Ep. 3: David Hanscom, MD – A Holistic Approach to Dealing with Pain and Anxiety

0:00 – excerpt from the episode
0:47 – intro (listen to discover a little more about your host. Martin will tell you a new lesser-known fact about Dr. Maya)

01:23
Dr. Maya Novak:
There's another amazing conversation in front of us. Today I'm joined by Dr. David Hanscom who is an orthopedic spine surgeon whose practice focused on patients with failed back surgeries. He retired from his practice in 2019 to focus on teaching people how to break loose from the grip of chronic mental and physical pain – with and without surgery. His approach to treating chronic pain is based on his personal experience with it, learning about medical practices you can apply yourself, and connecting to your own capacity to heal. He's the author of two books - Back in Control and Do You Really Need Spine Surgery?
David, thank you for joining me…

02:07
Dr. David Hanscom:
Yeah, thank you. I'm excited to be here.

02:09
Dr. Maya Novak:
Well I'm really excited about today's conversation because I know that not only you have theoretical knowledge but you also have a lot of personal experience, especially when it comes to pain. And this is what makes things interesting and this is also why I know that people will get a lot out of this episode. So let's talk slightly about your retirement and why did you decide to leave your practice in 2019. What was the main reason?

02:41
Dr. David Hanscom:
So through my own personal experience I learned tools based on neuroscience. Basically the basic research of how to solve chronic pain and it did not require surgery. The surgery was needed – great - we did it, but most of the time probably 80% of spine surgery should not be done. So I was a complex spine surgeon I took care of the worst of the worst cases, people had multiple surgeries before they got to me, and then it became increasingly apparent over my 30 year career that spines were being more and more surgerized, more damaged, horrendous problems. Like people with 5 and 10 operations pretty commonly. My record was 1 gentleman with 29 surgeries in 20 years. I had another woman who had 10 surgeries in 10 years, another person 15 surgeries in 18 months and what happens is that the downside of a failed spine trigger is a nightmare. And I could do surgery to correct some of the problems but I couldn't get people anywhere back to where they could be if they had never had surgery. Then when I would look at the original scans there were surgeries done on normally aging spines. So what's happening when you do spine surgery, especially a spine fusion, you're actively damaging the spine. So I was seeing… then at the same time I developed this process called the Direct Your Own Care Journey. The DOC Journey evolved over my long experience with myself and my patients. So using those tools, and we'll talk about that later how to get out of pain, I was watching hundreds and hundreds of patients go to pain free. I mean pain free and there is no risk, minimal resources required, and at the same time, I've seen 3 to 5, sometimes 6 patients a week having really terrible things done to their spines, and the downside of a failed spine surgery is a destroyed life many times. So what people do not uncomprehend when you're the patient you trust your surgeon. They're going to do the right thing. But. The downside of a failed surgery is just catastrophic. A big good share of the time it destroys people's lives. So let me ask you a question if you can be with back pain for like 2 years, you're very frustrated, you feel trapped, you just want to have something done, and in your mind why surgeons tell them a sort of the definitive answer. And so “Look I'll do a lumbar fusion on you for your back pain which is the standard of care.” What percent success would you want to undergo that surgery?

05:15
Dr. Maya Novak:
Yeah, probably a 100%, right?

05:19
Dr. David Hanscom:
Right. What if it was 80%?

05:23
Dr. Maya Novak:
Yeah, well not the best but potentially I can imagine that some people would take 80% over potentially 0%.

05:33
Dr. David Hanscom:
What about 50%?

05:35
Dr. Maya Novak:
Uh! That’s a tough one.

05:37
Dr. David Hanscom:
The actual success rate is 22%. So here's the problem. It's been very well documented in this fine literature that disc degeneration is a normal finding. So rupture disc, herniated disc, bulging disc, bone spurs, arthritis are all considered normally aging processes. So we call it degenerative disease in a much more accurate term would be a normal aging spine. The reason why it's so critical is that disc degeneration in all its forms has never been shown to be a cause of chronic pain. Period. So these are normal aging spines. So your spin is stiffer but just because a disc loses water content and isn't as flexible does not mean a source of pain and it is not. So it's so well documented that on every radiology report now the radiologists have a phrase we put on there that these findings are consistent with a painless spine. So if you're taking a 100 people off the street who have never had back pain by time we hit 65 years old one 100% of people have disc degeneration and when you're 30 years old maybe 25% of people have disk degeneration. But these people have no pain. So here we're doing an operation on a normally aging spine. It's a pretty big operation where you're actually stabilizing the spine, you're welding together, you're creating scar tissue. Then what happens is spine starts breaking down above and below the fuses because you have a stress point. And so the disc above and below often breaks down and that's where I come in as a salvage surgeon. And so you start climbing the spine. So the person that had 29 surgeries in 20 years started with a 1 level discectomy, then he had ongoing back pain, which by the way is not a result of the discectomy, so we had a 1 level fusion, then 2 levels, then 3 levels, then you get infected. So he eventually ended up being fused all the way from his neck to his pelvis. So. It's just surgery after surgery after surgery and it's become normalized. I mean these young fellows that come out see this all the time like part of their practice. So what I didn't realize is that the data came out in 1993, after about 8 years in practice, I thought the success rate was 90%. I was enthusiastic I was a zealot and one of the few surgeons who's truly been at both sides of this fence. So I was a guy who was doing the fusions I was excited about it, we had new technology, and I looked at my data and I had about a 45% success rate going “Huh.” Then the data came out from the state of Washington that's that the success rate 2 years after a spine fusion and for back pain was 22%. So I just stopped.
So I find these… then what happened about 10 years ago the spinal deformity surgeons got into the game and they started assuming that scoliosis was a cause of back pain. There's no data. And so what's happening now which is really a catastrophe for many, many people is that people have a relatively minimal curvature of their spine or even a large curvature. It's never been documented to be a source of pain. Ever. So now we're doing 1 and 2 level fusions that don't work. We're doing 8 10 12 14 level fusions that don't work. The complication rate of a major spinal fusion is devastating, blood loss, infections, all sorts of stuff happen. So now you have a stiff rot in your back, you can't twist or turn, you have a harder time bending, and it doesn't work. The pain is still there. So now doing even bigger operations that don't work. So I hit the threshold in 2018 where I walked into the room of a patient who was paralyzed by surgery. 32 years old and I was making rounds and I looked at the computer with my fellow - the guy didn't need surgery at all. So he's 32 years old now paralyzed. And that was sort of my tipping point and I just said “Enough! I'm just not going to do this anymore”. So that's when I stopped. I quit my practice pretty much to do this. I'm not really retired - I quit. It was frustrating because I really loved spine surgery, I had a great team with many many people getting better, mostly without surgery.

