related quality of life measures available including one developed by the World
Health Organization (WHOQOL Group, 1995) and the Short-Form Health Survey
(Ware, Kosinski and Keller, 1996), which assess the degree to which illness imposes
on everyday life and how patients’ feel about their everyday life.
Managing chronic pain
Chronic pain provides a useful illustration of the importance of psychological theory
and intervention to LTI. In a comprehensive review, Gatchel et al. (2007) indicate
how a biopsychosocial approach to understanding pain emphasizes the role of
psychological care in treatment. They note, for example, that anxiety reduction
interventions can result in reduced distress and interference with daily living. They
also note that enhanced self-efficacy in relation to controlling the impact pain has on
everyday living affects the body’s opioid and immune systems, reduces pain, improves
recovery after surgical procedures and improves overall psychological adjustment.
Higher levels of pain-related self-efficacy increase motivation to follow through with
goals that become challenging and so reduce activity avoidance and may increase social
engagement and support. Consequently these researchers note that, ‘pain cannot be
treated successfully without attending to the patient’s emotional state’ (Gatchel et al.,
2007: 602). Current treatment of pain focuses on multidisciplinary programmes,
which incorporate a combination of approaches including psychological interventions.
Turk and Burwinkle (2005) highlighted the effectiveness and cost-effectiveness of such
programmes compared to traditional approaches. They list commonly used measures
of pain assessment and show that multidisciplinary programmes are effective, not only
in reducing pain but in improving employment status and reducing medication and
medical services usage. They also emphasize the role of psychologists both in designing
and evaluating interventions within such multidisciplinary contexts.
There are a range of change techniques that may be used by psychologists working
with patients experiencing pain (see Chapter 2). The gate-control theory of pain
perception (Melzack and Wall, 1965) clarified how the brain is able to control pain
sensation providing a clear pathway for psychological moderation of pain experience.
Cognitive intervention techniques involve teaching patients to identify and change
cognitions and emotions that increase pain. So, for example, challenging catastrophic
or hopeless thoughts may reduce anxiety and enhance self-efficacy. Such interventions
have been shown to be effective, especially with chronic pain patients and can be more
effective than pharmacological interventions (Morley, Eccleston and Williams, 1999;
see also Andrasik and Schwartz, 2006). Patients may also be taught new coping
strategies including distraction (i.e. patient focuses on a non-painful stimulus in their
nearby environment in order to distract attention away from pain); non-painful
imagery (i.e. patient focuses on a positive, imagined event/scene unrelated to pain);
pain redefinition (i.e. patient learns to redefine negative thoughts about the pain
experience using positive self-statements); and hypnosis (i.e. patient experiences less
pain while in a relaxed, hypnotic state). Each of these cognitive techniques has been
found to be effective in reducing pain experience but the evidence is stronger for acute
pain than for chronic pain (Fernandez and Turk, 1989). Such cognitive techniques
can, of course, be combined with behaviour change techniques (see below) and, for
headache pain, this combination has been found to be as effective as conventional
250 RELATING TO PATIENTS