Re‐thinking over‐thinking pain: What can metacognition add to our understanding of pain catastrophising?

On Mindfulness Training for Promoting Mental Toughness of Female College Students in Endurance Exercise

OBJECTIVE

The aim of this study was to examine the promoting effects of mindfulness training on female college students' mental toughness in endurance exercise.

METHODS

A cluster sampling method was used to select 60 female college students as subjects. Based on the body mass index (BMI), stratified randomization was used to divide them into the mindfulness-training group and the control group. Participants in mindfulness-training group had an 8-week mindfulness training, while participants in control group waited. Before and after training, Five Facet Mindfulness Questionnaire (FFMQ) and Connor-Davidson Resilience Scale (CD-RISC) were used for pretest and posttest, and paired t-test and covariance analysis were performed on pretest and posttest between-group data.

RESULTS

(1) Paired t-test results showed the posttest scores (26.67 ± 3.56; 20.97 ± 3.66; 126.53 ± 8.59) of the three dimensions of description, nonresponse and FFMQ total score of the mindfulness-training group were higher than the pretest scores (25.53 ± 3.74; 19.23 ± 3.59; 121.43 ± 6.78). Statistical significance was shown in their differences (t = -2.25; -2.70; -3.25, p < 0.05). However, there was no statistical significance in the pretest and posttest of control group. The covariance analyses showed the posttest scores of the mindfulness-training group in three dimensions of description, nonresponse, and FFMQ were higher than the posttest scores of the control group. Statistical significance was shown in their differences (F = 6.55; 6.08; 5.91; p < 0.05). (2) Paired t-test showed posttest scores (46.50 ± 5.93; 30.40 ± 3.75; 15.00 ± 2.34) were significantly higher than pretest scores (42.60 ± 7.68; 26.50 ± 4.32; 12.87 ± 2.51) in all dimensions of the mental toughness of the mindfulness-training group. Statistical significance was shown in their differences (t = -3.135, -4.765, -4.922, p < 0.01). However, there was no significant difference in the pretest and posttest scores in all dimensions of the mental toughness of the control group. The covariance analysis showed that the posttest scores of all dimensions of the mental toughness of the mindfulness-training group were higher than those of the control group, and the differences were statistically significant (F = 11.133, 12.101, 16.053, all p < 0.001). (3) Paired t-test showed that the posttest score of the mindfulness-training group on exercise intensity perception immediately after 800-meter endurance run (5.67 ± 2.61) was lower than the pretest score (7.03 ± 1.24) and the difference was statistically significant (t = 4.18, p < 0.001), while the difference was not statistically significant in the control group. The covariance analysis showed that the posttest score of the mindfulness-training group on exercise intensity perception was lower than that of the control group, and the difference was statistically significant (F = 15.81, p < 0.001).

CONCLUSION

Mindfulness training improved the level of female college students' mindfulness and mental toughness in their endurance sports, while reducing the fatigue feeling of female college students in endurance sports.

Understanding Pain Catastrophizing: Putting Pieces Together

The present narrative review addresses issues concerning the defining criteria and conceptual underpinnings of pain catastrophizing. To date, the concept of pain catastrophizing has been extensively used in many clinical and experimental contexts and it is considered as one of the most important psychological correlate of pain chronicity and disability. Although its extensive use, we are still facing important problems related to its defining criteria and conceptual understanding. At present, there is no general theoretical agreement of what catastrophizing really is. The lack of a consensus on its definition and conceptual issues has important consequences on the choice of the pain management approaches, defining and identifying problems, and promoting novel research. Clinical and research work in absence of a common theoretical ground is often trivial. It is very surprising that clinical and experimental work has grown extensively in the past years, without a common ground in the form of a clear definition of pain catastrophizing and overview of its conceptual basis. Improving the efficacy and efficiency of pan catastrophizing related treatments requires an understanding of the theoretical construct. So far, most interventions have only demonstrated modest effects in reducing pain catastrophizing. Therefore, clarifying the construct may be an important precursor for developing more targeted and effective interventions, thereby easing some of the burden related to this aspect of pain. In our review, we have extracted and de-constructed common elements that emerge from different theoretical models with the aim to understand the concept of catastrophizing, which components can be modulated by psychological interventions, and the general role in pain processing. The analysis of the literature has indicated essential key elements to explain pain catastrophizing: emotional regulation, catastrophic worry (as repetitive negative thinking), rumination, behavioral inhibition and behavioral activation (BIS/BAS) systems, and interoceptive sensitivity. The present paper attempts to integrate these key elements with the aim to re-compose and unify the concept within a modern biopsychosocial interpretation of catastrophizing.

