The American psychologist
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The American psychologist · Feb 2014
ReviewCognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research.
Over the past three decades, cognitive-behavioral therapy (CBT) has become a first-line psychosocial treatment for individuals with chronic pain. Evidence for efficacy in improving pain and pain-related problems across a wide spectrum of chronic pain syndromes has come from multiple randomized controlled trials. ⋯ Innovations in CBT delivery formats (e.g., Web-based, telephone-delivered) and treatments based on CBT principles that are delivered by health professionals other than psychologists show promise for chronic pain problems. This article reviews (a) the evidence base for CBT as applied to chronic pain, (b) recent innovations in target populations and delivery methods that expand the application of CBT to underserved populations, (c) current limitations and knowledge gaps, and (d) promising directions for improving CBT efficacy and access for people living with chronic pain.
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The American psychologist · Feb 2014
ReviewHypnotic approaches for chronic pain management: clinical implications of recent research findings.
The empirical support for hypnosis for chronic pain management has flourished over the past two decades. Clinical trials show that hypnosis is effective for reducing chronic pain, although outcomes vary between individuals. ⋯ Neurophysiological studies reveal that hypnotic analgesia has clear effects on brain and spinal-cord functioning that differ as a function of the specific hypnotic suggestions made, providing further evidence for the specific effects of hypnosis. The research results have important implications for how clinicians can help their clients experience maximum benefits from hypnosis and treatments that include hypnotic components.
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The American psychologist · Feb 2014
ReviewFamily and parent influences on pediatric chronic pain: a developmental perspective.
Pain that recurs or persists is unfortunately a common experience for children. One of the unique considerations in pediatric chronic pain management is the bidirectional influences of children's pain experiences and parental and family factors. In this review we present a developmental perspective on understanding pediatric chronic pain and disability, highlighting factors relevant from infancy to adolescence, and family and parent influences. ⋯ Also, there is a lack of longitudinal data on family relationships and individual adjustment to allow for understanding of whether changes occur in parenting over the course of the child's chronic pain experience. Although parent interventions have been successfully incorporated into many cognitive-behavioral treatments for children with chronic pain conditions, little guidance exists for adapting intervention strategies to be developmentally appropriate. Additional research is needed to examine whether parent interventions are effective at different developmental stages and the best way to incorporate developmental goals into treatment.
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The American psychologist · Feb 2014
ReviewPsychological pain interventions and neurophysiology: implications for a mechanism-based approach.
This article provides an illustrative overview of neurophysiological changes related to acute and chronic pain involving structural and functional brain changes, which might be the targets of psychological interventions. A number of psychological pain treatments have been examined with respect to their effects on brain activity, ranging from cognitive- and operant behavioral interventions, meditation and hypnosis, to neuro- and biofeedback, discrimination training, imagery and mirror treatment, as well as virtual reality and placebo applications. ⋯ Moreover, new treatment targets can be developed and tested. Finally, the use of neurophysiological measures can also aid in motivating patients to participate in psychological interventions and can increase their acceptance in clinical practice.
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The American psychologist · Feb 2014
ReviewAcceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress.
Over 30 years ago, treatments based broadly within cognitive behavioral therapy (CBT) began a rise in prominence that eventually culminated in their widespread adoption in chronic pain treatment settings. Research into CBT has proliferated and continues today, addressing questions very similar to those addressed at the start of this enterprise. However, just as it is designed to do, the process of conducting research and analyzing evidence reveals gaps in our understanding of and shortcomings within this treatment approach. ⋯ This article reviews the progress of CBT in the treatment of chronic pain and the challenges now faced by researchers and clinicians interested in meeting this need for development. It then focuses in greater detail on areas of development within CBT, namely acceptance and commitment therapy (ACT) and mindfulness-based approaches, areas that may hold potential for future progress. Three specific recommendations are offered here to achieve this progress.