Program Comparison

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There are numerous TMS treatment programs, and while they all serve the same purpose, helping people become pain free, they have different techniques and guidelines on how to achieve this goal. The purpose of this project is to compare these programs and see how they are different and what characteristics are common in these programs. This document will serve as a guideline to developing a new treatment program.

What They Have in Common

All TMS-related books consist of some form of a treatment program. This program is located at the end of the book. The first part of the book consists of information regarding TMS in order to educate the reader on the condition. This part of the book serves as a persuasive tool that not only proves to the reader of the legitimacy of TMS, but also of the author's knowledge and ability to heal the reader. Programs that use the term TMS tend to provide an overview of Dr. Sarno, and how he developed his theory. Others such as Schubiner, Clarke, and Siegel, while they may mention Sarno, do not go into depth about his history, and do not use the term TMS.

One of the biggest commonalities between the programs is that they all have a list of conditions near the beginning of the book. Schubiner lists 32 symptoms, Selfridge lists 19, Clarke gives 28, Brady 15, and Schechter does not provide a list of symptoms but does mention about six and TMS. Books like Back Sense and Back and Neck Pain do not have lists, but they are concerned primarily with one symptom, so a list is not vital. By listing the conditions readers will be able to see if the program can work for them. They want to see their symptom listed, so they will have confidence that the program will work.

The next major component of the programs consists of a diagnosis section. Once patients realize their condition may be TMS, they need to have some form of diagnosis. Fred Amir's book consists of 7 questions a patient should ask to see if they have TMS. The questions are concerned with the persistence of pain, pain having no clear cause, and the lack of swelling. This is done immediately following the history of Dr. Sarno. Several other programs ask the reader to answer more in depth questions and write out what some stressors are in their life. Clarke first advises people to see a doctor, and then asks them to write about stresses in their life. Siegel asks readers to write about how previous treatments have worked, how ideas about their pain have changed, and how rest has affected their back in the long term. Schubiner has an extensive questionnaire that he uses to help readers diagnosis themselves. It includes listing when certain conditions began, an investigation into their childhood asking questions about their relationship with their father, mother, siblings, a focus on “Core Issues”, and a comparison with MBS personality traits. The questionnaire ends with the reader filling out a form that asks them to list when a symptom began, the potential triggering event, and emotions that were the core issues. Selfridge does not include a diagnosis form, primarily because her audience is Fibromyalgia patients, who by the time they read the book they have usually been diagnosed with the condition. For the most part the diagnosis section comes after an overview of TMS. Readers learn about TMS, and then have a chance to see if they fit the profile.

After the books help the reader learn if they have TMS, the next section tends to discuss the tools and techniques that make up the treatment program. This is not the program section, but rather a section that seeks to teach the reader how to successfully do the exercises in the program. There are several books that begin this section by asking the reader to either fully commit to the program or make sure they want to be healed. Selfridge discusses why some people may not want to become healed in several pages. Her main point is that personal relationships may be affected when a person is no longer in pain. Due to this she asks the reader to fill out a relationship evaluation form (76-77). Fred Amir also asks his readers to make a commitment. He wants them to become motivated to recovery. He does this by having them list activities they can not do, and activities they want to do in the future. He encourages them to become angry with their inability to live the lifestyle they want, and to use that anger as motivation to focus on their recovery. Schubiner only briefly discusses that the reader should make a commitment to the program. He recognizes that people have busy lives, and suggest the reader should not add more stress to their lives by doing the program. He does however encourage the reader to schedule a time to complete the exercises. Dr. Brady also suggests that patients plan a time to do the program.

Another aspect of the tools and techniques section is that some of the books want the reader to discuss their treatment with their family and friends. Clarke suggests that a person should discuss their treatment with their family and friends specifically when they have their “self-care time,” to make sure that certain chores and obligations are met.

Time of Daily Exercises

• Sarno: 30-45 min. This time can be split up into two sessions
• Brady: at least 30 min. but can be up to 1 hour. You can break hour up into two sessions
• Selfridge: : Two separate hours each day
• Amir: about 20 min. a day
• Clarke: varies by exercise
• Siegel: Varies
• Schubiner: 1 hour a day
• Schechter: 15-30 min. a day

A majority of people with TMS have a perfectionist personality, and they tend to try to do too many things at one time. Because of this many programs encourage the reader to simplify their life and cut out some of the lease important things. Selfridge devotes an entire chapter to simplification and makes a list of questions for the reader to ask to push them into evaluating their life. She wants the reader to look at their life like an objective consultant. Dave Clark also urges the reader to simplify their life. He wants them to take an inventory of all of their responsibilities and obligations and cut out the lease important ones. Schechter also asks the reader to make a list of current stresses and then begin to solve these issues, so that they will go away. In all treatment plans it is important for the reader to investigate their life and eliminate anything that is a source of stress and anxiety. By simplifying and alleviating stress the patient is creating an emotionally positive atmosphere that can promote healing from TMS.

