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Summary 3.3 Pain elective Problem 4
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Summary for problem 4 for 3.3 elective pain
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Problem 4THE COGNITIVE-BEHAVIORAL APPROACH TO PAIN MANAGEMENT (TURK & FLOR)
- most people with chronic pain will continue to experience some pain regardless of
treatment
- cognitive-behavioral treatments are meant to complement other interventions
- critical factor of the C-B model: people learn to predict future events based on
previous experiences and information processing
- C-B perspective integrates operant conditioning emphasis on external reinforcement
and the respondent’s view of learned avoidance within the framework of information
processing
- negative, maladaptive appraisals about the situation and personal efficacy may
reinforce overreaction to nociceptive stimulation, inactivity and demoralization
Overview of the cognitive-behavioral perspective
- all C-B treatments are characterized by being present-focused, active, time-limited
and structured
- consists of 6 overlapping phases
, Phase 1: assessment
- information obtained by interviewing
patients and significant others
- self-report measures and observations
- psychosocial and behavioral factors that
block might hinder rehabilitation should be
identified
Phase 2: reconceptualization
- this phase is about restructuring the
patient’s beliefs that pain is unmanageable
- focus on identifying anxiety-engendering
and other maladaptive appraisals
- therapist gathers evidence for or against the
patient’s interpretations and tests the
validity of these statements
- therapist encourages patient to challenge
the validity of their own beliefs
- therapist elicits competing thoughts from
the patient and reinforces these alternatives
- significant others may unwillingly
undermine patient’s efforts -should be
addressed
- patients should express their concerns, fear
and frustrations
- cognitive errors should be targeted if they
contribute to pain perception
- pain behavior and operant conditioning:
significant others might reinforce and
maintain patient’s overt expressions of pain
with their reactions
- a conceptualization of pain based on the
“gate control model” is presented:
interaction of thoughts, mood states and
sensory aspects is clearly presented using
patient’s self-monitored experiences
- to facilitate the reappraisal process:
patient’s experience of pain can be seen as
several manageable phases
- when negative thoughts inevitably arise,
patients are encouraged to use them as reminders to analyze their basis and initiate
coping strategies
Phase 3: skill acquisition
- patients learn self-management strategies and develop a sense of personal control
- therapist discusses the rationale for using a method, they assess whether the skills
are in the patient’s repertoires, teach the needed skills, and practice
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