We are no strangers to the invisible chains of chronic pain and symptoms. Our personal journey through discomfort and the discovery of unconventional healing have led us to question the very behaviours that promise relief, but instead, keep us trapped in a survival state. This episode is an intimate exploration into how these 'rules' we live by may be reinforcing our pain and symptom, and how breaking free can lead to a life of being pain or symptom free.
Join us as we outline a roadmap to rewriting your pain or symptom rules. We delve into the actionable steps essential for challenging the brain's association of fear with everyday activities. Through sharing our stories and the integration of nervous system regulation techniques like breath work, together with the art of graded exposure, we're here to guide you toward a balance of gentle progression and re-engagement with life. Ready to embark on a journey of transformation? Listen in and discover how to reclaim your freedom from the grip of chronic pain and symptoms.
This podcast is produced by Alex Klassen, who is one of the wonderful therapists at Pain Psychotherapy Canada.
Together we have a therapy agency called Pain Psychotherapy Canada. Learn more about our work on our website and book in for a free 20 minute consultation with one of our therapists: https://www.painpsychotherapy.ca/
We also post daily on instagram: @painpsychotherapy
Finally check out Tanner's YouTube channel: https://www.youtube.com/channel/UC-Fl6WaFHnh4ponuexaMbFQ
Disclaimer: The information provided by Anne and Tanner on this podcast is for general informational and educational purposes only and is not a substitute for professional advice, psychotherapy, or counselling. It you choose to utilize any of the education, strategies, or techniques in this podcast you are doing so at your own risk.
Education and techniques discussed in this Podcast originate from Polyvagal Theory, Pain Reprocessing Therapy, Somatic Experiencing, and Emotional Awareness and Expression Therapy. Reference: Peter Levine, Deb Dana, Dr. Porges, Pain Reprocessing Therapy Center, Alan Gordon, Dr. Schubiner, and Dr. Lumley.
We are no strangers to the invisible chains of chronic pain and symptoms. Our personal journey through discomfort and the discovery of unconventional healing have led us to question the very behaviours that promise relief, but instead, keep us trapped in a survival state. This episode is an intimate exploration into how these 'rules' we live by may be reinforcing our pain and symptom, and how breaking free can lead to a life of being pain or symptom free.
Join us as we outline a roadmap to rewriting your pain or symptom rules. We delve into the actionable steps essential for challenging the brain's association of fear with everyday activities. Through sharing our stories and the integration of nervous system regulation techniques like breath work, together with the art of graded exposure, we're here to guide you toward a balance of gentle progression and re-engagement with life. Ready to embark on a journey of transformation? Listen in and discover how to reclaim your freedom from the grip of chronic pain and symptoms.
This podcast is produced by Alex Klassen, who is one of the wonderful therapists at Pain Psychotherapy Canada.
Together we have a therapy agency called Pain Psychotherapy Canada. Learn more about our work on our website and book in for a free 20 minute consultation with one of our therapists: https://www.painpsychotherapy.ca/
We also post daily on instagram: @painpsychotherapy
Finally check out Tanner's YouTube channel: https://www.youtube.com/channel/UC-Fl6WaFHnh4ponuexaMbFQ
Disclaimer: The information provided by Anne and Tanner on this podcast is for general informational and educational purposes only and is not a substitute for professional advice, psychotherapy, or counselling. It you choose to utilize any of the education, strategies, or techniques in this podcast you are doing so at your own risk.
Education and techniques discussed in this Podcast originate from Polyvagal Theory, Pain Reprocessing Therapy, Somatic Experiencing, and Emotional Awareness and Expression Therapy. Reference: Peter Levine, Deb Dana, Dr. Porges, Pain Reprocessing Therapy Center, Alan Gordon, Dr. Schubiner, and Dr. Lumley.
Hi, we're the MindBodyCouple.
Speaker 2:I'm Tanner Murtaugh and I'm Anne Hampson. And this podcast is dedicated to helping you unlearn neuroplastic pain and mind-body concerns. Hi everyone.
Speaker 1:Hi everybody.
Speaker 2:Welcome back to the podcast. Welcome back Today, part two. Yeah, our topic is breaking the rule book.
Speaker 1:I like it Sounds like a bit rebellious or something I like it.
Speaker 2:I like it.
