Indiana University-Purdue University Indianapolis (IUPUI) / Chronic pain, defined as pain lasting more than 3 months, is a common and costly health condition. Thirty-three percent of adults and upwards of 35% of children report experiencing pain due to various diseases, disorders, or accidents. Recent research has identified perceived injustice and anger as important constructs in an adult’s pain experience and a possible focus for intervention efforts. The present study explored the extent to which perceived injustice and anger expression operate similarly in children with chronic pain as in adults. This was a retrospective analysis of data from 122 patients seeking treatment at a pediatric pain clinic. Results supported anger expression as a mediator in the relationship between perceived injustice and pain intensity but not psychological distress, suggesting that anger expression operates similarly in children as in adults with chronic pain. Unlike previous findings in adults with chronic pain, injustice did not moderate the relationship between pain intensity and psychological distress, suggesting that injustice operates differently in children with chronic pain compared to adults. The strong association between injustice and pain outcomes (i.e. pain intensity, quality of life, functional disability) suggests that injustice is an important construct to explore in the chronic pain experience of children.

Luk, Pik Shan Yvonne. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 134-146). / Abstracts in English and Chinese ; some text in appendix also in Chinese. / Abstract (English version) --- p.ii-iii / Abstract (Chinese version) --- p.iv / Acknowledgement --- p.v / List of Table --- p.vi / Appendices --- p.vii / Chapter 1 --- Introduction --- p.1-5 / Chapter 2 --- Literature Review / Introduction --- p.6-7 / Psychological Distress --- p.7-13 / Health-related Quality of Life --- p.13-25 / Marital Relationship --- p.26-31 / Summary --- p.31-34 / Chapter 3 --- Aims & Methodology / Aims & Objectives --- p.35-37 / Operational Definition --- p.37-38 / Research Design --- p.38-39 / Setting & Sample --- p.39-40 / Instrument / Psychological Distress --- p.41-43 / Health-related Quality of Life --- p.43.44 / Marital Relationship --- p.44-46 / Demographic Data --- p.47 / Data Collection Procedure --- p.4748 / Ethical Consideration --- p.48-50 / Data Analysis --- p.50-51 / Pilot Study --- p.51-52 / Chapter 4 --- Findings / Introduction --- p.53-54 / Sociodemographic Characteristics --- p.54-56 / Psychological Distress --- p.57-58 / Health-related Quality of Life --- p.59-61 / Marital Relationship --- p.62-65 / Normality of the Outcome Variables --- p.65-66 / Relationships between the Study Outcomes and Sociodemographic Data --- p.66-68 / "Relationships between Anxiety, Depression, Health-Related Quality of Life and Marital Relationship" --- p.68-76 / Summary --- p.16-78 / Chapter 5 --- Discussion / Introduction --- p.79 / Socio-demographic and Clinical Characteristics of CAPD patients --- p.79-84 / Psychological Distress of CAPD Patients --- p.84-85 / Components of Psychological Distress: Anxiety --- p.85-86 / Components of Psychological Distress: Depression --- p.86-88 / Gender differences of the Levels of Anxiety and Depression among CAPD Patients --- p.88-89 / Cultural Difference of Anxiety and Depression among CAPD Patients --- p.89-90 / Health-related Quality of Life among CAPD Patients / Health-related Quality of Life of CAPD Patients Affected by Renal Symptoms --- p.90-91 / Health-related Quality of Life of CAPD Patients Affected by the effects of Kidney Disease --- p.91-93 / Health-related Quality of Life of CAPD Patients Affected by the burden of / Having Kidney Disease --- p.93-94 / Health-related Quality of Life of CAPD Patients Affected by the General Physical Health --- p.94-96 / Health-related Quality of Life of CAPD Patients Affected by the General Mental Health --- p.96-97 / Gender differences of the Levels of Health-related Quality of Life among CAPD Patients --- p.97-98 / Cultural Difference of Health-related Quality of Life among CAPD Patients --- p.98-99 / Sexual Issues and Marital Relationship of CAPD Patients / Sexual Issues of CA PD Patients --- p.100-102 / CAPD Patients' Perception of the Marital Relationship --- p.102-104 / Gender Differences in Perception of the Marital Relationship among CAPD Patients --- p.104 / Cultural Difference in Perception of the Marital Relationship among CAPD Patients --- p.105-106 / "Relationships between Participants' Characteristics and Psychological Distress," / HRQoL and Marital Relationship / "Relationships of Income with Anxiety, Depression and General Mental