CHAPTER 43 PSYCHOLOGICAL CONSTRUCTS AND TREATMENT INTERVENTIONS Dennis Thornton, PhD, Charles E. Argoff, MD 1. List three possible psychological mechanisms for pain The first purely psychological mechanism that worsens pain is somatization. Psychic distress and conflict are converted into somatic complaints in an unconscious attempt to reduce intrapsychic tension. A second mechanism is psychosomatic: underlying muscle tension results in regional discomfort. Although this may be difficult to prove by examination, the fact that relaxation techniques and the use of anxiolytic drugs provide relief lends credence to the theory. The third psychological mechanism for pain represents the rare occurrence of somatic delusions or hallucinatory pain. These phenomena may occur in schizophrenia or in cases of severe depressive illness. 2. Why is it important to recognize the manifestations and processes of somatization? Expression of psychic distress via physical symptoms is universal. Up to two thirds of patients visiting a primary care service report at least one unexplained somatic symptom. In our society the prevailing belief is that more attention will be given to medically based problems over psychologically based ones. This then contributes to a preference to convey concerns with organically referenced language. 3. What are some pointers to keep in mind when evaluating the patient with nonspecific complaints? It is important to appreciate how the patient’s decision to seek help and the manner in which symptoms are described are shaped by social context. Potential factors include position in the life cycle, marriage satisfaction, job status and satisfaction, level of affective distress, and the presence of any personal crisis. 4. Name three contemporary conceptual models to help understand the process of somatization The transduction model can be seen as an extension of the concept of conversion, where emotional distress is unconsciously “transduced” into bodily sensations for which there is no physiological basis. The illness behavior model places emphasis on cognitive and appraisal factors, and sees environmental pressures and rewards as shaping health care decisions. The choice model postulates that cultural factors sanction the presentation of symptoms in somatic terms as a means of avoiding the stigma of mental illness. 5. Identify the salient tenets of the biopsychosocial model Instead of assuming the hierarchical perspective that ruling out organic disease precedes exploration of psychosocial issues, the biopsychosocial model attempts to incorporate all aspects of the human condition and place the presenting symptoms in a broader whole life context. 6. What are some points from the biopsychosocial model to try to incorporate into the patient evaluation? Avoid using blaming language if the patient presents with symptoms that do not make sense medically or do not improve with initial treatment. Attempt to reframe the symptoms in terms that reduce the need to classify the problem exclusively as either organic or psychological. Touch the symptom site during the physical exam. Suggest consideration of appropriate noninvasive, complementary treatments. Place emphasis on improved functioning rather than curing the disease as the outcome criterion. Educate the patient regarding body mechanics, adherence to treatment recommendations, and limitations and potential disadvantages of additional tests and/or procedures that you believe to be unnecessary. Open the discussion to touch upon psychosocial factors early on, rather than waiting until treatments have failed. 7. Are the same psychosocial factors present in all pain patients? No. There are a variety of pathways by which individuals can come to display pain behaviors. Histories of being raised in dysfunctional homes with abuse, alcoholism, or mental illness are common in chronic pain patients. The resulting harsh superego is reflected in alcohol and drug abuse, self-sabotaging behaviors, marital discord, suicide attempts, and workaholism. An injured worker may experience not only the loss of employment but also an absence of personal gratification and a diminished sense of self, leaving him vulnerable to reemergence of anger, depression, and other negative emotions repressed from childhood. Such dynamic factors then negatively influence the patient’s ability to invest in, and benefit from, psychological interventions. 8. What is the relevance of psychoanalytic theory to understanding the experience of pain? Psychoanalytic theory divides the psyche into three functions: the id—unconscious source of primitive sexual, dependency, and aggressive impulses; the superego—subconsciously interjects societal mores, setting standards to live by; and the ego—represents a sense of self and mediates between realities of the moment and psychic needs and conflicts. Psychoanalytic writings discuss how pain frustrates the satisfaction of dependency and sexual needs as well as appropriate dissipation of aggressive feelings. The blocked expression of these needs leads to inner turmoil. However, when sanctioned as a bona fide physical problem, pain allows for unconscious gratification of ambivalent dependency needs. Underlying anger may be expressed indirectly, in the form of passive-aggressive behaviors, whereby the patient holds family members and treating practitioner alike as hostages to endless complaints and demands for attention. The experiences of pain satisfy the superego’s need to suffer and atone. 