Chronic pain and psychopathology: Exploring the motivational context and its clinical implications

This chapter presents a motivational model designed to forge conceptual and empirical links among chronic pain perception, cognitive-affective pain processing, everyday task performance, and the emergence of psychopathology. Organized around the GRASSP perspective (introduced in chapter 1), the current chapter first addresses the nature of multi-leveled (top-down and bottom-up) regulatory/control systems and the hypothesized motivational mechanisms around which such systems are organized. Based on the twin premises that (a) dysfunctions of the goal-guided, self-regulatory system underlie most forms of psychopathology, and (b) chronic pain can disrupt goal- and self-regulatory system functioning, the chapter seeks to locate chronic pain and two prominent forms of psychological disturbance-depression and anxiety-within a broad, heuristic "motivational context." Among the key explanatory building blocks of the hypothesized model are goal episodes, extended goal striving processes, and four moderation pathways hypothesized to connect pain-related disruptions of self-regulation to the eventual emergence of depression and/or anxiety.