Relationship Between Behavioural Coping Strategies and Acceptance in Patients With Fibromyalgia Syndrome

Elucidating Targets of Intervention

Baltasar Rodero; Benigno Casanueva; Juan V Luciano; Margalida Gili; Antoni Serrano-Blanco; Javier García-Campayo

BMC Musculoskelet Disord. 2011;12

Abstract and Introduction

Abstract

Background: Previous research has found that acceptance of pain is more successful than cognitive coping variables for predicting adjustment to pain. This research has a limitation because measures of cognitive coping rely on observations and reports of thoughts or attempts to change thoughts rather than on overt behaviours. The purpose of the present study, therefore, is to compare the influence of acceptance measures and the influence of different behavioural coping strategies on the adjustment to chronic pain.
Methods: A sample of 167 individuals diagnosed with fibromyalgia syndrome completed the Chronic Pain Coping Inventory (CPCI) and the Chronic Pain Acceptance Questionnaire (CPAQ).
Results: Correlational analyses indicated that the acceptance variables were more related to distress and functioning than were behavioural coping variables. The average magnitudes of the coefficients for activity engagement and pain willingness (both subscales of pain acceptance) across the measures of distress and functioning were r = 0.42 and 0.25, respectively, meanwhile the average magnitude of the correlation between coping and functioning was r = 0.17. Regression analyses examined the independent, relative contributions of coping and acceptance to adjustment indicators and demonstrated that acceptance accounted for more variance than did coping variables. The variance contributed by acceptance scores ranged from 4.0 to 40%. The variance contributed by the coping variables ranged from 0 to 9%.
Conclusions: This study extends the findings of previous work in enhancing the adoption of acceptance-based interventions for maintaining accurate functioning in fibromyalgia patients.

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Table 1. Correlations of Acceptance scales and Coping strategies with Pain, Number of symptoms, Fibromyalgia impact, General health, Anxiety and Depression (N = 167)
	Activity engagement	Pain willingness	Pain (VAS)	Number of symptoms	Physical functioning	General health	Vitality	Social functioning	Fibromyalgia Impact	Anxiety	Depression
Acceptance- measures
Activity engagement			-0.42^{** c}	-0.20**	0.44^{** c}	0.41^{** c}	0.33^{** c}	0.50^{** c}	-0.62^{** c}	-0.42^{** c}	-0.53^{** c}
Pain willingness	0.28^{** c}		-0.32^{** c}	-0.14	0.34^{** c}	0.35^{** c}	0.28^{** c}	0.17*	-0.32^{** c}	-0.31^{** c}	-0.27^{** c}
Coping strategies
Guarding	-0.42^{** c}	-0.29^{** c}	0.28^{** c}	0.16*	-0.46^{** c}	-0.30^{** c}	-0.34^{** c}	-0.35^{** c}	0.49^{** c}	0.25^{** b}	0.28^{** c}
Resting	-0.45^{** c}	-0.37^{** c}	0.34**	0.22**	-0.29^{** c}	-0.28^{** c}	-0.39^{** c}	-0.39^{** c}	0.54^{** c}	0.35^{** c}	0.41^{** c}
Asking for assistance	-0.35^{** c}	-0.19*	0.23^{** a}	0.15*	-0.33^{** c}	-0.24^{** b}	-0.33^{** c}	-0.18*	0.42^{** c}	0.17*	0.22**
Relaxation	-0.06	-0.25^{** b}	0.01	0.30^{** c}	-0.18*	-0.14	-0.07	-0.14	0.10	0.05	-0.02
Task persistence	0.49^{** c}	0.17*	-0.34^{** c}	-0.10	0.35^{** c}	0.24^{** b}	0.21**	0.30^{** c}	-0.37^{** c}	-0.30^{** c}	-0.37^{** c}
Exercise/Stretch	0.08	-0.11	-0.01	0.11	-0.00	0.06	0.04	0.00	0.05	0.00	-0.07
Seeking social support	-0.14	-0.21**	0.17*	0.09	-0.20**	-0.07	-0.10	0.01	0.20**	0.21**	0.02
Coping self-statements	0.10	-0.08	-0.10	0.08	-0.02	0.21**	0.06	0.08	-0.06	-0.11	-0.24**

Note: Pain was assessed with a 100 mm visual analogue scale, Number of symptoms with standardised symptom checklist, General functioning with some of the SF-36 subscales, the Fibromyalgia impact with the FIQ, and Anxiety and Depression with the HADS.
*p < 0.01; ^** p < 0.05; Bonferroni-corrected p values; a = 0.003125 (0.05/16); b = 0.0028 (0.05/18); c = 0.00069 (0.05/72).

