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Alan G. More on conditioned responses

Discussion in 'Ask a TMS Therapist' started by Guest, Mar 25, 2015.

  1. Guest

    Guest Guest

    This question was submitted via our Ask a TMS Therapist program. To submit your question, click here.

    Question
    I’ve been working on my conditioned responses (pain with getting up out of a chair, bending over, etc.), and attempting outcome independence. I’m confused about the line between “rewarding” myself with pride for treating myself in a nice way versus not focusing on my pain level afterward. How can I develop an indifference to the pain if I’m thinking about my conditioned responses?

    For example, if I have to pick something up off the floor, I worry and brace myself for the pain that I expect to come. If I breathe and tell myself “You’re safe” or “Your back is healthy, strong and normal” as I’m bending down to pick it up, I stand up and can’t help but to monitor how my pain is, then I reward myself with that feeling of pride for comforting my inner child or tending to an emotional state – how is that not reinforcing a connection between my pain level and my mood?

    I feel that I’m missing a critical aspect to this idea. It has worked for so many people, and I feel so stuck.

    Thank you for any insights you can provide!
     
  2. Alan Gordon LCSW

    Alan Gordon LCSW TMS Therapist

    Answer
    Wow, what a nuanced question.

    Let's say you stub your toe. It hurts. But you know it's no big deal, and that in a week it'll be better. Whenever you take a step, you feel pain, but the pain doesn't carry any scary undertones (is it ever going to get better? Am I doing permanent damage?) It just hurts, but that's it.

    In this case, there's built-in outcome independence. You don't have to practice it or earn it, it's automatic because the pain is nothing more than just pain. It's uncomfortable, but you know it's temporary, so it doesn't scare you on a primitive level.

    That's the goal, that's where you want to get to with your chronic back pain. It's temporary, there's nothing structurally wrong with me (assuming it's TMS), and I'm not doing any damage.

    The words that you say don't matter, if you're monitoring your pain and feeling good/hopeful/optimistic if it doesn't hurt that much, and bad/scared/pessimistic if it hurts a lot, then you're being outcome dependent.

    When you stub your toe, some steps you take may hurt more than others, some will hurt less than others. But you're not really monitoring, or making conclusions based on how much it hurts. There's no additional meaning to the pain, so your fear response isn't activated.

    The purpose of working toward outcome independence isn't to reinforce a connection between your pain and your mood, it's to break the existing connection between your pain and your subsequent mood.

    Currently, every time you bend over and you have pain, the automatic response is fear or despair or hopelessness or frustration. Telling your primitive brain that you're safe and rewarding yourself with a feeling of pride for treating yourself in a nice way essentially works to override this automatic response of fear or despair or hopelessness or frustration.

    The goal is not to feel empowered or fulfilled or hopeful or optimistic when you have pain, it's to simply feel the absence of fear/despair/hopelessness/frustration. Getting to a point where you have virtually no emotional response to the level of pain you have, just like when you stub your toe, is the end goal. Soothing your primitive brain and positively reinforcing that behavior is just one path to getting there.

    Alan


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    Grateful17, linapina and Walt Oleksy like this.
  3. PamD

    PamD Peer Supporter

    Hello and welcome dear Guest, What a great question!
    Alan has said it so eloquently, I love the idea of what he says " getting to the point where you have no emotional response to the level of pain you have...Soothing the primitive brain". I think about the idea that it is has been the job of the primitive brain to protect us but it has gotten, perhaps, overprotective. It is primal vs cognitive, instinctual vs intellectual. Finding methods to soothe it help in so many ways. You are doing great!
     
    Walt Oleksy likes this.
  4. Walt Oleksy

    Walt Oleksy Beloved Grand Eagle

    Guest, Alan Gordon's reply is great. I didn't know I had a primitive brain, but now I do.
    And I am going to work more on soothing it.
     
  5. linapina

    linapina New Member

    Thank you for this! Just what I needed to hear. I have been thinking something similar to 'Guest'.
     

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