Welcome back to the Healing Pain Podcast with Dr. Amy Wacholtz, PhD
Many people have questions about the role of spirituality in pain management and pain relief. Dr. Amy Wacholtz, a licensed clinical psychologist, pain researcher and assistant professor of Psychology at the University of Colorado, explores the role of spirituality as part of an integrative pain management program. Spirituality can be defined as the experience of transcendence, connectedness, meaning and purpose. If you have pain, you know all too how it can derail you from your path and journey in life. Research on the neurobiology of pain has begun to explore the relationship between spirituality and pain relief. We know those who struggle with pain use a number of cognitive and behavioral strategies to cope, including religious and spiritual methods. What does the science say about the spirituality of pain? Is it truly an effective means of pain management? Find out more about this with Dr. Amy Wacholtz.
Like many of you, I have questions about the role of spirituality when it comes to pain relief. We’ll explore the role of spirituality as part of an integrative pain management program. Spirituality can be defined as the experience of transcendence, connectedness, meaning and purpose. If you have pain, you know all too how it can derail you from your path and journey in life. Research on the neurobiology of pain has begun to explore the relationship between spirituality and pain relief. We know those who struggle with pain use a number of cognitive and behavioral strategies to cope, including religious and spiritual methods. What does the science say about the spirituality of pain? Is it truly an effective means of pain management? If you’re a practitioner, how can you begin to integrate aspects of spirituality into your practice? If you’re one who is seeking pain relief, how can you explore the spiritual aspects of care? Should you adopt a daily practice of prayer? Should you seek the help of a spiritual healer or switch to a form of meditation that claims to put you in touch with the greater force?
People with chronic pain are turning towards spirituality as a means to cope and want to know more about what they can do. Here to speak with us is Dr. Amy Wachholtz. Dr. Wachholtz is a licensed Clinical Psychologist, pain researcher and Assistant Professor of Psychology at the University of Colorado. She graduated first with a Master’s Degree in Divinity and then continued her education to earn a PhD in Clinical Psychology with a specialization in Behavioral Medicine and the Psychology of Religion. Her work today as well as the more than 100 publications and presentations she has given focuses on the spiritual model for chronic pain disorders and the complexity of treating comorbid pain and opioid addiction.
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Demystifying The Role Of Spirituality In Pain Management with Dr. Amy Wacholtz, PhD
Amy, welcome to The Healing Pain Podcast. It’s great to have you here.
Thank you, Joe. It’s great to be here.
I’m excited to have you on the podcast, Amy, because you have an interesting blend of experience as well as credentials and education. You’re going to cover the topic of spirituality, religion, pain, and all things around that. It’s a great place to start by having you share your story with us about those credentials as well as how you got into this interesting aspect of pain and research.
I’m happy to share that because it’s not a straight-line journey. Nobody has a straightforward journey. I’m not that dissimilar from most people. I’ve always had this fascination with how the brain and the body interact with each other, how one influences the other, particularly how the brain can influence the body. Even all the way through undergrad and things like that, I was always fascinated with this interplay. When I completed my undergrad education, I did a Master’s of Divinity degree at Boston University. Boston University is a Methodist-affiliated school and it’s in Boston where there’s much rich history. There’s something like thirteen or fifteen different theology programs. I’ve heard the statistic that there’s more theology students in Boston than any place else in the world, including Vatican City. It’s a rich, dynamic environment.
The BU School of Theology was unique as well in that they allowed me to do a secondary graduate degree in Bioethics. I was doing work with what’s called xenotransplantation or the possibility that at some point in the future, we could genetically engineer pig organs in order to use those for human replacement. If someone needed a heart transplant or a kidney transplant, that there may be that possibility in order to save lives and alleviate some of the pain and suffering of individuals that wait for years on the list. I have faculty friends that still joke that I’m probably the only theology student that has ever turned in a western blot profile with their theology master’s thesis. It was a rich and dynamic area to be. It allowed me to do some of the bioethics theology work across Harvard University and Boston University.
