Full Engagement in DOCC

Scott was a 50 year-old architect who had been experiencing low back pain for about three years. It was not clear what had started it. The pain was difficult, but he remained very active, riding his bike on a daily basis and working out in the gym several times a week. He continued to work.

When he saw me, we discovered that he had no clearly identifiable structural problem. I discussed the DOCC program with him and explained to him that it was important for him to “calm down” his nervous system before the soft tissues could be effectively addressed. He agreed to give it a try.

We started off with some strategies to improve his sleep. When you’re in chronic pain, getting a good amount of sleep is vital: it increases coping skills and usually diminishes the perception of pain. I often treat patients with short-term sleep medication to get them on track initially. Scott required sleeping meds for about three months. His sense of well being improved, although in his case, the pain remained unchanged.

Next, we began to delve into some stress-related issues. He grudgingly began doing the writing exercises prescribed by the DOCC Project. He revealed that he had experienced significant anxiety most of his life and that, lately, it was spiraling out of control. His business was suffering; his marriage was in trouble; he was in conflict with his son over the son’s future. Much of his anxiety was created by his controlling tendencies. I had him re-engage with his psychiatrist for medications and also had him work with a pain psychologist.

One trait in Scott’s favor was his strong determination to get better. He did not want to spend the rest of his life with this level of pain and suffering. His suffering became even more severe for the first three months with increased pain, anxiety, and depression. Although the writing exercises are simple, it is a difficult process. We all have ways of covering up our anxieties and frustrations. Seeing them on paper initially is disconcerting. He began to realize how much he dealt with his anxiety by controlling circumstances and people close to him. His nervous system became more “fired up,” which increased his perception of the pain. But after six months of full engagement in the DOCC program, Scott made it through. His anxiety and depression improved. He did not need much physical therapy as he was in such good shape. He acknowledged some deep anger problems that he had not seen and took full responsibility. He was finally pain free. The greatest benefit, though, was that with the stress management skills he’d acquired, he was able to experience the kind of rich and full life with his family that he’d never thought possible. With the “reprogramming” skills outlined later in this book you are able to experience anxiety and anger without having them run your life. He was able to relax enough to actually listen to his family and enjoy being around them. They were able to enjoy being around him. It has not been a straight line up, but he is well on his way to creating a new life for himself.