Begin writing now

I ask my patients to begin the expressive writing quickly before they read my book. From the beginning it creates some level of a shift and seems to open the door to change. Many people resist this simple exercise. That includes me. I am not sure why so many people resist this foundational step, since there is no risk or cost. Over 2200 research papers have demonstrated its effectiveness. But I hear and endless number of reasons why he or she can’t write. One of them is, “My hands hurt or are unsteady.” “I don’t have the time.” “My life is unusually stressful.” There is another alternative – the verbal route.

The mirror

Dr. Wegner, author of the famous “White Bears” article (1) on suppressing thoughts pointed out that the verbal route of expressing thoughts is also effective. I recall in the midst of my misery that one exercise that helped create a shift was one suggested by David Burns in his book, Feeling Good. He said to stand in front of a mirror and talk to that person using the self-critical voices in your head. You would never talk to another person in that manner. Of course, you can speak with freedom and there is nothing to destroy. I have to say that it was disconcerting I and I quickly realized how toxic these thoughts were. So I suggest to my patients that they can express themselves verbally in private with or without a mirror.

One research paper (2) looked at switching the self-talk voice from the first to the third person. Of course, most of our self-talk is negative, which is an unfortunate part of the human experience. They were able to document on functional MRI (fMRI) scans, which document area of brain activity that this process calmed down the region of the amygdala (considered the danger signal area) without engaging the higher thinking areas of the brain. In other words, it cut through the need for using your cognitive function to do battle with anxiety.

Using words

I want to share an email I received from one of my colleagues.

While expressive writing is great, I find that at home, I rarely can find a solid uninterrupted 20-30 minutes to dedicate to it, with professional obligations, my wife, and daily life/planning/activities/chores. I’ve tried doing it at work, but distractions and tasks are ever-present.

So, what I have been doing is during my drive home (which can be up to 45 minutes or more), or during my 15-20-minute walk to the gym, I simply visualize writing, or narrate to myself what I would write. It flows even faster than writing, and once I get going, the words flow, the images flurry, and I get it all out in the open. Then, if in the car, my personal favorite is to laugh at how ridiculous it sounds or, if particularly angry, swear it all away. When at the gym, with every repetition I imagine squashing it.

I do this about 4 times a week and all the negatives of the day, personal challenges, or doubts about the future turn from massive, insurmountable problems to very solvable obstacles; it’s incredibly energizing.

I have found that even with the writing exercises, it wasn’t the act of writing, but the act of ripping it up and throwing it away that felt so liberating. If it was a great week and my writing was all positive, I’d read it a few times and be proud, and throw it away. It is that physical act of squashing, tearing, destroying negativity that is what makes all the difference.

A few months ago I read a book called The Charisma Myth, and one part was about managing stress with public speaking. The technique the author described was closing your eyes, identifying all doubts, negative thinking, worry, stress, and visualizing all this negative energy being expelled to either a benevolent god, the universe, or something that the individual personally identifies with. When I had to have some difficult conversations and meetings over the last few months, before every meeting I closed my eyes, identified my stress, nervousness, doubts, etc. and visualized myself breathing out these thoughts to a collective universal being, where I identified that billions before me and billions after me have had these same exact feelings, and I could expel it to a pre-existing unity. I walked into the meeting calm, cool, and collected, and though it was tough, I was able to think clearly, not shy away from making my case, and stand my ground confidently.

I think this illustrates that feelings, especially negative ones, like anxiety, stress, uncertainty, self-doubt, pain, etc. are all intangible ideas.  The act of making it tangible, whether it be through the written word, a visualized entity, or an audible sound (like when I dictate to myself) makes it something tangible and something people are comfortable dealing with. Squashing that tangible thing, whether by tearing it up, pounding it away in the weight room, swearing it away in my car, or breathing it out to a universal entity, are all physical, tangible methods of dealing with a now tangible foe that was before just an illusory concept. And that’s what makes these tools so powerful.

Neuroplasticity

The concepts of rewiring your brain (neuroplasticity) are based on awareness, separation and reprogramming. The writing creates an awareness of what is racing around in your brain and now there is a space between you and your thoughts. The verbal route also creates a separation, and you are now able to re-direct your attention to whatever you choose. The data is convincing.

