ESS3808Sport Psychology

Martin I. JonesBSc MSc Phd PGCHE CPsychol CSci AFBPsS SFHEA

Pain Catastrophizing

Key DefinitionAn unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage

(Merskey & Bogduk, 1994, pp 210)

Key points continued

if people regard their experience as pain, it should be accepted as pain

and therefore pain is always a psychological state (although often tied to a noxious proximate physical cause)

Pain has many valuable functions. It often signals injury or disease and produces a wide range of actions to stop it and treat its causes

(Melzack, 2001)

Primary vital signs

1. Body temperature2. Blood pressure3. Pulse4. Respiratory rate

5. Pain

Acute pain is the primary reason why people seek medical attention and the major complaint that they describe on initial evaluation

Of all the components of the injury response, none is less consistent or less understood than an individuals response to pain

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https://tinyurl.com/h7lqfk5

Pain is good for you, pain is a cleanser, pain is something that helps you grow . . .

The [training] intensity meant that you were a pretty formidable competitor when you got onto the track because you trained that way".

Herb ElliotOlympic Gold Medallist

Pain as a psychological construct

Which variables predict pain threshold and pain

tolerance?Pain threshold is the point at which

pain begins to be felt

Pain tolerance is the maximum level of pain that a person is able to tolerate

Hidden pain Pain is hidden from significant others, ensuring that the athlete promotes the image of a fully fit, injury-free competitor

‘The ankle she had injured in July was sore. She decided not to make an issue of it with Jenna [physiotherapist]. There was no point in giving Coach another reason to cut her. She would play through the pain. She could tie theskate tighter, no one would know’

(Turco, 1999, p. 60).

Unwelcomed pain Pain is described as a demoralizer and approached as something to be overcome

‘It don’t hurt, boy! It don’t hurt unless you let it! Suck up that pain’

(Oppenheimer, 1991, p. 66).

Combative pain The use of fighting language and images of warfare to depict pain as a foe that needs to be battled and defeated

‘It’s a battle every day…. I’m losing the fight, it [recovering ACL] hurts all the time. But I don’t want to be beaten, I want to keep playing’

(Killick, 2009, p. 229).

Disrespected PainThe athlete adopts an attitude of irreverence towards the pain and prioritizes some forms of pain over others

‘So what that I had fractured my back? I could still walk. ..I could deal with the pain’

(Ryan, 1995, p. 36).

‘Unless I see bone coming out of the skin, you ain’t injured’ (Oppenheimer, 1991, p. 66).

Depersonalized PainAthletes develop a way of talking and thinking about pain that dichotomizes the relationship between self-body; ownership of the pain is transferred to the body part rather than the athlete.

‘For 3 weeks I’d been running in water and riding a bike – I was in great shape. I just had this niggly bloody heel that hurt to put on the ground…I knew I had a stress fracture. Anyway I ran the race. I finished but pulled up hobbling – a tendon had come away with a piece of bone attached to it’

(Stratford, 1988, p. 139).

Pleasurable PainBoth the masochistic experience of being in pain and the sadist infliction of pain on others are verbalized as pleasurable, desired andan enjoyable element of the sports encounter

‘When it hurts, it gives you an adrenaline rush, it’s phat (sic), I love it… [tackling in rugby] feels good cos when other players get injured and really hurt and stuff you know that you were stronger than them.’

(Killick, 2009, p. 232).

Pain is a integral aspect of most people’s sport experience

PAINPersons experiencing or anticipating

pain may discontinue or avoid activities that might be associated

with pain

Sport hurts

The need for integration of information, data, and concepts to understand antecedents and consequences of painSolutions to the “problem” are beyond the scope of any one discipline in isolation

Culture of the sport?

Women football players 'tough it out' through injury

Why?Source: http://www.bbc.co.uk/news/uk-england-bristol-12286844

The collarbone was still together; it had a v-fracture but he said it was relatively stable. If I didn't crash again, it was probably going to stay together. He said if I could handle the pain, then maybe it was possible to continue

Liege-Bastogne-Liege is one of cycling’s 5 monumentsLa Doyenne (the oldest) one day classicIn 1980, legendary cyclist Bernard Hinault crossed the line 9 minutes 24 seconds ahead of the second placed man.

Not an ordinary raceOf 171 starters in that years edition, just 21 made it to the finish

Hinault suffered frostbite in two of his fingers, injuries which caused lasting damage to this day

Biopsychosocial model of pain

Moving beyond the biological aspects of pain  

Complex inter-relationship of biology with psychological processes and

social environments.

All three areas are of considerable importance in the

overall pain experience

Where the physiology meets the psychology

Cartesian concept of pain

Gate Control Theory of PainMelzack & Wall, 1965

Nonnociceptive neuron activation can inhibit the effects of pain fibres

Where does the psychology fit in?

