Monday, 20 October 2014

How to use your imagination to manage pain

  "Your imagination is an incredibly powerful tool, but it requires direction."

The neurologic signature for physical pain identified in a study in the New England Journal of Medicine. Credit Tor Wager.
Sometimes patients misunderstand when they are told how imagination can affect pain, and say crossly, "So you think the pain is all in my imagination?"

The answer is no. Imagination is about anticipating what may happen in future. What is in your imagination is not pain. It's fear - fear of disability, of being in a wheelchair, of never being able to go out or of never being without pain. That is what is in your imagination!

Imagination is incredibly powerful: you can make it work against you or for you. If you catastrophise, you unknowingly use your imagination against yourself. Now let's look at what you can do to help turn down the pain volume down instead of up, by imagining better, more desirable outcomes.

It helps to find the most comfortable position you can where you will not be disturbed, and to close your eyes. You might like to try imagining:

Being in a lovely, relaxing place. Perhaps there might be floating, fluffy clouds in the sky, a tinkling waterfall, warm sunshine on your skin or a cool soothing breeze. Try to use all your senses and imagine what you can see, feel, hear, touch or smell.

A soothing or healing light in a colour you like, that neutralises the pain.

A gold thread, which is connected at one end to the crown of your head and at the other to an invisible hook in the ceiling (or roof of the car or the sky). Imagine a gentle pressure from the thread, which makes your neck lengthen and your head drop slightly, your chin pull back a little towards your neck and your shoulders pull back a bit too. It is a lovely feeling that takes the pressure off your neck and shoulders.

A shape and size to the pain. See it shrinking or becoming diluted. Give it a colour (for example, fire engine red if it feels hot) and then change the colour to one that you find healing.

The pain being in a different place. Try shifting it in your imagination to a somewhat less bothersome place, like a thumb or an earlobe and then try shrinking it, once there.

An electronic control panel or dials that you can use to switch pain on or off or up or down.

That your pain perception is like computer software, which sometimes gets corrupted or brings the wrong program up. At first, you think the computer is damaged but, in fact, the hardware is fine and you just need to remind yourself to reboot the system or change the program to get it functioning again.

That the pain is a person. Researchers at Bangor University found that sufferers from rheumatoid arthritis could control their pain better when they visualised their pain in the form of a person, thanked that 'person' for alerting them to the problem area and then imagined asking the 'person' to leave, visualising them getting further and further away and finally disappearing altogether, leaving the sufferer free of pain.

Countering the physical sensations of your pain. For instance, if you feel intense heat, you could imagine a cool soothing gel being gently massaged into the area. If the pain is throbbing, perhaps try imagining it as a car with the engine running and then take your foot off the accelerator or turn the engine off. If a part of your body feels heavy, imagine it being gently lifted like a balloon. If the pain is sharp, imagine it as a sharp taste, such as a lemon, and then dilute it into sweetened lemonade.

Changing the nature of the pain. In your imagination, can you make a short, cutting blinding pain into a dull heavy ache? And then you can you make that dull heavy ache into an irritating itch? And then can you make that itch come and go?

Doing any of these exercises will enable you to experience for yourself the power of your imagination over pain.


This post was adapted from a section in Dr Grahame Brown's book How to liberate yourself from pain: practical help for sufferers - part of the Essential Help in Troubled Times series of books from Human Givens Publishing.

Dr Brown is also a tutor for Human Givens College (only available for in-house training) delivering his course: How to manage physical pain and accelerate healing

Wednesday, 1 October 2014

5 Golden Rules for Setting Achievable Goals

There is nothing more satisfying then setting and achieving a personal goal. The human mind is after all, a problem solving instrument.

If you or someone you know is feeling depressed, setting and achieving a goal can be an important step towards lifting depression. Indeed, goal setting is an important part of human givens therapy. By setting goals together, the client and therapist can both be clear about where the client wants to go with the therapy. But take care when setting goals, get the balance wrong and you risk setting a goal that isn't so manageable.

As you set yourself some clear goals that will put pleasure back into your life, consider these five golden rules:

1. Goals must be small and achievable 

Watch out for all-or-nothing depressive thinking that urges you to think too big. Make sure you start with small steps. Succeeding in those will motivate you to take larger ones. So, if you take no exercise, it is better to start by enjoying a short walk every evening than to determine to go to a gym and pump iron every morning and afternoon. If your self-esteem is low, it is not a good idea to decide to boost it by aiming to give up smoking and drinking, lose weight and train for a marathon, all at the same time. You are dooming yourself to failure by over-extending yourself and your self-esteem will then sink even further. Perhaps you need to feel more appreciated by others and to feel better about yourself, so one possibility might be to take on some charity work that involves you in helping others.

