Goal Preferences, Affect, Activity Patterns and Health Outcomes in Women With Fibromyalgia

Abstract

Some motivational models understand health behavior as a result of the interaction between goal preferences and mood. However, this perspective has not been explored in fibromyalgia. Furthermore, in chronic pain, it has only been explored with regard to negative affect. Thus, our aims were: (1) to develop a Spanish version of the Goal Pursuit Questionnaire (GPQ); (2) to explore the relationships between goal preferences and health outcomes, testing the moderator role of affect and the mediating role of chronic pain activity patterns. We conducted two cross-sectional studies. In Study 1, after a double translation/back-translation process, we interviewed 94 women attending the Fibromyalgia Unit of the Community of Valencia in order to identify the cultural feasibility and the content validity of the GPQ. Study 2 comprised 260 women. We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Eight activities from the original GPQ were changed while maintaining the conceptual equivalence. Exploratory factor analysis showed two factors: 'Painavoidance goal' and 'Mood-management goal' (37 and 13% of explained variance, respectively). These factors refer to patients' preference for hedonic goals (pain avoidance or mood-management) over achievement goals. Robust RMSEA fit index of the final models ranged from 0.039 for pain to 0.000 for disability and fibromyalgia impact. Pain avoidance goals and negative affect influenced pain mediated by taskcontingent persistence. They also affected disability mediated by task and excessive persistence. Pain avoidance goals and positive affect influenced fibromyalgia impact mediated by activity avoidance. We also found a direct effect of negative and positive affect on health outcomes. Preference for pain avoidance goals was always related to pain, disability and fibromyalgia impact through activity patterns. Affect did not moderate these relationships and showed direct and indirect paths on health outcomes, mainly by increasing persistence and showing positive affect as an asset and not a risk factor. Intervention targets should include flexible reinforcement of achievement goals relative to pain avoidance goals and positive affect in order to promote task-persistence adaptive activity patterns and decreased activity avoidance.

Self-Regulatory Processes, Motivation to Conserve Resources and Activity Levels in People With Chronic Pain: A Series of Digital N-of-1 Observational Studies

“…The findings of this study are generally supportive of motivational accounts of activity patterns in people with chronic pain (Van Damme, 2014; Van Damme and Kindermans, 2015;Karoly, 2018) and previous research demonstrating that the context of a goal pursuit episode is associated with activity patterns (Karsdorp et al, 2010;Karsdorp and Vlaeyen, 2011;Schrooten et Van Damme et al, 2012;Pastor-Mira et al, 2019). The most consistent determinants of motivation to conserve resources and sedentary time in this study were goal striving and perceived demands.…”

Activity Patterns and Functioning. A Contextual–Functional Approach to Pain Catastrophizing in Women with Fibromyalgia

“…In explaining this inconsistency, different variables have been analyzed in previous studies. The concept of goal, as a variable inherent to psychological flexibility [ 7 , 13 ], has been incorporated [ 25 ], showing that preference for pain avoidance goals has been consistently associated with pain and disability through different activity patterns, especially with regards to task-contingent persistence, excessive persistence and activity avoidance patterns. Other studies have studied the relationship between activity patterns and goal management strategies while also considering the roles of affectivity and optimism [ 15 ], showing that the latter can be associated with persistence, commitment to new goals, and flexible goal management, and is associated with persisting in finishing tasks despite pain, and can also show infrequent avoidance behavior when pain is anticipated.…”

“…Along the same line, Esteve et al [ 20 ] incorporated the goal orientation of patterns as a differential characteristic that can define their adaptive or maladaptive character (i.e., three pacing patterns, each of which is associated with a single goal (conserving energy for valued activities, increasing activity levels, and reducing pain)). Finally, recent studies have pointed out the validity of the psychological flexibility model in the relationship between activity patterns and certain disease outcomes, highlighting the role of both contextual (i.e., pain intensity [ 23 ]) and personal variables associated with one’s values (i.e., perfectionism [ 24 ], goal preferences [ 25 ]).…”

Associations between treatment goals, patient characteristics, and outcome measures for patients with musculoskeletal disorders in physiotherapy practice

“…They studied patients with stroke [ 32 ], depression [ 33 ] and vulvodynia [ 34 ], and suggested that associations with motivation, behaviour change and self-efficacy could be possible explanations. One study has found strong links between goal preferences and activity patterns for patients with widespread pain, and concluded that reinforcing achievement goals was recommended to improve chronic pain adaptation for patients with fibromyalgia [ 35 ]. Together with our findings, this shows there are associations between goal setting and outcomes for different patient groups and that this might be related to factors such as motivation, behaviour change and self-efficacy.…”