3 years ago

Try CBT To Get Rid Of Anger Caused By Back Pain

Cognitive Behavioral Therapy is a great way to turn your negative thoughts into positive ones and curb the anger caused by persistent back pain.

cbt anger

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Now it's no surprise that being in pain on a regular basis is likely to make you feel a little bit miffed.

After all, this pain can turn even the simplest activities into a chore and leave you feeling frustrated beyond words.

And no one enjoys having their back nagging away at them hour after hour.

This means that anger is an emotion that is extremely common in people with chronic pain.

But why is that?

A 2012 review of studies into the relationship between chronic pain and anger found that there were 3 main reasons that people with chronic pain became angry.

  • 1. Goal frustration - you get angry when you think your pain stops you from doing what you want to do in life.
  • 2. Blaming others - when you blame other people or external situations and events for your pain it only breeds resentment, bitterness, and anger.
  • 3. The feeling of injustice - chronic pain is random and unfair, but feeling sorry for yourself will just make you feel angry and frustrated.

So how you think about your pain and it's effects can be just as much of a cause of your anger as the actual pain itself.

And the really bad news is that by becoming angry you may be making your pain worse.

As you will hold this stress and tension in your body.

Causing tight muscles and forcing your body into an unhealthy posture that puts pressure and strain on your back.

And this anger can also put a strain on your relationships, leaving you without the support network you need to stay on top of it.

So if you regularly feel angry because of your pain, you need to find ways to change your ways of thinking about it.

And one of the best ways to do this is through Cognitive Behavioral Therapy (CBT).

What Is CBT For Anger?

Break the cycle of negative thoughts

The idea behind CBT is that emotional and behavioral problems begin in the mind.

So basically it's your negative thoughts, beliefs and attitudes that are the main cause of your emotional distress and unhealthy behaviors.

However, a lot of the time these negative thoughts and beliefs aren't accurate.

So CBT for anger is a process of identifying any negative thoughts and beliefs about your pain that may be causing you to become angry, challenging them with logic and reasoning, and then reframing them in a more positive way.

By doing this you can lower your anger levels and feel more relaxed and positive to be able to live your life to the full despite any pain.

And in doing so you will also lessen the amount of pain you feel too.

So why do people with chronic pain develop these negative thoughts about their pain that lead to anger?

It's because our brains are conditioned to respond to the feeling of pain as a sign of immediate danger that needs addressing straight away.

And this makes sense.​

Because if you put your hand on a hot stove it's pretty important that your brain tells you to react to it immediately!​

However, this isn't the case with chronic pain, as it's just a constant throbbing rather than a sign of danger.

But because our brains are programmed to respond automatically to all pain as urgent it can interpret chronic pain as being far more significant than it actually is.

And this can give you an unhealthy negative outlook towards your pain where you:

  • Have catastrophic thoughts where you always imagine a worst-case scenario for the pain you are feeling no matter how unlikely this is in reality.
  • Overgeneralise when thinking about your pain, which can lead to you not taking care of yourself (For instance: 'I've tried everything to fix my pain and nothing has worked so what's the point in trying something new?').
  • Let pain become your sole focus, which leaves you unable to recognise or appreciate the good things in your life.

These thoughts are all unhealthy and will leave you feeling angry, frustrated, and helpless.

However, they are not a true reflection of your actual chronic pain situation.

So the aim of CBT is to replace these harmful and inaccurate thoughts with positive ones that more accurately describe the situation.

As by doing this you will develop a more positive attitude which will allow you to better manage your chronic pain and gain control over the levels of pain that you feel.

And CBT is a great way to do this, as it has been shown in studies to be a good way of reducing anger. 

For instance, an analysis of 50 studies of people with anger issues found that those that had CBT treatment did better at reducing their anger levels than 76% of the untreated patients. 

So it's well worth giving a try.

And to do so you need to work through the 3 stages in the CBT process which are:

  • Identifying any negative thoughts, beliefs and attitudes that you hold about your pain.
  • Challenging these thoughts using evidence and logic to see how true they are.
  • Using the evidence to reframe these thoughts in a more positive and accurate way.

1. Identify Your Negative Thoughts & Beliefs

positive thinking

Negative thinking can leave you feeling trapped and helpless when it comes to living with your chronic pain.

