Surgical Preparation: Specific Details.

Recently we have been writing posts about preparing patients for surgery. Benefits can be mental, but our focus has been on learning mind-focused ways to improve patient’s physical reactions during and after surgery.

We found that many published studies indicate that outcomes are significantly improved in patients who were given presurgical training. For example, patients lose remarkably less blood if they are taught how to move the blood away from the spine during the surgery and then have it return to the spine to facilitate healing after surgery.

At this point, many readers may be thinking that there is no way for the mind to move blood around in the body. Patients who are being trained tend to feel that way too.

An important step is to explain how that can happen. Scientifically designed studies are normally kept very simple, but in clinical practice the methods may be more complex. A common method used in research is pointing out that our minds often trigger movement of blood. Remind the trainee that most people blush when they are embarrassed. We also move blood to our genitals by having erotic fantasies. You can direct your blood to your hands by relaxing, suggesting that your blood is flowing down your arm into your hands, and picturing the suggested flow. This is not at all remarkable, the “fight or flight” reaction includes moving blood away from the periphery of your body. Relaxation inhibits the “fight or flight” reaction, so it makes blood flow to the hands.

There is much more evidence that the mind can control supposedly “involuntary” bodily reactions, but for this post we want to describe Debbie’s experiences with preparing patients to deal with upcoming surgery. Like most clinicians, she uses methods that go far beyond the simple methods assessed in published studies.

In her words:

“As a therapist I had remarkable success in assisting some of my patients to prepare for surgery or other medical procedures.

In therapy sessions, I begin by having the patient talk about the surgery and what the aim or primary goal is particularly from their perspective. We explore any feelings or concerns that they have about the surgery. What is their relationship with the medical people including the surgeon? Have they had surgery in the past and how did it go? Were there any complications? Have there previously been any poor outcomes.

The potential benefits of preparing psychologically in advance of the surgery are explained. I cite examples from published literature and describe my own experiences with other patients to explain how beneficial preparation can be. If for example the patient does not trust the medical field or has had bad experiences, we work to come to some sort of peace with it, enough that this does not transfer to the present situation. If they have had bad outcomes from surgery we explore this together to see if there are differences in the present situation.

We talk about mentally shifting to a place where the patient can see the medical team as being there to help them achieve their objectives.

We discuss how getting to a place where they are trusting of the medical provider makes it possible for their body to cooperate with the surgeon and not fight against her/him. It is understandable that at some level the body will protest being cut into and it is best to get the surgeon and patient working together, helping the body to relax.

The patient  tries to find out as much as possible about the surgery and what the procedure consists of, including a description of the steps along the way.

The patient  learns some form of relaxation procedure and oftentimes  is provided an audio to practice at home. In the counseling sessions I use the same relaxation procedure and while the patient is relaxed begin to guide them in imagining the surgery and positive outcomes. I provide some of the “script” but also encourage them to offer input and improve it.

I re-emphasize that the surgeon is here to help the patient and cooperating with him/her is what is needed now. Usually they visualize the knife entering their body for a noble purpose and that the blood at the time moves away from the surgery site.

Surgical steps are reviewed and how particularly the patient, the surgeon and the patient’s body are cooperating. They visualize how the area of the body is being “corrected” and how wonderful it will be for the quality of their life and health afterwards.

They imagine the anesthesia wearing off in a pleasant manner. I suggest that, as the anesthesia wears off, they will soon want water and some food. We discuss their body eliminating in a normal way and the body vitals being such that they can soon go home.

Other images might include seeing loved ones arrive to take them home and how soon they see the anticipated surgical improvements. Any rehabilitation services can also be incorporated into the imagery exercise.

Typically, it is best  to have several weeks to prepare for the surgery but have seen benefit in just a few sessions.”

Notice that there are three main devices being used. They are relaxation, imagery and suggestion. This is a triad that can help get you through just about any difficult situation.