Speaker 1:We're going to break the rule book today.
Speaker 2:Yeah, so last episode, if you didn't, you know, chime in to what we talked about. We were talking about the rule book. Yeah, the rule book for chronic pain and symptoms.
Speaker 1:And it doesn't have to be so. I'm just going to interject. It's kind of your own rule book. It doesn't have to be like somebody else's rule book or like messages that we've gotten.
Speaker 2:It can be informed by that, but it's your rule book. Yes, everyone's rule book is a little bit different. Yeah, and the rule book is made up of behaviors that we do or don't do because we believe they will reduce our chronic pain and symptoms.
Speaker 1:Yes, I think we really leaned in last episode to kind of mention that everyone probably has a bit of a rule book.
Speaker 2:It's just having awareness that it's like, oh, I actually do have these guidelines that dictate my behavior throughout my day, and we really invited everyone all the listeners last time to you know, write out, write this out like, write out the rules, because a lot of these, as we said, become unconscious. Yeah, in this episode, part two, we want to discuss how you can rewrite the rules and this will allow people to have a lot of freedom in their life. Yeah, and it will actually cause the brain and nervous system to reduce chronic pain and symptoms yeah, we write our rule, we have that awareness that they're there.
Speaker 1:And now this is kind of the action piece.
Speaker 2:Yeah, it's the action of starting to break these rules and it's not necessarily a really fast process. It depends person to person how it's affected. But when we talk about chronic pain and symptoms, we know a lot of chronic pain and symptoms are neuroplastic. Yes, talk about chronic pain and symptoms. We know a lot of chronic pain and symptoms are neuroplastic. Yes, meaning what's driving this is this survival energy that we're caught in. When the brain and nervous system is in survival mode, we're in a state of fear and all the rules we develop are often in response to fear or fighting against the symptoms that actually can perpetuate and continue to trigger symptoms, and so, as we understand, a lot of chronic pain symptoms are all plastic. By starting to rewrite these rules, by breaking some of these rules, it's going to be really healing for a lot of people.
Speaker 1:Well, and why do you say that, tanner? Like? Why do you think it's so healing to challenge these?
Speaker 2:Well, I know from experience that it is. I know from experience that, as I started to feel safer to approach life, to approach the world, to eat whatever I wanted, to move my body the way I wanted, that was the medicine. That's how I started to heal. I was teaching my brain that I was safe to do these things.
Speaker 1:And so for people you know, listening or watching, there might be a lot of anxiety or fear of like, well, I have this rule book for a reason and it is to kind of not flare up my pain. So the thought of like challenging it would, I think, for a lot of people think, okay, my pain will flare.
Speaker 2:Yeah.
Speaker 1:What happens then?
Speaker 2:Yeah, and we're going to get into that, because some flares as you start to break these rules is really normal. So if you're listening to this, like that is a normal aspect.
Speaker 1:It's kind of even part of the process for that to happen.
Speaker 2:Like I've never seen someone start to rewrite these rules, break these rules and not have some setbacks along the way.
Speaker 1:Well, and I think that's the biggest challenge, Like that's totally what reinforces rules for people is that maybe they manipulate them or go against the grain a little bit, but then the pain comes and they're like oh no, okay, I need to keep this rule really tightly in place, which is why is that perpetuating cycle?
Speaker 2:Exactly because it's this excessive control. It's this excessive trying to fix it, trying to figure it out, and that raises the level of danger. That's survival energy in your system and that's going to then produce more symptoms Totally. And so, as we know, you know a lot of the. We had everyone write them out. Hopefully, if you're listening, you wrote them out. If not, at least hopefully you thought about it. But the thing to understand here is the rules we set.
Speaker 2:They're often not true, and they're not actually what's preventing the chronic pain or the chronic symptoms. They're actually perpetuating it. And, you know, as our brain starts to label certain things are safe or dangerous, the more rules we set, the more avoidance behaviors that are taking place, the more in danger the brain actually feels. Yes, Now, what you were kind of touching on is people will start to try to break these rules to. You know, maybe start to move their body a little bit more and they'll get this, this flare of pain or physical symptoms, fatigue, dizziness, whatever it is that people are dealing with. What's happening is conditioned responses.
Speaker 1:Yes, and it's important to have understanding of conditioned responses and that these can occur, to almost then understand why the flare is there and then move forward and not react to it.