During this time, I was also contacted by a mentor colleague who brought me into the United Methodist Commission on Relief, which is also part of the United Nations High Commission on Refugees. I was doing work in Bosnia and I was doing work in Tbilisi in the former Soviet Republic of Georgia. At the time when I was in Bosnia, the war was technically over but it was still one of the most heavily landmine countries in the world. We were doing a lot of work with individuals that had experienced traumatic amputations. There wasn’t the level of morphine. There wasn’t the level of opioids to help with that, the post traumatic amputation that we would see in the United States. Yet I was working with individuals that were somehow managing their pain. They were slowly getting their lives back. I started informally, not that I didn’t have the extreme scientific training that I do today, but informally asking them, “How are you managing your pain? What’s getting you through? How are you still getting up in the morning?” I became fascinated to hear their stories and learn from these courageous individuals who were telling me about how they were using what I later learned were psychological techniques, social techniques, and spiritual techniques to help reduce their pain experience and help them continue to function in their daily lives.
This became a part where after a while of hearing these stories I decided I need to learn more about this. What these individuals have developed on their own, somebody has got to be studying this. Somebody has to be looking at this biology, psychology and spirituality interplay when it comes to pain. I came back to United States and completed a Master’s and PhD in Clinical Psychology, working with Ken Pargament who’s a well-known psychology religion individual and also doing secondary specialty in behavioral medicine, exploring the biopsychosocial-spiritual model of pain and exploring how individuals’ spirituality plays a role in how the biology is interpreted by the brain and what the eventual pain experience that’s experienced by the person, what the outcome of that is.
That was a fascinating journey in learning about all the old ways that I used to think about pain. You stub your toe, it runs up your spinal column, it hits your brain, you say, “Ouch.” That was always the way I thought about pain. Then realizing that there are also these top-down modulation procedures that come from people’s emotions, behaviors, thought processes and spirituality that modulate that pain experience and modulate the pain signals that are coming from the body and coming into the brain and it modulates those signals to determine what the actual pain experience is. I continued my education. I kept learning more. There’s always more to learn.
When I look at your bio, all of us in healthcare have doctorate degrees and all of us have done a lot of education. For those of you who have not logged onto the website yet, you have to look at Amy’s bio and look at the amount of degrees that she has. She spent a lot of years studying. The topic of spirituality fascinates me, especially as it relates to pain, but when I look at your bio, I don’t know if there’s someone out there like you that has a better bio as far as talking about how spirituality impacts the biopsychosocial ramifications that people are under when it comes to pain. Congratulations on all that work. Tell us how many research articles you have published on the spirituality aspect when it comes to pain.
Strictly on spirituality and pain, I’m probably somewhere around 30 to 50. I don’t know the exact number because I look at a number of different areas related to pain. In the same way with is how I collect degrees, so to speak. The more I learn, the less I know. I’m always trying to get a better understanding of how pain interacts. I have some research that’s in the area of comorbid pain and opioid addiction. I have some that’s in the area of the biopsychosocial-spiritual model of acute pain and chronic pain. I know I’m over 100 total but how that differentiates between my different areas, I don’t know the exact number.
I want to take you back in your history for one moment. After your undergraduate degrees, after your four-year degree, the first masters you went for before you went on for your Ph. D. is you went for a Master’s Degree in Divinity, which is a specific type of master’s degree. Why did you choose that? What was inside of you to choose that obviously spiritual path?
I knew at the time I was still fascinated with how biology, psychology, and spirituality interplayed with each other. I wanted to use that information to work with patients and to help the patients better understand how to use spiritual resources in order to improve the quality of their life as they’re struggling with a chronic health or illness issue. At the time I was considering moving forward and doing some form of chaplaincy, either hospital chaplaincy or collegiate chaplaincy. That was where I was looking at that and then as I continued to learn more, I kept saying, “There’s more of a science component to this that can interplay deeply with the theology components of that,” and so I wanted to continue to learn.