Then the final part of this chapter is that I started doing what's called Prehab where we just followed the data, we work on people’s sleep, their stress, the medication, their diet… Just all the things that the literature says for us to do before any elective surgery. And 2/3 of my patients that needed surgery, these were structural problems with matching symptoms, cancel the surgery because the pain disappears. I had over 120 patients with severe spinal stenosis, that's those are pinched nerves in the lower back, they had leg pain, they would have done well with surgery. But they came in for their final visit and the pain was gone. So I essentially in a way put myself out of business.

10:52
Dr. Maya Novak:
Which is a good thing if you put yourself out of the business. You know, and the price is that you’re really helping people. Right?

11:03
Dr. David Hanscom:
Yeah, I was excited about it. I mean in this pace structure it was very awkward financially to deal with this but yeah to watch people get better without any risk, no risk, and minimal resources is mostly a self-directed process by definition. And the number 1 factor that determines whether people get better not is simply their willingness to engage. If people don't want to learn to take care of their own spines, own back, own pain, there's nothing I can do. However, the number 1 factor that predicts prognosis for getting better and my chief of the pain service taught this to me is simply willingness to engage.

11:42
Dr. Maya Novak:
Yes, and taking actually control over your own healing and taking responsibility. So not looking outside for a magic pill or “I'm gonna…” you know “They're gonna do this surgery and then I'm going to be perfect again.”

11:58
Dr. David Hanscom:
Right. Right.

11:59
Dr. Maya Novak:
So your personal story in regards to chronic pain. Can you talk a bit about this?

12:08
Dr. David Hanscom:
So I was a major spine surgeon and in 1990 I was driving across a five twenty bridge in Seattle I'd been in a practice for about 5 years and I had a panic attack, and I'm going “What is this?” So becoming a major spine surgeon means you have to be really tough and I was. The nickname I had for myself was the Prick which is actually not a very complimentary term in retrospect but I was really tough. So I my attitude to towards stress in general was “Bring it on, bring it on. I can take it” and so I did. So I was under incredible moment of stress and I kept just doing my thing thought it was I really had a badge of honor of taking on an infinite amount of stress. I did not know what anxiety actually was. And the reason why in retrospect I did not know what that was because I was so good at suppressing everything that I just honestly didn't experience that sensation. Then turns out I was a pretty angry guy in the form of perfectionism which is a different topic and I didn't recognize that either. So in general I had a very very fired up nervous system. So I went from no anxiety to a panic attack. So I thought anxiety was psychological and what I didn't realize and I now know from the neuroscience that anxiety actually is the pain. So simply a physiological state and what a panic attack is your body just explodes with stress hormones: adrenaline, cortisol, inflammatory cytokines, your heart races, you can't breathe, you feel like you're gonna pass out. So that's actually a physiological process. And when I say physiology I mean it’s how the body functions.
And so what happens is that I went to psychotherapy for 13 solid years which is a lot of psychotherapy and my symptoms getting worse and worse and worse. So I’m crippled with anxiety to the point I had obsessed a compulsive disorder which is severe, very bad prognosis. I also had 17 different physical and mental symptoms. I had migraine headaches, my ears were ringing, my back hurt, my feet were burning, skin rashes were popping up all over my body, my stomach bothered me. So I had over 17 different physical and mental symptoms including anxiety, major depression, OCD, and nobody could tell me what was going on. And so I was pretty serious about getting better, I loved my practice, I liked what I was doing and I picked up David Burns’ book one day in 19… don't remember when this was exactly [note: 2001], and there Burns said do this expressive writing. So I didn't know what that meant, I had no idea about the data. So I just simply started to write in a certain technique and I thought it was the book which is a great book and the book is obviously part of it… It turned out that the expressive writing is the 1 thing that started to break up the process. And even now in people that heal expressive writing is that one necessary step that actually starts the process.
And I have not seen people get better without it, just have not seen it. And there's a reason for that. And so within 6 weeks after I started expressive writing I started feeling “Hmmm. This is better.” Remember this is after 15 solid years after trying everything. Then about 6 months later due to personal circumstances I had to come face to face with my anger issues. I remember I was cold. I thought I was just fine, I was a cool spine surgeon, nothing fazed me. So my self-image was that of not being angry, of actually being cool, calm, collected. Reality was I was angry as anybody in this planet and I was suppressing it. It turned out the suppressed anxiety and anger actually physically damage your brain. So it turns out repressed thoughts and emotions are actually more of a problem than express thoughts and emotions. And the genealogy of anger is a circumstance that you blame and then you're victim and then you're angry. So the circumstance could be real or perceived, it could be just in your head, it could be for real. The brain doesn't know that. So the most deadly form of anger which again I now recognize is that I thought perfectionism was a virtue. Now, I’m a spine surgeon, I had to be perfect, perfect, perfect, and the problem is that you're never perfect. So you're always… so everything is less than perfect. So you're blaming yourself and the situation for less than perfect. Then you're victim on less than perfect and then you're always frustrated or angry. So what I thought was a virtue that quote took me to the top of the heap which it did I went to a major spine fellowship I was successful but I was sick. So what's success by the way? That's a different conversation but that perfectionism drove me to the top but it shook me right down the other side. And it's probably the biggest factor for a physician burnout right now is the self-critical voice, the perfectionism because you're always a victim, you're always frustrated, and it drives you but it also makes you sick.
So it turns out that actually you don't need to be a perfectionist to be successful. In fact, it takes away energy you need to actually be successful, and it took me a very long time to hear that or learn that but within 6 weeks after it came across this anger process and just confronted it, dealt with it, very poorly back then… and I might say very poorly, very awkwardly… within 6 weeks all my symptoms disappeared. All of them. And that was almost 20 years ago. And so I don't have OCD, I don't have depression, I don't have anxiety, the skin rashes are gone, I haven't had a migraine for at least 15 years, my ears don't ring and over 50 million people in the United States have ringing in their ears – it’s called tinnitus. It's gone. I had it for 25 years. It's gone and I was absolutely shocked. Never expected that ever. So it turns out that the problem of the anxiety is actually a physiological state, it is not psychological. It's your survival reaction called fight or flight. So you're threatened by anything mental or physical - your body goes into fight or flight. So what happens when you're in fight or flight, as you know, you have adrenaline, cortisol, inflammatory cytokine, histamines... All these things are in play to keep your body fired up including a nervous system. And so it turns out when your body's in a constant agitated state every organ responds in its own way. That's why there's so many different symptoms and so as you calm down the body's chemistry or the physiology symptoms disappear. (17:36) So I have seen hundreds and hundreds of patients improve, and again the sequence that evolved came out of my own 15 year struggle out of pain. And I tried everything. Obviously most things didn't work but I started gravitating toward that did work, and that's how what I call The DOC Journey evolved was with my successes, my patient successes, I had no agenda, I still don't, even last week things changed again. So the bottom line is I'm just following the science, following the literature, I'm doing what the literature says to do about calming people down, getting them to sleep, getting them to exercises, and it works. So everything I'm presenting is not new news. Everything is in the literature but I never always presented to me in a way I could apply to myself to prevent the problem in the first place. I'm still not that happy, I'm very grateful that I learned a lot to help other people. I'm still not that happy about losing 15 years of my life. Literally cost me marriage, cost me a practice, I mean it was a disaster.

