I recently conducted an informal cross-sectional study over at SomaSimple.com, to gather an idea of the individualized experience of others when watching the video below.
The responses from the participants varied and here is a summary of responses, to the following statement: This is a test. I want you to sit through this 2 minute video and then describe what you feel. I then want you to reflect on the experience and describe why you felt this way.
After a day or so, I gathered the responses and attempted to analyze them (n=15):
After careful analysis, I suspected there were two classifications of individuals :
No response (or down-regulated response):
Participant 5: Social factors influenced her response and caused her to feel “on-guard”
Participant 6: Able to experience a quality of pain (through visualization and memory). The participant recognized the quality was different than the actual experience.
Participant 7: No pain BUT did exhibit altered action programming (he curled in ball and grabbed his hand)
Participant 8: No pain but did have a sympathetic Response + altered action programming
Participant 9: No pain but the sound caused altered action programming
Participant 10: Didn’t need to watch the video; the words simply created fear avoidance behavior
Participant 11: Sympathetic Response
Participant 12: The participant had altered action programming
Participant 13: Sympathetic Response (felt queasy)
Participant 14: Fear-avoidance (refusal to watch video)
Participant 15: Laughed.
(To read the individual responses, click on the link above).
So when analyzing the above data, how do we make sense of it and what does it mean to us clinically? Again, these responses were simply from watching a video. There was no immediate or direct (real?) threat involved. But in over half of the participants, their brain responded in a very real way (by causing a variation of physiological actions).
I wanted to quote one of the participants descriptions of why they believe they did not experience a response:
As a child, I grew up amongst a large community of Micronesians (indigenous people of the Far NW Pacific) and accepted their culture as markedly different from the one I was getting used to – ours. If someone hurt himself, quite significantly, those around him would laugh out loud and almost roll on the ground with laughter. The kids laughed, the wives and girlfriends too. He ended up laughing as well, through gritted teeth. Then later I found myself wondering why our culture was so damn serious about pain and hurt which was not life-threatening. I still wonder. Five of my cousins grew up in the Solomons (NW Pacific) amongst a different culture – warmongering Melanesians who were ex-cannibals but the approach to discomfort and pain was the same. When the two of the five cousins started skin diving to get pearls, they often developed the bends. They were attached to a rope and breathing tube to the boat. They hung onto the rope until they could slowly surface. Once all was normalised, their father told them to go down again…and again. A little bit of history which may explain why a paper cut seems trivial to me. However I do understand why it isn’t to others – I think. Blame the culture??
When considering the study of pain, I am not truly convinced RCTs can account for group differences. Sure, you can randomize a study by assigning patients to groups with methods to assure equal probability of allocation, and then analyze for group homogeneity, but isnt this truly limited by the variables analyzed. In research, do we truly account for individualized experiences that influence responses to our experiences, as in the story above?
Moving forward, I am not convinced that more RCTs hold the answer. I suspect we need to conduct qualitative studies, and learn about the individualized responses we receive.
How did you experience the video above? How would you have answered this question? What does this mean for us clinically?
- Joe B
Categories: Critical Thinking