How to Build Resilience while Living with Chronic Pain: Tips from a Psychologist & Pain Researcher, with Dr. Afton Hassett

Summary:

Psychologist Dr. Afton Hassett and Cheryl Crow, OT explore the neuroscience behind chronic pain and how fatigue, sleep, stress, and emotions may affect your experience of pain over time. 

Dr. Hassett is an Associate Professor and Director of Pain and Opioid Research in the Department of Anesthesiology at the University of Michigan. In this episode, she explains how pain is not “all in your head,” however it is in your BRAIN! Because the areas of your brain that process pain overlap with the areas that process thoughts and emotions, there is much you can do to influence pain signals. Further, there is evidence that building your resilience through mindfulness, social support, optimism, and healthy lifestyle habits can positively alter how the brain perceives pain.

Dr. Hassett also shares lessons from her soon-to-be-released book, The Chronic Pain Reset, and Cheryl shares how she developed her Rheum to THRIVE course and program to help address the full picture of chronic pain patients’ needs. 

Video of episode

Episode at a glance:

• Professional background: Dr. Hassett studied clinical psychology in San Diego, where she received her doctorate. She now works as an Associate Professor and principal investigator at University of Michigan in the renowned Chronic Pain and Fatigue Research Center, one of the largest Chronic Pain Research centers in the world.
• Pain Science 101: Pain is not “all in your head”… but the brain processes pain using many of the same areas and structures of your brain that process emotions and thoughts. Thus, our thoughts, emotions, and life context can greatly affect how pain is processed and experienced. 
• Tools for Fatigue: Pain, poor sleep, poor mood, and lack of energy often group together and affect each other – if you can improve one it can help improve the others. Saving “spoons” for relationships and supportive connections and spending time outside getting fresh air and sunshine can also help improve symptoms of fatigue. 
• Tips for building resilience and optimism: Cope with uncertainty by practicing mindfulness, make time to do the things you love and value even with some lingering pain, and keep a gratitude journal or other practices to help you stay centered and increase positive emotions.
• Advice to newly-diagnosed patients: Seek a mentor who can help you navigate, find ways to do activities that feel purposeful to you, and know that you’ve got this!
• Chronic Pain Reset book: Set to release September 5, 2023, Dr. Hassett wrote this book for people with chronic pain and their care providers. She begins by explaining the neuroscience of chronic pain the connection between pain and stress, social relationships, positive and negative emotions, gratitude, joy, and physical health. The second part of the book leads you through a 30-day journey to try evidence-based activities and practices to find the ones you like best. The last part of the book helps you customize a program filled with activities that make sense to you and address multiple domains of wellness.
  

Medical disclaimer: 

All content found on Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Episode Sponsors

Rheum to THRIVE, an online course and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. See all the details and join the program or waitlist now! 

Speaker Bios:

Dr Afton Hassett

Dr. Hassett is a licensed clinical psychologist who is an Associate Professor and Director of Pain and Opioid Research in the Department of Anesthesiology at the University of Michigan. She studies behavioral interventions for people with chronic pain including those that promote resilience. She has published over 100 articles in scientific journals and has over $10M in NIH research funding. She is also a Past President of the Association for Rheumatology Professionals, a division of the ACR. 

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for nineteen years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.

Episode links:

• Links to things mentioned in episode or additional listening
  • Chronic Pain and Fatigue Research Center at U Michigan
  • Afton’s research – link to all research publications
  • Dr Marty Seligman Positive Psychology – UPenn
  • Afton’s research w/Dr. Martin Seligman (optimism) on soldiers – 
  •  Chronic Pain Reset book,  will be released September 2023
• Afton’s social media
  • Twitter – @aftonhasset 
• Cheryl’s Arthritis Life Pages:

• Arthritis Life website 
• Youtube channel
• Instagram @arthritis_life_cheryl 
• TikTok @arthritislife
• Arthritis Life Facebook Page
• Cheryl on Twitter: @realcc 
• Arthritis Life Podcast Facebook Group

Full Episode Transcript:

Cheryl:  

I’m so excited today to have a chronic pain researcher, and many others — she wears many hats — Afton Hassett with us today. Welcome!

Afton: 

Oh, thank you, Cheryl. I’m so excited to be here. Thank you for inviting me to be part of your podcast.

Cheryl:  

Oh, it’s so great. And if you could just let the audience know a little bit about yourself, like where you live, and what is your relationship to autoimmune illness and chronic pain?

Afton: 

Well, I live in Ann Arbor now; I’ve been here for about 13 years. I’m an associate professor in the Department of Anesthesiology at the University of Michigan. And I’m part of one of the largest pain research teams in the entire world. It’s the Chronic Pain and Fatigue Research Center, led by Daniel Clauw. And so, I am blessed to be working with some of the most exciting, fascinating, novel researchers around, and in a great environment. We really love Ann Arbor. So, that’s kind of where I am at now.

Cheryl:  

That’s wonderful. One of my best friends went to University of Michigan Business School. And so, I visited, and yeah, absolutely fell in love with the town. And it’s just, it’s wonderful to have you here because I think there is so much misinformation out there about chronic pain or the science has changed, you know, so much over the years. And so, but before we delve into that, I would love to know a little bit about your story, like what led you to become a specialist in chronic pain?

Afton: 

Wow. So, this goes back some time. This is back when I was studying clinical psychology in San Diego. At that time, I was in a clinical psychology program, and I was working on my doctorate, and I was working as a psychology intern at a center where I was training a number of women who had chronic pain. And I was so interested in their stories and their tremendous courage and what they’ve been through and I just didn’t understand enough about pain. And so, I talked to my supervisor about this. And she said, “Well, the main thing you need to do is you need to take a few minutes and go to the UCSD Medical Library and look up chronic pain. Learn a little bit about fibromyalgia, learn a bit about rheumatoid arthritis, learn about osteoarthritis, and just become familiar with how pain affects people’s lives.” And I have to tell you, Cheryl, I was hooked. I was amazed at what an incredible impact pain has on human life, and how it affects every aspect of someone’s life. Their friendships, their ability to move, the quality of the activities that they can do; it is just a profound impact. 

And so, that was the first thing that struck me. The second was that pain is not just a physiological event, that pain is so closely tied to our emotions, to our thoughts, to the stresses in the environment, to even our relationships. Pain can fluctuate incredibly, just in the context of one stress. And so, I think upon reading those journals, I was hooked. And what was — it’s actually kind of crazy, because it was a long time ago, Cheryl. It was back in the days when we went to libraries physically, and walked up and down the aisles and pulled great, big, huge bookshelves, books off the shelves that had all these articles from scientific journals. And I just remember sitting in this freezing cold library and reading these incredible, incredible cases. And it just, it just became my passion. It’s like, I want to help these people. I want to understand pain; I want to understand rheumatic disease. And I want to help. But as a psychologist, there’s limitations. And so, I really had to think about what can I do? How can I contribute? And that’s what kind of led me to wanting to understand more about emotions, thoughts, and behaviors and their role in pain.

Cheryl:  

Yeah, and I think — oh, my gosh, well, yeah, first of all, my hat goes off to anyone who wants to serve this population, because it can be really, really complex and challenging, right? I think when I first became an occupational therapist, I actually didn’t want to specialize in rheumatic disease for many reasons, one of them was that I was worried about my own work life balance, that would be too hard for me to have a separation. But the other is that I want to fix it, and you can’t. Like, and so it’s like, you can look at that as a glass half full or glass half empty. I know that we’re going to talk about like, resilience and coping and experiencing positive things with pain. So, you could say, okay, maybe we can’t fix the sensation of pain, but we can adjust your relationship to the pain but also, it’s just — gosh, it’s just hard. So, I’m thankful that you were not intimidated or turned off by it, especially because you don’t live with pain. Or do you do live with pain?

