Official Thread Section 2.3 Working Toward Outcome Independence

This is the official thread for Section 2.3 of the TMS Recovery Program donated by Alan Gordon of the Pain Psychology Center (PPC). This section is entitled "Working Toward Outcome Independence." Neither Alan nor the PPC necessarily endorses this thread or any of the viewpoints presented in it.

Please keep these official threads on topic and put your best thoughts down, as these threads will be read by many people. All posts in this thread should all relate to section 2.3 of the TMS Recovery Program:
http://www.tmswiki.org/ppd/TMS_Recovery_Program#Working_Toward_Outcome_Independence

In section 2.3, Alan writes the following:

Working Toward Outcome Independence

The way you respond when your symptoms arise can have a direct impact on how bad they get and how long they last.

Often TMS sufferers go through constant cycles of hope and disappointment. When the pain is either gone or minimal, there’s a desperate hope that it won’t come back, and a crushing disappointment when it does.

To eliminate your symptoms, this pattern needs to change; your objective needs to change. In the short term, the goal isn’t to prevent the pain from coming on, but to change the way you respond when it does. This is difficult but possible, even in cases of severe symptoms.

This article on outcome independence further expands on this point.

Hopefully some of the previous steps can help you alter the way you respond to your pain, and work toward a feeling of empowerment.​

To become free of our TMS-caused pain, we need to try to forget we have it. This is one of the most important things in TMS healing. I found that distracting my pain to be important in ignoring pain. We also have to believe that we will become pain-free, but not put a deadline on it. TMS pain can heal in its own time. Meanwhile, we must keep up with regular daily activities and practice TMS healing techniques such as meditation, deep breathing, positive thinking.

 

You know, recovery was really elusive for me until I realized that recovery is not so much about "freedom from pain" as it is freedom from the attitude of fear and dread that surround the pain. Once you can be circumspect about your relapses of pain, as if they are really no big deal and you are going to live your life the same as you would without the pain, the pain (as well as the TMS strategy behind it) begins to release it's grip on you. So "outcome independence", for me was not caring so much if I had pain or not. Once I was able to do this; for instance not feeling panicky when a twinge of pain happened and saying to myself "OH NO here it comes again", the pain became less and less important and this changed mental attitude would make the pain subside. It is a very subtle process whereby you begin to actually develop an attitude of independence from having to have a particular outcome, namely having or not having pain. When you are wedded to the outcome of not having pain, you are in a mental state of anxiety that almost guarantees you will have pain. I guess what I could say is that you must learn to live WITH the pain before you can learn to live WITHOUT the pain.

 

I want to say at the outset just how much I struggled with the idea of outcome independence! You see I was a master at monitoring my pain. It was the first thought I had when I woke in the morning and I had a running commentary in my internal monologue about the pain. When I first read Alan's article about a year ago, it made a lot of sense. But I had a really hard time imagining how you could not think about the pain when you are in pain. It just seemed like an unachievable mountain to climb. So how did I do it? Answering that question is like answering how did you fall asleep last night? Have you ever been in bed knowing that you really need to fall asleep soon or you'll be miserable the next day and the more you think about it, the harder it is? Its kind of like that with pain, the more you monitor it, analyze it, think about it, compare it to how it felt yesterday etc. the more likely it is to stay. I know some people scream at it and I tried that plenty of times, but that didn't make my pain go away. I just tried to become aware of when I was thinking about and monitoring my pain and then redirect my thoughts. Its easiest to redirect your thoughts with something you really enjoy. I like to play on the Lumiosity web site and there was one game in particular in which you have to switch train tracks to get multiple trains in stations. It takes a lot of focus to play well, to get in the zone. So when I noticed I was obsessing about my pain, I would get on there and play. I can't tell you how many hours I played that game! I would just try to distract myself as much as possible with things I enjoy and try not to think about how much more I would enjoy them if the pain was gone. I would say to myself "oh, your monitoring, stop that." And somehow, for the most part, I have stopped thinking about the pain all the time. I can't tell you the day I stopped thinking about and monitoring the pain all the time. I do remember that there was a day though when I thought, "you know, if I am never painfree, it will be okay, I can still live a good life." Prior to working on the outcome independence I felt much more desperate about it, I would think "how am I going to live with this pain?" Its true that I have much less pain now and so outcome independence is a whole lot easier. But it is also true that I have much less pain because I worked on outcome independence. Choo choo.

 

For me it was a huge struggle, given my TMS pain interrupted the thing I had grown to love - running.

Prior to my recent relapse I had been running every day, with growing confidence, so when TMS groin pain reared its head I kept running - just like Dr Sarno advised - but with the constant pain, it took the joy and ease out of it and the effort involved trying to ignore and be indifferent to it was exhausting!

