From 2005 to 2007 I suffered from excruciating back and leg pain. My pain was so severe that I could not sit for almost a year. The only time I sat down was to drive myself to work, and the pain during this ride was so severe that I had to crawl out of my car several times when I arrived.
An MRI showed a herniated disc, so I started a series of medical procedures in which two chiropractors (one second after the first did not help), two different types of physiotherapists with two different approaches , and an acupuncturist who receives three cortisone shots, to name just a few of my treatments. Although I experienced relief from time to time, it never lasted long and my pain worsened. I reluctantly opted for back surgery.
In order to cope with my pain while waiting for the operation, I started examining non-traditional approaches and came across a book by Dr. John Sarno entitled "Healing Back Pain: The Mind-Body Connection". In the book, doctor Sarno outlined a radical approach to curing back pain that he had developed over decades of observing his own patients with chronic pain. He suspected that pain like mine was not caused by structural abnormalities or injuries, but by lack of oxygen and defective neuropathies in the brain. Sarno also argued that the brain can actually create physical pain to protect people from painful emotions such as anger, anger, and guilt. He referred to this condition as tension myositis syndrome (TMS).
Learning about my pain
This is not to say that chronic pain is not real or is "all in your head". On the contrary, Sarno believed that TMS pain was real and could be unbearable. However, since chronic pain is often not caused by structural anomalies, Sarno said it could not be cured by focusing solely on the body. In other words, operations, manipulations, injections, stretches, etc. cannot heal the pain because the pain comes from the mind and not from the body. Even for me, a licensed mental health advisor, this theory sounded crazy at first. After all, I had an MRI that proved I had a bulging window.
At the same time, there was something that appealed to me about Sarno's ideas. First, he described how people with TMS tended to have changing pain that manifested in different ways and could get to other areas of the body. This can include migraines, heartburn and other digestive problems, knee and shoulder pain, etc. These were all things I had suffered from when I was a child, but now that I had back pain, nothing happened.
Second, Sarno outlined how people with TMS often had more severe pain during stressful times and how this pain could subside in less stressful times. That was certainly true for me. At that time, I was working very hard to earn a professorship at the University of Rochester, and my wife and I raised two young children. It was one of the most stressful times in my life. I also noticed that my pain sometimes eased in less stressful times like vacation.
Third, Sarno outlined a number of personality traits that correspond to people suffering from TMS. Not only do TMS patients tend to ignore their own emotional reactions, they are also incredibly hard on themselves (i.e., they are perfectionist, highly motivated, looking for no help, etc.). These personality traits fit me perfectly. Sarno also argued that MRI would reveal structural abnormalities in almost all patients over 30 years of age – but most people are not in pain. In other words, if you believe Sarno, my herniated disc was not the cause of my pain. rather it was my personality.
I decided that Sarno's approach was worth trying, so I delayed the back surgery, stopped the physiotherapy and saw chiropractors and started working on my emotions. I found a therapist who was working on a psychoanalytic approach to help clients uncover suppressed emotions and started therapy. I also started to deal with psychoeducation, behavioral interventions and mindfulness (which I will describe in more detail later).
Miraculously I was pain free after only a few weeks of this integrative mind-body intervention. In addition to avoiding back surgery, I was able to cure a number of other chronic health problems that I had suffered from for years. To this day, my back is painless and I can do physical exercise without restrictions.
In 2017 I started training and researching mind-body therapies. Later that year, I opened a private practice that focused on helping clients with chronic pain. Since then, I've helped dozens of people overcome a variety of chronic pain conditions, including back, neck, shoulder, knee, and hip pain. Fibromyalgia; Migraine; and chronic nerve pain. Like me, most of my clients suffered for years and could not find any remedies from common medical approaches. Some of them were disabled from work or school but have now resumed normal life activities.
In this article, I give an overview of the mind-body approach I use to clients with chronic pain, and I give counselors suggestions that are interested in integrating this approach into their work.
