University of Groningen
Living with chronic headache
Ciere, Yvette
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Ciere, Y. (2018). Living with chronic headache: A personal goal and self-regulation perspective. University of Groningen.
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Living with chronic headache
A personal goal and self-regulation perspective
_________________________________________________________________________
The research described in this thesis was funded by ‘Provincie Friesland’
and ‘Zorggroep Pasana’.
Cover layout: Pieter Oosthuizen
Printed by:
ProefschriftMaken || www.proefschriftmaken.nl
Copyright © 2017 Yvette Ciere.
No part of this dissertation may be reproduced or transmitted in any form or
by any means without prior permission of the author.
_____________________________________________________________
Living with chronic headache
A personal goal and self-regulation perspective
PhD thesis
to obtain the degree of PhD at the
University of Groningen
on the authority of the
Rector Magnificus Prof. E. Sterken
and in accordance with
the decision by the College of Deans.
This thesis will be defended in public on
Wednesday 17 January 2017 at 14:30 hours
by
Yvette Ciere
born on 21 May 1988
in Leiden, The Netherlands
_________________________________________________________________________
The research described in this thesis was funded by ‘Provincie Friesland’
and ‘Zorggroep Pasana’.
Cover layout: Pieter Oosthuizen
Printed by:
ProefschriftMaken || www.proefschriftmaken.nl
Copyright © 2017 Yvette Ciere.
No part of this dissertation may be reproduced or transmitted in any form or
by any means without prior permission of the author.
_____________________________________________________________
Living with chronic headache
A personal goal and self-regulation perspective
PhD thesis
to obtain the degree of PhD at the
University of Groningen
on the authority of the
Rector Magnificus Prof. E. Sterken
and in accordance with
the decision by the College of Deans.
This thesis will be defended in public on
Wednesday 17 January 2018 at 14:30 hours
by
Yvette Ciere
born on 21 May 1988
in Leiden, The Netherlands
Supervisor
Prof. R. Sanderman
Co-supervisors
Dr. A. Visser
Dr. J. Fleer
Assessment Committee
Prof. M.J. Sorbi
Prof. G. Crombez
Prof. M.F. Reneman
CONTENTSChapter 1 General introduction 7
Chapter 2 Positive affect buffers affective reactivity in chronic migraine – an experience sampling study
Yvette Ciere, Evelien Snippe, Mariëlle Padberg, Bram Jacobs, Annemieke Visser, Robbert Sanderman, Joke Fleer (Revision)
19
Chapter 3 Momentary pain intensity, negative affect, and energy predict daily activity interference in chronic migraine: a prospective smartphone-based diary study.
Yvette Ciere, Evelien Snippe, Mariëlle Padberg, Bram Jacobs, Annemieke Visser, Robbert Sanderman, Joke Fleer (Revision)
37
Chapter 4 Impaired Mood in Headache Clinic Patients: Associations with the Perceived Hindrance and Attainability of Personal Goals.
Yvette Ciere, Annemieke Visser, John Lebbink, Robbert Sanderman, Joke Fleer (Headache, 2016, 56 (6))
51
Chapter 5 Living with chronic headache – a qualitative study exploring goal management in chronic headache
Yvette Ciere, Annemieke Visser, Bram Jacobs; Marielle Padberg, John Lebbink, Robbert Sanderman, Joke Fleer (Disability & Rehabilitation, 2017, advance online publication)
69
Chapter 6 Distinct trajectories of positive and negative affect after colorectal cancer diagnosis
Yvette Ciere, Moniek Janse, Josue Almansa, Annemieke Visser, Robbert Sanderman, Mirjam Sprangers, Adelita Ranchor, Joke Fleer (Health Psychology, 2017, 36 (6))
87
Chapter 7 General discussion 103
Appendix Summary 121
Samenvatting 125
Dankwoord 129
Curriculum Vitae 131
Supervisor
Prof. R. Sanderman
Co-supervisors
Dr. A. Visser
Dr. J. Fleer
Assessment Committee
Prof. dr. M.J. Sorbi
Prof. dr. G. Crombez
Prof. dr. M.F. Reneman
CONTENTSChapter 1 General introduction 7
Chapter 2 Positive affect buffers affective reactivity in chronic migraine – an experience sampling study
Yvette Ciere, Evelien Snippe, Mariëlle Padberg, Bram Jacobs, Annemieke Visser, Robbert Sanderman, Joke Fleer (Revision)
19
Chapter 3 Momentary pain intensity, negative affect, and energy predict daily activity interference in chronic migraine: a prospective smartphone-based diary study.
Yvette Ciere, Evelien Snippe, Mariëlle Padberg, Bram Jacobs, Annemieke Visser, Robbert Sanderman, Joke Fleer (Revision)
37
Chapter 4 Impaired Mood in Headache Clinic Patients: Associations with the Perceived Hindrance and Attainability of Personal Goals.
Yvette Ciere, Annemieke Visser, John Lebbink, Robbert Sanderman, Joke Fleer (Headache, 2016, 56 (6))
51
Chapter 5 Living with chronic headache – a qualitative study exploring goal management in chronic headache
Yvette Ciere, Annemieke Visser, Bram Jacobs; Marielle Padberg, John Lebbink, Robbert Sanderman, Joke Fleer (Disability & Rehabilitation, 2017, advance online publication)
69
Chapter 6 Distinct trajectories of positive and negative affect after colorectal cancer diagnosis
Yvette Ciere, Moniek Janse, Josue Almansa, Annemieke Visser, Robbert Sanderman, Mirjam Sprangers, Adelita Ranchor, Joke Fleer (Health Psychology, 2017, 36 (6))
87
Chapter 7 General discussion 103
Appendix Summary 121
Samenvatting 125
Dankwoord 129
Curriculum Vitae 131
General introduction
Chapter
General introduction
Chapter
General introduction
______________________________________________________________________
Peter
Peter is 41 years old, married, and has two children. He used to work as a teacher, but in the last six months he has been on sick leave, due to his chronic migraines. Over the past ten years, he has tried all kinds of treatment, ranging from medications to alternative treatments. Yet, his headaches have only become more frequent and intense. Over this period with increasing headaches, Peter tried to continue work and family activities, as he did not want to miss out on opportunities or disappoint others. Until at one point, he collapsed. Peter could not function anymore and went into a severe depression. Everything could trigger a headache; he couldn’t even bear being around his children anymore. Peter used to be a social and bubbly person, but now he hardly recognized himself anymore.
