The relationship between dysfunctional schemata and outcomes from a pain management programme

Psychologists involved in the treatment of chronic pain have increasingly emphasised the importance of cognitive factors in the development and maintenance of chronic pain (Turk and Rudy, 1992). Most pain management programmes (PMP's) incorporate a cognitive-behavioural component that, for example, teaches patients to identify thoughts the might lower mood, exacerbate their pain or interfere with their ability to engage in rehabilitative behaviours. These treatment elements are derived from the cognitive model of depression (Beck, 1967), which states that depressed mood is maintained by negative automatic thoughts that arise out of the patient's dysfunctional schemata. Schemata are cognitive structures that organise our beliefs, attitudes and assumptions, and help the individual to construe themselves and their world. Whilst there has been some research suggesting that dysfunctional schemata (those thought to be associated with poor psychological adjustment) can interfere with outcome in cognitive-behavioural therapy for depression (Jarrett, Eaves, Granneman and Rush, 1991) no similar research has been conducted examining their influence on outcome from a PMP.In this study, 66 patients, who were attending six consecutive pain management groups, were asked to complete two measures of dysfunctional schemata (the Dysfunctional Attitudes Scale, Weissman, 1979 and the Young Schema Questionnaire - Short Form, Young and Brown, 1999). These measures were supplemented by two sets of informant ratings (provided by a close friend or relative and by the psychologist leading the PMP) of the patient's schemata. Outcome measures used to assess the effectiveness of the PMP included current pain intensity, iv self-reported mood disturbance, self-efficacy, readiness to engage in pain management, disability, and physiotherapist ratings of functional ability. These were collected at the beginning and at the end of treatment. The number of significant associations between the measures of dysfunctional schemata and patient outcomes (the difference between pre and post-treatment scores) were few and were often in the direction opposite to that predicted. Various substantive and methodological reasons were examined in an attempt to explain why the study hypothesis was not upheld