9. From a psychoanalytic perspective, how can the experience of pain be employed as a defense mechanism? Pain can be viewed as an ego defense mechanism in that the focus on somatic sensations deflects attention from intrapsychic conflicts and anxieties. The experience of physical pain is unconsciously perceived as more acceptable than the emotional pain. The patient represses his fears of loss and rejection, and the tension from these conflicts is displaced onto the body. The ensuing chronic pain behavior then serves as a form of interpersonal communication. Individuals frustrated and angry over their inability to alter their life situation in turn baffle health care professionals who attempt to treat the physical complaints, which are symbols of the underlying emotional pain. 10. What is meant when pain patients are described as experiencing some form of “gain” from their pain experience? The construct of gain is described in three basic forms—primary, secondary, and tertiary—all of which are means by which pain behaviors are reinforced. 11. What is primary gain? Avoidance of a psychic conflict by converting it to a physical ailment is a primary gain the patient experiences from his or her pain. This conversion process is usually interpreted as a defense against anxiety or as a compromise solution of unconscious conflicts. While the underlying conflict is kept out of consciousness, the conflict remains unresolved and there is a continued buildup of psychic tension always ready for discharge. The anxious individual then discharges the pent-up energy by responding to ordinary or mildly painful stimuli in an exaggerated way. 12. How is the term secondary gain applied? Secondary gain applies to factors that reinforce the display of pain-related behaviors. The reinforcing factors alluded to are most commonly litigation and disability payments. However, demonstration of caring and concern is also a factor. Under these circumstances, there is a perceived incentive for the patient to persist in the complaint of pain. If the pain is resolved, the plaintiff’s case will be weakened, or the love may be lost. Similarly, the injured worker who is partially improved may be pressured to return to work. Feeling in a weakened state, not ready to resume full responsibilities, the patient finds it easier to retreat into pain rather than face the threat of attempting to return to functioning and failing. 13. How is tertiary gain different from primary and secondary gain? Where constructs of primary and secondary gain apply to the individual, tertiary gain is external to the patient and involves family members or significant others who benefit from directly or indirectly reinforcing pain behaviors. The gain may be that interpersonal or family problems are suppressed as long as the patient remains ill; for example, a parent who feels inadequate successfully avoids having to work and interact with the world by caring for an ill child. By continuing to report that the child is symptomatic, the parent has a face-saving excuse for remaining dysfunctional. Similarly, the angry spouse may undermine the patient’s efforts toward regaining independence because a new balance has been achieved with the advent of chronic pain and disability. 14. Name some characteristics often associated with chronic pain syndromes Preoccupation with pain Strong and ambivalent dependency needs Characterologic masochism (meeting other people’s needs at one’s own expense) Inability to take care of self-needs Passivity Lack of insight to deal appropriately with anger and hostility Use of pain as a symbolic means of communication 15. What is meant by the term pain-prone disorder? The concept of a pain-prone personality evolved from psychodynamic theory. The dynamic was created to codify the process by which intrapsychic conflicts predisposed the individual to seek expression for repressed feelings in the form of somatic, particularly painful, complaints. Chronic pain was viewed as a variant of depression, even though patients might see themselves as not depressed but suffering from physical ailments. In this light the depressive symptoms were “masked.” 