(347) 506-1612 DrWolkin@BrainCurves.com
SPOTLIGHT: POST TRAUMATIC GROWTH IN REAL LIFE: HEALING THROUGH WORDS

SPOTLIGHT: POST TRAUMATIC GROWTH IN REAL LIFE: HEALING THROUGH WORDS

On the evening of March 26th, 2012, Yvonne Kent Pateras suffered a massive hemorrhagic stroke, leaving her unable to speak or move. She also experienced “locked-in” syndrome. These are Yvonne’s own words regarding the traumatic stroke she experienced:

“I had the experience of knowing what was happening to me from the beginning. I felt a sinus rhythm in my head becoming louder. I tried to center myself, but it was over before I had time to act. I opened my mouth to shout for help-the noise that left my body was the most primordial noise. My beautiful voice had been replaced by the noise of a wounded beast. I wouldn’t hear another word for the next for 3 months. I knew that I had not only suffered a stroke, I was paralyzed and locked in. I couldn’t tell my family that I knew what was going on. I tried to just keep my neurons busy and alive. I did simple counting exercises to stay calm and occupied-to keep my adrenaline levels under control. I was determined to survive.”

After four months in the hospital, to everyone’s surprise, and with extraordinary courage, Yvonne was able to regain speech and movement. Yet, in a span of approximately ten months, she suffered three ischemic strokes, and another hemorrhagic one. Since different kinds of strokes require different treatments, medical care was challenging.

Yvonne persevered. She said that recovery required “endless effort.” She can now walk without difficulty. She has a light speech impediment and lost some functioning in her right hand.

As we now know, with post-traumatic growth, trauma like this can often serve as a catalyst for a profound awakening to an emotional and spiritual transformation. Yvonne’s awaking came in the form of writing poetry.

“Following the stroke I went through a spell of re-learning, like being born again. Feelings were overpowering my mind’s concentration and understanding. Writing verses were facilitating the expression of my feelings. Publishing my work also gave me upmost satisfaction, particularly as the response by other stroke victims was so moving. Poetry takes the weight off my legs, gives me wings!!!”

You can find Yvonne’s poetry in her book, Stroke Journeys, by clicking on this link.

This is part 4 of a 4-part series of excerpts from the latest 2018 edition of Dr. Wolkin’s PTSD Packet

Repost: 4 Lessons I’ve Learned From Chronic Migraine About Mindful Living

Repost: 4 Lessons I’ve Learned From Chronic Migraine About Mindful Living

This blog post originally appeared on The Mighty 

 

I’ve had episodic migraines all my life, but they never debilitated me. A day or two before my period, when a bad headache would strike, I’d take four Advil, put an ice pack on my neck, and be fine a few hours later.

That all changed in June 2017. Here’s how I remember it: I took a flight from New York City to the West Coast, and then two more flights within the same week. I experienced 110 F Las Vegas summer weather, jet lag, and overall exhaustion. I was still feeling stressed from the news the month prior that I might be experiencing perimenopausal hormonal changes (read: premature ovarian failure). Then, on the fourth day of the trip, after sleeping for 16 hours straight, I woke up feeling an off-ness that grew into a slew of neurological symptoms that never went away.

This perfect storm of events, as my neurologist called it, must have set off a cascade inside my body that culminated in migraine, that has lasted for the last seven months in varying degrees of intensity. I have had various in and out symptoms including light sensitivity, dizziness, nausea, blurriness, stabbing eye pain, gastric stasis, brain fog, and headaches.

Some might call it status migrainosus, which by definition is a migraine that lasts for more than 72 hours. Whatever we call it, my migraines clearly went from being episodic to a chronic and disabling issue. The initial migraine technically broke two months later following a steroid taper, which gave me two days of relief. Since then, I have had on and off symptoms almost daily in varying degrees and intensities.

Despite the pain and discomfort, this time has been ripe with lessons in more mindful living:

1. Awareness

Knowing and eliminating my triggers:

While migraine is often genetic, and there is no one agreed upon cause, there are triggers involved – which don’t cause an attack, but can set one off. Some are uncontrollable, like barometric pressure, and some can be managed through lifestyle changes. The latter requires meticulous self-calibration.

