Your Hand Over the Heat

If you were to put your hand close to a hot burner on a stove, what would happen to your level of anxiety?

• It would quickly escalate.
• You would withdraw your hand.
• You would protect yourself.
• Anxiety would be alleviated.

What would happen to your anxiety if you were forced to leave your hand over the burner?

• It would go through the roof.
• You would feel trapped and extremely angry.

I don’t believe you’re OK.

Anxiety is a Programming Problem

The changes to the central nervous system during chronic pain represent a programming problem rather than a psychological problem.

• Anxiety gains strength with time and repetition.
• Anger is a powerful force that covers up the feeling of anxiety
• Anger spins anxiety-inducing neurological circuits more quickly.
• We deal with anxiety by exerting some form of control.
• If you are successful in controlling the situation or yourself, then your anxiety is alleviated.
• Without control, you become frustrated or angry. Anger = loss control

With chronic pain, you have, metaphorically, lost your ability to “withdraw your hand from the red hot burner.” How can you rate yourself as a zero on anxiety and irritability? If you had no other stress in your life, chronic pain alone would be enough to destroy the quality of your life.

There are several other stress factors to consider with chronic pain.

• People in chronic pain don’t see an end to their suffering. They lose hope in returning to a pain-free life.
• Chronic pain patients are truly victims of pain. So it’s more difficult to let go and not have anger run your life.
• When chronic pain patients suppress anxiety and anger, these negative feelings become much stronger. (2)  White Bears and ANTS.

Being Pain-Free is a Basic Need

We all deserve to live free of constant pain. Being pain-free is a basic need. It has been shown that the impact of chronic pain on a person’s quality of life is equivalent to having terminal cancer. (1) We cannot accomplish higher goals and flourish as human beings without first securing the comfort of being in our bodies. I discuss this in “Maslow’s Miss”  and in the video: “Your Hand Over the Stove.”

“The Link Between Pain and Anxiety”. Inspire, January 21st, 2013

1. Fredheim OM et al. “Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients.” Acta Anaesthesiologica Scandinavica (2008); 52: 143 – 148.
2. Wegener, DM et al. “Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5 – 13.

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Perception versus reality

But our minds are tricky. We are continuously scanning the environment for danger. Your brain is your own personal brain scanner, always looking for danger. Basic issues are oversimplified and threats are magnified. In spite of the mass shootings we actually live in the safest era in history. One of my friends sent me this article pointing out the sharp decline in violent deaths since 1980. Human history is essentially one of violence and power. The vast majority of police officers are remarkable role models and frequently perform acts of heroism. Just walking out the door in a uniform, knowing that he or she could be a sniper target from 200 yards is an act of courage. Massive decline in gun violence

However, the media visually dramatizes stories and focuses on the negative aspects. Every violent act is captured in detail on smart phones. We are helpless to enact common sense social changes due to major political and corporate interests blocking the efforts. This feeds into a collective state of anxiety regardless of how safe we really are and also our tendency to blame others. We have more material possessions and comforts than any society in the history of the world. Shouldn’t that calm us down? What is the problem? Why are we so angry and reactive? The DOC starting point 

It’s anxiety. The root cause of our societal angst is relentless anxiety, which is the driver of anger. Unfortunately, the medical profession treats anxiety as a psychological problem when it is really the body’s chemical response to unpleasant sensory input. It is a universal physiological reaction that enables living creatures to survive on this planet. Here is how it goes.

The neurophysiological basis for emotional and physical pain

Your unconscious brain processes 20 million bits of sensory input every second. Each sensation, sound, touch, taste, smell, vision has to be interpreted by your brain as pleasant, neutral or unpleasant. It continuously interprets the sum total of this input and directs your organs to secrete hormones that are relaxing and enjoyable (dopamine, GABA, oxytocin), or signal danger (adrenaline and cortisol). When you feel anxious or afraid you are experiencing the surge of these chemicals in your body.

Any stress, real or perceived, signals danger and your reaction will always be this survival response. The effects of adrenaline and cortisol include sweating, rapid breathing, shortness of breath, hyper-attentiveness, tightness in your stomach, urinary frequency, and a rapid heart rate. Anxiety, anger and adrenaline

The curse of consciousness

The curse of the human experience is that thoughts are also sensory input that cause the same chemical reactions as a physical threat and are competing for sensory attention. The problem with thoughts compared to the other senses is that you cannot escape them. You will consciously or unconsciously act in a manner to avoid unpleasant physical sensory input. Although you can try to suppress or mask disturbing thoughts, they will keep coming at you and will become progressively more intense with repetition. It is also a problem that is made worse by the fact that our lifespans are now about 30 years longer than in the early 1900’s.

