Graeme Ditchburn

Although the association between stress and pain is recognised, little is known about links between chronic pain and stress arising from perfectionist expectations. Two studies compared levels of socially prescribed perfectionism (SPP), self-oriented perfectionism (SOP), self-compassion (SC), and self-efficacy (SE) between individuals with and without chronic pain. In Study 1, 237 participants with chronic pain and 237 without pain completed an online survey. Participants with chronic pain had significantly higher levels of SPP and lower levels of SC than those without pain. However, there were no differences in SOP or SE. In Study 2, 294 individuals with chronic pain, and 278 without, completed an online survey. Individuals with chronic pain reported significantly higher levels of perfectionism and lower levels of SC and SE than pain-free individuals. SPP and SOP were higher in those with low SC scores. Correlation analyses identified that SOP and SC were positively associated with SE whereas SPP was associated negatively with SE. These findings largely align with the perfectionism social disconnection model. A clearer understanding of the inter-relationships between perfectionism and protective factors, such as SC and SE, has important implications for those experiencing chronic pain conditions, including potential pain management interventions and long-term wellbeing.

Purpose
COVID-19 forced organizations to implement protective measures changing how employees worked; however, empirical evidence is needed to explore how employees responded. This study examines the impact of COVID-19-related organizational changes in Singapore on employees’ perceptions of work pressure, stress and mental well-being (MWB) and the mediating role of resilience.

Design/methodology/approach
This study used a cross-sectional, anonymous online survey of 157 full-time employees who had worked for at least one year.

Findings
The results found that work pressure and stress had increased, and MWB had declined. Resilience acted as a buffer against increases in work pressure and stress while promoting the maintenance of MWB. Resilience significantly mediated the relationship between stress and MWB.

Research limitations/implications
The study does not allow for an assessment of causality but infers possible, albeit probable, casual relationships. Furthermore, stress and well-being could be influenced by a multitude of factors beyond organizational change. Future research should seek to account for additional factors and establish the generalisability of the findings beyond Singapore.

Practical implications
This study supports the engagement of resilience-based interventions to improve employees’ MWB during pandemic related organizational change.

Social implications
Policies that promote work-life balance, positive interpersonal relations and staying connected are some of the ways employers can bolster MWB and work-life balance to support employees who are engaged in remote work.

Originality/value
Given the unique context of COVID-19, this study allows for a better understanding of how a novel worldwide pandemic has transformed employees' experience of work and its associated impacts.

Increasing evidence reveals the damaging impact of having one's chronic pain symptoms invalidated through disbelief, discrediting, and critical judgement. In other instances, a caregiver's over-attentiveness to the daily tasks of individuals with pain can be problematic, potentially undermining rehabilitation. The aim of this study was to develop an instrument to measure different aspects of invalidation perceived by people with chronic pain. Item generation was informed through literature review and a thematic analysis of narratives from 431 peer-reviewed articles. The crowdsourcing platform Prolific was used to distribute survey items to participants. In Study 1A, Principal Component Analysis was performed on data from 302 respondents, giving rise to 4 subscales, including: Invalidation by the Self, Invalidation by Immediate Others, Invalidation by Healthcare Professionals, and Invalidation by Over-attentive Others. Confirmatory Factor Analysis of data collected from another 308 individuals in Study 1B supported the 4-factor model of the Pain-Invalidation Scale (Pain-IS) and identified a best-fit model with 24 items. The Pain-IS was further validated in another 300 individuals in Study 2. The Pain-IS demonstrates sound psychometric properties and may serve as a valuable tool for use by clinicians in the detection of pain-invalidation issues, as a first step in patient pain management.

Purpose: To validate an individual's feelings or behaviour is to sanction their thoughts or actions as worthy of social acceptance and support. In contrast, rejection of the individual's communicated experience indicates a denial of social acceptance, representing a potential survival threat. Pain-invalidation, though ill-defined, appears to be a fundamental component of psychosocial stress for people with chronic pain. As such, the aim of this paper was to define pain-validation and outline its importance for those with chronic pain. Methods: The pain-validation construct was defined using themes inherent in the narratives of those with chronic pain, as identified in a previously published systematic search and thematic analysis, together with examination of additional literature on pain-validation in the clinical context. Results: We present a construct definition, proposing that pain-validation must necessarily include: (i) belief that the pain experience is true for the individual, (ii) acceptability of the individual's expressions of pain, and (iii) communication of belief and acceptability to the individual experiencing pain. Further, we outline the importance of pain-validation as a protective factor and means of reducing many of the psychosocial stresses of chronic pain; for example, by indicating social support for pain-coping, buffering negative emotions, and re-enforcing unity and shared identity. Implications: The role of pain-validation in the current era of pain management intervention is discussed. Adhering to interventions that involve cognitive and behavioural change is often difficult. Acknowledging and validating the acceptability of the patient's pain experience in the early stages of pain management may, therefore, be a key component of intervention that encourages compliance to the treatment plan and achieving therapeutic goals.

