How ADHD Affects Adults, and Why Diagnosis Is Better Late Than Never

Though once considered a phase that kids just grew out of, attention deficit hyperactivity disorder (ADHD) is now recognized as a condition that can plague people of any age. When adults have ADHD, it can affect their jobs, their marriages and family life, and even their finances. The good news? It's never too late for treatment.

"In our practice, we see ADHD patients ages 16 to 65," says David W. Goodman, the director of the Adult Attention Deficit Disorder Center of Maryland and an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine. Most, if not all, of his patients elect to try medication, Dr. Goodman adds. Why bother treating older patients who have lived their whole lives with ADHD? "Because everyone is entitled to see how much better they can function when relieved of ADHD symptoms."

The following information from our A-Z Health Library describes common symptoms and warning signs of adult ADHD.

Attention deficit hyperactivity disorder (ADHD) in an adult is often not noticed because the person may maintain relationships and hold a steady job. It is not unusual for a parent to discover he or she has ADHD when his or her child is diagnosed with the disorder. The key to the diagnosis of ADHD for an adult is the presence of symptoms before he or she was 7 years old.

Hyperactivity in adults is often seen as:

• Fidgeting. Typically they swing their legs, shift in their seats, or tap their fingers.
  
• Constant motion. They feel “revved up,” on the go, and show little or no ability to relax until exhausted.
  
• An inability to relax. They have difficulty trying to relax or to do quiet activities such as reading or watching television.

Inattention in adults is often seen as:

• Difficulty completing tasks that they do not find interesting or easy. But these adults may become obsessed with activities that are interesting and enjoyable.
  
• Difficulty maintaining relationships.
• Difficulty focusing their attention on conversations, reading materials, or jobs. They may frequently move from one job to another.
• Forgetfulness, misplacement, or loss of things.
• Distractibility.
  
• Impulsivity.

Symptoms of ADHD in adults may affect:

• Job performance. Their work performance may be inconsistent because they have problems organizing their work, managing their time, and concentrating on one task at a time. They may be forgetful and misplace or lose things. They may quit their jobs out of boredom.
  
• Personal relationships. Relationships may suffer for adults who have problems focusing their attention on conversations, “reading” the behavior and moods of others, and expressing their own feelings.
• Temper. Becoming easily frustrated often is related to having difficulty tolerating stress. These adults may overreact and have a short, quick temper.
• Problem-solving ability. Adults who have difficulty waiting for things they want may not be able to accurately foresee the consequences of their actions. As a result, they may engage in risky behaviors, such as unprotected sex, unsafe driving, alcohol and drug use, or unwise financial ventures.

What If My Child Begins to Exhibit Symptoms of ADHD?

If you've been diagnosed with ADHD yourself (or suspect that you might be affected), you're probably on heightened alert when it comes to spotting symptoms in your kids' behaviors. And in a way, you're in a better position than other adults who have gone through life undiagnosed and untreated: Many only realize that they themselves have ADHD when their children are finally diagnosed.

Because many adults pass this disorder on to their children, it's important to know when to talk to a doctor and consider early treatment, should symptoms arise elsewhere in your family. Use this guide from our A-Z Health Library to determine what's worth acting on right away.

Call a doctor if:

You notice that you or your child has symptoms of attention deficit hyperactivity disorder (ADHD) that began before age 7.

Your child is showing signs of ADHD, such as inattention, impulsivity, and/or hyperactivity, that are causing problems at home or school. Parents and teachers often notice this behavior during the child's first few years in school.
Your child shows signs of other mental health disorders, such as depression or anxiety, that last more than a few weeks or seem to be getting worse.

Your child is having academic or behavioral problems at school.

Watchful Waiting

Preschool children

For young children who show signs of attention deficit hyperactivity disorder, watchful waiting is appropriate. It is difficult to diagnose ADHD in children younger than age 5. Young children generally have short attention spans, and their normal range of behavior includes periods of high activity and impulsivity. If you notice any ADHD symptoms in your preschooler that do not seem age-appropriate, work with your child to improve behavior. Keep a record of your child's behavior for 6 months to see if it improves. If it continues or has consequences, such as being expelled from day care or preschool, talk with your doctor about having your child evaluated.

School-age and teen years
Watchful waiting is not appropriate for school-age children and teens with ADHD symptoms. Children need attention from a doctor if they have behavior problems that occur in more than one setting, such as poor relationships with parents and poor academic performance.