19:58
Dr. Maya Novak:
Well, David, I know that so many people can relate to this. First of all, if I go back to… and thank you for sharing your story, in regards to how emotions… what kind of role they play in how the body reacts. Because how we were brought up, you know, when something happens or when you're in pain you go to the doctor and then they are going to tell you what to do. But the conventional medical approach doesn't have all… it doesn't cover all the things that it would need to cover for the person to really get free from pain, from anxiety, from whatever is happening. So I know that many people can really connect with your story right now and when you were talking about being perfectionist... I can relate to that part as well. I am I would say recovered perfectionist even though I'm not going to say that I don't care anymore. But I know what was happening in the past and I can so agree with you that emotions play such an important part when it comes to healing the body and we do need to talk more about this.

21:17
Dr. David Hanscom:
So under present model that I call it dynamic healing. And so what happens that every living creature has the same process. So you have the planet Earth that all its situations and circumstances. So every living creature has to assess the environment that it's in and take appropriate action to survive. And if they don't take appropriate action, of course, they don't survive. So what happens you have the circumstances or stresses or the threats - that's the input. Then you have the nervous system itself that's processing all the sensory input. Then you have the output which is the body's neurochemical state or what we call physiology. So the body's physiology can exist in safety which is rest or relaxation. Anti-inflammatory proteins called cytokines, dopamine, serotonin, growth hormone… all these great chemicals in your body when you're in safety. Then in fight or flight like we mentioned before you have stress chemistry. The essence of every chronic disease, all of them - mental and physical - is sustained exposure to threat chemistry or threat physiology.

22:24
Dr. Maya Novak:
Yes.

22:25
Dr. David Hanscom:
So it's like driving your car on the freeway in second gear, it’s high revolutions, it's revved up, it’s going to break down. So sustained fight or flight is what breaks the body down and again it’s physiological. And the family practice doctors came up with a term in 2002 called MUS - called medically unexplained symptoms and what they're saying people is that “We know you're in pain. We know you have this, this, and this. We don't know the exact cause. We know you're suffering. Have a good life. We’ll do the best we can do.” It could not be farther from the truth. We look in terms of fight or flight and body’s chemistry is completely explained, absolutely explained. Each organ system has its own function, its own response. That's why it's so many different physical or mental symptoms but it turns out that anxiety, depression, OCD, bipolar, and schizophrenia are actually all inflammatory disorders. I mean half the brain is the immune system that has glial cells with inflammatory receptors, cytokine receptors. So the brain's part of the immune system. So then we find out that Alzheimer's, Parkinson's, cardiac disease, peripheral vascular disease, diabetes, obesity, osteoporosis, cancer, auto immune disorders are all inflammatory disorders. It's all the same process. So again, if the problem with all chronic disease, including chronic pain, by the way including long Covid, the sustained exposure to fight or flight then the way you solve the problem is that you minimize your time in fight or flight, and you maximize your time in safety. So what you're doing when you're in safety your body regenerates. You build up proteins, you put away fat stores, your whole body rests – we call it rest and digest. So what you're doing you're allowing your body to heal itself. So there's a bunch of ways of doing that. So I call it dynamic healing. You have the input or your stresses, you have your nervous system, and then you have the output. So the final part of this equation which is huge for humans; what we have that other animals don't is language. So I think that language and consciousness is the essence of chronic disease. The reason for that is that we know that mental pain is processed in similar circuits as physical pain - shares the same circuits, have the same physiological response, and the problem with unpleasant repetitive thoughts – it’s the term - is that you cannot escape them.

25:03
Dr. Maya Novak:
Yes.

25:04
Dr. David Hanscom:
So we're trapped by our thoughts. So we don't lack our thoughts to be unpleasant. Emotional pain is as unpleasant as physical pain. And so we suppress them. Well, when you suppress them it actually causes the hippocampus of the brain to shrink; the memory center plus all sorts of other things happen. So whether you experience the thoughts or you repress them is the same problem. So every human being has this problem to some degree.

25:31
Dr. Maya Novak:
May I just interrupt you slightly because what you are talking about now is very important and this is something that I named this as a toxic positivity. Because for a decade or so there’s been so much “Oh you have to be happy. You have to be always in a good state.” So a lot of times what can happen is that we push aside unpleasant thoughts or unpleasant emotions and we are just playing as everything is perfect, but that doesn't mean that the body, you know, doesn't keep the score, sort of say. So we cannot be in this toxic positivity and just behave as everything is perfect and if we behave as everything is perfect then everything it’s going to be great, right?

