When our favourite team scores a goal, the physical sensation we describe as illation seems to mindlessly draw us collectively to our feet. On the other side, when we learn that we have been lied to, we say we are “Sick to the stomach” to describe the sensation of our gut tying in a knot as we experience the feeling we identify as betrayal. When someone we love informs us, “Oops, sorry, not the same,” the stab of pain in the heart is the only term that adequately captures words like sadness, despair, or shock. In fact, the neural correlates between physical and emotive pain experience have been understood in our vocabulary long before neuroscience explored this link: we are literally heartbroken with breakups, sick with worry, and burning with embarrassment. Through their research on human pain processing in the nervous system,” Eric L. Garland defines pain as, “A complex, biopsychosocial phenomenon” (2012), arising from many neural systems. It is “an unpleasant sensory and emotional experience associated with actual or potential damage,” whether that damage is observable or not (PubMed Central, 2012).
This paper will begin by examining the neural correlates between social and physical pain, explaining the brain systems these two sensations share or don’t share. Next it will focus on studies related to the articulation and perception of social and physical pain through the relationship between “feelings” and “bodily sensations” (Nummenmaa et al., 2013). Finally, it will shift to exploring some of the implications for this more integrated view of the pain-processing systems of the mind, such as how it is being applied in Cognitive Behavioural Therapy (CBT) to minimize painful experiences through understand its basis in biological survival instincts, positive social relationships, and mindfulness work. Overall, it will explore the question of what are the biological and socially adaptive components to our strongly correlated physical and social pain perception?
To begin, the research exploring the correlation between social and physical pain, especially the overlapping neural regions, aims to identify which brain regions are activated or not based on the negative emotionality perceived. In many ways, the hypothesis of connectivity appears intuitive in a lot of ways because pain is such an undeniable sensation- whether it is a visible wound or not. But this connection on a neurological level was identified and studied along three different parameters, namely pharmaceutical, cognitive, and linguistic studies (Moieni & Eisenberger, 2016, pp. 203-208)
The correlation between social and physical pain begins in understanding what exactly the biopsychosocial phenomenon of pain actually is. Garland offered the definition found in our introduction and goes on to outline the particulars of neural processing of pain. He calls it an, “unpleasant sensory and emotional experience (2012).” This outlines how pain is an experience perceived and categorized along two parameters.
Firstly, the sensory substrate describes the objective, detection and discrimination aspect of pain valuation. This is an analysis and appraisal of pain qualities such as location -where on the body do I feel this, quantity -how many painful experiences are there, and intensity -how much pain is there. It is the neural signaling that indicate that the unpleasant sensation has been detected (Eisenberger, 2012). It is therefore associated with the Primary and Secondary Somatosensory Corticals, where the level of activity detected in these regions is directly correlated to the intensity of the pain indicated (Moieni & Eisenberger, 2016, p. 205).
Secondly, there is the Affective Substrate of pain detection, which in contrast, is a subjective scale of pain perception. It is here where the brunt of our correlative research focuses. This substrate is processed by two particular regions of interest: the Dorsal Anterior Cingulate Cortex is related with reward/punishment mechanisms, as well as motor control and reflexivity (Shenhav et al., 2016) and the Anterior Insula, which is most active with impressions and emotional- valance gauging (Sterzer & Kleinschmidt, 2010). Garland notes that these two substrates, particularly the Affective anyalisis, indicate that the brain, “Does not passively receive pain information from the body” (2012); instead, it is actively analyzing this sensory transmission into emotional and motivating qualities we call feelings.
This affective pain appraisal is identified as playing a key role in studies that looked specifically at different types of social pain scenarios: social isolation, romantic rejection, and intimate loss. The first, social isolation/rejection, was studied in the famous Cyberball experiment, which created a low-risk environment to study the impact of social isolation on individuals. Eisenberger indicated that upon the experience of social rejection, individuals with an increased sensitivity to exclusion, such as those with an Anxious Attachment and low social support systems, indicated a significant increase of activity in the Dorsal Anterior Cingulate Cortex activation in response to the rejection from the simulated game (2015). This indicates that the emotive experience of rejection mimics that of a physical sensation of pain. This hints towards pain-types all being processed and valuated along similar parameters to reach a certain goal (to alleviate all pain- regardless of what type it is).
The second study evaluated individuals who had recently undergone a romantic rejection. These participants showed heightened activation of the Dorsal Anterior Cingulate Cortex and Anterior Insula regions when shown pictures of their ex-lovers, in contrast to neutral images of strangers (Eisenberger, 2015). More interestingly, the activation of these affective components of pain perception were accompanied with heightened sensory regions as well, such as the Second Somatosensory Cortex, which is activated in touch, pain, and visceral sensations (Borich et al., 2016), and the Posterior Insula which is associated with appraisal of attentional-stimuli from the amygdala (Herberlein & Adolphs).[1] These same results were found on a third study of mothers who had recently lost infants.
