Dr. Hanscom's Blog Thought Suppression and Chronic Pain – White Bears and ANTS

White Bears
Trying not to think about something will cause you to think about it more. All of us know this phenomenon but we don’t know how to deal with it. The most deadly emotion we suppress is anxiety. It is a survival response and our whole being is repulsed by it. Prolonged exposure to raw anxiety is the worst part of the human existence. It is a universal problem that few people want to admit to much less discuss.

A few weeks ago I was discussing the problem with one of my best friends, George. He has an 11 year-old son, Nate, who is personable, athletic, good-looking, and has many friends. He has a wonderful family life. George has engaged his family with many of the principles of dealing with Mind Body Syndrome. (MBS) One of the exercises is the writing down of negative thoughts and throwing them away. Recently he suggested that Nate draw a picture of himself with these thoughts.

He showed me the drawing. It was brutal. “I am ugly. I have no friends. No one likes me. I am stupid.” The list went on for 15 thoughts that were equally as negative. How could this be? Really……. He is living a childhood that is truly enviable.

In 1987 Dr. Daniel Wegner, a Harvard psychologist published a paper, The Paradoxical Effects of Thought Suppression. (1) The experiment is commonly referred to as “White Bears”. He asked a group of students not to think about white bears. He designed it in a way that demonstrated that when you try not to think about something, not only do you think about it more; you think about it a lot more. He used the term, “trampoline effect.” He pointed out in an essay; The Seed of our Own Undoing, that simply writing down or saying the thoughts you are suppressing interrupts the phenomenon.

ANTS

David Burns in his book, Feeling Good (2) uses a term he calls “ANTS”, which stands for “automatic negative thoughts”. These ANTS are a universal part of the human experience. Since I picked up his book in 1990 I have always wondered why we don’t have “APTS” or “automatic positive thoughts.” WE DON’T SUPPRESS POSITVE THOUGHTS.

Pain, ANTS, and White Bears

People suffering from chronic pain lose their sense of humor. Pain causes anxiety and when you are trapped by it, extreme frustration and anger will run your life.

Anger results from loss of control. What causes the need for control is anxiety. Anger is just anxiety on steroids. One step worse than suppressing anxiety is suppressing anger. The eventual outcome is rage. My term for the darkness that consumes my patients in pain (and historically me) is the “abyss.”

There is a Solution

I have learned that pain, anxiety, and anger are classic symptoms of the Mind Body Syndrome (MBS). Dr. John Sarno first described it in the 1980’s under the term, “Tension Myositis Syndrome” (TMS). (3) There are least 30 other MBS symptoms connected to and caused by the nervous system. (4) The nervous system component is NOT psychological it is a programming issue. Like any learned skill such as riding a bicycle these pathways are permanent.

Anxiety is not an emotion – it is a mental reflex. It is a link to behavior that causes you to react in a way to protect yourself. You can talk about it all day long but you cannot get rid of anxiety pathways nor can you eliminate pain pathways.

Fortunately your brain can do only one thing at time. That is why we are not safe texting and driving. When your mind is here it is not there. By creating alternate pathways around your fixed circuits you can shift your nervous system into a new set of pathways. Additionally we now know your brain can grow new nerve cells at any age. The term is “neuroplasticity.” At a certain tipping point your pain pathways will become dormant. The switches are turned off. Anxiety and anger also will dramatically drop.

I have had 16 of the 33 symptoms of MBS disappear. I not only have my life back, I have a new life.

Connecting thoughts with physical sensations is one way of creating new pathways. One foundation of treating MBS is the simple the act of writing down your negative thoughts and immediately throwing them away.

But I often cannot persuade my patients to begin this exercise. It’s a necessary first step of the reprogramming process, which is to create an awareness of these ANTS. The thoughts that come out are often unspeakable. My patient’s first response is, “This is not who I am.” That is correct. These thoughts are not who you are. They are JUST neurological connections and actually the opposite of you who are. Otherwise you would not be suppressing them. You are only giving them life by blocking them.

We all know that being reassured that our hidden thoughts aren’t valid does not make them disappear. I could collect dozens of signatures and testimonials from Nate’s peers and give them to him. He could win a “greatest human being contest” along with a big trophy. How would that work? I predict, based on my personal experience with MBS, the next set of thoughts would be centered on, “they don’t really know me.”

What if we could teach these simple writing exercises to our children in pre-school? We would have a shot at solving chronic pain at a societal level.