Afton: 

I am blessed. I do not. But I certainly have many people in my life who do. And maybe later we can get to this, but my husband is one.

Cheryl:  

Oh, okay. Yeah, no, that’s, I mean, your husband’s, I mean, lucky to have someone who understands pain so much, I’m sure. But yeah, you mentioned that pain is not just, quote-unquote, ‘in the body’ or it’s not just the physical. I think I’m gonna speak for some of the people I know in the audience who sometimes we can feel defensive, like, “What do you mean, you’re saying it’s in my head?” And how do you kind of help teach people about no, it doesn’t mean that it’s in your head. Like, do you know, I’m saying.

Afton: 

Yeah, no. This is one of the hardest concepts that we want to convey. So, I think part of the reason I was so attracted to coming to University of Michigan is I was a little groupie fan of Dan Clauw, and the work that was coming out at the time, Georgetown, but then eventually University of Michigan, where they were doing these phenomenal neuroimaging studies that really blew me away. And I think they were really some of the first scientists to show that the pain and chronic pain, especially fibromyalgia, is not something of an exaggeration. People aren’t just saying that they have more pain, they have more pain. And it’s shown in neuroimaging. There’re studies who took individuals with fibromyalgia and put them in a neuroimaging scanner, so they can have a scan of the brain, and applied kind of dull pain to the thumbnail. So, they did that in a number of individuals with fibromyalgia. And then, they also did it in healthy pain-free controls. And what they found is they had to apply twice as much pain to the thumb beds of the healthy non pain controls to get this same pain rating and the same neural activation. 

So, what we’re seeing in those early, early studies was that the brain was overreacting to the signal of pain; it was actually amplifying. And so, these early data said, hey, this is not a case of exaggeration, this is a case of the brain is processing pain in a different way. And that has really been at the core of pain research at the Chronic Pain and Fatigue Research Center, and really, across the world now. And over the last 10 years, most research and chronic pain has been looking at this phenomenon of how the brain takes what might be a benign signal, like, you know, something might be slightly painful, and interpret it as being tremendously painful. And what is fascinating is we’re also seeing this with other senses. So, information that comes in from sight, where light might be detected as incredibly bright and painful, or sense, you know, a smell might be felt as just incredibly overwhelming. Again, it’s like the central nervous system and the brain are now processing or amplifying all of these external signals. So, while we have a little sense of the underlying physiology of pain, this also opens the door for how thoughts and emotions might play a role. So, Cheryl, you might ask how does this happen?

Cheryl:  

Yeah, yeah. And I know that that could be a, you know, five-hour long lecture just on that topic. But yes,

Afton: 

But just briefly, we see that the areas of the brain that process pain tend to also process emotions and thoughts. And so, we see kind of this co-activation or just shared circuitry in the brain. And that begins to lay the groundwork for biologically how it is that when we feel stressed, and we’re thinking negative thoughts, or we’re afraid that pain can feel so much worse? It’s all going on in the brain. So, it’s not in one’s head. It’s in one’s brain.

Cheryl:  

Yeah, yeah. And when we say in the head, it’s like a shorthand for some people, meaning that you’re making it up or it’s not really real. But yeah, one of the first times this was explained to me — I think it wasn’t in occupational therapy school, maybe this is an outdated reference now — but it really stuck with me, which is like, the idea that if you’re in a calm environment, and you’re just walking to the bathroom and you step on a thumbtack, you’re gonna really experience that as like, “Oh, ouch!” Like, I’m putting all my attention to that, versus if you’re being chased by a lion and you happen to step on a thumbtack. It’s like you’re, maybe the same degree of tissue damage happening on your foot, but because of the context and your brain diverting its resources towards survival and everything else happening neurologically with the stress levels, it’s not going to be perceived the same. So, I thought, anyway, do people still teach that example?

Afton: 

It’s a great example. There are many like that. It’s just that, you know, what we pay attention to, what we attend to, what we pay attention to, is really what we experience. And if we think about all the bits of information that are coming in at our brains right now, I mean, if we sit still and think about the way our clothes feel on our bodies, there might be an itch somewhere, like my nose just itched. There might be some odd little pain, maybe their shoe is too tight. But generally, all that information is screened out. We’re totally not aware of that until we take a moment and get centered to, “Oh, my shoe is too tight,” or, “Oh, I do have an itch.” Pain is very bossy, and it yells for our attention. And so, we do tend to attend to it more than other things. But also, we can choose to some degree not to attend it, like you said, when you’re running from the lion, pain doesn’t matter. When you think of the athlete in the football game who has, you know, perhaps broken a bone and yet continues to play through and then at the end of the game goes, “Oh, my God, ouch. I broke my finger.”

Cheryl:  

No, it’s really fascinating. And so, I know that your research has focused on the importance of like, positive emotions for people with chronic pain. And I know to the layperson, it might seem like, “Wait a minute, it’s not — how can you add a positive emotion to an experience that feels intrinsically negative,” which is pain, right? So, I’m just curious, how did you come to focus on that? And then, what are some of the interesting findings?

Afton: 

Yeah. So, I kind of came at this sideways. So, I wasn’t always taken by resilience and positive emotions. And I came here because of my dissertation. So, like most doctoral students, when I came up with my dissertation topic, I was looking at pain in individuals with fibromyalgia and rheumatoid arthritis, and looking at differences and how pain was experienced and how and what other factors might impact it. And what I was pretty certain of is that the people who had paid were gonna have a lot of negative emotions. I was pretty sure it’s gonna be a lot of catastrophizing, a lot of pain. And it sure wasn’t what I found. And neither in the people with rheumatoid arthritis, or the people fibromyalgia. As a matter of fact, about half of both sets of patients really looked healthy. They actually look healthier than all of us who were doing their psychological analyses. They were just resilient and grateful, and they still had a ton of pain. And so, while they kind of blew up my dissertation, it did make me think about what is resilience? How do people have these tremendously painful diseases and this disruption to their lives, and yet not become depressed, and yet still bounce back? And so, I really, you know, 20 some odd years ago became so interested in that. And so, that became my passion. Understanding who are these individuals who do so well, despite illness. How do we bottle that for others? And that’s really been the course of it.

Cheryl:  

Oh, my gosh. I just, that reminds me so much of, I’m sure you’re aware of Dr. Martin Seligman —

Afton:

Very well.

Cheryl:

With the positive — I didn’t know you know him. 

Afton:

I do.

Cheryl:

Oh, my gosh. He’s like — you’re amazing, and he’s amazing. I was in undergrad when I discovered his research, you know, he had just opened the center on positive psychology and he had the same kind of experience you did, it sounds like, where he was like, “Everyone’s looking at post-traumatic stress. What about post traumatic growth?” Why is it that some children — like, I’ve read the optimistic child — you know, why are some children raised in really severely neglected situations or things that you would be traumatizing, to some of the kids, they just are resilient. So, I just, I love this topic, because it really resonates with my personal observations of being part of the rheumatoid arthritis community. There’s so much, you know, in a way, I’m almost like, I say sometimes, like, these are some of the strongest people I’ve ever met, you know, and I don’t mean to say that in like a, I don’t know if you’ve heard the phrase ‘inspiration porn’ before, kinda like that. I don’t mean it that way. I mean —

Afton:

It’s true.

