Managing depression, anxiety and anger
This chapter aims to help you understand:
• What moods can happen with chronic pain
• More about moods, such as depression and guilt, anxiety, worry and fear, anger and frustration
• How to manage these moods in helpful ways by using a Thought Challenge Worksheet
What moods can occur because of pain?
The most common moods that occur because of chronic pain are:
Circle those moods on the previous page that you feel are linked with your pain problem, and add your own mood experiences.
Pain is not just a physical event. It affects:
• Our moods and emotions or feelings
• Our thinking about ourselves, other people and the future
• The things we do or stop doing (our behaviors)
• Our relationships with others, including partner, family and friends
This chapter is divided into Part 1 (‘Managing Depression’), Part 2 (‘Managing Anxiety’) and Part 3 (‘Managing Anger’).
Part 1: managing depression
This section aims to help you understand:
• Why people become depressed with chronic pain
• How depression affects people’s thinking
• What factors can contribute to depression
• How to manage depression
Depression is very common – 1 in 10 people have depression at any one time. Count the next 10 people you see and remind yourself that one of them could be depressed. However you might not know, by looking at them, that they were depressed. Depression is a little like chronic pain. Only you know how it feels and other people may not notice or understand it. If they do notice, what they may see is a quieter, more withdrawn person who seems:
• To laugh less
• To be tearful sometimes, or look or sound tired
• Be forgetful or lacking in concentration
• Unwilling to do things or join in with others
• To lack confidence
• To be less interested in sex or intimacy
• To feel guilty and low
• To be negative or pessimistic, sometimes hopeless, about the future
If you experience any of these changes yourself for two weeks or longer, then you may have depression.
Why do people become depressed with chronic pain?
Persistent pain is very stressful and exhausting. Feelings of helplessness and frustration can contribute to low mood. Sleep patterns are upset. Tiredness can set in and this too can lower mood. There are many changes and losses, such as work or friends, or being less active and able to do things with others.
How depression affects people’s thinking
Depression in chronic pain can cause specific changes in how people think, leading to a negative ‘chain reaction’:
What factors can contribute to depression?
Tick any factors that you feel are important for you:
Life events
Financial difficulties
Bereavements
Relationship difficulties
Work stresses
UNHELPFUL BEHAVIORS
Reduced levels of physical activity and ability to do things, e.g. driving, gardening
Drinking too much alcohol, or using drugs like heroin or cocaine
LOSSES, SUCH AS
Your job
Some of your friends
Some of your family members
Your role or main purpose in life
Your health
Your plans or goals in life, especially future goals
OTHER PROBLEMS
Lack of sleep and frequent tiredness
Side-effects from medicines for pain-relief or lowering blood pressure (e.g. beta-blockers)
Changes in your thinking that become extreme and negative
Others? _______________________
If you are depressed, write in your notebook any factors that you think may be linked to your own depressed mood.
Depression can affect all five ‘parts’ of the person: their thinking, moods, behaviors, their body symptoms and their current life situation. This is shown in the person-centred model on the opposite page.
Add any additional symptoms you may have to this person-centred model.
The person-centred model can help you to see how to change your moods. Changing one part can enable the other parts to change. For example, if sleep is a problem, improving it may make you feel more energetic (body symptom) and more enthusiastic (mood). You may be able to do a few more activities at home with family or friends (behavior). You might then think: ‘I am glad I can do this and the family are supportive’ (more positive thinking).
The person-centred model on the next page shows the impact of chronic pain on Maria, her life, her moods, thoughts and behaviors. For example, it shows Maria:
• Not doing activities with and for other people
• Several life situation factors that play a part in her depression (for example, being stuck at home all the time)
This model shows the link between Maria’s chronic pain and her depression. (See page 201.) It helps to see possible areas to lessen and manage depression.
HOW UNHELPFUL THOUGHTS ARE LINKED TO DEPRESSION AND CHRONIC PAIN
In any situation, people try to make sense of what is happening by asking, ‘Why me?’ or ‘What if . . .?’ With chronic pain, your thoughts or beliefs about yourself, your illness and your health, and your ability to cope, may all be challenged. When people with chronic pain are depressed, they sometimes:
• Think they are useless or not needed
• Make assumptions about what others might think about them and their pain problem
• Have thoughts like ‘I am helpless’ about their pain control and their situation
• Avoid being with others
In depression, people frequently have negative and pessimistic thoughts. They also often find they have more memories of difficult and negative experiences, rather than pleasant or positive ones.
