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.

Sport, Train, Active, Fitness, Training, Sporty, Play
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Healing Flames and Gratitude Mandalas

For a more relaxed session today and informal conversation we held an ‘arts and crafts’ session-well loosely anyway. Having started with a mindful breathing exercise we had a couple of sheets to focus on something in particular if that is what people wished. One was ‘the healing flame’ helping individuals track a recovery process. This could be from past abuse of any kind. As a group we have witnessed members grow, grieve, become stronger and back to themselves having had abusive situations in their past. The other was a mandala prompting thoughts of things to be grateful for. Individuals chose different exercises for personal reasons. For some, tracking the linear process of recovery was helpful and for others a more circular idea of coping made more sense as life cannot always be tracked in linear process as anyone living with recurring anxiety or depression may well know. Whichever way we view our own recovery, our emphasis here is that movement is always possible; from the despair to hope and from broken dreams, hopes and crushed spirits to new growth, strength and contentment. Conversation was shared among the group as we worked on these exercises about how people managed, coped with and perceived life’s difficulties, leaving people feeling heard and understood.

The Healing Flame we found on a website called ‘Letting Your Light Shine’.

“Let Your Light Shine”
Developed by Alexandra House 2014
Adapted from the Healing from Abuse Wheel by Kate Cavett

The following mandala was found on a website called ‘Today’s Inkling’.

Posted in Weekly Blog

Escapism through movie characters

Group members talked about who their favourite movie characters were and why. They agreed that fictional characters provides them a feeling of escapism from their everyday lives. Movie characters can be form part of our public consciousenss in the same way as pieces of music do.

Imagining how your movie character would deal with someone who has bullied you can help inspire you with a little bit more strength. Equally a very anxious child can imagine having superhero powers like Spiderman to keep them safe.

Below is an example from Spiderman;

Posted in Weekly Blog

Songs that make me laugh!

This group regularly cite music and the arts as an important therapeutic tool for their well-being.  Today we wanted to continue this musical theme in a more light-hearted way and look at music and performances which made us chuckle. As musical tastes are totally subjective this can lead to some finding certain songs to be funny that were not necessarily intended to be so.

Below are some of the videos we watched.  Enjoy!

 

 

 

 

 

 

 

 

Posted in Weekly Blog

Dealing With The Benefits System

job-centre-plus-sign

Today’s group focussed on how people deal with the benefit system and more specifically, ‘Work Capability Assessment’ interviews. At group sessions we often hear of how the current system invokes strong feelings of anxiety and  sheer terror. With this in mind we thought it would be good to have a look at the different processes involved and the options people have.

Below is an example of the different stages involved upon receiving assessment letter; 

  1. Attend ‘Work Capability Assessment’ interview
  2. You receive a letter from the DWP* informing you that you are not being awarded benefit.
  3. You disagree with their decision so respond by sending a ‘Mandatory consideration letter’ to inform the DWP* of your reasons for disagreeing with their decision to see if they will reconsider.
  4. If the response from the DWP* is that they are upholding their original decision you then have the option to appeal it and have your case taken to at an independent tribunal.                                                       

If you are feeling anxious it is so important to seek support.

Some of the suggested supports were,

Group members felt that having someone to help support them in filling in forms was extremely beneficial and relievied some of their anxiety. With no support it can literally feel like a real life or death situation with the looming uncertainty of having no income to survive. That is why it is so useful to have supportive people around you to help provide some hope for your future.

 

 

*’The Department of Work and Pensions* 

 

 

Posted in Weekly Blog

Thinking about our Inner Child

Below is a small snap shot of how we used with Russian dolls to help us develop a better understand the dynamics of our ‘Inner child’

1. Inside the grown-up deep inside is the child just like these Russian dolls.
You might feel it a positive when you are playing with children. For example I feel it while playing football with my young nephews.

