Cognitive Behavior Therapy [CBT] for PHN people
Posted , 7 users are following.
On the "Depression with PHN?" forum, I've talked about CBT as probably the most effective and quickest route to decreasing depression. On this forum, I hope to offer some more detailed guidance toward using CBT. I'm thinking of offering maybe a weekly suggestion for thought and behavior change that will enable people to get better control of the pain and emotions associated with PHN. Anyone interested?
1 like, 54 replies
charlie58834
Posted
OK, it's been 9 days since we last touched base. Has anyone tried using the suggested CBT thought replacement, "I WILL find a way to manage this pain and make my life good again."
If so, how did the new thought affect you? Did you notice any change in your emotional state? How about behavior...any changes?
ruth57682 charlie58834
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Hi Charlie, Most days I have done pretty well. Only when other unrelated things go wrong such as a new nasty skin cancer and an eye infection, then I have a little "pity party". Starting a new large art piece has pretty well distracted me and I have found concentrating on that has given me a sense of normalcy and excitement which was badly lacking previously. Guess that is managing to some extent. Trying not to dwell on the fact that this may not ever go away. All in all, a very good week.
charlie58834 ruth57682
Posted
What type of art work do you do?
ruth57682 charlie58834
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I do Fiber Art. Working with various fabrics, some fabric painting and this summer after photographing our gorgeous mountain wildflowers, I am printing some out on fabric. That's got to be uplifting, right??
charlie58834 ruth57682
Posted
Your art sounds interesting! And combining photography with it too. Sounds like the subject of your art is improving your mood, but also the art requires a lot of concentration, and good distraction. I'll bet you don't notice pain so much when you're working, right? And, you get to congratulate yourself on doing something useful.
A good thought change/self-talk might be: "I can still do some things well, even with the PHN."
Do this experiment for me: say out loud to yourself, "I can't do anything anymore," and then ask yourself whether it makes you feel better or worse. Then, try on the new thought, saying it out loud to yourself: "I can still do some things well, even with the PHN." Ask yourself if you feel better or worse with that thought.
So, a healthy thought will be 100% true, and it will make you feel better, not worse.
babs99203 charlie58834
Posted
Ruth, I also had a few bad days, I guess we have to remember that they'll happen. The only GOOD thing about the Gab Brain is it's hard to remember why!! See, I can still laugh at myself. Generally it came from pushing myself physically, which really wasn't much, but sometimes I still forget what I can and can't do.. Yes, I did remember about "right now this is happening, it won't last, which was a bit of help. I told my husband about this forum, so he can help me re-frame--well sort of, he's pretty much a manly man and doesn't go for introspection, but he tries.
Unfortunately, I also had a major misunderstanding with a family member and some very negative, hurtful things were said. Not by me, but she felt I had done something to wrong her. She did "catastrophize" (HEY WE FINALLY GOT SPELL CHECK YIPPEE! but it's not in there) so I tried to just let it go. We have very different views of what's occurring or how to interpret something that was done. I don't know where this will end. But Thank God I was more emotionally stable right now, if it had been during a dark day, I'm not sure how I would have handled it. Sometimes people have to understand we each have a different view and that understanding the other's feelings or actions may be too hard to do, but you move one. I made the mistake of trying to explain why I felt the way I did, but she wasn't ready for that. Oh well.
It's good to hear from you both. Thanks for checking in.
charlie58834 babs99203
Posted
"Right now this is happening, it won't last." A good example of a healthy thought. It's true, and it makes you feel better: The two rules for healthy thoughts.
charlie58834
Posted
CBT [cognitive behavior therapy]:
People's response to PHN changes over time. My own story is that my shingles pain stopped on day 7 of an 8-day hospitalization. I remember the exact moment. My shingles head pain stopped, and it was immediately replaced by the most intense itching I had ever experienced. Frequently I would scratch my forehead and scalp to the point that it bled. I continue to have that itching now, 27 years later, though it has decreased in intensity over time, and I have learned ways to manage it better.
So, in the first year or so of my PHN, I was VERY depressed. My mental focus was often on my pain, and that just seemed to magnify it. But I didn't know what else to do. I did get some professional help for the depression. I saw various docs for pain management, but none were able to help much. Though my wife wanted to help, she really couldn't, and so when I talked about my pain it just left her feeling powerless, frustrated, and eventually irritated. So, I stopped talking about it.
At some point, a transformation occurred. I got so tired of feeling down and thinking how awful it was, that I decided to change my focus and take charge. I tried every topical remedy I could find in the drug store. I found two that worked: Aspercreme and lidocaine gel. I stopped myself from thinking depressing thoughts about how "horrible" the pain was, or how "unfair" it was that I had the pain, because these thoughts led only to more depression. I replaced those thoughts with ones that guided me toward taking charge as much as I could. Thoughts like, "I WILL find ways to manage this pain and make my life good again."
