Ep. 7: Les Aria, PhD – Neuroplasticity and Training Your Brain for Pain Recovery

0:00 – excerpt from the episode
1:30 – intro (listen to discover a little more about your host. Martin will tell you a new lesser-known fact about Dr. Maya)

2:08
Dr. Maya Novak:
Imagine being in pain – sometimes so persistent and strong that you can barely go through the day. You’re tired but you cannot fall asleep because no matter the position, it’s always uncomfortable and painful. Well… in short this was my story when I was dealing with chronic pain. I am pain-free now but I know that so many people are suffering right in this moment. And that’s why I invited Dr. Les Aria to join me today. He’s a pain psychologist and is one of the co-founders of Menda Health, a digital pain recovering platform. Les specializes in treating psychophysiological disorders, persistent pain, functional neurological disorders, and medically unexplained problems. His passion for mind-body interventions promotes a unique style to help patients relate differently to their suffering, and thereby shift them into pain recovery and wellness. Les, thank you so much for joining me.

03:18
Les Aria, PhD:
It's a pleasure to be here and honor.

03:19
Dr. Maya Novak:
I am so very grateful for you to be here today and for us to have this conversation because the mind-body interventions are so extremely important and yet the conventional medical approach is not there yet. So before we go deep into the topic I would love for you to share a bit about you, about your background, and why did you decide to go into pain.

03:45
Les Aria, PhD:
Yeah, it's a great… it's a question I often chuckle about. I used to be embarrassed about it but one is a personal story and one is where I like to say pain chose me I didn't choose pain. And so the personal story is when I was quite young, but twenty five years ago we'll just kind of say that, I had a very severe injury to my back to the point where all the muscles were ripped. And I was going through my healing process, I was basically told by some good doctors, I don't fault the doctors, we know what we know at that point. And the doctor basically said “This may result in future problems as you get older.” And the running joke right now is every time I'm doing a crossfit session or running my three miles every other day I have no pain at all. And I was told basically I will end up having pain as a result of the injuries. So I basically had it embedded that I was screwed, feeling screwed and feeling like “Well this is pretty much it because these are the doctors – the great in the white lab coat and their x-rays and everything else” and so I succumbed to that. But 1 of the things I noticed that so it's going through my personal recovery when I was joyful, when I was actually meditating at different periods, I had even used the word pain-free, I basically was not feeling any pain. And when I was upset or scared, when I was doing my residency back then, I was actually feeling more pain. So for example, when I got called on during rounds or rotations my back would light up, my legs would burn onto the point where I had to sit down. And then I started developing headaches, and then ringing in the ears, and then panic attacks, and it's almost like something was unfolding in me. But I kept it really quiet and the more I kept quiet the more pain I had in my body, and psychologically I became very distressed. So with that said, I was actually on my route to becoming a neuropsychologist which is someone who does brain and behavior assessments. like brain injury, spinal cord and strokes, and so during that rotation I was dealing with someone in my training who had chronic pain. And for whatever reason they got better as I worked for them from the inpatient all the way to outpatient. And I was doing what I intuitively thought would be good - is to kind of create a safe space for them and teach them how to calm their brain and body down, and inadvertently they got better. And I was a little bit surprised at that point I thought “Ha! Maybe I'll go into pain. I'll do a double fellowship.” So I decided to pursue at the same time with the neuropsych and then do pain management. The first time I sat with someone in, and attending a senior residents actually, in that clinic the person… there's a first pain patient I've actually sat in and to observe how it's properly done and assess. The person picked up the stool and threw it across the room and basically said “I want my damn medications!” And at that point I'm like “Oh, I don't think I want these people. I don't want to work with these people.” And so what was funny is the running story is pain… helping people get out of pain, helping people get into pain recovery. It is my passion, it's my heart's mission now. So it's funny. So the running story I have with myself is “I did not choose pain, pain chose me.” And then it's been a love affair since then.

07:24
Dr. Maya Novak:
Well, our story is very similar - I did not choose to be doing this but you know twelve, eleven years ago a rock-climbing accident, poof, and we are here today.

07:36
Les Aria, PhD:
Wow.

07:37
Dr. Maya Novak:
So may ask you this - when you were dealing with your own recovery and pain were you doing things intuitively? Like what you felt that it might be good for you to become pain-free or how was that process for you?

07:52
Les Aria, PhD:
Yeah, it's a great question. Firstly, I'm one of those compliant patients. So I do exactly what the doctor says or the physical therapist says or you know any other provider. And so I did that but I was not getting... I got some relief but not to the point where I would say I've got maybe 10 to 30% relief of doing certain things. But it did not… so intuitively I was so overwhelmed with panicking feelings and just couldn't understand what was going on. And they basically said “Well you know, maybe it's all psychological.” And at that point maybe it is and so what happened was I intuitively decided I'm like “What can I do to calm the brain down?” I was very focused on the brain and then I realized that a brain without a body is nothing, and the body needs the brain. The brain needs the body and in all of us we're humans. And maybe this might be a little bit off topic but there's a spark within all of us and after 20 years of doing this work I'm telling you there is something greater within us that can actually also heal us and we can tap that sense of healing power. But intuitively I think I gravitated towards things that I decided to stop fighting. I decided not giving up but I decided to lean into the pain. And I'll give you an example, I figured that I was overwhelmed with the pain and fear. So that's a common thing that we have and we've studied this now in brain studies that the fear-pain cycle… If you fear the pain the pain gets worse. So I decided to do something really ridiculous which I don't encourage anyone to do. I basically got up and started to run. And then that severity of that burning sensations in my leg and low back I said “I guess if we're going to fall we’re going to fall.” And I kept on running and the pain was severe and all of a sudden about half a mile into the run it just completely remitted. And I thought “My goodness! When I got rid of my fears about the pain I actually barely felt any pain.” And then that's when I accidentally found out that fear amplifies the circuitries of the brain, the nervous system and amplifies it. So we now have to date brain studies that affirm that fear amplifies and can maintain - and by the way not just fear of the pain but if you have fear in your life, finances, relationships, you know trying to look good, trying to smile when you feel bad. So I realized that when we have life problems they show up in the body. So fear is not just about the pain. After 20 years I realize that I was intuitively moving towards leaning into the pain with less fear.

