Greetings from Chicago!

Hmm. Interesting. I can definitely see how defining / labeling 'extinction bursts' can get one into trouble in terms of expectations. There's certainly no equivalent I've heard of yet in the anxiety / depression treatment world. As you said here, there's only ups and downs. Good days, bad days.

I do like Diana M's post on this subject:
https://www.tmswiki.org/forum/threads/good-info-on-extinction-bursts-and-plateaus.28974/

 

Extinction bursts exist in other areas, I train dogs, a dog who barks and begs for food because he always gets scraps from his owner, his owner finally starts ignoring the begging, the dog keeps barking, eventually it reaches a peak and then the dog realizes this is accomplishing nothing so gives up. The same goes for a child throwing a tantrum for junk food or soda or to play an extra hour on the computer. These are conscious decisions to achieve a result, when the result is unachievable they change course.

with TMS stuff I don’t believe it’s entirely conscious. I actually float between two camps, I think the initial generation of symptoms are by our higher selves trying to get us to change course, but after a certain point the brain just does what it does unconsciously, I don’t think it’s going “oh she/he is ready for this final test, let me really ramp it up and see how much they’ve learned/changed.”

I’ve seen Dr. schubiner use the term extinction bursts for patients, so who knows, I’m just some frog on the internet, lol.

I personally prefer just labeling increases in pain as flares and try and view them as opportunities.

 

I mainly agree with this as it relates to extinction bursts. @Scott G I know it may seem far away now (and it may take some symptom reduction) but you really fully recover when you cease to care about symptoms, you reach indifference. The idea of an extinction burst is obviously super attractive because it means I only have to deal with this last flare and I'm out, but even considering that means you still care too much. That is a very common question I receive, people, with hope in their eyes, is this an extinction burst? And I completely get it, no judgment as I've been there.

To put a different type of positive spin on it, what I think of with this flare (and they can be random too) to think psychologically is that this happened after you set up your first appointment, so it's probably a combination of nerves/excitement but it can also be a reflection of the brain knowing that you're onto something. If the pain is a protection/distraction, then you're threatening its very existence by flirting with the idea of discovering the truth (through a TMS coach), so it reacts and freaks out to try to throw you off the scent. Whether that's correct or not (from what I've read and from my experience it's a big possibility), I think that is a better way of looking at it and hopefully gives you some confidence

 

I'm probably a bit in the middle with this as I do believe that the brain can do that - more to test your belief in TMS - but at the same time I do think this is just the natural flow of TMS and to sort of label it and isolate it can lead to focus being lost in the process and can lead us away from indifference (because it suggests finality, and that really stands in stark contrast with indifference).

It's a good discussion though and with something like this I've seen many different opinions from people in the industry!

 

Yeah, thanks much for this Adam. I think I've landed on the notion that, in some way that I cannot fully understand, the part of my brain that's running this pain program is quite comfortable with the status quo and would rather I not spend any time trying to 'fix' something it's worked so hard at building up.

Not going to lie...I'm a bit terrified in thinking about just how I'm going to get to that 'indifference' mindset that is necessary. Regardless, I push onward.

 

I understand fully but it's a process - the more evidence you have that it's TMS the less you'll fear the pain/movements. Also, you'll start to understand more your emotional triggers and what you need to work on in that area, which will empower you further.

All of that leads to indifference - I think indifference is actually quite natural if the TMS process and path is followed correctly (you're in a fantastic position being guided by Dr Stracks of all people) - so please don't feel as if it needs to be a focus or it takes some unique effort - it's embedded in/is a consequence of the process (trying to be indifferent is an oxymoron in a sense)

 

Adam, so right about the emotional triggers; which, because I've been in deep full-time therapy for my anxiety since January, I'm able to much better identify now than at any other time in my life. Still much work to do in that aspect of my healing for sure, but grateful that these 2 issues are connected and I'm able to address them both at the same time with professionals.

Also very true about the process and Dr. Stracks. Love that about the 'path being followed correctly'. One thing I recognize is that I'm somewhat catastrophizing 'acceptance/allowing/indifference/' etc. when it comes to the pain I'm fearing that part of the process - and I haven't even formally started the process and course at Cormendi, lol. They aren't going to be reckless. I need to remember that always and trust in them and trust in the process.

 

Before retirement I was a therapist using Applied Behavioral Analysis and the concept of an extinction burst in TMS never made sense to me. I agree with you that the term doesn't apply to TMS. TMS symptoms fluctuate, but the process is subconscious.

 

Well, I had my first session with my new pain coach at Cormendi - Erica Walker. It went very well, indeed. While there's so much stuff online and in print in terms of Pain Reprocessing Therapy, it's nice to be able to connect with someone 'live'. Much of our first session focused on Somatic Tracking. While I had only read about it from Alan Gordon's book, I'd not actually tried it. I have to say, it was astounding when - after spending time objectively (and without judgement) observing a flare-up in my back - the pain went away when she guided me to a different area of my body in which I don't have pain (in this case, it was my feet). When we returned to my back, the pain very slowly returned. I was kind of blown away by this; even though I'd read about it happening.

