Wednesday, 23 September 2015

Your Brain is Just Trying to Protect You, Part Two: What Can You Do?

Today we are going to learn about the shield built by our fictional gentleman and his doctor. The tools they used to build this shield consisted of: respecting his body, therapeutic relationship, knowledge, self-efficacy and re-introducing activities. Some of the tools were focused on mitigating the effect of pain and fear on current and future behaviours. They also had tools that were more designed to help them deal with the thief and reclaim the activities that he had already taken. Their goal wasn’t to relieve all the pain, but instead to reclaim his life by putting him back in charge.

It’s important to note that none of these tools work as well in isolation as they do together. And that not every person will benefit from every tool. Rainville et al. (2011) talked about how there are multiple factors behind fear avoidance behaviour. There is misinformation (e.g. I will do harm because someone said so), learned behaviour (e.g. this hurt, so I avoid it), and emotional behaviour (e.g. fear driven). Recognizing these factors can give a good starting point to identify which tools may be most helpful.

The Tools

1.)  Respecting your body: Permission to not be okay

So often it is easy to fall into the “I shouldn’t feel like this” mentality. A good first step is to allow yourself the courtesy to respect whatever you are feeling. Part of this is simply acknowledging these concerns and fears. It’s respecting the fact that pain avoidance is a logical reaction and that it’s not a sign of weakness. Recently we both attended Bronnie Lennox-Thompson’s course on Graded Exposure for Pain Avoidance. One of the things she said during the course that really resonated with us was the idea of creating space for the fear around the task and doing it anyways. The goal isn’t to logic away the fear or ignore it but rather to acknowledge it and respect that it is there. It’s something that happened with the injury that you have to treat just as you do the physical symptoms.

2.) Therapeutic Relationship: Meet people where they are

The creation of a relationship between the practitioner and client is one of the first things that happens when a person seeks treatment. This relationship can have a huge impact on the outcome. Because it is so important we think it is worth it to step back and examine this relationship for a moment. If you’re reading this as a health care provider hopefully the explanation of this tool will give you a basis for understanding the importance of how you interact with clients. If you’re reading this as a person in pain or a family member, this can help you understand why it’s beneficial for you to find health care providers who really connect with you.

There are many factors that go into creating a strong therapeutic relationship. The way these factors interact may depend on the two people involved. One if the key factors that is common across situations is the idea of validating the person’s experience; allowing the client to have a voice and be heard and to feel safe expressing their experience, questions and concerns.   Pain is often a sensitive issue and like any “invisible illness” people can often feel judged. People in pain may be bombarded with societal messages such as “your pain is not real” or “suck it up and deal with it.” They might come feeling like they have to defend the pain or justify their behaviour.  They really need to know that their health care provider believes them and is on their side. They need to be able to trust that their concerns are valued, and that their questions won’t be minimized. A supportive health care provider will look for the reason behind the concerns a patient decides to voice.

The person in pain also needs to know and trust that the health care provider knows what they’re talking about. A client once told a therapist “you’re like a friend who comes, but is full of knowledge.” Having this type of therapeutic relationship can be the starting point that all the other tools build on. A study on therapeutic alliance  in the context of treating lower back pain suggested that “factors related to the therapist seemed to be as important as the therapy in pain modulation, and their interaction may produce substantive clinical benefits”. The authors of the study went further to say” The effect of accepted interventions can be improved when clinicians interact positively with their patients” (Fuentes et al). A good relationship is key to allowing any of the next tools to be effective.

Up Next

The two tools discussed in this post (respecting the body and therapeutic relationship) are the foundation for the other tools we will discuss. Next post, we’ll go into detail about knowledge, self-efficacy, and re-introducing movements. We hope this overview will be helpful to you as you begin to build a shield with your own tools.


Diagram by Ashley and Colleen at Reclaiming Life. Graphics from (man, grocery basket, doctor, shield).


Fuentes, J., Armijo-Olivo, S., Funabashi, M., Miciak, M., Dick, B., Warren, S….Gross, D.P., (2014). Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study. Physical Therapy, 94(4), 477-489.

Rainville, J., Smetts, R.J.E.M., Bendix, T., Tveito, T.H., Poiraudeau, S., & Indahl, A.J., (2011). Fear-avoidance beliefs and pain avoidance in low back pain. The Spine Journal, 11, 895-903.

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