Overcoming Perfectionism

In the last post, we discussed the nature of perfectionism and the problems associated with it. Specifically, we reviewed how perfectionism is problematic and how perfectionism leads to poor coping with chronic pain. In this post, let’s review some basic ways to begin to overcome perfectionism.

Accepting the problematic nature of perfectionism

The most basic step to overcome perfectionism is to recognize and accept that perfectionism is a problem. Despite the kudos that perfectionists might receive for the excellent quality of work that they do, perfectionism comes at a price. The perfectionist, as we saw in the previous post, lives with low-level emotional distress:

  • Nervousness (i.e., can’t sit still)
  • A persistent lack of satisfaction (i.e., things are never quite good enough)
  • Time pressure (i.e., there’s always more to do)
  • A persistent sense of self-criticism (i.e., the perfectionist rarely feels good enough)

Technically, what we are talking about is anxiety and the compulsive need to always do something just a little bit better. The compulsive behavior quiets the anxiety, but only temporarily. It lasts only until you see something else that needs to be done, which usually occurs not long after completing the previous task.

Moreover, none of these characteristics make for effective coping with chronic pain. In fact, they lend themselves to poor coping:

  • Failure to pace one’s activities
  • All-or-nothing approaches to life activities, which lead to persistent exacerbations of pain
  • Anxiety and depression
  • Problems in relationships

So, the first step in the process of overcoming perfectionism is to recognize that it is a problem.

This recognition and acceptance is difficult for some perfectionists. The degree of difficulty depends on the degree to which the perfectionist has skill sets that psychologists refer to as insightfulness and ego strength. These skill sets are important to understand because they have to be developed in order to overcome perfectionism (or most any other unwanted personality trait).

The prerequisite skill sets for learning and self-growth

The capacity for insight involves the ability to reflect on one’s own thoughts, feelings, intentions, or actions. People with insight can step outside of themselves and observe themselves. In so doing, they consider how they have been thinking, feeling, and behaving. This skill set is also sometimes called an ‘observing ego’ or an ‘observational self.’ Whatever we call it, it’s the ability to take yourself as your own object of observation, reflecting on your inner workings and outward behaviors.

The skill set of insightfulness allows you to self-correct and learn from feedback. Suppose someone doesn’t see the error of his ways. Others might point it out, but the person doesn’t see it and so doesn’t take heed. Instead, she continues to think that what she thinks or feels or does is right or accurate or warranted (whatever the case may be). What would allow her to see the error of her ways? It usually doesn’t help to get mad and yell at her, right? What helps in such situations is to help her to be able to step outside of herself and reflect on her thoughts, feeling or actions. We might help her to see that her perspective is but one of many perspectives. Moreover, we would help her to start weighing her perspective against other perspectives, coming to reflect on which ones are more true or accurate or warranted.

In so doing, she comes to the insight that what she thought wasn’t true or what she did wasn’t warranted. In short, she comes to the realization that she was making a mistake, but didn’t know it at the time, but now she does. In other words, she developed insight.

From here, we can see that the skill set of insightfulness goes hand in hand with another skill that we discussed in the previous post: ego strength. If you recall, ego strength is the ability to accept and learn from the feedback of others. To tolerate feedback from others, you have to be able to see that your thoughts and feelings are but one perspective among many and to reflect on how the perspectives of others may have more or less merit than your own. You subsequently come to see that how you had been thinking or feeling may or may not have been right in some way and as a result you learn and grow.

No one learns in a vacuum. Most of the time, in order to learn, we need others to point it out to us, to teach us, to show us. We thus need to be open to the feedback that others can provide.

So, in short, what we have been talking about are the pre-requisite skills for learning and self-growth. They are the following two abilities:

  • To be insightful
  • To accept feedback from others

They allow us to understand that not everything we think or feel is right (i.e., insightfulness) and be open to viewpoints that might differ from our own (i.e., ego strength).

The spectrum of skills

Like any other skills in life, the skill sets of insightfulness and ego strength vary across people. We can see them as occurring along a spectrum from those who aren’t very good at them to those who are really good at them.

The good news is that these skills can be learned, just as any other set of skills can be learned. Sometimes, it takes time and sensitivity, but they can be learned. Typically, people learn such skills in psychotherapy because it allows for learning in a safe and trusting environment in which sensitive issues can be discussed without criticism or judgment.

So, no matter how good you currently are at these skill sets, you can always learn to do them better.