A curious thing happened then. My pain didn't change really, but it bothered me a little less. I still had to work on not scratching my skin to the point of bleeding, but I eventually controlled that. As I replaced sad and scary and hopeless thoughts with more helpful thoughts, I noticed my mood was improving. The more my mood improved, the more I felt in control. I still had the pain, but it was no longer wrecking my life. I was back in charge.
So, I really think people go through some stages in their response to long-term pain. Initially we cry, look for help from others, look for a cure, feel hopeless, etc. This is very natural, I think. If we keep working toward a change, we can eventually break through to more healthy ways of thinking, feeling, and acting. Some people stay in the first stage, I'll call it the powerless stage, forever. It's a bad place to stay.
A key thing to making that transition is giving up the idea that someone or something outside ourselves will cure us. Looking for a cure is totally appropriate at first, but when we find it doesn't exist [as I believe it doesn't for most of us with PHN], we have to develop new strengths to adapt to our new life. If we do so, we can develop a good and happy lifestyle, and we become stronger because of our decision to take charge of a seemingly all-powerful force.
I hope to help people to discover that PHN is NOT all-powerful, that while we can't get rid of it we CAN force it into a corner of our lives where it doesn't get to determine our quality of life. WE get to determine that.
babs99203 charlie58834
Posted
Beautiful, Charlie, simply beautiful. Thank you for sharing this. I reached out to a friend today, realizing that no-one knows I feel isolated until I TELL THEM! Well, you've got to feel a little better to understand that you can and should do that. I was sharing with her some of your suggestions and how much it's helped me and I'm sure others too.
What you've described is similar to the stages of grief, isn't it? And what we're grieving is the life that we used to have and our preconceived notions of what our life was to be. I feel terrible when I read of people who'll try yet another invasive procedure by yet another doctor who's said, this will help you! We know it doesn't. This helps me to understand why this occurs.
ruth57682 charlie58834
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babs99203 ruth57682
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There's a new study out, that's featured in the New York Times, I can't post the link here, but look it up. It explains how it helps people with suicidal thoughts.
charlie58834 babs99203
Posted
Yes! The article is very good, written by Judith Beck, maybe the best-known trainer in CBT. You can access a given number of articles for free in New York Times (10 or so?). The article is titled “How Cognitive Behavior Therapy May Help Suicidal People.” Thank you, Babs.
croft4Penny charlie58834
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jeaneen09890 charlie58834
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charlie58834 jeaneen09890
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To continue the focus on CBT, the basic assumption of CBT is that it is not events or situations that cause emotions, it is how we think about those events and situations. As I think I said before, there is LOTS of evidence that this is true. The exception would be emotions that are caused by a biological issue affecting the brain, such as bipolar disorder. But even then thoughts play a huge role in determining the emotion and it’s intensity.
So, with PHN it is really important NOT to be allowing ourselves to think thoughts like “this is so awful and horrible...it’s ruining my life...this pain is unbearable.”
Instead, we will benefit from thoughts like “this is difficult but I will get through it ok...I will manage my pain and get back to doing things I like again...I AM bearing the pain, it’s just difficult, but I’m stronger than I think I am.” Again, the healthy replacement thoughts must be 100% true or they won’t work. And, the new thoughts must make us feel better, not worse. So when you “try on” a new thought, ask those two questions: “Is this thought 100% true, and does this thought make me feel better or worse.”
As we change to thoughts that that make us feel better, we are gaining better and better control over PHN. And, the quality of our life is improving.
jeaneen09890 charlie58834
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babs99203 jeaneen09890
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Jeaneen, and the good news is it really does help. Yes, there are times I'm pretty down or having more pain and I forget to do it or think it's not going to help. If I can I try and re-think or at least, don't beat myself up if I don't follow it's tenets that day. I did use it last night talking to my daughter, helping her with some things she's dealing with.
jeaneen09890 babs99203
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babs99203 jeaneen09890
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Here's another update, and I'll be honest, a way to get this to the top for others to find. As there are several threads along this line, I may not have posted here. In March I found a therapist who does a slightly different type of therapy, but it's akin to CBT and it's been tremendously helpful. I hit my lowest spot back then and a friend helped me find an opening with her. CBT and therapy DOES work and does help! I went every two weeks for the first 6 weeks, then once a month. She's given me tools and support to deal with it. Thanks again Charlie.
charlie58834 babs99203
Posted