The Mediational Effect of Pain Self - Efficacy on the Relationship Between PTSD Severity and Disability in Trauma - Exposed Adults with Chronic Pain Tyler Powers, B.S., Margaret Talbot, B.A., Danielle Correll , B.A., and Kristin Samuelson, Ph.D. University of Colorado at Colorado Springs Participants • 251 adults recruited from Amazon’s Mechanical Turk ( MTurk) • All participants were trauma exposed (as defined by Criterion A of the PTSD diagnosis in DSM-5) and experiencing chronic pain (as defined by suffering from pain for over three months) • PTSD symptom severity: M = 29.08, SD = 19.79 • Chronic pain severity: M = 6.25, SD = 1.68 Materials • Participants were administered instruments through MTurk • Pain Self-Efficacy Questionnaire: a measure of an individual’s perceived ability to manage their pain • World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0): a measure of disability severity • Brief Pain Inventory (Short Form): a measure of pain severity in the past 24 hours, on average, and at the present moment • PTSD Checklist for DSM-5 (PCL-5): a measure of PTSD symptoms Method Background Conclusions Results • There was a significant total effect of PTSD severity on disability, while covarying for chronic pain severity c = 0.65, p < .001 • Pain self-efficacy exerted an indirect effect on the relationship between PTSD severity and disability, F(2, 248), = 69.95, p < .001 • The total effect of PTSD severity on disability, while controlling for chronic pain severity, remained significant after accounting for the indirect effect of pain self-efficacy c’ = 0.49, p < .001 • The results of this study have clinical applications • Clinicians who see patients with comorbid PTSD and chronic pain should target pain self-efficacy along with trauma coping self-efficacy to improve overall outcomes • Individuals with comorbid PTSD and chronic pain should receive treatment for both disorders • Future research should examine trauma coping self-efficacy and pain self-efficacy as mediators between chronic pain severity and disability outcomes, and between PTSD severity and disability outcomes, in a sample of individuals with comorbid chronic pain and PTSD • The lifetime PTSD prevalence in the U.S. is approximately 6% (Kessler, Petukhova, Sampson, Zaslavsky, & Wittchen, 2012) • Chronic pain is defined as pain lasting or recurring for more than 3 to 6 months. About 20% of U.S. adults suffer from chronic pain (Dahlhamer et al., 2018) • PTSD and chronic pain are often comorbid conditions (Asmundson, Coons, Taylor, & Katz, 2002) • Comorbid PTSD and chronic pain are mutually maintaining, meaning that as one worsens, so does the other (Sharp & Harvey, 2001) • Self-efficacy has been established as a partial mediator between pain intensity and disability (Arnstein, Caudill, Mandle, Norris, & Beasley, 1999) • Perceived coping self-efficacy has also been established as a partial mediator between PTSD and recovery outcomes (Benight & Bandura, 2004) • Disability, as defined by the World Health Organization as impairment, activity limitations, and participation restrictions, is a construct comprised of cognitive, mobility, self-care, social, and occupational functioning (Üstün, 2010) • The present study aims to explore the mediational effect of pain-related self-efficacy on the relationship between PTSD severity and disability outcomes in a sample of trauma-exposed individuals with chronic pain Hypotheses 1. PTSD symptom severity is hypothesized to be positively related to disability outcomes. 2. PTSD symptom severity is hypothesized to be negatively related to pain self-efficacy. 3. Pain self-efficacy is hypothesized to be negatively related to disability outcomes. 4. Pain self-efficacy is hypothesized to mediate the relationship between PTSD symptom severity and disability outcomes, while statistically controlling for chronic pain severity. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub. Arnstein, P., Caudill, M., Mandle, C. L., Norris, A., & Beasley, R. (1999). Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients. Pain, 80(3), 483-491. Asmundson, G. J., Coons, M. J., Taylor, S., & Katz, J. (2002). PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. The Canadian Journal of Psychiatry, 47(10), 930-937. Benight, C. C., & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behaviour research and therapy, 42(10), 1129-1148. Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., ... & Helmick, C. (2018). Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. Morbidity and Mortality Weekly Report , 67(36), 1001. Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International journal of methods in psychiatric research, 21(3), 169-184. Merskey, H. (1994). Classification of chronic pain. Description of chronic pain syndromes and definitions of pain terms , 1-213. Üstün, T. B., Chatterji, S., Kostanjsek, N., Rehm, J., Kennedy, C., Epping-Jordan, J., ... & Pull, C. (2010). Developing the World Health Organization disability assessment schedule 2.0. Bulletin of the World Health Organization, 88, 815-823. Sharp, T. J., & Harvey, A. G. (2001). Chronic pain and posttraumatic stress disorder: mutual maintenance?. Clinical psychology review , 21(6), 857-877. Figure Chronic pain and posttraumatic stress disorder (PTSD) commonly cooccur and are mutually maintaining. Although previous research has established relationships between self-efficacy and positive outcomes among chronic pain (Arnstein, Caudill, Mandle, Norris, & Beasley, 1999) and PTSD patients (Benight & Bandura, 2004), the relationship between pain self-efficacy and disability outcomes in a trauma-exposed population with chronic pain is unknown. A sample of trauma-exposed adults with chronic pain ( N = 251) was collected using Amazon’s MTurk. We hypothesized that pain self-efficacy (measured by the Pain Self-Efficacy Questionnaire and defined as an individual’s perceived ability to manage pain) mediates the relationship between PTSD severity and disability (measured by the WHO Disability Assessment Schedule 2.0) while covarying for chronic pain severity. Pain self- efficacy mediated the relationship between PTSD severity and disability, F(2, 248), = 69.95, p < .001. There was a significant total effect of PTSD severity on disability, while covarying for chronic pain severity (c = 0.65, p < .001), which remained significant after being mediated by pain self-efficacy (c’ = 0.49, p < .001). Clinically, these findings suggest that targeting pain-related appraisals and pain self-efficacy in individuals with comorbid chronic pain and PTSD may in turn improve overall functioning. Abstract PTSD Severity Pain Self-Efficacy Disability c = 0.65 c’ = 0.49 a = -0.17 b = -0.94 Chronic Pain Severity Figure 1. Mediation model. The predictor was specified as PTSD severity, the outcome was defined as disability, the mediator was defined as pain self-efficacy, and chronic pain severity was specified as a covariate. All paths were significant at p < .001. Variable PTSD Symptom Severity Pain Self- Efficacy Disability PTSD Symptom Severity 1.00 Pain Self- Efficacy -.22** 1.00 Disability .58** -.42** 1.00 Table 1. Correlation Matrix **. Correlation is significant at the p < .01 level Table Contact Information: [email protected]