Relationship of insightfulness and ego strength to perfectionism

The skill sets of insightfulness and ego strength lend themselves to personal growth across all facets of life, including learning to overcome perfectionism. They allow the perfectionist to step outside himself and reflect on whether his drive to do better or to do more is really necessary. Without this capacity to self-reflect, the perfectionist simply takes his perfectionistic drive as obviously warranted and persistently engages in excessive activities, attempting to attain some unattainable, perfectionistic standard. With self-reflectiveness and openness to feedback from others, the perfectionist can catch himself in such thoughts and behaviors, consider whether they are warranted, and make an intentional decision to do something different.

Let’s take an example. Suppose a perfectionist with chronic pain wakes up one day with relatively little pain. He’s pleased by the good fortune of a good pain day and thinks, “Oh good, I’m going to get this filthy house clean (or my taxes done or clean the garage).” Prior to this day, he had been beating himself up for having allowed the house to get so messy, even though others in the family might think that the state of the house is pretty clean, or at least clean enough. Nonetheless, as a result of his relatively low level of pain today, our perfectionist comes to clean the entire house and makes it look perfect. In so doing, he relieves himself of the low level of guilt he had been carrying around for the previously perceived lack of cleanliness of his house. For these positive outcomes, he pays the price of exacerbating his pain and being laid up for the next few days.

Notice in our example that our friend never stops to consider whether his perceptions of the house as ‘filthy’ are accurate. He doesn’t reflect on whether making an already fairly clean house into a perfectly clean house is truly warranted. So too, he fails to consider the predictable consequences of his all-or-nothing approach to house cleaning – i.e., cleaning the entire house in one day.

I once worked with a man who had never considered the fact that most people don’t vacuum their carpets every day. When he finally came to believe me, the conclusion he came to was that most people must be slobs. In the course of the discussion, it didn’t ever occur to him that he was the outlier.

How do you intervene in the face of such perfectionism? Unfortunately, what often happens is that family and friends become frustrated and throw up their hands. Worse yet, some might even get angry and chastise our friend for doing too much and exacerbating his pain. Such reactions only serve to isolate the perfectionist as we saw in the previous post.

What happens, though, if we approached our friend with sensitivity to help him entertain the idea that his house is already clean enough. Remember, it was the perception of others in his family and, because we know our friend well, we know that his perceptions of what is clean or not are usually the outlier and that his family’s perceptions tend to be more accurate. So, in other words, what if we help him to see that his perfectionistic standards color his perceptions. In so doing, he comes to see that there are other legitimate ways to see things. From here, he might progress to the point of doing it on his own: that he can begin to weigh different perspectives against each other and subsequently come to see that he tends to be an outlier in how he sees the world. Still later, he might come to see that the standards of the majority are most often right – that good can truly be good enough. At this point in the process of overcoming perfectionism, he’s ready to practice this insight over and over again.

Practice

Learning any skill requires practice. Typically, you don’t try something once and then have it down pat for the rest of your life. No, to learn something and become proficient at it, you have to practice. So too it is with catching yourself in your perfectionistic tendencies and changing them.

You use the skill sets of insightfulness and ego strength to catch yourself. You literally practice being self-reflective and being open to feedback from others.

It’s actually a very difficult thing to do. Our thoughts, feelings, decisions, and subsequent behaviors fly by almost instantaneously without a moment’s notice. It’s this lack of noticing that makes everything that happens between the ears seem to fly by. We are, of course, the pilots of our own planes, but more often than not we are on autopilot. As such, we simply and automatically react to the events of life as they happen without ever making any intentional decisions to react in the ways we do. That is to say, we typically don’t pay attention to our thoughts and feelings and make an intentional choice as to how to respond to the events of our daily life. However, if we set out to practice remaining aware of our thoughts and feelings and reactions, we can subsequently become more intentional about our actions. It is here where you can begin to break the habits of acting out perfectionistic tendencies. However, this degree of self-awareness and intentionality is difficult for at least two reasons:

  • It’s difficult to remember to pay attention and maintain a degree of self-observation.
  • It’s difficult to gain intentional control over compulsive behaviors, such as acting on perfectionistic needs to do more or do something better.

Oftentimes, when setting out to make personal changes, it’s easy to forget to continue making the change almost as soon as you start. It might be a day or two or even a week before you realize that you haven’t been doing it and in fact had forgotten all about it.

There are a number of ways that you might try to remember to practice your self-awareness. You might, for instance, take some sticky notes and write the phrase ‘self-observation’ on them and then place them strategically around the house. You’ll run into them as you go about your daily life and they can serve as a reminder. You might also place a smooth stone in your front pocket and every time you accidentally touch it, it will serve to remind you to check in with yourself about what it is you are thinking, feeling and doing. If you are religious and have a prayer routine, you could add your intentions to practice self-awareness to your list of prayers. Maybe also you ask some trusted loved ones to help remind you to check in with yourself, especially if they see you engaging in perfectionistic thinking or behavior. When asking others for such help, it’s usually best to agree on some non-critical phrase that they will use when reminding you, such as, “I’m thinking it might be a good time to check in with yourself.” In any of these ways, you get reminders to practice self-observation.