Speaker 2:Yeah, because these conditioned responses and many of the listeners probably know what this is. But just as a quick review, you know our brain. It's an association-making machine. It does this. I like that. It's amazing at it. Our brain makes associations. Yeah, it starts to label certain conditions as either safe or dangerous. Yes, and it does this all the time right.
Speaker 1:What's an?
Speaker 2:example of one. You had An example of one, that where my brain was clearly making a mistake. It was a mistake in condition response, because the condition responses aren't always correct. Sometimes it's useful, right? So, for example, I'll give our cat Harry this is a condition response that harry harry always sits on the bottom of our basement stairs yeah and one day I like stepped on him and like almost fell down the stairs because he's a black cat and it was dark.
Speaker 2:yeah, I almost it was bad for harry's, bad for me. But now. So what harry learned is like, hey, when t opens that door like I could get hurt. Right, right, even cats make associations, and so now it's hilarious.
Speaker 1:Wait, your example is Harry's association. Yeah, yeah.
Speaker 2:I got Harry's association here, and so what happens now is when I go downstairs in the morning and I open the basement door, all three of our cats are sitting on that top stair we have a lot of cats.
Speaker 1:Yeah, we got a lot of cats.
Speaker 2:If you're just cluing in like we got a lot of cats.
Speaker 1:But they're all like cuddling together. It's quite adorable yeah.
Speaker 2:The other two don't move, so I'm like stepping around as soon as I open that door. Harry's like down the stairs. Yeah, there's some type of danger.
Speaker 1:So using this example that makes sense For. Harry that he'd be like okay, I don't want danger, I'm going to leave, yeah. Makes sense so what's wrong with that?
Speaker 2:There's nothing wrong with associations. They actually keep us quite safe. The problem is our brain's not perfect, and so when we have chronic pain and symptoms, your brain's making all sorts of associations, All sorts of them. My brain labeled walking as dangerous, and it did. I consciously believe this. When I would walk, my back would hurt. So my brain made that association. You know, when Tanner walks he gets back in hip pain. The problem was is it wasn't the walking. All that happened is I happened to be in pain at some point and I started to fear the walking. And then All that happened is I happened to be in pain at some point and I started to fear the walking, and then my brain conditioned the two together.
Speaker 1:So for Harry, maybe his belief that it was always going to happen kept him avoiding every time.
Speaker 2:Yeah, and rightfully so. He's a black cat. It's a dark basement.
Speaker 1:He should go down the stairs.
Speaker 2:But with walking, what happens? I avoided walking more and more. It became this real set rule. Yes, and what happened is, with a lot of these mistaken condition responses, my brain labeled walking as dangerous. But walking wasn't actually dangerous. Yes, all that was triggering the pain was my brain interpreted danger.
Speaker 1:Yes, yes, all that was triggering the pain was my brain interpreted danger, yes, and this concept has been around for a long time in terms of like kind of keeping fear going and anxiety going. So, if you think of kind of the basics of anxiety, the more we avoid something, it gets bigger and bigger and bigger in our mind and more dangerous, and so avoiding and which we think is protecting us often is making it worse. And that's exactly what you're talking about this. The more you're avoiding, the fear response grows bigger, and then your pain would happen every time you went towards.
Speaker 2:Yeah, it's like this avoidance symptom cycle that happens. Yeah, is that? The more I avoided walking, the more my brain learned, whoa, there must be something really wrong with walking. Tanner's not doing it. The more my brain learned, whoa, there must be something really wrong with walking, tanner's not doing it. And so the next time I needed to walk a little bit, all of a sudden more pain's triggered and then there's more avoidance.
Speaker 1:Well, and that makes sense, because the brain's like Tanner. You shouldn't be doing this. What are you doing? Here's some pain to get you to back off.
Speaker 2:Yeah, and here's the part that, here's the part of this episode that people aren't going to like very much To break the rule book. We need to slowly actually start approaching these rules.
Speaker 1:We need to slowly break them and we're going to give a process, so we need to break the rules.
Speaker 2:That makes sense. We're going to give a process of how to do this, because this is hard to do, but we do need to start doing that. We need to start giving our brain new experiences that these rules are actually not correct, yes, and that our body is actually capable and able of doing these things.
Speaker 1:Yeah.