Here is a link to a detailed overview I created to explain the details of expressive writing. You don’t have to write for 15-20 minutes day. As little as a minute can change the nature of your day. I also feel it is important to write at least several times a week indefinitely. It is a way of “maintaining” your brain.

We asked Dr. Pennebaker, the originator of the research, why he thought it was so effective. It was his impression that it was a simple way to release secrets, not solve or get rid of them. Everyone has some parts of themselves they are not particularly proud of. It is just the way human consciousness works. It is not a solution for your mental or physical pain in isolation, but it is a necessary starting point. I have seen few, if any, people deeply heal without this exercise.

References

1. Wegener DM, et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.
2. Moser, JS et al. Third-person self-talk facilitates emotion regulation without engaging cognitive control: Converging evidence from ERP and fMRI. Scientific Reports (2016); 7: 4519 | DOI:10.1038/s41598-017-04047-3

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“Now I will read the whole book. Recommend 100%”

–An Amazon reader

Breaking my fall

The above quote is an Amazon review of the second edition of my book, Back in Control. Feedback like this from readers bolsters my belief in the expressive writing exercise and how critical it is to the DOC (Direct your Own Care) process.

I completely understand what the reader went through: After over fifteen years of trying everything I could get my hands on to relieve my pain—“desperate” does not begin to describe my frantic search for a solution—I had lost all hope. Then, in 2002, I inadvertently discovered expressive writing and put it to the test. Within two weeks I noticed a shift in my mood, and within six months I had pulled myself out of the deadly tailspin of chronic pain.

But the expressive writing exercise seems so simple, I fear that, when I recommend it to patients, many of them feel that I don’t believe they are really in pain nor do I understand the depth of their suffering. Yet, in addition to my experience and that of many other chronic pain sufferers, over 300 research papers document its effectiveness; while essentially no papers validate the benefit of a spine fusion for low back pain. Compared to spine surgery, how much risk is there in writing down your thoughts and then discarding the pages? What can you lose by trying it out?

I have consistently observed that expressive writing is the first step toward healing, and little of substance happens until a patient engages the process. When I walk into an exam room, I can tell within thirty seconds if my patient has started to write. If not, I offer more details of its importance. I tell my patients that reading my book is helpful, but it will not make a difference in their mood or in their level of pain. I ask them to return a few weeks after they begin writing.

“This is ridiculous!”

One patient, a professor, came to me with lower back nerves that were so tightly pinched, they were causing leg pain. He refused to do the writing. I told him I thought he would benefit from a simple operation, called a laminotomy, to relieve the pressure. However, I said he would need to find another surgeon, since he was not willing to employ even the simplest tools to contribute to his recovery. A few weeks later, he returned. Laughing, he said, “This is ridiculous! I began the writing and within a week my pain was gone!” He began to employ the rest of the DOC strategies. Three years later, he is still pain free. He may need surgery someday; but now, it would make no sense. Why perform surgery on someone who is feeling fine?

Mental pain = physical pain

I have a theory to explain why expressive writing works so well to alleviate chronic pain, and it comes from my review of the latest neuroscience research, for the second edition of my book. The studies find that the nervous system processes thoughts the same way that it responds to physical sensations such as taste, smell, and pain. All these stimuli—whether they are thoughts, feelings, or physical sensations—are interpreted as sensory input, they travel the same neural pathways, and the body responds with essentially the same chemical reactions. So, from a purely neurological standpoint, emotional pain and physical pain are equivalent stimuli. In fact, I’m now convinced that anxiety is actually the pain. If that sounds crazy, consider this: Most of my patients, when I ask them if they would rather relieve their physical pain or the mental anguish that goes along with it, say they wish to be free of the anxiety. That is the intolerable part.  That certainly was my experience. Am I operating on your pain or anxiety?

Compared to other living creatures, we humans have the unique problem of harboring unpleasant thoughts that are difficult or even impossible to escape from. Each person struggles with anxiety over the course of his or her lifetime, either addressing it or masking it, with varying decrees of success. All the writing does is free you from these repetitive circuits, so that you can redirect your attention and focus on other things. That’s it. It is neither a solution nor a “fixing” exercise. It’s more of a “disassociation” exercise.

