Awareness is the essence of healing in that you cannot stimulate your brain to develop in a given direction, unless you know where you are starting from. Awareness is both a tool and foundation for moving forward with your life. There are four patterns of awareness that work for me.

Environmental awareness is placing your attention on a single sensation – taste, touch, sound, temperature, etc. What you are doing is switching sensory input from racing thoughts to another sensation. This is the basis of mindfulness – fully experiencing what you are doing in the moment.

I use an abbreviated version that I call “active meditation,” which is placing my attention on a specific sensory input for 5 to 10 seconds. It is simple and can be done multiple times per day.

Emotional awareness is more challenging. It often works for a while, but then it doesn’t. When you are suppressing feelings of anxiety, your body’s chemistry is still off and full of stress hormones. This translates into physical symptoms.

Allowing yourself to feel all of your emotions is the first step in healing because you can’t change what you can’t feel. Everyone that is alive has anxiety. It is how we survive.

Judgment is a major contributor to creating mental chaos in our lives. Dr. David Burns in his book Feeling Good outlines 10 cognitive distortions that are a core part of our upbringing. Some of them include:

• Labeling yourself or others
• “Should” thinking – the essence of perfectionism
• Focusing on the negative
• Minimizing the positive
• Catastrophizing
• Emotional reasoning

Becoming aware of these errors in thinking allows you to substitute more rational thought patterns.

Ingrained attitudes and thought patterns are problematic. By definition, you cannot see them without actively seeking them out.

Our family interactions in childhood are at the root of how we act as adults. The behaviors we develop over a lifetime of exposure to our environment are what I call ingrained patterns. They stem from our upbringing and the fact that our brain is somewhat “hard-wired” during our formative years. We now know from recent neuroscience research that concepts and attitudes are embedded in our brains as concretely as our perception of a chair or table. I used to say that thoughts are real because they cause neurochemical responses in your body. But they are not reality. I was wrong.

It turns out that your thoughts and ideals are your version of reality. Your current life outlook continues to evolve along your early programming or your “filter.” It is why we become so attached to our politics, religion, belief systems, etc. It is also the reason that humans treat each other so badly based on labels. One example, amongst an endless list, was how we locked up “communists” during the McCarthy era of the 1950’s and 1960’s. It is why so many minority groups are persecuted, but they also often treat each other badly.

It is critical to understand that these are attitudes and behaviors that you cannot see because they are inherent to who you are. It is also maybe the greatest obstacle to people getting along. We are hard-wired enough that we don’t recognize or “feel” these patterns; it’s just what we do. It’s behavior that sits under many layers of defenses and has to be “dug out” by each person. Our family-influenced habits and actions are much more obvious to our spouses and immediate family than they are to us; we can only get in touch with them through counseling, seminars, psychotherapy, self-reflection, spousal feedback, etc. What you are not aware of can and will control you.

Awareness in the operating room

Here is one example from the performance arena while at work. (My wife could give you dozens in the personal arena.) A few years ago, in the operating room I became aware that I consistently started to speed up towards the end of each case. I also realized that over the years, probably 80% of my dural tears (the envelope of tissue containing the neural elements and cerebrospinal fluid) had occurred in the last thirty minutes of a long case. The fatigue factor is an issue, but the speed issue is more critical. I still often didn’t notice that I was speeding up; I needed feedback from my partners or assistants, so I asked them to act as my “coaches.” I’d stop for a few seconds and say, “The difficult part of this case is done. It would be easy for me to relax and hurry to finish. Please speak up if you see me starting to rush.” Every move in spine surgery is critical, so I had to make the choice to consciously slow down. The end of a case is just as important as the beginning and middle. My complication rate dropped dramatically.

This is a brief overview of how awareness plays a role in successfully navigating daily life. It’s something of a paradox in that when one is truly immersed in the moment there are no levels of awareness. It’s just complete “engagement-in-the-present-moment” awareness. There’s many layers to this discussion, but I hope this is a good starting point. Life does become much more interesting.

The post Awareness–Ingrained Patterns first appeared on Back in Control.

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So, when the patient’s partner is snippy, critical, or hostile, the patient tends to feel worse, too. The region of the brain that elicits a bad mood simply is stimulated. Conversely, if one partner is in a great mood, the other tends to be happier.

That is why—indirectly for my patients’ sake and directly for that of their partners—I believe it is vital that both partners learn tools such as expressive writing and adding more play into their lives, that enable them to live a joyful life.

Where is the support?

However, there may be an additional issue beneath the surface because it is remarkably difficult to convince other members of the household to engage in these tools. If you care for your family member, why would you not try to do as much as possible to help him or her heal? I ran across this article that partially explains why. Family members may not believe that a patient really is experiencing that much pain. It may be more common than I believed. Therefore, their compassion may understandably be limited.

