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Understanding the anger, fear and shame of fibromyalgia, part 2 of 3

Soothing the emotions that worsen fibromyalgia / block recovery, in the context of domestic abuse recovery.



In part 1 of this series, I introduced the definition of fibromyalgia (FMS), how people get it, its relationship with domestic abuse (DA), and the ways we can describe it to ourselves.


In this article, we will explore the emotions that come along with FMS, how these are inflated by the trauma of previous DA and how we can soothe these, in their efforts to manage FMS.


An Emotional Storm


I have covered elsewhere the powerful roles of fear, obligation, guilt and shame (the FOGS) for people who have left abusive relationships. The role they play in keeping us in abuse, the explosion of their force on leaving an abuser, and the cycling nature of their presence whilst trying to recover.


In this article, let’s look at the experience of FMS, the interactions with abuse recovery, and the rationale for focusing on soothing these emotions as a primary need, when recovering from FMS.


So let’s start with the emotions.


Anger



Anger is perhaps a strange emotion to kick off with. But frustration, at ourself, is perhaps one of the most common experiences I have heard FMS clients refer to.


“I’m sick of my body”

“I’m useless”

“I’m pathetic”

“I’m a burden”


FMS has the strange ability to push us to be hard on ourselves, an ability that is well rehearsed in many DA survivors, who have likely endured angry attacks to the extent that they became normal — or even a need (re cycles of abuse and addiction / trauma bonding theories). A need we can meet for ourselves, despite it being unhealthy.


Being attacked can become a very familiar place for us — and one that we can bring ourselves back to in seconds without even realising. I’ve seen this in many FMS clients even without abuse histories, but it can be most stubborn to soothe in people with abuse histories, for the reasons just stated.


There is an interplay here, where FMS can cause anger at ourselves and our bodies — alongside an overlearned ability to blame ourselves and to feel anger and disappointment, in the context of previous abuse.


For now, let’s just name anger and recognise the overlap between the past and the current challenges.


Anxiety / Fear



FMS is a disempowering experience for many. It is characterised by a gradual increase in widespread pain, loss of abilities (fitness, activities, sleep, memory, concentrationetc) and an unpredictable experience of flare-up days and better days.


For many people, the condition makes no sense and is as much a puzzle to solve as it is a disability. The declining and unpredictable nature of FMS pushes people to lose confidence in ever making sense of their bodies, let alone hope for a cure.


Many FMS clients (abuse survivors or not) talk about the future as something they fear — more pain perhaps, less freedom, less confidence, more disability. Escape from FMS often seems impossible.


It’s a place abuse survivors know well. It resonates in many ways closely with our experience of an abusive relationship… pain, loss of confidence, fear for the future, loss of self-worth, and no faith that change is possible.

This can be disabling both ways, where FMS can feel like a blocker to abuse recovery and vice versa. Routes to self-confidence and empowerment can feel very out of reach.


Most notable is that fear is based on imagined realities or memories of trauma, for those who have escaped and are in recovery. The body often learns to expect the worse and we fall into a cycle of doing so, often without realising.


Guilt and Shame



Not named enough in the context of FMS I feel, but perhaps as disabling as the physical and emotional symptoms described to this point.

Many people, for fear of judgement, fear of being a burden, fear of rejection, fear of failure… isolate themselves and fail to seek support. FMS is a hidden disability and so can be difficult to explain to others, something I’ve heard many people say. It is made worse by this shared shame and so there is a consequential lack of conversations about FMS out in the world — pushing people to feel that they are odd / rare cases.


“People just think I’m lazy”

“I’m embarrassed asking for help”

“I used to be such a capable person”

“I just say no when invited out, as I don’t want to tell everyone how much I hurt”


The outcome is a withdrawal, even from oneself. Which is the worst outcome, as without even ourselves — where can recovery start?

In the context of DA recovery, this can be inflated — as shame and guilt are central to abuse experiences and similarly block abuse recovery and help-seeking behaviours.


It can feel like more reasons to feel bad about ourselves… which creates a loop back to anger and fear. Shame in particular is so powerful, as it pushes us away from getting help — or even paying attention to ourselves. For this reason, I often see soothing FMS-related shame as a critical need for clients.


Shame is rooted in guilt, and guilt infers something has been done that is objectively bad or wrong. In realising this, there is an obvious route to challenge this emotional state… more on this later.


The problem with living through an emotional storm…


Anger, fear, shame and guilt on loop can be considered an overwhelming and crippling experience for people — as you likely know.


Looking at our bodies through a biological lense, we can understand an emotional storm of this type as a form of bodily excitement/activation of the nervous system… or in other words… a turning up of the volume dial, on our pain sensitivity system (using the metaphor in Part I). Emotional distress can cause pain experiences to worsen.

People sometimes struggle to understand how charged emotions can cause pain to go up, here are some of the medical theories on this that you can explore with clients. By explore, I mean… finding the account that resonates with people as an explanation they can connect with… there is no single account that fits all experiences:


1. Neurochemical Responses:

  • Stress Response: Stress and anxiety trigger the body’s “fight or flight” response, leading to the release of stress hormones like cortisol and adrenaline.

  • Pain Sensitivity: These hormones can heighten the body’s sensitivity to pain. For individuals with FMS, whose pain processing pathways are already altered, this can lead to an increased perception of pain.

2. Central Sensitisation is linked to stress:

  • Hyperactive Nervous System: FMS is associated with central sensitisation (the volume beings set high), where the central nervous system becomes more sensitive to pain signals. Stress and anxiety can exacerbate this sensitization, amplifying pain signals.

  • Emotional and Physical Stress: Emotional stress (like anxiety and anger) and physical stress (such as that caused by injury or illness) can both contribute to this heightened sensitivity.

