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Thus, multiple systems are likely to interact and mediate the pain-modulatory effects of expectancies.

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Interpersonal reconstructive therapy assumes that maladaptive personality patterns such as passive–aggressive behavior are a repetition of behavior that was once appropriate to the client within the context of his or her childhood family experiences.

Therapy involves recognizing these repeated patterns and understanding where they come from and why they continue. Benjamin works with a 53-year-old man who has a history of chronic pain and unstable employment.

However, unlike the actor, who remained in the role, actual patients are more responsive to the interventions and begin to collaborate and work on change.

In the year before the client, Arthur, was referred for treatment, his father had died and his youngest daughter was diagnosed with multiple sclerosis.

Pain is highly modifiable by psychological factors, including expectations.

However, pain is a complex phenomenon, and expectations may work by influencing any number of processes that underlie the construction of pain.

► Intervening processes such as attention, affect, and control need further study.

► Likely to be important differences between expectations about stimuli and expectations about treatments.

His claim for long-term disability was denied, however, and he returned to work after 3 months.

Still complaining of pain, Arthur was referred by the VA for treatment at a private pain management clinic.

Neuroimaging has begun to provide a window into these brain processes, and how expectations influence them.

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