Advertisement

Acceptance, Cognitive Restructuring, and Distraction as Coping Strategies for Acute Pain

Published:January 28, 2013DOI:https://doi.org/10.1016/j.jpain.2012.12.005

      Abstract

      Little is known about treatment mechanisms underlying acceptance strategies. Acceptance is a strategy that is expected to increase pain tolerance more than distraction, while distraction should lead to lower pain intensity. The effect of cognitive restructuring on experimental pain has not yet been investigated. The present study aimed to explore differential short-term effects of acceptance, distraction, and cognitive restructuring on pain tolerance and intensity. Pain was induced in a sample of 109 female students using a thermode. We conducted analyses of covariance with instruction as the independent variable and posttest scores on pain variables as dependent variables, covarying for pretest scores. In addition, adherence to instructions and credibility of instructions were included as covariates. Acceptance led to a higher increase in pain tolerance than did cognitive restructuring of pain-related thoughts. No differences were detected between either acceptance and distraction or distraction and cognitive restructuring with respect to pain tolerance. Distraction led to lower pain intensity compared to acceptance. Cognitive restructuring did not differ from either acceptance or distraction with respect to pain intensity. As a short-term strategy, cognitive restructuring was not as useful as acceptance in increasing pain tolerance. Further studies should evaluate the preconditions under which different strategies are most effective.

      Perspective

      This study demonstrated that acceptance was superior to cognitive restructuring in increasing tolerance for experimentally induced pain, but was inferior to distraction with respect to decreasing pain intensity. Knowledge about the types of strategies that are useful in targeting diverse pain-related outcome measures is important for efforts to refine the treatment of chronic pain.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Aldao A.
        • Nolen-Hoeksema S.
        • Schweizer S.
        Emotion-regulation strategies across psychopathology: A meta-analytic review.
        Clin Psychol Rev. 2010; 30: 217-237
        • Bond F.W.
        • Hayes S.C.
        • Baer R.A.
        • Carpenter K.C.
        • Guenole N.
        • Or H.K.
        • Waltz T.
        • Zettle R.D.
        Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological flexibility and acceptance.
        Behav Ther. 2011; : 1-38
        • Branstetter-Rost A.
        • Cushing C.
        • Douleh T.
        Personal values and pain tolerance: Does a values intervention add to acceptance?.
        J Pain. 2009; 10: 887-892
        • Ehde D.M.
        • Jensen M.P.
        Feasibility of a cognitive restructuring intervention for treatment of chronic pain in persons with disabilities.
        Rehabil Psychol. 2004; 49: 254
        • Ellermeier W.
        • Westphal W.
        Gender differences in pain ratings and pupil reactions to painful pressure stimuli.
        Pain. 1995; 61: 435-439
        • Feldner M.T.
        • Zvolensky M.J.
        • Eifert G.H.
        • Spira A.P.
        Emotional avoidance: An experimental test of individual differences and response suppression using biological challenge.
        Behav Res Ther. 2003; 41: 403-411
        • Ferguson C.J.
        An effect size primer: A guide for clinicians and researchers.
        Prof Psychol Res Pr. 2009; 40: 532-538
        • Flor H.
        • Turk D.C.
        Chronic back pain and rheumatoid arthritis: Predicting pain and disability from cognitive variables.
        J Behav Med. 1988; 11: 251-265
        • Forman E.M.
        • Hoffman K.L.
        • McGrath K.B.
        • Herbert J.D.
        • Brandsma L.L.
        • Lowe M.R.
        A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study.
        Behav Res Ther. 2007; 45: 2372-2386
        • Geissner E.
        Fragebogen zur Erfassung der Schmerzverarbeitung: FESV.
        Hogrefe, Göttingen2001
        • Gratz K.L.
        • Roemer L.
        Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale.
        Journal Psychopathol Behav Assess. 2004; 26: 41-54
        • Greenspan J.D.
        • Craft R.M.
        • LeResche L.
        • Arendt-Nielsen L.
        • Berkley K.J.
        • Fillingim R.B.
        • Gold M.S.
        • Holdcroft A.
        • Lautenbacher S.
        • Mayer E.A.
        Studying sex and gender differences in pain and analgesia: A consensus report.
        Pain. 2007; 132: S26-S45
        • Gutiérrez O.
        • Luciano C.
        • Rodríguez M.
        • Fink B.C.
        Comparison between an acceptance-based and a cognitive-control-based protocol for coping with pain.
        Behav Ther. 2004; 35: 767-783
        • Hautzinger M.
        • Kuehner C.
        • Keller F.
        Das Beck Depressionsinventar II. Deutsche Bearbeitung und Handbuch zum BDI II.
        Frankfurt, 2006
        • Hayes S.C.
        • Bissett R.T.
        • Korn Z.
        • Zettle R.D.
        • Rosenfarb I.S.
        • Cooper L.D.
        • Grundt A.M.
        The impact of acceptance versus control rationales on pain tolerance.
        Psychol Rec. 1999; 49: 33-34
        • Hayes S.C.
        • Strohsal K.D.
        • Wilson K.G.
        Acceptance and Commitment Therapy: An experiential approach to behavior change.
        Guilford Press, New York, NY1999
        • Hofmann S.G.
        • Heering S.
        • Sawyer A.T.
        • Asnaani A.
        How to handle anxiety: The effects of reappraisal, acceptance, and suppression strategies on anxious arousal.
        Behav Res Ther. 2009; 47: 389-394
        • Keefe F.J.
        Cognitive behavioral therapy for managing pain.
        Clin Psychol. 1996; 49: 4-5
        • Keogh E.
        • Bond F.W.
        • Hanmer R.
        • Tilston J.
        Comparing acceptance-and control-based coping instructions on the cold-pressor pain experiences of healthy men and women.
        Eur J Pain. 2005; 9: 591-598
        • Kohl A.
        • Rief W.
        • Glombiewski J.A.
        How effective are acceptance strategies? A meta-analytic review of experimental results.
        J Behav Ther Exp Psychiatry. 2012; 43: 988-1001
        • Kuehner C.
        • Huffziger S.
        • Liebsch K.
        Rumination, distraction and mindful self-focus: Effects on mood, dysfunctional attitudes and cortisol stress response.
        Psychol Med. 2009; 39: 219-228
        • Kállai I.
        • Barke A.
        • Voss U.
        The effects of experimenter characteristics on pain reports in women and men.
        Pain. 2004; 112: 142-147
        • Levitt J.T.
        • Brown T.A.
        • Orsillo S.M.
        • Barlow D.H.
        The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder.
        Behav Ther. 2004; 35: 747-766
        • Masedo A.I.
        • Rosa Esteve M.
        Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress.
        Behav Res Ther. 2007; 45: 199-209
        • McCracken L.M.
        • Vowles K.E.
        • Eccleston C.
        Acceptance of chronic pain: Component analysis and a revised assessment method.
        Pain. 2004; 107: 159-166
        • McMullen J.
        • Barnes-Holmes D.
        • Barnes-Holmes Y.
        • Stewart I.
        • Luciano C.
        • Cochrane A.
        Acceptance versus distraction: Brief instructions, metaphors and exercises in increasing tolerance for self-delivered electric shocks.
        Behav Res Ther. 2008; 46: 122-129
        • Meyer K.
        • Sprott H.
        • Mannion A.F.
        Cross-cultural adaptation, reliability, and validity of the German version of the Pain Catastrophizing Scale.
        J Psychosom Res. 2008; 64: 469-478
        • Morley S.
        • Eccleston C.
        • Williams A.
        Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache.
        Pain. 1999; 80: 1-13
      1. Nilges P, Koster B, Schmidt CO: Pain acceptance - concept and validation of a German version of the chronic pain acceptance questionnaire. Schmerz (Berlin, Germany) 21:57-58, 60-67, 2007

