Knowledge is therapeutic. Knowledge offers control. In this case, knowing what’s happening in times of plight when you are suffering from discomfort/pain often provides reassurance.
I find that when clients come in the door with immense pain, they immediately fear the worst. It’s fear of the unknown which compounds the overall stressful experience of a pain event. And what allays these fears is information. Challenging beliefs and reevaluating validity of their fears can go a long way towards effective recovery and keeping it that way.
In fact, there are studies out there that examine reassurance and look into which types are more effective and helpful long-term (Pincus, Holt, Vogel, Underwood, Savage, Walsh, and Taylor, 2013). Affective reassurance (showing empathy, creating rapport) and cognitive reassurance (providing explanations and education) are the 2 types that healthcare folks usually employ. It’s found that cognitive reassurance has a greater impact and helps patients more long-term.
Cognitive reassurance included explanation of symptoms, explicit exclusion of serious disease, agreeing goals, negotiating treatment options, discussing prognosis and future care, checking understanding, discussing obstacles and summarizing. Meanwhile, affective reassurance includes verbal and nonverbal communication showing caring, empathy, and confidence, recognizing and responding to distress cues, being warm and friendly, and offering generic reassuring statements, such as ‘I don’t think you should worry.’
I think this makes a lot of sense if you think about it. Clients/patients want to know what’s wrong and clear explanations will provide reassurance and fill the void of unknowing. Perhaps it would be ideal for a therapist to embody and practice both types of reassurance. I’d assume one would want their therapist to have nice bedside manner but also convey that they know what they’re talking about based on quality, science-based evidence.
And so why educating a client (aka cognitive reassurance) provides longer lasting results is its efficacy in challenging and updating beliefs and increasing understanding and perception of the issue at hand improving behavior and self-management.
So let’s imagine a scenario with a patient who comes in with low back pain and is worried and anxious that it’s due to a disc bulge or some structural change in the spine.
Providing accurate info such as quality studies such as the one below would help ease those fears and hopefully veer the patient’s coping behavior towards a more positive and adaptive trajectory.
This graph shows that based on 3110 individuals, disk degeneration is part of the normal aging process and not necessarily pathological. Much like the wrinkles we earn as we age, these disc and spinal changes are like wrinkles on the inside. Within the sample group who had no pain but showed spinal changes were 37% of people 20 years of age to 96% of those 88 years of age, with a large increase of prevalence of those 50 years old (Brinjiki et al, 2014).
That’s a lot of folks with no back pain but have shown degenerative change of the spine!
Greater than 50% of asymptomatic individuals aged 30-39 have disk degeneration, height loss, or bulging which suggests that these changes are incidental and not the cause of pain.
So a big takeaway would be that the degree of degeneration does not indicate the amount or presence of pain. And it’s studies like these that serve as positive cognitive reassurance and arms clients with helpful info in hopes to prevent decline into disability and loss of quality of life.
- Pincus, T., Holt, H., Vogel, S., Underwood, M., Savage, R., Walsh, DA., Taylor, SJC. (2013). Cognitive and affective reassurance and patient outcomes in primary care. A systematic review. Pain. 154; 2407-2416.
- Brinjikji, W., Luetmer, PH., Comstock, B., Bresnahan, BW., Chen, LE., Deyo, RA., Halabi, S., Turner, JA., Avins, AL, James, K., Wald, JT., Kallmes, DF., Jarvik,JG. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 36(4): 811–816. doi:10.3174/ajnr.A4173.
- Photo Credit – pxhere.com