Hi Everyone! I’ve got a new limited mobility workout option for you that combines cardio and strength training. This was something I did (modified of course) during my initial hip recovery. As I’m still recovering it’s a great workout to have in my repertoire for days I don’t feel like I can do a lot on my feet. Make sure you consult with your healthcare team before starting a new workout routine! I’ll link the workout I did below. Enjoy!
“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” – Viktor Frankl
For those of you who are not familiar with Viktor Frankl, he is a psychiatrist, author, existential philosopher and Holocaust survivor. His belief system, which was seemingly helpful to him while he was in a concentration camp, is that life can have meaning even in the worst possible circumstances (like he himself faced) and we are motivated to continue to live when we find that meaning. Like many other existentialists, Frankl believed we had the choice to do what we wanted with the circumstances we are given, even if we don’t always get to choose the circumstances ourselves. When it comes to chronic illness – physical or mental – it can be hard to always see the choices available to us, and sometimes those choices may be more limited, but they are still there. If I am in pain today, I can choose to lie on the couch or I can choose to do some stretches. I can choose to do nothing, or I can choose to sit at the computer and write a blog post that will hopefully help someone else. Depending on your situation, your choice options will look different than mine and that’s okay. The last part of Frankl’s above quote says that “In our response lies our growth and freedom.” Personal growth, and healing journeys (check out my podcast about healing here and personal growth here) are difficult but necessary if we want to live full and rich lives, if we don’t want to give up and into our circumstances. There is so much overlap between chronic physical illness and mental illness and feelings like hopelessness and helplessness play into both. Breaking ourselves out of the cycle is the key. That often takes the form of reaching out for help, and/or using our own self-help and self-care skills to propel us forward (for example, reading self-help books about these topics can be helpful if you don’t want to or can’t afford therapy).
Recently I have been learning a lot about Acceptance and Commitment Therapy as that is what I would like my practicum to focus on (I have to pick something that is CBT – cognitive behavioural – focused and ACT is “third-wave” and combines a lot of mindfulness). Here is a quote from the ACT training I’ve been completing.
“In this moment I’m holding my pain so that I can choose to do the things I care about.” – Timothy Gordon
ACT is very values focused and as you can see values are closely related to life meanings which stem from growth and freedom, which stem from choice. This is a therapy with a lot of efficacy for chronic pain and chronic illness because it asks us to acceptance our pain, and helps us to move toward our values. I personally accepted my pain and my illness a long time ago. That acceptance has allowed me to do more with my life, like go back to school and start a new career, travel, exercise, write a book, and help others. These are all values of mine and they all bring my life meaning. But I didn’t have to choose to move toward any of these. I could have stayed where I was, but truth-be-told, I wasn’t happy. That realization of unhappiness sent me down this growth path which in many ways started with the acceptance piece. If you’re not happy, or you don’t know what your life meaning is or what you want it to be, I would suggest just starting with your values. What’s important to you? And then what your life would look like if you were living for those values. Now, this work is of course best done in the context of therapy, but if you’d rather some reading on the subject I would say check out the book The Happiness Trap by Russ Harris.
Your pain and illness don’t have to control your lives if you don’t want them to. Keep making the most of it everyone.
Guided can be very relaxing and many people find it helps with anxiety. It is also helps for regulating emotions in general. I recommend it for anyone who is also struggling with chronic illness, because of the overlap of anxiety with chronic illness. I want to note that this particular guided imagery is not one I wrote myself. I found it mixed in with some paperwork on a CBT group therapy course as a skill that therapists teach to clients. There are lots of other guided imageries out there and I hope to do more in the future.
Boundaries are super important for all of us. With work, relationships, even ourselves. While boundaries are important for everyone’s mental health, I think that for Chronic Illness Warriors, the key is to be able to set boundaries that still allow you to ask for help when needed. I would say that I am pretty good at setting boundaries, but that was definitely a skill that I developed over time. I was reminded of boundary setting as I was preparing for group counselling that I’m co-facilitating as part of my practicum. So I’ll admit I’m borrowing some of this information from Marsha Linehan’s Dialectical Behaviour Therapy (DBT). The group has a few pscychoeducation components as well as counselling, including mindfulness (you know that’s my favourite), emotional regulation, distress tolerance, and interpersonal relationships. Though I’m not a “DBT-er” (I’m clearly happy to be co-facilitating the group though and learning all of this) I think that many bits of information from DBT and this course have great applications for many of us! (For those of you wondering I am drawn to existential therapy as well as Acceptance and Commitment Therapy).
