Pain beliefs are a major factor that affects how we experience pain. It can work both for us, and against us!
The way we perceive each situation determines how we feel. Our perceptions are strongly influenced by beliefs we develop by thinking the same thoughts repeatedly. Healthy habits of thought result in more positive emotions, less stress, and less pain. Unhealthy habits of thought result in more negative emotions, more stress, and more pain.
When we are successful at regulating our emotional state on purpose, we feel more in control. More control makes us feel more empowered which creates more positive emotions and less fear. We can deliberately create an upward spiral of positive emotions that changes the way danger signals are interpreted by our conscious mind. As a result, we experience less pain which improves our mood even more.
Now, this is important, our emotions are not the result of our situation. The way we feel is the result of a combination of the situation, our thoughts about the situation, and how we appraise our ability to handle the situation.
The way we process our experiences can be healthy or unhealthy. Unhealthy habits of thought lead to worse outcomes. One example is catastrophizing. When I began experiencing foot pain from plantar fasciitis, I worried that I would wake up in pain every day for the rest of my life. That’s called catastrophizing. I jumped to a global conclusion (I would always wake up in pain) based on incomplete information (I didn’t know there were things I could do to make things better). Catastrophizing increases stress. It’s not healthy. I don’t do that anymore.
When I decide to try something new and believe I can do it, I feel eager. When someone wants me to do something new that I’m not sure I can do, my emotions range from trepidation to irritation to fear. If I find a way to believe I can do it, my emotions change, and feel better.
The way we feel about our abilities influences our emotional response. If we think we’ll fail we won’t feel as good as we would if we believed we would be successful. And on top of that, the way we feel when we think we’ll fail isn’t the same for everyone. If they’re like me and see failures as learning experiences, the idea of failure doesn’t create fear. Someone who thinks a failure makes them a failure will be afraid of failing.
Positive Reappraisal to Reduce the Experience of Pain
Here’s how you make things better. There’s always more than one way to look at a situation. Positive reappraisal is the process of recognizing that thought is stressful and finding a different thought we can believe about the topic that generates less stress. The trick is to try different perspectives about the situation to see how they feel. There isn’t just one point where we can decide to think about a situation differently. Imagine your boss assigns a project to you. A simple evaluation reveals three apparent decision points. Each decision can increase or decrease the amount of stress perceived:
Just because you think a thought doesn’t make it true. Thinking a thought doesn’t make that thought the only valid perspective about the subject you could think of. Is there a silver lining? Is there another, more empowered perspective you could consider? Are you thinking about it as if it is a permanent problem when it might be temporary? Catastrophizing can involve extending one bad event to another events. It’s a common cognitive distortion. Here are some examples:
- My boyfriend dumped me = no one will ever want me.
- I failed a test = I’m stupid or dumb.
- I did something that wasn’t nice = I’m an awful person.
- My spouse cheated on me = you can’t trust anyone.
- I’ve been in pain for months = I will always be in pain.
Generally, someone is catastrophizing when they take an isolated incident and imagine that it is permanent and pervasive. Catastrophizing significantly increases the amount of stress experienced in the situation. Increased stress means increased inflammation which prolongs and increases pain sensation.
Metacognition is thinking about what you’re thinking. By evaluating your thoughts, rather than believing the first thought that comes to your mind, you have the ability to adjust your thoughts so you experience lower levels of stress and less negative emotion. This process directly affects how much chronic pain you experience. As we consciously choose less stressful thoughts, we experience less stress. In the above example, choosing one of the more positive outcomes (I’ll be successful with the project) or (I’ll find a better new job before the project is due) are examples of positive reappraisal. Reappraisal is associated with less pain and experiencing more positive emotions.
Conscious Emotion Regulation
Emotion regulation can be conscious or unconscious. Conscious control involves changing our thoughts about something we are thinking about as we did in the above example of the boss assigning a new project. The other aspect of emotion regulation deals with our ability to direct our focus. We can focus on something that is causing discomfort or we can distract ourselves by transporting ourselves elsewhere using a variety of methods.
For example, reading an engaging fiction story or thinking about something pleasant can create enough of a distraction so that while we are engaged in the activity we do not feel pain even though part of our body may be sending pain-related danger messages to the brain. The ability to focus on something and block out pain is a skill that can be developed. Individuals with this skill are at a reduced risk of opioid addiction and they experience more positive emotions.
While skilled emotion regulation can reduce the amount of pain experienced, some people have habits of thought that do the opposite. In this situation, they are said to have maladaptive emotion regulation habits. Maladaptive means that the way they process the situation makes the pain worse. Catastrophizing is considered a maladaptive explanatory style that leads to unhealthy results.
A recent article in the Journal of Psychosomatic Research concluded that:
Maladaptive response-focused emotion regulation may be an important risk factor in the development and maintenance of chronic pain, as it is associated with pain and psychological comorbidities
Pay attention to how you feel in response to your thoughts. If your thoughts cause stress, consider choosing a different thought. Your ability to change your thoughts about the situation and your ability to handle the situation is much easier to change than the situation itself. Usually, changing your thoughts to more empowered perspectives makes changing the situation easier.
It’s not always easy to change your mind to see a better outlook, but with regular practice, it can become easier and easier. Mindfulness practices within the Pathways app, for example, help you step back and observe thoughts as just that – thoughts. From a somewhat removed perspective, you can objectively evaluate your options and pick what’s best for your health and healing. Doing so will make a big difference to the physical pain that you feel.
Precision Pain Care and Rehabilitation has two convenient locations in Richmond Hill – Queens and New Hyde Park – Long Island. Call the Richmond Hill office at (718) 215-1888, or (516) 419-4480 for the Long Island office, to arrange an appointment with our Interventional Pain Management Specialist, Dr. Jeffrey Chacko.