Thursday, July 29, 2010

A mindbody connection to pain?

I wanted to take a little pause in the CBT series to examine a theory that addresses chronic pain. Dr. John Sarno is a professor of clinical rehabilitation medicine in New York. Dr. Sarno has written several books based on his successful cures of back and other chronic pain that he calls Tension Myositis Syndrome. Dr. Sarno believes, based on his work, that many chronic ailments are due to repressed feelings of rage and sadness. He does not suggest that these chronic pain problems are "in the mind" but says that they are very real and that the mind and body cannot he separated. Dr. Sarno's program involves first ruling out any physical acute diagnosis and then partaking in a workshop designed to help people express repressed feelings and educate individuals about this link. I have read two of his books and I admit he makes a very strong case. Either way it is important for people with chronic pain to examine their emotions and express them in a healthy way because this facilitates a reduction in pain. To find out more check out:


Monday, July 26, 2010

Coping with Chronic Pain-More Cognitive Distortions

Two more cognitive distortions I would like to discuss are "Overgeneralization" and "mental filter."

With overgeneralization people take a few instances of a certain outcome and use those instances to make wide generalizations about how life is. For example:
"That doctor wasn't empathetic or helpful. No doctor will be able to help me! It's useless to keep going back for appointments!"

A more helpful, rational statement might be something like, "That doctor wasn't very helpful. I will either make another appointment with that doctor and try again or get a referral for a second (or third) opinion until I find a doctor that I am comfortable with. My well-being is worth putting out the time and effort."

Mental filter is the next cognitive distortion I would like to discuss. With mental filter we focus on negative aspects of an event or situation while ignoring the other equally valid aspects of the event. This is like a single drop of ink tainting an entire glass of water.

An example of a mental filter distortion would be, "I had a fibro pain flare-up and I was in pain at my grandson's birthday party. The whole thing was ruined!"

A healthier, more self-preserving belief would be, "It's too bad I had to leave right after the cake was cut due to my pain, but it was so great to give my grandson a big hug and see his face light up when he opened presents. It wasn't perfect but I was glad to be there."

A person emailed me privately regarding this series and asked in essence how to adjust to a new life with chronic pain or illness after the "old" you is gone. This sort of depends on many factors but using a cognitive distortions perspective, I would encourage that person to explore what distortion is causing the most distress. For example-if you lose a bunch of weight you are no longer the "old" you but this situation is a happy, exciting one.

I would guess that there would be some all-or-nothing or mental filter distortions going on. For example,
"I was always happy before and I will never feel that way again." or
"I have a very miserable life since my diagnosis. I don't see an end to this."

More helpful and just as real thoughts would be,
"I had challenges before that took time and adjustment to learn to cope with. I will learn to cope with my pain until I can rid myself of it."
"I still have some great things in my life-a loving partner, good friends."

A great self-help book that is along the lines of cognitive therapy is:
Loving What Is: Four Questions That Can Change Your Life

As always this blog does not substitute the real, in person therapy that a trained doctor or mental health clinician can provide. If you are currently suicidal please call 911 or go to the nearest emergency room.

Friday, July 23, 2010

Coping with Chronic Pain-The first of a series

Many people live their lives in a silent day-to-day struggle. Right now it may be your friend, family member, or co-worker who is dealing with a diagnosis that causes chronic pain. These disorders can run from rheumatoid arthritis, back pain, fibromyalgia, migraines, or one of several chronic pelvic pain disorders such as vulvodynia, vestibulitis, or endometriosis. Some of these disorders share some common traits.

Most of these problems are known as invisible disabilities. An invisible disability is not obvious to the naked eye. The person looks healthy and yet they call in sick to work or school a lot, can't work at all or only minimally, and have difficulties in their relationships but because they appear normal people around them might pass judgment unfairly about why the person isn't working, going to school, or passing up on social invites. Many of these disorders are poorly understood not just by the public at large but also by the medical community. With vulvodynia (chronic horrible unremitting vulvar pain), for example, the average woman sees eight doctors before she receives a diagnosis. Even after a diagnosis is made many doctors who are so called specialists understand very little about how to provide relief so it can take months or years of trying different treatment or switching doctors to get relief. Additionally pain management is very poorly understood by many physicians. Because of this doctors can be reluctant to provide pain medications or even a referral to a pain management specialist despite evidence that pain medicine can vastly improve a person's quality of life and a person who is actually in pain is at a low risk for abusing pain meds.

To make matters more difficult more women than men suffer from chronic pain. This is little comfort to the men out there who are trying to cope with a chronic pain disorder. However, for many years women in chronic pain were dismissed or stigmatized by the medical community as being "hysterical" or that the pain is "all in her head" or she was "frigid" and needed to "loosen up a little." These attitudes are unfortunately still found all too easily in doctor's offices across the country, and most women who find a good doctor who is both compassionate AND competent knows that doctor is like gold. So thank you to all of you doctors, NPs, PAs, and clinicians who are both compassionate and competent.