Table 2. Hierarchical regression analyses examining prediction of Pain, Number of symptoms, General functioning, Fibromyalgia impact, Anxiety and Depression after controlling for Coping strategies
Predictor	β (final)	ΔR ²	p <	R ²
Pain
1. Task persistence	-0.15	0.11	0.001
Resting	0.09	0.051	0.01	0.16
2. Activity engagement	-0.22	0.050	0.01
Pain willingness	-0.19	0.030	0.01	0.24
Number of symptoms
1. Relaxation	0.26	0.074	0.001	0.07
2. Activity engagement	-0.17	0.032	0.01	0.10
Impact
1. Resting	0.25	0.28	0.001
Guarding	0.17	0.058	0.001
Task persistence	-0.01	0.028	0.01	0.37
2. Activity engagement	-0.42	0.11	0.001	0.49
Physical functioning
1. Guarding	-0.24	0.18	0.001
Task persistence	0.13	0.064	0.01	0.24
2. Activity engagement	0.26	0.066	0.001
Pain willingness	0.16	0.024	0.05	0.33
General health
1. Guarding	-0.18	0.083	0.001
Coping self-statements	0.29	0.089	0.001
Relaxation	-0.18	0.033	0.05
Exercise/Stretch	0.13	0.025	0.05	0.23
2. Pain willingness	0.23	0.067	0.001
Activity engagement	0.20	0.032	0.05	0.33
Vitality
1. Resting	-0.30	0.16	0.001	0.16
2. Activity engagement	0.22	0.043	0.001	0.20
Social functioning
1. Resting	-0.17	0.13	0.001
Task persistence	0.05	0.041	0.01
Guarding	-0.14	0.021	0.05
Seeking social support	0.16	0.028	0.05	0.22
2. Activity engagement	0.35	0.084	0.001	0.30
Anxiety
1. Resting	0.13	0.11	0.001
Task persistence	-0.08	0.032	0.05	0.15
2. Pain willingness	-0.21	0.056	0.01
Activity engagement	-0.22	0.031	0.05	0.23
Depression
1. Resting	0.22	0.15	0.001
Task persistence	-0.08	0.070	0.001
Coping self-statements	-0.18	0.041	0.01	0.26
2. Activity engagement	-0.35	0.080	0.001	0.34

Note: Pain was assessed with a 100 mm visual analogue scale, Number of symptoms with standardised symptom checklist, General functioning with some of the SF-36 subscales, the Fibromyalgia impact with the FIQ, and Anxiety and Depression with the HADS.
In these analyses, the eight Coping scale scores were tested for entry (p < .05) and removal (p > 0.10) on initial steps based on statistical criteria. After Coping scores meeting criteria were selected, the Acceptance scores were similarly tested for entry.

Table 3. Hierarchical regression analyses examining prediction of Pain, Number of symptoms, General functioning, Fibromyalgia impact, Anxiety and Depression after controlling for Acceptance of pain
Predictor	β (final)	ΔR ²	p <	R ²
Pain
1. Activity engagement	-0.25	0.17	0.001
Pain willingness	-0.22	0.041	0.01	0.21
2. Task persistence	-0.17	0.022	0.05	0.23
Number of symptoms
1. Activity engagement	-0.17	0.040	0.01	0.04
2. Relaxation	0.26	0.067	0.01	0.10
Impact
1. Activity engagement	-0.42	0.38	0.001
Pain willingness	-0.06	0.024	0.05
2. Resting	0.23	0.071	0.001	0.40
Guarding	0.17	0.021	0.05	0.49
Physical Functioning
1. Activity engagement	0.33	0.22	0.001
Pain willingness	0.16	0.038	0.01	0.26
2. Guarding	-0.25	0.054	0.01	0.31
General health
1. Activity engagement	0.23	0.17	0.001
Pain willingness	0.26	0.060	0.01	0.24
2. Coping self-statements	0.25	0.043	0.01
Guarding	-0.17	0.024	0.05	0.30
Vitality
1. Activity engagement	0.20	0.13	0.001
Pain willingness	0.11	0.031	0.05	0.16
2. Resting	-0.27	0.057	0.01	0.21
Social functioning
1. Activity engagement	0.41	0.24	0.001	0.24
2. Resting	-0.19	0.030	0.05	0.27
Anxiety
1. Activity engagement	-0.31	0.15	0.001
Pain willingness	-0.25	0.057	0.01	0.21
Depression
1. Activity engagement	-0.38	0.26	0.001	0.26
2. Resting	0.23	0.035	0.01
Coping self-statements	-0.19	0.038	0.01	0.33

Note: Pain was assessed with a 100 mm visual analogue scale, Number of symptoms with a standardised symptom checklist, General functioning with some of the SF-36 subscales, the Fibromyalgia impact with the FIQ, and Anxiety and Depression with the HADS.
In these analyses, the two Acceptance of pain scores were tested for entry (p < .05) and removal (p > 0.10) criteria. The eight Coping scale scores were tested for entry or removal on subsequent steps based on the same statistical criteria.

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