Welcome back to the Healing Pain Podcast with Joan Rosenberg, PhD
We have an important episode. We’re discussing the association between chronic pain and suicide. The information you’ll learn in this episode may help you screen for the risk of suicide more effectively. It may help you effectively treat suicide, and by learning and sharing this information, you may save a life. According to the American Foundation for Suicide Prevention, suicide is the tenth leading cause of death in the United States.
In 2019, approximately 48,000 Americans died by suicide. In that same year, there were an estimated 1.4 million suicide attempts. Chronic pain is a risk factor for suicide, and research indicates that chronic pain is present in about 10% of those who die by suicide. It’s important as licensed healthcare professionals and loved ones of those who live with chronic pain that we learn how to ask the right questions, assess for risk factors, and intervene to help prevent suicide rates.
In a few moments, you’ll meet Clinical Psychologist, Dr. Joan Rosenberg, who has conducted research in the field of suicide, as well as treated patients in her clinical practice. Before we begin, I wanted to provide you with some information to effectively ask, assess, and intervene in those you feel may be at risk for suicide, especially those who live with chronic pain. First, I’d like to provide you with a shortlist of factors that may increase the risk of suicidal behavior among people living with chronic pain.
If you’re a healthcare professional, these might surprise you because we see common risk factors almost every day when we treat people with chronic pain. The first one is insomnia. Insomnia is common among people living with pain and also associated with an increased risk of suicide. The next is an over-reliance on passive coping strategies when you recognize or observe that someone is hoping their pain will go away from these passive coping strategies, increasing their risk of suicide.
The next is pain catastrophizing, a topic we’ve talked about in-depth on this show. All of us are well aware of the catastrophizing pain scale, and there are also other scales and self-report measures that identify catastrophizing. It’s very important that we include that in our initial paperwork. The next is prescription pain medication access when other factors are present.
We’re talking mostly about opioids here. It’s not just if someone is taking opioids. There have to be several other factors. The factors that you learned about now present. As we’re talking about prescription medication, always be on the lookout for what they call the triple threat, which is opioid, anti-anxiety medication, and alcohol use disorders. Those three together, people oftentimes overdose as well as an increased risk factor for suicidality.
There are specific pain diagnoses that have been associated with an increased risk, specifically chronic lower back pain. The diagnosis of psychogenic pain, which is medically unexplained pain or medically explained physical symptoms as well as migraine, those three, chronic lower back pain, psychogenic pain, and migraines.
Feelings of helplessness or hopelessness, individuals who will feel that they can do nothing to change or impact their pain and believe that positive outcomes are not possible for them may be at an increased risk for suicide, and then finally isolation or perceived burdensomeness. Oftentimes these go together. If you recognize or identify distressed and interpersonal relationships where someone feels like they are a burden to others or express feelings of not belonging, these are associated with an increased risk of suicide.
Suicide can look and sound a lot like depression. It’s important that we screen for depression. We all know that depression rates are high in those living with pain. There’s a simple way that you can screen for depression in your clinical practice, no matter what type of health professional you are. That’s with the PHQ-9, Patient Health Questionnaire-9. It’s readily available online if you google Patient Health Questionnaire-9.
This is a multipurpose instrument for screening, diagnosing, monitoring, and measuring the severity of depression. It includes nine questions. What’s great about this is not only does it screen for depression but question number nine is a single screening question on suicide risk. A patient who answers yes to question nine needs further assessment for suicide risk by an individual who is competent to assess this risk that may or may not be you. Hopefully, by the end of this episode, you will realize that screening for suicide is possible.
What I also like about the PHQ-9 is it gives you a couple of different cutoff points for mild, moderate, moderately severe, and severe depression. With those cutoff points, it recommends proposed treatment action for each cutoff point. It’s Patient Health Questionnaire-9, super simple, nine questions to screen for depression. Question number nine is specifically for suicide risk.
With some of that background information, let’s bring in our expert guest, Dr. Joan Rosenberg. Dr. Rosenberg is a cutting-edge psychologist known globally as an innovator in the field of mental health. She is a two-time TEDx speaker and serves as a blogger for Psychology Today and has been a featured expert in multiple documentaries on television and radio.
