Week 7-Psychological Therapy for Pain (incl. mindfulness) Flashcards
Define mindfulness
Intentional, non-judgmental focus on the present moment (Shapiro et al., 2006)
What is the history of mindfulness techniques?
Formal Meditation Practises:
1. Mindfulness Based Stress Reduction
(MBSR) (Kabat-Zinn, 1985): for those with chronic conditions
- Mindfulness Based Cognitive Therapy
(MBCT) (Segal, Williams, & Teasdale, 2002): evolved from the technique above, aimed to prevent the relapse of depression by building psychological resilience
Other exercises that promote mindfulness:
1. Acceptance and Commitment Therapy (ACT) (Hayes, Luoma, Bond, Masuda, & Lillis, 2006): Like CBT but with mindfulness as a core component. Does contain some formal meditation practises, but also contains other exercises such as visualisation or mental imagery type exercises which promotes mindfulness.
What are the Commonalities between MBSR and MBCT? (Day et al., 2014)
Both group setting interventions consisting of 4 to 8 weekly sessions.
Both provide guided mindfulness meditation audio files and are instructed to practice daily for 45 minutes.
Both use practice progression (i.e., build on mindfulness): body scan, seated meditations, mindful movement/yoga/walking, sharing experiences.
Both encouraged to infuse mindful practices into everyday tasks e.g., mindfulness in showering, eating, brushing teeth etc.,
-Almost no differences between the two
What are the Advantages of mindfulness meditation?
Just as effective as CBT and hypnosis
Additionally, suitable for delivery in large groups (in uncomplicated cases)
Can be delivered via internet or apps
Many opportunities for ongoing support (e.g., meditation retreats)
What are the Disadvantages of mindfulness meditation?
Requires preparedness of the patient (needs awareness that their mental state impacts their life and must be willing to do something about it)
“McMindfulness” (hype, over-marketing,
unrealistic expectation), need to set realistic expectations of the outcomes following mindfulness meditation
What’s the IAA model of mindfulness? (Shapiro et al., 2006)
-Intentional, non-judgmental [Attitude] focus [Attention] on the present moment
Intentions (i.e., reasons why one might want to practise mindfulness):
1. Self-regulation (behaviour/symptom change)
2. Self-exploration (curiosity)
3. Self-liberation (spiritual-i.e., overcoming self-concern at the expense of other people)
(non-judgemental) Attitude (qualities of attention/intention):
1. Open/accepting to experiences
2. Kindly
3. Curious
Attention:
1. Shifting attention away from mental processes and any occuring ruminations
2. Sustaining attention in the present moment
-All these components interrelate and interact with each other
IAA: What’s Decentring as a “meta-mechanism”? (Shapiro et al., 2006)
- Decentring or as Shapiro terms Re-perceiving, is a core component of mindfulness (originating from MBCT)
“Subject” becomes “Object” of attention e.g., mental events such as sensations
- ACT: Cognitive de-fusion (and “self-as-context”)
-These IAA components don’t necessarily drive therapeutic change
What’s Acceptance and Commitment Therapy (ACT)?
■ “ACT is a therapeutic approach that uses
acceptance and mindfulness processes (mindfulness components), and
commitment and behaviour change processes (CBT components), to produce greater psychological flexibility.” (Hayes, Wilson, Strosahl, 1999)
■ ACT is an evolution of Cognitive-Behavioural Therapy, with the key difference between the incorporation of mindfulness practices (McCracken and Vowles, 2014)
What’s The ACT Hexaflex? (Hayes, Strosahl & Wilson, 1999)
-It is a 6 component model of ACT
Psychological flexibility is linked with:
-Contact with the present moment
-Values
-Acceptance
-Cognitive Defusion
-Committed Action
-Self as Context
Acceptance and mindfulness approaches include:
-Contact with the present moment
-Acceptance (i.e., non-judgemental)
Commitment and behaviour change processes include:
-Values e.g., reduce pain, spend more time with family
-Committed action as a result of those values
Decentring includes:
-Defusion
-Self as Context
ACT Hexaflex: What is involved in the “Decentering” Process?
Bennett et al. (2021):
* “Allows individuals to experience distressing inner events as imperfect
models of the real-world rather than
precise reflections.”
- Article provides up-to-date overview
of different models and methods to
measure decentring; takes developmental perspective as this ability tends to develop between 10-13 years of age (Example: McCracken, et al., 2014).
Decentring has a two-factor structure ( McCracken, et al., 2014):
(1) Self-as-context - intentionally
disengage/disidentify from the content
of inner events
(2) Cognitive defusion - reduced
emotional reactivity to those events
What are some Key learning points?
■ Mindfulness is a well-defined construct, but implemented differently in different therapeutic models, and with different terminology.
■ The IAA model captures both the definition and core qualities of mindfulness; Decentring is the core cognitive mechanism.
■ The ACT model: Mindfulness is core, but supplemented by values clarification and committed action and is therefore more focused on behaviour change.
What are Specific and non-specific therapeutic components of drug therapies and psychotherapies? (Enck and Zipfel, 2019)
-Non-specific components are part of psychotherapies which are common in the control condition and therapeutic clinical condition
-Control/Placebo conditions if proper, will control for things like the regression to the mean, natural course of disease and methodological biases
-There are specific components which move past the control condition such as common factors (factors you would expect to improve as a result of any psychological intervention). These components are common across various psychological interventions. It could include therapist relationship, trust, empathy etc., which would impact the factors like conditioning and expectations in placebo conditions (the better the relationship the more likely the patient expects it to be positive)
-There are also effects specific to the therapy which are things that differ between therapeutic models e.g.,, the difference between IAA and ACT
How does mindfulness and placebo have theoretically distinct cognitive mechanisms?
■ Expectation:
– Placebo relies on the cognition fusion of expectations with reality (internal model of the world-dominating over the senses) i.e., getting in your head
– Mindfulness aims for cognitive de-fusion (“coming to your senses”) i.e., getting out of your head
■ Conditioning:
– Placebo relies on conditioning mechanisms to induce pain relief
– Mindfulness aims to recognise / bring awareness to the person’s conditioning history to undermine conditioned responses (e.g. acceptance of pain undermines threat-related conditioning)
What is the Specific effectiveness of mindfulness on pain above a simple placebo effect: study designs
- Active control conditions are crucial for filtering out non-specific effects, notably the placebo effect (expectation of benefit, not the treatment itself)
- Most active controls in mindfulness studies were not other established treatments, but rather minimally effective interventions (“shams”) i.e., teaching them something else, getting everything apart from the specific components
Study types:
Acute pain:
Short-term effects
* Randomised clinical trials
* Sham controlled studies available
Long-term effects
* Between-subject designs available
* Longitudinal designs not available
* Sham control impossible (not ethical)
Chronic pain:
Short-term effects
* Randomised clinical trials
* Few studies using sham controls
Long-term effects
* Lack of published data
What are the short-term effects of
mindfulness on acute pain beyond simple placebo effects?
■ Effect on pain unpleasantness and
importance of sham control condition(s)
■ Do placebo effects contribute to
mindfulness-based analgesia?
■ Physiological correlates (brain imaging,
pharmacological studies) may distinguish
mindfulness from sham or placebo