Cheryl:

But it’s true. Like, yeah. So, yeah, I think, first of all, I commend you for having the courage to blow up your thesis, right. Because that is actually some of the most exciting findings, right, are the ones that don’t go with your hypothesis. So, yeah, what are those resilient people doing?

Afton: 

That’s what I want to know. And you mentioned Martin, I can tell you how I met him and it actually is kind of part of this ‘How do I get to positive psychology’ story. So, soon after completing my dissertation, and I really kind of just, I finished it, I defended it, I set it aside, and I thought, “Yeah, I gotta come back to that someday. What is this resilience business?” And a couple years after that, I was actually meeting with somebody in industry and working for one of the pharmacological — a pharma company who did global outcomes. And he approached me said, “Hey, we’re so much more interested in quality of life. We’ve got this new drug for rheumatoid arthritis and probably lupus, and we’re super excited about it. And we’re seeing something weird, and we want you to come over and take a look at it.” And I said okay, and so I packed on over to the pharma company, and sat down with them. And they said, “Okay, we don’t know how to explain this, but we want you to see this.” Okay, so what we did is before our clinical trial, we had people with rheumatoid arthritis talk about their lives. And they just kind of describe what they were experiencing, what the pain was like, what the loss was like. And then, after they were on the medication for a while, we re-interviewed them, and we, you know, we want you to just see. 

Okay, so I looked at the first set of videos before the intervention, and it was people talking about how hard it is to have some of these diseases and how disruptive it is, and how things are changing in their lives. And, you know, and they looked at duly sad and upset. And then, soon after the intervention of a very successful compound, a very successful drug, yhey showed me videos of like people going, “And now I’m picking up my grandchildren, I’m running errands, and I’m doing this. And look, I can do this with my hand.” And they said, “So, what do you make of this? And what’s going on in these videos?” And I said, well, people were not happy, and now they’re happy. And I have no idea how to study this. And so, I reached out to Martin Seligman at that point and said, “Hey, we got this, we have a situation where we, you know, we want to be able to talk about these quality of life changes, and people have been in a clinical trial. And I really don’t know how to quantify happiness.” And so, that was kind of our first, you know, our first work together. And how do we talk about well-being? How do we talk about happiness? What does it mean in people with rheumatoid arthritis? And so, yeah.

Cheryl:  

Oh, my gosh, that’s so — I love that. And it really, it resonates with me as an occupational therapist, because we’re really talking about participation, right? So, the uncontrolled disease by itself poses a barrier to your participation. You can’t pick up your grandkids. You can’t read a book. You can’t, you know, or maybe you can do those things, but it’s laborious or painful or energetically taxing. So, then, yeah, then you’re alleviating this burden. But yeah, we don’t have — we have to look at how do you actually measure that. You’re like, we saw five times more smiles in the video!

Afton:

[Laughs] Exactly.

Cheryl:

So, it reminds me of John Gottman’s videos. It turns out — I did not know this when I found her, but my therapist in Seattle studied with, got her clinical psych doctorate under Dr. John Gottman, who does the marriage research. And she helped — what they did was they analyzed videos of people talking with their spouses, and they analyzed, they coded every frame for their micro expressions. So, that was why I was like, maybe you guys could do like, micro expressions. Anyway, but back, yeah, so you were helping medical company quantify those quality of life, which, first of all, I’m glad that — a lot of people are negative about pharmaceutical companies. But, you know, there’s no denying anyone who’s been around the rheumatology field for the last two decades or maybe three decades, and you’d see the pre and post, the improvements in quality life are stunning due to the medications. And I’m not saying, no one’s paying me to say that.

Afton: 

No, maybe they’re like — and I mentioned no company, but what I do have to say is the people I worked with were all ex-rheumatologists or had been practicing it, so they understood the patients, and they were really passionate. And really, were able to say, quality of life is so important. And so, that’s why I was compelled to kind of help and to bring, you know, Martin in on that. 

Cheryl:  

That’s so — oh, yeah, so what did you — how did you guys decide to quantify that? 

Afton: 

What we actually thought about it in terms of well-being. And the question was, can people actually look at videos, like a pre-video of somebody and a post-video, and actually quantify a level of improvement? And we showed that healthcare providers do this quite easily all the time. And so, we were kind of just proving what we knew. But again, because so little has been done on positive emotions in medicine at that time, it was kind of groundbreaking. And then, and recently, I can just do a little offshoot, because it’s a study that that Martin Seligman and I published together, they’re doing a marvelous job of training our soldiers. So, all army soldiers get a resilience training course that’s kind of taught by their drill sergeants. It kind of is, you know, we train the trainer. And the goal is at pre-deployment that we can teach them these resilient skills, that they’ll be more likely to come home with less depression, PTSD, anxiety, and even chronic pain. And so, the study that Martin and I worked on was looking at individuals who were deployed to either Iraq or Afghanistan over a long period of time. And we looked at least 10,000 soldiers and over multiple deployments. And our question was, can positive factors potentially predict who will not come home with new chronic pain? And we found that of all things, optimism predicted the soldiers who would not develop new chronic pain after deployments. Even multiple deployments, even being injured themselves, seeing somebody injured, seeing something very gruesome and terrible, these kind of battle entanglements. No matter what, just having higher levels of optimism was incredibly protective for them returning home and not developing new chronic pain. And so —

Cheryl:

Wow.

Afton:

Yeah.

Cheryl:  

I’m gonna link to that in the show notes along with the other research. And I’m sorry, I think, I feel like I didn’t do my due diligence of — I saw that, but I was like, oh, that doesn’t relate to me because it’s soldiers. But I was like, wait a minute, and I didn’t see those were done with Dr. Seligman, too. That’s so cool. Yeah, in a way, it’s like preventative medicine. Like, can you preventatively teach optimism, you know, and teach these resiliency strategies. And I know, I will say, I posted once like this little sticker I made that says ‘Reluctantly resilient’, because I want to, like, acknowledge that some people are like, I don’t need resiliency training, I just need you all to like, accommodate me, which I totally get. But it’s like, at the end of the day, it’s gonna make your quality life better to look into this at least and see if it resonates. I think for most people, you know, developing different different ways of interpreting, you know, what’s going on in your life and developing that resiliency is, for me, really important personally.

Afton: 

And it’s not about being a silly optimist, and not, you know, recognizing that there is a difficulty in the world and that this isn’t difficult to live with a chronic illness. But it’s about something a little different. It’s about this is kind of where I’m at. And now, I got to make a choice of where I go to lead a life that feels more rewarding. And these things aren’t just given. Sometimes we have to take life.

Cheryl:  

Oh, that’s so true. And I think a lot of times people think, “Oh, looking at the positive side, or looking at the possibilities. It seems like, actually easy, but to me, it’s actually harder,” right? It would be easy for me to just say, “I have RA, My life sucks. I give up.” Like, it’s harder to say, “No, I’m gonna take the mental energy and time —” sorry if I’m sounding defensive now. But you know, people are people will say things like, “It’s easy for you because your disease is well controlled.” And well, I’m on my fifth biologic in 20 years. So yes, we’re on a spectrum. I am not as severely impacted as somebody who’s had no response to treatment. But I am, and I have erosions, I have deformities that, you know, and it’s like, you know, you can play, you know, comparison Olympics. But sorry, I’m off track.

