New Program Day 18: Conditioned Responses

[Celayne]

Alan,

I definitely got the mold of TMS and have been struggling with neck and back pain since age 13 and knee pain which has subsided. I have the neck pain under control but it is still painful. My biggest struggle is my current diagnosis of Intersitial Cystitis which causes me to have to urinate frequently and I constantly have discomfort in my bladder. It has made my life so difficult because I get no relief. I tried everything except really apply the TMS protocol which I have done in the past. However I do get recurring UTI and strep b bacteria because of this so it causes doubt in my mind that it is TMS because I have an actual infection sometimes. But when I don't have the infection I still feel discomfort and antibiotics don't help. Is it still possible to be TMS?

Your immune system is suppressed because of your TMS. Deal with TMS and the infectious problems should abate.

 

[Ollin]

Thanks Alan. Very important point. Since my pain has been getting worse I stopped doing some yoga poses when i noticed that they cause me pain. But then i decided to challenge this belief and to my great surprise when i did them slowly and mindfully the pain was actually minimal or none.
I have an issue with sitting pain though i realize now that it may have developed the association because i experienced significant stress while i happened to be sitting. But then i now have the same pain in different positions like lying on my back or side. What i have most trouble with is the belief after doctors actually told me that i have hyperesthesia. I.e. oversensitized signal receptors in my tissues that interpret a gentle touch as dangerous pressure and make me feel pain. Which is true. I only feel this pain when something touches me in the sensitive areas of my back or leg. I know it's the CNS that decides to amplify the signal but some of my muscles and skin are obviously changed in comparison to other more normal body parts. Am I wrong and "thinking physical"?

 

[Lauren T]

Isn't EVERYTHING a conditioned response? I'm looking at my cell phone... where are my messages??? Lol thinking how this could apply to our lives in general! What a BIG thought!!!!!

 

[Alan Gordon LCSW]

What i have most trouble with is the belief after doctors actually told me that i have hyperesthesia. I.e. oversensitized signal receptors in my tissues that interpret a gentle touch as dangerous pressure and make me feel pain. Which is true. I only feel this pain when something touches me in the sensitive areas of my back or Leg. I know it's the CNS that decides to amplify the signal but some of my muscles and skin are obviously changed in comparison to other more normal body parts. Am I wrong and "thinking physical"?

Many people with TMS have hyperesthesia. In these cases it's the brain interpreting a safe stimuli as if its dangerous, and there is nothing wrong with the tissue. It is the fear around the pain and the belief around being damaged that perpetuates the symptoms.

 

[BOP]

Here's what I know: the pain in my spine and limb crippling is real from toxins pumped into my spinal cord during a botched diagnostic epidural. I do have that MRI and DX. But is it? Ok, it is, but not all of it. Because the Brain fear cycle can make a mountain out of a molehill. I blindly - with faith - follow MBS treatments because I know my brain will believe whatever I feed it. So we don't talk about diagnoses or labels here, we talk about hope and being ok with what is happening - no danger here; just some symptoms that are going away. And we (me and the people I surround myself with) cling to the belief that the body wants to heal and wants to be pain free. Where there is a moment of low or no pain, it's proof there can be MORE. I choose to believe my mind has the power to reverse what has been done and see me to the other side.

 

[MWsunin12]

Okay, I find, that more often than not, doctors don't say "nothing's wrong with you." They come up with something. I've had friends get 4 different diagnosis from 4 different doctors all prescribing 4 different medications or surgeries.

I know, for legal reasons, this board has to say check with a doctor first, but....how do you swim to shore in an ocean of conflicting diagnosis when all of these various doctors speak with such authority. No wonder our healthcare system is a mess.

I know Dr's are only human, but as Sarno said...they've known for years that back surgery doesn't really pay off.
Between medical/hospital/treatment errors being the 3rd leading cause of death in the U.S...and even just the sad stories of medical mistreatment here on this forum, we really are left on our own, to listen to our own internal wisdom. Maybe that's what it should be.

 

[aziemski]

I was also an avid mountain biker, equestrian and downhill skier before my back pain took over my life. I can relate to feeling like I have lost all my friends, social circles, even travelling and holidays as most of my trips were ski trips or hiking/camping trips. I built my life around that stuff and when I was suddenly unable to do it, I found myself spending all my time watching my friends doing it on facebook without me and being horribly depressed. They stopped asking me to come years ago because they know the answer :-(

However, this summer I have started riding my bike on trails again. As well as taking lengthier and more vigorous hikes. One of the things that has really been helping me stay motivated is the "evidence" that I don't really seem to have pain WHILE I am doing these activities. Only later, after. And if I have some kind of structural problem in my back then that shouldn't be the case. However, it makes total sense when I think about it from an oxygen deprivation perspective. What happens when your muscles warm up and your heart starts pumping? Your blood vessels dilate, and blood flows readily to the tissues carrying more oxygen with it. So of course, when I'm in the midst of the workout, I feel good, and when I stop, I go back to the O2-deprived state. I use this to keep myself calm when the pain comes back and to prevent myself from thinking things like "your back hurts because of that bike ride you took"....wrong. That bike ride made my back feel better, the TMS is what made it hurt again.