Problems caused by inattention may not become significant until the teen years, when greater self-reliance is expected. A change in school (such as advancing to junior high or high school) or a new environment (such as moving to another city) can trigger problems with inattention. If you think your child may have an inattention problem, see a doctor to find out if ADHD is the cause.

Adults
Watchful waiting may not be appropriate if you are an adult and think that you may have ADHD. Consider how long you have experienced symptoms, and think about any major changes or difficult situations that are affecting your life. Your symptoms may improve when you have addressed and worked on those issues. But talk to a doctor if your symptoms concern you. If you have other symptoms, such as depression or anxiety, a doctor can help diagnose and treat your problems.

Who To See

Health professionals who can diagnose and treat attention deficit hyperactivity disorder (ADHD) with medicine include:

• Family medicine doctors.
  
• Pediatricians (may specialize in developmental problems).
• Psychiatrists (may specialize in adults or children and adolescents).
• Neurologists (may specialize in child or adult nervous systems).
  
• Nurse practitioners who specialize in psychiatry.

Health professionals who do not prescribe medicines but can provide behavioral therapy or family counseling include:

• Psychologists. Psychologists also frequently diagnose ADHD.
  
• Behavioral specialists.
• Social workers.
• Psychiatric nurse specialists.
• Licensed professional counselors.
  
• Family therapists.

Ask your health professional about his or her training and experience related to ADHD. Diagnosing and treating ADHD requires an ability to identify and distinguish behaviors that can be subtle and complicated. In addition, make sure your health professional has enough time to evaluate you or your child. Accurate diagnosis and successful treatment of ADHD takes repeated office visits and observations. It is also necessary that your health professional be able to coordinate between other health professionals, family members, teachers, and caregivers.

What Is Osteoarthritis?

What is osteoarthritis?

Healthy joints help your body move, bend, and twist. Knees glide up and down stairs without creaking or crunching. Hips move you along on a walk without a complaint. But when osteoarthritis affects your joints, such simple, everyday movements can hurt. Taking the stairs can be painful. Walking a few steps, opening a door, and even combing your hair can be hard.

Osteoarthritis is mainly a disease of the hips, knees, hands, neck, and low back . But it can happen in other joints too. A joint is where two bones connect. And you have them all over your body.

Osteoarthritis is most common in older people. Although you cannot cure arthritis, there are many treatments that can help with your pain and make it easier for you to move. And you can do things to keep the damage from getting worse.

What causes osteoarthritis?

The simplest way to describe osteoarthritis is that it is wear and tear on the cartilage of your joints. Your joints have cushioning inside them called cartilage. This tissue is firm, thick, and slippery. It covers and protects the ends of bones where they meet to form a joint.

With osteoarthritis, there are changes in the cartilage that cause it to break down. When it breaks down, the bones rub together and cause damage and pain. Experts do not know why this breakdown in cartilage happens. But aging, joint injury, and genetics may be a part of the reason.

What are the symptoms?

• Pain: Your joints may ache, or the pain may feel burning or sharp. For some people, it may get better after a while. Pain while sleeping or constant pain may be a sign that your arthritis is getting worse.
  
• Stiffness: When you have arthritis, getting up in the morning can be hard. Your joints may feel stiff and creaky for a short time, until you get moving. You may also get stiff from sitting.
• Muscle weakness: The muscles around the joint may get weaker. This happens a lot with arthritis in the knee.
• Swelling: Arthritis can cause swelling in joints, making them feel tender and sore.
• Deformed joints: Joints can start to look like they are the wrong shape, especially as arthritis gets worse.
  
• Cracking and creaking: Your joints may make crunching, creaking sounds.

How is osteoarthritis diagnosed?

Your doctor will want to make sure your pain is caused by arthritis and not another problem. So first, you will need to describe your symptoms as best you can. Your doctor will ask you questions about your symptoms. Examples of questions include:

• Is the pain burning, aching, or sharp?
  
• Are your joints stiff in the morning? If yes, how long does the stiffness last?
  
• Do you have any joint swelling?

Knowing these things will help your doctor make a diagnosis. If your joints are tender and swollen and the muscles are weak, this will also help your doctor confirm whether you have arthritis. You may also have X-rays to check your joints for damage. Your doctor may want to do blood tests or other tests to see if there are other causes for your pain.

How is it treated?

There are many treatments for arthritis, but what works for someone else may not help you. Work with your doctor to find what is best for you. Often a mix of things helps most.

