• 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.

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Begin writing now

I ask my patients to begin the expressive writing quickly before they read my book. From the beginning it creates some level of a shift and seems to open the door to change. Many people resist this simple exercise. That includes me. I am not sure why so many people resist this foundational step, since there is no risk or cost. Over 2200 research papers have demonstrated its effectiveness. But I hear and endless number of reasons why he or she can’t write. One of them is, “My hands hurt or are unsteady.” “I don’t have the time.” “My life is unusually stressful.” There is another alternative – the verbal route.

The mirror

Dr. Wegner, author of the famous “White Bears” article (1) on suppressing thoughts pointed out that the verbal route of expressing thoughts is also effective. I recall in the midst of my misery that one exercise that helped create a shift was one suggested by David Burns in his book, Feeling Good. He said to stand in front of a mirror and talk to that person using the self-critical voices in your head. You would never talk to another person in that manner. Of course, you can speak with freedom and there is nothing to destroy. I have to say that it was disconcerting I and I quickly realized how toxic these thoughts were. So I suggest to my patients that they can express themselves verbally in private with or without a mirror.

One research paper (2) looked at switching the self-talk voice from the first to the third person. Of course, most of our self-talk is negative, which is an unfortunate part of the human experience. They were able to document on functional MRI (fMRI) scans, which document area of brain activity that this process calmed down the region of the amygdala (considered the danger signal area) without engaging the higher thinking areas of the brain. In other words, it cut through the need for using your cognitive function to do battle with anxiety.

Using words

I want to share an email I received from one of my colleagues.

While expressive writing is great, I find that at home, I rarely can find a solid uninterrupted 20-30 minutes to dedicate to it, with professional obligations, my wife, and daily life/planning/activities/chores. I’ve tried doing it at work, but distractions and tasks are ever-present.

So, what I have been doing is during my drive home (which can be up to 45 minutes or more), or during my 15-20-minute walk to the gym, I simply visualize writing, or narrate to myself what I would write. It flows even faster than writing, and once I get going, the words flow, the images flurry, and I get it all out in the open. Then, if in the car, my personal favorite is to laugh at how ridiculous it sounds or, if particularly angry, swear it all away. When at the gym, with every repetition I imagine squashing it.

I do this about 4 times a week and all the negatives of the day, personal challenges, or doubts about the future turn from massive, insurmountable problems to very solvable obstacles; it’s incredibly energizing.

I have found that even with the writing exercises, it wasn’t the act of writing, but the act of ripping it up and throwing it away that felt so liberating. If it was a great week and my writing was all positive, I’d read it a few times and be proud, and throw it away. It is that physical act of squashing, tearing, destroying negativity that is what makes all the difference.

A few months ago I read a book called The Charisma Myth, and one part was about managing stress with public speaking. The technique the author described was closing your eyes, identifying all doubts, negative thinking, worry, stress, and visualizing all this negative energy being expelled to either a benevolent god, the universe, or something that the individual personally identifies with. When I had to have some difficult conversations and meetings over the last few months, before every meeting I closed my eyes, identified my stress, nervousness, doubts, etc. and visualized myself breathing out these thoughts to a collective universal being, where I identified that billions before me and billions after me have had these same exact feelings, and I could expel it to a pre-existing unity. I walked into the meeting calm, cool, and collected, and though it was tough, I was able to think clearly, not shy away from making my case, and stand my ground confidently.

I think this illustrates that feelings, especially negative ones, like anxiety, stress, uncertainty, self-doubt, pain, etc. are all intangible ideas.  The act of making it tangible, whether it be through the written word, a visualized entity, or an audible sound (like when I dictate to myself) makes it something tangible and something people are comfortable dealing with. Squashing that tangible thing, whether by tearing it up, pounding it away in the weight room, swearing it away in my car, or breathing it out to a universal entity, are all physical, tangible methods of dealing with a now tangible foe that was before just an illusory concept. And that’s what makes these tools so powerful.

Neuroplasticity

The concepts of rewiring your brain (neuroplasticity) are based on awareness, separation and reprogramming. The writing creates an awareness of what is racing around in your brain and now there is a space between you and your thoughts. The verbal route also creates a separation, and you are now able to re-direct your attention to whatever you choose. The data is convincing.

