The idea here is that we can develop this “noticing self” or the part of us that can truly just observe our experiences without them taking control of us. I think that I’ve gotten pretty good at this over the years, to the point where not only do I not get swept away, but I am also just curious about my thoughts, feelings, sensations, etc. If you want to try the meditation I mention in the video, check it out here.
It’s been 84 years and I can still smell the fresh paint… No, just kidding. But it has been at least 2.5 years (possibly longer) since I had the common cold. Clearly the social distancing and masks and everything not only helped protect me from Covid (which I have managed to avoid thus far) but also the cold, flu and everything else. Then, on May 2, I caught a cold. Sore throat and all. And it was pretty bad. For me, it’s worse because of one of my chronic illnesses.
Getting any kind of additional illness usually sucks when you have a chronic condition. Example, if you have an autoimmune disease and you’re on immunosuppressants, that can also make you much more vulnerable to more severe illness and symptoms. It’s one of the reasons most people I know with chronic conditions have been so careful during the pandemic. Lucky for me, I’m not on immunosuppressants (I take antimalarials) so I don’t have to worry as much about that part, but still. What I do have that makes catching a cold particularly rough for me is glaucoma. Glaucoma is a degenerative eye disease that can eventually lead to blindness (luckily there are amazing treatments so the chances of going blind if caught early and treated are fairly small). My paternal grandmother had glaucoma and was virtually blind by the time she died. Both of my parents have glaucoma. And when I was 29 I was diagnosed with glaucoma, which is incredibly young (most people are 50+ when they develop it). The leading feature of glaucoma is high eye pressure.
So on May 2, before I started having cold symptoms, I actually happened to have an appointment with my new ophthalmologist. My eye pressure was pretty good and there was no degeneration. He actually made two comments that I found quite funny. First, “You are extremely near-sighted.” Yes, I know (that’s literally how I responded too). He actually informed me about possibilities of retinal tears, and what to look out for. His second funny comment, “Well, I guess we’ll be seeing you from now until indefinitely.” Yep, pretty much true. So, why is catching a cold worse when you have glaucoma. Well, over-the-counter cold medications actually increase your eye pressure. Therefore, I can’t take cold meds (other than cough drops).
Okay, so what happens to me when I can’t take cold meds and have a bad cold is that I get extremely wimpy. Basically life sucks for a few days. Unless I catch myself in these thought patterns, which is what I did recently. I know that “this sucks” and “everything is terrible” thoughts leads to more negative mental and physical health outcomes. It increases body aches and pains, it can keep me sick longer, and it can make me feel depressed (and there’s lots of research out there to back all of this – just type a few key words into Google Scholar and you’ll find it). To be effective I had to “manage my mind” (which is a phrase a life coach who’s podcast I listen to uses). I notice the thoughts, place them on a leaf and let them go. Or I notice and name the thoughts or name the story my thoughts are trying to tell me to create some distance. And then I take comfort in pleasurable activities that I can do. For example, I love movies and being sick is an excuse to watch them. But I don’t just pick any movie. I have some favourites that I used to watch all the time as a kid when I was sick… and then continued to watch into my adulthood when I’m sick. My favourite is Jurassic Park. So that’s what I did. I created distance between myself and my thoughts, acknowledged any emotions I was experiencing, made some tea and watched JP.
The other thing I did recently that was helpful, was talk to my ND about natural cold remedies. Now, I’m lucky in that I work at the same office as my ND (we actually share a room, just work on different days), so for me it’s a quick text and I realize that’s not the case for everyone. But if you see a naturopath, it’s worth asking about. Here are some suggestions she gave me for the common cold (sinus and cough):
Vitamin C: amount can depend on your bowel tolerance – I bought the chewables and used about 3g per day.
NAC supplement – I think you have to go to a natural health store to find these. I didn’t try them this time, but I’m keeping it in mind for the future.
Peppermint tea – which I love anyway, and interestingly it’s the only type of tea she recommended
Eucalyptus inhale: basically boiling water with some essential oils and inhaling with a towel over your head – I found this extremely helpful
wet stock treatment – I did not try this because my feet hate the cold, but apparently it is very effective.
Alas, I survived my first cold in 2.5 years and realized that the best things for me to do is use some natural remedies paired with some psychological coping skills. If you’re like me and unable to take cold medication, I hope this helps you to keep making the most of it!
