
- •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
What can make it difficult to practise relaxation?
It can be difficult to make time to practise relaxation without being disturbed. If you have a lot of demands on your time, you may need to be creative about when and how to do relaxation. You may feel like the sort of person who ‘just can’t relax’. However, there is usually a way round these obstacles.
You can use problem-solving skills (see Chapter 10) to help you overcome barriers. Here are some ideas that might be helpful:
• You could make a regular appointment with yourself at a certain time of day.
• Let others know that you are not available at that time.
• Unplug your phone, or leave the answer machine on.
• Notice times in the day when you are least busy, or when people are least likely to call – try using those times for your relaxation session.
• Perhaps you could make space when your children have gone to school, or your partner has gone out.
• You could practise your relaxation skills in the evening when you are by yourself.
• Remind others (and yourself!), if you need to, that this is a daily treatment. You are not ‘being lazy’.
• If you find yourself feeling guilty about taking time out, check out unhelpful thoughts (see Chapter 14).
When getting ready to listen to a relaxation tape, try to make sure the lights are not too bright, and the temperature suits you. It may be difficult to find a position to lie down or sit comfortably. But this does not mean that you can’t benefit from the relaxation. At first, as soon as you start, you may want to fidget or cough, or you may get an itch or a fit of giggles. If so, feel free to change position, scratch or laugh! Use breathing exercises as a guide. On relaxation tapes or CD roms, you are often asked to breathe deeply and evenly. Remember that you do not have to hold your breath to wait for the next instruction.
Some people find that they have odd thoughts or images going through their minds when they start to learn to relax. This is quite normal and happens to most people. However, if you get a lot of really distressing thoughts or images after trying an exercise a few times, talk to the person who gave you the information about it. There is usually a way to overcome such experiences.
Some people find that they fall asleep before the end of a session. This is not a problem, but, with more practice, you will probably find that you don’t fall asleep. Then you will feel even more relaxed and refreshed at the end of the session.
Relaxation exercises can be fun, as well as helping you manage pain. They can give you a feeling of well-being and alertness without tension.
IS THERE ANYONE WHO SHOULD NOT DO RELAXATION EXERCISES?
Nearly everybody can benefit from some form of relaxation exercise. However, you should seek advice from a health professional before you do a new relaxation exercise. This is particularly important if you have:
• An acute medical condition
• A history of severe mental illness, such as psychosis
• Untreated Post-Traumatic Stress Disorder
If you have any questions, write them down in your notebook for when you next see your therapist or healthcare professional.
CHAPTER SUMMARY
• Relaxation means being able to reduce bodily tension and stressful thinking.
• Relaxation can help with chronic pain and tension by helping to loosen the muscles and joints. It also helps to ‘unwind’ the mind.
• There are different ways of relaxing, including Time out relaxation and Quick relaxation.
• It helps if you can deal with obstacles to relaxation before starting your relaxation session.
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