Many instruments recommended for measuring attitudes toward fatness and “obesity” were developed in the 1990s, a time when the “obesity epidemic” was gaining momentum and anti-fat rhetoric was normative. Consequently, these instruments have tended to focus on assessing negative appraisals of fatness and fat people and reinforce weight stigma. As fat discourse has matured and expanded to incorporate fat positive attitudes, a nonstigmatizing way of measuring contemporary fat attitudes and beliefs in quantitative research is required. To address this need, we developed the Fat Attitudes Assessment Toolkit (FAAT). In this article, we describe the development of the FAAT and provide initial evidence for the scale's validity and psychometric properties across three studies. Study 1 included a systematic process for developing the extensive item pool that was reviewed by subject matter experts and a community panel. We explored and identified an initial multidimensional structure for the FAAT. Study 2 expanded and confirmed the factor structure with additional analyses in an independent sample and provided evidence for the overall reliability of the subscale scores and reliability as a function of gender and identification as fat. Construct and criterion validity of the subscale scores were also demonstrated. Study 3 provided evidence for the test-retest reliability of the FAAT subscales scores over time. The FAAT includes nine robust scales: Empathy, Activism Orientation, Size Acceptance, Attractiveness, Critical Health, General Complexity, Socioeconomic Complexity, Responsibility, and Body Acceptance. Specific subscales can be combined to form two composite measures: Fat Acceptance and Attribution Complexity. The scales that comprise the FAAT measure specific elements of attitudes towards fat people that are frequently targeted in weight stigma reduction research and activism; the FAAT thus offers a powerful and precise method for evaluating weight stigma reduction interventions that allows for an assessment of shifts toward more positive attitudes.

Purpose: Many people with chronic pain report feeling disbelieved or disparaged by others regarding their pain symptoms. Given the widely documented relationship between stress and pain, the importance of identifying psychosocial stressors such as pain-invalidation is apparent. This study was designed to identify and illustrate using first-person narratives, the effects of pain-invalidation by the self, family, friends, and healthcare professionals, toward individuals with chronic pain. Method: A systematic search of five databases was performed using a search strategy consisting of terms related to pain-invalidation. A review of 431 peer-reviewed journal articles, containing narratives from a pool of over 7770 study participants with a wide range of pain conditions, was conducted, followed by a thematic analysis to establish themes of invalidation experienced by those with chronic pain. Findings: Five major pain-invalidation themes were revealed: Not being believed, lack of compassion, lack of pain awareness/understanding, feeling stigmatized, and critical self-judgement. Themes additional to pain-invalidation included: Threats to Self-Image, Loss of Identity, and Isolation. Conclusion: Themes were largely interrelated and, together, build a picture of how levels of perceived social unacceptability of pain symptoms can impact on the emotional state and self-image of those with chronic pain. As such, pain-invalidation may potentially impede help-seeking or the effectiveness of therapeutic interventions.

In assessing and attempting to modify attitudes toward fatness, academics and researchers make use of measures and scales developed specifically for this purpose. Currently the more robust and recommended instruments focus on measuring anti-fat sentiment. While it may seem logical that to reduce anti-fat attitudes we need explicit anti-fat measures, this approach is not without consequence and deserves thoughtful critique. In this chapter, key measures of anti-fat attitudes are reviewed in order to draw attention to the problematic ways in which fatness, fat bodies and fat people are depicted. Examination of these measures indicates that assessments of fat people’s character and attractiveness are central to the current operationalizations of anti-fat attitudes, with the spectrum of negative appraisals including: being deviant, inferior, impaired and disgusting. Intervention research that attempts to engender more positive attitudes is also examined and found to frequently espouse negativity. Research participants are commonly engaged with stereotypically negative messages and deleterious images of fatness and fat people and then required to complete anti-fat measures. Even research approaching from a critical fat agenda, due to a lack of alternatives, paradoxically relies on anti-fat instruments for assessing positive change. Reflecting on this approach to measurement and intervention is vital if we are to continue to do work within this research protocol, and if we are to develop measures and materials that honor all bodies and reflect the colorful and complex landscape of fat discourse.

As public discourse has increasingly entrenched a view fatness as a major cause of disease burden in western countries, so too has stigmatization of fat people become an endemic feature of cultural, social, and psychic life. One of the main goals of fat acceptance movements is to remove this stigma, and a considerable body of research in social psychology and related fields has developed around creating and testing the efficacy of interventions designed to reduce weight stigma. In reviewing the extant body of work around weight stigma reduction, we are less interested in the outcomes or effectiveness of particular approaches; instead, we turn a critical lens on the types of interventions carried out and the materials and the messages presented to participants as part of these interventions. Although weight stigma reduction interventions are clearly motivated by a desire to reduce animosity and improve the lives of fat people, we worry that elements of their design may have the paradoxical effect of perpetuating and legitimizing some aspects of the negative stereotypes of fat people. In this chapter, we will review the typical forms of stigma reduction interventions with a critical eye towards the issues that researchers need to consider in designing interventions that embody the values of critical fat scholarship.