I don’t often have guest posters on my blog, but this guest is special; he’s close to my heart. And he’s one heck of a smart guy… He’s my dad. Dr. Randy Hurst, PsyD, is a clinical psychologist specializing in chronic pain and disability, as well as alcohol and drug treatment. In honor of the upcoming Pain Summit starting March 28 (register for FREE here), I asked my dad to expand on his concept of “fearworms,” and how fear can — ultimately — get in the way of pain relief.
Enter Dr. Randy Hurst:
Anyone who has experienced a tune that will not leave their mind, like it’s on repeat and won’t stop, has experienced what has come to be called an “earworm.” Years ago, upon personally experiencing an “earworm” — and then learning what it was called and how to help get rid of them — I also struck on the idea of the psychological aspects of disability, loss, and pain as “fearworms.”
Injury, especially disabling injury, can result in loss of a sense of one’s future and present “story.” Fear of what will happen, fear of how one will be limited, fear of what will exacerbate the pain, fear of the pain itself, and fear of whether it will ever leave all pique the feeling of fear for the future.
Some withdraw due to their sense of loss and do less and less.
Others try to press through, often ending up doing too much and then being thrown into a pain episode that can shut them down for days.
These are the issues on which chronic pain managers work with their patients, because both “too little” and “too much” usually lead to less and less activity, which then results in deconditioning. In turn, deconditioning causes increased pain perception and decreased abilities over time.
Add to this the FEARWORM about one’s future and there is a recipe for disability, as well as frustration by the patient, their healthcare providers, and their family members. This frustration only adds to their sense of fear and loss (or potential loss), and the fearworm grows unchecked; it intrudes, invades, and stresses – which, of course, all add pain.
the fearworm grows unchecked; it intrudes, invades, and stresses – which, of course, all add pain.
I love the Fear-Avoidance model of Steve Linton and Johan Vlayen seen below:
Inspired by Linton and Vlayen’s work, pain researchers Moseley and Butler (in their book, Explain Pain) refer to “thought viruses,” which are similar to fearworms but actually come from different parts of the brain. Fear, uncertainty, threat, and danger are represented in deep, reactive, self-protective parts of the brain, often referred to as the emotional or reptilian brain. They are “black and white,” fast reactions that are not thought out.
For example, a client had developed the pattern of walking slowly, taking small steps that resulted in a somewhat backward leaning gait. On exploring how this developed, she explained she had fallen and hurt significantly after, so she had been cautious to avoid ever being hurt again.
The self-protective reaction is often not thought through, but is a reactive self-defense.
Later the person might reflect on why they are walking slower than in the past and forget the issue of pain, but think it’s due to getting older and more fragile. Now the explanation of being older begins to become a “thought virus” and impacts (or infects) their thoughts about their other abilities.
If a fall and pain can lead to the sense of being older, then think of how all-encompassing the sense of loss and impact might be on life if one has a disabling injury.
Understanding fearworms and thought viruses (and how the brain creates and grows them) can be the first step to changing.
Like working through other fears, learning to rationally understand and talk oneself through them, learning to change breathing to help calm the body, exposing oneself to fears differently (as well as gradually), and succeeding through them becomes important.
One way to do this is to start slowly with a gentle exercise program that allows SMALL SUCCESSES rather than pushing too hard, too fast.
Additionally, working on a new “story” for one’s life that includes — and even gently embraces — the changes caused by limitations, pain, etc. becomes important. Those topics are too much for now but will be expanded upon in future posts.