3. Sleep Disturbances:

  • Impact on Sleep: Anxiety, worry, anger, shame and stress can disrupt sleep patterns, leading to poor sleep quality or insomnia.

  • Sleep and Pain Relationship: Poor sleep can worsen pain and fatigue, key symptoms of fibromyalgia. This creates a cycle where pain affects sleep, and poor sleep exacerbates pain.

4. Psychological Impact:

  • Cognitive Effects: Charged negative emotions can affect cognitive functions, such as concentration and memory, often referred to as “fibro fog” in FMS.

  • Mood Disorders: Chronic pain combined with stress can increase the risk of mood disorders like depression, which can further impact the overall quality of life.

5. Muscle Tension:

  • Physical Manifestation of Stress: Anxiety, anger and stress often lead to increased muscle tension. For someone with FMS, this can exacerbate muscle pain and discomfort.

Mechanism Summary:

  • Biopsychosocial Model: The interaction between FMS and emotions can be best understood through the biopsychosocial model, where we realise that biological, psychological, and social factors all play a role.

Shift the lens

The loop of self-blame, anger and fear, drive responses to FMS and previous DA, has to be broken.


It is difficult to tackle this cycle by directly tackling fear and anger, as they are both fight-and-flight emotions that are more reactive than receptive to rationale. They can be tackled, but shame often pulls people away from meeting their own needs — and so I often recommend shame as the first need to address.


When I refer to addressing shame, I am referring to guilt — as all shame stems from being ‘guilty’ of something, and the ideas that inform guilt are amenable to new information.


As you will soon see, we can address fear and anger via this route, but it is a route that invites an evaluation of reality — because it is based on an evaluation that is relatively easy to challenge with a thought exercise.

Let’s look at an example, of this approach that you can use with clients.


Start by informing your client of definition and causes of FMS , using the metaphor provided in Part I. Then move on to explain how anger at self, anxiety about the future and shame are common experiences for people who have FMS, without an abuse past.


By discussing the emotions that come as a consquence of DA experiences , show how these emotions can feel bigger and feel more difficult to soothe when we have an abuse history.


At this point, we want your survivor client to realise one important point… that these charged emotions and the cycles of negative thinking are keeping the volume setting high — when it comes to FMS. Emotions are charged and so pain sensitivity is high, along with the other FMS symptoms.


This isn’t another reason to blame themselves, it is an account of why FMS feels so crazy and unpredictable. It reacts to both how we use our bodies in the world (more on this in part 3), but also how we think and feel inside our minds and bodies. We can strain our nervous system (increase the volume) to the extreme, without even getting off the couch!


Further than this, and harder to accept for some, it’s the suffering that is unbearable — not the pain. When pain doesn’t cause us to feel angry, sad, hopeless and shameful — we can live with it. When pain prompts us to feel compassion, empathy and to activate self-care and adaptive living — we can thrive with it.


A thought exercise to support your work

Once these ideas seem to be accepted or at least entertained, we challenge anger, guilt and shame with an exercise, based on third-wave CBT and self-compassion approaches, targeting the underlying beliefs directly in relation to FMS.


Work through this exercise with your client, to illustrate how an emotion as powerful as shame can be revealed as irrational and unjustified:

  1. Let’s accept that all that we have learned about FMS is true. Many people have it, it is confusing and very common after abuse.

  2. Now, pick a loved one who is close to you who has had some challenges in her life that make you proud of them for overcoming. Bring them into this space now and imagine them here with us.

  3. Imagine this person developing FMS. They now feel pain, fatigue and other symptoms on an irregular basis. What feelings do you have for them right now, seeing their struggle?

  4. Given that they can now do less and their abilities go up and down daily. On a scale of 0–10 how much shame would you want them to feel for letting others down? On the same scale, 0–10, how angry would you be at them for letting others down by their health needs?

  5. Given that you are in the same situation, how much shame 0–10 would they want you to feel if they could see your struggles? How much anger would they want you to feel 0–10?

  6. Does it feel like you are much harder on yourself than you would be to someone else you care about and/or they would be to you?

Reflect on this in the session. Notice that false beliefs, over-rehearsed self-blame, shame and more are at play in the moment and interact with FMS. These emotions are created by us and directed at us, they can be soothed and replaced with the feeling we’d give to others — compassion and empathy.


I used to start FMS group workshops with the phrase “your suffering is your choice” written on the board, to an angry response from the group. Most clients left empowered by these same words.


Exercises of this type can be repeated, along with the advice in Part III about what to actually do to reduce the impact of FMS on our lives.

Of course, this is only one approach — but one that illustrates how shame can be evaluated and re-experienced. We are planning a training day for therapists / advisors, to explore a broader approach — register with us above, if you’d like to be updated (click Log In).


Summary

For many clients needing help, FMS is wrapped in fear, anger and shame.. it is suffering.


But, believe it or not, we can live with pain in a way that we self-care, feel self-worth and fulfill our lives. This is called living… we can live with or without pain.


The suffering, in reality — it’s these emotions and thoughts about ourselves, more than the pain itself… and the bonus!… when we learn to feel positivity about ourselves independent of pain levels, we actually soothe our emotions and the volume goes down.


I don’t make this claim wildly. I’ve seen many, many clients achieve this.

It is a therapeutic goal to excite the people you support to this possibility.


I generally start the work with clients by saying, “you’ve suffered up to this point, desperate for a cure, desperate for understanding…. let’s replace the task, with a simple question you need to answer. ‘How do I live in this moment, right now?’ How do you enjoy life, enjoy yourself and activate living, in place of suffering?’”


You can use these words, they are inspiring and they reframe FMS through a lens of hope.


Tangible hope, not false hope.


Let’s get to the tangible approaches, in part III




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