Category: Articles

Kia Kaha Does Not Cut It After 15,000 Earthquakes

Next time you are on a break, give this breathing practice a try (follow-up with optional beer). You will feel calm within three minutes. You can do it anywhere. You can do it dozens of times a day.

Do not be one of those people who melts down after six months like I did.

This post started life as a letter to those of us in the central South Island of New Zealand who suffered yet another major earthquake last week. I suppose it could be applicable to anyone else in the situation of an ongoing disaster, natural or otherwise.

An Open Letter

Dear fellow earthquake survivors,

Last Monday’s huge earthquake was a traumatic event. I do not use that word lightly. Trauma is a thing, and today I am going to write a bit about the challenges of earthquake trauma in particular. I have tried to keep it brief but that has not been easy, so please read the whole thing before you react.

Towards the end you will find an example of the sort of habit that will help you get through — long-term. It is how I eventually learned to find some calm during a time when it seemed impossible: the Christchurch earthquake sequence that started in September 2010.

This is not a comprehensive guide to coping with trauma. The knowledge in here will not be relevant to everyone.

I wish I could offer more, but I was unable to avoid becoming overwhelmed myself. All I have is what I learned by trial and error. This post is offered so that you may not have to repeat my mistakes. Read on.

Responding to Threats

The first thing you learn in the aftermath of a large earthquake is that they are not a one-off thing. By now you will know this. Aftershocks go on for months or years, and can be as bad or worse than the first event. With every new rumble from the earth comes the inevitable thought: “is this one going to get worse?” There is an ongoing situation where your life could be threatened at any moment, even while you are asleep.

Common wisdom goes: the less we buy into this threat, the more we will be able to respond to it without losing our shit judgement. This strategy often works. Unless you have suffered medical shock (a whole different ball-game), you have probably come through the last few days feeling more alert, more able, and more resilient than you do in normal life.

I’ve been there. For the first few weeks after our big one, I biked around Christchurch (the roads were impassable for cars) with a backpack full of hand tools. I checked on friends, family and neighbours. I helped make roofs weather-tight, shoveled liquefaction, and took too many photos. I kept my mum company. I visited churches and monasteries of all religions. This was all over town. I biked twenty to fifty kilometres every day. I felt strong and able-bodied.

Your body has a natural response that gives you a survival advantage through hormonal changes. This response is known as fight-or-flight, and you have probably heard of it. It makes you feel wired, ready to attack the nearest problem, or run away from danger, or both (hence the name).

Handy? Totes — for the short-term.

Living With Ongoing Threat

But the aftershocks grind on. The roofs leak less for a while, but they spring open again next time the ground shakes. People are still afraid. Although the frantic pace of repair-work eases back just a little, you start to realise how much has been lost.

My mind raced all day until late at night. In the mornings, I woke bone tired, but by evening I was so hyped that I could not sleep.

I started getting ill a lot, colds and flu in summer time, which interfered with my building apprenticeship. I found it harder to concentrate when working my other job. And despite still biking twenty ks every day, I started gaining weight.

While hyped up after a big aftershock, I would say “let’s do something to take our minds off it. Let’s have a BBQ”. And I would call up my mates.

What I had yet to learn was that insomnia, immune system slowdown, low libido, digestive problems, memory and concentration problems, and weight gain are all textbook features of ongoing chronic trauma. These are things you do not want.123

When February the 22nd came along, I was in the CBD, near the CTV building. I assisted for a while but had to leave and run to my son’s school, where they were trapped on the fourth floor. Too many needy causes. Once he was safely evacuated, my son and I abandoned the Kombi in a carpark due to gridlock, and walked out of town. That evening, I broke down in tears. My son was asleep and didn’t have to see it, thankfully.

I took time away from my jobs and we both headed for Golden Bay. Eventually this led to me being unemployed for a few months.

What went wrong?

In the months following the first 7.1 quake, the bumper-stickers read “Kia Kaha Christchurch” and “We’ll be back!”. This seems like a good sentiment for recovery; to make a stand, despite what had happened. Unfortunately, it did not take into account what was still happening. It assumed the threat had passed and it was time to pick up the pieces. That was naive.

In our case, the threat had not passed: large earthquakes are not a one-off event. I told myself that the probability of another large one decreased with each passing day. But as each pulse of shaking thrummed through my living room, or kicked me where I lay jacking up piles, I could not help the fear: will this one get worse? The familiar rush of energy would catch fire in my belly and burn into my chest. Big ones left my lungs bursting, my face flushed, my hands trembling.

Kia kaha did not cut it in the face of this ongoing threat to my life and loved ones. In fact, it had stopped working long before I realised.

I interpreted “kia kaha” to mean staying committed to my job, having goals, finding ways to have fun despite what had happened, and being a support to others. But when I left work for the day, what my nervous system actually wanted was safety and familiarity, not another social outing or support call to struggling family. I needed to put something back in my own tank.

Soothing

“Soothing”. It is not a word we associate with being resilient. If you are like me, there will be a kind of namby-pamby sound to it in your ears. That is a shame, because unless you vacate the region, you are in this for the long haul. It will be a busy time. Yes, you will need to keep your friends and family close; they will need your support and you will need theirs. Yes, you will need the odd blow-out from time to time. But your chances of coping will be much better if you add something that soothes your nerves, not pushes them further. You need to balance out your body’s crisis reaction.

Here in Christchurch it is six years later and finally there is a glimmer of rebirth in the CBD. You might be able to kia kaha without stopping for six years, but I could not. I barely lasted six months.

So What To Do, Then?

Most importantly, look for symptoms of fatigue in yourself and others. This is the best thing you can do to support your loved ones and neighbours. Signs to watch out for are trouble finishing sentences; tremor, tics and shaking; cravings to smoke, drink, or eat takeouts; losing hair, going grey or gaining wrinkles in the course of a few weeks; behaviour like repeatedly snapping at people or crying if that’s out of character. Thoughts interrupting one-another. Trouble sleeping, even when you’re exhausted.4

You may notice one or many of these in yourself or others over the coming weeks and months. The earlier you catch them, the easier they will be to shift. When they mount up for months like in my case, they become integrated into one’s neurology and harder to unravel.

