Building a recovery pathway and testing the disability pathway in the fear avoidance model of chronic pain

To broaden our understanding of chronic pain, it is imperative that limitations of the fear-avoidance model, one of the leading models, are addressed. It has been argued that the variables in the fear-avoidance model’s “disability pathway” do not occur in the sequential order that is theorised, and it has been argued that the model’s “recovery pathway” does not adequately explain the processes underlying adaptive coping to pain. To address these limitations, this thesis tested the proposed sequence of the disability pathway, and investigated whether mindfulness and resilience could be integrated into the fear-avoidance model’s recovery pathway. It was predicted that the disability pathway’s sequence would not be supported. It was also predicted that evidence would be found for either direct recovery pathways (where either mindfulness or resilience would be the driving variable), or indirect recovery pathways (where both mindfulness and resilience function together). Sixty-two participants were randomly assigned to a mindfulness meditation condition or a control condition, and cross-sectional data, along with time 1 to time 2 differences were examined on a battery of self-report measures assessing mindfulness, resilience, and psychological processes associated with the disability pathway. Results suggest that some of the processes in the disability pathway are bidirectional, refuting the proposed sequence. Cross-sectional data suggests that resilience has a significant effect on several disability pathway variables. Further results indicate that in the mindfulness group, an increase in resilience was associated with a reduction in depression. Taken together, these findings partially support resilience as a direct recovery pathway. Explanations of these findings are discussed along with the theoretical and practical implications, before directions for future research are recommended.