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Help with "thinking psychological not physical"

Discussion in 'General Discussion Subforum' started by toast38coza, Sep 21, 2017.

  1. toast38coza

    toast38coza New Member

    I am a little confused about a certain aspect of Dr. Sarno's treatment program. He states that when you feel the pain coming on, you should force yourself not to be distracted by the pain and rather to think about the emotions. Sarno speaks of it as a kind of battle of the wills.

    Alan further elaborates on this here: http://www.tmswiki.org/ppd/TMS_Recovery_Program#Feel_Your_Feelings (TMS Recovery Program)

    The logical process Alan outlines above is _exactly_ what I used to do. After reading his post, I have started working on "feeling my feelings" - actually this is something I used to use in reverse even before I knew about TMS: For example, if i was in a meeting and started feeling my stomach knot I would be like: "Oh! there's something I need to pay attention to here - someone just said something that's bad for this project/me!". It actually works incredibly well!)

    Now, my problem is that my pain is fairly constant. It hurts whenever I stand, lie down in most positions, and after sitting for a medium period. I think I can identify certain feelings in my body that also seem fairly consistent (and that I would associate with anxiety): e.g.: stiff shoulders, tight chest. But finding some kind of cause and effect is beyond me.

    I find it hard to pin-point something _new_ that's bringing this on. I also can't really pin-point a type of short-term cause and effect (as some people seem to be able to do) - I can identify longer term trends and causations .. but it's not like: I procrastinated (often as a result of the pain), now my workload is massive and now the pain is worse (the pain tends to be rather consistently bad!).

    I guess what I'm trying to say is that I feel like I'm doing this wrong - but I can't work out what "doing it right" looks like. e.g.:

    * What if I can't identify / feel anything going on at the time when I'm feeling pain? Does that matter? .. or is it good enough just to be looking?
    * How exactly is one supposed to be looking?
    * am I looking for physical reactions to emotions in my body? .. or am I thinking about things that have happened in my life that are causing repressed emotions?

    An interesting aside: When logically working through my emotional issues - inevitably some of them are directly caused by the pain. I only recently clicked that that is the TMS working as it wants to. So now I've learned not to pay attention to those issues (is that correct?)

    Apologies, this ended up being a rather rambling post, but hopefully someone can comment or send me some links that might help me better understand how one should combat the pain in the moment by thinking psychologically rather than physically.
  2. birdsetfree

    birdsetfree Well known member

    I think you are doing very well with this inward journey and getting to know yourself better. This is an important part of recovery.

    We do not want to focus too much on what the pain is doing as that is just preoccupation but generally you can look at something that has just happened or happened recently in your life as the culprit.

    Just knowing that the pain is caused by your own mind and reassuring yourself of this, that you are safe and the pain is harmless can be enough to change the outcome. This takes practice and in time will change the way your brain functions in relation to triggers and perceived danger situations as you will be calm.
  3. Tennis Tom

    Tennis Tom Beloved Grand Eagle

    What Birdsetfree said, summarizes the TMS "work" & theory in a nutshell--would make for a good tattoo for TMS'ers to print on their heads--or maybe a temporary tattoo until it sinks into the sub-c.

    For what the life issues are see, the Holmes-Rahe list of STRESSFUL LIFE EVENTS that trigger psychosomatic/TMS pain events. It lists the events that the sub-c decides to distract us from facing head-on, by bestowing us with TMS pain, defense mechanism, distractions. This is the science behind TMS. Last time I looked psychology was a science, but with the recent Freud bashing, it's somewhat in the shadows of the current medical/industrial/ Walgreens complex. White coats would rather refer you to PT, chiros, accus, or surgeons then to a shrink--patients don't take kindly to the "it's all in your head" rx.

    Refer to the HOLMES-RAHE list for the causality of TMS symptoms :
    The Holmes and Rahe Stress Scale and TMS, by Eric Sherman, Psy.D.
    The following introduction to how the Holmes and Rahe Stress Scale is used in TMS treatment was donated by Eric Sherman, PsyD. Dr. Sherman is a co-author of Pathways to Pain Relief, with Frances Sommer Anderson, PhD, SEP. He completed his clinical psychology internship at The Rusk Institute of the Langone Medical Center in New York where he rotated through the Psychophysiological Pain Service, under the direction of John E. Sarno, MD, and Arlene Feinblatt, PhD. He worked with Dr. Sarno for 29 years, providing psychotherapy to Dr. Sarno's patients.

