Reply to Johan W. S. Vlaeyen and to Melissa A. Day and Beverly E. Thorn

      There is much to discuss on the topic of psychological approaches to pain management—perhaps more now than previously. We are grateful that our colleagues have joined this discussion and presented a few of the key points for a wider audience.
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      Linked Article

      • Psychological Flexibility: What Theory and Which Predictions?
        The Journal of PainVol. 15Issue 3
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          In their review, McCracken and Morley4 elegantly present a new theoretical model that aims to integrate current knowledge of the psychology of pain and to expand where existing theoretical models reach their boundaries. The authors introduce a fresh new concept, “psychological flexibility,” which they define not so much in terms of content but more in terms of processes and behaviors that can be qualified as “open, aware and active,” in which language and thought are key mechanisms. Psychological inflexibility is said to occur when an individual generates and strictly adheres to dysfunctional rules about himself or herself or the environment, thereby creating personal struggles that in turn prevent engagement in behavior that serves long-term valued goals.
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      • Using Theoretical Models to Clarify Shared and Unique Mechanisms in Psychosocial Pain Treatments: A Commentary on McCracken and Morley's Theoretical Paper
        The Journal of PainVol. 15Issue 3
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          A shared goal among pain researchers is to develop robust theoretical models of pain and suffering and of those factors leading to its alleviation and relief. As described by McCracken and Morley in this issue of the Journal of Pain,6 chronic pain is a complex, multidimensional phenomenon that is often refractory to various treatments yet by its very nature entails multiple potential points of intervention (ie, cognitions, emotions/affect, behavior, and physiology). There is now widespread agreement that the focus of pain treatment research needs to broaden beyond treatment efficacy to understanding how treatments work, and to develop core principles by which we can match the best treatment to a particular problem given a patient's unique characteristics and circumstances.
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      • The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management
        The Journal of PainVol. 15Issue 3
        • Preview
          Scientific models are like tools, and like any tool they can be evaluated according to how well they achieve the chosen goals of the task at hand. In the science of treatment development for chronic pain, we might say that a good model ought to achieve at least 3 goals: 1) integrate current knowledge, 2) organize research and treatment development activities, and 3) create progress. In the current review, we examine models underlying current cognitive behavioral approaches to chronic pain with respect to these criteria.
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