They can indicate emotional, intellectual or physical exhaustion. Maybe all of them; it doesn’t matter. The important thing is what you do about it.

Stop on a dime

You need a practical way to unwind at the drop of a hat. In my case the most useful habits did not turn out to be the hour-long+ yoga and T’ai Chi classes that I attended. Those were an important part of my learning, and if something along those lines interests you, then I recommend adding them to your routine. But amidst a sequence of natural disasters, they were ultimately of limited practical use outside the studio or training hall.

I needed something I could roll into my days, so I could stop whenever I had a chance during daily life, take five and regroup. Something quick and reliable that I could use in the middle of endless roadworks, that wouldn’t take years to master.

The best example I have found is the simple breathing practice below. This for me was key.

A Simple Breathing Practice: Lengthening the Exhale

Next time you are on a break, before reaching for your smartphone, or a beer, give the below practice a try (and then have a beer). It is so simple, you will wonder what the point is — more on that soon. But partly because it is so quick and simple, it is also surprisingly effective.

You will feel calm within three minutes. You can do it anywhere. You can do it dozens of times a day.

  1. If preferred, find a private place (eg., bathroom, bedroom, or your car) so you do not feel self-conscious
  2. Make your exhales long — twice, three times or four times longer than your inhale:
    • Do this by blowing out between pursed lips like you would blow out a candle — slowly, in a thin stream of breath, without force.
    • At the end of each exhale, hold your breath out for a few moments. No air in your lungs.
  3. Do this for three to five breaths, or keep it up for a few minutes.

This practice will not unwind the entire stress of a shitty situation back to zero; but hey, nothing is perfect. It might still be the difference between making rational decisions or losing the plot at someone.

Do not be one of those people who melts down after six months of stoic endurance like I did.

There is a cumulative benefit from doing it frequently. Once every few days will not be enough. Aim for every couple of hours. That will make a difference.

How it Works: The Vagus Nerve

Lengthening your exhale like this reduces the urgency of your next inhale. More specifically, it increases the tone of your vagus nerve.

The vagus nerve is part of your body’s involuntary (or “autonomic”) nervous system. The involuntary system is separated into two branches: the sympathetic nervous system controls your body’s fight-or-flight response, while the para-sympathetic nervous system provides a natural counter-balance.

Your vagus nerve forms the main part of the para-sympathetic side of things. It is also the largest nerve of the whole autonomic nervous system, either branch. It runs from your brain down your neck and through your diaphragm. It communicates with all the major organs and glands in your torso — your heart, intestines, kidneys, liver, stomach, spleen, you name it; with one exception. It does not influence your adrenal glands. They are a tool of the sympathetic nervous system alone. 5

Lengthening the exhale in this way is a gentler form of the Valsalva manoeuvre, which stimulates the vagus nerve 6. This promotes three main neurological states that counterbalance the trauma response:

  • “rest and digest” (creates gentler breathing, slower heart rhythm, effective food breakdown and greater nutrient absorption)
  • “feed and breed” (fosters a healthy appetite in more ways than one)
  • “tend and befriend” (instincts around looking after friends and making new friendships)

These are the neural opposite of the fight-or-flight response. Without them, all that busy activity in the next few months will come at a high cost.

Good tone of the vagus nerve is also linked to heart-rate variability, which is an important marker for health and stress levels 7.

Practices that promote “rest and digest” down-regulate production of stress hormones, giving your body a break and the chance to find a new equilibrium.

Repeated often enough, it will make a lasting change on how you are able to bear up. Consider it an investment.

Final Tips

  • Don’t wait until a quiet time for this, or let’s face it you’ll never get there. Tell those nearby “I’m going to take three minutes” and just go for it. They’ll soon be copying you.
  • It’s better if you can sit or lie down; setting aside even just three minutes to unwind is part of the benefit. But you can also do it while moving around if resting is not an option (e.g. in the shower, while working). You might not notice the effect so much but it’ll still be there. And every little bit helps.
  • Have a glass of water afterwards (and chase it down with a beer if you want 🙂 ).
  • Repeat often! (Familiar theme yet?)
  • I just found a similar take on this technique at Mind Body Green 8. There isn’t much new there that I haven’t already covered but you can go ahead and use it for fact-checking if you want.

  1. Textbook of Functional Medicine. The Institute of Functional Medicine. Gig Harbor, WA. 2010.↩

  2. Cortisol (Wikipedia)↩

  3. Chronic Stress (Mayo Clinic)↩

  4. I KNOW!↩

  5. Vagus Nerve (Wikipedia)↩

  6. Valsalva Manouevre (Wikipedia)↩

  7. Measuring Compassion in the Body (Berkeley University of California, 2015)↩

  8. A Simple Breathing Exercise (Dr. Robin Berzin for Mind Body Green, 2012)↩

Relax and be gentle for your brain health

In the course of their normal duties, every cell in our body creates waste byproducts. Just left-over bits of molecules that have been partly used and then discarded. Like microscopic bread crusts. One of the purposes of the white blood system (also known as lymph) is to remove these waste byproducts — just like stormwater drains in a city.

Revealed: The brain’s sewage system

Did you know that this white blood aka lymph has it’s own vessels, similar to veins and arteries, that carry it around the body? Among other jobs, lymph percolates through our tissues and then collects in tiny vessels (like gutters) where it is channeled into larger ducts and eventually joins up with the red bloodstream.

Every part of the body has lymph vessels, except the brain. Curiously enough, until recently no one knew how, or even whether, the brain could get rid of the waste that it creates every day. This is important because the build up of waste products in the brain is known to be the primary cause of degenerative diseases like Alzheimer’s and possibly Parkinson’s.

