NPT eBook

NPT Neuro-Plasticity Training Making Change Easy

Scott Swinson

NPT

Making Change Easy

Retraining the Brain and Body for a Better Life

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Contents Welcome…………………………………………………………………………….....…4 The Science of Symptoms – flight fight responses………………………………….……5 Why Do Things Persist? – the unconscious nature of things…………………….……….9 Beliefs, Placebo and Physical Changes in the Body………………………………….….11 Posture and Physiology…………………………………………………………….…….15 Awareness…………………………………………………………………….………….18 The Art of “Doing”…………………………………………………...……….…………19 Excellence………………………………………………………………………………..20 Neural Plasticity………………………………………………………………………….21 Feedback…………………………………………………………………………………24 Nutrition………………………………………………………………………………….25 Action or Perfection……………………………………………………………………...26 Filtering and Reality?.........................................................................................................28 Gratitude………………………………………………………………………………….31 Summary…………………………………………………………………………………33 Next Steps………………………………………………………………………………..34 Appendix A – Lupus and Autoimmune Issues…………………………………………35 Appendix B – Irritable Bowel Syndrome………………………………………………44 Appendix C – CFS/ME…………………………………………………………………50 Appendix D – Pain……………………………………………………………………...63

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Welcome Hello and welcome. If you are reading this then you are probably soon to be embarking on a new training being delivered at St George Hospital called Neuro-Plasticity Training or NPT. This eBook has been written to help you to prepare for the training and make sure you get the most out of it. If you would like extra information about your issue then there should be some information in the appendix that covers your issue(s).

NPT is a training program and, just like any other training program, you are going to have to do some work in order to reap the rewards. The good thing is that it is you who is in control of whether that happens or not. Just like doing a course in Japanese, you could turn up to the sessions, but if you don’t put into practice what you have learnt, and make sure you really know what has been taught, then you will be unlikely to learn Japanese. If you learn Japanese for a week full time but then never look at it again or practice it again, a year later your Japanese will quite likely be poor.

Also just like learning to drive you can read many books about it, watch other people do it, watch videos and know that it is possible to do, but the only way you are ever going to become a good driver will be to actually get behind the wheel and drive. If on your first attempt to drive you let the clutch out too fast and stall the car and give up, do you think you will become a competent driver? No of course not. We all learnt to drive by practicing and making mistakes and being persistent because the goal of getting your license was important enough to you to keep going.

NPT is like that. You will need to persist with it. There will be times when you don’t really feel like doing it but that will be the time that you really need to take action and use the process. Just thinking about using the process does not count. You need to do the process physically and notice the positive changes that occur.

I think NPT is a bit like learning to ski or snowboard. It is amazing that someone can come along having never skied or snowboarded and then, with lessons and a good instructor, learn to do it reasonably well. Of course the new person will probably fall over even at the end of a week but it is amazing when someone totally submerses themselves in a new skill how quickly they are able to learn it. NPT is the same. With your full immersion in using the process you can make massive changes in a short period of time.

You can also take your time and make change slowly. Either way it is up to you.

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The Science of Symptoms If you are about to do NPT then you will have one or more of the following symptoms (processes): • • • • • • •

Pain Digestive problems (IBS) Sleep problems Fatigue Brain fog – head does not feel clear and have trouble remembering things Muscle tone and activation problems Immune system imbalances (autoimmune issues such as Lupus or an underactive immune system enabling your body to get many colds and the flu often)

You probably have one of the below diagnosis: • • • • • •

Chronic Pain Fibromyalgia (FM) Irritable Bowel Syndrome (IBS) Lupus Chronic Fatigue Syndrome (CFS) Myalgic Encephalomyelitis (ME)

Flight/Fight Responses The stress response or flight/fight response plays a huge role in keeping people stuck. If you investigate the stress response then you will find there have been a lot of developments over the past decade in our understanding of how this system works and what effects it has on our body. Whether you have chronic pain and/or have Fibromyalgia, CFS, Lupus or IBS then this response will be having quite a big effect on your body’s physiology, possibly even right now.

The stress response is a response our body activates in response to any “threat”. This can be cold weather, a broken leg, a bacterial infection, a police siren going off behind us while we are driving along, the thought of talking in front of a group of people or even someone in front of us with 15 items in their basket in the 10 item checkout lane! It can be activated by having an unsupportive work environment, family or partner disputes, feeling pain and thinking something is wrong or by being angry or irritated with your current situation. As you can see the “stressor” is not just what we might think of when we think of “stress”. When you have pain that persists the experience of pain is often retraining the brain and body for a better life

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enough to activate this response and this affects every cell of your body to some degree. It is easy to imagine what happens to our bodily systems if you imagine you are the zebra and a lion has just appeared out of nowhere! It is a very complex system but put simply when we activate this response certain things happen. We activate the sympathetic nervous system, which vamps things up. This is done by the release of adrenaline, noradrenaline, cortisol, dopamine and other hormones and neurotransmitters. The following things occur: • Breathing rate increases to deliver more oxygen to our working muscles • Blood pressure increases so we can move quickly while maintaining good blood supply to brain and working muscles • Heart rate increases to pump more blood around the body and deliver the oxygen and sugars to working muscles • Blood supply is diverted from your stomach to your working muscles (arms and legs).

• You may need to urinate and defecate as the zebra running away from the lion you want to get rid of as much weight as possible.

• Your thyroid activity increases to increase your basal metabolic rate • And many other things that would take many pages to list When this response occurs it has to steal energy away from other less important systems.

So the following things are affected:

• Ability to Think Clearly and Retrieve Memories. When I lion comes along it is important to make QUICK reflexive decisions! So the ability to think clearly and rationally is diminished by disruption to the cognitive areas of your brain leading to one of the common symptoms many people have called brain fog. With long term activation there can also be a disruption in the hippocampus (a part of brain in the center that look like a sea horse) and prefrontal cortex, which can lead to problems with memory retrieval and planning tasks.

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• Digestion. With the blood supply diverted from the stomach you won’t be unable to digest food properly and will not get the nutrients from the food you have eaten. You may feel nauseous or have stomach pains. Also there is a tendency for the body to evacuate what is already there so again a loss of digestion and nutrition. Over the long term the digestion can be adversely affected by high numbers of contractions of the intestine or you can even get the contractions going in alternate/wrong directions leading to constipation and or diarrhoea. This of course can lead to digestive and energy problems common with many pain suffers, people with fibromyalgia and people with irritable bowel syndrome.

• Sleep. It is not important to sleep when a lion is around! So the stress response leads to poor/fragmented sleep and lack of sleep is in its self a stressor! You can be stuck between a bit of a rock and a hard place! Lack of “good” sleep (slow wave sleep), or sleep that gets your body into the “rest and digest” part of sleep will lead to many issues. Immune system is affected, memory is impaired and energy restoration is poor as well as other issues. Many people who are stuck with similar issues to you report never waking feeling refreshed which as you can see makes sense.

• Immune system. The immune system can become either overactive or under active. If overactive then you will suffer from medication sensitivities, food allergies, auto-immune problems such as lupus and have a massive expenditure of energy. If under active then you will be prone to infections and generally be doing a poor job removing old, damaged, foreign and mutated cells out of your system. Many people with Lupus, CFS and Fibromyalgia don’t get colds but do suffer from sensitivities to medications, foot, light, sound and of course touch etc.

• Nervous system. Signals to and from the brain to the rest of the body via the nerves become confusing and disrupted. The nervous system is the system that controls everything in our body. We have 100 billion nerves in our body. That is 14 times as many nerves as there are people on this planet and each nerve has 2000-5000 synapses (joins to other nerves). Each synapse is affected by the stress response. This in turn affects our ability to turn muscles on and off and the feedback we get about how retraining the brain and body for a better life

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comfortable a muscle, ligament, tendon etc is. People with chronic pain often report a decrease in their co-ordination, balance and fine motor skills as well as many pain symptoms throughout their body. When the nervous system is on edge for a prolonged period then it is much more likely to fire and thus give pain. Once the nervous system is able to get back into balance then more helpful signals will be sent.

• Muscular system. As you can see from what happens to the nervous system the motor system may not be able to work properly. This occurs when the stress response is activated repeatedly. The muscular system becomes more on edge, it sends confusing signals back to the brain and the brain sends confusing signals back. People producing prolonged activation of the stress response often have issues with strength and muscular contraction. They often experience twitches in muscles or muscles suddenly going into spasm by increasing their tone.

As you can see from the long list of changes that can occur, if this response is activated repeatedly the body will not be able to functional normally. Repeated activation of the stress response can lead to a lack of refreshing sleep which activates the stress response even more which leads to less refreshing sleep which activates the stress response even more……lack of sleep also decreases energy restoration! A bad place to be in! Repeated activation may also stop you from digesting food properly, you may be unable to think clearly and retrieve short term memories, your pain may increase and your energy levels are likely to be very poor. You can feel like you constantly have the flu. Each person can have one or many of these symptoms and it tends to effect each person in a unique way.

This is why people with the diagnosis of Fibromyalgia have many of the same symptoms as people with Chronic Fatigue Syndrome and vice versa. Repeated activation of this response will produce unique symptoms in every person. We are all different.

The good thing is that we are all neurally plastic which means we have the ability to change what is going on in our nervous system and bodies. It is changing every day, whether we like it or not, and we can influence our nervous system in many ways using NPT. That is what this training is about, how can we influence something that is often unconscious in our nervous system and body?

Luckily it is you who gets to decide to take these steps and the action and no one else.

You can have some say in what happens next by taking ownership of your problem and really committing to doing what needs to be done over the three days of the NPT and into the future.

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Why do things persist? – the unconscious nature of things Our bodies have been designed to make things automatic and unconscious and this is a great thing. For instance at some stage we learn that chairs are for sitting in and from this we are able to, without thinking, know that all these various shaped things that are chairs can be sat in. We also learn how to sit and so the next time you have to sit you don’t think…now bend at my knees, hips and ankles simultaneously, while maintaining my lumbar stability. My quadriceps will need to contact eccentrically (lengthen while contacting) while my soleus will have to do the same. I will also need to have cocontraction of opposing muscles to provide stability. My back muscles need to turn on and I need to use my balance system to make sure I don’t fall over while doing this. If we had to perform everything consciously every time we did it then we would never have learnt to walk or even sit in a chair. You only need to watch a baby learning to sit with balance or stand. They sway around all over the place and sometimes they end of on the floor. Through repeated practice and our brains amazing ability to “learn” we are able to master a task such as sitting with balance, standing, walking and sitting in a chair. Luckily we don’t have to think about those activities any more and that serves us well. We can think about other things such as what we are going to order for lunch as we walk towards the café.

Now what happens to these automatic actions when we throw a spanner in the works. For instance we know how to drive here in Australia with no problems we can do it without thinking and it’s easy (most people!).

Then we go on a holiday to France and hire a car and all of a sudden we are having to drive on the other side of the road, change gears with the other hand and look in different directions when you pull up at an intersection.

This will be a steep learning curve, but luckily we have the ability to learn how to drive in a new way and if we stayed in France for a few months it would not be long before we were driving quite naturally and not having to think about our every move. This is the way our bodies work. It would be a good thing for you to fold your arms right now. Fold them and see which arm goes under and which one goes on top. You will do this the same way every time, although you probably never decided consciously which way you were going to do it. If you try and do it the other way then you will have to think about it more and it will feel a bit weird and uncomfortable, a bit strange.

The interesting thing is that you could make the “uncomfortable, weird” way your new normal by doing it many hundreds and thousands of times and “retrain” your brain to end up making this your automatic, unconscious way of doing it. After retraining your brain to do this you would then not need to think about it unless you wanted to change back again.

The same applies for many of our patterns of body posture, body movements, breathing and internal dialogue. We tend to do the same patterns over and over and over again and retraining the brain and body for a better life

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unless we are aware of us doing this and have a tool to change it, then the past will probably keep repeating itself, even if we don’t want it to. Now this is not a big deal when it comes to arm crossing or the way we stir our tea but it is important if the pattern is having a detrimental effect on our health and life. If your body keeps activating the stress response over and over and over again then you will have some unhelpful symptoms from this and unless you are aware of this and then take action with the right tool then it is likely to continue into the future. Because the body loves patterns and loves to make things automatic.

So once you have leant NPT then you will have a tool to be able to take any pattern that you are running that is not helpful and “retrain” your brain and body to replace it with a new response that is much more helpful and then you can go on to making this automatic, just like driving a car.

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Beliefs, Placebo and Physical Changes in the Body This next chapter is taken from the book “How your mind can heal your body” by Dr David Hamilton.

The Power of Believing “The outer conditions of a person’s life will always reflect their inner beliefs.”

James Allen What if scientists discovered a new drug – just one pill – that could cure or improve the symptoms of most known diseases? It would probably make headlines all around the world and become the greatest-selling drug of all time. Actually, such a thing already exists. Let me introduce you to . . . the placebo!

A placebo is a dummy drug that’s made to look just like real medicine. It’s used in trials so that the read drug can be tested against a control. Being a control, it isn’t supposed to heal – but it odes, because patients believe that it’s real. Their minds actually heal them.

“The placebo effect has evolved from being thought of as a nuisance in clinical and pharmacological research to a biological phenomenon worthy of scientific investigation in its own right.” These are the words of Fabrizio Benedetti, a neuroscience professor at the University of Turin Medical School, a member of the Placebo Study Group of the Mind/Brain/Behavior Interfaculty Initiative at Harvard University, and a world authority on the placebo effect.

