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Introduction:

Idiographic network analysis, where associations between multiple nodes are estimated, can potentially guide choice of interventions in psychological treatment. In this single case experiment using ecological momentary assessment data to estimate continuous time network models, we aimed to test the so-called centrality hypothesis. We did so by comparing effects of interventions guided by the most central node to those guided by the least central node. We used the composite level psychological inflexibility processes lack of openness, lack of awareness, and lack of engagement, alongside an interference outcome, as network nodes. Effects on pain interference, motivation, and pain intensity were examined.

Method:

We employed a multiple baseline design across six participants. Therapists and participants were blinded to participants' treatment conditions. Baseline length and order of treatment phases were randomized.

Results:

Four participants had an overall treatment effect on pain interference, but it was generally not possible to discern that one particular phase was more beneficial than another. For three participants, the picture was somewhat clearer, indicating one of the treatment phases as more beneficial, although the results for these participants were not consistently in line with hypotheses. Retrospectively examining other potential guidance methods for these three participants, we saw a potential in discrete time contemporaneous network models.

Discussion:

Current results are not in line with previous assumptions or research on idiographic network models for treatment personalization, although the previous research in this area is scarce. Future research should investigate alternative network models or estimation choices to determine the potential utility of data driven idiographic networks.

Psychological treatment for chronic pain can generally help people improve their functioning and well-being. Still, there is room for improvement in terms of overall effect sizes. There is also a need to address the gap between scientists, often focusing treatment on standardized manuals for treatment, and clinicians, often aiming to individualize treatment. One suggested step forward is to adopt the clinician’s agenda for individualization, but in a systematic fashion ensuring a scientific approach. The aim of this thesis was to examine the clinical utility of one method suggested to be useful for systematic individualization; individual level network analysis. Both study I and II tested the clinical utility of using so-called network centrality for treatment guiding, where centrality reflects how well connected one network node is to other nodes. Specifically, we tested whether interventions guided by the most central node were more beneficial for the individual compared with interventions guided by the least central node. In study I, we tested this by using networks based on participants’ one-time ratings of how aspects of psychological inflexibility and pain interference were perceived to cause each other. Results were promising in that individual level treatment effects most often occurred when treatment was guided by the most central node. Study II replicated study I, but networks were instead estimated using repeated measures of the network variables. Results did not indicate utility of guiding treatment based on centrality in such a data driven network. Study III demonstrated that individual level networks can give us information that may be lost in group level networks, but that there are group level connections that are generalizable to many individuals. Such generalizable connections can be used to generate initial hypotheses for individual level treatment, but may not be valid for everyone – prompting us to continue the evaluation of systematic methods for individualization. Further, individual level network connectivity was correlated with depression and pain interference, but did not contribute with unique explained variance in the outcomes when controlling for baseline levels of the outcomes. Finally, overall network connectivity did not predict pain interference or depression on the individual level.

Introduction: Idiographic network analysis, assessing associations between a system of variables of interest, also called nodes, is a proposed method for personalizing psychological treatment. The aim of this study was to test the centrality hypothesis that a treatment condition delivering interventions guided by the most central network node will yield better outcomes compared to a treatment condition delivering interventions guided by the least central node. We tested this using perceived causal networks (PECAN) and focusing on psychological inflexibility processes. Effects were examined in terms of pain interference, motivation, and pain intensity.

Method: We used a single case design with multiple baselines across six participants. Therapists were blind to treatment conditions. While participants were not blind to the responses that they provided for creating the PECAN, they were blind to the resulting network and the treatment conditions. Randomization was applied to baseline length and to whether the most central node or the least central node intervention came first.

Results: All participants had at least one outcome changing in beneficial directions in line with hypotheses. However, two participants also had one outcome each that changed in contradiction to the hypotheses.

Discussion: Adapting psychological treatment by matching interventions to the most central node in a perceived causal network looks promising. However, it is unlikely that this method will always be the best matching method. We need to keep exploring additional personalization methods and under which circumstances they are efficient.

This study investigates whether data from people with endometriosis (n = 58) and fibromyalgia (n = 58) exhibit what is called "ergodicity," meaning that results from analyses of aggregated group data can be used to support conclusions about the individuals within the groups. The variables studied here are commonly investigated in chronic pain: pain intensity, pain interference, depressive symptoms, psychological flexibility, and pain catastrophizing. Data were collected twice daily for 42 days from each participant and analyzed in 2 ways: as separate cross-sectional group studies using the timepoints as the separate data sets (between-person) and as individual longitudinal studies using each person's time series data (within person). To confirm ergodicity, the results from the 2 analyses should agree. However, this is not what was observed in several respects. The between-person data showed substantially less variability compared with within-person data. This was evident in both the summary statistics involving single variables and in the correlational analyses. Overall, between-person correlations were relatively restricted in range, while within-person correlations varied widely. These findings have potentially profound implications for the field of chronic pain research. Because ergodicity was not found, this raises doubts around the assumption that aggregated data collected from groups can accurately represent the range of individual experiences in chronic pain. These results advocate for a shift toward inclusion of more individual person-focused approaches as an addition to group-based approaches. This shift could lead to more personalized and effective treatments by better capturing and then clarifying the heterogeneous nature of chronic pain, including the processes that underlie it.

