COPING WITH GRIEF, ANGER AND DEPRESSION
Grief, anger and depression are normal emotions, says clinical psychologist Kate McGarva. They only cause problems when we are unable to “work through” our feelings or if negative feelings stay with us most of the time. Here she outlines some strategies which can make a real difference
Chronic pain usually means you are less able to do some of the “normal” things in life. Things you used to be able to do – without thinking. This is frustrating and a loss. When we suffer loss we experience a range of emotions such as sadness, despair, anxiety, frustration and anger – at different times and at different levels. These are normal feelings – we are grieving. All human beings have these feelings. They only become a problem if they are too intense, happen too often and last too long – because they then interfere with everyday living.
Cognitive behavioural strategies can be a useful weapon in your daily fight against the difficulties chronic pain brings. Why?
And cognitive behavioural strategies are about what we think and what we do (our behaviour).
Stress and muscle tension
Every day we meet situations which demand something from us. Sometimes we feel that what is being asked of us is more than we can give. When this happens, our stress levels rise, leading to tension and anxiety. Anxiety is a normal emotion which we all feel. What else is happening in our lives at the time will affect how we “manage” our anxiety. Anxiety causes unpleasant physical symptoms, including muscle tension, headaches, pins and needles, general aches and pains. It also makes us feel tired, irritable and forgetful. Because of the extra tension levels present in chronic pain, it is easier for a person to become even more stressed. The body’s natural mechanism of producing the stress hormone adrenalin is the reason for this.
Frustration, anger and depression
Having chronic pain means that everyday activities cost you more effort. This, combined with your high level of muscle tension, means that anxiety can reach a high level quite quickly. You are then more sensitive to stress which makes it more likely for you to also feel frustration and anger. In chronic pain, anxiety can arise because a person has lost a “normal” life and they may also lose confidence in themselves, feeling “less of a person”. When frustrated and angry, people often feel under-confident with high tension levels – leading to lower tolerance to everyday “hassles” – such as noise, people “not understanding”, unfairness. Being constantly tense, anxious and frustrated makes us very tired, both physically and mentally. We are then less able to cope, and this can lead to further undermining of our belief in ourselves as worthwhile people.
In these circumstances you can see that depression can easily take hold. A person feels they have lost their “self” and have also lost control over their lives. This is frightening – because we have no sense of what the future holds – but it looks bleak!
Negative automatic thinking
When this happens we tend to begin to think in a very specific way. When we are anxious, angry or depressed, our thoughts become very negative. We get Negative Automatic Thoughts or NATS – these thoughts come into our head very quickly and are very believable. These NATS start off the “bad” feelings and keep them going – often long after the event which triggered them in the first place. Like the insects (GNATS) these thoughts or NATS eat away at us. Or as they say in Scotland they “nip oor heid” so we don’t think clearly or logically. Our thoughts begin to follow a pattern of being rather rigid, self-blaming, catastrophising and jumping to conclusions. These thoughts – because we feel bad about ourselves – seem believable but are not accurate. Because we are thinking emotionally we are not as able to reason things out – we react rather than think things through. We completely miss any positive or good aspects of things (events, people, the world). We don’t do this on purpose – rather we get caught up in a vicious cycle of tension, bad feelings, negative thoughts – which lead to more pain – we feel less able –more hopeless/ helpless and so get even more negative thoughts.
Sometimes medication is needed
When this takes a hold it is often the case that we become clinically depressed and the balance of neurochemicals in the brain shifts. This makes it even harder for our mood to lift and we stay in the depressed circle of negative thoughts. Antidepressant medication will be needed to restore the balance. In turn this gives us a “kick start” in tackling the NATS.
What can we do to break the negative cycle?
This takes energy – which you don’t have a lot of – but you need to do it!
1. First of all you need to become aware of negative thoughts. You can begin by thinking of a situation when you felt “bad” (anxious/angry/depressed etc). You can then use a Thoughts Diary. A plain sheet of paper – divide into three columns.
EXAMPLE
You always need to challenge the negative thoughts in the middle column. Asking questions such as, “What’s the evidence for this thought? What’s another way of looking at this? What am I doing here — jumping to conclusions — personalising — catastrophising?” With practice, this technique can become almost second nature and you no longer need to write things down. You become able to turn the negative thoughts around whilst you are still in the situation.
2. You can also learn to talk to yourself in a more helpful way – using coping self-statements. For example, “It’s OK – I can handle this – as long as I keep my cool – I’m in control”. Or “I won’t take this personally – easy does it – look for the positives”. Or “I have nothing to prove – it’s not that serious – I know how to deal with it”.
