Ways to Improve Your Stress Response: and the correlations to chronic illness

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.

Image from: https://www.youtube.com/watch?v=DPWEhl7gbu4

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)
  • digestive problems
  • 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
Stress always worsens my UCTD symptoms.

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)
  • Progressive Muscle Relaxation – try this one out.
  • Massage – I personally find massages to be both relaxing and therapeutic
  • Acupuncture – there is research showing it helps with both stress and chronic pain
  • Social Support – from friends, family, colleagues, support groups (in person or online), and pets!
Furry friend social support.

Hopefully that gives you a few ideas for how to lower your stress response. Keep making the most of it!

My Ultimate Pain Coping Skills Part 2: Relaxation

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.

Time to get our relaxation on.

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.

I want to be as relaxed as this dude.

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.
Summertime, outdoor yoga definitely relaxed 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!

References:

Mind-body therapies Use in chronic pain management
Mindfulness-Based Meditation Versus Progressive Relaxation Meditation: Impact on Chronic Pain in Older Female Patients With Diabetic Neuropathy
Hypnotic Approaches for Chronic Pain Management

How to Manage Your Chronic Illness Through the Holidays

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.

Do you like my Star Wars Ugly Christmas Sweater?

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.

My only physical activity on this particular day in 2018 was ice skating.

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.

It’s okay to say no, even if you have to say it to Santa himself.

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.

I also recommend cuddling with your pet (if you have one) as they can help to reduce stress (RIP my little Spike).

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!

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Why Zebras Don’t Get Ulcers: A Book Review

Did you know most animals do not get ulcers? Or suffer these kinds of physical ailments from stress? To be honest I never really thought about this before reading this book. If you’re not familiar with Why Zebras Don’t Get Ulcers by Robert M. Sapolsky, I can’t say I’m surprised. I only heard about the book when I was taking an 8-hour online course during my practicum. But it sounded interested. The subtitle is The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping. If you have a chronic illness then this may be a good read to get some more understanding.

I bought it off of Amazon, but it should be available at your local bookstore or library as well.

What I liked about the book:
To start off, the subject matter is interesting. We hear a lot about how stress is involved with chronic illness, but how exactly does that work? That’s what this book aims to explain. It also gives anecdotes from the animal kingdom in every chapter, explaining how different animals react to stressors. The primary focus of the book is certainly on the physiological responses to stress, so there is a lot about the brain in their, with a touch of psychological responses (I would’ve preferred more). Overall it uses the biopsychosocial approach, which I definitely stand behind. There is also a chapter on stress-management, which is helpful.
The chapters are as follows: (1) Why Don’t Zebras Get Ulcers? (2) Glands, Gooseflesh and Hormones, (3) Stroke, Heart Attacks and Voodoo Death, (4) Stress, Metabolism, and Liquidating Your Assets, (5) Ulcers, the Runs, and Hot Fudge Sundaes, (6) Dwarfism and the Importance of Mothers, (7) Sex and Reproduction, (8) Immunity, Stress and Disease, (9) Stress and Pain, (10) Stress and Memory, (11) Stress and a Good Night’s Sleep, (12) Aging and Death, (13) Why is Psychological Stress Stressful? (14) Stress and Depression, (15) Personality, Temperament, and Their Stress-Related Consequences, (16) Junkies, Adrenaline Junkies, and Pleasure, (17) The View from the Bottom, and (18) Managing Stress.
If any of this sounds relevant to you, it may be worth checking out this book.

One of my stress management techniques (since childhood).

What I Didn’t Like About the Book: There are a few drawbacks to the book in my opinion. First, it’s pretty sciency. He does try to make it readable for lay people, but even with my masters in counselling psychology, I got a little overwhelmed by the neuroscience aspect of the book, which was a lot of it. So be prepared to wade through if you want to read it. The other thing I didn’t like was his use of language, which was very outdated. For example, he constantly referred to people with depression as “depressives,” which is stigmatizing and just not right in my opinion. He did this with other conditions as well. It brings up with the people first vs. illness first argument, which I’m not going to get into here, but it bothered me, as a person (and as a mental health professional).

