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Treatment of pain-related fear in chronic (persistent) pain: the role of safety-seeking behaviour and imagery

Published online by Cambridge University Press:  01 April 2008

Nicole Jamani  and
Zoe Clyde
Nicole Jamani*
Affiliation:
INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, UK
Zoe Clyde
Affiliation:
INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, UK
*
*Author for correspondence: Dr N. Jamani, Psychological Therapies Service, 6th Floor, Premier House, 112 Station Road, Edgware HA8 7EH, UK. (email: nicolejamani@beh-mht.nhs.uk)
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Abstract

It is widely recognized that psychological factors play a central role in the adjustment process and subsequent management of chronic pain. The role of anxiety, and specifically pain-related fear, has received particular attention. Paralleling developments in the anxiety disorders literature, psychological models of pain-related fear now highlight the importance of cognitive processes in its maintenance and treatment. However, theoretical and treatment advances in the anxiety disorders literature have not been widely applied to the pain field. In particular, certain cognitive processes, specifically safety-seeking behaviours and imagery, which appear to be involved in the maintenance of pain-related fear. This paper explores how these concepts may apply to pain-related fear and demonstrates how they may aid conceptualization and be used to guide a more cognitively orientated and efficacious treatment.

Keywords

Chronic painimagerypain-related fearsafety-seeking behaviours
Type
Practice article
Information
the Cognitive Behaviour Therapist , Volume 1 , Issue 1 , April 2008 , pp. 3 - 15
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2008

