Christie: So much of pain is wrapped up in fear. How might someone approach reducing their fear?
Daniel: From my perspective, there’s a multi-pronged approach to reducing fear. I teach all the clinicians that I work with that we want to focus on behavioral, emotional, and cognitive ways of decreasing fear. Behavioral, meaning physical behaviors, where we actually want to gradually expose ourselves to different behaviors that have triggered fear in the past. This is classic ERP (Exposure Response Prevention) which is used in OCD treatment and we kind of steal from that when treating chronic symptoms here. For example, with standing up and experiencing back pain, we want to first dismantle that back pain to know that it’s neuroplastic. Once we do that then we want to slowly and gradually expose ourselves to the thing that we are afraid of, which in this case is standing up. We want to actually lean into those fears. The thing that gets us over fear is leaning into whatever we are afraid of, it is often as simple as that when it comes to behavioral work. If you are afraid of the monster under the bed, the best way to not be afraid of the monster under the bed is to look underneath the bed.
The emotional aspect is that sometimes we are so triggered by certain symptoms we have experienced in the past that we have protected ourselves from a lot of the feelings around it. We haven't actually felt those feelings, so again we want to lean into those emotions and allow ourselves to feel them.
And also then the cognitive piece, so the way our thoughts work. If we are thinking about our pain or symptoms in a very specific, fearful way then we want to address that head-on. This is where a lot of CBT thought logs come in or even just generally understanding that our thoughts have no weight. Thoughts are just that, they are thoughts. They don’t have any meaning to them until we give them meaning. Until we think, “Oh I just had a thought that if I do this then this might be really bad for my back.” and then we spiral down. And those kinds of thoughts, as you mentioned earlier, can get really sticky. So we want to recognize that this kind of thinking causes a lot of fear in our bodies and that is exactly what is exacerbating this fear pain cycle.
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