Phase II

“On Your Feet”

OVERVIEW OF PHASE II

This phase is about anger. It is the one that will determine whether you are going to be able to truly move on or remain mired in the past.  It is the step that has the most initial impact on  decreasing my patients’ pain level.

• Letting go of your legitimate anger is the “Continental Divide” of chronic pain
• If you feel you are not angry in the presence of unrelenting pain you are just not connected to it—most of us really hate feeling angry and we really despise being in pain.
• This section outlines a lifetime practice

GOALS of Phase II

Education

• Learn if surgery is option—get it done or not
• Deepen understanding of pain
• Understand link between pain and anger

Sleep

• Full night’s sleep
• Usually still need meds

CNS

• Focus is on anger
• Understand how anger drives the formation of anxiety-producing neurological circuits
• Pain drives anger and therefore anxiety
• Recognize and acknowledge your own victim role—is universal

Medications

• Continue to stabilize
• Weaning is still not a priority

Goal Setting

• Later

Rehabilitation

• Begin physical therapy
• Join a gym—light weight training
• Increase aerobic activity–walking/ swimming/ machines

FIVE STEPS:

Step 1—UNDERSTAND INTERACTION BETWEEN PAIN, ANXIETY, AND ANGER

As mentioned in the post “Your Hand Over the Stove” there is a lot of anxiety associated with experiencing chronic pain.  There are several concepts to consider regarding the interaction between pain, anxiety and anger.  Anger and Anxiety-”The Highway to Hell”

• When a basic need such as air, food, or water is not met, anxiety ensues.  When you lose control of your ability to resolve the problem you will become angry.
• Anger causes you to increase your efforts—often dramatically
• Not being in pain is a basic human need

Anxiety represents a feeling of vulnerability and helplessness.  We are programmed to avoid anxiety at all costs.  Anger causes you to feel powerful, which covers up the feeling of anxiety.  Yet at the same time anger causes your mind to race faster and reinforce your anxiety-producing circuits.  It is the turbocharger that must be turned off. Video: Anger Fueled Anxiety-”The Highway to Hell”

There is a genealogy of anger:

• Anxiety-producing circumstance over which you have lost control—feel trapped  Video: Completely Trapped
• You then blame yourself or the situation
• You are now in a victim role
• Frustration, anger, or even rage is the final result

Anger is an anxiety-driven survival reaction.

The circumstance may be perceived or real:

• Examples of perceived victimhood are: a) being cut off in traffic b) not being invited to a party c) not enough time to do what you would like
• Examples of real anger are: a) being physically assaulted and robbed b) vicious gossip c) wrongfully imprisoned

The similarity between real and perceived victimhood is that the final result is anger and it will destroy you either way.

The difference between real and perceived anger is that real anger is much more difficult to let go.  “I Understand Your Anger. Get Over It.”

Chronic pain is REAL victimhood. You really are trapped “The Pit of Despair” and even worse there is usually not an end in sight.  Your Doctor May Not be Listening

Finally understand the devastating effects of chronic pain and anger on your immediate family.  You would do anything for them and you also need their support.  Why would you continue to allow pain to rule your life?  Pain = Anger = Abuse

Step 2—IDENTIFY YOUR OWN VICTIM ROLE—IT IS UNIVERSAL

• What person or circumstance is upsetting me?  Be specific.
• Acknowledge that you are blaming that person or situation for making you angry.
• Write or speak out loud to yourself, “I blame ___________ for making me upset.
• Understand that you are now in the role of a victim.
• Write or speak that I am allowing myself to be a victim of ________________.
• Differentiate clearly in your own mind whether you are:  1) Are truly being victimized?  2) Is it based on a perception based on a “story” or imagery in your mind?
• Note how much more difficult it will be to process the anger if you have been truly victimized.

Obviously your chronic pain will be high on the list.  Do not let it get in the way of identifying the multitude of other ways you might be playing the role.  Anytime you are frustrated or angry you are in a victim role.  Take full responsibility.