26:22
Dr. David Hanscom:
Right. I hadn't heard that term but I totally agree with that. It’s that I think positive thinking is a disaster. It really is a way of suppressing negative thinking, it's a disaster. So I like that term toxic positivity.
So turned out thoughts, negative thoughts, unpleasant thoughts, disturbing thoughts are sensory input that you cannot escape from. Then it goes into your nervous system which is either calm or hyperactive, then it comes out as threat physiology. So the problem is with, again with thought you can't escape from them, so you're in fight or flight a good share of the time. And so what you do is called dynamic healing. You have the input the nervous system and the output. So the physiology are your emotions, that's what you feel. So thoughts are input, your emotions are what you feel, it’s your physiology at least that's my particular breakdown of it. And so when you suppress these unpleasant thought you really fire up your physiology. So it's a whole different topic about obsessive thought patterns that we might talk about on a different podcast but it's a big deal. So there's a connection in the brain between your thinking centers called the neortex and the lower part of the brain called the limbic system the survival brain that Dr. Apkarian of Chicago showed that when that connection exists on functional or research and MRI scans that if a person has a new injury that they will have chronic pain 80% of the time. So that connection predicts the future physical pain. So my contention is “Why is that there?” So I think it's human consciousness. And what makes it worse is that these thoughts and concepts become embedded in our nervous system the same as a book or car or curtains, it’s a concrete set of things in your brain that become your version of reality. So then we start taking our life is determined by our concepts and thoughts, we take our behaviors and our life’s run on our concepts and thoughts. And a lot of them are distorted which is a big problem and end up with fight or flight most of the time. So again, every chronic disease and we could go through the list one by one has the same source. It's the same problem of sustained levels of fight or flight. So it turned out that we’re in fight or flight... How do you feel? You feel anxious.

28:50
Dr. Maya Novak:
Mhm.

28:52
Dr. David Hanscom:
So anxiety is just a word that describes your chemical state. And then you know Dr. Stephen Porges who I've worked with about the polyvagal theory is that we're trying to get rid of the word anxiety - just saying activated threat response. It's just a word that describes your chemical state. It is not the cause of pain. It is the pain.

29:11
Dr. Maya Novak:
Yes, and you know, I just want to acknowledge this that when someone is injured, after an accident or if the pain comes out of “nowhere” even though we both know that out of nowhere doesn't exist right?

29:28
Dr. David Hanscom:
Right.

29:28
Dr. Maya Novak:
There is a lot of emotional turmoil happening. So a lot of anxiety, a lot of fear, a lot of doubts, worries, and then people go to the doctor, to the surgeon, and then they tell them worst-case scenarios because you know…

29:46
Dr. David Hanscom:
Um, right.

29:46
Dr. Maya Novak:
“This is what we have to tell you - everything that could go wrong.” So then they are sent back home to wait and hope that everything is going to be okay, and they’re left alone with all these thoughts and everything.

30:00
Dr. David Hanscom::
Um, right, right.

30:00
Dr. Maya Novak:
And, of course, no wonder that the data shows that 80% of people will end up with chronic pain.

30:07
Dr. David Hanscom:
Right. So I want to just tweak the conversation a little bit. So you used the words guilt, shame, fear. So those are thoughts and then what happens… Sorry fear in my mind is another word for anxiety.

30:23
Dr. Maya Novak:
Yes.

30:23
Dr. David Hanscom:
So again, that's just an activated response. So we feel guilty, ashamed etc. That's those rational thoughts. So you have this fired up nervous system and these thoughts start flying out like crazy. So a nervous systems fired up it actually creates more thoughts then the unpleasant thoughts. The unpleasant thoughts fired up the nervous system. You've got a bidirectional problem here. And so that's the problem of the human existence; I call it the curse of consciousness. It’s that you cannot escape your thoughts. So that's the essence of The DOC Journey process – it’s learning how to regulate your body's physiology.
You cannot control your thoughts but you have a lot of say over your physiology. So here's the kicker of the whole process and I learned this from a friend of mine Dr. Bruce Lipton who I knew this but he stated it very very clearly. It’s that anxiety and anger are neurochemical states. They're automatic, they're hardwired, it’s how we survive. They are a million times stronger than your conscious brain. It's a million to one ratio. So my cat has the same reflex, she just doesn't have a word for it. So they're massive hardwired powerful circuits. You cannot deal with them with rational means. You cannot control them. His point being you can't control them, we have no say over them, so you might as well be talking to the hard drive of your computer to try to deal with these things. But they're also a gift. It’s how we stay alive. So if you didn't have anxiety and anger you wouldn't be alive. So they're necessary for survival but they're unpleasant, they're supposed to be unpleasant. They're not responsive to rational means. So how do you decrease anxiety? And the answer is you simply lower your threat physiology. So again, the unconscious brain process processes about 40.000.000 bits of information per second. The conscious brain process is about 40. It's a million to one ratio. So the 2 parts to healing are you become I call it professional at living your life which means you separate your identity from this massive survival reaction. It's not who you are It's what you have. You develop a call working relationship with it and so as you learn the tools and calm down then the anxiety starts to drop. What doesn't work are things like self-esteem because you’re down your rational brain, a million to one ratio, and I think that one of the major issues of human experience if not the major issue is this thing called self-esteem.

32:59
Dr. Maya Novak:
Mhm.

33:00
Dr. David Hanscom:
So you're using these thoughts and self- concepts to deal with these survival circuits. It's a complete mismatch plus when you get into self-esteem it's a judgment pattern. Always judging yourself “It’s better than or worse than” and there's no endpoint to it. So that's where you get this fired up nervous system, your brain becomes inflamed with the repetition, these reactions become memorized and you end up being in a chronically agitated state.

33:29
Dr. Maya Novak:
Yes.

33:30
Dr. David Hanscom:
And there's no escape. So when people say you're losing your mind it's not so funny because when you're… So half your brain's immune system, it has receptors for what's called cytokines, they're inflammatory molecules and half your brains was called glia cells which are the supportive structures of the neurons in the brain. And so when your body's in fight or flight the neuron, those glia cells in the brain become inflamed. Your whole nervous system becomes inflamed, your neurotransmitters go from calming to excitatory. So your nervous system is fired up, the speed of nerve conduct is fired up. We know that fear of pain actually makes the pain worse. Then you go to your doctor that you just pointed out who's not telling you great news which fires you up even more which makes the pain worse. But that's the beauty of this whole process. It’s that once you understand the problem, it is so solvable. It doesn't sound solvable this very second but it's not so hard to solve.