The Neurological evidence that pain of all types is evaluated and analyzed very similarly, hints towards a similar goal that is simply pain-relief. Pharmaceutical correlative evidence for this overlap points to this as well. Moieni & Eisenberger (2016) site studies that identified the effects of opiates such as morphine, heroine, and other opiate-derived suppressants, and the relief these drugs offer to both types of pain. The receptors sensitive to the opioid-chemicals trigger the same biochemical brain processes that reward positive life functions such as pleasure and pain relief (Kosten & George, 2002). Thus, this medically prescribed pain-depressant is a leading addictive substance for mental relief as well. This direct pain-reduction is found in both pain-types, relieving both physical pain but also numbing social pains such as loss, rejection, or trauma. This hints towards the shared brain regions aiming to pain alleviation of both social and physical pain.
Finally, the linguistic correlation between our articulation of physical and social pain indicates their shared role in our lives. Several studies conducted by Nummenmaa et al. explored in part the relationship between articulated emotional states, which we call “feelings” with their direct relationship to biological changes in the body, which they referred to as “bodily sensations” (2013). The study created a topographic self-report map of bodily sensations (Figure 1), controlling for
country, language, and even cultural bias through the inducement of the emotions rather than merely a retrospective self-report. What they found was that the “perception of these emotion-triggered bodily changes may play a key role in generating consciously felt emotions” (Nummenmaa et al., 2013).
· We say we feel “our chest bursting with pride,” and also “aching with love.” The study showed that emotions (pride, happiness, and love) were associated with elevated activity in the upper chest area, such as increased breathing and heart rate.
· Increased sensation in the head-area was shared across all emotions. This can indicate the physiological changes in face temperature (“burning with shame”) or expression (“lit up with delight”).
· We say we “clench our fists in rage” and “our body tensed with anxiety.” Bodily sensations in the upper limbs were most prominent in approach-oriented emotions like anger and happiness.
· “She grew numb with sadness” or “he sank into despair.” Whereas bodily sensations with decreased limb activity were a defining feature of sadness and depression, connected to withdrawal-oriented response emotions.
· “Her stomach tied in knots” or, “she felt sick with worry.” Finally, sensations in the digestive system and around the throat region are found in disgust, fear, and anxiety, correlated to more complex emotions connected directly with decreases in appetite, induced by an activated somatic nervous system. This can restrict appetite or trigger the gag-response, possible with literal disgust at a physical stimulus such as rotten food, or a social stimulus such as the realization that a “friend” can be rotten too (Nummenmaa et al., 2013).
What becomes increasingly clear in this study is that it is not just a simple correlation between social and physical pain. In fact the relationship goes deeper, hinting towards an embodied and deeply integrated body-mind synthesis between emotionality and perception.
Nummenmaa et al. suggests that, “emotion systems prepare us to meet challenges encountered in the environment by adjusting the activation of the cardiovascular, skeletomuscular, neuroendocrine, and autonomic nervous systems first” (2013). Thus, the connection results in a two-way appraisal: If the sensory and affective substrates overlap, as well as our emotive and physical states, then the bodily sensation of pain effects our mental state, while our mental state equally impacts our sensitivity to pain.
These findings are further supported by Seto & Nakao’s research regarding somatization,
defining is as, “The expression of psychological or emotional sensations expressing themselves as physical or somatic symptoms” (2017). In their research which focused on CBT models (Figure 2 and 3), they found that somatosensory disorders such as somatosensory amplification or catastrophizing (which are exactly what they sound like: overamplification of “feelings” of physical symptoms, such as an anxious person developing chronic migraines). Our sensory perception of a social pain is amplified by affective states, such as a setting where we experience ongoing social rejection: The anxiety and continuous discomfort heightens neural regions like the dorsal anterior cingulate cortex and anterior insula, resulting in a valuation appraisal of the situation, and possible activation of the somatic nervous system. The bodily sensations of clammy hands, tensed muscles, constricted throat- our fight/flight response- are interpreted by our valence systems and finally reaches the conscious articulation and realization that “I am anxious” (Nummenmaa et al., 2013; Seto & Nakao, 2017).
“Feelings” of social pain, words like sadness, depression, anxiety, or rejection, are the labels we apply to observed patterns in our bodily response to the environment, aiding our mind with the appraisal. Thus the correlation between physical and social pain becomes clearer. The sensation identified and analyzed by sensory substrates is experienced in order to make a valuation judgment on the sensation: attention orientation is shifted to the stimulus (a hurt knee or rude comment). The attention shift allows for “a proper cognitive appraisal of the meaning of the sensation, and the subsequent emotional, psychophysiological, and behavioural reaction, which then feed back to influence pain perceptions and therefore reactions to the pain now and later on (Garland, 2012).”