Helen
Helen is 38 years old and, like Peter, suffers from chronic migraines. Her full-time job as a manager is very important to her; it allows her to develop herself and to meet other people. Because her energy is limited due to the chronic migraines, she decided to focus on her work. Sadly, this meant that she and her partner had to give up the wish of having a family. Although Helen enjoys going out with friends, rest and regularity are the rule. She knows that if she stays out late, she will spend the next day in bed. Sometimes Helen feels sad or frustrated for being limited by her migraines, but overall, she is happy with her life the way it is. She feels there are still a lot of things she can do despite her chronic migraines!
Living with a chronic somatic condition such as chronic migraine is a true balancing act. Juggling multiple roles, responsibilities and projects in the pursuit of a meaningful life is a challenge familiar to many. However, obtaining this balance is even more precarious for people who have physical limitations, need to adhere to a burdensome treatment regimen, or have an uncertain future perspective as a result of a chronic somatic condition. Many people, like Helen, adjust well to these challenges. Yet, successful adjustment is certainly not self-evident. Let’s consider Peter. He has great difficulty finding a balance between managing his health and striving for important goals such as maintaining a fulltime job and being a good father. Peter is not alone in this: it has been estimated that
approximately one third of people with a chronic somatic condition has adjustment problems, as indicated by impairments in quality of life, mood, or social functioning (Rijken & Spreeuwenberg, 2004; Taylor & Aspinwall, 1996).
A process that is assumed to play a key role in the adjustment to chronic somatic conditions is self-regulation (Carver & Scheier, 1982; Karoly, 1999; Maes & Karoly, 2005). Self-regulation involves moving toward or away from personal goals, under changing, threatening or uncertain circumstances (Karoly, 2010). Personal goals are the projects or plans that drive our everyday actions and give meaning to life (Austin &
General introduction _________________________________________________________________________ Vancouver, 1996; Little & Chambers, 2004). Research in various chronic somatic
conditions, including chronic pain, has shown that the pursuit of personal goals can be disturbed by physical limitations (Affleck et al., 2001; Janse, Ranchor, Smink, Sprangers, & Fleer, 2015; Karoly & Ruehlman, 1996). Research has further shown that the way in which people perceive and manage these disturbances, explains individual differences in adjustment (Arends, Bode, Taal, & Laar, 2016; Boersma, Maes, & van Elderen, 2005; Janse, Sprangers, Ranchor, & Fleer, 2015; Kraaij, Garnefski, Schroevers, Weijmer, & Helmerhorst, 2010).
While personal goal and self-regulation processes have received considerable interest in research in other chronic pain conditions (Crombez, Eccleston, Van Damme, Vlaeyen, & Karoly, 2012; Hamilton, Karoly, & Kitzman, 2004), their role in the adjustment to chronic headache is thus far unexplored. Chronic headache is different from other chronic pain conditions (e.g., low back pain) in the sense that it usually starts with episodic headache and evolves into a chronic pattern over time (Bigal & Lipton, 2008). Unlike in many other chronic pain conditions, this process is also reversible (Scher, Stewart, Ricci, & Lipton, 2003). Hence, treatment strategies are typically focused on the prevention of, or recovery from, chronic headache rather than on helping patients to adjust to living with the condition. Yet, the majority of patients with chronic headache does not remit within two years of onset and treatment response is low (May & Schulte, 2016). A substantial number of patients will therefore have to live with chronic headache for a prolonged period of time. Inadequate adjustment to chronic headache does not only impair well-being, but may also reduce motivation to comply with behavioural and medical treatment (Lipton, Silberstein, Saper, Bigal, & Goadsby, 2003; Rains, Lipchik, & Penzien, 2006). Insight into the factors explaining individual differences in the adaptation to chronic headache is therefore important and may reveal new opportunities to optimize current treatment strategies.
The aim of this thesis was to study the adjustment to chronic headache from a personal goal and self-regulation perspective (see Figure 1 for the guiding framework of this thesis). Mood will be studied as an indicator of adjustment as it is both relevant to self-regulation and to the context of chronic pain. To advance research on the role of self-regulatory processes in the adjustment to chronic illness in general, this thesis also includes a study on goal disturbance, goal-management and mood in cancer patients. Three related questions will be addressed throughout this thesis:
1. How do chronic headache symptoms influence mood, and vice versa? (Ch. 2)
2. How do chronic headache symptoms and mood affect the pursuit of daily activities (Ch. 3) and how is thegoal disturbance related to mood in chronic headache (Ch. 4)
and cancer (Ch. 6)?
3. How do patients with chronic headache manage goal disturbance (Ch. 5) and how does
General introduction
______________________________________________________________________
Peter
Peter is 41 years old, married, and has two children. He used to work as a teacher, but in the last six months he has been on sick leave, due to his chronic migraines. Over the past ten years, he has tried all kinds of treatment, ranging from medications to alternative treatments. Yet, his headaches have only become more frequent and intense. Over this period with increasing headaches, Peter tried to continue work and family activities, as he did not want to miss out on opportunities or disappoint others. Until at one point, he collapsed. Peter could not function anymore and went into a severe depression. Everything could trigger a headache; he couldn’t even bear being around his children anymore. Peter used to be a social and bubbly person, but now he hardly recognized himself anymore.
Helen
Helen is 38 years old and, like Peter, suffers from chronic migraines. Her full-time job as a manager is very important to her; it allows her to develop herself and to meet other people. Because her energy is limited due to the chronic migraines, she decided to focus on her work. Sadly, this meant that she and her partner had to give up the wish of having a family. Although Helen enjoys going out with friends, rest and regularity are the rule. She knows that if she stays out late, she will spend the next day in bed. Sometimes Helen feels sad or frustrated for being limited by her migraines, but overall, she is happy with her life the way it is. She feels there are still a lot of things she can do despite her chronic migraines!