Since the advent of brain-imaging technology, there’s been a surge of interest in the placebo effect. Research now shows that when we take a placebo that we believe is really a drug, the brain lights up as if we were in fact taking that drug, and produces its own natural chemicals.

This has recently been shown with Parkinson’s disease. The symptoms of this disease arise from impaired production of a substance called dopamine in part of the brain, which affects movement. Research has indicated that patents who are given a placebo but told that it’s an anti-Parkinson’s drug are able to move better. Scans have even shown that the brain is activated in the area that controls movement, and the missing chemical is actually produced. The improved maneuverability isn’t just a psychological thing; it’s a physical release of dopamine in the brain.

Chemicals in the Brain The production of chemicals in the brain when a person takes a placebo was first proven in 1978 when scientists at the University of California, San Francisco showed that placebo analgesia (when a person gets pain relief from a placebo) occurs because the brain produces its own natural analgesics (painkillers). It was found that these are opiates, like morphine, but that they’re the body’s natural version, which are referred to as endogenous opiates. More modern research is beginning to show that the same kind of retraining the brain and body for a better life

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thing happens when placebos are given for any condition: the brain produces a natural drug that’s tailor-made to combat the illness.

There are thousands of natural substances in the brain and body. In the words of Dawson Church, author of The Genie in Your Body: “Each of us holds the keys to a pharmacy containing a dazzling array of healing compounds: our own brain. . . . Our brains are themselves generating drugs similar to those that our doctor is prescribing for us.”

In a 2005 scientific paper published in The Journal of Neuroscience, Fabrizio Benedetti wrote: “Placebo effect seen with different treatments are more likely to track closely with the active treatment to which they are experimentally paired.” In other words, if a person is given a drug to treat a condition and then it’s secretly swapped for a placebo, the chemicals produced are believed to be natural versions of the drug that was originally used – if it’s a pain killing drug, the brain produces natural painkillers.

Similarly, studies on depression suggest that the brain produces natural antidepressants.

Brain scans have now shown that taking a placebo in place of the antidepressant fluoxetine (Prozac), for instance, affects most of the same brain areas as the actual drug.

The brain always produces its own drugs, and this is mind over matter at the molecular level.

No longer can the placebo effect be dismissed as just a figment of the imagination – it really is all in the mind. When we believe something, chemicals are produced in our brains that carry out powerful roles that give us exactly. _______________________________________________________________ So as you can see beliefs play a massive role in how our bodies operate at the molecular level. You can take the same sugar pill and have vastly different biochemical changes in the body depending on what the sugar pill has been given for. What is produced will depend on your body’s unconscious “knowing” about what should be produced when you take that particular drug. The same applies to NPT. You will be asked about your belief about the training, about whether you think it is possible for you to get well and influence your body? Your answers will obviously depend on what you think about this sort of thing. If you do not believe that the mind can influence the body, or that is it is even possible to get well then you may need to do some more reading from the list of books at the end of this eBook to help you to get a belief that will help you in the training instead of hinder you. You will only do this training once and so we would like you to get the most from the three days and your life that follows.

This next story is from the book “The Magic of Metaphor” by Nick Owen That Won’t Work It was a four-day course in Vienna at one of the Pedagogical Institutes. There were about thirty teachers, trainers, and educators attending the course. The topic was cooperative retraining the brain and body for a better life

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learning, team dynamics in business-speak. At the regular evaluation sessions everybody reported satisfaction with the way the programme was going. They enjoyed the activities, they like the process of working in groups, of having to share information with each other in order to complete tasks. They were learning and having fun. Everybody thought they could use the ideas, the processes, and the activities with their students.

Except Werner Bichlmeyer.

His was the lone voice of dissent. His reasons were many and various. They concerned mainly two areas. First, the amount of additional preparation he would have to do. He had been teaching for twenty-five years, had all his lessons prepared, and valued the time he spent on his hobbies and various sports. His second area of concern was his views about his students. He felt them unable to take on borad the responsibilities required by group work and cooperative engagement. He thought they might take advantage of group situations and do less work. He thought they might behave in childish ways and there thoud be an increase in what he perceived as indiscipline. He flet sutdents would not want to share information and ideas, and above all he might lose control.

These responses of Werner’s leaked out slowly, evaluation session by evaluation session.

After a while the group began to respond to him as a stuck record. He was certainly stubborn in, and committed to, his views. I did my best to win him around, to reframe his views, to challenge him to see things from other perspectives, to listen to the views of his collegues, and the examples of success given by those educators already using these techniques.

Without success.

And I admired him for sticking to his guns in the face of such overwhelming opposition.

He could easily have pretended it might work for him and avoided the censure of his peers. At the end I said, “Werne, I’ve tried everything I know to get you to see it differently. And I have to admit I’ve failed spectacularly.”

“Yes,” he said. “It won’t work.”

“Werner,” I replied, “while that remains your belief, I have no doubt you are absolutely right. And you have every right to old to that belief, and I wish you well in your teaching.

There are many ways to teach, and there is no right way. Just different ways that suit different kinds of learners. We make our choices, and I wish you the very best of luck.”

A year later I was back at the same institution to run another four-day program on a different topic. As I walked up the stairs at the beginning of the first day, I passed the large notice board advertising forthcoming courses. My course was there as well as many others.

But one particular notice caught my eye. It was a two-day seminar on cooperative learning. And the facilitator was none other than a certain Werner Bichlmeyer. I was intrigued. retraining the brain and body for a better life

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Werner’s course was due to take place in a couple of weeks later, so I never got to talk to him about it. But curious, I started wondering about what had happened. When did he change his mind about cooperative learning? A week later? A month? Six months? He certainly had changed his mind. And how come it was Werner who was offering such a public course, with all the preparation and work required, and not one of the other twentynine educators who had so consistently espoused the course?

It is quite common that those who most resist have the most to learn. And, at a deep level, know this. Unlearning previously acquired skills, and even integrating new ideas into existing knowledge, takes effort and energy, and a degree of humility. The conscious mind sees the sacrifices needed and the time required, and baulks at it. The unconscious mind thinks WOW! And bides its time, searching for the integrating possibilities.

Every skill we have ever learned is a pattern. It has a structure and a sequence. It is our ability to run thousands upon thousands of patterns in our lives, at the level of unconscious competence – doing without thinking – that allows us to survive in a world of amazing complexity. Without this ability survival would be barely possible.

The oldest part of the brain understands this. The “reptilian” brain frequently resists new learning because it wishes to protect the acquired patterns that have allowed each one of us to survive successfully since birth. But at a higher level, the mid-brain and the neocortex have different kinds of wisdom. They search for possibility: if learning this new skill give me an increased change of survival and success, I’m open to it. And so the brain becomes more receptive, and learning becomes possible and even welcome.

Certainly is seemed likely to me that sometime during the previous twelve months the different parts f Werner’s brain may have had a similar kind of internal dialogue. _________________________________________________________________

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Posture and Physiology There is a very good TED talk by Amy Cuddy about posture and how it effects physiology. The team at Harvard were measuring cortisol and testosterone prior to and then after adopting different poses. They were either power poses or powerless poses.

Watch the talk at the below link and then start “faking it till you make it” Or as Amy says in the talk “fake it until you become it”.

http://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are.html This is a really important part of having some influence over your physiology by controlling your posture and body movements. If you would like to Do (Do refers to the fact that confidence is a process not a “thing” so we are either doing confidence or not.

We don’t “have confidence”, confidence is like a salsa dance we are either doing the salsa dance or we are not) confidence then you need to hold and move your body with confidence. If you would like to Do calmness but you are constantly jigging your leg up and down and moving in an agitated way, holding your body in an agitated way then it does not matter how often you repeat any sort of good internal dialogue about calmness or how much you want to be calm it will not happen. If you want your physiology to be really powerful then having mind and body congruent really helps, but as Amy found in her research as long as you use your body in a congruent way then you will have physiology to match! The body or posture is the most important part. So posture is an retraining the brain and body for a better life

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integral part of creating the physiology that you would like. Her research is further proof of the irrefutable constant communication between mind and body and body and mind.

So the first step is awareness. What sort of posture are you holding now while seated at your computer? Is your chest opened out? Is your back straight? Are you making yourself large or as small as possible? Are your hands folded across your body, clasped together in your lap or relaxed behind your head? All this will have an effect on many different hormone and neurotransmitter levels in your body (with cortisol and testosterone being two). Amy also found in her study that if people adopted a power posture for two minutes before an interview they were much more likely to be the people that were wanted for the job.

Power Postures

Non-power Postures

So if you want to take some level of control of your physiology then make sure you are really aware of your posture when you are going about your day. Record yourself so that you can really see if your body is congruent with what you want. You can practice, as Amy Cuddy states, power postures many times a day, find the posture that you really like and do that often. Everyone can be aware of the way we use our bodies and so therefore we can all have some influence over the biochemistry in our bodies, which is changing moment to moment. You can decide to take the time and kick back, adopt a power posture for two minutes and know that it will be changing your body and changing other peoples perception of you!

Amazing stuff! We know that a prolonged increase in cortisol leads to: • Increased blood pressure • Decreases in immune system function • Decreased bone formation • Increased frequency of urination and dehydration • Increased blood sugar levels retraining the brain and body for a better life

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• Increased gastric acid production • Decreases in amount of collagen in the skin

So of course if you can do anything to balance your cortisol levels then it is a helpful thing. That is why when you use NPT one of the things that we will be looking at is making sure that your posture is serving you. In other words is your posture helping to create the neurology that you want or not. That is why you do this training with a trainer, so that they can give you feedback about things that you are probably not even consciously aware of.

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Awareness Awareness is a very important step in the process of learning NPT and then using it in your daily life.

If you are not aware of a pattern you can’t change it.

For instance I noticed the other day that I had developed a pattern of moving my thumb repeatedly across the remote while I was holding it in my hand. My thumb would move back and forth across the buttons and I would not notice that I was doing this. Once I noticed it I thought this is definitely not helping my relaxation and calmness while watching tv and so I thought I won’t do this any more. But a few minutes later I realised I was doing it again! I had to make sure it was high on my list of priorities to notice every time I started to do it and then remind myself to stop and relax. After doing this about 30 times I stopped doing it and have not done it since….I’ll keep you informed if it starts again! The other option was of course to remove the remote from my hand which is all good, unless of course I start moving my fingers repeatedly even without the remote.

Then I would need to do a bit of brain/body training again to change this pattern.

So the important things to remember are: • Awareness is key to any change process • Taking action is the next step • Taking repeated action eventually leads to automation

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The Art of “Doing” This is an important concept to understand when completing Neuro-Plasticity Training (NPT).

Think of doing a dance like a salsa dance. Imagine I am up and doing a salsa dance in front of you now (it won’t be very good!) and then having finished my dance I sit down and you say, “Where is your salsa dance?” I answer “what do you mean, where is my salsa dance? It isn’t anywhere I was doing the dance before and now I’m not”.

The salsa dance is not a “thing” it is a “process”. You don’t “have” a salsa dance you are either “doing” it or you are not “doing” it. When you are not “doing” the dance it does not exist. We say I’m doing a salsa dance because it is a verb, a “doing” word.

It is interesting to contemplate that idea when thinking about pain, problems with digestion, sleep, fatigue and even with diagnosis of Lupus, Chronic Fatigue Syndrome, Chronic Pain, Fibromyalgia and Irritable Bowel Syndrome. We tend to say “I’ve got chronic pain” or “I’ve got IBS”. The way we are used to communicating about these things is to say that we “have IBS” which gives the problem more permanency than it needs to have. If we change “I have IBS” to “I’m doing IBS” how does that change your relationship to it?

The reason why we make this change is to help you to see a few things: 1. These health issues are “processes” not “things” 2. There is a window of opportunity that opens when we change our perceptions about an issue.

3. Even though they are currently unconscious processes you can make them conscious and then have some influence over what happens next.

4. We all have an ability to influence these subconscious processes with the right training and tools.

5. You are not to blame for your current processes they are unconscious and you do not know how to influence them yet.

6. Once you learn NPT you are responsible for what happens next.

7. We are often letting our bodies and minds run the show and we can learn ways of taking control of these processes.

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Excellence We all have the ability to excel; the interesting thing is that we tend to excel at different things in different areas of our lives. Take me for instance I excel at learning a new physical task and I also used to excel at procrastination and partially completing tasks then moving onto the next one. My ability to excel in some areas serves me and in others it doesn’t. It would obviously be good if I could train my self to excel at finishing a task completely before moving onto the next and whether I did train myself to do this or not will be influenced by many things including my thoughts about if I think it is possible for a leopard to change its spots or not (in other words whether I think it is possible for me to change will decide if I take any action at all).

“Whether you think you can, or you think you can’t, you’re right”

Henry Ford

The interesting thing is that a lot of these patterns are unconscious so to make changes to these you are going to have to be aware of them first in order to change them. If you are not aware of certain patterns then you can’t change them. These can be patterns of posture, breathing, body movements, internal dialogue or behavior.

Talents and Brilliance We all have different talents and the ability to be brilliant at things. There are some things that seem to just come naturally to us and so in those things we are seen as being “talented”. It is interesting to look at all the things that seem to come to you naturally and without thought. You can be talented at drawing for instance, you may be able to draw very well and it just comes naturally to you. Some of your other friends can’t draw and you seem unable to understand how that is possible because it takes no effort on your behalf. On the other hand, you may not be able to hit a tennis ball very well at all, it takes huge amounts of concentration, and you may find it quite difficult to do.

