Miles Thompson

Mindfulness with Children and Adolescents: Effective Clinical Application

Mindfulness interventions within adult populations are becoming increasingly popular. Research suggests that mindfulness can deliver lasting improvements in self-awareness and emotional stability to adults with severe and chronic conditions. As yet, research within child and adolescent populations is in its initial stages, although mindfulness shows great clinical promise for young people. This article aims to provide an overview of mindfulness to professionals who are working in child or adolescent settings. Initially, it will provide the reader with some orientation to and definitions from the field, before summarizing the current evidence for the utility of the approach. The article recommends specific clinical modifications for mindfulness with children and adolescents, as well as reviewing how to monitor and enhance the development of this skill. Finally, it highlights important differences among mindfulness, relaxation and other meditative techniques.

Acceptance and Related Processes in Adjustment to Chronic Pain

Chronic pain poses significant challenges in the lives of many people. At the root of many of these challenges are the behavior patterns pain naturally coordinates. For example, in some cases, attempts to control, reduce, or cure pain through medication, medical procedures, or lifestyle changes can prove unsuccessful, and can dominate all other potential goals. The experience of chronic pain also includes other discouraging, painful, or unwanted psychological experiences, such as thoughts, feelings, and memories. Attempts to control or reduce some of these psychological experiences also can prove unsuccessful and even harmful, further reducing quality of life. This review highlights recent evidence for the utility of acceptance as an alternative when control-based methods are unsuccessful. It describes evidence from experimental, clinical, and treatment outcome studies. The review also notes how work in this area is drawing attention to the wider concept of “psychological flexibility,” an overarching process that includes other component processes, such as mindfulness and values.

The patient-provider relationship in chronic pain

The relationship between patient and provider has long been the subject of study within the psychotherapy literature, with the available data suggesting a modest, but reliable, association between the strength of this relationship and treatment outcome. Conversely, there has been little work focused on the patient–provider relationship in chronic pain settings despite the complexities and difficulties that are often involved in this area. This review provides a brief, broad overview of the literature on the patient–provider relationship and identifies key aspects that are specifically relevant to chronic pain settings. In addition to reviewing the literature in this area, a series of recommendations for future clinical and academic work are offered.

Psychological advances in chronic pain: a concise selective review of research from 2010

Purpose of reviewIt is difficult to hold an organized view of psychological research related to chronic pain. There are many different theories and variables and the volume of literature is vast. The purpose of this review is to highlight some key trends in this research in 2010. Recent findingsWe conducted a search of the output of four prominent scientific journals in the field of chronic pain management. Five research topics from among those identified are summarized. Identified topics include psychological factors related to analgesic use, efficacy of cognitive behavioral treatments, and contextual approaches (including acceptance and mindfulness). SummaryThe largest number of psychological studies categorized for this review focused on psychological factors in relation to opioid use. These studies include ones to identify risk factors for aberrant drug behavior. This result seems to reflect that the dominant approach to chronic pain remains a pharmacological one. At the same time treatment from within a broadly cognitive behavioral approach seems to have reached a level of relative maturity with questions frequently being addressed with meta-analysis. Otherwise, there are developing and promising trends, such as in new treatment models and uses of information technology.

Relaxation and mindfulness in pain: A review

• This article reviews the existing, peer-reviewed evidence for the use of relaxation and mindfulness in both acute and chronic pain. • There is some evidence that relaxation can reduce pain outcomes in both acute and chronic pain, however there is evidence that these improvements are not maintained over time. • More limited research suggests that mindfulness can lead to improvements in psychological measures and physical functioning and these improvements appear to be maintained at follow-up. • Further research is needed. Both researchers and practitioners need to be clearer on the outcomes that their techniques best facilitate and the processes which are active within them.

Parental behaviour in paediatric chronic pain: A qualitative observational study

Objectives: Parental behaviour appears to influence the adjustment of children with chronic pain. However, research in this area has failed to produce consistent evidence. Studies have tended to rely on self-report measures derived from adult pain populations. This qualitative, observational research provides descriptive data of parental behaviour in a clinical environment. Design: A qualitative observational study was made of parents and adolescents in a physically stressful setting. Modified grounded theory was used to analyse verbal and non-verbal behaviours. Methods: Eight parent–adolescent dyads seeking treatment for chronic pain were videoed during physical exercise sessions. Verbal and non-verbal behaviours were recorded and transcribed. Results: Four overarching categories emerged: ‘monitoring’, ‘protecting’, ‘encouraging’ and ‘instructing’. These often had both verbal and non-verbal aspects. Within these categories, more precise behavioural groups were also identified. Conclusions: This research identifies categories of parental behaviour that were derived directly from observation, rather than imposed on the basis of results from different populations. Four categories of behaviour were derived, which clarify and extend dimensions used in existing self-report instruments. Careful description of parental behaviours showed features that past research has neglected, and highlighted potential drawbacks of apparently positive parental actions.

Comment on Nicholas and Asghari: Pain 2006;124:269–79

A letter to the editor of Pain commenting on a paper by Nicholas and Asghari (2006) which had suggested a revision to the Chronic Pain Acceptance Questionnaire (CPAQ). The letter addresses the make-up of the CPAQ and the definition of acceptance.

A qualitative analysis of patient-identified adaptive behaviour changes following interdisciplinary acceptance and commitment therapy for chronic pain

Interdisciplinary treatment programmes for chronic pain have strong evidence of treatment effect both immediately after treatment and at follow‐up. However, despite strong outcome evidence, it is less clear which specific changes in behaviour are most relevant to patients or to outcomes. Indeed, it is not unknown for clinicians and patients to have different views with regard to goals of treatment. This study sought to evaluate the patients’ perspective regarding important behavioural changes that occurred while they were enrolled in a 4‐week interdisciplinary programme of Acceptance and Commitment Therapy (ACT) for chronic pain.