How an Understanding of Our Ability to Adhere to Verbal Rules Can Increase Insight Into (Mal)adaptive Functioning in Chronic Pain

Published:February 27, 2019DOI:


      • Pain research has historically paid little attention to verbal learning pathways.
      • Relational frame theory is a relevant approach to study verbal processes.
      • Future research should examine the role of verbal rule-following in chronic pain.
      • Verbal rule-following can improve our understanding of (mal)adaptive functioning.
      • A focus on (in)flexible verbal rule-following may advance treatment strategies.


      Research on chronic pain has traditionally focused on how direct pain experiences lead to maladaptive thoughts, feelings, and actions that set the stage for, and maintain, pain-related disability. Yet the capacity for language (and more specifically verbal instructions or rules) to put people into indirect contact with pain has never been systematically investigated. In this article, we introduce a novel theoretical perspective on verbal processes and discuss how the study of verbal rules may increase our understanding of both maladaptive and adaptive functioning in chronic pain. Several useful characteristics of verbal rules and rule-following in the context of chronic pain are outlined. Future research directions and implications for clinical practice are then discussed.
      Perspective: This focus article argues that, by studying verbal rules and rule-following, we will gain a better understanding of (mal)adaptive functioning in the context of chronic pain. Future research directions are outlined and suggestions for improving clinical practice are considered.

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