A chronic pain cycle can begin when real physical pain interrupts daily life, then slowly shapes how a person thinks, feels, moves, rests, and connects with others. Pain rarely stays only in the body; over time, it can become part of an emotional and behavioral pattern that deserves compassionate support.

Chronic pain cycle
Pain management
Mind-body connection
Therapy support

In This Blog

	What the chronic pain cycle looks like
	Why emotions do not make pain imaginary
	The emotional side of chronic pain
	How therapy can help
	FAQ

Key insight: The chronic pain cycle does not mean pain is imagined. It describes how physical pain, nervous-system sensitivity, fear, avoidance, grief, and stress can influence one another over time.

In his counseling work, Bryan Van Vranken, MA, MBA, RMHCI, often meets people living with chronic pain after surgery, injury, cancer treatment, nerve-related conditions, repeated physical strain, or years of medically complex symptoms. Each story is different. Still, many people describe a similar pattern: pain interrupts life, distress grows around the pain, and the distress begins to make daily life feel smaller.

What the Chronic Pain Cycle Looks Like

The chronic pain cycle often begins with pain that makes ordinary tasks unpredictable. A person may wonder, “Will this get worse?” or “What if I cannot do what I used to do?” Those questions are understandable. Pain can affect work, sleep, relationships, movement, independence, and identity.

From there, many people start pulling back. They may avoid certain movements, activities, errands, social plans, or responsibilities. Sometimes avoidance is protective and wise. Other times, it grows because pain feels uncertain, overwhelming, or difficult to explain to others.

A common chronic pain cycle

Pain → distress → avoidance → decreased activity → sadness, anxiety, or hopelessness → pain feels heavier.

Over time, reduced activity can bring loss. Someone may grieve the life they had before pain, the version of themselves that felt more capable, or the ease they once had in their body. That grief can add emotional weight. The emotional weight can increase tension, worry, and isolation, which may make the experience of pain feel even harder to carry.

Why Emotions Do Not Make Pain Imaginary

One of the most important points is simple: the chronic pain cycle does not mean the pain is not real. Chronic pain is a real health concern. An NCBI Bookshelf overview describes pain as both a sensory and emotional experience, which helps explain why chronic pain can affect mood, relationships, movement, and daily life.

The body and mind are deeply connected. When pain persists, the nervous system can become more sensitive. Stress can increase muscle tension and guardedness. Thoughts can shift toward worst-case scenarios. The American Psychological Association describes how chronic stress can affect multiple body systems, including muscle tension, mood, and daily functioning.

This is not “all in your head.” It is a whole-person experience. GoodTherapy has explored this connection in the mind-body connection in chronic pain and in articles about how physical health and mental health can influence one another.

A compassionate reframe

Instead of asking, “Why can’t I just get over this?” try, “What is my body protecting me from, and what kind of support would help me respond with more steadiness?”

The Emotional Side of Chronic Pain

The emotional side of chronic pain often goes unspoken. Some people feel frustrated because their body no longer responds the way it used to. Others feel isolated because friends, family, coworkers, or clinicians may not fully understand what they are living with. Some carry constant worry about making symptoms worse.

There can also be grief. Grief for lost routines. Grief for independence. Grief for hobbies, work roles, intimacy, sleep, or simple activities that once felt automatic. These reactions are deeply human, not signs of weakness.

According to a 2024 CDC National Center for Health Statistics data brief, 24.3 percent of U.S. adults reported chronic pain in 2023, and 8.5 percent reported high-impact chronic pain that frequently limited life or work activities. Chronic pain is common, but the loneliness around it can still feel intensely personal.

Support is allowed

If pain is affecting your mood, relationships, sleep, or sense of self, a therapist can help you work with the emotional layer without dismissing the physical one. You can search GoodTherapy for a therapist who fits your needs.

How Therapy Can Help the Chronic Pain Cycle

Therapy does not replace medical care, and it does not promise to eliminate pain. Its role is different. Therapy can help reduce the added layer of suffering that builds around pain: fear, shame, isolation, hopelessness, all-or-nothing thinking, and the feeling that life has narrowed to symptoms alone.

In therapy, people often begin by understanding their own chronic pain cycle. From there, they may practice small, realistic shifts that support long-term well-being.

Therapy focus	How it may help
Thought patterns	Notice and gently question thoughts that increase fear, helplessness, or self-blame.
Movement fear	Reduce avoidance in gradual, supported ways that respect medical limits.
Meaningful activities	Reintroduce valued routines at a manageable pace instead of waiting for a perfect pain-free day.
Flare-up planning	Build coping tools for difficult days so setbacks feel less frightening and isolating.
Nervous-system support	Practice calming skills, pacing, mindfulness, or values-based choices that help the body feel less constantly on alert.

Research on psychological and mind-body approaches varies by condition and person, but some approaches have evidence for helping people cope with chronic pain. The National Center for Complementary and Integrative Health summarizes evidence on mind and body approaches for chronic pain, including relaxation, mindfulness, and multidisciplinary care. GoodTherapy has also covered pain reprocessing therapy and chronic pain as one emerging approach for some people.

Small Shifts That Can Make Pain Feel Less All-Consuming

Meaningful change is rarely immediate or perfectly linear. Still, small shifts can matter. Some people begin to feel less controlled by pain when they rebuild a sense of choice in the day. Others reconnect with activities they had avoided, even in modified ways. The pain may still be present, but it no longer defines every moment.

Try this now: the one-step pacing check

1. Choose one activity that matters but feels hard right now.
2. Name the smallest version that would still count.
3. Decide what support, rest, or modification would make it more realistic.
4. Afterward, note what helped, what hurt, and what you would adjust next time.

A helpful question is not always, “Why is this happening to me?” That question is understandable, but it can keep a person circling the same painful place. Another question may create more room: “How can I respond to this in a way that supports me?”

This is not passive acceptance. It is a flexible, compassionate response that can make space for engagement, connection, and meaning alongside the reality of pain.

Frequently Asked Questions

Common questions about the chronic pain cycle, emotions, and therapy support.

Q: What is the chronic pain cycle? +

A: The chronic pain cycle describes how pain, distress, avoidance, reduced activity, difficult emotions, and nervous-system sensitivity can reinforce one another over time. It is a way to understand patterns, not a judgment about the person experiencing pain.

Q: Does therapy mean chronic pain is all in my head? +

A: No. Therapy for chronic pain does not mean the pain is imaginary. It can help with the thoughts, emotions, behaviors, relationships, and stress responses that often develop around real physical pain.

Q: Can emotions make chronic pain worse? +

A: Emotions can influence the experience of pain by affecting stress, muscle tension, attention, sleep, coping, and activity patterns. This does not make the pain less real; it reflects how closely connected the body and mind are.

Q: What kind of therapy can help with chronic pain? +

A: Approaches may include cognitive behavioral therapy, acceptance and commitment therapy, mindfulness-based work, person-centered therapy, pain psychology, or trauma-informed support. The right fit depends on the person, the condition, and the goals of care.

Q: When should I seek support for chronic pain? +

A: Consider support when pain is affecting mood, relationships, sleep, movement, work, identity, or hope. A therapist can work alongside medical care to help you cope with the emotional and daily-life impact of pain.

You do not have to carry chronic pain alone

Therapy can help you understand the chronic pain cycle, reduce emotional distress, and rebuild steadier ways to move through daily life.

Find a Therapist Near You →

About the Author Bryan Van Vranken MA, MBA, Registered Mental Health Counselor Intern in St. Petersburg, Florida Bryan Van Vranken works with adults navigating chronic pain and illness, anxiety, depression, life transitions, stress, and injury recovery. His approach integrates person-centered therapy, cognitive behavioral therapy, mindfulness, and practical coping strategies. View Bryan Van Vranken’s GoodTherapy profile

Chronic Pain Reprocessing Therapy: Shattering the Cycle of Chronic Pain

If you’re one of the 100 million Americans who deal with chronic pain, you know how debilitating and depressing the condition can be. Pain reprocessing therapy is an approach to chronic pain management where therapists help individuals rewire their brains — which, in turn, causes that pain to subside in many cases.

