Here is a famous quote from Gabriel Garcia Marquez.¹

It is not true that people stop pursuing dreams because they grow old.

They grow old because they stop pursuing their dreams.

Gabriel Garcia Marquez

This is a wonderful quote except I have a different take on it.

People grow old because their dreams are crushed by anxiety.

Stress

Stress is the sum total of the obstacles we face every minute to stay alive. When your body is in a flight or fight state, the sensation is called “anxiety.” This reaction is present in every living species, but humans have language and can name it. It is challenging to achieve your dreams and experience the life you wish while feeling stressed. Your creativity and choice are compromised while you are in a survival mode; the blood flow in your brain shifts from the neocortex (thinking centers) to the limbic system (flight or fight).

The Holmes scale², developed in the 1960s, quantifies levels of stress connected with life events, and you can calculate your own cumulative score. A score of 300 points or more correlates to an 80% chance of a health breakdown within 24 months. In spite of overwhelming data connecting chronic stress with illness, disease, and early mortality, we are generally taught that stress and anxiety are “psychological” issues. Nothing could be further from reality. Why does chronic stress cause mental and physical illnesses?

One of my close friends and colleagues were discussing the role of stress leading to health problems and we decided to assess ourselves with Holmes scale. He had been dealing with an unspeakable number of challenges for several years. His score was 435 and then he told me that he had been diagnosed with cancer a few months earlier. Fortunately, he did well with treatment.

Safety

We want to feel safe. In this state our body’s chemistry consists of anti-inflammatory molecules called cytokines. Fuel consumption is lowered (metabolism). There are about 80 billion neurons in your brain that communicate by molecules called neurotransmitters. When feeling safe, these molecules are calming. Hormones include dopamine (reward), serotonin (mood elevator), growth hormone, and oxytocin (social bonding). Emotions represent feelings generated by your physiological state (how the body functions) and safety creates a sense of connection, contentment, and joy. Another term describing this state is “rest and digest.” Your body must refuel, regenerate, and heal in order to sustain life and health.

Threats

What happens when you don’t feel safe? Your body goes into various levels of threat physiology (flight or fight) to optimize survival. It is designed to deal with acute threats effectively and quickly, but it doesn’t do well when your challenges are unrelenting. At the core of all chronic mental and physical disease is being in a sustained stressed state.³ Here is what is going on.

Activated inflammatory cytokines fire up your immune system. In addition to fighting off viruses, bacteria, and other foreign materials, your own tissues are attacked.⁴ Neurotransmitters switch from calming to excitatory and your nervous system is hyperactive. Fuel is consumed from every cell in your body, including your brain. Chronic disease states cause physical shrinkage of your brain.⁵ Fortunately, it regrows as you heal. Stress hormones include adrenaline, noradrenaline, histamines, and vasopressin, which shift your body from thinking to fleeing. This situation can be likened to driving your car down the freeway at 65 mph in second gear. It will break down more quickly than if you are cruising in 5^th gear.

The driving force behind chronic mental and physical disease is sustained exposure to stress physiology. The solution lies in using approaches to increase “cues of safety” and allow your body to rest and regenerate whenever you can.

Dynamic Healing

Sustained stress translates into threat physiology, which creates symptoms. In mainstream medicine, we are just treating symptoms instead of addressing the root cause being the interaction between your stresses and nervous system. We don’t have time to know you, understand the nature of your circumstances, or how we can help you calm down. Treating only symptoms is similar to putting out an oil well fire with a garden hose. It is no wonder that the burden of chronic disease and suffering continues to skyrocket.⁶ In fact, you often feel more stressed while interacting with the medical system. We introduce the concept of “dynamic healing.

Dynamic Healing is a framework that categorizes interventions that decrease exposure to threat and increase safety. The three portals are:

• Input – processing your stresses in a manner to have less impact on your nervous system
• The nervous system – there are ways to lower its reactivity
• The output – directly stimulating your body to go from stress to calming physiology.

This model organizes known research to both clinicians and patients. You can regain control of your care and create a partnership with your provider.

Why not become a “professional” at living life?

Consider the process as becoming a “professional at living life.” It is similar to acquiring any skill such as playing the piano. You must learn the basics, incorporate them into your daily life, and then continue to deepen your expertise with practice. Mastery is critical, and as they become habituated and automatic, life becomes easier to navigate.

Additionally, the power of neuroplasticity (changing your brain) is powerful and unlimited. You can program your brain in whichever direction you wish, away from unpleasant survival circuits.

Modern stresses

Times have changed since 1962 regarding the Holmes-Rahe scale. The industrial revolution occurred only about 200 years ago. In light of over four billion years of evolution, this not even a drop of water in the ocean. The level of daily sensory input dramatically increased. Now we are in the information revolution that began in 1980’s forcing us to process magnitudes more information. Smart phones came online in 2007, and along with the barrage of social media, we are on a massive sensory overload. The human brain has not evolved to keep up with it. So, we have ongoing stress levels that weren’t present even several hundred years ago. It is somewhat perverse that we have so many anxiety-related problems when we have access to more physical comforts than any generation in history. One fallout is that of teen suicide, “deaths of despair”, have risen dramatically correlating with the advent of the bi-directional smart phone.⁷

A healing sequence

The DOC (Direct your Own Care) Journey course teaches skills to optimize your capacity to enjoy life by effectively dealing with adversity and nurturing joy. These are two separate, but linked, skill sets. As you lower your time feeling stressed and increase your sense of safety and joy, your body will regenerate and heal – mentally and physically. Your brain physically changes (neuroplasticity), pleasurable circuits strengthen, and pain (mental and physical) regions atrophy. You can reprogram your brain away from almost anything with persistence and repetition. The exciting aspect of neuroplasticity is that at some tipping point, your healing continues to build on itself and there is no limit as to what life (brain) you wish to create.

What do want out of this life? Decrease your exposure to threat physiology, increase time in safety, enjoy your life, heal, and thrive.

