The chronic disease helplessness survey: developing and validating a better measure of helplessness for chronic conditions

INTRODUCTION: Learned helplessness develops with prolonged exposure to uncontrollable stressors and is therefore germane to individuals living with pain or other poorly controlled chronic diseases. This study has developed a helplessness scale for chronic conditions distinct from previous scales that blur the conceptualization of control constructs. Extant measures commonly examine controllability, not the three pillars of helplessness identified by Maier and Seligman (1976): cognitive, emotional, and motivational/motor deficits. METHODS: Individuals who self-report a chronic pain condition (N = 350) responded to a Chronic Disease Helplessness Survey (CDHS) constructed to capture cognitive, motivational/motor, and emotion deficits. Exploratory factor analysis (EFA; N = 200) and confirmatory factor analysis (CFA; N = 150) were performed. The CDHS was assessed for convergent and discriminant validity. RESULTS: A three-factor solution corresponding to cognitive, emotional, and motivational/motor factors was identified by EFA. The solution exhibited sufficient model fit and each factor had a high degree of internal consistency. The CDHS was significantly associated with greater pain intensity and interference, PCS helplessness, lower perceived pain control, and lower general self-efficacy. Individuals with diabetes generally experience greater control strategies over daily symptoms (e.g., diet, oral medications, and insulin) than patients with chronic pain and in this study displayed significantly lower CDHS scores compared to individuals with chronic pain, demonstrating discriminant validity. CONCLUSIONS: This study provides preliminary evidence that the three-factor CDHS is a psychometrically sound measure of helplessness in individuals with chronic pain.