It had been requested by the group to look at ways of managing pain. Chronic pain, often with an undiagnosed cause, and for which medication is not effective affects about 7.8 million people in the U.K, 25% of whom have lost their job and 16% of whom experience such bad pain that at times they feel as if they want to end their life. (These statistics are from 2009 and cited by Corrie, Townend and Cockx , 2016). We considered a CBT coping model of coping with chronic illness, also presented by the above authors.
Because human beings are not easily compartmentalised into separate parts that function independently of each other, this model considers a number of factors; physical, environment, the impact of medical professionals, our thoughts and beliefs about illness, the social relationships that we have and support, the culture we live in, the level of activity we engage in, our emotional state and resilience. All of these areas affect our experience of pain. For pain “is simultaneously a sensory and emotional experience” (Dima, 2013).
Our medical journey can sometimes be very discouraging and disheartening when no diagnosis is forthcoming and we get passed from department to department with no resolution for the pain. When our emotions are affected by a sense of hopelessness or stress this can increase our sensitivity to pain. The things we tell ourselves about pain can contribute to our emotional state and maintain pain e.g. I will never be well, I will get worse, or we may hold images that are upsetting and unhelpful. We are also affected what other people or our culture tell us about pain. Group members talked about messages they had heard such as ‘well-you’re not getting any younger’. The level of activity people engage in is important-overdoing it leads to more pain, more injury, more recovery time and less wellness. Inactivity due to fear or beliefs about the pain maintains it and contributes to a reduced sense of overall wellbeing due to isolation and not engaging with pleasurable activities. Group members spoke about the importance of balance and how they continued normal activity although sometimes needed to moderate this at certain times but didn’t stop doing things altogether.
Group members spoke about how important it is to have support and how significant this is to them. Research shows that such support how ‘pain is perceived, expressed and experienced’ (Corrie, Townend and Cockx, 2016). Medical professionals and other social contacts can help or hinder what we tell ourselves about our pain and acceptance of illness and what we can manage.
Group members shared what helped them to deal with pain. Some said that a ‘mind over matter’ approach had been very important in helping them to push through very painful physio exercises to recover as they knew they felt better afterwards and eventually recovered completely. Using the mind differently, some people definitely recommended mindfulness as a way of coping with pain. Mindfulness involves observing what is happening in the body in a non-judgemental way. Clinical trials showed that mindfulness can reduce pain by 57% and for some up to 90%, brain imaging showed how the brain is soothed by mindfulness.
We talked about the importance of noticing our bodies. When we are in pain, or worried we become tense, we hold our bodies rigid and inflexible, this can both cause pain and exacerbate existing pain, so relaxation is important. As a group we have often used breathing techniques together as a form of relaxation and noticing where we are holding tension. One group member talked about a technique of full body stretching, as in if we think about how a cat stretches fully:
It was said that when animals stretch, they don’t do specific targeted stretching but just go for it….you don’t see bears doing shoulder stretches, however I did find this fun yoga bear workout!
People spoke about other activities which create the natural pain killers, endorphins, like exercise, and singing.
We spoke also about external and internal locus of control, and how much we believe we have power over elements of our circumstances or how much we believe we are helpless. As we looked at the model of managing chronic pain we could see areas where we could feel like we have more control:
Biological and physiological factors-if we are stressed this can increase the experience of pain, so finding ways to relax and calm down the threat system can help, such as breathing, nice walks and things we enjoy.
Psychological factors-the things we believe about our pain can sometimes increase our experience of it, so being aware of beliefs and reality testing them can be helpful, for example the group member who told us about believing that the physio exercises were helpful for healing helped her to push through and heal rather than giving up.
Social context and support-many group members today realised how important it is to have supportive relationships and places of support, isolation or lack of support can increase stress and upset emotions which can exaggerate the sensation of pain. For example many group members often leave the group feeling better than when they came in, this is an example of feeling soothed which can help pain.
