Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy

There are now numerous studies of Acceptance and Commitment Therapy (ACT) for chronic pain. These studies provide growing support for the efficacy and effectiveness of ACT in this context as well as for the role of ACT-specific therapeutic processes, particularly those underlying psychological flexibility. The purpose of the present study was to continue to build on this work with a broader focus on these processes, including acceptance of pain, general psychological acceptance, mindfulness, and values-based action. Participants included 168 patients who completed an ACT-based treatment for chronic pain and a three-month follow-up. Following treatment and at follow-up, participants reported significantly reduced levels of depression, pain-related anxiety, physical and psychosocial disability, medical visits, and pain intensity in comparison to the start of treatment. They also showed significant increases in each of the processes of psychological flexibility. Most uncontrolled effect sizes were medium or large at the follow-up. In correlation analyses changes in the four processes measures generally were significantly related to changes in the measures of depression, anxiety, and disability. In regression analyses the combined processes were related to changes in outcomes above and beyond change in pain intensity. Although in some ways preliminary, these results specifically support the unique role of general psychological acceptance in relation to improvements achieved by treatment participants. The current study clarifies potential processes of change in treatment for chronic pain, particularly those aiming to enhance psychological flexibility.     

Mindfulness meditation and relaxation training increases time sensitivity

Two experiments examined the effect of mindfulness meditation and relaxation on time perception using a temporal bisection task. In Experiment 1, the participants performed a temporal task before and after exercises of mindfulness meditation or relaxation. In Experiment 2, the procedure was similar than that used in Experiment 1, except that the participants were trained to mediate or relax every day over a period of several weeks. The results showed that mindfulness meditation exercises increased sensitivity to time and lengthened perceived time. However, this temporal improvement with meditation exercises was primarily observed in the experienced meditators. Our results also showed the experienced meditators were less anxious than the novice participants, and that the sensitivity to time increased when the level of anxiety decreased. Our results were explained by the practice of mindfulness technique that had developed individuals’ abilities in devoting more attention resources to temporal information processing.     

Is pain-related fear a predictor of somatosensory hypervigilance in chronic low back pain patients?

Pain-related fear has been found to be associated with increased disability and increased pain perception in patients with chronic low back pain. A possible mechanism by which pain-related fear could lead to increased pain perception is heightened attention to somatosensory sensations. In the present study, chronic pain patients reporting either a high or low level of pain related fear and control participants performed an auditory reaction time task, while occasionally non-painful electrical stimuli--accompanied by threatening instructions--were given to the arm or back. In the primary task condition, participants had to perform the auditory task while ignoring the electrical stimuli. Next, the task was presented under dual task conditions in which participants had to respond both to tones as well as to detection of electrical stimuli. It was hypothesized that for the primary task, high fearful patients would show greater disruption of performance on the auditory task than low fearful patients and controls when stimuli were presented to the back. For the dual task, slower reaction times for the auditory task, in combination with faster detection of electrical stimuli was expected. The hypotheses were not confirmed but patients scoring high on pain-related fear did show an overall increase in reaction time for all conditions of the primary task, with or without simultaneous stimulation. Regression analyses demonstrated that high pain-related fear was associated with increased reaction time to tones both in patients and healthy controls, and that within patients pain-related fear was a better predictor of reaction time to tones than present pain intensity. The findings may be interpreted as showing that patients with elevated levels of pain-related fear habitually attend to somatic sensations, giving less priority to other attention-demanding tasks.     

Deliberate Self-Harm and State Dissociation: An Experimental Investigation

The purpose of this study was to test the relation between deliberate self-harm (DSH) and state dissociation. Participants (N = 85) were randomly assigned to self-administer either a very mild electric shock below their pain threshold (a no-self-harm control condition) or an electric shock they were told could “cause minor tissue damage that would heal quickly,” but which was in fact equal to a predetermined pain threshold (a DSH condition). After task completion, 42 participants rated the extent of their dissociation before the shock and 43 rated the extent of their dissociation after the shock. Results indicated that women in the DSH group experienced more dissociation compared to men, but only after the shock. Potential reasons for this gender effect are discussed.     