Homework

1. Take the Holmes-Rahe stress assessment test.
2. Write down the details of each category affecting your life.
3. Consider what percent of your time you spend fighting off stresses compared to nurturing joy. Where is your brain developing?
4. The most stressful stresses are the ones you can’t solve. It is why you must learn techniques to minimize their impact, calm your nervous system, and spend less time exposed to threat physiology.
5. What is one aspect of your life that is the most important to you? Write it down. Are you willing to pursue it?
6. Your body is a complex powerful survival machine. It has evolved to seek safety, deal with threats, break loose, and thrive. Allow it to do its job.

 References

1. Gabriel García Márquez. Cien años de soledad (One Hundred Years of Solitude. 1967. Editorial Sudamericanos, S.A., Buenos Aires.
2. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
3. Furman D, et al. Chronic Inflammation in the etiology of diseases across the life span. Nature Medicine (2019); 25:1822-1832.
4. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007-8-9-r189
5. Seminowicz DA, et al. “Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function.” The Journal of Neuroscience (2011); 31: 7540-7550.
6. Bezruchka S. Increasing Mortality and Declining Health Status in the USA: Where is Public Health?Harvard Health Policy Review [internet]. 2018.
7. Miron O, et al. Suicide rates among adolescents and young adults in the United States, 2000-2017. JAMA (2019); 321: 2362. doi:10.1001/jama.2019.5054 – Connection with cell phones made by Dr. Rob Lustig lecture on 12.1.21 – https://drive.google.com/drive/folders/182pygqTnS2GPQ4LUmioO06zkRf4-jpIH

The post Stress Kills – Don’t Allow it first appeared on Back in Control.

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Anxiety is the sensation generated when you are in flight or fight. It is a physiological state. When you can’t resolve your anxiety, your body kicks in a stronger neurochemical response and you’ll be anger. Anger and anxiety are the result of stress, not psychological, and a million times stronger than your conscious brain. You have absolutely no control over these reactions. However, you are able to reprogram these responses.

This email was recently sent to me by someone who I have never met and reflects most of the concepts of healing presented in The DOC (Direct your Own Care) course and app.

The letter

Hello David,

I am writing to you on my day off, sun is shining and I am almost ready to go for my walk. I really feel supported by your program and thank you for replying my emails.

 It means a lot to me. I do a bit of reading and learning each day and then move on to the things in life that I need and want to do.

I touched a huge topic and adressed it. I arranged for a meeting with my ex-partner and told him I wanted to have a one on one conversation on how we are raising our son seperately and how this is going. In this conversation I was able to really listen to him and feel the hurt feelings and being uncomfortable. He let me have my moment and I spoke up about my grief and the things that caused my hurt feelings and what I would wish for my son, and also that it was hard for me to forgive him on how things went between us in the past.

It was the first time that I spoke and took this approach. Usually, I complain about him to my boyfriend, whom suggested that I should say these things in a mature way to my ex. Now, I feel like I forgave me and him. Actually, me meeting and speaking up, without the actual need for me to have him change anything made all the difference. But I needed to have the conversation. Only so much you can learn from books. In the playground of real life you are meant to use the things you learn.

It feels that I am moving forward and I am persistent. It is working for me because I am showing up for me everyday and do my writing, eating well, sleeping, and learning.

It is a life-long journey. I am also adressing the relationship between me and my parents. My mom has become ill and she is in her victim role most of the time. Also I am reviewing my role in family dynamics. For me this was also confronting, because stopping complaining and not talking about my pain was a huge step. My therapist friends help me accomplish this.

I have notes on my fridge. I crossed out “try” and the “do” note hangs on my bathroom mirror. Even my son participates with me. He manages to sleep in his own room, which is a huge step for him and for me.

Now I realise that trying to fix yourself is focusing on what you don’t want and you can fail easily. Moving forward and taking small steps to the life you want makes it possible to let them co-exist. Since the pain is needed to get myself moving. This time I am dedicated and for this reason I am making it work. I took control.

And what makes me happy everyday is that I show up for myself and do my work, everyday. This realisation makes it that I feel I can be more persistent and pursue life as I see fit. It is like getting married with myself, for better and for worse.

I will keep you updated. I am so grateful that my friend pointed out your work. Thank you for showing this way and helping people to live the life they want to live. To have hope and knowing that I can succeed with patience, persistance and dedication.

Wishing you well, WT

Summary of her journey

Her letter covers the core of the healing journey. I’ll just list them.

Leg 1 – Beginning the journey – and learn later

• Expressive writing is a major necessary step. It is not the final solution but nothing will really happen without this exercise.
• She stopped complaining
• Sleep improved

Leg 2 – Understanding the healing principles

• She quit trying to fix herself and pursued the life she wanted.
• The two separate but linked parts of healing are letting go and moving forward.
• Hope has been shown to lower inflammatory markers. Being trapped in pain without direction is a dark place and why I call it “The Abyss.”

Leg 3 – Lowering threat physiology – anxiety

• Relaxed enough that her son could be a part of all of this
• An anti-inflammatory diet contributes to lowering threat physiology.

 Leg 4 – Awareness

• She let go of her expectations and agenda and was able to listen
• Your family is the source of your deepest triggers and she took responsibility for her possible role. You can’t change your family, but you can work on yourself.

Leg 5 – Anger processing

• Confronting a given situation head on
• Stopped blaming her ex
• “Try” is the ultimate victim word. “Do” is the opposite. This is a strategy that I learned from my Hoffman process.

Leg 6 – Pursuing your vision

• Consistence and persistence are key – one day at a time.
• Continually trying to fix yourself places your brain on the problem and reinforces your pain.
• As you learn to let go, you can move forward away from your pain circuits. They will “atrophy” from disuse.

Leg 7 – Living life on your terms

• She is executing and moving forward.
• She took control. Nothing will happen until you lean into this. We are somewhat programmed to look outside of ourselves for fixes and also for blame.
• She understands what makes her happy and nurtures that energy.
• Connecting with friends for support and connection is also powerfully anti-inflammatory. Instead of complaining to her friends, they became her support.

