Cbt for pelvic pain/vaginismus

[Bubble_by]

Hello everyone.

Has anyone ever had any talking therapy/counselling for vaginismus or pelvic pain? It was recommended to me by my physio but I'm unsure of what to expect. Did it help anyone?

[SunlitSky]

Hi Bubble_by! 🙂

I have explored this topic a lot and have a number of resources on coping with the challenging emotions surrounding pelvic pain symptoms.

Opening up to a counselor specifically on pelvic pain is a very personal decision that largely depends on the level of emotional energy that is connected to your diagnos(es) and symptoms.

An individual with significant emotional stress or emotional trauma from pelvic pain symptoms benefits greatly from not only CBT with a licensed therapist, but also from basic talk therapy/feedback with the right Physical Therapist - for example if the patient is female it can be ideal to see someone who is both a Doctor of PT and Women’s Specialist Certified (WSC).

Difficult cases of pelvic pain often inevitably impact us as individuals and in our relationships. Therapy is necessary to process the personal impact of the pain and the relational impacts as well. Like the stress and anxiety of sitting and driving while feeling pelvic pain (individual)...or the stress and anxiety of being in a relationship and dealing with the pain with a partner or spouse (relational), or even the feelings of isolation when trying to communicate your symptoms to someone close to you who cares, in order to help them understand what you are going through.

If your pelvic pain symptoms affect your life, then talking it out can be helpful for you! It’s important to be intentional about it and choose carefully the very select few of who to open up to, who to get counseling help from.. that’s where the research comes in. And as always, trust your intuition!

[TennisAM]

Hello! I think high intensity CBT can be helpful to change how we feel about the pain but what I found more helpful is Acceptance and Commitment Therapy (ACT). Theres a great book that explains it well. If you commit to practising it, it can really help with how your mind responds to the pain. I get a lot of intense pain in the middle of the night - thanks to ACT I can sleep through 7/10 pain. I don't stress about it anymore. The book is called The Happiness Trap by Russ Harris.

P.s. Low intensity CBT won't be helpful in my experience.

Best wishes

[SunlitSky in reply to TennisAM]

Hi Roshsp, could you talk more about how ACT has helped you and/or what methods you use? Thanks!

[TennisAM in reply to SunlitSky]

Hey no problem, the main principles of ACT are

- commit to changing what you are able to

And

- accept what you can't change (this doesn't mean giving up on change but acceptance can bring peace to the mind. In the future you would still try to change what you've accepted).

I experience the following and this is how its helped:

Excruciating 7-10/10 pain, it used to happen during the day but also at night so it would ruin my sleep. Stabbing pains at 4am every day which meant I couldn't get back to sleep. ACT teaches you to observe the pain without judgement. Once you watch it you realise you don't have to stress about it, analyse it, its just pain and it will pass. This brought me peace and I went back to sleep (while in pain) within 10 minutes. I then got woken up by the pain 4 more times, I said to myself each time, "it doesn't matter." On those 4 occasions I went back to sleep within a few minutes. This shows in the past it was my attitude to the pain (stress/worry/ upset) rather than the pain itself stopping me from sleeping. I practised for 3 weeks on pain during the day, I'd observe and sit with it. After that practise the above happened and now mostly pain doesn't keep me awake.

Palpitations are another issue which which would keep me up at night, this generally doesn't thanks to the above mechanism.

I now have to get up in the middle of the night for the bathroom every night which affects me as I have Insomnia.

They teach you logical things to tell yourself and how to diffuse thoughts. So for example when I go to the bathroom I tell myself its normal to get up at night and this won't affect my sleep (ACT and CBT both promote this technique). This engages the logical part of my brain which is important as I won't stress about something normal. I go back to sleep within 10 minutes of waking. If I stress about getting up or start ruminating another good technique which engages logic is "is this helpful?" In the middle of the night the answer is always no so it helps stop the thought.

They teach funny diffusion techniques for upsetting thoughts, such as saying to yourself "radio doom and gloom" which I find amusing. Other techniques that are great are singing bad thoughts (in your mind, not out loud haha) to the tune of your favourite song or to happy birthday. The idea is to show you they are only words and they can't hurt you.

