This blog is written in conjunction with Dr. Les Aria, who is an experienced pain psychologist working in Northern California. He brings a wide range of approaches into successfully treating and solving chronic mental and physical pain.

Being triggered and stressed is so common during the holidays that it is somewhat normalized. Yet hope springs eternal and we keep gravitating back to the same historically chaotic situations. Why do some levels of crises keep happening at Holiday family gatherings? This article is written with all due respect to those of you who are socially isolated, which is devastating and magnified during the Holiday season.

There are many ways to enjoy your family and close friends during this time of year regardless of their behaviors and your stresses. It is supposed to be a season of peace and joy. Understanding the nature of the problem allows solutions.

We acknowledge the many additional stresses around the holidays that have been discussed in many venues and numerous excellent suggestions have been made. However, once you have navigated the obstacles to actually being with your friends or family, it would be reasonable to expect to relax and enjoy them.

Defining a trigger

The basic problem arises from people in close relationships triggering each other. What does being “triggered” mean? We survive by learning from prior experiences what is safe or threatening. This includes your emotional states and consciousness, which are processed in a similar manner as physical threats. Many, if not most, of these mental threats are perceived and are based on cognitive distortions. It is the reason many of us have a baseline state of being “fired up.”

So, anytime you feel anxious or angry, something in the present has been connected to a situation in the past that was perceived as threatening or was dangerous. Your adult brain will still process it in the same manner. You have been triggered. The problem arises from the fact that you are now in the past and not the present. You have lost awareness of the present moment, which is at the core of functional human relationships.

As your earliest and most powerful programming happens with your immediate family, they are the strongest and most consistent triggers. Close relationships are not far behind. The deeper problem is that when you are in this state of threat physiology, the activity of your brain shifts from the neocortex (thinking centers) of your brain to the lower regions (survival) of your brain and you cannot think clearly. It is not possible. So, then your behaviors or those of others may be less than ideal. What can you do? Here are some suggestions.

Dealing with triggers

The first and necessary step is to understand the problem and there are many resources that will help you understand the nature of chronic mental and physical pain. The essence of chronic disease is sustained exposure to your body’s threat chemistry or in other words, being constantly triggered. Here are a few practical suggestions.

Triggers are a whole-body response to a real or perceived threat. Here are 3 behavioral/ physical cues to help you identify that you are being triggered before becoming fully activated by past family triggers.

1. Mood Shifts: Notice when you experience a mood shift. Do not suppress those emotions. Burying emotions alive will lead you to step on them at some point during the holidays–KABOOM!
2. Tension Shifts: Notice when you experience sudden muscle tension in your body. Check your shoulders right now! Left = Anxiety and Right = Anger/suppression of emotions/complaining all day long!
3. Breath Shifts: Notice how often you hold your breath when around certain family members. You know who they are! Are you holding your breath? Are you breathing shallowly? Are you breathing rapidly?

What are the triggers when you are around your family?

1. Criticism is one of the most common triggers.
2. Financial worries from food to travel plans.
3. Feeling pressured to be happy or positive

These are just a few of many triggers–know yours.

*Note: Your physiological states determine your psychological states; vice-versa.

 If you are already feeling stressed or wired, be careful. Your nervous system is “trigger happy” and you’ll not only ruin your experience but create chaos for others.

Practical tips to process triggers

1. Manage expectations. Holidays have a way of making wanting to feel like what Hollywood puts out – this amazing, beautiful scene where we all get along. Not everyone experiences such stuff. Dashed hopes make things worse. Once you understand how to remain calm during any level of chaos, no one can take away your capacity to enjoy yourself.
2. Utilize your Mindbody practices. They are learned skills and include breathwork, meditation, exercising, expressive writing, restful sleep, humming, relaxing music, and mindfulness. Each person has their own set of tools that works best for them. If you haven’t learned to regulate your stress response, please make the effort to do so. They eventually become automatic with practice, and the Holidays are a great opportunity to practice.
3. Avoid all negative conversation–period. No complaining, gossiping, criticism, giving unasked for advice, or discussing your pain or medical care. This is something that is basic to healing and you’ll do the rest of your life. Consider how much time you are spending in this type of activity.
4. “5–3–2” is a strategy to create some “space” in your brain before you take any actions. The numbers represent the words describing each step.
   1. No action in a reaction
   2. Flip the switch
   3. Move on

The details are discussed in this article.

 5. Take time for yourself. This is something we practice and preach about. Set time aside from everyone. Go for a walk before the hoopla starts if you are staying over with your family. Break away from the family during the day or when you need some space to “come back online.”

Summary

Keep your perspective! Remember that you always have choices–once your brain is back “online.” Keep focused on who or what is important to you. How do you wish to show up for the holidays?  Practicing the skills we discussed, especially noticing when you are triggered and doing something about it will help you keep your love, peace, and joy during the holidays.

