How can I know if this EAET or PRT treatment is relevant for my condition?

By Kent Bassett

The PRT (Pain Reprocessing Therapy) or EAET (Emotional Awareness and Expression Therapy) approaches for treating chronic pain are recommended for 30+ conditions which are often—but not always—brought on by a brain-generated process that is reversible. The following list of diagnoses and symptoms was compiled by physicians like David Clarke, MD and David Schechter, MD at the Psychophysiologic Disorders Association in their book A Diagnostic Guide for Psychophysiologic Disorders, as well as in in Dr. Howard Schubiner’s book, Unlearn Your Pain:

anxiety, chronic abdominal pain and spasms, chronic arm or leg pain*, chronic back pain and spasms*, chronic neck pain, chronic tendonitis, repetitive strain injury (RSI), complex regional pain syndrome (CRPS), depression, dizziness (including PPPD & MmDS), face pain*, fibromyalgia, insomnia, brain fog, irritable bowel syndrome (IBS), painful bladder syndrome (interstitial cystitis), pelvic floor dysfunction, POTS (postural orthostatic tachycardia syndrome), temporo-mandibular joint dysfunction (TMJ), chronic inflammation, tension and migraine headaches, post-concussion syndrome, tinnitus (ringing or distortion in the ears), burning mouth syndrome, vulvodynia, coccydynia, some people with neuropathic pain, trigeminal neuralgia and other neuralgias, post-exertional malaise and chronic fatigue (ME/CFS), some people who are told their chronic pain is due to Hypermobility Ehlers-Danlos Syndrome (hEDS), and conversion disorders / functional neurological disorders, plantar fasciitis/foot pain.

* “As long as the X-rays and MRIs do not show a tumor, infection, inflammatory condition, or fracture, and if the neurological examination is normal to rule out nerve damage, then: the presence of degenerative discs, spurs, facet problems, and bulging discs should not be interpreted to be causing pain.” (citation: Howard Schubiner, MD)

While mainstream medical institutions have been slow to recognize this category of pain etiology, in 2022 the IDC-11 (International Classification of Diseases at the World Health Organization) acknowledged it and released guidelines for identifying “chronic primary pain,” meaning a condition of pain that has no clear underlying pathophysiology in the body, or where the pain is far more severe than injuries could explain. In concert with the International Association for the Study of Pain, they released a chart (see below) with this article and identified five main pathways of primary pain (widespread pain, head pain, CRPS, visceral, musculoskeletal).

There’s a potential drawback to the term “primary pain,” which is that it could imply the pain happens on its own, for no apparent reason, since tissue damage has been ruled out. But through careful interviewing, it is usually discovered that there is an underlying cause of the pain, which is specific for each individual. These causes tend to go by generic terms like “brain genesis,” fear conditioning, neuroplastic learning, psychosocial stress, or mind-body syndrome. And most people need help sorting out how and why their brain might be causing pain, since it’s so counterintuitive.

The PPDA list also includes additional disorders like inappropriate sinus tachycardia, paresthesias (numbness, tingling, burning), dizziness, eczema, non-epileptic seizures, globus sensation, burning chest pain (resembles acid reflux), difficulty breathing, chronic cough, spastic dysphonia, chronic hives, hypersensitivity syndromes (to touch, sound, smells, foods, chemicals, electrical waves, medications), piriformis syndrome, whiplash, patellofemoral syndrome, myofascial pain syndrome, amplified musculoskeletal pain syndrome (AMPS), as well as psychological disorders like obsessive-compulsive disorder, panic attacks, anxiety disorders, post-traumatic stress disorder (PTSD), eating disorders, and substance use disorders.

Additionally, many people who explore alternative medicine receive holistic diagnoses like adrenal fatigue, chronic Lyme disease, leaky gut syndrome, toxic heavy metal accumulation, candida overgrowth. These diagnoses can lead to the same incorrect belief that the body is damaged, and it can also activate the nocebo effect, or pain -> fear -> pain cycle, in an analogous way as when a doctor mistakenly assigns a herniated disc on an MRI as the cause of back pain. Patients who live in fear of a post-infectious agent wreaking havoc in their bodies can also unlearn the fear-pain cycle and unlearn their symptoms.

And then there are a handful of rare structural conditions, including Mast Cell Activation Syndrome (MCAS), that are sometimes applied to people loosely, when the criteria for diagnosis should be much more precise. For people dealing with a confirmed or questionable structural diagnosis but hoping to add mind-body treatment, a simple option is to start doing the mind-body work, which is quite conservative (while continuing any medical care) and see if the symptoms respond. Alternatively, it’s possible get assessment of your structural symptoms to see if they in fact bear the hallmarks of a brain-generated or neuroplastic syndrome, and were perhaps misdiagnosed.

For people dealing with auto-immune disorders, sometimes they have brain-generated symptoms that are simultaneously driving their symptoms. Which symptom is caused by which mechanism? Individual trial and error can sort that out. Some people have decided to do brain retraining to see which of their symptoms are driven by physical damage (like inflammation) versus which might be driven by the brain. They continue medical treatment for the ongoing structural issue while adding a mind-body component as a secondary treatment.