Living with a chronic somatic condition such as chronic migraine is a true balancing act. Juggling multiple roles, responsibilities and projects in the pursuit of a meaningful life is a challenge familiar to many. However, obtaining this balance is even more precarious for people who have physical limitations, need to adhere to a burdensome treatment regimen, or have an uncertain future perspective as a result of a chronic somatic condition. Many people, like Helen, adjust well to these challenges. Yet, successful adjustment is certainly not self-evident. Let’s consider Peter. He has great difficulty finding a balance between managing his health and striving for important goals such as maintaining a fulltime job and being a good father. Peter is not alone in this: it has been estimated that
approximately one third of people with a chronic somatic condition has adjustment problems, as indicated by impairments in quality of life, mood, or social functioning (Rijken & Spreeuwenberg, 2004; Taylor & Aspinwall, 1996).
A process that is assumed to play a key role in the adjustment to chronic somatic conditions is self-regulation (Carver & Scheier, 1982; Karoly, 1999; Maes & Karoly, 2005). Self-regulation involves moving toward or away from personal goals, under changing, threatening or uncertain circumstances (Karoly, 2010). Personal goals are the projects or plans that drive our everyday actions and give meaning to life (Austin &
General introduction _________________________________________________________________________ Vancouver, 1996; Little & Chambers, 2004). Research in various chronic somatic
conditions, including chronic pain, has shown that the pursuit of personal goals can be disturbed by physical limitations (Affleck et al., 2001; Janse, Ranchor, Smink, Sprangers, & Fleer, 2015; Karoly & Ruehlman, 1996). Research has further shown that the way in which people perceive and manage these disturbances, explains individual differences in adjustment (Arends, Bode, Taal, & Laar, 2016; Boersma, Maes, & van Elderen, 2005; Janse, Sprangers, Ranchor, & Fleer, 2015; Kraaij, Garnefski, Schroevers, Weijmer, & Helmerhorst, 2010).
While personal goal and self-regulation processes have received considerable interest in research in other chronic pain conditions (Crombez, Eccleston, Van Damme, Vlaeyen, & Karoly, 2012; Hamilton, Karoly, & Kitzman, 2004), their role in the adjustment to chronic headache is thus far unexplored. Chronic headache is different from other chronic pain conditions (e.g., low back pain) in the sense that it usually starts with episodic headache and evolves into a chronic pattern over time (Bigal & Lipton, 2008). Unlike in many other chronic pain conditions, this process is also reversible (Scher, Stewart, Ricci, & Lipton, 2003). Hence, treatment strategies are typically focused on the prevention of, or recovery from, chronic headache rather than on helping patients to adjust to living with the condition. Yet, the majority of patients with chronic headache does not remit within two years of onset and treatment response is low (May & Schulte, 2016). A substantial number of patients will therefore have to live with chronic headache for a prolonged period of time. Inadequate adjustment to chronic headache does not only impair well-being, but may also reduce motivation to comply with behavioural and medical treatment (Lipton, Silberstein, Saper, Bigal, & Goadsby, 2003; Rains, Lipchik, & Penzien, 2006). Insight into the factors explaining individual differences in the adaptation to chronic headache is therefore important and may reveal new opportunities to optimize current treatment strategies.
The aim of this thesis was to study the adjustment to chronic headache from a personal goal and self-regulation perspective (see Figure 1 for the guiding framework of this thesis). Mood will be studied as an indicator of adjustment as it is both relevant to self-regulation and to the context of chronic pain. To advance research on the role of self-regulatory processes in the adjustment to chronic illness in general, this thesis also includes a study on goal disturbance, goal-management and mood in cancer patients. Three related questions will be addressed throughout this thesis:
1. How do chronic headache symptoms influence mood, and vice versa? (Ch. 2)
2. How do chronic headache symptoms and mood affect the pursuit of daily activities (Ch. 3) and how is the goal disturbance related to mood in chronic headache (Ch. 4)
and cancer (Ch. 6)?
3. How do patients with chronic headache manage goal disturbance (Ch. 5) and how does
General introduction
______________________________________________________________________
Figure 1 – Guiding framework of this thesis.
In this introductory chapter, I will first explain what chronic headache is (section 1.1.) and what is known about its impact on mood. Next, I will outline the potential role of goal disturbance and goal-management in explaining individual differences in mood in the context of chronic headache.
Chronic headache
About 3% of the population worldwide suffers from chronic headache (Stovner et al., 2007). Chronic headache is diagnosed when headache is present on at least 15 days per month, for a period of 3 months (Headache Classification Committee of the International Headache Society (IHS, 2013). The two most common types of chronic headache are chronic tension-type headache (CTTH) and chronic migraine (CM). CTTH is characterized by episodes of two-sided, pressing, or tightening headache of mild to moderate intensity. Attacks last between hours and days, or pain may be constantly present (Headache
Classification Committee of the International Headache Society (IHS, 2013). In the case of CM, headache has features of migraine on at least 8 days per month. Migraine attacks last between 4-72 hours and are characterized by a one-sided, pulsating headache of moderate to severe intensity. Pain is aggravated by physical activity and is accompanied by nausea and oversensitivity to light or sound. In the case of migraine with aura, attacks are preceded by neurological symptoms such as altered vision, speech difficulties or numbness
(Headache Classification Committee of the International Headache Society (IHS, 2013). Chronic headache has a large impact on daily functioning. In addition to pain, chronic headache patients have been found to suffer from problems such as reduced energy, cognitive difficulties (e.g., concentration problems), and impaired sleep (Raggi et al., 2012). The negative impact of chronic headache on work, school and household
General introduction _________________________________________________________________________ productivity is well-documented (Lanteri-Minet, Duru, Mudge, & Cottrell, 2011; Stovner et al., 2007). A study in CM found that 34% of patients reported significantly reduced
productivity in work or school on at least 5 days over a three-month period. During this period, 23% missed at least one day of work or school (Bigal, Serrano, Reed, & Lipton, 2008). Although CTTH has a less direct impact on productivity, as patients can often continue activities in the presence of pain, patients nevertheless experience substantial impairment in daily functioning (Holroyd et al., 2000). For instance, Holroyd et al. (2000) found that 62% of patients reported impairments in physical, role or social functioning as compared to 9% of healthy controls.
