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Section 4
Cognitive Interventions for Chronic Pain

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In the last section, we discussed concepts of automatic thoughts.  These concepts of automatic thoughts included:  negative automatic thoughts; helplessness; and automatic thought evaluation.

In this section, we will examine three concepts related to core beliefs.  These three concepts of core beliefs include:  negative life events; self-identification; and culturally influenced core beliefs.

Unlike automatic thoughts, core beliefs are mindsets that have been in place prior to the client’s pain.  These underlying belief systems are believed to provide the thematic content of automatic thoughts, and by changing the distorted core beliefs, the client can change the automatic thoughts.

3 Concepts of Core Beliefs for Pain Sufferers

1. Negative Life Events
The first concept of core beliefs is negative life events.  Core beliefs arising from negative life events often cause the client to question their spirituality and their grip on reality itself.  The core beliefs arising from this type of stressor, obviously, are distorted and unrealistic.  Often, the client loses his or her sense of self-worth and even a sense of justice in the world.  If the actual life event was extremely dramatic, the client strives even harder to provide an explanation, even if that explanation itself is flawed. 

Kara, age thirty-four, had been involved in a near-fatal car accident with a brand-new car.  She stated to me, "I had no business buying that car.   I never deserved that car.  Whenever my pain starts up again, I know it’s the universe claiming its debt."  Kara believed that her accident and pain was a justified retribution set out by the universe in response to her unjustified actions.  Even clients who experience pain from birth can internalize these same core beliefs. 

For clients with chronic pain, the pain and the pain-related stressors represent long-term negative life events.  An especially severe flare-up can be uniquely disruptive of a positive sense of one’s self. 

Think of your Kara.  Has a negative life event triggered a negative core belief system? 

2. Self-Identification
The second concept of core beliefs is self-identification.  Clients with severe, chronic pain who have difficulty self-identifying themselves after the first onset often self-identify with the pain.  They become so absorbed in the pain itself that they will no longer categorize themselves as a "well" person with a pain problem, but as a "diseased, pseudo-person." 

This can result in a self-victimization in which the client believes themselves so diseased, that they are unable to function properly in the real world.  Even if the pain itself is not acute enough to cause disability, the core belief that the client has internalized creates this reality.  In short, they have become their pain. 

Joshua, age 42, had recurring problems with his spine.  After many surgeries, medications, and a plethora of doctors, he still believed his pain was worsening.  He stated, "My back is becoming more painful now.  People like me shouldn’t have to work, so I think I might apply for disability." 

I asked Joshua, "But couldn’t you ask for a more therapeutic chair, or maybe frequent breaks to relieve your pain so you wouldn’t have to completely quit work?"  Joshua responded, "No, nothing works anymore!  My spine is disintegrating and there’s nothing I can do about it!"  I then stated, "Joshua, the last time they X-rayed your spine, there was no evidence of disintegration or the original inflammation." 

But still, Joshua maintained his position, "That doesn’t mean anything!  The doctors don’t know me!  I’m becoming an invalid and soon I’ll be worthless!"  Did you notice how Joshua used the expression, "The doctors don’t know me"?  In actuality, the more appropriate phrase might have been, "The doctors don’t know my pain," but because Joshua had so completely identified himself with his pain, it had been extremely difficult to dissociate himself from this pre-conceived core belief. 

Think of your Joshua.  How has he or she self-identified with his or her pain?

3. Culturally Influenced Core Beliefs
In addition to negative life events and self-identification, the third concept of core beliefs is culturally influenced core beliefs.  These are certain beliefs that are perpetuated by society or a sub-society.  For instance, if a society believed that back pain was produced by an injury, not a biological source, clients would seek certain types of treatment.  Another, more extreme, example can be seen in fundamentalist religious movements.  

Chronic seizures may cause an epileptic to ask for an exorcism or a fibromyalgic client to ask for absolution.  Also, other non-sufferers may perpetuate these beliefs, encouraging the wrong type of healing process for the client’s pain. 

Louis, age eighteen, believed that his chronic migraines were a result of his diet.  I asked Louis where he heard this information.  He stated, "My mom always told me that whatever goes into the mouth will affect the brain.  I think I may be eating too much sugar, and just getting a head rush."  In Louis’s case, his culturally influenced core belief was readjusted with a few references to a doctor and informational pamphlets and books about chronic migraines.  Although he still maintained a sugar-free diet, he also took the advice of the doctors and texts.

Technique:  Harmful or Harmless Culturally Influenced Beliefs
Do you, like I, ever find it difficult when a fundamentally religious client brings up his or her beliefs to explain biological phenomenon? 

As you are quite aware, balancing between respect for the client and helping the client physically and mentally can be sometimes be a monumental task.  Although some culturally influenced core beliefs about pain may be harmless, there are others that prevent clients from seeking the kind of healing that would actually be beneficial to them.  To understand and evaluate these types of beliefs, I ask many of my clients to write an essay about their own beliefs. 

For instance, where do they think this pain is coming from; what do they think is the best treatment for their ailment; and, finally, how much control do they think they have over their pain? 

Karly, a twenty-seven year old client of mine, stated, "I believe my muscle pain is coming from an imbalance in my chakra points.  I need to stimulate my immunity chakras.  I believe that my level of control over my pain is high."  While Karly’s beliefs were new age, she was still open to trying modern medicine in addition to her yoga.  Because I believed her own beliefs did not inhibit her healing, I did not need to counteract these beliefs.  However, there are some clients who believe in only seeking spiritual and mental treatments to their pain. 

How do you handle such clients?

In this section, we discussed three concepts related to core beliefs.  These three concepts of core beliefs include:  negative life events; self-identification; and culturally influenced core beliefs.

In the next section, we will examine three characteristics of stress related to pain.  These three characteristics of stress related to pain include:  spontaneous stress and chronic stress; stress as an automatic thought trigger; and physical manifestations of stress.
Reviewed 2023

QUESTION 4
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