
- •Other titles in the series include:
- •Overcoming chronic pain a self-help manual using Cognitive Behavioral Techniques frances cole, helen macdonald, catherine carus and hazel howden-leach
- •Isbn: 978-1-84119-970-2 eIsbn: 978-1-47210-573-8
- •Table of contents
- •Acknowledgements
- •Foreword
- •Introduction by Peter Cooper Why cognitive behavioral?
- •Introduction
- •Who might benefit from using this book?
- •What does chronic pain mean?
- •What is Cognitive Behavioral Therapy?
- •How can a book help?
- •How can I get the most out of using this book?
- •What do the chapters cover?
- •How do I start using this book?
- •Four case histories
- •Using the person-centred model
- •Maria and the person-centred model
- •How did the model help Maria make changes for the better?
- •How can the person-centred model help you get ready tomake some changes?
- •Getting started
- •Reducing the impact of pain on your daily life
- •How do you or others see these changes occurring?
- •Understanding chronic pain and pain systems
- •Understanding pain
- •Acute and chronic pain
- •What is acute pain?
- •What is chronic pain?
- •Acute and chronic pain systems
- •The acute pain system
- •The chronic pain system
- •Theories of pain The Gate Control Theory of Pain
- •Other theories of pain
- •Frequently asked questions
- •Understanding investigations for pain
- •Blood tests
- •Waiting for tests and results
- •Understanding the roles of healthcare professionals
- •Healthcare professionals
- •What is the role of a physiotherapist?
- •How do physiotherapists work?
- •What is the role of a specialist pain nurse?
- •What is the role of a pain specialist?
- •What is the role of a psychologist?
- •What is the role of a psychiatrist?
- •Talking therapies
- •Cognitive Behavioral Therapy
- •Pain management programmes
- •Understanding medicines and using them better
- •What types of medicines are used to manage chronic pain?
- •How are medicines used? Analgesics
- •Problems with medicines
- •Making better use of medicines
- •Four suggestions for using medications more helpfully
- •Stopping or reducing your medicines
- •Part two Overcoming Chronic Pain
- •Introduction
- •Setting goals
- •What are goals?
- •Informal and formal goals
- •What are smart goals?
- •Setting goals
- •Using a goal ladder
- •Achieving your goals
- •Giving yourself rewards
- •What are rewards?
- •Creating a ‘fun presciption’
- •50 Mg of fun three times a day (at least) For maximum benefit, use imagination!
- •Understanding pacing skills
- •What is pacing?
- •What are the different styles of pacing?
- •What type of pacing style do you use at present?
- •If pain levels are low, do you:
- •If pain levels are high, do you:
- •How to change your pacing style
- •Experimenting
- •Planning
- •Priorities
- •How to deal with barriers to realistic pacing
- •Getting fitter and being more active
- •How being more active can help you manage your pain
- •Trying to get fitter: What does having more pain mean?
- •Why do these types of activity cause aches and pains?
- •Assessing your present activity level
- •Frequently asked questions about increasing physical activity
- •How to get started on a basic exercise programme
- •Strength exercises – do slowly
- •Stretches for flexibility
- •Understanding problem-solving
- •What is problem-solving?
- •The main steps in problem-solving
- •Putting the problem-solving process into practise
- •Problem-solving guide
- •Understanding sleep and sleep problems
- •What sort of sleeping problems can be caused by chronic pain?
- •What kind of sleep pattern do you have at present?
- •How much sleep do you need?
- •How to use a sleep diary
- •How can you change unhelpful sleep habits?
- •Relaxation
- •What is relaxation?
- •How can relaxation help with chronic pain?
- •What can help you relax?
- •How to practise relaxing
- •Time out relaxation
- •What can make it difficult to practise relaxation?
- •Pain, communication and relationships
- •Part 1: communication and sharing concerns How close relationships can be affected by pain
- •How to manage difficulties in relationships
- •How to change behavior
- •How to communicate and share your concerns
- •Part 2: chronic pain and sexual relationships
- •How to deal with sexual problems
- •How to make sexual relationships easier
- •Managing depression, anxiety and anger
- •What moods can occur because of pain?
- •Part 1: managing depression
- •Why do people become depressed with chronic pain?
- •How depression affects people’s thinking
- •What factors can contribute to depression?
- •Unhelpful thinking in depression
- •Using anti-depressants
- •Part 2: managing anxiety
- •What is anxiety?
- •What are the effects of anxiety?
- •How does anxiety affect the body?
- •Anxiety and chronic pain
- •Managing anxiety by dealing with unhelpful thinking
- •Overcoming avoidance
- •Changing unhelpful behaviors
- •Part 3: managing anger
- •How anger affects you and your pain
- •How chronic pain and anger are linked
- •How being angry can affect other people
- •How to manage anger better
- •A coping plan
- •Acceptance
- •What is acceptance?
