Notes from training w/ Dr. Schubiner and Alan Gordon

Hi all,

This past weekend, I got to attend a training with Dr. Schubiner and Alan Gordon on how providers can integrate the mind-body approach to chronic pain into their work. I feel so lucky that I was able to go to this training. I can’t say enough good things about Dr. Schubiner and Alan – they are both so kind, down to earth, passionate about what they do, and also, really funny. I also met a bunch of awesome, open-minded, and caring people including Andy B

I wanted to share some of the most helpful takeaways that I wrote down from the training (helpful for providers as well as people who have neural pathway pain). I’m not recapping everything I wrote because most of it is available in Unlearn Your Pain and Alan’s free program on this site, just some key points:

-Be careful of the language you use. For example, think “sensations” instead of pain.
-Pain is a message from the brain – it’s up to us to figure out what the message is.
-It is not required to have a major trauma leading up to your pain; it can be triggered by something relatively minor that you may not even be consciously aware of.
-Our brains cannot perfectly distinguish between a physical and a psychological threat.
-It’s important to document evidence of exceptions (e.g. if you are pain-free on the weekend but then the pain starts again on Sunday night right before you have to go back to work).
-Fear is fuel for pain.
-The faster you want to get better, the longer it will take.
-Conditioned responses can be addressed by exposure to activities while feeling safe and confident.
-Sometimes making a life change is a critical part of solving the problem.
-The stories we tell ourselves are powerful – you can be the hero of your own story.

This training helped me understand to not make things more complicated than they are. If all the evidence points to neural pathway pain (which it does for me), that’s the logical conclusion. All of my doubt is gone at this point.

I hope this helpful! Feel free to message me if you have any questions.

 

love your next to last sentence.

 

Hi Sadie,

Thank you so much for the summary and great bullet points. I also experienced a great deal of "heart" in all who attended, and in the leaders. As Howard said: "In order to help, you have to love."

Great to meet you too Sadie!! I know you'll get better and better after this deep dose of "reality."

Here are some additional points which I came away with.

Howard and Alan's experience with large numbers of people lends them ---and us watching them, great confidence in diagnosing this mind-body condition. Their experience confirms my experience with many people on this forum and as a coach. There is an epidemic of this neural pathway disorder, or TMS, or whatever you want to call it. And it is not that hard to spot.

I am really excited to practice/learn leading direct tolerance for the pain, to break the pain cycle. Alan linked this experience to the "belief" aspect of this work. "The best way for a client to be convinced they have a mind-body issue is to give a direct experience of 'no pain.'" When I look back at my own recovery, experiencing no pain when walking, after 3 plus years of pain every time I walked, was a major breakthrough. Just one experience. It is very exciting to know this experience can be imparted to clients using Alan's demonstrated skills. This was the main reason I attended, to grasp this technique more deeply, and see the love embedded in it. It is not just "pushing through."

And we watched as Alan did this with someone from another seminar at the center, in real time after he and Howard did a very brief screening to determine suitability (diagnosis). This was someone who has suffered with "Postherpetic Neuralgia" after a shingles outbreak, sought many treatments to no avail, for 12 years. We were all blown away by the results, including the recipient, who understands that her brief experience of no pain is not the end of this healing process, but the beginning.

Practicing tolerating the pain as in Alan's sessions on vid, can be done with a great deal of attunement and care for the client. Alan is very supportive as he leads "graded exposure." At the same time, he is directive, doing mostly a dialogue and "talking to the client's brain" as he/she sits there. The deeper work (therapy) gives one a chance to "listen to the pain's message." Both practices have their place, and time in recovery. I like that there is room for deeper work, which to me is something which we all want down deep, based on my experience: self understanding, self-compassion, and voicing our life's desires in relationship to others and the world.

Developing indifference to pain "makes pain go away." Deeper understanding/exploration/feeling work ("therapy") "keeps the pain away." This was Howard's summary when I asked how the two modalities fit with each other. I think of Steve O when I write this, for some reason.

The honesty, joy in discovery, humanity of both these leaders really comes through. They embody what they teach, and this, I think goes very deep in their effectiveness.

I thoroughly enjoyed this experience, including meeting so many others --nurses, MDs, psychologists, health coaches, PTs who want so much for their clients, and are willing to stretch their professional boundaries to do this. Lots of love in the room!

Andy B

 

Yes!!

 

That's a really important point, Sadie. Our brains should read "our primitive mammalian survival instinct brains". When someone browbeats you, your existence may not actually be threatened, but your primitive brain may take it that way and overreact.

