Building resilience is a goal of pain care. Resilience is adapting well to, or bouncing back from, significant challenges. It may also be described as thriving despite adversity, trauma, disease, or loss. Pain and its effects are challenges that can be met with resilience. Research suggests people vary in how resilient they are based on their genetics, social histories, and existing skills. However, we also know that resilience can be built or grown – resilience skills can be learned and practiced.
Resilience is not the absence of challenges, difficulties, worries, anxiety or occasional frustration, sadness, or distress. Resilience is NOT denial. Resilient people are very aware of their limitations, challenges, and health conditions.They are also aware of their strengths and ways to use strengths and skills to work around the challenges they face.
The building blocks of resilience Include:
- Supportive relationships
- Problem solving abilities
- Good communication skills
- Ability to cope with negative emotions and savor positive ones
- Self-efficacy: the belief that you can manage or cope with a challenge
- Self-management skills
- Using existing strengths
To help identify and build on your existing strengths, you might ask yourself:
- How have I gotten through challenges before?
- What has helped?
- Who has helped?
- What do I know about myself from getting through past difficulties?
- How can I use similar skills and resources to face my current challenges?
To develop your resilience skills, you might want to:
- Develop a realistic yet optimistic outlook
- Nurture positive emotions
- Think about your sense of control
- Practice living in the present
Realistic optimism is maintaining hope while moving forward and dealing with one's current reality. It requires flexibility and perseverance, and comprises both courage and hope. Realistic optimism is not determined by the number of adverse events in your life but rather by how you view and respond to the adversity.
- If adversity is perceived as a threat, this is an indicator of less resilience
- If adversity is perceived as a challenge, this is an indicator of more resilience
Nurturing Positive Emotions
Nurturing positive emotions
Research has shown that positive emotions play a vital role in our physical and emotional health. As you know from your own life, positive emotions such as joy can and do occur even when managing the challenges of living with pain. Positive emotions are not just about feeling good. Research has also shown that they can:
- Increase creativity
- Increase flexibility of attitude and thinking
- Help with problem solving
- Serve as a break or respite from stress and negative emotions (can replenish us)
- Sustain our efforts to manage challenges
- Build social connections (people who show positive emotions a lot tend to attract other people and build helpful support)
- Decrease distress
- Prevent depression, chronic stress and anxiety
- Improve our physical health
You may not realize it, but you no doubt do things every day that cause you to feel good, even if for just a few minutes. What are some things you are already doing that make you feel good? Or that you have done lately that made you feel good? For example, listening to music, or watching movies. What are some things you can do in the future to deliberately experience more positive emotions?
Sense of Control
Sense of Control
Beliefs about the control you have may influence how you manage your emotions. One core belief people have is about how much control they have over being able to manage their lives, including their health. The unpredictability and chronic nature of pain can leavepeople feeling like they don't have control of their lives. This (feeling not in control) can, in turn, lead to a number of other emotions, such as anxiety, fear, anger, sadness, or hopelessness.
Control is generally thought of in one of two ways:
- People who have an internal locus of control feel they are in charge of making change happen in their lives. Control comes from within.
- People who have an external locus of control believe things happen to them as a result of external forces such as powerful other people, or by chance/luck.
Research has shown that people who have an internal locus of control are better able to handle change in their lives and make the necessary adjustments to cope with those changes than people who believe that there is nothing they can do about their health.
- Benefits of feeling "in control" include:
- Increased self-confidence
- Increased positive mood
- Reduced anxiety and fear
- Reduced stress and tension
- Reduced feelings of being overwhelmed
- Increased ability to make decisions/take action on own timeline
- Increased ability to cope better with unexpected changes
- Increased overall health
Fortunately, there are several things you can do to increase your sense of control while living with pain. The first one is to recognize what you do and do not control. It's true that you cannot control everything and pain certainly can cause feelings of uncertainty and unpredictability. However, you do have control over the choices you make and how you react to your circumstances. Taking a few minutes to list several things that you feel you can control about your life is a helpful start. Save this list. Sometime in the future, it may come in handy to remind you that you have the ability, skills, and intelligence to make things happen. When you finish making this list, you may be surprised and realize that you have more control over the events in your life than you previously thought you had.
The approach of Self-Management is all about putting you in the driver's seat to have more control about how you manage your pain. This allows you to spend more time and energy on things that are meaningful for you. Thus, you can use your self-management skills to be and feel more in control.
Living in the Present
Living in the Present
Feeling in control of your life can help you to live more fully in the present and not be held back by things from the past.
Some examples are:
- Letting go of feeling guilty about things done or not done
- Forgiveness of others/letting go of old grudges
- Forgiveness of self for past actions
- Not dwelling on decisions or actions from the past
- Not getting caught up in "what if's"
Another aspect of living in the present involves reducing energy spent worrying about things that are out of one's control.
