Acceptance versus distraction: brief instructions, metaphors and exercises in increasing tolerance for self-delivered electric shocks

The current study compared the effects of an acceptance versus distraction rationale on coping with experimentally induced pain. Eighty participants were randomly assigned to one of five conditions: Full-Acceptance, Full-Distraction, Instruction-only-Acceptance, Instruction-only-Distraction and No-Instructions. Participants completed a simple matching task and were intermittently given the choice either to receive an electric shock and continue, or to avoid the shock and terminate the task. Only the Full-Acceptance strategy (that included experiential exercises and a metaphor) had a significant effect on task tolerance as measured by an increase in the number of shocks delivered post-intervention relative to baseline. In addition, the participants in both of the acceptance conditions showed lower levels of believability in that they were more likely to continue with the task even when reporting more pain. The results support the prediction that acceptance-based interventions work by undermining the behavioural-control functions of pain-related thoughts and feelings, and call for a systematic analysis of how metaphors and exercises work in analogue research.     

疼痛治疗方法在晚期癌痛病人中的应用

癌症是当今严重威胁人类健康和生命的疾病之一。解除癌症疼痛对改善晚期癌症患者的生存质量、延长生存期都具有十分重要的意义。癌痛的诊断和合理的疼痛评估是治疗癌痛的基础。癌症疼痛的治疗方法虽有多种,但其目的就是使用最佳方法解除患者痛苦,消除疼痛,从而提高生存质量。因此本文从科学的角度对晚期癌痛的治疗方法进行评价和阐述。     

Why Ferenczi today? The contribution of Sándor Ferenczi to the understanding and healing of psychic suffering

A society undergoing rapid change, which doubts its own possibilities of survival, calls into question the worth of psychoanalytical theory and practice. The author emphasizes that the Ferenczian clinical evolution could be a source of inspiration for reinvigorating our trust in the prodromes of the Freudian paradigm, and thus for relaunching the authoritativeness of our thought and our psychotherapeutic method. In this light the author examines the affective and cognitive qualities that render Ferenczi a mentor of our possible future development, taking into consideration the following aspects: the communicative and intersubjective perspective that denotes Ferenczi's thought since his first writings; the receptive, reflective, and self‐reflective capacities which have progressively accompanied his own commitment and clinical attitude; and his elective work on trauma and “the traumatic”, including the algogenic messages transmitted during the healing process by analysts in fear (and perhaps terror) of their own regression and countertransferential catastrophe. In particular, these last events (central in the Ferenczian vision) are today specifically stimulated by new forms of pathology which search for, with our help, a resolution of the apathetic pain and the tearing apart of the identity that characterize the suffering of patients.     

Pain in children: A review of the literature from a developmental perspective

Abstract

This article presents a review of the current psychological literature about pediatric pain. Prevalence and types of pain problems encountered in children are considered briefly, followed by a developmental perspective on the experience of pain in children, encompassing physical, cognitive, social and behavioral factors. A discussion of the clinical significance of pain in children includes its use in differential diagnosis and the impact of pain on a developing child. Recommendations are made for assessing pain and factors relevant to managing its effects in children. The review concludes with an overview of clinical techniques for management, and recommendations for future research.     

Predicting behavioral outcomes with two psychological assessment methods in an outpatient pain management program

Abstract

In research with pain patients, the determination of psychological variables that can predict physiological gains would be helpful for practitioners doing assessments on pain patients. The present study used the Millon Behavioral Health Inventory (MBHI) and the Minnesota Multiphasic Personality Inventory (MMPI) to assess whether gains in time sitting, time standing, number of stairs climbed, time on a treadmill, treadmill speed, grip strength in both hands, and a composite score of these variables could be successfully predicted for patients at a 20-day outpatient multidisciplinary pain rehabilitation program. Discriminant analyses demonstrated that both the MBHI and the MMPI were successful in this prediction. Advantages for using the two instruments singly and together in assessment procedures and suggestions for future research are made.     

