Commentary
Motivation, broadly construed, matters Paul Karoly
T
he links between chronic pain and psychological distress and disability are often indirect, operating through a compromised capacity for flexible goal directedness. With this in mind, a research team from Belgium and the Netherlands has programmatically sought to clarify the mechanisms underlying key instances of volitional dysfunction such as biased attention deployment, a susceptibility to fear conditioning, and persistent pain avoidance. Adopting paradigms from cognitive and learning theory, the team has likewise framed their efforts in a “motivational” light, consistent with the assumption that viewing chronic pain in terms of feedback-regulated and goal-centered choice and directional movement2,10,15,17 offers a compelling road map for unifying diverse clinical phenomena and disparate theoretical issues. Working within a so-called “motivational context” specifically implies a focus on 1 or more self-reflective or automatic processes presumed to influence the (1) selection, (2) initiation, (3) extended maintenance and coordination, (4) directional change or response probability alteration, and (5) termination or postponement of varied forms of goal-guided action, thought, and emotional responding. Isolating the (4) process noted above, ie, directional change or “self-control”7–9 as their motivational pivot point, Claes et al.3 used an experimental joystick movement paradigm that offered participants the choice between the safety of the high probability act of avoiding immediate pain vs the alternative of emitting movements that would result in the receipt of a painful shock, albeit a shock accompanied by delayed reward (a lottery ticket). This arrangement is an elegant way of experimentally formalizing the sort of self-control trade-off or goal prioritization decision that might confront a worker whose persistent back pain is exacerbated by certain job demands such as bending, heavy lifting, or sitting for hours before a computer screen. Going to work each day frequently means worsening back pain (a potent short-term negative outcome), although it carries the assurance of a weekly paycheck (a delayed positive outcome). As delayed payoffs are readily discounted by most of us, and not just persons with pain,1 the investigative team tested the somewhat risky hypothesis that the pairing of a painful unconditioned stimulus with the chance to win lottery tickets would attenuate participants’ fear of pain and reduce high probability avoidant choices. In addition, participants’ previous goal preferences were examined as a potential source of moderation. Although pain-related fear was affected neither by the pairing manipulations nor by previous preferences (for pain avoidance or reward seeking), participants nonetheless enacted more pain-engendering joystick movements when a concurrent Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Department of Psychology, Arizona State University, Tempe, AZ, USA PAIN 156 (2015) 1375–1376 © 2015 International Association for the Study of Pain http://dx.doi.org/10.1097/j.pain.0000000000000153
August 2015
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Volume 156
·
Number 8
reward was paired with such movements relative to a control condition wherein their motor behavior simply garnered either pain or no pain. Clearly, when something is to be gained by tolerating pain, people will exert sufficient self-control to override their natural predilection to avoid discomfort. However, in a related joystick experiment, Claes et al.4 found that the more important the painavoidance goal, the fewer times participants elected to move in the direction that yielded pain plus reward. Moreover, when working in a threatening context (an angry face lurking in the background), participants’ pain-related fear acquisition appears to have been enhanced.11 Thus, many factors (psychological, somatic, and context-dependent) can play a role in accentuating or mitigating pain-related fear and avoidance. It should also be noted that the choice between a painavoidant and a pain-tolerance goal in these experiments keeps the focus squarely on “pain-related” goals to the exclusion of other important life aspirations (social, vocational, recreational, family, spiritual, and the like) that in a “motivational context,” likewise have to be selected, initiated, maintained, and coordinated over time and across changing settings, redirected or reprioritized when short- and long-term outcomes conflict, and eventually terminated or put on hold. Dysfunctional patterns arising within any of these key motivational domains may meaningfully contribute to the deterioration of flexible control and decision making in the context of pain and goal striving. One particularly promising new research direction would be the exploration of when and by what means chronic pain influences the real-time in situ self-regulation of multiple goals, including but not limited to pain-tolerance and pain-avoidance proclivities. Fortunately, applied and organizational psychologists have for some time been focusing their energies on specifying the psychosocial determinants of successful and unsuccessful multi-goal management, including the singular and interactive roles played by goal setting, goal representation, goal shielding, if-then implemental intentions, success and failure feedback, means–ends trade-offs, attention and effort allocation policies, goal orientations, positive and negative emotionality, and many other motivational elements and processes.5,13,14,16,18 Pain researchers would therefore be in a good position to emulate some well-trodden empirical and conceptual paths, as they endeavor to factor both acute and chronic pain into the mix. The ability to resolve inter-goal competition may be a strategic requirement of special relevance when considering the intersection of pain regulation and multiple goal pursuit. If most people with pain are able to orchestrate their lives effectively, presumably maintaining a balanced minimally conflicting repertoire of goals, it would be essential to discover why, for a substantial minority, various manifestations of self-regulatory failure allow pain-generated goals to negatively impact the strength and accessibility of other highly valued nonpain goals. Yet, it is also important to ascertain, when an array of active goals is measured in real time, on a day-to-day basis, www.painjournalonline.com
1375
Copyright Ó 2015 by the International Association for the Study of Pain. Unauthorized reproduction of this article is prohibited.
