Gratitude Exercises for Acute Pain

Overseen By Ashley Pfeiffer, DPT

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Black Hills State University

Must not be taking: Opioids

Disqualifiers: Cardiovascular, Epilepsy, Diabetes, Pregnancy, others

Compensation: Varies

Number of Visits: 2

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how writing about gratitude affects people's experience of sudden pain. Researchers aim to determine if positive thinking influences both mental and physical responses to pain, particularly in light of genetic differences. Participants will either engage in a Behavioral Writing Intervention, writing about someone they are thankful for, or write a neutral story about arriving at the lab. Ideal participants are adults who are pain-free and do not have certain health conditions, such as heart disease or chronic pain.

As an unphased study, this trial offers participants a unique opportunity to contribute to understanding the psychological aspects of pain management.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are currently taking opioids.

What prior data suggests that this behavioral writing intervention is safe for managing acute pain?

Research shows that gratitude writing exercises are generally safe. Studies have found that writing about what one is thankful for can reduce stress and improve overall well-being. This type of writing, often used as therapy, is considered low risk because it involves writing about someone or something appreciated.

Expressive writing, including gratitude writing, has been researched for its effects on people with various health issues. These studies suggest it can boost mood and help with pain without causing harmful side effects. Overall, gratitude writing is well-tolerated and considered safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how a simple, non-drug-based approach like gratitude writing might help manage acute pain. While most treatments for acute pain rely on medications like opioids or nonsteroidal anti-inflammatory drugs, this trial investigates if focusing on positive emotions can alter pain perception. The gratitude writing technique is unique because it uses the power of positive psychology, encouraging participants to reflect on things they are thankful for, which could potentially change how the brain processes pain. If successful, this method could offer a low-cost, side-effect-free alternative or complement to traditional pain management strategies.

What evidence suggests that this behavioral writing intervention could be effective for acute pain?

This trial will compare the effects of gratitude writing with neutral writing on acute pain. Research has shown that writing about gratitude can help with pain. One study found that people who practiced gratitude reported feeling healthier and experiencing fewer painful symptoms. Another review found that gratitude writing improved mental health and overall well-being. These findings suggest that gratitude exercises might reduce the intensity of sudden pain. Writing about gratitude often leaves people feeling more hopeful and strong, which could enhance their ability to manage pain. ^{3 4 6 7 8}

Who Is on the Research Team?

Nathan Deichert, PhD

Principal Investigator

Black Hills State University

Are You a Good Fit for This Trial?

This trial is for adults who are currently pain-free and at least 18 years old. It's designed to explore how a positive mindset, specifically gratitude, can affect the way people experience pain.

Inclusion Criteria

I do not experience any pain.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Intervention

Participants are randomized to a gratitude or neutral writing condition and complete a cold pressor task

1 day

1 visit (in-person)

Follow-up

Participants are monitored for psychological and physiological responses immediately after the intervention

10 minutes

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Behavioral Writing Intervention

Trial Overview

The study tests a behavioral writing intervention that encourages gratitude to see if it changes psychological and physiological reactions to acute pain. The trial will also look into how genetic differences might influence these effects.

How Is the Trial Designed?

Group I: Gratitude Writing Experimental Treatment 1 Intervention

In the gratitude writing condition, participants will write continuously for 5 minutes about someone they are grateful for.

Group II: Neutral Writing Placebo Group 1 Intervention

Participants in the neutral writing condition will write continuously for 5 minutes about how they got to the research laboratory.

Who Is Running the Clinical Trial?

Black Hills State University

Lead Sponsor

Trials

5

Recruited

400+

National Institute of General Medical Sciences (NIGMS)

Collaborator

Trials

315

Recruited

251,000+

Published Research Related to This Trial

A new digital intervention app called Strength Back was developed through interviews and focus groups with 21 stakeholders (9 healthcare professionals and 12 spinal surgery patients) to help patients cope with anxiety, pain, and stress before and after spinal surgery.

The app includes 13 modules that provide procedural information and exercises based on Acceptance and Commitment Therapy and positive psychology, aiming to enhance psychological flexibility and improve overall well-being and recovery outcomes for spinal surgery patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Strength Back - A qualitative study on the co-creation of a positive psychology digital health intervention for spinal surgery patients. Van Der Horst, AY., Bohlmeijer, ET., Schreurs, KMG., et al.[2023]

A study of 80 individuals living with chronic pain revealed that those who adopted a 'Positive Approach Model' (PAM) demonstrated greater resilience and well-being, emphasizing themes like acceptance, self-efficacy, and social support.