Okay, so why should we set boundaries? Boundaries allow us and others to know what we are okay with and what we are not. For example, some people are huggers while others don’t like to touch (granted Covid, so many of us are in the non-hugging category right now). The person who doesn’t like to be touch needs to tell the other person (politely, if possible) that they are not okay with that. The tough part with boundaries is that if they are crossed, it can be awkward or feel rude to point that out. However, your mental health is important and if you’re really not okay with something it’s good to be vocal about it. Another example is a work one. Is it okay for your work to contact you when you’re not there? I was in a position about 6 years ago where I told my work it was totally okay for them to contact me when I wasn’t there. About two years ago (same company, different store) I told them I wasn’t okay with it. I set the boundaries and stuck with them based on the level of stress I was able to handle at the time.
When it comes to chronic illness, setting boundaries can revolve around many different areas, but I’ve found two are the most important: others, and ourselves. With others, you can decide how much or how little information those in your lives get about your illness/health, mental health, etc. I totally believe in sharing but everyone has different comfort levels with sharing, and I totally respect that, as I expect others to respect mine. Boundaries can also include what other people get to help you with. I loosened my boundaries after my hip surgery because I acknowledged I needed more help. Now granted I found myself feeling more grumpy at the time, but it wasn’t because I changed my boundaries, it was because I couldn’t as much myself! And that ties into our boundaries with ourselves. What are we okay doing? Saying? When we push our boundaries are we doing it to help ourselves or because we “think we should”? Sometimes it’s okay to push personal boundaries. With phobias for example, it’s possible to get over them by stepping out of your comfort zone and confronting the feared animal/situation/whatever it is (best to do it with a professional but I’ve known people to do this on their own). Getting over a phobia can be helpful for overall mental health. Saying yes to a night out with friends when you’re not feeling up to it is an instance of crossing your personal boundaries when it is not okay.
I’ve been sharing example from a “personal bill of rights” (Linehan, 2015) throughout and if you’re struggling with boundaries, I would say create your own (or use which ones of these resonate with you). Even stick it somewhere that you’ll see it often. Remember, that boundaries while important should be flexible because they lead to healthier relationships (including the one with yourself). I would love to see what you come up with so feel free to share on Instagram and tag me (@janeversuspain)!
That darn hip surgery may have prevented me from my normal routines but I adapted (safely). Make sure you consult with your healthcare team before trying any new exercise routine and please make sure to modify as needed (that’s what I did!). By the way, I managed to maintain my abs throughout the 6 week recovery through doing this and other similar routines found on YouTube. This one by Kym NonStop is my favourite but there are tons out there!
For the breathing abs exercise I mention, listen to my podcast episode with Tanya Walker.
My mom actually suggested I do a post on mental strength and I thought about it for a bit because I find that it is very similar to resilience, which I’m fairly certain I’ve posted about before. However, I did some research and found that while there are similarities there are differences as well and to be honest, both are pretty essential when you’re a chronic illness warrior and can increase positive mental health. I’m going to give you an overview of each concept and how they tie together and some ways that can help you increase them (many of which I have personal experience with) so that we can all grow stronger together in our own separate battles.
First, let’s define resilience. Resilience is our ability to respond positively and to adapt to negative, traumatic, and stressful events, in a way that is constructive. Now let’s define mental strength. Mental strength is our ability to effectively handle stressors and challenges in our lives the best we can despite the situation we find ourselves in. As you can see there are similarities, what I think the biggest difference in is that resilience occurs in the face of significantly impactful events such as trauma, whereas mental strength helps us with less significant (yet still impactful) stressors. We often hear of mental strength in regards to athletes and their ability to practice the same thing over and over. People who are mentally strong like adversity because it’s a challenge not a threat.
The great thing is that both resilience and mental strength can be learned! According to the American Psychological Association (APA), the thoughts, and behaviours involved in resilience can be learned. They state that what makes up resilience includes:
your ability to make “realistic plans” and accomplish them
self-confidence and self-esteem
problem-solving and communication skills
How does this apply to chronic illness? I see it as (1) making realistic plans is including limitations you do have because of your illness but not letting your illness limit you; (2) you can still have self-confidence and self-esteem with a chronic illness; (3) problem-solving and communication actually become more important when you have a chronic illness; and (4) emotion regulation is essential for everyone.
What are some ways we can build resilience? Let’s break each of these down further:
making realistic plans & accomplishing them: includes gaining skills (like going back to school or just learning something new in general); and taking action toward the goals you make for yourself while keeping a positive and hopeful outlook on your ability to accomplish them!
self-confidence and self-esteem: accepting change because nothing stays the same, including your illness; engaging in activities that help you learn more about yourself (try something new, be creative, get as active as you can, etc.); view yourself in a positive way (stop the negative self-talk and write down things you like about yourself); and of course, self-care!!!!
problem-solving and communication: setting goals for yourself; and making connections with friends, family and colleagues because support is important.
emotion regulation: controlled exposure (I would suggest with the help of a therapist); taking a realistic view of crisis situations (I like the phrase, “if that happened, then what would I do?”); and activities such as journaling, meditation and other spiritual practices can help with emotion regulation (I’ll probably do a longer post on emotion regulation at some other time).
