Application of Meaning-Based Psychotherapy to a Sample of Patients With Chronic Pain (DOLORSENT)

Meaning-Based Psychotherapy (MBP) Protocol. The intervention consists of 10 modules of treatment defined in 15 sessions held over 4 months, in a group format of two hours each, on a weekly basis

Module 1: Introduction to MBP. Acquired illnesses and the loss of meaning in life. How can we develop a low sense of purpose in life? Module 2: Psychoeducation on MBP. Module 3: Human experiences occur in three dimensions: biological, psychological, and the noetic/meaning dimension. Sources of meaning.

Module 4: Creative sources of meaning and experiential sources of meaning. Module 5: The noetic/meaning dimension is the compass of our life. Module 6: Sources of attitudinal meaning. Transforming an unexpected situation into a personal triumph.

Module 7: Responsibility as a source of meaning. Module 8: The past is a potential source of enduring meaning. Module 9: The capacity for self-transcendence Module 10: Development and processing of your book of Life.

Cognitive Behavioral Therapy for pain will be applied, including: psychoeducational content, training in emotional regulation strategies, attention and relaxation exercises, and problem and conflict resolution. 10 modules will be implemented over 15 sessions following Kovacs and Moix Cognitive Behavioural Therapy for Chronic Pain

Module 1: Understanding the multidimensional experience of pain Module 2: Identifying emotions and aspects related to pain I Module 3: Identifying emotions and aspects related to pain II Module 4: Emotional regulation strategies Module 5: Cognitive restructuring and flexibility Module 6: Mindfulness exercises Module 7: Participation in graded activities Module 8: Interpersonal Problem and Conflict Resolution Module 9: Relaxation Exercises Module 10: Relapse Prevention

The Beck Depression Inventory (BDI; Beck et al., 1996), consisting of 21 items with four response options (0-4), assesses depressive symptoms. It establishes different quantitative ranges of depression: absent or minimal depression (< 13), mild to moderate depression (14-19), moderate depression (20-28), and severe depression (>28). We will use the Spanish version (Sanz et al., 2005), which has adequate reliability (α = .93). It includes two subscales: a cognitive-affective subscale and a somatic-motivational subscale.

The MLQ is a self-reported questionnaire made up of 10 items, and it was developed to assess the two main dimensions of meaning in life: presence and search for meaning in life. The items are rated on a 7-point scale ranging from 1 (absolutely false) to 7 (absolutely true). The factors of Presence and Search were correlated (r = -.19), and internal consistency was good for Presence (.86) and Search (.87). One-month test-retest reliability coefficients were .70 for Presence and .73 for Search.

The MEMS assesses the dimensions of meaning in life: Understanding, Purpose, and Significance, with a total of 15 items. Likert-type responses are given on a 7-point scale (1 = Strongly disagree; 7 = Strongly agree). We will use the Spanish version (Marco et al., 2022), where the three MEMS subscales showed adequate internal consistency: Understanding (ϖ = .91), Purpose (ϖ = .92), and Significance (ϖ = .86).

In this study, we used Part A of the PIL, which consists of 20 items with a Likert-type scale (1 to 7). It provides a measure of the level of achievement of meaning in life. Items include: "Life seems completely boring to me," with a Likert-type response (ranging from "1 = completely routine" to "7 = always exciting"). Scores range from 20 to 140 points, with three levels: scores below 90 indicate a level of existential emptiness, scores between 90 and 105 indicate a level of uncertainty regarding the meaning of life, and scores above 105 indicate a level of achievement of meaning. We used the Spanish version (Noblejas de la Flor, 2000), which has adequate reliability (α = .88).

Validation of the Spanish version of the Pain Catastrophizing Scale in fibromyalgia. Medicina Clínica, 131(13), 487-492. It measures the tendency to have exaggerated negative thoughts about pain, such as ruminating about suffering or feeling hopeless. It consists of 13 items grouped into three subscales: rumination, magnification, and helplessness. It is useful for predicting pain intensity, disability, and response to treatment. A validated Spanish version exists for patients with fibromyalgia and chronic pain with a reliability of (α = 0.79).

The OASIS is a five-item instrument that assesses the frequency and intensity of anxiety symptoms during the past week. In addition, it measures interference in work and academic, social, and daily life domains, as well as avoidance behaviors. The items are rated on a Likert-type scale (0-4). The psychometric properties are good in terms of internal consistency (α= 0.86), convergent and discriminant validity, and sensitivity to change (α= 0.86).

Validation of the Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ) for the assessment of acceptance in fibromyalgia. Health and Quality of Life Outcomes, 8, 37. https://doi.org/10.1186/1477-7525-8-37). It assesses acceptance of chronic pain, including willingness to experience pain and maintain activities. It measures behavioral flexibility and functional adaptation to pain. Higher levels of acceptance have been shown to be associated with less depression and better functioning. It is available in a Spanish version, including a short, 8-item version with adequate reliability (α = 0.83).