I was hoping to post on positive psychology and chronic pain, but have failed to find any specific references using these two headings – I then had a brain-wave and without waiting for someone reading this to locate something for me… I remembered the body of research in contextual cognitive behavioural therapy – mainly by Lance McCracken.
So this post is dedicated to CCBT, positive psychology and the season of good cheer!
Anyway, the reason for wanting to post on this aspect of psychology is that I have a hunch that resilience (my PhD topic!) and aspects of positive psychology might just be relevant for people learning to live with chronic pain.
So, what is positive psychology?
It is the ‘scientific study of the strengths and virtues that enable individuals and communities to thrive’ (Positive Psychology Centre )
It’s derived from the early humanist psychologists such as Carl Rogers, Abraham Maslow and others, and further developed by Martin Seligman, Albert Bandura and others, with the focus being on strengths, and those features of human life that promote wellbeing, resourcefulness and the ability to develop.
For a great list of resources and links relevant to positive psychology, go here: and go here for links to various questionnaires that may be useful.
Anyway, to come back to my hunches… psychological flexibility is a feature of positive psychology, and involves processes of acceptance, mindfulness, values, and cognitive defusion (for a longer explanation of these see McCracken, L. M., & Vowles, K. E. (2007)).
Positive values such as the following seem to enable people to live well despite life events around them:
- finding good things about each event that happens in our lives,
- having compassion for ourselves and others,
- being creative and finding opportunities for development
When people don’t demonstrate cognitive flexibility, they can remain fixed in resentment and anger, attend to only a few things (and judge the experience negatively), and believe that what they think is so, rather than a thought that alters depending on context. What this means in pain management is that people fixate on their pain and the negative judgement of that pain and how it interferes with their activities, remaining angry and fixed in the ways that they approach life.
Using what we can learn from positive psychology, we may be able to help people in this position draw on their strengths by assessing coping strategies in terms of strengths rather than us as professionals dwelling on their vulnerabilities and problems.
For example, we may look at the values that they are using when declaring that ‘I can’t do pacing’ – does this reflect their desire to achieve and their ability to persevere despite pain? Instead of a negative feature, can we help them identify their strength with task persistence or achievement, and develop the ability to apply this value flexibly and in contexts in which this is helpful?
McCracken and others have spent a good deal of time exploring the concept of acceptance, finding strong positive relationships between acceptance and function, acceptance and positive affect, and acceptance and reduced use of avoidance (see below for references). I’m looking forward to the time when we can read of others researching this area – perhaps from the Positive Psychology Centre or similar.
In the meantime, we can learn from this research ways to encourage the people we work with to sit ‘with’ their pain, becoming aware of pain but not judging it negatively (or positively), help them to look for positives (remember the post about counting your blessings?
And in this season of good cheer, perhaps we can interpret the ways people cope with their pain in positive ways – what is adaptive about their strategies? How can they be used to help them achieve their goals in life? What features of what they currently do can be drawn upon to help them succeed?
Finally, can we as treatment providers look on the bright side too? Can we give ourselves credit for continuing to work in this complex and challenging area, often with limited idea of just how effective we are? And perhaps, by being ‘Pollyanna’ for a while, we might catch sight of the promise, possibilities and potential in our clients and ourselves – and have a Brilliant New Year!
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BTW For a great place to review positive psychology from a personal perspective, go to Authentic Happiness and spend some time mooching about the information and resources held there…
McCracken, L., & Samuel, V. (2007). The role of avoidance, pacing, and other activity patterns in chronic pain. Pain, 130(1), 119 – 125.
McCracken, L. M. (2007). A Contextual Analysis of Attention to Chronic Pain: What the Patient Does With Their Pain Might Be More Important Than Their Awareness or Vigilance Alone. Journal of Pain, 8(3), 230-236.
McCracken, L. M., Eccleston, C., & Bell, L. (2005). Clinical assessment of behavioral coping responses: Preliminary results from a brief inventory. European Journal of Pain, 9(1), 69-78.
McCracken, L. M., & Vowles, K. E. (2007). Psychological flexibility and traditional pain management strategies in relation to patient functioning with chronic pain: An examination of a revised instrument. The Journal of Pain Vol 8(9) Sep 2007, 700-707.
McCracken, L. M., & Yang, S.-Y. (2006). The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain, 123(1-2), 137-145.