Implications for Pain Guesses to Yoga Therapy

In this extract from Matthew J. Taylor’s latest book, Yoga Therapy as a Creative Response to Pain, Taylor discusses how yoga therapy can be used to decrease pain and the perception of pain. 

How does one teach from the wisdom of pain? And how could yoga therapy be a creative response? My hope is you are starting to see some answers emerge. (Pun intentional and literal.) In this section I will offer some direct implications to make some of this what they used to call “lieutenant-proof” in the army when I was a lieutenant. (Do note later, though, Nora’s caution around giving “direct” instructions.)

We “know,” taken together, the above findings are important because they demonstrate that the neural mechanisms involved in mindfulness- based pain relief are consistent with greater processing of sensory experience and at the same time decreases in pain appraisal (Zeidan et al. 2015). Our familiar practices of paying attention inward and editing narratives. Pain reduction may also occur by fine-tuning the amplification of nociceptive sensory events through top-down control processes of inhibition of incoming nociceptive information and that such pain relief does not reduce pain through one avenue, but rather multiple, unique neural mechanisms. Ah, CDSR. Zeidan and Vago (2016) also cite evidence that mindfulness meditation engages mechanisms that are distinct from placebo to reduce pain and that this could be of critical importance to the millions of chronic pain sufferers seeking a fast-acting non-opioid pain therapy. See the marketing section coming up next for how to use this information. There is a decoupling between “sensory and appraisal-related brain regions,” and similarly, between “sensory and affective pain” to increase coping with the pain that does improve. An alleviation of suffering even if pain is unchanged in intensity? This is the frequently reported decrease in the unpleasantness dimension of pain with respect to pain intensity (Zeidan et al. 2015) plus what we already discussed about yoga also altering the meaning, interpretation, and appraisal of nociceptive information, all of which could be important tools for producing more stable and long-lasting improvements in chronic pain symptoms. Wow! How do we do that?

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Memory in Trauma by Steve Haines

In this article, Steve Haines shares his thoughts on memory and trauma, and how important it is to recall past memories. Steve Haines is the author of medical graphic book Pain is Really Strange. His new book Trauma is Really Strange will be available on the 21st December.

 

The old primitive brain is shown in blue and red: the limbic system, brain stem and cerebellum.

The old primitive brain is shown in blue and red: the limbic system, brain stem and cerebellum.

Some Thoughts On Memory

Where are memories stored? In order to heal trauma, how important is it to remember what happened? These are common questions that often come up working with clients and teaching on trauma.

There are folklore phrases such as ‘muscle memory’ and ‘cellular memory’ that can be very useful but need to be applied carefully. They speak to the importance of information stored in the body. However it is essential to understand that for the information to be available to our awareness, our brain needs to be involved in processing the patterns of information flow happening in the body. Where the information is processed – in the primitive brain (unconscious) or in the cortex (conscious) – determines whether or not the memory is explicit.

I have a favourite old pair of jeans right now, some holes are on the second round of stitching. The wrinkles and folds in the material are a memory of sorts, the jeans mould to my body like no other pair of trousers. The fascia researcher Gil Hedley (2005) talks about fascia as ‘fuzz’. The fuzz accumulates and represents time. A certain stickiness and alignment of the fibres in the tissues holds the joints in more habitual ways.

Imagine a small child being shouted out by her father. Her shoulders tense, her neck tightens and there is a surge of fear related hormones and activity in the body. If this happens continuously the pattern of ‘shoulders tense and neck tight’ becomes a deep ‘action pattern’ (Kozlowska et al 2015).

Now imagine 30 years later the adult is on your treatment table. With grounded presence and soft, safe, warm, hands you are holding her head and neck. The tissues in her neck begin to express long held contractions and tightness. A shape in her body emerges, similar to the pattern generated when she got shouted at. Your client begins to feel unease and may think about her father.

