Psychology and Behavioral Medicine

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Pain is both a physical and a psychological experience and can dramatically affect all aspects of your life including the things that you do, the way that you feel and how you think. The opposite is also true: the things that you do, the way that you feel and how you think can affect your pain.

Behavioral medicine complements the medical treatment of pain by using the skills of a psychologist to teach children and families how to manage their medical condition. These interventions, which target a child's thoughts or feelings related to pain (e.g., counseling, relaxation techniques), often are effective in relieving pain.

Through comprehensive treatment programs that address chronic pain's physical, psychological and the social/environmental aspects, children with pain disorders can gain the tools they need to overcome the pain's potentially disabling effects.

Caring for Disabilities Caused by Pain

Psychologists are trained to help people examine and change behavior, feelings and thoughts. These specialists are an important part of a pain clinic's team and can provide a number of important services, including:

  • helping increase a child's functional abilities in the face of pain

  • examining, with parents, how they respond to their child's pain and suggest ways in which responding differently might benefit everyone

  • working with school personnel to find ways of helping a child with pain function in the school environment

  • identifying a child's coping skills and creating self-reliance through adaptive coping techniques (e.g., problem-focused coping).

Caring for Emotional Difficulties Related to Pain

Although chronic pain is not necessarily caused by emotional difficulties, it is very common for children with chronic pain to experience sadness, frustration, anger and anxiety. These feeling can arise not just from the experience of pain itself, but also from the feeling of being misunderstood and questioned about whether the pain is "real."

Because the mind and the body are so strongly inter-related, emotional distress and pain can amplify each other such that sadness or anxiety make the pain worse.

A psychologist can:

  • help the family and the rest of the treatment team understand the extent to which mood or anxiety may affect a child's pain problem

  • address mood or anxiety concerns through cognitive-behavioral or family-centered interventions, with the ultimate goals of reducing pain and increasing function

Self-Management Techniques for Pain

Children can learn to manage their own pain using relaxation strategies such as deep breathing exercises, muscle relaxation, guided imagery and biofeedback. Relaxation techniques can give a child an increased sense of control over her pain, which can help to reduce pain. With less pain, children can function better.

Self-management techniques can also include cognitive skills such as "thought stopping" or "reframing," which can help children fend off some of the negative thoughts and feelings that often arise as a consequence of living with pain.

Relaxation Training

Relaxation training involves learning to do the opposite of what your body wants to do and decrease the muscle tension in order to decrease the pain, and is frequently used with pain patients.

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When you experience pain, your body automatically responds to protect the area with pain by tensing muscles in that area. In chronic pain, the muscles are chronically tight and this tightness actually increases the sensation of pain.

It is a skill that must be learned and practiced to optimize its effects. Relaxation audiotapes help patients practice at home and can also help other problems that can be related to pain such as trouble getting to sleep at night.

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Biofeedback

Biofeedback is a treatment that allows you to gather information about your body’s functions so that you can learn to change them. Simply put, with biofeedback you get information (“feedback”) about what your body (“bio”) is doing. Weighing yourself on a scale and taking your temperature with a thermometer are examples of biofeedback.

A psychologist uses biofeedback to give you information about your body so that you can learn how to change what your body is doing and control your pain.

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How does biofeedback work?

Biofeedback brings you immediate information about how your body is functioning. You can use this information to gain some control over your body.

Biofeedback sensors work with a computer to show you things like:

  • how fast your heart is beating
  • how often you take a breath
  • your skin temperature
  • how tense your muscles are


The sensors—which do not cause any discomfort—turn that information into a sound and/or an image on the computer that allows you to see how your body is working. You can then learn to control how your body works, which in turn may help you to better control the symptoms that you are experiencing.



 

 

 

How does biofeedback help with pain?

When you are in pain, your body becomes activated (e.g., muscle tension increases, heart rate increases and body temperature decreases), which can increase the sensation of pain.

With biofeedback, you can learn to recognize problematic changes in your body and control them to manage your pain.

Who can benefit from biofeedback?

Children with:

  • migraine and tension headaches
  • chronic pain associated with complex regional pain syndrome (CRPS)and other chronic pain conditions
  • gastrointestinal conditions such as functional abdominal pain and inflammatory bowel disease
  • anxiety

Depending on the symptoms, biofeedback is usually most helpful when combined with other treatments such as counseling (including cognitive behavioral techniques and relaxation training), physical therapy (if prescribed) and medication (if prescribed).

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Imagery and Distraction Techniques

By learning some simple strategies to distract your attention from pain, you can decrease your pain. It is often thought that pain is a “thing” that is there whether or not you pay attention to it. In reality, pain is a sensation and if you do not feel it, it isn’t there. Learning how to divert your attention away from the pain is actually learning to control your pain level.

