Good question! And this is TMS theory 101 so I could probably write for days, but I'll reference these two quotes from Steve Ozanich before answering:
"Pain and illness are messages from the inner self revealing that we have become out-of-touch with our inner self. The pain dramatically rises when we aren’t listening – determined to hold our attention”.
"You need to understand that your pain and symptom is both a distraction and a message. The distraction is being paid too much attention, and the message not enough attention”.
I think it's both a distraction and a message, as Steve says. I like to look at it more as a message of inner turmoil and as Steve said above becoming out of touch with our inner selves.
I think that diving deep emotionally and working on how you feel about past events can have a benefit in and of itself (to me that's more the fact that it's a big act of self-compassion, you're validating your own emotions, and that if you put that into practice in the now in your daily life then that will be hugely regulating and reduce stress - but people will point to the release itself which yes I think can be beneficial by itself - more so for bigger traumas). The biggest benefit to me of this though (and it proves that it's not always necessary to do) is that it helps you understand where your patterns came from (people-pleasing, perfectionism etc.) which often helps you change and improve in the present day. If you can change and improve on these aspects (which reduces stress and anxiety) without having to go back into the past and without the knowledge of where they came from, then more power to you (but it can provide very valuable insights that you were unaware of - remember too that all those traits are are protective mechanisms based on fear, the only reason we people please excessively for example is because of fear of rejection (or at the extreme level harm) - so understanding the root of that fear from the past is often very useful, because if you get rid of the fear then the behaviour becomes unnecessary). Obviously in cases of severe trauma, it pretty much always impacts the person's daily life and how they function, so in those cases it has to be addressed (Dr Sarno recognises this and recognises that a small proportion of people will need psychotherapy). I should note too (I don't want to turn this into an essay) that to me the emotional side of things is as simple (doesn't mean it's easy - especially if trauma is present) as being more self-compassionate and more authentic (as an example, perfectionism isn't authentic and it isn't self-compassionate, all these traits will be improved upon if these two things are raised).
Another thing to note is in terms of the quote around traditional therapeutic models (like CBT) not being as effective when it comes to TMS, I think a big part of that is because with TMS recovery the emotional work is more targeted (rather than throwing things at a board and seeing what sticks - which can happen in traditional therapy - many people say with TMS emotional work that they don't know where to start). I'll give you an example to illustrate everything that I've said so far.
Social anxiety triggers my symptoms (used to be a lot, now very minimally but it can still happen). When I thought something was physically wrong with me, I wasn't aware of this trigger (despite how obvious it was) as every time I went out and got pain I'd blame it on the chair or standing (amongst other things). It's confirmation bias because that made sense based on my belief I was injured (I guess you could say it's a distraction here - but that was more due to my knowledge deficiency at the time as I had no idea about TMS). Once I knew it was TMS, the obvious actually became obvious and I could see this pattern clearly. The pain was a message and it was trying to help me, by pointing out that I felt (needlessly) unsafe in such an environment. I wouldn't get too caught up on what the brain is trying to do exactly as no one knows, I look at it instead in terms of what it means practically. Whether the brain meant to send me that message or not, I take it as a message that I need to address (or at the very least acknowledge) my social anxiety and it's link to my pain. If I knew this - and say I was unwilling to work on my social anxiety and just thought I should be able to have it and have no pain (I'm not saying I fixed my social anxiety and I'm not saying that's necessary to heal - but I think I did need to make certain amounts of improvement to generate enough safety) - then I might go back to the physical explanation and try again there (despite my knowledge now that it's TMS). In that case, the pain then does become a distraction (to the extent that it's explained physically) in so much as it is distracting me from the emotional work I need to do. It doesn't really become a distraction unless I'm unwilling to make positive internal change (if you are, then you bypass this problem as the pain and your triggers will guide you on that path).
It seems the other primary alternative is fully engage as much as possible in live WITH the symptoms, and stay with it as long as it takes.
I think that's too simplistic and I don't see that as the natural alternative. By suggesting that you just have to stay with it as long as it takes, you're also giving your power away and suggesting that it's a matter of hope (hope is important - but this is more than hope) - TMS healing makes more sense than that and is more predictable if you do the right things.