Living in the present involves:
- Awareness of the current moment and what you are thinking or feeling without judgment of those thoughts/feelings
- Experiencing what you are doing with all your senses: sight, sound, taste, smell, touch
- Savoring positive emotions/experiences as they occur
- Fully engaging with others/in your activities
- Practicing self-care as you need it (not after you've pushed too far)
- Appreciating things that are currently going well
- Avoiding thinking and worry about the future
Leading a gratifying and meaningful life despite the pain
Living with chronic pain can be a frustrating, demoralizing and depressing experience. Having negative thoughts and emotions is normal, but having optimistic thoughts and positive emotions can also be normal, even with pain. The people with chronic pain who also manage to have positive emotions and thoughts tend to do the best. There are simple and even fun steps that you can take to increase your positivity and in the process lead a life that is more fulfilling even in the face of pain.
In this module you will learn skills that can help you assess and use your personal strengths, get more enjoyment out of your daily activities, and feel more optimistic about your future. By practicing these skills, we hope that you will be able to increase the occurrence of positive emotions, deepen engagement in day-to-day life, and experience greater meaning in your life even though you may experience pain. A major objective of this module is to help you learn strategies to not just survive living with chronic pain, but to actually thrive – in living a life that is more enjoyable and rewarding.
Pain and resultant life changes.
People who are living with chronic pain are more likely to report giving up the things they love to do in order to get the things done that they have to do. Thus, going to work, running errands, paying bills and taking care of cooking and cleaning are made a priority, while hanging out with friends, reading a book, spending time on your hobby, or even taking a long bath are skipped. This makes for a life that is not terribly enjoyable. For some, chronic pain has caused them to reconsider who they are and what they can or cannot do – this can have an impact on one's self-image and sense of purpose in life
What can I do to bring more joy to my life?
Doing one or more of these positive activities each day can help decrease your pain, improve your ability to function and/or greatly affect your overall sense of well-being. Below is a list of positive activities that were developed to promote resilience. You may try a different activity each week or, if you find an activity you really like, you can do that for a much longer period of time. You can also do a couple of activities at the same time, such as keeping a gratitude journal for months and conduct many random acts of kindness in one day. While these activities might seem too simple or too fun to make a difference in your pain or mood, do know that all of these activities are supported by scientific studies as meaningful approaches to managing persistent pain. By changing your mental state, you can temporarily alter the very nature of pain (which of course is in your brain).
Savoring involves the mindful act of noticing a pleasant moment and trying to make it last. To most effectively savor something, it is helpful to use all of your senses. For example, if you wanted to savor a cup of coffee, notice the sound it makes when poured, become aware of the deep brown color, rich aroma, and the warmth of the mug in your hands. Allow a feeling of gratitude to wash over you for having a cup of hot coffee and a new day to explore.
Step 1: Savor life's best moments. Consider a typical weekday. Review your morning routine, your daily activities, and your evening rituals, and consider how much time you spend noticing and enjoying the pleasures of the day, both small and large. Every day for the next week, be sure to savor at least two experiences (for example, your morning coffee, or the sun on your face as you walk to your car). Spend at least 2–3 minutes savoring each experience. Be sure to use all of your senses.
Step 2: Enhance your savoring experience (optional). Snap a picture with your cell phone or even collect a physical souvenir of the event and reminisce about it later with others. You could even start a scrapbook of memorable moments you want to savor forever.
Positive Piggy Bank
Keeping a Positive Piggy Bank
Sometimes our lives are so busy or chronic pain is so dominating that we forget to note and remember the good people, moments and things in life. This little daily activity can help you become more aware of the good things in your life.
Step 1: Find a box or container with a lid or a piggy bank. Place it someplace where you will see it every day. Your pleasant memories will be placed in this container. You will also need some small slips of paper and a pen or pencil.
Step 2: Take note of a pleasant memory. Every evening, think about the people, things or events for which you are grateful. You may make a list if you like. Pick one of these and spend a moment savoring it. What made it so special to you? Now, write this moment down on a small piece of paper. Use enough detail that later you will be able to immediately recall what happened. Next, add the date, fold up your grateful memory "currency," and drop it in the piggy bank or container. You will make these gratitude memory "deposits" in the same way every evening. You may choose for how long you would like to do this. It could be for one week, 30 days or even longer.
Step 3: Review your grateful memories. At the end of a week, 30 days or however long you chose to keep a positive piggy bank, you will "close your account." This means that you will withdraw all of the "currency" from your piggy bank and read each and every one of the deposited grateful memories. As you read them, try to recall details of the event and what made it so special to you at the time. Reading your piggy bank account can serve as a "pleasant activity."
Random Acts of Kindness
Random Acts of Kindness
Acts of kindness can have a ripple effect – one simple act of kindness can inspire others to act more kindly too. Acts of kindness can make both the person conducting the act and the recipient feel happier, so why not try a few?