Every human faces this problem. If you come from a difficult background or are trying to meet unrealistic expectations, physical symptoms and illness will begin earlier. If you have a great upbringing you may make it through your entire life without too much trouble. I had a rough beginning but thought I had figured it out until I began having panic attacks and extreme anxiety in my mid-30’s. I achieved my “success” through extreme suppression of my thoughts and did not have any sense of anxiety or anger. My body (brain) knew better.

Since you cannot escape your thoughts, you’ll be under a greater or lesser degree of constant chemical assault. Your progressive anxiety may become disruptive. I was in this state for over 15 years, with the last seven of them being intolerable. My battle with NPD Even in the presence of physical pain, most of my patients tell me that they can deal with the physical pain better than the constant worrying and anxiety. Am I operating on your pain or anxiety? What does all of this have to do with the current societal angst and ongoing violence? Anxiety and anger are the same entity.

Anger = anxiety with a chemical kick

Anger occurs when you have lost control. When you do not have the ability to alter an anxiety-producing situation, your body will secrete even more adrenaline in an attempt regain control. Anger is anxiety with a chemical kick. Anger = loss of control

With the correct diagnosis and treatment approach, relentless anxiety is eminently treatable with remarkably simple strategies. It involves:

• Stimulating the formation of new neurological pathways.
• Shifting onto more functional and enjoyable brain circuits.
• Decreasing the adrenaline rush by training yourself to chill out in presence of stress.

Anxiety is a public health issue

These are easily learned skills that should be part of the basic learning curriculum in elementary school. With the added stresses of over-population, etc. it is rapidly becoming a skill that needs to be learned by every one of us quickly and especially by the medical profession, who society has entrusted with its healing. Societal disintegration – untreated anxiety

This conceptual framework is the basis of the second edition of my updated book. We are not going to solve any of this planet’s problems until we address the root problem of sustained anxiety and anger as a major public health issue using the correct therapeutic approach.

The DOC starting point 

Listen to the Back in Control Radio podcast Neurophysiological Basis of Pain

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Anger

It is my observation that the whole system of care ignores the most significant factor that contributes to the development of chronic pain—anger. Anger is universal and part of the human experience. Some argue for the necessity of anger. In any case, it is not going away any time soon. Anger provides a useful survival mechanism. When you are threatened and feel anxiety, you will take evasive or avoidance action. When that ability to escape is lost, you will become angry, which increases your body’s physical reaction and mental focus to solve the problem.

Control

The antidote to anxiety is control.

Loss of control = anger.

The current disability system strips the worker of control. Additionally, at least in Washington State, the injured worker is at the mercy of a medically unsophisticated claims examiner. That examiner has final say in everything. As “enlightened” as I am, I cannot discuss a case with an examiner for more than a few minutes before I feel like I am losing my mind. I cannot imagine having my well being, as well as my livelihood, at the mercy of this system.

Dealing with the Anger

It will not matter what systems are designed to “incentivize” workers to return to work, unless this core issue of anger is addressed. You don’t have to incentivize any living creature to jump out of a cage. You just have to the door. Anger not only traps workers so they cannot fully engage in their care, but it also robs them of the ability or motivation to become engaged.

Although anger can be a useful survival mechanism, it is usually destructive to you and everyone around you.  Your anger imposes its own will on the immediate surroundings, and you lose all ability to rationally interact with your environment. The consequences are often disastrous. The most well designed programs are not going to be effective unless the wall of anger can be penetrated.

Anger and Frustration with Workers Compensation 

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And a need for control to escape the threat

When you can’t solve the problem (trapped)

Your body increases the stress response in an effort to regain control

Now you are angry

Anger = turbocharged anxiety

Both are unconscious, automatic, and not controllable

The biggest problem with anger is that since anger is your last-ditch effort to survive, your brain activity shifts from the neocortex (rational thinking area) to your midbrain (reflex survival center). You have lost awareness of others’ needs, it is only about you, and it’s destructive. It’s impossible to think clearly and while you are angry, you must just stop – somehow. Taking any action while you are angry rarely improves your life or relationships and is usually damaging. Here is a sequence of steps you can use to minimise its impact.

