- So this morning was the bridge, right?
Provocative testing or neuro circuit testing is the bridge
between assessment and therapy.
So today is the therapy, the PRT,
pain reprocessing therapy this afternoon.
Tomorrow we'll start on emotional processing.
It'll be good.
So PRT is based on making the pain less dangerous,
lowering the fear.
And as I said before,
we don't have a switch to make the pain turn off
or the fatigue turn off
or the insomnia turn off or the anxiety.
But the brain is constantly neuroplastic,
constantly learning, constantly changing.
And we can train the brain, we can teach the brain.
And that's the simple model that you know, we're using.
So the certainty is there.
If you don't have the certainty,
if you feel like you can't be certain,
then you investigate, keep looking, keep watching over time.
See if you find evidence over time.
If a situation occurs and the pain goes up
or the situation, other situation occurs
and the pain goes down,
you're starting to see these neural circuits in action
and then you can become more certain
and the person you're working with can become more certain.
If you're not certain, you can try these other techniques
like the provocative testing.
And so I'm never kind of pushing or saying
we have to do this now.
You know, people want relief right away.
And you can do body and somatic work
and see what happens, right?
And as you're doing that, you can see the sensations
come and go or shift or move or go to different places
and you can begin to see the triggers
of the sound or the light or the rain or the cold
or all those things and you're gathering all that evidence.
But when you get to the point where you feel confident,
and you don't have to be a doctor to be confident in this
'cause people do this, it's just common sense.
If it's common knowledge that pain
that shifts and moves around is mind-body pain,
then everyone would know it.
Grandmothers would know it,
grandfathers would know it, children would know it.
One of my good friends, Charlie Merrill,
he was on a trip.
He and his wife are divorced
and he was taking a trip with his children
and his new wife's children, so a blended family,
and they were on a trip and his son was with them
and they were going and having a great time.
And about the fourth day, his son goes to,
they climb up a little hill and all of a sudden,
the kid can't walk.
His leg is hurting so much,
he can limp and he's just limping.
He can't walk at all.
And Charlie says to him, "Are you okay?"
And he looks at his leg and there's just common sense,
he didn't hurt it, nothing happened.
And he says to his son,
"You know sometimes when we're feeling upset
about something, we just, you know,
it just affects us.
Is there something bothering you?"
And he looks at him and he says, "I miss my mom.
I wish my mom was here."
He said, "I know."
And they talked about his mom and how he's gonna see her
and how she can talk to her.
And his leg was fine, he ran up the hill.
Just common sense, right?
Just common sense.
So what we're gonna do now
once we have this common sense is seeing,
how can we train the brain?
Well there's ideas, there's a model,
we talked about the scared child, right?
Child lying in bed, fearful of a monster in the closet.
We're not gonna be mad or angry,
we're gonna open the door, say, look, it's okay.
There's nothing wrong.
Lie down, give love,
tell a story, get a smile.
Be okay.
The fallen child, like I said before,
a child falls off a bike, looks to the parent
to see if they should cry or not.
If the parent freaks out, they cry,
if the parent smiles and laughs , then you're okay,
let's try it again, maybe they don't cry.
And I'm telling all my patients these exact stories, right?
To give them the idea of how we're gonna deal with this.
Sometimes it's the brain is like a child, a fearful child.
So sometimes a child has a temper tantrum.
What's gonna happen when you realise
that if a child's crying,
what's the first thing you wanna do?
You wanna make sure they're not hurt.
Do they have something in their eye?
Do they have a bee sting?
What's wrong?
If nothing's wrong, maybe it's a temper tantrum.
What are you gonna do?
You're just gonna wait.
You're not gonna do anything.
And what happens if you ignore a temper tantrum?
The first thing that happens,
it gets worse. before it gets better.
Cry louder, cry harder,
try to get your attention,
try to get you to, you know, pay attention to them.
But if you just keep ignoring, it'll gradually die down.
And what's gonna happen a couple days later, try it again.
Have another temper tantrum.
Try it again.
The brain will do that.
And we say it's like training a puppy.
How do you train a puppy?
You train a puppy with a persistent message
over and over again, consistently in a persistent message,
with kindness, with gentleness, and with patience.
Then the patience is a hard thing for a lot of people.
Why?
'Cause they wanna be out of pain now,
right now and that's hard.
You can't promise that.
But if it's a neuro circuit problem, you will be okay.
You'll be fine, this will help.
You'll get better.
But we can't push it.
If you're gonna make a timetable,
say I have to be better by tomorrow,
then you're putting more pressure on yourself.
That's gonna it harder.
So it's patience, it's kindness and gentleness,
how we're treating the brain with patience,
with kindness, with gentleness,
with a consistent message over and over again.
You're okay, you're okay, you're okay.
I had a patient come to me as a dentist from North Carolina
in the south of the US
and he had this pain up and down his arm.
