How do I know when to back off vs when to continue with an activity that’s causing symptoms?

[catkins]

I’ve been working to recover from a mindbody condition that has resulted in a wide array of symptoms (food and smell sensitivities, brain fog, digestive issues, anxiety and emotional issues, etc.) for many years. I more recently developed neuroplastic pain on top of the other issues I’m dealing with and have found some of the approaches to recovering from chronic pain more helpful than some of the previous programs I tried to address my symptoms.

One of the things I struggle with the most is knowing when to remove myself from or stop an activity that’s causing symptoms vs continuing with that activity and having to deal with the consequences. I’m not necessarily talking about incremental training, but about situations that may arise unprompted.

For me, this most often arises due to sensitivities I have to fragrances (e.g. finding myself sitting next to someone wearing perfume), but does sometimes arise regarding pain as well (e.g. picking up a grocery bag and realizing halfway to the car that it’s too heavy).

Is is better to stop the activity and work on incremental training around that thing in a more intentional way? Or is it better to continue with that activity so as to not reinforce the idea that’s it’s dangerous?

If I stop the activity, I’m concerned that I’m reinforcing the idea that it’s dangerous and that I may start to spiral into a situation where I’m able to tolerate fewer and fewer things like this (this has happened to me before when I became housebound with multiple chemical sensitivity).

If I continue the activity, I’m concerned about overwhelming my body with something that’s just too far beyond what I might do in incremental training and thereby causing a larger setback. I’m also concerned that the symptoms may be so severe they’ll affect my ability to work the next day. This has often happened to me with fragrances which cause brain fog and anxiety and hamper my ability to do my job. With fragrances, it’s also difficult to tell in the moment if something is a problem as the symptoms themselves may not arise until hours later.

Trying to make a decision between these two options in the moment also creates a lot of anxiety for me, which I realize is further exacerbating the situation. I've been trying to come up with a formula for myself to quickly assess a situation and make a decision, but I would love to hear if anyone else has words of advice for how to deal with this type of scenario.

 

[JanAtheCPA]

Hm, three days with no responses. I have to admit, I'm at a loss to know where to begin, @catkins. There's a lot of analysis and intellectualization going on here, neither of which is conducive to the emotional vulnerability required to recover from TMS /MBS / PPD /NS or whatever you choose to call it.

I think if I had to point to one thing, it's that you are hyper focused on symptom details, and probably a little obsessed about finding the perfect (and very detailed) way to achieve... whatever it is you're trying to achieve which is frankly too convoluted for me to follow. Actually, to be quite brutally honest, it's too convoluted for me to care about trying to understand - because we know here that this kind of focus on details is simply not effective, therefore it's irrelevant.

So let's back up and have you tell us what you understand about Dr Sarno's theory of repressed emotions, and whether you have done any kind of emotionally vulnerable work, such as Dr Schubiner's workbook, our free Structured Educational Program on the main TMSwiki.org, or psychotherapy from a strong mindbody point of view encompassing repressed negative emotions.

I'm also going to suggest that you read this thread, and answer the quick 10-question quiz regarding adverse childhood experiences.
https://www.tmswiki.org/forum/threads/aces-quiz-online-printable-versions.27061 (ACEs "quiz" - online & printable versions)
When I see somebody with so many seemingly intractable symptoms that's the first thing that comes to mind.

 

[Cactusflower]

Alan Gordon addresses what you are talking about, it often called "graded exposure" (but he doesn't give it a name). If this is the strategy you are looking for, his book The Way Out would be a great resource for you.

 

[catkins]

Thanks! I’ve actually just ordered that book and am looking forward to reading it as I think it will be quite helpful.

 

[Ollin]

I One of the things I struggle with the most is knowing when to remove myself from or stop an activity that’s causing symptoms vs continuing with that activity and having to deal with the consequences. I’m not necessarily talking about incremental training, but about situations that may arise unprompted....

If I stop the activity, I’m concerned that I’m reinforcing the idea that it’s dangerous and that I may start to spiral into a situation where I’m able to tolerate fewer and fewer things like this (this has happened to me before when I became housebound with multiple chemical sensitivity).

