• 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.

The root cause of disease

Two aspects of this sequence determine the expression of symptoms. One is the magnitude and duration of your stresses (input), and the other is the reactivity of your nervous system. There are three possible outcomes (output) – safe, neutral, or threat. Living creatures are in the neutral zone most of the time and gravitate to safety whenever possible to rest and regenerate.

The perception of danger (threat) causes the nervous system to send signals to prepare for battle and wage it if necessary. The common term is, “fight or flight,” and your body’s response (activated) is intended to feel unpleasant enough (anxiety) to compel you to take action to resolve the situation. The goal is to remain in this agitated state for as short a time as possible. But what if you cannot solve the problem and you’re chronically fired up? Your body stimulates even more of a response to regain control, and you are hyperactivated (angry).  Unpleasant sensory input progressively impacts your body at three levels.

• Response
• Symptoms
• Illness/ Diseases

When the threat is short-lived your response will be appropriate to the situation and quickly disappears when it has passed or resolved. Almost every internal and external action of your body is automatically directing you in a manner, so you don’t feel many unpleasant sensations. It is called the nociceptive system. If you do sense danger, you are programmed to resolve it immediately. Examples are looking away from the sun, spitting out rancid food, pulling your bare foot back from hot pavement, frequently shifting in your chair to avoid skin breakdown, and avoiding predators.

When threats are prolonged, you will experience symptoms such as back pain, tension headaches, anxiety, poor appetite, nausea, urge to urinate, sexual dysfunction, burning sensations, skin rashes, dizziness, ringing in your ears, and insomnia. There are over 30 different physical and mental symptoms that can occur.²

When threats are sustained, you have a significant chance of becoming seriously ill or developing a disease. It is well-documented that chronic stress kills people and unfortunately the symptoms of an illness or disease also add to the threat load. This is particularly true in chronic pain.³

Dynamic Healing Overview

The nature of your body’s physiology under threat

Environmental cues of threat set off a defensive response. Immediately, before you are even aware, your immune system girds for the possibility of injury by initiating inflammation (to protect cells against invaders (bacteria, viruses, cancer cells), elevates metabolism to provide fuel for defense, increases the speed of nerve conduction–which increases your alertness but also your pain sensitivity, and elevates the levels stress hormones (cortisol, adrenaline, noradrenaline, histamines). Much of this defensive state is modulated by small signaling proteins called inflammatory cytokines.

So how do you think you feel when you are in this physiological state? Your heart is racing, you are sweaty, tired, anxious, overwhelmed, nervous, stomach feels tight, blood pressure is elevated, pain is worse, and your breathing is rapid. The bottom line is that you don’t feel great when your body is in this heightened neurochemical state. Are these symptoms imaginary? Not a chance. None of them.

Defining threat

Examples of physical threats include viruses, bacteria, being attacked by a predator – human or animal, hunger, lack of shelter, poverty, lack of opportunity, being bullied at work or school, racism, authoritarianism, trapped in a difficult living or family situation, and physical maladies.

Mental threats are processed in a similar manner as physical ones with the same physiological response.⁴ They are more problematic in that humans have consciousness, many of our thoughts and emotions are unpleasant, and unlike visible threats like tigers or a severe storm, we cannot escape our thoughts. Repressed thoughts and emotions are even more impactable on your body’s neurochemical state. Many of our unpleasant thoughts are based on cognitive distortions or “stories” about our lives. Unfortunately, whether the threat is real or perceived it has the same deleterious effect.⁵

Systematically addressing the root cause – circumstances versus coping capacity

First, it is always important to undergo a medical workup to make sure there is not a structural issue such as vascular disease, pinched nerve, tumor, or an infection.

Second, regardless of the findings of the workup, maintaining your body’s metabolic, immune, and nervous system balance is important. If you require a procedure, your odds of a good outcome will be maximized.

Third, all three aspects of chronic illness must be addressed. Here are some examples of interventions for each one.

Input (what are you uploading into it and what are you holding onto?)