Here is a link to a detailed overview I created to explain the details of expressive writing. You don’t have to write for 15-20 minutes day. As little as a minute can change the nature of your day. I also feel it is important to write at least several times a week indefinitely. It is a way of “maintaining” your brain.

We asked Dr. Pennebaker, the originator of the research, why he thought it was so effective. It was his impression that it was a simple way to release secrets, not solve or get rid of them. Everyone has some parts of themselves they are not particularly proud of. It is just the way human consciousness works. It is not a solution for your mental or physical pain in isolation, but it is a necessary starting point. I have seen few, if any, people deeply heal without this exercise.

References

1. Wegener DM, et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.
2. Moser, JS et al. Third-person self-talk facilitates emotion regulation without engaging cognitive control: Converging evidence from ERP and fMRI. Scientific Reports (2016); 7: 4519 | DOI:10.1038/s41598-017-04047-3

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“Don’t turn the ball over!”

Which brings us to the Golden State Warriors, who have become an NBA basketball dynasty. There are many facets to winning a game, involving strategies and skills that are well beyond my comprehension. However, one aspect of winning is minimizing the number of times you turn the ball over. Each time you turn the ball over, you open the door to making a bad pass or having the ball stolen by the opposing team. But it also involves a different energy than free throws, shooting, conditioning, and ball handling. There are many factors causing ball turnover; it always means less control.

The Warriors are legendary for their ability to move the ball around quickly, and you would expect a higher number of turnovers. It was a topic prompting discussion in multiple public forums, and decreasing turnovers must have been a focus of the team. However, something I read in the newspaper one day caught my attention: The Warriors had decided to quit worrying about turnovers and just play.

It was inspiring to watch their performance improve. Not long after, they went on to win the NBA championship.

Their experience is a classic example of “the ironic effect.” Trying not to think of something not only causes you to think about it more, but it also sets off a documented trampoline effect, you’ll think about it a lot more. Focusing on the highest level of performance is much different than “not trying to make mistakes.”

Skiing “not to lose”

My son is a world-class mogul skier and won the Junior Nationals championship in dual moguls two years in a row. He then hit many rough spots, including multiple significant injuries. One of them was a high-speed fall than caused his left shoulder to dislocate. He was moving so fast that he thought he was going to die as he hit the snow and narrowly missed a tree. He lost some of his edge of being infallible. He didn’t quit; he began skiing, “not to lose.” Of course, at that level, you also can’t win. His efforts to improve kept getting sabotaged in spite of an incredible commitment to conditioning and practice. In the midst of a few more injuries, including nine concussions, he really struggled.

He engaged the expertise of an athletic performance coach, David Elaimy, with an emphasis on connecting with one moment at time and visualizing what he wanted to accomplish. He also understood the powerful effects of expressive writing, writing down thoughts then destroying the paper they’re written on. It is the one exercise that breaks up the need for mental control, which is the driving force behind the ironic effect and repetitive thought patterns.¹

As he stood at the starting gate for his last attempt at qualifying for the U.S. ski team, my son carved in the snow  the word, “fail” with his ski pole, then trusted himself to execute what he already knew how to do—ski at the highest level. He went on to ski the best run of his life and qualified for a shot at the Olympic Freestyle team. For other reasons, a skier who finished below him was chosen for the team. But he did it. He broke through and performed to his potential under extreme pressure.

What does this have to do with pain?

There are two separate but tightly linked areas of expertise involved in resolving mental and physical pain.

One is learning how to process stress by developing a “working relationship” with your powerful survival fight-or-flight response. By learning the tools to stop fighting it, you can place your attention on what you want to accomplish.

The other is learning to nurture yourself and actively create the life you want. Few of us have been taught these skills.Your nervous system and body’s physiology will shift from an activated defensive state to that of safety, with profound benefits to your mental and physical health.

Winning is not the same as “not losing”

By trying “not to turn the ball over,” your powerful unconscious brain is trying to help with that effort, but it is also taking attention and energy away from what you desire. Focusing on what you want to accomplish is a more effective way of enjoying your life.