As a licensed psychologist, Dr. Rosenberg speaks on how to build emotional strength and resilience, psychotherapy, and suicide prevention. She’s a Professor of Psychology at Pepperdine University in Los Angeles, California, as well as maintains an active clinical practice. This episode aims to create a roadmap or a blueprint for assessing and intervening with suicide. Without further ado, let’s begin and learn about this important topic and meet Dr. Joan Rosenberg.
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Suicide Prevention And Chronic Pain With Joan Rosenberg, PhD
Dr. Joan Rosenberg, welcome to the show to talk to us about this important topic of suicide, which has important links to those living with chronic pain.
Joe, it’s great to be back. I love being here with you.
I know you’ve done some work in this area on the research side as a clinical psychologist and working with patients in the clinic in practice. I’m excited to talk to you because you have that nice balance of both. You’ve researched it and also lived this with the people that you help. We have both people who have chronic pain who read this or loved ones of people with chronic pain as well as practitioners who are seeing people with chronic pain who are at an increased risk for suicide. The best place to start is how do I identify the warning signs of someone who is planning or contemplating suicide?
The first for me, Joe, is to listen to the language. I’m listening to the language of hopelessness, profound sadness, and depression. I will be listening for references certainly to suicide, “People would be better off if I were dead. I wish I could go to sleep and this would all be over,” or people who are actively content contemplating it. There’s such a wide array of ways to start to attend to people feeling that degree of hopelessness and considering taking their life.
As a practitioner or someone living with someone who may be at risk, it’s tuning your ear and listening to what people are saying either in direct conversation with you or in passing.
Whether I’m out professionally or personally with somebody, if they use the language of suicide, I have a very strong reaction to it because I don’t think it’s something that we ought to be taking lightly and joking about.
I’ve heard this before from friends, family, and colleagues alike, “If I left the planet, this would be so much easier,” for example, in a joking way, but we should be tuned to that.
Yes, for me, that’s a signal.
Other than language and obviously the cognitions and thoughts that go with that, other professional behaviors or someone living with a loved one can watch out for the behaviors or habits that might change as someone moves or contemplates suicide.
There’s a wide variety of things that we can watch for, Joe. Some people call these risk factors. Other people might call them warning signs. We can use the language of either one of those. Certainly, one would be watching for depression. When I’m talking about depression, two things that are strong here have to do with isolation and withdrawal, shutting down and moving away from other people and moving away from their own experiences. That would be one.
Certainly, increased substance use can come in all sorts of forms, whether it’s increased alcohol, drinking to get drunk, and checking out in that way, or checking out in the wide variety of other substances that people can use. I don’t know if people have attempted. When people are in pain, oftentimes, there’s access to medication, as we know.
Whether there’s been a prior attempt, that there is a possibility. People have problems thinking clearly, and sometimes that comes with substance use. Sometimes there is a family history of people who have trouble thinking. These would be situations where maybe somebody has bipolar or maybe a head injury. We know historically now in terms of what’s been in the media about people who’ve had very severe concussions that sometimes prompt some suicidal reaction.
We know that there’s anxiety and agitation. If there are bad sleeping habits and people are not sleeping well through the night, that can also be a contributor. On an emotional level, the things I would be looking for would be losses. Has somebody experienced a recent loss? I think of loss, Joe, as far more broad than relational loss. What I mean by relational loss is a relationship with another human being or a relationship with a pet.
Loss goes way broader than that. There can be a loss of reputation, finances, or health. Chronic pain could be part of what prompts this. The loss of finances and employment are extensive. If there are recent losses, that would be something to pay attention to. If there’s an experience of helplessness, that would be super important to pay attention to. I have roughly close to 30, but those are a handful of important ones.
The ones you mentioned are resonating with all of us who treat chronic pain. I think back to the pandemic. The first one you mentioned is in isolation. At one point, obviously, before the pandemic, it was common when people who got treated for pain came into a clinic where there was a PT clinic or a multidisciplinary clinic. All of a sudden, for a period of time shut down, luckily Telehealth has proved to be effective for most people with regard to that. Luckily, we have that.