Differences in high and low anxiety sensitive women's responses to a laboratory-based cold pressor task

Anxiety sensitivity (AS) has been linked to a variety of disabling chronic health conditions, including pain-related conditions. A recent study has found that healthy women with high AS reported significantly higher levels of sensory and affective pain on an experimental cold pressor task compared to women with low AS. However, this study found no differences between AS groups for pain tolerance or pain threshold. In the present study, which was designed to replicate and extend these findings, 90 undergraduate university women were selected for inclusion in 1 of 2 AS groups (high or low) based on their screening scores on a 16-item measure of AS. Participants were tested individually on a lab-based cold pressor task using a variety of self-report and observer-measured variables. Data analyses revealed that, as expected, the high AS participants reported significantly more fear in response to the cold pressor on a relevant item of the McGill Pain Questionnaire-Short Form (SF-MPQ) than did the low AS participants. Also as expected, the high AS participants reported more pain in response to the cold pressor on the Present Pain Index (PPI) of the SF-MPQ than did the low AS participants. High AS participants did not differ from low AS participants on other aspects of the cold pressor response (e.g. pain threshold, pain tolerance, pain recovery). These results support the role of pain-related fear as a mediating variable between AS and increased perceived pain intensity.     

Differences in High and Low Anxiety Sensitive Women's Responses to a Laboratory‐Based Cold Pressor Task

Anxiety sensitivity (AS) has been linked to a variety of disabling chronic health conditions, including pain‐related conditions. A recent study has found that healthy women with high AS reported significantly higher levels of sensory and affective pain on an experimental cold pressor task compared to women with low AS. However, this study found no differences between AS groups for pain tolerance or pain threshold. In the present study, which was designed to replicate and extend these findings, 90 undergraduate university women were selected for inclusion in 1 of 2 AS groups (high or low) based on their screening scores on a 16‐item measure of AS. Participants were tested individually on a lab‐based cold pressor task using a variety of self‐report and observer‐measured variables. Data analyses revealed that, as expected, the high AS participants reported significantly more fear in response to the cold pressor on a relevant item of the McGill Pain Questionnaire – Short Form (SF‐MPQ) than did the low AS participants. Also as expected, the high AS participants reported more pain in response to the cold pressor on the Present Pain Index (PPI) of the SF‐MPQ than did the low AS participants. High AS participants did not differ from low AS participants on other aspects of the cold pressor response (e.g. pain threshold, pain tolerance, pain recovery). These results support the role of pain‐related fear as a mediating variable between AS and increased perceived pain intensity.     

Reducing the threat value of chronic pain: A preliminary replicated single-case study of interoceptive exposure versus distraction in six individuals with chronic back pain

This paper describes a preliminary experimental evaluation of a technique intended to help people suffering from chronic back pain and low pain acceptance to alter the aversiveness or threat value of their persisting pain. Using a multiple baseline cross-over design six individuals with chronic back pain were taught to use a form of interoceptive exposure as well as a relaxation/distraction breathing-based technique in the presence of their pain. Half the participants used one method for three weeks, and then crossed over to the other method for a further three weeks. The other half did the reverse. Assessments were conducted at pre/post treatment and at a three month follow-up. Daily monitoring of pain-related distress was also completed. The results indicated moderately high improvements in pain acceptance across most participants and corresponding declines in pain-related distress. No clear differences occurred between conditions, but the changes on disability and catastrophising scales for most cases were consistent with those reported after more substantial interventions. The study raises some important clinical and methodological issues that could inform future research in this area.     