34:32
Dr. Maya Novak:
Yes. Oh, I love this because it's so important that we talk about the mind-body connection and how important it is to… so how to support the body. The conventional medical approach is “Take some pills to reduce the pain and this is how you're supporting the body.” But actually we support the body by doing everything that you are talking about here.

34:55
Dr. David Hanscom:
Um, right.

34:56
Dr. Maya Novak:
So talking about emotions, processing emotions, dealing with unpleasant thoughts and not pushing them aside in regards “Oh, I shouldn't have these thoughts or emotions” but just dealing with them. This is how we support the body. Yes.

35:10
Dr. David Hanscom:
Right. And not suppressing them either.

35:12
Dr. Maya Novak:
Yes, yes.

35:13
Dr. David Hanscom:
So let me go back to your thing about toxic positivity. So the whole healing journey is actually anchored in skepticism and doubt. That makes sense?

35:23
Dr. Maya Novak:
Yes.

35:24
Dr. David Hanscom:
And people look at me and go “What?” Ah okay, so look you've tried everything. Nothing's worked. You've heard David Hanscom, you've heard Maya and they have these ideas that sound good but nothing else has worked. Why would this work? That's what's real. You have to connect with what's real in your body to connect to its capacity to heal. So all we're asking to do is as out generate believe in David Hanscom's process or your process or some book or… it's not about generating belief in anything because it doesn't work. Again it's a million to one mismatch. So it does work is connecting to your own body's capacity to heal which means connecting with what's real. So what's real is doubt, skepticism, and anger, and frustration. So you have to connect to that actually in order to heal and stay there.

36:12
Dr. Maya Novak:
Mhm.

36:13
Dr. David Hanscom:
Because that's life. Your brain's always looking up for danger. That's your baseline state is looking for danger. Your brain's program is to survive. It is not programmed to have a good time. So there's 2 parts to healing one part is learning how to develop a working relationship with these survival reactions anger and anxiety. And so those are over here, you separate your identity from that. Then the other part of healing is as you move your brain into a place that you want to live. What do you want your life to look like? So you have to decide what you want your life to look like and move that direction. So a positive outlook is much different than positive thinking. So what do I want? How do we want to get there? And when you're not fighting anxiety and frustration every second then you have, she has the space in your brain to create what you want. It’s you create this new life, that's enjoyable, fulfilling. That's the healing. That's the true healing. It’s that you're not gonna actually get this life unless you practice it. So one metaphor I use is developing a new language. It’s that you're not going to learn French by trying to fix your English. Same thing with your brain. You're not going to learn what I call an enjoyable life because your default language is survival. So you keep working on these survival reactions which are infinitely deep and powerful. How are we going to fix those?

37:39
Dr. Maya Novak:
So let me ask you about, you know… I so agree with you but I also know that some of people will say now that they are listening, they're going to say “Yeah, but you don't understand my life. I have xyz things. There is so much stress in my life. And kids and family and job and other relationships…” and so on and so on. So “How can I start actually taking care of these since I don't know where to start?” Do you have any advice for those people?

38:11
Dr. David Hanscom:
Yeah I do. That's why I developed what’s called The DOC Journey. We have an app and the course and you can't go from that life to an enjoyable life without a sequence. Other words you have to calm the brain down you have to give yourself some space to learn. You have to just… I recommend people do like 15 minutes a day at the most. And so as I've learned how to play the piano or any musical instrument or any performance of any kind it takes repetition repetition repetition. So remember the stress. That's the most stressful is the stress that you can't control.

38:44
Dr. Maya Novak:
Mmm. Mhm.

38:45
Dr. David Hanscom:
So guess what? Everybody has this problem. This is universal, number one. Second of all, one of my mentors pointed out very clearly that the human brain is not designed to process this much sensor input every day. W evolved in the prairie, the hills, the mountains, nature, we sat around campfires and had rhythm and dance, we had community. So we're in concrete jungles, we're isolated from people. All those are inflammatory. So our human brain… that's why this is so universal that's why I having so much trouble with anxiety at every level especially in teens and people in their 20s. It’s that our brains are not from evolutionary standpoint geared to process data at this rate. So all of us have the same problem. So the sequence is the Dynamic Healing Model. You have the input, the nervous system, and the output. So remember the only goal here isn't to solve all your stresses. You can't do that. Remember the stresses that are most stressful the ones you can't control.

39:44
Dr. Maya Novak:
Mhm.

39:45
Dr. David Hanscom:
So but what you can do is find ways to regulate your body's physiology and you have more energy actually to deal with the problems you have to deal with because life doesn't go away. It keeps coming at you. People want their pain to go away and be done. Well pains are there every day, that's part of life.
You not exist without pain. So what you learn to do I call it becoming a professional at living your life. So let's go through the 3 portals. The first one is the output or the physiology. So when you're feeling stressed and anxious. That's just reflecting your physiology, not psychological. So things like deep breathing, slow breathing actually stimulate what's called the vagus nerve which is highly anti-inflammatory. We know that humming actually stimulates the seventh cranial nerve which stimulates the vagus nerve. People can rub their forehead - stimulates the fifth cranial nerve, which again is close to the tenth cranial nerve which is the biggest nerve. Certain pitches of music like lullabies actually again stimulate the vagus nerve and calm things down. So there's things you can physically do to actually stimulate the anti-inflammatory response that regulates the vagus nerve. The second factor of the nervous system, remember there’s the input, nervous system, and the output. So if you come from an abusive environment your nervous system is hyperactive.

41:05
Dr. Maya Novak:
Mhm.

