Book Review

Young people can change themselves

The chronic pain and illness workbook for teens: CBT and mindfulness-based practices to turn the volume down on pain

Zoffness R (2019). Oakland, CA: Instant Help Books, 176 pp. ISBN 978-1684033522 (Paperback: $16.95 USD; eBook: $13.55 USD). Link

Reviewed by Jeremy Gauntlett-Gilbert

printable version (PDF)

Pediatric pain clinicians usually welcome well-written self-help materials for young people with chronic pain. At the moment, a range of self-help books exist, but most are targeted at parents (e.g. Palermo & Law, 2015; Coakley, 2016). Nonetheless, it seems that it should be possible to write a book that is aimed directly at the young person, that is interactive, developmentally appropriate, and that fosters pain management skills. Rachel Zoffness, PhD, has pursued this important goal. She is a pain psychologist, medical educator at UCSF, and clearly also has a mission as a science communicator.

Chronic pain and illness workbook for teens weighs in at about 150 pages and aspires to communicate facts about chronic pain before going on to cover many of the cognitive-behavioral therapy (CBT) techniques that are involved in evidence-based pediatric pain management. The book is straightforward and written in an amiable, upbeat tone that speaks directly to the young person and avoids being patronizing. The book has relatively few illustrations but strives to be interactive, breaking the text regularly with prompt questions and response boxes; clearly the author hopes for active personal engagement rather than passive reading. Tables and worksheets are here in number, and extra online resources include a range of recordings of techniques such as relaxation and imagery scripts.

The book has several strengths – first, it has immense scope and really tries to cover most of the issues addressed in interdisciplinary chronic pain treatment approaches. A wide range of topics are competently and deftly covered, from pacing and goal setting to screen time and nutrition. Other standout sections are excellent pain education and coverage of the CBT model and cognitive and behavioral techniques. From the outset, readers are informed about the nature of chronic, amplified pain, and then presented with a philosophy of “turning down the volume of pain” and techniques aimed to support this.

A reader might hope that a book like this would do some great pain education, and Zoffness delivers. Sharp, helpful explanations clarify what chronic pain is – and isn’t – and centrally they emphasize that hurt does not equal harm. The reader can feel the voice of a passionate science communicator here, and it’s a strong point of the book. This book could support both young people and parents to come to terms with chronic pain and the common lack of a classic medical diagnosis accounting for the pain symptoms.

As one of several programs across the US treating children with chronic pain, our program evaluates almost 300 children annually and provides intensive interdisciplinary pain rehabilitation for over 100 children per year. Our children report an average of over 11 days of school absences each per month. Our program, like others, reports positive outcomes (Banez et al. 2014; Kempert et al., 2017; Benore et al., 2018); however our program also has a teacher from our local school district embedded in the program to assist with instruction, modeling effective classroom behavior, and supporting school re-entry. Following our program, most children return to their local school, stay in school the full school day, and resume desired school and extracurricular activities (Banez et al., 2014). Based upon over 10 years of clinical practice, this paper provides an updated review of existing literature on school re-entry for children with chronic pain, as well as practical guidelines and accommodations to optimize a child’s successful school re-entry.

The explanation of the role of emotions in the pain experience, and the teaching of core CBT components, is nothing short of excellent. The content is sharply presented, accessible, and thoughtfully punctuated with tables and worksheets. Two meaty, comprehensive chapters detail the role of cognitions in pain and techniques to change them. The whole book is well-written, but these sections in particular bear the mark of an expert clinician who is experienced in presenting this material to young people. Other clinical messages feel robust and helpful. Despite the book’s emphasis on controlling pain and relaxing, there are helpfully clear behavioral messages, for example, “act first, feel changes later.”

Despite the sheer scope of the book – there are sections on biofeedback, negative self-talk, sleep hygiene and school return – the book hangs together and, towards the end, encourages the young person to develop a comprehensive selection of their coping skills, which feels thorough and genuinely helpful.

Obviously, a single book cannot cover all bases, and the strong emphasis on pain education, cognitive techniques, and pain reduction / control results in some techniques and concepts having less space. First, exercise gets minimal attention, meriting only one and a quarter pages out of 150. Of course, this is a psychology-authored book focusing on CBT, but often pain rehabilitation entails more attention to moving the body. Notably, the topic of nutrition is given more pages than exercise.

Second, mindfulness is in the title, but there is no clear description of mindfulness or acceptance-based approaches in the book. Throughout the book, it is assumed that pain control is the goal of all efforts, and that it is achievable. Although a single mindfulness exercise is included in the Mind-Body Skills chapter, no time is given to the idea that it can be counterproductive to constantly struggle to control the pain experience. The book promises to ‘turn the volume down on pain’ from the title page onwards, and concepts and practices around acceptance of pain, or decreasing struggle with pain, are not covered. Distraction is heavily promoted, and it is always assumed that the right mix of relaxation, distraction and mood management will reduce the intensity of the pain experience. This will be an upbeat message for many, but it may not serve those young people with particularly intense or uncontrollable pain patterns or who have tried and failed more classic CBT approaches for managing pain.

Overall, the book is an intelligent, warm and effective presentation of pain-reduction CBT techniques, made accessible to young people. It is probably best aimed towards relatively literate older teens, and at those with mild to moderately severe pain conditions. I can imagine this work being used very effectively in conjunction with a therapist or with parent support – it would be invaluable as a source of homework or as guided self-help. At the end of the book, the author’s overall stance and disposition shine through – she genuinely has no doubt that young people can cope with pain differently, which should help many of her readers to feel this way too.

Cite as: Gauntlett-Gilbert J. Young people can change themselves. Book review: The chronic pain and illness workbook for teens: CBT and mindfulness-based practices to turn the volume down on pain. Pediatric Pain Letter 2020;22(1):19-20. ppl.childpain.org

References

Coakley R. When your child hurts: effective strategies to increase comfort, reduce stress, and break the cycle of chronic pain. New Haven, CT: Yale University Press, 2016. Link  

Palermo TM, Law EF. Managing your child’s chronic pain. Oxford: Oxford University Press, 2015. Link