Pain catastrophizing and defusion techniques

The happiness in your life depends upon the quality of your thoughts said Marco Aurelio almost 2000 years ago. Even though I love Marco Aurelio as a philosopher I don’t agree with the aforementioned quote: quality of life depends on how we manage our thoughts rather than on the kind of thoughts we have.

I am going to expand further  this concept and I am going to explain how this apply to people suffering of persistent pain. I will give you as well couple of effective cognitive tools to use with yourself and your patients.

About thoughts:

Despite of common beliefs we are not responsible for the thoughts we have or for the quality of them. Researchers estimate we have around 60 000 thoughts a day and 80% of them has a negative connotation. Some thought can be very positive and happy, some very weird and others can be very scary (intrusive thoughts like harming yourself or others, screaming obscene things in church, socially unacceptable images etc..) that can cause great distress and a great deal of anxiety. In the attempt to cope with the anxiety rose from those thoughts people can develop compulsions and develop a proper OCD disorder. Some OCD can be very obvious while others can be very subtle. So subtle that the person struggling with unwanted thoughts is not aware of the mechanism created.

Negative thoughts and negative thinking (like catastrophization) are a very common and normal presentation among people suffering from persistent pain. “is this ever going to get better”, “why I am not getting better despite having done so much physiotherapy”, “I won’t be able to enjoy life again”, “this is not fair, life cheated on me”, “My life is ruined” etc.. are only a very little example of what goes on in people’s mind. As I said before we don’t have any control whatsoever on the quality and quantity of thoughts that pop in our mind as we cannot control our feelings (this is topic for another post though!) but we have a huge amount of control over our actions and this is how we can change the quality of our life.

About fusing with thoughts:

A thought per se is meaningless: it is a bunch of words put together. The reason why thoughts affect so much our life is because we believe they are true. We see a logic behind them and we buy into them. We give way too much importance to them. We can spend hours a day dwelling upon thoughts (negative thoughts in the vast majority of the cases). People suffering from persistent pain spend a huge amount of energy every day ruminating on their unlucky and unfair condition. The jargon for this is “Fusion”. We fuse with our thoughts, we associate with them giving them power and control over our psyche. Once realized that the thought pattern we are caught in is negative, unwanted and not beneficial for us we try to remove it, to suppress it. This mechanism although has the only effect of making the thoughts stronger.

In a nutshell, the more we dwell over our situation, the more we buy into our negative thoughts (doesn’t matter how true they are!) the more miserable and the more in pain we are. Pain, especially persistent pain, is hugely influenced by our mind activity and by how we process what is going on.

Looking at this popular tool used in CBT we understand how our pain experience (and not only) it is strongly influenced by bodily sensations, emotions, behavior and thoughts. In reality the situation is even more complex but sticking to this diagram we realise how changing the way we manage our thought pattern we change the pain experience. It will be necessary to tackle the way we manage emotions and our avoidant behaviors as well to get good results but a big change can be made by “simply” learning how to manage our thought, how to “defuse” from them and I am going to show you how to do it now!

Defusing Techniques:

If it is true we cannot choose the kind and the quality of thoughts that show up in our mind it is true as well we can learn how to manage them better. Dwelling upon thoughts and fusing with them have the only results to increase their power on us. Defusing from thoughts they will have much less impact and influence over you. As you learn and improve to defuse from unhelpful and unnecessary thoughts (doesn’t matter how true they are) they will impact less and less on your behaviour, mood and pain and eventually they will disappear.

The following exercises “belong” to Acceptance and Commitment Therapy (ACT) and are taken from the book “The Happiness Trap” by Russ Harris that I do recommend to buy for it is a game changer book.

I am having the thought that…

Bring to mind one of the most upsetting thought that often recurs. Focus on it and believe it the best you can for 10 seconds

Now take the thought and in front of it put “I am having the thought that …..”. Think that to yourself and notice what happens

Now put “I notice I am having the thought that I am X”. Think that to yourself, notice what happens

Musical thoughts

Bring to mind one of the most upsetting thought that often recurs. Focus on it and believe it the best you can for 10 seconds

Imagine the same thought and sing it in your head to the tune of “happy bday”

Try with the tune of “jingle bells”

The Story:

Identify your mind favourite’s story and then give them names such as “the broken back story”, “ the I am never going to get better story” “the loser story”, “my life sucks story”, “the idiot story” , “the nobody likes me story”.When the story shows up acknowledge them by name. For example you could tell to yourself : “oh I know this! It is the it is the forever in pain story!!!”Then just let the story be . Don’t fight it. Let it come and goes as it pleases.

Thanking your mind:

Thank your mind for the story it is bringing up. Say thank you in a warmth way

This powerful technique is going to be described better in the following clip

Start practicing the aforementioned 4 defusion techniques 10 times a day for at least 10 days. Anytime you are feeling stressed, anxious or depressed think “what story is my mind telling me now?”. Once you have identified it, defuse from it

“Defusion is aimed at freeing ourselves from the oppression of our thoughts aim at disentangling you from unhelpful thought process” Russ Harris.

The aim to these techniques is not to get rid of pain or thoughts. The aim is to take your thoughts  less seriously, to not buying into them so much. You won’t try to get rid of them or control them in any way, to debate if they are true or not or to replace them with positive affirmations but you will take a step back from them and observe them for what they are: a bunch of words. This exercises may feel a little bit complex and difficult to do at the beginning. They require constant practice every day, like riding a bike! And if it happens that your mind tells you “ Give up with this crap you are not going to change anything, you have a broken back and that is the cause of your pain” simply thank it for that thought and carry on practicing the exercises.

Thus spoke Zarathustra

Thank you for reading


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