Health" --- p.107-108 / Relationship between Duration of Receiving Dialysis and Health-related Quality of Life --- p.108-109 / Relationship between Occupational Status and General Mental Health --- p.199.110 / "Relationships among Anxiety, Depression, HRQoL and Marital Relationship" / The Relationship between Anxiety and Depression --- p.110-111 / "The Relationship between Anxiety, Depression and HRQoL" --- p.112 / "The Relationship between Anxiety, Depression and Marital Relationship" --- p.112-113 / The Relationships among Domains of Health-related Quality of Life --- p.113-114 / The Relationship between Health-related Quality of Life and Marital Relationship --- p.114-115 / Predictors of Health-related Quality of Life among CAPD Patients / Anxiety and Depression as Predictors of Health-related Quality of Life --- p.116-118 / Marital Relationship as Predictors of Health-related Quality of Life --- p.118-119 / Summary --- p.119-121 / Chapter 6 --- Conclusion / Limitations / Validity of Participants' Responses --- p.122-123 / Generalization of the Study's Findings --- p.123-124 / Psychometric Property of the Chinese Version of KDQOL-36 --- p.124-125 / The Sexual Items ofKDQOL-SF --- p.125 / Appropriateness of Using HADS and Multiple Correlations --- p.126 / Implications of the Study Findings / Implications for nursing knowledge --- p.126-128 / Implications on the Nursing Practice --- p.128-130 / Recommendations for Further Research --- p.130-132 / Conclusion --- p.132-133 / Chapter 7 --- Reference --- p.134-146 / Chapter 8 --- Appendix --- p.147-179

Indiana University-Purdue University Indianapolis (IUPUI) / The presence of a chronic pain condition can have a profound impact on one’s self-concept. Some individuals may have had to make major lifestyle changes. As a result, some people may start to define themselves in terms of their pain, such that their self-schema and pain-schemas become intertwined in a process termed schema-enmeshment. It is thought that schema-enmeshment is related to psychological distress making it a prime target for intervention. Little research has been conducted on interventions to reduce schema-enmeshment. Acceptance-based interventions may be especially appropriate in reducing schema-enmeshment or the connection between self and illness symptoms as these interventions tend to emphasize learning to live with pain and other symptoms and to work toward important life goals rather than continually fighting against the condition and allowing it to control their life. This study is a randomized trial comparing Acceptance and Commitment Therapy (ACT) to education about pain management in a sample of women with Fibromyalgia Syndrome (FMS). The primary aim of this study was to assess the efficacy of ACT in reducing schema-enmeshment between self and pain, as well as enmeshment between self and other symptoms and FMS as a whole. In addition, this study also explored the role of pain acceptance, specifically activity engagement as a mediator of the relationship between treatment group membership and changes in schema-enmeshment. The data was analyzed as an intent-to-treat analysis using the “last measure carried forward” method. Results indicated that the ACT group reported statistically significant differences in self schema-enmeshment with FMS, fatigue, and cognitive symptoms, but not with pain, following the intervention, compared to the educational control group. In each of these cases, the ACT group experienced greater reductions in schema-enmeshment compared to the education group. Interestingly, no statistically significant differences were observed for schema-enmeshment with pain. Statistically significant group differences were also observed for acceptance of pain following the intervention. Finally, a mediational model in which changes in activity engagement (a form of pain acceptance) served as the mediator of the relationship between treatment group and changes in schema-enmeshment with FMS was tested. The model was tested using a bootstrapping method, and results revealed a trend toward a significant indirect effect of changes in activity engagement leading to changes in schema-enmeshment with FMS. Taken together, the results of this study indicate that ACT may be a promising intervention for targeting maladaptive beliefs about the self in relation to illness, especially schema-enmeshment of self with illness and illness symptoms. Additionally, there is evidence that ACT may target key constructs such as activity engagement, which may be related to other cognitive and behavioral changes. Future directions for research and clinical practice related to ACT as an intervention for FMS are discussed in depth.