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17-12-2019 | Original Article

Evaluation of Exposure Instructions to Pain: Should Therapist Focus on Fear Reduction or Expectation Violation?

Auteurs: Lea Schemer, Karoline Körfer, Julia Anna Glombiewski

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 3/2020

Abstract

Exposure elements are highly effective for the treatment of individuals with chronic pain and elevated fear-avoidance. However, different therapeutic instructions are justified by competing theories regarding underlying mechanisms. The habituation model suggests that therapists should focus on fear reduction. The inhibitory learning approach suggests that therapists should aim for maximal expectation violation. We employed a mixed 3 × 2 experimental design with the between-group factor instruction (habituation, expectation violation, control) and the within-group factor time (pretest, posttest) to provide a fine-grained analysis of both instructions. Nociceptive thermal pain was induced to female students (N = 112). Both instructions improved cognitive pain coping. Only the expectation violation instruction increased pain tolerance. Similarly, only the expectation violation instructions led to specific psychophysiological changes, characterized by a significantly higher initial increase and subsequent decrease in the skin conductance level. This study provides experimental evidence for the effectiveness of exposure-based interventions among individuals confronting acute thermal pain. Instructions addressing expectation violations appeared to produce the greatest effects. Testing concrete expectancies might further improve exposure effects. Future research needs to translate our findings into clinical practice.

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Arch, J. J., Twohig, M. P., Deacon, B. J., Landy, L. N., & Bluett, E. J. (2015). The credibility of exposure therapy: Does the theoretical rationale matter? Behaviour Research and Therapy,72, 81–92. https://doi.org/10.1016/j.brat.2015.05.008.CrossRefPubMed

Baker, A., Mystkowski, J., Culver, N., Yi, R., Mortazavi, A., & Craske, M. G. (2010). Does habituation matter? Emotional processing theory and exposure therapy for acrophobia. Behaviour Research and Therapy,48(11), 1139–1143. https://doi.org/10.1016/j.brat.2010.07.009.CrossRefPubMedPubMedCentral

Beck, A. T., Steer, R. A., & Brown, G. K. (2000). BDI-Fast Screen for medical patients: Manual. San Antonia: Psychological Corporation.

Berntson, G. G. (1991). Autonomic determinism: The modes of autonomic control, the doctrine of autonomic space, and the laws of autonomic constraint. Psychological Review,98(4), 459–487. https://doi.org/10.1037/0033-295X.98.4.459.CrossRefPubMed

Bos, M. G. N., Jentgens, P., Beckers, T., & Kindt, M. (2013). Psychophysiological response patterns to affective film stimuli. PLoS ONE,8(4), e62661. https://doi.org/10.1371/journal.pone.0062661.CrossRefPubMedPubMedCentral

Bradley, M. M., Codispoti, M., Cuthbert, B. N., Lang, P. J., Bradley, M. M., Codispoti, M., et al. (2001). Emotion and motivation I: Defensive and appetitive reactions in picture processing. Emotion,1(3), 276–298. https://doi.org/10.1037//1528-3542.1.3.276.CrossRefPubMed

Craske, M. G., Liao, B., Brown, L., & Vervliet, B. (2012). Role of inhibition in exposure therapy. Journal of Experimental Psychopathology,3(3), 322–345. https://doi.org/10.5127/jep.026511.CrossRef

Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy,58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006.CrossRefPubMedPubMedCentral

Crombez, G., Eccleston, C., Vlaeyen, J. W. S., Vansteenwegen, D., Lysens, R., & Eelen, P. (2002). Exposure to physical movements in low back pain patients: Restricted effects of generalization. Health Psychology,21(6), 573–578. https://doi.org/10.1037//0278-6133.21.6.573.CrossRefPubMed

Culver, N. C., Stoyanova, M., & Craske, M. G. (2012). Emotional variability and sustained arousal during exposure. Journal of Behavior Therapy and Experimental Psychiatry,43(2), 787–793. https://doi.org/10.1016/j.jbtep.2011.10.009.CrossRefPubMed

Damme, S. V., Crombez, G., Wever, K. V. N., & Liesbet, G. (2008). Is distraction less effective when pain is threatening? An experimental investigation with the cold pressor task. European Journal of Pain,12(1), 60–67. https://doi.org/10.1016/j.ejpain.2007.03.001.CrossRefPubMed

Devilly, G. J., & Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry,31(2), 73–86. https://doi.org/10.1016/S0005-7916(00)00012-4.CrossRefPubMed