Assessing Beliefs Underlying Rumination About Pain: Development and Validation of the Pain Metacognitions Questionnaire

Metacognitions, which are beliefs about our own thinking processes, can modulate worry and rumination and thereby influence emotional distress. This study aimed to develop a self-report measure of unhelpful pain-related metacognitions which might serve as a clinical and research tool to better understand pain catastrophizing, a significant risk factor for adverse pain outcomes. Two phases of validation are presented. Phase 1 reports on how the Pain Metacognitions Questionnaire (PMQ) was empirically developed through a qualitative study of 20 people with chronic back (n = 15) or knee (n = 5) pain in secondary or tertiary care and then validated in a large internet sample of people experiencing pain (N = 864). Rasch analysis yielded a 21-item scale with two dimensions (positive and negative metacognition) assessing how useful and problematic people believe rumination about pain to be, respectively. In Phase 2, further validation using a new sample (N = 510) replicated initial findings. Both PMQ subscales have good retest reliability (r = 0.76, r = 0.72) and internal consistency (0.86, 0.87). They correlate negatively with mindfulness and positively with pain intensity, disability, anxiety, depression, catastrophizing, rumination, and metacognition. The PMQ also predicts unique variance in catastrophizing when other variables are controlled and predicts 'patient' status for pain catastrophizing. Sensitivity analysis yielded preliminary suggestions for clinically meaningful cut-offs. Unhelpful pain metacognitions can be validly and reliably measured using a self-report instrument. Future studies using the PMQ might shed new light on pain-related thinking processes to develop better interventions for people prone to worry and rumination about their pain.

A Mindfulness Program Adapted for Adolescents With Chronic Pain: Feasibility, Acceptability, and Initial Outcomes

OBJECTIVES

Pediatric chronic pain is a major health issue that can lead to significant interference in daily functioning. Mindfulness-based interventions (MBI's), which emphasize acceptance rather than control of pain, have gained increasing attention as a viable treatment option among adults with chronic pain. The effectiveness of MBIs for chronic pain in pediatric populations remains largely unknown. This prospective pre-post interventional study was conducted to examine the feasibility, acceptability, and initial effectiveness of an 8-week group MBI adapted for adolescents (MBI-A) with chronic pain.

MATERIALS AND METHODS

Self-report measures assessing pain characteristics, anxiety, depression, disability, pain catastrophizing, perceived social support, mindfulness, and pain acceptance were administered at baseline, postintervention, and at a 3-month follow-up. In addition, session data were collected to assess each session's impact on patients' coping with pain and stress, body awareness, and sense of feeling less alone.

RESULTS

In total, 42 consecutive patients in a tertiary care chronic pain clinic met eligibility criteria to participate in the MBI-A group. Of these, 21 participated. A treatment completion rate of 90.5% was observed. Between session mindfulness practice was reported by 77% of participants. Participants were highly satisfied with the MBI-A and all participants reported they would recommend the group to a friend. Improvements in pain acceptance were observed between baseline and the 3-month follow-up, in domains of Pain Willingness and Activity Engagement. Session data revealed improved body awareness and improved ability to cope with stress across sessions.

DISCUSSION

The MBI-A is a feasible, well-received intervention for adolescents with chronic pain conditions. Findings support the need for further investigation of the efficacy of MBI-A through randomized-controlled trials.