Here is a famous quote from Gabriel Garcia Marquez.¹

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

They grow old because they stop pursuing their dreams.

Gabriel Garcia Marquez

This is a wonderful quote except I have a different take on it.

People grow old because their dreams are crushed by anxiety.

Stress

Stress is the sum total of the obstacles we face every minute to stay alive. When your body is in a flight or fight state, the sensation is called “anxiety.” This reaction is present in every living species, but humans have language and can name it. It is challenging to achieve your dreams and experience the life you wish while feeling stressed. Your creativity and choice are compromised while you are in a survival mode; the blood flow in your brain shifts from the neocortex (thinking centers) to the limbic system (flight or fight).

The Holmes scale², developed in the 1960s, quantifies levels of stress connected with life events, and you can calculate your own cumulative score. A score of 300 points or more correlates to an 80% chance of a health breakdown within 24 months. In spite of overwhelming data connecting chronic stress with illness, disease, and early mortality, we are generally taught that stress and anxiety are “psychological” issues. Nothing could be further from reality. Why does chronic stress cause mental and physical illnesses?

One of my close friends and colleagues were discussing the role of stress leading to health problems and we decided to assess ourselves with Holmes scale. He had been dealing with an unspeakable number of challenges for several years. His score was 435 and then he told me that he had been diagnosed with cancer a few months earlier. Fortunately, he did well with treatment.

Safety

We want to feel safe. In this state our body’s chemistry consists of anti-inflammatory molecules called cytokines. Fuel consumption is lowered (metabolism). There are about 80 billion neurons in your brain that communicate by molecules called neurotransmitters. When feeling safe, these molecules are calming. Hormones include dopamine (reward), serotonin (mood elevator), growth hormone, and oxytocin (social bonding). Emotions represent feelings generated by your physiological state (how the body functions) and safety creates a sense of connection, contentment, and joy. Another term describing this state is “rest and digest.” Your body must refuel, regenerate, and heal in order to sustain life and health.

Threats

What happens when you don’t feel safe? Your body goes into various levels of threat physiology (flight or fight) to optimize survival. It is designed to deal with acute threats effectively and quickly, but it doesn’t do well when your challenges are unrelenting. At the core of all chronic mental and physical disease is being in a sustained stressed state.³ Here is what is going on.

Activated inflammatory cytokines fire up your immune system. In addition to fighting off viruses, bacteria, and other foreign materials, your own tissues are attacked.⁴ Neurotransmitters switch from calming to excitatory and your nervous system is hyperactive. Fuel is consumed from every cell in your body, including your brain. Chronic disease states cause physical shrinkage of your brain.⁵ Fortunately, it regrows as you heal. Stress hormones include adrenaline, noradrenaline, histamines, and vasopressin, which shift your body from thinking to fleeing. This situation can be likened to driving your car down the freeway at 65 mph in second gear. It will break down more quickly than if you are cruising in 5^th gear.

The driving force behind chronic mental and physical disease is sustained exposure to stress physiology. The solution lies in using approaches to increase “cues of safety” and allow your body to rest and regenerate whenever you can.

Dynamic Healing

Sustained stress translates into threat physiology, which creates symptoms. In mainstream medicine, we are just treating symptoms instead of addressing the root cause being the interaction between your stresses and nervous system. We don’t have time to know you, understand the nature of your circumstances, or how we can help you calm down. Treating only symptoms is similar to putting out an oil well fire with a garden hose. It is no wonder that the burden of chronic disease and suffering continues to skyrocket.⁶ In fact, you often feel more stressed while interacting with the medical system. We introduce the concept of “dynamic healing.

Dynamic Healing is a framework that categorizes interventions that decrease exposure to threat and increase safety. The three portals are:

• Input – processing your stresses in a manner to have less impact on your nervous system
• The nervous system – there are ways to lower its reactivity
• The output – directly stimulating your body to go from stress to calming physiology.

This model organizes known research to both clinicians and patients. You can regain control of your care and create a partnership with your provider.

Why not become a “professional” at living life?

Consider the process as becoming a “professional at living life.” It is similar to acquiring any skill such as playing the piano. You must learn the basics, incorporate them into your daily life, and then continue to deepen your expertise with practice. Mastery is critical, and as they become habituated and automatic, life becomes easier to navigate.

