The gift of life

Every living creature, from one-celled organisms to mammals, have a reaction to threats that improves it odds of survival. It is intended to be so unpleasant that action has to be taken to resolve it. Once the danger is passed, the chemistry of the organism returns to a neutral or safe state. Humans have the additional characteristic of language and consciousness. Unpleasant thoughts and emotions cause the same reaction except that we can’t escape them. Repressed thoughts and emotions are even more problematic. Every person has to deal with this issue at some level. Although every animal has this response to danger, humans have labeled it “anxiety”. It describes your total bodily response to threat; it is not the cause. It signals danger and it is the pain – and also a gift.

It is critical that you separate your identity from this powerful reaction. It is amoral and unpleasant and not who you are.  The first step is to get rid of the word, “anxiety” from your vocabulary and substitute, “elevated stress chemicals” or “survival response.” So, regardless of how you accomplish it, lowering your stress hormones and levels of inflammatory proteins/cells decreases this unpleasant sensation. It does not respond rational means.

When your stresses overwhelm the coping capacity of your nervous system, you will experience mental or physical symptoms. There are ways of increasing the resiliency of your nervous system and also methods to process stress so it has less of an impact. But this response is part of life and inevitable. When it occurs, you will want to minimize the time spent in this state. This set of tools directly lower your elevated stress reaction.

Taking control of your body’s neurochemical state

Much of the effect is modulated through the vagus nerve, which is at the core of the autonomic nervous system. It is calming and strongly anti-inflammatory. Many of these suggestions directly stimulate this nerve.

Changing sensory input

• • Active meditation/mindfulness – you are placing your attention on something more pleasant.
  • Deep tissue or light touch massage
  • A cold compress to the face (Mäkinen), especially after exercising or if acutely stressed.
  • Connecting with nature – historically a basic aspect of the human experience.
    • Walking barefoot in the sand.
    • “Hearing” the silence
    • Taking in all of the senses
      • Birdwatching
      • Learn about the flowers and trees
      • Notice different smells and fragrances
    • Awareness
      • Become aware of your feelings of anxiety and anger and train yourself to separate from and observe them.
      • Awareness is a powerful tool. A pain psychologist and close friend of mine pointed out that, “You have to feel to heal.”

Breath work directly stimulates the vagus nerve, which is strongly anti-inflammatory (Mason).

A lot of research has been done on the effectiveness of meditation. It is challenging to measure as there are so many schools of thinking that espouse different methods. However, one common factor that has  been documented in an extensive medical literature review  (Zaccaro), is slow breathing.

• A respiratory rate of < 6 breaths per minute (bpm) and < 10 bpm was consistently correlated with stimulation of the parasympathetic nervous system, which also decreases inflammatory cytokines (communication proteins). Whether you paid attention to your breath or not, was not a factor.
• Breathing through your nose during either inspiration or expiration could be of some benefit.
• One deep breath, followed by a slow exhalation
• Meditation with deep breathing. Try using a counting method (such as 4 counts breathing in and 4 counts out; or 4 counts in, hold for 7, and release for 8)
• Alternating nostril breathing (block one nostril while breathing in and the other nostril while breathing out)
• Focus solely on your breath (Mason).

Calming activities

• • Acupuncture
  • Exercise – hard workouts
  • Biofeedback
  • Medical hypnosis
  • Yoga, Tai Chi, Chi Gong

Visualization

• • Remembering in detail the most enjoyable of your life.
    • Connect with and feel it.
  • Visualize what others are seeing when you are upset.
    • Would you be attracted to you?
    • Would you want to be around you?
    • Is this really how you want to treat those who care about you?

Decrease stimulation of your nervous system

A sensitized nervous system more quickly creates anxiety. So, it is important to be mindful of activities that fire up your brain. It is not a matter of right or wrong. The point is to observe the effects on your nervous system. Consider what you feel happening to your body when you:

• Play intense video games or watch violent movies
• Argue with family members
• Watch news that upsets you

Some additional suggestions to remain calm include:

• No discussing your pain or medical care with anyone except your health care providers.
• Limiting the time that you spend watching news and other over-simulating programs.
• Choose less intense video games.
• No complaining about anything, including the pandemic.
• No criticizing anyone. You are simply projecting your view of yourself onto them.
• No offering advice that is not requested. How do you feel when you are on the receiving end?
• No gossip

These techniques are effective and necessary short-term strategies, they can be incorporated into the larger picture to solve your pain. The bottom line is to use common sense to actively calm yourself and avoid activities that stress your nervous system. It is surprising how much difference it can make.

