A Mixed-Methods Investigation Into the Us Versus Them Mentality in Facebook Groups for Chronic Pain

Objective: Social media groups for chronic pain have become increasingly popular, but the effects of these groups are largely unknown, and members may be exposed to both helpful and harmful group processes. We created a Facebook intervention for adults with chronic pain and used a mixed-methods design to evaluate the effects of group membership on social support, including examining social dynamics that may benefit or impede existing pain care. Method: A total of 119 adults participated in either peer-led or professionally-guided Facebook groups for 1 month. Chronic pain support was assessed at baseline, post-intervention, and 1-month follow-up, and qualitative data were collected to explore social dynamics. Results: Chronic pain support increased for participants in both group types from baseline to post-intervention and then decreased at follow-up. Thematic analysis of qualitative data (i.e., participant posts and comments in response to posts) revealed an overarching theme: us versus them-a dichotomizing view of the world that distinguishes people with pain (us) versus everyone else who does not understand pain (them). Participants discussed their tendency to withdraw socially due to feeling misunderstood regarding their pain. Conclusions: Facebook groups for chronic pain enhance perceptions of support among peers. Although generally beneficial, group cohesion may facilitate an us versus them mentality, resulting in isolation and potentially poorer outcomes. Future research should explore ways to maintain benefits of the us versus them mentality, while reducing its costs.