How chronic pain and illness affect your mood

As I sit writing this, I am in a moderate amount of pain. Like millions of people around the world, I suffer from chronic musculoskeletal (back and hip) problems, so most days come with either a small or large dose of pain, depending on how well I am looking after myself, how stressed I am, how much sitting I do that day, and various other factors.

Having been in some degree of daily pain for almost two years now, I have learned a few things about the relationship between physical pain and mental suffering:

  • It's important to distinguish between 'primary' and 'secondary' pain. I learned this from Vidyamala Burch, founder of the excellent Breathworks. This organisation provides the Mindfulness-Based Pain Management programme, which has a strong research base behind it and helps many people in the UK and beyond deal with chronic pain and illness.

  • Burch also co-wrote Mindfulness for Health: A Practical Guide to Relieving Pain, Reducing Stress and Restoring Wellbeing with Danny Penman. In this superb book the authors explain that primary pain is the actual raw data caused by, say, a gash in your leg. Intriguingly, the majority of the pain you end up experiencing is secondary – the pain created by your brain as it amplifies that raw data, depending on the way you think about and respond to your primary pain.

  • This only became clear to me recently when I visited my osteopath during a bad patch physically, feeling down and hopeless about resolving my problems. He reminded me that the pain was significantly better now than when I first came to see him; and that it was crucial to remain as positive as possible, because my negative thoughts ('I will never get over this'; 'Nothing will help'; 'I can't stand the pain any more') were undoubtedly making the pain worse (this is essentially what the Buddha taught – that human life inevitably involves pain, but we create suffering by our response to that pain. But that's a topic for another day).

Managing the pain

I think it's important to note here just how hard it is to maintain a positive, optimistic mood in the face of chronic pain or illness. As anyone with a long-term condition knows, it grinds you down, especially when it flares up or your symptoms get worse for whatever reason. Please don't think I underestimate the impact of physical ailments on your mood – it is a struggle and gets everyone down from time to time, as well as causing stress and worry/anxiety about the future.

I couldn't understand that vicious cycle any better. But once you understand the relationship between pain sensations in the body and the way that your brain either amplifies or minimises those sensations, it seems crucial to me that you do all you can to use your brain/mind to help your body.

 When I first hurt my back and was really struggling, Vidyamala Burch's guided meditations really helped pull me through. Here is a great one on being more compassionate to yourself, available for free, if you would like to try it. And if you are dealing with chronic pain or illness, my thoughts and well wishes go out to you – I hope you get the medical help you need and manage to overcome your problem soon.

If you would like some help with the psychological aspects of your condition, call me on 07766 704210, email or use my Contact form to get in touch.

Warm wishes,


The difference between pressure and stress

People often tell me that they 'thrive on stress'. I respond that they might be confusing pressure – which can be energising and motivating, if we respond to it well – and stress, which always has a negative impact on us. Let me give you two examples:

James is a 30-year-old entrepreneur, who has recently launched a startup website selling his own brand of clothing. James is passionate about his new business and thrives on the pressure he puts himself under to make it successful. He works long hours, but knows this is necessary to get a new business up and running. James thoroughly enjoys every minute of his working day, so never feels stressed or overwhelmed – the fact that his business is doing well helps him stay positive and optimistic about the future. 

So for James, it's clear that the – self-imposed – pressure is a positive thing; it gives him the energy and drive he needs to make his new business a success.

Emma is a 26-year-old nurse working in a busy hospital in inner London. Over the last year, she has seen wave after wave of cuts in the number of nurses and support staff working on her ward. She and her colleagues work very long hours with no breaks – Emma wolfs a sandwich during her daily meeting with the other nurses. Sometimes she goes hours without even a drink of water or toilet break, as she is swamped with constant crises and demands from her patients. Emma's nerves are stretched and jangling, she feels exhausted and irritable all the time – recently she snapped at a difficult patient, which shocked and upset her. Emma is so stressed that she doesn't know how much longer she can take it and is seriously considering quitting nursing before she becomes seriously ill.

It's clear that Emma is suffering from chronic, debilitating stress, which is affecting her physically and psychologically. Like many people suffering from stress, she feels overwhelmed, under-supported and out of control of her working life. If she doesn't do something soon, she may will burn out or develop a more serious illness, as all the research shows that long-term stress is harmful to the body and mind.

In schema therapy terms, this kind of stress is generally caused by the Demanding Parent mode, which drives us on to work harder and harder, never feeling that what we do is good enough. This part can also make us feel under pressure – but it's not the kind of positive, motivating pressure James thrives on. Demanding Parent-induced pressure is unpleasant, debilitating and overwhelmingly negative. James's enjoyable pressure is probably coming from his Healthy Adult, which encourages and motivates us, rather than being critical or undermining of our best efforts.

If you are struggling with short-term stress, cognitive behaviour therapy (CBT) will be extremely helpful. If becoming stressed is a pattern for you, or it's affecting every area of your life, schema therapy may be more suitable. If you would like some help from me, email

Warm wishes,


Feeling tired, stressed and under pressure?

If you often feel stressed or pressured, are hard on yourself and prone to self-criticism, you may well have a strong Demanding Parent – one of the most common modes in schema therapy. These modes are parts of our psyche, which have different functions and can be more or less helpful, depending on the messages they give us. For example, the Healthy Adult is a nurturing and protective mode, which helps us function well day to day and defends the more vulnerable parts of us from the critical, unsympathetic parts.

This may all seem a bit confusing, but we all have different sides to our personality – some more positive and helpful than others. In order to work directly with these different sides, in schema therapy we name them and try to get clear on their particular flavour: protective or attacking; encouraging or destructive; soothing or upsetting. The Demanding Parent is the part that drives us on, trying to achieve ever greater volumes of work or higher standards in our work, parenting or academic achievement. To an extent, this is helpful – it's good to be hard-working and ambitious, to take pride in everything we do. That's certainly the approach I take to my therapy sessions – I always want to do my best for people and help them as much as I can.

Never good enough

The trouble is, your Demanding Parent is never satisfied. It's like however hard you try, however many hours you spend slaving away at your desk, however much praise you get from your boss, that internal pushy parent always wants more. I see this mode in people who are perfectionistic, never happy unless they get all As or a first in their degree. Also those who are harshly self-critical, jumping on every mistake, however small, and berating themselves for it. If you have a strong Demanding Parent, no wonder you feel exhausted and under pressure all the time!

In schema therapy, we aim to quieten this destructive voice down and get the Healthy Adult to take over its job. This part of us still pushes us and helps us achieve, but is encouraging, not aggressive; positive, not negative; and supportive, not undermining. Think of it this way: if you wanted to lose weight, would you rather have a personal trainer who screamed at you and put you down all the time, or one who was encouraging and on your side, helping you achieve your goals without making you feel bad about every little slip-up? I know which I would choose.

Remember to be kind to yourself, even when you are striving and aiming high. Research clearly shows that being harshly self-critical is not remotely helpful or motivating. A firm but fair approach achieves far better results – and doesn't leave you vulnerable to developing mental health problems like chronic stress, anxiety or depression.

If you would like to learn how to be less self-critical, email

Warm wishes,