References:

Berk LS, et al. The neuroendocrine and stress hormone changes during mirthful laughter. Am J Med Sci (1989); 6:390–396.

Kok BE, et al. How positive emotions build physical health: perceived positive social connections account for the upward spiral between positive emotions and vagal tone [published correction appears in Psychol Sci (2016); 27: 931]. Psychol Sci (2013); 24: 1123‐1132. doi:10.1177/0956797612470827.

Mäkinen TM, et al. Autonomic nervous function during whole-body cold exposure before and after cold acclimation. Aviat Space Environ Med.

Mason H, et al. Cardiovascular and respiratory effect of yogic slow breathing in the yoga beginner: what is the best approach? Evid Based Complement Alternat Med (2013); 2013:743504. doi:10.1155/2013/743504.

Miller M, et al. Positive emotions and the endothelium: Does joyful music improve vascular health? Circulation (2008); 118: S1148

Vickhoff, B, et al. Music structure determines heart rate variability of singers. Frontiers in psychology (2013); 4: 334. 10.3389/fpsyg.2013.00334.

Zaccaro A, et al. How breath control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers of Neuroscience (2018); 12: 1-16.

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Couldn’t outrun it

The stress of a surgical residency began to increase my physical symptoms. My ears began to ring incessantly and my feet burned. Some unusual thought patterns emerged. But I just kept plowing ahead. Private practice was even more intense and I began to have heart palpitations, some chest pain, sweats, trouble sleeping and various inflammations throughout my body. I still did not let it slow me down – until I was driving across a bridge across Lake Washington and experienced a severe panic attack. I had no idea what was going on and why. I did not become a major spine surgeon by having anxiety and honestly had not experienced much of it. It was just “stress” and that was what surgeons were supposed to experience. My capacity to handle stress was a badge of honor. But I couldn’t outrun it. My body wouldn’t let me.

The Abyss

For the next 13 years I spiraled into a black hole without a bottom with the last seven of them being intolerable. I became severely depressed and of the 16 symptoms my anxiety was the worst. It was unrelenting and intolerable. I developed an obsessive compulsive disorder, which is manifested by intense repetitive intrusive thoughts and resultant extreme anxiety. I was “tough enough” that I was still able to maintain a successful surgical practice. What I couldn’t hold on to was my personal life and I became increasingly socially isolated that may have been one of the worst aspects of the ordeal. By 2002, I was ready to end it all and still not quite sure why I didn’t.

About that time, I picked up a book I had read years earlier, Feeling Good by David Burns. It is a great book and one of his first admonitions to actively engage in the tools he described with one of the basic ones being writing in a three-column format. I was alone with plenty of time and I began to write for hours. I instinctively tore it up immediately and it was initially disconcerting to observe the cognitive distortions that were torturing me. But for the first time I felt a shift. By six weeks I noticed an appreciable difference in my anxiety and I began to sleep a little better. I finally had a ray of hope.

Anger

But I was still having more anxiety than I was comfortable with and wasn’t sure what to do next. Then I exploded in a manner I can’t describe in words. My personal situation became so difficult that I became extremely angry. Up to that point I did not think I had anger. I had developed a persona of being cool under any amount of pressure. I was so good at it that I actually did not feel anger. However, it was clear to everyone else that I was not that relaxed. I was first forced to acknowledge the fact I had anger and that I was in a perpetual victim mode. The details of how I processed the anger are not important and I didn’t do it well. But one day I simply gave up and admitted that I was angry and that I couldn’t solve it. I could feel another massive shift. Within six weeks my physical symptoms almost completely disappeared. I still did not know what had happened. She just let go

It took me another five years to make sense out of any aspect of this ordeal. What had I done wrong? I did have a difficult childhood. But at age 15, I just left it behind and moved on. I worked hard, coped with my past, underwent counseling, took leadership roles, committed to caring for my patients and was intent of not repeating the past. I still feel at the deepest level that this was an undeserved ordeal. I have also learned at a deeper level that holding on to the past is a huge problem and you will guarantee yourself a life of misery. It is clear in retrospect that acknowledging my anger was the key beginning the process that would eventually solve my chronic pain. It was when Dr. Luskin’s book, Forgive for Good, was introduced into the process that patients began to consistently go to pain free. When they get stuck, it is almost always around not being able to forgive and move on.

