Health psychology is defined by Matarazzo as “the sum of the distinctive educational, scientific and professional contributions of the discipline of psychology for the promotion and maintenance of health, the reduction and treatment of diseases and related functional losses. Health psychology; It rejects the body-mind distinction, arguing that the mind has a role in both the causes and treatment of diseases, but that, unlike psychosomatic medicine and behavioral medicine, research in health psychology is more specific to the discipline of psychology. Because there is an interaction between the mind and the body.
Human beings are considered as a biopsychosocial being. Bio (viruses, bacteria, wounds), psycho (behaviors, beliefs, stress, pain, coping) and social (class, employment, ethnicity). Various methods are used in health psychology. These are quantitative methods in the form of surveys, random control trials, experiments and case control studies. Qualitative methods such as interviews and focus groups are also used. Researchers analyze their data using narrative analysis, interpretive factual analysis, and grounded theory.
Pain
Pain has a very clear function in human psychology and anatomy. It also functions as an important feedback mechanism about our body. Pain is often a sign that something is wrong. It prevents us from certain behaviors, such as behaving in a certain way or carrying heavy objects, and helps us engage in protective behaviors. Pain also triggers help-seeking behavior and is one of the main reasons patients seek medical attention. One of the psychological consequences of pain is anxiety and fear. That is why pain directs the individual to take action. It necessitates the search for help or support alternatives to a certain extent. Still, some pain has no obvious reason behind it. Therefore, instead of helping the person, it can also play a hindering role by causing significant problems in maintaining their lives. This type of pain actually has a very strong psychological aspect.
We can basically classify pain as acute and chronic pain. Acute pain is pain that lasts for 6 months or less, has an identifiable reason, and can be treated with painkillers. On the other hand, chronic pain is pain of variable intensity or increasing level that lasts more than 6 months. Back pain lasting more than 6 months and rheumatoid arthritis diseases are generally examples of chronic pain.
Pains are often modeled as follows:
- Damage to tissue causes pain sensations.
- Psychology is included in this model as a consequence of pain. (anxiety, fear, depression) Psychology has an impact more as a result.
- Pain is an automatic response to an external stimulus. It is not possible to talk about interpretation or editing.
- Pain is classified as psychogenic pain or organic pain. Psychogenic pain originates entirely from the patient's mind. Organic pain is “real pain.” It is observed when there is clear injury and damage.
- Phantom Extremity pain, which is a combination of psychogenic and organic pain; It is the reporting of pain in an organ that has been cut off as a result of amputation. This type of pain increases immediately after amputation and continues even after recovery. Sometimes this pain may feel like it is spreading from the amputated arm or leg to the whole body and is often described as nails digging into the palm of a fisted hand (even though there is no arm) or toes pulling from the wrist towards the body (even though there is no foot). Phantom Limb pain actually has no physical basis. Because the organ that is said to hurt does not actually exist. Additionally, Phantom Extremity pain is not observed in every patient who undergoes amputation, and they do not experience this pain in the same way. Moreover, even people born without some organs have been reported to sometimes report Phantom Limb pain. Therefore, these reports point to the importance and role of psychology in pain. Psychosocial factors are important in the perception and interpretation of pain. These; anxiety, fear, secondary gains, catastrophizing, pain behavior, attention, self-efficacy, meaning, classical conditioning and operant conditioning.
in pain your feelings role
Many patients who experience pain may be very afraid of increasing or recurring pain, which may cause them to avoid many activities that they consider risky. For example, patients avoid certain movements and may even experience general movement restrictions. However, patients do not address such experiences in terms of fear. Instead, they approach the situation in terms of what they can do and what they can't do. That's why they don't say they're afraid of increasing the pain by lifting a heavy object; instead they say they can't lift the item anymore. Fear of pain and fear-based avoidance beliefs are primarily related to the experience of pain in terms of triggering pain.
of cognitions role
“Catastrophizing” is a common condition, especially in patients with chronic pain. Research results indicate that there is a relationship, albeit at a low level, between the onset of pain and the level of catastrophizing. Crombez et al (2003). They developed a measurement tool related to catastrophizing and evaluated this aspect of pain in children in three dimensions. These are: rumination, exaggeration and helplessness. Research results showed that catastrophizing could predict pain intensity and skill loss, independent of age and gender. Researchers have suggested that catastrophizing may function by facilitating escape from pain and sharing distress with other people.
Although at first glance it may seem that any pain may have a negative meaning, research shows that pain may have different meanings for different people. For example, the pain felt during birth, although intense, has a very clear reason and consequence. If the same type of pain were experienced after the birth of a child, it could mean something completely different and would likely be experienced differently. Pain can also mean a secondary gain for patients in some cases.
The role of self-efficacy in pain perception and pain reduction is important. Studies on attention to pain have concluded that focusing on pain can increase pain. On the contrary, it has been pointed out that distraction can also reduce the experience of pain.
Behavioral processes
A person's reactions to pain can decrease or increase the perception of pain. It is suggested that pain behaviors are reinforced by secondary gains such as attention, approval from others, and not going to work. Positively reinforced pain behaviors can also increase pain perception. Pain behaviors also lead to lack of activity, slowness in movements, decrease in social communication and stagnation. Thus, the patient contributes to his/her role; This may increase the perception of pain. Williams (2002) suggested that facial expressions may serve the purpose of communicating pain to the other party and asking for help from other people for recovery. Furthermore, Williams suggests that people often believe they have more control over their pain-related facial expressions and are more likely to offer help or show sympathy even when the expressions are mild. When the violence in the expression increases, people may think that the situation is exaggerated or faked. Some pain measurements for people; can be given by using words such as shocking, punishing, lethal and enraging.
Findings regarding gender distribution showed that women wanted their pain experiences to be seen and accepted and were therefore engaged in the process of finding a diagnosis. However, they often stated that they were not listened to and left out of this process, and that they felt powerless and in an uncertain condition like limbo. Researches; It shows that psychology plays a role in pain perception through factors such as learning, anxiety, anxiety, fear, catastrophizing, meaning and attention. In this regard, the number of multidisciplinary pain clinics that include psychological interventions in their treatment protocols is increasing day by day. It is possible to talk about various pain treatment methods that reflect the interaction between psychological and physiological factors.
reaction Based on Methods
It is designed to directly change the physiological system by reducing muscle tension. Examples under this heading include relaxation exercises that aim to reduce anxiety, stress and therefore pain, and biofeedback that aims to provide the person with voluntary control over his or her body. Hypnosis is also used to relax the person. It is mostly used for acute pain and repetitive and painful procedures such as dressing the wound.
cognitive Methods
The cognitive approach to pain treatment focuses on the person's thoughts about pain. It aims to change cognitions that increase the experience of pain. It has a solution-oriented approach with a cognitive approach. Techniques include changing dysfunctional thoughts with the help of distraction, daydreaming, and Socratic questioning. Socratic questioning offers the person the opportunity to capture and make sense of automatic thoughts. Therapist; May also use additional techniques such as role-play and role reversal.
Behavioral Methods
Some treatment approaches focus on basic operant conditioning principles and use reinforcement to encourage the individual to change behavior. For example, if a chronic pain patient prevents himself from performing active movements because it will increase his pain, the therapist gradually encourages him to become more active. Each change in behavior is rewarded by the therapist, new exercises are developed, and the patient is encouraged to progress towards previously determined goals.
