How to Have a Better Attitude Toward Fitness (When You Have Chronic Pain)

We all know that the majority of the research says exercise = less pain. Honestly, I’m a supporter of this idea. Why? Because it has literally worked for me. I’ve managed to get off one medication, which happened when the only major lifestyle changes I had made were daily exercise (strength and cardio/waling) and daily meditation (plus yoga 2-3x/week). No more Lyrica for me! Now that doesn’t mean that I no longer have pain. It’s just more manageable. I notice that when I don’t exercise, my pain actually increases. Of course, this all seems totally backwards to our brains., mine included. When exercise was initially presented to me as an option for reducing pain, I was like “no way I’m going to do that! I’ll be in more pain.” Then I tried it and the rest is history.

yoga!

The thing is, even if you believe that exercise will help (and I’m aware that some of you don’t believe it, and that’s okay)the problem becomes, how do we reframe our minds so that we can actually start to engage in some physical activity? There are a way different ways we can approach this (or use all of these ways, depending on what you need). The very first thing I do is connect with my values. Why is this important to me? What values will I be living by? For me, when it comes to exercise this is often aligning with values of health, self-care, and independence. They might be the same for you, or totally different. The second thing I do is to just looking at my thoughts. I ask myself, are these thoughts helpful or unhelpful? Are they taking me toward the life I want to live or away from it? Then it’s helpful to create some distance from them. This can be anything from naming the story I’m telling myself, to speaking the thought aloud with the phrase “I’m noticing I’m having the thought that…”, to placing the thought on a leaf in my mind and watching it float down a stream.

At this point if I notice any sensations of anxiety or another emotion, I try to make some room for those. Maybe I send my breath into that area, or remember it’s normal to have anxiety, or drop an anchor which involves allowing my emotions to be there. By this point, I can usually do whatever activity it is I’ve decided I need to do (so in this case, exercise). While exercising there are a few more things I do so that I can improve my attitude. Firstly, I make sure my movement is mindful. I stay with the sensations of the movement, the smells in the air around me, what I can see and hear, all while exercising. This can be done on a walk or while doing strength training. You could also try yoga as a form of mindful movement that allows for stretching and exercise as added benefits. All my stretching in general is also done mindfully. I also make room for sensations while exercising. DO NOT exercise if it’s actually causing you extra physical pain. A little discomfort though is completely normal. I might do a quick body scan to check in with myself and make room for physical discomfort. I definitely use my noticing self to step back and just notice if it’s actually pain I’m feeling or if it is just discomfort that comes from exercise.

Lastly, I commit. I started out just going to the gym 3x/week. During the pandemic I built it up to strength training at home and going for walks to get fresh air and yoga a few times a week. The point is, you can start slow. And it’s probably better to if it’s a big change. You can also work with a physio/physical therapist, kinesiologist, occupational therapist, or personal trainer to help you get started (I worked with my physiotherapist, chiropractor and a personal trainer when I started). Here’s a podcast episode about exercise for chronic pain. So hopefully, this gives you some ideas on how to improve your attitude toward fitness with chronic pain. Until next week, keep making the most of it!

Video: Daily Mindfulness – There Go Your Thoughts

In this short exercise, we work on developing our “noticing self” in order to help create some perspective. The “noticing self” can be extremely helpful to develop when you have a chronic illness and/or chronic pain. Rather than get overwhelmed by our sensations or try to get rid of them, it can help us live more effectively with our current, present-moment experience. If you have questions or comments about this, feel free to comment on the video and I’ll try my best to answer. I did do a podcast episode on this concept back in the day, here’s the Youtube link.

Keep making the most of it!

3 Ways to Reduce Rumination, Worry, and Attachment to Self Stories

Have you ever found yourself caught up in thoughts about the past? What life was like before your chronic illness/pain? Ruminating over and over about that old life… What about thoughts about the future? Worrying about what will happen to you and how your health will affect you, maybe even getting worse? Perhaps you are also really fused with the idea that you are just a sick person now and that is all your life will be. These are all common thought processes when you have a chronic illness or chronic pain. I’ve certainly dealt with these before. The problem with this dominance of the conceptualized past or future, or the conceptualized self, is that it often takes us away from living right now. It makes life worse. It increases suffering.

Rumination and worry are like the fog. Can you come back to the present?