Speaker 2:Or not doing these things Like say you're, you know if you're doing hot yoga for two hours a day trying to prevent, you know, migraines? Right, that's something that, like you know, it's a lot of hot yoga.
Speaker 1:Well, I like that you said that actually, because the rule book can be things that we're avoiding. It can also be things that we are doing, maybe in excess, that we think is helping but is not. Like maybe we are doing hot yoga every day because we're like this is the solution, yeah, but it's actually reinforcing and so what's happened is like, again, it's the conditioned response, it's just the brain is not labeled.
Speaker 2:Okay, doing hot yoga for two hours a day, okay, we're safe. Then we do that, we're good. Like it starts to make these associations in the other direction too and it's okay to have safety associations.
Speaker 1:that's part of like healing and recovery almost creating a new rule book but we want to make sure that is not driven by fear.
Speaker 2:Not driven by fear and doesn't become excessive? Yeah, because then we're just controlling, yeah, and so we're going to dive into this. So you know, to break the rule book, like we said, we need to start actually breaking our rules and we need to start breaking our conditioned responses, and we're going to talk about five areas that you can start to do this, yes, so I'll list them off first and then we'll dive into a little bit of detail.
Speaker 2:Number one look for exceptions. Number two specific messages of safety yes. Number three nervous system regulation. Number four graded exposure. And number five pleasant and rewarding. Ah, yes, it's a great list. Okay, I like lists We've talked about this?
Speaker 1:Yes, we often do lists. It just helps keep us organized.
Speaker 2:It helps keep us organized and, yeah, I can be a little scattered as Anne knows, he's often scattered.
Speaker 1:You know, like, sometimes I keep you organized, you do keep me organized.
Speaker 2:Sometimes Anne comes downstairs in the morning and I've been up for an hour and she's like what has happened, Because the cupboard doors are open, and it's just like it's a disaster. I got it. You know, I'll be honest with you. We're getting sidetracked here. I got a bit of ADHD.
Speaker 1:There's some ADHD going on for sure. Like if people have been following this podcast for a while, they'd be like yeah, they'd be like yeah, yeah, it's not surprising.
Speaker 2:It's like we're happy you came to that, Tanner.
Speaker 1:Good work, Tanner.
Speaker 2:Okay, we're diving into this list. No side conversations we're diving into this list. Okay, no side conversations. Okay, number one Looking for exceptions. So this is something from pain reprocessing therapy yeah, a really important skill and technique and it's not super complicated. Yeah, but unless we start to do it, we don't actually find exceptions, and so exceptions are important pieces of evidence for physical safety. So exceptions are when the pain or symptoms don't act like structural damage or disease should.
Speaker 1:Yes.
Speaker 2:And so really, they help us recognize the brain is making a mistake about a potential threat or a condition response, and it helps us recognize there's no physical threat, and so really, what it's helping us do is understand that the rule itself is incorrect, that we've come to believe is reducing our symptoms in some way is there an example, then tenor of this, with maybe a rule or?
Speaker 2:talk about the walking, because we yeah, we already talked when I was in pain. This was a couple of years in, so I was pretty immobilized at this point. Wasn't walking much. A lot of avoidance, that's for sure. And I had a job interview, right, you probably remember this. I had a job interview. I'd been off work for maybe three or four months because of my pain. I had this job interview and I was off work for maybe three or four months because of my pain at this job interview and I was feeling stressed. I was feeling stressed.
Speaker 2:But one thing about me, um, not to toot my own horn too much, but like, when I come under pressure, I usually perform pretty well. Like nine times out of ten I'll perform like quite well, yeah, even though I'm like quite anxious. And so I had this job interviewed and I just killed it like it was. It was great, like it, you know, like it was natural, it was very nice, like I knew I got the job and I did um, and after that I left and it was at the university and I walked around for like half an hour and I didn't think about it. Usually I was so on edge, but I was so elated that I like just knocked this interview out of the park, that all of a sudden I walked around for half an hour and there was almost no pain. And I remember driving home being like my back and hips don't really hurt right now.
Speaker 1:Do you remember when you're walking, realizing there's no pain or no like? You just were so like.
Speaker 2:It was at the tail end In love with, not in love, but like you know.
Speaker 1:With myself yeah, oh, okay, but you were so like lost in that that you weren't even thinking about your body at the time.
