Category Archives: Anxiety

12Nov/17
Overcome stress and pain to live well

The worried world and what we can do

Overcome stress and pain to live well

A recent article by Oliver Burkeman entitled ‘Anxiety bites. How to keep calm when world events are freaking you out’ highlighted the impact of Brexit and Trump upon people’s life perspectives. He states that levels of anxiety and being troubled have gone up, quoting the American Psychological Association as finding 57% of those surveyed to feel stressed by the political climate. There has also been a rise on the UK. We are, it seems, as a society, worrying about life and the future. Are we in a worried world?

We can argue that anxiety, like all perceptions, are inferred states as we try to make sense of the possible and most likely causes of the sensory information. After all, we are a bag of chemicals, and depending upon where they are and what they are doing, our brain has to make a best guess as to what they could mean based upon what we already know (priors). It is interesting that the ‘feeling’, the ‘what it is like’ of anxiety is similar to excitement. The key is the interpretation and what you tell yourself: I am excited or I am anxious. Try it.

Burkeman raises some good points. He mentions the contagion of anxiety as we are tacitly capable of sharing our emotions with others whereby both you and I feel anxious together despite being distinct organisms. Consider how quickly the atmosphere changes in an office or the mood of a football crowd. We are supposed to do something about the problems we perceive, but what should that action be? A feeling of outrage, powerlessness, isolation, and despair can prevail when we become over-focused on problems. This is some protective biology at play that results in us drifting into that state and maintaining it by continuing to attend to certain thought patterns. Burkeman also picks up on the notion of fear, with one of the therapists he interviewed mentioning the deep rooted and basic fear in life that stems from childhood. Without the safety of reliable parents, a child is destined to fend for herself, making the world appear to be a very dangerous place. Of course this can be hugely amplified if suffering or having suffered abuse when the protect systems are deeply provoked and remain active.

This is a serious issue. We have progressed remarkably as a species and the momentum is building, yet we appear to be falling behind when it comes to the so-called mental health. Regular readers and followers will know that I have an issue with this term, which I feel implies a dualist approach to the human experience. Experience is embodied (Varela et al. 2017). Everything we think and do is embodied, meaning that suffering depression and anxiety, the common and increasing problems previously identified, emerge in the bodily self. Where do you feel anxious? Most people will say in their stomach or chest.

Consistently being in a state of protect has health consequences as our resources divert towards defence rather than nourishment. This in turn raises the chance that the person will suffer a plethora of conditions, including those of an inflammatory and auto-immune nature. In my view a serious consideration for society (and policy makers), this is likely one of the reasons for the uptick in chronic pain, remembering that pain is also a mode of defence inferred from the existing circumstances.

what can we do?

This all seems a bit grim as we quickly forget the possibilities in life and the beauty that we are surrounded by in nature and human beings. So what can we do? Certainly knowing what we can control and focusing upon this rather than what we cannot control is a good start point together with a picture of what we actually want. This is the basic model of success. In terms of chronic pain, this is the first step we take when addressing the problem(s) before coming up with the principles to follow in order to achieve wins and overcome pain.

Here are a few simple tips, beginning with the creation of inner calm. Why is this so important? Because it gives us a perspective, making contact with our reality, allowing us to see things for what they are instead of being caught up in emotions that are the fabric of thoughts past and future. We learn to sense that inner calm, a feeling in the body akin to a deep peace and knowing. I would argue that this is a natural state, and one we can learn to access routinely each day, through the day, as well as when we need to be calm, clear and to see things as they really are. Biologically speaking, when we know and live this calmness, we are in parasympathetic mode, the branch of the autonomic nervous system that nourishes us.

Two simple ways to create inner calm: (1) take 3 breaths and slowly breathe out, paying attention to the breathe all the way in and all the way out. (2) take 10 breaths, following your breathing from the entry into your nose or mouth into your body and then letting go naturally, not trying to control or change your breathing at all. Note how you feel.

Further practices that can be integrated and implelemented into daily living include the practice of gratitude (Mccullough et al. 2002) and acts of generosity or kindness (Layous et al. 2014). Both are now known to be distinctly healthy and easily practiced each day, much like learning a musical instrument. We are not only considering the healthy effects, but also buffering against life’s challenges and the approach that the person takes to life–how do you do life? Possibility our problem?

Two easy ways to practice gratitude and generosity: (1) each day write down 5 things that you are grateful for in your life. (2) choosing to do something for someone else, including people you do not know, such as giving up your seat or letting someone go first. There are many opportunities through the day, however we must be aware and take note of how we feel, noticing the positive emotions as they arise. The more we notice, the more we notice, establishing the build and broaden effect (Kok et al. 2013).