 2. Goals must be concrete 

It is no good deciding that you want to 'be happier' or 'less of a burden on others. That's too vague. You have to clearly define your objective. What does being happier or less of a burden look like? Unpack what it means to you. If you can't answer the question easily, try putting it this way. "If I woke up in the morning and found I was no longer depressed, what (realistically) would be happening that is different from the way it is now?"

One man who had become deeply depressed after a back injury enforced his early retirement from work said, "Well I'd be getting out of bed in time to have breakfast with the children before they go to school, and I would talk to my wife about her day like I used to. Even though I can't work long hours anymore because of my back, I would be doing something practical in the house and the garden, to make my contribution."

Seeing this picture of his life enabled him to decide on three goals: he could set his alarm clock each morning and, regardless of how poorly he had slept, get up to have breakfast with his children; he could ask his wife at least three questions during the day about what she planned to do/had done with her day; and he could decide on some DIY task that needed doing in the house and do it. (This gave him even more to discuss with his wife and required him to go out and buy materials." Of course, all of these activities started to increase his engagement with ordinary life once more and helped him regain a sense of meaning and purpose (whereas before he had been mired in self-pity, resulting in withdrawal from family and friends).

When attention is directed outward into activity, there is less time to worry and ruminate, so his sleep quickly improved and his mood lifted significantly.   

3. Goals must be positive  

It is no use deciding what you need to do is concentrate on not worrying. You can't concentrate on not doing something, If all you are doing it thinking. "I'm worrying again! I must concentrate on not worrying. I must stop those thoughts coming into my head," you are still worrying. Turn your goal into a positive action. To stop yourself worrying endlessly, you need to find activities with which to distract yourself, so that you are too absorbed and busy to worry.

4. Goals must be focused on fulfilling the unmet needs you have identified in your life. 

All depressed people gradually disengage from life, doing less and less of what they used to enjoy before, so one of your definite goals should be to reverse this, be re-introducing an activity that involves being with other people. It could be something you used to enjoy doing before or something entirely new. If you used to enjoy good relationships with people in the past, you will be able to build on those same resources to do so again. Like riding a bicycle, even if you haven't done it for years, you haven't really lost the knack. (If however, you have always found it hard to form attachments with others, you may benefit from working with a therapist to develop the social skills that perhaps, for whatever reason, you never had the chance to learn when you were younger. These can be learned at any age, even by the very shy, and be continually improved with practice.)

Consider whether any of these ideas for re-engaging with life and experiencing pleasure is appropriate for you. If not, think of some that are:

- call a friend whom you have been meaning to call for ages and suggest you get together
- go out for a walk or a meal with your partner take your children to the park and join in their games
- invite a friend, or a couple of friends, for a meal at your house take up an activity again that you used to enjoy, such as tennis, swimming, painting, listening to live music, dancing, gardening, amateur dramatics
- walk the dog with a neighbour or go along when the neighbour takes their dog
- suggest a social drink after work with colleagues
- go to the cinema or theatre with a friend or partner
- book a holiday where you will meet you people and explore new places
- decide on a charity you would like to help and make sure this involves your being in direct contact with people – for instance, visiting at an old people's home, helping disabled children, serving hot food at a soup kitchen for homeless people
- join an evening class or go on an activity weekend, where you can meet new people.

Decide on one of two of these sorts of strategies, to start with. They should help you meet your needs for emotional and social connection. Make sure you are doing something that benefits others as well as yourself.

Other unmet needs may require you to take a deeper look at your life and explore or plan carefully for change. List your options if you are no longer happy with work or a relationship and discuss them with someone whose opinion you trust. Perhaps an appropriate strategy might be to research alternative areas of employment or look into the practicability of mending or ending a problematic relationship. What would restore meaning and purpose to your life? 

5. Goals must be appropriate 

Certain things that happen in life will not be possible to change. We cannot bring back the leg that has been amputated, or the partner who has left to live with another lover, or the husband or wife who has died. And if we are old we cannot bring back our youth. We must look at our new circumstances and set goals based on those – to regain as much fitness as possible and to take up different challenges, to engage in social activities or to meet new people to spend time with. And we can be young at heart whatever our age.

Sometimes depression occurs because someone feels stuck between a rock and a hard place, or because they have a difficult decision to make and they don't know what to do for the best. Feeling incapable of taking a decision, they slump into depression instead. But sometimes the right thing to do is not to take a life-changing decision if the courses of action on offer seem as perilous as each other and there is no way of knowing at the time which one would be best. At such times you may need to wait for other factors to click into place before your path becomes clear to you. In the meantime, it is best to concentrate on doing whatever averts unhelpful depressive thinking – for instance being active, keeping your mind productively busy, spending time with friends and eating properly.  

Remember, life events change all the time and the vast majority of depressed people, even left untreated, come out of it spontaneously in 4-10 months. 

This information was taken from the book Lift - we also have a website on depression.