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We Need to Talk About Mental Health and Pain

Mental health is often ignored when treating pain but could be key to helping reduce healthcare costs and dependence on prescription medication

In honor of mental health month, we are talking about mental health and pain.

Ballooning health costs and an opioid epidemic can all be linked, in part, to the treatment and management of pain, specifically individuals who are dealing with chronic pain. So what is the answer?

A good start is to focus on non-invasive therapies that help chronic pain sufferers learn to better manage and help reduce their pain.

One example is physical therapy, where patients learn exercises that can help them move better with less pain.

Another option is to start focusing more on the mental aspect of pain. Chronic pain sufferers often experience a wide range of mental health conditions including anxiety and depression, which often perpetuate the difficulties and costs of treating pain.

Cognitive Behavioral Therapy, or CBT, is one specific type of therapy that has been proven to help reduce anxiety and depression. CBT teaches patients coping skills and ways to better manage their physical care, helping reduce the need for medications and other procedures.

Though CBT may not work for everyone, more experts are suggesting therapy as an integral part of pain management.

What Is Cognitive Behavioral Therapy or CBT?

CBT “is really about people learning how thoughts trigger emotions and emotionally fueled behaviors, and then learning how to control their thoughts so their reactions do not elicit those negative emotions or behaviors.” Says GinaMarie Guarino, Licensed Mental Health Counselor at PsychPoint.

Terri Bacow, PhD, Director of Training at Hallowell in NYC explains that CBT is similar to other types of therapy in that it involves a one-on-one conversation with your therapist. However, she says, a CBT therapist is “is more active and directive” and they are working towards a goal of teaching patients “specific coping skills to manage his or her symptoms.”

It is not hard to imagine how constant pain could lead to feeling depressed, which in turn could lead to less motivation to attend doctors appointments or do physical therapy exercises. This is a prime example of the type of detrimental behaviors that CBT can help with.

Child and Adolescent Anxiety Specialist, Kelsey Torgerson, LCSW explains that with CBT patients will learn how to 

turn thoughts like “there is no way I can get through this” into “this is tough but I can keep trying.”

The idea is that by changing patients’ thoughts and their reactions to those thoughts, patients can become more committed to treatment and strive for a future without pain.

Bacow explains that CBT is based on the idea that 

“if you change the way you think or the way you behave, you can improve the way you feel.”

Will CBT Help Me Deal with My Pain?

The short answer is it could, but it depends! (as does everything when talking about healthcare)

Since pain can be experienced as much mentally as physically, finding a way to influence thoughts and actions around managing pain can be a critical step in feeling better.

“While it isn’t going to cure every ache and pain, it can help you to not be fixated on it,” explains Alisha Powell, PhD, LCSW

Negative thoughts like “I will never feel better” or “my body is betraying me” can become deeply engrained in a patients belief system, perpetuating the difficulties of managing and reducing pain. “CBT aims to bring awareness to these core beliefs, challenge them, and works to find ways to help patients feel better,” explains Alena Gerst, LCSW, RYT.

The way a patient thinks about pain can also have a huge impact on how they manage it.

Jodi Baretz, LCSW, CHHC, licensed psychotherapist, health coach, and author explains, that when people experience and think about pain, “they often tighten and constrict which makes the pain worse.” CBT can be used to help patients “breathe into the pain, relax the area, and give it space, helping the pain shift and possibly begin to dissolve,” she explains.

“Because both thoughts and actions strongly affect our experience of pain, cognitive behavioral therapy is a key element of effectively managing pain.” Says Marni Amsellem, Ph.D, licensed psychologist in CT and NY.

Though the field is still emerging, Amsellem explains that although “not every person experiencing chronic pain is in need of mental health treatment, but mental health (especially depression) should always be considered when treating chronic pain.”

How Does CBT Work?

CBT helps patients become more aware of their thoughts and patients learn how to replace unhealthy thoughts with healthy ones, explains Powell.

The overall goal of CBT is to help a patient react to pain in a healthier way. With CBT, patients “may experience less stress, less anxiety, and consequently less mental anguish”, says Caleb Backe, Health and Wellness Expert at Maple Holistics.

All therapy will be personal to each patient, but therapists employ a wide variety of techniques to achieve these goals. Techniques may include “simple skills such as problem solving and more complex ones such as identifying and reframing our beliefs in a variety of situations that trigger negative emotions,” says Bacow

Are There Any Techniques That I Can Start at Home?

Dr. Lisa Wilke, PsyD, LP, Licensed Psychologist and the Clinic Director at Center for Mental Health and Wellness shares four techniques that are often used in CBT that people can start implementing at home.

1. Mindfulness

Mindfulness is the practice of awareness in the moment. Mindfulness approaches are often used by psychotherapists to help people manage pain related issues.

It is an effective tool as mindfulness helps people just notice their experience without judgement or getting hooked into negative thinking which can worsen the experience.

A simple technique such as noticing your five senses or observing your environment can be helpful.

2. Body Scan

Body scan is a technique that may be useful for those with pain experiences. Body scanning is the process of observing and noticing what you feel in your body without judging your experience.

You want to just notice what is uncomfortable and what is comfortable without getting stuck on any particular place or experience. This can take practice and may need to be done with a mental health professional until you are comfortable with the process on your own.

3. Breathing Exercises

Breathing exercises are often useful as these techniques can alter your physiology. Intentional breathing can lower your heart rate and even decrease your blood pressure.

A technique that may be useful could be to take in a breath for five seconds, hold for five seconds, and exhale for five seconds. Repeating this process several times can help sooth your nervous system.

4. Self Care

Self-care is important with managing any type of discomfort, physical or emotional. Mainly, self-care is recognizing your basic needs and caring for yourself.

In terms of chronic pain, when you are able, engage in some type of movement that can help manage your symptoms (like physical therapy or walking). Additionally, make sure you are getting enough sleep, nutrition, and manage your daily life stress.  

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