Contextual Cognitive-Behavioral Therapy for Chronic pain (Progress in Pain Research and Management, Volume 33) [Hardcover]

Lance M., Ph.D. McCracken (Author)

Product Details

• Hardcover: 132 pages
• Publisher: Intl Assn for the Study of Pain (March 31, 2005)
• Language: English
• ISBN-10: 0931092582
• ISBN-13: 978-0931092589
• Product Dimensions: 9.5 x 6.2 x 0.6 inches
• Shipping Weight: 13.6 ounces (View shipping rates and policies)
• Average Customer Review: 5.0 out of 5 stars  See all reviews (1 customer review)
• Amazon Best Sellers Rank: #2,043,066 in Books (See Top 100 in Books)

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2 of 2 people found the following review helpful:

5.0 out of 5 stars If You Already Do ACT and You Want to Treat Chronic Pain, This Book will Get You There, December 11, 2009

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Pen Name and That A - See all my reviews

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This review is from: Contextual Cognitive-Behavioral Therapy for Chronic pain (Progress in Pain Research and Management, Volume 33) (Hardcover)

You do not actually have to read the whole book. You can skip straight to chapter 7, then do values based action (which is covered in chapter 8).

I am told that Acceptance And Commitment Therapy For Chronic Pain is about as good. I have not read it and ordered the book I reviewed because it is shorter. Chapter 7 was only 18 pages long; more good news.

The material in this book is somewhat incompatable with the pain chapter in Mindfulness and Psychotherapy. Mindfulness and Psychotherapy seemed to want to use mindfulness as a way of relaxing and therby decreasing pain. I suppose, but I do not know for sure, that the approach of Mindfulness and Psychotherapy is compatible with MBST.

Much of the early chapters of the book are a comentary about ACT, rather than a description of what it is. The book goes very close to describing what relational frame theory is, but does not quite get there. It wouldn't have killed McCracken to put in a few pages about this. At least I now know that "functional contextualism" is a posh phrase way of saying "behaviorism" (pg. 26).

My own experience is that CBT and rational emotive therapy is a good foundation for ACT. There are two problems with going straight to ACT, a) you do not have to bypass a thougght if you can modify it and b) going straight to ACT is too much of a leap without the framwork of CBT. If you wanted to do CBT for chronic pain, perhaps you could use Cognitive Therapy for Chronic Pain: A Step-by-Step Guide. I find that Cognitive Therapy for Chronic Pain: A Step-by-Step Guide is a little hearltess and does not bring much to the CBT tablet that Beck et al had not already put there.

Below is a summary that I did for my own benefit.

Contextual Cognitive Behavioural Therapy for Chronic Pain
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Lance M. McCracken. 2005. IASP Press.

Foreword
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Bonica (1953) argued that even if the underlying disease was absent, pain could persist. Graded exposure is not used to control fear but to help patients develop a capacity to experience thoughts and feelings they may be avoiding.

Foreword
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The life role of thoughts and feelings can change even if the thoughts and feelings themselves do not change. Thoughts and feelings are situated events. So, the shift is from the content of the thoughts to the context and functioning of the thoughts and feelings.

1. The Problem of Chronic Pain
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Psychological variables such as depression and perception of work are the strongest predictors of treatment outcome.

The first wave of CBT used operant and stimulus-response theories. Second wave: social learning, cognitive processes and meditational models.

2. Psychological Approaches to Chronic Pain
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1879 was the year the first psychological laboratory was opened by Wilhelm Wundt. "Psychogenic pain": Otto Binswanger, 1904. Pain has both sensory and emotional qualities: Edward Tichener, 1909. Pavlov, 1920s. Gate control theory, Melzack and Wall, 1965.

Fordyce defined chronic pain as an excess of pain behavior and relative absence of well behaviour. All that was needed was the passage of time and exposure to systematic contingencies of reinforcement in the environment.

Some experiences of pain may occur to a discrimination problem: pain, anxiety, depression frequently occur at the same time.

Avoidance. Other things causing withdrawal include limitations in social skills, problem solving or neuropsychological deficits. Other things are family members, health care providers, emotional support, financial gain.

