How to deal with the stress of having chronic pain and fatigue

We hear all the time about how terrible stress is for our health. But when you have a chronic health condition that causes pain and fatigue, stress is unavoidable. So are you doomed to terrible health because of that stress? Or is there a way to deal with that stress so that you can still live your life?

What is stress?

We have all heard how stress is supposedly as bad for your health as smoking. We’ve learned that life itself is stressful, and having chronic pain and fatigue is a whole other level of stress on top of that. When you stop to think about it, it’s easy to begin to worry about your stress levels.

You start to stress about stress. Not exactly a productive method of stress management.

Whether the stress you feel is based on a physical threat or emotional, your body cannot tell the difference. The hormone release and physical reaction are the same.

Your heart starts to race, your blood sugar rises, your focus narrows, and your breathing speeds up. These systems fill your muscles with energy and oxygen, your brain is alert to find and deal with the threat. You are ready to fight, flee, or freeze as the situation demands.

This system exists in you because it kept one or more of your ancestors alive. In many ways, we should be grateful for this stress response.

Is all stress bad for your health?

In the short term, your body’s stress response is amazing. It gives you access to more strength and energy than you would otherwise have available. You can run faster, throw harder, focus better.

Many “stressful” situations are incredibly meaningful or positive. Having a child, getting advanced education, travelling to a new place, learning a new skill — everything that challenges you and allows you to grow as a human and feel a sense of accomplishment is a source of stress. Yet, we don’t often count that as “stress”.

This is often referred to as ‘eustress’. It is also called a stressor in the biological/scientific sense of an external situation exerting pressure on an organism — and to which the organism must respond.

The hormonal release of the stress response only happens when you perceive the stress. Your heart doesn’t start racing until after you find the bear in your backyard. If you never looked out the window, you would never have felt the stress because you weren’t aware of the situation.

Or if you live in a rural area and have apple trees, you just know that bears will come into your yard almost every year, even though you do your best to pick the apples as soon as they ripen. So when you see the bear, you might sigh or maybe chase it off, but it isn’t a surprising or stressful sight. (And yes, this example is coming from personal experience.)

Distress comes when you perceive the stress. This is the “bad stress” that we will be focusing on here.

Destress the distress

In many cases, the situation is only stressful because you think it is. Reframing the situation can help you to defuse the negative energy surrounding the situation.

I have psoriatic arthritis so sometimes my joints are stiff. Mostly I feel it in my hands, but my knees (or other joints) sometimes join the party as well. In the spring and fall (cool and damp weather), it seems to be worse for me. I could complain about it. I could worry about it. I could fixate on how it feels and whether this is the first sign of another flare.

And don’t get me wrong, those thoughts always pop into my head.

But I refuse to let it stop me or stress me out.

I know that my joints are going to get stiff at times. I know I will likely have another flare. But worrying about the potential future only serves to ruin the present. I refuse to let the arthritis control me.

So instead of worrying, I ask, “Is there anything that can make this better?”

I have a blanket that I keep at my desk to cover my legs because warmth helps me. I have compression gloves for my hands. I chose the chair that was the most comfortable for my body to work in. I stretch or rest based on the signals that my body is sending me.

These skills are explored in Dialectical Behaviour Therapy (DBT), especially the focus on distress tolerance. If you want to learn more about DBT, this resource will walk you through all the primary skills. I found it extremely useful to learn about the framework of DBT — and to realize that many of the tools I already use personally and with clients are integral to this framework.

What is Distress Tolerance?

Shit happens in life. Situations come up that you don’t know how to handle at first. You will have stress in your life. And you wouldn’t actually want a completely stress-free life. You don’t want to be numb or never do anything.

(Important Note: If you are feeling numb or as though you never do anything or can’t do anything, it is possible that you need to set goals & have “more stress,” but I expect it is far more likely that you got there after experiencing high levels of anxiety and stress, burning out and leading to depression. If you are needing mental health assistance, make sure that you seek out support from a mental health provider!)

So stress is unavoidable in the kind of life that you would want to live. But for a variety of reasons, you may not yet have the skills to be able to cope with the level of stress that you currently have in your life.

And that, right there, is a very important reframe. You do not YET have the skills to cope with the stress. There are skills that you can build and tools that you can learn to use. With these new skills and tools, you will be able to cope with the inevitable — and positive — stressors in your life.

This is what the concept of distress tolerance is all about.

Self-soothe to re-center yourself when you feel overwhelmed

When you feel completely overwhelmed by stress, it will be difficult (or impossible) to resolve the issue. Your mind is not in a rational or reasonable state. You won’t be able to see the (potentially obvious) solutions.

In this case, the first step is to calm your body and mind. Use self-soothing techniques to feel grounded, centered, and balanced. Mindfulness techniques can be really powerful, especially those that help connect you to your senses.

In my experience, most of the stress is taking place in my mind and a good chunk of it isn’t even real. So getting out of my head for a few moments can help stop the spiral and let me see the situation more accurately when I return to it later.

There are many techniques that you could use, but one that I’ve talked about in another article here is the raisin exercise. It is a common introductory mindfulness or mindful eating practice — so I walk you through that in my article all about mindful eating.

