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Self Monitoring

Discussion in 'General Discussion Subforum' started by Forest, Jun 5, 2013.

  1. Forest

    Forest Beloved Grand Eagle

    I am working on a series of pages on the Present Based approach, and want to share one of them with you. The following is from a new page called Self Monitor. A lot of this is similar to some of the ideas Chickenbone has been posting about (btw, if you haven't read her posts I highly suggest you do. They are amazing). As I am still in the process of formulating a lot of these ideas, I would love to hear what people think about it.

    Recovering from Tension Myositis Syndrome (TMS) involves learning to use your body as signal that something else is going on. This condition is caused by repressed emotions, which means that most of us are not skilled at knowing what we are feeling and, perhaps more importantly, why we feel they way we do. A useful technique to learn to think psychologically is to use your body to identify when you are activated and hyperaroused. Doing so will allow you to reduce your current emotional tension and therefore reduce your present symptoms.
    What do you mean by Current Emotional Tension?

    Emotional Tension refers to anytime we are acting in a repressing manner, and are not being in touch with our true emotions. This consists of having negative thoughts and focusing on the worse-case scenarios. Some examples of emotional tension are:
    • anxiety
    • worrying about the past and/or future
    • rage
    • ruminating on something
    • Letting our internal bully get out of control
    • Obsessing over recovering the right way
    • Being afraid of our symptoms
    Learn to Recognize Your Tension

    All of these emotional states activate our Amygdala, an emotional center of our brain, which amplifies our symptoms and leads to more fear, anxiety, and worrying. In addition, the emotional tension we create, on a minute by minute basis, also engages our body’s physical stress response through the Autonomic Nervous System and the HPA axis. This is the reason your heart beats faster when you have anxiety. Our bodies react to our emotional states. If we have emotional tension, our bodies will reflect that.
    By paying attention to the sensations in our bodies, we can use these physical signals to Think Psychologically and figure out what is generating our tension. This can help us better understand what we react to. This means that if we feel our bodies activating our stress response, we can identify when we have emotional tension building up inside us presently. If you feel your heart rate start to increase, your pupils dilate, your breathing accelerate, these are all signs that you need to get in touch with your present emotional state.
    Use your body’s natural stress response to identify when you are repressing present emotions. From there, go back one to one of the most basic principles of Sarno’s work and Think Psychological. Ask yourself, “what am I thinking right now,” and “why do I feel this way right now.” If you can bring your focus back to the present and to what you are feeling in this moment, your symptoms will reduce.
    1. Monitor Your Body
    2. Think Psychological
    3. Your symptoms will reduce
    Where is Your Energy

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  2. spiralgirl1

    spiralgirl1 Peer Supporter

    Thank you Forest for posting this.. just what I needed to see and be reminded of today.. I have lots of learning to do around being in touch with my physical stress symptoms and what emotions are driving them.. inspiring stuff!! :)
  3. chickenbone

    chickenbone Well known member

    Forest, I just saw this and it is really fabulous. You explained it better than I ever could. It is so important for people to realize that physical sensations and emotional states always come in pairs. Where there is one, there will be the other. And it goes both ways, we can use a perceived physical sensation to discover a possibly repressed emotional state, or an emotional state can lead us to a corresponding physical sensation. I also like to call it "look for the missing emotional state". For example, I realize now that I have always had a severe phobia of travel. Because I repressed this fear whenever I traveled, I always had physical symptoms such as asthma, allergies, back pain, GERD, headaches, etc. Before I discovered TMS principles, I had no idea why this was happening and felt afraid that my body was betraying me and thought these symptoms were purely physical. Now I realize that the hidden emotion is "fear" that I repress. I need to get in touch with this fear by focusing on, accepting, giving space to, these physical sensations.

    I like when you said that most of us are not good at being in touch with our true emotions. We often repress them because of the demands society place on us.

    I am so happy that you understand what I have been saying. A lot of people misinterpret what I am saying by thinking that I am saying they should focus on the physical. You are really focusing on the psychological, but following the physical sensation to discover the emotion that has gone missing. Once we begin to feel and recognize our true emotions, we have no need to create distracting physical pain and discomfort.

    This is great Forest and you have a really good understanding of it and a talent for putting these difficult concepts into words. I think this has the potential to help lots of people. Because it is somewhat counter-intuitive, it can be difficult to grasp.
  4. chickenbone

    chickenbone Well known member

    Forest, you are also right on about how important it is to recognize our states of hyper-arousal and where the energy resides in our body and what it is doing.
  5. Forest

    Forest Beloved Grand Eagle

    Thanks so much for you kind words, Chickenbone, you helped inspire the post. I really love how you said that "physical sensations and emotional states always come in pairs. Where there is one, there will be the other." I think that this perfectly captures the mind-body connection when it comes to thinking psychologically. When we have emotional Tension (TMS), we will also have physical tension. By monitoring our biological stress response, the manifestation of that physical tension in our bodies, we have an "early warning system" that can help us better understand the real cause: our emotional repression! Once we find the "missing emotional state" (great phrase), we become more aware of our unconscious emotions, which gives us more tools to deal with those emotions. If we do so with openness, honest, and respect, we can even use our rational brain to figure out how our emotional brain needs to be soothed.

    Dr. Sherman and Dr. Anderson, two of Dr. Sarno's most trusted psychologists speak eloquently about the importance of recognizing our feelings so that we can better learn to respectfully deal with them in Pathways to Pain Relief. One example of doing this is during the case history of Antoinette, who, through talk threrapy, was able to become aware of feelings of anger and fear related to being outshone by her brother (in childhood) or infant son (in the present). By becoming aware of those feelings, she was able to grieve them properly and soothe her feelings of dependence and fear:
    That's a really terrific example. I bet you'd enjoy Pathways to Pain Relief. It really gets good starting with the section on "Pain Vignettes," because that's where the case histories, like Antoinette's above, start.
  6. chickenbone

    chickenbone Well known member

    I will get Pathways to Pain Relief. I am working my way through several books. It has been on my wish list for awhile.
  7. Forest

    Forest Beloved Grand Eagle

    I hope you do. Psychoanalysis is the deepest of the depth therapies, and I think we are tremendously lucky to have a book where we can read case histories presented by psychoanalysts with a collective 60 years of experience working with Dr. Sarno's most difficult patients.