Depending on the severity of the pain, it can be hard to relax, sleep, work, or otherwise enjoy life. And it can be downright depressing, too, as you begin wondering whether the pain will ever subside — or you’ll be forced to deal with it for the rest of your life. 

In many cases, it’s not uncommon for depression to cause stress and spiral into anger as those who suffer wonder what they ever did to deserve their pain. Even worse, the link between chronic pain and suicide is well-documented; 8.8 percent of those who committed suicide between 2003 and 2014 were dealing with chronic pain.

When most people think about treating chronic pain, they think about using drugs, engaging in physical therapy sessions, or trying alternative treatments like acupuncture and reiki healing. 

While such approaches can certainly help, an increasing number of individuals dealing with chronic pain are trying to heal using a technique called pain reprocessing therapy.

What Is Pain Reprocessing Therapy?

Therapists use pain reprocessing therapy as an approach to chronic pain management helping individuals rewire their brains — which, in many cases, causes that pain to subside.  In fact, one recent study found that 66 percent of those treated with pain reprocessing therapy were “nearly or fully” pain-free, while 98 percent showed signs of improvement.

In other words, just because someone might think they’re experiencing chronic pain doesn’t necessarily mean they’re actually feeling chronic pain. In fact, research suggests that chronic pain can be exacerbated by — or, in some cases, even caused by — neural pathways in their brains.

To illustrate, imagine somebody slips on ice and injures their hip on a cold winter day. This individual is no doubt experiencing serious pain in the aftermath of the injury, and that pain persists for several months. 

During that time, this person’s brain begins to “learn” about the injury and the associated pain. A year later, though the actual pain has fully subsided, the person still “feels” it because their brain is telling them it exists — even though their body appears perfectly fine when examined by physicians.

In such a scenario, pain reprocessing therapy can help this individual overcome their chronic pain by retraining their brains and “forgetting” what that chronic pain feels like — which can make the pain disappear entirely.

What Does Pain Reprocessing Therapy Look Like?

At the core of pain reprocessing therapy sits a technique called somatic tracking, which involves teaching clients to practice mindfulness, reexamine the way they think about pain, and do everything they can to view pain in a more positive and less fearful light. 

From a high level, pain reprocessing therapy consists of five steps:

1. Educating clients about the pain-fear cycle, where pain triggers fear, which causes more pain, which triggers more fear, and so on.
2. Helping clients understand that the pain they’re experiencing is not due to any physical ailment but rather stems from psychological conditions.
3. Leading clients through exercises to change their perception of their pain and break through the pain-fear cycle.
4. Helping clients respond to other threats with a more level head.
5. Encouraging clients to use the power of positive thinking to transform the way they interpret the world around them with a positive mindset.

By helping folks understand the role their brains play in chronic pain, they can proactively begin to heal by rethinking their pain and the external triggers that might amplify it.

The Benefits of Pain Reprocessing Therapy

There’s a reason pain reprocessing therapy has been generating a good deal of buzz recently: the approach to healing can deliver significant benefits.

Conquering persistent pain

First things first: Pain reprocessing therapy can help clients overcome chronic pain. This, in turn, improves their overall health and makes life more enjoyable.

Learning more about yourself and your capabilities

Pain reprocessing therapy teaches us that we have more power than we might think. Simply by reframing the way you think about pain and your experiences, you learn that it’s possible to overcome physical discomfort. This teaches a valuable lesson: What else have you been holding yourself back from? 

For example, someone who uses pain reprocessing therapy to overcome chronic pain might also have a fear of heights. After their experience with therapy, they might decide to tackle their fear head-on in a similar fashion. 

Having a healthier outlook on life

When you deal with chronic pain over a long enough timeline, it’s easy to get down on life. Once that pain is alleviated, you can develop a healthier outlook on the future — which makes life more fulfilling for you and those around you.

What to Do If You’re Dealing with Chronic Pain

If you’re dealing with chronic pain, take comfort in the fact you’re not alone. Beyond that, here are some ways you can make your pain at least a little more bearable.

Stay positive

While we don’t have control over many things in life, we do have control over the way we think about our experiences and the world we live in. By making a conscious effort to stay positive, you can alleviate stress and anxiety, which can help you feel better physically. 

Exercise 

Though it might seem a bit counterintuitive, research suggests that you can actually relieve your pain by exercising and releasing endorphins, which are nature’s painkillers. Of course, your chronic pain might prevent you from going on five-mile runs. But anything you can do to be active — whether it’s stretching, yoga, or walking down the street — can help.

Be social

Chronic pain can make you want to isolate yourself from the world. Resist these temptations. Spending time with other people can help you overcome negative feelings and become more resilient in the face of your chronic pain.

Search for a therapist

If the preceding three tactics aren’t working for you, it may be time to begin your search for a therapist and give pain reprocessing therapy a try. The right therapist can help you overcome your chronic pain by changing the way you think about it.

Ready to conquer your chronic pain and live your best life? Begin your search for a professional therapist near you today.

People are generally entitled to access their medical records, including progress notes made by mental health providers to document the progress of treatment. Increased use of online progress notes makes it easier than ever for people to access their mental health records. A small study published in the journal Psychiatric Services suggests these records can both strengthen and harm the relationship between mental health provider and the person in therapy.

Researchers followed 28 people seeking treatment for mental health conditions at the Veterans Affairs (VA) Portland Health Care System in Oregon. Each participant answered interview questions about their reaction to provider progress notes. When records were consistent with what happened in treatment sessions, when notes indicated that providers listened, and when providers openly discussed diagnoses, participants expressed positive feelings about their providers and their medical records.

However, some components of progress notes eroded the relationship. Information gaps, incorrect information, and outdated treatment details were common sources of frustration. Some people said their records contained diagnoses their providers never discussed with them, significantly decreasing trust.

They study’s authors suggest their research provides important clues about how mental health providers can use progress notes and in-session discussions to strengthen their relationships with people in therapy.

Feeling Burned Out at Work? Join the Club

[fat_widget_right]Burnout at work is increasingly common, significantly affecting performance and morale. Most companies are ill-equipped to treat worker burnout. Moreover, issues with company culture—such as job insecurity and pressure to continually do more while working with less—can cause or worsen burnout.

Scientists Test Deep Brain Stimulation as Potential Anorexia Therapy

Deep brain stimulation, which uses electrodes to electrically stimulate the brain, may reduce symptoms of anorexia nervosa, according to a small pilot study of 16 people. Participants’ body mass index (BMI) increased an average of 3.5 points during the study, and some experienced a reduction in anxiety and depression.

Chicago Leaders Use Cognitive Behavioral Therapy to Combat Violent Crime

A violent crime wave in Chicago has sparked international media coverage, with 812 people murdered last year alone. A cognitive behavioral therapy program that supports social skills, encourages trust, and offers healthy outlets for anger and aggression is trying to tackle the crime wave by improving the well-being of Chicago’s at-risk teen boys.

Researchers See Promise in Light Therapy to Treat Chronic Pain

Chronic pain is an intractable and complex issue, affecting as many as 100 million Americans. Many people with chronic pain turn to opioids to manage symptoms, but these drugs can be addictive and are not always effective. New research suggests light therapy might offer relief. Researchers still are not sure how this nonpharmacological remedy works, but they say it does appear to reduce symptoms.

Stressed by Success, a Top Restaurant Turns to Therapy

El Celler de Can Roca consistently ranks among the world’s top restaurants. The competitive restaurant world can be stressful, but the dining establishment’s owners have found a novel way to cope. Weekly staff sessions with an on-site psychologist offer a chance to blow off steam and discuss challenging emotions.

Schools Strained by Kids’ Mental Health Woes

In Wisconsin alone, 175,000 students have an undiagnosed mental health condition. These unmet mental health needs, which are often the product of traumatic experiences or chaotic home lives, can strain school resources.

