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Coping, depression, anxiety, self-efficacy what is the biopsychosocial model example social support: Impact on adjustment to chronic pain. Jensen 3. Pain is a multidimensional, unique, and private experience. Contemporary biopsychosocial models of chronic pain hypothesize a key role for psychosocial factors as contributing to the experience of and what does red up the room mean to chronic pain. The psychosocial factors what is the biopsychosocial model example have been most often examined as they relate to chronic pain include coping responses, attributions such as self-efficacymood including depression and anxietyand social support.
Knowledge concerning the relative importance of each of these factors to adjustment is necessary for what is the biopsychosocial model example and developing effective psychosocial interventions. This article reviews the literature what does 420 friendly mean the associations between psychosocial bbiopsychosocial and adjustment to chronic pain, with a focus on coping, attributions, mood, and social support.
Overall, the findings of this research are consistent with biopsychosocial models of chronic pain, and support continued research to help identify the causal relationships among key psychosocial variables and adjustment. Conocer la importancia relativa de cada uno de éstos en los procesos de ajuste a la experiencia del dolor crónico es necesario para entender y desarrollar intervenciones psicosociales eficaces.
En general, las conclusiones de este trabajo son compatibles con los modelos biopsicosociales de dolor crónico, y sugieren continuar las investigaciones para identificar las relaciones causales entre ciertas variables psicosociales y el ajuste al dolor crónico. Although large regional and national differences have been reported in prevalence, severity and primary causes of pain e.
The financial burden generated by chronic pain is at about the same level as that caused by cancer and cardiovascular diseases, and recognized as a major healthcare problem Breivik et al. Without denying the biomedical factors that contribute to pain, wat recent decades, there has been a steady increase in research studying the subjective nature what is the biopsychosocial model example pain and an what is the biopsychosocial model example that the experience of pain is influenced by emotional, psychological, social and spiritual factors e.
There have been types of causation in criminal law psychosocial factors that have been studied what is the biopsychosocial model example respect to chronic pain. They include pain-related fear, pain coping responses, mood e. However, the most commonly studied psychosocial factors as they relate to pain and adjustment to chronic pain include: 1 pain coping responses, 2 depression, 3 anxiety, 4 attributions, and 5 social support.
There is a vast literature on the association between coping responses mofel chronic pain, especially in populations with chronic non-cancer pain. Research results are not always consistent with respect to the relationship of global categories of coping strategies with pain experience, particularly what is the biopsychosocial model example regard to problem-focused vs. For this reason, studies exsmple have used Lazarus and Folkman's coping model as a theoretical basis have not proved that useful.
This construct appears to overlap, at least in part, with the concepts of active and wellness-focused ezample Esteve et al. In fact, according to Van Damme and colleagueswhen a meaningful goal is blocked by pain, hte can either attempt to diminish the impact of pain in order to achieve goals, or reappraise the goal e.
The hypothesis is that spiritual beliefs and practices can influence cognitive and emotional processes, which in biopsychsoocial may impact biological mechanisms and influence the experience of pain. The decision to use a can genital warts lead to cervical cancer coping response or set of coping responses is influenced by a what is the biopsychosocial model example number of variables.
Among them are culture, personality, age and development stage, cognitive appraisals e. The sex of the patient is yet another factor that could influence coping responses. A third potential sex difference mode the possibility that, due to social role functioning, men may engage in more active coping strategies than women Ramírez-Maestre et al. For both research and clinical purposes, it may what is the biopsychosocial model example useful to distinguish adaptive strategies that tend to be associated with a decrease in frequency or what is the biopsychosocial model example of pain, or in the negative effects of pain biopsycyosocial patients' lives from maladaptive pain coping strategies responses that tend to be associated with increases in pain or pain-related disabilityas this classification can be based on empirical findings and has clear clinical relevance Soares, Research shows an interesting pattern with respect to the association between coping responses that have been classified in this way and patient outcomes.
Specifically, although some adaptive coping strategies e. López-Martínez et al. This pattern of findings raises the interesting possibility that it may be more important for patients to cease using maladaptive coping responses than to start using adaptive ones. However, a coping response is not likely to be "adaptive" or "maladaptive" for every patient or even within the same patient at different times, as the adaptability of coping seems to biopsgchosocial on a large broad of factors for how to make a bumble profile reddit circumstances, motivation, goals Van Damme et al.
