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Hey everyone,

Fear is a huge part of TMS. A lot of us start TMS treatment after being in pain for a long time. We have been conditioned to fear physical activity and our symptoms, but thinking along these lines will only prevent us from recovery. Dr. Howard Schubiner wrote the following blog post on fear which I thought I would post hear. Dr. Schubiner has graciously allowed us to repost his blog articles on the wiki. The following is also on the page Relapser's Curse, there is hope.

Written by Dr. Schubiner on June 4, 2009

It has become very clear to me over the last year or so that one of the biggest impediments to recovery from Mind Body syndrome (MBS) is fear. It seems to be a part of the experience of so many people that it should be considered as a normal part of the MBS experience and therefore everyone will probably need to deal with fear at some point in their recovery. In this blog, I will take a stab at identifying the sources of fear, the meaning of fear and offer some thoughts and methods on dealing with fear.

Where does fear come from? We should recognize that fear is part of the normal experience of life. We are born with a brain system that is built to protect us from danger and harm, i.e. to help us survive in a dangerous world where we may become stalked by a predator or endangered by one of our own species; another human being. This system resides in the deeper parts of the brain (sometimes called the “reptilian brain”), it operates all of the time by constantly scanning the environment for danger, and it is clearly in the subconscious (or unconscious) part of the brain, i.e. we are not aware of its actions until after it has acted. When we sense danger, the brain sends immediate signals from the amygdala (the emotional center of the brain) to the hypothalamus (where the autonomic nervous system resides) to cause some kind of action in our bodies. Again, this occur without conscious awareness and our bodies are programmed to react to danger by activating the fight or flight reaction pathways. After our body reacts (with muscle tension, gut or bladder tension, and many other reactions), we THEN become aware of the sensation of fear. Interestingly, studies have shown that people who are paralyzed have lesser degrees of the sensation of fear (and other emotions).

So, everyone will experience fear at some points in our lives. In addition, studies have shown that scientists can develop rats which are more or less fearful, suggesting that there is also a component of fear which can be inherited. Therefore, it is likely that some people are born with more or less predisposition to feeling fear. Of course, we are also a product of our environment. People who are brought up in homes or environments which create a sense of danger (of being hit, of being yelled at, of being abused, of being criticized or teased or taunted) learn to be afraid. Once they learn fear, it is much more likely that they will experience higher levels of fear later in life when they are exposed to situations which create a sense of danger, especially situations which are similar to their early experiences, such as fear caused by a powerful authority figure, or by situations which remind them of early stressors. This is the most important thing to understand about the development of MBS. People who take a very careful look at their life experiences will almost always find these connections between early life experiences and situations which trigger the onset of MBS symptoms later in life. When I conduct my clinical examinations (which take 90-120 minutes), I search carefully for these connections and most people (even those who are experiences in this area) are amazed at the simplicity and power of understanding the specific causes of their MBS symptoms.

In addition to external dangers and early life experiences as sources of fear, human beings have the unique ability to think backwards and forwards. We can have concerns about things we either did or didn't do in the past and these can cause worry and fear (not to mention guilt, regret, resentment, and/or anger). And obviously, we can think about the future and develop concerns that can cause worry and fear. It is this part of fear that is most commonly evoked when dealing with MBS.

During the recovery from MBS, several thoughts are likely to occur to everyone. These are things such as:

“I am afraid that I'll never get better and will be in pain forever.”
“I am afraid that I will re-injure myself and get the pain back again; and then it will be even harder to get rid of.”
“I am afraid that I won't be able to relax enough to do the psychological work required.”
”I am afraid that I will have more stress in my life and that will cause a recurrence of pain (or other symptoms).”
”I am afraid that I will not be able to change my situation and therefore will never recover from MBS.”

Briefly stated, all fear arises from learned inbred and learned experiences of fear, which are compounded by the worry of some future uncomfortable mental or physical state. When we are feeling better, fear tells us, “This will not last. You will relapse and feel worse.” When we are feeling poorly, fear tells us, “This is forever. You will never recover.” Listen to those statements. How do they make you feel? Even in me, writing this at a moment when I feel perfectly fine. These statements create a sense of dread that is palpable and comes from deep within my mind.

