Regaining My Balance: Coping With Anxiety and Depression With Chronic Pain
Six years ago I was in graduate school pursuing my career goals when my body gradually started to fall apart. I actually don't know how I pushed myself to finish that year, but I do know that by the end I was experiencing body-wide pain and illness symptoms 24/7.
But my challenges were more than just physical — I began experiencing frequent panic attacks. I was terrified at my own helplessness to do anything about the fact that my life as I knew it was turning upside down.
With huge relief, I finally finished the year and went on medical leave from my studies. However, I was immediately confronted by the problem that my days were empty of activity or responsibility.
Seeking Normalcy
I remember dragging myself out to a local cafe in the afternoons while my fiancé was at work. I wanted the anonymity of a public place, where I could feel 'normal' for a while.
It was the only cafe I could go to because the chairs were sensible rather than funky. Still, I had to bring my backrest with me, which generated stares from other patrons.
I would cover it with my coat in order to try to hide it from attention. I could no longer type or hold a book due to pain, so I was embarrassed to be sitting at a table without a laptop or reading material, like everyone else. I listened to audiobooks or free online course video lectures instead.
I would set up my tablet so it looked like I was working, rather than listening and staring around. I envied all the other people my age, surrounded by papers, purposely tapping away on their computers.
The goals that I had been pursuing were on pause, indefinitely. I grieved for my old life. I pushed myself to go to the cafe, even on days I experience brain-fog or fatigue, because staying home felt like giving up.
How Does Chronic Pain and Mental Health Interact?
I am not alone in facing mental distress caused by a chronic pain condition. In fact, depression commonly occurs alongside chronic pain.
Research has demonstrated that anxiety disorders are more common in patients with chronic pain conditions like arthritis, fibromyalgia, migraine and chronic back pain than in the population at large.
As patients know all too well, the challenge of living with chronic pain on a daily basis is very stressful and raises difficult emotions. Additionally, anxiety and depression share common neurological patterns with chronic pain conditions, including heightened signalling in certain regions of the brain dealing with pain and emotion, as well as changes in the levels of neurotransmitters like serotonin.
The onset of chronic pain may cause changes in the brain that make anxiety/depression more likely, and vice versa. In other words, pain causes depression and depression intensifies pain.
Treatment Options for Depression and Anxiety
Cognitive Behavioral Therapy
One of the most effective treatments for chronic pain and anxiety or depression is a program called cognitive behavioral therapy (CBT). Studies have found that participating in CBT can help reduce pain, depressive thoughts, and improve quality of life.
For example, one study found CBT to be as effective as an anti-depressant treatment for people with major depression who had MS.
I found participating in a group CBT course offered at my pain clinic very valuable for learning tools to manage the negative thoughts and feelings that accompanied my fibromyalgia. One of the core parts of the program was learning to identify negative thinking traps, or cognitive distortions.
These are thoughts that seem rational, but really only make us feel down. Sound familiar?
For example, if you're like me and tend to think in “all or nothing" terms — a cognitive distortion — you might say to yourself, “If I can no longer pursue my career, I am a failure."
This negative self-talk can fuel a sense that negative experiences are catastrophes, which further increases stress, anxiety, depression and pain. In CBT, I learned to challenge these distortions with the reality of each situation.
In response to the statement above, I challenge it by saying, "While being in pain means I have to do less, that does not reflect on my personal worth, nor does it mean what I can do is meaningless."
I challenge thoughts that are unhelpful to my wellbeing and replace them with helpful statements, rather than getting stuck on being right or wrong on a particular issue.
Another key tool I learned in CBT for managing my pain and mental distress was to practice deep relaxation in order to elicit my body's relaxation response (RR). Examples of RR techniques include guided visualizations, breathing exercises, meditation, and progressive muscle relaxation.
I personally have found deep breathing and guided body scans helpful for daily stress management. Knowing I can always turn to these practices helps me feel more in control, even during tough times.
The purpose of doing RR techniques daily is not just to de-stress during the practice; regular practice actually reduces your physical and mental stress response in your everyday life, which can in turn help to manage pain, anxiety and depression.
Treatment Options for Depression and Anxiety
Mindfulness Meditation
The Mindfulness Based Stress Reduction (MBSR) program created by Jon Kabat-Zinn to teach mindfulness to patients had demonstrated remarkable benefits for reducing chronic pain, as well as anxiety and depression.
I personally have found that meditation for pain has helped reduce my anxiety, improve my quality of life, and manage my pain.
Being mindful means intentionally being present with your breath, thoughts, feelings and sensations. Inevitably, your mind will become distracted by worries, thoughts, memories, or plans. When you notice this has happened, you gently guide your awareness back to the present moment.
You can practice mindfulness through meditation, body scans, mindful eating, or mindful movement like yoga or Tai Chi.
Here are four key takeaways I have learned from participating in an MBSR program and continuing a meditation practice that help me manage the mental and emotional impacts of living with chronic pain:
"Cross that bridge when you get there"
Much of our anxiety comes from worrying about the future or reliving difficult moments from the past, rather than from anything going on directly in front of us at this moment in time. Worrying about it now only makes me suffer more.
It's better for my quality of life if I return my focus to the next best thing I can do for myself in this moment.
"Stop and smell the roses"
Even during pain flares and illness relapses, there are small moments of enjoyment if we stop and notice them — the taste of a good meal, sharing a hug, a sunny day, a favorite hobby. Intentionally taking in the good moments by staying present while I experience them is a powerful way for me to rebalance my mindset towards the positive.
"This too shall pass"
One of the key lessons I learned through mindfulness is that my thoughts, feelings and sensations, no matter how difficult, are changeable, like the weather. When I hold on to the fact that even my darkest moods will eventually lift, I feel calmer and more in control.
"Always, we begin again"
Initially, I was very judgmental of myself when I started meditating because my mind could not stay focused on my breath for very long. Over and over I would notice that my attention had wandered off and I would have to refocus my attention on the present.
Eventually, I realized this was a crucial learning opportunity. As renowned meditation teacher Sharon Salzberg explains, "The invitation to begin again (and again and again) that meditation affords is an invitation to the practice of self-compassion - to heal through letting go rather than harming ourselves with cycles of self-doubt, judgment, and criticism."
Resources to Try for Depression and Anxiety
- Excellent selection of free guided mindfulness meditations.
- Free guided mindfulness practices between 15-20 minutes (breath, body scan, movement, yoga nidra).
- Free Mindfulness Based Stress Reduction online course — a scientifically proven program to reduce pain and stress.
- Free guided imagery practices for relaxation, breathing practices, and meditation practices.
- Four practices using relaxation techniques by Dr. Emmet Miller and Steven Halpern used in CBT programs.
- Book describing a mindfulness program for pain by an expert in the field, Dr. Jackie Gardner-Nix.
- Guided audio program using mindfulness meditation for pain management, by Jon Kabat-Zinn, who first developed programs using mindfulness for health.
- The original landmark book on using mindfulness meditation for stress relief, pain and illness by Jon Kabat-Zinn.
- Using sound to promote sleep, relaxation and meditation by Dr. Jeffrey Thompson.
- Using breathing exercises and meditation to promote self-healing by Dr. Andrew Weil.