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Pahavit's Universe

pahavit
Date: 6-25-2009 4:17 PM
Subject: Pain Management Class No. 6
Security: Public
Tags:disability/medical, me/cfs, pain management class, stanford pain management center
Pain Management Class No. 6

In last week's pain management class, we learned about how cognitive distortions can twist our thinking enough to alter our perception of events and their consequences, making it more difficult for us to manage our chronic pain. In this week's class we learned about cognitive restructuring, or how to disrupt maladaptive thought processes.

The first thing we can do when we catch ourselves engaging in a cognitive distortion is to ask ourselves, "Is this helpful?" and "Is this accurate?" If the answer is "No," it's time to modify the thought(s). To wake up with a pain flare and think, "My whole day is ruined now" is definitely not helpful, nor is it necessarily accurate; none of us is such a gifted fortune-teller that we know ahead of time whether any particular day is going to be ruined or not. In spite of having many days of pure hell, I've also had many days that started out hellish but changed later on for the better, and I was glad I had been open to the possibility of my day improving in spite of a really bad start. So we must be aware of these kinds of twisted thoughts and work to "untwist" them.

This is definitely not to say that we just blithely become a Pollyanna and turn negative thoughts into something positive ("I'm in agony but there's a pretty butterfly outside my window, gee golly ain't life just wonderful!"), because that is just too simplistic. Sometimes these kinds of thoughts are okay because they are just blowing off some steam. But beyond that, we need to employ some of these techniques to get back on track:

Identify the distortion (from the ones we learned about last week);

Examine the evidence (don't assume the negative thought is true without looking at the actual evidence);

Double-standard method (talk to yourself the same compassionate way you'd talk to a friend with a similar problem);

Experimental technique (test the validity of the negative thought);

Thinking in shades of gray (don't see the problem in all-or-nothing extremes, but find some middle ground);

Survey method (ask people questions to see if your thoughts and attitudes are realistic);

Define terms (when labeling yourself "fool," "loser," etc., to dispel validity);

Semantic method (substitute language that is less colorful or extreme);

Re-attribution (instead of blaming yourself, look for other factors that play a role in creating the problem);

Cost-benefit analysis (list advantages and disadvantages of your negative thought; this can also be used to modify a self-defeating belief).

We learned it is hard to apply these techniques in the heat of the moment when we are overcome with negative thoughts, so at first it's best to analyze our thinking after the fact, when we can be more objective. Gradually we need to shift this analysis process to when the thoughts are actually happening, in the moment itself. Eventually it will become automatic, and we will be able to avoid falling into the cognitive distortion trap right off the bat, for the most part.

I recognized that I have been engaging in my own kind of cognitive restructuring for a long time now. I spent years stuck in the "Why me?" phase until I realized that it wasn't getting me anywhere useful, so I consciously steered myself away from those thoughts until they simply stopped occurring in the first place. Whenever I wake up in a pain flare I always say to myself (after first thinking "Oh crap!"), "How bad is it? What can I get done anyway today? I know there's something I can do, even if it's just a little. And maybe I'll feel better after a while." Whenever I think a particular appointment is going to go badly, I stop and remind myself not to put that kind of affirmation into the universe and try to summon the courage to be open to a positive outcome, or at the very least a neutral one, instead of a negative one. Whenever my short-term memory fails me and my brain fog gets really bad and I start to think, "You're so stupid for forgetting that! You're such a moron not to understand something so simple!," I tell myself it's the ME/CFS that makes me feel stupid, not the real me that's stupid. (That last one is something I still struggle with, though.)

We ended the session with a visualization exercise, imagining ourselves in a beautiful, relaxing, safe place. A previous session's relaxation exercise involved a mental body scan, which for some people can be uncomfortable because as it sweeps through the whole body its focus naturally includes painful areas, so this week's relaxation exercise had a different focus -- being out in nature. I imagined myself in Sunol Regional Wilderness, the time D. and I were there in March and we were surrounded by bright waves of migrating painted lady butterflies. A lovely respite from chronic pain, even for a few moments.


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