Prediction of Treatment Response in Chronic Pain Patients: The Relationship Between Illness Behavior and Self-Concept

This study investigated self-concepts held by chronic pain patients. It was hypothesized that self schemas of probable and ideal levels of control, dependence on medical care, physical vulnerability, affiliation and conflict with physicians would predict response to treatment. At intake into a three week in-patient program 72 pain patients were given a self perception scale which measured these five dimensions across three possible selves (now self, probable self and ideal self). Patients were also given at intake, and at follow-up (5 weeks after discharge), a battery of psychological and behavioral measures. Control, dependence on medical care, and vulnerability (CDV) were identified as the three most important constructs since patients rated themselves lower and identified themselves more frequently on these dimensions than they did on affiliation or conflict with physicians. Three types of analyses of outcome were conducted. (1) Follow-up measures were regressed upon the three CDV scales, a global measure of optimism and a measure of negative affectivity. Negative affectivity was found to be the measure most consistently related to changes in mood and pain; and Probable Self was found to be the best predictor of behavioral improvement. (2) Patients\u27 subjective estimates of improvement showed the strongest pattern of correlations with Self and Probable Self. (3) Differences in the intake scores of patients identified at follow-up as active (N = 23) and inactive (N = 33) were also examined Probable Self and Ideal Self discriminated between active and inactive patients. Now Self was marginally related to active status at follow-up. Negative affectivity, optimism, mood, self-esteem, pain and physical activities at intake were unrelated to active status at follow-up. Implications for the importance of a domain specific measure of a self-schema of future functioning are discussed