Chronic headache and mood
Mood is a commonly studied indicator of the adjustment to a chronic somatic condition (Stanton, Revenson, & Tennen, 2007). Mood consists of positive affect (e.g., joy, pleasure) as well as negative affect (e.g., frustration, sadness), which are seen as relatively
independent dimensions (Watson, Clark, & Tellegen, 1988). Persistent and impairing disturbances on these dimensions are classified as mood disorders according to the Diagnostic and Statistical Manual of Mood disorders (American Psychiatric Association, 2013). There is high co-morbidity between mood disorders (in particular anxiety or depression) and chronic headache (Figure 1, arrow from CH to mood, and from mood to CH) (Buse, Silberstein, Manack, Papapetropoulos, & Lipton, 2013). In CM, the prevalence of anxiety and depression ranges between 13 and 47%, depending on the assessment method used (Buse et al., 2013). In CTTH, depression occurs in 10-59% of patients and anxiety in 23-56% (Holroyd et al., 2000; Juang, Wang, Fuh, Lu, & Su, 2000; Mongini, Ciccone, Deregibus, Ferrero, & Mongini, 2004; Puca et al., 1999). The link between chronic headache and mood disorders is most likely bidirectional. That is, mood disorders have been found to be a risk factor for the onset and progression of headache, and vice versa (Radat & Swendsen, 2005).
Although the prevalence of mood disorders among patients with chronic headache is high, there is limited insight into how changes in headache symptoms influence changes in mood symptoms over time. There are however studies that have examined the longitudinal associations between pain and depressive symptoms in patients with other chronic pain conditions (Husted, Tom, Farewell, & Gladman, 2012; Kroenke et al., 2011; Lewandowski Holley et al., 2013). These studies have found evidence for a reciprocal connection between pain and depressive symptoms, with one study showing a stronger relationship for the impact of pain on depressive symptoms than vice versa (Lewandowski Holley et al., 2013). Insight into the causal order of the relationship between chronic headache symptoms and mood symptoms in daily life may help to understand how improvement in either of these symptoms may have an impact on the other. Furthermore, insight into factors that moderate the relationship between pain and mood in the context may reveal targets for interventions aiming to improve functioning in chronic headache patients. Therefore, Chapter 2
General introduction
______________________________________________________________________
Figure 1 – Guiding framework of this thesis.
In this introductory chapter, I will first explain what chronic headache is (section 1.1.) and what is known about its impact on mood. Next, I will outline the potential role of goal disturbance and goal-management in explaining individual differences in mood in the context of chronic headache.
Chronic headache
About 3% of the population worldwide suffers from chronic headache (Stovner et al., 2007). Chronic headache is diagnosed when headache is present on at least 15 days per month, for a period of 3 months (Headache Classification Committee of the International Headache Society (IHS, 2013). The two most common types of chronic headache are chronic tension-type headache (CTTH) and chronic migraine (CM). CTTH is characterized by episodes of two-sided, pressing, or tightening headache of mild to moderate intensity. Attacks last between hours and days, or pain may be constantly present (Headache
Classification Committee of the International Headache Society (IHS, 2013). In the case of CM, headache has features of migraine on at least 8 days per month. Migraine attacks last between 4-72 hours and are characterized by a one-sided, pulsating headache of moderate to severe intensity. Pain is aggravated by physical activity and is accompanied by nausea and oversensitivity to light or sound. In the case of migraine with aura, attacks are preceded by neurological symptoms such as altered vision, speech difficulties or numbness
(Headache Classification Committee of the International Headache Society (IHS, 2013). Chronic headache has a large impact on daily functioning. In addition to pain, chronic headache patients have been found to suffer from problems such as reduced energy, cognitive difficulties (e.g., concentration problems), and impaired sleep (Raggi et al., 2012). The negative impact of chronic headache on work, school and household
General introduction _________________________________________________________________________ productivity is well-documented (Lanteri-Minet, Duru, Mudge, & Cottrell, 2011; Stovner et al., 2007). A study in CM found that 34% of patients reported significantly reduced
productivity in work or school on at least 5 days over a three-month period. During this period, 23% missed at least one day of work or school (Bigal, Serrano, Reed, & Lipton, 2008). Although CTTH has a less direct impact on productivity, as patients can often continue activities in the presence of pain, patients nevertheless experience substantial impairment in daily functioning (Holroyd et al., 2000). For instance, Holroyd et al. (2000) found that 62% of patients reported impairments in physical, role or social functioning as compared to 9% of healthy controls.
Chronic headache and mood
Mood is a commonly studied indicator of the adjustment to a chronic somatic condition (Stanton, Revenson, & Tennen, 2007). Mood consists of positive affect (e.g., joy, pleasure) as well as negative affect (e.g., frustration, sadness), which are seen as relatively
independent dimensions (Watson, Clark, & Tellegen, 1988). Persistent and impairing disturbances on these dimensions are classified as mood disorders according to the Diagnostic and Statistical Manual of Mood disorders (American Psychiatric Association, 2013). There is high co-morbidity between mood disorders (in particular anxiety or depression) and chronic headache (Figure 1, arrow from CH to mood, and from mood to CH) (Buse, Silberstein, Manack, Papapetropoulos, & Lipton, 2013). In CM, the prevalence of anxiety and depression ranges between 13 and 47%, depending on the assessment method used (Buse et al., 2013). In CTTH, depression occurs in 10-59% of patients and anxiety in 23-56% (Holroyd et al., 2000; Juang, Wang, Fuh, Lu, & Su, 2000; Mongini, Ciccone, Deregibus, Ferrero, & Mongini, 2004; Puca et al., 1999). The link between chronic headache and mood disorders is most likely bidirectional. That is, mood disorders have been found to be a risk factor for the onset and progression of headache, and vice versa (Radat & Swendsen, 2005).