16. Is the concept of “masked depression” still accepted as a relevant theory? Proponents of psychodynamic theory believe that individuals with repressed conflicts are less distressed expressing their dependency needs through physical rather than emotional symptoms, because the former are more socially acceptable. However, it is extremely difficult to conduct research to confirm this theory. As investigators inquire more into this issue, there is mounting evidence that the experience of chronic pain and the negative lifestyle changes imposed by it constitute a major life stressor and that dysphoria is a frequent consequence. Of course, a multitude of factors, including a premorbid vulnerability for depression, can make some individuals more vulnerable to the development of a major depressive disorder in response to the advent of chronic pain. 17. How has learning theory been applied to the field of chronic pain? Learning theory proposes that there are two classes of responses that can be displayed by an organism: respondents and operants. Respondents are essentially reflexive in nature and are under the control of the antecedent stimulus, like Pavlov’s dog being trained to salivate at the sound of the tone preceding the presentation of food. In contrast, operants involve actions potentially subject to voluntary control. Here the magnitude of the response depends on the nature and duration of the antecedent stimulus. In this sense, the behavior is under the control of the environmental consequences (reinforcements) and is, therefore, time-limited. In terms of chronic pain, the theory suggests that if the behavior (e.g., moaning) is positively reinforced (by attention from others), it will increase in relation to the amount of reinforcement received and the meaning of that consequence (attention) to the person. Conversely, if the behavior is not reinforced (others ignore the moaning), the behavior will gradually extinguish. This learning theory model has been presented as an alternative to the medical model to explain how individuals evolve into chronic pain patients: their pain-related behaviors are reinforced by those around them. 18. According to learning theory, what are the three principal pathways by which chronic pain syndromes develop? Operantly acquired pain behaviors are maintained through the following three basic pathways, which are not mutually exclusive: Direct and positive reinforcement of pain behavior Indirect but positive reinforcement of pain behavior by avoidance of adverse consequences Failure of well behavior to receive positive reinforcement 19. Give two examples of direct and positive reinforcement of pain behaviors Continued rest can become a major positive reinforcer of pain behavior. If certain movements result in pain, the person is less likely to perform such behaviors and will instead rest in bed. Initially, this may decrease the level of discomfort (direct positive reinforcement). However, as the overall activity level decreases, so does the pain tolerance, resulting in longer and longer rest periods and a downward spiraling in general functioning. Rest, as a pain contingent reinforcer, becomes self-perpetuating. Analgesic medications provided on an as-needed basis can also foster pain behaviors. In both acute and chronic pain circumstances, patients may feel forced to take the attitude: “If the doctors will not keep me comfortable, I will have to complain and exaggerate my pain to get relief.” In many inpatient programs, the cycle of drug-related pain behaviors is disrupted through detoxification. 20. Can others, aside from health professionals, reinforce pain behaviors? Monetary rewards play a significant role in the maintenance of pain behaviors in a substantial proportion of chronic pain patients. Another example of how others impact the display of pain behaviors was demonstrated in a study that examined how chronic pain patients, participating in an inpatient pain program, acted in the presence of their spouses in comparison to how they acted in the presence of the staff. The spouses were classified as either solicitous or nonsolicitous, with the former group described as responding to patients’ pain behaviors in a manner that would reinforce the display of such behavior. As expected, patients with solicitous spouses displayed pain-related behaviors more frequently in the presence of their spouses than when interacting with neutral staff, who did not reinforce these behaviors. Patients with nonsolicitous spouses did not show an increase in frequency of pain-related behaviors in the presence of their mates. 21. Provide an example of indirect reinforcement (avoidance learning) of pain behaviors Much of our everyday behavior results from avoidance learning. We act to minimize or avoid behaviors and/or circumstances that may lead to adverse or punishing consequences. Pain may allow a person to avoid the unpleasant job, the test for which he was unprepared, or the argument with his spouse. Behaviors that are successful in avoiding the undesired circumstances are reinforced. Once established, these behavior patterns are extremely resistant to change. This pattern is offered as a major explanation for why so many injured employees fail to return to work once they are out of work for any prolonged period of time. 22. Comment on the way in which failure to reinforce well behaviors can continue the pain cycle There is a clear overlap between the failure to reinforce well behaviors and the direct and indirect reinforcement of pain behaviors. The wife who actively encourages her husband to spend another day in bed resting his back before considering returning to work is both discouraging well behavior (return to work) and directly reinforcing a pain behavior (resting), which may or may not be coupled with the husband’s own desire to avoid work. Similarly, the husband who rushes in to assist his wife with physical chores because of her sore hand is discouraging her attempts to resume normal responsibilities. A more appropriate response would be to offer assistance and respond only upon the spouse’s cueing that help is needed. 