I went skiing for the first time when I was 14. Our family was not a ski family, but my father decided to take us on a ski vacation at Mammoth Mountain. The whole trip was somewhat of a disaster as we were so unprepared. I got to the mountain too late for ski school, so my brother, who had skied once said he would teach me. We ended up on an intermediate slope. In spite of his best non-efforts, I twisted my knee, tore one of the ligaments, and ended up in a long leg cast for eight weeks.

No choice

For those of you who have never skied, being on a slope that is above your skill level is not only frightening, but it can also border on terrifying. Most skiers have experienced this scenario at least once. But any situation in life where you are in above your head elicits a similar response. What makes skiing unique is that you have no choice. You must get down the hill by the end of the day.

You must also make it through life. Consider life as a major ski resort with many choices except one. When you check into the ticket window early every morning, instead of buying a ticket, you are assigned to ride one chairlift. You must ride it regardless of the difficulty of the run or your expertise. No one is going to help you down.

Ski runs

The difficulty of a run is rated by colors. The easiest slope is called the “magic carpet.” You stand with your skis on a moving belt and get off on a hill that is almost flat. Green circles are usually accessed by chairlifts and the runs are smooth and gentle for beginners.  A blue square indicates a somewhat steeper slope for intermediate skiers. Some runs have bumps called moguls. Black diamond runs are steep, usually ungroomed, and often have many moguls. Double black diamond runs are challenging even for high level skiers and dangerous for beginners. There are many warning signs saying, “experts only.”

Life

One problem we all face is that life is full of double black diamond runs. However, it is all relative. Anytime you are on a hill that is beyond your skill level, it is problematic. A beginner skier on an intermediate hill is not having a great time. Consider a beginner skier who has to navigate a double black diamond run. It is truly terrifying.

The core cause of all chronic mental and physical illness is sustained levels of stress. Stress can be defined as threat physiology or flight or fight. This state is necessary in order to keep you alive. The reason why chronic stress is so deadly is that you have no time to rest and regenerate. For example, the reason your heart can function for so long is that it rests between beats.

Dynamic Healing

There are three aspects of staying alive: 1) your input or stresses, 2) the nervous system which processes sensory input, 3) and the output, which is your body’s physiology. It can be in threat or safety. Sustained threat physiology is what creates mental and physical illnesses. It is the balance between your circumstances and coping mechanisms that determines your body’s chemical state. The essence of healing is decreasing your exposure to threat physiology and increasing time in safety. These are acquired skills.

They consist of processing input (stress) so it has less impact on your nervous system, calming the nervous system so as to be less reactive, and directly lowering your threat physiology. All three portals are accessed daily, and it requires repetition to make them automatic. Over time, you will be a “professional at living life.”

On the slopes

Taking this back to the ski resort metaphor, anytime you are in over your head, you will be in threat physiology. Your goal is to increase your skill level to the point where you have less of a chance of being on a hill that is frightening to you. Before you begin, you must have equipment that is safe and comfortable, including  being dressed according to the weather (too hot or too cold is a problem). Skiing requires strength, flexibility, and endurance, so conditioning is also important.

But the next step once your skis are on, is that you must learn to stop, regardless how steep the hill is. Even on a bunny hill, this is critical. On expert terrain, you must be able to set a firm edge. You cannot learn anything until you can stop. My wife endlessly reminds me that the first time I took her skiing, I neglected this detail, and she stopped by running into a building. It was a slow speed, so she wasn’t injured; but she wasn’t that happy.

Why do you ski? Why do you live?

Your desire is to enjoy your experience as much as possible. For example, if you are an intermediate skier on a blue slope, you can feel relaxed, work on skills, let the skis do the work, and have a great time. Isn’t that the reason you are skiing? But what if you are a blue skier on a black run or a green skier on a double black diamond run. It really is terrifying, and one experience will cause people to quit forever. But you have no choice. Life keeps coming at all of us and there is no end to the challenges. What are you going to do? You cannot stay on top of the hill all night. You don’t want to fall down a double black run at a high speed. It happens and people get hurt.

Then consider the scenario of an expert skier on an intermediate run well below his or skill level. Normally, it is an enjoyable experience. But today is 12 degrees, the wind is blowing about 20 mph, it is foggy, hard to see, and extremely icy. The expert skier must go into a defensive survival mode and might be OK. But it isn’t  much fun. What if you are green skier on a double-black diamond run in these conditions? It is beyond terrifying and also life threatening.

Good luck – or is it luck?

You cannot control most of the circumstances in your life, but you can develop skills to deal with them more effectively. Many more days will be enjoyable, and you also possess the confidence to deal with severe adversity. Your body frequently goes into threat physiology because it is protecting you. But you don’t have to stay there.

Few of us are taught the life skills of regulating our physiology (stress) and even fewer are taught to nurture joy. You might say, I don’t want to learn how to ski. I don’t like it. Good luck. You still have to check in at the ticket window and get your assignment for the day. We spend a lot of time learning many different skills but not much attention is spent on learning how to navigate life.

The post Downhill Skiing is Dangerous – So is Life first appeared on Back in Control.

The post Downhill Skiing is Dangerous – So is Life appeared first on Back in Control.

• Healing chronic illness happens by moving towards health not by “fixing” yourself.
• An analogy can be made to becoming a professional baseball player. The goal is to be “safe” as often as possible.
• Your skills to process adversity and nurture joy improve with focused repetition. Attempting to get rid of your mental and physical pain without specific tools is futile, frustrating, and counterproductive. Focusing on your problems only reinforces them.
• Healing is a dynamic daily process,  and you frequently make outs. That is life. Keep moving forward towards the life you desire.

“When is my anxiety and pain going to go away?” This is the wrong question. If you are monitoring your progress in terms of how you feel, your pain (mental and physical) is at the center of your life, and you are reinforcing survival circuits and reactions. The better question is, “how can I learn skills to feel safe?” It is while you are in safety that your body refuels, regenerates, and heals. Your focus must be on learning and practicing becoming a “professional at living life.” As you heal, many, if not most of your symptoms will improve or resolve. When they recur, which they always do, you possess skills to calm yourself and move on.

Major league baseball

Consider your life journey in the context of becoming a major league baseball player. You are the hitter and life is the pitcher. The pitcher is not your friend, and neither is life. Every living creature has to compete for resources to stay alive, much less thrive. Your goal is to get on base safely as often as you can.

Life throws us every type of pitch at any speed—fastball, curve, slider, sinker, and changeup. It may be delivered overhand, sidearm, or even underhand (submarine pitch). Don’t forget the knuckleball that is thrown without the ball having any spin. Although it is a slower pitch, it “floats” so much that it is unpredictable where it is going to end up. Major league catchers even have to wear an oversize catcher’s glove in order to be able to consistently catch it. Some pitchers “cheat” with spitballs, which increase the movement of the ball and are illegal. That a human ever hits a major league pitch borders on miraculous.

There are several ways to reach base safely. You might get on with a walk, an error, balk, dropped third strike by the catcher, base hit, or being hit by a pitch. It requires years of repetition to develop a disciplined eye for “your pitch”, have the patience to walk (especially with two strikes), have a reproducible consistent swing, and be in excellent physical and mental shape. Years of coaching and practice are required to make it to the majors.

The skill level ranges from knowing nothing about baseball, to playing T-ball (hitting a plastic ball off of a stand), little league, high school, college, minor leagues (A, AA, AAA levels) and finally the majors. A nickname for the highest level is the “circus”— not a subtle analogy to life.

Baseball is considered one of the more perverse and stressful sports. The “team” effort is a collection of individual efforts and collaboration.  This is in contrast to a sport, such as basketball or soccer where perfecting teamwork with passing, defense, and strategy is equally as critical. Mistakes in these other team sports and are less obvious and usually have less impact on the overall outcome. So, in baseball, heroic feats are highlighted but so are mistakes. One error or strikeout can cost the game or even a whole season. Life is even a higher stakes contest, and the smallest poor choice can alter your life’s trajectory.

Keep in mind that the best players make an out a high percentage of the time. Life keeps coming at us and sometimes we do well and often we don’t. That is not failure; it is just life. Most of us are not taught the basic skills of effectively navigating adversity, regulating our body’s chemistry, and nurturing joy. We are tossed into life doing the best we can to survive. Our examples of how to live are taught to us by our parents, teachers, peers, and society, who also did not learn effective self-regulating skills. It is no wonder that there is so much suffering and societal chaos.

Creating Safety

With regards to chronic mental and physical pain, we are generally focused on resolving symptoms. But that causes your brain to develop where you don’t want it to, instead of creating what you want (neuroplasticity). You must separate from what you don’t want and learn to “get on base,” by creating safety physiology. In this state, your body regenerates and heals. The more time you can spend in safety, the better.

The key to healing is developing your own set of strategies to live life skillfully. The approaches fall in two different arenas. One is efficiently processing adversity and the other is nurturing joy. Each person is unique and attains his or her own best skill set in each realm. If you are waiting for a medical provider, course, or book to fix you, how is that going to work?

Practice, practice, practice

Your skills will be limited in the beginning. You must attain a minimum level of expertise to play the game, including just learning the rules and strategies. Initially, you will make an out most of the time, but it is critical to always treat yourself with kindness, regardless of your result at the plate.

As you work your way through the system, starting with little league, high school, and then Single A ball to the Majors, you’ll begin to feel better. The good news with chronic illness is that it doesn’t require years as much as it requires repetition of the correct approaches for you. Each person progresses at his or her own speed.

Many people experience enough relief that they stop learning and practicing, even though he or she may just be entering the minor leagues with regards to their level of expertise. But once you are out of the “Abyss” and moving forward, you are just beginning your journey. Why would you stop? If you were aiming for the majors, why would you just drop out? You might feel that you don’t want to put in that much effort, or it is too much work. What is work is fighting anger, anxiety, and pain for the rest of your life. Even at the top level, professional athletes and performers utilize coaches. Why would you not want to attain the highest expertise for navigating your whole life?

“I don’t want any pain.”

One common trap in dealing with pain, is that people want it gone forever. If they heal and then relapse, they’ll become upset and self-critical. Even worse, they might blame someone for their troubles. Staying alive is a challenge and there will always be some level of pain every day. It may be minimal. Sometimes your stresses may be overwhelming, or your nervous system may be hyper-reactive, and you’ll go into threat physiology. But you’ll understand how to lower it quickly. Eventually, you’ll learn better ways to avoid it.

Recap

Focus your efforts on becoming a “professional at living life.” Your focus is on learning better skills instead of trying to get rid of your pain. As you come out of The Abyss, you’ll have more energy to learn even faster, and life becomes easier. Of course, you want less suffering, but you must focus on solutions instead of the problems. It is a never-ending but progressively more enjoyable journey.

Questions and considerations

1. Switching your focus from fixing to creating yourself is a huge paradigm shift. Like all creatures we react more to threats. Humans are a reactive species, and we often don’t respond until situations become crises.
2. Few of us understand the physiological basis of chronic illnesses. They arise from the body malfunctioning and healing happens as it returns to normal function. What about learning to maximally optimize it?
3. Baseball is just one example of a performance. Consider one that you relate to more-music, art, electronics, computers, endurance sports, or dance. You can consider them in terms of a hobby or developing expertise. Life is not a hobby.
4. Turn your energy to becoming the highest-level performer of life. It is much easier than just trying to survive it. Attempting to hit a 95-mph fastball without adequate skills is impossible. Is life so different?
5. Take note of where most of your daily attention is focused. Consider what you were excited about when you were younger. Are you focused more on what you wish for or on avoiding what you don’t want? The answer is where your brain and nervous system will develop.

The post Navigating Life is Similar to Playing Major League Baseball first appeared on Back in Control.

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Here is a famous quote from Gabriel Garcia Marquez.¹

It is not true that people stop pursuing dreams because they grow old.

They grow old because they stop pursuing their dreams.

Gabriel Garcia Marquez

This is a wonderful quote except I have a different take on it.

People grow old because their dreams are crushed by anxiety.

Stress

Stress is the sum total of the obstacles we face every minute to stay alive. When your body is in a flight or fight state, the sensation is called “anxiety.” This reaction is present in every living species, but humans have language and can name it. It is challenging to achieve your dreams and experience the life you wish while feeling stressed. Your creativity and choice are compromised while you are in a survival mode; the blood flow in your brain shifts from the neocortex (thinking centers) to the limbic system (flight or fight).

The Holmes scale², developed in the 1960s, quantifies levels of stress connected with life events, and you can calculate your own cumulative score. A score of 300 points or more correlates to an 80% chance of a health breakdown within 24 months. In spite of overwhelming data connecting chronic stress with illness, disease, and early mortality, we are generally taught that stress and anxiety are “psychological” issues. Nothing could be further from reality. Why does chronic stress cause mental and physical illnesses?

One of my close friends and colleagues were discussing the role of stress leading to health problems and we decided to assess ourselves with Holmes scale. He had been dealing with an unspeakable number of challenges for several years. His score was 435 and then he told me that he had been diagnosed with cancer a few months earlier. Fortunately, he did well with treatment.

Safety

We want to feel safe. In this state our body’s chemistry consists of anti-inflammatory molecules called cytokines. Fuel consumption is lowered (metabolism). There are about 80 billion neurons in your brain that communicate by molecules called neurotransmitters. When feeling safe, these molecules are calming. Hormones include dopamine (reward), serotonin (mood elevator), growth hormone, and oxytocin (social bonding). Emotions represent feelings generated by your physiological state (how the body functions) and safety creates a sense of connection, contentment, and joy. Another term describing this state is “rest and digest.” Your body must refuel, regenerate, and heal in order to sustain life and health.

Threats

What happens when you don’t feel safe? Your body goes into various levels of threat physiology (flight or fight) to optimize survival. It is designed to deal with acute threats effectively and quickly, but it doesn’t do well when your challenges are unrelenting. At the core of all chronic mental and physical disease is being in a sustained stressed state.³ Here is what is going on.

Activated inflammatory cytokines fire up your immune system. In addition to fighting off viruses, bacteria, and other foreign materials, your own tissues are attacked.⁴ Neurotransmitters switch from calming to excitatory and your nervous system is hyperactive. Fuel is consumed from every cell in your body, including your brain. Chronic disease states cause physical shrinkage of your brain.⁵ Fortunately, it regrows as you heal. Stress hormones include adrenaline, noradrenaline, histamines, and vasopressin, which shift your body from thinking to fleeing. This situation can be likened to driving your car down the freeway at 65 mph in second gear. It will break down more quickly than if you are cruising in 5^th gear.

The driving force behind chronic mental and physical disease is sustained exposure to stress physiology. The solution lies in using approaches to increase “cues of safety” and allow your body to rest and regenerate whenever you can.

Dynamic Healing

Sustained stress translates into threat physiology, which creates symptoms. In mainstream medicine, we are just treating symptoms instead of addressing the root cause being the interaction between your stresses and nervous system. We don’t have time to know you, understand the nature of your circumstances, or how we can help you calm down. Treating only symptoms is similar to putting out an oil well fire with a garden hose. It is no wonder that the burden of chronic disease and suffering continues to skyrocket.⁶ In fact, you often feel more stressed while interacting with the medical system. We introduce the concept of “dynamic healing.

