Temporal dynamics of mental defeat in chronic pain : a longitudinal network analysis of ecological momentary assessment data

Mental defeat – negative self-appraisals in relation to pain – has been linked to greater pain interference, disability and suicide risk in chronic pain populations. However, little is understood about how fluctuations in mental defeat shape daily pain experiences and responses. This study applied network analysis on time series data from an experience sampling study to examine these dynamic within-person relationships in 137 adults (Mage=41.9, 84.7% female) with chronic non-cancer pain, who completed online surveys three times daily over two 7-day periods spaced six months apart. Surveys captured in the moment ratings of mental defeat, pain (intensity, impacts, medication use), mood, stress, compassion (to self and others), attention (to pain, inwards/outwards, body/mind), and activity engagement (physical, social). Multi-level vector autoregression models generated temporal and contemporaneous networks, with stability verified via comparison to 1000 simulated models. The temporal network revealed 71 significant edges (top 25% edge weights: 0.07-0.15), showing that increases in mental defeat predicted subsequent increases in attention to pain and perceived pain impacts on self, relationships and future. In turn, perceived pain impacts on routine and future and predicted lower physical activity engagement. The contemporaneous network identified 62 significant edges (0.12-0.37), indicating that mental defeat was connected with increases in attention to pain and perceived pain impact on future, independent from the effects of pain, stress and mood. Simulation studies confirmed high network stability. These findings offer insights into the interplay between mental defeat and cognitive, emotional and behavioural pain responses. They support the development of just-in-time interventions targeting mental defeat for pain management.