COPING WITH STRESS AND PAIN

Personal Resources That Influence Coping

 Stress and chronic pain are common conditions for humans-common but not normal

 The normal tendency is toward health and any inclination away from health is actually a

state of” Disease”

WAYS TO FIGHT AGAINST DISEASE

1. Immune System

The body’s natural protection from invasion by foreign materials.

2. Medical Treatments

People sometime recovers through medical treatments such a s consulting with doctors

who suggest drugs or surgery for the betterment of chronic pain and stress.

3. Other Ways

People use some other ways for relief from stress and chronic pains that may include follows

 Recreational Drug

 Over Eating

 Abusing Alcohol

 Smoking
  Exercising

SOCIAL SUPPORT

Definition

Social support is a verbal and non verbal communication between recipients and

provider. Social support can come from many sources such as family, friends, pets, neighbors,

co-workers etc.

Meaning of Social Support

Social support has been widely researched and no single definition is emerged.

Researcher used dozen of inventories to measure this it refers to a variety of material and

emotional support a person receive from others.

Concepts

 It can be measured as a structural support that includes the number of social relationships

social support is actually that

 One is cared for it is a part of supportive social network that can be

 Emotional(nurturance)

 Informational(advice)

 Companionship(sense of belonging)
  Social contact and social network sometimes used interchangeably, but both refer to the

kindness of people with whom one associate. The opposite of social contact is social

isolation.

The Link Between Social Support And Health

 Stress researches generally agree that a link exist between social support and health:

people who receive high levels of social support are usually healthier than those who do

not

 Georgia, Michigan studies demonstrate that people.

 With higher levels of social support have lower rates of mortality and better health than

people with lowest level of support.

Personal Control

Personal control beliefs, also referred to as locus of control, reflect individual beliefs

regarding the extent to which they are able to control or influence outcomes.

 Person’s ability to cope with stressful life events is a feeling of personal control.

 Many investigators believe that people who believe that they have control over the

events of their lives are better able to cope with stress then are the people who feel that

their lives determined by forces outside themselves. For example: Rick felt that the

events happened to him were beyond his control, and he was accustomed to feeling in

control.
Locus of Control

Most well known is the concept of "locus of control" which derived originally from

Rotter's social learning theory (Rotter, 1966; 1982) and which focuses on "beliefs that

individuals hold between actions and outcomes". In 1966, Julian Rotter published a scale for

measuring internal and external control of reinforcement. Rotter hypothesized that people can be

placed along a continuum according to extent to which they believe they are in control of the

important events in their lives. Those who believed that they control their own lives score in the

direction of internal locus of control. Those people who believe that luck, fate or the acts of

others are determinants of their lives score on external locus of control.

Psychologist have applied the locus of control concept to health problems in order to

learn if a sense of personal control can help people adopt a healthy life style. For example: one

study (Jih, Sigro, Thomure 1995) studied locus of control and drinking behavior in college and

high school students and found that students high in external control tended to drink more in a

variety of situations, in both pleasant and unpleasant.

Two Process Model of Perceived Control

The model, as presented by Rothbaum, postulates that "the motivation to feel 'in control'

may be expressed not only in behavior that is obviously controlling but also, subtly, in behavior

that is not.” Whereas "primary control" reflects more directly controlling behaviors, "secondary

control" reflects behavior that, while not directly controlling, is focused on promoting a sense of

control, not by altering the environment, but by altering oneself (e.g., ones values, priorities, or

behavior) so as to bring oneself in line with the environment.

.
Importance of A Scene of Personal Control For Health

The effects of personal control were reported by “Ellen Langer and Judith Rodin”

(1976) in a study that demonstrated the importance of a scene of personal control for health.

These researchers studied older nursing home residents, some of whom were encouraged to

assume more responsibility and control over their daily live and some of whom had decisions

made for them. The type of control was fairly minor rearranging their furniture, choosing when

and whom to visit in home. These residents were offered a small plant, which they were free to

accept or reject and to care for as they wished. A comparison group of residents received

information that emphasized the responsibility of the nursing staff, and each received a plant.

The two groups are of same age, gender, physical and psychological health. The main

difference was in the amount of control they had, and that factors made a substantial difference

in health. Residents in the responsibility induced group were happier, more active and more alert;

they had a higher level of well being. In just three weeks, comparison group (71%) had become

more debilitated, whereas responsibility induced group (93%) showed overall mental and

physical improvement.

Langer and Rodin studies suggest that control over relatively minor matters can have

major consequences in the life of the individual. People need to be able to make choices and to

assume responsibility for their choices.

 RELAXATION TRAINING

Definition

“A relaxation technique is any method, process, procedures, or activity that helps a

person to relax, to attain a state of increased calmness, or otherwise reduce levels of pain,

anxiety, stress or anger.”

