A common misconception is that emotions or feelings occur in direct response to a sensory event. Such events can be internal, such as our physical state (e.g., a backache), or external to us (e.g., being stuck in traffic). So it may seem that the event causes the resulting emotion. Yet, in response to an event, thoughts actually occur before feelings. It is the way we think about the event, our beliefs about it and how we interpret it, that creates our emotional response. Our emotional response, the way we feel about an event, then, has great influence over our consequent actions. This helps explain how different people can experience basically the same event and have completely different feelings in response to it. For example, two women are waiting to be picked up by their husbands after work. They were expecting to be picked up at 5:00 pm and it is now 5:20. The automatic thoughts that occur to the first woman go something like: “He’s so late. He obviously doesn’t care about me enough to get here on time!” In contrast, the thoughts that come up for the second woman are: “He’s so late. Traffic must be especially heavy.” Based on those different thoughts, and the divergent beliefs about the same situation that those thoughts represent, the emotions each of these women feels are likely to be very different. Place yourself in each position for a moment, thinking each of those different thoughts. What feelings come up for you in response to each set of thoughts? In response to this same event, there are multiple different thoughts that could occur automatically, including, but not limited to: “He must have forgotten about picking me up”; “I wonder if everything’s okay”; “Maybe the kids’ practice ran late”; “I hope he didn’t get into an accident.” Each of these thought responses has different beliefs or interpretations attached to it, and, in turn, each belief or interpretation is likely to generate different feelings in response to the same event.

Connecting Thoughts and Emotions

Describe an event you have experienced where the initial thoughts you had and your beliefs about the situation turned out to be inaccurate. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Identify the feelings that came up for you in response to your thoughts about this event. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Imagine yourself back in the situation and change your initial thoughts and beliefs so that they match what actually happened. Identify the feelings that come up for you now in response to these changes in your thoughts and beliefs about the event. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Notice how different the feelings that came up for you were after you changed your initial thoughts and beliefs to accurately fit the situation, compared to your first set of feelings.

How Does This Process Relate to Chronic Pain?

If, in our example, it were you waiting to be picked up by your spouse or a friend after work and you have a chronic pain condition, and your automatic thoughts and the beliefs related to the event are negative (e.g., “He doesn’t care enough about me to get here on time”), the emotions that result are frustration and/or anger. Frustration and anger lead to increased muscle tension and stress, which generally lead to increased sensations of pain. There is a correlation between negative thinking and beliefs and the level of pain you experience—the more negative the thoughts and beliefs, the greater the pain sensations. This can quickly become a vicious cycle as pain triggers negative thoughts and self-talk that can then translate into suffering, as well as increased muscle tension and stress, which, in turn, amplify the pain signals, triggering more of them. The longer such a cycle continues, the more out of balance you may become. The progression is essentially as follows:

• event (overshadowed by chronic pain) –>
• negative thoughts/self-talk/beliefs –>
• suffering/anger/depression/fear/anxiety –>
• Muscle tension and stress –>
• More pain –>
• Increased negative thoughts/self-talk/beliefs –>
• Greater suffering –>

The process of pain recovery includes dramatically changing this negative progression through regaining balance in thinking. Reestablishing balance counteracts this negative progression thus:

• • Pain –>
  • Decreasing negative thinking/increasing positive self-talk –>
  • Decreased feelings of frustration, anger, depression, hopelessness, and helplessness –>
  • Positive thoughts and feelings –>
  • lower stress and tension –>
  • less pain –>

This blog post is an excerpt from Pain Recovery – How to Find Balance and Reduce Suffering from Chronic Pain by Mel Pohl, MD, FASAM, Frank Szabo, LADC, Daniel Shiode, PhD, Robert Hunter, PhD; Published by Central Recovery Press (CRP).