One key concept was her statement, “It is like getting married with myself, for better and for worse.” In other words, she connected to every aspect of herself, including her capacity to heal. The DOC Journey is not a self-help program. It is a set of documented tools based on deep medical research and provides a foundation of knowledge that allows you to figure your own way out of The Abyss. You cannot go from pain to pleasure without a sequence and tools.

Then, as you move into the life that you desire, your brain will continue to evolve in the direction of your choice (neuroplasticity), physical and mental symptoms abate, and you’ll thrive and move into a life that you never thought was possible.

Her journey is an example of how you can heal. You will implement your own version of it, and healing is always possible regardless of how long you have been in pain. The choice is yours. Do you want to learn the skill set to move forward and become a professional at living your life?

The post How to Heal – A Patient’s Story first appeared on Back in Control.

The post How to Heal – A Patient’s Story appeared first on Back in Control.

I am somewhat beside myself regarding several aspects of her story.

• Mainstream medicine is overlooking the basic physiology that we all learned in high school. When you feel threatened, your body goes into flight or fight and you experience physical symptoms. When this state is sustained, your body will break down, and you’ll develop serious illnesses. (1)
• The medical profession took away her hope. It has been documented in the neuroimmunology literature that hope/optimism directly lowers inflammatory markers. Taking it away does the opposite.(2)
• You may consider her story unusual or a “miracle.’ What is a miracle is life and the body’s capacity to heal. What if broken bones couldn’t mend as strong as they were before? What about cuts and deep wounds? What if your body couldn’t fight off infection? What kills patients in cancer treatment is often infection because strong drugs that kill cancer cells often compromise the immune system.
• Every day, I take a moment to consider how my heart can beat 60-80 times a minute with the only rest being between beats. It doesn’t make any rational sense.
• But what I find especially upsetting is the story of her early family life, of which variations occur on over 35% of American families.(3) How can this continue to be? We know better and it all keeps happening. The effects of an abusive childhood have been documented to last the rest of your life.

Here is her story of hope and what keeps me moving forward.

I am an unwanted child who was abused by her family. I do not remember ever being healthy. At 13, I started getting migraines.

5 years ago, at age 52, I broke my ankle and had horrible pain after surgery. Even though the most prominent pain doctor in our country diagnosed me with CRPS (chronic regional pain syndrome), physical therapists and the physiatrist didn’t believe it. I tried my luck at another great centre for PT, but it was the same. After each session I could not live for days because the pain was so bad even though I was on opiates.

I reluctantly decided I would re-learn to walk by myself. I had to go excruciatingly slowly, but in a few months I was able to walk with almost no pain. I got off opiates without a problem. Getting in touch with anger that I repressed all my life was extremely beneficial. Even though both my surgeon and the pain doctor were mad at me for giving up on PT, they each wrote that the PT was “a bit too harsh” after they saw me walk again.

Everything was going quite well until I got herpes zoster. When I recovered I was very keen to go walking. I pushed myself to walk for the next few years, but each step I took was painful. In the midst of it, I convinced the surgeon to remove the hardware, which did not help. In the last few months I finally gave up on walking longer distances even though I love to walk.

I have been writing JournalSpeak/expressive writing for 2+ years. It has been a great way to get the anger and other repressed feelings out. In the first 4 months, I got rid of my lifelong insomnia, and my chronic depression was way less. I was able to slowly lower the dose of antidepressants. I am able get rid of my migraines with writing the anger out, and I also need to validate my feelings. While writing down my feelingsI discovered I was scapegoated and gaslit by my family. I see others and myself in a completely new way, and do not feel so helpless anymore.

I was incredibly lucky to discover Dr. Hanscom on the Trauma Superconference. No matter how much anger I got out in writing, I could not get any relief from ankle/hip/back pain. I was eager to try his advice: no listening to the news, no criticising, no talking about pain, and using another virtual desktop on my computer without pain being discussed. He also gave me “permission” to focus on happier things like planning for things I would love to do and am able to do instead of trying to make sense of the past.

I realize that I have pushed myself too hard all my life. I can walk the same distance, but if I push myself, every single step is painful. If I say to myself, “I am going out and will walk as much as I can,” I can walk the same 1.5 km with little to no pain at all. If the pain returns, my nervous system is calm enough now that I can believe myself when I say, “I am safe. My ankles/hip/back are OK” – and the pain goes away!

The fact that the pain doctor said in an interview only a couple of years ago that nothing much can be done for chronic pain, incredibly saddens me. Two of Dr. Sarno’s books(4) were translated to our language years ago. A psychologist that works with people with chronic pain has a 3+ years waiting  list for her groups. She recently said in a lecture for rheumatoid patients that they need to talk about their pain. Even though one patient insisted that people ignore or do not believe her, the psychologist insisted they continue to talk about pain. I know firsthand this does not work. A couple of years ago I joined an online support group for chronic pain, and just reading about pain made my pain so much worse that I had to leave.

I am so incredibly grateful to Dr. Hanscom for saving my life. All the advice and information he shares, allows us to help ourselves even if we live on another continent.

This is not about me

I would like to emphasize that the healing journey is based on deeply-documented interventions. The DOC (Direct Your Own Care) Journey is simply a framework that presents them in organized and accessible manner. There are a growing number of practitioners that understand the human need to feel heard, validated, and safe. Each of them has their own style of educating their patients, implementing effective treatments, and helping patients access their own capacity to heal. Some of the main principles are that chronic disease is complicated, multiple aspects of it must be simultaneously addressed, and the patient must take responsibility for his or her own care.

One interesting aspect to her story is that belonging to a pain support group carries a poor prognosis in that most them are focused on discussing the pain, medical care, and how badly they have been treated.(5) Although they may be correct, these discussions place your brain on the problems and not moving into the two-part solution – letting go and moving forward.

Some other effective interventions include:

• PRT – Pain Reprocessing Therapy(6)
• EAET – Emotional Awareness and Expression Training(7)
• ISTDP – Intermediate Short-Term Dynamic Psychotherapy(8)
• ACT – Acceptance and Commitment Therapy(9)
• Mindfulness-base Stress reduction(10)

She found way out on her OWN 

Again, each of these must be framed in an overall treatment approach. As much (most) of it is self-directed, not a lot of resources are required. When needed, they can be plugged into the bigger picture. I liken it to doing a jigsaw puzzle that is not that difficult. They key is persistence.