Speaker 2:I wasn't really thinking about it until the end. And then I was like, whoa, I've walked way. Yes, and that's an exception. Yes, and that's why you're looking for exceptions, because I reminded myself of that moment, so many times when I started to do exposure work.
Speaker 1:That's awesome and I like that you say that, that you, when you're exposing yourself, reminded yourself of that, because it can again be very scary with exposure work and then scary and maybe like the pain might come on.
Speaker 2:Yeah.
Speaker 1:So it's reminding. Maybe there's a possibility that I won't.
Speaker 2:Yeah, so you know, some other examples could be sometimes when I do this activity. I feel fine and other times it hurts or I have symptoms.
Speaker 1:Yeah.
Speaker 2:Inconsistency. Right, yeah, I can do a similar activity and it doesn't cause symptoms. So sometimes it doesn't cause symptoms. So sometimes it doesn't quite make sense, like in one setting. I've seen this a lot with people where they can sit at home, relax, hang out, no pain, no symptoms. Then all of a sudden they're sitting at work and their back hurts.
Speaker 1:Could that be the same as like the chair, because I think that's a common thing where people will talk about this chair is okay, this chair isn't.
Speaker 2:Yes, exactly, and that's what we're looking for. It just it doesn't make sense. You know physically that that's taking place. So that's number one. Everyone look for exceptions. It's very key here. Number two specific messages of safety.
Speaker 1:Specific. Why do you say specific? I like the word specific.
Speaker 2:There's a reason for that. It's very specific.
Speaker 1:I have to know right here how much you're like I like the word specific.
Speaker 2:I know it's been a weird way here. It sounded weird when I said it. Yeah, I'm sorry.
Speaker 1:Because I bet everyone else felt.
Speaker 2:I know I'm sorry, like really, because I bet everyone else felt, but I know I'm sorry to the listeners, but we do need to be specific, like we really do, because we did a episode on cognitive messages of safety a lot back, which is an essential part of pain reprocessing therapy, a mind-body approach. But when we talk about specific messages of safety, um, when we're experiencing a conditioned response based on a rule we've set, the brain has that deep belief that this activity, this stimuli is causing pain or symptoms, and so the conditioned response even can occur without us consciously thinking about it. And so what we need to do is we need to give very consistent messages of safety. Reminding ourselves hey, this is just a rule that I've set. It doesn't actually make sense logically, yes. Or reminding yourself hey, this is a conditioned response.
Speaker 1:And the exception piece. Looking for exceptions can help us believe the message of safety.
Speaker 2:Yes, and you can use your exceptions to make the specific messages of safety and you can use your exceptions to make the specific messages of safety. Sure so for example, with the walking at the job interview. That was a very clear, specific message of safety I was giving myself every time I engaged in walking. Yes, I reminded myself like you walked for half an hour.
Speaker 1:Yeah.
Speaker 2:When you were happy and excited and you didn't have pain. Yeah, so I know that walking's not actually triggering my pain, like I was so direct and specific with myself around that, and this is it. So you just want to really state clearly, as you're starting to break these rules, these specific messages of safety. So I wrote down a few examples. You know the rule is wrong. This is simply a conditional response. I know I'm physically safe right now. Yeah, you know, like I said, I know this activity does not actually damage my body. My brain has just mistakenly understood that this activity causes symptoms. Yes, I'm safe to engage in this movement Totally and by giving these consistently, you know, we're helping rewire our brain. Yeah, because a lot of these roles we've set are increasing fear and they're keeping us stuck in chronic pain, chronic illness.
Speaker 1:Yeah.
Speaker 2:And so really specific cognitive messages of safety. They're not the whole deal Like. This is important, but there's other things we need to do as well as we kind of go through this Number three nervous system regulation Right One of my favorites One of my favorite topics? Yes, you know, safety steps happen when we think and feel safe enough while engaging in exposure.
Speaker 1:So we need to be working on nervous system regulation with exposure.
Speaker 2:Yeah, one thing that we don't want to do is just power through.
Speaker 1:No, which is, I think, all of us, lots of people can fall into just powering through yeah, but that actually sends the opposite of like okay, something is wrong here, or it completely dysregulate the nervous system yeah, I've seen people powers through a lot still. It's just so everyone's working better. I know, but I just want I just want to be clear that this is a hard thing to change it is really hard.
