COGNITIVE THERAPY AND PAIN MANAGEMENT

Those who work in the field of healthcare have known for some time that a connection exists between our underlying beliefs and thoughts and the functioning of our bodies. Dr. Herbert Benson, in his 1970’s landmark book, The Relaxation Response, articulated the concept that stressors can trigger a “fight or flight response”, an inner startle response that indicates we are about to experience an unpleasant event. Although there is a healthy fear that protects us from harms way, many times how one interprets stressful events and one’s ability to manage it, can affect the immune systems functional capacity. There is now sufficient research to validate Benson’s work, that relaxation techniques such a meditation, can have a direct link to minimizing the effect of a wide range of disorders such as high blood pressure, irritable bowel syndrome, back problems, neurological pain, and headache problems. Relaxation strategies calm the sympathetic nervous system, making it easier for the body to heal.
In Barbara Levine’s book, Your Body Believes Every Word You Say, she explores how our thoughts and underlying beliefs about our physical maladies affect our auto-immune system which regulates our ability to ward off illness, manage pain, and promote healing. In other words, legitimate pain from various illnesses and somatic complaints can be intensified by the kind of messages we tell ourselves. Spontaneous self-defeating thoughts such as, “What’s the use, my body will always betray me and never get better.” can reinforce the pain cycle of making things worse. People with such chronic self-defeating reactions have been shown to create inner chemical changes and constricted blood flow which further erodes the individual’s ability to manage pain. How we respond to our bodily disorders, in terms of core beliefs and inner dialogue, may affect the outcome of our health.
Some time ago, I attended a presentation by psychiatrist M. Scott Peck. He talked with mental health providers about his struggles with neck pain, a problem that had plagued him for years. An operation resolved some of his pain, but he felt that there might be some negative underlying belief that was also contributing to the problem. He ultimately concluded that he was a conflict-avoider, lacking the ability to appropriately assert himself, refusing to “stick his neck out.”
Physical illnesses can be intensified by self-defeating underlying thinking that is a metaphor for the chronic condition experienced. For example, people with back pain may at times lack the “backbone” to express their thoughts and feelings courageously. Individuals with gastrointestinal problems may not be unable to “stomach” certain intolerable thoughts and feelings. People with headache syndromes may experience beliefs and thoughts about events that make them want to say, “Life is making my head hurt.” Eating disordered people may experience core assumptions such as, “I’m so angry that I could just vomit, or if I monitor my weight and eating habits, at least it’s one area in my life that I can control!” People with neurological pain such as inner ear disorders may exacerbate their pain by experiencing thoughts of panic such as, “Oh my God, here it comes again, that nasty, annoying pain. I’ll never get over this because the volume in my life is turned up too high.”
Anxiety, panic, and depression are typical characteristics associated with physical pain. The more effectively one manages these symptoms, the less troublesome the pain may be. Learning to cope with anticipatory anxiety by rationally responding, “Ok, I know that this pain can be troublesome, but when it comes I will do my deep breathing and manage just fine!”, or dealing with panic, “When a wave of pain comes, I’ll just go with it. It’s not a big deal, my scary feeling are time-limited, they’ll be over soon”), and managing depression, “Just because I feel awful doesn’t mean I can’t do things to stay active and make me feel involved” are important ways of adaptively responding to pain.
The following ideas are some guidelines for managing pain more effectively:
· Try to get you pain in perspective. Make a realistic appraisal. “In the scheme of things, how bad is my condition?”
· Don’t fight with your symptoms, it only makes them worse. The more you accept your symptoms, the more they are likely to diminish.
· Use various activities to refocus away from your pain. Dwelling on pain makes it more painful. Stretching, music, swimming, meditation, and other activities are important.
· Seek a multidisciplinary approach to your problem, if necessary. Get a team of healthcare specialists, including a quality physician, psychotherapist, physical therapist, message therapist or other providers of pain management.
· Develop a solid support system of family and friends. Also, there are many support groups in our community for people suffering from a variety of physical ailments.
· Remember, that the things we tell ourselves have an impact on our physical and emotional well-being.
James P. Krehbiel is an author, freelance writer, and nationally certified cognitive-behavioral therapist in private practice in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at http://www.booklocker.com/. He can be reached through his website at jkboardroomsuites@yahoo.com.

