Why Are You Attached to Your Illness Identity?

How many times have you said, “I am sick” or “I am a Spoonie” or “I am in pain” or “I am depressed,” and so on? And how often do you feel that is really so? That is what you are? If your answers to one or both of those questions is “a lot,” then know you are likely not the only one answering that way. I rarely use those phrases for myself anymore because I find them unhelpful, but before you run away I want to explain why they are unhelpful. Not just from my perspective from my lived experience, but also what theories in Acceptance and Commitment Therapy (ACT) and related research suggests, particularly when it comes to chronic illness.

Image from: https://www.facebook.com/ProjectSpoonies/

First I think I need to introduce you to a few terms. The first is event centrality. This can be described as the degree to which a person perceives an event (often traumatic but can also work for being diagnosed with an illness) as central to their identity. In other words, being a sick person is who you are because of your diagnosis. The second concept is the conceptualized self. This refers to who we think we are (in fancy ACT terms we call this self-as-content). The conceptualized self can take on all the identities we have such as being son or daughter, a parent, a spouse, a friend, and of course a sick person. It also includes our self-evaluations, so whether we describe ourselves as smart or dumb, happy or sad, fun or boring, and so on. What sometimes happens is that we get fused with one (or a few) of these aspects of our identity. In other words, we hold it tightly, are attached to it, and in the long-run doing so usually causes us more problems.

How do you conceptualize yourself?

Now this attachment to the conceptualized self can happen to anyone, and we often see it in depression and anxiety as well as chronic illness and chronic pain. There has been some research suggesting that our illness self-concept is a predictor of our adjustment to chronic illness. When we are attached to the identity of being ill we tend to have a lower overall quality of life. I talked about the use of language once on the podcast, and you should listen to that episode if you haven’t already. I want you to think about these pairs of phrases:

• “I am anxious” vs. “I am experiencing the feelings of anxiety.”
• “I am depressed” vs. “I am experiencing the feelings of sadness”
• “I am sick” vs. “I am experiencing the symptoms of lupus” (or whatever illness you have)
• “I am in pain” vs. “I am experiencing uncomfortable sensations”

You’ll likely notice that you attachment to that identity changes. And when we aren’t overly attached we actually can take better care of ourselves (health behaviours, self-caring, etc.) and our quality of life improves because we find we are able to do more values-based activities that we enjoy (yep, even with illness and pain). When we remove the attachment to our conceptualized self we are more willing to allow our experiences and see them as passing.

We want to have room to engage in values-based activities, because that’s what makes life meaningful.

There’s a few ways we can learn to do this. First, we can just start to notice and name are thoughts and feelings – “I notice I’m having the feeling of an uncomfortable shooting sensation in my hip” or “I notice I’m having the thought that I’m always in pain.” There are tons of ways to create some space between us and our thoughts and feelings when we are attached to them. This is just one way. The other process we can use to change this attachment to the conceptualized self is to develop self-as-context. This is what is also referred to as the noticing self. The part of us that just watches and notices all our experiences: what see, hear, smell, taste, touch, think, feel, do, etc. It’s a part of us that never changes. It’s like the sky and all of the thoughts and feelings and sensations are like the weather. The sky sees the weather but the weather cannot hurt the sky. And if you go above the clouds, the sky is still there, even when it can’t be seen. I’m going to encourage you to follow along with the video below to get an idea of what it is like to experience the noticing self.

I personally find this really helpful (and so do many of my clients) in creating a new relationship with my thoughts, feelings, and sensations, and forging out new identity, where I’m not limited by any of these things because I can notice them. They are not me. I am not chronically ill, I have the experience of having a chronic illness.

Image from: https://psychotherapyacademy.org/acceptance-and-commitment-therapy-the-essentials/self-as-context-a-core-process-in-the-act-hexagon-model/

Keep making the most of it!

Video: Daily Mindfulness – Mountain Meditation

Grounding practices can be so helpful, for pain, for intense emotions. I personally love them and use them all the time with my clients. This grounding practice uses visualization. For more meditations and mindfulness practices, check out my YouTube channel.

Keep making the most of it!

Why You Shouldn’t Avoid Your Pain

Today I’m giving you a choice.

• Option A: you never have to feel pain again. No physical pain. No sadness. No anxiety. No guilt, fear, or anger. But… you can also never feel physical relaxation. No joy. No happiness. No love, pride, or serenity.
• Option B: you still have to feel pain, both physical and emotion. But you also get to feel relaxation, joy, happiness, love, pride, serenity, etc.

