1. Dr. Audrey Kinzel Dep’t of Educational Psychology & Special Education University of Saskatchewan Presentation to CCPA Ottawa May 19 2011

3. To present the findings of research on “The Acceptance of Chronic Pain” with emphasis on the findings which relate most to the choices that characterize the acceptance or process. Describe how a multi/inter disciplinary treatment approach facilitates acceptance of chronic pain. Present the parallel between chronic pain and other conditions/situations.

5. Identity a situation or circumstance which you “accepted” – write this idea on a piece of paper This might be a situation that: Was unexpected or expected, You asked for or wished for, Was a part of your life plan, or definitely not a part of your plan, Keep this paper handy as I will ask you to refer to it later

7. Reason for studying chronic pain Increasing number of individuals affected: from 16% in 2007 to 18% in 2009 (CPS, 2009) Financial cost to society and individual Personal distress Less than satisfying outcomes despite the advances in knowledge and treatment Reason for studying acceptance Learn more about how to learn to ‘live with the pain’.

8. Based on Chronic Pain Acceptance Questionnaire (McCracken) McCracken found 4 factors constitute acceptance: 1. Life Focus 2. Acceptance of Chronicity 3. Cognitive Control 4. (not) Avoiding/Controlling Living with pain without reaction, disproval, or attempts to avoid or reduce Acceptance is following what a client wants, ie, less distress so this is following their preference ( Miller)

9. Methodology Based in phenomenology Data collection: Active-Indepth Interviews using Seidman’s process. Data Analysis: Atlas TI and constant comparative analysis

10. Current non malignant chronic pain Pain for a minimum of 6 months Pain has disrupted life Now living a meaningful life with pain Accepted their pain

11. Ten participants – 7 female, 3 male From 3 provinces including 6 communities Age range: Twenties to mid seventies Duration of pain: 1 to 40 years Time to acceptance from pain onset: months to 20 yrs Pain diagnosis : dislocated elbow, low back, RSD, neuropathy, fractures, fasciitis Source of income: - only 1 (of working age) was on full time disability, 1 was part time disability/part time working, - Remainder working, retired (and volunteering).

12. - The time before acceptance, (nonacceptance) highlighted acceptance - Meaning of acceptance - Characteristic attitude and language - Acceptance is ongoing = Accepting

13. Support as Strength & Comfort Psychological Support from professionals Encourage support from others, faith, workplace Communication to Connection Relates to support but also emotional expression Momentous Interactions

14. Shared Experiences - Appropriate disclosure - Group treatment Being Believed - Believing the client’s level of distress/pain is * - Not believing impacts clients core person Abandonment or Support: (Professionals) Response to Uncertainty - Relates to the response when a cure is not possible or not in the near future – requires long term support - This theme has implications for interdisciplinary treatment/management and you as a counsellor/psychologist

15. - A personal journey - Starts with a decision - Involves a series of steps only the person can take - Takes time (months or years)

16. Refer back to the situation you accepted, what did you have/choose to do in this situation to manage it, live with it, accept it...? Keep this in mind...

17. Knowledge and Learning Acquiring knowledge/information Learning from doing/not doing Adaptation to Limitations Acknowledge the need to adapt Action of adapting (avoid some activities, modify others) Problem focused coping vs emotion focused coping

18. Taking (and giving) of Responsibility - Recognize personal responsibility - Others, gave responsibility to higher power Recognition of Choices Change of Focus - to life - resolution of court cases, insurance claims critical

19. Relationship with Self - with acceptance of pain came acceptance of the self (less self blame, increased confidence. Control: Some Giving and Some Taking - realization of what can be controlled and when Values and Priorities Re-examined - Re-evaluated long standing beliefs and values resulted in letting go of some societal and family expectations. Which, if any of these choices, did you identify in your acceptance?

20. Acceptance is not appropriate nor desirable for every person or every condition. Acceptance may be helpful for individuals for whom: The present is unsatisfactory. There is a desire for a better future. The path to the better future, acceptance, or wellness, may/may not involve getting over something – may involve learning to live with. What are some of the situations acceptance is suited? Not suited for?

21. Think about your practice, identify conditions or situations in which your client is being managed by more than one type of provider. (example depression – counsellor/psychologist and family physician) Identify strategies for assisting clients to realize their choices while keeping a multi/interdisciplinary approach in mind?

22. As a professional we can help facilitate acceptance of a situation or circumstance to achieve a more satisfying future or wellness But it is the client who makes the decision to start or move toward (with the help, patience, and support) of the psychologist. A current client just came to a realization (and acceptance) “I am tired of waiting until I get better to... “