117: Unlearn Your Pain with Dr Howard Schubiner

Chazmith 

 Welcome to Our Power Is Within Podcast. I'm your host, Chazmith, and my hope for this podcast is to inspire you to take your power back and to realize that you are the healer that you have been looking for. All along, we are capable of healing in mind, in body, and soul, and by the. Happy New Year. Happy 2023.

Before I introduce our guest today, I wanted to start out by letting you know that this episode is sponsored by Jeannie Kulwin Coaching. Jeannie Kulwin is a stress and mind body coach based in LA. If you aren't familiar with her, you can go back and check out episode 95, feeling Our Feelings with Jeannie as our guest on the show.

It was one of my favorites because she leaves us with simple, practical action steps that we can begin implementing in our life right away to make positive impact. Jeannie spent 16 years battling fibromyalgia, chronic fatigue in a myriad of other chronic symptoms that left her physically and mentally exhausted.

She healed herself completely and is obsessed with getting her clients fast results through her one-on-one mind, body, and TMS coaching program. The three month program gives clients support, consistency, and accountability to decrease stress release stuck negative emotions, and finally heal their chronic pain.

Jeannie offers free 45 minute consults where together you will identify what's holding you back so that you can take your next steps for healing. Go to her website: jeanniekulwincoaching.com  And as I mentioned in last week's episode this week, I have a really special treat as a Happy New Year gift to you all.

I have partnered with the producer of a film called This Might Hurt. The producer of this film, Kent Bassett and his team want to offer you all a complimentary streaming of the film for the next two weeks, followed by a live Q&A with Kent and another mind-body coach, Michelle Wiegers. This is going to be so much fun you guys.

The film is a documentary that follows the life of several chronic pain clients who after years with no success in feeling better, begin this program with our guests today, Dr. Howard Shubiner, and they learn about mind body syndrome and how to unlearn their pain. It was so good. I really can't wait for you all to get to watch this film.

And please feel free to send me a message after you watch it and let me know your thoughts and also. Mark your calendar now for January 17th at 7:00 PM Eastern Time for the live Q&A. Now, as I already mentioned, our guest today is featured on the film, Dr. Howard Shubiner as a certified internist for nearly 40 years.

Dr. Shubiner is one of the leading physicians in the mind body, chronic pain management world. He has been a part of conducting cutting edge research on the brain and pain science. He is an author of, uh, several books, uh, including Unlearn Your Pain and Unlearn Your Anxiety and Depression. So let's see. Dr. Shubiner, he articulates the science of mind body pain, so well, he makes it so easy for us to understand, and he gives us practical insights in today's episode so that we can begin to take small, simple steps today to, as he calls it, unlearn our pain. Please enjoy. 

All right Dr. Shubiner, thank you so much for being here with me today.

I am excited to get to have this chat with you. 

Dr Schubiner: 

Yeah, it's a pleasure. I appreciate it. Thank you. 

Chazmith - Host

Yeah, of course. My first question is, where in your career and how did it start becoming obvious to you that there were so many people dealing with what we now know to be mind, body symptoms, rather than physiological problems?

Because I know you have an extensive background, so at what point did you start having this epiphany or realization or connecting these dots? 

Dr Schubiner: 

Yeah, it's a good question. I mean, even back in my college days, which goes quite a ways back, uh, I was interested in the mind body connection, uh, interested in meditation and things like that.

And, and throughout my medical career, I was working for 18 years at a medical school, university faculty position. You know, we, we were interested in how the psyche affected the body. We were interested in things like irritable bowel syndrome and how stress could affect that. But I never was, it wasn't my major focus by any means, and I certainly didn't have a great interest in pain per se.

And then in 2002, someone introduced me to a book by Dr. John Sarno about the mind body connection. It was called the Mind Body Prescription Book. And I read it and I was kind of at a crossroads in my career.  I had finished up a lot of other work that I had done and, I was just kind of taken, smitten by what he was saying there, and that a lot of people with chronic head pain, headaches or back pain or stomach pain or whatever would be purely due to  stress and emotions and neuro circuits in the brain as opposed to any physical problem.

And so I called up Dr. Sarno and I said, Hey, can I come work with you for a bit? And he was gracious enough to have me come to New York City and I worked with him for a few days and I came back to my hospital and I said, you know, I'd like to maybe start a clinic in this and would that be okay? And they said, yeah, sure, go ahead.

And so I started talking to people. and I just started spending time talking with people and getting to know them and getting to understand their life and looking at the connection between their life events and the symptoms that they had, like headache pain, stomach pain, back pain, uh, you know, anxiety, depression, fatigue.

And I began to see these patterns that people would have stressful life events, often early in their childhood, and then later stressful life events that would trigger a particular symptom. And then the symptom would not go away and could last for months or years or even decades. And then when we started to learn how to treat people like that, we began to see that they could recover, they could recover fully. That was just an amazing, that was the epiphany when we saw that. It was really amazing. 

