Chronic pain is a costly public health problem that is associated with poor quality of life. While promising treatments for pain have been developed, a number of chronic pain patients-those with interpersonal dis- tress-often do not complete, and thus, do not benefit fully from individual treatments. Even among treatment completers, one cannot expect individuals to maintain change if they return to distressed social environments. The purpose of this proposal, which is in response to PA-13-119 Mechanisms, Models, Measurement, &Management in Pain Research (R21) and NCCAM's call for the development of mindfulness interventions for chronic pain, is to provide a preliminary test of a new integrativ model of pain that posits that psychological flexibility skills must be exercised within a supportie environment. We will test this model by refining and piloting a novel couple-based intervention for people with chronic pain and marital distress that aims to alleviate chronic pain by addressing each partner's individual and relationship skills. This is a departure from current practice, which focuses solely on the patient's individual functioning, does not ad- dress the spouse's psychological inflexibility, and does not address relationship problems. Our central hypothesis is that a theoretically integrative intervention that improves both partners'psychological flexibility (i.e., acceptance, mindfulness, values-based action) and relational flexibility (i.e., emotional disclosure, empathic responding) skills will be feasible and valid and that it will alleviate pain and improve quality of life. This proposal stems from our substantial theoretical development, descriptive research, and intervention research in pain. In addition, the proposal's aims are consistent with NCCAM's high priority on research testing the extent to which mindfulness alleviates pain and a range of quality of life outcomes. Phase 1 will consist of an open trial of 5 couples to refine intervention materials. During this phase, therapist training and supervision procedures will be developed and tools will be identified or created to assess treatment adherence and competence, and couples'engagement in and response to treatment. During Phase 2, a randomized pilot trial of 50 couples will be undertaken to test the integrative model. Pre- and post-treatment and 3- month follow up assessments will be conducted to test the ability of the intervention to reduce pain severity (primary outcome) and improve other indicators of pain and quality of life (secondary outcomes) relative to a wait-list control group. Psychological flexibility and relational flexibility variables will be identified as mechanisms of treatment outcomes. The results from this project will be used as background work for a larger funding proposal (e.g., R01) to test the intervention in a rigorous RCT. Thus, the proposed research will foster the translation of basic research on psychological flexibility and relationshi processes to intervention development and contribute to our long-term objective to develop, test, and disseminate effective mind-body treatments for physical disorders that account for patients'social context.
Chronic pain is a public health problem that is associated with poor quality of life. Unfortunately, people with marital distress do not benefit from current treatments for pain. To address this problem, we propose a novel, couple-based intervention for people with chronic pain that teaches both partners psychological and relationship flexibility skills to promote better quality of life and alleviate pain. This project will form the basis of a ong-term research program aimed at developing and disseminating effective mind-body treatments for people with physical health problems that also account for the social context in which they live.