What do you choose?

I know Option A is super tempting, but I’ve found that most people choose option B, because no one wants to permanently get rid of the things that make us feel “good.”

We don’t like to feel “blue” so we resist it.

When it comes to pain – and throughout this post when I refer to pain, I mean both physical and emotional – we tend to try to block it or avoid it at all costs. Literally, people will drink alcohol, take illicit drugs, take prescription drugs and over-the-counter drugs, mindlessly scroll on their phones for hours, and so on, just to avoid or get rid of the uncomfortable things we really don’t like to feel. Here’s the problem: when we do this it tends to make all the pain much, much worse. (And yes, there has been a TON of research done on this).

Image from: http://www.picturequotes.com/suffering-pain-x-resistance-quote-771963

PAIN X RESISTANCE = SUFFERING

This formula has been said by meditation teachers, such as Shinzen Young, psychologists, such as Tara Brach (who is also a meditation teacher), and researchers, such as Kristin Neff. And I’ve found both personally and through my work as a therapist, that it’s true. I’m literally in more pain when I resist it, avoid it, distract from it, push it away. And when I just let it be, I’m okay. This morning I woke up with so much anxiety. Anxiety about finances, anxiety about work, anxiety about my life and things I could have done. At first I did try to resist it. I instinctively grabbed my phone and scrolled. I decided I wasn’t going to have a workout and that I’d eat an extra waffle for breakfast while I watched YouTube videos about horror movies. But none of that made my anxiety go away…

We naturally want to hide from pain.

Here’s the thing about emotional pain specifically, it can actually lead to several additional problems (or increase the intensity of them if you already have them):

• More anxiety
• Lower mood
• Increase risk of heart disease
• Gastrointestinal issues
• Headaches
• Insomnia
• Autoimmune Disease Flares

We experience all types of pain for a reason. If we didn’t need our emotions (both the ones we like and dislike) and if we didn’t need physical pain, then we would have evolved without them. Our ancient ancestors needed them to stay alive. To protect us from life and death danger. To keep us safe. Instinctually, our brain and bodies still try to keep us alive the same way, it’s just that we encounter a lot less life and death situations now. And yes, all this applies to chronic pain too. Our bodies are telling us something is wrong, it’s just often not what we think. We think it’s telling us to stay in bed and not move and give in or up on all that’s important to us. In reality, it’s often telling us that we might need to stretch and move our bodies. To do something meaningful with our day – not as distraction but as a way to bring meaning and value to our lives.

Doing something meaningful is much more effective than trying to get rid of something that is a natural part of being human.

…This morning when I decided that I was done resisting my emotional pain, I sat down to meditate. I did my full 20 minutes (meaningful activity) and then I went for an hour walk (moving my body, and a meaningful activity). Then I did my workout that I had put off from the morning. I didn’t do all of this with the intention of distracting myself from my pain (emotional or physical) but to make room for it. I used some practices that I help my clients use to: like observing my pain, breathing into it, expanding around it, and just allowing it to be there WHILE I did things that were important to me. Guess what happened? Not only did it no longer control me, but it actually lessened a lot – to the point where it’s barely noticeable. I also noticed that my drive and creativity and all these things that I’ve been lacking lately came back full force. My suggestion to all of you is to make room for your pain, just to help you make the most of it.

Try this mindfulness exercise out to learn how to make room for pain.

Video: Daily Exercise – Hip Abductors

https://videopress.com/v/tZsjqyFq?resizeToParent=true&cover=true&preloadContent=metadata&useAverageColor=true

Disclaimer: Please consult your appropriate healthcare professionals before making changes to your exercise routine.

This is a new exercise given to me by my physiotherapist that I have found helpful for hip strengthening and pain reduction. What are your favourite hip exercises? As always, keep making the most of it with your exercise routines!

What Can We Control When We Have a Chronic Illness?

Here’s how I see it: in my life there are things that are out of my control. No matter what I do, I cannot change them. And then there are things in my life that are totally within my control, and I do what I can to change them. Seems pretty simple, right? Well, yes and no. There is this concept in psychology called ‘locus of control’ that has been vigorously studied. It basically describes how people make sense of different influences on their life. There are two types of locus of control. The first is internal, in which we believe what happens to us is caused by our own actions. The second is external, in which we believe that what happens to us is caused by outside forces. Would you believe that having a high internal locus of control is helpful? Especially for those of us with chronic illness or pain? Well, that’s what the research says…

Image from: https://www.simplypsychology.org/locus-of-control.html

There have been a ton of studies showing that people with high internal locus of control tend to have better health habits overall, are more likely to be screened and tested for health conditions, and actually have better mental health after being diagnosed with an illness. Janowski et al. (2013) found this was the case across chronic health conditions in their study. According to a study by Brown et al. (2018), people with high external locus of control have a lower quality of life, in their study on cancer patients. The great thing is, this is information we can utilize to make our lives better with our chronic illnesses. But how, you might ask?