The second that you mentioned is when people feel helpless or hopeless and have items or things around them that they could potentially injure themselves with. Opioids are one. It’s this double-edged sword where people may need opioids for a period of time to help them with their pain, but we should be aware that this could be a potentially negative substance for danger. Depression itself, most people with chronic pain suffer from some form of depression. I’m curious when you say obviously depression is a major risk factor. Are you saying major depression, or is even moderate middle depression a factor?
I’m thinking of the severity, a more severe depression, and then it gets a bit backward because people tend to lose energy when they’re depressed. People always talk about that recovery period when they start to feel a little bit better that often becomes a time for planning. There would be 8 or 9 different symptoms if we were able to go into clinical depression. It would be changes in sleep, interest, energy, concentration, appetite, and some sense of wanting to take their life potentially are thinking about that. I’m talking about severe clinical depression.
I’ve reached out to you about this topic. In Episode 249, I interviewed a colleague of mine. His name is Dr. Zachary Stern, a physical therapist. He put out a paper on how to screen for psychological factors when treating people with chronic pain. Specifically, that paper is for physical therapists. It’s an excellent paper. I recommend everyone read it and check out that interview.
There’s a framework he has in that paper of moving from what we would identify as a biomedical approach to pain toward a bio-psycho-social approach to pain, where you’re screening for the psychological factors as a PT. In that screening process comes up the topic of suicidality. Screening for suicidality, what do you do as a PT specifically if someone says, “Yes, I have a plan to hurt myself, or “Yes, I’ve been thinking and contemplating hurting myself or taking my own life?”
In that paper is to call 911. He’s part of a team. It’s a group effort here. I’ve read that we should call 911 and that we should not call 911. I’ve heard even mental health providers who I know personally and professionally are on both sides of the seesaw. I’m wondering, what is your perspective? I know you have some research on this and some data, probably. Should we call 911 if someone confides in us and says, “Yes, I have a plan to take my life?”
“If I have a plan,” my next question is, “Do you have the intent?” For me, these get into very nuanced situations, Joe. Can I globally say, “Yes, 911. No, 911?” My effort would be to lean on the no 911, which wouldn’t be my first reaction unless there was the intent. Having a plan is one thing. Having the intent to do it is something else. Part of the assessment process that I want people to go through is assessing thoughts, intent, plans, and means. I gave you examples of this.
There’s a difference between passive and active thoughts of suicide. Certainly, there’s a difference between intent and plans. Many times, what I will watch is clinicians on every spectrum, whether it’s mental health clinicians, or otherwise, want to immediately turn to 911 or ER services, Emergency Room services, as a first response, mostly because we are unable to, one, assess accurately enough, and two, intervene, and three, manage our own anxiety. Lots of times, the management of the client or the patient is more tied to the management of our own experience as opposed to the patient themselves.
There’s a whole lot to unpack there, which is why I wanted to invite you on and talk about this. The nuance is what’s important. This is what I want to talk about first. I want to talk about the practitioner or the clinician’s own sense of feeling anxious and vulnerable.
The first place to start is that people are not trained well enough. There are two pieces to this. One has to do with the literal knowledge involved to understand the suicidal thinking or process or all the factors that are tied into this. One part of it is the assessment phase. The second knowledge piece is the intervention part of that. Those are two areas that are important.
The third is if we don’t manage our own unpleasant emotional state very well, we’re typically not going to be all that great at containing someone else’s experience. It might take a simple reflection of feeling back to the patient that might calm the patient down, or a few different questions that deepen your assessment that then makes a huge difference in calming the situation in finding out that the person is only thinking occasionally about it.
They have no intent, plans, or means, so we’re approaching the patient in a very different way. It’s much more sensitive, attuned, and responsive. In fact, the early writings and why I wrote the article I did many years ago are because most of the literature that existed had to do with action-based interventions. That to me was all mostly managing the clinician’s anxiety and not containing for the client. It’s responding to the feeling state of the client or the patient that makes a huge difference in terms of responding more accurately to what’s going on when somebody starts to talk about the pain that then registers to suicidality.
It’s very difficult to put out someone’s emotional fire if we can’t manage our own.
It’s important that we are able to do more of that.
