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Advances in Evidence-Based Mental Health Care
by Dr. Steven Mee
Part 1: Psychological pain: A critical component of many mental illnesses
In this installment we'll discuss an area of medicine with which each of you has had extensive experience, but which is relatively neglected in medical research: psychological (or emotional) pain. This is the first of a two-part series on this important and newly evolving area of research.
From our first moments outside the safety of mothers' womb, pain has served as a powerful motivator of our behavior. While pain, either physical or emotional, is generally protective (we withdraw our hand from a flame in order keep from being burned) sometimes it can be harmful. We believe this type of pain plays an important role in the development of depression, suicidal thinking, substance abuse, and other conditions such as anxiety disorders.
In 2006, our research group published a review article outlining the importance of psychological pain in these areas and examined previous evidence regarding the particular brain regions that may be involved. Following this effort we developed a patented instrument to assess psychological pain that our doctors at AIP will be utilizing to help assess our patients pain levels. We will discuss the outcome of the first study to examine this scale in depressed patients in a future discussion, currently being readied for submission for publication.
The following are some key points about psychological pain and important brain regions that link it to depression and suicidal thinking.
- It is completely ‘normal’ to experience psychological pain and there is no medication per se that is used to treat it . Psychological pain can follow life experiences of loss (grief), envy, anger, or be associated with depression.
- Many instances of drug abuse may actually be a person attempting to reduce psychological pain
- Only severe and seemingly unending psychological pain is associated with depression, anxiety, substance abuse, or possibly suicidal thinking
- The brain appears to process psychological pain in a manner similar in many, but not all, ways as it does physical pain. In the brain, physical pain is divided into different facets: sensory (what is hurting), emotional (how one feels about experiencing this pain—usually badly!) and motivational (how to make it stop). Brain imaging suggests that psychological pain is processed in a similar way.
- Two brain areas in particular may be critical in generating psychological pain: the Insular Cortex and Anterior Cingulate Cortex.
- Understanding how the brain processes and generates psychological pain may provide powerful clues into substance abuse, depression suicidal thinking, and other issues.
- Accurately measuring psychological pain may be of great benefit for assessing and treating depression and other conditions
Please look for Part 2 in this series as we will discuss how anxiety relates to psychological pain and share some of our most recent research findings, where we developed a tool to measure emotional pain and examine it in patients with depression.
Summarized from 'Psychological pain: A Review of Evidence'; Mee et al., Journal of Psychiatric Research, 2006
