The effects and mechanisms of psychological treatments

for pain management

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Mark P. Jensen, PhD

09:15-09:55 | יום חמישי 
 

This talk will present the findings from two recently completed randomized clinical trials examining different psychological treatments for chronic pain. The first trial examined the effects and mechanisms of individual treatment with cognitive therapy, self-hypnosis training focusing on pain reduction, self-hypnosis training focusing on changing maladaptive thoughts about pain (hypnotic cognitive therapy), and a pain education control condition, in 173 individuals with chronic pain. The second study examined the effects and mechanisms of group therapy treatment with training in mindfulness meditation, training in self-hypnosis training, and a pain education control condition in 308 individuals with chronic pain. In both studies, outcome variables included measures of pain intensity and depression; anxiety was also assessed as an outcome variable in the second study. Potential treatment mediators (e.g., pre- and post-treatment measures of pain-related beliefs, pain-related cognitive processes, and EEG-assessed brain activity) and moderators (e.g., pre-treatment measures of pain-related beliefs, pain-related cognitive processes, and brain activity) were also assessed in both studies. The talk will present the findings with respect to the relative efficacy of the treatments for reducing pain and improving psychological function, as well as to identify the factors that would help us understand how the treatments work (treatment mediators) and for whom they work (treatment moderators). The talk will end by discussing the implications of the findings for enhancing treatment efficacy; specially, by targeting the most important treatment mediators and by improving patient-treatment matching.

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Mark P. Jensen, PhD, is a professor and is the Vice Chair for Research in the Department of Rehabilitation Medicine, University of Washington. Dr. Jensen received his PhD from Arizona State University, and his postdoctoral training at the Multidisciplinary Pain Center, University of Washington Medical Center. His research program focuses on understanding the effects and mechanisms of psychological pain interventions. He has published over 700 articles and chapters, and has authored or edited 11 books. Dr. Jensen is a Fellow of the American Psychological Association, and has received numerous awards for his scientific contributions, including the Clark L. Hull Award for Scientific Excellence in Writing on Experimental Hypnosis and the American Psychological Association Division 30 Award for Distinguished Contributions to Professional Hypnosis. He was also the Editor-in-Chief for the Journal of Pain for 12 years, from 2010 to 2022.

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What is the relationship between pain and emotion?

Dr. Gadi Gilam

יום חמישי | 09:55-10:35

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In this talk I will retrace the conceptual, mechanistic, and clinical relationships between pain and emotions, illustrated through examples of empirical research focused on the cognitive neurosciences. Highlighting the inherent and complex connection between these two constructs emphasizes the value of bridging the pain an emotion research and clinical communities.

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Dr. Gadi Gilam has recently joined the Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem as an Assistant Professor, and director of the translational Social Cognitive and Affective Neuroscience (tSCAN) lab. The lab's primary research focuses on the causes, consequences, and prevention of human suffering related to affective states, such as pain and anger, as they manifest at the intersection of psychopathological and chronic pain conditions. To address these issues, the lab uses a combination of methods from cognitive neuroscience, experimental psychology, and health informatics, while integrating perspectives from emotion science, social psychology, and pain medicine.

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Autoimmune Disorders: A Psychosomatic Perspective  

Moshe Torem M.D

10:45-11:25 | יום חמישי

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For many years Western Medicine has conceptualized the immune system to be separate and independent from the central nervous system. However, significant scientific advances and research discoveries in the past several decades have provided new evidence that the immune system does interact with the central nervous system with mutual influence. This lecture provides a review of autoimmune disorders from a psychosomatic perspective. Moreover, it also provides the rational and guidance for employing mind-body interventions to promote healing and better therapeutic outcomes in achieving a faster and enduring reemission for patients with an autoimmune disorder.

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Dr. Moshe Torem is a senior psychiatrist & psychotherapist with special training in Psychosomatic Medicine. He is a distinguished life fellow of the American Psychiatric Association, a Life Fellow and former President of the American society of Clinical Hypnosis. He is a former President of the International society for the study of Trauma & Dissociation. He is also a Professor of Psychiatry at Northeast Ohio Medical University. Dr. Torem has published numerous articles and book chapters in the field of Psychiatry, Psychotherapy, Mind-Body Integrative Medicine, Hypnosis, and Behavioral Sciences. He is certified by the American Board of Psychiatry and Neurology and has many years of experience in clinical work. In addition, he has provided lectures and workshops in the USA, Israel, and other countries covering the topics of psychotherapy, mind-body integrative therapeutic interventions, hypnosis, guided imagery, and future focused interventions.  

