
- •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
How chronic pain and anger are linked
Chronic pain can lead people to be very easily irritated. It can mean that they think about themselves or other people in a negative and unhelpful way. Many people with pain have angry feelings at times. There is often a sense of unfairness.
They may feel it is right to feel angry about the pain or the events that caused it. They can become angry because other people do not understand their pain and its unhelpful or distressing effects on them.
In Steve’s case, the accident had not been his fault so he believed he had a right to be angry about it. Sometimes, even when there is no one to blame, life can still feel very unfair.
Unfortunately, unhelpful thinking like this can lead to:
• Increased tension in muscles and joints
• Paying attention to the pain
• Not noticing positive or enjoyable experiences
• Becoming tired
All these factors can, in turn, lead to more pain.
This does not mean that angry feelings and showing anger is ‘bad’. It is more about how anger is expressed, or how intense it is and how it then affects you and your pain.
These are more helpful ways of dealing with anger, such as:
• Sharing feelings without blaming someone
• Asking for someone to change their behavior
• Trying to get fairness or justice in a respectful way
• Being realistic about the extent to which you have been treated unfairly
• Not seeing yourself as totally right or wrong
• Seeing the other person’s point of view
• Getting things changed for the better, for yourself or others
• Deciding to stop plotting revenge
How being angry can affect other people
Being irritable can affect others you spend time with at home, at work or in other places. People may not understand your situation, especially people you don’t know well. Relationships at home may become strained or tense. People in public places, such as shops or hospitals, may not understand the pain problem and the irritation and frustration you experience because of it.
Case history: Steve’s anger affects his partner
Steve had always been close to his partner, Nicole. She had been happy to help more since Steve had had his accident. However, she became upset when he shouted at her. She said it was hard to ‘know where I stand’. Sometimes Steve would shout and say she didn’t ‘understand how bad the pain is’. At other times, he would shout at her that she was ‘treating him like a cripple’. She was beginning to find him hard to live with. They were both embarrassed when he lost his cool in public. Steve seemed to get even angrier when Nicole became upset, sometimes ending up in tears. He said he didn’t mean to shout at her and really knew how much she cared. He was angry with himself for being angry.
Think about the people who are close to you, as well as people you meet in public places or at specific events. How does your anger affect all these people? Write your ideas in your notebook. It may help to think about the last few times you were angry.
Firstly, you can look at what happens when you start to feel angry, using the following questions to help you.
Something happens:
Where?
When?
Who with?
What am I/we doing?
Thoughts:
What went through my mind as I started to feel angry?
Moods (emotions):
How did I feel?
Body sensations:
What did I notice?
Behaviors:
What did I do or not do?
These observations will give you a better understanding of how anger affects you, especially your thoughts and behaviors. Then you can look at what makes a difference to the way you express anger and find out how you could handle anger better.