If I continue the activity, I’m concerned about overwhelming my body with something that’s just too far beyond what I might do in incremental training and thereby causing a larger setback.

...

Trying to make a decision between these two options in the moment also creates a lot of anxiety for me, which I realize is further exacerbating the situation. I've been trying to come up with a formula for myself to quickly assess a situation and make a decision, but I would love to hear if anyone else has words of advice for how to deal with this type of scenario.

Thanks for sharing, I believe that your experience is very common to those dealing with TMS, and you certainly have a lot of insight into how your activities affect your symptoms. You are working on preventing set-backs (or flare-ups), which is an essential part of any pain recovery program.

If by incremental training you refer to something akin to graded exposure therapy (a term I believe used in psychology for the purpose of desensitization), then it is very relevant to TMS recovery, but as you point out, life can throw triggering situations unexpectedly with which you need to deal in the moment. Unfortunately we can't 100% bulletproof ourselves to all potential challenges, but the key to recovering from TMS is "ALWAYS THINK PSYCHOLOGICAL".

In this case, you talk about (paraphrasing) a bag being too heavy and overloading your body which will cause you consequences. Sure, the body has its limits, but what also (and maybe more importantly) goes on is your nervous system going into a threat response and that escalates the symptoms. Physically: If a bag is too heavy you won't be able to lift it. You may have a lower physical endurance (weaker muscles) due to unuse - completely normal with chronic pain, but this is usually easy to recognize and stopping the physical strain is a normal response of selfcare. By all means, exercise, do strength training if you think it's below a normal level for your age/build etc, But this is the physical aspect, and if you end with this you are not addressing the psychological factors that fuel TMS.

To do this, I would suggest that in such moments of deciding whether or not to continue an activity: ask yourself how do you FEEL emotionally? Beyond wondering intellectually 'am I reinforcing the fear of activity by avoiding it?' are you feeling safe, excited, empowered about the activity itself, or do you fear that it can cause a real damage to your mind or body? See, there is a difference between fixation and mindfulness. As we learn about TMS we often fall into the trap of strategizing, rigidly following some structured program because we fear that any slip can undermine our healing potential. In the process, we abandon our own inner guidance - our moment-to-moment feelings. We can't think our way out of symptoms, but we can always honor our emotions, and feeling SAFE is essential to healing. That's what you need to work on - assessing risk to your wellbeing 'here and now', and decide accordingly whether to continue the activity or not. Never push through anything when your mind-body is screaming "Danger!" This is how we sensitize ourselves, reinforce the maladaptive neural pathways and escalate symptoms.

So, how can you prepare yourself for the unexpected situations? Without exposing yourself to them, establish your sense of safety through grounding in the current place and time. Once you determine you're not in danger - start imagining yourself in a potentially triggering situation, but go slowly, take small steps and the goal is to not overwhelm your nervous system with a fear response. This is the basis of graded exposure therapy, which I'm sure others can describe better and guide you through - check Alan Gordon's recovery program as suggested above. Also, Howard Schubiner's book is excellent. Your body responds to imaginary situations in the same way as real stimuli, so it can harm us but can also heal us.

 

[Baseball65]

John Sarno said "Return to full physical activity , even the most strenuous" ..He didn't consider a person recovered unless they could do that without fear.

Sarno "Never recalled a case where doing strenuous activity too soon caused a problem" and his 'too soon' meant a couple of weeks.

All of these 'ease into it' measures sound like you're treating yourself like your injured....and you're not.
It all sounds like being heavily focused on what is happening in your body...which is what TMS wants you to do.
Every time you 'take it easy' the TMS is winning unless you've first broken all of the conditioning associated with your TMS

Human Body is one of the most strong and quickly healing machines on our planet

 

[Rusty Red]

@Baseball65, I'm reading HBP now and didn't he say only after a reduction in pain? I thought he said doing it while still in full pain would just prolong the symptoms.