It was very hard to know how to respond to the symptoms. I accepted fully I had TMS, but my two big heroes of TMS healing - Dr Sarno and Steve Ozanich - had different approaches. On the one hand SteveO's advice was to "begin to exhaust yourself physically", while Sarno's advice was to "begin the process of resuming physical activity when you experience a significant reduction in pain". I imagine SteveO might have agonised over this, given he didn't have this significant reduction prior to his resuming activity… and thank goodness he didn't wait!

So I picked somewhere in between, and continued running, but slower, and for shorter periods, still unsure what approach would work best.

At this stage this gem from Steve's book really helped me. In his book "The Great Pain Deception" he wrote::

"You need to dissociate your being from your body. When you move or walk or sit, think of your body as being "not yours" - think of it as an outside object and your spirit as a painless entity that IS you. When I started becoming physical again, I began thinking of my body as an esoteric process - my real self was a spirit moving around pain-free inside my body (this dissociation moved my healing along faster). When the bottom of my feet hurt so much that I could barely walk, I began imagining that my feet weren't actually attached to me; that they belonged to someone else - not of me - beyond tangible flesh and bone. You are more than your pain, more than your body. When you walk or run or go anywhere… simply take your body with you. The body is along for the ride in life. Do your work, play and live while using your body as a tool, as a means to an end, and not simply as a means."

I used to notice the pain more while walking, so on my walks to/from the train to work, I would play and replay my favourite music to distract me… to the point where I would have to resist the urge to sing out loud in the street or on the train! Distraction in the form of throwing myself into a task at work, or giving friends and work colleagues undivided attention really helped and finding any excuse to have a laugh worked wonders. I found the more I felt a sense of purpose and joy in my everyday life the more content I felt, and the less time I had to ruminate on my pain. Fun and purpose in the day, combined with mindful soothing exercises at night gave me a new inner peace, and with this new state my pain dissolved.

One TED talk that gave me a boost during this period of recovery was from Diana Nyad - the 63 year old woman who swam from Cuba to Florida. She is truly inspiring and her talk is a metaphor for every TMS journey - enjoy

http://www.ted.com/talks/diana_nyad_never_ever_give_up

 

I had already come round to the idea of distracting myself from the pain - just because I was SO fed up over the years of being in so much pain. I was in pain if I did things - or if I didn't. So I realised that I might as well get on and do stuff I wanted than lie around just feeling pain! So I had quite a few years of rollercoaster living where I would push myself to walk or cycle or go shopping - then spend days in pain 'recovering'. Sometimes I was in less pain doing an activity than afterwards. I suspect because gradually my body got stronger - and because you do get distracted FROM the pain when doing an activity especially if its in the open air and nature. I always felt better being outside than I ever did indoors...
But I didn't;t get the empowerment Alan talks of until I discovered TMS and the forum. If I had less pain or noticed it less I just was happier and when there was more pain I took it as a result of 'overdoing it' ! Now I do have the empowerment - so when I feel pain I do my 'tms' stuff - and just get on with life...

 

I too struggled with outcome independence. How could I not care about when my symptoms would go away? Could I not take a sneaky peek at the calendar every now and then? I'm definitely a tortoise rather than a hare in the healing department so over time I just gave up trying to effect an outcome. I've accepted that there are barriers to my recovery and none of them are physical. There are reasons why I cling to my pain and my goal now involves investigating those reasons. I no longer ask when or how I can rid myself of my symptoms, I ask myself how I can learn to forgive and where I can find joy and meaning in my life.

 

For me outcome independence was the most effective method of dealing with my symptoms. I think other techniques such as journalling are good for keeping my healthy mental state, but the thing that made my symptoms reduce and then disappear for 90% of the time was to literally ignore them. I actively took up activities that would proof impossible if I actually had weak damaged wrists (my symptoms were RSI related) such as rock climbing, and I just typed through my pain, I asked for more to do at work so I could not have the time to dwell on the pain, I made it loose its power over me by acting like it was not there. I'm a very bullheaded stubborn person so while this approach worked for me it may not work for everyone.

 

I was lucky to have significant pain reduction early into my Sarno practices. As the pain diminished in the first couple of months, “outcome independence” helped me not freak out with the lingering symptoms, but it was kind of easy, because the progress was so good that I truly believed Sarno's way was working.


Toward the end (and it is still ending for me), I remember deciding that the symptoms were not important. I had gotten my life back, and some minor pain or stiffness was not a problem. I was running, and that was the main thing. And by running, I was “deeply educating” myself that the symptoms need not arise –because I was moving on with my life.


