
- •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 to manage anger better
Here are some ideas about how to handle angry feelings differently. You can use these ideas to work out your own ‘coping plan’ for situations where you get angry or frustrated.
Steve used a ‘coping plan’ to make changes:
He talked his feelings over with Nicole when he was feeling calm and she helped him with his plan.
He practised the breathing exercise (see below) when he wasn’t angry, so that he could remember to use it in difficult situations.
He found his bad temper was worse when the pain was severe. So he made a plan for coping with pain setbacks. This planning made him feel more confident about dealing with difficult times.
He practised saying to himself ‘So what is the issue here?’ to check his thinking.
He used the ideas below to help challenge unhelpful thoughts. The ‘thinking of other explanations’ was very helpful.
RESULT: Steve became less irritable as he began to handle events more calmly. He found the reception staff at the doctor’s surgery quite friendly when he made appointments.
A ‘coping plan’ can be very helpful at times when you are becoming frustrated, or begin to feel insulted or attacked, and start to feel angry.
A coping plan
1: COPING WITH THE FIRST RUSH OF ADRENALINE (SOMETIMES CALLED AROUSAL)
The adrenaline rush of anger can lead to body sensations (like a thumping heart in the chest, getting hot and sweaty or shaking) that may increase the pain at the time.
Try self-talk as anger feelings rise, like:
• My muscles are getting tight, relax and slow things down.
• It’s time to take a long, deep breath out first.
• My anger is a signal of what I need to do – problem-solving
2: IF ANGER CONTINUES TO RISE . . .
Don’t respond immediately – pause.
Breathe OUT first, so as to feel yourself and your body relax. Focusing on your breathing can help you unwind. Taking a breath IN first can make you more tense, not less.
Make your OUT-breaths longer than your IN-breaths by counting to 4 for an out-breath and 3 for an in-breath for a least 2 minutes.
It is crucial to breathe slowly out first, not in first. This helps to reduce the adrenaline rush of anger that makes your heart race and makes you feel hot and tense. It also helps to reduce the tightness in your chest and other body sensations.
3: CHECKING YOUR THINKING
Useful questions to ask:
• What is making me angry?
• Have I listened properly?
• Have I got the facts here right?
• Have I got the whole story?
Think about what will happen afterwards if you react differently. What will the consequences be? Check out your thoughts again:
• Have I been clear about what I want?
• Have I jumped to conclusions and made a mistake?
• Are there any other reasons that could explain the situation?
• Is it worth getting angry about this at the moment?
Start to respond in non-aggressive ways, using methods that will control your anger. Try helpful self-talk, like:
• I am not going to let this wind me up.
• I can try my muscle-relaxing exercise.
• I can listen and try to understand the situation. I can ask questions to help us be clear about the problem.
• Maybe we will have time to think about it and talk later.
• I can cope with the pain. Getting angry will only make it worse. What’s the point?
If you are dealing with conflict or being wound up by others, try saying to yourself:
• As long as I keep my cool, I’ll be in control of the situation.
• I don’t need to prove myself.
• STOP – there is no point in getting mad.
• Look for positives, and don’t jump to conclusions.
• Let’s take the issue point by point.
• It feels like they want me to get angry, but I will deal with it in helpful ways.
4: PREPARING FOR A SITUATION WHICH YOU KNOW CAN GET YOU ANGRY
Try saying some of these things to yourself:
• This situation has made me angry before, but I can deal with it.
• Remember to stick to the issues.
• Don’t take it personally.
• There won’t be any need for an argument.
• I know what to do. I have planned and rehearsed it.
• I will have some time out to help reduce angry feelings and to review and plan.
• Maybe the other person has chronic pain too!!!
5: AFTER THE EVENT
What you can say to yourself afterwards, when thinking about what happened?
Situation unsettled:
• Forget the aggravation, thinking about it gets me upset.
• Remember relaxation, it is better than anger and more pain.
• Don’t take it personally.
• I can come up with a better way of dealing with the issue.
Situation settled:
• I handled that one pretty well.
• I could have got more upset but it was not worth it.
• My pride can get me into trouble but I’m doing better at this all the time.
• I got through that one without getting angry.
MAKING YOUR OWN COPING PLAN
When you make your own plan for dealing with situations that can make you angry, it will need to help you with two main areas:
Angry or frustrated thoughts and feelings
Body sensations, like getting flushed or hot, or if your heart pounds faster.
Ask yourself:
What can I do if I begin to feel insulted or attacked or frustrated, and start to feel angry?
Then write your plan in your notebook, starting:
‘I can . . .’
Case history: Maria’s plan for managing anger
Maria goes shopping with her daughter Janette, usually on a Wednesday. Sometimes Janette arrives late. This means that Maria has to rush her shopping. This makes her tense because she is worrying about when Janette will arrive. She knows if she rushes round the shops she gets more pain. It makes her irritable because she has to rely on her daughter. ‘I wish I could manage it myself.’
Maria’s plan
If feeling upset and cross I can . . .
• Explain my concerns about the time and pain to Janette. She cannot read my mind.
• I can ask her if she could come another time.
• I can say to myself: ‘Is it worth getting cross? At least I got out of the house.’
• Maybe it would help to make a plan if we are short of time.
If feeling body sensations caused by anger
I can . . .
• Try and watch out for the quick flash of temper when I am tired.
• Breathe slower and slow down my thinking and speech.
• Notice that I am getting tired. Let Janette know that we need to stop for a break.
• Postpone talking about important issues.
YOUR PLAN
In the same way, you can write down in your notebook what you plan to do, under the following headings. In each case, start with the phrase ‘I can’:
What can I do if I begin to feel insulted or attacked or frustrated and start to feel angry?
How can I cope with the body sensations I get when I am angry?
How can I prepare for a situation I know is likely to make me angry?
What can I say to myself when thinking later about what happened in the situation?
If it went well . . .
If it went less well . . .
PART III SUMMARY
• Anger can affect a person’s feelings, thoughts, behaviors and body sensations.
• Anger can also affect chronic pain and it is important to express anger in a ‘healthy’ way.
• You can learn to respond in a helpful way to situations and deal with unhelpful thoughts, feelings and body sensations.
• Using coping plans can help you deal with situations that make you angry.
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