1. Getting Started and Ready for Change

Your ability to make a change in your life or achieve a goal depends largely on your attitude, commitment, and motivation to do something about your problem. The decision to maintain or overcome the problem is yours. Taking full responsibility to do something about your problem is the most empowering step you can take.

You have the power to make a change, recover, and grow. Taking responsibility does not mean blaming yourself for the problem, and it does not mean that you have go through it alone!

Ask yourself these questions:

“Am I ready to make a change in my lifestyle?”

“Am I willing to learn and incorporate new habits into my daily routine?”

“Each of us guards a gate of change that can only be opened from the inside.” –

Merilyn Ferguson

Some Thought Barriers to Maintaining Motivation

If you have difficulty maintaining your motivation to make changes in your life then ask yourself,

“What are the payoffs if I continue in the same way and in not making this change?”

If your answer is:

  • “I don’t deserve this change!” – If you have been saying this to yourself, then you have the tendency to hold yourself back and the key will be to work on your self-esteem.

  • “It will be too much work!” – This assumption will overwhelm you and make you even more stressed. Instead, replace this negative belief with a more positive one and start by breaking your problem down into smaller steps and work at achieving them at your own pace!

  • “I don’t have time!” – It will be important to give your goal sufficient priority over all other activities going on in your life.

  1. Setting Goals

  • Set clear and concrete goals. Your goals should be realistic and attainable. In setting your goals, try to answer the following questions:

“What are the most positive changes I would like to see in my life?”

“How would these changes affect my thinking, my feelings, my relationship with others, at work, and with myself?

“What new opportunities could I gain from making these changes?”

  • Make a list of your desired goals and then prioritize them from what is most valuable to you and in improving your life.

  • Break down each goal into smaller manageable steps, and plan out what needs to happen in order for you to achieve the next task. This makes attaining your ultimate goal less intimidating. Sometimes it is easier to work backwards from their end goal.

For example, if your goal is to run a 10km marathon, you could divide up this goal into manageable steps to be achieved over a long period of time:

  • Walk for 30 minutes,
  • Run for 20 minutes,
  • Run for 45 minutes,
  • Run 5km in one hour,
  • Run a total distance of 15km in one week,
  • Run a total distance of 25km in one week, etc.

  • Set a realistic time frame for achieving your goals. Don’t be over ambitious. Give yourself enough time to achieve each of the smaller goals at a comfortable pace.

  • Recruit support from spouse, family, or few close friends to help you through the process. By sharing your plans with these trusted individuals, you are more likely to stay committed in achieving your goals or to get back on track after a setback.

  1. Visualizing Your Goals

Once you have defined what you would like to change in your life, it is helpful to practice visualizing it. Research has shown that competitive athletes who mentally rehearse their routines have more positive performances and lower anxiety. In fact, mental practices activate the same brain patterns as actually carrying out the physical practice, and that doing both is even more effective at ensuring positive performance. This is the strength of the mind-body connection!

Try this: Begin by thinking about what you would like to achieve and imagine the scene as if it were happening. Focus on this mental “image” by engaging the five senses and with as much detail as much as possible.

  • Where are you?
  • Who are you with?
  • Which emotions do you feel?
  • What physical sensations are you experiencing?

Imagine how the changes can affect your future, functioning, and relationships. It is helpful to do these visualization following deep relaxation or while in a calm state. Practicing this exercise for 5-minutes everyday will increase your confidence about succeeding. Good luck!!

  1. Putting Your Goals into Action

When you finally decide to do something about your fears or tackling a problem, the initial motivation and enthusiasm may be enough to get you started. But the real test is in following through with a personal commitment and to persist even on days when you don’t feel like it. Do you feel motivated to change? Are you willing to learn new skills and make them into your daily routine and lifestyle?

As you write down your goals, list two reasons why they are valuable and important to you. Keep this list so that you can read them on days where you are in doubt or feel particularly unmotivated.

  1. Dealing with Set-Backs

Set-backs are an inevitable part of achieving any goal. However, the way in which you deal with these set-backs can either motivate you or deter you from striding forward. Instead of brooding over the situation, try and figure out a way to solve the problem. Ask yourself:

“What interfered with my progress?”

“Are these factors within my control to change?”

“Am I trying to achieve a realistic goal and were the smaller steps attainable?”