We can look at some of the problems that you may have in this way. It is not the “normal” way of looking at things but it is helpful. You could look at what you are producing brilliantly at the moment. Are you really brilliant at “doing” chronic pain, “doing” fatigue, “doing” digestion problems or “doing” autoimmune issues like Lupus?

What ever you are brilliant at “doing” it is obviously unconscious, as you would never choose it! But it does tell you that you have the ability to excel, you are just excelling at something that is not very helpful in your life! What NPT is about, is teaching you the tools needed to be able to excel at things that are much more life and health enhancing!

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Neural Plasticity We have touched on this already, the ability of our brains and bodies to be naturally plastic. This means that until the day we die we all have the ability to create new neural pathways and do different postures, body movements and internal dialogue. One book that has launched this idea into the general public has been the amazing book entitled “The Brain that Changes Itself” by Norman Doidge. This book shares stories at the frontiers of brain science and how different people around the world have used the brains ability to adapt and change and take on new roles to enable people to see who were previously blind, to stand up straight when they were constantly falling over (vestibular problems) and many other things.

The Jar The very famous Chinese professor from the very famous Chinese university sat in front of a group of new students. In front of him was a large glass jar, translucent and slightly greenish. The kind of jar some people keep plants in.

The professor looked at the students but said nothing. Then he leaned down to his right hand side. By his foot was a pile of fist-sized rocks. He took a rock and very carefully dropped it through the hole at the top of the neck of the jar. Then another and another and another. Until no more rocks could be dropped through the hole at the top of the neck of the jar.

He turned to the group and said: “Tell me, is the jar now full?”

The group murmured assent: the jar was now full.

The professor said nothing and turned to his left side. By his foot was a pile of pebbles.

He took a handful of pebbles and carefully poured them through the hole at the top of the neck of the jar. Handful by handful, around the rocks, until no more pebbles could be poured through the hole at the top of the neck of the jar.

He turned to the group and said: “Tell me, is the jar now full?”

The group mumbled that it certainly appeared as if the jar could possibly now be full, maybe.

The professor said nothing and turned again to his right side. By his foot was a pile of course dry sand. He took a handful of sand and carefully poured it through the hole at the top of the neck of the jar. Around the rocks, around the pebbles, handful by handful, until no more sand could be poured through the hole at the top of the neck of the jar.

He turned to the group and said: “Tell me, is the jar now full?”

There was silence.

The professor said nothing and turned again to his left side. By his foot was a jug of water. retraining the brain and body for a better life

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He took the jug and carefully poured the water through the hole at the top of the neck of the jar. Around the rocks, the pebbles, the sand. Until no more water could be poured through the hole at the top of the neck of the jar.

He turned to the group and said: “Tell me, is the jar now full?”

There was silence, even more profound than before. The kind of silence where those present check to see if their nails are clean or their shoes polished. Or both.

The professor turned again to his right side. On a small blue square of paper he had a small pile of fine dry salt. He took a fingerful of salt and carefully dissolved it in the water at the top of the beck of the jar. Fingerful by fingerful in the water, around the sand, around the pebbles, around the rocks, until no more salt could be dissolved in the water at the top of the neck of the jar.

Once again the professor turned to the group and said: “Tell me, is the jar now full?”

One very courageous student stood up and said: “No, Professor, it is not yet full.”

The professor said: “Aaah! But it is now full.”

The professor then invited all the people who were there to consider the meaning of his demonstration. What did it mean? How did they interpret it? Why had the professor done it? And after some minutes the professor listened to their reflections.

There were as many interpretations as there were people in the room.

When the professor had heard from each of the students, he congratulated them, saying that is was hardly surprising there were so many different interpretations. After all, everybody here was a unique individual who had lived through unique experiences, unlike those of anybody else. Their interpretations simply reflected their own lived experience and the particular and unique perspective through which they understood the world.

And in that sense no interpretation was any better, or any worse, than any other. And, he wondered, were the group curious to know his own interpretation? Which of course, he stated, was no better or worse than theirs. It was simply his interpretation.

Oh yes, they were curious.

“Well,” he said, “my interpretation is simply this. What ever you do in life, whatever the context, just make sure you get your rocks in first.”

When it comes time to do NPT you will be retraining your brain and body to do new responses. It may become apparent that what you thought you were going to have to work on in the training is not the biggest obstacle to your success. It is important to deal with the big stones first…. retraining the brain and body for a better life

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Some good examples of neural plasticity are: People who have lost the use of their arms and now paint detailed paintings with their feet. If you or I tried to do this right now we would end up with a massive mess but with persistence we could also learn this still. People can also learn to paint with the paintbrush in their mouth, which again would take persistence but is possible for any of us to learn.

People who are blind have much larger area of their brain designated to the ability to hear and feel. The number of nerves in the brain that represent the fingers of a blind person who uses brail will be massively increased.

We are all neurally and physically plastic (changeable) until the day we die and we can make use of this. NPT makes use of this ability in all of us to change our neurology and create new responses.

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Feedback Three Steps to Success A former world tennis champion was being interviewed on a radio programme. “Had he always been a champion?” the interviewer asked.

No, he hadn’t, he said. Although when he’d been young he’d been picked as a potential future prospect. But other boys had been better than him, more naturally gifted. And he had often had to play the best of the girls, who were a better match for him than the more naturally talented boys.

“So where are they now, those boys?” said the interviewer. “What happened to them all?”

“Well,” said the former champion, “they just didn’t make it. For all their talent they didn’t have what it takes.”

“So what does it take?” asked the interviewer.

“You’ve got to want it enough.”

“Is that the secret?”

“There’s another. It takes discipline. No matter how much talent you have, you’vee got to have the discipline to nurture and develop it. You’ve got to prioritise and give up on a lot of things that can seem very attractive at the time.”

“Is that the secret?”

“There’s another,” said the former tennis ace, “and it’s harder and more demanding than the first two put together. You need humility, no matter how good you are. You need humility to listen to your coaches, to take advice, to test new possibilities, and to admit you don’t know everything. Feed back is the breakfast of champions. These three things are the secrets of my success.”

Reconstructed sports radio interview with Boris Becker

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Nutrition – wheat free, lactose free….

NPT is not a training course in how to eat. In fact one of the most important things is to make sure that you are “doing” calmness around food and eating and not “doing” stressed about every bit of dairy, gluten or other things that you are eating.

For people with food intolerances we know that this is an overactive response to an external stimulus. Meaning that for some reason your unconscious has concluded that a particular food or protein is potentially dangerous and launches a response to this. A little like someone with hay fever. If you have hay fever then when you breath in a particular pollen or other substance then your body decides that it is potentially dangerous and so launches a protective response to stop the “invader”. The body does this by producing mucus in the airways to halt and trap the “invader” from going any further. It will also probably make you sneeze so that you expel any from your upper airways. This is all about protection from something that is not dangerous but for some reason or another your body has come to the decision that it is dangerous. The same can occur with foods.

For many people once they are able to interrupt the stress response and produce an immune system that is in balance then they no longer have those food intolerances. They are often just a symptom of an imbalanced autonomic nervous system.

If we drink many coffees or cokes every day, consume huge amounts of fatty foods, simple sugars and generally have a poor diet then this will have an effect on our bodies. It will have an effect on pain and on or nervous system, on our digestion and our energy levels. You do not need to monitor every little thing that goes into your body but at the same time you can’t just put any sort of stuff in and expect it to keep running well. That is all I’m going to say on this topic. If you want to get advice on this then see a nutritionist or a personal trainer. What we put in our mouths is important, if you know this aspect of your life is poor then you can decide to take action and change it and of course

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Action or Perfection Story…

A holy man was walking by the river considering the nature of true holiness. He was a precise man, who kept to the letter of the holy law, and considered it his holy duty to notice those frailties he detected in himself and others. He studied and prayed very hard so that he should become as perfect as possible.

As he walked by the river, reciting his prayers, he heard floating across the river from afar the holiest of the prayers of his order. The prayer, as was custom, was repeated over an dover again in order to induce a holy trance in the reciter.

But the prayer disturbed the holy man. Whoever was saying these prayers had filed to learn them correctly. The syllables of the first words of the prayer were in the wrong order. The holy man knew that a prerequisite for attaining bliss in the next life was an intention towards perfection in this life. And clearly the getting wrong of an important prayer was going to be a hindrance to the pilgrim across the river in his quest to achieve Paradise.

At this opportunity to do “good work” by correcting this misguided worshipper, the holy man hired a rowing boat and set out across the river to find the man who was mangling such holy and beautiful words.

As he was paddling across the lapping wavelets and negotiating the currents his mind wandered to a curious phenomenon of holiness that he himself had never had the opportunity to witness. He considered that one would have to reach a very high level of holiness indeed to achieve the art of walking across water. Perhaps if he was able to perfect himself a little more, and achieve greater saintliness through acts similar to the one that he was even now engaging in, to wit the important and necessary correction of a misguided sinner who hadn’t taken sufficient trouble to learn his prayers properly, he himself might one day reach the level of sanctity sufficient to traverse the waves on foot.

And another thing. It was surely the duty of all right minded people to give advice and corrective feedback to those who erred. Just as it was their duty to accept the advice and feedback with humility and without justification.

The mangled opening of the prayer broke through once again into his consciousness, disturbing his meditations on holiness and its higher manifestations. The sound was coming from an island in the middle of the river. He drew up to a small jetty and moored his boat, and walked up a short gravel path. Inside a small and simple cave he was much surprised to find another holy man of his order praying.

“Brother,” said the perspiring rower, “I have taken the trouble to row all the way across the river to draw your attention to the fact that you are mis-saying your prayers.” You are saying, ‘Yee moo yen zaa’ and you ought to be saying ‘Yen moo zaa yee’ “Thank you,” said the hermit, “I feared that might be the case and am most grateful to you for the trouble you have gone to in order to correct me. Would you care to repeat the correct form once again so that I may follow the more enlightened path? ”

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The holy man offered once again the correct version and then returned to his boat. As he paddled back across the river he reflected on the nature of good works and the duty of the moral man to restore order to a misguided world. Acts of saintliness such as this were the signs and symbols that one was indeed on the true path to holiness and Paradise.

He was much surprised to be disturbed in his meditations on holiness by a voice calling to him.

“Wait a moment good sir,” came the voice across the waves.

Looking up, the holy man saw the hermit walking rapidly across the water towards him.

“I’m terribly sorry to bother you again, but I’m afraid my memory is short and I am not the quickest of learners. Did you say it was ‘Yen zaa moo yee’ or ‘Yen moo zaa yee’? “’Yen moo zaa yee’,” echoed the holy man numbly.

“Thank you so much. May your good deed be richly rewarded.”

And so saying the hermit turned and walked lightly back across the water to his island in the river.

Sufi Tradition

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Filtering and Reality?

Gandhi’s Completeness The story goes that on a certain day Gandhi and a companion entered the gates of a great city in order to share their teachings with the in habitants. Almost immediately a follower of the Mahatma, who lived in the city, approached and told him, “Master, you are wasting your time and energy here. The people here are hard of hart, and resistant to change and the words of truth. They are dumb and ignorant and have no wish to learn anything. Do not waste your gifts upon them.”

Gandhi smiled at the man and replied, “I have no doubt you are right.”

Some minutes later another adherent approached Gandhi saying, “My Lord, you are indeed most welcome by all in this fortunate city. The people await and anticipate the jewels of learning that will fall from your lips. They are hungry to learn and eager to serve you. Their hearts and minds are truly open to you.”

Gandhi smiled and replied, “I have no doubt you are right too.”

His companion turned to him and said, “Master, how is it possible you can say one thing to one man and something completely different to another? The sun and the moon can never be the same ting, the day cannot be night.”

Gandhi smiled at his friend and replied, “I have no doubt you are right. And you may also consider that both men spoke truly according to their own values. The fist expects to see the bad in everything. The second sees only the good. Both men perceive the world as they expect it to be. How can you say either man perceives wrongly since all humankind perceives the world as they choose and expect to experience it? Neither man spoke falsely; just something incomplete.

Reality? (from “Learned Optimism” by Dr. Martin Seligman) “Learned helplessness is the giving up reaction, the quitting response that follows from the belief that whatever you do doesn’t matter.”

“The very thought “Nothing I do matters” prevents us from acting.”

Two fish were put into the same tank. One was big, and one small. The species of the small fish was one of the favorite foods of the big fish. The big fish took off after the little fish, but a pane of glass separated them, so the big fish smashed his face...over and over again. Finally, he gave up. Then the experimenters removed the pane of glass, but the big fish never again tried to eat the little fish. Sometimes the two fish would swim right past each other, sometimes they would even brush up against each other, but the big fish never made another attempt.

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Apparently, he was convinced he couldn't do it, no matter how hard he tried. Sometimes we find ourselves in a helpless situation, and there’s nothing we can do about it. The point of the fish story is that we can assume our helplessness is permanent, even when it isn't. If we make that assumption, we just give up. We feel hopeless and have no energy, because we believe all our efforts are in vain.

Five gorillas were put in a room with a bunch of bananas hanging from the ceiling...too high for them to reach. A stepladder was in the corner of the room. One of the gorillas surveyed the situation and figured out what to do. He brought the step ladder under the bananas and went up, but when he grabbed a banana, he received an electric shock.

Surprised and shaken, he came down with no banana. A second gorilla tried, and then a third. One by one each gorilla went up and got a shock...but no banana. The experimenters then turned off the electricity, but the gorillas never again ascended the ladder.

A few hours later one of the gorillas was removed and a new one was added. He started to go up the ladder, but the other four pulled him down. He tried again; they pulled him down again. Eventually, he gave up. The other gorillas obviously believed the bananas were still electrified. They thought they knew what would happen to him, and they knew he didn't know. Another one of the original gorillas was removed, and a new one entered.