Here's a video of Erica with Dr. Stracks; walking through the steps:


Anxiety and My Neuroplastic Pain
I'll share a rather harrowing but illuminating (for me) story from a couple of nights ago...

After having experienced Hypnogogic Hallucinations for most of my adult life (imagery and sounds appearing almost immediately after closing my eyes when I go to sleep), I had my first two episodes with Hypnopompic Hallucinations (seeing something immediately upon openning your eyes after waking up) this week. As mentioned before, I'm in treatment for anxiety and two nights ago I was really freaked out that these Hypnopompic Hallucinations would happen again that night. My anxiety was off the charts and, sure enough, my back pain started to slowly ramp-up. No matter how many mindfulness or breathing exercises I did - telling my brain that I'm in no real 'danger' - the anxiety and the pain kept ramping up.

Around 1am I start getting out of bed to urinate and WHAM! A spasm. Not a big one, not a small one. Pain for a few seconds. I was happy that, due to my studies so far and new mindset, I didn't freak out. Rather, I nodded at the pain and tried to examine it a bit in my head. Later, I went back to bed but was unable to contain the anxiety. After 45min of breathing exercises and a few CBT skills that didn't seem to be working, the anxiety - and the pain - calmed down.

Conditioned Responses
Another area that's been fascinating for me to learn and experience is this notion of 'Conditioned Responses'. This kind of thing had been on my mind leading up to my joining Cormendi and starting to read Alan Gordon's book. If I'm super relaxed, but I bend over a certain way, I will most likely get hit with a spasm. These 'conditioned responses' are so sneaky. Similar, there's been times when I'll be sleeping on my side, wake up, and within seconds get hit with a massive series of quick and painful spasms when I just move a tiny bit (still on my side!)

These are often the worst for me because it's so shocking - no warning. You're not even really awake yet. I chalk those up to the fact that my brain has probably been processing all kinds of uncomfortable emotions and feelings and thinks "Right! Let's get ready, everybody! He's really troubled in his thoughts and we need the pain to pull him out of that situation!" It might also be some Conditioned Response as well - because of the position I'm in.... Who knows.

Avoidance Behavior
One of my main avoidance behavior traits is to always sleep on my back now. lol. I laugh, but it's not funny. It's something I'm going to have to work on over time. Along with a lot of other things....

Tnx all.

 

What an awesome experience first up and great TMS evidence!

That is the way out though (pun intended), the more you respond with calm and indifference that's the way the conditioned response unravels. It's just old processing from the time where you thought this was structural. I always like to look at it as a conversation between you and your brain (that way, people demonise the brain less and understand that it is on our side and trying to protect us). When you bend, the pain is basically the brain's way of saying "are you sure about this, I thought that we thought this was dangerous because there's a structural problem". The more you re-assure your brain that it isn't (through exposure), eventually that subconscious part will catch up to your conscious belief and it will go

 

Yeah, absolutely love this. Tnx Adam. I'm getting better at being calm and indifferent but it certainly does require substantial discipline, lol.

My pain most often hits when I'm standing and/or walking. I can be at the kitchen counter or sink and, after a few minutes, the dull ache starts. At that point I start talking to my brain. "Hey there. We are in no danger here. It's okay. I know this is the expected thing after so long, but I want to let you know it's no longer necessary..." Etc. I try and never think or tell my brain to STOP! From what I gather, that's only telling my brain that I'm afraid.

As the pain continues to ramp-up, I try to be as mindful as I can... I'm not skilled enough yet to turn this into a true Somantic Tracking opportunity, but go through much of the same thought processes. Because the pain when I'm standing tends to come on slow and steady, I take the opportunity to keep practicing remaining calm. However (and this just happened, BTW) at some point it just becomes too intense and I go and sit down - all the while telling my brain "Hey, it's okay. You're doing what you feel you have to do. But I'm just saying...it's not required anymore."

Then I start to feel a bit bad and ashamed that I can't stick it out and just keep standing. It's at that point that I remember to give myself some self-compassion. "I'm not perfect, and I'm going the best I can... One step at a time. One pain event at a time. One spasm at a time..."

Also, sticking it out until I really get racked with a bad spasm is terrible for my anxiety - ramping it up to dangerous levels that will only serve to bring more pain. All that just serves to make me feel a bit worse, and then I call on more self-compassion...

 

I wanted to say too that I don't like putting too much pressure on reacting better in the moment. It is important (and for those who follow PRT more strictly they'll probably disagree), but don't discount the fact that as your belief and knowledge in/of TMS grows, you will naturally become more indifferent. More evidence of TMS will pop up by itself (you may be doing something and get distracted, and then reflect on the fact that for that period of time it didn't hurt), which will naturally give you more belief and will impact your reactions going forward without you having to consciously try (that's the great thing about it - in fact I didn't do strict somatic tracking to heal personally - my reactions followed my belief and my evidence).

The shame and feeling bad here I feel is easily avoidable if you keep what I just said in mind - please don't put too much pressure on yourself!

This is good, and you're not supposed to do somatic tracking when the pain is higher than a 6/7 anyway - it isn't possible.

You're doing great

 

Thanks Adam, truly. Your words of advice and encouragement mean a lot.