So, when the patient’s partner is snippy, critical, or hostile, the patient tends to feel worse, too. The region of the brain that elicits a bad mood simply is stimulated. Conversely, if one partner is in a great mood, the other tends to be happier.

That is why—indirectly for my patients’ sake and directly for that of their partners—I believe it is vital that both partners learn tools such as expressive writing and adding more play into their lives, that enable them to live a joyful life.

Where is the support?

However, there may be an additional issue beneath the surface because it is remarkably difficult to convince other members of the household to engage in these tools. If you care for your family member, why would you not try to do as much as possible to help him or her heal? I ran across this article that partially explains why. Family members may not believe that a patient really is experiencing that much pain. It may be more common than I believed. Therefore, their compassion may understandably be limited.

Couple’s study

A multi-center published in 2013 (1) measured the following variables in 105 couples over two weeks:

• Patient’s pain
• Spouse’s observations of patient’s pain behaviors such as complaining, grimacing or grabbling.
• The patient’s perceived criticism or hostility from his or her partner

The following observations were made:

• Patient’s pain increased for over three hours when they felt hostility or were criticized.
• Patient’s observed pain behavior consistently created a negative reaction from their partner.
• These interactions were consistent. The assumption was that long-term low level negative interactions will erode relationships and quality of life.

This interaction is similar to what has been found in depression research. Depressed patients act in ways that cause rejection from others, which in turn exacerbates the depression.

There is no question that chronic pain is a family issue. The couples study does not even take into account the damage an angry person in chronic pain can inflict on his close relationships. The family unit can become a living hell and it can seem like a hopeless situation. But, like the patient’s condition, the family dynamic can get better, with the right tools. It did with me.

Pain = anger= abuse

Feeling Good Together

David Burns, MD is a Stanford psychiatrist and the author of Feeling Good. I attended his five-day seminar a few years ago where advanced Cognitive Behavioral Therapy (CBT) techniques were presented. One afternoon was devoted to relationships. He had been given a large advance to write a similar book applying (CBT) to relationships. He then used these techniques on 50 couples without any success. He returned the advance and went on a five-year quest to find out what was really going on. Subsequently, he wrote a second remarkable book called Feeling Good Together. One stunning insight from this book that hit me hard was that, when your partner acts in a way that upsets you, of course you want to blame him or her; but you are the one who set it up. It was your actions that caused your partner to react in a way that made you angry.

That insight had a major impact on my awareness of my own behavior—not just toward my wife, but in my relationships with everyone. However, I found it to be by far the hardest part of my journey. Whenever I feel upset as a result of something my spouse says or does, it still feels like it is she, not I, who caused the upset. It has taken me years to consider the effect my words and behavior have on others’ feelings. I still have a long way to go. It is unbelievably humbling.

Protect your family from your pain

The Marriage-go-round

How do you break the cycle of pain behavior, criticism from your partner, and more pain? Let’s face it: You have the choice whether to engage in pain behavior or not. At some level you must know that your partner is going to react negatively to it, but you do it anyway. When you feel the hostility and criticism from your partner, your pain increases. This is expected, since we know that stress chemicals increase the speed of nerve conduction, resulting in more pain. (2) Since there is seemingly no end to the pain, the cycle can continue for a long time. You’re already mad at your partner; why not continue to be irritating?

If endless conflict is damaging your whole family, consider it an opportunity to work through the solution together and come out stronger than ever before. The solution for chronic pain is not difficult once you understand the nature of the problem. It turns out—and I say this from experience—that anxiety and anger are the pain. Use the DOC tools to help you, your partner, and other family members to live a life you all cherish.

Listen to the Back in Control Radio podcast The Chronic Pain Marriage Go Round

1. Burns, JW, et al. Temporal associations between spouse criticism/ hostility and pain among patients with chronic pain: A within-couple daily diary study. Pain (2103); 154: 2715-2721.
2. Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166-173

The post The Chronic Pain Marriage-Go-Round first appeared on Back in Control.

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In response to a debate regarding an orthopedist’s role in dealing with mental health issues David Burns wrote me this letter. I have seen consistent and profound results with just having my patients use his book in addition to the free writing of thoughts. It is self-directed by the patients. My role has been making my patients accountable to fully engage in using his tools. Whenever possible I do work with pain psychologists who have added wonderful dimensions to my patient’s care.

David Burn’s Letter

Thanks so much. There is evidence based on quite a bit of research that reading Feeling Good: The New Mood Therapy can have significant antidepressant effects. Dr. Forrest Scogin has reported (based on numerous controlled outcome studies published in Journal of Consulting and Clinical Psychology and other journals) that approximately 2/3rds of individuals seeking treatment for a major depressive episodes will be substantially improved or recovered within four weeks if they are given a copy of Feeling Good, with no other treatment offered during this time. Those patients did not need any further treatment, and maintained their gains during 3-year follow-up studies.

It is certainly not a panacea or cure-all, but does seem to help many people who are struggling with depression and anxiety. Some, of course, will need more than just a self-help book.

There are many techniques and ideas in Feeling Good, and there has not been much research on what the effective therapeutic “ingredients” might be. Research indicates that this is not a placebo effect, since a placebo book was not effective in a controlled study.

In my own research in clinical settings, we have seen that doing psychotherapy “homework” (such as reading Feeling Good between sessions, recording automatic negative thoughts, and so forth) does seem to have profound antidepressant effects.

All the best,

David D. Burns, M.D.

Adjunct Clinical Professor,

Department of Psychiatry and Behavioral Sciences,

Stanford University School of Medicine

The post David Burn’s Letter first appeared on Back in Control.

The post David Burn’s Letter appeared first on Back in Control.

Trapped

In 2002, I was in a terrible emotional state. I could barely get through the day; it took tremendous effort. I was still an excellent, technically competent surgeon; however, internally, I was not having much enjoyment. Most surgeons, including myself, love performing surgery.  It is interesting, challenging, and satisfying to help bring a patient back to health. However, I was continuing to experience severe burnout. I had pursued every avenue possible with a vengeance. This turned me into an anxious wreck. I didn’t really know how to turn it around and couldn’t find an answer.

Mother’s Day 2002

I was in Oakland, CA on Mother’s day weekend of 2002. My future step-daughter was with my girlfriend (now wife) and me, and the three of us were washing the car on a beautiful sunny day. It was one of those special times in life where I should have been happy being with my future family. It wasn’t. I was in mental agony. For some reason, in the middle of washing the car that day, it dawned on me how tired I was tired of all of this internal unrest. I realized that I was looking for an outside source to solve my problem. I felt a deep shift and saw how deeply I was imbedded in the victim role. I made a simple decision to stop.

No answer

It took another year before I really pulled out of my tailspin, but my life took a basic turn that weekend. I had been looking for some answer that would change my life. I realized that there was no single solution to my problems and I needed to take full responsibility.

Re-engaging

I returned to doing the writing exercises in David Burns’ book Feeling Good”, and re-committed to understanding anger. His book had already had a major effect but I had given it up. I didn’t realize it before, but by not pursuing a resource that I knew was powerful I really was choosing to remain a victim. I also did not know about the concept of developing alternative neurological pathways. It had caught my attention that the author pointed out that cognitive restructuring was effective in relieving anxiety 85% of the time using just the book.

I continue to be creative both in remaining a victim and in hiding it from myself and others. Increasing awareness of this pattern of behavior is my strongest commitment to myself and family.

The post My Victimhood first appeared on Back in Control.

The post My Victimhood appeared first on Back in Control.