1. Wegener, D.M., et al. “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology (1987); 53: 5-13.
2. Burns, David. Feeling Good. Avon Books, 1999
3. Sarno, John. Mind Over Back Pain. Berkley, 1999
4. Schubiner, Howard. Unlearn Your Pain. Mind Body Publishing, 2010.

 

I really want to understand what you're saying here but I am confused.
How do you "connect thoughts with physical sensations," and how does that relate to writing down negative thoughts?

For example, when I am in pain it is really hard for me to "accept" or "ignore" the pain. I can't help thinking about how much pain I am in. Should I simply write down "I am in pain" and throw that away? Or are you suggesting something else that I am not understanding?

 

Gailnyc, I think what he is saying that you should identify the thought that is causing you the emotion that is causing you the pain. I agree with the CBT folks that negative thoughts will produce negative emotion and that can often produce pain, especially if you repress the thought. However, I don't believe that all negative emotion and pain originates with negative thoughts. Sometimes we experience negative emotion with no thought behind it. This is where I think CBT may not help. Deep psychology approaches may be of more help here. Frankly, writing down negative thoughts and throwing them away did not work for me. Writing them down only helped me to see what I might be repressing or suppressing and allowed me to realize what beliefs were not serving me well.

 

I also really want to understand what you're saying here, but am confused. Maybe I'm not clear on the difference between "suppressing" and "repressing". My understanding of "suppression" is that it is a conscious act, for example I might be completely aware that I am really angry with my boss but I would "suppress" that anger (consciously NOT express it to my boss) in an effort to stay employed. My understanding of "repression" is that it is an unconscious act, in that I wouldn't even consciously know I was angry with my boss to act on the anger.

David Burns' book have been super helpful to me in the past and I am familiar with his thoughts on ANTS. Am I correctly understanding here that the act of recognizing the negative thought and consciously choosing not to act on it (suppressing) and then journaling about the event later is not enough to begin the reprogramming process? Does the process require the negative thought be the center of attention in that it gets written all by itself somewhere and discarded? And I guess my follow up to that would be, where do the "repressed" negative thoughts come into play? I might be wrong, but I believe for myself the majority of my difficulty comes from the "repressed" negative thoughts - the ones I don't even know I'm having. How do I move these from being repressed to suppressed, which if I'm understanding correctly here, would need to happen before I could take the necessary first step of the reprogramming - writing them down and throwing them away?

 

I think some clarification is required here. First of all, let me state that I am not a doctor or psychologist and am only using my own personal experience. I am quite familiar with the work of David Burns and his books helped me a lot with day to day issues. However, I would caution that CBT (Cognitive Behavioral Therapy) is pretty lightweight when it comes to handling psychological problems. I say this because CBT basically only deals with the material that is available to the conscious mind. We can all do this if we just use some mind control regarding negative thoughts (that cause negative emotions). For example, and this is a David Burns example, lets say we walk out to our car in the morning and find that there is bird droppings on the windshield. So we say to ourselves: "It figures, birds are always crapping on my car". If you employ CBT principles here, you will challenge the reality of what you just said to yourself by saying "Gee, I really can't remember the last time a bird crapped on my windshield" and realize that your first negative thought is really not true. And, actually, we now know that that this is probably not a really good strategy anyway because the mind tends to want to persist in negative thoughts longer when they are challenged. So you just end up in a big argument with yourself, which means you have just gone from bad to worse. It is better to just notice the negative thought without judgement and let it float by or through you, but in any case, make some space for it. If you want to write down a negative thought and symbolically throw it away, which you could do with "suppressed" negative thoughts, this does help some people, but it never worked for me. I guess the point I am trying to make here is that CBT cannot work well with "repressed" emotion and thought, because CBT's subject matter is only the psychological material that is available to the conscious mind.

On the other hand, if you are talking about "repressed" psychological material, you are talking about material that is not available to the conscious mind. We know this must exist because, whenever we do, say or think anything that we do not immediately understand, it is probably ties in with with some sort of unconscious material or primitive belief system. CBT cannot help with this. CBT has it's limitations. If you can write it down (unless you have mastered automatic writing, that is writing directly from your unconscious), then it is not repressed. Also, one needs to be careful when fooling with "repressed" material. One does not know what is repressed (it could really shock you), or why it is repressed, or what could happen if it suddenly popped into consciousness. This is the field of Depth Psychologists. They can help you get in touch with this material in a safe way in order to integrate your fragmented personality. In other words, Depth Psychologists are trained to handle material that is below the level of consciousness and CBT
practitioners are trained to handle material that is available to consciousness awareness, such as logical thinking errors, etc.