Borderline personality (BP) is estimated to affect between 1.5% and 6% of people in the United States. Core features of BP include black-and-white, all-or-nothing thinking, intense, rapidly shifting emotions and difficulties with emotion regulation, challenges in relationships and with self-image, and a tendency toward impulsivity. All of these can exacerbate distress, decrease coping, and make it harder to function socially, at work, and in general. Furthermore, the prevalence of BP in people with chronic pain is significantly greater than in the general population (30%) and is linked to increased pain severity and poorer coping with pain.

Non-suicidal self-injury is a tool frequently used by those with borderline personality in an effort to decrease emotional pain and induce calm. Those who have BP often report both the absence of pain and an increase in well-being or feelings of euphoria when engaging in self-harm, both of which may reinforce the tendency to continue self-harming as a way of coping.

The Pain Paradox

The relationship between pain, self-injury, and BP is complex. Between 70% and 80% of those diagnosed with BP engage in self-injury to distance themselves from painful emotions and distressing thoughts. On the surface, it is perplexing that BP predisposes individuals to not only higher pain tolerance in the face of acute (short-duration) and self-inflicted pain, but lower pain tolerance, as well as greater pain severity and poorer coping, in response to chronic (ongoing) pain.

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The Overlap of Emotional and Physical Pain

Contrary to popular belief, there is no one “pain center” in the brain; multiple brain structures are responsible for the experience of pain. A complex and multifaceted experience, “pain” refers to sensing the location of discomfort, assessing pain severity, registering the quality of pain (e.g., piercing, hot, throbbing, intermittent, etc.), linking to memories related to pain, the emotional response to pain, beliefs one has about the potential for coping with pain, and the ability to devise and follow through with a plan for pain management, among others.

The current and rapidly growing body of research on pain has found that distressing cognitive responses, such as catastrophizing (“I can’t handle this pain; I’m never going to get better!”) and emotional responses, such as depression and anxiety, can worsen both pain severity and coping, as well as challenge one’s ability to stick with a pain management plan that may require patience, persistence, and possibly a temporary increase in pain severity (such as with physical therapy).

This relationship among thoughts, feelings, and physical sensations and their related brain structures is not one-directional: physical pain tends to increase distressing thoughts and emotions and impair coping; distressing thoughts and feelings and poor coping strategies are linked to worsening physical pain. Relatedly, employing adaptive coping, such as taking good care of one’s body via a healthy diet, exercise, and stress management program, and treating any issues related to anxiety or depression, can improve pain and general well-being.

The Brain and Self-Harm as Self-Medication

Borderline personality is associated with increased rejection sensitivity and a tendency to personalize others’ intentions and emotional states. This is thought to occur in part due to over-activation of the amygdala, a small, almond-shaped structure deep in the brain, and under-activation of the anterior cingulate cortex, or ACC.

The amygdala is involved in the experience of intense, often unpleasant emotions, such as anger and fear, as well as emotional memories. The ACC is involved in, among other things, decision making and regulating emotions. Recent research has found that BP is linked to having less gray matter density in the ACC and more in the amygdala, as well as decreased activity in the ACC and increased activity in the amygdala in response to viewing fearful or angry faces.

Theoretically, in response to perceived social rejection, the ACC should help assess the situation, turn down the volume on intense, negative emotions (calm down the amygdala), and help make a “rational” decision about how to handle the situation. This process is compromised in people with borderline personality. Emotional distress due to social pain is a frequent trigger of self-harm in those with BP.

Repeatedly self-harming is thought to stimulate the release of the body’s opioid and cannabinoid receptors, leading to feelings of increased well-being, relaxation, and euphoria. You may be familiar with the effects of exogenous cannabinoids and opioids (those from a source outside of the body). Opioid pain medications are exogenous opioids, and marijuana contains exogenous cannabinoids (the most well known of which is THC). Both substances can prompt feelings of pleasant detachment, pain relief, and euphoria, among other effects.

Self-harm has also been found to increase the predominance of theta brainwaves, which are associated with light sleep, deep meditation, and dissociation, or feeling disconnected from one’s thoughts and feelings. Other studies have found that those with a history of repetitive self-injury had lower cerebrospinal fluid levels of two neuropeptides (proteins) that are associated with analgesia (pain reduction): beta-endorphin and met-enkephalin. It is unclear if low levels of these neuropeptides result from severe childhood trauma, a biological predisposition, or some combination of these. Thus, self-injury appears to prompt the body to release pain-relieving chemicals and induce a trance-like state that blunts physical and emotional pain.

Challenges in Treating Pain

It remains an unfortunate truth that most medical and mental health professionals generally receive minimal or no education about diagnosing and treating chronic pain unless they pursue specialized postgraduate treatment in this area. Imaging, blood tests, and physical exams frequently fail to isolate a cause for many pain syndromes, which can leave both patients and providers feeling frustrated or on the defensive. In the absence of physical evidence for pain, providers may conclude that a person is reporting pain in an effort to gain attention or assistance from others, referred to as “secondary gain.” Providers may also conclude that overwhelming emotions are the sole cause of physical pain.

There is no definitive answer for why borderline personality would be so much more prevalent in people with chronic pain than in the general population.

Although some people do manufacture or exaggerate reports of pain, and emotional distress can be experienced via physical symptoms, the picture is typically more complex for most of those in pain. Furthermore, advances in genetics, immunology, endocrinology, and brain imaging are revealing biological correlates of many pain syndromes once thought to be purely psychogenic (caused by the mind), such as phantom limb pain, irritable bowel syndrome, chronic fatigue/myalgic encephalomyelitis, and fibromyalgia.

Providers who are not well informed about pain can leave pain sufferers both without a plan for pain management and vulnerable to feeling unheard and invalidated. In addition, those who react dismissively to reports of pain and distress are likely to trigger feelings of rejection and abandonment, particularly in those with borderline personality, who are already more vulnerable to these feelings. Overwhelming painful emotions may worsen pain and decrease the ability to manage it.

Why Is Borderline Personality Common in People with Chronic Pain?

There is no definitive answer for why borderline personality would be so much more prevalent in people with chronic pain than in the general population. Because pain is a complex, mind-brain-body phenomenon, one hypothesis is that pain that feels random or beyond one’s control may induce feelings of depression, hopelessness, helplessness, anger, and anxiety—all of which amp up pain. Invalidation by ill-informed providers is more likely to elicit poor coping, particularly in those who may struggle with coping already.

Reports of increased severity of pain and other bodily symptoms in those with BP are correlated with greater levels of anxiety and depression. When researchers have statistically controlled for anxiety and depression in those who have both BP and pain, symptom severity has been similar to that of those without BP.

Another possible explanation for the greater prevalence of BP in chronic pain is that when under significant and prolonged stress, everyone is vulnerable to psychological regression, or using earlier ways of coping that are not adaptive in adulthood. Factors associated with BP, such splitting or black-and-white thinking, emotional instability, impulsivity, and greater emotional intensity, may become more prominent when dealing with the ongoing stressor of chronic pain. Furthermore, because many who have borderline personality experienced trauma or neglect at a developmental stage prior to being able to express feelings verbally, regulate their emotions, or negotiate relationships skillfully, the regression prompted by pain may be both retraumatizing and leave those with BP or BP traits feeling unable to process overwhelming emotions directly. This distress may be acted out in interpersonal relationships with providers and others. In addition, unexpressed distress may be somatized, or experienced as bodily pain. This does not mean that a person cannot have an actual chronic pain condition and also somatize; the relationship between the two is often difficult to tease apart.

Finally, as stated above, clinicians unfamiliar with chronic pain may respond in a way that reactivates the experience of invalidation that is thought to be an important factor in developing BP.

Although there is no definitive conclusion as of yet about the reasons for the pain paradox in borderline personality, it appears to be the result of a complex relationship among the following: a biological predisposition to greater emotional pain, and a higher pain threshold for acute pain but a lower tolerance for chronic pain; the analgesic effects of self-harming; and the feelings of helplessness and rejection often inherent in the processes of seeking treatment for chronic pain. For those with BP, self-harming may serve what feels like an essential function in relieving emotional pain; yet, the ongoing and intense stress of chronic pain can overwhelm coping resources and diminish the ability to cope with either pain or the social, medical, and interpersonal challenges that accompany it.