- •How can acceptance help you manage chronic pain?
- •What is attentional control or mindfulness?
- •1. Reasonable (thinking reasonably)
- •2. Emotional (thinking emotionally)
- •3. Wise (being mindful)
- •Mindfulness skills
- •1. Observing
- •2. Being ‘non-judgemental’
- •3. Focusing on one thing now and being in the present
- •4. Doing what works
- •Mindfulness exercises
- •Maintaining progress and managing setbacks
- •How can you maintain progress?
- •Obstacles to progress
- •What is a setback?
- •How can you manage a setback?
- •Looking to the future and managing work
- •How are new ways of life and new roles possible?
- •How can you use a positive data log?
- •Thinking through work, training and other options
- •How can you stay at work or return to work successfully?
- •Useful information
- •Professional organizations
- •Self-help groups and organizations
- •Books and publications
- •Self-help books
- •Tapes and cDs
- •Useful videos
- •Wordlist
Setting goals
People often say, ‘There are so many things that I want to achieve, I don’t know where to start.’ It may help to divide your goals up into areas, as in the examples opposite:
Have a look at these examples and then, for each area, decide on a goal for yourself:
I want to achieve . . . by the end of . . . weeks.
Write down at least three goals in your notebook.
Then, for each goal, write down all the skills and information you need to help you achieve that goal.
It may be helpful to look at some examples of people from the Case Histories you read earlier (see pp. 11–19). For instance, Razia wants to achieve a physical activity goal. She wants to be able to swim twice per week for 30 minutes. And she wants to achieve her goal in eight weeks.
What skills and information does Razia need to achieve her goal? She might need to:
• Find out the opening times of the local pool and how much it costs to swim
• Find out the bus route and timetable
• Buy or borrow some swimming goggles
• Improve the flexibility, strength and stamina in her arm and neck muscles (see Chapter 9)
• Practise deep breathing and relaxation skills (see Chapter 12)
• Work on her pacing skills (see Chapter 8)
• Learn how to reward herself for making progress (see Chapter 7)
You may have thought of other things you need to know or do to achieve your goals. In your notebook, write the key pieces of information and skills that you need for one of your goals.
Using a goal ladder
A useful total time period to set for a goal is six to eight weeks. Then you can divide your goal into six or eight smaller short-term goals. Write one small goal next to each step on the ladder. Each step is a week.
You can use the ladder on p. 107 for each of your goals. The ladder gives you your plan, week by week, helping you reach a specific goal.
For example, look at Steve’s goal ladder for an eight-week period. Steve’s goal aims to gradually build up his skills and fitness levels, working towards his goal to wash his car by hand.
Steve knows that he may have setbacks and barriers to his progress during the eight weeks. So he needs to plan for these setbacks and be prepared to review his plan if he has problems. Taking one step at a time increases his chances of being successful.
Choose one of your goals and see if, following Steve’s or Razia’s example, you can complete your own ladder.
There is a spare Goal Ladder sheet at the back of the book (see p. 294).
Achieving your goals
Here are some tips for success in achieving your goals:
• Try to work on two or three goals at any one time.
• Talk to others; get their views on what goals to focus on at present.
• Consider all the skills and key pieces of information you need to help you reach each goal.
• Plan and carry out one step at a time – each step counts as an achievement. Use the goal ladder sheet.
• Consider what reward you might give yourself when each goal is achieved (see Chapter 7). Write the rewards in your notebook.
• Reward your successes and save the biggest reward until last.
What will happen if you come up against difficulties or barriers? Forewarned is forearmed. It will help if you consider, in advance, how you’re going to cope if things don’t quite go according to plan. Consider the following questions and jot down the answers in your notebook:
• Are there any barriers that might prevent you from reaching your goal?
• Is there anything that you can do about them at the moment?
In addition, you should record your achievements, either daily or on a weekly basis, as evidence of progress. This will help to reassure you at times when the pain is severe, and you might otherwise be tempted to give up. It’s also important not to attempt more than one step of the ladder at any time, or you could fall off! If you do fall off, check what might have caused the setback.
You can use these answers to help reduce the chances of falling off the ladder or having another setback.
And what happens after you have achieved all the goals on your ladder?
Then you can ask yourself the following questions:
• Do you want to continue and build on the same goals?
• Do you want to maintain the same goals?
• Do you want to change to other goals?
Planning and working towards goals is ongoing activity. It can help you make steady progress towards fulfilling your long-term goals.
CHAPTER SUMMARY
• Goal setting is a valuable skill.
• You can use goal setting to help you work towards improving different areas of your life, despite the pain.
• Goal setting can be an enjoyable, rewarding experience, which requires realistic step-by-step planning.
• It may mean using your problem-solving skills to cope with difficulties that occur along the way.
• Rewarding successes or progress in small steps can help keep motivation going and build self-confidence.
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