Posted in Weekly Blog

Struggle thoughts and counter thoughts

At this time of year now when we are noticing a lot less light in the morning and evening, it can be quite typical for people to notice a drop in energy and mood and experience sleep disruption. There did seem to be a sense of this in the group this week so we did something a little different to create a little energy as we investigated some troublesome little thoughts. Our room became a brain and each of us a thought. The difficult thoughts would present themselves whilst the other thoughts sought to neutralise them. This allowed some physical movement and some cognitive acrobatics.

The first thought to present itself was a belief: ‘I can’t do this’ in response to trying something new. This belief had the potential to quit or miss out on things. But the other thoughts reasoned with this belief ‘you don’t know that until you try’. ‘You can practise’, ‘no-one can do the things they haven’t learned to yet’. This quietened down ‘I can’t do this’ and allowed some patience with self and an acceptance that it is ok to not be able to do some things when we start out; but it’s important that we try.

The next thought said ‘I’m so tired I don’t think I’ll manage my day’. Balance was quite quickly on the scene here with a reminder that we could prioritise some things and that we could manage what we needed to. Practicality came in with a few suggestions too that if we we able to have a more gentle day we could do some relaxing things like have a bath and feel better rested for tomorrow. If our day was a bit more demanding we could have a shower to revive us and we would manage. what is required.

Worry showed up on the scene this morning too with beliefs that if we have always been this way we won’t change. Evidence came into the conversation here and asked if worry ever changes the outcome or ever made a situation different? Worry conceded that actually sometimes it got worse and didn’t change anything at all! Worry sometimes caused people to avoid and miss out on things. Bad things still happened whether they worried about it or not. In fact worry seemed to reproduce itself into bigger and bigger worries, and the worry about worry could cause another whole set of problems intruding into not being able to focus on other things or speak to people and causing distressing feelings. Identity spoke up too and said just because worry is something you have always done, it doesn’t mean that is who you are and need always to be that way. You will still be you if you worried less. Everyone has worries, that is quite normal but we made an agreement to spend a bit of time over the next week analysing the evidence for seeing if worry makes us feel better or changes anything. It was also suggested that a specific time could be given for worrying rather than it dominating the diary everyday.

A more stubborn relative then intruded into the conversation. Obsessively believing that ‘I am responsible for everything and everyone and if I think about a possible danger somewhere for someone and don’t do all I can to protect people from this danger and someone gets hurt then it’s all my fault, I’m the only one to blame. OCD then compulsively convinced us that unless we take the time and energy to do all sorts of precautionary and checking activities and carefully going through all sorts of mental check lists then disaster may occur which we could have prevented. Admittedly OCD was harder to quieten down. We concluded that it would be very frightening to tackle as we would just have to try really hard to not do the stuff it was convincing us that we needed to do. We will take it slowly at first and check a little less to start with.

A big thanks to the group who were willing to get involved in this exercise today in a slightly different way. We learned some new things from each other about how we think affects us, some new understanding and some new ways to start trying to change our troublesome thinking.

Posted in Weekly Blog

Pain Management

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:

Image result for stretch like a cat

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.

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