Image from: https://www.miskawaanhealth.com/chronic-disease-prevention/

I want you to take a moment and ask these questions to yourself. What do I have most control over in my life? What do I have the least control over?
We often focus on things that are not in our control, such as the behaviour of others, actually getting an illness, and our difficult thoughts and feelings that are associated with all of this (and are an important part of being human). When we focus on these things we end up feeling helpless, hopeless, angry, anxious, guilty, sad, and so on (the struggle switch). We get stuck on these stories of “if I wasn’t sick my life would be good” or “my life will be great when I’m not in pain anymore, and will be miserable until that day comes.” This is common when you have an illness or a severe injury (like a concussion for example). The problem is, we don’t know if or when we will ever be without our illness or pain or injury, etc.

I didn’t have control over getting sick, nor can I stop my thoughts and feelings from occurring (they’re part of being human).

What we can do instead is start focusing our time and energy on what is in our control, such as our actions/behaviours/whatever you want to call it. Self-empowerment is one of those now almost silly terms that was hijacked by the self-help life coach world, but essentially, having a high internal locus of control and then taking control of what we can is the epitome of self-empowerment. The better health behaviours we have = the better quality of life we have (even with illness and pain).

What can we do to take control?

• Unhook from our difficult thoughts and feelings – try this or this.
• Connect with our values to determine how we want to act even with the challenges that we face – listen to this.
• Take action, behaving like the sort of person we want to be, so that we can live the sort of life we want to live – listen to this.

I can take control over my actions and lead a values-based life.

If you currently have a high external locus of control and a low internal one, this switch might be difficult to do. You may need the extra support of a psychotherapist/counsellor, and you will definitely want to give yourself patience, time, and kindness. We all have the opportunity to live a great life, regardless of our health status, so let’s see if this helps us make the most of it!

Video: How to Drop the Struggle Against Your Pain

https://videopress.com/v/uW6hvLBz?resizeToParent=true&cover=true&preloadContent=metadata&useAverageColor=true

Pain – both physical and emotional – are parts of life. They are also inevitable with chronic illness and chronic pain syndromes. The more we try to fight or resist our pain, the more it comes at us. So, let’s talk about why that is and what to do about it. Because, really, we can’t keep making the most of it if we struggle. Check out this podcast episode for more about this.

Keep making the most of it!

What Does Aesop’s Fable of the Wind and the Sun Say About Chronic Pain & Illness?

Aesop’s Fable: The Wind and the Sun
The Wind and the Sun were disputing which was stronger. Suddenly they saw a traveller coming down the road, and the Sun said, “I see a way to decide our dispute. Whichever of us can cause that traveller to take off his cloak shall be regarded as the stronger. You begin.” So the Sun retired behind a cloud, and the Wind began to blow as as hard as it could upon the traveller. But the harder he blew the more closely did the traveller wrap his cloak around him, till at last the Wind had to give up in despair. Then the Sun came out and shone in all his glory upon the traveller, who soon found it too hot to walk with his cloak on.

Image from: https://www.kids-pages.com/folders/stories/Aesops_Fables_2/page2.htm

“Kindness effects more than severity.” This is the moral of the fable. How does this apply to chronic illness, chronic pain, health and mental health more generally? So many of us have harsh, relentless inner critics. The voice in our heads that tells us we didn’t do a good enough job, or we aren’t good enough or smart enough, etc. In terms of pain and illness it may tell us we are being punished or we can’t have a good life, that our life is over and ruined. Our mind thinks it’s helping us and protecting us when it does this, but like the Wind in Aesop’s fable, all this does is demotivate us. It makes us struggle more and more against the difficulties in our lives. Vast amounts of research show that struggling makes it worse – yes, even symptoms of pain and illness are worse with struggle (struggle can include avoidance and distraction).

Notice what it’s like to respond to yourself with kindness, like the Sun.