 

Do you think that also applies if we are in the habit of browbeating ourselves?

 

Yes, and talking on the way back from the conference with a friend, I realized how this "confusion" in signals and brain responses might happen:

The child's survival is threatened, on a physical level, when the caretaker is not available or not attuned. This is pre-verbal, but creates and becomes a deep imprint. The infant knows/feels its existence is threatened when certain "psychological" experiences are happening in the inner or outer world. So from the very roots of personality/ego development, there is a deep overlap of psychological and physical threats ---similar, overlapping "threat pathways in the brain."

 

Absolutely. That is why Inner Critic work is helpful.

 

Thank you Andy B

 

The bully inside you that does the beating is usually a part of yourself that matches a parent figure. I guess Freud would say the Superego beats up on the ID. Yes, our attitudes toward our parents when we are very young is problematic and ambivalent and continues to be for all our lives. Great parenting and a live well lived can make up for it, but the old terror persists. After all, our parents were bigger than us way back when and could easily morph into a physical threat. In some families, they really do turn into monsters that torture their own offspring. No supposed do happen, but it does.

 

Yes, but the threat of being banished from the tribe is a real threat to our primitive brain, as we could not survive alone. So criticism from the social group (tribe) is a real threat, which is why bullying is so very harmful.

 

Sure was enough of that in my 8th grade class! There always would be someone - weaker, littler, less aggressive, more introverted, less physically fit - that the class bullies picked on in public. Worse thing was though that certain teachers - particularly NCO-type PE instructors - would add on to the abuse by picking on the same people. A whole social Darwinian bullying culture. Would be interesting to plot how the "retards" and "wimps" faired later on when they went out into society after high school?

 

You write well Andy I like the style, I look forward to reading your book one day. Call me sometime. I would be careful framing it as some type of neural pathway problem or disorder. Increasingly more people are contacting me as that notion spreads and who have latched onto it as yet another physical problem. The T personality seeks things to obsess on in order to divert fear, and they're latching onto this notion of having a physical neural problem in their head that needs somehow fixed like a herniated disc, and it's causing them to TMS about it. It doesn't matter if it's pain, or the spider in the corner the sufferer is looking for a target to obsess on which the neural pathway disorder notion provides them. Some may heal through the knowledge of these pathways but some get worse. Does the brain change and new pathways develop with new understanding? Yes! ... and Dr. Sarno knew it years ago and stated it publicly. But no one needs to know it to heal.

The situation should be framed in terms of feelings and emotions and thinking, and then of course toward the deeper realm of presence/being. The success rate is much higher when not focusing on body. I still believe that the good doctor's most world changing statement is, "As long as he is preoccupied with what his body is doing his symptoms will continue." This includes what the brain is doing. Unfortunately the T persona demands answers and reasons and information, all of which are the cause of the symptoms in the first place. It's the ouroboros of thinking and mind.

Peace
SO

 

As per usual, Steve Ozanich brings us all back on track!

 

They're not booing they're yelling Bruuuuce! Bruce how are you doing? Still active?

 

Sold my parents' haunted house, moved to Sonora, then started working out so hard I came down with hypertension last week. Realized I'd been inhaling Qvar steroids for my asthma the last 7 years. Two puffs per day as prescribed by a large Cali HMO. Kept all the old injured nerve endings in my back and legs fired up, so it was easy for TMS to locate the pain there. Stopped Qvar and completely cleaned up 10 days ago and instantly the tingling and pain in my left leg started to let up. Now I'm walking around the grocery store without fear of leaving the cart to grab a plastic bag. A revelation. Chilling out too. Have you seen where the physical and the psychological combine together to reinforce and program TMS pain symptoms? The steroids in the Qvar I feel pushed my symptoms out of my lungs and nasal passages into other areas like my LB and left leg. Of course, I'd broken my left leg in a hundred pieces 20 years ago, but healed completely until - dum, da, dum, dum - my mother died in 2001. Then, bango, a herniated disk while out manically running to run away from my grief. I'd taken care of her while she suffered from dementia for 5 years. Worked 2 jobs, managed lawsuits, wrote books at the same time. A real martyr! Seems like I was reinforcing the whole process by continuing to take Qvar, failing to recognize the role it played in perpetuating the TMS pain. Was this all just something I had to do? Was my unconscious hiding the answer from me that was always in plain sight if I'd chosen to notice instead of continuing to perpetuate the problem? Puzzled! At first the Qvar did wonders for my allergies and asthma, but after a while, I realize now it was perpetuating my symptoms, requiring more and more inhalations per diem, which made me more obsessive and manic, very much like a drug addict. Quit Qvar and now my allergies have disappeared. Was TMS just playing a huge trick on me? Bet you have a strong opinion!