The ‘muscle memory’ is the tension and tone in the tensegrity of the neck (Ingber 2008). The ‘cellular memory’ is cellular membrane receptors on local and global cells that grew to be sensitive to the all the stress hormones, immune system signaling and inflammatory chemicals that used to be secreted in the fear response (Damasio and Carvalho 2013). The ‘action patterns’ are simple, default movement schemas held in the old primitive brain.

Sensory nerves signal the changes in tension and chemical milieu to the brain. Only with the brain involved do we have emotions, feelings and thoughts generated in awareness. They may or may not be fully integrated into cognition, but something is happening. A memory is being expressed.

Instead of explicit memories we can have implicit memories (I first heard this term from Babette Rothschild, 2000), here the activation is chiefly in the primitive brain (brain stem, cerebellum and limbic system). The client on the table becomes scared when you touch her neck and too much changes too soon, but she does not really know why she is getting upset.

As a therapist working with trauma it is important to note the surges and changes in the rhythmic activity of the body as implicit memories occur. There are some great early warning signals that something is happening.

We can then help find the right pace of change for the individual so they can learn to self-regulate. The therapist’s skillful presence can lead to co-regulation such that the individual can learn to self-regulate (Ndefo 2015). The primitive brain does not do words and concepts very well, but will respond to safety, touch and presence.

Implicit memories are coded very simply in the primitive brain. Often they are without a timeline. The amygdala – an important part of our threat detection system (LeDoux 2015) – holds lots of symbolic representations of threat. The amygdala will trigger ‘fight-or-flight’ or ‘immobility’ responses (‘defense cascade’ Kozlowska et al 2015) if it senses danger in the incoming information stream.

If the cortex gets involved then we will have explicit memory – we can pull in associated events and a timeline to contextualise the activity in the body. Explicit memories usually only emerge into awareness after the body has changed. The hippocampus and prefrontal cortex should help us say ‘That happened 30 years ago’. The skill of the therapist here is to honor the memories and stories that appear but keep orienting the client to resources in the body and environment; ‘Its not happening now’, even if your body is screaming at you be scared.

Following Dr David Berceli (2008), founder of Trauma Releasing Exercises (TRE), I am fond of saying ‘You do not need to remember or do not need to understand to heal trauma’. The goal is to overwrite the symbols in the amygdala with present time information. The body is a great source of good news that can bring you into now.

Summary

Information is stored in the tissues and cells of the body.

The threat detection systems in the primitive brain can be activated as the body changes.

The primitive brain does not do words and concepts very well, but will respond to safety, touch and presence.

If we can support change in the body and down regulate arousal we can change memories with out needing to understand or remember the trauma event.

The goal is to uncouple the charge of the defense cascade from the sensations of the implicit memory.

Notes

1 Kozlowska et al (2015) list some early signs of arousal. For flight-or-fight (their preferred order of this phrase) they list; changes in breath, furrowing of the eyebrows, the tensing of the jaw, or the clenching of a fist, narrowing of the range of attention. For immobility states they list; visual blurring, sweating, nausea, warmth, light-headedness, and fatigue. 

My favourite signs to look out for are anything going too quick (thoughts, sensations or emotions that cannot be integrated into the present moment) and anything going too slow (spacey, floaty, absence, hard to make eye contact, numbness or tingling or loss of body awareness). 

Dry mouth, sense of small or far away feet, absent belly, cold hands and a sense of someone withdrawing are all good signs to put the brakes on, whatever process is being expressed. David Berceli teaches ‘Freezing, Flooding or Dissociation’ as signs that too much arousal is occurring.

Download as pdf: memory v3 2015-10-29

References

Berceli D (2008) The Revolutionary Trauma Release Process. Transcend Your Toughest Times. Vancouver: Namaste Publishing.

Damasio A and Carvalho GB (2013) The nature of feelings: evolutionary and neurobiological origins. Nature Reviews Neuroscience, Vol 14, February 2013, 143.

Hedley G (2005) The Integral Anatomy Series. 4 Vol DVD set. Integral Anatomy Productions, LLC, 430 Westwood Avenue, Westwood, NJ 07675, USA (or check ‘The Fuzz Speech’ on YouTube).