Note, that although the framework provided by Back in Control helped her move forward in a powerful way, she had already done a lot of work. I have never seen or corresponded with her. She truly pulled herself out of the hole and entered into a new life! For many who heal, this is the way it often happens.

References

1. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
2. Dantzer R, et al. Resilience and Immunity. Brain Behav Immun (2018);74:28-42. Doi.10.1016.j.bbi2018.08.010
3. Felitti VJ, Anda Rf, Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine (1998); 14:245-258.
4. Sarno J. The Mind Body Prescription. Warner Books, New York, NY, 1998.
5. Friedberg F, et al. Do Support groups help people with chronic fatigue syndrome and fibromyalgia? A comparison of active and inactive members. J Rheumatol ((2005); 32:2416-20.
6. Asher YK, et al. Effect of pain reprocessing therapy vs. placebo and usual care for patients with chronic back pain. JAMA Psychiatry (2021).doi:10.1001/jamapsychiatry.2021.2669
7. LumleyMA, Cohen JL, Stout RL, Neely LC, Sander LM, Burger AJ. An emotional exposure-based treatment of traumatic stress for people with chronic pain: preliminary results for fibromyalgia syndrome. Psychotherapy (Chic) 2008;45:165–72.
8. Abbass Allan, et al. Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study. CJEM (2009); 11:529-34.
9. McCracken LM and Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. Am Psychol (2014); 69:178–87.14. Hann KEJ,
10. Cherkin DC, et al. Effect of mindfulness-based stress reduction vs. cognitive behavioural therapy or usual care on back pain and functional limitations in adults with chronic low back pain. JAMA (2016); 315:1240-1249. doi:10.1001/jama.2016.2323

The post “My Way Out” (of “The Abyss”) – One Patient’s Story first appeared on Back in Control.

The post “My Way Out” (of “The Abyss”) – One Patient’s Story appeared first on Back in Control.

• Anxiety is at the core of how we evolved and continue to survive. It is a gift.
• It is universal, powerful, automatic, and intentionally unpleasant. There is no reason to take it personally.
• It is not subject to rational interventions and the way to lower it is simply lowering your stress reaction to threats.
• An important and critical step is to separate your “identity” from it and develop a “working relationship” with it.

Every living creature has a threat avoidance response that involves every cell in their bodies. Humans are unique in that we possess language and can name it. Anxiety is a word that describes this intentionally extremely unpleasant sensation that compels us to take action to alleviate it. There are levels of intensity. Here is a word progression that falls under the umbrella term of anxiety.

• Alert
• Nervous
• Afraid
• Angry
• Paranoid
• Terrorized

The neurochemical state that we have labeled as anxiety is an amoral powerful survival reaction in response to stress and is not the cause of it. It is how we evolved, and it also keeps us alive. You can’t and don’t want to get rid of it. It is so powerful you can’t control it by rational means. It is hardwired and automatic. You might as well try to have a conversation with the hard drive of your computer.

Relentless anxiety is the worst aspect of suffering for many people. So, if rational interventions can’t work, how can you lower your anxiety? Since it simply describes the feelings created by your body’s neurochemistry, the answer is to learn and use approaches that lower your stress hormones, metabolism, and inflammatory proteins. In other words, you can stimulate your body to switch from flight or fight physiology to safety.

Effectively dealing with anxiety

The goal is not to control or “manage” this reaction, but to develop a “working relationship” with it. As you quit fighting anxiety, it will be less disruptive to your quality of life. There are four aspects to consider.

• Separating your identity from it. Anxiety is a gift of survival and life, but not who you are as a conscious human being.
• Using tools to directly lower your stress chemicals (output) through stimulating the parasympathetic nervous system (vagus nerve).
• Increasing the resiliency of your nervous system.
• Becoming aware of the input into your nervous system that creates threat physiology.

Separating your identity from anxiety

These will be discussed further in the next few lessons in this rest stop. But the first step is to separate your conscious identity from this all-encompassing feeling and view it is simply your body’s mechanism of protecting you. It is a gift.

One helpful step is to eliminate the word, “anxiety” and substitute phrases such as, “heightened stress response”, “elevated stress hormones”, or “increased sympathetic tone.” Any words that describe your body’s heightened physiological activity will do. What happens with many people is that they feel badly about these disturbing feelings and impulses. However, they are universal and why would any of us take them personally? It has nothing to do with your identity or value system. In fact, the research shows that the more of a well-intentioned person you are, the more you will fight these deep impulses, which reinforces them. The result can be crippling anxiety.¹

Another separation strategy is to visualize a large thermometer on a wall. As you feel your physiology become more activated, describe the intensity of emotion with one of the above words. Then mentally assess your “temperature” in light of the “thermometer.” Again, the way to lower anxiety is to use tools to shift your physiology from a threat profile to that of safety. In other words, “lower the temperature.” You’ll be using approaches from all three areas:  input, nervous system, and output.

As our challenges keep coming at us, you’ll use these tools multiple times per day. The key is learning to process adversity effectively and efficiently so as to minimize your time in threat and maximize your time in safety. Healing can only occur when you are in safety and not consuming your body’s resources to survive. There will many times when stresses are overwhelming, or you are overtired when you will not do well. That is the norm.

Once you can consistently separate “you” from this physiological reaction, you’ll be free to “observe it” and get on with your day and life. You must break loose in order to move forward into the life you desire.

Recap

Thoughts are what you think, and unpleasant ones can be considered “mental pain.” They are processed in similar brain circuits as physical pain and is why they are so disruptive. They create a flight or fight response with a resultant surge of stress hormones, increased metabolism, and inflammation. Emotions are the feelings caused by these changes in your body’s neurochemical profile. The word that describes this heightened state is anxiety. It is not primarily psychological.

This is a critical concept in that you cannot control these automatic and powerful survival responses with rational means. It is huge mismatch. You cannot outrun your mind.