Good Lord! That is a lot of diagnoses and symptoms. We wanted to make information available for this relatively exhaustive list because it is very common for people to identify with their diagnosis and to believe it is incurable. If your diagnoses or symptoms are in this list, there is hope.

• Note: the brain retraining treatments are generally not recommended for people with cancer, infections, fractures, muscle diseases, and other structural problems associated with tissue damage. However, it is unfortunately quite common, even routine, that people are incorrectly told they have structural problems (like degenerative disc disease), which are not responsible for causing their symptoms. Each person should be examined as an individual by a doctor. To find a mind-body-informed clinician, check out the directory updated by the PPDA.

In This Might Hurt, you see people struggling with and overcoming several of the conditions listed above. Additionally, many other success stories exist of people recovering using a neuroplastic approach.

We’ve collected success stories for many of these conditions because people say they didn’t believe they could get better until they heard a story they could identify with—someone who’s been through the same ordeal they have.

Resources for Other Common Diagnoses

PELVIC PAIN

INCLUDING vulvodynia, Coccydynia, & Pelvic floor dysfunction

At least about 10% of chronic pelvic pain is due to structural causes (or tissue damage). The most common structural causes are endometriosis, large fibroids, large cysts that rupture, cancer, infections, and hernias.

For people who do not have such a clear structural diagnosis for pelvic symptoms, it is worth considering neuroplastic or brain-generated causes, which are usually related to a process that is reversible through brain-retraining and fear reduction. Here are some resources for exploring how the brain can create, amplify, or trigger chronic pelvic symptoms, and how these can be unlearned as well:

➡️ Pelvic Pain Recovery Story

➡️ Interview with Howard Schubiner on the “V-Hive” Podcast

➡️ This Endo Life Podcast: “How the Brain Increases Endo Pain and How Pelvic Pain Becomes Chronic with Christie Uipi”

From a recent academic discussion of Chronic Pelvic Pain, “Current Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside”

“Chronic Pelvic Pain may sometimes be completely dissociated from any other medical condition or may persist even after the woman has undergone adequate treatment for the underlying disease. Consequently, distinguishing between states of chronic secondary pain and states of chronic primary pain, as proposed by the International Association for the Study of Pain (IASP), also seems to be important.” …

Around 60–80% of patients present with complaints that fulfill the International Classification of Diseases, 10th revision (ICD-10) criteria for somatoform disorder.” [somatoform disorder is a synonym for mind-body, or primary pain disorder] …

Psychosocial factors such as adverse childhood events (physical, sexual, emotional abuse), physical and/or sexual abuse in adult life, depressive disorders, anxiety disorders, pain catastrophizing and other mental disorders can be associated with chronic pelvic pain in women.

➡️ “Not Defined by Endo” podcast interview with Howard Schubiner, June 2, 2020

Howard Schubiner, MD: “Endometriosis can be mild, moderate, or severe. And people with severe endometriosis are more likely to have pain due to the endometriosis. What about people with mild endometriosis? It turns out that many women have endometriosis without any pain.

“And so research shows that when you do laparoscopies on women, some women with pain have endometriosis and some do not. Some women without pain have endometriosis, some women without pain do not have endometriosis. In someone who is diagnosed with endometriosis, to blame all of their pain on endometriosis could be incorrect. You have to distinguish that on an individual basis. You can’t make a blanket statement. … The answer lies somewhere in the middle.” … “If the endometriosis stays the same but the pain gets significantly worse over time, that’s a sign that neural circuits may be involved [in amplifying the pain].”

*Note: Endometriosis is not on the list of mind-body conditions because there is clear evidence of lesions and other tissue damage. But often, pain is attributed to endometriosis incorrectly. So it needs careful assessment and compassion to navigate proper care.

Here’s a down-to-earth overview of how to use pelvic imaging studies to understand chronic pelvic pain better:

Watch some stories about pelvic pain recovery below:

Plantar Fasciitis & Foot Pain

Many people with chronic foot pain and plantar fasciitis have made full recoveries by recognizing the brain-generated, or mind-body nature of the symptom.

An important piece of information that can hopefully reduce fear is that the typical healing time for soft tissue damage or damage to fascia is within 2-6 weeks. Howard Schubiner, MD often will reassure patients, “Injuries always heal, and scars don’t cause pain.” It’s extremely unlikely that a soft tissue injury has never healed, despite concerns about micro-tears in the facia or tendons. Foot pain often feels like there’s damage because the pain happens when you step on the foot, but for chronic foot pain the brain is able to trigger identical pain out by being “over-protective” and fearful. The pain does not indicate damage any longer.

