How to write your way out of chronic pain

What is journaling?

There are many forms of journaling, but the one I found the most effective in dealing with my own chronic pain was ‘therapeutic journaling’.

Therapeutic journaling is a simple and effective way of releasing the pressure valve on our own internal pressure cooker – which, for sufferers of chronic pain, is often close to bursting, since they are the most likely to repress their emotions so as not to cause a fuss or upset anyone. They are often people pleasers, goodists, stoics and perfectionists, making it harder for them to express the silent rage, resentment, distress, pain, frustration, fear or worry they are experiencing. They would prefer to be the sounding board for another person’s worries than ‘burden’ another with their own.

This is why therapeutic journaling can be such an effective outlet for their unexpressed thoughts and emotions. It allows them to free themselves of pent up emotion, see an issue objectively and gain a sense of perspective.

Put simply, therapeutic journaling involves writing down all your thoughts and feelings without censorship, judgement or the fear of anyone else reading your words. It’s an honest outpouring of emotions.

Your journaling time is private and is your opportunity to let it all out. No holds barred. You can be as angry, hurt or upset as you wish. Use foul language if it helps and don’t even think about spelling errors or grammatical correctness (this can be somewhat challenging to the ‘Type T’ personality).

It can help to imagine yourself as a 5-year-old having an enormous tantrum. Use phrases like ‘I feel angry/sad/hurt/mad because……….’ Don’t hold back and don’t be frightened or ashamed of what comes up.

Write, offload, then delete, throw away or burn. It will feel liberating. Any anger, resentment or shame you feel will lighten and the pressure will release. You will often physically sense the tension leaving your body.

How does journaling help?

Creating an awareness of your thoughts, good or bad, separates you from them. When you can detach yourself from your thoughts you are able to look at them in a more objective manner and gain a different, more positive, perspective on them.

Scientifically proven to do you good..

Clinical studies have shown that journaling can:

  • Reduce pain
  • Allow healthier emotional reactions
  • Reduce fatigue
  • Improve sleep quality and duration
  • Reduce symptoms of depression
  • Reduce stress reactions in relation to a traumatic event
  • Reduce and regulate heart rate

Could journaling be upsetting?

If you have experienced particularly traumatic events in your life, you may initially find journaling too direct or upsetting. This is not to say that journaling should be avoided, rather that other strategies or treatments may be necessary first in order for you to reach the point of feeling safe to journal. Please do seek help from a professional counsellor or therapist if you feel this would be beneficial.

Getting started

Find a quiet room where you won’t be disturbed. First thing in the morning, when others are still asleep, or not requiring you attention, is a good time to write. Take a few deep, calming breaths and make sure you have something comfortable to sit on. Don’t overthink things, and don’t plan what you will write.

Choose your preferred style (you can alternate depending on your needs):

1)      Unsent letters to people who have upset you (past or present). This has two possible benefits: you get to tell the person what you think of them without fearing their reaction, and the act of forgiveness is very healing. Of course, you can always just be bold and tell them to their face! Realistically though, good, kind, conflict-avoiding people pleasers often find this very hard to do.

2)      Exploring emotions in the here and now, and gently inquiring into the thoughts that led to those emotions. Was it really the spilt milk on the floor that upset you, or was it the many small but challenging events leading up to that minor incident that resulted in your angry outburst?

3)      Exploring a traumatic or upsetting event in the past and writing to shed light on how this is bringing up emotions in the present.

Any of the above can take more than one attempt, in order to work through the layers of emotion we hold onto and repress – often likened to the layers of an onion. The goal is to be able to put these thoughts into perspective, reframe them and move on. Please don’t attempt to move onto the next stages before first really allowing yourself to feel the feelings and express them fully, without judgement or criticism. Be a passive observer of your thoughts.

The following guide, written by Georgie Oldfield, founder of SIRPA (https://www.sirpa.org/) in the UK, contains some really useful information on journaling, including the helpfulness of visualization techniques at the end of your journaling, and expressing gratitude for what is going well in your life https://www.sirpa.org/wp-content/uploads/2019/07/7-Tips-for-successful-Therapeutic-Journaling.pdf. Georgie has also written a very helpful eBook called ‘Journaling for Health’ https://www.sirpa.org/product/journaling-for-health-ebook/

Sometimes, you may feel the need to search around a little when you begin to write, so try asking yourself the following to help get things going: Am I annoyed, upset, angry, frustrated or disappointed about anything or with anyone?

How long should I write?

