Elsevier

Behaviour Research and Therapy

Volume 38, Issue 11, 1 November 2000, Pages 1117-1124
Behaviour Research and Therapy

Shorter communication
Suppressing and attending to pain-related thoughts in chronic pain patients

https://doi.org/10.1016/S0005-7967(99)00150-3Get rights and content

Abstract

Attempted suppression of pain-related thoughts was investigated in consecutive referrals for pain management (N=39). Participants monitored their pain-related thoughts for three 5-min periods. In period 1, all participants were instructed to think about anything. For period 2, participants were instructed to either suppress pain-related thoughts, attend to pain-related thoughts, or to continue to think about anything. In period 3, all participants were again instructed to think about anything. Participants instructed to attend to their pain reported more pain-related thoughts than suppressors and controls in both periods 2 and 3. Suppressors experienced reduced pain-related thoughts during period 2. There was no immediate enhancement or delayed increase.

Introduction

The attempted suppression of a target thought has been shown to result in an ironic increase in the occurrence of that thought (McNally and Ricciardi, 1996, Salkovskis and Campbell, 1994, Trinder and Salkovskis, 1994). Ironic effects of thought suppression have been proposed as a model for the causation and maintenance of intrusive symptoms that are characteristic of clinical disorders such as obsessive compulsive disorder and posttraumatic stress disorder (Trinder and Salkovskis, 1994, Wegner, 1989). Recent empirical work has provided preliminary support for these claims as related to trauma-related thoughts (Harvey & Bryant, 1998a).

A key controversy in the literature on chronic pain has been the relative effectiveness of cognitive control strategies. Specifically, researchers have been interested in which of two strategies, attention to or distraction from the pain, is more effective in reducing pain awareness and discomfort (Eccleston, 1995, McCaul and Hangtvedt, 1982, Thompson, 1982). While some studies have found that attention is a more effective thought control strategy than distraction in reducing pain experience (Ahles et al., 1983, McCaul and Hangtvedt, 1982), others have suggested that distraction works better when pain is acute, with attention being a more helpful strategy when pain is persistent (Cioffi, 1991). The majority of this research is based on the experimental induction of pain. While analogue experiments have utility in exploring clinical phenomena at a basic level, it cannot be assumed that the results will generalize to clinical samples.

Wegner (1994) highlighted the potential applicability of the thought suppression literature to the exploration of cognitive control in chronic pain. To date, only one study in the pain literature has employed a thought suppression paradigm but it investigated experimentally induced pain (Cioffi & Holloway, 1993). Accordingly, the present study represents the first investigation of the relationship between attempted suppression and chronic pain in a clinical sample. The study was designed to investigate the two types of ironic effects that have been previously reported in the literature; namely, the immediate increase in the target thoughts when suppression is attempted (e.g., Lavy & van den Hout, 1990) and the delayed increase in the number of intrusive thoughts after attempted suppression has ceased (e.g., Clark, Ball & Pape, 1991).

Section snippets

Participants

Successive referrals for pain management were asked to participate in the study. Thirty-nine participants (21 male, 18 female) were randomly allocated to the suppression (n=14), attention (n=12) or control (n=13) conditions. Participants were excluded if they had sustained a traumatic brain injury (TBI), displayed poor English, or had taken analgesic medication within 24 h of the study. Areas of pain included back (n=20), hands (n=6), neck (n=10), knee (n=1), hip (n=1) and arm (n=1). Sixteen

Participant characteristics

Table 1presents the mean scores for participant characteristics. A one way analysis of variance (ANOVA) across the three groups was conducted for each of the following variables: age, frequency of pain in the past month, discomfort caused by the pain in the last month, severity of pain in the last month, P3-somatization, P3-anxiety and P3-depression. No significant effects were found. Scores for each group on the P3 were consistent with the published norms based on a large chronic pain sample

Discussion

Consistent with the intended experimental manipulation, following period 2 the ratings for attention made by the attention group were higher than the ratings made by the suppression and control groups, and the ratings of suppression made by the suppression group were higher than ratings by the attention and control groups. Perhaps the increase in ratings of attempted suppression during period 3 for the attention (M=6 for period 3, M=2.42 for period 2) and control (M=5.23 for period 3, M=3.46

Acknowledgements

This research was supported by the Australian Behaviour Modification Association.

References (20)

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