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Thinking and Depression: Changing Negative Thought Patterns

Thinking and Depression: Changing Negative Thought Patterns

By Wesley Buch, Ph.D., R. Psych.

Pain and the problems associated with pain – sleep disturbance, limitations, losses, conflict, and stressful circumstances – can all negatively affect how you think about yourself, others, and your world. Negative thinking can contribute to depressive feelings.

Life Events (injury/pain) —> Thoughts, Interpretations —> Feelings

If life events like an injury and other pain-related circumstances are distorted and misinterpreted in a negative way, this can lead to a depressed mood. A depressed mood is feelings of sadness or emptiness that linger all the time throughout your days for at least two weeks.

For example:


You overdo an activity and experience a pain flare-up.

  • “I must have re-injured myself. Maybe this pain is from a whole new injury. It seems that whenever I get active, I end up harming myself all over again” (Hurt vs. Harm Interpretations of Pain).
  • “I’m going to give up all my activities so that I don’t harm myself anymore” (All or Nothing Thinking).
  • “I’m never going to get better. I could end up in a wheelchair” (Catastrophizing).

Discouraged, down, hopeless; this depressed mood can then lead to more depressive thinking, which continues the vicious cycle between pain and mood.

Some thinking tends to increase pain. For example, negative thoughts, images, and feelings can actually make pain feel worse.


“I can’t take this headache any longer!”


“A vice crushing my head.”



Changing Negative Thought Patterns

Here are some ideas about how to change the negative thinking patterns that lead to depression. There are other approaches to altering negative thought patterns, but these ideas will get you started:

  • Train yourself to recognize your negative thought patterns and write them down (a cognitive therapist can help you with this).
  • Learn how these thoughts are distorted.
  • Practice ‘talking back’ to your negative thoughts – challenge them and ‘gather evidence’ against them.
  • Replace them with positive coping thoughts and images:

“I’ll use a strategy I’ve learned, e.g. rapid self-calming with breath work, to deal with this. I’ll try to keep the pain at a manageable level. I’ve withstood worse than this.”


A peaceful scene; a place you love to be; an imaginary adventure, or foreign travel.


Calmness, self-nurturance, satisfaction with your efforts to cope.

Here are some questions that will help you to effectively challenge any negative thought patterns:
  1. What is the evidence for or against this idea? Where is the logic? Are my judgments based on feelings and past experiences rather than the facts of this situation?
  2. Am I oversimplifying a cause-and-effect relationship?
  3. Am I confusing a habit with a fact?
  4. Am I confusing my version of the facts with the facts as they are?
  5. Am I thinking in all-or-nothing terms?
  6. Am I using words or phrases that are extreme or exaggerated? (e.g. can’t, must, every time, should, need, never, forever, always)
  7. Am I taking selected examples out of context?
  8. Am I thinking in terms of certainties instead of probabilities? Am I confusing a low probability with a high probability?
  9. Am I focusing on irrelevant factors?

If You Feel Depressed

Tell someone you trust.

Join Live Plan Be’s supportive forum to benefit from the wisdom of others who have chronic pain and depression – and share some of the helpful things you have learned. Or find a support group near you. Pain and depression both tend to ‘disappear’ you and disconnect you from others, so do the opposite in small steps.

Book a counselling session

Book a ‘counseling session’ appointment (usually 10-15 minutes) with your physician if your emotional life is taking a turn for the worse. You will learn about medications that lessen depression but also pain and sleep disturbance at the same time. Ask about side effects. Seek specific medication advice about greater nighttime pain control in order to obtain a deeper sleep. Medication and self-management activities can also help each other. You can also book a few counseling sessions at your local mental health centre.

Learn self-management strategies

Learn about pain self-management strategies from Live Plan Be’s educational material. Learning to ‘put a muffler on your pain’ will benefit your mood. For example, learn about pain distancing, compassionate self-talk when in pain, gentle movement routines despite pain, pacing to prevent pain flare-ups, hurt vs. harm pain interpretations, and rapid self-calming strategies during pain flare-ups.

Get better quality sleep

Learn about how to get a better night’s sleep. Review the Live Plan Be sleep module for tips and resources. Ask your physician about how to get a better night’s rest. Getting better sleep tends to improve mood and stamina for self-management activities.

