The Behavioral Approach-Avoidance and Distress Scale: An Investigation of Reliability and Validity During Painful Medical Procedures

Abstract Common medical procedures to assess and treat patients can cause significant pain and distress. Clinicians should have a basic approach for minimizing pain and distress in children, particularly for frequently used diagnostic and therapeutic procedures. This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures. Simple, evidence-based strategies for managing pain and distress are reviewed, with guidance for integrating them into clinical practice as an essential part of health care. Health professionals are encouraged to use minimally invasive approaches and, when painful procedures are unavoidable, to combine simple pain and distress-minimizing strategies to improve the patient, parent, and health care provider experience. Health administrators are encouraged to create institutional policies, improve education and access to guidelines, create child- and youth-friendly environments, ensure availability of appropriate staff, equipment and pharmacological agents, and perform quality audits to ensure pain management is optimal.

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Coping Skills for Children Undergoing Painful Medical Procedures

Issues in Comprehensive Pediatric Nursing ◽

10.3109/01460868809038009 ◽

1988 ◽

Vol 11 (2-3) ◽

pp. 113-143 ◽

Cited By ~ 20

Author(s):

Katherine L. Patterson ◽

Leanne Lewis Ware

Keyword(s):

Coping Skills ◽

Medical Procedures ◽

Painful Medical Procedures

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Use of Sucrose Analgesia in Low Birth Newborns with Congenital Heart Disease Undergoing Painful Medical Procedures

Pediatric Research ◽

10.1038/pr.2011.861 ◽

2011 ◽

Vol 70 ◽

pp. 636-636

Author(s):

D Dmytriiev ◽

K Dmytriieva ◽

O Nazarchuk

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Congenital Heart ◽

Medical Procedures ◽

Painful Medical Procedures

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Ethnic Differences in Parent Preference to Be Present for Painful Medical Procedures

PEDIATRICS ◽

10.1542/peds.2004-2626 ◽

2005 ◽

Vol 116 (2) ◽

pp. e191-e197 ◽

Cited By ~ 23

Author(s):

M. Jones

Keyword(s):

Ethnic Differences ◽

Medical Procedures ◽

Painful Medical Procedures ◽

Parent Preference

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Underpredicting Pain: An experimental investigation into the benefits and risks - Preprint

10.31234/osf.io/yr9jt ◽

2020 ◽

Cited By ~ 1

Author(s):

Kaya Peerdeman ◽

Andrew Geers ◽

Delia Della Porta ◽

Dieuwke S. Veldhuijzen ◽

Irving Kirsch

Keyword(s):

Skin Conductance ◽

Healthcare Providers ◽

Correct Prediction ◽

Medical Procedures ◽

Contrast Effects ◽

Fear Of Pain ◽

Skin Conductance Responses ◽

Experienced Pain ◽

Painful Medical Procedures ◽

Pain Unpleasantness

Expectancies can shape pain and other experiences. Generally, experiences change in the direction of what is expected (i.e., assimilation effects), as seen with placebo effects. However, in case of large expectation-experience discrepancies, experiences might change away from what is expected (i.e., contrast effects). Previous research has demonstrated contrast effects on various outcomes, but not pain. We investigated the effects of strong underpredictions of pain on experienced pain intensity. Additionally, we assessed related outcomes including (certainty of) expectations, fear of pain, pain unpleasantness, autonomic responses, and trust. Healthy participants (Study 1: n=81, Study 2: n=123) received verbal suggestions that subsequent heat stimuli would be moderately or highly painful (correct prediction), mildly painful (medium underprediction; Study 2 only), or non-painful (strong underprediction). Both studies showed that participants experienced less intense pain upon strong underprediction than upon correct prediction (i.e., assimilation). Expected pain, fear of pain, and pain unpleasantness were generally also lowered. However, strong underprediction simultaneously lowered certainty of expectations and trust in the experimenter. Study 2 indicated that the effects of strong underprediction versus medium underprediction generally did not differ. Moreover, Study 2 provided some indications for reduced heart rate and skin conductance levels, but increased skin conductance responses upon strong underprediction. In conclusion, even strong underpredictions of pain can reduce pain (i.e., cause assimilation), although not significantly more than medium underpredictions. However, strong underpredictions can cause uncertainty and undermine trust. These findings suggest that healthcare providers may wish to be cautious with providing overly positive information about painful medical procedures.

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Evaluating the role of Approach-Avoidance Training on action-tendencies in individuals with skin-picking disorder: A preliminary randomized experiment

Journal of Behavioral Addictions ◽

10.1556/2006.2021.00031 ◽

2021 ◽

Author(s):

Abel S. Mathew ◽

Madeline A. Rech ◽

Han-Joo Lee

Keyword(s):

Avoidance Training ◽

Cognitive Intervention ◽

Behavioral Approach ◽

Skin Picking ◽

Assessment Task ◽

Approach Training ◽

Approach Avoidance ◽

Excoriation Disorder ◽

Skin Picking Disorder ◽

Action Tendencies

AbstractBackground and aimsPathological skin-picking (PSP) or excoriation disorder is a destructive behavior that affects 1-2% of the general population. The purpose of this pilot study was to evaluate the effect of a computerized behavior modification task on action-tendencies (i.e., approach or avoidance) in adults with PSP. We aimed to modify these action-tendencies by having participants with PSP complete the Approach-Avoidance Training (AAT) task, using a joystick to simulate an approach (=pull) or avoidance (=push) response.MethodForty-five participants diagnosed with PSP were randomized to one of three training conditions: (1) Avoidance Training (AvT; n = 15), (2) Approach Training (ApT; n = 15), or (3) Placebo Training (PT; n = 15). We hypothesized that after training, those in the AvT would have the greatest reduction in behavioral approach (i.e., their overall reaction time [RT] to approach pictures of irregular skin stimuli).ResultsResults of the pre-training assessment task revealed a positive correlation between behavioral approach to irregular skin stimuli and skin-picking severity as assessed by the Skin Picking Scale-Revised (SPS-R). After training, a lower behavioral approach and urges to pick were found in the AvT and PT groups, while those in the ApT reported higher behavioral approach and urges to pick. At two-week follow-up, no significant changes on the SPS-R were reported between groups.DiscussionOur preliminary data suggest that the AAT is a promising avenue of research to develop as a cognitive intervention to address an excessive behavioral approach tendency that characterizes skin-picking problems.

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