|
Questions:
1.
What does reconceptualization of pain involve?
2.
How could the therapist proceed if the patient/client feels completion of a pain assessment is aversive or a waste of his/her time?
3.
What is an example of how the therapist might discuss the cycle of chronic pain with the patient/client?
4.
What goals might you discuss with your patient/client to divert their focus away from their pain?
5.
What might be a response to facilitiate the patient/client to conceptualize and manage chronic pain effectively?
6.
What analogy can be made regarding practicing and learning relaxation, to demonstrate that over time, relaxation exercises become easier to implement with less thought?
7.
Clients/patients, especially those prone to black and white thinking, may not have considered more creative solutions for how to be involved in
pleasurable activities, for example...
8.
What are examples of self-monitoring that your patient/client can use to process his/her negative thoughts associated with pain?
9.
What are some examples of coping statements the patient/client in chronic pain can make to him/herself?
10.
What are examples of insomnia stimulus control instructions for a patient/client?
11.
What is an example of collaborating to develop a discharge plan for activities?
12.
What would you discuss if the patient/client has reverted back to a low level of activity and has resumed resting and guarding for much of the day after therapy has ended? |
Answers:
A. Brainstorm ideas regarding how to overcome any potential barriers to completing measures; provide a rationale for the measures.
B. Helping the patient move from a view of pain as purely sensory/biomedical to more multidimensional.
C. What is something specific that you would like to see change in your life over the next few months? What would you like to be able to do (do better, do more of, etc.)? Are there relationships that you would like to improve? If CBT-CP worked, how would your life be different?
D. Think of yourself like a machine. All the gears work together to keep your body going. When you are not in pain life tends to be easier, you feel good and it’s easier to get things done. When you have chronic pain, it’s like having a bad gear that doesn’t go away. It disrupts all the other gears and slows down the whole machine. Over time, it can bring the entire machine to a stop.
E. Learning to play the guitar. While at first it may be difficult and uncomfortable with little noticeable improvement, regular practice helps a person become a skilled musician over
time. In fact, fingers may begin to play certain songs on “autopilot” as the body develops a memory for the movements.
F. Provide an explanation of the difference between the physical sensation of hurt and the physical.
G. What was going through my mind just before or just after I started to feel this way? What is the thing I am most afraid might happen? What is the worst thing that could happen? What memories does this lead me to experience? What does this mean about my future, my life, my health?
H. Inquire about their willingness to teach an activity to others; coaching is a path to share knowledge and experience regardless of pain, as many are unable to play sports; s/he may like the idea of being able to “give back.”
I. Only go to bed when sleepy. Use bed only for sleep and sex. If unable to sleep after 20 minutes, get out of bed and return only when sleepy. Wake at the same time every day. Do not nap.
J. “I’ve been through pain increases like this before, I just need to focus on something else until it passes” and “I just have to make it through this moment.”
K. The dangers of avoidance as well as the benefits of using time-based pacing and engaging in regular, moderate activity. If one of the relaxation strategies has been implemented regularly, inquire about the specific times used and benefits obtained. Naturally, all adaptive techniques adopted should be commended and encouraged.
L. Ask about specific behaviors that the patient/client wants to avoid doing or saying, and use these to develop items for the schedule that will combat negative habits. For example, if someone wants to avoid isolating from others, perhaps “Meeting my friend John at Java Hut for coffee” can be scheduled for every Tuesday morning. |