Ingber DE (2008) Tensegrity and mechanotransduction. Journal of Bodywork and Movement Therapies 12, 198–200.

Kozlowska K, Walker P, McLean L, and Carrive P (2015) Fear and the Defense Cascade: Clinical Implications and Management. Harv Rev Psychiatry. 2015 Jul; 23(4): 263–287.

LeDoux JE (2015) The Amygdala Is NOT the Brain’s Fear Center. psychologytoday.com http://bit.ly/ledoux-no-fear-center  Accessed 2015-09-01

Ndefo N (2015) Personal communication. www.trelosangeles.com ‘Sometimes we have to co-regulate before we can self-regulate’.

Rothschild B (2000) The Body Remembers – The Psychophysiology of Trauma and Trauma Treatment. London: W.W. Norton.

Medical graphic books by Steve Haines, published by Singing Dragon

Haines-Standing_Pain-is-Really_978-1-84819-264-5_colourjpg-web

Pain is Really Strange is a scientifically-based, detailed, and gently humorous graphic book on pain and pain management. Answering questions such as ‘how can I change my pain experience?’, ‘what is pain?’, and ‘how do nerves work?’, this short research-based graphic book reveals just how strange pain is and explains how understanding it is often the key to relieving its effects.

 

Haines-Standing_Trauma-is-Reall_978-1-84819-293-5_colourjpg-web

Trauma is Really Strange is a science-based medical graphic book explaining trauma, its effects on our psychology and physiology, and what to do about it. When something traumatic happens to us, we dissociate and our bodies shut down their normal processes. This unique comic explains the strange nature of trauma and how it confuses the brain and affects the body. With wonderful artwork, cat and mouse metaphors, essential scientific facts, and a healthy dose of wit, the narrator reveals how trauma resolution involves changing the body’s physiology and describes techniques that can achieve this, including Trauma Releasing Exercises that allow the body to shake away tension, safely releasing deep muscular patterns of stress and trauma.

Trauma is Really Strange will publish on December 21st 2015.

Putting life first and CRPS second

Karen Rodham is a health psychologist who has spent seven years working exclusively with people who are living with Complex Regional Pain Syndrome (sometimes known as Reflex Sympathetic Dystrophy or RSD).

Karen 2aImagine your loved one has developed a pain condition. Medicine does not reduce the pain, they can’t tolerate being touched in the area affected by the pain; they find it difficult to leave the house because they are afraid that someone might accidentally bump into them;  they are less tolerant than they used to be and they can no longer do the things they used to do. You are desperate to help them, but nothing seems to work. You can’t even give them a hug because this makes their pain worse. How might you feel?

 

Complex Regional Pain Syndrome (CRPS) is a pain condition. Most people who experience it improve in the first year, but for a significant minority (up to 20%); CRPS becomes a chronic long term condition. The key symptom is burning pain, but this is a kind of pain that medication barely affects and because of this chronic CRPS is a very difficult condition to live with. Other symptoms include: swelling, colour and temperature changes, hypersensitivity, as well as increased sweat and hair growth in the affected area(s).  Although the symptoms are usually experienced in a single limb, it is possible for CRPS to occur in more than one limb, and indeed in other body regions. In addition to all of this, it can take a long time for CRPS to be diagnosed because the symptoms could also be a sign that other serious conditions are developing. These other serious conditions need to be ruled out first which can be a frustrating process, not just for the person who is in pain, but for their loved ones and for the health professional who is trying to work out what is going on. For the person who is diagnosed with CRPS, coping and learning to live with CRPS is not easy, but in the same way that the person with CRPS is learning to live with and cope with the condition, so too are friends, family and loved ones. So what can you do if a loved one is living with CRPS?