And the only thing he did when he came back home
to his dental practise was he just said his name was Donnie.
And he said, Donnie, you're okay to himself.
And then he did it again over and over again
with gentleness and patience and persistent.
Donny, you're okay.
And there's some research showing
that when you talk to yourselves,
talking in the third person,
saying your name actually has a lot of benefit,
there's some research on that.
So what are the six Fs?
What is the normal response to, if you can't sleep,
if you're anxious, if you're depressed, if you're in pain,
if you're fatigued?
The normal response is to fear it.
To worry about it, to worry about the problem,
to hope it never comes, to dread it.
So it's fear and fear drives the pain,
drives the dangerous signal to make it worse.
It's focus on it, focusing on it,
monitoring, checking on it.
Is it here? Is it there?
When's it gonna happen?
All that focus makes it worse.
It's frustration with it, resentment of it,
anger toward it,
that makes it worse.
And everybody has these.
And my patients will go, yeah,
I have that, I have that, I have that, I do that.
Of course you do because you're human.
Everyone does this.
It's not your fault you're reacting this way.
That's how people react.
It's fighting it, pushing against it.
I'm gonna push through it.
Push, push, push,
but the pushing is actually giving it more power over you
'cause you have to fight it.
It's trying to figure it out.
And people go to extreme lengths of course,
as anyone would to figure it out.
This doctor, that doctor, this physio,
that here and there and everywhere, reading online,
constantly reading online, looking for the key, the answer,
something that will fix it, which is the sixth one,
trying to fix it.
And of course you wanna fix it.
Everybody wants to fix it,
but trying so hard to fix it,
making it life and death,
if it gets fixed or not
can become part of the problem.
And it's really hard to explain this
and kind of help to understand this sometimes
because again, this pain or the symptoms
can be so debilitating, so overwhelming.
And what we're saying is kind of like,
don't make a big deal out of it.
That's pretty counterintuitive.
Don't make a big deal out of it.
Are you kidding me?
It's a big deal, it's my life.
And what we're saying is we want you to be better.
You're going to be better.
This is a neurocircuit problem.
The method for getting better is this way,
is lowering these six Fs.
And that's what PRT is.
Different methods of lowering the success
'cause we can't control whether the pain comes or not,
but we can learn how to have control
over our reactions to it, which are these.
So that's the preliminary part of setting the stage,
setting the tone for what PRT is
and how we're gonna approach it.
So I do that all like ahead of time.
And then I say, okay, now are you ready for a treatment?
And then Ludmilla, do you wanna come up and be our?
Yeah, we had a request
for a more demonstration.
So we asked Ludmilla if she would come and help us.
(audience applause)
So what I say now is I say, well,
what we're gonna do is silly.
We're gonna play, we're gonna have fun.
- Yes.
We're just going to see if we can figure out ways
to calm your brain, to soothe your brain,
to help your brain know that you're actually okay.
Okay?
- Yes. - Yes, good.
Affirming. I like it.
We're smiling already.
- Yes. - Thank you.
Can you say no?
- Yes.
(everyone laughs)
They're laughing.
- I thought that was funny.
So what we're gonna do,
I'm gonna give you a quiz, okay?
And it has, it's a very simple quiz
'cause it's one question and I'm gonna give you the answer
and then I'm gonna ask you the question.
Okay? - Yes.
- Good, you're doing great.
- I cheated, I see the answer.
- [Howard] You saw the answer?
The answer is nothing. - Yes.
- The question is, Ludmilla, what's wrong with you?
- Nothing.
- Louder.
- Nothing.
- Louder.
- Nothing.
- How does it feel to say that?
What is your reaction to saying?
I'm kind of forcing you to say there's nothing wrong, right?
Is it the truth? Do you feel ambivalent?
Do you feel doubtful?
How do you feel when you say that?
- I do feel doubtful and I feel fear.
- Fear?
- Yeah.
- [Howard] And what's the fear?
- I will warn you that I will cry.
I would say that I will not be taken seriously
and the pain will not be taken seriously.
- [Howard] That no one would believe you.
- Yes.
- [Howard] Because there's nothing wrong.
- Exactly.
- Yeah.
And when we say nothing wrong, what we're saying is,
is that there's nothing physically wrong,
but the pain is real.
- Yeah.
- And the brain can create real pain.
Have you had people tell you
that there's nothing wrong?
Have you had people be dismissive or judgmental?
- Way too many people.
- [Howard] Yeah and how does that make you feel?
- So a lot of things.
So sad, angry, I think it's unfair, so.
- Very unfair, all right. - Yeah.
- So you can see how when you start to ask a question,
you get to somewhere
and you're not sure where it's gonna go.
Here, it went to emotions.
So we have a lot of emotional techniques.
We have lots of ways of validating emotions
and helping people feel emotions and express emotions
that we're gonna talk about tomorrow.