So if that’s how we build resilience, what can we do to build mental strength? Turner (2017) states that the elements of mental strength include having a sense of control and purpose of your life and emotions; making a commitment by setting goals for yourself; challenging yourself when necessary; and having that self-confidence. Very similar to what we just talked about for resilience. I’ve got to say that I possess all of these, and I’m not sharing that to make anyone feel like they aren’t enough because they are currently not mentally strong. I’ve had times when I haven’t been strong, it takes a lot of work to get here. My point in sharing is that you can come from a place of anxiety and stress over your health condition and get to a point where you can deal with most things that come your way (I say most because no one can deal with everything perfectly). It just took me a few years of hard work to get here. Here are some ways you can develop your mental strength:
gratitude – write down 5 things every day that you are thankful for. I also recommend taking the free Science of Well-being course offered by Yale University. Here’s the link!
practice mindfulness – in whatever way you like. I prefer meditation and body scans, and throw in the occasional mindful walk.
act “as if” – this is an interesting concept developed by psychologist Alfred Adler. He stated we should act as if things are the way you want them to be (essentially you get to reauthor your life). This one is a bit more complicated and may also deserve its own post.
Before I wrap up this very long post, I want to share research by Pickering & Holliday (2010). They stated that “mental strength contributes to resilience processes and resilient behaviour.” So basically develop your mental strength and you’ll develop your resilience. I mean as we’ve seen there is a lot of overlap between the two so it totally makes sense!
Let me know what you think of mental strength and resilience! Comment on the post or shoot me a DM on Instagram (@janeversuspain). I would love to hear from my readers! For now, keep making the most of it!
Back after my hip surgery I wanted to continue to do yoga but had to be very careful. (Technically I still have to be careful, just not as). So I found chair yoga on YouTube and thought it was great for people with limited mobility. I modified a lot at the time, so I suggest if you’re going to try these out, you can modify so it’s safe for you to do depending on your needs. I’m a big fan of yoga practices because it has so many health benefits. Yoga falls into the category of mindfulness. You can check out my podcast on that topic here.
Recently I read an article in a psychotherapy magazine put out by the BCACC (British Columbia Association of Accredited Counsellors) about how therapists can and perhaps should integrate health promotion into their clinical practice. Being interested in health psychology anyway, and wanting to work with people with chronic illness as well as mental health problems, I devoured the article. Then I did a quick google search to see what others are saying. And while there are not a ton of journal articles on the subject, there are a few, all pointing to the same thought – this is something therapists should do. What makes it difficult is that psychotherapists, whether they hold a Masters or PhD (or not, depending on where you live they may not need either), typically don’t have a lot of training in health outside of mental health (always a little bit as it relates but rarely a large amount). This makes me curious as to what everything thinks about therapists encouraging health promotion, in some way, during counselling.
What this article really looks at is not just physical health or mental health but all components of health. A holistic approach. Sometimes people go to therapy for things like weight loss, which in that case, health promotion and education seems necessary. Other times someone might bring it up as a secondary concern. There’s also, of course, the interrelation between things like exercise and nutrition and mental health. As well as sleep and mental health. See where I’m going with this? It actually might be almost impossible for therapists to not integrate health into counselling. So, while I usually save this kind of stuff for my premium blog, I thought I would share some health behaviours I’m going to put extra effort into this week, and I hope everyone reading thinks about some that they can as well! Body-mind connection week indeed!
nutrition: I’m going to go with making sure I eat fruit everyday (which I typically do but sometimes stumble on the weekends)
exercise: putting yoga back back into my routine at least 2x/week
sleep: ensuring I don’t have anything to drink after 8pm (part of sleep hygiene!)
other (social, hobbies, gratitude, mindfulness): playing the piano daily (I haven’t been playing as much as I would like)
As you can see, integrating health is rather inclusive and definitely extends beyond just physical aspects. Medication adherence can be another really important one for chronic illness warriors. The article I read speaks about Maslow’s hierarchy of needs, which I’ve mentioned in previous posts. We need to take care of our basic needs in order to take care of our higher needs. The three basic components of physical health I mentioned above are so important. So here’s my question (and I’d love answers in the comments), would you want your therapist to help you with aspects of health promotion that you are neglecting? Why or why not?