Monday April 22 2013
Paracetamol is good for physical pain, not existential dread
"Popping paracetamol could also help treat EMOTIONAL pain," is the surprising suggestion on the Mail Online website.
In this study, "emotional pain", also referred to as "existential dread", was taken to be distress experienced during perceived threats to our existence or world view. This study tested two related concepts:
- whether emotional pain causes distress that people then feel the need to compensate for
- whether painkillers such as paracetamol can dull this emotional pain, lessening the need for compensation
The researchers tested their theory on two groups of psychology students who were placed under two very specific examples of existential dread. These examples were:
- asking people to contemplate their own death, and
- watching an unsettling surrealist film by director David Lynch.
They were then asked to assess two compensation mechanisms – hypothetically either setting bail for a prostitute or setting punishment for rioters. The researchers found that people who had taken the paracetamol did not seek as much compensation (punishment). The researchers say that this implies that paracetamol reduced emotional pain and lessened the desire for compensation.
As interesting as this study is, it certainly should not be regarded as a recommendation to take paracetamol on a regular basis in order to cope better with emotional pain.
Where did the story come from?
The study was carried out by three researchers from the University of British Columbia, and was funded by the Social Sciences and Humanities Research Council of Canada.
The study was published in the peer-reviewed journal Psychological Science.
The Mail Online website has exaggerated the findings of an interesting if very unusual psychological study looking at how paracetamol may blunt psychological response to stress.
The two experimental scenarios used in the study are highly unlikely to occur in most people’s day-to-day experiences. So the results of the study arguably have little to no ‘real-world’ application.
Also, the reporting could give the impression that emotional painkilling is a unique effect that this particular brand of paracetamol (Tylenol) has been found to have. In fact, this is just the brand of paracetamol (or acetaminophen as it is called in the US) that the researchers happened to use in their study.
The news report from the Mail Online also quotes the author of the research paper as saying that the results may shed light on chronic anxiety. As this study was not in people with chronic anxiety it cannot tell us what the effects of paracetamol would be in people with anxiety.
Perhaps most importantly, the Mail Online does not make it clear that paracetamol has not been through the formal testing and application process required for it to be approved by drug regulatory bodies as an effective treatment for “emotional pain”. It is irresponsible not to highlight the risks of taking paracetamol outside of its approved use.
What kind of research was this?
The current research investigated “the common foundation that underlies people’s reactions to various kinds of events that cause anxiety, unease and pain”. The theory is that we get distressed when we experience events that are surprising or confusing, or in complete opposition to what we had been expecting. This leads us to find ways to ‘compensate’ for this unpleasant arousal, or make it better. The researchers call this the “meaning-maintenance model” (MMM).
However, as the researchers say, in many cases it is not possible to resolve or compensate for unpleasant experiences we have suffered, often because the situation is too difficult or because we have not clearly identified the precise aspect that’s making us so distressed.
The researchers say that the area of the brain that responds to physical pain (the dorsal anterior cingulate cortex (dACC) is also the area of the brain that responds to ‘social pain’, such as rejection. Therefore, they theorised that as paracetamol can reduce physical pain, it may also have an effect on social pain, and could be effective for preventing the meaning-maintenance response. They predicted that if a person took paracetamol and then experienced a social threat, such as rejection, then the resulting “emotional pain” from the threat would be dulled, and so they would not seek compensation for this threat. They conducted two experiments using different threats to examine this.
What did the research involve?
Experiment one: contemplating death
This study involved 121 people, of whom 67% were female, and the biggest group (45%) were of East Asian origin. They were recruited from university psychology classes. The participants were made aware of the aims of the study – to look at the cognitive and emotional effects of paracetamol.
Participants in the study were randomly assigned to a single dose of either paracetamol (1g of a rapid release tablet from the Tylenol brand) or 1g of sugar placebo in a similar gel capsule. They were then given 30 minutes’ free time before being asked to complete 25 minutes of ‘filler tasks’ (such as completing sudoku puzzles).
The participants then took the main test, in which they were asked to write about either:
- what would happen to their body after they died, and how they felt about this, or
- about dental pain (as a control).
