Abstract
Co-occurring emotional distress and chronic pain are a true challenge in the clinic. This combination of symptoms is quite common but associated with poor treatment results, frequent relapses and costly dysfunction. This paper describes a transdiagnostic approach to the problem by focusing on psychological processes that drive both the emotional as well as the pain problem. Avoidance and context (in)sensitivity are suggested as potential transdiagnostic factors that might be targeted in treatment. Since both pain and distress are aversive, they may be avoided. This may be helpful in the short-term, but paradoxically the avoidance maintains the problem in the long-term. Context sensitivity concerns how well our responses are in tune with the changing demands of the environment. We propose that context insensitivity may drive emotional distress and pain problems. We present data that show that disclosure of pain is important emotionally, but that it is also a challenge to respond in manner that is sensitive to the social context. Indeed, disclosing how we feel emotionally or concerning pain might be helpful in some situations, but enhance the problem in others. Finally, we outline a hybrid treatment that combines exposure for pain (feared movements) and emotions (disclosure) with context sensitivity training. While such new treatments are promising, there remains a dire need for more clinical research to test and improve treatments for co-occurring emotional distress and pain.
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References
Aldao, A., & Nolen-Hoeksema, S. (2012). The influence of context on the implementation of adaptive emotion regulation strategies. Behaviour Research and Therapy, 50(7), 493–501.
Bonanno, G. A., Colak, D. M., Keltner, D., Shiota, M. N., Papa, A., Noll, J. G., et al. (2007). Context matters: The benefits and costs of expressing positive emotion among survivors of childhood sexual abuse. Emotion, 7(4), 824–837.
Bonanno, G. A., Papa, A., Lalande, K., Westphal, M., & Coifman, K. G. (2004). The importance of being flexible the ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychological Science, 15(7), 482–487.
Coifman, K. G., & Bonanno, G. A. (2010). When distress does not become depression: Emotion context sensitivity and adjustment to bereavement. Journal of Abnormal Psychology, 119(3), 479–490.
Craig, K. D. (2003). A new view of pain as a homeostatic emotion. Trends in Neurosciences, 26, 303–307.
Ehring, T., & Watkins, E. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205.
Flink, I., Boersma, K., & Linton, S. J. (2013). Pain catastrophizing as repetitive negative thinking: A development of the conceptualization. Cognitive Behaviour Therapy, 42(3), 215–223.
Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132(6), 823.
Gross, J. J. (2007). Handbook of emotion regulation. New York: The Guilford Press.
Harvey, A., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford: Oxford University Press.
Klein, S. B. (1996). Learning: Principles and applications (3rd ed.). New York: McGraw-Hill.
Koerner, K. (2012). Doing diablectical behavior therapy: A practical guide. New York: The Guilford Press.
Linehan, M. M. (2014). DBT ® skills training manual. New York: Guilford Publications.
Linton, S. J. (2005). Understanding pain for better clinical practice. Edinburgh: Elsevier.
Linton, S. J. (2013). A transdiagnostic approach to pain and emotion. Journal of Applied Biobehavioral Research, 18(2), 82–103.
Linton, S. J. (2016). Improving psychologically oriented treatments for Whiplash Associated Disorders. In H. Kasch, D. C. Turk, & T. Jensen (Eds.), Whiplash injury: Perspectives on the development of chronic pain. New York: Walters Kluwer.
Linton, S. J., & Bergbom, S. (2011). Understanding the link between depression and pain. Scandinavian Journal of Pain, 2(2), 47–54.
Linton, S. J., & Fruzzetti, A. (2014). A hybrid emotion-focused exposure treatment for chronic pain: A feasibility study. Scandinavian Journal of Pain, 5(3), 151–158.
Lippert, T., & Prager, K. J. (2001). Daily experiences of intimacy: A study of couples. Personal Relationships, 8(3), 283–298.
McCracken, L. M., & Morley, S. (2014). The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management. The Journal of Pain, 15(3), 221–234.
McEvoy, P. M., Nathan, P., & Norton, P. J. (2009). Efficacy of transdiagnostic treatments: A review of published outcome studies and future research directions. Journal of Cognitive Psychotherapy, 23(1), 20–33.
Merskey, H., & Bogduk, N. (Eds.). (1994). Classification of chronic pain (2nd ed.). Seattle, WA: IASP Press.
Nicholas, M. K., Linton, S. J., Watson, P. J., & Main, C. J. (2011). Early identification and management of psychosocial risk factors (“Yellow Flags”) in patients with low back pain: A reappraisal. Physical Therapy, 91, 737–753. doi:10.2522/ptj.20100224.
Pennebakker, J. W. (1990). Opening up: The healing power of expressing emotions. New York: Guilford.
Radcliffe, A. M., Lumley, M. A., Kendall, J., Stevenson, J. K., & Beltran, J. (2010). Written emotional disclosure: Testing whether social disclosure matters. Journal of Social and Clinical Psychology, 26(3), 362.
Schrooten, M. G., Vlaeyen, J. W., & Morley, S. (2012). Psychological interventions for chronic pain: reviewed within the context of goal pursuit. Pain Management, 2(2), 141–150.
Skinner, B. (1965). Science and human behavior. New York: The Free Press.
Sullivan, M., Adams, H., Horan, S., Maher, D., Boland, D., & Gross, R. (2008). The role of perceived injustice in the experience of chronic pain and disability: Scale development and validation. Journal of Occupational Rehabilitation, 18(3), 249–261.
Trost, Z., Vangronsveld, K., Linton, S. J., Quartana, P. J., & Sullivan, M. J. L. (2012). Cognitive dimensions of anger in chronic pain. Pain, 153(3), 515–517.
Van Damme, S., Crombez, G., & Eccleston, C. (2008). Coping with pain: A motivational perspective. Pain, 139(1), 1–4.
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85, 317–332.
Vlaeyen, J. W. S., & Linton, S. J. (2012). Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain, 153, 1144–1147.
Vlaeyen, J. W. S., Morely, S. J., Linton, S. J., Boersma, K., & de Jong, J. (2012). Pain-related fear: Exposure-based treatment for chronic pain. Seattle: IASP.
Webb, T. L., Schweiger Gallo, I., Miles, E., Gollwitzer, P. M., & Sheeran, P. (2012). Effective regulation of affect: An action control perspective on emotion regulation. European Review of Social Psychology, 23(1), 143–186.
Williams, A., & Schäfer, G. (2016). How do we understand depression in people with persistent pain? Journal of Contemporary Psychotherapy. doi:10.1007/s10879-016-9325-8.
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This research was supported by a Grant from The Swedish Foundation for Humanities and Social Sciences, grant number P14-0799:1.
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For the data reported, all procedures were in accordance with the ethical standards of the institution and the 1964 Helsinki declaration and its later amendments and informed consent was obtained.
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Linton, S.J., Flink, I.K., Schrooten, M.G.S. et al. Understanding Co-occurring Emotion and Pain: The Role of Context Sensitivity from a Transdiagnostic Perspective. J Contemp Psychother 46, 129–137 (2016). https://doi.org/10.1007/s10879-016-9323-x
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DOI: https://doi.org/10.1007/s10879-016-9323-x