I’ve eliminated many dietary triggers, including alcohol, chocolate, anything with tyramine, anything with nitrates, and even some food high in histamines. The calibration continues, as even the amount of caffeine that I put in my body can put me at risk for symptoms. So every morning I have just the right amount of espresso, no more, no less. This also applies to sleep. I need enough sleep to feel well, but too much sleep can actually tip the scales in the wrong direction. This awareness to detail has been a bit painstaking, and it sometimes feels like a roulette game. Yet, I’ve never been so aware of what my body needs in any given moment.

Recognizing the subtle signs of a migraine before they escalate:

My interoceptive awareness has been heightened in a beneficial way. Some of the medications to abort migraine work best when you can catch the symptoms early. This has required me to be consciously aware of the subtle nuances in the way I feel at any given moment. Of course, at its extreme, this can become almost obsessive. But when it’s for the sake of one’s wellness, it feels calming to be able to know that I can help myself by being more attuned to my body.

For me, my heart starts to race, my vision tends to blur, and my shoulders and neck start to tighten. I’ve learned that by noticing these symptoms early, I can sometimes even skip the medication by immediately applying peppermint oil to my wrists and temples, ice on my forehead, and heat on my neck area.

2. Self-Compassion

Less “shoulding” all over myself:

I have a tendency to “should” all over myself to the tune of, “I should be writing my book right now, I should be creating my e-courses, and I should expand my practice to include group therapy, etc.” At times, however, the symptoms were so disabling that I couldn’t do much but lay in a dark room. In those moments, I worked hard on letting go of my “shoulds, ” such as, “How can I be laying here when I should be accomplishing this and that and the other thing?!”

Compassion for my body:

Chronic migraine forced me to take a break from physical exertion. With the lack of consistent cardio, coupled with the weight-gain side effects of certain medications, I saw the number on the scale go up. At first, I started to obsess over the weight that I “should” be at. Then, I started to have compassion for the strength of my body as it went through this process. Instead of focusing on pounds, I focused on wellness.
I am finally challenging many of the “shoulds” I’ve amassed, and as I do I notice the seeds of self-compassion budding within me.

3. Gratitude

Gratitude for moments of relief:

I’m certainly not going to imply that we have to struggle in some capacity to feel and express gratitude! Yet, the caliber of gratitude that I felt in the moments when I experienced even modicums of relief from my migraine symptoms, was something I’d never experienced in all my years of gratitude training. I found myself literally saying, “Thank you, thank you, thank you!” But when the pain returned, and I was at risk for falling into a darkness, “Why was that relief taken away from me!?” I challenged that thought, and reminded myself that if I had a moment of relief, I would have another – and that gave me hope.

Gratitude for the care I have been, and continue to be, shown:

I tend to be more of a nurturer, caregiver type — much better at giving than receiving — but because of the sometimes disabling nature of migraine, I literally had no choice but to allow myself to surrender to others’ giving.

Whether it was foot massages in the throes of a more severe attack, ice and heat around the clock as needed, mailing me different essential oils, including peppermint — which I’ve found has been crucial — showing up to the ER when the relentless pain called for a visit, calling or checking in daily, helping me strategize to find the best and highest caliber treatment team, and even just holding me during some of the more emotional moments when I’d cry from exhaustion, when the hope was too hard to hold, when I couldn’t see my future.

To see those I love show up in many different ways to bring me even just a little more relief filled me with gratitude — again, the kind I had never quite felt before.

4. Patience

Patience in finding the right treatment:

By nature, I tend towards the more impatient end of the spectrum. I like to take productive action and see immediate results — cause and effect, right? Well, sometimes, life just doesn’t work like this and I have had to maintain patience across many facets of my migraine experience.

Finding the right treatment team takes time. Not every doctor is going to be the right fit for your needs, and that’s OK. However, it can feel like a job finding the point person who will facilitate the appropriate treatment, the clinician who is the right fit. After a few months, thanks to a friend’s recommendation, I’ve finally found someone.

Often, treating migraine also calls for finding the right cocktail of medications. This takes a lot of time, too. Not only do you need to find the right combination that works for each unique individual, but it also takes at least one month before you’ve given each and every medication its “fair shot.” Plus, some come with egregious side effects, and you have to decide: do you wait it out and hope they subside as the medication takes effect – or do you stop it, and start over?

