This electronic momentary assessment study explored the relationship between flow and pain intensity and examined whether flow is an optimal experience for people with chronic pain. Adults with chronic pain (n = 30) were signaled randomly seven times daily during 1 week to respond to a flow questionnaire via personal digital assistant. The participants responded to 718 questionnaires from 1,447 beeps (response rate = 49.6%). Results indicated that participants were most commonly at home, doing self-care activities, with family or alone. Participants experienced flow 34.9%, apathy 44.6%, relaxation 11.6%, and anxiety 8.9% of the sampled time. Participants' mean concentration, self-esteem, motivation, and potency scores were highest in flow compared to the other three states. Separate one-way between-groups analyses of variance comparing concentration (F(3) = 11.85; p < .001), self-esteem (F(3) = 11.98; p < .001), motivation (F(3) = 29.29; p < .001), positive affect (F(3) = 2.89; p = .035), potency (F(3) = 19.88; p < .001), and pain intensity (F(3) = 1.39; p = .245) scores across the four states showed a significant overall effect on all comparisons except pain intensity and positive affect.
AeglerB.SatinkT. (2009). Performing occupations under pain: The experience of persons with chronic pain. Scandinavian Journal of Occupational Therapy, 16, 49–56.
2.
BarrettD. J.BarrettFeldman L. (2000). The Experience Sampling Program (ESP).Retrieved October 20, 2010, from http://www.experience-sampling.org.
3.
BreivikH.CollettB.VentafriddaV.CohenR.GallacherD. (2006). Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal of Pain, 10, 287–333.
4.
BrooksJ. C. W.NurmikkoT. J.BimsonW. E.SinghK. D.RobertsN. (2002). fMRI of thermal pain: Effects of stimulus laterality and attention. Neuroimage, 15, 293–301.
5.
ChenH. (2006). Flow on the net: Detecting Web users' positive affect and their flow states. Computers in Human Behaviour, 22, 221–233.
6.
ChristensenT.BarrettL.Bliss-MoreauE.LeboK.KaschubC. (2003). A practical guide to experience-sampling procedures. Journal of Happiness Studies, 4, 53–78.
7.
CorvinelliA. (2005). Alleviating boredom in adult males recovering from substance use disorder. Occupational Therapy in Mental Health, 21(2), 1–11.
8.
CreekJ. (2007). Engaging the reluctant client. In CreekJ.Lawson-PorterA. (Eds.), Contemporary issues in occupational therapy: Reasoning and reflection (pp. 127–142). Chichester: John Wiley and Sons Ltd.
9.
CsikszentmihalyiM. (1990). Flow: The psychology of optimal experience. New York: Harper Collins.
10.
CsikszentmihalyiM. (1996). Creativity. New York: Harper Perennial.
11.
CsikszentmihalyiM. (1997). Flow and the psychology of discovery and invention. Chicago: University of Chicago Press.
12.
CsikszentmihalyiM.CsikszentmihalyiI. (1988). Introduction to Part IV. In CsikszentmihalyiM.CsikszentmihalyiI., (Eds.), Optimal experience psychological studies of flow in consciousness (pp. 251–265). Edinburgh: Cambridge University Press.
13.
CsikszentmihalyiM.LeFevreJ. (1989). Optimal experience in work and leisure. Journal of Personality and Social Psychology, 56, 815–822.
14.
de WiedM.VerbatenM. N. (2001). Affective pictures processing, attention, and pain tolerance. Pain, 90, 163–172.
EmersonH. (1998). Flow and occupation: A review of the literature. Canadian Journal of Occupational Therapy, 65, 37–43.
17.
FarnworthL.MostertE.HarrisonS.WorrellD. (1996). The experience sampling method: Its potential use in occupational therapy research. Occupational Therapy International, 3, 1–17.
18.
FisherG. S.AlbrightL.FinelliJ.LevineL.RooneyC.ZanghiJ. (2006). Paradigm of life: A grounded theory of occupational renewal in persons with chronic pain. Californian Journal of Health Promotion, 4, 155–167.
19.
FisherG. S.EmersonL.FirpoC.PtakJ.WonnJ.BartolacciG. (2007). Chronic pain and occupation: An exploration of the lived experience. American Journal of Occupational Therapy, 61, 290–302.
