Balancing Negative and Positive Thoughts

Changing the way you think about your chronic pain may be one of the most effective ways of coping with it. However, this does not mean that the pain is "all in your head." What it does mean is that you can use your head to change the way your pain affects your life, because there are direct connections between your thoughts, emotions, and behaviors.

Regardless of the cause, many people with chronic pain have developed negative thinking habits. (A habit is something that happens automatically and you may not even be aware of making a conscious decision about the thoughts you are having.) When you do gain awareness of your negative thinking habits, you are then able to change them. And by changing your thoughts, you can change the way you feel and how you behave.

As you saw in Part 1, the Anger, Anxiety, and Depression Cycles illustrate the relationships between how you think, feel and behave. For example, in the Depression Cycle, the thought "I'm useless!" produces the emotions of sadness and hopelessness. The emotions of sadness and hopelessness lead to a behavior such as staying inside the house all day and watching television (rather than going out into the beautiful sunshine). In turn, the decision to stay inside all day and watch television contributes to the muscle weakness. And the muscle weakness produces more pain.

Eliminate Stinking-Thinking!

You can think of the negative thinking that accompanies chronic pain as "Stinking-Thinking". Many people without pain also apply Stinking-Thinking to their daily lives. For now, however, let's focus our attention on chronic pain.

After you identify your negative thinking habits, you can learn to substitute positive thoughts for the negative ones. In so doing, you eliminate Stinking-Thinking and change how you feel. Here is a list of some of the most common kinds of Stinking-Thinking seen in association with chronic pain followed by suggestions to counter the negative thoughts.

All or None

One of the most common negative thinking habits is called all or none thinking, also known as black and white thinking. All or none thinkers tend to see things as either all good or all bad. These kinds of thoughts distort reality since most things in life are partly good and partly bad. Some examples of all or none thinking include: "I can't do anything anymore because of this pain;" and "If I can't be exactly like I was before the injury, then I might as well not bother living."

The next time you have a thought like this, try to think about the parts of your situation that are good, as well as the parts that are bad. For example, maybe you can no longer play tennis, but you can still swim. Perhaps you can no longer carry your grandchild on your back, but you can still take her to the zoo. Make an effort to look for the good things in your life and remember them when you're feeling negative.

Overgeneralization

Another type of negative thinking habit is called overgeneralization. Overgeneralization occurs when you make a firm judgment about something or someone, based upon one or two experiences, and then apply that judgment to all similar situations and/or people. If something bad happens to you once, then you expect bad things to always happen. For example, you might think "All doctors are bad and only care about getting my money;" and "I tried it once yesterday, so I know it won't help at all today."

Instead of overgeneralizing, try to give situations and people multiple chances before making a negative judgment. Just because the heating pad did not alleviate your pain yesterday, that does not mean that it won't work today.

Catastrophizing

Catastrophizing is yet another type of negative thinking that occurs when you find yourself worrying about something bad happening to you or someone you know. Catastrophizing can also make something bad seem worse than it really is. For example, you might think "Oh no, I can't believe this has happened to me. Just last week I had a cold and now my back is acting up again. Next week, I'll probably have a heart attack or something."

Try to stop yourself before you even start worrying. As soon as a worry enters your mind, imagine a big, red stop sign. Instead of worrying that you are going to have a heart attack following your cold and back pain, tell yourself that your cold is almost over, which means you can start exercising again. And the exercise will make your pain feel less severe.

Mind Reading

Mind Reading occurs when you convince yourself that you know what another person is thinking without even asking him. For example, you might think, "I know my son doesn't really believe I'm in pain. He probably just thinks I'm a big baby;" or "This doctor is just like that last one. She thinks the pain is all in my head!" You automatically tell yourself that the other person has negative thoughts about you before you even ask the person what he or she is thinking.

Rather than imagining what someone else is thinking, just ask them. Perhaps your son doesn't think you are a big baby, but he is worried about how he can help you pay for your doctor's bills. Maybe that doctor isn't exactly like the one you saw earlier. Perhaps she has a completely different approach to pain management - one that may help you. Ask her what she thinks about your situation.