    One of the people who I learned the importance of self-monitoring the body from is Dr. Anderson, one of the authors of Pathways, from her presentations at the TMS conferences in LA, in NYU, and at the recent Masterclass (as well as through working with her on the board of the PPDA and helping organize the three conferences). In addition to having a Ph.D. and a postdoctoral psychoanalytic credential, Dr. Anderson also has the SEP qualification. SEP stands for "Somatic Experiencing Practitioner," which is very germane to this thread, in that the very name of the discipline is about experiencing the soma (body). She just got the qualification in 2011, and last fall was interviewed about how she integrates somatic experiencing with psychoanalysis.

    When asked about her experience of integrating psychoanalysis and Somatic Experiencing (SE), Dr Anderson replied,
    The interview is intended for other therapists trained in somatic experiencing. Given that she is speaking to a highly educated professional for the benefit of other highly educated professionals, I hope people won't be offended if I comment on a couple of the things she mentioned so that newcomers get as much as possible from it. Of course, everything I say is only my own interpretation; I can't speak for her. I encourage you to listen to the interview (linked below) or read her books to hear her thoughts in her own voice. Then you can draw your own conclusion.

    I take the above as her simply saying that she is interested in the mind-body connection and how thoughts (cognitive processes) and emotions are connected. She is particularly interested in how this plays out in therapy (i.e. talking therapy), but my hunch is that the insights carry over to the deep work that some of try to do in our TMS healing, so it is still very helpful on this forum. Basically, she seems to be saying that in her experience, psychoanalysis and somatic experiencing are complementary, and that the SE helps her do psychoanalysis better.

    She continues on to say,
    When she talks of helping people link up what is happening in their bodies as they talk about a difficult experience, I think that she is teaching people who are lucky enough to work with her basically the same thing that Chickenbone was speaking of when she said that "physical sensations and emotional states always come in pairs." This is what this whole thread is about, so we know we are on track!

    When she speaks about overwhelming experiences, this reflects directly back on the core idea of TMS that Dr. Sarno taught us. That the mechanism of TMS is that we have overwhelming emotions that our unconscious mind wants to protect us from, so it creates symptoms as a distraction. Referring to the title of Dr. Sarno's most recent book, our mind is divided because some emotions are too overwhelming for us to tolerate. The sense that I get from reading Pathways to Pain Relief is that the goal of therapy for people who are lucky enough to be referred to psychoanalysis by Dr. Sarno is to bridge that divide. I.e. the goal is to to be able to consciously tolerate the powerful unconscious emotions that are brought up when we talk about "a particular episode or incident in [our] life." As I described in my last post, the first step is to become aware of one's unconscious emotions, and a key tool for doing this is monitoring the reactions in one's body. I think that that is what Dr. Anderson is referring to in the above quote. This, after all, is just what we are doing when we "Think Psychologically."

    She continues on to describe another vitally important idea. Because physical states and emotional states come in pairs :) , in addition to listening to our body to help bridge the divide between our conscious minds and powerful emotions, we can also deliberately calm down our body's activation and arousal in order to "get our minds straight," so that we are our best selves and able to process these powerful emotions:
    I interpret this as meaning that after decades of working with many of Dr. Sarno's most challenging patients, she has found that if they get hyperactivated/hyperaroused/"hyped up," they can tend to that arousal, cool it down, and then be better able to be more present and less activated in everything they do. In the context of therapy, and in her words, it helps them to 'integrate the emotions with the narrative' - i.e. feel their feelings as they recount a story.

    She illustrates this idea with an example of her work with a patient that she had been seeing 3 times a week for several years before beginning her SE training. Dr. Anderson described difficulty helping the patient because the patient seemed to come in in a hyper-aroused state. She noted that the patient always spoke very rapidly, had a lot to say and brought up many topics at the beginning of the session. The patient asked the same questions over and over during the session.

    You might ask, what's wrong with asking a lot of questions?

    Well, have you ever noticed people with a crazy manic or anxious energy in the forums? Have you noticed someone who shows up and then asks a million questions like a machine-gun? You give them the answers and then they ask another and you just get the sense that while they are super nice people and trying to be good, they just aren't able to attend?

    An example of this type of hyper-arousal in a forum thread would be the following:
    In it you have about 240 posts, mostly long and mostly between two people. As I read it, I get a sense of a highly driven, crazy energy, between two very nice people. It's a crazy ride and might serve as an example of how we can all learn better how to self-soothe to calm ourselves down.

    This may be easier to identify in the drop-in chat, because you get more of a sense of how quickly people change topics and whether they get what you are saying. Of course many many TMSers give you the sense that they are coiled like a tightly wound spring, so full of tension and energy (this is one version of hyper-arousal that we commonly see in the online community). But when someone can't listen, I think that that is when they really need to work with a professional, who can monitor their level of activation and has the authority and sensory power of a physical presence to cool the person down. Hence, when I notice that in the chat room, I tend to take over and guide them to a professional. This calms the entire room because everyone is generally slightly triggered by the person's manic energy, and it feels good for everyone in the room to see someone in charge, restoring equilibrium.

    Anyway, I think that Dr. Anderson is referring to someone like that. What is interesting is how she helps her patient. The standard psychoanalytic approach of interpreting the stress-response activation as resistance (i.e. Freudian repression) wasn't helping. Her mind-body somatic experiencing training taught her a different approach. Instead, she realized that what she needed to do was help slow down the patient's stress-response activation because the patient literally couldn't think and couldn't remember because she was in a state of chronic arousal. That was why she kept asking the same questions and couldn't focus. That awareness helped enormously in working with this patient.

