• Processing anger is more doable if it is broken down into its components.
• Anger is a powerful, necessary, and hard wired survival reflex. You cannot tame it with the conscious brain.
• It is an acquired skill that requires ongoing “adult education” in order to refine it.
• Framing the approaches in terms of an “anger academy” will help you rethink the complexity of anger and enable you to deal with its parts in a focused manner.
• Developing a “working relationship with anger” is your degree.
• It an expertise that you will be using daily indefinitely.

Anxiety is the sensation you feel when you sense real or perceived danger and anger represents a more intense reaction when you can’t solve the threat. They are hard-wired responses that are present in every living creature and sustain life. The only way to lower them is to decrease your levels of the stress hormones, inflammatory markers, and metabolism (rate of fuel consumption). You cannot reason with or control the flight or fight response. It is as effective as talking to the hard drive of your computer – can’t work. Consciousness elicits the same threat physiology, but you can’t escape it. Consider how much of your life’s energy is consumed by battling these unpleasant emotions.

There are two distinct aspects of deep healing.

• Learning tools to neutralize and lower these survival reactions
• Placing your energies and attention on creating the life you want.

Healing occurs as you move into wellness and away from the pain circuits. What doesn’t work is using “fun” and other activities to counteract these emotions. The bottom line is that you want to minimize your time in threat physiology and learn to create mental and physical safety. Regardless of the site of intervention, processing anger is focused on lowering the levels of the hormones and inflammation caused by your threat response.

You can directly lower these hormones, increase the resiliency of your nervous system, and learn to change the nature of your input. All three areas are important and require different tools. We are going to use the metaphor of a boarding academy to conceptualize the various strategies.

Welcome to “Anger Academy”

Visualize a walking onto a beautiful campus and seeing the main building bordered by two departmental ones. There is an entry gate with a security guard, and you must be carefully screened before you are allowed be on the grounds. The three buildings represent:

• Output – the student center/ food/ spa/ lounge – Main building
• Your nervous system – engineering and design center – on your right
• Input – educational/ training center – on your left

The curriculum – Enrollment

It is most desirable on a given day or moment to have your “output” or your body’s neurochemical state in a range that is neutral or relaxed. The more time you can spend in this state the better. But, anger is inevitable, and it is important to use it only when necessary and be careful not to cause damage–especially to those who are close to you. The final physiological response is affected by 1) the reactivity of your nervous system and 2) the content of your input. It is a dynamic process that varies from minute to minute.

The state of your nervous system is influenced by your prior programming, current circumstances, and how you are caring for your body. For example, lack of sleep and exercise along with a highly inflammatory diet will elevate your levels of inflammation and compromise your coping skills.

Daily stresses are often overwhelming. If you come from a challenging and chaotic childhood, it is hard to feel safe because maybe you really never knew what that was like. Consider the hypervigilance of a feral cat compared to a pampered domestic one. It is difficult to truly tame a cat who had to fend for itself from birth. It takes less stress to set off the threat response and this is also hardwired in for each individual.

Output is clearly affected by your “input.” There are two categories of input.

• What are you choosing to put into your nervous system?
• What are you holding onto from the past?

The first step is becoming aware of the nature and effects of your ongoing input. Once you have some clarity, there are multiple strategies to alter it. It is a deeply personal process.

Security gate

The security area represents the current state of your body’s chemistry, and it can vary from a profile of being content and safe to upset and inflamed. Of course, the reason you are coming to this institution is that you are trapped in pain and the levels of frustration often reach a level of rage. The sensations are intense and powerful. Your whole body, including your brain, is full of inflammatory markers. Your brain’s blood supply is diverted from your neocortex (thinking centers) to the lower centers that are meant more for basic survival. In this state it is not possible to think clearly or absorb new information. So, before you can enter the university to master anger processing skills, you must first normalize this inflammatory state. Your “output” is hypervigilant, which is the outcome of being trapped for any reason.

The “security guard” will take your temperature, vital signs, and see if you are calm enough to engage in the learning the skills to process anger. This is not a small step, in that anger is the greatest block to healing. There are many facets to it; it is powerful, and most people don’t want to give it up because it keeps you safe – whether the sense of safety is real or perceived.

If you are fired up, you can leave and return another day, or you can hang out in the spa just outside of the campus intended for your use to calm down. It has a pool, hot tub, massage, sauna, gym, and soft music. It is a beautiful modern building and could not be a more relaxing place to be. You can stay as long as you would like and return anytime.

If you choose to turn around and return to your prior situation without taking some action to calm down, it is unlikely that you will be able to meet the criteria to enter the campus. Regardless, whether you calm down on your own or with some help from your time in the spa, it is the first step in being able to engage in learning the strategies to understand and deal with anger. Your brain has to come back “online.”

On the grounds

Once you are through security, you have a choice of which building you want to enter but continuing to calm yourself is probably the best option. Each one has multiple resources to help you acquire anger processing expertise.

