pain, mood, & meditation- where does spirituality fit?- by: amy wachholtz, phd, mdiv umass medical...

7/29/2019 Pain, Mood, & Meditation- Where does Spirituality fit?- By: Amy Wachholtz, PhD, MDiv UMass Medical School Psychiatry Day, 2009

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Pain, Mood, & Meditation-

Where does Spirituality fit?

Amy Wachholtz, PhD, MDiv

UMass Medical SchoolPsychiatry Day, 2009


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Outline

1. Bio-psycho-social-spiritual model of pain

2. What are the mechanisms linking meditationand pain?

3. Who uses Prayer/Meditation to cope with pain?

4. When do people use Prayer/Meditation for pain?

5. What does spirituality add to meditation for paincoping?


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Question #1 What is Pain?


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Typical Pain Cycle


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Gate/Neuromatrix Theory of Pain

Injury Signals

Gate

ThoughtsEmotions

Behaviors

Ouch!

I feel good!

Melzack & Wall, 1965


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Influences on Chronic Pain

Chronic

Pain

BiologicalFactors

Psychological

Factors

Social

Factors

SpiritualFactors


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Question #2: What arethe mechanisms linkingmeditation and pain?


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What role does meditation play?

Secular meditation & pain MBSR (Kabat-Zinn)

Relaxation response (Benson)

Spiritual meditation & pain TM

Yoga Loving-Kindness

Beyond the Relaxation Response

Religious Tradition based meditation


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Meditation Pathways and Pain

Meditation

Positive Mood

Internalized Locus of Control

Self-Efficacy

Anxiety

Distraction from Problems

Decreased Focus on the Body

Reduced Pain FrequencyIncreased Pain ToleranceDecreased Pain Sensitivity


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Altered Perceptions

Changed Mood

Changed Social Interactions

Changed Behaviors

Physiological/Neurological Changes

Altered neurotransmitter levels

Altered sleep

Altered HPA activity levelsAltered threshold for recognizing distress signals

Psycho-Social Changes

Meaning Making Attributions

Self-Efficacy

Distraction

Social Support

Instrumental Support

Relaxation

Possible Unique R/S Factor

Spiritual Support

Spiritual Growth

Spiritual Meaning Making AttributionsAdditional Efficacy Beliefs

Spiritual Beliefs and Practices

Positive vs. Negative

Public vs. Private

Intrinsic vs. Extrinsic

Existential vs. Religious

(Adapted from:

Wachholtz, Pearce

& Koenig, 2007)


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Common R/S Coping Tools

1. Prayer2. Spiritual Meditation3. Hope4. Reading faith-based literature5. Finding spiritual role models for coping6. Seeking spiritual support/connection7. Church attendance8. Seeking instrumental support9. Religious reappraisal


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Question #3: Who usesprayer/meditation to cope

with pain?


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National Health Interview Survey 2002-2007(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


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Question #4: When dopeople use prayer/meditation

to cope with pain?

Pain


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The initial spiritual pain coping response to acute pain(self-directive), is the least likely spiritual copingresponse 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 spiritualcoping is efficacious (Keefe, et al., 2001; Pargament, 2002)

Religious/spiritual coping AND secular coping- not

either/or


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Question #5: What doesspirituality add to meditation?


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Intervention Studies

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

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

Doubled pain tolerance to laboratory induced acutepain task

Meditation inherently spiritual?


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Improved pain tolerance among a chronicpain group (Wachholtz & Pargament, 2008)4 weeksDecreased pain frequencyGreater pain tolerance

Acute- laboratory induced painChronic- decreased rescue medication usage

Limited change in pain sensitivityGreater decrease in negative moodGreater decrease in anxiety

Intervention Studies


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Buddhist Loving-Kindness

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.)


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Summary

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 thatsupport its use

Spiritual meditation may be a useful resource with uniqueadditive components for patients with a spiritual/religiousbackground


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pain, mood, & meditation- where does spirituality fit?- by: amy wachholtz, phd, mdiv umass medical...

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