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This chapter aims to provide an overview of the dissertation presented here as a whole. It outlines the purpose, content and organisation of the following literature review (chapter 2) and empirical paper (chapter 3). This chapter also intends to show how the two main chapters fit together, and how they represent important research within the wider literature. Fibromyalgia (FM) is a chronic pain syndrome characterised by pain in the soft tissues of the body, general fatigue and sleep disturbance (Wolfe et al., 1990). Many individuals face a long and difficult journey to receive a diagnosis of FM. A recent survey reported that on average, respondents waited 2.3 years and saw 3.7 physicians before receiving a diagnosis of FM (Choy et al., 2010). Furthermore, individuals with FM have also reported that there is a considerable stigma associated with having the condition. In one qualitative study, women with FM reported feeling that others, including their physicians, questioned their credibility when reporting symptoms and their work ethic; and also implied that their illness was entirely psychological. As a result, the women reported that they coped with these difficulties either by withdrawing from social activity to avoid such experiences, or by putting on a façade that masked the true extent of their suffering (Asbring & Narvanen, 2002). Current medical and psychological treatments for FM are limited in success with regards to providing consistent benefits to the FM population as a whole (Abeles, Solitar, Pillinger & Abeles, 2008; Vlaeyen & Morley, 2005). Traditionally the dominant approach to intervention within both the medical and psychological fields is to focus on the reduction of negative symptoms. In contrast, the growing field of positive psychology continues to demonstrate the utility of exploring the processes and conditions that are conducive to optimal human functioning (Seligman & Csikszentmihalyi, 2000) as an alternative or complimentary approach to conventional methods of healthcare. Subjective well-being (SWB) can be defined as “a person’s cognitive and affective evaluations of his or her life” (Diener, Lucas & Oishi, 2002, p.63). A large body of evidence suggests that individuals who have higher SWB enjoy a range of positive outcomes, including health-related benefits (e.g. Deiner & Chan, 2011). The application of a positive psychology approach may be particularly relevant to FM, where there is growing evidence of a specific deficit in positive affect (PA), a major component of SWB. Chapter 2 of this thesis is a systematic review of the literature regarding PA in individuals with FM. It focuses on the quantitative literature and specifically aims to answer the question: is there a deficit in PA in individuals with Fibromyalgia relative to other pain conditions, general health conditions, and also the general population? The literature review begins by giving a rationale as to why exploring the evidence for a deficit in PA specific to the FM population is important. It also summarises the background literature regarding the structure of affect, as well as theories relating to the potential function, and proposed mechanism of action, of PA. Next, the method section outlines the systematic methods that were used to identify the relevant studies that are included in the review. This is followed by the results section, which succinctly presents a synthesis of the characteristics of the included studies, along with the key findings regarding PA. The discussion section considers how the findings answer the question of whether there is a specific deficit in PA within the FM population. It also considers the clinical implications of the findings. This is followed by an in-depth discussion of the potential limitations of the review, in terms of both the quality of the studies included and also the methodological considerations of the review process itself. Finally, recommendations for future research are made. It has been hypothesised that hope is a major contributor to well-being (Snyder, 2002). In non-clinical samples, the association between hope, particularly goal-focused hope, and SWB has been well documented (e.g. Snyder, 2002). More recently, mindfulness has also been identified as promoting increased SWB (e.g. Brown & Ryan, 2003). Chapter three of this thesis is an empirical paper that aims to add to the current literature by exploring the specific impact SWB has on improving FM-related symptoms and difficulties. It also builds on the existing literature in non-clinical samples by investigating if goal-focused hope and mindfulness significantly contribute to the promotion of SWB within the FM population. To achieve these aims, the research utilises structural equation modelling (SEM) techniques to simultaneously explore the relationships amongst the key study variables. This was done by pre-specifying a hypothesised model of how hope and mindfulness may lead to increased SWB in FM, based on past research. The extent to which this model fit the actual data collected was then examined. The empirical paper starts by considering the importance of SWB with regards to physical health outcomes. It also introduces the concepts of goal-focused hope and mindfulness, and begins to consider the theory behind how they may lead to higher SWB within the FM population. The method section then gives details of the study’s participants, measures and procedures. It also reports how the data was analysed, with a particular focus on a description of SEM. Next, the results section begins with details of how the data was prepared and includes findings from the preliminary analysis. The main focus of this section involves testing the hypothesised SEM model against the study data. Finally, the discussion section reflects on the study’s findings within the context of existing research and theory. Potential limitations of the study are considered, as well as the implications for future research and clinical practice. This section is concluded with a succinct summary of the study’s key contributions to the literature and how this should inform future work. |
