I was sitting in a dank Irish pub last night *, working on my book, when I noticed I was getting a slight headache. It might have been from staring at the screen for too long, or thinking about the countless rejection letters from publishers over the years but, for the most part, tension headaches never seem to have much of a pattern with me. I was drinking club soda with lime the entire time I was there so it certainly wasn’t dehydration that was causing the discomfort.
I worked for another ½ hour and the pain in the front of my skull started to worsen. I might be getting a migraine. I asked both the barmaid and the one other patron there – an exhausted looking 50-something, salt-and-pepper haired man in a black suit with an undone tie – if they had any aspirin.
“Why? Your vagina hurt, soda boy?” he said.
Miserable investment banker.
“No, my vagina doesn’t…I have a headache. Do you have any aspirin or not?”
I closed up my laptop and started the five-block trip back home. As I walked, I started to get the “aura” of a migraine. The street lights I passed had massive coronas around them and I started to feel nauseous. By the time I got home I couldn’t even walk in a straight line, and I imagined the douchebag from the bar yelling to me from afar: Better go easy on the club sodas next time, Buddy. They pack a punch!
I got upstairs, made a cold compress and lay on the bed. The throbbing in my head felt like a mallet crashing into my skull, chipping away at, soon to crush my brain, rendering me reliant on life support.
This is the worst pain imaginable. Nothing can hurt more than this. I’d rather be dead than have to experience this catastrophe.
Note the emotionally-loaded, absolute terms used in that self-talk: “worst pain imaginable,” “nothing,” “dead,” “catastrophe.” Are any of the statements I made factually accurate? No, they are not. I’m sure Jigsaw from the “Saw” franchise could think of significantly more intense pain than a migraine. Hell, my friend in college dislocated his shoulder and looked in way worse shape than me on my bed, holding a wet rag on my face. Did I actually want to be dead? Not really, although it seemed like the only viable option to get rid of the pain at the time.
This is a classic example of thoughts influencing mood. By using such extreme language, I (again) placed myself in a position of being simply in pain to being both in pain and emotionally miserable by telling myself that this was the worst, the most absolute horrible, God-awful thing that one could go through. I myself increased my own suffering exponentially.
Fortunately I vomited a few minutes later and fell asleep.
Years ago I had a client who needed to have a closed MRI. Claustrophobic by nature, the very idea of being inside of a giant tube for 45 minutes terrified her. The test was not optional, however, and it needed to happen within a few months.
Systematic desensitization is the treatment of choice here, but we added a specific visual/cognitive element. I asked the client, a mid-20’s woman I’ll call Gail, to describe the entire day leading up to and including the MRI. This meant telling me the details of the upcoming afternoon, beginning with waking up in the morning and ending with her completion of the MRI. I stressed that word to her because there was to be no room for doubt that she would succeed.
As she described her morning: getting dressed, eating breakfast, getting on the subway, emerging from underground and walking to the office where the MRI was to take place, she didn’t feel very nervous. However, when she mentally arrived in the room, her anxiety quickly escalated.
“Tell me what you see as you describe it,” I said.
“They are forcing the cage over my face.”
“I’m sorry, cage? What do you mean?”
“There’s a sensor, it kind of looks like a catcher’s mask or something, that acts like a sensor.”
“Okay,” I said. “So it’s not a ‘cage,’ it’s a sensor. And they are not ‘forcing’ it, you are allowing them to place it over your face to facilitate the process.”
“What’s the difference?” she asked.
“Think about your self-talk. The words ‘force’ and ‘cage’ make you sound victimized. That inner monologue doesn’t allow you to be your own agent in the medical process. Make up your mind, right now, that you are going to allow all of these to occur by your own choice, to engage in appropriate medical care for your body. There is no cage and there is no forcing here.”
Sometimes in therapy you’ll see something ‘click,’ an almost visible shift in perception and mood. Gail didn’t immediately lose all fear of the MRI, and she wasn’t going to until she completed her task, but something happened for her at that moment.
“I’ve been saying these words over and over for weeks,” she said.
“No wonder you’re so anxious about it. What have you been telling yourself about what happens next?”
“They shove me into the machine and I can’t get out for 45 minutes,” she said.
“Okay, so change that for me. Make it a more active experience on your part.”
“I…go in the machine and can’t get out?”
“That’s close. Is that true you can’t get out?”
“Not exactly. If I give a signal the technicians come in and turn off the machine.”
“Okay, so you will choose to go into the MRI machine, and you will decide to stay in there as part of your medical care. If it becomes too much, you can always get out and try again at another point, but you will always have the ultimate say. Is that accurate?”
“Yes,” she said, with a small, almost embarrassed smile. “That’s fair to say.”
Because Gail was such a trooper, she actually obtained a refrigerator box from an appliance store and practiced lying inside of it for 45 minutes a day. While simulating the MRI experience, she told herself the “active” words, dropping the extreme terms that were generating such a strong anxiety response. And while she couldn’t ever say that she actually enjoyed the MRI – who could unless you took a nap or had a bottle of pinot noir in there with you? – she got through it. Pretty painlessly, in fact.
The morals of the story:
– Monitor your self-talk for extreme terms that generate misery
-Correct your phrasing to allow for more accurate perceptions of your experience
-Cold compresses are useless for migraines, although vomiting helps
-Don’t drink club soda in a bar unless you want to be branded a woman. Or at least some sort of vagina-having man-type creature
* For those who are wondering, I don’t sit in Starbucks to write because their coffee sucks, it’s overpriced and the very idea of sitting for four hours in some pretentious, glorified Dunkin Donuts makes me sick to my stomach.