Dynamic Healing is a framework that categorizes interventions that decrease exposure to threat and increase safety. The three portals are:

• Input – processing your stresses in a manner to have less impact on your nervous system
• The nervous system – there are ways to lower its reactivity
• The output – directly stimulating your body to go from stress to calming physiology.

This model organizes known research to both clinicians and patients. You can regain control of your care and create a partnership with your provider.

Why not become a “professional” at living life?

Consider the process as becoming a “professional at living life.” It is similar to acquiring any skill such as playing the piano. You must learn the basics, incorporate them into your daily life, and then continue to deepen your expertise with practice. Mastery is critical, and as they become habituated and automatic, life becomes easier to navigate.

Additionally, the power of neuroplasticity (changing your brain) is powerful and unlimited. You can program your brain in whichever direction you wish, away from unpleasant survival circuits.

Modern stresses

Times have changed since 1962 regarding the Holmes-Rahe scale. The industrial revolution occurred only about 200 years ago. In light of over four billion years of evolution, this not even a drop of water in the ocean. The level of daily sensory input dramatically increased. Now we are in the information revolution that began in 1980’s forcing us to process magnitudes more information. Smart phones came online in 2007, and along with the barrage of social media, we are on a massive sensory overload. The human brain has not evolved to keep up with it. So, we have ongoing stress levels that weren’t present even several hundred years ago. It is somewhat perverse that we have so many anxiety-related problems when we have access to more physical comforts than any generation in history. One fallout is that of teen suicide, “deaths of despair”, have risen dramatically correlating with the advent of the bi-directional smart phone.⁷

A healing sequence

The DOC (Direct your Own Care) Journey course teaches skills to optimize your capacity to enjoy life by effectively dealing with adversity and nurturing joy. These are two separate, but linked, skill sets. As you lower your time feeling stressed and increase your sense of safety and joy, your body will regenerate and heal – mentally and physically. Your brain physically changes (neuroplasticity), pleasurable circuits strengthen, and pain (mental and physical) regions atrophy. You can reprogram your brain away from almost anything with persistence and repetition. The exciting aspect of neuroplasticity is that at some tipping point, your healing continues to build on itself and there is no limit as to what life (brain) you wish to create.

What do want out of this life? Decrease your exposure to threat physiology, increase time in safety, enjoy your life, heal, and thrive.

Homework

1. Take the Holmes-Rahe stress assessment test.
2. Write down the details of each category affecting your life.
3. Consider what percent of your time you spend fighting off stresses compared to nurturing joy. Where is your brain developing?
4. The most stressful stresses are the ones you can’t solve. It is why you must learn techniques to minimize their impact, calm your nervous system, and spend less time exposed to threat physiology.
5. What is one aspect of your life that is the most important to you? Write it down. Are you willing to pursue it?
6. Your body is a complex powerful survival machine. It has evolved to seek safety, deal with threats, break loose, and thrive. Allow it to do its job.

 References

1. Gabriel García Márquez. Cien años de soledad (One Hundred Years of Solitude. 1967. Editorial Sudamericanos, S.A., Buenos Aires.
2. Holmes TH, Rahe RH. The Social Readjustment Rating Scale.J Psychosom Res (1967); 11:213–8. doi:1016/0022-3999(67)90010-4
3. Furman D, et al. Chronic Inflammation in the etiology of diseases across the life span. Nature Medicine (2019); 25:1822-1832.
4. Cole SW, et al. Social Regulation of gene expression in human leukocytes. Genome Biology (2007); 8:R189. doi: 10.1186/gb-2007-8-9-r189
5. Seminowicz DA, et al. “Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function.” The Journal of Neuroscience (2011); 31: 7540-7550.
6. Bezruchka S. Increasing Mortality and Declining Health Status in the USA: Where is Public Health?Harvard Health Policy Review [internet]. 2018.
7. Miron O, et al. Suicide rates among adolescents and young adults in the United States, 2000-2017. JAMA (2019); 321: 2362. doi:10.1001/jama.2019.5054 – Connection with cell phones made by Dr. Rob Lustig lecture on 12.1.21 – https://drive.google.com/drive/folders/182pygqTnS2GPQ4LUmioO06zkRf4-jpIH

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Each new year, many of us spend time figuring out how we’ll make it better and also to really complete some projects that we have been putting off, maybe for decades. Few of us are able to accomplish a fraction of what we envision. Why? It’s because our unconscious behavioral patterns are so powerful and are going to win over our rational mind.

ACE study

This process has been documented in the now famous and replicated “ACE” study performed on about 17,000 Kaiser patients in the mid-1990’s. (1) ACE stands for, “adverse childhood experiences.” Eight then ten questions were answered by the cohort and then the population’s health was looked at compared to the severity of the ACE score. The following questions were asked:

Abuse

• Emotional – recurrent threats, humiliation (11%)
• Physical – beating, not spanking (28%)
• Contact sexual abuse (28% women, 16% men, 22% overall)

Household dysfunction

• Mother treated violently (13%)
• Household member was alcoholic or drug user (27%)
• Household member was imprisoned (6%)
• Household member was chronically depressed, suicidal, mentally ill, or in a psychiatric hospital (17%)
• Not raised by both biological parents (23%)

Neglect

• Physical (10%)
• Emotional (15%)

This study was done on a sample of middle-class Kaiser patients and chronic pain was not taken into account. What is shocking is that only a third of the group had and ACE score of 0 and over a third had a score of 3 or more. It would be anticipated that these numbers would be worse in a lower income group, as there would be more stress and also in a group suffering from chronic pain. The higher the ACE score, the greater the negative impact on a person’s health. Aced out

“Damaged”

My ACE score is 4. At one point a friend of mine gave me a book, Damaged, which related the story of a young man who was so abused that he was never able to pull out of his tailspin. It was his way of saying to me, “You’re going to have to live with all of this internal chaos. You’re not going to be able to surmount your childhood abuse.” I know it was a well-intentioned move, but I was devastated, to say the least. I am sure the feeling it wasn’t too far off from what many of you have experienced when your physician tells you that everything has been done and you’re going to live with the pain. Many of you have also discovered through your self-healing journey that this simply isn’t true.

The health consequences are clear and severe as the ACE score climbs. They include:

• Early mortality
• Obesity
• Substance abuse
• Anxiety/ depression
• Teen promiscuity
• Attempted suicide
• Early smoking/ heart and lung disease
• High risk health behaviors
• Abusive behavior within their own families

What really caught my attention about this study is that it arose out of an intense weight loss program that was quite successful in helping the participants lose a large amount of weight. Yet the most successful ones were the most likely to drop out. It turns out that obesity does serve a function and the higher the ACE score, the more likely they were to return to their prior eating patterns.

Mental or physical health – which is more critical?

Good intentions

“The Road to Hell is Paved with Good Intentions”. This phrase is defined as, “Merely intending to do good, without actually doing it, is of no value.” (2)

I have years of my own resolutions that I have made and not followed through on. That has changed and I now follow through more often. However, it isn’t because of more will power or determination. It’s because I “gave up” and settled into what is real for me. My reality is that my core patterns revolve around being a victim. I was a victim and it was reinforced every day, until I became aware of being a victim was. I couldn’t solve what I wasn’t aware of. Although I made a lot of progress in 2002 after I began to use the expressive writing exercise, it wasn’t until I even learned the word, “victim”, did I begin to truly heal. I certainly had no clue that the word applied to me. In my mind, I had been “enlightened” for years, as I had done a lot of personal work.

By settling into what was and is for me, I’ve been able to move forward. I did the Hoffman process in 2009, which gave me even more clarity. It was there I learned that the victim role is permanent and will continue to manifest itself in more and more subtle ways, especially when I work even harder to disguise it and remain “enlightened”.