10:32
Dr. Maya Novak:
I love what you just mentioned because it's so often that people think about “Well if I want to heal my body I have to focus on the body,” and then the rest it doesn't matter. But so many times things from the outside or any other area of your life might be the reason why your body is actually in this turmoil and is speaking to you. So it's so important that we look holistically on life, every area, and work on everything because this is how we can really treat the body and heal the body.

11:09
Les Aria, PhD:
Yeah, absolutely. I'm smiling here because I have this conversation day in, day out and not only with my closest friends, psychiatrists, physical medicine doctors, spine doctors, some of my closest friends besides psychologists and surgeons. And so I talk to them, and even my colleagues who at work they still find it hard to believe they've meaning that the medical system, good people... They know it intuitively that thoughts and emotions actually a part and parcel of a physical experience. To separate that is to basically do this. Very often when I tease my physician friends I say “I want you to talk with me with just your body and leave your head outside the door.” And the joke is that “Wait a minute, that's not possible, right?” So then why do we separate this? Separate this mind-body, the thoughts and emotions from physical experiences. Because Rene Descartes who used to be my favorite philosopher… Rene Descartes is where all of this comes from - the separation of mind and body. Rene Descartes was a philosopher and his father was a physician. And Rene Descartes went to roam the world and his father said “Stop being a vagabond. You need to do something with your life.” So he started to become a philosopher and somehow he basically wrote several papers in the medical system back then. And the late 15th and 16th century basically adapted him into the medical model. And there begin the separation of the dualism between mind and body. And ever since then medical school is not changed - the mind and body, the thoughts, emotions, and physical sensations are not stoic. It's a dynamic interaction and exchange that produces what we call the pain experience.

12:57
Dr. Maya Novak:
Absolutely. And you know it's time that we update the medical system. So it's you know we cannot live in the past. I mean we updated so many things from those times and yet the medical system is still there “Oh, mind-body… they’re not connected. So let's zoom in to this bone…” and then do the surgery or put on the cast or whatever. That's it. And the rest “Well go home, fingers crossed, and come back in three weeks.”

13:28
Les Aria, PhD:
Well said, that's really nice. What a nice summary of the medical model and hopefully we're not offending anyone. As medical profession is what you’re saying is there's a place where we need to have growth and I think Dr. Stephen Porges and I were just talking about this just recently in a group is that it's the medical system has forgotten what they learned in medical school in the sense that it's everything within is not stoic - meaning that it's not static. It doesn't operate by itself the way the beautiful system of our nervous system, our brain, our body, our mind. There is a dynamic interaction that's going back and forth and that's what's missing is they basically focus on just this. Very often I tell surgeons who wish to do surgery on them and they usually send them to me for surgical, what we call ‘pre-surgical consult’ to make sure that there's nothing too serious - can they go ahead and operate. This is pretty serious surgeries, complicated surgeries, and in my report I'd say “I cannot tell you not to operate but I can tell you the outcome will be either helpful or not.” And when I tell them “This person has depression. If you cut into them or this person that has unprocessed trauma and you cut into them, you will have someone who will have very high opioids above 100 mmed” which is just a dosage formula for opioids. “It'll be extremely high and it'll continue to escalate within three months.” And that's where the problem begins. And they usually say “Yes, yes, but can I operate?” I say “Doc, I can't tell you whether… it’s your license, you do it, but…” I get to predict based in my years of experience and psychological assessment if you do certain interventions with certain people the outcome will be poor. And sure enough it's poor and they go “Well can you fix them?” I said “Well, they're not a car to be fixed. They're not a door hinge to be replaced.” I said “What I can do is I can teach them to retune the nervous system and transform them but it will take some time.” And so this is the running conversation as you're right I think you said it beautifully. The world needs to change the medical system so that it's a dynamic interaction, not an isolated process.

15:41
Dr. Maya Novak:
Yes, absolutely. So let me ask you this - would you say that potentially one of the solutions or one of the steps of how those who are dependent on opioids might be also for them to deal with trauma from the past? Something that they haven't dealt with and that potentially this could also help them becoming free of this addiction? Would you say that this is something to think about?

16:16
Les Aria, PhD:
Yeah, actually you don't even have to take it from me, but Gabor Maté is probably world renowned for this. And in his books, in his lectures, and his training really is the foremost leader in an addiction and unprocessed trauma. And where if people are right now listing and saying like “Wait a minute, what do you mean?” It doesn't have to be large traumas, it can be small, accumulated traumas like constantly needing to be perfectionistic or needing to please. It doesn't have to be sexual abuse, physical abuse, it can be lifelong unhealthy relationships of your adulthood. So what I am saying as Gabor Maté has experienced and he's as many years beyond my experience and I agree is…. So I treat people, I work with a team, with a physician who's very well trained, ordinary physician but physician is trained in opioids; like really well trained short of saying they're addictionologist - so very, very experienced; an experienced pharmacist and then the psychologist, me, the pain psychologist in the middle. We do take people off opioids and one of the things I often tell them is before I tell my medical team, before we touch people's opioids “We need to kind of instill some resources in them. We need to educate them and teach them skills on how to downreg the nervous system and if need be we have to use evidence-based treatment like EMDR eye movement desensitization reprocessing trauma evidence-based treatment. Or something like brain spotting and or somatic experience in dream.“ These are all evidence-based treatments for trauma. Not talk - more talk does not change the nervous system. Practice is the drive changer of the nervous system. So yes.

18:07
Dr. Maya Novak:
Yes, it's about theory and then doing the practical stuff, right? We can just talk, talk, talk, discuss, discuss, discuss, but then nothing changes. And that's why in all of my interviews we have implementation time so that we can really start doing stuff because otherwise we're just listening and then 5 minutes later we forget about stuff and “Oh I'm still in pain, my back still hurts, my ankle still hurts.” You know nothing changes.

18:34
Les Aria, PhD:
Right.

18:35
Dr. Maya Novak:
You mentioned two things, 1 fear which I always come back to. I think that everything ends and starts with fear. I have that feeling - I mean fear is such a strong emotion. But you also mentioned one other thing which is anger. We are fighting stuff, we are fighting pain, we are fighting disease, we are fighting climate change. So what you said is that we have to lean into and surrender. We have to stop fighting and trying to win no matter what.

