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768 J. Oosterhaven et al. viders in their decision-making to prevent dropout in IPMPs. Nonetheless, future research should first focus on confirmation and external validation of the findings of this study in larger samples and may reveal whether other predictors are involved. In this study only reliable and valid measurements used in daily practice were chosen. However, one might criticize the instruments used to operationalize the E-CSM of Self-Regulation. Research has shown that the emotion part of the E-CSM Self-Regulation is less investigated. The Brief IPQ, the PSEQ, the TBQ and the PCS, used in this study to operationalize the emotional representations, may not be the most ideal instruments to measure emotions such as anger, shame, happiness/ joy, depression/sadness and fear/anxiety (41). In addition, the conceptual overlap between the psychological concepts and measurements with regard to chronic pain might have hindered the efficient mea- surement of the E-CSM of Self-Regulation. Research has shown that catastrophizing overlaps with depres- sion, anxiety, distress and self-efficacy (36). Another study has revealed that catastrophizing may be viewed as a subdomain of an overarching construct, such as emotional distress. In this view emotional distress is measured indirectly by the persons’ experience of pain (catastrophizing, emotional reactions and kinesio­ phobia) and the persons’ self-view (pain self-efficacy) and directly by anxiety and depression (36, 41). This prospective cohort study could only find evidence for an association of indirect measures for emotional dist- ress, such as pain self-efficacy and pain catastrophizing with dropout in this IPMP. Conclusion To our knowledge this is the first study to investigate the E-CSM of Self-Regulation as a conceptual framework for the prediction of dropout in IPMPs. Multiple regres- sion analyses revealed that patients with chronic pain who catastrophize were more prone to dropout from this chronic pain management programme. However, due to the small sample size and the exploratory nature of this study no firm conclusions can be drawn about the predictive value of the E-CSM of Self-Regulation for dropout in interdisciplinary pain management. Future research should focus on confirmation and external validation of the findings of this study. ACKNOWLEDGEMENTS The authors thank all patients who supported the study, Josca Snoei, Willemien Wiersma, Irene Koss and Hans Popma from the Rehabilitation Centre of Heliomare, Wijk aan Zee for their help with the initial construction of this prospective cohort study. 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