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Alan G. Overcoming conditioned responses

Discussion in 'Ask a TMS Therapist' started by Guest, Jun 16, 2014.

  1. Guest

    Guest Guest

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


    Thank you for your time.

    Having suffered from severe lower back pain for past 3 years, which I know is TMS, I cannot overcome conditioning.

    I cannot stand up from seated position without a struggle and without the full support of my arms - I know this is conditioning...my subconscious and conscious focus is always on the lower back to check if pain is there or not when I get up.

    Also I cannot bend at all, I can just about touch my knees.

    Please advise on how to overcome this, as until this is overcome I cannot fully recover.

    Thank you,

    Peter (UK).
    Last edited by a moderator: Jun 23, 2014
  2. Alan Gordon LCSW

    Alan Gordon LCSW TMS Therapist

    Hi Peter,

    First of all, it's important to get physical causes ruled out. It's best to have this done by a TMS physician, as non-TMS physicians can sometimes attribute pain to incidental disc bulges or herniations.

    Getting a TMS diagnosis from a physician can also be a great psychological intervention. Accepting that the pain is psychologically generated is an important component of recovery, and getting a diagnosis of TMS from a physician can help with that.

    Now, I'm going to get a little deep with you. I'm questioning whether you truly believe 100% that your symptoms are TMS. In your question, you state, "which I know is TMS" and "I know this is conditioning." Sometimes when we have ambivalence about something, we overcompensate by expressing things with complete certainty. (This is a defense mechanism known as reaction formation. Isn't learning fun?)

    Ambivalence can be a difficult thing to consciously tolerate, but it's important to be honest with ourselves. Work toward accepting that there's probably a part of you that questions whether your pain is TMS (it's hard not to have doubts when you're in a pain state), and continue gathering and focusing on the evidence that it is TMS.

    Now to answer your question. The single greatest weapon in overcoming conditioned responses is genuine, authentic indifference. The harder you try to get rid of the pain and the more you monitor it, the more power you're giving it.

    Of course, it's hard to be indifferent toward something that matters so much to you. Sometimes it can help to change your habitual response to the onset of the symptoms.

    Right now, I can guess how you respond each time the conditioned response comes on: disappointment, fear, hopelessness. As natural as these responses are, they are destructive and serve to perpetuate symptoms.

    Try working toward developing a new automatic response to the onset of symptoms. Something along the lines of "I know what you are, and I know you're trying to bring me to a state of disappointment, fear, and hopelessness. I'm not going there. You're safe, and it's going to be okay." And be genuinely proud of yourself for responding in such a healthy way. Then take three deep breaths to help bring you out of a fight or flight state.

    Eventually, you can shorten it to, "You're safe." Reward yourself with a feeling of pride for responding in such a nice way, and take a few breaths.

    Altering your reaction to the conditioned response changes the pattern of reinforcement, and over time, the symptom will lose it's power over you.


    Any advice or information provided here does not and is not intended to be and should not be taken to constitute specific professional or psychological advice given to any group or individual. This general advice is provided with the guidance that any person who believes that they may be suffering from any medical, psychological, or mindbody condition should seek professional advice from a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions. No general advice provided here should be taken to replace or in any way contradict advice provided by a qualified, registered/licensed physician and/or psychotherapist who has the opportunity to meet with the patient, take a history, possibly examine the patient, review medical and/or mental health records, and provide specific advice and/or treatment based on their experience diagnosing and treating that condition or range of conditions.

    The general advice and information provided in this format is for informational purposes only and cannot serve as a way to screen for, identify, or diagnose depression, anxiety, or other psychological conditions. If you feel you may be suffering from any of these conditions please contact a licensed mental health practitioner for an in-person consultation.

    Questions may be edited for brevity and/or readability.

    Last edited by a moderator: Jun 23, 2014
    scrat26, Jenny, tarala and 3 others like this.
  3. Leonor

    Leonor Peer Supporter

    Hi Alan,
    I totally agree with your response. It has happened to me. I know a lot of my chronic fatigue and other symptoms are conditioned. I have been so eager to get rid of it that it has gotten worse. I read a lot of books, articles and materials about it, did several tms healing programs but have not been able to be successful. I constantly feel tired and cannot even recall what is really going on. Right now I don't even want to read anything, it is too overwhelming. I am still reminding myself, when I remember, that it is a mind/body condition. My deep depression also kicked in, and I absolutely do not want to fall into the victim category, but I am deeply struggling with it. I have always been very reserved about my condition, I do understand that most people can't take too much complain, it took me a long time to understand it even though I suffer from it, so I do not expect people to understand it. I try to stay focused and not fall into the victim/mad position. I am not giving up and know deep down that I have a chance to overcome it.