    As part of Dr. Sarno’s psycho-educational approach to treating TMS/PPD, he introduces patients to the Holmes and Rahe Stress Scale. The scale predicts a person’s chances of developing a physical or emotional condition, based on cumulative exposure to stressful external events in the preceding year. Events range from mundane nuisances like getting a parking ticket to catastrophic events like the death of a spouse or the diagnosis of a life-threatening illness. The events are weighted: The parking ticket receives l point, the death of a spouse is assigned 50 points. Research indicates that when an individual accumulates more than 200 points in a year, he or she is at much greater risk of developing serious physical, emotional, or psychophysiologic conditions.

    Although constitutional factors and personality variables play a role in an individual’s vulnerability and resistance to stress, no one can imagine an individual entirely unaffected by experiencing one or more of the following in the same year: the loss of a spouse, the amputation of a limb, an adult child’s bitter divorce, or a hefty assessment by the co-op board. However, the specific nature and magnitude of these effects vary greatly because of the highly subjective ways in which different people experience the same situation.

    Personality variables, childhood experiences, and external stressors all contribute to the development of TMS/PPD. Holmes and Rahe Stress Scale is predicated upon the idea that individuals react in typical and therefore predictable ways to life events. Although this observation is largely true, there are no events that are intrinsically stressful, or benign. The experience of stress is always the co-creation of the event and how a particular individual subjectively perceives it. Let me illustrate this concept with an example from my own life. During a brief break in between appointments with patients, I dashed across the street to the bank to deposit a Canadian check. I live in New York City. The check had been declined for deposit by the ATM earlier that same day and I was advised to visit my branch manager. Upon my arrival, I encountered a line with 6 people ahead of me. In my impatient and pressured state of mind, it seemed that the customers couldn’t have been processed more slowly if the tellers had all been corpses. Then, much to my surprise and fascination, a young man, probably no more than 19 or 20 arrives 3 places behind me in line; he couldn’t be happier. I briefly entertained the possibility that he was one of those preternaturally cheerful people before I realized the long line represented a cherished escape from his job. The boss had sent him to make a deposit and the longer and slower the line, the more time he spent away from the office, a place he detested. That same line that tormented me in my hurried attempts to accomplish yet one more task in an already over-scheduled day was the answer to this young man’s prayers.

    Therefore, the Holmes and Rahe Stress Scale should never be used either as the basis for diagnosing TMS/PPD, or excluding a diagnosis of TMS/PPD. The Holmes and Rahe Scale is an adjunct to a thorough examination by a physician experienced in diagnosing and treating TMS/PPD and a carefully conducted clinical inquiry by a mental health professional familiar with the varied presentations of TMS/PPD. Because of the highly subjective nature of the experience of stress, the Holmes and Rahe Stress Scale is not to be viewed as Gospel. However, it is a valuable tool for generating hypotheses about a person’s condition and guiding introspection in individuals who have already received a diagnosis of TMS/PPD.

    The Holmes and Rahe Stress Scale can be viewed as a portal into an individual’s psychological interior. If an individual is appropriately diagnosed with TMS/PPD and his or her score on the Holmes and Rahe Stress Scale says “tilt”, one’s understanding of that person is far from complete and has only just begun. If the person is mourning the loss of a significant relationship, is the patient bereft or guilt-ridden because now there are no longer any obstacles standing in the way of an outside relationship? Or, does the death of the person force the individual to confront his or her own ambivalence about formalizing this outside relationship? Also, many people with TMS/PPD are so estranged from their own needs and feelings that they are genuinely surprised when they recognize the cumulative toll of their suffering. These people are often highly adept at rationalizing why their own needs and feelings should go unmet. The discrepancy between their own self-experience and the Holmes and Rahe Stress Scale illuminates how disconnected they are from recognizing the impact of events on their emotional state. The scores do not tell the story; they are footprints that can lead you to the heart of the matter when used correctly.