Couple’s study

A multi-center published in 2013 (1) measured the following variables in 105 couples over two weeks:

• Patient’s pain
• Spouse’s observations of patient’s pain behaviors such as complaining, grimacing or grabbling.
• The patient’s perceived criticism or hostility from his or her partner

The following observations were made:

• Patient’s pain increased for over three hours when they felt hostility or were criticized.
• Patient’s observed pain behavior consistently created a negative reaction from their partner.
• These interactions were consistent. The assumption was that long-term low level negative interactions will erode relationships and quality of life.

This interaction is similar to what has been found in depression research. Depressed patients act in ways that cause rejection from others, which in turn exacerbates the depression.

There is no question that chronic pain is a family issue. The couples study does not even take into account the damage an angry person in chronic pain can inflict on his close relationships. The family unit can become a living hell and it can seem like a hopeless situation. But, like the patient’s condition, the family dynamic can get better, with the right tools. It did with me.

Pain = anger= abuse

Feeling Good Together

David Burns, MD is a Stanford psychiatrist and the author of Feeling Good. I attended his five-day seminar a few years ago where advanced Cognitive Behavioral Therapy (CBT) techniques were presented. One afternoon was devoted to relationships. He had been given a large advance to write a similar book applying (CBT) to relationships. He then used these techniques on 50 couples without any success. He returned the advance and went on a five-year quest to find out what was really going on. Subsequently, he wrote a second remarkable book called Feeling Good Together. One stunning insight from this book that hit me hard was that, when your partner acts in a way that upsets you, of course you want to blame him or her; but you are the one who set it up. It was your actions that caused your partner to react in a way that made you angry.

That insight had a major impact on my awareness of my own behavior—not just toward my wife, but in my relationships with everyone. However, I found it to be by far the hardest part of my journey. Whenever I feel upset as a result of something my spouse says or does, it still feels like it is she, not I, who caused the upset. It has taken me years to consider the effect my words and behavior have on others’ feelings. I still have a long way to go. It is unbelievably humbling.

Protect your family from your pain

The Marriage-go-round

How do you break the cycle of pain behavior, criticism from your partner, and more pain? Let’s face it: You have the choice whether to engage in pain behavior or not. At some level you must know that your partner is going to react negatively to it, but you do it anyway. When you feel the hostility and criticism from your partner, your pain increases. This is expected, since we know that stress chemicals increase the speed of nerve conduction, resulting in more pain. (2) Since there is seemingly no end to the pain, the cycle can continue for a long time. You’re already mad at your partner; why not continue to be irritating?

If endless conflict is damaging your whole family, consider it an opportunity to work through the solution together and come out stronger than ever before. The solution for chronic pain is not difficult once you understand the nature of the problem. It turns out—and I say this from experience—that anxiety and anger are the pain. Use the DOC tools to help you, your partner, and other family members to live a life you all cherish.

Listen to the Back in Control Radio podcast The Chronic Pain Marriage Go Round

1. Burns, JW, et al. Temporal associations between spouse criticism/ hostility and pain among patients with chronic pain: A within-couple daily diary study. Pain (2103); 154: 2715-2721.
2. Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166-173

The post The Chronic Pain Marriage-Go-Round first appeared on Back in Control.

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Behavioral patterns laid into your nervous system are the essence of your life view. Until you become aware of them and their effect on your day-to-day life you cannot connect with the core of you really are. Being around your family usually will precipitate a massive resurgence of these patterns. BTW, any time you are anxious or angry you are in a patterned behavior.

As these family patterns are so familiar it is very anxiety-producing to change or even think about changing them. Your family feels the same way. All parties involved have a vested interest in having you remain unchanged – regardless of how miserable you might be. “Misery loves company” is not a joke.

Paraplegic

I had a patient who became paraplegic after spine surgery at an outside institution. He had multiple medical problems associated with his paraplegia in addition to suffering chronic pain in his back and legs. Working through the phases of the DOC project had resulted in a significant decrease in pain. Unexpectedly, his bipolar disorder of over 40 years disappeared and he was able to discontinue his medications. The key was addressing his deep anger.  The transformation was dramatic. He felt happier in a wheelchair than when he was bipolar and walking.

“I don’t want to see you”

I had been seeing him monthly for several years. We had entered the goal-setting phase of his rehab. He was interested in interacting with other wheelchair-bound people to help them cope with their disability. He purchased a laptop computer and started pursuing his dream. Then he called my assistant and told us that he was not going to be seeing me anymore. My first response was to wonder what I had done to upset him. He had truly been an inspirational person. I gave him a call to ask why he no longer wanted to see me.

Thanksgiving

What happened was that his family from the East joined him for Thanksgiving. Instead of being excited and supportive of his transformation, they destroyed him. They told him that there was no use in reaching out to other paraplegics. They also bluntly reminded him that he had been diagnosed with a bipolar disorder since he was 12 years old and that the disorder is incurable. Finally, the family instructed him to stop seeing me.

The family environment that contributed to him becoming bipolar was now focused on keeping him that way. His deep changes were upsetting to his family because there was a major redefinition of roles taking place. He had been the sick one. If he could create this depth of insight and healing, why couldn’t they do the same? When he was in his own familiar patterns, which were based on anger, he could not see his anger or theirs. He saw it as clear as day. He had not been chronically angry for over a year and was moving forward quickly. To now see the people you love live in anger was extremely distressing.

