This is a guest post written by a colleague, Dr. Daniel Lyman, who has effectively treated chronic pain for many years. Each of us that are successful in treating chronic pain approach it from a neurochemical perspective. More psychologists are adopting this paradigm. I appreciate his taking the time to present his treatment strategies.
As Dr. Hanscom states clearly in his post entitled “Mental Health Is More Critical Than Physical Health,” there are a number of chronic physical conditions that stem from psychological behaviors and functions of the brain. It is only when we understand how our mind works that we can begin to heal our body.
As a psychotherapist who works with people suffering from chronic pain (from migraines to back pain, neck pain to tinnitus, vertigo to pelvic pain, etc.), I am acutely aware of a handful of important steps that every individual must undertake to help themselves heal. It is only through self-awareness of our own psychological habits and behaviors that we can then begin to change them. As I often say to clients, we can’t stop smoking if we don’t even realize that we’re a smoker in the first place.
5 steps to get you on the path toward healing
1. Notice hyper-vigilance. Many people that develop chronic pain are highly focused individuals who find themselves spending a lot of time paying attention to their symptoms. It is quite common for me to hear that clients have spent hours, days, or weeks on Google trying to diagnose themselves. Some clients will go to countless specialists (one client traveled to 5 continents seeking solutions) and subject themselves to numerous scans (other clients have had over 20 MRIs on the same part of their body). That is hypervigilance.
Now don’t get me wrong; nobody could be blamed for trying to feel better. It is only human to want to improve our situation. However, there is a delicate balance between trying to feel better and still living our lives. Like any task we try to accomplish, it’s imperative we give our brain breaks. If we ruminate endlessly on one particular goal, we can create more anxiety, and therefore increase our symptoms — much in the same way over-exercising in the gym can lead to physical injuries.
The most common symptom of hypervigilance is talking about our symptoms. With many of my clients, we work towards a goal of only speaking about our pain/symptoms while in therapy and nowhere else. At first, this often feels limiting to clients, but quite quickly they report that it is ultimately liberating.
After you notice your own hyper-vigilance, your challenge is to curb that behavior as much as possible, and replace it with a behavior that makes you feel better (reading, exercise if possible, watching your favorite show, etc.)
2. Become comfortable with uncertainty. In his popular book, The MindBody Prescription, Dr. John Sarno posits that the only way for a client to overcome their chronic condition (he called his diagnosis TMS) is by accepting with 100% certainty that their symptoms are caused by the mind. (1) This is ultimately because those who develop chronic physical symptoms oftentimes apply splitting or black and white thinking. That is to say that when there is a gray area, they have difficulty sitting with it without developing pain and/or anxiety.
For example, not knowing why your knee is hurting can be scary for some people. For those of us that are scared by our pain, solving the problem of where that knee pain is coming from becomes the focus of our daily lives. We feel that we must know exactly what’s going on so that we can develop a plan of how to treat it. Our response to that uncertainty is often to work harder when ultimately it would serve us better to simply become comfortable in the face of that uncertainty.
With many of my clients, we develop ways to lean into the anxiety of not knowing what’s going on and therefore become less agitated by our uncertainty.
3. Allow yourself to feel your feelings. When we suppress our feelings, we tell our brain that emotions aren’t safe, and therefore anxiety (and pain) can increase when we inevitably have those feelings. To break this cycle, it’s imperative to allow yourself to feel your feelings.
For many people suffering with chronic symptoms, countering this anxiety can feel very foreign. It can be like learning a completely new language. Journaling has been found to be an effective technique to learn how to feel our feelings, and of course, psychotherapy has been proven to increase emotional literacy. Your understanding of emotions will not only help with your pain but is a huge step towards better interpersonal relationships.
4. Face your fear. A common thread that exists amongst every client that I’ve ever worked with is that fear has taken control of their thoughts. There is more and more evidence that this addiction to fear can actually be viewed on fMRIs of the brain with an overactive amygdala.
The only way to move past our fears is to face them head-on. Once we are confident that our pain is a function of our mental health, then we can begin the process of exposing ourselves to the movements and positions that have caused pain in the past. When we do this, our pain can and will decrease over time. It takes time, however, to retrain our brain not to fear a movement or position that we previously felt we had good reason to be afraid of, which brings me to the final step…
5. Have patience. I’ve often told my psychotherapy clients to think of me as a personal trainer for their brain. I like this analogy because personal training at the gym is about learning new habits and behaviors and having someone by our side to push you to continue those new habits, even when it’s hard.
But just like trying to get in shape or build muscle, changing our brain takes time. If we have cognitive habits that we’ve been practicing for most of our lives, it will take some time to build new, healthier habits that stick. That said, I’ve worked with countless people who have resolved a chronic condition that has been with them for years in just a number of weeks. But similar to losing weight in a short period of time, we have to work hard to maintain those gains.
Repetition is the key
These five steps won’t get rid of your pain in an hour or even a day, but if you continually work at them, you’ll be surprised at how quickly you can feel better.
I’ve worked with countless clients who have been in bed for many years, unable to move because of crippling pain. Through this work, they have changed both cognitive and physical behaviors and in turn, their pain has decreased and been eliminated.
If you’re reading this and currently suffering from chronic pain, challenge yourself to be open to these ideas… they just might change your life.
Daniel G Lyman, LCSW is a licensed psychotherapist specializing in chronic pain for nearly 10 years. In his therapy, he utilizes a variety of methodologies, including CBT, MBSR, ISTDP, Psychodynamic, and Pain Reprocessing Therapy. He is based in both Los Angeles and Portland, Oregon.
1. Sarno, John. The Mind Body Prescription. Warner Books, New York, NY, 1998.