Living Effectively and Adapting to Fibromyalgia PART 3: Techniques for Managing Pain
By Dennis Turk, Ph.D. University of Washington School of Medicine •
August 27, 2001
Editor’s Note: This is the third in a series of excerpts from the syllabus of the FAME 2001 Conference and is used with permission.
Psychological Techniques for Managing Pain
Living with FM affects all aspects of one’s life: physical, social, and emotional. Psychological methods can be helpful in providing a sense of control over the body that feels out of control. Using self-control methods does not mean that the pain felt is not real or that psychological factors caused the pain.
It is easy to indulge in negative thinking when you have chronic pain. Your pain drags on, and a part of your reaction to that situation comes in the form of thoughts and feelings of rear and frustration. These negative thoughts can be so automatic that you may not be aware of how frequently they occur and how debilitating they are. You need to take the time now to examine your negative thinking and understand its effect on your ability to manage your pain.
Negative thoughts have the effect of increasing your anxiety and pain because they focus on catastrophe and resentment, creating a reality where the worst seems bound to happen and you are the helpless victim. Your body reacts by tensing with fear and anger. As your body tightens, your pain increases.
Right now try to recall some of your typical negative thoughts. See if they sound like any of these:
* I have no control over my pain.
* I’ll never get better.
* No one else can ever really understand this pain.
* I’ll never be able to enjoy life again.
Do any of these statements sound familiar to you? These are only a few of many pain-related messages. You may have others of your own that are unique to your situation.
Dr. Aaron Beck described negative thoughts as part of a “downward spiral” of depressed thinking. They argue that your thoughts create your emotions and that your perception of a situation determines your reactions to it. What you think becomes what you feel. Once you get started, the momentum of your negative thoughts continues to carry you down and down, unless you do something to break out of the pattern. Through cognitive restructuring (for example, changing the way you think) you can learn to change the negative internal monologue that fuels your anxiety, depression, and anger and inevitably makes your pain worse.
Consider Sally’s case. Sally’s boss has a deadline to meet, and Sally finds herself at the word processor furiously typing away. She skips lunch and breaks in order to try to get it all done. She feels her back strain from the buildup of pressure and from sitting in a rigid position. She clenches her teeth against the pain and thinks:
* “My boss should have planned ahead better.”
* “If I ignore the pain, I can get this one now and relax later.”
* “I can’t afford to go slowly or take a break because my boss might think I can’t do the job.”
By the end of the day, Sally has not only an aching back, but also a pounding tension headache from gritting her teeth all day. She arrives home exhausted and collapses into bed.
Sally could have managed this situation better by controlling some of her negative thinking. Here’s a different way to think about each one of those statements above:
* “Yes, it would have been nice if my boss had planned ahead better, but that didn’t happen. My getting upset about that doesn’t help me get through this work. I can manage this.”
* “If I stretch and relax in short intervals throughout the day, the pain won’t be so bad later.”
* “For this hassle, I’ll reward myself by stretching and doing an easy workout at the gym after work, or I’ll relax in the sauna/Jacuzzi.”
* “Back injuries/strains happen to many people. My boss won’t think less of me for having a back problem. I’m good at what I do and can get the work done.”
What was your reaction when you read this second set of statements? Did you feel a sense of relief that Sally did not have to lock herself into a mindset that only leads to frustration and hopeless thinking? When you have pain, how do you typically think?
Eight Styles of Negative Thinking
1. Blaming. You make someone or something else responsible for your pain. “My lousy boss is to blame for my job accident.” “My family demands so much from me, I can’t afford the time or money to take care of this pain.” Some people go too far in the other direction and focus all the blame entirely on themselves. “It’s all my fault that this happened to me.” If you continually put yourself down in this way, the insidious nature of self-blame can lead to lethargy and depression. This self-defeating stance can also serve as an excuse for inactivity.