I have been out of this hole for over 13 years. It is still hard for me to believe and am thankful for every second that I am not in the Abyss. Additionally, I am thriving at a level that I could never imagined was possible.

Practice, practice, practice

That being said my wife reminds me (almost daily) that I am free of pain if I continue to practice the concepts that I teach my patients. If I quit, I have a recurrence of symptoms within a couple of weeks. My scalp itches, ears ring, feet burn, can’t sleep, and rashes show up on the back of both of my wrists. I do have severe arthritis of both of my knees that is my current challenge. Although I am not thrilled with my daily knee pain, it is not nearly as disruptive as during my period of suffering that had the additional layer of anxiety. Am I operating on your pain or anxiety?

The ongoing tools that I have found helpful include:

• Few minutes of daily expressive writing
• Practicing being aware of my reactions to others and other’s reactions to me.
• Forgiveness
  • Acknowledging the endless ways I go into the victim mode and disguising it.
• Visualizing a different outcome before an expected unpleasant situation happens.
• Active meditation – my most frequent tool
• Nurturing a sense of play in almost any situation
• Continually “letting go”
• Giving back
• Understanding the role of the family dynamics in triggering pain pathways
• Regular reading of Anthony DeMello’s The Way to Love

I think that one of the reasons the DOC process has been effective is that I learned every millimeter of it by enduring extreme suffering. I know the depth of despair and misery, especially when there seems to be no hope and endless broken promises. I am now able to pass on these concepts in a way that enables people to come of pain in months rather than my 15 years of doing mostly the wrong things. Each person who comes out of this pit of pain does it in a personal way. Chronic pain is solvable and I am honored to be able to pass on what I have learned.

The post My Story of Hope first appeared on Back in Control.

The post My Story of Hope appeared first on Back in Control.

Objectives

• Most of us are under the impression that you must first solve your chronic pain before you can move forward and enjoy your life.
• It is actually the opposite scenario. You have to fully engage in life in order to move away from your pain.
• Fully engaging in today, with or without the pain, is your only option. To change your brain, you have to direct your attention to where you want to go and keep doing it.
• You also must use tools to lessen the impact of mental and physical pain. These are critical in that you can’t move forward without letting go.
• To have a good life, you have to live a good life; It requires practice.

“Life is like riding a bicycle. To keep your balance, you must keep moving forward.”

Albert Einstein

The goal of The DOC Journey is not to rid yourself of your pain. In fact, there is no goal because there is no beginning or end to it. The only “goal” is to live your life fully today with the deck of cards you have been dealt – with or without your pain. You must keep moving forward to move through and past your pain.

Understandably, everyone wants to be free of pain. But that isn’t life. The brain treats emotional and physical pain in a similar manner and the body’s physiological response is the same. So, even you were to be rid of your physical symptoms the quality of your life would not change as much as you might think. The emotional circuits will keep firing in response to day-to-day stresses.

Historically, I felt if I surgically relieved a specific symptom caused an identifiable structural problem, the degree of relief would be so compelling that it would propel him or her out of chronic pain and back into a full life. I could not have been more wrong. Unrelenting anxiety, which essentially is the pain, was intolerable and it didn’t improve with surgery. I was shocked as normally the pain should have been easily relieved with the operation. What was also disturbing was that even if the pain resolved with surgery, another body part would frequently light up.

I now understand that research has documented that if you have surgery in the presence of untreated chronic pain, you can induce pain at the new site between 40-60% percent of the time. Five to ten percent of the time it will be a permanent problem.¹ Of course, you can worsen the original pain.

Moving on

So, if you can’t fix yourself and there is no “goal”, what can you do? The patients who were successful in regaining their lives just moved on – with or without their pain. Paradoxically, there was a much higher chance they would leave it behind. Your incredibly adaptable brain develops wherever you place your attention. One metaphor is that of diverting a river into a different channel. There is initially a small amount of water flowing in the new direction, but eventually the volume of water will create its own channel. There are many ways to re-direct. Some include:

• Not discussing your pain – ever with anyone.
• Mindfulness – active meditation
• Meditation
• Visualization
• Engaging with family and friends in a meaningful way.
• Awareness – simply watching where your attention is focused allows you to re-direct it.
• Play

Visualization

 A friend of mine, who may have been the first DOC success in 2006 sent me this email that suggested a different take on visualization. My take on the following quote is that people age because their dreams are crushed by anxiety. You will note that this quote has been used several times in The DOC Journey.

