I Shall Please

“Oh, it’s just placebo…”

Just?

Start with this 4 minute video overview:

Towards the end, the authors suggest that placebo is a problem, because it could prevent people from receiving helpful drugs… an interesting comment, that may distract us in a negative way from the potential and the power of our own beliefs and expectations? What do you think? How do we make this largely unconscious mechanism conscious, and how does doing so impact the power that it holds? And how do we unlearn the “I shall harm” (nocebo) effect, its opposite, which equally as powerful and active in our mind-body relationships?

You may also want to read this short article in Yoga Therapy Today that I co-authored about a yogic view of this topic.

Biopsychosocial Practice Starts Now!

Disclaimer: Long post ahead, and those following this page that are not professionals interested in these topics, may wish to bypass this one!

Here goes: I am pleased to see this editorial and thank the authors for preparing and publishing it. Since it is a paid subscription journal I am unable to share the full text, and still want to relay a few things.

The first is the recognition that the biopsychosocial construct, while a very important and valuable concept for moving forward into integral care, still falls short in understanding the inseparability of all things “mind” from the body and one’s experience of it, by suggesting these are distinct or separate things.

The first section of the editorial is titled “Psychosocial factors are not always mental health disorders”… yes, and I wish to add two topics: 1) Comorbidity is common and represents overlapping/shared neurophysiological correlates and equipping rehab therapists with capacity to understand and attend to whole-person needs is part of integrated care models. 2) given that PTs, OTs and other rehab therapists are appropriate for and capable of service provision directly for mental health conditions (not diagnosing or analyzing, but contributing to effective treatment options on referral from the appropriate disciplines)… that even this construct needs to be challenged in our reduction of the body away from the mind. European models are well ahead of the US in this regard, including as recognized by the World Confederation of Physical Therapy’s subgroup on physiotherapy in psychiatry and mental health.

The second section is “Psychosocial factors are not distinct from biological factors” and I have the utmost respect to these authors to put this out there for the rehab professions (and all!) to consider. Our psychology and our body-mind-environment interactions, including the extent, nature and quality of our social engagement/social experiences, are not distinct from biological representations, and while I understand the ‘sometimes need’ for such a breakdown in explanatory literature, it points people towards an either/or form of thinking about how to address their problem or challenge. When I touch someone’s knee, or whisper into their ear, I’ve entered their mind, and when I relay a cognitive construct that reframes a belief or perception, and/or support the process of affect labeling or expression, I’ve equally entered the body. Non-dual thought is warranted as both patients and clinicians unconsciously fall into an “either/or” trap in an attempt to understand or address their problem. It is always “both/and”. Mind-body integration is applicable to all presentations and not just those deemed chronic or flagged by an intake screening tool, though the level of engagement varies based on a number of factors. This underscores the heading of the third section, “Psychosocial factors are not just in persistent pain presentations”.

Finally, I encourage a shift away from “psychologically-INFORMED practice” towards “psychologically- and socially-INTEGRATED practice” as the latter still represents a distancing from psychosocial content that may reduce the power base within whole-person care constructs. We need to move beyond lip-service to the well-defined need for this in scientific literature (with the science supporting the chronic pain epidemic leading the way). For example, reducing the provision of “psychosocial care” within rehab therapy, to functional pain neuroscience education, is insufficient. Support for and provision of constructs of attunement, self- and co-regulation, cognitive-behavioral and mind-body skills learning, emotion/affect awareness, expression and regulation; spirituality, and other inter-related self-referential processes, when person-centered, is well-within the scope of rehab therapy practice and serves a larger goal of meeting individual and collective needs. The truth is that most with chronic pain will not access psychological services and in many cases, are not available or even accessible. Even in rehab therapy, resources are limited. It is time we step up and do better – it is time we work upstream and consider the public health perspective and the negative impact across levels, when we perpetuate faulty beliefs and overly reduce health manifestations to a purely physical construct. I consider it a public health imperative that rehab therapy professions deepen their capacity to support whole-person constructs.

I am working with colleagues on the development of educational materials (book, online courses, etc.) built off of the whole-person practice model that I and other colleagues utilize, to assist in this movement, and we will be addressing additional professional factors and considerations within this discussion.

You can access the editorial by going here.