Anxiety is a universal survival reaction that is your protector. You cannot and don’t want to get rid of it nor do you want to take it personally. There are many ways to develop a “working relationship with it, use it to move forward with your life and heal. The critical first step is to separate your personal identity from it.

 Questions and considerations

1. Every cell in your body is bathed and affected by stress hormones and inflammation when you are in flight or fight. It is the reason people identity with this sensation, when it actually has nothing to do with who are as a person.
2. Carefully consider anxiety for what it is. It describes the feelings generated by your physiological state when your body is in a survival mode. It is critical to understand this situation, as the conscious brain is no match for your unconscious brain.
3. You cannot control the unconscious aspect of your nervous system, but you can reprogram it. It is a step wise process and why The DOC Journey is in the sequence it is.
4. View your unconscious brain as your guardian and learn to develop a “working relationship” with it. As you quite fighting the unwinnable battle with anxiety, you’ll much more energy to live an enjoyable life – and heal.
5. You cannot heal when you are in flight or fight and consuming your body’s resources to survive. Healing can only occur when your physiology is one of safety.

 References

1. Wegner DM. The Seed of Our Undoing. Psychological Science Agenda. Jan/Feb 1999, pp 10-11.

The post Eliminate the Word, “Anxiety” first appeared on Back in Control.

The post Eliminate the Word, “Anxiety” appeared first on Back in Control.

• There is deep basic science research that has revealed the nature of chronic pain and this understanding will allow you to discover your version of a solution. The essence of the problem is sustained exposure to threat and the core of the solution lies in finding safety.
• Create safety by learning skills to:
  • Stimulate neuroplasticity – create and shift to new neurological circuits in your brain.
  • Learn to regulate your body’s neurochemical response to threats (stresses).
• As you learn about chronic pain, it is helpful to simply get started using some of these core tools to “jump start” the healing process.
  • Expressive writing
  • Active meditation
  • Restful sleep
  • No discussing your pain or medical care with others – especially your family

Many years ago, I would spend hours explaining chronic pain to my patients in the office but it was too complicated and it wore me out. That is when I decided to write, Back in Control. Patients would have a better understanding but there was no action. The website, www.backincontrol.com was the action plan and evolved into a self-directed process that allowed hundreds of people to break free from their chronic pain. The DOC Journey is the next rendition of the program. But the healing process begins when you begin to use methods that stimulate your brain to change. During the last few years of my practice I would ask patients to simply begin to learn and use the basic tools as quickly as possible and the rest of the concepts would fall into place. This is the first lesson of The DOC Journey.

 The nature of chronic pain (mental and physical) – sustained threat vs. safety

The essence of chronic illness, including chronic pain, is your body’s reaction to sustained stress because it responds with profound elevations of stress hormones, metabolic activity (rate of fuel consumption), and inflammatory markers (destroys invaders and your own tissues). The result is many different disruptive mental and physical symptoms.

The solution lies in learning the tools to create sense of safety, which normalizes your body’s survival fight or flight reaction. Successfully implementing these strategies causes a shift your mood, pain, and other physical symptoms. I am suggesting to dive in and begin using some of these basic foundational strategies right away. Why wait?

Creating Safety

Neuroplasticity is a term that describes your brain’s capacity to change its structure. You can form new connections, grow cells, increase the insulation around the nerves (myelin), and shift from unpleasant to pleasant circuits. Your brain physically changes in shape and structure based on programming.

As you learn strategies to regulate your body’s responses to stress, you have regained control, which creates safety. There are many ways to accomplish this and with repetition the process becomes automatic. It is like an athlete or musician attaining a high-level of skill. It cannot be done by just reading a book.

Let’s begin with these core strategies – Now

• Begin expressive writing. It is the one mandatory step to start. People can improve without doing it, but I have rarely seen people go pain free without engaging in this exercise. It has been documented in over a thousand research papers to be effective in creating significant shifts in multiple organ systems. (1)
• Practice active meditation. This involves placing your attention on a physical sensation for five to ten seconds as often as you can remember. You are switching to neutral or pleasant sensory input which causes less of a reaction in your nervous system. It requires minimal time and effort.
• Adequate sleep is critical. Lack of sleep has been shown to cause chronic pain. (2) With a multi-pronged approach, restful sleep can usually be achieved within 4-6 weeks. Medications may be needed for a few months.
• Never discuss your pain or medical situation with anyone except your medical providers. The solution for chronic pain lies in rewiring your brain around your memorized pain circuits. Your nervous will develop and evolve wherever you place your attention.

Why should this program work?

An important early step is to acknowledge and embrace your skepticism. Why should this DOC Journey work? You have been bounced around, promised relief time and time again, undergone failed interventions, and your pain is worse than ever. There is not any reason to think that this is going to work. I agree. In fact, primate research has shown that you can induce a major depression by repeatedly dashing hope. (3)

Every treatment offered in this program has been well-documented by decades of deep medical research; implement what is already known. I have watched well over 1500 patients break free from chronic pain and not only regain their life but thrive at a level they had never experienced at any point in their lives. It happened by them learning and using this DOC Journey sequence that evolved from my experience coming out of severe chronic pain and discovering what was effective with my patients.

What is not helpful is “believing” in the DOC Journey or David Hanscom, using positive thinking, or affirmations. It is about connecting with your current reality, which is unpleasant enough for you to sign up for this Journey. You are rightfully angry, frustrated, and trapped. It is the starting point. Feeling and knowing where you are at allows you to learn the strategies that allow you change direction. One successful patient commented what you need is a, “suspension of disbelief.”

Anything is possible

The DOC Journey begins with acknowledging doubt, learning awareness, and allowing hope to re-enter. Research has shown that hope and optimism are anti-inflammatory. (4) There is a lot of hope in hearing about other’s successes. I am increasingly convinced you can stimulate your brain to rewire around almost any pain regardless of the source.

I got another reminder when a patient who I never personally treated resolved his pain largely through The DOC Journey approach. He is now in his late 60’s and had experienced severe pain for over 22 years. He lost his marriage and business, ended up addicted to high-dose narcotics and attempted suicide. During this period, he underwent 28 surgeries. He has not only been free from pain for over five years, but he is enthusiastic that he has not felt this good since he was 30 years old. Historically, I would never have thought that this was possible in light of the severity of his trauma.