Although the prevalence of mood disorders among patients with chronic headache is high, there is limited insight into how changes in headache symptoms influence changes in mood symptoms over time. There are however studies that have examined the longitudinal associations between pain and depressive symptoms in patients with other chronic pain conditions (Husted, Tom, Farewell, & Gladman, 2012; Kroenke et al., 2011; Lewandowski Holley et al., 2013). These studies have found evidence for a reciprocal connection between pain and depressive symptoms, with one study showing a stronger relationship for the impact of pain on depressive symptoms than vice versa (Lewandowski Holley et al., 2013). Insight into the causal order of the relationship between chronic headache symptoms and mood symptoms in daily life may help to understand how improvement in either of these symptoms may have an impact on the other. Furthermore, insight into factors that moderate the relationship between pain and mood in the context may reveal targets for interventions aiming to improve functioning in chronic headache patients. Therefore, Chapter 2
General introduction
______________________________________________________________________ examined the moment-to-moment associations between pain intensity and negative affect in chronic migraine, as well as the potentially buffering role of positive affect and mindfulness in this association.
Goal disturbance and mood in the context of chronic headache
Although headache symptoms may directly impact on mood (see previous section), they may also influence mood by disturbing the pursuit of personal goals (Figure 1, arrow from CH to goal disturbance and from goal disturbance to mood). According to Control Theory, goals pursuit is disturbed when there is a perceived discrepancy between someone’s current and desired state (i.e., goal) (Carver & Scheier, 1982; Carver & Scheier, 2001). Control theory further suggests that the appraisal of one’s rate of progress towards personal goals has strong implications for mood. That is, (appraisal of) less than anticipated progress towards a goal is expected to elicit negative affect (e.g., frustration). On the other hand, (appraisal of) more than anticipated progress towards a goal is expected to elicit positive affect (e.g., pride, joy) (Carver & Scheier, 2001). In the context of chronic pain, progress towards goals may however be hindered by the interference of pain with daily activities, a lack of time or energy, or conflict between multiple goals (e.g., go exercising and avoid pain). This may put individuals with a chronic pain condition such as chronic headache at risk of elevated negative affect and reduced positive affect.
Research in various pain conditions has indeed shown that chronic pain can disturb goal pursuit and that these disturbances have implications for mood (Affleck et al., 1998; Affleck et al., 2001; Crombez, Lauwerier, Goubert, & Van Damme, 2016; Hardy, Crofford, & Segerstrom, 2011; Karoly & Ruehlman, 1996). For instance, in women with
fibromyalgia, Affleck et al. (1998) found that on days with greater increases in pain and fatigue, progress towards health and social goals was appraised as more hindered by pain and fatigue. Similarly, a study in working adults with chronic pain showed that individuals had less positive expectations regarding work and lifestyle goals when morning pain intensity was higher than usual (Karoly, Okun, Enders, & Tennen, 2014). It should be noted that the relationship between goal pursuit and mood may be reciprocal in the sense that emotions may also influence the appraisal and process of goal pursuit (Hamilton et al., 2004). For example, a prospective diary study in women with fibromyalgia found that higher morning emotional distress preceded the overestimation of goal conflict as well as the selection of less demanding goals during the day (Hardy et al., 2011). These findings underscore the complexity of goal pursuit in the context of chronic pain, in particular when pain is accompanied by high negative affect.
In the context of headache, goal disturbance and its consequences for mood have thus far only been examined in adolescents with episodic headache (Massey, Garnefski, Gebhardt, & van der Leeden, 2011; Massey, Garnefski, & Gebhardt, 2009). Massey et al. (2009) found that adolescents with weekly headache perceived themselves less successful
General introduction _________________________________________________________________________ in attaining goals than those with monthly or no headache. In a prospective diary study, they further demonstrated that adolescents reported greater goal disturbance on days when a headache was present and that days with higher goal disturbance were characterized by higher negative affect and lower positive affect (Massey, Garnefski, Gebhardt, & Van Der Leeden, 2009; Massey et al., 2011). These findings demonstrate the possible negative impact of headache on goal pursuit and its consequences for mood. However, they still await replication in adults with chronic headache. In Chapter 3, we therefore examined how pain intensity, low energy, and negative affect, independently and additively
contribute to the perceived interference of daily activities in patients with chronic migraine. As such daily interference may culminate in the disturbance of more abstract personal goals, Chapter 4 explored the associations between headache severity, goal disturbance, and mood in a cross-sectional study among patients presenting to a specialized headache clinic.
Finally, most research on the relationship between goal disturbance and mood in the context of chronic illness to date has been cross-sectional. Furthermore, most studies have not distinguished between positive and negative aspects of mood, and their (potentially) differential relationship with goal disturbance. Insight into the impact of disturbed goal pursuit on mood across the illness trajectory is therefore limited. To fill this gap, Chapter 6 examined the association between goal disturbance and positive and negative affect in the 18 months following diagnosis of colorectal cancer.
Goal-management and mood in the context of chronic headache
The extent to which people experience goal disturbance, and the extent to which this impacts on mood, may depend on the way in which people manage their personal goals. According to Life-span theories of development (Baltes, Baltes, & Baltes, 1990; Brandtstädter, 1989; Heckhausen & Schulz, 1993), people use pro-active strategies to be able to continue to pursue meaningful goals in the face of changing and sometimes limiting circumstances (e.g., illness). Of these theories, the Dual-process model (DPM)
(Brandtstädter & Renner, 1990) has been most often applied to the context of chronic pain. The DPM distinguishes two modes of coping with disturbed goal pursuit: an assimilative mode and an accommodative mode. Assimilation involves attempts to hold on to goals by engaging in efforts to remove goal-related barriers. For example, Peter uses pain killers to keep his headaches from interfering with the goal to be a good teacher. In contrast, accommodation involves the adjustment of goals to the current situation, by disengaging from unattainable goals and re-engaging more attainable goals (Brandtstädter &
Rothermund, 2002; Wrosch, Scheier, Miller, Schulz, & Carver, 2003). Helen, for instance, let go of the goal of having a family and focused on her career instead.