That being said, I'm balls to the wall. Steve O was my motivator in powering through. Regretting it a bit today with s high pain day but I'm still lifting and running and praying I'm not wrong. LOL

Also wanted to comment to you because I have read some of your posts here and like your forward style.

 

[Baseball65]

didn't he say only after a reduction in pain?

Yes. You are correct.....but if you pick up the context, he is talking about weeks, not months, years,etc. In fact, in the section right after the 12 reminders, he mentions that one of the patients in the group doesn't get better becuase "They couldn't get up the courage to become active".

Then in Mindbody Prescription he gets even more imperative about getting back out there. He uses the same 'cautious' (by his standards) tone, but remember, he thought that a doctor shouldn't really lend himself via a Book Diagnoses in the first place, and then he wrote a book (LOL)...

When you read his vignettes and he is speaking to people who understand TMS and have had some degree of familiarity with it, he is always "Go..Now....focus on your anger....this is a contest of wills"
Cry. Scream. Barf if you need to. It WILL not hurt you. I have done it. It is always scary. Find God. You will rejoice at the far end of it. That is the 'Frontline' of TMS recovery.

I will re-iterate. When I first read the book I had an overwhelming sense of Euphoria. THIS was my Problem. Then a week or so in, I was still in pain. Nothing had really changed.
I was walking the same track I had walked during all of my 'Medieval Medical Mythology' treatment. I was moving. I was not sitting around...
I was off work so I had all day to write lists of anger makers, resentments, study the book with a fine tooth comb....but all of the pain patterns were in Place. Nothing had jarred them.

Then the flash of insight was :This is the same 'careful shit' I did under the tutelage of the Chronic Pain Center. They had warned me I risked paralysis if I even JOGGED.

I sprinted across the grass as fast as my overweight atrophied ass could....collapsed into a heap...and laughed my ass off...I was still in Pain, BUT I wasn't paralyzed. I went home, paid very close attention to all of the MYTHOLOGY that had snuck into my life and deleted all of it....Back Brace, Pain killers, Ice, Heat (bags) I lifted weights. I ran around the block. I was at the batting cage. All in Pain. It diminished exponentially with each "F-you"
It was scary. I sometimes got the same sort of feeling you get when you're somewhere high up and look over the edge. "OH shit! What if he's wrong? what if they were right?"

Every time I stood up to it, I was 'scratching the record' that had been playing for 18 months...If you keep scratching the record, it eventually won't be able to play at all. It didn't go away when I thought it would but it went away. Every time I saw a little daylight? I got out a 16d Nail and scratched the record again.

The book was the information. The healing began when I opened up to "There is nothing wrong with me" which means "I can do anything I want"

I have had relapses BUT the faster I get involved with an activity that is a direct challenge at what the symptom implies, the faster I heal. Hours, Days. Yes, I do all of the writing and mental exercises, BUT The action is what sends the message to the unconscious...which doesn't read or write or move very fast...so you gotta give that little bastard a Poke in the Eye and say "NOPE"

 

[Rusty Red]

@Baseball65 I love everything about this. Thank you.

 

[catkins]

I really appreciate all the thoughtful replies here. I've done some more thinking and experimenting with this issue and have come to a few conclusions.

• Often I create a lot of anxiety by trying to decide whether to back off or stick with a trigger. The decision itself isn't as important as deciding quickly and not second guessing myself.
• Whether or not I should stay with the trigger really comes down to whether or not I think I can have a productive experience doing and whether I'm willing to be with whatever symptoms may arise:
  • If my body has already been stressed from other factors, adding another trigger on top of this might not be helpful
  • If I feel like I don't have room in my life to manage the symptoms, like having something important at work they might interfere with, staying with the trigger might not be helpful (this pertains more to my fragrance sensitivities, which cause neurological symptoms that make it difficult for me to do my job)

Basically, this means, I should assess how I'm feeling and what other things are going on in my life and try to make a decision quickly without obsessing over it. I've tried this several times and do feel that it's been helpful in decreasing the anxiety that I have when trying to make a decision about staying with a trigger.