I have no idea whether the Warrior’s coaching staff was aware the ironic effect. I am even not sure whether turnovers dropped much. But the switch likely allowed them to focus more attention on execution.

Successfully dealing with ironic effect has a major influence on people’s quality of life. I have witnessed hundreds of people heal. that way. Deep healing cannot occur while you are in a sustained defensive mode, in fight or flight. Life is meant to be more than just surviving. Becoming a “professional” at living your life allows you spend less time feeling stressed, and decreases your exposure to fight or flight physiology. To win, you must practice winning.

References

1. Wegener DM. The Seed of Our Undoing. Psychological Science Agenda (1999)/ 10-11.
2. Wegener, D.M., et al. Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5-13.

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The ability to process anxiety in a healthy way is critical to maintaining your quality of life. It is even more important for someone who is experiencing chronic pain. Anxiety is a reflection of your body chemistry changes when you are in an arousal state. Your senses are heightened and your perception of pain is heightened. (1)

There are several principles I have learned from my own experience and working with my patients:

• Untreated disruptive anxiety always gets worse. It will NEVER get better on its own.
• Anxiety is the pain. It is simply indicating, “danger” whether it is real or perceived.
• Anxiety is highly treatable if it is acknowledged and treated as a physiological problem and not psychologically.
• Anxiety is both normal and necessary–it will never disappear. Every living creature is programmed to avoid situations that would potentially affect its survival.
• It is important to separate the threat from the chemical reaction (anxiety).
• Mental pain is more disruptive to people’s lives than physical pain.
• The harder you try to suppress fear, the stronger it will become. (2) White bears
• Avoiding anxiety becomes its own stressor.
• It is necessary to learn to live with anxiety; is it not solvable.
• The way to decrease anxiety is to utilize methods that lower the stress hormones. The ultimate answer is to learn to switch over to “play” chemicals. It is a set of learned skills and not “mind over matter” or “positive thinking.”

I think that unrelenting and uncontrolled anxiety is intolerable and the one of the worst aspects of being a human. It will infiltrate every corner of your life. I find it tragic that such a treatable problem is so often not adequately addressed because of the incorrect perception of what it represents. It is actually your gift of life.

1. Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166-173.
2. Wegener DM, et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.

The post Anxiety first appeared on Back in Control.

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• Modern civilization offers more opportunities than any other era of human history. Yet our mental health is declining.
• We have been led to believe that experiences, knowledge, possessions, and accomplishments can make us happy.
• You cannot outrun your mind. It is a futile effort because your unconscious survival reactions dictate how you feel.
• The key is to learn approaches to calm your body’s flight or fight response and “just be.”

Chronic mental and physical Illnesses are rampant amongst teenagers. A 2014 paper out of Indianapolis demonstrated an 830 percent increase in hospital admissions for pain in adolescents over a seven-year span. In the vast majority of patients, a cause of the symptoms could not be found. I gave a talk at a high school a few years ago and was told that over 350 of the 1500 students had a chronic medical problem that had to be monitored. Eating disorders are increasing, even amongst males. Teen suicide is a serious problem. We have more resources and opportunities at our disposal than at any point in human history. We live in a free country with unlimited opportunities. Yet much of the population is miserable. We keep wringing our hands about the problem but are not coming up with real solutions. What is going on?

We are not addressing the root cause, anxiety, with an effective paradigm. It is a powerful physiological (how the body functions) response to real or perceived danger, and avoiding it is a driving force behind much of human behavior. All life has some form of a “flight or fight” reaction. Humans have language and describe it with the word, “anxiety.” It is automatic, hard-wired, unresponsive to conscious control, and evolved to be incredibly unpleasant. A common approach to quell anxiety is to experience, accomplish, achieve, and remain busy in order to outrun it. It is impossible to avoid feeling your body’s chemistry. A fired up nervous system also interprets these sensation and creates an endless flow unpleasant thoughts that I call, “RUTs” (repetitive unpleasant thoughts). You cannot escape your body or outrun your mind. Our modern era of opportunity has actually worsened this scenario. We didn’t evolve to process so much information in a day.

Choices

First, we have too many choices. I will never forget during my psychology course in medical school learned that volunteers’ anxiety was as high when given choices about equivalent positive or negative options. Humans have trouble with choice and we don’t like feeling anxious.