I had another insight as to why I was able to re-create my life. I recently read a book, How Emotions are Made, by Lisa Feldman Barrett. She runs a neuroscience research lab and presents data explaining the formation of human consciousness. Every millisecond we are interpreting sensory input to make sense out of environment, including thought and concepts. They become imbedded in our brains and are our version of reality. The are as real to us as the chair you are sitting in. You are programmed by your past. I was initially discouraged about this idea until she pointed out that from this second forward you have a choice about how you want to program your nervous system. Repetition is key and I found it encouraging that I have that much choice about my life and what reality I want to create.

Awareness

A while ago another level of awareness arose in me. It was that essentially my whole being was created around truly being victim. I had been trying to fix and solve it for decades. However, if victim part of me “disappeared”, I would cease to exist as me. When I finally learned that the answer was to assimilate it, I’ve been able to create a reality that is rich, functional, productive, rewarding and a lot of fun. Solving the unsolvable

I would suggest that one resolution that’s more possible to keep is simply committing to becoming more aware. It isn’t possible to solve anything unless you understand the nature of the issues. I spent over three decades doing battle with adversaries that I didn’t know or see. I just kept fighting and fighting. Settling in and “being” takes much less effort. Paradoxically, you will have more energy to actually accomplish your dreams.

1. Felitti VJ, Anda Rf, Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine (1998); 14:245-258.
2. The New Dictionary of Cultural Literacy, Third Edition, Houghton Mifflin Company, 2005.

The post Why are New Year’s Resolutions So Hard to Keep? first appeared on Back in Control.

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• Most of us strongly commit to making concrete changes at beginning of a New Year. Why can’t we follow through more consistently?
• The reason is because our behavioral patterns are so deeply ingrained. Just deciding to make a change won’t make it so.
• The commitment needed is to pursue aspects of your healing journey every day whether you are successful or not.
• The other commitment is a deeper one to keep moving forward towards your vision regardless of the obstacles.
• Then you have to trust your skills.

I was skiing on Christmas day, 2008, with my son Nick and his best friend Holt. Holt was the 2007 US mogul champion (bump skiing). My son had just won a national mogul event the two weeks earlier. The three of us were standing on top of a cornice at Snowbird, Utah. For non-skiers, a cornice is a snow formation that occurs at the top of a mountain ridge. As the wind blows the snow up the mountain a drop-off of 20-40 feet will be formed. Most skiers make a diagonal trail down this drop-off, which is fairly simple and safe. US ski team skiers often jump straight off of them.

Just below the cornice was a chute that was about 20 feet wide at the top but only about six feet wide about 2/3 of the way down. About 100 feet down on the left there was an outcropping of rocks, and it was about 200 feet before it opened up.

“Don’t attempt it!!”

While Holt was looking down at this chute, I said to him, “Holt, you are on the US ski team. I don’t think your coaches are going to be thrilled with you skiing down this kind of terrain.” He looked at me and immediately jumped into the chute. He skied about 75 feet straight down, made a gentle turn to the right, another gentle turn to the left and ended up in a large bowl. Nick started off to the right, jumped from a 15-foot cliff into the same chute and made the same turns into the bowl. They were traveling about 40-50 mph when they reached the open area. This was simply an undoable feat for most human beings. It was clear that if they did not remain committed to their decision that they had a high chance of a serious injury.

Practice, practice, practice – and trust yourself

They had been involved in competitive skiing for nine years. Each year, they had logged over 120 days on the slopes, worked on their jumping skills on water ramps in the summer, and exercised in the weight room several times per week. Every winter they spent the first few weeks on flat simple terrain honing basic turning techniques. They had supreme confidence to ski an icy mogul course at high speeds and had a strong commitment to excellence.

They each knew they could make that jump because they were supremely confident skiers and had done tough jumps before. So, when they made the jump into this steep chute, they were well within their capacity to execute the move. But at that moment, it also required them to commit.

Your life

Consider your life with regards to your capacity to effectively deal with adversity, pick yourself up when you fail, and keep moving forward. Unfortunately, most of us are not taught these skills in school, or within our families. Once we are out in the world, life becomes more competitive and the emphasis turns to survival, physically and emotionally.

Why not view your life from the perspective of an athlete, performing artist, or musician? There is a singular focus learning and mastering basics and acquiring additional expertise with repetition. Is your life any less important?

Recap

Commit to scheduling time daily with doable tasks that will stimulate your brain to change. Eventually, with repetition, these more functional behavioral patterns will become your baseline and you will be able to transform your life into one that you want. Don’t hesitate in your pursuit of your new life. It happens from connection, confidence, and commitment. Schedule it into your day.

The approach of the healing journey is not focused on “fixing” yourself. It is about acquiring skills to navigate adversity more effectively. You will spend less time in flight or fight physiology and your body and brain will heal.

Questions and considerations

1. How confident are you in your capacity to navigate adversity?
2. Did you ever consider it in terms of a learned skill?
3. How committed are you to living an excellent life, regardless of the obstacles?
4. We often have high expectations for our children or partners. What are your expectations of yourself? Are you the person you want your children to be?
5. This series of questions is not about being perfect. We are all “flawed” and endlessly fall short of our expectations. The issue is, “what is your ongoing commitment to living a better life and being an example?”
6. The problem is that while suffering from chronic pain, your energy becomes drained to the point that you may not care anymore. It is the reason that your commitment must begin with, “doing something” and keeping at it.

The post Commit to a Daily Practice first appeared on Back in Control.

The post Commit to a Daily Practice appeared first on Back in Control.

• Learning any new material or skill is an active process than can only be acquired through repetition. There are few people with a photographic memory and even they need repetition to embed a skill.
• Living your life in the manner you wish requires many different skills, and most of us are not taught them at any point in our learning experience.
• To have a good life, you must live a good life and also learn to efficiently process adversity.
• The Talent Code presents the concepts of how genius is created and illustrates the process with many interesting examples.
• Chronic pain evolves from repetition of specific sensory input and your brain becomes excellent at feeling pain. It requires the same process to create an alternate set of more pleasant circuits.

I have recommended an educational and entertaining book, The Talent Code,¹ to illustrate how new information assimilated by our brains. The author compiled knowledge from experts and explains how genius is formed. It is rarely an inherent trait. Although, the neuroscience is outdated, the concepts of how learning occurs are correct. There are three parts to creating genius.

• Deep learning
• Master coaching
• Ignition (obsessive repetition)

Deep learning involves reprocessing new information in your mind in a retrievable way. This is critical to use in any advanced learning. For example, one my medical school classmates would read through his pages of notes only once. But he would look at a page and not go to the next one until he could say it back to himself or write most of it down. He was number three in my class. This is in contrast to another college buddy of mine who would read for hours and hours and not retain the material.

In medical school, I would memorize for 20 min and lay down and nap for 10 minutes and keep repeating the cycle over and over again. I would also “rearrange” the material on my own “internal mental grid” that I would construct as I gathered new information.

By using deep learning, you can increase your capacity to learn by 500-600%. That is not an exaggeration. Sometimes in medical school, we would come home with 75 – 100 pages of notes to learn in a day. You cannot passively process this information and be successful at mastering it. Conversely, the author points out that random repetitions decrease your learning by 15-20% and you are wasting a lot of time.¹

Master coaching is critical in that you want to practice specific tools and techniques in a precise manner. You have heard the phrase that, “practice makes perfect.” What if you are practicing the wrong techniques or the right ones in an incorrect manner. You’ll embed bad habits. Often, it takes an outside observer to pick up the small details and keep your repetitions in a narrow constructive range. It is perfect practice that makes perfect.