Now we’re coming to it.

In 2012, scientists discovered that our brains do have a waste-removal system, but it’s entirely different than the rest of our body. Instead of using separate lymph vessels, the brain trickles its waste metabolites along the outside of tiny blood vessels in the brain.

That’s just weird if you ask me. But even stranger, some other scientists have now discovered that what drains the brain of waste is not just a passive trickling effect. It turns out that tiny “smooth” muscles in the brain’s blood vessels help to squeeze the lymph along. Also, the pulse of tension and release while we breathe acts like a pump to shift the brain’s white blood, or “glymph” as it’s now being called, along the tiny blood vessels of the brain to sites where it can be returned to the (red) bloodstream. [2]

Now here’s where gentleness comes in: both of these forces (smooth muscle contractions and breathing) involve a complex dance between parts of our involuntary nervous system — the part of our brain, spinal cord and nervous system that we don’t consciously control.

Fight or Flight vs Rest and Digest

You’ve probably heard of the “fight or flight” reaction — a state of high alert that we all can access in the presence of danger. That fight or flight reaction is initiated by our involuntary nervous system. But the involuntary nervous system also has another trick it can play: what is often called “rest and digest”, the opposite of the fight or flight response.

Now say you are biking to work when the car next to you swerves to avoid an obstacle and is now encroaching on the bike lane, directly threatening to knock you over. The fight or flight reaction is important in times of emergency like this. However Stephen Porges, PhD, in his breakthrough work, has shown that despite these kind of emergency situations being pretty rare in our lives, many of us are actually in a state of ongoing fight or flight for most of every day. Some of us are even in this state from the moment we wake up to the minute we try to sleep. [1]

Adapting ourselves to avoid the fight or flight instinct is perhaps the best way to improve the “tone” of our involuntary (aka “autonomic”) nervous system. When we are able to be gentle, the smooth muscle contractions in our brain’s blood supply can function more effectively to remove waste. It also allows our breathing to slow and become more subtle, removing the knots of tension that interfere with the pumping action of breath on our brain’s waste system. We are not talking about deep breaths or even slow breaths. Maybe you already have noticed the natural breathing that you have on waking, but if not then try tomorrow morning — that will give you a taste of the brain-health-promoting nervous system state of rest and digest that we are aiming for here.

As the video explains, improving the tone of our involuntary nervous system just turned out to be crucially important in our efforts to stay healthy and mentally alert as we age. We can thus add brain health as another benefit of gentle, non-striving yoga, meditation and short moments of rest throughout the day.

Far from making us “weak”, softness builds strength and the ability to remain pliable, not just in body but in our brain and mind as we age, adapting quickly when faced with trouble. The science behind this just got a bit more solid.

[1] Stephen Porges, The Poly-Vagal Theory, http://stephenporges.com
[2] New Scientist, Best Look Yet at How our Brain’s Sewage System Flushes Out Waste, https://www.newscientist.com/article/mg23130864-200-best-look-yet-at-how-our-brains-sewage-system-flushes-out-waste/

Pain Trivia Learned from Neuroplastic Brain Hacking for Persistent Pain

Unlike a simple sense impression such as taste or smell, pain seems to be a fully-fledged, mind-body experience. We don’t just feel pain — we are gripped by it almost like an emotion or mood. How does that happen? Does pain always correlate with injury in the body? I’ll try and keep this short, and as jargon-free as possible!

Fancy a warm day at an idyllic beach. Wading towards the shore after a long leisurely swim, gazing around at the sunlight on the waves, you unexpectedly stub your toe on a submerged rock. Let’s use that example to analyze what’s going on as you suddenly find yourself dealing with a flurry of unpleasant feelings.

Nociception

I know, you’re like noci… wha?? Jargon straight up! Don’t stress — I never heard this word until a couple months ago either. But this is the only jargon for the whole article, ok? Bear with me …

Roughly speaking, nociception is the name for the pain signal before it reaches the brain. Interestingly enough, nociception itself does not cause much of a reaction in the area where the injury happens.

In the case of your accident at the beach, it is not until your brain receives a signal from the toe, that any kind of response begins to take place.

Nociception vs Pain

When we get a signal that “something hurts”, how does that expand into such a rich experience that all or most of our concentration and our emotions are suddenly turned towards it?

Well, as soon as your brain receives the nociception signal it does some trickery to figure out how bad the damage is (if you just scratched yourself or if you cut yourself deeply). It also looks into where the signal is coming from and how easily damaged that area tends to be (if you stub your toe it hurts more than if you hit your arm).

You’re already starting to feel things in a context that is more than just simple nociception. Next up perhaps memories will crop up of the last time you stubbed your toe, you’ll lift your foot out of the water and examine it closely. Your eyes and visual parts of your brain will be processing all those images. If you’re like me you’ll be wondering if anyone has noticed and if you perhaps look a trifle silly standing on one leg in the water with your other foot held up in front of you. You’ll be trying not to topple over.

Our mind has gone from soaking up the summery day, to a more active state. After the initial fast signals, the toe is now sending slow throbbing nociception signals to our brain, and every time a new throb reaches our brain, it goes through that whole activation state again. It returns our focus to our foot from whatever else might be going on. Now we are experiencing pain.

What’s interesting is that nociception and pain can be experienced separately. While normally of course, nociception does lead directly to an experience of pain, in some cases it is possible to experience great amounts of nociception but to be in an entirely pain-free state. This is sometimes noticed in cases of “massive trauma” [2] by paramedics in victims at the site of a car crash.

The opposite is also possible, for example when “individuals with functional pain syndromes report considerable anguish in spite of having [no measurable -nociceptive activity]”. [2]

Pain as a Perception

These understandings and many more led Ronald Melzack, a Canadian who studied phantom limbs and pain, to refer to pain as an “output of the central nervous system”. (Ok, a tad more jargon. “Central nervous system” is a medical term for the brain and spinal cord.)