Please acknowledge your disbelief, embrace it, start with using these basic tools, and you’ll learn as you go. Helping patients emerge from The Abyss of chronic pain has been the most rewarding phase of my career. I am continually inspired by the resiliency of the human spirit and I am honored to be a part of your journey.

Recap of Lesson one – “Let’s Start Now”

Healing your pain requires repetition of tools that simulate your brain to change (neuroplasticity) and calm down your body’s survival response. The sooner you can engage with these strategies, the quicker you can begin to heal. That is why you might as well begin to use them ASAP. You will learn more about the nature of chronic pain and the principles behind solving it in a logical stepwise sequence throughout the rest of the course.

The next lesson will expand on the concept of threat vs safety and then more detailed explanations of these basic tools will be presented as you progress through leg one.

References:

1. Pennebaker JW and JM Smyth. Opening Up by Writing It Down. The Guilford Press, New York, NY, 2016.
2. Agmon M and G Armon. Increased insomnia symptoms predict pain among employed adults. PLoS One (2014);9:e103591. doi:10.1371/journal.pone.0103591
3. Blum D. Love at Goon Park. Perseus Books, New York, NY, 2002.
4. Dantzer R, et al. Resilience and immunity. Brain Behav Immun (2018);74:28-42. doi:10.1016/j.bbi.2018.08.010

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The nature of illness

All physical and mental symptoms are the result of you gathering data from your surroundings from different sensors, your brain interpreting the sum total as safe, neutral, or threatening, and then you automatically responding in a manner to ensure survival. You may or may not be aware of the reactions. They can be dictated by signals from chemicals, small proteins (cytokines) produced from your cells, signalers from the nervous system (neurotransmitters), or signalers from our glands running through our blood (hormones).

The term, “mind body” is not a useful term in that it implies that there is a separation between them. There is actually just you; one system that responds as a unit. Your nervous system, including your brain, is simply one of the many ways your cells communicate to coordinate your functions. The mind and the body are inaccurate constructs and distractions to understanding illness and disease compared to wellness and health.

Safety

With cues of safety from your environment, including your mind, your response will be signalers such as safety cytokines (anti inflammation and pr- anabolism), GABA (calm), acetylcholine (restoration), serotonin (contentment), dopamine (rewards), oxytocin (connection and bonding), growth hormone and growth factors (regeneration). The immune response will be strong yet inflammation low when stimulated by safety cytokines. Clinically the result is feeling less inflamed, less painful, relaxed, composed, present with a slower heart rate, blood pressure and breathing. The more time that can be spent in this regenerative state the better for health and wellness.

Your body’s goal is to survive. Defeating or dissipating threats and discord and maintaining safety and harmony to keep your range of behaviors and chemistry in a stable restorative and regenerative zone is key to thriving. The nociceptive (pain) and the emotion systems, both with and without awareness, guide you to take actions to avoid harm. When you experience an uncomfortable or unpleasant feelings from any source, it is simply signaling danger and then you can take appropriate steps to find safety.

Threat

Environmental cues of threat or internally generated ones are met with a defensive response including stimulation of your immune system with elevations of inflammation, elevated metabolism to provide fuel for defense, and increases in multiple stress signalers including the threat cytokines (IL1, IL6, IL17, TNF), inflammatory chemicals, (histamine, prostaglandins), mobilizing neurotransmitters (glutamate, dopamine, noradrenaline), and stress hormones (adrenaline, cortisol, aldosterone, vasopressin and endorphins).

Clinically, you are on “high alert” and there are numerous bodily responses to threat. The basic ones include an increased heart rate, rapid breathing, increased speed of nerve conduction (increases pain), elevated blood pressure, sweating, muscle tension, and a sense of danger that we call anxiety. There also numerous symptoms created by this physiological state. They include tension and migraine headaches, neck and low back pain, skin rashes, stomach cramps, depression, bipolar, burning sensations in various parts of your body, and there over 30 different responses. Although the chemical environment encompasses your whole body, each organ and organ system will manifest its unique response.

Symptoms, illness, and disease

 When the threat is transient or resolvable, there will be different physiology that will quickly abate the symptoms. When the threat is more prolonged, people will develop illnesses and diseases that, also, are reversible with appropriate treatment including the removal of threats and restoration of safety. When threat is sustained people can develop serious illness and diseases that may cause permanent tissue damage and create physical, mental and social havoc.

 What causes disease? There are two aspects consider.

• Your nervous system/ body
  • Your inherent coping skills
  • Your current state of reactivity influenced by diet, exercise, sleep, meds, etc.
• Your environment or perception of it
  • The magnitude and duration of threat – the inability to find safety

So, it is the interaction of the surrounding stressors with the human organism that determines the manifestation of physical and mental symptoms; illness and disease versus wellness and health.

The current state of “mainstream” medicine

Modern medicine has nullified these aspects of care in that we are not given the time nor are we encouraged to talk to our patients. From the beginning, we are not providing cues of safety. Then, we don’t know our patients and their coping capacity and really don’t know much about their environment. We are given only the time to treat symptoms. We are ignoring the root cause of the problem–total threat load. It is similar to putting out a major fire with a garden hose. It can’t and doesn’t work. Indeed, there is an ongoing and growing epidemic of chronic disease – both mental and physical, social and spiritual.

Solving our medical care crisis

Our medical care crisis could be solved with one simple move – significantly increase the reimbursement for talking to patients. This would allow a sense of safety, allow providers to assess both the patient and his or her surroundings, and direct them to resources to reduce the threats in their lives, improve safety,  coping and connection skills and provide tools to more effectively process their stresses.

The other half of the equation is to quit paying as much for procedures and also not reimburse for interventions that have been proven to be ineffective or damaging.

