NPR did a great piece on an integrated program that treats patients with chronic pain using exercise, nutrition and education. Sound familiar? The program is sponsored by Kaiser Permanente in response to the opioid epidemic and the growing concerns around using opiates as "front line" treatment for pain complaints. Restore Fx is proud to say that we have been providing this type of integrative care for the past 12 years! Listen to the podcast and we think you will see the similarities -- not only is their program interdisciplinary (as is ours) but it has all of the practitioners/healthcare providers in the same location functioning as a team (again, like ours!). Kudos to Kaiser for making this program available to its clients in Colorado. We hope that other insurance providers take note and start to offer this kind of care to their clients.
We all get angry sometimes because we don’t live in a perfect world; in fact, we live in one that is constantly changing moment to moment. This means that our environment, our communities, our friends, our family, our bodies, are all under this influence of change and thus we are having to respond to that change; in ourselves, and in those around us. If you don’t like a change that has happened to you, or around you, the natural emotional response may be to feel anger. Living with chronic pain is a hard change to endure, not only physically, but emotionally, and spiritually. Because of this inner struggle, there may be times when anger seems like a distraction from the pain,sometimes it may even seem reasonable to be angry at the diagnosis, your doctors, those who don’t understand, etc. Even though anger may feel good in the moment, there are many negative consequences that it can have on your physical health, mental health, and your relationships with others.
Anger is inevitably felt when we feel we are under threat, being treated unfairly, or when we feel that an injustice has occurred. Someone who is experiencing chronic pain is likely to be feeling mild to severe stress in their body already, which can make it even harder for them to manage their anger. Learning anger management techniques can help you avoid the negative effects anger may have on your health, and your relationships. Knowing how you express your anger, can help you to prevent destructive patterns and build a more positive foundation for communicating your anger. Here are three of the most common ways that people express their anger.
1. Passive Aggressive Anger: One form of anger that is relatively common, is passive aggressive anger. This form is expressed as a subtle behavior, and may occur in individuals who think it is wrong to directly express their anger. Instead they mask their anger with an affectation of passive aggressive behaviors such as sullenness, withdrawal, procrastination, and stubbornness. For example, if you were to ask a passive aggressive coworker if something was wrong, they would most likely reply “nothing”. However, they may be exhibiting signs that something is clearly wrong by giving you the silent treatment, subtly insulting you, or not finishing a task they were given.
2. Aggressive Anger: Aggressive anger is much more direct. Aggressive behavior can be manifested physically, verbally and/or emotionally, and the person who is on the receiving end usually feels abused, bullied, and/or threatened. Aggressive anger can permanently damage relationships because it may arouse strong fear, mistrust, and violence. Considering that aggressive anger is emotionally charged with
intense stress or fear, it can cause the “fight, flight, freeze” response in those involved.This creates a situation where effective communication and the ability to resolve tension is no longer an option.
3. Assertive Anger: Assertive anger positively acknowledges negative feelings and allows for constructive communication. Assertive anger arises out of a core belief that both oneself and the other person(s) involved in the conflict should be respected. The goal with assertive anger is to create healthy boundaries within that relationship. A way to picture what assertive anger looks like is to imagine yourself setting an assertive boundary. Assertive boundary setting could be directed at others, or even oneself (as
silly as that may seem). However, when you think about it, we are in a lifelong relationship with ourselves, and assertive boundary settings can be beneficial in sticking to new personal goals, stopping yourself when you notice negative self-talk, and ultimately being kind to yourself. If you aren’t used to setting boundaries, it is important to remember that this act is ultimately done for the benefit of all people who are involved — setting boundaries with others explicitly teaches them about your needs in a safe, respectful way. For example, if someone is experiencing chronic pain, and has a family member who persistently asks them to do physical activities beyond their comfort level, It is completely fair and healthy to create an assertive boundary and say: “No, I absolutely can not do that, please stop asking me. I will let you know when I feel better and am able to take part in that. If you want to spend time together let’s do something that is easier for me to approach right now”. It is easy to get angry and feel helpless when we are in pain and feel that people don’t understand us. This is why it is important to be able to clearly explain our boundaries and feelings. Before practicing assertive boundary setting, we need to identify the distorted beliefs that may push us towards a more passive aggressive or aggressive style of anger management. By identifying distorted beliefs, we can look for these distortions in our own patterns of thinking and therefore challenge these thoughts when we experience them. These underlying irrational and distorted beliefs prevent us from having healthier, constructive discussions about our feelings by undermining our efforts to regulate conflicts.
