Changes in Cognition, Coping, Pain and Emotions after 12-months access to the Digital Self-management Program EPIO

Elin Bolle Strand ^1,2* Cecilie Varsi ^3,4 Elin Børøsund ³ Hilde Eide ^4,5 Karlein MG Schreurs ⁶ Lori B Waxenberg ⁷ Karen E Weiss ⁸ Eleshia J Morrison ⁸ Hanne Stavenes Støle ^3,9 Olof Birna Kristjansdottir ^10,3 Audun Stubhaug ^11,12 Lise Solberg Nes ^12,3,8

• ¹ Department of Digital Health, Oslo University Hospital, Oslo, Norway
• ² Faculty of Health Sciences, VID Specialized University, Oslo, Oslo, Norway
• ³ Department of Digital Health Research, Oslo University Hospital, Oslo, Norway
• ⁴ Faculty og Health and Social Sciences, University of South-Eastern Norway (USN), Kongsberg, Vestfold, Norway
• ⁵ Faculty of Health and Social Sciences, Oslo University Hospital, Oslo, Norway
• ⁶ Department of Psychology, University of Twente, Enschede, Netherlands
• ⁷ Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States
• ⁸ Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, United States
• ⁹ Norwegian Institute of Public Health (NIPH), Oslo, Oslo, Norway
• ¹⁰ Mental Health Team West, Primary Care of the Capital Area,, Reykjavik, Iceland
• ¹¹ Department of Pain Management and Research and Regional Advisory Unit of Pain, Oslo University Hospital, Oslo, Norway
• ¹² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Oslo, Norway

Psychosocial pain self-management interventions can be of support for people living with chronic pain. Since psychosocial support is not always accessible, digital health interventions may increase outreach of these types of evidence-based interventions.To explore participants' experiences from 12-month access to the digital pain selfmanagement program EPIO, particularly in terms of any behavioral and/or psychological changes experienced.Participants (N=25) engaged in individual semi-structured interviews following 12-month access to the EPIO intervention. Qualitative thematic analyses were conducted seeking to identify any behavioral and/or psychological changes experienced through intervention use, and what contributed to these changes.Participants were predominantly women (72%), median age 46 (range 26-70), with a range of self-reported pain conditions and the majority reporting pain duration >10 years (64%). Analyses identified three main themes and subsequent sub-themes: 1) Changes in Cognition; insight and self-awareness, acceptance and shifting focus, 2) Changes in Coping; pain, emotions, and activity pacing, and 3) Content and Functionality Specific Engagement; breathing and other mind-body exercises, thought-reflection exercises, and functionalities.People with chronic pain experienced positive behavioral and/or psychological changes in terms of cognition and coping after 12 months access to the EPIO digital pain selfmanagement program. The most prominent changes included increased understanding of the connection between own thoughts, feelings, and behavior, gaining concrete strategies to cope with everyday life living with pain, and utilizing these strategies to reduce pain and interference of pain, as well as to improve emotion regulation and psychological well-being.