Hi David,

Great quote from your latest post:

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

Gabriel Garcia Marquez

To your quote about anxiety crushing dreams and the ability of dreamers therein, I’d add that pushing through the anxiety and daring to dream, regardless of how you feel, creates an inverse effect of calming the anxiety, because sometimes, just having something to believe in, as simple as that, takes us out of our anxiety momentarily enough to see clearly, and thus move forward to a better place.

It works for me as a visualization tool to break the “anxiety cycle” as I call it. And if someone doubts this protocol, they only need to buy a lottery ticket. For the cost of $1, you walk out of that store and start visualizing what you’ll do with the money, and in that very moment, you’re not anxious. Instead, you find yourself, calming, your breathing slows, as you really indulge, if for only a few moments, how you’d be with all that extra cash on hand. It’s an amazing, albeit temporary salve, a balm to the anxious heart. And here’s the trick: We can recall that feeling over and over again and build on it, finding new ways to create the lives we want, just by using this tool of positive visualization. As our mind uses this, our thinking becomes stronger and we can begin to avert the waves of anxiety and in the spaces between, create constructive, positive events, in which to build the life of our dreams. Ironic that what starts with a fantasy – a one-dollar lotto ticket – can actually become reality, with positive visualization techniques tasked toward constructive events in real life context. And hey, we can use every tool we can find along the way, as I see it! Even for a buck!

Play

Play circuits are also permanent and are present to a greater of lesser degree in everyone. Re-connecting with them, with or without your pain, is a powerful way out of pain. These circuits do get buried under the weight of life stresses, but you can create a shift back onto them with specific tools and repetition. This does not mean obsessively engaging in play to distract yourself. Rather, it is a mindset of wonderment and curiosity. Your body chemistry will shift to safety hormones and an anti-inflammatory state, your brain will be less sensitized, nerve conduction improves, and your pain can dramatically decrease or resolve.

It is not logical to think that if your pain was gone that you could enjoy your life. There are too many ways to experience pain. You have to first learn to enjoy life regardless of its challenges, understanding there are days that you will enjoy it more than others. A positive outlook, which has been shown to lower inflammation, with a sense of play will move you moving forward.²

An old song returns

One example I often used in clinic is that any time you do not spend time practicing a skill, you will eventually lose it. My wife played guitar in her 20’s and became proficient in a picking style of performing. Two years ago, she began to take lessons from an extraordinary Bay Area guitar teacher. About six months into her lessons, parts of some old songs began to return in her head. One day she sat down and played a complete piece that she had not thought about for decades. The memory was still there. Pain, anxiety and anger circuits will atrophy, if you turn your attention elsewhere. But they will never completely disappear since these are also necessary survival emotions.

Recap

Nurturing the part of your brain that enjoys life is a learned skill. That is why it is so critical what you choose to program it with. If your default state of mind is that of being agitated and upset, that is what will evolve. As you trigger the same response in those close to you, then there is no end to this universal ping pong game. Conversely, if you choose gratitude and joy, the same phenomenon will lift you upward.

There is a lot to be angry about and also much to enjoy. What is your choice? How and when are you going to move forward?

Two Wolves

Questions and considerations

1. Life is challenging in many ways for all of us. It never stops and solving problems tends to be the default program of our brain. Consider how much of your life is spent solving or thinking about problems compared to purposefully enjoying yourself.
2. It would be great not to have pain, but how long would you survive without its protection. People born without pain sensors don’t live past 10 – 15 years of age.
3. When pain becomes chronic, it is permanent and memorized and does not serve a protective function. The more you try to get rid of it, the stronger it will become.
4. It is by separating from it, moving on, connecting with enjoyable circuits, and leaving it behind that allows your brain to heal.

 References

1. Perkins FM and H Kehlet. Chronic pain as an outcome of surgery. Anesthesiology (2000); 93:123-33.
2. Dantzer R, et al. Resilience and immunity. Brain Behav Immun (2018); 74:28-42. doi: 10.1016/j.bbi.2018.08.010

Listen to the Back in Control Radio podcast Moving Forward with Your Pain.