Speaker 2:We you know people with neuroplastic pain and symptoms. We can be an intense group of people. I'm, yeah, I, maybe I'll speak for myself, but from what I've witnessed. We can be an intense group of people. Maybe I'll speak for myself, but from what I've witnessed, we can be an intense group of people and a lot of people's default is powering through. So what I've seen happen is people will realize whoa, this is a conditioned response.
Speaker 1:They'll see all these exceptions.
Speaker 2:They'll be given those messages of safety and even as they start engaging in it, they'll have a flare and they just keep pushing.
Speaker 1:Yeah, the power through which I get, which kind of makes sense of like, okay, I'm okay. I know it's a conditioned response, but if we're powering through too much, we might know cognitively, but the nervous system is like what's going on here?
Speaker 2:Yeah, what happens is, even though we know cognitively we're safe, yeah, we're all of a sudden fighting. We're now in this like fight, response, like fighting against our symptoms, being like I know you're making a mistake, brain, I'm gonna power through. Like it, it creates more of a sense of danger and it's not like again that that thinking isn't bad.
Speaker 1:But that's why we want to kind of do the exposure work slow.
Speaker 2:And that's why I always recommend is you know, with with breaking these rules, with breaking condition responses, we need to do some type of nervous system regulation.
Speaker 1:Yes.
Speaker 2:And you don't need to get really fancy. We're not gonna dive into this right now, but you know, even just some breath work before I would go and do walks yes, that's what I would do.
Speaker 1:I would do some breathing for 15, 20 minutes and that was really really beneficial overall well, in some ways, that's almost the opposite of powering through, because you're taking a moment, you're slowing down, you're creating that safety, and then, hopefully, while you're through, because you're taking a moment, you're slowing down, you're creating that safety, and then, hopefully, while you're doing exposure, you're listening to your nervous system yeah and of what it needs yeah, because what we're trying to bring on is we're trying to give people access to this like ventral vagal energy.
Speaker 2:What I mean by that? Uh, we have a whole episode on polyvagal theory, but ventral vagal energy is where we feel calm, we feel safe, we feel at ease, socially connected, your breathing's deep, your heart rate's regulated, and as you engage in the exposure and start to break these rules, it's okay to have some fight or flight energy. It's okay to have some even despair or right or hopelessness, like that makes sense, like these kind of like blended states, but we want some of that ventral, safe, connected, calm energy in the mix that's right.
Speaker 1:So I think that's a really good telltale sign of like am I just pushing through and creating more dysregulation, or am I kind of regulating that nervous system and creating safety as I go?
Speaker 2:Yeah, and I'll say it again, I just said it but if you're struggling with graded exposure, work. If you're struggling with breaking these rules, start with some regulation. It can go a long way. Yes, that is like one of the main ingredients I included before I started to engage in exposure, of actually starting to walk yes and do things.
Speaker 1:And again back to your example that regulation can just be three deep, long breaths.
Speaker 2:Yeah, yeah, we don't need to get super fancy here. Yeah, you can if you want. I like all the fancy regulation skills. Yes, you can check out my youtube channel. They're all on there.
Speaker 1:But yeah, but it can be as simple as that of like okay, I'm gonna, you can, if you want, I like all the fancy regulation skills.
Speaker 2:Yes, you can check out my YouTube channel.
Speaker 1:They're all on there, yeah, but it can be as simple as that of like, okay, I'm going to slow down, do some breathing, listen to my body, be aware of kind of what I'm doing with challenging and breaking this rule, and then move forward.
Speaker 2:Yes, okay, what number are we on Number four Graded exposure.
Speaker 1:Right.
Speaker 2:We've already started touching on that. We've started touching on this because this is where the the kind of meat and potatoes really is around, some of this. And so you know, graded exposure, as we've said, is when you approach something slowly and gradually that you fear. This is key when rewriting the rules and breaking condition responses we can't heal by avoiding. We got to approach and we can do it gently, curiously, compassionately, but there needs to be an approaching that takes place, and what we're doing is we're teaching our brain, you're teaching your brain in real time, to approach physical sensations, to actually approach movements activities, the role that you fear. Approach movements activities, the role that you fear.
