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This is a guest blog written by a friend and colleague of mine, David Schechter. He has been a pioneer in integrative mind-body medicine for many years. There are many physical symptoms created by sustained exposure to stress hormones. I experienced 17 of them at the same time during the worst phase of my burnout. There are several descriptive terms for this phenomenon. They include NPD (Neurophysiologic Disorder), MBS (Mind Body Syndrome), Stress–Illness Syndrome, CSS (Central Sensitization Syndrome, and TMS (Tension Myoneural Syndrome).
Schechter's approach
When I work with patients with chronic pain, I am looking to make a clear diagnosis. For many, that diagnosis is TMS (Tension Myoneural Syndrome). Making an accurate diagnosis is a crucial first step towards change in the nervous system that leads to pain relief.
I use a variety of treatment approaches and teach patients several skills during this process. A key element is journaling. I have been using this in my practice for 25 years. Since I wrote The MindBody Workbook in 1999, most of my patients have preferred this structured journaling approach, although we still use free form writing as well. Patients write about feelings to get rid of pain. They do not write about pain, as was traditional for a time. It has been documented that a "pain diary" is counter-productive and reinforces the pain circuits in the brain. (Ferrari, 2013).
Another skill is “Self-talk” or “Affirmations.” We all have a dialogue going on in our heads throughout the day. Some of that internal dialogue is beneficial and some of it holds us back. Hearing those “fear” statements in our head is counterproductive. Listening to ourselves worry about never getting better, what we have missed in life, replaying anxious moments is not helpful. I teach patients simple positive affirmations that help to counteract and eventually quiet the negative thoughts that can permeate our thinking.
Affirmations help us to challenge and defeat self-sabotaging thoughts. Just as we do repetitive physical exercise to get stronger, affirmations can be thoughts of as exercise for our mind/brain. For 25+ years I have used the analogy of “reprogramming” our brain. Learning to think differently is part of how we learn to get rid of the pain pathways and replace them with new circuitry. Affirmations can help us stop bad habits and pain is a kind of habit that we need to break, in a neurologic sense.
Affirmations are typically positive, optimistic statements we create or use those that others have created that resonate for us. We can use the same one for days or weeks or vary them from day-to- day. Both techniques can be successful. Here are some examples to start with:
- "My pain is just TMS; I can overcome it completely."
- "My body is healthy and strong. I am learning to move freely again."
- "I can achieve this goal and be happier and more fulfilled."
- "I have a benign condition; the body naturally heals."
You will notice that the word “I” appears in many of these statements. Most are written in the present tense and include an optimistic future. State these generally in the positive as the brain may be confused with a “not” sentence. Specific, brief, action words and feeling words are great to include. Short and powerful is great for these phrases.
The science
This approach is based upon clinical experience and psychological theories, such as self-affirmation theory (Steel, 1988). Empirical studies were done that suggested that we maintain our sense of self by affirming what we believe in positive ways. Cohen and Sherman in 2014 wrote about “self-efficacy” and how we protect ourselves from threats by strengthening our resilience with affirmations.
Self-affirmations have been shown to decrease stress (Sherman, et al 2009 and Critcher and Dunning, 2015) They were used effectively to help people increase physical activity (Cooke, et al 2014) and even helped people to eat more fruits and vegetables (Epton and Harris, 2008).
Affirmations can help us to develop a more optimistic way of looking at ourselves and our experiences. Optimism is known to be a powerful concept. Chronic physical symptoms are, in part, about a destructive narrative within us. My patients learn to change this narrative through diagnosis, education, journaling and affirmations. More hopeful and positive narratives that acknowledge the pain of the past, but offer hope for the future lead to successful outcomes.
Part of a comprehensive approach
Positive affirmations must be part of an overall healing process, as no tool works well in isolation. They are not intended to “fix” or solve your pain. The practice keeps your attention in a powerful place and your brain can create new circuits in response. However, it is also important to allow yourself to feel the mental or physical pain before you redirect. Positive affirmations are not to be confused with positive thinking, which is a way of suppressing negativity. No one is asking you to enjoy being in pain. You won’t win that battle. A consistently positive outlook is an important effort and much different.
"ThinkUp"
After using phrases with patients for many years, such as the ones above, I discovered an app this past year. It is called ThinkUp. (It includes free download, premium features, and is built for iPhone and Android.)
The unique features of this app that have helped my patients include:
- Recording your own voice reading the affirmations
- Lists of affirmations from experts and authors
- Affirmations, broken down by topic
- Ability to combine recorded affirmation with soothing music
- Easy playback system
Some empirical, as yet unpublished data suggests that recording the affirmation and hearing it aloud in your own voice may be more powerful than internal dialogue or hearing another person’s voice reading the affirmation. (There are analogies here to writing in a journal in comparison to thinking the answers, which is not as effective). The ability to access affirmations for anxiety, for gratitude, for self-confidence, for motivation, and now for “Back Pain Management” (my 16 contributions) offers a lot of flexibility.
Practice, practice, practice
In conclusion, there is a fair amount of research supporting the use of self-affirmation for a variety of conditions, mostly psychological ones. My own work supports its use, with a proper diagnosis, of course, for chronic pain, back pain, tension headaches, and other psycho-physiologic disorders (also known as neurosomatic or neuroplastic). You can incorporate this into your life with a smaller time commitment than meditation or even journaling. A few minutes a day is enough to start and obtain some benefit. You become more sophisticated at the fine-tuning of your affirmations over time and more adept at using them for a variety of issues and goals.
David Schechter, M.D. has over 30 years of experience in the field of mind-body medicine and chronic pain. He is the author of Think Away Your Pain, The MindBody Workbook, The MindBody Workbook for Teens and other publications.
References
Cohen GL and Sherman DK. The Psychology of Change: self-affirmation and social psychological intervention. Annu Rev Psychology (2014); 65:333-71
Cooke et al. Self-affirmation promotes physical activity. J Sport Exercise Psychology (2014); Apr: 36(2) 217-23.
Critcher CR and Dunning D. Self-affirmations provide a broader perspective on self-threat. Pers Soc Psychology Bulletin (2015); Jan: 412(1): 3-18.
Epton T and Harris PR. Self-affirmation promotes health behavior change. Health Psychology (2008); Nov 27 (6): 746-52.
Ferrari R and D Louw. Effect of a pain diary use on recovery from acute whiplash injury: a cohort study. Journal of biomedicine & biotechnology
(2013); 14: 1049-1053.