As a result, the effects of a coping response may be modek evaluated in light of its effects for any patient in each situation Ramírez-Maestre et al. Thus, there are likely situations when a specific coping response that is usually maladaptive might be adaptive e. For the most part, however, passive and emotion-focused coping responses, as well as avoidance, tend to be maladaptive, even if they sometimes result in short-term reductions in pain and suffering.
In the long term, these coping responses tend to be associated with an increase in pain intensity, greater disability, poor psychosocial adjustment and higher levels of anxiety and depression across numerous different chronic pain populations e. Keefe et al. As with many maladaptive coping responses, however, passive coping might be appropriate at times; especially when the situation cannot be changed.
In this case, avoidance might be beneficial, at least in the short term, for reducing pain intensity Dysvik et al. Similarly, active and problem-focused strategies tend to be considered adaptive and beneficial, especially in situations that can be controlled and changed. But even here the findings are not entirely consistent Jensen et al. Some studies love quotes good night what is the biopsychosocial model example the use of such coping strategies is associated with decreases in pain intensity, disability, depression, and distress, as well as increases in physical and psychological functioning, across different samples of individuals with chronic pain e.
Dysvik et al. In other studies, however, the associations between these coping responses and measures of pain were weak and nonsignificant Dysvik et biopsychosicial. Also, it is important to keep in mind that, in general, the findings show stronger associations between coping and measures of pain adjustment than between coping and pain experience itself e.
It is possible that active coping does not directly result in a decrease in pain intensity and disability, but the benefits of these coping responses may be mediated by their effects on the use of maladaptive passive tge responses, although their use is not mutually exclusive Esteve et al. Similarly, the use of active coping strategies may, through their association with acceptance, result in better physical, psychological and emotional niopsychosocial Esteve et al. Recent findings have suggested that "acceptance" may also be classified as an adaptive coping strategy in pursuit of pain adjustment, especially when the individual is dealing with pain interference with a valued goal Van Damme et al.
The results showed an increase in pain tolerance and decrease on pain intensity in both what is the biopsychosocial model example. However, only the patients given acceptance-based treatment reported an increased in task performance. When we consider the role of spiritual or religious coping, the results are again inconsistent. Acknowledging that inconsistent findings are more common than consistent ones, there has emerged some consistency concerning some specific coping strategies.
Specifically, most studies suggest that for most people, most of the time, avoidance, pain-contingent rest, and guarding are maladaptive and result in increased pain and disability over time e. As a result, unless there is a specific medical contraindication, patients should examplr be advised to move without guarding and be at least moderately active regardless of pain, biopschosocial to notice it and yet pursuit valuable goals less affected by pain.
Another factor that can complicate our mdel what is the biopsychosocial model example the associations between coping and chronic pain is the possibility that there are confounding biopsychoscoial which might explain the associations found. For example, an association between depression and the use of emotion-focused coping strategies has been established, both in samples of patients with cancer pain as well as in samples of patients with non-cancer pain e.
At the same time, there is also a negative association biopsychosocisl depression and the use of active ks strategies Esteve et al. Depression, through its possible effects on both coping and functioning, is a possible confounding variable that could explain some, or even all, associations found between coping and pain-related adjustment. Other psychosocial variables may act as mediators between coping and functioning.
Examples of such coping responses could include task persistence in spite of the pain as boopsychosocial as some spiritual strategies e. Even faith, the pattern of prayer and spiritual support, could potentially impact the perception of social support. Ramírez-Maestre and colleagueson the other hand, proposed that if personality can predispose one to use different coping responses neuroticism predispose to the use of passive coping responsesand modulate as well pain perception, coping has, on the other hand, a modulating effect on the relationship between certain personality variables and pain intensity.
The association between the presence and severity of chronic pain and symptoms of depression is well established Baker ghe al. Sex differences have been observed with respect to the association between depression and pain e. Keogh et al. Clearly, further research is needed to clarify sex differences in affective response to and emotional association with pain.
Depression can be the result of biological factors associated with the cause of pain e. These is particularly true with respect to highly threatening diagnoses e. Moreover, there is evidence that the use of tricyclic antidepressants and some mood stabilizers can be effective in alleviating health problems associated with pain Miró et al. Depression associated with pain can contribute to sadness, passivity, low self-esteem and decreases in the belief that pain can be managed or controlled Soares, Depression can also contribute to the experience of pain itself, given what is the biopsychosocial model example that people with depression or a depressive personality have a greater sensitivity biposychosocial acute and chronic pain Bär et al.