1376
·
P. Karoly 156 (2015) 1375–1376
at work, at home, and at play, how much of an attentional and/or behavioral rivalry, in fact, exists between pain and nonpain pursuits. Although it is widely acknowledged that pain captures attention6,19 and draws resources away from other focal life endeavors, recent research suggests that attentional states tend to fluctuate spontaneously even in the presence of continuous nociceptive signals.12 How might this provocative finding relate to the present set of concerns? First, a competing goal may not be a necessary factor in the attenuation of pain-avoidance behaviors. Second, a focus on the interaction between pain and everyday mind wandering may yield new insights into the nature of pain-related cognitive control. Do intense pain flares suppress normal fluctuations in attention? Might habitual mind wandering in combination with low levels of what Kucyi and Davis12 call “intrinsic attention to pain” serve as protective factors against pain-related fear and avoidance? Clearly, a host of intriguing questions arise when motivation is broadly construed.
Conflict of interest statement The author has no conflicts of interest to declare. Article history: Received 10 February 2015 Accepted 13 February 2015 Available online 6 March 2015
References [1] Ainslie G. Breakdown of will. New York: Cambridge University Press, 2001. [2] Carver CS, Scheier MF. On the self-regulation of behavior. New York: Cambridge University Press, 1998.
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[3] Claes N, Crombez G, Vlaeyen JWS. Pain-avoidance versus rewardseeking: an experimental investigation. PAIN 2015;156:1449–57. [4] Claes N, Karos K, Meulders A, Crombez G, Vlaeyen JWS. Competing goals attenuate avoidance behavior in the context of pain. J Pain 2014;15: 1120–9. [5] DeShon RP, Gillespie JZ. A motivated action theory account of goal orientation. J Appl Psychol 2005;90:1096–127. [6] Eccleston C, Crombez G. Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychol Bull 1999;125:356–66. [7] Kanfer FH, Phillips JS. Learning foundations of behavior therapy. New York: Wiley, 1970. [8] Karoly P. Self-control. In: Hersen M, Rosqvist J, editors. Encyclopedia of behavior modification and cognitive behavior therapy, Vol. 14. Thousand Oaks: Sage Publication, 2005. p. 504–8. [9] Karoly P. Self-regulation. In: O’Donohue W, Fisher JE, editors. Cognitive behavior therapy: core principles for practice. New York: John Wiley, 2012. p. 183–213. [10] Karoly P, Jensen MP. Multimethod assessment of chronic pain. New York: Pergamon, 1987. [11] Karos K, Meulders A, Vlaeyen JWS. Threatening social context facilitates pain-related fear learning. J Pain 2015;16:214–25. [12] Kucyi A, Davis KD. The dynamic pain connectome. Trends Neurosci 2015;38:86–95. [13] Locke EA, Latham GP. A theory of goal-setting and task performance. Englewood Cliffs: Prentice-Hall, 1990. [14] Louro MJ, Pieters R, Zeelenberg M. Dynamics of multiple-goal pursuit. J Pers Soc Psychol 2007;93:174–93. [15] Nuttin J. Motivation, planning, and action. Hillsdale: Erlbaum, 1984. [16] Okun MA, Fairholme C, Karoly P, Ruehlman LS, Newton C. Academic goals, goal process cognition, and exam performance among college students. Learn Indiv Diff 2006;16:255–65. [17] Powers WT. Behavior: the control of perception. Chicago: Aldine, 1973. [18] Schmidt AM, Dolis CM, Tolli AP. A matter of time: individual differences, contextual dynamics, and goal progress effects on multiple-goal selfregulation. J Appl Psych 2009;94:692–709. [19] Van Damme S, Legrain V, Vogt J, Crombez G. Keeping pain in mind: a motivational account of attention to pain. Neuro Biobehav Rev 2010;34: 2014–213.
Copyright Ó 2015 by the International Association for the Study of Pain. Unauthorized reproduction of this article is prohibited.