19:18
Les Aria, PhD:
Yeah, yeah, absolutely. There's a thing I have with my patients; I have many sayings and 1 of the sayings basically to just to piggy back on what you said is that the very thing that you're trying to avoid, maybe trying to avoid feeling fear, trying to avoid feeling pain, trying to avoid feeling the anger, and eventually it comes out. But the very thing that it's trying to protect you is the very thing that keeps you from living life. So fear and anger really are, if you want to kind of have the audience do this with me… so a little trick question to the audience is that imagine driving and all of a sudden someone… you've got a nice space in front of you and all sudden it starts to rain and then a car comes in between the narrow space between you and the front of the car. And you're driving at high speed on the highway and the car zips right in, slams the brakes, now you slam your brake and then it takes off. The question I wanted to ask the audience is this: was that fear or anger you expressed? And very often people will say “I was angry. Like son of a gun, what's the matter with you!? Drive better!” And often say is your real emotion is not anger. It was fear. And let me slow it down for everyone. The moment the brake slammed, neurologically you did “Aaaaaa” that was fear, that was the primary emotion. And then once that went down what showed up manifested was anger. So when you're angry, the real root is fear. And when you're really fearful like “Oh my gosh” thrill brute is anger. So think of anger and fear with the same brain chemical like … sort of in a line of a continuity. So whenever we remember like, why does a mother get so angry or a father chasing a child who ran out a 3 year old who thinks it's funny to break the parent's hands and runs out into the streets and they're laughing and… but the parent is angry. Why are they angry? It's because they're actually fearful as the real emotions. And when we're fearful we're also angry at the pain. And when I'm angry we really are fearful.

21:26
Dr. Maya Novak:
Thank you for explaining this and I think that when listeners just take the time and really observe their reactions they will notice that even if anger comes up there are even just tiny moments before, it's exactly what you said, you know. And then “Oh how could this happen!!” And what you described… I live in Mexico so driving can be really chaotic. So what you just described is like “Oh, just a normal day here in Mexico.”
So talking about emotions. We talked about fear, we talked about anger. Can we go a bit more into the connection? How is this then connected with the body and why do we have to deal with emotions? What is the connection: pain, emotional pain, mental pain, physical pain.

22:20
Les Aria, PhD:
Yeah, that's great, great question again. So I want everyone to think about this – it’s one of my favorite fruits. In California we think avocados are fruit not a vegetable. That's how we can tell a real Californian from. And so when you think of an avocado - what's an avocado got to do with what you just asked? Well, the next time you eat an avocado think about how you cut the avocado. It's in neurology we call that a sagital cut, which is lengthwise, you cut the avocado lengthwise. Now when you cut the avocado you've got the avocado pit. Now everyone focus on the pit because the pit is identical to the middle part of our brain. It's dead encompassing. It's that large, the middle part of the brain is called the limbic system and with the latest signs we've received especially thanks to the work of Dr. Apkarian at the University of Northwestern. And he's discovered that pain, chronic pain actually develops in 4 stages. And what he discovered is in the last third and fourth stage of how pre-chronic pain develops, check this out…. Imagine you're looking at the avocado that's the avocado pit and right above it that's where the somatosensory actually process. All the nerves get processed, like that's why when you're cutting and you nick your finger, you know exactly it's your left pinky that just got nicked. And so the brain has a body map there. So what's that got to do with the emotions or pain? So, check this out. When pain becomes persistent, for example from the medical definition three months or plus or six months longer what happens is this: the brain reorganizes the real estate of how pain is processed into the keyword, into the avocado pit. Which is hereafter known as the limbic system. And so why stress, why emotions and thoughts seem to amplify and maintain persistent pain, such as fear, such as anger, unprocessed trauma. All of that is housed in the middle of the avocado pit.
So let me pause here for a second. The big take, a message is this. This is not psychological. There's a psychological component that's called suffering and complaining among other things. And so the neurophysiology of this is that when pain becomes persistent, the brain is so amazing, it becomes so protective that everything is automated. So the pain is processed from the area in your brain where the real estate is where they process it and then they move it into the middle part of your brain. Why? We don't know why but we hypothesize the reason the brain shifts the way it processes pain from acute to subacute to persistent pain is to be resourceful, so it doesn't have to waste energy. So pain becomes then a habit. And where do we have habits in the brain? In the avocado pit, the limbic system. So you know how do you remember how to put on your shoes? Think about someone who's had a stroke or a brain injury. We have to retrain the brain so pain is shifted from a location into the avocado pit, the limbic system, and in the limbic system is where we have unprocessed trauma, all emotions. It's like a kitchen that cooks up all the stuff in a storage room. And so when we have thoughts of negativity, the front part of the brain it sends a message to the middle part, and it lights it up. So this is why stress, which I can definitely define in a simple way stress, thoughts, emotions amplify. And what I'm trying to say to everyone is your lived experiences, your day-to-day influences, how much pain you will have or not will also influence whether you will come into recovery.

26:08
Dr. Maya Novak:
It's very important that we are conscious about stuff, that we are doing that, that we are tuning into that, that we are listening. You know every single day and yes at the beginning I know from my personal experience, it takes energy, and it takes effort. But then it becomes a habit as well. And what you said about habits, I think for some people this is hard to hear, like “My pain is a habit? What do you mean??” You know it's almost like “I'm then I'm guilty of this.” And let's talk a bit that it's not their fault in that regard. Because then people start beating themselves up like “Oh it's my fault then”. Can we just slightly talk about this?

