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.
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.