I am going to use this series to go over some cognitive distortions that can make the emotional and relationship of pain disorders worse. I am also going to discuss how therapy can be of help and also discuss alternative therapies that you might not know about that might also offer you some emotional or even physical relief. I will go over how to make your own "emergency list" of coping tools of what to do in a pain flare-up so you can feel as if you have some control over your life. And hopefully through this I can encourage you to keep trying treatments and coping skills until you feel as if you get your life back or your pain disorder goes into remission-it does happen!

One of the best known psychotherapeutic techniques to help people who are suffering from chronic pain is cognitive behavioral therapy also known as CBT. CBT is also used to help people deal with depression, anxiety, trauma, and relationship issues. For the purpose of this series I will give examples that relate to chronic pain. There are ten common cognitive distortions and I will discuss a few per blog over the next several weeks. I encourage you, the reader, to journal about the distortion and examine your life to see if or where you are using any of these distortions in a way that is harmful to your well-being and I challenge you to substitute the distortion with more rational, healthy thoughts.

The first distortion I would like to discuss is called "All or nothing thinking." This distortion can contribute to depression and anxiety, thus making your pain physically feel worse AND having a devastating effect on your emotional well-being. It is true that somebody who is depressed or anxious about chronic pain actually experiences that pain more acutely. A clue that you are getting tripped up with all or nothing thinking is words such as "always" "never" or "ever." There are very few situations in life that are all-or-nothing.

A few examples of all-or-nothing thoughts are:
1. I will never feel better again.
2. This pain flare up will never end. I just can't cope.
3. I will always feel horrible.
4. I will never be able to work full-time because of this.
5. Nobody will ever love me if I am always sick (wow-there's TWO distortions for the price of one there!).

Some healthier examples of thoughts that are also true and more advantagous to coping are:

1. I may feel better again. After all, I have some days where I don't feel so well and some days where I feel fine. I can learn to ride out the ups and downs and be easy on myself when I am not feeling well.
2. Most of my pain flare-ups last six or seven days (or a month, etc. It is important to track your pain so you know what the REAL answer is to this question). Even if I am in daily pain some days are better than others. I have a list of coping tools that I can use to help make flare-ups more bearable such as relaxation, massage, acupuncture, and pain medications.
3. Many people who have chronic pain find some type of relief-even if it takes years. I will be one of those people and I will continue to plug away at this because my well-being and comfort is worth it.
4. It is ok to find a flexible or part-time job that will accommodate my health because my health is a priority. I will explore options such as job-sharing, self-employment, work from home, and even disability so I can remain self-sufficient. Because I'm not a fortune teller I don't know for sure that I will NEVER be able to work the future may hold physical relief or a job that fits my situation.
5. The vows of "in sickness and in health" also apply to me. I deserve to find somebody who is compassionate and mature enough to understand and be supportive of my limitations. Everybody comes to a relationship with baggage-it may be a chronic pain issue, a mental illness, a crazy family, or an annoyingly quirky love of stamp collecting. Just as I will be loving an accepting of my partner's quirks I expect my partner to work with me with mine.

These healthy thoughts in no way are meant to minimize the difficulties of living with pain. It is depressing, anxiety producing, angering, and upsetting to be in pain. But cognitive distortions don't serve us and taking an honest look at which ones we may be self-harming with help us break out of patterns of depressive or anxious thoughts and move forward to feel better both physically and emotionally.
Next entry will cover a few more cognitive distortions. Here are a few books/CDs that I think are helpful for coping:

Pain Free 1-2-3: A Proven Program for Eliminating Chronic Pain Now

Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach Workbook (Treatments That Work)

The Mindbody Prescription: Healing the Body, Healing the Pain

Sunday, July 11, 2010

Suggested Reading Material

Much like my suggestions to almost every client to exercise regularly, there are a few "tried and true" book suggestions I have that I find myself making over and over again.  Whether you are in therapy now with me or somebody else, you are considering therapy, or you would just like some decent self-help books here are some that I find incredibly valuable.

A few general self-help books for anxiety and depression:

The next one is a favorite not just because it's so good but because the title is fantastic.  Definitely remove this one from your coffee table before any family gatherings...

Incredibly helpful as an assist to couples therapy or for couples to try working thru on their own to increase their communication skills:

Fabulous depression self-help book:

Wonderful book for sexual abuse survivors as they prepare for pregnancy, birth, postpartum and lactation written by my mentor Phyllis Klaus:

For clients who are living with chronic pain this book has solid treatment options along with holistic support:

My favorite parenting book in the whole world: