Fear

Reduce Fear of Pain at Work and Musculoskeletal Pain with Mindfulness

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Reduce Fear of Pain at Work and Musculoskeletal Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“a regular meditation practice is the best ongoing foundation for working with pain. Mindfulness practice is a wonderful opportunity to do just that. It helps to shift the locus of control from the outside (“this is happening to me and there is nothing I can do about it”) to the inside (“this is happening to me but I can choose how I relate to it”). – Mindful

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have common chronic pain conditions. It has to be kept in mind that pain is an important signal that there is something wrong or that damage is occurring. This signals that some form of action is needed to mitigate the damage. This is an important signal that is ignored at the individual’s peril. So, in dealing with pain, it’s important that pain signals not be blocked or prevented. They need to be perceived. But, methods are needed to mitigate the psychological distress produced by chronic pain.

 

The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the patient’s ability to cope with the pain. Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain.

 

In today’s Research News article “Ten weeks of physical-cognitive-mindfulness training reduces fear-avoidance beliefs about work-related activity: Randomized controlled trial.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400305/, Jay and colleagues examine a fear avoidance model of pain where a vicious circle develops creating more pain. The individual when they start to move and feel pain, interpret the pain as potentially damaging and so alter their movements. This is counterproductive and can create more pain, producing more pain avoidance behaviors, producing even more pain, etc. To examine this idea, they recruited female laboratory assistants who were suffering from chronic musculoskeletal pain and randomly assigned them to receive either physical-cognitive-mindfulness training or to follow treatment-as-usual. Therapy consisted of 10 weeks of exercise, cognitive behavioral therapy, and mindfulness training. They were measured before and after training for pain intensity, pain frequency, and leisure time and work related pain fear avoidance.

 

They found that before training, as predicted, there were significant positive relationships between work pain fear avoidance and pain, particularly in the neck and shoulders, such that the greater the pain fear avoidance the greater the pain. They also found that in comparison to the treatment-as-usual control group that the physical-cognitive-mindfulness training group had significant improvements after training of over 50% in pain and in work related pain fear avoidance. Leisure time pain fear avoidance was not related to pain and not affected by the treatment.

 

The results suggest that work related pain fear avoidance is related to musculoskeletal pain intensity and that physical-cognitive-mindfulness training improves both. These relationships, however, are situation specific as leisure time pain fear avoidance  was unrelated. It is unclear if the relationships between pain and pain fear avoidance are causal because of the correlative nature of the relationships. It is also unclear which, or which combinations, of the three components of the treatment was effective in reducing pain and pain fear avoidance. The results, however, are interesting and should be followed up with further research.

 

So, reduce fear of pain at work and musculoskeletal pain with mindfulness.

 

“Chronic pain is frustrating and debilitating. The last thing we want to do is pay more attention to our pain. But that’s the premise behind mindfulness, a highly effective practice for chronic pain (among other concerns).” – Margarita Tartakovsky

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

Jay, K., Brandt, M., Jakobsen, M. D., Sundstrup, E., Berthelsen, K. G., schraefel, mc, … Andersen, L. L. (2016). Ten weeks of physical-cognitive-mindfulness training reduces fear-avoidance beliefs about work-related activity: Randomized controlled trial. Medicine, 95(34), e3945. http://doi.org/10.1097/MD.0000000000003945

 

Abstract

People with chronic musculoskeletal pain often experience pain-related fear of movement and avoidance behavior. The Fear-Avoidance model proposes a possible mechanism at least partly explaining the development and maintenance of chronic pain. People who interpret pain during movement as being potentially harmful to the organism may initiate a vicious behavioral cycle by generating pain-related fear of movement accompanied by avoidance behavior and hyper-vigilance.

This study investigates whether an individually adapted multifactorial approach comprised of biopsychosocial elements, with a focus on physical exercise, mindfulness, and education on pain and behavior, can decrease work-related fear-avoidance beliefs.