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References

Asmundson, GJG, Norton, PJ, Vlaeyen, JWS (2004). Fear-avoidance models of chronic pain: an overview. In: Understanding and Treating Fear of Pain (ed.Asmundson, G. J. G., Vlaeyen, J. W. S. and Crombez, G.), pp. 3–24. Oxford: Oxford University Press.CrossRefGoogle Scholar
Barlow, DH (2000). Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist 55, 247–1263.CrossRefGoogle ScholarPubMed
Beck, AT (1976). Cognitive Therapy and the Emotional Disorders. New York: International Universities Press.Google Scholar
Beck, AT, Ward, CH, Mendelssohn, MJ, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.CrossRefGoogle ScholarPubMed
Bennett-Levy, J, Butler, G, Fennell, M, Hackmann, A, Mueller, M, Westbrook, D (2004). Oxford Guide to Behavioural Experiments in Cognitive Therapy. Oxford: Oxford University Press.CrossRefGoogle Scholar
Clark, DM (1999). Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy 37 (Suppl. 1), S5–S28.Google Scholar
Clark, DM, Ehlers, A, Hackmann, A, McManus, F, Fennell, M, Grey, N, Waddington, L, Wild, J (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: a randomized controlled trial. Journal of Consulting and Clinical Psychology 74, 568–578.CrossRefGoogle ScholarPubMed
Clark, DM, Wells, A (1995). A cognitive model of social phobia. In: Social Phobia: Diagnosis, Assessment and Treatment (ed.Heimberg, R., Liebowitz, M., Hope, D. A. and Schneier, F. R.), pp. 69–93. New York: Guilford Press.Google Scholar
Clyde, Z, Williams, A (2007). The psychological management of persistent (chronic). pain. In: Psychological Management of Physical Disabilities (ed.Kennedy, P.), pp. 80–103. New York: Routledge.Google Scholar
Fordyce, WE, Shelton, JL, Dundore, DE (1982). The modification of avoidance learning in pain behaviours. Journal of Behavioural Medicine 5, 405–414.CrossRefGoogle Scholar
Hackmann, A (1997). The transformation of meaning in cognitive therapy. In: The Transformation of Meaning in Psychological Therapies: Integrating Theory and Practice (ed.Power, M. and Brewin, C. R.), pp. 125–140. New York: John Wiley & Sons.Google Scholar
Hackmann, A, Clark, DM, McManus, F (2000). Recurrent images and early memories in social phobia. Behaviour Research and Therapy 38, 601–610.Google Scholar
Hackmann, A, Holmes, E (2004). Reflecting on imagery: a clinical perspective and overview of the special issue of Memory on mental imagery and memory in psychopathology. Memory 12, 389–402.CrossRefGoogle ScholarPubMed
Hackmann, A, Surawy, C, Clark, DM (1998). Seeing yourself through others’ eyes: a study of spontaneously occurring images in social phobia. Behavioural and Cognitive Psychotherapy 26, 3–12.Google Scholar
Holmes, EA, Hackmann, A (2004). A healthy imagination? Editorial for the special issue of Memory: Mental imagery and memory in psychopathology. Memory 12, 387–388.CrossRefGoogle ScholarPubMed
Holmes, EA, Mathews, A (2005). Mental imagery and emotion: a special relationship? Emotion 5, 489–497.Google Scholar
Jensen, MC, Kelly, AP, Brant-Zawadzki, MN (1994). MRI of degenerative disease of the lumbar spine. Magnetic Resonance Quarterly 10, 173–190.Google Scholar
Kori, SH, Miller, RP, Todd, DD (1990). Kinesiophobia: a new view of chronic pain behaviour. Pain Management 3, 35–43.Google Scholar
Kugler, K, Wijn, J, Geilen, M, de Jong, J, Vlaeyen, JWS (1999). The Photograph Series of Daily Activities (PHODA). CD-Rom version 1.0. Heerlen: Institute for Rehabilitation Research and School for Physiotherapy.Google Scholar
Lethem, J, Slade, PD, Troup, JDG, Bentley, G (1983). Outline of a fear-avoidance model of exaggerated pain perceptions. Behaviour Research and Therapy 21, 401–408.CrossRefGoogle Scholar
McCracken, LM, Zayfert, C, Gross, RT (1992). The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Pain 50, 67–73.CrossRefGoogle ScholarPubMed
Morley, S, Eccleston, C (2004). The object of fear in pain. In: Understanding and Treating the Fear of Pain (ed.Asmundson, G., Vlaeyen, J. and Crombez, G.), pp. 163–188. Oxford: Oxford University Press.CrossRefGoogle Scholar
Ottaviani, R, Beck, AT (1987). Cognitive aspects of panic disorders. Journal of Anxiety Disorders 1, 15–28.Google Scholar
Salkovskis, PM (1991). The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy 19, 6–19.CrossRefGoogle Scholar
Salkovskis, PM, Clark, DM, Gelder, MG (1996). Cognitive-behaviour links in the persistence of panic. Behaviour Research and Therapy 34, 452–458.CrossRefGoogle Scholar
Salkovskis, PM, Clark, DM, Hackmann, A, Wells, A, Gelder, MG (1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy 37, 559–574.CrossRefGoogle ScholarPubMed
Salkovskis, PM, Hackmann, A, Wells, A, Gelder, MG, Clark, DM (2006). Belief disconfirmation versus habituation approaches to situational exposure in panic disorder with agoraphobia: a pilot study. Behaviour Research and Therapy 45, 877–885.CrossRefGoogle Scholar
Schott, GD (2004). Communicating the experience of pain: the role of analogy. Pain 108, 209–212.CrossRefGoogle ScholarPubMed
Sharp, T (2001 a). The ‘safety seeking behaviours’ construct and its application to chronic pain. Behavioural and Cognitive Psychotherapy 29, 241–244.Google Scholar
Sharp, T (2001 b). Chronic pain: a reformulation of the cognitive-behavioural model. Behaviour Research and Therapy 39, 787–800.CrossRefGoogle ScholarPubMed
Sieben, JM, Vlaeyen, JWS, Portegijs, PJM, Verbunt, JA, Van Riet-Rutgers, S, Kester, ADM, Von Korff, M, Arntz, A, Knottnerus, JA (2005). A longitudinal study on the predictive validity of the fear-avoidance model in low back pain. Pain 117, 162–170.Google Scholar
Sullivan, MJL, Bishop, S, Pivik, J (1995). The Pain Catastrophizing Scale: development and validation. Psychological Assessment 7, 524–532.Google Scholar
Tang, NKY, Salkovskis, PM, Poplavskaya Wright, KJ, Hanna, M, Hester, J (2007). Increased use of safety-seeking behaviours in chronic back pain patients with high health anxiety. Behaviour Research and Therapy 45, 2821–2835.Google Scholar
Thwaites, R, Freeston, MH (2005). Safety seeking behaviours: fact or function? How can we clinically differentiate between safety behaviours and adaptive coping strategies across anxiety disorders? Behavioural and Cognitive Psychotherapy 33, 177–188.CrossRefGoogle Scholar
Vlaeyen, JWS, De Jong, J, Geilen, M, Heuts, PHTG, Van Breukelen, G (2002). The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. Clinical Journal of Pain 18, 251–261.CrossRefGoogle ScholarPubMed
Vlaeyen, JWS, De Jong, J, Leeuw, M, Crombez, G (2004). Fear reduction in chronic pain: graded exposure in vivo with behavioural experiments. In: Understanding and Treating Fear of Pain (ed.Asmundson, G. J. G., Vlaeyen, J. W. S. and Crombez, G.), pp. 313–343. Oxford: Oxford University Press.CrossRefGoogle Scholar
Vlaeyen, JWS, Kole-Snijders, AMJ, Boeren, RG, Van Eek, H (1995 a). Fear of movement/(re)injury in chronic low back pain and its relation to behavioural performance. Pain 62, 363–372.Google Scholar
Vlaeyen, JWS, Kole-Snijders, AMJ, Rotteveel, A, Ruesink, R, Heuts, PHTG (1995 b). The role of fear of movement/(re)injury in pain disability. Journal of Occupational Rehabilitation 5, 235–252.Google Scholar
Vlaeyen, JWS, Linton, SJ (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85, 317–332.Google Scholar
Waddell, G, Newton, M, Henderson, I, Somerville, D, Main, C (1993). A Fear-Avoidance Beliefs Questionnaire (FABQ). and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52, 157–168.CrossRefGoogle ScholarPubMed
Wells, A, Clark, DM, Salkovskis, P, Ludgate, J, Hackmann, A, Gelder, MG (1995). Social phobia: the role of in-situation safety behaviours in maintaining anxiety and negative beliefs. Behaviour Therapy 26, 153–161.CrossRefGoogle Scholar
Wells, A, Hackmann, A (1993). Imagery and core beliefs in health anxiety: content and origins. Behavioural and Cognitive Psychotherapy 21, 265–273.CrossRefGoogle Scholar
Winterowd, C, Beck, AT, Gruener, D (2003). Eliciting and modifying imagery. In: Cognitive Therapy with Chronic Pain Patients, pp. 183–207. New York: Springer Publishing Co.Google Scholar
Woods, MP, Asmundson, GJG (2007). Evaluating the effects of graded in vivo exposure for the treatment of fear in patients with chronic back pain: a randomised controlled trial. Pain 136, 271–280.CrossRefGoogle Scholar
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