The Lived Experience of Individuals with Chronic Back and Neck Pain, Depression, and/or Anxiety

226 Pages·2017·2.23 MB·English

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Dissertations Graduate College
8-2016
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Tara L. Palmeri
Western Michigan University, [email protected]
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THE LIVED EXPERIENCE OF INDIVIDUALS WITH CHRONIC BACK
AND NECK PAIN, DEPRESSION, AND/OR ANXIETY

Tara L. Palmeri, Ph.D.

Western Michigan University, 2015

More than 1.5 billion people worldwide suffer from chronic pain (CP). People
who experience chronic pain are 20 to 40% more likely to meet criteria for an anxiety
disorder, and three to four times more likely to be clinically depressed than their pain-free
counterparts. The relationship between CP and mental health has been studied
quantitatively; however, few researchers have investigated co-morbid CP and mental
health through a phenomenological lens. The subjective nature of the relationship is not
comprehensively addressed within the literature.
This qualitative phenomenological study explored (a) how individuals with
chronic back and/or neck pain (CBNP) experience, understand, and draw conclusions
about the relationship between their physical pain and mental health; and (b) how
individuals perceive talking about their experiences with CBNP and depression and/or
anxiety. To further understand the intersection between CP and mental health, 10
individuals diagnosed with CBNP and depression and/or anxiety, were interviewed.
Lengths of diagnoses ranged from 1 year to 30 years. The participants are six females
and four males. Racially, they are black, Latino, or white, and between the ages of 19
and 53.
Major findings of this study are as follows. Participants perceived (a) a direct and
positive relationship between their CBNP and depression and/or anxiety; (b) pain to
precede depressive and/or anxiety symptoms; (c) a cyclical nature of the relationship; (d)
five underlying mechanisms that affect the relationship (disability, tension, vulnerability,
thought patterns, stress); (e) navigating institutions, conflicting treatment protocols,
identity changes, invalidation, isolation, and lethargy as unique experiences; (f) the
opportunity to talk about CBNP and depression and/or anxiety as beneficial; (g) themes
around coping strategies, the process of acceptance, future plans, and treatment
utilization; and (h) that the experience transcended all contexts and was all-
encompassing.
Discussion of the findings include relating findings to existing research,
implications for medical and mental health professionals, limitations and strengths, and
recommendations for future research. This researcher sought to give voice to this often
silenced population and aid in the development of effective strategies to improve the
quality of life for individuals with co-morbid CP and mental health distress.
THE LIVED EXPERIENCE OF INDIVIDUALS WITH CHRONIC BACK
AND NECK PAIN, DEPRESSION, AND/OR ANXIETY

by

Tara L. Palmeri

A dissertation submitted to the Graduate College
in partial fulfillment of the requirements
for the degree of Doctor of Philosophy
Counselor Education and Counseling Psychology
Western Michigan University
August 2015

Doctoral Committee:

Alan Hovestadt, Ed.D., Chair
Stephen Craig, Ph.D.
Glinda Rawls, Ph.D.
© 2015 Tara L. Palmeri
ACKNOWLEDGMENTS

The opportunity to solidify my professional development within the context of a
study that I am so passionate about is greatly appreciated. First and foremost, I am
indebted and grateful to the ten participants who co-created this project with me. The
words of those ten individuals composed the most meaningful segments of the following
manuscript. I dedicate this study to them and to all individuals who experience chronic
pain and associated mental health struggles. This is as much your dissertation as it is
mine.
The participants and I share credit with Dr. Alan Hovestadt. As my advisor and
chairperson of my doctoral committee, he provided me with the perfect balance of
freedom and support, which allowed me to grow and develop as a researcher. Because he
trusted me throughout this process, I trusted myself.
I would like to thank the members of my committee, Dr. Stephen Craig and Dr.
Glinda Rawls. These two brilliant people were instrumental in the design of this study.
Dr. Craig asked me the tough questions that eventually led to the rigor of my study. Dr.
Rawls asked the questions that clarified my research objectives.
I would like to thank my supportive friend, and soon-to-be-Dr. Jen Bauer. I met
Jen four years ago, at the start of the doctoral program. Since then, we have started every
program milestone together and emerged victorious together, each time. She has stayed
my colleague, ally, confidante, and voice of reason during a time in which I needed her
most.
ii
Acknowledgments—Continued

