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Pain and Stress Processes: the Role of the Transactional Model of Stress and Mindfulness in Acute Pain

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Pain and Stress Processes: the Role of the Transactional Model of Stress and Mindfulness in Acute Pain Pain and Stress Processes: The Role of the Transactional Model of Stress and Mindfulness in Acute Pain by Samsuk Kim A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science (Psychology) in the University of Michigan-Dearborn 2017 Master’s Thesis Committee: Associate Professor David K. Chatkoff, Chair Associate Professor Caleb Siefert © Samsuk Kim 2017 i Acknowledgements I have an enormous gratitude and special thanks to my primary thesis adviser, Dr. David Chatkoff, for all the help and guidance. His knowledge and expertise in stress, cardiovascular function, and chronic pain throughout this process has been incredible. His time and devotion as well as his encouragement and support in a warm and kind demeanor have also been invaluable. In addition, I would like to give a special thanks to my secondary advisor, Dr. Caleb Siefert for his collaboration, wonderful input, wealth of knowledge, and kind support. It has been truly my privilege working with two of the most amazing advisers. I would also like to thank my wonderful family and friends for their caring, support, and encouragement throughout the past two years. Lastly, I would like to send my special love and thanks to my beloved father for helping me understand the meaning of my life. ii Table of Contents Acknowledgements ............................................................................................................ ii List of Tables ...................................................................................................................... vii List of Appendices ............................................................................................................. viii List of Abbreviations ......................................................................................................... ix Abstract .............................................................................................................................. x Chapter I ............................................................................................................................ 1 Introduction ....................................................................................................................... 1 Pain Experience and Chronic Pain ............................................................................ 2 Historical approaches to understanding pain: theories of pain ........................ 3 Specificity theory of pain (nociception) ................................................ 4 Gate control theory of pain .................................................................... 5 Operant conditioning and social learning theory of pain ....................... 6 Neuromatrix theory of pain ................................................................... 8 Stress and the Experience of Chronic Pain ................................................................ 10 Models of stress ............................................................................................... 11 Cannon: fight-or-flight and homeostasis ............................................... 11 Selye: general adaptation syndrome ...................................................... 13 Lazarus & Folkman’s transactional model of stress .............................. 14 Allostasis model of stress ...................................................................... 20 iii Transactional Model of Stress and Chronic Pain Experience .................................. 21 Primary appraisal and pain experience ........................................................... 21 Secondary appraisal and pain experience ....................................................... 23 Pain catastrophizing and pain outcomes ............................................... 24 Reappraisal and pain experience .................................................................... 27 Stress appraisal, physiological responses, and pain experiences .................... 28 Blood Pressure ...................................................................................... 28 Cortisol ................................................................................................. 29 Stress appraisal and pain experience .................................................... 31 Mindfulness as a New Topic in Chronic Pain .......................................................... 31 Mindfulness .................................................................................................... 32 Mindfulness and chronic pain ......................................................................... 33 Mindfulness and primary appraisal ................................................................ 36 Mindfulness and secondary appraisal: pain catastrophizing .......................... 37 Mindfulness and reappraisal ........................................................................... 39 Mindfulness and physiological stress responses ............................................. 40 The Present Study ..................................................................................................... 41 Hypotheses of the present study ............................................................................... 42 Chapter II .......................................................................................................................... 44 Methods ............................................................................................................................. 44 Participants ............................................................................................................... 44 Research Design ....................................................................................................... 45 Apparatus .................................................................................................................. 45 iv Cold Pressor Task ........................................................................................... 45 Blood Pressure and Heart Rate ....................................................................... 46 Measures ................................................................................................................... 46 Demographic and screening questionnaire ..................................................... 46 Pain outcomes ................................................................................................. 46 Salivary Cortisol ............................................................................................. 47 Stress appraisal measure (SAM 1 & 2) ............................................................ 47 Pain Catastrophizing Scale (PCS) .................................................................. 48 Mindfulness (MAAS & FFMQ) ..................................................................... 49 Procedure .................................................................................................................. 50 Statistical Analysis Related to the Hypothesis ......................................................... 53 Chapter III ........................................................................................................................ 55 Results ............................................................................................................................... 55 Descriptives .............................................................................................................. 55 Manipulation Check .................................................................................................. 55 Primary Analyses ...................................................................................................... 56 Hypothesis 1 Results ....................................................................................... 56 Hypothesis 2 Results ....................................................................................... 57 Hypothesis 3 Results ....................................................................................... 57 Hypothesis 4 Results ....................................................................................... 58 Hypothesis 5 Results ....................................................................................... 58 Hypothesis 6 Results ....................................................................................... 59 Chapter IV.......................................................................................................................... 60 v Discussion ........................................................................................................................... 60 Hypothesis 1 Discussion ........................................................................................... 65 Hypothesis 2 Discussion ........................................................................................... 67 Hypothesis 3 Discussion ........................................................................................... 68 Hypothesis 4 Discussion ........................................................................................... 69 Hypothesis 5 Discussion ........................................................................................... 70 Hypothesis 6 Discussion ........................................................................................... 70 Strengths and Limitations of the Current Study ......................................................... 70 Strengths ..........................................................................................................
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