References:

1. Ducasse, D., Courtet, P., & Olie, E. (2014). Physical and social pains in borderline disorder and neuroanatomical correlates: A systematic review. Current Psychiatry Reports, 16, 443.
2. Magerl, W., Burkart, D., Fernandez, A. Schmidt, L. G., & Treede, R. (2012). Persistent antinociception through repeated self-injury in patients with borderline personality disorder. Pain, 153, 575-584.
3. Mayo Clinic News Network: Irritable Bowel Syndrome. Retrieved from http://newsnetwork.mayoclinic.org/discussion/mayo-clinic-researchers-find-genetic-clue-to-irritable-bowel-syndrome/
4. Minzenberg, M. J., Fan, J., New, A. S., Tang, C. Y., & Siever, L. J. (2008). Frontolimbic structural changes in borderline personality disorder. Journal of Psychiatric Research, 42(9), 727-33.
5. National Alliance on Mental Illness (NAMI) – Borderline Personality Disorder. Retrieved from http://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder
6. Niedtfeld, I., Schulze, L., Kirsch, P., Herpertz, S. C., Bohus, M., & Schmahl, C. (2010). Affect regulation and pain in borderline personality disorder: a possible link to the understanding of self-injury. Biological Psychiatry, 68, 383-391.
7. University of Maryland: Chronic Fatigue Syndrome. Retrieved from http://umm.edu/health/medical/reports/articles/chronic-fatigue-syndrome
8. Light, K. C., White, A. T., Tadler, S., Iacob, E., & Light, A. R. (2012). Genetics and gene expression involving stress and distress pathways in fibromyalgia with and without comorbid chronic fatigue syndrome. Pain Research and Treatment. Retrieved from http://www.hindawi.com/journals/prt/2012/427869/

The National Institutes of Health (NIH; 2011) reports that approximately 5 million American adults—or about 2% to 3% of the general population—are affected by fibromyalgia. Of those individuals, 80% to 90% are women. People experiencing fibromyalgia commonly report widespread chronic pain, anxiety, a lack of energy, and erratic sleep patterns. But as some doctors are focused on developing drugs and treatments for the condition, other medical professionals doubt its very existence.

Fibromyalgia is a hotly debated topic in the medical community. The primary issue is that although doctors do recognize the chronic pain experienced by people with the condition and acknowledge that therapeutic programs are needed to help affected persons find relief, some doctors do not recognize fibromyalgia as a categorical illness. It has even been suggested that the condition might all be psychosomatic, existing only as an illness in the affected individual’s head.

Is Fibromyalgia All in Your Head?

Some health care professionals claim fibromyalgia is psychosomatic because there are no X-ray images, blood tests, or biopsies that will definitively indicate the presence of fibromyalgia. The condition is not quantifiable. The debate is further heightened by the fact that Dr. Frederick Wolfe—a researcher who spearheaded a 1990 paper that presented the world with a diagnostic protocol for fibromyalgia—has since stated that “fibromyalgia exists as a continuum rather than a dichotomous diagnosis.” In other words, fibromyalgia exists on a spectrum and not as a black-and-white illness according to Wolfe.

Wolfe’s assertion and other research has led to several medical professionals calling for a reclassification of fibromyalgia from a categorical illness to a spectrum health condition. However, any such decision could have significant repercussions. Andrea M. Risi, LPC, a Denver-based counselor and Topic Expert in health, illness, and medical issues, said, “The problem with a spectrum diagnosis is that it can be unacknowledged in the medical community. Some doctors refuse to diagnose a condition that’s not quantifiable (such as the result of an X-ray or blood test). Therefore, it can be difficult for the patient to find and obtain the most effective treatment with a spectrum diagnosis.”

What Is Fibromyalgia?

Fibromyalgia is a chronic pain syndrome characterized by fatigue, sleep disturbances, and tenderness. Localized pain is felt when light pressure is applied to tender points throughout the body, and the pain can spread to other areas when light pressure is applied to fibromyalgia trigger points.

The Centers for Disease Prevention and Control (CDC) reports that individuals with fibromyalgia demonstrate abnormal pain perception processing. As a result, affected persons might react strongly to stimuli that others do not find painful, such as the sharp ridges on a paper bag or the feel of one’s clothes on the skin. Individuals with fibromyalgia are also 3.4 times more likely to experience major depression than persons who do not have the condition.

According to the CDC, other common fibromyalgia symptoms include:

• Frequent headaches
• Tingling sensations or numbness in the hands or feet
• Morning stiffness
• Irritable bowel syndrome (IBS)
• Problems with memory and thinking (also referred to as fibro fog)
• Painful menstrual periods

While risk factors such as stressful or traumatic events, repetitive injuries, viral infections, obesity, genetic predisposition, and certain diseases (such as chronic fatigue syndrome) have been linked with fibromyalgia, the CDC says there are no known fibromyalgia causes. Fibromyalgia might also occur on its own according to NIH. Additionally, the United States Food and Drug Administration (FDA) says people with lupus, rheumatoid arthritis, and spinal arthritis are at greater risk for developing the condition. Despite the debate that exists on whether fibromyalgia is a psychological or physical illness, researchers are making strides toward developing strategies for effective fibromyalgia treatment.

Approaches to Treating Fibromyalgia

“A diagnosis of fibromyalgia is based entirely on the self-report of a patient and the use of a sliding pain scale. Pain tolerance varies from person to person, so self-reports of different patients are difficult to compare,” Risi said. As such, doctors often have to approach fibromyalgia cases on both per person and per symptom bases.

Pharmacotherapy, or treatment with the administration of drugs, is a popular method by which fibromyalgia symptoms are treated. People experiencing fibromyalgia symptoms are typically given pain medication, muscle relaxants, sleep medication, and antidepressants to address specific symptoms.

There are beneficial approaches other than FDA-approved drugs used to treat fibromyalgia pain too. Risi explains, “A healthy lifestyle is particularly important for people living with fibromyalgia. Low-impact exercise, massage, nutrition, yoga, acupuncture, physical therapy, and chiropractic treatments can all help manage the symptoms. All of these options keep joints moving and muscles loose, which can help ease pain. Many people find supplements like omega-3 fatty acids, turmeric, ginger, magnesium, and calcium help ease the pain as well.”

Risi also suggests that affected individuals can benefit from speaking with a qualified therapist.

The Benefits of Psychotherapy in Fibromyalgia Treatment

There is a split between health care professionals as to whether fibromyalgia is best treated as a physical or mental condition. What is clear, however, is that in addition to medication and relaxation techniques, emotional support is crucial to finding relief. Such support is especially effective when it is regularly received from family members, friends, and an experienced therapist.

According to Risi, “If a person is depressed or anxious about the illness, there can be a greater frequency and intensity in pain and flare-ups. A therapist can help identify negative thoughts, feelings, and behaviors that are adding to the pain cycle and when the person uses coping skills, those flare-ups can diminish.”

If someone you love is affected by fibromyalgia, be a source of comfort by showing patience, affection, and understanding. Increase your understanding of the condition and, if appropriate, encourage your loved one to seek the help of a therapist. A qualified mental health professional can help alleviate symptoms and some conditions that may accompany fibromyalgia.

Fibromyalgia can severely affect a person’s quality of life. Even when an affected individual looks healthy, they might not feel healthy. Ongoing research is revealing more and more about fibromyalgia and the best way to treat it, and with dedicated doctors continuously testing new treatments and understanding the nature of the condition, the future is looking brighter for people experiencing fibromyalgia symptoms.