But for now, do you feel like you're,
you said you have frustration and anger.
- Yes.
- Toward people who've been dismissive.
- Yeah.
- [Howard] Do you think that anger is justified?
That your anger, your frustration is justified?
- I want to believe that all emotions are justified.
That does not mean that we should address
them towards someone.
- [Howard] Well, I'm not suggesting that you become violent
'cause you might end up in jail.
- Fair.
- But your anger is justified.
- Okay.
- It's justified to be angry and resentful
when people treat you poorly.
And we're gonna address that anger as well.
And the sadness that you have, right?
I can see the sadness in you, right?
- Yes.
- [Howard] And who are you sad for?
- Myself and maybe all the people
that get treated the same way.
- [Howard] Yeah, it's not only sadness for you,
but it's sadness for other people
being treated this way, right?
- Yes. - Yeah, that's beautiful
and poignant for you to say that.
Very beautiful.
But it's also sadness for you.
- Yes. - Right,
and the sadness that you have toward you is caring.
If you're sad for someone, it's 'cause you care about them.
You're sad for other people in pain
'cause you care about them
even though you don't even know them all.
But you're also sad for yourself.
- Yes. - And that sadness
is caring for yourself.
And I wonder if you could just take a minute
and take a deep breath in
and allow yourself to feel compassion
or kindness for yourself.
Can you do that?
- Yes. - Okay, try it.
Take a breath in
and I'll hold this
and put your hand over your heart for a second.
Yeah and just close your eyes for a second
and just take a deep breath in,
breathing in kindness for yourself.
Everyone can do that.
Take a deep breath in and feel kindness for yourself.
Take a deep breath in and feel compassion for yourself
'cause what you're doing now is you're taking that sadness
'cause sadness is caring
and you're morphing, you're turning that sadness
into compassion for yourself, okay?
'Cause some people have a hard time
being compassionate to themselves even.
Do you ever notice that?
I bet you do.
But you can and you can feel compassion from others.
Just now, just for a moment.
Deep breath.
Ludmilla, you're okay.
You're gonna be okay.
Okay, are you with me?
- Yes. - Okay and how does that feel?
- Tiring. - Tiring?
- Yes. - It's a lot of work.
- Yes. - You've been through a lot.
- I think so. - I think so too.
Does anybody have any tissue maybe?
Would you like a tissue? - Yes, please.
Oh, there we go.
People come prepared.
So when emotions emerge, we wanna address them.
We don't want to just ignore them, right?
So when you say the quiz,
when you say there's nothing wrong,
one part of it is that you've been dismissed or invalidated,
but that's not true here.
That's not true right now.
We're not asking the question.
We're asking the question of,
is there anything physically wrong with you?
'Cause you have pain in lots of different areas,
but you know that that pain is due to your brain, right?
- Yes.
- And so when I ask the quiz, I'm saying,
what's wrong with you?
And if you're saying nothing,
what you're affirming is there's nothing
physically wrong with you.
And there's nothing mentally wrong with you either,
by the way.
Good to know.
And I wonder if you could set aside for now
the emotional part for a moment.
We can come back to that.
But if you can set aside the emotional part for a moment,
let's try it again and see what comes up
if we ask you if what's wrong with you physically, okay?
- Yes, yeah. - You ready?
Is that on?
It is, oh, Ludmilla, can I ask you another question?
- Yes. - Okay.
What's wrong with you?
- Nothing. - Louder.
- Nothing.
- Okay and how does it feel to say that now?
- Good or neutral, it's okay.
- It's okay? - It's better.
- You said good? - Yeah.
- Did you say wonderful?
- Neutral, good or neutral. - Oh, neutral, okay.
(everyone laughs)
Wonderful.
Sometimes people do say it's wonderful,
they say it's a relief.
But you said good.
- Yes.
- It feels good in some way.
There's some part of you that feels good,
you know, there's nothing wrong.
- Yes.
- That's affirming.
Do you have any doubt about, do you have any doubt
that there's something structurally wrong with you?
Any medical doubt or any reason
that there's some doubt about this?
'cause we don't want you to lie to yourself.
- I do have some doubts because I had so many diagnoses
and so many things that I'm always thinking maybe,
there's some slight stuff.
- Right. - I also think
that everyone has some slight stuff.
So I might not be wronger than (chuckles)
just the normal human experience.
- Right, right, right.
And so just to review, you have pains
in your shoulder and your arm
and a variety of places, right?
- Yes.
- And they tend to move during the course of the day.
- Yes.
- Sometimes in the day it hurts in one spot,
and another time in the day it hurts in another spot.
- Exactly. - Right.
That's mind-body pain.
So let's say that we're just talking about these pains
that shift around and come and go
and move as part of the day.
We're just talking about that now.
- Yes. - Okay,
so what's wrong with you?
- