• Learning any new material or skill is an active process than can only be acquired through repetition. There are few people with a photographic memory and even they need repetition to embed a skill.
• Living your life in the manner you wish requires many different skills, and most of us are not taught them at any point in our learning experience.
• To have a good life, you must live a good life and also learn to efficiently process adversity.
• The Talent Code presents the concepts of how genius is created and illustrates the process with many interesting examples.
• Chronic pain evolves from repetition of specific sensory input and your brain becomes excellent at feeling pain. It requires the same process to create an alternate set of more pleasant circuits.

I have recommended an educational and entertaining book, The Talent Code,¹ to illustrate how new information assimilated by our brains. The author compiled knowledge from experts and explains how genius is formed. It is rarely an inherent trait. Although, the neuroscience is outdated, the concepts of how learning occurs are correct. There are three parts to creating genius.

• Deep learning
• Master coaching
• Ignition (obsessive repetition)

Deep learning involves reprocessing new information in your mind in a retrievable way. This is critical to use in any advanced learning. For example, one my medical school classmates would read through his pages of notes only once. But he would look at a page and not go to the next one until he could say it back to himself or write most of it down. He was number three in my class. This is in contrast to another college buddy of mine who would read for hours and hours and not retain the material.

In medical school, I would memorize for 20 min and lay down and nap for 10 minutes and keep repeating the cycle over and over again. I would also “rearrange” the material on my own “internal mental grid” that I would construct as I gathered new information.

By using deep learning, you can increase your capacity to learn by 500-600%. That is not an exaggeration. Sometimes in medical school, we would come home with 75 – 100 pages of notes to learn in a day. You cannot passively process this information and be successful at mastering it. Conversely, the author points out that random repetitions decrease your learning by 15-20% and you are wasting a lot of time.¹

Master coaching is critical in that you want to practice specific tools and techniques in a precise manner. You have heard the phrase that, “practice makes perfect.” What if you are practicing the wrong techniques or the right ones in an incorrect manner. You’ll embed bad habits. Often, it takes an outside observer to pick up the small details and keep your repetitions in a narrow constructive range. It is perfect practice that makes perfect.

The DOC Journey is largely self-directed but if you can engage a coach to keep you on track, it will hasten the process. It is difficult to see your own behaviors. Additionally, you must experience a huge shift in your thinking from “fixing” to “letting go and moving forward.” In other words, you are learning a new set of skills while using an old approach. Even when you think you “have it”, you may still unconsciously be trying to fix yourself.

Coaching is also helpful for support. It is common to become socially isolated and human contact is healing.

Ignition refers to being excited enough about what you are doing that you begin to do endless repetitions. Again, it has to be in a narrow range, but the more the better. Consider something that you have become skilled at, whether it is your work, a hobby, music, art, or play. Nothing changed until you consistently practiced. What is commonly called “muscle memory” is really neurological memory from circuits etched into your brain.

As you  become more engaged and excited about your new life, you’ll instinctively increase your repetitions. However, early on, you just have to do it to get over the hump. When you are in pain, it is difficult to get excited about anything. The DOC Journey will not solve your pain. It is providing tools and approaches for you to learn and master in order to navigate your life more competently and at first you may have to “grind it out.”

You are already a “genius” at feeling pain

Unfortunately, the development of chronic mental and physical pain fits the criteria for creating genius. The impulses are “deep learning” in that you predictably react to them, and as you try to cope with them, you are reinforcing them.

You don’t need a master coach in that the impulses are already in such a narrow range and usually predictably affected by specific factors.

The ignition or obsessive repetitions goes without saying as the pain signals are rapid and relentless – especially with obsessive thought patterns that quickly become memorized. The current definition of chronic pain is that “……it is an embedded memory that becomes connected with more and more life experiences and the memory can’t be erased.”² You are not going to change the trajectory of this complex problem with simplistic random interventions. You must use the same programming principles to become a genius at feeling pleasure.

Recap

It is critical to conceptualize your pain and response to it in terms of programmed circuits. Using re-programming tools, you can create “detours” around them or shift onto circuits that do not include pain. It appears that you can reprogram around almost any pain in any part of your body regardless of the length of time it has been there. The brain’s capacity to adapt is remarkable.

It takes tens of thousands of swings for a major league baseball player to be able to hit a baseball coming at him over 90 mph. There is also a huge variation in speed and trajectory. I think it is one of the most incredible feats in the human experience. With chronic pain – mental or physical, you’ll receive a lifetime of “baseball swings” in a matter of weeks. We do know that chronic pain can be memorized in a matter of six to twelve months.³

Additionally, since pain circuits are linked to anxiety/ anger ones, any situation that fires up your frustrations will fire up pain and of course pain will fire up the anxiety/ anger circuits. The good news is that all of this can calm down with the same set of approaches.