 

Hi Steve,
I appreciate what you're saying here, that the fear and the need to fix will attach to whatever it can!! To me, the physiology is less important than the treatment; and I think all practitioners pretty much agree on the basics there, thank goodness! Thanks for the encouragement in my work.
Andy B

 

Steve, I think the neural pathway concept, when correctly framed, is not incompatible with what you teach and practice and, if fact, may be useful. It might seem like I am starting off on a tangent below, but please bear with me.

The New York Times Magazine recently profiled some famous people who died in 2017 (thanks for the tip Tennis Tom). One of the articles was about Dr. Sarno, and it was subtitled “At war with the medical establishment—and his own body.” The article mentions Sarno’s own TMS equivalents of an irritable stomach, itchy skin, shrieking headaches. But much of the article is about his frustration in being treated as a laughingstock by his NYU medical colleagues and being rejected by the broader medical establishment. The article quotes Sarno as saying in a 1994 interview: “I can’t stand not being recognized. I hate it.” That made me feel said for Sarno.

But here is what I loved about the article. It contains a quotation from Sarno’s 1994 interview that is a brilliantly succinct statement of his prescribed treatment for TMS and its equivalents: “Know about the anger, and know why it’s there. And if you do those two things, your pain will go away.”

Some of Sarno’s patients (about 20%, if I recall) needed help with “those two things,” and he referred them for psychotherapy. As I am sure you know, Sarno’s chief psychologist was Dr. Arlene Feinblatt, and she was trained in and practiced ISTDP. ISTDP is a perfect fit for Sarno’s approach because it focuses on uncovering unconscious anger (and guilt about the anger) to treat various psychological problems, including psychosomatic pain.

While Dr. Schubiner is associated with the neural pathway approach to psychosomatic pain, he is also a fan of ISTDP—which he discovered after writing the first edition of Unlearn Your Pain and incorporated elements of it into his later editions of the book. Scubinber and leading ISTDP therapist Dr. Allan Abbass have co-authored a book due out next month titled Hidden from View: A Clinician’s Guide to Psychophysiologic Disorders. I have not seen an advance copy, but based on recent publications by Abbass that I have read, I expect that the book seeks to educate establishment medical clinicians about the physiology (including neural pathways) of psychosomatic disorders and how to treat patients by getting them to do what Sarno said in 1994: know about the anger, and know why it’s there.

By extensively marrying physiology with psychology, the book might be more successful than Sarno was in gaining acceptance from the medical establishment. Interestingly, a selling point advanced for the book is that it can help primary care doctors avoid burnout due to their frustration in being unable to help patients with an big emotional component to their “physical” problems.

In short , Steve, I understand why you don’t want patients to be distracted from uncovering their unconscious anger by focusing and obsessing about neural pathways instead. (ISTDP would regard that as a defense mechanism to avoid unconscious anger and guilt about it.) But there is a broader perspective here: linking the physiology and the psychology of TMS and TMS equivalents might result in more acceptance by the medical establishment of Sarno’s treatment method. And if patients think correctly about neural pathways as being triggered by emotions hidden from view, that might help them to accept that what they really need to do is “know about the anger, and know why it’s there.”

 

Bruce it's common for something like that to trigger some or all the symptoms. I got 2 people off of pain meds and their pain immediately stopped. As long as fear is present there will be a need for it to be diverted somewhere. The mind is the hell, it's the problem because it includes thinking. The physical and the psychological are always in touch back and forth communicating. They magnify and reinforce one another in a closed loop for survival until you move beyond them into simply being. At that point there's no need for diversion because the mental is out of the picture.

Andy you will write a great book, you have style and class and more importantly compassion. Yes the mind wants the fear diverted and the notion of something physical needing fixed only shifts the problem. The physiology is indeed not important, only the treatment. But the treatment itself often becomes the TMSing and the loop starts all over again if they feel that they have to "fix" something in their head. The more I work with people the more I see they do not want to heal.

SteveO

 

the victim mentality. The longer you're in it the harder it is to convince your self that the pain is tms. Somehow it is more comfortable inside that cocoon of suffering than being heal.