Wow, this is some heavy stuff. It's a great "chicken or the egg" paradox. Which came first? Did the injury/pain jump start some tough mental thoughts and emotions or were the mental "habits" already there? Although I am not a counselor, psychologist, or psychiatrist, I am a witness to these mental states in the clinic on a daily basis and so I wanted to talk about them.
When we understand our minds and bodies, we shed fear and gain compassion for ourselves, which is paramount for healing.
Of course after some review in the literature, learned helplessness, rumination, and catastrophizing are all correlated with increased perceived pain and decreased function. It's important to be aware!
To learn more about these concepts or if you feel that you identify with them, reach out to a mental health professional. In the research, therapists that practice cognitive behavioral therapy tend to get the most favorable outcomes. I also really enjoyed reading Learned Optimism by Martin Seligman and the tips shared below are provided in this book.
Learned helplessness: The belief that what you do doesn't matter. You have no influence over what happens. There is no controlling your predicament. There is a famous behavioral study in which scientists shocked 2 groups of dogs repeatedly while leaving a 3rd group alone. The first group learned that when they pushed a button, the shock would stop. The second group learned that pushing a button wouldn't stop the shock and they continued to fire at random. The third group had no intervention. They took these 3 groups and opened a door to the cage where they could escape the experiment altogether. The first group that learned they had control jumped out of the door no problem. The second group with no control laid down in dismay, despite the door staying wide open. They had developed what is called "learned helplessness" and this has been documented in human behavior. The happy part of this experiment is that once the second group was taught that they had control with an effective button for the second round, they jumped out of the open door, meaning learned helplessness isn't a life sentence.
Learned helplessness and victimization go hand-in-hand. Things happen to you and there is nothing you can do about it or anything thereafter. This is a true lesson of understanding what you CAN control and what you CAN'T. To keep it relative to physical therapy, let's talk about pain. When an injury happens, there is a timeline of healing that generally can't be significantly sped up beyond normal physiology. The more tissues that were injured, the longer the healing time. Healing can most definitely be delayed with poor choices and/or not addressing the root cause. What you CAN'T control: the injury that occurred, normal tissue healing time. What you CAN control: what you put inside your body, what you put inside your mind, sleep quality, stress management, modalities of exercise that are pain-free, your beliefs of your situation, professional guidance. Remember, we are intricate beings that are made up of many different parts. Focus on what you CAN control and get to work.
Rumination: When your mind feels like the hamster wheel of worry and turmoil. This is a broken record of thoughts about bad stuff and man is it not helpful. Personally, I am practically a professional ruminator. I am seriously good at being stuck on the same thoughts and I should probably receive a medal of some kind. Ruminating is not helpful when it's about thinking about bad things on repeat with no progress forward. Sometimes it can be helpful if you're thinking about different solutions to target a problem. Nonetheless, rumination are commonly linked to compulsions to provide some sort of short "relief" i.e. online shopping, checking and re-checking things, scrolling on social media, drinking/drugs, and the like. This can be tough because it's sneaky and before you know it, you're doing the relieving bit without realizing those same thoughts are there once again! Sticking to physical therapy, let's say you're thinking over and over again about how something will never get better. The first step is to recognize the thought train is there once again. Let it happen without doing anything but watching it. Allow it to happen for 10-15 minutes if you need it. Don't judge the thoughts or yourself for having them. Then, signal that they are done and it's time to go on with your day. This can been writing them down and then putting it away, saying "It's time to do something else", or doing some kind of hand gesture ("Talk to the hand, betch!") Finally, go do something that feels like you are taking care of yourself. That will be different depending on the day. I'm not talking about buying those $300 pair of shoes you saw your favorite celebrity wearing but the kind of thing that fills you with the deep kind of self-love. Some examples are hanging out with friends or family, creating, meditating, and exercising.
Catastrophizing: This is the "always" and "everywhere" statement. "Everything bad always happens to me." "Why doesn't this happen to anyone else?" "I'm never good at anything." In physical therapy land, this could sound like "This is never going to get better" or "Why don't my friends have this problem?" If you find yourself thinking or saying these things, ask yourself, is this actually true? What are some other statements that could be just as true? If we only focus on the crappy stuff in our lives, our brains get better at finding more of them. Same is true with hopeful things. There's a catchy phrase that says "What fires together, wires together." This means, if there is repetition of thoughts or movements, our brain makes those neural pathways stronger so we can be more efficient at doing them because it obviously must be important if it's happening so much. You know what's cool about that? You can develop new pathways that actually serve you. That gives me goosebumps! It takes practice, repetition, persistence and PATIENCE.
This is by no means ultimate mental or emotional cure-alls but I hope it gives you insight into what may be happening in the background while you navigate physical symptoms. A mental health professional that you can truly connect with is worth their weight in gold. It is completely normal to experience mood changes, feel down or alone, and feel helpless when you are physically injured. The great news it there is SO much support out there, you just have to find it.
I'd like to leave you with a great photo from Dr. Moseley and Dr. Butler, two Australian researchers that have given us so much insight about the fascinating world of pain. Take a look at all the aspects that contribute to health!