As always –be kind to yourself. Let the Holidays begin!

The post No One Can Take Away Your Holiday Joy – But You first appeared on Back in Control.

The post No One Can Take Away Your Holiday Joy – But You appeared first on Back in Control.

Anger

There is a a “genealogy” of anger that is important to recognise.

• Circumstance
• Blame
• Victim
• Frustration/ anger

Anger is the set of sensations generated by an intense fight or flight response and it is damaging to your body when it is sustained. There is a set of tools that I call, “anger processing” that calm down this response and it is a set of skills you must use many times a day. Life keeps coming at us. Unfortunately, the more legitimate your anger, the more difficult it is to process – but it still damages your body. Being trapped in mental or physical pain is one of those situations.

Carol

Carol is a woman who contacted me about ten years ago. She had read Back in Control and began to use the strategies outlined on my website to calm her nervous system. She had been severely disabled with pain throughout her body. Within a few months she began to improve and was markedly better by the time she connected with me.

I have since learned that all chronic disease, mental and physical, is caused by chronic stress, which means your body’s chemistry is in sustained activated threat physiology. She had already developed a significant set of medical problems by the time I had met her with many physical setbacks. She kept moving forward and her efforts were inspiring.

Then she had to be put into a nursing home on the other side of the country, and she was truly miserable. I did not have any suggestions and was also a bit discouraged by her situation. Then a few months ago, I received this letter.

Her letter

Dear David,

Just a note to let you know your DOC Journey has pulled me through yet another trip back to The Abyss. Since moving here last June, I have felt I have been in a “third world country,” also known as an Assisted Living Facility. It’s bad enough being 83 and sick, but it’s even worse when the facility you live in is way below par in every way, Staff, food, medical needs, activities, cleanliness, and caring. Add that to that the frustration over my loss of hearing. Closed Captions are now a part of my TV world and I find myself wanting them everywhere. I cannot afford the doctor who recommended hearing aids right now because I am working on yet another expensive “fix it” project, my teeth. What else can go wrong? The depression/anxiety and pain were also taking over my life again.

However, rather than just sit here and play the victim, I thought; what can I do to make this better? I remembered a conversation you and I had after I read his book, Back in Control and about helping others. That is what I felt he did for me. He took his knowledge and experience and has helped me and others understand how we can apply it to our own situation with his book, the weekly newsletters, various posts, and podcasts, the Q&A sessions and other educational material. He shared what he knew and paid it forward! How could I make this work in my own situation?

I remembered the experience I had of working with my mother back in 1977. She had Alzheimer’s. I knew nothing about that, Medicare, Medicaid, and elderly living. I moved in with her, turned her 3^rd bedroom into an office and worked on getting her proper care and eventually, into a lovely Skilled Nursing Facility. It was an exasperating experience as I was suffering from a recent divorce, depression/anxiety, chronic pain, and Fibromyalgia. But, as I look back on it now, I realize it was very also very educational. Several years later, when I was the Executive Secretary for both the Director and the Administrator of a 27-story health care facility in San Francisco, it occurred to me that I could use that expertise and knowledge as well, and act as an advocate for residents who could not be an advocate for themselves.

Subsequently, living here for a while, I realized that most of the residents have some level of dementia, and no one is paying much attention to them. Unfortunately, their families have just dumped them off for someone else to look after. I knew how good it made me feel when I talked with you because you validated me as a real person, not just a number. For such a long time I felt that no one understood what I was talking about. His understanding and willingness to share gave me so much hope and began to restore me as a human being. I learned that this is what people want most, to be recognized, cared for, and loved.

As bad as this place is (and it’s bad), I felt that perhaps God had placed me here for a reason. Before moving here, I lived in a fabulous Assisted Living facility in Washington, so it gave me something to compare this to. Maybe I could make a difference. I found out where to complain, the State Health Care Facility Complaint Board, and contacted them. I also contacted the Ombudsman for this district. I wrote to and talked with both parties, plus Administration heads and some of the board members of the place where I live and pointed out nearly 20 complaints. The more I have worked with these residents and staff, instead of thinking about my problems, the better I’ve felt. And, I am pleased to say that because I was willing to stand up and pay it forward, the facility is making some real changes that have made a major difference in most of the resident’s wellbeing.

–Carol

Trapped – or not

People often use the term, “stress management” to deal with adversity. What is overlooked in this phrase is that at the situations that are the most stressful are the ones you can’t control. So, the approach needs to be flipped. You must learn to calm yourself first, which requires learning the skills and practice (there are plenty of opportunities). Positive thinking doesn’t work. You have to address each scenario head on. If you can change it, do it. If you can’t, then use your tools.