For clinical techniques we recommend Stanley Fischer’s “Discovering the Power of Self Hypnosis : A New Approach for Enabling Change And Promoting Healing.” The book was published in 1991, so is likely to be out of print but you can probably get a good used one at at a very low price.

For a very good review of research on the evidence that supports the efficacy of this kind of method for surgical preparation we recommend “Mind-Body Interventions for Surgery: Evidence and Exigency,”published in Advances in Mind-Body Medicine, volume 14, Number 3 in the Summer of 1998, Pages 165-234. You can probably get a copy at little or no cost from your library. Be sure to ask for an interlibrary loan. Reading the article will likely be a challenge unless you have background in scientific writing , including statistical methods.

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Surgical Preparation

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Powers of the Mind 2 : Preparation for Surgery

In our last post we discussed the case of a woman who volunteered to take a drug that has many of the same effects that are produced by adrenalin, the “fight or flight response.” A central feature of this response is faster, stronger heartbeats. As expected, heartbeats increased as volunteers were given increasing dosages of the drug, and the heart rate increased with each increase of drug dosage. Remarkably, the heart rate of the woman at the center of that post suddenly began dropping at about half-way through the study. It continued to slow to the end of the study.

When asked what happened at the unexpected turning point, she said she was a self-taught meditator and had become bored, so started to meditate. The meditation was able to override the powerful effects of the fight or flight reaction. What she did was far enough away from normal expectations that the researchers published a follow-up article focused entirely on this remarkable performance.

Obviously, we shouldn’t make too much out of this work because it involves only one person. It is remarkable, but a very weak basis for a discussion of the “powers of the mind” in general.

There have been many reports of remarkable bodily control on the part of people who had devoted a great deal of their lives engaged in training to have unusual control of mind over body. For example, the Swami Rama was studied at the Menninger Clinic, and was able to do things such as making one part of his hand warm up while cooling a nearby part. He also showed that he could voluntarily stop his heart from pumping. This is impressive, but falls short of scientifically controlled studies with large samples of participants tested.

Many published studies meet these requirements. One interesting category is focused on mind-body techniques for preparing people for surgery. There are several meta-analyses of data from thousands of patients. (Meta-analysis refers to using sophisticated statistical methods for combining the results of many studies. They tell us whether the interventions had a statistically significant effect and how large that effect was.)

These studies have examined the effects of mind-body preparation on a variety of post-surgical outcomes. Here are examples:

1. How many pain pills were needed?

2. What was the emotional state, e.g.  Anxiety level, of the patient?

3. How long before the patient was able to leave the hospital?

4. How long did it take the patient to recover?

5. How much blood did the patient lose?

In general, studies using these outcomes as their measure of success indicate that mind-body interventions lead to statistically significant positive changes. The desirable effects tend to range from small to moderate. That doesn’t sound like much, but they tend to be outcomes that most of us would gladly seek if we were facing surgery.

Particularly interesting are the changes in blood loss during spinal surgery. There is a tendency to lose a lot of blood during such surgery.

A method that involves deep relaxation, suggestion, and guided imagery reduced the average loss by almost a half. We intend to give more details about that method in a later post. The technique is applicable to  many issues other than blood loss.

Note: We are indebted to Henry Dreher’s excellent review of this topic, “Mind-body interventions for surgery: evidence and exigency”.  Advances in Mind-Body Medicine , 1998, 14, 165-234.


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The Powers of the Mind 1

There is a graph that has stayed alive in Jerry’s mind for decades. It was in a study designed to see what happens if a person is given gradual increases in the dosage of isoproterenol, a drug that imitates adrenaline, the familiar “fight or flight” hormone. It is used primarily to deal with abnormally  slow and weak heartbeat  ( bradycardia), and heart block.

(Heart Block is an abnormal heart rhythm in which the heart beats too slowly. In this condition, the electrical signals that tell the heart to contract are blocked between the heart’s upper and lower chambers.)