The center main building (output) is a deluxe version of  the spa area just outside of the campus. It’s large with nice facilities and concierge services. There is no limit as to how well you are treated. You can hang out with your friends, eat great food, and kick back in the jacuzzi. There are resources to teach you to self-soothe and nurture yourself. You may want to spend more time there to re-energize before you start to work on the other aspects of anger.

The engineering and design building on the right is where you will be rebuilding and strengthening your nervous system. Every action you take today is based all of your life experiences up to this very second. It consists of your prior life programming, the state of your general health, and how skilled you already may be in using tools to calm and improve it. In essence, it is the sum total of your coping skills and resilience. Both can be refined and strengthened with a thoughtful approach.

The training/ education building on your left is where you will learn strategies to process the input from your life – all of it. What is being entered into your nervous system affects the composition of output?

CHOICES OF INPUT

Examples of what you might currently be uploading are conversations that are critical of others – either directly to them or in the form of gossip, discussing your pain and medical care, complaining, sharing a generally negative world view, watching violent TV, etc. These types of activities keep your nervous system fired up with many direct effects on your body and peace of mind.

What are you holding onto from your past that continues to agitate you? Why would you do that? The past has little if anything to do with your day. You have given your quality of life over to someone or some entity that you despise. Forgiveness is an advanced set of techniques that dramatically alters the input into your nervous system.

Your degree

An “working relationship with anger” diploma will allow you to efficiently neutralize your flight or flight response. It is one of the more practical degrees you can attain. Acquiring these skills is one of the most powerful and definitive moves you can make to take back control of your life. But remember, the first step is getting past security.

Recap

Anxiety is the sensation generated by your neurochemical response to a threat and intended to motivate you to take action to solve it. If the stress persists, your reaction will become stronger, you’ll secrete more stress chemicals, and feel anger. Anger is your body’s last ditch effort to regain control.

It is a powerful and hard wired impersonal reaction. It is also complex and involves every cell and organ system in your body. You cannot survive without it, and it is impossible to thrive if this physiological state is sustained.

Developing a “working relationship” with it involves understanding the different aspects of it and learning to minimize your time in a threat state through different portals. Do you want your life to continue to be an ongoing replay of your past or are you ready to create the life you want – from reactive to creative?

 Questions and Considerations

1. When trapped by chronic mental or physical pain, your brain and body are literally on fire. Your inflammatory markers are sky high, and you cannot think clearly. Have you considered how you feel in this state and compared it to when you are calm? Even without pain, what is the quality of your life when you are enraged?
2. Your brain is “offline” while you are angry, and it really is temporary insanity. It is humbling to consider how many “issues” disappear after you have calmed down.
3. Every living creature, including homo sapiens, has a version of this reaction. It is universal and intended to be unpleasant. So, why you take it personally? It is protective, and what you have, but not who you are.
4. Forgiveness alone is the historic approach in addressing deal anger. However, it is a big leap to forgive in light of many circumstances. Anger is a complex full body response to an uncontrollable threat and breaking it down into its components is a basic starting point to master dealing with it.

The post Anger Academy first appeared on Back in Control.

The post Anger Academy appeared first on Back in Control.

What next?

He elected to go ahead with surgery. He improved for a couple of months and the pain returned except that it was worse. He then underwent a second operation about six months later that did not help and in fact worsened his pain. He asked me again what I thought he should do next. About six weeks before I talked to him he had fired everyone and stopped everything. No more doctors, medications, or surgery. Within a week of making that decision his pain disappeared. He had taken complete charge of his care.

What makes his story more interesting was that when I looked at the MRI scan done after his second operation the bone spur was still there. The surgeon had missed it. He had worked on the middle part of his spine freeing up the 1^st sacral nerve root, not the L5 nerve root. He had needed to remove the bone spur out to the side of the spinal canal, not the middle. He should still have been in pain.

Both L5 nerves pinched

I treated another woman a couple of years ago who had pain down both of her legs in the pattern of the L5 nerve root. She had resisted the DOC project for a long time. She decided to undergo surgery to free up both of the L5 nerve roots. She did have significant spurring touching both of the nerves. When she made the decision to have the operation she also finally engaged in the DOC project. When she came in for her pre-operative visit her leg symptoms disappeared. I cancelled her surgery.

They Both Had Structural Problems

In both of these cases there were structural problems with matching symptoms. In the first case, if the L5 nerve root had been correctly freed up his pain would have disappeared after the first operation or the second operation. As the bone spur was never removed it now was clear that he could have gotten the same improvement without any surgery. With the second case she would have also done well with surgery. Both of them solved their own problem with engagement and taking charge. That is why my book is titled, “Back in Control.” Every patient I have seen get better has taken full responsibility for their pain and care.

Raising the Pain Threshold

When your nervous system calms down utilizing Neurophysiologic Disorder principles the threshold for sensing pain is raised. I am sure that the structural lesions in their spines are still firing pain impulses to the brain. It is just that they are now below the elevated pain threshold and are not interpreted as pain.