23. What is social learning theory? Social learning theory is a psychological construct that proposes that behavior is not merely a result of inherited or acquired psychological conditions and environmental forces. Rather, individuals develop in a more complex manner by interacting in a meaningful way with their environment, with both actions and environment impacting each other. New experiences reshape views of the past and vice versa. 24. How does social learning therapy apply to the understanding of chronic pain? It is accepted that family members and other culturally important figures serve as models for both desirable and undesirable behaviors. Children are particularly open to the effects of modeling adults. Studies of children with recurrent abdominal pain were shown to be over five times as likely to have relatives (parents or siblings) who had similar symptoms in the study period than children who did not report recurrent abdominal pain. Fear of dental procedures has been demonstrated to be transmitted from fearful parents to their young offspring. Adults who scored high on a scale for hypochondriasis, dependency, and use of health services recounted that when they were ill as children, their own parents were very likely to call the doctor. There is a relatively high incidence of relatives with similar or other chronic illness reported by adults with chronic pain syndromes. 25. What is cognitive-behavioral therapy? Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Neuroimaging in the Patient with Pain Pharmacologic Management Tension-Type Headache Neuropathic Pain Migraine Pain Measurement Stay updated, free articles. Join our Telegram channel Join Tags: Pain Management Secrets Jun 14, 2016 | Posted by admin in PAIN MEDICINE | Comments Off on Psychological Constructs and Treatment Interventions Full access? Get Clinical Tree
CHAPTER 43 PSYCHOLOGICAL CONSTRUCTS AND TREATMENT INTERVENTIONS Dennis Thornton, PhD, Charles E. Argoff, MD 1. List three possible psychological mechanisms for pain The first purely psychological mechanism that worsens pain is somatization. Psychic distress and conflict are converted into somatic complaints in an unconscious attempt to reduce intrapsychic tension. A second mechanism is psychosomatic: underlying muscle tension results in regional discomfort. Although this may be difficult to prove by examination, the fact that relaxation techniques and the use of anxiolytic drugs provide relief lends credence to the theory. The third psychological mechanism for pain represents the rare occurrence of somatic delusions or hallucinatory pain. These phenomena may occur in schizophrenia or in cases of severe depressive illness. 2. Why is it important to recognize the manifestations and processes of somatization? Expression of psychic distress via physical symptoms is universal. Up to two thirds of patients visiting a primary care service report at least one unexplained somatic symptom. In our society the prevailing belief is that more attention will be given to medically based problems over psychologically based ones. This then contributes to a preference to convey concerns with organically referenced language. 3. What are some pointers to keep in mind when evaluating the patient with nonspecific complaints? It is important to appreciate how the patient’s decision to seek help and the manner in which symptoms are described are shaped by social context. Potential factors include position in the life cycle, marriage satisfaction, job status and satisfaction, level of affective distress, and the presence of any personal crisis. 4. Name three contemporary conceptual models to help understand the process of somatization The transduction model can be seen as an extension of the concept of conversion, where emotional distress is unconsciously “transduced” into bodily sensations for which there is no physiological basis. The illness behavior model places emphasis on cognitive and appraisal factors, and sees environmental pressures and rewards as shaping health care decisions. The choice model postulates that cultural factors sanction the presentation of symptoms in somatic terms as a means of avoiding the stigma of mental illness. 5. Identify the salient tenets of the biopsychosocial model Instead of assuming the hierarchical perspective that ruling out organic disease precedes exploration of psychosocial issues, the biopsychosocial model attempts to incorporate all aspects of the human condition and place the presenting symptoms in a broader whole life context. 