There are three aspects you’re talking about here. Probably the most important part is how do I manage my own feelings as a professional, as I’m entering into this potentially anxiety-provoking situation. Two, how do I accurately assess this? The third is the actual intervention part. Where do we go with regard to assessment?
For me, there’s a sequence that I talk about. Certainly, if you’ve had an opportunity to do a thorough assessment, and frankly, I don’t care what profession we’re in at that point. Whether it’s me as a psychologist, you as a doctor of physical therapy, or some other discipline, it’s important that we’re covering these kinds of important questions. Most of us, we’ll do some interview or an intake in order to do that. A routine part of it needs to be two things. I know people touch on pain. It would be great if people touched on depression. There’s knowledge out about how to do that.
We do this interview. Part of that interview is assessing for depression, and one element of assessing for depression involves suicide. We’re then also asking questions, “Have you ever thought about hurting yourself, taking your life, or completing suicide?” It becomes routine as part of what we ask, and you’d be surprised at how many people give yes answers to that. A yes answer doesn’t mean alarm necessarily. It might be, “Help me understand that.” That would be the next layer is, “Let me understand the thoughts that you’ve had. How long ago did they occur? Was there ever an attempt?”
When you’ve screened, and someone has said, “Yes, I’ve thought about this,” at that point, what you’re trying to do as a clinician is to potentially normalize the experience for them because it’s normal that people have suicidal thoughts.
It’s very common.
It’s even more common in the populations that we see as health professionals.
Now that we’ve normalized that somewhat, how do we move forward from there?
For me, I started to approach it a little bit. My shorthand for it is to ask about thoughts, intent, plans, and means. If it comes up, I want to get a sense of how long ago they thought about this? It could have been years ago and never happened again, but they said yes to the question. Maybe it was a couple of months ago or right now. Especially if it was recent or right now, I’m going to want to deepen that conversation.
For me, it’s, “What thoughts are you having? How frequently do you have them? How intensely do they disrupt your thinking or disrupt your day or feel intrusive to you? When you start to have them, how long do they last? Are they lasting for fleeting or are they lasting for minutes or hours, or it seems like it lasts the whole day?”
There are ways to also deepen in the understanding and the kind of thoughts. Are they active thoughts like, “I went out and bought a gun? I’m going to go drive my car off a given cliff?” They’ve got plans and thoughts in there together, or is it, “People would be better off if I were gone.” Both are important. I’m not going to dismiss the one that seems a little bit more passive. It’s as important. Why? They have it, and that’s going to give me a measure of distress.
I want to find out about intent. Joe, this is the one question people across the board have to ask is, “Do you intend to follow through?” You can’t walk around this question. There are no circling rose bushes or anything else. You have to ask the question straight out, direct. “Do you intend to take your life? Do you intend to complete suicide?” Anything that smacks of that has got to be asked directly because we need to know intent. The intent question is the one that leads us more towards 911.
That’s the answer that everyone’s looking for.
If it’s a yes, the next question you want to find out about is imminence. I’ve had people say yes to that question, but the response, I’ll give you an example of a response, was, “I wouldn’t do it until I paid off all my debts.” They didn’t want to leave people with debts. When evaluating for that, it came out that that would be 6, 9, or 12 months later, then imminence is not an issue. The intent was, but imminence wasn’t. With the intent question, the next thing we want to know is imminence. Those two pieces are part of what led to 911.
I like these frameworks you have because it helps everyone see, “How can I embed this in my evaluation.” In general, I’m screening for psychosocial factors. In chronic pain, there are many that we screen for, fear, anxiety, but you mentioned depression, and we screen for that as PTs all the time. As a part of a good quality evidence-based validated depression screen, there should be something with regard to suicidality in there. You have this intention that we’re looking for in part of the patient interview, so to speak.
If there’s an expression of suicide, then I’m deepening the conversation to the next level. The next level is these thoughts, intents, plans, and means. If it’s intent, we add eminence. How quickly does someone intend to respond? I’ve had some of the same things. We’ve had somebody say, yes, they had intent. He was a scuba diver, but the issue was when was he next going to go scuba diving? Could we work within that timeframe and before he ever did that again?