Despite the world events and those closer to us in our days to day lives, it is our perception that is key–my own unique interpretation. As Shakespeare wrote: ‘there is nothing either good or bad but thinking makes it so’. These words highlight the importance of how you choose to approach life and the situations within your life. The practice of daily skills such as those outlined above are simple habits we can create to develop our thinking and our style of ‘doing’ life. Like other habits they become part of what we do with greater and greater ease, building our wellness that does not simple happen without effort and persistence.


The skills of being well are an intrical part of The Pain Coach Programme that is not only about overcoming pain, but living well, the best you can.

 

05May/17

Exams, stress and pain tips

Exams, stress and pain tips
Exams, stress and pain tips

Exam exhaustion | Felix Neumann

Exams, stress and pain tips ~ It is that time of year again when kids are preparing for their exams. With the emphasis on high grades reflecting success, the pressure on youth has increased. There is the sense that if they do not achieve all those ‘A’ grades, then somehow they are a failure. What a terribly damaging way to go about it, and indeed one of the major influences upon kids health. Levels of pain, anxiety and depression are on the rise. Social media also has a part to play, not the channels themselves per se but the way in which it is used and relied upon as a source of temporary reward ~ ‘likes’ etc. We can and must change this as a society.

One of the most respected and successful sports coaches of all time, John Wooden, made the key point that each person should be focusing upon what they can control and to do their very best. If your attentions are on doing your very best, you will be successful, for you. If you thinking drifts towards the grade ‘you must’ achieve, then your focus is not on doing your best, it is on the grade. Re-focus on doing your very best: maximum effort. Besides, if you are focusing on and doing your best, there is no worry or anxiety because you are doing. Those feelings only appear when we are thinking about being somewhere else, whilst embodying the feelings and hence suffering. That somewhere else is the past or future, and neither exist.

We can realise that this is not necessary as we learn to make other choices. Ask yourself: How am I choosing to feel? Could you choose to think about the situation in another way and feel better or good? Yes you can. Try it and see!

Read hereJohn Wooden ~ Wooden: A Lifetime of Observations and Reflections On and Off the Court
Choice

You could choose to think about something in life you face as a problem, that it is difficult, perhaps impossible or that your efforts are doomed to failure. How are you likely to feel? Or, you could choose to view the situation as a challenge, an opportunity to learn something and seek to find and practice ways to overcome the challenge. How would this feel? Very different. We feel better when we have understanding and a plan that we action because we are actually doing, and this includes writing a new inner dialogue or script. How are you pre-empting or expecting things to go? How often do they actually turn out that way? Well if so, why not water the seeds of positivity rather than anticipate the worst outcome or a miserable outcome? Re-frame your thinking that is always embodied, i.e. we experience our thoughts with our whole self including our bodies — where do you feel the feelings that you label as anxiety? They are remarkably similar to the feelings of excitement but which label are you choosing? Choose another and see what happens.

Here are some exercises from Mike Pegg on Positive Scripting: click here
The inner dialogue

What are you telling yourself? Are you listening? The two are different. You cannot stop thoughts popping in but you can choose what you do with them. The practice of mindfulness is a way of achieving this as you are aware and open to the different thoughts, feelings and emotions as they pass through rather than become embroiled.

Self-confidence relies upon the inner dialogue. No matter what you have achieved before, what you are telling yourself and listening to now is what determines your confidence. Create a positive script about what you can do and what you can control: my own thoughts, my own actions, where I focus, doing my best.

Developing insight into your own mind creates the opportunity to choose your direction. We are always changing, but which way do you want to go?

Some great reading on how to communicate with yourself and others: Thich Nhat Hanh
Movement and posturing

Movement and exercise are healthy. During periods of revision we need to move to nourish the body but also our thinking — the two are NOT separate but parts of you. Changing position, using some exercises, walking, jogging and other activities punctuated through the day help to keep the focus. Some exercise in the morning before starting, changing posture and position every 30 minutes or so and having a good break every 45-60 minutes can help to keep a certain freshness and concentration.

This is about performance and to perform we need to focus in the present moment. Refresh and renew then, are key ingredients.

Recharging and sleep

You need good sleep patterns for healthy functioning. Make sure you have a routine that you stick to through the exam period. Many important healthy activities occur during sleep, including a kind of physiological cleaning in the brain. When this does not happen we can feel groggy and moody the next day.

If you are tired, focus on mantras such as ‘I need energy’ rather than ‘I am tired’. We notice what is on our agenda and therefore by telling yourself that you need energy, you’ll be orientated towards this as a goal: regular healthy snacks, fresh air, movement, mindful practice, periods of relaxation.