How long is a piece of string? Don’t overdo it (journaling can sometimes feel a little emotionally draining), but allow yourself sufficient time to release the thoughts and associated tension you’re holding onto. Nicole Sachs, creator of JournalSpeak™, recommends 20 minutes of journaling, followed by 10 minutes of meditation. This could be in the form of a relaxing guided meditation, or a silent meditation where you observe the thoughts and feelings that arise from the journaling. Allow them to wash over you without judgment or attachment.

It can also be helpful to ask yourself ‘what have I learned?’, ‘has anything good come of this?’ or ‘how can I reframe this?’

Reframing means changing your perspective on a given situation to give it a more positive or beneficial meaning to you.

Then destroy your writing! Rip it up, burn it, delete it.

As Nicole Sachs (https://www.thecureforchronicpain.com/) says ‘Repressed emotions are only powerful in creating pain if they don’t have a voice. Nobody needs to hear this voice but you’.

(I hope journaling will help you, as it did me. This is no longer a daily practice for me, but I find it useful as one of my tools to occasionally return to if I feel any symptoms returning).

How to turn off the stress response

In my last post ‘Could my personality be contributing to my chronic pain?’ I mentioned that, after recognising myself in many of the ‘Type T’ character traits, I started to ask myself what I was really feeling and what I wasn’t allowing to surface. I felt it was this repression of my emotions that was causing my body to remain in a stressed, over-adrenalized, anxious state and was responsible for my chronic lower back pain.

What is the stress response, also known as the ‘fight-flight response’?

The body has a natural way of protecting itself when faced with a threat or danger, though the ‘fight-flight response’. Walter Cannon (1871-1945), an American physiologist, first coined this phrase when he observed the common reactions of animals to danger. Once the danger was over, the animals returned to homeostasis – the body’s attempt to stabilize itself by internal corrective mechanisms when its equilibrium has been disturbed. When this is reached, ‘rest and repair’ can occur.

When the human brain perceives us to be in a danger, the hypothalamus in the brain stimulates the pituitary gland, which in turn signals the adrenal glands to produce what are commonly called “stress hormones.” The most familiar of these hormones are epinephrine (adrenalin), norepinephrine, and cortisol (a natural steroid similar to cortisone).

How does the body respond to the stress response?

Our pulse quickens, pupils dilate, digestion stops as the blood supply is sent to the muscles rather than the stomach and intestines, heart rate and blood pressure increase, muscles tense, thinking quickens, we have a surge of energy as fats are released into the bloodstream as emergency fuel, and the thyroid increases our metabolic rate.

The problem is that this stress response can be triggered by both real and imaginary threats. The brain doesn’t know the difference.

Nowadays, despite all our modern conveniences, our lives are often stressful – or at least we perceive them as stressful – and many people live in a perpetual state of fight of flight stress response. This means our bodies cannot rest and repair, and the relaxation response (the opposite of the stress response) is not activated.

What happens to our bodies when the stress response doesn’t switch off?

Eventually extended cortisol release results in:

Increased blood sugar levels, weight gain, bone loss, elevated blood pressure, digestive problems, adrenal fatigue, obesity, sleep deprivation, decreased sexual drive, anxiety and a weakened autoimmune system making the body more susceptible to viral and bacterial infections, and allergies.

Eventually serious physical problems develop as adaptive resources are depleted and the body goes into stress ‘overload’. The effects of this are:

Weight gain, autoimmune dysfunction, extended illnesses, chronic fatigue, chronic pain, thyroid depletion, inflammatory disorders, heightened allergies, coronary complications, and insomnia.

Worry and anger keep the body in this state of emergency, and so ‘feeling our feelings’ and expressing our thoughts becomes paramount.

Who suffers and who doesn’t?

Generally speaking, Type T personalities (as discussed in Part 1) suffer more as they are the most likely to repress their emotions. They don’t want to ‘rock the boat’ as they are often people pleasers and goodists. They can be fearful and anxious, often worrying about what others will think about them if they speak their mind.

Anxiety and fear activates the stress response as the brain cannot distinguish between a real or perceived threat. Our brain is just trying to protect us.

Non-Type T personalities suffer less as they are more able to express frustration, fear or anger in the moment, rather than repressing these feelings. They worry less about how people perceive them and so are more able to release their stress quickly and effectively.

Type T personalities tend to bottle up their thoughts and emotions. As a result, their minds and bodies very easily revert back to the stress response in an act of self-preservation.

