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Some personal thoughts on future
challenges
1. A motivational perspective
on pain and suffering
2. The practice of science:
lessons learned
A motivational perspective on pain
and suffering
Motivated behavior & goals
• What? Mental representations of desidered states,
where states are broadly construed as outcomes,
events, or processes
• Tasty meal
• Career success
• Performing lab task
• Being pain free
• Two type of goals
• Approach goals
• Avoidance goals
Five Markers of
Motivated Behavior
1. Persistence until
Zeigarnik effect
2. Equifinality
More directed towards goal attainment than towards means
3. Docility
Behavioural selection that facilitates goal attainment
4. Affect
During goal progress, attainment, obstacles,…
5. Effort
Increase motivation in face of obstacle
(Martin & Tesser, 2009)
• Pain is part of an old motivational
system
• Pain is urge to escape from bodily
threat
• Focus not upon its sensory-
discriminative, but affective-
motivational characteristics
• Primary task paradigm
When becoming aware of bodily
sensations…
• What?
• Selection of information...
at the expense of other information
• Function?
• To protect goal-directed behavior
• Selection for action
• How?
• Optimisation of current goal-directed behavior (Top-
down control)
• Facilitation of goal-relevant information
• Inhibition of goal-irrelevant information (goal shielding)
• Interruption of attention (Bottom-up control)
Goal pursuit & motivated attention
• The interruptive quality of (chronic) pain
• The motivational dynamics of hypervigilance
• The motivational dynamics of distraction
0
10
20
30
40
50
60
Control group Goal group
Pain cue
Non-pain cue
An Example: Attentional Bias in Multiple Goal
Context
cue validity effect (ms)
• Fear is part of an old
motivational system
• Fear is urge to avoid threat
• Three pathways
• Direct learning (CC & IC)
• Observational learning
• Verbal instruction
When the fear of the expected evil is
worse than the evil itself…
Fear-avoidance model: the next
generation
• Single motivation model: goal to avoid pain
• The motivational dynamics of pain avoidance
• The motivational dynamics of task persistence despite pain
(Crombez et al., submitted)
An example: Avoidance in Multiple Goal Context
• Goal selection: Behavioural Choice Paradigm
• Voluntary task switching paradigm
– Instructed to randomly chose between tasks
– Trial of Task A: Earn money (30%), but also get pain (30%)
– Trial of Task B: Avoid pain (0%), but also no money (0%)
– Self-reports: Which goal was most important?
• Group Earn money: 35%
• Group Avoid pain: 65%
30
32
34
36
38
40
42
44
46
48
50
No money Money No money Money
No Pain
Pain
When switching to avoidance of pain?% switch from earn money trial to pain avoidance trial
Group
Earn moneyGroup
Avoid pain
PainTenacious pursuit of pain relief
When coping becomes a mission
impossible…
• Pain avoidance in network of multiple goals
• Pain avoidance is a hub goal
When multiple goals meet …
• Intergoal Interference
• Incompatible goal attainment strategies
• Be open to dating vs avoid rejection
• Resource limitations (time, energy, effort)
• Be professionally succesful vs be with family
• Intergoal facilitation
• Instrumental relation
• “being professionally succesfull may generate resources for
financially supporting one’s children
• Overlapping goal attainment strategies
• “attending ballet lessons may be effective for both learning to
dance and getting in touch with people”
(Riediger & Freund, 2004)
-> distress
-> goal persistence
Example: Pain (avoidance) in a
network of multiple goals
?Pain
Clinical context of motivational
perspective
• Constructive view– Patient is active problem-solver
– Normal psychology of pain and suffering
– Health psychology: “individuals in abnormal situation”
– Link to existing clinical psychology models
• Focus on more than symptom, also on disability and
suffering– Psychology of (dis)ability
– Key characteristic of psychiatric diagnoses (DSM)
– Treatment objective