“Did I set a reasonable time frame to achieve each task?”

“What have I learned from this setback?”

Reach out to your social support system who can provide you with a “reality check” to determine if your goals are realistically attainable and provide you with encouragement to get back on track. It is very important to not allow setbacks to discourage you from obtaining your goals. Setbacks should not be viewed as personal failures rather they are opportunities for you to learn from what happened and persist.

  1. Tips for Effective Goal Setting

Set realistic goals and have realistic expectations.

Do not compare yourself to how you used to perform or to others. Be sure to work towards your goals at your own pace.

It is best to evaluate your progress after reasonable amount of time has passed instead of on a daily basis.

Let go of ‘stubborn’ attitude where the expectation is for change to occur quickly or doing each task to perfection.

Enjoy the process of doing tasks and going through change instead of just looking to finish or accomplish the task. As the popular saying goes, “The journey is more important than the destination.”

Monitor your thoughts and consider factors that may be interfering with your progress.

Do not let setbacks discourage you. Setbacks are an integral part of life and you can use them as a learning experience.

Do not magnify small errors or flaws. Remember that there is no real learning without making mistakes.

Do not minimize or disqualify positive changes you are making. Pay attention to the word “but” – for example, “Yes I completed my report, but it is not my best work.”

Reward yourself for making gradual changes and for achieving each of the smaller steps towards your ultimate goal. Every small step counts!!

Demonstrate patience and be kind and fair to yourself!

Dr. Niusha Ghazban PhD

Chronic PainMind Body


When we are stressed and have tension in our bodies, our breathing becomes more rapid and shallow. This exercise allows the diaphragm – muscles that separate the abdomen from the chest cavity – to move downwards triggering our body’s normal relaxation response.  Here is breathing exercise you can try (adapted from: Bourne, E., The Anxiety and Phobia Workbook, 2005):

  1. Follow the relaxation techniques discussed previously.
  2. Place one hand on your abdomen underneath your rib cage, and the other on your chest. Monitor your natural breath for a few minutes.
  3. Inhale slowly and deeply through your nose by a count of four, so that the air fills the lower part of your lung. You will feel your hand on your abdomen As your lung continues to fill with air, your chest should only slightly move.
  4. Pause and hold your breath for a few seconds (count of four).
  5. Exhale slowly through your nose or mouth and completely empty your lungs (count of eight). As you exhale, visualize your body becoming relaxed.
  6. Repeat the steps and complete ten slow diaphragm breathing (1 set). You may wish to extend this exercise by completing 2-3 sets or for 5-minutes.

If you feel light-headed or dizzy, breathe normally for 30-seconds and resume the exercise. Be sure to keep your breathing regular and smooth without gulping in air. Once you have mastered this skill, this exercise is particularly effective at reducing early symptoms of panic and anxiety.

Chronic PainMind Body


Here is breathing exercise you can try (adapted from: Bourne, E., The Anxiety and Phobia Workbook, 2005):

  1. Refer to the relaxation techniques discussed previously.
  2. Begin by inhaling through your nose slowly while counting slowly: “1, … 2, … 3, … 4 … 5.”
  3. Pause and hold your breath for a count of five.
  4. Exhale slowly through your mouth to a count of five (or longer).
  5. Once you have exhaled completely, take two breaths in your normal rhythm.
  6. Repeat the exercise for 3-5 minutes.
  7. If desired, you can choose to practice by visualizing that with each inhalation energy is flowing to all parts of your body and form a mental picture of this energizing process. Alternatively as you exhale, you may wish mentally repeat to yourself, “peace,” “calm,” or “relax” or any other calming words you prefer. With enough practice, you can eventually achieve the state of relaxation or calm by just saying these words.

As you continue this exercise, you might notice that you are able to count higher when you exhale than when you inhale. You should adjust your counting to allow yourself to fully exhale. If you feel light-headed or dizzy, breathe normally for 30-seconds and resume the exercise. Be sure to keep your breathing regular and smooth without gulping in air. Once you have mastered this skill it is particularly helpful to apply it at the first sign of anxiety symptoms or reducing stress.  