Become a genius at running your life and take back control.

Questions and considerations

1. Consider a skill you acquired at any point in your life. The degree of expertise was proportional to your time spent on it. Consider navigating your life as a learned skill.
2. There are many components to living a successful and enjoyable life. Each one needs to be considered in relation to the big picture.
3. We have discussed the importance of creating a vision of what you want your life to look like. What set of unique skills to you need to acquire to get there?
4. You have already spent an endless number of hours pursuing a cure for your pain. Why not get focused and solve it with a fraction of the time and effort?
5. How committed are you to creating deep change versus holding onto your old life?

References:

1. Coyle, Dan. The Talent Code. Random House, New York, NY, 2009.
2. Mansour AR, et al. Chronic pain: The role of learning and brain plasticity. Restorative neurology and neuroscience (2014); 32:129-139. doi: 10.3233.RNN-139003
3. Hashmi JA, et al. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain (2013); 136: 2751–2768.

The post Repetition and Healing first appeared on Back in Control.

The post Repetition and Healing appeared first on Back in Control.

We are all programmed by our past The way we survive is that our brain is constantly comparing the present to the past and any situation that triggers a hint of a prior threatening scenario, will create a danger signal. There are over 20 million bits of sensory input being processed every second. This warning system has different forms – hot, cold, sharp, pressure, dizzy, bright, loud, bitter, rancid, and the list is long. However, they are all creating a similar reaction of being unpleasant enough to compel you to take action to solve it. They can all be lumped under the word, “pain” and the simultaneous reaction of anxiety.

Since this is what our brain is repetitively processing the environment every second, it is all being deeply programmed into your nervous system. It is also the reason that chronic pain (anxiety) almost always worsens with time. You are becoming more skilled in recognizing and feeling the pain. It is similar to a pianist practicing to the point where he or she develops the skills to be considered a virtuoso performer. The term for this process is, “neuroplasticity.” We are all programmed by our past up to this exact second.

The Talent Code What does this have to do with my golf swing? One of the first books I have historically had my patients read is a book called The Talent Code by Dan Coyle. He has done a wonderful job of looking at the factors that create genius. It is a growing observation that genius is rarely born. It occurs after about 10,000 hours of repetition. However, it is a specific kind of repetition called “deep learning.” The other two factors are “ignition” (obsessive repetitions) and “master coaching” (laying down the correct pathways).

Deep learning is the most basic concept in that it is necessary to enter information into your brain in a way that you can retain it. Each of us knows that if you just read or hear some new information that you will retain very little of it. It is necessary to use some technique such as visualization, verbally repeating new thoughts and concepts to yourself, writing them down, analyzing and challenging the ideas, re-interpreting material according to your perception of it, etc. By using techniques you are comfortable with, you can increase your learning by 500 to 600%. Conversely, random repetitions will decrease learning by 15-20%. In other words, you must actively process information to retain it and make it part of your nervous system. Master coaching keeps the repetitions within a narrow range.

Holt’s deep learning So, my way I approached golf was to take a lesson, learn a new concept, not practice enough, and jump to another concept. It is no wonder that I never came close to being an expert. My son’s best friend, Holt, won the 2007 US Mogul skiing championship by using deep learning. He broke down one of jumps called a “D-spine” into 13 different parts. Each practice jump was focused on just one of the components. It is a stunt where the skier does both a back flip and rotates sideways. He could lay down a competitive run almost 80% of the time, which is stunning considering the complexity of the sport. And he did it by practicing about a third as much as most of his competitors. Consider chronic pain. You are trapped by relentless unpleasant sensations without an obvious alternative. The pain impulses fit the definition of “deep learning” in that they are so specific. The obsessive repetition is self-apparent and these circuits don’t require master coaching.

Stimulating neuroplasticity So, these basic automatic survival circuits are permanently embedded. Paradoxically, the more you pay attention to them or, even worse, suppress them, the stronger they will become. The key is to reprogram your brain to have alternative and more functional responses to threat – whether it is real or perceived. There are three steps: 1) awareness of the automatic response 2) create some “space” between the stimulus and reaction  3) substitute a response that is your choice. With repetition your brain will develop new circuits that are more pleasant and eventually automatic. You are creating a new nervous system within your current one. It is similar to having a virtual desktop installed on your computer. By trying to “fix” my bad golf swing, I got nowhere. If I had created and pursued a vision of what I wanted to create, I may have had more success. You have heard the saying, “Practice makes perfect.” What is more true is, “Perfect practice makes perfect.” Why keep embedding your mistakes or dysfunctional reactive patterns?    

