Dr. Schubiner The Role of Triggers

Forest · Apr 22, 2012

I think a lot of people have certain things that trigger their TMS/PPD. This can be meeting with our boss, having lunch with critical family members, or almost any other thing. Understanding our symptoms is very important, so I was really glad to see that Howard Schubiner focused on triggers in one of his blog posts. It made me start to wonder what are other people's triggers?

I included his article below, with his permission. The rest of Dr. Schubiner's blog articles can be found at Howard Schubiner's Blog Posts.

Dr. Schubiner said:

The role of triggers: Holidays and headaches

As the holiday season approaches, I am reminded of the importance of things that trigger MBS symptoms.I once heard a description of families during the holidays as being, “just the way they are, only more so.”It is quite obvious that certain events and times of the year can cause stress that is clearly recognized by our conscious minds, for example, “I have so many things to do that I can’t find a moment to relax.”However, it is also important to realize that stress is often not recognized, and we would call that subconscious stress.“It seems like I always get sick this time of year, but I don’t know why?”Symptoms that occur at times like this may be caused by underlying feelings about certain family events, or missing certain family members who are not present, or stressful memories that are associated with the holiday season.

I see this all the time in my MBS practice.In fact, one of the most important aspects of successful MBS treatment is the ability of the person with MBS to recognize which triggers are commonly associated with their symptoms, to understand that these triggers are not actually causing the symptoms in a physical sense (more about this point in a moment), and to have the courage to actively overcome these triggers.

What is the definition of a trigger?The way I use this term, a trigger only applies to people with Mind Body Syndrome, that is, to people who suffer from physical or psychological symptoms that are caused by mental and emotional processes.Therefore, in this situation the symptoms are not caused by a pathological condition (or a tissue breakdown condition in the body, such as cancer, a fracture, or inflammation).Of course, the symptoms we feel are real, very real and are caused by a connection of nerve pathways that have been learned by the brain and the body.However, these pathways are physiological, that is, they are not permanent and can be reversed by changing how we understand the condition, how we think about it, how we respond to stress and emotions, and how we actively fight to overcome the symptoms.When I apply the term, trigger, to people with MBS, I am referring to things that are associated with the onset of symptoms or occur just before or at the same time.Triggers are further defined as things that would not cause such symptoms in someone without MBS.This is the most important point to emphasize.Since the trigger occurs right before or at the same time as the symptoms, it appears to actually be causing the symptoms.

The way most people best learn about triggers is by the scientific experiments of Ivan Pavlov, the Russian scientist.At the beginning of the 20th century, he found that dogs would salivate when they heard a bell or other sounds, if those sounds were presented to the dogs at the time that they were fed.Their brain and body had learned that the sound preceded food and it triggered a physical reaction.When he stopped playing a certain sound, the dogs eventually unlearned the association and stopped salivating to that sound.Hundreds of experiments have been done since that time to document how triggers can produce physical and emotional reactions.Robert Ader of Rochester, NY conducted one of the most important of these studies in the 1970’s.Dr. Ader put a powerful immune suppressing chemical (cyclophosphamide) into the bowls of mice and flavored it with saccharine.Predictably, the immune system of the mice was severely affected after they drank the chemical.Several weeks later, after their immune system had recovered, Dr. Ader gave them bowls of saccharine with its distinctive flavor.Amazingly, their immune system became depressed again as their brain and body had learned that the flavor of saccharine was associated with changes in the immune system.This study has also been conducted in people with similar results.

Therefore, it is extremely important for people who have MBS to recognize that there are many triggers that can be associated with their symptoms and that unlearning these triggers is one of the best ways to get better.I met a woman who told me that she had been hospitalized for a variety of illness over 20 years, but that each time she was hospitalized it was in September, the month her brother had been killed in Vietnam 21 years before.I treated a woman who had recurrences of abdominal pain each fall at the time her husband had died several years earlier, but in addition, she had developed anxiety episodes at about 3-4 pm.Upon closer investigation, it turned out that her husband had died at approximately 3:30 pm.

Many people have triggers that seem to make more sense as possibly actually creating symptoms, such as bending, walking, lifting for people with back pain.Many people have symptoms when there is a change in the weather.Foods and smells are common triggers for people with headaches or irritable bladder (often called interstitial cystitis).I have seen people who developed symptoms when they passed a certain intersection or drove through a certain town.Of course, certain people can be triggers, or certain thoughts or emotions.And that brings us right back to the holidays.Once I have diagnosed MBS in my patients, we investigate their triggers.The most important piece of advice I give is this: If the symptom would not be caused by this trigger in someone without MBS, then it is truly a trigger, and it can be reversed by the treatment of MBS..I saw a women who gets severe bladder symptoms when she ingests black pepper.I met a guy who developed headaches when the weather changed.I’ve seen countless people who developed back pain when they sit, drive, bend, walk, or lift.And of course, the holidays bring up so many thoughts and feelings about families, about childhood memories, and about stressful times, that it is very common to have exacerbations of symptoms at this time of year.

