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Access Type

WSU Access

Date of Award

January 2022

Degree Type


Degree Name




First Advisor

Mark Lumley


Tens of thousands of adults belong to private Facebook groups dedicated to supporting those in chronic pain. These groups provide their members with a gathering space to exchange support and advice, though the effects of being a member are unknown. Our team created a novel Facebook intervention that not only tests the effects of group membership on health outcomes, but also incorporates socially-oriented psychological techniques so that chronic pain can be targeted from a truly psychosocial perspective. A total of 119 adults with chronic pain were recruited from online sources and randomized into one of two conditions: a peer support Facebook group (control condition; n = 60), which was modeled after groups that naturally exist on Facebook, or the intervention condition (n = 59), which incorporated evidenced-based cognitive-behavioral and emotion-focused intervention techniques into the peer support group. Participants engaged in their respective groups for 4 weeks and completed measures at baseline, post-group, and 1-month follow-up.

Utilizing a mixed-methods intervention design, this study evaluated the social dynamics within the groups. Participants in both conditions significantly improved on measures of perceived chronic pain social support and self-efficacy, and these improvements were significantly related to improvements in four health outcomes: pain severity, pain interference, depression, and anxiety. Qualitative data (i.e., participants’ Facebook posts and comments) were then analyzed to help identify the types of group engagement that led to positive changes, with the most common themes being requesting and offering emotional and practical support, and emotional disclosure. An overarching theme emerged from the data: us vs. them—which is described as a view of the world that includes two groups: people with pain, who can understand the pain experience, and everyone else, who does not understand. Although this strong sense of group cohesion has the potential to offer benefits including enhancing perceived social support, self-efficacy, and daily functioning, this cohesion was also observed to have negative consequences. Group members discussed their tendency to withdraw from close others due to feeling judged or misunderstood in regard to their pain, and as such, being part of the “us” group may unfortunately lead to isolation and reduced functioning. Future research may explore ways to support group cohesion among pain peers, including promoting a strong social support network and a safe haven to disclose emotions, all while encouraging members to strengthen relationships with family members and friends who can offer invaluable support and promote adaptive health behaviors for individuals with chronic pain.

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