As part of a large scale 10-week worksite randomized controlled intervention trial focusing on company initiatives to combat work-related musculoskeletal pain and stress, we evaluated fear-avoidance behavior in 112 female laboratory technicians with chronic neck, shoulder, upper back, lower back, elbow, and hand/wrist pain using the Fear-Avoidance Beliefs Questionnaire at baseline, before group allocation, and again at the post intervention follow-up 10 weeks later.

A significant group by time interaction was observed (P < 0.05) for work-related fear-avoidance beliefs. The between-group difference at follow-up was –2.2 (–4.0 to –0.5), corresponding to a small to medium effect size (Cohen’s d = 0.30).

Our study shows that work-related, but not leisure time activity-related, fear-avoidance beliefs, as assessed by the Fear-avoidance Beliefs Questionnaire, can be significantly reduced by 10 weeks of physical-cognitive-mindfulness training in female laboratory technicians with chronic pain.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400305/

Improve Neuroticism with Mindfulness

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Mindfulness Neuroticism2 Armstrong

By John M. de Castro, Ph.D.

 

“Self-deprecating comedians and complainers wear their neuroticism as a badge of honor. In truth, the negatively biased are more prone to depression, anxiety, self-consciousness and hypochondria, to name just a few behavioral tripwires. Neuroticism is no fun for anyone.” – Psychology Today

 

We often speak of people being neurotic. But, do we really know what we’re talking about? Do we really know what it is? Neurosis is actually an outdated diagnosis that is no longer used medically. The disorders that were once classified as a neurosis are now more accurately categorized as post-traumatic stress disorder, somatization disorders, anxiety disorder, panic disorder, phobias, dissociation disorder, obsessive compulsive disorder and adjustment disorder.

 

Neuroticism, however, is considered a personality trait that is a lasting characteristic of the individual. It is characterized by negative feelings, repetitive thinking about the past (rumination), and worry about the future, moodiness and loneliness. It appears to be linked to vulnerability to stress. People who have this characteristic are not happy with life and have a low subjective sense of well-being and recognize that this state is unacceptable. There is some hope for people with high neuroticism as this relatively stable characteristic appears to be lessened by mindfulness training. This is potentially important and deserves further investigation.

 

In today’s Research News article “Mindfulness-Based Cognitive Therapy for Neuroticism (Stress Vulnerability): A Pilot Randomized Study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1245647922125798/?type=3&theater

or below

Armstrong and Rimes examined the ability of Mindfulness Based Cognitive Therapy (MBCT) to treat individuals high in neuroticism. They randomly assigned participants with high neuroticism to either an 8-week, once a week for 2-hours, MBCT treatment group or and on-line self-help treatment control group. Measures were taken before and 4-weeks after treatment of mindfulness, neuroticism, impairment in everyday functioning, anxiety, depressive symptoms, self-compassion, beliefs about emotions, rumination, and decentering.

 

They found that after treatment in comparisons to the control group the MBCT group had significantly lower neuroticism scores, and rumination, and a trend toward lower functional impairment due to stress. In addition, the MBCT group had significantly higher self-compassion and decentering and trends toward lessened unhelpful beliefs and emotions and higher mindfulness. Surprisingly, since MBCT was developed specifically to treat depression, there were no significant differences in anxiety or depression.

 

These results are interesting and potentially important. This, however, was a pilot study that had relatively small group sizes (17). The fact that significant differences were detected nonetheless indicates that the effects were fairly strong. The results clearly indicate that a larger randomized controlled trial is called for.

 

Mindfulness may affect neuroticism in a number of ways. By focusing the individual on the present moment, mindfulness should lessen the neuroticism characteristics of rumination about the past and worry about the future. Mindfulness is also known to reduce the psychological and physiological responses to stress and stress is known to contribute to neuroticism. Finally, mindfulness has been shown to produce heightened emotion regulation. So, the mindful individual feels and appreciates their emotions but responds appropriately and adaptively. This should lessen the moodiness, negative feelings, and loneliness characteristic of neuroticism. So, it is not surprising the mindfulness based treatments would be effective in lowering neuroticism. This is a hopeful development, as people high in neuroticism are very unhappy people. Mindfulness may provide some relief and help them toward a happier life.

