Health Psychology : a Textbook

effectiveness for other pain related problems or for outcomes other than pain severity and

frequency.

Psychological factors can therefore exacerbate pain perception. Research also

indicates that they are also important in the treatment and management of pain.

FOCUS ON RESEARCH 12.1: PUTTING THEORY INTO

PRACTICE – TREATING CHRONIC PAIN

A study to examine the effectiveness of cognitive behavioural treatment for

chronic pain (Basler and Rehfisch 1990).

This is an interesting paper, as it illustrates how a theoretical approach can be used as

a basis for clinical practice. The paper emphasizes pain as a perception and suggests

that treatment interventions can focus on the different factors that contribute to this

perception. In addition, the paper highlights the role of adherence in treatment success,

which has implications for understanding placebos and compliance with medical/

clinical recommendations.

Background

What is the cognitive–behavioural approach to pain?

A cognitive–behavioural approach to pain regards pain as a perception that involves an

integration of four sources of pain-related information:


 Cognitive, e.g. the meaning of the pain (‘it will prevent me from working’).


 Emotional, e.g. the emotions associated with the pain (‘I am anxious that it will never

go away’).


 Physiological, e.g. the impulses sent from the site of physical damage.


 Behavioural, e.g. pain behaviour that may increase the pain (such as not doing any

exercise) and pain behaviour which may decrease the pain (such as doing sufficient

exercise).

The cognitive–behavioural approach to pain therefore aims to reduce pain by focusing on

these different sources of pain-related information.

The central role of self-control

In particular, the cognitive–behavioural approach to pain aims to improve the indi-

vidual’s self-control over the pain. Turk and Rudy (1986) summarize the objectives of

interventions to improve self-control as follows:


 Combat demoralization. Chronic pain sufferers may become demoralized and feel help-

less. They are taught to reconceptualize their problems so that they can be seen as

manageable.

298 HEALTH PSYCHOLOGY