Hope, Optimism, and Clinical Pain: A Meta-Analysis

Hope as a predictor of physical activity behavior in middle-aged and older adults with musculoskeletal pain

Background

Musculoskeletal pain is a barrier to physical activity, enhancing functional decline in older adults. Thus, identifying psychological factors that promote physical activity in older adults with musculoskeletal pain is warranted. Prior research shows that the psychological construct of hope predicts the frequency of exercise in healthy younger adults. However, the impact of hope on physical activity behavior in an older population with clinical pain is unknown. This observational study was designed to determine whether hope predicted self-reported and objective physical activity levels in older adults with musculoskeletal pain.

Methods

Fifty-two middle-aged to older adults (age range 55-85 years; 67% female) completed all assessments. Participants completed questionnaires to assess hope (Adult Hope Scale), self-reported physical activity (Physical Activity Scale for the Elderly), bodily pain (SF-36), kinesiophobia (Tampa Scale of Kinesiophobia), and pain catastrophizing (Pain Catastrophizing Scale). Participants also wore accelerometers on the hip for one week to objectively measure physical activity levels. Correlations were conducted to determine relationships between variables. Hierarchical regressions were conducted to determine whether hope predicted self-reported and objective physical activity levels after controlling for relevant demographics, pain, and other psychological variables.

Results

After controlling for bodily pain, hope significantly predicted self-reported physical activity and was associated with greater physical activity levels. Bodily pain, but not hope, significantly predicted average daily steps derived from the accelerometer. Decreased bodily pain was associated with more daily steps.

Conclusion

These findings suggest that trait hope could be a key psychological predictor of self-reported physical activity in older adults with musculoskeletal pain. Clarifying the role of hope in the physical activity behavior of older adults could present a novel target for intervention.

Psychosocial Phenotypes of Older Adults With Pain and Their Associated Clinical Outcomes

A comprehensive understanding of the patterns of psychosocial characteristics in older adults with pain is needed. Our objectives were to (1) identify psychosocial phenotypes (comprising depression, anxiety, affect, self-realization, resilience, and social participation) among older adults with pain and (2) compare pain characteristics, physical health, and cognition among the identified phenotypes. Using cross-sectional 2021 data from the National Health and Aging Trends Study, we performed latent class analysis to identify four psychosocial phenotypes of older adults with pain (N = 1903): Favorable (best psychosocial characteristics, 67.7%), Adverse (worst psychosocial characteristics, 4.9%), Intermediate (moderate scores on psychosocial variables, 12.6%), and Compensated (moderate scores with relatively high self-realization and resilience, 14.9%). Phenotypes with less psychosocial adversity had generally better clinical outcomes. Future research should explore precision pain management interventions in older adults based on their psychosocial phenotypes, longitudinal trajectories of phenotypes, and technology-based, point-of-care clinical insights for pain management.

Pain-Related Smoking Expectancies and Smoking Behavior Among U.S. Adult Cigarette Smokers with Chronic Pain

BACKGROUND

This study investigated the factor structure of a measure of pain-smoking interrelations and expectancies (pain and smoking inventory (PSI)) and examined associations with risk factors for smoking maintenance among smokers with chronic pain (CP).

METHOD

Participants (n = 504; M age = 46 ± 13 years; 58% female) completed an online survey about health-related factors and smoking characteristics. Data were analyzed using Horn's parallel analysis (PA) and multiple linear regression.

RESULTS

PA indicated that a single-dimension structure was the best fit for the PSI. Our regression model accounted for 34% of the variance in PSI score. The PSI was associated with younger age, higher education, poorer physical functioning, greater pain severity and pain intensity, higher psychological distress, greater nicotine dependence, lower self-efficacy and greater perceived difficulty quitting, and lifetime use of behavioral treatment for quitting smoking.

CONCLUSION

This research is the first step in identifying potential targets for smoking cessation approaches tailored to smokers with CP.

The Central Role of Daily Hopeful Feelings in Predicting Well-Being: A Network Perspective

OBJECTIVE

Hope is associated with many positive outcomes. However, most research on hope has focused on its cognitive aspect, with few studies examining the affective aspect. To further clarify the nature of hope and its association with well-being, this study examined the relationship between the affective aspect of hope-namely, hopeful feelings-and various aspects of well-being.