Chronic PainMind Body


It is easy for our mind to mix up our feelings and sensations with our identity. specially when the anguish of pain or anxiety become long lasting or chronic. We tend to start knowing our identity as:

In Pain or Anxious. Anxiety may be one of the longest unwanted guests in our mind that we ever get to know. The worry we feel is what we call anxiety. It can come from all negative thoughts and experiences we have endured. Once we get used to having negative thoughts, we get used to having worries and we start to mix up worry with who we really are. Many dangers exist in life and we have to plan to stay safe despite these dangers.

However, the fear from danger and the worry that comes with it, are products of our mind. ZEN MINDFULNESS MEDITATION teaches us how to become observer of all these mental events and how to separate our identity from these mental events. It is all about trying to take a break from feeling one with your anxiety and separating yourself from it. With practice we can learn to do this separation more often and ultimately suffer much less from Anxiety.


Chronic PainMind BodyPatient’s VoiceRemedies

There are numerous studies that have documented the benefits of mindfulness and relaxation practices on health and wellbeing. Relaxation is more than unwinding in a warm bath or going for a walk in nature. It refers to a psychological and physiological state that allows you to counteract the stress your body feels. Regular practice of relaxation combined with breathing exercises can result in increased energy levels, reduced anxiety, reduction in muscle tension and pain, as well as improved concentration and memory. Many other skills learned through Cognitive Behavioral Therapy (CBT) to overcome anxiety, depression, and coping with chronic pain build on the capacity to achieve states of deep relaxation.

  Tips for Effective Meditations and Relaxation

  1. Practice daily, at approximately the same time of day, for 20-30 minutes. This will help set up a routine and maximize the effects of relaxation. Initially, it may take the entire 30 minutes to feel any effect of relaxation, but with practice you will be able to achieve a state of relaxation more quickly.
  2. Find a quiet location, free from as much distracting noises as possible.
  3. Ensure you are in a comfortable position, with your head and neck If you are laying down, find a soft surface and place a pillow or two underneath your knees for further support. If you feel drowsy or sleepy, sitting in a comfortable chair with a good posture is a better option (to avoid falling asleep). You can put a pillow on your lap and rest your hands there, too.
Remove eyeglasses, take off shoes, remove any jewelry or tight fitting clothing, and let your hair down (if you have it tied back in a bun).

  1. Make a decision to clear your mind. Give yourself the permission to relax your mind from any concerns and worries in your life. It is helpful to direct your focus on your breath. If your mind happens to wander off, gently re-focus your attention back on your breath. But in doing this, do not judge your thoughts. Merely acknowledge them and redirect your attention to your breath.
  2. The most important tip is … Do not try to relax or control your body. Do not judge how well you can relax or whether you are applying the techniques correctly. Be in the present moment and allow your body to “let go.”

Chronic PainMind Body


Yoga is an ancient practice that involves purposeful movements, mindfulness, and mental and physical awareness.

Yoga is an art, taking time and patience to perfect. However, those who dedicate the time reap the abundant rewards found in Yoga practice.

Many chronic pain sufferers find pain relief and pain control through regular Yoga practice. Yoga focuses on breathing, releasing body tensions, changing the way the body responds to the pain and changing the way the mind views the pain. The different poses and stretches, combined with focused breathing makes it difficult to zero in on the pain. The goal is for your mind to lose focus of the pain, pushing the pain sensation to the back of your mind where it will seem less intense. With ongoing practice, you can push the pain so far back that it all but dissolves into the background of the conscious mind.

Yoga practice is also beneficial in combating anxiety, which is often coupled with chronic pain. When you live with pain as a daily reality, the stress of the pain flaring up, becoming worse, or the fear of the pain limiting your ability to complete you daily functions can lead to anxiety. With Yoga, the mind is trained to calm and quiet down, decreasing anxiety and again, gaining perspective.

The different poses also offer a chronic pain sufferer the opportunity for self-correction. Many times, our movement and positions are tense, and without realizing it, will increase our pain and discomfort. We are so used to these positions and movements that we may not realize that it is actually making our pain worse. Because Yoga offers the smooth, slow and rhythmic changes in position and posture, we are made to discover alternative and less painful body stances. Our body tension is decreased, allowing us to use muscles and movements with a little more ease, which we can then incorporate into our daily life.

It is important to consult with your primary care physician before starting a new exercise regimen. You should not push your body further that it is able to go comfortably. Yoga is not meant to cause or aggravate pain and all Yoga poses can be modified to fit your specific capabilities.