Integration of a mind-body approach
When I started my own healing journey, there were few resources beyond this intervention beyond Sarno's books. Fortunately, things have changed. The advent of social media has enabled hundreds of people cured of Sarno to share their stories (many of them in the All the Rage documentary), and a growing body of research is now supporting the effectiveness of Sarno's ideas.
This increased awareness and popularity has resulted in numerous options for professional advisors to receive additional training in this modality. Although I strongly advise counselors to continue this additional training through workshops and clinical monitoring, many of the interventions for counseling body and mind match the skills that counselors already have.
Initially, counselors must carefully review clients to ensure that they are suitable for the intervention. The most important thing is that clients have to be examined by their doctors for serious illnesses such as cancer, heart diseases or broken bones, which require medical help and cannot be cured by mind-body consultation. Second, as with all counseling interventions, the mind-body approach is most helpful to those who believe in it, are familiar with the process, and are committed. While most customers arrive with some skepticism (like me), those who are completely closed to the idea (e.g., customers who only care to appease someone else) are unlikely to be helped and can often go with the process get frustrated. In addition to posting information about my approach on my website, I also conduct extensive telephone consultations with potential customers to explain the approach in detail and evaluate its potential fit.
Once clients have been screened, various counseling interventions can be used to effectively integrate Sarno's strategies. These interventions include:
Psychoeducation on the nature of chronic pain
Behavioral techniques to build trust and reduce fear
Mindfulness to help clients feel more comfortable with uncomfortable physical and emotional sensations
Intensive dynamic short-term psychotherapy (ISTDP) so that clients can perceive and express painful emotions
Social support from other mind-body clients
Psychoeducation
The first step in integrating this mind body approach to chronic pain healing is to offer clients psychoeducation regarding the relationship between their mind and their pain. In addition to Sarno's books, a number of other recent books by mind-body experts such as Howard Schubiner, Allan Abbass, Nicole Sachs, David Clark, Steve Ozanich, and spine surgeon David Hanscom are reviewing scientific evidence that supports and extends Sarno's ideas about mind. Body connections to many forms of chronic pain. These resources expose customers to research that shows:
1) Most people with healthy (ie painless) back, knees, shoulders and hips have structural anomalies that should cause pain, which supports the assumption that the human body naturally ages with age changed in a way that looks structurally problematic but doesn't cause pain.
2) There are relationships between childhood trauma and physical health, including many forms of chronic pain.
3) fMRI research has made connections to neuropathies that are responsible for physical and emotional pain.
4) There are strong relationships between chronic pain and the inability to recognize, experience and express painful feelings such as anger and guilt.
If you familiarize your customers with studies that show that their pain is unlikely to have a structural origin, which is contrary to what other healthcare providers say, and offer them a path to recovery, you can raise hope and reduce the fear. This process alone can begin to reverse the anxiety-pain-anxiety cycle, which can activate and exacerbate pain neuropathies in the brain.
Behavioral Therapy
While clients learn about the mind and body connections to chronic pain, counselors should also include behavioral interventions to reduce anxiety and promote reintegration into their normal activities. Well-meaning healthcare providers often instruct people with chronic pain to stop doing physical activities so that their bodies can heal. This is good advice for injuries such as broken bones or sprained ligaments, but is extremely problematic for mind-body complaints. Several health professionals told me to swim laps instead of playing basketball. After a few weeks of swimming (which I hated), a chiropractor told me that swimming was the worst thing I could do for my back because of all the twists and bends involved. He instructed me to free myself from all activities. In reality, the less activity I had, the more depressed and hopeless I felt, and the worse my pain got.
When clients are made aware of the connections between mind and body to their pain, they are encouraged to exercise gently again the next day without fear of harm. Consultants can facilitate this process by encouraging clients to affirm themselves on a daily basis to reduce their fear of physical activity. This could include meaningful statements such as "I am strong and my body is able to participate in this activity" or "There is nothing structurally wrong with me, so it cannot hurt me".
Customers should also be instructed to record their progress when they resume life activities. Customers can often get discouraged and feel hopeless when minor setbacks occur. Logs that show their overall progress over time can help customers maintain optimism during these setbacks.