6. What are some points from the biopsychosocial model to try to incorporate into the patient evaluation? Avoid using blaming language if the patient presents with symptoms that do not make sense medically or do not improve with initial treatment. Attempt to reframe the symptoms in terms that reduce the need to classify the problem exclusively as either organic or psychological. Touch the symptom site during the physical exam. Suggest consideration of appropriate noninvasive, complementary treatments. Place emphasis on improved functioning rather than curing the disease as the outcome criterion. Educate the patient regarding body mechanics, adherence to treatment recommendations, and limitations and potential disadvantages of additional tests and/or procedures that you believe to be unnecessary. Open the discussion to touch upon psychosocial factors early on, rather than waiting until treatments have failed. 7. Are the same psychosocial factors present in all pain patients? No. There are a variety of pathways by which individuals can come to display pain behaviors. Histories of being raised in dysfunctional homes with abuse, alcoholism, or mental illness are common in chronic pain patients. The resulting harsh superego is reflected in alcohol and drug abuse, self-sabotaging behaviors, marital discord, suicide attempts, and workaholism. An injured worker may experience not only the loss of employment but also an absence of personal gratification and a diminished sense of self, leaving him vulnerable to reemergence of anger, depression, and other negative emotions repressed from childhood. Such dynamic factors then negatively influence the patient’s ability to invest in, and benefit from, psychological interventions. 8. What is the relevance of psychoanalytic theory to understanding the experience of pain? Psychoanalytic theory divides the psyche into three functions: the id—unconscious source of primitive sexual, dependency, and aggressive impulses; the superego—subconsciously interjects societal mores, setting standards to live by; and the ego—represents a sense of self and mediates between realities of the moment and psychic needs and conflicts. Psychoanalytic writings discuss how pain frustrates the satisfaction of dependency and sexual needs as well as appropriate dissipation of aggressive feelings. The blocked expression of these needs leads to inner turmoil. However, when sanctioned as a bona fide physical problem, pain allows for unconscious gratification of ambivalent dependency needs. Underlying anger may be expressed indirectly, in the form of passive-aggressive behaviors, whereby the patient holds family members and treating practitioner alike as hostages to endless complaints and demands for attention. The experiences of pain satisfy the superego’s need to suffer and atone. 9. From a psychoanalytic perspective, how can the experience of pain be employed as a defense mechanism? Pain can be viewed as an ego defense mechanism in that the focus on somatic sensations deflects attention from intrapsychic conflicts and anxieties. The experience of physical pain is unconsciously perceived as more acceptable than the emotional pain. The patient represses his fears of loss and rejection, and the tension from these conflicts is displaced onto the body. The ensuing chronic pain behavior then serves as a form of interpersonal communication. Individuals frustrated and angry over their inability to alter their life situation in turn baffle health care professionals who attempt to treat the physical complaints, which are symbols of the underlying emotional pain. 10. What is meant when pain patients are described as experiencing some form of “gain” from their pain experience? The construct of gain is described in three basic forms—primary, secondary, and tertiary—all of which are means by which pain behaviors are reinforced. 11. What is primary gain? Avoidance of a psychic conflict by converting it to a physical ailment is a primary gain the patient experiences from his or her pain. This conversion process is usually interpreted as a defense against anxiety or as a compromise solution of unconscious conflicts. While the underlying conflict is kept out of consciousness, the conflict remains unresolved and there is a continued buildup of psychic tension always ready for discharge. The anxious individual then discharges the pent-up energy by responding to ordinary or mildly painful stimuli in an exaggerated way. 12. How is the term secondary gain applied? Secondary gain applies to factors that reinforce the display of pain-related behaviors. The reinforcing factors alluded to are most commonly litigation and disability payments. However, demonstration of caring and concern is also a factor. Under these circumstances, there is a perceived incentive for the patient to persist in the complaint of pain. If the pain is resolved, the plaintiff’s case will be weakened, or the love may be lost. Similarly, the injured worker who is partially improved may be pressured to return to work. Feeling in a weakened state, not ready to resume full responsibilities, the patient finds it easier to retreat into pain rather than face the threat of attempting to return to functioning and failing. 