Chazmith - Host: 

That’s so awesome. I'm glad you brought up that book. That was my first introduction to learning about the mind body syndrome in a, as Dr. Sarno referred to it back then, the Tension Myositis Syndrome.  My question regarding that is, when you read that book, and it's still such a magical book to read today, I still often refer it to people and loan it out.

But Dr. Sarno in this book and his early understanding of this connection of mind body pain, he has a very interesting way of explaining and breaking down what's actually happening scientifically. I think how he explains it as the restriction of blood flow to a certain body part, therefore creating a high level of pain.

But I know that over the years since this original work was discovered  we've really come a long way in terms of understanding the science behind this type of pain, and I was wondering if you could explain some of the ways that our understanding has evolved. 

Dr Schubiner: 

Yeah. Dr. Sarno was way ahead of his time, and he intuited and he saw people and he looked at 'em carefully and he really made incredible advances and, has a cult following for that, for good reason.

And thousands and thousands of people have bought his books and have even been cured by just reading his books. But he wasn't right about every last little detail. He didn't have the advantage back in the seventies and eighties of knowing a lot of what we know now about the brain and what we call predictive processing, how the brain works, how neural circuits in the brain can create these sensations.

And early in his career, he was trying to come up with a physiologic reason for, for these pains. And he hit upon this idea that the brain would cause constriction of blood vessels, which would cause decreased blood flow to muscles and would cause pain, but that just hasn't stood the test of time.

So we don't think that that's the actual cause of the pain in it for a variety of reasons. Yeah. So what do we think it is nowadays? Well, neuro circuits in the brain, it turns out that the brain creates what we experience. We don't see with our eyes. Light comes in our eyes, but the brain creates those images.

Can the brain create images that are not there? Of course, we dream every night. Do we hear things? You know, when we hear things airwaves come in our ears, but the actual hearing is done in the brain, and it's the same with feeling. When you touch a hot stove, it's not your finger causing pain.

It's actually the brain causing pain. And we know that because people can have significant or severe injuries and not have any pain at all. Pain is a function of the brain, so neuro circuits in the brain are what's creating pain. And you can have pain  in a foot that's been amputated. Of course, phantom limb pain.

And so we know it. You don't need a body to have pain . 

Chazmith: 

Yeah, that's pretty crazy . That's really, that was a huge catalyst for me when I started doing some research and learning about phantom limb pain, that was such a huge light bulb moment for me to understand and connect the dots of what I was experiencing in my body.

And just understanding between that concept and Dr. Sarno's book, I was like, oh my gosh, this is what makes so much sense. And that was a huge changing point for me where I was able to suddenly realize that I didn't have to be afraid of the pain I was feeling in my body. 

Dr Schubiner: 

Exactly. And, those are light bulb moments and when people understand if it's true that they're not actually damaged, and most of the people with chronic pain are not actually damaged, the vast majority of people with headaches, fibromyalgia, irritable bowel, stomach pain, chronic pelvic pain, and even neck and back pain, the vast majority of those people do not have a structural problem to account for their pain.

And that doesn't mean that no one does. There certainly are certain medical conditions if you have a fracture, an infection, a tumor, uh, there's certain medical conditions that can clearly cause pain. Uh, but chronic pain is usually due to these neuro circuits in the brain that have been activated.

Sometimes they start being activated through an injury, and even though the injury heals, the pain may persist because the brain's neuro circuits are now the driving force for that pain, and it's not due to a physical injury. And of course, another cause of, of pain is emotional stress and emotional trauma that can cause pain.

And research shows that stress and emotion cause the exact same parts of the brain to light up as a physical injury. So the pain that's occurring when someone has an emotional trauma. If they're having pain in their body, that's real pain. It's not imaginary. It's as real as any pain. And it can be extremely severe, even in the absence of an injury.

And what happens is people become a fearful of that pain, worried about it. They focus on it. They're paying so much attention to it, they're trying to fix it drastically. And the harder they try and the more fearful they are of it, the more the pain occurs. So one of Dr. Sarno's great contributions was he realized that when people were educated to the fact that they weren't actually damaged or broken, and they stopped fearing the pain, and they started using their body as if there was nothing wrong.

Frequently they started to get better or they could even get better. , right? 

Chazmith: 

Yeah, exactly. And I'm, this is a really good point because we're talking about chronic pain, but you just gave two totally different examples of how the pain can manifest in the body. So I was actually gonna ask you too, because sometimes we learn about the work of Dr. Sarno or we fall into, this whole community of everybody out there, like yourself and Alan Gordon and everybody that's teaching this pain science and helping us understand that pain does not equal something as physiologically wrong, but a lot of times we're kind of like overwhelmingly taught that it is emotional, where you just gave this great example of it could have started as a actual injury, but then the brain got stuck in this feedback loop.

But part of what could have caused that to linger and get stuck was our fearful reaction to the, the injury and the pain to begin with. And so a lot of people are at a place where they're kind of being taught that they need to do emotional reprocessing or emotional release, or you gotta journal your thoughts and feelings and emotions out.

But do you think that everyone actually needs to do this work? Or is that not necessarily the case for everyone who is experiencing chronic conditions? 

