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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