The other four gorillas (including the one who had not been shocked) would not let the newcomer go up the ladder. By the end of the experiment, ALL the original gorillas had been replaced by newcomers. Nevertheless, whenever a new gorilla tried to ascend the ladder, the others would pull him down.

Think about the situation. The electricity has been turned off, so there’s no good reason not to have a banana. However, no one is having a banana, no one is allowing anyone else to have a banana, and no one knows why! The gorilla story shows that helplessness not only can be learned; it can also be taught! Helplessness can be taught to others…even when it is not based in reality. The original gorillas had been shocked, and they educated the newcomers based on their false assumption that the bananas were still electrified.

They were not trying to deceive the newcomers. Rather, they were trying to help them, based on their belief that they had superior knowledge of the situation.

Are you familiar with the name Roger Bannister? He was the first runner in recorded history to break the four-minute mile. What is especially interesting about the story is that the scientists and sports physiologists of the day said it could not be done. These experts said the human body wasn't made to go that fast. They said the runner’s heart would explode and these other awful things would happen to him (although I don't know why he'd care once his heart explodes).

In 1954 Roger Bannister proved all of them wrong. For the first few laps, two of Bannister’s friends set a good pace for him and shielded him from the wind. Then Bannister burst forth and did what had never been done. Now here's the truly amazing part. After the news spread about Bannister’s accomplishment and people realized that the statements of those “experts” were obviously not true, the next year thirty-three people broke the four-minute mile! The year after that, over two hundred people did it! retraining the brain and body for a better life

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The point is this: a thought can limit you and keep you from reaching your potential, even if the thought isn't true.

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Gratitude - The Quarryman The quarryman’s work was hard. He worked all day in the quarry from dawn to dusk. His hands were hard and callused. His back was bent, and his face was weathered and lined.

He was not happy. He said, “This is no life. Why is it my fate to be a quarryman? Why can’t I be someone who has more wealth than I do? If only I were rich, then I’d be happy.”

An angel appeared and said, “What would have to happen for you to know you were rich and happy?”

“That’s easy. If I was rich I’d live in the city, in a beautiful apartment on the top floor. I’d be able to see the sky. I’d have a four-poster bed with col black silk sheets, and I’d sleep all day. Then I’d be happy.”

“You are rich”, said the Angel waving her magic want. And he became rich. And he lived in the city in an apartment on the top floor. And he slept all day in a four-poster bed with cool black silk sheets. And he was happy.

Until one day he was disturbed by a commotion in the streets below. He sprang out of bed and ran to the window. Looking down he saw a graceful golden carriage. In front were horses and behind were soldiers. It was the King. And the people who thronged the street were cheering and bowing.

The rich man instantly knew unhappiness. “I’m not happy. The king has more power than I do. If only I was the King, then I’d be happy.”

And the Angel appeared and said, “You are the King!” And he became the King. And he was happy. He felt his power and he felt his might. And he loved the way people paid him homage, and the way his servants obeyed him, and the way he had power to decide whether others should live or die. He was happy.

And then one day he noticed the Sun. And he saw how Sun had power to do things he couldn’t even dream of. He saw how Sun could turn all the fields from green to yellow, and from yellow to brown. He saw how Sun could dry up even the mightiest rivers and leave nothing but parched mud banks. He saw how Sun could starve the world of life.

And he knew unhappiness. “I’m not happy, the Sun has more power than I do. If only I were the Sun, then I’d be happy.”

And the Angel appeared and said, “You are the Sun!” and he became Sun. He was happy.

He felt his power and he felt his might. And he loved the way he could turn fields from green to brown, dry up rivers and change the world. And he was happy.

And he ruled the world in his zenith, exulting in his power.

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Until one day he noticed Cloud, big black Raincloud. And he saw how Cloud had the power to turn all the fields from brown to green, refill the rivers with flowing, frothing water, and retrieve the life of the world.

And depression filled him. “I’m so unhappy. This Cloud has more power than I. If only I was Cloud then I’d be happy forever.”

And the Angel appeared and said, “You are Cloud.” And be became Cloud, and he was happy. He felt his power and might. And he loved the way he could reverse the work of the Sun and re-instate life where so little had been before. And he knew real happiness for the first time.

Until one day he saw, far below him, Rock. And he saw how Rock, black, strong, unyielding, was unchangeable. And he saw that no matter how much or how hard he rained, nothing he could do could challenge or destroy Rock. Rock was rugged and resistant.

And he knew bitterness and unhappiness once again. And he said, “I’m so unhappy. If only I were Rock then I’d be happy.”

And the Angel appeared and said, “You are Rock.” And he became Rock, and he felt his might and he felt his power, and he was happy. He exulted in his strength and sense of permanence. He loved his ability to withstand everything Nature could throw at him. He laughed at the Sun and he ridiculed the Raincloud.

Until one day, a Quarryman arrived…

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Summary I trust the information in these pages has been interesting. It has been designed to increase your understanding and prepare you so that you can make change easily over the three days and beyond. I look forward to working with you over those three days and in the months that follow to help you to move in the direction you would like with purpose and a sense of control.

Warm regards Scott Swinson

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Next Steps The next steps you need to take are: Contact Scott to let him know you are interested in completing the NPT program. If you don’t contact us we will assume that you have read the material and don’t feel this training is for you.

Phone: 91132381 Email: Scott.Swinson@sesiahs.health.nsw.gov.au

Email is probably the best way of contacting Scott.

The next dates for NPT are: 2nd of September 2013 to 4th of September 2013. The training runs from 0900 to about 1300 each day and will have a maximum of 5 people on it.

You will need to have an assessment call with Scott to find out if you are in a position to get benefit from the training.

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Appendix A Lupus and Autoimmune Problems

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This information has been taken from the book “Why Zebras Don’t Get Ulcers” by Robert Sapolsky and deals with the science behind the relationship of stress responses and Autimmunity.

CHAPTER 8 – IMMUNITY, STRESS AND DISEASE HOW DOES STRESS INHIBIT IMMUNE FUNCTION?

It's been almost sixty years since Selye discovered the first evidence of stress-induced immunosuppression, noting that immune tissues like the thymus gland atrophied among rats subjected to nonspecific unpleasantness. Scientists have learned more about the subtleties of the immune system since then, and it turns out that a period of stress will disrupt a wide variety of immune functions.

Stress will suppress the formation of new lymphocytes and their release into the circulation, and shorten the time preexisting lymphocytes stay in the circulation. It will inhibit the manufacturing of new antibodies in response to an infectious agent, and disrupt communication among lymphocytes through the release of relevant messengers. And it will inhibit the innate immune response, suppressing inflammation. All sorts of stressors do this—physical, psychological, in primates, rats, birds, even in fish. And, of course, in humans, too.

The best-documented way in which such immune suppression occurs is via glucocorticoids. Glucocorticoids, for example, can cause shrinking of the thymus gland; this is such a reliable effect that in olden days (circa 1960), before it was possible to measure directly the amount of glucocorticoids in the bloodstream, one indirect way of doing so was to see how much the thymus gland in an animal had shrunk. The smaller the thymus, the more glucocorticoids in the circulation. Glucocorticoids halt the formation of new lymphocytes in the thymus, and most of the thymic tissue is made up of these new cells, ready to be secreted into the bloodstream. Because glucocorticoids inhibit the release of messengers like interleukins and interferons, they also make circulating lymphocytes less responsive to an infectious alarm. Glucocorticoids, moreover, cause lymphocytes to be yanked out of the circulation and stuck back in storage in immune tissues. Most of these glucocorticoid retraining the brain and body for a better life

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effects are against T cells, rather than B cells, meaning that cell-mediated immunity is more disrupted than antibody-mediated immunity. And most impressively, glucocorticoids can actually kill lymphocytes. This taps into one of the hottest topics in medicine, which is the field of "programmed cell death."* Cells are programmed to commit suicide sometimes. For example, if a cell begins to become cancerous, there is a suicide pathway that gets activated to kill the cell before it starts dividing out of control; a few types of cancers involve the failure of the programmed cell death to occur. It turns out that glucocorticoids can trigger those suicide pathways into action in lymphocytes, through a variety of mechanisms.

Sympathetic nervous system hormones, beta-endorphin, and CRH within the brain also play a role in suppressing immunity during stress. The precise mechanisms by which this happens are nowhere near as well understood as with glucocorticoid-induced immune suppression, and these other hormones have traditionally been viewed as less important than the glucocorticoid part of the story. However, a number of experiments have shown that stressors can suppress immunity independently of glucocorticoid secretion, strongly implicating these other routes.

WHY IS IMMUNITY SUPPRESSED DURING STRESS? Figuring out exactly how glucocorticoids and the other stress hormones suppress immunity is a very hot topic these days in cell and molecular biology, especially the part about killing lymphocytes. But amid all this excitement about cutting-edge science, it would be * Another trendy term in this field is apoptosis, which is derived from Latin for something like "falling off" (as in the falling off of leaves in the fall, an example of programmed death). There are great debates as to whether apoptosis equals programmed cell death or is just a subtype of it (I subscribe to the latter view), as well as, amazingly, whether you pronounce the second p in the word (I do, a pronunciation that is considered to have a rough-hewn man-in-the-street plebian air to it). reasonable to begin to wonder why you should want your immune system suppressed during stress. In chapter 1, I offered an explanation for this; now that the process of stress-induced immunosuppression has been explained in a little more detail, it should be obvious that my early explanation makes no sense. I suggested that during stress it is logical for the body to shut down long-term building projects in order to divert energy for more immediate needs— this inhibition includes the immune system, which, while fabulous at spotting a tumor that will kill you in six months or making antibodies that will help you in a week, is not vital in the next few moments' emergency. That explanation would make sense only if stress froze the immune system right where it was—no more immune expenditures until the emergency is finished. However, that is not what happens.

Instead, stress causes the active expenditure of energy in order to disassemble the preexisting immune system—tissues are shrunk, cells are destroyed. This cannot be explained by a mere halt to expenditures—you're paying, energetically, to take apart the immune system. So out goes this extension of the long-term versus short-term theory.

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our immune system during stress? Maybe there isn't a good reason. This actually isn't as crazy of a response as you might think. Not everything in the body has to have an explanation in terms of evolutionary adaptiveness. Maybe stress-induced immunosuppression is simply a by-product of something else that is adaptive; it just came along for the ride.

This is probably not the case. During infections, the immune system releases the chemical messenger interleukin-1, which among other activities stimulates the hypothalamus to release CRH. As noted in chapter 2, CRH stimulates the pituitary to release ACTH, which then causes adrenal release of glucocorticoids. These in turn suppress the immune system.

In other words, under some circumstances, the immune system will ask the body to secrete hormones that will ultimately suppress the immune system. For whatever reason the immunosuppression occurs, the immune system sometimes encourages it. It is probably not just an accident.* * My tiny footnote in science: I was part of the group that discovered the fact that interleukin-1 stimulates CRH release. Or at least I thought I was. It was in the mid-1980s.

The idea made some sense, and the lab I was in jumped on it under my prompting. We worked like maniacs, and at two o'clock one morning I had one of those moments of euphoria that scientists die for: looking at the printout from one of the machines and realizing, "Aha, I was right, it does work that way—interleukin-1 released CRH." We wrote up the findings, they were accepted by the prestigious journal Science, everyone Various ideas have floated around over the years to explain why you actively disassemble immunity during stress with the willing cooperation of the immune system. Some seemed fairly plausible until people learned a bit more about immunity and could rule them out.

Others were quite nutty, and I happily advocated a few of these in the first edition of this book. But in the last decade, an answer has emerged, and it really turns this field on its head.

SURPRISE It turns out that during the first few minutes (say, up to about thirty) after the onset of a stressor, you don't uniformly suppress immunity—you enhance many aspects of it (phase A on the accompanying graph). This is shown with all realms of immunity, but in particular for innate immunity. This makes sense—it may be helpful to activate parts of your immune system that are going to make some swell antibodies for you over the next few weeks, but it makes even more sense to immediately activate parts of the immune system that are going to help you out right now. More immune cells are rushed into the circulation and, in the injured nervous system, more inflammatory cells infiltrate the site of injury. Moreover, circulating lymphocytes are better at releasing and responding to those immune messengers. And more of those generic antibodies of the innate immune system are released into your saliva. This boosting of immunity doesn't occur only after some infectious challenge. Physical stressors, psychological stressors, all appear to cause an early stage of immune activation. Even more surprisingly, those immunosuppressive villains, glucocorticoids, appear to play a major role in this (along with the sympathetic nervous system).

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So, with the onset of all sorts of stressors, your immune defenses are enhanced. And now we are ready for our usual other side of the two-edged sword, when the stress goes on longer. By the one-hour mark, more sustained glucocorticoid and sympathetic activation was very excited, I called my parents, and so on. Paper gets published, and right next to it was an identical study from a group in Switzerland, sent in to the journal the same exact week. So I became a discoverer of this obscure fact. (To hark back to a theme of chapter 2, if you are a mature, confident individual—which unfortunately I am only rarely—you take pleasure in this sort of thing: two labs, working independently on opposite sides of the globe, come up with the same novel observation. It must be true. Science lurches forward an inch.)

