Department of Psychology, Arizona State University, Tempe, AZ, 85287, USA.
J Clin Psychol Med Settings. 2021 Jun;28(2):201-211. doi: 10.1007/s10880-019-09693-5.
Because many persons living with chronic pain achieve a relatively balanced lifestyle without experiencing functional disability, medical psychologists must explain the well-documented co-occurrence of pain complaints and DSM-5-disorders (including but not limited to depression and anxiety) in a significant subset of individuals. The question of differential resilience versus susceptibility has received modest theoretical and empirical attention, but remains open. In this review, I deconstruct the temporally extended pain adaptation process in order to address this vexing question, relying upon two complementary explanatory frames. The first is a motivational/cybernetic systems formulation labeled the Goal-Centered, Self-Regulatory, Automated Social Systems Psychology (GRASSP) model, erected upon feedback sensitive, goal-guided, hierarchically organized self-regulatory processes. Depression and anxiety presumably result from compromised regulatory functions undermining pain processing, goal pursuit, and everyday performance. The second perspective postulates a "Bayesian Brain"/"Predictive Mind" capable of unifying perception, action, and emotion via predictive processing. From a Bayesian perspective, predictive processing implies that our brains evolved to compare, without conscious direction, incoming environmental information against prior, model-based predictions in order to arrive at accurate perceptual representations of the world. Maladjustment results from failures of active inference. When applied to the perception of visceral information, the embodied process, termed interoceptive inference, can also yield pathogenic outcomes. The Bayesian model holds that depression and anxiety in individuals with pain result from error-prone (biased, rigid, or highly certain) prior evaluations of aversive feeling states and their relation to the external milieu. I consider how the hybrid conceptual framework advanced by the two models points to several novel and familiar avenues of intervention.
由于许多患有慢性疼痛的人在没有经历功能障碍的情况下实现了相对平衡的生活方式，因此医学心理学家必须解释在相当一部分人群中，疼痛主诉与 DSM-5 障碍（包括但不限于抑郁和焦虑）的明确共病现象。关于差异弹性和易感性的问题已经引起了适度的理论和实证关注，但仍未解决。在这篇综述中，我解构了时间扩展的疼痛适应过程，以解决这个令人困扰的问题，依赖于两个互补的解释框架。第一个是一个被标记为“以目标为中心、自我调节、自动化社会系统心理学（GRASSP）”的动机/控制论系统模型，它建立在反馈敏感、目标导向、层次化的自我调节过程之上。抑郁和焦虑可能是由于调节功能受损，破坏了疼痛处理、目标追求和日常表现。第二种观点假设存在一个“贝叶斯大脑”/“预测思维”，能够通过预测处理来统一感知、行动和情绪。从贝叶斯的角度来看，预测处理意味着我们的大脑进化到能够在没有意识指导的情况下，将传入的环境信息与基于先前模型的预测进行比较，以便对世界产生准确的感知表示。失调是由于主动推理的失败而导致的。当应用于内脏信息的感知时，被称为内感受推理的体现过程也会产生致病的结果。贝叶斯模型认为，疼痛患者的抑郁和焦虑是由于对厌恶感觉状态及其与外部环境的关系的先验评价存在错误倾向（有偏差、僵化或高度确定）所致。我考虑了这两个模型提出的混合概念框架如何指向几个新颖和熟悉的干预途径。
