Welcome back. This is the final section of this module on managing negative emotions, and their effects on chronic pain more effectively. It really wouldn't be complete without sharing with you. Skills from this area that we call self-regulation. We started to touch on them in the last section. Negative emotions, when handled poorly, have definite physiological impacts on our muscles, nerves, connective tissue, and make it harder to heal. When we learn to regulate our nervous system and regulate our muscles differently, we heal better. Also important to keep in mind that if you think of the brain, not the rational brain but the primitive [COUGH] that some people call the reptilian brain. That part has a lot to do with controlling pain experience. And that part learns better from experience than it does, from just didactic verbal talking. So we need both types of information to learn. In this section, you're going to learn specific experiential exercises that you can practice that will help alter your body, alter the state of your autonomic nervous system, and help you to cope better with your chronic pain, and to heal better. [BLANK_AUDIO]. So one fact here. Alteration of the breath beneficially affects the balance of the nervous system. [COUGH] Our autonomic nervous system is divided into two parts. There is the sympathetic part branch. Sympathetic is the activating branch. And the parasympathetic, which is the calming branch. You can think of sympathetic as the gas pedal. Parasympathetic is the brake. When they are in balance, we feel pretty good. Chronic pains tends to disregulate the balance of the autonomic nervous system. And so, things to regulate it help. Why is breathing important? Turns out that when you take a deep breath and exhale, [SOUND] that exhalation actually triggers what's called the vagal nerve system. The vagal nerve system has a lot to do with the parasympathetic or calming branch of your autonomics. So, this is why you hear so much about breathing techniques, whether it's expectant mothers going through Lamaze training be, before having, giving birth to their baby, you see athletes do it a lot. What do we often see? If you, if you're a fan of basketball you seeing someone up at the free throw line. They got the ball right before they shoot the free throw, what do they do? [SOUND] They take a breath. Someone's about to give a big speech in front of thousands of people, what do they do before they start their speech? [SOUND] Take a breath. Someone's about to start a violin concerto. [SOUND] Take a breath before they start. Instinctively we know to do this. Why? Because taking that breath, exhaling, changes the state of our nervous system. So, we’re going to show you some skills to alter and focus on your breath for greater comfort. These techniques reduce anxiety, they reduce arousal. And this regulation of your mind, body, and emotions, and these strategies, of course, will help you heal more effectively from chronic pain and reduce the impact of these negative emotions on your life. So, let's go back to our notion of the alarm system for a moment. remember, that we have an alarm system in pain. Sometimes it helps, sometimes it doesn't. In acute pain, something that happens just in the last minute or two, our alarm system is very important. If I put my hand over a flame, I'm going to get an ouch. going to have an alarm that's going to pull my hand back. And that alarm is important. [COUGH] That protects my hand from being injured from the flame. If you get sharp in the chest that radiates down, down the arm, that's, that's an alarm and you want that alarm because it signals you to take action. What happens though in chronic pain is that our alarm system gets distorted. Once we already know that the herniated disc has been repaired, once we know that the tight muscles have been addressed, once we have learned that the factors affecting the pain are no longer an active disease process. Parts of our brain sometimes still set off the alarm system as if it is a threat. Setting off all these hormones, all these neurotransmitters, and making the pain worse and harder to heal. And so what happens then is that the person with chronic pain, starts to get an over reaction, even to a minor signal. So there's a term called allodynia, which means that, someone with chronic pain, you touch their skin and they have a heightened response of pain to that sensation. That's because their neurosytem has become sensitized [COUGH] and overwhelmed. So, self regulation, learning breath techniques can be an effective way to help reduce this, and help you heal. This is training your brain to turn off your nervous system's false alarm, okay? Remember the principle of neural plasticity. Our brain can change and learn. Breathing techniques is one way to learn how to do this. So here's the first one. I'm going to teach you this technique. I'm going to encourage you to practice it on a regular basis. This one's called four, four, eight breathing. And so what