Obviously in medicine and research, we hope that by delving into the scientific method that we can fast forward and figure out what works when it comes to something large like spirituality. What is the component of spirituality that helps people with pain or helps people live a meaningful and valued life? Were you particularly religious growing up? Did you have any spiritual awakening that led you to that master’s? Was it more of that curiosity?
I was always raised in the Methodist Church and that was something that was always a strong component of my life. Boston University is a Methodist-affiliated university. It’s also something that I want to point out especially given its importance. It’s also where Dr. Martin Luther King received his degree and doctorate in Theology. It’s a university that is deeply embedded in the Methodist tradition. The Methodist tradition has a strong component of social justice and serving the world around them. It was an excellent fit for me in order to pursue my degree as well as being ecumenical.
I always joke that my first Theology 100 class in my Master’s program sounded like the start of a bad joke, it was a Protestant woman walks into a classroom. Among the other students, there’s a Catholic priest, there was a Buddhist nun, there was a woman from the reformed Judaism tradition. There were individuals from evangelical traditions. There were a number of individuals from different Protestant traditions. Obviously, it sounds like the start of a bad joke of a priest, a Buddhist nun and Protestant woman all walk into a classroom together. That again made it such a rich and diverse culture in which to study, learn, argue and come together and debate issues of theology and how this interplays with society, with our daily life and with health, both in general and on an individual, how do we use this information to help clients, patients or parishioners.
Let’s dive into the first question I have for you. It’s a big one that a lot of people probably have a hard time answering, so I’m curious to hear how you would answer it. People have their own way to answer it. How does spirituality differ from religion?
I would fall back on my research training for that differentiation because you’re right, everyone has their own takes on what that is. For a lot of my research studies, we have to explicitly lay out, “Here’s the definition, this is what we’re using to define spirituality. This is what we’re using to define religion.” Within that, there are a number of different people that may disagree with that or have their own interpretations of what those phrases are. When we use the vocabulary in research studies, we always want to lay out what it is that we’re talking about. For my definition of religion, I rely on Ken Pargament’s definition of the search for the sacred and search for meaning in relation to the sacred. A lot of times, religion often has a more organized component to it. It may have a little bit more of the rituals that are involved; it may have more of the books that are involved.
Spirituality on the other hand tends to be a little bit more on the private side. It may have more of the emotional component that is inherent with a religious experience. When you wake up on Sunday morning, for example, and you have to make the decision of, “Do I hit the snooze button or do I get up, get dressed up and go into a church service?” What is it that’s driving that? If it’s more of an internal motivation of saying, “I want to go because I want to have a connection with other people and I want to have a connection with my higher power,” then that would be more on the spirituality component of things. I fully recognize though everybody comes with their own definition of what that may look like, but I always want to make sure that we laid out in our research studies so that we’re at least starting from the same page.
We talk about this all the time on the podcast, the biopsychosocial model. You actually put another “S” on the end of that, the social spiritual model. I’m going to weave in two questions here for you. Should the spiritual be a separate category or should it be embedded within the social part of the biopsychosocial model? With that, how often or how popular is spirituality a go-to method for those looking to alleviate their pain?
The first one, should the spiritual model be separate from the other ones, I would obviously argue that it is separate. It’s a unique process. Someone might be healthy psychologically and not have a spiritual component to their life or they might have a strong spiritual component to their life and yet still be struggling psychologically or socially. We can’t assume that wellbeing in any one category equals wellbeing in the other categories. We do need to separate these out. If we start becoming reductionistic and saying it’s all psychology or it’s all biology as some of the early arguments for the biopsychosocial model even started, why do we even talk about the social aspect? Why do we even need to talk about psychology, it’s all biology anyway? Over time we started realizing there’s a unique process that happens in the psychology interactions and there’s a unique process that happens in social interactions that contributes to and interacts with the biological processes.
