avoidance

Task Persistence – the least used coping skill


Apart from pacing, there can be few coping strategies that people dislike more than task persistence.

What is task persistence and why do people dislike it?

Task persistence is about maintaining activity despite fluctuations of pain intensity – allowing pain to increase without stopping. Isn’t that pacing, you say? Well, perhaps part of pacing … In a recent paper by McCracken and Samuel (2007), pacing was positively related to activity avoidance and disability. ‘People who accepted their pain andparticipated in high activity in conjunction with little avoidance demonstrated distinctly better physical and emotional functioning than other groups.’

As I’ve mentioned before, pacing can become confused in the minds of people with pain and become instead ‘avoiding activity that increases my pain’. While pacing can be useful for people who may be over active, it is less than helpful for people who readily avoid.

So, how can someone keep going with an activity when their pain increases? Apart from using efficient movements, planning to ensure appropriate rest breaks are taken and so on, some cognitive strategies are very useful.

Distraction using engaging imagery or activities can be useful. Distraction by actively trying to suppress thinking about pain has the paradoxical effect of increasing the frequency of intrusive thought, so it’s more helpful to have something really interesting, something that the person is intrigued by, or something that requires concentration to use in this situation. Some examples:

  • stimulating conversation
  • imagining a scene or object in visual, auditory, olfactory and textural detail
  • singing a song or reciting poetry or readings

The important thing about distraction to help maintain activity is that it shouldn’t interfere with the completion of the task.

Coping statements are statements that reassure or encourage coping – things like ‘only five more minutes’, ‘only 10 more times’, ‘I can make it’, ‘I’ll be fine’, ‘I can keep going’ can be used as self encouragement to maintain engagement in the task. At times this may be combined with thought stopping, a deep ‘out’ breath and previously rehearsed statements. When presenting this to the person, it can help to say that it’s like having an internal coach!

It may also be useful to work through automatic thoughts that may arise when trying to carry out task persistence – becoming aware of these automatic thoughts may help identify the content, underlying attitudes, beliefs, rules or assumptions, and provide an opportunity for the person to challenge their beliefs about pain, particularly catastrophic beliefs. When doing this, identifying suitable replacement statements is an essential component.

Planning ‘chunks’ or scheduled stops or changes of activity help to maintain task persistence because it assures the person that the activity will end – provided the person continues to the end.

Setting a target and recording achievement has been established for years in sports training. Setting and recording the frequency of a behaviour has been used in behavioural therapy and the act of recording itself can change the behaviour. In task persistence, setting a target and recording achievement can be a powerful way to help the person maintain frequency or time undertaken. It can become a self-competitive strategy, with pain intensity NOT being recorded. Recording can be physical charting or verbal reporting to another person.

Encouragement from others when we achieve is a strategy that we don’t always specifically employ. In task persistence it can be a real boost, and one that we can gradually reduce over time as part of a gradually reducing level of intermittent reinforcement, especially in the middle phases of a programme to increase activity level.

Why do people not like using task persistence?

It specifically asks people to learn to accept the presence of pain. Although many of us believe that we help people manage their pain, we can inadvertently help people avoid approaching painful activities, and in doing so reinforce pain as a threat, and to be feared. McCracken and colleagues have studied acceptance and positive coping with pain and their findings strongly suggest that until people accept their pain as being ‘OK’, or ‘an experience’ rather than a feared experience, disability continues.

I’ll post more on this topic later – until then, a couple of readings for you to refer to:

McCracken, L. M. (2007). A Contextual Analysis of Attention to Chronic Pain: What the Patient Does With Their Pain Might Be More Important Than Their Awareness or Vigilance Alone. Journal of Pain, 8(3), 230-236.

McCracken, L. M., & Samuel, V. M. (2007). The role of avoidance, pacing, and other activity patterns in chronic pain. Pain Vol 130(1-2) Jul 2007, 119-125.

McCracken, L. M., & Yang, S.-Y. (2006). The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain Vol 123(1-2) Jul 2006, 137-145.

 

And – a really good website on Acceptance and Commitment Therapy.

This is an awesome repository of knowledge on ACT, including specific areas referring to pain management.

A book well worth considering, developed for people with pain but great for therapists, is Living beyond your pain: Using Acceptance and Commitment Therapy to ease chronic pain by Dahl and Lundgren.

This post is also in my Coping Skills section in this blog.
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