What Melzack is saying here is that although pain does start starts in the site of injury, it is not until it is taken into the central nervous system and evaluated as being important enough to warrant attention, that the pain begins to intrude on our thoughts and emotions. This is more like a perception, where we are not just receiving sensory input but thinking about it and evaluating it.

Although this may seem quite obvious, you can see that rolling all of this together and calling it “pain” turns pain from being a simple realisation that “something hurts” to being the full mind-body response to an incident of nociception, and not just the nociception itself. Linking it all together like this is the only way to explain complex pain syndromes like those outlined above, or in the case of a phantom limb causing pain, where the pain persists in the brain long after the nociception has ceased.

The particular brain regions that are involved in taking up the call of pain, on behalf of the nociception from the site of injury, in order to generate this “output” are many. Moskowitz identifies no fewer than sixteen different brain regions! [3] and [4] Many of these are connected with our emotions and our thinking patterns, and others are connected with our body’s most basic self-monitoring and survival systems.

This explains why pain can be such a distressing experience, and why we sometimes shrink away even from the thought of hurting ourselves. The emotional centres of our brain are anticipating our potential distress and creating aversive reactions before the pain has even happened, by simulating the pain independently of receiving any actual nociception.

Conclusion

I’ve found this knowledge to be the start of a whole investigation into the nature of pain. Knowing that pain is partly to do with how I evaluate it, and not just a result of being told “something hurts” by my body, has been quite an eye-opener for me.

I hope you’ve found it interesting too. If so be sure to like my Facebook page or follow my blog for more updates. I write about wellbeing and mindfulness, with a few creative pieces thrown in from time to time.

Further Reading

Here are some useful links I’ve found while reading about pain theory.

How do our brains process pain? contains a good introduction with some diagrams.

And there’s way more to be learned from this How Pain Works at HowStuffWorks.

[1] Melzack, Ronald. “Gate control theory: On the evolution of pain concepts.” Pain forum. Vol. 5. No. 2. Churchill Livingstone, 1996.

[2] Garland EL. Pain Processing in the Human Nervous System: A Selective Review of Nociceptive and Biobehavioral Pathways. Primary care. 2012;39(3):561-571. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438523/

[3] Moskowitz, Michael MD and Golden, Marla. Neuroplastic Transformation Workbook. pg10-13. https://www.amazon.com/Neuroplastic-Transformation-Workbook-Michael-Moskowitz/dp/0615814654

[4] Doidge, Norman. The Brain’s Way of Healing. Penguin Books 2016. pg 13-14.

Puppy Training, or Why Visualisation Works: Neuroplastic Brain Hacking for Chronic Pain Day 17

What’s so special about visualisation? There are many things that we can focus our minds on instead of pain. Listen to music. Daydream. Do exercise. Develop software. Play. Go for a walk. Have coffee dates. Go to parties. Travel. Trust me, I’ve tried all of the above and more. The list of things is as long as our society’s bewilderingly long list of entertainments. It even goes beyond entertainment: meditation (focus on breathing), yoga, psychotherapy. Then there’s painkillers, ice-packs, massage… Why choose to visualise, out of all these possibilities? How is it any different?

On some level, it’s not different at all. All these things — visualisation included — remove the pain from our consciousness. The difference is, that most items from the above list don’t stop the pain programme from running subconsciously. They push the pain out of our awareness, but that just means the pain signals are received and processed in our brains on autopilot, while our backs are turned if you like. They run unopposed. It is in this exact environment that the pain maps are enlarged through “neuroplasticity gone bad”, until they are running at up to five times the level of sensitivity than is usual for non-persistent “acute” pain.

Visualisation is different because in order to visualise at all, we must engage the very brain regions that are hyper-involved — fivefold — in persistent pain processing. We are not distracting ourselves or ignoring the pain. We are challenging it directly.

Say you have an over-eager puppy at the park. Your puppy is running up to kids and jumping at their face, eating their sandwiches, crapping in front of their mums (bear with me here). She’s generally just acting as she pleases.

You have several choices on how to improve things. You could scold her and tell her how bad she is, give her a smack every time she nears another person. That will get her behaving, but she’ll be scared of you, scared of other people, and eventually the relationship you have with this puppy won’t contain the love and companionship you’re both aiming for. You could take her home and never to the park again, but that would have a similar effect.

You could also take her running around and around the park, to all the trees and the river and back to the playground and around the park again, distracting her until she’s so exhausted that the idea of eating a kid’s sandwich never even enters her mind. Good luck with that. Most puppies have more energy and can run much longer than you can. And as this puppy matures, all you’re going to get is one very fit and healthy animal that can outrun you all day and still jumps up at children, still eats their sandwiches and craps on their picnic blankets (sometimes it might even mix those actions up a little!)

Another option is to put your puppy on a leash, and train it up with little doggy-snacks to come when it’s called, so that eventually you can drop the leash.

In our analogy, the pain is the puppy. Maybe you’ve tried scolding yourself to get rid of the pain, or maybe you haven’t. Chances are though, if you’re in persistent pain, then you’ve tried the distraction tactic — giving your mind so much to focus on that it “can’t” process the pain. Now you’ve got a very strong, fit and healthy network of neurons that you’ve unwittingly trained to outrun and outpace every distraction you throw at it.

Time to get serious and take those neurons to puppy school! Continuing our analogy, the visualisation is the leash. By visualising, we give those neurons something else to do instead of pain processing, just like with the leash we can guide the puppy to stay on the path. When the puppy is on a leash, she can’t run quite so riot. We are not distracting her temporarily, nor punishing. We are training her to do a different job.

Training means being relentless. We train our neural architecture just like the puppy. We even have temporary pain relief that functions like a little snack as an incentive.

Of course, at times puppy will still get ideas about eating duck poo or chasing cats. But because you have not just indulged her with temporary distractions, because you have invested time in teaching her a different job, you can call on that training. Call her back to neutral. And she will stray less and less. Eventually you won’t even need a leash or the snacks.

