How to Navigate Christmas (or whatever you celebrate) with Chronic Pain

The holiday season is a stressful time for most people. It’s often financially draining. Physically draining when trying to attend all of the events. And for many people it can be a lonely time or a triggering time or a time when there is more sadness or anxiety than the rest of the year. When I lived in Toronto from 2015-2020, I spent 1 Christmas with just my partner at the time (and my dog), followed by 2 Christmases with just my dog, followed by 2 Christmases with a friend and his family, and then finally a Christmas with my parents. Last year I was with my brother and his wife and stepkids (and my SIL’s brother and his family). This year I get to spend it with my parents, other brother and his wife (and 2 dogs). I know what it’s like to have a lonely Christmas. I also know what it’s like to have a busy Christmas. I spent many years (including with chronic pain) working in retail and working 45+ hour weeks throughout December, doing a lot of standing and running around. This year I’ve gone to so many holiday events already that even though I feel a lot better physically (and emotionally) than I have in the past, I still notice a bit more pain than I had. How do we navigate all of this?

I’ve had many different types of Christmases over the years (2018)

Emotions: Loneliness, Sadness, Anxiety & Stress
First, I think that recognizing what you’re feeling is important. I’m a big believer in not trying to repress emotions (while also not getting swept away by them). Making some room for this experience is actually okay. You’re not alone in any of these feelings and remembering that is so important. Giving yourself a lot of compassion can help a lot. Also trying to connect with others as much as possible – even if its short durations, or online instead of in-person can help ease a lot of these feelings. If you can muster up a gratitude practice, I find it can be helpful. Of course, reach out to local helplines for support if you’re in crisis. Maybe try this self-compassion/Christmas gratitude practice I released last year.

Pain and Other Symptoms
Noticing your triggers for pain – as I’m sure many of you are aware – is important. There’s no point pushing yourself to the point of exhaustion. Taking breaks and pacing is extremely important, even if you’re “in charge” of buying presents or cooking meals (actually this is when it’s most important). Think about who you can share some of these responsibilities with and ask for help (making room for uncomfortable feelings that may come with it). Try not to schedule too much for yourself in one day and keep all the days with as equal amount of activity as possible. I know that the amount of events I’m attending is actually winding down over Christmas and all of the cooking is shared between myself, my parents, and my brother and SIL. My New Years’ plans are pretty chill – my partner and I are just going to a brewery (just us). Maybe try some relaxation practices throughout the holidays when you’re taking breaks. Something like yoga nidra.

All in all, just doing what is within your control to make this a good holiday and allowing what is not in your control to just be there, without it overtaking you. I know from experience that this is easier said than done. Just keep on making the most of it everyone!

My Favourite Self-Compassion Practices

We all struggle with self-compassion. I’ve written about it before on this blog, talked about it on the podcast, written guests posts on other blogs about it. I do self-compassion work all the time with my clients. And most importantly, I do self-compassion work all the time with myself. Self-compassion has been shown to lessen chronic pain, improve resilience, and keep us motivated – all of which are important when you have a chronic health condition. It can also help when experiencing trauma symptoms, anxiety, and depression. Being honest, while my pain is much, much less than it used to be, self-compassion has and continues to help me deal with it. More recently I’ve noticed the great effect it has for me during trauma triggers and anxiety. Self-compassion is also hard – at first – eventually it becomes a lot easier and more natural to do (though there is always effort to be put in). When I notice (using my mindfulness skills), I’m able to pause and ask myself what would be helpful now. More often than not I end up doing a self-compassion practice, which helps me regulate, centre, and continue on with my day.

Being self-compassionate allows me to do more.

There are tons of different self-compassion practices you can do. I do highly recommend the Mindful Self-Compassion Workbook by Kristin Neff and Christopher Germer. I bought it, used in on myself, and now use the exercises with my clients. Beyond the ones from the workbook, I have some other practices that I quite enjoy, use often, and really help. Without further ado, here are my 4 favourite self-compassion practices.

  1. Lovingkindness Meditation – this is actually a really old Buddhist practice that is used secularly now. It involves generating feelings of warmth and kindness towards ourselves and others (typically someone we care about, someone we feel neutral about, a difficult person, and everyone). We then repeat lovingkindness phrases, sending them first to ourselves, and then to each of the others. The reason I like this practice is because it is easier to send compassion to other people, and we still get to practice giving it to ourselves.
    Typical lovingkindness phrases include:
    May I be happy.
    May I be safe.
    My I be healthy.
    May I be at peace.