METHOD

A daily diary analysis was conducted with 187 Chinese adults (meanage = 28.17 ± 5.56). Hopeful feelings and affective (positive and negative emotions), eudaimonic (meaning in life), and evaluative (life satisfaction) aspects of well-being were assessed twice per day (morning and night) for 14 consecutive days. A multilevel vector autoregressive model was used to investigate the temporal, contemporaneous, and between-person networks of hopeful feelings with positive emotion and well-being.

RESULTS

Hopeful feelings had the strongest outstrength in the temporal networks and were the most central node in the between-person networks. In addition, hopeful feelings exhibited significant cross-lagged predictive roles on all the well-being nodes except negative emotion.

CONCLUSIONS

These findings revealed a close association between hopeful feelings and well-being, with hopeful feelings predicting various aspects of daily well-being. Future interventions to improve well-being should focus on the enrichment of daily hopeful feelings.

Adoption and Discontinuance of Innovation Packages: A Longitudinal Study of Transitions in COVID-19 Mitigation

The past decades have seen growing interest and application of interventions targeting the change of multiple behaviors at once. We advance this work by using the diffusion of innovations theory (DOI) to consider constellations of behaviors as innovation packages: multiple innovations that are logically related, interdependent in their use or effects, and often promoted as a set (Rogers, 2003). In addition, we embraced DOI's focus on behavioral decisions as a continual process that can include adoption and discontinuance over time, especially as new innovations (e.g., COVID-19 vaccine) appear. To that end, we conducted a latent transition analysis of COVID-19 mitigation behaviors (N = 697; 97% received a COVID-19 vaccine) across three time points in the pandemic: initial outbreak; a secondary, record-breaking rise in cases; and after the CDC recommended that fully vaccinated adults could discontinue wearing masks. This analysis allowed us to identify latent classes based on shared behavioral patterns and transitions between classes over time. The results showed evidence of three possible packages: (a) a package of traditional, symptom-management behaviors (covering coughs and sneezes, staying home if ill, and seeking medical care), (b) a package of just-novel COVID-19 behaviors (wearing masks, keeping six feet apart, and avoiding mass gatherings), and (c) a package of all COVID-19 mitigation behaviors. Movement between classes exemplified adoption and discontinuance of different packages, as well as widespread discontinuance with the replacement innovation: COVID-19 vaccines. Additional analyses showed that increases in hope were associated with sustained and delayed adoption; decreases in social approval were associated with discontinuance. Future directions in theorizing around innovation packages are discussed.

Testing the validity of the broaden-and build theory of positive emotions: a network analytic approach

Introduction

The Broaden-and-Build Theory of positive emotions is one of the best known and applied theories in Positive Psychology. It argues that positive emotions initiate an upward movement by opening up the mind and broadening thoughts and thus represents a counter model to the vicious circle-models of clinical psychology. The number of studies directly testing this theory in all components is scarce, ambiguities in the model impede clear inference.

Method

To draw a conclusive picture on within-model processes, we applied network modeling on the components of the theory across two studies (N 1 = 312; N 2 = 302).

Results

In both studies, the positive relationship between positive emotions, resources and life outcomes is well-supported, yet the role of broadening, as an intermediary component within these is questioned.

Discussion

As the broadening component consistently deviated from the model's predictions and thus did not contribute to the model as expected in either study, the validity of the Broaden-and-Build Theory in its current conceptualization is challenged, and our results point to the need to reassess the role of broadening.

Randomized controlled trial investigating the effectiveness of a multimodal mobile application for the treatment of chronic pain

Background

Until recently, treatments for chronic pain commonly relied on in-person interventions, and despite more hybrid care options today, capacity for delivery remains challenged. Digital programs focusing on the psychosocial aspects of pain may provide low-barrier alternatives.

Aims

Through a randomized controlled trial, we investigated the effectiveness of a multimodal mobile application.

Methods

Participants (n = 198; 82% women, mean age = 46.7 [13.1] years; mean pain duration 13.6 [11.2] years) with nonmalignant chronic pain were randomized to either a 6-week intervention (n = 98) or a wait-listed usual care group (n = 100). The intervention involved regular engagement with a user-guided mobile application (Curable Inc.) informed by the biopsychosocial model of pain that included pain education, meditation, cognitive behavioral therapy, and expressive writing. The co-primary outcomes were pain severity and interference at 6 weeks.

Results

We observed significant improvements in the intervention group compared to the control group with estimated changes of -0.67 (95% confidence interval [CI] -1.04 to -0.29, P < .001, d = 0.43) and -0.60 (95% CI -1.18 to -0.03, P = .04, d = 0.27) for pain severity and interference, respectively. There were significant improvements across secondary outcomes (Patient-Reported Outcome Measurement Information System pain interference; pain catastrophizing; anxiety, depression; stress). Frequency of app use was correlated with improved pain interference (P < .001) and pain catastrophizing (P = 0.018), and changes from baseline persisted in the intervention group at 12 weeks (P < .05).

