313: Mapping psychological (in)flexibility and pain catastrophizing in chronic pain and healthy controls

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Psychology

Background and Aims: Psychological inflexibility (PI) and flexibility (PF) are core processes influencing how individuals respond to challenges in life, including pain. Pain catastrophizing (PC) is consistently elevated in chronic pain, yet interventions targeting PC have had limited success. Enhancing PF may provide a more effective route to adaptive regulation of PC, but relations between these constructs remain underexplored. Network analysis can identify patterns of conditional dependence among survey items, thus this approach may be useful for examining interconnections among the psychological constructs of PI, PF and PC in individuals with and without chronic pain.

Methods: This cross-sectional study included 1026 adults (mean age 34.9, range 18-65 years), and 50% of these had been experiencing pain for ≥3 months. The sample included 518 females, 506 males, 1 intersex, and 1 preferring not to report their sex-at-birth. Respondents completed an online survey, assessing PI, PF (Multidimensional Psychological Flexibility Inventory), and PC (Pain Catastrophizing Scale), pain resilience, pain sensitivity, distress (depression, anxiety, stress) and wellbeing (quality of life, flourishing), alongside demographics, pain status, and injury history. Exploratory graph analysis (EGA) with bootstrapping was used to model item networks and compare those with and without chronic pain.

Results: Based on the full sample, PI and PF were negatively correlated (R=-0.17, p<.001). PC was positively correlated with PI (R=0.45, p<.001) but not correlated with PF (R=0.027, p=.80). EGA revealed a three-community structure corresponding to PC, PF, and PI items, although results for experiential avoidance were inconsistent during bootstrapping. Group comparisons revealed that for those without chronic pain, three-communities were preserved and experiential avoidance was positioned stably within the inflexibility items. In contrast, for those with chronic pain experiential avoidance appeared within the flexibility community. Interestingly, four of the six PC helplessness items produced a separate community.

Conclusions: PI was strongly associated with PC, while PF only related to PC indirectly via PI, further underscoring the importance of PI. The network interactions between PF, PI, and PC differed depending on the presence of chronic pain. As theoretically conceived, experiential avoidance is context-dependent and potentially adaptive, such as under extreme stress. This may explain its instability and positive associations with PF-related items. Within PC, a distinct affective helplessness community emerged in chronic pain, characterised by behavioural resignation (e.g., “I feel I can’t go on”), that may reflect reduced emotional engagement, low motivation, and/or avoidance.

References: NA

Presenting Author: Samantha K. Millard
Submitting Author: Samantha K. Millard

Senior Author: Thomas Graven-Nielsen

IASP 2026 Global Year theme of Neuropathic Pain: No

• Laura Petrini - Center for Neuroplasticity and Pain (CNAP), Health Science and Technology, Aalborg University, Denmark
• Bruno A.N. Couto - Center for Neuroplasticity and Pain (CNAP), Health Science and Technology, Aalborg University, Denmark
• Lance M. McCracken - Department of Psychology, Uppsala University, Sweden