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I am trying to understand my husband's behavior. He has chronic low back pain but sits in front of the TV for hours in a chair with no support. The doctor has recommended exercise. He does nothing. Says it will hurt to exercise. I'm the kind of person who sees a problem and goes after finding ways to solve it. If it were me, I'd be at the health club everyday, not investing in being a couch potato. Can you help me wrap my brain around this kind of passive behavior?

Psychologists who study chronic pain patients are also trying to understand what's going on in cases like this. Research is ongoing to find better ways to treat pain or help patients manage their chronic pain. To answer your question, we turned to the experts in human behavior and actions. There seem to be two different ways people with chronic low back pain respond to their situation. They either avoid activities that might cause pain or they persist in being extremely active despite their pain. Pain experts suggest these behaviors called avoidance and persistence are the result of self-discrepancy. Your husband is demonstrating avoidance behaviors. Your question is, "Why?" The concept of self-discrepancy may shed some light here. Even without pain, you have probably experienced self-discrepancy at times in your life. Some people refer to this as the "split-mind." You perceive yourself one way but think you should be (or think) different. There are several different ways self-discrepancy plays a role in our lives. There's the actual self or how you really are in your natural state. That is compared with your ideal or perfect self -- the way you would like to be. Then there's the "ought" self (i.e., I ought to be ...you fill in the blank here). And finally, the "feared" self. The feared self is the one you are most afraid of being like or becoming (i.e., becoming someone you do not want to be). Any of these discrepancies or conflicts can result in emotional distress such as anxiety, depression, and pain. In addition to emotional experiences, the person may develop these other behaviors mentioned earlier (avoidance or persistence). In a recent study from the Netherlands, the researchers tried to explain avoidance and persistence in terms of self-discrepancy and behaviors designed to "self-regulate" (or change). They proposed that people who engage in "I ought to do or be this way" kind of thinking are more likely to be driven to be their "ideal" or "perfect" self. Their behavior would tend toward persistence. And fear-based behaviors are more likely to result in avoidance. Fear of hurting or pain drive avoidance of activity. The 83 patients included all had chronic low back pain lasting at least three months. Everyone in the study filled out various surveys and questionnaires designed to measure self-discrepancy. Other factors were measured using surveys specific to depression, anxiety, activity patterns, disability, pain intensity, and health-related quality of life (QOL). All of the survey tools were self-report (patients answering questions about themselves and how they think, feel, and act. Avoidance was associated with a lower quality of life and greater disability. The patients who saw themselves as becoming the person they feared or didn't want to be increased their avoidance of activities that might increase pain. This study made the point that patient behaviors (whether towards avoidance or overdoing it) have underlying reasons. One of these reasons is the role of self-discrepancy as either a protective or motivating factor. This information might be helpful in understanding how emotions and behavior are driven by how patients see themselves.

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