Çalışkan Elif, Gökkaya Füsun
Department of Psychology, Institute of Postgraduate Education, İzmir Tınaztepe University, İzmir, Türkiye.
Curr Pain Headache Rep. 2025 Mar 22;29(1):68. doi: 10.1007/s11916-025-01373-4.
Psychological practices have emerged as promising treatments for coping with chronic pain (CP) as a psychological resilience (PR) enhancer mechanism. These practices contain cognitive, behavioral and emotional modulation of pain. In this regard, classical cognitive-behavioral therapy (CBT) and current trends in CBT, including acceptance and commitment therapy and mindfulness-based practices may demonstrate significant improvements in pain perception, physical functioning, catastrophic beliefs and fear-avoidance behaviors among patients with CP. However, understanding the neurocognitive mechanisms of these practices includes challenges, such as the need to identify associated brain regions with PR to CP. Our review explored psychological practices to enhance PR as a dynamic neurocognitive process (e.g., changing affect) rather than only being a static trait.
Psychological practices have promising results in improving positive outcomes for CP sufferers. To illustrate, along with superior PR scores, higher positive affect, adaptive pain beliefs, and physical functioning were reported after these practices. Conversely, lower pain catastrophizing, pain-related fear-avoidance, and self-reported pain ratings were seen as PR factors. Moreover, enhanced PR process may be associated with increased activity of the brain regions, including prefrontal cortex and orbitofrontal cortex, whereas diminished activity, reactivity, and functional connectivity in the anterior cingulate cortex, amygdala and insula. This review discusses the neurocognitive modulation of CP through psychological practices and highlights the role of enhancing the PR process for individuals with CP. As the field continues to evolve, understanding the importance of psychological practices to develop PR-related factors is crucial for increasing pain management outcomes.
心理疗法已成为应对慢性疼痛(CP)的有前景的治疗方法,作为一种心理韧性(PR)增强机制。这些疗法包括对疼痛的认知、行为和情绪调节。在这方面,经典认知行为疗法(CBT)以及CBT的当前趋势,包括接纳与承诺疗法和基于正念的疗法,可能会使CP患者在疼痛感知、身体功能、灾难性信念和恐惧回避行为方面有显著改善。然而,理解这些疗法的神经认知机制存在挑战,比如需要确定与CP的PR相关的脑区。我们的综述探讨了将心理疗法作为一种动态神经认知过程(如改变情感)来增强PR,而不仅仅是作为一种静态特质。
心理疗法在改善CP患者的积极预后方面有很有前景的结果。举例来说,在这些疗法之后,除了PR得分更高外,还报告了更高的积极情感、适应性疼痛信念和身体功能。相反,更低的疼痛灾难化、与疼痛相关的恐惧回避和自我报告的疼痛评分被视为PR因素。此外,增强的PR过程可能与包括前额叶皮质和眶额皮质在内的脑区活动增加有关,而前扣带回皮质、杏仁核和岛叶的活动、反应性和功能连接性则减弱。本综述讨论了通过心理疗法对CP进行的神经认知调节,并强调了增强CP个体PR过程的作用。随着该领域的不断发展,理解心理疗法对发展与PR相关因素的重要性对于提高疼痛管理效果至关重要。