Once you are practicing this kind of self-observation, you might notice that you can sometimes be aware of your perfectionistic tendencies, but be unable to stop yourself from acting on them. Old habits die hard, as the saying goes. This experience is a normal stage in the process of change. Try not to be critical with yourself. Keep trying to catch yourself in the moment and make an intentional decision as to what you are doing. You will get better at it with practice.

Remember that in the course of practicing any new skill there is a stage in which it is uncomfortable. When you first learn to play a musical instrument or a sport, there’s a time in which you aren’t very good at it and it’s sort of an unpleasant experience. Your jobs at that point are to simply tolerate this discomfort and continue to practice. With time and patience, you will get better and it is will become easier and more pleasant.

It helps to foster a sense of curiosity and humor with yourself. It oftentimes seems that those who make personal changes easiest are those who become pleased or excited when making connections between some insight they had and their own behavior. When catching themselves in some behavior that they want to change, they exclaim, “Oh there I go again!” but do so with a light-hearted curiosity or even some humor. In the right spirit, insightfulness can oftentimes be funny. It can also foster a certain sense of appreciation or fascination for how complicated we are as humans.

Conclusion

In summary, what you are practicing is the following:

  • Remaining observant of your thoughts, feelings, intentions (or lack thereof) and behaviors
  • Come to recognize that your perfectionism clouds your perceptions and that your perceptions can tend to be outliers when compared with those of others (i.e., you might tend to see something as not good enough when in fact most others would see that it is good enough)
  • Make an intentional decision to do something different than your usual attempts to make something better when it’s already good enough (i.e., you practice being satisfied)

The ultimate goal is to become satisfied when things are good enough. When you can do that, you’ll have a handle on your perfectionism.

Author: Murray J. McAllister, PsyD

Date of last modification: June 8, 2015

The Perfectionist and Chronic Pain: How to Cope with Pain Series

While clinical lore is that perfectionists are more prone to the development of chronic pain, it may just be that perfectionists are more likely to seek care for their chronic pain. Reason? Perfectionists with chronic pain are more prone to behavioral exacerbations of pain as well as anxiety and depression. Let’s see how.

Are you a perfectionist?

First, let’s define perfectionism. Perfectionism is a trait of an individual that involves two components:

  • Holding oneself to standards that are never quite attainable (or at least not for very long)
  • The compulsive need to nevertheless try to attain those excessively high standards.

So, the perfectionist is never quite satisfied with what he or she does and can’t seem to keep from trying to make what they do better in some way. If, on those infrequent occasions the perfectionist is satisfied, it usually lasts only until he or she sees some flaw in the original project and attempts to correct it or only until he or she moves on to the next thing on the ‘to do list.’

So what might a perfectionist look like in real life? Perfectionists tend to see how any given project might be done better. Others might congratulate them on a job well done, but the perfectionist tends to respond, either overtly or silently to themselves, ‘yes, but, this could have been done better, or if only we had more time, we could have…’ In such responses, you see the persistent lack of satisfaction with the quality of work, even when others think the quality is superior. In other words, perfectionists hold themselves to unattainably high standards, standards to which no one else would hold them accountable. These Perfectionismexcessively high standards are evident in the cleanliness and orderliness of their homes work environments. Everything has a place and is in its place. Sometimes, the unattainably high standards and the subsequent persistent lack of satisfaction come out in the quantity of work that perfectionists tend to think they should attain. They always have more to do on their ‘to do list.’ It’s hard for them to sit still, when they know that there is ‘so much more to do.’ In other words, it’s hard for them to stop their activity and simply enjoy a leisurely moment.

Notice the compulsive sense of urgency that operates with these unattainably high standards. It’s hard to just sit still and be leisurely or satisfied. Having cleaned the entire house before having guests, the perfectionist finds herself continuing to straighten up even after the guests have arrived. If the perfectionist does sit down to chat with the guests, his attention keeps returning to the one pillow across the room that’s out of place or the picture that’s hung slightly crooked on the wall. Sometimes, it’s persistent underlying tension that fuels this compulsivity – if you don’t act to fix the problem, you just get too antsy or nervous. Still other times, it’s excessive self-criticism that fuels the compulsivity – you beat yourself up in your head for having missed the one flaw and you keep at such self-criticism until you get up and fix it.