Dr Schubiner: 

No, not everyone needs to do deep heavy emotional work to recover. That's obviously the case because as I pointed out a minute ago, and you know, thousands of people have gotten better just by reading one of Dr. Sarno's book. 

On the other hand, some people will need to do that emotional type of work because just doing the pain reprocessing work, which is rewiring the neuro circuits in their brain may not be enough or the symptoms keep coming back. So we just take it on an individual by individual basis.

I think it's wrong to be dogmatic to say that everyone needs a certain prescription and because people are different. It may be that you can make the pain go away, or the fatigue or the insomnia, or the anxiety or the depression. You can make that go away by doing the pain reprocessing work, changing the relationship to the symptoms, stop fearing them, stop worrying about them, et cetera.

But it may be also beneficial to do the emotional processing work in order to kind of heal on a deeper level in order to feel more comfortable in your own skin and who you are and help you to change how you relate to people. Sometimes it may involve setting boundaries or changing things in your life, changing a job, changing a relationship, or whatever.

And those things can help prevent future episodes of mind body symptoms because you're not putting so much pressure on yourself or you're not in such emotionally fraught situation situations , right? 

Chazmith: 

Yeah. And that makes so much sense. And so, yeah, something that I had experienced was when I read the book, like you had already mentioned, I, that alone was enough for me to go and start exercising and doing the things I loved without fear, and I definitely was able to immediately feel relief from some muscular skeletal chronic pain that I had been experiencing. 

But something that I really struggled with wrapping my head around were the other symptoms. Like, and, and I, and I've talked to many people, and this is very commonly the case, but when we get the label of CFS, chronic fatigue or IBS or SIBO, which we're taught as a presence of bacteria in the gut, when we're dealing with some of these other labeled illnesses, it can be harder to wrap our head around the idea that these are still, um, mind, body, uh, related.

So  I'm curious how over time you guys also became able to notice and connect the dots that these “illnesses and diagnoses” also fell into that category. 

Dr Schubiner: 

Yeah.  you know, little by little over time, I just learned . Little by little over time, I just saw more and experienced more. For example there's a condition of zoster shingles, herpes zoster infections where you can have these really horrible rashes and severe pain, when you get the, the disease.

But then there's a symptom of post-herpetic neuralgia or pain in the area where the symptoms were originally. And I always thought that was a, that was due to damage to the nerve. But over time I started seeing people with that condition and I started seeing that the pain was variable. It would come and would go, I had one patient look at his arm and he could make the pain come out.

And then I began to realize that this was akin to an injury that had healed and the brain had taken over and it was causing the pain. So that's a condition that I, I learned, not the acute infection that's due to the virus, but the, but the painful symptoms afterward I learned were actually mind, body.

And so that became the case for all these other syndromes and the, the medical profession. And frankly, the alternative medical profession has a pension for wanting to blame all symptoms on some kind of physical or structural problem. And so they're looking very hard for that and trying to find that.

And I think that's gone overboard in a variety of these symptoms where people are claiming that. You know, irritable bowel is a structural problem, or migraine is a structural problem, or chronic fatigue is a structural problem, or chronic Lyme disease is a structural problem. Or the wide, wide range of symptoms that are purportedly caused by EDS now, or long covid now even.

So, I mean, everyone needs a careful evaluation. I'm not advocating saying that just because someone has a label that we know for certain that it is or isn't a mind body problem. But I am an advocate for listening carefully, looking carefully, doing judicious medical examination and testing to make sure that it is a mind body condition before proceeding with treatment.

And the way we do that is by using a variety of clinical criteria to look carefully at the symptoms. . For example, if the symptoms go away when you're on vacation and come back when you come home, that's a sign that your brain is producing them. It's not a structural problem if the symptoms are there in the morning, but not in the afternoon or vice versa.

If the symptoms occur after exercise, but not during exercise. If the symptoms are triggered by innocuous stimuli such as light wind or heat or cold or the weather, there's a whole variety of these factors that we can look closely at to actually what I call rule in a mind body or a neural circuit condition.

Chazmith; 

That makes so much sense. You obviously have been studying this for a long time now and studying people and witnessing people in their experiences. Like you said, you really talk to them, you understand what's happening in their life and when you  are going through this over the years.

Are you noticing patterns or trends where there's generally certain, emotional experiences tied to specific symptoms, or is it really more random in your experience? 

Dr Schubiner: 

I have found that if you take the time and investigate and ask and look closely, almost all the time, not all the time, but the vast majority of the time, I would say it is relatively easy to come up with the reason.

that people have these mind body symptoms. The reason, meaning what stresses in their life produced it. For example, I saw a woman who had a childhood where it was pretty decent, except her father was quite unpredictable. And sometimes he would come home from work and he would be fine, but sometimes he would come home from work and he would be really mean or nasty, and he would yell and scream and he would just be really mean and critical.

And so that was her girl's upbringing, this little girl. And she grows up and she's okay. She's fine. She goes school, she gets married, she has kids, and one day she gets a new pair of glasses and she put the new pair of glasses on and she had this weird, funny feeling in her head. And then she tried to wear the glasses, but it got worse.

And pretty soon she had this significant head pain and they tried different glasses and different lenses and all sorts of things, but the head pain continued and it continued for 17 years. And, and she was suffering. And she had been, she had been to many, many doctors, many headache clinics, tried many different medications, injections, all sorts of things.

And so I asked her, you know, what was going on in your life at the time you got the glasses? Because I didn't think changing glasses would cause headache pain for 17 years. And she said, well, everything was okay. You know my husband was fine. My kids were fine. My job was fine. I said, yeah, okay.

Anything else? She said, well, I got, I had a new boss around that.  and I said, well, what was your boss like? And she said, well, he was really kind of unpredictable. Yeah. Sometimes he'd be really nice and then sometimes he would just inexplicably yell or scream or get mad or be critical and. You know, no one had thought about that or put that together, but when you knew, if you took the time to listen to her and see what her childhood was like and what was something that would be very stressful to her.

And then you found out that that same thing was happening in her life as an adult, and that her brain was fearful for that. And it was, you know, in a funny way, was trying to protect her. And it was causing head pain, basically, to get her, you know, to stop going to work. And, you know, theN when I saw her 17 years later, she was long gone from that job that wasn't going on anymore, but the pain had persisted because of the learned neural circuits and she got better.

She completely recovered from that by changing the neural circuits, and maybe doing some emotional work as well. 

Chazmith:

That’s crazy. What are some of the tools she used to help her change those circuits? 

Dr Schubiner: 

Well, changing the neuro circuits in the brain, we're calling basically PRT or pain reprocessing therapy.

Now it applies more to more than just pain. It can be fatigue or insomnia or anxiety or depression. the idea is to stop, to reduce the fear of the symptom, to reduce the focus on it, to reduce fighting it or being frustrated and angry about it. To stop trying to figure it out and to stop trying to fix it.

Which sounds silly cuz of course you wanna fix it. But when you, you can change the neural circuits in the brain by teaching the brain that you're safe. The brain has been living, and by brain I mean the subconscious brain. That controls the danger alarm mechanism in the body. And the subconscious brain is getting messages of being unsafe all the time.

Messages, cuz you're, you're sick, you're broken, you'll never get better, the treatment hasn't worked, you're having all this pain and the brain is fearful. And so what we're teaching people is to retrain, it sounds silly, this all sounds silly, but to retrain the brain by teaching the brain that it's actually safe and not in danger.

When people do that, when every time they get the pain or the other symptom, they're saying, I'm safe. I'm okay. There's nothing wrong. They start to stop anticipating the pain and start living their life as if they're free of it and start doing more rather than doing less. Stop avoiding things.

Stop feeding into the fear and the worry, and start becoming more, um, sound sounds silly to say, but more joyful in their life and more purposeful. And because what happens with chronic pain, you just close in and you do less and less. You withdraw, you do less social activities, less work, less movement, less activity, and you're taking all the joy and connection out of life.

And so if people can be compassionate to their brain and treat their brain like it's a scared child and calm it en soothe it, and then start doing more to show the brain that they're safe and that they're gonna be okay, then they get better. Right. Yeah. And it's helping somebody then to like make their world bigger again, rather than so small like they had been doing in the past.

Chazmith: 

And so you're saying just these little things that we do, like rebuilding our life, saying yes to more joy, not being so afraid, just gently and compassionately speaking to our brain. All of this really does make a big difference. 

Dr Schubiner: 

It does. It, it does. When you know that you're not actually damaged, when you know you're telling yourself the truth that you're safe.

If people feel like they're lying to themselves, that's not gonna work. Right? 

Chazmith: 

Right. So they have to buy into it. They have to believe that they truly are safe, and then teach their subconscious. 

Dr Schubiner: 

Exactly. It's like being a faith healer. You have to believe in order to get better . Yeah. But if I say, oh no, I believe this, I believe this and, and there's a part of me that believes this, but then I still limit myself.

Like if I say no, I believe my knees okay. Or my back's okay, but then I'm still afraid to go exercise or afraid to go out on a walk or afraid to do things, or I, I still with like restrict myself. That's seriously sending the opposite message to our brain then that we're trying to convey. Yes, that's absolutely right.

Chazmith: 

Mm-hmm. . And that makes all the difference in the world. , right? So it's interesting cuz as you explain this, it seems so easy, right? It doesn't have to be that much work. As long as I believe this, it's little simple things like recreating a life I love and not being afraid that makes a big difference.

But yet I still see sometimes in the mind, body world where it gets very complicating and like so many people feel like they have to do so much work to get better and they're still trying to “fix their pain”. Especially when they do automatically believe there's an emotional component.

So I see a lot of people get very fixated on needing to find the exact emotion and in their, in that if their pain persists, they must still be doing something wrong or not good enough. And so they kind of get stuck in this pain cycle even when they believe it's not physiological, because now they're so focused on thinking it's emotional and that they still have to do more work to get to the solution.

Does that make sense? 