 

[jml19]

Alan,

I definitely got the mold of TMS and have been struggling with neck and back pain since age 13 and knee pain which has subsided. I have the neck pain under control but it is still painful. My biggest struggle is my current diagnosis of Intersitial Cystitis which causes me to have to urinate frequently and I constantly have discomfort in my bladder. It has made my life so difficult because I get no relief. I tried everything except really apply the TMS protocol which I have done in the past. However I do get recurring UTI and strep b bacteria because of this so it causes doubt in my mind that it is TMS because I have an actual infection sometimes. But when I don't have the infection I still feel discomfort and antibiotics don't help. Is it still possible to be TMS?

 

[jml19]

Alan,

I definitely got the mold of TMS and have been struggling with neck and back pain since age 13 and knee pain which has subsided. I have the neck pain under control but it is still painful. My biggest struggle is my current diagnosis of Intersitial Cystitis which causes me to have to urinate frequently and I constantly have discomfort in my bladder. It has made my life so difficult because I get no relief. I tried everything except really apply the TMS protocol which I have done in the past. However I do get recurring UTI and strep b bacteria because of this so it causes doubt in my mind that it is TMS because I have an actual infection sometimes. But when I don't have the infection I still feel discomfort and antibiotics don't help. Is it still possible to be TMS?

I can totally relate to what you are going through. I don't know how old you are, but I am 65 and post menopausal. Since the end of April, I have had what are believed to have been four UTIs in a row--each a month apart. I say "believed" because nobody is really sure. Antibiotics seemed to help, but never really took away the bladder urgency symptoms. Did you know that bacteria can show up on a culture but that doesn't necessarily mean it's a UTI? Even though a lot of my symptoms suggested Interstitial Cystitis, in my case, the urologist did not find anything in the bladder that would suggest IE. I have learned that many many women (and some men) have pelvic pain due to muscle tension and spasms and that condition can mimic UTI symptoms! Lots of different things can cause that tension but in my case I really do believe some of it is hormonal but most of it is stress related. I've got the hormones under control and I found a physical therapist who specializes in pelvic pain dysfunction and believes in the mind-body connection. The PT is helping a lot but she and I both agree that if I don't deal with my anxiety, I will continue to have pain. I discovered this TMS site just a few days ago and already it is changing my life. I hope it helps you too!

 

[Freedom]

This (Evidence Sheet) may be my favorite part of this series. I have seen the best results (i.e. reduced pain) from using this technique over any other technique. I have one in my phone (using the notepadd app) so that wherever I am I can add something to the sheet if something new comes up. Here are some of mine from a year ago to today:

• Had neck pain from sleeping on my side. Then for months I stopped having it
• Had pain in my mid back when waking up. Then it stopped for a few months (came back again aka the ebb and flow mentioned in this post)
• Could not hang from a pullup bar without pain. Can do assisted pullups now with no pain
• Could not sit in my 3 hour lectures at grad school a year ago, now I can sit with minimal or no pain
• Had burning pain in my upper back/neck when typing at keyboard, have it very infrequently now
• Had lots of nerve pain in all areas of my body, get this almost never now.

 

[Click#7]

Day 18: Conditioned Responses

In the late 1960s, comedian Steve Martin was on top of the world. His career was taking off, he was making good money, and he was dating up a storm. But then one night, it all came crashing down. He was out with his friends, when out of nowhere he had a crippling panic attack.

“My heart began to race above two hundred beats per minute,” he said. “The saliva drained from my mouth so completely that I could not move my tongue.”

The next day he was feeling better, but that very evening, he had another panic attack!

His brain had developed an unfortunate connection - he came to associate nighttime with anxiety. And this association lasted for months. During the days he was fine, but as soon as the sun would set, he was a mess.

Steve Martin developed a conditioned response - his brain connected a physical symptom with a neutral stimulus. Conditioned responses are very common with people in pain as well. This occurs when pain becomes linked with a physical position or activity.

For example:
Sitting

Back pain
Typing

Wrist pain
Eating

Stomach pain

But in the case of neural pathway pain, it isn’t the position or activity that’s causing the pain, rather it’s the belief that the position or activity is dangerous that’s causing the pain.

Learned Behavior

Evolutionarily speaking, conditioned responses are actually helpful. If you eat a poisonous berry and get sick, you brain creates an association. It puts a “DANGER” sign up, and after that, even the smell of that berry can make you nauseous. Conditioned responses can protects us from repeating dangerous behaviors.

