Tuesday, 9 October 2012

Cope with pain by changing how you picture it

Most people who suffer from serious pain have one or more mental images that they associate with the discomfort and what it represents to them. A new study by Clare Philips and Debbie Samsom has shown that these pain-sufferers can be taught to re-imagine this pain imagery in a more positive light, bringing them instant relief and emotional comfort.

Of 73 volunteers at an occupational rehab centre in Vancouver, 57 had pain and said they experienced imagery associated with that pain, and so they were recruited into the study (there were 24 men, the average age was 45).

After being interviewed about their baseline pain and their psychological state - including feelings of mental defeat, anxiety and depression - the participants were asked to select their most powerful and distressing pain-related mental image. "I see myself on all fours - like a dog but unable to move," said one. All participants spent time forming this "index image" in their mind before answering more questions about how they were feeling. Focusing on the unpleasant image increased pain and emotional distress. Remember, this is an image that the participants experienced spontaneously in their everyday lives (for nearly half of them, it came to mind several times a day).

Next, after a six-minute gap talking about where they grew up (as a distraction), 26 of the participants were taught to re-picture their pain. They were asked to think "how would you rather see the image?" and to describe in detail what this would entail. They then focused on this new image - for example, the participant above who'd previously described the dog-image now imagined: "I am at the start of a race….the gun goes off and the crowd cheers as I take off." The remaining participants acted as controls and spent the same time focused on their original, unpleasant index image.

After picturing a "re-scripted" pain image, the participants in that group experienced a dramatic drop in their pain levels. In fact, 49 per cent of them said they felt no pain at that time, compared with 11 per cent of them feeling no pain after imagining their index image. "The pain decrements were fast, easily produced and dramatically large," the researchers said. The re-script group also exhibited improvements in anxiety, sadness, mental defeat and beliefs about their own fragility. The control participants, by contrast, experienced none of these improvements.

There was another six-minute gap and the re-script group again pictured their positively re-imagined pain image. The controls were now also taught how to re-imagine their pain image - the local research ethics committee had insisted on this. The original re-script group continued to enjoy reduced pain and psychological benefits, which counts against the idea that the novel image had merely served as a temporary distraction. The controls now also enjoyed the benefits of re-picturing their pain.

Philips and Samsom said that the participants found it easy and pleasurable to re-script their pain images. Of course there is a need now for research to see whether these benefits of re-picturing pain can last into the long term. It would also help to have a different kind of control group - for example, one that merely visualised random positive images, to see if the effects of specifically re-picturing pain are more powerful. Where this study focused on the sensory detail of pain images, future work could also look into the re-writing the images' cognitive meaning.

The findings add to a broader literature showing that our experience of pain is affected by many psychological factors, such as our beliefs about our ability to cope. This doesn't mean the pain isn't real, but it does mean that psychological techniques can be incredibly effective at bringing relief and improvements to people's quality of life.

_________________________________ ResearchBlogging.org

Philips C, and Samson D (2012). The rescripting of pain images. Behavioural and cognitive psychotherapy, 40 (5), 558-76 PMID: 22950868

-Further reading-
Psychologist magazine special issue on the psychology of pain
Acceptance, not distraction, is the way to deal with pain (Digest item)
Verbal reassurance can dull the effect of pain, but only if it's from someone we identify with (Digest item)

Post written by Christian Jarrett for the BPS Research Digest.

14 comments:

  1. This reminds me of an interesting work by photographer Deborah Padfield, who is working with patients on visualizating their pain. http://news.bbc.co.uk/2/hi/health/2268417.stm

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  2. Is there a reason why this is not called by its actual name - conversational hypnosis? Of course it is effective and we've know this for a long time!

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    1. No, the participants were not hypnotised and the re-scripting of their pain-related images was almost entirely down to them, done consciously and deliberately.

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    2. Christian, there are a lot of misconceptions about what is and is not hypnosis, or about what it looks like. When you watch a movie and the suspense makes your heart race or a character's death makes you cry, these automatic responses are everyday examples of hypnosis. Encouraging someone to change how they are picturing something, even if they decide what the picture new is and you've done no formal hypnotic induction, it is still hypnosis. This is what is presented in state of the art hypnosis training these days.

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    3. I'm afraid your definition of hypnosis is so broad as to be meaningless and is not in keeping with what is meant by the term in mainstream psychological science.

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    4. The mainstream of psychological science is the last place anyone should go for information on hypnosis. They do not currently understand it. They are trying to, but they have a long way to go. The main problem is most of them have no clue as to what hypnosis is or even half the skill of most hypnotists.

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  3. Dave Berman is absolutely correct. This is how visualization meditation is done, how many nlp techniques are done and so on. Many would call this waking hypnosis. This is because there is suggestion taking place and their state of mind is altered to some degree even if it may only be just slightly.

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  4. It's great to see that those who have the funding to perform trials are verifying and validating the processes that hypnotists, meditation teachers, and NLP practitioners have been using for decades.

    Of course, it's tempting to claim that the participants were not hypnotized--which is true, if you base your definition of hypnosis entirely on Saturday morning cartoons and Sunday afternoon horror movie matinees.

    However, if you study the work of such non-state theorists as T.X. Barber, a PhD psychologist and luminary in the world of mainstream scientific investigation of hypnosis, you'll understand that many mainstream scientists hold the view that hypnosis is not necessarily a special state, and that it does not require a hypnotic induction to achieve.

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    1. The paper reports on pain imagery rather than hypnosis which has distinct features from mental imagery interventions. A body of research on mental imagery in therapeutic situations is available from the sources below. Hypnotists, meditation teachers and NLP practitioners are not proponents of the scientist-practitioner model so I cannot readily understand why this study could validate their claims, given the idiosyncratic nature of practice in these domains.

      Hackmann, A, Bennett-Levy, J., & Holmes, E. A. (2011). Oxford Guide to Imagery in Cognitive Therapy. Oxford: OUP.

      Holmes, E. A. & Mathews, A. (2010). Mental imagery in emotions and emotional disorders. Clinical Psychology Review, 30, 349-362.

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  5. Mental perceptions play a big role in determining our pverall health. This does not only apply to science and medicine but also to spirituality. I am not surprised to see how it can help to cope with pain.

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  6. Anonymous6:39 pm

    I'm curious, were participants told to form a new image that was of escaping or managing the pain? Or just any new image?

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    1. they were asked to imagine how they would rather see the image, and to provide details.

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  7. Interesting article. It will be interesting to see the long term effects, and the affect on their actual pain.

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