The "dead man test": if a dead man can do it, it can not be a behaviour. Over time, the operant approach included relaxation and biofeedback. There is little correlation between what people say about their pain and what they actually do. Spousal supportive behaviour important. A reinforcer must be measured to be a reinforcer - the definition should be functional rather than formal.

New approach: "Pain and Behavioural Medicine: A Cognitive Behavioural Perspective", by Turk, 1983. Two types: reappraisal and divert attention.

3. Contextual Cognitive-Behavioral Therapy
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"Psychology as the Behaviourist Sees It": 1913, Watson, rejected introspection completely; limited by truth by agreement or logical positivism.

Radical behaviorism restores some king of balance... does not dismiss them as subjective... It simply questions the nature of the object observed and the reliability of the observations: Skinner 1974.

Intermittently the environment elicits reflexive responses (respondents), but more frequently, on a moment-to-moment basis, it provides occasions for behaviours (operants) and consequences for those behaviours. There is a reciprocal relationship between the individual and the environment.

The term `behaviorism' does not always convey clear meaning in conversation... post-Skinnerian behaviorists instead use the term "functional contextualism." It expands on behaviorism of the past. The subject matter is the act in context. The context means the history of relevant events leading up to and including the current situation. Temporal and situational. Functionally, not structurally (what they mean and not what they look like). Cause is rules/verbal and past learning experiences.

Responses with different forms but the same function will gain strength in the process. For a pain sufferer, being irritable, complaining of pain, sleeping excessively and refusing invitations, may all have the same function - avoiding social occasions. The above are a response class because they are functionally similar but structurally different.

Functional antecedents form the basis for what is referred to as stimulus control, also known as discriminative stimulus control or cuing.

Some recon thoughts control behaviour and some recon the environment does. The both do. "I can't stand this pain" at their daughter's wedding.

Rule governed behaviour. Rules have been defined as antecedent, verbal, contingency-specifying stimuli. The rule does not have to be in awareness. Many behaviours persist despite problems with the outcomes.

There are three main classes of rule following: 1) because of past correlation between rule-following and contingencies, 2) socially mediated consequences and 3) changing the effectiveness of a reinforcing consequence. Examples of rules are "pain of exercise will help in the long term" and "pain means damage."

Verbal stimuli participate in events that they represent. Functional contextualism ' RFT ' ACT.

Relational frame theory is the broader theory that encompasses stimulus equivalence. Relational frame theory offers an account of how verbal stimuli come to acquire influences (cueing, evoking emotion, motivating, reinforcing) over other behaviour by participation in relations with the events they represent. Words that describe life events can readily take on the psychological properties and influences inherent in those events. These behaviour-influencing functions can then be readily transferred without direct training to other related stimuli. Importantly, these derived relations are arbitrary, not necessarily relying on any formal similarity between similarity between the related events. Once a class of related events is established, behaviour-influencing functions trained for one event can transfer to all members of the class. These transfers are contextually determined, such that the function of an event may be relationally determined in one situation but not in another. Behaviour that is acquired by these verbal processes can be extremely durable. Once derived relations are formed, further training does not eliminate them, and behaviour change can only occur by adding further relations not subtracting.

Verbal processes can add meaning and therefore suffering to experiences of chronic pain. Depression... Dougher and Hackbert 1994. Consequences that have never been directly encountered can nonetheless exert powerful influences in such as way that pain with movement can produce responses as if that pain means paralysis, a crumbling spine, repeated injury, death, insanity, or other conditions bearing no necessary relationship to the pain itself, leading for example, to what we see as pain-related fear and avoidance.

4. Contextual Cognitive-Behavioral Assessment
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Usual domains: severity, disability, emotional distress, social factors and coping. Coping includes overt and covert measures. Disability is a molar construct and not a patient behaviour. A patient can not be observed "doing disability." There are limitations that come with working at the level of inferred categories of functioning rather than behaviour itself. Topographical assessment can be misleading.

A psychological trait can be an effect rather than a cause. Description can be confused with explanation.

Generalizability vs. reliability and validity vs... Read more ›