Reappraisal and Reinterpretation of Experience

An interesting study, reviewed by BPS (a link to original study is embedded in the review for those interested). While the study has noted flaws (they all do :), it is in support of other areas of similar research and I see parallels to fundamental mind-body constructs.
Cognitive reappraisal is intimately linked to self-referential processes and mindfulness constructs. Awareness of the storylines that we tell ourselves about an experience, followed by re-scripting of that story, is associated with top-down neurocognitive processes – capable of influencing attentional and emotional modulation as reflected in, for example, amygdala activity; also capable of influencing pain unpleasantness and intensity.
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Try to view the pain dispassionately, like a scientist studying the experience. By Christian Jarrett

 

 

Detoxing From Opioid Use

Over the last 3-4 years, I have seen an increase in the number of people on long-term opioid management of persistent pain, who are wishing to come off of the medication. Most have been successful. We now know that exposure to these medications interrupts normal processes and has a very high potential to make pain worse over time. The side-effect profile is also of significant concern. This recent article demonstrated that in general, when stopping opioids, pain does not worsen, and there is potential for it to improve. Imagine if the process involved a comprehensive integrative pain management approach with a focus on mind-body medicine… potential for improvement in the overall pain experience may be facilitated. I honor the resilience of those experiencing chronic pain as part of their path through life, and the courage and strength that it takes to undergo an opioid reduction program. It may not be everyone’s path, and I experience compassion for the dilemma. Opioids medicate far more than physical sensation – the dampen stress, medicate emotion, impact sleep, and more. Weighing the costs and benefits is difficult. I offer support for those experiencing pain, as well as guidance for those wishing to reduce or eliminate opioid use. I can offer remote sessions tailored to your needs…

Stopping long-term opioid treatment does not make chronic, non-cancer-related pain worse and, in some cases, makes it better, Washington State University researchers have found.

 

I’m more right than you are?

It has been said that the fastest route to the core of the human ego structure is to cease having opinions on anything. What an interesting thought.

The relative truth, spiritual alignment, or consciousness level of any given stance aside, no doubt this dynamic contributes to the emotionalized polarization of politics in these challenging, charged times.

And, while not part of this study, I suggest there are identifiable, embodied (mind-body) stress patterns associated with the beliefs, cognitions, emotions and personality characteristics that inform this.

The good news is at the end… and underscores the importance of self-reflection and intra and inter-personal ethics in our way of relating in this world. May we all look to temper our opinions in favor of self-reflection and cultivation of wisdom…

From the review article link:

“Across five studies Hall and Raimi found that those people with the highest belief superiority also tended to have the largest gap between their perceived and actual knowledge – the belief superior consistently suffered from the illusion that they were better informed than they were. As you might expect, those with the lowest belief superiority tended to underestimate how much they knew.
Finally and more promisingly, the researchers found some evidence that belief superiority can be dented by feedback. If participants were told that people with beliefs like theirs tended to score poorly on topic knowledge, or if they were directly told that their score on the topic knowledge quiz was low, this not only reduced their belief superiority, it also caused them to seek out the kind of challenging information they had previously neglected in the headlines task (though the evidence for this behavioural effect was mixed).
The final picture is of human rationality that is flawed, but correctable, not doomed.”

For the journal source of the study, go here.

Understanding Pain

Here is a short 5-minute video that was designed to aid the public in better understanding current pain science:

Also, for the more scientific minded, this recent podcast with pain scientist Lorimer Moseley discusses a number of important concepts in pain research and recovering from chronic pain. He discusses a helpful tagline: “Rethink, reengage, recover…”
Lorimer also encourages a focus on these three practical questions?
  1. How do I know if my pain system is being over protective?
  2. What can I do to retrain my pain system to be less protective?
  3. Am I safe to move?
In addition, I would encourage exploring the following:
  • Can I move away from “Why is this happening?” towards “What can I learn from this experience?”
  • What do I need to feel safe in relation to my pain experience, as well as all other areas of my life experience?
  • How can I feel more nurtured and more empowered at the same time, in relationship to what is happening?
  • What would it be like to view pain as universal instead of personal?
  • How can I lessen aversion, avoidance, or resistance to what is happening?
  • Does the teaching that suffering comes equally from an attachment to feeling good as it does from our aversion/resistance to discomfort, help me understand my relationship to pain?
  • And finally, can I see pain as a catalyst that:
    a) inspires me to look for answers
    b) is a seed for compassion
    c) increases my interest in not doing things that sow the seeds of suffering – in other words: helps me want to avoid patterns, beliefs, choices, etc. that contribute to it?