 

Things to do together:

  • Communication: First, find a way to talk openly and honestly about how CRPS is impacting on both your lives. It is very likely that your loved one is not only trying to come to terms with their CRPS, they are probably also afraid that they are becoming a burden. If this is how they are thinking, the chances are they will be working very hard to keep their feelings to themselves. You will also be likely to be skirting around the issue because you don’t know how to help them. This is a recipe for upset and misunderstanding for everyone concerned. Without open and honest communication you won’t be able to work out what the problems and issues are, and without identifying the problems, you won’t be able to think about how to solve them.
  • Seek external help: Many people find that those first few conversations can be easier if they use a couple counsellor. Couple counsellors can help you to find a new and non-threatening way of telling each other how you really feel in a safe and constructive way.

 

Things the person living with CRPS can do:

  • Stock Story: Many people with CRPS say that when someone asks what is wrong with them, they feel they should explain CRPS in detail. It is fine to do this, especially when you are talking with close friends and family, but it can be exhausting going over and over what CRPS is and how it affects you. One solution is to develop a stock story that gives enough information to give them the gist, without going into minute detail. Something along the lines of “I have a rare form of arthritis” works well, because people have heard of arthritis, know that it is painful and that it is a long term condition, but you can make your own stock story and find something that works for you.
  • Crisis Card: Sometimes things can get very difficult and it can be hard to know which way to turn. Rather than wait for the next crisis, it is a good idea to make a note of the coping strategies that work for you (e.g. go for a walk, phone my sister, take a bath). You could put them on a credit card sized piece of self-laminating card and carry it in your purse or wallet – that way the next time you feel thoroughly fed up, all you need to remember is to read your crisis card and be reminded of what works for you.
  • Pacing: A key aim of pacing is to make our daily activities and rest patterns more consistent. It can be tempting when you have CRPS to overdo things on your good days, but this can impact on how you feel on the following days. Doing things at a steadier pace actually helps you to achieve more in a more balanced way.
  • Building a support network: It is important to have the right kind of people around you. Some of this is to do with you being able to communicate your needs so that other people know and understand how to support you, but it is also about you growing your network and finding positive and like-minded people.
  • Change your focus: Allow yourself time to effectively grieve for what you can no longer do and then turn your attention to things you can do, or new things you can try. It is normal to feel sad and frustrated about the things you can no longer do when you are diagnosed with a chronic condition. Allow yourself time to process this and to come to terms with the idea that this is how things are for now. No-one knows the future, so you cannot predict whether you will improve or get worse. What you can do is to proactively focus on the positive. Don’t be fooled by how simple this sounds, it is not an easy thing to do, but it is a positive way of dealing with the changes enforced on you.
  • Relaxation: Stress makes pain worse. Finding different ways to cope when you feel stressed, and learning to head off stress before it takes hold can help reduce the tension you feel in your body, which in turn could reduce the likelihood of stress-related pain flares.

 

Things the family can do:

  • Keep your own hobbies going: If you can keep your interests and hobbies going, you will be able to maintain a level of normality. This will ensure that you have an external focus and will go some way to reducing the fear often voiced to me by people living with CRPS that their condition has had such an impact on their loved one’s lives that they are now a burden to them.
  • Learn about CRPS: This last point is one for the family and the person living with CRPS. Ask the health professionals who work with you for their recommendations about where to get good and accurate information about CRPS. The better informed you are, the better understanding you will have as a family about how to work together.

 

With all of these points in mind, I wrote the book Learning to Cope with CRPS / RSD: Putting life first and pain second. I share coping strategies that people who live with CRPS find work well. I have also included a chapter focusing attention Rodham_Learning-to-Cop_978-1-84819-240-9_colourjpg-webon loved ones (friends and family of people living with CRPS) who often feel bewildered, frustrated and neglected by the health profession and worry that no-one realises that CRPS impacts on them too.  It is important to remember that everyone’s CRPS journey is unique – we are all human beings with different backgrounds and experiences, but it can be helpful to know that there are a range of different strategies you can try that might make coping with CRPS a little easier. Whether you are a person living with CRPS or a person who cares about someone living with CRPS, this book should highlight how you too can move towards putting life first and CRPS second.

Books for Mental Health Awareness Week

Mental health awareness week is a great time to look at how natural therapies can complement mental health treatment and be fundamental to keeping the mind healthy and preventing problems in later life. Here is a selection of some of Singing Dragon’s books for improving mental health.