Speaker 1:And over time it actually learns hey, I'm safe, I'm okay. And again, like we've mentioned before, as we're kind of approaching something that we had rules around, it's normal for pain to maybe come up, and so that's a part of that process.
Speaker 2:Yeah, it's knowing that setbacks happen. It's not just going to be this steady decline of symptoms as your physical activity increases. There is going to be some bumps and, like we said, make sure you don't push through too hard and make the steps too big, because that's what I'll see people do. They make the exposure steps a little bit too big, and then there's other people that make them too small. They could probably push the line a little more.
Speaker 1:Okay, so it's finding that balance.
Speaker 2:Yeah, it really is, and so the first step in this is beginning to actually approach or engage in the conditional response.
Speaker 1:Yes, so having that awareness, noticing it, naming it, yeah.
Speaker 2:Start small at first. So, for example, with my walking, like one or two minutes at a time, yeah, lifting your arm once or twice, things like doing one push-up or one sit-up if you want to get back to movement, yeah, but small, small at first. If people are getting dizziness or headaches with screens, you could also. This is another example. You could look at the screen for a minute or two, and so then step two is noticing what starts to shift in your body, with your pain, your symptoms, your emotions, your nervous system state, and so what you do in step three is you actually pause the exposure.
Speaker 2:So you stop doing the approaching or engaging in the activity and you start to create safety with the pain, symptoms, emotions, nervous system state and how we do this and we won't get too complicated here. But we actually start to approach the unpleasant sensations inside, no matter what they are, it doesn't really matter. We actually start to approach them with curiosity, without a desired outcome, to make them go away, Because we actually want the pain or symptoms to be there at that time.
Speaker 1:I feel like sometimes hearing that might feel like no, it's hard but that's what we're doing.
Speaker 2:We're trying to create safety with the pain symptoms. Maybe you're feeling some fear, frustration, dysregulation, like we want that to come on, because that's what we're trying to rewire.
Speaker 1:Yeah, so that's right. So that's why it's like okay, if some some symptoms do come on, maybe that's not so bad, because now I'm going to work on creating that safety with yeah and this would be the time you'd be giving those specific messages of safety.
Speaker 2:you could savor any pleasant sensations you feel inside that can be really essential. And then you know in step four, once regulated, then you begin to approach the condition response or approach breaking that rule again. Yeah, so you could do another round. You don't have to, but if you're feeling up for it after you go through this process you can kind of repeat the process, okay.
Speaker 1:And so there's something about consistency with this which is I always like to point out as it being important that we need to kind of start one, continue with that exposure, but also keep that exposure going.
Speaker 2:Anytime Anne has a chance to say the word consistent.
Speaker 1:Well, because I think it's really key and I think it's something that we don't give enough credit to the consistency part of rewiring and relearning things.
Speaker 2:And you know, once you've gone through this once and you're ready to approach again, you could increase a little bit.
Speaker 1:Yes.
Speaker 2:You could walk a little bit more. You could look at the screen a little bit longer. Yes, because that's the goal is, over time you could do multiple rounds in one sitting and increase a little bit more. But over time, as you do this consistently, you can increase more. That's how I went from walking a couple of minutes to being able to walk an hour within a matter of a couple months.
Speaker 2:That took place for me, but it took a lot of consistent effort, so I'm in agreeance for me, but it took a lot of consistent effort, so I'm in agreeance.
Speaker 1:This is not something you're going to do once a week and expect change. Ah, okay, so that's a really good point.
Speaker 2:Yeah, and everyone's different. So I'm cautious to say like a set number, because everyone wants like an exact plan, but we don't know your case. If you're listening, we don't, and we want to be ethical around that. We don't, and so you're going to have to modify this. But if it's not consistent enough, your brain has all these other experiences that are maybe negative around the pain, yeah, so breaking that rule takes some real consistency. So, for myself, what I did with walking is I did it twice a day. Okay, I did it twice a day. As it got a little bit longer, I did it maybe once a day, yeah, but I was very consistently practicing this and I got great results. Now, if you have a setback and I had many setbacks with walking, even I took some days off.
Speaker 1:And that's okay. So it's important to kind of like, allow time off, allow rest, because you're still listening to your body of like okay, what does my body need right now? I need to rest, yeah, and then be okay with that too.
Speaker 2:Yeah, yeah. So be flexible for sure. And number five pleasant and rewarding.
