The Impact of Validation (and Invalidation) on Pain in Young People and Adults

Session Title: The Impact of Validation (and Invalidation) on Pain in Young People and Adults

Topic: EXPERIMENTAL (NON-CLINICAL) HUMAN STUDIES

Description: One experience shared in nearly every story told by children and adults living with pain is that others did not believe them and denied their fundamental truth: their pain is real. This invalidation happens in every corner of society: in homes, schools, workplaces, and healthcare settings. This is especially true for minoritized and marginalized people (e.g., those who are queer, neurodivergent, racialized) who experience pain at disproportionately higher rates and are also far more likely to be invalidated, disbelieved, stigmatized, and denied pain relief. Such invalidation can have a significant and negative impact on the health and wellbeing of those individuals. Conversely, when someone’s pain experience is validated, this can have a powerful impact on their journey; it can impact cognitions, mood and behaviour, the perception of pain itself, and restore trust.
In this session, we present cutting edge empirical work identifying key interpersonal communications around validation and invalidation at different points in patients’ lifespan and their influence on socioemotional development, pain, and mental health. We start with findings from emerging longitudinal research examining (in)validation in videotaped interactions between 1.) parents and children (preschoolers; adolescents with chronic pain) while they reminisce together about past painful experiences and 2.) youth with chronic pain, caregivers, and clinicians during clinical encounters at a tertiary chronic pain clinic. Evidence for the role of (in)validation about pain experiences in the development of children’s empathy for another’s pain and their own clinical pain outcomes will be shared. A novel conceptual framework will be presented, providing compelling evidence to consider how validation of young children’s pain could be a modifiable social pathway to build children’s resilience against future chronic pain. Support for this framework is grounded in Linehan’s biosocial theory of emotion regulation. We will share the experiences of (in)validation from young people with juvenile idiopathic arthritis from across multiple social contexts, including the clinical encounter, while at school, and during peer-related activities. The impact of pain (in)validation on mental health, misdiagnosis, and family functioning for these young people will be discussed. Finally, we present evidence suggesting that immersive autobiographical memories of validating consultations in adults living with pain impact on recall capacity of health messages, while recounting memories of invalidating consultations increase self-reported interoception. These findings are interpreted in the context of known risk factors for exacerbation and maintaining pain, including fear, avoidance and hypervigilance.

Speakers

Sarah Wallwork Adelaide University
Australia

Dr. Sarah Wallwork is a Senior Research Fellow and physiotherapist within IIMPACT in Health and the Robinson Research Institute at Adelaide University. She leads a program of research that targets childhood to reduce the prevalence and burden of chronic pain in young people and adults. Her work explores the ecology in which a child is situated, including interconnected social, cultural and societal contexts, and how that may shape a child’s resilience against chronic pain. She has been awarded >$5m in funding, has published >45 peer-reviewed articles, has been invited speaker to 26 national/international conferences/seminars, and has been recipient of multiple national and international competitive scholarships. In 2021, she was named Field Leader in The Australian Research Magazine’s top researchers from 250 fields of research.

Tamar Pincus University of Southampton
UK

Tamar is a Professor in Health Psychology. Her research into psychological aspects of chronic pain spans over 30 years, has been cited by NICE guidelines, and has changed practice on the ground. She was the Director of the research centre for the study of pain and well-being at Royal Holloway, and a core member of the Consortium to Research Individual, Interpersonal and Social Influences in Pain (CRIISP), which focuses on how people perceive pain and how others affect their pain, as well as considering wider social and environmental influences on pain.. Her research includes experiment approaches to explore psychological mechanisms in pain, observation studies to measure risk over time, trials to test effectiveness, and qualitative work, to examine the thoughts and beliefs of people living with pain and those who are part of their life. Examples include investigations of cognitive biases in people living with pain; the psychological predictors for poor outcome in low back pain, and the study of clinicians’ beliefs and behaviours and their effect on patients with pain, especially in reference to effective reassurance and return to work. She has been a core team member of many randomized controlled trials, and regularly provides advice on behavior change. Her practical work has focused on training practitioners in effective communication skills and fostering awareness of patients’ psychological needs and concerns, and her on-line videos have been viewed widely across the world.

Steven J. Linton Örebro University
Sweden

Steven J. Linton is Professor Emeritus of Clinical Psychology whose research has focused on the role of psychological factors in the development and treatment of pain. Throughout his career, he has conducted influential longitudinal and clinical studies that have identified key processes in the etiology of chronic pain and disability.

His work has contributed to important theoretical advances, including the Fear-Avoidance Model and a model describing the interaction between emotions and pain. He has also been dedicated to translating research into practice, developing interventions across a variety of health care settings in collaboration with physicians, physical therapists, nurses, and occupational therapists.

Today, he continues to work with an international team of physical therapists, physicians, and psychologists. A particular area of interest is patient-provider communication, where he has pioneered research on validation and its role in health care interactions.

When he is not studying pain and communication, Steven can often be found enjoying the great outdoors, tending his self-sufficient garden, or nurturing his enthusiasm for trees. He firmly believes that both research and gardening require patience, persistence, and occasionally a willingness to dig a little deeper.

Melanie Noel University of Calgary
Canada

Melanie Noel, PhD, RPsych is a Professor of Clinical Psychology and the Director of Clinical Training (Clinical Psychology Program) at the University of Calgary. She directs the PEAK (Pain Education, Advocacy, Knowledge) Research Laboratory in Calgary, Alberta, Canada. Dr. Noel’s expertise is on children’s memories of pain, and intersections of pediatric pain, trauma, and mental health, as well as its intergenerational transmission. Dr. Noel adopts a bio-psycho-social-structural conceptualization of pain, which is rooted in early life trauma across generations, dismantles biomedical models that have stagnated progress, and embraces socio-cultural approaches to understanding and addressing pediatric pain broadly. In tandem, she partners with people with lived experience and community organizations to co-design trauma- and equity-informed solutions to prevent and treat this rising epidemic.

Dr. Noel published guiding conceptual models on pain memory development and the co-occurrence of trauma and mental health issues and chronic pain. She published > 265 papers in peer-reviewed journals (H index = 56). In recognition of her contributions to advancing knowledge of children’s pain, Dr. Noel received early career awards from the International Association for the Study of Pain (IASP), the Canadian and American Pain Societies, the Canadian Psychological Association, and the Society of Pediatric Psychology. She was named Avenue Magazine Calgary’s Top 40 Under 40 (Class of 2017), a Killam Emerging Research Leader (2020), and held the inaugural Killam Memorial Emerging Leader Chair (2021-2026). In 2022, she was inducted into the Royal Society of Canada’s College of New Scholars, Artists, and Scientists.

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