Treating chronic low back pain: is it as simple as changing a person’s mindset?

Mindset. It’s an interesting, some would say controversial topic. Carol Dweck and colleagues [1] first started investigating school students’ attitudes to failure and were intrigued as to why some students rebounded and others seemed devastated by small setbacks. Following years of research, they created the terms ‘fixed mindset’ and ‘growth mindset’ to describe the underlying beliefs people have about personal attributes such as intelligence and learning. With reference to intelligence, a fixed mindset describes the belief that intelligence is a fixed trait, a personal attribute that cannot be changed, whereas a growth mindset is the belief that intelligence can be developed [1]. Dweck noted that students with a growth mindset of intelligence believed they could get smarter and appeared to understand that effort made them stronger. These students embraced challenges and persisted in the face of setbacks, which lead to higher academic achievement. Since this time, Dweck’s ‘mindset theory’ has been extended across various domains, and the emergence of a fixed and growth mindset specific to other constructs (e.g. athletic ability, social behaviour, and body weight) has been studied [2-4].

So, could mindset be implicated in chronic pain? Well, a study in 2015 showed that people with chronic low back pain (LBP) who have a fixed mindset of pain used fewer active coping strategies, felt more depressed, and catastrophised more than people with a growth mindset of pain [5]. Here, mindset of pain was deemed to be ‘fixed’ if a person viewed their pain as static and something that couldn’t change, and ‘growth’ if a person viewed their pain as changeable and something they had control over. The authors suggested that a person’s mindset of pain may underpin important coping and emotional reactions to chronic pain and raised the possibility that changing a person’s mindset may be a potential target for treatment. While this study provided valuable information that may aid in the assessment and treatment of chronic LBP, a link between mindsets of pain and symptoms of pain and disability was not established. Understanding this relationship is essential if the assessment of mindset is to have clinical utility – so this is what we set out to determine.

We surveyed over a 100 people with chronic LBP, split them into two groups based on their mindsets (fixed or growth), and asked them about their level of pain and pain-related disability. A person’s mindset of pain was determined by adapting Dweck’s mindset of intelligence questionnaire, which assess the extent to which intelligence is perceived as a malleable trait. Replacing the word ‘intelligence’ with ‘pain’, the mindset of pain questionnaire included eight items answered on a six-point Likert scale of 1 (Strongly Agree) to 6 (Strongly Disagree) that assessed an individuals’ beliefs about whether their pain is fixed or malleable [6]. Interestingly, we found a link between a person’s mindset of pain and their symptoms. That is, those individuals with a fixed mindset of pain reported a higher level of pain and disability than those with a growth mindset of pain.

This finding, together with the results from the 2015 study, suggests that individuals with a fixed mindset of pain may be at a greater risk of long-term pain and disability than those with a growth mindset of pain. However, this suggestion is speculative as both studies were cross-sectional in design (only assessed outcomes at a single time point). Thus, we cannot determine the causal relationship between a person’s mindset of pain and their coping strategies, emotions, or symptoms. Longitudinal studies (where outcomes are repetitively assessed over time) are required.

Overall, our research highlights the potential role a person’s mindset of pain may play in the assessment and treatment of chronic LBP. More research is needed to understand mindsets of pain in chronic LBP and in other chronic pain conditions. Currently, only two studies have been published in this area and both studies have investigated mindsets of pain in a chronic LBP population [5,6]. It is possible that the assessment of mindsets may have relevance in other chronic pain conditions. Further, mindsets of pain may provide valuable information to clinicians when identifying which patients could be at risk of not engaging in rehabilitation programs. However, this possibility has not yet been tested and requires further investigation.

We also think that further research should explore the effect of an intervention that facilitates a growth mindset of pain on clinical outcomes. This approach has been explored in other areas of research and shown promise. For example, interventions targeting a growth mindset of intelligence have demonstrated shifts in growth mindsets that are associated with greater longer term academic performance [7].

Please get in contact if you have any questions or if you would like further information about the tool used to assess mindsets of pain – summers.simonj@gmail.com.

About Simon  Summers

Simon is a PhD student at Western Sydney University and a Research Associate at the University of Canberra Research Institute for Sport and Exercise (UCRISE). His area of research focuses on understanding the neurobiological and psychological mechanisms that underpin the transition from acute to persistent pain.

Twitter: @SimonJSummers

References

[1]   Dweck CS, Chiu C-y, Hong Y-y. Implicit theories and their role in judgments and reactions: A word from two perspectives. Psychological Inquiry. 1995;6(4):267-85.

[2]  Ommundsen Y. Implicit Theories of Ability and Self-regulation Strategies in Physical Education Classes. Educational Psychology. 2003;23(2):141-57.

[3]   Shyness mindset: Applying mindset theory to the domain of inhibited social behavior. Personality and Individual Differences. 2011;50(8):1174-9.

[4] Burnette JL. Implicit theories of body weight: Entity beliefs can weigh you down. Personality and Social Psychology Bulletin. 2010;36(3):410-22.

[5]  Higgins N, Bailey SJ, LaChapelle DL, Harman K, Hadjistavropoulos T. Coping styles, pain expressiveness, and implicit theories of chronic pain. The Journal of psychology. 2015;149(7):737-50.

[6]   Summers SJ, Higgins NC, Te M, Byrne A, Chipchase LS. The effect of implicit theories of pain on pain and disability in people with chronic low back pain. Musculoskeletal science & practice. 2019;40:65-71.

[7]   Blackwell LS, Trzesniewski KH, Dweck CS. Implicit theories of intelligence predict achievement across an adolescent transition: A longitudinal study and an intervention. Child Development. 2007;78(1):246-63.