Speaker 1:So when you're approaching kind of these rules, you're doing exposure. How can you bring in pleasant when it can be very hard and scary?
Speaker 2:So this is the thing I always say pair with pleasant. That's what it comes down to. You want to pair with pleasant? That's going to be very essential in some of this. Yes, and so when we're pairing with pleasant, this could be while you're engaging in the exposure work, listening to an upbeat playlist or a comedy show, like a comedy podcast. Yes, that's used a lot when I was walking. That was something I did often. Yeah, it could be watching a funny or warm-hearted show. For people that are practicing sitting in different places, that works great, right.
Speaker 1:It's funny I feel like Tanner, like you, maybe you weren't doing any exposure in the car, but sometimes Tanner borrows my car and you would always have it to the country channel. Yeah, and at one point I was like, when did Tanner start listening to country music? But you told me you know, it just makes me feel good and it's light and easy.
Speaker 2:And I imagine that was pairing with Pleasant for some way with you to some pretty intense like metal kind of music, because it definitely doesn't maybe bring up the happiest emotions and so, like there was a lot of laid back, you know, enjoyable playful country songs that would cultivate that. Yeah, because even sitting while I was driving would cause pain, right, so it could be that. But you know the other ways I've seen people do this is just focusing on what feels pleasant inside, like when you engage in the movement, when you work on breaking that rule, what feels pleasant about the way you're using your body.
Speaker 1:Which is a challenge, because I think the mind often is like oh, this is where it hurts, or this is where the pain is. So, challenging to look at it in a different way.
Speaker 2:Yeah, so there's other sensations going on. Yes, this could also be things like soothing touch, yep, like your hand on your chest, wrapping your arms around yourself.
Speaker 1:Yep.
Speaker 2:Petting an animal, mm-hmm, having your favorite snack. It's a great one.
Speaker 1:I have my special granola bar at night.
Speaker 2:Yep, you have your special. Well, you're not breaking condition responses, but you do have your special granola bar, if I do.
Speaker 1:And your teeth. Like I just shared that for no reason, you're saying no.
Speaker 2:no, you can share that it's just like and share the teeth granola bars.
Speaker 1:Wait, it brings me feelings of joy. It does? It's a conditional response in the other way.
Speaker 2:Ah, it's like a safety response.
Speaker 1:Yes, Tanner.
Speaker 2:I like it, no you were correct.
Speaker 1:I was wrong. I was wrong.
Speaker 2:I apologize, Don't like make me feel bad about that. Hey, the cats also try to eat your granola bar.
Speaker 1:They do they go at it.
Speaker 2:Okay, you're right, they do.
Speaker 1:they go ahead, okay, anyway sorry, we got off track there. We did pretty good on being on track most of the time.
Speaker 2:Yeah, okay, you're off track. Okay, sorry, um, and so just think about this. You know what are ways you can make it more pleasant, more rewarding actually engaging in this exposure work, because the goal again is to create safety.
Speaker 1:Yes, yes, and so if you're doing it and it's that white neckling pushing through, well, there's no safety in that. If it's like, oh, like, I know to expose myself and I have to do it, and it's like begrudgingly, there's no safety in that either.
Speaker 2:No, exactly, and so you want to try to maximize the chances of your brain feeling safe, and what we're doing is this positive reinforcement and that helps retrain the brain.
Speaker 1:Yes.
Speaker 2:So this was our episode.
Speaker 1:We hope this was helpful. And also a bit tangible for people to really take these ideas away, to start challenging their rule books a little bit.
Speaker 2:Yeah, start to break those rules. So in review we kind of covered five main areas of how we go about breaking the rules. Yes, so number one look for exceptions. Yes. Number two specific messages of safety. Number three nervous system regulation. Number four graded exposure. And number five pleasant and rewarding.
Speaker 1:Yes.
Speaker 2:So we appreciate everyone listening. We hope this was very helpful and we will talk to you all next week talk to you next week.
Speaker 1:Thanks for listening. If you want to book in a session with one of our therapists, you can go to our website at painpsychotherapyca.
Speaker 2:You can also follow us on Instagram at painpsychotherapy, where me and Anne are posting content daily and are there to respond to your comments. Also, check out our YouTube channel, which is named Tanner Merton, msw RSW.