27:03
Les Aria, PhD:
Yeah. I love that. And so I'm so glad you asked that because one of the reasons why the way I frame how pain actually is maintained is I use something called the polyvagal theory framework. When I teach my residents, my interns, especially people emerging in this field, one of the things I tell them is this “We need to have a framework.” When you have a framework, as my dad used to say “If you don't stand for something you're going to fall for everything.” So I took that same adage and said you know “What's the framework I can help explain?” So my framework in helping explain why pain persist and why we should remove the blame, and the blame game, and the shame game is to basically use science. So if we stop for a moment is… When we have, for example, an anger outburst because… or we just weep, we break down and burst into tears because we are just so frustrated, we cannot get out of this pain. And you sit there and you weep and weep and you maybe even punch yourself in the leg and you're like “What's the matter with me?” And you start to weep… and I've done something like that, and some of my patients… When you get to that point you basically say “What's the matter with me?” We start to blame ourselves. Or maybe, and I want to be gentle with this, a physician or a medical health provider says “Well maybe it's all the stress in your life, and maybe…” it starts to then gaslight you. So when we're not gaslit by a medical provider like “Well I don't know why you're having this pain. You shouldn't have pain, surgery went great.” Or “You have yourself…” so we are gaslighting, we're gaslit by medical providers of the medical Merry-go-around. And so here's the framework I use - whenever you feel incredible anger, emotions or negative thoughts, or increased physical pain, or the pain is just getting worse, it feels like it. It is a biological imperative. That means, your brain is so beautiful that, I know this is a very hard reframe but you have a beautiful brain and body that's trying to protect you. So let's pause for a second. Pain is a protector. It's protecting you from something inside of you, outside of you or whomever's in between you. And so the framework I use is a neurophysiological framework that says “When we feel like we cannot get better it's because, check this out, it's because the brain senses that we're not safe inside, outside the environment, or whomever's in between you on a day-to-day basis. We cannot, and I've been doing this for 20 years, and one of my patients said “How many patients have you seen?” I said “Well I think I've seen…” I calculated one day just for the fun of it “approximately 58.000 patients I've seen in my 20 years.” And after a period of time I realized that there's a pattern. I've not seen a single human being on Earth heal, get better, get back to life until they feel safe inside, outside and/or in whomever is between you. So it comes back to the word stress, comes back to the word thoughts and emotions. When we don't feel safe with things inside of us, we don't know how to deal with the sensations, we don't know how to deal with something that's over stimulating us, we don't know how to deal with an unhealthy relationship or something that's not giving us what we want - it could be work, it could be home - when we don't know how to deal with the sensations that show up, that's when things.... Actually we start to feel “What's the matter with you?” And my message to you and the audience and back to myself is “There's nothing wrong with you. You just have a beautiful protective defensive nervous system.”

30:54
Dr. Maya Novak:
This is so beautifully said. I love this safety thing because when we feel safe then we can grow, then we can do stuff. When we don't feel safe what we want to do is go to bed and cover ourselves up and never come out. And I'm talking from my own experience. I mean there were times when I was in pain and didn’t want to come out and deal with stuff. And of course then we get back to fear and everything that you shared so far. Let me share slightly what I was doing when I was healing my own chronic pain. One of the things that I decided to do back then was in one moment I asked everybody around me who knew about pain not to talk about pain. So for me, it was so important because otherwise people are just asking you all the time “So how is that pain? Are you improving?” ta-ta-ta-ta-ta and then you are in that cycle of just thinking about pain constantly. And I asked people, I said “Until I tell you that it's safe to talk about pain, don't ask me anything.” And it took me months. So would you say that that was a good decision?

32:20
Les Aria, PhD:
That was beyond a good decision. How about intuitively spot on, 100%, outstanding. I wish more providers would do this. My good buddy, my good surgeon buddy, David Hanscom, just a famous surgeon gave up surgery by the way. He's an orthopedic surgeon so he fixes complex back issues and he stopped doing surgery because he really realized that that's exactly it. His one major rule is stop talking about pain to family members. And so what I've come up with as David and I have talked about this is I have a pat state in a patent statement that people can say to themselves and to their family members. When someone's “How’s your pain?” “Thank you for inquiring about it. Every day in every way I'm getting better and better. Let's get off this topic. How are things with you?” So do a pivot and so you simply respond “Thank you” and also say “Every day I'm getting better and better.” And then if you see them again “You know there's more to me than just my pain.” You know “What about this beautiful face? What about these great things that are happening in us.” That's why it's really important for us to communicate that to family members. And my patients say “Well then who do I talk about this?” Well then this is why you have your pain psychologist, you have a therapist, or people who are caring for you and that's the realm. Anyone else outside of that will get drained and they will feel and they'll sometimes they'll blame me like “Well, what's the matter with you? Why don’t you take your medications because you're really crabby?” And so taking the word pain is a good thing out of it I think that's beautiful, more people need to do that.

33:53
Dr. Maya Novak:
Yeah. So I'm sure that you get many patients who say to you “You know I've been doing everything and anything and nothing helps.” What do you say to your patient? Because I have a feeling and I also know of people and my clients who have been doing so many things and what I'm noticing a lot of times, they’ve tried one thing and it didn't work, and another thing, and another thing, but they’ve never combined things. What is your experience and what do you usually tell your patients?

34:31
Les Aria, PhD:
Yes. If you hang out with me long enough… For anyone, my patients know this, they've written 200 statements I say. So this one of the 200 statements “Divorce the outcome and marry the process.” Take your eyes off getting rid of the pain because that is way too much. When I was a kid and I was so frustrated and stressed out when I got an A- I was so stressed out trying to get an A+. And so I got worse, I got less of great than that. It’s so much stress which now activates your threat physiology in your brain and body. We just light ourselves on fire whenever we demand things we're not ready for and can’t receive, we tend to activate the stress of the threat physiology in our body. So with that said divorce the outcome basically says, “Your fruits, your crops will come someday, just keep watering the process and using, integrative things that will help you mind, body and spirit.” That will actually help you. Things that promote a safety physiology is really crucial to healing. So divorce the outcome basically says “Want the pain to go away?” So when I teach meditation and when I teach different techniques what I call nervous system regulating skills, when I teach people to get into a state of safety physiology I tell them, for example… Meditation - when are you meditating to get rid of your thoughts and emotions and sensations? Or are you meditating to get to know your nervous system, befriending it so you can actually show up like a living parent to nurture that part that's really screaming and scared? So the process is using an integrative skills and approach just kind of like what you said in simplicity mind, body and spirit in that sense. Really doing things to dial the physiology down, the mind down, to say that you're safe, to not just use talk therapy but I use a lot of somatic skills things to calm the body down. And I'm very big on something called the vagus nerve and that's why I said I use a framework and the framework I use in that is the polyvagal theory which basically says “The biggest nerve carries about 80% of the information in the body to the brain.” So if you can learn to calm the body down, the brain tends to also calm down and then the brain calms the body down. So ultimately is when people are not making progress ask them “What is a hidden motive? Are you trying to get rid of the pain?” “Of course, then why do you think I'm doing this?” Well, that's like saying “I want to get marriage so I can have lots of sex.” And so it doesn’t make sense, right? But it sounds logical to some degree. But it sounds logical to say “I'm doing this to get rid of the pain.” But I'm telling you it is identical to “I have to get an A+” and that creates a threat physiology, it dampens and lessens your chance. This is why leaning into the pain which is like making full contact with quicksand. You don't want to do it because counter intuitively the mind says “How do I get rid of this?” And the reason the mind does that is because the brain says “Me no safe.” When the brain says “I'm not safe” and senses it through the five senses it tells the psychology, the mind part to help us figure out how to get rid of things. So we're caught up in how to get rid of the pain, how to get rid of my anxiety, you actually create more anxiety and more pain. The very thing we don't want to have we will end up having more of. So the simplicity in this is just do the process, stay with the process. “When will it be?” The reason I cannot answer that, like “Why can I not get better faster?” is because I don't know your life experiences. Because your nervous system has all your lived experiences. So every time you had a trauma or something horrendous, it's like a knot on a rope. And so when we are forcing ourselves to try to get rid of something we go back and reactivate some trauma, we reactivate the threat physiology, and it becomes counterproductive. But it's human to want to get rid of the pain and the skills I teach, and the things that you teach actually on your wonderful channel, teaches you to be here right here right now and to stop bullying yourself into recovery.

38:49
Dr. Maya Novak:
This is so beautifully said. And how about if we talk a bit more about this inner child? And what you mentioned is that you’re meditating just to be in complete silence because a lot of times people think of meditation in that regard – so “I shouldn't be thinking about anything, I shouldn't be feeling. I shouldn't… I should be sitting in a lotus pose…. So why is this not working for me?” So how about if we talk more about this leaning into all those feelings and talking to that inner child and why is it so important?

39:29
Les Aria, PhD:
Yeah, it's a really, really question. Again is that it's really important because if you know… Now let's get into the mind and body. Let's really get into it. So, if you think about this and this might be different for many, many people but I use a different framework. I don't believe there's one inner child because traditionally when I was going through school and my residency, and all my training, and all the courses I took they basically talk about the inner child. There is an inner child but actually we have inner children, multiple children. Has anyone ever experienced this? There's a part of you it says “I want to go exercise” and part of you're like “No, I'm just a little too tired.” Or how about this, there's a part of you it says “You better tell that person off.” “No, I'm scared or else they’ll not love me.” So we have different parts. So that's the first point. When we have certain things that we kind of think about and experience in body and here's the framework I use, thoughts, emotions, and physical sensations are all children. So if you hear a negative thought think of a 5-year-old complaining. If you think of the panic attack that you're feeling like pounding physical like “Oh my gosh, I think I'm going to die.” If you thought of that body or emotion sensation as a child screaming we tend to be less afraid of it. So I train my patients that thoughts, emotions, and physical sensations are really children. They're your inner children. Inner child and so it kind of steps away from traditional psychology but I lean my thoughts and practices on evidence-based treatment. And this is based, now we’ve talked about the mind-body stuff, this is based on the framework of internal family systems - Dick Schwartz - world-renowned for teaching people how to deal with the trauma using internal family systems. And he basically says this “When you are meditating and when you are feeling curious and compassionate and courageous and confident, you tend to come into the self.” The self is the part of us that was untouched until we said we heard messages of good girl bad girl, we were trained by the people that raised us and they raised us the best they could. But the self emerges, shows up, is present very often in meditation when we are neutral where in the middle of this tornado which is often from a physics perspective the most peaceful. So when you actually become the observer in meditation with the self tends to emerge when we tend to ground ourselves, when we tend to tap our chest, and even slow our breath down. We are emerging into this present moment and the present moment is very neutral. And so, and also that's where it's like a portal where yourself comes through, your true self comes through in internal family systems. We basically say “Do not talk to the inner child until you are grounded in this present moment with compassion and curiosity.” And then you can talk to those children.
And let's go back to the same lesson thoughts, emotions, and physical sensations. I train my patients and myself that they're children. So when I wake up in the morning, this might be funny and the audience might be going “This guy's really a cuckoo,” when I wake up in the morning I actually say “Good morning, kiddos.” And what I'm saying is I'm saying good morning my thoughts, the good the bad the ugly, and the naughty ones also. And so the ones are like “We got to get going! We gotta get…” because when I open my eyes I have a very busy lifestyle but I'm relaxed in my busy routed lifestyle if that makes sense. I try not to get too worked up about things in busyness I need to do. So I wake up in my morning, my stomach churns, my cabs tighten, my back might tighten, and I say “Hello little ones.” So mind, your thoughts, emotions, and body sensations are children. So I'm saying good morning to them. So one of my patients said “That's the most ridiculous thing I've heard.” I said “I know, right? Go try it.” So don't knock it till you've tried it because it is wonderful. As I go through the day and I notice my side joint that starts to tighten up, the lower part of my body, when it starts to tighten up I like sounds like “You're trying to get my attention.” Every single negative thought, negative feeling, and negative physical experience is not there to harm you. They're trying to protect you and you need to show up as the healthy pair to say “Honey, I know you're trying to help me with those negative thoughts, I know you're trying to stop me from overdoing. That's what you're producing this pain. I know you cannot say ‘No’
But you keep doing… you are producing this pain to protect me. So can you go and dial it back down?” So I have a skill set and we'll talk about this later on if you wish - it's called the 3 Ns to actually take everything I talked about, the neurophysiology and then to tie it into the mind-body with IFS, to be able to tell and retrain the nervous system that we're safe. So as you said, if we have skill sets to kind of learn how to lean into it we become less fearful. It's like taking someone who's never skied and telling them now to ski down a black diamond slope. In America here we have black diamonds which are very steep, right? So that's like telling someone to lean into the pain without skills is like telling someone to jump off a cliff and fly. It's dangerous. So this is why leaning into the pain requires you to understand that if you can learn to work with those thoughts, emotions and physical sensations as children, you become less threatened. And if you have a very clear stepwise process to work with them it's like parenting skills from a very loving and compassionate manner. It will help you move into safety physiology and finally into recovery.

45:20
Dr. Maya Novak:
This is such a beautiful insight and I've never actually heard of inner children. But I love that because it's true. And also when you think of inner children, for me, the feeling is like “I'm actually never ever alone” because I have so many kids internally that I need to take care of, and it's great to have this kind of insight because it's so easy for us when we are suffering to try to run away, to push aside what is actually calling us but if you imagine having 1 2 3 4 children in front of you having a tantrum you cannot go “Oh, I'm not going to talk to you until you behave!” I mean you can do that but it doesn't work.

46:07
Les Aria, PhD:
No, yeah.

46:09
Dr. Maya Novak:
So, we have to lean into, we have to talk, and my view on the body is that the body is always communicating. So it's what you just described “What are you trying to tell me?” Or the pain “What are you trying to tell me? Tell me,” you know.

