Why Psychotherapy Helps the Patient in Chronic Pain – Psychiatry (Edgmont). 2008 Dec – Linda J. Griffith, MD – free full-text /PMC2729621/
Psychiatrists frequently see patients in their practices who struggle with issues of chronic physical pain. This can present diagnostic and therapeutic dilemmas.
These patients require an approach that allows them to talk about their pain and feel supported while simultaneously being nudged to develop a meaningful life alongside their pain.
This article addresses an approach to accomplish this difficult balancing act over the course of time and includes case examples. Continue reading
Patient action: as means and end for chronic pain care: PAIN – August 2017
Historically, pain has been understood as a sensory problem. Even the IASP defines pain as “an unpleasant sensory and emotional experience….”
This aversive sensory experience can prompt a protective motor response, which can include reflexive withdrawal, splinting and resting of the painful body part, and avoidance of activities that can increase pain.
This sensory understanding of pain implies that the pain experience must be reduced to reduce motor reactions. Continue reading
Forced Exercise With CBT Fails for CFS – Journal of Health Psychology – August 29, 2017 – free full-text Research Article
The results of this study showed what patients have known all along:
For sufferers of CFS/ME,
exercise is the problem, not the solution,
it’s in the body, not the mind.
Cognitive behavioural therapy and graded exercise theapy are promoted as evidence-based treatments for myalgic encephalomyelitis/chronic fatigue syndrome.
This article explores patients’ symptom responses following these treatments versus pacing therapy, an approach favoured by many sufferers. Continue reading
Frontiers | Metacognitive Therapy for Depression in Adults: A Waiting List Randomized Controlled Trial with Six Months Follow-Up | Psychology for Clinical Settings – January 2017
This small study (39 patients) shows this type of therapy is effective for depression.
This randomized controlled trial examines the efficacy of metacognitive therapy (MCT) for depression.
Participants receiving MCT improved significantly more than the WL group. Continue reading
Dialectical Behavioral Therapy for Chronic Pain Management – Florence Chaverneff, Ph.D. – September 24, 2016
Still a recent form of cognitive behavioral therapy, dialectical behavioral therapy (DBT) combines dialectics and mindfulness meditation for therapeutic purposes.
The goal with this method is to help patients “gain insight and skills to manage their thoughts, emotions, and behaviors.”
A study presented at the American Academy of Pain Management’s Annual Meeting in San Antonio, Texas, proposed the use of this technique in pain management.
DBT was initially developed in the United States as a treatment complement for patients with the most severe cases of borderline personality disorder (ie, cases of suicidal attempts and ideation). Continue reading
When Added to Opioid Agonist Treatment, Psychosocial Interventions do not Further Reduce the Use of Illicit Opioids: A Comment on Dugosh et al. – PubMed – NCBI – J Addict Med. 2016 Jul-Aug;
This commentary reviews the limitations of the recent literature review by that examined the role of psychosocial interventions with medication for opioid addiction treatment.
The commonly held belief that opioid agonist treatment alone is inferior treatment to such treatment combined with ‘psychosocial’ treatment (which many will understand to mean counseling) is not supported by the research evidence and it results in limitations on the use of these effective medications.
Below is the review addressed by this commentary: Continue reading
In Search of Meaning: Values in Modern Clinical Behavior Analysis | Free full-text PMC article
One of the distinguishing features of human behavior, compared to that of other species, is the extent to which our lives are influenced by values and purpose.
This uniqueness is based on the fact that, unlike other species, we engage in verbal behavior.
Acceptance and commitment therapy (ACT) provides a theory for values and values-based action, based on basic behavioral principles and grounded in a functional analytic theory of language and cognition that we believe provides a strong foundation for creating flexible assessment and intervention strategies related to personal values. Continue reading
Fear-Avoidance Conditioning: Maintaining the Chronic Pain Cycle? – Pain – International Association for the Study of Pain | August 11, 2016
In an article recently published in Pain, researchers at the University of Leuven, Belgium propose a model for the transition from acute to chronic pain, based on fear-avoidance
With this model, which describes the distinct behaviors underlying perpetuation of or breaking from pain, researchers seek to guide pain-related research as well as pain management
In this model, conditioning plays a central role in the maintenance of pain, and authors argue that its disruption may lead to recovery. Continue reading
An Overview of Dialectical Behavior Therapy | Psych Central
This is a “flavor” of Cognitive Behavior Therapy that’s touted as a treatment for chronic pain by the CDC:
Dialectical behavior therapy (DBT) treatment is a cognitive-behavioral approach that emphasizes the psychosocial aspects of treatment.
The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships.
DBT theory suggests that some people’s arousal levels in such situations
- can increase far more quickly than the average person’s,
- attain a higher level of emotional stimulation, and
- take a significant amount of time to return to baseline arousal levels. Continue reading
The causal status of pain catastrophizing: an experimental test with healthy participants. – PubMed – NCBI Eur J Pain. 2005 Jun
In the current study we report findings on the effects of experimentally induced catastrophizing about pain on expected pain, experienced pain and escape/avoidance behavior during a cold pressor task in a sample of healthy participants
It was hypothesized that increasing the level of catastrophizing would result in a higher level of expected pain, a higher level of experienced pain, and a shorter duration of ice-water immersion. Also, it was hypothesized that these relations might be stronger for participants who already catastrophized about pain prior to the experiment.
The results demonstrated that despite the successful attempt to induce catastrophizing, this neither significantly affected
- expected pain,
- experienced pain, and
- duration of ice-water immersion,
nor were these relations moderated by the pre-experimental level of catastrophizing.
Of course, because this study is from a decade ago, it will be disregarded.