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411
ISSN 1758-1869
Pain Manag. (2016) 6(5), 411– 414
REVIEW
part of
Pain Management
10.2217/pmt-2016-0028 © 2016 Future Medicine Ltd
EDITORIAL
Generalizing, deleting and distorting
information about the experience
and communication of chronic pain
Mark I Johnson*,1 & Matt Hudson2
KEYWORDS
• chronic pain • frameworks of
communication • neurolinguistic
programming
There is growing support for a shift in
chronic pain management toward a patient-
centered approach that accounts for the
lived experience of the person. A review
of research using interpretative phenom-
enological analyses of the lived experience
of people with chronic pain found that
they had challenges understanding their
self-identity and sense of moral worth [1] .
Disbelief of others that a person has chronic
pain results in emotional distress, isolation
and stigma that is perceived as a challenge
to that person’s integrity and identity [2].
A meta-ethnographic synthesis of the find-
ings of qualitative research investigating
the experience of people with chronic low
back pain has found that people struggle
to reconcile the self with their persistent
pain revealing a need for further research
on pain and social identity [3] .
A person’s mental map of themselves
and their world, including their underly-
ing thinking, affects their final experience
of pain. This mental map is reflected in the
language used by people in daily conversa-
tion, including the stories they tell (narra-
tives) about their pain experience. In the
social sciences narratives are used to study
a person’s experience of illness, including
pain, to provide insights into the social and
cultural underpinnings of their physiologi-
cal reality [4 ]. Narratives used by people to
describe their experience of living with pain
help in the understanding of a person’s core
values and the meaning they attribute to
the pain [5] . However, people rarely com-
municate events and experiences as they
actually happen but describe the event by
generalizing, deleting and distorting infor-
mation. Filtering information in this way
influences the person’s future thinking,
core values and health and well-being. The
purpose of this editorial is to discuss the
influence of generalizing, deleting and dis-
torting information when people describe
their experience of persistent pain in rela-
tion to communicative frameworks during
consultations.
First draft submitted: 29 June 2016; Accepted for publication: 12 July 2016;
Published online: 1 August 2016
1Centre for Pain Research, School of Clinica l & Applied Sciences, Leeds Beckett University, City Campus, Leeds,
LS1 3HE, UK
2Mind International Training Associates, Wallsend, Tyne & Wear, Wallsend, UK
*Author for correspondence: Tel.: +44 113 812 3083; M.Johnson@leedbeckett.ac.uk
“...Pain practitioners are more
likely to establish what pain
means to a person if they are
able to understand the
person’s experience and the
context within which it is
situated.”
“There is growing support for a
shift in chronic pain management
toward a patient-centered
approach that accounts for the
lived experience of the person.”
For reprint orders, please contact: reprints@futuremedicine.com
Pain Manag. (2016) 6(5)
412
EDitORial Johnson & Hudson
future science group
“The eyes will only affirm or deny what your
mind believes.”
– Matt Hudson [6]
The concept of generalizing deleting and dis-
torting information during communication was
developed as a central tenet of the meta-model
of neurolinguistic programming (NLP). NLP
was developed in the 1970s as a neurological
language and behavioral approach to commu-
nication, personal development, counseling
and psychotherapy [7] . NLP practitioners seek
to improve well-being by influencing mental
(subjective) representations of experiences and
to encourage them to imitate ‘healthy skills’.
Subjective representations of a person’s expe-
riences can be modified through introspec-
tion and are expressed through language and
behaviors. NLP is popular within sporting
and business environments, but is also used as
an adjunct in the management of depression,
phobias and habit disorders. NLP training is
informally regulated and accredited at diploma,
practitioner and master practitioner level by
The International NLP Trainer’s Association
and by The Association of NLP in the UK.
Sturt et al. [8] reported that spending on NLP
training within the National Health Service
trusts in the UK was modest and mostly by
administrative and managerial staff. NLP-
based counseling services have been devel-
oped in some National Health Service trusts
for weight loss, substance misuse and smoking
cessation, although NLP has not been approved
by NICE because of a paucity of research on
effectiveness for health-related outcomes.
Sturt et al. [8] conducted a systematic review
that included ten studies on anxiety disor-
ders, weight maintenance, morning sickness,
substance misuse and claustrophobia during
MRI scanning. They concluded that there was
insufficient evidence to support the allocation
of resources to NLP therapy outside of research
purposes. Five randomized controlled trials
were included in the review and four of these
randomized controlled trials found no signifi-
cant difference between NLP and comparison
groups. One study found improvements in ‘psy-
chological difficulties’ compared with a waiting
list control [9] . Moreover, there has been criti-
cism of the theoretical underpinning of specific
aspects of NLP leading to claims that NLP is
pseudoscience [1 0] . For example, some propo-
nents of NLP claim that there is a relationship
between eye movements and thought, although
the paucity of experimental research that exists
does not support this claim [1 1, 12] .
Skepticism of the theoretical underpinning
techniques adopted by NLP practitioners cou-
pled with a lack of evidence for clinical effec-
tiveness has resulted in NLP being ignored by
mainstream medicine. Pain practitioners use
various psychological approaches to help people
manage persistent pain with cognitive–behav-
ioral therapy – the foundation of most practice.
Cognitive–behavioral therapy is delivered over
a series of sessions to develop adaptive cogni-
tive and behavioral pain coping skills, including
restructuring of maladaptive cognitions, appro-
priate goal setting stress management through
relaxation, breathing and visual imagery, and
effective use of social reinforcement. Recently,
however, there has been renewed interest in the
use of NLP in primary care settings as part of
communication frameworks used to influence
thinking and behavior [8,1 3]. We are interested
in the use of NLP to explore a person’s mental
map of themselves and their world. By explor-
ing how underlying thinking affects the mental
map, it may provide a novel approach to aid a
person’s reconceptualization of pain. The foun-
dation of NLP is a pragmatic communications
model (the meta-model) suggesting that we do
not communicate our experiences faithfully.