The goal is to get out of your head and step away from the overwhelming situation so that you can come back to it with a clear head.

Come back to the problem with your wise mind

In DBT, the goal is to be able to use both your rational knowledge and your emotional experience to make wise decisions for yourself. This is called your wise mind.

This is also how I describe intuitive eating — yes, you should use the nutrition knowledge that you learn but combine that with your lived experience. Temper the rational knowledge with your emotional experience.

Ask yourself powerful questions, “What do I need right now?” “How will this [decision I am about to make] make me feel?”

In the food realm, you might notice yourself looking in the fridge or the pantry for a snack. Pause before the snack and ask, “What do I need right now?” “Am I hungry?” If you are hungry, get a snack that will be satisfying to that need. If you are not hungry, what is it that you need? And how can you best meet that particular need?

If you decide you want a snack — even though you are not hungry — you can absolutely have that snack. You will enjoy it even more, however, if you first ask, “How will this snack make me feel?” If your intuition — your wise mind — pipes up and lets you know that you won’t feel good, then may choose to eat it later. (For me, this is a very physical reaction: my stomach clenches.) But if your intuition/wise mind thinks you’d feel good, then you can fully enjoy that snack, knowing you probably won’t feel crummy later.

This same process can be used for every decision and every habit that you are dealing with.

Radical acceptance helps you move forward

You have chronic pain and chronic fatigue. That sucks. You probably will never completely get rid of it. It is always going to be a part of your life and a part of your story.

Railing against the universe and throwing a pity party are sometimes a part of emotionally processing that fact. But at some point, you need to simply accept that this is how your life is and move on.

Acceptance has nothing to do with passive resignation — far from it. If things are going to hell in a handbasket, then that knowing — that awareness — of things going to hell in a handbasket can give you a place to stand, an orientation for taking appropriate action in the next moment. But if you don’t see and accept things as they actually are, you won’t know how to act. Or you might be overwhelmed by fear, and that fear might cloud the mind just when you most need clarity and equanimity…

Jon Kabat-Zinn, Mindfulness for Beginners p130

Until you accept the situation, you will be stuck in the suffering. Trying to resist reality only leads to more suffering.

Avoid the second arrow

There is a parable in mindfulness circles that you may have come across already. It essentially says that when you are hit by an arrow, don’t shoot yourself with a second arrow. It is also sometimes summed up as ‘Pain is inevitable, suffering is optional.’

When you become more aware — and accepting — of your present moment experience, sometimes you are more aware of pain. Yet, ultimately, this leads to a place where you “hurt more, suffer less” (Jeff Warren, Meditation for Fidgety Skeptics p 58).

You will feel the pain far more deeply, initially, because you are not numbing or distracting yourself. But because you face the pain head-on, you can resolve it more easily and effectively.

Cognitive Behavioural Therapy

DBT is all about the skills to be able to manage the situation. Alongside these skills, cognitive behavioural therapy (CBT) can also be beneficial. In CBT, the goal is to identify the thoughts and beliefs that are leading to your emotional state, which influence your behaviours. By addressing those unhelpful (and often false) thoughts and beliefs, you can replace them with more helpful (and true) thoughts and beliefs.

These more helpful thoughts and beliefs lead to a more balanced emotional state, which allows you to choose the behaviour that will be the most helpful to you.

You can do this on your own to some extent, through journaling and mindfulness, interrogating the ideas that are in your mind. However, in my experience, I needed to be trained on this way of thinking through working with a mental health provider. Having an outside perspective to help dig deeper into the thoughts and beliefs — and identify which thoughts and beliefs were false — was key to being able to unlock the power of CBT, for me.

It is also important to note that CBT does not work for everyone. It is also important to have a mental health provider that you resonate with. It is possible to have two different practitioners who say nearly the same thing, and yet you benefit from one and not the other. It’s not necessarily about the skills or the approach. Somethings it’s simply the personality of the person.

Bonus Strategy: Use your inner rebel

One really fun strategy I found is called Alternate Rebellion. All of us, to some degree, have the desire to rebel against the rules and expectations put upon us. Some people even rebel against their own expectations for themselves. This desire to rebel can be used for good.

There are small ways that you can rebel, ways that don’t hurt anyone. The article I linked above gives a whole list of examples. But I can see that feeling like you are restraining yourself.

This got me thinking: why not create or identify an ‘enemy’? Imagine a person or a force that doesn’t want you to succeed. They want you to self-sabotage. They don’t think you can do it (where “it” is the positive habit or behaviour you want yourself to do). Then try to focus your inner rebel on this enemy.

Your rebel would then become a powerful ally in creating the types of habits you want for yourself.

Now, I can also see this backfiring. I could see a person trying this and burning out or becoming rigid. But if you’re able to find a balance, I could see it working.

Bottom Line

Dealing with chronic pain and fatigue is stressful. The flavour of the stress is different for each of us because each of us is living a different life. But we are all going through the same storm. We may each be on our own boat, but we all know the storm. We know the ups and downs and the fact that the stress is unavoidable. But with the right coping strategies, we can make it suck less.