Mr Tanner’s mood has deteriorated since his initial assessment. This is largely due to his frustration at the limitations imposed by his hemiparetic right hand and his inability to sleep due to right-sided shoulder pain. His mood was irritable and he seemed pessimistic about the future, but I have assured him that the function of his hand is likely to improve significantly throughout rehab and that relaxation techniques can help overcome insomnia.
We practiced a number of relaxation techniques, including a progressive body scan to relax the entire body, sound meditation and guided meditation, which are often easier for people new to meditation.
Mr Tanner was sceptical at first as he thought meditation was ‘mumbo jumbo’. However, after practising each technique a number of times, his did admit that both his mind and body felt more relaxed.
Hopefully, regular use of meditation will help overcome pain and induce peaceful sleep by enhancing Mr Tanner's sense of self-control over his pain and combat feelings of helplessness and demoralisation.
I also used some CBT to introduce pain coping, anxiety management and self-efficacy strategies. We discussed the role negative thinking plays in potentiating and maintaining pain levels and feelings of anxiety and depression. I worked with Mr Tanner in challenging his negative thoughts and replacing them with more adaptive coping thoughts. I have also encouraged Mr Tanner to work towards gradually increasing his activity levels with a particular focus on scheduling pleasant events. An increase in the level and range of his activities should lead to an improvement in mood and motivation.