One problem people have when learning coping skills is remembering what to do and when to do it. In the heat of the moment it can be really difficult to recall exactly what the new strategy is! We also know that pain interferes with recall because of the disruptive effect on attention, and this effect is heightened when people are anxious about their pain. One good measure for whether attention and thinking processes are disrupted is the Pain Anxiety Symptoms Scale (McCracken & Dhingra, 2002).
There are a few techniques for helping people to remember what to do – including some of my favourites like a sticker on a doorframe, post-it notes on the computer or dashboard of the car, or reminders on a cellphone or computer. But one way that has been helpful for several reasons is using a cue card.
Now cue cards are not new – think of the flash cards that teachers use for kids, or the laminated cards that you can use to review algorithms or flow charts – but this process is a little more complex.
There are several ways to do this, but I’m going to describe a reasonably general one.
Firstly I work with the person to identify a trigger or high risk situation in which they have had trouble using a new strategy. BTW I use small credit card-sized cards, small enough to fit into a wallet or pocket.
After working through the antecedents, we write a brief summary of the main triggers on the front of the card. For example: ‘When I’m really busy and enjoying my activity”
On the reverse of the card, we write out one or two ‘early warning signs’ or moments when the person can start to identify they are likely to forget to use the coping strategy. For example: ‘There is a deadline”
Underneath this, we work out several options for coping more effectively with the situation. This might include something the person can do to preempt the high risk situation (eg planning a timetable and breaks on the day of the deadline); things the person can do during the high risk situation (eg set my cellphone to remind me to take a break at certain times); and things the person can do if they fail to use the coping strategies at the time (eg when I note I’m overdoing it, stop and do some diaphragmatic breathing).
The process of working out what to do brings the high risk situation into the mind of the person while the three ways of coping at different times during the event ensures they have choices, so they feel more certain they have control.
- Cue cards need to be small so they can be carried around!
- The statements and coping strategies need to be written in positive language eg ‘take a five minute break’ rather than ‘stop working so hard’
- They need to be written in words the person would use, and be generated by the person rather than you as a therapist
- They need to focus on one event and be very specific, eg if the person wants to talk to ‘someone’ as a coping strategy, put the person’s name and how to contact them on the card!
I have written about the ‘Can Cope’ card before – this is like a general coping card for flare-ups or highly stressful situations and is slightly different from the cue card I’ve described here. Can Cope cards are great as a reminder during a high risk situation and I use them more for well-learned coping strategies that are now in the ‘maintenance’ phase of use.
Cue cards are more for learning and as a problem solving process, and an aid while the person develops awareness of antecedents and options during and after high risk situations. Cue cards can be phased out once the technique is embedded, while Can Cope cards are able to be carried for those times when things don’t work out, a bit like an ambulance at the bottom of a cliff!
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McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain Anxiety Symptoms Scale (PASS–20): Preliminary development and validity. Pain Research & Management, 7(1), 45-50.