Through the day we need to plug in. Refreshing yourself allows you to focus well for bursts of time.

Pain and stress are body (whole person) states due to a perceived threat

People come to see me because thus far they have not been able to recover from their pain problem. This is inherently stressful, which adds to the biological and behavioural mix resulting in on-going states of protect.

~ pain and injury are poorly related and are definitely not the same

Pain is about protection and not a precise guide for tissue health or state. This is the common misunderstanding that leads to ineffective treatments. Pain and injury are not well related and they are definitely not the same. Pain is a unique perception emerging in the person and belonging to the person. This is one of many we experience but it is a dominant feeling, as it should be, to motivate action in line with getting better.

Persistent pain involves many adaptations that include those in the brain (emotional, reward and emotional centres in particular), the way we perceive the world and ourselves, the way we make decisions, behave and the way we act. The world appears to be far more dangerous than it really is and the rating of threat is applied in normal circumstances, just in case. For example, sitting is not dangerous yet it is often associated with back pain. The body systems in weighing up the evidence and based on prior experience, deem sitting in a chair to be actually or potentially dangerous. It is the result of the weight of this evidence that manifests as pain in the area of the body deemed to need protection and awareness.

Overcoming pain is about changing this weighting of evidence by taking new actions (habits) based upon new thinking (understand your pain), beliefs and expectations.

During exam times there is usually a change in routine. More sitting, less exercise, and potentially more stress depending upon how the individual views the situation. For optimising performance, this must be addressed whether there is pre-existing pain or not.

It is common for pain to increase during times of stress and pressure. This is not because the tissue state changes greatly but instead the perception of threat is raised and hence protection more likely. We can also tend to anticipate certain relationships. For example: ‘sitting will hurt’, which can become a predominant thought pattern unless we work to create a new way forward. We are always changing, it is a matter of which way you choose to go.

Simple practices during exam times can make a significant difference. Starting with understanding your pain, you can choose to use the strategies mentioned previously that include regular movement, appropriate exercise, practicing a positive script, refreshing & renewing, together with mindful practices (that actually enable many of the others), deep relaxation, imagery and visualisation. Making a plan of which to use and when through the revision and exam timetable can make all the difference.

Pain Coach and Wellness Coach ~ to overcome life’s challenges, live well and perform

For appointments or enquires about Pain Coach Mentoring and speaking events, call Jo on 07518 445493
12Sep/16

Mindful commuting

Mindful commutingMany people commute to work creating a great opportunity to create calm, focus and prepare for a top performance, simply with mindful commuting. In London, a huge number of commuters use the tube, which is rammed with people (in a rush), often smelly and particularly hot in the summer. How can one create calm and focus in those circumstances you may wonder?

As a commuter you join thousands of others, some of which push you, breathe on you, lean on you, rest their paper on you (I once saw a woman rest her newpaper on a man’s back, which she quickly moved when he turned, only to put it back when he looked away — it was quite amusing), stare at you and nudge you. Today there was a small space next to me and a man forced his way into it creating discomfort for everyone, including himself. So there are just a few incidences that could challenge one’s patience and yet what a great opportunity to develop the skills of patience and compassion towards others. In doing so, you feel better versus feeling anger, frustration or annoyance. We can choose.

Over and above developing a compassionate outlook for the day ahead by looking deeply at a situation (we can consider that the other person may be suffering for a range of reasons and hence behaving in a certain way), we can use the following practices to orientate ourselves towards positive emotions. Being aware of and acknowledging positive emotions broadens our thinking and receptiveness as well as enhances our resilience in the face of a challenge, all of which impact upon our performance at work based on how we communicate with ourselves and others.

  • each time you find yourself becoming irritated on your commute, take 3 breaths and in particular notice your out-breath
  • walk mindfully, paying attention to each step and just be curious as to what is going on around you. Notice how it makes you feel and return your attention to your walking
  • if you cannot get through the crowd because it is busy, return your attention to your breathing to create calm and then walk mindfully
  • be aware of those around you and wish them well in your thinking, noticing how this makes you feel and how the world then appears
  • as you pay attention to your breathing, think kindly about your colleagues and boss so that when you encounter them, you communicate with skill and not on a background of feeling stressed and anxious
  • if you feel stressed and anxious it is because your thinking (embodied) has drifted into the past or future, thereby flavouring the present. Take 3 breaths and see things for what they are; be aware of this moment
  • listen to a mindful app on the journey
  • practice mindful breathing when you simply pay attention to your breath that holds you in the present moment

There are many more ways of practicing but in essence just using one or two will help you create calm and focus. Try it and see!