2. You might feel it in a negative way if you are waiting to go in for formal appointment and you start to feel as if you did when you were called to the headmaster’s office. (Or maybe you were all good kids and were never sent to the headmaster’s office!)

3. (Using an elastic band)
Like this band we are all big and stretched out, but certain events, circumstances or people could make us feel small again.

4. (Imagining all our younger selves)
Thinking about when you were at primary school what 3 words would you use to describe the wee person you were then?

5. (Pick an age between 5-10 years old)
– Thinking about you at the age you have chosen  we will ask a few questions if that is OK to that part of you, be it 5 or 7 or 10 years old- whatever age you have picked.
– Think about who was your teacher, your favourite toy or who were your friends then.
Ok so we are all focused in on an age and who we were then.
QUESTIONS-
If that child had something to say, to be heard what might it say?
What did it need?
What would you like to say to it?
How might you soothe it? (Note: Demonstrate by putting the little one in the big one.

6. We end by putting all the dolls back inside each other so there is just one big one. It demonstrates we are back in our adult place.

Posted in Weekly Blog

Decision making and responsibility

make-good-decisions

Do you feel that you struggle to make decisions?  Do you feel defeated trying to choose a cereal in the supermarket, or tormented about whether to attend your niece’s wedding?  We make so many decisions daily, and life is scattered with huge life changing decisions with a myriad of implications.  Popping into Starbucks for a coffee alone offers you no less that 80,000 ways to take your caffeine, or maybe no caffeine, or milk, full fat, semi or skimmed, or soya, latte or americano, tall or grande…..you get the picture (!) So how do we cope with making decisions.  Or do we not?  Or is not making a decision actually making a decision?

First of all in the group we looked at what is it about making a decision that can feel difficult? People said not knowing the outcome, the fear that if it goes wrong it’s all your fault.  People also said that a history of making bad decisions makes it hard to trust yourself and so decreases confidence.  Overthinking and rumination over the potential ‘what if’s’ of a decision provokes anxiety and procrastination.  And a final difficulty cited is that once a decision has been made you may then be tied to the consequences of it, and that is scary.

So, the second part of our discussion was around responsibility-the level at which we are able to accept responsibility probably promotes our decision making abilities.

Taking no responsibility leads to blaming everyone else, whereas taking all the responsibility is blaming yourself for everything.

We had a think about what these two elements look like: Not taking any responsibility manifests in procrastination, always letting others decide, not paying bills, not contributing, not thinking of others, avoidance, not willing to look at oneself, unhealthy coping mechanisms [to escape e.g. alcohol or sleep], and blaming others.  Taking all the responsibility conversely involves always making decisions for others, taking the blame for everything, putting others before self, only seeing the negative in yourself, dis empowering others, not trusting others which can lead to micromanagement and bullying. Another direction of over responsibility is taking so much care of others that it can lead to obsessive compulsive behaviours trying to protect everything.

The question was posed to the group ‘Do you actually know what decision is best to make, but fear and doubt are what comes in creating confusion and reluctance to decide’.  Interestingly people mostly did seem to concur that they did in fact know what to do, so it isn’t the not knowing that creates a barrier to deciding but rather the implications of the made decisions.  People did chat too that as well as not making or avoiding decisions, sometimes they just make very impulsive choices, we talked about whether at times these were self-sabotaging behaviours.

There are some things we can do to help in combating decision fatigue.  A study of an Israeli prison parole board showed that prisoners appearing earlier in the day were more likely to receive parole for no other reason than by the end of the day the judges were tired and less likely to have the mental energy to make a decision regarding a prisoner’s release.  This study is cited in the New York Times in an article about decision fatigue. 

It is no different for us, when we are tired, hungry or it’s the end of the day having already made thousands of decisions, it becomes more difficult to decide.  So sometimes putting an important decision off until the morning may be wise, and planning and organising can significantly reduce the pressure of having to make extra decisions.

9 tips here to make better choices.