Skip to content
Leeds Community Healthcare NHS Trust Logo

Mood management

When we talk about mood management, this could include; low mood, depression, bereavement, panic attacks, anger, anxiety, stress, PTSD, OCD, self harm

Here, we will focus on stress and stress and stress management but please look at the end of this booklet for information, resources and links for each of the above

You may notice that when you are feeling stressed, angry, depressed or anxious, you baseline level of pain or small knocks, may hurt more than usual. And on the flip side, when you’re feeling more relaxed and happy, you are able to manage existing pain and new bumps more easily. Our perception of and ability to effectively manage and cope with pain changes depending on how we feel mentally. This is why it is important to address your mood in relation to managing your pain.

Negative thoughts can lead to a change in how you feel about your pain. You may experience: worry, fear, anxiety, feelings of hopelessness, social isolation, relationship problems, loss of interest.

This cycle of behaviour can lead to worsening of existing pain or new pains.

Pain cycle

Things that may contribute to a more sensitive nervous system:

  • Persistent pain
  • Being less active
  • Loss of fitness, weak muscles and joints
  • Inactivity
  • Sleep problems
  • Mood changes(anger, fear, and frustration)
  • Relationship difficulties
  • Time off work and money worries
  • Anxiety and stress

Because our thoughts are often the cause and driving force behind the feelings we experience, it can be helpful to identify negative thoughts and patterns and discuss them with a member of Leeds Community Pain Service to explore ways in which to break this cycle. These negative thoughts may be contributing to low mood and lead to making unhelpful decisions about how to manage the pain.

An example of changing negative thought patterns might look like this:

For example:

Thought: I have a slipped disc in my spine.

  • By the age of 50, 60% of people will have a slipped disc.
  • Many people with slipped discs don’t have any back pain.
  • My MRI is considered normal for my age.
  • This isn’t as serious as I first thought.

Feelings: Less anxiety, less stress.
Behaviour: Continue to work, continue to move, and continue to meet friends and family.

Stress management

Stress can be positive or negative. Positive stress in the short term can be useful as it can help energize and motivate you, such as when in a job interview. However, negative stress can be caused by feeling overwhelmed and can result in symptoms such as anxiety, fatigue, headaches and irritability.

Long term stress is not good for our bodies as it puts us in ‘fight, flight or freeze’. This can cause our body to experience; anxiety, feelings of tension, low mood, headaches, tight and painful muscles, feeling ‘wired but tired’.

One of the ways our body reacts to stress is by making our muscles tight. We can hold tension in our bodies without realising it. It is only when we take a minute to stop and look more closely the we might find our shoulders are hunched or our fists and jaw are clenched.

Supporting information

  1. Forehead: Check it now, is it creased and frowning? or smoothing and relaxed? Push your eyebrows up, then let them into a relaxed position
  2. Jaws: Are your teeth clenched? Let them come apart without opening your mouth. Feel jaw muscle, is it hard or relaxed? Let it go
  3. Tongue: Is it up against your front top teeth? Let it lie on the floor of your mouth
  4. Shoulders: Are they up or down and relaxed? Push them up and then let them fall into a relaxed position
  5. Breathing: Is it from your cheat and fast or from your stomach and slow with full out-breaths?
  6. Hands: Are they clenched like fists or floppy and relaxed
  7. Toes: Are they curled up tight or relaxed

When we are stressed and in a fight, freeze or flight response, the body prepares for action. The body’s reaction is the same as if you were running away from a tiger. There are many changes that happen within the body as shown below (taken from The Pain Management Plan: How people living with pain found a better life, the things that helped them and the things that set them back (Npowered 2010).

  • Look for more danger feel need to escape fear and anger
  • Breathing changes to emergency breathing to get more oxygen to muscles
  • Muscles all tense up ready to run or fight
  • Blood supply is diverted from the stomach to the main muscles
  • Senses of sight, hearing, touch and pain all heightened
  • Sweat to cool muscles so that they will work better
  • Heart beats faster to get more blood to your muscles to give them extra power

Set a time for 15 minutes each day when you are free of distractions.

Progressive muscular relaxation (PGMR) is the name of a technique which teaches you how to become more aware of the tension in your body and how to relax the different muscle groups.

During this technique you will tense particular muscles in your body and then release them to help you notice the difference when your muscles are relaxed. This will help you realise when your muscles are starting to tense during the day so that you can manage your tension before it starts to increase.

