of psychological treatments for WAD. I will first provide important background for understanding what psychological interventions may be applicable and when they might best be applied. Subsequently, I will examine some of the treatments themselves and explore the results obtained to date. This is central since the field is facing major challenges in providing effective interventions that will prevent chronic WAD, rehabilitate those with persistent WAD, while at the same time being cost-effective and applicable to several clinical settings. Finally, given this great challenge, I will emphasize some ways in which the application of psychological interventions might be improved.
targeting the psychological factor noted and these listed will be examined more closely below. As Table 12-1 shows, several psychological factors on the behavioral, cognitive, and emotional planes come into play. Typically, WAD is associated with a traumatic injury (e.g., an automobile accident), and early research demonstrated a link between the injury and problems associated with Posttraumatic Stress Disorder (PTSD) . The injury also triggers pain and soft-tissue symptoms like swelling and stiffness. The Fear and Avoidance model is therefore particularly applicable during the early stage of the problem [58, 59]. Briefly, this model suggests that the pain triggers catastrophic thoughts and fear that focus attention on the injury and result in the avoidance of movements believed to be dangerous for exacerbating the pain and causing further injury. When the problem recurs or persists, this is thought to trigger more catastrophic worry, and a host of negative emotions including anger and frustration [14, 52]. The emotional distress and cognitive activity is believed to contribute to the problem and makes solutions more difficult. Anger, for example, is a prevalent reaction known to be related to chronic pain . Further, some patients may feel victimized since the accident was not their fault and they may have experienced problems in receiving adequate treatment . Increasingly, they may face important goal conflicts (e.g., on the one hand
wanting to participate in work, family, and social activities, while at the same time not wanting to exacerbate their pain or the injury) . This process may result in even more distress including shame and guilt, inflexible thinking patterns that make creative problem solving difficult and generally leave the individual vulnerable to a variety of additional problems such as unemployment, relational problems, and depression . This range of factors opens the door to a range of treatment interventions that might be initiated from the point of injury forward.
TABLE 12-1 Examples of Psychological Factors that Affect WAD According to the Time Point for Their Peak Relevance
central theme in these treatments is to focus on the trauma. In particular, exposure training (similar to that used for phobias) is employed where patients are gradually exposed until habituation occurs for the stimuli that trigger the symptoms. For those patients with a WAD diagnosis who also have PTSD, psychological treatment may offer clear help.
diagnosis often avoid movements they believe will exacerbate their pain or result in injury. Treatment is based on identifying movements that provoke this fear and therefore maintain avoidance, and then systematically exposing the patient to these movements to achieve extinction of the feared response.