I was listening to a podcast a few weeks ago and the guest was talking about the physiology of our fight-flight-freeze response and how it can specifically relate to certain chronic illness. The guest used the following examples: lupus as being the fight response, and CFS/ME as being the freeze response. I had never thought of it this way and it made me interested in this topic. (The podcast is called Therapy Chat if anyone is interested but I can’t remember the specific episode number, sorry!). Fight-flight-freeze is also known as the stress response, which is a product of evolution that kept our species alive for a long time, however, if you ask many people with chronic illnesses (especially autoimmune diseases) you’ll have a lot of people tell you about chronic stress, trauma history, and attachment issues, all of which can dysregulate our stress response. Usually this occurs in childhood, and I can specifically remember 5 years where I had chronic stress (at school only, due to a traumatic friendship).
I’m going to try to explain the stress response in the easiest, most non-technical way possible (because honestly my eyes glaze over when I have to read about brain anatomy, and I’m guessing I’m not alone in that). So there are a few different parts of our autonomic nervous system, most notably the sympathetic nervous system (fight and flight) and our parasympathetic nervous system (freeze). There is also our vagus nerve which is really important in understanding the nervous system but I’ll leave polyvagal theory for another time. Sympathetic activates us to either fight or run away in order to survive, whereas the parasympathetic suppresses everything in order to keep our bodies alive when we can’t fight or flight. The problem is that when our stress response is chronically activated, it can impair our physical and mental health. I want to put a caveat here for the rest of this post, correlation does not mean causation, however, most theories do point to chronic stress as being causation (at least partially – biopsychosocial approach) for a lot of illnesses.
I think it’s also important to talk about stress-related disorders, because they tend to also be diagnosed in people with autoimmune diseases. Examples include acute stress disorders (same symptoms as PTSD but only lasting between 3-30 days), posttraumatic stress disorder (which most people seem to have a basic understanding of), and adjustment disorders (occurs during major life changes). Attachment disorders can also contribute. One study I looked at found that people with a stress-related disorder were more likely to not only develop an autoimmune disease, but to actually be diagnosed with multiple ones, and had a higher rate of them if they were younger when having the stress-related disorder.
Let’s talk about chronic stress – when our stress response is activated for a long period of time (i.e., daily stress as opposed to one major stressor) – because a lot of research has been done in this area. Here is a bunch of things that chronic stress can do:
contribute to high blood pressure
contribute to anxiety, depression, OCD, anorexia nervosa, and substance use disorder (and withdrawal)
contribute to obesity (increase appetite, leading to weight gain)
suppress or dysregulate immune function (leading to inflammatory disorders and hyperactive immune systems such as in RA and lupus)
suppress the reproductive system
suppress growth in children (lots of studies of children in orphanages)
switch off disease-fighting white blood cells, increasing risk of cancer
worsen symptoms in lupus patients
contributes to malnutrition
contributes to poorly controlled diabetes
contributes to hyperthyroidism
So that’s a lot. I mentioned ME/CFS as the beginning of this post as well, which is associated with the physiological state of freeze, as examined by metabolic changes. Some research indicated that people with ME/CFS are “wired,” meaning a combination of both the fight/flight and freeze responses, leading them to feel wired and tired at once. I hope this gives you some understanding of what is going on with you if you have any of the illnesses mentioned in this post. Understanding is one thing, but what can we do to help ourselves, especially if we are in a chronic stress response? While there is no right answer, there are definitely things we can try (and a bunch have worked for me!)
Deep breathing (into the diaphragm) – for many people this lowers stress (it sometimes increases anxiety for me, so I personally find it more effective to do mindful breathing)
visualizations and guided imagery – try this one out.
Prayer – this is a mindful activity that many people find helpful
Yoga and Tai Chi – mindful movement can be very grounding – listen to this podcast episode about it.
Walking (and other forms of exercise) – for many people this lowers the stress response, for some people it can increase it due to heart rate increases
Journaling – you have to like to write/journal for this one but it can be helpful to get your thoughts out of your head
Biofeedback – this is a technique in which you can learn to control some of your bodily functions (i.e., heart rate)
If you’re just tuning in this week, we’re halfway through a 4-part series on some of my favourite pain coping skills. Why are they my favourites? Well, for one, they all have worked for me so direct experience is useful. Two, they are all evidence-based – there has been scientific research on them (and yes, I’m nerdy enough to spend the time reading the articles published in scientific journals). Third, I see them work with my clients in my counselling practice. And as such, I thought it was about time I shared them all with you. This week we’re talking about self-talk and changing that from the harsh inner critic to something a lot more compassionate.