And this is a major cause of anger and frustration.

So next time you are feeling angry and in pain try to identify your thought processes.

Now this can be quite difficult to do.

As these negative thoughts are sometimes hard to pinpoint as they can become automatic, so you may not even realise they are there.

But you need to become aware of them as they happen if you are going to be able to challenge them and reframe them in more positive ways.

And a great way to do this is by keeping a pain and anger diary.

So for the next couple of weeks make a note of:

  • Your anger and pain levels out of 10.
  • What you are doing at the time.
  • Which thoughts you are having.
  • How you are feeling.
  • What is happening around you.

As by doing this consistently you will become aware of the negative thoughts, feelings and behaviors that may remain invisible to you if you didn't consciously try to observe them.

And these are the thoughts you need to change if they are causing you to be angry.

So hopefully after a couple of weeks you will have a list of these thoughts in your diary and an idea of the beliefs and attitudes towards pain that are making you angry.

Also keeping a pain diary comes with added benefits. 

As it can make you aware of behaviors, events, and situations that trigger your pain and anger, which you can then think about changing or avoiding.

And writing down how you feel at the time is a positive way to release any anger and frustration you are holding. 

For instance, one study found that chronic pain patients that kept a pain journal over a 9 week period had far greater control over their pain and anger levels than those that didn’t.

So keeping a pain journal is a pretty good way of identifying negative thought processes that cause anger.

2. Challenge Your Negative Thoughts & Beliefs

Now unfortunately you can't stop negative thoughts from occurring.

However, you can learn to challenge and disrupt them when they do arise.

So once you become aware of your negative thoughts and beliefs towards your pain that are causing you anger they can be challenged.

And you do this by looking at each one in detail and seeing just how accurately they represent your pain experience.

Because you'd be surprised at how often your brain can trick you into thinking things that​ are simply not true.

And this makes it all too easy to get stuck in ways of thinking that are exaggerated and unhealthy. 

But by changing how you think about chronic pain and it's effects on you, you can get a more balanced view of reality.

Which will leave you feeling more relaxed, positive and in control rather than stressed out, angry, and frustrated.

So you need to challenge your negative thoughts and beliefs using evidence and knowledge that can disprove them.

In this way the more knowledge you have about your pain experience and chronic pain in general the easier this is going to be.

​And the good news is you've already made a start without realising it!

Because by reading through websites like this one, speaking to professionals, and using Facebook groups and forums you can gain a greater understanding of what living with chronic pain entails.

And you can use this greater understanding and experience to realise just how irrational and false most of your negative thinking is.

So once you're armed with this knowledge it's time to reframe those negative thoughts in a more positive and realistic way.

3. Reframe Your Thoughts From Negative To Positive

positive thinking

So now you have a list of negative thoughts from your pain diary and have educated yourself on chronic pain you are ready for the final stage.

Which is reframing your negative thoughts into more positive ones that will stop you feeling so angry.

And one way to do this is to go through each of them one by one and replace them with a positive coping statement.

These coping statements are more positive and accurate ways of thinking about pain than the negative thoughts you are currently having.

So I'll start by giving you examples of 3 very common types of negative thoughts you can change, which are false beliefs, feeling sorry for yourself, and catastrophic thinking.

Reframing False Beliefs

False beliefs are the main culprits when it comes to negative thoughts that may be holding you back and making you angry.

So for example, during one anger episode you may have found yourself thinking:

‘This pain is so bad that I won’t be able to make it through the day’ 

​Now having this thought going over and over in your mind is only going to make you feel helpless, angry and frustrated.

But look at it closely. Is it really true?

​I mean think of all the times in the past when your pain has been at the same level (or worse) yet you still managed to survive.

When you look at it like this it doesn't stand up to scrutiny.

So use this knowledge of past experiences​ to replace the negative thought with a more positive one such as:

‘I’ve coped with this level of pain before and it always gets better eventually. I’ll cope today as well’

With this thought in your mind you are now far more in control than before and less likely to get angry.

Reframing Thoughts That Make You Feel Sorry For Yourself

Feeling sorry for yourself is a bad trap to fall into.

As when you are having a 'woe is me' kind of day thoughts such as the following keep going around on a loop inside your head:

'Why me? Why do I have to suffer this pain while others don't?'