• Forgiveness
• Cognitive Behavioral Therapy
• Expressive writing
• Never discussing your pain or medical care

State of the nervous system (calm or hypervigilant)

• Exercise
• Sleep
• ACT (Acceptance Commitment Therapy)
• Processing prior trauma

Output (physiological profile – safe, neutral, threat)

• Breath work
• Mindfulness/ meditation
• Humming
• Vagal stimulation
• Certain pitches of music

Finally, you must take charge of your own body and health. Chronic diseases are complex, and you are unique. You are the only one who can figure out a solution. The first step is understanding the nature of chronic disease. The solutions lie In implementing strategies that address the root cause of disease and lower inflammation,⁶ which destroys tissues throughout your body. It is more doable than you think. Not taking charge may have severe consequences.

Modern medicine is continuing down the wrong road

Modern medicine is mainly addressing symptoms. This approach works well when there is an identifiable structural problem that can be fixed. But the vast majority chronic illnesses/ diseases result from being in a prolonged fight of flight state and structural approaches cannot and do not work. The burden of chronic disease continues to rise without an end in sight.¹ Why do we continue to travel down the same road?

The tragedy is that It is an eminently solvable problem at a fraction of the risk and cost. There is  deep data revealing the common neurophysiological nature of chronic mental and physical diseases. Most of modern medicine is ignoring it.⁷ A significant percent of interventions have no supporting data. Integrative medicine and similar approaches are much better at systematically addressing the dynamic interaction between a person and his or her circumstances. Treating symptoms is necessary but won’t definitively heal you. The more accurate term for current “mainstream medicine” is “disintegrative medicine.”

Dynamic Healing Medicine

Dynamic healing medicine requires listening and knowing you. Feeling safe positively affects your neurochemical profile.⁶  It is important to understand both your circumstances (input) and your coping skills (nervous system resilience) to develop a healing relationship with your provider.

My book, Back in Control: A Surgeon’s Roadmap Out of Chronic Pain,⁷ provides a foundation and framework to understand and implement your own solution to chronic illness.

The DOC Journey course and app are frameworks that reflect updated neuroscience research. They include a guided course, videos tutorials, webinars, and access to supportive group sessions. We have been delighted that we have been able to provide clearer explanations for chronic mental and physical pain and allow patients to more quickly find their way out of The Abyss.

Join us in bringing Dynamic Healing into mainstream awareness.

References:

1. O’Neill Hayes, Tara, and Serena Gillian. Chronic disease in the United State: A worsening health and economic crisis. Americaactionforium.org; September 10^th, 2020.
2. Schubiner H and M Betzold. Unlearn Your Pain, 3^rdMind Body Publishing, Pleasant Ridge, MI, 2016.
3. Smyth J, et al. Stress and disease: A structural and functional analysis. Social and Personality Psychology Compass (2013);7/4:217-227. 10.1111/spc3.12020
4. Eisenberger NI, et al. An experimental study of shared sensitivity to physical pain and social rejection. Pain (2006);126:132-138.
5. Burns, David. Feeling Good. Harper Collins, New York, NY, 1980.
6. Porges, Stephen. The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. Norton and Co, New York, NY, 2017.
7. Hanscom, David. Back in Control: A Surgeon’s Roadmap Out of Chronic Pain. Vertus Press, Seattle, WA. 2016.

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The post Dynamic Healing first appeared on Back in Control.

The post Dynamic Healing appeared first on Back in Control.

Acknowledging the extreme complexity of this topic, I have three basic observations. One is that anger is powerful and addicting. It does serve an important purpose in that it keeps you safe. There are few, if any rewards from a survival viewpoint, for being vulnerable. The second reason people can’t let go of their anger is that they have not learned to be vulnerable. It is an intolerable feeling and why would you want to experience it? Because it is also the essence of relationships and being human. What a dilemma!!

The final reason is that people are not connected to their anger. They have dissociated from it and can’t feel or see it. It manifests in multiple ways. However, just because you are not aware of them doesn’t mean that they are hidden from those who are close to you.

Processing anger overview

I have changed my thinking and have observed that you can’t just jump to forgiveness from anger without understanding and addressing all aspects of it. I now use the term, “processing anger” and there are three categories of interventions to accomplish it. Keep in mind that anger is a necessary and powerful force to stay alive. Instead of fighting, suppressing, or trying to get rid of it, a better concept might be, “developing a working relationship with it.