Authenticity and the Gay Identity

Many years ago, when I worked in education, I spent my summers directing outdoor park district activities for kids. The children would come from the neighborhood to play various games. One year I recall a teenage boy coming to the park with a desire to talk with me. He attended a youth group at his church (which was located nearby) and then would meander over to the park facility. At some point in our conversation, he told me that he was gay and that he felt ashamed as a result his church’s anti-gay sentiment. He felt very alone because he had told no one in his youth group of his sexual orientation. His parents were not informed, and would have been mortified had they known of his sexual identity. Each time he came to the park we would talk about his struggles with being gay. Because I had trained student leaders to work with the park kids, I was able to devote some attention to this troubled young man. This was my first exposure in conversing with an individual who professed to be gay. I learned a great deal about a segment of society that played out their lives in agonizing silence.

Over time, I learned that gay people, like other minorities, are used to being stereotyped. Those of us who are straight, perceive gays to be effeminate, flamboyant, impulsive and artsy. Most of the gay people I have met do not fit that pattern. They typically feel isolated because their behavioral patterns are actually heterosexual in nature with the exception of their sexual affinity toward others of the same sex.

With the advent of multicultural thinking, gays are beginning to feel more comfortable and accepted. Their level of confidence affects their relationships and style of relating to the world. The acknowledgement of being gay takes supreme courage. The odds have been stacked against those who choose to make their sexual orientation known. Many adults, now in midlife, are just beginning to acknowledge their true sexual identity. With such exploration comes the awareness that “I feel a stronger sexual connection with those of the same sex.” Such a realization may signal the emergence of terror – “I am not who I pretended to be.”

When you listen to the stories of those who are gay, you get a sense of the conflict and tension they have experienced in their struggle to be authentic. Most have known from an early age that they felt different about their sexual identity. In an attempt to conceal their feelings and behavior, many gays worked feverishly at removing any vestiges of gay traits from their behavior. This is exactly what African-Americans have done as they experienced the distain from those who embraced a Caucasian world-view.

Adolescence is a difficult time of turmoil for most youngsters. Add to that the issue of sexual identification and it certainly makes the process of navigating adolescence that much more strenuous. Many schools are afraid to acknowledge their gay students and provide little or no support for those in need. Ideological and political pressures play a role in keeping school administrators and school board members from stepping up to the plate in support for gay youth.

In my professional counseling practice, I have personally witnessed the anguish and conflict experienced by those individuals who have professed to be gay. I have also observed the courage that many patients have demonstrated in the process of emerging from their silence over their sexual orientation. Learning to be authentic is an important component of counseling and to honestly identify one’s sexual identity may be apart of that process.

Although there is little evidence to support its efficacy, many counselors surprisingly continue to espouse reparative treatment for gay clients. Counselors, who many times disguise their intentions, choose to subscribe to the archaic notion that sexual orientation is a learned pattern or choice rather than a lifelong identity. Reparative therapy views the gay individual as disordered and in need of transformation. Generally, counselors who conduct reparative therapy for gays look for deep-seated traumas as a causative factor in the “identity conflict” of those they serve.

Counselors who insist on touting reparative therapy for gays typically maintain their own biases regarding homosexuality. They carry these biases into treatment and negatively affect the self-worth and integrity of those they serve. Their insistence in curing gays creates a climate of self-doubt and defectiveness among those they treat.

