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Communication in the context of acute pain: Persuasion or validation?
Örebro University, School of Law, Psychology and Social Work.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Historically, the dominating theoretical framework for communication in the context of acute pain is reassurance. An inherent assumption of this framework is that the person in pain needs to have their fears and doubts removed and be educated, or persuaded, that the pain problem is not dan-gerous. This is then thought to lead to a shift in beliefs that later explain future beneficial outcomes

In later years, another communication technique known as validation has started to gain traction in the pain field. This technique focuses on le-gitimizing the thoughts and emotions of pain patients and is instead thought to influence outcomes through better emotion regulation.

The overall aim of this dissertation is to extend current knowledge on effective communication in the context of acute pain. In one observational study a variable supposedly sensitive to shifts in beliefs was observed in a cohort of acute pain patients over the course of the first three months after pain onset. Also, in two controlled experiments we explored the impact of validating communication on pain relevant variables while investigating if this effect was due to improved emotion regulation.

Taken together, this dissertation indicates that validating communica-tion shows promise as a form of effective communication in the context of acute pain, in that it influences both pain catastrophizing and recall. The dissertation does not give support to either changes in beliefs nor emotion regulation being the mechanism of change for effective communication. Thus, this dissertation propose a new model of effective communication based both on previous research highlighting the effectiveness of infor-mation and the research presented in this dissertation, more focused on the role of psychological processes such as pain catastrophizing.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2018. , p. 94
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 39
Keywords [en]
Acute pain, communication, validation, reassurance, expectations for recovery, catastrophizing, recall, misdirected problem solving, psycho-logical flexibility
National Category
Psychology (excluding Applied Psychology)
Identifiers
URN: urn:nbn:se:oru:diva-65435ISBN: 978-91-7529-239-7 (print)OAI: oai:DiVA.org:oru-65435DiVA, id: diva2:1187132
Public defence
2018-04-20, Örebro universitet, Långhuset, Hörsal 2, Fakultetsgatan 1,, Örebro, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2018-03-02 Created: 2018-03-02 Last updated: 2018-03-28Bibliographically approved
List of papers
1. When the wind goes out of the sail - declining recovery expectations in the first weeks of back pain
Open this publication in new window or tab >>When the wind goes out of the sail - declining recovery expectations in the first weeks of back pain
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2014 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 18, no 2, p. 269-278Article in journal (Refereed) Published
Abstract [en]

Background Expectations for recovery are a known predictor for returning to work. Most studies seem to conclude that the higher the expectancy the better the outcome. However, the development of expectations over time is rarely researched and experimental studies show that realistic expectations rather than high expectancies are the most adaptive. This study aims to explore patterns of stability and change in expectations for recovery during the first weeks of a back-pain episode and how these patterns relate to other psychological variables and outcome.

Methods The study included 496 volunteer patients seeking treatment for work-related, acute back pain. The participants were measured with self-report scales of depression, fear of pain, life impact of pain, catastrophizing and expectations for recovery at two time points. A follow-up focusing on recovery and return to work was conducted 3 months later. A cluster analysis was conducted, categorizing the data on the trajectories of recovery expectations.

Results Cluster analysis revealed four clusters regarding the development of expectations for recovery during a 2-week period after pain onset. Three out of four clusters showed stability in their expectations as well as corresponding levels of proximal psychological factors. The fourth cluster showed increases in distress and a decrease in expectations for recovery. This cluster also has poor odds ratios for returning to work and recovery. Conclusion Decreases in expectancies for recovery seem as important as baseline values in terms of outcome, which has clinical and theoretical implications.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:oru:diva-33642 (URN)10.1002/j.1532-2149.2013.00357.x (DOI)000329303600013 ()
Note

Funding Agency: Liberty Mutual Research Institute for Safety; Scan/Design by Inger and Jens Brun Foundation

Available from: 2014-02-07 Created: 2014-02-07 Last updated: 2018-06-04Bibliographically approved
2. Lending an ear to pain: The impact of emotionally oriented communication on pain catastrophizing
Open this publication in new window or tab >>Lending an ear to pain: The impact of emotionally oriented communication on pain catastrophizing
(English)Manuscript (preprint) (Other academic)
National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:oru:diva-66217 (URN)
Available from: 2018-03-28 Created: 2018-03-28 Last updated: 2018-03-28Bibliographically approved
3. Effects of validating communication on recall during a pain-task in healthy participants
Open this publication in new window or tab >>Effects of validating communication on recall during a pain-task in healthy participants
2017 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, p. 118-125, article id S1877-8860(17)30143-XArticle in journal (Refereed) Published
Abstract [en]

BACKGROUND: Increasing recall of instructions and advice in a pain consultation is important, since it is a prerequisite for adherence to treatment recommendations. However, interference due to pain-related distress may result in poor recall. Whereas there are some indications that recall can be increased by empathic communication that reduces interference, this interesting possibility remains largely untested experimentally. The current experiment aimed at studying effects of empathic communication, and more specifically validation, on recall during a pain test and possible mediators and moderators of this effect.

METHOD: Participants received either validating (N=25) or invalidating responses (N=25) from the experimenter during a pain provoking task, followed by self-report measures of interference (affect, situational pain catastrophizing) and recall (accurate and false memories of words).

RESULTS: As expected, the validated group exhibited higher accurate recall and less false memories following the pain test as compared to the invalidated group. This was partly due to the effect of interference being counteracted by moderating the relationship between pain catastrophizing and recall.

CONCLUSION: These novel results suggest that validating communication can counteract interference due to pain catastrophizing on recall, at least in a controlled experimental setting.

IMPLICATIONS: Good communication by health professionals is of utmost importance for adherence to pain management. The current results expand our knowledge on the effects of pain communication by establishing and explaining a clear link between empathic communication and recall, highlighting the role of pain catastrophizing.

Place, publisher, year, edition, pages
Walter de Gruyter, 2017
Keywords
Validation; Communication; Memory recall; Pain catastrophizing; Affect
National Category
Applied Psychology Neurology
Identifiers
urn:nbn:se:oru:diva-61698 (URN)10.1016/j.sjpain.2017.07.003 (DOI)000419851500017 ()28850364 (PubMedID)2-s2.0-85028312094 (Scopus ID)
Funder
Swedish Research Council
Available from: 2017-11-13 Created: 2017-11-13 Last updated: 2018-03-28Bibliographically approved

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Carstens Söderstrand, Johan

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