This process is an ongoing learned skill with much overlap.

• Output – Lowering inflammatory markers and elevated metabolism (body burning fuel) is a necessary starting point. Sustained elevations cause illness, chronic diseases, and early death. Your brain is also “off-line” because it is inflamed and blood supply is diverted from the thinking centers.
• The nervous system–If the nervous system is hyperactive for any reason, it will consistently overstimulate every aspect of your survival response.
• Input–Anger is always linked to an event in the past that either gets replayed in the present or is continually interfering with your current reality. Forgiveness simply breaks that link. It does not get rid of it. That is why forgiveness is such a dynamic ongoing skill that you use multiple times every day.

Why this sequence?

Addressing the output first is critical for several reasons. Your brain is affected by inflammation. The supporting cells of your neurons, called glial cells, throw off inflammatory proteins call “inflammatory cytokines” and your brain is sensitized. The danger signals to your brain are magnified and you’ll experience more pain. The blood flow to your neocortex (human thinking regions of the brain) is also compromised and it is impossible to think as clearly. The only intention in this state is your own survival and not the needs of those around you (unless it serves you). So, the first step is to use methods that directly lower this response by stimulating your autonomic nervous system (via the vagus nerve) to secrete anti-inflammatory calming cytokines, so you can learn and implement these new strategies.

Addressing the status of your nervous system is the next important phase. If you were raised in a chaotic or abusive family that was devoid of safety and deep nurturing, you won’t have much capacity to nurture and care for yourself, much less allow yourself to feel vulnerable (anxious). This is also a learned process that you will allow to happen over your lifetime. One of the paradoxes is that you can’t force it. That would be the antithesis of vulnerability.

Finally, forgiveness is a multi-dimensional process that changes the input into your brain so there is less intensity being sent to your brain and there will be a calmer output in the form of anti-inflammatory cytokines and safety hormones. It is actually a selfish act in that you are making a powerful move to take back the present moment. You are breaking the neurological links to the unpleasant aspects of your past.

Addressing the three aspects

Output

• Breath work
• Calming music
• Mindfulness/ meditation
• Medical hypnosis/ biofeedback

These are  autonomic nervous system interventions that directly stimulate the parasympathetic nervous system (calming). It may take a few weeks to learn and consistently implement them before you begin to feel less anxious and agitated. There are many layers of these tools. It has been a better starting point than trying to jump straight to forgiveness. You can only do what you can do when you can do it.

The state of your nervous system.

This is a critical piece of the big picture. Your central nervous system is processing over 20 millions bits of information per second and directing your behavior in ways to keep you safe and functional. Most of this occurs at an unconscious level. It is programmed to recognize danger that you learned from past experiences. Anytime you are anxious or angry, something in the present is connected to an unpleasant learning experience from your past. Understanding the nature and source of these “triggers” is important and then retraining your brain to choose different reactions when you really are not in danger.

Your immediate environment also dictates your state of alertness. Lack of sleep, poor nutrition (inflammatory), little physical exercise, troubled relationships also are factors affecting your perception and processing of pain. Each and all of them make a difference.

Input

What you choose to put into and keep in your brain is up to you. You can decide to continue to complain about your pain and troubles. Any time you are complaining, you are now the victim of that person or situation. Or you can be critical of almost everyone, anything, including the news and yourself. How does any of this help calm your nervous system? This does become challenging in that most things we are upset about are valid–but you are the one who gets to suffer.

Forgiveness is another layer of decision-making that dramatically alters the input. It is the method where your links to the past can be broken so that your prior life experiences quit ruining your day (life).There are many aspects to it. It is a complex, but learnable skill. You cannot do it intellectually. It is too powerful. The goal is to understand and implement this set of tools to the point it all becomes almost automatic. The groundwork of diminishing the output and increasing the resilience of your nervous system are first steps and productively dealing with unpleasant input will launch you into a new reality. Processing anger really is the “Continental Divide” for healing your pain.