The DOC Journey is largely self-directed but if you can engage a coach to keep you on track, it will hasten the process. It is difficult to see your own behaviors. Additionally, you must experience a huge shift in your thinking from “fixing” to “letting go and moving forward.” In other words, you are learning a new set of skills while using an old approach. Even when you think you “have it”, you may still unconsciously be trying to fix yourself.

Coaching is also helpful for support. It is common to become socially isolated and human contact is healing.

Ignition refers to being excited enough about what you are doing that you begin to do endless repetitions. Again, it has to be in a narrow range, but the more the better. Consider something that you have become skilled at, whether it is your work, a hobby, music, art, or play. Nothing changed until you consistently practiced. What is commonly called “muscle memory” is really neurological memory from circuits etched into your brain.

As you  become more engaged and excited about your new life, you’ll instinctively increase your repetitions. However, early on, you just have to do it to get over the hump. When you are in pain, it is difficult to get excited about anything. The DOC Journey will not solve your pain. It is providing tools and approaches for you to learn and master in order to navigate your life more competently and at first you may have to “grind it out.”

You are already a “genius” at feeling pain

Unfortunately, the development of chronic mental and physical pain fits the criteria for creating genius. The impulses are “deep learning” in that you predictably react to them, and as you try to cope with them, you are reinforcing them.

You don’t need a master coach in that the impulses are already in such a narrow range and usually predictably affected by specific factors.

The ignition or obsessive repetitions goes without saying as the pain signals are rapid and relentless – especially with obsessive thought patterns that quickly become memorized. The current definition of chronic pain is that “……it is an embedded memory that becomes connected with more and more life experiences and the memory can’t be erased.”² You are not going to change the trajectory of this complex problem with simplistic random interventions. You must use the same programming principles to become a genius at feeling pleasure.

Recap

It is critical to conceptualize your pain and response to it in terms of programmed circuits. Using re-programming tools, you can create “detours” around them or shift onto circuits that do not include pain. It appears that you can reprogram around almost any pain in any part of your body regardless of the length of time it has been there. The brain’s capacity to adapt is remarkable.

It takes tens of thousands of swings for a major league baseball player to be able to hit a baseball coming at him over 90 mph. There is also a huge variation in speed and trajectory. I think it is one of the most incredible feats in the human experience. With chronic pain – mental or physical, you’ll receive a lifetime of “baseball swings” in a matter of weeks. We do know that chronic pain can be memorized in a matter of six to twelve months.³

Additionally, since pain circuits are linked to anxiety/ anger ones, any situation that fires up your frustrations will fire up pain and of course pain will fire up the anxiety/ anger circuits. The good news is that all of this can calm down with the same set of approaches.

Become a genius at running your life and take back control.

Questions and considerations

1. Consider a skill you acquired at any point in your life. The degree of expertise was proportional to your time spent on it. Consider navigating your life as a learned skill.
2. There are many components to living a successful and enjoyable life. Each one needs to be considered in relation to the big picture.
3. We have discussed the importance of creating a vision of what you want your life to look like. What set of unique skills to you need to acquire to get there?
4. You have already spent an endless number of hours pursuing a cure for your pain. Why not get focused and solve it with a fraction of the time and effort?
5. How committed are you to creating deep change versus holding onto your old life?

References:

1. Coyle, Dan. The Talent Code. Random House, New York, NY, 2009.
2. Mansour AR, et al. Chronic pain: The role of learning and brain plasticity. Restorative neurology and neuroscience (2014); 32:129-139. doi: 10.3233.RNN-139003
3. Hashmi JA, et al. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain (2013); 136: 2751–2768.

The post Repetition and Healing first appeared on Back in Control.

The post Repetition and Healing appeared first on Back in Control.

• Most of us intellectually understand that the only moment we have in life is this very one. That is it.
• Being in medicine for over 40 years has shown me the incredible unpredictability of life. Life changes in second – sudden heart attack, bad car accident, diagnosis of terminal cancer, and the list is endless.
• But our minds play tricks on us by constantly worrying about the future and hanging onto regrets from the past.
• This problem arises from our unconscious mind that is protecting us. It is continually scanning the present looking for situations from the past that were perceived or were actually dangerous.
• So, your actions today are a result of your cumulative perceptions of what is safe – or not.
• You can’t control this response but by using tools to stay connected to the moment, its impact is lessened.

Commitment to change is one thing but sticking with it is challenging. One way to help yourself along is to bite off small bits at a time and proactively make the choices all day long. It will become a habit and your norm. A starting point is repeatedly asking yourself a simple question, “Who do I choose to be today?”

A tough start to my day

One morning I woke up feeling low, having just completed eight straight 15-hour workdays, including a long weekend. As I lay there exhausted on a Tuesday morning, I reviewed my choices: either 1) stay in bed feeling sorry for myself; or 2) give thanks for the opportunity to help so many patients during the week, be grateful for how well the week went, and meet my work-out group early at the gym. I chose the second alternative. I got up, worked out, went into the office, and gave 100% to each patient and my staff. I’m not saying it was easy; but it turned out to be a great day.

Proactively choosing how to experience your day is the farthest thing from “positive thinking.” No one is asking you to pretend to be happy when you are coping with a difficult situation, especially your ongoing pain. On the contrary, you must be aware of the depth of your frustration before you can choose to live a full and productive life with or without pain – or decide to enjo. Positive substitution—filling your life with positive experiences— is the essence of neurological reprogramming.

A Tough Beginning

Recently, I was talking to a friend’s teenage son. This kid was good-looking, athletic, and personable; yet he felt isolated, insecure, anxious, and emotionally unstable. He continually compared himself to others and tried to fit in. He was also justifiably upset about his family situation. His father, who was extremely critical of him, had essentially abandoned him by moving out of the country. I  understood where he was coming from, since his experience was not much different from mine at his age.

About halfway through our conversation I realized that he too, had a choice. I pointed out that, after years of stress, he had remained remarkably intact. He could choose to be proud of his resilience in the face of adversity and use this gift to take on new challenges. I could see his eyes light up.

Some suggestions

FOMO (Fear of Missing Out) seems to be rampant in this modern era. Maybe it is because we are overwhelmed with options? What we are missing out on is enjoying our day. It is a deeply embedded thinking pattern that doesn’t resolve over time. It requires specific approaches.

You can’t “solve” FOMO. By trying not to be this way, you’ll actually reinforce these circuits. The answer lies in cultivating connection, meaning, and purpose. Trying to be “happy” actually doesn’t work due to the “ironic effect.”¹

• Nurture deep gratitude for you have. It may not be as much as you want but focus on it.
• Compare your situation to those who are less well off than you. It may not seem possible in light of your pain but start somewhere.²
• Become aware of how frantic you get about your “to do” list and how endless it is. It is endless for all of us.
• Then don’t put ANYTHING on your list that you are not going to do TODAY.
• Frequently practice active meditation or breath work to calm yourself. It is one tool that connects you to the moment you are in.
• Listen to some of your favorite music – especially if it is connected to enjoyable experiences from the past.
• What is one thing you can do today that brings you pleasure? – a cup of coffee  your favorite donut; a call to a close friend; a compliment to a family member or friend; anything. There is an endless of list of small deeds that can change your day.

Recap – Your choice

What do you want out of your life? Is it more than being a sufferer enduring pain? Do you really want to live your one life this way? Of course not, you may be thinking. But trust me. It is unlikely that you will magically wake up one morning and find your troubles gone. Focusing on solutions is an ongoing conscious choice because your powerful unconscious brain automatically gravitates towards the problems. There are no shortcuts.

So, who do you want to be today? Choose carefully because you will either be reinforcing old neurological circuits or creating new ones. What is your choice this year, this month, today, the next 15 minutes, or this minute? Carve a few minutes out every morning to ask yourself that question, ponder your options, and commit to whatever choice you make.