    But can include any phrases that resonate best with you.
    Try it here.
  2. Kind Hand – this is a practice I actually learned from a counselling textbook (ACT Made Simple) and find I use it a lot with myself because it’s such an easy gesture and quick way to offer myself compassion. (My clients tend to like it too). Basically you imagine your hand filling with the same kindness and care you offer others, and then place it on the part of your body you feel the most pain (emotional or physical) and let the kindness flow into it and then all around your body.
    Try it here.
  3. Heart Opening Yoga – this is working with the heart chakra, which helps with self-compassion and self-love. I’ve done this both as a vinyasa class and a yin class (I personally prefer the yin class, especially when I’m feeling anxious/activated because it’s more grounding). This usually includes a lot of chest openers, expansions and back bends to help us make room in the physical, emotional and spiritual bodies for compassion.
    I personally recommend Yoga with Kassandra on YouTube for some great practices (I’ll be launching my own as soon as I finish my Yoga Teacher Training).
  4. Compassionate letter writing or journalling – if you’re open to writing and/or like journalling, this can be a very effective practice. My former therapist had me do this once and I did find it helped (and of course, I’ve had my own clients do this as well). It can be quite difficult if you’re not used to giving yourself compassion, so I actually recommend trying any of the above 3 practices first. The formula for the letter is pretty simple:
    -mindfully write what happened – being open, curious, and nonjudgmental about your experience, thoughts and feelings (who, what, when, where, maybe why).
    -write some words connecting yourself to common humanity – we all experience pain, hurt, emotions, etc. and telling ourselves something like, “everyone feels this way sometimes” (etc) can help us remember that we are not alone.
    -write something kind to yourself – imagine what you would say to a friend who was struggling. What kinds words would you offer? Just write those down, offering them to yourself.

    Try it here.

Self-compassion is a powerful and useful practice. The more I integrate it into my life, the easier my life becomes. And of course I want the same for all of you, so that you can keep making the most of it!

Video: Daily Mindfulness – Compassion with Equanimity

Added from the work of Kristin Neff.

This practice is particularly good for anyone finding themselves in a caregiving role. This may be as a healthcare practitioner, doctor, nurse, or as someone taking care of an elderly parent, a partner or child who is chronically ill, or really any other caregiving role. Sometimes the best thing we can do is offer compassion to another, while also taking care of ourselves.

Keep making the most of it!

Video: Are You Being a Good Friend to Yourself?

Building resiliency is extremely important when you have chronic pain or chronic illness. One of the best ways to do that is through self-compassion, and yet most people cringe when they hear that word. Self-compassion is treating yourself the way you would treat a friend. Would you treat a friend the way you’re currently treating yourself?

Keep making the most of it everyone!

Why Do You Feel Shame About Your Pain?

During my last supervision session with my clinical supervisor (which is recommended for all practicing therapists/counsellors to have), she asked me to think about how I address shame in session with clients and we could discuss it next time (unless I have more pressing topics I need to talk about). Interestingly, just a few days later I stumbled upon an article about shame, and then a podcast. Both around shame and illness. Shame is a natural human emotion that we all experience. Myself included. I’m trying to remember if I felt shame around my chronic pain/illness and if I did, I would say it was near the beginning of my healing journey, which almost feels like a distant memory. Yet, I think it’s really important for us to talk about shame because it is one of (if not the) most uncomfortable emotions to experience.

Shame, like all of our emotions is important. We wouldn’t have evolved all of these emotions if they weren’t useful in some way. If we go back to that caveman mind metaphor I’ve written about before, shame helped to keep us alive. As cave people, if we got kicked out of the clan, we would die because there would be less protection. So shame helps keep us in check with the expectations of those (clan members) around us so that we don’t get “kicked out.” The problem with that is, we will probably physically survive if we do get “kicked out” in 2022. It also, maybe even more importantly at this point in our history, lets us know when we’ve done something that contradicts our values (those qualities of action that determine how we treat ourselves, others and the world). When we don’t follow our values, we often experience shame.