I’d like the healing to be more linear and more blatant, but it’s not. There’s a lot of waiting involved, and the waiting feels compounded because it happens sometimes in the context of great discomfort and pain. Baby steps is my new mantra, but none of this feels easy.

So, while it’s taken a solid treatment team, preventative meds, significant lifestyle and dietary changes, and incredible support, I have no doubt that these lessons are part of my healing process.

That’s the irony of all ironies. The lessons learned are like lifeboats in an unpredictable, roaring sea. Again, one doesn’t have to struggle to “see the light,” but if one is experiencing discomfort and pain, there’s more to see in that muck than meets the eye.

Repost: 4 Lessons in Mindfulness from the Olympians

Repost: 4 Lessons in Mindfulness from the Olympians

This post originally appeared on Mindful.org

When you watch the Olympics, you can’t help but imagine the countless hours of training all of the athletes have devoted themselves to in order to accomplish the unfathomable feats of stamina, incomprehensible shows of endurance, and extraordinary acts of skill.

And that kind of rigorous training, steeped in competition, often can’t be fully actualized without training the mind as well.

Some of the athletes have been vocal about their penchant for mindfulness meditation as an integral part of their quest for gold. For example, Tom Daley, a diver from Great Britain, told the Telegraph: “You can only do so much in the gym or in the pool.” He continued, “Every morning I do 10 minutes of mindfulness where I do meditation and I use that in competition and every day life… It’s helped me massively and I feel like that’s one of the reasons why this year I’ve been the most consistent that I’ve been in competition.”

Other athletes might be practicing mindfulness without knowing that’s what they’re doing—they just experience the flow state that comes with focused attention.

But what’s clear is that the very mindful way these athletes approach their craft can be seen in their actions. Here are 4 lessons in mindfulness we can learn from the Olympians:

  1. Focused Attention is a Skill

    A main component of mindfulness is that it helps cultivate awareness by paying attention, on purpose, and in the present moment.

    If left to its own devices, our human mind habitually wanders away from the present moment. When we’re not in the here and now, we dwell in the past, grasping and replaying it, or we project into the future, trying to anticipate the unknown (and often catastrophizing).These habitual thought patterns don’t serve our ultimate well-being. This kind of thinking is unhelpful for an athlete who can’t stop thinking about their last failed performance, or one who can’t stop obsessing over what this performance will mean going forward.Have you ever heard a sports announcer say that an athlete must have “been in his head” too much – which caused them to make a simple mistake, but one that cost them the game or race? When we are too focused on what we need to do to win, we lose ourselves in that thought and forget to remain in the moment.

    This year, Wilhem Belocian of France, bolted a split second before competitors. The false-start alarm rang out, and the 21-year-old’s hopes of winning a medal in Brazil were over. It was heartbreaking to watch as he collapsed to the ground and punched the pavement before laying on his back with his hands over his face, clearly in agony.

    Present moment awareness, honed, is true gift. Equally important is allowing ourselves to grieve, and then forgive ourselves, and move on

  2. Compassion is Essential

    Mindfulness is more than sitting on a cushion, eyes closed, back aligned, thumbs grazing forefingers, hands resting on thighs. No doubt, this is a feasible and efficient way to cultivate mindfulness, but it’s not the only way.The essence of mindfulness practice is learning to live with more integrity, by nurturing the power to choose our response in any given situation. We begin to live mindfully when we start to cultivate a way of being that embodies mindfulness-based principles like gratitude, loving-kindness, and compassion.

    When we are too focused on what we need to do to win, we lose ourselves in that thought and forget to remain in the moment.

    For an Olympic athlete, this kind of mindfulness practice is perhaps most reflected in the ability to engage in “good sportsmanship.”A prime example of this is reflected in the actions of Abbey D’Agostino, a Team USA 5,000-meter runner, and Nikki Hamblin of New Zealand. They both collided during a run, fell, and subsequently chose to spend the rest of the race encouraging one another, despite the fact that this had the potential to snuff out either’s chance to qualify for the next run. If someone who has trained and competed for years for this spot can forgive and help out their competition, surely we can see the bigger picture in our own lives as well.