Addressing  root causes

A basic concept in extinguishing a fire is to deprive it of its fuel. Forest fires are the classic example. Fire breaks eliminate fuel and are only ineffective if the fire is so powerful as to jump over them. Fire retardants cover wood in a manner that it cannot be consumed. If water is used, it may be delivered in a mist, which helps lower the oxygen available. Water also removes heat. A carbon dioxide fire extinguisher displaces oxygen and suffocates it. The bottom line is that to fight a fire you have to address one of the root causes of it – oxygen, heat, or fuel.

Treating only symptoms is not only ineffective, the “fire” will continue to burn causing ongoing tissue damage. Successfully minimizing the impact of chronic illness requires minimizing the multitude of threats and maximizing access and opportunities for safety. coping and connection while also improving skills to better process toxic environmental inputs.

Summary

Every mental and physical symptom is created by the interaction between your surroundings and your body. Your body contains trillions of sensors that collect data that is sent to and processed by your central nervous system. Unpleasant sensations compel you to take action signaled by your brain and local tissues to resolve threat. Pleasant input causes you to take actions that are restful and regenerative.

The two factors creating symptoms and disease are you (and you coping capacity) and your surroundings (stressors). When you stresses overwhelm your coping capacity, you’ll experience symptoms, maybe become ill, or develop a serious disease. The solution lies in 1) increasing your coping capacity and 2) teaching you skills to more effectively process stress so it has less of an impact on your body, health, and sense of well-being. As you learn to regulate your body’s neurochemistry, you’ll have control, a sense of safety, and thrive. The DOC (Direct your Own Care) Journey presents a well-traveled sequence of lessons that will allow you to master these skills.

References

1. O’Neill Hayes, Tara and Serena Gillian. Chronic disease in the United States: A worsening health and economic crisis. Americanactionforum.org; September 10th, 2020.

Plan A–Thrive and Survive COVID-19, 2nd edition; Loving Life Lengthens It

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• A guided course of seven legs and rest stops
• Video tutuorials
• Webinars
• Weekly group Q&A sessions
• Weekly blogs and podcasts
• Access to having questions answered
• An app based on our workshops – awareness, hope, forgiveness, and play

This post is the introduction to the final rest stop of the guided journey. We are excited in that it represents a much clearer sequence of concepts and there is more clarity as to what are next steps. One of the most powerful aspects of The DOC Journey is the sequencing. You are dealing with deep patterns in the unconscious brain and it takes awareness and repetition to access and redirect them. But the core of it all is much clearer and has been easier to present and explain to people. With engagement, the outcomes have been consistent with the main variable being how much time it takes.

Introduction to rest stop seven

Your Journey has not ended but it has just begun. You began from a place that was dark and you are working your way into the light or maybe you are already there. People often get frustrated because they don’t feel they are healing quickly enough or wonder why others seem to be doing so much better than they are. There is no time frame or rush. Everyone is different and each of us has experienced more than our share of suffering. There are no exceptions. It is important to keep learning and using your tools that allow your brain/body to heal. The key words are patience and persistence.

Remember the deep paradox of this journey. You are letting go to move forward in contrast to our strong inclination to keep fixing ourselves and those close to us.

Thrive

Many people feel better after a few months. They are no longer in a crisis, their pain has improved, and they stop. They usually continue to stick with some basic strategies and do fine. But my observation is that they are missing a huge opportunity to thrive. Once you break free of The Abyss, your potential to move forward is unlimited. The more you nurture this opportunity to grow, the farther you’ll be away from your pain circuits. The concepts of play, giving back, and the spiritual journey are not tools to combat anxiety and pain. That turns into obsessive behavior and little is accomplished. They are more about expanding your life and horizon into the life you always wanted. There are several aspects to creating this capacity to navigate and fully experience every aspect of your circle of life.

• The foundation is awareness combined with the circle of life, which includes “the ring of fire.” Being aware of which part of the circle you are in is a powerful approach. You now have a choice of using your tools to change direction or stay where you are.
• The goal of using the ring of fire model is not to attempt to be in one particular part of it. It is a common perception to feel that most of your life should be spent in the center. That is not life or realistic. Being aware of when you are in the center is the key and knowing when you need to enter it to “re-fuel.” It is the foundation for passing through the ring of fire and engaging in your life activities in the blue ring.
• There are several important concepts to consider.
  • You should nurture and expand the center. The more time you can realistically spend there, the better. It is where your body regenerates.
  • As you learn to develop a “working relationship” with the ring of fire, it will paradoxically be less daunting and easier to navigate.
  • The blue periphery is life and there never was a limit to it. We create our own limitations.

 Your new home

This final rest stop is a framework for settling into your new life and continue to practice the tools that will help you indefinitely. We will conceptualize this stop as where you are building your new home.

• The green center is your lot and it is round. It provides the foundation for your house and you can landscape it to your heart’s content. This is done by using tools that engender self-compassion and you are expanding the center.
• It is important to protect your home and the red ring will do that for you. Anxiety and anger necessary danger signals. You will also be personally arming yourself to defend yourself and your safe haven.
• Each room of your house represents an aspect of your life that you will furnish and decorate.

The phases of the construction include:

• Dreaming of what you want and defining it
• Drawing up final plans
• The rooms
  • Entry – Awareness
  • Family room – Social connections
  • Kitchen – Diet/ Nutrition
  • Bathroom – Processing anxiety/ frustration
  • Master bedroom – Sleep/ Nurturing your closest relationships
  • Other bedrooms – Your family/ guests
  • Den/ office – headquarters
  • Garage – Transportation to the outside world/ your reserves
  • Landscaping – Nurturing and growing the center
  • Protection
    • Alarm system
    • Dog
    • Self-defense
  • Basement–workout room/ exercise

The essence of life is avoiding threat and seeking safety. It is necessary to actively seek both in that you need safety to create the reserves you need to deal with life’s challenges. Otherwise, you’ll be overwhelmed a good percent of the time, with a limited capacity to enjoy your life or even worse, continue to suffer.

You have only just begun

We all equate home with safety, but all too often it is not, especially when chronic pain is in the middle of it. Family members are also our most powerful triggers and it is bidirectional. Creating a “safe house” or haven takes a focused effort but none of the steps are difficult with the right tools. You have heard the saying, “A carpenter is only as good as his/ her tools. You now have the opportunity to create whatever life you want and even though this is the end of this course, you have just begun your journey.

