Greetings from Chicago!

[Scott G]

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/

 

[Rabscuttle]

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.

 

[Adam Coloretti (coach)]

Extinction bursts are an unproven idea as it relates to TMS, and IMO it just sets people up for disappointment. Ebbs and flows are the nature of TMS pain. Something can be an extinction burst in hindsight, when the pain fully goes away, but wouldn’t that imply the extinction burst never existed in the moment? Shifting pain/symptom imperative can be seen as a sign of progress, as the brain itself is forced to rethink its strategy, but if you’re in a full fledged panic at the old pain the brain in that shared panic can generate new symptoms (I dealt with this for a long time and foolishly thought I was making progress, I was just a wreck, lol)

personally I would try to avoid fixating on the severity of the pain, imo you’re going into a bit too much detail, which is normal when you’re starting this. It’s more important how you’re reacting in response to the pain, how you’re treating yourself, emotions, finding joy etc.

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

 

[Adam Coloretti (coach)]

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'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!

 

[Scott G]

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

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.

 

[Adam Coloretti (coach)]

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)

 

[Scott G]

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.

 

[Ellen]

Extinction bursts are an unproven idea as it relates to TMS,

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.

 

[Scott G]

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.

 

[Adam Coloretti (coach)]

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!

If I'm super relaxed, but I bend over a certain way, I will most likely get hit with a spasm

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

 

[Scott G]

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...

 

[Adam Coloretti (coach)]

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..."

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!

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."

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

 

[Scott G]

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

 

[Scott G]

Been awhile, so wanted to post an update. The work is going slow and steady. One tiny win at a time. I continue to learn how to drop my unrealistic schedule expectations, and ridiculous 'self-imposed timelines' by the wayside. I have gotten better at not letting pain flare-ups put me in a state of fear...gotten better at taking those moments to quickly jump into some good somatic tracking.

However, there was an incident I'd like to share from this morning that really had me rattled. At first it felt (natrually) like a setback, but I'm trying to reframe it as another learning experience:

I got up this am and felt pretty good. My anxiety was pretty low, and the lumbar back pain also low. A bit later, I could feel some tightness setting in... The day before, I had been reviewing some work stuff that was mildly upsetting to me, but managed to reframe how I felt about it (I return to work in 2 weeks, so have been slowly getting myself acclimated back each day with a bit of content review and such).

Anyway, back to this am. I was sitting down in a chair that I don't normally sit in, and could feel my back getting more sore. I shifted a bit and WHAM! A huge, nasty, sharp pain hit me immediately. The fear response was on me instantly; much to my disappointment. A powerful, horrible panic in which my stomach falls through the floor and everything feels cold, lol. I've certainly read enough, and heard enough from my pain reprocessing coach to know this is to be expected in many ways.

I hadn't felt this kind of pain in months, though - so it was shocking. I became immediately depressed and thought "I've gained no ground. Is this what I can expect from now on again?" All the usual stuff...

Thankfully, I was able to recover and come to my senses pretty quickly - remembering to first allow some self-compassion. Then I began to see this as another learning exercise - that it's a process. Beating myself up over this isn't going to solve anything. I began talking to my brain again right away: "It's okay, man. You thought I was in danger again - maybe more so than usual hence the stronger pain - but it's okay. I'm safe. The situation I'm in is perfectly safe. We are a team. I understand. When you instigated the pain message I thought I was in danger also, but I'm not. Let's keep working together on this... etc etc.

Anyway, yeah. The automatic fear response for a spasm that comes on that fast - whew! Normally my pain has been such were I've got some advanced warning (even if it's sometimes only a few seconds), and I can mentally prepare. Would welcome anything thoughts on this !

Tnx all.

 

[Rabscuttle]

You handled it well Scott. You’ve identified something very important about many types of TMS pains which are their cyclical nature. That is, they decrease, we feel good, confident in the process and our progress, then we get a flare which can fill us with doubt. If you respond well to flares then you are well on your way. Be mindful that the brain has lots of tricks, and that when we are really feeling good and making progress we are a bit more vulnerable to ‘setbacks’ (really they’re learning opportunities) as we may forget what it was like to have severe sensations and doubt can creep in. Just do as you did and treat yourself well and you’ll get out of this.

 

[Adam Coloretti (coach)]

At first it felt (natrually) like a setback, but I'm trying to reframe it as another learning experience:

The only way it's a setback is if you let it impact your mindset and belief (in the longer term). We naturally still tend to judge progress by our symptoms (which makes sense) but that's not really what I'm reading for when I assess whether I think someone is on the right track (that will be the end result but that's not the best measure of progress, at least in the shorter term). It's always about belief and mindset.

Anyway, back to this am. I was sitting down in a chair that I don't normally sit in

There you go! As you expand your life, the brain will fear what you've been avoiding (naturally), so I wouldn't be concerned about this flare (even though I understand it is scary and painful) as it makes complete sense.

Thankfully, I was able to recover and come to my senses pretty quickly - remembering to first allow some self-compassion. Then I began to see this as another learning exercise - that it's a process.

The more you react like this (sort of overwriting your past reactions), you better you'll get. Great work

 

[Scott G]

Thanks much Adam and Rabscuttle. The flares continued yesterday as well, and the time spent afterward in 'fear/panic mode' was a bit less; so I guess that's some progress. For whatever reason in my last post I forgot to mention that my anxiety symptoms have also been enjoying somewhat of an overall revival as well - perhaps due to my impending 'return to work' date? For me, this could no doubt explain the pain flares as well. They are so connected.

I'll be honest, yesterday it was a full-time job to fight back the depression - as everyone knows it can be so damned soul-crushing. I just kept going back to the various mantras that I've picked up along the way; including Alan's and Dr. Schubiner's work. I like this one from Alan's book:

"If you gravitate toward hopelessness, it’s not because you’re hopeless, but because your brain has done it so many times before. If your mind naturally goes to despair, it’s not because your situation is dire, but because you have developed strong neural pathways for despair."

It's Monday morning, and I'm a bit anxious for what the day will bring. Hoping and praying for positive thoughts! Tnx again.

 

[Rabscuttle]

Things will get better Scott. These waves of depression and despair are normal, what we’re going through is difficult. We shouldn’t fall into full victimhood but we shouldn’t be delusional either. We can’t adjust our mindsets overnight but if we push back at that despair just a little each time, it will eventually add up. You’re putting in the work, you’ll see lasting results eventually.

 

[Scott G]

These waves of depression and despair are normal, what we’re going through is difficult.

This simple sentence (and the one that follows) means so much to me....and are so timely. Thank you. It very much reminds me of.....

My pain coach from Cormendi, Erica, has me working chapters from the excellent book by Kristin Neff and Christopher Germer called 'The Mindful Self-Compassion Workbook'. In the book there's an exercise called the Self-Compassion Break in which you say the following to yourself in 3 parts (paraphrased):

Mindfulness Statement:
I'm really suffering, and it's not pleasant.

Acknowledgement of Common Humanity
Suffering is just a part of life, and many people have endured this exact form of suffering. I'm not alone.

Act of Self-Kindness
May I be kind and forgiving to myself and take this one day at a time.

The first time I read these I thought they were corny. Then I said them to myself in a time of distress and felt incredibly comforted.

 

[Cactusflower]

Kristin Neff's Loving Kindness meditation where you extend your love and kindness out to the world (META meditations) jolted me back into reality. When I felt that I was no use to anyone, simply offering kindness and love to the world began to give me a sense of worth. It also really helped bring my own personal beliefs to the forefront and helped me really affirm them, reminding me of who I really was, at my core and in my soul.