The study appears to have been a routine one of the “dose-response curve”, to observe changes in heart rate as the dosage of the drug was gradually increased. Isoproterenol works by making changes in the junctions between the nervous system  and the heart muscle.

Not surprisingly, heart rate increased with each increment of the drug dosage, but there was one person whose heart followed the expected pattern as the dose was increased from zero to .1 on to .5 micrograms, but then began slowing down as the dose continued to be increased to 1.0, 2.0, and on to 4.0 micrograms.

The heart rate of the unusual person went from around 68 beats per minute (bpm) before any drug was given, to above 80 bpm at a dosage but then went down steadily to end up at around 53 bpm when the drug was at its top level. At this top dosage the other participants had a heart rate around 90 bpm.

What was going on? When the researchers asked the outlier that question, she said she had become bored and started meditating just before bher heart rate slowed down.

On occasion, there are reports of remarkable bodily control on the part of people who have devoted a great deal of their lives engaged in training that results in unusual control of mind over body. For example a Yogi, the Swami Rama was studied at the Menninger Clinic, and was able to make one part of his hand warm up while cooling a nearby part. He also showed that he could stop his heart from pumping while connected to an electronic device that measured his physiological reactions. This device would make it impossible to do any tricks to give an unreal impression of  bodily control.

If you want more detail on Swami Rama, the person who acted as his personal assistant in the  United States wrote a book, “Swami”, about him. It appears to be out of print, but inexpensive copies are available at

A lesson that we can take from such accomplishments is that regular practice of effective procedures such as meditation  can lead to our developing skills that enable us to gain remarkable control over our minds and bodies.

The woman who lowered her heart rate was able to challenge and defeat the biological system that underlies fight or flight. It is a system that also underlies “losing one’s temper” and even violent acts under some circumstances. It also underlies such things as stage fright, and a score of other things that we might want to bring under our control.

It is interesting to know that the woman who controlled her heart was self- trained. It is usually best to have a trainer, but some people can do well even on their own. The take-home message is that self-control is probably within your reach. The key is “practice, practice, practice”.



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Loving Kindness Meditation: A Practice That May Increase Your Altruism

In our previous post, which was about the Harvard Grant Study, we mentioned that altruism was one of a handful of characteristics associated with good a successful life. We didn’t do much with the topic until Debbie wrote a post on her own experience with altruism, which came to the front and grew while taking care of her mother, who  has Alzheimer’s disease.

Looking back at the book written by George Vaillant on the Harvard Grant Study, we saw that he also had elaborated very little on altruism. He had a few comments on it, but nothing like the space given to other resilience-promoting characteristics.

Both of us thought of giving an account of “Loving Kindness” practice, since a major goal of that kind of meditation is to induce people to love themselves and also to love others.  There is reason to see Loving Kindness Meditation as a way to increase your altruism. This suggests that it might be a manifestation of altruism that has been evaluated with fairly well-controlled research.

What You Can Gain by Practicing Loving Kindness

Here is a short list of examples of benefits of training in Loving Kindness:

1. Reduction of chronic low back pain and accompanying irritability.
2. Lengthening of telomeres, which indicates less biological aging.
3. Reduction of self-criticism.
4. More positive feelings and fewer negative ones
5. Greater improvements than training to be more compassionate.
6. Increases in social connectedness.
7. Relief from symptoms of Post-Traumatic Stress Disorder (PTSD).

How To Do Loving Kindness Meditation

We did a search on Google Scholar and found that there have been many studies on loving kindness, and there was a consistent pattern of Loving Kindness Meditation leading to good results, often better than alternatives.

Our search showed that there are many variations on how to practice this kind of meditation. This suggests that you can be somewhat flexible in the small details of how you choose to do it.

Begin by scanning your body and letting go of any tension you experience. Continuing to breathe in and out and use either one of these traditional phrases or ones you choose yourself. Say or think them several times.

May I be free from inner and outer harm and danger. May I be safe and protected.