Afton: 

No, no. But so well said, because you’re saying that almost no matter kind of what your state is, it’s kind of incumbent upon you to make a decision about what kind of life you still want to have.

Cheryl:  

Yeah, it sounds, it really reminds me of the choice point in Acceptance and Commitment Therapy. And that’s like, that’s what I’m always harping on the podcast is it’s just my, like, obsession right now; it’s just really helped me a lot. But I know that most researchers and psychologists are kind of using a, what would you call it, eclectic — you use multiple tools in your toolbox? But yeah, like how — okay, so let’s get into maybe some of the how do you teach optimism, or what are some of the pointers for that? Do you know I’m saying? If someone’s like, I want to — yes, this sounds good to me, I want to become more optimistic with my pain, or resilient.

Afton: 

Yeah, in general. So, the heart of it is kind of recognizing where you are. So, some of us are naturally optimistic. I’m ridiculous. So, I’m on the ridiculous end of the scale. It can get me in trouble, right? You know, my husband’s kind of the opposite. And so, we balance each other.

Cheryl:

Me too! Us too.

Afton:

And so, you kind of figured that’s kind of what your setpoint is, but we can move a little bit in different directions, right? So, I can be a little bit more realistic and think, “You know what? Stuff does go wrong, and I need to prepare for when things do go sideways, because they do and I’ve had enough sideways things happen in my life to know that’s true.” And just like the person says, you know, but things always don’t go bad. You know, sometimes they do go well. I’m going to prepare for the worst. But you know what? I’m going to hope for the best. That’s a shift in pessimism. When you start hoping for the best, it’s a little different, right? So, we all kind of go to where we are, and is there some wiggle room to move more towards the positive? And a way that people can tend to become more optimistic is kind of sideways. And that’s through gratitude.

Cheryl:  

Oh, yeah, I can see that.

Afton: 

Yeah. I mean, there’s something so powerful. It’s almost impossible to be miserable and grateful at the same time. Gratitude tends to shift everything. So, if you kind of find yourself at a really, really low, terrible point, to take a moment to say, “But you know what? I’m really grateful for my best friend. I’m so grateful for the food that’s sitting in front of me. I’m so grateful that, you know, I actually don’t feel as bad today as I did yesterday. I’m so grateful I just saw them was beautiful sunrise.” So, you know, it’s taking what would you say, okay, I’m gonna step away from all the bad, and just open the door, crack open the door to what might be good. And gratitude is a really nice way to do that.

Cheryl:  

Yeah. And I always, when I, in my Rheum to THRIVE program, when I kind of introduce gratitude, I will say, it’s not meant — there’s a way that you can take a tool like gratitude or an experience and use it to shame yourself. Like, “Yeah, look at all that good stuff. So, you shouldn’t be unhappy.” No, it’s that kind of intelligence, like to be able to told two opposite things at the same time, and be able to say that, “There’s a lot of things that are difficult in my life right now, and there are things that are good.” And I can just kind of sit with both, you know, and that can feel hard. It can be hard to allow yourself in a way when you’ve become so fixated on, you know, your pain is the barrier, and then you have to remove that before you get anything else in life that’s good.

Afton: 

Right? Oh, that’s so important that you said that. So, before I did nothing but research, I did clinical practice. And so, I worked with individuals with chronic pain, you know, across the rheumatic disease spectrum. And so, many of them held the same belief that ‘I will be happy when I no longer have this illness, I no longer have pain, I no longer feel fatigue’. And it’s like, oh, no, that’s a tough contingency to hold because you don’t know when that is, when really, all you have is today. And so, a thing we often focused on is how do you invite just a little bit of happiness and not make this contingency? It’s something that humans do. We call it kind of the hedonic treadmill, that we tell ourselves, “I will be happy when I X, I’ll be happy when I have that job, I’ll be happy when I graduate, I’ll be happy when I’m married.” And then, we move that bar constantly so that we can never really truly be happy, rather than, “I’m actually kind of happy right now for X,” whatever that X is.

Cheryl:  

Yep. One of the questions that was posed in one of the many Acceptance and Commitment Therapy books, I can’t remember which one. Sorry, I want to give them credit. 

Afton:

Oh, they’re all good. They’re all good.

Cheryl:

One of them was like, “What if somebody could take your pain away, but it meant that you would never see your family again?” And you’re like, “Oh, okay.” And it’s not a way to shame you, like, “So, yeah, like, so you shouldn’t feel that.” No, of course. Pain sucks. But actually, it’s a way of — maybe it’s the reverse psychology.

Afton: 

No, it’s a shift. It’s just shifting your attention to like, oh, okay. That’s a new way of thinking about it.

Cheryl:  

Yeah, like, I still have these — these relationships are important to me, and they exist. They coexist with pain. Does pain make it harder to fully be present for me? Yeah, it does. If I’m in a lot of pain, then I am not necessarily able to enjoy those relationships with as much ease as in times when I’m not in pain, but they’re still some quality available, right, quality in that relationship. But, yeah. Oh, my gosh, I love that. I love the idea of coming at optimism in a sideways shift, you know. And I think the other thing I was thinking of is your take with the hedonic treadmill, is I’m really interested in like, social media as like a double-edged sword, right. Just like people are double-edged swords, right. There’s great people and terrible people. But, you know, there’s so many positive benefits of connecting to other patients on social media. But you also have potentially this algorithm that may be kind of showing you only certain kinds of stories that may be, “Hey, everyone else, it looks like everyone on social media is doing great. Why am I the only one?” So, you know, I think it is super important to kind of remember that to compare yourself in that hedonic treadmill, compare yourself to yourself. I know it’s easier said than done, but not get too caught up in — well, it’s okay. I allow myself to feel jealousy, you know, because that’s one of the best things about therapy is allowing your emotions be like, “Oh, my emotions aren’t my enemies.” Like, yeah, if somebody is like, in total remission, I think, logically, I’m jealous of that, because I wish I had that. But at the same time, I can also recognize that my disease, you know, I can kind of do that perspective taking of my disease is also more well-controlled than some other people’s, right. So, it could be worse. It could always be better; it could always be worse. And what is, again, I’m living my life. At the end of the day, I’m not living their life. So, kind of reorienting to the here and now has been just a really meaningful experience for me, a helpful experience. Yeah.

Afton: 

I love that. And it seems like you really kind of connect to the Acceptance and Commitment Therapy kind of the mindfulness and the fact that we are full of emotion. So, just because I love positive emotions and inviting those, it doesn’t mean that negative emotions aren’t valuable too, and interesting, and important, and worthy of being felt. But often, you know, they just are emotions. And the jealousy that we experience is like, “Oh, interesting. I was feeling jealous. Okay, well, that’s just a human emotion. Buh-bye. It isn’t me, it just is,” right?

Cheryl:  

Yes. I love that. Yeah, that non-judgmental awareness. I’m like, wow, I didn’t realize how judgmental I was about myself until I started practice, and it’s a skill. It’s like optimism. It’s you have these well-worn pathways that you’re used to interpreting things like they — I know, Dr. Russ Harris calls it like ‘radio doom and gloom’, you know, like the radio in the back of your head that’s playing like, “No one will ever love you. You will always make mistakes, you’re not good enough,” or in my case, “You talk too much,” or, you know, it’s like, well, I talk too much. Okay, I’ll start a podcast.

Afton: 

Perfect, right. You can channel that, whatever that is. But yeah, I think that, you know, he called that radio, what did you call that?

Cheryl:  

The radio doom and gloom.