I remember having the thought that I don’t want to suffer any longer. This was in the fall of 2016. My very recent ex blamed me for all the things that were wrong in the relationship because of WHO I was. What I quickly came to realize was that I was ruminating and worrying and fused with having an autoimmune disease. We didn’t break up because of who I was (trust me there were a lot of other issues that didn’t stem from me at all). However, the dominance of my thought processes wasn’t helping me at all. It was taking me away from the life I wanted to live and away from the person I wanted to be.

The Conceptualized Past & Future
I don’t think that being able to reflect on our pasts or contemplate our futures is inherently problematic. Our brains have evolved to be able to do this. Initially to keep us safe and alive. We just don’t run into as many instances of life-and-death situations anymore. When we excessively focus on the past, or ruminate, we tend to feel overwhelmed and depressed. When we excessively focus on the future, or worry, we tend to feel overwhelmed and anxious. Both anxiety and sadness can increase pain and set of flares for those of us with autoimmune disease, which in turn tends to lead to more sadness and/or anxiety. It’s a vicious cycle.

The Conceptualized Self
We all have stories we tell ourselves about ourselves. Like who we are, where we came from, and why we act the ways we do, essentially why we are the way we are right now. Often being sick or in pain is a large part of this story. The problem with these stories is that while they do contains some objective facts, they are also chalk full of our own subjective interpretations. When we are really fused with these stories about ourselves, we forget that life is constantly changing, most of it is not predictable, and we can also create change for ourselves. And yep, I know this is really hard to grasp when you have a chronic illness.

Why we need to contact the present moment
We we are stuck in the past or future, and when we dwell on our stories about ourselves, we are definitely not experiencing the here-and-now. The benefits of being present are plentiful, including the ability to gain more self-knowledge and self-awareness, enjoying our experiences more, feeling less pain (emotional and physical), and being more flexible in our interpretations of ourselves and of life. I meditate daily because it helps me become more present (and it took me so long to get into a daily routine). I also notice myself being able to come back to the present much faster throughout the day, even when I notice physical pain.

How do we counteract rumination, worry, and attachment to our self stories?

  • Mindfulness – it can be meditation, but really mindfulness means contacting the present moment, being here-and-now. So it can also be yoga, or mindful walking or eating. It can be fully engaging in an activity. It can be noticing your thoughts/feelings/sensations and then coming back to the present by noticing your feet on the floor. It can be many, many things, but it is always: being curious, open and nonjudgmental about your present moment experiencing. Check this out.
  • Noticing Self – the idea that there is a part of us that can step back and notice. Like the sky and the weather. The sky always has room for the weather. Even when the weather is thunderstorms and hurricanes, the sky is not bothered by it because eventually the weather changes. We can use this same part of ourselves, to just step back and watch our experiences without being swept away. It’s a safe place that just notices. This is particularly helpful for attachment to our conceptualized self.
    Check this out.
  • Creating Distance Between Ourselves and Our Thoughts – we can’t stop our minds from thinking, but we can notice when our thoughts are unhelpful and learn to let them pass like leaves on a stream. The more distance we can create, the more psychological flexibility we can have in order to return to the present. Check this out.

I know that was a lot of information! I’m a big believer in seeking help from a mental health professional in your area if you are really struggling with your mental health. Many people with chronic illness, chronic pain, TBI, etc. find it hard to cope on their own. One of the best things I ever did was go to therapy. I learned a lot of skills to help me cope and felt I had nonjudgmental support as I continued down this path we call life. And on that note, keep making the most of it!

Video: You are Like the Sky…

Videos by: Pressmaster, Roman Odintsov, The Element, and Taryn Elliott at Pexels.

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.

In the meantime, keep on making the most of it!

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.

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.

Keep making the most of it!

Effective Ways to Challenge Chronicity Thoughts

How much time do you spend thinking about your pain or illness? Does it consume most of your day? Just a little bit? I remember the time when I was spending a lot of time thinking about being in pain, and wondering “why me” or what my life would be like going forward etc. These are often referred to as chronicity thoughts. Happily, this was the past for me and is not my experience anymore. I know that many of you may be having this as your current experience though, so I wanted to take sometime to talk about it.

As human beings, we spend a lot of time thinking.