Notice that perfectionism isn’t a healthy or an adaptive way to be in the world. Despite the kudos that perfectionists tend to get from their employers or others, low-level negative emotional states tend to predominate the inner life of a perfectionist. They recurrently feel lack of satisfaction, tension, self-criticism, and time pressure (because there’s always more to do). As a result, relaxation, leisure, playfulness, spontaneity, care-free, and peacefulness are relatively uncommon experiences for the perfectionist.

Notice too that perfectionism and self-esteem are closely tied together. The perfectionist tends to mistake the quality and quantity of what they do with who they are or their worth. When what they do is never quite good enough, it’s easy to start thinking that they are never quite good enough. This dynamic further fuels the compulsivity to act to make things better: their self-esteem is riding on it. However, the compulsive actions to make the job or task at hand better is just a temporary fix. When the perfectionist puts the perfectionistic finishing touches on a job, any sense of satisfaction is short-lived, lasting only as long as it takes to move on to the next thing on the ‘to do list.’

Perfectionists are prone to all-or-nothing thinking and behavior. Because of their high standards, perfectionists tend to see only two options for engaging in any task or project: the right way or not at all. Any other way besides the right way leads to unresolved tension or self-criticism and so you might as well do it the right way right from the start. Otherwise, how can you sit still until the job is done, which means, of course, done right? It’s this kind of thinking that leads to compulsively excessive behaviors – staying up all night until the job is done or cleaning the entire house in one day or not sitting long enough to enjoy the company who came over to visit.

Over time, such all-or-nothing thinking and behavior also leads the perfectionist to be the only one who ever does anything around the house or on the team at work. Maybe initially, all the others in the family or at work pitched in. To the perfectionist, though, the quality or quantity of their work wasn’t quite good enough. So, the perfectionist felt the need to ‘finish the job’. That is to say, the perfectionist compulsively acts on his or her excessively high standards, which are of course higher than the good-is-good-enough standards of most people. At some point, the others start to catch on and think to themselves, ‘Why bother to help? She [i.e., the perfectionist] is just going to take over at some point and do it anyway.’ They may even come to resent the perfectionist for thinking that what they do is never quite good enough. If this process happens for a long enough period of time, then the perfectionist ends up with all the jobs, for the perfectionist is the only one who knows how to ‘do it right’ (at least to the eyes of the perfectionist).

Like any other personality trait, people can have varying levels of awareness or insight into their perfectionism. On one end of the spectrum of self-awareness, some perfectionists have a lot of insight into their perfectionism and can catch themselves when they get too uptight about some minor flaw. They might even be able to laugh about it when others bring it to their attention. These people, we say in the healthcare field, have ego strength – the ability to tolerate feedback about themselves and learn from it. The prognosis for these kinds of perfectionists is good. On the other end of the spectrum of awareness, some perfectionists lack insight into their perfectionism and keep compulsively trying to catch up to their inner standards without ever stopping to reflect on whether their standards are realistically attainable or not. Failing to engage in such self-reflection, they might actually see others as lazy or lacking attention to detail. They might carry around an underlying resentment that they have to do everything because ‘no one seems to do anything around here.’ In reality, though, the others aren’t lazy or inattentive, but rather squarely within the norm for quality and quantity of work. These kinds of perfectionists can therefore lose sight of the abnormal nature of their unattainably high standards and so come to see others, who hold themselves to normal – good-is-good-enough – standards, as abnormal. Such perfectionists thus can have little awareness of their own perfectionism and can in fact get defensive or irritated when it is brought to their attention. As such, these kinds of perfectionists lack ego strength – the ability to tolerate feedback about themselves and learn from it. The prognosis for these individuals is guarded.

Now, one can be a perfectionist without ever having chronic pain and one can have chronic pain without ever being a perfectionist. However, when perfectionists develop chronic pain, it’s an unfortunate combination. It lends itself to coping poorly with chronic pain. As such, they likely come to chronic pain rehabilitation in disproportionate numbers.

Perfectionism leads to behavioral exacerbations of pain

Perfectionists with chronic pain get stuck between a rock and a hard place. They experience compulsive needs to stay busy and ‘get the job done right,’ but if they do, they exacerbate their pain. If, however, they keep themselves from acting on their compulsive needs, they subsequently experience high levels of tension and/or self-criticism for failing to ‘get the job done right.’ So, they are caught between either high levels of pain or high levels of tension and self-criticism. As a result of this dilemma, perfectionists commonly go with the former: they give in to their perfectionistic needs and compulsively become excessively productive, thereby exacerbating their pain.