Questions and considerations

1. The impact of chronic pain on your life has been documented to be that of having terminal cancer – except worse.³ So, first of all, honor your own suffering and give yourself a break.
2. Depending on the severity of your suffering, you may not feel like nurturing a better life, even for a few minutes. This is one point in your journey that you must begin somewhere, and the next 10 minutes is the place.
3. Then you have to keep repeating it, whether you feel like it or not.
4. Even when you are feeling better (and it will happen with practice), you’ll still gravitate towards the negative because that is what your powerful unconsciousness brain is supposed to do – protect you from danger.
5. To have a good life, you have to live a good life. It is just the way your nervous system works.

References

1. Wegner DM. The seed of our undoing. Psychological Science Agenda (1999); Jan/Feb:10-11.
2. Dalai Lama. The Art of Happiness. Penguin Random House. New York, NY, 1998.
3. Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhøy M, Bortchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand (2008); 52:143-148. 

The post Who Do You Choose to be Today? first appeared on Back in Control.

The post Who Do You Choose to be Today? appeared first on Back in Control.

• Regular exercise is a defined and to measurably lower inflammation, which will decrease your pain.
• It is basic to healing from any chronic disease, including chronic pain. It won’t solve your pain by itself, but other interventions will have limited impact without it.
• There are well-documented weekly recommendations regarding the type and amount of exercise.
• Both aerobic conditioning and resistance training are important.
• If you are not willing to exercise, you have to ask yourself, “why?”

Being inactive is unhealthy.^1,2 This is a statement that is reflected in many reviews of the benefits of exercise. So, regular exercise is good for your health. There are multitude of papers documenting the benefits of regular exercise, including decreasing chronic pain. Due to the overwhelming amount of data, some of this blog will be presented in a list format.

According to the CDC, 60% of Americans do not engage in the recommended amount of weekly exercise. About 25% are completely sedentary.³ The consequences are severe.

 What are the benefits of exercising?

The list of reasons to exercise is almost endless but it begins with adding about four extra years to your lifespan. More importantly, the quality of life is maintained almost to the end.² There is less of chance of a slow decline in your health, which is not the way you want to pass on.

We don’t want to think much about death, but there are a few factors to consider from the literature and also from my observations being in medicine for over 45 years.

• People don’t want to be dependent on others. There is a fierce drive to hold onto your driver’s license, live in your own house, take care of your daily hygiene needs, and to be able to partake in enjoyable activities.
• People are less afraid of death than the possibility of prolonged suffering.
• No one wants to die. The only ones who do are miserable to the point that they can no longer endure it anymore or are completely dependent on others.
• Social isolation is intolerable. But what happens when your thinking capacities drop, you don’t hear as well, can’t go out for a cup of coffee with friends, or your life is consumed with medical problems?

Here is a short list of diseases/ conditions that are lowered with regular exercise and increased if living a sedentary life.^1,2

• Lower risk of ALL cancers – except prostate and melanoma³
• Heart disease
• Chronic pain
• Adult-onset Diabetes
• Hypertension
• Obesity
• Osteoporosis
• Decreased cognitive function/ dementia
• Stroke
• Depression
• Disability/ less capacity to engage in self-care
• Serious falls
• Insomnia

How much exercise?

The research breaks down exercise into light, medium, and intense. The tipping point for significant health benefits is between 150-300 minutes per week of moderate exercise. An example of moderate exercise would be brisk walking and if you decided to jog, you could lower the time to 75-150 minutes per week.^1,2

You don’t have to engage in intense exercise to receive significant health benefits. The minute you begin any light exercise, you have positively impacted your health. You may feel that a little exercise is not worth your time. That is simply not true. The relative benefits are actually higher if you have been inactive.

How intense should the exercise be?

It is important to be careful as you engage in a new level of activity. The CDC recommends getting a medical clearance if you have a chronic medical condition. If you are going engage in more vigorous exercise, clearance should be obtained in men over 40 and women over 50.⁴

Although the benefits far outweigh the risks, in every age group, there is a higher chance of a cardiac event during exercise compared to not exercising. If you have been sedentary, then just begin with light exercise for 5-10 minutes/day.^1,2 It is a lifestyle change and you’ll gradually improve in all domains. The key is being persistent – whether you feel like it or not. Consider the reality that for a short period of potential discomfort, you’ll feel better the whole rest of the day.

People often say that they can’t exercise because of their pain. It is a catch-22 in that exercise is anti-inflammatory, calms the nervous system, and decreases pain. However, in the short-term, it may increase your pain. There is no point in taking a “mind over matter” approach and try to keep pushing through the pain. Just exercise to tolerance or find exercise a body part that is not painful. It is important to enjoy your exercise time in order to maintain it. Again, any exercise in any part of your body will start you on the road to better health. Also remember, you aren’t trying to “conquer” chronic pain. As you lower your inflammation in your body, the pain does decrease.

What kind of exercise?

There are two general categories of exercise. Aerobic conditioning and resistance training. They both need to be utilized with doing aerobic activities maybe three or four days/ week and resistance training two to three days/ week. Heavy resistance training does have an aerobic component but walking or jogging does not meet the strengthening needs.

Regarding aerobic conditioning, it doesn’t matter how you increase your heart rate. Any activity works. Again, make sure that you stay in a range that is safe for you. It is common for orthopedic surgeons to see patients with tendonitis (inflammation) of the achilles tendon, tendons around the kneecap, plantar fascia, or even have stress fractures in the bones of their feet. It is always from a person deciding to “get in shape” and start to overexercise – usually walking or jogging. Otherwise, any graduated activity that increases your heart rate is effective. Think in terms of a long-range change and there is no rush.

The rest of this article will discuss resistance training as there are specific benefits and not enough people consider it as part of their routine. The main reason to implement regular strength training to halt or reverse the muscle loss of aging called, “sarcopenia.”  It lowers your chances of becoming dependent of others for your self-care. If you think being in pain is bad enough, people really dislike feeling helpless. You might consider visiting a nursing home for a few hours. It will motivate you to do whatever you can to stay out of that situation. Research shows that lack of control causes inflammatory markers to increase, thereby increasing your pain.⁴

Resistance training is integral to aging

We all lose a certain percentage of muscle mass every year (estimated to be about 3% after age 60). Since lifespans are significantly longer in the last half of the twentieth century, it means each of us will lose over 30 percent of our strength.⁷ So, resistance training becomes more important as we age.⁶

You not only prevent muscle loss (sarcopenia), but you can also reverse it. It’s been shown that people over forty-five receive a tremendous benefit from resistance training. There are many ways to accomplish this including the weight room, Pilates, yoga, elastic bands, and isometrics.

You will also be exerting stress on your bones, which simulates them to from new bone. It is a way to prevent your skeleton from becoming brittle (osteoporosis).

I prefer resistance training to be done outside of a person’s residence, as few people will consistently work out at home. It’s helpful to be in an environment where others are exercising; also, the equipment is better. Pilates is also excellent in that it emphasizes core strength, and yoga is helpful if the extreme postures are avoided.

The weight room

Regarding the resistance workout program, essentially all of the machines are safe. Avoid the free weights, as there is more the risk of straining your core muscles. Begin with very light weights and do sets of high repetitions –  ten to fifteen per muscle group. Work on opposing sets of muscles. Avoid unsupported bending at your waist no matter what the situation. Supported bending is fine and so is twisting.

Most health clubs offer at least one free personal training session to set you up and ensure your safety. Many physical therapists will help transition their patients from the specific/functional exercise phase into a long-term conditioning program.