“I read your book and I still hurt” It is common for people to say that they have read multiple books, including Back in Control, and they still feel the same. Yet when I ask them what reprogramming skills they are regularly using, the answer is always the same – none or maybe just a couple on occasion. You don’t want your brain’s reactive response to a threat to always be unpleasant. Even worse, what we often perceive as a threat is actually not a threat. It is a “cognitive distortion” and really a huge waste of time and energy. If you want to break free from pain, you have to develop a regular practice. It does not require much time once you have learned the healing concepts.

The DOC Journey presents a sequence of learning that allows you to first understand the nature of the problem, develop a strong foundation by using tools to calm and stabilize your nervous system, provides strategies to break free from your past programming, and most importantly move forward into the life that you desire. What kind of golf game (life) do you desire? I am probably not going to commit to a great golf swing at this point in my life. You have no idea how much I know about the mechanics of the swing, but I don’t want to spend that much time practicing. But I am committed to learning as much as I can about the latest neuroscience research around chronic disease and bringing these ideas into the public domain. My personal challenge is presenting them as clearly as possible. I am excited about learning these skills and encouraged that patients are responding more quickly. I am continually inspired by people’s persistence and courage in the face of the adversity of chronic pain.

References:

1. Coyle, Dan. The Talent Code: Greatness isn’t Born. It’s Grown. Here’s How. Random House, New York, NY, 2009.

The post Become a Genius at Solving Pain first appeared on Back in Control.

The post Become a Genius at Solving Pain appeared first on Back in Control.

Having read (devoured actually) The Talent Code by Daniel Coyle, I can now share with others the benefits I received through reading this book.

The author demystified that very mysterious quality of world-class excellence. He teaches that through deep practice, anyone can train themselves (and hence their neural circuits) such that they become excellent at virtually any task. Repetition in ‘deep practice’ mode, at the very edges of the person’s (or organism’s) ability, is essential. For me, learning to experience life in a non-sad baseline state is a skill. It is profoundly comforting to have learned that, through repetition, I can train myself to feel ”default non-sadness” as a new way of life. I’ll undergo something akin to Clarissa’s famous 6 minutes’ practice of “Golden Wedding” on her clarinet. I’ll need to experiment with just which behaviors to repeat. Starting with mindfulness-based meditation, and writing as described in the DOC Project, I’ll develop and refine a ‘flexible regimen’ in the nature of a workout-for-the-spirit.

I have come to believe that my severe physical (if neuropathic) pain can be eased and possibly eliminated through repetition-based deep training. My reasoning is this: Because my experience of pain comes in waves lasting anywhere from 5 to 15 days, separated by weeks of almost no pain, something or things (probably anxiety and concomitant anger) must be triggering the pain.  I believe it is just as valid to conclude that something (or things) must trigger the cessation of my pain. Inspired by (ignited motivationally by!) the Talent Code, I’ll experiment and reflect, eventually learning which of my behaviors trigger this “cessation” of physical pain. As The Talent Code articulates, through repetition and practice – “pain-quelling” behaviors in my case – I can strengthen (myelinate) just the right neural circuits to reprogram, or overwrite, my nervous system’s pain script. I’ll need coaching to succeed; regular meetings with Dr Hanscom will be needed.

Part III – Master Coaching resonated with me. I had thoroughly enjoyed learning about the Curacao talent hotbed in Part II. As it happens my father coached my little league team. But a friend of our family who had been head coach of Seattle University’s basketball team, The Chiefs, did much of the real coaching. Our friend knew how to inspire (if not ignite) motivation.

As a little leaguer, I developed a decent pitching arm through genuine deep practice. Every day after school, I came home and practiced pitching a rubber ball – a surrogate for a little league baseball – by hurling it down our driveway at the “knob” or “door handle” of our closed garage door (the knob is a metal handle located a perfect 2.5 feet above ground, making a perfect target, just like a catcher’s mitt would). From 45 feet I threw that ball for hours, nearly every day, until I became accurate and fast. I realize now this was classic deep-practice. I hit that door handle about once a night. That handle is no bigger than a closed fist. Although my motivation to be a little league pitcher was self-ignited, having a university-level athletics coach in the “family constellation” added much to the experience. I was as good a pitcher that first year as I could possibly have been. I was having a “Talent Code” experience. 44 years later, Daniel Coyle wrote about the code in an informative, practical and enjoyable volume.