Your puppy will be trained.

How I Visualise — Pursuing a Cure for Persistent Pain

Nearly two weeks ago I began practising a form of “neuroplastic brain training” designed for people suffering persistent pain. This was in an attempt to resolve neck, head and at times whole-body pain that I’ve been experiencing since being hit from behind by a bus while driving in 2012 (there were two subsequent cases of whiplash and a concussion after that, which have likely contributed to the pain getting worse and not better).

Today I’ll try and explain how I practice the technique every day. Hopefully you’ll see that, despite the seemingly complex theory behind it all, the visualisation is actually quite simple, and even rather beautiful if you use the suggestions in here. There is also plenty of freedom to engage your own creativity when coming up with your own visualisation — in fact, that’s encouraged!

When I first started this technique thirteen days ago I didn’t have a lot of material about it. I had read of the benefits and some pretty useful discussions about attitude in Doidge’s book [2]. But there were no actual images of what to be picturing in my mind. Instead, for visual specifics, all I really had to go on was a single paragraph:

“[Moskowitz] visualised the very brain maps he had drawn, to remind himself that the brain can really change, so he’d stay motivated. First he would vbisualise his picture of the brain in chronic pain — and observed how much the map in chronic pain had expanded neuroplastically. Then he would imagine the areas shrinking, so that they looked like the brain when there was no pain.” [4]

Not willingly idle while awaiting Moskowitz’s book from Amazon USA, I went ahead anyway and did it kiwi style, as the first ever entry in this Chronic Pain diary explains. [1]

I figured, “well, I’ve seen pictures of fMRI scans online. I’ll just Google some of those and play around with them visually.”

I knew from Norman Doidge’s book [2] that it doesn’t matter at all what you visualise. The whole point is, that by visualising anything — anything at all — we engage brain regions that are involved in both pain processing and visual imagination. By bigging up the visual imagery, we dampen down the pain, goes the logic. Eventually, through thought stimulation, we rebuild the anatomy in those regions (hello, neuroplasticity) to focus less on pain. Eventually, we can leave out the visualising altogether and go on about our lives, only occasionally making recourse to the technique whenever pain spikes recur (but that apparently becomes a rare event — bring that shit on).

So far, nearly two weeks in, I’ve found all the information I could have needed in Doidge’s book, by reading the relevant chapter a few times and relying on my own imagination when coming up with the visual images. Moskowitz’s book is definitely worth having too, and although pricey, you can’t fault the shipping which had it to my door from the US within a week!

Moskowitz, the creator of the technique, suggests to visualise brain maps shrinking, because it probably helps with motivation to relate it directly to the intended goal, but if I was feeling facetious I’d suggest it’s also because he’s spent a lot of time looking at such things in his professional life. From what I understand you could just as well be visualising Tibetan deities (an interesting thought, considering how important that practice is within the Tibetan tradition). There could well be advantages to coming up with your own imagery, as this will engage more regions of your brainware than just memorising the images that Moskowitz uses.

Having said that, I went with the “brain maps” idea, and I’ve found it solid.

Whenever a pain spike intrudes on consciousness, I gotta say my first instinct is to ignore it, and hope it’ll go away. Next tactic is, to rearrange my body — to “twitch” it into a shape where the pain is lessened. I’m a slow learner.

Eventually, I remember that I’m doing that other thing now, that visualisation stuff. I don’t have to live with this persistent pain shit any longer. For real! OK, wake up from distraction.

Feel the pain. Recognise it. And then I do my best to get motivated by remembering that the pain isn’t actually in my neck — not really. Pain is only experienced when neural signals are interpreted at “the thinking parts of [my] brain” [5]. I remember that once acute pain develops into persistent pain, the number of neurons dedicated to processing it increase five-fold [6].

Set the Intention: to return the brain to its original pain processing configuration, freeing up those neurons to do other jobs, and freeing my mind from the constant bracing against discomfort.

After all that talk, the visualisation is actually a simple three-step process:

  1. Establish mentally that the location of pain is actually inside my head, not in my body.
  2. Visualise the pain as glowing “starburst” regions — it doesn’t, in fact, matter at all where one puts them or how they’re shaped. I find that there are certain locations in my imaginary skull cavity that my mind naturally puts them, so I just go with it.
  3. Shrink them, using whatever imagery comes to mind — but I make it quite a long animation. Not just two frames, I shrink them progressively. I think about colour, and I change the colour of the regions as they shrink, cycling through all the rainbow (remember Roy G. Biv?).

Using Moskowitz’s “pain maps” suggestion a) helps remind me that the pain only exists if I allow my brain to reinforce those neural pain pathways. But b) it’s also my understanding that associating the visualisation with a particular location in my body engages the “posterior parietal lobe”, which, as well as being a pain-processing region, can be targeted neuroplastically by generating an “internal location of stimuli” [5].

I continually remind myself to visualise the shapes inside my actual skull where it is sitting now, not in some imaginary simulation of my skull out in front of or beside my actual body.

And that’s it! I repeat three times for strong pain, or until the pain diminishes, whatever is sooner. Whenever I feel pain.

It takes patience to interrupt what I’m doing and visualise, especially when I’m pressed for time. That’s probably the most challenging (and crucially important) aspect of the whole technique. R for Relentlessness.

But other than that, the visualisation itself is rather simple and even quite pretty, if you go for the colourful approach.

[1] Here in NZ, there is a bit of mythology around “making do” without necessarily having access to all the latest tools or materials. Number 8 wire and some tape will repair most things. That kind of thing. http://zigzagyogi.com/2016/07/visualization-for-chronic-pain/
[2] Doidge, Norman. The Brain’s Way of Healing, Penguin Books. www.normandoidge.com/?page_id=1042
[3] ibid. pp19
[4] ibid. pp15
[5] ibid. pp14
[6] Moskowitz, Michael, MD. Neuroplastic Transformation Workbook pp4, https://www.amazon.com/Neuroplastic-Transformation-Workbook-Michael-Moskowitz/dp/0615814654
[7] ibid. pp10

The MIRROR Acronym for Neuroplastic Visualisations

Moskowitz[1] uses the MIRROR acronym to describe six qualities of a successful neuroplastic intervention.

