In
The Mindbody Prescription, Dr. Sarno wrote: “ There are two major fields of psychotherapy: behavioral and insight-oriented (analytical). Behavioral psychotherapy tends to focus on life events and how best to deal with them. . . .It should be clear from the theories propounded in this book that insight-oriented therapy is the choice for people with TMS or its equivalents.” By behavioral psychotherapy Sarno meant cognitive behavioral therapy (CBT).
Dr. Schubiner’s treatment approach includes (but is hardly limited to) some cognitive reappraisal techniques of CBT. But he was highly critical of what he called standard CBT in
Hidden from View: A Clinician’s Guide to Psychophysiologic Disorders, which he co-authored with ISTDP psychiatrist Dr. Allan Abbass. “Psychophysiologic disorders” is their term for what Sarno called TMS and its equivalents. Schubiner wrote this about CBT on age 46:
“Most patients receiving CBT for pain do not have a careful evaluation to search for PPD and therefore all pain is treated as being due to structural disorders. Because of this, the primary goal of standard CBT for chronic pain is to cope with the pain in order to manage it better. Finally, CBT treatments typically do not address underlying emotional conditions. Indeed meta-analyses (van Dessel, et. Al., 2014) point to only small effects from standard CBT in somatoform disorders. The goal of the following inverventions (i.e., treatments techniques in Hidden from View) is to the eliminate, rather than cope with, the pain and other PPD symptoms. This distinction is critical to the success of this approach."
This passage dovetails with Sarno’s position that for a person to recover from TMS, it is essential for him or her understand and accept that the cause of the pain is not structural. If I am not mistaken, CBT has evolved over the years to pay more attention to emotions, but if its focus remains on how to cope with the pain in order to manage it better rather than eliminate it, Schubiner’s criticism seems devastating to me.