But what if that berry wasn’t poisonous? What if you just happened to get sick shortly after eating it? Your brain – not taking any chances – might create an association anyway, and put a “DANGER” sign up on a food that’s actually safe.

Assuming you have neural pathway pain, this is how conditioned responses develop. Your brain interprets a safe behavior (sitting, walking, typing, etc.) as if it’s dangerous.

In the following clip, a 17-year-old named Mya developed a conditioned response to eating. Her brain learned that food = danger, and it’s responding accordingly.

Thankfully, Mya’s currently working with a specialist to help her unlearn this association.

Unlearning What We’ve Learned

The way to overcome conditioned responses is to teach your brain that the position or activity it's interpreting as dangerous, is actually safe.

The first step in this process is acknowledging the obstacles. Often we're able to accept intellectually that we have neural pathway pain, but on a gut level we still have a tendency to think physically.

And this makes sense.

If you sit and you have pain, or you walk and you have pain, it’s a logical conclusion to think that it’s the sitting or the walking that’s causing your pain. Everything you've ever learned about cause and effect is telling you that's what it is.

So to overcome conditioned responses, we actually have to embrace a perspective that's inherently counterintuitive: “It isn’t the sitting that’s causing me pain even though it hurts every time I sit?”

Searching for Exceptions

It’s hard to embrace a reality where our senses are essentially lying to us. Gathering evidence to support this perspective can make it lot easier.

The most compelling evidence that there’s nothing physically wrong with us comes in the form of exceptions.

The Exception

By 2006, I’d been suffering from chronic back pain for several years. It was pretty consistent – the longer I sat, the worse the pain was. Even though it hurt to sit, I tried not to let that stop me from living my life, and in April of that year, I went to a Lakers-Suns playoff game. In the fourth quarter of the game, the Lakers made a huge comeback, and Kobe Bryant made a last second shot to push it into overtime. Overtime was even more exciting, and he made another last second shot to win the game!

It was pandemonium!

But nobody in the stadium was more excited than me, because for the first time in two years, I was sitting without pain.

Sometimes when we’re deeply distracted, we’re unconsciously depriving our pain of its one fuel source: fear.

When this happens, we can develop exceptions – instances where the pain isn’t what we would expect it to be, given our physical position or activity.

Finding exceptions can help us more easily believe that it isn’t the position or activity that’s causing our pain.

While finding these past exceptions can be helpful, if you don’t have any of these instances, it’s okay. As you continue teaching your brain that it’s safe, you increase your likelihood of getting these exceptions.

Compiling the Evidence

There are other ways to gather evidence that your pain isn’t physically caused as well.

Have physicians been unable to find any cause for you pain?
Did the symptoms come on without any preceding physical trauma?
Does the pain seem to ebb and flow based on your stress level?

None of these are definitive proof, but we’re trying to build a case.

As you continue to gather evidence, it’s a good idea to put together an evidence sheet: a list of all the reasons to support that your pain is psychogenic.

One of our former patients has offered her evidence sheet for us to share:

Reinforcing the Evidence

The night of my magical Lakers experience, I remember thinking, “It’s psychogenic for sure! I’m free!” Then the next night I was out to dinner and my back started hurting, and all that went out the window.

No matter how much evidence we have that our pain is psychogenic, it can be hard to hold on to that when we’re in a pain state.

It can help to reinforce the evidence that you’ve gathered throughout the day, especially when you’re in a pain state. “Right now, I’m thinking it hurts because I’m sitting, but because of this piece of evidence and that piece of evidence, I know that it isn’t the sitting that’s causing the pain, it’s the belief that sitting is dangerous that’s causing the pain.”

The more you’re able to internalize this message, the more likely you are to gather even more evidence. It can become a positive feedback loop.

Ultimately, when you’re able to teach your brain that these physical sensations are non-dangerous, the pain begins to fade.

Tomorrow, I’ll be going over two techniques that can help communicate this message: systematic desensitization and sensory reprocessing.

​

Let's see if Alan answers this ? I can actually feel the nerve stretching when I bend over. If feels like an individual nerve being pinched and burns. The MRI shows nothing other than slight spinal stenosis , disc bulging and a small protrusion. None of which Dr. Sanro says should bother me. Is this a conditioned response ? I feel it when I lift my leg to dry it in the morning after I shower.

 

[MindBodyPT]

Let's see if Alan answers this ? I can actually feel the nerve stretching when I bend over. If feels like an individual nerve being pinched and burns. The MRI shows nothing other than slight spinal stenosis , disc bulging and a small protrusion. None of which Dr. Sanro says should bother me. Is this a conditioned response ? I feel it when I lift my leg to dry it in the morning after I shower.