If patients are living in fear of soft tissue injuries, it’s worth exploring the latest neuroscience of pain which is clear that this kind of chronic pain is usually driven by the brain rather than damage in the body. This is similar to how musculoskeletal changes in the back like “degenerative disk disease” are not causal of chronic pain—they are commonly found in people with no pain. Similarly, micro-tears are a correlation with foot pain, not a cause.

What can happen is that after a soft-tissue injury in the foot has healed, the brain will remember how to generate identical symptoms, and because of fear or other stresses or for unknown reasons, it will generate pain as an over-zealous protective mechanism (according to neuroscientist Lorimer Moseley, PhD, “pain is always about protection, it is not a measure of tissue damage”). This over-protective, fear-driven process can be unlearned and people can gently resume full use of their legs and feet while retraining their brains.

Nicole Sachs, LCSW podcast interview about Plantar Fasciitis

Curable’s interview "Aaron’s journey to recovery from foot pain.”

Practitioner Regina G. Peirce, LCSW
Chronic pain coach and behavioral health therapist and certified Pain Reprocessing Therapist
Regina suffered from and was able to unlearn plantar fasciitis by doing brain retraining. She now helps others do the same.
Connect with her: The Path Therapy

Hand, Wrist, & Arm Pain / Repetitive Stress Injury (RSI) / TENDINITIS / Carpal Tunnel Syndrome / chronic tennis elbow

Recovery Stories

“How I Eliminated My Chronic Pain Through a Mind-body Approach”

A comprehensive success story of overcoming repetitive strain injuries from Mark Phillips, who was initially alienated by John Sarno’s writing.

“Curing Pain By Doing Nothing”

An amusing success story by told by someone who recovered simply by refusing to worry about her pain. Note: of course this only works for a subset of people—for some the pain is impossible to ignore.

A gamer describes his descent into chronic hand pain:

Chronic Lyme Disease

Doctors specializing in researching and treating mind-body disorders like Dr. Howard Schubiner, Dr. David Clarke, and the Psychophysiologic Disorders Association are aligned with the mainstream infectious disease understanding of Chronic Lyme Disease, which is that “Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics.” (citation: Center for Disease Control)

There is not much written about chronic Lyme disease from the mind-body perspective, simply because they hold — along with infectious disease researchers — that chronic Lyme should not be addressed with months-long courses of antibiotics, which have been proven ineffective several times.

“Study: Prolonged Antibiotic Treatment Gave No Relief For Lasting Lyme Symptoms,” by NPR
“There have been four other clinical trials, funded by the NIH, that have come to the same conclusion as Kullberg's study and none suggested long-term antibiotics helped.”

In the New England Journal of Medicine, they describe Chronic Lyme Disease as "The latest in a series of syndromes that have been postulated in an attempt to attribute medically unexplained symptoms to particular infections."

Criticism of Treating Chronic Lyme Disease as an “Ongoing Infection”

Note: According to mainstream medicine, chronic Lyme disease falls under the umbrella term, Medically Unexplained Symptoms (MUS), which typically do not have proven treatment options. The Psychophysiologic Disorders Association has said there is a solid basis for treating a large number of Medically Unexplained Symptoms (including those associated with chronic Lyme disease and “co-infections”: fatigue, chronic pain, brain fog, insomnia, rapid heart rate) from a mind-body perspective. In other words, symptoms that have been incorrectly attributed to chronic Lyme can be reversible through brain retraining. Not all medically unexplained symptoms can be ascribed to mind-body syndrome or learned neural pathways. They would need to be assessed on an individual basis.

What if Lyme symptoms persist after several weeks of antibiotics?

There are published studies demonstrating the effectiveness of mind-body treatment for people who have a similar collection of symptoms, but who were labeled as having fibromyalgia, not chronic Lyme. But there has not been a study of the mind-body treatment for people labeled as chronic Lyme disease, to our knowledge.

There’s a contingent of doctors and researchers who are sometimes referred to as “Lyme literate,” a documentary film Under Our Skin, and patient advocates who say that having Chronic Lyme Disease means you continue to have an active infection even if you took antibiotics for a few weeks, and that taking antibiotics and other remedies for months and years can be effective, and that mainstream science is wrong about chronic Lyme. This is not accepted by medical organizations like the CDC or the National Institutes of Health. For more information about this debate, see the journalistic articles below.

It’s worth noting that these two camps (Lyme literate doctors vs. mind-body doctors)— who both agree that mainstream medicine has huge blind spots when it comes to chronic illnesses—nevertheless have opposing opinions on the question of Chronic Lyme Disease.

Chronic Lyme Success Stories

Rita LaBarbera has written up her story of recovering from Chronic Lyme Disease (as well as CRPS) in a blog post. She now does coaching for people with Chronic Lyme. And many people have overcome Chronic Lyme Disease through brain retraining and told their success stories on Youtube.

“I got off the whole Lyme train”

Additional Resources

https://www.cdc.gov/lyme/postlds/index.html
The Lancet issued a comprehensive report, “Antiscience and ethical concerns associated with advocacy of Lyme disease,” 2011.

