# The Role of Self-as-Context as a Self-Based Process of Change in Cancer-Related Pain: Insights from a Network Analysis

## TL;DR

This study explores how a self-based coping strategy called self-as-context helps manage cancer-related pain, showing it's linked to effective coping and less substance use.

## Contribution

The study introduces self-as-context as a novel coping mechanism for cancer-related pain, supported by network analysis.

## Key findings

- Self-as-context (SAC) is positively correlated with active coping and humor, and negatively with substance use.
- Psychological inflexibility and SAC are key predictors of pain adjustment, with SAC explaining more variance in active coping.
- Active coping, SAC items, and transcending items show the highest influence in the network model.

## Abstract

Background/Objectives: The dual burden of cancer and pain during chemotherapy can negatively impact individuals’ personal integrity, or the “self”. Yet, coping strategies addressing these dual challenges are rarely employed in cancer-related pain management. Recent findings from evidence-based behavioral models, such as psychological flexibility in pain, highlight the potential role of self-as-context (SAC) as a central coping strategy for adjustment. The aim of this study was to examine the network structure of “conventional” coping strategies, such as active coping, behavioral disengagement, substance use, seeking support, religion, humor, and avoidance (Brief-COPE-8 coping strategies), in relation to “self-based” coping strategies. Methods: Individuals diagnosed with cancer, mostly in advanced stages (i.e., II and III), experiencing cancer-related pain (n = 135), completed a cross-sectional online study. Participants filled out self-reported questionnaires, including the Brief-COPE, the Psychological Inflexibility in Pain Scale—Greek Version (G-PIPS-II), and the Self-as-Context Scale (SACS) scale, which included two subfactors: centering and transcending. The study employed a stepwise analysis plan. We first conducted a series of traditional correlations, analysis of variance (ANOVA), and hierarchical multiple linear regressions, to examine the predictive role of demographics/clinical characteristics, psychological inflexibility, and SAC (independent variables) on the eight coping strategies (dependent variables). We then selected the highest predictors of coping in cancer-related pain and included them in a network analysis model. In the network analysis, we estimated the LASSO network regularization and examined network stability. We also assessed the centrality and stability of the network model, focusing on the associations between SAC items, the most predictive coping strategies (Brief-COPE), and psychological inflexibility (G-PIPS-II). Results: SAC correlated positively with effective coping (active coping and humor) and negatively with substance use. There were no correlations between demographics, type, stage of cancer, and coping strategies for pain. Multiple linear regressions identified psychological inflexibility and SAC as the main contributors to pain adjustment, with SAC explaining substantially more variance in active coping. The partial correlation network included 12 nodes. Active coping, centering, and three of the six transcending items were the most influential in the network. Active coping demonstrated the highest centrality, exerting positive links with SAC items that reflected calm reactions and invariant perspective-taking in response to the pain experience. Conclusions: SAC might be considered as a tailored, self-based coping strategy for managing cancer-related pain. Future analog studies should explore the role of integrating self-based perspective-taking strategies to momentarily address cancer-related pain.