Paradoxically, as you are not burning up energy on situations you have no control over, you’ll have more to actually solve more of your problems. If you are dependent on your circumstances for your peace of mind, you are at the mercy of them.

She was truly trapped, and actually still is. Many, if not most of us are in similar situations, whether it is finances, difficult work environment, lack of opportunity, racism, or family dynamics. She chose to relate to her circumstances differently, which allowed her body to reconnect to its capacity to heal. You will be surprised to see how many more of your problems are solvable when you can calm down first. She continues to be an inspiration for me.

The post No More Being a Victim – Pay it Forward and Heal first appeared on Back in Control.

The post No More Being a Victim – Pay it Forward and Heal appeared first on Back in Control.

• Most of us intellectually understand that the only moment we have in life is this very one. That is it.
• Being in medicine for over 40 years has shown me the incredible unpredictability of life. Life changes in second – sudden heart attack, bad car accident, diagnosis of terminal cancer, and the list is endless.
• But our minds play tricks on us by constantly worrying about the future and hanging onto regrets from the past.
• This problem arises from our unconscious mind that is protecting us. It is continually scanning the present looking for situations from the past that were perceived or were actually dangerous.
• So, your actions today are a result of your cumulative perceptions of what is safe – or not.
• You can’t control this response but by using tools to stay connected to the moment, its impact is lessened.

Commitment to change is one thing but sticking with it is challenging. One way to help yourself along is to bite off small bits at a time and proactively make the choices all day long. It will become a habit and your norm. A starting point is repeatedly asking yourself a simple question, “Who do I choose to be today?”

A tough start to my day

One morning I woke up feeling low, having just completed eight straight 15-hour workdays, including a long weekend. As I lay there exhausted on a Tuesday morning, I reviewed my choices: either 1) stay in bed feeling sorry for myself; or 2) give thanks for the opportunity to help so many patients during the week, be grateful for how well the week went, and meet my work-out group early at the gym. I chose the second alternative. I got up, worked out, went into the office, and gave 100% to each patient and my staff. I’m not saying it was easy; but it turned out to be a great day.

Proactively choosing how to experience your day is the farthest thing from “positive thinking.” No one is asking you to pretend to be happy when you are coping with a difficult situation, especially your ongoing pain. On the contrary, you must be aware of the depth of your frustration before you can choose to live a full and productive life with or without pain – or decide to enjo. Positive substitution—filling your life with positive experiences— is the essence of neurological reprogramming.

A Tough Beginning

Recently, I was talking to a friend’s teenage son. This kid was good-looking, athletic, and personable; yet he felt isolated, insecure, anxious, and emotionally unstable. He continually compared himself to others and tried to fit in. He was also justifiably upset about his family situation. His father, who was extremely critical of him, had essentially abandoned him by moving out of the country. I  understood where he was coming from, since his experience was not much different from mine at his age.

About halfway through our conversation I realized that he too, had a choice. I pointed out that, after years of stress, he had remained remarkably intact. He could choose to be proud of his resilience in the face of adversity and use this gift to take on new challenges. I could see his eyes light up.

Some suggestions

FOMO (Fear of Missing Out) seems to be rampant in this modern era. Maybe it is because we are overwhelmed with options? What we are missing out on is enjoying our day. It is a deeply embedded thinking pattern that doesn’t resolve over time. It requires specific approaches.

You can’t “solve” FOMO. By trying not to be this way, you’ll actually reinforce these circuits. The answer lies in cultivating connection, meaning, and purpose. Trying to be “happy” actually doesn’t work due to the “ironic effect.”¹

• Nurture deep gratitude for you have. It may not be as much as you want but focus on it.
• Compare your situation to those who are less well off than you. It may not seem possible in light of your pain but start somewhere.²
• Become aware of how frantic you get about your “to do” list and how endless it is. It is endless for all of us.
• Then don’t put ANYTHING on your list that you are not going to do TODAY.
• Frequently practice active meditation or breath work to calm yourself. It is one tool that connects you to the moment you are in.
• Listen to some of your favorite music – especially if it is connected to enjoyable experiences from the past.
• What is one thing you can do today that brings you pleasure? – a cup of coffee  your favorite donut; a call to a close friend; a compliment to a family member or friend; anything. There is an endless of list of small deeds that can change your day.

Recap – Your choice

What do you want out of your life? Is it more than being a sufferer enduring pain? Do you really want to live your one life this way? Of course not, you may be thinking. But trust me. It is unlikely that you will magically wake up one morning and find your troubles gone. Focusing on solutions is an ongoing conscious choice because your powerful unconscious brain automatically gravitates towards the problems. There are no shortcuts.

So, who do you want to be today? Choose carefully because you will either be reinforcing old neurological circuits or creating new ones. What is your choice this year, this month, today, the next 15 minutes, or this minute? Carve a few minutes out every morning to ask yourself that question, ponder your options, and commit to whatever choice you make.