Longform Journalism Exploring Chronic Lyme Disease

Exposé by scientists about Chronic Lyme starts half-way through this episode:

This is a solid analysis of the misinformation around chronic Lyme and co-infections, but a small quibble is they refer to people with Chronic Lyme as people who “feel crappy” when actually the symptoms can be totally debilitating and are quite real.

They imply that most people with chronic Lyme have other medical conditions like MS or “degenerative disk disease,” when it’s far more likely that medically unexplained systems are a form of primary pain, or a learned, neuroplastic process that is reversible through brain retraining.

“Maybe It’s Lyme: What Happens When Lyme Disease Becomes an Identity,” The Cut, New York Magazine, July 24, 2019, by Molly Fischer

Molly Fisher: “No one disputes that Lyme disease can leave patients with long-term symptoms; the source of disagreement is their cause. Is the illness the aftereffect of an infection that has passed? Or is it an ongoing, active infection, the kind that might require continued treatment with antibiotics? At present, the vast majority of mainstream medical authorities do not support the use of long-term antibiotics for persistent Lyme symptoms; this includes the Centers for Disease Control, the National Institutes of Health, the American Academy of Neurology, the American College of Rheumatology, and the Infectious Diseases Society of America.”

…And here is the crux of the medical establishment’s objection to the treatment of chronic Lyme, the source of the mutual distrust between the chronic-Lyme community and mainstream medicine: the demand for a treatment as extreme as long-term and intravenous antibiotics. From a mainstream medical perspective, Aronowitz explained, the situation is something akin to patients who have not been diagnosed with cancer deciding to seek out “cancer-literate” doctors willing to administer chemotherapy.”

“The Challenge of Chronic Lyme,” by Rachel Pearson, MD, New York Review of Books, July 25, 2018.

Dr. Rachel Pearson, MD: “MS was essentially chalked up to hysteria until the invention of Magnetic Resonance Imaging (MRI), which allowed doctors to see the characteristic lesions in the brains and spines of patients with MS. When doctors could see it, we designated it as real.

MS was real before the MRI, and chronic Lyme is also real. It comprises a constellation of symptoms and a community of sufferers, too often attended to by unscrupulous providers. Insofar as the history of chronic Lyme is a history of physicians’ ignoring, downplaying, or refusing to investigate the symptoms of women, chronic Lyme is also a feminist issue.

Should women’s suffering be listened to, attended to, and investigated? Yes. Does our suffering deserve heroic efforts to develop and provide evidence-based therapies? Absolutely. But is our suffering caused by tick bites? Usually not.

DIAGNOSIS OF LYME
In her article, Dr. Pearson disputes the idea that Lyme is difficult to test for: “In cases where symptoms have been present for more than four weeks, physicians perform a two-tier blood test to confirm the diagnosis: an enzyme assay, followed by a Western Blot, which looks for antibodies to Borrelia. If performed alone (without the preceding enzyme assay), or performed on people who are unlikely to have actual Lyme disease (Australians, for example), the Western Blot produces some false positives. False negatives are rare.

“…The diagnosis of Lyme disease is frequently described as tricky and unreliable. In his 2013 New Yorker article “The Lyme Wars,” Michael Specter writes that “Diagnostic failures cause much of the confusion associated with Lyme disease… many people who become infected will test negative in error, while others who aren’t infected will test positive.” Few physicians would agree either that there is a war going on or that the test is so unreliable. When used as it should be (on patients with classic symptoms, four or more weeks after a plausible exposure), the classic two-tier test detects 99 percent of cases, and the false-positive rate is vanishingly small.”

Myalgic Encephalomyelitis / Chronic Fatigue SYNDROME (ME/CFS)
AND Post-exertional malaise

Chronic pain and fatigue often go hand in hand. Just as extreme chronic pain without a clear structural injury can be understood of as an incorrect warning signal from the brain, overwhelming fatigue generated after moderate activity can be understood as a fear-associated overreaction of the nervous system.

This is a common problem for people after an infection has caused their nervous system to generate fatigue in order to give the body rest and to recover. But after the disease has been cleared from the body, the fatigue symptoms can remain and cause havoc.

A downward spiral of activity -> fatigue -> fear -> reduced activity can get locked into place. The medical term for this is “post-exertional malaise.” These are neuroplastic brain changes that can be learned and unlearned through similar evidence-based therapies that guide people to unlearn their pain.

Two former chronic fatigue patients have overcome their fatigue and now lead workshops to help others. Even just their stories of overcoming post-exertional malaise are powerful in helping people realize these symptoms can be reversed.

Michelle Wiegers’s interview on the Mind and Fitness Podcast

Michelle talks about getting diagnosed with Ehlers Danlos syndrome and dealing with swollen feet and foot pain, dizziness, POTS (confirmed with a tilt table test), trying ionic foot baths for removing toxic heavy metals, and so many other things.

Rebecca Tolin has told her story here: Tiny Buddha’s “How I Finally Healed When I Stopped Believing a Diagnosis of Incurable.”
Rebecca Tolin interview on the podcast, “Our Power is Within.”

