Applied Psychology

Applied Psychology

Intolerance of Uncertainty and Chronic Pain in Multiple Sclerosis Patients: Cognitive Avoidance, Negative Problem Orientation and Positive Beliefs to Worry

Document Type : Original Article

Authors
Majid Zargham Hajebi 1
Maryam Shahmoradipilehrood 2
Malek Mirhashemi 1
1 Associated Professor, Department of Psychology, Islamic Azad University of Qom, Qom, Iran.
2 Ph.D. Student in Psychology, Department of Psychology, Islamic Azad University of Qom, Qom, Iran.
10.48308/apsy.2024.236440.1685
Abstract
Aim: This study aimed to examine the mediating roles of cognitive avoidance, negative problem orientation, and positive beliefs about worry in the relationship between intolerance of uncertainty and chronic pain in patients with multiple sclerosis.
 
Method: This correlational study included 350 patients (194 men and 156 women) selected through convenience sampling from visitors to the Kosar Imaging Center and the MS Society of Iran in Tehran. Participants completed the Intolerance of Uncertainty Scale (Freeston et al., 1994), the Metacognitive Beliefs Questionnaire (Wells & Cartwright-Hatton, 2004), the Negative Problem Orientation Questionnaire (Robichaud & Dugas, 2005), the Cognitive Avoidance Questionnaire (Sexton & Dugas, 2004), and the Short-Form Pain Inventory (Cleeland, 1989). Path analysis was used to examine the proposed model.
 
Results: The findings from path analysis indicated that the model incorporating cognitive avoidance, negative problem orientation, and positive beliefs about worry as mediators between intolerance of uncertainty and chronic pain demonstrated a good fit with the data.
 