Conclusions

A short-term mobile app intervention resulted in significant improvements across physical and mental health outcomes compared to wait-listed usual care.

How future orientations predict healthy outcomes: Information avoidance as a potential mechanism

This study elucidates whether information avoidance may help explain demonstrated links between future orientation and health. In an online study, college students reported their self-reported prevention and detection health behaviors and responded to a prevention and detection health message. Path analyses indicated that information avoidance mediated the relationship with the future orientations (optimism and consideration of future consequences), such that, greater and more positive future orientations were associated with less information avoidance, and less information avoidance was associated with greater self-reported health behaviors and positive responses to health information. Correlational analyses revealed that information avoidance was particularly related to health outcomes, and to a greater extent than future orientations. Our findings join a growing literature showing the importance of information avoidance for a variety of health behaviors and suggest a potential intervention target for individuals whose characteristic ways of (not) thinking about their future might keep them unaware and unhealthy.

Exploring the effects of fitbit incentive on treatment outcomes in veterans undergoing intensive pain rehabilitation program

OBJECTIVE

This study compares clinical pain outcomes between patients in a pain treatment program that received a Fitbit, to patients that did not. We also explored: (1) cognitive, emotional, and psychological factors that may have impacted the decision to opt in to receiving a Fitbit; and (2) whether the choice to receive a Fitbit impacted changes in cognitive, emotional, and psychological factors following treatment.

METHODS

Among 58 patients in a multidisciplinary pain treatment program at a Veterans Affairs Healthcare System hospital, 31 patients opted to receive a Fitbit as adjunct treatment, while 27 did not. This study utilized patient-reported and practitioner-collected data from the pain treatment program.

RESULTS

Compared to the non-Fitbit group, the Fitbit group displayed a significant decrease in average pain intensity, however showed no correlation between Fitbit activity and average pain intensity. Additionally, treatment satisfaction was the only predictor of treatment group, when modeling pre- and post-treatment outcomes changes.

CONCLUSION

The implementation of a Fitbit may lead to improved pain intensity. Initial evidence suggests that opting to receive a Fitbit during a pain treatment program indicates treatment engagement leading to greater treatment satisfaction. Future work is needed to verify and expand upon this potential mechanism.

Shifting the perspective: how positive thinking can help diminish the negative effects of pain

OBJECTIVES

The field of pain psychology has taken significant steps forward during the last decades and the way we think about how to treat chronic pain has radically shifted from a biomedical perspective to a biopsychosocial model. This change in perspective has led to a surge of accumulating research showing the importance of psychological factors as determinants for debilitating pain. Vulnerability factors, such as pain-related fear, pain catastrophizing and escape/avoidant behaviours may increase the risk of disability. As a result, psychological treatment that has emerged from this line of thinking has mainly focused on preventing and decreasing the adverse impact of chronic pain by reducing these negative vulnerability factors. Recently, another shift in thinking has emerged due to the field of positive psychology, which aims to have a more complete and balanced scientific understanding of the human experience, by abandoning the exclusive focus on vulnerability factors towards including protective factors.

METHODS

The authors have summarised and reflected on the current state-of-the-art of pain psychology from a positive psychology perspective.

RESULTS

Optimism is an important factor that may in fact buffer and protect against pain chronicity and disability. Resulting treatment approaches from a positive psychology perspective are aimed at increasing protective factors, such as optimism, to increase resilience towards the negative effects of pain.

CONCLUSIONS

We propose that the way forward in pain research and treatment is the inclusion of both vulnerability and protective factors. Both have unique roles in modulating the experience of pain, a finding that had been neglected for too long. Positive thinking and pursuing valued goals can make one's life gratifying and fulfilling, despite experiencing chronic pain.

A shared love: reciprocity and hopefulness in romantic relationships of young adults with chronic pain

Introduction

Chronic pain (≥3 months) creates pain-related challenges that may negatively affect how young adults perceive themselves, and, indeed, they often report feeling different compared to peers and prospective romantic partners. Most studies of romantic relationships in young adults living with a long-term condition (including pain), do not consider the perspective of their partner. We present the findings of a qualitative, exploratory interview study (Phase 2 of a mixed methods study). This qualitative phase aimed to explore how young adults with chronic pain and their partners navigate romantic relationships. We focused on how young adults perceive and experience their romantic relationships and the impact, challenges, and benefits associated with living with chronic pain.

