Abbie O. Beacham, Ph.D. Stacy Lorenz, M.A. Xavier University, Cincinnati, OH USA

1. Pain matters! Implications for acceptance-based interventions with women with co-morbid chronic illnesses Abbie O. Beacham, Ph.D. Stacy Lorenz, M.A. Xavier University, Cincinnati, OH USA

2. Key Collaborators Xavier University ACT Research Team John Forrette, M.A., Desiree Green, B.A., Amy Houston, M.A., Caroline Kelley, M.A., Stacy Lorenz, M.A., Matthew Maley, M.A., Amy Olzmann, M.A. & Stephanie Parazak, M.A. University of Colorado Denver Dana Brown, M.A. Jessica Geller, M.A., Andrew Herbst, M.A., Carissa Kinman, M.A., & Jessica Payne-Murphy, M.A. Spalding University Ann Brugh, Psy.D. , Steve Katsikas, Ph.D. , Ken Linfield, Ph.D., Kristen Thacker, Psy.D. & Brooke Threlkeld, Psy.D.

3. Agenda • Background & Significance • Challenges of co-morbid chronic illness and pain presentations • Method • In depth description of sample • Results • Discussion • Connect to clinical and research implications

4. Background & Significance • Non-communicable Diseases/Chronic Illnesses (CI) – including Chronic Pain – majority of health care costs worldwide • World Health Organization, 2011 • Empirically supported behavioral assessments and interventions for CI management • Modest-to-good outcomes • Most diagnosis specific • e.g., diabetes & depression

5. Background & Significance • Room for improvement • interventions for chronic illness management • specialty & primary health care settings • Acceptance-based interventions • considerable promise in CP populations • McCracken, Vowles & Eccleston, 2003, 2004, 2005; Vowles, McCracken & Eccleston, 2007; McCracken & Zhao-O’Brien, 2010 • becoming widely applied in patients with co-morbid chronic illnesses

6. Perceived Illness-related Disability Perceptions of disability due to illness and symptoms Functional & Medical Outcomes *Beyond objective indicators of disability *Alschuler, Theisen-Goodvich, Haig & Geisser, 2008

7. Conceptual Model of factors related to Perceived Illness-related Disability(Caveat: Not SEM!) CI Acceptance Experiential Avoidance Perceived Disability OUTCOMES Mindfulness +/- Affect

8. “…patients seek care for all of their conditions, not just for a solitary condition. In fact, visits for comorbidities outnumber visits for any single condition…” • Starfield et al, 2003

9. Co-morbid chronic illness presentation

10. Study Questions • In a sample of women, does concomitant pain matter when among myriad CI symptoms? • When pain is a primary concern for patients with co-morbid CIs, how might patients “differ” on ACT related variables/constructs?

11. Method Procedure: Recruited sample through online CI specific support groups Yahoo! & Facebook • “SurveyMonkey” survey • 45-60 mins to complete • No incentive for participation

12. Measures Perceived Illness Disability Index • Adapted from the Pain Disability Index • Pollard, 1984 Mindful Attention & Awareness Scale • Brown & Ryan, 2003 Chronic Illness Acceptance Q’aire • Two-factor structure: Activity Engagement & Willingness • Beacham, Linfield, Kinman & Payne-Murphy (Under review) Acceptance & Action Q’aire-II • Bond et al, 2011 Positive & Negative Affect Schedule • Watson, Clark, & Tellegen, 1988

13. Sample: Recruited CI Support Groups(Most frequently endorsed CI’s) • Diabetes • Hypertension • Heart Disease • COPD • Asthma • Arthritis • Rheumatoid Arthritis • Fibromyalgia • Multiple Sclerosis “Chronic Pain” groups not targeted

14. 1 Item: “Is chronic/recurring pain a primary concern?” 58% of “Yes” Chronic Pain Diagnosis

15. “Is chronic/recurring pain a primary concern?”

16. “Overall, how much pain relief have pain treatments or medications provided?” Mean Relief = 45.7, SD= 24.56 Percent of Sample Percent Relief

17. Perceived Illness-related Disability “Yes” versus “No”

18. The short of it: Overall differences “Yes” versus “No” = Pain Matters MeanSD CIAQ ActivityEngagement No 40.49 12.49 Yes 33.52 11.82 CIAQ Willingness No 25.55 11.12 Yes 22.75 7.96 MAAS TotalNo 4.34 0.955 Yes 4.00 0.971 PANAS Positive Affect No 29.52 8.09 Yes 26.41 7.97 PANAS Negative AffectNo 18.43 7.22 Yes 21.51 8.25 NOTE: *All p’s < .05

19. The long of it: Upon closer examination “Is chronic/recurring pain a primary concern? “Yes” versus “No” ACT related variables Legend: Higher scores - Positive outcomes Higher scores - Less Positive Outcomes

20. Experiential Avoidance “Yes” versus “No” 

21. Negative Affect “Yes” versus “No” 

22. Mindfulness “Yes” versus “No” 

23. Positive Affect “Yes” versus “No” 

24. Levels of CI Acceptance “Yes” versus “No”  p <.001

25. Total Disability Scores  by CI Acceptance

26. Family/Home Disability Scores  by CI Acceptance

27. Recreation Disability Scores  by CI Acceptance

28. Occupation Disability Scores  by CI Acceptance

29. % Pain Relief by CI Acceptance 

30. Limitations Sample from online support groups Although online samples not drastically different from clinical samples characteristics Replication and extension Retrospective recall of self-identified support group members Prospective studies next step Assess objective (i.e., behavioral) and subjective outcomes in multiple domains

31. Discussion • Patients presenting with co-morbid CIs may also be struggling with concerns about pain in concert with many other symptoms • Pain concerns may not be reflected in chart diagnoses • Lack of assessment of whole picture of complexity could make patients SEEM treatment resistant

32. Discussion • Transdiagnosticacceptance-based approachesmay have promise for these patients • Enable a focus on values-based function – committed action within context of the WHOLE symptom picture • Utility of acceptance subgroups in these approaches?