20.
GamesP. A.KeselmanH. J.RoganJ. C. (1981). Simultaneous pairwise multiple comparison procedures for means when sample sizes are unequal. Psychological Bulletin, 90, 594–598.
21.
GerhardssonC.JonssonH. (1996). Experience of therapeutic occupations in schizophrenic subjects: Clinical observations organized in terms of the flow theory. Scandinavian Journal of Occupational Therapy, 3, 149–155.
22.
HektnerJ.SchmidtJ.CsikszentmihalyiM. (2007). Experience sampling method: Measuring the quality of everyday life. Thousand Oaks, CA: SAGE Publications, Inc.
23.
HektnerJ. M. (1996). Exploring optimal personality development: A longitudinal study of adolescents (Unpublished doctoral dissertation). Chicago: University of Chicago, Illinois.
24.
HoogstraL. (2005). The design of the 500 family study. In SchneiderB. L.WaiteL. J. (Eds.), Being together, working apart: Dual-career families and the work-life balance (pp. 18–38). New York: Cambridge University Press.
25.
IlottI. (2007). Did Elvis Presley die of boredom?British Journal of Occupational Therapy, 70, 415–415.
26.
JamisonR. N.RaymondS. A.LevineJ. G.SlawsbyE. A.NedeljkovicS. S.KatzN. P. (2001). Electronic diaries for monitoring chronic pain: 1-year validation study. Pain, 91, 277–285.
27.
KennedyB. L.VecitisR. N. (2004). Contexts of the flow experience of women with HIV/AIDS. OTJR: Occupation Participation Health, 24, 83–91.
28.
KeponenR.KielhofnerG. (2006). Occupation and meaning in the lives of women with chronic pain. Scandinavian Journal of Occupational Therapy, 13, 211–220.
29.
KubeyR. W.CsikszentmihalyiM. (1990). Television and the quality of life: How viewing shapes everyday experience. Hillsdale, NJ: Lawrence Erlbaum Associates.
30.
LeFevreJ. (1988). Flow and the quality of experience during work and leisure. In CsikszentmihalyiM.CsikszentmihalyiI., (Eds.), Optimal experience psychological studies of flow in consciousness (pp. 307–318). Edinburgh: Cambridge University Press.
31.
LevyM. L.CummingsJ. L.FairbanksL. A.MastermanD.MillerB. L.CraigA. H.. (1998). Apathy is not depression. Journal of Neuropsychiatry and Clinical Neurosciences, 10, 314–319.
32.
LindmanH. R. (1974). Analysis of variance in complex experimental designs. San Francisco: W. H. Freeman.
33.
MarinR. (1990). Differential diagnosis and classification of apathy. American Journal of Psychiatry, 147, 22–30.
34.
MartinM. (2009). Boredom as an important area of inquiry for occupational therapists. British Journal of Occupational Therapy, 72, 40–42.
35.
MassiminiF.CarliM. (1988). The systematic assessment of flow in daily experience. In CsikszentmihalyiM.CsikszentmihalyiI. (Eds.), Optimal experience psychological studies of flow in consciousness (pp. 266–287). Edinburgh: Cambridge University Press.
36.
MassiminiF.InghilleriP.Della-FaveA. (1996). La Selezione Piscologica Umana [Human Psychological Selection]. Milan: Cooperativa Libraria IULM (University of Milan).
37.
MerskeyH.BogdukN. (1994). Classification of chronic pain: Description of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press.
38.
NakamuraJ.CsikszentmihalyiM. (2002). The concept of flow. In SnyderC. R.LopezS. L. (Eds.), Handbook of positive psychology (pp. 89–105). Oxford: Oxford University Press.
39.
PetrovicP.PeterssonK. M.GhatanP. H.Stone-ElanderS.IngvarM. (2000). Pain-related cerebral activation is altered by a distracting cognitive task. Pain, 85, 19–30.
40.
RajP. P. (1996). Taxonomy. In RajP. P. (Ed.), Pain medicine: A comprehensive review. St. Louis: Mosby.
41.