Rather, communication and thinking is modi-
fied through filters that generalize, delete and
distort information providing people with ‘short
cuts’ when analyzing incoming information
enabling them to survive in the information
overload of modern society. However, these fil-
ters can limit the view of oneself and the world
in which we live.
Persistent pain and suffering affects a person’s
sense of self by interfering with cognitive, affec-
tive and behavioral processes threatening the
identity of the person [14 ] . Self is not a single
entity but rather a construction of a variety of
aspects of self, including, for example, self in
the past, present and future; actual and ideal
self; and how others see oneself. This sense of
self develops over time from beliefs and values
of oneself and others. Persistent pain and the
self become enmeshed to create a self-identity
of ‘pain patient’. Morley [14 ] provides evidence
that people with persistent pain may be suscep-
tible to preferentially respond to certain types
of information (cognitive biases) because pain
and the self were intertwined. Thus, diagnoses
“The development of
communication
frameworks with
a patient-centered
focus ... are more likely to
result in accurate diagnosis
of factors influencing pain
and disability resulting in
pain management
solutions tailed to the
specific needs and
viewpoint of the patient.”
413
Generalizing, deleting & distorting information about pain EDitORial
future science group www.futuremedicine.com
and pain management solutions, especially in
relation to lifestyle changes, offered by practi-
tioners may be misinterpreted by pain patients
as judgments on their beliefs, values and sense
of self. These cognitive biases are associated
with generalization, deletion and distortion of
information related to events and experiences.
Generalization is the process of making gen-
eral conclusions about an event by attributing
the experience of one event to the entire cat-
egory of which the experience was an exam-
ple. Generalization is useful because it enables
individuals to apply overarching principles to
single events and enables rapid adaptation to
novel situations. For example, from an early age
we know how to open doors because we general-
ize the outcome of the experience of ourselves
and others using doors. Generalization helps
to generate beliefs and, therefore, they may be
dangerous in certain contexts. For example, the
act of one person from a particular group can
be generalized to represent the act of all people
from that group as seen in racism, sexism or
nationalism. Generalization may hamper posi-
tive self-beliefs and positive emotional states by
establishing rules that are detrimental to health
and well-being. For example, generalization may
reinforce maladaptive behaviors such as fear-
avoidance of movement because of the gener-
alization that moving causes pain which causes
harm. This generalization is beneficial imme-
diately following a traumatic injury because it
will prevent further tissue damage and promote
tissue healing. However, the generalization can
be disadvantageous for long-term nonspecific
chronic musculoskeletal pain where the drivers
for pain are not strongly coupled to damage in
peripheral tissue. Hence, g eneralizations may
manifest as phobias.
Deletion is the process of filtering out infor-
mation by omitting details from events through
selective attention of certain aspects of an expe-
rience. Deletion enables people to focus on the
critical aspects of our experiences and to ignore
the vast amount of less important information
encountered in daily life. However, there is
a danger of deleting (ignoring) information
that is considered meaningless when it is not
and this may impact negatively on the preci-
sion and accuracy of information conveyed to
oneself and to others. Distortion is the process
of misrepresenting incoming sensory informa-
tion and modifying the meaning, interpreta-
tion and description of events and experiences.
Distortion is mediated by cognitive biases
where people fail to adequately assess their
capabilities, resulting in illusory inferiority or
superiority (i.e., Dunning–Kruger effect). The
process of distortion influences a person’s self-
image where people interpret experiences con-
firm pre-existing beliefs, even if these beliefs are
not necessarily representative of reality. People
often have a distorted self-image of themselves
and this can reinforce illness and hinder well-
being. People with long-standing unresolved
pain often have a negative self-image of them-
selves. Thus, cognitive biases associated with
generalization, deletion and distortion affect an
individual’s sense of self and may contribute to
self-sabotage whereby thoughts, attitudes and
behaviors prevent individuals achieving their
desired goals.
Systematic reviews of show that interactions
between patients and practitioners during con-
sultations are critical for positive health-related
outcomes [15] . Pain practitioners are more likely
to establish what pain means to a person if they
are able to understand the person’s experience
and the context within which it is situated. The
development of communication frameworks
with a patient-centered focus, such as ideas,
concerns and expectations [16 ] , are more likely to
result in accurate diagnosis of factors influenc-
ing pain and disability resulting in pain man-
agement solutions tailed to the specific needs
and viewpoint of the patient. To date, little
attention has been given in research literature to
frameworks of communication adopted by NLP
practitioners such as cognitive processes that
generalize, delete and distort the communica-
tion of experiences of pain patients and how this
affects the mental map of themselves and their
world. We hope that this editorial will catalyze
interest in this field.
“Thought defines who you are today and can
sabotage who you can be tomorrow.”
– Matt Hudson [6] .
Financial & competing interests disclosure
M Hudson is Director of Training at Mind International
Training Associates. The authors have no other relevant
affiliations or financial involvement with any organiza-
tion or entity with a financial interest in or financial
conflict with the subject matter or materials discussed in
the manuscript apart from those disclosed.
No writing assistance was utilized in the production of
this manuscript.
“...little attention has been
given in research literature
to frameworks of
communication adopted
by neurolinguistic
programming practitioners
such as cognitive processes
that generalize, delete and
distort the communication
of experiences of pain
patients and how this
affects the mental map of
themselves and their
world.”
Pain Manag. (2016) 6(5)
414
EDitORial Johnson & Hudson
future science group
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