Dr Howard Schubiner, MD, and I recently wrapped up co-teaching a weekend-long course at Boulder Community Health. Our 6th cohort! 42 family practice & internal medicine physicians and 45 physical therapists, chiropractors, acupuncturists, psychologists, social workers, body workers, healing and fitness professionals, and a few people on their own pain journey from across the country chose to take the brave step of radically changing the way they conceptualize and treat chronic symptoms. While we were there to teach, we always learn a ton. In this post, I’ll share a few takeaways that I think will benefit you.
I can’t overstate the importance of this paradigm shift. Many of you already know this, but we often compare its significance to the shift in belief toward the earth being round, the discovery of electricity, or the existence of gravity. All things that were ridiculed, resisted, and/or controversial initially; but all of which are now accepted as self-evident truths (ok maybe a few still think the earth is flat!).
Considering that 1 in 4 people worldwide suffers from at least one chronic physical symptom (not to mention the psychological and social ailments that underlie them), I believe disseminating this paradigm shift is consequential. Partly because the well-being of humanity is currently failing to thrive in a system of sick care. Pain, fatigue, insomnia, depression, anxiety, skin rashes, autoimmune conditions, and most diagnoses with the word “long” or “syndrome” are currently being treated ineffectually. The reality, based on modern neuroscience, is that the majority of people living and suffering with these symptoms don’t have to be…
Change is hard.
One clear reason people end up in chronic pain is that they resist change. As a barometer for what’s going on in your life, symptoms are your brain’s invitation to evaluate what’s not going well, what you’re resisting, and what you’re unhealthfully attached to. From a young age, we’re conditioned to be a certain way in our lives. We rarely question why, much less whether that way of being is still serving us or others. So what happens if we start to think of pain as a helpful message that’s inviting us to grow in some way?
It’s clear that a bigger reason people end up and stay in chronic pain is because clinicians resist change. We had our biggest attendee turnout ever this year! However our numbers pale compared to the number of clinicians who continue to pursue learning interventions with little to no evidence and poor clinical outcomes. The clinicians who make the brave choice to take our course are special. For many of them, it’s uncomfortable at first and it takes time and energy. They’re outliers, early adopters, and even rebels to change the way they think and treat in an otherwise outdated medical system. Outside of this cohort, many clinicians are 20 years behind the research based on how they treat day-to-day. Despite the “pain” many clinicians face in their clinical practices (burnout, recidivism, poor outcomes, lack of meaning and purpose), it’s so easy to stay with what’s familiar. So people continue to suffer
While patients and clinicians both face the discomfort of change, the reality is that change is the only constant. Change drives growth and progress in our physical, emotional, and spiritual lives. Pain demands change, and change requires a shift in belief that leads to a new way of thinking, behaving, and feeling. We know belief is the most important predictor of outcome when it comes to pain and other chronic symptoms. So what I’m asking is for everyone to believe in the importance and power of change. Especially this change. Pick your providers thoughtfully. Patient-directed care is the new reality in “health” care. You deserve a forward-thinking provider that’s on the leading edge of chronic pain/symptom care.
Recovering from chronic symptoms is an inside job.
Clinicians have a hard time shifting out of a paternalistic fixing mindset where they’re tasked with having all the answers and telling their patients what’s “wrong” with them before also choosing and dispensing extrinsic solutions. The new model we’re teaching demands nearly the opposite belief and mindset where patients have agency and authority over their healing. One of the most important concepts we teach is how listening and therapeutic alliance skills (the relationship between provider and patient) are effective stand-alone modalities. When patients haven’t felt seen and heard prior, they can cure chronic symptoms without any other intervention because relationships and connection are so calming to the nervous system. Reinforcing this is the idea that the contextual factors AROUND the things we do are more predictive of someone’s outcome than the interventions themselves. This is true with manual therapies, exercise, medicine, and interventions like injections and surgery. Here’s one recent study highlighting this phenomenon.
When we understand how belief, context, and agency are such strong predictors of outcome, we have to acknowledge that every client is unique. So, we can’t treat based on rules. Starting every session with what I call a “Vu Ja De” mindset (I’ve never been here before) is liberating and powerful. We have to remember that the patient has all the answers to cure their dis-ease and that our role is to listen to support them in becoming aware of those answers.
It’s not our role to fix anyone. You have everything you need inside of you to unlearn your chronic symptoms and recover the things you’re missing in your life. It’s the provider’s role to reinforce what’s RIGHT with each person and then to collaborate on opportunities for positive change. Reassurance is our most powerful medicine. But, most clinicians do the opposite. Many think they can predict the future, and it’s usually in a negative direction, mostly due to a fear of liability if they over-promise. Patients need what we all need…to be seen, heard, celebrated, reassured, and supported on the journey. The clinician ultimately doesn’t do any fixing, your mind and body do it all. This new way of thinking is liberating for clinicians and powerfully healing for patients.
Anger, then compassion.
I’m always blown away by the stories of recovery that are shared throughout a weekend of teaching. I wish you could all experience how powerful this work is across such a wide spectrum of different people and varied symptom presentations. The list of acute and chronic symptoms that respond to mind/body medicine is massively long and ever-growing.
One story Dr. Schubiner shared was about a woman who presented with a conversion disorder where she’d lost the ability to walk and speak normally (essentially her brain took away these functions to protect her) despite nothing being medically wrong. After a single session of Howard bearing witness to her story and then supporting her in an anger awareness and expression session connected to events in her earlier life, she regained the ability to walk and speak the next day! After years of suffering! I realize this sounds like faith healing, but it’s not. It’s a testament to the importance of our emotions and to the power of neuroplasticity
While symptoms don’t always change this quickly, the story highlights the importance of anger expression in recovering from chronic symptoms. Most would never connect the emotion of anger to the expression of physical symptoms. But the link is strong and we know that anger “held in” from any phase of life can manifest as just about any symptoms you can imagine. This is because many of us were never supported in learning healthy anger expression as children. So we either express anger in outward and destructive ways and/or subvert it to protect others, instead turning it inward on ourselves. Anger is an intense and important emotion that’s meant to protect us and spur powerful and meaningful action. But without the skills to express anger in a private and directed way, many get stuck in anger and ultimately only experience the negative consequences. Once you understand the healing power of healthy anger expression, and how you can move through it to a place of forgiveness and compassion, you’ll start to see it as an asset and a powerful force for change in your life. Here’s a visual representation of the visualization process through which I guide my clients.
I’d like to offer my paid subscribers access to my new guided emotional awareness and expression audio visualization. Contribute at any level and you’ll get access to the 25-minute “time traveler” exercise (and an intro orientation to the process) which allows you to go back and process the layers of emotion around any past stressful life event, regardless of whether it was last week or 50 years ago. It’s a beautiful practice and, now that you know recovery is an inside job, I want to encourage you to try it for yourself. Please click subscribe below and contribute at whatever level you can to see the rest of this post and get access to the time traveler exercise.
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