Michelle and Rebecca are now health coaches who help people especially with fibromyalgia and chronic fatigue.

You can find Michelle on her site. And Rebecca has her site.

Though it is less prevalent among men, they can also get brain-generated fatigue and pain, and can find relief through brain retraining. Jason tells his incredible story of going from 11 years of ME/CFS to a full recovery and hiking mountains in just 2 months.

Jump to his breakdown of how he used brain retraining at 34:43.

Watch Somatic Tracking for Fatigue with Tanner Murtagh MSW, RSW :

NEUROPATHIC PAINS & NEURALGIAS

Neuropathic pain is another tricky category of illness because, much like with chronic back pain, these conditions can of course be caused by structural damage, but are frequently diagnosed incorrectly. Often people are given neuropathic diagnoses without enough careful examination to differentiate symptoms that can be learned and created by the nervous system, versus symptoms due to nerve damage.

From Howard Schubiner, MD:

“People are told that they have neuropathic pain when the pain feels like nerve pain, whether there is actual nerve damage or not. And EMG findings that supposedly show nerve damage are regularly unreliable, just like MRIs for chronic back pain.”

“Clearly some people do have neuropathy due to nerve damage because of diabetes, alcoholism, chemo toxicity, and rare genetic disorders to name the major causes of neuropathy. But when the diagnosis is idiopathic neuropathy [meaning symptoms of unknown cause], it's likely to be mind-body syndrome; or when the diagnosis is small fiber neuropathy as well. Or when the diagnosis is any of the neuralgias, e.g., pudendal neuralgia, occipital neuralgia, trigeminal neuralgia, etc., these are also typically due to mind-body syndrome.”

In our film This Might Hurt, Maureen suffers from tingling, numbness, burning, aching in her hands — symptoms that are similar to those caused by neuropathy. But nerve damage does not explain her pain.

Dr. Schubiner gave a talk analyzing Trigeminal Neuralgia (TN). He makes the case for why the diagnosis of neuralgia can usually be classified as one of the neural circuit-based disorders, which can be dramatically reduced and reversed using brain retraining and mind-body therapies.

Chronic Inflammation

Macro- versus Micro-inflammation explained by Howard Schubiner, MD at 22:42 in the webinar above ^

hypermobility Ehlers-Danlos Syndrome (h-EDS)

Hypermobility Ehlers-Danlos Syndrome (hEDS) causes connective tissue changes and flexible joints that can sometimes subluxate (partially dislocate). This is a trending diagnosis for people presenting with chronic pain at the moment: more and more people are being labeled with hEDS and not given accurate information about the brain’s ability to reverse chronic pain.

It’s worth noting that hypermobility in itself does not cause chronic pain. For example, children tend to have much more mobility in their joints than adults, yet they do not have higher rates of chronic pain.

Right now there is a significant and unfortunate trend of physicians ascribing patient’s chronic pain to hEDS incorrectly. If the pain tends to migrate around the body, varies a lot by time of day, is way worse one day than another day, gets triggered by stress—those are the hallmarks of brain-generated pain rather than connective tissue damage, and it is very unlikely to be caused by hEDS.

Michelle Wiegers was told her EDS caused her chronic pain, which terrified her, but she recovered fully through brain retraining and is now pain-free. She talks about how her children have probably inherited hypermobile joints and none of them have developed chronic pain.

MICHELLE TELLS HER EDS STORY AT 36:20

Georgie Oldfield has written about hypermobility from a mind-body perspective.

In her book The Sleeping Beauties, the neurologist Suzanne O’Sullivan, MD comments on the unfortunate medical trend of over-diagnosis of connective tissue conditions like hEDS. In her book she tells the story of a patient named Sienna, who also suffered from POTS:

Sienna also had a diagnosis of joint hypermobility, which was applied when she complained of joint pains in her mid-teens. Extreme joint hypermobility associated with an objective genetic abnormality has always been a disease, but in very recent years the general flexibility of a person’s joints has had disease parameters assigned to it without any disease needing to be present [also known as hpyermobility Ehlers-Danlos Syndrome (hEDS)]. This has drawn a large population of “mild” cases of joint hypermobility into the fold—people who are deemed to be too flexible to be normal, even though they do not have the genetic abnormality that goes with the severe form of this problem. (p. 302)

Having a medical diagnosis for a body that is more-or-less normal, for some people, is not a problem. But for so many people, it nudges them down a pathway of fear, more biomedical tests, more ineffective biomedical treatments. The diagnosis pushes them into a fear-driven cascade of expensive medical workups. The way out of this dead-end process is to de-medicalize and de-pathologize connective tissue problems, and begin exploring the psychosocial aspect of illness. In other words, by unlearning fear, healing can begin.