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The DOC Journey is a condensed set of core resources that reflects the experience of hundreds of patients suffering from chronic pain that have successfully taken their lives back. It reflects the evolution of our knowledge of about pain and how to more clearly present the problem, principles behind the solutions, and how to continue to thrive and move forward once you have broken free.

The guided course is one one of the resources that provides a guided pathway through the maze of choices offered to patients. It provides background information, tools, strategies and support that enables you to develop a game plan around your unique set of issues and circumstances. As it’s a largely self-directed process, you can then create partnerships with your medical and non-medical providers to solve your pain.

Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain provides the framework for a deeper understanding the nature of chronic pain and breaks it down in its component parts. It is recommended that you use it as your reference book.

Overview of the guided course

This course is organized around principles we learned in our workshops. We witnessed profound shifts in pain and mood during the three or five-day events and we were consistently amazed by the magnitude of the changes. For those who continued to learn and practice the tools, the outcomes were sustained. Your brain can only rewire by consistent repetition. This is the sequence that emerged from our experience.

• Awareness – first step in solving anything
• Hope – has been shown to be a powerful healing force
• Forgiveness – you cannot move forward until you have let go.
• Play – is how we evolved and figured out human relationships. Re-connecting with this energy is precipitates rapid changes. It does take a series of steps to get there.

Why this sequence

This process is evolved from my own 15-year suffering from severe chronic pain. There was no reason it should have happened and I was extremely fortunate to break out of it. It all began with a panic attack in 1990 out of the blue. I was under a lot of stress but nothing more than I was used to. For 30 years I have been searching for the answer of how could my life been so dramatically and permanently altered in 10 minutes?

I broke free from the grip of pain in 2003, but I only knew that some writing exercises that I had inadvertently began to engage in seemed to be a significant factor. I still did not know why it happened and I certainly didn’t know anything about chronic pain. The neuroscience research since 2009 has clearly revealed the answers and the solutions.

I feel the reason that this journey has been so successful for well over 1500 patients is that I painfully traveled every millimeter of it and learned a process from mostly from what didn’t work. If some approach seemed to have promise, I pursued it personally and shared the ideas with my patients. It is still evolving and I am excited in that I am able to present it more clearly and my patients have been able to respond more quickly.

Awareness is the foundation of healing. You will develop an awareness of:

• The nature of chronic pain – as opposed to acute pain, there is nothing useful about being in ongoing pain. Mental pain is a bigger issue than physical pain.
• Your situation. What factors are relevant to your specific situation? What is your diagnosis? Has it been clearly explained to you?
• The principles behind solving chronic pain. Once you understand the problem and the nature of the solutions, you’ll be able to take charge of your own care.

Hope has been shown to exert a favorable effect on the inflammatory response and is a key factor in healing. (1) Loss of it is a common theme with almost every patient experiencing chronic pain. You are suffering miserably, no one can tell you what is wrong with you, you’ve been told that you just have to live with it and do the best you can, and no really believes how much pain you are in. Where is the endpoint? Not only do patients break loose from the grip of chronic pain, they often thrive at a level they never conceived possible. You will hear many of their stories.

Forgiveness is critical and is the dividing line between healing or remaining stuck. Your brain processes mental pain in the same way as a physical threat. Most people in pain hold onto the situation or person who wronged them. (2) It is understandable, but you cannot heal and move forward until you let go. Forgiveness is learned skill and a powerful statement that you are taking your life back!

Play is how mammals learn to socialize. Humans take it to a different level since we have language added to the mix. You learn safety vs. threat, body language, negotiation skills, effect of tone of voice, etc. When you are in a play mode your body’s chemistry is optimized and your sense of contentment and well-being is increased. This is not play intended just to distract you, but rather that in which you are fully engaged in something you love.

The goal

You will learn methods that will stimulate physical changes in brain (neuroplasticity) and can re-direct your nervous system to form more functional circuits. The outcome is to optimize your body’s reaction from one threat to safety. The final signal to your body’s cells is sent through cytokines. These are extremely small communication proteins. The defensive one are inflammatory (Pro-I) and the safety cytokines are anti-inflammatory (Anti-I). You will learn to regulate your body’s chemistry and inflammation to create a favorable healing environment. The effects are often profound with all parties excited and somewhat incredulous at the degree of healing.

Navigating the course

The core journey is arranged in sequence that begins at where you are at suffering from unrelenting pain and lays down a foundational set of concepts and tools in order to move forward. The intention is for you to move at your own pace, as the healing process is different for everyone. Some people experience rapid relief of pain within a few weeks. Most people experience significant shifts in pain and mood within 3-6 months. But never give up. I have had many patients email me years later that they had broken free from the bonds of pain.

Although there is often some improvement early in the Journey, the tipping point for deep healing always occurs around processing anger, which is inevitable when you are trapped in misery. Anger is protective and we are not programmed to be vulnerable. It threatens survival. That is why the DOC Journey is arranged in this order. You must first be ready to let go before you can accomplish it.

The guided course

There are seven legs to this guided journey with “rest stops” along the way. The reason for the stops is to embed and practice your tools. Calming your nervous system and optimizing your body’s chemistry is a learned skill set. Each person will find his or her own best set of methods.

Leg 1 – Preparing for your journey

Leg 2 – Starting your trip

Leg 3 – Anxiety is the Pain

Leg 4 – Awareness

Leg 5 – Anger processing – the Tipping Point

Leg 6 – Moving Towards Your Vision

Leg 7 – Expanding the Center of Your Circle of Life

The DOC Journey

Although this course is a core aspect of The DOC Journey, other resources are available that will provide additional support and depth of knowledge about how to proceed. The group coaching is especially helpful. Many of your questions will be also be answered with the video tutorials, which are connected to the appropriate lesson and also accessible in the Toolbox.

The best part of The DOC Journey is that the effects continue indefinitely. You have “changed your filter” and you’ll continue to process your environment with this new perspective. Since your brain keeps physically changing, it takes an active effort to turn back. Once you own your life, it is yours.

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