health psych pain + coping with chronic illness ( post midterm 2)

The importance of pain (why do health psychologists study it?) 

• Common complaint (most americans experience pain everyday) 

• Huge financial cost → annual cost of $530 to $722.8 billion in USA

• Symptom most likely = care seeking 

• Common fear for illness and treatment

What does health psychology have to offer in terms of pain/healthcare?

• Psych can help with How can we measure pain? Pain is subjective so health psychology can help with this. 

• What is the impact of pain?

• What psychosocial factors predict the experience of pain?

• How can we help people manage pain?

Gate control theory of pain overview

• Early model addressing role of psychology in pain (Melzack and Wall, 1965, 1982) 

• When do we experience pain? What psychological factors influence this?

Gate control theory of pain steps of experiencing pain:

1. Injured body tissue 

2. Nociceptors transmit impulse to the dorsal horn region. 

1. A-delta fibers=fast, sharp pain 

2. C-fibers= slow, dull pain

3. Some impulses sent on to the bain = experienced pain. Subjective experience of pain. Only some impulses make it to the brain. 

A-delta fibers

fast, sharp pain

C-fibers

slow, dull pain

Why do only some impulses reach the brain? In GCToP

• A gate controls whether pain signals reach the brain. 

• Gate open= pain 

• Gate closed= less likely to experience pain

what controls the gate? GCToP

• Competing signals 

• Psychological factors 

Competing signals close gate factors in experiencing pain GCToP

• Other signals could be: pressure, heat, cold, pain

• Ex: getting shot so pinch fingers, rub leg cramp 

• counterirritation pain control

counterirritation pain control

• inhibit pain by stimulating another part of the body. Bottom-up process. 

Psychological factors and GCToP

• Brain can also control gate. 

• Central control mechanisms 

1. Anxiety opens gate

2. Relaxation closes gate 

3. Distraction closes gate 

• Ex: delayed pain: runner during race does not feel pain until race is over. The game is too distracting so that the runner does not realize it until later. 

Gate control theory of pain takeaway:

• Explains why same event can be perceived differently 

• Suggests we can control pain experience 

• Older theory

modern theories in comparison to GCToP

• Modern theories place greater emphasis on the brain 

• Ex: Ability to feel pain without sensory input. (skipping step 1 of GCToP)

• Ex: phantom limb pain 

• More top down process that excludes any physical injury.

social support

information from others that one is loved and cared for, esteemed and valued, and part of a network of communication and mutual obligation 

Social support and pain

• In general, greater social support is associated with lower pain. More support= less pain.

Social support and pain why?

• Adaptive coping strategies are used more

• Changes appraisals: knowing someone is there makes the pain feel more manageable.

• Express emotions: venting about pain helps regulate negative emotions

ways to induce pain ethically in the lab

• Cold pressor task: arm gets placed in cold water to create mild pain.

• Thermal stimulation: metal plate touching skin that can heat up and cool down quickly. This raise and fall prevents tissue damage. 

What type of support reduces pain? Master et al. 2009

questions

• Support partner vs. stanger?

• Support partner vs a simple reminder of the partner?

• Is social support just a distraction?

What type of support reduces pain? Master et al. 2009

set up

• Female participants with a long-term romantic partner 

1. Pain threshold determined with each participant as pain is very subjective.  

2. Arm placed behind a curtain 

3. Thermal stimulations under 7 different conditions: 

• Holding hand: either partner’s hand, stranger’s hand, object (ball)

• Photo: looking at partner, stranger, chair 

• Fixation only: control 

4. Rate pain using Gracely box scales 0-20 scales 

5. Reaction time to beeps included too as a way to test if it was just distraction between the groups: 

• no differences across conditions found.

What type of support reduces pain? Master et al. 2009

results

• Pain ratings compared to fixation-only control: lower numbers= less pain

• Holding condition: partners hand made the most difference as it has the lowest pain ratings. However, the photo verison of the partner had the lowest scores overall. Holding a stranger's hand had the highest pain rating. 

• Photo condition: partner group had significantly lower scores of pain. 

• partner , but not stranger, hand holding had lower pain 

• Even a photo of a partner had lower pain 

• Not more distracting. Feeling loved and supported impacts pain. 

What might explain results in Master et al. 2009

• Holding a stranger’s hand might be socially weird=stress=more pain?

• Photos may sometimes work better than the real thing?

• Partners vary in ability to provide support?

Guillory et al. 2015 questions (social support)

• Can social support via text messaging reduce pain during surgery?

• Can strangers provide support (in a non-holding example)

• How does text messaging compare to distraction?

distraction impact on pain (Guillory et al. 2015 questions (social support))

distraction is associated with less acute pain: music being played during surgery. VR and dental procedures

Texting support vs. something that should work: disraction as an active control 

Guillory et al. 2015 questions (social support)

set up

• Patients receiving regional anesthesia for minor surgeries, randomly assigned to one of 4 conditions: 

1. Texting a close friend or family member during the procedure 

2. Texting a stranger during the procedure

3. Distraction: playing a game during the procedure

4. Control: nothing 

Guillory et al. 2015 questions (social support)

what was measured

Measured: pain rated during the procedure, and opioids given/requested.

Outcome: painkiller dosage→ more amounts = more pain they were feeling

Guillory et al. 2015 questions (social support)

results

• Control had highest amount of painkiller dosage 

• Texting a stranger was pretty effective in decreasing pain compared to game and control 

• Text a companion was higher than texting a stranger, not significantly though 

Guillory et al. 2015 questions (social support)

overall meaning

• Stranger = lower pain than distraction and control 

• Companion: lower pain than control 

• Texting conditions did not differ

Guillory et al. 2015 questions (social support)

Why did strangers work best?