Behavioural responses and level of activity-here we spoke about balance. It is important to do the right level of activity that we can manage. Pushing ourselves too hard can result in worsening pain, leading to the necessity of inactivity, which can in the long term worsen pain. Not enough activity can increase our sensation of pain but is also likely to lead to more isolation and missing out on things we enjoy. This can be to do with our thoughts and fears as well that activity may be bad for us, so growing confidence may be important. People spoke about for example taking a walk each day, and that sometimes they may need to walk for 5 minutes rather than the usual 50 minutes, but they are still managing to go for a walk.
The group had suggested that we could do a session on letter writing to process difficult emotions.
We had an outline for a process to follow if this would be helpful:
We recognised that each persons situation was very different, some issues are maybe in a current relationship, some may be with people from whom we are now estranged or may be deceased. Actual contact with the other person may or may not be possible or appropriate depending on the circumstances.
Some letters had dealt with anger or being controlled and realised some new things through writing it out. Other letters addressed betrayal and forgiveness. Some had written a letter to self, recognising that they were deserving of self-care and were worthy of value. Some people had written to a person in their life that had previously bullied them and realised that they now felt sorry for this person.
Through this process we acknowledged that there could be conflicting feelings, for example feeling angry yet loyal, or hurt yet had hope for reconciliation. People noticed that there was something helpful in the act of writing things down, that in the flow of that there could be more clarity. Some people saw that their process was still very active and that there were further layers of processing to do.
During the letter writing exercise we enjoyed having Neil Young’s song on about writing a letter!
It had been requested by the group to look at dealing with shame as a group topic. We began by watching the video clip of Brene Brown talking to Oprah about her research about shame.
Group members responded to this idea that talking about shame is helpful as some of them had experienced that this process for them, of talking about things they were ashamed of was very healing. People also responded to the idea that shame grows with silence and secrecy but cannot survive empathy and understanding. We talked about what is the difference between guilt and shame concluding that shame is about our identity; how we see ourselves and also how it extends externally in how we worry about how we are seen by others. We talked about what it is like to grow up with shaming messages or the message that our worth is dependent on us achieving or doing well-it is conditional.
Shame can come as a result of being abused, sexual or otherwise in childhood. Thoughts about this can create a very visceral reaction and people can physically feel sick, disgusted and a sense of revulsion.
People also talked about things that they had done or said when younger that we now feel shame over, what can we do about this now? Sometimes we just have to acknowledge that we did some things we wished we had not, but recognise that this is common to every human being. In some situations there is maybe a possibility to say sorry if it is appropriate and may help the other person. However, a sense of shame does not serve anyone, so maybe this same message applies that if we talk about the things we feel ashamed of, this can dissipate the shame. We can accept the error, accept ourselves and move on with the learning and growth from the experience.
It is important to have self-compassion and understand common humanity, (rather than thinking ‘I am such a bad person, no-one else is like me or would do such a terrible thing’) and bring some understanding for maybe why we did things at the time.
Shame is sometimes connected to responsibility we carry that isn’t ours to carry, other people make us feel bad for things we are not actually responsible for.
Deborah Lee in her book ‘The compassionate mind approach to recovering from trauma’ explains how shame can lead to feelings of anxiety; internal shame because when we are self-critical and self-hating this activates the threat system, causing us to feel anxious. With external shame we are afraid of how we exist in the minds of others. This links back to a basic survival need to belong in a group for protection. When we fear this social loss this activates the threat system again resulting in feelings of anxiety. Lee lists some of the common fears and beliefs we can have when feeling ashamed such as ‘I do not deserve love, kindness and care, or for good things to happen.’ Or feeling weak and pathetic for not being able to ‘get over things and move on with life’. Participants could identify with some of these thoughts.
After the group it was interesting to find an article in ‘Therapy Today’ about shame, saying:
“The way out of shame is to talk about the very issue you are ashamed of with people you trust”.
I guess this helpfully consolidates the conclusions we had come to as a group, when we do find the courage to speak, it is very important that those we speak to are trustworthy.