Modern uses of relaxation training are traced to Edmond Jacobson (1934, 1938) who termed

this method Progressive Relaxation.

The therapeutic uses of relaxation methods predate modern psychology with ancient

Egyptians, Hebrews, Tibetans, and others using some forms of Rhythmic Breathing.

Rhythmic Breathing.

Breathing occurring at a regular state or in a particular rhythm especially as a result of

voluntary control of the respiratory muscles.

Types of Relaxation Training

There are the 3 types of relaxation training.

1. Progressive Muscle Relaxation

2. Meditative Relaxation

3. Guided Imagery
 PROGRESSIVE MUSCLE RELAXATION

Definition

In progressive muscle relaxation people learn to relax one muscle group at a time,

progressing through the body’s entire range of muscles groups until the whole body is relaxed.

Explanation

For progressive muscle relaxation patients are first given a rationale for the procedure

including an explanation that their patient tension is mostly a physical tension resulting from

tense muscles. While reclining in a comfortable chair, often with eyes closed and with no

distracting lights or sounds, patients first breathe deeply and exhale slowly.

How to Learn Progressive Muscle Relaxation?

Although some people may need the help of trained therapist to master this approach,

others are able to train themselves.

Recline in a comfortable chair in a room with no distractions. You may wish to remove

your shoes or either dim the lights or close the eyes to enhance relaxation. Next breathe deeply

and exhale slowly. Repeat this deep breathing exercise for several times until you begin to feel
your body becoming more and more relaxed. The next step is to select a muscle group, e.g your

left hand and deliberately tense that group of muscles. If you begin with your hand make a fist

and squeeze the fingers into your hand as hard as you can. Hold that tension for about 10 seconds

and then slowly release the tension, concentrating on relaxing, smoothing sensations in your

hands as the tension gradually drains away. Once the left hand is relaxed, shift to the right hand

and repeat the same procedure. After both hands are relaxed go through the same tensing and

relaxing other muscle groups including the arms, shoulders, neck, mouth, tongue, eyes, theis,

feet, toes, back and stomach. And repeats the deep breathing until you achieves a full state of

relaxation. Focus on the enjoyable sensation of relaxation, restricting your attention to the

pleasant interval events and away from irritating external sources of pain, stress and anxiety.

Patient can rate their level of relaxation on a scale of 1 to 10, or they can signal the

therapist by raising their index finger whenever they experience increasing levels of pain or

distress.

Length of relaxation training programs varies but 6 to 8 weeks and 10 sessions with an

instructor are sufficient to allow patients to easily and independently enter a state of deep

relaxation.
 MEDITATIVE RELAXATION

Definition

“A way to rest and enjoy yourself: time that you spent resting and enjoying yourself.

It is developed by Herbert Benson and his colleagues.”

Explanation

This approach is derived from various religious meditative practices but as used by

psychologists it has no religious connotations with a quiet environment, comfortable position,

and repetitive sound and passive attitude. Participants usually sit with eyes closed and muscle

relaxed. Then they focus on their breathing and repeat silently a sound such as “om” or “one”

with each breath for about 20 minutes. Repetition of a single word avoids from distracting

thoughts and sustains relaxation. It involves conscious intension to focus on a single word that

avoids distraction.

Mindfulness Meditation

It is a type of meditative relaxation.

In it people do not try to ignore unpleasant thoughts or sensations by focusing on their

breathing or on a single sound. Rather they take the opposite approach, focusing on any thoughts

or sensations as they occur. However they are asked to observe these thoughts non-judgmentally.

By noting thoughts objectively people can gain insight into how they see the world and

what motivates them. Observing without judging moment by moment helps you see what is on

your mind without editing or intellectualizing it or getting lost in your own incessant thinking.
 GUIDED IMAGERY

Definition

“A method of relaxation which concentrates the mind on positive images in an attempt to

reduce pain.”

Explanation

It has some elements in common with meditative relaxation.

In it patient conjure up a calm peaceful image such as repetitive rhythmic roar of ocean or

a quiet beauty of pastoral scene. Patient then concentrate on that image for the duration of a

painful or anxiety filled situation. The assumption underlying guided imagery is that a person

cannot concentrate on more than one ring at a time. Therefore the patient must imagine an

especially powerful or delightful scene one so pleasant or powerful that it averts attention from

painful experience.

How Effective Is Relaxation Training?

Relaxation can only be regarded as effective if it proves more powerful than a placebo.

Placebo

A measure designed merely to humor someone.

Researches shows that it is more effective than placebos. In addition, relaxation is at least

equal to biofeedback in reducing pain and alleviating stress and it may be an essential part of

both biofeedback and hypnotic therapies.

 Relaxation techniques have been used successfully to treat both tension and migraine

headaches.