Methods

This study used remote (videoconferencing) photo-elicitation interviews with a convenience sample of young adults with chronic pain (aged 18-25 years, UK and Canada) and their partners. Recruitment occurred via social media, pain-related websites and organizations, and professional networks. Five young adults with chronic pain from the UK and Canada formed the e-Advisory Group and provided detailed advice throughout the study. Data analysis used the principles of inductive reflexive thematic analysis to explore the dimensions and meaning of romantic relationships from the views of young adults with chronic pain and their romantic partners.

Findings

Sixteen young adults participated (seven couples plus two young adults with pain who were interviewed without their partner). The young adults with chronic pain were ages 18-24 years (mean 21.88 years, SD 2.23). Four major interpretive themes were generated: Kindred spirits-we just sort of work; Loving in everyday acts-it's not above and beyond, it's concerned supportiveness; It's OK to be vulnerable with each other-we can talk it through; and You can't see over the horizon-hopes and fears for the future.

Discussion

Hopefulness and reciprocity were key to the stories shared by the young adults in the current study. Despite the challenges and limitations imposed by chronic pain, their relationships were characterized by partnership and reciprocity, and they were able to be vulnerable with each other and offer each other support.

Five challenges for hope and resilience research

Twenty years after Snyder's seminar article on hope theory, research on hope has moved in many directions and has spanned multiple spheres of personal life and social life, including psychological adjustment, physical health, lifespan development, and interpersonal relationships. Given its importance for well-being, it is somewhat surprising that a close look at the literature reveals that the question of whether hope is a source of resilience is far from resolved, and key questions remain unanswered. Here, we outline five challenges for future hope and resilience research, including conceptualization, measurement, research design, modeling methods, and multidirectional and multidimensional perspectives on adaptation. Although each of these challenges has received some attention, additional work is needed to build a more cumulative science, thereby contributing important insights into what it means to be well in the face of adversity.

Hope and physical health

This article provides a brief overview of the recent research focusing on hope and physical health. The reviewed research is limited to research primarily on hope as conceptualized by Snyder and colleagues [33] and to those studies in which the researchers measured hope using scales based on Hope Theory proposed by Snyder and colleagues. Studies on hope and health behaviors, as well as specific health outcomes such as pain, cancer, and chronic illness are included. Overall findings indicate that hope is plays an important role in health.

Experiences of Health-Promoting Activities among Individuals with Knee Pain: The Halland Osteoarthritis Cohort

Knee pain is an early sign of knee osteoarthritis (KOA) and a risk factor for chronic widespread pain (CWP). Early prevention is vital, and more research is needed to understand health-promoting activities for individuals with knee pain from a patient perspective. This study aimed to explore how individuals with knee pain experienced health-promoting activities. Explorative qualitative design with inductive approach was applied to explore the experiences of 22 individuals (13 women, 9 men; median age: 52). Semi-structured interviews were conducted and analysed using latent qualitative content analysis. The results revealed health-promoting activities in individuals with knee pain and were interpreted in the overall theme, striving for balance in everyday life. Two categories explored the content in health-promoting activities: (1) Caring for the body-being physically active, having a healthy diet, and utilising support; and (2) Managing life stressors-allowing for recovery, promoting vitality, and safeguarding healthy relationships. In conclusion, individuals with knee pain described various health-promoting activities. They strived for balance in everyday life by caring for the body and managing life stressors. We suggest that a broader approach to everyday life can be helpful in treatment plans and health promotion to manage and prevent KOA and CWP, while striving for a healthy lifestyle.

Outcomes as experienced by older patients after hospitalisation: satisfaction, acceptance, frustration and hope-a grounded theory study

Background

outcomes of hospitalisation are often described in quantitative terms. It is unknown how older frail patients describe their own outcomes.

Objective

to discover how older frail persons describe their own hospitalisation outcomes and the meaning of these outcomes for their daily lives.

Design

Constructivist Grounded Theory approach.

Participants

frail older people discharged from hospital.

Methods

Open interviews in the participant’s home. Transcripts were coded inductively according to the Constructivist Grounded Theory approach.