In this group in a season fast approaching autumn with nights growing longer and more darkness around, people are beginning to notice the difference of less light, increasing tiredness, disturbance of sleep and possible changes in mood.
So we focused on light; how when light shines in the darkness it can’t be dark anymore, and how this doesn’t work the other way around-you cannot put darkness into light as the same principal does not apply. We considered how all living, growing things need light and turn to the light. For the scientifically minded we thought about Einstein’s theory of light; how it bends in waves and reaches everywhere.
We considered what could help us as we move into the time of year with less light. What strengths and resources have we gathered through the summer that will keep us going into the darker months? Group members compared this idea to being like a solar panel and storing energy from growth and development, as well as sunshine to energise us through the winter. Some members talked about what it looks like as you walk through a long tunnel and the pin prick of light becomes bigger and bigger as you keep going-a reminder that light comes, and spring comes again too. We were also reminded that in shorter days it is a good idea to try and get out for a walk each day in the daylight and get some sunshine. We considered too that although the trees drop their leaves, this allows more light through during the winter time.
The group had a creative task today which everyone got involved and engaged with as they produced images, poems, word pictures and arranged lights all with personal meaning about the importance and value of light and how we will maximise it where we can over the next few months.
Today’s group looked at how we saw ourselves in romantic relationships. The way we are in relationships stems from beliefs we hold on our self. The blueprint for how we see ourselves most likely originates from our first relationships, Our parents and family.
We did an exercise to look at this and find out what messages we learned from childhood. Below are a couple of examples of this;
In this group we looked at how body language impacts us in a couple of ways; in feeling powerful and in flirtation. Amy Cuddy (Ted talk below) talks about powerful and powerless body language, so we tried out being in the different positions and noticed what it felt like. In the positions where we made ourselves smaller and protected people felt a mixture of it was harder to breathe, a bit crushed, a bit vulnerable, and for some it felt safer. When we tried the more open, expansive positions this gave a little more confidence, some people thought that in some circumstances maybe it could be a bit arrogant so we discussed context and appropriateness.
Flirtation! Now this can be a minefield when we start to try and interpret our own body language towards someone we like or try and read other’s as we wonder ‘are they flirting with me?’ So we had fun with the points raised by the Ted talk below in considering how humour, open body language, touch, attention, proximity and eye contact are signs of flirting or showing a genuine interest in another person. It is interesting to note that when feelings are reciprocated, a close proximity and longer eye contact is welcome, but if we are not interested, that feels uncomfortable for us or vice versa. So, it can be quite be tricky to navigate these unspoken social cues. This is where having a bit of awareness in reading the signs can be helpful. Personally my favourite is in which direction are the feet pointing! If it’s towards the exit this is a helpful sign.
We reflected on ‘how do you walk into a room?’ We thought of this in line with Amy Cuddy’s encouragement to fake it til you become it. She believed that she didn’t belong but behaved as if she did. Finally she realised she had come to feel like she belonged.
We considered the power of words over our body language; we tried an experiment where it seemed that negative words may actually deplete us physically where as affirming, kind, compassionate and encouraging words give us strength.
At today’s group we looked at how bullying can affect us. We looked at it from the view point of both the aggressor and victim. People who use bullying behavior often have very low self-worth and enjoy putting others down in order to make them feel better about themself. This person is behaving from a fearful place and is most likely very vulnerable. If you have been the victim of bullying this may feel hard to believe.
We did an exercise where we looked at people’s experience of bullying behaviour.
One is a statement about past experiences while the other is in the present looking forward. Below is the template used;
“Bullying made me feel like I am…”
“Today I honour myself by choosing to feel that I am…”
Below is a written example of how it may be used;
“Bullying made me feel like I am worthless and deserving of this behaviour. “
“Today I honour myself by choosing to feel that I am a worthwhile person who values themself. I will not let people control me and can use these past experiences to help myself and others”.