References:

1. Atzeni, F., Cassisi, G., Ceccherelli, F. & Sarzi-Puttini, P. (2013). Complementary and alternative medicine in fibromyalgia: A practical clinical debate of agreements and contrasts [Abstract].Clinical and Experimental Rheumatology, 31, Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24373372
2. Cashin-Garbutt, A. (2013, March 22). Fibromyalgia: An interview with dr. frederick wolfe, university of kansas school of medicine. News Medical. Retrieved from http://www.news-medical.net/news/20130322/Fibromyalgia-an-interview-with-Dr-Frederick-Wolfe-University-of-Kansas-School-of-Medicine.aspx
3. Centers for Disease Control and Prevention. (2012). Fibromyalgia. Retrieved from http://www.cdc.gov/arthritis/basics/fibromyalgia.htm
4. United States Food and Drug Administration. (2014). Living with fibromyalgia, drugs approved to manage pain. Retrieved from http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107802.htm
5. National Institutes of Health. (2011). What is fibromyalgia? Fast facts: An easy-to-read series of publications for the public. Retrieved from http://www.niams.nih.gov/Health_Info/Fibromyalgia/fibromyalgia_ff.asp

Editor’s note: This story contains sensitive material and descriptions of childhood abuse and trauma that may be triggering to some readers.

My story focuses on two areas of trauma: childhood sexual abuse and the lasting effects of working in the field of law enforcement and rescue work. I am, for all intents and purposes, a normal adult—a college educated mother and grandmother. You wouldn’t know it to look at me, but I am a survivor of trauma for many decades.

In my family, I was known as the “spooky smart” child. As soon as I could talk, it became apparent that I had an intellect unlike other children my age. I seemed much older than my chronology would attest. It’s true that I did understand a lot; the saying about little pitchers having big ears was spot on. I could listen to those around me and because I was a little person; no one thought too much about what they said around me.

It didn’t take long for me to figure out that my father was emotionally distant—trying, but often failing not to repeat the abuse he received as a child. He never hit like his father before him, but the words were weapon enough against us. My mother was a black-out alcoholic who, for all of the good in her, spent her life slowly committing suicide by drinking herself to death. She would rather drink than face her demons and get help.

It began when I was about four years old. A family “relative,” the boyfriend of my great-grandmother, began sexually assaulting me and my sister, who was two years younger than I. When I learned he had touched my sister, I decided I needed to stop him.

I could not tell anyone about the abuse, as my dad was in the process of divorcing my mother. Any reports of any type could threaten his ability to maintain custody of us; something I understood, even at such a tender age. So instead of telling another adult, I made a deal.

I told him that he could do whatever he wanted to do, but only to me; he had to leave my sister alone from now on. I told him I would never tell, never yell—nothing. He could do anything to me as long as my sister was free of him. He accepted.

[fat_widget_trauma_ptsd_right]Over the course of the next 10 years he raped me repeatedly; always just outside my sister’s door so she could hear everything. I tried to stay as quiet as possible; even when he made me get on my knees and beg him to rape me. I cannot forget his greasy hair or the alcoholic sweat stink of his body and his breath on me while he used his adult-sized body against me.

As I grew up, around the age of 7 or so, I became involved in rescue work. My father was a cop on a specialized team sent to major accident scenes where someone must be extricated from the vehicle. He also assisted in other areas including search and rescue, looking for the lost, working in the local jail, and ordinary day-to-day beat cop duties.

Because he was a single parent, called out at all hours of the day or night, he sometimes had to scoop up my sister and me, taking us with him to the crime scenes. We stayed in his truck and I would try to occupy my sister so she didn’t look out the windshield at the crash. No child should see the death, grief, anger, and confusion we witnessed. Even though I thought of my dad as a hero for saving others, these are still scenes to which no child should be privy.

I too began learning these fields, taking an interest first in ambulance rescue work and later on to law enforcement. Since then, I have been involved in these areas. I worked with an ambulance crew at 11, becoming one of the youngest people ever to complete the EMT certification at 13. I would later become a police dispatcher, marry a man who became an officer, and have a son who decided to become Military Police officer in the Army.

My life has been spent helping others—being their protector, their advocate, a voice on the phone to help, to instruct them how to breathe life back into the lifeless body of their infant grandchild, trying to talk someone out of committing suicide or homicide. Sometimes I succeeded, but sometimes I failed. Needless to say, I have a somewhat overinflated sense of protecting others, often to my own detriment.

As an adult, I can now say I typically fell for men who would treat me abusively. I know now that I was searching for what I knew was familiar. Even if it’s wrong, familiar is comfortable. It wasn’t until just last year that I realized I needed help. In 2012, I began a relationship with a man I had known for a number of years before; we were friends and co-workers.

He is the first person to be in a relationship with me who was not abusive to me. I didn’t know how to handle it. The whole idea of a life with this man was at once both terrifying and desirable. I knew that while I’m okay overall, when I get angry about something I really overreact. I have thrown things in anger—never toward anyone, though; I have given up on relationships way too quickly, been too ready to believe I don’t deserve to be treated reasonably, all of the things which go hand in hand with abuse.

I couldn’t see any of that until I lived in a nonabusive household. Not being abused freaked me out. He and I discussed it many times and it was then that I decided to find a therapist and a therapy style which would work for me.

I contacted our employee assistance program. They gave a preliminary diagnosis of posttraumatic stress (PTSD) due to sexual and other abuse. They recommended eye movement desensitization and reprocessing (EMDR) therapy for me and gave me the name of a therapist. She did not work out at all. She was truly only worried about the money, not the people she treated. Her half-hearted attempts at helping me did worse than nothing —I was full of uncertainty, emotions, and questions to which she had no real answers.

So I decided to look around on my own. I did some searching and found a therapist who was specifically trained in first responder trauma, a type of trauma that affects those personnel who first respond to crime scenes. He also treated sexual abuse trauma.

Another nice addition was that he was familiar with the trauma of chronic pain and disease. I have rheumatoid arthritis and fibromyalgia, as well as issues related to the removal of my thyroid gland. I am in pain constantly and will be for the rest of my life. My health is overall sound and I have great doctors, but even that can’t compensate for the physical and emotional trauma these diseases offer. I contacted him about my situation and he agreed to let me interview him and vice versa as a potential patient. This invitation was to become the beginning of the rest of my life.

I have been in therapy for only a few months. In that time, I can say I have never felt better overall about myself, my health, and my place in this world. Yes, I am scared. I am scared of what will happen when I begin to feel things again, about traveling back in time to those places, about the idea of bringing up and reprocessing these memories—all of it.

Some days I feel like I can take over the world; other days I can cry at the drop of a hat. I am nervous about the type of person I will become over time and whether I am strong enough to live with it. I am nervous about trusting anyone with my mind and allowing them to help me change. It is a good struggle; I can feel it is worth it.

To anyone with trauma or involved in the treatment of it, I offer my story. My life was filled with visions of unimaginable horror. I have seen more death, destruction, and hate than anyone ever should. But I know I will survive and thrive in the future. To do that, I must deal with the demons of my past and decide that they will no longer direct that future. I have removed control from them. Now I’m practicing keeping that control.

With the help of my therapist and the support of my mate, I look with a cautious smile toward my future. If you are troubled, I hope you will soon be able to do the same. Your situation is unique, but that doesn’t mean you are alone.

Most people get a massage in order to relax, perhaps a pleasurable way to unwind after a long work week. Others go to address some physical discomfort or injury. Maybe your lower back aches from sitting too much in front of a computer. Massage can be a sumptuous delight that treats your body’s aches and pains.

But it can also be an effective choice of treatment for a number of psychological issues: depression, attention-deficit hyperactivity, and posttraumatic stress, to name a few. After a massage, we may find our spirits have been lifted, or that we’ve broadened our everyday perspectives. The opportunity is one for self-awareness.

The benefit of massage on mental health is not a surprise if we think about the connection between the mind and body. The body is a miraculous manifestation that gives us direct access to unknown parts of ourselves. The body revealed by posture, muscle contraction, and flexibility demonstrates the sort of armor we use to protect ourselves in a sometimes difficult world. For instance, an individual with depression might tense up or constrict the stomach or back in order to be less vulnerable to particular emotions.