The post Three Aspects of Processing Anger first appeared on Back in Control.

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fMRI study documenting the phenomenon 

A functional MRI (fMRI) is an MRI that measures metabolic activity in the brain. A 2004 study looked at the brain’s response to a pressure stimulus applied to the thumb of three groups of volunteers. (1) The groups consisted of people with:

• No history of chronic pain
• Widespread pain through the body
• Chronic low back pain for more than 12 months

In the volunteers without chronic pain, one specific area of the brain lit up that corresponded to the thumb. In the other two groups, five regions lit up – in every patient every time. Then the experiment was reversed so that only enough pressure was applied to light up only the thumb center, and it became active with one third of the pressure. In other words, the nervous system became three to five times more sensitive to the same stimulus if the volunteers had either localized or widespread chronic pain . This is the reason that people in chronic pain feel that there is something progressively happening in their bodies because universally the pain worsens over time. What is occurring is that the pain is worsening because the nervous system is becoming more sensitized.

Hod Carriers and a frayed wire

I have a good friend, Dennis, who related an interesting experience he had regarding Sensitization to Pain. It occurred when he was working as a hod carrier in his early twenties. A hod carrier is a person who sets up the work area for brick masons. Essentially, the hod carrier enables the brick masons to lay blocks or bricks as efficiently as possible. The work involves mixing cement and carrying it along with the building materials to the next section of wall. This has to be done quickly enough to stay ahead of the masons. The materials often have to be hauled up scaffolding. I worked as a hod carrier for three summers while I was in high school, and I discovered that the masons aren’t usually happy if the hod carrier falls behind – even by one block. It is an extraordinarily intense, physical job.

The Saw

On one particular job, Denis’s duties also included cutting basalt blocks with a “wet” saw. This is a saw with an industrial diamond blade. To prevent the blade from overheating, water from a small sump pump is continuously pumped over the blade. One day on the site, he felt a mild tingling sensation as he placed his hand on the saw handle. As he cut blocks early in the morning, the sensation was not particularly uncomfortable. As the morning progressed, the sensation gradually became stronger. By early afternoon, the sensation was so strong that he could no longer comfortably touch the handle. He felt an actual shock. Even the anticipation became a problem, and he wouldn’t touch the handle.

“You’re a wimp”

There were three hod carriers on this crew. They watched him get more and more cautious and finally refuse to touch the handle. Yet when they touched the handle, they could barely feel anything. Needless to say, they gave him a hard time. The next day, they rotated and the second guy had the same experience. By mid-afternoon he would no longer touch the handle. The last guy now thought they were “toying” with him. Again, when he touched the handle, the sensation was almost imperceptible. Then it was his turn, and by mid-afternoon he was a believer. The ultimate cause of this phenomenon, a frayed wire, was finally fixed on the fourth day.

Sensitization

What is interesting to me about this story is how quickly the sensitization occurred over just six to seven hours of repeated exposure. If the initial impulse had been somewhat uncomfortable, the story would have seemed more plausible. However, the sensation went from barely perceptible to an electric shock. Dennis said that even the thought of touching the handle produced a physical response within him.

Pain is always in your brain

It would be reasonable to assume that if a functional MRI was available to measure the hod carriers’ brain activity, that there would be an increased number of areas of the brain firing by the end of the day. Your nervous system is incredibly adaptable. It doesn’t take much repetition for your brain to figure out how to process a known, predictable impulse.

Pain is an output not an input. Your nervous system is processing billions of bits of data every second and deciding if you are safe or not. If there is a threat, you’ll take action to protect yourself. That’s how we survive. There is nothing inherent in your eyes, ears, nose, mouth, skin and internal organs that assesses and interprets your environment. The signals from all of these sensors have to be unscrambled to interpret your reality as pleasant, neutral, or unpleasant/ threatening. What I find interesting is that we become highly sensitized to pain and desensitized to pleasurable input. Doesn’t seem quite fair……..

1. Gieske T, et al. Evidence of augmented central pain processing in idiopathic chronic low back pain. ARTHRITIS & RHEUMATISM (2004); 50: 613–623.

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