13. How is tertiary gain different from primary and secondary gain? Where constructs of primary and secondary gain apply to the individual, tertiary gain is external to the patient and involves family members or significant others who benefit from directly or indirectly reinforcing pain behaviors. The gain may be that interpersonal or family problems are suppressed as long as the patient remains ill; for example, a parent who feels inadequate successfully avoids having to work and interact with the world by caring for an ill child. By continuing to report that the child is symptomatic, the parent has a face-saving excuse for remaining dysfunctional. Similarly, the angry spouse may undermine the patient’s efforts toward regaining independence because a new balance has been achieved with the advent of chronic pain and disability. 14. Name some characteristics often associated with chronic pain syndromes Preoccupation with pain Strong and ambivalent dependency needs Characterologic masochism (meeting other people’s needs at one’s own expense) Inability to take care of self-needs Passivity Lack of insight to deal appropriately with anger and hostility Use of pain as a symbolic means of communication 15. What is meant by the term pain-prone disorder? The concept of a pain-prone personality evolved from psychodynamic theory. The dynamic was created to codify the process by which intrapsychic conflicts predisposed the individual to seek expression for repressed feelings in the form of somatic, particularly painful, complaints. Chronic pain was viewed as a variant of depression, even though patients might see themselves as not depressed but suffering from physical ailments. In this light the depressive symptoms were “masked.” 16. Is the concept of “masked depression” still accepted as a relevant theory? Proponents of psychodynamic theory believe that individuals with repressed conflicts are less distressed expressing their dependency needs through physical rather than emotional symptoms, because the former are more socially acceptable. However, it is extremely difficult to conduct research to confirm this theory. As investigators inquire more into this issue, there is mounting evidence that the experience of chronic pain and the negative lifestyle changes imposed by it constitute a major life stressor and that dysphoria is a frequent consequence. Of course, a multitude of factors, including a premorbid vulnerability for depression, can make some individuals more vulnerable to the development of a major depressive disorder in response to the advent of chronic pain. 17. How has learning theory been applied to the field of chronic pain? Learning theory proposes that there are two classes of responses that can be displayed by an organism: respondents and operants. Respondents are essentially reflexive in nature and are under the control of the antecedent stimulus, like Pavlov’s dog being trained to salivate at the sound of the tone preceding the presentation of food. In contrast, operants involve actions potentially subject to voluntary control. Here the magnitude of the response depends on the nature and duration of the antecedent stimulus. In this sense, the behavior is under the control of the environmental consequences (reinforcements) and is, therefore, time-limited. In terms of chronic pain, the theory suggests that if the behavior (e.g., moaning) is positively reinforced (by attention from others), it will increase in relation to the amount of reinforcement received and the meaning of that consequence (attention) to the person. Conversely, if the behavior is not reinforced (others ignore the moaning), the behavior will gradually extinguish. This learning theory model has been presented as an alternative to the medical model to explain how individuals evolve into chronic pain patients: their pain-related behaviors are reinforced by those around them. 18. According to learning theory, what are the three principal pathways by which chronic pain syndromes develop? Operantly acquired pain behaviors are maintained through the following three basic pathways, which are not mutually exclusive: Direct and positive reinforcement of pain behavior Indirect but positive reinforcement of pain behavior by avoidance of adverse consequences Failure of well behavior to receive positive reinforcement 19. Give two examples of direct and positive reinforcement of pain behaviors Continued rest can become a major positive reinforcer of pain behavior. If certain movements result in pain, the person is less likely to perform such behaviors and will instead rest in bed. Initially, this may decrease the level of discomfort (direct positive reinforcement). However, as the overall activity level decreases, so does the pain tolerance, resulting in longer and longer rest periods and a downward spiraling in general functioning. Rest, as a pain contingent reinforcer, becomes self-perpetuating. Analgesic medications provided on an as-needed basis can also foster pain behaviors. In both acute and chronic pain circumstances, patients may feel forced to take the attitude: “If the doctors will not keep me comfortable, I will have to complain and exaggerate my pain to get relief.” In many inpatient programs, the cycle of drug-related pain behaviors is disrupted through detoxification. 