May I be free of mental suffering.

May I be happy.

May I be healthy and strong.

May I be able to live in this world happily, peacefully, joyfully, with ease.

Now pick someone who you find easy to apply these phrases to and repeat the exercise.

Next apply them to a neutral person, someone you neither like nor dislike, and then move on to someone you don’t particularly like and have hostile feelings toward.

Take your time do not try to rush your mind and heart.


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Small Acts of Altruism Can Significantly Improve Your Resilience

The last blog post about the Harvard Grant Study really got me to reflect on the adaptive style of altruism and how it has been fitting into my life of late. It strikes me that simple gestures of kindness or help toward others has been an especially effective resilience tool in my life.

I began showing simple signs of altruism in the context of visiting my mother in an assisted living facility that specializes in caring for people with Alzheimer’s.  I found that as the weeks went by, I began to develop relationships with some of the other residents. Simple gestures of help and interest really spurred the development of more authentic relationships despite the presence of some pretty severe levels of communication deficits.

Examples of help include guiding one lady to her room and another to get out of her chair and on to her feet. Interest shown might be asking them about past professions and talking about family and pets. Most of them have moderate to severe memory problems, a few are non-verbal, and agitation is a common product of frustrations in living.

It felt good to be of minor help but also I liked it when big smiles showed on the faces of the otherwise non-expressive. Joining with a woman resident in listening to a pianist playing old time songs, tapping her foot and softly mouthing some of the lyrics is just one minor example. In nice weather several of us would navigate to the deck to enjoy the fresh air, tease each other and recall previous times.

Taking time to engage with each resident seemed such a natural progression and I noticed that I had fewer symptoms of stress in my role as caregiver to my mother. Somehow seeing these individuals as people beyond their disabilities was a gift for both of us.

I also found myself displaying small gestures of kindness to others (outside the long term care facility) more and more often most of the time with strangers that I encountered in daily activities. Of course it was not a daily occurrence but I found myself noticing opportunities and often took advantage of them.

In reflecting on how this might be so helpful in being more resilient it struck me that part of it was pulling myself out of my own internal thoughts and worries to engage with others.Most of the time this led to a momentary nice connection. It also felt good to ease a struggle or a minor problem of another.


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Tips on Resilient Aging 3


(Note: we are dealing with a long chain of  technological failures, so this post was prepared on our iPad. Please forgive errors.)


This is the third of a series of groundbreaking studies dealing with aging that we are covering in this blog-the Harvard Grant Study.

I For many decades there has been a study going on of characteristics leading to overall life success of Harvard students. To give you a sense of how long the study has been taking place, President John Kennedy was one of the undergraduates studied, and it is still going on.

The meaning of “overall life success” was borrowed from Freud, who defined it as the ability to love and to work, i.e. to develop stable loving relationships and a productive, satisfying career.

For many years, the head of the Grant Study was George Vaillant and he published “Adaptation to Life”, a very useful book for anyone interested in details on how others have lived happy, fruitful lives.

Vaillant described several adaptive styles that led to success. Here is a list of them:

1. Anticipation: being aware of future challenges and planning how you will avoid being blinded by them.
2. Suppression: After doing what can be done about difficult circumstances, being able to put them aside and direct your attention to things that are in your control.
3. Humor: People who used humor to help deal with stress did better than the humorless.
4. Altruism: Taking the needs of others seriously, and letting them be important to you in the ways your own needs are important.
5. Sublimation: Fulfilling unconscious yet unacceptable urges by putting your energy into doing something that is socially useful and acceptable that fulfills those urges. Two participants in the study illustrated this contrast. Both went hungry in their youth. One of them became determined to never be deprived again. The other sublimated his feelings by working
for the US Department of Agriculture in the area of food aid.

How can you make use of this information?

