Candice, you mentioned you are doing Dr. Schubiner’s program. I am going to respond to your inquiry about Moskovitz’s approach with some thoughts that might at first seem like heresy, if not idiocy. They are actually based on something Schubiner said in a recent video-taped lecture about treating psychophysiological disorders (PPD) that he did for the Commonwealth Club of California. Thanks to TG957 for providing a link to the video in another thread in this General Discussion Subforum.
To set the stage, I need to begin with the topic of placebos. The word “placebo” used to be a term of opprobrium. It was thought that placebos merely conned unintelligent and gullible people into thinking they have less pain than they do. Dr. Sarno more or less reflected this view in Healing Back Pain when he wrote: “A placebo is any treatment that produces a good therapeutic result despite the fact it has no intrinsic therapeutic value.” Modern research on placebos, however, has destigmatized them by showing they work by causing empirically verifiable therapeutic physiological changes. As one example of these physiological changes, placebos trigger the brain to produce endorphins and other endogenous opioids. (The term “endorphin” is an amalgam of two words: endogenous morphine.) These natural opioids are as effective, if not more so, at reducing or stopping pain as exogenous opioids put into the body by ingestion or injection, but with NONE of the adverse side effects of exogenous opioids. (If interested in more on modern placebo research, see the opening chapters of Jo Marchant’s best selling book Cure: A Journey into the Science of Mind over Body.)
At the end of his Commonwealth Club lecture on PPD, Schubiner took several questions from the moderator. One concerned a person the moderator knows who has weekly appointments for his chronic pain with a practitioner of the Feldenkrais method (a type of exercise therapy). The moderator asked: “Do you think that has a role to play?” Schubiner responded that when a patient’s pain is due to the firing of neural circuits in his or her brain “[w]hat we are trying to do is calm the brain down. There are many ways to do that.” As examples, he mentioned Feldenkrais, mindful meditation, acupuncture, and breathing work. What follows is most of the rest of Schubiner’s response to the moderator’s question, as best I was able to transcribe it, with bracketed numbers added by me:
“The placebo effect consists of people [1] having an explanation for what’s wrong with them, [2] having a technique they can use, [3] having a practitioner that they trust, and [4] having hope and optimism. So when you put all those things together, you get a strong placebo effect. Placebo effect is all you need for brain-induced pain. So what I do is, in a sense, a placebo effect. I am helping people help themselves by harnessing the power of their own brain. Whether you do that through other methods that are body-focused or whatever, Feldenkrais, that’s fine, but my view is that if people doing Feldenkrais and acupuncture and physical therapy would also understand the concepts of brain-induced pain, that will make their work even more powerful, even more successful.”
It has been several years since I read Moskovitz’s website, and I don’t remember many specifics of his approach. What I remember most vividly is that it did not appeal to me. Putting that aside, one can readily apply Schubiner’s placebo remarks to Moscowitz’s approach. His approach provides a person with [1] an explanation of what’s wrong with her, namely, neural circuits in her brain have gone awry, and [2] a technique (or techniques) she can use to recover, namely, visualization of brain circuitry, etc. If she [3] trusts Moskovitz enough to accept what he says about explanation and technique fully and without any reservations, she will [4] have hope and optimism that implementing the element [2] technique(s) will reduce or end her PPD symptoms. If she then implements the technique, she will get a strong placebo effect. As Schubiner said in his Commonwealth Club talk, that is all you need to treat brain-induced pain. But if she does not understand and accept fully and without reservation Moskovitz’s explanation and technique(s), the essential elements for a strong placebo effect will not be met.
I don’t see magic in any particular technique for treating PPD whether it be Feldenkrais, acupuncture, physical therapy, mindful medication, breathing work, or Sarno, Schubiner, Moskovitz, etc. The magic—if one wants to call it that—comes from putting in place all four of the elements necessary for a strong placebo effect and then implementing the element [2] technique(s).
Schubiner’s most recent book, coauthored with psychiatrist Dr. Allan Abbass, is titled Hidden from View: A Clinician’s Guide to Psychophysiologic Disorders. As the title suggests, the book’s purpose is to teach healthcare providers how to treat PPD. (I am not a clinician, but I read the book anyway.) In the first chapter, under the heading “Central Role of a Trusting Relationship,” Schubiner and Abbass instruct clincians: “As a foundation for this clinical work, creating trust with your patient is always key . . . . uch a therapeutic relationship with your patient is a necessary ingredient for success at each step.” Why would trust be necessary at every step? I think the answer is obvious. If the patient trusts the clinician, she [1] will accept fully and without reservation the clinician’s explanation for her pain, [2] will accept fully and without reservation that the clinician’s prescribed technique(s) will end her pain, and [4] will have hope and optimism about succeeding. Element [3], trust in the clinician, is needed to generate elements [1],[ 2], and [4].
Alan Gordon, whose PPD approach is similar to Schubiner’s, never talks (so far as I am aware) of the need for a trusting relationship between patient and clinician, but if you listen to audio or video clips of him with patients any pay attention to it, he is absolutely masterful at developing patient trust. The necessary trust might well develop more readily in a face-to-face personal relationship between PPD sufferer and PPD clinician that if the relationship is impersonal in the form of a PPD sufferer reading a book written by a PPD clinician. But the trust necessary to generate elements [1], [2], and [4] can be achieved in the latter situation. I did it and am not the only one. Ultimately, success comes down, as miffybunny likes to say, to belief or what I call acceptance fully and without reservation. And as she says, belief is a choice. Without belief in the diagnosis, i.e., the element [1] explanation of what is wrong with you, and belief in the element [2] technique to use to fix it, no technique is going to help you even though it has helped others.
With necessary belief in an explanation of what is wrong with you and the technique to use to fix it, just about any technique will work. The craziest “success” video I’ve seen was by some guy who claimed vigorous dancing to upbeat music cared his pain. Most of the video consisted of him showing off his dancing. I would not recommend that anyone with PPD try to find the video and replicate his dance moves.
