Coping When Pain Is Appraised As A Potential Threat: The Efficacy Of Acceptance Versus Distraction

Pain is a complicated physiological and psychological process, including emotional, cognitive, motivational and physiological factors. The presence and development of pain is affected by psychological factors, especially in preventing or leading to functional disability. People always hold threat or reassurance cognitive appraisal of pain. People holding the threat value of pain think pain is harmful and going to make damage to people's body. But people holding the reassurance value of pain think pain is safe and will not make damage to people's body. Clinic pain studies showed that if people suffering acute pain perceived pain as a potential threat, their acute pain might be more likely to turn into chronic pain, and they might have more catastrophizing thoughts, depression and serious pain. People who perceived pain as a potential threat might have more pain medicine, lower work efficacy and life activities, and even lose their work ability. Experimental studies suggested that participants who received threatening information about pain had lower pain tolerance and less use of pain coping strategies and catastrophized more. The threat value of pain reduced participants'pain tolerance and impaired their pain coping ability.There are two different ways of approaching the pain problems. One approach is to focus on the patient's environment and opportunities for overt behavior change. A second approach is to seek direct change in thoughts, beliefs, emotions, or sensations. As the development of psychological therapy, modern therapies such as traditional Cognitive and Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) build on the successes of these two approaches. The main aim of CBT is to change and alter pain patients'negative understanding of pain and enhance their confidence and self-control, and give pain patients interventions with behavior approaches. The CBT developing and teaching patient strategies is to change and alter unwanted personal events (e.g., pain). Most treatment methods (e.g., distraction) for chronic pain aim to reduce pain. Even methods designed to improve patient functioning are often applied with a rationale that the return to normal functioning should lead to pain reduction. However, efforts to control pain can be problematic under some circumstances:when they (a) dominate the patient's life and do not succeed, (b) lead to unwanted side effects or complications, and (c) move the pain sufferer increasingly away from the things that are important to them, such as health, work, friends, and family. The pain control agenda can lead to extended rest, avoidance of activity, medication consumption, repeated medical consultations or procedures, and retirement from work. In some situations it may be difficult for a person with chronic pain to devote their efforts equally to pain control and to valued aspects of their life at the same time. If efforts to control pain dominate, quality of living may be sacrificed. ACT maintains that it is more beneficial for people to be willing to experience unwanted psychological events (e.g., pain), instead of trying to control, or change them. When people are willing to experience unwanted events, the form of the events does not change, but their impact, or function, is not as debilitating. For example, if they are willing to accept the painful sensations and accompanying thoughts, people with pain are likely to still feel it, but may no longer experience the pain as so overwhelming or all consuming. As a result, such people may be better able to act in a way that is congruent with their values and goals. Thus, acceptance-based treatments encourage patients to experience unwanted psychological events, so that they can better act in a way that is consistent with their goals.Psychological pain management teaches pain patients pain coping strategies. But the issue that whether the efficacy of pain coping strategies is impacted by people's threatening appraisal of pain still needs to be investigated. In the current experiment, we used the cold pressor task (CPT) to investigate the efficacy of two pain coping strategies, ACT-based acceptance strategy and traditional CBT-based distraction strategy when pain was appraised as a potential threat, with the measurements of pain intensities, pain tolerance, increased pain tolerance and the frequency of using pain coping strategies. The purposes of the current research:(1) whether the threat value of pain impairs the efficacy of ACT-based acceptance strategy; (2) whether the threat value of pain impairs the efficacy of traditional CBT-based distraction strategy; (3) Compare which strategy is superior at increasing the participants'pain tolerance and their pain coping ability when pain is appraised as a potential threat.The experiment is composed by two 2 x 2 between groups designs. Experiment 1 is aimed at examining the efficacy of acceptance strategy when pain is perceived as a potential threat. Experiment 2 is aimed at examining the efficacy of distraction strategy when pain is threatening. The results indicated that acceptance-reassurance group was better at increasing their pain tolerance and strengthening their pain coping ability than distraction and control group either in threat or reassurance condition; but acceptance-threat group was only better than distraction-reassurance group. However, opposite of our expectation, no significant differences were found between the distraction group and the control group either in threat or reassurance condition. The acceptance group reported more acceptance strategy used during the CPT. The distraction group reported more ignore used during the CPT, but we also found they used more catastrophizing. The threat group reported less self-statement than the reassurance group. We concluded that the threat value of pain indeed impaired the efficacy of acceptance strategy. ACT-based acceptance strategy worked better at improving individual's pain tolerance and pain coping ability than the traditional CBT-based distraction strategy.The present research should be considered when the clinical psychological experts treat their patients. The ACT-based acceptance strategy may be helpful in pain management and can be applied into clinical patients. Still, the intervention on patients'threat cognitive appraisal of pain should be concerned.