Some of our common irrational beliefs are to: “awfulize” situations, or take part in “I-Cant-Stand-It-Itis”, “blaming” or “feeling entitled because of the pain we are experiencing”. When we use these irrational and distorted beliefs as scapegoats for our anger, it can escalate our negative emotions and prevent us from finding a more appropriate way to solve our problem. An example of a irrational belief is: “If someone
does something that hurts me, they must be a bad person”. This sort of black-and white thinking may happen very quickly, and thus distort the way we perceive the situation we are in. If we are able to mindfully pause when we are riled up, we can try to question the validity of our underlying beliefs. For example: “If I believe someone who does something to hurt me is a bad person, then that also means that only good people can perform good acts, and good people would never do anything bad. I am
also assuming that bad people can only perform bad acts.” Checking for the validity of our beliefs can show us the assumptions we are making when we are emotionally triggered with anger and help us calm down and respond more appropriately.
Understanding our anger and learning how to manage it is important because at some point in our lives, we are bound to experience people treating us unfairly, not getting our way etc. If we respond to stress and conflict in a mal-adaptive way we can actually worsen things, make ourselves miserable, increase our stress, and find ourselves in a repetitive and exhaustive cycle of being either passive aggressive or too
There are many ways to help yourself when dealing with anger, these are some of the approaches and activities that can help you calm down when experiencing anger:
In conclusion, anger is a natural human emotion that we aren’t supposed to suppress, or get overly attached to. Instead, the goal is to learn from it. If we investigate our anger there is always an underlying need that is not met. When we can identify that need through awareness and compassion, we are more likely to be able to communicate that need, set appropriate boundaries, and feel more in control of our
life. In order to learn how to use assertive anger and boundary setting, you need to practice those skills. It may surprise you to see how people tend to respond well to this form of expressing oneself — they may even admire the courage you are displaying by taking greater care of yourself and of your relationships. When you channel your anger in a healthy manner, you will have greater mental clarity, emotional ease, and physical calmness that will allow you to actually approach your chronic pain and listen to your body with care, kindness and wisdom.
“Each time you meet an old emotional pattern with presence, your awakening to truth can deepen. There’s less identification with the self in the story and more ability to rest in the awareness that is witnessing what’s happening. You become more able to abide in compassion, to remember and trust your true home. Rather than cycling repetitively through old conditioning, you are actually spiraling toward freedom.”
― Tara Brach, True Refuge: Finding Peace and Freedom in Your Own Awakened Heart
There has been a lot of research coming out on loneliness as a risk factor for health and longevity. Some studies have even gone as far as to say that loneliness is a higher risk factor for mortality than cigarettes. So what does social support (or it’s inverse, loneliness) have to do with chronic pain?
Well, there have been studies done on this subject and the results probably won’t surprise you. For example in one study of almost 200 patient, people who described their families as being supportive reported significantly less pain intensity, less reliance on medication and greater activity levels (Jamison,R., Virts, K. The influence of family support on chronic pain. Behaviour Research and Therapy. 1990. Volume 28, 4, 283–287). Several other studies have found that a lack of social support is associated with higher levels of depression and poorer pain adjustment (Campbell, Clauw & Keefe, 2003; López-Martínez et al., 2008; Romano, Turner & Jensen, 1997; Tsai et al., 2003).
So what can be done with this information if you are living with chronic pain? Check your social support network. Who do you see every day? Who can you call if you need help or a favor? If your social circle has dwindled down to one or two people then it’s probably time to expand it. Thanks to the internet there are all kinds of “Meet-Up” groups one can find, for everything from learning to macramé to people who love poodles. Or consider checking out a church, synagogue, mosque or temple. Religious and spiritual communities can be a great place to meet others and feel supported. Volunteering is another great way to meet new people as well as take the focus off of yourself. You can check out volunteer opportunities in Austin at www.volunteermatch.org or http://www.austin360.com/entertainment/night-life/austin-volunteer-opportunities/d73i07tUhqIJcz63ZPD74I/. Or contact your favorite charity—The American Red Cross, American Diabetes Association, American Cancer Society, Easter Seals…the list is practically endless. Even if your chronic pain keeps you from working you can probably find a volunteer situation that would work for you. It may be sitting for an hour stuffing envelopes for a charity drive or taking calls on a help line. Or sorting donations for a church garage sale. The opportunities can be one-time or repeating. You would be surprised at how much you can get out of giving back to others, even when you yourself are not feeling so great.
I hope that this topic inspires you to do a wellness check on your social support and take action if it is lagging. Your pain will be less and your spirits will be better!
Yours in health,
The following article is from Shreveport Times and is a great overview of the problems with treating pain in this country. The opiate epidemic has clearly shown that throwing medications at pain patients is short-sighted and ineffective. It's time to mainstream Functional Restoration programs like Restore Fx and make them the gold-standard for patients with persistent pain problems.
If opioids aren’t the answer for treating chronic pain, what is?
Krista Jordan, Ph.D., ABPP