Take your protein pills and put your helmet on

Commander Chris Hadfield was already a hero to thousands when he strapped a massive Soyuz rocket to his back and was launched into orbit to take command of the International Space Station in December 2012. However he reached true legendary status by tweeting about his time on the ISS and then recording a version of David Bowie’s Space Oddity (one of the best songs of all time)…. in space (possibly the most expensive music video of all time?). The man can also wear an old-school ‘tash like it’s nobody’s business.

[youtube http://www.youtube.com/watch?v=KaOC9danxNo?rel=0&w=853&h=480]

Recently, and back on earth, Commander Hadfield gave a TED talk about danger and fear

[youtube http://www.youtube.com/watch?v=Zo62S0ulqhA?rel=0&w=853&h=480]

If you haven’t already, stop reading and watch the whole thing through, right to the end. Its really worth it. After talking about being booted off the planet by the most complex flying machine ever built, with a 1 in 38 chance of dying, going blind in space while floating around his tin can, he picks up a guitar and sings. He could have finished with “I’m on a horse”….. he’s a living, breathing Old Spice commercial.

Commander Hadfield is also pretty adept at conceptual change – at the 8:44 mark he launches into a discussion about spiders – he does a bit of “Explain Spiders”. In the space of a few minutes he explains that in the local region there is only one, out of 729 different spider species, that is venomous (I like that he doesn’t make the mistake of calling it poisonous), he then further dethreatens this one venomous spider by explaining that it’s bite isn’t likely to be fatal, that it won’t ever be in a web hanging across a path and finally that it is easy to spot as potentially dangerous due to its bright markings.

Of course I’m building the obvious link here between Commander Hadfield’s reconceptualisation of the danger of spiders and the goal of Explain Pain in reconceptualising the experience of pain. Commander Hadfield uses accurate information and education (with a bit of story telling, some humour and a range of media) to reduce the fear associated with spiders – there’s a great line at the end of this when he explains “the danger is entirely different than the fear”.

I couldn’t help but think of a person with chronic low back pain who is terrified to bend forwards. Maybe they’ve been told that if they flex, a bit of stuff will squeeze out the back of a disc and push on a nerve, maybe they bent forwards two years ago and felt pain which started the whole thing off – is it fair to say that “the danger is entirely different than the fear” in this example too? How likely is it that this person will do any actual harm or damage to their body by bending forwards? However, the strongly held conceptions that bending forwards is harmful, that pain is damage occurring in their body, that their back is “weak”, “unstable” or in some way vulnerable, might be enough to maintain and trigger a pain neurotag.

After doing some conceptual change, Commander Hadfield then suggests a bit of exposure therapy – emboldened by accurate information about the actual (minimal) danger, he suggests that we find a few cob webs, check to make sure they aren’t venomous (hey, just in case) and then walk through them; allowing the freedom of expression of our protective outputs but at the same time, through repeated exposure, modulating and dampening down the response of these systems so that they don’t fire off based on the perceived threat (fear) but respond appropriately (not at all) to the actual, minimal (if any at all) danger.

With a person experiencing persistent pain, there might need to be some grading – figuratively; maybe touch a few spider webs first, with gloves on initially, and then without, brush through a spider web with your hands and not your face and then work up to the full face exposure – all the while remembering that the danger is entirely different than the fear.

This all takes guts and courage – the advice to “take your protein pills and put your helmet on” again in the figurative sense, might not be out of place.

For the right person, I think Commander Hadfield’s 20 minute talk could be a fantastic part of an Explain Pain intervention; maybe a bit of homework, maybe something they could watch on an iPad in the waiting room? There’s some really powerful implicit learning in Commander Hadfield’s talk that could really power up a discussion of threat, danger, fear, pain, protective output systems and graded exposure.

– Tim Cocks

www.noigroup.com

The art and science of conceptual change for pain features in Explain Pain 2nd Ed, the Graded Motor Imagery Handbook and all noigroup courses. Check out the links for more information and to find a course near you.