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Mapping the Affective Dimension of Embodiment With the Sensation Manikin

Validation Among Chronic Pain Patients and Modification by Mindfulness-Oriented Recovery Enhancement

Hanley, Adam W. PhD; Garland, Eric L. PhD

doi: 10.1097/PSY.0000000000000725

Objective Mindfulness-based interventions target novel pain relief mechanisms not captured by legacy pain scales, including 1) cultivating awareness of pleasant and neutral sensations proximal to unpleasant sensations and 2) interoceptively mapping sensation location and spatial distribution.

Methods We created a digital sensation manikin (SM) by overlaying a human figure silhouette with a grid of 469 “sensation” pixels. A series of five research questions examined the SM’s discriminant validity, construct validity, incremental validity, convergence with an objective measure of pain attentional bias, and sensitivity to a mindfulness-based psychological treatment, Mindfulness-Oriented Recovery Enhancement (MORE). A sample of opioid treated chronic pain patients (n = 108; age, 53.79 (12.94) years; female, 65%) was recruited to answer research questions 1 to 5, and a sample of healthy controls (n = 91; age, 36.47 (13.50) years; female, 55%) was recruited as the comparison group for research question 1.

Results Chronic pain patients reported significantly more unpleasant sensations than did healthy controls (p < .001, d = 1.23) and significantly fewer pleasant sensations (p = .001, d = 0.50). The SM also evidenced expected relationships with multiple measures of pain (r = 0.26–0.29) and well-being (r = −0.21 to 0.28), uniquely predicted pain interference (β = −0.18), and exhibited a significant association with pain attentional bias (r = 0.25). Finally, mindfulness-based intervention via MORE significantly increased the ratio of pleasant to unpleasant sensations reported by chronic pain patients relative to an active control condition (p = .036, d = 0.51).

Conclusions This study supports the SM’s validity and indicates that assessing both pleasant and unpleasant sensations broadens the scope of pain measurement. Although the SM would benefit from further optimization, its continued use is likely to contribute to improved assessment and treatment options for chronic pain patients.

From the College of Social Work (Hanley, Garland), University of Utah, Salt Lake City, UT.

Address correspondence to Eric L. Garland, PhD, College of Social Work, University of Utah, Center on Mindfulness and Integrative Health Intervention Development, 395 S. 1500 E. RM 275, Salt Lake City, UT. E-mail:

Received for publication January 4, 2019; revision received April 15, 2019.

Online date: July 2, 2019

Copyright © 2019 by American Psychosomatic Society
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