Recently I wrote a post about being kinder to ourselves, which seems to be quite popular, so we can think of this as an extension of that. Most people have a harsh inner critic, or voice in their heads, telling them that they aren’t good enough, or shouldn’t have done this or that, etc. The voice is there for evolutionary purposes (see the video below on the caveman mind) but it unfortunately isn’t too helpful in our modern world. When we have chronic pain, the voice often shows up as “you’ll never be able to do anything again,” “this is what your life is now,” “no one will ever love you if you’re like this,” etc. Sound familiar? If it does, know that you’re not alone. This is extremely common. But what if we could combat this voice somehow?
The great thing is, we can learn to respond to it with a compassionate voice. No, that inner critic voice probably won’t just go away (remember, we evolved to have it). But we can learn to respond to it differently. We don’t have to just listen to it, give into it, get hooked by it. This takes some practice though.
I recently went through the Mindful Self-Compassion Workbook by Kristin Neff and Christopher Germer. In it there is an exercise on developing your compassionate voice. You are supported to think about a behaviour you’re struggling with. Then notice what your inner critic is saying. So example, with chronic pain this might be getting up to go for a walk or clean the house, etc. Your inner critic might be saying “you’re never going to be able to do these things again.” Then you are to try out a few self-compassionate phrases. Such as “I am here for you, and will take care of you.” or “I know you are suffering. I love you.” And so on. It should be something you really need to hear. Then when that critical voice appears, we can use our new phrases to respond to it.
What does this do for us? Well for one, it greatly improves our mood. The relationship between low mood and chronic pain has well been documented (low mood creates more pain, more pain creates lower mood). So by improving our mood, we may actually have less pain (I find this is very true for me). It is also more motivating to respond this way. Yes, it may be hard to engage in the behaviour, but by being here for yourself, supporting yourself, you may be able to take some steps (however small) toward doing that behaviour.
I hope this helps with your chronic pain coping. As always, keep making the most of it!
This is part 2 of my 4-part series on my favourite coping skills for chronic pain. These are all things that I use and find helpful. Additionally, they all have scientific evidence supporting them as being helpful. This week we’re going to talk about relaxation: how it can be beneficial and some ideas for incorporating relaxation into our daily lives.
Let’s start with what the research says is helpful about incorporating relaxation into our “treatment” for chronic pain. Relaxation enhances our ability to tolerate pain. But how does it do this? First, it increases our brain’s ability to respond to endorphins, which are our body’s natural pain relievers. Second, it reduces inflammation, which is often a cause of pain. Third, it allows our muscles to relax, and tense muscles tend to cause more painful sensations than relaxed muscles. Fourth, it reduces hypervigilance and desensitizes our central pain pathways, meaning that it helps to decrease our sensitivity to painful sensations. Fifth, it improves our mood and makes us less emotionally reactive to our pain, and since we know the mind-body connection is a thing, this makes sense. I also want to point out that the research states that mindfulness skills are more effective than relaxation skills. However, I think having both is important, and the research seems to support that as well.
So, let’s talk about a few different relaxation skills we can access, learn, and some other ones that I use that aren’t necessarily research based but are helpful for me.
Progressive Muscle Relaxation: in this practice we tense each muscle group, one at a time, and then release the tension allowing for relaxation. I love this one and feel very relaxed afterwards. There’s been a lot of research on it, and it’s one we can do on our own as there are a ton of guided versions. Here’s a guided version I made from my YouTube channel.
Guided imagery is another practice we can do on our own. I personally like “safe place” imagery, which I haven’t made for my YouTube channel yet but any guided imagery that uses peaceful, soothing or symbolically therapeutic mental images has evidence that it enhances relaxation from physical and emotional pain.
Yoga is another practice that I normally associate with mindfulness, though I will admit that I find it relaxing as well. Yoga emphasizes a number of processes including acceptance, attention, mediation and relaxation, which is likely why many people find it effective. Here’s an interview I did with MS Warrior and Yoga Instructor, Clarissa, on the podcast.
Hypnosis in an intervention that I haven’t tried, however there is growing research that it shows promise as being helpful for chronic pain. It alters our perception and cognitive patterns that occur in chronic pain syndromes through the use of relaxation. Here’s an interview I did with physical therapist, Sam, who uses hypnosis with his patients.
Biofeedback is another intervention I haven’t tried but has a lot of research support it’s use and was discussed at the World Pain Summit I attended last fall. It increases our physical awareness and induces relaxation through the use of markers of the stress response. I definitely think it’s worth looking into.
Pick any activity you find relaxing! Okay so this doesn’t have specific scientific evidence but if it induces relaxation then it can’t be bad. For me, that is taking a bubble bath (or epsom salt bath) and reading a book. I find it incredibly relaxing and definitely helpful for me.