Would I recommend it? Yes. Look, overall I think there is a ton of great and interesting info in there. Will it make you feel better? Not necessarily, but I’m all for having a better understanding of what’s going on in my body, that way I can take appropriate steps to help myself. For example, mindfulness has a large evidence base of helping with stress, and I therefore, practice meditation and other mindfulness techniques on a regular basis.

A mindful moment.

As I keep reading, I’ll keep sharing. And I hope you all keep making the most of it!

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Your Repression of Emotions Can Affect Your Health

I know this is a bold statement, but honestly it’s not one that I’ve come up with. It’s one that’s been studied, and it came to my knowledge through the form of a book – When the Body Says No by Gabor Mate. Now, I have done a whole post giving my review of that book awhile back, so that might be something you want to check out before or after reading this today.

First things first, I want to reflect on my own life. As an adult I wouldn’t say I repressed my emotions. Well, sometimes, when I was in my 20s, I would repress anger until it boiled over and spilled out like. Then I was accused of having ‘anger problems’ but really, looking back I was just not expressing it as it came about. On the other hand, sadness, joy, etc. all seemed to come out appropriately. Diving further back, I know there was a time between the ages of 8-13 that I repressed emotions – again, usually anger. Through those 5 years I had a group of friends at school, and one girl in particular was good at manipulating the others into not talking to me for periods of time. Like I mean I had no one to hang out with at school when they did this. It started as just being a day, then a few days, then a week, sometimes a month. It was honestly unpredictable of when it would happen and how long it would happen for. I never knew what ‘I was doing wrong’ and was always only told by them, “If you don’t know, then I’m not going to tell you.” I think this was actually a traumatic experience for me. Actually, my therapist told me it was. However, this post isn’t about that trauma, it’s about repressing me emotions. I think the only way I could get through 5 years of elementary and middle years schooling was to repress. Not show any emotion about it at school. I remember crying myself to sleep at night, but certainly not every night. Luckily, I was enrolled in a ton of extracurricular activities which probably helped me too.

I think I was 6 in this photo.

What does repression of emotions have to do with chronic illness? Well, in When the Body Says No, Gabor Mate explains that repression of emotions – particularly anger – has been linked to several illnesses. These include autoimmune diseases, cancer, and ALS. Now, this doesn’t necessarily mean EVERYONE fits the bill, but certainly, in my conversations with others, people readily admit they have difficulty expressing anger in an appropriate and healthy way. Very interesting.

I was first diagnosed with autoimmune in 2016.

Why does repression of anger cause chronic illness? Well, in and of itself, it does not. However, when we look at illnesses from a biopsychosocial standpoint (this is the mostly widely accepted view in the medical community – both Western and holistic), it is a contributing factor stemming from the “psycho” portion. Bio stands for biological – so any genetic or epigenetic (meaning our genes were changed by our environment) – contributions to illness. Psycho stands for psychological contributors, which can also include personality, management of emotions, how we handle stress, and so on. Social usually relates to the environment, which often includes factors like traumatic events.

Biopsychosocial model of illness (physical & mental).
Image from: https://www.physio-pedia.com/Biopsychosocial_Model

What can we do with this knowledge? For me, the best thing I’ve learned to do is appropriate and consistent expression of emotions. This means I don’t ‘boil over’ with rage but rather can notice and accept the feelings of anger, expressing them through words. This is sometimes referred to as emotional regulation, and in my practice it definitely falls under acceptance. There are many ways to learn to do this. The most effective would be going to see a therapist. There’s also the self-help section of the bookstore or library. The practice of mindfulness. Just to name a few. Will doing this help heal our illnesses? Well, not exactly, but it can help lessen the severity and impact of our symptoms on our lives. I think it is a part of the healing process we often neglect, but really shouldn’t. This week’s episode of the podcast talks about acceptance (find it here). If you have questions about it, feel free to DM me on Instagram (@chronically.living_)

Learning to express our full range of emotions – anger, sadness, joy, nervousness, etc. – is important to our overall well-being (just watch the movie Inside Out if you’re not convinced).

Keep making the most of it everyone!