41:06
Dr. David Hanscom:
So your brain was programmed that a lot things in life are dangerous because they were dangerous when you were a kid or perceived as dangerous. That's your life filter. And many of you know about what what's called the ACE scores - Adverse Childhood Experiences. And that's things like physical, sexual, or emotional abuse, parent in prison, parent on drugs, etc. And just having a high ACE score predicts really bad health, included in shorter lifespan. Why is that? We are programmed about many things in life being dangerous because they were dangerous that filtered as it changed as you become an adult so your nervous system is hyperactive most of the time. So what you do with the nervous system is ways of calming that down. So it's less hyperactive. The metaphor I like to use is that of a feral cat which is hyperactive hyper alert which it has to be compared to a domestic cat which is completely spoiled. So as well as saying is where you can learn how to calm down nervous system. So anti-inflammatory diet makes a big difference, exercise, and sleep is huge. Without sleep people just don't heal. So people say “Well, I'm in chronic pain I can't sleep.” The data shows actually that lack of sleep actually causes chronic pain. Causes it - it's not the other way around. So what happens at nighttime if you're not sleeping… well your brain doesn't clean out the waste products. It doesn't filter things correctly, it doesn't regenerate, doesn't relax.
So sleep is a big deal and so what you're doing is you increase the resiliency of your nervous system and takes more stress to set off fight or flight. So a big factor with the nervous system is trauma therapy. And so some people's trauma, mine was pretty bad, but it's not as bad as some of the stories I hear which are just horror stories beyond words. So you can't fix that. You have to rebuild your brain. You can't rebuild a burn down house with the same timbers. So literally a good trauma therapist will help people reconstruct the nervous system to feel safe. So talk therapy doesn't work sort of reinforces it but a skilled trauma therapist can make a big difference.

43:22
Dr. Maya Novak:
May I just interrupt slightly. You said the talk therapy doesn't work. Can you just explain a bit about this? Because I'm sure that some people are hearing this for the first time and now if they are in therapy, they're potentially a bit worried. So can you slightly explain why talk therapy doesn't work?

43:42
Dr. David Hanscom:
So obviously with any therapy there's talking involved. So the key issue is this person helping you feel safe. So we call it somatic experiencing or somatic therapist. So obviously you have to use words to talk. But if you just want to talk about your past and just understand it, nothing changes. In fact, it actually reinforces the pattern. So I am not a proponent of going back and analyzing all your trauma every time. So when you're triggered… the skill set comes in processing the triggers quickly not going back in the past and trying to solve every trigger. So the past is done. You can't change it. You can't fix it. You can't do it. So again, my perspective comes from... and I respect psychiatrists and psychologists a lot. I think they're really helpful but it depends on their approach.

44:31
Dr. Maya Novak:
Mhm.

44:32
Dr. David Hanscom:
So the key issue is feeling safe. You go through the trauma that you went through, you allow yourself to feel it, and there come strategies to deal with it but just talk therapy alone actually just reinforces the circuits. So remember the way you live a good life is that you have to practice it. So that brings us to the next aspect of it of the input about what do you put into your nervous system that fires up the physiology. So one of the most powerful things that evolved in our process is that we do not let people discuss their pain or the medical care at all. But also no complaining. No giving unasked advice. No criticism, no malicious gossiping because what's that doing to your brain. You're just putting in input that is firing up your physiology. So when you're just talking about your past, analyzing your past, your brain's on the problem. Not the solution.

45:28
Dr. Maya Novak:
Mhm.

45:29
Dr. David Hanscom:
And it's interesting because we found out through our workshops in our apps-based on our workshops people would go to pain-free within 3 to 5 days almost every time. About 80% of the people went to pain-free but one of the cardinal rules that we had was simply you cannot discuss your pain or your medical care and no complaining. So that's where we found out that people in pain probably spend 60-70% of their conscious hours discussing their pain or medical care.

45:57
Dr. Maya Novak:
Yes.

45:58
Dr. David Hanscom:
Or being critical or whatever. So I get it. I was one of those people. I did the same thing. I call myself an epiphany-attic. You're desperate, you're looking for a solution after solution after solution and it doesn't work. So not discussing your pain by the way not watching violent movies or watching the news also is input that fires up the nervous system. So by not discussing your pain or medical care you're actually changing the input dramatically. It's hard to do. People actually look at me go “Well what do I talk about?” Or at our workshops people would actually sneak out behind the buildings to talk about their pain. It's like smoking cigarettes in high school.

46:35
Dr. Maya Novak:
Mhm.

46:36
Dr. David Hanscom:
So you're so used to doing it as a behavioral pattern you actually bond with other people in chronic pain. And we also know data that shows that one of the worst prognoses for fibromyalgologists belong to a fibromyalgia support group.

46:51
Dr. Maya Novak:
Yes.

46:52
Dr. David Hanscom:
Because discussing the pain, same thing with eating disorders, you're discussing all these problems problems problems. So the question is what do you want? Do want to stay a victim mole? Do you want to keep talking about your pain? Or do you actually want to move forward? Again, the problem is a learned skill set. This is all - a learned skill set. Again that's why the sequence is what it is. So that's input. There's another exercise called expressive writing which you know I've talked about a lot before...

47:17
Dr. Maya Novak:
Yes.

47:18
Dr. David Hanscom:
And Dr. James Pennybaker published the first paper 1986 since then there've been over 2000 papers documenting the effectiveness of what's called expressive writing.

47:29
Dr. Maya Novak:
So may I ask you this expressive writing is this the same as journaling or diary writing or what is the difference here?

47:37
Dr. David Hanscom:
No. Huge difference. So with expensive writing you should be right under your thoughts, any of them, the more clear the better, and tear them up instantly. So journaling is trying to analyze things and try to search, see who you are as a person which is actually quite counterproductive. So remember you can't escape your thoughts. So what I think again, this is my explanation, is that the thoughts are in the piece of paper: you're here and you tear them up for 2 reasons. You have to tear them up, shred them, burn them, whatever you want to do. Is that you're separating from your thoughts; cannot control them; it’s just an exercise and as you write all these issues come up. Well they're not issues. They're just thoughts. So it's these stories in our life that we create about ourselves actually keeps the nervous system fired up. We call it self-esteem or whatever. When you journal to see all these issues it’s very, very counterproductive. So one of my favorite pain specialists put out really clearly that if you hold onto your writing you're holding onto your pain. So they're just thoughts. It's just this separation exercise. And you can do it verbally, you can do it on the computer. Dr. Burns has a technique called The 3 Comp Technique. So we can do creative writing just expressing to the world how you feel. But if you're journaling to sort of analyze yourself and fix yourself and really understand yourself, that's a huge problem.

49:01
Dr. Maya Novak:
So if we give people right now more like a hands-on work… Really like step-by-step how to do this expressive writing. Since you are mentioning that it's a really good to tear up the piece of paper. It's better probably to have a journal or just a piece of paper and then write down whatever comes up to your mind, am I hearing correctly?

49:24
Dr. David Hanscom::
Right. right.

