The Intervening Roles of Psychological Inflexibility and Functional Impairment in the Relation between Cancer-related Pa
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The Intervening Roles of Psychological Inflexibility and Functional Impairment in the Relation between Cancer-related Pain and Psychological Distress Sarah L. Brown 1,2
&
Jared F. Roush 1 & Andrew J. Marshall 3 & Catherine Jones 4 & Charlene Key 4
# International Society of Behavioral Medicine 2020
Abstract Background Psychological distress is a significant problem among patients with a diagnosis of cancer and is associated with elevated risk for mortality; however, not all patients with a diagnosis of cancer experience significant psychological distress. Cancer-related pain has been associated with greater psychological distress among patients with a cancer diagnosis (current or previous). The current study aimed to examine potential theoretical mechanisms (i.e., cognitive fusion, experiential avoidance, and functional impairment) as proposed by the psychological flexibility model, for the association between cancer-related pain and psychological distress. We hypothesized that cancer-related pain would be indirectly positively associated with psychological distress among patients with a cancer diagnosis (current or previous) through psychological inflexibility (i.e., cognitive fusion and experiential avoidance) related to pain and functional impairment, in serial. Method Sixty-one adult outpatients diagnosed with cancer completed self-report assessments of cancer-related pain, psychological inflexibility related to pain, pain-related functional impairment, and psychological distress. Results Cancer-related pain was positively associated with psychological distress indirectly through greater pain-related psychological inflexibility (i.e., cognitive fusion and experiential avoidance) and functional impairment, in serial. Alternative models were explored but unsupported. Conclusion Consistent with the psychological flexibility model, psychological inflexibility and functional impairment may be potential mechanisms underlying the association between cancer-related pain and psychological distress among patients with a cancer diagnosis (current or previous). Keywords Acceptance and commitment therapy . Cancer . Cognitive fusion . Experiential avoidance . Pain . Psychological distress
Introduction An estimated 14.5 million individuals in the USA have a history of cancer [1] and approximately 35% of patients with
* Sarah L. Brown [email protected] 1
Department of Psychological Sciences, Texas Tech University, Mail Stop 2051, Lubbock, TX 79409-2051, USA
2
Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Box Psych, Rochester, NY 14642, USA
3
Department of Family and Protective Services, Austin, TX 78751, USA
4
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
cancer [2], with some variation across types of cancers [3], experience significant psychological distress. Previous research suggests that patients with cancer who experience psychological distress, including depression and anxiety are at e
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