Each of us has first hand experience with the body’s abilities to heal itself. No ones life is free from injury and pain, and we have observed the incredible process of our cuts being repaired and our illnesses fought off. The process seems nothing short of miraculous. As extraordinary as it is, there are many factors which facilitate or hinder the process. Some of these factors are under our own control and can be influenced by of our thoughts and emotions. This is what I wish to address here. Recent research with surgery patients has made it clear how important ones mental state is in the healing process. Some of the most exciting findings are that patients who are prepared psychologically for surgery experience less pain, less distress, and quicker recovery.

What is psychological preparation? Surprisingly, it can be as simple as learning to relax. Several studies have shown that pre-surgical relaxation training produced striking benefits, like less need for anesthesia and quicker healing. A more thorough examination of the literature reveals that patients prepared with training in stress management, psychologically-based pain control techniques and/or therapies to increase optimism have an easier time of surgery and a quicker recovery.

Surgery creates a less than optimal situation for healing because it is so stressful. The mere thought of surgery is often very scary. The reason for needing surgery can be frightening. The need for surgery implies that something is so wrong that it is beyond the body’s normal healing capacity. In addition, the anticipation of surgery is so full of uncertainty and possible problems that anyone would become nervous: thoughts of being admitted to the hospital, undergoing a painful procedure, things that could go wrong, how long you will be laid up afterwards, how your family will do without you while you are away and so on. Having surgery is not an everyday event so there are many unknowns for you. It adds up to being very stressful and, at a time like this, the last thing you need is more stress.

Some of the research I mentioned agrees that stress is not at all helpful for surgery and the healing process . Evidence suggests that patients with greater distress and anxiety before an operation were more likely to have slower recovery afterward and more complications from surgery. This can happen in a variety of ways. Emotions like fear, anxiety and stress can directly alter the immune system so that the early stages of healing are slowed. Stress can also have an indirect negative effect. Not sleeping well due to stress and worry can alter the hormones that are needed for healing. In addition, people who smoke or drink alcohol often increase these activities under stress which further depletes the body’s healing resources.

The anticipation of pain increases stress which in turn actually increases the amount of pain experienced. It has been found that anxious or stressed patients need more anesthesia during and after surgery. As it happens, higher doses of anesthesia have a negative impact on immune and endocrine responses that further retards healing.

Another psychological variable that influences surgical outcome is optimism. Optimism has the effect of accelerating the recovery process. Put simply, patients who are confident that things will go well for them actually do better in surgery. Even when patients are in worse physical shape prior to surgery, being optimistic appears quite beneficial. On the other hand, those who are depressed before surgery take a longer time to recover. Depression often includes a gloomy outlook that can be considered the opposite of optimism.

These results suggest that you can improve the likelihood of a positive surgical outcome by 1) becoming better able to manage the stress surrounding surgery, 2) becoming familiar with pain control techniques, and 3) having a more positive, optimistic outlook about your prospects. If you do these things you will become what is known as an empowered patient. An empowered patient is one who has learned to be an active participant in the entire healing process from preparation for surgery through recovery and rehabilitation.

One theory on the negative impact of stress on the immune system and the healing process suggests that the body has limited resources for defending itself. We have large threats, like finances and traffic, and small threats, like bacteria and viruses. Since the body’s energy for defense are limited, it can’t to do well with both simultaneously. An immediate large scale threat evokes the stress reaction which diverts energy from the micro defense system of the immune system and healing resources. Therefore, decreasing your stress response will free more of your body’s defense energies for healing.

We all know the feel of stress. Any frightful event will produce an immediate stress response preparing your body and mind for the emergency. Suddenly wide awake, heart racing, muscles tight, you feel ready for action. We recognize this stress reaction as not a normal state. However, two facts can make stress a very dangerous condition. First, stress accumulates. A barrage of smaller stressors can build slowly into an extreme stress state. The second dangerous fact is that we get used to stress. We can become so accustomed to being stressed that we no longer notice what an extreme state we are in functioning in. This is when systems break down and diseases occur.

There are three basic strategies for managing stress, each equally important. Complete stress management will utilize all three. The first strategy is learning to counter the stress reaction with relaxation. Relaxation lowers heart rate and blood pressure, releases muscle tension, restores immune and endocrine functions, improves breathing and digestion. It is the opposite of the stress reaction. It is also an excellent way to connect you to your physical self in a positive, nurturing way. There are many approaches to relaxing. I have reviewed the many approaches to relaxation in an earlier chat. (It can be found under “resources” at my web site: www.drborrie.com). It is important to realize that relaxing is a skill that requires practice. Also remember that being relaxed is a temporary state and requires frequent repetition. You might ask “Why bother if it doesn’t last?”

