Dataset Information

'All these things don't take the pain away but they do help you to accept it': making the case for compassion-focused therapy in the management of persistent pain.

ABSTRACT:

Background

People with persistent pain are frequently offered a pain management programme (PMP) as part of their care plan. Cognitive behavioural therapy (CBT) principles often underpin PMPs and has a good evidence base; nevertheless, more recent systematic reviews have suggested that its effectiveness is limited. Compassion-focused therapy (CFT) is a form of 'third-wave CBT' that offers an alternative and complementary view of pain, encouraging the person to be alongside their experience of pain and respond to it using skills of compassion they have learnt.

Method

The current research explored the effectiveness of a 12-week CFT group for people who experience persistent pain. Research interviews explored CFT members' experiences of the CFT group. Feedback was collected on the facilitators' experience of running the group and questionnaire data collected on participants' mood, pain disability, acceptance of chronic pain and levels of self-criticism and self-reassurance.

Results

Interviews were analysed using interpretative phenomenological analysis that revealed five master superordinate themes representative across all interviews. These were then triangulated with data from the questionnaires and facilitator feedback.

Conclusion

In people whose persistent pain was compounded by a significant psychological component, a CFT group approach helped reduce feelings of isolation, improve ability to self-reassure, learn new ways of coping and develop a growing acceptance of the limitations associated with their pain. The possible implications for future clinical practice are considered.

SUBMITTER: Gooding H

PROVIDER: S-EPMC7026828 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

'All these things don't take the pain away but they do help you to accept it': making the case for compassion-focused therapy in the management of persistent pain.

Gooding Hannah H Stedmon Jacqui J Crix Doug D

British journal of pain 20190617 1

<h4>Background</h4>People with persistent pain are frequently offered a pain management programme (PMP) as part of their care plan. Cognitive behavioural therapy (CBT) principles often underpin PMPs and has a good evidence base; nevertheless, more recent systematic reviews have suggested that its effectiveness is limited. Compassion-focused therapy (CFT) is a form of 'third-wave CBT' that offers an alternative and complementary view of pain, encouraging the person to be alongside their experienc ...[more]

PMID: 32110396

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Project description:IntroductionIt is widely known that the mind and the body, although described medically almost as separate entities, are in fact highly interrelated. This is not, however, always reflected within medical settings where physical interventions are often favoured over more holistic management, even in the case of long-term symptoms and/or pain where there is a strong evidence to favour the use of the latter. Mindfulness is an established and evidence-based intervention which can help people living with pain and physical symptoms. Interventions based on Compassion and Loving-kindness have also shown early promise but have not been fully explored. This study proposes a compassion-focused conceptualisation of persistent pain and reports on an intervention based upon this formulation.MethodsThe study took place within a routine clinical setting. Standardised outcome measures were collected pre- and post-intervention and effect sizes calculated for mean differences on each measure. Written qualitative comments that participants attributed to the group were also collected post-intervention and analysed with a thematic analysis. This was an uncontrolled, unpowered study conducted within a clinical setting which aimed to examine the intervention for any initial evidence of promise and to explore how it would be received by patients.ResultsThe results of the study indicated that engagement of patients in the intervention was reasonable. Improvements were recorded in pain distress (effect size (ES), 0.47) and intensity (ES, 0.23), anxiety (ES, 0.72), depression (ES, 0.46) and self-efficacy (ES, 0.36). Following the intervention, patients described changes that were grouped into the categories of feeling different, doing things differently and changed attitude.ConclusionThis exploratory study has demonstrated that a group-based intervention based on a model of compassion and including mindfulness and loving-kindness exercise has potential as an intervention to be used within routine pain management settings.

Project description:Approximately 20% of sleeping sickness patients exhibit respiratory complications which are commonly attributed to secondary bacterial infections, with an unknown role of the parasite. Using a Glossina morsitans tsetse fly initiated Trypansoma brucei infection in mice we found that parasites rapidly and permanently colonize the lungs, representing one of the major target organs next to the adipose tissue. Trypanosomes were found by immunofluorescence staining and scanning electron microscopy to occupy the extravascular spaces surrounding the blood vessels of the alveoli and bronchi. Parasites were even found in the lung cartilage. Trypanosomes were often observed as nests of multiplying parasites exhibiting close interactions with collagen and highly active secretion of extracellular vesicles that are engaged in intercellular communication. The local immune response was analysed by flow cytometry after 10 and 21 days of infection and was characterized by a substantial increase of CD11b+ Ly6C+ monocytes, CD11b+ Ly6C+ F4/80+ macrophages and CD11b+ CD11c+ dendritic cells. CD11b+ Ly6G+ neutrophils only accumulated prominently at the late infection time point. Interestingly, parasite presence resulted in a significant reduction of B220+ IgM+ B cells, CD11b+ CD11clo/- SiglecF+ eosinophils and TcR-β- NK1.1+ natural killer cells. Digital transcriptomics revealed infection-induced upregulation of Il-10, IFN-ɣ- and IFN-α-responses, IL-2-, IL-6- and TNF-signalling, a Th1 pro-inflammatory signature, negative immune checkpoint regulators and a predominant M1 macrophage polarization. Il12a and genes associated with complement and the B cell receptor were downregulated. No infection-associated pulmonary dysfunction could be detected by in vivo lung function measurements, mirroring the limited pulmonary complications during sleeping sickness. However, the substantial reduction of eosinophils, B cells and NK cells may render individuals more susceptible to opportunistic infections. Collectively, these observations provide essential insights in the peculiar parasite biology, immunological reactions and physiological function of a largely overlooked target organ which may trigger new diagnostic approaches for sleeping sickness.

Project description:This paper presents an outline of voice-hearing phenomenology in the context of evolutionary mechanisms for self- and social- monitoring. Special attention is given to evolved systems for monitoring dominant-subordinate social roles and relationships. These provide information relating to the interpersonal motivation of others, such as neutral, friendly or hostile, and thus the interpersonal threat, versus safe, social location. Individuals who perceive themselves as subordinate and dominants as hostile are highly vigilant to down-rank threat and use submissive displays and social spacing as basic defenses. We suggest these defense mechanisms are especially attuned in some individuals with voices, in which this fearful-subordinate - hostile-dominant relationship is played out. Given the evolved motivational system in which voice-hearers can be trapped, one therapeutic solution is to help them switch into different motivational systems, particularly those linked to social caring and support, rather than hostile competition. Compassion focused therapy (CFT) seeks to produce such motivational shifts. Compassion focused therapy aims to help voice-hearers, (i) notice their threat-based (dominant-subordinate) motivational systems when they arise, (ii) understand their function in the context of their lives, and (iii) shift into different motivational patterns that are orientated around safeness and compassion. Voice-hearers are supported to engage with biopsychosocial components of compassionate mind training, which are briefly summarized, and to cultivate an embodied sense of a compassionate self-identity. They are invited to consider, and practice, how they might wish to relate to themselves, their voices, and other people, from the position of their compassionate self. This paper proposes, in line with the broader science of compassion and CFT, that repeated practice of creating internal patterns of safeness and compassion can provide an optimum biopsychosocial environment for affect-regulation, emotional conflict-resolution, and therapeutic change. Examples of specific therapeutic techniques, such as chair-work and talking with voices, are described to illustrate how these might be incorporated in one-to-one sessions of CFT.

Dataset Information

'All these things don't take the pain away but they do help you to accept it': making the case for compassion-focused therapy in the management of persistent pain.

Background

Method

Results

Conclusion

Publications

'All these things don't take the pain away but they do help you to accept it': making the case for compassion-focused therapy in the management of persistent pain.

Similar Datasets

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