If your pain is mild, you may only need pain medicines you can buy without a prescription. These include acetaminophen (such as Tylenol), aspirin, ibuprofen, or naproxen (such as Aleve). But if you still have pain, you may need a stronger prescription medicine. Because you will take these medicines for a long time, you will need to have regular checkups from your doctor.

Using ice or heat on the painful joint can help. Heat may help you loosen up before an activity. Ice is a good pain reliever after activity or exercise. Your doctor may give you gels or creams that you can rub on the joint to make it stop hurting. Having shots of medicine in the joint also helps some people.

If you are overweight, losing weight may be one of the best things you can do for your arthritis. It helps take some stress off your joints. Exercise is also good, because it can help make your muscles stronger. Having stronger thigh muscles, for example, can help reduce stress on your knees. Swimming, bicycling, and walking are good activities. But make sure you talk to your doctor about what kind of activity is best for you. You may also get help from a physical therapist.

If your pain gets so bad that you have trouble walking, you may need surgery. Hips and knees that have been severely damaged can be replaced with man-made joints.

Last Updated: May 15, 2008

Weight Loss Might Not Curb Knee Arthritis

FRIDAY, March 13 (HealthDay News) — Losing weight may not help prevent the progression of knee osteoarthritis, a new study suggests.

Researchers looked at more than 2,600 people with the knee ailment who were at high risk for the condition because they were overweight or obese or had other risk factors such as knee pain or previous knee injuries. Participants were given a physical examination and hip bone mineral test and had X-rays taken of both legs at the start of the study and of their knees again after 30 months.

The study found that obesity did increase the risk of knee osteoarthritis but that weight had no overall effect on the likelihood of the disease progressing, said D.T. Felson, of Boston University School of Medicine, and colleagues.

However, the researchers did find that weight had an effect on progression depending on how the knees were aligned. People with high body mass index and neutral alignment had an increased risk of progressive knee osteoarthritis, those with valgus (knock-kneed) alignment had a small risk and people with varus (bowlegged) alignment had no increased risk.

Among participants who did not have knee osteoarthritis, obesity increased the risk of developing the disease, regardless of their knee alignment.

“The failure to demonstrate that obesity increases the overall risk of [osteoarthritis] progression in our study and others does not eliminate opportunities for weight loss trials aimed at slowing disease progression, especially among knees in extremities with neutral or valgus alignment,” the researchers wrote.

The study was published in the March issue of the journal Arthritis Care & Research.

More information

The American Academy of Family Physicians has more about knee osteoarthritis — Robert Preidt

SOURCE: Wiley-Blackwell, news release, March 3, 2009

Last Updated: March 13, 2009

Copyright © 2009 ScoutNews, LLC. All rights reserved.

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Related Links: (Please Search)

Take Control of Your Osteoarthritis
Almost Half of Adults Will Develop Knee Osteoarthritis by 85
What Is Osteoarthritis?
7 Steps to Easing Your Osteoarthritis at Home

"Fibromyalgia Is Like a Bruise That Covers Your Entire Body"

"You're always on guard not to be in situations where someone might bump into you."
Rebecca, a fibromyalgia patient, shares what your body feels like when you have fibromyalgia.

Rebecca, 52, has been living with fibromyalgia for more than 30 years. After struggling without proper treatment, she took charge of her disease and sought alternative therapies such as cognitive-behavioral therapy, acupuncture, and chiropractic manipulation to achieve pain control. She used to describe her pain as a nine or a 10 but now she says it’s a one or a two. She has written a book to help others who are like her, Beyond Chronic Pain: A Get-Well Guidebook to Soothe the Body, Mind, and Spirit. In this video, Rebecca explains how her body feels and how carefully she has to navigate the world to keep pain at bay.

For comprehensive information about symptoms, treatment options, and the experience of living with fibromyalgia, visit our Chronic Pain Health Journey.

View video at: http://www.health.com/health/condition-video/0,,20193540,00.html

Using Cognitive-Behavioral Therapy to Control Your Chronic Pain

Content provided by Healthwise

Treatment Overview
Cognitive-behavioral therapy (CBT) teaches relaxation techniques, stress management, and other ways to help you cope with pain. Physical, psychological, and social factors all play a role in pain management.

Cognitive-behavioral therapy is based on the idea that thought and behavior patterns can affect symptoms and disability and may be obstacles to recovery. For example, when you feel a familiar type of pain starting or getting worse, you probably have a sense of how it will progress. If you are used to the pain being severe or long-lasting, you may expect the pain to become more intense. This thinking may make you feel out of control or helpless. A stress response like this can trigger physical changes in your body, such as a rise in blood pressure, the release of stress hormones, muscle tension, and more pain.

