With the previous post on meaning, this classic noinote from 2010 seemed apt for a Flashback.
Big brain shifts
Can you recall a time when you have had a sudden and massive shift in thinking ‘when the lights really went on’? We are often asked about the possibility of big learning shifts during one on one therapy sessions (manual or education therapy), or in group education sessions. People ask, “can someone really just get the explain pain message instantly and have a huge cognitive shift with beneficial behavioral changes?” It kind of goes against traditional Hebbian concepts of learning as an incremental event of synapses “firing together and wiring together”. These rapids shifts, if they do occur, are too fast to attribute to wiring changes. Something else is going on!
Reflecting on patients
A patient with a complex and chronic pain state once said after an education session “I don’t need to be here any more, all I wanted to know was that moving, especially gardening won’t cause any damage”. Another chronic pain sufferer, after two sessions including a well explained physical examination said “so I don’t need all my pain, do I?” These are big shifts, often leading to huge behavioral changes.
I am sure our psychology readers will find this all very familiar, but this possible radical cognitive restructuring is worth reflecting on in terms of the new biological education strategies being proposed and possible mechanisms. We are seeking help here with your input and experiences.
It’s not just in the clinic
These sudden and large conceptual shifts happen though our life, mostly when young. I recall my mother saying very offhand to me, “of course you know that Santa Claus is not real”. It just happened that the death of Santa had not yet clicked in my brain, and this startling new knowledge required a massive conceptual shift for me – including the place of the easter bunny, parental lies, and what the other kids must have thought of me. An expert in the conceptual change field, Michelene Chi noted that when you learn that electricity is a process and not a substance, you change a lot of your related thinking. We sampled our office staff about big shifts. One said, “when I realised that being gay is OK and not a disease it changed a lot”. Another said, “I had panic attacks and when my doctor told me it’s nothing harmful and I was panicking about having panic attacks, so much changed in my life.”
Radical and incremental conceptual change
Conceptual change theorists such as Gale Sinatra and Paul Pintrich talk of two kinds of change as we learn – an incremental change with a gradual enrichment of knowledge or a radical change. Radical change means completely replacing an old concept with a new one – there must be an awareness of major anomalies that no longer make sense with existing thoughts and beliefs and it therefore requires considerable questioning of the person views. Nobody knows what happens in the brain – it is unlikely that a module of brain function is suddenly removed. After all, the person may want to revisit the old thoughts to check on the new concept from time to time and in different contexts. Perhaps in our brains with their multiple oscillations, the old cognitive event is no longer coherent with the oscillations and a new memory is rapidly made coherent (Başar 2005).
Perhaps the new brain knowledge can do it
From our own experiences and repeated anecdote, it appears that a radical cognitive restructuring is occurring in some patients via the power of the biological knowledge. There are a number of patient, clinician and contextual variables associated with such a change, but my growing belief is that the power of the neuroscience narrative can do it.Anecdotally, these are particularly powerful…
Pain is more related to how much danger you think you are actually in, not how much danger you actually are in (Lorimer Moseley’s Painful Yarns).
For health professionals – an awareness of pain is an output not an input and also the difference between nociception and pain can also initiate powerful and rapid conceptual change (David Butler and Lorimer Moseley’s Explain Pain).
I also think that radical conceptual change can hurt a bit. Just as I was hurt by the loss of Santa Claus, I feel that some clinicians who are making a change to biopsychosocialism and making the neuroimmune system the central system in rehabilitation instead of muscles and joints can experience some pain – all the clinical mileage can take some letting go.
Can you help?
Can you share your radical conceptual change experiences here – personally perhaps or in patient education. We would like to research it further. Is it safe, should we be seeking it? We would love to know your thoughts.
– David Butler, December 2010
Sinatra GM and Pintrich PR (2003) Intentional Conceptual Change, Lawrence Erlbaum Associates, Mahwah, New Jersey
Başar E (2005) International Journal of Psychophysiology 58: 199-226
– Tim Cocks