Additionally, the power of neuroplasticity (changing your brain) is powerful and unlimited. You can program your brain in whichever direction you wish, away from unpleasant survival circuits.

Modern stresses

Times have changed since 1962 regarding the Holmes-Rahe scale. The industrial revolution occurred only about 200 years ago. In light of over four billion years of evolution, this not even a drop of water in the ocean. The level of daily sensory input dramatically increased. Now we are in the information revolution that began in 1980’s forcing us to process magnitudes more information. Smart phones came online in 2007, and along with the barrage of social media, we are on a massive sensory overload. The human brain has not evolved to keep up with it. So, we have ongoing stress levels that weren’t present even several hundred years ago. It is somewhat perverse that we have so many anxiety-related problems when we have access to more physical comforts than any generation in history. One fallout is that of teen suicide, “deaths of despair”, have risen dramatically correlating with the advent of the bi-directional smart phone.⁷

A healing sequence

The DOC (Direct your Own Care) Journey course teaches skills to optimize your capacity to enjoy life by effectively dealing with adversity and nurturing joy. These are two separate, but linked, skill sets. As you lower your time feeling stressed and increase your sense of safety and joy, your body will regenerate and heal – mentally and physically. Your brain physically changes (neuroplasticity), pleasurable circuits strengthen, and pain (mental and physical) regions atrophy. You can reprogram your brain away from almost anything with persistence and repetition. The exciting aspect of neuroplasticity is that at some tipping point, your healing continues to build on itself and there is no limit as to what life (brain) you wish to create.

What do want out of this life? Decrease your exposure to threat physiology, increase time in safety, enjoy your life, heal, and thrive.

Homework

1. Take the Holmes-Rahe stress assessment test.
2. Write down the details of each category affecting your life.
3. Consider what percent of your time you spend fighting off stresses compared to nurturing joy. Where is your brain developing?
4. The most stressful stresses are the ones you can’t solve. It is why you must learn techniques to minimize their impact, calm your nervous system, and spend less time exposed to threat physiology.
5. What is one aspect of your life that is the most important to you? Write it down. Are you willing to pursue it?
6. Your body is a complex powerful survival machine. It has evolved to seek safety, deal with threats, break loose, and thrive. Allow it to do its job.

 References

1. Gabriel García Márquez. Cien años de soledad (One Hundred Years of Solitude. 1967. Editorial Sudamericanos, S.A., Buenos Aires.
2. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
3. Furman D, et al. Chronic Inflammation in the etiology of diseases across the life span. Nature Medicine (2019); 25:1822-1832.
4. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007-8-9-r189
5. Seminowicz DA, et al. “Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function.” The Journal of Neuroscience (2011); 31: 7540-7550.
6. Bezruchka S. Increasing Mortality and Declining Health Status in the USA: Where is Public Health?Harvard Health Policy Review [internet]. 2018.
7. Miron O, et al. Suicide rates among adolescents and young adults in the United States, 2000-2017. JAMA (2019); 321: 2362. doi:10.1001/jama.2019.5054 – Connection with cell phones made by Dr. Rob Lustig lecture on 12.1.21 – https://drive.google.com/drive/folders/182pygqTnS2GPQ4LUmioO06zkRf4-jpIH

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• Connecting with your sense of play is one of the most powerful ways of shifting your physiology from threat to safety.
• Play circuits are also simply more pleasant.
• Everyone has some level of play in their life, although for some, it is quite limited.
• The interactions created while at play is one of the basic ways humans learn to cooperate with each other, including reading body language, interpreting tone of voice, and negotiating boundaries.
• When suffering from chronic anxiety and other symptoms, play circuits are used less and don’t evolve.
• Nurturing a sense of play and joy is a learned skill that requires thoughtful repetitions. These are not usually taught to us throughout our life experience,
• The benefits of reconnecting with play are healing and have a significant impact on your health and quality of life.

This is the real secret of life –

to be completely engaged with what you are doing

in the here and now.

And instead of calling it work,

realize it is play.