I would argue that spirituality is much the same way that it is important to study it as an independent factor because it does interact and affect each of the other three areas, the biopsychosocial model as well. That would be my argument for why we need to pull out that extra S and tack that extra S onto the end of the biopsychosocial model and turn it into the biopsychosocial-spiritual model. There’s a lot of research that’s going on as well that’s looking at individuals that may not have a specific theistic background or may not have a specific religious background but do certainly have a spiritual life. Some of this research is going into, it’s been called things like secular reverence or peak experiences.
Among individuals that are not saying, “I’m Catholic or I’m Jewish or I’m Buddhist or I have this religious background,” there’s some recognition even within the psychology of religion and spirituality that there are still some unique experiences that someone who is coming from an agnostic or an atheistic background may still feel something unique, a peak experience or a secular reverence experience when they stand on a mountain top or when they listen to a specific piece of music or when they watch the birth of their child or they give birth to their child, that is outside of the standard day to day mundane living. When we talk about the biopsychosocial-spiritual model, we are also recognizing multiple dimensions of spirituality. We’re not saying we are only interested in studying individuals that come from a traditional background, with a traditional pathway and their spirituality, that it really is looking at the multiple dimensions of spirituality as well.
It’s a really important distinction. There was a second part of that question. When it comes to spirituality, it doesn’t come in a bottle. It’s not prescribed on a prescription pad by a prescriber. You don’t know what the patient is doing unless you ask about it. How popular is this for people with chronic pain?
With the number of the epidemiological research studies that I’ve done and also seeing research that has been done by others, it is number one or number two prayer for chronic pain and for chronic illness comes up as the number one or number two most frequently used in what’s called alternative medicine approach that gets used over and over again in the United States. Even as the society may become slightly more secular or slightly less connected to organized religion, we’re still seeing a strong component of using religious meditation or spiritual meditation, prayer, as part of the treatment plan, an individual’s treatment plan for their chronic pain condition.
Number one or number two as an alternative. The word alternative is difficult to unpack sometimes. Choosing that before, let’s say acupuncture or choosing that before homeopathy, for instance.
That’s what those studies are showing is that individuals are using prayer or spiritual meditation techniques time and time again over on top of acupuncture, even massage therapies. Either they’re getting something from that, there’s no particular cost associated with it, it’s imminently portable. It’s something that people can do regularly on their own. It’s something that they can also use as part of their daily practice where I certainly have a great deal of respect for a number of different complimentary, alternative, and integrative medicine approaches to chronic pain. Usually that requires you have to go to a specific practitioner, maybe you go once a week, maybe you go once a month. It’s a special call out time where you’d receive that acupuncture, you’d receive some recommendations, and meet with a specific consultant.
This is something that people can do once a day, twice a day, three times a day, however often they need to and integrate this into their daily life as well. There are a couple of different reasons why people use that and then ultimately the individuals must be experiencing something positive from that. A reduction in pain, an increase in pain-related self-efficacy, a feeling of connection and support from a higher power that keeps them using that technique and keeps them accessing those spiritual resources. They wouldn’t do it if they wouldn’t continue with that practice, if they weren’t experiencing something positive from it.
I know through your research you have started to look at how spirituality can help someone cope with their opinion either in the short term as well as long term. Are there any negative aspects to religion and spirituality when it comes to coping with pain?
Like all tools, all resources, spirituality can be a source of strength or it can be something that’s detrimental and not helping someone adapt. I’m relying on Dr. Ken Pargament’s model where he identified four different approaches to spiritual coping with illness or chronic pain. The first group is the integrated. The individual says, “I’m going to do my part, my higher power’s going to do their part and together we’re going to get through this. I’m going to keep rolling forward and I’m responsible for the sections that I’m responsible for. My higher power is going to support me through that. We’re going to tackle this together.” Those individuals tend to do the best. Whether we’re talking medical illness, injury, chronic pain. Those individuals tend to have the best outcomes.