Questions and considerations

1. The impact of chronic pain on your life has been documented to be that of having terminal cancer – except worse.³ So, first of all, honor your own suffering and give yourself a break.
2. Depending on the severity of your suffering, you may not feel like nurturing a better life, even for a few minutes. This is one point in your journey that you must begin somewhere, and the next 10 minutes is the place.
3. Then you have to keep repeating it, whether you feel like it or not.
4. Even when you are feeling better (and it will happen with practice), you’ll still gravitate towards the negative because that is what your powerful unconsciousness brain is supposed to do – protect you from danger.
5. To have a good life, you have to live a good life. It is just the way your nervous system works.

References

1. Wegner DM. The seed of our undoing. Psychological Science Agenda (1999); Jan/Feb:10-11.
2. Dalai Lama. The Art of Happiness. Penguin Random House. New York, NY, 1998.
3. Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhøy M, Bortchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand (2008); 52:143-148. 

The post Who Do You Choose to be Today? first appeared on Back in Control.

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This is Scott, who is a personal trainer that I work out with on Tuesdays and Thursdays at 6 am. This is his picture at the gym one memorable Halloween. He’s a little unusual in that he laughs at us – the whole time we are working out. He pushes us hard and the more we “complain” the more he works us – and keeps laughing. Of course we also end up laughing. It doesn’t matter what lines we give him he will one-up us. It is impressive in that we have some excellent complainers in our group.

I am paying you for this??

It hit me one day that people pay me to do whatever I can to relieve their pain and I am paying Scott to inflict pain – some days quite a bit of it. Yet I come out of my workout invigorated and refreshed. My day is always better and my mood is light. That’s in spite of the fact that my patients keep asking me the rest of the day if I’m in pain. My back and right knee is stiff after my sessions with him. I limp and have a hard time getting out of the chair after a patient visit. Although I am uncomfortable I don’t really perceive it as pain either during the workout or the rest of the day. What’s going on? I don’t have a particularly high pain tolerance.

Choice

I think one reason is because I have a choice. I make a decision to get out of bed early and spend time at the gym. We have a great time in spite of a lot of physical sensations that are often not that pleasant. But I could always leave or quit working out with this group. With chronic pain you have no choice. You’re trapped by unpleasant sensations. Feeling trapped creates anger and over time it can evolve into a rage. Contrast the same uncomfortable sensations combined with deep anger versus laughing and having a complete choice over how much pain you are going to allow to be inflicted on you.

Interpreting signals

Every time the body sends a pain signal to your brain it has to be interpreted as pleasant or unpleasant. When the sensation is combined with a pleasurable experience (and I hate to admit to Scott I am having a good time) it’s a completely different situation then when these sensations are combined with fear and anger. The final perception is dramatically different. Make no mistake about it. Pain is a perception and is interpreted only through your nervous system. It is confusing in that although the pain is felt at the point of origin it is perceived only in your head. All pain is “in your head. If you think otherwise, “wake up”. Video: Explain Pain

The quest

If you are on a quest to “find the source” of your pain or you’re convinced that “The doctor is missing something” you’re stuck. In fact you’re being trapped by the same disease that’s also contributing to your chronic pain – the Neurophysiological Disorder (NPD). Obsessive thought patterns are one of the classic symptoms that also blocks treatment. I liken them to phantom limb pain where pain persists in the arm or leg after it is amputated. The pain circuits keep spinning. So can obsessive thought patterns. Patients frequently have undergone many tests for years without an answer and can’t stop going to the doctor to have more of them done. The need to “find an answer” is an endless pilgrimage. The term I used for my search was an “epiphany addict”. I kept having major “breakthroughs” that would last for a few days or weeks but there was no meaningful change in the overall quality of my life.

Your choice

Right now you may not feel like you have much say about your pain. But you do have a choice to learn about the various components, engage in effective treatments and take full responsibility for solving it. I enjoy my workouts with Scott and my friends because I have a choice. I experienced years of chronic pain in where I had no choice. It was unpleasant beyond words.

I ended my quest for an “answer” in 2002 in that somehow I realized that the answer to my pain was there was no answer.  I made a decision to live my life with or without the pain. It happened on Mother’s Day. As I took back complete control of my life, my pain eventually disappeared. I didn’t make the decision in order to get rid of the pain. It was an unexpected bonus. It’s what happens to my patients as they reach the point where they make that same choice. With a deep commitment, becoming pain free is the rule, not the exception.

Make a choice to live. You only have one shot at this life.

The post “I’m Paying You to Inflict Pain??” first appeared on Back in Control.

The post “I’m Paying You to Inflict Pain??” appeared first on Back in Control.