This all-or-nothing dilemma of perfectionism can make pacing almost intolerable. Chronic pain rehabilitation programs encourage patients to learn to pace their activities, as a way of finding the middle ground between the ‘all’ and the ‘nothing’ options. To perfectionists, though, pacing means that they have to get used to a life of not being good enough. In reality, what they might do when pacing themselves is good enough, but, to perfectionists, good enough isn’t good enough – it has to be perfect. Thus, to the perfectionist, pacing activities doesn’t seem a viable pain management option.

Perfectionism leads to chronic resting and activity avoidance

The only other option in this dilemma is to come to the conclusion that because of the pain you can’t do anything. Let’s see how this works. Suppose the perfectionist initially keeps attempting to maintain the perfectionistic standards and subsequently repetitively exacerbates his pain through the compulsive over-activity and productivity. At some point, he comes to find this state of affairs intolerable. His chronic pain rehabilitation providers have been recommending and encouraging pacing, but pacing leads to too much tension and self-criticism – living a life of recurrently failing to meet his expectations for himself. So, holding firm to his all-or-nothing perfectionism, he comes to the conclusion that if he can’t get the job done right, he can’t really do it at all. Pacing is a bogus option: there really are only two options – do it right or not at all.

As a result, perfectionists often become convinced that they can’t do anything because they can no longer do it exactly the way they used to do it.

The long-term behavioral consequence of this belief system is chronic inactivity. It leads to resting, staying home, and activity avoidance. These passive coping strategies, however, lead to de-conditioning, social isolation, a general decline of health, a worsening of pain, and increasing disability.

Now, perfectionists tend to buck at the term ‘avoidance’ above because avoidance implies choice – that they are tending to avoid activities when in fact they could do otherwise. Perfectionists thus assert that they aren’t avoiding anything, but rather they can’t do anything.

This belief in their inability to engage in their old activities is predicated, however, on having only two options for engaging in their old activities: either the ‘right way or not at all.’ If they could learn to tolerate pacing their activities, which would entail learning to tolerate being ‘good enough,’ they would find that there are all sorts of ways to engage in their old activities of life. They’d find that it just isn’t true that they categorically can’t do what they used to do. Indeed, they may just learn in their chronic pain rehabilitation program that there are all sorts of different ways to engage in the old activities of life.

Using opioids to maintain unhealthy perfectionism

Sometimes, perfectionists come to solve their all-or-nothing dilemma by relying on high doses of opioid pain medications. They maintain engaging in the ‘all’ option of the all-or-nothing dilemma by taking high doses of opioids to mitigate for the pain it elicits. In other words, they continue engaging in excessive levels of activities and productivity, which exacerbates their pain, but they compensate for it by taking high doses of medications.

This solution isn’t healthy or effective over the long-term. Most non-perfectionists would agree that using opioids to medicate behaviorally exacerbated pain is not the best use of these medications. It would be healthier and more effective to overcome the perfectionism and learn to pace. By doing so, one could get by on less medication or perhaps not even on any medication. From this perspective, we might see that the use of opioids in this way is not only a means to medicate pain but also medicate a psychological problem. Opioids are not an effective therapy for perfectionism.

From this perspective, we might also see that the continued use of opioids to treat behaviorally exacerbated pain puts the perfectionist at high risk for psychological dependence, increased tolerance, and/or addiction to opioids.

Perfectionism and anxiety

Perfectionism involves some degree of underlying anxiety. The perfectionist can’t sit still because if he did he’d become too tense or nervous or antsy. The excessive activity and productivity are thus solutions to the nervousness. It is for this reason that we consider such behavior to be compulsive. Compulsive behaviors are the behavioral antidote to anxiety – they get rid of the anxiety, but only temporarily.

We discussed above the role of ego strength when it comes to perfectionism. Those perfectionists with a high level of ego strength, who have insight into their perfectionism, can typically readily acknowledge the anxiety that underlies perfectionism. Those who struggle to maintain such insight, however, typically deny the connection. Instead, they remain convinced that maintaining perfectionistic standards is the right way to go about life.

To overcome perfectionism, one has to come to see the problematic nature of perfectionism. Once having insight into it, you subsequently have to begin the process of refraining from engaging in compulsive productivity. To do that, however, you also have to acquire ways to resolve the anxiety that remains when refraining from engaging in compulsive over-activity.