Make a plan

Use Live Plan Be’s action planning tools to make some goals about daily activities that increase your interest, enjoyment, or sense of accomplishment but without repeated pain flare-ups. You can also target activities that you miss or avoid now. Make these activity goals small and manageable. For example, go for a short walk, especially with a friend. Go to your local aquatic centre to enjoy the weightlessness of moving and floating in the water, then go to the hot tub and let go of all bodily tension. These are mood-boosting activities. Incorporate these activities into your daily routines. Show these goals to your physician at your next visit. Discuss them with a friend and make some goals for social activities – an especially powerful mood booster.

Focus on positive thought patterns

Review the information on Changing Negative Thought Patterns above. Thinking patterns affect mood for better or worse, and you can learn how to manage these more effectively.

Go for a massage

Go for a few gentle massage sessions from a Registered Massage Therapist in your area. People with chronic pain and depression often feel alienated from their own bodies. They become ‘the untouchables.’ Massage not only provides professional touch but the release of bodily tension that often accompanies depression.

Take advantage of available resources

In British Columbia, try the free Bounce Back program for depression online. This program will connect you with a real person who will walk you through a cognitive-behavioural self-management approach to depression using a DVD.

This article and other helpful educational links, stories, articles and research van be found on the below website



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Airing Pain 134 – Warwick Study Of Mental Defeat In Chronic Pain

What is mental defeat and does it have an impact on the experiences of those living with pain?

In this edition of Airing Pain, Paul Evans interviews the team at the Warwick Study of Mental Defeat in Chronic Pain (WITHIN Project) and research participants, as well as taking part in the study as a participant himself.

The study, which runs until May 2023, is investigating how mental defeat can influence pain sensation, sleep patterns, social activity, physical activity and the general health of individuals who have chronic pain.

Mental defeat is defined as the perceived loss of autonomy in the face of uncontrollable, traumatic events. In the context of chronic pain this can be explained as a loss of identity and self in relation to repeated episodes of pain.

Paul talks to the team about their experimental, lab-based study and the sleep-tracking survey, then undergoes the lab experiment himself. Afterwards, he discusses how he found it and the possible outcomes of the research. He also interviews other participants on their experience.

Research into mental defeat is in its early stages. It is hoped that the WITHIN Project will generate important information to help us further understand the influence that mental defeat has on distress and disability in chronic pain patients. This is essential listening for anyone wanting to know more about the research process, or wanting to participate.

Issues covered in this programme include:

Mental defeat, pain research, insomnia, psychological effects of pain, chronic pain, patient perspective, acceptance and commitment therapy, research participation, pain thresholds.

Click on below link to listen to the podcast

If you prefer to read the transcript please click on link to download PDF

Mental Defeat In Chronic Pain



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Chronic Pain Podcasts

Sometimes it can be extremely tiring and stressful reading detailed information about chronic pain, and the many ways to reduce the impact chronic pain has on the quality of life.

Many people prefer to listen to content rather than read. You can relax, close your eyes, and take in the spoken word via podcasts.

With that in mind, below are links put together by Annette Leonard, who lives with chronic pain herself.

This is not what I ordered

This is not what I ordered is a podcast by San Francisco psychotherapist and podcast host, Lauren Selfridge. The host conducts honest, humorous, and inspiring conversations with people to understand what it’s like to live with long term pain.

Chronically Chilled

We hope these podcasts can be a valuable tool for those experiencing chronic pain. Is there one you enjoy that we have missed? Let us know on our community Facebook group – you could be the one to introduce someone to their next favourite podcast! The link is here if you would like to join. Our community provides a place for people living with chronic pain to get support, tips, advice and support. We are better, together.

Trigeminal Neuralgia with Kelsey Darragh

Tune in as Kelsey shares…that she developed trigeminal neuralgia (TN) after two botched jaw surgeries.  That her surgeon gaslit her from the get-go after her surgeries, telling her it was all in her head and part of the healing process that she should be in such pain

click here for other podcasts to listen to

Continue reading Chronic Pain Podcasts

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Chronic Pain Online Tool

As an Association we are constantly looking for programs which can support sufferers of trigeminal neuralgia by utilising chronic pain online tools.