Here is a brief run down of what these letters stand for:

M — motivation. The motivation part refers to being motivated to change the pain pattern. Active visualisation, an active role in our own treatment, in the face of inevitable setbacks.
I — intention. The intention is to not necessarily to remove pain (which is not the experience for the first week or so). The intention is “focus the mind to rewire the brain”. More on this below.
R — relentlessness. Again, more on this below. Briefly: we must be utterly ruthless with our visualisation and be more relentless than the pain.
R — reliability. Cultivating a reminder that the brain is not an enemy, and it is doing something it has evolved over millions of years to do. In most cases, the very mechanism at play in chronic pain is the same mechanism that we can use to unwind it.
O — opportunity. Somewhat pathologically optimistic this one, but it’s good to get in the habit of trying to see each pain spike not as a threatening event but an opportunity to learn new ways to untangle ourselves from these eruptions. Mentally re-framing our experience like this reduces the panic of each spike onset.
R — restoration. We are not trying to mask the pain but to restore normal brain function.

Today I’m a bit confused about two of these qualities — ‘I’ for Intention and ‘R’ for Relentlessness. So what are these concepts all about anyway?

Intention

The Intention aspect is a reminder of why we are doing the technique. Surprisingly, this “is not to get rid of pain — it is to focus the mind”.[2] By focusing on the visualisation, we are engaging a part of our brain that would otherwise be processing pain and encouraging it (Relentlessly) to process visual imagery. If we instead focus on pain, or on getting rid of it, we engage other thinking regions of our brain that are not involved in the pain cycle, and so the results will be different.

Relentlessness

Relentlessness is all about intensity of focus. Any pain “intruding into consciousness is the signal to push back. When the pain is just beginning to act up, (we) may think perhaps it will be enough to tolerate the pain or distract (ourselves) … casual distraction must be resisted, because it allows the pain to run unopposed … Relentlessness means, every time pain is detected, push back, with full focus and the Intention to rewire the brain back to what it was before the chronic pain began. No exceptions. No negotiations with pain.”[2]

Question

My question is, what about long-running stubborn pain, i.e., that lingers for minutes or hours even with visualisation? These two aspects seem to be in conflict then.

Example

Say I drive to the supermarket nearby. Halfway there I feel a spreading pain and tightness from the base of my head into my shoulders and down my arms. This is a classic repeat symptom for me, so I pull over and run through the pain maps in my mind. No relief. All good, I’ll run through it again. No relief.

According to Doidge, a helpful internal dialogue at this point would go “I got a pain attack and used it as an opportunity to exercise mental effort and develop new connections in my brain, which will help me in the long run.”[2]

But that runs counter to the aspect of Relentlessness, which says to push back every time pain “intrudes on consciousness”.

Resolution

Until I learn otherwise, I’ve set myself an arbitrary maximum of three times through the visualisation. That way I’m not falling short of strong focus (after all, Three Is a Magic Number). But in keeping with the Intention, I am also not trying to calculate whether the pain has relinquished its hold. If the pain melts away in less than three iterations, then I will smilingly carry on my way to the supie. Freedom is its own reward, to paraphrase Ghandi.

[1] http://www.neuroplastix.com/styled-2/page1/styled-23/mirror.html
[2] Doidge, Norman. The Brain’s Way of Healing, Penguin Books. pp19-20.

What is Neuroplastic Visualisation for Chronic Pain?

Today I’m going to try and describe the theory behind this neuroplastic technique in my own words (mostly)* in the hopes that someone finds it interesting. Hopefully, nobody finds it useful! Because although that would mean my writing was not in vain, one more person with chronic pain is one too many.

The visualisation I’m doing involves imagining the boundaries of the brain regions that process pain and then making them shrink in your “mind’s eye”. But what are these regions? And how does that help?

There are (at least) sixteen brain regions involved in processing pain

According to Michael Moskowitz, quoted in Norman Doidge’s book, there are many different regions involved in processing a single incident of pain. Without having done my own research to verify these, I won’t go into specifics of which areas he mentions (they all have funny names like ‘hippocampus’). But what is worth knowing is that pain is processed in many parts of the brain.

When not processing pain, these regions do other stuff

When an acute (new and intense) pain signal is generated somewhere in our bodies, those sixteen brain regions light up on brain scans. But in fact, even before the pain signal, those regions are not dormant. They do other stuff too. They just light up even more once the pain signal arrives. Before the interruption, these sub-networks do things like (quoting from Doidge again) “sense pressure, position, vibrations. [They] detect conflict … solve problems [that are presented to them], plan movement sequences, process and retrieve emotional memories. [They] connect emotion with bodily sensations, empathise with others, retrieve autobiographical memories” [1]

And finally, the posterior parietal lobe “processes visual perception [and] internal location of stimuli”. The prefrontal area is involved in “executive function, creativity, intuition, emotional balance”. And the posterior cingulate processes “visuospatial cognition”. [1]

Those last three are where the visualisation comes in.

Chronic pain is neuroplasticity gone wild

When those regions process acute pain, only about five percent of the neurons in each area are dedicated to processing the pain signal, leaving about ninety-five percent to carry out the other important tasks they are involved with.

What Doidge reports is that Moskowitz discovered that in chronic pain, the number of neurons processing pain has grown to between fifteen and twenty-five percent. This leaves a shortfall in the number of neurons that can carry out other jobs.

Essentially, the constant ongoing signals of alarm and damage have rewired the brains of people (like me!) with chronic pain, so that the neural networks no longer function like they used to. That is neuroplasticity — but not in a good way.