  3. Stress is Manageable

    Stress-reduction has been noted as a useful byproduct of the practice of mindfulness.

    But an appropriate amount of stress is actually adaptive. For athletes especially, the stress-response (also knows as “fight or flight”) elicits an acute surge of adrenaline, and stimulates an increase of blood pumping to the limbs, which helps them as they race towards the finish line. While this mental pressure to beat out the competition is often crucial to success, sometimes the physiological stress response never turns off, and for many of us, stress begins to take the form of negative and unhelpful thinking styles that are often paralyzing.That’s where mindfulness comes in.

    A foundational element of mindfulness entails focusing on the sensation of the breath. Engaging the breath provides an opportunity to help lower your heart rate. Diaphragmatic breathing, or “belly breathing,” utilizes the diaphragm, and allows for a fuller, slower, and more rhythmical breath. This is a technique used to reduce stress by breaking shallow patterns of breathing that use the abdomen and the chest. It works, because the breath is intimately connected to the autonomic nervous system and the mind

  4. Autopilot is Detrimental to Your Health

    The practice of cultivating our attention to the present moment also prevents us from living on autopilot. When we live on autopilot we often fail to notice our automatic thoughts, our innermost feelings, and the subtle physical messages that our bodies send us.For an athlete, who is constantly putting their body through high-intensity training, it can be easy to let minor sensations slide, as the adrenaline itself drowns out some experience of acute pain. Mindfulness particularly allows an athlete to cultivate an acute awareness of their body, to know when and how to take care of it; when it needs a break, when it’s okay to push harder, when it needs to refuel, and when it needs a longer respite to heal.

    When we live on autopilot we often fail to notice our automatic thoughts, our innermost feelings, and the subtle physical messages that our bodies send us.

    To use Abbey D’Agostino as an amazing example again, after tearing ligaments in her knee, she understood that her season was over. But her message that it is more important to honor where her body is at, than to put it through activity that might exacerbate her injury beyond repair, prevailed nonetheless, and to many, she is still an Olympic winner—the true embodiment of what it means to be an athlete on the world stage.

    Sometimes life takes us out of the race that we are in, out of the path we saw ourselves on, but at the same time, this change allows us instead to succeed in things we never imagined.

Go For the Gold

We all have our own golden pursuits. And we all have our own hurdles in life to jump, targets to aim for, and sand traps to avoid. But the real gold medal is a life of thriving, cultivated by paying attention to fully living and enjoying every moment. It really isn’t the destination that matters, but the journey that we take to get there.

How will you take these Olympic gold messages with you as you reach for your life goals?

Repost: How the Brain Can Change Your Experience of Pain

Repost: How the Brain Can Change Your Experience of Pain

This blog post originally appeared on Mindful.Org

painbrain

 

Imagine being poked by a thermal probe that heats a small area of your skin to 120.2 degrees Fahrenheit. Ouch.

Now imagine trying mindfulness meditation, and having that probe touch your skin again. Painful, you’d think. Not as much.

Researchers at the Wake Forest Baptist Medical Center found that the brains of meditators respond differently to pain—a huge finding, given the continued skepticism regarding the benefits of mindfulness meditation as an effective treatment for pain with unique mechanisms above and beyond providing a placebo effect.

The research is even more poignant given that pain is one of the most pervasive, debilitating, and expensive health problems faced by approximately 100 million Americans. Until recently, the go-to treatment has been opioid medications, which have a high side-effect profile, and are highly addictive. More and more, doctors and patients alike are looking toward non-pharmacological ways to supplement current treatment options to help reduce pain and the toll it takes on quality of life.

Mindfulness as a Treatment for Pain

As mindfulness meditation is being introduced into the mainstream to help combat pain, many questions are surfacing about whether it really helps, and the exact mechanisms by which it might provide some benefit.

Jon Kabat-Zinn, the pioneer who brought mindfulness to the West as a possible psychological intervention, was the first to study the connection between mindfulness meditation and pain. In his 1985 study, 90 chronic pain patients were trained in Mindfulness-Based Stress Reduction (MBSR). Results indicated statistically significant reductions in measures of present-moment pain, negative body image, inhibition of activity by pain, mood disturbance, and psychological symptomatology, including anxiety and depression. Additionally, pain-related drug utilization was reduced. Since that study, there have been many more with similar findings.