BackgroundThe Multidimensional Psychological Flexibility Inventory (MPFI) is a measure of all facets of psychological flexibility and inflexibility, potentially important processes of change in psychological treatment for chronic pain. In some contexts, it can be considered too long. The aim of this study was, therefore, to validate a short form MPFI (MPFI-24P) in a chronic pain sample.MethodsAdults with chronic pain were recruited online (N = 404) for a cross-sectional survey study. They first completed pain background questions and the MPFI. For examining convergent construct validity and explained variance in pain-related outcomes, participants also completed the Brief Pain Inventory (BPI) Pain Interference Scale, the Work and Social Adjustment Scale (WSAS) and the Patient Health Questionnaire (PHQ-9), a depression measure. Data were collected on two occasions, 2 weeks apart. Item response theory (IRT) and confirmatory factor analysis (CFA) were used for selecting the best-performing items.ResultsIRT parameters were overall adequate, and hierarchical CFA demonstrated a good model fit. Network analysis of the MPFI items indicated that, in general, items intended to measure the same facets were substantially interconnected, more so for the inflexibility items. Temporal stability was adequate, and internal consistency was good. The MPFI-24P correlated with pain interference, work and social adjustment and depression, with the inflexibility scale better predicting these outcomes. The MPFI-24P correlated strongly with the full-length MPFI.ConclusionsThe MPFI-24P for chronic pain is generally valid and reliable, especially the inflexibility scale. It performs similarly to the full-length MPFI.SignificanceThis paper contributes with a measure that is both feasible to use in clinical practice and research, while being able to measure all facets of psychological flexibility and inflexibility-psychological processes of change that are important to evaluate in psychological treatment of chronic pain in order to better individualize treatment.

Psychological treatments tend to be created based on group averaged results of how variables relate to each other. This means that treatments may not be applicable to individual people where variables may relate to each other in other ways than seen in the group models. While the personalization of psychological treatments is on the rise, such attempts need to be accompanied by idiographic research methods in order to achieve a high degree of personalization. Ideally, treatments can be formed targeting individual specific psychological processes of change. If personalization is conducted on the basis of subgroups, such subgrouping needs to be done using idiographic methods rather than using categories defined in nomothetic research.

Objective: Ineffective pediatric post-operative pain management increases the risk of Chronic Post-Surgical Pain (CPSP), affecting around 20% of children undergoing major surgery. Psychological predictors of recovery, in both children and their parents, have been identified. However, how these variables change throughout the recovery process remains unclear. The aim of the present study was to investigate the associations of adolescent and parental risk and resilience variables in everyday life, during post-operative recovery, for adolescents undergoing spinal fusion surgery.

Methods: Participants were adolescents with Idiopathic Scoliosis (AIS), aged 12-18 years, undergoing spinal fusion surgery, and their parents, recruited at four hospitals in Belgium. Participants completed daily assessments for 7 consecutive days, at 5 time-points, before surgery, and at 3 and 6 weeks, and 6 and 12 months, post-surgery. Diary measures included adolescent and parental pain and recovery variables known to be relevant in the context of pediatric post-operative pain. Network analysis was used to explore correlations between all variables throughout the post-operative recovery process.

Results: The sample comprised N=190 participants. Associations were stronger within adolescent and parent variables, than between them. For adolescents, psychological flexibility was associated with positive mood and activity engagement, and pain intensity with pain catastrophizing and activity avoidance. For parents, higher levels of pain-related fear and catastrophizing were related to more parent-to- child instructions to avoid activities. Regarding adolescent-parent between correlations, parental instructions to avoid activities were associated with adolescent physical complaints and activity avoidance, and parent pain catastrophizing was associated with adolescent pain- related fear and catastrophizing. Generally, networks displayed both similarities and differences across post-operative phases.

Discussion: The study sample was small in relation to the statistical analyses conducted. Even so, the present findings provide a new perspective on psychological predictors at play in everyday life throughout the pediatric post-operative recovery process, indicating important targets, both clinical and for future investigation.