Afton: 

Yeah, beautiful. There’s a researcher here at the University of Michigan, his name is Ethan Kross. And he wrote a book, he called it ‘Chatter’, right. It’s chatter, that we have these dialogues that are constantly going on in the background. And often, it’s the inner critic just having a party. And, you know, the more that we can say, “Oh, I’m having this interesting thought that I’m a loser. Okay. Fine, that thought isn’t any more real than a cloud,” and you let these things go. But, you know, it’s becoming more mindfully aware of your emotions and your thoughts, and more mindfully bringing in happy emotions, because you said something earlier, too. You said, “It’s so easy to be negative.” And it’s true. We’re wired for bad, for negative emotions. We’re wired to be fearful and angry because those are kind of survival emotions. The more that we’re wary and anxious, the more likely we are to survive.

And so, they’re easy, obvious emotions. Happiness and other emotions take a little more work. Memories from negative experiences like traumas are encoded so powerfully and so easily. But happy memories take work. So, when you’re in the middle of having a really lovely experience with somebody, and you think, “Oh, my gosh, this is such a great moment,” take a moment to savor that moment and encode that moment. What does it smell like? Feel like? What are they saying? What are you experiencing? How can you remember this moment? Can you grab a memento? We have to work harder to encode our positive memories. The negative ones just stick right in there.

Cheryl:  

It’s so true. It’s like they say with parenting, like for every one negative thing you say to your kid, you have to say like 20 positive, because they’re gonna remember, you know. But yeah, it’s so — understanding the human brain is just so helpful for living with chronic pain and chronic stress from a chronic illness. Because then you can be like, “Okay, this is just, this is not a personal failing that I’m focusing on the negative, this is my brain trying to protect me. Thank you brain for trying to protect me. And I’m going to put —” you know, you can focus on all the ways, you know, when you get a diagnosis, like rheumatoid arthritis, basically, a giant spectrum is possible for you, right? You could go into remission on your first treatment, whether that’s most likely medication, and have total remission the rest of your life or you could have a really, really rough, progressive, fast deterioration. That is the reality.

And so, the diagnosis doesn’t — or let me tell you, if this makes sense to you, but like, to me, it’s like intrinsically the diagnosis doesn’t mean your life is over or your life is gonna be perfect. The proof is only going to be you don’t know in that moment, you have to become tolerant of uncertainty. And you can say okay, like 70% of people with rheumatoid arthritis respond well to current medications, right. So, that’s a helpful, you know, piece of data that can say, okay, well, most likely, then. It’s not like a total crapshoot, right? But at the end of the day, even if it was 99%, you could be in the 1%, you know. So, I guess this is begging the question, something that I didn’t even realize was an issue for me or was a trigger of stress for me until my own therapy experience was uncertainty.

And I know we didn’t have all this beforehand when we prepared this, but I’m curious, has that come up in your research or, you know, I think a lot of times with such waxing and waning flareups, remissions, changes over time that you have with a rheumatic disease or fibromyalgia, you know, is there anything in this, you know, any resiliency tips for coping with that uncertainty? Because our brain wants to just know, right. Just tell me what’s going to happen, I can adjust. Just tell me my future, and I’ll figure it out. But not knowing… It’s freaking me out just talking about it. Okay, sorry. 

Afton:

No, it’s all good. Don’t say sorry. 

Cheryl:

No, no, it’s okay.

Afton: 

But yeah, I think uncertainty or fear of the unknown kind of plagues most of us, especially for those who are more anxiously. 

Cheryl:

Yeah, it’s true.

Afton:

Because we don’t know what’s coming. And then, you add the complexity of an illness that has so many different faces. And there can be even faces within one person, so many different experiences; it can be absolutely overwhelming. And so, I like kind of mindfulness to kind of quell some of that. When we find ourselves worrying about the future or afraid of the past, usually the best thing we can do is just kind of get in the here and now and just be kind of calming ourselves, which is being, where am i right now? What am I feeling right now? What do I have control of right now? And just kind of do centering, right. Because no matter what we envision for the future, we’re probably so wrong. Where there’s really great and really bad, it just might be really great in a different way or maybe not as good in a different way. But we’re terrible at prognosticating where we are and what we’re doing.

Cheryl:  

I have tried to remind myself of that. Like, think about your list of worries on March 1st, 2020, you know? Those worries having that list of worries didn’t protect you from what ended up — that was a thing I’d tell my therapist, “No, no, no, I’m good at worrying. It’s great. It’s helpful because I make a plan and I plan a plan B, plan C, if this goes wrong, then that.” They’re like, “How’s that been working for you? You’re here, so it’s not working out.”

Afton: 

But Cheryl, I love that you hit on something that’s so important, is that if you are to write these things down, I love people to journal. I think journaling is so helpful. And then, you do go back, even go back two months and say, “Oh, man, I was so far out base. What a waste of time to worry about those things.” All those other side of things happened that I could never prepare for, but here I am. And I’m dealing with it.

Cheryl:  

Yes. Survival, kind of motivate — the fact that you survived, like, you’ve survived 100% of your worst days.

Afton: 

Yeah. It’s amazing. It’s amazing what we do. And so, the thought is that, okay, so if I’m not going to spend all this time worrying, what instead can I do? So, how do you put that — and sure, there’s still energy that needs to go somewhere. Why not put it towards something that’s going to make your life feel better and richer, you know? Why not text a friend out of the blue? Why not, you know, call somebody you haven’t spoken to in a while, why not do some silly act of kindness, why not do something kind for yourself like I take a bubble bath? Now there’s so many better things we can do with our energy that we put towards worrying.

Cheryl:  

So, so true. 

And it is, when you live with fatigue, you really have to protect your energy. And that was the last thing I wanted to ask you about before we talk about your book, which I’m really, really excited about, coming out later this year. But I’m intrigued that you, that the center that you work at, or that you do research at is for both chronic pain and fatigue. Because fatigue is like the forgotten symptom of rheumatoid arthritis, particularly, you know, and rheumatic disease, right. Like, okay, how’s your pain? Okay, well, my pain might be at a three but my fatigue is at a six, and that’s affecting my quality of life. So, what are — like, first of all, what are some of, I guess, the relationships between fatigue and pain that you’ve discovered, and any exciting late breaking tips on fatigue that would be exciting to know about?

Afton: 

Fatigue is so fascinating and it appears to be a brain process, too. It appears to be mediated by kind of the same brain processes that make our pain worse. There’s actually a series of symptoms that kind of hang together. And it’s pain, fatigue, kind of emotions like negative emotions, like poor mood, poor sleep, and energy. So, these all kind of clump together. And what’s so fascinating about them, we call them the ‘SPACE’ symptoms. So, SPACE, the final frontier. So, space, so S, S is Sleep, P is for Pain.

Cheryl:  

Oh, I just got that was an acronym. Yeah, yeah.

Afton: 

A is for Affect, C is for Cognition — how we think — and E is for Energy or lack thereof. And these symptoms clumped together in really predictable ways. Like, for example, when people have an infectious disease, and your immune system gets all activated. Well, how do you feel? You usually got pain, you’re usually sleeping or not sleeping well, your mood really, usually stinks. You can’t think. And you have zero energy, right? So, these symptoms are all kind of clumped together, and they seem to be biologically related, right. So, the cool thing is that fatigue is hard to address. So is pain. But the secret sauce sometimes is attacking the symptom sideways. So, if you can improve sleep, so if you’re not a great sleeper, and you figure out how to get yourself sleeping better, it’s amazing how your fatigue and your pain both can be improved, right? So, sometimes just getting your pain to be better gets you sleeping better. And then, your fatigue gets better.