You can expect to attend several sessions with a therapist, each lasting an hour. Sometimes therapy takes place in a group setting. You will be taught specific exercises that increase your ability to cope and your feelings of control. Your therapist will give you homework to encourage you to change the way you respond to your symptoms. You will then be taught how to practice changing a certain behavior until the next session.

What To Expect After Treatment
Cognitive-behavioral skills can change the way your mind influences your body. When you shift your thinking away from the pain and change your focus to more positive aspects of your life, you change the way your body responds to the anticipated pain and stress.

Why It Is Done
The goal of cognitive-behavioral therapy is to change the way you think about the pain so that your body and mind respond better when you have episodes of pain. Therapy focuses on changing your thoughts about illness and then helping you adopt positive ways of coping with illness. For cognitive-behavioral therapy to be most effective, work together with your counselor toward common goals.

How Well It Works
CBT can be helpful for chronic pain by changing the way you think about pain. It also teaches you how to become more active.1 This helps, because pain can also improve with appropriate physical activity, such as walking or swimming.

Risks
There are no risks associated with cognitive-behavioral therapy.

What To Think About
Whatever the reasons for improvement, it is clear that cognitive-behavioral therapy can be helpful for some people who have persistent pain. It has virtually none of the side effects that other treatments, such as medications, can cause.

Complete the special treatment information form (PDF) (http://www.health.com/health/static/hw/media/pdf/hw/form_zm2258.pdf) to help you understand this treatment.

References
Citations Max MB (2004). Pain. In L Goldman, D Ausiello, eds., Cecil Textbook of Medicine, 22nd ed., vol. 1, chap. 29, pp. 138–145. Philadelphia: Saunders.

Last Updated: April 20, 2008

A Guide to Biofeedback: How This Complementary Therapy Can Help Pain Patients

Content provided by Healthwise

What is biofeedback?
Biofeedback is a method that uses the mind to control a body function that the body normally regulates automatically, such as skin temperature, muscle tension, heart rate, or blood pressure.

When you are first learning biofeedback, you will have sensors attached to your body and to a monitoring device. This provides instant feedback on a body function (for example, your skin temperature). The biofeedback therapist will then teach you physical and mental exercises that can help you control the function. The results are displayed on the monitor while you learn how to control that function. The monitor beeps or flashes when you achieve the desired change in that body function (such as increasing skin temperature or reducing muscle tension).

Two types of biofeedback are:

• Electromyography (EMG). This type of biofeedback uses a device that measures muscle tension while you practice a relaxation technique, such as meditation, progressive muscle relaxation, or visualization.
  
• Peripheral temperature or hand temperature biofeedback. This type of biofeedback uses a device that measures the skin temperature of your hands while you try to increase it, often through visualization or guided imagery. For instance, you may listen to a tape that stirs images of blood flowing to your hands. Increasing blood flow to the hands makes the hands warmer.

Learning biofeedback requires several sessions in a biofeedback lab or other setting. Most people can have success with biofeedback by the time they complete 12 sessions. Home feedback units are also available. With practice, many people may be able to learn to influence their muscle tension or blood flow without the help of the feedback monitor.

What is biofeedback used for?
People most often use biofeedback to control problems related to stress or blood flow, such as headaches, high blood pressure, and sleep disorders. Using it may also help control long-term (chronic) pain.

Is biofeedback safe?
Biofeedback is a safe procedure. It is most effective when taught by someone well-trained in biofeedback techniques.

The sensors placed on the skin to measure a body function may irritate your skin.

Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.

Last Updated: May 15, 2008

Change the Way You Think About Pain With Cognitive-Behavioral Therapy

Proponents of cognitive-behavioral therapy (CBT) say that it can help pain patients end the downward spiral of negative thinking that worsens pain. People suffering from chronic pain can spend a lot of time thinking negatively about their pain, growing concerned, anxious, or pessimistic. Those thoughts can actually increase pain, so therapists work with patients to reframe some of the negative thoughts surrounding their pain. By identifying and changing negative thought patterns, patients can actually help relieve their pain.

To benefit from this technique, patients should see a therapist trained in using CBT for chronic pain to help create a list of coping thoughts relevant to particular situations they are having difficulty dealing with.

In the chart below, Francis Keefe, PhD, director of the Pain Prevention and Treatment Research Program at Duke University School of Medicine, in Durham, N.C., and colleague Daphne McKee, PhD, have identified some specific examples of the kinds of thoughts people in pain might feel and some possible ways of reframing them. These are not intended to address your situation directly but to give you an idea of how cognitive-behavioral therapy attempts to change the negative thought patterns that can worsen pain.

