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The Mediational Effect of Pain Self-Efficacy on the Relationship Between PTSD
Severity and Disability in Trauma-Exposed Adults with Chronic Pain
Tyler Powers, B.S., Margaret Talbot, B.A., Danielle Correll, B.A., and Kristin Samuelson, Ph.D.
University of Colorado at Colorado Springs
Participants• 251 adults recruited from Amazon’s Mechanical Turk (MTurk)• All participants were trauma exposed (as defined by Criterion A of the
PTSD diagnosis in DSM-5) and experiencing chronic pain (as defined by suffering from pain for over three months)
• PTSD symptom severity: M = 29.08, SD = 19.79• Chronic pain severity: M = 6.25, SD = 1.68Materials• Participants were administered instruments through MTurk• Pain Self-Efficacy Questionnaire: a measure of an individual’s
perceived ability to manage their pain• World Health Organization Disability Assessment Schedule 2.0
(WHODAS 2.0): a measure of disability severity• Brief Pain Inventory (Short Form): a measure of pain severity in the
past 24 hours, on average, and at the present moment• PTSD Checklist for DSM-5 (PCL-5): a measure of PTSD symptoms
Method
Background
Conclusions
Results
• There was a significant total effect of PTSD severity on disability, while
covarying for chronic pain severity
c = 0.65, p < .001
• Pain self-efficacy exerted an indirect effect on the relationship between
PTSD severity and disability,
F(2, 248), = 69.95, p < .001
• The total effect of PTSD severity on disability, while controlling for
chronic pain severity, remained significant after accounting for the
indirect effect of pain self-efficacy
c’ = 0.49, p < .001
• The results of this study have clinical applications
• Clinicians who see patients with comorbid PTSD and
chronic pain should target pain self-efficacy along with
trauma coping self-efficacy to improve overall outcomes
• Individuals with comorbid PTSD and chronic pain should
receive treatment for both disorders
• Future research should examine trauma coping self-efficacy
and pain self-efficacy as mediators between chronic pain
severity and disability outcomes, and between PTSD severity
and disability outcomes, in a sample of individuals with
comorbid chronic pain and PTSD
• The lifetime PTSD prevalence in the U.S. is approximately
6% (Kessler, Petukhova, Sampson, Zaslavsky, & Wittchen,
2012)
• Chronic pain is defined as pain lasting or recurring for more
than 3 to 6 months. About 20% of U.S. adults suffer from
chronic pain (Dahlhamer et al., 2018)
• PTSD and chronic pain are often comorbid conditions
(Asmundson, Coons, Taylor, & Katz, 2002)
• Comorbid PTSD and chronic pain are mutually maintaining,
meaning that as one worsens, so does the other (Sharp &
Harvey, 2001)
• Self-efficacy has been established as a partial mediator
between pain intensity and disability (Arnstein, Caudill,
Mandle, Norris, & Beasley, 1999)
• Perceived coping self-efficacy has also been established as
a partial mediator between PTSD and recovery outcomes
(Benight & Bandura, 2004)
• Disability, as defined by the World Health Organization as
impairment, activity limitations, and participation
restrictions, is a construct comprised of cognitive, mobility,
self-care, social, and occupational functioning (Üstün, 2010)
• The present study aims to explore the mediational
effect of pain-related self-efficacy on the relationship
between PTSD severity and disability outcomes in a
sample of trauma-exposed individuals with chronic
pain
Hypotheses
1. PTSD symptom severity is hypothesized to be positively related to
disability outcomes.
2. PTSD symptom severity is hypothesized to be negatively related to
pain self-efficacy.
3. Pain self-efficacy is hypothesized to be negatively related to disability
outcomes.
4. Pain self-efficacy is hypothesized to mediate the relationship between
PTSD symptom severity and disability outcomes, while statistically
controlling for chronic pain severity.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-5®). American Psychiatric Pub.
Arnstein, P., Caudill, M., Mandle, C. L., Norris, A., & Beasley, R. (1999). Self efficacy as a mediator of
the relationship between pain intensity, disability and depression in chronic pain
patients. Pain, 80(3), 483-491.Asmundson, G. J., Coons, M. J., Taylor, S., & Katz, J. (2002). PTSD and the experience of pain:
research and clinical implications of shared vulnerability and mutual maintenance models. The
Canadian Journal of Psychiatry, 47(10), 930-937.
Benight, C. C., & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role of
perceived self-efficacy. Behaviour research and therapy, 42(10), 1129-1148.Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., ... & Helmick, C. (2018).
Prevalence of chronic pain and high-impact chronic pain among adults—United States,
2016. Morbidity and Mortality Weekly Report, 67(36), 1001.
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012).
Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International journal of methods in psychiatric research, 21(3), 169-184.
Merskey, H. (1994). Classification of chronic pain. Description of chronic pain syndromes and
definitions of pain terms , 1-213.
Üstün, T. B., Chatterji, S., Kostanjsek, N., Rehm, J., Kennedy, C., Epping-Jordan, J., ... & Pull, C.
(2010). Developing the World Health Organization disability assessment schedule 2.0. Bulletin of the World Health Organization, 88, 815-823.
Sharp, T. J., & Harvey, A. G. (2001). Chronic pain and posttraumatic stress disorder: mutual
maintenance?. Clinical psychology review, 21(6), 857-877.
Figure
Chronic pain and posttraumatic stress disorder
(PTSD) commonly cooccur and are mutually maintaining.
Although previous research has established relationships
between self-efficacy and positive outcomes among
chronic pain (Arnstein, Caudill, Mandle, Norris, & Beasley,
1999) and PTSD patients (Benight & Bandura, 2004), the
relationship between pain self-efficacy and disability
outcomes in a trauma-exposed population with chronic
pain is unknown. A sample of trauma-exposed adults with
chronic pain (N = 251) was collected using Amazon’s
MTurk. We hypothesized that pain self-efficacy (measured
by the Pain Self-Efficacy Questionnaire and defined as an
individual’s perceived ability to manage pain) mediates the
relationship between PTSD severity and disability
(measured by the WHO Disability Assessment Schedule
2.0) while covarying for chronic pain severity. Pain self-
efficacy mediated the relationship between PTSD severity
and disability, F(2, 248), = 69.95, p < .001. There was a
significant total effect of PTSD severity on disability, while
covarying for chronic pain severity (c = 0.65, p < .001),
which remained significant after being mediated by pain
self-efficacy (c’ = 0.49, p < .001). Clinically, these findings
suggest that targeting pain-related appraisals and pain
self-efficacy in individuals with comorbid chronic pain and
PTSD may in turn improve overall functioning.
Abstract
PTSD Severity
Pain Self-Efficacy
Disability
c = 0.65
c’ = 0.49
a = -0.17 b = -0.94
Chronic Pain Severity
Figure 1. Mediation model. The predictor was specified as PTSD severity, the outcome was defined as disability, the mediator was defined as pain self-efficacy, and chronic pain severity was specified as a covariate. All paths were significant at p < .001.
Variable PTSD
Symptom Severity
Pain Self-Efficacy Disability
PTSD Symptom Severity
1.00
Pain Self-Efficacy
-.22** 1.00
Disability .58** -.42** 1.00
Table 1.
Correlation Matrix
**. Correlation is significant at the p < .01 level
Table
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