Below are details taken from a new program developed by St Vincent’s Hospital in Sydney called This Way Up.  The tool covers not only chronic pain but also wellbeing, mindfulness and anxiety.

Members can enrol for the chronic pain program by getting a referral from a GP.  Other services may requires paid subscription.

Disclaimer:- by publishing information about available programs we aim to provide information and education.  We do not recommend services, please consider your own circumstances and consult with your health care provider in respect of your care plan.


Chronic Pain Program

Learn practical strategies for managing chronic pain, and associated low mood and anxiety with our clinically-proven online program.


Chronic Pain at a Glance

The pain system involves all of our body’s systems and is a sensible and necessary system that functions to protect our bodies from a perceived threat. Sometimes the pain system can be ‘faulty’ and act in unusual ways. Chronic pain or persistent pain is pain that lasts longer than 3 months – beyond the healing period of tissue damage. This generally means that you experience pain despite having no new damage to the tissue. Pain does however impact on your ability to carry out your normal activities, whether these are at home or work, or in social or recreational settings. People with chronic pain will face different problems and barriers that prevent them from living their normal lifestyle, and stop them from achieving their goals.

Fortunately, you can learn to reduce the impact of chronic pain on your quality of life and many people who seek help get better. This program will teach you practical skills to tackle chronic pain and improve the way you feel.

About The Chronic Pain Program

This 8-lesson program takes a multidisciplinary approach to pain management and is based on an effective psychological treatment called Cognitive Behavioural Therapy (or CBT), which is designed to help you lessen the impact of pain on your wellbeing and quality of life.

It will teach you proven strategies for managing pain and show you how to work with your thoughts, emotions, and behaviours so you can make a positive change in how you feel.

The Chronic Pain Program was developed in conjunction with the multidisciplinary team at the St Vincent’s Hospital Sydney Department of Pain Medicine. The program has undergone clinical trials under the title ‘Reboot Online.

How to Get Started

To enrol in this program you will need to speak with your regular clinician (e.g., your GP, psychologist, or other health professional), and see if they can prescribe you this program and monitor you throughout your online treatment. You can download and take the Clinician Letter to your appointment.


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Catastrophizing – how to stop making yourself depressed

It is easy when you are coping with chronic pain to see the worst scenarios in everything around you.

Your mind sets off on a flight of fancy and before you know it, the sky has fallen and all hope is gone.

Mental responses can be retrained to reduce the impact on mental health and quality of life.  Learn how to recognised the signs.

Emma McAdam is a licenced marriage and family therapist who uses her therapy skills and psychological research to create bite sized nuggets of help.

You can access her full library here with many short videos which may help you cope.


– YouTube Emma McAdam – Therapy in a Nutshell

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The Dialectic of Pain: Synthesizing Acceptance and change

Dr. Deborah Barrett offers a framework and tools to help people improve their quality of life, just as they are, while also reducing pain and suffering. Her work draws from empirically based cognitive and behavioral interventions, and she practices what she preaches every day.

We thank the FPA for the great work they are doing publishing webinars in this field.

Watch the webinar here

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Loving yourself isn’t easy when chronically ill

Our Association connects to other chronic illness individuals via our Twitter account.  Some have trigeminal neuralgia, however many have other conditions.

What is the same though, are the struggles that anyone with a condition that causes chronic pain, can relate to.

We have to be kind to ourselves at all times, even when our bodies refuse to play nice.

The following blog was written by Rhiann who has been diagnosed with long-standing brain stem lesion and spastic paraparesis.

We hope her insights help to manage your journey with chronic pain

Loving Yourself Isn’t Easy When Chronically Ill

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How to Help People With Chronic Pain or Illness

This article was written by Liz the owner of the Despite Pain Blog .  The article contains links to other content that you may find useful.

Liz suffers from scoliosis (a curvature of her spine) when she was about ten years old. Initially, the orthopaedic surgeon said it was a cosmetic problem and no surgery was needed. But it wasn’t just a cosmetic problem. It started causing chronic back and rib pain when she was a teenager. The scoliosis worsened and when she was eventually referred to see a specialist, he could do nothing to help. Her pain continued to worsen, became constant and eventually, when she was 28, she had to retire from work.

Her back pain was chronic and disabling, but she lived with another pain condition that is just as debilitating. Trigeminal neuralgia, which causes severe facial pain. For an unknown reason, the trigeminal nerves in her face send pain signals to her brain.