Fear creates more fear. The more we believe what fear tells us, the more fear we will have and the deeper we will learn the brain pathways that create the experience of fear in our bodies and in our minds. As people go through the process of healing their MBS, they are often successful (at least to some degree) in reducing their MBS symptoms. This is commonly when fear arises. Fear is one of the main causes of MBS (along with anger and resentment, guilt and shame) and when we retrain our brains to reduce physical symptoms, fear often rears its head and begins speaking to us. It is a good sign when this occurs, because the emotions are closer to the source of the pain and this means that we have peeled off a layer within our minds and therefore we are getting closer to full healing. Of course, we are often not used to experiencing fear and it can be incredibly uncomfortable. I have seen several people who began to feel fear as their pain began to resolve and their response to this was to retreat into pain (actually to welcome their pain back because they were “used to their pain and knew how to cope to some degree with the pain” while the fear was much too uncomfortable to bear.

So, how can we deal with fear? I will present a series of thoughts and methods that many have found useful. It is often helpful to try many or all of these techniques and to be very resolute in your approach to dealing with fear. Fear can be a vexing problem and it may take many weeks or months of thought and effort to overcome. However, the battle is critical. When you learn to deal with fear, you will become a much healthier and happier person. You will learn a great deal about yourself and about the condition of being human. You will be on a journey towards a higher level of cognitive, moral and spiritual awareness and growth. So, dig in. This is fantastic work that relatively few people undertake. But it is well worth it.

1: Recognize fear for what it is.

Fear is universal; it is a part of everyone and is to be expected to occur. So, don't fear it; don't fear fear. As mentioned, fear feeds on itself. Look for it to occur. Be aware that when you feel fear, you are experiencing an emotion that is inbred and that has been learned. You will never exist as a human being without the capacity to feel fear. However, you can learn to co-exist with it and learn to cope with it when it arises to the point where it threatens to overwhelm you or make you feel uncomfortable. Fear occurs for a reason. Your mind is trying to protect you. It is up to us to figure out what the situation is that has caused fear and to respond to our brain.

2: Recognize the situation that is causing fear.

What is going on? Is it fear of never getting better? Fear of recurrence? Fear of a situation in your life? Fear of someone? Fear of looking into yourself? Fear just because you've always been afraid? Fear of fear? If your mind is trying to protect you, what is it trying to protect you from? Is this a realistic fear; i.e. is there something to be afraid of right now at this very moment? By that I mean, is there a grizzly bear in your room right now or is there someone trying to hurt you at this very moment? You may have someone who is trying to hurt you in your life, but that is probably in the future. Are you worried about the future? If so, that is not what is happening in your life right now, this very second. It is much easier to deal with fear if you recognize what is causing it and if you can realize that there is no IMMEDIATE danger to your body.

3: Recognize what the fear is trying to teach you.

Fear is one of our teachers in life. It is there to tell us something very important. It is our minds way of talking to us. Therefore, we can look at it as a way to understand ourselves better. If we become aware of what are some of the underlying causes of the fear, we will begin to see what things we have to do in our lives to allay the fears. If there is a particular person who causes fear, we need to learn ways of dealing with that person or ways of ignoring them. If it is our own mind telling us that we will never get better or we will relapse, we need to learn how to quiet that voice, learn to ignore it, learn to let it pass on by, and even learn to laugh at it.

4: Learn to face your fears.

Albert Camus said that “travel is exciting in part because it is dangerous.” Fear makes us realize we're alive and a little fear is good for us. If you're having MBS symptoms or are fearful that they will recur, it is critical to tell yourself that you are OK, that you can tolerate MBS symptoms, that they won't hurt you. Pain due to MBS cannot hurt you. It cannot damage your tissues or cause death. You have had pain or other MBS symptoms before and if you have them again, you will be OK. It's not such a horrible outcome. You are strong and healthy. You must continue to tell yourself these things. This is an antidote to the words of fear. Talk to yourself and talk to your body and your mind. You cannot be hurt by fear either. Tell yourself that fear is just an emotion from your past. It will arise from time to time, but it is not permanent. It is a temporary response to thoughts and situations. Just as it comes, it will go. If you relax with fear and face it, it cannot hurt you.

5: Use meditation techniques.