    Similarly, when someone with a score that is “off the charts” doesn’t manifest any significant physical, emotional, or mindbody symptomatology, it doesn’t necessarily mean the Holmes and Rahe Stress Scale is no longer useful. Instead, several intriguing possibilities are raised. Is this individual someone who is genetically resistant to stress, as demonstrated by his or her history? Or, does this person have extraordinary coping resources and/or an extensive support network? Another possibility is that this individual cannot report distress that he or she is oblivious to. When this situation occurs, it suggests other lines of inquiry, for example: is the individual cognitively impaired; is the person deliberately providing an inaccurate account; is this behavior symptomatic of a personality disorder characterized by dissociative tendencies; is this person soothing him or herself with drugs and alcohol, thereby averting any experience of distress?

    When the Holmes and Rahe Stress Scale is not used mechanically, another layer of understanding about an individual’s inner world is often revealed. If the person reports, for example, a bankruptcy or serious health problem in the past year, a history of financial recklessness or self-destructive habits might emerge. This same approach can also identify resources which mitigate the impact of stressful events. And of course, not all divorces are created equally. Some represent liberation and a new beginning; others are experienced as grievous losses and shameful failures.

    Never should a high score on the Holmes and Rahe Stress Scale be used to blame anyone for his or her TMS/PPD symptomatology. As mentioned earlier, TMS/PPD symptomatology is a multifactorial phenomenon involving genetic resistance or vulnerability to stress, personality variables, the effects of childhood experiences, and the impact of external stressors. TMS/PPD can be likened to a perfect storm; no single contributing factor in and of itself ever leads to the development of this condition. Therefore, the Holmes and Rahe Stress Scale should never be misused to establish, confirm, or refute the diagnosis of a mindbody disorder. However, the Holmes and Rahe Stress Scale is a valuable tool to examine and understand an individual’s history and psychodynamics with respect to the development of TMS/PPD.

    In 1967, psychiatrists Thomas Holmes and Richard Rahe examined the medical records of over 5,000 medical patients as a way to determine whether stressful events might cause illnesses. Patients were asked to tally a list of 43 life events based on a relative score. A positive correlation of 0.118 was found between their life events and their illnesses.

    Their results were published as the Social Readjustment Rating Scale (SRRS),[1] known more commonly as the Holmes and Rahe Stress Scale. Subsequent validation has supported the links between stress and illness.[2]

    Supporting research
    Rahe carried out a study in 1970 testing the reliability of the stress scale as a predictor of illness.[3] The scale was given to 2,500 US sailors and they were asked to rate scores of 'life events' over the previous six months. Over the next six months, detailed records were kept of the sailors' health. There was a +0.118 correlation between stress scale scores and illness, which was sufficient to support the hypothesis of a link between life events and illness.[4]

    In conjunction with the Cornell medical index assessing, the stress scale correlated with visits to medical dispensaries, and the H&R stress scale's scores also correlated independently with individuals dropping out of stressful underwater demolitions training due to medical problems.[4] The scale was also assessed against different populations within the United States (with African American|African, Hispanic and White American groups).[5] The scale was also tested cross-culturally, comparing Japanese[6] and Malaysian[7] groups with American populations.

    In The Mindbody Prescription
    In the chapter on "The Psychology of Mindbody Disorders" in The Mindbody Prescription, Dr. Sarno identified three sources of rage: "Trauma in Infancy and Childhood," "Personality Traits," and "The World Around Us." For the section on "The World Around Us," he reviewed how Holmes and Rahe constructed the list of life events in the stress scale and he also reproduced the entire list of 42 life events. Commenting on the list, he wrote: “We postulate that these events produce 'disease' through the mechanism of internal rage. ... Both positive and negative stress generate unconscious anger, whether or not one is consciously angry. Accumulated anger is rage, and frightening, unconscious rage leads to the development of physical symptoms.” He noted that the list, while it contains negative events, as might be expected, also contains positive events that could be socially desirable and “consonant with the American values of achievement, success, materialism, practicality, efficiency, future orientation, conformism, and self-reliance.”

