Health Psychology : a Textbook

their bodily functions. Biofeedback aims to decrease anxiety and tension and there-

fore to decrease pain. However, some research indicates that it adds nothing to

relaxation methods. Hypnosis is also used as a means to relax the individual. It seems

to be of most use for acute pain and for repeated painful procedures such as burn

dressing.


 Cognitive methods: A cognitive approach to pain treatment focuses on the individuals’

thoughts about pain and aims to modify cognitions which may be exacerbating their

pain experience. Techniques used include attention diversion (i.e. encouraging the

individual not to focus on the pain), imagery (i.e. encouraging the individual to have

positive, pleasant thoughts) and the modification of maladaptive thoughts by the use

of Socratic questions. Socratic questions challenge the individual to try and under-

stand their automatic thoughts and involve questions such as ‘What evidence do you

have to support your thoughts?’ and ‘How would someone else view this situation?’.

The therapist can use role play and role reversal.


 Behavioural methods: Some treatment approaches draw upon the basis principles of

operant conditioning and use reinforcement to encourage the individual to change

their behaviour. For example, if a chronic pain patient has stopped activities that they

belief may exacerbate their pain, the therapist will incrementally encourage them to

become increasing more active. Each change in behaviour will be rewarded by the

therapist and new exercises will be developed and agreed to encourage the patient to

move towards their preset goal.

The three components of psychological therapy are often integrated into a cognitive

behavioural treatment package (CBT).

Cognitive behavioural therapy

Cognitive behaviour therapy (CBT) is increasingly used with chronic pain patients. CBT is

based upon the premise that pain is influenced by four sources of information: cognitive

sources such as the meaning of the pain (‘it will prevent me from working’); emotional

Fig. 12-3 Psychology and pain treatment

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