Chronic Pain


Cognitive therapy is not about positive thinking, rather it is about looking at the situation from many sides whether they are positive, negative, or neutral; This can lead to new solutions and conclusions.

The key to understanding one’s problems or distress is to identify five components: situation, physical, moods, behaviors, and thoughts. These areas interact with each other and even a small change in one area can lead to changes in another area (Greenberger & Padesky, 1995).  You can try to describe any recent changes in your life or long-term distress by breaking it down into these five areas:

  1. Situations or Environmental changes involve identifying the most stressful ongoing circumstances, which can include events going as far back as childhood.
  2. Physical Reaction or symptoms such as changes to one’s sleep patterns, energy levels, motivation, appetite, sweating, heart racing, headaches, muscle tension, pain, dizziness, or difficulty breathing.
  3. Moods are generally single-words that describe one’s emotions (e.g., sad, frustrated).
  4. Behaviors are actions we would like to see change or improve at home, work, with friends, or to ourselves.

    • Behavior

    • Much of our behaviors are repetitive and rehearsed many times throughout the day.

  1. Thoughts are beliefs, memories, and images that pop into our head throughout the day including words and statements we say to ourselves.

    • Thoughts / Self-Talk

This subject will be continues in future

Dr. Niusha Ghazban

Chronic Pain

Folic acid article

Folic acid and folate are both B vitamins. Folate occurs naturally in certain foods that we eat. Most common foods that are high in folate include dark, leafy greens, meats such as liver and kidney, mushrooms and dried beans.

Folic acid is the synthetic form of folate and is used to treat low blood levels of folate. Many foods such as pastas, cereals, breads and flours are enriched with folic acid to prevent a deficiency.

Although a full blown folic acid deficiency is not common, it is seen more often than one would think. Low folate levels have been linked to depression, anemia, seizures, developmental delays in small children and behavioral and psychiatric symptoms in adults.

While diet can be to blame for low folate levels, it can also be caused by a variety of factors such as a chronic illness, the body’s ability to absorb supplements, as well as other prescribed medications that may interfere with the absorption of folic acid. It has even been thought that chronic stress can lead to vitamin deficiency, including folate deficiency.

Folate or folic acid is used in the body to help build and maintain new cells. Folic acid helps to make and repair DNA in the body.  The red blood cell development in the body relies on the folate levels. People who suffer from anemia often have low folate levels or a folate deficiency, and can benefit from supplementing with folic acid as part of a regimen.  Studies have also shown that folic acid may decrease the risks of developing high blood pressure, particularly in women.

Folic acid has many health benefits when taken at a safe dose. Always consult with your primary care physician before starting any new treatment regimens. There can be side effects when taking a high dose of folic acid over a long period of time. Folic acid should be used with caution for people who are deficient in vitamin B12, people who have epileptic seizures, or who have had procedures to widen arteries (Angioplasty). Speak with your primary care physician to determine if a folic acid regimen is the right choice for you.

Chronic Pain

Biofeedback: mind over matter

Our bodies are very complex machines. We function at different levels: voluntary, and involuntary. Voluntary functions are actions and movements that we control. We can decide to climb up stairs, turn our head to the side, or walk in any direction. Involuntary functions are controlled by your involuntary nervous system and are difficult to control, such as your heart beating, your blood pressure rising, or your body regulating its temperature.

Biofeedback therapy puts the focus on your involuntary body functions, and can help with conditions such as chronic pain, anxiety, high blood pressure and headaches. Biofeedback therapy is not meant to replace prescribed medications. You should always consult with your primary care physician before starting a new treatment.

Biofeedback therapy uses a variety of sensors and electrodes that collect the information on your heart rate, brain waves, rate of breathing, skin temperature and muscle tension. This information is then translated into sound, images or lighting on a monitor for you to see.

These involuntary functions can undergo dramatic changes when your body is under stress or in pain. By viewing and understanding the changes that are happening you are better able to control them. For example, when you can see that your heart rate is becoming rapid due to stress, you are better able to combat these physical changes with exercises such as slow deep breaths, imagery or even meditation practices. A biofeedback therapist would help you to practice these exercises.

The idea behind biofeedback is that you can change how your body responds to physical or mental stimuli through various techniques along with a better understanding of how the human body works. While biofeedback is not a cure, with practice it can aid in an overall better quality of life.

Chronic Pain