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….