The worst part of my ordeal was the mental pain and being bombarded with unpleasant and intrusive thoughts. It was the most disturbing aspect of it all and the more I did battle with them, the more intense they became. I had already slipped into an “internal OCD” (obsessive compulsive disorder) five years earlier. It  manifested with repetitive disturbing thoughts that I countered with positive thoughts. Internal OCD does not have external characteristics such as hand washing and counting.

I had begun the expressive writing about six months earlier with a lot of success. My anxiety and other physical symptoms had diminished but I was still struggling on many fronts.

“I am a victim”

On Mother’s Day of 2002, I suddenly realized what being a victim entailed and saw that I was deeply enmeshed inthat role. Up to that point, I had no idea that I was even angry. I was just “right” and “frustrated.” But since I had so many legitimate reasons for feeling this way, I never considered myself as angry. In fact, my concept was that I had dealt with anger and had moved on. Nothing could have been further from the truth.

I felt a deep shift and over the next six weeks, more of my physical symptoms began to resolve, with the most unexpected one being that the ringing in my ears (tinnitus) decreased dramatically. After 25 years of dealing with it, I had assumed that it was a permanent symptom. However, many of the disturbing thoughts persisted and were interfering with my capacity to enjoy my life. I felt stuck.

The circus mirrors

One day, I suddenly had an image of myself standing in front of the kind of reflecting mirrors that you see in the circus. I was staring at repeating versions of  myself, going into infinity. I could see the battle playing out in my brain – a disruptive thought followed by a  counterthought – without an end. This had been playing out in me for years. I realized that there was nothing I could do and I “gave up.” I had reached a point where I had to let go. I truly became deeply discouraged yet at the same time, this realization was accompanied by a deep physical feeling of release. I was perplexed.

I continued to use all the tools of writing, mindfulness, forgiveness, etc. But with my new outlook, I began to move forward with my life and within six months most of my physical and mental symptoms (Including the obsessive thoughts) had dramatically abated. I didn’t realize it at the time, but it turned out that letting go and moving on was the definitive answer. This was well before I understood the concepts of neuroplasticity. Your brain develops whereveryou place your attention and I had been reinforcing the problem by trying to fix it.

Take a break

My patients and I frequently discuss the idea of taking a break from The DOC Journey. They have been diligent in reading, writing, not discussing their pain or medical care, meditating, processing anger, and even working hard at play. But they continued to be frustrated because, even though their pain had diminished, their anxiety levels remained too high, upsetting thoughts continued to bombard them, and they still didn’t have the quality of life that would allow them to thrive.

Perfectionism came into play in that he or she wanted to be the best student and really do it right. But the harder they worked at it, their neurologic energy was still directed at themselves. Inadvertently, by stimulating neuroplastic changes towards the problem, they were reinforcing these unpleasant neurological circuits.

Remember that the victim role (including perfectionism) is so powerful, you will never want to give it up – even afteryou have felt how free you can be. It is too strong of a survival need. The  decision to let go of the victim role is a day-by-day decision, sometimes a minute-by-minute one. Being triggered is inherent to being alive, and you have to decide if and when you want to let go, and when you are ready, just do it. I have not found an alternative and logic doesn’t work. I call it, “flipping the switch.”

Bill

Occasionally, at the end of an office visit, I asked my patient to sit in the exam room and not leave until they committed to “letting go” of the victim role. They may have sat for 10-20 minutes before they left. Walking out the door was symbolic of them stepping into their new life. It was surprising how effective that simple action could be.

Bill was a middle-aged, small-business owner who had been in chronic pain for over twenty years. He had done quite well with the DOC principles, along with the help of one my colleagues. One day Bill was triggered by one of his business partners and fell deeply back into the Abyss of pain and despair, to a depth he had not experienced before. He was becoming suicidal. Unfortunately for me—but fortunately for others— through my own experience, I gained extensive insights into suicide and realized that anger is what pounds your soul into the ground. Bill was in an extreme victim mode. I called him out on it during an extremely intense conversation. Although it was nerve wracking for both of us,  it clicked. He sat in the exam room for about half an hour.  When I saw him back a few months later, he was achanged man and re-entering the workforce.

A friend sent me this poem:

“She Just Let Go”

She let go. Without a thought or a word, she let go.

She let go of the fear. She let go of the judgments.

She let go of the confluence of opinions swarming around her head

She let go of the committee of indecision within her.

She let go of all the “right” reasons. Wholly and completely, without hesitation or worry,

She just let go.

She didn’t ask anyone for advice.

She didn’t read a book on how to let go….

She didn’t search the scriptures.

She just let go.

