Self-concepts and illness attitudes in chronic pain. A repertory grid study of a pain management programme

Four patients completed a 10-session out-patient pain management programme which included didactic information, relaxation training and cognitive-behavioural techniques. At the beginning and completion of the programme a number of measures were taken, including symptom inventories and a repertory grid designed to tap the patients' self-concepts and attitudes towards illness. These two sets of before and after measures were compared. No changes in the symptom inventories nor in daily visual analogue measurements of pain were shown. Despite this, the repertory grids showed a significant increase in the distance between 'as I would like to be' and 'like a physically ill person;' suggesting that physical illness had become less desirable. At the same time the distance between 'like a physically ill person' and 'like a hypochondriac' decreased, suggesting that these two concepts were less clearly distinguished in the patients' minds. Analysis of the raw data suggested that emotional factors were considered more relevant to physical illness at the completion of the programme. It would seem, therefore, that the main impact of our programme was on the patients' attitudes towards illness rather than on symptoms. Since attitudes may partly determine subsequent illness behaviour, it is encouraging to note changes here which suggest that our patients have adopted a more healthy view of physical illness.