                                                                                                                                                     

Recovery and Renewal by Baylissa Frederick

Frederick_Recovery-and-Re_978-1-84905-534-5_colourjpg-webMany people will be perscribed medication at some point in their lives to help with a mental health issue, but they can lead to dependency and coming off prescription drugs can be one of this most challenging parts of maintaining mental health. This book will be a lifeline for anyone taking or withdrawing from sleeping pills, other benzodiazepine tranquillisers and antidepressants. The author draws on her personal experience of coming off benzodiazepine tranquillisers to explain everything you need to know about withdrawal, including how to identify symptoms, manage them, and take firm steps towards recovery. It’s an uplifting, empowering read which will also be useful to families and friends of people overcoming perscription drug dependency, as well as medical professionals.

 

 

                                                                                                                                                     

Managing Depression with Qigong by Frances Gaik and Managing Stress with Qigong by Gordon Faulkner

Gaik_Managing-Depres_978-1-84819-018-4_colourjpg-webFaulkner_Managing-Stress_978-1-84819-035-1_colourjpg-webThese two practical books give step-by-step instructions for Qigong forms designed to combat depression and stress. No previous experience of Qigong is necessary. Frances Gaik is a clinical professional counsellor and provides a treatment plan with helpful advice from her years of practicing Qigong and meditation in therapeutic settings. Gordan Faulkner is Prinicpal Instructor at the Chanquanshu School of Daoist Arts. His anti-stress exercises are designed specifically to fit around a busy lifestyle and have been extensively trialled with Maggie’s Cancer Care Centres.

                                                                                                                                                     

The Mystery of Pain by Douglas Nelson

Nelson_Mystery-of-Pain_978-1-84819-152-5_colourjpg-webThis is a personal tutorial for understanding the psychology of pain. Douglas Nelson takes an in-depth and surprisingly entertaining look at how we experience pain and what medical professionals and therapists can do to improve treatment. Through asking strange questions like ‘Why does scratching an itch feel so good?’ and ‘Why is pain from a mosquito bite preferable to the same pain from an unidentified source?’ Nelson shows how us that the more we understand pain, the more power we have to control it.

 

 

 

 

                                                                                                                                                     

Fragrance and Wellbeing by Jennifer Peace Rhind

Rhind_Fragrance-and-W_978-1-84819-090-0_colourjpg-webFragrance has a powerful impact on our mental and emotional states, with scent playing a key role in forming memories and sense of place. This book explores the impact of fragrance on the psyche from biological, anthropological, perfumery and aromatherapy viewpoints. The author explores how scent has been used throughout history and across cultures, discusses the language of fragrance and presents detailed profiles of a broad range of fragrance types including their traditional and contemporary uses, and mood-enhancing properties.

 

 

 

 

                                                                                                                                                   

Principles of EFT (Emotional Freedom Techniques) by Lawrence Pagett and Paul Millward, and Principles of NLP by Joseph O’Connor and Ian McDermott

Pagett-Millward_Principles-of-E_978-1-84819-190-7_colourjpg-webO_Connor-McDerm_Principles-of-N_978-1-84819-161-7_colourjpg-webThese are quick and easy introductory guides to teaching yourself the therapeutic psychological techniques of EFT and NLP. EFT (Emotional Freedom Techniques) work by removing blockages in your body’s energy using tapping  in order to feel more positive, energetic, and less stressed. EFT can relieve a wide range of conditions including anxiety, anger, depression, insomnia and migraines. NLP (Neuro-Linguistic Programming) is a system of modelling your speech and behaviour to achieve your goals and connect better with those around you. It’s applications include building confidence, beating depression, and developing your career. NLP is a great starting point for anyone looking to improve their life.

                                                                                                                                                   

Mental Health Awareness Week runs from May 12-18, for more information see www.mentalhealth.org.uk. For more books on a range of mental health issues visit Singing Dragon’s parent company, Jessica Kingsley Publishers, www.jkp.com.