“Happiness, it seems to me, consists of two things: first, in being where you belong, and second -- and best -- in comfortably going through everyday life, that is, having had a good night's sleep and not being hurt by new shoes.”

Theodor Fontane

While Theodor Fontane was a 19th-century German language realist writer, he certainly seems to have stumbled upon some truths about chronic pain.  Getting a good night’s sleep, and being able to get where one needs to go with minimal pain are some of the everyday challenges of the chronic pain patient.  But on a larger scale, the task of managing chronic pain is a proverbial work in progress.  And although there can be many benchmarks along the way, the process of learning to cope with chronic pain is a lifelong one. 

One such key benchmark along this learning curve is the patient’s ability to exercise greater control over the mind and body, despite the certainty of the challenges chronic pain may pose.  While chronic pain puts prolonged physical stress on the body, and may fuel emotional distress, the experience of pain can be increased or decreased by how a person perceives his or her ability to cope with the pain.  In other words, if a person feels overwhelmed by chronic pain, then stress related symptoms can result.  But if a person feels in control of the pain, stress related symptoms are minimized.  These beliefs are based on the principle that the mind and body are inextricably tied to one another.  For better or for worse, the way a person thinks can affect the way a person physically feels, and vice versa. 

Biofeedback training takes advantage of the mind/body principle by teaching a patient to use the power of the mind to effect positive change within the body.  This is an especially important skill for chronic patients to develop and employ in daily life, as it can inspires a feeling of a control, and can be as psychologically empowering as it is physically empowering.  Biofeedback techniques are able to engender a relaxation response in the body, which can re-establish balance or homeostasis and support the body’s recuperative efforts.  Through the use of such strategies like diaphragmatic breathing, progressive muscle relaxation and guided imagery, patients are taught to focus on objective physical measurements of the body (i.e., skin temperature, muscle tension and respiration rate) and will eventually learn to reduce the signs of stress.      

The advantages of biofeedback can be significant for chronic pain sufferers.  It is a non-invasive procedure, which has no side-effects nor is it habit-forming in any way.  The process works on developing the body’s natural relaxation response, so it can immediately lower stress levels in the short-term, and can decrease incidence of pain flare-ups over the long term.  And on a psychological level, biofeedback can adjust a chronic pain patient’s perspective about treatment of chronic pain in a more appropriate manner since it a management-focused - not cure-focused – coping strategy.

A branch of psychology called cognitive behavioral therapy has identified specific thought patterns that attack self-esteem and can lead to depression.  These thought patterns are learned. But they can also be unlearned. Cognitive behavioral therapy (CBT) provides an effective, straightforward way to eliminate these self-destructive thoughts and replace them with more reasonable thoughts. 

The following model, for example, has been developed by psychologist Albert Ellis:

A----------------------------------------B---------------------------------------C

A stands for the Activating (upsetting) event. B is the Belief (or automatic thoughts) that we tell ourselves about A.  C is the emotional Consequence (or feelings, such as worthlessness or depression).  Most people think A causes C.  In reality it is B, our self-talk, that has the greater influence.  Therefore, counseling which employs cognitive behavioral therapy is geared toward identifying a person’s pattern of self-talk (aka, automatic thoughts or thinking “errors”) and changing the pattern into something more positive or more neutral in nature.

Automatic Thoughts and Thinking Errors

Whenever an upsetting event occurs, automatic thoughts (ATs) run through our minds.   Although we’re each capable of thinking reasonably about upsetting events, sometimes our automatic thoughts are erroneous---or unreasonably negative.  Erroneous ATs occur so rapidly that we hardly notice them, let alone stop to question them.  Yet these ATs profoundly affect our moods and our sense of worth.  In this section, you’ll learn to catch these distortions, challenge their logic, and replace them with thoughts that more closely align with reality instead of thoughts that depress.  The thinking errors fall into 13 general categories.  With the help of counseling, you can gain awareness of and reduce these negative thinking patterns:

1. Assuming

In these circumstances, we assume the worst without testing the evidence.  Assuming self-talk would also be when you tell yourself “I know I won’t enjoy myself,” or “I know I’ll do a lousy job even though I’m prepared.”  More reasonable self talk would be:  “I might or might not enjoy myself but I’m willing to experiment and see what happens.”

2. Shoulds (aka Musts/Oughts)

Shoulds (musts/oughts) are demands we make of ourselves.  For example: “I should be a perfect lover”; “I must not make mistakes”; “I should have known better”; “I should be happy and never depressed or tired.”  We think that we motivate ourselves with such statements, Usually, however, we just feel worse (Since I should be ______, and I’m not that way, I then feel inadequate, frustrated, ashamed, hopeless, etc).