Posttraumatic Stress Disorder and Chronic Pain Arising from Motor Vehicle Accidents: Efficacy of Interoceptive Exposure Plus Trauma-Related Exposure Therapy

Preliminary data are presented on the pattern of treatment response of combining interoceptive exposure (IE) with trauma-related exposure therapy (TRE) in five female patients with posttraumatic stress disorder (PTSD) and comorbid chronic musculoskeletal pain originating from motor vehicle accidents. Treatment consisted of four sessions of IE followed by eight sessions of TRE. Four participants reported a reduction in PTSD symptoms after completing treatment, and three no longer met diagnostic criteria for PTSD. Although both interventions were associated with reductions in PTSD symptoms, TRE was associated with greater reductions in PTSD symptoms than IE and was particularly effective at reducing avoidance. IE was associated with larger reductions in anxiety sensitivity than TRE. Pain symptoms lessened slightly during IE and then worsened following TRE. Anxiety decreased after completing treatment, whereas panic and depressive symptoms responded less so. Three individuals completed a 3-month follow-up assessment. There was no change in their PTSD diagnostic status, and all experienced a slight loss of pre–post gains, particularly involving the return of pain. Clinical and research implications are discussed.     

慢性疼痛与心理障碍

疼痛是一种复杂的心理生物学过程。疼痛的感知和情绪活动密不可分,疼痛是一种包括感觉、情绪和认知的多维性体验,人与人之间差异很大,甚至同一个体也随疼痛的背景、意义以及心理状态而异。认知因素和情感因素对疼痛感知具有非常重要的影响。本文回顾疼痛认知和情感状态调节（身心治疗的重要组成部分）潜在的神经学机制。回顾慢性疼痛本身会改变大脑环路、包括参与内源性疼痛调节的循证证据,这些证据表明随着疼痛转为慢性,控制疼痛越来越困难。     

Children's racial bias in perceptions of others' pain

Previous research indicates that American adults, both Black and White, assume a priori that Black people feel less pain than do White people (Trawalter, Hoffman, & Waytz, 2012, PLoS One, 7 [11], 1–8). The present work investigates when in development this bias emerges. Five‐, 7‐, and 10‐year‐olds first rated the amount of pain they themselves would feel in 10 situations such as biting their tongue or hitting their head. They then rated the amount of pain they believed two other children – a Black child and a White child, matched to the child's gender – would feel in response to the same events. We found that by age 7, children show a weak racial bias and that by age 10, they show a strong and reliable racial bias. Consistent with research on adults, this bias was not moderated by race‐related attitudes or interracial contact. This finding is important because knowing the age of emergence can inform the timing of interventions to prevent this bias.     

自我-他人重叠影响疼痛共情的ERP研究

为探究自我-他人重叠影响疼痛共情的神经机制,记录并分析被试在高、中、低重叠程度条件下共情判断的脑电活动。发现在早期N2上,重叠程度三水平间差异显著,表现为密友＜熟人＜陌生人（密友与熟人差异边缘显著）;在晚期P3上,疼痛条件下重叠程度间呈显著差异,密友比熟人、陌生人显著要大;在LPP上疼痛条件诱发更大波幅。表明早期阶段（N2）区分不同重叠程度,可能是对威胁性刺激的检测阶段,自我-他人重叠程度影响共情加工晚期阶段（P3）的社会认知评价加工。     

Personality disorders and response to outpatient treatment of chronic pain

As part of a comprehensive interdisciplinary evaluation conducted prior to participation in an outpatient chronic pain treatment program, the psychological status of 101 persons was assessed. The majority of participants was found to have a form of personality disorder, determined by conservative cutoff scores applied to their Millon Clinical Multiaxial Inventory (MCMI) profiles. DSM-III-R Cluster C disorders (i.e., Avoidant, Dependent, Obsessive-Compulsive, and Passive-Aggressive) were overrepresented in this sample. Subsequent analyses revealed that personality disorders were related to higher levels of self-reported distress and pain at both the beginning and the end of outpatient treatment. Differential responses to treatment were observed on self-report measures; however, few relations were found between personality disorder and physical therapist ratings of impairment and improvement. Implications for the assessment of personality disorders in outpatient pain treatment programs are discussed and appropriate intervention strategies are considered.