Cheryl:  

Yeah, I often think about how, yeah, that the fact that these all kind of travel together, it’s good news and bad news, right. The bad news is that a deterioration in one affects the others. But the good news is that improvements in one area can affect the others. And it’s interesting that sometimes, I know with rheumatoid arthritis, there’s a certain group, and I think they’re just, they’re figuring out — the scientists are figuring out — kind of the etiology. And maybe there’s multiple diseases that are actually within rheumatoid arthritis. But there’s some people, you know, they get all their inflammatory numbers get better, their pain gets better, but the fatigue can persist. It’s so tricky sometimes. That’s a good starting place to say, okay, can I hit at, can I improve the sleep, can I improve my mood, and — or I can improve my pain, maybe, and hoping that that will improve the fatigue, too.

Afton: 

And then, it’s also the other piece with fatigue is how you use that precious resource? Like, I mean, I’m sure you’ve heard of spoonies, you know.

Cheryl:  

Yeah, yeah. Yeah.

Afton: 

Right. And, you know, how do we do a better job of saving a spoon or two for the things that we love and the people we love in our lives, and having that balance? I think that’s one of the most crucial elements. And even if you’re dealing with hideous fatigue, if you do something you actually enjoy, sometimes I can even make the fatigue better.

Cheryl:  

Oh, yeah. There’s, there’s so many paradoxes too, because exercise is one of the most evidence-based interventions. A just right level of exercise, though. 

Afton:

Yes, yes. 

Cheryl:

The problem is that it’s hard to find that just right level for you. And people sometimes go, “Oh, I’m gonna go all in or go home, go big or go home,” and then they feel worse. And you’re like, yeah, they’re like, “Exercise doesn’t help.” And you need to realize, okay, no, I just needed to pull the brakes, put the brakes on a little bit. But I’ve really, I’ve been playing with this in my life. Now I have a, I have an exercise bike; I’ve had it for about a year. And sometimes I’ll be like, I’ll feel like I want to take a nap. Let me just see if I can push myself to do the exercise, like, for 20 minutes. And lo and behold, it’s actually like, sometimes I’m still tired. But other times I’m like, oh, actually, I expended energy, but then I gained energy.

Afton: 

Isn’t that interesting? And I think the other one that’s really powerful is the power of being outside. So, for those of us who are very cold right now, because the weather’s crappy out, there is a lot of power, even if it is chilly, to get outside and have a little bit of sunshine, get a little bit of fresh air, listen to birdsong, walk in nature. That is actually incredibly invigorating and it’s a way of getting just kind of gentle exercise, just going for a walk outside to, you know, at least kind of add some balance. You might be fatigued, but there’s something really invigorating about, you know, we need to be in nature. It’s kind of a human thing, and we feel so much better when we’re exposed to a little nature and fresh air.

Cheryl:  

Yeah, I feel really lucky living in the Pacific Northwest because even if it’s raining, it’s usually temperate enough to where you can comfortably go outside, you know, except for like the dead of winter. But I do have heated — because I have Raynaud’s also, so I will lose my circulation if it’s too hot or cold, mostly when it’s too cold — so I have battery heated gloves, and a battery heated shirt, and battery heated socks. And I can go out in the cold with those things on.

Afton: 

Love it. And you’re going out. You probably feel better, or at least I hope you feel better.

Cheryl:  

Yes, I do. Yeah, I do. Unless, again, unless I’ve overdone it. I think being too cold or being too hot is a fatigue trigger, I’ve noticed for myself. And being in the sun. But I’m also, I’m very, my sister and brother are redheads, you know, I come from a very fair-skinned family, you know, my genetics would suggest don’t go in the sun. But I know that’s really common with lupus too, like having heat or sun intolerance, but I definitely experience it. Part of it’s knowing yourself, right. There’s people who I know who are like, “Wow, I have rheumatoid arthritis. I moved to Arizona, I sit out in the sun every day, and I’m the happiest person in the world, my joint pains are all gone,” you know, knowing your patterns.

Afton: 

It’s so individual. I think that that’s really on the mark too, that, you know, all this is so individual. And we have to be little scientists ourselves, you know, and just be willing to experiment and do so incrementally, non-judgmentally, objectively. Don’t judge ourselves because we tried something and it failed, but be willing to try, and to find what is the right balance of exercise? What’s the right balance of outside? What’s the right balance of doing things with friends, versus time alone, versus self-care, versus work? Finding balance is critical.

Cheryl:  

And you’ll have different seasons of your life, too. You know, for me, before I had a child, it was different, right? I was younger, and I had different levels of energy. And after having a baby, you know, not to scare anyone, I always say not to scare anyone because everyone’s different. But I did experience, you know, postpartum flare-up like many people do. I had a great, super easy pregnancy. I was teaching swing dance lessons through like, seven months pregnant, you know, just a little, like, ‘Look at me, I got the perfect little —’, like, I had that. I always say that, but then I’m like, okay, I had gestational diabetes, but it was like a really mild case that was like, very much able to be addressed through some diet and exercise interventions, fortunately. But then, the postpartum I feel like, you know, who knows, right, whether my condition — what trajectory I would have taken if I hadn’t had a baby. 

But definitely, it’s gotten, you know, harder to control my underlying disease since having a child. Totally worth it, a hundred percent. But point being, you know, there were times, I think, a lot of times when I was, you know, previously, I would think I had this mentality of just figure it out. Just figure it out. Like, figure out the system, figure out the solution, and then you just do it. Versus now, and I have a much more better understanding that like, you may figure it — everything is temporary, that kind of Buddhist, like, everything’s temporary. And what worked yesterday might not work today. And that’s not — that’s a system problem, that’s not a me problem. Like, I didn’t do that. That’s just how it is. That’s how life is. So, I might have said, “Okay, yeah, I used to be able to swing dance for three hours at a time, you know, and not stop, and be happy as a clam, no joint pain or fatigue.” That’s different now. And that’s, it doesn’t mean that I did something wrong. It’s just, you know, it’s just things change.

So, yeah, it all comes back to mindfulness and being like, this is where I’m at now. I can grieve, right? That it’s where people say, okay, they talk a lot about grieving your old self before your diagnosis. But you can also grieve your old self at a point in your disease where you were well-controlled relative to now, right. So, there’s all different kinds of layers of grief and I allow myself to grieve, but I also love my son. And I can still do my dorky, you know, Tik Tok dances now. I’m not going out to the dance party all night long, but I can do a minute long dance on Tik Tok. And that’s really fun. And yeah, so sorry, I feel like I’m talking too much.

Afton: 

No, no. I love it. Because you are kind of a walking embodiment of so much of what I preach, you know. How do you have — how do you maintain both having a disease and being realistic about it, and mourning, and being angry about it sometimes, but also, you know, what, hey, I’m going to leave my life, and I’m going to do things that matter and I value, and it may not be perfect, but I’m going to, I’m just gonna do it. And I think that is really cool, Cheryl.