20. Can others, aside from health professionals, reinforce pain behaviors? Monetary rewards play a significant role in the maintenance of pain behaviors in a substantial proportion of chronic pain patients. Another example of how others impact the display of pain behaviors was demonstrated in a study that examined how chronic pain patients, participating in an inpatient pain program, acted in the presence of their spouses in comparison to how they acted in the presence of the staff. The spouses were classified as either solicitous or nonsolicitous, with the former group described as responding to patients’ pain behaviors in a manner that would reinforce the display of such behavior. As expected, patients with solicitous spouses displayed pain-related behaviors more frequently in the presence of their spouses than when interacting with neutral staff, who did not reinforce these behaviors. Patients with nonsolicitous spouses did not show an increase in frequency of pain-related behaviors in the presence of their mates. 21. Provide an example of indirect reinforcement (avoidance learning) of pain behaviors Much of our everyday behavior results from avoidance learning. We act to minimize or avoid behaviors and/or circumstances that may lead to adverse or punishing consequences. Pain may allow a person to avoid the unpleasant job, the test for which he was unprepared, or the argument with his spouse. Behaviors that are successful in avoiding the undesired circumstances are reinforced. Once established, these behavior patterns are extremely resistant to change. This pattern is offered as a major explanation for why so many injured employees fail to return to work once they are out of work for any prolonged period of time. 22. Comment on the way in which failure to reinforce well behaviors can continue the pain cycle There is a clear overlap between the failure to reinforce well behaviors and the direct and indirect reinforcement of pain behaviors. The wife who actively encourages her husband to spend another day in bed resting his back before considering returning to work is both discouraging well behavior (return to work) and directly reinforcing a pain behavior (resting), which may or may not be coupled with the husband’s own desire to avoid work. Similarly, the husband who rushes in to assist his wife with physical chores because of her sore hand is discouraging her attempts to resume normal responsibilities. A more appropriate response would be to offer assistance and respond only upon the spouse’s cueing that help is needed. 23. What is social learning theory? Social learning theory is a psychological construct that proposes that behavior is not merely a result of inherited or acquired psychological conditions and environmental forces. Rather, individuals develop in a more complex manner by interacting in a meaningful way with their environment, with both actions and environment impacting each other. New experiences reshape views of the past and vice versa. 24. How does social learning therapy apply to the understanding of chronic pain? It is accepted that family members and other culturally important figures serve as models for both desirable and undesirable behaviors. Children are particularly open to the effects of modeling adults. Studies of children with recurrent abdominal pain were shown to be over five times as likely to have relatives (parents or siblings) who had similar symptoms in the study period than children who did not report recurrent abdominal pain. Fear of dental procedures has been demonstrated to be transmitted from fearful parents to their young offspring. Adults who scored high on a scale for hypochondriasis, dependency, and use of health services recounted that when they were ill as children, their own parents were very likely to call the doctor. There is a relatively high incidence of relatives with similar or other chronic illness reported by adults with chronic pain syndromes. 25. What is cognitive-behavioral therapy? Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Neuroimaging in the Patient with Pain Pharmacologic Management Tension-Type Headache Neuropathic Pain Migraine Pain Measurement Stay updated, free articles. Join our Telegram channel Join Tags: Pain Management Secrets Jun 14, 2016 | Posted by admin in PAIN MEDICINE | Comments Off on Psychological Constructs and Treatment Interventions Full access? Get Clinical Tree