Stress turns out to transiently stimulate the immune system. begins to have the opposite effect, namely, suppressing immunity. If the stressor ends around then, what have you accomplished with that immunosuppression? Bringing immune function back to where it started, back to baseline (phase B). It is only with major stressors of longer duration, or with really major exposure to glucocorticoids, that the immune system does not just return to baseline, but plummets into a range that really does qualify as immunosuppressing (phase C). For most things that you can measure in the immune system, sustained major stressors drive the numbers down to 40 to 70 percent below baseline.

The idea of temporarily perking up your immune system with the onset of a stressor makes a fair amount of sense (certainly at least as much as some of the convoluted theories as to why suppressing it makes sense). As does the notion that what goes up must come down. And as does the frequent theme of this book, namely, that if you have a stressor that goes on for too long, an adaptive decline back to baseline can overshoot and you get into trouble.

Why did it take people so long to figure this out? Probably for two reasons. First, because many of the techniques for measuring what's happening in the immune system have only recently become sensitive enough to pick up small, rapid differences, the thing needed to catch phase A, that fast immunostimulatory blip at the beginning of a stressor. Thus, for decades, people thought they were studying the immune response to stress, whereas they were actually studying the recovery of the immune response to stress. As a second reason, most scientists in this field study major, prolonged stressors, or administer major retraining the brain and body for a better life

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amounts of glucocorticoids for prolonged periods. This represents a reasonable bias in how experiments are done— start with a sledgehammer of an experimental manipulation.

If nothing happens, pick a new field to study. If something does happen and it's been replicated enough times that you're confident about it, only then begin to think about more subtle elaborations. So in the early years, people were only studying the sorts of stressors or patterns of glucocorticoid exposure that pushed into phase C, and only later got around to the subtler circumstances that would reveal phase B. This reorientation of the field represents a triumph for Allan Munck of Dartmouth University, one of the godfathers of the field, who predicted most of these new findings in the mid-1980s. He also predicted what turns out to be the answer to a question that pops up after a while. Why would you want to bring immune function back down to the prestress level (phase B in the diagram)? Why not just let it remain at the enhanced, improved level achieved in the first thirty minutes and get the benefits of an activated immune system all the time? Metaphorically, why not have your military that defends you always on maximal alert? For one thing, it costs too much. And, even more important, a system that's always on maximal, hair-trigger alert is more likely to get carried away at some point and shoot one of your own guys in a friendly fire accident. And that's what can happen with immune systems that are chronically activated—they begin to mistake part of you for being something invasive, and you've got yourself an autoimmune disease.

Such reasoning led Munck to predict that if you fail to have phase B, if you don't coast that activated immune system back down to baseline, you're more at risk for an autoimmune disease. This idea has been verified in at least three realms. First, artificially lock glucocorticoid levels in the low basal range in rats and then stress them. This produces animals that have phase A (mostly mediated by epinephrine), but there isn't the rise in glucocorticoids to fully pull off phase B. The rats are now more at risk for autoimmune disease. Second, doctors have to occasionally remove one of the two adrenal glands (the source of glucocorticoids) from a patient, typically because of a tumor.

Immediately afterward, circulating glucocorticoid levels are halved for a period, until the remaining adrenal bulks up enough to take on the job of two. During that period of low glucocorticoid levels, people are more likely than normal to flare up with some autoimmune or inflammatory disease—there's not enough glucocorticoids around to pull off phase B when something stressful occurs. Finally, if you look at strains of rats or, weirdly, chickens, that spontaneously develop autoimmune diseases, they all turn out to have something wrong with the glucocorticoid system so that they have lower than normal levels of the hormone, or have immune and inflammatory cells that are less responsive than normal to glucocorticoids. Same for humans with autoimmune diseases like rheumatoid arthritis.

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A schematic representation of how a failure to inhibit immune function during stress can bias you toward autoimmune disease.

Thus, early on in the stress-response, the immune system is being activated, rather than inhibited, and a big thing that the stress-response does is make sure that immune activation doesn't spiral into autoimmunity.

So that has forced some revisionism in this field. But just to add to this, once stress has gone on long enough to begin to suppress immunity, some of what have classically been taken to be aspects of immune suppression are actually more subtle versions of immune enhancement.

This is seen in two ways. Give someone massive amounts of glucocorticoids, or a huge stressor that has gone on for many hours, and the hormones will be killing lymphocytes indiscriminately, just mowing them down. Have a subtle rise in glucocorticoid levels for a short time (like what is going on at the start of phase B), and the hormones kill only a particular subset of lymphocytes—older ones, ones that don't work as well.

Glucocorticoids, at that stage, are helping to sculpt the immune response, getting rid of lymphocytes that aren't ideal for the immediate emergency. So that indirectly counts as a version of immune enhancement.

A second subtlety reflects reinterpretation of something people have known since the dawn of humans (or at least during Selye's prime). As noted, glucocorticoids not only kill lymphocytes, but also yank some remaining lymphocytes out of the circulation. Firdhaus Dhabhar of Ohio State University asked, Where do those immune cells go when they are pulled out of the circulation? The assumption in the field had always been that they all go into immune storage tissues (like the thymus gland)—they're taken out of action, so that they aren't much use to you. But Dhabhar's work shows that they don't all get mothballed.

Instead, glucocorticoids and epinephrine are diverting many of those lymphocytes to the specific site of infection, such as the skin. The immune cells aren't being deactivated— they're being transferred to the front lines. And a consequence of this is that wounds heal faster.

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hormones transiently activate the immune system, enhancing immune defenses, sharpening them, redistributing immune cells to the scenes of infectious battle. Because of the dangers of the systems overshooting into autoimmunity, more prolonged glucocorticoid exposure begins to reverse these effects, bringing the system back to baseline. And during the pathological scenario of truly major, sustained stressors, immunity is suppressed below baseline.

These new findings help to explain one of the persistent paradoxes in this field. It concerns autoimmune diseases. Two facts about autoimmunity: 1. Insofar as autoimmune diseases involve overactivation of the immune system (to the point of considering a healthy constituent of your body to actually be something invasive), the most time-honored treatment for such diseases is to put people "on steroids"—to give them massive amounts of glucocorticoids. The logic here is obvious: by dramatically suppressing the immune system it can no longer attack your pancreas or nervous system, or whatever is the inappropriate target of its misplaced zeal (and, as an obvious side effect to this approach, your immune system will also not be very effective at defending you against real pathogens). Thus, administration of large amounts of these stress hormones makes autoimmune diseases less damaging. Moreover, prolonged major stressors decrease the symptoms of autoimmune diseases in lab rats.

2. At the same time, it appears that stress can worsen autoimmune diseases. Stress is among the most reliable, if not the most reliable, factor to worsen such diseases. This has often been reported anecdo-tally by patients, and is typically roundly ignored by clinicians who know that stress hormones help reduce autoimmunity, not worsen it. But some objective studies also support this view for autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, Grave's disease, ulcerative colitis, inflammatory bowel disease, and asthma. There have been only a handful of such reports, and they suffer from the weakness of relying on patient-reported retrospective data, rather than on prospective data. Nevertheless, their findings are relatively consistent—there is a subset of patients whose initial onset of an autoimmune disease and, to an even greater extent, their intermittent flare-ups of bad symptoms are yoked to stress. Moreover, there is, by now, a pretty hefty literature showing that stress can worsen autoimmunity in animal models of these diseases.

So, do glucocorticoids and stress worsen or lessen the symptoms of autoimmunity? The graph below gives an answer that wasn't clear in earlier years. We've now seen two scenarios that increase the risk of autoimmune disease. First, it seems as if numerous transient stressors (that is, lots of phases A and B) increase the risk of autoimmunity—for some reason, repeated ups and downs ratchet the system upward, biasing it toward autoimmunity. Second, while it seems not to be great to have lots of instances of phase A followed by phase B, having phase A not followed by phase B increases the risk of autoimmunity as well. If you don't have an adequate phase B, that pushes the immune system spiral upward into autoimmunity (back to diagram on page 157).

As we would now expect, if you instead have massive prolonged stressors, or are administered big hefty doses of glucocorticoids, you put the system in phase C—dramatic immune suppression, which decreases the symptoms of autoimmunity. Supporting this retraining the brain and body for a better life

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summary is the finding that while acute stress puts rats more at risk for a model of multiple sclerosis, chronic stress suppresses the symptoms of that autoimmune disease.

The system apparently did not evolve for dealing with numerous repetitions of coordinating the various on-and-off switches, and ultimately something uncoordinated occurs, increasing the risk that the system becomes autoimmune.

A schematic representation of how repeated stress increases the risk of autoimmune disease.

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Appendix B Irritable Bowel Syndrome

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This information has been taken from the book “Why Zebras Don’t Get Ulcers” by Robert Sapolsky and deals with the science behind the relationship of stress responses and IBS. BOWEL MOVEMENT AND BOWEL MOVEMENTS Thanks to the preceding part of this chapter and to chapter 4, we've now sorted out how stress alters what you ingest, how it gets stored and mobilized. We have one last piece to fill in, which is getting food from your mouth to its digested form in your circulation.

This is the purview of the gastrointestinal (GI) tract—your esophagus, stomach, small intestines and large intestines (also known as the colon or the bowel). * The hormones involved obviously include the ones we've already heard of, like insulin, leptin, CRH, and glucocorticoids, plus other players like growth hormone, estrogen, and testosterone. But there's also an array of brand-new appetite-related hormones and neurotransmitters with names that are so hideous that I have no choice but to bury them in a footnote. Neuropeptide Y. Cholecystokinin. Melanocyte-stimulating hormone.

Oleylethanolamide. Adiponectin. Hypocretin. Agouti-related protein. Ghrelin (yes, that's actually how you spell it; however, I have no idea how you pronounce it).

When it comes to your GI tract, there's no such thing as a free lunch. You've just finished some feast, eaten like a hog—slabs of turkey, somebody's grandma's famous mashed potatoes and gravy, a bare minimum of vegetables to give a semblance of healthiness, and—oh, why not— another drumstick and some corn on the cob, a slice or two of pie for dessert, ad nauseam. You expect your gut to magically convert all that into a filtrate of nutrients in your bloodstream? It takes energy huge amounts of it. Muscular work. Your stomach not only breaks down food chemically, it does so mechanically as well. It undergoes systolic contractions: the muscle walls contract violently on one side of your stomach, and hunks of food are flung against the far wall, breaking them down in a cauldron of acids and enzymes. Your small intestines do a snake dance of peristalsis (directional contraction), contracting the muscular walls at the top end in order to squeeze the food downstream in time for the next stretch of muscle to contract. After that, your bowels do the same, and you're destined for the bathroom soon. Circular muscles called sphincters located at the beginning and end of each organ open and close, serving as locks to make sure that things don't move to the next level in the system until the previous stage of digestion is complete, a process no less complicated than shuttling ships through the locks of the Panama Canal. At your mouth, stomach, and small intestines, water has to be poured into the system to keep everything in solution, to make sure that the sweet potato pie, or what's left of it, doesn't turn into a dry plug. By this time, the action has moved to your large intestines, which have to extract the water and return it to your bloodstream so that you don't inadvertently excrete all that fluid and desiccate like a prune. All this takes energy, and we haven't even considered jaw fatigue. All told, your run-of-the-mill mammals, including us, expend 10 to 20 percent of their energy on digestion.

So back to our by-now-familiar drama on the savanna: if you are that zebra being pursued by a lion, you can't waste energy on your stomach walls doing a rumba. There isn't time to get any nutritional benefits from digestion. And if you are that lion running after a meal, you haven't just staggered up from some all-you-can-eat buffet. retraining the brain and body for a better life

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Digestion is quickly shut down during stress. We all know the first step in that process. If you get nervous, you stop secreting saliva and your mouth gets dry. Your stomach grinds to a halt, contractions stop, enzymes and digestive acids are no longer secreted, your small intestines stop peristalsis, nothing is absorbed. The rest of your body even knows that the digestive tract has been shut down—as we saw two chapters ago, blood flow to your stomach and gut is decreased so that the blood-borne oxygen and glucose can be delivered elsewhere, where they're needed. The parasympathetic nervous system, perfect for all that calm, vegetative physiology, normally mediates the actions of digestion. Along comes stress: turn off the parasympathetic, turn on the sympathetic, and forget about digestion.* End of stress; switch gears again, and the digestive process resumes.

As usual, this all makes wonderful sense for the zebra or the lion. And as usual, it is in the face of chronic stress that diseases emerge instead.

BOWELS IN AN UPROAR Regardless of how stressful that board meeting or examination is, we're not likely to soil our pants. Nevertheless, we are all aware of the tendency of immensely terrified people— for example, soldiers amid horrifying battle—to defecate spontaneously. (This reaction is consistent enough that in many states, prisoners are clothed in diapers before an execution.)

The logic as to why this occurs is similar to why we lose control of our bladders if we are very frightened, as described in chapter 3. Most of digestion is a strategy to get your mouth, stomach, bile ducts, and so forth to work together to break your food down into its constituent parts by the time it reaches the small intestines. The small intestines, in turn, are responsible for absorbing nutrients out of this mess and delivering them to the bloodstream. As is apparent to most of us, not much of what we eat is actually nutritious, and a large percentage of what we consume is left over after the small intestines pick through it. In the large intestines, the leftovers are converted to feces and eventually exit stage left.

Yet again, you sprint across the veld. All that stuff sitting in your large intestines, from which the nutritive potential has already been absorbed, is just dead weight. You have the choice of sprinting for your life with or without a couple of pounds of excess baggage in your bowels. Empty them. * Back to stress turning off salivation, an inhibition mediated by the sympathetic nervous system. What if you have to salivate for a living, if you are, say, an oboe player? Big audition comes along, good and nervous and—disaster—no spittle. Thus, many reed musicians wind up using drugs like beta-blockers that block the action of the sympathetic nervous system in order to slobber just in time for the big arpeggio.

