Although a teenager with chronic pain might never admit it, research has shown that parents influence their pain and functioning even beyond annoying them (and thus “causing” pain). In fact, research shows that many things parents do, or even think, can impact their child’s pain. Unfortunately, most things are not always good or always bad! Pain professionals often give parents some guidelines to follow, such as encouraging their child to go to school or not asking their child about pain. But even these guidelines have exceptions – the bottom line is often “it depends” without a sense of what it depends on!
A recent idea called psychological flexibility provides a framework for understanding how parents’ thoughts, feelings, and actions impact their children. Psychological flexibility is at the core of Acceptance and Commitment Therapy (ACT), and has been studied for the past 30 years or so. It can be defined as the ability to keep doing something or to change, based on things you have decided are important to you, while recognizing the impact of the situation, your thoughts, and your own history on your action. Psychological flexibility (and the related idea of “acceptance”) is known to help people with pain to cope and function. Therapies that target acceptance and psychological flexibility help adults and teens by reducing physical disability, depression, and worry, and helping them to better engage in work, school, and activities with friends.
It seems likely that parents with more psychological flexibility model this for their kids, which could also model better coping. Additionally, parents with more psychological flexibility may be able to keep their sights on longer-term goals, and choose to do even difficult things that support these goals. For example, psychological flexibility would help families engage in treatments that are uncomfortable, would help parents to experience worry about their child’s functioning and still expect their child to attend school, or help parents to choose not to ask their child about pain when they recognize the question comes from their own worry.
However, before we can directly study these ideas, we need to be able to measure psychological flexibility in parents of children with chronic pain. In our recent article in The Journal of Pain (Wallace, McCracken, Weiss, & Harbeck-Weber, 2015), we looked closely at a new measure of this construct. We discovered four sub-parts to the measure, describing different aspects of psychological flexibility, and titled these Values-Based Action, Emotional Acceptance, Pain Acceptance, and Pain Willingness. These sub-parts were consistent in both the mothers and the fathers in our sample.
Values-Based Action measured the extent to which families kept doing important activities even when one member was experiencing pain. Emotional Acceptance measured how much parents were able to tolerate thoughts about their child’s pain without being overwhelmed, struggling for control, or suffering. Parents who reported more values-based action and more emotional acceptance had teens who were less depressed, more likely to be in school, and functioned better, regardless of the teen’s pain intensity, how long they had pain, or the number of hours per day they had pain!
Pain Acceptance and Pain Willingness each measured the extent to which pain avoidance was not the most important goal for the family, though in slightly different ways. These were less related to teen functioning and emotional outcomes, though fathers with more pain willingness had teens who were less anxious about physical injuries. An interesting finding buried in this paper is that mothers’ psychological flexibility played a stronger role in teens’ school attendance, whereas fathers’ flexibility played a stronger role in teens’ own pain acceptance (related to psychological flexibility) and teens’ depression.
Taken as a whole, these results reaffirm the importance of parents to the emotional and physical functioning of teens with chronic pain. We hope this measure opens up opportunity for interventions to help these parents! More importantly, we hope that ongoing research will help us and parents to better understand how they can best support and coach their kids when “it depends.”
About Dustin P. Wallace
Dustin Wallace is a psychologist at Children’s Mercy Hospital in Kansas City. He is the Director of Behavioral Health for the Rehabilitation for Amplified Pain Syndromes (RAPS) program, an intensive program for adolescents disabled by chronic pain, and is Assistant Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine. His clinical and research interests center on the use of acceptance-based interventions to help families cope with chronic pain, and to directly alleviate pain along with its physical, social, and emotional impacts.
Wallace DP, McCracken LM, Weiss KE, & Harbeck-Weber C (2014). The Role of Parent Psychological Flexibility in Relation to Adolescent Chronic Pain: Further Instrument Development. J Pain PMID: 25499065