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6 Ways I’m Managing a Weather-Caused Flare (+ 5 More Ways I Could)

Long title, I know. But nonetheless I thought I’d share some of my tips with you, plus a few other evidence-based ones I found online as I’m trying to get through this. I’m writing this exactly one week before it will be published so fingers crossed that it’s over by the time you’re reading it, but if not, then I’ll just have to accept it as it is. My flare is likely caused by a few things. First, I recently moved and moving is stressful (even a relatively easy move like I had) and stress can cause a flare. Second, I moved from a dry climate in the interior of British Columbia to the wet, lower mainland of BC. I always notice my symptoms, especially pain gets worse when it rains… but then I knowingly moved to a rainy climate (*face palm*). All jokes aside, my symptoms are increased pain, increased fatigue, really bad jaw pain, my left foot is super veiny and sore (my calf is fine though so unlikely anything super serious). How the heck can I manage all of this?

Even on a flare I’ve managed to explore my new neighborhood.
  1. Acceptance. Yes, I know some of you are rolling your eyes or saying that this is ridiculous or unlikely to work. But I find it does. I accept that my pain is here, while knowing that the intensity changes hour by hour, sometimes even minute by minute, and I know that when my flare is over I’ll go back to baseline. Acceptance is helpful. I’ve been doing body scans and other mindfulness activities to help with the acceptance, but honestly just acknowledging my experience without getting wrapped up in it is helpful. Check out this acceptance practice.
  2. Exercise, Movement and Stretching. If you read this blog regularly you know that I like to exercise. And I still pace myself by trying to stay consistent with what I do. I definitely increase my stretching during flares. Particularly I focus on the areas that seem to hurt or need it the most. For example, my jaw is the worst today as I write this, and I’ve made sure to do jaw stretches throughout the day. For more on jaw pain specifically, check out this podcast episode with Dr. Shirazi.
  3. Warm Baths. I LOVE my baths. I literally take a bath 4-5x a week in the winter months. And with the rain, I’m definitely needing them. They help relax my muscles, keep me warm, and are very relaxing. Trust me when I say I could never (and would never) live in an apartment without a bathtub. Knowing what is vital to your self-care is essential to dealing with a flare. Check out this podcast episode on it.
  4. Dressing Warmly and in Layers. Vancouver, if you’ve never been, is a city where everyone dresses in layers. It will likely rain at some point during the day, though you never know exactly when. It could also start off cool and warm up, or vice versa. So I’ve been making sure to put on 3 layers when I go out, and have a pair of mittens on me. I need to remember a hat and/or an umbrella, but I’m working on it!
  5. Hydration. I tend to drink a lot of water. Admittedly more when I’m working. Staying on top of my water intake is so important to managing my flares and really my health! I’m trying to drink 5 full glasses of water a day minimum. I basically keep a glass of water next to me all day and every time it’s empty, I refill it. Listen to my podcast conversation with Beau Berman about gut health and how important drinking water is to him.
  6. Omega-3’s and Vitamin D. I typically try to get these from the foods I eat. Lots of fish mostly (rich in both), as well as mushrooms, spinach, avocado and tofu and really a variety of others foods are rich in vitamin D. These are really important for reducing inflammation naturally and honestly are just really good for you! Also, Vitamin D is a way to combat with the “winter blues” (which I often get) and the more severe, Seasonal Affective Disorder.

So those are the 6 things that I am doing, but what are the 5 things that I’m not but probably should be?