Shame and chronic pain can often coexist. Many people with chronic pain experience higher levels of shame than in the general population (Boring et al., 2021). Part of the reason this happens is because chronic pain, especially if the cause isn’t quite yet known, is often invalidated – by family, friends, and healthcare professionals (especially medical doctors). When our pain is constantly invalidated by others, we are more likely to question the severity of our pain, hide our pain, and disregard our pain and other feelings. The more we do this, the more internalized shame develops. There are several problems with this:

  • shame can lead to depression – there is a huge correlation between depression and chronic pain as they can amplify each other. If shame leads to depression then…
  • pain not only increases but can also stick around longer – yes chronic pain means it’s sticking around, but to what intensity, to what end? and does it have to be that bad all the time?
  • it can also change our beliefs about ourselves – this can lead to increased substance use and other behavioural problems that just increase shame and pain
  • shame also causes stress, and we know from research by people like Gabor Mate and Bessel van der Kolk, this can cause physical symptoms such as chronic pain, as well as a myriad of other illnesses

How do we deal with shame? I mean, I’m always going to say that therapy/counselling (they’re interchangeable terms) is a good route to go because many therapists can help you talk through and give you skills to deal with these feelings. Brene Brown, who has done a ton of research on shame, has said that empathy is the best cure for it. Empathy is our ability to share in the feelings of others. Based on the definition of empathy, we need that support from others. What can we do for ourselves though? Kristin Neff, who has done a ton of research on self-compassion, has unsurprisingly found that self-compassion is an effective antidote to shame. As a clinical counsellor I am able to offer empathy to my clients, while not hiding away from shame when it comes up in session, which is generally effective. And then I teach my clients to be more self-compassionate so that they can deal with those feelings when they come up when they are alone. Try any of these self-compassion practices from my Youtube channel.

I hope this helps bring you an understanding of the natural experience of shame you may be feeling with your chronic illness. Keep making the most of it.

Ways to Determine Acts of Self-Care From Acts of Health Care

First off, the media’s portrayal of what is self-care is VERY different from what mental health care professionals think of as self-care. Self-care in the media is bubble baths and spa days and bottomless brunches. I am not against any of this! In fact it all sounds quite fabulous. Counsellors and therapists such as myself think of self-care more in terms of activities of daily living (ADLs) like getting showered and dress and eating meals, etc. And then there is this weird grey area of overlap. For example, I see meditation as a form of self-care. It’s not an ADL, and the media would categorize it as self-care, and yet it can be extremely beneficial for mental and physical health. So I see things like that really as acts of health care.

Relaxation and meditation.

Here are some activities that I see as health care (that are sometimes categorized as self-care):

  • meditation and mindfulness – contacting the present moment to be here-and-now
  • self-compassion – taking a moment to be kind to yourself through touch or words
  • massage therapy – having a registered massage therapist do deeper work (than just purely going to the “spa”)
  • acupuncture – it has been around around for thousands of years and sessions are usually between 20-45 minutes
  • swimming and other forms of exercise – water therapy, strength, cardio
  • baths – more water therapy!

For all of these, research actually supports that they are important for health and mental health. Mindfulness and self-compassion can release tension in the body, make us feel calm and centred and present. Massages and acupuncture can reduce physical sensations of pain and also create relaxation in the body. Exercise reduces pain and increases strength. Baths, swimming and in general water therapy is supported for pain because of its strength, flexibility, heat and relaxation effects (depending on what you’re doing).

Thinking in terms of how these things will benefit my health, as opposed to just being things to enjoy (I mean, these are all things I do also enjoy) makes me more motivated to do them. It’s funny, because the idea for this topic came to me as I’m having a massage later today (I write these about a week before they’re posted). Getting a massage purely for pleasure hasn’t occurred to me in the longest time. Instead I always consider my massage therapist part of my healthcare team. I’m just like, hey, it’s time to take care of those muscles, especially because I have fibromyalgia and I’ve been neglecting them recently! And honestly, this type of health care is also self-care. I think we can get pulled into all these labels, rather than just going with what we need, regardless of whether it’s real self-care or media self-care or health care or anything else. What will make your mind, body and spirit feel better today? Do that, and keep making the most of it!