The second group of individuals that’s been identified is what’s called the self-directed. These are individuals that they don’t currently have a faith background. There’s no negative emotion related to the lack of faith background. They’re not angry at the church and have left because of those anger issues or they’re not feeling negatively towards a higher power or something. They’re emotionally neutral and they say, “I don’t have a higher power. I don’t believe in a higher power and it’s on me and I’m going to do what I’m going to need to do.” For the most part, those individuals do slightly less well than the individuals that use the integrated forms of care but not horribly. They certainly don’t do horribly well.
The third group is what’s called deferring. These individuals are individuals that say, “I have no control over anything. It’s not up to me; it’s all up to my higher power. I’m going to put both burden of responsibility and the knowledge that they’re going to help me on them.” These individuals, for example, if they have diabetes and they’re experiencing diabetic neuropathy, they’re not going to check their blood sugar. They’re not necessarily going to follow a strict diet because they’re putting the responsibility on their higher power to make sure that they’re okay. After an accident, somebody might not go to physical therapy or follow through with adherence to the provider’s recommendations because they say, “My higher power is going to take care of me. They’re going to make sure that it’s all okay.” These individuals don’t tend to do well both with chronic pain conditions as well as in general medical conditions.
They’ve given up all their self-efficacy and it’s become passive in a sense.
Exactly. That passivity generally doesn’t do well. There’s one exception to this that’s been found in hospice care. The individuals, when they’re in hospice, by giving up that self-efficacy and using the remaining time to strengthen and finalize their relationships with their friends and their family members, those individuals tend to have a stronger quality of life at the end of life compared to individuals that are constantly seeking one more cure or, “If I go and do this alternative cure that nobody’s ever heard of and isn’t supported, maybe that’s going to save me,” which would be more of either self-directing or integrated care model. Deferring in hospice is the one exception to that rule.
There’s the fourth group. This group is the group that feels abandoned or punished by their higher power. These would be individuals that say, “God’s not involved in my care because God has abandoned me,” or, “God is punishing me,” for some something that they did previously. This is somebody who doesn’t feel they have the support of their higher power, but it has a lot of negative emotion related to that, a lot of anger, a lot of feelings of abandonment. Across the board these individuals tend to do far worse. They tend to have much higher opioid medication needs. These are individuals that will rate their pain experience much higher. These are individuals that will report that they have extremely low self-efficacy related to dealing with their pain, either directly with the pain itself or with the illness and injury that created the circumstances that led to the chronic pain. Those are the four different ways it’s been identified through the research of how people interact with a higher power and use spiritual coping resources. Each one has unique and distinct outcomes related to medical illness and to chronic pain conditions.
The average person probably wouldn’t think there are different ways to interact with spirituality, source, your divine, your intervention power. In that last group, the group who has, as professionals we’d say, “a negative way to cope with pain via spirituality,” there’s a question that probably comes up in that person’s mind. It’s a difficult question to answer and I’ve heard it. People have asked me the question. “How can there be a benevolent God if I’m in so much pain?”
That is a question that has clearly led to a number of books, articles, and pieces like that. While I can’t answer the theology question for individuals, I can rely on some work that I did with Jessie Dezutter out of Europe where we were looking at the trajectory of chronic pain in individuals and how they used meaning making too come to for each individual, how they came to their own response for that, and how they made meaning or how they explained their chronic pain condition. We tracked a number of individuals who generously gave their time to the study over the course of multiple years. What we were able to find is that for individuals that were able to come to some resolution, end up with some form of meaning making for why they’re experiencing chronic pain in the context of their own personal theology.