That is where I am now. Nothing stops me from doing what I want to do. This is a huge diminishment of fear. Saying this, I can see how the components: education, re-framing the pain, working with fear, outcome independence ---all work together to support each other.


I will say this to those new to Sarno's work. None of it has to work perfectly. If you can get some of the components to start working, others will open with time, and it becomes synergistic. Patience and steadfastness are key. I took a very slow and steady approach, increasing activity over many months. I went from my first 80 ft pleasure walk to skiing around Crater Lake, in about 10 months, and that was fine for me!

 

This was the hardest technique for me to learn. I mean how do you ignore pain that is so debilitating right? How do you stop caring about whether you are in pain is there or not when we are hardwired at birth to move away from pain?

To me this technique was the ultimate test of the depth of belief, faith in the diagnosis. If it hasn't reached your gut level of belief, 100% metaphysical certainty in your being, I think this is where it gets revealed

I think you have to parse this technique a bit. I found there was a difference between ignoring the pain and not caring. The self talk or mindset I used as I desperately experimented with this technique was different. When I tried to ignore the pain I expended a lot of energy trying to focus on a mantra or breathing. I also used music to help me not pay attention. When I tried to not care about the pain I would say to my brain I dont care about the pain, I know its real but there's nothing structurally wrong with me, Im going to do x-y-z anyway. Or "fine, go ahead, I know what you are doing Im going to keep going" This is when I would sometimes get angry at my brain.

Finally there is the technique of moving toward your pain which found is very similar. This was really hard to understand but Herbie and Steve O really helped. For me it meant focusing on the pain. Going right at. Talking to it, accepting that its there and knowing it will go away eventually even though it hadnt for months.

I have to say that I never felt like I fully mastered any of these techniques though now that I am free of major symptoms the version I use the most is going right at my brain and saying "really? you are really trying to pull that on me?" Then I just move on with life knowing its all, as the good Dr Sarno said "chicken feed"

My advice is dont worry about mastering this or anything else. be honest about your depth of belief in the diagnosis. Just keep trying different approaches. Figure out what works for you, this was the great advice many of the other members gave me. Be patient. Dont get stuck! Dont give up! You can cure yourself.

 

Agree Andy - a slow and steady approach worked best for me too. As pain diminished with this approach, confidence returned. I still get twinges, but I barely give them a second thought, and they certainly don't interrupt my running anymore!

 

I recently read the book "The Power of Habit" by Charles Duhigg. It's a great book, and Howard Schubiner and I have been talking about how to apply some of the concepts to TMS treatment.
Outcome independence is usually effective in significantly reducing or eliminating symptoms, but it's really hard to achieve. I think some of the tenets from this book could most effectively be applied to this section.

Most TMS sufferers automatically go to a place of fear when their symptoms come on, and it's this fear that serves to perpetuate the symptoms. It's a difficult pattern to break.

By creating a new routine, it's possible to replace this seemingly instinctive response with another: telling yourself you're safe, reminding yourself that the purpose of the pain is to try and scare you and you're on to it, or some similarly themed response can become the new automatic response to the onset of symptoms. We respond with fear out of habit, but habits can be changed.

I definitely recommend this book if you're interested in trying to more effectively replace the fear response to TMS pain. It will take some discipline and plenty of repetition, but it will eventually happen if you keep at it.

 

Like many others have said (and Steve Ozanich seems to be the exemplar) I find if I get a twinge, I physically lean into the pain, and say to myself "give it your best shot; I'm not going anywhere." I find within a few seconds the pain is gone, or my mind wonders onto other things. This is so different than when I started the Sarno process, and this change in my approach took about 12 months to become a "conscious habit." It is still not a mindless habit.

 

This is about where I'm at in the process, so this is a good reminder for me. Outcome Independence has been difficult for me, as I suppose it is for everyone. It goes against our instincts to ignore/accept pain. Actually, Dr. Sarno has said not to try to ignore the pain, but to " Try hard not to pay attention to the pain. ...force yourself to think about the psychological factors." This has been difficult as well. I can't really sit there and think about psychological issues at work. Outside of work I've found success in just living my life as if it wasn't there. Pain has made me avoid physical activity, but actually I've found that engaging in physical activity in spite of it can actually make it go away sometimes. Two or three times recently I've gone out after work and done things and actually had little to no pain afterwards. Whereas on a normal day I get off of work and the pain comes on as soon as I start relaxing. It's kind of funny that the pain is programmed to come on once I get home now.