The neuroscience research has shown that chronic pain is driven by the emotional regions of the brain. Since writing taps into and releases strong emotions such as anger, blame and anxiety there is “space” for other more positive connections. (1)

Just start the expressive writing

So I ask my patients to begin their expressive writing even before they read my book or dive into my website, and to destroy their written pages immediately after they finish them. There are two good reasons for not saving your pages: First, knowing that no one else will see them, you can write with complete freedom. You do not want to censor any thoughts or feelings, no matter how harsh or otherwise unacceptable they may seem to you. (Research shows that suppressing thoughts can damage the memory center of your brain.) (2) Second, as I mentioned in the last section, the writing is meant only to create distance from your thoughts. For our purposes, analyzing your thoughts and feelings is counter-productive. It focuses your attention on those negative thoughts, which further reinforces the pain-inducing neural pathways. Trying to “fix” yourself is like placing your hand into a hornet’s nest. A pain colleague has succinctly pointed out that holding on to your written words from the expressive writing exercise means you are holding on to your pain.

Certainly many other forms of creative writing are meant to be saved and refined. But expressive writing is only an exercise, to be performed once or twice a day, and its output is to be discarded. If you can’t write, you could record your thoughts audibly, although saying them out loud engages a different set of brain circuits. David Burns, in his book Feeling Good, suggests standing in front of a mirror and verbalizing the self-critical thoughts in your head. Notice how hard on yourself you are. Would you ever talk to another human being that way?

Make it a routine

Consider expressive writing as something you do automatically every day, like brushing your teeth. You’ll find that it’s such a powerful tool that it is habit forming. I’ve made it part of my daily routine, although I confess that sometimes I neglect it. During these periods, within a couple of weeks, symptoms of neurophysiologic disorder (NPD) predictably return. My sleep quality drops, I am more reactive, my scalp itches, my feet burn, and rashes reappear on my wrists. My wife will ask me, “Honey, have you been doing your writing?”

Resistance to Expressive Writing

It is remarkable how resistant so many people are to this simple but profound exercise. There is no cost or risk. It can be done anywhere and it only takes a few minutes. How much time do you spend on your smartphone? Why on earth wouldn’t you do this? I have so many more thoughts on this subject, which I will discuss at a later date; but for now, I have only one question for you: How much do you really want to give up your pain?

1. Hashmi J, et al. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain (2013); 136; 2751–2768.
2. Hulbert J, et al. Inducing amnesia thought systemic suppression. Nature Communications (2016); 7:11003.

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Chronic pain is at an epidemic level, affecting about a third of the adult population. In adolescents, the number of in-patient admissions rose 831 percent over a seven-year period. The reason? Many of these patients are treated for acute pain, when they are really suffering from Neurophysiologic Disorder (NPD). NPD requires a different treatment plan, and it’s one that may surprise you — expressive writing.

Chronic pain is stressful both physically and emotionally, and causes your body to secrete stress hormones, such as cortisol and adrenaline. NPD is a constellation of symptoms that occur after these hormones run rampant in your system. Over time, each organ system will either respond or shut down, resulting in disruptive physical symptoms.

Researchers see physical evidence of NPD when they look at functional brain MRI scans. In a study published in 2013, researchers looked at scans of patients who had acute back pain—pain for less than three months—and compared them to patients who had suffered chronic pain—for ten years or longer. The scans demonstrated that within 12 months of the onset of pain, the “driver” of the pain sensation switched from the acute pain center of the brain to the emotional center of the brain. (1)

Writing Separates You From Your Thoughts

Treatments that target acute pain only address the physical aspect, so they aren’t effective for someone with NPD. Patients with NPD have permanently imbedded pain pathways that need to be “disrupted” and “relearned.” They cannot be unlearned—it would be similar to trying to unlearn riding a bicycle.

Fortunately, if you follow the sequence below, you can creating alternate pathways:

1. Awareness: Become aware of the effects that these disruptive pathways have on your body and nervous system.
2. Separation: Create a space between these stimuli and the automatic responses. You have to let go in order to move forward.
3. Reprogramming: The essence of cognitive behavioral therapy. Reprogramming fits in alternatives in the space between you and your thoughts that was created with the writing

And this is where writing comes in.

Expressive Writing

Writing separates you from your disturbing thoughts, so it can be used to help you let go. We are not our thoughts! When you create space between you and your thoughts, you can become connected to a bigger vision for your life—you are more than the pain you feel. Writing helps to reprogram the nervous system, so you can respond more appropriately to pain.

