Testing a Cognitive-Behavioral Treatment Model for Chronic Pain
Cognitive-behavioural conceptualisations of chronic pain (Catalano & Hardin, 1996; Fordyce, 1976; Pilowsky, 1986; Sarno, 1991; Turk & Meichenbaum, 1994), suggest that common predisposing factors are (1) alexithymia (a trait of limited awareness of different emotional states, inability to express emotional states in general); (2) external locus of control (attribution of causes of problem to others or to situations outside their control and absence of a proactive problem-solving approach); (3) A history of learned pain behaviours. Typical precipitating factors are an injury or illness episode associated with pain and a period of exposure to unusual stressors. Maintaining factors include: (1) Belief that best thing to do is to rest. This results in inactivity and attentional focus on site of pain and may lead to decreased blood flow to muscles and weakening of muscles which increases pain sensitivity; (2) Depression which increases focus on pain and increases sensitivity to pain; (3) Anxiety also increases focus on the pain and causes muscle tension; (4) Muscle tension related to unexpressed anger can also exacerbate the problem; (5) Secondary gain: Expectation of reinforcement from family members in the form of nurturance and relief of responsibilities.
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