Distraction and attention
How we focus our attention can have a significant impact on our experience of pain. Research has shown that being able to focus attention on a task, activity, or experience - or to distract yourself - reduces pain and distress for people in chronic pain. This is true in the short term, and in the long run. The more we can divert our attention from pain, the less signal we create in our pain pathways. The less signal in our pain pathways, the less pain receptors and sprouts our nerves create, and the less sensitive our nerves become. If we are diverting our attention to pleasant activities, even better. When engaged in enjoyable experiences, we increase our production of good chemicals (neurotransmitters), such as endorphins. And, as you know, these "good" chemicals help to calm pain pathways even more. So, there are very good reasons to learn how to strengthen and focus your attention, and to distract yourself, especially with enjoyable activities.
An important point about attention is that we all only have a limited amount of attention to allocate to various aspects of our experience. If much of our attention is taken up by a particular thing, then there is less attention to be allocated to anything else. It is very much like shining a big spotlight in the dark. Imagine a farm in the dead of night. You are in a helicopter with a spotlight. At first you focus the spotlight on the farmhouse, and that is all you can see. You are not aware of anything else on the farm, because you do not have enough light to illuminate the whole thing. Now imagine you swing the spotlight around to see a paddock of cows. You did not know they were there, because you had not shone any light on them before. But now they are all you can see. And it is the same with attention. You experience what you attend to - and you only have a certain amount of attention to go around.
This is one of the reasons it is difficult to concentrate when you are in pain. You have probably experienced the problems of limited attention on many occasions, if not constantly. The good news is that attention is like a muscle. You can strengthen it with practice and exercise, just like you can strengthen a muscle. And as you strengthen it you can learn to control it.
To start with, and to illustrate the importance of attention, just spend some time thinking about your big toe. Really focus on it. Notice sensations there - become aware of its temperature, any tingling, heaviness, lightness, twinges, aches or other feelings you notice. You will probably discover sensations in your toe that you didn't know you had. And if you kept on focussing your attention on your toe day in and day out, you would become highly attuned to its physical state. You would know what was happening down there in great detail at any time of the day.
The purpose of attentional training is to increase your control over where you direct your attention, despite pain. This is achieved by working on two areas - Attentional strengthening and Attentional focussing.
Attentional strengthening is aimed at improving your ability to concentrate and focus more intensely and for greater amounts of time. Attentional strengthening can be practiced in two ways - through the regular use and practice of brief meditation or mindfulness exercises, and by practicing sustaining attention for increasing lengths of time on mundane tasks. Regular practice is crucial to achieving and maintaining improvement.
Exercises
- Mindfulness - observing your thoughts and feelings
- Meditation / relaxation - check out Relaxation Techniques
- Breathing
Attentional focussing involves learning to direct your attention more productively on you current activities. The aim is to try to maximise ‘task-focussed attention', that is, attention that is directed towards the task, experience, activity, conversation, information, or environment of the moment. This is not easy, and again requires regular practice! Practicing mindfulness and being in the moment is an effective way to do this. Other suggestions for practice exercises and activities are attached. Make it fun or relaxing, and make it a regular part of your day.
As you practice your attentional focussing, it is important not to pressure yourself to attend totally to one thing or another. Think in terms of the percentage of attention that you give to a task or experience. You may start out with only 20% of your attention on the task at hand, and 80% on your pain. But if you practice, you can gradually increase your task focussed attention to 30%, 40%, 50%, 70% and so on, until you eventually learn to direct most of your attention where you want it.
Exercises
- Pick an enjoyable activity - or something you used to enjoy - and do it mindfully. Be in the moment.
- Notice parts of your body that are not in pain - Spend a few minutes focussing on one body part. Make a list of the sensations you can detect there.
- Look around the room. Guess how many blue things are in the room. Then count and see how many are actually there. Repeat for yellow things. Then purple things. Then red things and so on. You can adapt this in any ways you like - e.g. shapes.
- Sit and count how many sounds you can hear. List them. Become aware of every tiny little sound - near and far. Listen for more sounds.
For all of these exercises, make a mental note of the percentage of attention you devoted to the task. Aim to increase the amount gradually over time.