Dr Schubiner: 

Yeah. Yeah. We see that a lot and a lot of people can get better quite quickly, but not everybody does. And sometimes it's a lot harder. The, the fear reduction work or the repaying reprocessing work doesn't seem to be enough. So we move to the emotional awareness type work and sometimes people get stuck there.

Like as you were pointing out, really, sometimes people just try too and  the more focus on trying to get better actually puts more focus on the problem, which gets in the way of getting better. So it can be complex  and some people definitely struggle with it. There's no question about that.

But most of the people do well, the research that we've done shows that most people do well. Most people get better. And and sometimes it just takes longer. Sometimes you have to really be patient. I have a patient now who it's taken two years for him to, to recover, but he has, uh, but he kept working at it and he kept working at it and he and I kept encouraging him and cheerleading for him and giving him other techniques.

You know the main thing is to not take away hope. Cuz when people lose hope, it really becomes hard. 

Chazmith: 

Right. Yeah, exactly. Yeah. Cuz the power of belief is so strong in itself. So if I lose that hope and don't believe that I can heal, that's gonna play a role. 

Dr Schubiner: 

Right. And speaking of saying that some people can get better rather quickly, some people it takes longer.

Chazmith: 

Do you see any pattern or trend in that realm? Like do people, like people overall have an ability to overcome or heal from certain pains or certain illnesses faster versus others? Or like if somebody has been in chronic pain for three decades, is it tend to linger longer than somebody who's only been in pain for two years?

Dr Schubiner: 

Or is it really.  rather random. Yeah, it is fairly random actually. It, it's weird that you would think that if the pain was there shorter, it would be a lot easier to, to reprogram than pain that's been there longer. You would think that, right? Yeah. you would think that if the pain is more severe would be more difficult.

You would think that  if the person has had more childhood trauma or more stressful life in their event events in their life, or if there was ongoing stress and trauma living in a situation which is particularly difficult, that that would make a difference. And sometimes any of these things seem, seem to be factors.

You know, people with long, long amounts of pain, severe pain, ongoing trauma, more childhood trauma, oftentimes those do take more time, but not always. So we just try to keep an open mind and try to maintain positivity. 

Chazmith: 

Right, right. that is so interesting. I wonder, do you have any advice for anybody who is potentially listening to this episode that falls into that category where they do feel stuck?

Where they do literally feel like they know this is it, they know it's mind body, it's not physical, but yet they're still just feeling like they're trying all the things and not getting any results. What could shift for them or where could they start? 

Dr Schubiner: 

 Yeah. Well, you know, kind of starting all over, like start at the beginning.

Are you sure? You know, are you absolutely sure? Do you have doubts about it? Are there medical things that you're worried about that maybe you need to take care of or get tested to rule out any fears and doubts? So stopping the doubt can be a really important thing, starting over with that.

And then if you're really certain, then you can go really full force into the pain reprocessing so that you're actually doing more, and you’re not limiting yourself. So that can be part of it. One of the things that is actually very powerful is what's called paradoxical intention or reverse psychology, where we teach people when they're certain that they're not broken, to tell their brain to give them more symptoms.

Rather than telling, trying to tell their brain to stop producing symptoms, that's not gonna work. They actually have to do the opposite. They have to say, go ahead brain, give me more symptoms. Bring it on. Oh, this is the very powerful psychological mechanism. It was made popular by Viktor Frankl back in the 1950s.

So if people are saying to their brain, and it sounds really silly and stupid, but it's incredibly, incredibly powerful when you say bring it on. I'm not afraid cuz you're really vanishing all fear when you do that. So that can be really powerful. Emotional work, as we mentioned, can be really powerful.

There's newer forms of therapy now. And this is controversial, but showing a tremendous amount of progress, psychedelic as assisted, therapies can be very powerful in kind of getting people's brains out of their ruts, so to speak. And sometimes there's other therapies.

Internal family systems is a therapy model that I know and practice and think very highly of. So that can make a big difference in, in people. 

Chazmith: 

That makes sense when you do meet new clients and you're helping them through their pain or illness when you first meet them. So let's say  there's somebody and they might have like one persistent pain, you know, and maybe they are fearful of it and and it consumes them in some regard.

But then there's other people who, they start with one thing and then it becomes another and another and another, and another to the point that they are like, where almost life becomes a trigger and they're so deeply afraid of everything. So you're talking about a very dysregulated person, when you're working with somebody like that, where do you even start with them to begin to allow their nervous system to calm down?

Dr Schubiner: 

Yeah. Frequently you start with either the symptom that's the most bothersome or the one that they're most certain is a mind body symptom. If they're very certain that a particular symptom is a mind body, then that might be a good place to start to get them to a place where they can see a little bit of progress, a little bit of a victory, a little bit of success in calming their brain and turning off a particular symptom.

And then you can move on to other ones. Sometimes you want to, with somebody like that, you might wanna address the emotional underpinnings of it earlier in the course of therapy, I often do that and sometimes you might wanna address the fear itself looking at actually the fear response they have or the anxiety response that they have, rather than the symptom.

And that can be another way to approach it. 

