To work through their

emotions.

And children learn that.

We learn when we're young to hold our emotions in.

What are children taught? Don't be angry.

Don't get angry.

Okay, I won't get angry.

So what does it actually look like when you're working with someone? What are the components of it? How do you do emotional awareness and expression therapy? So

So what we want to focus on this podcast is, I think, didn't EAET start before PRT? That's something you've been doing for a while?

I started doing the more of the PRT work first.

That's what I learned from Dr. Sarno back in 2003.

And then we developed EAET after that, around 2012-ish.

We've been doing research on both of those.

And both of those have begun to merge a little bit, especially in the research.

Clinically, we use both, you know, complementary-wise.

And so the EAT is a little

So when you work with people, how do you approach that?

Well, that gets into the details.

So then the question is what can we learn about them in their life? What is the context of their life? Once you understand that the brain is a dangerous, you know, works out of a danger or safety.

And when danger occurs, the brain is going to be like a smoke alarm and send an alarm.

So what caused, what causes danger in them? What causes danger in you? You know, so if someone had, father who was critical and later in life has a boss who's critical that could trigger the danger signal someone in life had a mom who just said you know you know I don't you know just just keep going doesn't matter what you what you feel and then has a spouse who says just I don't care what you feel just just do the job it's not being seen it's not being heard it's not being validated and so The, and then, so we're looking for things that trigger the brain to move into danger mode.

And then we're looking for the symptoms themselves as to assessing them from a medical point of view to see if they seem to be more structurally related or not.

The vast majority of people with chronic symptoms that haven't been diagnosed through routine medical testing have what I would call neuroplastic a condition, meaning a brain generated symptom.

Can you discuss that with us?

That was the exact freaking things that were coming into my brain, right? Yeah,

things started to get a little heavy.

And anyway, and this was so mid-career.

This was around mid-90s.

I'm old.

I graduated from medical school in 74, okay, before you were born.

Anyway, so I started having neck pain.

What has that shift been for you?

and

seeing that the brain can turn on different neural circuits like that really helped me expand this understanding to a whole variety of other other conditions The other thing was, as I was saying before, the whole view of predictive processing and really understanding the neuroscience behind that and delving deeply into that and determining that our brain literally creates all of our experiences.

So mind boggling, so mind boggling.

And then the third thing was really beginning to see the importance of emotions and emotional work and trauma work.

And working with Mark Lumley to develop a type of therapy we call EAET, emotional awareness and expression therapy, which has been now shown in several randomized controlled trials to be highly effective and more effective than standard psychotherapies like cognitive behavioral therapy.

for pain and other conditions.

So that whole arena, and I'm an internist, but we developed this therapy And then the question is, what do you do with the therapy? Who should be trained in that? We're doing a lot of training in this.

So how do you differentiate and navigate through those things?

What have you seen possible?

Yeah.

I'm just talking to a woman the other day.

She was having this back.

She was lying down.

She's having this back pain.

She couldn't get in a good position and she just simply put her hand on her back and she put her hand on her back with a compassionate, and compassion feeling for herself, for her back, for her pain.

Where do you start with those people who are so far into this feedback cycle that their capacity is now so low?

There's higher rates

of online bullying.

And the other thing that we didn't really talk about is not only minorities, poor people, distant transgender people, but it's higher in young people and in women.

Young people, this increases of all these things are not happening in old people getting older.

They're happening in teenagers and people in their 20s, 30s, and 40s.

And, you know, I'm hardly the spokesperson for women.

But I will say, if you look at the data, women have higher rates of these things.

And how would you connect that finding for your neuroplastic model alongside a biomedical reason that they have for their pain?

Dr. Howard Schubiner says that having this understanding and believing that your pain can be fixed is crucial to successful treatment.

If you think you have a chronic condition that's never going to get better and you're just pushing through it or you're just trying to distract yourself, the chance of that working extremely well is going to be low because in the back of your mind, you're like, oh yeah, this is damaged.

It's broken.

I'll never get better.

I'll just have to cope with it.

The coping model for chronic pain and other conditions is necessary if there's actual structural damage, but if there's not, the coping model can actually be counterproductive.

It's hard to fully dive in or lean into this and say, it's hard to fully be liberated and say, I'm going to walk, I'm going to exercise, I'm going to love my life and do it with the hope and the knowledge and the expectation that you're actually going to get better.

However, Schubiner says his patients often have the opposite problem.

