• Much of our identity or self-esteem revolves around the “stories” we create to make sense out of the world.
• Many if not most of our stories involve judgment and labeling, which are classic cognitive distortions. They are not real although they seem real.
• Once you become aware of both the nature of these stories and the damaging effects on the quality of your life, you will be able to let go and move on.
• Life is much easier and free when you shed them.

Another level of awareness involves judgment and storytelling. We are programmed from birth to be a certain way or not based on the opinions of our parents, siblings, teachers, peers, and society. Each input is processed by your brain to create your version of life and how to best live it. The problem is that we are living out these stories, but we are not necessarily connected to who we actually are. These judgments/ stories tend to be rough and inflexible self- criticisms. The brain will focus on the negative judgments that ramp up our emotions because that is what is supposed to do – be on the lookout for danger. What does all of this have to do with being in pain? It fires up our flight or fight response, is inflammatory, sensitizes our nervous system, and we feel more pain.

These “stories” we have about ourselves that we project onto the world is the way we create our egos or self-image. One term for this process is “self-esteem.” It is a deadly process that is a root cause of many bad behaviors. Humans are focused on not being vulnerable because it threatens survival. We also know that emotional pain is as or more disruptive to your well-being as physical pain. So, we spend a tremendous amount of energy on appearing powerful–both to ourselves and the world.

The problem is that it can’t and doesn’t work. The unconsciousness survival response which is the source for the sensation we call anxiety, is far more powerful than our conscious brain. The personal and societal consequences are severe. Our “identity” is defined by our mental constructs of ourselves, most of which is created by the perceptions and reactions of those close to us. This is even a bigger problem if you were raised in a chaotic or abusive environment. Instead of feeling safe and connected, you are constantly “on alert” and you also have to build your own identity (façade).

What is more convoluted is that your identity becomes dependent on being accepted and validated by others but it is more powerful to withhold approval or even bully someone that you perceive is weaker. This circular power struggle continues throughout life unless you understand and use the tools that will pull you out of this game.

“ANTS”

It  becomes even more complicated when you begin to understand how the human brain works and much, if not most of our self-esteem (or lack thereof) is based on cognitive distortions. Dr. David Burns, in his best-selling book, Feeling Good,¹ categorizes them into ten “errors of thinking.” He uses the term “ANTS” to describe them, which stands for “automatic negative thoughts.” Some of the categories are:

• Labeling
• “Should thinking”
• Minimizing the positive
• Emphasizing the negative – “Not good enough”
• Mind reading
• Catastrophizing

I highly recommend looking at his book to understand them and become aware how much space they occupy in your conscious brain.

For example, imagine someone at work walked by you and didn’t acknowledge you. You might think they’re upset with you about a situation that occurred the day before. The error in thinking in this case would be “mind reading.” You can’t read other people’s minds. It’s possible that the other person had just received some bad news and wasn’t engaging with anyone. But you don’t really know. Making assumptions consumes emotional energy.

Labeling

Then there is the error of labeling. For example, a frequently late spouse becomes “inconsiderate.” A forgetful teenager becomes “irresponsible.” In the act of labeling, especially negative labeling, you’re overlooking the details of a given set of circumstances and also someone’s good qualities. You have limited your capacity to enjoy interacting with them.

Then there are the labels we have for ourselves: you knock something over and call yourself “clumsy.” If a lover breaks up with you, then you’re “unlovable.”  Rehashing these critical self-judgments in our minds turns them into deeply embedded stories. Such stories are much harder to move on from than single judgments. Once a judgment sets into a story, you tend to lose perspective. Over time, faulty thinking becomes your version of reality.

Regardless of what sets these patterns of thinking off, they are a universal part of the human experience called consciousness. My cat doesn’t have this problem. This is true whether chronic pain is involved or not. With chronic pain you have the added frustration of the physical stimulus to keep these circuits really spinning.

Self-Perceived Flaws

To better understand the story concept, consider common situations where the brain focuses on a self-perceived flaw that is not physically painful. It might be your height, weight, the shape of your body, or even an individual body part. Or it might be some particular quality, such as a lack of intelligence, athletic skill, musical talent, etc.

Thinking about these flaws over and over snares you in a destructive cycle of spinning neural circuits. For example, many years ago I had a patient with neck pain who was absolutely convinced that he was “stupid.” His self-labeling wasn’t rational, as he was clearly a bright guy. I don’t know if his view of himself somehow triggered it, but he eventually developed a significant chronic burning sensation around his mouth.