 

Outcome independence was the most difficult thing for me as well, although about a month in, I feel as though I'm starting to get the hang of it. I never thought I'd be able to break that habit of focusing on the pain. But it seems to almost happen by itself when you start to learn to focus on the feelings underneath the pain. The other thing that is beginning to help me is Dr. Dispenza's book You Are the Placebo. He has good advice on learning new habits of being, which sound a little like what Alan is talking about with the Duhigg book. I'm going to check that out as well. The other thing I've been doing is to take Steve O's advice as mentioned and lean into the pain. I'll even say "oh good! more pain" sometimes, especially if it's in a new area and is obviously TMS. I get kind of excited about it, and usually that pretty much eliminates it. This whole thing takes time and focus, but man is it ever fantastic!!!!

 

I have nothing to add to the excellent posts above about Outcome Independence, other than to offer this quote that I feel sums it up well.

"Suffering can end before pain ends."~Eckhart Tolle

 

YES!

 

Hi all, really useful to see how people have overcome this.

I wanted to share my experiences with cycling, trying not to monitor the pain usually associated with it, back pain and Raynauds (cold numb fingertips), and instead focus on enjoying the cycling, and saving money from public transport.

I have set myself the challenge to cycle to and from work, which takes 55 minutes each way, every day this week.

Previously, without painkillers, I could always cycle exactly 35 minutes before my back would start hurting (in any direction, not just to work).

My doctor had prescribed me ibuprofen three times a day, pregabalin at night, and nifedipine for Raynauds, and told me to carry on exercising a moderate amount, but without overdoing it. With the meds I could get to work, or beyond, but even then I could only commute twice a day for three days in a row before the pain would come anyway.

(Reading this now I realise how ridiculous and classically TMS this is! Always 35 minutes. Always 3 days! )

Last week I ditched all the meds.

Once I decided I would do the five day challenge, irrespective of the pain, I've had basically no fear, or back pain, at all. The first time I got on my bike, Monday this week, I tried to not care whether I experienced pain, but I couldn't help rejoicing, "I've cycled for 40 minutes without pain... this is a record", "Wait now I've been cycling for 50 minutes without pain... THIS is a record!" "Now it's been to and from work, no pain!" "Now two days in a row, no pain!"

So far, three days, no pain! I'm trying to just enjoy cycling, as if there never had been any pain, but I keep thinking about how there hasn't been any pain!

The Raynauds has been even harder to not think about. I realised I have a very real fear of the cold. Or of what the cold represents. Or of something that once happened when I was cold. Or something.

When I felt an attack of Raynauds coming on my initial response was disappointment, and a wave of stress. But then I recognised the fear and I responded by doing the opposite of what I normally would. Instead of putting on more scarves, jackets, or hats (I should point out, it wasn't very cold, maybe 12-15 C), I started taking layers off. The first time this didn't seem to do much, but yesterday I tried it with more conviction, and the Raynauds attack plateaued, without getting worse. I tried not to pay to much attention to the outcome and carried on, though felt like this was an improvement. Today when the Raynauds hit I proactively took off all my outer clothing at once, including my gloves which I never part with, and the Raynauds went away INSTANTLY. I have literally never seen it fade that fast. It always takes ages for blood to come back to my fingers, and is often very painful. I tried to be nonchalant about it but I couldn't help being really happy!

I still haven't finished my five day challenge, and there's a part of me thinking, hey why don't you quit while you're ahead, three days without meds is way more than normal, why not stop there? But, this is where focusing on the outcome independence is crucial I think. It doesn't matter if this week I do three days pain free and two days in excruciating pain, I'll still have saved £30 on tube fares. And that is definitely a good thing!

 

Dervish,
I am so happy for you! You seem to have on boarded defiance toward your TMS. It will serve you well. Once it gets the message that you don't believe it it becomes like our new dog: it might test once and awhile but a quick correction reminds it who is master. The Raynauds is so interesting to me. My mother has suffered from it for decades. After my back pain went away one of the other symptoms TMS threw at me was cold hands and feet. I realized these too were symptoms and they subsided as well. I wish I could convince her try a TMS program

You are doing great! Stay with it!

 

I love Andy B's comments - 'I will say this to those new to Sarno's work. None of it has to work perfectly. If you can get some of the components to start working, others will open with time, and it becomes synergistic. Patience and steadfastness are key. I took a very slow and steady approach, increasing activity over many months.'
It really sums up how the whole process can be. Sometimes you are a hare and sometimes a tortoise - but as long as you are facing the TMS and working towards health - you are on the right track!
Love the Eckhart quote too Ellen-
Suffering can end before pain ends."~Eckhart Tolle
That has certainly worked for me....

 

Hi, hecate. I liked your reply. No one should expect a miracle, to heal just in reading Dr. Sarno's book,
as some claim they have. A more steady approach is even better because we spend more time on journaling
to discover the repressed emotions that brought on the pain. The longer process to healing helps us to
know ourselves better, and know others better, too.