46:29
Les Aria, PhD:
Yes, yes, yes, yes. Oh, I'm so excited that you even said that. And one on things I'm hoping the audience will get even more excited about this, check this out. One of the things is when I do the first evaluation, a body check and they often start to “No, no, no. You don’t have to take everybody’s body check.” So, let's do this, and we can do this with the audience. If people don't know where your trapezius muscle is… so your shoulder muscles and so have people take their right hand and check their left trapezius muscle, left shoulder muscles. And just kind of press as they come along the neck, and then tour the shoulders, and then switch hands, take your left hand and check your right trapezius muscle, your shoulder muscle. And just press. Now, if you have left-sided body pain independent of structured nerves and tissue injury that I've healed independent of it. So basically when your left side of your body, if you split your body left hemisphere from top, from head to toe, the left side is highly associated with anxiety. The next time you have some sort of fear, you're anxious, you're worried about “How do I pay for that bill. Oh my gosh…” though as we were checked with technology like “Oh my gosh, is this going to work?” If people are fearful of something or someone tells you something, notice which side of your body left side or right side. Left side is highly associated with anxiety, future planning, trying to control things. You don't have control over the right side. That hemisphere of your body is associated with a couple of things: anger, suppressed emotions like frustration, and also lots of complaining the chatter that does not matter, constantly listening to the talk, to the mind. So when I notice that sometimes I talk my mom, and my mom is getting up there in age, and so I'll say something that is a little bit hypercritical, and then I notice that I will wear a smile “Thank, mom,” but I’ll notice my right shoulder just tightened up. So I basically just suppressed my anger. And so what I'm telling the audience is this is “Listen to the body because it's speaking. Are you listening?”

48:29
Dr. Maya Novak:
Oh, I have goosebumps. This is really amazing conversation and thank you for all the insights. Now, how about if we take the time for that implementation. And you guide us through those 3Ns because I think that it's going to be so amazing for the listeners - something to take and then implement right away and start seeing results.

48:51
Les Aria, PhD:
Yeah, absolutely. Let me set up the framework of this. So this is based on the polyvagal theory and the first N is basically what we call a Notice. And if anyone knows about the polyvagal theory it basically helps us understand why we think, feel, and experience the sensations in our body. So it helps navigate and remove shame and blame. And so everything that shows up inside of us is meant to help us and protect us. We need to start thinking of it that way and we need to start showing up to what showed up with a different attitude. And so, the 3Ns, if you think of the first one I'm going to run through them and then we'll do the practice. The first N is called Notice. That's basically what we call nociception. It’s when your brain says “Am I safe or not?” So let's go through that. And then the second N is called Name. Name is basically “Name it to tame it.” Name the physiology state that you're in. You know if you're in shut down, a stress, if you’re feeling safe. Name it also means “What is the emotion that's showing up in your body?” And that's called perception awareness. We want you to wake up from that trance of the mind, that habitual pain habit, or trauma habit, and you want to wake up from it. So naming it. What we have research it shows when you say like “So this is what anger feels like in my body. So this is what fear…” we start to wake up from the trance and what we call physical distancing from thought, emotion and sensation. That's a very important thing to do. And then the last one is basically what we call… we had Notice, Name and now we have Nurture. And I have a silly saying with that so “Nurture your tormentors” “Wait a minute! I’m nurturing things that are bad to me on the inside?” “Mhm.” Because they're not bad. They're little kiddos, five-year-olds, eight-year-olds, or ten-year-olds. They're beautiful children just very scared and protective. Your job as a parent is to mentor them. My grandmother used to say “You raise cows, you train children to be loving self-respecting of themselves.” So this is a training skill. And the last part which is nurture is what we call discernment. Discernment basically says “Is this helpful right now?” I have this negative thought “Is this helpful for the pain to be dialing up?” Your job as a human being right now, right here is to teach the nervous system that you're safe. And sometimes it doesn't know it's safe until you influence it. It's like a child is scared and you're like “I don't know what to do.” How would you just go hold a child? How about you ask the child “Honey, what can I do? What do you need? How can I support you right now?” That's what we need to do in this practice. So, let's put this all together: notice, name, and nurture. It is a way to influence what shows up inside of you. So, let's go through it.

51:45
Dr. Maya Novak:
Let's do it.