Perfectionism and depression

Depression can also become a consequence of perfectionism, especially when perfectionists never gain insight into the unhealthy nature of their perfectionism. Here’s how it works. Suppose a perfectionist remains steadfast to her unattainably high standards despite having chronic pain. She comes to see herself as persistently failing when chronic pain prevents her from attaining the standards. Persistent failure experiences lead to persistent self-criticism, which in turn can lead the perfectionist to see herself as a failure. Now, she sees chronic pain as the sole source of this recurrent sense of failure because, as we said above, she doesn’t see that her perfectionism is part of the problem. She subsequently attributes the source of her failure to chronic pain, something she has no ability to fix. As a result, she becomes hopeless. Hopelessness combined with a persistent self-critical sense of oneself as a failure equals depression.

Perfectionism as an obstacle to coping with pain well

In each of these ways, perfectionism lends itself to coping poorly with chronic pain. Of Perfectionistcourse, we are not blaming the perfectionist with these observations. Rather, the purpose is to see that perfectionism is an unhealthy personality trait that creates obstacles to coping with chronic pain well. It’s also something that can change with a concerted effort over time. Perfectionists with chronic pain learn to make such changes in chronic pain rehabilitation programs. By overcoming perfectionism, you can come to cope better with pain and as a result chronic pain becomes less problematic.

Living well with chronic pain is possible, but you have to learn how. For perfectionists, living well with chronic pain involves, at least in part, learning how to overcome perfectionism. In our next post, we’ll review common ways in which chronic pain rehabilitation programs coach patients how to overcome perfectionism.

(For more information on perfectionism in general, please see the information at Dr. Paul Hewitt’s Perfectionism and Psychopathology Lab or Dr. Gordon Flett’s video on perfectionism and health.)

Author: Murray J. McAllister, PsyD

Date of last modification: 5-3-2015

How People Cope with Pain Really Well: 2

In the last post, we started a discussion about how people cope with chronic pain really well. Specifically, we looked at five attributes and skills that people do when coping well with chronic pain. The point of the discussion was that it is a way to learn how to cope better. Coping with chronic pain is a set of skills like any other set of skills and you learn how to cope with pain just like you learn other skills – like learning how to knit or play the piano or play tennis. If you wanted to learn how to play the piano really well, you would do a number of things (such as take piano lessons), but one of the most important things is that you would study those who are better than you. You would play their recordings and listen and watch how they do it. You would then try to do what they do. The same can be true with learning how to better cope with pain. With this idea in mind, we looked at five attributes and skills that people do when they cope with pain really well.

These five things were the following:

  • Being open to change and learning from others
  • Accepting that chronic pain is chronic
  • Focusing on self-management
  • Engaging in a mild, low-impact aerobic exercise on a regular basis
  • Understanding the relationship between pain and stress, and managing stress well

These are things that people do when coping really well with chronic pain.

Lets look at five more attributes and skills that make for good coping. As we do, remember one more thing from the last post. It was the discussion about how there is no shame in acknowledging that you can learn to cope with pain better. All skills, including the skills of coping, can be seen as on a spectrum for which there is no point at which you are as good as you ever will get. Rather, if you take any skill imaginable, you can always get better at doing it no matter how good you are at it. Any guitar player can get better with learning and practice – even rock and roll superstars. Any tennis player can get better too – even the pros. Similarly, anyone with chronic pain can learn to cope better — no matter how good you are at it. So, there is no shame in acknowledging that you can learn a thing or two. You are in the same boat as everyone else. So, let’s look at five more ways to cope better with chronic pain.

1. People who cope really well don’t react to their chronic pain as if it is acute pain.

If you accidentally stepped into a hole and broke your ankle, the pain of the broken ankle would be considered acute pain. The normal reaction to such an injury would be to become alarmed, seek help, stop using the ankle, stay at home, and rest. With the pain of acute injuries, such as a broken ankle, this set of reactions would not only be normal but largely helpful. Generally, a broken ankle gets put into a brace or cast and we are told to stay off it. By doing these things, we allow the bone fracture to heal. Subsequently, the pain goes away. As such, this set of reactions to acute pain is a good thing.

However, what’s good for acute pain is not good for chronic pain. The normal sense of alarm that goes along with being in pain becomes problematic when occurring on a chronic basis. It can become any number of negative emotions, such as fear, anxiety, irritability, and even depression. The normal reaction of resting becomes problematic too when done on a chronic basis. While resting can help an acute injury, it can make chronic pain worse. Your body is made to move and if you don’t use it for too long you get stiff, achy, and sore. It’s not just you. It’s true for everyone of us. We also get out of shape and gain weight when we are inactive for too long. Becoming de-conditioned in these ways can make pain worse too. Staying home and resting for too long also leads to what healthcare providers call “fear-avoidance.” Fear-avoidance is the cycle of avoiding activities out of concern that the activities will increase pain. Any number of normal activities of daily life can increase pain and so it can become easy to stop doing them out of anticipation that they will cause pain. When done in response to acute pain, it might be helpful. When done on a chronic basis, it’s one of the ways pain can become disabling. Moreover, staying home and not doing your normal daily activities for too long can lead to becoming chronically bored or aimless or depressed. In all these ways, responding to chronic pain as if it is acute pain becomes problematic.