TINNITUS (Ringing or Distortion in the Ears)

Ringing or distortion the ears can be either be fully a mind-body disorder, where it can be 90-100% reversible by working through fear and dealing with stress. Or in some cases, tinnitus can be a sort of subtle, background noise that is a baseline part of hearing—it cannot be undone, and doesn’t need to be. Unfortunately, fighting tinnitus is an attitude which tends to make it worse. Thirdly, there is subtype of tinnitus that may be caused by some kind of injury, which is much harder to change. If you notice your tinnitus changes based on your stress levels or based on other factors like time of day, there is a good chance that mind-body and neuroplastic therapies could be relevant.

The mind-body treatment focuses on changing the relationship with ringing so that you don’t resist it, don’t fight it, and instead regard it as a kind of music. (Paradoxically, resisting tinnitus can sometimes reinforce it, just like resisting pain can sometimes trigger anxiety which makes pain worse. Often ringing sounds are perceived as unpleasant and aberrant, and they are latched upon as a horrible perception that must be stopped. This is an understandable but ultimately unhelpful reaction.)

In ancient meditative traditions, this baseline noise is called “the sound of silence,” and it’s often thought of as a positive development in spiritual practice born of inner peace. Adept meditators even use the sounds as an object of meditation to practice with. To learn more about the meditative path using ringing in the ears, check out this article. This may be possible only if the tinnitus is relatively subtle. If you have a blaring, disruptive inner noise that disturbs your ability to communicate and understand people when they speak, then more extensive mind-body and neuroplastic brain retraining is worth looking into.

Many people who have both chronic pain and tinnitus have found that by doing the mind-body work for their pain, they also noticed their tinnitus go down dramatically. So it is commonly thought of as a mind-body “equivalent.”

For this person, over time their tinnitus has become a mind-body signal of stress, just like for many people pain serves as a message that something is off balance in their lives.

POTS (postural orthostatic tachycardia syndrome)

POTS (postural orthostatic tachycardia syndrome) is a diagnosis given to patients who have trouble standing or moving without spikes of heart rate that cause dizziness and inability to stand. This is a heavily medicalized disorder, which does not typically benefit from being medicalized. Johns Hopkins website says, “Although there is no known cure for POTS, the condition can be managed in most patients with diet, exercise and medications.”

One way that doctors have medicalized this condition in recent years is by using a “tilt table test” which has been thought to standardize the diagnosis. But studies have shown that tachycardia (rapid heart rate) begins right before tilting patients into an upright position, during fearful anticipation of dizziness and fainting. This mean that addressing fear is critical reducing and unlearning the dizziness and other symptoms, just like with chronic pain and other mind-body conditions.

Mind-body physicians have consistently found that with the right information and treatment, POTS can be fully reversed, not just managed. One important step to the process is to de-medicalize the condition, and to reduce the fear around the heart or the body being damaged. The rapid heart rate experienced by people with POTS is not caused by heart damage, but rather by dysregulation of the nervous system.

The heart rates is controlled by the autonomic nervous system, which is controlled by the brain. Through brain-retraining, rapid heart rate can be gradually unlearned, and people can resume standing and walking without any heart rate issues.

POTS RESOURCES

Patrick Ussher wrote a book, POTS: What Really Happens, detailing his successful recovery from POTS using brain retraining (specifically an online program called DNRS, which we are not affiliated with).

And Ussher made a website, What POTS Really Is, that links to several recovery stories.

From a recent study on POTS and fear-learning:

Patients with POTS in this study “had a more pronounced anticipatory tachycardia right before assuming the upright position in a tilt-table test (p = 0.015), a physiologic indicator of fear conditioning to orthostasis.”

This fear of standing can be unlearned and symptoms and POTS can be reduced through therapies featured in This Might Hurt.

The mind-body coach Michelle Wiegers, who has recovered from POTS herself, had helped many POTS patients unlearn rapid heart rates and get back to their lives.

Burning Mouth Syndrome

Functional Neurological Disorders & Conversion Disorders

Functional neurological disorders (FND), a.k.a. conversion disorders, include symptoms like paralysis, seizures, tremors, twitching, tics, problems with seeing or speaking (including blindness), which are not caused by structural damage or disease in the nervous system.

A classic example of FND is a type of paralysis where a patient is unable to move an arm during the school week but whose arm works fine on the weekend. Another notable characteristic is that upon reflex tests, doctors find that the nerve tissues are healthy and the paralysis is therefore reversible. (If the tissues are healthy and working properly, the illness is called “functional” by doctors, meaning not resulting from injury.)

There are so many misconceptions about functional disorders that have led to unnecessary stigma, so it’s important to underline that these disorders are real, they are not a choice, and they are definitely not "malingering” or imagined — they arise from a process that is automatic and outside of awareness. They are also quite common and the suffering is just as severe as for structural disease process. Unfortunately, because most doctors are not trained on how best to help these patients they often prefer to avoid them. 

FNDs are thought to be triggered by psychosocial stress and/or inaccurate beliefs about the body being damaged. Alternatively, they can seemingly happen for no apparent reason. Careful history-taking about stressful life events and personality traits are necessary before arriving at etiological conclusions.