Incidentally, to me this seems to explain why those of us with chronic pain can seem to lack concentration or struggle to form sentences, solve problems or recall facts. We may have trouble empathising with others or controlling emotion. Our own brain is being appropriated by excessive signals from our peripheral nerves.

Our posture comes to reflect a defensiveness that is nothing to do with how we feel about the world, but has everything to do with how much finesse and fidelity has been lost in our actual cognitive experience.

Disconnecting is harder than connecting

Making new connections between things in our minds is relatively easy — just repeat it a few times and soon you’ll have no trouble remembering the way to a friend’s house, or how to tie a shoe. But have you ever tried to unlearn something? That’s not so easy. Many of us have nights we’d rather forget 😉 But how many of us have managed to intentionally ditch those unpleasant scenes? Or once we hear a song that we detest and it’s going round in our head, how do you stop it?

That’s essentially what we’re doing with the visualisation technique. We focus our mind and use thoughts themselves (visual images) to literally force our brains into using the neurons for their original purpose — visual perception, internal location of stimuli, creativity, intuition, visuospatial cognition. Visualisation involves all these functions and more. By doing this, we are unlearning a pattern of neural behaviour that has become so ingrained that we were until now unable to break free in any meaningful way, as the neurons became more and more tightly connected. That is why we need to bring such seemingly unreasonable levels of conscious determination to the situation. Relentlessness, as Moskowitz calls it. We must be more relentless than the pain, or else we stand no chance of disconnecting a network that has become progressively more deeply wired over time.

A final point

Eventually, the goal is to use the mind to return our brains largely to the same state they were in before they began producing the experience of chronic pain. When that has been achieved, the visualisation is no longer necessary and we can go about our lives with more normal pain-processing neurology.

We will still receive normal pain signals. The five percent of neurons that are dedicated pain processors will still do their jobs. And the injuries or limitations in our bodies will remain — they will need to be treated in their own way.

An as-yet unanswered question

Although there are sixteen brain regions responsible for processing pain, Moskowitz’s technique only targets three of them. Despite this, anecdotally it seems to have had remarkable success. Why is this? Are these three more central to the experience of pain?

—

[1] Doidge, Norman. The Brain’s Way of Healing. Penguin Books 2015. pp13-14

  • Note that this is not a systematic scholarly review of the latest research. My list of sources is minuscule. There may well be errors or mistakes compared to the latest neuroscience. I’m just trying to present the basic gist of what I’m doing so people can do their own reading about it if they choose.

Mind Training and Mental Health

Blessed are the cracked, for they shall let in the light -- Groucho Marx
Blessed are the cracked, for they shall let in the light — Groucho Marx

Some of the sanest people I know also have the most disordered thinking underneath. We all do have plenty of that in reality. But those of us with a bonus dose of thought chaos — we are the ones who’ve had to learn to pause before we leap. To mind the gap between thought and action. To calm ourselves inwardly, somehow, first, before we jump to conclusions or react. No matter where you are in life, it’s those pauses that make us sane. Nothing else. One can have the most measured, efficient, rational thought processes in the world, and if you never pause from one thought to the next, you can still be a complete psychopath. Maybe that’s even a workable definition of a psychopath (I don’t know — IANAP).

Morality

We pause. We doubt our own minds — our own ego — our own so-called self. Most of us have learned to do that through toil and pain. Seeing how negatively our disordered thoughts affect others or our self. And so at this stage the pause is more like suppression — a squashing down of our own thoughts and feelings for long enough to consider the feelings of others. We have to or else the chaos takes over.

Squashing down is ok. It’s like morality — what Buddhists call the first training. (By the way I should mention that I don’t identify as Buddhist. I’m way too zig-zaggy for that. But I have done a lot of Buddhist meditation training, and naturally use their frameworks for talking about our minds).

The problem with just relying on morality for our sanity is that it becomes a habit of mistrust towards ourselves. We don’t give ourselves free rein, ever, even when our intentions are good. We have learned to never listen to ourselves. This is plain unpleasant.

Not only is suppression unpleasant, it’s also not enough in the long run — because, by not listening to ourselves, we learn to not look at ourselves, and then all sorts of shadow issues start coming out sideways without us being aware.

Moralising alone is necessary, and yet both painful and not sufficient. This is why we need mind training.

From Morality to Mind Training

What mind training teaches is a new way to pause. A new way to “mind the gap” between our thoughts / emotions and our actions; a way that doesn’t involve suppressing our feelings. The disordered thinking won’t go away. Although it may lessen somewhat, we’ll still need to pause. But we learn to use those pauses to let our feelings flow through us like rain (American Beauty, major spoiler alert). Instead of squashing them down anymore, we let ourselves feel them; radically, like never before. This takes some serious emotional-mental strength and insight. Which is most often called “mindfulness”.

Morality really shines, and ceases to be unpleasant or difficult or boring, when it’s combined with high levels of attention and awareness.

In short, while there may be good reasons why we suppress our knee jerk reactions, over time that’s harmful to ourselves, and even with all that hard work it’s not reliable.

That’s why we need mind training. We all need it — but especially the sanest, kindest-acting ones among us, who’ve learned not to trust ourselves.

There is a better way.

Afterthoughts

Since penning these words, I realized that of course sometimes we are so confused or baffled in our thinking that we cannot even learn to squash down our thoughts or mind the gap, even in a suppression sense, let alone take mind training practices into our lives. Although my post does intentionally edify emotional and thought disorders, which I think is a much needed and refreshing viewpoint from current attitudes of mental “illness” (I dislike this term), it was not my meaning to minimize the suffering of being in the full grip of our difficulties. I certainly didn’t mean to imply that, when we find ourselves gripped by chaos, we should just “try harder”. Internal suppression or transcendence are impossible for all of us at times — and some of us more than others. When this is the case long-term, I still recognize the need for conventional medicine in helping to find traction within thoughts / emotions / moods, as imperfect and riddled with side-effects as most of those treatments are.