The Impact of Demand Characteristics on Brief Acceptance- and Control-Based Interventions for Pain Tolerance

The present analog study compared the effectiveness of an acceptance- and control-based intervention on pain tolerance using a cold pressor task, and is a partial replication and extension of the Hayes, Bissett et al. (Hayes, S. C., Bissett, R.T., Korn, Z., Zettle, R. D., Rosenfarb, I. S., Cooper, L. D., & Grundt, A. M. (1999). The impact of acceptance versus control rationales on pain tolerance. The Psychological Record, 49, 33-47) study. Our aim was to test the effects of a nonspecific source of therapeutic change within the context of ACT therapy. Otherwise healthy undergraduates (N = 20) were exposed to a cold pressor task before, immediately after, and 10 min following one of the two interventions. Half of the participants also were assigned to a high demand characteristic condition in which the experimenter maintained close physical proximity, eye contact, and placed subtle social pressure on participants to please the experimenter. The results showed that the most important factor influencing latency to withstand the cold pressor task was social pressure. The acceptance-based intervention was more subject to demand than the control strategy. Evaluative ratings of pain were unaffected by the demand manipulation. The current data suggest that demand characteristics can exert a significant positive impact on the outcome of therapeutic protocols. The implications of this view for acceptance- and control-based psychosocial interventions are discussed.     

Inference suppression and semantic memory retrieval: Every counterexample counts

Reasoning with conditionals involving causal content is known to be affected by retrieval of counterexamples from semantic memory. In this study we examined the characteristics of this search process in everyday conditional reasoning. In Experiment 1 we manipulated the number (zero to four) of explicitly presented counterexamples (alternative causes or disabling conditions) for causal conditionals. In Experiment 2, using a generation pretest, we measured the number of counterexamples participants could retrieve for a set of causal conditionals. One month after the pretest, participants were presented a reasoning task with the same conditionals. The experiments indicated that acceptance of modus ponens linearly decreased with every additionally retrieved disabler, whereas affirmation of the consequent acceptance linearly decreased as a function of the number of retrieved alternatives. Results for denial of the antecedent and modus tollens were less clear. The findings show that the search process does not necessarily stop after retrieval of a single counterexample and that every additional counterexample has an impact on the inference acceptance.     

The role of values with personal examples in altering the functions of pain: comparison between acceptance-based and cognitive-control-based protocols

The purpose of the present study was twofold. First, to compare the effect of establishing a motivational context of values on pain tolerance, believability, and reported pain, with three experimental conditions: pain acceptance (ACT condition), pain control (CONT condition), or no values (untrained condition). Second, the study aimed to isolate the impact of adding the corresponding coping strategies to both the ACT and the CONT conditions. Thirty adults were randomly assigned to one of the three experimental conditions. The participants went through the pain task in two occasions (Test I and Test II). In Test I, the effects of the ACT-values protocol (which established pain as part of valued action), the CONT-values protocol (which established high pain as opposed to valued action), and the no-values protocol, were compared. In Test II, the effect of adding the corresponding coping strategy to each condition (defusion for ACT vs. suppression for CONT) was examined. Test I showed a clear superiority of the ACT-values protocol in increasing tolerance and lowering pain believability. In Test II, the superiority of the ACT protocol was replicated, while the CONT protocol proved useful to reduce reported pain, in accordance with previous studies.     

The effects of vicarious experience and stimulus intensity on pain termination and work avoidance

The purpose of the present investigation was to evaluate the role of vicarious experience in the acquisition of pain termination and work avoidance. Fifty-six experimental subjects were randomly assigned to view a film of a model who either terminated exposure to a pain stimulus and work task after 10 sec (high-avoidant) or 70 sec (low-avoidant). Following the film presentation, subjects were exposed to the pain stimulus and work task. Half of the subjects were randomly chosen to perform the task with a low-intensity pain stimulus (LP) and the other half performed the task while exposed to a high-intensity pain stimulus (HP). The results indicated that subjects in the high-avoidant model conditions (HA) did significantly less work and tolerated the pain stimulus for significantly fewer seconds compared to the low-avoidant model groups (LA). Subjects in the LP groups tolerated the pain stimulus significantly longer and did significantly more work compared to subjects in the HP groups. No significant interaction was observed. The results provide support for the hypothesis that behavioral reactions to pain can be acquired by vicarious experience. Implications for future research are discussed.     