49:27
Dr. Maya Novak:
And then after you pour out everything you burn it, tear it up, do whatever you want to do just not keeping it because keeping it you're kind of also trying to keep the pain.

49:42
Dr. David Hanscom:
Yeah. Well essentially how hard it is for people to do this. Cause see the problems is that they identify with their thoughts. Why wouldn't we? All of us do this. I'm not trying to lecture here, I mean I have the same issue but I would tell you after 15 solid years of severe chronic pain… I mean I was suicidal a big part of this time. Within 2 weeks after I started the writing I felt the shift with all my patience. It's not the solution but you talked about well how do I do this? How do I do this? Well, that's the sequence. So the 3 things that... Let me cover 1 more process here called active meditation or mindfulness.

50:19
Dr. Maya Novak:
Mhm.

50:20
Dr. David Hanscom:
So we talked about input. So what expressive writing does it changes the input so you're diverting the thoughts. So you simply separating from the thoughts, so you now change the input. So mindfulness or what I call active meditation… just for 3 to 5 seconds throughout the day you just put your brain on a different sensation. Like just right now just drop your shoulders, sit in the chair. That's it. So you're just simply changing from racing thoughts to a different sensation. Again as you change sensations you have less impact on your nervous system and you’re in less fight or flight.
The final one I cover and there's many more parts to this is forgiveness or letting go of the anger. 90% of people in chronic pain are still angry at the situation or person that cause a problem in the first place. But the person that's the most angry at is themselves. So where does that stop? What you're holding onto fires up the nervous system and we know the deadly nature of anger. But what we don't know is anger is anxiety is an activated threat physiology. Anger is a hyper activated threat physiology. So no matter how legitimate your anchor is it’s still going to destroy your body and it does. So I don't like the word forgiveness anymore because it's too big of a word but there's ways of processing anger again in The DOC Journey. And so it's one of the things where you learn how to simply process anger, watch what's going on, watch the distortions, watch the effects happen on you. It’s all based on awareness and so as you learn how to change that input again things drop down. So again, the Dynamic Healing Model you can change input by not discussing your pain by changing sensations by letting go of anger. But the nervous system you can increase the resiliency with diet, exercise, sleep, and trauma therapy.
Then with the physiology you can directly lower it through very specific techniques stimulating the vagus nerve. So the key issue is this happens every day multiple times a day. Like it's not one and done. So somebody whos stresses are huge and you're gonna buckle. I mean no question about it. I mean certain stresses you just can't deal with in a given day that's fine. But how long do you want to stay there? How do you pull yourself out of the hole? So maybe an hour maybe a day maybe a day, maybe a minute. You just learn tools to go from fight or flight back into safety. It becomes very automatic with repetition and that's when life starts to change is that when you're not in fight or flight most of the time your brain becomes creative again, you have better energy and options to actually solve the problems that are stressing you out. So not only do people come out of chronic pain their anxiety drops through the floor, their activity drops down but they also become very creative. They start thriving at a level they’ve never knew it’s possible - that includes me.
I mean I was as bad as it gets. I mean I don't think I had the trauma some people have and I do think some people are so badly traumatized. They're so fragile it's hard for them to engage. And again, that's a different topic but there are ways of actually helping those people that are incredibly traumatized to feel safe. So they're not ready for The DOC Journey; you have to get them on board to allow themselves to feel any pain at all. As their pain is so horrible that they can't actually face it at all. So that's a different topic but yeah, if somebody decides to engage in the process and learn how to calm down their nervous system call it another physiology and I call: become a professional at living your life. Which means you process stress more skillfully, you nurture joy more consistently. They're separate skills but they're linked of course. In other words, if you're using joy to counteract the massive survival circuits that's what doesn't work. If you’re using self-esteem to counteract these survival circuits that doesn't work either. So they're 2 separate skill sets and they become automatic with repetition. Again, we have a very consistent result with engagement but if you don't engage, of course, nothing changes.

54:27
Dr. Maya Novak:
Yes. So would you then agree, witheverything that right now you explained, that when we are healing the body it is important to also deal with past trauma that at first glance it doesn't have any connection to right now, to this trauma, to this physical trauma? But when we do deal with this or when we are working on dealing with this the body does respond because that's how we are calming the nervous system down. Would you agree?

55:00
Dr. David Hanscom:
So I’m gonna say something that's very controversial. So yeah, you've heard the term how the body keeps a score? That trauma is stored in your body?

55:07
Dr. Maya Novak:
Yes.

55:08
Dr. David Hanscom:
So I completely disagree with that. Your body just responds to threats in a very generic manner. So in fight or flight adrenaline, cortisol, your whole body fires up. It is what it is.

What is stored in your body is your filter. Your life lens. So if you're a program that the life is dangerous that program becomes embedded so it happens you have a very reactive nervous system. That's what the trauma does to you. It creates a very hyperactive nervous system. The beauty of that is once you become aware of the traumas you actually can create a new life. You actually can construct a new life. So you don't have to be a victim of your past traumas but you can see what they've done and actually construct a new life. So what I dislike I mean the terminology is somewhat misleading because people feel like “I'm traumatized. I'm a victim. I can't come out of it.” That's not true. All of us have trauma some people extreme trauma, some people are so damaged it’s hard to come out of it. By the way my psychologist years ago gave me a book called Damaged with imply that I was so damaged I would never get better. I mean my situation was pretty darn bad. Not as bad as some people's but bad enough.

So the trauma causes your life lens to be distorted and the beauty of is you can change that. That's what you can change. So you can actually create any life that you want. So what I don't do anymore is that somebody's triggered or upset, if you're going back trying to analyze where the triggers are coming from, you're actually reinforcing those circuits. You're going the wrong direction. You're on the problem and not the solution. So the solution comes in developing a skill set to minimize your time in fight or flight and maximize your time in safety. And so when you're triggered you’re triggered. So we tend to look at say “Well this trauma where my mother treated me like this. My father did this. Or my sister did this,” we tend to keep going back to that trauma. There are trillions of triggers in life because we're programmed by every second of our life. So it didn't really help to identify “Maybe that's the trauma. Maybe this is the trauma.” All I know is I'm triggered right now this very second that's a sum total of my life experience somehow get manifested right this second. So okay, that's fine if I happen to understand the role of trauma in my life that's fine. I said before I went through 13 solid years of psychotherapy trying to understand my past and I did but I got worse because it's focusing on the trauma and the problem not using tools to feel safe. So remember once you can actually auto regulate or regulate your own body's physiology, it's game on. You can take on anything and you are save because you have control.