Those individuals, after controlling for every other variable that was out there, the individuals that were able to come to an understanding and make meaning out of why they have that severe pain ended up having less pain. Some responses we got, for example, “I have this chronic pain condition because it’s made me slow down. I have more time for friends and I have more time for family because I’m not doing 120 hours a week at my career job and ignoring friends and family.” That might be one way that somebody makes meaning out of why they have their pain condition. Even after controlling for what the condition is, age, gender, medication levels, etc., if we track those individuals over time, they end up with less pain based on how they make meaning and how they’re searching for meaning three or five years previously.
I love the meaning making. When people hear that, what does that mean? You’re saying it’s how words affect someone’s cognition. When we talk about cognition, it’s a fancy word which means that words can affect how you think, how you feel, and the images that you can conjure up in your head. As a psychologist, that’s all super important when it comes to pain, correct?
Absolutely. If someone can put a reason on why they’re experiencing pain, it suddenly becomes a purpose. It also gives a purpose. If someone says, “I’m not able to work 120 hours a week or I’m not able to work 100 hours a week that I was working before. I have more time for my kids and my grandkids,” that also creates a purpose for why they’re experiencing that pain. That cognition, putting it into the rubric of who that person is, what their new self-identity is as an individual, living with chronic pain, it allows things to click into place and allows someone to have the self-efficacy to move forward within this new self-identity that they’ve developed because they’ve established meaning behind it.
I’m a big fan of your research and in one of your research articles you say, “The spiritual media is of spirituality and religion. In this particular study, we focused on one of four phrases. God is peace, God is joy, God is good, and God is love. All four phrases express a sense of goodness, support, and comfort for the participants in the study.” When I read that, it’s important because we don’t know what people are saying or “doing” in their head when they’re doing a spiritual practice.
That is certainly one of the challenges when we look at these large epidemiological studies and we say that people are using spiritual meditation or they’re using prayer. We don’t know necessarily what prayer they’re using or what type of spiritual meditation they’re using. That’s the hazard when you get a database of 20,000 people. You can’t ask that many detailed questions sometimes for a large database. We don’t know what they’re doing. When we can break it down into a smaller study and control what is being said or what is being used as the focus for somebody’s spiritual meditation, then we have a little bit more control over that. What I loved about that study that you’re referencing is we had similar statements in the positive secular meditation technique as well. On the spiritual side, we had phrases such as, “God is love.” On the secular side, we had phrases such as, “I am loved.” We still have the positive emotional component and the only thing that we changed was the target.
Was it an internal self-target or was it a higher power target? Individuals were allowed to change the word God if that wasn’t what they considered the focus of their higher power. For the spiritual one, it was whatever their higher power was, it became, “A lot is love or Mother Nature is love,” versus, “I am loved.” Changing that one word and changing that focus allowed individuals to potentially tap spiritual resources that otherwise they wouldn’t have access to. We saw significant difference after four weeks in how people experienced pain, the level of frequency of their pain, the severity of their pain, and how much control they felt like they had over their pain based on changing one word, which I thought was exciting and fascinating at the same time.
If you look at things like “act” and you start to figure out how words have meaning and symbolism, it’s so important. That research is great. When people talk about spirituality nowadays, a lot of people look at their meditation practice as a spiritual practice, which it is. There are two types of meditation. One is focused attention, the other is open monitoring. Those are fancy technical terms, but they are an important distinction when it comes to spiritual practice because one has been not proven but is showing it to be more effective when it comes to pain relief. Can you talk about that for a moment?
Whenever I’m working with patients, I do a 2×2 grid. What are you doing cognitively? Are you doing a tight focus on something, whether it’s a meditation on a candle flame, meditation on a specific passage or is it more of an open awareness such as the mindfulness techniques? On the other part of the 2×2 grid, are you moving or are you still? There are some beautiful techniques that involve movements such as Tai chi, Buddhist walking meditation, and things along those lines or are you sitting quietly? When I work with patients, one of the first things that I tell them is that thousands of different cultures have literally practiced thousands of different types of meditation techniques for thousands of years. We can find one that’s going to fit you and is going to work for you. Even today, we also get a lot of patients that walk in my office. If I say meditation, they still have this concept that they need to be sitting still in the Lotus position for an hour at a time. That’s sometimes concerning or even frightening for them. I always start with that phrase whenever I’m working with patients trying new meditation techniques.
