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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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The Impact of Bullying

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”.

Click here for article on bullying from theconversation.com

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Tolerance and attitudes in society

In this session we decided to have a look at our own unconscious biases and prejudice. It can be very easy to be judgmental of other peoples prejudice (Yes! I know that’s ironic). It can be easy to get self-righteous about the prejudice of others without being aware of our own as per a spectacular piece of graffiti which used to grace a bridge in Edinburgh saying “Go Home Bigots”. And here I am self-righteously judging their prejudice, and so it goes on!

We looked at the ‘Unconscious Prejudice Questionnaire’ which we did notice some of the language maybe had an unconscious prejudice of it’s own. People quietly reflected upon areas where they maybe did have a bias, we noticed that sometimes we are afraid to admit this. But people did share biases and we noticed that often these were connected to personal experience.

Everyone has implicit biases and prejudice, these come from family upbringing, cultural norms, media portrayal of certain groups and about people groups with whom we are not familiar or not educated about-ignorance is not always bliss, nor is it helpful. Businesses, recruitment and community suffer when we discriminate due to unconscious bias, we miss out on skill, diversity and different perspectives. As is often the case in our conclusion, keeping an open mind, being open to be educated and as we did in this session and be honest about the thoughts you are uncomfortable with.

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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;

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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!

 

 

 

 

 

 

 

 

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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* 

 

 

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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.