As previously discussed, your pain is real. But, we know that our psychology can definitely make pain worse. Have you ever noticed that the more you think about your pain, the level starts to increase (you know, the pain scale that medical providers always talk about)? We often start to become stressed when we think of our pain, thereby creating a physiological response. A physiological response may include tense muscles or the “fight or flight” response (panic–> increased heart rate, blood pressure, constriction of blood vessels, etc.).
Finding a mental health professional who understands pain is really important. I’ve had some clients tell me the therapist didn’t understand their pain or didn’t believe in their pain – that is obviously not helpful. First and foremost, look for someone who has experience working with people who have pain or chronic pain. Colleagues and friends have asked me, how do I find a good therapist? Well, first they should be a licensed clinician. In some states, individuals can offer treatment without being licensed. That’s scary because without a license, there is no accountability for bogus treatments. For example, a licensed marriage and family therapist (MFT) or licensed clinical psychologist are held to ethical guidelines. There are safeguards in place to protect patients if something goes wrong. Secondly, you want to look at their training and how they word their advertising/”about me” section. You have to feel like it’s a good fit. Thirdly, what types of therapeutic modalities to do they offer? You can find therapists on Psychology Today (https://www.psychologytoday.com/us/therapists) or through your insurance. Some clinicians don’t take insurance. It would require me to write an additional blog post about why, but briefly, it’s because it’s a lot of paperwork and sometimes not a great reimbursement. I always tell my clients, I may not be a good fit for you and that’s okay. I would rather you find someone who you can work with and see improvements, because at the end of the day, that’s the most important thing. Don’t write off therapy if you’ve had one bad therapist! There are plenty of good ones out there!
There are several researched-based therapies that have been known to help individuals who suffer from pain. Here is a good list:
- Cognitive Behavioral Therapy (CBT): CBT is a structured approach in therapy where the therapist will work with you on understanding how your thoughts and behaviors impact your emotions and pain levels. For example, we may have thoughts like, “My pain is horrible. It will never improve. I hate my life.” A clinician will help you to figure out if these thoughts are helping your mood/pain or making it worse. If it’s worse, the goal is to create alternative, more helpful thoughts.
- Dialectial Behavioral Therapy (DBT): DBT is also a structured therapy where the therapist (in individual or in a group setting) will teach different modules on Mindfulness, Interpersonal Effectiveness, Distress Tolerance, and Emotion Regulation. There are many simple, every-day coping skills one can learn to minimize stress or over-reacting to situations. When it comes to pain, it’s crucial to keep anger, stress, frustration, anxiety, and panic low.
- Mindfulness: I’ve had patients ask me, “what is Mindfulness?” According to the American Psychological Association, it is “a moment-to-moment awareness of one’s experience without judgment. In this sense, mindfulness is a state and not a trait” (http://www.apa.org/monitor/2012/07-08/ce-corner.aspx). Mindfulness training may include visualization, progressive muscle relaxation, stretch-based relaxation, deep breathing, and autogenic training. Mindfulness is important because it can help with stress reduction, decrease emotional reactivity, and improve focus.
- Biofeedback: “Biofeedback is a treatment method that uses monitoring devices to measure several physiologic processes, such as heart rate, muscle tension, and galvanic skin response. Biofeedback has most often been used to treat headaches, fibromyalgia, rheumatoid arthritis, and a number of other chronic pain disorders. Through therapy, patients become adept at controlling these processes that were previously not under voluntary control and thereby control overall physiological arousal. Normally, biofeedback treatment involves 10 to 20 sessions and includes other cognitive-behavioral strategies such as deep breathing or progressive muscle relaxation” (Songer, Psychotherapeutic Approaches in the Treatment of Pain: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000182/).
- Medication management/supplements: There are many antidepressants that can help with anxiety and depression. While benzodiazapines definitely help with panic and anxiety, they are actually very addictive and do not help with getting rid of panic or anxiety long-term (https://www.npr.org/sections/health-shots/2018/04/26/602213172/benzodiazepines-america-s-other-prescription-drug-problem).
Pain can be very isolating. Many patients tell me they have lost friends and family support because of their pain (e.g., missing friend dates, birthday parties, etc). A therapist can provide support, understanding, compassion, and coping strategies to deal with pain. Also, some therapists provide telehealth (on-line or phone therapy). This can be great if you are in too much pain to drive to the clinic or are on pain meds and can’t drive to the clinic. I hope this was helpful!
Until next time,