Does psychological flexibility influence the amount of stigma given to individuals with persistent pain from healthcare staff?

  • Laura Room

Student thesis: Doctoral Thesis


Background: Persistent pain is a common and debilitating problem in the United Kingdom. People experiencing persistent pain are prone to stigma from others, even healthcare
professionals, especially when their pain does not have a biomedical explanation. However, stigma associated with persistent pain, and related psychological processes, are not well under-stood. The model of psychological flexibility could offer a theoretical explanation for
understanding persistent pain stigmatisation. Therefore, the current study aims to apply this model to persistent pain stigma processes.
Method: A cross-sectional, online-survey design was used to collect data from healthcare staff in three acute and three mental health NHS trusts in the North East and North West of England. Measures included five stigma items used in De Ruddere et al.’s (2013) study: pain attribution, inclination to help, level of sympathy, likeability, and perceived deception and the Acceptance and Action Questionnaire – Stigma to measure psychological flexibility with stigmatising thoughts. A total of 239 healthcare staff completed the survey. Regression analyses explored whether psychological flexibility moderated the propensity of healthcare staff to stigmatise vi-gnettes of people with explained or unexplained persistent pain and whether participants’ age, gender, and experience of persistent pain impacted this relationship.
Results: Psychological flexibility significantly moderated the relationship between medical ex-plainability and level of sympathy i.e., higher psychologically inflexible healthcare staff felt less sympathy for people with medically unexplained persistent pain, and higher
psychologically flexible healthcare staff felt more sympathy for people with medically
unexplained persistent pain. Psychological flexibility, however, did not moderate the
relationship between medical explainability and the other four stigma items or the overall
Composite Stigma Score. Generally, healthcare staff without persistent pain, and healthcare staff who were presented with vignettes of medically unexplained persistent pain, were more stigmatising towards persistent pain.
Conclusions: The results contribute to the understanding of psychological processes associat-ed persistent pain stigmatisation, and the stigma surrounding persistent pain without medical
evidence. Further research is required to further understand the psychological flexibility model in relation to stigma towards persistent pain. The results have clinical implications in terms of clinical outcomes and delivery of stigma reducing interventions for healthcare staff.
Date of AwardAug 2023
Original languageEnglish
Awarding Institution
  • Teesside University
SupervisorAlan Robert Bowman (Supervisor)

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