Affect and pain

1. Affect and pain Mark Grant

2. Affect and pain Mark Grant MA

3. Affect and pain Mark Grant MA

4. Emotional stages of pain Mark Grant MA

5. Cognitive and behavioral aspects of emotional stages of pain Mark Grant MA MAPS

6. Therapeutic implications • Validate emotions • Normalize emotions • Encourage acceptance and understanding • Educate client about how to utilize emotions as survival resource • Develop regulation skills Mark Grant MA MAPS

7. Develop regulation skills In addition to acceptance etc; • Changing perspective • Building distance • Expanding range of +’ve emotions • Breathing techniques • DAS/Bls Mark Grant MA MAPS

8. A Closer look at DAS/Bls Mark Grant MA

9. DAS/Bls Mark & Ana Grant

10. What does DAS/Bls do? • Relaxation effect/decreased physiological arousal; > respiration rate, >skin conductance, <heart rate variability, • Distancing effect; Decreased vividness of autobiographical memories • Increased attentional flexibility • Decreased cognitive abilities/worry • Drowsiness • Feeling more ‘grounded’, more present • Feelings of lightness, euphoria. (Elofsson et al, 2008, Sack et al, 2008, Schubert, Lee & Drummond, 2010, Andrade et al, 2001, van der Hout et al, 2001, Lee 2008, Andrade, Kavanagh, & Badderly, 1997, Grant 2011) Mark Grant MA

11. Decreased worry “To be stupid, selfish and have good health are three requirements for happiness, T though if stupidity is lacking, all is lost.” Gustav Flaubert(1850) Mark Grant MA

12. How does DAS/Bls work? DAS/Bls stimulates; • a mind-brain state that facilitates information processing (Shapiro, 2001, Shapiro & Solomon, 2008) • Effects on working memory (Gunter & Bodner, 2008) • Physiological changes, de-arousal, reciprocal inhibition (Sondegaard & Elofsson, 2008) • Orienting reflex(Armstrong & Vaughan, 1996, MacCullochand Feldman 1996.) • Exposure (Australian Centre Posttraumatic Stress). • REM sleep like state (Stickgold, 2002, 2008) • Distancing effect (Lee, 2010) Mark Grant MA

13. Orienting response • … an automatic novelty detection mechanism subserved by cortical neural networks including superior temporal gyrus(involved in sound detection) • Sensory information (non-linguistic) is processed in primary sensory cortexes in both hemispheres and then travels along higher-level modality specific regions. • Meaning is processed by right PFC • Repeated presentation = habituation (Sechenov, 1863, Pavlov, 1927 Sokolov,1958, MacCullochand Feldman 1996). Mark Grant M

14. input-output model Mark Grant MA

15. input-output model Mark Grant

16. Attention: “The taking possession by the mind, in clear and vivid form, of one out of what seem several simultaneously possible objects or trains of thought. Focalization, concentration of consciousness are of its essence. It implies withdrawal from some things in order to deal effectively with others, and is a condition which has a real opposite in the confused, scatter-brained state known as distraction.” William James,1889 Mark Grant MA

17. 5 Types of attention • Focused attention • Sustained attention • Selective attention • Alternating attention • Open attention Sohlbergand Mateer Mark Grant MA

18. Inter-hemispheric information processing RH (Open attention): gives new experience to LH… LH(Focused Attention): “unfolds” experience and… gives it back to RH in an enhanced form Mark Grant MA MAPS

19. Inter-hemispheric information processing RH: (Open attention): “I had a terrible accident” LH: (Narrow attention) “I’m going to die” RH: “I had a terrible accident but I survived.” Mark Grant MA MAPS

20. Mindfulness • “Therapist and patient together study what is going on, not as disease or something to get rid of, but in an effort to help the client become conscious of how experience is managed and how the capacity for experience can be expanded.” - Kurtz, 1990 • “… paying attention to particular elements of internal experience (body sensation, movement, emotions, senses, thoughts) considered important to therapeutic goals.” - Ogden, 2006 Mark Grant MA

21. Non-responders Check for: • Open attention (broad, sustained) • Awareness (mindfulness) • Responsivity (feeling) • New memories (learning in present) Mark Grant

22. Modifications to normal trauma protocol (for working with pain) • Targeting fragments of experience rather than whole memoryie; sensory events (present pain) • Use of continuous Bls • Questioning client during Bls (tracking changes) • Increased attention to physical changes following Bls (via grounding and accessing questions) • Option of Hypnotic installation (cognitive interweave) Mark Grant MA MAPS

23. Accessing questions • “what are you noticing now?” (tracking question) • What seems to be happening with the pain now? • What do you notice if I ask you to think about your pain (or distress) the way I did before now? • How does it seem …now compared with how it felt before (Look for present, felt experience) • Where do you notice the sensations in your body? • Cognitive Interweave; suggest relaxation, bigger or smaller, seems further away etc. Mark Grant MA

24. Assessing suitability for DAS/Bls Look for: • Presence of Affect • + some capacity to objectively observe feelings (Ability to concentrate and suspend ‘thinking self’) • Ability to be in the present (vs intellectualizing, dissociating etc) • Ability to observe, discriminate and label bodily changes, non-judgmentally Mark Grant MA

25. Self-use of DAS/Bls • For self-soothing, not reprocessing • Stable personality • Emotionally stable (within window of tolerance) • Not dissociative • Not hypersensitive Mark Grant MA MAPS