Emotional Suppression and the Gut

An overview of a very interesting, though small study. This is not surprising from my experience and understanding of body-mind patterning and I’ve been a long advocate of the importance of emotional self-awareness and self-expression in health and healing. This facet is often ignored, for a variety of reasons, and fortunately this is slowly changing as public understanding of the science of mind-body medicine evolves.
 
From the linked article and overview of the study:
 
“Researchers led by Elyse Thakur at the Department of Psychology, Wayne State University in Detroit conducted a randomised controlled trial on a specialised form of talking therapy, Emotional Awareness and Expression Training (EAET), aimed at helping IBS patients to better recognise and express their emotions.
 
The research team compared the treatment to either relaxation training – which has been previously shown to be a helpful treatment – or to a control group of patients on waiting list for intervention. Both the EAET and relaxation groups received three 50-minute training sessions delivered over three consecutive weeks i.e. one session a week. They were assessed two weeks after the end of the last session, and again 10 weeks after that.
 
Participants in the EAET and relaxation groups received a similar explanation about the link between stress and IBS but the EAET group were provided with specific skills to improve emotional expression such as thinking of someone they have a difficult relationship with and being encouraged to describe those feelings out loud as if the person were present. They were later encouraged to express their emotions directly to that person. In comparison, the relaxation group were coached in muscle relaxation, deep breathing and mindfulness meditation.
 
At the end of the 10-week follow-up period 63% of the people in the EAET group reported significant improvements in their IBS symptoms while people in the relaxation and waiting list groups did not report any significant change in the severity of their IBS.
 
What is striking about this result is that the intervention was very brief, less than three hours in total, and the participants had been ill for many years. This could mean, in practical terms, that provision of this kind of treatment might be highly cost-effective.”
 
Read the full review of the study from the British Psychological Society here.

Good, bad, I do not know?

This story has been on my mind a lot since last Sunday when I was reminded of it in a class on divine love and relationships. It seems to me of paramount importance that I move deeper into embodying the truth contained within the story. I share it here and invite your own awareness of how it speaks to you:
 
——
 
A Chinese farmer gets a horse, which soon runs away. A neighbor says, “That’s bad news.” The farmer replies, “I do not know if this is good or if this is bad.”
 
Time passes and one day the horse comes back and brings another horse with him. Good news, you might say? The neighbors said, “What good news!” The farmer replies, “I do not know if this is good or if this is bad.”
 
The farmer ends up giving the second horse to his son, who rides it, and who then is thrown from the horse one day and badly breaks his leg.
 
“So sorry for your bad news,” says the concerned neighbor. “I do not know if this is good or if this is bad” the farmer replies.
 
In a week or so, the emperor’s men come and take every able-bodied young man to fight in a war. The farmer’s son is spared due to his broken leg. Good news, of course! Again, the farmer tells his neighbors, “I do not know if this is good or if this is bad.”
 
(Image Credit Unity Codex WordPress)
——
The tale of the farmer is said to be Taoist in origin. Taoist theology emphasizes themes such as naturalness, peace, equanimity, ataraxia, effortless action (inaction), non-attachment, and acceptance. Applied individually, we look at it in relation to good/bad events and the concept of “good luck”/”bad luck”… and this can also be extrapolated to world events as well.
 
The farmer’s story points to the path of non-duality, something that is exceptionally difficult to embody. In short, it reminds people that it’s best not to get too upset — or attached — to what happens to us. Even something that seems dark and confounding can turn out to be an opportunity, when looked on in hindsight.

More on e-motion…

Emotions are often described in mind-body medicine as “e-motion”: energy in emotion. They are present to tell a story about what we need to pay attention to – an inner reflection of what is happening in our lives. 

Unfortunately, some emotions get labeled as being ‘negative’ and end up conveniently tucked away so that the conscious mind does not have to be present to discomfort. Since emotions are physiologically represented in our bodies (patterns of neurological activity, as well as patterns of immune system and hormonal/endocrine activity, etc.), the suppression of our emotions has simultaneous physical and psychological ramifications.

In the linked study, beliefs about emotion, coping styles, and their connection to anxiety/depression and fatigue were examined.

http://www.ncbi.nlm.nih.gov/pubmed/27585982

Aims: “This study investigated two hypotheses: a) greater endorsement of beliefs about the unacceptability of negative emotions will be associated with greater emotional avoidance and lower levels of support-seeking and self-compassion; b) these beliefs about emotions will be associated with higher levels of symptoms of depression, anxiety and fatigue and that this relationship will be mediated by social support-seeking, emotional avoidance and self-compassion.”

