Week 23- Group-level health psychology interventions

Question 1

Pain

Answer 1

A sign that something is wrong or has been damaged

Not just biological and physical, it is how we interpret pain which is affected by how we feel about it such as emotions, what we think it means, and what we do about it

Question 2

What can pain be affected by?

Answer 2

‒ Emotional state, e.g. state or trait anxiety, negative mood
‒ Schemas and our beliefs about pain and how we cope with pain
‒ Worry about intensity of pain, how long it might last, origin or consequences of the pain

Question 3

Early conceptualisations of pain

Answer 3

• Pain viewed from a biomedical perspective:
  
  • Caused by tissue damage
  • SEVERITY DEPENDS ON EXTENT OF TISSUE DAMAGE

Question 4

Evaluation of early conceptualisations of pain

Answer 4

• Pain experienced not always related to observable tissue damage (e.g. chronic back pain; phantom limb pain)

Pain is clearly beneficial – warns us of danger/damage
Pain sensation can continue even in the absence of physical damage

The brain takes into account not only info from pain receptors but info from elsewhere

May cause brain to keep sending signals of pain even if physical damage is no longer there

Question 5

Types of pain: Acute pain

Answer 5

‒ Necessary to protect us from damage or infection
‒ Pain for short amount of time/ painkiller or treatment used

Question 6

Types of pain: Chronic (persistent) pain

Answer 6

‒ Pain lasting 3 months or longer – any original injury may have healed, but pain pathways have become altered meaning that pain is felt in the absence of injury
‒ Psychological consequences such as anxiety, depression and hopelessness

Question 7

Types of pain: Biopsychosocial model of pain

Answer 7

Physiological factors: injury, disease, general health

Psychological factors: anxiety, stress, fear-avoidance, pain beliefs, somatisation, coping, learned helplessness

Environmental factors: SES, work/home environment, healthcare services, family and social/cultural attitudes and norms

Social factors: social context, responses of others, support, dependence, restricted social activity

Question 8

FAM in chronic (persistent) pain (Crombez et al 2012)

Answer 8

• Identifies risk factors for chronic pain:
  ‒ avoidant coping strategies
  ‒ fear of movement/(re)injury
  ‒ catastrophizing
  ‒ expecting high level of pain
  ‒ low perceptions of control over pain
• Supports model, e.g. fear-avoidance predicted who would suffer back-pain episode in the year post-baseline (Linton et al. 2000)

Question 9

Why are group intervention needed?

Answer 9

Group interventions or no more or less effective than individual-level interventions

Systematic review of smoking cessation found group interventions no more effective than intensive individual interventions (Stead et al 2017

Question 10

Why are group intervention needed? Evaluation

Answer 10

‒ May allow participants to feel additional social support – shared understanding of their condition or situation
‒ More cost-effective for NHS
‒ Group interventions still allow for individual goals to be set

Question 11

Social support: Learning from others

Answer 11

self-disclosure from other group members on how to address a specific problem; self-disclosure of experiences

Question 12

Social support: Trust and understanding

Answer 12

a shared “safe” space creates a feeling of acceptance

Question 13

Social support: Self-disclosure

Answer 13

allows for modelling and learning from others

Question 14

Social support: Relationships with group members

Answer 14

friendships developed in the group may continue after therapy has finished

Question 15

Pain Management Programmes (PMPs)

Answer 15

• Intensive (complex) interventions for patients with chronic (persistent) pain
• Theory-based (CBT) – FAM is a CBT model
• Cover a range of topics/strategies, depending on the theory:
  
  • Medication education
  • Mindfulness
  • Exercise
  • Goal-setting

Question 16

Aim of Pain Management Programmes (PMPs)

Answer 16

Improve function, to improve quality of life, to reduce pain

Question 17

NHS PMPs

Answer 17

Run over a 6-8 week period
* Initial assessment
‒ Information about patient’s pain, comorbidities
‒ Suitability for a PMP

Question 18

Group sessions

Answer 18

full day (or two half days) per week
Meet different members of the team: pain consultant, psychologist, physiotherapist

Question 19

Process of Group sessions 1

Answer 19

• Explanation of why pain is still being perceived

Underlying biological mechanisms of pain

Explaining to the patient that there is no physical cause for their pain (i.e. medical treatment is ineffective)

Help them understand the psychosocial explanations for their pain and what else might be impacting their perception of pain

Question 20

Process of Group sessions 2

Answer 20

• Acceptance of pain
  Often very difficult for patients
  Focus on positive opportunities/experiences

Question 21

Process of Group sessions 3

Answer 21

• Pacing
  Gradually increasing activity over a period of time

People with persistent pain may try and do too much on good” days, leading to them feeling much worse on subsequent days – pacing helps break this cycle

Question 22

Process of Group sessions 4

Answer 22

• Goal-setting
  Individual goals set by each participant related to activities meaningful to them

Question 23

Process of Group sessions 5

Answer 23

• Activity
  Putting activity goals into practice under the supervision of a physiotherapist

Physiotherapist may challenge patients (catastrophising and fear-avoidance) where appropriate

Question 24

Process of Group sessions 6

Answer 24

• Managing moods/Sleep
  Mindfulness – accepting thoughts as just thoughts

Question 25

Process of Group sessions 7

Answer 25

• Relaxation and mindfulness
  Breathing exercises

Question 26

Process of Group sessions 8

Answer 26

• Managing setbacks