There are many different ways to start to listen and hear that even though there might be intent, there is no imminence, so the threat is not there. I want to find out certainly is whether somebody has the means available or do they have plans? Do they have the means? I’m asking the questions directly and also listening for the kinds of answers that they’re going to suggest to me that it’s closer as opposed to farther away.
I’m assuming people reading probably want to know someone has an intent and imminence, maybe there’s a stat on this, or you know this, how likely are they to share that information with you?
The research suggests that 80% of the time, people are going to give you signals or signs, and 20% of the time, people won’t do that. That 20% that none of us can help. They’re very clear about it and intent on it. Even if you ask, they’ll tell you no, and then they’ll follow through anyway. On our end as clinicians or family members, frankly, it’s living with the helplessness that it evokes. It evokes a profound sense of helplessness in all of us. Don’t think that clinicians don’t feel that. Clinicians feel it.
It’s normal if you’re vulnerable as a clinician if you don’t have the proper training, right?
That’s why when I saw that in the paper, I deeply appreciated my colleague for opening the conversation up about that. As you know, a research paper is limited in words and content and what we can do. I appreciate the conversation. I’m like, “It’s great, but there’s more to it than just referring to 911, obviously.” If a practitioner does call 911, what’s the risk to the patient at that point if they don’t have that intent or that imminence?
There’s a wide variety of things. One, you’re boxing the individual in, and that’s not emotionally where they are. They’ve been up-leveled into potentially a medical system, or it can have other implications as well for careers, depending on who they are. They’re boxed into that system. We were talking that a hospital might not have beds. Psychiatric hospitalization isn’t what it was many years ago. People don’t get the benefits of a long-term treatment if it’s truly needed.
Instead, they’re in a short-term system that gets turned over to anywhere between 24 hours, 3 or 14 days in most states. What I was telling you is that a hospitalization doesn’t decrease risk. The research suggests that hospitalization contains risks. Somebody’s in the hospital and now have to deal with the stigma, medical costs, and array of other experiences that might be meaningless in relation to their genuine experience, and even tell you that they were suicidal.
Can you tell us a little bit about that paper that you wrote and the findings that came out of that? I know obviously, you teach this to your psychology students, but it’s formed your work in many ways.
You’re talking about the 1999 article. What I found there and wrote about when I first started to address this issue was that more of what was contained in the general psychology research literature at that point were suggestions about what a clinician should do when somebody was suicidal. It was more than all the action-based kinds of things. My impression was it was designed to contain the clinician’s experience more, but it didn’t seem to be addressing the experience of the client or the patient.
My focus was to dial into what I called feeling-based interventions as opposed to action-based ones. The feeling-based interventions were to focus on the patient. Edwin Shneidman, who was considered one of the leaders in terms of the field of Suicidology, used to call suicide psychic. It’s totally in line with this. What I found is that the part of the way that I look at suicide, especially if there’s moderate to low risk, as opposed to high risk.
The high risk we’re talking about may be severe depression, thinking difficulties, a whole array of things where there is also intent. Those are going to be high-risk people. Those might be the people that will go 911 and focus on action-based strategies, perhaps almost entirely. The intent is not there. Maybe there are thoughts and plans, but there’s no means and intent, or it’s even less than that. I’m going to go for some mix of action-based plus what I would call feeling-based interventions.
The first thing that I want to do with somebody is to thank them for being honest about their experience. What I will say to them is, “One, I’m glad that you’re here. Second, I’m glad that you’re talking about this because what it suggests to me or tells me is that not only do you have the desire to live, you have the desire for help.” I’m going to do it the other way around. They have the desire for health and to live. I’m going to frame it that way in part because I want them to get the message that’s what talking about it and making it open so others can respond and help makes a difference. That, to me, is a signal that they want to live.
There are 8 or 9 that I have written in that particular article, but the three that I want to highlight that’s the first one. The second one, oddly enough, Joe, is to convey to people that there’s a difference between the desire to end one’s life and pain. It’s so interesting because people don’t necessarily make that distinction. They’re in pain, and the only solution is because they’re in so much pain, and this could be physical or emotional that they go, “I got to end my life.” It’s like, “No.” There is a difference between the two. Sometimes offering that up makes a difference in terms of someone shifting their experience like, “You’re right. It’s the pain I want to end. It’s not my life I want to end.” Most of us don’t want to end our lives.