Have you ever cried or ‘snapped’ because you or someone else spilt a drink on the floor? Was it really about the mess on the floor, or was it just the final straw – the one that broke the camel’s back? The reality is that you were already feeling stressed and it just took one small thing to tip you over the edge.

Type T personalities, who often repress their feelings, are much more likely to suffer from the aforementioned effects of being in stress overload. In my personal experience, this came in the form as chronic back pain, and prior to that, debilitating neck, shoulder and hip pain.

So how do we move from the stress reponse to the relaxation response?

  • Exercise

Exercise is a simple and effective way of calming the nervous system. It not only uses up the energy created in the body from the fight-flight response, it also breaks down stress hormones. Lower stress hormones mean a calmer body and mind. Just 5 minutes of intensive movement will start to break down excess stress hormones: Shake it out! Dance to your favourite tune, do a few star jumps, run up the stairs, dash around the garden. Most importantly, find something you enjoy. Doing an activity you loathe may only increase your stress through any resentment you feel towards it! I love running, but I know it’s not for everyone. Longer exercise obviously benefits your health and well-being, but 5-minute bursts are surprisingly effective. Exercise also increases endorphins, the feel-good hormones, so it’s a win-win situation!

  • Express yourself!

This is particularly helpful for those of us who find it challenging to express our thoughts and feelings openly, but that is certainly worth exploring too!

Expressive writing, or journaling, is scientifically proven to help reduce stress. It helps us to put distance between ourselves and our thoughts. After all, our thoughts are just that – thoughts. They are not necessarily true and are often not. Thoughts lead to feelings, feelings lead to actions and actions lead to results. When we can separate from our negative, self-destructive thoughts we can then rationalise them and question them. Try journaling for 20 minutes a day. Write as though you were a 5-year-old having an enormous tantrum. Don’t hold back! Don’t mind your language or your spelling. Just let it flow. It will feel like the pressure valve has been released. Get it all out, then throw the paper away (or delete the file). This is for your eyes only, and your opportunity to get all your frustration, resentment, anger or sadness out, rather than put a lid on it, only for that lid to blow at some point when you, and those around you, are least expecting it.

Find something relaxing to do after this. Expressive writing can often bring up trauma from the past when we start to connect our present feelings to things that have happened to us in the past. It can be very draining, but that reservoir of emotions will only spill its banks if we don’t get out those thoughts and feelings somehow.

  • Know you are safe

The fear we feel is based on our own perception of a situation, otherwise we would all be scared of rollercoasters and spiders. Telling yourself you are safe stops the message to the brain that we need to activate the stress response. The more we say, ‘I can take care of myself’ instead of ‘I’ll never be able to cope’, or ‘I can handle this’ instead of ‘I can’t deal with this’ the more our confidence increases and our worry decreases.

If we want to feel safe, we need to believe we can handle life’s ups and downs. To start, try increasing your motivational self-talk and decreasing the negative self-talk. Louise Hay (1926-2017) was an American motivational speaker and the founder of Hay House, and is famous around the world for her positive affirmations, including:

All is well. Everything is working out for my highest good. Out of this situation only good will come. I am safe.

  • Be Present

We need the present to feel good and safe. Depression, nostalgia and regret live in the past, and anxiety and fear need a future (and are often fuelled by the past). Living in the present moment, the ‘Now’ as Eckhart Tolle refers to in his bestselling book ‘The Power of Now’, allows us to enjoy what we are experiencing as it happens, rather than worrying about what has happened, or what might happen. We spend so much of our time either living in the past or imagining the future. The future is not guaranteed, and so the present is all we ever have. Take a moment to breathe calmly and deeply and notice the sounds, smells and sights around you. Use all four senses by touching something to help you feel more grounded to the moment.

Thoughts will come and go. Allow them to pass by and acknowledge them without judgement. Notice them but don’t react to them or embody them. We have 50-70,000 thoughts a day. Most of them are repeated and many of them are not true. Don’t associate with your thoughts, and if you do question whether they are really true.

The acronym I created for doing this is CARE:

Catch the thoughts as they arise
Acknowledge them rather than repressing them
Reframe the thoughts by looking at them from a different, more positive perspective
Experience the change in your thought patterns

  • Have fun!

Learn how to distract yourself from things you find stressful: play your favourite music and sing to it – singing releases endorphins and improves sleep. Meet friends and family – this helps boost our mental health and improve our quality of life. Eat something you enjoy, watch a funny film, read a good book……..the list is endless!

And most of all, educate yourself on the mind body connection. It is your key to healing.