Early Maladaptive Schema Factors, Chronic Pain and Depressiveness: a Study with 271 Chronic Pain Patients and 331 Control Participants

Abstract

Chronic pain and depression are coexisting entities with high simultaneous prevalence. Both are linked with early adversities. Early maladaptive schemas (EMS) can be seen as a reflection of these adversities. EMSs extensively indicate underlying psychic patterns and provide a good opportunity to detect covert processes and psychic shapes (latent factors), which create the basis of how people rate their schemas. The purpose of this study was to explore these latent, higher order schema factors (SF) and to find out how they are associated with pain intensity or depression in chronic pain patients and a control sample. The study subjects consisted of 271 first‐visit pain patients and 331 control participants. Sociodemographic and pain data were gathered by questionnaire; 18 EMSs were measured with the Young Schema Questionnaire (short form) and depressiveness was measured with the Beck Depression Inventory, Version II. Exploratory factor and regression analyses were used. The chronic pain patient group showed two SFs. The first SF showed a shameful, defective, socially isolated, failure, emotionally inhibited, deprived, submissive and resigned pattern. The second SF showed a demanding, approval seeking, self‐sacrificing and punitive pattern. SF1 predicted more than half of the depressiveness in the pain patient sample. A three‐factor structure was found in the control sample, and SFs 1 and 3 together predicted almost one‐third of depressiveness. The pain patient and the control groups had a different, higher order factor structure. We assume that SF1 in the pain patients reflected a rather serious, undefined early psychic trauma and was also associated with their depressiveness. Copyright © 2011 John Wiley & Sons, Ltd. Key Practitioner Message Chronic pain patients showed a two‐factor higher order schema factor (SF) structure, which we labelled Loser and Encumbered. The control participants showed a three‐factor structure with many similarities to earlier studies. The first SF (Loser) was strongly associated with depression in the chronic pain patients. The data support the view that early adversities predispose chronic pain patients to depression. From the therapeutic point of view, we should be able to support the ashamed, failure, dependent, incompetent, negative and vulnerable ones (Loser) to feel dignity and calm down the ‘Encumbered’ ones to get them relaxed and their suffering bodies to heal.