Now it is time to examine the tools and how programs use similar techniques. Meditation is commonly used in these programs, however there are several different ways in which it can be performed. Selfridge encourages silence and for the patient to sit in a supportive chair for 30 minutes and listen to classical or easy-listening music. Next begin breath deeply and relax each body part going from head to toes. Then imagine a majestic place and go there in your mind. Amir utilizes several mediation techniques including imaging you are doing an activity pain free, and focusing on a relaxing word and saying it several times. Schubiner's meditation program is similar to Selfridge's in that he also wants the reader to be in a quiet place. You need to begin to focus on your breath, without judging it, and then begin to scan through your body noticing each part and relaxing the parts that are uncomfortable. Next begin to notice your thoughts and feelings. Do not judge these thoughts, but simply notice them, understand how they are connected to past events, and let them go. Schubiner wants the reader to do this short exercise whenever they experience strong emotions during the day or when they are in pain. Sarno briefly mentions that meditation can be useful for people who are really busy during the day, and it can help these people think about their emotions and how they are connected to their pain.

Another aspect to almost every program is journaling. Journaling helps people examine their past, present, and personal characteristics and understand how these issues relate to their pain. Selfridge encourages the reader to write about anything other than their pain or what they did that day. The entries should be dated and kept in a journal so they can review what they have written. Schubiner uses several different journaling techniques including free writing, cluster writing, unsent letters, and dialogues. Every week the patient uses a different technique. Sarno simply tells the reader to take some time and write about their emotions. Schechter has a much more organized journaling plan, where he asks specific questions, including “what did you do today.” Brady instructs the reader to write about three different things: their past, personality, and present. They are to choose on of the things each time they journal. The reader is to focus on one topic for two-three days and then change topics. He encourages the reader to keep track of their pain intensity so they can look back on it and see how far they have come. For the most part journaling exercises are designed to be completed at the end of the day. There seems to be some disagreement on the need to have a highly organized journaling program. Some of the programs simply call for the participant to journal anything that they want, in any style they want. Others, like Schubiner and Schechter, have a much more organized approach that gives specific prompts, questions, and writing styles. I tend to think that a more structured program is better because it guides the participant along. It starts them out slow and then helps them reach a point where they are willing and able to uncover repressed emotions.

Some of the techniques, like journaling, are pretty standard and most practitioners suggest similar practices. However, while affirmations are common they have many different uses. Selfridge encourages the reader to talk with their brain by either holding a conversation with their brain, telling it that you know why it is giving you pain, or by commanding your body to stop repressing emotions and causing pain. Brady has an extensive chapter on affirmations or pain-talk where he describes principles and techniques to successfully talk to your subconscious. Primarily this involves being confrontational and firm. A person can say things out loud or in their head, but it must be firm and clearly state you what you want. A person should also use their imagination to communicate with their subconscious. Sometimes when you are journaling you can journal your self-talk by writing out things like “subconscious mind, stop now.” Schubiner also utilizes affirmations in his treatment program. After every journaling and meditation exercise he tells the reader to repeat several affirmations. He also gives several examples of affirmations the reader can say when they are experiencing pain or highly emotional situations. He considers these techniques ways to “reprogram the brain.”

Nancy Selfridge includes two interesting approaches in her book that are not extensively covered in others. First is the issue of anger. While many other books mention anger as the primary cause of TMS, other books do not provide the resources that Selfridge does in helping a person express anger. Selfridge developed an anger list that has the reader summarize the anger, locate the time, identify the source, and describe how they got rid of it. This form allows a person to adequately express what makes them angry, and what they can do about it. It gives them a forum to notice their emotions and let them pass in a safe and healthy manner.

Another aspect of Selfridge's program is her chapter on dreams. She gives an extensive account on the value of remembering your dreams and then journaling about them at a later time. While there may be some usefulness to this exercise I find that it is asking too much from the participant. By making people focus on their dreams and write down every dream they have, the program may result in the participant becoming obsessive over the program.

The structure of the programs varies drastically, yet there are some common themes throughout each of the programs. In most programs the first week is concerned with helping the participant develop the tools needed to successfully complete the program. For instance, Selfridge asks that the participant name their TMS, read the book and make plans to read other TMS-related books. She then asks the participant to schedule times to do the program, and fill out the forms about their relationships and past, present, future triggers. She ends week 1 by asking the reader to journal about how they will use what they learned in week 1 throughout the rest of the program. Similarly Schubiner begins his program by asking the participant to make a list of past and present stressors, and personality traits. These lists guide the participant in future journaling exercises. However, Schubiner does tell the participant to begin full journal activities as well as mediation exercises. Schechter's program is unique in that it begins with the participant journaling about why they feel a mindbody approach will help them. He even asks the participant about how they felt when their doctor told them there was nothing wrong with them. He also asks the participant to list their concerns or doubts about the approach. Schechter's week 1 approach is designed to get the reader to seriously examine the mindbody approach and get them committed and believing in its ability to cure them of their pain. He goes on to have the participant formulate affirmations to use throughout their treatment. The main goal of Schechter's week one is to help the participant learn about TMS. Fred Amir has an interesting approach when at the end of week one. He suggests that after finishing the first week the participant should reward themselves somehow. Siegel also mentions the validity of rewarding yourself after you achieve something in your program. Although he doesn't specifically mention buying yourself something, he does suggest that a person should keep track of their progress and pain intensity. Lastly, Brady's program is not in the same structured format as the others. He explains the exercises and how to do them, but he simply says to do the exercises for 30-60 minutes a day. He does not give specific tasks to do on specific days/weeks. In developing a program the first week is crucial. It needs to help the participant grasp the concepts of TMS and provide them with the tools to successfully complete the program. There should be some meaningful exercises that can begin getting participants in touch with their subconscious. If someone sees improvement in the first week, they will be more likely to believe in TMS and finish the program.

