How To Reduce Nervous System Windup

With the now clear understanding that IC/BPS is not a bladder disease but rather a chronic pelvic pain condition (AUA 2022 IC/BPS Guidelines), treatment has expanded beyond the bladder to the nervous system and reducing the chronic “fight or flight” which has been found in patients struggling with multiple pain conditions. What can we do to calm our nervous system and break out of “fight or flight”? We encourage you to participate in classes and/or courses in your community and, ideally, to work with a therapist who specializes in anxiety and stress management. Here are some techniques that you can do at home.

Reflexercise®

Developed by Scott Musgrave, Reflexercise® can calm the vagal nerve response. It’s simple to do and basically reminds your body, through its position, to leave the fight or flight response. When standing:

  1. Curl your toes into the ground, as if you are gripping the surface. You are not running away, you are anchored to the ground.
  2. Open your arms to the side, with palms facing forward. Your hands are not clenched, but relaxed and open. The front of your body is open and receptive, not hunched over or hidden by your arms
  3. Turn your head from one side to the other, gently loosening your neck.
  4. Close your eyes.
  5. Put your tongue between your teeth.
  6. Take three deep breaths and, at the end, think about something that you love.

The Power Pose

Remind your body what it feels like to be in control. Amy Cuddy gave a fabulous TED talk about how body posture influences your attitude, brain and nervous system. Stand tall, legs spread, chin up and with your arms on your hips. (i.e. the wonder woman pose) Make yourself big. Hold the position for two minutes. This position increases testosterone (and courage), while decreasing cortisol. It can help reverse adrenal fatigue and will increase your sense of confidence. Even if you’d don’t feel powerful, fake it. Anytime you have to walk into a situation where you might feel powerless, do a power pose before hand.

Diaphragmatic breathing

Taking a minute or two to take some deep, diaphragmatic (belly) breaths will calm the nervous system. The exhalation should be longer than the inhalation. Better yet, sing along to the radio or your favorite song. Singing encourages slowing down the breath and increases your exhalation on.

Inversion

Lay on the floor and put your legs on a couch or wall. This creates a nice increase of blood flow to the brain and lymphatic system which can also improve anxiety and depression if held for 15 minutes a day. You must make sure that it is ok with your doctor to this, particularly if you struggle with blood pressure issues.

Healing the Nervous System

When a physician suggests that a patient get “therapy”, it’s infuriating to the patient. Of course, any suggestion that implies that our pain is the result of mental illness is met with anger, fear, frustration and, in some cases, rage. The problem is that they don’t tell you why it’s important. Programs that can calm the nervous system and ease anxiety can and will help with pain processing. They aren’t suggesting that you are mentally ill. They are suggesting something which has been proven to help calm the nervous system.

Emotional Freedom Technique (Tapping)

Dr. Milspaw swears by the use of EFT, a form of psychological acu- pressure that actually helps turn off the amygdala and stress response. EFT uses fingertip tapping at meridian points (energy hot spots) to balance energy by sending signals to the part of the brain that controls stress. It can and should be used when you are feeling anxious, stressed or would like to address a specific issue. It has been studied with veterans struggling with PTSD and within one month, these patients had significantly reduced their stress and some no longer struggled with PTSD.

EFT should be used on one problem at a time.

Step 1: Identify the issue. What pain or fear would you like to work on. This will be your focus while your tapping. (i.e. I have bladder and pelvic pain).

Step 2: Rate your initial fear on a scale of one to ten, with ten being the most difficult. If, at the end of tapping, your fear intensity has dropped to a 5, that’s a 50% improvement.

Step 3: Pick a phrase that explains what you are trying to address and that you accept yourself despite the problem. “Even though I have bladder pain, I deeply and com- pletely accept myself.”

Step 4: Tap each meridian point seven times as you repeat your statement. As you tap on the meridien, it signals a signal to the amygdala to turn itself off.

