https://scholarworks.gsu.edu/cgi/viewcontent.cgi?article=1085&context=psych_facpub

Acceptance and Commitment Therapy: Model, processes and outcomes

&NA; In an attempt to explain how and why some individuals with musculoskeletal pain develop a chronic pain syndrome, Lethem et al.(Lethem J, Slade PD, Troup JDG, Bentley G. Outline of fear‐avoidance model of exaggerated pain perceptions. Behav Res Ther 1983; 21: 401‐408).ntroduced a so‐called ‘fear‐avoidance’ model. The central concept of their model is fear of pain. ‘Confrontation’ and ‘avoidance’ are postulated as the two extreme responses to this fear, of which the former leads to the reduction of fear over time. The latter, however, leads to the maintenance or exacerbation of fear, possibly generating a phobic state. In the last decade, an increasing number of investigations have corroborated and refined the fear‐avoidance model. The aim of this paper is to review the existing evidence for the mediating role of pain‐related fear, and its immediate and long‐term consequences in the initiation and maintenance of chronic pain disability. We first highlight possible precursors of pain‐related fear including the role negative appraisal of internal and external stimuli, negative affectivity and anxiety sensitivity may play. Subsequently, a number of fear‐related processes will be discussed including escape and avoidance behaviors resulting in poor behavioral performance, hypervigilance to internal and external illness information, muscular reactivity, and physical disuse in terms of deconditioning and guarded movement. We also review the available assessment methods for the quantification of pain‐related fear and avoidance. Finally, we discuss the implications of the recent findings for the prevention and treatment of chronic musculoskeletal pain. Although there are still a number of unresolved issues which merit future research attention, pain‐related fear and avoidance appear to be an essential feature of the development of a chronic problem for a substantial number of patients with musculoskeletal pain.

Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.

Cognitive and behavioral pain coping strategies were assessed by means of questionnaire in a sample of 61 chronic low back pain patients. Data analysis indicated that the questionnaire was internally reliable. While patients reported using a variety of coping strategies, certain strategies were used frequently whereas others were rarely used. Three factors: (a) Cognitive Coping and Suppression, (b) Helplessness, and (c) Diverting Attention or Praying, accounted for a large proportion of variance in questionnaire responses. These 3 factors were found to be predictive of measures of behavioral and emotional adjustment to chronic pain above and beyond what may be predicted on the basis of patient history variables (length of continuous pain, disability status, and number of pain surgeries) and the tendency of patients to somaticize. Each of the 3 coping factors was related to specific measures of adjustment to chronic pain.

The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment

The tendency to "catastrophize" during painful stimulation contributes to more intense pain experience and increased emotional distress. Catastrophizing has been broadly conceived as an exaggerated negative "mental set" brought to bear during painful experiences. Although findings have been consistent in showing a relation between catastrophizing and pain, research in this area has proceeded in the relative absence of a guiding theoretical framework. This article reviews the literature on the relation between catastrophizing and pain and examines the relative strengths and limitations of different theoretical models that could be advanced to account for the pattern of available findings. The article evaluates the explanatory power of a schema activation model, an appraisal model, an attention model, and a communal coping model of pain perception. It is suggested that catastrophizing might best be viewed from the perspective of hierarchical levels of analysis, where social factors and social goals may play a role in the development and maintenance of catastrophizing, whereas appraisal-related processes may point to the mechanisms that link catastrophizing to pain experience. Directions for future research are suggested.

Theoretical perspectives on the relation between catastrophizing and pain.

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Chapter 4. European guidelines for the management of chronic nonspecific low back pain.

Behavioral Methods for Chronic Pain and Illness

Annual review of behavior therapy theory and practice

This case illustrates the rapid systematic desensitization of a fear of injections following two in-office treatment sessions and seven daily in-vivo exposures to the phobic situation over a three week period. The reoccurrence of the phobic response in selected situations, and the generalization effects of counter conditioning upon unrelated classes of fears is discussed.

Rapid In-Office and In-Vivo Desensitization of an Injection Phobia Utilizing Hypnosis

Treatment of Grand Mal Epilepsy by Covert and Operant Conditioning Techniques: A Case Study

This study describes the use of deep muscle relaxation, cue controlled relaxation, hypnosis with handwarming, cognitive behavior therapy, and an extension of thought stopping in the treatment of severe migraine headache. The importance of antecedent precipitating stress was emphasized.

Lloyd K. Daniels

Papers

Behavioral Methods for Chronic Pain and Illness

Annual review of behavior therapy theory and practice

Rapid In-Office and In-Vivo Desensitization of an Injection Phobia Utilizing Hypnosis

Treatment of Grand Mal Epilepsy by Covert and Operant Conditioning Techniques: A Case Study

Treatment of migraine headache by hypnosis and behavior therapy: a case study.