Posts Tagged ‘tms’
The relationship between OCD and MBS: Jacob’s story
I have learned so many things about the mind and the body over the past 5 years of working with patients with Mind Body syndrome. One of the most interesting things is that disorders that we considered psychological, such as anxiety, depression, PTSD (post-traumatic stress disorder), and OCD (obsessive-compulsive disorder) actually are similar to (dare I say identical to?) Mind Body syndrome. In other words, these disorders are caused by patterns of neurological response to stress and emotional reactions to stressful situations. This leads to two conclusions: 1) that psychological disorders such as these occur as part of MBS and typically are exchanged (substituted) with pain and other typical MBS symptoms and 2) we can treat these disorders effectively using the same methods as we use for MBS.
Read the story of Jacob, who had OCD, which morphed into chronic pain. He learned that he had to deal with the OCD and the pain, but that they were connected by being components of Mind Body syndrome.
“About 10 years ago I had back pain for 2-3 years and read Dr Sarno’s book and also had a MRI which showed no problems and my back pain went away. A couple years ago when having my second child I started getting high anxiety and really bad obsessive-compulsive disorder (OCD) about things like locking doors, chemicals around house and just about anything else. Then about a year ago, I had surgery, and the pain after surgery started going away but lingered and then after taking numerous tests and seeing specialists and searching the internet about why the pain was not going away it started getting worse and worse. Soon I was taking Vicodin for pain and searching for any cure I could find. I even tried a pain clinic and had a nerve block which did not work and even made my back hurt for a few weeks (the doctor warned me that it was a possible side effect). I was getting pretty desperate and depressed. The pain was nearly unbearable. I was taking sleeping pills at night to sleep and pain killers during the day.
It has become very clear to me over the last year or so that one of the biggest impediments to recovery from Mind Body syndrome (MBS) is fear. It seems to be a part of the experience of so many people that it should be considered as a normal part of the MBS experience and therefore everyone will probably need to deal with fear at some point in their recovery. In this blog, I will take a stab at identifying the sources of fear, the meaning of fear and offer some thoughts and methods on dealing with fear.
Where does fear come from? We should recognize that fear is part of the normal experience of life. We are born with a brain system that is built to protect us from danger and harm, i.e. to help us survive in a dangerous world where we may become stalked by a predator or endangered by one of our own species; another human being. This system resides in the deeper parts of the brain (sometimes called the “reptilian brain”), it operates all of the time by constantly scanning the environment for danger, and it is clearly in the subconscious (or unconscious) part of the brain, i.e. we are not aware of its actions until after it has acted. When we sense danger, the brain sends immediate signals from the amygdala (the emotional center of the brain) to the hypothalamus (where the autonomic nervous system resides) to cause some kind of action in our bodies. Again, this occur without conscious awareness and our bodies are programmed to react to danger by activating the fight or flight reaction pathways. After our body reacts (with muscle tension, gut or bladder tension, and many other reactions), we THEN become aware of the sensation of fear. Interestingly, studies have shown that people who are paralyzed have lesser degrees of the sensation of fear (and other emotions). Read more »
Many people find that fear of not being able to recover from MBS and fear of pain are major factors preventing their recovery. In order to address these issues, I offer the courageous story of Brad in his own words. Following that (in the next blog), you will find my comments on dealing with fear and several methods that can help.
“In the late 1980s, I became totally crippled with back pain shortly after an incredibly stressful four-month period. I couldn’t do much besides lie around. I saw several doctors, who gave me a variety of diagnoses, and I realized they were just guessing, so I went to the library do some research. By chance (thank God!) I saw Dr. Sarno’s first book, Mind Over Back Pain, on the shelf. I took it out, and after reading it I knew that my pain had been caused by my recent psychological tensions. I also concluded that I had become literally phobic about many movements and decided that the only way to break the phobia was to challenge it with graduated exercise. So I began to exercise and lift weights. However, I was very timid and therefore didn’t exercise as aggressively as I could have. Read more »
Emotions, particularly those that are subconscious, were not seriously studied by the scientific community until relatively recently. For much of the 20th century, psychologists were more interested in studying our conscious awareness and didn’t think that it really mattered what might be going on beneath the surface of consciousness.