Motivation, broadly construed, matters Paul Karoly
T
he links between chronic pain and psychological distress and disability are often indirect, operating through a compromised capacity for flexible goal directedness. With this in mind, a research team from Belgium and the Netherlands has programmatically sought to clarify the mechanisms underlying key instances of volitional dysfunction such as biased attention deployment, a susceptibility to fear conditioning, and persistent pain avoidance. Adopting paradigms from cognitive and learning theory, the team has likewise framed their efforts in a “motivational” light, consistent with the assumption that viewing chronic pain in terms of feedback-regulated and goal-centered choice and directional movement2,10,15,17 offers a compelling road map for unifying diverse clinical phenomena and disparate theoretical issues. Working within a so-called “motivational context” specifically implies a focus on 1 or more self-reflective or automatic processes presumed to influence the (1) selection, (2) initiation, (3) extended maintenance and coordination, (4) directional change or response probability alteration, and (5) termination or postponement of varied forms of goal-guided action, thought, and emotional responding. Isolating the (4) process noted above, ie, directional change or “self-control”7–9 as their motivational pivot point, Claes et al.3 used an experimental joystick movement paradigm that offered participants the choice between the safety of the high probability act of avoiding immediate pain vs the alternative of emitting movements that would result in the receipt of a painful shock, albeit a shock accompanied by delayed reward (a lottery ticket). This arrangement is an elegant way of experimentally formalizing the sort of self-control trade-off or goal prioritization decision that might confront a worker whose persistent back pain is exacerbated by certain job demands such as bending, heavy lifting, or sitting for hours before a computer screen. Going to work each day frequently means worsening back pain (a potent short-term negative outcome), although it carries the assurance of a weekly paycheck (a delayed positive outcome). As delayed payoffs are readily discounted by most of us, and not just persons with pain,1 the investigative team tested the somewhat risky hypothesis that the pairing of a painful unconditioned stimulus with the chance to win lottery tickets would attenuate participants’ fear of pain and reduce high probability avoidant choices. In addition, participants’ previous goal preferences were examined as a potential source of moderation. Although pain-related fear was affected neither by the pairing manipulations nor by previous preferences (for pain avoidance or reward seeking), participants nonetheless enacted more pain-engendering joystick movements when a concurrent Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Department of Psychology, Arizona State University, Tempe, AZ, USA PAIN 156 (2015) 1375–1376 © 2015 International Association for the Study of Pain http://dx.doi.org/10.1097/j.pain.0000000000000153
August 2015
·
Volume 156
·
Number 8
reward was paired with such movements relative to a control condition wherein their motor behavior simply garnered either pain or no pain. Clearly, when something is to be gained by tolerating pain, people will exert sufficient self-control to override their natural predilection to avoid discomfort. However, in a related joystick experiment, Claes et al.4 found that the more important the painavoidance goal, the fewer times participants elected to move in the direction that yielded pain plus reward. Moreover, when working in a threatening context (an angry face lurking in the background), participants’ pain-related fear acquisition appears to have been enhanced.11 Thus, many factors (psychological, somatic, and context-dependent) can play a role in accentuating or mitigating pain-related fear and avoidance. It should also be noted that the choice between a painavoidant and a pain-tolerance goal in these experiments keeps the focus squarely on “pain-related” goals to the exclusion of other important life aspirations (social, vocational, recreational, family, spiritual, and the like) that in a “motivational context,” likewise have to be selected, initiated, maintained, and coordinated over time and across changing settings, redirected or reprioritized when short- and long-term outcomes conflict, and eventually terminated or put on hold. Dysfunctional patterns arising within any of these key motivational domains may meaningfully contribute to the deterioration of flexible control and decision making in the context of pain and goal striving. One particularly promising new research direction would be the exploration of when and by what means chronic pain influences the real-time in situ self-regulation of multiple goals, including but not limited to pain-tolerance and pain-avoidance proclivities. Fortunately, applied and organizational psychologists have for some time been focusing their energies on specifying the psychosocial determinants of successful and unsuccessful multi-goal management, including the singular and interactive roles played by goal setting, goal representation, goal shielding, if-then implemental intentions, success and failure feedback, means–ends trade-offs, attention and effort allocation policies, goal orientations, positive and negative emotionality, and many other motivational elements and processes.5,13,14,16,18 Pain researchers would therefore be in a good position to emulate some well-trodden empirical and conceptual paths, as they endeavor to factor both acute and chronic pain into the mix. The ability to resolve inter-goal competition may be a strategic requirement of special relevance when considering the intersection of pain regulation and multiple goal pursuit. If most people with pain are able to orchestrate their lives effectively, presumably maintaining a balanced minimally conflicting repertoire of goals, it would be essential to discover why, for a substantial minority, various manifestations of self-regulatory failure allow pain-generated goals to negatively impact the strength and accessibility of other highly valued nonpain goals. Yet, it is also important to ascertain, when an array of active goals is measured in real time, on a day-to-day basis, www.painjournalonline.com
1375
Copyright Ó 2015 by the International Association for the Study of Pain. Unauthorized reproduction of this article is prohibited.