I like to explain it with the following analogy. Imagine holding a glass under a running tap. Think of the glass as you and the water flowing in as the stressors of your life. It doesn’t take long before the glass is full and overflowing. Water spilling out as fast as it pours in. You are not able to handle the demands being thrown at you. Taking time to relax is like carefully dumping the water from the glass where you want it and then returning the glass under the stress tap. It doesn’t stop the flow of demands that stress you but now you are able to handle it. Taking a short break to remove the effects of stress permits you to handle those demands again. At least for a while, because depending on the flow of stress from your tap, you will need to relax and empty your glass regularly.

The second basic strategy for managing stress is improving your coping skills for dealing with specific stressors. This requires assessing the sources of your stress in your life and examining each for how to increase the effectiveness with which you manage it. While everyone has a unique set of stressors, there are many common factors. Those facing surgery share many common stress factors. These include:

questions about the need for surgery and possible alternative treatments
uncertainty about the procedures
worry about the outcome
the possibilities of pain
wondering about the recovery
imagining how you will be afterwards
how your family will be
fears of death
dealing with all the preparations for the surgery and period of convalescence
wondering who will take care of the things you usually do
Most of these stressors revolve around the uncertainty of the situation and the future. More effective handling of these comes from become a better information gatherer, which includes learning to identify your questions, expressing those concerns to the appropriate people, listening carefully to explanations, and going for clarification when information is unclear. When a question or concern arises, start by writing it down. This way you won’t forget it when the right person to ask is available. Your list of questions becomes a “to do” list of information to be gathered. When you are working from a list it is easier to ask more clearly, without emotional overtones that can interfere with communication. When you are working with a busy doctor, let him know you have a list of questions and want each of them addressed.

People are frequently our biggest stressors, so learning to communicate better is an important skill. Communication involves only two basic elements - expressing and receiving information - but it is amazing how frequently the process can break down. In addition to communicating your questions, you want to express your needs, wants and emotions. Recent research has proven that expressing emotionally traumatic experiences actually enhances your immune function. Surgery can often qualify as an emotionally traumatic event. Talk about your fears and concerns to those you trust.

As mentioned above, both pain and the anticipation of pain are major stressors. As I have mentioned in a prior chat (also archived under “resources” on my web site - www.drborrie.com), there are ways to reduce pain without medication that are fairly easily learned. Relaxation and hypnosis are two such techniques that do reduce pain. It is also important to discuss concerns about pain with your doctor. Simply knowing how much pain to expect and knowing that pain killers are readily available decreases the stress and increases your sense of control even if you never use the pain killers.

The third basic stress management strategy begins with the question “How does some event occurring outside us become something we wear physically?” While each of us wears our stress slightly differently, all stress enters through our minds. Your appraisal or interpretation of events is what determines whether something is stressful or not. Stress is caused by the importance you place on an event and the degree to which you perceive that a demand exceeds your capacity to handle it. By changing your perception of an event’s importance or our ability to cope, you change its stress power. To do this you must identify the judgments you are making that give events their stress power, and then consciously work to change your interpretation to a less stressful one. This will also increase your feelings of control.

This area of stress management is also where increasing optimism can be developed. A crucial element to feeling more optimist and fending off depression is to feel you have some control. Often surgery tends to rob of any sense of control. Everything is being done by others, even the healing is up to the doctors. The patient can come to feel like an object for them to work on. You can avoid this kind of thinking by focusing on all the ways you can participate in the process, like practicing relaxation and gathering information to reduce the uncertainties. When I am working with a pre-surgery patient, we will work on developing self-hypnosis skills and mentally rehearse the entire scenario from the present through the surgical procedure and subsequent recovery and rehabilitation. All of this is done from the most optimistic perspective of everything going extremely well.

Special problems and concerns are addressed in this mental rehearsal to increase confidence and optimize the outcome. For instance, one patient, anticipating a lengthy surgery, was told she would need about seven units of blood. She prepared by giving enough blood in advance and by mentally rehearsing shunting the blood away from the surgery sight during the procedure, even while under anesthesia. The surgeons were surprised, but she wasn’t , when she required only one unit of her blood.

When I develop imagery with these patients I usually start them with the idea of seeing themselves well into the future, perhaps a year or two ahead. From there they can look back at all they went through, all they did, and how well it went. From their perspective of being done with the ordeal and on with their lives, they are able to increase their confidence. Surgery and healing are now an old accomplishments. Remember, it is your body that is the expert in healing and knows how to do it better than the doctor. The doctor is there to assist.

I am currently putting together a Surgical Readiness Program but it will not be ready until Spring or Summer 2001. If you are facing surgery now you can benefit from learning relaxation skills from Relaxing on the Run and psychologically-based pain management skills from The Mastering Pain Series.

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