EXAMINING THE THOUGHTS INSIDE OUR HEADS:

Taking a closer look at the thoughts that are running through our mind can be a useful practice. For one thing, once we become more aware of the constant self-talk inside our head, we begin to realize that our minds are fairly frequently commenting on the process of our everyday lives. When it comes to the thoughts that our mind generates in response to stress and pain, we often feel at the mercy of these thoughts. Once we become more observant of our thoughts, we can begin to examine them and decide:

• which parts of the thought are true,
• which parts of the thought are not true.

Simply put, thoughts are ideas that may or may not be true. Some thoughts in response to pain or stress are completely true. However, most thoughts about our pain or stress are partly true, but not completely true. The untrue parts of automatic thoughts do the most damage to our:

• emotions
• physical bodies
• and our actions.

In essence, negative automatic thoughts widen the pain gate and let in more pain signals. So it's important to become aware of these thoughts as you are having them and to realistically separate out the true from the untrue parts. Examining the thought, and perhaps changing the thought, allows us to have more control over what is actually happening inside our head. This is one way to take the "edge" out of some of our more negative thoughts. Think of your thoughts as if they were a garden. You've got the flowers and you've got the weeds. Once you can tell the difference between a flower and a weed, you can pull the weeds and leave the flowers. Pulling the "weeds" of our negative automatic thoughts is another way to close the pain gate. Here are some hints about looking for the untrue part of the thought:

• An automatic thought can be partly false in lots of different ways.
  • The untrue part may be in the "always" or "never" part of the thought-for instance, "I will never be able to play ball with my kids again."
  • The untrue part could be in the level of intensity attributed to the pain,
  • The threat value of the pain-for example, "This pain is intolerable. I cannot survive this pain."

Another example of how a thought can be untrue is when:

• we forecast the outcome of an event before it has happened-for example, "Oh, oh, there's a twinge in my back.Today is going to be a bad day."

It might be useful to go back to your list of examples of negative thinking from Session 3 and look them over again. This list gives a lot of examples of ways an automatic thought can be untrue. Another important point about negative thoughts is that they are often quite general and all-inclusive. For example, when I say to myself, "I just can't stand it," am I talking specifically about the pain sensation I feel at that moment, or am I creating a "one size fits all" statement about my pain condition and all of its associated stressors? It is natural and understandable to tend to have global, sweeping automatic thoughts during a pain flareup or during times of stress. But when you learn how to identify those all-inclusive general thoughts and make them more specific and more realistic, this has the effect of decreasing the part of your life you feel you have no control over, and expanding the part you can take control of. The exercise in your Session 4 workbook called Examining your Automatic Thoughts will teach you a step-by-step way of breaking down your automatic thought once you know what
it is. This is particularly useful when the thought is negative. Once you write it down, you can see whether any "redflag" words like "always" or "never" are embedded in the thought. Red-flag words are often not true but can make the thought a much more powerful "hook" for you. You can also make a list of the facts that support your thought and the facts that don't support your thought. You can weigh the facts, like a judge, to decide whether it is true or not true.

CREATING THOUGHTS THAT ARE TRUE FOR YOU:

Often, once you've figured out which parts of your negative automatic thought are not true, you can pretty easily come up with an alternative thought. The Creating a New Thought exercise in your Session 4 workbook will guide you to write down your new thought after examining the evidence for and against the old thought. If you're having trouble coming up with a new thought, you might ask yourself:

• "Is there another way to look at this?"
• "What would I tell a friend in this situation?"

Once you've come up with your new thought, it is useful to see whether this decreases the strength of your belief in the old thought-it usually does. You may also see a difference in the effect of your new thought on your pain level. Often, negative automatic thoughts increase one's pain level and the new, more realistic thoughts do not have the effect of increasing one's pain level. Creating alternative thoughts to replace the negative, automatic ones inside our heads is one useful way to take more control. Now your thought are no longer commentary being generated from your brain and leading you around -your new thought is one that you purposefully created as true for you. In this way, you can take charge of your own thoughts rather than being a helpless bystander.

KEEP PRACTICING THOSE RELAXATION SKILLS!

As we've learned, the relaxation response is another powerful "gate closer" to pain signals. Practicing the relaxation exercise every day helps you reset your stress "thermostat," which has likely gotten out of balance owing to the stress of chronic pain. Remember that the relaxation response can narrow or close the pain gate that we talked about in session 1. It's also useful to practice creating the relaxation response as you go about your everyday life, even without the help of the audioguide. As you get more and more comfortable with your relaxation skills, you will find that you can create the relaxation response "on demand," whenever you need to quiet your body and your mind. Because it is such a useful skill to have, create lots of opportunity to practice it. In the next session, we will teach you a different relaxation exercise called "passive muscle relaxation."