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Alex B. What are barriers to getting better?
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Hi there, thanks for the question.

So this a pretty broad one. I can give you some idea of what barriers I see my clients encounter most frequently. I would start by stating that first and foremost, the primary barrier is truly accepting the TMS diagnosis. So many of the people I work with come to me and say that they are "100% sure" that they are dealing with a mind-body issue. However, when we begin to confront and examine symptoms and try to reframe the meaning of the pain, they continually get stuck with the anxiety and fear that they are going to make things worse or that they can't get better. These fears will continue to plague you as long as there is a potent part of your mind that is thinking structurally. Now, it must be said that I think this is the most challenging aspect of TMS treatment. And it makes sense that it is; thinking of your pain as a non-structural issue goes directly against millions of years of evolution! We are hard-wired to associate pain with damage, injury and vulnerability. I understand how difficult this can be. I don't think I've encountered a single person who wasn't skeptical when first exposed to the concept of TMS. This doesn't mean you can't overcome it. What it means is that the most important thing you can do for yourself is to accumulate as much evidence as you possibly can that what you are dealing with is a mind-body issue. Create and evidence sheet, see a TMS doctor, whatever it takes to help you become convinced that the symptoms you are feeling just aren't congruent with a structural problem.

The second barrier is directly related to this: the continuing capacity for the symptoms to generate fear and anxiety. The reason it is so important for you to gather evidence and foster certainty that you are dealing with TMS is so that you truly believe that when you experience symptoms they can't actually hurt you. Yes, they may be painful. Yes, they may be annoying. But when you realize that they aren't structural and can't cause long-term damage, you have the opportunity to overcome the fear that they generate. It is this fear and anxiety that fuels TMS and keeps it relevant. The concept is that your pain is there for a reason and it's goal is to keep you fearful and preoccupied. The more you buy into this fear, the more it reinforces the purpose of the pain. People get hung up on the fear and it keeps them in this cycle.

So, to summarise the above: The first barrier is overcoming the built-in skepticism of TMS. This is done by accumulating evidence and conditioning yourself to accept that your pain isn't structural. Overcoming this first barrier allows you to overcome the second barrier, fear. Once you have accepted that the pain isn't structural, you can put aside the fear that it will hurt you.

The next major issues is outcome independence. The process I have outlined above is all well and good, but people still have difficulty with it because they become totally focused on using it simply to banish symptoms. This approach won't really work because the symptoms will still remain the focus of their efforts. Remember when I said the pain has a purpose, that it's there to keep you preoccupied? Well by having the symptom be the focus of your efforts, you are once again reinforcing that purpose. Monitoring constantly pressuring yourself to take on the techniques the "correct" way so that the pain disappears is still keeping you just as preoccupied as the fear did. The goal is to change the way you relate to the symptoms a the most basic level. Once you have accepted that they can't hurt you, it becomes about dismissing them as best you can. Again, it may still be very uncomfortable, but it doesn't need to have power over you. The goal of outcome independence is to change the way you relate to yourself, your process and your symptoms. The goal of your efforts becomes the abandonment of fear and anxiety not the banishment of your symptoms. Ideally you can get to the point where it doesn't matter if they are there or not: they can't hurt you so they no longer have the potential to keep you feeling powerless and afraid.

No this is also a difficult thing to do, and it won't always work. There will be times when the pain is too uncomfortable, the ringing in your ears to intense, your neck too stiff or whatever symptom it is you're experiencing. But this is paramount: that's ok! It's ok that this doesn't "work" every time. You don't have to completely banish fear and anxiety to be effective, just like you don't need to banish pain to make progress. This is about cultivating a different, more patient and caring perspective with yourself. Ideally you will be able to abandon the fear that accompanies your symptoms, but if you can't, simply observe what is happening, acknowledge that you're trying and keep at it. I can tell you with confidence that the less you let it scare and demoralize you, the sooner you get the long-term results that you want.


Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific professional or psychological advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical, psychological, or mindbody condition should seek professional advice from a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions.

The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

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