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Starting to think about DIMs and SIMs

By Amy Gowland

I am privileged to be able to work with so many different clients that each have their own unique story and journey. This is not something I take for granted, as I know how hard it can be to open up and share your story with someone who you have only just met. It is something that we appreciate can be very taxing, daunting and overwhelming for our clients, so we thank you for allowing us to come on this journey with you.

There is a quote from Laurie Jean Sennott that states “every flower must grow through dirt” and this is so true on so many different levels. There is no-one in the world that has not had to overcome an obstacle in their life, whether it be related to their health, finances, lifestyle, education, work, etc., Such highlights that life is going to present with its challenges, for some, more than others, and varying in size, but there are tools and strategies that we can coach you with to help you get your life onto the trajectory that you would like it to be. I can’t guarantee that we are always going to have to answer, as sometimes there is a bit of digging that needs to be done to get to the roots, but in time, once the roots are untangled and there is greater clarity, the flower can bloom.

If you have been seen by a practitioner at Evolving Pain before, it is quite likely that you have heard of the DIMs (Danger in Me) and SIMs (Safety in Me) from the Protectometer (NOI). What we know is that as the credible evidence of danger increases, the more our pain indicator increases. However, as the credible evidence of safety increases, our pain indicator tends to move down. This is a very condensed explanation of the Protectometer - feel free to have a chat with your clinician to find out more.

Check out the SIM board in my consulting room at the clinic - it is a work in progress, so please help add to it!

A Visualisation for DIMs and SIMs Let’s imagine DIMs are reflected by a red balloon and SIMs are reflected by a yellow balloon. Everyone has a red balloon and a yellow balloon, regardless of whether they have pain or not. But for the purpose of this blog, let’s consider that the balloons are representative of someone living with persistent pain.

The red balloon contains pain, fear, anger, frustration, exhaustion, loss of identity, loss of life roles, unhelpful thought patterns, etc. Remember, each person is going to have different things in their balloon that are reflective of their own DIMs and pain journey, so this is just an example. The yellow balloon contains strategies that help us get through daily life, such as talking with others, eating your favourite food, using sensory strategies and tools for pain management, etc. The yellow balloon is reflective of your SIMs, remembering that these are unique to you and cannot be generalised. Naturally, it is easy for us to get sucked into the red balloon, particularly when the pain is such a dominating factor in daily life, sucking all the air out of the yellow balloon and further inflating the red balloon. But what happens when a balloon is inflated too much? It bursts. Conceptualising this in relation to your pain, as the red balloon gets more air, the balloon naturally rises, demonstrating an increasing presence of pain. As the red balloon rises, the yellow balloon starts to slowly deflate, as our SIMs appear to decrease. When there is too much air in the red balloon, it bursts, resulting in an unpleasant sensory experience (that noise!), and a flare in your pain. The yellow balloon is mostly deflated at this point.

So, what we are aiming for is the yellow balloon to be sitting higher in the sky than our red balloon. It is not uncommon for our balloons to inflate and deflate gradually throughout the day, changing their position in the air, as life is not representative of a single line. But what we are aiming to do is empower you with the tools to inflate your yellow balloon further to reduce the presence of the red balloon bursting (pain flares), optimising your daily functioning.

I know it is easy to sit here and write about this in the context of metaphors, but the application to life is not always easy. Please reach out to your Evolving Pain clinician if you would like to further explore this.

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