A cognitive behavioral perspective on treatment of chronic pain patients

1. A cognitive behavioral perspective on treatment of chronic pain patients Chapter 7

2. CBT model has become the most commonly accepted to conceptualization of pain. • It appears to have a heuristic value for explaining the experience of and response to chronic and Acute recurrent pain • It hasn’t been researched closely as related to acute pain states but It is widely accepted.

3. This approach incorporates the pain sufferers: fear, avoidance, contingencies of reinforcement, but suggests cognitive factors in particular, expectations rather than conditioning factors are of central importance therefore, it takes an integrated approach in which contextual factors and principles of learning theory are integrated with the pain, suffering and pain management..

4. This theory proposes that so-called condition reactions are largely self activated on the basis of learned expectations rather than automatically invoked. • Let’s discuss this concept Do we agree • Therefore, the critical factor for this model is not that events occur together in time or are operantly reinforced, but that people learn to predict them based on experiences and information processing- they anticipate

5. They filter information through their pre-existing knowledge and organize representations of knowledge or cognitive schemas and react accordingly. • Consequently responses are based on idiosyncratic interpretations of reality. • however, consider how challenging to tease This apart when there is clear physical adversative stimuli. Like pain

6. Now consider even if you can tease it apart, how does the patient react to this: • Do they justify the reaction, though, psychological, because of the pain- saying “well, is it not normal” • This idiosyncratic pattern will interact with its environment, attention is given to this ongoing reciprocal relationship. • According to this model, the pain sufferers perspective equates their idiosyncratic beliefs, appraisals, unique schemas that filter and interact reciprocally with emotional factors, social influences, and behavioral responses as well as sensory information. In turn, this will elicit responses are reactions from the environment.

7. Assumptions of the CBT model • 1. People are active processors of information rather than passive reactors to invent for environmental contingencies • People tend to make sense of stimuli from external environment by filtering information through organized schemas derived from their prior learning history’s and by general heuristics that guide the processing of information • Responses overt or covert are based on appraisals and subsequent expectations and are not totally dependent on the actual consequences of their behaviors

8. From this perspective, anticipated consequences are is important in guiding behavior as actual consequences

9. 2. one’s thoughts (appraisal, attributions, expectancies) can elicit or modulate affect and physiological arousal, both of which may serve as impetus for behavior. Conversely, affect, physiology and behavior can instigate or influence one’s thinking process. • Does the causal priority depends on where in the cycle. Where one chooses to begin in the causal priority may be less important than the actual cycle.

10. 3. behavior is reciprocally determined by both the environment and the individual • People don’t only response their environment, but elicit responses by their behavior • As such, they can create their environment as much their environment can create them

11. 4.people have learned maladaptive ways of thinking, feeling and responding than successful interventions designed to alter behavior should focus on maladaptive thoughts, feelings, physiology and behaviors, and not one to the exclusion of others • Be careful about the expectation that changing thoughts, feelings, or behaviors will necessarily result in the other two. We have heard cases in which people have increased insight, but not necessarily behavioral change, behavioral change, but not necessarily insight estimates significance

12. 5. the same way as people are instrumental in developing and maintaining maladaptive thoughts, feelings and behaviors, he should be considered active agents of change of their maladaptive modes of responding. • People with chronic pain, no matter how severe can consider how to be instrumental in learning and carrying out more effective modes of responding to their environment and their plight; if not, what else is there short of a cure

13. From this perspective, people with pain are viewed as having negative expectations of their own ability to control certain motor skills without pain. In fact, pain patients experience and begin to believe they have limited ability to exert any control over their pain Such an experience will lead to demoralization, inactivity and overreaction to nociceptive stimulation

14. If we accept the pain is complex, subjective phenomenon that is uniquely express page person, then knowledge about the idiosyncratic beliefs, appraisals, and coping skills becomes critical for optimal treatment planning and giving patient a sense of hope

15. Biomedical factors may have initiated the original report of pain, but secondary conditions develop which are associated with alterations within the nervous system by the way of deconditioning, which may exacerbate and maintain the problem Inactivity leads to increased focus and preoccupation with the body and pain in these cognitive attention changes increase the likelihood of misinterpreting symptoms, overemphasis on symptoms and the perception of oneself is being disabled

16. Therefore, our role may be the most difficult outside of actually being the patient as we are helping them to acknowledge and be mindful of the pain existing in their life, but deciding whether they want to still pursue and reclaim psychosocial aspects that may have been compromised, which then exacerbate their experience of suffering.

17. When confronted with any new stimuli patients engage in a meeting analysis that is automatic. • Look on page 141 second column middle to explore this aspect • Exercise: Consider low back pain that is excruciating allowing your legs to buckle and then be told that it will just disappear in six weeks-what consequences

18. The specific thoughts and feelings that patients experience prior to exacerbations, during an exacerbation of intense episode pain as well as following a pain episode can greatly influence the experience of pain • Consider when an athlete is injured or child falls. The concept of walking it off versus collapsing

19. CBT treatment • Self-management and rehabilitation required great deal of patience of management as treatment success as a therapist. Patient • Patient was motivated and willing to come cannot assume that all patients • Therefore, the process is designed to identify, evaluate and correct maladaptive conceptualizations of beliefs about self in order to to some form of these

20. Therefore, we assist them in reconceptualizing their plight • Consider a patient that attributes its religious meaning • Let us look at table 7.2 on page 144 goals on cognitive approach • Then let us look at table 7.3 functions conceptualization process