As a therapist, I’m always surprised how many of my clients don’t have a lot of relaxation skills, which makes me wonder how many people actually actively use relaxation skills in general. So, I hope this gives you some helpful options, and I encourage you to try to make some time each day to actively do something relaxing. Keep making the most of it!
I decided to do a 4-part series on some of my favourite pain coping skills. They are all either my favourites because I have found them to be particularly useful for me, or that reason plus I have seen them be useful for other people. I will also add that I always double check to see if there is any scholarly literature on the subjects I write about, and there definitely is for all of these coping skills. So, without further ado, lets start off with self-monitoring.
You might be asking, what is self-monitoring? It is a part of our awareness (executive functioning in the brain) that we all have, that tracks our behaviours and the impacts they have on us and our environment so that we can alter our behaviour in the future if we choose to. We all use this pretty often. For example, adjusting to social norms would be using self-monitoring. So would reviewing your work for mistakes (because ideally you won’t want to make the same ones in the future). We can break self-monitoring down into two types. Qualitative – or what I’ll call subjective monitoring – which is how our emotions, sensations and behaviours change throughout the day and during different situations. Then there is quantitative – or what I’ll call objective monitoring – which is the frequency, duration, and difficulty of our behaviours.
What the heck does this have to do with chronic pain? Sometimes people with pain over-self-monitor in that we overthink our pain and our behaviours which is typically not helpful (I’ll get to that in a minute). When done properly, self-monitoring can be used to help us accept our emotions and sensation, create some distance between us and our thoughts about pain, and get us to do behaviours/actions/set goals/whatever you want to call it, that will improve our lives or just in general fulfill us! And this is what I see is often difficult for chronic pain warriors. For example, if I notice that a certain activity causes me more pain than normal, I would mentally note that as well as the frequency, duration and difficulty of the activity so that I can make adjustments in the future (i.e., not to the activity, do the activity for less time, do the activity less – or more, depending on the situation – often, or do a similar activity that is less difficult). A few years ago I did a pole dancing class. Super fun and a great workout. However, I did notice that my hip pain increased, especially after the class was over. I decided that while though it was fun, the friend I went with and I have lots of other activities we can do together and I exercise in other ways, that maybe this wasn’t the workout for me. I adjusted. Another example is hiking. I know how long a hike I can do (about 75-90 minutes max.) before I have expended too much energy and/or crossed my pain threshold. What does that mean? I still hike because I LOVE hiking, but I do it for 90 minutes or less, followed by rest.
Earlier I mentioned that when we over-self-monitor we often do things that aren’t helpful. This also happens when we don’t self-monitor our pain at all. Let’s tie it into that pain cycle I wrote about a few weeks back. In the pain cycle we see that being less active leads to a loss of fitness, weak muscles, and joint stiffness. If you self-monitor and notice that if you lay on the couch all day this happens but if you go for a (short) walk it doesn’t lead to these specific symptoms, that might lead you to do the walking. Pain cycle again says that then we create lists of “no go” things we cannot do, and this leads to sleep problems, tiredness, and fatigue, which also leads to stress, fear, anxiety, anger, and frustration. Okay, so doing less isn’t necessarily helpful even though our brains say it will be. We can also skip ahead in the cycle and go to negative thinking and fear of the future and how that leads to depression and mood swings. Monitoring our thoughts is helpful at this stage. And then there is time off work, which inevitably causes money worries and often ties into relationship concerns. And then everything leads back to more chronic pain. I want to point out with the activity portions of the above paragraph, that pacing is essential and I did a whole post on that a few weeks ago.
What can we do to start self-monitoring in an effective way? First thing is to keep track of your pain. This can be mentally, but if you have brain fog or just tend to forget it can be more effective to write it down in a journal. There’s a few ways you can track it. Just a general 1-10 score for the day and a list of what you did during the day. Or, if you want to be more effective with your activities, you could write a score before and after each activity you did to track changes. That will also tell you when there was no to little change so you know if you can keep doing the activity the same way, for the same amount of time. The other important thing to track in the journal can be other triggers to pain. For this one, I would suggest tracking emotional pain (sadness, anxiety, anger, etc.) as much as physical pain. Why? The body-mind connection. Often the more depressed we are, the more pain we have (and vice versa). Same with anxiety. It’s easier to make adjustments when we know what’s going on.
Okay, longer post than I anticipated but I hope that it’s helpful for all of you warriors! Keep on making the most of it!
