
- •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
The main steps in problem-solving
There are five main steps in problem-solving.
STEP 1: RECOGNIZE AND DEFINE THE PROBLEM
This means realizing that something is in fact a problem, and describing it. This can give you time to think. Recognizing that there is a problem also means that you can choose how to deal with it. You can decide how important it is to do something about it (or not!). This puts you more in control of your response. It offers an alternative way of dealing with problems – instead of acting on ‘first impulse’ without considering alternatives, or ‘doing nothing’ and hoping the problem will go away. Sometimes unpleasant emotions (such as feeling low or worried) can give you clues as to where the problem lies. If you realize that something is making you feel like this, you can then decide how much of a problem it is to you, and choose what to do next.
Defining the problem means being clear about exactly what the problem is. You can try talking it through with someone until you are able to write it down. Or you can make rough notes for yourself until you can write it down clearly.
For example, Steve wrote down his problem like this:
‘Getting fed-up and frustrated, which happens when I think about being stuck in the house all the time.’
TIP
If it turns out to be a number of different problems, choose one to concentrate on first. Or you can break a large problem down into parts. You may already have some experience of breaking things down into steps from working on your pacing skills in Chapter 8.
STEP 2: LIST ALL POSSIBLE SOLUTIONS
Write down all the ways in which the problem might get solved. List all the ideas you can come up with, even ‘bad’ or ‘silly’ suggestions. If nothing comes to mind, think of the most ridiculous ideas possible, and take it from there! You can even think first of what would make the problem worse. At least then you can write down ‘doing the opposite’! If you are discussing it with someone else, get the other person to think of ideas, too. See how many ideas you can come up with. At this stage, don’t ‘filter out’ or discuss the advantages of any suggestions. Just jot them down in your notebook.
Steve thought of the following ideas – with help from his friend Malcolm:
• Get my neighbour to take me out
• Go on a romantic weekend to Paris with Nicole
• Join a wine-making club
• Get my brother to let me baby-sit for my nephew
• Move house
• Visit my friend Paul more often
• Go down the pub
• Blow up the house
• Redecorate
• Keep my eyes shut all day
• Try staying in the house more so I get used to it
• Go for a walk to the park
• Sit in the garden
STEP 3: LIST THE ADVANTAGES AND DISADVANTAGES OF EACH POSSIBLE SOLUTION
Now go through your list, and highlight the main advantages and disadvantages of each solution.
What would the consequences be:
• In the short term and in the long term?
• For you, and for others?
Bear in mind the resources that you have now, including time, skills and money.
Steve listed the advantages and disadvantages opposite.
STEP 4: CHOOSE THE ‘BEST’ SOLUTION
From your list, choose the solution that you are most likely to be able to carry out, given your present circumstances. It may not be the ‘perfect’ answer, but at least it gives you an option to try. Remember to plan each step, think about any problems or hitches that might arise, and practise the difficult parts beforehand.
Steve decided: The best solution at present is to go and see my friend, Paul, more often.
I will phone up this afternoon and try to arrange a short visit this week.
Possible hitches?
If he’s not in, I will either leave a message or try again.
If I have no luck getting hold of him, I will send him a text message after three days and ask him to phone.
If we have fun, we will do it again. If not, I can have another look at my list.
Review in two weeks.
STEP 5: REVIEW YOUR PROGRESS
Decide when you will review your progress in carrying out your plan. Have a look at how you got on with each step. Remember to praise yourself for effort, rather than achievement.
You may need to revise your plans, and set another review as you go along. Keep problem-solving until you have achieved your goal, or resolved the stress. If you still find that something can’t be changed, then at least you will know that you have tried. You can use problem-solving to help you to deal with feelings, such as anger or sadness, which may arise. You could also try talking your feelings through, focusing on something else, or finding ways of accepting the way things have turned out (see Chapter 15).
Steve reviewed his progress after two weeks:
I have been round to Paul’s house twice, and we are off to the garden centre tomorrow. It’s a good start. I want to do other things as well now – I feel a bit better. Maybe I’ll try a photography evening class?