What did they do? They both took charge of their problem. They took control, which instantly decreases anxiety. That, in and of itself, is a major step in calming down the nervous system. Their pain did not just decrease; it disappeared. In the future there is a chance that the symptoms will re-appear under a certain level of outside stress. I am now used to having my patients go through the steps that originally calmed them down and the symptoms will reliably disappear. Remember that pain circuits are permanent. I also reassured them that if the symptoms don’t diminish I could always perform an operation.

Why Not Just Do the Surgery?

You might be asking, “Why not do the operation and then they would not have to worry about it in the future?” There are a several reasons. First, even with a successful operation it is common for pain pathways to get fired up under stress, even if there is not a recurrence of the structural problem. Second, even the simplest operation has risks. I could write a book of simple operations going bad. Third, with spine surgery you always cause the formation of scar tissue that can be permanently irritating. You are just better off avoiding surgery if at all possible. Video: “Get it Right the First Time”

The Change in My Thinking

I witnessed over one hundred cases similar to these two. It has caused me to change my thinking about the timing and role of surgery. I use to think that surgery was always required in the presence of a structural problem. My conversation with my patients would be, “Let’s get the surgery done and we’ll work through the rehab later. You cannot rehab a structural problem.” Now my discussion is, “I am happy to perform your surgery but I have seen patients go to pain free even in the presence of a structural problem. If we can calm down your nervous system your post-operative pain will be less and easier to control.” We now have decided that we will not perform elective surgery until a given patient has been involved in addressing his or pain in a structured manner for at least 8 to 12 weeks. Our outcomes have been much more consistent.

I am a surgeon. My thinking around the DOC project is continually evolving. The idea that a person could raise their pain threshold enough to avoid surgery simply by taking complete charge of their decision-making has been surprising to me.

“My Son Just Died”

The post Avoid Surgery by Raising the Pain Threshold first appeared on Back in Control.

The post Avoid Surgery by Raising the Pain Threshold appeared first on Back in Control.

Anger

Nonetheless, there are obstacles to becoming pain free. The absolute biggest block that I encountered daily was anger. I honestly didn’t know how to help a patient get past it. He or she becomes irrational. When you are chronically angry, it is your baseline, and you cannot even recognize that you are angry. I personally had no clue that I had any anger issues until I was 50 years old. In fact, one of the first lines to my wife when I first met her was that I was a “good catch” because  I had dealt with all of my anger issues. I am glad that neither of us had any idea that I had not even opened the door to my frustrations, as we never would have made it.

Noncompliant

The problem with anger is that you cannot listen and accurately assess a given situation. The conversation I have with a patient who is noncompliant goes like this. “Doctor, you mean to tell me that there is nothing wrong with my back? I have been in pain for several years and I know that this pain is not in my head. You must be missing something.”

I reply, “The pain you are experiencing is not imaginary pain, nor is it psychological. We know that if we did a functional MRI of your brain right now, the part of your brain that corresponds to your area of pain would light up brightly. All that matters is what is happening in your brain. We also know that the brain can fire spontaneously without an indentifiable source of the pain. I don’t just believe you have pain–I know you are experiencing pain and are frustrated about being trapped.”

I also explain to them that degenerated discs are normal as you age and that there is no correlation between a degenerated disc and back pain. The surgical success of a fusion for LBP is less than 30% with a significant downside of a failed surgery. They then say, “I don’t want surgery. I just want to be fixed and get my life back.” When I reply that we have had very consistent results following the steps outlined in this book, they explode saying, “I don’t want to read a book or anything like this. Just do something to fix my back.” They will then start ranting and often even yelling that no one will help them. Occasionally they will walk out of the room.

Anger is an absolute block to moving on

This is a frequent scenario. I would estimate that at least 50% of my patients fall somewhere in this part of the spectrum. They are noncompliant actually not by choice. I realize that chronic pain causes anger, but It is this anger that is also a complete block to engagement in effective treatment. Anger is destructive and it is multi-directional. It is particlurlarly self-destructive. You also have a strong sense of “being right” when you are angry and an even stronger sense of everyone else “being wrong.” I honestly do not know what to do to break this mind set.  I have tried everything from being confrontive to being incredibly patient. Nothing has worked. In fact, I have found that the longer I spend trying to convince someone to engage, the angrier they become. Angry people become upset when trying to be convinced to give it up. They just cannot hear me.

Address Your Anger

If you are angry or living in one of the above disguises of anger, be careful. You are trapped. You are truly stuck, and no one can even throw you a lifeline. What you cannot see is the havoc you are wreaking on those around you and onto yourself. I do not know how best to quell the anger rooted in chronic pain. I am open to suggestions.

The post Anger-The Absolute Block first appeared on Back in Control.

The post Anger-The Absolute Block appeared first on Back in Control.