Once you have recognized your triggers, you can start to reverse them; this is known as ‘extinction’ in the psychological literature.There are several methods to overcome triggers.A common response to triggers is to avoid them.People learn to avoid the movements or foods or people or events.However, that is exactly the wrong thing to do.When you avoid the triggers, you actually give them more power over you.What you really need to do is to overcome them.You need to retrain your brain to avoid developing the MBS symptoms when you encounter the triggers.The way to do that is to be brave and to look forward to encountering the triggers bit by bit and to learn techniques for stopping the nerve pathways that get triggered.The techniques to use are self-talk, breathing and other meditation techniques, therapeutic writing, psychotherapy and a variety of other psychological techniques, such as EMDR.The self-talk or affirmations are very powerful and should be done continually whenever you find yourself encountering a trigger.These are detailed in my educational program as are the therapeutic writing techniques.You can also find some of these techniques in books by Dr. John Sarno, Dr. David Clarke, Dr. Ronald Siegel and others.I also teach mindfulness techniques to deal with triggers.These are also detailed in the program, and have to do with learning to be alert, focused, and relaxed while encountering stressful situations.

So, as you encounter the holidays, practice paying attention to how you respond to the events and the people.Pay attention to how your body responds.Practice talking to yourself to overcome the MBS symptoms that may emerge.Be brave and strong.Learning to overcome MBS is a great opportunity to improve not only your symptoms, but your understanding of yourself.It is often not easy, but it can be done and it can be done wherever you are.A wonderful poet, Mary Oliver, writes about a visit she took to Walden Pond where Henry David Thoreau studied the meaning of life.She wrote:
“It is the slow and difficult trick of living, and finding it where you are.”For this holiday season, I wish that you find these tricks to living, that is, living without pain or fear.I also wish that you find “it” (which I often interpret as “life,” or “love,” or “happiness”) wherever you are.

To your health,

Howard Schubiner, MD
Click to expand...

veronica73 · Apr 22, 2012

This is great--conventional medicine teaches us to avoid the triggers but they aren't the true cause of the pain.

BruceMC · Apr 23, 2012

I was surprised this March when I came down with a cold that seemed to come out of the blue and just kept getting worse until I went in to Kaiser and got some antibiotics to treat it. Well, it was odd the way it came on when I was feeling so good and improving so much in my workouts and bicycle rides. In fact, I hadn't had so much as a sniffle in three years. The doctor said I'd caught a virus and then after it had worn me down, a secondary infection developed in my upper chest. However, one day after I'd started the antibiotic run, I recalled that March was the same month my father had died in 1997, so I went to check the death certificate in my file of important documents. Imagine my surprise! The very day that I had first started clearing my throat (but not yet feeling sick) was the same day that my father had passed away, March 9th. But the time the symptoms had first began was also the same time in the morning that the hospice had called me with the bad news, around 11 a.m. Of course, I was aware of the role of triggers before reading Dr. Schubiner's piece above, but I'd never observed such a direct correlation before between the clock in my subconscious and physical symptoms. I speculate that the memory of receiving the bad news affected my autoimmune system in such a way that a virus that would ordinarily be unable to break through my defenses could then invade my body.

Another similar experience I had perhaps involving psychological "triggers" occurred when I had a TMS relapse in 2007. I was sitting on a stool in the breakfast nook of my late parents' house on X-mas morning when I suddenly developed spasms in my lower back that developed into a major TMS episode. Some time later, after reading Dr. Sarno's HBP, I remember that it was when I was sitting on that same stool in the breakfast nook that my father always came downstairs and gave me an ear-full when I was cornered in a position where I could not escape his attentions. And of course it was always at X-mas that he was most enraged about anyone taking attention away from him as 'Master of the House'. X-mas by its very nature was always a psychologically loaded time in my family because that was when my late father always complained about the gifts we gave him not being good enough. Not so nice and neat as my cold this March, but certainly an example of psychological "triggers" being associated with physical situations and the layout of the family home.

What is that famous essay that Freud wrote about the "psychopathology of everyday life"? Sure sounds like unconscious meaning is always lurking beneath the surface of mundane domestic objects and ordinary family situations.

veronica73 · Apr 23, 2012

I usually feel worse on the weekends...I think it's mostly that I have more downtime so I'm more likely to start obsessing about things, but there might be a connection to weekends being tough for me when I was growing up too. Sunday especially can be tough.

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