Last Updated: April 23, 2008

4 Ways Yoga Relieves Low Back Pain

Yoga is one of the nondrug, nonsurgical therapies that has been shown to benefit back pain. In 2005 a study published in the Annals of Internal Medicine found that a yoga program was more effective in treating low back pain than another exercise regimen or educating yourself about proper back care. In October 2007 the American College of Physicians and the American Pain Society released guidelines that recommend therapies that include massage, Viniyoga (a gentle, therapeutic yoga style), acupuncture, and spinal manipulation for persistent back pain.

According to Timothy McCall, MD, the medical editor of Yoga Journal, yoga can enable patients to do the following.

• Strengthen weak muscles
  
• Increase flexibility
• Improve oxygenation to body tissue
  
• Shift the balance of the autonomic nervous system from the sympathetic "fight or flight" response to the parasympathetic "rest and digest" state

All of those changes can help support the musculoskeletal system and bring pain relief, but beyond those physical improvements, Dr. McCall believes that the greatest benefit yoga can provide to patients is in their mind.

"In yoga there is a difference between pain and suffering. Pain is often caused by physical things, but the mind fuels the fires of suffering by thinking about it and coming to negative conclusions, which activates your stress response system," says Dr. McCall. "When you do meditation or breathing practices, you start to see the role that the mind plays. Advanced meditators can modulate their pain. They know the pain is there, but they don't react to it the same way."

Last Updated: April 15, 2008

How Acupuncture Helped: One Pain Patient's Story

Though we don't know exactly how acupuncture works, many patients are just happy to know that it can—sometimes with dramatic results. For author and former actress Adryenn Ashley, 39, of Mill Valley, Calif., the alternative treatment helped her recover from a life-changing injury. In 1997, while Ashley was standing in for Sarah Michelle Gellar on the set of I Know What You Did Last Summer, she fell off a truck and severely injured her ankle.

"I was in a boot cast for 18 months. I was in constant pain. I couldn't work and walked with a cane," she remembers.

A former 105-pound cheerleader, Ashley quickly put on more than 50 pounds during her period of painful inactivity. "I hit a low point where the pain was really bad, and I was just distraught. I was crying, I hurt, and I was depressed because I was heavy." Ashley avoided medication, because she often reacted badly to it, and thought exploratory surgery would be too invasive. She felt doomed to suffer until a friend suggested acupuncture.

"I'm needle phobic, the thought of someone sticking a needle in me did not make me happy," she remembers. But the pain gave her little choice.

Not much needle pain and lots of pain relief
At her first visit Ashley was pleasantly surprised: "It doesn't hurt as much as you think it will. It's not as bad as drawing blood."

Her fear conquered, Ashley committed to an intense schedule: three times a week for six weeks.

Soon she began to look forward to her treatments: "As soon as the lights go out and the tinkle-tinkle, New Age music goes on, I'm out like a light. It's your time. If you use it also as a meditative time you can double the productivity of it."

A Western doctor might talk about the gate control theory of pain, or endorphins, but Ashley's acupuncturist, Jeffrey Szilagyi of Acupuncture of Marin, in San Anselmo, Calif., described her treatment with a mix of Chinese and Western terms.

"We regulated chi and blood stagnation, and we dispersed a cold and dampness that was in the ankle joint from the old injury," says Szilagyi. "Her pain went away and circulation improved. If you think about it from a physiological point of view, we activated the body's own healing mechanism and blood circulation, and its local tissue function."

Whatever the mechanism, Ashley was simply grateful that by the end of treatment she had found relief. "No pain, no swelling," she says. "It was great."

Lead writer: Suzanne Levy
Last Updated: April 21, 2008

3 Ways Biofeedback Helps Patients Control Chronic Pain

Biofeedback, a technique in which patients use their mind to control bodily functions that normally occur automatically, can give patients the skills to lessen their pain at home.

Migraine sufferer Amanda, 39, of Manchester, N.H., found success the first time she experienced biofeedback. In considerable pain that day, her skin temperature was low. But with a few minutes of relaxation training by a biofeedback practitioner, she found that she could raise it.

"I knew that when I get in pain, my [skin] temperature drops," she says. Within a few minutes, Amanda was able to raise it. "The practitioner was shocked because I got it up so quickly. I really did warm up. It's a matter of just clearing your mind and deep breathing."