Conclusion: These findings provide further evidence for understanding chronic pain in multiple sclerosis patients through the lens of intolerance of uncertainty, mediated by cognitive avoidance, negative problem orientation, and positive beliefs about worry. The results also support the relevance of cognitive models in explaining psychological aspects of chronic pain.
Keywords
Cognitive Avoidance
Negative Problem Orientation
Positive Beliefs about Worry
Chronic Pain
Multiple Sclerosis
Subjects
Akbari, M., Alipour, A., Zare, H., & Sheykhi, A. K. (2014). The effectiveness of mindfulness based on stress reduction program on quality of life and pain in patients with breast cancer. Journal of Applied Psychology, 8 (29), 7-28. ]  link[
Allan, N. P., Gorka1, S. M., Saulnier, K. G., & Bryan, C. J. (2023). Anxiety sensitivity and intolerance of uncertainty: Transdiagnostic risk factors for anxiety as targets to reduce risk of suicide. Current Psychiatry Reports, 25, 139–147. [Link]
Alschuler, K. N., Whibley, D., Kratz, A. L., Jensen, M. P., Wundes, A., von Geldern, G., Qian, P., Bombardier, C. H., & Ehde, D. M. (2022). Quality of life in individuals newly diagnosed with multiple sclerosis or clinically isolated syndrome. Journal of Neurology, 269, 2560–2572. [Link]
Barajas, S., Garra, L., & Ros, L. (2017). Avoidance in anxiety and depression: Adaptation of the Cognitive-Behavioral Avoidance Scale in a Spanish sample. The Spanish Journal of Psychology, 20, 1-11. [Link]
Bogosian, A., Day, F., Norton, S., Silber, E., Sakel, M., Sharrack, B., & Moss-Morris, R. (2022). Key demographics and psychological skills associated with adjustment to progressive Multiple Sclerosis early in the diagnosis. Frontiers in Rehabilitation Sciences, 3, 966133. [Link]
Borthwick, C., Penlington, C., & Robinson, L. (2024). Associations between adult attachment, pain catastrophizing, psychological inflexibility and disability in adults with chronic pain. Journal of Clinical Psychology in Medical Settings, 1-14.[Link]
Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behavioral Research and Therapy, 40(8), 931-945. [Link]
Chang, E. C. (2024). Expectativas oscuras: On the added burden of concomitant negative problem orientation and pessimism in predicting depressive symptoms and suicidal behaviors in Latinx young adults. Cognitive Therapy and Research, 1-13. [Link]
Cleeland, C. S. (1989). Measurement of pain by subjective report. In C. R. Chapman & J. D. Loeser (Eds.), Advances in pain research and therapy: Issues in pain measurement (Vol. 12) (pp. 391-403). New York: Raven Press. [Link]
Cohen, S. P., Vase, L., & Hooten, W. M. (2021). Chronic pain: An update on burden, best practices, and new advances. Lancet, 397(10289), 2082-2097. [Link]
 El‑Maaty, A. A. A., Sherifi, S. S. E., El‑Gilany, A. H., Zehry, H. I., Salim, A. A., Rohiem, M. F., & Ismael, A. F. (2024). Arabic translation, content validity and reliability of the Multiple Sclerosis Intimacy and Sexuality Questionnaire‑19 (MSISQ‑19). The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 60, 44-55. [Link]
Esfahani, A. A., Pourshahbaz, A., & Dolatshahi, B. (2024). Structural relations of illness perception, fatigue, locus of control, self-efficacy, and coping strategies in patients with multiple sclerosis: a cross-sectional study. BMC Public Health, 24, 1354-1365. [Link] 
Esnaashari, S., Mohammadkhani, S., Hassanabadi, H. R. (2017). Cognitive model of anxiety in cancer patients: The role of cognitive and metacognitive components. Health Psychology, 4 (21), 66-85. [Link]
Freeston, M. H., Rheaume, J., Letarte, H., Dugas, M. J., &Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791-802. [Link]
Guarnaccia, G. B., Njike, V. Y., Dutton, A., Ayettey, R. G., Treu, J. A., Comerford, B. P., & Sinha, R. (2023). A pilot, randomized, placebo‑controlled study of mindfulness meditation in treating insomnia in multiple sclerosis. BMC Neurology, 23, 263-278. [Link]
Hebert, S. V., Green, M. A., Mashaw, S. A., Brouillette, W. D., Nguyen, A., Dufrene, K., Shelvan, A., Patil, S., Ahmadzadeh, S., Shekoohi, S., & Kaye, A. D. (2024). Assessing risk factors and comorbidities in the treatment of chronic pain: A narrative review. Current Pain and Headache Reports, 28, 525–534. [Link]
Horenstein, A., Rogers, A. H., Bakhshaie, J., Zvolensky, M. J., & Heimberg, R. G. (2019). Examining the role of anxiety sensitivity and intolerance of uncertainty in the relationship between health anxiety and likelihood of medical care utilization. Cognitive Therapy and Research, 43, 55–65. [Link]
Hu. Y., Yang, Z., Li, Y., Xu, Y., Zhou, X., Guo, N. (2022). Anxiety symptoms and associated factors among chronic low back pain patients in China: A cross-sectional study. Frontiers in Public Health, 10, 878865. [Link]
Hanna, M., & Strober, L. B. (2020). Anxiety and depression in Multiple Sclerosis (MS): Antecedents, consequences, and differential impact on well-being and quality of life. Multiple Sclerosis Related Disorders, 44, 102261. [Link]
Jellinger, K. A. (2024). Depression and anxiety in multiple sclerosis. Review of a fatal combination. Journal of Neural Transmission, 131(8), 847–869. [Link]
Kline, R. B. (2015). Principles and practices of Structural Equation Modeling (2nd Eds.). New York: Guilford. [Link]
Knowles, K. A., & Olatunji, B. O. (2023). Intolerance of uncertainty as a cognitive vulnerability for obsessive-compulsive disorder: A qualitative review. Clinical Psychology: Science and Practice, 30(3), 317–330. [Link]
Kodosaki, E., Watkins, W. J., Loveless, S., Kreft, K. L., Richards, A., Anderson, V., Hurler, L., Robertson, N. P., Zelek, W. M., & Tallantyre, E. C. (2024). Combination protein biomarkers predict multiple sclerosis diagnosis and outcomes. Journal of Neuroinflammation, 21, 52-67. [Link]
Kusec, A., Murphy, F. C., Peers, P. V., & Manly, T. (2024). Measuring intolerance of uncertainty after acquired brain injury: Factor structure, reliability, and validity of the Intolerance of Uncertainty Scale–12. Assessment, 31(4) 794–811. [Link]