Vaillant interpreted the studies within a Freudian framework. He saw these adaptive styles as “defense mechanisms”, which are ways we control our anxieties and keep undesirable desires out of our conscious awareness. Normally defense mechanisms are not seen as controllable by the conscious mind. Our purpose in this blog has never been to do psychotherapy,especially not depth therapy,like psychoanalysis,that attempts to uncover thoughts and feelings from the unconscious. Instead,we teach people to change their thoughts and habits,and even environments,to ones that help them do well in life. Looking at the five items in our list above, here are some ways to put some of them to use without venturing into depth psychology.


Anticipation is looking ahead, and planning for ways we might be able to get control of predictable stressors,then using the results of our planning to maximize good outcomes and minimize bad ones.

Try this: Imagine how you would like to be in the future(for example, six months or a year from now). Imagine the obstacles that might get in the way of your reaching your goals.Pick one of the barriers and plan ways to get past it. When opportunities arise to do this again, repeat with another barrier. Continue this until you can clearly imagine a reasonably smooth path to success.


Suppression is allowing yourself to be aware of your feelings without acting on them. An example of useful suppression: The idea that “I’ll cry tomorrow” allows you to be aware of your sadness, but also allows you to do what you need to do until the time is right for expressing the feeling.


A few decades ago, Norman Cousins, had a disease that his doctors could not cure. He decided to cure himself by watching films that made him laugh. He wrote a book about how this worked out, and felt it was quite successful.

The research literature on the healing effects of laughter, or of humor in general, despite having some evidence of such healing effects, does not lead to sound conclusions. However the use of laughter in common experiences lends support to the idea that laughter is beneficial. Laughter can engage us in ways that enable us to put aside painful thoughts, for a time even painful realities. In the meanwhile our resilience resources can replenish us and give us the stamina to settle the situation.

We need more and better research on various aspects of humor before reaching solid conclusions.

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Tips for Resilient Aging 2

This post is our second in a short series on resilient aging.

In our previous post on successful aging we discussed research indicating that a great deal of the physiological changes thought to be due to aging may be due to shifting toward a sedentary lifestyle.

Giving elderly people a program of gradually increased exercise, stretching, and relaxation can lead to physiological changes that make elders physiologically more like those of the young. Furthermore, paying young people to shift to a sedentary lifestyle leads to physiological profiles more typical of the elderly.

So, to a considerable degree, our biological age can be controlled by adopting the right lifestyle.

One of the things most of us see as inevitably linked to getting older is memory loss. Research done comparing samples of elders versus younger adults has shown that memory is typically less reliable in older people.

However, there are techniques that can markedly improve memory. These are techniques known since ancient times, and still used by “mnemonists”, experts who can do such things as entertain audiences by introducing themselves to each person in a sizeable audience and then accurately remembering each persons name.

If the old are taught these techniques, they can perform as well as or better than younger people who lack the training. This is a pattern that is not limited to memory. Training in well-selected resilience techniques can compensate for a wide range of limitations related to aging.

Two gerontologists, Paul and Margret Baltes developed a model of how losses due to aging can be kept under control. It is called the SOC model, for “Selection, Optimization, and Compensation”.

Selection refers to picking abilities that are important to us and that we are willing to work to maintain. To illustrate selection, the Baltes once used the example of the great violinist, Yehudi Menuhin who was able to perform brilliantly into his elder years, in part by reducing the number of pieces he maintained in his repertoire.

“Selection” is familiar to most of us, since it is basically setting your goals.

The “O” in SOC refers to optimization. This means developing skills or other assets that help you attain your goals.

Resilience training is one such means of developing widely applicable skills and habits that can move you toward the goals you chose during the selection phase. Finding a good place to exercise, or friends to join you in your exercise are other examples.

Compensation is illustrated by another thing that enabled Yehudi Menuhin to keep performing at the highest professional level into advanced age. After deciding which things to keep in his repertoire, he intensified his practice of the musical pieces that remained.

Now what if you are neither a professional musician nor a person close to old age? Well, after developing the SOC model, it was applied to young people and its results were assessed.