3. Breathing control and relaxation will help you manage anxiety and anger problems. It isn’t possible to be anxious or angry and relaxed at the same time. Relaxation also helps to rest the body and the mind, so it benefits depression too. Used together with the cognitive approach – that is tackling negative thinking – you will get back control of your emotions. In turn you will experience less muscle tension, will feel better and so be able to manage your pain better.
4. Another weapon is to make sure that you have distractions – things to do to occupy your mind – things which you can look forward to and enjoy. We all need them – every day – so make a “hit list” of things to do. These can be things you really need to do but must include the fun things too. Work your way through your list – remember – goal setting and pacing! Passive things such as watching TV or even reading are not ideal because you can sit and still carry on with any negative thinking quite easily. Try to find something that you will need to think about while you are doing it – that is, actively distract your mind.
Success gives you confidence!
When you have chronic pain everything takes more effort and feels more tiring than usual. Practising pacing yourself in everything you do will become second nature to you and will save you energy. Challenging the NATS will help you see things more clearly and rationally and you will be less inclined to “react” to people or events. This gives you some balance in life and the successes you get will also make you feel more confident and lift your mood.
Managing chronic pain means lifestyle change. It also includes changing the way you think about things, for example not feeling guilty about doing nothing or about doing relaxation. This isn’t giving in to pain – it is being sensible and kind to your body and your self. Successes will also make you feel less frustrated, less tense and less likely to become angry. You will feel more in control of your pain. None of this is easy but as you know – there are no easy answers to chronic pain. You will need to have patience, particularly with yourself – accepting you have pain – there is no cure – but not giving up on yourself – or on life!
Kate McGarva is a clinical psychologist at Stratheden Hospital in Fife and specializes in teaching pain-management skills.
Pain Concern Publications
Pain Concern, PO Box 13256, Haddington EH41 4YD, Tel: 01620 822572,
www.painconcern.org.uk
Grief, anger and depression are normal emotions, says clinical psychologist Kate McGarva. They only cause problems when we are unable to “work through” our feelings or if negative feelings stay with us most of the time. Here she outlines some strategies which can make a real difference
Chronic pain usually means you are less able to do some of the “normal” things in life. Things you used to be able to do – without thinking. This is frustrating and a loss. When we suffer loss we experience a range of emotions such as sadness, despair, anxiety, frustration and anger – at different times and at different levels. These are normal feelings – we are grieving. All human beings have these feelings. They only become a problem if they are too intense, happen too often and last too long – because they then interfere with everyday living.
Cognitive behavioural strategies can be a useful weapon in your daily fight against the difficulties chronic pain brings. Why?
Because —
Pain affects thoughts, feelings and behaviour
And —
Thoughts, feelings and behaviour affect pain
Pain affects thoughts, feelings and behaviour
And —
Thoughts, feelings and behaviour affect pain
And cognitive behavioural strategies are about what we think and what we do (our behaviour).
Stress and muscle tension
Every day we meet situations which demand something from us. Sometimes we feel that what is being asked of us is more than we can give. When this happens, our stress levels rise, leading to tension and anxiety. Anxiety is a normal emotion which we all feel. What else is happening in our lives at the time will affect how we “manage” our anxiety. Anxiety causes unpleasant physical symptoms, including muscle tension, headaches, pins and needles, general aches and pains. It also makes us feel tired, irritable and forgetful. Because of the extra tension levels present in chronic pain, it is easier for a person to become even more stressed. The body’s natural mechanism of producing the stress hormone adrenalin is the reason for this.
Frustration, anger and depression
Having chronic pain means that everyday activities cost you more effort. This, combined with your high level of muscle tension, means that anxiety can reach a high level quite quickly. You are then more sensitive to stress which makes it more likely for you to also feel frustration and anger. In chronic pain, anxiety can arise because a person has lost a “normal” life and they may also lose confidence in themselves, feeling “less of a person”. When frustrated and angry, people often feel under-confident with high tension levels – leading to lower tolerance to everyday “hassles” – such as noise, people “not understanding”, unfairness. Being constantly tense, anxious and frustrated makes us very tired, both physically and mentally. We are then less able to cope, and this can lead to further undermining of our belief in ourselves as worthwhile people.
In these circumstances you can see that depression can easily take hold. A person feels they have lost their “self” and have also lost control over their lives. This is frightening – because we have no sense of what the future holds – but it looks bleak!