  • Relaxation breathing is a skill you will need to learn, practise at least once a day for relaxation to have a longer term effect.
  • Begin by practising this exercise at times when you are feeling more relaxed (and can concentrate better) and then when you feel more confident start to use it at times when you feel more anxious.
  • Don’t try to relax too hard. Let it happen naturally.

Find somewhere quiet where you won’t be disturbed. Lie or sit somewhere comfortable. This could be on your bed, in a reclining chair or on the floor.

  • Wear lose comfortable clothes. Take off your shoes if possible.
  • Close your eyes.
  • Start by focusing on your breathing. Breathe through your nose rather than your mouth.
  • Breathe smoothly and steadily. Breathe in and say the word ‘calm’ quietly to yourself.
  • Breath out and say the word ‘calm’. Repeat for a few minutes.
  • If distracting thoughts jump into your mind. Try not to follow them, concentrate on your breathing.
  • Become aware of the tension in your body.
  • Work through the following muscle groups. Each time tensing the muscles for a few seconds and then releasing the tension. Feel the difference between relaxation and tension.
  • Shoulders: Pull them down towards the floor. Think about the tension this creates and then let go. Feel the difference. Circle your shoulders once backwards, once forwards.
  • Arms and elbows: Tense your arms and then bend your elbows. Think about the tension this creates and then let go.
  • Hands: Pull your hands back at the wrist, stretching all your fingers as much as you can. Think about the tension this creates and then let go (let your hands fall back on your thighs).
  • Hips: Pull your hips open, so your legs roll apart. Stop pulling and feel the difference.
  • Knees: Pull the angle of your knees open, tightening your thigh muscles and slightly lifting your heel as you do this. Stop pulling and feel the difference.
  • Legs and ankles: Pull your toes upwards towards your face and then point your toes to the floor. Stop pulling and feel the difference.
  • Lower back: Pull the curve of your back into the chair and then relax and let go.

Take a breath in through your nose and out through your mouth (your tummy should rise while your chest should stay still). Count in for two and out for four twice (your tummy should fall as you breathe out) before returning to the exercise.

  • Neck: Pull your chin downwards towards your chest. Don’t tense your shoulders. Stop pulling and feel the difference.
  • Eyebrows: Pull your eyebrows up towards your hair line and then relax. Feel the difference.
  • Mouth and jaw: With your lips together, pull your jaw down towards the floor. Think about the tension this creates and then relax. Pull your tongue down in to the bottom of your mouth, behind your teeth. Stop pulling and feel the difference.
  • Wriggle your fingers and toes. Breathe out.
  • Slowly open your eyes and take a moment to come back to the present after you carry out any relaxation exercise, and resume your next task slowly.

‘Oh no’ thoughts are when we pre-empt that something is going to happen before it actually happens.

  • “I know I won’t sleep”, this often leads to more anxiety about sleep, which can cause worry, an active mind and no sleep.
  • “This is going to hurt”, this can lead to more tension, tight muscles, fear of movement,
    which can lead to inactivity and more muscle pain.
Situation Thought Feeling Physical changes in your body Behaviour Answer back thought
Realising it’s nearly bedtime I know I won’t sleep Frustrated Annoyed Increased heart rate. Stress. Stay up extra late. Take a nap the next day. I sometimes sleep better. Things have improved slightly since having a daily walk and reducing caffeine.
  • You can escape from the ‘oh no’ trap by doing the following things; recognise them! How do the make you feel? Think of an anti stress thought, for example, a happy memory, a song. Get control of the ‘oh no’ thought. What advice would you give to a friend who was having ‘oh no’ thoughts?
  • Avoidance of ‘oh no’ thoughts might work in the short term, but ultimately, they will make things worse in the long term
  • Relaxation
  • Do things that make you happy
  • Mindfulness
  • Learn about your pain
  • Manage stress where possible
  • Correct breathing
  • Regular exercise
  • Distraction
  • Daily fun goals
  • Say no to ‘Oh No’ thoughts
  • Tackle avoidance
  • Get the right support
  • Talking to someone
  • Counselling

Fun goals

What do you want to change? What is your current behaviour (baseline)? What are the barriers to change? Goals

Examples of fun goals are:

  • Meeting or calling a friend
  • Visiting your favourite restaurant
  • Buying yourself a bunch of flowers or a new outfit
  • Getting your hair done
  • Watching your favourite film
  • Singing to your favourite song
  • Watching sport
  • Tinkering with the car
  • Model making.
survey icon
Tell us what you think

We would love to know what you think of our website and if there is anything we can improve.

Complete our survey and share your thoughts.