Examining the role and malleability of future self perceptions in the context of psychological treatments for chronic pain

Abstract

The central purpose of this three-paper linked dissertation is to explore the role of future self perceptions in the context of psychological treatments for chronic pain. The studies that comprise this dissertation share a common framework and instrument (the Future Self Questionnaire; Future-SQ), although they differ in their aims, methodologies, and scope. Following an introduction to the public health problem of chronic pain and an extensive literature review of the concept of the future self, the first study is a psychometric evaluation of the Future-SQ in a sample of individuals with chronic pain. Using baseline data from a randomized controlled trial comparing three psychological treatments for chronic pain (the MATCH study), the purpose of this study was to determine the component structure of the Future-SQ items, and evaluate the reliability and validity of the total scale and any subscales that emerged. Data were analyzed by conducting a principal component analysis, calculating the internal consistency of the scales, and conducting correlational analyses with validity criterion measures. Results indicated that the Future-SQ was comprised of two distinct subscales, and that the factor structure and subscales were psychometrically robust. This study established the Future-SQ as a valid and reliable instrument for measuring future self perceptions in the subsequent papers. The second paper, “Examining the role of future self perceptions on the outcomes of psychological treatments for pain,” used responses to the Future-SQ items that were administered to participants of a separate randomized controlled trial and its sub-study comparing three psychological treatments for chronic pain (the BOT/LIFE study). The purpose of this paper was to examine the predictive, moderating, and mediating effects of future self perceptions on improvements in the outcome variables of depression, pain intensity, and pain interference. Linear regression analyses were used to evaluate whether pre-treatment Future-SQ subscale scores predicted and/or moderated the response of treatment condition to the outcome measures. Mediation analyses sought to understand if and to what extent changes in future self perceptions might serve as an intermediary variable between treatment condition and changes in outcome variables. Results suggested that future self perceptions did not play a strong predictive or mediating role in this sample. With respect to results of the moderation analyses, the study identified a statistically significant interaction between treatment condition and baseline future self perceptions related to overall well-being on changes in pain intensity, and interaction trends suggesting the possibility that direction of effects of future self well-being on pain intensity might vary as a function of treatment condition. The findings have implications for advancing precision medicine by assigning individuals with chronic pain to appropriate types of psychological treatments. The third paper, “Exploring the potential moderating effects of age and disability due to chronic pain on changes in future self perceptions in a sample of individuals with chronic pain,” used data from the same randomized controlled trial (the BOT/LIFE study) as the second paper. The purpose of the analyses reported in this paper was to determine whether there were boundary conditions that identify if changes in future self perceptions might occur differently as a function of age or disability due to chronic pain status. Moderation analyses were conducted to understand the presence and strength of interactions between the two candidate moderators (age and perceived disability due to chronic pain) and changes in future self perceptions. Results indicated that participants’ views of their future selves improved across treatment conditions. However, no significant interactions emerged between changes in Future-SQ subscale scores and either age or disability due to chronic pain status, although non-significant trends for moderation effects suggested future self perceptions were modestly more malleable for older respondents and those who identified as having disability due to chronic pain in this sample. If the findings from this study are replicated in studies with larger samples, individuals with chronic pain across age ranges and with or without self-identified disability due to chronic pain might be able to improve their future self perceptions to a similar degree, for the most part. If the trends identified are found to be reliable in this research, then it is possible that for older individuals and those who identify as having disability due to chronic pain, self perceptions might be a little less stable and more malleable.