Negative automatic thinking
When this happens we tend to begin to think in a very specific way. When we are anxious, angry or depressed, our thoughts become very negative. We get Negative Automatic Thoughts or NATS – these thoughts come into our head very quickly and are very believable. These NATS start off the “bad” feelings and keep them going – often long after the event which triggered them in the first place. Like the insects (GNATS) these thoughts or NATS eat away at us. Or as they say in Scotland they “nip oor heid” so we don’t think clearly or logically. Our thoughts begin to follow a pattern of being rather rigid, self-blaming, catastrophising and jumping to conclusions. These thoughts – because we feel bad about ourselves – seem believable but are not accurate. Because we are thinking emotionally we are not as able to reason things out – we react rather than think things through. We completely miss any positive or good aspects of things (events, people, the world). We don’t do this on purpose – rather we get caught up in a vicious cycle of tension, bad feelings, negative thoughts – which lead to more pain – we feel less able –more hopeless/ helpless and so get even more negative thoughts.
Sometimes medication is needed
When this takes a hold it is often the case that we become clinically depressed and the balance of neurochemicals in the brain shifts. This makes it even harder for our mood to lift and we stay in the depressed circle of negative thoughts. Antidepressant medication will be needed to restore the balance. In turn this gives us a “kick start” in tackling the NATS.
What can we do to break the negative cycle?
This takes energy – which you don’t have a lot of – but you need to do it!
1. First of all you need to become aware of negative thoughts. You can begin by thinking of a situation when you felt “bad” (anxious/angry/depressed etc). You can then use a Thoughts Diary. A plain sheet of paper – divide into three columns.
EXAMPLE
| What happened / How did I feel ? | What was I thinking? (negative automatic thoughts) | Alternative/ other way of looking at things |
| Walking down street – saw Jane. She walked straight past –didn’t say hello. Feeling upset. | She walked past me – she isn’t talking to me – I must have done something to upset her – this is awful – it’s all my fault. | Jane probably didn’t see me – her mind was on something else – she did look in a hurry – besides I couldn’t have upset her – I haven’t seen her for weeks. |
You always need to challenge the negative thoughts in the middle column. Asking questions such as, “What’s the evidence for this thought? What’s another way of looking at this? What am I doing here — jumping to conclusions — personalising — catastrophising?” With practice, this technique can become almost second nature and you no longer need to write things down. You become able to turn the negative thoughts around whilst you are still in the situation.
2. You can also learn to talk to yourself in a more helpful way – using coping self-statements. For example, “It’s OK – I can handle this – as long as I keep my cool – I’m in control”. Or “I won’t take this personally – easy does it – look for the positives”. Or “I have nothing to prove – it’s not that serious – I know how to deal with it”.
3. Breathing control and relaxation will help you manage anxiety and anger problems. It isn’t possible to be anxious or angry and relaxed at the same time. Relaxation also helps to rest the body and the mind, so it benefits depression too. Used together with the cognitive approach – that is tackling negative thinking – you will get back control of your emotions. In turn you will experience less muscle tension, will feel better and so be able to manage your pain better.
4. Another weapon is to make sure that you have distractions – things to do to occupy your mind – things which you can look forward to and enjoy. We all need them – every day – so make a “hit list” of things to do. These can be things you really need to do but must include the fun things too. Work your way through your list – remember – goal setting and pacing! Passive things such as watching TV or even reading are not ideal because you can sit and still carry on with any negative thinking quite easily. Try to find something that you will need to think about while you are doing it – that is, actively distract your mind.
Success gives you confidence!
When you have chronic pain everything takes more effort and feels more tiring than usual. Practising pacing yourself in everything you do will become second nature to you and will save you energy. Challenging the NATS will help you see things more clearly and rationally and you will be less inclined to “react” to people or events. This gives you some balance in life and the successes you get will also make you feel more confident and lift your mood.
Managing chronic pain means lifestyle change. It also includes changing the way you think about things, for example not feeling guilty about doing nothing or about doing relaxation. This isn’t giving in to pain – it is being sensible and kind to your body and your self. Successes will also make you feel less frustrated, less tense and less likely to become angry. You will feel more in control of your pain. None of this is easy but as you know – there are no easy answers to chronic pain. You will need to have patience, particularly with yourself – accepting you have pain – there is no cure – but not giving up on yourself – or on life!
Kate McGarva is a clinical psychologist at Stratheden Hospital in Fife and specializes in teaching pain-management skills.
Pain Concern Publications
Pain Concern, PO Box 13256, Haddington EH41 4YD, Tel: 01620 822572,
www.painconcern.org.uk
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