Background Chronic post-surgical pain (CPSP) affects approximate to 20% of children after major surgery, and the condition is associated with functional disability and ill-health. Psychological flexibility (PF) and parental factors have been shown to predict CPSP in youth following spinal fusion surgery. However, the daily dynamics of these processes throughout post-surgical recovery remain unknown. This study aimed at exploring how PF fluctuates in everyday life for youths undergoing spinal fusion surgery, and to investigate the associations between parental responses and adolescent PF.

Methods Adolescents with Idiopathic Scoliosis (AIS), aged 12-18 years, undergoing spinal fusion surgery at four hospitals in Belgium, and their parents, completed diaries, measuring adolescent PF and parental responses (including instructions to avoid or engage in activities, parental protective behavior, and parental pain catastrophizing) for 7 days, at five phases: before surgery (T0), at 3 (T1) and 6 weeks (T2), and 6 (T3) and 12 (T4) months, post-surgery. A single-case approach with aggregated results was used, including Tau-U calculations and cross-lagged correlations.

Results In total, data from 47 adolescents and seven parents were analyzed. Substantial within- and between-person variability characterized the patterns of adolescent PF. Cross-lagged correlations showed bidirectional relationships, demonstrating that parental responses predicted adolescent PF, and that adolescent PF, similarly, predicted parental responses.

Discussion The results reveal the complex dynamics of PF among adolescents following surgery, and that parent-adolescent patterns after surgery may vary across both individuals and time. These findings also emphasize the need for idiographic pain research and individual-level assessments as well as person-centered treatments in clinical practice.

Objectives

Processes of psychological flexibility (PF) are positively associated with health and wellbeing in several chronic pain disorders. However, these processes have not been investigated in endometriosis, a chronic pain disorder affecting 5–10 % of women worldwide. This study is a preliminary investigation of the associations between PF or psychological inflexibility (PI) and daily functioning in people with a primary diagnosis of endometriosis.

Methods

This study is based on a secondary analysis of survey data from Swedish-speaking adult participants with chronic pain recruited online. The current study included only those reporting a diagnosis of endometriosis and significant long-term pain. All participants completed the Multidimensional Psychological Flexibility Inventory (MPFI), a measure of PF and PI, as well as other measures of PF, and measures of pain and daily functioning. Correlation and multiple regression analyses were performed to examine relations of PF and PI with measures of pain and daily functioning.

Results

In general, PF facet scores from the MPFI did not correlate with pain interference but did correlate with depression, with the exception of acceptance. The overall facets of PI appeared to perform better as correlates and in regression. Established measures of PF performed in correlation and regression analyses generally as has been observed in other chronic pain populations, with significant positive associations.

Conclusions

In this preliminary analysis of PF and PI in participants with endometriosis-related pain, these processes appear relevant, especially in understanding depression, but results varied along with the measures used. Specifically, when employing the MPFI, the PI facets emerged as stronger correlates. The findings underscore the potential benefit of incorporating assessments of PF and PI as process variables in endometriosis-research, but also that careful consideration should be given when selecting instruments.

Background

People with chronic pain are frequently exposed to stigma, which is typically distressing and may lead to internal stigmatizing thoughts. The thought content associated with stigma has similarities to pain catastrophizing, although these concepts differ in that stigma is arguably more social in origin. Stigma can be measured by the Stigma Scale for Chronic Illness – 8-item version (SSCI-8). In this study, we first demonstrate the validity of this measure in Swedish. We then examine the role of stigma in the health and functioning of people with chronic pain, particularly beyond the role played by pain catastrophizing.

Methods

Adult participants (N = 404) with chronic pain recruited online completed measures of pain, stigma, catastrophizing, pain interference, work and social adjustment and depression on two occasions.

Results

A one-factor solution had an overall good model fit as long as residuals were allowed to covary, indicating some redundancy in the items. The SSCI-8 demonstrated good internal consistency and moderate temporal stability, and SSCI-8 scores demonstrated medium-to-large correlations with the measures of health and functioning. Furthermore, stigma was found to significantly contribute to explained variance in pain interference, work and social adjustment and depression, uniquely adding to the explained variance in these outcomes even after accounting for pain catastrophizing.

Conclusions

The SSCI-8 provides an adequate measure to capture stigma experiences. Stigma is uniquely associated with pain-related outcomes and should be further considered in pain research and clinical practice in the future.

Significance

This study points to the importance of a social perspective on pain-related outcomes. We may need to more fully appreciate the way that people with chronic pain are treated by both health care providers and others can have an impact on their well-being. Potential negative impacts of stigmatizing responses to people with chronic pain are highlighted by the current results.