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Don’t worry, be happy: Could optimism counteract negative effects of pain?


ResearchBlogging.org

Warning: there is an earworm contained in this post!

How on earth could anyone be happy when they have pain, huh? Well, more about that in a minute, first let’s look at this interesting study from Maastricht University by Jantine Boselie, Linda Vancleef, Tom Smeets and Madelon Peters.

We know that having chronic pain reduces a person’s ability to undertake complex cognitive tasks, particularly those that involve making decisions or problem solving. People become overwhelmed, fatigued and then perform poorly when they need to maintain concentration when they’re experiencing pain, and researchers have found that this is, at least in part, because pain demands attention. More than this, self regulation, or the ability to modify thoughts and behaviours in order to achieve what is important, can become depleted over time, compounding the original loss of capacity. It’s enough to make you feel just a bit unhappy!

These researchers investigated whether optimism might (a) be able to be induced in people who are currently experiencing pain, and (b) might be able to reduce some of the fatiguing effects of self-regulation depletion. This is based on the notion that people who remain optimistic keep persisting with tasks even when the going is tough. They also investigated whether experimental pain has a direct effect on self-regulation (well, actually, executive task performance which is in turn affected by self-regulation status).

Once again, healthy undergraduates were the participants in this study, so for what it’s worth, these are people who are warped enough to participate in a pain study, and who are generally well. It’s also an experimental pain, so probably doesn’t have the same effect on people as chronic pain, but then again, it’s probably one of the few ways to carry out this kind of research.

There were four conditions: (1) pain plus optimism induction; (2) no pain plus optimism induction; (3) pain without optimism induction; and (4) no pain and no optimism induction. The pain induction was a cold pressor test cold pressor test

Yes, that’s ice. 2 degrees C. For a maximum of 3 minutes. Ouch.  This is what participants were told: ‘‘The aim of the task is to submerge your right hand in this cold water tank for as long as possible until you cannot
take it anymore. When you cannot take it any longer, you are allowed to remove your hand from the water. Try, however, to hold on as long as possible.” They weren’t told of the maximum time limit.The optimism induction was taken from the “Best Possible Self” technique developed by King, while the neutral or control condition was simply writing about a typical day.

All the participants were asked to complete a working memory test (the operation-span task).

As with most studies of this type, every participant also completed a set of questionnaires, to help determine some of the characteristics that might be associated with their ability to do the task, or influence the outcome.

What did they find?

Firstly, they found that the optimism induction did have an effect. That’s good – people can indeed feel more positive and optimistic if they imagine themselves succeeding.

Secondly, they found that people who went through the cold pressor test did, in fact, report more pain. Whew! That’s good.

They also found that irrespective of whether the participants went through the optimism induction, or the neutral writing task, they reported the same pain intensity. So – it’s not possible to “think yourself pain free”, at least, not in this study.

Now for the good stuff: using ANOVA (Yay! ANOVA is awesome! Read the link if you want to know more about the maths), the researchers found that there is an interaction between optimism and performance on the executive task, in the presence of pain. In other words, when a person experiences pain and has not participated in an optimism induction, their performance on the executive task is poor. If they’ve participated in an optimism induction, their task performance did not suffer.

What this means

Well, bearing in mind that this is an experimental study, so we can’t translate directly to clinical practice for people who have chronic pain, what it shows is that pain degrades performance, particularly complex executive functioning. IT also shows that people who can become optimistic don’t show this kind of performance degradation.

Optimism is a complicated construct. Some people appear to be more cheerful, happier, more likely to think they’re doing well, and this seems to be their normal state. I’m not one of these people! However – it’s been shown that people CAN increase their sense of optimism by doing certain things, such as imagining themselves succeeding and doing well, feeling grateful for what they have in life, “counting blessings” and so on  (Meevissen, Peters, & Alberts, 2011).