Trapped by success

Second, we are encouraged to experience life to the fullest and achieve. We are entering organized sports at an early age, traveling the world, and given wonderful options of becoming creative. There is no limit as to what is possible. That also the problem. You can achieve many things but you cannot outrun your mind. What is even more of a problem is that when you have accomplished what you think should give you peace of mind and you are still unhappy, where do you go next? Then you really feel trapped.

I recall riding a chairlift with my son in Utah during the midst of my anxiety-driven burnout. There was about a foot and a half of fresh powder, my 10-year old son was an accomplished skier, we were spending a wonderful day together, and I was miserable. I also had a great practice, beautiful family, nice house, and was becoming financially secure. The sense of being trapped was overwhelming. What else was I supposed to do to be “happy?”

That same year I was talking to a middle-aged gentleman in my office who broke down crying because he had sold his business for 45 million dollars and did not know what to do. It had been his life. His anxiety was crippling. Over an 18-month span while I lived in Sun Valley, ID six men between 45 – 60 committed suicide. All of them on the surface were accomplished, had experienced many adventures, had families, friends, and were wealthy. It wasn’t enough. I do not know details, but there is a well-documented link between rumination and suicide. (1)

Your personal brain scanner

Third, even when your situation is idyllic your brain continues to search for threats. The human body is designed to firstsurvive; not to have a great time. Humans also have the problem in that danger can be created in our minds, which Dr. David Burns terms, “cognitive distortions”. These become our ego. The  “stories” we create to feel better about ourselves are compilation of faulty thinking and “good self-esteem” is a massive cognitive distortion of labeling.

Many of us are driven by our self-critical voice, which represents the cognitive distortion of “should thinking.” Perfectionism is a particularly insidious version of it, and we may drive ourselves unmercifully to attain remarkable heights. Since our “ideal self” is unattainable we have set ourselves up for endless and progressive frustration. My son, Nick, and his best friend, Holt, were competing in mogul skiing at a national level their focus was on winning. If they lost, then they were pretty unhappy until the next event. David Elaimy, their performance coach and I kept trying to tell them to enjoy the process and be happy they were able to travel the world and compete. The day after Holt won the national championship he finally said, “You were right. I still have to get up and go to work. My life has not changed that much.” When your peace of mind is dependent on your circumstances or other’s opinions, you are at the mercy of them.

Golf and life

Golf is one sport that highlights this issue. David Elaimy, is a performance coach who teaches our fellows performance concepts to be utilized in surgery. He pointed out that at the end of a round of golf that 80% of golfers are unhappy with their game – because of the score. It personally took me years to get past the score but my biggest accomplishment in golf is truly enjoying being outside with my friends and seeing how well I can do. I do not have the time to drop my handicap but it no longer makes sense to me to spend any part of my free time being frustrated about a score. It is just a story.

A life-changing moment on the golf course

Here is a letter from one of my administrative colleagues who I really enjoyed working with. He had read my post, The Tale of Two Golf Holes. The joy of my second hole-in-one had been completely wiped out by my frustration. It was one of the most enlightening moments of my life.

Dear Dave,

The frustration and joy of golf can easily lead to some strong emotions including anger. I know my brother and I struggled with that for a long time, until one day I realized what it is all about.

My brother was having a particularly difficult day on the course with my Dad some years ago and was just about ready to throw a fit. My Dad told him to stop playing. They both laid down on the green, looked up at the clouds on a beautiful day and took a moment to appreciate spending time together outside with nobody else around. “This is what it is all about.” My brother walked up back to his ball and asked my Dad, “So I don’t have to keep playing, I can just walk the rest of this hole and start back up on the next one if I want?” Right as my Dad was about to affirm his question he whispers to my brother to turn around. Not five feet behind him stood a deer.

My dad and brother always describe this as one of their epiphany moments, and for me it illustrates that golf is just a game. While it can be challenging and frustrating, you can’t let that aspect of the game get the best of you and distract you from the joy and awe it can bring. Great article Dave, it really got me thinking of just how toxic anger towards something or someone can be, and how powerful forgiveness can be. (this includes perfectionism –  anger towards yourself). Best, George

Be all that you can be?