    So what did she do?

    Basically, she taught the patient how to self-soothe, to cool herself down. At the beginning of the session she had the patient slow down and de-rev by just taking a brief moment to decompress and settle in. Just a simple body-scan meditation, for example, is all it takes. But that moment of relaxation was enough to deactivate the stress response, which allows her to be more present in the session and just be in a better state. In some sense, by calming the stress response, it calms the mind.

    Dr. Anderson spoke of how, if someone is in a state of hyper-arousal, they really can't make use of what you have to say. I've seen this many time on the forums and chat room, and that's why when I see someone in the drop in chat who seems unable to make use of what we have to say, I suggest that they work with a professional, who, if they are lucky, will teach them skills of self regulation (unfortunately, I'm not convinced that all professionals are very good, but I don't have data and that is another question).

    Later in the interview, Dr. Anderson is describes how after Dr. Anderson has intervened a number of times, the patient has learned to self-monitor, so that the patient can identify on her own when she is becoming activated (i.e. aroused; I use the terms interchangeably) and then take steps to cool herself down. This is crucial because then the patient can essentially act as her own therapist and can independently manage her level of activation. This is ability is known as "self-regulation" because it means that she can regulate her own level of arousal.

    You can hear a terrific example of a therapist teaching self-monitoring and then self-soothing in the recording of Alan Gordon's second session with John in the TMS Recovery Program.
    It's the same idea popping up in the work of two very talented TMS Therapists. Alan has described that his goal in therapy is to teach people how to be their own therapists, and in my mind, the TMS Recovery Program that he recently donated is an example of how important that goal is to him.

    Believe it or not, everything I've described so far is actually described in the first 9 minutes of the interview with Dr. Anderson. If you've read this far, I definitely encourage you to give it a listen. It's a special opportunity to have a chance to listen to one of Dr. Sarno's most trusted psychologists (she is, arguably, the most senior of the psychoanalysts that Dr. Sarno worked with - it's my understanding that Dr. Feinblatt's background is in ISTDP). The first 12 minutes or so are great.

    The reason that I'm going into this in such depth is that I want to make sure that everyone who visits this forum is at least exposed to this idea, so that they can maybe try it on themselves. You seem quite evolved in this, Chickenbone, so I apologize for belaboring the point, but my hope is that others will read it and benefit.

    Anyway, here's the link to the interview:

    Please let me know what you think!
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  8. chickenbone

    chickenbone Well known member

    Forest, I listened to all the videos and they were fabulous. Perhaps I could tell you a little about myself from a personal perspective. When I listened to these videos, I was thinking that these people being helped are exactly like me. I often feel like I was born an adult. I had loads of responsibility heaped on me at a very young age. My father was a very emotionally volatile alcoholic and my mother was extremely co-dependent. I was the oldest child of 3. I had a very difficult birth, both my mother and I both almost died. I spent the first 6 weeks of my life in an incubator, only the nurses were allowed to feed me, wearing bio-hazard gear. (Just a joke). I started babysitting and being a nanny at the age of 9 to avoid being around my family. I never wanted any children because I felt I lost my childhood to taking care of children. Ever since, I think I have been trying to get my lost childhood back.

    Unfortunately, my first husband, who I loved dearly, died at age 32 of cancer. I took care of him before he died. This was a terribly difficult experience. I had a good, successful career, but things were always difficult for me emotionally, but I managed. My husband and I retired early (I was 55, he was 62) and came to live in Panama, realizing a dream of a farm on the beach. I have a wonderful set up here, but I still can't relax. In the past, I have had therapy but never felt that I got anything out of it. I did better with self-help books. I am not against therapy, but I never seemed to get any of the really good ones. They were always nice and it was good to have someone to talk to, but they seemed powerless to help me.

    I learned about TMS in 2010 by reading 2 of Dr. Sarno's books. I had been surfing the net for help with my back pain which neither me nor my husband (who is a doctor) thought was organic. After reading his books, my back pain practically disappeared. I think my back pain was caused by the feelings of guilt I had after the death of my sister at 58 from alcoholism. She never forgave me for spending so much time away from the family and finally leaving for good. I think she actually blamed me for my Mother's death. I still struggle with this.

    I came upon SE on my own while working with a energy healer in Panama. She is actually from California, but I don't see her anymore. This was the only therapy that ever helped me. I have always had a physic bent and I have been developing it more here. I seem to be able to relate to my issues better through chakra and energy work. I use some really good chakra meditation CD's. A favorite book of mine is called "Eastern Body Western Mind" by Anodea Judith. I am able to see energies and am developing spiritual gardening. The way I would explain what happened to me (and countless others like me) is that our root, sacral and solar plexus chakras (lower chakras) did not develop properly because our basic physical and emotional needs were not met. Therefore, our energy escapes to the higher chakras for comfort. That is why people like me find so much comfort in intellectualism and spirituality. We become extremely ungrounded and often have difficulty relating to the physical world and other people. Most of us are extremely sensitive, which doesn't help matters much. I am working on getting more of my energy into my ground and lower body. It seems to me that mainstream Psychology is embracing more and more spiritual and somatic approaches. The excellent work of Dr. Peter Levine is rich in spirituality. For a long time, Psychology needed to come out of the mind and into the mind/body connection. Energy healers have been teaching this approach for a long time.
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  9. chickenbone

    chickenbone Well known member

    Anyway, Forest, I have come to believe that I have a lot of other symptoms that I have had on and off most of my life are TMS related, such as frequent colds, hypochondria, allergies, asthma, Gerd, and bad insomnia. Those I am working on now and they are proving to be much more challenging than the pain. I would like to get more involved in the audio sessions, but we often don't have a stable internet connection at home for Skype, so I will have to see what I can do about that.

