Dr. B's Blog

Guilt and pain

"When reminded of an immoral deed, people are motivated to experience physical pain."

This is the opening line of the discussion section in a recent article published in Psychological Science. The hook is alluring, isn’t it? Thinking about times that you were “bad” makes you want to punish yourself. I was attracted to this article for review because of my interest in working with self-injurious patients. There are two predominant reasons people engage in self-injurious behavior (SIB):

  1. He/She wants to regulate his/her emotions through distraction or
  2. He/She wants to punish him/herself for some perceived wrong or defect.

As a starting point in understanding SIB, these two perspectives are helpful. They give us a framework to begin to explain possible motivations and the function of that particular SIB. In other words, how do we get those needs met without having to engage in SIB?

The Article

Getting back to the article, the authors engaged in a simple experimental manipulation in which participants were assigned to either the recall of “immoral”[1] interpersonal behavior or more generic interpersonal behavior. Participants rated their affect using the PANAS[2] and then engaged in the pain part of the study. Following the painful/non-painful experience, their level of “guilt” was measured by completing the PANAS again.[3]

The researchers found that participants in the guilt inducing/pain condition expressed lower levels of guilty feelings after the manipulation, leading them to conclude that the painful experience caused a drop in guilt ratings.[4]

The participants in the guilt/pain condition also perceived more physical pain during the manipulation than those in the non-guilt/pain condition.[5]

Reading the Tea Leaves

The authors go on to claim that the motivation for causing pain is to reduce guilt. I believe they’ve got their conclusions backwards. Guilt is reduced because of the pain, not the other way around. Getting into divining motivation is a specious area at best. Unfortunately, I don’t see how the results of their study supports that explanation. This reading of the data is basically saying that the second of my two reasons for SIB listed above is the reason for engaging in the behavior. However, I believe that emotion regulation aspect of painful experience is not to be understated.

Pain as Emotion Regulation

The explanation of this article is a long way around to talk about my favorite therapeutic technique — mindfulness. Specifically, using mindfulness as a way to stop thinking about particular experiences can help reduce the intensity of those thoughts and the subsequent emotion. Rumination on particular misdeeds fires off a host of strong emotions and breaking into that ruminative cycle prevents continued emotional experience. In this particular case, the ice was an unavoidable mental focus and we can see support for this supposition in the subjective experience of the pain.

To further draw out the supposition, without too much of a stretch, we can say that people actively avoid thinking about times they did something “wrong”. When the participants were presented with a mental “out”, they took it. Ice is painful and it’s relatively easy to focus on pain. Focus on the physical pain increases the subjective experience of the pain. Two conclusions can be drawn from this:

*For those who were suffering from emotional pain as a result of the manipulation — those in the “guilt” condition — this physical pain was deemed to be less intense, so they focused on the ice.

For those in the non-guilt — those without emotional pain — the physical pain was more uncomfortable to they focused *away from it, leading to subjectively less pain.

Mindfulness as Emotion Regulation

The revealing thing about this article is that a mindful experience can be emotionally regulating. In DBT, we talk about using ice as a distress tolerance skill. This research, coming from a non-DBT perspective, corroborates that belief. I don’t believe that you necessarily need to subject yourself to physical pain to get the same sense of relief — you don’t need to punish yourself to feel better, at least all the time — you just need to be able to mindfully turn away from your rumination.

The process isn’t as easy as it sounds since being able to turn away from your ruminative thoughts is work. Our minds have a tendency to stick to things that we least like them to stick to. Cultivating mental control through regular practice and developing a sense of forgiveness and genuine caring for yourself can help. You should not let yourself violate your values if you can avoid it, but if you have, make up for it and then move on.


[1] The authors defined “immoral” behavior as ostracizing someone. I’d buy that as a particularly embarrassing experience.

[2] The PANAS is a well-validated measure of affect. I’m not sure how well it measures guilt, but since this is a peer-reviewed article, I’m going to give the authors the benefit of the doubt.

[3]This type of within subject/repeated measure design is common in psychological research. It’s designed to measure change across time or via experimental manipulation and has much theoretical support. It’s an especially powerful design because each subject is his/her own control.

[4]Given that this was an experimental design, causal conclusions are warranted.

[5]This finding, I believe, is particularly salient.