 

[Diana-M]

Every time I stood up to it, I was 'scratching the record' that had been playing for 18 months...If you keep scratching the record, it eventually won't be able to play at all. It didn't go away when I thought it would but it went away. Every time I saw a little daylight? I got out a 16d Nail and scratched the record again.

LOVE THIS!

 

[Cactusflower]

I really appreciate all the thoughtful replies here. I've done some more thinking and experimenting with this issue and have come to a few conclusions.

• Often I create a lot of anxiety by trying to decide whether to back off or stick with a trigger. The decision itself isn't as important as deciding quickly and not second guessing myself.
• Whether or not I should stay with the trigger really comes down to whether or not I think I can have a productive experience doing and whether I'm willing to be with whatever symptoms may arise:
  • If my body has already been stressed from other factors, adding another trigger on top of this might not be helpful
  • If I feel like I don't have room in my life to manage the symptoms, like having something important at work they might interfere with, staying with the trigger might not be helpful (this pertains more to my fragrance sensitivities, which cause neurological symptoms that make it difficult for me to do my job)

Basically, this means, I should assess how I'm feeling and what other things are going on in my life and try to make a decision quickly without obsessing over it. I've tried this several times and do feel that it's been helpful in decreasing the anxiety that I have when trying to make a decision about staying with a trigger.

It seems you are discussing "triggers" purely in physical form.
You are hyper focused on the physical and your symptoms.

Have you read a book by Dr. Sarno or done any TMS work at all, or understood @JanAtheCPA 's initial post.
TMS is not about the physical at all. Period.
Triggers are not physical, they are your emotional reaction to things. It sounds like the real trigger is your fear.

You are fearing the fear of the "trigger". We tend to dislike feeling fear, as much as we dislike feeling the symptoms of any kind. I went through massive neurological symptoms including pseudo seizures, fainting, irregular heart beat, temperature swings and a host of other things. They all went away when I stopped worrying about what would happen to me if they started. Yes, it was inconvenient to faint in public, and horrible at times when I almost soiled myself, and embarrassing when I'd have a seizure of weird, repetitive movements. I'd feel really yucky afterwards but I recognized that the "feeling" of "yucky" was actually the physical sensations of the emotional response. So I just stopped worrying about it, fearing it, avoiding it or essentially pushing it away and let it wash over me. I just let myself feel the fear, and all the other emotions and the neurological symptoms were the very first to go. Sure, new ocular and dental symptoms took their place for a while, but it was so easy to see that they were simply replacement symptoms, and that my brain was scrambling to find ways to keep me afraid and keep me "safe" from the big bad world out there.
The fear and anxiety are addressed directly in the books of Claire Weekes. I followed her directions and in a very short time - a matter of weeks, those symptoms disappeared.

 

[catkins]

Yes, I’ve just finished Claire Weekes's book and found it immensely helpful. It felt like it was directly addressing most of what I deal with. I’ve had some luck beginning to implement it, but am not sure I’ve completely gotten the hang of it yet. I’m supposed to start working with a coach from the Pain Psychology Center soon and am hoping she'll be able to provide support with some of these things.

 

[Cactusflower]

You should also read a book by Dr. Sarno. He explains much.

 

[catkins]

I just wanted to follow up on this thread with some additional information from Alan Gordon's book, The Way Out that I found quite helpful.

In his book, Gordon describes a situation where he decided to stand up to his back pain by pushing through an activity that typically caused problems for him, so he drove from LA to San Francisco. By the time he arrived his pain was 10 out of 10 and it ended up being a really big setback for him.

He explains that "sometimes we think its empowering to push through when our pain is high, but it's the opposite. Pushing through will lead to a setback. When you fight against your pain you are just putting your brain on high alert and reinforcing that the pain is dangerous." he goes on to say that it's perfectly fine to engage in avoidance behaviors when your pain is high.

This whole section of the book describes what he calls "corrective experiences", which are siutations where your pain is low or moderate and you can feel safe. The idea is to maximize these experiences and minimize setbacks in order to heal. I found this information really helpful and definitely recommend the book to anyone who hasn't read it.