Exploring the Roles of Impulsivity and Self- Compassion as Risk Factors for Analgesic Addiction.

Addiction to analgesics remains a global problem among those with chronic pain while prevention strategies remain limited. This thesis aimed to investigate and reduce the effects of psychological risk factors towards painkiller dependence. These included impulsivity and meta-cognitive factors [Self-hate (HS), Self-inadequacy (IS) and Self-reassurance (RS)]. The meta-cognitive factors are sub-scales within the “Forms of Self-criticising/Self-attacking” self-report measure often used in researching Self-compassion. Compassion is regarded as being warm and understanding towards ourselves during suffering or feeling inadequate, rather than responding harshly with self-criticism. Impulsivity, the tendency to choose smaller-but-sooner rewards in lieu of larger-but later rewards, is a well-known risk factor for developing drug dependence but has not been fully investigated for its role towards painkiller dependence. Additionally, the meta-cognitive risk factors have not been investigated for their role towards painkiller dependence or their relationship with impulsivity. A novel facet of all three studies was that they were all delivered via a bespoke webplatform. Study 1, a cross-sectional study of one group of participants (N=259) aimed to (1) explore the prevalence of painkiller dependence within participants who had chronic pain; (2) elucidate the role of cognitive and behavioural aspects of impulsivity towards painkiller dependence and (3) to investigate the role of IS, HS and RS towards painkiller dependence. Notable significant positive correlations were found between painkiller dependence and daily prescription painkiller consumption; Pain Intensity; Pain Frequency (PF); IS; HS and facets of impulsivity. Regression analysis highlighted low scores for Delay Discounting (DD) and high scores on Lack of Perseverance, NU and IS predicted higher levels of painkiller dependence. Three significant interaction terms (PF x IS; HS; RS) allowed for a moderation analysis to address Aim 3. This showed that IS, RS and HS acted as moderators for PF on Painkiller dependence. Results indicate impulsivity, IS, and HS to be risk factors for painkiller dependence. Study 2 was a pilot randomised controlled trial (RCT) aimed to assess acceptability and feasibility of a web-platform that delivered a Compassionate Mind Training (CMT) intervention to those with chronic pain. Participants were randomised
into one of two groups (CMT vs. Relaxation). CMT group participants engaged with a 4 psycho-education video library and a CMT intervention. RM group participants listened to theory-neutral relaxation music and did not engage with CMT related activities. All participants completed the study with no attrition. All feedback questions pertaining to acceptability and feasibility were above the threshold value of 5. Analysis of participant feedback led to two major additions to the web-platform: A dynamic colour-coded timetable and a personal Pain Diary. These new features were applied to Study 3 which was a large-scale version of Study 2. Study 3, an RCT aimed to (1) reduce severity of identified risk factors for painkiller dependence (as found in Study 1) by increasing Self-reassurance and (2) seek associations between variables which reduced/increased in CMT group participants. Participants were randomised into one of two groups (CMT [n=39] vs. Relaxation [n=40]) Both groups completed self-report measures and the DD task at three timepoints. An Intent-To-Treat analysis was applied to reduce attrition bias. Major outcomes of the study were significant reductions within CMT group participants for: painkiller dependence (p < .001), prescription painkiller consumption (p < .001). NU (p < .001) and Self-hate (p < .001). Additionally, Self-reassurance in the CMT group significantly increased (p = .02). To conclude, this piece of research identified and reduced previously unknown risk factors for painkiller dependence. These results may provide benefit for those prescribed painkillers by screening those who may be deemed vulnerable as well as widening our understanding of risk factors for substance dependence.