June 17th, 2009

Pain Management Class No. 5

Pain Management Class No. 5

In today's pain management class we learned about cognitive distortions, and how our thinking can get twisted enough to alter our perception of events and their consequences making it more difficult for us to manage our chronic pain.

Today we learned about the ABC/D model, where A is an activity, situation or event, such as waking up with a bad pain flare; B is our beliefs about and interpretation of that situation or event, such as any negative thoughts about waking up with a pain flare; and C is the consequences of our thoughts: the emotional, behavioral and physical changes that happen inside us, such as the stress response we create when negative emotions come up or negative thoughts jump to mind.

As we learned in the second class, the stress response creates a feedback loop that escalates the stress and the pain. (The D in the ABC/D model represents how to disrupt this feedback loop, and we will cover that next week.) So we need to look at what part of this model we can control or influence. We can't really control the event or make it as though it never happened. And we can't really control the consequences either, because they are the result of our thoughts and cognitive activity. The B, or belief, level is where we can intervene. So we need to look closely at our beliefs, interpretations and thoughts about the event.

A lot of us are not always aware of our thought processes when we endure a negative experience. Many people confuse their emotions or feelings with their thoughts. One way to help distinguish the two is to remember that an emotion can be described in one word: angry, frustrated, confused, resentful, despairing, etc. But a thought process will usually take a whole sentence to describe: "Not again!" "I'm not going to get anything done today!" "This is going to be another hellish day." "I never asked for this to happen to me," etc.

Here are 10 forms of twisted thinking:

All-or-nothing thinking (everything is black or white, nothing in-between);

Overgeneralization (seeing a single negative event as a never-ending pattern of defeat by using terms such as "always" or "never");

Mental filtering (picking a single negative detail and dwelling on it exclusively);

Discounting the positive (rejecting positive experiences by insisting they "don't count");

Jumping to conclusions (arbitrarily concluding that someone is reacting negatively to you based on no actual evidence [mind-reading], or predicting ahead of time that things will turn out badly [fortune-telling]);

Magnification (exaggerating the importance of your problems and shortcomings);

Emotional reasoning (assuming that your negative emotions necessarily reflect the way things really are);

"Should" statements (telling yourself that things should be the way you hoped or expected them to be);

Labeling (an extreme form of all-or-nothing thinking, e.g., instead of "I made a mistake," you think "I'm a total loser," or "failure," "jerk," etc.);

Personalization/blame (holding yourself personally responsible for an event that isn't entirely under your control, or blaming other people or your circumstances for your problems while overlooking ways you yourself might be contributing to the problem).

We ended the session by holding ordinary hardware washers tied on the ends of strings like pendulums and trying to will them to swing a certain way without moving our arms or hands. Some people could not get theirs to move at all; others got theirs to move a little bit. But mine was alive the moment I took hold of it! It started swinging in a clockwise circle all by itself as soon as I got it in my hand, before we had even started the exercise. I was able to make it stop circling and get it to swing left/right, and then in/out, although not very much. I got it going again clockwise again, and was even able to reverse the direction to counterclockwise.

Supposedly our fingers were making very tiny, minute movements to influence the pendulum's movements even though there were no conscious or visible arm motions. My fingertips are pretty numb (so numb, in fact, that I could not feel the string at all because I was grasping it so lightly), so if I was indeed making any movements I certainly could not feel them. The point was that our bodies will respond in a certain way if we put our attention to it, so being mindful of our thoughts can influence the emotional, physical and behavioral consequences of any situation we might find ourselves in.

Our assignment for next week is to come up with some examples of our own cognitive distortions. Hmm, right away I can think of lots of times I've been a fortune-teller and have engaged in overgeneralization. In time I could probably come up with several examples of each type of twisted thinking from various times during my life. What that says about me, I don't like to think . . . Oh, wait, I am supposed to think about it . . .


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