The second week of most programs involves the participant actively participating in all aspects of the programs. However the main goals in week two can vary drastically between the programs. Selfridge uses week 2 to help the participant simplify something in their life. She does this by having them journal about what they need to simplify and how they can do it. Throughout the week she asks them to journal about their progress on simplifying their life. In the second week of Schechter's program he asks the participant to examine how the program is working for them and to set physical and psychological goals for the coming week. The questions during this week are designed to uncover some of the participant's current and past stressors, and how they may be related to TMS. Schubiner's program in week 2 helps the participant examine their past. The journal exercise to do this is unsent letters. The participant is allowed to write a letter about how a person's past actions have affected them. He then asks the participant to meditate about past events, focus on the emotions, and then let go of the emotions. Lastly in this week Schubiner instructs the participant on how to use acupuncture points when saying affirmations. If a large portion of TMS pain is caused by past events, then it is imperative that these events and issues be examined in the second week. Simplifying one's life may help in removing current stress, and create an environment where an individual can adequately treat themselves, but it delays addressing the deep rooted causes of TMS. By helping a person come to grips with their past these programs can help individuals overcome TMS.

Week 3 in structured programs is a major week. The participant should be releasing some of their repressed emotions, and begin to see how past events have affected their emotions and triggered their pain. In the third week the primary focus is on current stressors and how a person can handle these triggers. Schubiner's program asks the participant to start a dialogue with a person, entity, or body part. Instead of writing a one voice entry, the dialogue allows the participant to interact with another party (or interact with what they think the other party would say). The meditation exercise is focused, not on yelling at the subconscious, but on gently talking with it, and asking it to stop the pain. It is a “carrot” method and the participant is supposed to reward the subconscious and tell it how good a job it is doing. Schubiner ends his 3rd week exercises by asking the reader to list some things they want to do next week, this month, in 6 months, and write down how they will achieve these goals and what some of the barriers are. There is not a primary focus on the past during this week. Schechter has a similar approach in the 3rd week of his program. He also tries to guide the reader to get in touch with their emotions and current stressors. He asks questions about what is currently going on in the reader's life, and what emotions are they currently feeling. However, Schechter also asks how these feelings relate to their childhood, and how would these emotions be handled in their childhood. Schechter still relates present events and emotions to the past. Interestingly, Schechter also asks the reader to make a list of future goals and commitments, and to brainstorm ways to achieve these goals. He also asks the reader to think about things they are doing right lately, and to “give themselves credit.” Schechter, like Schubiner and Amir, use the reward system to help patients overcome TMS.

Several of the programs are only four weeks long, so the fourth week attempts to bring several of the components together and have the reader focus on their future. Schubiner calls his 4th week chapter, Creating the New You. The writing exercises help the user understand how to live their life in a positive accepting manner. The meditation and affirmation exercises also focus primarily on telling the subconscious that the participant is open and accepting. Schechter's program also focuses on the future in the fourth week. He poses questions designed to help the participant understand how they want to live, and what sort of activities they want to participate in. The questions posed in this week also help the participant understand how to express emotions and be accepting of themselves. All in all the fourth week of a program needs to focus on pointing the participant in a direction that leads to a healthy, accepting, pain free life.

The last portion of most of the programs involves an evaluation of how the program went. The reader is instructed to examine their level of pain now to the level it was when they first started the program. If the reader is still in pain after completing the program, they are instructed to seek a medical evaluation to rule out any serious medical condition. If there is nothing structurally wrong most of the books instruct the reader to think about starting psychotherapy, and to continue the exercises described in the book. Most of the programs allow the reader to go back through them several times and work out any unresolved issues. Different people heal in different time frames, so there is nothing wrong with finishing a program and still being in pain. It just means that you have to do a little more work to be healed.

The structured programs laid out in the various TMS-related books differ according to techniques and structure, but they all seek the same goal of helping people become pain free. In the end the course of action a person takes in their treatment is entirely up to them, however structured programs can be vital in guiding a person to a pain free life.

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