Let’s face it, we all stress through the holidays. It’s rarely an “easy” time of year for anyone. Over the years I have spent many holidays working in retail; I have had to share time between families (back when I was married); I’ve had to spend some Christmases all alone. And then there’s all the things we normally have to do like cook, and clean, and buy gifts (sometimes with limited money) and almost always with limited spoons (for those of you who use Spoon Theory). How can we be expected to manage all of this? And many of you may not handle it well. So, here’s what I’ve learned.
The most important thing to do is PACING. For those of you unfamiliar with my blog post on Pacing earlier this month, it basically comes down to doing the same amount of activity every day (so no over-exerting) regardless of how you feel. What usually happens, especially at this time of year, is we have a good day so we go ham and do as much as possible on that day (cooking, cleaning, etc) and then we end up not being able to do anything for day(s) after. If we do just 1 activity on that “good” day and then also do just 1 activity the next day, regardless if we feel better, the same, or a little worse, we will more easily avoid a string of “bad” days.
The other most important thing is setting boundaries. Who says YOU have to host dinner? If you do host dinner, then maybe you don’t need to be the one to cook (can everyone bring a dish?) or clean by yourself (if you have a partner, can they help with the cleaning and prep). When shopping for presents, have you done it online? If you do have to go to the store, just use that as your 1 activity for the day (and wrapping the presents being an activity for another day). Tell your support system what you can do, and what you need help with. Stand up for yourself and don’t let them bully you.
If you don’t have a strong support system, which I know sometimes happens, then again, revert back to pacing, and say NO if you can’t do something (again, this could be hosting dinner, cleaning, etc), and see what other help you can get. Maybe there’s a neighbour or friend you can pay to help you cook or clean (that way it’s less expensive then hiring a professional). We need to use some flexible thinking and get outside the box.
The holidays are stressful, so we need to do what we can to manage our stress levels and take care of ourselves, while still living by our values (and hey, self-care may be one of your values). Have a Happy Holidays and keep making the most of it!
I used to always use problem focused coping. Like 99.9% of the time. And it usually served me well, but not always, and certainly not always after my chronic illness snuck up on me. Then I started to use more emotion-focused coping, a totally different coping style. And here’s the thing, I now use both and you probably need to as well. But hold on! What the heck are problem-focused and emotion-focused coping anyway?
Problem-focused coping is typically used for solvable problems, ones that can be fixed, and make the problem go away. For example, if we lose our job due to company restructuring (this happened to me back in the day) then we would use problem-focused coping in order to find another job and make sure we can support ourselves in the meantime. Emotion-focused coping is what we use when the problem can’t be fixed, and the problem will not go away. It is dealing with emotions that arise from an unfixable problem. Kind of like what happens when you have a chronic illness. Both of these skills are necessary in life, but the problem is, most of us are taught more about problem-focused coping that emotion-focused.
Let’s look at problem-focused in the context of chronic illness or chronic pain. What are some solvable problems or areas in which we would use problem focused coping? Well, lifestyle changes are one area. We are told or we read up on different “diets” or exercise routines or incorporating meditation, etc that will help us with some of our symptoms. Or maybe it’s just taking medication as prescribed. We would use problem-focused coping because lifestyle changes and medication adherence are fixable problems. We’ll likely use SMART goals (specific-measurable/meaningful-attainable/adaptive-relevant/realistic-timebound) or other techniques to make these changes. And, while nothing is a guarantee, there is a lot of evidence supporting that certain lifestyle changes will help with symptoms, essentially “fixing” (I use that term loosely) the problem.
How about emotion focused coping in the context of chronic illness or chronic pain? While, chronic disease distress, anxiety and depression are all common in those of us with chronic illness. Our illnesses likely won’t go away and our emotions – well, we’re meant to have them. So with this I see a lot of acceptance practices being used and needed (here’s a link to one of my favourites). Self-compassion is another area where we are utilizing emotion focused coping (here’s a link to one of those practices). We have to learn to live with difficult emotions that come and go, and difficult sensations, such as pain. If you’re not good at this, I want to normalize it for you – most people aren’t! This is a skill set most people need help with.
Who can help you add these skill sets? Well, there are lots of places to go. A counsellor/therapist or health coach is one place. I would say the health coach would help more with problem-focused and therapist with emotion focused (as well as problem-focused). You can also look in the self-help section of your local library or bookstore. Those meditations I linked are another place, and I’ve done a number of episodes on these in my podcast (check out this episode on acceptance for example).
Once you have and start using both types of coping skills, you can start making the most of it!