Exposure and the reduction of fear of pain

Abstract

This research investigated interoceptive exposure as a treatment option for disabling pain-related fear. Interoceptive exposure was conceptualised as an extension of the Fear Avoidance Model and a literature review highlighted three important areas: attention/hypervigilance to pain and its threat value, fear-avoidance and the acceptance of pain. A treatment manual was developed based on a literature review and an elaborated single case experimental design methodology was used to determine treatment efficacy.

Seven participants were recruited and four completed treatment which was designed as an ABC sequence: A, baseline; B, education; C interoceptive exposure. Follow up data were obtained at three months post-treatment. Data were obtained from psychometrically standardised assessments, daily measures of the treatment target, and sessional process measures. Participants completed a post-treatment Change Interview in an attempt to evaluate treatment causality in a non-biased way.

There was variation on the standard measures; all of the participants made significant changes on some but not all of the measures. Target measures showed both variation and stability. Process measures showed that all of the participants could engage in the treatment exercises. The participants rated the treatment as being fairly logical however there was differences in expectations about how successful the treatment would be. At the Change Interview, all of the participants described changes which they stated were important and unlikely to occur without therapy.

There is some evidence at different levels that this treatment may be effective. A combination of attention, fear-avoidance and acceptance of pain treatment approach has not been used before and this research indicates promising results for those suffering with chronic pain. However further research is necessary. The procedure could be refined; interoceptive exposure could be explored in more depth and pain and avoidance behaviour could be considered in relation to other goals.