People who cope with pain really well make the transition in their understanding that their pain is no longer acute pain but chronic pain. They know what their chronic pain is and are no longer alarmed by it. They understand that chronic pain is a nervous system condition and not a long-lasting orthopedic injury. They understand that engaging in normal activities won’t make the nervous system condition worse, as it might if it was an acute orthopedic injury, like a bone fracture. Consequently, they no longer become alarmed that they will make the underlying condition worse when they do normal activities of life.

Now, of course, their pain might be worse when they do things, even if it doesn’t make the underlying nervous system condition worse. However, they recognize that not doing things makes their pain worse too. Staying home and resting doesn’t serve a useful purpose when done on a long-term basis. So, people who cope with pain well respond to their pain by saying, “I got to get up and do something!” or “I’ve got to get out of the house or else I’ll go stir-crazy!” That is to say, they react to their chronic pain in ways that are almost opposite to how you normally react to acute pain.

People who cope with pain well have gotten back into the normal activities of their lives despite the pain because the pay off is that it leads to improved coping. They are no longer bored or aimless or depressed. They are getting things done, checking things off their lists, and even having fun on occasion. Because they are doing these things, they feel productive. They feel like they are going somewhere and have a direction again to their life. Their self-esteem is on the rise. In all these ways, they are now coping better and their improved abilities to cope buffer the increased pain they may have from doing these activities.

2. People who cope with pain well pace their activities.

Having gotten back into the normal activities of life, people who cope with pain well are reasonable about how much they do. They do some things, but not everything. They break up a large activity or their entire ‘to do’ list into manageable size chunks. Referring to the story about the tortoise and hare, they might joke that their motto is “slow and steady wins the race.” That is to say, they have overcome any tendencies to engage in what psychologists call “all-or-nothing” approaches to life.

Additionally, they are reasonable about what they do, and not just how much they do. They might not expect to be able to water ski or dirt bike race. Nonetheless, they make it a point to still do a lot of fun things.

3. People who cope well with pain overcome any perfectionist or workaholic tendencies they may have had.

Perfectionists and workaholics get a lot of kudos in our society. They get a lot done and what they do they do very well. Employers love them and reward them for it. So, if you are a perfectionist or workaholic, it may have gotten you far before the onset of chronic pain. However, now that you have chronic pain, perfectionism and workaholism are problematic.

Perfectionism and workaholism are problematic in many ways. First, perfectionists and workaholics engage in “all-or-nothing” thinking and as such tend to struggle with pacing themselves. If they have a good day in terms of their pain level, they clean, not just the kitchen, but the entire house. As they do, they might say to themselves, ‘If you are going to do it, do it right or not at all.’ However, their strict adherence to perfectionistic standards leads to exacerbating their pain through over-activity. Second, their ‘do it right or not at all’ attitude lends itself to the ‘not at all’ side of the equation because they have chronic pain and the pain makes it difficult to ‘do it right.’ Not doing things leads to all the problems described above – getting out of shape, weight gain, aimlessness, and more pain. Third, once they have stopped doing things, they are prone to self-criticism. Their perfectionistic standards are hard taskmasters. When they don’t live up to their standards, they get down on themselves. No one is harder on him- or herself than the perfectionist or workaholic. Such persistent self-criticism can lead to poor self-worth and depression. Fourth, perfectionism and workaholism tend to make people inflexible and poor adapters. We reviewed in our last post that one attribute of a good coper is someone who is flexible and can adapt. The ‘all-or-nothing’ thinking of the perfectionist or workaholic makes it hard to adapt and be flexible. They have difficulty finding the middle ground between their ‘either-or’ thinking. In all these ways, perfectionism and workaholism do not lend themselves to coping well with pain.

People who cope with pain well tend to have worked through their perfectionist and workaholic tendencies. With persistent effort and time, they have broken themselves of the habit of holding themselves accountable to perfectionistic standards. They have come to see that even before the onset of their chronic pain they never really did achieve those standards. Whatever they did, they could always find some fault or room for improvement. There was always something more on the list to do. It never really was a very good recipe for happiness. By overcoming perfectionism, they came to see that what they thought was happiness was really just temporary satisfaction. The feeling associated with a job well done lasted only as long as it took to move on to the next thing on the ‘to do’ list. And there was always more to do on the ‘to do’ list. So, people who cope with pain well have worked through these issues and no longer hold themselves to perfectionistic and workaholic standards.

