Cope with pain by changing how you picture it

Most people who suffer from serious pain have one or more mental images that they associate with the discomfort and what it represents to them. A new study by Clare Philips and Debbie Samsom has shown that these pain-sufferers can be taught to re-imagine this pain imagery in a more positive light, bringing them instant relief and emotional comfort.

Of 73 volunteers at an occupational rehab centre in Vancouver, 57 had pain and said they experienced imagery associated with that pain, and so they were recruited into the study (there were 24 men, the average age was 45).

After being interviewed about their baseline pain and their psychological state - including feelings of mental defeat, anxiety and depression - the participants were asked to select their most powerful and distressing pain-related mental image. "I see myself on all fours - like a dog but unable to move," said one. All participants spent time forming this "index image" in their mind before answering more questions about how they were feeling. Focusing on the unpleasant image increased pain and emotional distress. Remember, this is an image that the participants experienced spontaneously in their everyday lives (for nearly half of them, it came to mind several times a day).

Next, after a six-minute gap talking about where they grew up (as a distraction), 26 of the participants were taught to re-picture their pain. They were asked to think "how would you rather see the image?" and to describe in detail what this would entail. They then focused on this new image - for example, the participant above who'd previously described the dog-image now imagined: "I am at the start of a race….the gun goes off and the crowd cheers as I take off." The remaining participants acted as controls and spent the same time focused on their original, unpleasant index image.

After picturing a "re-scripted" pain image, the participants in that group experienced a dramatic drop in their pain levels. In fact, 49 per cent of them said they felt no pain at that time, compared with 11 per cent of them feeling no pain after imagining their index image. "The pain decrements were fast, easily produced and dramatically large," the researchers said. The re-script group also exhibited improvements in anxiety, sadness, mental defeat and beliefs about their own fragility. The control participants, by contrast, experienced none of these improvements.

There was another six-minute gap and the re-script group again pictured their positively re-imagined pain image. The controls were now also taught how to re-imagine their pain image - the local research ethics committee had insisted on this. The original re-script group continued to enjoy reduced pain and psychological benefits, which counts against the idea that the novel image had merely served as a temporary distraction. The controls now also enjoyed the benefits of re-picturing their pain.

Philips and Samsom said that the participants found it easy and pleasurable to re-script their pain images. Of course there is a need now for research to see whether these benefits of re-picturing pain can last into the long term. It would also help to have a different kind of control group - for example, one that merely visualised random positive images, to see if the effects of specifically re-picturing pain are more powerful. Where this study focused on the sensory detail of pain images, future work could also look into the re-writing the images' cognitive meaning.

The findings add to a broader literature showing that our experience of pain is affected by many psychological factors, such as our beliefs about our ability to cope. This doesn't mean the pain isn't real, but it does mean that psychological techniques can be incredibly effective at bringing relief and improvements to people's quality of life.

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Philips C, and Samson D (2012). The rescripting of pain images. Behavioural and cognitive psychotherapy, 40 (5), 558-76 PMID: 22950868

-Further reading-
Psychologist magazine special issue on the psychology of pain
Acceptance, not distraction, is the way to deal with pain (Digest item)
Verbal reassurance can dull the effect of pain, but only if it's from someone we identify with (Digest item)

Post written by Christian Jarrett for the BPS Research Digest.

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