Neuromatrix Theory of PainMelzack, 2001

Neuromatrix theory of pain The perception of painful stimuli does not result from the brain's passive registration of tissue trauma, but from its active generation of subjective experiences through a network of neurons

Pain and the Brain

The areas of the brain involved in pain experience and behaviour are very

extensive. They must include the limbic system as well as

somatosensory projections . . . Yet the plain fact is that we do not have an

adequate theory of how the brain works(Melzack, 2001)

Pain could emerge over other demands for attention; however, the interruptive function of pain depends on pain related characteristics (e.g., threat level of pain)

(Eccleston & Crombez 1999)

A. 20 million

C. 2 million

B. 200 million

D. 200,000

A. B. C. D.

25% 25%25%25%

How many (youth) sport injuries in USA?

2 million injuries per year that require

medical attention. 20 million sports participants

A. 70 million

C. 7 million

B. 700 million

D. 17 Million

A. B. C. D.

25% 25%25%25%

How many sport injuries in USA?

70 million injuries per year that require

medical attention

29.7 million sports

injuries per year

Source: Nicholl et al., (1993; 1995)

A. £99.7 million

C. £9997 million

B. £997 million

D. 9.7 million

A. B. C. D.

25% 25%25%25%

How much do injuries cost in the UK?

£997 million£643 million new injuries £354 million recurrent injuries

Source: Nicholl et al., (1993)

Which variables are empirically associated with “acute” pain experiences?

Pain as a psychological

constructPain threshold

Pain IntensityPain tolerance

Pain threshold is the point at which

pain begins to be felt

Pain tolerance is the maximum level of pain that a person is able

to tolerate

Pain catastrophizingAn exaggerated negative mental set brought to bear during actual or anticipated painful experience

(Sullivan et al., 2001).

A false alarm to an otherwise benign stimulus

(Beck, 1989)

RuminationRepetitive thinking about the negative sensations associated with noxious stimuli

"I can´t stop thinking about how much training hurts"

Magnification Elevation of the threat value of pain

“This is the worst pain I’ve ever experienced, I’m afraid that something serious might happen"

HelplessnessA belief that nothing can be done to extricate oneself from the pain experience

“There is nothing I can do to reduce the intensity of my pain"

Helplessness

Magnification

Rumination

Myopically focusing upon pain sensations Displaying a tendency to increase the intensity

and threat value of these sensationsPerception of inadequate coping resources

Individuals who score high on measures of pain catastrophizing

Report more intense pain (Sullivan et al., 1995, 2006)

Individuals who score high on measures of pain catastrophizing

Report more severe depression and anxiety (Keefe et al., 1989; Martin et al., 1996)

Individuals who score high on measures of pain catastrophizing

Show higher levels of pain behaviour and disability (Sullivan et al., 1998, 2000, 2006; Keefe et al., 2000; Sullivan and Stanish, 2003)

Individuals who score high on measures of pain catastrophizing

Consume more analgesic medication (Bedard et al., 1997; Jacobsen and Butler, 1996)

Individuals who score high on measures of pain catastrophizing

Have more prolonged stays when hospitalized (Gil et al., 1992)

PCSMean 20.90

Median 20.00Std. Dev. 12.50

Minimum 0Maximum 50.00

PCS score of 30 represents clinically relevant level of

catastrophizing.

A total PCS score of 30 corresponds to the 75th

percentile of the distribution of PCS scores in clinic

samples of chronicpain patients

My Pain research

Jones & Parker 2015Journal of Sports Sciences

Researchers have not examined ways of reducing catastrophic thinking in athletes

Consequently, athletes who catastrophize are missing out potentially useful training regimens

Mindfulness

The non-judgmental focus of one’s attention on the

experience that occurs in the present moment

(Kabat-Zinn, 1994)

Clinical populationsHigh mindfulness associated with low catastrophizing

High catastrophizing associated with disability, higher pain intensity, relapse, depression, and duration of rehabilitation

THEORYAdopting a receptive attention to, and awareness of, painful stimuli

that is non-discriminatory or judgemental is more likely to

reduce levels of painful experience than increase it.

Pain Cat (

S800m PB (

Mindful ()

Gender (W)

Pain Cat (

S800m PB (

Mindful ()

Pain Cat x

Gender

Gender (W)

Mindful x

Gender

𝑎2 𝑖

c

𝑏2

𝑏3𝑖

𝑏1 𝑖

ParticipantsN =109 800m runners with a PBAged 18-40 years73 males (Mage = 25.48 years, SD = 5.31)36 females (Mage = 24.53 years, SD = 5.46)

Controlling for GenderStandardised 800m PB time by dividing the participants’ PB by current world record time males = 100.91 seconds, females = 113.28 seconds.

Standardised scores ranged from 1.06 to 1.67

QuestionnairesPCSpain catastrophizing scale(Cronbach’s α =.914).

MAASmindful attention awareness scale(Cronbach’s α =.865).