Progressive Muscle Relaxation

Progressive muscle relaxation can be an effective treatment for such stress related disorders

as migraine, and tension headache, depression, hypertension, low back pain and the stressful

effects of cancer chemotherapy. Meta analysis study shows that an abbreviated form of

progressive relaxation shows to be effective in coping with these disorders; however their sizes

varied from study to study. And the best results depends upon the number of adequate sessions,

skills , audiotape recording and enough time then a person will be able to get relief.

Progressive muscle relaxation seemed to work best with tension headache.

a) Significantly reduces a substantial number of chronic headaches.

b) Is more effective than a placebo.

c) Is at least equal to biofeedback in decreasing tension headache pain.

Meditation relaxation also helps people to cope with stress and anxiety. Jon kabat zin

and his colleagues studied the effectiveness of mindfulness meditation on chronic pain patients

and found it to be more effective than a traditional intervention that included physical therapy,

analgesics and anti depressants. Patients trained to use mindfulness meditation reported a

decrease in present pain, negative body images, depression, anxiety and mood disturbances and

fewer psychological symptoms. Moreover they decrease their use of pain medications improved

their activity levels and increased their feelings of self esteem.

In another study a meditation based stress reduction programmed for treating anxiety disorders

was effective in over 90% of the participants with GAD, panic disorders or panic disorders with

agoraphobias.

Guided imagery is a third relaxation strategy to copying with pain, anxiety and stress. A

small number of studies have been conducted on this type. In a study John horn and his

colleagues found that in vivo imagery reduced reported dental discomfort, childbirth anxiety and

discomfort, and experimentally induced pain.

Other studies found that guided imagery is more effective than either a therapist attention group

or a non treatment control group in reducing both anxiety and nausea during and after

chemotherapy adds significantly relaxation in helping severely burnt patients cope with pain.

BEHAVIOR MODIFICATION

Definition

 “A process for changing behavior through the application of operant conditioning

principles”

 “A treatment approach, based on the principles of operant conditioning, that

replaces undesirable behaviors with more desirable ones through positive or

negative reinforcement”

Origin of The Theory

Behavior modification relies on the concept of conditioning. Conditioning is a form of

learning. There are two major types of conditioning; classical conditioning and operant

conditioning.
 Operant conditioning, which involves using a system of rewards and/or punishments.

Which were developed by American behaviorist B.F. Skinner (1904-1990)(a famous

psychologist who is known as the “Father of Behaviorism), And introduced operant conditioning

to the general public in his 1938 book, The Behavior of Organisms. Dog trainers use this

technique all the time when they reward a dog with a special treat after they obey a command.

Behavior modification was developed from this because they supported the idea that just

as behaviors can be learned, they also can be unlearned. As a result, many different techniques

were developed to either assist in eliciting a behavior or stopping it. This is how behavior

modification was formed.

Description

The first use of the term behavior modification appears to have been by Edward

Thorndike in 1911.Behavior modification is a form of Behavior therapy now known as “Applied

behavior analysis”. The goal of behavior modification is to shape behavior, not to alleviate

feelings of stress or sensations of pain.

What is Behavior Modification?

 People in pain usually communicate their discomfort to others. They complain, moan,

sigh, limp, rub, grimace, miss work, or behave in a variety of other ways that indicate to other

people that they are suffering. Many of these behaviors have been reinforced by the

surroundings-that is, other people have in some manner rewarded these verbal and nonverbal

expressions of pain.

Behavior modification strategies for coping with stress and pain are based on B F.

Skinner’s (1987) notion that positive and negative rein forcers are central to operant

conditioning.

Techniques of Behavior Modification

The purpose behind behavior modification is not to understand why or how a particular

behavior started. Instead, it only focuses on changing the behavior, and there are various

different methods used to accomplish it. This includes:

 Positive reinforcement

 Negative reinforcement
  Punishment

Positive Reinforcer

“It is any stimulus that, when added to a situation, increases the probability that the behavior

it follows will recur”. It is also known as “rewards”. Positive reinforcement is pairing a positive

stimulus to a behavior. One way of giving positive reinforcement in behavior modification is in

providing compliments, approval, encouragement, and affirmation.

Example

 A good example of this is when teachers reward their students for getting a good grade

with stickers

 The attention and sympathy a person receives from family and friends and friends when

exhibiting pain behaviors.

 An example of positive reinforcement might be giving a child a hug when she does a

good job.

 Positive reinforcement is often used in training dogs. Pairing a click with a good

behavior, then rewarding with a treat, is positive reinforcement

 Negative Reinforcement

“It is the opposite and is the pairing of a behavior to the removal of a negative stimulus”.

A negative reinforcer is any aversive or painful stimulus that, when removed from a situation,

increases the probability that the behavior it follows will recur.

Example

 A child that throws a tantrum because he or she doesn't want to eat vegetables and has his

or her vegetables taken away would be a good example.