Computer Monitoring of Work Performance: Extending the Social Facilitation Framework to Electronic Presence1

This study demonstrated the utility of employing a social facilitation framework to the study of computer monitoring of work performance. The physical presence of an observer watching a subject work on a complex task (as a supervisor might “look over an employee's shoulder“) was contrasted with four conditions involving the electronic presence of computer-based work monitoring (as a supervisor might monitor an employee's work remotely via computer) and a control condition of subjects working alone without any monitoring of their work. Task performance was severely impaired for participants who were monitored electronically as well as for those who were monitored “in person.” Two interventions, providing participants with a sense of control over their work conditions and monitoring participants as a group rather than as individuals, each reduced the negative impact of monitoring on task performance by almost 40%. Results also indicated that individuals with an external locus of control (who believe reinforcements received are primarily determined by factors outside of themselves, e. g., other people) experience greater anxiety than those with an internal locus of control under monitoring conditions. Implications of these findings for social facilitation and the rapidly expanding use of computer-based work monitoring are discussed.     

Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress

Wegner's Theory of Ironic Processes has been applied to study the effects of cognitive strategies to control pain. Research suggests that suppression contributes to a more distressing pain experience. Recently, the acceptance-based approach has been proposed as an alternative to cognitive control. This study assessed the tolerance time, the distress and the perceived pain intensity in three groups (suppression, acceptance and spontaneous coping groups) when the participants were exposed to a cold pressor procedure. Two hundred and nineteen undergraduates volunteered to participate. The suppression group showed the shortest tolerance time and the acceptance group showed the longest tolerance time. The acceptance group showed pain and distress immersion ratings that were significantly lower than in the other two groups, between which the differences were not significant. In the first recovery period, the suppression group showed pain and distress ratings that were higher than in the other two groups. In the second recovery period, although the acceptance group showed pain and distress ratings that were significantly lower than in the other two groups, the suppression and the spontaneous coping groups did not differ. The presence of a 'rebound' of physical discomfort and the effects of suppression on behavioural avoidance are discussed. These results support the acceptance approach in the management of pain.     

Imitation of Self‐Aggressive Behavior: An Experimental Test of the Contagion Hypothesis1

The purpose of the present study was to experimentally examine the influence of a self‐aggressive model on self‐aggressive behavior under controlled laboratory conditions. Participants (N= 94) were given the opportunity to self‐administer electric shock while competing with a fictitious opponent in a reaction‐time task. Participants observed the opponent self‐administer either increasingly intense shock (a self‐aggressive model) or constant low shocks (a non‐self‐aggressive model). Self‐aggression was defined as the intensity of shock that was self‐administered by participants. Results provide support for the notion that social information can influence the expression of self‐aggressive behavior. Specifically, participants attended to the opponent's shock choices in both model conditions, and chose shocks consistent with those of the observed model.     

Impacts of a Congestion Assistant on driving behaviour and acceptance using a driving simulator

In-vehicle systems that assist the driver with his driving task are developed and introduced to the market at increasing rate. Drivers may be supported during congested traffic conditions by a so-called Congestion Assistant consisting of a mix of informing, assisting and controlling functions. This paper describes the impacts of the Congestion Assistant on the driver in terms of driving behaviour and acceptance. Thirty-seven participants took part in a driving simulator study. The observed driving behaviour showed promising improvements in traffic safety when approaching the traffic jam. Moreover, positive effects of the system on traffic efficiency can be expected in the jam. The participants stated to appreciate the Congestion Assistant, although not all functions were equally rated. To increase the performance and acceptance of the total system, some refinements were suggested.     

Reward Influence on the Heart: Cardiovascular Response as a Function of Incentive Value at Five Levels of Task Demand

This study examined cardiovascular effects of incentive value in men and women confronted with cognitive challenges that were more and less difficult to meet. Participants performed computer memory tasks varying in difficulty from low to high, with instructions that they could earn chances toward a $100 prize or $10 prize by attaining a 90% success rate. Analysis of cardiovascular responses assessed during work revealed an interaction between difficulty and incentive value for heart rate. Participants' heart rate responses were proportional to task difficulty and unaffected by incentive value in all conditions except for the most difficult one. Where difficulty was greatest, $100 participants showed relatively high heart rate responsiveness, whereas $10 participants showed low heart rate responsiveness. This heart rate finding corroborates and extends cardiovascular results from previous experiments, and lends further support to the view that cardiovascular responses will be proportional to incentive value only under some task conditions.     