Benefits of resistance training

Strength training is a significant  factor in reducing pain and improving your sense of well-being from lowering your inflammatory markers. Here are some benefits of resistance training.

First, there is the obvious benefit of having more strength, so a smaller percentage of your energy is spent on daily activities. You are able to stay well away from the pain threshold.

Second, you have more capacity to engage in vigorous physical activities that are enjoyable and relaxing. Actively placing your attention on these neurological circuits stimulates neuroplasticity in a desirable direction. Many of these activities can shared with other people. Social isolation is over 50% in the US ⁸ and spending quality time with others is part staying healthy.

Third, although it’s not going to be at the level of the long-distance runner, there is some degree of the release of pleasant hormones such as serotonin, dopamine, and endorphins with strength and aerobic training. (Endorphins and enkephalins are the body’s natural pain killers).

Finally, I feel the most important contribution that strength training adds is a reprogramming function. You are now sending a different set of signals to the body regions that have been firing pain impulses to the brain. As you are voluntarily stressing a given muscle group, you have control as to the intensity of the signals. Somehow the combination of control and different inputs has a significant impact on pain.

Recap

Regular exercise improves almost every aspect of life, including sleep. Activities should involve both aerobics and resistance training. If it fits in with a hobby you love, that is an additional benefit. Invite a friend to join you, take a neighbor’s dog for a walk, accompany a grandchild to the park, join a local team—all of these activities allow you to connect not only with your body, but also with your community. Experience of connection in itself promotes a feeling of safety and lowers inflammatory markers.

However, per the sleep hygiene principles, intense exercise should not be performed in the evening. If you must exercise late in the day, keep it light and relaxing; otherwise, the neurochemical stimulation will disturb your sleep. Remember that adequate sleep is one of the cornerstones of alleviating chronic pain.

The key to incorporating exercise into your care is to select an activity you enjoy from the start. Exercise is a long-term commitment, and it is important to have fun while you do it. It’s easy to look at your exercise equipment and feel badly that you aren’t using it more than you should; but those thoughts are counter-productive to your healing. If you reframe exercise as a reward comprised of leaving the house, being with people, and moving your body, you’re more apt to keep it up.

Questions and considerations

1. If you are serious about breaking free from chronic pain, you must exercise. It is a concrete and defined way of affecting your body’s physiology. Are you exercising at all? Are you exercising the recommended amount of time per week? If you are not, you have to ask yourself, “why?”
2. Any exercise helps and the proportional benefits are actually greater at the beginning of your program. Benefits increase with more exercise, but you have to begin somewhere.
3. If you are not in good physical shape, it is hard to have good mental health and enjoy many other activities. What do you want your overall life to look like?
4. Consider the time you may be spending with medical visits, looking for solutions on the Internet, reading self-help books, considering surgery, and discussing your pain and medical care. What if you took 30 min a day from these activities and exercised?
5. These comments sound like I am lecturing and I am. I continually challenge myself and my patients with the question, “What do you want?” The answer is usually, “I want to be free from my pain.” Then do it. There are many basic ways to break free from chronic pain without aggressive medical treatments. Sleep and exercise are foundational steps. If these two are not in place, you will not be able to move forward easily regardless of other interventions.
6. “Just do it.”

References

1. Paterson DH and Darren ER Warburton. Physical activity and functional limitations in adults: a systematic review related to Canada’s physical activity guidelines. International Jrn of Behavioral Nutrition and Physical Activity (2010); 7:38-50.
2. Powell KE, et al. Physical activity for health: What kind? How much? On top of what? Annual Review Public Health (2011); 32:349-65. doi: 10.1146/annurev-publhealth-031210-101151.
3. Moore SC, et al. Association of leisure-time physical activity with the risk of 26 types of cancer in 1.44 million adults. JAMA (2016); 176:816-825. doi: 10.1001/jamainternmed.2016.1548
4. Surgeon General Report. Physical activity and health. CDC (1999). https://www.cdc.gov/nccdphp/sgr/adults.htm
5. Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42.
6. Volpi E, et al. Muscle tissue changes with aging. Current Opin Clin Nutr Metab Care (2004); 7:405-410.
7. Crimmins EM. Lifespan and healthspan: Past, present, and promise. The Gerontologist (2015); 6:901-911. doi: 10.1093/geront/gnv130
8. Cigna US Loneliness Index. Cigna, 2018.

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The post Exercise Improves Your Health, Quality of Life, and Lifespan appeared first on Back in Control.

We are all programmed by our past The way we survive is that our brain is constantly comparing the present to the past and any situation that triggers a hint of a prior threatening scenario, will create a danger signal. There are over 20 million bits of sensory input being processed every second. This warning system has different forms – hot, cold, sharp, pressure, dizzy, bright, loud, bitter, rancid, and the list is long. However, they are all creating a similar reaction of being unpleasant enough to compel you to take action to solve it. They can all be lumped under the word, “pain” and the simultaneous reaction of anxiety.

Since this is what our brain is repetitively processing the environment every second, it is all being deeply programmed into your nervous system. It is also the reason that chronic pain (anxiety) almost always worsens with time. You are becoming more skilled in recognizing and feeling the pain. It is similar to a pianist practicing to the point where he or she develops the skills to be considered a virtuoso performer. The term for this process is, “neuroplasticity.” We are all programmed by our past up to this exact second.

The Talent Code What does this have to do with my golf swing? One of the first books I have historically had my patients read is a book called The Talent Code by Dan Coyle. He has done a wonderful job of looking at the factors that create genius. It is a growing observation that genius is rarely born. It occurs after about 10,000 hours of repetition. However, it is a specific kind of repetition called “deep learning.” The other two factors are “ignition” (obsessive repetitions) and “master coaching” (laying down the correct pathways).

Deep learning is the most basic concept in that it is necessary to enter information into your brain in a way that you can retain it. Each of us knows that if you just read or hear some new information that you will retain very little of it. It is necessary to use some technique such as visualization, verbally repeating new thoughts and concepts to yourself, writing them down, analyzing and challenging the ideas, re-interpreting material according to your perception of it, etc. By using techniques you are comfortable with, you can increase your learning by 500 to 600%. Conversely, random repetitions will decrease learning by 15-20%. In other words, you must actively process information to retain it and make it part of your nervous system. Master coaching keeps the repetitions within a narrow range.

Holt’s deep learning So, my way I approached golf was to take a lesson, learn a new concept, not practice enough, and jump to another concept. It is no wonder that I never came close to being an expert. My son’s best friend, Holt, won the 2007 US Mogul skiing championship by using deep learning. He broke down one of jumps called a “D-spine” into 13 different parts. Each practice jump was focused on just one of the components. It is a stunt where the skier does both a back flip and rotates sideways. He could lay down a competitive run almost 80% of the time, which is stunning considering the complexity of the sport. And he did it by practicing about a third as much as most of his competitors. Consider chronic pain. You are trapped by relentless unpleasant sensations without an obvious alternative. The pain impulses fit the definition of “deep learning” in that they are so specific. The obsessive repetition is self-apparent and these circuits don’t require master coaching.

Stimulating neuroplasticity So, these basic automatic survival circuits are permanently embedded. Paradoxically, the more you pay attention to them or, even worse, suppress them, the stronger they will become. The key is to reprogram your brain to have alternative and more functional responses to threat – whether it is real or perceived. There are three steps: 1) awareness of the automatic response 2) create some “space” between the stimulus and reaction  3) substitute a response that is your choice. With repetition your brain will develop new circuits that are more pleasant and eventually automatic. You are creating a new nervous system within your current one. It is similar to having a virtual desktop installed on your computer. By trying to “fix” my bad golf swing, I got nowhere. If I had created and pursued a vision of what I wanted to create, I may have had more success. You have heard the saying, “Practice makes perfect.” What is more true is, “Perfect practice makes perfect.” Why keep embedding your mistakes or dysfunctional reactive patterns?    

