Dr. Schubiner's Blog Dealing with Doubts, Fear, and Worry

Written by on October 2, 2008

Several people have asked me how they can deal with troublesome thoughts and emotions that arise. These thoughts and emotions, such as doubts about really having TMS/MBS or worry if you'll ever get better or fear about developing pain, are extremely common. Everyone has those from time to time or even very frequently.

So, how can you deal with doubts, fear and worry? You may worry about having some medical/physical problems instead of MBS/TMS and how do you deal with others when they challenge your view of MBS/TMS and suggest that there is some medical/physical problem going on. These questions boil down to two main issues, I think. The first has to do with doubt about the diagnosis of MBS/TMS. The second has to do with the issue of the power of thoughts and emotions.

Dr. Sarno always (correctly) says that we need to “erase doubt.” People always do better in the MBS/TMS program when they are convinced that their physical and psychological problems are due to emotions, stress and reactions to stress, both conscious and unconscious. However, we are in this boat because we are human, i.e. we have minds and bodies and they constantly interact. Because we have minds, we will frequently have thoughts that make us wonder if we're on the right track. I spoke to a lady today who told me that she must have something physically wrong because her pain was so severe, despite the fact that her pain had gotten much better after one week of working with the MBS/TMS program. So, it is important to erase doubt, but some doubts will undoubtedly creep in. Severe pain can definitely impair your ability to think and process emotions. It can lead to depression and more emotions, which can further impair your ability to cope with pain and which can itself lead to more pain. Some doctors also suggest that severe pain can lead to decreases in efficacy of anti-depressant medications, thus compounding the problem further. The more pain, the more doubt and then things can get spiraling out of control. In those cases, you really need to stop and go back to the beginning. You may need to seek medical advice for reassurance that there is in fact nothing more serious going on and you may even need some more testing to confirm this.

This leads to the second issue: the power of thoughts and emotions. It is critical to realize that thoughts are uncontrollable, i.e. one can never choose what thoughts will come into their heads. The mind will continually come up with a huge variety of thoughts, many of which are unproductive, weird, wild, inane, or beautiful. If we can't control out own thoughts, one certainly cannot control other people's thoughts, and therefore we must learn ways of dealing with thoughts and reacting to thoughts or else we will be at the mercy of every stray thought that we (or someone else) comes up with. And, of course, it is not only thoughts that we need to deal with, but emotions as well, which are basically thoughts that are connected to important material from our past.

After doing a lot of research on how the brain works, I have developed a model to explain how MBS develops in the brain. You can watch a video about this on my web site,www.yourpainisreal.com. When pain occurs, it activates nerve pathways which send those pain signals to the brain and particularly to the amygdala, which is the emotional center of the brain and the area that can immediately activate the autonomic nerve system (ANS), which is the unconscious connection to the body to create the fight, flight or freeze reaction. These reactions are immediate, so that if you feel the pain of a burning match, you will immediately pull your hand away before you can even think about what is happening. This reaction occurs within 12 milliseconds, much faster than could occur if you had to send those signals up to the frontal cortex where you would become aware of them consciously. This reaction protects us from danger and happens without our conscious awareness.

How do troublesome thoughts, fear and worry affect this reaction? Research studies by Dr. John Burns in Chicago have shown that fear decreases the pain threshold, i.e. when we are worried or anxious, we cannot tolerate as much pain. Many brain MRI studies have shown that the anterior cingulated cortex (ACC) is activated when we are in pain. This part of the brain is higher than the amygdala and ANS and processes these emotions. Fear, worry, anxiety all activate the ACC, which in turn activates the amygdala and the ANS to produce physical reactions in the body, such as pain and other symptoms (including symptoms in the GI tract and urinary system). When the ACC is activated, the dorsolateral prefrontal cortex area (DLPFC) is inactivated and vice versa. The DLPFC is even higher up in the brain and the area in which we can consciously process emotions. When we process emotions and calm ourselves down, talk to ourselves to help us relax, remind ourself that we are OK, that there is no real danger, then the DLPFC is activated and then the ACC will automatically become inactivated. This will turn off the ANS and amygdala responses which activate pain. As I often say, my whole program is designed to activate the DLPFC!!

Ways to activate the DLPFC are my meditation, by writing, by processing emotions, by coping with the stresses in our lives, by confronting the issues that hold us back and keep us in a state of worry, fear, anger or guilt. In other words, all the activities and exercises in the program are designed to decrease the ACC and increase the DLPFC.

An important method that is often a great first step comes from the practice of mindfulness. The first reflection/meditation in the MBS/TMS program gives you a crash course in mindfulness. The essence of mindfulness is to be aware of the present, accept the present moment without having to react to it or respond to it, and then choose to let that moment go in order to pay attention to the next moment. Or, of course, we can choose to act and do something about the thought or emotion we have just noticed. This practice teaches us to be aware of thoughts and emotions without having to react to them, without having our bodies react to them, without allowing the mind to cause pain or other physical symptoms as it has done in the past.

So, listen carefully to the first meditation and practice paying attention to all thoughts that arise, no matter if they are silly, happy, sad, scary, or divine. As you listen to the reflection, practice this: Notice each thought, accept each thought as “just a thought,” and let it go. Then do the same thing as you go through your day: Notice thoughts and emotions, accept them as just thoughts and emotions, and choose to let them go.

As you practice paying attention without reacting to thoughts and emotions, you will learn to free yourself from the tyranny that your thoughts (and other people's thoughts) can have.

One important point: If thoughts (such as doubts) and emotions such as worry and fear can cause you to have pain or other physical symptoms, it is highly likely that those symptoms are due to MBS/TMS. Makes sense, doesn't it? That, in itself, should help you erase doubt. Then you can see that you really have to deal directly with the thoughts and emotions. These are what drives pain and other MBS symptoms.

Emotions are usually seen as scary and our usual response to emotions is to try to push them away and get rid of them. It doesn't feel good to live with fear and worry. Unfortunately, the more we try to push them away, the more they tend to have power over us. The mindful approach is not to fight them or be afraid of them, but to notice them, accept that they are here and learn from them. We can treat them as something important coming up from our minds (both conscious and unconscious) that we can learn from and need to learn from in order to get better.

See the poem from Rumi below to get a totally different perspective on emotions. Write me if you want to learn more about this critical topic.

To your health,

Howard Schubiner, MD

The Guest House

By Rumi

This being human is a guest house

Every morning a new arrival.


A joy, a depression, a meanness,


some momentary awareness

comes
as an unexpected visitor.


Welcome and entertain them all!


Even if they are a crowd of sorrows,


who violently sweep your house


empty of its furniture.


Still treat each guest honorably.


He may be clearing you out for some new delight.


The dark thought, the shame, the malice,


meet them at the door laughing,


and invite them in.


Be grateful for whoever comes,


because each has been sent
 as a guide from beyond.

Disclaimer: It is important to recognize that the information contained in this blog, whether posted by me or anyone else, cannot be considered to be specific medical diagnoses, medical treatment, or medical advice. General information about MBS/TMS will be posted in response to questions, but you will need to decide if this information is relevant to your situation and, as always, you should consult with your physicians and counselors regarding new symptoms and any changes that you might make in medications or activities.

 

This is important information and I thank Dr. Schubiner for making it available to us. Mindfulness and being in the present moment is important for me. I have heard this saying and think it is great. If you have on foot in the past and the other in the future you are ...tinkling... on the present. And another that the present is a gift. ( this one goes over better at Christmas)

Oh, and I just love Rumi