Video script: thinking about our thinking, part 6
GGC - 10 Week Pain Management Programme
This content is designed for the participants of the GGC Pain Management Programme.
Thinking about our thinking, part 6: getting distance from our thoughts
Hello, welcome to the next video in our section on thinking. In this video, I will talk about the second strategy for managing our thoughts. This approach comes from ACT or Acceptance and Commitment Therapy and may be familiar if you worked with one of the psychologists in the pain service before you came to the PMP. ACT helps us to manage troublesome thoughts but stepping back and getting distance from our thoughts. We’ve already talked about getting distance from our thoughts in earlier videos and this session will focus on this a bit more.
In the last video, we talked about challenging our difficult thoughts. This works well and there is a huge amount of research that shows this is an effective way to manage our thinking.
However, can you think of any troublesome thoughts that you can’t really challenge? What about - It’s not fair, why me, I can’t bear it, why me? These are harder to challenge in this way.
There are also thoughts that we know aren’t rational but we still experience. I know I am not a terrible parent, but sometimes I still think I am.
Some thoughts that keep returning even though we have tried to challenge them in the past.
So challenging our thoughts is not the only answer. We need another technique.
When difficult thoughts come up, what do we often try to do with them?
We often try pushing these thoughts away. Telling ourselves not to think like that or beating ourselves up for thinking this way, hoping this will make us change our thinking.
It’s a bit like the tug of war with pain that we talked about at the start of the PMP. But, like we said in one of the earlier videos on thinking, we cannot control our thinking in this way. If we try to push these thoughts away, if we try not to think about the pink elephant, these thoughts only become more powerful.
What else can we do then?
Bear with me for a moment while I try to show you another approach – put your hand up in front of your eyes but keep your eyes open. How clearly can you see your hand? How much of the room can you see?
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Now move your hand a few inches away from your face. How clearly can you see your hand now? Can you see more of the room? Finally, move your hand all the way out until you can focus on it clearly and you can see all that is around you. You can put your hand down now.
Sometimes we see the world through our thoughts, this can be like peering through your fingers trying to see the rest of the room. Instead, what we want to do, it learn ways to step back and see our thoughts, notice them, observe them, see them for what they are, thoughts, not facts.
This takes time and practice but is a useful strategy when we feel our thoughts are pushing us about and stopping us leading the life we would like to.
The ACT approach states that you and your thoughts are not the same thing. Therefore, to reduce the power your thoughts have over your mood and behaviour it is important to develop distance from your thoughts and look at them for what they are and not what they say they are. We want to develop ways to step back and get out thoughts in focus, like we did with our hand just now.
In ACT the term “Cognitive Defusion” is used to describe the act of getting distance from your thoughts. Defusion is the ability to watch your thoughts come and go without attaching yourself to them. Defusion allows you to have thoughts without putting those thoughts in the driver’s seat of your life.
What defusion can offer you is the means to gain enough distance from your thoughts to make choices on your own, without the influence of the ever-buzzing mind machine at your back. Once you learn to notice your thoughts and look at them instead of from them, you can make choices about your behaviour and therefore, your life.
You might be sitting thinking, that all sounds a bit crazy. How on earth do you step back from your thoughts. We have outlined a few different approaches that might help.
The first one is very simple. When you notice a troublesome thought, label it as a thought. So, for example, if you notice yourself saying on a bad pain day, “This is going to be an awful week.” Catch yourself and rephrase it, “I am having the thought, this is going to be an awful week.” What does that do? How does it change the meaning of it? I think it takes some of the sting out of the thought, it loses some of its power.
The thought observer is good if you are a very visual person, someone who can imagine things well. The example of this in your manual is to stand and watch traffic go by on a busy road – label the vehicles as they go by in whatever way you like – colour, manufacturer, whatever. Notice then the thoughts that come up. Maybe “that’s an expensive car, I could never afford that now I’m not working,” or “I should hire a van like that to get rid of the old furniture sitting in the hallway, but I’m too sore to lift it all.”