 The relief from pain one experiences after taking pain medication and the avoidance of

work or school responsibilities that can occur when a person shows pain.

 An example of negative reinforcement might be turning off an annoying sound when the

child does a good job.

Punishment

 “Punishment is designed to weaken behaviors by pairing an unpleasant stimulus to a

behavior”.

Example: Receiving a detention for bad behavior is a good example of a punishment.

Role of Operant Conditioning in Pain Behavior

Wilbert E. Fordyce (1974) was among the first to emphasize the role of operant

conditioning in the perpetuation of pain behavior. He recognized the reward value of increased

attention and sympathy, financial compensation, relief from work and social obligations, and

other positive reinforcers that frequently follow the various pain behaviors. Behavior
modification techniques of pain management assume that pain behaviors are observable and can

be reliably measured.

Once behaviors and their reinforcers have been identified, the process of behavior

modification can begin. Nursing staff and patients spouses can be trained to use praise and

attention to reinforce more desirable behaviors and to withhold reinforcement when patients

exhibit less desired pain behaviors. In other words, the inappropriate groans and complaints are

now ignored while efforts toward greater physical activity and other positive behaviors are

reinforced. Progress is noted by such criteria as amount of medication taken, absences from

work, time in bed or off one’s feet, number of pain complaints, physical activity, range of

motion, and length of sitting tolerance.

Effective Tips for Coping from Pain

Learning how to cope effectively with the pain is extremely important. Some important

tips on coping can make the difference in the individual's desire to live with the pain.

First, the sufferer should stay active and focus on the things they can do. They should

attempt new hobbies and activities. With a physician's permission the sufferer should get some
exercise. The person in pain should remember the slogan "no pain, no gain" is incorrect. It is

pertinent to start off slowly and do what can be done without causing excess pain. The idea of

pacing is crucial.

Second, the sufferer should focus on others by volunteering or helping those individuals

in need. The more the sufferer pays attention to others' the less they think of themselves.

Third, it is important for the sufferer to accept the pain. This is different than liking the

pain. The individual should not exaggerate how they feel or deny they are in pain. It is important

for the sufferer to be clear and honest about their capabilities and their limitations. It is crucial

for the person in pain to be practical about what they can accomplish.

Fourth, the person in pain should stay as healthy as possible. They should try to eat and

sleep on a regular schedule. The pain sufferer should reduce stimulants such as caffeine and

nicotine because some stimulants may intensify the pain.

How Effective is Behavior Modification?

Fordyce and his colleagues have successfully used behavior modification to improve

mobility in pain patients. Using a single-subject design, Fordyce and his colleagues (Fordyce,

Shelton & Dundore,1982) used behavior modification treatment for a young man suffering

abdominal pain, dizziness, and disturbances in walking. As part of therapy, the young man was

given his choice of either walking the assigned distance at a predetermined speed or walking

twice that distance at his own pace. The young men’s mother was instructed to ignore him when

he failed to walk and to encourage him when he showed progress in walking.

 The treatment intervention, which also included vocational counseling, was successful.

At the end of treatment, the young man was walking more freely and complaining less of severe

pain. Twenty-seven months later, the patient had maintained his gains despite no further

treatment. Single-subject studies such as this show that behavior modification can work in

individual cases, but they do not demonstrate the treatment’s general efficacy.

The success of behavior modification in controlling pain is difficult to judge because

many studies lacked adequate controls and they employed multimodal treatment interventions.

An early review found some consistent trends for more than a dozen studies that used behavior

modification to control a variety of pain syndromes (low back pain).

One study (Nicholas, Wilson &Goyen,1991)

found an initial advantage for behavior therapy in

reducing medication and improving physical

functioning of low back pain patients. However,

another study (Turner & Clancy, 1988) suggested that

this early advantage for behavior modification may not continue after treatment.

How do Behavior Modification Methods Compare with Traditional Medical Treatments

for Chronic Low Back Pain?

Fordyce and his associates found some evidence to support the superiority of behavior

methods over traditional medical treatment. Patients in the traditional management group

received medication on “as needed” basis and with the possibility of prescription renewal, while

patients in the behavior therapy group were given modification on a time-contingent basis and

with no renewal of the original prescription. The traditional treatment patients could stop their
activity and exercises whenever they wished. For the behavior treatment patients, activity and

exercises were completed on a predetermined basis. After 9 to 12 months, patients in the

behavior management group were doing better than those treated with traditional procedures.

A later review of studies confirmed that behavior therapy lead to improved psychological

and physiological functioning for back pain patients. Behavior based programs of pain

management are at least comparable in effectiveness to the more traditional physical therapy

programs for managing back pain. Behavior modification programs are probably most effective

in increasing levels of physical activity and decreasing use of medication.

COGNITIVE THERAPY