Although assimilation is typically the preferred way of coping with disturbed goal pursuit, people may need to switch to accommodation when opportunities to control the situation are low (Brandtstadter, Wentura, & Greve, 1993). As people with a chronic
General introduction
______________________________________________________________________ examined the moment-to-moment associations between pain intensity and negative affect in chronic migraine, as well as the potentially buffering role of positive affect and mindfulness in this association.
Goal disturbance and mood in the context of chronic headache
Although headache symptoms may directly impact on mood (see previous section), they may also influence mood by disturbing the pursuit of personal goals (Figure 1, arrow from CH to goal disturbance and from goal disturbance to mood). According to Control Theory, goals pursuit is disturbed when there is a perceived discrepancy between someone’s current and desired state (i.e., goal) (Carver & Scheier, 1982; Carver & Scheier, 2001). Control theory further suggests that the appraisal of one’s rate of progress towards personal goals has strong implications for mood. That is, (appraisal of) less than anticipated progress towards a goal is expected to elicit negative affect (e.g., frustration). On the other hand, (appraisal of) more than anticipated progress towards a goal is expected to elicit positive affect (e.g., pride, joy) (Carver & Scheier, 2001). In the context of chronic pain, progress towards goals may however be hindered by the interference of pain with daily activities, a lack of time or energy, or conflict between multiple goals (e.g., go exercising and avoid pain). This may put individuals with a chronic pain condition such as chronic headache at risk of elevated negative affect and reduced positive affect.
Research in various pain conditions has indeed shown that chronic pain can disturb goal pursuit and that these disturbances have implications for mood (Affleck et al., 1998; Affleck et al., 2001; Crombez, Lauwerier, Goubert, & Van Damme, 2016; Hardy, Crofford, & Segerstrom, 2011; Karoly & Ruehlman, 1996). For instance, in women with
fibromyalgia, Affleck et al. (1998) found that on days with greater increases in pain and fatigue, progress towards health and social goals was appraised as more hindered by pain and fatigue. Similarly, a study in working adults with chronic pain showed that individuals had less positive expectations regarding work and lifestyle goals when morning pain intensity was higher than usual (Karoly, Okun, Enders, & Tennen, 2014). It should be noted that the relationship between goal pursuit and mood may be reciprocal in the sense that emotions may also influence the appraisal and process of goal pursuit (Hamilton et al., 2004). For example, a prospective diary study in women with fibromyalgia found that higher morning emotional distress preceded the overestimation of goal conflict as well as the selection of less demanding goals during the day (Hardy et al., 2011). These findings underscore the complexity of goal pursuit in the context of chronic pain, in particular when pain is accompanied by high negative affect.
In the context of headache, goal disturbance and its consequences for mood have thus far only been examined in adolescents with episodic headache (Massey, Garnefski, Gebhardt, & van der Leeden, 2011; Massey, Garnefski, & Gebhardt, 2009). Massey et al. (2009) found that adolescents with weekly headache perceived themselves less successful
General introduction _________________________________________________________________________ in attaining goals than those with monthly or no headache. In a prospective diary study, they further demonstrated that adolescents reported greater goal disturbance on days when a headache was present and that days with higher goal disturbance were characterized by higher negative affect and lower positive affect (Massey, Garnefski, Gebhardt, & Van Der Leeden, 2009; Massey et al., 2011). These findings demonstrate the possible negative impact of headache on goal pursuit and its consequences for mood. However, they still await replication in adults with chronic headache. In Chapter 3, we therefore examined how pain intensity, low energy, and negative affect, independently and additively
contribute to the perceived interference of daily activities in patients with chronic migraine. As such daily interference may culminate in the disturbance of more abstract personal goals, Chapter 4 explored the associations between headache severity, goal disturbance, and mood in a cross-sectional study among patients presenting to a specialized headache clinic.
Finally, most research on the relationship between goal disturbance and mood in the context of chronic illness to date has been cross-sectional. Furthermore, most studies have not distinguished between positive and negative aspects of mood, and their (potentially) differential relationship with goal disturbance. Insight into the impact of disturbed goal pursuit on mood across the illness trajectory is therefore limited. To fill this gap, Chapter 6 examined the association between goal disturbance and positive and negative affect in the 18 months following diagnosis of colorectal cancer.
Goal-management and mood in the context of chronic headache
The extent to which people experience goal disturbance, and the extent to which this impacts on mood, may depend on the way in which people manage their personal goals. According to Life-span theories of development (Baltes, Baltes, & Baltes, 1990; Brandtstädter, 1989; Heckhausen & Schulz, 1993), people use pro-active strategies to be able to continue to pursue meaningful goals in the face of changing and sometimes limiting circumstances (e.g., illness). Of these theories, the Dual-process model (DPM)
(Brandtstädter & Renner, 1990) has been most often applied to the context of chronic pain. The DPM distinguishes two modes of coping with disturbed goal pursuit: an assimilative mode and an accommodative mode. Assimilation involves attempts to hold on to goals by engaging in efforts to remove goal-related barriers. For example, Peter uses pain killers to keep his headaches from interfering with the goal to be a good teacher. In contrast, accommodation involves the adjustment of goals to the current situation, by disengaging from unattainable goals and re-engaging more attainable goals (Brandtstädter &
Rothermund, 2002; Wrosch, Scheier, Miller, Schulz, & Carver, 2003). Helen, for instance, let go of the goal of having a family and focused on her career instead.