Thoughts about death are believed to produce a unique type of anxiety – often described in the field of philosophy as ‘existential dread'. The writing task about dental pain was used as a control because it was thought it would stimulate unpleasant associations but not surprising or confusing associations. The researchers theorised that using this control would help rule out negative mood as an explanation for any findings.
The participants were then asked to complete a questionnaire to assess how they were feeling at that time. This consisted of questions such as “how many times have you felt excited/proud/upset/afraid over the course of the last week”.
To assess any “compensatory” response to the distress, the participants were then asked to read a hypothetical arrest report about a prostitute and were allowed to set the amount for bail (on a scale from $0 to $999). The theory was that people who had experienced the ‘threat’ (of writing about their own death) would set a higher bail.
Experiment two: surrealism
This second experiment focused on the concept of surrealism, which involves the juxtaposition of unfamiliar elements in familiar settings.
For this experiment 207 students were recruited, of whom 60% were female, and most (52%) were of European origin. They were recruited in the same way as the participants in the first experiment. They were also randomly assigned to receive paracetamol or placebo.
This time participants in the ‘threat situation’ group first watched a Donald Duck cartoon. They then watched a short film called ‘Rabbits’ by the director David Lynch (most famous for his surrealist thriller ‘Blue Velvet’). This film first seems like a sitcom, but consists of a seemingly unrelated sequence of events with random laughs and applause, long pauses, eerie landscapes, people in rabbit costumes and no narrative. Overall, the clip is said to seem ominous, despite having no reference to disturbing topics. After ‘Rabbits’ the participants watched a Snoopy cartoon as a distraction. People in the control group watched The Simpsons rather than ‘Rabbits’.
The compensatory assessment this time was to look at the participants’ response to a recent and well-publicised local riot. They were asked about the punishments that should be given to the rioters – the theory being that those who experienced the threat would be less lenient.
What were the basic results?
As the researchers had expected, only those who had experienced the ‘threat’ (writing about their own death), and had taken placebo showed evidence of seeking compensation for the threat (setting a higher bail). People in this group set the bail at a significantly higher amount than the other three groups.
People who had to write about death but who had taken paracetamol did not differ in their compensation-seeking from those who had written about the dentist. Those who had written about the dentist did not differ from each other in their compensation-seeking regardless of whether they had taken paracetamol or not.
Similarly, in this study only people who had experienced the ‘threat’ of seeing ‘Rabbits’ and had taken placebo showed evidence of seeking compensation for the threat (wanting higher punishment for the rioters). Meanwhile, people who had watched ‘Rabbits’ but had taken paracetamol did not differ in their compensation-seeking from those who had watched The Simpsons. Again, there was no difference between paracetamol and placebo groups among those who had watched The Simpsons.
How did the researchers interpret the results?
The researchers say that in both of their studies, participants who had been placed under ‘threat’ conditions and taken a placebo showed “typical compensatory affirmations by becoming more punitive toward lawbreakers”, whereas those who had taken paracetamol did not, and neither did those in the control groups who did not experience ‘threat’.
This is an unusual psychological study, and has no obvious implications for medical practice or everyday life. It certainly does not mean that people who are going through distressing life situations – or who anticipate that they may experience distress – should take paracetamol.
These were two highly experimental situations with two very specific ‘threats’ – writing about your own death or watching an unsettling film. The researchers also assessed two very specific ‘compensation’ mechanisms – hypothetically setting bail for a prostitute or setting punishment for rioters. These are not necessarily representative of the various distressing and unexpected experiences that we may encounter in our everyday lives. Nor do they represent how we may respond to unpleasant experiences or ‘compensate’ to make ourselves feel better.
Even the results for these specific scenarios may not have been the same had another sample of people been assessed rather than these psychology college students.
This study is not a green light for taking paracetamol inappropriately. Paracetamol – when used correctly – is an effective medication for treating pain and fever, and has formal approval from drug regulators for use in this way.
It is not appropriate to suggest that paracetamol can be taken for any possible effects on emotional pain and feelings of distress. It has not been formally tested or approved for this use. It is also important to highlight that paracetamol can be dangerous when taken in quantities higher than the recommended dose.
If you are having difficulty coping with feelings of anxiety and stress speak to your GP for advice.
Read more about stress, anxiety and depression in the NHS Choices’ Moodzone.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.