I could actually head this post with the title ‘Essential Skills for Living’ and leave out the pain part, because as I reflect on the events over the past week, and the aftermath as residents of Christchurch start to demolish then rebuild their homes and businesses, these same skills apply.
How do people live well despite adversity? Our lives are not straightforward and both major events and daily hassles are encountered and influence thoughts, emotions and behaviour. It’s normal to have a range of emotions, abnormal to be ‘happy, happy, joy, joy’ all the time (despite the adverts!).
It has been postulated that the ability to regulate emotions is a sign of adulthood, and that being unable to regulate emotions is a contributor to much emotional ill-health. Emotion regulation is about being able to monitor, judge, and work with emotional responses in order to achieve goals. We can’t simply give up because it’s hard to learn to do something. We need to manage disappointment and develop grit and determination. Berking, Wupperman et al (2008) summarise the skills thought to be important for life – the ability to:
- consciously process emotions and be aware of them
- identify and label emotions
- interpret emotion-related bodily sensations
- understand what emotions prompt us to do
- support oneself when emotionally distressed
- actively modify negative emotions in order to feel better
- be resilient to or tolerate negative emotions
- accept emotions
- confront emotionally distressing situations in order to achieve important goals
Whew! That’s a bit of a list! These same authors carried out a study to establish those skills that are associated with good mental health, and to look at those that are enhanced during treatment to influence a good outcome. What they found was that three skills in particular were associated with good mental health – the ability to modify negative emotions; the ability to be resilient to negative emotions; and acceptance of emotions.
In other words, being able to do things to lift spirits or reduce frustration, to know that negative emotions won’t last forever and won’t overwhelm, and being able to accept that emotions are present without judging them are all skills that, in particular, help people cope with adversity.
The question now is – how can these findings be transferred into what clinicians working in pain management can offer the people we see every day?
Most of us working in chronic pain management know that we can influence other people through what we say and do. We can help the people we work with by recognising that therapy is not easy – and that it’s OK to experience disappointment, frustration, sadness and grief. We can model this by ‘making space’ for people to express these emotions during sessions without quickly moving along, making a joke, or otherwise trying to alleviate the feeling. What we can say are things like ‘it’s OK to take some time to feel what you’re feeling’; ‘let’s just give you a moment to be with what you’re feeling right now’.
In ACT, this is called ‘being present’ – and the people we work with may themselves rush past a moment of negative emotion. They may do this by changing the subject, turning away or making a quick quip. We can help people experience their emotions by gently stopping them for a moment and asking them to ‘just notice what is happening’.
When we do this, we’re modelling that it’s OK to experience emotions, that it’s not going to de-rail the session, that we’re not afraid of emotions and that we’ll be there. We’re not trying to comfort or challenge that emotional content, but instead we’re allowing it to be.
Flink, Nicholas, Boersma and Linton (2009) describe another approach – what they call ‘interoceptive exposure’. Participants in this study were asked to “calmly focus their attention on their pain sensations, whether sitting or performing activities associated with more bothersome pain (e.g. standing, walking). They were told to expect some increase in pain initially but to keep their attention calmly focused on the pain, allowing themselves to feel it, as much as possible without thinking about it or trying to change it or block it, until it was less bothersome.”
This is a specific attentional control skill that asks the person to experience their pain, probably initially increasing their anxiety about doing so, but then, by being calm and allowing it to be present, allowing that anxiety to reduce. It is a form of mindfulness.
I intend to look, over the next few days, at some of the other strategies that we can use during pain management to help people develop skills of emotion-regulation. I think they’re skills everyone could learn and use – what are your thoughts?
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BERKING, M., WUPPERMAN, P., REICHARDT, A., PEJIC, T., DIPPEL, A., & ZNOJ, H. (2008). Emotion-regulation skills as a treatment target in psychotherapy☆ Behaviour Research and Therapy DOI: 10.1016/j.brat.2008.08.005
Flink, I., Nicholas, M., Boersma, K., & Linton, S. (2009). Reducing the threat value of chronic pain: A preliminary replicated single-case study of interoceptive exposure versus distraction in six individuals with chronic back pain Behaviour Research and Therapy, 47 (8), 721-728 DOI: 10.1016/j.brat.2009.05.003