Psychological adjustment to chronic pain has been recently explored within three separate frameworks: a behaviour-focused account of chronic pain acceptance within the broader remit of Acceptance and Commitment Therapy; an emotion-focused approach with various research programs investigating the role of anger, fear, depression and also shame and positive emotions in chronic pain; and a cognitionfocused perspective more recently reframed in terms of illness perceptions as part of a wider model of response to health threats, the Self-Regulatory Model. Although these frameworks have broad areas of overlap, limited research has been directed at integrating acceptance, emotions and illness perceptions into a common, comprehensive account of psychological adjustment to chronic pain. Such an account would be beneficial both for providing a parsimonious approach that would guide further research and for developing pain management interventions that would take advantage of existing research from all three domains. The aim of the present thesis was to explore the possibility of integrating these separate areas by studying the relationships between the main concepts (acceptance, emotions, and illness perceptions) in the context of chronic pain. Based on a review of the relevant conceptual and methodological issues of each domain, a theoretical analysis of the similarities and differences between them was developed, with particular emphasis on the potential of existing models to support an integrative account. This analysis provided specific hypotheses regarding each domain and the interrelationships between them, which were investigated in a longitudinal study on a heterogeneous sample of 265 chronic pain patients using the services of the NHS Lothian Pain Clinic and several patient support organisations. Data were collected via postal and online questionnaires at 3 time points, at 41/2-month intervals (21% attrition rate). Validated questionnaires were used to measure the relevant constructs, with additional questions obtaining information regarding health status, medical history and demographics. The confirmatory analysis (employing a variety of statistical procedures, from correlation to multiple regression, factor analysis, cluster analysis and structural equation modeling) largely confirmed the expected relations within and between domains and was also informative regarding the most suitable data reduction methods. A detailed psychometric analysis of the questionnaires used offered a complementary view on the theoretical and methodological issues involved. An additional exploratory analysis focused on identifying the comparative characteristics of acceptance, emotions, and illness perceptions in predicting health status indicators, controlling for contextual factors such as medical history and demographics. Although no significant longitudinal changes were identified in most parameters (confirming the clinical observation of chronic pain as a stable condition), the longitudinal data allowed an analysis of the stability of the concepts and of the magnitude of their relationships in this patient sample. The analysis of intra- and interpersonal variation via hierarchical longitudinal modeling confirmed the stability of the data, highlighted the necessity of studying variation at both levels, and revealed interesting moderation effects, explained via the proposed concept of ‘discrimination ability’ and several alternative mechanisms. These results can be considered as first steps towards an integrative model of psychological adjustment to chronic pain. It is proposed that the behavioural, cognitive and emotional aspects need further conceptual clarification and these future efforts can be supported by the Cognitive-Affective Model of the Interruptive Function of Pain, within the wider framework of the Self-Regulatory Model.

Denna studie har undersökt och skapat ökad förståelse kring hur befordran inom organisationer kan påverka den psykosociala arbetsmiljön för medarbetarna och den befordrade kollegan. Syftet med studien var att skapa ökad förståelse kring ämnet och finna väsentliga aspekter som organisationen bör ha i beaktning kring beslut om befordran. Studien bygger således på både teoretiskt ramverk och empirisk datainsamling i form av semistrukturerade intervjuer med respondenter som anses relevanta för studien. Ett urval gjordes av respondenterna och det bidrog till åtta intervjuer utifrån mål- samt bekvämlighetsurval. Hälften av respondenterna har befordrats, medan den andra hälften inte har befordrats. Detta skapade således ett perspektiv kring frågan om befordran och den psykosociala arbetsmiljön. I studien har dessutom den deduktiva forskningsstrategin tillämpats tillsammans med förstående epistemologi. Vi har därmed varit intresserade av att se respondenternas uppfattningar kring frågan, och tolkat detta för att kunna dra en slutsats. Vi fann det svårt att dra en konkret slutsats för studien. Vi uppfattade att de psykosociala reaktionerna varierade. Somliga av respondenterna upplevde starkare reaktioner än andra, och utifrån detta drog vi slutsatsen att frågan är tämligen individbaserad. Förslag för vidare forskning kan därmed vara att undersöka frågan utifrån en kvantitativ forskningsmetod istället för den kvalitativa. Vi antyder att det på detta sätt kan ge ett mer omfattande perspektiv kring befordran och psykosocial arbetsmiljö. / This study has examined and created a bigger appreciation in how promotion within organizations can affect the psychosocial working environment for the employees and the promoted colleague. The purpose of the study is to create increased understanding around the subject and find further essential aspects that the organization should consider in decisions regarding promotion. The study is thus based on both theoretical framework together with empirical data collection in the form of semi-structured interviews with respondents that are considered relevant to the study. A selection was made of the respondents and it ended up with eight interviews that were conducted with a target- and purposive samplings. Half of the respondents have been promoted, while the remaining half have not been promoted. This created a perspective on the issue of internal promotion and the psychosocial work environment. In the study, the deductive research approach has also been applied together with understanding epistemology. We have therefore been interested in seeing the views of the various respondents on the issue, and we have consequently interpreted this to further draw a conclusion. The conclusion that was presented was that the perceptions about the psychosocial aspects were rather individual-based. Thus, we found it difficult to draw a concrete conclusion for the study. However, we found that the psychosocial reactions varied. Some of the respondents experienced stronger reactions than others, and from this we concluded that the question is rather individual-based. Suggestions for further research could therefore be to examine the issue from a quantitative research method instead of the qualitative one. We believe that in this way it can provide a more comprehensive perspective on promotion and the psychosocial work environment.