Resilience

Realistic optimism is maintaining hope while moving forward and dealing with one's current reality. It requires flexibility, perseverance, courage, and hope.

Realistic optimism is not determined by the number of adverse events in your life but rather by how you view and respond to the adversity. You can increase resilience by approaching adversity as a challenge rather than a threat.

A growth mindset is simply the belief that improvement is possible. Someone with a growth mindset believes that they can change things for themselves through effort, strategies, and help from others. If you have chronic pelvic pain, you might not be able to do everything you could do before, and this might make you feel frustrated and exhausted. You can gradually learn to thrive while you deal with your challenging health issues through effort, planning, and support from others.

The opposite of a growth mindset is a fixed mindset, or the belief that you cannot improve your skills or situation. A fixed mindset would lead you to overlook the good things in your life and ruminate about what you cannot change. Having a growth mindset involves appreciating the happy moments, no matter how small they may be.

Beliefs about the control you have may influence how you manage your emotions. One core belief people have is about how much control they have over being able to manage their lives, including their health. The unpredictability and chronic nature of pain symptoms can leave people feeling like they don't have any control over their lives. Feeling like you are not in control can, in turn, lead to several other emotions, such as anxiety, fear, anger, sadness, or hopelessness.

Control is generally thought of in one of two ways:

• People who have an internal locus of control feel that they are in charge of making change happen in their lives.
• People who have an external locus of control believe things happen to them because of external forces such as powerful other people, or by chance/luck.

There are benefits for those with an internal locus of control:

• Increased self-confidence
• Increased positive mood
• Reduced anxiety and fear
• Reduced stress and tension
• Reduced feelings of being overwhelmed
• Increased ability to make decisions/take action on own timeline
• Increased ability to cope better with unexpected changes
• Increased overall health

Fortunately, there are several things you can do to increase your sense of control while living with chronic symptoms. The first one is to recognize what you do and do not control. It's true that you cannot control everything, and pain certainly can cause feelings of uncertainty and unpredictability. However, you do have control over the choices you make and how you react to your circumstances. Taking a few minutes to list several things that you feel you can control about your life is a helpful start. Save this list. Sometime in the future, it may come in handy to remind yourself that you have the ability, skills, and intelligence to make things happen. When you finish making this list, you may be surprised to realize that you have more control over the events in your life than you previously thought you had.

Feeling in control of your life can help you to live more fully in the present and not be held back by things from the past. Some examples:

• Letting go of feeling guilty about things done or not done
• Forgiveness of others/letting go of old grudges
• Forgiveness of self for past actions
• Not dwelling on decisions or actions from the past
• Not getting caught up in "what if's"

Another aspect of living in the present involves reducing energy spent worrying about things that are out of your control.

Living in the present involves:

• Awareness of the current moment and what you are thinking or feeling without judgment of those thoughts/feelings
• Experiencing what you are doing with all your senses: sight, sound, taste, smell, touch
• Savoring positive emotions/experiences as they occur
• Fully engaging with others/in your activities
• Practicing self-care as you need it (not after you've pushed too far)
• Appreciating things that are currently going well
• Avoiding thinking or worrying about the future

Here is one activity you might try to help you focus on living in the present:

Sit quietly. Look around you and notice:

• 5 things you can see.
• 4 things you can touch.
• 3 things you can hear.
• 2 things you can smell.
• 1 thing you can taste.

The goal of this activity is to help you learn what your strengths are and how to use them in ways that make your life more engaging and successful. Studies have shown that using your signature strengths on a regular basis can result in feeling happier, more engaged with life and even more hopeful.

Step 1: Determine Your Character Strengths. You can do this by taking a test like the one offered by the VIA Institute.

Step 2: Write down your top five strengths and post them somewhere that you can see them. Pick one of your top 5 strengths and think of a way you regularly use this strength. For example, if your top strength is leadership, in what ways do you use that strength daily?