Ellermeier, W., & Westphal, W. (1995). Gender differences in pain ratings and pupil reactions to painful pressure stimuli. Pain,61(3), 435–439. https://doi.org/10.1016/0304-3959(94)00203-Q.CrossRefPubMed

Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin,99(1), 20–35. https://doi.org/10.1037/0033-2909.99.1.20.CrossRefPubMed

Geissner, E. (1999). Processing of chonic pain—scales to measure pain coping and pain-related psychological disability. Journal of Clinical Psychology and Psychotherapy,28, 280–290. https://doi.org/10.1026//0084-5345.28.4.280. (in German).CrossRef

Greenspan, J. D., Craft, R. M., LeResche, L., Arendt-Nielsen, L., Berkley, K. J., Fillingim, R. B., … & Consenus Working Group of the Sex, Gender, and P. S. of the I. (2007). Studying sex and gender differences in pain and analgesia: A consesus report. Pain,132(1), 26–45. https://doi.org/10.1016/j.pain.2007.10.014.…CrossRef

Hofmann, S. G. (2008). Cognitive processes during fear acquisition and extinction in animals and humans: Implications for exposure therapy of anxiety disorders. Clinical Psychology Review,28(2), 199–210. https://doi.org/10.1016/j.cpr.2007.04.009.CrossRefPubMed

Hofmann, S. G., & Hayes, S. C. (2019). The future of intervention science: Process-based therapy. Clinical Psychological Science,7(1), 37–50. https://doi.org/10.1177/2167702618772296.CrossRefPubMed

Jackson, T., Pope, L., Nagasaka, T., Fritch, A., Iezzi, T., & Chen, H. (2005). The impact of threatening information about pain on coping and pain tolerance. British Journal of Health Psychology,10(3), 441–451. https://doi.org/10.1348/135910705X27587.CrossRefPubMed

Kállai, I., Barke, A., & Voss, U. (2004). The effects of experimenter characteristics on pain reports in women and men. Pain,112(1–2), 142–147. https://doi.org/10.1016/j.pain.2004.08.008.CrossRefPubMed

Kircanski, K., Lieberman, M. D., & Craske, M. G. (2012). Feelings into words: Contributions of language to exposure therapy. Psychological Science,23(10), 1086–1091. https://doi.org/10.1177/0956797612443830.CrossRefPubMedPubMedCentral

Kliem, S., & Brähler, E. (2013). Beck Despressions-Inventar-FS: deutsche Überarbietung. Frankfurt: Pearson.

Kohl, A., Rief, W., & Glombiewski, J. A. (2013). Acceptance, cognitive resturcturing, and distratction as coping strategies for actue pain. Journal of Pain,14(3), 305–315. https://doi.org/10.1016/j.jpain.2012.12.005.CrossRefPubMed

Kohl, A., Rief, W., & Glombiewski, J. A. (2014). Do fibromyalgia patients benefit from cognitive restructuring and acceptance? An experimental study. Journal of Behavior Therapy and Experimental Psychiatry,45(4), 467–474. https://doi.org/10.1016/j.jbtep.2014.06.006.CrossRefPubMed

Lang, P. J. (1971). The application of psychophysilogical methods to the study of psychotherapy and behavior modification. In A. Bergin & S. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 75–125). New York, NY: Wiley.

Leeuw, M., Goossens, M. E. J. B., van Breukelen, G. J. P., Boersma, K., & Vlaeyen, J. W. S. (2007). Measuring perceived harmfulness of physical activities in patients with chronic low back pain: The Photograph Series of Daily Activities—short electronic version. Journal of Pain,8(11), 840–849. https://doi.org/10.1016/j.jpain.2007.05.013.CrossRefPubMed

Leeuw, M., Goossens, M. E. J. B., van Breukelen, G. J. P., de Jong, J. R., Heuts, P. H. T. G., Smeets, R. J. E. M., …, Vlaeyen, J. W. S. (2008). Exposure in vivo versus operant graded activity in chronic low back pain patients: Results of a randomized controlled trial. Pain,138(1), 192–207. https://doi.org/10.1016/j.pain.2007.12.009.…CrossRefPubMed

Linton, S. J., Boersma, K., Jansson, M., Overmeer, T., Lindblom, K., & Vlaeyen, J. W. S. (2008). A randomized controlled trial of exposure in vivo for patients with spinal pain reporting fear of work-related activities. European Journal of Pain,12(6), 722–730. https://doi.org/10.1016/j.ejpain.2007.11.001.CrossRefPubMed

McCracken, L. M. (1997). “Attention” to pain in persons with chronic pain: A behavioral approach. Behavior Therapy,28(2), 271–284. https://doi.org/10.1016/S0005-7894(97)80047-0.CrossRef

McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain Anxiety Symptom Scale (PASS-20): Preliminary development and validity. Pain Research and Management,7(1), 45–50. https://doi.org/10.1155/2002/517163.CrossRefPubMed

Meyer, K., Sprott, H., & Frances, A. (2008). Cross-cultural adaptation, reliability, and validity of the German version of the Pain Catastrophizing Scale. Journal of Psychosomatic Research,64(5), 469–478. https://doi.org/10.1016/j.jpsychores.2007.12.004.CrossRefPubMed

Milad, M. R., Wright, C. I., Orr, S. P., Pitman, R. K., Quirk, G. J., & Rauch, S. L. (2007). Recall of fear extinction in humans activates the ventromedial prefrontal cortex and hippocampus in concert. Biological Psychiatry,62(5), 1139–1142. https://doi.org/10.1016/j.biopsych.2006.10.011.CrossRef

Morley, S. (2011). Efficacy and effectiveness of cognitive behaviour therapy for chronic pain: Progress and some challenges. Pain,152(3), 99–106. https://doi.org/10.1016/j.pain.2010.10.042.CrossRef

Moseley, G. L., & Butler, D. S. (2015). Fifteen years of explaining pain: The past, present, and future. The Journal of Pain,16(9), 807–813. https://doi.org/10.1016/j.jpain.2015.05.005.CrossRefPubMed

Rauch, S., & Foa, E. (2006). Emotional Processing Theory (EPT) and Exposure Therapy for PTSD. Journal of Contemporary Psychotherapy,26(2), 61–65. https://doi.org/10.1007/s10879-006-9008-y.CrossRef

Rief, W., & Glombiewski, J. A. (2016). Expectation-focused psychological interventions (EFPI). Behavior Therapy,26, 47–54. https://doi.org/10.1159/000442374. (in German).CrossRef

Ruscheweyh, R., Marziniak, M., Stumpenhorst, F., Reinholz, J., & Knecht, S. (2009). Pain sensitivity can be assessed by self-rating: Development and validation of the Pain Sensitivity Questionnaire. Pain,146(1–2), 65–74. https://doi.org/10.1016/j.pain.2009.06.020.CrossRefPubMed

Salkovskis, P., Hackmann, A., Wells, A., Gelder, M. G., & Clark, D. M. (2007). Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: A pilot study. Behaviour Research and Therapy,45(5), 877–885. https://doi.org/10.1016/j.brat.2006.02.008.CrossRefPubMed

Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment,7(4), 524–532. https://doi.org/10.1037//1040-3590.7.4.524.CrossRef

Vlaeyen, J. W. S., de Jong, J. R., Geilen, M., Heuts, P., & van Breukelen, G. (2001). Graded exposure in vivo in the treatment of pain-related fear: A replicated single-case experimental design in four patients with chronic low back pain. Behaviour Research and Therapy,39(2), 151–166. https://doi.org/10.1016/S0005-7967(99)00174-6.CrossRefPubMed

Vlaeyen, J. W. S., de Jong, J. R., Leeuw, M., & Crombez, G. (2004). Fear reduction in chronic pain: Graded exposure in vivo with behavioral experiments. In G. J. G. Asmundson, J. W. S. Vlaeyen, & G. Crombez (Eds.), Understanding and treating fear of pain (pp. 313–343). New York: Oxford University Press.

Vlaeyen, J. W. S., & Linton, S. J. (2012). Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain, 153(6), 1144–1147. https://doi.org/10.1016/j.pain.2011.12.009.CrossRefPubMed

Vlaeyen, J. W. S., Morley, S. J., Linton, S. J., Boersma, K., & de Jong, J. R. (2012). Pain-related fear: Exposure-based treatment of chronic pain. Seattle: IASP Press.

Walter, B., Hampe, D., Wild, J., & Vaitl, D. (2002). The measurement of fear of pain: A modified German version of the Pain Anxiety and Symptom Scale (PASS-D). The Pain,16, 83 (in German).

Woods, M. P., & Asmundson, G. J. G. (2008). Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic back pain: A randomized controlled clinical trial. Pain,136(3), 271–280. https://doi.org/10.1016/j.pain.2007.06.037.CrossRefPubMed

Titel: Evaluation of Exposure Instructions to Pain: Should Therapist Focus on Fear Reduction or Expectation Violation?
Auteurs: Lea Schemer
Karoline Körfer
Julia Anna Glombiewski
Publicatiedatum: 17-12-2019
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 3/2020
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-019-10070-7

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