Wednesday, October 3, 2007

Pain For Dummies - Part IV

Metacognition - the coolest feature you have and didn't know about.

Let's face it - changing one's habits isn't easy.
Just watch smokers who unsuccessfully try to give it up.
Our brains are prediction machines - they use experience and other stored information (motor patterns) to get us through the day.
That's why we are able to identify people by the sound alone that they make when they walk - because they always walk that way (the same motor pattern is used over and over again).

Using established motor patterns and habits makes sense because it doesn't require any attention and is therefore a very efficient process - as long as things go according to plan.

It is also very quick - so that you are able to regain your balance very quickly after you slip. If you had to do something like that consciously you would start sending signals to your muscles only after you were already lying on the floor. It's incredible to see just how slow our brains get when the cognitive demand is even just upped a little: see these kind of tests/games for example.

The message is this: learning/re-learning requires time and a non-threatening/not-distracting environment. If you want to learn something new your brain has to be convinced not to use the fast and efficient old pattern - but the slow, inefficient new one.

Try this simple little experiment at home: brush your teeth with your other hand tonight. Sounds simple enough - right?
After you've done this think about people who have to learn to walk again after a stroke and maybe you'll be able to understand what they have to achieve.
I'd rather climb Mt. Everest than ever having to do that!

This far we have only talked about motor patterns - but what about habits?
Well - it's all just electric signals - so we can treat them the same - the brain does so too.

Thoughts - those that are automatic - are the same as motor patterns. They just aren't visible to an outsider. They are also stereotypical - based on experiences and memories. If you express them outwardly they are mostly called "prejudice".

Think about it: our brains form categories for everything around us - they have to in order to be fast enough. When you look at a picture like this your brain doesn't really "look" at it but simply calls up the appropriate categories (toys, Playmobil, bath, ...) and constructs the visual experience you have.
And it has no problem making huge mistakes doing this. That's why 99% of people fail to notice that the Playmobil figure has a frowny face!

And that's why we are prejudiced: experiences we have with only one person with a "special" characteristic are applied to the whole category that person belongs to!
"All Men are the same" is just one of those things we say and hear all the time.
But the same goes for skin colors, professions, weight, height - every observable difference to oneself really.

Where does chronic pain fit into all this?
Pain is in your brain - it has to be. And we know from research that people who suffer from chronic pain react automatically with a stress response when they just read words that are associated with pain! This alone can lead to an increase in their pain!
Do they know this - are they aware of it? No.
It's an automated learned response that is outside of conscious awareness.

But - and this is where the cool feature of Metacognition comes in - you can learn to become aware of this automatic reaction if you choose too.

Metacognition means "thinking about thinking" and is the same as watching yourself walk in front of a mirror. You observe an automated motor pattern/habit - thereby creating feedback that you can use to change the pattern.

Let's say you don't like dogs - your automatic thought is something like "He is jumping up and down because he is going to bite me in the leg."
Changing this reaction requires you to become aware of it - just "stand back" and watch what your brain and your body does when you see a dog. Heart rate? Pulse? Breathing? Muscle tension?, ... - just observe these reactions.

That's the first step you have to master: you have to notice all those little things - especially the rise in muscle tension in stressful situations. You have to become aware of the position of your shoulders in order to be able to change it later on.

And just to give you a rough idea of how long this first step takes: it'll be well into 2008 - still 3 months away at this point - before you are any good at it. Think weeks and months instead of days. That's why "old habits die hard".

The good point is that even a little experience is better than nothing and you can start improving the situation right away.

The second step is to actively stop the automated reaction. As soon as you start thinking "He is going to bite me!" - interfere.
Rationally observe the situation, look at the real facts - not the ones your brain is pumping out - and act on it. The best way to do this is to find someone who has a dog and explains their body language to you. Interact with one (a friendly one of course) and simply get to know them.
I did this myself a few years ago and am no longer afraid of them because I can tell from the way they move that they are mostly just curious about who you are and want some attention.

Again - when it comes to chronic pain - stop those automatic reactions.
Since the stress response is the easiest to feel and observe it's a good starting point - that's why relaxation techniques often bring fast relief. Like taking a bath:


The other things like thinking "This is going to hurt" when you perform a movement are a little harder to change - but it's not impossible.
Take your time doing them, don't do too much at once (pacing) and gradually expose yourself more and more in order to adapt. Sleep on it in order to establish new patterns.

By the way: in Psychology this form of therapy is called Cognitive behavioral therapy - and it is extremely effective.

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