Richard W. Hanson, Ph.D.
Sources of Stress
Chronic pain and psychological stress go hand in hand. Three sources of stress can be identified for chronic pain sufferers. First, the pain experience is in itself inherently stressful. Unless you happen to be a masochist, pain sensations are perceived as unwanted and undesirable. You tend to automatically fight and resist pain. Pain creates tension, both physical and mental/emotional. Physical tension typically manifests as elevated muscle tension in areas where the pain seems to originate. Of course other body systems react to tension as well (e.g., cardiovascular, gastrointestinal, and immune systems). Mental and emotional tension can take different forms such as increased frustration and anger, anxiety and worry, sadness and discouragement, etc. Unfortunately, the physical and mental/emotional tension created by pain tends to worsen the pain. This is illustrated by the following vicious cycle where pain leads to tension and tension leads to more pain.
The second source of stress refers to all of the negative consequences that the chronic pain condition has had on your life. Chronic pain can have adverse consequences on your employment, financial security, family activities, social life, hobbies and recreational activities, etc. Many find that dealing with doctors, medical clinics, and disability systems are stressful. Chronic pain and disability can also adversely affect your self-esteem and feelings of self-worth. All of these adverse consequences can be viewed as stressful.
The third general source of stress refers to all of the stressful life events and hassles that you encounter, probably nearly every day, that have nothing to do with the pain itself or the consequences of the pain on your life. We refer to this as the stress of everyday living. Unfortunately, when these everyday stressors get added on top of your pain-related stressors, the problem becomes much worse. As a result, you not only have chronic pain, but also chronic stress.
Effect of Stress on Pain
Whatever the source of stress, the effect on pain is usually to intensify it. Some people respond to chronic stress with excessive or prolonged activation of body systems. This in turn can create additional stress-related physical problems including headaches, muscle aches and pains, elevated blood pressure, upset stomach, bowel problems, etc. Chronic anger and irritability, or anxiety and worry can make you feel constantly on edge. Others respond to chronic stress with physical deactivation and loss of energy. They become depressed and listless, with little motivation or interest. Whether you respond to stress with excessive physical and emotional activation or deactivation and depression, the result in most cases is increased pain and suffering.
As a result of this important connection between pain and stress, we place a lot of emphasis on learning how to either minimize or cope better with stress and tension. Although you may not be able to completely rid yourself of pain, you can have a significant influence on your pain by learning how to better manage stress in your life.
Stress Management
The issue of stress management can be approached from two directions. One direction is to identify and change maladaptive ways of coping with stress. The word maladaptive refers to ways of coping with stress which may seem to work in the short run, but ultimately do not work and in many cases create additional problems in the long run. Examples of some common maladaptive ways of coping with stress include
In addition to changing maladaptive ways of coping with stress, the other direction is to find and make use of more healthy ways of managing stress.
Healthy Stress Management Procedures
It is important to understand that there is no single right way or best way to cope with stress. Your response to a particular stressful situation will depend upon several factors including the nature of the situation itself, how you perceive that situation, the degree of emotional distress that you are experiencing, and the specific coping options and resources which are available to you.
Following are examples of some healthier strategies for managing stress and tension:
Stress and the A-B-C-D Model
To get a better handle on the process of managing stress, we use the following simple A-B-C-D model where
A = Adverse situations or Stress-Activating eventsSome of the general stress management procedures which will be discussed include:B = Beliefs (thoughts) about stressful situations or events, i.e., how you mentally perceive these situations and what options you have to cope with them
C = Consequent emotional reactions to stressful situations or events (e.g., anxiety and worry, feelings of depression and discouragement, anger and irritability)
D = Decisions about what to Do or how to Deal with the situation or event, i.e., how you go about coping with it
1. Constructive problem solving aimed at directly altering A (the adverse situation or event)We will begin by discussing constructive problem solving and then address the issue of acceptance for those situations which do not easily lend themselves to problem solving. Next we will discuss the use of relaxation techniques to lessen both emotional distress and pain. Then we will discuss the issue of how distorted beliefs and perceptions often magnify one's emotional distress (see the section entitled, "Thoughts and Feelings").2. Examining and modifying B (beliefs about the situation) which may be causing undue distress
3. Constructive strategies aimed at reducing C (distressing feelings in response to the adverse situation or event)