Chazmith: 

Yeah, that makes sense. Speaking on the same kind of person. Often what happens is at this point we may have developed, I mean, so many external triggers, you know, where it's like every food, you hear stories where people can only eat four foods, or that sunshine or wind or all these external factors have become triggers.

And I know that for us to close off our world and allow it to get smaller and smaller by avoiding every trigger, we're actually reinforcing that pattern, we’re reinforcing to the brain that that trigger is “a bad thing”. So in terms of helping the brain to no longer perceive these things outside of us as threats, what are some ways that people can teach their brain safety around these triggers? 

Dr Schubiner: 

Yeah, it's a really great way to work with people because it, it's often very easy to show that these triggers are innocuous. One of the ways that I often work with that is to have people imagine being in the triggering situation.

Imagine being out in the cold or imagine the weather changing or imagine standing or sitting or bending. Imagine working at a computer screen and If what happens when they imagine the triggering activity, often it'll produce a fear reaction or it'll produce the actual symptom that they have sometimes to a milder degree.

But nevertheless, this is demonstrating to them that the trigger is actually a trigger, a conditioned response and not actually causative. Because if they just imagine the situation and they get the symptom, it's obviously their brain. It's not the actual trigger. And so then what we're doing is we're helping people to calm their brain in the face of the trigger by doing simple.

Calming techniques, breathing, telling themselves they're safe, telling themselves they're okay. Laughing at the, at the, at the idea that it's, you know, not really a, a, a significant problem. That they're gonna get better, giving 'em hope and optimism. And then when they do that, we'll say, now imagine this trigger again.

Imagine going out in the cold again. Or imagine the weather. Imagine any of these situations. And oftentimes the situation will change or the, the symptom won't occur then. So they just imagine the situation and they got a symptom, and then we did calming and, and safety exercises. And then they imagine the situation, and now they don't get the symptom.

Now what you've done is you've just reprogrammed their brain a little bit, and then you, and then you can keep on this path of calming their brain and doing these simple affirmations and then having gradually. , go into the exercise or situation, stand in the cold for 10 seconds, or type on the computer for 30 seconds.

You know, just do a small exposure to it. All the while saying, you're safe, you're not in danger. Everything's okay. And then gradually the brain will learn that these activities are safe and they won't trigger them anymore. 

Chazmith: 

Yeah. Just slowly over time, just teaching the brain. 

Dr Schubiner: 

Exactly. Sometimes when we start to experience, um, relief of a symptom that is mind, body, all in the sudden we begin to experience an uptick of new symptoms.

Chazmith: 

Can you explain why that's happening? 

Dr Schubiner: 

Sure. Well, The, the danger signal in the brain is there to alert or alarm us to a problem. And if your brain on a subconscious level feels there is a problem in your life, it's going to send an alarm or a message. And the, the purpose of that message is to alert you.

And another way to say that is to scare you,  to take action, to do something and a smoke alarm has to be loud in order to be effective, to get your attention. So the brain produces one symptom and then you're stopping paying attention to that, you're not worried about that symptom anymore.

The brain may realize, well, gee, this is doing what? It's not serving a purpose. It's not alarming the person, so it gives them a different symptom or another one to alarm them and alert them. But over time, as you calm the danger signal in the brain, the brain will stop doing that hopefully.

Usually it does stop giving people more and more symptoms. If they keep getting more and more symptoms or different symptoms you want to kind of look at some underlying issues. Is there something going on in their life that's still stressful or, or difficult? Is there some emotional thing that you want to address?

Chazmith: 

Right. And I guess that's why I've also learned that how we respond to those new symptoms is also so important because if we respond to every new symptom and fear, we're continuing to exasperate that danger signal. But if we can look in the face of these new symptoms and see them for what they are with, and we can re respond with ease, that's literally helping us to downgrade that danger signal.

Dr Schubiner: 

Exactly. And so what I tell people is, it's really good idea to expect that new symptoms will occur or expect that the original symptom will come back cuz it will because you're human and you have a mind and you have a body. And when you're under stress or just for random times, the neural circuits fall back into those pathways.

The symptom may occur, but as you said, if you meet it with fear, it'll make it worse. But if you meet it with calm and a smile and knowing you're okay and looking for something in your life, if there's something there that's triggering it, then you're gonna be fine. And it's not gonna gain a foothold.

It's not gonna become chronic. 

Chazmith: 

Right, right. In your experience over the years of helping support people through their healing journeys and watching people and witnessing, do you, have you seen instances in cases where there's been somebody who is just starting out extremely dysregulated and they've really lost their resilience, have you seen them able to do this work and get back to a fully resilient, healthy, normal life again?

Dr Schubiner: 

Oh yeah. Absolutely. Absolutely. people can be and feel so broken, so hurt and down and in despair, but if they can really understand this, and if we can show the two of them and demonstrate that they're really not as damaged as they thought they can make in incredible strides. And it just really depends on the, on the person.

Chazmith: 

Mm-hmm. . Yeah. Do you think that we can do it on our own or do you feel more people have success when they do seek support in an out, in a coach outside of themselves? 