• Strangers' texts were more exmotionally positive and affirming. 

• Companions’ texts were more biological terms. 

Wrong type of support

punishing responses (creating anger, ignoring)

solicitous responses

solicitous response

• positive attention, sympathy, taking over duties. Enables you. makes you inactive

Why is solicitous response bad

• why bad: Inactivity increases risk of: further pain, distress, isolation, physical  deconditioning. 

• Disuse syndrome= lower pain threshold 

Matching hypothesis

different kinds of sttessful/painful events create different needs. Social support is most effective when it meets those needs.

Some needs from experiencing pain:

• Emotional support

• Information or advice 

• Tangible assistance

adjustment

the absence of diagnosed psychological disorder, psychological symptoms, or negative mood. 

important aspects of adjustment

• Adjustment is dynamic not linear 

• Considerable variability in adjustment to chronic illness

theory of cognitive adaptation (taylor 1983)

• How do we adjust to threatening events?

• 
  

• Coping consists of three processes:

• A search for meaning (why did this happen to me?)-

• A search for mastery (how do I find control) 

• A process of self enhancement (how do I feel about myself) 

• 
  

• Focus on reestablishing equilibrium and status quo 

A search for Meaning: causality and implications main question

• Why did this happen to me? And what impact has it had on my life? 

Search for cause

• Often can not know cause in reality even if people look for it

• Make attributions in order to understand and predict environment

Taylor et al., 1984: cancer patients  search for cause

• 95% of them had identified the cause of their cancer. 

• Causes current and past

• Changeable or not

• Finding the cause is more important than the type of cause → we need to “know” why. 

Meaning: implications question

• What meaning has my illness had for my life?

meaning implications of illness on life

• Over half of cancer patients reported reappraising life:

-Reprioritization

-Self-knowledge

• Finding meaning contributes to adjustment 

What are two common ways cancer patients reappraise their lives post-diagnosis?

• Reprioritization (shifting values, e.g., family over work)

• Self-knowledge (redefining identity, e.g., "Am I a fighter?") e.g., "Who am I now?", "Am I optimistic?", "Who do I want to be?").

Mastery on illness

• Chronic illness can undermine sense of control of body and life

• 66% of patients believe they can influence course or reoccurrence of cancer by doing ⅓ of these things

• Feelings of control associated with adjustment 

How do people find control? (mastery)

Through Mental and behavioral techniques: 

• Positive attitude/ thinking → positive attitudes will give me control of illness outcome 

• Education → learning about illness gives me control of illness 

• Changing lifestyle → changing diet, stop smoking, and that will give me control of illness a

self enhancement and adjustment

• Adjustment involved restoring self-esteem 

• We make sense of our world by comparing ourselves to others 

• Lumpectomy patient: at least I didn’t have to have a mastectomy like others 

upward vs downward comparisons

-Upward and downward social comparisons. (comparing ourselves to those who are better than us or worse than us. Downward comparisons can help with self esteem) 

theory of cognitive adaptation diagram

• Overall these are positive illusions. Helps with adjustment 

how do illusions help adaptation

• Based on theory, illusions are essential to cognitive adaptation.

Positive interpretation of reality 

• I understand cause 

• I can control if I get better 

• I am doing better than others 

what happens when illusions are disconfirmed? Ex: what if someone does something to prevent cancer from happening but what happens if it does anyways. 

• People adapt: new cause or new mastery over treatment not reoccurrence. 

Application of theory of cognitive adaptation (Lee et al., 2006) question

Does promoting meaning improve well-being among cancer patients?

Application of theory of cognitive adaptation (Lee et al., 2006) set up

• Patients randomly assigned to one of two conditions:

-Treatment as usual: no formal psychological support (support groups available )

-Meaning-making intervention

• Meaning-making intervention: story telling approach (“lifeline exercise) drawing a timeline and having all the positive and negative events. 

-Tell your story 

-Asking questions to allow patients to explore:

-Why did this happen (cause)

-Good and bad events since diagnosis (implications)

-Changes in life priorities (implications) 

summary of theory of cognitive adaptation

• Theory addresses positive adjustment to the onset of disease 

-Poor adjustment reflects failure to create or sustain “illness”

• Large body of research providing evidence that self-esteem, optimism, and control all have higher psychological well-being

• Provides a framework for thinking about how to help people adjust

Post traumatic growth (PTG) (Tedeschi and Calhoun 1996)

Can coping lead us to perceive life is better than before illness?

: positive change after a negative event 

PTG theory is for negative events that are:

• Extremely undesirable and intense

• Cause a breakdown in past and future assumptions of life

What is PTG? 6 parts

• Better appreciation of life than before diagnosis 

• A better sense of personal strength 

• A better relationship with others 

• A deeper spirituality 

• Recognition of new possibilities. 

• A change of behavior in the interest of better health 

How common is PTG?

• 8%-83% in at least one life domain 

Graph here shows that 80% or more have more compassion for others 

PTG summary

• People with chronic health conditions not only adjust but may also report their lives improve 

• PTG is fairly common and positively associated with positive outcomes

PTG critiques

The concept of PTG not universally accepted

• Is PTG really different from adjustment? Is PTG just an illusion?

• How do we know if someone has grown or it is the illusions of growth?