Defining myself by my accomplishments and “score” has been my entire life. These deeply etched in behavioral patterns are not going to disappear. However, by being aware of their presence and power allows me to separate my “identity” from them. The solution lies learning tools to pull into the “centre of the storm”, skilfully deal with adversity, and nurture joy. It is an ongoing daily lifetime practice. So, just “be” – and enjoy your day.

References

1. Morrison, R., & O’Connor, R.C. A systematic review of the relationship between rumination and suicidality. Suicide and Life-Threatening Behaviour (2008); 38:523-538.

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Trying not to think about something will cause you to think about it more. All of us know this phenomenon but we don’t know how to deal with it. The deadliest emotion we suppress is anxiety. It is a survival response and our whole being is repulsed by it. Prolonged exposure to raw anxiety is the worst part of the human existence. It is a universal problem that few people want to admit to much less discuss.

Nate

A few weeks ago, I was discussing the problem with one of my best friends, George. He has an 11-year-old son, Nate, who is personable, athletic, good-looking, and has many friends. He has a wonderful family life. George has engaged his family with many of the principles of dealing with Neurophysiologic Disorder. (NPD) One of the exercises is the writing down of his  thoughts and throwing them away. Recently he suggested that Nate draw a picture of himself with these thoughts.

He showed me the drawing. It was brutal. “I am ugly. I have no friends. No one likes me. I am stupid.” The list went on for 15 thoughts that were equally as negative. How could this be? He is living a childhood that remarkably rich and supportive. It reinforced to me that every human being struggles with disruptive thoughts.

Harvard study – white bears

In 1987 Dr. Daniel Wegner, a Harvard psychologist published a paper, The Paradoxical Effects of Thought Suppression. (1) The experiment is commonly referred to as “White Bears”. He asked a group of students not to think about white bears. He designed it in a way that demonstrated that when you try not to think about something, not only do you think about it more; you think about it a lot more. He used the term, “trampoline effect.” He pointed out in an essay; The Seed of our Own Undoing, that simply writing down or saying the thoughts you are suppressing interrupts the phenomenon.

“ANTS”

David Burns in his book, Feeling Good (2) uses a term he calls “ANTS”, which stands for “automatic negative thoughts”.  These ANTS are a universal part of the human experience. Since I picked up his book in 1990, I have always wondered why we don’t have “APTS” or “automatic positive thoughts.”  WE DON’T SUPPRESS POSITVE THOUGHTS.

Pain, ANTS, and white bears

People suffering from chronic pain lose their sense of humor. Pain causes anxiety and when you are it, extreme frustration and anger will run your life. Anger results from loss of control. What causes the need for control is anxiety. Anger is just anxiety on steroids. One step worse than suppressing anxiety is suppressing anger. The eventual outcome is rage. My term for the darkness that consumes my patients in pain (and historically me) is the “Abyss.”

There is a solution

I have learned that pain, anxiety, and anger are classic symptoms of the Neurophysiologic Disorder (NPD). Dr. John Sarno first described it in the 1980’s under the term, “Tension Myositis Syndrome” (TMS).  (3) There are least 30 other MBS symptoms connected to and caused by the nervous system. (4) The nervous system component is NOT psychological it is a programming issue. Like any learned skill such as riding a bicycle these pathways are permanent.

Anxiety is a physiological reaction to sensory input of any kind including thoughts. It results in behavior that causes you to react in a way to protect yourself. You can talk about it all day long, but you cannot get rid of anxiety whether it is from a  mental or physical source. It is a symptom of NPD.

Fortunately your conscious brain focuses on one thing at a time. That is why we are not safe texting and driving. When your mind is here it is not there. By creating alternate pathways around your fixed circuits, you can shift your nervous system into a new set of pathways. Additionally, we now know your brain can grow new nerve cells at any age. The term is “neuroplasticity.” At a certain tipping point your pain pathways will become dormant. The switches are turned off. Anxiety and anger also will dramatically drop.

I experienced 17 of the 33 symptoms of NPD disappear. I not only have my life back, but I also have a new life.

Connecting thoughts with physical sensations is one way of creating new pathways. One foundation of treating NPD is the simple the act of writing down your thoughts and immediately throwing them away.