3. The Fairy-Tale Fantasy

The fairy-tale fantasy means demanding the ideal from life.  This is really a special type of “should”.  “That’s not fair!” or “Why did that have to happen?” often means “The world shouldn’t be the way it is”.  In reality, bad and unfair things happen to good people—sometimes randomly, sometimes because of the unreasonableness of others, and sometimes because of our own imperfections.  To expect that the world be different is to invite disappointment.  To expect that others treat us fairly, when they often have their own ideas about what is fair, is also to invite disappointment.  Again, a “would” or a “could” is a wise substitute for a “should”  (e.g. “It would be nice if things were ideal, but they’re not.  Too bad. Now, I wonder what I could do to improve things”.) 

4. All or Nothing Thinking

With all or nothing thinking you hold yourself to the impossible standard of perfection (or something close to it).  When you fall short of this standard, you conclude that you are a total failure as a person.  For example, “If I’m not the best, I’m a flop”; “If I’m not performing perfectly, I’m a loser”; “If I score below 90 percent, I’m a failure”.  This is unreasonable because such absolute, black and white extremes rarely exist.  Even if it were possible to perform perfectly (it isn’t), performing below some standard usually means we’ve performed at 80 percent or 35 percent-rarely at 0 percent. 

5. Overgeneralizing

Overgeneralizing is deciding that negative experiences describe your life completely.  For example, “I always ruin everything”; “I always get rejected in love”; “No one likes me; everybody hates me”; “I never do well at math.”  Such global statements are unkind, depressing, and usually inaccurate to some degree.  The antidote is to use more precise language; “Some of my skills are not yet well developed”; “I’m not as tactful in some social situations as I’d like”; “sometimes people don’t approve of me (sometimes some people do)”; “Although some aspects of my life haven’t gone well, that doesn’t mean I never do reasonably well.” Be a healthy optimist: expect to find small ways to improve situations and notice what’s going well.

6. Labeling

Here you give yourself a label, or name, as though a single word describes a person completely.  For example: “I’m such a loser”; “I’m stupid”; “I’m dumb”; “I’m boring.”  To say, “I am stupid” means I always in every way, am stupid.  In fact, some people who behave quite stupidly at times, also behave quite intelligently at other times.  Because humans are too complex for simple labels, confine labels to behaviors (e.g. “That was a silly thing to do.”)

7. Dwelling on the Negative

In this thinking error, you focus in on the negative aspects of a situation, while ignoring the positive aspects. Soon the whole situation looks negative. Other examples:  “How can I feel good about the day when I was criticized?”; “How can I feel good about myself when I make mistakes?”; “The steak is burnt—The meal is ruined!”  A solution to this habit is to re-examine your options:  “Would I enjoy things more (and feel better about myself) if I chose a different focus?”; “What pleasing things could I still find to enjoy?”;  “What would I think on a good day?”

8. Rejecting the Positive

Dwelling on the negative overlooks positive aspects. Here we actually negate positives. For example, someone compliments your work.  You reply “Oh, it was really nothing. Anyone could do that.”  You discount the fact that you’ve worked long and effectively.  No wonder accomplishments aren’t fun.  You could just as easily have replied, “Thanks”.  You would give a loved one or friend credit where it’s due.  Why not do yourself the same favor?<

9. Unfavorable Comparisons

Suppose you had an unusual magnifying glass that magnified some things (like your faults and mistakes, or the strengths of others) and shrunk others (like your strengths, and the mistakes of others). In comparison to others, you would always seem inadequate or inferior-always coming out on the short end of the stick.
For example, you think to yourself: “I’m only a housewife and mother” (minimizing your strengths).  “Jan’s a rich, bright lawyer” (magnifying another’s strengths).   A way to challenge this thinking error is to ask, “why must I compare?  Why can’t I just appreciate that each person has unique strengths and weaknesses?  Another’s contributions are not necessarily better, just different.”

10. Catastrophizing

When you believe that something is a catastrophe, you tell yourself that it is so horrible and awful that “I can’t stand it!” In telling ourselves this, we convince ourselves that we are too feeble to cope with life.  For example, “I couldn’t stand it if she were to leave me.  It would be awful!”  Although many things are unpleasant, inconvenient, and difficult, we can really stand anything short of being steamrolled to death, as Albert Ellis has said.  So one might think, “I don’t like this, but I certainly can stand it.”
Asking the following questions will challenge the belief that something will be a catastrophe:

• What are the odds of this happening?
• If it does happen, how likely is it to do me in?
• If the worst happens, what will I do?  (Anticipating a problem and formulating an action plan increases one’s sense of confidence.)