1376
·
P. Karoly 156 (2015) 1375–1376
at work, at home, and at play, how much of an attentional and/or behavioral rivalry, in fact, exists between pain and nonpain pursuits. Although it is widely acknowledged that pain captures attention6,19 and draws resources away from other focal life endeavors, recent research suggests that attentional states tend to fluctuate spontaneously even in the presence of continuous nociceptive signals.12 How might this provocative finding relate to the present set of concerns? First, a competing goal may not be a necessary factor in the attenuation of pain-avoidance behaviors. Second, a focus on the interaction between pain and everyday mind wandering may yield new insights into the nature of pain-related cognitive control. Do intense pain flares suppress normal fluctuations in attention? Might habitual mind wandering in combination with low levels of what Kucyi and Davis12 call “intrinsic attention to pain” serve as protective factors against pain-related fear and avoidance? Clearly, a host of intriguing questions arise when motivation is broadly construed.
Conflict of interest statement The author has no conflicts of interest to declare. Article history: Received 10 February 2015 Accepted 13 February 2015 Available online 6 March 2015
References [1] Ainslie G. Breakdown of will. New York: Cambridge University Press, 2001. [2] Carver CS, Scheier MF. On the self-regulation of behavior. New York: Cambridge University Press, 1998.
PAIN®
[3] Claes N, Crombez G, Vlaeyen JWS. Pain-avoidance versus rewardseeking: an experimental investigation. PAIN 2015;156:1449–57. [4] Claes N, Karos K, Meulders A, Crombez G, Vlaeyen JWS. Competing goals attenuate avoidance behavior in the context of pain. J Pain 2014;15: 1120–9. [5] DeShon RP, Gillespie JZ. A motivated action theory account of goal orientation. J Appl Psychol 2005;90:1096–127. [6] Eccleston C, Crombez G. Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychol Bull 1999;125:356–66. [7] Kanfer FH, Phillips JS. Learning foundations of behavior therapy. New York: Wiley, 1970. [8] Karoly P. Self-control. In: Hersen M, Rosqvist J, editors. Encyclopedia of behavior modification and cognitive behavior therapy, Vol. 14. Thousand Oaks: Sage Publication, 2005. p. 504–8. [9] Karoly P. Self-regulation. In: O’Donohue W, Fisher JE, editors. Cognitive behavior therapy: core principles for practice. New York: John Wiley, 2012. p. 183–213. [10] Karoly P, Jensen MP. Multimethod assessment of chronic pain. New York: Pergamon, 1987. [11] Karos K, Meulders A, Vlaeyen JWS. Threatening social context facilitates pain-related fear learning. J Pain 2015;16:214–25. [12] Kucyi A, Davis KD. The dynamic pain connectome. Trends Neurosci 2015;38:86–95. [13] Locke EA, Latham GP. A theory of goal-setting and task performance. Englewood Cliffs: Prentice-Hall, 1990. [14] Louro MJ, Pieters R, Zeelenberg M. Dynamics of multiple-goal pursuit. J Pers Soc Psychol 2007;93:174–93. [15] Nuttin J. Motivation, planning, and action. Hillsdale: Erlbaum, 1984. [16] Okun MA, Fairholme C, Karoly P, Ruehlman LS, Newton C. Academic goals, goal process cognition, and exam performance among college students. Learn Indiv Diff 2006;16:255–65. [17] Powers WT. Behavior: the control of perception. Chicago: Aldine, 1973. [18] Schmidt AM, Dolis CM, Tolli AP. A matter of time: individual differences, contextual dynamics, and goal progress effects on multiple-goal selfregulation. J Appl Psych 2009;94:692–709. [19] Van Damme S, Legrain V, Vogt J, Crombez G. Keeping pain in mind: a motivational account of attention to pain. Neuro Biobehav Rev 2010;34: 2014–213.
Copyright Ó 2015 by the International Association for the Study of Pain. Unauthorized reproduction of this article is prohibited.