Cheryl:  

Oh, well, I do — my parents, we always have this argument because I always say, you know, my parents gave me like, the best foundation, you know, and they’re always like, “We just got out of your way, you came out of the womb like this.” But I’m like, no. Especially, actually, when I read ‘The Optimistic Child’ by Martin Seligman. I was like, wow, my parents did all of these things. Like, they did, they they did that kind of help me reframe, like, is there a different way of looking at this, and they were — they were just, they’re amazing. So, I think it does, it helped to have that solid foundation of, you know, self. I do love myself very deeply, you know, and so I can allow myself — I still can be hard on myself and say like, you know, like, be hard on myself when I’m having a bad moment. But I still fundamentally — like, I grew up in the 80’s in the self-esteem movement where you’re like, tell every child they’re special, every child gets a trophy. And I’m like, nowadays I know everyone’s saying that no, don’t do that. But I’m like —

Afton: 

[Laughs] But yeah, I think it was the foundation. I think you’re right. That’s such an important piece

Cheryl:  

I mean, I did learn how to earn it, too. It wasn’t just like, you can be a total, you know, horrible person, and you’re still special and we love you. No, okay. It was like, anyway, but okay, I want to move on to your ‘Chronic Pain Reset’ book. Okay, tell me everything. But don’t tell me everything because then people won’t buy the book.

Afton: 

So, Cheryl, I think it was right in the middle of the pandemic, and I probably watched all the Gilmore Girls, all seasons. And, you know, it’s like I was doing whatever I needed to do to kind of buoy my spirits. It was just such a hard time and we’re all working. We’re working on Zooms. And in my spare time, I’m just kind of watching shows. And finally, it’s like, oh, I’ve got to do something meaningful with his time. And it’s been — something I’ve wanted to do is to translate the remarkable neuroscience research that we have done in pain, these rheumatic diseases, and tell people what is it that we know, and what is it we know about pain, what is it we know about the immune system, what is it we know about stress, you know. What do we know about social emotions, or social relationships, and positive emotions, and gratitude, our purpose in life? And so, I just set out writing a book that first thought about each of these topics and talked a little bit about the neuroscience. What do we know? What are studies telling us about how the brain works in, you know, in pain, how the brain works when we have purpose? What are the protective effects of positive emotions? And just, really, what do we understand about positive emotions, positive thoughts, and physical health. And so, the book is kind of just, kind of short chapters, 60 short chapters, kind of looking at each of these topics from doing valuable life activities, to character strengths, to gratitude, to grit, you know, to perseverance. And just, you know, what do we know about the neuroscience? How and what, how does it pertain to people with chronic illness and chronic pain? 

And so, I do that in the first 16 chapters. And really, what the goal is, is to help the reader say, hey, there is a biological, physiological, neuroscience explanation for how doing simple things like keeping a gratitude journal, or going on walks, doing kind acts, that actually might have health benefits. And so, I really lay out what’s the literature for the health benefits of kind acts. And then, once we, I feel like, you know, the reader has a sense, “Oh, my gosh, there’s something here,” then I have them go on a little mini journey for 30 days. And one of the things that we don’t do well as clinical scientists, is we discover things that work well for patients, really cool skills and tips and tricks, and somehow, we just don’t do a good enough job of getting them to individuals who can actually benefit from them. So, the goal then is to introduce one of these new skills, strategies, activities a day, and it allows the reader to say, “Oh, okay, so here’s this thing called diaphragmatic breathing. Okay, so what is this? How is it done? What’s this? What’s, you know, what’s the evidence that might be helpful? And I’m gonna give it a try that day.” And so, each day, it’s just like, okay, try this. Sit there for five minutes and try diaphragmatic breathing, “Oh, I hate that. I never want to do that again,” or you try, like, “Oh, I suddenly feel a little less pain. And I feel a little bit better. I kind of like this.” And so, each day one of these skills is evaluated. And if it’s a skill you think you might want to explore a little further, you put a little star — there’s little stars — and color it in. And then, the next day, you try something entirely differently new. And then, you try that skill. Like, “Ooh, I like that,” or, “Oh, this doesn’t make any sense to me,” right. And so, every single day for 30 days, a new skill or activity is tried. And it’s everything from walking in nature, to doing a gratitude journal, to having a positive piggy bank where you count something good that happens each day, to really good cognitive behavioral skills like how to do activity pacing, and things we may have learned in CBT for pain. But then, also using techniques from ACT, from Acceptance and Commitment Therapy, from dialectical behavioral therapy, you know, how to do calming activities from Mindfulness Based Stress Reduction. 

So, you learn these different skills and at the end of 30 days, ideally, you’ve had this kind of journey — maybe you’ve done the journey with somebody else — and then, you look back and say, “Oh, there’s like five or six of these that I love. This resonates.” And then, the rest of the book is how do you put together a program that addresses kind of the multi domain, the multi domains that we need to have good well-being and health. And it’s not just about the ill, it’s also about skills that everybody can benefit from to lead a life that feels richer, more rewarding, more interesting. And so, we deal with purpose in life, we deal with character strengths, and how do we engage these more in our lives. And for some people, 10 of these will maybe sound great and resonate; for others, 30 will be fantastic. But it’s all about what works for the individual. It’s tailoring a program that makes sense to you, that feels like it’s something, that’s something you want to do, and something that feels engaging. And so, that is kind of the whole purpose of the book, is that people get to try on different things and find the stuff that they think that works for them that they’re excited about, and then building a program going forward using that. And so, we’ll have all sorts of tools and things online on aftonhassett.com, it will be up and will have all sorts of guided imagery and breathing techniques and other information there for the readers. But so, that was kind of it in a nutshell.

Cheryl:  

I love it. Firstly, as somebody who gets, you know, has a lot going on each day, I love the idea of, hey, take 30 days and just do one a day. 

Afton:

One little thing.

Cheryl:

You can do that. A little bite size. I love that. 

Afton:

It’s a nugget.

Cheryl:

Yeah, and I just, I mean, like, you’re preaching to the choir when it comes to the knowledge translation piece of like, every time I go to a conference, I’m excited. But I also get frustrated because I’m like, who’s translating this information to the average person who lives with these conditions? So, I love the idea that you’re saying, look, like, I’m going to teach — like, teach a man to fish kind of thing, you know, based on the research. And I’m just, I’m really excited to read it myself. I just completed, yeah, I just did a six-week program. A little bit different. But it’s a it was an app and it’s kind of an educational and experiential for people with IBS. It’s actually like a — technically, they call it hypnotherapy. I guess it’s different than what I thought hypnotherapy was. Because it’s more like it really felt more like guided meditations, you know, 15-minutes a day. And a long way — you would actually imagine it was really fascinating, like, and I was a little skeptical at first, but I was like, again, I mean, what do I have to lose? A little bit of time and money if it doesn’t work. But so, I think it’s always good to do these things where you’re like, I’m gonna try it, right. I’m not gonna decide I don’t like it before trying it. And, you know, even though some of it was a little, I was like, laughing a couple of times because it was like, imagine a warm light coming down, like, really specific, like, coming down your esophagus into your stomach, you know? And I was like, yeah, actually, like, this is changing my relationship to like, my GI, or my gastrointestinal health, because I used to be like, “Oh, I kind of hate my stomach, it’s not working well,” and now it’s like, “Oh, I have these like, positive —” you know, I was able to replace some of those negative ideas with like, oh, you know, like, my GI tract is doing its best and positive improvement is possible. And but anyway, I’m saying that as like an example of something that, you know, it was really bite sized, and it was also enjoyable to do. And this sounds really enjoyable, too. Learning diaphragmatic breathing, learning one exercise, you know, from ACT, or from DBT, or CBT. And then, you kind of have that, like that self-management piece of, I’m gonna take this. You’re gonna present the tools as the author, right, and then the patient or whoever’s reading it, it’s their responsibility to then take it and apply it in their lives.

