title: Attributions regarding unmet treatment goals after interdisciplinary chronic pain rehabilitation.
abstract: BACKGROUND
  The goal violation effect (GVE), a component of the relapse process model, occurs when patients make internal, stable, global, and uncontrollable rather than external, unstable, specific, and controllable attributions about the causes for unmet goals. GVE consistent attributions lead to guilt and self-blame, reduced self-efficacy, and greater probability that a lapse will lead to a full-blown relapse.
  
  
  OBJECTIVE
  To determine if chronic pain patients make attributions regarding the causes of unmet goals consistent with the GVE and to determine differences for the GVE and the individual attributions making up the GVE among unmet coping skills, medication, exercise, social, and work goals.
  
  
  METHODS
  In the last week of an interdisciplinary pain program, patients stated 4 to 6 treatment goals. At 6 months follow-up, 100 patients rated the cause for each of their own unmet goals using 7-point scales assessing whether they made internal, stable, global, and uncontrollable attributions. Together, 165 unmet goals were rated and a GVE was calculated for each unmet goal by adding the 4 individual attributions and dividing by 4.
  
  
  RESULTS
  The GVE for each of the 5 goal types was above the midpoint toward model consistent attributions. A multivariate analysis of variance was significant for goal type (P<0.0001). No significant differences were found among goal types for the GVE, the stable or global attributions. However, work and social goals were found to have lower internal attributions compared with coping, medication, and exercise goals. Work goals were found to have great uncontrollable attributions compared with coping, medication, and exercise whereas coping was found to be lower than social and exercise goals.
  
  
  CONCLUSIONS
  Patients made attributions for unmet treatment goals consistent with the GVE component of the relapse process model. Internal and uncontrollable attributions for causes of unmet goals varied with goal type, which has implications for the design of relapse prevention strategies.
authors.affiliation: Department of Family Medicine, Creighton University School of Medicine, Omaha, NE 68102, USA. tpguck@creighton.edu
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Guck
authors.forename: James C
authors.initials: JC
authors.lastname: Willcockson
authors.forename: Rex L
authors.initials: RL
authors.lastname: Schmidt
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Criscuolo
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data*; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D009329:Nebraska / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D010348:Patient Care Team / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D015995:Prevalence; D011785:Quality Assurance, Health Care / Q000379:methods; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome