Psychological flexibility and stigma in chronic pain: a cross-sectional study of healthcare professionals in the UK.

Aims: Healthcare professionals' attitudes toward chronic pain patients can contribute to stigma, affecting care and patient outcomes. This study examined whether psychological flexibility moderates the relationship between stigma vulnerability (i.e. patient characteristics that invite stigma) and enacted stigma (i.e. discriminatory behaviors) among healthcare professionals.

Participants & methods: A cross-sectional study recruited 239 National Health Service (NHS) staff from six UK NHS Trusts. Participants were randomly assigned one of four vignettes manipulating patient stigma vulnerability (high vs. low) and gender. Enacted stigma outcomes (e.g. perceived deception, pain attribution) were assessed via Likert scales. Psychological flexibility and inflexibility were measured using the Acceptance and Action Questionnaire - Stigma (AAQ-S). Robust ANOVA tested main effects and moderation.

Results: Psychological flexibility did not significantly moderate the stigma vulnerability - enacted stigma relationship (p >0.05). However, higher psychological inflexibility was associated with greater enacted stigma, U  = 3133, p  = .017 suggesting its role in stigma-related behaviors. The AAQ-S flexibility and inflexibility subscales showed distinct associations with stigma outcomes.

Conclusions: Psychological inflexibility plays a role in stigma-related behaviors and may be a target for interventions to reduce healthcare provider bias in chronic pain care. Further research is needed to examine these mechanisms and their implications.