Dr. Howard Schubiner says that having this understanding and believing that your pain can be fixed is crucial to successful treatment.

If you think you have a chronic condition that's never going to get better and you're just pushing through it or you're just trying to distract yourself, the chance of that working extremely well is going to be low because in the back of your mind, you're like, oh yeah, this is damaged.

It's broken.

I'll never get better.

I'll just have to cope with it.

The coping model for chronic pain and other conditions is necessary if there's actual structural damage, but if there's not, the coping model can actually be counterproductive.

It's hard to fully dive in or lean into this and say, it's hard to fully be liberated and say, I'm going to walk, I'm going to exercise, I'm going to love my life and do it with the hope and the knowledge and the expectation that you're actually going to get better.

However, Schubiner says his patients often have the opposite problem.

Well, I was actually going to backtrack a little bit just for any of our listeners that are new to this and ask you in your words, what is neuroplasticity?

Yeah, so the brain is neuroplastic, meaning the brain learns.

You only have to look at children to see how much they're learning every day.

I have a young granddaughter now.

It's amazing what she's learning every day.

New words, new concepts, new memories are being formed.

All those are coming into her brain, and those are neural circuits.

So then why didn't the pain go away?

And so that is what can lead to a cycle of of chronic pain where the brain doesn't have the opportunity to stop its own warning signal and how you can explain it in your

own way.

That's brilliant because it really captures in a real way what people experience.

and how they can understand it from a point of view of, oh, that's like a computer or an overload system.

Makes perfect sense.

The brain, on a neuroscience level, what we think about is predictive processing.

So the brain creates what we experience.

And

Schubiner details this journey in his new book, Unlearn Your Pain, The Science of Recovering from Chronic Pain, Fatigue, Anxiety, and Depression.

I had spent 18 years being a doctor.

I was a full professor at a medical school.

I thought I knew everything about everything, but I didn't.

And I read a book by Dr. John Sarno, who a lot of people have revered or the opposite.

But he had this idea that especially back pain could often be neuroplastic or generated by the brain in the absence of of tissue damage.

And I was intrigued.

The doctors assume to be the problem, which leads patients down a treatment path that ultimately won't fix their pain.

Yeah.

Why would anyone listen to me if they don't know that I love them, that I care about them, that I'll do anything, that I'm going to leave no stone unturned? Why would they ever listen to me? And the second thing is not listening to me.

Mm-hmm.

but believing themselves and looking for the evidence.

So one of the things, you know, one of the stories in my book is about a guy who had 25 years of back and leg pain, 25 years getting worse and worse and worse, plus roughly 10 years, I think, of foot pain getting worse and worse, having surgery, having injections, having medication, having physical therapy, having acupuncture, having everything at two top medical centers, not, you know, the top, I'm talking about top medical centers.

And there are pain centers.

And everybody concluding this is irreversible.

Why?

i didn't have the personality for it which i'm like i kind of i i kind of think you might

i god i just didn't think so this was in the during the middle of college and that's when i decided to go to medical school because i thought if i was a doctor i could work in a community and maybe have some you know respect or gravitas and be able to work with with leaders or with people who are influencing things in the right way and i was You know, it was funny, you know, I was part of a group of young people who wanted to move to some community and set up shop and have an influence there.

And we looked in Virginia and North Carolina and Vermont and all these beautiful places.

And, you know, that didn't happen.

I ended up, you know, doing residencies in both internal medicine and pediatrics and After that, I was at Wayne State University in Detroit in the medical school, and some of the people there asked me if I would stay on as faculty.

And I thought, okay, I could do that for a year or two, but I had no skill.

You know, if you're a medical school faculty, you have to do research.

Right.

And is that pain something that's located in a specific area, or is it sort of global generalized pain when we're thinking about that large population of chronic pain sufferers? What are we kind of thinking about there?

Well, the most common cause of chronic pain is neck and back pain.

After that, it's headaches, facial pain, abdominal pain, pelvic pain, and other musculoskeletal pains and joint pains.

And so what we're saying is that in order to get good treatment, you need to have the right diagnosis.

It's, it's so elemental.

That's what doctors do.

That's what we've been trained as, as doctors.

But I'd love for you to dig into this sort of concern that patients often have is being told by their doctor or someone that this just means it's all in their head.

So that's my long-winded way of saying how do we apply this to psychology and mental health? [laughs]

Absolutely.

Yeah.

It's so moving and this work is so moving because people are suffering and they're being told that there's something physically and structurally wrong with them.

