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.     

Peripheral pain enhances the effects of incentive downshifts

Physical pain (induced by tissue damage) and psychological pain (induced by surprising incentive loss) share a set of common neural substrates, but little is known about their interactions. The present research studied such interactions using the formalin test to induce physical pain and consummatory successive negative contrast (cSNC) to induce psychological pain. In the formalin test, animals receive an intradermal injection of formalin (1%) in a hind paw. In cSNC, rats with free access to 32% sucrose show a sharp suppression of drinking behavior after a downshift to 4% sucrose, compared to rats that always receive 4% sucrose. In Experiment 1, formalin administration before the first and second 32-to-4% sucrose downshift trials enhanced cSNC. In Experiment 2, a similar treatment before the first downshift trial after a 16-to-4% sucrose downshift, which normally produces little or no evidence of cSNC, significantly increased cSNC. In Experiment 3, using a 32-to-4% sucrose downshift procedure similar to that of Experiment 1, no effects were observed following formalin administration immediately after Trial 11. Thus, no evidence was found that the effects of physical pain on cSNC were caused by changes in memory consolidation. The procedures used in these experiments offer a new approach to study the neural substrates of interactions between physical and psychological pain.     

Seeing bodies in pain: from Hippocrates to Freud

The study of pain has a history as long as that of Western medicine. In the 20th and 21st centuries much has been made about the epistemological problem of seeing somatic as well as psychic pain in the clinical setting. The two schools seem to be those which rely on self-reporting and those that rely on the interpretation of visual materials (expression or brain scans) by trained specialists. That this problem was central to the 19th century study of pain is clear as these origins (especially Darwin) are often cited in today's literature as 'proof' of their validity. That the problem was also central to one of the early 20th century thinkers most indebted to Darwin, Sigmund Freud, is less well known and how he resolved this paradox of self-reporting versus seeing seems to have been overlooked.     

Reflections on coma: Man deprived of his consciousness

In this paper the authors reflect on the phenomena produced by the surprising communication between the unconscious of a therapist and that of a comatose patient. In a particularly disturbing context, when the patient’s sternum is open and exposed, the therapist communicates empathically with the comatose person, identifying the patient’s inexpressible experience and generating signs of a response from him in the form of the blinking of his eyelids. The absence of any reaction to pain, a pathognomonic sign of the comatose condition, could be related to the splitting‐off of the trauma, as if the situation were frozen, through a denial of the sensory and neurological perception of pain – a kind of self‐anaesthesia as a defence against the catastrophic anxieties raised by the threat of the return of the primary trauma. Starting from this encounter a relationship is formed whose guiding thread emerges in the shared illusion of a regression that makes it possible. It involves a process of returning to the past and a re‐actualization of the past that includes the question of its change through representation.     

The points of concepts: their types,tensions, and connections

ABSTRACT

In the literature seeking to explain concepts in terms of their point, talk of ‘the point’ of concepts remains under-theorised. I propose a typology of points which distinguishes practical, evaluative, animating, and inferential points. This allows us to resolve tensions such as that between the ambition of explanations in terms of the points of concepts to be informative and the claim that mastering concepts requires grasping their point; and it allows us to exploit connections between types of points to understand why they come apart, and whether they do so for problematic ideological reasons or for benignly functional reasons.     

疼痛的心理学研究

心理学对疼痛的研究已经进行了几十年,成果颇丰。众多的研究已经证实了疼痛与基本心理过程之间的相互关系,包括注意、情绪、动机和记忆。除了基本心理过程外,社会因素也能够调节疼痛,如社会排斥、信仰、音乐、虚拟情境、金钱和权利等。已有疼痛研究中的疼痛测量方法过于主观,并且疼痛调节因素在临床中缺乏实践价值。当前疼痛研究呈现与具身思潮相结合的趋势,未来应更加重视发掘调节疼痛的社会因素。     

消费者决策分析的新视角:双通道心理账户理论

双通道心理账户是指人们在购买决策时具有一个双向通道的心理账户,其中一个通道记录了付款后消费者剩余的正效用,而另一个通道则记录了除去消费后付款带来的负效用.当消费与支付联结紧密时,会让人们更易想起支付的痛苦,从而降低消费快感,此时快乐弱化系数(α)大;当消费与支付联结较弱时,人们更不易记起支付的金额,从而在消费时拥有更多快乐,此时痛苦钝化系数(β)大.文章通过整理已有研究发现:先付款后消费的α系数更小,而先消费后付款的β系数更小;奢侈品的α系数更大,而必需品的β系数更大;吝啬者的α系数更大,而挥霍者的β系数更大.文章进一步阐述了影响消费者购买联结的心理机制是债务规避和负的时间偏好、支付贬值等.在此基础上为消费者做出购买决策以及商家选择促销方式提出了建议.同时也为消费者决策行为研究提供了新的视角和研究课题.     

麻醉科医师在晚期癌痛治疗中的作用

1986年WHO推出的“三阶梯”癌痛镇痛用药方案目前在临床工作中存在误区。麻醉科医师必须明确在晚期癌痛治疗转变中的责任和义务:具有专业能力、保健与防病能力,消除使用阿片类药物成瘾恐惧症;团队协作能力、新技术的评估能力,实行跨学科综合姑息保健;遵循生物心理社会医学模式,对晚期癌痛患者实施人文关怀。不仅会运用药物和医疗技术手段,还需配合心理和社会方面进行全面的诊疗,更好地为患者服务。     

从卦爻辞的内容看其性质

根据卦爻辞的形式和内容,我们把它分为三类;直接表述吉凶等断辞的;记述象占的;单纯纪事,无吉凶等断辞的。从性质上来说,《易经》是一部老皇历式的著作。卦爻画表示的是日历。直接表述吉凶的卦爻辞记述的是时日占候。记述象占的卦爻辞表述的是一些行为禁忌,其中的某些卦爻辞也应和时日有关系。单纯纪事的卦爻辞情况则较复杂,有些卦爻辞可能是祈使句,表示此卦爻所当时日内应做某事,有些则是记述的某时日内“名人”“名物”的事迹,供后人参考,有些则可能是些“半拉子工程”。     

高中生文理分科刻板印象的实验研究

采用2×4×2的重复测量的实验设计,探讨了性别是否会引起对于文理分科期望的刻板化加工以及刻板印象的意识性抑制问题,同时验证目前占主导地位的对范畴信息信任的减弱会增强对个体化信息的信赖这一假说。结果表明:(1)性别刻板印象会影响对文理科这种社会范畴的判断;(2)刻板印象比较顽固,较难受到意识性的抑制;(3)与刻板化信息完全相反的个体化信息的作用大于刻板化信息的作用,对刻板化信息的作用产生了一定的抑制,但无法完全抑制;(4)刻板印象与个体化信息的加工通路是平行的,同时它们彼此之间也是相互联系和限制的。