Av, jeg har kroniske smerter, hvad gør jeg?

Kroniske smerter - 3

 

Lever du med kroniske smerter og er træt af, at det påvirker dit sind og din livskvalitet? Har du accepteret smerternes tilstand? Lever du i vrede eller frustration grundet dine smerter? Hvad undgår du at gøre grundet smerter? Undersøgelser viser, at den måde, du håndterer smerter på, er afgørende for smerterne. Din psyke og det, du siger til dig selv, er meget afgørende for kroppens tilstand.

 

Dinna Trehøje cand.psych, biopat/naturopath ibm og zoneterapeut

Adskillige studier viser, at flere behandlingsformer har effektive resultater ved kroniske smertetilstande. En af disse behandlingsformer er Acceptance & Commitment Therapy (hvilket forkortes ACT), som omhandler, hvordan du selv via ændrede tankemønstre kan påvirke smerten. Det er ikke en behandlingsform, der har til opgave at reducere smerten, hvilket kan synes underligt, da man kunne forestille sig, at det ligger højt på ønskelisten hos en med kroniske smerter. Det handler i stedet om at acceptere den tilstand, man er i og forsøge at finde værdi på trods af smerte.

Det behøver ikke kun at være fysisk smerte, som ACT kan være behjælpelig med. Denne behandlingsform viser også sin effektivitet ved psykisk smerte. De fleste af os oplever fra tid til anden psykisk smerte eller negative tanker. En nær persons død eller andre omstændigheder kan medføre smerte. Endda på eksempelvis vores gode dage eller ved lykkelige begivenheder, hvor vi ønsker, at en bestemt afdød person er til stede, vil fremkalde smerte. Tanker om noget negativt fra fortiden, nutiden eller fremtiden kan alt sammen fremkalde smerte hos os alle, ligegyldigt hvor privilegerede vi synes at være.

Når vi oplever fysisk smerte, ubehagelige kropslige fornemmelser, destruktive tanker og ubelejlige følelser, så reagerer vi mennesker ofte uhensigtsmæssigt. ACT har til formål at lære os at håndtere smerte, hvilket både kan afhjælpes gennem mindfulness og seks kerneprocesser, som hjælper mod et mere værdistyret og nærværende liv.

De seks kerneprocesser

  • Accept

Accept omhandler det at åbne sig og acceptere smerter eller det, som generer. Det at acceptere dine smerter betyder ikke nødvendigvis, at du kan lide dine smerter, men det handler om at give plads til smerterne. Vi holder op med at kæmpe mod dem og lader tankerne og følelserne være, som de er, uanset karakter. Hvorfor bruge al din energi på at kæmpe mod og skubbe smerterne væk? Dog skal det nævnes, at hvis du befinder dig et usundt sted i livet eller relation, så handler det stadig om at acceptere, men du må stadig handle på dine værdier og flytte dig fra det usunde, krænkende, farlige eller voldelige, du måtte befinde dig i. Man skal ikke acceptere alle omstændigheder og lade stå til.

Forestil dig, at en person presser en tyk, stor bog op i hovedet på dig. Du forsøger med al din kraft at skubbe bogen væk. Du bruger al din energi, styrke og tankevirksomhed for at forsøge at få bogen skubbet væk fra dit ansigt. Du kan ikke koncentrere dig om andet vigtigt i livet, for bogen er mast helt op i dit ansigt og generer, og personen, der skubber, har ikke i sinde at slippe presset. Pludselig lægges bogen i dit skød. Du får nu mulighed for at se dine omgivelser, være til stede, og din energi kan bruges på andet. Forestil dig nu, at denne bog er den smerte, du bærer på. Hvordan føles det, hvis du lægger smerten i skødet og accepterer følelserne omkring smerten?

Et svensk studie fra 2016 undersøgte, om accept spiller en rolle for kroniske smertepatienters helbredstilstand. Resultaterne viste, at accept har en effekt på forandring i deltagernes fysiske funktion hos deltagerne med kroniske smerter.

  • Defusion

Defusion vil sige at iagttage sine tanker og dermed adskille sig selv fra disse tanker. Vi må ikke blive fanget af vores tanker, men skal i stedet se dem som forbipasserende biler, der ikke skal styre vores tilværelse. Blot fordi du får en tanke om noget, så betyder det ikke, at det er sandheden. Lad tanken køre forbi dig, og bliv opmærksom på, at det er en tanke. Er tanken nyttig for dig? Hjælper tanken dig på nogen måde til at leve et liv med mening, og skaber tanken værdi for dig?

Holder du fast i dine negative tanker grundet smerte og undgår at gøre det, du egentlig vil, eller ønsker du fra nu af at ændre dit tankesæt ved at blive opmærksom på dine tanker og kigge på funktionaliteten af tanken? Hvilken vej vælger du?

Hvordan adskiller du dig fra dine tanker?

Gentag din mest negative tanke om dig selv, og fasthold, og tro på tanken i 30 sekunder. Det kunne eksempelvis være: ”Jeg er ikke god nok”.

Sæt nu følgende frase foran din negative sætning: ”Jeg har den tanke, at…”, så det kommer til at lyde: ”Jeg har den tanke, at jeg ikke er god nok”.

Tilføj følgende foran: ”Jeg bemærker, at…”, så sætningen nu lyder: ”Jeg bemærker, at jeg har den tanke, at jeg ikke er god nok”.

Gentag den sidste sætning, og mærk, hvordan denne sidste sætning føles modsat den første sætning. Mærker du en forskel? Dette er en enkel øvelse, og det kræver øvelse at kunne distancere sig fra sine negative tanker. Øv dig.
 

