Cognitive techniques to prepare for back surgery

1. Directly decreasing preoperative anxiety and fear

2. Providing coping skills to help decrease postoperative anxiety and pain

These techniques include methods such as:

• Distraction

• Thought stopping

• Identifying negative automatic thoughts

• Developing coping thoughts

Automatic negative thoughts comprise the negative or pessimistic self-talk (often subconscious) that occurs when we are under stress and can cause emotional and physical reactions. There are several types or categories, but the most common ones that occur in preparing for surgery include:

• Catastrophizing - imagining the worst possible scenario and then acting as if that will actually happen (e.g. "What if I never get better?")

• Filtering – focusing only on the negative aspects of a situation to the exclusion of any positive elements or options (e.g. "There is nothing that will help my situation")

• Black and white thinking – also termed "all-or-nothing" thinking, there is no middle-ground or any shades of gray (e.g. "The surgery is either a complete success or a complete failure")

• Overgeneralization – an aspect of one situation is applied to all other situations, whether appropriate or not (e.g. "With this surgery, I will never have any fun again")

• Shoulds – "Should" statements are a key element to negative self-talk. "Should" thinking is operating from a list of inflexible and unrealistic rules about how you (your body) and others "should" act or respond (e.g. "I should never have allowed this to happen")

In preparing for back surgery, a patient can be taught to identify negative thinking and develop challenging or coping thoughts to counteract it (a method called "Stop-Challenge-Reframe"):

• Quickly identify the negative automatic thoughts when they occur

• Challenge them through a self-questioning process

• Replace them with coping thoughts

Patients master this technique fairly quickly using a written journal. With a little practice, negative automatic thoughts begin to diminish and coping thoughts become more natural. Examples of coping thoughts are:

• "I am choosing to have this back surgery for the positive outcome of..."

• "I can take control of my situation in the following ways...."

• "I can cope with the pain and discomfort by..."

• "I am looking forward to having the back surgery completed and getting on with my recovery"