Mindfulness is a very practical way of being that creates calm, peace and allows you to to see things for what they are as you are consistently aware of the present moment, you listen deeply and speak with skill to communicate understanding and compassion. This is transformative in all situations and achievable for all.

Mindfulness practice forms part of the Pain Coach Programme for pain and chronic pain | t. 07518 445493

11Jul/15

Pain and the perfectionist

By LordEfan | https://flic.kr/p/kUfKKZ

By LordEfan | https://flic.kr/p/kUfKKZ

Pain and the perfectionist could be a title of a book in which the character suffers on-going pain, seeking to conquer himself using his perfectionist traits. I know of no such book, but I do know that a significant number of people who I see with chronic pain are perfectionists.

Like most things though, it is how you look at it that makes the difference. Most traits that we exhibit have a benefit and a purpose in our lives in one quarter but can be problematic in other arenas. Perfectionism is no different.

Whilst being a perfectionist would be highly adaptable when studying the detail of a document, arranging a bouquet or organising an event, when this spills over into being hard upon oneself, it can push the individual too far. Compassion must start with the self — being kind to yourself. It is all too common that people are self-critical, either overtly or more frequently via the inner dialogue. Continually telling yourself that you are not good enough or that you will never achieve is the exact opposite of believing in yourself. If there is one characteristic that is vital in overcoming pain, it is the belief that you can do it.

The sense of never being quite good enough is a safety mechanism of sorts. On the flip side it may drive the individual to practice or work harder, and this is acceptable if it does not cause angst and on-going stress that is incongruent with health and a feeling of wellness. Chronic stress is a significant issue in the modern world, having a huge role in many of the common problems that we see today — e.g. functional pain syndromes such as IBS, headache, migraine, functional abdominal complaints. Chronic stress causes the body to set itself in an inflammatory state, and there is a constant preparedness for action to fight or run away from a wild animal. Except there is no wild animal, just our thoughts and interpretations. These we can learn to observe rather than become embroiled within with techniques such as mindfulness.

Perfectionism is a strength that we can foster as part of the programme of overcoming pain. I base my treatment and training programmes upon your strengths as these are what we use in life to succeed, and succeed you will by nurturing these within an action plan that takes you back to a meaningful life. It is easy to say don’t be too hard on yourself, yet difficult to master. But it is possible to harness the strength of perfectionism and use it to overcome your pain.

For information about the Pain Coach Programme to overcome chronic pain, call 07518 445493. The Pain Coach Programme is also a learning programme for clinicians who want to develop their skills, either 1:1 mentoring or in small groups. Call us for details or email [email protected]

 

16Apr/15

Mindfulness is a great skill

Mindfulness is a great skill to learn at any age. To be mindful simply means to be aware of what is happening right now and without judgement–notice how you judge your thoughts and how that makes you feel.

Everything that we are aware of is our own, unique interpretation that emerges from our belief system. We appraise our thoughts, our actions, others, and the environment around us. This appraisal evokes an emotional and bodily response in many cases, even if it is just a shrug of the shoulders. It is important to clarify that emotions, body responses, thoughts and actions are all part of one and the same; i.e. the whole person. Sadly, much of the thinking, particularly in health, remains Cartesian and separates mind and body. This is despite reams of research papers and common sense telling us otherwise. What does your tummy do when you think about giving the presentation tomorrow? Your body reacts in response to the thought, and that reaction involves the nervous system, the motor system, the brain, the immune system etc etc….WHOLE PERSON.

So, if the appraisal or our perception guides how we respond, then we have a buffer between any give situation or thought and what happens next. We have a choice — ‘the greatest weapon against stress is our ability to choose one thought over another’ said the great philosopher William James. Shakespeare had insight: ‘there is nothing either good or bad, but thinking makes it so’.

Mindfulness is the skill that allows you to observe thoughts and interpretations rather than become embroiled, living out thinking that is felt in the body as emotions and tensions. You notice with quiet curiosity how your body is responding, lifting the veil of suffering.  We have that choice, but most don’t realise, operating on automatic overdrive leading to repeated stress physiology that affects every body system.

A stress response is designed to protect us from the dangers of wild animals. The same responses kick in to a threatening thought–the most dangerous things we face are our own thoughts and interpretations: a shadow after watching a horror film is threatening because of the way you think about it and create a story of a murderer lurking behind the tree. Actually, it’s a cat but that story does not feature. What stories do you tell yourself to create fear? How useful is fear? Not very.

Fear triggers further negative thinking, and that gets us nowhere. Respect and understanding create opportunities to learn and grow. Much better.

How are you mindful? If you look on the bookshelves, tome after tome sits there awaiting your mind. It seems that everyone has something to say on the matter. The reality is that mindful practice is simple. Practice is a habit that needs to be grooved. You must fail and fail and fail again. That is how we learn. And when you think you are good, fail again to get better. Learn to love failing because then you are getting better!