57:44
Dr. Maya Novak:
Yes, thank you. Thank you for sharing this. Now before we… we're going to slowly wrap up even though I know that we could be talking for hours, right? So let me just ask you this. You talked about this whole journey and what to do and how to do it, you very much connected it to chronic pain to chronic disease. If someone is right now acutely injured so an accident happened just a week ago or two weeks ago does this process help as well? Or should they do something else?

58:20
Dr. David Hanscom:
Well going back to that whole part of the process that there's a link in the brain between your thinking centers and the survival centers that when that link is there you'll develop chronic pain with a new injury 70-80% of the time. So it does help. Well first of all, to me anxiety is the pain. So even though you don't have chronic pain most people have stress and anxiety. So the process really helps us live our life more carefree. Second of all, 50% of people that have that acute injury go on to chronic pain. 50%. So that's a person that you don't want to be. So yeah for acute pain, technically, you don't need this stuff except what if that person has a fired up nervous system that develops chronic pain off a simple injury? So the answer it indirectly is ‘Yes’.

59:08
Dr. Maya Novak:
Okay. Perfect. Now before we finish I do have 2 fun questions for you that I ask every guest and the first question is what is your #1… well, this is not so much fun but it is in that category. So what is your # 1 advice that you would give someone who is recovering from any kind of physical trauma?

59:33
Dr. David Hanscom:
Just have hope. This is a solvable problem. Period.

59:38
Dr. Maya Novak:
And if someone right now is losing hope how to get hope back?

59:44
Dr. David Hanscom:
Well, again, that's the whole topic of today's discussion. And again, that's the sequence in The DOC Journey. It’s that you start with simple things. Again embrace the disbelief that's the case you don't try to believe anything just say “Okay I'm in trouble, deep trouble. I don't think… I don't see any hope” And that's why I call it the abyss because it's so dark in there. I was there for many years when I listen to my patients describe how frustrated and trapped they are I go “There's no words for this. It's just the darkest place in the planet.” It’s where you're trapped in chronic pain. So I call it the abyss and the point is just do something - some expensive writing or breath work. Just to get your brain back online a little bit. It's like splitting a log. You've go just get that wedge started and allows the log to split open as you keep working on it. So the key is embrace your disbelief. You don't have to generate hope you're just gonna have to just do something. Whether you feel like it or not.

1:00:38
Dr. Maya Novak:
This is great advice. Now, David, if you were stuck on a desert island with an injury and you could break only 1 thing with you to help you heal amazingly well, what would that be and why?

1:00:53
Dr. David Hanscom:
Of course that would be my book. [laughs]

1:00:55
Dr. Maya Novak:
Which one? [laughs]

1:00:58
Dr. David Hanscom:
Back in Control.

1:00:59
Dr. Maya Novak:
Good. Okay and why would that be? Why would you take your book?

1:01:05
Dr. David Hanscom:
Well I mean I’m gonna sound extreme here for a second. So people look as stress is the problem. It's not stress - it's your reaction to it. So I'm being semi-serious but semi obviously kidding, but once you understand the tools of how to process stress you can take on anything. And so the most extreme example and I'm pretty sure I could not do this but you've heard this book called Man's Search For Meaning by Dr. Victor Frankel?

1:01:29
Dr. Maya Novak:
Mhm.

01:01:30
Dr. David Hanscom:
Okay, he was in a concentration camp. He's a psychiatrist. He's an Austrian psychiatrist and in the middle of this horrible unspeakable situation which just cannot be worse than this human planet he had hope. He generated hope, he healed, and he lived to be 90 years old. Lived a thriving life and he was of course lucky he survived but he generated hope right then middle of a concentration camp. So I… it's a remarkable story. It's unusual. But also demonstrates that anybody can generate hope regardless of your circumstances. So yeah, learning those tools actually just changed your life whether you’re on a desert Island or in New York City or wherever you are you can generate hope.

01:02:15
Dr. Maya Novak:
Great. David, where can people find more about you and your work?

01:02:20
Dr. David Hanscom:
So I think the best place is my… it’s called www.backincontrol.com and that's sort of the landing place where all my resources are. So if you click the resources page, you'll see The DOC Journey app, The DOC Journey course. The app is based on my wife's work. My wife's name put on my workshops which is based on play which is also a neurochemical state which we can talk about someday at some time. So the app is very engaging and interesting. And then The DOC Journey course is a bit more academic. Both of them have the same sequence of learning how to get a line, calm down, move forward. And then I have coaching that I do twice a week as part of the process part of the either of the app or the course. Then on that page, you'll see everything that I do which is probably too much. [laughs] We've talked about that. I a blog for Psychology Today which has now over a million views on it. I have lots of things on that resources page that you can just peruse and look at. But yeah, The DOC Journey course, The DOC Journey app represent a sequence of learning and teaching that would give you the tools to actually find out your own solution to pain.

01:03:36
Dr. Maya Novak:
Yes, and we're going to put the direct link to this resource page so people will easily find all the information that they need. David, this was amazing. Thank you so much for being here and for sharing your experience and your knowledge.

01:03:53
Dr. David Hanscom:
Yeah, thank you! I really enjoyed it.

1:03:57
Dr. Maya Novak:
So… that was Dr. David Hanscom – if you enjoyed this episode, make sure you leave a review so we can reach even more people who should be hearing these lessons. Also, hit that subscribe button on whatever platform you’re using to tune in.
That being said, if you or someone close to you is currently injured or recovering from an injury, make sure you check out my book Heal Beyond Expectations – it’s really the most complete step-by-step manual on how to apply my Mindful Injury Recovery Method. It is also a memoir of my own experience, both with my own injuries and trauma and helping other people overcome theirs. You can find out more about it on healbeyondexpectations.com, or directly on Amazon if you search for Heal Beyond Expectations. Of course, if you want to go even deeper, you can also find out more about the various self-paced programs on my main website mayanovak.com, as well as coaching options if you prefer a more personalized approach and would like to work with me 1-on-1.