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Pain, Mood, & Meditation- Where does Spirituality fit?. Amy Wachholtz, PhD, MDiv UMass Medical School Psychiatry Day, 2009. Outline. Bio-psycho-social-spiritual model of pain What are the mechanisms linking meditation and pain? Who uses Prayer/Meditation to cope with pain?

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Pain mood meditation where does spirituality fit

Pain, Mood, & Meditation- Where does Spirituality fit?

Amy Wachholtz, PhD, MDiv

UMass Medical School

Psychiatry Day, 2009


Outline
Outline

  • Bio-psycho-social-spiritual model of pain

  • What are the mechanisms linking meditation and pain?

  • Who uses Prayer/Meditation to cope with pain?

  • When do people use Prayer/Meditation for pain?

  • What does spirituality add to meditation for pain coping?




Gate neuromatrix theory of pain

I feel good!

Ouch!

Gate/Neuromatrix Theory of Pain

Thoughts

Behaviors

Emotions

Gate

Injury Signals

Melzack & Wall, 1965


Influences on chronic pain
Influences on Chronic Pain

Biological Factors

Spiritual Factors

Chronic Pain

Social Factors

Psychological Factors



What role does meditation play
What role does meditation play? pain?

  • Secular meditation & pain

    • MBSR (Kabat-Zinn)

    • Relaxation response (Benson)

  • Spiritual meditation & pain

    • TM

    • Yoga

    • Loving-Kindness

    • Beyond the Relaxation Response

    • Religious Tradition based meditation


Meditation pathways and pain
Meditation Pathways and Pain pain?

Positive Mood

Internalized Locus of Control

Self-Efficacy

Anxiety

Distraction from Problems

Decreased Focus on the Body

Reduced Pain Frequency

Increased Pain Tolerance Decreased Pain Sensitivity

Meditation


(Adapted from: Wachholtz, Pearce & Koenig, 2007) pain?

Spiritual Beliefs and Practices

Positive vs. Negative

Public vs. Private

Intrinsic vs. Extrinsic

Existential vs. Religious

Possible Unique R/S Factor

Spiritual Support

Spiritual Growth

Spiritual Meaning Making Attributions

Additional Efficacy Beliefs

Psycho-Social Changes

Meaning Making Attributions

Self-Efficacy

Distraction

Social Support

Instrumental Support

Relaxation

Physiological/Neurological Changes

Altered neurotransmitter levels

Altered sleep

Altered HPA activity levels

Altered threshold for recognizing distress signals

Altered Perceptions

Changed Mood

Changed Social Interactions

Changed Behaviors


Common r s coping tools
Common R/S Coping Tools pain?

  • Prayer

  • Spiritual Meditation

  • Hope

  • Reading faith-based literature

  • Finding spiritual role models for coping

  • Seeking spiritual support/connection

  • Church attendance

  • Seeking instrumental support

  • Religious reappraisal



National Health Interview Survey 2002-2007 pain?

(Wachholtz & Sambamthoori, 2009)

  • Older (>33 years)

  • Female

  • More Educated (> High School)

  • African-American (vs. white)

  • Have chronic mental or physical health issues: depression, chronic headaches, back and/or neck pain


Question 4 when do people use prayer meditation to cope with pain

Pain pain?

Question #4: When do people use prayer/meditation to cope with pain?


  • The initial spiritual pain coping response to acute pain (self-directive), is the least likely spiritual coping response to chronic pain (collaborative) (Dunn & Horgas, 2004)

    • Terminal stage illnesses with co-morbid pain (Yates, et al., 1981; Ironson, et al, 2002)

    • Long-term chronic pain (Abraido-Lanza, et al., 2004; Glover-Graf, et al., 2007)

    • Uncontrollable, intermittent pain (Harrison, et al., 2005)

  • When other coping mechanisms fail and spiritual coping is efficacious (Keefe, et al., 2001; Pargament, 2002)

  • Religious/spiritual coping AND secular coping- not either/or


Question 5 what does spirituality add to meditation

Question #5: What does spirituality add to meditation? (self-directive), is the least likely spiritual coping response to chronic pain (collaborative)


Intervention studies
Intervention Studies (self-directive), is the least likely spiritual coping response to chronic pain (collaborative)

  • Spiritual interventions affect physiological outcomes (Carlson, Bacaseta, and Simanton, 1988; Ironson, et al., 2002, Pargament et al., 2005; Wenneberg, et al., 1997 )

  • Increase pain tolerance in healthy, non-chronic pain individuals (Wachholtz & Pargament, 2005)

    • Doubled pain tolerance to laboratory induced acute pain task

    • Meditation inherently spiritual?


Intervention studies1
Intervention Studies (self-directive), is the least likely spiritual coping response to chronic pain (collaborative)

  • Improved pain tolerance among a chronic pain group (Wachholtz & Pargament, 2008)

    • 4 weeks

    • Decreased pain frequency

    • Greater pain tolerance

      • Acute- laboratory induced pain

      • Chronic- decreased rescue medication usage

    • Limited change in pain sensitivity

    • Greater decrease in negative mood

    • Greater decrease in anxiety


Buddhist loving kindness
Buddhist Loving-Kindness (self-directive), is the least likely spiritual coping response to chronic pain (collaborative)

  • Cancer patients(Carson, et al, 2008)

  • Migraineurs Pilot Study(Wachholtz, 2009)

    • 4 week class, 4 week follow up

    • Increased spiritual experiences

    • Elevated pain tolerance

    • Fewer headaches (n.s.)


Summary
Summary (self-directive), is the least likely spiritual coping response to chronic pain (collaborative)

  • Pain a multi-dimensional disorder including physiological, psychological, social and spiritual components

  • Prayer and spiritual meditation used by many with chronic pain

  • Multiple psychological and physiological pathways that support its use

  • Spiritual meditation may be a useful resource with unique additive components for patients with a spiritual/religious background


Thank you

Thank You (self-directive), is the least likely spiritual coping response to chronic pain (collaborative)

[email protected]


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