According to the Mayo Clinic, “FND is related to how the brain functions, rather than damage to the brain's structure (such as from a stroke, multiple sclerosis, infection or injury).” But symptoms usually happen for a reason, which is why it’s so critical to interview patients about psychosocial stresses when damage has been thoroughly investigated and ruled out.

The treatment for FND is essentially the same as for people with neuroplastic pain or other functional symptoms: getting an accurate diagnosis, understanding the neuroscience of predictive coding, doing fear reduction, brain retraining, and emotional transformation to calm the nervous system and reduce symptoms. Not only do symptoms typically resolve, but many other benefits can accrue as well.

The treatment is detailed on our site here:

One of the fascinating things about functional neurological disorders is that in contrast to other functional syndromes (e.g. fibromyalgia, or irritable bowel syndrome), there is more certainty when doctors arrive at the diagnosis. For example, after doing reflex tests for paralysis, or an electroencephalogram (EEG) during a seizure, they can confirm a functional diagnosis with certainty. This is because a person suffering from non-epileptic seizures will clearly not have unusual electrical activity in the brain that is characteristic of a brain disease. Their brain’s electrical activity will be normal, confirming these patients do not have epilepsy.

And yet, because of the stigma of mind-body/functional disorders, there is much confusion about how to help patients with FND, or even give the diagnosis with compassion, understanding, and hope. A significant number of people diagnosed with epilepsy, for example, do not actually have epilepsy, but rather non-epileptic seizures (NES). And NES do not respond to anti-seizure medications. For more about this problem, see neurologist Suzanne O’Sullivan’s thoughtful discussion in her book, The Sleeping Beauties.

What’s the best treatment for FND? The standard treatment is cognitive-behavioral therapy (CBT). CBT is somewhat effective but not as much as we wish: about 30% recover. The treatment depicted in our film This Might Hurt adds to CBT with additional modalities of neuroscience education, diagnostic clarity, awareness practices, and emotional processing. Research has suggested that these additional supports lead to better outcomes and more empowerment for patients.

Here’s a study indicating the effectiveness these therapies, known as EAET or ISTDP:

To summarize the meta-analysis, for 2094 patients across 17 studies, “somatic symptoms improved significantly from pre-treatment to short-term follow-up with a large effect size, which was maintained at long-term follow-up.”

FND has a different history than many other chronic physical symptoms in that when it was first theorized, it was thought to be a conversion disorder, and thought to be caused by emotional suppression. An organization called FNDhope has questioned the wisdom of framing FND so narrowly. They have a helpful perspective on FND to keep in mind.

From: https://fndhope.org/fnd-guide

FURTHER BACKGROUND ON FND

“Time for a new deal between neurology and psychoanalysis,” Brain, August 2021

“We Might Have Long Covid All Wrong,” The New Republic, by Natalie Shure

This thoughtful and well-researched article explores Long Covid through the lens of how functional neurological disorders are diagnosed and treated. Might be of interest to people with FND.

“Functional disorders”: one of medicine’s biggest failures, The BMJ, by Richard Smith

How Bill Watson, PhD talks to patients about the FND diagnosis

I wanted to offer an extended quotation (starting at minute 48) from the Youtube interview with Dr. Watson, who has a thoughtful, caring approach to discusses the nuances with how FND can show up either because of trauma or other reasons.

Patients will ask, “Well what is it, if not epilepsy?!”

My way of talking about it is, “I understand these problems as your body’s way of letting you know something is troubling you, something that you’re probably not even aware of. Our emotions show up in our bodies in ways that are involuntary and are not under our direct conscious control. These are not something that’s happening because you’re making it up, you’re not faking it, you don’t want these to happen, you’re not doing it on purpose, you’re not imagining them. This is happening, these are are real things that are actually happening. Does this make sense? I give space to respond.

Sometimes there’s anger, tears… Then sometimes they say, “I can understand sometimes they happen when I’m stressed, but a lot of times I’m feeling fine when they happen, so how can you tell me these are happening because of emotional things, or stress, because that’s not happening?”

So one of the things I tell my patients is the stress that’s relevant for these kinds of symptoms is internal stress. It’s not necessarily stress that’s going on around you in your environment, which is why sometimes nothing at all could be going on. You could be having a relaxing evening, and you have a spell, you go into a seizure, why might that be? Where there’s something triggering that at the time, but you’re not aware of it, it’s in the back of your mind. Why might that be?

Well all of us develop skills to ignore what’s going on for us, just to get through the day. And I would say from what we talked about a couple of days ago with you, when we talked through your history, you’ve had a lot of training in how to tune out what’s going on for you, because of what you’ve been through growing up. Remember that? -Yeah

So there’s really good reason for you to have developed a way of managing your life by tuning out stuff that was overwhelming, that you couldn’t do anything about. So you get to the point where you’re very good at not noticing what’s happening inside of you. Usually they agree or if they don’t agree their spouse is there to challenge them [laughs].