2. “Should” Statements. The words should, must, or ought appear regularly in chronic pain negative thinking and are examples of irrational thoughts. Shoulds are usually a put-down, implying that you were stupid, foolish, or weak for not living up to some standard. “I should have thought of good body mechanics before I lifted that box.” “I shouldn’t have been in such a hurry when I slipped on the ice.” “I must keep up with all my responsibilities, pain or no pain.” “I shouldn’t react to pain like this.”
3. Polarized Thinking. Everything is “black or white,” “good or bad.” There is no gray area in the middle for improvement. Polarized thinking assumes things must go perfectly or else. If you have a pain relapse, then you’re likely to think that the program you’re using is no good or it’s a sure sign of your ineptness. This thinking leads to damaging overgeneralizations. You have one relaxation session where you are unable to decrease your pain, and you assume that you’ll never be able to decrease your pain. Overgeneralizations are often couched in terms of absolute statements-cue words are all, every, none, never, always, everybody and nobody.
4. Catastrophizing. People who engage in this kind of thinking react to life situations by imagining the worst possible outcome and then reacting to their fear-provoking scenario as if it will surely come true. “I know that the only option left open to me is to have surgery. I’m sure I’ll be laid up for months. What if the operation is a failure?” “What if” statements characterize this thinking, and greatly add to anxiety levels. “What if my pain never gets better, and I have to live like an invalid for the rest of my life? What if my spouse leaves me? What if I am unable to work?”
5. Control Fallacies. Some chronic pain sufferers see themselves as “externally controlled” by others, such as those in the medical profession. By assigning a doctor or a clinic total power over their fate, they make themselves helpless victims of their pain and of the system. In effect, they absolve themselves of any responsibility. Others may see themselves as powerless to change a dysfunctional family situation. On the other hand, people who see themselves as “internally controlled” believe that they have complete responsibility for everything and everyone. “Everyone depends on me. The family will fall apart if I don’t recover quickly from this mess.”
6. Emotional Reasoning. This line of thinking assumes that what you feel must be true. If you feel guilty about needing time to heal, then taking the time must be wrong and needing the time must be your fault. If you’re frightened that the pain will never stop, then you believe it will never stop. If you feel grief at the thought that you’ll never run again, then you must be right-you won’t run again. You let your feelings rule your reasoning ability. The strength of the feeling creates conviction, but later things may seem different as the emotional storm dies down.
7. Filtering. Some people have a tendency to see their pain through tunnel vision, filtering out any potentially positive aspects. These people make things worse than they are by focusing only on the pain and nothing else. The process of filtering can also be very selective. You may choose to remember only those things, which support your angry feelings, thus pulling your negative memories out of context and isolating you from positive experiences.
8. Entitlement Fallacy. People often feel that they are “entitled” to a pain-free existence. They believe they shouldn’t have to suffer pain or loss. They feel cheated, that life is being unfair. People who harbor the entitlement fallacy feel that the luxury of ignoring or taking their bodies for granted is their right. And if they lose some capacity due to chronic pain, they feel that their life has been diminished.
These eight styles of thinking are related to each other. In fact, if you have a tendency towards one line of thinking, you will probably catch yourself doing several of the others. While the categories are a helpful way of showing how negative thinking works, between styles can blur. It’s also quite possible to bombard yourself with a number of negative thoughts all at once in a lightening-fast mental shorthand. You rapidly heap negative thought upon negative thought until you feel overwhelmed and ready to give up. Be patient with yourself and allow yourself to gradually become familiar with your unique way of negative thinking.
Learning More About Your Thoughts – The ABC Model
The ABC Model can be a useful tool in structuring your approach to understanding negative thinking about pain.
A is the activating event or stressor. In this case, let’s make it a muscle spasm in your back that keeps you from fulfilling a commitment.
B is your belief system, or your thoughts and attitudes about the stressful event. For example, you may think, “Now I can’t do what I said I would-they’ll think I’m weak. I can’t do anything anymore.”
C stands for the consequences of the activating event, or basically, your feelings. When you think poorly of yourself as in B, you feel guilty, frustrated, depressed.
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