~Alan W. Watts

Play is a physiological state that reflects a sense of safety. You cannot play or feel playful if you are in a survival mode. The essence of escaping from the grip of crippling anxiety is feeling safe. In this state your body is full of relaxing chemicals such as oxytocin (love/bonding drug), serotonin (antidepressant), GABA hormones (anti-anxiety), dopamine (rewards), and small anti-inflammatory proteins called cytokines. Your metabolic rate (fuel consumption) also drops, which allows your energy reserves to be replenished. This scenario not only creates a deep sense of well-being, but it is also healing.

The data regarding the devastating effects of chronic stress on your mental and physical health is extensive and deep. Prolonged exposure to the body’s neurochemical survival response predictably causes illness and disease and shortens life.^1,2,3

Research also shows that cultivating optimism, having a sense of purpose, and feeling hopeful has the opposite effect. When people learned how to skillfully process their stress and nurture joy, they experienced an improvement in anxiety and many other symptoms.⁴ One paper had participants visualizing their best self for five minutes a day over a course of two weeks. They all noted significant improvements in anxiety.⁵

 Play

In our workshops, we discovered that shared play is a powerful force and most of the participants had a significant improvement in their anxiety and pain during the three or five – day events. It happened after people began to relax, share, let go, and laugh together. We initially didn’t understand reasons why people could shift so quickly after being so miserable for years. I now understand that anxiety reflects a sustained inflammatory state that also causes many other symptoms. Feeling connected to others in a relaxing environment stimulates the release of oxytocin. Oxytocin is a hormone that is critical for social bonding and is also powerfully anti-inflammatory. The participants felt safe in this setting and several people commented that they felt like they were in an “adult summer camp.”

Of course, when they returned home to their triggers, their anxiety and pain would reappear. But now they not only possessed new knowledge and tools, but they had reconnected to feeling playful, and relaxed. Many had not felt that way for years. Now they had a memory that they could return to and over time, and they became skilled at it. Years later, many have continued to thrive.

The basis of The DOC Journey is learning how to re-program your brain away from embedded anxiety circuits by stimulating neuroplastic changes in the brain. This requires repetition and eventually it becomes automatic. However, you can make this change happen even faster by shifting onto pre-existing play circuits.

All mammals have play as a part of their development. It is a multi-dimensional experience that processes many environmental cues and reactions are learned that are appropriate to the situation. Play is a core step in how we developed language and consciousness. Even if they feel deeply buried or almost non-existent, your play circuits are there, waiting to be accessed.⁶ Any skill that is not practiced will fade, but those neural circuits can be re-awakened.

As you use the playful part of your brain more and spend less time feeling anxious, your brain’s structure and neurological activity physically changes and grows . Conversely, when you experience chronic stress, your brain physically shrinks. Fortunately, as you heal and create more connections, it re-expands.⁷

I used to play trumpet in high school

An example of how this works is to consider a skill you had in middle or high school. Without practice, it has faded, but the memory is still there. I played trumpet in high school and a little bit in college as well. I could play reasonably well through medical school, but it all disappeared in the midst of the rigors of residencies and fellowships. I recently picked it back up, and although I have no lip strength or dexterity, I still remember the basic techniques and hope to re-connect with them quickly. It is doable, whereas if I were to try to learn a completely new instrument, it would take much longer.

My wife started playing the guitar again after a 30-year hiatus, and within a few weeks, was able to finger-pick like the old days. One day, it just all came back to her, and she  quickly progressed beyond where she left off.

The same is true for you – your play circuits are still there, waiting to be re-vitalized.

A deliberate decision

Many years ago, I was pondering my own journey out of The Abyss and considering some additional approaches. It hit me that the words “work” and “play” are somewhat arbitrary. I realized that my vacations were spent largely with trying to recover from the rigors of work. I didn’t have the energy to fully engage in enjoying my time off.

Much of the problem had to do with how I viewed work and my strong reactions in dealing with the challenges of being a spine surgeon. I decided that I would work on removing those labels from my life.

If I loved my work, and spent most of my waking hours doing it, why call it work? I decided to just embrace the whole experience. My entire team relaxed, and I enjoyed my patients, fellows, and colleagues a lot more. We had fun to the point where sometimes we would have to work on toning it down while we were in clinic.

At the same time, one of my mentors told me, “Challenges are an opportunity to practice your stress-coping skills and are part of any endeavor.” I began to embrace challenges head on and my reactions to stress dropped dramatically. By seeing problems as opportunities, I was both more effective and engaged with the difficult aspects of my job. This simple paradigm shift created a world of difference.