As a mindfulness meditation teacher for many years, I have helped many people cope with fear and worry. In the online educational program I have developed to help peole overcome MBS, there is some training in mindfulness techniques. Mindfulness teaches us to listen to fear and other emotions and to learn to notice them without reacting, accepting what has occurred and letting go. Learn to notice fear from a distance. You can feel it without as much of a reaction; you can watch it arise in exactly the same way that you notice that your breath. If you don't react strongly to fear, you are breaking the cycle of fear feeding fear. Accept that fear has occurred. Look at it; listen to it; learn what it is trying to tell you. Realize that it cannot hurt you if you don't react to it. Then learn to let it go. Tell it that you are not going to be overcome by it. It is not correct when it says you will not recover. That is just a thought that can be rejected. Pema Chodron's book, The Places that Scare You, can help. So can Tara Branch's book, Radical Acceptance. There are mindfulness meditation teachers all over the world who can help. One resource for finding them is on the web sites of the University of Massachusetts Center for Mindfulness, founded by Jon Kabat-Zinn and currently directed by Saki Santorelli.

6: Use reasoning skills to reject the message of fear.

You are going to get better. You are not going to relapse or if you do have some recurrences of pain or other MBS symptoms, you will be able to tolerate them and recover from them. The messages you are getting from fear are WRONG. The methods of Bryon Katie as described in week four of the online program and this approach will help you to recognize your incorrect thoughts and will help you learn how to dismiss such thoughts. The videos on her website (www.thework.org) will help you see how to change thoughts which are incorrect and harmful if you continue to believe them.

7: Express your fears/cope with your fears by writing and speaking.

The writing exercises that I have included in the online program are examples of therapeutic writing. Therapeutic writing is an excellent to express emotions, to understand why you may have them, to learn to cope with them more effectively, to learn to accept certain situations, and to make decisions about courses of action. Several books have been written on therapeutic journaling, such as Writing the Natural Way by Gabrielle Lusser, Writing Down the Bones by Natalie Goldberg, Writing Without Teachers by Peter Elbow, and The New Diary by Tristine Rainer. Just as it can be helpful to write about physical symptoms, it can also be helpful to write about fear itself. Some of the techniques that are included in the online program are fast writing, unsent letters and dialogues. These are different methods which can be used to express and process emotions. In addition, it can be very helpful to express your fears out loud and to deal with them by speaking to them and to your body. These exercises are included in the online program under the heading, “Reprogramming the mind” and are also described in many of Dr. Sarno's books and books by Nancy Selfridge, Fred Amir and Scott Brady. An excellent workbook for healing MBS has also been developed by Dr. David Schechter.

8: Taking action to deal with sources of fear

For many people, there are some life situations that are causing fear and other emotions. Often people feel trapped and helpless due to a situation in their family, at work or in their neighborhood. In these situations, it is often necessary to take action of some kind, if possible. Wisdom is always required to decide if there are actions that can be taken or if this is impossible. The Serenity Prayer describes this situation and people often need courage to take action. However, if you believe that action is necessary and possible in your situation, please find that courage and act. You won't regret it. It can be freeing to act in ways that show your courage, your assertiveness, and your kindness to yourself.
Another critical thing to do is to confront the patterns your body has learned. Many people have become afraid of physical activity and in particular of activities which have caused MBS symptoms in the past. A wonderful example of someone who have taken this on is described in the last blog; a story by Brad. It take courage and confidence to do this, but the more you are able to be active and confront old patterns of body pain, the more courage and confidence you will have.

9: Acting with purpose and gratitude; being kind to self and others, forgiving self and others

Finally, one can often allay fears by acting in ways which produce positive feelings. There are several ways to do this.
–Create a list of things for which you are grateful and writing about those things.
–Figure out what gives you purpose and meaning in your life and acting in ways to incorporate those things.
–Do things which are fun for you. Take time each week to do things which make you happy and are enjoyable. Many people with MBS have difficulty doing this, but it is precisely these people who need to take this time for themselves.
–Practice being kind to yourself in little and large ways each day and each week.
–Take time to be kind to others (but only do this if you are also taking time for yourself). Kindness to others without kindness to self is not a prescription for health or healing.
–Decide on forgiveness. If some life events call for forgiveness, consider granting that forgiveness, especially if it is for yourself.

A good web site for learning more about developing positive emotions is www.authentichappiness.sas.upenn.edu

I hope this blog has helped to clarify the role that fear plays in our lives. We need not be afraid of having fear if we learn to recognize it, accept it and learn techniques of reducing fear when it arises. Remember, it is normal to have fear and learning from fear is something that will further your recovery from MBS, enhance your confidence in yourself, and further your development as a healthy, aware, conscious human being.

To your health,
Howard Schubiner, MD
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