Paul Ekman has gained a great deal of notoriety recently (the new TV show “Lie to Me” is based on his work) and his pioneering work demonstrated that people from all of the different cultures of the world experience and show the same emotions via their facial expressions. His work is detailed in his book, Emotions Revealed, and is fascinating reading. Dr. Ekman and others have also conducted research that shows that emotions cause very specific reactions in the body that are distinct. In other words, emotions are universal and they are indelibly attached to specific physical reactions. This work has helped to explain why someone may develop back pain when angry and another person may develop headaches.
Another giant in the study of emotions has been Joseph LeDoux, a neuroscientist at New York University. Dr. LeDoux has done studies to help us understand how emotions are generated and processed in the brain. His excellent book, The Emotional Brain, details what we know about how the brain handles emotions and we have learned a lot!
We now know that emotions are part of our survival mechanism and are part of the brains of all creatures. We are hard wired to constantly scan the world around us for danger. We do this as part of being alive by subconscious brain mechanisms. When we encounter something that might be dangerous, such as a snake, a menacing look, or a car heading towards us, we instantly react (even before we are truly aware of the danger) in order to avert the danger and save our life. These reactions are controlled by the amygdala and the autonomic nervous system. We pick up cues to potential dangers and these nerve signals are instantly transferred to these centers; the amygdala is the center that processes emotions such as fear and anger and the autonomic nervous system (ANS) controls our heart, lungs, bowels, bladder, blood vessels and muscles. The ANS acts to generate the fight or flight reaction (actually the fight, flight or freeze reaction), which causes our bodies to react to danger. These systems operate in all creatures on a subconscious basis, meaning we are not consciously aware of these systems. Read more »
Several people have asked me how they can deal with troublesome thoughts and emotions that arise. These thoughts and emotions, such as doubts about really having TMS/MBS or worry if you’ll ever get better or fear about developing pain, are extremely common. Everyone has those from time to time or even very frequently.
So, how can you deal with doubts, fear and worry? You may worry about having some medical/physical problems instead of MBS/TMS and how do you deal with others when they challenge your view of MBS/TMS and suggest that there is some medical/physical problem going on. These questions boil down to two main issues, I think. The first has to do with doubt about the diagnosis of MBS/TMS. The second has to do with the issue of the power of thoughts and emotions.
Dr. Sarno always (correctly) says that we need to “erase doubt.” People always do better in the MBS/TMS program when they are convinced that their physical and psychological problems are due to emotions, stress and reactions to stress, both conscious and unconscious. However, we are in this boat because we are human, i.e. we have minds and bodies and they constantly interact. Because we have minds, we will frequently have thoughts that make us wonder if we’re on the right track. I spoke to a lady today who told me that she must have something physically wrong because her pain was so severe, despite the fact that her pain had gotten much better after one week of working with the MBS/TMS program. So, it is important to erase doubt, but some doubts will undoubtedly creep in. Severe pain can definitely impair your ability to think and process emotions. It can lead to depression and more emotions, which can further impair your ability to cope with pain and which can itself lead to more pain. Some doctors also suggest that severe pain can lead to decreases in efficacy of anti-depressant medications, thus compounding the problem further. The more pain, the more doubt and then things can get spiraling out of control. In those cases, you really need to stop and go back to the beginning. You may need to seek medical advice for reassurance that there is in fact nothing more serious going on and you may even need some more testing to confirm this.
This leads to the second issue: the power of thoughts and emotions. It is critical to realize that thoughts are uncontrollable, i.e. one can never choose what thoughts will come into their heads. The mind will continually come up with a huge variety of thoughts, many of which are unproductive, weird, wild, inane, or beautiful. If we can’t control out own thoughts, one certainly cannot control other people’s thoughts, and therefore we must learn ways of dealing with thoughts and reacting to thoughts or else we will be at the mercy of every stray thought that we (or someone else) comes up with. And, of course, it is not only thoughts that we need to deal with, but emotions as well, which are basically thoughts that are connected to important material from our past.
After doing a lot of research on how the brain works, I have developed a model to explain how MBS develops in the brain. You can watch a video about this on my web site, www.yourpainisreal.com. When pain occurs, it activates nerve pathways which send those pain signals to the brain and particularly to the amygdala, which is the emotional center of the brain and the area that can immediately activate the autonomic nerve system (ANS), which is the unconscious connection to the body to create the fight, flight or freeze reaction. These reactions are immediate, so that if you feel the pain of a burning match, you will immediately pull your hand away before you can even think about what is happening. This reaction occurs within 12 milliseconds, much faster than could occur if you had to send those signals up to the frontal cortex where you would become aware of them consciously. This reaction protects us from danger and happens without our conscious awareness.