• Treatment– Reframe within motivational and goal perspective
Some personal thoughts on future
challenges
• A motivational perspective on pain and suffering
• Practice of science: lessons learned
– “Detecting and correcting the lies that data tell”
– “Do not throw out the baby with the bathwater”
– “Beware of the emperor’s new clothes”
• Conclusion
• Study 1: 22 children, looking at the “Lion’s King”,
cold pressor pain
• p = 0.25
• Study 2: 50 students, solving mathematical
problems, heat pain
• p = 0.001
• Study 3: 30 patients, visual detection task, heat
stimuli
• p = 0.10
• “If my finding is significant, I know it is a reliable
finding”
• “The p-value is an index of the importance or
size of an effect”
• “If a relationship is not significant, there is
probably no effect”
• Study 1: 22 children, looking at the “Lion’s King”,
cold pressor pain
• p = 0.25; Cohen’s d = 0.60, 95%CI [-0.30;1.20]
• Study 2: 50 students, solving mathematical
problems, heat pain
• p = 0.001 Cohen’s d = 0.40, 95%CI [0.05;0.90]
• Studie 3: 30 patients, visual detection task, heat
stimuli
• p = 0.10 Cohen’s d = 0.40, 95%CI [-0.12;0.90]
Effect sizes
Cohen’s d Pearson’s r
Neglectable >-0.15 en <0.15
Small effect > 0.15 en <0.40 > 0.10 en < 0.20
Moderate effect >0.40 en <0.75 >.20 en < .33
Large effect >0.75 en <1.10 >.33 en <.50
Very large effect >1.10 >.50
Cohen’s d = (M1 – M2) / SD pooled
An example: Distraction experiment
F(1,27)=11.12, p=.002
3
3,5
4
4,5
5
5,5
6
Away Towards
(0-10 VAS intensity)
Lessons learned
• To focus upon effect size and confidence
interval instead of p-value
• To be beware of errors and biases in
data/method
• To increase the quality of your articles
– www.consort-statement.org
Do not Throw the baby out with the
bathwater
• Search for internally valid
paradigms may lead to low
ecological validity
• Search for anwers on “why”
questions may limit our
knowledge base
“Why” questions may limit our
knowledge base
• Once paradigm becomes standard
– Development of “theoretical model” (“processes”)
– Critical experiments with “same” paradigm
– Paradigm becomes to be explained
• No search for boundaries/limits of phenomenon
– Exposure vs nocebo
– Exposure & attentional retraining
• “When” questions are also important
– Generalizibility of functional relationships between
variables
Lessons learned
Beware of the emperor’s new
clothes
• Distinction from other
constructs?
• Overlap with outcome variable
• Misuse of constructs
Somatisation
“a tendency to experience and
communicate somatic distress and
symptoms unaccounted for by pathological
findings, to attribute them to physical
illness, and to seek medical help for them”
(Lipowski, 1988,p. 1359).
- Cochrane Review procedure
- 113 empirical studies between 1989 and 2007
- Communicate somatic symptoms
- Unaccounted for pathological findings
- To attribute them to physical illness
- Seek medical help
100%
3.4%
0.0%
1.0%
Lessons learned
• To carefully read papers in terms of constructs
• To look at operationalisation of constructs
• To read “original” papers
When you want new ideas read old
books
Conclusions
Unformalized principles of scientific
practice (Skinner, 1959)
• When you run into something interesting, drop
everything else and study it
• Some ways of doing research are easier than
others
• Some people are lucky
• Apparatus sometimes break down
• Serendipity
Unformalized principles of scientific
practice (Skinner, 1959)
• When you run into something interesting, drop
everything else and study it
• Some ways of doing research are easier than
others
• Some people are lucky
• Apparatus sometimes break down
• Serendipity: the art of finding one thing while
looking for something else
Liesbet Goubert
Stefaan Van Damme
Tine Vervoort
Valéry Legrain
Marieke Dewitte
Chris Eccleston
Ken Craig
Paul Karoly
Stephen Morley
Charles Spence
Johan Vlaeyen
Katrien VerhoevenEmelien LauwerierAnnabelle CasierDimitri van RyckeghemLine CaesKim HelsenLore Van HulleLies De RuddereSofie VandenbrouckeAnnelies LammertynIlse Viane
Acknowledgements
… and many more….
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