How to Find Inspiration in Poetry: The Peace of the Wild Things

When despair for the world grows in me
and I wake in the night at the least sound
in fear of what my life and my children’s lives may be,
I go and lie down where the wood drake
rests in his beauty on the water, and the great heron feeds.
I come into the peace of wild things
who do not tax their lives with forethought
of grief. I come into the presence of still water.
And I feel above me the day-blind stars
waiting with their light. For a time
I rest in the grace of the world, and am free.
-William Berry

I think this is an absolutely beautiful poem for many reasons. Two main thoughts came to mind when I first heard it as I was attending a Compassion in Therapy summit in April (yes, I know I do a lot of these types of summits, they’re terrific). The first, is that it does remind me of self-compassion practices, and second, that nature has ultimate healing powers. While I’ve blogged about these topics before, I want to write about them in the context of this poem, as a way for me (and you) to remember why they are so important, especially if you have a chronic illness.

Costa Rica, 2019

Self-Compassion

Self-compassion is comprised of 3 elements: mindfulness, common humanity, and self-kindness. In the poem, Berry describes mindfulness of his thoughts in the first part, and then just being present with full experiencing in the second part. “I come into the presence of still water” and “I rest in the grace of the world, and am free.” These are very mindful phrases and experiences. Then there is the phrase, “I come into the peace of wild things who do not tax their lives with forethought of grief.” I see this as relating to common humanity as it suggests that all human “tax their lives” with these thoughts and feelings – in contrast to wild things, which (as far as we know) don’t have the cognitive abilities to have these thoughts that can consume us. Thinking is part of being human. What I think represents self-kindness in this poem is that (a) Berry doesn’t judge himself for having these thoughts, and (b) he makes the decision to take care of himself in the moment and give himself what he needs – a reprieve into nature. Now, I’m personally left to wonder, what can I do today that is self-compassionate? Maybe lay a kind hand on my chest, maybe imagining breathing in compassion for myself and out compassion for others, or maybe it is literally going outside into nature. What do you need?

Nature

Ecotherapy and forest bathing are totally a thing. I actually talked to a client of mine about this recently because they mentioned that they feel good in the forest, literally touching the trees. Me too. So much research supports being in nature. I recently listened to a podcast that suggested even just eating outside is good for us (which I immediately told my parents about because we ate el fresco all summer long when I was growing up). Near my apartment, there is an inlet with beautiful hiking trails along it and tons of big, beautiful trees that are ever-so-present in British Columbia. The air is so refreshing, especially if it’s recently rained. Everything about this trail (and really a lot of trails in this province) makes me feel good. Both physically and mentally. I had the same experience in Costa Rica. My friend and I would touch the trees and vines, really connecting with the beauty and nature, and all of the healing properties of it. When’s the last time you spent time outside? Is there a park near you that you can go to? Can you eat outside on your patio or deck?

Sometimes we can find inspiration to improve the quality of our lives (with these easy and gentle practices) in the most interesting places, like The Peace of the Wild Things. I hope this inspires you to keep making the most of it!

How I Accommodate My Illness & Pain

There is a Taoist parable that tells of an old man who fell into a river that swept him toward a dangerous waterfall. There were people watching who feared for the old man’s life. By some miracle, the old man came out of the water at the bottom of the falls completely unharmed. The onlookers asked him how he managed to survive, and he replied, “I accommodated myself to the water, not the water to me. Without thinking, I allowed myself to be shaped by it. Plunging into the swirl, I came out with the swirl. This is how I survived.”

I think I can accommodate myself to the river of life.

If the old man had struggled against the water, he may not have survived the fall. At least that’s how he sees it and is what the parable is suggesting. This is non-contention. I came across the parable when I was… well if you read this blog regularly then you can probably guess it… meditating. I was doing a guided meditation and at the end, the meditation teacher told this parable. It really spoke to me because I have heard this idea spoken in many different ways already, and it’s something I have been practicing for sometime. I notice that in my day-to-day life, when I am swept up by my pain or symptoms of my illness or thoughts about my pain or emotions such as anxiety that arise, when I struggle with these things, it just makes the day worse. It makes the pain (physical and emotional worse) and I feel less resilient. When I do the opposite – accommodate – then my days are pretty good. Thankfully I’ve gotten good at accommodating.

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While I’m sure some of you are also good at accommodating, there are probably many of you who are not. It takes a lot of work and practice to be able to do this. It’s way more natural for our minds to struggle because our minds think that it’s the best way to survive – I mean, thousands of years of evolution have told them this. Yet in modern times, the struggle often ends up being less helpful (but try telling that to the primitive part of your brain). I find that meditating is helpful for accommodation but I totally get that it’s not for everyone. I also find similar mindful practices like body scans, observing-breathing into-making room for-and allowing my feelings to also be helpful. And engaging in those values-based behaviours that I love. That doesn’t mean I push through my inner experiences. There is a delicate balance between pacing and going to my edge. And on days that I go to far and do too much, I offer myself some compassion because it is hard to be human, and it is hard to be a human with a chronic condition.