The post Moving Forward with Your Pain first appeared on Back in Control.

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Visualization techniques have been used in the athletic and performing arts world for many years. There have been numerous studies demonstrating the effectiveness of these methods. Detailed focused visualization is an effect method of Reprogramming.

Holt and Nick

My son, Nick, is a mogul skier. He is an excellent skier and has come close to making it all the way to the top. He and his best friend Holt have engaged in performance training, which utilizes skills involving both awareness and visualization. They have not only elevated their performances, but they have also been able to handle the stress of the inevitable failures that are inherent in the sport.

Video: Holt’s US 2007 moguls championship run

US Mogul Championships – 2007

In March of 2007, our family was watching the competition for the US National Championship in moguls. My son, Nick, had had a bad day and did not make the finals. Everyone, including Holt was upset. Nick had been talked into trying a trick he hadn’t mastered and just couldn’t pull it off in the heat of the national championship. Holt had a great run and had qualified 2^nd. The top skier on the US ski team had qualified third. The top twelve skiers out of a field of fifty get a second run. There is no carry-over of points from the first run.

It was around 4:00 in the afternoon by the time the final run was winding down. The sun was low and the light was flat. Flat light makes it much harder to see the shapes of the moguls. The top US ski team skier took his run and it was almost flawless. He had a giant score at 27.2 out of a possible score of 30. Usually a score above 26.5 has a high chance of being the winning run. Holt was the next skier. We all were wishing him the best but just hoped that he would have a good run and possibly finish second or third. He came out and scored a 27.6 to win the US championship. We were ecstatic and dumbfounded. It was an incredible run under any circumstances, but almost impossible to pull off under that kind of pressure.

How did he pull it off?

At that point, I did not have that clear of an understanding of the reprogramming process. I could not understand how it was different from positive thinking. I spent the next day picking Holt’s brain, asking how he was able to perform so well under those circumstances. Here’s what he told me. It is first of all critical for the performer to acknowledge the anxiety that is associated with the upcoming performance.

Holt was extremely anxious and he knew that the score he had to beat was high. However, instead of suppressing his anxiety he stuck with it and experienced it. He then concentrated on the feel of the breeze on his face and the edges of the skis on the snow. When his mind would wander off into the potential negative story of how he might fail, he’d  pull himself back into the current sensations that were immediately around him. By doing this, he’d made a choice to detach, effectively saying, “I am not going to be controlled by these thoughts and emotions.” Next he visualized the first few turns and was then able to just ski his run. He also had been practicing these techniques the whole season.

In the past, Holt said his prior strategy would have been to suppress his negative emotions. It would have fallen under the category of  positive thinking: “Don’t’ worry about the other skier’s score.” “Don’t’ be nervous.”  “I can do it.” However, the energy spent on suppressing negative emotions would have taken away from the energy and focus he needed to perform. He instead chose an alternate neurological pathway that was the one he needed to maximize his performance.

The tools

He inadvertently used the sequence of 1) awareness, 2) detachment, and 3) reprogramming to optimize his chances of laying down a winning run.  He was aware of the score of the prior skier and also his level of anxiety. Instead of suppressing he engaged his fears and separated from them. He used “active mediation” and visualization as reprogramming tool. As he felt the breeze and the listened to the sound of the snow under his skis he was connecting himself to the current moment. Reprogramming through visualization is a powerful method: you completely play out the event in your head so that it’s the only program that’s playing. It’s important to mentally experience the smallest detail from beginning to end.

The power of visualization was demonstrated in a study done with volunteers learning to play the piano. The researchers set it up so that two different groups were learning to play a simple scale. One group was taught the skill with an actual piano. The other group was taught by visualizing themselves playing the scale. When they were randomly tested on their ability to do the scale, the results were the same. The experiment was done again with volunteers who were basketball players. One team was asked to learn a play on the court, while the others merely visualized the play. Again, when they were tested, the results were similar.

The tools are the same for dealing with chronic pain. It is critical to become aware of all of the variables that affect your pain, including fear. There are many ways of detaching from your pain as well as an infinite number of possibilities to move forward. Can you connect with your day? Are you able to visualize a productive and fulfilling life? The stakes are much higher than a national championship.

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