Entitlement

Many people with chronic pain also suffer from the negative thinking habit of entitlement. Entitlement occurs when you think you deserve to be treated a certain way. Usually, the entitled person believes they deserve extra nice treatment. When these expectations are met, there is no problem.

However, when these expectations are not met, the entitled person is left feeling angry, disappointed, and sad. Feelings of entitlement also occur when a person feels that he or she should be punished for things he or she has done. Some examples of entitlement include, "I deserve better treatment than this! They should be doing everything they can to make this situation better for me;" and "I probably deserve this pain for being such a bad parent when the children were younger."

Rather than becoming upset and irritable because you think people are not doing enough for you, try to concentrate on everything they are doing for you. For example, you may feel that your children should visit you every day and have dinner with you four times per week. Instead of focusing on what they are not doing, think about how your daughter takes you shopping every weekend and how your son calls you on the telephone every night when he gets home from work. Focusing on what is missing rarely changes anything, but thinking about all the things that are being done for you may lift your mood.

Filtering

Another negative thinking habit is filtering. Filtering occurs when you pay attention to only select pieces of information from everything that is going on around you. Filtering becomes a problem when you only hear the negative information. You only hear what makes you feel more depressed, more angry, or more anxious.

For example, perhaps your doctor tells you that he does not think you are a good candidate for surgery. He also says that he thinks your pain will be alleviated by a new medication in combination with physical therapy. All that you hear is that you won't be getting the surgery you wanted. You don't even hear the good news that your doctor does have something else in mind to help you. It's even something less painful and expensive than surgery!

When you listen to what people say to you, make sure you hear the entire message. That doesn't mean that you should ignore any negative information, just that you should pay attention to the positive information as well.

Personalizing

Personalizing occurs when you interpret another person's actions as being directed toward you specifically. Usually, however, there are other possible explanations for the person's behavior. For example, imagine that your doctor's secretary calls to tell you that your appointment has been canceled and that you need to reschedule. You think your appointment was canceled because the doctor is tired of hearing about your imaginary pain. Or, imagine that you are walking down the street when your best friend drives by in his car. You wave to him and he does not wave back. You think he must be angry with you because you weren't able to go bowling last week.

When trying to find alternative explanations for someone's behavior, you should try to think of explanations that have nothing to do with you. If your doctor's appointment is canceled, perhaps it's because she was called out of town on a family emergency. When your friend doesn't wave at you, maybe it's because he didn't see you on the street. After all, he is concentrating on the road in front of him!

Breaking the Cycles

The Anger, Depression, and Anxiety Cycles all have two things in common: pain and negative thinking habits. Since people with chronic pain often cannot get rid of their pain, the only other option is to change the negative thinking habits that accompany it.

If you replace negative thinking with positive thinking, the cycles will be broken. For example, if you replace the thought "My life is ruined now!" with "I still have a good life, filled with a loving family and friends, despite this pain." you can avoid the Anger Cycle. You avoid feeling frustrated and angry, which means you are less likely to develop stress and muscle tension. This in turn means that it is likely your pain will not increase.

It takes a lot of practice and determination to learn to recognize your own negative thinking habits. It takes even more patience and determination to change them into positive thinking habits. But the effort is worth it. Breaking the cycles of anger, anxiety, and depression will help you manage your pain more effectively and give you more satisfaction in life. A skilled therapist can help you with this task. If that is not an option for you, there are workbooks available to help you learn to manage your chronic pain and stop your negative thinking. (Please see list below.)

Finally, while many people with chronic pain have tried medications and surgery, far fewer numbers have incorporated psychological approaches into their treatment. If you are feeling hopeless and frustrated in the face of your chronic pain, remember that you are not helpless! With the help of a qualified psychologist, you can use your head to eliminate Stinking-Thinking, and thereby manage your chronic pain and achieve more satisfaction in life.

NOTE: The purpose of this article is to offer readers general information about the ways in which psychology and psychotherapy can help a person cope with chronic pain, and is not intended to serve as treatment in any form. Please check with your physician if you have specific questions about pain management.