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

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

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

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

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

Environmental Awareness

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

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

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

Active meditation in action

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

Setting up the day

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

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

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

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

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

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

The “to do” list

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

Recap

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

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

Questions and considerations

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

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

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

Good Times

It’s always a wonderful weekend and incredibly relaxing in that everything is right there. Good food, fireplace, hot tub, warm pool and a lot of bantering (that would be the mild term). We do revert back to middle school behavior (at best). My wife keeps asking me the question if guys ever grow up. I think the answer is obvious. It’s a great break for all of us.

We ski in smaller groups and we usually meet at a restaurant in the middle of the mountain called “Watsons” at 11:30, just before the lunch crowd arrives. I don’t ski quite as well as I used to and decided to come in a little early and relax. I purposely worked on enjoying the fantastic view of the valley and could not have been in a better state of mind. It was also one of the few times when I was well ahead of the curve with regards to saving enough seating for 18 people. The restaurant was almost empty.

I was sitting at the end of two tables that seated 12 and had placed my gear on a table for six just across the aisle. Four of my group appeared at 11:20 and sat down at the large table. My plan was working well, and I was having a great time. We were talking about the morning, which included skiing on fantastic snow. Suddenly I turned around and there were four boys between nine and eleven, who had pushed aside my gear on the other table and were sitting down.

Trouble

I pointed out to them that I had another six people arriving shortly and this table was saved. “Where are they? We’re here! You can’t save tables.” They were clearly veteran Alta skiers, but I had never heard of that rule at any ski resort in over my 50 years of skiing. I also didn’t see any signs that I couldn’t save a table. I was caught off guard and firmly restated my case. At that point four more of my “ buddies” sat down at the large table. There were also two older women immediately behind the boys and they started hissing, “Just give them the table.” As I continued my protest, one of the boys looked at me said, “We’ll give you five minutes.” I was getting more confused and flustered. I don’t remember that I would have talked to an adult in this manner when I was 10 years old. Usually skiers just walk on by, since saving a table for your group is the norm (so I thought).

Thrown under the bus

Then I asked my friend, Bill, to come over and sit down at the embattled table with me, since the larger table was continuing to fill up with members of my group. Instead of coming over and helping me out, he said, “Come on, why don’t you let them have it?” while looking directly at them. I was now well into looking like a “grouchy old man” and the women continued to hiss at me. I caved in, but I wasn’t happy. My tranquil meditative state had been severely compromised, and I was being thrown under the bus. My “friend” fist-bumped them and they said, “Thanks!”

Three minutes later, another seven people showed up and had no place to sit. This wasn’t going well, and my group thought all of this was hilarious. I wasn’t happy with them, the kids, the women or me. I really was upset, and it was just over a table. My friends know how much stress I deal with every week and were surprised how triggered I was over such a non-issue. Of course, the more frustrated I became, the harder they laughed – even though I was holding the space for them. I haven’t been that angry in a while. What the heck happened?

Gulliver

The image that jumped into my head was that of Gulliver being tied to the ground after being captured by Lilliputians. Gulliver’s Travels was written in 1726 by Jonathan Swift, and was a disguised commentary on world affairs, as well as on human nature. The book is divided into four sections. The first is about being captured by the Lilliputians, who were one twelfth his size. He was tied to the ground by hordes of them while he was sleeping. They wanted to seal the deal by blinding him. He had to navigate some tricky situations to eventually escape.

I was trapped by people a fraction of my size and age. My “adult” friends finished me off. The similarities to being pulled into the Abyss of chronic pain weren’t subtle. It’s always a combination of factors that pull you into the hole. They add up quickly and escape becomes essentially impossible. When I was pulled into the Abyss in 1990, I didn’t see it coming and it took me 13 years to come out of my tailspin. And it was by pure luck that I did. It took me years to figure out what had happened to me, and longer to learn how to share the concepts with my patients. A few of the variables that can trap you are:

• The source of pain is usually not able to be identified, so no one really believes you’re in pain.
• Although modern neuroscience research has revealed the answers to solving your chronic pain, mainstream medicine continues to ignore the data. Essentially every treatment in spine care that is covered by insurance has been shown to be ineffective. Proven effective treatments are usually not covered. We are pretending to practice medicine.
• Repeatedly having your hopes dashed is a reliable way of inducing a major depression, as demonstrated in animal studies.
• You are labeled and judged.

This list is only a hint of the multiple ways  you are trapped by mental or physical pain. You can’t see them coming and the adversities keep pummeling you from multiple directions. The worst aspect of it is that since there doesn’t appear to be any viable solutions offered to you, where is the endpoint? You eventually lose hope and retreat into an angry survival mode.

I felt trapped and any one of the variables alone would not have stopped me from holding onto my treasured table. I didn’t anticipate all the angles of the situation that took me down. A major one was my own sense of not looking good to the other parties or to me. I was a “grouchy old man.” I am still not sure, as I am writing this piece a couple of weeks later, that I’ve completely let it go…………

The post Trapped – I Know How Gulliver Must Have Felt first appeared on Back in Control.

The post Trapped – I Know How Gulliver Must Have Felt appeared first on Back in Control.

The essence of curing chronic pain is connecting to your own body’s capacity to heal. When you are trapped by any circumstance, especially chronic pain, first your anxiety escalates and then you become angry. Your body is full of stress chemicals and you’ll experience many physical symptoms. Once or twice a year we hold a retreat for people that have been suffering from chronic mental or physical pain.The intention of the workshop is for you to experience a weekend of sharing enjoyable experiences in a structured safe environment and relax. Relaxing is challenging in the context of suffering.