  1. Acupuncture. This is actually an evidence-based and recommended treatment for chronic pain. I’ve had it in the past and I’m hoping to start back up with bi-monthly sessions next month. Listen to the podcast episode on recommended treatments for chronic pain for more info.
  2. Massage. I miss getting massages. It’s been nearly a year since I had one, and this is also a service I used to get bi-monthly. I’ll likely also start these back up soon as well. Clearly I need to. The benefits of massage can be heard in the podcast episode with Danielle Potvin.
  3. NSAIDs. I’m not a fan of these drugs to be honest. They can cause stomach problems when on them long term. I’ve drastically cut back on them and only take them to supplement the more natural medications I take (i.e., CBD). If you’re aware of the risks and find them helpful then this can be a helpful solution.
  4. Natural supplements. The only natural supplement I currently take is magnesium bis-glycinate which is a muscle relaxant (and I mainly use it when I’m menstruating). Other recommended supplements are fish oil, ginger (which I sometimes have in food and/or tea), turmeric (which I sometimes have in tea), and gingko. These are definitely worth checking out to use in addition to some of the other suggestions.
  5. Limit Stress. Oh I can’t wait until I’m passed the stress of the move and starting up new counselling practices. The truth is there is always some kind of stress in our lives and it really comes down to how we manage stress. I typically do a good job with mindfulness, meditation, yoga, and relaxation practices. So this might just be a reminder to do a bit more of that. And also, if you are able to avoid stress then that’s a good plan (I do not plan on moving again for quite some time!).
Taking it easy on Halloween. Needed some time to relax after the move.

So that’s it! 11 ways in total to manage a flare. Keep making the most of it everyone!

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My Experience at the World Pain Summit ’21, Part 2

If you read last week’s blog post then you know that I recently attended the World Pain Summit, put on by the Alberta Pain Society. I did this as both an allied healthcare practitioner (as a clinical counsellor) and as a person with lived experience. By the way, this event is apparently always free to people with lived experience, so keep an eye out for it next year. The summit was 3 days and had so much info, that this is going to be part 2 of a 3-part post, and focuses on the content of Day 2. Without further ado, here’s what I learned.

How Living with a Dog Can Improve Quality of Life and Well-Being in People with Persistent Pain. The first bit of interesting info was a bit of an aside – only 1% of the curricula for healthcare professionals is on pain, which means if your doctor doesn’t understand (and isn’t attending these kinds of conferences) that is likely why (definitely not an excuse – all healthcare professionals should be attending conferences/summits/etc throughout their careers). The most interesting parts of this session was the statistics on dog/pet owners (cats and other kinds of pets count):

  • they report lower pain
  • less depression and anxiety and loneliness – i.e., better mental health
  • improved well-being and meaning/purpose in life

Having a pet also gives you a non-judgmental listener whom you can talk to, and petting an animal releases oxytocin in our brains, which has a calming effect. Yay for pets!

This is my parents’ dog, Beau.

Is Supported Pain Self-Management Your First Choice or Last Resort?: 5 Key Coaching Support Skills. This was present by Pete Moore, a person with lived experience, who wrote a book on the subject. The 5 key skills he talked about were: (1) goal setting and action planning; (2) practicing daily activities – I know ADLs can be hard for some people but they are important to well-being; (3) problem solving; (4) keeping active, moving, including stretching and exercise; and (5) knowing what to do if you have a set-back (i.e., planning for that in advance). Much of this involves having a support team, pacing, prioritizing, being patient with yourself, learning relaxation skills, tracking your progress, and resilience.

Pete Moore presented this cycle, which really resonated with me and probably many others.

How a Pain Doctor is Using Social Media to Spread Knowledge About Chronic Pain. This was a session more for healthcare professionals on how to start a YouTube channel (and why they should). But some interesting factors for Spoonies: the current quality of medical information on YouTube is very low, so please be careful and look for trusted sources (i.e., trained healthcare professionals in different areas).

My YouTube channel is for meditations (with an emphasis on pain and illness).
Let me know if I should include other psychoeducational content and skills.

Trauma, Illness, and Healing – Dr. Gabor Mate’s keynote. I’ve written a ton about Dr. Mate’s work in the past, and there was obviously some repeat in content about trauma, childhood abuse, insecure attachments and stress and their relationship to chronic pain and illness. A couple of things I will share:

  • mind body practices (like yoga) should be included in chronic pain treatment
  • a lot of back pain is associated with psychoemotional stress (tension, stress, trauma)
  • Go to a physician for what they can do (prescribe medications, perform surgery, etc.) and find other practitioners to help you with the other parts of treatment
  • diagnoses are descriptions, not explanations
  • psychological and spiritual support is important

If you’re not familiar with Dr. Mate’s work, check out When the Body Says No (I also did a post about the book awhile back).