 

 

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Developmental Theory of Centralized Pain/Somatic Symptoms Distress: Translational research and implications for treatment

Alla Landa

09:00-09:40 יום שישי 

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Somatic Symptoms (including centralized chronic pain) are highly prevalent, debilitating conditions with paucity of effective treatments.  There is an urgent need to uncover their etiologic mechanisms. In a large subgroup of patients, a disease or injury causing symptoms cannot be identified or the heightened reactivity to emotional distress is associated with exacerbation of symptom severity and duration.  Based on the integration of translational research findings -- animal and human studies in developmental neuroscience, social-cognitive-affective neuroscience, psychoneuroimmunology, genetics, epigenetics, clinical psychology, and treatment studies, -- presenter formulated the Developmental Theory of Predisposition to Somatic Symptoms/Centralized Chronic Pain (CCP) (Landa et al., 2012), which proposes mechanisms of pathogenesis and symptom maintenance in this disorder. Multiple lines of evidence show that interpersonal distress is associated with chronic pain and shares genes, neural circuits, neurotransmitters and immune markers with pain system. Development of this shared system in non-optimal early interpersonal environment may predispose a person to CCP, ultimately leading to heightened sensitivity to pain and interpersonal distress and to problems with their differentiation and regulation. After a theory, model and prior research overview, the data from multilevel methodology studies supporting this theory will be presented as well as implications of this theory for the treatment of these conditions.

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Dr. Alla Landa is a clinical psychologist  who specializes in psychosomatics. The research of her Developmental Psychosomatics Lab at Columbia University Medical Center's Department of Psychiatry bridges psychology, psychoanalysis, neuroscience, and psychoneuroimmonology, and is focused on the interface of emotion regulation, interpersonal well-being and physical health, with the goal of uncovering etiology of psychosomatic distress and developing new, effective treatments. Other studies target developing programs that help with emotional distress in the context of medical conditions. Dr. Landa also conducts psychotherapy in private practice and is a founder and Director of the annual Columbia Psychosomatics Conferences at CUMC that has been engaging a multidisciplinary group of researchers and clinicians from around the world.

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האם המוח זוכר את התגובה החיסונית?

ד"ר הילה אזולאי דבי

09:40-10:10 יום שישי 

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מחשבות ורגשות עשויים להשפיע על הפיסיולוגיה שלנו ועל יכולתו של גופנו להתמודד עם מחלות. כך לדוגמא ניתן לראות עלייה בשכיחות של מחלות בעקבות מצבי סטרס, מחלות על רקע פסיכוסומטי או מנגד הטבה במצב בריאותי של מטופלים המקבלים תרופת פלסיבו. למרות שהקשר הזה מוכר לנו מחיי היום יום, המנגנונים הביולוגיים העומדים בבסיס הקשר הזה אינם ידועים. 
בהרצאה זו אתמקד במעורבות של המח בוויסות של התגובה החיסונית ההקפית ואתייחס לשאלה כיצד המח מעריך ומייצג את מצב מערכת החיסון שאת פעילותה הוא מבקר.

 

ד"ר הילה אזולאי-דבי, בעלת דוקטורט בביוטכנולוגיה מהטכניון, מנהלת את מעבדתה של פרופ' אסיה רולס בפקולטה לרפואה בטכניון.

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רפואה רגישת טראומה 

ד"ר דפנה ערמון

יום שישי | 13:30-14:15

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הצעה לפרקטיקה רפואית שלוקחת בחשבון את ההשפעות של הטראומה המינית על הגוף, על הנפש ועל בריאות האדם. לטראומה, התעללות ופגיעה מינית במהלך החיים השפעה מכרעת על בריאות נפשית וגופנית. שיעור הא.נשים שחוו טראומה בילדותם ובהמשך במהלך חייהם הוא כה גבוה שיש שרואים בו את הגורם מספר אחת לתחלואה באדם. הזכרון הגופני של הטראומה יחד עם ההשפעות הגופניות של סטרס כרוני הם חלק מהגורמים לתסמינים סומטיים שונים במי שעברו טראומות בחייהם. בקרב א.נשים שחוו אלימות ופגיעה בחייהם קיימים כאלו שנמנעים ונמנעות מצריכת שירותי בריאות לעומת אלו שצורכים וצורכות אותם ביתר. בשני המקרים א.נשים אלו סובלים מתחלואה גבוהה מהממוצע.
המפגש בין אדם שחווה טראומה בין אישית לבין שירותי הבריאות עלול לשחזר אספקטים טראומטיים ולעודד הימנעות או, לחלופין, להוות מפגש מרפא ומעצים. החוויה היא הדדית בין צרכני השירות לנותני השירות הרפואי ומפגש שאינו מותאם עלול ליצור לחץ וחרדה,ולהוות טריגר לשחזור או דיסוציאציה אצל שני הצדדים. זאת, לעומת מפגש מותאם שיכול לתת תחושת סיפוק והעצמה ולקדם בריאות.
בהרצאה נסקור את ההשפעות של טראומה מינית בכלל ופגיעה מינית מילדות בפרט על התפתחות האדם וכן על המפגש הרפואי ודרכים שבהן נוכל לפעול מתוך הבנה זו.

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ד"ר דפנה ערמון, פסיכיאטרית מרכז לטם לטיפול בטראומה מינית, המרכז הרפואי תל אביב. חברת ועד היפ״ם- החברה הישראלית לקידום אבחון, טיפול ומניעה של פגיעה מינית.

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