“5-3-2” 

The numbers represent the number of words in each step.

• No action in a reaction
• Flip the switch
• Move on

5 – “No action in a reaction.” First recognize that you are upset. There are many ways to disguise anger. Then you must acknowledge that any action, physical or verbal, is not going to be helpful in the long run. Finally, don’t take any action while you are upset. Say nothing. Leave the room. Take a walk. The anger may lessen quickly or last for a while. Much of it depends how skilled you are at processing anger, and everyone is different.

3 – “Flip the switch” will be discussed in greater detail, but anger is so powerful that you will never be able to give it up nor will you want to. There is an addictive component to it. So, flipping the switch means that you let your anger drop enough that you are able to think more rationally, and then you make a decisive choice to come out of the victim mode. However, it is important not to “flip the switch” until you think you can actually do it. You may drop right back into anger, and you just keep making the choices to change direction.

2 – “Move on.” Once you have returned to a rational state of mind, you’ll be able to address the upsetting situation more clearly and constructively. What is interesting, is that often what seemed so important and intense just disappears. Since anger is a trigger within you, and the situation or a person is what set it off, the “problem” often ceases to exist. It is critical to keep moving forward into the life that you want or the solution you desire. If you spend your time trying to keep solving what makes you upset, the list is endless, it isn’t that enjoyable, and you’ll drag yourself back into The Abyss.

There are many facets to anger and ways to process it to minimize its impact on your life. This little “5-3-2” strategy will get you started, and you’ll find it useful many times a day. Don’t let anger run your life – starting now.

The post Anger Simplified first appeared on Back in Control.

The post Anger Simplified appeared first on Back in Control.

• Invasion of your boundaries
  • Boss
  • Bully
  • Spouse
• Inability to meet your basic physical needs
  • Food
  • Water
  • Air
  • Sex
  • Freedom from pain
• Inability to meet your basic psychological needs
  • Nurture and love
  • Protection
  • Be heard
  • Control of anxiety

There is a genealogy of anger:

• Circumstance – perceived or real
• Blame
• Victim
• Anger

It doesn’t matter whether the situation is a physical or mental threat, your body’s chemical stress response is similar. There is a surge of fight or flight hormones that enhances your chances of survival.

While anxiety represents feelings of helplessness, anger is a powerful feeling that covers up the sensation of anxiety. It is the most powerful role that a human can experience. Anger results in action that can help regain control—whether the actions are admirable or not is a different discussion.  Even if it isn’t possible to regain control, anger allows you to feel like you are in control. (you can’t control your thoughts) Anger is nearly impossible to give up. Nor should you give it up. It is a survival reaction. By being aware of and understanding how powerful and potentially destructive it can be, you be able to separate from it. Then you’ll be able to let go and move forward to experience a full, rich, and productive life.

For more on anger and control, see:

• A Tale of Two Golf Holes
• Completely Trapped

Listen to the Back in Control Radio podcast The Impact of Litigation on Your Pain.

The post Anger = Loss of Control first appeared on Back in Control.

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In this way, a treacherous cycle forms. You experience chronic pain in addition to the rest of your life stresses. The pain produces anxiety because you don’t know where it’s coming from and you don’t get adequate answers from your doctor. Over time, you become angry about the pain, the lack of answers, dashed hopes, and your loss of control.  As your nervous system gets more and more fired up, your pain increases and feeds back into the cycle.

Anger is an understandable response to chronic pain. In my experience, the more legitimate your anger, the harder it is to let go. You may find yourself angry for some or all of the following reasons:

• You cannot escape the pain—you feel like a victim.
• You cannot engage in many recreational activities.
• You may not even be able to handle the normal activities of daily life.
• If you are on disability leave–your employer, workers’ compensation board, disability insurance companies and others who want you to get back to work may harass you.
• The medical system has no answer to why you’re in pain, nor is it offering any direction for the future.
• Your relationships suffer because you are irritable; instead of being an energy source for your family, you are a drain.

How can you not be angry? But anger, no matter how legitimate, will destroy you and your quality of life.

The post Anger first appeared on Back in Control.

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