Pain, Mood, & MeditationWhere does Spirituality fit?
Amy Wachholtz, PhD, MDiv
UMass Medical School
Psychiatry Day, 2009
Outline
1. Bio-psycho-social-spiritual model of pain
2. What are the mechanisms linking meditation
and pain?
3. Who uses Prayer/Meditation to cope with pain?
4. When do people use Prayer/Meditation for pain?
5. What does spirituality add to meditation for pain
coping?
Question #1 What is Pain?
Typical Pain Cycle
Gate/Neuromatrix Theory of Pain
Thoughts
Emotions
Behaviors
Gate
I feel
good!
Ouch!
Injury Signals
Melzack & Wall, 1965
Influences on Chronic Pain
Biological
Factors
Spiritual
Factors
Chronic
Pain
Psychological
Factors
Social
Factors
Question #2: What are
the mechanisms linking
meditation and pain?
What role does meditation play?
• Secular meditation & pain
– MBSR (Kabat-Zinn)
– Relaxation response (Benson)
• Spiritual meditation & pain
– TM
– Yoga
– Loving-Kindness
– Beyond the Relaxation Response
– Religious Tradition based meditation
Meditation Pathways and Pain
Positive Mood
Internalized Locus of Control
Self-Efficacy
Meditation
Anxiety
Distraction from Problems
Decreased Focus on the Body
Reduced Pain Frequency
Increased Pain Tolerance
Decreased Pain Sensitivity
(Adapted from:
Wachholtz, Pearce
& Koenig, 2007)
Spiritual Beliefs and Practices
Positive vs. Negative
Public vs. Private
Intrinsic vs. Extrinsic
Existential vs. Religious
Possible Unique R/S Factor
Spiritual Support
Spiritual Growth
Spiritual Meaning Making Attributions
Additional Efficacy Beliefs
Psycho-Social Changes
Meaning Making Attributions
Self-Efficacy
Distraction
Social Support
Instrumental Support
Relaxation
Physiological/Neurological Changes
Altered neurotransmitter levels
Altered sleep
Altered HPA activity levels
Altered threshold for recognizing distress signals
Altered Perceptions
Changed Mood
Changed Social Interactions
Changed Behaviors
Common R/S Coping Tools
1.
2.
3.
4.
5.
6.
7.
8.
9.
Prayer
Spiritual Meditation
Hope
Reading faith-based literature
Finding spiritual role models for coping
Seeking spiritual support/connection
Church attendance
Seeking instrumental support
Religious reappraisal
Question #3: Who uses
prayer/meditation to cope
with pain?
National Health Interview Survey 2002-2007
(Wachholtz & Sambamthoori, 2009)
• Older (>33 years)
• Female
• More Educated (> High School)
• African-American (vs. white)
• Have chronic mental or physical health issues:
depression, chronic headaches, back and/or
neck pain
Question #4: When do
people use prayer/meditation
to cope with pain?
Pain
• 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
Ironson, et al, 2002)
– Long-term chronic pain
(Yates, et al., 1981;
(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/or
Question #5: What does
spirituality add to meditation?
Intervention Studies
• Spiritual 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 task
– Meditation inherently spiritual?
Intervention Studies
• Improved pain tolerance among a chronic
pain group
(Wachholtz & Pargament, 2008)
– 4 weeks
– Decreased pain frequency
– Greater pain tolerance
• Acute- laboratory induced pain
• Chronic- decreased rescue medication usage
– Limited change in pain sensitivity
– Greater decrease in negative mood
– Greater decrease in anxiety
Buddhist Loving-Kindness
• Cancer patients
(Carson, et al, 2008)
• Migraineurs Pilot Study
(Wachholtz, 2009)
– 4 week class, 4 week follow up
– Increased spiritual experiences
– Elevated pain tolerance
– Fewer headaches (n.s.)
Summary
• Pain a multi-dimensional disorder including physiological,
psychological, social and spiritual components
• Prayer and spiritual meditation used by many with chronic
pain
• Multiple psychological and physiological pathways that
support its use
• Spiritual meditation may be a useful resource with unique
additive components for patients with a spiritual/religious
background
Thank You
Amy.Wachholtz@umassmemorial.org