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Just like the injured athlete in the middle of an important event, your mind can turn down or off the pain signals by focusing on something else. Unlike the injured athlete, these techniques are taught as skills that you can use whenever you like, not just in the middle of “the big game.”

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Hypnosis

There are a lot of misconceptions about hypnosis, mostly because the average person’s exposure to the technique is limited to entertainment hypnosis, where it appears that the hypnotized individual is under control of the “hypnotist.” In reality, hypnosis state of focused attention and concentration that empowers individuals to control both their thoughts and physiological (body) functioning. While under hypnosis, your focus excludes practically everything else.

Learning self-hypnosis is a lot like learning to go into a daydream, except that you also have the ability to control what you daydream about as well as when, how deeply and how long you daydream.

Hypnosis is one of many tools a psychologist may recommend to help you learn to manage your pain.

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What does hypnosis feel like?
Have you ever been so absorbed in a good book or movie that you blocked out what was going on around you? If so, you’ve experienced the focused attention or trance-like state that occurs during hypnosis. When you are under hypnosis, you can block out distractions and become more receptive to suggestions that may decrease your experience of pain and increase your ability to cope with pain.

Who benefits from hypnosis?
Hypnosis has been used successfully to treat a variety of conditions including:

  • asthma
  • nausea and vomiting associated with chemotherapy or pregnancy
  • certain skin conditions (including eczema, psoriasis and warts)
  • chronic pain (e.g., headaches, abdominal pain, back pain)
  • acute pain (e.g., during dental procedures, childbirth and surgical procedures)

Myths and Facts about Hypnosis

Myth: During hypnosis you lose control of your thoughts and actions.

Fact: Hypnosis is a heightened state of attention and concentration. Hypnosis cannot take away your control or your ability to make decisions. All hypnosis is in fact self-hypnosis and cannot be imposed on you. Instead of being out of control, learning hypnosis actually requires strong self-control and self-discipline.

Myth: You can be put under hypnosis without your consent.

Fact: Hypnosis depends on your willingness to participate. It is not something that is done to you but requires your consent and engagement. Your therapist can only guide or facilitate the process.

Myth: During hypnosis you lose consciousness and don’t remember what happens.

Fact: A small number of people who enter a very deep trance have experienced spontaneous amnesia. However, most people remember everything that happens under hypnosis.

Myth: Hypnosis only works on gullible or weak people.
Fact: Actually the reverse is true. Hypnosis works best for people who are highly motivated and strongly committed to learn to cope with their symptoms.

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Stress Management & Cognitive Behavioral Therapy

People with the exact same injury or diagnosis can have very different types and intensities of pain; many times, no diagnosis can be found for pain. It can be a frustrating problem, and the frustrations of pain can lead to stress, which can makes pain worse.

Through cognitive behavioral therapy, psychologists help children and families talking about these frustrations, find different ways to combat stress and help people cope with these difficulties, all of which can be extremely valuable and lead to improved physical functioning.

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What is cognitive behavioral therapy?
Cognitive behavioral therapy (CBT) is a scientifically supported treatment that can help you feel better by focusing on the links between what you think, how you feel and what you do. CBT helps reduce negative feelings and behavior by teaching you how to change your negative thoughts. You will learn to change the way you think and feel, allowing you more time and energy to do the things you enjoy, even if a difficult situation in your life does not change.

What happens in cognitive behavioral therapy?

Specific treatment plans are individualized. Therefore, you will learn a number of different skills that will help you best cope with your particular symptoms. In general, you will learn:

  • what causes your symptoms
  • which skills will best help you cope with your symptoms
  • how to identify negative thoughts that make you feel worse
  • how to change negative thoughts into more helpful ones that make you feel better

You will get a chance to practice the skills you learn in sessions and in your daily life. Together with your therapist, you will track your progress and you will learn to reward yourself for making positive changes in your thinking, mood and activity level.

Who does cognitive behavioral therapy help?
Research demonstrates that CBT has been helpful in treating a number of common childhood problems like:

  • coping with pain
  • stress and worries
  • adjusting to an illness
  • dealing with problems at school or with friends or family

Some recent research studies have shown that CBT can be more effective than medicines in treating pain and negative feelings.

CBT is effective for children as young as 8, and also works well for teenagers and adults.

How does cognitive behavioral therapy from other treatments?
CBT is skill-based and structured. You and your therapist will focus on learning specific skills that can help you feel better. CBT also tends to be short-term (typically 8-16 sessions) and problem-focused.

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