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This dovetails perfectly with the Butler & Moseley approach to treating pain. They say: "You will have pain when your brain concludes that there is more credible evidence of danger in me (DIM) than there is credible evidence of safety in me (SIM). Explain Pain Supercharged p. 17 (2017) (I added the italics). One problem is that your brain does not always regard simple brain talk like "I'm safe" as credible evidence.

More strikingly, they say: "[E]ven if problems do exist in your joints, muscles, ligaments, nerves, immune system or anywhere else, it won't hurt if your brain thinks you are not in danger. In exactly the same way, even if no problems whatsoever exist in your body tissues, nerves or immune system, it will hurt if your brain thinks you are in danger. It is as simple and as difficult as that." Explain Pain p. 8 (2nd ed. 2013). This accords in some respects with Alan Gordon's Pain Recovery Program. Alan's Day 2 lesson titled The Nature of Pain says Pain = Danger.

Butler and Moseley are not New Age mystics. They started out as physical therapists but Moseley then earned a Ph.D. in pain science, was a research fellow in neuroscience at Oxford in the UK, and is now a prominent researcher and prolific author of professional journal articles on the neuroscience of pain. Butler earned a Ph.D. in education "to further his professional love of devising ways to take the complex ‘gifts’ of neuroscience to students, clinicians and sufferers in ways that can change their lives." Without getting into all the complex "gifts" of the central and peripheral nervous systems, one example is that if your brain thinks you are safe, it triggers the production of endorphins, but if your brain thinks your are in danger, it does not. "Endorphin" is a clever amalgam of two words: ENDOgenous + mORPHINe. Endorphins shut down pain sensors as effectively as exogenous morphine, if not more so, but without any of the adverse side effects.

The task, as Butler & Moseley see it, is to maximize SIMs and minimize DIMs in your life. They define a DIM as "anything that is dangerous to your body tissues, life, lifestyle, job, happiness, your day to day function - a threat to who you are as as person." They define a SIM as "anything that makes you stronger, better, healthier, more confident, more sure and certain - within and about yourself." The Explain Pain Handbook: Protectometer p. 16 (2015). They identify seven categories of DIMs and SIMs, such as things you do, places you go, people in your life, what you think and believe, etc. They note that what is a SIM for one person might not be for another, e.g., doing yoga might be a SIM for some people but, I must say, is not a SIM for me; and they note that what might be a SIM for one person might even be a DIM for another person, e.g., going into the hospital.

I was able to overcome more than two decades of low back pain with the help of Sarno's Healing Back Pain by becoming aware of when I was angry but did not realize it. For Sarno, the major cause of TMS is repressed anger, and we repress anger (mainly anger at people we are close to) because we learned in childhood that it is a dangerous emotion to experience. After my success in eliminating low back pain, I had what Sarno calls the symptom imperative, i.e., other TMS symptoms. I was able to overcome those symptoms with the help of Butler & Moseley. Repressed anger is only one thing (one DIM) that can cause your brain to conclude you are in danger rather than safe. There are potentially many other things that can be DIMs, and as Butler & Moseley say, they can hide in hard to find places.

I think anyone not getting relief from Sarno's approach might consider giving Butler & Moseley a try (but without abandoning Sarno). Their books are not inexpensive but can pay big dividends, especially their first two books. Their Protectometer book is intended to help one minimize DIMs and maximize SIMs, but it is pretty short and, in my opinion, contains too little neuroscience information to stand alone and is best read together with Explain Pain (2nd. ed. 2013). Their third book, Explain Pain Supercharged, might also be of interest for its advice in chapters 8 and 9 (even though the advice is aimed at therapists), but I caution that it cannot be understood without reading their first two books and that chapter 3 is a daunting read that is definitely not for everyone.