Learn to do this exercise on a regular basis.  This is the most challenging part of my own journey.  I went through a phase of my journey where I felt I knew enough about being a victim that “I was above it.”  It was a very bad phase of my life.  What you are not aware of can and will control you.  I now am fully committed to acknowledging my victim role and using my tools.  Reactive versus Creative

Step 3—COMMIT TO NOT REMAINING A VICTIM

Once you have a clear idea of the depth of your anger and your role of being a victim, make a simple decision to not be a victim anymore.

• Write down, “I choose not to be a victim.”  Date it and put it in a place you will see it on a daily basis.
• It is an intellectual choice
• You will repeatedly fail
• You must commit to being honest with yourself
• Using reprogramming tools are mandatory—your intellect cannot contain your level of frustration associated with being in chronic pain
• “I will try” is the ultimate victim phrase.  Write “try” on a piece of paper, “X” it out, and hang it on your refrigerator.
• Write the word “Do” on another piece of paper and hang it on your bathroom mirror.  (Concept from the Hoffman Process)

I made my choice on Mother’s Day 2002.  It is still a daily challenge but my life took a dramatic turn out of the abyss that day.

Step 4—TAKE OFF YOUR DISGUISES

None of us like the idea that we might be playing the role of a victim.  There are many ways that we disguise it.  The list is infinite.  I will share a few of my personal favorite methods.  Anger-The Absolute Block

• “Being right”
• Feeling sorry for myself
• Suppression
• Disassociating—closing the door on the past
• Identity” of being “cool and calm”
• Perfect/ judgmental
• High ideals/ standards
• Strong opinions

My list would truly fill a thick book.  As you are more honest with yourself you can at least give yourself a little credit for creativity.

Write these disguises down.

• Don’t throw this list away.
• The intent about writing down these disguises are to give you more awareness of who you are.
• This step is not intended to be a re-programming step.

Step 5—ACCEPTANCE AND FORGIVENESS

This is the station where I have to get off of the train.  There are many books that have been written over centuries on this subject.  This is the area where I struggle with the most.  I will only make a few comments regarding what I feel does not work.

• Positive thinking
• Denial/”Intellectual” forgiveness and acceptance
• Extreme adherence to religious beliefs

Positive Thinking

• Positive thinking is another way of suppressing negative thinking.  This is a tricky concept in that by committing to a process of true forgiveness the results are very positive.  You first have to go through the steps to achieve the positive result.
• Intellectual forgiveness/ denial

All of us already know that forgiveness is important.  It is so important that we will suppress or deny that we are angry and/or we have “let it go”.  I only know in retrospect that my past forgiveness was a form of denial and positive thinking.

• Extreme religious belief systems

As I will point later a deep spiritual connection to yourself and a higher power is critical to your healing.  Many of my patients have had great success with the support of their religious leaders and fellow believers.  A genuine deep faith is powerful.  However any religious belief system that is critical of one’s self or others is incredibly damaging.  This is one situation that I cannot penetrate and have to let go—quickly.

The book that has been the most effective for my patients and me is “Forgive for Good” by Fred Luskin.  He is out of Stanford University and has conducted four major research projects on forgiveness.  He will educate you as to the nature of true forgiveness and outline steps in order to achieve it.

RESOURCES:

“Forgive for Good” by Fred Luskin

“Back in Control”–full draft (unedited)

Strong consideration of a pain psychologist

CRITERIA TO MOVE TO THE NEXT PHASE:

• Continue to free write and also in the “Feeling Good” three column format
• Finished and engaged in the tools of “Forgive for Good”
• Feel that you have fully accepted your role as a victim
• Sleep should be 7-8 hours per night-with or without meds
• Physical therapy should be completed
• Be doing light workouts in the gym 3-5 hours per week with weights
• Completed All of the above five steps—it is not possible to move into phase three without taking full responsibility for your frustrations and anger.