Now I know that dealing with chronic pain is unfair and really awful.

But thinking along those lines is only going to make you angry and resentful.

And when you think about are you REALLY the only one struggling?

Of course not.

As there are millions of people struggling with chronic pain every day, and many with far worse pain than you have.

So change this thought to:​

'There are millions of people out there suffering the same pain or even worse than me and they're still coping. So I'll be fine too.'

Just this simple shift in thinking will stop you feeling helpless, angry, resentful, and alone.

Reframing Catastrophic Thoughts

Another type of negative thinking that is common among people with chronic back pain are catastrophic thoughts such as:

'This pain keeps getting worse and worse so that's me done for, it's escalating out of control.'

And this thought leaves you feeling like the end of the world is nigh.

But again, through a mixture of past experience and knowledge that chronic pain has peaks and troughs, you can change your thought process to: 

'I’m just having a bad pain day. I’ve had them before and they pass. I’ll be feeling better again soon'

Do you see how this thought is much more accurate and will make you feel a lot less angry and anxious?

Here are a couple more quick examples to give you an idea of how to reframe your negative thoughts about pain:

'I'm useless because I can't do X like I used to be able to/like so-and-so can'

By shifting focus from what you can do rather than what you can't, this thought becomes 'I'm proud that I can still do X even though I have chronic pain' .

While the thought 'If I try to do X then my pain will get worse. Maybe I could seriously injure myself'.

Can be changed by using your knowledge of the difference between chronic and acute pain to 'My pain is chronic not acute, so doing X won't injure me further. I just need to pace myself and not overdo things'

And this will help you to do more in life.

So do you see the idea here?

As the first thought in each of these examples would create anger and frustration at the pain and leave you feeling helpless.

While the coping statement you replace it with would put you in a more positive and hopeful frame of mind and give you a greater sense of control over your life.

And this is the change we are looking for with CBT.

So go through all the negative statements that you have noted in your pain diary and challenge and reframe them with a coping statement that more accurately reflects reality.

And then try and commit these coping statements to memory so they become second nature.

How To Make These Changes Stick: Use Flashcards

While challenging and reframing your negative thoughts is a great thing to do, it can be a difficult process.

As old habits die hard.

And this is especially the case with thought processes that may have become automatic.

So for this change in thinking to occur you need to work at it.

As positive coping statements need to be repeated over and over again until they become automatic in your mind and override the negative thoughts.

And in time your brain will use these positive beliefs to replace the negative thoughts.

The result of this is you will be more positive, relaxed and less angry about your pain.

And my favourite technique for doing this is to use flashcards.

As these are a great way of memorising things for exam revision and they can work just as well for getting those positive coping statements into your brain.

So write down a negative thought on one side of a flashcard and on the other side write down the positive coping statement that replaces it.

Now do this for each and every negative thought and belief you have about pain that you have in your pain diary.

Then keep these flashcards handy and when you are feeling angry have a quick read through them.

As through repetition your brain will learn to associate the positive coping statement as the counter for the negative thought or belief.

And hopefully over time this will not only lessen the frequency and power of these negative thoughts, it may even replace them completely.

A Great Book That Can Help You

Now I've given you a few CBT techniques to try out here.

But if you are curious to discover these techniques in more depth then a good book to buy as a starting point is 'Managing Anger With CBT For Dummies' by Gill Bloxham.

As it gives you easy to follow instructions on how to let go of anger and deal with frustration without letting it get to you.

And while it focuses on CBT for anger specifically, not just anger from chronic pain, there are easy to follow techniques in there that you can adapt to your own situation.

Rounding Up

Feeling angry and frustrated is extremely common among people that suffer from persistent back pain.

And unfortunately becoming angry can actually increase your pain levels even further.

So you need to break this vicious circle, and one way to do this is to change the way you think about your pain using Cognitive Behavioral Therapy techniques.

As by replacing negative thoughts with more positive ones you can gain more control over your whole pain experience.

And become a lot less angry and frustrated in the process.

So give these techniques a try for yourself if you find that your pain is making you angry on a regular basis.

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I'm a psychology graduate and a veteran of 5 spinal surgeries. I want to help people learn how to fight back against persistent back pain just like I have.

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