1. The Perception of Personal Control
Psychologically healthy people believe that they are able to exert considerable personal control over most aspects of life that are seen as important to their happiness and sense of well-being. Psychologists refer to this as having an "internal" as opposed to "external" locus of control. Those with an external locus of control believe that their lives and their happiness is determined by forces outside of themselves. Outside or external loci of control may include powerful others or impersonal factors such as fate or luck.
While believing that they are in control of their lives and masters of their own fate, healthy people also manage to avoid the mental fallacy (cognitive distortion) of excessive personal control and responsibility. Instead, psychologically individuals are able to accurately differentiate between those aspects of life over which they have control and those aspects over which they do not have control. Some unpleasant situations and events in our life over which we have no control must be accepted. Attention and energy can then be focused on those aspects of our lives which we can control. There may be very little you can do about the mere fact that you have pain and physical limitations. However, there is a great deal you can do to cope more effectively with chronic pain and physical limitations.
2. The Inevitability and Desirability of Change
Healthy people recognize and accept the fact that change is inevitable throughout their lives. Changes can occur for better and for worse. While we can easily rejoice over positive changes and accomplishments, we know that life is inevitably filled with disappointments and losses as well. Things do not always turn out as expected. It is perfectly normal to feel sadness and grief over losses and disappointments (e.g., loss of health and physical capabilities). However, psychologically healthy people eventually learn to convert negative change to positive challenge. Learning to live a reasonably happy and productive life despite having chronic pain can be a major life challenge.
Healthy people also recognize that the absence of change is undesirable. The absence of change usually means being "stuck in a rut." Many people with chronic pain and disability get stuck in ruts. Their lives become overly restricted, routine, dull, and unfulfilling. The challenge is to break free of these ruts and bring about positive change and stimulation, despite the presence of chronic pain. These positive changes can occur by acquiring new knowledge, learning new skills, meeting new people, taking on new challenges, and so on.
3. The Value of Personal Commitments
Healthy people recognize that life has little meaning unless there are commitments to something or somebody. Commitments can help give purpose and positive direction to one's life. Of course a lot depends on what those commitments are. A certain amount of commitment can be made to oneself. Being committed to self-improvement and psychological growth are healthy commitments, since we can all stand to better ourselves. However, healthy commitments should extend beyond our immediate selves. Many people find meaning through commitment to their families. Others develop commitments to helping others who are more needy and less fortunate. Some become committed to certain causes and organizations including social and political causes, social organizations, or special interest groups. Others become committed to religious organizations, religious beliefs, or spiritual growth. Just because you have chronic pain does not mean that you have to give up commitments. Having healthy commitments can make it easier to cope with chronic pain.
4. Developing a sense of Connectedness
Related to having healthy commitments is maintaining a sense of connectedness. Healthy people recognize that when you feel connected to someone or something, that connection gives you a purpose in living. A major part of connectedness concerns maintaining healthy relationships with other people. This form of connectedness is a great antidote to feeling socially isolated, lonely, and alienated from others. Many studies have shown that having healthy social ties serves as a buffer against the destructive effects of stress. Feeling connected to other people promotes both physical and psychological health. These social ties may exist within your family, circle of friends, workplace, church, social organization, club, etc. Many persons with chronic pain find that participating in a chronic pain support group can be a way of developing a healthy feeling of connectedness. This sense of connectedness can also extend beyond people. A number of my chronic pain patients have experienced the benefits of maintaining a sense of connectedness with animals. Having a special pet who depends upon your care can be therapeutic to your body and mind. Others have even felt connected to plants. Knowing that the plants depend upon your care in order to grow and thrive can give you a sense of purpose. Dr. Kabat-Zinn, who emphasizes this sense of connectedness in his stress management program, also speaks of another form of internal connectedness. This has to do with developing awareness of the connectedness between your body and your mind. The more connected and harmonious you feel within yourself, the easier it will be for you develop healthy relationships with others.
Additional Healthy Attitudes
Following are some additional attitudes which have been identified as promoting both physical and psychological health.
An optimistic attitude has been shown to be associated with increased health and well-being, whereas pessimism is associated with depression and poor health. According to Dr. Martin Seligman at the University of Pennsylvania, one crucial issue is how people explain to themselves why a bad event occurs. Pessimistic people are more likely to blame themselves for bad things that happen, expect that the effects of whatever happened will last for a long time, and think that the unfortunate event will have an adverse impact on nearly all aspects of their lives. An optimist, on the other hand, may experience the same bad event as the pessimist, but see it very differently in his or her mind. Optimists are less likely to blame themselves for bad things that occur, but even if they do, they see it as a specific and momentary event. That is, optimists are more likely to view adverse events as temporary and limited to specific situations rather than long-lasting and all pervasive. An optimist with chronic pain views the pain as having only specific and limited effects on his or her life. Rather than allowing pain to dominate their entire existence and cast a negative shadow on everything they do, optimists view pain as only impacting specific aspects of their life for specific periods of time.
Self-efficacy is closely related to the sense of personal control as discussed above. It refers to a belief in your ability to exercise control over specific events in your life. Thus, self-efficacy reflects personal confidence in your own ability to handle difficult or challenging situations. High self-efficacy in a person with chronic pain reflects confidence in his or her own ability to cope with and manage the pain rather than feeling overwhelmed by it. Chronic pain patients with high self-efficacy also tend to rely less on medications and passive medical procedures.
Sense of Coherence
This concept was developed by Dr. Aaron Antonovsky at the Ben-Gurion University in Israel to help explain how some people are able to survive extremely stressful or traumatic conditions (e.g., holocaust survivors). People who have a high sense of coherence about the world and themselves possess three characteristics. First, they strongly believe that they can make sense out of both internal and external stressors (the stress is comprehensible). Second, they have a pervasive and enduring confidence that they possess the resources necessary to meet demands resulting from these stressors (the stress is manageable). Finally, they believe that these demands are actually challenges to which they can find meaning and commit themselves to (they can find meaning in the situation). A strong sense of coherence can help one successfully cope with even the most severe and disabling pain conditions.
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