By Ron Potter-Efron
I’ve recently read a chapter entitled “Chronic Pain and Depression: Vulnerability and Depression,” by Akiko Okifuji and Dennis Turk (in The Neuroscience of Pain, stress and Emotion (edited by Mustafa al’Absi and Magne Flaten). The authors try to determine what factors help people with chronic pain cope well while others become depressed. I think the answers apply to many aspects of life beyond chronic pain.
So what factors predict that someone with chronic pain will be more likely to become depressed?
These factors overlap a lot but here’s their list.
- Feelings of helplessness.
- Feeling no sense of control.
- Low self-efficacy.
- Rigid thinking.
- Feeling defeated/overwhelmed.
- Lack of perceived social support.
Here’s the list of factors that predict less likelihood of depression for someone with chronic pain.
- Sense of control.
- High self-efficacy.
- Psychological flexibility.
- Availability of positive social support.
The first three factors in the upper list could be summarized as “vulnerability.” As in “I can’t change it, and I have no control over what is happening to me, and that’s generally true for me in many situations.” Catastrophizing adds “And it will get worse and worse” and then the combination of rigid thinking and feeling overwhelmed lead to “What’s the use of even trying?” Finally, lack of perceived social support (“perceived” meaning how the person thinks about efforts to give support) leads to isolation and getting trapped in one’s world of gloom and doom.
The second list is mostly the opposite of the first. The authors have a nice definition of resiliency, though: “the ability to encompass and exhibit adaptive coping within a context of significant adversity.” With regard to chronic pain, resilience is defined as having little interference with one’s activities and low emotional distress despite high pain.
Three factors are cited as important protections against developing depression despite chronic pain:
- Positive emotion;
- Perceptions of life control
- Social support
Resilient people seek ways to enhance positive emotion while less resilient individuals tend to focus more on negative emotions which in turn lead only to the desire to escape the pain rather than live a good life.
Finally, the authors discuss the need for people with chronic pain to balance acceptance of that reality with a sense of personal control. The combination helps people accept reality while at the same time committing themselves to change.
This chapter is focused only upon chronic pain. However, it seems reasonably obvious that the same factors cited above that help people cope with chronic pain and still have good lives apply to all manner of emotionally and/or physical adversities: relationship problems, financial stress, success in school, etc.
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