She let go of all of the memories that held her back.

She let go of all the anxiety that kept her from moving forward.

She let go of the planning and all of the calculations about how to do it just right.

She didn’t promise to let go.

She didn’t journal about it.

She didn’t write the projected date in her day timer.

She made no public announcement and put no ad in the paper.

She didn’t check the weather report or read her daily horoscope.

She just let go.

She didn’t analyze whether she should let go.

She didn’t call her friends to discuss the matter.

She didn’t do a five-step Spiritual Mind Treatment.

She didn’t call the prayer line.

She didn’t utter one word.

She just let go.

No one was around when it happened.

There was no applause or congratulations.

No one thanked her or praised her.

No one noticed a thing.

Like a leaf falling from a tree,

She just let go.

There was no effort. There was no struggle.

It wasn’tgood, and it wasn’t bad.

It was what it was, and it is just that.

In the space of letting go, she let it all be.

A small smile came over her face.

A light breeze blew through her.

And the sun and the moon shone forevermore.

–Rev. Safire Rose

This poem “She Just Let Go” by Reverend Safire Rose beautifully conveys the essence of The DOC Journey. Letting go is the simplest and simultaneously the most difficult aspect of the healing process. Our anger is powerful and often legitimate. We are accustomed to fixing others and ourselves, but our attention is still on our flaws and those of others. Too much attention to shortcomings inadvertently strengthens our unpleasant neurological circuits.

The DOC Journey provides guidance and tools to get to a place where you are able to let go. The freedom you will experience is remarkable. For me, it was unlike anything I had ever experienced in my life. Watching people enter this realm is inspiring and is a major factor in motivating me to keep me moving forward with this project.

Reconnecting with Your True Self

On Saturday, November 6th, Dr. Les Aria, a friend of mine, and I are holding a workshop that is being hosted through The Open Center in New York. We will be discussing both the process of letting go using specific strategies to connect to the best part of who you are. The intention is for you to leave with a clear concept of the power of the unconscious survival mind, how to develop a “working relationship” with it, and move forward into the life you desire. Click this link to take a look at the course and register.

The post “She Just Let Go” first appeared on Back in Control.

The post “She Just Let Go” appeared first on Back in Control.

Acknowledging the extreme complexity of this topic, I have three basic observations. One is that anger is powerful and addicting. It does serve an important purpose in that it keeps you safe. There are few, if any rewards from a survival viewpoint, for being vulnerable. The second reason people can’t let go of their anger is that they have not learned to be vulnerable. It is an intolerable feeling and why would you want to experience it? Because it is also the essence of relationships and being human. What a dilemma!!

The final reason is that people are not connected to their anger. They have dissociated from it and can’t feel or see it. It manifests in multiple ways. However, just because you are not aware of them doesn’t mean that they are hidden from those who are close to you.

Processing anger overview

I have changed my thinking and have observed that you can’t just jump to forgiveness from anger without understanding and addressing all aspects of it. I now use the term, “processing anger” and there are three categories of interventions to accomplish it. Keep in mind that anger is a necessary and powerful force to stay alive. Instead of fighting, suppressing, or trying to get rid of it, a better concept might be, “developing a working relationship with it.

This process is an ongoing learned skill with much overlap.

• Output – Lowering inflammatory markers and elevated metabolism (body burning fuel) is a necessary starting point. Sustained elevations cause illness, chronic diseases, and early death. Your brain is also “off-line” because it is inflamed and blood supply is diverted from the thinking centers.
• The nervous system–If the nervous system is hyperactive for any reason, it will consistently overstimulate every aspect of your survival response.
• Input–Anger is always linked to an event in the past that either gets replayed in the present or is continually interfering with your current reality. Forgiveness simply breaks that link. It does not get rid of it. That is why forgiveness is such a dynamic ongoing skill that you use multiple times every day.

Why this sequence?

Addressing the output first is critical for several reasons. Your brain is affected by inflammation. The supporting cells of your neurons, called glial cells, throw off inflammatory proteins call “inflammatory cytokines” and your brain is sensitized. The danger signals to your brain are magnified and you’ll experience more pain. The blood flow to your neocortex (human thinking regions of the brain) is also compromised and it is impossible to think as clearly. The only intention in this state is your own survival and not the needs of those around you (unless it serves you). So, the first step is to use methods that directly lower this response by stimulating your autonomic nervous system (via the vagus nerve) to secrete anti-inflammatory calming cytokines, so you can learn and implement these new strategies.