The first step is engaging in what I term “expressive writing,” and it’s an essential step in the process. It simply involves writing down any thoughts on a piece of paper and then destroying it. You destroy your text as a way to give you complete freedom to write whatever is on your mind. The more specific you can be, the more effective the writing process will be for you. The other reason to destroy the paper is to NOT analyze your thoughts. You are just directing more attention to them and reinforcing them. You are just separating from them; not fixing them.

I have seen many patients heal just by doing a version of this basic exercise. It was the first tool that I used to pulled myself out of a 15-year tailspin of chronic pain, so I know it works. The effects of expressive writing have also been well documented in the medical literature.

There are some general guidelines regarding how long you should write. My general recommendation is once or twice a day for five to twenty minutes. I view it as similar to brushing my teeth.

I have been writing like this for over 15 years. For many years, I wrote daily and now I write three or four times a week. Whenever I have stopped expressing my thoughts on paper, my symptoms recurred with two to three weeks.

Expressive writing is a remarkably effective tool, especially considering how simple it is. Try it and begin your healing. The Dangers of Positive Thinking

1. Hashmi, JA et al. Shape shifting pain: chronification of back pain shifts representation from nociceptive to emotional circuits. Brain (2013); 136: 2751-2768.

Warning: Please note that most people do experience an early decrease in mood and sense of well-being. Pain may also initially increase. This is not a bad prognosis for a long-term beneficial effect. It is recommended that you limit the writing to about 20 minutes per time until you are feeling better. If you feel too uncomfortable, stop the writing immediately and contact your physician or mental health professional.

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Trying not to think about something will cause you to think about it more. All of us know this phenomenon but we don’t know how to deal with it. The deadliest emotion we suppress is anxiety. It is a survival response and our whole being is repulsed by it. Prolonged exposure to raw anxiety is the worst part of the human existence. It is a universal problem that few people want to admit to much less discuss.

Nate

A few weeks ago, I was discussing the problem with one of my best friends, George. He has an 11-year-old son, Nate, who is personable, athletic, good-looking, and has many friends. He has a wonderful family life. George has engaged his family with many of the principles of dealing with Neurophysiologic Disorder. (NPD) One of the exercises is the writing down of his  thoughts and throwing them away. Recently he suggested that Nate draw a picture of himself with these thoughts.

He showed me the drawing. It was brutal. “I am ugly. I have no friends. No one likes me. I am stupid.” The list went on for 15 thoughts that were equally as negative. How could this be? He is living a childhood that remarkably rich and supportive. It reinforced to me that every human being struggles with disruptive thoughts.

Harvard study – white bears

In 1987 Dr. Daniel Wegner, a Harvard psychologist published a paper, The Paradoxical Effects of Thought Suppression. (1) The experiment is commonly referred to as “White Bears”. He asked a group of students not to think about white bears. He designed it in a way that demonstrated that when you try not to think about something, not only do you think about it more; you think about it a lot more. He used the term, “trampoline effect.” He pointed out in an essay; The Seed of our Own Undoing, that simply writing down or saying the thoughts you are suppressing interrupts the phenomenon.

“ANTS”

David Burns in his book, Feeling Good (2) uses a term he calls “ANTS”, which stands for “automatic negative thoughts”.  These ANTS are a universal part of the human experience. Since I picked up his book in 1990, I have always wondered why we don’t have “APTS” or “automatic positive thoughts.”  WE DON’T SUPPRESS POSITVE THOUGHTS.

Pain, ANTS, and white bears

People suffering from chronic pain lose their sense of humor. Pain causes anxiety and when you are it, extreme frustration and anger will run your life. Anger results from loss of control. What causes the need for control is anxiety. Anger is just anxiety on steroids. One step worse than suppressing anxiety is suppressing anger. The eventual outcome is rage. My term for the darkness that consumes my patients in pain (and historically me) is the “Abyss.”

There is a solution

I have learned that pain, anxiety, and anger are classic symptoms of the Neurophysiologic Disorder (NPD). Dr. John Sarno first described it in the 1980’s under the term, “Tension Myositis Syndrome” (TMS).  (3) There are least 30 other MBS symptoms connected to and caused by the nervous system. (4) The nervous system component is NOT psychological it is a programming issue. Like any learned skill such as riding a bicycle these pathways are permanent.

