In our quest to stay on top of the latest research and treatment trends and then implement them in our practice, it can be easy for clinicians to forget the value of covering some simple but vital bases in patient self-care. An engaged and resilient patient is more likely to be equipped for successful rehabilitation.
In Part One of this series, we took a deeper look at the construct of chronic pain. In Part Two, we looked at the body’s protection strategies, how those can overprotect and create other problems, and how clinicians can address these. Now, we are going to look at how we can deconstruct the chronic pain construct by training our patients to recruit their A. B. S., or “attend, befriend, and sanctify.”
We get better at what we practice, so I encourage both patients and clinicians to train their A.B.S. through self-care to build resilience. Training the A.B.S. is a tool to deconstruct the construct of chronic pain—or to find ease from any source of suffering.
We can learn to attend to our sensory experience of our body, breath, thoughts, and emotions. Sensing our inner body environment is part of many practices, and which we learn to stimulate through our attention may be referred to as energy, prana, or chi. There is evidence that teaching our patients to cultivate such interoceptive skills builds resilience. The mechanisms appear related to vasovagal parasympathetic tone.
It is useful to teach the patient to redirect their attention from the dominating sensory input of their chronic pain symptoms, which can be thought of as “distorted data,” and the brain’s self-evaluative default mode network. Instead, patients can learn to focus on other aspects of our rich human sensory landscape, both inner and outer, to create experiences of sensory pleasure, such as beauty, wonder, and awe, using simple mindfulness tools.
A phenomenon of distorted embodiment involving a type of “smudging” of the somatosensory and somatomotor cortex can accompany a chronic pain experience. Helping the patient figure out if this type of distortion is present can be very helpful in resolving fear of movement.
An unreliable body, which may be seriously de-conditioned, overweight, or not perceived as sexually desirable, must be befriended again as part of the healing process. Repeated experiences of movement as threatening can be gradually disproven to the nervous system.
Again, we get better at what we practice. Physical activity practiced as a safe movement experience deconstructs the mind-body habits of overprotection, and the patient can learn that hurt does not equal harm. The patient is also taught to befriend the brain and body using movement to reawaken our amazingly effective neuropharmacy.
Finally, the patient’s religiosity or spirituality is welcomed and integrated into the treatment plan. This helps to sanctify the rehabilitation process in a way that aligns with the patient’s own beliefs and values.
As a yoga therapist as well as a physical therapist, I study wisdom traditions and infuse them into my clinical practice and personal self-care. During my 35 years of practice, I’ve learned that movement matters—literally! The yoga tradition suggests that human form evolves from consciousness and the collective consciousness of humans continually evolves as we move in creative play with our environment. These are intriguing concepts and allow us to consider how science might approach the study of movement in the future as it relates to the healing of both individuals and societies.
How might the patient incorporate their beliefs and values in a way that sanctifies their self-care practices. Examples include:
- Applying body products or taking in food with appreciation for the body
- Applying an existing habit of daily readings to an aspect of one’s own healing
- Taking a few extra moments to absorb sunlight into the bones or feel the freshness of the morning air
How the patient chooses to sanctify their self care is a deeply personal process. As the health professional, we can remind our patients of the opportunities available to us when we reframe custodial self care into practices that may build our resilience.
To learn more about integrative treatment and yoga therapy as a part of physical therapy, please see my MedBridge courses, “Integrative Treatment for Patients Experiencing Chronic Pain,” and “Aging Gracefully: Informed Choices for Health, Wellness, and Well-Being.”
- Bornemann, B., Herbert, B. M., Mehling, W. E., & Singer, T. (2016). Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training. Frontiers in Psychology. doi: 10.3389/fpsyg.2014.01504.
- Egnew, T. R. (2005). The meaning of healing: transcending suffering. The Annals of Family Medicine, 3(3): 255-262. doi: 10/1360/afm.313.
- Farb, N. A. S., Anderson, A. K, & Segal, Z. V. (2012). The mindful brain and emotion regulation in mood disorders. Canadian Journal of Psychiatry, 57(2): 70-77. doi: 10.1177/070674371205700203.
- Farb, N., Daubenmier, J., Price, C. J., Gard, T., Kerr, C., Dunn, B, Klein, A. C., et al. (2015). Interoception, contemplative practice, and health. Frontiers in Psychology. doi: 10.3390/fpsyg.2015.00763.
- Interagency Pain Research Coordinating Committee. (2016). National Pain Strategy. https://iprcc.nih.gov/sites/default/files/HHSNational_Pain_Strategy_508C.pdf
- Molton, I. R. & Terrill, A. L. (2014). Overview of persistent pain in older adults. The American Psychologist, 69(2): 197-207. doi: 10.1037/a0035794.