    Thank-you so much for your interest and help.
  10. Gigi

    Gigi Well known member

    I love the idea of self-monitoring and intervening with your feelings so that they don't get expressed physically. Unfortunately, I feel as if I need a how-to manual! I never seem to be able to hone in on what I'm supposedly dealing with.

    I just re-read Sarno's HBP. I hadn't read it since 1997. I was disappointed in the lack of practical advice--as in, "Try saying these things to your subconscious!" I've used his approach in getting angry with your subC, but I keep thinking I'd prefer a more gentle way to approach talking to my brain. After all, my subC believes it's being good to me by intervening and producing physical instead of psychological pain. Maybe it's my educational background, but I feel as if it's more misguided and in need of redirection, rather than having evil intent and deserving of being told off!

    If this sounds bizarre, so be it!
  11. chickenbone

    chickenbone Well known member

    Dr. Sarno was brilliant in recognizing the psychological nature of a lot of our symptoms, but was not himself a Psychologist. Fortunately the ball has been picked up by a lot of good Psychologists today. Alan Gordon and James Alexander are good examples. I was also a more difficult case and needed depth psychology, so I can relate to what you are saying. We are simply not always aware of what emotions are hidden. This makes perfect sense because TMS is largely an unconscious phenomenon, so our minds are not consciously aware of our feelings. Since those feelings/emotions strive to be expressed to achieve healing and wholeness, we get physical symptoms/pain. Sometimes, just using your conscious mind to discover these can work, but often it cannot because, after all, it is mostly the emotions and feeling that we are not conscious of that are the cause of the problem. I think the best way to discover these are using the wisdom of the body. What is the story that your body is telling you? This will lead you to repressed emotions/feelings that we can consciously experience. For example, I used to have really bad hot flashes that were not associated with any common cause. One day, when I started to have "that sensation in my body" before the hot flash happened, I just moved mentally TOWARD it with a sense of curiosity about it instead of fear or loathing. I felt the sensation completely, a fluttering and sort of momentary panicky sensation in the pit of my stomach. I went with it completely and tried to discover the nature of it and determine what it wanted to do and say to me. I did this with complete acceptance and staying anchored in the present moment (do NOT let your mind take you anywhere OR make up a story). I could feel the physical sensation as it branched out to other parts of my body and to my brain where it seemed to be registering some hyper-arousal and then fear. It seemed to want me to run around, which is what I usually wanted to do when I felt hyper-aroused. I resisted this urge and stayed present with the sensation. Then I felt the fear that I had identified as the missing emotion, no matter how irrational it seemed to do so. Then the sensation went away much more quickly than before. Sometimes, during this process, a image of the past will come up and sometimes not. This is not easy to do, it takes a lot of concentration and sometimes the hyper-arousal is too much for me. I know these may be deeper issues. Anyway, this process seems to be helping with some of my worst TMS symptoms. I don't often know what the unconscious triggers are.
  12. gailnyc

    gailnyc Well known member

    This thread has been tremendously helpful to me. I know I will come back to read it over, so I am posting here so I can keep track of it.
  13. gailnyc

    gailnyc Well known member

    This is a wonderfully descriptive image of your process. Do you do this whenever you feel a TMS symptom? What about TMS symptoms that are often/always there? (sorry if I have asked this before)
  14. chickenbone

    chickenbone Well known member

    Hi Gail. No, I don't do this every time that I feel a TMS symptom coming on because either I am not in a setting where I can do it or I haven't caught the sensation I get right before the symptom starts. Mainly right now, I am trying to learn how to do this. I have been quite successful with my hot flashes. What I am really trying to learn to do is to self-regulate so that I don't have hyper-arousal right before bed. I realized, through the process of somatic experiencing, that this is the cause of my insomnia. However, this has been much more difficult than dealing with hot flashes. I have made some progress, though. I discovered that my body wanted to listen to classical and gospel music after getting into bed to relax (it likes the vibration), sometimes it wants to do chakra meditations. So I do this now before going to sleep and the insomnia has improved dramatically. I have been able to get rid of pain almost completely. It has been about six months since I have had severe sciatic pain. I initially got rid of the pain using Ace's Keys. However, sometimes whatever was causing the pain was too deeply unconscious to discover, so I began just listening to my body whenever I felt an odd sensation coming on. I found that, before a pain episode, I would get a contracting sensation in my back and leg muscles. Then I began to notice this each time. By exploring the sensations, I realized that I was unconsciously constricting, tightening my muscles. So I was able to identify repressed anger or fear or other bad emotion in my muscles. Once I consciously felt the emotion, the physical sensation would usually go away without producing pain. One of Ace's Keys tells you to monitor your internal sensations. This just carries that much further into the realm of the unconscious. It helps to think of my body as my unconscious.

    I don't have TMS symptoms that are always present. If you look closely, yours are probably not always there either. We tend to create them when we think of them, so I just think it just seems like they are always there. The pain was my most constant companion. The next would be the hot flashes. The ones I don't get very often seem to be the most difficult to deal with, like allergies. It seems to me that you don't need to be able to do this every time. If you are like me, your conscious mind will not like doing this, especially the part about experiencing the bad emotion in real time. I only needed to do it for, maybe a half dozen times for the symptom to decrease dramatically. I find that fear, guilt (shame) and anger are usually at the bottom of my issues. It always leads to these emotions. I was surprised how much I experience fear. Also, it is the unconscious hyper-arousal that always sets things off. Ace says that bad emotion, feelings are arousing, straining. He is right but it works the other way also. When I become hyper-aroused for no good reason in real time, I can bet that bad feeling/emotions are in the mix also.