The faculty includes my wife, Babs Yohai, who is a professional tap dancer and movement artist, and my daughter Jasmine Yohai, who is an expressive arts therapist. The weekend begins Friday evening and ends Sunday at noon. We spend Sunday afternoon relaxing by the lake with many of the participants. The core concepts of the workshop are:

• Awareness – It is important to understand the nature of chronic pain and your relationship to it.
• Hope – We enjoy sharing many success stories – and some will be returning.
• Forgiveness – Processing anger is the tipping point of  becoming pain free.
• Play – Relaxation and play are the essence of what Babs and Jaz bring to the weekend.

Jasmine

Jaz has an unusual background in that she graduated as a dance major, has a Masters in psychology, spent extra time learning expressive arts therapy and is currently working for a non-profit organization in Oakland, CA housing homeless people. She is relaxed, although she’ll tell you that she often doesn’t feel as relaxed as she appears.  She exudes concern and compassion and loves to be of service in whatever capacity she can. Her role is putting us through different shared exercises that are calming, and she is excellent.

Babs

When I first asked Babs to be a part of the workshop in 2013, I was becoming aware of the power of play in addressing the power of pain. Chronic pain is a result of memorized neurological circuits in your brain. The more you try to fight and fix them, the stronger they will become because you’re paying too much neurological attention to them. One approach is to create alternative circuits by stimulating new connections in your brain – neuroplasticity. Learn another language Another is to shift back on to your play circuits, which is a more rapid and powerful strategy. Although, that may seem like a forgotten word to you after so much suffering, it is one of the basic foundations of the development of human consciousness. Play exists deeply in all of us even if we can’t consciously connect to it.

In addition to tap dance, Babs is accomplished in Tango, Salsa and Balinese mask dancing. She has a lot of depth in rhythm and movement. I asked her to be one of the faculty, as these types of practices can quickly reconnect and create new neurological circuits. She was apprehensive about her role but agreed to give it a try.

I wasn’t asking her to teach us to dance. I was interested in re-connecting the mind with the body through music and movement. She began with a simple song combined with stepping and clapping. Then she introduced The Cup Song. She and Jaz led us in learning a new language of rhythm, causing a shift from pain to play circuits. We began to relax and laugh.

The Cup Song

A shift in pain

My original concept of the workshop was that I had five days to give an intensive course in teaching the DOC concepts, and then people would learn to implement them at home more quickly than when learning in the office setting. What happened was completely unexpected in that many people experienced a shift their mood and the pain would drop – sometimes dramatically during the workshop. I think it happened for a couple of reasons.

First, it is common, almost the rule, that people in pain become socially isolated, which is a terrible way to live. In fact, research shows that the pain of social rejection shares similar brain circuits to that of physical pain.  One of my goals was to create a structured environment where the participants could be with others in a safe place and share enjoyable experiences. What I eventually realized was that my main function was to create and maintain the structure, and that people heal each other. By connecting to others, you are able to find your way back to you.

Secondly, “neurons that fire together, wire together” is a common phrase among neuroscientists. Anger, anxiety and pain circuits are tightly intertwined, and stress usually fires up the pain circuits. Shifting to the play area of the brain unlinks them and pain drops.

Third, anxiety is an indicator of elevated levels of adrenaline, cortisol and histamines. You are on high alert and one of the results is that these hormones increase the speed of nerve conduction and you’ll feel more pain. The weekend gives you a chance to feel again what it is like when your system is full of chemicals that are elevated when you are at play.

Omega 2019 

The workshop is now three instead of five days and we were surprised to see that it was equally as effective. It feels like the participants are more focused and dive in quickly. Much of the work is done in small  groups of four or five.

It was at Omega that we learned about the deadly effects of people discussing their pain with their family, friends and colleagues. One basic ground rule is to never discuss your pain or medical care with anyone or complain. Your brain will develop wherever you place its attention. Research even shows that belonging to a pain support group or keeping a pain diary is counter-productive. You might as well place your hand right into a large hornet’s nest. You are reinforcing the pain circuits, not moving away from them. I didn’t realize how much time people in pain spent discussing it or endlessly searching for a solution. It is completely understandable.

Although, many mindfulness-based pain programs have impressive results, it is unusual to experience such a shift within a couple of days. What has happened is that the group has tasted freedom from pain. They now have the knowledge and tools to get back to that spot. With practice, a high percent of participants can break free of chronic pain and re-create their life.

The Cup Song or the gym?

Here is an email from one of the participants who has made steady progress over the year after Omega. He had been experiencing quite severe back and leg pain for about five years:

Ah, the victim role, that is me seemingly all the time. All of David Burn’s (author of “Feeling Good”) cognitive distortions are helpful to recognize in myself, but victimhood is the reminder most useful for me. I fall into it so easily!

I had a bad evening with the lower back several days ago. Instead of my usual hour+ strengthening and stretching routine, I practiced The Cup Song for 45 minutes, and most of the tension in my back went away. I’m starting to synch the lyrics with the percussion! I’ll need to go back to Omega for The Natural Singer In You to work on my tone and pitch!

At no point during my career would I have ever anticipated play being a major healing modality.

Enjoy your day today

The post “The Cup Song” first appeared on Back in Control.

The post “The Cup Song” appeared first on Back in Control.