Operator/Interactor

[byronselorme]

Diane, I think your Operator / Interactor model is a really big deal. I think it should be the foundational model that is impressed upon anyone working with people in their occupation. Therapy, education, whatever.

I explain it to people over and over.

I don't know if it is all you creation or not (so far, your who I attribute it to) but if it is, I think it is amazing.

[Diane]

Gee, thanks Byron.
As far as I know, it's my idea. I haven't seen anyone else ever take manual therapy apart in quite that way, but me.

[Diane]

On medical interaction as opposed to operativeness

Science-Based Medicine blog has been a good tutor for me. This whole operator/interactor distinction came about because of a conversation I was involved in, there, about placebo, years ago, and a comment by Mark Crislip about how contact was stress-relieving and didn't need to be much more than that:

“Monkeys, and other animals, groom each other often with a marked reduction in stress. Touch is good, and one doesn’t need to wrap it up in pseudoscientific nonsense for it to be beneficial.” - Mark Crislip discussing reflexology on ScienceBased Medicine blog

Anyway, Science-Based Medicine bloggers also evolve: today Harriet Hall posted this: Beyond Informed Consent: Shared Decision-Making. It pretty much sums up all the tricky elements involved with the medical approach [which started out as purely "operator", but is carefully transforming itself into "interactor"], based on evidence that has come to us by way of neuroscience. :clap2:

It seems to me that nowadays everywhere I see bits of evidence that remind me of Iain McGilchrist's book, and attempts to loosen "left hemisphere-like" control by the culture on thinking by all aspects of human primate social grooming, from SBM to SomaSimple, and who knows where it will all end? Maybe a whole lot of chaos, or a whole lot of world peace, or maybe a whole lot of both in some infinitely far away human or no-longer-human-as-we-currently-know-ourselves future.

[carrita98]

I read that post this morning on SBM, and I thought to myself: FINALLY!

[ts.vassilev]

Here is a Bulgarian translation of the original document. I have tried to preserve as much as I can of the formatting and language. Trying to translate Diane is no easy task

[Diane]

Here is a Bulgarian translation of the original document. I have tried to preserve as much as I can of the formatting and language. Trying to translate Diane is no easy task

Wow, thank you ts! :thumbs_up

[Diane]

This looks like it might be good: Treating Thoughts as Material Objects Can Increase or Decrease Their Impact on Evaluation

Thoughts can include conceptualizations, categorizations, ideations of all kinds, perceptual fantasies, patternicities, pareidolias.

Deric Bownds thinks it's interesting too.

It's hard to get rid of unwanted thoughts. What about just throwing them in the garbage like unwanted objects? In some conditions might we discard our thoughts as easily as we dispose of objects? If Mr. Descartes was right (straw man, I know), a thought cannot literally be thrown into the garbage, because it does not have a material or physical nature. If a component of our cognition is taken to be a physical object, we should be able to discard it. Briñol et al. make some observations relevant to these points. Their experiments involved subjects writing down positive and negative thoughts about their bodies. First, their abstract:

In Western dualistic culture, it is assumed that thoughts cannot be treated as material objects; however, language is replete with metaphorical analogies suggesting otherwise. In the research reported here, we examined whether objectifying thoughts can influence whether the thoughts are used in subsequent evaluations. In a firstexperiment participants wrote about what they either liked or disliked about their bodies. Then, the paper on which they wrote their thoughts was either ripped up and tossed in the trash or kept and checked for errors. When participants physically discarded a representation of their thoughts, they mentally discarded them as well, using them less in forming judgments than did participants who retained a representation of their thoughts. A second experiment replicated this finding and also showed that people relied on their thoughts more when they physically kept them in a safe place—putting their thoughts in their pockets—than when they discarded them. A final study revealed that these effects were stronger when the action was performed physically rather than merely imagined.

Now, a bit more detail on the first experiment:

The experiment was presented as a study on body image. All participants received written instructions asking them to complete several tasks. As part of the first task, each participant was randomly assigned to generate and write down either positive or negative thoughts about his or her own body during a 3-min period. In the positive-thoughts condition, participants were told to list as many positive thoughts about their bodies as they could; in the negative-thoughts condition, participants were told to list as many negative thoughts about their bodies as they could (e.g., Killeya & Johnson, 1998). Examination of the thoughts listed indicated that all participants followed the instructions.
After listing his or her thoughts, each participant was randomly assigned to either the thought-disposal or the control condition. All participants were asked to look back at the thoughts they wrote. In the thought-disposal condition, participants were asked to contemplate their thoughts and then throw them into the trash can located in the room, because their thoughts did not have to remain with them. In the control condition, participants were asked to contemplate their thoughts and to check for any grammar or spelling errors they could find.

The dependent variable in our analysis was participants’ attitudes toward their bodies. Participants were told that they should record these attitudes because their self-image might have influenced their previous responses. Attitudes were assessed using three 9-point semantic-differential scales (e.g., bad-good, unattractive-attractive, like-dislike). Ratings were highly intercorrelated (α = .88), so we averaged them (after reverse scoring as appropriate) to create a composite attitude index. Higher values on this index indicated more favorable attitudes.