 

So, improve neuroticism with mindfulness.

 

“Being in the moment with those thoughts and recognizing them for what they are has really helped me to kind of shove them aside, or to kind of diffuse them,” she says. “I think it’s really helped me become a more aware person of what other people might be feeling.” – JoSelle Vanderhooft

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available  on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Armstrong L, Rimes KA. Mindfulness-Based Cognitive Therapy for Neuroticism (Stress Vulnerability): A Pilot Randomized Study. Behav Ther. 2016 May;47(3):287-98. doi: 10.1016/j.beth.2015.12.005. Epub 2016 Jan 5. PMID: 27157024. doi:10.1016/j.beth.2015.12.005

 

Highlights

  • A new MBCT intervention for neuroticism versus online general self-help is examined
  • Compared with self-help, MBCT results in significantly lower levels of neuroticism
  • Rumination and self-compassion improved more in the MBCT group than the control group
  • MBCT is an acceptable and feasible intervention for neuroticism
  • Neuroticism may be amenable to change through psychological intervention

Abstract

Objective: Neuroticism, a characteristic associated with increased stress vulnerability and the tendency to experience distress, is strongly linked to risk of different forms of psychopathology. However, there are few evidence-based interventions to target neuroticism. This pilot study investigated the efficacy and acceptability of mindfulness-based cognitive therapy (MBCT) compared with an online self-help intervention for individuals with high levels of neuroticism. The MBCT was modified to address psychological processes that are characteristic of neuroticism. Method: Participants with high levels of neuroticism were randomized to MBCT (n = 17) or an online self-help intervention (n = 17). Self-report questionnaires were administered preintervention and again at 4 weeks postintervention. Results: Intention-to-treat analyses found that MBCT participants had significantly lower levels of neuroticism postintervention than the control group. Compared with the control group, the MBCT group also experienced significant reductions in rumination and increases in self-compassion and decentering, of which the latter two were correlated with reductions in neuroticism within the MBCT group. Low drop-out rates, high levels of adherence to home practice, and positive feedback from MBCT participants provide indications that this intervention may be an acceptable form of treatment for individuals who are vulnerable to becoming easily stressed. Conclusions: MBCT specifically modified to target neuroticism-related processes is a promising intervention for reducing neuroticism. Results support evidence suggesting neuroticism is malleable and amenable to psychological intervention. MBCT for neuroticism warrants further investigation in a larger study.

 

Don’t be afraid!

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Fear is a worry that something dreadful will occur in the future. In the case of recovery from dire health conditions, it is the fear of reoccurrence. That worry isn’t unreasonable, but often it is excessive relative to the real danger.

When this occurs, it stresses the individual and makes them anxious. This in turn, produces physiological reactions similar to those that occur when something is truly wrong that requires a response. But nothing is really wrong. The unneeded pro-inflammatory responses when nothing is actually wrong can itself induce damage. This, to some extent makes the fears come true. This can create a self-fulfilling fear cycle.

Mindfulness shifts perspective from the future to now where everything actually is well. When we’re mindful in the present moment we are not fearing the future, we’re not ruminating about the past, instead we’re focused on how we’re feeling and what we’re experience right now. Since everything is fine at this present time, we can relax and distress.

In today’s Research News “Mindfulness Based Stress Reduction (MBSR(BC)) in Breast Cancer: Evaluating Fear of Recurrence (FOR) as a Mediator of Psychological and Physical Symptoms in a Randomized Control Trial (RCT)”

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627743/pdf/nihms-424471.pdf

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1013640941993165/?type=1&theater

it is demonstrated that Mindfulness Based Stress Reduction reduces  the fear of reoccurrence in breast cancer survivors and this, in turn, reduces stress and anxiety. This mindfulness induced reduction in the fear, stress and anxiety produces improved physical functioning.

Mind and body are amazingly interconnected. Today’s study shows how altering the mind by focusing it in the present moment with MBSR can result in favorable physical functioning. This is one of the many ways that mindfulness improves both physical and psychological health.

CMCS