Annals of Behavioral Medicine, 22, 191198. doi: 10.1007/BF02895113CrossRefGoogle ScholarPubMed
Pressman, S. D., & Cohen, S. (2005). Does positive affect influence health. Psychological Bulletin, 131, 925971. doi: 10.1037/0033-2909.131.6.925CrossRefGoogle ScholarPubMed
Rhudy, J. L., Williams, A. E., McCabe, K. M., Rambo, P. L., & Russell, J. L. (2006). Emotional modulation of spinal nociception and pain: The impact of predictable noxious stimulation. Pain, 126, 221233. doi: 10.1016/j.pain.2006.06.027CrossRefGoogle ScholarPubMed
Roy, M., Peretz, I., & Rainville, P. (2008). Emotional valene contributes to music-induced analgesia. Pain, 134, 140147. doi: 10.1016/j.pain.2007.04.003CrossRefGoogle Scholar
Seligman, M. E. P., Rashid, T., & Parks, A. C. (2006). Positive Psychotherapy. American Psychologist, 61, 774788. doi: 10.1037/0003-066X.61.8.774CrossRefGoogle ScholarPubMed
Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60, 410421. doi: 10.1037/0003-066x.60.5.410CrossRefGoogle ScholarPubMed
Seligman, M. E. P., Wyatt, R. C., & Yalom, V. (2008). Positive Psychology and Psychotherapy. San Francisco: Psychotherapy.net.Google Scholar
Sin, N. L., & Lyubomirsky, S. (2009). Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: A practice-friendly meta-analysis. Journal of Clinical Psychology: In Session, 65, 467487. doi: 10.1002/jclp.20593CrossRefGoogle Scholar
Spinhoven, P., Ormel, J., Sloekers, P. P. A., Kempen, G., Speckens, A. E. M., & VanHemert, A. M. (1997). A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychological Medicine, 27, 363370. doi: 10.1017/S0033291796004382CrossRefGoogle ScholarPubMed
Strand, E. B., Kerns, R. D., Christie, A., Haavik-Nilsen, K., Klokkerud, M., & Finset, A. (2007a). Higher levels of pain readiness to change and more positive affect reduce pain reports - A weekly assessment study on arthritis patients. Pain, 127, 204213.CrossRefGoogle Scholar
Strand, E. B., Kerns, R. D., Christie, A., Haavik-Nilsen, K., Klokkerud, M., & Finset, A. (2007b). Higher levels of pain readiness to change and more positive affect reduce pain reports - a weekly assessment study on arthritis patients. Pain, 127, 204213. doi: 10.1016/j.pain.2006.08.015Google Scholar
Strand, E. B., Zautra, A. J., Thoresen, M., Ødegård, S., Uhlig, T., & Finset, A. (2006). Positive affect as a factor of resilience in the pain-negative affect relationship in patients with rheumatoid arthritis. Journal of Psychosomatic Research, 60, 477484. doi: 10.1016/j.jpsychores.2005.08.010CrossRefGoogle ScholarPubMed
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7, 524532.CrossRefGoogle Scholar
Tang, N. K. Y., Salkovskis, P. M., Hodges, A., Weight, K. J., Hanna, M., & Hester, J. (2008). Effects of mood on pain responses and pain tolerance: An experimental study in chronic back pain patients. Pain, 138, 392401. doi: 10.1016/j.pain.2008.01.018CrossRefGoogle ScholarPubMed
Tang, N. K. Y., Wright, K. J., & Salkovskis, P. M. (2007). Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. Journal of Sleep Research, 16, 8595. doi: 10.1111/j.1365-2869.2007.00571.xGoogle ScholarPubMed
Tugade, M. M., & Fredrickson, B. L. (2004). Resilient individuals use positive emotions to bounce back from negative emotional experiences. Journal of Personality and Social Psychology, 86 (2), 320333. doi: 10.1037/0022-3514.86.2.320CrossRefGoogle ScholarPubMed
Valrie, C., Gil, K. M., Redding-Lallinger, R., & Daeschner, C. (2008). Brief report: Daily mood as a mediator or moderator of the pain-sleep relationship in children with sickle cell disease. Journal of Pediatric Psychology, 33, 317322. doi: 10.1093/jpepsy/jsm058CrossRefGoogle ScholarPubMed
Villemure, C., Slotnick, B. M., & Bushnell, M. C. (2003). Effects of odors on pain perception: Deciphering the roles of emotion and attention. Pain, 106, 101108. doi: 10.1016/s0304-3959(03)00297-5CrossRefGoogle ScholarPubMed
Walker, B. F. (2000). The prevalence of low back pain: A systematic review of the literature from 1966 to 1998. Journal of Spinal Disorders and Techniques 13, 205217.CrossRefGoogle ScholarPubMed
Walker, J., Holloway, I., & Sofaer, B. (1999). In the system: The lived experience of chronic back pain from the perspectives of those seeking help from pain clinics. Pain, 80, 621628. doi: 10.1016/S0304-3959(98)00254-1CrossRefGoogle ScholarPubMed
Weisenberg, M., Raz, T., & Hener, T. (1998). The influence of film-induced mood on pain perception. Pain, 76, 365375. doi: 10.1016/S0304-3959(98)00069-4CrossRefGoogle ScholarPubMed
Williams, A. E., & Rhudy, J. L. (2009). Emotional modulation of autonomic responses to painful trigeminal stimulation. International Journal of Psychophysiology, 71, 242247. doi: 10.1016/j.ijpsycho.2008.10.004CrossRefGoogle ScholarPubMed
Zautra, A. J., Johnson, L. M., & Davis, M. C. (2005). Positive affect as a source of resilience for women in chronic pain. Journal of Consulting and Clinical Psychology, 73 (2), 212220. doi: 10.1037/0022-006X.73.2.212.CrossRefGoogle ScholarPubMed
Zelman, D. C., Howland, E. W., Nichols, S. N., & Cleeland, C. S. (1991). The effects of induced mood on laboratory pain. Pain, 46, 105111. doi: 10.1016/0304-3959(91)90040-5CrossRefGoogle ScholarPubMed
Zhao, H., & Chen, A. C. N. (2009). Both happy and sad melodies modulate tonic human heat pain. The Journal of Pain, 10, 953960. doi: 10.1016/j.jpain.2009.03.006CrossRefGoogle ScholarPubMed
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361370. doi: 10.1111/j.1600-0447.1983.tb09716.xCrossRefGoogle ScholarPubMed