Participants identified integrative therapies and lifestyle behaviors, such as art and spending time in nature, as beneficial, with 'wisdom exemplars' showing significantly higher scores in traits like Openness and Gratitude compared to those with more negative experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stories of Growth and Wisdom: A Mixed-Methods Study of People Living Well With Pain. Owens, JE., Menard, M., Plews-Ogan, M., et al.[2020]

Understanding pain as a protective function can help in developing strategies for recovery, emphasizing the importance of cognitive, emotional, and behavioral responses to pain.

The proposed framework using Cognitive Functional Therapy focuses on safety learning and experiential learning to help individuals regain control over their pain and improve their quality of life, addressing the psychological aspects of pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

From Fear to Safety: A Roadmap to Recovery From Musculoskeletal Pain. Caneiro, JP., Smith, A., Bunzli, S., et al.[2022]

Recent research emphasizes the importance of behavioral and cognitive-behavioral approaches in managing chronic pain, highlighting their effectiveness in addressing the social context and psychological factors related to pain.

Studies show that these approaches can lead to significant improvements in pain management outcomes compared to control conditions, suggesting they are a valuable part of chronic pain treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral and cognitive-behavioral approaches to chronic pain: recent advances and future directions. Keefe, FJ., Dunsmore, J., Burnett, R.[2019]

In a pilot study involving 30 children aged 7 to 18 undergoing painful medical procedures, 83% of participants found the BrightHearts biofeedback app helpful and expressed a willingness to use it again, indicating strong acceptability.

Healthcare professionals also reported that BrightHearts facilitated the procedures, with 64% believing it made the process easier, suggesting potential benefits for both patients and providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Feasibility of Using the BrightHearts Biofeedback-Assisted Relaxation Application for the Management of Pediatric Procedural Pain: A Pilot Study. Burton, KLO., Morrow, AM., Beswick, BV., et al.[2019]

The study developed and validated three scales for measuring negative responses to pain (BIS-related) and two scales for positive responses (BAS-related) in a sample of 395 undergraduates, including 325 with recurrent pain.

The results support the Behavioral Inhibition System-Behavioral Activation System (BIS-BAS) model, showing that the scales are reliable and valid for assessing pain responses, although the positive response scales showed less stability over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Measuring the Cognitions, Emotions, and Motivation Associated With Avoidance Behaviors in the Context of Pain: Preliminary Development of the Negative Responsivity to Pain Scales. Jensen, MP., Ward, LC., Thorn, BE., et al.[2018]

The Positive Emotion Induction (PEI) intervention significantly reduced pain, fear, and anxiety levels in 80 male subjects during a brief pain trial, suggesting its potential effectiveness in acute pain management.

The Brief Relaxation (BR) intervention improved blood pressure recovery but did not affect pain or emotional ratings, indicating that while relaxation techniques may help with physiological responses, they may not directly alleviate pain perception.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Two brief interventions for acute pain. Bruehl, S., Carlson, CR., McCubbin, JA.[2021]

Chronic postsurgical pain (CPSP) is influenced by psychological factors, with negative emotions like anxiety and depression identified as significant risk factors, while protective factors are less studied.

The Acceptance and Commitment Therapy (ACT) approach used in the Transitional Pain Service at Toronto General Hospital shows promise in reducing pain and opioid use, with patients receiving this intervention reporting greater improvements in pain management and lower depression scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. Weinrib, AZ., Azam, MA., Birnie, KA., et al.[2020]

In a study of 174 patients undergoing acceptance and commitment therapy for chronic pain, improvements in physical and emotional functioning were observed even when pain intensity and distress did not significantly decrease during treatment.

The findings suggest that changing responses to pain, rather than reducing pain itself, may be key to enhancing functioning, indicating a shift in how chronic pain treatment can be approached.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Are reductions in pain intensity and pain-related distress necessary? An analysis of within-treatment change trajectories in relation to improved functioning following interdisciplinary acceptance and commitment therapy for adults with chronic pain. Vowles, KE., Witkiewitz, K., Levell, J., et al.[2022]

Patients referred for pain management from Disability showed less improvement in pain, mood, and control compared to those referred from Medical Subspecialties, indicating a potential difference in treatment response based on referral source.

Patients from the Disability group not only improved less but also had longer hospital stays and lower compliance with treatment, suggesting that factors related to their referral may influence the effectiveness of behavioral pain management approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral treatment of chronic pain: variables affecting treatment efficacy. Block, AR., Kremer, E., Gaylor, M.[2021]

In a study involving three adolescents with chronic debilitating pain, Acceptance and Commitment Therapy (ACT) led to an increase in participation in valued activities, even though pain intensity did not decrease during the treatment period.