Start being mindful by noticing what is happening now. Where are you? What are you thinking? How are you feeling? Take a breath and observe it. The rise and fall of your chest and tummy. It’s a wonderful feeling to sit still. Especially in this crazy, high speed world with demands pouring in digitally and otherwise. Simply recall that whatever comes your way, it is your perception that counts. You are in charge of that perception. Make a choice. Create calm so that your body systems can do their job and slip out of protect mode and into health mode. On-going stress accounts for and contributes to most of the modern day ills–chronic pain, infertility, headaches, chronic inflammation, IBS etc etc. To think effectively about stress we need to look at it as a societal, cultural, physiological, personal phenomena.

So, I thought I would write a book about it as well. A very short one. Coming soon.

Mindfulness practice is part of the Pain Coach programme; a complete strategy to overcome chronic pain | t. 07518 445493

08Apr/14

The habitat — multisensory memories

Running in the woods today I was taken back to school days when we would go down to the habitat to learn about nature. Our enthusiastic science teacher, whose laboratory experiments would invariably go wrong, led us down the hill, across the playing fields and into a small wooded area that surrounded a murky pond. This was safer than a bunsen burner, and I do not recall anyone ever falling into the water.

In the habitat we would collect data on flowers, plants and insects. In particular I recall that we should note down the irritability of insects, in other words, how reactive they were to a stimulus — the stimulus being a group of excited kids. Generally they flew away; the insects.

My point here is that whilst running I was taken back by the context of where I was, especially the smell of wild mustard. It was this olfactory experience that evoked a clear memory of the habitat, most likely helped by the fact that I was in a wood.

Recently I was talking to a patient about an experience that he had when visiting a hospital where he had been in ITU. On entering the building and walking the corridors, he was hit with a storm of emotions and memories that triggered a need to escape. He did not understand why this happened.

We are unaware of the vast majority of the things going on around us. Our brain filters and draws our attention to what is important right now. We can only focus on a limited amount of data otherwise it would be impossible to function. You may now be thinking about your right butt cheek, but probably not before I mentioned it. And whatever you do, do not think about a white elephant…

The brain stores memories that can be retrieved when it thinks that a reminder is useful. In the case of re-entering the hospital, although the feelings of panic are unpleasant, it is a useful set of responses to a threatening environment as this is where the brain recorded the events in the first instance. Knowing that this is a normal response allows for control to be re-gained. Not understanding often kick starts further thinking that evokes further protection via the autonomic nervous system — increased heart rate, dilated pupils, sweating etc. This demonstrates the importance of understanding our biology.

In chronic pain the same mechanisms are on alert. As we are multisensory, any of the senses can evoke a protective response. Sounds, smells, touch, taste and sights can all evoke emotional and physical responses. Think of that song, the one that perks you up or brings you down. It is a song, yet it is the meaning that you give to the song that determines how you respond.

Pain being an output from the individual, from the brain, in response to a perceived threat is no different. The more protective the systems, the wider the range of cues that can trigger a pain and stress response. This is equally true in anxiety. Our individual interpretation of a situation or a thought effects the response. We notice butterflies in the stomach (a change in blood flow through the gut) and know that we are anxious before realising what is making us feel anxious; or we have a thought and this leads to feelings of anxiety. It is bi-directional.

From a survival perspective, the brain registering information from all the senses during an experience is useful. Learning is vital. The next time we are in that situation, or one that is similar, the brain will use prior experience to work out if a threat exists, or a potential threat. On concluding that there is something dangerous going on, or about to happen, the brain will initiate protective responses that drive protective behaviours. Whilst this is entirely appropriate in acute pain, on going protection is a problem in chronic pain. Pain is always a normal response to what the brain thinks is going on, but in persisting pain it is often the underlying processes in the nervous and immune systems that are problematic and need targeting for effective treatment.

Memories play a fundamental in how we live and learn. We can actively search our archive but often reminders seemingly just pop into the mind’s eye. There will always be a reason why your brain thinks this is useful but that may not be immediately obvious.

RS

Specialist Pain Physio Clinics, London — for chronic pain and complex pain — 07932 689081

14Jan/14

Are you turned on?

At the risk of sounding ambiguous, many people are turned on. In particular, city dwellers and workers who are being hit with innumerable stimuli, bombarding the senses, triggering on-going responses by the brain, the mind and the body. Whether it be the noise of the traffic, the lights at night, the phantom vibrations of the phone, pollution or close-quarter travel on the train, outputs are being generated by the nervous system, the immune system and the endocrine system that are experienced as thoughts, feelings and physical sensations, some being pleasant, others not so.