My Perspective

I performed a successful neck surgery on this patient a couple of years ago.  He did well and I did not see him for almost a year.  He did not engage in the DOC Project, but from my perspective, it did not seem necessary.  When he came back to see me about eight months ago, he was in terrible pain from what seemed like bone spurs in his neck affecting the nerves that ran down his right arm.  I re-worked him up with a new MRI scan.  We discussed the option of re-doing his neck surgery from the front and adding two more levels.  A three-level neck fusion was going to be a significant operation.

A year earlier, he was not open to the re-programming concepts of the DOC protocol.  Reading the Talent Code gave him a lot of hope, as he was able to conceptualize how the brain lays down circuits to form new neurological pathways. He then not only engaged fully in the writing program, but he also pursued everything else I gave him to read.

Lo and behold, his pain disappeared.  It has returned several times again to a point that tempted me to offer him the option of surgery.  Each time we talk, he is able to see what might be triggering his pain pathways and the pain disappears.

Ongoing learning

He is teaching me more about how the neurological pathways can be specifically triggered by life events.  As a surgeon, I am still trying to get my head around how powerful a role the nervous system plays regarding the perpetuation of chronic pain. It is also gratifying that his anxiety is decreasing despite him holding down a very stressful managerial job.

In the world of neurological circuits, there is no beginning or end.  I see everyone with the potential of living a pain-free, full, rich life, without limitations. I don’t know where this patient will end up. All I know is that last week he had his smile back.

BF

The post Motivated by “The Talent Code” first appeared on Back in Control.

The post Motivated by “The Talent Code” appeared first on Back in Control.

Thoughts are also memorized and can become obsessive circuits. Unfortunately, the brain becomes more focused on negative thoughts because there is natural tendency to suppress them. Although you make think you are successfully conquering them, you are actually giving them more neurological attention.  “The surgeon screwed up my back.” “I can’t get out of bed.” “The pain is ruining my life.” These circuits can take on a life of their own, running on a constant loop. If left unchecked, they turn into a serious obstacle to recovery; one that’s not a psychological issue as much as it is a “programming” issue. You can develop tools to break the cycle of negative thinking, but first you have to conceptualize how the brain works.

The Talent Code

Dan Coyle wrote a book, The Talent Code, where he points out how genius is created. He also makes a nice connection to neuroscience research. There are three factors contributing to high-level learning: 1) Deep learning 2) obsessive repetition 3) Master coaching. The ideas is to engage in repetition of specific moves within a narrow range. I feel the same concepts apply to way the brain processes pain. Reading this book has been helpful for my patients to better conceptualize the formation of pain circuits. Motivated by The Talent Code

Phantom limb pain

Neurological connections associated with pain will often continue to function, even if the offending stimulus is removed. A classic example of this is “phantom limb” pain. It occurs in patients who require an amputation, usually because blood supply to the limb is compromised by vascular disease. Common causes are diabetes or atherosclerosis, when there is not enough blood to sustain viability to the limb. Prior to the amputation, lack of oxygen causes the limb to become very painful. After the limb is removed, up to 60% of patients feel the pain as though the limb were still there.  Almost 40% of sufferers characterize the pain as anywhere from distressing to even more severe than before. (4)

There is not a more definitive operation than removing the entire source of the pain by performing an amputation. The nervous system does not even know the leg is gone, and it still feels the same sensations and pain. From those of us who have the visual experience of performing these amputations, this is a dramatic example of the power of the nervous system. It is also a reminder that the brain also is an extremely complex sophisticated computer, which is programmable. To “de-program,” it takes much more than will power.

Body image disorder

Another example of a situation where a stimulus was removed, but the brain couldn’t be “de-programmed,” was a major reconstructive spine surgery that I performed in my third year of practice. Brad, the patient, was a 27 year-old athletic banker who had a moderate “hunchback” deformity called kyphosis. He was experiencing a lot of pain in middle of his back associated with it.  The deformity was about an 80- degree forward curve (the highest normal value is around 55 degrees).  I was hesitant to perform surgery, as it is a major five to six hour procedure with significant risks.  The surgery went well, however, and his curve was reduced to 50 degrees.  Post-surgery, it became clear that his body image had been his major issue, and it didn’t change at all nor did his pain.

There are many examples of negativity. However, the point is that once the nervous system becomes fixated on one specific negative thought pattern, it is not going to stop on its own. It’s possible to break the circuit but it takes very specific techniques.

Video: Standard Stress Skills Inadequate

The post 3 – Memorization of Neurological Circuits first appeared on Back in Control.

The post 3 – Memorization of Neurological Circuits appeared first on Back in Control.