Although assimilation is typically the preferred way of coping with disturbed goal pursuit, people may need to switch to accommodation when opportunities to control the situation are low (Brandtstadter, Wentura, & Greve, 1993). As people with a chronic
General introduction
______________________________________________________________________ somatic condition are typically confronted with uncontrollable obstacles to goal pursuit (e.g., symptoms, lack of energy), it has been argued that accommodative coping is a critical aspect of self-regulation in the context of illness (Wrosch, Scheier, Carver, & Schulz, 2003). That is, the disengagement from unattainable goals may protect against the repeated confrontation with limitations and resulting distress, while the re-engagement in alternative goals may allow someone to stay engaged in rewarding and pleasurable activities (Wrosch et al., 2003). Accordingly, findings of studies in a range of chronic conditions, including chronic pain, have shown that the tendency to use accommodative strategies is associated with better adjustment to chronic illness (Arends, Bode, Taal, & Van de Laar, 2013; Goossens et al., 2010; Hullmann, Robb, & Rand, 2015; Schmitz, Saile, & Nilges, 1996; Wrosch, Scheier, & Miller, 2013).
Despite increasing evidence for the role of goal-management in the adjustment to chronic somatic conditions, at least two questions remain unanswered and will be addressed in this thesis. First, as previous research has not focused on headache it is still unclear how people manage goal disturbance in the specific context of chronic headache, i.e., which strategies they use and how they experience the process of goal-management. Such knowledge may however give direction to future research on goal-management in chronic headache, as well as inform clinical practice. In Chapter 5, we therefore used a qualitative
method to explore goal-management in chronic headache. Second, although theory suggests that goal disengagement and goal re-engagement have a different influence on positive and negative affective dimensions of mood, previous studies have typically focused on only one of these dimensions. Empirical support for the different functions of goal disengagement and re-engagement may however reveal whether different processes need to be intervened upon when aiming to enhance positive affect, or alleviate negative affect. Chapter 6 therefore investigated the association between goal disengagement, goal re-engagement and trajectories of positive and negative affect after diagnosis of colorectal cancer.
General introduction _________________________________________________________________________
References
Affleck, G., Tennen, H., Urrows, S., Higgins, P., Abeles, M., Hall, C., . . . Newton, C. (1998). Fibromyalgia and women's pursuit of personal goals: A daily process analysis. Health Psychology, 17(1), 40-47.
Affleck, G., Tennen, H., Zautra, A. J., Urrows, S., Abeles, M., & Karoly, P. (2001). Women's pursuit of personal goals in daily life with fibromyalgia: A value-expectancy analysis. Journal of Consulting and Clinical
Psychology, 69(4), 587-596.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) American Psychiatric Pub.
Arends, R. Y., Bode, C., Taal, E., & Laar, M. A. (2016). The longitudinal relation between patterns of goal management and psychological health in people with arthritis: The need for adaptive flexibility. British
Journal of Health Psychology, 21(2), 469-489.
Arends, R. Y., Bode, C., Taal, E., & Van de Laar, M. A. F. J. (2013). The role of goal management for successful adaptation to arthritis. Patient Education and Counseling, 93(1), 130-138.
Austin, J. T., & Vancouver, J. B. (1996). Goal constructs in psychology: Structure, process, and content.
Psychological Bulletin, 120(3), 338-375.
Baltes, P. B., Baltes, M. M., & Baltes, P. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. Successful Aging: Perspectives from the Behavioral Sciences, 1(1), 1-34.
Bigal, M. E., & Lipton, R. B. (2008). Clinical course in migraine: Conceptualizing migraine transformation.
Neurology, 71(11), 848-855.
Bigal, M. E., Serrano, D., Reed, M., & Lipton, R. B. (2008). Chronic migraine in the population - burden, diagnosis, and satisfaction with treatment. Neurology, 71(8), 559-566.
Boersma, S., Maes, S., & van Elderen, T. (2005). Goal disturbance predicts health-related quality of life and depression 4 months after myocardial infarction. British Journal of Health Psychology, 10, 615-630. Brandtstädter, J. (1989). Personal self-regulation of development: Cross-sequential analyses of
development-related control beliefs and emotions. Developmental Psychology, 25(1), 96-108.
Brandtstädter, J., & Renner, G. (1990). Tenacious goal pursuit and flexible goal adjustment: Explication and age-related analysis of assimilative and accommodative strategies of coping. Psychology and Aging, 5(1), 58-67. Brandtstädter, J., & Rothermund, K. (2002). The life-course dynamics of goal pursuit and goal adjustment: A
two-process framework. Developmental Review, 22(1), 117-150.
Brandtstadter, J., Wentura, D., & Greve, W. (1993). Adaptive resources of the aging self: Outlines of an emergent perspective. International Journal of Behavioral Development, 16(2), 323-349.
Buse, D. C., Silberstein, S. D., Manack, A. N., Papapetropoulos, S., & Lipton, R. B. (2013). Psychiatric comorbidities of episodic and chronic migraine. Journal of Neurology, 260(8), 1960-1969.
Carver, C. S., & Scheier, M. F. (1982). Control theory: A useful conceptual framework for personality–social, clinical, and health psychology. Psychological Bulletin, 92(1), 111-135.
Carver, C. S., & Scheier, M. F. (2001). On the self-regulation of behavior. New York: Cambridge University Press.
Crombez, G., Lauwerier, E., Goubert, L., & Van Damme, S. (2016). Goal pursuit in individuals with chronic pain: A personal project analysis. Frontiers in Psychology, 7, 966.
Crombez, G., Eccleston, C., Van Damme, S., Vlaeyen, J. W. S., & Karoly, P. (2012). Fear-avoidance model of chronic pain the next generation. Clinical Journal of Pain, 28(6), 475-483.
Goossens, M. E., Kindermans, H. P., Morley, S. J., Roelofs, J., Verbunt, J., & Vlaeyen, J. W. (2010). Self-discrepancies in work-related upper extremity pain: Relation to emotions and flexible-goal adjustment.
European Journal of Pain, 14(7), 764-770.
