the role of awareness and expression in recovery

This week I came across an article titled, "A New Psychotherapeutic 'Gold Standard' for Chronic Pain?". (The question mark suggests more study is needed...) It described a technique called emotional awareness and expression therapy (EAET) which, to me, sounds a lot like training in mindfulness and storytelling. In this study, it out-performed traditional CBT (Cognitive Behavioral Therapy) in reducing pain, depression, and anxiety in a group of injured and traumatized veterans.

"Awareness is the first step in healing."

~Dean Ornish~

In CBT, patients are taught to use guided imagery, relaxation techniques, and other techniques to change the way they think about pain.

In EAET, patients are asked to recall a difficult or traumatic memory, to re-experience how the related emotions felt in their body, to express those feelings in words, and how to release or let them go. They learn that the brain's perception of pain is influenced by their emotional reaction to it, the big culprits being grief, fear, anger, and shame. In this study, the researchers concluded that "the evocation and expression of emotions is superior to the mere cognitive discussion of these emotions in therapy..."       

Some time ago I listened to a program on NPR about the factors that influence the perception of, response to, and recovery from a painful or traumatic injury or condition. It focused on the differences in perception between persons who feel victimized by an injury, for example, a car crash, as opposed to soldiers who are hailed as heroes when they sustain injuries on the battlefield. 

In a futile attempt to revisit the program for the purposes of this blog, I reviewed a mountain of research and literature on the topic. It astounds me that so much academic effort is devoted to a topic that seems intuitive to me. We witness it all the time. Athletes who play through or continue to compete despite injuries that would sideline most of us. The fact that any woman would put herself through childbirth again, after the first ordeal. This is in contrast to the person who seizes on his injury or pain to excuse himself from work, or to gain sympathy.

"Pain is inevitable; suffering is optional."

~Haruki Murakami~

Many factors affect the way a patient responds to a painful injury or illness. In addition to gender and age, there is a role for:

• social and cultural norms and expectations
• past experience and conditioning
• the sense of victimization vs heroism
• the patient's motivational state
• his emotional state
• his spiritual inclination
• his social support system

"Often it isn't the initiating trauma

that creates seemingly insurmountable pain,
but the lack of support after."
~S. Kelley Harrell~

The easy part for the health care provider/therapist is to diagnose and treat the injury. The hard part is to understand the patient's attitude toward his pain, and how it affects his recovery:

• Is he angry, fearful, ashamed, or depressed?
• Who does he feel is to blame for his injury?
• Will he be able to work? Does he want to work?
• Where can he turn for support? Will he accept it?
• How will she take care of her children? Who can she turn to for help?
• Is he using his injury as an excuse or escape, or as a way to gain sympathy?
• Are his family and friends supportive or dismissive?

These dynamics suggest themselves when the patient fails to respond to treatment as expected, or is non-compliant with the treatment plan.

If you suspect this is happening, it may be time to put your laptop to sleep, look your patient in the eye, and sort through some of the other issues that complicate recovery from an injury, issues you won't find bulleted in the EMR. If you're the health care provider, you must explore the patient's whole story.

If, on the other hand, you're the patient, you must be honest and compassionate with yourself. It makes sense that awareness and storytelling can play a significant role in recovery.

"Self-care is a divine responsibility."

~Danielle LaPorte~

jan

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