The biology of this is quite well understood. The sympathetic nervous system is responsible. At the same time that it is sending a signal to your stomach to stop its contractions and to your small intestine to stop peristalsis, your sympathetic nervous system is actually stimulating muscular movement in your large intestine. Inject into a retraining the brain and body for a better life

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rat's brain the chemicals that turn on the sympathetic nervous system, and suddenly the small intestine stops contracting and the large intestine starts contracting like crazy.

But why, to add insult to injury, is it so frequently diarrhea when you are truly frightened?

Relatively large amounts of water are needed for digestion, to keep your food in solution as you break it down so that it will be easy to absorb into the circulation when digestion is done. As noted, a job of the large intestine is to get that water back, and that's why your bowels have to be so long—the leftovers slowly inch their way through the large intestine, starting as a soupy gruel and ending up, ideally, as reasonably dry stool.

Disaster strikes, run for your life, increase that large intestinal motility, and everything gets pushed through too fast for the water to be absorbed optimally. Diarrhea, simple as that.

STRESS AND FUNCTIONAL GASTROINTESTINAL DISORDERS Broadly, there are two types of gastrointestinal disorders. In the first, you feel terrible, something isn't working right, and the doctors find something wrong. These are "organic" GI disorders. A gaping hole in the wall of your stomach, in other words, a peptic ulcer, counts as there being something demonstrably wrong. We'll consider ulcers shortly. Out of-control inflammation of tissue throughout your GI tract, which is what inflammatory bowel disease is, also counts as demonstrably wrong. This disorder will be briefly touched on in chapter 8.

But suppose you feel terrible, something isn't working right, and the docs can't find a thing wrong. Congratulations, you now have a "functional" GI disorder. These are immensely sensitive to stress. And this is not just the touchy-feely psychologists saying this. Papers about stress and functional GI disorders are even published in tough-guy meat-and- potato scientific journals with names like Gut. The most common functional GI disorder, which will be considered here, is irritable bowel syndrome (IBS), which involves abdominal pain (particularly just after a meal) that is relieved by defecating and symptoms such as diarrhea or constipation, passage of mucus, bloating, and abdominal distention. Despite physicians checking you from every which end, they can't find anything wrong, which qualifies IBS as a functional disorder.

IBS is among the most common of stress-sensitive disorders. Personally, all the major rites of passage in my life have been marked by pretty impressive cases of the runs a few days before—my bar mitzvah, going away to college, my doctoral defense, proposing marriage, my wedding. (Finally, here's that confessional tone obligatory to successful books these days. Now if I can only name some Hollywood starlet with whom I've taken diuretics, this may become a bestseller.)

Carefully conducted studies show that major chronic stressors increase the risk of the first symptoms of IBS appearing, and worsen preexisting cases. This makes sense. As we saw, what stress does is increase the contractions in the colon, getting rid of that dead weight.

And IBS—also known as "spastic colon"—involves the colon being too contractile, an excellent way of producing diarrhea. (It is not clear why lots of stress-induced retraining the brain and body for a better life

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contractions of the colon can lead to constipation. As a possible explanation, the stressinduced contractions in the colon are directional, which is to say, they push the contents of the colon from the small intestinal end to the anus. And if they do that a lot, things get accelerated, resulting in diarrhea. However, in one plausible scenario, with long enough periods of stress, the contractions begin to get disorganized, lose their directionality, so that not much of anything moves toward the anus).

So people with IBS are disproportionately likely to be experiencing a lot of stressors. But in addition, IBS can be a disorder of too much gastrointestinal sensitivity to stress. This can be shown in experimental situations, where a person with IBS is subjected to a controlled stressor (keeping her hand in ice water for a while, trying to make sense of two recorded conversations at once, participating in a pressured interview). Contractions in the colon increase in response to these stressors more in IBS patients than in control subjects.

Another connection between stress and IBS concerns pain. As we'll see in chapter 9, stress can blunt the sort of pain you feel in your skin and skeletal muscles while increasing the sensitivity of internal organs like the intestines to pain (something called "visceral" pain). And that is the profile seen in IBS patients—less sensitivity to skin ("cutaneous") pain, and more visceral pain. Even more support for the stress/IBS link is that people with IBS don't typically have hypercon-tractility of their bowels when they are asleep. Gut spasticity is not something that's going on all the time—only when the person is awake, amid the opportunities to be stressed.

What's the physiology of this gut that is too contractile? As we saw earlier, the sympathetic nervous system is responsible for the increased large intestinal contractions during stress. And as would be expected, people with IBS have overactive sympathetic nervous systems (though it is less clear whether glucocorticoid levels are abnormal in IBS). And just to make the whole process worse, the pain of that gassy, distended, hypersensitive gut can stimulate sympathetic activation even further, making for a vicious circle.

So ongoing stress can be closely associated with IBS. Interestingly, traumatic stress early in life (abuse, for example) greatly increases the risk of IBS in adulthood. This implies that childhood trauma can leave an echo of vulnerability, a large intestine that is hyperreactive to stress, long afterward. Animal studies have shown that this occurs.

Despite these findings, there is a great deal of resistance to the link between stress and IBS (prompting some semi- irate letters to me from readers of earlier editions of this book). One reason for this is the linkage between IBS and certain personality types. In the cases of depression or anxiety, the connection is solid, but earlier linkages seem pretty suspect. These studies tended to focus on a lot of psychoanalytic gibberish (there, now I'll get myself into trouble with that crowd)—some hoo-ha about the person being stuck in the anal stage of development, a regression to the period of toilet training where going to the bathroom gained great acclaim and, suddenly, diarrhea was a symbolic reach for parental approval. Or the approval of the doctor as a parental surrogate. Or something or other. I'm not sure how they factored in constipation, but I'm sure they did.

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Few gastroenterologists take these ideas seriously anymore. However, in less scientific circles, some still cling to these views. It is easy to see how someone suffering from IBS, who has just managed to clear up the perception that they're still having some pottytraining issues, isn't enthused about getting fingered for not dealing well with stress.

Another reason why the stress /IBS connection is often viewed with suspicion is because there have been many studies that have failed to find a link. Why should this be?

First, both the severity of IBS symptoms and the intensity of stressors that someone is experiencing tend to wax and wane over time, and detecting a link between two such fluctuating patterns takes some very fancy statistics. (Typically, a technique called timeseries analysis, a subject four classes more advanced than the statistics that most biomedical scientists have sort of learned. When my wife had to do a time-series analysis as part of her doctoral research, it made me nervous just to have a textbook on the subject in the house.) Such waxing and waning of stress and of symptoms is particularly difficult to track because most studies are retrospective (they look at people who already have IBS and ask them to identify stressors in their past) rather than prospective (in which people who do not have a disease are followed to see if stress predicts who is going to get it).

The problem here is that people are terribly inaccurate at recalling information about stressors and symptoms that are more than a few months old, a point we're going to return to often in this book. Moreover, as was mentioned above, the sorts of stressors that can increase the risk of IBS can occur many years prior to the emergence of symptoms, making the link hard to detect even in prospective studies. Finally, "IBS" is probably a hodgepodge of diseases with multiple causes, and stress may be relevant to only some of them, and it takes some additional fancy statistics to detect those folks as a meaningful subset of the whole, instead of as just random noise in the data.

At later junctures in this book, we will see other supposed links between stress and some disease, and be in the same quandary—there definitely is a link in some patients, or clinical impressions strongly support a stress-disease link, yet hard-nosed studies fail to show the same thing. As we will see repeatedly, the trouble is that the supposedly hardnosed studies are often asking a fairly unsophisticated, straightforward question: does stress cause the disease in the majority of sufferers? The far more sophisticated questions to ask are whether stress worsens preexisting disease, whether patterns of symptoms and of stressors fluctuate in parallel over time, and whether these links occur only in a subset of vulnerable individuals. When asked in those ways, the stress-disease link becomes far more solid.

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Appendix C Chronic Fatigue Syndrome and ME

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Behavioral and Brain Functions BioMed Central Review Open Access Can sustained arousal explain the Chronic Fatigue Syndrome?

Vegard B Wyller*1, Hege R Eriksen2,3 and Kirsti Malterud4 Address: 1Division of Paediatrics, Rikshospitalet University Hospital, Oslo, Norway, 2Department of Education and Health Promotion, University of Bergen, Bergen, Norway, 3Unifob Health Bergen, Bergen, Norway and 4Research Unit for General Practice, Unifob Health Bergen, Bergen, Norway.

Email: Vegard B Wyller* - brwylle@online.no; Hege R Eriksen - hege.eriksen@unifob.uib.no; Kirsti Malterud - kirsti.malterud@isf.uib.no * Corresponding author Published: 23 February 2009 Received: 4 November 2008 Accepted: 23 February 2009 Behavioral and Brain Functions 2009, 5:10 doi:10.1186/1744-9081-5-10 This article is available from: http://www.behavioralandbrainfunctions.com/content/5/1/10 © 2009 Wyller et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract We present an integrative model of disease mechanisms in the Chronic Fatigue Syndrome (CFS), unifying empirical findings from different research traditions. Based upon the Cognitive activation theory of stress (CATS), we argue that new data on cardiovascular and thermoregulatory regulation indicate a state of permanent arousal responses – sustained arousal – in this condition. We suggest that sustained arousal can originate from different precipitating factors (infections, psychosocial challenges) interacting with predisposing factors (genetic traits, personality) and learned expectancies (classical and operant conditioning). Furthermore, sustained arousal may explain documented alterations by establishing vicious circles within immunology (Th2 (humoral) vs Th1 (cellular) predominance), endocrinology (attenuated HPA axis), skeletal muscle function (attenuated cortical activation, increased oxidative stress) and cognition (impaired memory and information processing). Finally, we propose a causal link between sustained arousal and the experience of fatigue. The model of sustained arousal

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embraces all main findings concerning CFS disease mechanisms within one theoretical framework.

Background Chronic Fatigue Syndrome (CFS) is characterized by unexplained and disabling fatigue, accompanied by symptoms such as musculoskeletal pain, impaired memory and con- centration, headache and sleep problems [1]. Research on disease mechanisms has been conducted along several tracks (Table 1).

Twin studies indicate a moderate heritability of CFS [2]. Recent molecular analyses report an association to polymorphisms of genes involved in autonomic and endocrine effector systems [3].

Personality traits such as perfectionism, conscientiousness and internalization may have an impact [4], as do illness perceptions such as a poor sense of personal control over symptoms and a strong focus on bodily sensations [5]. In many patients, firm evidence supports a relation to long-lasting infection caused by different microorganisms, such as Epstein-Barr virus, enteroviruses, and Coxiella burnetii [6,7]. In addition, CFS may be initiated by critical life events or perceived chronic difficulties [8,9].

Regarding perpetuating and associated factors, hemodynamic disturbances characterized by increased sympathetic and attenuated parasympathetic cardiovascular neurotransmission have been documented [10,11]. Immune system alterations (Th2 vs Th1 immune response predominance) are also reported [2]. There is evidence for hypofunction of the HPA-axis in some CFS patients [12].

Reduced function of skeletal muscles [13] might be due to functional changes in cortical motor areas [14], but could also be caused by changes in muscle metabolism due to Table 1: Summary of main findings related to disease mechanisms in Chronic Fatigue Syndrome Predisposing factors Genetic traits Polymorphisms in autonomic and endocrine effector systems Personality traits Inappropriate illness perceptions Precipitating factors Long-lasting infections Critical life events Perceived chronic difficulties Perpetuating and associated factors Hemodynamic alterations Sympathetic vs parasympathetic predominance Immune alterations Th2 vs Th1 predominance Endocrine alterations Attenuated HPA axis Skeletal muscle alterations Attenuated cortical activation Increased oxidative stress Cognitive alterations Impaired memory and information processing

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increased oxidative stress [15,16]. Finally, cognitive tests have revealed disturbances of memory and speed of information processing [17,18], but overall normal functioning in other cognitive domains.

A coherent and integrative model of CFS disease mechanisms combining these findings is lacking. In this article, we propose such a model, based upon the Cognitive activation theory of stress (CATS) [19]. Specifically, we suggest that CFS is caused by sustained arousal.

The sustained arousal model of CFS Below, we first present CATS – the stress theory upon which our model is based. Then we outline empirical indications of an association between sustained arousal and CFS. From this point of departure, we apply CATS to hypothesize the potential mechanisms leading to sus- tained arousal in CFS, and finally we substantiate our model by discussing sustained arousal consequences in other organ systems in relation to CFS research evidence.

The Cognitive activation theory of stress (CATS) Among various definitions of the term "stress", a common denominator is that stress denotes any condition being a threat to homeostasis in a broad sense [20,21]. Stress occurs whenever there is a discrepancy between what is expected ("set value") and what really exists ("actual value"); hence, it always implies comparison of present sensory information with stored brain information [19,22]. This may be a fast and partly automatic process, for instance when exposed to a significant and unexpected change in the environment [23], or when certain physio- logic variables (such as blood pressure) are perturbated [20]. Eventually, the comparison may involve complex cognitive evaluations of situations and their potential consequences, which in turn is based on previous experiences in equal or similar situations [19,24].

Stress normally elicits a quite non-specific arousal response, involving the somatic and autonomic nervous system as well as several endocrine axes [25] (Figure 1). Important characteristics include elevated plasma levels of epine- phrine and a change of set-point in homeostatic control circuits (causing, for instance, elevated blood pressure and body temperature) [20]. The overall purpose of the arousal response is to restore homeostasis by counteract- ing the initial discrepancy between expectations and real- ity. The arousal response is gradually turned off when successful ("coping"). If not, the arousal may be sustained [19].