You can't help but laugh when you are, for example, singing "i am pathetic" to the happy birthday song. There are many techniques if these don't work for you.

The difference between CBT and ACT is CBT tries to change your thought to make it more balanced. This of course can be useful but sometimes our thoughts aren't subjective and they only move a little bit after thought challenging. So for example "I hate doctors", thought challenging would turn this into " I hate a handful of doctors but there is one that i like and value." but you also need to believe the new statement too which is harder. As you may have noticed the statement hasn't moved much so therefore didn’t have much of an impact on my mind.

There definitely are good things about CBT such as promoting and fostering compassion (self and to others) as those with chronic illnesses can be quite hard on ourselves. I found this very effective thought art therapy and self critical / compassion letters.

Overall I still think for me ACT is better as it teaches how to handle the thought without engaging with it, as it will come back over and over again. Its done in a humorous way which is something I appreciate and it feels more durable than the CBT principles. There's some thoughts I challenged via CBT a few months ago and now still believe the original thought. Whereas with ACT I can diffuse as needed and it doesn't bother me as much. I can think the thought without engaging with it much. I'm not holding on to any of these thoughts or beliefs. In fairness some of that will be thanks to the CBT compassion work as self criticism is something I struggle with.

Hope that helps.

[SunlitSky in reply to TennisAM]

This does, I will incorporate it into my practice, thank you 🙂

Acceptance has helped me A LOT. it’s helped me be less judgmental about the symptoms that are out of my hands. It’s also helped me invite the compassion inside.

[TennisAM in reply to SunlitSky]

This is a great resource if you haven't seen it before. Glad acceptance has helped😊

ggia.berkeley.edu/

[SunlitSky in reply to TennisAM]

This looks great, especially the link on self-compassion.

How do you overcome your 7-10 pain? Is it every day? What alleviates pain for you?

For me it is not so much excruciating pain as the guilt and shame and fear that I feel surrounding it. The constant sensitivity, wanting to protect and care for myself yet feeling like I’m not fully able to...I’ve experienced excruciating migraine pain that’s left me unable to do much of anything for several days, more than 10/10, radiating and throbbing in the neck, debilitating side affects - awful.

But pelvic pain is something entirely different.

I almost feel that I need to take a step in addition to acceptance. And that’s where I get a bit stuck. Like accepting that pelvic pain hurts me emotionally probably more than anything else. I’m struggling to accept that. I don’t know how to. It feels like a continual sense of grief/loss where I make improvements in things like internal PT, and then have a setback, and then more improvements.

Maybe I simply need more time to mend.

[TennisAM in reply to SunlitSky]

Hi, I'm sorry if these questions upset you or I'm putting words into your mouth. Does pelvic pain affect you more because of how it has affected your life? Is it because of the emotions of what you may have lost? Such as the difference between your life now and what you envisaged? Lost relationships? Is it the loss that hasn't been processed/accepted?

I used to feel fear (of what was going wrong internally) and guilt (of what others thought and what I couldn't do) but acceptance and mostly not caring about what others think has lessened that.

For me acceptance is only part complete, as sometimes I feel excruciating pain and am emotionally back to square 1. Other times no issue. The biggest issue i face is the feeling of missing out, not being able to accept the difference between what my life is like now and how I envisaged it.

It might sound odd but maybe practising forgiveness to your self and the condition you face too.

I did this analysis, it might be worth you thinking about what's causing the emotion and doing your own version of this. It will give you something to work towards.

ACCEPTANCE ANALYSIS AND PLAN

Acceptance that I have a chronic medical problem, and this means I do not always feel well enough to do what I want to do/need to do.

What does this look like?

· Pace myself (work, socialising, events) and not feel annoyed, upset, as if I have missed out

· Find alternatives to the above (zoom calls, go for a bit instead of the whole time)

· Rest without feeling guilty or pressure to meet my expectations or the expectations of others

· Do not compare myself or what I can do/cannot do with others

How will this be achieved?

· use mindfulness when experiencing pain, heavy bleeding, nausea etc

· zoom calls, go for part of an event/outings – whatever I can handle

· continue to find ways to manage my symptoms

· Do things I can achieve and not push myself when I cannot achieve them

· Try to take a balanced view in moments where I cannot do what I want to do (for and against thought challenging)

· Try not to place too much emphasis on other people’s views of what I can and cannot do – they do not understand and are judging by their own healthy life standards. Use the below to process the emotions.

