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Section 8
Pain Catastrophizing

Question 8 | Test | Table of Contents

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In the last section, we discussed three manifestations of anger commonly found in chronic pain clients.  These three manifestations of anger commonly found in chronic pain clients include:   anger arising from limitations; outbursts; and inbursts. 

In this section, we will examine three challenges related to helplessness.  These three challenges related to helplessness include:  humility vs. humiliation; catastrophizing; and asserting independence. 

3 Challenges Related to Helplessness

♦ #1 Humility vs. Humiliation
The first challenge related to helplessness is humility vs. humiliation.  Have you found, like I, that many clients suffering from chronic pain feel a sense of humiliation when asking for help?  In the case of dependence, many once-independent clients begin to feel embarrassed about asking for help because of their condition.  They feel guilty for placing their burden on another's shoulders and they also feel a drop in self-esteem at losing their individuality

However, I try to reverse this concept and reframe it as a positive attribute to admit weakness.  In short, I turn "humiliation" into "humility."  Viewed in this way, clients begin to feel more comfortable about needing the help of another. 

Stacey, age 21, had been debilitated by her fibromyalgia.  She stated, "I used to be a cross-country runner.  I loved that sport.  I used to run from work to home again.  I've never needed a car.  Now, I have to ask my roommate to drive me to work every morning because walking is too painful.  Everyone used to admire me for my strength, and now I have to put my tail between my legs and beg for their help." 

I stated, "Did you really have to beg to get their help?  Being such a strong personality before is quite a difficult task, but an even more difficult one is admitting you need help.  Exposing your vulnerability doesn't make you any less of a person.  In fact, not admitting your limits only exhibits stubbornness, not will power.  Knowing what's best for your body and taking steps to secure its health reveals a person who respects herself." 

Think of your Stacey.  How would you address his or her humiliation?  How would you change humiliation to humility?

♦ #2 Catastrophizing
The second challenge related to helplessness is catastrophizing.  As we discussed in section 3, catastrophizing is a type of negative automatic thought which causes the client to believe that their pain has ended their life as they know it.  Ultimately, the catastrophizing client has given up hope for a normal and happy life within the confines of his or her disease. 

This mindset directly relates to the client's inability to help him or herself.  As the client reduces his or her self-reliance and intake of activities, he or she may envision life itself slipping away.  For many clients, this vision becomes seemingly unbearable and such phrases as "I can't go on living like this" and "My life is over!" become common. 

Suzie, age 48, had developed rheumatoid arthritis in both her hands.  As a tailor, Suzie prided herself on her work, but because of her pain, she had to quit the job she loved so much.  With that, she lost close friends and a source of income.  Suzie stated, "I'm alone and unemployed!  What am I going to do?  I'll never be able to retire and I'll be working for the rest of my life just to make ends meet!"  Suzie had begun to exaggerate her position. 

Her husband, Geoff, had just been promoted to a more lucrative position in his company, so Suzie could live comfortably without having to work.  She stated, "It doesn’t matter!  I've been financially self-supported all my life, and I won't start accepting money now!"  Geoff, eager to help his wife in her time of need, was hurt by Suzie's refusal of his support. 

To help Suzie feel less helpless, I suggested she try a profession which did not require extensive use of her hands.  One of her friends owned a restaurant and offered Suzie a job as a hostess.  The use of her hands was limited, minimizing the pain she felt, and she received a great deal of satisfaction from being employed once again. 

Think of your Suzie.  How could you alleviate his or her catastrophizing?

♦ Technique:  Asking Yourself for Help
Many clients have difficulty asking for help while at the same time maintaining a degree of self-worth.  Also, they do not wish to place their burdens on others.  To help clients like Stacey and Suzie ask for help, I suggested they try "Asking Yourself for Help."  This technique involves standing in front of a full length mirror and practicing a "help speech.

The help speech includes asking for assistance and also provides specific tasks that the other person would need to perform in order to aid the client.  This is a simple practice exercise to help these clients form the words they will use when asking another person.  Stacey stated, "It was more effective practicing with a person in front of me, so when I asked my roommate, I was much less intimidated." 

Think of your chronic pain client.  Does he or she need to ask for help?

♦ #3 Asserting Independence
In addition to humility vs. humiliation and catastrophizing, the third challenge related to helplessness is asserting independence.  Although many clients must resign themselves to a dependent life, I believe that if a balance between reliance and independence can be reached, it aids the feelings of helplessness the client is experiencing.  This "independence" is a new kind of independence, one which involves menial tasks, but tasks that the client lays out for him or herself. 

Peggy, age 71, could not walk without pain after her hip shattered.  Peggy stated, "Everyone wanted to do things for me.  They cooked me dinner, brought me my paper, took me to the bathroom.  I love my family dearly, but they are driving me up a wall!  I felt like I had completely lost control of my household." 

To help Peggy regain her independence, I asked that she write a list of activities she could do herself, which included:  making phone calls; mending clothes; and writing letters to friends and family.  I told Peggy to attach this list to refrigerator with a heading in big, bright letters that said, "Peggy's Chores."  In this way, her family could still help her with more physical chores, but at the same time respected her decision to remain independent in some degree. 

Think of your Peggy.  In what way could he or she assert his or her independence?

In this section, we discussed three challenges related to helplessness.  These three challenges related to helplessness included:  humility vs. humiliation; catastrophizing; and asserting independence. 

In the next section, we will examine three concepts related to self-victimization.  These concepts related to self-victimization include: sense of betrayal; projections; and resentment.
Reviewed 2023

Peer-Reviewed Journal Article References:
Akbari, F., Dehghani, M., & Mohammadi, S. (2020). Factor structure and invariance of the pain catastrophizing scale in patients with chronic pain and their spouses. Rehabilitation Psychology. Advance online publication. 

Noyman-Veksler, G., Shalev, H., Brill, S., Rudich, Z., & Shahar, G. (2018). Chronic pain under missile attacks: Role of pain catastrophizing, media, and stress-related exposure. Psychological Trauma: Theory, Research, Practice, and Policy, 10(4), 463–469. 

Ong, A. D., Zautra, A. J., & Reid, M. C. (2010). Psychological resilience predicts decreases in pain catastrophizing through positive emotions. Psychology and Aging, 25(3), 516–523.

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, 32(9), 818–828.

What are three concepts related to helplessness?
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Section 9
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