The alternative is kindness. You may recall my fairly recent post called “Why Aren’t We Kinder To Ourselves?” where I explain why this all happens. When we are kind to ourselves we are actually more motivated to make our life better. We struggle less and are more accepting and open to our experiences. This isn’t necessarily an easy change to make. After so long of the Wind of our minds doing its thing, we need to learn to respond like the Sun. Maybe it’s offering kind words. Maybe it’s doing a self-compassion journal at the end of every day. Maybe it’s doing compassionate meditations, like the one below. There are many ways to cultivate the kindness of the Sun toward ourselves and it will also make our symptoms – both physical and mental health – a lot better. And by the way, I use this all on myself as well.

The same goes if we are motivating others. Have you ever tried to tell your partner or children to do something in a harsh and demanding way, like the Wind? What was the result? Probably not great, and even if you got what you wanted, you may have inadvertently hurt the relationship. What if you responded with kindness, like the Sun? It’s like the result was what you wanted and you may have even improved the relationship. Just some things to consider.

So this week, see if you can be more like the Sun to yourself when you’re struggling with the difficult sensations, emotions, and thoughts that come up. This is all in service of making the most it.

Video: Cooking with Kels – Healthy Pumpkin Cookies

https://videopress.com/v/MtswAx3M?resizeToParent=true&cover=true&preloadContent=metadata&useAverageColor=true

Having healthy snacks is always a good idea (and I love snacks). These cookies are super customizable depending on your dietary needs (though you do have to like pumpkin to enjoy them). They are very soft cookies so that is also important to consider. Here’s the recipe: https://runningonrealfood.com/healthy-pumpkin-oat-cookies/

Enjoy the cookies and keep making the most of it!

My Ultimate Pain Coping Skills Part 4: Connection

Welcome to the fourth part of my 4-part series on coping skills for chronic pain! Of course, there are way more than these ones out there. The reasons I’ve been focusing on these is because I have personally used them, and there is a ton of research supporting them. This week we’re talking about connection. By connection, I mean social connection – spending time with others. I know this is a tough one for many warriors for a variety of reasons. Many of you may not have a good support network, you may have pulled away from friends or had friends pull away from you because of your pain. You may not be close with your family or they may not understand. This happens to a lot of people with chronic pain and illness. It is important for us to find ways to connect with others, so let’s talk about why that is.

I find it important and helpful to connect socially with my friends, even if I don’t see all of them often.

There is a surprising amount of research in this area. I did a search on Google Scholar and got a lot of results. One area the research has focused on is the actual neural pathways in our brains and there seems to be a connected between physical pain and social pain. What I take from this is that when we experience emotional pain – such as through the loss of social connections – our physical pain gets worse. I’ve touched in previous posts about the connections between physical and emotional pain (mind-body) and how that works. You can also listen to this podcast episode. Other research has found that people with chronic pain tend to perceive others as being hostile toward them. Because it’s perception it’s hard to determine if the others are actually being hostile, but this could be another reason for the increased physical pain when there is “social” pain.

Sometimes pain can make us want to bail on social outings, and yet having that connection can actually decrease our pain.

Okay so if that explains the connection between our minds and bodies in general, what are some of the things social connection does for us that are helpful?

• Improves our self-esteem and self-confident
• Increases our sense of control and empowerment
• Improves our emotional wellbeing.
• Decreases anxiety and improve mood
• Changes our pain perception
• Improves coping skills

I’m lucky to have great support systems, but sometimes we can look outside the box to find social conections.

How that we’ve settled what it does for us, what are some of the actions we can take? How do I get more socially connected when I have pain and illness and all the struggles that come with it?

• Cognitive reframing, emotional expression, problem-solving, and distancing oneself from pain – this is literally what I work with clients on in therapy, and there are studies that show it increases satisfaction with your support systems, whether those are friends, family or your healthcare team.
• Accessing pain resources – we’ve all heard the phrase, “knowledge is power” and even by just reading this blog, you may feel more socially connected with others, like myself, who experience pain.
• Online support groups – even if you can’t find an in-person support group, having an online community is often very helpful for people. I’ve done a post on the pros and cons of these, but in general, if this is the only way you can socially connect with others, it can be enough.
• Volunteering – if you are physically capable of doing any kind of volunteer work, I highly recommend it. There has been so much research showing that volunteering is good for all humans as it actually increases our happiness because we are helping others. And of course, we are interacting with others too!
• Lovingkindness Meditation – the idea of this meditation is that we send out kindness to others, as well as ourselves. The others include people we care about, neutral people, people we don’t like, and all of humanity. Some of the benefits include stress reduction, being more compassionate, and better perspective-taking. You can find a version of this here.

I hope this helps you on your journey to be more socially connected and that it helps with your pain tolerance. Keep making the most of it everyone!