This all leads to our final question of why is this all important? In many ways, the linguistic/articulation connection being emphasized is intuitive. It seems obvious that what we say we are feeling is what we are literally feelings- the word itself is also synonymous! However, in relation to social pain and therapeutic practices to mitigate the impact on patients shows that understanding the correlation of overlapping regions, processing, motives, and expression of emotions and pain more specifically can have lasting impacts on how we approach therapy in the future. From a philosophical standpoint, the mind-body dualism introduced into western though through Descartes shaped early psychology, as the mind-over-body hierarchy of control resulted in a particular view of how humans operate. What these studies indicate is that we are not minds controlling a skeletal frame. Instead, the entire embodied self in an integrated communicating whole. Just as the value appraisal systems indicate the amplification of pain, so too the bodily sensation indicates just what interpretation will be applied.
This is at the basis of CBT methods and models. The therapeutic practice fundamentally understands that changes in behaviour directly impact the neural pathways. Our habits form our views and vis versa. Seto & Nakao highlight this understanding, as their study on somatosensory amplification and catastrophizing discussed how this knowledge of our embodied understanding and interpretation of pain can be applied therapeutically (2017). Their model of the somatic amplification, which was a result of a positive closed loop system, led them to develop a possible
Intervention Method, based on “breaking the cognitive-behavioural vicious cycle” (Seto & Nakao, 2017). Some of their theorized methods include the following:
1. Provide the patient with conventional medical explanations and discuss the biological, psychological, and social aspects of their symptoms. For example, if a patient suffers from chronic migraines, discussion around an integrative whole including their dietary habits, social group, job stress, medical history, and psychological state, are all factors to be considered. The discussion must be comprehensive and all-encompassing.
2. Keeping a daily symptom diary can enable the discovery of relationships between patient’s symptoms and factors that are easy to change, such as their mood, stressors, and physical discomfort.
3. Identify the patient’s false beliefs about their symptoms (Seto & Nakao, 2017).
Finally, there is the component proposed by Moieni & Eisenberger (2016): A human being has basic fundamental needs. According to Maslow’s Hierarchy of Needs (Gepp & West, Medical News Today, 2022), we understand the fundamental necessity of social inclusion and group identity as on par with our physiological needs of food, water, and shelter. The evolutionary advantages provided by being part of a group, notes Moieni & Eisenberger, are their potential to provide and simplify the accessibility of these fundamental needs. Discomfort then, in the form of the sensation of social rejection, is the signal to take and action (2016, p. 204).
Another implication of this research is the affect on gender differences and the ability to analyze and articulate physical and social emotions. Pain is an actively appraised and analyzed sensation in the mind, which makes an approach or avoid response (Garland, 2012). In social rejection, the bodily sensation tends to result in avoidance. In the research by De Dreu, we noted the identified gender gap in life expectancy between males and females (Social Neuroscience, 2016, p.149-150). This can be linked to the tendency of men to respond to stress through withdrawal and isolation. But perhaps it is also linked to cultural expectations for men, where they are expected to “feel” less- showing less reactivity to both physical pain and social pain, toughing it out rather than experiencing and articulating the emotion fully. Moreover, woman are typically categorised as having a wider social network, and therefore there is greater risk in losing social status in that social network. Therefore, social pain might actually be more “felt” by females because of the valence appraisal that determines a greater impact on her long-term. But what is the long-term impact of ignoring the bodily sensations of social pain? It would be interesting to see the impacts of these studies when controlling for gender, particularly for bodily sensation mapping for males vs. females.
Overall, the correlation between social and physical pain also indicates a greater relationship with our articulation of the bodily sensations we experience due to biological responses to pain perception- be that a literal or physical knife in the back. In any case, the correlation between language and neural structures and function in perceiving, appraising and finally, expressing pain is a hopeful recognition. I believe we intuitively know this from witnessing family and friends engage in physical actions to heal their bodies first, which in turn heals their mind:
· Seeing grieving siblings engage in family functions long before they are “mentally” in the space to actually enjoy it, and finding their moods uplifted anyways.
· Friends who force themselves out of bed during depressive episodes to do a short workout, knowing that the dopamine increase afterwards will reward them mentally.
· Other friends with eating disorders who fight through nausea to eat, later discovering they mentally feel they can let go of a little bit more control with their primary needs met.
If our language itself intuitively acknowledges this similarity, the implication for therapy could be significant. Just as a doctor asks, “where does it hurt?” what if a therapist could do the same, as we come to understand pain as not just a felt emotion, but an embodied experience of the integrated whole. What all this talk of social pain boils down to is a simple acknowledgeable truth that “we are human beings” and we feel deeply in many ways, and the best thing we can do is to continue to express and share those feeling, in whatever form they come, because recognition and acknowledgment is the first step to heal a wound -be that physically or socially.
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