  • Selvet som kontekst

Dette punkt handler om det iagttagende selv. Vi har hele tiden følelser, tanker og fornemmelser, som kommer og går, men bagved ligger din bevidsthed, der er opmærksom på tankerne, fornemmelserne eller følelserne. Selvet som kontekst kan også forklares ved, at man lægger mærke til, at man lægger mærke til eller bliver bevidst om egen bevidsthed.

For at nuancere det endnu mere kommer her en metafor, hvor det iagttagende selv sammenlignes med himlen. Himlen er der hele tiden ligesom dit iagttagende selv. Vejret sammenlignes med dine tanker og følelser. Vejret skifter hele tiden, og selvom der er stormvejr, orkan, tordenvejr, snestorm eller regn, så er der stadig stille og sikkert over skyernes buldren, og måske endda solen skinner. Der vil altid være et sikkert sted inde i dig, der bliver bevidst om uvejret eller tankerne og følelserne.
 

  • Værdier

Det er meget vigtigt at kunne klargøre sine værdier for at kunne leve et meningsfuldt liv. Vi er på denne jord i kort tid og bør få det bedste ud af tiden. Lever du i overensstemmelse med dine værdier, eller begrænser du dig selv grundet smerter? Vores værdier skaber retningen og motivationen i vores liv, og kun du bestemmer, i hvilken retning dit liv skal gå.

Værdier kan beskrives som vores inderste ønsker for den måde, vi lever på, den måde, vi interagerer med andre på, eller hvem vi ønsker at være. Ofte kan det være svært at skelne mellem mål og værdier, og derfor kommer her en nuancering. Mål er noget, der kan udrettes eller opnås, hvorimod værdier er en retning, man kan forsøge at bevæge sig imod. Eksempelvis er et ønske om at tabe sig fire kilo et mål, hvorimod det at tage vare på sin krop er en værdi.

  • Engageret handling

Engageret handling betyder, at man skal gøre det, der skal til, hvilket er at handle effektivt ud fra ens værdier. Bevæg dig i den retning, som skaber værdi for dig, ligegyldigt om vejen dertil medfører smerte. Målet er at skabe forandring og skabe et nyt mønster, hvor man handler ud fra sine værdier og vender tilbage til disse nye handlingsmønstre, selvom man kommer ud af kurs.

For at komme nærmere engageret handling skal du vælge et område som du ønsker forandring omkring. Noget, som har stor betydning for dig. Vælg nu de værdier, som du vil forfølge, og som skaber grobund for forandringen. Opstil mål ud fra disse værdier. Vær konkret med dine mål. Målene må være specifikke, meningsfulde, realistiske, tidsdefinerede og tilpassede. Efter at have klargjort dine mål, så påbegynd handlingen, der opfylder dine mål og værdier.
 

  • Kontakt med nuet

At være i kontakt med nuet omhandler det at være bevidst nuværende og ikke lede sine tanker hen på fortiden eller fremtiden. Forsøg at engagere dig i det øjeblik, der foregår omkring dig lige nu, hvad enten det er verden omkring dig eller dit indre, der optager dig. Hvorfor er dette punkt vigtigt, tænker du måske? Fordi mange mennesker er fæstnet i fortiden eller forgaber sig i fremtiden og har brug for at komme i kontakt med deres oplevelse af nutiden. Der er kun en tid, der er vigtig, og det er lige nu, fordi du lige nu har mulighed for at påvirke dig selv og dine omgivelser.

Mindfulness

Mindfulness er en opmærksomhedsproces og er relevant for ACT for at blive bedre til at øge evnen til accept og defusion (iagttagelse af dine tanker). Blot at være i nuet og tillade det svære på trods af smerter er formålet med mindfulness. Det er meget individuelt, hvor længe man kan sidde med sig selv og blot være til stede med sig selv, da smerter er individuelle, og for nogle kan to minutter i sådan en øvelse synes som en evighed. Øv dig, mærk dig selv, vær åben, og vær nysgerrig på dig selv, selvom det synes ubehageligt eller smertefuldt, og du i virkeligheden har lyst til at flygte fra smerten eller finde noget at dulme smerten med. Mindfulness er et værktøj til at komme i bedre kontakt med sig selv og være med sig selv på trods af vanskelighed. Hvordan ville det føles for dig at sidde i stilhed og blot dyrke dig selv et øjeblik?

Forsøger man at undgå eller undertrykke sine smerter, så viser studier, at det blot intensiverer smerten og er forbundet med angstlidelser, depression, højere niveauer af stofmisbrug, overdrevne bekymringer, ringere livskvalitet, dårligere arbejdspræstationer, hvilket synes som nok grunde til at begynde at arbejde ud fra principperne i Acceptance & Commitment Therapy til at skabe et bedre liv for sig selv. Kun du kan foretage ændringer til at skabe forandring.

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Om Dinna Trehøje

Dinna Trehøje er uddannet cand.psych. fra Aarhus Universitet i 2018 med speciale i sygdomsopfattelse, smerte og funktionelle lidelser. Derudover har hun samtidig studeret til zoneterapeut og biopat/naturopath i biologisk medicin på Institut for Biologisk Medicin og blev færdiguddannet i 2017. Dinna Trehøje arbejder i øjeblikket med Support & Care-uddannelsen på Institut for Biologisk Medicin, der er en ny overbygningsuddannelse omhandlende konventionel og komplementær behandling af kræft.

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