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How does pain catastrophizing impact on Pain? Mediational analyses.

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Steven J. Linton

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The aim of this study was to experimentally investigate psychological mechanisms that are important in the development or maintenance of chronic pain and whether validating communication might counteract this. Indeed, psychological factors, like catastrophizing and negative emotions, are known potent risks for the development of chronic pain. A better understanding of this process is vital because chronic pain affects more than 1,250,000 Swedes resulting in immeasurable suffering, distress, and functional disability. Yet, while catastrophizing and negative emotions are strongly related to chronic pain, we know little about the mechanisms involved and have therefore not been able to capitalize on this in the clinic. Indeed, clinicians are faced with trying to deal with the patient's catastrophizing, and professionals often respond in ways that actually increase both catastrophic thinking and negative emotions, resulting in poorer communication and problems with adherence to treatment. One inroad is the relationship between catastrophizing and emotions, where negative emotions might play a significant role in the vicious circle in which catastrophizing catalyses the pain problem into a chronic state. Validation, a specific type of empathic responding, is known to influence current (state) emotions, but little is known about how it is related to catastrophizing. It is thought that validation might well be one powerful way of influencing it. To move the research area forward, experimental designs are needed where the variables are not just correlated but actually manipulated, providing much needed insight into causal relationships. We studied the mechanisms by which catastrophizing and validation, in relation to emotions, work by manipulating them in cleverly designed experiments where direct and mediated effects on outcomes such as pain, communication, and adherence can be ascertained. Knowledge gained move theoretical conceptions forward and could provide health care providers with a simple but powerful tool to facilitate adherence.

The results support the fundamental role of catastrophizing in relation to pain, and point at a need for validating communication to support patients with catastrophizing within the health care setting.


Flink, I.K.L, Boersma, K., & Linton, S.J. (2013). Pain catastrophizing as repetitive negative thinking: A development of the conceptualization. Cognitive Behaviour Therapy, 42(3), 215-223.

Flink, I.K., Boersma, K., & Linton, S.J. (2010). Catastrophizing moderates the effect of exposure in vivo for back pain patients with pain-related fear. European Journal of Pain, 14, 887-892.

Flink, I.K., Boersma, K., & Linton, S.J. (2014). Changes in catastrophizing and depressed mood during and after early cognitive behaviorally oriented interventions for pain. Cognitive Behaviour Therapy, 43 (4), 332-341.

Flink I.K., Boersma K, MacDonald, S, Linton, S.J. (2012). Understanding catastrophizing from a misdirected problem solving perspective. British Journal of Health Psychology, 17(2), 408-419.

Flink, I. K., Engman, L., Thomtén, J., & Linton, S. J. (2017). The role of catastrophizing in vulvovaginal pain: Impact on pain and partner responses over time. Journal of Applied Biobehavioral Research, 22(1).

Flink, I. K., & Linton, S. J. (2016). Pain, sleep and catastrophizing: The conceptualization matters: Comment on Wilt JA et al. “A multilevel path model analysis of the relations between sleep, pain, and pain catastrophizing in chronic pain rehabilitation patients”. Scandinavian Journal of Pain, 10, 119-121.

Research funding bodies

  • Swedish Research Council