Consultants should also encourage clients with chronic pain to engage in somatic persecution. These clients often come to counseling after having spent a lot of time looking for possible relationships between their pain levels and physical activities (e.g. exercise, housework) or the foods they eat. This process can be incredibly frustrating, as many of the activities or foods that have once associated you with your pain are often refuted over time. Counselors who incorporate this mind-body approach should instead encourage clients to document relationships between their physical pain and emotional states.
A very common example is that people who suffer from chronic pain experience less stressful times in their lives, such as B. during the holidays, can experience a pain reduction. Traditional structural pain models often try to relate these improvements to things like nice weather, changing humidity, or even the quality of the mattress in the hotel. However, counselors who work with a mind-body approach should encourage clients to document their emotional states when they feel pain-free. The same procedure is used when the pain increases.
For example, pain that has disappeared while on vacation often returns or worsens when the client returns home. It is tempting to attribute this increase in pain to uncomfortable travel conditions (e.g. car or plane seats) or weather changes. However, customers should instead be encouraged to investigate problematic interpersonal issues that they may return to at home. Sometimes these answers can be very clear; In other cases, the answers are not visible, especially when it comes to traumatic events or emotions that make customers feel guilty towards others. In these cases, ISTDP plays a central role in uncovering hidden emotions related to pain outbreaks.
Consultants can also help clients, without judgment or fear, take into account the secondary gain that their pain may bring them, particularly in terms of what they do or feel through their pain. Chronic pain often requires that people confine themselves to their homes and therefore miss potentially stressful interpersonal encounters. These can be social events that they fear, conflicts with colleagues or family members or even the care of children, partners or aging parents.
Understandably, clients often resist exploring these possible relationships because they feel they are blamed for their pain or accused of having everything in their heads. Consultants need to reassure their clients that mind-body pain is real and is not deliberately “created”. In fact, it is often the result of people trying to subconsciously protect others from how they feel about them.
Consultants should encourage clients to keep a record of what they miss when there is a severe outbreak of pain. This can reveal connections between her pain and her hidden (but possibly strong) feelings of fear, anger, and guilt. Sometimes the patterns that appear, although initially difficult to see, can become too prevalent for customers to ignore. Once these patterns are identified, ISTDP can be particularly helpful in helping clients unpack and understand the complex relationships between their pain and their hidden emotions towards others.
Mindfulness Therapy
Mindfulness-based stress reduction, which was first introduced into Western medicine by Jon Kabat-Zinn, has been used to treat chronic pain for over 30 years. While research shows that mindfulness has only a moderate impact on relieving chronic physical pain, the approach has proven to be extremely effective in improving mental symptoms associated with chronic pain, such as depression and anxiety, and physical pain related Reduce restrictions.
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In my experience, mindfulness is also extremely useful to help customers feel more comfortable with uncomfortable emotions. This can significantly improve the effectiveness of the aforementioned behavioral approaches as well as emotionally focused therapies such as ISTDP.
A detailed description of mindfulness is beyond the scope of this article. Consultants who are interested in the effective implementation of this mind-body approach should be trained in mindfulness and mindfulness-based therapy. But counselors without mindfulness training can also encourage their clients to participate in mindfulness workshops and develop regular mindfulness practices outside of their counseling sessions.
ISTDP
While Sarno argued that many people could heal themselves through psychoeducation and behavioral approaches, he also realized that some people (like me) needed psychotherapy to recognize, experience, and express suppressed painful emotions that could cause pain . In particular, Sarno advocated that people with chronic pain participate in ISTDP, a bond-based, emotion-oriented somatic therapy developed by psychiatrist Habib Davanloo.
Through extensive research spanning several decades, Davanloo identified a number of core defenses that some people have often developed since childhood to block uncomfortable feelings and suppress traumatic experiences. While these defenses are often adaptable when people are children, Davanloo found that they cause enormous emotional and physical suffering later in life.