Patients won’t write

But I often cannot persuade my patients to begin this exercise. It’s the necessary foundational step of the reprogramming process, which is to create an awareness of these ANTS. The thoughts can be positive or negative. I have my tear them up both to write with freedom and not to spend any time analyzing them. This exercise is only a separation process from your conscious thoughts.

Regarding the negative thoughts that arise, my patient’s first response is, “This is not who I am.” That is correct. These thoughts are not who you are. They are JUST neurological connections and the opposite of you who are. Otherwise, you would not be suppressing them. You are only giving them life by blocking them. Your brain will develop wherever you place your attention.

We all know that being reassured that our hidden thoughts aren’t valid does not make them disappear. I could collect dozens of signatures and testimonials from Nate’s peers and give them to him. He could win a “greatest human being contest” along with a big trophy. How would that work? I predict, based on my personal experience with NPD, the next set of thoughts would be centered on, “They don’t really know me.”

Possibilities

What if we could teach these simple writing exercises to our children in pre-school? We would have a shot at solving chronic pain at a societal level.

References

1. Wegener, D.M., et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.
2. Burns, David. Feeling Good. Avon Books, Harper Collins, New York, NY, 1999.
3. Sarno, John.Mind Over Back Pain. Berkley, 1999
4. Schubiner, Howard.Unlearn Your Pain. Mind Body Publishing, 2010.

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There are over 2200 research papers that document that expressive writing in some form is effective for improving both your mental and physical health. I have been adamant for a long time that you should write down just negative thoughts – not positive ones. That has also been the general feeling of many papers. Interestingly enough, I ran across several papers that documented that writing down positive thoughts is equally effective. It appears that expressing thoughts and emotions works. The debate is how and why it is effective. One theory is that it switches your thinking into a slower, more rational mode, than automatic fast thinking. For me, writing was the first and only effective strategy that pulled me out of a 15-year tailspin. I had been in psychotherapy for 13 years and continued to spiral downward. I am an advocate of psychological interventions but they have to be combined with some other tool that helps to calm and re-route the nervous system.

My first step with every patient is to have them write down his or her thoughts and instantly destroy them. Thoughts are only connections between neurons within your brain.  There is no substance to them – none. However, as your body secretes chemicals in response to thoughts, they seem like real and part of your identity. Your goal is to bring these thoughts to life as vividly as possible and then separate from them. Unhooking from the train Meaningful healing will not occur until you start writing. It has been the one common strategy of essentially every patient I have seen go to pain free. I ask that patients begin this process before they do much reading, as it is the true beginning of the program. Write Your Way Out of Pain

Much of the DOC program is based on neuroplasticity, which is the term for your brain’s capacity to physically change. It can grow new nerve cells, lay down myelin and form new circuits and connections at any stage of your life. In fact, it has been demonstrated that your brain physically shrinks in the presence of chronic pain and re-expands when the pain resolves. The basic steps of the reprogramming process is: 1) awareness 2) separation 3) reprogramming. I feel that the expressive writing accomplishes the awareness and detachment steps simultaneously. There is now a space between you and your thoughts that is connected with the physical sensations of vision and feel. Somehow the brain processes this separation. 

The reprogramming process begins the day you begin to write. Write anything – positive or negative. It is important to immediately destroy them so that you can write with complete freedom. I encourage people to write for 10 or 15 minutes a couple of times per day. I do not encourage writing throughout the day. What I do suggest is to combine the writing with active meditation. You choose a physical sensation to place your mind on for 15-20 seconds as many times a day as you can. You have now shifted your nervous system off of unpleasant pathways to neutral or pleasant ones. I would like to do it more but I probably am successful 20 – 30 times per day. Instead of doing battle with unsolvable circuits you simply shifting your attention to other sensations.

Creating New Pathways

Thoughts are connected with:

• Other thoughts
• Emotions
• Physical sensations
• Mental pictures

Each these associations creates new neurological pathways. With writing, thoughts are connected to vision and feel, which creates new circuits. It clarifies your thinking and it is also the staring point. The writing exercise is not the solution for your pain. You will discover your own solution as the process unfolds.

The post Write and Don’t Stop! first appeared on Back in Control.

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