• When you are suffering for any reason, you mind races, which makes it harder to think clearly.
• Doing battle with your thoughts or suppressing them makes it all worse.
• Simply placing your attention on a specific sensation for a short time separates you from your racing thoughts.
• Your body also calms down, your thinking brain functions better, you can better engage in learning, and live your life with more clarity.

 Dr. Daniel Wegner out of Harvard, wrote a paper in 1987 called, Paradoxical Effects of Thought Suppression.¹  He demonstratedthat the more you try not to think about something the more you will think about it. The paper has been nicknamed, “White Bears.” This not news to any of us. But he also demonstrated that there was a trampoline effect, in that you think about it a lot more. When you frame this discussion in terms neurological circuits and programming this phenomenon becomes a huge problem. Disruptive thoughts progress with age.

A basic tenet of many Eastern philosophies is that worrying about the future and thinking about the past causes internal unrest. There is anxiety around the future and many regrets and frustrations about the past. Staying in the present moment is key, but how do you accomplish it?

You cannot control your mind with your mind. When your mind is racing your body will be tense and tight. The harder you try to calm down your thoughts, the faster your brain will spin. Neurological circuits are deeply embedded, especially the unpleasant ones you instinctively fight.

Active meditation

As you cannot fix, repair, or outrun them, one option is shifting from them to more functional and enjoyable circuits. This is quickly accomplished by focusing your attention on a specific sensation from your immediate surroundings. Any sense works – sound, smell, taste, feel, pressure, and sight. My term for this tool is “active mediation.” It is an abbreviated version of mindfulness, and you focus on any sensation for a few seconds up to a minute. You have connected your consciousness to the present moment. The intention is incorporating this practice frequently into your daily routine until it becomes habitual.

Three steps from Eastern philosophy.

• Relaxation
• Stabilization
• Focusing on a sensation

I learned them in a workshop given by Alan Wallace, a prominent researcher in integrating Buddhist contemplative practices with Western science.

Active meditation in practice

I practiced this daily during my hectic days at work. I often did it with my patients in clinic, especially if I was running behind. We sat back in our chairs, let our shoulders sag, jaws relax, took a long deep breath, and slowly let it go. (Relaxation). We stayed relaxed for 5-10 seconds (stabilization), while I had them listen to the ventilation system. Then our attention shifted to voices outside the door, our feet on the floor, and back to the vent. It took about a minute.

Invariably, everyone felt more relaxed and I heard my voice change to a softer pitch. Our attention had shiftedoff of racing thoughts to the current moment through sensory awareness. I encouraged them to do this often until became automatic.

You can also do this much faster for just three to five seconds. Simply engage with any sensation for short periods as often as possible throughout the day. During surgery, I would engage with active meditation with essentially every move I made.  My “go to” sensation was grip pressure on my surgical instruments. There is more feel and control with light touch. Eventually, the sensation and moves I made become so automatic that I developed a “safe zone”, and it would have required a conscious choice to be unsafe. The consistency of my performance improved my enjoyment of the day as well.

Listening

Another rendition of this tool is listening; I mean really listening in a way that you can visualize the other person’s perspective and realizing that the words they are saying mean something different to them than they do to you. It is remarkably more interesting to hear other’s perspectives rather than replaying your own.

The past is the past

You cannot change the past or control the future, and neurological circuits are permanently embedded. Tryingharder to analyze and fix them stimulates and reinforces these patterns (neuroplasticity). Going to battle with them is deadly. Simply shift your attention to any immediate sensory input. That is it and it is that simple.

Homework

1. Begin using this strategy right now. Sit back in your chair and let yourself relax from your head to toe. As you do this, focus on different sensations.
2. Then do this for 5-10 seconds through the day. Just let your attention land on a sensation while you continue your activities.
3. Keep doing this daily and indefinitely. With repetition, you’ll do this automatically. It is an important foundational tool on which to rebuild your nervous system.
4. Small calming steps add up, body chemistry shifts from threat to safety, and your neocortex (thinking centers) function better.
5. You cannot control your thoughts, but you can separate from them and redirect your focus.

References

1. Wegener, D.M., et al. Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5-13.

The post Active Meditation – a simple starting point first appeared on Back in Control.

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• Humans are subject to an endless barrage of unpleasant thoughts that cannot be controlled.
• These thoughts are sensory input that is disruptive and creates a flight or fight response.
• Resisting them makes them stronger.
• It is much more effective to switch your attention to different sensory inputs that is neutral or calming.

Humans survive by the brain interpreting impulses from various sensors located in every millimeter of your body and interpreting the sum total as safe or a threat. Every sense has a threshold that indicates danger – hot, cold, bitter, loud, bright, sharp, pressure, burning, nausea, etc. Without that immediate feedback, you could not protect yourself.

Humans have a unique characteristic in that unpleasant thoughts create the same defensive reaction, but since we can’t escape them, we are often subjected to prolonged elevations of stress hormones and inflammation. Suppressing them, which is somewhat the norm, makes the situation even worse. What can you do?

Instead of doing battle with these thoughts, you can switch sensory input. There are many choices. You can listen to enjoyable music, practice meditation, mindfully notice small details of your day, take slow deep breaths, pay attention to your breathing, engage with your passion whether it is at work or play, and deepen your relationships with your friends, family, and colleagues. In other words, by fully engaging with what is directly in front of you, your mind has gone that direction.