Step 3: Put your strengths to work. Each day find at least one way to use one or more of your strengths in a way that you haven't before. You can do this by modifying something you already do on a regular basis or by creating a new activity altogether. What's important is that you use one of your strengths in a new way. For example, if you usually use your strength of creativity for artwork, try using creativity to solve a difficult problem or perhaps settle a disagreement with a friend.

Try using one of your strengths in a new way every day for a week. It can be helpful to note what you did and how things turned out.

When you have chronic pelvic pain, you might feel a lack of control over your life, which can lead to feeling angry, sad, nervous, or helpless. While you might not be able to make your symptoms go away, you can control how you respond to them and how you think about them. By regaining control over how you think about your symptoms, you can reduce your stress, make healthy choices that align with your goals, and cope with changes in your health status over time.

Self-talk is the inner chatter that runs in your mind, the little voice in your head that helps you make sense of the world around you. If the voice is critical and negative, it may stress you out without you realizing it. You are probably unaware of how negative your inner voice can be. The first step to change your inner voice is to acknowledge its patterns.

You might recognize thought patterns by writing down a summary of your negative thoughts in a journal and then rereading them. Another technique is when you notice yourself slipping into a negative thought pattern, consciously say “stop” to yourself. Saying it aloud may be more powerful and allow you to track how often you slip into negative thinking. Some negative thoughts might be self-limiting statements, or ones like “I can’t deal with this!” or “I’ll never feel better!”. Next time you have one of these thoughts, try turning it into a question. “How can I deal with this?” and “How can I feel better?” are statements that enable you to problem-solve and will guide you back to self-care.

The use of positive affirmations, or statements that rewire your brain toward positivity and empowerment, is a scientifically backed way to improve your self-talk and ease your symptoms. You might choose to write affirmations down and hang them on your mirror or bedroom door. You might also write them down in your journal, or simply repeat them when you wake up, before you go to bed, or during the day when you feel overwhelmed.

Research has shown that positive emotions play a vital role in our physical and emotional health. As you know from your own life, positive emotions such as joy can and do occur even when managing the challenges of living with pain. Positive emotions are not just about feeling good. Research has also shown that they can:

• Increase creativity
• Increase flexibility of attitude and thinking
• Help with problem solving
• Serve as a break or respite from stress and negative emotions (can replenish us)
• Sustain our efforts to manage challenges
• Build social connections (people who show positive emotions a lot tend to attract other people and build helpful support)
• Decrease distress
• Prevent depression, chronic stress and anxiety
• Improve our physical health

You may not realize it, but you no doubt do things every day that cause you to feel positive emotions, even if for just a few minutes. What are some things you are already doing that make you feel positive emotions? What are some things you can do in the future to deliberately experience more positive emotions?

Savoring is the mindful act of noticing a pleasant moment, engaging your senses, and trying to make it last. To savor a cup of coffee, listen to the sound it makes when poured, notice the deep brown color, the rich aroma, and the warmth of the mug in your hands.

Savor life's best moments. Consider a typical weekday. Review your morning routine, your daily activities, and your evening rituals, and consider which activities you most enjoy. Every day, try to savor a few simple pleasures, no matter how small. You might want to savor your morning coffee, for example, or the sun on your face as you walk to your car. Spend a few minutes savoring each experience.

Other pleasures to savor include warm baths, your favorite song, and holding hands with a loved one.

Sometimes our lives are so busy, or the chronic symptoms are so dominating that we forget to note and remember the good people, moments, and things in life. This little daily activity can help you become more aware of the good things in your life.

Step 1: Find a box or container with a lid or a piggy bank. Place it someplace where you will see it every day. Your pleasant memories will be placed in this container. You will also need some small slips of paper and a pen or pencil.

Step 2: Take note of a pleasant memory. Every evening think about the people, things or events that made you happy or for which you feel grateful. You may make a list if you like. Pick one of these and spend a moment savoring it. What made it so special to you? Now, write this moment down on a small piece of paper. Use enough detail that later you will be able to immediately recall what happened. Next, add the date, fold up your positive memory "currency," and drop it in the piggy bank or container. You will make these special memory "deposits" in the same way every evening. You may choose for how long you would like to do this. It could be for one week, 30 days or even longer.