Many in the religious community are unable to reconcile their beliefs and faith and are reluctant to identify with those who define themselves as homosexual. This fact causes many gays to reject their faith or live in a constant state of religious conflict. Years ago, a friend of mine decided to spend a weekend of solace at a religious retreat center. This was to be a time of isolation and reflection. However, her time quickly took on a new meaning. Gay men from churches throughout the country flew into this retreat center. Many of them were board members, elders, and pastors of their congregations. No one knew of their sexual orientation with the exception of the hundreds of Christian colleagues who met at this retreat center to worship together once a year. Every year, these men got together in the freedom of their real identity and worshiped God. They talked with my friend, expressing their sense of liberation and love for the God they embraced. My friend said it was a moving experience as she was asked to join them in their religious services which were filled with energy and passion.

Denial is a dangerous thing. Those who choose to ignore their true sense of self pay a price for their own personal betrayal. It takes courage to live with the way things really are. There are pitfalls along the way, but integrity calls for being true to who we are and who we have become. Those in the gay community have the right to define themselves in a way they desire. Unfortunately, for openly gay people, there are consequences for living with an identity they did not choose.


James P. Krehbiel, Ed.S, LPC is an author, freelance writer, and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His personal growth book, Stepping Out of the Bubble is available at www.booklocker.com. James can be reached at www.jkboardroomsuites@yahoo.com.

It's a Long Way from Richwood to the White House

Several weeks before her death on July 26th of this year, my mother made an interesting discovery. Here was a 93 year old woman from Richwood, West Virginia, who clung tightly to her conservative Republican beliefs. But on this particular day, she smiled intently at me and proclaimed, "Barack Obama seems like such a nice young man." It was the first moment in my lifetime that my mother and I politically connected.

This country has been down a perilous path in the past eight years. We have struggled through the presidency of George W. Bush, who failed this nation with his lack of integrity, feeble domestic direction and disastrous foreign policy. With Bush at the helm, we fought the wrong war for the wrong reasons and are still paying the consequences in loss of lives and economic calamity.

We are in need of a new direction. Although John McCain stands out as a war hero, he has waged a campaign that is without substance. He has spent more time bashing his opponent than laying out clear plans to get the country moving again.

Barack Obama has the vision, intelligence and judgment to lead our country down a more positive path. His campaign has been steady, and his campaign organization has been stellar. He has been maligned by many, some on this site, who ironically use their Christian faith as the basis for divisive comments. Accordingly, he is the "Muslim," "the enlightened one," "the anti-Christ," "the radical," "the terrorist," and “a Hitler.” He was also deemed guilty by association, as if John McCain didn't have enough affiliations with troubled individuals himself.

Barack Obama's concepts and ideology mirror many valuable Judeo/Christian principles. He is not interested in continuing to feed the pocket-books of the wealthy. He personally identifies and has compassion for those of our comrades in need. He has one wife, one house and tattered shoes. He understands the needs of the middle class and the poor. By focusing on this country's crumbling infrastructure, he will get our people working again. His administration will create new jobs that will spur the economy. He understands that a "trickle down" economic policy does not work because the wealthy are tainted by their greed. He will work toward providing healthcare plans for all Americans. He will prioritize the budget and will eliminate wasteful governmental spending.

His foreign policy will be founded on the principles of diplomacy, not power and control. He will fight the right war in the proper place, on the border of Pakistan and Afghanistan. We will regain our respectful standing in the world through promoting understanding rather than division. His vice presidential selection, Joe Biden, is ready to step in on the international stage. We will regain our credibility at home and abroad as Obama seeks to call out and prosecute those in our government who have shredded the Constitution, needlessly tortured prisoners, demonstrated political collusion, and overstepped executive privilege.

Those Christians who would try to reduce this election to a referendum on abortion are mistaken. Most reasonable Americans do not "believe" in abortion. Rather, they embrace the sanctity of life, and believe that such a concept is much broader than any narrowly focused discussion regarding this complex moral dilemma.

This is the most exciting election I've ever witnessed. For the first time in history, an African-American candidate is positioned to become President of the United States. The first 16 presidents of this country could have owned Senator Obama as a slave! How far we have come as we look forward to a new day in American history. I pray for him and his family as he seeks to lead this country out of turmoil.


James P. Krehbiel, Ed.S., LPC, CCBT is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. He can be reached at (480) 664-6665.