I guess the times I’m talking about — when we are apparently sane but inwardly tortured — are those in which we are in active recovery. I define active recovery as putting into daily practice some system of morality to keep us from getting trapped by our own internal chaos. Whether we arrive at active recovery through medication (and I include herbal medications in that), through internal work, or a combination as in my case, it is an essential first step.

Vedana — Nothing is Neutral, or is it?

The Buddha placed the notion of “feeling tones” pretty high up in his teachings. Known in Sanskrit as vedana, these feeling-tones refer to the way sensations and thoughts get sorted by our minds into pleasant, unpleasant or neither.

When hearing this, my first thought was always “what about feelings that are both pleasant and unpleasant, like nostalgia?” But I’ve since come to think of a single hit of nostalgia as actually a constellation of many different sensations and vedana.

These vedana have been coming to the fore in my sitting meditation practice lately, usually with some kind of reminiscence woven in, and it got me thinking …

12b3gv

The pleasant / unpleasant feels often get the most attention from our conscious mind. You could say that a main function of having an attention span is to limit our exposure to the details by tuning out the neutral vedana as “inconsequential”. There is good reason for this: take a scene like sitting beside a stream in a forested glade with bird and insect life all around, the smells, the feeling of the sun’s warmth. There is simply too much sensory input to process through our focused attention span without overwhelming ourselves. Instead, most of it fades into the background, our peripheral awareness. Or else never even enters our field of experience at all. There are whole brain circuits in charge of keeping input out of our mind.

This is one reason why in meditation often we close our eyes. We tend to favour quieter locations. Because during meditation we are making a deliberate attempt to be as aware as possible. This has powerful effects on those input-dampening brain circuits. It requires, at least initially, that we create an environment with less input, so that we can focus more intently on noticing every sensation that is present.

I’ve found that even after meditation (so, off the cushion as it were) there is a lot to be gained from being a little more mindful of the full spectrum of feeling including the neutral. For one thing, the neutral tones are far more numerous than the rest, and so by becoming more aware of them we are coming closer to a complete experience of life. Also, there is something to be said for coming to see the world less as a source of entertainment and conflict.

A more comprehensive awareness of the plainness of reality promotes a kind of sensory moderation that in itself is liberating from the push and pull of striving and attainment. Think of how a flower grows on time-lapse through day and night, wind and sun and rain, with a total lack of vainglory and a simple impression of selfless expression. Total surrender to its own being with no regard for right or wrong, sun or rain, pleasant or unpleasant.

Thirdly, there is an important amount of insight in the very arbitrariness of these “neutral” experiences — the sound of the refrigerator kicking in. Bzzzzzzz… reality. Mundane reality. Not a psychodrama of wonder, delight and horror. Just … refrigerator turning on. Chains of cause and effect. Neighbour loads a trailer. A smell of smoke.

And then you have the Tantric viewpoint, which takes neutral beyond the mundane, with realizations that bring deep insight even from the neutral vedana. If we take the object of these neutral feeling tones into deeper awareness they have the same capacity to reveal the nature of mind as any other experience. Tantrikas place great weight on the insight that all phenomena are “intrinsically luminous” — even the mundane. Even the agonisingly painful. All can be taken skilfully as objects for deepening consciousness.

In Buddha’s original teachings, in fact there are no true categories of feeling, not to the Enlightened Ones. All is simply taken as “such”. This is the essence of equanimity — full comprehension of the entire input stream, without preference for any of the vedana. All simply are in possession of suchness — tathātā. That page is a highly worthwhile read. And another name for the Buddha? Tathāgāta: “one who goes such”.

A human. Transmuted, through the effortless effort to let things be just as they are, into a frictionless passage for cause and effect, in each moment synchronised with and manifesting of the beginningless and endless suchness of reality.

Let this be the goal and the actual attainment of all beings.

People usually consider walking on water or in thin air a miracle. But I think the real miracle is not to walk either on water or in thin air, but to walk on earth. Every day we are engaged in a miracle which we don’t even recognize: a blue sky, white clouds, green leaves, the black, curious eyes of a child — our own two eyes. All is a miracle. — Thích Nhất Hạnh

Autumn peeps through

Rising early doesn’t come naturally to me. Traditionally I’d roll from bed with half an hour to spare, and head straight to work via the kettle and maybe breakfast.

But yoga’s morning benefits became too numerous to resist — a hidden blessing of an older body perhaps. I’d regret sleeping in whenever my discipline slipped (consider that a warning). Since then I added post-asana meditation. A penny more focus and a sliver of presence. Worth it.

These days I’ve swapped it around: meditation then asana. I’m interested in what my mind feels like, before I properly waken. I get up, ablute and then sit down, yawning, to notice what I’m noticing.

Mornings stay dark much longer in March. When I sat the other morning, all was dim, but after, as the timer chimed and I opened my eyes, light was all around. I went outside.

Autumn peeps through.
Autumn peeps through.

The new sun lit up the leaves like stained glass. Birds were all about it. The day had a plan, tickety-boo.

Breath lifted my inner body, my shoulders opened. I scanned the horizon. And I thought, why wait for the sun? Even if the world is grey, or dark, everyday moments (even wretched ones) are precious. Passing away. Never to come again.

How fortunate was that moment of early sunlight! But how just like a sunny morning it was that the universe later manifested me in the murky afternoon, foibled and confused, amidst smog filled traffic:

image

If we allow, the cold or the grey, just like sunlight in the trees, can draw a surgeon’s blade through our surface worries.

Our compassion for ourselves and others is weak, when all we choose is this single-masted yacht, a cocoon aboard which to sail the vast sea of human experience.

Leap from your craft, I said aloud. Immerse yourself in the waters of happenstance. Occupy love.

At dusk, the cock announces dawn.
At midnight, the bright sun.