Once a chronic state of arousal has been reached, the on-going energy demands can eventually result in burn-out or a gradual state of declining physical and mental health — the two being inextricably linked.

How does this manifest?

The all-too common conditions that we see include general body-wide muscular aches and pains, headaches and migraines, irritable bowel syndrome (IBS), anxiety, indigestion, pelvic pain, fertility issues. The thread that ties these seemingly unrelated problems is stress. Stress however, is a physiological response to a situation that is perceived to be threatening. Two people can give entirely different meanings to a particular scenario, thereby having diverse experiences — it is all about an individual’s perception. Our perception is based upon beliefs about the world, sculpted over the years by exposure and influences.

The biological response to threat involves the autonomic nervous system and the motor system at least, preparing to either flee from the danger or confront the situation. An incredible set of responses, they evolved from the need to deal with wild animals. Fortunately this does not happen too often these days, but there are plenty of potential threats including the thoughts that pass through our mind. The brain does not differentiate between a thought and actually being present. The response is similar and usually thinking about something unpleasant that may happen will lead to feelings of anxiety — tingling in the tummy, tension, increased pain.

If these systems are persistently triggered by stress, there is less opportunity for smooth digestion, conception, healing and clarity. Being chronically turned on hence results in digestive issues, sensitivity of the bowel (bloating, pain etc), difficulty conceiving (thoughts of sex and conceiving are not going to be high on the brain’s agenda if there is a constant perception of danger) and pain that results from gradual changes in the tissues. In fact, every body system is impacted upon by the chemicals released during an on-going stress response. And not in a good way. Performance is affected, mood varies, sleep is disrupted, concentration is poor, catastrophising becomes rife and negative thinking about life predominates.

How do we turn off?

Relaxation or having the ability to switch off is often a skill that requires learning and practice. Going to the gym, having a cigarette or a coffee is not turning off. These are all stimulating a system that is already fraught. It is the calming, restorative, digestive and healing mechanisms that need to be fortified.

Promoting calm in a habitual way across the day is a potent way of re-programming the right responses for the right scenarios. Checking in on the body and thought processes, attending to the present moment rather than automatically drifting into the past or future, avoiding stimulation (e.g./ electronic screens, coffee, cigarettes, sugary foods and drink, certain reading material), mindful practice, breathing techniques and cultivating focused attention are all ways in which we can build our positive bank account in terms of energy and feeling good. Creating good habits. Exercise although stimulating, and certainly in a gym with bright lights and loud music, should form part of a routine for the overall healthy benefits. It is the best wonder drug that we know of and it is free.

Changing behaviours is difficult but it is achievable with the right programme that addresses both body and mind. Cultivating a routine around sleep, movement, diet, exercise, mindfulness, work and family will groove a healthy, resilient, positive and happy path forward. Turn off.

09Jan/14

PoTS — Postural tachycardia syndrome

Postural Tachycardia Syndrome

The autonomic dysfunction that manifests as PoTS is poorly understood yet can cause alarming and distressing symptoms that hugely impact upon an individual’s quality of life. The experience of PoTS includes dizziness, palpitations and syncope, triggered by a range of stimuli such as heat, exertion, food ingestion and others. The variable nature and the plethora of symptoms that can be subtle on occasion, extending to the more overt collapse, can mean that day to day living becomes extremely challenging. The shift in the sense of self with PoTS as with other conditions, defines the suffering that the individual bears.

PoTS is often associated with hypermobility, joint hypermobility syndrome (JHS) and Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT). Many patients who visit the clinic with chronic pain and functional pain syndromes will demonstrate hypermobility on moving — lumbar spine, knees, elbows, thumbs, little fingers. It makes sense then, to be vigilant for symptoms of PoTS and dysautonomia.

For further information about PoTS, visit the PoTS UK website

There are several very good reviews of PoTS:

Postural tachycardia syndrome–current experience and concepts –Mathias CJ, Low DA, Iodice V, Owens AP, Kirbis M, Grahame R.

Abstract
Postural tachycardia syndrome (PoTS) is a poorly understood but important cause of orthostatic intolerance resulting from cardiovascular autonomic dysfunction. PoTS is distinct from the syndromes of autonomic failure usually associated with orthostatic hypotension, such as pure autonomic failure and multiple system atrophy. Individuals affected by PoTS are mainly young (aged between 15 years and 40 years) and predominantly female. The symptoms–palpitations, dizziness and occasionally syncope–mainly occur when the patient is standing upright, and are often relieved by sitting or lying flat. Common stimuli in daily life, such as modest exertion, food ingestion and heat, are now recognized to be capable of exacerbating the symptoms. Onset of the syndrome can be linked to infection, trauma, surgery or stress. PoTS can be associated with various other disorders; in particular, joint hypermobility syndrome (also known as Ehlers-Danlos syndrome hypermobility type, formerly termed Ehlers-Danlos syndrome type III). This Review describes the characteristics and neuroepidemiology of PoTS, and outlines possible pathophysiological mechanisms of this syndrome, as well as current and investigational treatments.

