Targeting mental defeat in pain patients could prevent depression

A new study of Hong Kong chronic pain patients suggests that targeting feelings of mental defeat could prevent severe depression, anxiety and interference with daily activities.

The concept of mental defeat has previously been associated with post-traumatic stress disorder, but the new study applies it to the experience of chronic pain.

Mental defeat occurs when pain patients view their pain as an ‘enemy’ which takes over their life and removes their autonomy and identity.

The study, published in the Clinical Journal of Pain, analysed three groups of individuals living in Hong Kong – people with chronic pain who had sought specialist treatment, people with chronic pain who did not require specialist treatment and people with acute pain.

The chronic pain individuals reported pain in a variety of sites, with the majority in both groups identifying back pain as their predominant complaint.

The researchers monitored levels of mental defeat through how much the participants agreed with statements such as ‘because of the pain I felt destroyed as a person’ and ‘I felt humiliated and that I was losing my sense of inner dignity’.

When the two groups of individuals with chronic pain were compared, those who were seeking specialist treatment for their pain were found to have higher levels of mental defeat than those who did not require such treatment.

Both chronic pain groups had higher levels of mental defeat than the acute pain group.

Dr Nicole Tang from the Department of Psychology at the University of WarwickThe study also found that people who had a sense of mental defeat because of pain also reported higher levels of depression and anxiety as well as a higher incidence of the pain interfering with their daily lives.

The findings of the Hong Kong study reflect earlier studies carried out in the United Kingdom, which suggests that mental defeat is common across cultures.

The study’s lead author Dr Nicole Tang from the Department of Psychology at the University of Warwick said: “The presence of mental defeat in both Western and Eastern populations suggests that aspects of the psychological impact of pain on people’s sense of self and identity are shared across geographical boundaries.

“We know from work in the UK that mental defeat is a significant factor differentiating chronic patients who thrive despite pain from those who develop high levels of distress, depression and interference from pain in their every-day lives.

“These findings suggest that early screening for mental defeat can predict whether a patient will go on to suffer from severe anxiety and depression.

“Standard group pain management programmes do not have a treatment component targeting the sense of mental defeat.

“The current development of multidisciplinary pain management services in Hong Kong presents an opportunity to address this gap with a view towards enhancing overall treatment effectiveness.”

The study, Mental Defeat Predicts Distress and Disability in Hong Kong Chinese with Chronic Pain, is published in The Clinical Journal of Pain.

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