Step 1: Pick a day and plan your acts. Pick one day in the next week where you will do five kind things all on that same day. These acts can be for people who are complete strangers, friends or family members or for society or the planet. These can be small acts of kindness such as sharing a genuine compliment or giving somebody a hug. Or you can do larger acts of kindness such as volunteering for an event, making a donation to a favorite charity or giving a homeless person a meal. You can even do anonymous things or start a project that will take some time to finish. Here is a link to a website that offers some fun ideas to get you started: https://www.randomactsofkindness.org/kindness-ideas
Step 2: Do your 5 random acts of kindness all in the same day. When you do your kind acts, do not expect anything in return. You might even get some strange looks or reactions as sometimes kind acts are unexpected. Smile as you do them knowing that you are putting positivity out in the world.
Step 3: Conduct one more acts of kindness. After you have done your 5 kind acts, do one more kind thing for yourself. People with chronic pain tend to put others first and forget to be kind to themselves. It's important to take care of yourself too. If you are rested and happy, you will be in a much better position to do things for others. Perhaps you could take a long bubble bath, go for a walk in the park, or see a movie with a friend.
The goal of this activity is to help you learn what your strengths are and how to use them in order to make your life more engaging and successful. Studies have shown that using your signature strengths on a regular basis can result in feeling happier, more engaged with life and even more hopeful. If you'd like to learn more about character strengths and the science underlying their power, you might enjoy this video: https://www.youtube.com/watch?v=U3nT2KDAGOc
Step 1. Take the Strengths Test.
A Brief Strengths Test can be found here: https://www.viacharacter.org/
Write your top five strengths and post them somewhere that you can see them. Do they seem about right to you? Pick one of your top 5 strengths and think of a way you regularly use this strength. For example, if your top strength is kindness, in what ways do you use that strength on a daily basis.
Step 2. Put your strengths to work. Each day, find at least one way to use one or more of your strengths in a way that you haven't before. You can do this by modifying something you already do on a regular basis or by creating a new activity altogether. What's important is that you use one of your strengths in a new way. For example, if you usually use your strength of creativity for artwork, try using creativity to solve a difficult problem or perhaps settle a disagreement with a friend.
Dose: Try using one of your strengths in a new way every day for a week. It can be helpful to note what you did and how things turned out.
Myths and Facts
Myths about positive activities, positive emotions and resilience
"My emotions have nothing to do with my pain."
Pain and emotions are processed in many of the same areas of the brain. This helps explain why depressed people are more sensitive to pain and why happy people report lower levels of pain, have better functioning despite pain, and have better quality of life. Positive emotions buffer the effects of negative emotions, so even if you are sad, doing a gratitude activity or act of kindness can help you feel better.
"I don't have time for myself."
Just as a car needs gas to run, you need to recharge and refuel your mind and body. Pleasant activities can be that fuel! Just taking five minutes to read a funny cartoon or a note from a friend may give you a little boost and help take your mind off your symptoms. But if you don't take time to renew yourself, you may exhaust yourself and run out of gas.
"As soon as my pain goes away, I'll be happy."
You likely have already discovered this, but waiting for your pain to go away before you can enjoy your life is not a good strategy for success. Studies show that people who have more positive emotions, feelings of gratitude, a sense of purpose in life and feel socially connected have less pain and a better quality of life.
"Some days the pain is so bad that you simply have to write them off."
Of course there will be days that you feel terrible and like you don't want to do anything at all. As part of this program, try to do something you enjoy anyway – something pleasant. If you at least do that one fun thing, you will look back on the day knowing something positive happened that day. Many of the activities you will do in this module will help you learn such resilience skills.
"I'll feel instantly better once I try one of these positive activities"
Actually, you might feel a bit happier right away, but for others it may take up to several weeks to notice improvements in your mood and outlook. Know that your efforts are not wasted because improving your mood and general well-being can help ease your pain and other symptoms.
"My pain is more serious than these activities – they can't possibly help."
Engaging in pleasant activities is not meant to cure pain. These activities are designed to bring balance to your mind which is likely to be focused on pain. If pain gets processed in the brain against a background of pleasantness rather than negative emotions (e.g., despair, anger, anxiety, frustration) it will alter how the pain is processed by the brain. This can lead to less pain and a more enjoyable day.
» A note for family & friends
Social Support is good "medicine"
People with chronic pain often do better when they have other people in their lives who love, support and understand them. Being there to try some of these positive activities with your loved one with pain or encouraging him/her to do these positive and enjoyable activities can go a long way to ensure their success.
The Science of Gratitude
Happify module: Love Your Life Despite Chronic Pain
How you sit, stand, transition and lift can either make pain worse or allow you to function even with pain. This section offers help in optimizing how you interact with your environment in ways that don’t exacerbate pain.