Wednesday, December 8, 2010

Psychological Flexibility and Pain Management

In a previous blog post, I briefly wrote about the benefits of psychological flexibility. Psychological Flexibility refers to one's ability to adapt thinking, emotions and behaviour to various situations. A helpful way to think about psychological flexibility is to use the example of 'control.' There are things in life we have control over and things that we do not. For example, while driving a car we have control over the vehicle's movement. However, we do not have control over other vehicles on the road. Therefore, whenever we decide to go for a drive, we have some control over our safety -- but not complete control, as other drivers could cause an accident for us.



This example of control/ lack of control highlights the importance of psychological flexibility.

It is not always pleasant to give up control of one's personal safety. However, whenever you drive there is a certain amount of risk that accompanies this experience and your personal safety is partly in the hands of other people. Being psychologically flexible in this example would mean that you match your attitude to the situation. For example, thinking to yourself (on some level): "There's no point in worrying about things that I cannot control, my best option is to simply focus on my own driving and trust the other drivers."

A psychologically inflexible response would be: "I need complete control of my personal safety at all times, and I will try to avoid driving." The person in this example is likely to feel very anxious during the few times they actually drive.

In this example, the situation (driving with other people) demanded a certain psychological attitude in order to avoid feeling extremely anxious and to complete the task at hand (drive). The attitude used in the 'flexible' example involves trust of other people. However, this trusting attitude is not always a good thing to have. There are situations where you would want to change that attitude. For example, if you read in the newspaper that many people drink and drive in your neighbourhood between the hours of 1 and 3pm, then a new attitude may be required. So, people should not think of a specific attitude as being healthy or unhealthy. It is more important to know when the attitude is being used.

The main point is that psychological flexibility allows people to face situations in their daily life with as much ease as possible. Whenever someone is psychologically inflexible -- they try to fight a situation by using the same behaviour or attitude regardless of the situation -- there can be feelings of anxiety, stress and depression.

The benefits of psychological flexibility were recently highlighted by a research study on chronic pain. Researchers compared two types of pain management approaches: traditional pain management and psychological flexibility pain management. Traditional pain management requires chronic pain patients to try and change something about the current situation in order to manage pain. For example, someone might try to change their thinking about the pain or do something to reduce the pain (ex: use a heat pad). Psychological flexibility pain management emphasizes active acceptance of pain. Active acceptance of pain means the person recognizes that pain is present, but does not allow the pain to prevent them from living life. This differs from passive acceptance where someone gives up because of pain -- acting like a helpless victim. An example of psychological flexibility pain management would be a person who is aware and acknowledges the presence of negative emotions and pain, and allows these psychological experiences to be present, but continues to engage in activities of daily life.

The researchers found that psychological flexibility was associated with more positive outcomes for pain and negative emotions than traditional pain management.

This does not mean that traditional pain management techniques do not work. In fact, the researchers found that these traditional "change" techniques were indeed effective -- just not as effective as the flexibility techniques. In my experience as a psychologist who specializes in pain management, the best treatment approach strikes a balance between changing things that can be changed and accepting things that are beyond one's control. Of course, this sounds like a nice and easy philosophy, but putting it into practice is certainly a challenge.

At the present time, psychologists around the world are conducting research of what is termed "the third wave" of treatment approaches. The first wave was older Freudian/ Psychodynamic therapies that were not adequate for many mental health problems. The second wave included therapies that were heavily evaluated with research, the most notable being Cognitive-Behavioural Therapy (CBT). This new wave of treatments emphasizes the disadvantages of trying to fight and change experiences in life that are not amenable to change, or should not necessarily be changed. For example, trying to always get rid of anxiety is not a healthy strategy and can lead to more problems in the long-term.

There is already much empirical support for the third-wave treatments, which include mindfulness meditation and Acceptance and Commitment Therapy (ACT). I have found that combining aspects of CBT with newer generation treatments to be most helpful, and I suspect that the field of psychology will continue to move toward integration of various approaches -- especially as psychological research continues to show that the nuances of mental health problems demand a range of treatment response options.

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