you do is just find a comfortable position. You can either sit in bed propped up, lay comfortable in bed, sit in a comfortable chair, or whatever is most comfortable. Close your eyes. And I'm going to take you through the steps of this. [COUGH] And I'm going to introduce it to you just like I would introduce it to a patient that I'm teaching it to. So here's how it works. I'm going to inhale through my nose for four counts. I'm going to hold it for four counts. And I'm going to exhale for eight counts. So by the end of eight, we'll have completely exhaled. And I'll do this to show you the counting. So here's what it looks like. First I inhale. Hold it. Exhale [SOUND]. Okay, that's one cycle of the four, four, eight. Now, that cycle I want you to repeat at least ten times. So ten times, in for four, hold for four, out for eight. That takes about oh, two to three minutes to do. It's very quick. But almost everyone who practices it tells me that after the very first time they feel better. Their pain's reduced. Their tension's reduced. It's a very powerful technique. I want you to be sure and careful while you do this technique. Keep your eyes closed and keep your attention focused on the numbers. And so I inhale one, two, three, four. Hold two, three, four, etc. Keep your mind focused on the counting, that way you give your mind a point of focus and keeps your mind from getting worked up and distracted as well. So four-four-eight breathing, very effective technique. Here's another technique you can use called abdomen-focused breathing. [COUGH] And again, I'll show you how to do this. Just sit in a comfortable chair. One thing we know about the breath is that when people are tense or in a lot of pain their breathing becomes very shallow. We tend to constrict through our torso. We want to be able to open the torso and breathe more fully. This technique helps you to do that. When we breathe shallow, we tend to breathe more through the chest, so we see, when I see a patient with shallow breathing. We see their chest moving, but not their abdomen. When we see someone with relaxed ab, abdominal breathing we see their abdomen moving. You've seen examples of this, if you have a pet, if you have a dog, and you see them sleeping. What do you notice? You see their belly moving up and down. When we see an infant or a young child sleeping you see their belly, their abdomen moving up and down. It's relaxed abdominal breathing. That's how we want to breath and that's going to help you when you have pain. So, here's how to do it. Place a hand on the center of your lower abdomen. Just like this. Close your eyes and take a slow deep breath. And inhale, one two three four. Exhale, one two three four. Just notice the sensation of your hand resting on your abdomen. When you're doing abdominal breathing properly you should notice that your hand will rise slowly on the inhalation. And will fall slowly on the exhalation. If your hand's not moving, it may mean that you're still breathing up in the chest, and just need some practice. So, just keep working with this, hand here, and think of actually pressing your hand out as you breath. That's going to be helpful. Here is another technique that we use with many of our patients. [COUGH] It's called sensation-focused breathing. And so again, I'm going to explain this to you just like I'm explaining it to one of my patients. So sit with your eyes closed. And just breathe normally. And, and I would say to you, you know, people tend to notice their breathing differently in different parts of their body. Some people feel the sensation of the breath in their stomach and abdomen, feeling their abdomen rise and fall as they breathe. Some people feel their chest moving, feel their chest wall expand and deflate. Some people feel the breath at the tip of their nostrils. Feeling the air going in and out from the tip of the nostrils. So just sit back, close your eyes and just breath normally. Now first of all, I'm going to have you focus attention. On your, on your abdomen. And of course, for the purposes of our lecture today I'm going to do this more quickly than I would. I'd have you take a longer time, probably about three, four minutes with each one of these. But for now, just feel the sensation of your abdomen rising and falling as you breathe. Just focus on the physical sensation of it. Do that for about the next minute. Okay? So, I would have you do that for a minute or two. Then, you'd switch your focus to your chest. Same thing. Now, breathing normally, switch your attention from your abdomen to your chest wall. And now, just feel the chest wall expand. On the inhale and deflate on the exhale. Keep your attention there for about a minute. Don't think about anything other than just the sensation of your chest wall moving as you breathe. Good. Now, part three. Switch the attention up to your nostrils. Same thing, breathe normally and just now keep your attention focused on what's the air feel like flowing into my nostrils and flowing out