Nóirín Nealon Lennox has prepared this article exclusively for HOMS Assist.
If you had been diagnosed with chronic or persistent pain and you were on a journey of engagement with healthcare providers to reduce symptoms and to live a fuller life, the likelihood is that that journey has been interrupted or has changed direction in recent months. These changes can lead to worry and stress, and in turn, anxiety may add to already existing suffering.
Due to the global pandemic some healthcare resources have been diverted to other areas in order to respond to the threat of Covid-19. However, many resources that were not available or were hard to access in the past have now been made available online and are more readily accessible. These include coping strategies to help support the public in these uncertain times, such as mindfulness meditations, pilates and yoga, to name just a few. In fact, there has been such a surge in online support that it may even be difficult to wade through the choices and to find helpful resources for the particular individual needs of people attempting to live well with persistent pain.
With this in mind I have put together some easy to follow steps for coping with threats during these uncertain times; the threat of illness, the lack of clear resources, or the increase in symptoms of pain and associated anxiety. These steps for coping can help you build resilience that will allow you to focus on continuing your journey towards better health and prevent against further increases in pain itself, as well as preventing any increases in pain anxiety.
Recognising anxiety is the first step towards coping with it.
Below you will find two features of anxiety that will help you recognise it when it appears. The first is a common pattern our minds engage during times of threat and the second is a familiar pattern our bodies engage in times of threat.
When threat is present it is common for us to lose our capacity to step back and tune into clear thinking. Two familiar loops our minds can get attached to when faced with threat are what ifs and if onlys.
What ifs tend to be associated with the future: What if I get the virus?
If onlys tend to relate to past events: If only I had kept in touch with my friends more, I would have more support now!
When a new threat is present, the body will draw on previous patterns of responding to threat. The fight-flight-freeze response is the body’s automatic, built-in system, which is designed to protect us from threat or danger. However, if a threat is present for some time and the fight-flight-freeze response is sustained in the longer term, it can be unhelpful and impact our physical and mental health.
When fight-flight-freeze predominates, our focus can be increasingly directed inwardly. We tend to spend more time worrying about ourselves, communicating less frequently with others, and our compassion for ourselves and others can go off-line.
Coping Strategies for Anxiety
So we have seen that clear thinking and compassion can go off-line when we are frightened. Research has shown that when the following practical coping steps are taken, they can help redirect our minds’ and bodies’ habitual responses to threat. In turn symptoms of anxiety can be reduced and therefore fewer layers of suffering are added to the experience of persistent pain.
Let’s take a look again at 1. Mind and 2. Body, but this time through the lens of coping strategies:
Let’s look at the example of the What ifs. When you notice what ifs appearing, an effective strategy is to gently turn towards then what using an ADD approach. ADD stands for a series of 3 steps: Assess-Decide-Discuss. Here is an example below:
What if I get the virus, then what?
- Assess how likely this is, taking into account all the available information i.e. number of cases in your area, your exposure etc.
- Decide practical responses i.e. call G.P., order a test, decide where you would isolate etc.
- Discuss with family and friends, letting them know what your response would be if you get sick i.e. arrange to speak with a family member every day if you live alone, monitor temperature daily, etc.
When this process has been completed, you can put aside the ADD and observe the mind’s chatter in the following days. You may notice the particular what if decreasing in frequency or you may notice the anxiety associated with this what if lessens. Awareness of having faced the what if and put a plan in place can provide comfort.
We have identified that the fight-flight-freeze response is our bodies’ helpful, built-in system that is designed to protect us from immediate danger. However, in the modern world this response can get activated when we are faced with events that are not immediately dangerous or life threatening, such as the experience of persistent pain, or the absence of our usual support systems. In addition, we know that prolonged activation of this response can negatively impact our physical and mental health. For example, when the threat is removed or when it is reduced, our bodies may remain in the fight-flight-freeze state.
Fortunately for us, and similar to the example above for 1. Mind, science has identified ways in which we can interrupt the body’s response to threat and activate more adaptive responses. These include an exercise called ACE: Acknowledge thoughts and emotions, Come into your body, and Engage with your surroundings.
The infographic below outlines this exercise in more detailed steps.
ADD stands for 3 practical steps that can be taken when the mind throws up a lot of What ifs. These steps are Assess, Decide and Discuss. When we face the What ifs, we can turn towards the Then whats and make a practical plan. This has been shown to reduce the frequency of what ifs and/or the associated anxiety when a threat is present.
ACE stands for a further 3 steps we can take to interrupt the fight-flight-freeze response to threat. Acknowledge thoughts and emotions, Come into your body, and Engage with your surroundings are 3 steps that can help bring focus and clarity to our experiences. Furthermore this exercise can help us feel grounded and connected in uncertain times.
Nóirín Nealon Lennox is a Health Psychologist and ACT therapist. She has specialised in working with people with Chronic Pain for over a decade. She is a member of the British Psychological Society (BPS) and she currently sits on the committee for the Division of Health Psychology (DHP) with the Psychological Society of Ireland (PSI). She is also a member of the Association for Contextual and Behavioural Science (ACBS).