The mechanisms behind how mindfulness reduces pain proposed in these studies continue to include mindfulness meditation’s ability to provide pain relief by cultivating the ability to parse between the objective sensory dimension of pain, and the more subjective judgement that we attach to the pain that constructs the way we experience it.

Pain is a complex phenomenon, mainly due to it being a multi-dimensional and subjective experience that consists of sensory, affective, and cognitive elements. Meaning, when we first experience a sensation of pain, we begin to judge it as bad and as something we want to immediately eradicate. Then, we start to conspire ways to escape the pain, to find any solution we can come up with, all the while continuing to judge our pain as negative. The subjective judgement we add inflates the pain, making the experience of it far more noxious than the sensory experience alone.

Mindfulness meditation can be used as a tool to create more awareness of the sensation of pain itself, without the judgment or resistance, and the affective and cognitive evaluation that we often project upon it. When we impose a litany of negativity upon our pain, it only becomes worse, and potentially elicits other difficulties including depression and anxiety.When we become more aware of what we are actually experiencing, without the overlay of our judgment, the overall perception of pain is reduced.

Kabat-Zinn articulated this well in The Mindful Solution to PainHe writes, “From the perspective of mindfulness, nothing needs fixing. Nothing needs to be forced to stop, or change, or go away.” Kabat-Zinn is making the case for awareness of a sensation, without the overlay of our thoughts, in order to elicit healing. He goes on to say “…It is only awareness itself that can balance out all of our various inflammations of thought and the emotional agitations and distortions that accompany the frequent storms that blow through the mind, especially in the face of a chronic pain condition.”

While focusing on the sensory experience of pain could sound counterproductive, it actually provides a pathway to pain relief that is different than the traditional pharmacologic interventions that aim to quell the sensation of pain immediately.

Mindfulness Meditation and Possible Mechanisms of Pain Relief

With the advent of modern imaging techniques such as the functional magnetic resonance imaging (fMRI), neuroscientists are finding changes in the brain that are in sync with Kabat-Zinn’s proposed mechanisms.

  • The brains of meditators respond differently to pain: Grant et al. (2011) used functional and structural MRI to ascertain the brain mechanisms involved in mindfulness-related pain reduction. They found that during pain, meditators (albeit in a non-meditative state while being studied) had increased activation in areas associated with processing the actual sensory experience of pain (including primary and secondary somatosensory areas, insula, thalamus, and mid-cingulate cortex). They also found decreased activity in regions involved in emotion, memory, and appraisal (including medial pre-frontal cortex (mPFC), orbital frontal cortex (OFC), amygdala, caudate, and hippocampus).
  • Activation of different neural pathway than a placebo: Zeidan et al.’s most recent (2015) study found mostly consistent results and went a step further and accomplished the feat of proving that mindfulness meditation has a different neural pathway than, and reduces pain intensity above and beyond, placebo. In this study, relative to other comparison groups, mindfulness meditation was associated with decreased activity in the brain area called the thalamus. This possibly reflects the inability of sensory information from reaching areas of the brain associated with thinking and evaluation.

 

Despite the increased elucidation of neural mechanism related to mindfulness-related pain reduction, and its viability as an additional tool doctor’s can “prescribe,” questions still remain. There are many conflicting studies that seem to indicate that mechanisms may vary based on a meditator’s expertise level, as well as a meditator’s engagement in Focused Attention (FA) vs. Receptive Attention (RA) also called Open Monitoring. Findings also differ by stimulus type (heat vs. laser), and diverse experimental directives. Additionally, more research is needed to parse between mindfulness’s ability to reduce both acute and chronic pain.

While mindfulness meditation is not the end all be all panacea for pain, there is enough evidence to indicate that mindfulness practice does in fact lead to reductions in pain intensity and unpleasantness, even more so than placebo. The proof is even in the brain circuitry.  In this way, it can be a safe addition to treatment options that have heretofore mostly included highly addictive opioids.