Dr. Gabor Mate is world leading expert on the trauma-stress interaction with illness.
Image from: https://californiahealthline.org/news/addiction-rooted-in-childhood-trauma-says-prominent-specialist/

Challenging Chronicity Thoughts: Words Matter. So this was a mental health session, if the title isn’t clear! It emphasized that psychological factors are an important component of pain experience and are the most powerful psychological predictor of adverse health and mental health outcomes associated with pain – they even affect our treatment responses to medications, injections, physical therapy, and most other treatments. Recovery is not just about talking (to a therapist), needs and activity but also about ways of thinking. Two important notes for my fellow Spoonies: (1) pain is perceived by your brain (all in your head) but it is real; and (2) the word pain takes you right to thinking about/feeling pain (check out this podcast episode I did on externalizing language and pain/illness).

Chronicity thoughts are about way more than language. I highly recommend seeking therapy if you find you think about your illness/pain a lot.

Next week I’ll bring you a post on the information from the final day of the summit. I hope that you find some of this helpful when thinking about illness and well-being. Keep making the most of it everyone!

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Video: Cooking with Kels – Farmer’s Markets & Choice Overload Stress Management

This video has 2 main themes: first, why shopping at farmer’s markets and eating organic food is beneficial to our health, especially as Chronic Illness Warriors; and second, how to deal with choice overload so that it isn’t stress (because that causes flares) whether it be shopping, or really anything else.

Are you feeling hopeless when it comes to making lifestyle changes to improve your chronic illness? Check out this week’s podcast episode on Creative Hopelessness, to help find ways to overcome that feeling.

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How Do I Become a Castle with My Boundary Setting?

A lot of people struggle with boundary setting in their relationships. I often see people complain that their family members don’t treat them well, that their spouses don’t, and it seems all the worse for people with chronic illnesses. And actually, that is part of what Gabor Mate says in When the Body Says No. Boundary issues are common within families, and perhaps are part of the “social” part of the biopsychosocial aspect of disease.

And look, I’ve been there. Though I have good boundaries with my family members, it’s often because I set them. For example, I tend to not talk politics with some of my family because our differences in views were causing me stress (and stress is bad for chronic illness!). I do sometimes still struggle in romantic relationships and friendships. Setting a boundary means being assertive, and sometimes that pisses other people off, especially if they’ve gotten a way with violating that boundary for a long time. As chronic illness warriors we need to get good at setting boundaries as part of our self-care. Here is one way of thinking of boundary setting.

De-stressing does not just mean bubble baths…

Imagine that you are a castle, and the boundary is the personal space that you are placing between yourself and other people. The walls of the castle show that personal space. The moat lets other people know how close they can get to you, and in this case it can change size depending on the person and/or situation. The draw bridge itself is what allows people to get in, and keeps people out. This draw bridge helps us to feel secure. The castle guards are the actual skills we have to protect our boundaries. They can also help us when someone crosses our boundaries. And it’s important to remember that boundaries can be verbal, physical, emotional or spiritual.

This is the image my practicum site gave clients when we gave psychoeducation on boundary setting.

So how do we exactly do this? Well, short answer is to say no, resolve conflicts, follow our values, be assertive, and express our needs. But that is easier said than done. Saying no and being assertive both require practice, and if we’re nice (which most of us with chronic illness apparently are), it’s super difficult to do these two things. If you have a therapist, then that might be where you practice these skills. Otherwise, it’s easiest to start with boundaries that aren’t going to upset the other party as much. The other pieces of this: resolving conflicts, following our values and expressing our needs can be handled with some self-exploration, by answering the following questions for ourselves:

  • Who are the most important people in my life?
  • Who is there for me when I’m struggling?
  • What are these above relationships like for me?
  • What are the positive things I get from this other person?
  • What are the negative things this other person says or does? And how does that affect me?
  • What do I want to get? And what am I willing to give?
  • What have I tried already in regards to boundary setting and how has this worked for me?