Anxiety is a physiological reaction to sensory input of any kind including thoughts. It results in behavior that causes you to react in a way to protect yourself. You can talk about it all day long, but you cannot get rid of anxiety whether it is from a  mental or physical source. It is a symptom of NPD.

Fortunately your conscious brain focuses on one thing at a time. That is why we are not safe texting and driving. When your mind is here it is not there. By creating alternate pathways around your fixed circuits, you can shift your nervous system into a new set of pathways. Additionally, we now know your brain can grow new nerve cells at any age. The term is “neuroplasticity.” At a certain tipping point your pain pathways will become dormant. The switches are turned off. Anxiety and anger also will dramatically drop.

I experienced 17 of the 33 symptoms of NPD disappear. I not only have my life back, but I also have a new life.

Connecting thoughts with physical sensations is one way of creating new pathways. One foundation of treating NPD is the simple the act of writing down your thoughts and immediately throwing them away.

Patients won’t write

But I often cannot persuade my patients to begin this exercise. It’s the necessary foundational step of the reprogramming process, which is to create an awareness of these ANTS. The thoughts can be positive or negative. I have my tear them up both to write with freedom and not to spend any time analyzing them. This exercise is only a separation process from your conscious thoughts.

Regarding the negative thoughts that arise, my patient’s first response is, “This is not who I am.” That is correct. These thoughts are not who you are. They are JUST neurological connections and the opposite of you who are. Otherwise, you would not be suppressing them. You are only giving them life by blocking them. Your brain will develop wherever you place your attention.

We all know that being reassured that our hidden thoughts aren’t valid does not make them disappear. I could collect dozens of signatures and testimonials from Nate’s peers and give them to him. He could win a “greatest human being contest” along with a big trophy. How would that work? I predict, based on my personal experience with NPD, the next set of thoughts would be centered on, “They don’t really know me.”

Possibilities

What if we could teach these simple writing exercises to our children in pre-school? We would have a shot at solving chronic pain at a societal level.

References

1. Wegener, D.M., et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.
2. Burns, David. Feeling Good. Avon Books, Harper Collins, New York, NY, 1999.
3. Sarno, John.Mind Over Back Pain. Berkley, 1999
4. Schubiner, Howard.Unlearn Your Pain. Mind Body Publishing, 2010.

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The post Inability to Escape from Our Thoughts appeared first on Back in Control.

There are multiple physical and mental manifestations of a chronically fired up nervous system. With engagement of the principles that calm it down, the improvements in my patients’ quality of life are consistent and frequently dramatic. The foundational step continues to be the writing exercises. I don’t know all of the reasons why it is so impactful, but its effectiveness has been documented on over 2200 research papers published since 1986.

Stimulating neuroplastic changes in the structure of your brain is key to healing. However, you must continually be aware of the impact of your past experiences on today’s actions. Then you are able to redirect and program your nervous system in the direction of your choice.

Reprogramming

There are three aspects of the re-programming process:

• Awareness
• Separation
• Re-programming

Most of us seem to be fairly enmeshed in our past, and it affects much of our current behavior. We all have many past negative experiences to process, and we do our best to deal with them. Strategies include:

• Suppressing
• Analyzing
• Ignoring
• “Re-writing” it
• Escaping through addictions
• Pursuing self-esteem

The expressive writing allows you to combine awareness and separation

Brain circuits are permanent

You cannot change the past, or the neurological connections to it. Memories may fade with time, but once a given memory is retrieved, it is completely present. Our inability to alter the past certainly doesn’t keep us from expending tremendous energy in trying to do so. It is more effective to connect and be with the past, and then release from it.

The Train

Picture a long completely loaded freight train. It’s impressive that engines have been developed to pull that kind of a load; even up a significant incline. It isn’t dissimilar to how we drag our past into the current day and can still function.

The writing exercises allow me to disconnect from the past—immediately. It creates an awareness of what is contained in the “train cars of my life”. The space created between the thoughts now on a piece of paper and me is the separation process. It’s as if I simply unhooked the first car from the engine.

Who Says I Have to Pull this Load?

There is no rule of life that says I have to stay connected to that huge load. And I still have the same power of the engines that is now pulling NOTHING. The available energy to be creative is almost limitless. I just regret that there is a physical limit to what my body can take.