Mindfulness Practice for Pain Relief: The Body Scan Meditation

So how can we put this theory and research into actionable guidance for our own lives? One of the most effective mindfulness practices with regards to pain reduction is the body scan technique, which provides us with the ability to identify physical discomfort in different parts of the body.

The body scan can allow us to use our bodies to experience present-centered, non-judgmental awareness. We can learn to be aware of whatever sensation arises in our bodies, particularly the painful ones, and then we learn to notice the difference between the direct experience of these sensations and the indirect perceptions that we add on to that experience.

The body scan allows us to non-judgmentally identify what we are feeling and where we are feeling it as we narrow our focus on each detailed part of our body. Yet, we also begin to train our minds to broaden our focus away from the intricate body parts to a broader and more spacious awareness of the body as it exists as a whole, with different co-existing parts and sensations. A greater understanding of what our body endures allows us the opportunity to see what it feels, accept it, and cultivate compassion for it, without immediately judging it or trying to escape it.

I invite you to take the time to try a guided body scan meditation. In this practice, I guide you through an 18-minute body scan. It is my hope that together we can work toward a more mindful approach to pain relief.

Repost: Debunking Fibromyalgia as Just in Your Head. The Real Truth.

Repost: Debunking Fibromyalgia as Just in Your Head. The Real Truth.

This blog post originally appeared on Further Food.

Fibromyalgia consists of a complex array of symptoms, which include widespread muscle and joint pain along with overwhelming fatigue.  It is often a diagnosis with higher prevalence rates in women and has been described as one of the “most controversial conditions in the history of medicine.” To many medical critics, fibromyalgia is one of several “somatic syndromes” driven by sensationalized media coverage, self-interest, and litigation. For these critics, chronic pain syndromes are believed to reside in the minds of the sufferers.

A variety of social and medical critics view chronic pain as a post-modern illness sharing a lineage with nineteenth-century pseudo-maladies like hysteria. These illnesses, they contend, originate in vulnerable human psyches. Central to these suspicions is the seemingly unshakable belief that chronic pain is a psychosomatic disorder, with the implication that the sufferer’s pain is not medically “real.”

Psychosomatic explanations ultimately reduce chronic pain to mental factors, the consequences of which are significant.

One consequence is that psychosomatic pain is inevitably devalued and the credibility of its sufferers is questioned. Another consequence is that accepted treatments for “physical” pain, like analgesics, may be discouraged even when they may be necessary. Often, being invalidated triggers depression and anxiety, which increases the burden of the disease, adds to the pain, and results in more stigmatization.

A lot is at stake, then, if chronic pain is conceived as psychogenic.

When it comes to fibromyalgia, there is a lot that Western Medicine continues to ignore. There is still no certain cause or recognized treatment that works for everyone.  Many things, however, have become, at least anecdotally speaking, crystal clear:

1. People who suffer with symptoms can find relief by making certain lifestyle choices.

2. The expression and manifestation of Fibromyalgia is diverse and what works for one person might not work for another.

3. Fibromyalgia symptoms can have a significant impact on your life—your work, relationships with family members and friends, and your overall outlook.

4. A combination of treatment modalities is very beneficial.

Many people who suffer with fibromyalgia turn to their diets when making lifestyle choices that will offer relief and improve their overall functioning.  The fibromyalgia-diet connection has in part emerged from the idea that people with fibromyalgia have mitochondria dysfunction, and therefore they need to increase levels of certain nutrients in order to produce enough energy.

While research hasn’t indicated specific foods that all fibromyalgia patients should add or avoid, there is a lot of anecdotal evidence that supports eliminating and adding certain nutrients to the diet for relief.  For example, caffeine and highly processed foods are often linked to exacerbation of fibromyalgia symptoms. The relief that comes through this kind of mindful eating is buttressed by other healthy lifestyle choices, such as adding an exercise regimen to your day, getting enough sleep, and reaching out to a mental health professional.

Since fibromyalgia is so diverse in its symptom presentation, what works for one person might not work for you. There will most likely be trials and errors as one finds relief, and a multi-disciplinary and holistic approach will likely work best. This might include dietary changes, psychological support, and perhaps medications and/or herbal supplements.

Whatever your journey entails, I know and trust it is worth the hope of a healthier and happier life.  You can and will come to thrive, one step at a time!