The physiotherapy practice can not run without a theory framework. The meaning of the consonance and dissonance theory for the cognition of pain
Prof. dr. Rob Oostendorp, revalidatiewetenschapper, fysiotherapeut | Dr. Han Samwel, klinisch psycholoog
Patients with (chronic) pain are often limited in following the advice to (continue to) exercise and remain physically active. This may have a negative impact on treatment outcomes. However, so far in the literature no valid explanation for this limited adherence has been presented. A possible theoretical explanation is sought in the cognitive dissonance theory. This theory shows that communication between the therapist and the patient may maintain complaints. Many patients with chronic pain suffer from pain-related fear and tend to avoid pain inducing exercises and activities, including pain inducing instructions for practice outside the therapy session. In contact with the physical therapist, the patient experiences signals which may serve as a legitimation to avoid the exercises and physical activities. Physiotherapists themselves are often more or less anxious to induce pain. In their communication with their patients, they may, often unconsciously, express their own fear cognitions in the form of verbal, para- and non-verbal signals to the patient. Although the therapists may see these signals as expressions of empathy and thus therapeutic, the patients may interpret these signals as a justification of their own fear of pain and accordingly as a justification of their avoidance behaviour. This concurrence in and corroboration of each other’s fear cognitions is termed iatrogenic symbiosis. Preventing iatrogenic symbiosis and thus increasing the adherence of patients can be achieved by consistently ignoring pain signals from the patient, both verbally and para-and / or non-verbal. Empathic acting within the therapeutic relationship should therefore be defined as professional ability to act consistent with achieving the treatment goals in the longer term. In this way, being aware of iatrogenic symbiosis may act as a springboard towards an optimal treatment outcome.