The way I split it up conceptually is how I explain book cures. In the case of a book cure, the only lack of safety (really) driving the symptoms is the fact that they think something is wrong with them (which is the main driver when it comes to fear around symptoms, at least initially). Once they know their body is ok, the fear completely diminishes and the pain naturally leaves. There wasn't really an emotional message to the pain, other than it being reflective of their belief that something was structurally wrong (or if there was, then it just clicked for them and they were able to address it immediately). This is more common in cases where the pain was preceded by an injury (whether genuine and it healed, or an apparent one), as the belief in damage is higher (not always though, my pain started from an injury and I wasn't in this category). Interestingly enough (and I don't think this is a coincidence) most people I have met who had TMS but didn't have the TMS personality (and after speaking to enough people with the personality they stick out like a sore thumb, even after only speaking with them for 10 minutes - and there aren't many), were book cure cases or healed extremely quickly, supporting the notion that all that was needed is knowing nothing was wrong. Just my opinion, but I think the reason that Dr Sarno highlighted the importance of awareness of how emotions played a role is not really because there's anything inherent in that knowledge from a healing POV (there are plenty of people who know all about their pasts and why they are how they are, doesn't necessarily mean they change just from that or heal), but rather it's such an amazingly strong piece of evidence that nothing is wrong with the body, I think that was its main value to his patients (and once they knew nothing was wrong physically, their fear vanished). After all, he was selective and he didn't take people on that were too skeptical of the possibility that there's was TMS (you could have the most emotionally aware person on the planet, but if they think TMS is rubbish and aren't willing to change that stance then I'm not sure their awareness will make much difference).
For most people (myself included), however, especially when the pain starts seemingly randomly (or a stressful event triggered it, but it seems random to the person because they don't know about TMS), it's a mix of fear of there being structurally wrong but it's also a sign of too much internal stress (whether that be a build up from trauma or just life stressors). It's too much of a sustained level of fight or flight and eventually the body/brain has had enough (again, not putting too much focus on the exact mechanism as no one could possibly know that - at least not yet in this day and age). Even though my pain was from an injury and was heavily fuelled by the fact that I thought I'd severely screwed up my body, my personality and the stress that comes with that was also a huge factor. This was evident by the fact that even after I got rid of my physical triggers (and I have none now - nothing I do physically causes any pain whatsoever), I still had emotional triggers (and I still do at a low level).
You might have read up to here and think that I actually agree with your quote, and that getting back to full life is all that it takes if you're in the first category. Not necessarily, and hopefully this helps you determine where you are at. If you have a book cure, that represents genuine and basically full belief that this is TMS. What happens with full and unequivocal belief is that your actions also follow (which needs to happen for the brain to be convinced). People with book cures have such a strong belief that they'll go to the gym the next day despite not going for 10 years. They'll start to move naturally almost immediately. You can still be in this category technically and it still may take a while to heal, as even if there's not much emotional work to be done, your actions still don't align with the TMS belief (which shows that your belief isn't quite there yet - like if you are telling yourself you believe but you are still hesitating with movement, that doesn't align and it's still suggesting to your brain that you're damaged). You could say this is encapsulated in getting back to a full life, but not necessarily and this mistake is still made (you could still do everything like get back to work and exercise but you could still be doing subtle things that are suggesting there's still a problem - one doesn't necessarily mean the other).
Your quote also kind of bypasses PRT fully - in that you either need to just get back to life and forget about healing or you need to do deep emotional work and find repressed emotions. If you're in the second category, it's a mix of emotional work and PRT. Emotional work (in addition to being beneficial because it leads to more overall life safety, which is always conducive to healing) is often crucial when it comes to PRT, and I'll explain using your example.
If you get pain before a big day at work - obviously if that's the trigger then not only is that great TMS evidence (which helps your belief), but it also shows you what you may need to work on. Let's say that this thing you need to work on is you put too much pressure on yourself at work (you can go back into the past to better understand why, and that may help, but regardless). Even if that's not the actual trigger though but say you were already in pain and the thought of work and that stress made it worse (technically it's still a trigger, but I'm just trying to cover both scenarios so you know it applies to both). How can you be indifferent to this pain (which is really the end goal)? First of all, you're not going to be indifferent to it if you still have genuine doubts over the TMS diagnosis and you think something might be wrong. We are evolutionarily wired to care that our bodies are damaged for survival purposes, so unless you can re-wire yourself against evolution then you're stuck with this (you can't think your way out of not caring whether or not you're damaged). Say this is ok and your mind doesn't jump to "What if it's this or that", the only other reason for catastrophising more broadly (the first one is fear of damage) is what the pain means to your life. This at times is unavoidable granted, but if you have pinpointed that you put too much pressure on yourself at work, then the pain will be way more of a disaster for you than someone who doesn't put that same level of pressure on themselves (the pain means less to them, at least in this sense - and maybe they don't have to work through their emotions as much in order to be indifferent as a result - everyone's different). The catastrophising fuels the pain in large part, so even if you took a little bit of pressure off of yourself at work, that would mean the pain is less of a disaster, which means you catastrophise less, which means it loses some fuel (and should go down). This is an example of how the inner work (lowering pressure on yourself - which involves being more self-compassionate) directly impacts your reactions to the pain (for the better), which impacts symptoms positively. In other words, the emotional work has benefit beyond it just improving overall safety and reducing stress (which is still important and is beneficial too beyond pain - that internal work results in a better and happier life).
I'll go on forever (although I've nearly explained TMS fully from my viewpoint) so I'll stop there for now and happy to continue (including what I think you should do), but probably a good pause moment to ensure you understand that first