Results

Twenty-four interviews were conducted involving 20 unique participants. Although for some participants hospitalisation was just a ripple, for others, it was a turning point. It could have positive or negative impacts on outcomes, including remaining alive, disease, fatigue/condition, complaints, daily functioning, social activities and intimate relationships, hobbies, living situation and mental well-being. Few participants were completely satisfied, but for many, a discrepancy between expectation and reality existed. Some participants could accept this, others remained hopeful and some were frustrated. Factors associated with these categories were research and treatment options, (un)clarity about the situation, setting the bar too high or pushing boundaries, confidence in physicians, character traits and social factors.

Conclusions

of the persons whose outcomes did not meet their expectations, some were frustrated, others hopeful and others accepted the situation. The following interventions can help patients to accept: clear communication about options and expectations before, during and after hospitalisation; giving room for emotions; help finding social support, encouragement to engage in pleasant activities and find meaning in small things. For some patients, psychological treatment may be needed.

Loneliness is not a homogeneous experience: An empirical analysis of adaptive and maladaptive forms of loneliness in the UK

Understanding loneliness is pivotal to informing relevant evidence-based preventive interventions. The present study examined the prevalence of loneliness in the UK, during the COVID-19 pandemic, and the association between loneliness, mental health outcomes, and risk and protective factors for loneliness, after controlling for the effects of social isolation. It was estimated that 18.1% of the population in our study experienced moderately high to very high loneliness. We also found that loneliness was positively associated with self-disgust and social inhibition, and negatively associated with trait optimism and hope. Cluster analysis indicated that two distinct groups emerged among those experiencing higher levels of loneliness: "adaptive" and "maladaptive" loneliness groups. The maladaptive loneliness group displayed psychological characteristics like self-disgust and social inhibition including symptoms of depression and anxiety that can potentially undermine their ability to connect with others and form meaningful social relationships. These findings suggest that not all people experience loneliness in the same way. It is possible that a one-size-fit-all approach to reducing loneliness, may be less effective because it does not take into account the differential psychological profiles and characteristics of lonely people, relevant to their capacity to connect with others.

Age progression in hypnosis for pain and fatigue in individuals with disabilities

The purpose of this paper is to describe in detail a specific age progression approach that we use in our clinical practice and clinical trials in interventions including hypnosis for chronic pain and fatigue in individuals with disabilities. Moreover, we present preliminary evidence regarding the effects of the hypnosis sessions that use age progression suggestions compared to hypnosis sessions that provide different suggestions, as well as to sessions that did not include hypnotic procedures. Findings indicate that age progression suggestions for pain management with individuals participating in hypnosis treatment resulted in substantial immediate reductions in pain intensity, which were greater than pain reductions associated with treatments sessions providing pain education or cognitive therapy. In addition, age progression sessions provided to individuals receiving online hypnosis treatment for fatigue resulted in immediate large reductions in fatigue severity. Although the design of these two studies does not allow to report specific or long-term effects of the age progression techniques, findings indicate that including age progression suggestions to hypnosis protocols for pain and fatigue management is effective for reducing the immediate level of both symptoms. The development and continued evaluation of hypnotic interventions that increase or restore hope in, and optimism, for the future has the potential for enhancing the psychosocial well-being and quality of life of individuals with pain and fatigue.

Psychophysiological correlates of pain resilience in anticipating, experiencing, and recovering from pain

Although researchers have documented behavioral and brain structure correlates of pain resilience, associated physiological responses have received little consideration. In this study, we assessed psychophysiological differences between high (HPR), moderate (MPR), and low (LPR) pain resilience subgroups during anticipation, experiencing, and recovery from laboratory pain. In an initial pain anticipation task, participants (79 women, 32 man) viewed visual cues to signal possible mild or intense shocks prior to receiving these shocks. Subsequently, in a pain recovery task, participants received uncued mild and intense shocks. Subjective appraisals were assessed during each task in tandem with continuous recording of skin conductance level (SCL), heart rate variability (HRV), and corrugator electromyography (cEMG). On physiological indexes, HPR subgroup members displayed significantly lower SCL than MPR and LPR subgroups did during anticipation and experiencing of pain while no resilience group effects were found for HRV or cEMG. During pain recovery, HPR and LPR subgroups displayed weaker SCL than the MPR subgroup did in the immediate aftermath of shock. However, HPR members continued to display lower SCL than other groups did over an extended recovery period. On self-report measures, the LPR subgroup reported higher levels of anticipatory anxiety and expected pain than HPR and MPR subgroups did during the pain anticipation task. Together, results suggested higher pain resilience is characterized, in part, by comparatively reduced SCL during the course of anticipating, experiencing and recovering from painful shock.