So, here’s what I suggest:

  • try out some mindfulness practices, like the ones found on my YouTube channel
  • incorporate more self-compassion into your life: kind words, soothing touching, remembering that it is human to have pain
  • engage in values-based activities that allow you to pace and don’t take you past your edge
  • seek mental health (and physical health) help from a licensed professional as often as needed.

As always, keep making the most of it!

Why You Should Be Curious & Nonjudgmental About Your Illness

Curiosity and nonjudgmental awareness are important tools for healing when you have a chronic illness. I’m not saying, cure the illness, but rather to increase our pain tolerance, decrease our stress levels, and heal from any associated wounds from our illness. This becomes even more important if you have a trauma background, which as we know from all the research on the subject, is very common when you have a chronic illness. Myself included in that statement, “little t” trauma that lasted for 5 years in elementary and junior high, something I initially scoffed at as possibly being considered trauma until I learned more about what trauma is, and how it has contributed to my current health. I didn’t process any of it until I was an adult, seeking psychotherapy for pain and stress, and it eventually came out because I was having difficulties in adult friendships… all stemming back to the “little t” trauma from my childhood (let me know if you want more information on little t and big t trauma, I’ve written about them before but can again).

What should we be curious and nonjudgmental about?

I mean a part of me just wants to say EVERYTHING! Because there are definitely huge advantages to approaching life this way. However, it is completely unrealistic to think we could experience life this way all the time. We’re human and it’s totally normal to make judgments (evolutionarily, it helped our species stay alive!) When it comes to chronic illness there are 4 things I think are really important to be curious and nonjudgmental about (this is, as always, based on my own lived experience as well as what I’ve seen in clinical practice).

  1. Our Thoughts – even the ones that are “judging” in the first place. Can you notice your thoughts without thinking about them or getting swept away by them? I find it interesting to see not only the content of my thoughts but also how they come and go, with some being more sticky than others.
  2. Our Emotions – like our thoughts, they tend to come and go, but typically can stick around for longer periods of time. Not only should we explore what we are feeling, but where we are feeling it in our bodies. All emotions have related sensations. What can we notice about them by just sticking to the facts?
  3. Our Behaviours – why do we do the things we do? It’s fascinating to notice how I act in certain ways or do certain things and how that changes with time or on a different day. It’s equally as fascinating to observe how my behaviours change when my thoughts and feelings are in different states.
  4. Our Sensations – not only the ones associated with our emotions, but all the sensations in our bodies – hunger, fatigue, pain. Noticing the quality, where it is, what it feels like, even what we imagine it looks like.

How can we become more curious and nonjudgmental?

There are a lot of ways we can learn to become curious and nonjudgmental. I think of myself as being a curious child, discovering something new for the first time, and approaching whatever it is – thought, emotion, behaviour or sensation – just in that way. But I’ll be more specific:

  • Describe it – using only facts, not your interpretations or judgments. Here is anxiety. Here is a sharp sensation in my leg. Here is a worry thought.
  • Notice and Name it – I am noticing the thought that… or I’m noticing the feeling of…
  • Send your breath into it – rather than judge the sensation or emotion as good or bad, see if you can just pause and send your breath to the area of you feel it the most, giving it some room.
  • Practice meditation – in meditation all you’re really doing is noticing your experience as it comes and goes. This can be a good way to learn to interact with your thoughts, feelings and behaviours nonjudgmentally because the whole point is to be open and nonjudgmental. Check this one out.
  • Do a body scan – this is another way to really be open to any feelings and sensations present in your body. We often notice that the intensities change and that sensations do often come and go. Find a short version here.
  • Offer yourself some kindness – it’s so easy to be harsh and judgmental about your experience. Kind self-talk or kind self-touch can be useful to counteract what our minds are doing. Check out this kind hand exercise.

It can be hard to think that things can get better, but I’ve had the first-hand experience of my life improving from doing these kinds of practices and really just changing my experience of life. I hope this helps you to 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.

“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.