In a biofeedback session, sensors attached to your body are connected to a monitoring device that measures body functions such as breathing, perspiration, skin temperature, blood pressure, and heartbeat. When you relax, clear your mind, and breathe deeply, your breathing slows and your heart rate dips correspondingly. As the numbers change on the monitors, you begin to learn how to consciously control body functions that are normally unconscious. For many patients, it can be a powerful, liberating experience.

Already familiar with the relaxation techniques of yoga and meditation, Amanda was impressed with what she could accomplish during a biofeedback session. "We think 'I'm tense and there's nothing I can do about it,'" she says. "But if you stop your mind and you breathe, it can help anyone with anything."

Biofeedback patients learn to control the sympathetic nervous system—the ancient "fight or flight" response, which when we are stressed, leaves us with beating hearts, sweaty palms, and tight muscles that can worsen pain. The technique works in several ways.

Lead writer: Suzanne Levy
Last Updated: May 01, 2008

How Acupuncture Works From the Perspective of Western Medicine

Releasing natural painkillers
One theory is that acupuncture stimulates the release of the body's own painkillers, such as endorphins.

Putting up a roadblock
The "gate control theory" posits that acupuncture may activate peripheral nerves to shut the "gate" on pain signals traveling through the spinal cord. The idea of interrupting pain signals is also the basis for another alternative therapy—transcutaneous electrical nerve stimulation (TENS).

"The gate control theory of pain is one of the predominant theories of pain right now," says John Lefebvre, PhD, a professor of psychology at Wofford College in Spartanburg, S.C. "If you can shut the gates down, you can eliminate the pain. Acupuncture seems to close the gates most of the way."

Helping the brain take control
For other scientists, acupuncture's effects may be, at least in part, connected to patients' beliefs. Some research has indicated that patients' expectations of the benefits plays a role in their experience. "This is at some level getting at the placebo response," says Sean Mackey, MD, chief of the pain management division at Stanford University School of Medicine, in Palo Alto, Calif. "I don't want to suggest that we view acupuncture as a kind of voodoo magic. There's clearly something going on, we're still trying to understand it. I believe there is a large central—i.e., brain-related—component to this, and for some people it can be very effective."

Lead writer: Suzanne Levy
Last Updated: April 19, 2008

Cognitive-Behavioral Therapy Can Stop Pain Obsession

Cognitive-behavioral therapy (CBT) can help pain patients end the downward spiral of negative thinking that worsens pain. People suffering from chronic pain can spend a lot of time thinking about it—projecting that it will render them useless and worthless, tear apart their family, or cost them their job. But proponents of CBT say that the technique can stop those thoughts in their tracks and actually alleviate pain.

"The irony is that the more you believe these frightening, catastrophic things are going to happen, the more anxious you become and the more your pain goes up," says Kimeron Hardin, PhD, a pain psychologist in the San Francisco Bay Area.

CBT helps patients identify negative thoughts and then change them. It sounds simple enough, but it takes hard work and time. Just recognizing your thoughts can be difficult, since they may be unconscious and automatic and even date to childhood.

The goal is to reframe the thoughts and change the pattern. "We teach them to be aware of the automatic thought patterns they have when they experience pain," says Robert Twillman, PhD, clinical associate professor of psychiatry at the University of Kansas Medical Center, in Kansas City, Mo.

An example of a negative thought pattern might be: "Oh, there's that pain again, I better lie down and stop what I'm doing, which makes me mad," says Twillman.

How to change it
Twillman says a patient can decide if the pain is terrible and life-destroying, "or they can decide, 'I have it, I can learn to live with it, and I'm not going to let it dominate me.'"

Be your own best friend
"Almost everyone has the ability to come up with rational statements when they're helping a friend who's upset," says Hardin. "What would you say to someone you really cared about who was starting to think catastrophically? You can teach yourself to take that perspective with your own thinking."

Coping cards for negative thinkers
One CBT technique involves writing down a negative thought on one side of a card. On the other side, write a rational comeback to that thought. When a destructive thought comes along, patients can reach for their card and repeat the coping statement to themselves. Francis Keefe, PhD, director of the Pain Prevention and Treatment Research Program at Duke University School of Medicine, in Durham, N.C., says they can be invaluable in creating new thought habits. "I can't tell you how many patients carry these cards around, they're absolutely dog-eared. People tell me that just having the card in their wallet makes them more aware of their tendency to think that way, and it helps them to know they have an option, a different way to think about the situation."

Lead writer: Suzanne Levy
Last Updated: May 06, 2008