Afton: 

Yeah. And that’s kind of the way it works, right? I mean, we go to physical therapy, and then we have to kind of walk away and use the things, or occupational therapy; same thing with CBT. But where we tend to fail patients is we don’t give them things that resonate with them. And it’s like, it kind of is one size fits all. So, you guys do this and you’re like, “Ah, I just don’t really feel like it aids my symptoms, and it doesn’t really feel like it makes sense, you know, based on what or how I understand my pain,” whereas this allows you to kind of sort through their, you know, maybe pain reprocessing therapy, you know. They’re all different skills and all different activities that just might resonate with different people. So, we just hope people will give it a try.

Cheryl:  

I love it. No, and, yeah, I’m excited. I’m excited about it. So, I’ll definitely put a link to — is your website up yet or no?

Afton: 

It’s not up yet. I will share that with you. The book is released September 5th. And so, we’re in the process of doing the recording. So, part of what we wanted to add to the book is that, you know, on the day that we’re doing guided imagery, there’s a couple of guided imageries you can try. The day we’re doing progressive muscle relaxation, there’s a progressive muscle relaxation you can see, you can use. You can either read the book and read the instructions and just kind of do it, or you can actually pop in your earphones and go to the site, and you can use the recordings to help you with your practice.

Cheryl:  

Awesome. Oh, this is so helpful. Do you have some time for a few rapid-fire questions before wrapping up?

Afton:

Yeah. Sure, hit me.

Cheryl:

Okay, perfect. Yeah, well, this is a biggie one, but what are some of your favorite words of wisdom or encouragement for people newly diagnosed with a rheumatic disease or fibromyalgia?

Afton: 

Oh, seek a mentor. Seek somebody who has been there, who can help you navigate, to navigate the healthcare system, to ask the right questions, and to lean on. Because this is new. It’s a big adjustment. So, find somebody that you can connect with and has been there before.

Cheryl:  

Oh, I love that. That’s come up a couple of times, actually, in the podcast. That’s a really wise one. Do you have a favorite maybe mantra or inspirational saying that you think is particularly helpful for people with chronic pain?

Afton: 

Oh, you’ll think it’s simple. It’s kind of what works for you. I like ‘You got this’ because I, when I tell you, “I got this. I got this,” and I think that when you find one that works, put it someplace where you see it like a little sticky note or even have a little medallion within it, ‘I got this’, just to help us remember that, you know, mantras can be helpful.

Cheryl:  

I love that. Yeah, I do that. I use that one. I also do, like, ‘We can do hard things’ or ‘I can do hard things’. You know, it might be hard, but I can do it. 

Afton:

You can do it. 

Cheryl:

And you mentioned the Gilmore Girls, but is there any of like a book or movie or show that you’ve been really enjoying recently?

Afton: 

Oh, my goodness. Well, this is just way off base, but ‘Only Murders in the Building’.

Cheryl:  

Oh, my gosh, I love that one. I binged all seasons. Yeah, ‘Only Murders in the Building’. Yeah.

Afton: 

Only Murders in the Building’.

Cheryl:  

I’ve been watching ‘Shrinking’. I don’t know if you’ve heard of this, with Jason Segel and Harrison Ford. It’s about a therapist who goes rogue and starts kind of like breaking a lot of rules. But it ends up being more about the interpersonal relationships with people.

Afton:

Oh, that sounds awesome. 

Cheryl:

Yeah, it’s great. And what’s something that’s bringing you joy right now?

Afton: 

Oh, my goodness. Sunshine. Sunshine brings me such joy. It’s sunny here in Ann Arbor. You know, I am such a pushover for anything positive. And so, yeah, sunshine brings me joy. But so does cookies.

Cheryl:  

Oh, yes. Yeah. I’m like, chocolate chip cookies would be like, on my list of like, three, you can only bring three foods onto a desert island. Like, cookies are gonna be on there. 

Afton:

Right there. 

Cheryl:

And then, what — this is a big one — but what comes to mind when I say the phrase, you know, or what does it mean to live a good life and thrive with rheumatic disease?

Afton: 

It means whatever you say it means, right. So, we all have different definitions of what is a valuable life and what is a rewarding life. I think the most important thing is to determine what it is that you want to do; what is your purpose. And it’s something we talk about in the book. And it’s the kind of the very end of it, it’s at the end of the chapters, and it’s towards the end of the 30-days. But when people have rheumatic disease, what they thought was their purpose of where they’re going often is abandoned. And so, it doesn’t be that now you no longer have purpose, it just means your purpose might be a little bit different. And not to stop asking what is it that I can do that is meaningful and rewarding. So, I think that’s probably the most important thing, is to identify what is the next level of purpose, and what will make life feel rewarding and meaningful?

Cheryl:  

Yeah, that really resonates. I remember — I don’t know if you know her, Dr. Bronnie Lennox Thompson. She’s the Acceptance and Commitment Therapy — she’s an occupational therapist. And then, she got her PhD, and she’s in New Zealand. But she was one of my first interviews I ever did. But she said one of her questions that just kind of broke my brain, but in a good way, was she said that when she asked a lot of her patients — and she leads groups of people with chronic pain through Acceptance and Commitment Therapy — she said, “What would you do if pain wasn’t a problem for you?” But it is a problem. Like, you know what I mean? That’s what broke my brain. But what would you do if it wasn’t? Because if you’ve been living in pain, it’s so — like you mentioned earlier, you know, our brains are wired to pay attention to pain, and it’s a problem. We want to solve it. But it’s a different way of approaching it. Like, what if pain isn’t actually the only barrier and you could do that? 

Afton:

It’s so good.

Cheryl:

Yeah, it’s so good. Yeah, because your purpose in life when you live with pain sometimes becomes alleviating pain.

Afton: 

Oh, that’s it. And I can only have purpose in life when my pain is gone.

Cheryl:  

And I get it. For acute, for really severe acute pain, it’s really, really hard to focus on anything else. I don’t ever want to minimize that. But when we have the kind of low levels of chronic pain that, you know, are the more like stiffness, soreness, that’s not necessarily like screaming. Like, I’m thinking of dental pain right now. Like, I don’t know, if I had to live with some dental pain, that would be a whole other level of therapy.  

Afton: 

It would become survival, exactly. Yeah. And there’s gonna be days it’s like that. But ideally, every day is not. And when do you open up the door for it?

Cheryl:  

I love it. Yeah. And then, what do you have any social media links? I’m sorry, if you already sent them.

Afton: 

Oh, yeah. You know, I do a little bit of Twitter. I wish I had more time because I kind of love it. But it’s @AftonHassett.

Cheryl:  

Yeah, okay. Okay. I’ll put these links in the show notes. But it’s good. Sometimes people are listening, and they have their phone, and they’re like, “Oh, I want to just look her up right now.” So, I’ll put that link in the show notes. But thank you so, so much for taking the time. I know you’re a very busy researcher, a very prolific researcher. And I think it’s, you know, again, a silver lining from the pandemic that you were able to, you know, achieve your maybe kind of a bucket list item, it sounds like, of writing a book, right?

Afton: 

It is, it is. And thank you so much for having me on. I love your podcast; I love what you’re doing for people who have arthritis and live with rheumatic disease.

Cheryl:  

Oh, like, it’s been a dream. Definitely, for sure. So, thank you. All right. Bye-bye for now. 

Afton: 

Bye!