[fat_widget_right]The massage therapist is as much a student of the mind as they are of the body. The massage therapist bears witness to our mounting stresses and vulnerabilities, and helps unblock the passageways that allow us to fully breathe in life. They soothe feelings of angst that cause depression, and prevent us from connecting to our bodies and experiencing joy.

An observant massage therapist need only consult a client’s muscles to gain an understanding of their psychology. For instance, some individuals’ muscles may come across as more or less penetrable. A hardened collection of back muscles can serve as a force field, making it difficult to reach deeper layers of musculature. Such a force field is simultaneously physical and psychological. Psychologically, it may represent a general distrust or impermeability to others. Granted, such armor can be invaluable in adapting to threatening situations.

If the client is unaware of this “body armor,” the therapist has an opportunity to bring it to the their attention. With such awareness, the individual may choose to slowly “disarm” if they are carrying “unnecessary armor.” While massaging, the therapist may ask the client to “breathe into it,” which encourages the development of a deeper trust. Every point of contact on the body is an opportunity for self-awareness. Psychological healing occurs when we sink into the reality of our bodies.

Technological advances in communication can paradoxically leave many feeling more isolated and alone. When that happens, our life forces may dwindle. We communicate with greater numbers of people, especially online, but it may be less direct contact and interaction. The mind and body become estranged from physical and emotional stimulation. You may then experience feelings of dissociation, depression, or detachment. What is needed is a return to a nurturing touch, both physically and emotionally.

Depression can be seen as an estrangement from a caring world. The sense of being “held” in a massage awakens a feeling of being cared about, as the therapist’s focus is a kind of concentrated care for the client. Massage offers an opportunity for learning a different way of being. Your body may begin to realize that you don’t have to tense up so much when work gets stressful. If depression is the expectation that you will not receive the connection and nurture that you need, a massage can rattle the rigid sense of isolation. Rigidity then dissolves. It liquefies into the stream of life.

The uninvited house guest often stays on well beyond the point of “wearing out his or her welcome.” Likewise, for many people, chronic illness/disability is not a short-term inconvenience but rather a long-term, often permanent way of life. In the early stages of adaptation, the changes that happen in our lives and families may seem tolerable—at least while we still think there is a chance that the diagnosis is wrong or the cure is in the magic pipeline offered by big pharma.

Eventually, denial and bargaining give way to anger and depression. The uninvited guest is still ever-present, and no amount of cajoling or suggestions result in change. Bouts of anger may become a way of life for a while.

Anger
Many people flow in and out of anger and depression, rather than progressing neatly through one stage and into the next. It is often said that depression is anger turned inward, which makes expression of anger in a safe and effective way very important. Getting adequate support from formal and informal support networks is critical.

It is not unusual for tempers to flare and fuses to shorten during this period of adjustment. People who are typically long-suffering seem to be constantly on edge; those with fewer coping skills may be in a chronic state of agitation and irritability, if not outright rage. It often seems as if they are pushing away those who are closest to them at the time when they need them most.

Loved ones may unconsciously spend less time with the person who seems to find fault in their best efforts. Children are often left confused and afraid. Doctors and other providers frequently find themselves being blamed for their inability to help. This is all part of the process of adaptation.

While most people understand cognitively that their loved one is struggling and coping as well as can be expected, their own feelings of inadequacy and powerlessness may lead them to retreat on some level—if not physically, then emotionally. This often feels like abandonment to the person who is already overwhelmed by disability or illness. It is very important for caregivers and loved ones to be aware of their own feelings and find support.

Coping skills: Separate the person from the behavior. Try to remain aware of the real target for your anger—the illness or disability, not the person in your midst. Remember that we often treat those we love the most with the least respect; make amends as soon as possible if you do so. Give each other a break and extend the benefit of the doubt when possible. If your loved one treats you badly, remember that everyone is under extreme stress and doing the best they can at that moment. It is also good to remember that your caregivers and medical providers are probably not inadequate, but the resources they have to work with may be.

Caregivers and loved ones should speak up if they are being treated badly. Being sick is not an excuse to mistreat people, particularly if there is a pattern of abusive behavior developing. These behaviors need to be identified and discussed in a calm, loving way (not in the heat of the moment). This may require professional help, or perhaps the assistance of a minister or family friend who is not emotionally involved.

Most of the time, the person who lashes out or treats people badly feels guilty and needs the opportunity to make amends. For those who are unaware of how their behavior comes across, specific examples of the unacceptable behavior or hurtful/abusive language helps them develop a better awareness of their inappropriate behavior. In some cases, this is a manifestation of the illness or disability. In others, it may be the result of coping skills that are maxed out. Either way, left unattended, it usually gets worse. This is not the time to let conflicts and hurt feelings stack up. If you need help addressing these issues, ask your medical provider for a referral. Providers often have therapists or chaplains they work with who may be able to help.

Depression
Depression often occurs during the adaptation process, and may happen at other times or continue. Clinical depression can be very difficult to manage. It is more than sadness or disappointment; depression is a collection of symptoms that exist most days for two weeks or longer and create some level of impairment in daily functioning. The symptoms may include many of the following:

• sadness/tearfulness
• low energy or agitation/irritability
• loss of interest in things previously enjoyed
• problems with concentration/foggy thinking or trouble making decisions
• changes in sleep or eating patterns
• feelings of guilt or worthlessness
• thoughts of death or suicide/not wanting to live
• rumination/negative thinking
• others (physical pain, changes in motor skills, etc.)

If you or someone you know have four or more of these symptoms that are present for more days than not over a two-week period, talk to your medical provider about getting help.

There is also a type of depression called situational depression that is a normal reaction to a loss or change. Almost all people with chronic illness or disabilities and their loved ones experience this. The same symptoms are involved, but the symptoms may not be present most of the time, or may not be severe enough to impair your ability to function (relationships, work, taking care of your kids, etc.).

Situational depression can linger or become more serious after a while, becoming clinical depression. If the symptoms begin to impair functioning or last longer than a few weeks, it is wise to speak with a medical provider or therapist. People with situational depression are often able to experience periods of happiness when receiving good news, or other momentary reprieves from the darkness of depression. Those with clinical depression may be unable to experience even brief moments of relief when the situation calls for it.

The best treatment for depression is believed to be a combination of talk therapy, exercise (I know—it is very hard to exercise when you are depressed), a good diet, and medication, if deemed medically necessary. The right intervention for depression depends on which type of depression you are experiencing. For those with a few symptoms that are not present all the time, self-help may be sufficient. People with four or more symptoms that are present most of the time probably need to see a therapist and possibly a psychiatrist.

Anyone who is suicidal should seek professional help immediately. This national hotline is for people struggling with depression. The crisis line is staffed 24 hours a day by trained volunteers: 1-800-273-TALK.

Coping skills: I recommend that people talk with a therapist when dealing with situational depression and try to get as much activity in as possible. This may mean simply walking outside to get the mail, sitting on the porch for 20 minutes to have a cup of coffee or juice, watering the plants, or walking the dog. Sunshine is another natural remedy that increases vitamin D, which is often deficient in people who are depressed and those who do not go outside often. Eating properly is also critical, and there are natural supplements available at your local health store that may help with situational depression. Talk to your medical provider or therapist about these options.

Support groups and self-help groups can be very helpful. Groups provide a great resource for people living with chronic illness and disabilities and their loved ones. You can find online and local resources, and most are free. Many are affiliated with local hospitals or nonprofit agencies that serve people with chronic illness or disabilities.

If depression is serious enough to impair functioning, or you/your loved one has thoughts of suicide or not wanting to live, it is important to get professional help immediately. Start with your medical provider or therapist unless the person with depression has a plan to cause self-injury or death.

In situations where someone’s safety is at risk, call 911 or the local emergency number for your area, or take the suicidal person to the closest emergency room. Your role in the situation is not to intervene, but to get professionals involved as soon as possible. If the suicidal person is unwilling to go to the ER (or medical provider’s office during business hours) or you believe it may be unsafe to transport them, simply call for the emergency medical providers to come to you.