    Forest, Birdie and North Star like this.
  4. Walt Oleksy (RIP 2021)

    Walt Oleksy (RIP 2021) Beloved Grand Eagle

    Leonor, I think you need to find some distractions to take your mind off your symptoms including fatigue.
    Maybe get back to a hobby you have neglected. Something that you enjoy and that will lift your spirits.

    Make a list of things you like to do or think about, and spend some time with them.

    Who do you admire that you'd like to learn more about? Look them up in a Google search.
    Or maybe an event in history. Surfing the web can be a great distraction.
  5. North Star

    North Star Beloved Grand Eagle

    {{{Leonor}}} You're not alone! Keeping on the course; remember this is a journey of perseverance, not speed.

    Alan, you have given me food for thought on something I frequently say, "I KNOW this is TMS." Hmmmm….reaction formation? The on-going severity of my pain levels has lead me to conclude that something ain't working right despite all my knowledge quest. Thankfully, I am doing a trip to see Dr. Schubiner in about a month…I think it's time for some professional intervention.

    Finally, Alan, I could feel my eyes welling up with tears reading your caring response to Peter. Availing yourself to this community in such a deep and generous way reminds me of the goodness in people. May your generosity be reward many times over!
    scrat26, Anne Walker, Forest and 3 others like this.
  6. tarala

    tarala Well known member

    I couldn't possibly say this better. Thanks Alan.
    Anne Walker, Forest and North Star like this.
  7. Peter77

    Peter77 New Member

    Hi Alan,

    Thank you for your encouraging response.

    I have been putting into practice the advice you have given me, and yes you are correct everytime my response to my conditioned symptoms had been negative.

    I am pleased to say that for a few days I managed to get up without support of my arms, by focusing on something else but at the same time having a positive response, and it worked everytime. However a few days later fear/focus of whether this would work everytime started, which eventually meant that the conditioned symptom showed its ugly head again. I am pleased that I tried and in a way proved to myself that if it works once it can work everytime, however I am not sure how to successfully overcome this, like you said in your reply overtime it will lose its power.

    Also I am not sure how to breathe when getting up from a chair. It seems I am holding my breath when I am getting up, which causes further tension in my back. How should one breathe when getting up from a seated position?

    Kind regards, Peter.
    Forest likes this.
  8. Alan Gordon LCSW

    Alan Gordon LCSW TMS Therapist

    That's great, Peter. You've stumbled upon an important barrier to TMS recovery: fear. The underlying purpose of most TMS pain is to scare you.

    There's a part of your mind that has the ulterior motive of scaring you (don't worry about the "why" for now...it's not really important outside of intellectual understanding, though I'm going to talk about that in a future post.)

    The part of your mind that is trying to scare you is always looking for ammunition. So here's what happened:

    You started making positive changes in your attitude toward your symptoms, and you found success. You were feeling more empowered. Yay!

    "Uh-oh," said the part of your mind that has an ulterior motive of scaring you, "He's on to us. We need to find another way to scare him and quick. Otherwise he might overcome this whole pain thing."

    And then you have the thought, seemingly out of nowhere, "Uh-oh, what if this doesn't work every time?"


    And you responded by getting scared. And all of a sudden the symptom is back.

    If instead, you would have responded, "Ha! Look at you, part of my mind that is trying to scare me, you're trying to bring me back into a fear state. I see what you're up to, you sneaky bastard," you would have been fine.

    The goal is to see behind the curtain, see how your mind is using the pain and other tactics to try and scare you, and laugh at it's feeble attempt. It's easier not to buy into something when you see what it's up to.

    Regarding your last question, don't worry about breathing when you stand up from a chair. That's not important. It's just another thing your clever mind is using to try and preoccupy you.

    Forest and Ellen like this.
  9. Peter77

    Peter77 New Member


    Your advice and replies are truly priceless, I cannot thank you enough for your time and kindness.

    Just to clarify, you say to see behind the curtain, is the mind using every tactic possible just to distract me from how I am feeling inside? Basically if I acknowledge how I am feeling then there is no need for the symptoms?

    Kind regards Peter
  10. Alan Gordon LCSW

    Alan Gordon LCSW TMS Therapist

    Hi Peter,
    That's a complicated question. If you were able to access your feelings every time they came up, you probably wouldn't need symptoms in the first place. It isn't about acknowledging the feelings, rather learning how to consciously tolerate them, learning how to feel them. This is often the goal of psychotherapy.

    I see this as a recipe for you to just put more pressure on yourself to feel these feelings that you don't have complete access to.