First of all, I want to say that this is a totally normal experience for anyone with chronic pain or a chronic illness. Our minds are literally trying to help us (or they think they are trying to help us, which is what they evolved to do). The problem is, this kind of constant thinking about pain makes our lives worse, not better. There are three types of common chronicity thoughts: (1) ruminating about being in pain/sick – I keep thinking about it, it’s all I can think about because it hurts; (2) magnifying our pain/illness – it will get worse, something terrible is going to happen; and (3) thoughts of helplessness – nothing I do makes it better, nothing I can do will ever make it better.

Are your thoughts making your life better, worse, or the same?

If you went to a doctor (Western or functional) or a therapist, they’d likely assess this with a tool called The Pain Catastrophizing Scale (PCS). My commentary is that I don’t like the name because “catastrophizing” sometimes has the connotation that it’s all in your head, but that’s not what it means in this case – it’s really referring to chronicity thoughts. The questions on the scale include:

  • I worry all the time about whether the pain will end
  • I feel I can’t go on
  • It’s terrible and I never think it’s going to get any better.
  • I wonder whether something serious will happen.
  • and so (there are 13 questions total, and you self-report on a scale of 0-4 for each question, with 0 meaning not at all and 4 meaning all the time.)

So what can we do about all these chronicity thoughts? First, I will always suggest that working with a therapist is the way to go. Remember this blog is educational and not mental health/medical advice. We all have unique situations and unique thoughts, so having someone you can work with one-on-one (or in a small group) is always the way to go. I will let you know about a few different approaches. First, let’s talk about classic Cognitive Behavioural Therapy approach, where we challenge thoughts.

  • Notice and name the thought: I’m having the thought that “It’s terrible and I never think it’s going to get any better.”
  • Review evidence for and against the thought: For might include things like, it occurs frequently, has high intensity, a doctor’s prognosis, etc. Against might be things like, there are times of day when I don’t notice it or it’s less intense or my doctor said with this medication or these lifestyle changes it will improve
  • Replace the thought with a more accurate one: This doesn’t mean being optimistic or denying anything that’s true. Instead it’s incorporating the evidence against the thought (not just for the thought which is what we tend to do). So a different thought might be: “It’s really unpleasant right now, but it might not always be this bad/constant.” (You choose a thought that works for you, this is just what might work for me.)

As a therapist, I am well-trained in CBT but I prefer to use Acceptance and Commitment Therapy (ACT) on myself and with clients, especially those with chronic pain/illness. There is no step-by-step way to challenge thoughts in ACT because we don’t challenge them, but here’s now I might work with them.

  • Contact the present moment: ground myself my noticing and acknowledging my thoughts and feelings, while noticing what I can touch, taste, smell, hear, and see. (Here’s a guided version of this).
  • Use my noticing self: the part of me that notices everything and even notices my noticing. And the similar part of me that can put myself in my shoes on the days when my pain is less. (Here’s a guided version of how to learn to do this).
  • Creating distance between myself and my thoughts: This might be noticing and naming the thought. It might be reminding myself that my brain is just trying to help me and saying “thank you mind.” This might be just watching my thoughts come and stay and go in their own time (guided version of this one is here).
  • Accepting my experiences: particularly physical and emotional pain that I might be going through. This could be actual sensations or emotions such as sadness or anxiety. For this I often just observe what the sensation/emotion looks like, where it is in my body, and so on. Then I send my breathe into the part of my body I feel it most intensely. Then I make some room for it, noticing that my body is bigger than it. Finally, I just allow it to be there without consuming me. (Guided version here).
  • I connect with my values: what qualities of being are important to me? I know that compassion (for myself and others) is a big one that is often helpful in moments of pain, sadness, anxiety, etc. (Here’s an exercise on connecting with your values.)
  • Taking an action to live by my values: So if we’re going with my above example/value than it might be doing some self-compassion work. (Here’s a guided practice). It could also be setting goals to make some of those lifestyle changes that might help. It doesn’t matter what the action is as long as it is rooted in your values. (podcast episode on how to do this available here).

So that’s it. A bunch of different ways to work with your chronicity thoughts so that hopefully you can improve your life and keep making the most of it!

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Video: Daily Mindfulness – The Continuous You

In this practice we are working on developing the “noticing self,” “observer self,” “self-as-context,” or whatever you would like to call the part of you that notices everything. Many people find this type of awareness to be very beneficial in many areas of their lives. This was adapted from Russ Harris’ ACT made simple. The noticing self is something that I have found to be very important in my own life, and in the lives of my clients.

You can access my full meditation library here.