Don’t worry about the person who is suicidal being upset by your actions—when people are in crisis, they are usually not thinking clearly, so it becomes crucial for you to make good decisions on their behalf. The medical professionals who are trained to help in these situations will make the decisions once they arrive. This will likely mean that the person who is suicidal will be transported to the hospital for an evaluation, and may need to stay there for a few days until stabilized.

Again, it is not up to you to make that decision, only to make sure the person is safe until medical professionals can take over. It is a lot of responsibility and instills fear in most of us, but in the end, when your loved one is thinking rationally again, he or she will likely be grateful. If not, you will know that you have done what you needed to during the crisis.

Ongoing thoughts of suicide or not wanting to live need to be addressed with mental health and/or medical professionals regularly. Some states (Washington, Oregon, and Montana) permit medical professionals to participate in a well-thought-out, documented plan to end life (known as rational suicide), but most do not. Discussion of a patient’s end-of-life wishes should also be considered carefully and documented in a legal document for your specific state. Legal resources such as a living will specifically identify a person’s end-of-life wishes.

It is a good idea to talk about signing a consent form that allows you to discuss your loved one’s mental health (and physical) treatment with medical providers and therapists. This will enable you to enlist their help if depression becomes unmanageable or a crisis occurs. The consent can be relinquished at any time if the patient is considered to be of sound mind, and could be a great resource. Fortunately, resources are available to assist you in being prepared for a suicidal crisis should you need them.

There are many issues to be discussed regarding suicide, including family members’ thoughts and feelings about it. It is important to remember that euthanasia is against the law in all U.S. states, and assisted suicide with the help of a physician who prescribes a lethal cocktail after careful planning and documentation is legal only in Oregon, Washington and Montana. Legal professionals should be consulted if “rational suicide” is something you or a loved one is considering.

Adaptation
Using the analogy of the uninvited house guest, this is the period when people have settled into their routines and learned to live together with whatever adjustments are necessary. The initial period of adjustment after a disability or illness almost always requires going through each of the stages in the process outlined here. It can take a long time for some to arrive at adaptation, and not everyone in a family gets there at the same time. With some luck, a lot of support, good communication, and teamwork, the process will likely resolve in time for most people.

Unfortunately, surviving the initial period of adjustment does not ensure there will not be others. As mentioned earlier, people tend to get emotionally triggered when there are relapses or new symptoms/stages of the illness or disability occur. Triggering means that some reminder of the initial trauma (usually diagnosis or the actual accident or illness) sets off the same cascade of emotions experienced at the time of the original event.

Living in fear of a relapse or a change in physical status creates a certain amount of anxiety for everyone. The unpredictability of living with a chronic illness or disability will be the focus of our next article.

In the meantime, please share below how you have effectively coped with anger and depression.

I almost always suggest to clients that they learn focused abdominal breathing and practice a minimum of 5 minutes every day; for the best results, I recommend they practice 20 or more minutes per day. Sometimes they look at me funny and ask “You mean all I have to do is just breathe and everything will be better?” I tell them that no, everything is not going to magically change to exactly what you want in life, but learning and practicing focused abdominal breathing every day WILL do this for you:

1) Special breathing techniques can help reduce physical pain. Often when people are in pain, they breathe in a very shallow, disordered pattern. They also may frequently hold their breath without even realizing it. These are mostly unconscious protective reactions to pain, but they can actually increase the level of pain. Several recent scientific studies have shown that breathing at a slower rate from the diaphragm can significantly reduce sensations of pain.

2) Breathing helps to properly balance oxygen and carbon dioxide levels in the body.  Breathing properly from the diaphragm will:
•    Fuel energy production
•    Improve focus and concentration
•    Increase relaxation and calmness
•    Reduce tension and anxiety
•    Eliminate toxins
•    Strengthen the immune system
•    Improve bowel function
•    Lower blood pressure
•    Increase metabolism, aiding in digestion and weight loss

On the other hand, not breathing correctly can cause problems for a number of systems in the body, including the immune, circulatory, endocrine, and nervous systems. Improper breathing can produce various symptoms including:
•    Difficulty focusing attention
•    Dizziness
•    Numbness
•    Anxiety
•    Chest pain
•    Digestive problems
•    Irritable bowel
•    Neck and shoulder pain

3) Breathing releases emotional energy that is trapped in the body. People with anxiety and/or depression are almost always (and I mean 99.9% of the time) either breathing very shallowly or frequently holding their breath. Holding the breath is one of the most common ways that people stop emotions from coming up (think about the last time you tried not to cry, feel afraid, or get angry). Once you hold in an emotion it stays trapped in your body, until you release it. Breathing allows stifled, buried emotions to finally start to surface and be released.

4) Breathing keeps you in the present moment, instead of the past or the future. People with depression are often stuck in thoughts about the past, and people with anxiety are stuck in thoughts about the future. When you’re concentrating on your breathing, you are paying attention to your body sensations, the sound of your breath, and the process of breathing, all of which are happening RIGHT NOW. When you’re paying full attention to RIGHT NOW, you take AWAY energy and attention from the thoughts about the past or future. When you bring your attention to NOW, you automatically feel calmer.

Using the breath is a way to learn how the body and mind are connected. This is why I teach proper breathing to clients. Thoughts are directly related to feelings in the body and likewise, body sensations give rise to thought patterns in the mind. Mind and body are in a constant dance of influence, and it is important for people to learn that they have more choice and control in the matter than they thought.

Basic Instructions for Focused Abdominal Breathing
More than likely, if you are experiencing depression, anxiety, or pain, you are breathing shallowly from your upper chest. You want to train yourself to breath from your diaphragm/abdomen. Although it’s most effective to have someone teach you the process in person, here are the basic steps:

1) Sit in a comfortable upright position with your back against your chair and your feet on the ground. Keep your back straight, but let your shoulders and the rest or your body be very relaxed.

2) Place your left hand on your abdomen. Imagine that the entire area from your lower abdomen up to your chest is one large, rectangular balloon. Now, start by exhaling as completely as possible. Empty out as much air as possible. Your left hand will move inwards as the “balloon” area deflates. Now, slowly and gently, inhale, imagining that you are filling the balloon starting from the bottom, all the way up to the top. When you are breathing correctly from your abdomen, your lower abdomen will inflate, followed by your chest expanding, and your left hand will be pushed outward. Your shoulders will not go up, they will stay in place. When you inhaled did your hand move? Or did your shoulders go up instead? If your shoulders rise up when you inhale, you are breathing from your upper chest. Exhale and try again. This type of breathing may take a little practice to get the flow going. Work on this step until you can fill and empty the “balloon” completely. Then add the next steps.

3) Now that you are breathing abdominally, relax into a natural breathing rate. Your body will take over the breathing and settle into its own rate and depth. Your job is to just observe your breathing. Focus your attention on the tip of your nose and intently notice the pressure, temperature, and sensations of the air passing in and out of your nose. If it helps you to focus, you may also silently say “breathing in” on your inhalation and “breathing out” on your exhalation. Do this focusing for 5 minutes a day to start with, and work up to 20 minutes or more per day.

4) During your focused breathing session, especially when you first start practicing, you will more than likely notice that you are thinking about something else other than breathing. Thoughts have intruded into your mind and distracted your attention. When this happens, try not to react with any emotion (such as frustration). Just gently and silently allow the thoughts to drift upwards far away in to the sky like a soap bubble and then turn your attention back to your breath. At first you will find yourself re-directing your attention many, many times each session. Over time you’ll be able to maintain focus on your breathing for longer and longer periods of time and it will get easier to let go of intruding thoughts. It will even become easier to let go of unhelpful thoughts you have during the rest of the day (such as disturbing thoughts of the past or worrisome thoughts of the future). The most important thing is to keep doing the focused breathing every day, no matter what.

