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All
comprehensive fibromyalgia (FM) treatment programs include non-drug
components such as cognitive-behavioral treatment. This broad treatment
area emphasizes the relationship between thoughts, beliefs, emotions and
behavior. In fact, it assumes that thoughts are powerful determiners of how
we feel and behave and that altering maladaptive thought patterns will
result in desirable behavior changes. Cognitive strategies include
education in recognizing thought patterns that are maladaptive along with
learning and practice of specific techniques for decreasing distress, pain,
fatigue, and anxiety. Cognitive therapy contains 4 components: (1) coping
skills training, (2) self-control training, (3) problem-solving skills
training, and (4) cognitive restructuring methods. Although I have found
that most people with FM already engage in a number of positive coping
strategies, are ready to learn relaxation strategies and able to develop
better ways to solve problems, when approaching the area of cognitive
restructuring some people respond skeptically.
“Oh, here
we go again! Just thinking positively doesn’t take my symptoms away.”
“If I
change the way I think about my pain and my pain decreases, people (my
family, my
work colleagues, my doctor) are going to believe that fibromyalgia is ‘all
in my head.’”
“What am I
supposed to do, try to fool myself into believing that things are
different?”
Let’s
explore cognitive restructuring with the goal of understanding better what
it is and what it isn’t and what its potential is for helping people with FM
manage their symptoms better.
Have you ever worried about
anything? Have you ever felt your body relax when someone said a kind word
to you? If so, you have experienced the intimate connection between
thoughts and feelings. Think about it, when you worry your body responds
with sensations of anxiety (knots in your stomach, increased heart rate,
sweaty palms, insomnia). Yet, the negative things you are worrying about
aren’t actually happening at the time that you are worrying. They are
happening only in your thoughts. On the positive side, if someone says,
“I’m really sorry that you are in so much pain,” or, “I want to help in any
way I can,” you may feel your muscles relax, your stomach stop churning,
and your breathing become less shallow. Again, these body reactions happen
even though the helper only said something to you. She didn’t massage your
muscles, give you a Zantac or even tell you to breathe deeply. If you want
to try out this connection in a simple way, think about eating a lemon or
savoring a piece of Godiva chocolate and see what happens. Bet you start to
salivate. What I’m trying to convince you of is that a very powerful
connection exists between how you think, how you perceive messages from
yourself and others, and how you feel both emotionally and physically.
These ongoing thoughts are
the little voice in your head that babbles to you all the time. Sometimes
people I see in counseling aren’t aware that they are constantly engaged in
a running automatic dialog. If that seems to be the case, I ask them to
spend the next week listening to themselves. Invariably, they come back
with all sorts of tales that their conscious mind has been telling them.
This cognitive part is always actively evaluating, rationalizing, scheming,
analyzing and distorting reality at times. Have you ever said something
and then wondered, “Why did I say that?” followed by, “That was a dumb thing
to say.” Or maybe your neighbor brought over a plate of freshly baked
cookies. You smiled, thanked her and felt both a little happy and a little
sad. Then you realized that your thoughts were centering around, “She
probably thinks I can’t cook. I look like such a mess and my house is a
disaster. I’m just inadequate.”
All people engage in
cognitive distortions from time to time. Some very common negative thoughts
that people with FM have include:
“Why me?” Life isn’t
fair.”
“My
pain will never get better.”
“I
shouldn’t ask for help.”
“No one
understands me.”
What cognitive
restructuring focuses on is helping you to identify the long-standing
patterns of automatic thinking associated with unhappiness, anxiety,
depression, and physical symptoms. Once these patterns are identified, you
can decide if you wish to change them. In other words, cognitive
restructuring is an active, individual process that you control. A good
therapist serves as a guide to the process, often asking questions such as,
“Can you think of
an alternative way to view this situation?”
“Is believing that
you are worthless helpful to you?”
“Is your pain
always this bad?”
“Who told you that
you should ______?”
Sometimes she/he might suggest a
different label like,
“Instead of
seeing yourself as a martyr, maybe you could think of yourself as a
nurturer.”
“Maybe
instead of telling yourself that you should do something, you could ask
yourself if you want to do it.”
These questions and suggestions are
meant to help you reframe or restructure your thoughts into more realistic
and helpful thoughts. As these new thoughts and belief become more a part
of you, they won’t feel foreign or feigned. For example, reframing the
belief that life isn’t fair into, “perhaps that is true, but believing and
telling myself that doesn’t help me feel any better; instead I will tell
myself that living my life to the fullest is more important than being
frustrated about whether it is fair,” is likely to change your emotional
state from one of depression and anger to one of peace and joy. As the
ancient writer of Proverbs said, “ A depressed spirit saps one’s strength
but a happy mind is good medicine.(17:22) ”
First published in
The Fibromyalgia Times, 3(3), 14-15, 1998
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