51:46
Les Aria, PhD:
When you notice… So, this is a big clue. The number 1 question that I often get, which then I had to figure it out for my patients because I was doing it, and so sometimes me able to translate it to practicality. I want everyone to write this down is “When do I practice the 3Ns?” Again, the 3 Ns - notice name and nurture. It's a way to influence what shows up inside of you. So with that said, there are 3 behavioral cues when to apply it: one when you notice a mood shift. You know a mood shift happens when you notice tension - that's what I call pain or discomfort. I don't call it pain I call it tension. Your brain senses and tenses when you have a mood shift. When there's tension that all shows up and spikes up and or your breathing rate has changed. Everyone pay attention to the way you're breathing right now. Are you holding your breath? Is it rapid, is it slow? And even so when you notice mood shift, tension shift, and or breath rate shift, your nervous system has just taken over. You look and seem like you're in control. But you're not. The past will show up in the present and it's your job to show up to what showed up. So let's go through it. So those 3 behavioral: mood shift, tension shift, breath rate shift - that is your cue, and the implementation of the 3 Ns. The first n is notice. What about it? Notice where that negative thought is in the body, hear me on this one. When you have a very punishing or repetitive thought, or you have a very strong emotion or a physical sensation, notice where in the body. That's step 1. The second step you want to notice, when you're in that notice phase is to ask yourself “What is the size, shape and even color of that sensation?” So, let's just say, let's keep it simple. I have a negative thought like “I don't know whether this is going to work. This is ridiculous. What's the matter with me?” Take that thought and find it in your body. Because why do you do that? Because when you can take a thought, and or an emotion and finding your body now it becomes tangible. You can actually work with it. Because now it's no longer scary and is out there but you notice exactly where it is. So notice where that thought, that emotion is in your body. So notice the location of it. Next notice the size, shape, and even quality of it. Is it burning, stabbing, aching? Is it like the size of a grapefruit? Is it a size of an avocado? Whatever it is. Where is, the size, shape, and I love asking this color… What is the color of that sensation? And people go “Why do you ask that?” Because it's kind of fun. It's the human experience I like to have fun when I play when I do this work. That's the first segment of notice. Notice what is showing up and where in your body. Notice the size, shape, color and even quality of that sensation. Why do we have to do all the steps, Les? It's because this is a skill to reparent your nervous system from a place of compassion and a place of understanding. Because if we show up with fear we're going to amplify everything else. If you can show up with a sense of distancing what the sky and all the clouds behind it and in the storm, we don't get caught up in it. So noticing is a step of getting some distance because you're not your thoughts, you are not your emotions, and you're not your physical sensations. You are the observer. Second step Name it to tame it. “What about it, Les?” Name your physiological state. “What do you mean, Les?” The three physiological states 1. Are you safe? Are you stressed? Or 3. Are you in shut down? “I don't know, I guess you're irritating me. I'm stressed now.” All right, great. So in the name it just say like “I guess I'm activated.” You can simply say that. “I'm activated. I'm feeling like I'm shutting down.” So name your physiological state. This is based on the polyvagal theory. So, if my patients said “I don't know, it just that's too complex.” So I simply tell them “In the name it phase just say ‘activated’.” And then then what? In the name it the second part, you want to go like “What is the emotion that best associate with that sensation?” You're feeling you know “I don't think this is going to work. I'm so stupid. What's the matter with me?” So maybe I notice the size of it – it’s a grapefruit, the color of it is red, and maybe black inside of it. It's stabbing and turning and churning. Name it to tame it: ‘activated’. “So this is what fear feels like. Wow! So this is what fear feels like inside of me.” You then go to the last step: Nurture your tormentors. And so what that means is your thoughts, emotions, sensations are all fired up. There's a very clear step here in the nurture part. So I'd like everyone to do this with me. This is very often therapists kind of get this wrong, so I'm not bagging on them, I'm just saying is we need to follow the physiology. So I don't want my patients talking to the sensations. For example, I just mentioned “What's the matter with me? I feel it my chest. It's size of a grapefruit. It's red and black I'm activated. This is what fear feels like.” You're like “Wow, this is a lot of steps.” This is a skill. You get to the nurture part. You want to do three things 1. breathe intentionally slowly, 2. rub or touch, rub or tap, and then after 3 to 5 breaths then 3. talk in a soothing manner to that child that showed up. So, let's run through it is basically in the nurture part is, I like to tap, some people don't like to tap. So I'm intentionally breathing, I'm focusing… “So who am I talking to, Les?” I'm talking to that physical sensation that I just talked about in the Notice section. So you can rub, you’re intentionally breathing, touching, which means rub or tap, after 3 to 5 breaths of feeling the rub, the breath, and focusing on what showed up specifically in your body, then and then only after you feel settling down, then you say “What would be something soothing?” And here's what I would suggest “It's okay. It's okay. Settle down, settle down right here, I'm right here for you. I'm right here with you. I am here.” I repeat that over and over again. “I'm right here for you. Right here with you. I'm right…” “What are you doing, Les?” I'm talking to that child. I'm talking to that thought emotion, sensation which is basically your nervous system. And in that moment you are showing up differently and relating differently to what showed up and that is neuroplasticity.

58:44
Dr. Maya Novak:
Oh, this is beautiful. And before we start recording you said that we have 90 seconds before we go into automatic response, right?

58:58
Les Aria, PhD:
Yeah, yeah.

58:59
Dr. Maya Novak:
So what you just described it's kind of we don't need a lot of time, 5, 10 minutes. We really need just a few moments and once we get used to the process it's like this [snaps the fingers]. It's really quick. So what I would like you to also tell the listeners is that this is really learning the process. So don't get discouraged if you are not successful right away. Would you agree or how do you explain this to your patients?

59:37
Les Aria, PhD:
Yeah, I know, great again. The 90-second thing… I just want everyone to know so we can give credit to the right person. The 90-second thing really comes out of the work of Dr. Jill Bolte. Dr. Jill Bolte Taylor a Harvard trained neuroscientist. And she had a stroke in the late 1990s and she had to retrain her brain and to kind of process things, and do things. And out of that book and I can look it up, she basically talks about this 90 seconds integral. And so I start to look into it because I was experiencing it that if I can sit with a very troubling thought, leaning into the thought, dipping my toes into that emotional pool, just dipping my toes and maybe my ankles but not emerging into it. But you have 90 seconds. So here's what happens. Your brain senses and tenses your body. So how does your brain sense? So the research shows us in brain science that the brain uses all our 5 senses and it also listens to our thinking. And so check this out. When you notice a mood shift, tension that shows up in your body, and or your breath rate change at that point the 90 second clock starts “Go!” Here's a sad part and scary part, new researcher came out that said by the time you like “Oh my gosh, I'm getting anxious,” by the time you actually believe or hear that thought, 7 seconds has gone by. The middle part of the brain, one of the primitive parts, the brainstem and then the emotional brain… The brainstem and emotional brain got that message 7 seconds before you experienced it. 7 seconds. So now we have 83 seconds. So and as I tease my patients “Oh my god, I got less… 7 seconds.” It's okay.

01:01:26
Dr. Maya Novak:
“Let's stress about it! Quick - we have to be stressed out.”

01:01:29
Les Aria, PhD:
Yeah, exactly! They're like “Oh great, why did you tell me that?” “No, no, no. This is beautiful because you don't even need 83 seconds.” You said it so right. The more you practice this, it takes me less than 10 seconds to do the 3 Ns because it's so fluid, right? Because it's become a habit, and I'm trying to have people create a pain recovery habit. Just like the pain habit and trauma habit, we can create a pain recovery habit. It's called implementing these skills, right? So with that said I want everyone to know that when you notice a mood shift, tension shift, or breath rate shift all you have to do is notice where in the body, say “Activated” and then lean into the thing that you don't want to lean into. The negative font. And when you're talking, you're not talking to the universe, you're talking to the body sensation that showed up. That's why it's important if you ever thought that's unhelpful, find it in the body. Because your body, when you have a thought, your body actually experiences it too. And so with that said when you just simply… “Les, I can't remember all of that!” Can you remember this: breathe, touch, talk? Just start to slow your breath down, find the sensation in your body, just start tapping or touching. Intuitively when we hold a child that's crying, we rub or do this [taps]. Because neurologically when we tap or rub it slows the C fiber messages up the spine into the brain… blah, blah, blah. It basically reduces pain signals. And so rubbing or tapping. So breathe, touch, and then talk. “What do I say? I don't know. I never had loving parents.” Do you know how to talk to a child or a dog that's scared? And so use soothing talks and you said it best “What do you need from me? How can I help?” Whenever I have a negative thought I often say this “What can I do to support you? What can I do to help you?” “Well I just need you to do this.” “Okay, sounds like you're really, really trying to help me but I got this. Would you like to hum or whistle inside of me? So breathe with me.” So breathe, touch, talk. If you simply do those 3 things, if it's too complicated for you to do the 3 Ns, breathe, touch, talk is a way of somatically grounding yourself with any grounding skill. And in less than 80 seconds you will start to dial down. Now a little disclaimer here. Many of my patients they do this “That’s great, I did it but hey, you know what I felt a little bit better, but the pain didn’t go away or the negative thought didn’t go away. “ My skills that I teach people to transform the nervous system is not to get rid of anything. I want to define this: to heal is to integrate, not segregate. When you're trying to heal you cannot say “I don't want that, I don't need this.” You take the good, the bad, the ugly, and the funny inside of you and you welcome it. So welcome the unwelcomed and in welcoming the unwelcomed in less than 90 seconds you will start to train your brain into pain recovery and trauma recovery and that's called neuroplasticity.

