Intendus interruptus, or ‘I want to but I can’t do it’
There is no doubt that having chronic pain stops many people from working towards things they want in their life. At least for some of the time, especially during the early phases of their experience, people tend to focus on obtaining a diagnosis, then either a cure or some form of pain reduction. Comments from people during this time are ‘I put my life on hold’, ‘I’m just focusing on getting through each day’.
What we then see, as chronic pain persists, is a gradual reduction of engagement in firstly leisure activities, then work activities (however you construe this), and finally self care activities. Over time, as Paul Karoly puts it, they develop ‘… a self-defeating reappraisal of one’s everyday goals and aspirations in light of the unabating discomfort and pain.’ (Karoly & Reuhlman, 1996) We see this as deactivation, demoralisation and reducing levels of function.
Paul Karoly and colleagues have, for many years, explored the concept of goals, motivation and factors that either enhance goal achievement or disrupt them. His view of goals and pain is that ‘patients who have had to live with pain for extended periods of time (6 months or more) come to develop a schematic model about their predicament that serves to guide (or misguide) perceptions, preferences, attentional foci, and task-specific actions’ (Karoly & Ruehlman, 1996).
Using a goal-centred self-regulatory model, (for a simple application of this model to diabetes self management, go here) Hamilton and colleagues state that ‘an event is only considered stressful (or challenging) to the extent that it impedes or threatens to impede people’s ongoing goals or personal projects.’. (Hamilton, Karoly & Kitzman, 2004).
This means that the more pain disrupts life goals, the more stressful it is perceived – and the emotional impact especially in terms of distress influences the choice of daily actions that lead towards achievement.
A study by Affleck and colleagues identified that ‘when pain and fatigue interfered with progress towards health and social goals, women reported less positive affect (Affleck et al., 1998). …These results suggest that day-to-day accomplishments of health and social goals despite pain and fatigue have important mental health consequences for women with this chronic illness.’
So, we can see that goals are disrupted in people who experience chronic pain, and that by achieving even simple activities, people can feel more emotionally resilient. Pain influences patterns of goal cognition, and goal cognition influences depression and anxiety (two key indices of psychological status) over and above that due to pain. (Karoly & Reuhlman, 1996) In a study by Karoly, it was found that ‘goal-related value and self-efficacy were of lower magnitude in pain sufferers, suggesting a potential deficit in what self-regulation theory calls the feedforward or directive function. Such a function is involved in the “process of using thoughts about potential future events to organize current behavior” (Ford, 1987, p. 333). It appears that pain, even mild pain, is associated with a slightly diminished intentionality.’ (Karoly & Reuhlman, 1996).
What this means is that it’s probable that efforts to manage even mild pain reduces the value placed on other goals that are usually important, and at the same time it also affects the confidence that people have to achieve these goals.
In the same study by Karoly & Reuhlman, pain generated lower levels of excitement about working towards work goals and instead, raised negative feelings. ‘The arousal function, in control theory terms, is concerned with the fine tuning of energy production and distribution (Ford, 1987, Chapter 13), and is manifest in the form of emotions whose purpose is to help the individual evaluate situations and organize goal-directed action toward valued incentives. Our data suggest that normative pain experience in working adults is associated with both diminished environmental engagement and heightened disengagement from incentives (Karoly & Reuhlman, 1996).
What happens when a person with pain can’t do what he or she wants to? Firstly, the person’s thoughts about the importance of his or her goals are challenged. At the same time, their confidence to achieve them becomes eroded. As time goes on, the positive buzz of looking forward to the benefits of achieving a new goal reduces, and the negative feelings and physiological arousal become more evident.
These negative patterns affect individuals’ overall happiness in life, and increase the chances of the person becoming depressed and having more trouble recovering from pain.
So, that’s why goals relevant to an individual’s own life are so important.
Tomorrow: more on the hows and whys of goal setting.
Affleck, G., Tennen, H., Urrows, S., Higgins, P., Abeles, M., Hall, C., Karoly, P., and Newton, C. (1998). Fibromyalgia and women’s pursuit of personal goals: A daily process analysis. Health Psychol. 17: 40–47.
Affleck, G., Tennen, H., Zautra, A., Urrows, S., Abeles, M., and Karoly, P. (2001). Women’s pursuit of personal goals in daily life with fibromyalgia: A value-expectancy analysis. J. Consult. Clin. Psychol. 69: 587–596
Hamilton, N. A., Karoly, P., & Kitzman, H. (2004). Self-regulation and chronic pain: The role of emotion. Cognitive Therapy and Research Vol 28(5) Oct 2004, 559-576.
Karoly, P., & Ruehlman, L. S. (1996). Motivational implications of pain: Chronicity, psychological distress, and work goal construal in a national sample of adults. Health Psychology Vol 15(5) Sep 1996, 383-390.