· Try to see emotions as neutral neither good or bad, whether they are upset or happiness

· Use mindfulness during periods of anger, upset, frustration etc to observe but not engage. This may lead to a change in perception about some feelings being ‘good’ and others ‘bad’ (same could apply to symptoms of endometriosis)

· Use mindfulness as a tool to stop / reduce resistance to ‘bad’ feelings (same for endometriosis symptoms)

· Use diffusion mechanisms (both for thoughts / feelings re missing out and thoughts about having endometriosis)

· Try to stay as present and in the moment as possible - gratitude is a useful tool to note happiness of any good things that have happened during the day (write down three good things from that day at night, every day)

- always notice when I am not in pain as this is sometimes overlooked

- Commit to practising the above

I've found a lot of natural things that work in the last 4 months so thankfully pain is much lower now, but previously yes it would be 7-10 out of 10 daily.

Please always remember progress is never a straight line upwards, there's always a dip, pick yourself back up and carry on. As long as the progress is upwards the odd dip here or there is normal.

Happy to share the natural pain relief that Ive been using if you send me a private message. Not sure if it can help but worth reading about if it can.

Hope the above helps

[SunlitSky in reply to TennisAM]

Gratitude ** I can treat pelvic pain as something to be nurtured, not shamed distanced or neglected. And use it as an opportunity to pursue greater healing, listening to what I need in the moment and using all of the resources that I have to get well.Being grateful for the tools and resources that I have!

Gratitude is key I’m so glad you mentioned that. And forgiveness. I experience symptoms related to vestibulodynia and PN.

[TennisAM in reply to SunlitSky]

I'm glad that's helped, I think gratitude as a whole is important so that you're not just concentrating on the pain. So sometimes my gratitude diary entries are as trivial as my hair was complemented and other times they are deep and meaningful about friends that have been supportive. When someone has said something funny. When I don't feel pain, when I've had a better day etc etc. Good luck with it all

This is a great course about wellbeing (its free)

coursera.org/learn/the-scie...

x

[SunlitSky in reply to TennisAM]

Re: Roshsp’s questions. I hope this brainstorming is helpful to Bubble_by as well. Perhaps it can help you identify what you might be looking for in therapy and how therapy may or may not be helpful for you:

Roshsp: “Does pelvic pain affect you more because of how it has affected your life? Is it because of the emotions of what you may have lost? Such as the difference between your life now and what you envisaged? Lost relationships? Is it the loss that hasn't been processed/accepted?

I used to feel fear (of what was going wrong internally) and guilt (of what others thought and what I couldn't do) but acceptance and mostly not caring about what others think has lessened that.”

-> Pelvic pain has affected my relationship with myself more than anything or anyone else. I have had a general fear of pelvic pain because at it’s worst, it’s made me emotionally traumatized. I think I need to figure out what the grief/guilt/loss is. It is something along the lines of a loss of opportunity at feeling a sense of wholeness, security, and safety. It has been a loss of a part of my sense of self.

[pelvicpain123]

Hi Bubble_by.

I have had counselling before and also been seen by a clinical psychologist. I found my counselling to be very helpful and supportive and feel that I wouldn't have gotten through that period of my life without it. I had a negative experience with my clinical psychologist. I think it was the individual rather than the role (so I wouldn't rule out trying again in the future with someone else).

I think that it is worth giving it a go and seeing how comfortable you are. Remember that you can share as much or as little as you like in the session. If you don't like it, you don't have to go back :).

I found the counselling helpful as I told my counsellor things that I wouldn't necessarily tell my family and friends and I was able to offload without any judgment and my counsellor often helped me to feel more positive about things, especially as I can be really hard on myself and not be very patient. Sometimes I feel that I am constantly moaning or complaining about the same things (being in pain, not feeling listened to by Doctors, battling to get appointments or care/tests that I might need) and it was nice to know that I could have a good old moan and not worry about having to balance the conversation/relationship as you would do naturally with friends.

What to expect?

A place where you can share how you feel without judgment and where you can feel listened to and supported.