Addressing the status of your nervous system is the next important phase. If you were raised in a chaotic or abusive family that was devoid of safety and deep nurturing, you won’t have much capacity to nurture and care for yourself, much less allow yourself to feel vulnerable (anxious). This is also a learned process that you will allow to happen over your lifetime. One of the paradoxes is that you can’t force it. That would be the antithesis of vulnerability.

Finally, forgiveness is a multi-dimensional process that changes the input into your brain so there is less intensity being sent to your brain and there will be a calmer output in the form of anti-inflammatory cytokines and safety hormones. It is actually a selfish act in that you are making a powerful move to take back the present moment. You are breaking the neurological links to the unpleasant aspects of your past.

Addressing the three aspects

Output

• Breath work
• Calming music
• Mindfulness/ meditation
• Medical hypnosis/ biofeedback

These are  autonomic nervous system interventions that directly stimulate the parasympathetic nervous system (calming). It may take a few weeks to learn and consistently implement them before you begin to feel less anxious and agitated. There are many layers of these tools. It has been a better starting point than trying to jump straight to forgiveness. You can only do what you can do when you can do it.

The state of your nervous system.

This is a critical piece of the big picture. Your central nervous system is processing over 20 millions bits of information per second and directing your behavior in ways to keep you safe and functional. Most of this occurs at an unconscious level. It is programmed to recognize danger that you learned from past experiences. Anytime you are anxious or angry, something in the present is connected to an unpleasant learning experience from your past. Understanding the nature and source of these “triggers” is important and then retraining your brain to choose different reactions when you really are not in danger.

Your immediate environment also dictates your state of alertness. Lack of sleep, poor nutrition (inflammatory), little physical exercise, troubled relationships also are factors affecting your perception and processing of pain. Each and all of them make a difference.

Input

What you choose to put into and keep in your brain is up to you. You can decide to continue to complain about your pain and troubles. Any time you are complaining, you are now the victim of that person or situation. Or you can be critical of almost everyone, anything, including the news and yourself. How does any of this help calm your nervous system? This does become challenging in that most things we are upset about are valid–but you are the one who gets to suffer.

Forgiveness is another layer of decision-making that dramatically alters the input. It is the method where your links to the past can be broken so that your prior life experiences quit ruining your day (life).There are many aspects to it. It is a complex, but learnable skill. You cannot do it intellectually. It is too powerful. The goal is to understand and implement this set of tools to the point it all becomes almost automatic. The groundwork of diminishing the output and increasing the resilience of your nervous system are first steps and productively dealing with unpleasant input will launch you into a new reality. Processing anger really is the “Continental Divide” for healing your pain.

The post Three Aspects of Processing Anger first appeared on Back in Control.

The post Three Aspects of Processing Anger appeared first on Back in Control.

Awareness

You cannot successfully address any problem without understanding its root cause. But many people in pain stubbornly insist that, “The problem is that I am in pain,” and leave the solution to their health professionals. Unfortunately, the neuroscience research has not worked its way into mainstream care and they don’t understand the problem either. A recent paper that reviewed hundreds of studies stated that “chronic pain is a maladaptive neuropathological disease state.” (1,2,3) You cannot successfully solve a neurological problem with interventions aimed at structural issues. It is just not possible. This approach can’t and doesn’t work. That is why over 1 in 3 American adults are suffering from some level of chronic pain.

The body processes both emotional pain and physical pain by responding with stress hormones? Both kinds of pain are successfully treatable using similar strategies? Given a choice most of my patients would like to eliminate their emotional over their physical pain. Paradoxically, as the emotional pain drops, so does the physical pain. It doesn’t work the other way around.

My friend, Fred Luskin, author of Forgive for Good, pointed out that the human body is designed for survival, not necessarily for quality of life. All stress–real or imagined–is perceived as a threat and triggers your body to secrete adrenaline and cortisol. If you are under constant stress you may not even notice it, but your body will continue to secrete these chemicals that keep you in a continual “fight or flight” mode. You may be so used to being in this state, that it seems normal. The first step in healing is to become aware of your state of mind, life outlook and the effect they have on your body’s chemical balance. You have to understand your current state of being before you can change direction.

Hope

Hope is a critical component for thriving and living a meaningful life.

The observation and experience of core group of physicians and some other health care professionals is that of chronic pain is solvable. However, most physicians view it as a diagnosis to be managed. They simply haven’t been trained in utilizing an effective approach. They are almost as frustrated as their patients because they went into medicine to help people. Most of my patients have been to many providers and undergone multiple treatments without success. Additionally, since no one has provided them a plan should the treatment fail, there does not seem to be any way out.  They feel trapped. The indescribable anger and frustration really crank up their stress chemical output, which increases the pain. How many times can you experience that kind of disappointment and still keep moving forward?

