Granded Exposure and Pacing

Written by Eileen Hopkins

My road to counselling and psychotherapy has been interesting. Having worked in a caring profession, nursing for over 30 years, I was always at my happiest when interacting with my patients & I have always been a people person.

Graded exposure & pacing – there are often particular activities that are challenging, painful and sometimes avoided for fear of causing damage, pain or harm. With new knowledge of pain and confidence to move we can gradually re-engage with these activities.

In self-management the focus is not on your body, it is on you instead. Pacing comes under the umbrella of Self-Management. As the name suggests, self-management is about the person and the ways they can adapt their situation in order to live a more fulfilled life despite their pain. However it is important to stress that self-management is not a replacement for medication though many people find that they can reduce their medication.

Graded exposure and pacing can be a useful technique for persons living with chronic pain or immobility. Pacing means that we set a baseline and work towards our goals. Graded exposure is a method of finding movement that is pain-free and building on that. The idea is to break the brain’s association between a particular movement and the fear that it will result in the onset of pain.

Let me give you an example of how this can work, if you are experiencing pain when you sit upright, at about a 45° angle; utilizing graded exposure, you would start by finding a very easy range of movement. Perhaps you would start by raising your upper body only 5° of the bed. When lying down, bring your attention into your body, make sure that you feel relaxed, and slowly bend at the hips to about 5°. Even if you are comfortable in this position you only stay for 20 minutes and then return to your starting position. Start to notice how you feel, and acknowledge to yourself that you can do this successfully. Don’t be afraid to set your limits very small to start. This is the opposite of pushing yourself to the limit because this can result in the ‘Boom burst’ cycle.

By doing less more often your body learns to tolerate what you are doing.
Each week, bend just a little further. If you reach a point where you begin to feel tension or pain, then you return to where you can still move without pain or tension for a day or two. The idea is to find successful position and keep building on it. The idea is that you are essentially trying to trick your brain by breaking its association between a particular movement and pain.

The “Boom/Burst cycle


When you look at this graph, you can see that your 100% effort decreases and your rest or recovery time increases each time you ‘boom’ i.e. each time you overdo it. Ultimately this results in the ‘burst’, when you can do very little or nothing because your ‘flare ups’ are so severe.

Graded exposure can be adapted to almost any movement. You can design it to fit your own specific needs. In extreme cases where even slight movement is painful, just a hint of movement
or mentally visualizing successful movement can be the starting position.

Vidyamala Burch, international author of ‘Living well with pain and illness’, has lived with chronic pain due to spinal injuries and partial paraplegia for over 30 years. She is quoted as saying the following: “Take a break before you break.”
Check out her you tube on managing pain here:

Pain is a huge emotional experience as well as a physical sensation. You may think that your pain has a life of its own, however this is not the case. There are many thoughts that increase our pain experience, for example, anger, frustration, guilt, despair, anxiety, and hopelessness.

The Tony Robbins quote, “Where the focus goes, energy flows” is useful in trying to understand your pain.
Where is your attention focused?
Where your attention goes has a lot to do with your pain.
This is the reason I recommend that you keep a ‘Pain free diary’. By doing this you are training your brain to expect less pain. Consistency is the key and this doesn’t mean that you wont have bad days, but it’s about searching for the ‘glimmer of sunlight’ on those ‘darker’ days.

As a Pain management coach, my work with you is about you, mind, body, thoughts, and other people in your life.
Self-management is about getting yourself back into the driving seat of your own life. It may be necessary for you to change the way you do things to take account of your limitations but the most important thing is to believe in yourself and capture the good things about yourself once again.

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