Hey Click,

I know i'm not Alan but since he probably wouldn't answer that since he's a psychotherapist...yes pain and sensation with bending and stretching is also a conditioned response. I had similar issues when I had sciatica and that is all gone since I healed from my TMS. Literally any movement can wind up being associated with any sensation to create a conditioned response! I know it feels structural but don't let it fool you.

 

[BruceMC]

"Conditioned responses are very common with people in pain as well. This occurs when pain becomes linked with a physical position or activity."

I noticed this today while I went out shopping at the grocery store. Around my house I can walk anywhere now and my stride up and down the front steps has improved immensely and is pain-free. However, every time I drive down to Safeway in Sonora, in the aisles I start getting more and more sciatica and when I drive back to my place uphill my left leg hurts and stings. Then, when I get back in the house, the pain peaks and if I lay down for a while is gone completely. It's become a kind of weird cycle. Maybe I don't like buying groceries or maybe it's a programmed response that's become fixed in my psyche? And of course how do I break this programmed response? Am I afraid of something when I leave my house and go out shopping at the grocery store?

 

[kkcarlton]

How would I apply this to pain that happens at night? I know there is no reason to have pain at night and there was one night last June that I slept 8 hours and woke up feeling amazing, so I know it's possible. But by the time I wake up the pain is usually already at a 7 or an 8 on a scale of 1 to 10. So do I just practice outcome independence, which is actually getting harder, or is there something I can do proactively? Thank you?

 

[MindBodyPT]

Yes as you said above...outcome independence and the other skills you've learned through the program! Conditioned responses are one aspect of TMS but not the only thing that causes the pain to occur. Lots of people have TMS pain at night.

 

[BruceMC]

And of course how do I break this programmed response? Am I afraid of something when I leave my house and go out shopping at the grocery store?

I notice that I wrote this about the pain peaking in the grocery store on January 14th, 2018. A couple of weeks back, I actually noticed that the pain I was experiencing in the Sonora Safeway was going way down. No more fear of having to abandon the cart and go get a bag for pears or tomatoes. I realize now that the pain has actually been going down since I moved up to Sonora in July. It's just been going away so slowly that I didn't notice it. So, it's important to maintain a detached perspective on your pain condition, even while it seeks to distract you. But when it lets up you begin to take your improved condition for granted. I guess you lose perspective in the middle of your improvement. The now is so overwhelming.

 

[andy64tms]

Hi BruceC,

Ref: "The Now is so overwhelming"

When I did my “One repressed Emotion” post I realized we are under continual repression in everything we do. Not only do we repress “nasty emotions” but others also. It seems to me this mechanism is a survival tactic to keep us sane and stop us from getting brain overload.

The now has to be "so overwhelming" to even get a look in. I agree "detached perspective" is a good rule to have.

Examples:

We don’t comprehend what we hear, so we repress it for the “later” that may or may not ever come, absolute non caring detachment.

I am otherwise focused playing FreeCell, my wife calls me for dinner, and I ignore her with detachment and play one more game. Her voice gets louder and guilt sets in. No more repression my “in the now” is diverted.

I wonder if all emotions go to Cache before moving to the Repressed vault or maybe a mixture of both perhaps? I am assuming we always exuding some kind of emotion or other.

I was exhausted after the chat today, it was fun, it became a stress test keeping up.

 

[BruceMC]

Tonight I had even less left-leg and hip pain while walking around the Sonora Safeway. However, I notice that now I've manufactured other distraction to feel bad about. Always a balancing act! The heater in my house went out this morning so I kept thinking about myself as a victim of misfortune. Left leg hardly a bother, but now I've manufactured something else to feel bad about. Endless balancing act.

 

[andy64tms]

Is your broken heater event 1 or 2? I've noticed things normally go wrong in threes. I normally take cover at #2, but this seems to advance #3 coming.

Things breaking also make me feel victimized. Unfortunately I am a "jack of all trades", and self compelled to excel fixing them. I always succeed so why the big deal. Even my granddaughter of five pointed out that "Grandpa can fix anything". Not only do we have our self image to live up to, but all those around us as we are challenged to do even better than before, You can't win, we need to laugh, step up to the plate enjoy the stress, then enjoy the soothing.

 

[BruceMC]

Is your broken heater event 1 or 2? I've noticed things normally go wrong in threes.

Replacing the striker in the driver door of my BMW Z3 must have been number 1, considering how long it took for me to take the initiative and get in there and fix it. But I also installed a new Dinan fiber-Ti strut brace on the front towers and now I've finally got the 7 LEDs to replace the old lights in my Third Eye on the trunk. Also got a Nikkor 24mm f/1.8 lens. So that sort of cancels out the heater, doesn't it? Well, hanging in an icebox till Tuesday to get the motor for the heater kinda counts as 2 and 3, so it seems? Take the good with the bad!