The research literature also shows consistent associations between measures of anxiety and pain, suggesting the possibilities that: 1 pain contributes to feelings of anxiety; 2 anxiety can make people more sensitive to pain and its negative effects; and also that 3 anxiety, either associated or not with fear, predicts pain what is the biopsychosocial model example disability by contributing to hypervigilance and avoidance behaviors, maintaining the pain experience e. For example, the perception of pain may contribute to expectations hiopsychosocial an event or behavior may cause or amplify pain, which can then increase anxiety and fear, and this in turn result in hypervigilance to bodily sensations and avoidance behaviors, followed by disability, disuse and depression, and ultimately to maintenance and exacerbations of pain McCraken et al.
Over time, and as pain becomes chronic, some individuals may transition to a permanent state of anxiety, resulting in chronic muscle tension and anticipatory anxiety, which can then lead to avoidance behavior and disability. As people stop performing usual activities especially those, perhaps, that involve moving the body areas that are most painfulthis can lead to less mobility, muscle atrophy, and an increase of muscular tension, all of which can then make patients more prone to experience pain flare-ups.
On the other hand, the association between anxiety and pain could operate, at least in part, via a somatic mechanism. In this case, anxiety contributes to an increase of muscular tension, which then increases nociceptive input and the experience of pain Miró et al. A large number of studies have examined the associations between attributions beliefs, schema, etc. From this research, two attributions have emerged as particularly important: catastrophizing cognitions and self-efficacy what is the biopsychosocial model example.
Catastrophizing may be defined as an exaggerated and overly negative evaluation of stressful events, and in the particular case of pain, as interpretation of pain as a threat, leading to focus more on the negative aspect of the situation, what is the biopsychosocial model example physical arousal as pain cues, fear of pain and avoidance behaviors Vlaeyen et al. Whether viewed as a coping response e. Research shows that higher levels of catastrophizing are linked to higher levels of bopsychosocial intensity, greater disability, poorer psychosocial adjustment, higher levels of anxiety and depression e.
Francoa et al. Although the fear-avoidance model Lethem et al. This model proposes that catastrophizing cognitions are associated with higher levels of brain activity in the areas of anticipation and attention to pain, emotional aspects of pain and motor control Woby et al. Self-efficacy has been defined as the belief or experience that one can engage in a behavior that is necessary to produce a desired outcome Bandura, cit.
It represents a personal judgment about how well a person thinks he or she is able to carry out certain behaviors in a particular situation Arnstein, Self-efficacy beliefs are thought to be important determinants of other thoughts, feelings and coping responses Bandura,Turner et al. In general, the person with chronic pain will use coping responses more effectively if he or she believes that he or she how to write composition in english capable of performing those responses Bandura, examplle.
This hypothesis is consistent with the results reported by Brown and Nicassioin a sample of patients with chronic pain, who found that participants with higher self-efficacy tended to use active what is the biopsychosocial model example strategies, while those with lower self-efficacy were more likely to use passive coping strategies to deal with their pain.
Similarly, Nicholas found a positive correlation between self-efficacy and the use of active coping strategies of the Coping Strategies Questionnaire, and a negative correlation with catastrophizing. Moreover, self-efficacy has been shown to be negatively associated with both anxiety and depression Arnstein et al. Their findings supported this hypothesis, suggesting that social support and coping are interdependent.
Moreover, general beliefs that others are available to provide emotional comfort and practical assistance in times of need appear to be beneficial to health and well-being Navalhas,Santos et al. In fact, research in many different populations indicates a positive association between social support and physical and psychological functioning, as the quality and quantity of social support positive emotional support has a positive influence in mood, and the lack any doubt meaning in hindi social support is associated to higher levels of depression and poorer pain adjustment e.
However, the findings regarding the associations between measures of social support and pain-related outcomes are inconsistent, perhaps due to the differences in how social support is defined across studies López-Martínez et al. Although, the findings to date suggest the possibility that social support can reduce the negative effects of pain on physical and psychological functioning, separate from any effects of social support on coping, in some studies greater social support is, in fact, associated to higher levels of pain intensity López-Martínez et al.
Thus, it is possible that social support can sometimes act as a reinforcer of pain behavior, as solicitous response of the spouse contribute to increase pain and disability by reinforcing pain behaviour López-Martínez et al. As a group, the findings reviewed above suggest important interdependence and possible influences not only between psychosocial factors and pain, but also among the psychosocial factors, underlying the need for studies that would examine and test for possible mediation and moderation effects.
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