Family Patterns

Family patterns are passed down from generation to generation.  From birth to age 12, your family environment is “downloaded” into your brain. It is your database for the rest of your life and also your frame of reference. What are your patterns?  Are you being held back by your own patterns that you cannot recognize?  Are you unconsciously making sure that the people close to you maintain a certain familiarity, even though it may be destructive?  Do you have control issues?  Do you feel controlled?  (For more on this, you might want to check out My Interpretation of Hoffman.)

Wake up. Your life will not improve until you become aware of your behavioral patterns and the impact they have on those around you.  If you are chronically angry, you cannot see anything clearly.

I had a great discussion with him and he continued to see me for about six months. The phase of breaking free of his family patterns was challenging. In order to break free, he had to first recognize that he was trapped. He was undertaking a significant step, one that I’ve talked about before in “ Anger: The Continental Divide.”

Personally, I had never understood how strongly these family patterns could hold you down.  I thought his family would have been ecstatic. He was happy for the first time in his life. His family was not. The crab bucket

Back into the abyss

I am rewriting this story after about a year. For about six months his mood and pain were great and rehab was moving forward. The anger returned for reasons that are unclear. He was never completely the same after that Thanksgiving holiday. He did quit seeing me, his anger consumed him. His pain returned and his mood turned black. I don’t know all of the issues that pulled him back into the abyss but his family was a significant part of of it.

What effect is your family having on your journey? Are they your cheerleaders – or not?

Pain Rules the Roost

NH, BF

The post Breaking Loose – Not Quite first appeared on Back in Control.

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The initial download to your brain

There are many theories about how an infant and child acquire knowledge.  My thoughts are that your brain is an empty slate that is downloaded from the environment. During your first couple of years of life, you have no say in what is put into your nervous system. Around the time your consciousness emerges around three years of age, you have little awareness or skills to deal with the automatic responses to your environment. The term I learned from the Hoffman Process was “patterns.”  Anytime you are anxious or upset you are in a pattern because something in the present connected to something upsetting from the past. Until you become aware of your patterns programmed in by your family, you are at the mercy of them

These patterns play out as you move out into the world. You either adopt a given pattern or you reject it. The problem is that either way you are a reflection of your parent’s patterns and they are not you. You are not living connected to who you are – “your authentic self.”

Passing on of patterns

If one or both of your parents are disabled you might rebel and become a super-achiever or become disabled yourself. Either way you are not running the show. Your family patterns are. Of course your parents had similar experiences with their parents and so on. Until you become aware of the impact of your family’s programming on your nervous system you cannot live your life on your terms.

Did you graduate from high school with your dream to become disabled??

I am aware that the vast majority of people on disability hate being on it. You are under the control of a person (claims examiner) or system that is depersonalized and unresponsive. In addition to the frustration of being in pain you have also lost control of your life. However, the deep, familiar family patterning of being disabled may be an even stronger force.

Breaking Loose?

Additionally, if you decide to break loose (and it is doable), often some or all of your family will not let you. I used to think that family members would be ecstatic to watch a sibling or offspring become pain free. Many of them are, but many are not. First of all, you are challenging their paradigm of who you are. This is particularly true if you are dependent on that sibling or parent. You are challenging their role as a “caretaker”.  Second, as you get better it calls them out. You are doing and have done it – getting better. What about them? Why are they not pursuing the same path?

Triggers

Another huge problem is that your family is the deepest source of your “negative “triggers”. It was in this environment that your negative patterns were created and it is not possible to be around your family without these being set off on a regular basis. The eventual goal of the somatic work with the DOC project is to “de-engergize” them, but initially you often need to put distance between you and your family. Eventually you will be able to enjoy your family at a much deeper level.

The holidays

I was reminded of this problem in a very profound manner a couple of years ago. I had worked with a severely disabled gentleman who had a marked decrease in pain and improvement in his quality of life as he worked with the DOC project. Every holiday was a disaster as his family overtly reminded him that he was “not normal” nor ever would be. Finally about a year ago he caved in and descended back into his familiar anger patterns. His life is now more miserable than ever.

The crab bucket

I ran across a metaphor I am sharing with you from Wikipedia. Crab fishermen never need to put a lid on the bucket of crabs they have trapped. As soon as one tries to escape several other crabs will grab onto it and pull it back into the bucket.

Why be successful?

There have been multiple surveys showing that if a given person is successful that few others are truly happy for their victories. They become jealous and backbiting. How often are you excited by another person’s success, especially if they are a close friend? Why do we instinctively jump to the thought, “Why not me?” From elementary school on, being different or unique, either in a positive or negative way, is grounds for being bullied. Wouldn’t it be much more enjoyable and interesting to celebrate differences?

Breaking loose from your family and its patterns is one of the biggest obstacles on your road to a fulfilling and pain free life. What is your role in preventing others close to you from being successful?

The post Escaping Your Family – The Crab Bucket first appeared on Back in Control.

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