4. People who cope with pain well maintain a regularly structured day.

Everyone has a routine. We typically go to bed and get up at more or less the same time each day. We typically eat our first meal in the morning, our second meal in the early afternoon, and our third meal in the late afternoon or early evening. We typically shower or bathe shortly after awakening or shortly before bed. Our typical daily chores and activities also follow a routine. We all do better when, more or less, we follow a routine.

Sometimes, of course, it’s fun to break up the routine. When we are on vacation, we enjoy the break in the routine. Right after retirement or obtaining disability, it is nice to have a break in our usual routines and many people have some fun with it.

However, if the break in the usual routine never returns to the normal routine or is never supplanted by a new routine, a couple of problematic things happen that reduce our abilities to function well in life. First, we become aimless. After awhile, we don’t know what to do with ourselves if we don’t have a focus for the day. Without a focus for our concentration and efforts, our attention tends to focus in on the problems of life. For those with chronic pain, our attention gets focused on pain and all the stressful problems associated with living a life in chronic pain. Second, we tend to start napping. Now, an occasional nap is fine, but when it starts happening everyday, it become problematic. It disrupts our nightly bedtime routines. It’s hard to fall asleep because of the nap earlier in the day. Once we start falling asleep later in the evening, we tend to start sleeping in longer and longer in the morning. In turn, this shift pushes the naptime later into the afternoon, which subsequently pushes bedtime later and later. As a result, a shift occurs in your sleep-wake cycle, sleeping more and more into the day and awake more and more at night. Chronic disruption in your sleep-wake cycle is a common cause of social isolation, aimlessness, persistent fatigue, and depression.

I often tell patients that we all need a reason to get up in the morning. We need to have some idea of what we are going to do with ourselves throughout the day. When, on a chronic basis, we don’t have any plans or routine to guide us through the day, then every moment requires a decision – “What am I going to do?” The question can become surprisingly hard to answer! It’s like when you were a kid during the last few weeks of summer vacation and you and the neighborhood kids have done everything you wanted to do; you sit around the house or backyard, staring at each other, asking, “What do you want to do? Oh, I don’t care, what do you want to do?” Back and forth it goes and boredom and aimlessness are the result. Routines serve the function of allowing us not to think so hard. We just know what we are supposed to do from one thing to the next. They keep our minds focused on getting things done, rather than becoming aimless or, worse yet, becoming focused in on all the problems of life while awake in the middle of the night when every one else is sleeping. That’s not what good coping looks like.

5. People who cope with pain well engage in a daily relaxation exercise.

Like mild aerobic exercise, a regular relaxation exercise is an essential component of successful self-management. People who cope with pain really well engage in both on a regular basis.

People commonly misunderstand the role of relaxation in pain management. They tend to think of it as something you do when experiencing a lot of pain in order to get through it. When they try it, it doesn’t work real well and so give up.

While a relaxation exercise can be done in the midst of a pain flare (think, for example, the deep breathing women learn for childbirth), relaxation for this purpose is a very difficult skill to achieve and it takes a lot of practice – more than most people are initially willing to do.

The most important reason a relaxation exercise is an effective treatment for chronic pain is that it is an intervention that targets the nervous system and reduces its reactivity over time. It’s more of a prevention type treatment than something you do in the midst of a pain flare.

Chronic pain is the result of the nervous system being stuck in a persistent state of reactivity that makes nerves highly sensitive to pain. As you know, any normal movement can be painful. Mild pressure like massage or even touch in the painful area of the body can feel painful. Of course, normal movements and massage and touch shouldn’t be painful, but they are because the nerves and the rest of the nervous system are stuck in a persistent state of reactivity, making the nerves in the painful area sensitive. It’s called central sensitization.

A daily relaxation exercise is one of many treatments for this condition. A relaxation exercise targets the nervous and relaxes it for a short period of time. After awhile, the nervous system returns to its high level of reactivity. If you do it again everyday, however, the nervous system begins to return to lower and lower levels of reactivity. As a result, you have less and less pain over time.

You are also more grounded and less stressed. As a result, you also tend to cope better.

A daily relaxation exercise is a two-fer: less pain over time and improved coping over time.

There are literally countless ways to get better at coping with pain. In this post, we reviewed five of them. We reviewed a different five ways in the last post. I intend to periodically review more ways to cope with pain on this blog.

 

Author: Murray J. McAllister, PsyD

Date of last modification: 9-27-2013