A substantial amount of people with a rheumatic disease perceive invalidation consisting of lack of understanding and discounting (negative social responses). To get insight into the potential buffering role of self-efficacy and pain acceptance against invalidation, this cross-sectional study examined associations between these variables. Spanish speaking people (N = 1153, 91% female, mean age 45 ± 11 years) with one or multiple rheumatic diseases completed online the Illness Invalidation Inventory, the Chronic Pain Acceptance Questionnaire, and the Chronic Disease Self-Efficacy Scale. Higher self-efficacy (t = − 4.80, p = < 0.001) and pain acceptance (t = − 7.99, p = < 0.001) were additively associated with discounting. Higher self-efficacy (t = − 5.41, p = < 0.001) and pain acceptance (t = − 5.71, p = < 0.001) were also additively associated with lack of understanding. The combined occurrence of high self-efficacy and high acceptance was associated most clearly with lower lack of understanding (interaction: t = − 2.12, p = 0.034). The findings suggest the usefulness of examining whether interventions aimed at increasing self-efficacy and pain acceptance can help people with rheumatic diseases for whom invalidation is a considerable burden.

BackgroundA substantial number of people with a rheumatic disease perceive invalidation consisting of “lack of understanding” and “discounting” (negative social responses) [1]. Our study was guided by the notion that high self-efficacy will make people feel competent to deal with situations in which control of invalidation is possible and likely to be successful. In other situations, high acceptance will help people to actively and in full awareness experience even adverse situations such as invalidation without unnecessary attempts to change their frequency or form, which is considered a core aspect of acceptance.ObjectivesTo get insight into the potential buffering role of self-efficacy and pain acceptance against invalidation, we examined the association of self-efficacy and pain acceptance with invalidation in people with diverse rheumatic diseases.MethodsThe design was cross-sectional. Spanish speaking people (N=1153, 91% female, mean age 45±11 years) with one or multiple rheumatic diseases completed online versions of the Illness Invalidation Inventory [2], the Chronic Pain Acceptance Questionnaire, and the Chronic Disease Self-Efficacy Scale.ResultsBefore and after adjustment for age, gender, education, and fibromyalgia diagnosis, higher self-efficacy and higher pain acceptance were independently associated with discounting and lower lack of understanding (P<0.001, see Figure). The combined occurrence of high self-efficacy and high acceptance was associated most clearly with lower lack of understanding (interaction: P=0.03) and with discounting (interaction: P=0.07, not reaching statistical significance): see Figure.ConclusionsThe present study convincingly shows that self-efficacy and pain acceptance are associated with less invalidation. This suggests the usefulness of examining in prospective studies whether interventions aimed at increasing self-efficacy and pain acceptance can help people with rheumatic diseases for whom invalidation is a considerable burden. A cognitive-behavioral model including self-efficacy and acceptance to deal with invalidation is proposed.References Kool MB, van Middendorp H, Boeije HR, Geenen R. Understanding the lack of understanding: invalidation from the perspective of the patient with fibromyalgia. Arthritis Rheum-Arthritis Care Res 2009;61:1650–6.Kool MB, van Middendorp H, Lumley MA, Schenk Y, Jacobs JW, Bijlsma JW, Geenen R. Lack of understanding in fibromyalgia and rheumatoid arthritis: the Illness Invalidation Inventory (3*I). Ann Rheum Dis 2010;69:1990–5. Disclosure of InterestNone declared