Since the core issues surrounding TMS deal primarily with repressed material, I don't feel that CBT is always the best strategy. Of course, it will help us to avoid exacerbating our pain and discomfort in a conscious fashion. But it is unlikely to get at the "core" of a serious TMS problem. I think this is often why people get "cured" and then years later, have the same type of problem resurface. Of course, some people do not need psychological therapy to get over TMS, they just need the knowledge that the pain is TMS and is harmless. I believe we don't really know why some get over TMS quickly and some don't. We don't know much about the general nature of unconscious material.

 

Great job explaining it, chickenbone. I think that CBT is a lot like affirmations in that it needs to be mixed with more depth-based approaches like psychodynamic therapy to be helpful. Affirmations alone are not enough, but they can be a helpful complement to deeper explorations from therapy or journaling. The problem comes from the fact that scientific studies have shown CBT to be so effective at treating conditions like depression and anxiety that some people just do the superficial CBT work without doing the deeper exploration. That just leaves the deeper issues unexplored and is fundamentally missing the point.

I don't know if you've watched the interview with Nicole Sachs yet, but let's take her case as an example. She was a single mom and being a single mom is incredibly stressful. Toddlers can be the most wonderful thing in the world, but they can also be enraging. Part of us may even grow to hate the way that they make our lives so much harder. But we can't face the idea that we might hate our lovely babies (it's hard to even say the idea), so we repress the emotion of rage. To even entertain the idea of hating our babies makes us feel like bad people, so we repress it.

Using an affirmation, Nicole could have said, "I am a good person and I don't have anything but positive feelings for my babies," which would have denied and repressed her underlying rage. It wouldn't have solved that underlying tension and probably would have just made things worse, because, as Dr. Hanscom explains, we can't fight things that we know to be true. If part of us is furious at these babies that we also love, then we can't just repress that part of ourselves. That would be like trying not to think about white bears. (I bet you're thinking of white bears now. Stop it! Stop thinking about white bears! ... I bet you can't. Now you will be stuck thinking about white bears for a while, lol. Sorry, but that's what happens when you try to repress a thought - it doesn't work!)

Anyway, just as Nicole could have used affirmations counterproductively, she also could have used a CBT approach. A good example of CBT is drawing up an evidence sheet for why a physical explanation of your symptoms simply doesn't make sense. The goal is to marshal your rational mind to counterbalance old irrational conditioning. A bad example would be if Nicole had said, "My children are wonderful and I love them, so I can't be angry at them. I only love them and I have no rage." That would be just as silly as trying not to think about white bears because, fundamentally, she was furious at her rebellious children.

Instead, she took the approach that leads to long term health. She journaled and, using journal-speak, she realized that her reservoir of rage was just about full and that part of her hated being a mother. She even realized, if I remember correctly, that part of the reason why she hated them was that they reminded her of their father, an insight that had previously been completely unconscious. This is exactly what Dr. Hanscom suggests. She wrote the emotion down in her journal to get it out of her system.

Of course, she might have been left with some residual shame about her feelings. This is where good affirmations and good CBT comes in. Just like there can be bad affirmations and bad CBT that doesn't build on a foundation of deep insight, there can also be good affirmations and good CBT that does.

So, for example, maybe she feels some deep shame about her feelings. That shame could become an Automatic Negative Thought (ANT). Rather than repressing this negative thought, she could write it down, crumple it up, and throw it away. Alternatively, she could use an affirmation such as, "I am a good person and a loving mother." Finally, she could use a more cognitive approach (the C in CBT is for cognitive - it just means using your thoughts) and could argue with the part of her brain that still feels the shame. For example, she could say, "yes, I feel hate toward these children, but as a goodist I try so hard to be a good mother that sometimes RAGE builds up and that doesn't mean that I am a bad mother. In fact, my children are my life and I love them more than I can put into words."

Once we have a foundation of understanding and have dug up the unconscious feelings as well as we can, there are a number of tools available to dispose of the automatic negative thoughts that we might be left with. We can't always make all of our unconscious thoughts conscious. Some of them may simply be down too deep and it might take decades before we are finally ready. However, a good understanding of the unconscious is crucial to use the more superficial tools of affirmations and cognitive reframings effectively.

 

PS, if you haven't watched the Nicole Sachs interview, it's really great. An inspiring example of how important the work is and how we can heal.
http://www.tmswiki.org/forum/threads/interview-with-nicole-sachs-lcsw.1715/