In the research literature, the more open and the more mindfulness components of it are being supported in the literature quite widely. From UMass, we have the mindfulness-based stress reduction program which uses a tight prescribed series of meditations over the course of eight weeks. For eight years I was a faculty member at it, at UMass Medical School. I’d occasionally joke with my MBSR colleagues that, “I love what you’re doing but you realize the Buddhists had it first, right?” Everything you’re doing, the Buddhists had at first. Certainly, they’ve done a wonderful job of supporting that in the research literature of the mindfulness techniques that have been shown to be useful in helping with pain management.
My approach to that is usually that it’s more about finding the right meditation approach for each individual patient rather than prescribing and saying, “This is the right approach for all patients,” or “That is the right approach for all patients.” I want to work with the meditation techniques more with an individual patient to find out what feels right for them. If it doesn’t feel right for them, they’re not going to do it. This is something that I’ve tried when I was younger in my career, I would say, “This is the meditation technique that just came out. It’s greatly supported. It’s wonderful. You have to do this,” and if it doesn’t fit with their lifestyle, their personality, their view of the world, they’re not going to adhere to it. They’re not going to do it. I’d rather have the technique that allows the individuals to continue to practice that technique rather than having a specific right technique. Usually I’ll go to the research literature and find out, “These are the two or three that have been empirically supported. Do any of these feel right for you?” and try to encourage them to use one that has been empirically supported.
In many ways, I liken it to carrying something heavy. In the era before rolling suitcases, we’ve all probably carried heavy backpacks or heavy luggage at some point. You’re carrying it and your arms starts feeling extremely tired after a while. If you put it down and rest for a minute, you can pick it back up and for some reason that backpack doesn’t feel as heavy as it did ten minutes before. It’s not because the backpack changed. It’s not because the weight of what you’re carrying changed. It’s because you had a rest and that is in many ways what meditation is also, in addition to the other positive biology that’s happening. That’s what meditation is allowing to have happen in your brain. You’re allowing your brain to put down the burdens that you’re carrying, chronic illness, chronic injury, chronic pain. Rest for a few minutes and then pick it back up. When you pick it back up, it doesn’t seem as heavy as it was when you put it down, not because the weight of the burden that you’re carrying, but because you’re more rested and you’re better able to approach it and you’re better able to use the other techniques that you’re hopefully learning in pain psychology therapy.
When you look at definitions of what mindfulness is or what meditation is, sometimes no one understands what any of that means. When you talk, when you put it in a metaphor like that, it’s something that most of us can latch onto and then understand what it is. There’s a question that I have to ask you before you leave because obviously your work focuses on why and how spirituality is important. The question is how can the average practitioner, let’s say not a psychologist, integrate spirituality into their practice? Should they be doing that?
This is a question that I work with a lot; particularly I work with a number of family care providers as well as palliative care and oncologists that are working not necessarily hospice but with advanced cancer patients where the concept of spirituality may become the elephant in the room at times. I’m often asked, “How would I begin to do this?” and if so, “How do I make sure that I’m doing it right? I’m not trained for this so what would I do with that?” The first step is always listening to the patient. It’s not about the providers’ belief system; it’s about listening to the patient’s belief system and being able to enter their world and asking them, “How does your religion or your spirituality affect the care that I may be providing to you?” or, “Is there something else that we can provide that we’re not providing?”