You are not alone – adolescents’ experiences of participation in a structured skills training group for ADHD

Little is known about how adolescents with attention deficit/hyperactivity disorder (ADHD) experience participating in group therapy, an important factor to consider when developing treatment methods for this age group. This study aimed to explore how adolescents with ADHD experience participating in a structured skills training group program based on dialectical behavioral therapy. Semi-structured interviews were conducted with 20 adolescents (15–18 years of age) with ADHD after participating in a structured skills training group. The interviews were transcribed verbatim and qualitative content analysis were used to analyze the text. The participants emphasized the value of meeting other adolescents with ADHD and the opportunity to exchange experiences, strategies and tips. Participating in the group treatment made the adolescents realize that they were not alone, and feelings of togetherness and an increased acceptance of themselves were described. The participants associated the treatment with elevated knowledge and understanding, for example, about ADHD, their own functioning and helpful strategies. They also described emotional and behavioral changes, such as higher self-esteem, fewer inter-personal conflicts and improved concentration. Activating and experiential exercises were considered important elements of the treatment, and the participants expressed a need for a variation of exercises, as well as more time for practicing skills, discussions and breaks. The results indicate that the group format add an extra value to the treatment and that the use of an active approach throughout the treatment is of importance for this group of patients.     

Shifts in attention biases in response to acute pain induction: examination of a model of "conversion" among repressors

Unlike most people, those who are characterized by a repressive coping style report high levels of physical (sensory) pain but low levels of emotional distress (affective pain), which is a discrepancy that may suggest a "conversion" process. In two studies, we tested an attention allocation model, proposing that repressors direct attention away from threatening negative affective information and toward nonthreatening physical pain information during emotionally arousing (painful) situations. In Study 1, 84 participants underwent a cold pressor and then recovered. Repressors reported greater pain during recovery than low- and high-anxious participants, but they reported lower distress than high-anxious participants. Repressors reported significant and large discrepancies between high pain and low distress, whereas these differences were less pronounced for other groups. In Study 2, 77 participants underwent an ischemic pain task while performing a modified dot-probe task with sensory and negative affective pain words as stimuli. Repressors showed increasing biases away from affective pain words and toward sensory pain words as the pain task continued, whereas low- and high-anxious participants did not show these shifts in attention. The results support the notion that conversion among repressors may involve a process by which attention is directed away from emotional distress during noxious stimulation and is focused instead on sensory information from pain.     

干扰任务对说谎影响的研究

摘要:本文将干扰任务对记忆的影响同测谎结合起来,试图运用这一方法来对求职者的真实学历和虚假学历进行区分。实验采用模拟面试的方式,对被试在有或无干扰任务条件下进行两次提问,结果发现,四种任务条件对被试真实经历和虚假经历都具有区分度,其中双双条件的区分度是最高的。并且,被试在双双任务条件下虚假经历的得分显著低于其他三种任务条件。     

Competitiveness and the Similarity of Preferred Coworkers1

The study investigated effects of different work contexts on the individual's desire to work with a similar or dissimilar coworker. Business students (N= 536) were assigned to 1 of 3 conditions (competitive task, skill‐development task, and nonspecific task) and were asked to describe their preferred coworker for that task. Individuals were expected to prefer coworkers whom they perceived as similar in noncompetitive situations, but those whom they perceived as dissimilar in competitive situations. Further, it was hypothesized that the type of similarity emphasized (skills, personal values, and personal style) would reflect the type of anticipated interaction. As expected, participants in competitive conditions chose coworkers with lower skills and generally dissimilar values and personal style. Coworkers selected for the skill‐development condition possessed similar skills and were more similar in values.