The findings suggest that while ACT can enhance engagement in meaningful activities for youth with chronic pain, it may not necessarily reduce pain levels, indicating a need for further research on how ACT facilitates change in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring Changes in Valued Action in the Presence of Chronic Debilitating Pain in Acceptance and Commitment Therapy for Youth - A Single-Subject Design Study. Kemani, MK., Olsson, GL., Holmström, L., et al.[2020]

In a study involving 108 participants with chronic pain due to spinal cord injury, those who practiced positive psychology exercises for 8 weeks reported significant reductions in pain intensity and improvements in pain management compared to baseline.

The benefits of these exercises were maintained at a 3-month follow-up, suggesting that positive psychology can be an effective complementary treatment for pain management, with no known negative side effects and easy implementation into daily life.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inducing positive emotions to reduce chronic pain: a randomized controlled trial of positive psychology exercises. Müller, R., Segerer, W., Ronca, E., et al.[2022]

Behavioral treatments for chronic benign pain, including operant, relaxation, cognitive, and multimodal approaches, show positive outcomes, but the overall quality of the studies is poor, making it difficult to conclusively determine their effectiveness.

The operant method is associated with increased activity and reduced pain and medication use, while relaxation techniques can lower muscle tension and pain; however, more rigorous research is needed to establish the efficacy of these treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A critical review of behavioural treatments for chronic benign pain other than headache. Linton, SJ.[2019]

The biopsychosocial model emphasizes that pain is influenced by biological, psychological, and social factors, making it essential to use multifaceted evidence-based outcomes to assess treatment efficacy.

Two main categories of outcomes for pain management are identified: patient-reported outcomes, which include pain levels and quality of life, and objective outcomes, which focus on healthcare utilization and occupational status, both of which align with current evidence-based guidelines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evidence-based outcomes in pain research and clinical practice. Gatchel, RJ., Theodore, BR.[2019]

In a study involving 149 patients in a 15-day chronic pain management program, Goal Attainment Scaling (GAS) demonstrated significant improvements, indicating its effectiveness as a therapeutic tool for achieving personalized goals in rehabilitation.

Patients maintained their improvements in GAS and other measures like pain intensity and disability at a six-month follow-up, suggesting that GAS is a valid and reliable outcome measure for assessing long-term benefits of rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Goal attainment scaling in evaluating a multidisciplinary pain management programme. Fisher, K., Hardie, RJ.[2017]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10393216/

The effects of gratitude interventions: a systematic review and ...

The meta-analysis demonstrated that patients who underwent gratitude interventions experienced greater feelings of gratitude, better mental health, and fewer ...

2.

researchgate.net

researchgate.net/publication/328866406_EXPRESSIVE_WRITING_IMPROVING_OPTIMISM_PURPOSE_AND_RESILIENCE_WRITING_AND_GRATITUDE

EXPRESSIVE WRITING: IMPROVING OPTIMISM, ...

Results of the post survey found that for those in gratitude and expressive writing; physical health, resilience, and optimism improved (p <.05). This ...

3.

journals.plos.org

journals.plos.org/plosone/article?id=10.1371/journal.pone.0308928

Positive expressive writing interventions, subjective health ...

This systematic review aimed to determine the optimal conditions under which positive expressive writing interventions benefit subjective health and wellbeing ...

4.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC12094736/

Positive expressive writing interventions, subjective health ...

At a glance, it could appear that BPS and gratitude writing interventions are most effective in improving psychological health and wellbeing relative to ...

5.

digitalcommons.georgiasouthern.edu

digitalcommons.georgiasouthern.edu/cgi/viewcontent.cgi?article=1938&context=honors-theses

The Effect of a Gratitude Intervention on Acute Pain Toleration

This work confirmed results published by Emmons &. McCullough in 2003, where participants reported improved physical health and reduced painful symptoms after a ...

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8867461/

A Brief Gratitude Writing Intervention Decreased Stress and ...

Some research suggests expressive writing interventions are most successful in individuals who are experiencing more severe traumas or distress ...

7.

researchgate.net

researchgate.net/publication/241701008_Health-related_effects_of_creative_and_expressive_writing

Health-related effects of creative and expressive writing

Purpose – The purpose of this paper is to provide an overview of some health‐related effects of creative and expressive writing.

8.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC6676535/

Expressive writing as a therapeutic intervention for people ...

To synthesise the evidence of the effects of expressive writing on pain, sleep, depression and anxiety in people with advanced disease.