01:04:41
Dr. Maya Novak:
This is so important what you just described. Because I can almost hear it from people “You know, it's like a magic pill. So I just did it and now I'm still in pain and still have negative thoughts and stuff,” so great that you explained this. And it's really about first of all surrendering to the process and not being oriented, time oriented, like “I have to be free of pain by that date!” Because then you are just stressing out “Oh the date is coming and things are not improving.” And then just really learning how to talk to yourself to be that kind parent, friend, cheerleader, someone who is always in your corner.

01:05:27
Les Aria, PhD:
Beautiful and that I love that word someone in your corner. If you're not for you who is for you? If you cannot parent your inner children then who will parent? Are you waiting for your neighbor, your doctor your therapist? They're all good people to help you, they're there to support you, but it's an inside job and it's your job. No one's responsibility and I want to say this, remember I told I had like over 200 sayings that my patients wrote actually. And so one of my other sayings is this “You cannot have authority over your mind and body without responsibility.” You cannot expect your real children in life to love you and come to you when you've actually been abusive to them and not loving them and being you know, constantly hypocritical of them. In the same way I treat my real children - I have two kids, Sebastian and Ashley. 2 amazing human beings and I've invested a lot of time in training them to be good human beings and kind to themselves. Here's what I want everyone to know: the way I treat my real children is the way I treat my inner children. And the way I treat my inner children is how I treat my real children. So the point here is when you take time to invest in the safety physiology of the mind and body, your crops, your recovery will come, and someday the way it came from me was all of a sudden it just showed up. “I want that!” Take a look at your life and balance your life. Whenever we have trauma and chronic pain that continues to imperil us it's because there's something imbalanced in your life. Your life is showing up in your body. Are you?

01:06:57
Dr. Maya Novak:
Yes, and sometimes we have to be really honest with ourselves in regard to how we are talking to others. It actually tells a lot about ourselves. So if we are criticizing others and being negative, it's impossible that we are very welcoming and kind to ourselves. And the other thing is sometimes I hear people say “Well no, I'm great with myself. I'm so kind to myself.” And I think that what's in that moment, what we can do is: take off all your clothes and go stand in front of the mirror and just listen.

01:07:38
Les Aria, PhD:
Beautiful.

01:07:39
Dr. Maya Novak:
And just listen because when no one is watching and listening then we get out what we are actually saying to ourselves and all of our children.

01:07:51
Les Aria, PhD:
That's fantastic. What a great experiential exercise to get to the real matter of the heart, and the heart of the matter. Beautifully said.

01:07:58
Dr. Maya Novak:
Yeah, yeah. Oh, Les, we talked about so many things, and I would love to talk to you for the next three hours but we don't have time right now. But let me ask you this: out of all of this or maybe something extra, what is your number 1 advice that you would give someone who is right now recovering, and it's suffering, and is in pain?

01:08:23
Les Aria, PhD:
The number 1 thing is basically I want you guys to realize that if you're suffering, it’s triggering thoughts and emotions and physical sensations, know that practice is the drive changer of the nervous system. And one more thing, besides practice being the drive changer of the nervous system - it means that you have to show up and keep doing it. Be kind to yourself and be a prisoner of hope with practice.

01:08:48
Dr. Maya Novak:
Beautifully said. Now I have one last question which is a bit out of the box. So, if you were stuck on a desert island with an injury and could bring only 1 thing with you to help you to heal amazingly well, what would that be and why?

01:09:05
Les Aria, PhD:
That's great. That's ah, that's a really, really, really tough question. Probably my chocolate lab. Big, funny, loves me no matter what I say to him or what he experience. He’s a great companion and makes me laugh with his goofy play.

01:09:26
Dr. Maya Novak:
Which is what we need during recovery! And it helps you to practice that kind loving relationship with yourself, like “It's okay, we're fine.”

01:09:29
Les Aria, PhD:
Yeah.

01:09:30
Dr. Maya Novak:
Where can people find more about you, about your work, about your platform? Please share with us so that people can now, after this episode, go and discover even more.

01:09:51
Les Aria, PhD:
Yeah, fantastic, and happy to help communicate to anyone who needs help. And so you can go to my website at lesariaphd.com or they can go to my website www.menda.health. There you go.

01:10:15
Dr. Maya Novak:
Thank you, Les! I so enjoyed our conversation. I know that listeners got so much out of it. So thank you for being here. Thank you for all the insights, knowledge, and also the implementation time and what you shared.

01:10:29
Les Aria, PhD:
Yeah, thank you very much to you and your audience.

1:10:33
Dr. Maya Novak:
So this was Les Aria on The Mindful Injury Recovery Talks. If you enjoyed this conversation, know that there are new episodes released every week, so make sure you hit that subscribe button on whatever platform you’re using to tune in. And I’m thanking you in advance – with a cherry on top - for leave a review. Your review will help us reach even more people who should be hearing these lessons.
Now in regards to healing - 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 built on cutting-edge new research, centuries-old knowledge, and years of personal experience. It’s in part a step-by-step guide to applying my Mindful Injury Recovery Method, and in part a raw, relatable memoir of overcoming physical and psychological trauma. To find out more about it go to healbeyondexpectations.com or jump to Amazon and search for the title – 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.