Acceptance, Mindfulness, and Values-Based Action May Counteract Fear and Avoidance of Emotions in Chronic Pain: An Analysis of Anxiety Sensitivity

L M McCracken, Edmund Keogh

Research output: Contribution to journalArticlepeer-review

114 Citations (SciVal)


People often respond with distress and avoidance to their own negative experiences, such as the physical, cognitive, and emotional aspects of depression or anxiety. When people with chronic pain respond this way, their overall level of distress may increase, they may struggle to avoid their emotional experiences, and their daily functioning may decrease. The purpose of this study was to examine the role of anxiety sensitivity (AS), or "fear of anxiety," in relation to these processes. It was predicted that those persons with chronic pain who report higher AS will also report higher emotional distress and greater disability caused by chronic pain. A second purpose was to examine whether therapeutic processes designed to reduce emotional avoidance, namely, acceptance, mindfulness, and values, could be demonstrated to reduce the role of AS in relation to this distress and disability based on a statistical model including these variables. Subjects were 125 consecutive adult patients (64.8% women) seeking services from a specialty pain service in the United Kingdom. All patients completed a standard set of measures of AS, acceptance of pain, mindfulness, and values-based action, as well as measures of pain, disability, and emotional functioning, at their initial consultation, and these data formed the basis for the current study. In correlation and regression analyses, AS was associated with greater pain, disability, and distress. In regression analyses, the 3 proposed therapeutic processes reduced the average variance accounted for by AS in patient functioning from Delta R-2 = .21 to Delta R-2 = .048. This means that when the 3 therapeutic variables are taken into account statistically, AS alone retained relatively little association with patient functioning. These results suggest that AS may amplify the impact of emotional distress on patient functioning in chronic pain and that processes of acceptance, mindfulness, and values-based action may reduce this effect. Perspective: Humans can fear and struggle to avoid their own emotional experiences, even when these cannot harm them. Data presented here show individuals with chronic pain have more distress and disability when they manifest more fear of anxiety symptoms, and behavior patterns of "acceptance" and "mindfulness" may reduce this effect.
Original languageEnglish
Pages (from-to)408-415
Number of pages8
JournalJournal of Pain
Issue number4
Publication statusPublished - 2009


  • Chronic pain
  • anxiety
  • acceptance
  • mindfulness
  • avoidance


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