28 informonline.org.au Health Feature What can psychology offer in Chronic Pain Management? Anyone who suffers from persistent pain knows how much it can severely impact health and well-being. Psychology has come a long way in helping people manage persistent pain. Psychological factors such as mood, beliefs about pain and coping style have been found to play an important role in an individual’s adjustment to persistent pain.
Health Feature informonline.org.au 29 In many cases, people respond well to psychological interventions, particularly those that target pain self-efficacy (PSE) and pain catastrophising (PC). PSE reflects the confidence people have in performing activities whilst experiencing prolonged pain. It relates to feelings of control a person has over their pain symptoms and selfmanagement. Interventions that increase understanding and a sense of control over pain have been shown to improve PSE. PC relates to a person’s unhelpful thinking styles and exaggerated negative concepts around the experience of pain. In addition to causing distress, high levels of PC have been linked to disability and depression in chronic pain sufferers. Cognitive Behavioural Therapy for Chronic Pain Cognitive behavioural therapy (CBT) for chronic pain utilises similar techniques that are used in any CBT intervention, however, the focus is on the psychosocial factors that influence a person’s pain. Therefore, the first goal is to help people alter their perceptions of their pain. The task of the therapist in this instance is to help people see their pain as something that they can learn to manage, rather than something that is overwhelming to them. The second goal of CBT is to provide self-regulatory and stress management skills. Self-regulatory skills include relaxation training, guided imagery and distraction techniques which are all designed to help reduce the client’s autonomic negative response to the pain. This helps the person reduce anxiety around their pain by physically altering their unhelpful physiological responses. In addition, stress-management skills involve teaching the client how to communicate, problem solve, time manage and plan to ensure they can adequately manage their work and everyday activities, despite their debilitating pain. Acceptance and Commitment Therapy for Chronic Pain In contrast to CBT, which involves cognitive restructuring and challenging thoughts, Acceptance and Commitment Therapy (ACT) emphasises observing thoughts and feelings as they are, without trying to change them. ACT stresses that even when a person is experiencing chronic pain; it is the struggle with pain (e.g., the client’s pain catastrophising) that causes suffering. For this reason it is fundamentally important that the person continues to behave in ways that are consistent with their valued goals and life directions despite their experience of pain. Within the ACT framework, pain is seen as an inevitable, and in some cases, a necessary part of living that can be accepted. The extent of a person’s suffering is directly related to the extent to which the person believes and acts on their pain related thoughts. The aim of ACT therapy is to help the client develop greater flexibility in the presence of thoughts, feelings and behaviours associated with pain. Mindfulness is a key element in ACT therapy for chronic pain. By practicing mindfulness strategies, the client can learn to be the observer of the pain, rather than an active participator. This observer perspective is also helpful in maintaining neutral thoughts when unhelpful thoughts and feelings arise. Chronic pain can become debilitating, demotivating and tiresome for those affected. It can wear people down. In the ACT model, value illness is a condition where a person puts valued activities on hold in order to reduce pain symptoms. Over time, this can affect the person’s relationships, social activities, work satisfaction, and general meaning of life. This severely compromises a person’s self-efficacy. ACT incorporates exercises that help a person identify their values, and identify how near or far they are living in accordance with those values. The therapy helps the client specifically identify which values are compromised by their activities to avoid or manage pain. It helps them devise strategies for managing pain, whilst maintaining their values, and thus increasing PSE.