Once we’ve done this, we have three options:

  • Leave or end the relationship.
  • Stay and live by our values: change what we can (remembering that we can’t change other people’s behaviour) and make some room for things that we may not like (that aren’t in dire need to change)
  • Stay and give up acting effectively – which is all to common an occurrence
How I look when I set some boundaries…

The more you practice setting boundaries, the easier it will be. It will also start to reduce your stress, which means you may start to see an improvement in your symptoms (be it physical or mental health), and are more likely to improve your well-being. Let’s keep making the most of it everyone!

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Book Review: When the Body Says No

If you haven’t heard of this book and you have a chronic illness you need to get in the know. And to be fair, and I hadn’t heard of the book until about a year ago, and I didn’t actually read it until recently. The author I had heard of. Dr. Gabor Mate. He has written several books over the years on topics ranging from chronic illness to substance abuse to ADHD, and he’s quite well-known in both the self-help and medical communities. So, now that I’m done reading this (must-read) book, let me share some thoughts and opinions, and hopefully help encourage you to also give it a read.

It’s available at all major book sellers
(I got mine from Amazon)

First, for those of you unfamiliar with Gabor Mate, he is a Canadian (now retired) doctor who spent his career in family practice, palliative care, and working with people who use substances in Vancouver’s East End. And he’s touted as being an expert in these areas. The book, When the Body Says no is about how “stress” influences chronic illness. Now, stress encompasses a lot of things here, which is why I put it in quotations. It includes life stress, attachment, coping styles, trauma, adverse early childhood experiences, adult relationships, and so on. Basically a lot of stuff, though Dr. Mate posits that it’s our early life stresses that have the greatest impact on us. The book takes a biopsychosocial approach. This means it includes biological, psychological and sociocultural influences on health and illness. This is the approach that science is backing when it comes to both physical health and mental health (literally my first class in grad school was “A Biopsychosocial Approach to Mental Health”). What’s interesting, if you go online to research most illnesses (come on, we’ve all googled our actual illnesses, as well as other potential ones) usually only biological causes are listed. And I will agree with Dr. Mate, that biological causes don’t tell the whole story (and neither to strictly psychological or sociocultural). For example, he writes (based on scientific research) that some people with biological markers for illnesses never actually develop one. Why? If it was strictly biological then everyone with the biological markers would clearly develop it. Again, there is more to the picture.

Like I said, I agree with a lot of the content in the book. I mean, many autoimmune diseases are diagnosed after a person has gone through a stressful experiences. It makes sense that the body would take on what our minds don’t want to – such as a repression of emotions. And clearly trauma can manifest in many, many ways (illness, substance use, psychiatric disorders, etc.). Many people will read the book and find themselves very well represented for whatever illness they have (and he covers a lot of illnesses from cancer to a variety of autoimmune diseases to Alzheimers and so on). My only problem with it is that he asserts that attachment issues (to parents) are the #1 determinant of illness, and that virtually all people with illnesses have more than one of these issues. And this is where I didn’t find myself represented. My attachment style with my parents has always been healthy. My early childhood experiences were really good. In fact, the first trauma I suffered was ongoing between the ages of 8-13 (being bullied at school). At the time, yes, I did probably repress a lot of my emotions, but as I got older, and certainly by the time I was diagnosed with my illnesses, and I was not repressing emotion (at least as often) anymore. Now, that being said, maybe all it took was that experience to account for the psychosocial part of my illness. I can’t say either way, but regardless I don’t feel I perfectly represent the picture Dr. Mate paints in his book, though I can appreciate that a lot of people do.

My brother and I, circa 1988-89.

All of that said, I do highly recommend reading this book if you have a chronic illness OR if you have a loved one with a chronic illness. It gives insight into the causes, which some people find helpful. And if you’d rather live in the here-and-now, rather than try to decipher what caused your illness, the last chapter is called the “Seven A’s of Healing” and it really resonated with me, because for the most part, it is exactly what I work on with clients, and it is strongly evidence-based. So, go read When the Body Says No, it’s definitely worth it.

My podcast episode this week is on Creative Hopelessness, so if you’re finding it difficult to make changes in your life and/or you’ve been feeling hopeless, please check it out. Until next week, keep making the most of it!

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