A Couple-Based Psychological Treatment for Chronic Pain and Relationship Distress.

Chronic pain impacts individuals with pain as well as their loved ones. Yet, there has been little attention to the social context in individual psychological treatment approaches to chronic pain management. With this need in mind, we developed a couple-based treatment, "Mindful Living and Relating," aimed at alleviating pain and suffering by promoting couples' psychological and relational flexibility skills. Currently, there is no integrative treatment that fully harnesses the power of the couple, treating both the individual with chronic pain and the spouse as two individuals who are each in need of developing greater psychological and relational flexibility to improve their own and their partners' health. Mindfulness, acceptance, and values-based action exercises were used to promote psychological flexibility. The intervention also targets relational flexibility, which we define as the ability to interact with one's partner, fully attending to the present moment, and responding empathically in a way that serves one's own and one's partner's values. To this end, the intervention also included exercises aimed at applying psychological flexibility skills to social interactions as well as emotional disclosure and empathic responding exercises to enhance relational flexibility. The case presented demonstrates that healthy coping with pain and stress may be most successful and sustainable when one is involved in a supportive relationship with someone who also practices psychological flexibility skills and when both partners use relational flexibility skills during their interactions.

Pain Anxiety and Its Association With Pain Congruence Trajectories During the Cold Pressor Task.

Incongruence of pain severity ratings among people experiencing pain and their observers has been linked to psychological distress. Previous studies have measured pain rating congruence through static self-report, involving a single rating of pain; however, this method does not capture changes in ratings over time. The present study examined the extent to which partners were congruent on multiple ratings of a participants' pain severity during the cold pressor task. Furthermore, 2 components of pain anxiety-pain catastrophizing and perceived threat-were examined as predictors of pain congruence. Undergraduate couples in a romantic relationship (N = 127 dyads) participated in this study. Both partners completed measures of pain catastrophizing and perceived threat before randomization to their cold pressor participant or observer roles. Participants and observers rated the participant's pain in writing several times over the course of the task. On average, observers rated participants' pain as less severe than participants' rated their own pain. In addition, congruence between partners increased over time because of observers' ratings becoming more similar to participant's ratings. Finally, pain catastrophizing and perceived threat independently and jointly influenced the degree to which partners similarly rated the participant's pain. PERSPECTIVE: This article presents a novel application of the cold pressor task to show that pain rating congruence among romantic partners changes over time. These findings indicate that pain congruence is not static and is subject to pain anxiety in both partners.

Global and Situational Relationship Satisfaction Moderate the Effect of Threat on Pain in Couples.

OBJECTIVE: The aim of this study was to test the hypothesis that greater global and situational relationship satisfaction would reduce the negative impact of threatening information on acute pain. DESIGN: An experimental design was used to manipulate threat and elicit acute pain via a cold pressor task. SETTING: The study was completed in a research laboratory at a large urban university in the Midwestern USA. SUBJECTS: Participants were 134 couples, in which at least one individual was an undergraduate student. METHODS: After administration of a global relationship satisfaction measure, couples were randomly assigned to either receive high or low threatening information about the painful task. Following the threat manipulation, couples discussed the upcoming task and rated their satisfaction with the interaction (i.e., situational relationship satisfaction). The designated pain participant then completed the painful task alone. RESULTS: The threat manipulation altered couples' perceived threat of pain. Situational relationship satisfaction moderated the effect of threat on pain trajectories such that situational relationship satisfaction predicted less pain intensity at an earlier point in the task for the low threat condition than the high threat condition. Greater global relationship satisfaction predicted greater likelihood of task completion among those in the low threat condition, whereas it was unrelated to task completion in the high threat condition. Greater global relationship satisfaction also predicted lower pain intensity throughout the task. CONCLUSIONS: These findings demonstrate that the interpersonal context is independently related to acute pain and may also alter the effect of threatening information on acute pain.

A Perspective-Taking Manipulation Leads to Greater Empathy and Less Pain During the Cold Pressor Task.

UNLABELLED: The objectives of this study were to demonstrate that empathy and validation could be increased in an observing partner who received a brief perspective-taking manipulation, resulting in less pain severity and greater pain tolerance in their partner, who experienced experimental pain. In addition, we examined the correlations between perceived empathy/validation and behavioral ratings of validation and invalidation. In 126 pain-free romantic couples, 1 partner was randomly assigned to complete the cold pressor task while the other observed. The couples were randomly assigned to a) a perspective-taking group in which observing partners were privately instructed to take the perspective of the pain participant; or b) a control group in which observing partners received only a description of the task. Compared with the control group, pain participants in the perspective-taking group reported that observing partners had been more validating during the task and they also reported significantly lower pain severity. In addition, pain participants' reports of their partners' validation and observing partners' self-reported empathic feelings were significantly related to lower pain severity over time. The results provide support that perspective taking may induce empathic feelings, in addition to perceptions of validation, which in turn promotes emotion regulation during pain. PERSPECTIVE: The experimental evidence in this study suggests that empathic feelings can be induced in significant others with simple instructions, and this manipulation leads to less pain in their partners undergoing a painful task. The results suggest that perspective taking, empathy, and validation should be further investigated as pain intervention targets.