Landmark, L., Sunde, H. F., Fors, E. A., Kennair, L. E. O., Sayadian, A. Backelin, C., & Reme, S. E. (2024). Associations between pain intensity, psychosocial factors, and pain‑related disability in 4285 patients with chronic pain. Scientific Reports, 14, 13477. [Link]
Lleraa, S. J., & Newman, M. G. (2023). Incremental validity of the contrast avoidance model: A comparison with intolerance of uncertainty and negative problem orientation. Journal of Anxiety Disorders, 95: 102699. [Link]
Margoni, M., Preziosa, P., Rocca, M. A., & Filippi, M. (2023). Depressive symptoms, anxiety and cognitive impairment: emerging evidence in multiple sclerosis. Translational Psychiatry, 13, 264-279. [Link]
McHugh, R. K., Kneeland, E. T., Edwards, R. R., Jamison, R., & Weiss, R. D. (2023). Pain catastrophizing and distress intolerance: prediction of pain and emotional stress reactivity. Journal of Behavioral Medicine, 43, 623–629. [Link]
Mihailova, S., & Jobson, L. (2020). The impact of depression and culture on responses to intrusive autobiographical memories: Cognitive appraisals, cognitive avoidance, and brooding rumination. British Journal of Clinical Psychology, 59, 66–79. [Link]
Nombela-Cabrera, R., Pérez-Nombela, S., Avendaño-Coy, J., Comino-Suárez, N., Arroyo-Fernández, R., Gómez-Soriano, J., & Serrano-Muñoz, D. (2023). Effectiveness of transcranial direct current stimulation on balance and gait in patients with multiple sclerosis: systematic review and meta-analysis of randomized clinical trials. Journal of NeuroEngineering and Rehabilitation, 20, 142-155. [Link]
Panjwani, A. A., Applebaum, A. J., Revenson, T. A., Erblich, J., & Rosenfeld, B. (2024). Intolerance of uncertainty, experiential avoidance, and trust in physician: a moderated mediation analysis of emotional distress in advanced cancer. Journal of Behavioral Medicine, 47, 71–81. [Link]
Pennington, C. R., Oxtoby, M. C. S., & Shaw, D. J. (2023). Social Cognitive Disruptions in Multiple Sclerosis: The role of executive (dys)function. Neuropsychology, 38 (2), 157–168. [Link]
Pinel, L., Perez-Nieto, M. A., Redondo, M., Rodrıguez-Rodrıguez, L., & Mateos, L. L. (2020). The impact of cognitive anxiety and the rating of pain on care processes in a vigilance task: The important part played by age. Pain Research and Management, 10, 3204720. [Link]
Poquet, N., & Lin, C. (2016). The Brief Pain Inventory (BPI). Journal of Physiotherapy, 62(1), 52-60. [Link]
Pourhaji, F., Jamali, J., Mahdizadeh Taraghdar, M., Peyman, N., & Tehrani, H., (2024). Design and validation of a Questionnaire on the factors influencing self‑care behaviors in patients with Multiple sclerosis (QFASMS). BMC Neurology, 24, 20-31. [Link]
Racke, M. K., Frohman, E. M., & Frohman, T. (2022). Pain in multiple sclerosis: Understanding pathophysiology, diagnosis, and management through clinical vignettes. Frontiers in Neurology, 12, 799698. [Link]
Rivel, M., Achiron, A., Stern, Y., Zeilig, G., & Defrin, R. (2024). Emotional burden among MS patients: associations between specific chronic pain diagnoses and psychological features. Journal of Neurology, 271:688–698. [Link]
Robichaud, M., & Dugas, M. J. (2005). Negative problem orientation (Part I): Psychometric properties of a new measure. Behaviour Research and Therapy, 43, 391–401. [Link]
Sexston, K. A., Dugas, M. J. (2004). An investigation of the factors leading to cognitive avoidance in worry. Poster presented at the annual convention of the association for advancement of behavior therapy, New Orleans, LA. [Link]
Shahnawaz, M., Nabi, W., Nabi, S., Afaq, M., Paul, M. A., War, F. A., & Shah, N. N. (2024). Relationship between intolerance of uncertainty and symptom severity in Covid‑19 patients: the mediating role of illness perception and Covid‑19 fear. Current Psychology, 43, 13945–13952. [Link]
Shirinzadeh Dastgiri, S., Goodarzi, M. A., Rahimi, C., & Naziri, G. (2009). Study of factor structure, validity and reliability of metacognition questionnaire-30. Journal of Psychology, 12 (4), 445-461. [Link]
Sparaco, M., Miele, G., Abbadessa, G., Ippolito, D., Trojsi, F., Lavorgna, L., & Bonavita, S. (2022). Pain, quality of life, and religiosity in people with multiple sclerosis. Neurological Sciences, 43, 3247–3254. [Link]
Spirin, N. N., Kiselev, D. V., Baranova, N. S., & Karpova, M. S. (2023). Nociceptive and mixed pain syndromes in patients with multiple sclerosis. Neuroscience and Behavioral Physiology, 53 (3), 44–51. [Link]
Stapinski, L. A., Abbott, M. J., Rapee, R. M. (2010). Evaluating the cognitive avoidance model of generalised anxiety disorder: impact of worry on threat appraisal, perceived control and anxious arousal. Behavior Research Therapy, 48(10), 1032-1040. [Link]
Sturgeon, J. A., Zubieta, C., Kaplan, C. M., Pierce, J., Arewasikporn, A., Slepian, P. M., Hassett, A. L., & Trost, Z. (2024). Broadening the scope of resilience in chronic pain: Methods, social context, and development. Current Rheumatology Reports, 26, 112–123. [Link]
Wells, A. (2009). Metacognitive therapy for anxiety and depression. Guilford Press. [Link]
Wells, A., & Cartwright-Hatton, S. (2004). A short form of the metacognitions question­naire: properties of the MCQ-30. Behavior Research and Therapy, 42(4), 385–96. [Link]
Werkheiser, A. (2023). Worry as coping: The roles of worry beliefs, anxiety, and emotion regulation. Thesis, Georgia State University. [Link]
Wu, M., Mennin, D. S., Ly, M., Karim, H. T., Banihashemi, L., Tudorascu, D. L., Aizenstein, H. J., & Andreescu, C. (2019). When worry may be good for you: Worry severity and limbic-prefrontal functional connectivity in late-life generalized anxiety disorder. Journal of Affective Disorders, 257, 650–657.  [Link]
Yaseri, A., Roozbeh, M., Kazemi, R., T., & Lotfinia, S. (2024). Brain stimulation for patients with multiple sclerosis: an umbrella review of therapeutic efficacy. Neurological Sciences, 45, 2549–2559 . [Link]