    I hope this makes some sense to you. I don't often explain it very well.
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  15. yb44

    yb44 Beloved Grand Eagle

    I think you do a good job of explaining things, chickenbone. I have had a major relapse of sciatic pain over the last three weeks that isn't shifting. Ignoring symptoms, thinking generally about what's bothering me and just getting on with life is how I have been tackling all of the other aches, pains and gripes I've experienced but this isn't shifting my current pain. This is the pain that is hard to ignore but I see that as a sign that I have been ignoring other messages my body has been sending me. I like the idea of viewing one's body as the unconscious. Like you I have noticed that I tighten my left leg muscles unconsciously. I wonder why those particular muscles. I have also noticed after reading and pondering this thread that I am pretty hyper-aroused, currently about the pain but prior to this for an extended time I had been hyper-aroused, hyper-vigiliant and catastrophising about other people. Now my body is screaming at me. As hard as it is to admit, I need some outside support.
  16. gailnyc

    gailnyc Well known member

    It does, actually. I think these ideas are awfully hard to put into words, but you do a very good job.
  17. gailnyc

    gailnyc Well known member

    The idea of hyper-arousal is one of the most useful things about Ace's keys. I'm not sure I'd seen it linked to TMS anywhere before I came across it there. So this thread has been good to read, as it backs up that idea and expands on it.

    The weird thing is, I never before saw hyper-arousal as a form of anxiety, and used to see it as something good. Now I realize that getting excited or obsessive about something can cause me to get activated, which is not so good. Maybe there is a "reservoir" of arousal as well. A certain amount of excitement is fine, but too much stimulates the pain.
  18. chickenbone

    chickenbone Well known member

    yb44, It sounds to me like you are doing really well although at times it may not seem like it. I have had a lot of temporary relapses - once a TMSer, always a TMSer. I am having one now of sciatic discomfort because I just got a new puppy and one of my adult dogs had a really bad episode of skin problems. She also will not accept the puppy. But I am aware of why I am having it, am much better in touch with my own emotions which ensures that the pain will not get bad and am not projecting my pain experience beyond the present moment. In this way, the worst of times are the best of times because my reaction to the pain is so different than before. Each time I relapse, I have a chance to practice my new found mind/body knowledge. So don't be discouraged. Whenever you are thinking about the pain in a healthier way, progress is being made. I don't really even notice the pain much anymore.

    Thanks, Gail, I agree with you.

    I know what you mean about arousal. You know, I recently read something in Dr. Peter Levine's book, "In An Unspoken Voice" that really resonated with me. As background, I laid awake night after night recently when I had a months long attack of insomnia (caused by anxiety). I kept thinking over and over why it was, what actual sensation in my body was preventing me from sleeping. I knew that I was inappropriately aroused, but I had always thought it was because of my brain. As I listened to my body night after night, I realized that it definitely was not my brain that was responsible for it, although my mind was registering it. Then I realized that this sensation of hyper-arousal was actually coming from my gut (stomach). This was the part of me that couldn't relax. Then about a month later, I read in Dr. Levine's book that the body may actually have a sort of brain of it's own. This is called the "vagus nerve" that connects the gut and body with the lower centers of our brains. It is the largest nerve in the body other than the brain. What I found so interesting is that when studies were done on this nerve, researchers discovered that for every 1 neural signal going from the brain to the gut, there were 9 neural signals going the other way from the gut to the brain. So almost all of the impulse traffic goes from the gut to the brain not the other way. I thought this to be a big breakthrough in discovering the nature of how our body and mind communicate.
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  19. chickenbone

    chickenbone Well known member

    Also, Gail, I think that Ace's Keys don't explain much about the somatic experiencing that you need to learn to get at deeply repressed feeling and emotions that can often result from trauma. For example, whole books could be written about "monitoring internal sensations". I think Ace's Keys only scratch the surface issues which can be enough for some people, but not for everyone. I needed to go much deeper than Ace's Keys, although they were a good start.
  20. quert

    quert Guest

    This is a great discussion. For me at least what makes it particularly interesting is how closely it parallels a mind blowing book I recently read entitled The Emotional Liffe of Your Brain: How It's Unique Patterns Affect The way You Think, Feel, And Live – And How You Can Change Them. The title may be long enough that it's hard to tell where the title leaves off and the book begins, but it was fascinating and really opened my eyes to new ways of understanding our emotions.

    It's written by Dr. Richrd Davidson, a brilliant scientist who was educated at Harvard and now runs the Center for Investigating Healthy Minds at the University of Wisconsin, Madison. He has been a pioneer in the field of affective neuroscience, the field of brain science that deals with emotions. It's quite impressive that he found the time to write a book, as the center he runs has a staff of 46, all reporting to him, and twenty million dollars of grants!

    At its root, TMS is all about emotions, and Davidson uses cutting edge neuroscience to help us understand our "emotional style." He breaks emotional style down into six dimensions, with each one being based on different research:
    Resilience: how slowly or quickly you recover from adversity.​
    Outlook: how long you are able to sustain positive emotion.​
    Social Intuition: how adept you are at picking up social signals from the people around you.​
    Self-Awareness: how well you perceive bodily feelings that reflect emotions.
    Sensitivity to Context: how good you are at regulating your emotional responses to take into account the context you find yourself in.​
    Attention: how sharp and clear your focus is.​

    For this thread, and perhaps for TMS in general, Emotional Self-Awareness is the most important of the six dimensions. What is particularly interesting is how emotional self awareness in Davidson's book seems to be all about how you perceive bodily feelings. It's like we perceive our emotions through our body. This was certainly a new idea for me when I first read it. But it seems to be right in line with this thread.