It’s a nice distinction. It creates some space between the two experiences.
Surprisingly, people don’t think about that, the people in pain.
It’s subtle, but it creates some mental space between two potentially different experiences for them.
The third one to me is the one that does the most important. What I started to hear when people were suicidal, and again, if I go with Dr. Shneidman’s response of psychic, we don’t have a word in our language that captures the depth of pain we’re in. When people start to use the word suicide, that’s where my brain goes first. It’s like, “They’re not feeling a little blue, a little down, nor are they necessarily feeling profound sadness or disappointment.”
They are in such depths of pain that the only word they can use to capture that depth of pain is the word suicide. Part of it, when I teach about this or train others, mostly clinicians, what I will talk about and I’ll write on the whiteboard, “Suicide equals act or action.” I’ll put a little one of those slash marks through the equal sign and go, “No.” When moderate low-risk, suicide equals communication, it’s a signal about the depth of typically unbearable or intolerable pain that I’m in.
What I will do is I’ll talk to the patient about this, and I’ll say, “This is what I hear you communicating. The only word you have to capture what you’re going through is to tell me that you’re suicidal.” That gives me an idea of the depth of the pain that you’re in. What is also telling me is that it feels unbearable or intolerable to you. What I’m going to ask you to do is that when you leave our room where we are, virtual or otherwise, at this point, is I want you to switch out the word.
Anytime you think the word, suicide, or anytime you think about taking your life, what I want you to do is to shift it over. We’re not talking about life or death. We’re talking about finding a way now to help you either manage the pain or end the pain you’re experiencing. People wrap their heads around this and find it useful. In fact, I had a grad student years ago come up to me probably ten years after he graduated from his doctoral program. He told me that I had saved his life. It’s like, “What are you talking I saved your life?”
He was in a class where I taught this material. I did not know he was suicidal. He never told anybody, but he would continually remind himself that it was about the emotional pain. He was in unbearable pain, and it wasn’t about taking action. That’s what he used to get him through until he was on the other side of it. I had no idea, Joe.
The words hopeless and helpless have never seemed quite appropriate to me, especially when you start to talk to people and they start to tell you what their life is like, what they’re experiencing and struggling with. What I’d like with what you’re saying is you are helping facilitate a sense of hope in them. You see suicide as the way out almost. You can’t see anything else, but there’s this space between where we can help you manage, alleviate, relieve a lot of what’s happening so that now we can start to see a life that’s there.
I would say here and what I advocate that there is some proportion, balance of action-based and feeling-based interventions. I will never know what that balance is because those are the nuances tied to the individual that’s coming in and saying, “This is what I’m experiencing.” It’s understanding that there needs to be some mix of the two, the proportion is going to change based on the individual.
I know negative self-talk and self-criticism are something you talk about often. It shows up all the time in the clinic. How does that relate to this topic?
This is a big one. I have no way to prove it at this point unless I were to go out and do a study. We should think about this one. Harsh self-criticism is one of the most important contributors to suicidality. It’s the takedown. If we’re in a wrestling match or some other encounter, this is the punch that knocks people down to suicidality.
That’s a wrestling match with ourselves.
When I am working with somebody, first meeting them and hearing layers of harsh self-criticism, I’ve now shifted, part of the way, I practice making efforts to help them end the harsh self-criticism first so that we have the space to work on other stuff. Harsh self-criticism, in general, I look at as a distraction from unpleasant feelings. For me, harsh self-criticism is a thought hijack of unpleasant feelings.
How is it a distraction? Can you give us an example of that?
I was doing an interview similar to what we’re doing. I could hear the other person, but he could not hear me. I’m watching him trying to do all this stuff on the keyboard, and that’s not working. I watched him dip it down, and you can imagine he’s now crawling underneath. I can see him crawling underneath and playing with the chords. You got the whole picture. This is going on for a few minutes and I’m totally chill. I’m fine. I’m not saying anything. I’m waiting. Out of his mouth comes, “I’m so embarrassed.” Without missing a beat, he says, “I’m so stupid and such an idiot.” That’s the thought hijack. Embarrassment would have been fine. No, it didn’t stop at embarrassment. It went to, “I’m the idiot and stupid.” That’s the distraction from the embarrassment.