From an ISTDP perspective, chronic pain is an unconscious attempt to protect (or distract) people from it, unpleasant emotions and harmful impulses towards others, especially relatives, and the guilt they bear for the reception of these negative feelings and impulses, to experience . Consultants who conduct ISTDP therapy help clients identify strategies (or defenses) they have developed to prevent them from getting close to and experiencing emotions towards them. Consultants also incorporate experimental techniques to help clients perceive, experience, and express these painful, suppressed emotions towards others, and to recognize and even exercise potentially threatening impulses associated with these painful feelings.
This process of skillful pressure and the challenge of customer defense can lead to what Davanloo calls "unlocking" suppressed emotions, where the body's defenses are relaxed and waves painful feelings are consciously experienced. If unlocking is partially or fully experienced in therapy, it can dramatically improve physical and mental wellbeing.
ISTDP is a complex and powerful therapeutic approach, which requires years of supervised training to implement. Even after completing an extensive read on ISTDP, attending numerous conferences and workshops, and participating in a core training group and individual support from an experienced ISTDP practitioner for several years, I still feel like a newcomer. Even so, leading mind-body doctors like Sarno and Schubiner have suggested that all health professionals, including those without formal ISTDP training, should incorporate aspects of this approach into their mind-body practice. In particular, they advocate that people with chronic pain report their feelings to others and do meditations to help them relate their emotions to their bodies.
For more information on ISTDP, including integrating elements of the approach into health practice, see Abbass and Schubiner's book Hidden From View: A Guide for Physicians on Psychophysiological Disorders.
Social support
When I started this process 15 years ago as a customer, I remember that I felt very alone on my trip. The few attempts to discuss these ideas with healthcare providers or even friends and family members have usually met with skeptical or condescending looks and comments. Now that I have advised many others, I have learned the power of social support for the success of this process. A consistent comment that I hear from clients in my pain groups is how important the support they receive from their group members is for their success.
Participation in pain groups may not be possible for everyone, but a number of online communities are available through Facebook and other social media platforms that offer chronic pain clients the opportunity to connect with others like them . There are also several podcasts, including The Mind and Fitness Podcast, that are moderated by former chronic pain patients and share their own and others' success stories to help overcome various forms of chronic pain through the mind-body process. These stories usually describe their struggles with chronic pain; their frustrations with health professionals who have carried out costly and unnecessary tests and medical procedures; their healing journeys between mind and body, including how they have overcome setbacks; and their quality of life since they have been free from chronic pain.
Such connections offer customers not only role models, but also continuous support from others. This can improve the effectiveness of the intervention, especially in times of struggle. There is even an app called Curable that is specifically designed to provide resources, activities, and social support to people with chronic pain in a way that is consistent with Sarno's approach.
Summary and conclusions
The integrative mind-body approach described in this article is a powerful and underutilized approach to help clients cure chronic pain. The approach is particularly suitable for clients who have been relieved of serious health problems and who have exhausted traditional medical interventions without relief.
While many of the intervention strategies fit well with traditional counseling approaches, counselors who want to specialize in this work should develop professionally by attending mind body trainings and workshops and participating in an ISTDP core training group. ISTDP master clinicians who offer basic training include Allan Abbass, Patricia Coughlin, Marvin Skorman and Jon Frederickson. Consultants may also consider enrolling in the University of Rochester's advanced certificate program for mind-body healing and wellness (see tinyurl.com/Mind-BodyCert ). It is the first program of its kind to offer advanced training for this type of mind-body intervention.
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Douglas Guiffrida is a professor, director of the counseling program, and director of the program for healing and wellbeing of the mind and body at the Warner Graduate School of Education and Human Development at the University of Rochester. He is a licensed mental health advisor and certified advisor. To learn more about his private practice or to contact him, visit DouglasGuiffrida.com.
Knowledge sharing articles were developed from sessions presented at American Counseling Association conferences.
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It should not be assumed that opinions and statements in articles appearing on CT Online reflect the opinions of the editors or guidelines of the American Counseling Association.