Although quite uniform in gross, the details and dynamics of the arousal response vary among individuals. Genetic variability has some impact [20], but cognitive processes, evaluating the relationships between stimulus and expect- ancy, may be more important to explain individual varia- tion [22]. These mechanisms have been systematized in the Cognitive activation theory of stress (CATS) [19]. The the- oretical basis of CATS is the cognitive reformulations of learning theory [24,26], where classical conditioning is regarded as acquisition of expectancies of the outcomes of stimuli (stimulus expectancies), and instrumental or oper- ant conditioning as the acquisition of retraining the brain and body for a better life

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expectancies of the results of available responses (response outcome expectan- cies).

Arousal response intensity increases if the stimulus expectancy has high affective value or if the response out-

NFiogrumreal 1arousal response, according to the Cognitive activation theory of stress (CATS) Normal arousal response, according to the Cognitive activation theory of stress (CATS). A threat to homeostasis elicits an arousal response, characterized by nervous and endocrine adjustments aiming at regaining homeostatic stability (1). This retraining the brain and body for a better life

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compensatory mechanism is mutually connected to cognitive processes; in addition, it is influenced by personality, genetic traits and sensitization (2). If successful, i.e. if homeostasis is restored, the arousal response is turned off (3). come expectancy is inadequate. Furthermore, experimental studies have demonstrated that arousal response can be modified by sensitization, the enhanced response to repeated stimulation [27]. This phenomenon has been described in detail on the cellular level [28], and is also considered important for disease development [29,30]. Thus, sensitization has been suggested as an important underlying mechanism in fibromyalgia [31], irritable bowel and functional dyspepsia [32], chemical intolerance, and somatization [30].

The arousal response is primarily adaptive and health- promoting. However, alterations of the response dynamics – in particular a state of maintenance, in CATS denoted sustained arousal – may contribute to disease [19,21].

Indications of sustained arousal in CFS patients The first author investigated cardiovascular and thermoregulatory homeostasis in adolescent CFS patients and healthy controls. During supine rest, CFS patients had increased sympathetic nerve activity to the heart, the skeletal muscle arterioles and the adrenals; the latter causing increased plasma levels of epinephrine. There was also evidence of increased arterial blood pressure and body temperature [33-35]. During orthostatic challenge, CFS patients demonstrated enhanced sympathetic nerve activity to the heart and the skeletal muscle arterioles, as well as increased arterial blood pressure [33-37]. However, when orthostatic challenge was combined with isometric exercise, CFS patients presented attenuated sympathetic cardiovascular outflow and a smaller increase in the arterial blood pressure [34]. During local cooling, CFS patients had attenuated sympathetic outflow to skin arterioles combined with normalization of body temperature [35]. Finally, CFS patients presented symptoms suggesting enhanced sympathetic nerve activity to the sweat glands, the skeletal muscles and the skin vessels [34,35].

Similar findings have previously been reported in other studies [10,11], and hypovolemia and deconditioning have been suggested as possible underlying mechanism. Yet, neither of these mechanisms can fully explain the results: Moderate hypovolemia usually does not cause altered blood pressure and body temperature [38], and deconditioning leads to attenuated sympathetic cardio- vascular responses during orthostatic challenge [39].

Rather, the results suggest alterations of CNS autonomic control, corresponding with neuroimaging studies indicating functional alterations in relevant brain stem areas [40].

More specifically, the response patterns might all be explained by abnormalities in homeostatic set-point adjustments of blood pressure and body temperature [41]. For instance, abnormal increase in arterial blood pressure set-point during orthostatic challenge might enhance sympathetic nerve activity to the heart and the skeletal muscle arterioles, causing increased heart rate and total peripheral resistance and bringing the observed blood pressure value to a higher level.

According to stress theory, set-point changes of homeostatic control circuits are hallmarks retraining the brain and body for a better life

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of the arousal response, as is increased level of epinephrine [20], demonstrated in CFS patients by Wyller [35] and others [42]. Furthermore, Wyller and co-workers' results comply neatly with human and animal studies directly addressing cardiovascular and thermoregulatory alterations during arousal [43,44]. Thus, CFS patients seem to present an arousal response-physiology which is, however, inappropriate, being present both at rest and during maneuvers which are normally not distressing. We propose these findings to be interpreted as indications of sustained arousal in CFS patients.

Potential origin of sustained arousal in CFS The mechanism leading to sustained arousal in CFS might be hypothesized from stress theory (Figure 2). Infections, which commonly trigger CFS, generally elicit a normal arousal response [45]. Comparable arousal responses can also be elicited by critical life events and perceived chronic difficulties [20], which have been associated with CFS outbreak (Table 1). Thus, a common characteristic of CFS precipitating factors seem to be their long-lasting character, which – according to CATS – may cause a comparably prolonged arousal response [19].

However, this arousal response might be insufficient in solving the initial problem. An attempt of compensation would be to generate a stronger one. As there is no apparent solution to the individual, such attempts might be perceived as inadequate, resulting in negative stimulus and response outcome expectancy. Thus, a vicious circle is established, as the evaluation of the arousal response depends upon expectancies: negative expectations rein- force the arousal response [19]. This inappropriate learning process can be strengthened by attentiveness, corresponding with reports of increased focus on bodily sensations in CFS [5]. Increased worry about coping abilities is also suggested to be a risk factor [29], complying with personality traits that might be associated with CFS [4].

Finally, genetic factors might have important impact [19], and recent evidence indicates that certain polymorphisms in autonomic and endocrine effector systems are associated with CFS [3].

Therefore, when certain prerequisites are met, the arousal response might be strongly and paradoxically reinforced. This, in turn, may counteract homeostasis rather than restoring it, resulting in another vicious circle. Similar phenomena are demonstrated in hyperventilation, where an unpleasant experience triggers a mutual amplifying cascade of arousal response and unstable respiratory homeostasis, resulting in grossly abnormal blood gas levels [46]. A parallel would be that CFS patients maintain arousal in their pursuits to gain control over their own arousal response.

When the initial triggering factor subsides, classical conditioning may lead to associations between the arousal response and common neutral stimuli [47], like moderate physical activity. Therefore, inappropriate arousal may be precipitated in numerous situations.

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PFrigouporese2d model of the origin of sustained arousal in Chronic fatigue syndrome Proposed model of the origin of sustained arousal in Chronic fatigue syndrome. Certain threats to homeostasis, such as long-lasting infections and psychosocial challenges, may elicit a prolonged arousal response, which does not, however, solve the initial problem (1). The mutual relation to cognitive processes results in negative stimulus and response outcome expectancies, creating a vicious circle (2).

Certain genetic traits and aspects of personality may reinforce the arousal response further. This situation causes homeostatic instability in itself, establishing another vicious circle (3). In addition, the arousal response may eventually become associated with neutral events, such as moderate physical activity, through the process of classical conditioning (4). We propose that these mechanisms altogether elicit a state of sustained arousal (5).

We suggest that these mechanisms altogether can elicit a state of sustained arousal. retraining the brain and body for a better life

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Potential consequences of sustained arousal in CFS Sustained arousal might have detrimental effects, as evident from stress research experiments (Figure 3). Such consequences correspond well with empirical findings in CFS patients (Table 1). The hemodynamic alterations have been presented above. Below, we shall substantiate our model discussing sustained arousal consequences in other organ systems in relation to CFS research evidence.

A broad range of distressing events, including psychosocial challenges, have an impact on the immune system, such as attenuated cellular immunity and a tendency towards reactivation of latent virus infections [48]. Some of these effects might be attributed to increased sympathetic nerve activity and heightened levels of catecholamines, which in general promote a shift towards Th2 immune responses at the cost of Th1 immune responses [49], complying with findings among CFS patients [2]. Thus, immune dysfunction in CFS may be regarded an epiphenomenon rather than a causal factor [50]. Further- more, the findings of increased activity of intracellular microorganisms in CFS patients, most convincingly reported for enteroviruses [7], are explained by reactivation of latent infections due to immunological alterations [51]. Although not a primary abnormality according to the sustained arousal model, immune dysfunction in CFS may contribute to vicious circles. For instance, catecholamines stimulate CNS secretion of the Th2-cytokine IL-6 [49], which in turn influences centers involved in arousal responses [52].

An arousal response has profound endocrine consequences, mainly influencing plasma levels of adrenal hormones [20]. Whereas short-lasting arousal activates the HPA axis and increases levels of glucocorticoids, sustained arousal might have the opposite effect [53]. Similar endocrine changes have been documented in CFS [12], and thus seem coherent with our postulate of sustained arousal.

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FPrigouporese3d model on the consequences of sustained arousal in CFS Proposed model on the consequences of sustained arousal in CFS. Sustained arousal may cause alterations of immunity, skeletal muscle, cognitions, endocrine function and hemodynamics. Some of these alterations may in turn establish vicious circles due to altered cytokine pattern, oxidative tissue damage and insufficient coping. Finally, sustained arousal might be directly responsible for the experience of fatigue in these patients.

Arousal responses also include behavioral changes, which seem to be mediated – at least in part – by catecholaminergic neurotransmission to brain motor areas [54]. Accordingly, if CFS is resulting from a state of sustained arousal, disturbances of locomotor control will follow [14]. Peripheral interactions between arousal responses and motoric systems might also contribute to skeletal muscle dysfunction in CFS. First, catecholamines strongly influence the excitability of striated muscle cell membrane [55], probably explaining why psychological challenges alters EMG records of skeletal muscle [56].

Similar findings were reported by Jammes and co-workers in CFS patients [16]. Second, catecholamine outflow during an arousal response promote production of free oxygen radicals in striated muscles [57], eventually causing myocyte damage [58]. Corresponding muscular pathology has been reported among CFS patients [16], as well as increased oxidative load in general [15]. Such deleterious effects may in turn enhance resting sympathetic outflow through ordinary reflex mechanisms [59], thus establishing a vicious circle.

Prolonged arousal has a negative influence on memory and information processing [60].

Similar cognitive dysfunctions are found among CFS patients [17,18], giving further retraining the brain and body for a better life

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support to a hypothesis of sustained arousal. Such dysfunctions may be reinforced through mechanisms of conditioning, establishing negative response outcome expectancies, possibly explaining why patients evaluate their cognitive abilities as even lower than they really are [61]. According to CATS, perceived impairment may be a stronger predictor of outcome than the 'real' impairment, resulting in a self-fulfilling prophecy [19].

Yet the question remains to explain CFS patients' experience of overwhelming fatigue as an effect of sustained arousal. The processes underlying physiologic as well as pathological fatigue are still largely unknown. However, there are several indications of a potential association between fatigue and sustained arousal. Painful and inescapable stimuli increase the serotonin (5-HT) neurotransmission in different brain stem and limbic areas in rats, such as the raphe nucleus [62] and the amygdala [63]. Comparable experiments have demonstrated a concomitant lowering of CRH levels in the hypothalamus [64]. Similar alterations in serotonin and CRH neurotransmission have been reported in CFS patients [65,66], and in other conditions of fatigue [67]. Hence, these two neurotransmitters constitute a possible link between sustained arousal and fatigue.

In addition, more indirect relation involving the immune system might be important. As outlined above, sustained arousal can explain increased production of IL-6 and other Th2 cytokines, which in turn might promote the experience of fatigue through a direct action on the brain stem [67,68]. Finally, CATS suggests a relation between sustained arousal and fatigue at the psychological level, recalling avoidance behavior as a hallmark of arousal responses [19,20]: When a diverse range of stimuli elicit arousal, fatigue and the corresponding functional impairment constitutes an apparently effective way of avoiding them.

Discussion What is known from before – what does the CFS sustained arousal model add? The model we have presented corresponds with other, recently presented models of CFS disease mechanisms. Altered sympathetic nervous activity at rest and during different challenges has been regarded a key feature by some researchers, but not interpreted within the frame of stress theory [69,70]. Although focusing primarily on a cognitive behavioral model of medically unexplained symptoms in general and CFS in particular, the importance of homeostatic dysregulation and perpetuating vicious circles has been recognized in recent papers [71,72]. Like- wise, Gupta outlined the possibility of conditioned responses, but confined this process to the amygdala and emphasized a close relation to the emotional state of fear [73]. In fibromyalgia, a stress model related to ours was promoted by von Houdenhove [74]. Furthermore, the sustained arousal model shares several basic aspects with recently proposed models for the overtraining phenomenon in sports medicine [75], the posttraumatic stress dis- order [76], and subjective health complaints [30] The CFS sustained arousal model holds the capacity to explain all main findings concerning CFS disease mechanisms within a unifying theoretical framework. Thus, it represents a synthesis where several important features are included. First, complying retraining the brain and body for a better life

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with recent cognitive behavioral and self-regulation models [71,72], the sustained arousal model allows heterogeneity of causal factors among individuals. Sustained arousal is seen as a 'common pathway' for the origin of the cluster of CFS symptoms, whereas the combination of predisposing, precipitating and perpetuating factors may vary from patients to patient. Second, the model allows symptom severity to be relative to the extent of distressing challenges; CFS is regarded a kind of maladaptation between stimuli and responses. Third, the model implies a bio psychosocial construct, opposing a fundamental dichotomy between bodily and mental processes, while acknowledging the impact of cognitive processing on physiological responses. Finally, the sustained arousal model seems to possess a kind of 'face validity' when appraised in relation to patients' uniform experience of an inability to respond properly to the physical and mental challenges of daily life [77].