    Here's what he writes about the Self-Awareness dimension in a chapter called "Assessing Your Emotional Style:"

    The Self-Awareness Dimension

    Do you have friends for whom introspection seems as foreign as Urdu? Do you yourself act and react without knowing why, as if your inner self is opaque to your consciousness, an utter mystery? Do those closest to you ask why you seem anxious, jealous, angry, or impatient—and now that it’s been called to your attention, are you surprised that you do feel that way? We have all known people who are completely blind and deaf to their own emotions. They’re not in denial; they are honestly unaware of emotional cues that arise within their own bodies. In part, that reflects differences in the strength of such signals. But it also reflects differences in the ability to recognize and interpret those signals, as well as sensitivity to them (that is, how strong the signals must be in order for you to perceive them). Some people have a very hard time “feeling” their feelings: It may take them days to recognize that they’re angry, sad, jealous, or afraid. At this extreme of the Self-Awareness dimension are people who are Self-Opaque.​

    At the other end are Self-Aware people, who are acutely conscious of their thoughts and feelings and attuned to the messages their body sends them. They know that the real reason they’re yelling at the kids is not that refusing to eat kale is so heinous, but that a monster traffic jam on the way home put them an hour behind schedule for the evening, ratcheting up their stress level to TILT. They can be supersensitive to the messages their body transmits, experiencing the physical aspects of their emotional states with heightened, sometimes crippling intensity. This heightened sensitivity can be beneficial in several ways. It appears to play a crucial role in empathy, the ability to feel what others are feeling, and by allowing you to understand your own emotional state it can help you avoid misunderstandings during arguments with a significant other: If you grasp that you are upset about something that happened before you got home, then you are more likely to understand that the explosive anger you are suddenly feeling is not really because dinner isn’t on the table yet.​

    High Self-Awareness can also exact a cost, however. Someone with very sensitive emotional antennae for his own feelings who observes the pain of another will feel that person’s anxiety or sadness in both mind and body—experiencing a surge of the stress hormone cortisol, for instance, as well as elevated heart rate and blood pressure. Such extreme sensitivity is likely a factor in the burnout that nurses, counselors, therapists, and social workers suffer.​

    In the lab, one way we measure people’s sensitivity to their internal physiological signals is by how well they can detect their own heartbeat. First, we measure a person’s heart rate while she is resting comfortably. Then we use a computer to construct a series of ten tones perfectly in sync with her heartbeat; each tone occurs precisely when the heart beats. We then construct a second sequence, shifted a bit, so that the tones sound a little before or after each heartbeat. To assess how sensitive the person is to her internal signals, we play (through headphones) two sequences of ten tones; her task is to choose which one is in sync with her heartbeat. We run the in-sync and out-of-sync sequences a hundred or so times each, alternating them randomly. Self-Aware people score in the top 25 percent of performance on this test.​

    Assessing your sensitivity to your body’s signals doesn’t lend itself to the kind of questionnaire we’ve developed for the other five dimensions of Emotional Style, so I’ve included both questions and a simple exercise you can try. The latter should be done with a partner.​
    • Often, when someone asks me why I am so angry or sad, I respond (or think to myself), “But I’m not!”
    • When those closest to me ask why I treated someone brusquely or meanly, I often disagree that I did any such thing.
    • I frequently—more than a couple of times a month—find that my heart is racing or my pulse is pounding, and I have no idea why.
    • When I observe someone in pain, I feel the pain myself both emotionally and physically. I am usually sure enough about how I am feeling that I can put my emotions into words.
    • I sometimes notice aches and pains and have no idea where they came from.
    • I like to spend time being quiet and relaxed, just feeling what is going on inside me.
    • I believe I very much inhabit my body and feel at home and comfortable with my body.
    • I am strongly oriented to the external world and rarely take note of what’s happening in my body.
    • When I exercise, I am very sensitive to the changes it produces in my body.

    Give yourself one point for each True response to questions 4, 5, 7, 8, and 10; score one point for each False response to questions 1, 2, 3, 6, and 9. Score zero for each False response to 4, 5, 7, 8, and 10, and for each True response to 1, 2, 3, 6, and 9. A score of eight or higher means you are Self-Aware; a score below three means you are Self-Opaque.​

    For the exercise, have a partner take your pulse for thirty seconds while you direct your attention internally and try to detect your own heartbeat. Focus your awareness on your internal bodily sensations, and do your best (without touching your wrist or anyplace else to feel a pulse) to sense your heartbeat and count the number of beats. Do this three more times—that is, four thirty-second trials. Compare your counts to those of your partner. The closer the match, the greater your Self-Awareness.​

    The point of the book is to better understand emotions (mind) by studying the seat of thinking and emotions (the brain). Here's what he has to say about that in a chapter called "The Brain Basis of Emotional Style:"

    The Self-Aware Brain

    Back in graduate school, I began to study a personality type characterized by what was then called repressive defensiveness. People with this personality deny experiencing much anxiety or stress, yet their bodies tell a very different story, as we saw in one particular experiment. We had participants do what’s called an emotional-phrase association task, in which they would say the first words that came into their minds when they read a phrase. The phrases were neutral (“The lamp is on the bedside table”), sexual (“The prostitute slept with the student”), or aggressive (“His roommate kicked him in the stomach”). The subjects who had high levels of repressive defensiveness rated the emotional phrases as not perturbing them at all—yet their heart rate and skin conductance (which measures sweating and hence anxiety) were off the charts. Clearly, these were not the most self-aware people. Subsequent research showed that people with marked repressive defensiveness do not consciously suppress their reactions, or lie about not feeling them. Rather, they are honestly oblivious to what is happening inside them. As a result of the failure to accurately perceive their internal states, what they say about how they feel diverges wildly from objective measures of those states.​