Consequent

M (Pain Catastrophizing) Y (standardized 800m PB time)

Antecedent Path Coeff. [LLCI, ULCI] SE p Path Coeff. [LLCI, ULCI] SE p

Constant i1 28.557 [16.861, 40.253] 5.899 ≤ .001 i2 1.322 [1.157, 1.487] 0.083 ≤ .001

X (Mindfulness) 𝑎1𝑖 -0.220 [-0.402, -0.039] 0.091 .018 c’ -0.003 [-0.005, -0.001] 0.001 .017

M (Pain Catastrophizing) - - - 𝑏1𝑖 0.001 [-0.001, 0.004] 0.001 .311

W (Gender) 𝑎2𝑖 25.086 [5.010, 45.162] 10.125 .015 𝑏2 0.138 [0.040, 0.237] 0.050 .006

Mindfulness x Gender 𝑎3𝑖 -0.356 [-0.684, -0.029] 0.165 .033 - - -

Pain Catastrophizing x Gender - - - 𝑏3𝑖 -0.006 [-0.010, -0.002] 0.002 .002

R2 = .265, F(3,105) = 11.276, p ≤ .001 R2 = .130, F(4,104) = 3.830, p = .006

Pain Cat (

S800m PB (Mindful ()

Pain Cat x Gender

Gender (W)

Mindful x Gender

= -0.220**

= 25.086*

c = -0.003*

= -0.356*= 0.138**

= -0.006**

= 0.001

Visual Representation of the Moderation Effect of Mindfulness (X) on Pain Catastrophizing (Y) by Gender (W)

Visual Representation of the Moderation Effect of Pain Catastrophizing (M) on Standardized 800m PB times (Y) by Gender (W)

What does this mean?

Be criticalWhat is wrong with this research?

Predicting pain intensity of Delayed Onset Muscle Soreness

A = peak torque evoked due to superimposition of the electrical peak torque evoked due to superimposition impulses

B = voluntary torque at time of stimulus delivery

C = voluntary peak torque of the D = stimulus evoked torque at rest

Jones In preparation

ai

c’c

bi

Mindfulness(Mi)

Pain Catastrophiz

ing(Y)

Mental Toughness

(X)

Indirect effect of X on Y through Mi = ai bi Direct effect of X on Y = c’Total effect (c) of X on Y = c’ + ai bi

Method123 (-2 outliers) cyclists from online cycling forums.

mindful attention awareness scale (Brown & Ryan, 2003)mental toughness index (Gucciardi et al., in press)pain catastrophizing scale (Sullivan et al., [1995)

Simple mediation model with 10,000 bootstrapped resamples BCa 95% CIs

.30**[ai]BCa 95% CIs [.07, .53]

−.37** [c’] BCa 95% CIs [−.58, −.15 ]

−.42** [c]BCa 95% CIs [−.64, −.20 ]

−.18** [bi] BCa 95% CIs [−.32, −.04]

Mindfulness(Mi)

Pain Catastrophiz

ing(Y)

Mental Toughness

(X)

Note. ** significant at the p ≤ .01 level (2-tailed)

Zero-order Pearson’s correlation (1-tailed)Measures 1 2 3

1. Pain Catastrophizing

(α = .91 [.89, .94])

2. Mental Toughness −.38**[−.54, .−.20]

(α = .89 [.86, .92])

3. Mindfulness −.29** [−.44, −.12]

.23** [.07, .40] (α = .81 [.76, .86])

Mean 15.55 42.02 61.21

SD 8.83 7.94 10.33

Skewness 0.14 − 0.81 − 0.11

Kurtosis − 0.58 0.39 0.16

Note. ** significant at the p ≤ .01 level (1-tailed) Cronbach’s α on diagonals with 95% CIs. Pearson’s r (1-tailed) with 10, 000 bootstrap resamples BCa 95% CIs [LLCI, ULCI]

The indirect effect = −.05BCa 95% CIs [−.14, −.01]

Indirect effect and significance using normal theory test = .−.05, SE = .03 z = −1.87, p = .08

Effect size for indirect effect (κ2)

= .05, BCa 95% CIs [.01, .12], SE = .03

Mindfulness

Pain behavior

Mental Toughness

Pain catastrophizing

Moving forwardMental toughness, pain catastrophizing, and mindfulness and experimentally induced pain

DOMSCold Pressor TaskSpecial ForcesClinical ApplicationsMilitary

Williams and Andersen (1998)Williams, J. M., & Andersen, M. B. (1998). Psychosocial antecedents of sport injury: Review and critique of the stress and injury model'. Journal of applied sport psychology, 10(1), 5-25.

Stressful event

History of stressors Personality Culture of

sport

Stress response

Injury No injury

Coping

Martin I. JonesBSc MSc PhD CPsychol CSci AFBPsS SFHEA

m.i.jones@exeter.ac.uk@drmijones