But it goes both ways. If you choose to remain angry, complain, be critical, and constantly discuss your problems, your body will react in kind, and you will remain on high alert. Being aware of your environment, whether it is pleasant or unpleasant is the first step and then you have a choice to remain in an agitated state or to use tools to calm down. The exact tool doesn’t matter as long it is effective for you. As has been mentioned, many of us are so used to being agitated, we aren’t aware of it or its impact on others.

Environmental Awareness

Being aware of your senses – known as environmental awareness –  is a strategy that allows you to switch sensory input from racing thoughts to another sensation. It doesn’t matter which sense you choose. I practice one that I call “active meditation” or “meditation on the run.”

During my years of performing complex spine surgery, there were occasional complications that were considered well within the scope of care. But the consequences were sometimes severe, and I was committed to bringing them down to zero. But no matter how hard I tried, I wasn’t able to eliminate them. My own thoughts were interfering with my performance.

Things changed when I decided to enlist the help of a performance coach to improve my consistency. I brought him into the operating room and clinic so he could better understand my world. For 18 months, he and I underwent regular debriefings and coaching. I began to use “active meditation” in the operating room. The most common interferences I felt during surgery were frustration, anxiety, distraction, complacency, and moving too quickly.

Active meditation in action

This meditation model is not based on suppressing interference – for instance, if you’re frustrated, you don’t pretend otherwise. Rather, face the frustration, detach from it, and proceed in the manner of your choice. I learned to identify interferences either before or during surgery, and then used mindfulness-based approaches to let go of them quickly. This version of mindfulness is fast. It took about 3-5 seconds and was repeated frequently during a case. It was often connected with one quick deep breath in and a slower one out.

Setting up the day

Each surgical morning, I woke up and assessed how I was feeling. Like everyone, my feelings ranged from calm and relaxed to tired and anxious. I would sense smells, touch, and taste, etc. I felt the water on my back in the shower. I savored my coffee. I also reminded myself that although that day’s surgery is “just another case” for me, it’s one of the most important days of my patient’s life.

I continued this process in the operating room. I carefully arranged the room, talked to each member of the surgical team, and reviewed the imaging studies. I remained focused and immersed in what was right in front of me.

During surgery, awareness allowed me to perform my next move at an optimum level. I felt my grip pressure on each surgical tool; noticed the shape of the contours of the anatomy; felt my shoulder and arm muscles stay relaxed; and watched the flow of the case.

If I noticed disruptive thoughts and emotions enter my consciousness, I quickly practiced my environmental awareness techniques in order to re-focus. I would usually focus on light touch. With practice, I learned to be fully connected to each move, so I could “program” myself into the “zone.” Eventually, it all became automatic. I was so connected to each move that I might experience 10 distracting thoughts in a six-hour case. It was a remarkable shift from dealing with endless racing thoughts.

Surgery evolved into wonderful experience for me. I eagerly looked forward to Monday instead of surviving until Friday. I committed to getting a good night’s sleep before every surgical day. If I woke up “wired” and uneasy, I slowed down until I felt relaxed, no matter how many things were on my to-do list.

The same approach is a core tool to remain calm throughout your day. It is more difficult outside the OR with less structure. But with repetition, it will become automatic.

The “to do” list

I use my “to do” list as an opportunity to practice mindfulness. I remind myself that this list is an expression of my life, and so I deliberately become aware as I go about each item. For instance, when I had an appointment with a patient, I would carefully focus on listening to myself talk to him or her. Of course, carefully listening to them was critical. I felt the pen on the paper as I jotted down notes. I also practiced meditative techniques, such as “watching” disruptive thoughts such as “need to finish up here, I have other things to do” enter my consciousness and then leave. I reminded myself that my goal was to engage and enjoy every second of my “to do” list. It didn’t always work, but it’s surprising how often it did. It is still part of my day.

Recap

Environmental awareness engages me in the present moment regardless of the circumstances. It is not positive thinking, but just switching to a different sensory input. With repetition, it became and remains somewhat automatic. In the presence of ongoing pain, it is not the final solution, but will calm you so other tools can contribute.  It is a simple strategy without a downside.

This is the first and most basic of the different types of awareness. The other types of awareness are more challenging – emotional, judgment, and ingrained patterns. It is one of the reasons it is important to implement your own version of environmental awareness that will help you deal with the other ones that are more stimulating.

Questions and considerations

1. Many of you have heard the phrase, “be here now.” It is brilliant except it is rather hard to do. By actively engaging with a given sensation, you are here now. Your attention cannot be in two places at once.
2. Then consider a more complex phase in action. As you engage in various activities, interesting or not, by immersing yourself in every aspect of them, you’ll become more connected and calmer. For example, imagine you are sitting in an important lecture. By listening to every word, you’ll find it more interesting and have a much higher chance of learning what you need to learn. Detailed notetaking also has the same effect.
3. If you can actively learn this awareness skill, notice how much calmer your mind becomes. Listening to another person’s tone of voice and content is a great one to focus on and is more interesting than hearing yourself.

The post Connecting to Life with Your Senses – Environmental Awareness first appeared on Back in Control.

The post Connecting to Life with Your Senses – Environmental Awareness appeared first on Back in Control.

Objectives

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

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

Albert Einstein

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

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

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

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

Moving on

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

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

Visualization

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

Hi David,

Great quote from your latest post:

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

Gabriel Garcia Marquez

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

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

Play

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

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

An old song returns

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

Recap

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

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

Two Wolves

Questions and considerations

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

 References

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

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

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