    At the time, there wasn’t much more I could learn about this extreme lack of self-awareness, but that changed with the advent of neuroimaging. A key region of the brain for self-awareness is the insula, shown in the diagram below:​
    [Kindle doesn't copy and paste pictures, so try these two pictures of the insula from Grey's Anatomy:​
    Basically, it's a part of the surface (cortex) of the brain that has folded inward so much that it is practically on the inside of the brain and is therefore very close to the other emotional centers of the brain (i.e. the limbic system) near the brain's center. This is clear from the following picture:​
    Caption from the diagram: Self-Awareness: The insula receives signals from the visceral organs, with the result that high levels of activity support high levels of Self-Awareness and lower activity marks low levels of Self-Awareness.​

    Located between the temporal and the frontal lobes, the insula contains what is called a viscerotopic map of the body. That means the visceral organs—heart, liver, colon, sexual organs, lungs, stomach, kidneys—are each mapped to a specific spot within the insula. By “mapped,” I mean something akin to how each spot on the skin is mapped on the somatosensory cortex, where distinct clusters of neurons receive signals from every spot on the surface of the body, from our forehead to our toes and every sensitive spot in between. Each region of the skin sends signals to only one spot in the somatosensory cortex; in this sense, the surface of the body is mapped onto the somatosensory cortex. The insula similarly receives signals from our visceral organs and forms a map of them in the sense that specific regions of the insula receive input from specific organs. It is therefore the brain’s monitoring station for everything below the neck and within the body. The insula also sends signals to the organs, instructing the heart to beat more quickly, for instance, or the lungs to inhale more rapidly. In addition to the insula, recent research shows, the somatosensory cortex is also involved in perceiving internal sensations. Next time you are aware of your heart racing when you feel scared or your face reddening when you’re furious, you can thank both your insula and your somatosensory cortex.​

    Not surprisingly, then, the insula snaps to attention when it receives instructions (from other areas of the brain) to monitor heart rate. When this structure dials up its activity—by bringing online more neurons that receive input from the heart, for instance, or by enlisting more neurons to transmit these data to regions in the brain that do the actual counting—people are more sensitive to their heart rate. British researchers have found through neuroimaging that people who are more accurate in estimating their heart rate also have a larger insula; the larger the insula, the better the estimate.​

    Interestingly, higher insula activation is associated with greater awareness not only of physical sensations but also of emotions. In a 2010 study, also in Britain, scientists had people answer questions designed to assess where they fall on a scale of alexithymia (difficulty identifying and describing one’s feelings). They indicated whether various statements accurately described them, such as: “When other people are hurt or upset, I have difficulty imagining what they are feeling”; “When asked which emotion I’m feeling, I frequently don’t know the answer”; “I can’t identify feelings that I vaguely sense are going on inside of me.” Later, they measured the participants’ insula activity. The more alexithymic someone seems from answers to such questions, the lower the insula activity.​

    What this all adds up to is that individuals with high levels of Self-Awareness have greater activation in the insula, while those with low levels of Self-Awareness have decreased activation. In the extreme, ultrahigh levels of insula activity seem to be associated with the excessive awareness of bodily cues that sometimes occurs in, for instance, panic disorder and hypochondrias. People with these illnesses are hypersensitive to their pulse, respiration rate, temperature, and other measures of anxiety and tend to overestimate them. As a result, a slight uptick in, say, heart rate that someone else might pay glancing attention to, perhaps wondering if something just beneath conscious awareness triggered a stress reaction, is interpreted as a sign of an impending heart attack.​

    Already knowing about TMS, I was interested in Self-Awareness and wanted to learn more about the insula. I found this great article from the New York Times:
    Interesting stuff...

    Finally, everyone wants to get better, right? Here are his tips on developing your emotional awareness from a chapter entitled "Rewired, or Neurally Inspired Exercises to Change Your Emotional Style:"


    “Blissfully unaware” is a misnomer: Being blind and deaf to what your body is trying to tell you is a good way to miss important signs of illness, whether a fever that signals an infection or a tightness in the chest that means a heart attack. Being Self-Opaque has consequences for relationships, as well: If you cannot tell that your blood pressure is rising and your heart rate is increasing because you are angry, then you do not have a chance to walk it off before you have a crucial meeting, attend a conference with your child’s teacher, drive home during rush hour, or do anything else that anger can cause to go off the rails. On the other hand, being acutely Self-Aware is a road to hypochondria and panic attacks, as well as to paralysis in your emotional life: If you are constantly besieged by messages about your state of mind and heart (Uh oh, I’m feeling nervous again; or Here comes that tidal wave of anger), it can be tough to get on with life.​

    In chapter 4, I explained that individuals with high levels of Self-Awareness (emotional or physical) have greater activation in their insula, while those with little Self-Awareness have decreased activation. In the extreme, ultrahigh levels of insula activity seem to be associated with the hyperawareness of every little change in heart rate or respiration that sometimes occurs in panic disorder. To move yourself toward the Self-Aware end of this dimension, then, you need to increase insula activation; to dial it back, you need to decrease it.​

    Thanks to research on panic disorder, we know something about how to decrease the insula activity that makes us too Self-Aware. The best-validated treatment for panic disorder is cognitive-behavioral therapy. In this approach, patients learn to reframe or reappraise the significance of internal bodily cues. For example, if you experience chest pain or another sensation that you interpret as a danger signal, tell yourself you have many sensations that are perfectly innocuous, and in all likelihood this one is, too. This kind of cognitive reframing, by reducing insula activity, often reduces panic symptoms substantially.​

    An alternative to becoming less Self-Aware of your body, thoughts, and feelings by decreasing insula activity is to decrease the rest of the brain’s reactivity to the insula’s signals. Basically, the idea is to alter your relationship to your thoughts, emotions, and bodily sensations so that you do not become entangled in an endless, self-reinforcing loop (heart skips a beat; I’m having a heart attack; heart rate spikes; repeat) and leap to the conclusion that some aspect of what you are feeling portends doom. The trick is to keep your mind from ruminating in response to these internal cues. Rather than target the excessive Self-Awareness that comes from the insula, therefore, the idea is to reduce activity in the amygdala and the orbital frontal cortex, which form a circuit that assigns emotional value to thoughts and sensations. By reducing this circuit’s activity, the brain can start perceiving thoughts, emotions, and sensations less judgmentally and less hysterically, so that we are not hijacked by our internal chatter. You’re still very Self-Aware, but it’s not debilitating.​

