Noticing your thoughts

Knowing what you think about your chronic pain and your anxiety is a big step in helping you to Be Pain Smart.

You might ask ‘Why do I need to notice my thoughts when I am feeling down all the time? It only reminds me of how bad things are. It’s hard enough to live with my chronic pain without worrying about what I’m thinking’.

But knowing what you think about when you are feeling anxious is a big step in helping you to Be Pain Smart.

There is an interactive relationship between what you think, what you do and how you feel

How you feel impacts on what you think and changes how you act. This in turn guides how you feel – this can be either a helpful or unhelpful cycle.

It is hard to be aware of what these thoughts are because they are often quick and habitual. Your brain can tune them out, but they are still there and guide a lot of your feelings and actions.

Over time, the events and experiences you have in life, good and bad, program your brain to have certain beliefs about how you, other people and the world works. These beliefs or brain programs then guide the way you see the things that happen in your life.

Feelings and actions are often linked to common thoughts, for example:

  • when people feel depressed they commonly think their life is hopeless
  • when people are anxious they commonly think that they are in danger or see situations as threats
  • when people are angry and yell or lash out at others, they commonly think that the situation is unfair and unjust.

You can change these brain programs by changing the way you think about what has happened.

Thoughts come and go over the course of a day, but certain ones come up a lot. The ones that come up a lot tend to be the same for people who are feeling anxious or are in pain.

How can you start to be more aware of the thoughts you are having?

There are a few main ways:

1. Often your feelings can show you – remember key thoughts tend to go with the same feelings




You often feel nervous, your heart races or you feel shaky, or you feel worried or fearful all the time.

I worry that might pain will get worse and that things will be worse in the future.



You often feel angry, frustrated, or mad.

People are ALWAYS out to get me.

I SHOULD be able to go for a walk without getting more pain.



You often feel sad, down, or hopeless.

I will never be able to do what I used to do. There is no point in doing anything. I am a failure.

I am a failure.



You obsess over things you cannot change or feel overwhelmed a lot of the time.

Things would be better if I could take my back out and replace it with a healthy one.

I am not coping.

Read the Noticing your thoughts guide to see the common thoughts that go with your feelings.

2. Often how you act can show you – remember key thoughts tend to go with the same actions




You often avoid or pull out of situations.

If I go out, I will embarrass myself.

If I go out, then it will not go well.

I will wake up tomorrow and my pain will be worse.



You often yell at others or storm away from others.

No-one ever understands what it is like for me.

The deserve what I said to them because they made me so mad.


You are staying home all the time, staying away from family and friends, or not getting things done.

Everyone would be better off without me.

Nothing good ever happens to me.

I am not good at anything.

I am a failure.



You often feel restless, cannot settle down or sit still.

Everything feels overwhelming.

I cannot cope with anything when I have pain.

It is all too much for me.

Read the Noticing your thoughts guide to see the common thoughts that go with your actions.

Thought diary

This is a place where you can record what you thought, felt and how you acted during tense situations. This can help you to notice what your thoughts are and to learn how to separate them from your feelings and actions. When you can do this, it is then easier to change or challenge the way you think about what has happened. This can help you to feel and act differently… but first you need to notice what those thoughts are.

Download the anxiety thought diary My thought diary – anxiety. Read through the example and then start noticing and writing down your own thoughts.

Pain and anxiety thought swaps

Swapping unhelpful and anxious thoughts for helpful ones can help you manage your pain and meet your goals. Remember your thoughts, feeling and actions are linked, so the way you think about your pain is important.

Lots of people with chronic pain also start to feel anxious, this can lead to a cycle of avoidance, which often makes pain worse. The way you think about your pain is really important. Often these thoughts can be worries about what might happen, you might think that because you are not happy with how things are right now, the future will be worse.

Some people talk about positive or negative thoughts, but it is more useful to think about your thoughts as helpful or unhelpful. Helpful thoughts allow you to deal better with your problems and  meet your goals. Unhelpful thoughts make you feel worse and lead you further away from your goals.

It can be hard to find helpful thoughts when you are in pain. There is no point denying that you are in pain – but what is the most helpful way to think about this?

‘Yes, I am in pain but the best way for me to deal with this is to stay calm, stop getting stressed and remind myself that the pain will pass, I have dealt with this pain before and I will be okay.’

This is more helpful to you than becoming distressed or angry, thinking the pain will never go away, it is worse than ever and that you cannot cope with it.

What kind of thinking would you prefer?

Sometimes it is hard to stop those unhelpful thoughts. It can be easier to swap these for more helpful thoughts. Read the Pain and anxiety thought swap guide and then try swapping your thoughts for more helpful ones and learn to Be Pain Smart.

Use the links below to download the files