In 2017, she was also diagnosed with the autoimmune condition, coeliac disease.

She has lived with chronic pain for most of her life, but try’s to keep smiling.

Click here to find out more about Liz.

10 Suggestions on How to Help People with Chronic Pain or Chronic Illness

If you have a friend or relative who lives with chronic pain or a chronic illness, the following suggestions are ways in which you could possibly provide physical help and support.

1. Believe Them

Believing them is the most important and supportive way to help people with chronic pain or illness.

Believe them when they tell you about their pain or illness. Believe them if they tell you that their life is difficult and that they’re struggling to cope. Believe them when they say their pain is off the charts. Believe them when they say they feel depressed. Please, never doubt them.

They need your empathy and understanding and that starts by letting them know that you believe them.

2. Listen to Them

Listen to them. Really listen.

If you ask them how they are feeling, please listen to the answer. There’s no point in asking otherwise.

Tell them that you are there if they want to vent. Many people feel they can’t or shouldn’t do that so tell them that you don’t mind listening.

They might say they’re fine when you know they’re not. So say, “I know you say you’re fine, but it’s okay to be honest with me.” If they still say they’re fine, don’t push it. Some people simply don’t like talking about their health or they might not be in the mood for opening up.

Never repeat what they tell you – if they feel comfortable enough to talk to you, don’t betray them by repeating what they say to others. You’ve gained their trust so don’t lose it.

3. Learn About Their Condition

Try to learn about their condition and how it affects them so that you understand more. I’m not suggesting you need to learn enough to obtain a medical degree, but if you learn a little bit, it will let them see that you are actually interested rather than being there out of a sense of duty.

4. Empathise

Empathise with them, but don’t tell them you know exactly how they feel. You might get an occasional bad headache, but that’s not the same as living with trigeminal neuralgia or chronic debilitating migraines. Even if you suffer from the same condition, everyone’s experience is different so, in reality, you don’t really know exactly how they feel. Empathise and tell them that you appreciate that their life can’t be easy.

5. Be There

Living with chronic pain or chronic illness can be a lonely life. Sometimes people just need a friend so give them your time.

They don’t need or want to talk about their pain or illness all the time. They don’t want pity or sympathy. Nor do they want to be treated with kid gloves and they do not expect you to be a nursemaid. They want to feel normal, do normal things and have normal chit-chat with you.

They need distractions from their health. You could share a meal with them, help them with a hobby or just sit with them to play a board game or enjoy a movie together. You could take them for a drive, go for a walk or take them shopping if they’re able. If you do this, please go at their pace so they don’t feel as though they’re holding you back, otherwise they will feel guilty. Talk about other things, including yourself. Talk about your own troubles if you have any because they still care about what’s going on in your life.

6. Help with Appointments

Offer to take them to their medical appointments. They might need your help getting there or they might be grateful for some moral support or an extra pair of ears during the appointment.

7. Offer Practical Help

Living with chronic pain or illness is debilitating, therefore simple tasks are often more like huge, possibly impossible, chores. They might be grateful for your help with some basic housework, making a meal or doing some shopping. Or perhaps you could help by picking their kids up from school or walking their dog occasionally.

But be tactful about how you offer your help as it may be construed as criticism.

For example, don’t tell them that their house needs to be cleaned. Instead, tell them that you realise that some chores must be extremely difficult due to their pain or illness, and you’d be happy to help out with something they find too difficult.

Try to offer help in a way that it’s easier for them to accept. For example, say, “I will be at the supermarket tomorrow, so it will be easy to pick up some shopping for you while I’m there.” That way, they know that you are already going to the supermarket, so you aren’t going out of your way just for them.

Offer help but try to understand if your kind offer is turned down. They might feel embarrassed, or they may still want independence so if they repeatedly say they don’t need or want your help, accept that and back off. Rather than be upset or take offence, simply tell them that you’re there if they ever need you.

8. Be Inclusive

When people are living with pain or illness, they might not be well enough to attend social events but please invite them anyway. They might not be well enough to come to your birthday party or to meet for coffee, but they also don’t like to feel excluded, so invite them and let them decide.