Hamilton, N., Karoly, P., & Kitzman, H. (2004). Self-regulation and chronic pain: The role of emotion. Cognitive
General introduction
______________________________________________________________________ somatic condition are typically confronted with uncontrollable obstacles to goal pursuit (e.g., symptoms, lack of energy), it has been argued that accommodative coping is a critical aspect of self-regulation in the context of illness (Wrosch, Scheier, Carver, & Schulz, 2003). That is, the disengagement from unattainable goals may protect against the repeated confrontation with limitations and resulting distress, while the re-engagement in alternative goals may allow someone to stay engaged in rewarding and pleasurable activities (Wrosch et al., 2003). Accordingly, findings of studies in a range of chronic conditions, including chronic pain, have shown that the tendency to use accommodative strategies is associated with better adjustment to chronic illness (Arends, Bode, Taal, & Van de Laar, 2013; Goossens et al., 2010; Hullmann, Robb, & Rand, 2015; Schmitz, Saile, & Nilges, 1996; Wrosch, Scheier, & Miller, 2013).
Despite increasing evidence for the role of goal-management in the adjustment to chronic somatic conditions, at least two questions remain unanswered and will be addressed in this thesis. First, as previous research has not focused on headache it is still unclear how people manage goal disturbance in the specific context of chronic headache, i.e., which strategies they use and how they experience the process of goal-management. Such knowledge may however give direction to future research on goal-management in chronic headache, as well as inform clinical practice. In Chapter 5, we therefore used a qualitative
method to explore goal-management in chronic headache. Second, although theory suggests that goal disengagement and goal re-engagement have a different influence on positive and negative affective dimensions of mood, previous studies have typically focused on only one of these dimensions. Empirical support for the different functions of goal disengagement and re-engagement may however reveal whether different processes need to be intervened upon when aiming to enhance positive affect, or alleviate negative affect. Chapter 6 therefore investigated the association between goal disengagement, goal re-engagement and trajectories of positive and negative affect after diagnosis of colorectal cancer.
General introduction _________________________________________________________________________
References
Affleck, G., Tennen, H., Urrows, S., Higgins, P., Abeles, M., Hall, C., . . . Newton, C. (1998). Fibromyalgia and women's pursuit of personal goals: A daily process analysis. Health Psychology, 17(1), 40-47.
Affleck, G., Tennen, H., Zautra, A. J., Urrows, S., Abeles, M., & Karoly, P. (2001). Women's pursuit of personal goals in daily life with fibromyalgia: A value-expectancy analysis. Journal of Consulting and Clinical
Psychology, 69(4), 587-596.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) American Psychiatric Pub.
Arends, R. Y., Bode, C., Taal, E., & Laar, M. A. (2016). The longitudinal relation between patterns of goal management and psychological health in people with arthritis: The need for adaptive flexibility. British
Journal of Health Psychology, 21(2), 469-489.
Arends, R. Y., Bode, C., Taal, E., & Van de Laar, M. A. F. J. (2013). The role of goal management for successful adaptation to arthritis. Patient Education and Counseling, 93(1), 130-138.
Austin, J. T., & Vancouver, J. B. (1996). Goal constructs in psychology: Structure, process, and content.
Psychological Bulletin, 120(3), 338-375.
Baltes, P. B., Baltes, M. M., & Baltes, P. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. Successful Aging: Perspectives from the Behavioral Sciences, 1(1), 1-34.
Bigal, M. E., & Lipton, R. B. (2008). Clinical course in migraine: Conceptualizing migraine transformation.
Neurology, 71(11), 848-855.
Bigal, M. E., Serrano, D., Reed, M., & Lipton, R. B. (2008). Chronic migraine in the population - burden, diagnosis, and satisfaction with treatment. Neurology, 71(8), 559-566.
Boersma, S., Maes, S., & van Elderen, T. (2005). Goal disturbance predicts health-related quality of life and depression 4 months after myocardial infarction. British Journal of Health Psychology, 10, 615-630. Brandtstädter, J. (1989). Personal self-regulation of development: Cross-sequential analyses of
development-related control beliefs and emotions. Developmental Psychology, 25(1), 96-108.
Brandtstädter, J., & Renner, G. (1990). Tenacious goal pursuit and flexible goal adjustment: Explication and age-related analysis of assimilative and accommodative strategies of coping. Psychology and Aging, 5(1), 58-67. Brandtstädter, J., & Rothermund, K. (2002). The life-course dynamics of goal pursuit and goal adjustment: A
two-process framework. Developmental Review, 22(1), 117-150.
Brandtstadter, J., Wentura, D., & Greve, W. (1993). Adaptive resources of the aging self: Outlines of an emergent perspective. International Journal of Behavioral Development, 16(2), 323-349.
Buse, D. C., Silberstein, S. D., Manack, A. N., Papapetropoulos, S., & Lipton, R. B. (2013). Psychiatric comorbidities of episodic and chronic migraine. Journal of Neurology, 260(8), 1960-1969.
Carver, C. S., & Scheier, M. F. (1982). Control theory: A useful conceptual framework for personality–social, clinical, and health psychology. Psychological Bulletin, 92(1), 111-135.
Carver, C. S., & Scheier, M. F. (2001). On the self-regulation of behavior. New York: Cambridge University Press.
Crombez, G., Lauwerier, E., Goubert, L., & Van Damme, S. (2016). Goal pursuit in individuals with chronic pain: A personal project analysis. Frontiers in Psychology, 7, 966.
Crombez, G., Eccleston, C., Van Damme, S., Vlaeyen, J. W. S., & Karoly, P. (2012). Fear-avoidance model of chronic pain the next generation. Clinical Journal of Pain, 28(6), 475-483.
Goossens, M. E., Kindermans, H. P., Morley, S. J., Roelofs, J., Verbunt, J., & Vlaeyen, J. W. (2010). Self-discrepancies in work-related upper extremity pain: Relation to emotions and flexible-goal adjustment.
European Journal of Pain, 14(7), 764-770.
Hamilton, N., Karoly, P., & Kitzman, H. (2004). Self-regulation and chronic pain: The role of emotion. Cognitive
General introduction
______________________________________________________________________
Hardy, J. K., Crofford, L. J., & Segerstrom, S. C. (2011). Goal conflict, distress, and pain in women with fibromyalgia: A daily diary study. Journal of Psychosomatic Research, 70(6), 534-540.
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