Originally written: December 21, 2008 The role of triggers: Holidays and headaches As the holiday season approaches, I am reminded of the importance of things that trigger MBS symptoms.I once heard a description of families during the holidays as being, “just the way they are, only more so.”It is quite obvious that certain events and times of the year can cause stress that is clearly recognized by our conscious minds, for example, “I have so many things to do that I can’t find a moment to relax.”However, it is also important to realize that stress is often not recognized, and we would call that subconscious stress.“It seems like I always get sick this time of year, but I don’t know why?”Symptoms that occur at times like this may be caused by underlying feelings about certain family events, or missing certain family members who are not present, or stressful memories that are associated with the holiday season. I see this all the time in my MBS practice.In fact, one of the most important aspects of successful MBS treatment is the ability of the person with MBS to recognize which triggers are commonly associated with their symptoms, to understand that these triggers are not actually causing the symptoms in a physical sense (more about this point in a moment), and to have the courage to actively overcome these triggers. What is the definition of a trigger?The way I use this term, a trigger only applies to people with Mind Body Syndrome, that is, to people who suffer from physical or psychological symptoms that are caused by mental and emotional processes.Therefore, in this situation the symptoms are not caused by a pathological condition (or a tissue breakdown condition in the body, such as cancer, a fracture, or inflammation).Of course, the symptoms we feel are real, very real and are caused by a connection of nerve pathways that have been learned by the brain and the body.However, these pathways are physiological, that is, they are not permanent and can be reversed by changing how we understand the condition, how we think about it, how we respond to stress and emotions, and how we actively fight to overcome the symptoms.When I apply the term, trigger, to people with MBS, I am referring to things that are associated with the onset of symptoms or occur just before or at the same time.Triggers are further defined as things that would not cause such symptoms in someone without MBS.This is the most important point to emphasize.Since the trigger occurs right before or at the same time as the symptoms, it appears to actually be causing the symptoms. The way most people best learn about triggers is by the scientific experiments of Ivan Pavlov, the Russian scientist.At the beginning of the 20th century, he found that dogs would salivate when they heard a bell or other sounds, if those sounds were presented to the dogs at the time that they were fed.Their brain and body had learned that the sound preceded food and it triggered a physical reaction.When he stopped playing a certain sound, the dogs eventually unlearned the association and stopped salivating to that sound.Hundreds of experiments have been done since that time to document how triggers can produce physical and emotional reactions.Robert Ader of Rochester, NY conducted one of the most important of these studies in the 1970’s.Dr. Ader put a powerful immune suppressing chemical (cyclophosphamide) into the bowls of mice and flavored it with saccharine.Predictably, the immune system of the mice was severely affected after they drank the chemical.Several weeks later, after their immune system had recovered, Dr. Ader gave them bowls of saccharine with its distinctive flavor.Amazingly, their immune system became depressed again as their brain and body had learned that the flavor of saccharine was associated with changes in the immune system.This study has also been conducted in people with similar results. Therefore, it is extremely important for people who have MBS to recognize that there are many triggers that can be associated with their symptoms and that unlearning these triggers is one of the best ways to get better.I met a woman who told me that she had been hospitalized for a variety of illness over 20 years, but that each time she was hospitalized it was in September, the month her brother had been killed in Vietnam 21 years before.I treated a woman who had recurrences of abdominal pain each fall at the time her husband had died several years earlier, but in addition, she had developed anxiety episodes at about 3-4 pm.Upon closer investigation, it turned out that her husband had died at approximately 3:30 pm. Many people have triggers that seem to make more sense as possibly actually creating symptoms, such as bending, walking, lifting for people with back pain.Many people have symptoms when there is a change in the weather.Foods and smells are common triggers for people with headaches or irritable bladder (often called interstitial cystitis).I have seen people who developed symptoms when they passed a certain intersection or drove through a certain town.Of course, certain people can be triggers, or certain thoughts or emotions.And that brings us right back to the holidays.Once I have diagnosed MBS in my patients, we investigate their triggers.The most important piece of advice I give is this: If the symptom would not be caused by this trigger in someone without MBS, then it is truly a trigger, and it can be reversed by the treatment of MBS..I saw a women who gets severe bladder symptoms when she ingests black pepper.I met a guy who developed headaches when the weather changed.I’ve seen countless people who developed back pain when they sit, drive, bend, walk, or lift.And of course, the holidays bring up so many thoughts and feelings about families, about childhood memories, and about stressful times, that it is very common to have exacerbations of symptoms at this time of year. Once you have recognized your triggers, you can start to reverse them; this is known as ‘extinction’ in the psychological literature.There are several methods to overcome triggers.A common response to triggers is to avoid them.People learn to avoid the movements or foods or people or events.However, that is exactly the wrong thing to do.When you avoid the triggers, you actually give them more power over you.What you really need to do is to overcome them.You need to retrain your brain to avoid developing the MBS symptoms when you encounter the triggers.The way to do that is to be brave and to look forward to encountering the triggers bit by bit and to learn techniques for stopping the nerve pathways that get triggered.The techniques to use are self-talk, breathing and other meditation techniques, therapeutic writing, psychotherapy and a variety of other psychological techniques, such as EMDR.The self-talk or affirmations are very powerful and should be done continually whenever you find yourself encountering a trigger.These are detailed in my educational program as are the therapeutic writing techniques.You can also find some of these techniques in books by Dr. John Sarno, Dr. David Clarke, Dr. Ronald Siegel and others.I also teach mindfulness techniques to deal with triggers.These are also detailed in the program, and have to do with learning to be alert, focused, and relaxed while encountering stressful situations. So, as you encounter the holidays, practice paying attention to how you respond to the events and the people.Pay attention to how your body responds.Practice talking to yourself to overcome the MBS symptoms that may emerge.Be brave and strong.Learning to overcome MBS is a great opportunity to improve not only your symptoms, but your understanding of yourself.It is often not easy, but it can be done and it can be done wherever you are.A wonderful poet, Mary Oliver, writes about a visit she took to Walden Pond where Henry David Thoreau studied the meaning of life.She wrote: “It is the slow and difficult trick of living, and finding it where you are.”For this holiday season, I wish that you find these tricks to living, that is, living without pain or fear.I also wish that you find “it” (which I often interpret as “life,” or “love,” or “happiness”) wherever you are. To your health, Howard Schubiner, MD Disclaimer: It is important to recognize that the information contained in this blog, whether posted by me or anyone else, cannot be considered to be specific medical diagnoses, medical treatment, or medical advice. General information about MBS/TMS will be posted in response to questions, but you will need to decide if this information is relevant to your situation and, as always, you should consult with your physicians and counselors regarding new symptoms and any changes that you might make in medications or activities.