Keep making the most of it everyone!

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Video: Daily Mindfulness – Observation of Body & Breath

It It is extremely therapeutic for chronic pain and chronic illness warriors to get into our bodies. Yes, this is the opposite of what we want to do (run away from being in our bodies) but there is a lot of research that shows this is far more helpful for both our physical and mental health. In this practice we can gently get into our bodies, while using the breath as an anchor. If you haven’t listened to this episode of the podcast on achieving a sense of accomplishment (with Darren Radke), check it out.

I hope you enjoy this practice, and keep making the most of it!

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How Can I Become More Resilient?

This isn’t the first time I’ve posted about resiliency on this blog. The truth is, it’s a topic that comes up often. I see it on online support groups, on Instagram, and hear it in conversation with people. I also read it on other blogs, and many healthcare organizations post about it on their sites. Here’s the thing, if you have a chronic illness and you’re not feeling resilient, just know that you are not alone. A lot of people feel that way. Are people born resilient or do we develop resilience? I think it’s an interesting question and possibly a bit of both. Children tend to be more resilient than adults, suggesting we can lose some resilience as we age. In one of my courses for my graduate degree we had to more-or-less do a family tree. Except this family tree was supposed to trace something like a mental health or substance use issue. I chose to trace resilience, and found that going back just to my grandparents generation (that was the requirements for the project) there was a strong theme of resilience (my maternal grandmother/baba faced abuse, neglect, lost 2 children, and she and my mother were trapped in Siberia for a week during the Cold War – I know it sounds too crazy to be true). Yet she not only survived but was a loving parent to her other children and an amazing grandparent. Had my mom not shared my baba’s history I would not have know. She was that resilient.

Three generations of resilience in my family.

The good thing is, that even people with chronic illness can develop resilience. Warning: it does require work on your part. Luckily, some of the work may not feel like work at all… it just requires consistent commitment to it. I want to add, that many of these suggestions overlap with what the National MS Society suggests, in case you don’t want to just take my word for it.

  • finding meaning and committing to that action: what is the reason you get out of bed in the morning? If you don’t have a reason it will be difficult to do so. Is it your family? Or work? I know a lot of people with chronic illness go on disability, but work provides meaning and purpose for people. If you are on disability what is your purpose going to be instead?
  • improvisation/adaptability/problem solving: I think these all kind of overlap and go together. We often have to improvise in order to do things we enjoy. Maybe we can’t go on the 5k walk with our friends, but we could meet them for coffee afterwards. How flexible and adaptable are you to changing plans? Or asking others to? What’s an alternative way you can participate or do the things you like to do? I would go as far to make a list of ideas (remember when brainstorming there is no such thing as a dumb idea) and try out some to see if they work.
  • Self-care: we all know I love self-care, and this includes the basics (getting out of bed, making breakfast, taking a shower) and then doing activities like relaxation techniques, yoga, meditation, or prayer. What hobbies do you enjoy that you can participate in? Pick one a day. Reading is an example of something that is low energy and can be fulfiling.
  • Being able to tolerate “negative” emotions: I personally don’t categorize emotions as negative or positive. All emotions are important because they tell us very important things. If you’re not used to be able to just sit with emotions, try out this mindfulness practice that aims at helping people do just that.
  • Self-efficacy: I did a post on this recently, and you can read it here. Do you believe you can cope with your illness? Part of this is being a realistic optimist, being hopeful.
  • Using skills such as curiosity and humour: When is the last time you laughed? Are you able to have fun and joke around (and not in a self-deprecating way)? Do you get curious about your situation or feelings or sensations or emotions? What are you noticing about them right now as you read this? The noticing self is a helpful skill to develop. We touch on it in this podcast episode (about half way through).
  • Radical acceptance: This is a skill from Dialectical Behaviour Therapy (DBT) and essentially the same used in Acceptance and Commitment Therapy (ACT). It is about fully accepting your situation/thoughts/feelings/sensations/etc. Fully. Accepting. It doesn’t mean you have to like it. It’s hard to do a lot of the above without this kind of acceptance.
My curious, nonjudgmental, accepting, “what am I noticing” face.

I hope this helps give you some ideas for building resilience some more. Well-being and a good quality of life do require us to be resilient, and trust me, it is possible even with chronic illness. Here’s the link to the MS Society page on resilience. Take care, and keep making the most of it!

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