Control Versus Influence

I came across an interesting concept in an excellent book I recently read – CBT for Chronic Pain and Psychological Well-Being. In the session looking at “orientation to change”, Dr. Carlson points out that when an individual feels they have some control over a situation, they are more apt to act and advocate for themselves. This thinking is in alignment with the Health Belief Model and also the concept of Locus of Control. For individuals with persistent pain problems a major focus around treatment should be to try and increase their internal locus of control. This can be challenging as many individuals that have suffered with pain for long periods of time. They often feel a loss of control over their situation and thus a significant shift toward external locus of control regarding their situation. As part of our assessment we want to gather information to identify how the person perceives control in their life. Then we can dive deeper into how those beliefs and perceptions affect their function.

Control can be simply defined as having power over something. I think it may be fair to say that there is a common perception for many in our culture that everyone needs to be in total control of themselves. The thought that we should be able to exert our willpower to overcome anything is held by many. If you are unable to, then this can be seen as a character weakness when you fail. (Side note: read Kelly McGonigal’s The Willpower Instinct to gain a greater understanding of willpower. This book goes into what it is and is not.) An example might be how some think we should be able to control our emotions. Emotions are just a brief conscious experience that emerge based on neural activity mostly centered on pleasure or displeasure. Our emotions are primarily subconscious processes of our brain that are naturally occurring based on mood, genetics, personality, learning, and environmental factors. We do have an opportunity to choose our reactions and behaviors during the emotions, but the emotions themselves not so much. When individuals create a dichotomous response to control (‘I have full control’ versus ‘I have no control’), they lose flexibility and freedom in their ability to cope and address situations. The idea that things can always be controlled implies that there is a straight linear path that is predictable regarding the outcome. The problem is in persistent pain there are biological and environmental factors that are outside of one’s control that will affect their pain experience. This is why pain is never linear in its reaction to nociception or when it persists past the normal healing time frames.

Influence on the other hand can be defined as producing some effect without exerting direct control or power over it. When people focus on influencing things they can have more variability and options in their choices to their response to situations. This allows someone to avoid the black and white choice of control or no control. We have to be accepting of the fact that we will never have full control of everything. This is difficult for some to accept, but shifting them to seeing they can have influence in everything can be helpful. My approach with patients is often done by this example:

“Let’s look at the food you just ate a bit ago. How much control do you have on deciding which fats, carbohydrates and proteins are stored and distributed throughout the body and which ones are sent off as waste? Can you control where each of those molecules goes in your body?”

This bit of Socratic method often times highlights that many things are outside of our conscious control. This example does allow me to then start to talk about influence.

“While we cannot control what the body does with all the food it takes in, we can have significant influence on it by making good choices on the foods we choose to put into our mouths. While we cannot control why you are experiencing pain, we can influence it. We can provide you with many “healthy” options that have been shown to help influence pain in a positive direction.”

This then can lead into a discussion about many healthy options they can look at working on to influence their pain (exercise, sleep, goal setting, pacing, mindfulness, diet, etc.). The good news, just like with the food we eat, the healthier options we feed and provide our bodies with the more it seems to self-correct. As this happens the person in pain most often feels better and able to function and move forward toward their goals.

What say you? What are your thoughts about this concept of control versus influence? Can we control pain or only influence it?

via Dr. Kory Zimney

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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