So then we talk about the ways in which that ability to tune things out, while at the time was very useful, in the long run gets to a point where it’s not working so well for them anymore, and that time is now. It’s not necessarily a specific stressor in their environment, it’s something that’s going on inside.

One fellow told me indignantly, “But I was in church the other day, and I was just sitting there, and had a seizure, you’re tell me that- Where’s the stress there?” So I said well what were you doing as you were sitting in church? “I was just sitting listening to the sermon.” What was the sermon about? “Well the preacher was talking about how God the father loves us as children.” What did that make you think of? “Well that made me think of my father, who… Ohhh” And then he got it. So he’s sitting there in the pew not consciously in the front of his mind thinking about his dad, but in the back, it’s sort of floating around, it happens to all of us, right? And that brought up feelings.

Another woman said “I was having dinner with friends on a lovely summer evening” [and got a seizure]. Oh tell me about your dinner. “I was talking to Becky and Jim and they were back and talking about their trip to Italy and how they were taking all these trips, and doing all these fun things all the time, and I’m sick of how they talk- Ohhh” A lot of feelings were coming up, as you were sitting talking with the two of them. There’s usually some feelings in there, floating in the background, that we tune out [and can trigger non-epileptic seizures].

We can have very strong reactions to repressed feelings. That’s why we repress them. The idea of being angry, saying that I’m angry, saying that I’m angry with you, fills me with nausea and dread and anxiety and panic, because I was beaten, and my dad was mad all the time, and he drank, and he beat me and my mother and my brothers. And to think that I’m mad, ever? No way, not me, I want to throw up right now thinking about it. The extremity of our reaction to our own feelings, has a lot to do often with the extremity of our experience growing up, in childhood, and adolescence, and adulthood. 

At the same time, I want to add that there’s a misconception that these [FND] symptoms are always the result of trauma, and they’re not. The research shows that trauma, abuse, is in the background of patients with psychogenic events … about 50% of the time. If you have patient who’s got psychogenic events, and they say they don’t have trauma, believe them, they don’t. That’s not the only way to develop this kind of problem. There’s lots of ways to learn to tune out your feelings. You could be in a family where you’re told explicitly “tune out your feelings.” The way you deal with stuff that’s bothering you is “Quit whining, suck it up, and deal!” You can be in a family where a parent is exhibiting so much suffering, that all your attention goes to them, and you feel like you have to suck it up to take care of them. So you learn to suck it up, and be a caretaker. Which is a good thing up to a point, but things can become a problem if that’s the main or only way you’ve learned. If you find paying attention to your own feelings is not something you were taught. 

-William Watson, PhD from the TMS Roundtable Podcast

Chronic Dizziness and Vertigo (including PPPD and MmDS)

In the comprehensive seminar below, Daniel Lyman, LCSW, a teacher of brain retraining therapies, gives a masterclass with Dr. Yonit Arthur on how to unlearn symptoms of dizziness. Even when medical terms like PPPD and MmDS are given to patients, it still possible for many patients to fully recover with the insights and methods of neuroplastic therapies.

Other helpful videos:

Some people with Mast Cell Activation Syndrome (MCAS)

Mast Cell Activation Syndrome (MCAS) is a very rare structural condition that is being diagnosed at much higher rates lately because of improper testing standards.

Many symptoms are incorrrectly attributed to MCAS, for example fatigue and widespread pain, according to this 2021 study on diagnostic criteria.

Additionally, MCAS when properly diagnosed should respond to medical treatment. If the symptoms don’t respond, then it makes sense to re-assess with an eye toward mind-body or brain-generated pathways of causation.

A patient who is curious about working MCAS symptoms in a different way does not need to give up their diagnosis, or accept a different etiology, in order to try mind-body practices and see if they can be of help.

Looking for success stories for your particular diagnosis?

We suggest the following podcasts. If you do a search for your condition in the podcast app of your choice, you will likely find 1-3 episodes, per condition, of people describing their journeys to recovery.

Nichole Sach’s The Cure for Chronic Pain
Eddy Lindenstein’s The Mind and Fitness podcast
Curable’s Like Body, Like Mind podcast
Curable’s Tell Me About Your Pain podcast
Dan Ratner’s Crushing Doubt podcast

What about holistic diagnoses like adrenal fatigue, chronic Lyme disease, leaky gut syndrome, toxic heavy metal accumulation, or candida overgrowth?

These diagnoses can sometimes lead to the same pain -> fear -> pain cycle in a parallel way as when a doctor mistakenly assigns “normal signs of aging” on an MRI to the cause of back pain. Often people with these diagnoses can recover from their symptoms without drugs or special diets or other costly remedies.

As Marcia Angell, MD discusses it, the term “alternative medicine” can be misleading: “There are not two kinds of medicine. There's medicine that has been tested, and there's medicine that hasn't been tested.” The EAET treatment explored in This Might Hurt has been tested with promising results. More research is needed.