Dr Schubiner: 

That’s a good question. I think both are true. Certainly many people do this on their own. I got an email last week from a doctor, a young woman who'd been in practice for 10 years.

She started having hand and arm pain after a couple years in practice, and it got worse and worse, and she had to quit her practice. I mean, she literally could not work. Uh, and she went through a lot of medical interventions and therapies and nothing helped her. But when she found this particular work, she was reading some material, I think on my website  just understanding that, and she felt so broken, but understanding that she started to get better within a day or two.

And then in a month she started using, uh, my workbook and doing the exercises therein. She was 90% better in a month. So she did that all on her own. And other people really need, need someone to hold their hand and walk 'em through it and help them and support them. And that's fine too. There's lots of people now who we've trained who are listed on the TMS Wiki or the PPD association.org or the pain reprocessing therapy website that are doing this work, and many of them are doing it remotely.

So hopefully people can find coaches and therapists who do this work to help them. 

Chazmith: 

Right. Yeah, absolutely. And so this is a strange question, but have you noticed or encountered this happening because as I'm listening to you tell this woman’s story,  I'm thinking this woman literally, obviously she had a goal.

She went through a lot of schooling and a lot of training and a lot of, probably of just challenges and things in life to get to the point she could open her own medical practice and then to have it all stripped away and taken from her and doing all this stuff, probably spending thousands of dollars and time on treatments and all these things that don't work.

And then she reads some information on your website and has this massive like pull towards trusting that this is the solution and within one month she feels better. Do people in those kinds of situations ever experience l like grief or secondary anger or heavy emotions that arise because we learn, oh my gosh, this is all it took.

And I went through all of that and lost everything and now I'm only finding the solution. 

Dr Schubiner: 

Yeah, for sure.  I've had, we see that all the time. There's tremendous grief for what they people have lost, especially when they feel it's unnecessary. There's often tremendous anger to the medical profession for not helping or not understanding this.

Almost all my patients say, how come  no one ever told me about this before? Right. How come my doctors didn't tell me? How come they don't know that that's enraging? Sometimes people feel a lot of guilt because they haven't been able to do all these things, and they feel guilt for subjecting their spouse or their family or their children to, to someone who's less than fully, capable and functional and joyful.

So grief and, and anger and guilt are all very common reactions and. , what we're doing to help people is help them understand that their emotions are valid and real and important and justified. And it's not dangerous to allow oneself to feel these emotions and people can process their emotions. And one of the most important things that people can do in order to deal with these issues that you're bringing up is be compassionate.

Mm-hmm. , be compassionate to themselves, caring and loving toward themselves. Not blaming themselves, not beating themselves up, blaming themselves and beating themselves up are part of the problem in the first place. We see this all the time, so the work can be fairly nuanced and deep and, and me meaningful and moving and emotional.

But in the end the purpose of the symptoms is to protect them and help them and point them as a guide towards something that they need to do. Right. Yeah. And if, if the symptoms are pointing them to something they need to do in their life, that help them be a better person, a better spouse, a better parent, to help them be more assertive and more compassionate to themselves, and, and better able to stand up for themselves.

uh, these are, these are gifts. Mm-hmm. . And so in the long run, the symptom is actually a message, a guide, and, and often viewed as a gift, even though it's very hard to see that when you're in the throes of significant symptoms. 

Chazmith: 

Absolutely. And I'm so glad you bring that up and you're, what you're saying is that it's okay to be in both spectrums.

It's okay to see this as a gift or to see the bigger picture or the message, and also to acknowledge, honor and have compassion for whatever real emotional, like feelings you have around the experience. So it's like, okay to be angry or frustrated or sad or upset and, and allow yourself to have all those emotions and feel them all and process them all, and then also get to that place where you can also see how it is essentially helping us to evolve.

Dr Schubiner: 

Yeah, exactly. You know our goals in life are to be a good person, be a better person, be wise, learn and, and be connecting to others, caring in others, finding purpose and meaning in life. Those are the things that make people happy and healthy. And you know, when people do that they're gonna feel better about themselves and their brain is gonna be calmer and less likely to produce mind body type symptoms.

Right? 

Chazmith: 

Yeah. This is why this message is so important to get out as far and wide as possible so that more and more people can discover it sooner and not go through 5, 10, 20 years saying, why didn't anybody ever teach me? Exactly. And speaking of that, I know we're short on time here, I wanna ask one more question pertinent to all of this, because you mentioned it very briefly early on, but something that we know is a really big thing right now is the long haul covid symptoms. I know there's a lot of fear out there where there's thousands of people who literally are experiencing these long symptoms and they're so afraid because there's one message that's being conveyed that they're stuck with these symptoms. But that's not true, and we know that now. So could you explain briefly, for anyone who's listening how people like yourself and everyone else studying this brain and pain science, how have you guys come to be able to see long covid fall into the same category that we've been talking about this whole conversation?

