Chronic pain and depression sometimes co-occur. It has been estimated that 30-50% of people with pain also report feelings of depression. While severe pain can be a trigger for depression, feeling depressed can make pain worse. Depression makes it more difficult to cope with pain, harder to feel hopeful, and is often a barrier to activity. For many depressed people, antidepressants, cognitive behavior therapy, or a combination of both have been found to be effective treatments. If you feel you may be depressed, these therapies, or others, may help you too. Tell your doctor if you think you need help. But, one thing you can do right now to begin to manage your depression, is to take a look at how you think.
The Role of Thinking in Depression
How you think plays an important role in depression and in chronic pain management. One type of thinking that is often associated with depression is called “Negative Fortune Telling”. This kind of thinking involves making negative predictions about the future, often with little or no firm evidence. When you are depressed, the future can look terribly bleak. You may predict that things will not work out for you and that you will always feel bad. You may feel certain that your pain problem will never get resolved or that you will not be able to cope. You may assume the worst, and you may feel helpless. In a sense, pessimistic beliefs can give you a “hope phobia.” You may be afraid to hope for a good future, so you may give up. Here are some examples of Negative Fortune Telling.
- “I'm going to turn down all of the holiday invitations. I won't be able to handle any of it.”
- “I'll never find a doctor who can help me.”
- “What’s the use? It’s hopeless anyway.”
- “Trying to get back to work will be a disaster. I just know it.”
- “My family doesn't understand my pain and never will. I give up trying to explain.”
- “I'll never be able to be as athletic as I used to, so there's no use trying.”
- “I am dreading going to physical therapy. It won't do any good.”
If my examples sounded like how you sometimes think, then you may have developed the habit of using Negative Fortune Telling. It is common for people who are depressed to think this way on a regular basis. But, Negative Fortune Telling can create a “self-fulfilling prophecy” – what you fear actually comes true, partly (and unwittingly) by your own doing. It is a scientific fact that our expectations can influence what we do, which then can affect how things actually turn out. If you always expect the worst, you are stacking the deck against yourself, needlessly.
I am not saying you should be unrealistically hopeful.
I am saying that hope – when combined with good problem-solving and planning — is one of the best natural antidotes to depression. If you fear hope itself, you are robbing yourself of an important tool in keeping your spirits up, and in being motivated to make improvements in your life. How can you tell if you use “Negative Fortune Telling?” Here are a few hints:
- You find yourself dreading the future, since you “know” things will be bad.
- You disagree with others about the future; they see hope where you do not.
- You use words or phrases that suggest a bleak future, such as “It’s no use”, “Things will never get better”, “Why bother trying?”, or “It will never change”.
I hope you will take a look at how you have been thinking. When you find yourself making bleak predictions, stop for a moment and ask yourself if the evidence supports your predictions or is there room for hope? Then, try to come up with a more realistic assessment and some possible solutions, alternatives, or coping strategies.
About the Author. Dr. Linda Ruehlman is a social/health psychologist and researcher, co-founder of Goalistics, and Director of the Chronic Pain Management Program, an interactive site that helps people with chronic pain to manage their pain and live richer, more effective lives.
DISCLAIMER: This blog is provided as an educational and informational resource only. It is not intended nor implied to be a substitute for professional psychological or medical advice.