Being “unhooked” from that load allows me to use the tools I have learned to more fully engage in the present moment, which is the re-programming part of neuroplasticity. The tool I use the most is “active meditation”. That is choosing a physical sense to become as aware of as much as possible throughout the day. I tend to choose sound or food at mealtime.

Writing Seems to be a Great Foundation

There are now over two thousand research papers documenting the effectiveness of various writing exercises creating a separation from these unpleasant neurological circuits. I still haven’t seen anyone be that successful without using the expressive writing as the foundational step.

Leave the past behind you—now. You can spend a lifetime trying to unload the freight in these cars, or you can take a few minutes to disconnect from it.

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“Not much I can do”

I prepared to walk out the door and have her referred to a primary care physician. He or she could offer some basic care such as medications and physical therapy. But I did not know a way to have this quickly done, and she seemed like she was in a crisis. I turned around and walked back into the room realizing that at least her husband spoke some English. I spent about 20 minutes explaining the relationship between pain and the central nervous system’s response to it and gave them a copy of my book. I asked both of them to at least engage in the expressive writing.

Surprisingly, she and her husband returned. She could walk and conversed with me through the interpreter. Her whole body still hurt but she felt a little better. Her husband had not really engaged in reading the book. I was encouraged by the little progress, but I felt that if I was going to teach her anything about chronic pain, it was going to have to be done by me in the office through the interpreter. I spent about a half an hour going through the relationship between pain, anxiety, and anger. I again asked the husband to assist her in learning and translating the concepts. I also requested that she further commit to writing down her thoughts and immediately destroy them.

It was anxiety

They returned two weeks later and her pain was markedly improved. As I talked to her it became crystal clear that she was being tormented by extreme anxiety. She stood in the opposite corner of the room with her arms wrapped around herself and her whole body was quivering with fear. They had decided to move their family back to Puerto Rico so she could be with her mother. I realized that this was the last chance to turn this around.

I explained to her that although she might have a temporary decrease in her anxiety, she was not going to completely outrun it by being around her family. It was fine to move back home if that was what she wanted to do. If it was to escape anxiety, I felt that was a bad idea and it would follow her. I became very blunt with her and her husband about the whole situation. He needed to engage. She needed to address her anxiety as its own issue and commit to the writing process. I re-explained some of the central nervous system concepts. I was fairly sure they were headed back to Puerto Rico.

Better

Two weeks later they returned. She and her husband were both smiling. Her pain and anxiety were much better. They were not moving to Puerto Rico and were excited about how the situation was turning around. Her husband was more engaged and she had pursued her expressive writing with a vengeance. It had been extremely helpful. Her husband’s comment was, “I have my wife back.”

I have no illusions that she is yet home free. Recovery is not a straight-line endeavor.  But she now had tools and more importantly—hope. Her problem was not chronic pain; it was anxiety. I did not order any tests. I prescribed some medications for sleep and pain. I spent about two hours of my time talking to her. She engaged in the simple but powerful tool of expressive writing and has a high probability of continued improvement.

Back in action

What is this worth? There are two adults and two children in this family who have a higher chance of being contributing members of society. There is less family stress, which improves the behavior of the children, who are going to school with your children. The wife has a better chance of being an effective mother and getting back into the workforce. Minimal medical resources were expended and less will probably be spent in the future.

Four lives affected. Minimal medical resources expended. With her severe language barrier, writing down her anxieties was her only choice of tools. This occurred relatively early in my presenting the DOC process to my patients. I did not anticipate this outcome. Treating chronic pain has become one of the most rewarding parts of my practice.

BF

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Associations

Riding a bike does represent a new level of freedom similar to learning to walk and drive. For most of us it becomes connected with an innumerable number of life experiences – both positive and unpleasant. Regardless of my thoughts about wanting or not wanting to ride a bike, the skill is a permanently embedded set of neurological circuits.

You can’t unlearn how to ride a bicycle. In fact, you can’t eliminate any of the past experiences from your brain. They just become more difficult to pull up over time. The past can be triggered by a word, comment, or image. Pain is a more intense set of pathways that become tightly connected to your life experiences. The current definition of chronic pain is “…….. it is an embedded memory that becomes associated with more and more life experiences and the memory can’t be erased.” (1)

Reprogram

So you are stuck with deeply ingrained pain patterns and the more attention you pay to them by trying to fix them just reinforces them. It is a miserable state of affairs. What are you going to do?

