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Section 2
Pain Anxiety

Question 2 | Test | Table of Contents

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In the last section, we discussed three concepts related to depression and fibro fog.  These three concepts related to depression and fibro fog included:  depression:  fact vs. fiction; fibro fog; and dispelling the fibro fog myth.

In this section, we will examine three manifestations of anxiety in chronic pain clients.  These three manifestations of anxiety in chronic pain clients include:  generalized anxiety; social anxiety; and fear of mortality.

3 Manifestations of Anxiety

♦ #1 Generalized Anxiety
The first manifestation of anxiety is generalized anxiety.  This type of manifestation includes an entire conglomeration of fears, including the fear of medications, treatment, and disability.  Clients who experience significant generalized anxiety exhibit the normal symptoms of someone with anxiety disorder, suffering from heart palpitations, dizziness, and insomnia.  Clients with generalized anxiety cannot normally pinpoint the exact source of their anxiety.  They just feel anxious and on edge at sporadic moments during the day. 

Jenny, age 27, suffered from this type of generalized anxiety which acted comorbidly with her spina bifida.  Jenny stated, "I always feel like there’s something wrong, like I needed to do something today, but I can’t remember what it is.  So I’m constantly making lists.  Sometimes, I write out lists of over a hundred things I did today, from when I woke up to when I went to bed.  But I still can’t shake the feeling that I missed something, and then I start believing that that little something I forgot to do is going to completely destroy my entire life!" 

Jenny had begun to exhibit the symptoms of a compulsive checker in which the client creates a system and continually checks him or herself. 

Think of your Jenny.  What sort of new behaviors have arisen since the onset of his or her generalized anxiety?

♦ #2 Social Anxiety
The second manifestation of anxiety is social anxiety.  In some cases, clients will develop a fear of meeting new people because of the awkwardness of explaining their condition.  They begin to fear being rejected or scrutinized or even disbelieved.  I have found that the anxiety increases if the client suffers from a condition that also manifests itself through dermatological disorders.   In these instances, clients cannot hide the fact that they have a disorder, and the potential for a negative initial reaction increases. 

Juliet, age 46, had a severe case of lupus.  In addition to her chronic weakness and pain, Juliet had a large rash on her arms, legs, and hands.  Because of this, she became self-conscious about meeting new people and what they would think about her physical features.  Juliet stated, "I’m so afraid they’re going to judge me by how I look and not my personality.  I’ve seen so many people stare or even jump a little when I reach out my hand to shake theirs.  I’m really afraid when I meet bosses or new clients.  They might think that I’m not as capable as someone else because of my disease." 

Juliet’s anxiety about her appearance also translated into her anxiety about her job and her clients’ confidence in her ability. 

Think of your Juliet.   Does he or she have social anxiety arising from dermatological disorders?  How else is he or she experiencing social anxiety?

♦ Technique: Confidence List
To counteract Juliet’s anxiety and self-consciousness, I suggested that Juliet write up a "Confidence List."  In it, I asked that Juliet write up characteristics that she felt were positive attributes of her character.  As in section 6 about redefining self-worth, the object here is to shift the client’s source of self-esteem away from negative characteristics to a new source of self-worth.  I also asked her to list evidence for these positive characteristics 

The next week, Juliet included the following characteristics on her list:
            (1) Confidence
            (2) Competency
            (3) I just received a promotion and a raise

After Juliet had completed her list, I asked her to tape this list to a place that she would be able to see it when she needed an extra boost of pride most.  She decided to put it next to her computer screen in her office. 

Think of your Juliet.  Would he or she benefit from this exercise?

♦ #3 Fear of Mortality
In addition to generalized anxiety and social anxiety, the third manifestation of anxiety is fear of mortality.  Although such syndromes as fibromyalgia and bursitis are not fatal, clients who experience severe chronic pain generally begin to develop fears of death and their own mortality.  The experience of pain itself becomes a constant reminder to these clients that death is a very real and unavoidable conclusion to life and despite reassurances that their conditions do not necessarily shorten a life span, many clients harbor fears that their disease could lead to an early death. 

This type of anxiety will result in many sleepless nights and, in some cases, affects the client’s ability to perform daily tasks.  Unlike social anxiety, which comes as a result of a specific stimulus, the fear of death is always present in the minds of clients.  To address these fears, I sometimes recommend that the client take solace through spiritual means, but only if it is clear that the client has spiritual beliefs or connections. 

Yolanda, age 59, suffered from fibromyalgia, and even though she knew the syndrome was not fatal, she still had worries about her mortality.  She stated, "I’ve been thinking about death recently.  What my family would do when I’m gone and things like that.  I know it’s impossible to comprehend nonexistence, but I get the willies just thinking about it.  My family is made up of atheists, so we don’t believe in an afterlife.  Sometimes I wish I did, it would make thoughts like these much easier to handle. 

I suggested Yolanda create a "List of Life" to try and get her to focus on life’s positives rather than the negatives.  She listed:  playing with the kids; long walks with my husband; well-written books; fabulous movies.  I asked that Yolanda focus on putting her energy into these activities and to tell herself to pull out of the divebomb of fear by saying "halt."

In this section, we discussed three manifestations of anxiety in chronic pain clients.  These three manifestations of anxiety in chronic pain clients included:  generalized anxiety; social anxiety; and fear of mortality.

In the next section, we will examine three techniques for helping clients lessen their chronic pain in day-to-day life.  These three techniques to help lessen daily, chronic pain include:  Brain Talk; Focus Anger; and Name Your Symptoms.
Reviewed 2023

Peer-Reviewed Journal Article References:
Amtmann, D., Askew, R. L., Kim, J., Chung, H., Ehde, D. M., Bombardier, C. H., Kraft, G. H., Jones, S. M., & Johnson, K. L. (2015). Pain affects depression through anxiety, fatigue, and sleep in multiple sclerosis. Rehabilitation Psychology, 60(1), 81–90.

Ditre, J. W., Zale, E. L., Kosiba, J. D., & Zvolensky, M. J. (2013). A pilot study of pain-related anxiety and smoking-dependence motives among persons with chronic pain. Experimental and Clinical Psychopharmacology, 21(6), 443–449.

Kaye, S., Wygant, D. B., Umlauf, R. L., & Marek, R. J. (2021). Factor structure and validity of the Inventory of Depression and Anxiety Symptoms-II (IDAS-II) in a chronic back pain treatment-seeking sample. Psychological Assessment.

Kauffman, B. Y., Manning, K., Rogers, A. H., Garey, L., Gallagher, M. W., Viana, A. G., & Zvolensky, M. J. (2020). The role of anxiety sensitivity in terms of weight-related impairment and fatigue severity among adults with obesity and chronic low back pain. Cognitive Therapy and Research, 44(6), 1132–1139.

Rogers, A. H., Gallagher, M. W., Garey, L., Ditre, J. W., Williams, M. W., & Zvolensky, M. J. (2020). Pain Anxiety Symptoms Scale–20: An empirical evaluation of measurement invariance across race/ethnicity, sex, and pain. Psychological Assessment. Advance online publication.

What are three manifestations of anxiety in chronic pain clients?
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Section 3
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