Open, full, unrestricted, unobstructed breathing is very important for your physical, mental and emotional health. It is something simple that can make a very big difference in your life. There are many things in life that we have no control of, so doesn’t it make sense to do the things we can have some control over? You can actively affect your own physiology and mental/emotional state just by mastering the art of breathing, focusing, and being present.

Related articles:
Deep Breathing and Guided Imagery
Alcohol and Anxiety: Not As Helpful As You Think
Managing Your Moods Through Mindfulness

Binaural beat technology (BBT) was discovered in the early 1800s and first described in the popular literature in the early 1970s. In the last four decades, binaural beat audio programs have been touted as tools for reducing stress, improving sleep, enhancing concentration, and even fostering altered states of consciousness. In the ‘70s and ‘80s, BBT audiotapes were primarily found in more esoteric venues, such as New Age bookstores, health food emporia, and retreat centers dedicated to consciousness exploration. One such center, the Monroe Institute in Virginia, is well known for their use of Hemi-Sync recordings, which feature BBT.

Today, BBT has become more commonplace, as one can download MP3s and smartphone applications in a matter of moments. Although the prevalence and popularity of such products has waxed and waned, several studies examining the potential usefulness off BBT have been conducted with a variety of populations.

What is BBT?
The term “binaural beat” refers to the brain’s tendency to hear the difference between two similar tones that are played in opposite ears as one new tone.  Our ears hear tones in terms of hertz (Hz), or cycles (the number of times a wave repeats itself) per second. Beats played at frequencies that are characteristic of brain wave frequencies are both audible and thought to facilitate alterations in our predominant brain-wave state.

Types of Brain Waves and Their Associated States
At any given time, our predominant brain wave may be in the frequency associated with deep sleep or deep trance (delta; 1-4 Hz), meditation (theta; 4-8 Hz), relaxed awareness or daydreaming, (alpha; 8-12 Hz), a state of relaxed focus (low-beta, or sensorimotor rhythm [SMR]; 12-15 Hz), alert mental activity/concentration (mid-beta; ~15-18 Hz), anxiety (high-beta; >18 Hz), or high-level information processing (gamma; >30 Hz). Gamma brain-wave states appear to be the least well researched. There is no “best” state to be in; however, at different times we will understandably want to be able to shift into one that is appropriate to the task at hand, whether sleeping, working on a project, or relaxing.

What Type of BBT for Which Conditions?
It has been hypothesized that a number of conditions, including chronic stress, chronic and postoperative pain, migraines and other headaches, problems with attention/concentration or learning, and insomnia, to name a few, reflect an imbalance or irregularity in brain-wave states. The deliberate use of BBT to change the predominant brain-wave state is referred to as brain-wave entrainment (BWE). BWE is not limited to BBT, but discussion of other methods is outside the scope of this article. However, a 2008 review of the BWE literature found that delta stimulation was associated with improvement in migraines and other headaches and reduction in short-term stress. A single session of alpha stimulation was associated with stress reduction in some settings, but not for those undergoing root canal. Alpha stimulation was also linked to pain relief. Beta improved attention, reduced short-term stress, alleviated headaches, reduced behavioral problems, and improved performance on measures of overall intelligence. An alpha-beta protocol improved verbal skills performance and attention, and a beta-gamma protocol showed improved arithmetic skills in children who had learning disabilities or attention-deficit hyperactivity. Most of these studies examined photic stimulation (presented via flashing lights) or combined photic and BBT entrainment rather than BBT alone. Thus, it is difficult to draw a definitive conclusion about the specific utility of BBT from this review.

BBT as a Potential Tool for Reducing Anxiety and Pain
The results of a small pilot study published in 2007 found that listening to an hour-long program emphasizing delta BBT for 60 days was associated with a decrease in self-reported trait anxiety and an increase in quality of life among eight healthy adults. The level of dopamine (an excitatory neurotransmitter) was also decreased significantly and may be related to the decrease in trait anxiety scores. Interestingly, the team assessed changes in the level of growth hormone because the BBT’s producer claimed that listening would increase these levels. Growth hormone decreases with age, and thus, an increase would be considered a potentially beneficial outcome; yet, listening to this BBT program was associated with a significant decrease in growth hormone. Both the reasons for this result and it’s implications are unclear.

Perhaps two of the more intriguing studies about BBT were the following trials with patients undergoing surgery. The first is a 2005 double-blind, randomized controlled trial in which 108 patients undergoing general anesthesia for elective surgeries received either a BBT plus music audio, the same music without BBT, or no intervention other than standard care for a 30-minute period prior to their operations. The BBT audio featured a progressively slowing beat that ended with 10 minutes of delta. No adverse events were noted, and although initial state anxiety scores were higher in the BBT group (prior to the intervention), the most significant decrease in anxiety was also in the BBT group—even after adjusting for the fact that participants in this group on average had higher initial anxiety. Listening to music alone was also associated with a significant decrease in anxiety, but this decrease was of a lesser magnitude than that of the BBT group. This study showed that an inexpensive, one-time intervention of short duration was beneficial despite the stress characteristic of undergoing surgery.

The other study was a randomized controlled trial of 60 patients about to have surgery with general anesthesia. Twenty patients were assigned to each of three conditions: a Hemi-Sync BBT program, listening to the music of their choosing, or listening to a blank audiocassette for 30 minutes prior to surgery. None of the participants was offered any sedative premedication. Stereo headsets from all groups of participants were removed before the patients entered the operating room but were replaced and the respective audio programs restarted after the induction of anesthesia. Headsets were discontinued at the conclusion of surgery. The researchers found that using the Hemi-Sync programs resulted in significantly less intraoperative use of fentanyl (a very potent, synthetic opiate pain medication), lower self-reported pain scores several hours after the surgery, and being discharged from the hospital sooner. Unfortunately, the specific frequency of BBT was not described in this article.

Anecdotally, several months ago I went for my first-ever root canal and noticed considerable anxiety at the thought of having a very sensitive tooth drilled (even with anesthetic). On the way to the endodontist’s office, I listened to both a guided imagery program designed specifically for medical procedures in which one must remain awake (available via HealthJourneys.com) and also to a free delta BBT program (Napuru) I’d downloaded for my iPhone. The delta tones were played against a backdrop of ocean waves. My subjective experience was that the BBT and imagery, combined with mindfulness practice before and during the root canal, reduced my anxiety significantly and enabled me to get through what seemed like an eternity of loud drilling. I cannot say what the most “active” ingredient in this integrative approach was; however, the point is that this nondrug, inexpensive, easy-to-use adjunct was effective for me.

BBT has been around for decades and is now readily and inexpensively available. There are some data to suggest that it may be helpful for relieving anxiety in general and in the context of a stressful event. There is also some evidence that BBT or other methods of brainwave entrainment may help with pain, concentration, headaches, and other issues, and serious risks or side effects have not been reported. The current research does not definitively answer the question of whether there would be a dose-response effect or a benefit from listening to BBT more regularly versus listening once; however, this seems plausible. More research needs to be done to better elucidate whether BBT could be used as an independent therapeutic tool, however. Additionally, assuming BBT is effective, one should not drive or perform tasks requiring sharp focus when listening to delta, theta, or alpha tones, as these may induce a very relaxed state.

For More Information:

1. Dabu-Bondoc, S., Vadivelu, N., Benson, J., Perret, D.,  Kain, Z. N.  (2010). Hemispheric Synchronized sounds and perioperative analgesic requirements. Anethesia & Analgesia, 110(1), 208-210.
2. Huang, T. L., Charyton, C. (2008). A comprehensive review of the psychological effects of brainwave entrainment. Alternative Therapies in Health and Medicine, 14(5), 38-50.
3. Padmanabhan, R., Hildreth, A. J., Laws, D. (2005). A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anesthesia for day case surgery. Anesthesia, 60, 874-877.
4. Wahbeh, H., Calabrese, C., Zwickey, H. (2007). Binaural beat technology in humans: A pilot study to assess psychologic and physiologic effects. The Journal of Alternative and Complementary Medicine, 13(1), 25-32.

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