“I read your book and I still hurt” It is common for people to say that they have read multiple books, including Back in Control, and they still feel the same. Yet when I ask them what reprogramming skills they are regularly using, the answer is always the same – none or maybe just a couple on occasion. You don’t want your brain’s reactive response to a threat to always be unpleasant. Even worse, what we often perceive as a threat is actually not a threat. It is a “cognitive distortion” and really a huge waste of time and energy. If you want to break free from pain, you have to develop a regular practice. It does not require much time once you have learned the healing concepts.

The DOC Journey presents a sequence of learning that allows you to first understand the nature of the problem, develop a strong foundation by using tools to calm and stabilize your nervous system, provides strategies to break free from your past programming, and most importantly move forward into the life that you desire. What kind of golf game (life) do you desire? I am probably not going to commit to a great golf swing at this point in my life. You have no idea how much I know about the mechanics of the swing, but I don’t want to spend that much time practicing. But I am committed to learning as much as I can about the latest neuroscience research around chronic disease and bringing these ideas into the public domain. My personal challenge is presenting them as clearly as possible. I am excited about learning these skills and encouraged that patients are responding more quickly. I am continually inspired by people’s persistence and courage in the face of the adversity of chronic pain.

References:

1. Coyle, Dan. The Talent Code: Greatness isn’t Born. It’s Grown. Here’s How. Random House, New York, NY, 2009.

The post Become a Genius at Solving Pain first appeared on Back in Control.

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The DOC Journey is a condensed set of core resources that reflects the experience of hundreds of patients suffering from chronic pain that have successfully taken their lives back. It reflects the evolution of our knowledge of about pain and how to more clearly present the problem, principles behind the solutions, and how to continue to thrive and move forward once you have broken free.

The guided course is one one of the resources that provides a guided pathway through the maze of choices offered to patients. It provides background information, tools, strategies and support that enables you to develop a game plan around your unique set of issues and circumstances. As it’s a largely self-directed process, you can then create partnerships with your medical and non-medical providers to solve your pain.

Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain provides the framework for a deeper understanding the nature of chronic pain and breaks it down in its component parts. It is recommended that you use it as your reference book.

Overview of the guided course

This course is organized around principles we learned in our workshops. We witnessed profound shifts in pain and mood during the three or five-day events and we were consistently amazed by the magnitude of the changes. For those who continued to learn and practice the tools, the outcomes were sustained. Your brain can only rewire by consistent repetition. This is the sequence that emerged from our experience.

• Awareness – first step in solving anything
• Hope – has been shown to be a powerful healing force
• Forgiveness – you cannot move forward until you have let go.
• Play – is how we evolved and figured out human relationships. Re-connecting with this energy is precipitates rapid changes. It does take a series of steps to get there.

Why this sequence

This process is evolved from my own 15-year suffering from severe chronic pain. There was no reason it should have happened and I was extremely fortunate to break out of it. It all began with a panic attack in 1990 out of the blue. I was under a lot of stress but nothing more than I was used to. For 30 years I have been searching for the answer of how could my life been so dramatically and permanently altered in 10 minutes?

I broke free from the grip of pain in 2003, but I only knew that some writing exercises that I had inadvertently began to engage in seemed to be a significant factor. I still did not know why it happened and I certainly didn’t know anything about chronic pain. The neuroscience research since 2009 has clearly revealed the answers and the solutions.

I feel the reason that this journey has been so successful for well over 1500 patients is that I painfully traveled every millimeter of it and learned a process from mostly from what didn’t work. If some approach seemed to have promise, I pursued it personally and shared the ideas with my patients. It is still evolving and I am excited in that I am able to present it more clearly and my patients have been able to respond more quickly.

Awareness is the foundation of healing. You will develop an awareness of:

• The nature of chronic pain – as opposed to acute pain, there is nothing useful about being in ongoing pain. Mental pain is a bigger issue than physical pain.
• Your situation. What factors are relevant to your specific situation? What is your diagnosis? Has it been clearly explained to you?
• The principles behind solving chronic pain. Once you understand the problem and the nature of the solutions, you’ll be able to take charge of your own care.

Hope has been shown to exert a favorable effect on the inflammatory response and is a key factor in healing. (1) Loss of it is a common theme with almost every patient experiencing chronic pain. You are suffering miserably, no one can tell you what is wrong with you, you’ve been told that you just have to live with it and do the best you can, and no really believes how much pain you are in. Where is the endpoint? Not only do patients break loose from the grip of chronic pain, they often thrive at a level they never conceived possible. You will hear many of their stories.

Forgiveness is critical and is the dividing line between healing or remaining stuck. Your brain processes mental pain in the same way as a physical threat. Most people in pain hold onto the situation or person who wronged them. (2) It is understandable, but you cannot heal and move forward until you let go. Forgiveness is learned skill and a powerful statement that you are taking your life back!

Play is how mammals learn to socialize. Humans take it to a different level since we have language added to the mix. You learn safety vs. threat, body language, negotiation skills, effect of tone of voice, etc. When you are in a play mode your body’s chemistry is optimized and your sense of contentment and well-being is increased. This is not play intended just to distract you, but rather that in which you are fully engaged in something you love.

The goal

You will learn methods that will stimulate physical changes in brain (neuroplasticity) and can re-direct your nervous system to form more functional circuits. The outcome is to optimize your body’s reaction from one threat to safety. The final signal to your body’s cells is sent through cytokines. These are extremely small communication proteins. The defensive one are inflammatory (Pro-I) and the safety cytokines are anti-inflammatory (Anti-I). You will learn to regulate your body’s chemistry and inflammation to create a favorable healing environment. The effects are often profound with all parties excited and somewhat incredulous at the degree of healing.

Navigating the course

The core journey is arranged in sequence that begins at where you are at suffering from unrelenting pain and lays down a foundational set of concepts and tools in order to move forward. The intention is for you to move at your own pace, as the healing process is different for everyone. Some people experience rapid relief of pain within a few weeks. Most people experience significant shifts in pain and mood within 3-6 months. But never give up. I have had many patients email me years later that they had broken free from the bonds of pain.

Although there is often some improvement early in the Journey, the tipping point for deep healing always occurs around processing anger, which is inevitable when you are trapped in misery. Anger is protective and we are not programmed to be vulnerable. It threatens survival. That is why the DOC Journey is arranged in this order. You must first be ready to let go before you can accomplish it.

The guided course

There are seven legs to this guided journey with “rest stops” along the way. The reason for the stops is to embed and practice your tools. Calming your nervous system and optimizing your body’s chemistry is a learned skill set. Each person will find his or her own best set of methods.

Leg 1 – Preparing for your journey

Leg 2 – Starting your trip

Leg 3 – Anxiety is the Pain

Leg 4 – Awareness

Leg 5 – Anger processing – the Tipping Point

Leg 6 – Moving Towards Your Vision

Leg 7 – Expanding the Center of Your Circle of Life

The DOC Journey

Although this course is a core aspect of The DOC Journey, other resources are available that will provide additional support and depth of knowledge about how to proceed. The group coaching is especially helpful. Many of your questions will be also be answered with the video tutorials, which are connected to the appropriate lesson and also accessible in the Toolbox.

The best part of The DOC Journey is that the effects continue indefinitely. You have “changed your filter” and you’ll continue to process your environment with this new perspective. Since your brain keeps physically changing, it takes an active effort to turn back. Once you own your life, it is yours.

The post The Guided Course of “The DOC Journey” first appeared on Back in Control.

The post The Guided Course of “The DOC Journey” appeared first on Back in Control.