- Psychologists and Back Pain
Psychologists have become involved with the management of back pain for a number of reasons. The most important of these is the fact that the distress caused by the organic injury is a psychological matter. It is true also that getting back into life is often a matter of learning how to manage and live with pain or disability rather than simple physical healing, and psychologists can assist in this adjustment.
In other articles I have written about the importance of deliberately trying to take control of one's life again, the need to build up activity levels, the value of hypnosis/relaxation/meditation for pain and stress control, and the critical importance of consciously choosing to have at least some pleasant experiences on a daily basis.
I have also recommended counselling to help to "get it off your chest", to "ventilate the problems". It gives a chance to bounce your ideas around, and to explain your pain, without being criticised for complaining. It can be a wonderful emotional support, and can help in lifestyle change. From a counselor you can get advice about specific problems that need to be sorted out. For example, sexual and relationship problems; diet; quitting smoking; cutting down on drugs.
There are other strategies that have been used to help people resume a more normal life style despite chronic pain. A very commonly used approach is called behavior modification. This aims to structure the injured person's situation so that there are plenty of rewards for improved activity levels and pain tolerance (like increased attention from other people for example), and few for continued pain behaviour. This approach has been very successful in helping to get people back to some kind of work, though it seems that it does not have much impact on the experience of the pain itself. In other words, the person's behaviour looks more normal, and this has a lot of significance for the individual's self-esteem and emotional stability, but the physical discomfort is not very much improved. People learn to live with the pain, rather than to reduce it.
There are some new approaches that have relevance to actually reducing the pain itself. Research into the expression of emotions, even the mere acting of emotional states, suggests an important impact on health status. In a series of studies men were encouraged to weep intensively and uncontrollably during regular weekly sessions. These men experienced a change in the levels of the male sex hormone, testosterone, which depended on their initial levels of the hormone. Those with low levels of testosterone at the beginning of the programme, raised them through crying leading to a long term increase of up to 30% following the crying experiences. They also reported feeling more assertive and comfortable with themselves and some actually grew more hair on their chests. All of this suggests quite profound changes within their bodies.
On the other hand, those men who started with initial high levels of testosterone, lowered them with crying. There was a coinciding drop in the levels of anger and aggression that these men reported. Of course the effects are likely to be somewhat different with women, but initial evidence suggests that women also achieve a kind of normalising of some hormone levels through the process of crying. The effects here have been less clear cut, apparently because women already use crying much more than men as a way of helping themselves to feel better. They may actually be doing much more than just temporarily feeling better. It is as though crying serves some kind of balancing function. In fact some other research has shown that tears may reduce some of the chemical imbalances that go with stress.
This line of research has direct relevance for people suffering from chronic pain. Typically they show distortions of emotions such as increased irritability and anger, high levels of stress and bouts of depression. Being willing to deliberately cry from time to time may help in the restoration of the body's normal chemical balance and therefore stabilise emotions and even reduce the subjective experience of pain.
Other research work with facial expressions indicates that a people can alter their feeling states and the activity of their immune systems by putting on a happy or sad face. Norman Cousins, an American medical doctor and writer, described dramatic improvements obtained in his own health, including the reduction of chronic pain, when he used laughter as his treatment. He found a whole series of funny videos, like Candid Camera and Bill Cosby programmes to watch on a daily basis, and the improvements followed.
An important point to remember is that these kinds of changes are not just "in the mind". The improved emotional condition is experienced in the body. For instance, when research subjects were trained to control their facial muscles and to form smiles voluntarily, their physiologies immediately changed and hormones, and white blood cells circulating through their bodies altered drastically. Similarly, when students watched a film on the theme of selfless love and compassion, they experienced immediate increases in the levels of protective antibodies circulating in their blood.
What all of this means in practice as far as people with chronic pain are concerned, is that they may directly improve their condition by deliberately crying or smiling more, by improving their posture, and by exposing themselves to laughter and other emotionally uplifting experiences. They may not feel like doing any of these things, but deliberate exposure to them may still have strong positive effects.
More readings will be added to my blog from time to time. Have a quick look now to see the first posting on my blog PSYC1PLUS