Imagine that as you have a thought, you can simply attach it to one of the cars and watch it glide past. For example let’s say you had the thought “my pain ruins everything”. Mentally paint those words on the side of a car and watch it disappear down the street with the words attached. Watch your thoughts come up, and watch them roll away down the street. Go ahead and do this with the thoughts that are coming up right now. If you are thinking “wow, this is really a silly exercise,” go ahead and put that on the side of a car and watch it go by. On the other hand, if you are thinking “this is really cool and I’m really good at it,” put it on the side of a car and watch it go by as well. Do this for a few minutes and watch your mind.
While watching your mind, see if you can find the point when you stop watching the thoughts go by on cars and start looking through the lens of the thoughts themselves. This is the point at which you are sinking in to the content generated by your mind, and it happens all the time. Do you find yourself praising or critiquing yourself on your performance in this exercise? If so, you’ve fallen into a very common mental trap. Any attempt to judge your performance is only your mind generating more thoughts. Do you find yourself becoming caught up in thoughts about pain? Again, this a common trap. If this is the case, don’t be hard on yourself. Rather, try to take those thoughts, paint them on cars, and watch them disappear down the street. This exercise for observing your thoughts can be an incredibly powerful cognitive defusion tool.
This next one is not a spelling mistake! It’s a bit different to the usual meaning of kicking your butt! When we use the word “but,” we usually intend to indicate opposition to a statement. For example, you might say “I would love to go for a drink with you tonight, but I am in so much pain.” In this case, the word “but” is telling you that there is no practical way for you to go for a drink because of your pain. Now let’s see what happens when you simply replace the word “but” with “and.” In the example above this would mean saying “I would love to go for a drink with you tonight and I am in so much pain.” How does this sound different? Generally people say it sounds like going out for a drink might be a possibility…and then you can consider what adaptations to make to make it manageable, maybe some of the strategies introduced on the programme like pacing or goal setting.
The last one might sound odd. I have seen it prove very helpful though. Think about the word or phrase that sums up your pain – it might be a particular area or a word that describes it. It might be “Back” or “Crumbling” or “Burning.” Or it might be a phrase you say to yourself, like “I’m useless” or “No one cares about me.”
Think about all the thoughts and feelings that come up when you hear that word or phrase. Next, repeat the word or phrase over and over for 2 minutes. What happens? The word just becomes a noise, a collection of sounds, it doesn’t hold the same meaning and emotional connection to it. It sounds like a strange technique but it is very powerful. Have a go with it!
The key thing we want to help you to do is not notice your thoughts and find ways to step back from them so you can learn to respond to them rather than automatically reacting to them. How do we do this?
Remember, your thoughts are not you. You are separate from your thoughts.
Remind yourself that your thoughts are constantly changing and not always reliable.
We have a “tricky” brain, not designed for the complexities of modern life with all its stressors.
Another good approach to work on is to develop a habit of stopping and asking ourselves, does this reaction, this thought, this feeling, get me closer to where I want to be or further away?
You might have seen this slide before in a previous talk. We use it as an illustration of the idea that we are all bus drivers of our lives. We are directing the bus where we want to go. Sometimes the passengers are unhelpful, disruptive, rude, critical, painful. We can get distracted from driving and get caught up trying to get the difficult passengers off the bus. But they always get back on…. An alternative approach is to learn to let the difficult passengers to just be there, AND continue to drive the bus where we want it to go. We can focus on what is important to us and find ways to move towards that despite difficult thoughts.
So, to summarise these last two videos, where we have been discussing two different approaches to reduce the power of our thoughts, sometimes you can challenge your thinking and sometimes it is better to work on standing back from your thoughts. In both cases though, it takes intention and practice.
Your task is to use some of these thinking techniques before the next group session and to complete the checklists in task number 6.