In principle, the arousal response is general and quite non-specific. However, genetic factors, early experiences, personality traits, attributions, and beliefs may all contribute to the specificity of complaints developed by each individual [71]. Likewise, sensitization has been suggested as an underlying mechanism for a number of different conditions; whether these should be lumped together or regarded as distinct entities (such as CFS, irritable bowel syndrome, etc), remains a matter of debate [30].

Suggestions for further research Although the assumptions of the sustained arousal model cannot be proved per se, it allows for deduction of testable hypotheses. Below, we suggest a selected sample: • Certain polymorphisms of genes whose products are involved in arousal responses are more common among CFS patients than healthy controls. This could explain the hereditary pre- disposition for CFS. A search for polymorphisms should be governed by updated knowledge of the genetic basis for normal arousal responses.

• Infections associated with CFS elicit a more comprehensive and long-lasting arousal response than other infections of similar clinical presentation. This is to be expected if certain infections are more prone to establish a conditioned arousal response. For instance, patients with verified acute EBV infection might be compared with patients suffering from acute viral pharyngitis of other origin. Autonomic and endocrine reactions to different experimental challenges could be used as markers of an arousal response.

• When exposed to physical or mental challenges, perfusion, metabolism and transmitter activity in brain areas responsible for arousal responses differs among CFS patients and controls. Of particular interest are the serotoninergic pathways in the brain stem and limbic structures. Modern neuroimaging technology makes such studies feasible.

• The characteristics of autonomic reflexes differ among CFS patients and controls during rest and challenges due to set-point alterations. Exploring further the characteristics of the homeostatic control circuits in CFS patients might add to the evidence supporting a sustained arousal model. A possible analytic tool would be the mathematical technique of transfer function analyses.

• Cognitive behavioral therapy (CBT) specifically designed to abolish sustained arousal retraining the brain and body for a better life

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is more effective in the treatment of CFS than unspecific cognitive behavioral therapy. CBT is of proven value in CFS [1]; to our knowledge, however, the effectiveness of different approaches has not been subjected to research. The design should be randomized and controlled.

• Pharmaceutical inhibition of brain centers eliciting the arousal response will improve the functional abilities of CFS patients and normalize the hemodynamics in distressing situations. Clonidine, an agonist to the inhibitory alfa2 adrenoceptor, attenuates central sympathetic outflow by an effect on brain stem centers which also constitutes fundamental elements of the arousal response [20]. Thus, this drug – which has well-known antihypertensive and some analgesic properties – might be beneficial in CFS; as yet, no systematic trials have been carried out.

Concluding remarks In this article, we have applied CATS and related stress theories to propose the concept of sustained arousal as a coherent and integrative model of disease mechanisms in CFS. This model opposes the reductionist approach where explanations from psychology, neurology immunology and other areas are seen as competing rather than complementary. As stated

by Manu [78], page 173: «... more than any other issue in contemporary medicine, chronic fatigue syndrome reflects the unresolved conflict between the mechanistic and the bio psychosocial construct of illness». This warning should guide further research in the field.

Abbreviations CFS: Chronic fatigue syndrome; CATS: Cognitive activation theory of stress; HPA-axis: Hypothalamus-pituitary- adrenal-axis; CNS: Central nervous system; CRH: Corticotropin-releasing hormone; CBT: Cognitive behavioral therapy.

Competing interests The authors declare that they have no competing interests.

Authors' contributions VBW conceived of the theory and drafted the manuscript. HRE and KM elaborated on the theory and helped to draft the manuscript. All authors have read and approved the final manuscript.

Authors' information VBW has conducted research projects regarding autonomic control in CFS, and is currently head of the Unit for Chronic fatigue syndrome at Division of Paediatrics, Rikshospitalet University Hospital, Oslo, Norway. HRE has published extensively on the Cognitive activation theory of stress, and is professor at the Dept. of Psychology, University of Bergen, Norway. KM has conducted clinical research on CFS and heads the national research network 'CFS in theory and practice'. retraining the brain and body for a better life

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Appendix D Pain

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Pain – one word so many feelings These pages are not a full explanation of pain, they are designed to give you some insight into the experience of pain and by increasing your understanding help you to be more relaxed and comfortable about it. If you would like a full explanation of pain then I would suggest that you buy or get from your local library “Explain Pain” by Lorimer Moseley and David Butler. The initial text is taken from this book. As it is you in pain, it is up to you to help yourself and gain an understanding and learn what actions you can take to help yourself. Luckily for you that is where the three-day Neuro-Plasticity Training comes in. You will learn a tool that you can use to interrupt responses that are not helpful for your physiology and learn to do new helpful patterns.

No-one really wants pain. When it comes on, you want it to go away. It makes you take action to rest, take pain relief, see your doctor or some sort of physical therapist. Pain is a normal response that is brilliantly designed to protect you. For people who do not have this protection mechanism they hurt themselves many times a day because they don’t get the feedback you or I get.

Sometimes the pain system acts strangely like the army soldier who has their arm blown off and does not feel any pain until the threat of being killed is over; or the rugby player who plays a game with a broken arm with no pain.

We believe that all pain experiences are normal and are an excellent, though unpleasant, response to what your brain judges to be a threatening situation. We believe that even if problems do exist in your joints, muscles, ligaments, nerves, immune system or anywhere else, it won’t hurt if your brain thinks you are not in danger.

In exactly the same way, even if no problems whatsoever exist in your body tissues, nerves or immune system, it will still hurt if your brain thinks you are in danger. It is as simple, and as difficult, as that.

Most commonly, pain occurs when your body’s alarm system alerts the brain to actual or potential tissue damage. But this is only one part of a bigger picture of pain. Pain actually involves all of your body systems and all of the responses that occur are aimed at protection and healing. Pain can be so effective that you can’t think, feel or focus on anything else.

We know from research that if you have a good understanding about how pain works then you will change the way you think about and improve your management of it.

Pain is a normal response to tissue injury. I remember at about the age of 8 I was breaking open some rocks from our property to see if there were any fossils inside. I was using my dad’s hammer and managed to hit my thumb with the hammer really hard. My body had the usual response of bleeding under the nail and my parents put my finger in a glass of spirits. My nail fell off and grew back. From that day onwards when ever I was breaking open some rocks with a hammer or even using a hammer with my hands near-by I would always remember to be wary of where my thumb was and to concentrate on where I was hitting with the hammer. Pain can teach us things and cause us to modify our behavior. So even something as simple as hitting my thumb with a hammer involves hammers, thumbs, rocks, the backyard, glasses of spirits, status at school for losing a nail, my parents retraining the brain and body for a better life

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responses (could have been you stupid child or you silly duffa), my sisters responses and many other things. You will come to learn from reading this that “things that fire together wire together”.

Pavlov’s dogs is a famous example of this “firing together”. He would ring a bell just before he fed some dogs. He did this for quite some time and then found that all he needed to do was to ring the bell and the dogs would salivate. Meaning that the dogs minds/nervous system had wired together the sound of the bell and food so even just the sound of the bell and no food was enough for them to start thinking food was coming. We are all just like this.

But we all know that pain can be a much more complex picture. All pain (in fact all experiences) involves many thoughts and emotional contributions. We need the brain to really understand pain- especially pain that persists, spreads or seems unpredictable. We need the brain to help us understand why emotions, thoughts, beliefs and behaviors are important in pain.

If you have pain now then you are not alone. In fact, at any one time on the face of the earth, around 20 percent of people have pain that has persisted for more than 3 months!

When pain persists and feels like it is ruining your life, it is difficult to see how it can be serving any useful purpose. But even when pain is chronic and nasty, it hurts because the brain has somehow concluded, for some reason or another, often completely subconsciously, that you are threatened and in danger – the trick is finding out why the brain has come to this conclusion.

Low back pain and neck pain are among the most common pains in humans. In low back pain, research has shown that the amount of disc and nerve damage rarely relates to the amount of pain experienced. In fact many of us have scary sounding disc bulges, even squashed nerves, yet may never have any pain. This is probably quite relieving as many of the changes in the tissues are just a normal part of being alive and don’t have to hurt.

What’s more, these changes don’t necessarily have to stop anyone leading a very functional and active life. It is very likely that an x-ray of an older person’s spine will reveal changes which could be described as arthritic or degenerative, people with the same scans can have no pain or large amounts of pain.

Pain relies on context. I remember I saw a man who came to see me (the physiotherapist) for post operative knee rehabilitation. He said that he had had an arthroscopy (debridement – scraping of joint surfaces and washout). He said that he had had pain in his right knee before the operation for a number of years but that it was pretty good and not too bad. Just a bit stiff in the morning and ached a bit if he did too much. He came in after the surgery and was unwilling to bend his knee. I asked him why he seemed to be exhibiting so much fear of bending his knee as he had had the surgery and should be retraining the brain and body for a better life

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moving forward. He said that the surgeon had talked to him after the surgery and stated that his knee was pretty bad. The surgeon had said “his knee was like an 80 year olds and looked like a cheese grater” and he should not even think about returning to bush walking and definitely never run, jump or put any strain through his knee. So when he went to bend his knee and felt some pain or discomfort he immediately thought of the cheese grater and what must be going on inside his knee. This is a definite threat or danger and will likely produce a very different response to a person that was told (with the very same knee and operation) “the operation went really well and if you are gradual in your return to activity you shouldn’t have any problems”.

Story…

I was told this story by Lorimer Moseley (Pain Guru) about a guy who had his hand mangled in an industrial strength bread machine while at work. His had got trapped in the machine and damaged very badly. A few different specialists including a neurosurgeon and a specialist hand surgeon reconstructed his hand.

He did quite well after the operation and was doing his rehabilitation every day. Then months after the surgery he started getting pain in the operated hand on a Saturday morning. He thought he was going crazy, as it was every Saturday morning. He went back to see his specialists as it was not just a little bit of pain it was excruciating pain just like straight after the injury. His specialists essentially told him that from a structural point of view the operation was a success and that there was nothing that they could see on rescanning the hand to account for this excruciating pain. He really did think he was going crazy and was thinking of seeing a Psychiatrist about it. He then happened to see Lorimer Moseley who said that there are things called “Ignition Cues” or “Neuro Tags” which can ignite the pain experience. He said that what he needed to do at the time that the pain started coming on he needed to notice what he could smell, feel, see, what he was thinking and what he was doing physically.

He did this on the Saturday morning….and do you know what he realised?

He noticed, consciously, for the first time, that he could smell the smell of fresh bread coming from his next-door neighbors. He found out from them that they had recently bought one of those bread machines that you can put on a timer to make sure you have lovely fresh loaf of bread at 7am in the morning.

His body had responded in the best way it could to “protect” him from the “danger” of the bread machine. From any bread machine he my encounter in the future and the best way of protecting him and stopping him from going anywhere near one, EVER! was to give him the experience of pain and lots of it.

Once he realised that it was the neighbor’s bread machine he still had to train his unconscious brain that it was not dangerous. It’s all well and good to know consciously that a little bread machine is not dangerous but what is important is that your subconscious knows this! He had to gradually expose himself to the smell of fresh bread over a period of time until his unconscious learnt that it was not dangerous and would not impact on his survival (our hands are pretty important!). retraining the brain and body for a better life

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Which brings us onto the idea that “things that fire together, wire together”. In other words at the time of his hand injury his brain has wired together bread machines, the smell of bread, hands, pain, work, the sounds that were happening at the time, the people he was working with and many other things even he was unaware of! The good news is that “things that fire apart, wire apart” as well. Meaning that our conscious and unconscious brains are trainable and that if we can separate things that have become neurally linked.

For instance when me and my wife went back to Tassie to visit my Mum and Dad a while ago we started having cups of tea and with these cups of tea we would always have something sweet like a mint slice biscuit. It was totally great until we came home and then went to make a cup of tea and suddenly realised, without having to think about it at all, that there was something missing. We went to the shop and bought a packet of mint slices and enjoyed our cup of tea with something sweet. This habit may have continued indefinitely into the future if we had not of stopped buying sweet things to have with a cup of tea and made those two things – cup of tea and sweet biscuit – fire and wire apart.

Once we stopped having them together and had done that enough times we now had a new pattern of just a cup of tea on its own was totally fine. There was no trigger any more for something sweet.

If you are in pain then you will have certain things that you “know” that pain represents.

You might have back pain and “know”, either from what you have been told or what you have found out for yourself, that your pain is due to the disc pressing on the nerve. You “know” that the disc could “come out” at any stage in the future and that the last Orthopaedic surgeon you saw said you had the back of an 80 year old. You know from the scans that you have arthritis and degenerative changes in your back that are only going to get worse with time.

If you think the above thoughts then your response to any onset or increase in pain in your lumbar spine area is bound to set off alarm signals and you are bound to attend very closely, to any signals from that area. Your response will be different if you think “oh look, my nervous system has become more sensitised. I wonder what I might be able to do to enable my nervous system to find a more balanced/relaxed state.” You might also want to stop and think about what your states have been like in the last week. Have you been really relaxed, happy and in the present or have you been depressed, very uptight and worrying about things in the future or thinking about things from the past? Your past and present states will have an effect on your nervous system and on your pain.

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Some important things to remember about pain Pain is an output (not an input) and a process People with chronic pain tend to unconsciously perform body checks very often which is not helpful We often will unconsciously react to pain with activation of the stress response.

Pain has a “neurotag” that has a number of ignition cues Things that “fire together wire together” and things that “fire apart, wire apart” Rebalancing the Central Nervous System is the most important thing to help comfort levels.

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