It’s not that the difficult or unpleasant feelings he was having at that point of being embarrassed or necessarily the problem. It’s how the thoughts can have a consequence on his behavior at that moment or even later on throughout the day throughout his life.
Now that becomes the talk. Harsh self-criticism and unpleasant feelings are not equal. There is zero equivalence. Think of an elevator tanking.
It can take you down fast.
Depending on how much you do it, how intensely you do it, how frequently you do it, you’re coloring your whole experience in a profoundly damaging way. What we know is that this thinking also promotes more pain. There’s an intersection between how we treat ourselves from a thought and a feeling perspective that contributes to more pain.
That’s why I love mindfulness so much because aspects of mindfulness and the type of mindfulness-based approach study are a lot about letting some of these feelings, difficult sensations unfold and realizing there’s the body component and also a mind component that happens and how those two interact? How you can create that space and interrupt that automaticity that we’re talking about that steamrolls in people with depression, chronic pain, a lot of the populations.
I was doing some research for this episode, and pain catastrophizing is all over the literature with regard to chronic pain, but it comes up with everything. One of the highest risk factors for chronic pain is pain catastrophizing. It fits in so well with what you’re talking about with regard to negative self-criticism. It’s a form of rumination.
The other thing that I didn’t mention that is worth also mentioning is the unresolved trauma. Trauma is a contributor. There are leftovers that people also need to address. If those can get addressed, sometimes that also makes a difference in relieving some of the physical pain.
Any comments or suggestions for clinicians who want to receive more training in this area, brush up, or learn about the latest evidence-based research, things like that?
What I would do is probably, believe it or not, encourage people to go back to the ’99 article. It’s in Professional Psychology Research and Practice is where it was published. It’s a suicide and assessment and intervention and it has to do with action-based and feeling-based interventions. That’s a nice start. Bruce Bonger has written a lot in this area and there is also David Joves. There’s a wide variety of authors who’ve also written in this area. They can go to some of those materials. The training is out there, but the important thing is getting it. With increased knowledge, it will make a difference in terms of your more accurate and attuned response to suicidality.
Tell us again the title of your paper and the journal it was in.
It is in the Professional Psychology Research and Practice, Suicide Prevention and Integrated Training Model Using Effective and Action-Based Interventions.
Dr. Joan Rosenberg, it’s always a pleasure to speak with you. I know you have lots of other great stuff in the realm of anxiety and unpleasant feelings. You have two TED Talks, multiple books, a website, and your own podcast. Let people know how they can learn more about you.
Certainly, if they go to DrJoanRosenberg.com, that would be the first place, or you go to YouTube, there ultimately will be TEDx up there. I’m doing one on imposter syndrome coming up. It’ll be a Ted Silon conversation. YouTube will carry you to all sorts of podcasts and other information. Certainly, you can reach out to me through my website directly. If there are people who want to reach me, I’m very findable.
You can reach out to Joan and learn about her work, books, products, or programs at DrJoanRosenberg.com. You can search on YouTube.
If you’re on Instagram, we’d love it if you take a screenshot on your phone of this episode, and you can tag both myself and Dr. Joan Rosenberg on Instagram. We’ll make sure to reach back out to you. If you’re someone who is struggling with suicide or needs help, you can always call or text the National Suicide Prevention Hotline at 1-800-273-8255, where you can talk to a trained professional and receive immediate support. It’s been a pleasure being with you on this important topic. We’ll see you next episode.
- Dr. Joan Rosenberg
- Episode 249 – Past Episode
- @DrJoanRosenberg – Instagram
- Twitter – Dr. Joan Rosenberg
- Podcast – The MindStream Podcast
About Dr. Joan Rosenberg
Joan I. Rosenberg, PhD, creator of Emotional Mastery™ and Emotional Mastery Training™, is a highly regarded expert psychologist, master clinician, trainer and consultant. As a cutting edge psychologist who is known as an innovative thinker, trainer and speaker, Joan has shared her life-changing ideas and models for emotional mastery, change and personal growth in professional and educational seminars, psychotherapy sessions and graduate psychology teaching.
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