Step 3: Review your grateful memories. At the end of a week, 30 days or however long you chose to keep a positive piggy bank, you will "close your account." This means that you will withdraw all the "currency" from your piggy bank and read each one of the deposited positive memories. As you read them, try to recall details of the event and what made it so special to you at the time.

Acts of kindness can have a ripple effect – one simple act of kindness can inspire others to be kinder, too. Acts of kindness can make both the person conducting the act and the recipient feel happier, so why not try a few?

Step 1: Pick a day and plan your 5 acts of kindness. Pick one day in the next week where you will do five kind things all on that same day. These acts can be for people who are complete strangers, friends or family members or for society or the planet. These can be small acts of kindness such as sharing a genuine compliment or giving somebody a hug. Or you can do larger acts of kindness such as volunteering for an event, donating to a favorite charity, or giving a homeless person a meal. You can even do anonymous things or start a project that will take some time to finish.

Step 2: Do your 5 random acts of kindness all in the same day. When you do your kind acts, do not expect anything in return. You might even get some strange looks or reactions as sometimes kind acts are unexpected. Smile as you do them knowing that you are putting positivity out in the world.

Step 3: After you have done your 5 kind acts, do an additional kind thing for yourself. People who have PASC symptoms like pain and fatigue tend to put others first and forget to be kind to themselves. It's important to take care of yourself too. If you are rested and happy, you will be in a much better position to do things for others. Perhaps you could take a long bubble bath, go for a walk in the park, or see a movie with a friend.

MYTH #1: "My emotions have nothing to do with my pain and other symptoms."

FACT: Pain and emotions are processed in many of the same areas of the brain. This helps explain why depressed people are more sensitive to pain and why happy people report lower levels of pain, have better functioning despite pain and other symptoms, and have better quality of life. Positive emotions buffer the effects of negative emotions, so even if you are sad, doing a gratitude activity or an act of kindness can help you feel better.

MYTH #2: "I don't have time for myself."

FACT: Just as a car needs fuel to run, you need to recharge and refuel your mind and body. Pleasant activities can be that fuel! Just taking five minutes to read a funny cartoon or a note from a friend may give you a little boost and help take your mind off your symptoms. But if you don't take time to renew yourself, you may exhaust yourself and run out of fuel.

MYTH #3: "As soon as my symptoms go away, I'll be happy."

FACT: You likely have already discovered this but waiting for your pain symptoms to go away before you can enjoy your life is not a good strategy for success. Studies show that people who have more positive emotions, feelings of gratitude, a sense of purpose in life and feel socially connected have fewer symptoms and a better quality of life.

MYTH #4: "Some days my symptoms are so bad that you simply have to write those days off."

FACT: Of course, there will be days that you feel terrible and like you don't want to do anything at all. As part of this program, try to do something you enjoy anyway – something pleasant. If you at least do that one fun thing, you will look back on the day knowing something positive happened that day. Many of the activities you will do in this module will help you learn such resilience skills.

MYTH #5: "I'll feel instantly better once I try one of these positive activities."

FACT: You might feel a bit happier right away, but for others it may take up to several weeks to notice improvements in your mood and outlook. Know that your efforts are not wasted because improving your mood and general physical and emotional well-being can help ease your pain and other symptoms.

MYTH #6: "My condition is more serious than these activities – they can't possibly help."

FACT: Engaging in pleasant activities is not meant to cure pain and other symptoms. These activities are designed to bring balance to your mind which is likely to be focused on pain. If pain gets processed in the brain against a background of pleasantness rather than negative emotions (e.g., despair, anger, anxiety, frustration) it will alter how the pain is processed by the brain. This can lead to feeling less pain and having a more enjoyable day.

Character Strengths

The Science of Gratitude

Happify module - Love Your Life Despite Chronic Pain