++++

Postural tachycardia syndrome: a heterogeneous and multifactorial disorder — full article free here
Benarroch EE.

Abstract
Postural tachycardia syndrome (POTS) is defined by a heart rate increment of 30 beats/min or more within 10 minutes of standing or head-up tilt in the absence of orthostatic hypotension; the standing heart rate is often 120 beats/min or higher. POTS manifests with symptoms of cerebral hypoperfusion and excessive sympathoexcitation. The pathophysiology of POTS is heterogeneous and includes impaired sympathetically mediated vasoconstriction, excessive sympathetic drive, volume dysregulation, and deconditioning. POTS is frequently included in the differential diagnosis of chronic unexplained symptoms, such as inappropriate sinus tachycardia, chronic fatigue, chronic dizziness, or unexplained spells in otherwise healthy young individuals. Many patients with POTS also report symptoms not attributable to orthostatic intolerance, including those of functional gastrointestinal or bladder disorders, chronic headache, fibromyalgia, and sleep disturbances. In many of these cases, cognitive and behavioral factors, somatic hypervigilance associated with anxiety, depression, and behavioral amplification contribute to symptom chronicity. The aims of evaluation in patients with POTS are to exclude cardiac causes of inappropriate tachycardia; elucidate, if possible, the most likely pathophysiologic basis of postural intolerance; assess for the presence of treatable autonomic neuropathies; exclude endocrine causes of a hyperadrenergic state; evaluate for cardiovascular deconditioning; and determine the contribution of emotional and behavioral factors to the patient’s symptoms. Management of POTS includes avoidance of precipitating factors, volume expansion, physical countermaneuvers, exercise training, pharmacotherapy (fludrocortisone, midodrine, β-blockers, and/or pyridostigmine), and behavioral-cognitive therapy. A literature search of PubMed for articles published from January 1, 1990, to June 15, 2012, was performed using the following terms (or combination of terms): POTS; postural tachycardia syndrome, orthostatic; orthostatic; syncope; sympathetic; baroreceptors; vestibulosympathetic; hypovolemia; visceral pain; chronic fatigue; deconditioning; headache; Chiari malformation; Ehlers-Danlos; emotion; amygdala; insula; anterior cingulate; periaqueductal gray; fludrocortisone; midodrine; propranolol; β-adrenergic; and pyridostigmine. Studies were limited to those published in English. Other articles were identified from bibliographies of the retrieved articles.

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03Jan/14

Changing pain and suffering in 3 steps

Changing pain and suffering in 3 steps –> Logically, anecdotally and empirically, understanding one’s pain is a foundation from where action can be taken to initiate change. Conversely, lacking insight into the cause of pain and being unaware of the contributing factors creates anxiety that forms its own cycle of problems. This is certainly true when pain persists with no obvious structural or pathological reason — a common scenario.

The initial feeling of pain could be termed the primary sensation. The location, quality and intensity are noted, motivating responses: have a look, move, perhaps touch and seek advice. From the primary feeling comes an automatic thought that is deeply grounded in a belief system about pain, injury, life, health and the landscape of our world. This automatic thought triggers a range of emotional and physical responses that are experienced as secondary effects. The secondary effects of limitation, suffering, further pain and sensitisation — an often downward spiral accompanied by despair,  a perceived loss of control — accounting for much of the impact upon quality of life.

There is a fulcrum point between the primary and the secondary that is so potent; a fulcrum point being the place where leverage can be applied to affect a process. In physical therapy — for this is my background — this could be the careful and reasoned application of a hands-on technique to effect change in the way the brain processes sensory information from the body; the basis for relief as the brain alters it’s outputs and hence the sense of physical self. Similarly, to intervene at the point of feeling pain so as to minimise or even prevent the secondary effects that are driven by the automatic thought is a practice that can be cultivated.

  • Pain -> thought — meaning? -> increase in pain, tension, suffering
  • Pain -> thought — mindfulness -> reduced pain, tension, suffering

3 steps to easing pain & suffering 

There are several steps to developing the practice. Firstly, understanding your own pain is vital. What are the biological mechanisms and sources? And what can influence this biology? The latter includes stress, fatigue, movement, thinking, beliefs and the environment. A further point to consider is always that of perception. We all have our own unique perception that is created by our mind~brain, again based on our view of ourselves and the world, moulded by years of experience that blends with our genetics. No matter what the situation, our own reality is the one we respond to, and in the case of pain and sensitivity, the responses can increasingly be triggered by non-threatening situations and environments that are perceived now to be threatening.