The key is utilizing the brain’s capacity to change. The descriptive term for this phenomenon is “neuroplasticity”. You can’t control your brain but you can direct it. You have a choice every second regarding what you want to put into your brain. The first step is is become aware of what is. Just awareness begins to create change. Then you create space, which can be accomplished with expressive writing or meditation. Then you’re able to re-direct.

This video, The backwards bicycle, illustrates another process of disrupting circuits by changing sensory input. It also illustrates the complexity of the unconscious brain. Many interactions have to happen simultaneously in order to ride a bicycle. You can’t force your brain to change but you can stimulate it.

1. Mansour AR, et al. Chronic pain: The role of learning and brain plasticity. Restorative Neurology and Neuroscience (2014); 32: 129-139.

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I talk about how the suppression of negative thoughts associated with chronic pain can really fire up the nervous system.  Dr. Daniel Wegner from Harvard published an elegant paper in 1987 demonstratng the impossibity of trying to suppress thoughts. I’ve talked about it before in White Bears and ANTS.

BF

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In response to a debate regarding an orthopedist’s role in dealing with mental health issues David Burns wrote me this letter. I have seen consistent and profound results with just having my patients use his book in addition to the free writing of thoughts. It is self-directed by the patients. My role has been making my patients accountable to fully engage in using his tools. Whenever possible I do work with pain psychologists who have added wonderful dimensions to my patient’s care.

David Burn’s Letter

Thanks so much. There is evidence based on quite a bit of research that reading Feeling Good: The New Mood Therapy can have significant antidepressant effects. Dr. Forrest Scogin has reported (based on numerous controlled outcome studies published in Journal of Consulting and Clinical Psychology and other journals) that approximately 2/3rds of individuals seeking treatment for a major depressive episodes will be substantially improved or recovered within four weeks if they are given a copy of Feeling Good, with no other treatment offered during this time. Those patients did not need any further treatment, and maintained their gains during 3-year follow-up studies.

It is certainly not a panacea or cure-all, but does seem to help many people who are struggling with depression and anxiety. Some, of course, will need more than just a self-help book.

There are many techniques and ideas in Feeling Good, and there has not been much research on what the effective therapeutic “ingredients” might be. Research indicates that this is not a placebo effect, since a placebo book was not effective in a controlled study.

In my own research in clinical settings, we have seen that doing psychotherapy “homework” (such as reading Feeling Good between sessions, recording automatic negative thoughts, and so forth) does seem to have profound antidepressant effects.

All the best,

David D. Burns, M.D.

Adjunct Clinical Professor,

Department of Psychiatry and Behavioral Sciences,

Stanford University School of Medicine

The post David Burn’s Letter first appeared on Back in Control.

The post David Burn’s Letter appeared first on Back in Control.

Both the unpleasant physical pain impulses and your thoughts about your situation are pounding away at your nervous system are causing the secretion of stress hormones and you feel anxious and frustrated. These chemicals compound the problem in that they sensitize the nerves and you feel your pain even more.  There is a single general area of the brain that causes you to feel anxious and frustrated, which means that there is an intersection of pain, anxiety, and anger.

Additionally, we have other sources of anxiety and frustration. Pain sets off anxiety and anger, but so do other stresses. They are now are connected to the pain pathways. When you are under a lot of stress and experience more pain, it is NOT  imaginary pain or “psychological” pain.  These pathways are now just linked together. Neuroscientists have a saying, “Neurons that fire together wire together.” It is this connection between pain, anxiety, and anger that I call “The Terrifying Triad.”

My patients that work with the DOC process become quickly aware of this connection. It is clear that when other stresses rise past a certain point, there is a corresponding increase in their pain. It is unfortunate that the severity of the pain can be so severe that I frequently feel compelled to reorder expensive diagnostic tests, which rarely reveal anything of significance.

One final thought about the intersection of these pathways.  Even when I can surgically remove the source of pain, I think there is a permanent elevation of the intensity of these anxiety and frustration circuits. There is no reason they should dissipate, as there are so many other reasons for these pathways to remain stimulated. I feel that chronic pain is such a terrible experience, the elevation of anxiety and anger is often extreme.  Calming these pathways requires specific strategies that are outlined throughout this web site.

JYR, BF

The post The Terrifying Triad first appeared on Back in Control.

The post The Terrifying Triad appeared first on Back in Control.