Western Michigan University ScholarWorks at WMU Dissertations Graduate College 8-2016 The Lived Experience of Individuals with Chronic Back and Neck Pain, Depression, and/or Anxiety Tara L. Palmeri Western Michigan University, [email protected] Follow this and additional works at: https://scholarworks.wmich.edu/dissertations Part of the Counseling Commons, and the Health Psychology Commons Recommended Citation Palmeri, Tara L., "The Lived Experience of Individuals with Chronic Back and Neck Pain, Depression, and/ or Anxiety" (2016). Dissertations. 1953. https://scholarworks.wmich.edu/dissertations/1953 This Dissertation-Open Access is brought to you for free and open access by the Graduate College at ScholarWorks at WMU. It has been accepted for inclusion in Dissertations by an authorized administrator of ScholarWorks at WMU. For more information, please contact [email protected]. THE LIVED EXPERIENCE OF INDIVIDUALS WITH CHRONIC BACK AND NECK PAIN, DEPRESSION, AND/OR ANXIETY Tara L. Palmeri, Ph.D. Western Michigan University, 2015 More than 1.5 billion people worldwide suffer from chronic pain (CP). People who experience chronic pain are 20 to 40% more likely to meet criteria for an anxiety disorder, and three to four times more likely to be clinically depressed than their pain-free counterparts. The relationship between CP and mental health has been studied quantitatively; however, few researchers have investigated co-morbid CP and mental health through a phenomenological lens. The subjective nature of the relationship is not comprehensively addressed within the literature. This qualitative phenomenological study explored (a) how individuals with chronic back and/or neck pain (CBNP) experience, understand, and draw conclusions about the relationship between their physical pain and mental health; and (b) how individuals perceive talking about their experiences with CBNP and depression and/or anxiety. To further understand the intersection between CP and mental health, 10 individuals diagnosed with CBNP and depression and/or anxiety, were interviewed. Lengths of diagnoses ranged from 1 year to 30 years. The participants are six females and four males. Racially, they are black, Latino, or white, and between the ages of 19 and 53. Major findings of this study are as follows. Participants perceived (a) a direct and positive relationship between their CBNP and depression and/or anxiety; (b) pain to precede depressive and/or anxiety symptoms; (c) a cyclical nature of the relationship; (d) five underlying mechanisms that affect the relationship (disability, tension, vulnerability, thought patterns, stress); (e) navigating institutions, conflicting treatment protocols, identity changes, invalidation, isolation, and lethargy as unique experiences; (f) the opportunity to talk about CBNP and depression and/or anxiety as beneficial; (g) themes around coping strategies, the process of acceptance, future plans, and treatment utilization; and (h) that the experience transcended all contexts and was all- encompassing. Discussion of the findings include relating findings to existing research, implications for medical and mental health professionals, limitations and strengths, and recommendations for future research. This researcher sought to give voice to this often silenced population and aid in the development of effective strategies to improve the quality of life for individuals with co-morbid CP and mental health distress. THE LIVED EXPERIENCE OF INDIVIDUALS WITH CHRONIC BACK AND NECK PAIN, DEPRESSION, AND/OR ANXIETY by Tara L. Palmeri A dissertation submitted to the Graduate College in partial fulfillment of the requirements for the degree of Doctor of Philosophy Counselor Education and Counseling Psychology Western Michigan University August 2015 Doctoral Committee: Alan Hovestadt, Ed.D., Chair Stephen Craig, Ph.D. Glinda Rawls, Ph.D. © 2015 Tara L. Palmeri ACKNOWLEDGMENTS The opportunity to solidify my professional development within the context of a study that I am so passionate about is greatly appreciated. First and foremost, I am indebted and grateful to the ten participants who co-created this project with me. The words of those ten individuals composed the most meaningful segments of the following manuscript. I dedicate this study to them and to all individuals who experience chronic pain and associated mental health struggles. This is as much your dissertation as it is mine. The participants and I share credit with Dr. Alan Hovestadt. As my advisor and chairperson of my doctoral committee, he provided me with the perfect balance of freedom and support, which allowed me to grow and develop as a researcher. Because he trusted me throughout this process, I trusted myself. I would like to thank the members of my committee, Dr. Stephen Craig and Dr. Glinda Rawls. These two brilliant people were instrumental in the design of this study. Dr. Craig asked me the tough questions that eventually led to the rigor of my study. Dr. Rawls asked the questions that clarified my research objectives. I would like to thank my supportive friend, and soon-to-be-Dr. Jen Bauer. I met Jen four years ago, at the start of the doctoral program. Since then, we have started every program milestone together and emerged victorious together, each time. She has stayed my colleague, ally, confidante, and voice of reason during a time in which I needed her most. ii Acknowledgments—Continued Perhaps the most acknowledgement should be given to my loving and patient partner, Joshua Lantis, for he sacrificed the most over the last four years. He was willing to be 14 hours away from his girlfriend for four years, and only had been dating her for two months before she moved from Massachusetts to Michigan. He has spent countless hours on planes, Skype, and the phone in order to support me through thick and thin. He gave me perspective, hope, and comfort when I had none. Furthermore, his deep insights about chronic pain and the associated physiology motivated me throughout this project. Josh, I thank you for all you do for me every day. Lastly, I would like to thank my parents, sister, and grandmother for their ever- giving generosity and support. When I was a child, my mother took me to the library every week, checked out the maximum number of books, and read each one to me multiple times. This emphasis on education served as the foundation that made it possible for me to achieve what I have today. Tara L. Palmeri iii TABLE OF CONTENTS ACKNOWLEDGMENTS ............................................................................................. ii LIST OF TABLES ......................................................................................................... ix CHAPTER I. INTRODUCTION .............................................................................................. 1 Overview of the Study Topic ....................................................................... 1 Background and Key Research Findings ..................................................... 1 CP and Counseling Psychologists .......................................................... 3 CP and Depression and Anxiety ............................................................ 4 Focus of the Current Study .......................................................................... 6 Practical Problems ................................................................................. 6 The Researchable Problem .................................................................... 7 The Purpose of the Study ....................................................................... 7 Research Questions ................................................................................ 8 Significance of the Study ....................................................................... 9 Definition of Terms...................................................................................... 10 Summary of the Introduction ....................................................................... 12 II. LITERATURE REVIEW ................................................................................... 13 Conceptualization of CP and Mental Health: Directionality and Causality ...................................................................................................... 14 Chronic Pain and Depression ....................................................................... 17 Chronic Pain and Anxiety ............................................................................ 20 iv Table of Contents—Continued CHAPTER Chronic Pain and Depression and Anxiety .................................................. 22 Variables That Affect the Relationship Between CP and Depression and Anxiety .................................................................................................. 24 Self-Efficacy .......................................................................................... 24 Anxiety Sensitivity and Health Anxiety ................................................ 27 Interpersonal Relationships and Social Support .................................... 29 Disability ................................................................................................ 32 Quality of Life........................................................................................ 33 Gender, Age, and Racial Differences in Pain .............................................. 34 Disability and Cultural Factors .............................................................. 39 Review of the Qualitative