The second step is to develop awareness of one’s own thinking and perception at the point that pain is noted. It is by becoming aware that we can then make the necessary change and apply leverage. To be aware means that you must be present as opposed to the autopilot mode where the mind drifts into the past, replaying tapes of previous events — that can equally trigger emotional and physical responses — ruminating on what has been, or fantasising or constructing a future. Neither fundamentally exist, yet we respond and behave as if this is the case; it is our reality for that moment. In doing so, the present moment is missed and we follow the mind and it’s wanderings. All minds do this, this is normal, but if the wanderings create suffering, angst and discomfort, it does not bode well for a happy existence.

The third step is to practice. Being aware is being mindful; the way in which pain and suffering can be eased. Creating a habit of regular practice is certainly achievable with a little motivation, guidance and support. Within a few weeks, people often report a significant difference in how they feel in terms of pain but also in their ability to deal with pain, their resilience. Mindfulness practice changes how the body physically feels and there is a fortified sense of facing life. The release of tension, the removal of the sandbags from the shoulders is welcome in all cases.

Specialist Pain Physio Clinics in London for chronic pain and injury — mindfulness is part of a comprehensive treatment and training programme to reduce pain and suffering, and guide individuals back to a fulfilling life — call us on 07932 689081

23Dec/13

Thoughts can be threatening

A threat can arise in many forms. Years ago, it would have been a wild animal that posed a potential danger, responded to with a fight or by running away — flight. Nowadays we don’t often face the physical threat of an animal attack, more likely it being the menace of street crime or the risk of an injury whilst undertaking activity. The context of each of these scenarios is very different with distinct and personal meanings that result in varying responses.

The key point about a threat is that is must be interpreted as being dangerous in order to arouse activity in the autonomic nervous system. This system is the link between what we think, the meaning we ascribe to a circumstance and how the body responds. With connections that reach far into the body systems, in particular the cardiovascular system and the gut, the autonomic system is a major player in creating awareness that something is potentially unsafe and hence drives behaviours to approach or avoid.

Most of the time we do not face a physical threat. However, familiar feelings in the body signify anxiety most likely on a daily basis: tension, butterflies in the stomach (actually changing blood flow that triggers neural activity), increased heart and breathing rates and perhaps a sense of panic. Why? Because of our thoughts.

Thoughts can be threatening. A thought that is lived, given significance, engaged with or is considered to be self-defining, will evoke emotional and physical responses. If the thought is one that plays a tape of an unpleasant past experience, fashions an image or a story that is troubling or builds a future of uncertainty, the autonomic system will be aroused. This happening over and over ensures that the system becomes more easily switched on and vigilant to a range of cues, even normal situations that can become threatening in some cases.

Feeling anxious is normal. It warns us that we need to place our attention upon the trigger and take the necessary action. Once this has been done, there is no need to continue to feel anxious, but often the association continues. Automatically there is a response to a thought, or waves of thoughts, and without control over this, the spiral continues. How can we gain control?

Mindfulness is a very potent way of tackling stress. The bodily feelings of stress are triggered by our perception of a situation being negative, risky, dangerous and somehow threatening to our beliefs about ourselves and our world. At the point where a thought or a situation prompts an automatic thought that is negative, these emerging from our belief system that has been evolving from a very young age, this propels us into greater suffering, pain, and sensitivity with increasing impact. Mindfulness practice refines the awareness of this process, maintaining a presence that prevents the dwelling upon the past or a leap into the future. Neither of these actually exist as they are constructs of our mind. The problem is the brain’s response to past or future thinking is very similar to actually being there — a lack of discrimination means that the same autonomic actions are triggered.

In the short-term, the autonomic responses are adaptive and useful. If they persist, the chemicals released over and over become problematic as certain systems are shut down due to the perception of danger. For example, the gut and reproductive system are not needed when we are escaping the clutches of a wild animal. But, similarly, chronic stress from an on-going negative assessment of a situation, thinking, will have the same effect. This is often a feature of infertility when the reproductive system is being impacted upon time and again.

The biological reality then, is that no matter what the situation, it is the individual interpretation that is key in determining what happens next. In developing mindfulness practice and emotional intelligence at the fulcrum point that is the automatic thought popping into consciousness, suffering, pain and on-going stress responses can be subdued and dissolved as presence and awareness rules over.

For further details about our treatment and training programmes for persisting pain and stress, call now 07932 689081