They're being told physically and structurally wrong with their back when they just have mild changes that are normally seen.

They're being told that they have something physically wrong with their brain when they're depressed because they're told they have low serotonin levels and there's no evidence for that.

That's not true and it's not scientifically valid.

And again, in the context of your specific work, I think it really helps us s- expand and understand why these types of treatments can be quite effective.

So that's my long-winded way of saying how do we apply this to psychology and mental health [laughs]?

Absolutely.

Yeah.

It's so moving and this work is so moving because people are suffering and they're being told that there's something physically and structurally wrong with them.

They're being told physically and structurally wrong with their back when they just have mild changes that are normally seen.

They're being told that they have something physically wrong with their brain when they're depressed because they're told they have low serotonin levels and there's no evidence for that.

That's not true and it's not scientifically valid.

And again, in the context of your specific work, I think it really helps us s- expand and understand why these types of treatments can be quite effective.

How is it different from, from your previous, yeah, your previous work.

Well, it's different.

It's the same because it has the same name, and this is very confusing, but it's called Unlearn Your Pain.

That's because the publishers wanted that.

This is the first book that I've written by a major publisher.

So that's why it's, you know, so it's really more for more general, more for the public.

It's not a workbook, which actually people seem to appreciate.

Number

But one thing you brought up that I thought was really interesting was the condition of long COVID, and how that can be structural or neuroplastic.

It is controversial.

And when I started this book, I was writing for Penguin Random House, big publisher.

I said, "Are you guys gonna back me up? 'Cause I'm gonna be controversial.

I'm gonna tell it like it is." There's an old, old saying.

You're way [laughs] you probably never even heard that.

[laughs] Anyway, so I'm just gonna put it out there, and you have to ask the question.

Yeah.

Right.

Are you okay? Cause then you're giving feedback to the brain.

No, I've got this pain.

I got to go to the doctor.

He told me it's the MRI is bad.

That makes this cycle pain, fear, pain cycle worse.

Whereas when you step back, and this is one of our treatments we call pain reprocessing therapy, which we've shown in randomized controlled trials to be effective and more effective than standard psychological treatments for pain.

for doing your job yeah

No, especially after 20 years.

Yeah.

I have feelings about this, and maybe those feelings are connected to my back pain.

What an idea.

That's the revolution, right? So I start swearing.

I start screaming in my car, yelling and screaming.

No one can hear me.

Um, anyway, it just-

Right.

Are you okay? 'Cause it doesn't know.

You, it needs feedback from us to say, "I'm actually okay." So this pain-fear, pain cycle is really, really important to understand.

And so when, when people recognize that there's fear underneath their symptoms, that's where they wanna go because the fear itself is the key to understanding what's happening with them.

And so there's a lot of things to do with fear itself.

One is to recognize it, to feel it, to be with it, to understand that it is itself a danger signal that the brain is creating, and it's there for a reason.

So we can thank it for being there and protecting us and worrying about us.

So hard.

the most important one, though.

Yeah.

Yeah, because I think one of the things that I really try to do when people, because a lot of people get this information and they get unstuck kind of quickly.

And People who aren't getting it quickly get mad and angry at the people who got it quickly because it's annoying and frustrating because they read these stories and week, two weeks, a couple months, everything's fine.

And they're like, why is this not happening for me? So what I try to do when that happens is I try to go back to the basics.

Like, what are the steps? to take starting from the beginning to make sure we've covered all the bases.

And the first step is making the assessment and the diagnosis and making sure that people really have ruled out some structural problems, are clear that those structural problems are ruled out, and are really understanding the notion that the brain can generate Sensations, all sorts of sensations in the absence of physical danger.

Could you share that?

Mm

... biopsychosocial model in some instances.

But all of that is bio.

It means there must be something wrong in the body when there's a sensation, and it's not necessarily true.

We're just not trained in neuroscience.

And when you catch a virus, the virus can directly cause nose running, throat tickling.

Cough can directly cause that, and it ... and the, and the body will send out...

Mm

Why is that a myth?

[laughs] It is so big, it is so widespread to know that MRIs can show the inside of the body, which is true, they can.

It's revolutionary.

Amazing technology.

I was a doctor before there were MRIs, and we're like, "Oh my God, you can do the scan.

You can see tumors, cysts, bleeds, everything," and you could see degenerative discs.

But it turns out that discs degenerate over time, just as hair gets gray over time, and graying of hair does not actually cause pain.

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