Chronic pain and cognitive therapy
With chronic pain and fibromyalgia, we often overlook out emotional wellbeing in favour of our physical wellbeing. That is to say, we do a great deal to try and handle our physical pain and other symptoms which do take a great deal of attention. We believe the emotional distress of any sort is a natural result of the difficulties associated with living with chronic pain, which is entirely true. It is no walk in the park and emotionally it can be quite the roller-coaster ride. It only makes sense then that we ought to take the time to maintain or consider our emotional wellbeing. How we are handling our coping process and how we are handling obstacles and life overall. Do we need to take any special care to help with our emotional needs? There is always the risk we might fall into a depression or develop an anxiety disorder from the burden of coping with pain so if we can prevent that from happening all the better.
Some people think it is absurd to think so-called ‘positive thinking’ is any solution to chronic pain, but it should not be tossed away off hand. It is a matter, literally, how you look at things. Or specifically how you react to things, stimulus, your environment. How you react without thinking at times. If in those habitual responses you react negatively or have negative thought patterns then positive thinking may very well help change your worldview a bit. Changing your worldview a bit may ease the stress of coping with pain. Anything that makes coping a little easier to handle is a good thing. Often cognitive therapy is used to help with depression but it may be just the sort of thing people need to help with long-term chronic pain. We have a great deal of emotional strain, at times depression, anger, frustration, pure drained numbness and any number of emotions from dealing with such pain constantly. Therefore, the same methods might uncover similar thought patterns.

Cognitive therapy for chronic pain

Maladaptive habitual thought patterns

  1. Ignoring the positive: We tend to notice the negatives in our lives and remember them. We then fail to notice the overall positives to an experience, even if it outnumbers the negatives by far. This leads to such things as assuming the worst is bound to happen since your negative history suggests that. For example, someone may know from experience treatments have failed and make the assumption all treatments will fail in the future.
  2. Minimizing the positive: When we manage to achieve something, despite the obstacles of our health, we make little of the achievement because clearly if we were in perfect health it would have been easier or not such a great achievement.
  3. Skills: We can make a long list of things we are not good at, or character flaws without acknowledging the fundamental power we have to alter them, and therefore we acknowledge our failures as par the course. Yet we cannot name anything we are actually good at. We make compromises for our health and sometimes people see them as failures or they see the things they can no longer to as well, or as effectively as failures. We fail to acknowledge anything that we can actually do well, despite our disability.
  4. Overgeneralizing: Just because a situation went down badly once, does not mean it will always go down the same way. While this seems self-explanatory think of all the times you say ‘this is always the case’. Sometimes we believe after trying many treatments that we never will find a treatment. Or if we are in a bad work situation we feel it must always be this way that we must suffer this way forever.
  5. Self-talk: This is crippling to a depressed person because negative self-talk sets you up for failure so that when said failure occurs, you expect it… in an attempt to save yourself from disappointment. When confronted with a problem instead of saying ‘This is going to be a challenge. I better get right on it.’, someone might say ‘There is no way I can do this.’ For someone with chronic pain it might be, ‘I cannot do this, it will hurt too much’. Or with fibromyalgia, it could be ‘I want to do this but I’m too tired.’ or ‘I wish I could do this but I wouldn’t be able to think straight’. Immediately it shuts down the possibility without even thinking of ways around the problem.
  6. Self-evaluation: The depressed mind it an overly critical one. We don’t give ourselves any slack. We make any sort of error and automatically we think ‘I’m worthless’, ‘I shouldn’t have tried’, ‘I’m useless’, and ‘it’s hopeless’. As such we blame ourselves for everything wrong and credit others when things go well. We have to avoid black and white thinking. With a chronic health condition, we tend to blame ourselves for our illness. No matter what happened or any other factors or people involved, we blame ourselves because we are not 100% healthy and therefore not as effective as we could have been.
  7. Automatic thoughts: We have more than enough time to have programmed ourselves to think and react in a certain way. So when something happens in a situation we have a knee-jerk response that is often negative. Anything that involves statements with should, must, always, never. Often we have rigid standards we hold ourselves to, impossible to hold to… like: ‘I have to succeed or I am worthless’.
  8. All or nothing thinking: Thinking in black or white. ‘I used to have a social life but now I am a complete hermit and never go out.’ ‘I used to want to have a career but now I know it is impossible to achieve.’ It is never all or nothing. There are always shades of grey and many options in the middle. We know we are capable of social events with preparation, proper environment, and recovery time and with the understanding, we are willing to take an increase in pain in the short term for some events. With compromise and acclamation, we can achieve some work goals as well.

Our minds can be our worst enemies

All this negative background noise accumulates and can compromise any coping strategy. It can be beneficial to work on what irrational underlying assumptions are made when these thoughts, statements or automatic thoughts occur to us so we can reflect on them, break them down and realize they do not make any logical sense. Then comes in the positive thinking aspect or replacing those thoughts with rational responses. A sort of way to reprogram the brain and is an effective way to have these thoughts occur less and less when the same stimulus is presented. Call it positive thinking or mindful introspection, either way, it is like the brain is a broken record singing the same tune it has been told by experience to sing until you override it with something more realistic and functional.