Perhaps the most acknowledgement should be given to my loving and patient
partner, Joshua Lantis, for he sacrificed the most over the last four years. He was willing
to be 14 hours away from his girlfriend for four years, and only had been dating her for
two months before she moved from Massachusetts to Michigan. He has spent countless
hours on planes, Skype, and the phone in order to support me through thick and thin. He
gave me perspective, hope, and comfort when I had none. Furthermore, his deep insights
about chronic pain and the associated physiology motivated me throughout this project.
Josh, I thank you for all you do for me every day.
Lastly, I would like to thank my parents, sister, and grandmother for their ever-
giving generosity and support. When I was a child, my mother took me to the library
every week, checked out the maximum number of books, and read each one to me
multiple times. This emphasis on education served as the foundation that made it
possible for me to achieve what I have today.

Tara L. Palmeri
iii
TABLE OF CONTENTS

ACKNOWLEDGMENTS ............................................................................................. ii

LIST OF TABLES ......................................................................................................... ix

CHAPTER

I. INTRODUCTION .............................................................................................. 1
Overview of the Study Topic ....................................................................... 1
Background and Key Research Findings ..................................................... 1
CP and Counseling Psychologists .......................................................... 3
CP and Depression and Anxiety ............................................................ 4
Focus of the Current Study .......................................................................... 6
Practical Problems ................................................................................. 6
The Researchable Problem .................................................................... 7
The Purpose of the Study ....................................................................... 7
Research Questions ................................................................................ 8
Significance of the Study ....................................................................... 9
Definition of Terms...................................................................................... 10
Summary of the Introduction ....................................................................... 12
II. LITERATURE REVIEW ................................................................................... 13
Conceptualization of CP and Mental Health: Directionality and
Causality ...................................................................................................... 14
Chronic Pain and Depression ....................................................................... 17
Chronic Pain and Anxiety ............................................................................ 20
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Table of Contents—Continued

CHAPTER

Chronic Pain and Depression and Anxiety .................................................. 22
Variables That Affect the Relationship Between CP and Depression
and Anxiety .................................................................................................. 24
Self-Efficacy .......................................................................................... 24
Anxiety Sensitivity and Health Anxiety ................................................ 27
Interpersonal Relationships and Social Support .................................... 29
Disability ................................................................................................ 32
Quality of Life........................................................................................ 33
Gender, Age, and Racial Differences in Pain .............................................. 34
Disability and Cultural Factors .............................................................. 39
Review of the Qualitative Research on Chronic Pain .................................. 41
Summary of the Literature Review .............................................................. 50
III. METHODOLOGY ............................................................................................. 53
Research Design........................................................................................... 53
The Phenomenological Approach .......................................................... 53
Sampling, Subjects, Access, and Setting ..................................................... 54
Data Collection Methods, Procedures, and Instrumentation ....................... 56
Data Analysis Processes and Procedures ..................................................... 58
Phase One............................................................................................... 59
Phase Two .............................................................................................. 60
Phase Three ............................................................................................ 60
The Researcher: An Epoche......................................................................... 61
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Table of Contents—Continued

CHAPTER

View of the Relationship Among CBNP, Depression, and Anxiety ..... 62
Trustworthiness ............................................................................................ 65
Additional Ethical Considerations ......................................................... 69
Assumptions ................................................................................................. 69
Summary of Methodology ........................................................................... 70
IV. FINDINGS .......................................................................................................... 71
Overview of Findings .................................................................................. 71
Summary of Participants .............................................................................. 71
The Connection Between CP and Mental Health: Research Question 1 ..... 76
Causation................................................................................................ 77
Five Underlying Mechanisms of the Relationship ................................. 78
The Power of the Connection Between Pain and Mental Health........... 81
The Unique Challenges of Chronic Pain and Depression and
Anxiety ................................................................................................... 82
Experiences of Being Interviewed: Research Question 2 ............................ 92
The Talking Cure ................................................................................... 93
Reflection and Insight ............................................................................ 94
Taking Action ........................................................................................ 95
Helping Others ....................................................................................... 95
Themes ......................................................................................................... 96
Coping Strategies ................................................................................... 96
The Process of Acceptance: “You Can’t Direct a Fish”
(Participant I) ......................................................................................... 100
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