Play is a mindset

A word of caution – I am not referring to play as a way to distract yourself from your suffering. You can’t outrun your mind. Rather, it is mindset of curiosity, deep gratitude, listening, anticipation, awareness, and improving your skills to calm your nervous system. Nothing initially has to change in your life. My work environment was unchanged. It was my attitude that changed. I chose different words every day to reflect a sense of play. The result was a sense of contentment and peace.

Remember, nurturing joy is a learned skill along with processing  stress. You will eventually become an expert. At some tipping point, you’ll simply refuse to let people or situations ruin your day. You’ll also progress to being a source of peace and vitality. That is a long way from being trapped by anxiety and pain,

Recap – Moving forward

Play is one of the most effective ways to give your nervous system cues of safety. However, in the presence of relentless anxiety and pain, this probably seems impossible, and it is without effective tools and an approach that works well for you. You must simultaneously learn to de-energize anxiety and anger while nurturing safety.

Play to distract yourself from unpleasant feelings doesn’t work and is actually counterproductive. You cannot outrun your mind and your inflammatory markers go straight up. Conversely, living life with connection and purpose causes them to plummet.⁸

Choose play –  every day and watch your life transform.

Questions and considerations

1. Have you noticed that much of your vacation is spent trying to recuperate from work? By viewing work as play, you may have more energy to enjoy your time off.
2. You have heard the phrase, “don’t sweat the small stuff.” This is another way of letting go and simply enjoying your day.
3. There are many ways to connect with play. They include deep gratitude, a sense of curiosity, cultivating a sense of humor, and consistently choosing joy as opposed to complaining or feeling like a victim. When where you taught to nurture these traits?
4. As you continue to make these choices, your brain will begin to move in this direction automatically. Consider how much your brain is being programmed with negative self-talk and external messaging.
5. Notice how your mood affects those close to you. A good mood is contagious because it directly stimulates a similar area of the other person’s brain through “mirror neurons.” Conversely, a negative mindset is also having a ripple effect.

References

1. Tennant F. The physiologic effects of pain on the endocrine system. Pain Ther. 2013;2(2):75-86.
2. Torrance N, Elliott AM, Lee AJ, Smith BH. Severe chronic pain is associated with increased 10-year mortality: a cohort record linkage study. Eur J Pain. 2010;14(4):380-386.
3. Rahe R, et al. “Social stress and illness onset.” J Psychosomatic Research (1964); 8: 35.
4. Hausmann, LRM, et al. Reduction of bodily pain in response to an online positive activities intervention. Jrn of Pain (2014); 15: 560-567.
5. Meevissen,YMC, et al. Become more optimistic by imagining a best possible self: Effects of a two-week intervention. Jrn of Behavior Therapy and Experimental Psychiatry (2011); 42: 371-378.
6. Brown, Stuart, and Christopher Vaughan. Play: How it Shapes the Brain, Opens the Imagination, and Invigorates the Soul. Penguin Group, New York, NY, 2009.
7. Seminowicz, David A., et al. “Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function.” The Journal of Neuroscience (2011); 31: 7540-7550.
8. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (200); 8:R189. doi: 10.1186/gb-2007-8-9-r189

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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.

Some of the problems include the following:

• Early mortality – average life span is shortened by seven years (1)
• Increased heart disease (2)
• Depression/ anxiety/suicide
• Autoimmune disorders (3)
• Eating disorders
  • Obesity
  • Anorexia
  • Bulimia
• Addictions
• Chronic pain – in all parts of the body (4)

When you feel threatened, your body goes into high alert to increase your chances of survival. It is intended to be short-term reaction that quickly resolves once the threat has passed. A major problem with humans is that mental threats are processed in our brains and bodies in the same way as physical ones, but we can’t escape our thoughts. This means we are all exposed to varying levels of sustained elevations of stress hormones. Most of us cope with these Repetitive Unpleasant Thoughts (RUTs) by suffering, suppressing, or masking them. Although these strategies may help us think we have dealt with the issues, it’s ultimately ineffective. RUTs will continue to stimulate the stress response.

