Originally written by Dr. Schubiner on June 4, 2009 Many people find that fear of not being able to recover from MBS and fear of pain are major factors preventing their recovery.In order to address these issues, I offer the courageous story of Brad in his own words.Following that (in the next blog), you will find my comments on dealing with fear and several methods that can help. “In the late 1980s, I became totally crippled with back pain shortly after an incredibly stressful four-month period. I couldn’t do much besides lie around. I saw several doctors, who gave me a variety of diagnoses, and I realized they were just guessing, so I went to the library do some research. By chance (thank God!) I saw Dr. Sarno’s first book, Mind Over Back Pain, on the shelf. I took it out, and after reading it I knew that my pain had been caused by my recent psychological tensions. I also concluded that I had become literally phobic about many movements and decided that the only way to break the phobia was to challenge it with graduated exercise. So I began to exercise and lift weights.However, I was very timid and therefore didn’t exercise as aggressively as I could have.Nonetheless, I improved enough in eight months that I was able to return to work. At the time, I had a very physically demanding job (landscape construction), and because I wasn’t entirely better, it was very frustrating: I wanted to work hard and lift heavy objects, but I couldn’t. Anyway, I made it through the summer. In the subsequent fall and winter, I went back to university and began lifting and stretching more aggressively. I did it gradually, but I persevered in always increasing the weights I was using and getting stronger. By the end of eight months I was at least 90 percent over my TMS. When I then returned to landscaping, I was overjoyed that I could physically work hard. By the end of the summer, the TMS had completely disappeared. For the next seven years, I never had the slightest back discomfort. In 1997, I experienced a surreal conjuncture of stressors (my father had just died, my mother had just been diagnosed with terminal cancer, my wife landed in the intensive care unit of the hospital, and my sisters and I had some serious disagreements). That’s when the TMS returned — it came on gradually when I was walking down the street — but perhaps because I was distracted with all the stressors in my life the pain didn’t bother me; I knew it was TMS and had no doubt it would soon resolve itself. And it did — it was completely gone in a week or so. Then, two years later, when I was doing some yard work I had some pain. I didn’t really think I was that stressed out; anyway, I just “worked” the pain out, and it was gone in about five minutes. I was as good as new, and my back felt completely strong. Fast forward to the end of the year 2000, when my academic career appeared uncertain and I was feeling very insecure (and had become a workaholic): the pain returned. This time, I was inexplicably seized with fear about the pain. I was terrified it would become like it had been in the late 1980s and that I would have trouble getting rid of it. Fortunately, it never became as bad as it had been back then, but I did feel kind of disabled and afraid of lifting and moving naturally. So I started doing exercises again to weaken the fear, but in retrospect I was too cautious. I didn’t fully challenge the fears and therefore the soreness and tightness remained with me for years. Last summer I came upon Fred Amir’s book, and based on it I designed an exercise regime that I thought would break the phobia. Unfortunately, I kind of quit the “scarier” exercises (like dead lifts): I rationalized that I didn’t need to do them any more. Thus, I had been on the right track, but gave up too easily. Finally, with your endorsement and encouragement, this past November I went back to a weightlifting regime to face my fears head on. Since then, I’ve been relentless in doing more and more movements and heavier lifting. (Of course, I’ve been very sensible and have avoided any injuries.) I’ve made slow but unmistakable progress with the TMS and have come to the point that I’ve overcome most of my fears. The little bit of residual muscle tension that remains is probably caused partly by lingering fear, or perhaps I should call it mental resistance: I get mental “flashes” when my mind tells me it doesn’t want me to bend to pick up a paper clip — even though I can effortlessly dead lift 50 lbs. for 30 consecutive repetitions! It’s bizarre! I also think some of the muscle tension is caused by my emotions about TMS; I still sometimes struggle with worry and frustration, especially. Today, when I really felt in control of my thought patterns and emotions and wasn’t worried or frustrated I had virtually no TMS symptoms at all.” This powerful story describes in vivid detail the tension so many of us (those with TMS/MBS) feel in our lives.We understand MBS very well, but it can be difficult to feel fully cured and fully healthy.As Dr. Sarno often says, “You’re not fully healed until you’re free of pain and free of fear.” I admire people like Brad who have been able to meet their fears head on.I have seen so many people who have seen reductions or elimination of pain, but continue to struggle with fear of activity or of a return of MBS symptoms.One option for dealing with the fear is to engage it and work through it as Brad has done.This component should always be part of healing because it directly confronts your fears and forces you to recognize that you can get better and that in fact you are better when you are able to do activities that used to cause pain.However, there are many other methods to deal with fear and I will cover some of those in the next blog. To your health, Howard Schubiner, MD Disclaimer: It is important to recognize that the information contained in this blog, whether posted by me or anyone else, cannot be considered to be specific medical diagnoses, medical treatment, or medical advice. General information about MBS/TMS will be posted in response to questions, but you will need to decide if this information is relevant to your situation and, as always, you should consult with your physicians and counselors regarding new symptoms and any changes that you might make in medications or activities.