Dr. Viktor Frankl, author of Man’s Search for Meaning, was an Austrian psychiatrist who survived the WWII concentration camps. In his book, Dr. Frankl described how the worst part of the ordeal was not the indescribable physical suffering, but not knowing when if and when it was going to end.

Every week I see huge smiles on the faces of patients who are now pain free after years, sometimes decades, of pain. They cannot express their feeling in words, and I feel privileged that I have been able to provide a framework for them to pull themselves out of the hole. It began with awareness and hope.

Forgiveness

You will not heal while you hold on to anger, no matter how justified your anger might be. In fact, the more legitimate your anger, the harder it is to let it go. How can you move forward while hanging on tightly to the past? There are many resources out there to help you process your anger, and Stage 2 of this website is a solid starting point. The method does not matter as long as it enables you to truly let go. Remember, that to stimulate your brain to develop new pain-free pathways you have to move forward with or without your pain. I highly recommend Dr. Luskin’s book, Forgive for Good. When it entered the DOC program, I began to see many more patients free themselves from their pain. I consider acknowledging and processing anger the “Continental Divide” of chronic pain.

Several studies have shown that the vast majority of people in chronic pain still blame the person or situation that caused their injury. Interestingly, the person they blame the most is themselves. (4) When patients tell me they are not angry I often will ask them how critical they are of themselves. The most important person to let off of the hook is you. Knowing how anger obstructs healing and creates more pain, why do you insist on holding on to it? Is it really worth it?

Pain free after suffering for decades

Iris became pain free after decades of severe chronic pain. She had been on high-dose narcotics and using a walker. Now she is off her meds and walking unassisted.  She wrote me, “The book you have written has saved my life. It is so much more than a book on back pain; it is back in control of my sanity, my depression, my self-worth, and my caring. I had no idea that anger was behind my anxiety and depression.” I have never met her but was able to talk to her a few months later. The key to her healing was awareness and letting go.

Play

Anger and play could not be farther apart. Anger disconnects us from others, from ourselves and from life; while sharing play is the essence of life.

Play is an essential aspect of child development. It is how we learn to constructively interact with others. Play areas of the brain are powerful and permanent circuits present in every human being; but they can get buried in the hubbub of daily life and the distraction of chronic pain. They’re present even in someone who did not develop an overabundance of them in childhood. But although play exists in all of us, they must be nurtured by making conscious choices to play. You do not need to continue to live your life in anger.

About ten years ago, I made a conscious decision to re-inhabit my play pathways when I chose to enjoy my day regardless of the circumstances. I am not always successful; but I committed to re-engaging with these circuits as quickly as possible when I wandered off course. Eventually, the labels “work” and “play” have merged into one. Play for me is curiosity, gratitude, awareness, letting go and simply deciding to enjoy and appreciate what I am doing at the moment.

Three of the principle methods for eliminating chronic pain are: 1) “de-adrenalizing” the nervous system, which slows the speed of nerve conduction and decreases the level of pain; 2) building new circuits that circumvent the embedded pain ones; and 3) shifting to new and more functional areas of my brain.  Play does all of this.

Omega Workshop

I didn’t realize how powerful play pathways were until a five-day workshop I facilitated at the Omega Institute in Rhinebeck, New York. Fred Luskin worked with us during the forgiveness portion, and my wife and daughter helped us play together. Feeling safe and relaxed, we began to laugh. Many attendees went pain free within five days and have remained that way. Even I did not expect such a powerful outcome. The Cup Song

My book presents a robust framework to help you organize your thinking about pain. Using awareness, hope, forgiveness and play will allow you to discover your own way out. Give it a go. Those of us physicians who use some version of this approach feel strongly that the majority of our patients will significantly improve or free themselves from the grip of pain.

1. Davis KD and M Moayedi. “Central mechanisms of pain revealed through functional and structural MRI.” Journal of Neuroimmune Pharmacology (2013); 8: 518–534.

2. Baliki MN and A Vania Apkarian. “Nociception, pain, negative moods, and behavior selection.” Neuron (2015); 87: 474-491.

3. Tracey I and MC Bushnell. “How neuroimaging studies have challenged us to rethink: Is chronic pain a disease?” The Journal of Pain (2009); 10, 1113–1120.

4. Eccleston C, et al. “Patients’ and professionals’ understandings of the causes of chronic pain: blame, responsibility and identity protection.” Social Science & Medicine (1997); 45: 699–709.

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The post Awareness, Hope, Forgiveness and Play first appeared on Back in Control.

The post Awareness, Hope, Forgiveness and Play appeared first on Back in Control.