The authors of this research suggest that these findings might be important for people who have chronic pain. We know that chronic pain depletes self-regulatory functioning. We also know that people with chronic pain can become more optimistic if they use something like the Best Possible Selves induction on a daily basis. The argument is that perhaps, by using an optimism induction, people with chronic pain might be able to mitigate their self-regulatory depletion.

I’m a little less optimistic (heh! heh!), but I do think there’s some merit in looking at this further.

I wonder what would happen if we focused on helping people identify some of the positive aspects of having chronic pain. And yes, there ARE some positives.

When people with chronic pain successfully manage their pain, demonstrate courage, personal strengths, planning and problem solving ability. In bucketloads. They become capable of navigating through healthcare systems. They learn more about themselves. They become skilled at stress management, relaxation, exercising and delegating. They develop greater awareness of what is a priority in life. They recognise that energy is a precious resource – and they get good at allocating that energy where it matters the most to them.

More than this, we as health professionals can help people be more optimistic by focusing on what they want to achieve despite pain. We can help people recognise that they are making progress, developing skills, becoming their own pain experts. We can guide them to appreciate what they have, rather than what they do not have. This reminds me of coach John Wooden’s quote: “Do not let what you cannot do get in the way of what you can.”

Could we do more to show how a life with chronic pain CAN be good?

Meevissen YMC, Peters ML, Alberts HJEM. (2011). Become more optimistic by imagining a best possible self: effects of a two week intervention. Journal of Behavioral Therapy and Experimental Psychiatry, 42: 371-8

 

 
Jantine J.L.M. Boselie, Linda M.G. Vancleef, Tom Smeets, Madelon L. Peters (2014). Increasing optimism abolishes pain-induced impairments in executive task performance Pain, 155 (2) DOI: 10.1016/j.pain.2013.10.014

6 comments

  1. Adiemus, what i love about so many of your posts is that you truly GET what might be worth investigating further. My experience with pain says “Hell yes” optimism matters. I often think that those who do not succeed in participating in their own pain management feel that they will not succeed and that it is unmanageable. Your findings present wonderful argument for a team approach to pain management for working on mind, body and spirit. Keep rockin it. Had to Facebook share.

  2. Thanks so much Mary! Optimism only a recent focus for psychology, along with all the other positive psych topics, so I hope we’ll see more of this coming out. If it makes life worthwhile, I think it has to be tried, hence the partner post in my Healthskills4Pain blog.

  3. Adiemusfree, I have dealt with chronic illness severe enough to be disabling for five years, with symptoms of the illness going back about 30 years. The local pharmacy has remarked I am the happiest chronically ill person they know.

    I have a Facebook support group that encourages gratefulness. I encourage chronically ill people to focus on what they do have, rather than what is lost. Often this does a lot to at least reduce the frustration and depression that can sometimes befall someone as they learn to cope.

    I worry now that I have grown too accustomed to how I manage my life, and wonder if I could squeeze out a bit more – “Am I working on habit instead of challenging myself?” As someone who has been to a level of disability for so long, I have to wonder if somehow I might have improved enough to be able to push a little harder if I just tried. Maybe it is a good thing – at least I refuse to be complacent – that would be a slow death, in a way.

    Thank you for your insights.

    1. Wow! You’re an inspiration – as long as you don’t think you MUST do more, be more, have more. I think we, who have chronic illness, could spend a lot more time appreciating now. Appreciating just what is. And remember that we’re humans, not heroes, so we don’t have to “prove” anything or do more than anyone else, because doing “normal” means doing more than most.
      I hope you, and everyone else like me who has a chronic pain problem, can take a moment or two to rest, knowing that we’ve done what we can, and we don’t need to do anything more to be OK.

  4. “Show them how life with chronic pain can be good?” Please do be carefull expressing these kind of opinions to People with chronic pain. As you say it yourself:”they are the experts at dealing with it. ”
    They will probably think that it is easy for you to say, since youhave no clue to what it is to be in constant pain.

    1. Before you decide to comment on a post, it’s worthwhile reading about the author. I live with fibromyalgia, and I think I do know something about what it’s like to live with chronic pain.

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