Fight the Downward Spiral by Activating Positivity in Your Life
The following is adapted from The Language of Pain by Dr. Trevor Campbell.
Chronic pain is not established overnight. It takes time to develop, a period patients often describe as a “downward spiral.” Have you experienced this yourself?
When patients describe the downward spiral to me, they say their pain intensity has increased and their functionality has progressively declined, even though there has been no new tissue damage. Although they may not be aware of it, the downward spiral was preceded by the increasing absence of healthy behaviors, and that absence contributes to the depression, anxiety, and sleep problems they may experience.
In other words, you don’t stop walking to the corner store because you’re depressed; you’re more likely depressed because you’re no longer walking to the corner store.
Behavioral change is most often when the downward spiral begins.
If you’re in the midst of the downward spiral — or at the bottom of it — how do you begin to make your way back up? That’s what we’ll focus on in this article.
Small Steps Are Big Steps
When you’re at the bottom of the spiral, there’s only one way to go — up.
The counterintuitive truth is that when you’re feeling your worst, that’s the time to force yourself to be as active as you can, even if it means taking the smallest of steps, such as re-engaging with a friend. It sounds like a minor thing, perhaps not even like medical advice, but I believe that we physicians should give this kind of advice as readily as we hand out prescriptions, because friendships and social contacts are pivotal to our happiness and health, not just for chronic pain patients, but for all of us.
The sooner you begin to reverse, and later prevent, the downward spiral, the better.
One of the major red flags for the development of chronic pain is physical under- or inactivity in the acute pain phase. People who progressively restrict their activities and social encounters in the early days after an injury tend to fare worse than those who keep up some participation in their lives and communities, because the restrictions establish and set off that faulty alarm system of chronic pain.
Where Happiness Originates
You don’t have to alter your entire life to make a positive change; just a few well-chosen choices can make all the difference. In fact, in the field of positive psychology, where scientists analyze what makes people truly happy, most researchers conclude that there are only a few things that significantly make us happy after our basic needs are met — social connections, altruism, gratitude, meaning, and a sense of purpose.
It turns out that most of our happiness, by far, is derived from our social connections — social interactions and sense of community. Friends, family, and colleagues are what buoy us through our life. Collaborating, sharing, keeping an eye out for others, and being there for them are the essential ingredients of sustainable joy.
The happiness studies also showed that happiness can be achieved through altruism, gratitude, and finding purpose. The psychologist Martin Seligman conducted a study in which he asked participants to do several tasks that included keeping a gratitude journal, writing a detailed letter of gratitude to someone of their choosing, and trying to remember three blessings at the end of each day. After six months, most reported increased energy, decreased pain and fatigue, and increased well-being.
Most with chronic pain aren’t seeking out social opportunities or writing in gratitude journals — understandably so, if they believe that these activities will be painful and draining. They may not even realize it’s possible for them to do these things.
I admit, it’s notoriously difficult to change patterned behaviors or habits. If you’ve ever tried to eat less to lose weight, you’ll understand how tough that can be.
For those living with chronic pain, the barrier to behavioral change can seem too high, but remember that perception is a thought, and thoughts can be wrong. Too many chronic pain patients peer into the future with dark glasses, an outlook related to poor self-image, ongoing negative thoughts, and repetitive negative self-dialogue.
Thankfully, there are two ways chronic pain sufferers can combat this negativity.
The Power of Visualization
The first way to combat negative thoughts is visualization.
With visualization, where you consciously select a scenario that is both personal and desirable when you consider future possible outcomes. A good way to start is to free yourself of possible disturbances and to relax as much as possible.
Next, remember a time when you were free of pain and doing really well. Note how you felt about yourself, your body, the future, and the people closest to you. Then try to remember how you occupied your free time, noting all these details.
Try to keep this feeling of health, positivity, and contentment, and think of a future time. Imagine yourself doing a series of activities that you currently are unable to do, such as playing a sport or enjoying hobbies and note how you feel.
Then, using all your senses, take in the activity. For example, if you visualize cycling on a bike path, try to notice the smell of the pine trees, hear the birds, or feel the fresh breeze against your face. Lock in the details with some quirky observations, such as the rattling sound of your water bottle in the bike support. These unusual and small details really help to lock in the experience, as they also generally help with memory recall.
As you get to complete your visualization, make sure you have recorded it. Remember that if this is a new practice for you, it feels quite difficult and onerous at first, but as with all things, repetition and practice makes it easier. Then add other activities.
The benefit of visualization is that if we can imagine something in detail, then we move closer to the possibility of getting there, as the mind becomes less resistant to the idea and ultimately embraces the possibility. You then learn and practice to reach the goal much like a trainee pilot learns to fly on a flight simulator.
Affirmations to Lift You Up
Affirmations are another way you can handle negative thoughts.
Affirmations can be thought of as positively oriented slogans that you repeat to yourself to increase your motivation and confidence. In doing this, you’re trying to align your mental state toward success and positive outcomes with regard to health, achievement, and the future. These affirmations may be combined with visualizations.
Here are a couple examples of affirmations:
“I have the courage and endurance to face all obstacles.”
“If I persevere, success is assured.”
You’re encouraged not only to repeat these frequently but also to write them out.
Affirmations should be specific and written or spoken as if they’re already happening (i.e. in the present tense). It’s believed that if affirmations are repetitive, compelling, and resonant, the unconscious brain will evoke solutions to manifest them.
For more advice on fighting the downward spiral, you can find The Language of Pain on Amazon.
Dr. Trevor Campbell is a family physician who studied medicine at the University of Cape Town, South Africa, before emigrating to Canada, where he became interested in treatments for chronic pain. He has worked in multidisciplinary pain management and opioid reduction programs, and has served as medical director for a leading pain management provider in Western Canada. When not involved with medical matters, he enjoys literature and is an avid hiker, cyclist, and traveler.