The model works for younger people too!

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Tips for Resilient Aging 1

It’s well known that the population of the US and other Developed Countries is getting older, and this shift has many consequences.

A wide range of important stressors increase with age. Elderly people face many losses. Their friends and neighbors die, their appearance tends to drop below social standards for attractiveness, they typically become less agile and peppy. Eventually they often have to let go of their homes and many of their possessions; many people end up in assisted-living facilities with little beyond the things that fit into a small closet or chest.

This is, of course, only a tiny, hapharzardly selected, sample of stressors that tend to accompany the passage of years. Without regard to such details, the old quote from Bette Davis says it all “Getting old ain’t for sissies”. If you are smart, you will prepare for it.

Since it takes time and energy to develop techniques for enhancing resilience and turn them into personal habits, it is fortunate that resilience techniques are also have a myriad of benefits for dealing with any of life’s stages.

Several major studies have influenced our view of techniques that help us respond to aging with resilience. Our plan for this and the next few posts is to describe these influential bodies of evidence.

The first is based on research done by Herbert DeVries and colleagues. and summarized in a book entitled “Vigor Regained”.

DeVries determined “scientifically whether carefully planned and controlled exercise can help restore vigor to older people”, and solidly affirmed that it could. He found that sedentary people, even in their 70s,80s,or 90s were, after training, able to run a nonstop mile.

Continue reading

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Spirituality as a Resilience Asset: the Trapped Chilean Miners

We have not yet discussed the important resilience tool of Spirituality. This can take many forms,but is frequently expressed through ordinary religious practices.

Many people rely on spirituality as the center of their resilience assets. Many others may call upon spirituality only if the situation seems frightening or even desperate.

A perfect example of spirituality used in a dramatic crisis is that of the Chilean Miners who in August 2010 were trapped underground in the San Jose mine for 69 days.The story, narrated by Hector Tobar in his best-selling book, “Deep,Down,Dark” is, as we write, opening as a movie.

Tobar’s book is rich in descriptions of spiritual practices and attitudes that served as resilience tools, sustained the miners and, apparently played an important role in their ability to persevere and recover.

Spirituality helped keep the miners sane and helped them to apply their problem-solving abilities to assist those up top to save them before their health deteriorated beyond recovery.

Hector Tobar aptly titled the chapter where prayer by the miners were first described as “We have Sinned.”

One angry miner cried out for the miners to pray, seeing God as the only way out of the grave situation.

He turned to one Christian miner to lead them in prayer. Although many reacted with surprise and amusement, nevertheless all 33 men, as instructed dropped to their knees to humble themselves before their Creator. The miners came from relatively diverse religious backgrounds. They prayed open eyed, closed eyed, with and without tears.

The prayer leader began by stating “We aren’t the best men, but Lord have pity on us.” This statement had a big effect on several of the miners, leading them to acknowledge silently their sins and faults such as drinking too much, being too quick to anger, not being a good father, and infidelities. The miners were encouraged by the leader to humble themselves before God, asking God to guide the rescuers to them. It was common for the men to commit themselves to begin new lives as better men.

The prayers became a daily ritual which preceded the one very skimpy meal each miner had. Soon the prayers included asking out loud for forgiveness for the misdeeds and failings they delivered to family members at home. This morphed into “self-criticism” sessions with apologies to fellow miners for things such as raising their voice toward another, not helping with retrieving water and displaying anger toward another.

Turning to a more powerful force to help them changed the seemingly impossible situation to one that might set them free. They tried their skills to get free and knew at this point that rescuers were working for their release, but this seemed less than reliable and adequate. This daily prayer ritual brought them closer to each other and helped to create a buffer against all the fears and trials of their daily existence.

It provided some daily meaning to their lives and the expressions of gratitude for at least a short time distracted them from negative thoughts and fears. The communal nature of spirituality fostered the extremely valuable resource of connecting with each other as an asset and a means through troubling and challenging times.

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