of my nostrils as I exhale. You may find that the air feels slightly cool and dry as you inhale, slightly warm and moist as you exhale. Take about a minute. Focus there. Now, what I would say to you next. We, we sped that up a little bit for the demonstration but you get what I mean. [COUGH] Say, okay now. Of those three places you focused on. Your abdomen, your chest and your nostrils, which was the easiest one for you to focus on? And I get all different answers, some say the stomach, some say the chest, some say the nostrils, good. Whichever one you picked that was the most easy to focus on, I want you to keep your focus on that one. Now, I want you to take about five to six minutes. And just breathe normally and focus your attention very, very closely on that spot. Where ever the spot was, abdomen, chest, or your nostrils. And just focus on the physical sensation of the breathing. What does it feel like? See how closely you can notice the nuances of the sensations as you inhale. And the nuances of the sensations as you exhale. [SOUND] If your mind wanders off onto something else, that's okay. Just bring it back to the, to the physical sensation once you notice that you're distracted. Within five to six minutes of doing this you'll find that you feel profoundly calmer and more comfortable. Some people like to do this before they go to bed, it helps them fall asleep. Some people set a timer because they get, they get so comfortable they might fall asleep while they're doing it. At any rate experiment with it, see where it's most comfortable to focus. And you'll find this to be a very helpful exercise. Here's another variation. [COUGH] It's called the concentration meditation exercise. You've probably heard, and will hear, other lectures in this series about the value of meditation for pain. We're going to show you one quick example here that's very simple to learn and easy to do. What I'd have you do is just sit in a comfortable chair and focus just on the inhalation and exhalation. [SOUND] Just like that. Just breathe normally. We're going to add a piece. As you inhale, I'm going to suggest that you silently say to yourself internally the word so. As you exhale, say the word hum. So, from the outside you're watching me, I'm just going [SOUND]. But internally if you could hear what I'm saying inside as I'm inhaling I'm going, so, hum, so, hum. But I'm just saying it mentally. You don't have to say the words externally. But say those words. And focus on those words as you inhale and exhale and do that for anywhere from five to ten minutes. Be aware when you do these meditation techniques that your attention may well wander. I wonder what time it is, What time do I have to get to the office? Did I forget to pick something up at the store? This is perfectly normal. And it's important to keep in mind that the goal of this meditative practice is to cultivate concentration, and to cultivate calming. So each time you notice yourself getting distracted just bring yourself back to the breath, and back to saying those words. Do it gently. Do it without self criticism. Whenever you get distracted, and you will find this a useful practice too. So in general, I showed you a couple of, actually three breathing exercises and including a meditation technique. There are many, many more techniques you can learn including self-hypnosis, but the value of these is that your body learns to re-regulate. Reset its set point so that you calm the activation that comes from stresses of negative emotions. These are life skills. And these are things I would like you to be practicing at least once or twice every day. It's really good preventative medicine. It helps your body heal quicker from chronic pain. And will help you to feel better in general, be more creative, and more productive. So, we have reached the end of the last section of this module. want to review with you just briefly what we covered. We talked about risk factors, and protective factors. For chronic pain. And particularly how negative emotions can be a risk factor if we don't address them. Or negative emotions can be a protective factor if we learn how to manage them more effectively. We covered many, many self management tools. And I really encourage you to go back after the course. Look at these again. Take all the time you need, and learn several of these strategies and practice them. Some of them you'll like better than others, but you'll find several that you'll be able to use. These management tools and experiential skills help you tame the psychophysiological effects of negative emotions. And to health from the effects of the negative emotions on your chronic pain. These are new skills and they get better with practice. What I encourage you is to make them part of your daily routine and practice them every day. That's the end of this module. It's been my pleasure to share this time with you. Feel free to contact my website if you have questions. Please practice them, and I wish you the best of health.