SchmidtJ. A.ShernoffD. J.CsikszentmihalyiM. (2007). Individual and situational factors related to the experience of flow in adolescence: A multilevel approach. In OngA. D.van DulmenM. (Eds.), Oxford handbook of methods in positive psychology (pp. 542–558). New York: Oxford Press.
42.
ScollonC. N.PrietoC.DienerE. (2003). Experience sampling: Promises and pitfalls, strengths and weaknesses. Journal of Happiness Studies, 4, 5–34.
43.
StammT.LovelockL.StewG.NellV.SmolenJ.JonssonH.. (2008). I have mastered the challenge of living with a chronic disease: Life stories of people with rheumatoid arthritis. Qualitative Health Research, 18, 658–669.
44.
StavrouN. A.JacksonS. A.ZervasY.KarteroliotisK. (2007). Flow experience and athletes' performance with reference to the orthogonal model of flow. Sport Psychologist, 21, 438–457.
45.
StoneA. A.BroderickJ. B.SchwartzJ. E.ShiffmanS.Litcher-KellyL.CalvaneseP. (2003). Intensive momentary reporting of pain with an electronic diary: Reactivity, compliance, and patient satisfaction. Pain, 104, 343–351.
46.
StoneA. A.ShiffmanS. (1994). Ecological momentary assessment (EMA) in behavorial medicine. Annals of Behavioral Medicine, 16, 199–202.
47.
StoneA. A.ShiffmanS.SchwartzJ. E.BroderickJ. E.HuffordM. R. (2002). Patient non-compliance with paper diaries. British Medical Journal, 324, 1193–1194.
48.
StoneA. A.ShiffmanS.SchwartzJ. E.BroderickJ. E.HuffordM. R. (2003). Patient compliance with paper and electronic diaries. Controlled Clinical Trials, 24, 182–199.
49.
TangN. K. Y.SalkovskisP. M.HodgesA.WrightK. J.HannaM.HesterJ. (2008). Effects of mood on pain responses and pain tolerance: An experimental study in chronic back pain patients. Pain, 138, 392–401.
50.
TomarkenA. J.SerlinR. C. (1986). Comparison of ANOVA alternatives under variance heterogeneity and specific non-centrality structures. Psychological Bulletin, 99, 90–99.
51.
TraceyI.MantyhP. W. (2007). The cerebral signature for pain perception and its modulation. Neuron, 55, 377–391.
52.
TsangA.Von KorffM.LeeS.AlonsoJ.KaramE.AngermeyerM. C.. (2008). Common chronic pain conditions in developed and developing countries: Gender and age differences and comorbidity with depression-anxiety disorders. The Journal of Pain, 9, 883–891.
53.
TurkD. C.OkifujiA. (2010). Pain terms and taxonomies. In FishmanS. M.BallantyneJ. C.RathmellJ. P. (Eds.), Bonica's management of pain (4th ed., pp. 13–23). Philadelphia: Lippincott, Williams & Wilkins.
54.
Van HuetH.InnesE.WhitefordG. (2009). Living and doing with chronic pain: Narratives of pain program participants. Disability & Rehabilitation, 31, 2031–2040.
55.
VillemureC.BushnellM. C. (2002). Cognitive modulation of pain: How do attention and emotion influence pain processing. Pain, 95, 195–199.
56.
WaddellG.BurtonA. (2006). Is work good for your health and well-being?London: The Stationary Office.
57.
WellsA. (1988). Variations in mothers' self-esteem in daily life. Journal of Personality and Social Psychology, 55, 661–668.
58.
WiechK.TraceyI. (2009). The influence of negative emotions on pain: Behavioral effects and neural mechanisms. Neuroimage, 47, 987–994.
59.
WrightJ. J.SadloG.StewG. (2006). Challenge-skills and mindfulness: An exploration of the conundrum of flow process. OTJR: Occupation, Participation and Health, 26, 25–32.
60.
WrightJ.SadloG.StewG. (2007). Further explorations into the conundrum of flow processes. Journal of Occupational Science, 14, 136–144.
61.
ZautraA. J.JohnsonL. M.DavisM. C. (2005). Positive affect as a source of resilience for women in chronic pain. Journal of Consulting and Clinical Psychology, 73, 212–220.