Dr Schubiner: 

Yeah. It's a really important topic. It's affecting millions and millions of people. Some people who've had covid, have had severe infections, have had damage to their lungs or heart, and some of those people can certainly have damage ongoing if they had that damage. Um, and so some people clearly can have physical structural changes due to covid, but this is a very small percentage of the people who are afflicted with long covid symptoms and long covid symptoms are in a much wider array of symptoms, not just like heart and lung problems.

They're fatigue and aches and pains all over the body. And mental fogginess, confusion headache, stomach issues,Insomnia, anxiety, depression. What we know about Long Covid is in a French study there was 20,000. Some people they followed over time and they found that the incidence of long covid was just as high, even slightly higher in people who did not actually have covid by, they didn't have the antibody testing to prove it has compared to the people who did have covid.

So from our point of view, what we're seeing is that a virus infection can cause fear. Covid has caused tremendous fear as a pandemic. Millions, unfortunately, people have died. So there's tremendous fear and worry about it and. And when you catch a virus and you have tremendous fear about it on top of it, and if you've had anxiety or depression on top of it in your life.

And one of the studies showed that people with anxiety, depression, loneliness prior to covid were more likely to develop long covid. But even people who had none of that can still develop long covid, uh, because the brain just falls into these ruts of creating all these symptoms. And another study showed that people with childhood trauma and adverse childhood experiences were more likely to develop long covid as well.

So this whole thing, and everyone needs a careful clinical individual evaluations to make sure they're not structurally damaged. But the people I've seen and the people we've seen in our community of doing this mind body work have seen, you know, tons of people with long covid recover and recover quickly when they are.

Understanding that they're not actually damaged, that these are neuro circuits in the brain that they can recover. And then doing the work that I described, uh, people are getting better. And that's really positive thing to see. On the other hand, there's a lot of doctors and scientists who are working very hard to find the physiologic or the structural problems causing long covid.

And if they find some physiologic or structural problems, that would be good to know and we will incorporate those into our models. But my reading of the literature has not, I haven't, I haven't, um, been convinced that long covid for most people, uh, is a structural problem. I think it is a mind body problem for most people, and therefore most people can recover.

Chazmith: 

Absolutely. Yeah. And we definitely need to get that message out. , how can people connect with you, um, to stay up to date on your latest findings, your resources, and better yet even participate in the programs or services that you offer. 

Dr Schubiner: 

Yeah, there's a lot of, lot of programs and a lot of services that we offer.

My website is unlearningyourpain.com, and from there you can get access to a lot of materials, videos, books, research, et cetera. The P P D A is a psychophysiologic disorders Association, ppd association.org, and there's a tremendous amount of, there's a bibliography there of tons of research.

There's questionnaires, there's videos, there's all sorts of information there. And there's a listing of practitioners who do this work around the country and around the world. The tms wiki.org is another site. It's peer site  with Patient testimonials, resources, and another list of practitioners, pain Reprocessing Therapy Institute.

Pain reprocessing therapy.com also has a list of practitioners and there's tons of training. So people who are professionals, who are, who are physicians, nurses, psychologists, social workers, physical therapists, occupational therapists, other therapists, massage therapists, coaches, chiropractors, osteopaths, et cetera,  all sorts.

Folks can take our trainings. We have a training program called odx.com. That's an online mobile training app that anybody can take at any time. And then we have a bunch of training courses that are live and virtual that we offer. And so all those can be accessed on the training tab on my website, unlearnyourpain.com.

If people wanna keep abreast of research, new research and new findings and updates, they can subscribe to my newsletter and they can just go to my website, unlearnyourpain.com, and sign up to be notified to be on the mailing list. So there's a lot of stuff out there that, can really help.

Chazmith: 

Awesome. Thank you so much. I'm excited to get to share all that with everyone who will be listening. As just like parting advice from you, what would you say to anyone who's listening who maybe has been at a place where they are starting to feel like they're losing hope, even though they really wanted to believe this was a mind body situation for them, but they're kind of feeling like they're failing at this.

Dr Schubiner: 

Yeah, it's, it's really hard to feel like you're failing. And I think what happens sometimes is people have had difficult times in their life and felt like they've been failing in their life, and then they feel like they're failing in this. So it's kind of a double, double whammy, double trauma kind of situation.

And I think the most important thing is compassion, is starting with compassion for yourself, starting with kindness for yourself and just using these resources and getting help. like I say, most people will, will get better and I really hope that people don't give up hope. 

Chazmith:

Thank you so much and thanks for being here with me today.

And thank you for everything you're doing in the world. And yeah, I just, I think you're amazing. I appreciate everything you've put out into the world for, um, people like myself and so many people listening that have suffered from pain or illness and have found a way through it. So thank you. Thank you very much.

Dr Schubiner: 

It's a pleasure to speak with you and keep doing what you're doing. 

Chazmith: All right. That's a wrap for today. Do not forget to click the link in the show notes to my website and sign up for your free streaming of the film. This might hurt, and if you're finding value in this podcast, please remember to like, subscribe, review, and most of all, share your favorite episode with a friend and on your social media.

Please help me reach my 2023 goals and get this message of hope and healing to more and more people who also deserve to heal. I love you all and until next time, make this week great.