    This arguably suggests that even positive events, because they lead to change, can be stressful to our unconscious minds.

    To measure stress according to the Holmes and Rahe Stress Scale, the number of "Life Change Units" that apply to events in the past year of an individual's life are added and the final score will give a rough estimate of how stress affects health.

    Life event Life change units
    Death of a spouse 100
    Divorce 73
    Marital separation 65
    Imprisonment 63
    Death of a close family member 63
    Personal injury or illness 53
    Marriage 50
    Dismissal from work 47
    Marital reconciliation 45
    Retirement 45
    Change in health of family member 44
    Pregnancy 40
    Sexual difficulties 39
    Gain a new family member 39
    Business readjustment 39
    Change in financial state 38
    Death of a close friend 37
    Change to different line of work 36
    Change in frequency of arguments 35
    Major mortgage 32
    Foreclosure of mortgage or loan 30
    Change in responsibilities at work 29
    Child leaving home 29
    Trouble with in-laws 29
    Outstanding personal achievement 28
    Spouse starts or stops work 26
    Begin or end school 26
    Change in living conditions 25
    Revision of personal habits 24
    Trouble with boss 23
    Change in working hours or conditions 20
    Change in residence 20
    Change in schools 20
    Change in recreation 19
    Change in church activities 19
    Change in social activities 18
    Minor mortgage or loan 17
    Change in sleeping habits 16
    Change in number of family reunions 15
    Change in eating habits 15
    Vacation 13
    Christmas 12
    Minor violation of law 11

    Score of 300+: At risk of illness.

    Score of 150-299: Risk of illness is moderate (reduced by 30% from the above risk).

    Score <150: Only have a slight risk of illness.​
    Last edited: Sep 21, 2017
  4. toast38coza

    toast38coza New Member

    Hey Guys

    Thanks for the responses. Sounds like I'm doing ok.

    @birdsetfree that makes sense. Thanks I guess my issue was that after 3 months or so of pretty regular pain, the psychological checklist starts becoming a little monotonous! I think I mistook that for me missing something.

    @Tennis Tom thanks for the link. I've read through it .. but probably need to go through it a little more slowly to properly digest. I think I score high enough on that scale that it may make sense I'm getting some physical symptoms. It's quite useful to go through the list and use it to bring one's attention to things one may have overlooked.

    I think it's also useful to note that sometime positive change can also be a trigger. That was interesting.
    birdsetfree and Tennis Tom like this.
  5. Tennis Tom

    Tennis Tom Beloved Grand Eagle

    YES! Anything that disrupts our homeostasis--comfort zone--can add to our reservoir of rage, eventually overflowing into TMS symptoms. Seemingly positive events like going on vacation or holidays can create unconscious TMS dis-ease. When you understand Dr. Sarno's TMS theory, then you can understand the pain is benign, created by the sub-c as a defense mechanism.
    birdsetfree likes this.
  6. gutter3

    gutter3 Peer Supporter

    Have you gone through the Multimedia Pain Recovery Program? It's very insightful. The program brings a lot to light, one thing that I noticed I do (and sounds like you do as well) is putting too much pressure on yourself. Don't overthink everything. If you haven't you should go through that program. It helped me a lot. I'm not completed pain free but I learned a lot from going through the program. What your doing sounds like Day 7: Pressure and Criticism. I don't think there is any "doing it right" when it comes to TMS. It's more what works for you.
    birdsetfree likes this.
  7. toast38coza

    toast38coza New Member

    Hi @gutter3 Thanks for the response. I am going through the program .. am about 2/3 of the way through. I often catch myself being a little obsessive about TMS - the irony is not lost on me!

    I'm also glad to say that I feel like I'm starting to beat this thing! I think I've got it on the run! :)
  8. Chris GR

    Chris GR New Member

    This is my problem too: I will expect to have TMS pain on days that are stressful, but often have no pain and conversely, I can be enjoying a relaxing weekend and be hit with TMS from out of nowhere.
  9. Sonic

    Sonic Peer Supporter

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