Mindfulness, Acceptance and Catastrophizing in Chronic Pain

Abstract

ObjectivesCatastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT) suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to examine the influence of mindfulness and general psychological acceptance on pain-related catastrophizing in patients with chronic pain.MethodsA cross-sectional survey was conducted, including 87 chronic pain patients from an academic outpatient pain center.ResultsThe results show that general psychological acceptance (measured with the AAQ-II) is a strong predictor of pain-related catastrophizing, independent of gender, age and pain intensity. Mindfulness (measured with the MAAS) did not predict levels of pain-related catastrophizing.DiscussionAcceptance of psychological experiences outside of pain itself is related to catastrophizing. Thus, acceptance seems to play a role in the pain experience and should be part of the treatment of chronic pain. The focus of the ACT treatment of chronic pain does not necessarily have to be on acceptance of pain per se, but may be aimed at acceptance of unwanted experiences in general. Mindfulness in the sense of “acting with awareness” is however not related to catastrophizing. Based on our research findings in comparisons with those of other authors, we recommend a broader conceptualization of mindfulness and the use of a multifaceted questionnaire for mindfulness instead of the unidimensional MAAS.

The Role of Catastrophizing Beliefs in Effective Chronic Pain Treatment

“…David and Szentagotai (2006) explore many subcategories within cognition, including the distinction between appraisals and knowledge, or as Abelson and Rosenberg (1958) describe them, hot and cold cognitions, respectively. ''It is now generally accepted that as long as cold cognitions remain unevaluated, they are not sufficient to produce emotions'' (David and Szentagotai 2006). David and Szentagotai (2006) argue that one will not appraise a cold cognition if they do not in some way believe it to be true.…”

“…''It is now generally accepted that as long as cold cognitions remain unevaluated, they are not sufficient to produce emotions'' (David and Szentagotai 2006). David and Szentagotai (2006) argue that one will not appraise a cold cognition if they do not in some way believe it to be true. It is when something is possible that it warrants appraisal, and therefore evokes an emotional response.…”

“…If cognitive treatment merely questions the accuracy of the cold cognitions, the component of the statement that makes it active in an emotional process is missed entirely. David and Szentagotai (2006) present a seven step cognitive framework of human feelings and behaviors; which they report are based on reviews of the cognitive psychology literature and Lazarus' model of emotions, as well as, an updated extension of Wessler's model (Lazarus 1991;Wessler 1982).…”

“…Irrational beliefs may be appraisal components, and that there are both primary and secondary appraisals. Secondary appraisals include ''emotional focused potential, coping focused potential, selfaccountability, other-accountability, and negative expectations'' (David and Szentagotai 2006).…”

“…This may in fact be what makes therapeutic change possible in a cognitive framework. It is believed by cognitive theorists that a behavior is an outcome of cognitive processing and that a change in cognition will induce a change in the behavior (David and Szentagotai 2006;Rorer 1989).…”