Liv Haugli

The Brief Approach/Avoidance Coping Questionnaire: Development and validation

The objective of the research was to construct a brief coping questionnaire designed to assess the approach-avoidance dichotomy. A 20-item questionnaire was designed and tested in samples of 206 students and 93 patients. Based on empirical analyses and interviews with patients, 12 items were chosen for the final scale, which was named the Brief Approach/Avoidance Coping Questionnaire (BACQ). BACQ was then tested in a clinical sample of 299 primary care patients. A Cronbachs alpha of 0.68 was found in a primary care sample. In testing concurrent validity, BACQ indexes correlated significantly with relevant COPE sub-scales in a 0.34 to 0.57 range. A factor structure based on a two-factor solution gave one bipolar factor, ranging from active approach to resignation and withdrawal, and a second factor with items indicating diversion. In conclusion, the 12-item BACQ is a brief measure of coping strategies with satisfactory psychometric properties. The instrument is designed to measure a general concept of approach versus avoidance oriented coping, but the findings also point to two sub-dimensions of avoidant coping, resignation/withdrawal and diversion.

Learning to have less pain - is it possible? A one-year follow-up study of the effects of a personal construct group learning programme on patients with chronic musculoskeletal pain.

A randomised controlled study with the objective to explore the effects of a group learning programme based on a phenomenological epistemology and personal construct theory. Main outcome measures were: experienced pain, pain coping strategies, absenteeism, disability pension and health care consumption. One hundred and twenty-one patients with chronic musculoskeletal pain and high absenteeism were included in this study. The intervention group (n=77) consisted of nine smaller groups with 6-10 persons in each and were counselled by health personnel with special training. The control group consisted of 44 persons. The learning programme emphasised awareness, possible relations between bodily symptoms, emotions, mind and life situation, and change of focus from pain and disability to resources and potentials. One year after the end of the learning programme (T3), patients in the intervention group reported significant pain reduction, increased pain-coping abilities and a higher reduction of health care consumption than the control group (P<0.05). Absenteeism was not significantly reduced compared to the control group, but there were fewer persons receiving disability pension in the intervention group at T3 (38 versus 59%) (P<0.05). This group-learning programme should be considered an important adjunct to the therapy of patients with chronic muscular pain.

The body has a history: an educational intervention programme for people with generalised chronic musculoskeletal pain.

A phenomenological stand, where the situation is understood explicitly from the subjective experience of the person as opposed to the Cartesian dualistic paradigm regarding the body as a material object, was the fundament for an educational programme for people with generalised chronic musculoskeletal pain. In a randomised controlled study these came out significantly better than the control group with respect to pain and pain coping, taking care of themselves, life satisfaction and health care consumption. Through participation in the group, persons with chronic pain were invited to identify their body from the first person perspective, and possibly become aware of the experienced-based knowledge embedded in their bodies. Possibilities were created for construction of new meanings of embodied life experiences. A philosophy of teaching, where participation and activity are central elements, is presented and elaborated. The theoretical rationale and different educational methods used in the 12 sessions are described. Possible differences between this programme and cognitive therapies are discussed.

Psychological distress and employment status. Effects of a group learning programme for patients with chronic musculoskeletal pain

Seventy-seven patients participated in a group intervention programme counselled by the occupational health service personnel in a randomized controlled trial. The educational programme was inspired by personal construct theory that calls attention to the human capacity to redefine and reconstruct the meaning of any situation or symptom. A significant reduction in psychological distress was obtained at treatment completion and at 1-year follow-up. At follow-up a significant group × work status interaction effect was found, and also a mean reduction of distress among both working and non-working participants in the intervention group, whereas in the control group only those who received disability benefits reported a reduction in psychological distress. Distress at baseline significantly predicted work status at follow-up. An intervention programme such as the one applied in this study may reduce distress and help patients with chronic musculoskeletal pain to remain in their jobs.

Generalised Chronic Musculoskeletal Pain as a Rational Reaction to a Life Situation

While the biomedical model is still theleading paradigm within modern medicine and healthcare, and people with generalised chronicmusculoskeletal pain are frequent users of health careservices, their diagnoses are rated as having thelowest prestige among health care personnel. Anepistemological framework for understanding relationsbetween body, emotions, mind and meaning is presented.An approach based on a phenomenological epistemologyis discussed as a supplement to actions based on thebiomedical model.Within the phenomenological frame of understanding,the body is viewed as a subject and carrier ofmeaning, and therefore chronic pain can be interpretedas a rational reaction to the totality of a personslife situation. Search for possible hidden individualmeanings in painful muscles presupposes meeting healthpersonnel who view the person within a holistic frameof reference.

Vitality training—A mindfulness- and acceptance-based intervention for chronic pain

Chronic non-malign pain has a substantial impact on all parts of an individuals life. Mindfulness- and acceptance- based interventions are increasingly offered to help people manage their pain and strengthening their health promoting resources. In this paper, we present a mindfulness- and acceptance-based intervention, the Vitality Training Programme (VTP), to mitigating pain and accompanying symptoms and increasing pain coping abilities. Based on a clinical case presentation, we discuss how the VTP can help individuals to live a better life with pain. The VTP has been evaluated in two randomised controlled trials and two qualitative studies. Existing evidence is presented. Finally, based on a recently published theoretical model, we present some possible common explanatory mechanisms across various mindfulness- and acceptance-based interventions that might also apply to the VTP.