If they say yes, they might have to cancel or leave early due to their illness getting in the way. If that happens, don’t take it personally. Try to understand that it’s out of their control and accept that their health can be unpredictable. They are probably embarrassed and annoyed with themselves, so a little understanding will go a long way.

9. Don’t…

There are a lot of things you shouldn’t do or say. Here are a few:

    • Please don’t abandon them. Their pain or illness might get in the way, but they still value and want the relationship they have with you.
    • Never suggest that they shouldn’t take their medication or that they take too much. If you have a serious concern that it could be making them ill, suggest they speak to their doctor.
    • Don’t insinuate that they can’t be trying hard enough by telling them that your amazing friend has the same condition but is able to do so much more than them.
    • Don’t minimise their pain or illness by saying things like, “Well, it could be worse…” or “At least it’s not cancer.”
    • Don’t be dismissive of their symptoms or feelings and don’t tell them how
    • they should feel. Their pain or illness is real. Their feelings are real and valid.
    • Never suggest that they just need to give themselves a shake, pray a bit harder, go for a brisk walk or be more positive in order to feel better. Statements like that undermine them and their condition. They are also patronising and extremely rude.
    • Avoid suggesting strange herbal concoctions which are advertised online. Most of those strange herbal concoctions are expensive snake oil cures.
    • And please don’t suggest that they drink a kale and turmeric smoothie to cure their ills. If you do, you might get said smoothie tipped over your head.

10.Bring Chocolate

Unlike kale and turmeric smoothies, chocolate is nearly always welcome. So, bring on the chocolate. Or cake. That works too.

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Emergency Department – Break-through Trigeminal Neuralgia Pain

This week the Association launched our Emergency Department plastic wallet cards – to assist sufferers with communicating when attending a hospital emergency department with break-through trigeminal neuralgia pain

The following study highlights why this is such an important issue – and very relevant to all of our sufferers

Treatment of acute exacerbations of trigeminal neuralgia in the emergency department: A retrospective case series


  • 1Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal.
  • 2Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.


Objective: To evaluate the response to treatment of acute trigeminal neuralgia (TN) exacerbations in the emergency department (ED).

Background: TN is characterized by recurrent and intense pain paroxysms. Some patients experience severe acute exacerbations requiring ED presentation. The optimal management of these episodes is not well established.

Methods: We present a case series of TN exacerbations in adults who presented to the ED of a tertiary centre from January 2008 to December 2020. We analysed demographic and clinical data, including pharmacological management in the ED. The primary outcome was pain relief, classified into “no relief,” “partial relief,” and “satisfactory relief” based on the qualitative description in the ED’s records.

Results: Ultimately 197 crisis episodes corresponding to 140 patients were included. Most were women (61%, 121/197) with a median age of 63 years (interquartile range: 52-73). Acute TN exacerbations were treated with opioids in 78% (108/139) of crisis episodes, nonsteroidal anti-inflammatory drugs in 42% (58/139), corticosteroids in 21% (29/139), intravenous phenytoin in 18% (25/139), and intravenous lidocaine in 6% (8/139). Of the 108 cases treated with opioids, 78 (72%) required additional drugs for pain management. Intravenous phenytoin allowed satisfactory pain relief in 64% of cases.

Conclusion: In our sample, opioids were the most used therapeutic approach in acute TN exacerbations despite their low efficacy and subsequent need for further drug treatment in most cases. Most crisis episodes managed with intravenous phenytoin reached total pain relief. Prospective studies are needed to guide the treatment of acute exacerbations of TN.

Keywords: emergency department; exacerbation; lidocaine; opioids; phenytoin; trigeminal neuralgia.

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    1. van Hecke O, Austin SK, Khan RA, Smith BH, Torrance N. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014;155(4):654-662.
    1. Zakrzewska JM, Wu J, Mon-Williams M, Phillips N, Pavitt SH. Evaluating the impact of trigeminal neuralgia. Pain. 2017;158(6):1166-1174.
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Emergency Department Plastic Wallet Cards

Following the webinar presented by A/Prof Arun Aggarwal in July, we brainstormed the possibility of providing a plastic wallet card for our sufferers to present to the Emergency Department of their hospital, when Trigeminal Neuralgia break through pain becomes too much to cope with. We worked with PR Design and produced a fantastic card which […]
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