    I would just say that for now, work on not buying in to the fear thoughts that your mind is sending you, work on seeing that this is your mind's way of trying to bring you a place of fight or flight.

    If you ever want to get better at "feeling your feelings" I'd recommend working with a therapist who specializes in Intensive Short Term Dynamic Psychotherapy (ISTDP).

    Jenny, Anne Walker and Forest like this.
  11. Alan Gordon LCSW

    Alan Gordon LCSW TMS Therapist

    Incessant worrying/analyzing/planning is usually a defense mechanism, serving the same purpose as the pain.

    It's hard to tell someone to use their symptoms as a guide to look at their feelings before you know whether they have the capacity to feel their feelings.

    For example, if I'm working with someone who has a tendency to repress feelings of rage or sadness, and hasn't yet learned to tolerate those feelings consciously, then what purpose would it serve for me to tell them to try and figure out what they're feeling when the pain comes up? They don't know how.

    Sometimes looking for feelings that are unconscious can just lead to more pressure. You can't logically figure out what your feelings are, that's going through the wrong channel.

    The initial thread was about conditioned responses. When pain comes on because you're engaging in physical position or activity that has become linked with pain, it doesn't necessarily mean that you're repressing a feeling at that moment. Pain as a function of repression and pain as a function of conditioned responses are two different things.

    Everyone has their own way of reacting when the pain comes up as a result of a conditioned response. Some people feel empowered by getting angry at it, some people tell themselves that they're safe and that it will pass. Some people laugh it off.

    Feeling empowered, seeing that your mind's trying to use it to bring you to a state of fear, and working toward not buying in to that fear is your ultimate goal. How you achieve that is up to you.

    Jenny and Anne Walker like this.
  12. Peter77

    Peter77 New Member

    Hi Alan,

    When I get pain/twinge/spasm in my lower back, my first thought is how I feel and what I have been thinking. I also do deep breathing and sit with my pain - I am not sure if this is right what I am doing or should I be doing anything else?

    Also another thing that I am not sure about: Can the way I think be the sole reason for my TMS?

    I am constantly worrying/analysing/planning about the future. Is it possible that my addiction to worrying be the only reason my symptoms are there and continue to come back when I feel a bit better?

    Best regards Peter
  13. Walt Oleksy (RIP 2021)

    Walt Oleksy (RIP 2021) Beloved Grand Eagle

    Hi, Peter. Yes, thinking and worrying about your symptoms will keep them alive.
    Distract yourself or spend time discovering your repressed emotions and/or personality traits that cause the
    unconscious to send the pain.

    The way into pain is to think it's structural. The way out is to believe in TMS, that the pain is psychological.

    Try to live in the present moment. Don't think about or worry about the present or stress about the future.

    Deep breathing is one of the best ways to fight fear, worry, and the pain. It is profoundly relaxing.
    There are many posts in the subforums on deep breathing. Breathe in through the nose, hold the breath,
    then release it through the mouth a little longer than the in-breath. How long varies. Many prefer
    in 6, hold 4, out 7. It's up to each person.

    Give up worrying about the future. It probably will never be what you worry it is going to be.
    As Jesus said, today's troubles are enough in themselves.
    Ryan likes this.
  14. Ryan

    Ryan Well known member

    Walt great advice my friend, fear is a big part of my tms. Just try to be aware of how much you do fear things. It really was mind blowing at how many things I feared, I was in a constant fight or flight mode. It will take a lot of time to break this habit, but keep at it. I would suggest you look at the answer that Daniel posted on ask a tms therapist thread in regards to fear, i think there is 2 different ones, they are very helpful.
  15. Birdie

    Birdie Peer Supporter

    Hi Alan,

    That's interesting! Because I often made the experience that sudden pain outside the usual range often seems to be linked to repressed emotions (a sudden pain in my hand before I visit some relatives ... my hand usually does not hurt versus pain in my feet which always hurt as soon as I put some weight on it....they hurt since 1996!).

    So, but although there are two different mechanisms at work: they still serve the same purpose (as a distraction), is that right? Or does that mean that long-term-conditioned pain does not serve a purpose any more because it's "only" a neuronal pathway and we "only" (difficult enough!) have to reverse that bad conditioning?
    Last edited: Jul 8, 2014
  16. Walt Oleksy (RIP 2021)

    Walt Oleksy (RIP 2021) Beloved Grand Eagle

    Hi, Alan. Most of the time when I have anxiety or pain from a conditioned reflex,
    I laugh it off. If I can make light of it, the load on me becomes lighter.
  17. Alan Gordon LCSW

    Alan Gordon LCSW TMS Therapist

    I'm actually not sure, Birdie. I imagine sometimes it's the former and sometimes it's the latter. It's a good question.

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