Something similar often happens in the entertainment industry, where performers commonly focus only on their negative reviews. My wife, who is a tap dancer, has seen this in her profession for years. She pointed out to me that a performer might have 99 positive reviews but will fixate on the one that’s negative. It’s a common saying among entertainers that, “You’re only as good as your worst critic.”

ANT’s and Relationships

Another destructive phenomenon is focusing on a spouse or partner’s negative traits. The other person usually has innumerable positive qualities that are forgotten in the face of their “flaw.” Over time the “story” we tell ourselves can become so strong it can break apart an otherwise great relationship. If you realized that you were just projecting your own negative perception of yourself onto him or her, you might think twice about verbalizing your thoughts. You might as well talk into a bullhorn and broadcast, “This is what I think about me.”

What’s curious to me is why the human brain does not become equally fixated on positive traits. Reconsidering Wegner’s “white bears” experiment,² maybe it’s because we don’t suppress positive thoughts. As proven in his experiment, fixation goes hand in hand with suppression.

Let your ego go

You may be unaware how much of your identity is wrapped up in creating and reinforcing these stories about who you are. So, you may spend much of your time in an agitated state and not know why.

But awareness of these stories is what can dissolve them. These perceived thought distortions are just as damaging as real threats, but with awareness, you can separate from them, and then redirect your attention where you choose. You don’t have to “fix” them because they are not real (even though they seem that way). You can train your brain to let go and move past them.

Awareness is the starting point and as these stories about yourself and others drop way, you’ll begin to experience your life at a deeper and more interesting level.

Recap

Self-esteem is a disaster at every conceivable level as it not only separates you from others, but you also can’t even work your way back to finding out who they really are. And what about the effects on you. You are not connected to yourself. It requires a tremendous amount of mental energy to create and maintain your ego, and it just a collective opinion of what the world has programmed you to be.

You can’t fix this issue. It is at the core of human language and consciousness. But by becoming aware of the issues around this situation, they will lose their power, and you’ll be free.

Questions and considerations

1. Please look at one of several books by Dr. David Burns, where he presents these 10 categories of cognitive distortions. You may be surprised to discover how much of your self-esteem is made up from these stories.
2. It is one of the easiest problems to deal with in that since these are truly distortions there is nothing to do except to be aware of them, separate, and move on.
3. Consider how much of your day is consumed by racing thoughts you can’t control. Every minute in this state reinforces unp neurological circuits and you are moving the wrong direction.
4. Healing occurs as you focus your attention on where you want your life to go and what you want it to look like. But you have to first let go before you can move forward.

References

1. Burns, David. Feeling Good. Avon Books, 1999.
2. Wegener DM, et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.

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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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I personally used the book extensively for many years, and the three-column technique was a major factor in pulling me out of my free fall. In 1997, I realized that it was a tool I could use in my own practice, and I liked using it because it was so much faster than trying to get someone to see a pain psychologist. They could engage almost instantly and often aggressively. This book was the entire component of the stress management  for the DOC Project for many years. I originally told my patients that if they could obtain some stress management skills, they would cope with it better. I was surprised to see many patients report both a better quality of life and a significant decrease in pain. However, it was puzzling to me why some patients would respond so much better than others. It eventually became clear that the patients who did well were the ones who participated in the writing process. The results have been consistent. Patients who commit to a daily writing process, based on the suggestions in the book always have a significant response.

His book is a wonderful book, but I have them initially read only the first third of the book to get started in the “three-column technique.” He outlines ten “errors in thinking.” They cover the range of cognitive distortions. We all use them a lot, as that is how we were raised. Some of the categories he describes are:

• “Should” thinking
• Catastrophizing
• Labeling
• Minimizing the positive
• Emphasizing the negative
• Emotional reasoning

In the first column you write down your “ANT”.  That stands for “automatic negative thought. This step represents the first step of stimulating neuroplasticity, which is increasing the awareness of the disruptive thought.

Then you write down the “error in thinking” that the thought represents in the second column. As you categorize the thought and understand the effect it has on your peace of mind, it separates you from it.

In the third column you write down the more rational thought. The more specific you are the better. This is the phase of burning a new circuit.

For example, your son may have just flunked a test. Your first response might be, “He is lazy and stupid.” You would  write those thoughts down in the first column. In the second column you would note that represents “labeling”. In the third column you might write, “My son just flunked a test. I wonder why. Is he being bullied at school? Could he be depressed? I am going to try to find out what is going on.” Positive thinking would be represented by, “He isn’t lazy.  He is my son and I love him.” That might be it. Except, without writing the more specific rational response, your thoughts might start spinning around. By the time you actually talk to him, you might not be in a great frame of mind.

The technique is effective for most people and it certainly was for me. The key to keep in mind is that the writing is only a starting point in the healing journey.

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