  • Start at the karate chop point on the side of your hand. Tap 7 times, while repeating your phrase. You can do one or both hands. Repeat this sequence three times.
  • Move to your eyebrows, just where the hair begins above your nose. Tap 5 to 7 times and say “Even though I have bladder pain, I deeply and completely accept myself.” Repeat three times.
  • Move to the side of your eyes (not the temple) and tap 5 to 7 times. You can do one or both sides at the same time. Repeat your phrase.
  • Move under the eye, at the top of your cheeks. Tap 5 to 7 times, repeating your phrase.
  • Move under the nose, and tap 5 to 7 times, repeating your phrase
  • Under the mouth, tap 5 to 7 times, repeating your phrase.
  • Move to an inch below your collar bone, on both sides. Tap 5 to 7 times, repeating your phrase.
  • Move to under your armpit, at the bra line for women. Tap 5 to 7 times, repeating your phrase.
  • Finally, move to the top of your head. Tap 5 to 7 times and repeat your phrase.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a way to update the software of our brain by focusing on the present. It challenges the mind with positive thoughts rather than catastrophic negative thoughts, which then calms the amygdala and promotes systemic healing. Positive affirmations are essential. “I am in the process of healing.” or “I am finding balance in every step that I take.”

With the help of a CBT trained therapist, patients will focus on current problems and finding solutions for them. It does not deal primarily with the past. Cognitive behavioral therapy focuses on what is happening today and identifying and changing current distressing thought and behavioral patterns. While popular, it has a high relapse rate because it doesn’t focus on healing the nervous system.

Mindfulness

Is your mind full? Or are you mindful? Mindfulness is physical therapy for the brain and focuses on healing the nervous system. The more calm and peace we teach our brain, the more we react to life stressors with that same sense of calm. Rather than focusing on the past or on anxiety, mindfulness focuses your brain and all of your senses on the present moment. Mindfulness is about being curious, amazed and wondrous about the nature around us.  It is remarkably effective. Research studies have shown that it elevates Brain Derived Neurotrophic Factor (BDNF), the molecule that jumpstarts neuroplasticity and the formation of new neurons in the brain. It also lowers inflammation and increases brain volume.

Dr. Milspaw explained that it can also work quickly. “Mindfulness techniques can begin to heal the physiological changes in the brain from chronic stress, trauma and pain within ten days. But, ten days of negative stress can cause brain changes as well,” she said, “It’s a lifestyle. We have to move, stay healthy and train our brains to be present.”

There are two approaches to mindfulness: active or meditative. She said “Active exercises seem more effective for chronic pain than meditative exercises… In order to get the anti-inflammatory and neuro-regenerative benefits of exercise, you have to actually pay attention to what you are doing.” This can include:

  • Breathwork/Singing
  • Progressive Relaxation
  • Mindful Eating and Drinking
  • Swimming
  • Creative Arts
  • Sense focused touch
  • Yoga and qi gong
  • Playing an instrument
  • Playing ping pong
  • Playing red light, green light
  • Playing Simon Says\
  • Brushing your teeth or any activity with the non dominant hand
  • Walking super slowly.

Eye Spy

The Eye Spy technique engages all of your senses and your brain.

  • Look around and notice what you see – Take a breath
  • What do you smell? – Take a breath
  • What do you hear? – Take a breath
  • What do you taste? – Take a breath
  • What do you feel with your fingertips? – Take a breath
  • Now imagine seeing something that usually brings a smile to your face. – Take a breath
  • Imagine hearing something that usually brings a smile to your face – Take a breath
  • Imagine smelling something that brings a smile to your face – Take a breath
  • Imagine tasting something that brings a smile to your face – Take a breath
  • Imagine feeling something that brings a smile to your face – Take a breath

Which of the senses felt the most powerful and were the easiest to access? This is your most powerful sense and probably how you learn. This is also how you can anchor yourself and create a safe place for relaxing.

Bumblebee Breathing Exercise

Inhale completely and then exhale and hum or make your lips buzz as long as possible. Or, you can breathe in and then sigh it out. Try moving up the scale to lift your vocal chords. This can help uplift your spirit and emotions.

Visualizations

If you’ve ever watched an athlete prepare for a possible gold medal performance, you often see them visualizing and/or rehearsing in their mind what they are planning to do. Dr. Milspaw said “The mind can guide neural connections. Visualization is used in sports psychology, hypnosis and neurolinguistic programming.” If we can imagine doing something, our brain is experiencing it and we’re telling the brain what we want it to do. For the pain patient, this might include visualizing an excellent and productive doctors appointment before you walk into the office or visualizing an easy, pain free and successful test. She encouraged the use of imagery and metaphors, such as visualizing a microscopic army moving to your bladder and fighting any infection or disease present. Or, it could be as simple as weeding out negative thoughts by visualizing a garden.

Author: Jill H. Osborne
Adapted From “Chronic Overlapping Pain Conditions.” IC Optimist. Fall 2020 pages 5-15
Created: September 27, 2022 – jho