Results: “Beliefs about the unacceptability of negative emotions were significantly associated with more emotional avoidance and less self-compassion and support-seeking. The relationships between beliefs about emotions and depression, anxiety and fatigue were significantly mediated by self-compassion and emotional avoidance but not social support-seeking.”

Essentially, the message is that when we relate poorly to some or all of our emotions, especially the one’s we’ve labeled as bad or negative, we isolate and are harder on ourselves. In contrast, when we cultivate a healthy relationship to our feelings and interact with them with the attitude that they carry important energies, truths, and meaning, we can reduce our risk for anxiety, depression and fatigue. While the study did not find that the relationship between beliefs and depression, anxiety, and fatigue were mediated by social support-seeking, there is a solid scientific foundation for the argument that social engagement and prosocial behavior is bi-directionally linked to health and disease, and ultimately the quality of our relationships is reflected in our physiology. Mind-body medicine that supports self-regulation, self-awareness, and self-expression, can enhance our capacity to cultivate and engage in healthy relationships with others.

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It was William Blake who said something along the lines of “All emotions are innocent.” Thus, it is our relationship to them and how we interact with their presence that determines if they contribute to ill-health or wellness. May we all strive to explore healthier relationships and  improved understanding about the emotional patterns that we experience. In a future post, I will discuss how many psychological models of emotion list primary and secondary emotions and how recognizing that one emotion may be riding out in front of another less comfortable emotion can aid our exploration…

Election Stress

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Hello friends

If you are like me, this election is taking its toll. I have been deeply affected by it, unlike any other election that I have experienced. I have talked with a number of others who are also deeply impacted by what is happening in this country right now. Some people are naturally more “energy sensitive” and empathic and if you fit that bill, you are probably having an even harder time than the average person. I have read several interesting articles describing psychological, spiritual, and even shamanic views of this election. These can provide interesting context, and perhaps even some comfort, but do not necessarily help us to directly regulate the stress of it all. When we look at the fundamental structure of the human ego, it is rooted in survival mechanisms, and the development of an identity… a necessary and useful process, but one that also comes with dynamics that can contribute to our stress: strongly rooted beliefs and labels such as “Democrat” or “Republican”; or labels tied to any myriad of individual topics where one stands on one side or the other of of an issue, thus reinforcing identity and opinion, both parts of the basic structure of the egoic psyche. This duality and identification then can trigger the stress response anytime those labels are challenged. This often occurs at the subconscious level and often generates a threat response rooted in one’s very sense of self or identity (ego) being challenged, condemned, or criticized. We naturally respond with the emotional brain – usually to defend, entrench even deeper, or fight back. Some of us might also flee the interaction or freeze up inside during the exchange. The first step is becoming aware of this mechanism. One of my spiritual teachers, David Hawkins, taught that one of the fastest ways to come face to face with the structure of our ego is to “cease having any opinions on anything”! Wow, what a lofty goal that is. I certainly do not think that is attainable for most of us, but we might consider who we would be when we soften the edges around these structures. Often, this mechanism that we all carry in the structure of our ego prohibits our ability to practice deep listening and to provide space to hear another’s perspective. When we can turn our political danger detection system off long enough, we might see that underneath these labels and identifications we are all fundamentally seeking safety, as well as an experience of life that is as equally nurturing as it is empowering. I sense that if we can look past the storylines and emotionalized topics and see these shared human substrates, as well as to work towards finding internalized ways of seeking to get these needs met, we might move a little closer to an inner experience of peace. It is not easy. It takes practice. The fundamentals skills that we can cultivate include 1) real-time body awareness –> the conscious tracking of bodily sensations and the subsequent building up of our tolerance to these bodily sensations, especially uncomfortable ones. This is done using the observer curiosity approach, aka mindfulness – wherein we notice, as best we can, the continuous shifting flow of sensations in the body with a “hmm, isn’t that curious, I’m noticing sensations occurring in the body”; 2) breath awareness and breath control; and 3) the concurrent use of simple affirmations such as “now is not an emergency – relax – let go”. Sometimes the emotional circuits will win out, and this is a necessary part of our learning. In such cases, we chalk it up to experience, practice gentleness and compassion towards our own humanness, and take self-care actions to help the body and the mind to settle down and reboot. With practice, we can gradually improve our real-time ability to stay balanced amidst the chaos. Here is a simple 5 minute meditation I recorded to help you practice easing election stress… or stress during any other charged or difficult time – because that is a certainty (that there is going to be more of it – even after this particularly unique and charged election!):