It’s not asking the provider to become the spiritual resource for that individual, especially if they’re not trained. It runs the risk of evangelizing the provider’s own belief system. It runs the risk of the provider feeling like they have to be all things to that one patient and trying to do it in a fifteen-minute care appointment when it’s not possible or feasible. It is about asking the question and having resources available, and knowing what resources are available in your community to refer. If you do have a patient that is in spiritual distress, how would you know that? First step is by asking the question, “How does your religion or spirituality affect the care that I might give you today? How would you like that to affect the care?” The patients may say, “It’s not.”
Other patients may disclose that they are experiencing a lot of struggle and the provider’s role is to listen, be that listening ear and then refer to somebody who is trained. Whether that’s a psychologist that has experience working with psychology of religion concerns, whether that is a chaplain or some spiritual provider that also has training and experience in both spiritual direction as well as counseling approaches, making sure that you have made that list of resources available or that you know somebody who has that list of resources that are available. The other piece to keep in mind is a lot of ministers, rabbis, religious individuals may not necessarily get training in psychotherapy or counseling as part of their training process to become a religious leader. Referring somebody back to their religious leadership may not always be the most effective way.
Plus, if they are having spiritual distress, it may be related to something that’s going on in their religious community as well. Making sure that you have those referral sources that can enter that patient’s world and into their psychospiritual world and help them through whatever struggles they’re going through. Some of it may be coming from their religious communities themselves and so just referring back to the original religious community may not be the most appropriate or the most adaptive approach for that patient.
That one question that you mentioned a couple of moments ago, any practitioner can take that and put it on their intake form. The patient can answer it in their own words and then you can glance down at it and see is this something that could help this patient cope with their pain or is it something that at this point the patient is not interested in. It’s not going to be the focus of care at that moment. It’s been great having you on. It’s a fascinating topic. Obviously, you are the go-to for it. If people want to learn more about you, your work, all your research and your practice, how can they find you?
You can go to the University of Colorado Denver website and search for Amy Wachholtz. I have two different websites, one that’s more focused on who I am as a faculty member and then I have one that’s more focused on my lab and the research that’s happening right now in my laboratory. Those are both through the University of Colorado Denver website. Not to be confused with the University of Denver website, as many people confuse those two universities, but the University of Colorado Denver website.
You can explore more of Dr. Wachholtz work on spirituality and pain in the book below Healing with Spiritual Practices.
She authored a special chapter on chronic pain.
I want to thank Amy for being here on The Healing Pain Podcast. Talk about a great topic. I ask you to please make sure you share this out with your friends and family. If you’re reading and you’re a first-time reader, make sure you sign up for the podcast. You get on the mailing list, I send out a new podcast and other great information every week on how you can treat your pain 100% naturally. I want to thank all of you. I’m Dr. Joe Tatta and we’ll see you next time.
About Amy Wacholtz
Dr. Amy Wachholtz is an Assistant Professor of Psychology at the University of Colorado Denver, affiliate faculty with the Addiction Treatment and Research Service in the Psychiatry Department of University of Colorado Medical School, adjunct Assistant Professor of Psychiatry at the University of Massachusetts Medical Center, and a licensed clinical psychologist. Dr. Wachholtz graduated with a Master of Divinity degree from Boston University and a specialized graduate degree in Bioethics from a joint Harvard University and Boston University program. She the continued her education to earn her MA and PhD in Clinical Psychology from Bowling Green State University where she had a dual specialization in Behavioral Medicine and Psychology of Religion. She completed her internship through fellowship training at Duke University where she focused on medical psychology and pain management. She also recently completed a post-doctoral Master’s degree in Psychopharmacology. Her research and clinical interests focus on 1) the bio-psycho-social-spiritual model for chronic pain disorders and palliative care, and 2) the complexities of treating of co-morbid pain and opioid addiction in both acute pain and chronic pain situations. Her research encompasses bench to bedside methodology from psycho-physiological research methods to testing improved patient treatments and has resulted in over 100 publications and presentations. She enjoys teaching trainees of all levels in classroom, laboratory, and clinical settings.
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