Presentation on theme: "Pain, Mood, & Meditation- Where does Spirituality fit?"— Presentation transcript:
1 Pain, Mood, & Meditation- Where does Spirituality fit? Amy Wachholtz, PhD, MDivUMass Medical SchoolPsychiatry Day, 2009
2 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?
5 Gate/Neuromatrix Theory of Pain ThoughtsBehaviorsEmotionsI feel good!Ouch!GateInjury SignalsMelzack & Wall, 1965
6 Influences on Chronic Pain Biological FactorsSpiritual FactorsChronic PainBio-psycho-social model of pain:::Gate control theory (Melzack & Wall, 1965)/ Neuromatrix theory of pain (Melzack, 1999)New model incorporates spiritual factors as well (McKee & Chappel, 1992; Sulmasy, 2002)Bio-psycho-social-spiritual model of chronic painSocial FactorsPsychological Factors
7 Question #2: What are the mechanisms linking meditation and pain?
8 What role does meditation play? Secular meditation & painMBSR (Kabat-Zinn)Relaxation response (Benson)Spiritual meditation & painTMYogaLoving-KindnessBeyond the Relaxation ResponseReligious Tradition based meditation
9 Meditation Pathways and Pain Positive MoodInternalized Locus of ControlSelf-EfficacyAnxietyDistraction from ProblemsDecreased Focus on the BodyReduced Pain FrequencyIncreased Pain Tolerance Decreased Pain SensitivityMeditation
10 (Adapted from: Wachholtz, Pearce & Koenig, 2007) Altered PerceptionsChanged MoodChanged Social InteractionsChanged BehaviorsPhysiological/Neurological ChangesAltered neurotransmitter levelsAltered sleepAltered HPA activity levelsAltered threshold for recognizing distress signalsPsycho-Social ChangesMeaning Making AttributionsSelf-EfficacyDistractionSocial SupportInstrumental SupportRelaxationPossible Unique R/S FactorSpiritual SupportSpiritual GrowthSpiritual Meaning Making AttributionsAdditional Efficacy BeliefsSpiritual Beliefs and PracticesPositive vs. NegativePublic vs. PrivateIntrinsic vs. ExtrinsicExistential vs. Religious-Kevin Seybold has done some work on identifying the physiological pathways through which R/S may affect pain.
11 Common R/S Coping Tools PrayerSpiritual MeditationHopeReading faith-based literatureFinding spiritual role models for copingSeeking spiritual support/connectionChurch attendanceSeeking instrumental supportReligious reappraisal
12 Question #3: Who uses prayer/meditation to cope with pain?
13 National Health Interview Survey 2002-2007 (Wachholtz & Sambamthoori, 2009)Older (>33 years)FemaleMore Educated (> High School)African-American (vs. white)Have chronic mental or physical health issues: depression, chronic headaches, back and/or neck painPrayer use studyStudied 2055 nationwide households on use of CAM (including prayer).
14 Question #4: When do people use prayer/meditation to cope with pain?
15 Religious/spiritual coping AND secular coping- not either/or 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/orAbraido-Lanza, AF.; Vasquez, E; Echeverria, S E., (2004) En las Manos de Dios [in God's Hands]: Religious and Other Forms of Coping among Latinos with Arthritis. Journal of Consulting and Clinical Psychology, 72,
16 Question #5: What does spirituality add to meditation?
17 Intervention StudiesSpiritual 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 taskMeditation inherently spiritual?Comparing spiritual vs. secular interventions on pain
18 Intervention StudiesImproved pain tolerance among a chronic pain group (Wachholtz & Pargament, 2008)4 weeksDecreased pain frequencyGreater pain toleranceAcute- laboratory induced painChronic- decreased rescue medication usageLimited change in pain sensitivityGreater decrease in negative moodGreater decrease in anxiety
19 Buddhist Loving-Kindness Cancer patients (Carson, et al, 2008)Migraineurs Pilot Study (Wachholtz, 2009)4 week class, 4 week follow upIncreased spiritual experiencesElevated pain toleranceFewer headaches (n.s.)
20 SummaryPain a multi-dimensional disorder including physiological, psychological, social and spiritual componentsPrayer and spiritual meditation used by many with chronic painMultiple psychological and physiological pathways that support its useSpiritual meditation may be a useful resource with unique additive components for patients with a spiritual/religious background