From their discussion:

Consistent with our hypothesis that a thought-disposal treatment can influence judgments by invalidating people’s thoughts, results showed that the attitudes of participants who physically threw their thoughts away showed less impact of the thought-direction induction than did the attitudes of participants who physically retained their thoughts....It is important to note that because the treatment was induced after thoughts were already generated, it could not affect the valence or the number of participants’ thoughts. Rather, the treatment decreased the strength of the influence that participants’ thoughts had on their attitudes.

Here is the paper (abstract): Treating Thoughts as Material Objects Can Increase or Decrease Their Impact on Evaluation

Maybe one needs to include a bit of ritual "tossing out" of old ideas in every manual therapy class one teaches. Great piece on social ritual.

[zimney3pt]

Thanks, for bringing this here. Adds some science to why it is helpful to right down your goals if you want to make behavioral changes. Just the process of writing them down looks to add to strengthening them.

And maybe I need to physically throw some of those old course materials away. I keep some of them now as reminder to be a bit more selective in what courses I take.

[byronselorme]

This leads me to think of an exercise as a course opener where all the participants are asked to write down specific concepts on different sheets of paper and then in a discussion afterwards dispose of the ones that are outdated.

That would be fun to watch.

[Diane]

Exactly what I was thinking Byron. Or write them on the sides of the balloons I use to teach with anyway, then burst them.

[Diane]

Link to the paper.

[nari]

The concepts won't actually vanish forever with defusion, but like negative thoughts, they become irrelevant and ineffective. The crucial thing is to set out to render them ineffective.

Nari

[Diane]

Nice blogpost in Spanish by Fernando Calvo, in his blog, on operator interactor philosophy. I think he actually improved the ideas. :angel:

Part 2 is forthcoming.

I love that this set of ideas is moving around, being translated into other languages. Thank you for that.

Humans being human, our brains (in all their working glory) will likely always want/need to assign agency to something, instead of nothing.. better it be to the patient's own nervous system and locus of control than to our own conceptualizations and objectifications and pareidolias and apophenias and above all, delusions of grandeur.

[Diane]

Check it out!! A PT from Chile just got his PhD in Alberta - did an RCT on operator versus interactor PT, apparently. :clap2::clap2::clap2:

Physiotherapy patient interaction a key ingredient to pain reduction, research says

With a master's and Ph.D. in rehabilitation sciences from UAlberta under his belt, Jorge Fuentes will help train a new generation of physiotherapists in his native Chile -- using his own research on how patient interactions can reduce lower back pain.

How many times have you been to a physiotherapist where you've had more time in the waiting room than face-time with the physio?

Well, according to University of Alberta physical therapy PhD grad Jorge Fuentes, how a physiotherapist interacts with a patient verbally, through eye contact, body language and listening skills is almost as important as the treatment itself.

"The way we are applying treatment today is not the best approach," Fuentes says. "That might be the reason physical therapy interventions have such a modest effect for patients with chronic conditions. The therapeutic context, in which the interventions are delivered, matters. We have to take these non-specific factors into consideration."

For his PhD dissertation, Fuentes found that how physical therapists interact with patients—open communication, active listening, eye contact, facial expressions, tone of voice—plays a significant role in pain reduction. It's the first time that such non-specific factors of physical therapy treatment have been studied in a randomized controlled study.

In the study, 117 patients with chronic low back pain were split into four groups. The first received electrotherapy after limited, five-minute interaction with the physical therapist, who avoided eye contact and did not openly engage the patient. The second group received the same electrotherapy with enhanced interaction in which the physical therapist spent the entire 30-minute treatment with the patient and exhibited strong verbal and non-verbal communication.

The third group received the limited interaction while hooked up to electrotherapy, but the patient was unaware the device was not connected—what Fuentes calls "sham" treatment. Patients in group four received enhanced interaction with the same sham treatment.

Fuentes found that patients with enhanced interaction and real electrotherapy reported a three-point reduction in pain intensity on a 10-point scale, along with a two-kilogram increase in their pain thresholds—results he said that are considered clinically significant.

What was surprising, he said, was patients who received enhanced interaction during a sham treatment reported the next greatest improvement in pain intensity and threshold—even greater than the group that received actual treatment and limited interaction. The group that received limited interaction and a sham treatment reported the least change.

Fuentes says his findings, which he recently presented to strong feedback at the International Society for the Study of the Lumbar Spine Conference, are just the first step in understanding the importance of non-specific factors and optimizing treatment for patients.

Fuentes received his PhD from the U of A on June 5, capping off eight years of study that started with his master's in rehabilitation sciences. Next month he returns to his native Chile to help improve that country's clinical research and teaching in physical therapy.

:clap2::clap2::clap2:

[Diane]

A Canadian osteopath crossed the chasm.
Confessions of an ex-operator, by Monica Noij.