11. Personalizing

Personalizing is seeing yourself as more involved in negative events than you really are.  For example, a student drops out of college and the mother concludes “It’s all my fault.”  A husband takes full responsibility for his spouse’s fatigue or anger, or for a divorce.  Here the ego is so involved that each event becomes a test of worth. There are two helpful antidotes to this distortion:

• Distinguish influences from causes.  Sometimes we can influence other’s decision, but the final decision is theirs, not ours
• Look realistically for other influences outside of ourselves.  For example, instead of thinking, “What’s wrong with me? Why can’t I do this?” one might say, “This is a difficult task.  The help I need isn’t here.  It’s noisy, and I’m tired.” Instead of thinking, “Why is he snapping at me?” one might say, “Maybe I’m not the central character.  Maybe he’s mad at the world today.”

12. Blaming

Blaming is the opposite of personalizing.  Whereas personalizing puts all the responsibility on yourself for your difficulties, blaming puts it on something outside of yourself.  
For example:

• He makes me so mad!
• She has ruined my life.
• I’m a loser because of my crummy childhood.

The problem with blaming, much like catastrophizing, is that it tends to make us think of ourselves as helpless victims who are too powerless to cope.  The antidote to blaming is to acknowledge outside influences, but to take responsibility for your own welfare: “Yes his behavior was unjust and unfair, but I don’t have to turn bitter and cynical.  I am better than that.” 

13. Making Feelings Facts

Making feelings facts is taking one’s feelings as proof of the way things really are. 
For example:

• I feel like such a loser.  I must be hopeless
• I feel ashamed and bad. I must be bad
• I feel inadequate. I must be inadequate.
• I feel worthless. I must be worthless.
  

Remember that feelings result from our thoughts.  If our thoughts are erroneous (as they often are when we’re stressed or depressed), then our feelings may not reflect reality.  So question your feelings.  Ask, “What would someone who is 100 percent inadequate (or bad, guilty, hopeless, etc.) be like?  Am I really like that?  This challenges the tendencies of labeling or all or nothing thinking.  Remind yourself that feelings are not facts.  When our thoughts become more reasonable, our feelings become brighter.

Schiraldi, G. 2001. The Self-Esteem Workbook. Oakland, CA: New Harbinger Publications.

“My initial experience of illness was a series of disconnected shocks, and my first instinct was to try and bring it under control by turning it into a narrative.  Always in emergencies we invent narrative.  We describe what is happening, as if to confine the catastrophe.  When people heard I was ill, they inundated me with stories of their own illnesses, as well as the cases of friends.  Storytelling seems to be a natural reaction to illness.  People bleed stories, and I’ve become a bloodbank of them.  The patient has to start by treating his illness not as a disaster, an occasion for depression or panic, but as a narrative, a story.  Stories are antibodies against illness and pain.”         
                                                                                                                         -- Anatole Broyard

The above quote perhaps explains a person’s proclivity toward connecting with others, especially in times of duress.  If emotional stress taxes both body and mind, then an open, trusting dialogue that can be established through the counseling process can certainly be thought of as a “tax rebate” of sorts.  Our need to heal, connect, and discuss what matters through verbal discourse probably dates back as far as the birth of verbal communication among humans.  By comparison, however, the field of counseling – particularly counseling based on the notion of the mind/body connection - is relatively young.  Below are some milestones marking the development of what we know as the mind/body connection and its inevitable union with modern day counseling:

Health Psychology

A branch of psychology based on the mind-body connection; the way we think and feel about events in the world has an impact on our bodies – for better or for worse.  The ability a person has to tell his/her story is important both from a mental and physical standpoint.

The “Talking Cure; the basis of modern psychotherapy

The “talking cure” used by Breuer and Freud (1895/1966) was believed to relieve patients’ hysterical (bodily) symptoms.  Alexander (1950) revealed that physiological problems – such as ulcers, asthma or high blood pressure - could be alleviated through one’s confession of repressed desires.     

“I have something I need to get off my chest…”

People subjectively feel better when they can talk about how they feel about stressful events.  And there is a science behind why this is so.  The physiological work required for one to keep emotions to oneself becomes a stressor per se (Selye, 1976) and can actually increase susceptibility to a number of illnesses (Pennebaker and O’ Heeron, 1984;  Pennebaker, Hughes & O’ Heeron, 1987).  The more a person keeps “bottled up,” the more stress is put on the body.  Thus, a person’s ability to disclose inner thoughts and feelings – either through counseling, friendship and family dialogues, or active journaling can determine the wellness of the whole person – both body and mind.