        • Páez-Blarrina M.
        • Luciano C.
        • Gutiérrez-Martínez O.
        • Valdivia S.
        • Ortega J.
        • Rodríguez-Valverde M.
        The role of values with personal examples in altering the functions of pain: Comparison between acceptance-based and cognitive-control-based protocols.
        Behav Res Ther. 2008; 46: 84-97
        • Páez-Blarrina M.
        • Luciano C.
        • Gutiérrez-Martínez O.
        • Valdivia S.
        • Rodríguez-Valverde M.
        • Ortega J.
        Coping with pain in the motivational context of values: Comparison between an acceptance-based and a cognitive control–based protocol.
        Behav Modif. 2008; 32: 403
        • Roche B.
        • Forsyth J.P.
        • Maher E.
        The impact of demand characteristics on brief acceptance-and control-based interventions for pain tolerance.
        Cogn Behav Pract. 2007; 14: 381-393
        • Ruscheweyh R.
        • Marziniak M.
        • Stumpenhorst F.
        • Reinholz J.
        • Knecht S.
        Pain sensitivity can be assessed by self-rating: Development and validation of the Pain Sensitivity Questionnaire.
        Pain. 2009; 146: 65-74
        • Sullivan M.J.L.
        • Tripp D.A.
        • Santor D.
        Gender differences in pain and pain behavior: The role of catastrophizing.
        Cognit Ther Res. 2000; 24: 121-134
        • Szasz P.L.
        • Szentagotai A.
        • Hofmann S.G.
        The effect of emotion regulation strategies on anger.
        Behav Res Ther. 2011; 49: 114-119
        • Vlaeyen J.W.S.
        • Morley S.
        Cognitive-behavioral treatments for chronic pain: What works for whom?.
        Clin J Pain. 2005; 21: 1
        • Vowles K.E.
        • McCracken L.M.
        Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process.
        J Consult Clin Psychol. 2008; 76: 397-407
        • Vowles K.E.
        • McNeil D.W.
        • Gross R.T.
        • McDaniel M.L.
        • Mouse A.
        • Bates M.
        • Gallimore P.
        • McCall C.
        Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain.
        Behav Ther. 2007; 38: 412-425
        • Wetherell J.L.
        • Afari N.
        • Rutledge T.
        • Sorrell J.T.
        • Stoddard J.A.
        • Petkus A.J.
        • Solomon B.C.
        • Lehman D.H.
        • Liu L.
        • Lang A.J.
        • Atkinson J.H.
        A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain.
        Pain. 2011; 152: 2098-2107
        • Wicksell R.K.
        • Melin L.
        • Lekander M.
        • Olsson G.L.
        Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain–A randomized controlled trial.
        Pain. 2009; 141: 248-257