Be mindful of your internal self-talk

It is not a process that occurs right away. There are some of these negative thought patterns you will catch right away and as time goes on you will notice more and more of them once you begin to pay attention to them. You will find they occur more often than you think. The first step is to merely record what negative thought occurred to you and what situation caused it and then to think about what assumptions that thought was based on. One example is: ‘I can’t seem to work full time with my illness, but if I can’t work then I’m not even a functional part of society anymore and am useless. I’m a liability, not an asset.’ At times with a chronic illness, we struggle with our jobs and keeping our jobs. A job holds a great deal of our self-worth since it holds part of our identity, our income, and our independence. When it is threatened we can feel worthless, ashamed, a failure or useless or fill in the blank here. Using the above example what assumption makes this true? That self-worth is dependent on what the person can do while suffering pain and when they can no longer do that they have no worth at all anymore? This is an irrational belief because our self-worth, or our worth as a person overall, is not merely dependent on what we do for a living.
Once you can pinpoint these sorts of beliefs and thoughts and the irrational beliefs and assumptions that hold them together you are halfway there. Then it is simply deconstructing what and why you have that belief. Record your understanding of why you hold that belief and why it is irrational. Why you know it makes no sense. Writing these things down and working them out on paper is a very good way to work through the process.

Positive self-talk

Here is where the positive self-talk comes in. Once you have picked out your list of negative talk, then every time during the day you have one of those knee-jerk thoughts, you simply pause and think the opposite. You know the negative thought is irrational, so you counter the thought with a positive truth and think it clearly and distinctly. Every time you actively counter these automatic thoughts the more your brain absorbs the new patterns the more it becomes your new habitual thought pattern. Using our example if the thought was ‘If I can’t work then I am worthless’ the replacement could be ‘No, my self-worth is not dependant on my work alone and my worth to others has little to do with it. I am worthy.’ Self-talk is not a new trick or something new you are going. Stream consciousness is a flow that includes a lot of self-talk. It is just a matter of paying attention and choosing how that conversation is going. Feeding it something new to replace the negative influence.

Some statements to analyze

 These are examples of statements you want to look at and see if they apply to you and how much they apply to you. If they do why do they? What is the underlying belief that makes them true? Is it a rational belief and if it isn’t what makes it false? The list used from Cognitive Therapy for Chronic Pain by Beverly Thorn;
  1. If I fail partly, it is as bad as if I fail completely.
  2. If others dislike you, you cannot be happy.
  3. I should be happy all the time.
  4. People will always think less of me if I make mistakes
  5. I should always have complete control over my feelings
  6. What others think of me is very important
  7. I ought to be able to solve my problems quickly and without a lot of effort.
  8. I’m nothing if a person doesn’t love me
  9. A person should be able to control what happens to him/her
  10. I must be a useful, productive, creative person or life has no purpose
  11. I can find happiness without being loved by another person.
  12. A person should do well at everything he/she undertakes
  13. If I don’t do well at the time, people do not respect me
  14. People who have good ideas are more worthy than those who don’t

Some affirmations that can be used

  • Things are getting better.
  • I’m making progress in my health.
  • Today I can do what I need to do for my recovery.
  •  Every day is a new day and what pain there was yesterday may not persist today. I can treat myself with the same sort of love and attention I would a loved one.
  • I am beginning to understand what I need to do to take care of my body.
  • I focus on positive actions I can take to begin a health plan with my doctors.
  •  I will begin a slow stretching and exercise regimen.
  • I can accept each day as a new day.
  •  I will see positive support for my FM and avoid negative people.
  • I believe every day has the potential to be better than the last.
  • I will reduce the stress I encounter each day with stress-reducing techniques
  • I can overcome any problem that occurs today with calmness and problem-solving skills or seek the resources to do so
  • I will use slow and easy breathing techniques to keep oxygen throughout my body and reduce stress.
  • I will try to keep my muscles relaxed throughout to the day or pause to ease the tension in them with gentle stretching exercises.
  • I will take the time during the day to pause and relax my muscles and refresh myself.
  • I am confident in my ability to deal with my health

The brain is a sponge

The reason this sort of introspection process works is because the brain is a sponge. Feed it those positive reaffirmations over and over and it will become the new habitual automatic thoughts. Coping with chronic pain and fibromyalgia is already a long difficult road. You might want to consider that road to have a lot of cracks in the pavement that our psyche has already put there from our own experiences in life and from the years of pain we have already coped with. This sort of emotional work can help pave over some of those cracks. In fact, if you find yourself to be depressed and overwhelmed a therapist will use similar methods to help talk you through some of the more problematic areas on the road to help you cope better. Any of those cracks you can pave over will help smooth the coping process which let’s face it is a bumpy road as it is. This article is hardly sufficient to cover everything there is to the process but enough for you to begin the process. There are self-help books out there based on the cognitive therapy model used for chronic pain or depression that are excellent to help guide you along in your process. A psychologist as well if you wish to have one can also guide you through the process. What is important is that we take care of our emotional health in order to help with our coping.

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Maybe you do not want or cannot afford a psychologist at the moment. Well, I have to tell you in my first depression bout my mom gave me this book that helped me immensely. Sometimes a good book on CBT can really help you out if you do the work. I found one with some basics I think would be a good place to start. So think about that as an option anyway.

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