Cold pressor: acceptance, control and expectations

Emily Williams


To begin to examine how non-specific therapy factors, in particular expectations, may impact on treatment outcomes for Acceptance and Commitment Therapy for the treatment of chronic pain, an investigative analogue study was conducted; completed by Psychology undergraduates from the University of Plymouth (N=52). This study re-examined the effectiveness of Acceptance and Control-based instructions on cold pressor pain; but extended this to explore whether high or low expectations of these strategies impacts their effectiveness. Participants were exposed to a cold pressor task to determine baseline tolerance, followed by a Short-form McGill Pain Questionnaire (SF-MPQ). Control or Acceptance-based instructions, with an embedded high or low expectation manipulation were provided; followed by an adapted SF-MPQ to record participants’ expectations regarding their treatment strategy for completing a cold pressor task. Participants completed a subsequent cold pressor under their treatment conditions, and a final SF-MPQ. A series of analyses of covariance were conducted. Contrary to previous studies, neither the acceptance nor control instructions were found to be superior for either pain tolerance or self-reported pain, supporting the common factors debate. In addition it was found that expectations were successfully manipulated; however expectations were not found to significantly impact upon outcomes, suggesting that expectations regarding ACT and CBT may be malleable, and have potential to be maximised to benefit treatment. However, future research, in clinical populations, is needed to explore the mechanisms by which expectations operate to determine whether expectations of ACT or CBT can indeed impact on treatment outcomes. Implications and limitations are discussed.

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