    One of the most effective ways to reduce activation in the amygdala and orbital frontal cortex is through mindfulness meditation. In this form of mental training, you practice observing your thoughts, feelings, and sensations moment by moment and nonjudgmentally, viewing them simply as what they are: thoughts, feelings, sensations; nothing more and nothing less. By learning to observe nonjudgmentally, you can break the chain of associations that typically arise from every thought. Ugh, I have to stop worrying about work becomes Oh, how interesting that a thought about problems at work has entered my consciousness. Ouch, my knee is killing me becomes Aha, a signal from my knee has reached my brain. If these observations start spinning off into judgmental thoughts, as they tend to (I should have finished that project sooner than two minutes before the deadline!), try to return to the process of mere observation.​

    Developing these mindful habits often takes considerable practice, though our research indicates that even short amounts of time can make a difference. Many people report benefits after just twenty minutes of practice.​

    The best mindfulness instruction I know of comes in a course in mindfulness-based stress reduction, the most widely taught form of secular mindfulness meditation in medical centers today. You can find courses by checking out the University of Massachusetts Center for Mindfulness Web site, at www.umassmed.edu/content.aspx?id=41252. Alternatively, you can get an instructional CD that provides detailed guided instruction in mindfulness meditation, such as those produced by Jon Kabat-Zinn or Sharon Salzberg.​

    If you want to give mindfulness meditation a try before taking a formal course, you can begin on your own with awareness of breathing:​

    Choose a time of day when you are the most awake and alert. Sit upright on the floor or a chair, keeping the spine straight and maintaining a relaxed but erect posture so you do not get drowsy.​
    Now focus on your breathing, on the sensations it triggers throughout your body. Notice how your abdomen moves with each inhalation and exhalation.​
    Focus on the tip of the nose, noticing the different sensations that arise with each breath.​
    When you notice that you have been distracted by unrelated thoughts or feelings that have arisen, simply return your focus to your breathing.​

    You can do this practice with your eyes open or closed, depending on which feels most comfortable. I recommend you try this for five to ten minutes at a sitting, ideally twice a day. As you feel more comfortable, you can increase the length of your practice sessions.​

    Once you feel that you’ve got the hang of mindful breathing, let go of your breath as the anchor of your attention and allow your focus to come to rest on the dominant content of your conscious mind at the moment—a thought, feeling, or bodily sensation. Cultivate awareness of what is occurring without thinking about it and without judging it.​

    You might also try something I practice, called the body scan:​
    • Sit upright on the floor or a chair, keeping the spine straight and maintaining a relaxed but erect posture so you do not get drowsy.
    • Move your attention systematically around your body, from one location to the next—toe, foot, ankle, leg, knee. Notice the specific sensation at each, such as tingling or pressure or temperature. Don’t think about those parts of the body, but experience the sensations. In this way you cultivate awareness of your body in the context of nonjudgmental awareness.
    • If you start to get lost in a chain of thought or feeling, you can reengage with your breathing to settle your mind.

    I recommend trying the body scan for five to ten minutes, ideally twice a day. After a few weeks, you should find that your relationship to your inner thoughts, feelings, and sensations has changed: You are now able to experience them with less judgment, panic, or obsession. You can be aware of them without getting sucked into the vortex that they often create. By strengthening nonjudgmental awareness, you keep thoughts and feelings from hijacking your mind.​

    Paradoxically, one of the most effective strategies for increasing activity in the insula, and thus becoming more Self-Aware, is also to practice mindfulness meditation. A 2008 study found that people who have practiced mindfulness meditation every day for about eight years have a larger insula than people of the same sex and age who do not meditate. How can the same practice both increase and decrease Self-Awareness?​

    The answer lies in how Self-Awareness arises and what, exactly, we mean by it. If you are so overcome by internal sensations that you have trouble functioning, chances are you have normal levels of internal signals, thus likely normal levels of insula activity, but you react to these signals with catastrophizing thoughts and feelings. In this situation, mindfulness meditation will transform your reactivity to the signals by turning down the volume on your amygdala and orbital frontal cortex. But if you have trouble discriminating internal bodily cues, mindfulness meditation can amplify them by increasing the gain on the insula. Mindfulness meditation, in other words, has a regulating effect on the mind. If you lack Self-Awareness, it can help make internal sensations more salient and vivid. If you are hyperaware, feeling and hearing your internal signals all too vividly and loudly, it can bring about a kind of equanimity so you are not as bothered by this internal noise. That equanimity eventually helps the noise itself die down.​

    As with every dimension of Emotional Style, enduring change will come about through mental practice that shifts patterns of neural activity. But you can also rearrange your environment to encourage or discourage Self-Awareness. To boost Self-Awareness, decrease distractions and choose quiet environments, which make it easier to perceive internal feelings and sensations. They’re the “signal” you want to perceive; the stuff around you is the noise. By decreasing the noise, you can increase the signal-to-noise ratio. To decrease Self-Awareness, do the opposite: Arrange things so you have more external stimuli to focus on. Keep a radio on, for instance, but don’t let it become background noise. Multitask, checking e-mail while you watch TV or listening to music while you work. This will leave you with fewer attentional resources to devote to internal sensations, decreasing your signal-to-noise ratio.​

    It's a long book and I've only scratched the surface here. If you're interested in this stuff, I highly recommend that you get a copy. There's actually an entire chapter on "The Mind-Brain-Body Connection, or How Emotional Style Influences Health."

    I hope you found it as interesting as I did. It was first published in 2012, so it is quite up to date in a rapidly changing field.
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