Humans have a name for this state – anxiety. It is a non-specific reaction of which we have no control over. Rational interventions can’t and won’t work. The only way to decrease anxiety and alleviate the impact of these hormones on your body is to lower their levels.

There are three aspects of accomplishing this and they all are important:

• Separate your identity from anxiety
• Directly lower the stress hormones
• Dampen the survival response by stimulating neuroplastic changes in your brain

Separate Your Identity from Your Survival Response

It is critical to understand that anxiety is a state that you experience, but it is not who you are. Without it, you couldn’t survive more than few minutes from lack of air, your body’s chemistry spiraling out balance, your heart rate not matching what a situation requires, etc. Anxiety is the essence of sustaining life and you can’t (and shouldn’t) want to completely eradicate it.

It is also powerful. You cannot control your anxiety. Therefore, the initial step in dealing with anxiety is to separate from it. One suggestion is to remove the word, “anxiety,” from your vocabulary. Instead use the term, “elevated stress chemicals,” whenever you feel nervous or afraid.

Another approach is to visualize a large thermometer. When you are anxious or upset, imagine how high the  red line in your thermometer is going. This visualization will help you understand the most critical step – your anxiety is simply a stress response that is common to everyone. It is not your identity. When your identity gets wrapped up with this reaction, you will not only suffer, you’ll waste a lot of energy in your effort to control it.

Directly Lower the Stress Hormones

Once you understand the problem, there are proven practices to lower your stress response. Strategies include mindfulness, exercise, meaningful engagement with others, meditation, visualization, martial arts, yoga, as well as a variety of other methods. Find which ones work for you.

The key is to understand the context of the practice and allow yourself to feel unpleasant emotions. Then you can use the method of your choice to calm yourself down. This is a necessary approach to deal with day-to-day stresses. If you instantly jump to suppressing the thought or emotion, then your nervous system will stay engaged in a fired-up state.

One of the most helpful forms of mindfulness is called “active meditation.” When your mind begins to race or you feel upset, simply place your attention on another sensation for a few seconds. It can be any one of your senses. I tend to gravitate towards sound or taste. Instead of doing battle with your thoughts, you have simply switched to another sensory input. This is a practice you can easily incorporate into your busy life without adding another thing to do.

 Dampen the Survival Response

 Your brain changes every second with the formation and destruction of neurons, connections to other neurons, and supporting cells. The term for this phenomenon is, “neuroplasticity.”

There are three part to stimulating it:

• Awareness
• Separation
• Redirection

These are some of the tools that will allow you evolve a process you can reinforce many times a day.

• Not ever discussing your mental or physical pain or care with anyone close to you. The only people you can discuss your issues with are your healthcare team. Your brain will develop wherever you place your attention.
• Expressive writing accomplishes awareness and separation in one step and it’s easy to do. It is the most necessary step in allowing yourself to move forward. Take a few minutes a day to freely write down your thoughts and immediately destroy them.
• Play – make a daily decision to create an attitude of curiosity, awareness, and openness in all of your interactions. Look at adversity as a challenge and an opportunity to practicing some of your strategies.
• Forgiveness – you can’t move forward without letting go of the past. How long do you want to continue to suffer? This will be an ongoing, daily practice. Life is challenging, and we are all wronged to some degree, every day.
• Create a vision of what you want your life to look like, regardless of your chronic pain. If you are waiting for your pain to resolve before you pursue your vision, that means your pain is still front and center and running the show. This is one of the more powerful tools.

The bottom line is if you want to decrease anxiety, you must understand the necessity of decreasing the levels of your stress hormones. It begins by separating your identity from your survival reaction, and then learning short and long-term methods to improve your life. This is a remarkably simple process, especially considering how overwhelming anxiety feels, Once you choose your new life direction, there is no telling where that freedom will take you.

1. Torrance N, Elliott AM, Lee AJ, Smith BH. Severe chronic pain is associated with increased 10-year mortality: a cohort record linkage study. Eur J Pain. 2010;14(4):380-386. 
2. Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press; 2011. 
3. Song, H., et al. Association of stress-related disorders with subsequentautoimmune disease. JAMA (2018); 319; 2388-2400.
4. Abass, A., et al. Direct diagnosis and management of emotional factors in chronic headache patients. Cephalgia (2008); 28: 1305-1314..

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