
- •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
Maintaining progress and managing setbacks
This chapter aims to help you understand:
• How to maintain progress
• What a setback is
• How to manage setbacks
How can you maintain progress?
There are many ways to maintain your progress and continue to build on your success and increase your confidence. You could:
• Vary your activities and exercises as they can soon become boring.
• Try fun and enjoyable ways to increase your activity level, like a game of crazy golf.
• Steadily increase your exercise routine.
• Set yourself short-term and long-term SMART goals (see Chapter 6).
• Reward yourself frequently and enjoy it (see Chapter 7)!
• Pace yourself (see Chapter 8).
• Prioritize, especially on bad days. Focus on what ‘could’ be done on that day or that week. Avoid the ‘must’ or ‘should’ type of thinking or I’ll just do . . . thinking.
• Keep a diary and record your progress.
• Learn a new skill (such as yoga or computer skills), or a new craft (like cross-stitch or painting) or take up a new hobby (like fishing, photography or model-making).
• Join a leisure group, such as a walking or line dancing group, or a gym, where qualified instructors can help design a programme to suit your needs.
• Tell others around you how they can help you (see Chapter 13). For instance, they could focus on your achievements or suggest rewards for your progress.
• Refresh your mind by reading this chapter regularly.
• Other? ________________________
In your notebook, write down your plan for maintaining progress, including at least three of the above points and/or your own ideas.
My plan for maintaining progress is:
1 ____________________________
2 ____________________________
3 ____________________________
Obstacles to progress
There may be all sorts of obstacles and barriers that affect or even stop your progress.
Tick the factors that you think may affect your progress or stop you making changes in the future:
Lack of time
Lack of motivation or drive
Too many interruptions
Family issues
Feeling better!
Other factors, e.g. feeling very tired, being very angry
Now think about what might affect your progress now and write these difficulties in your notebook.
Work out some solutions and write them down too. It may help to look at the list of ideas on how to maintain progress (see above). You could also use Chapter 10 to help you with specific difficulties.
TIP
Try out the best solution overall!
What is a setback?
A setback may disrupt your daily routine or activities and can last for a few days or several weeks. It can often be due to a severe increase in pain. Or it can be linked to other factors, such as feeling very low, having a viral infection or a severe cold, family illness, a crisis with a child or elderly relative, having to do overtime at work, going on holiday, or worry over debts. A setback stops or limits many activities. It can make you feel down, disappointed or frustrated.
Think about any issues in your life that are likely to cause a setback, such as:
• Family
• Work
• Lack of time
• Going into hospital
• Moving house
• Travelling by car, bus or train
• Caring for an elderly or disabled family member
• Holiday
• Feeling low
• Other issues? _________________________
Depending on your own situation, some of these factors will be more likely or less likely to cause a setback. Mark the ‘high risk’ factors with (H) and the ‘low risk’ factors with (L).
Maria made the following list of issues that she felt were linked to her latest setback:
• My tooth pain and infection.
• Getting angry with my brother, John.
• Sleep problems, waking hourly.
• Having fallen out with the neighbours.
• Worrying about my sister Angela, who drinks too much alcohol, and who will look after her children.
• Not having enough money to pay the telephone bill.
TIP
Think about your last or current setback. In your notebook, write down what may have contributed to it.
Sadly, setbacks are inevitable. The good news is that what you do during a setback will make a real difference to:
• The impact it has on your day-to-day life
• The length of time it lasts
• How often you experience setbacks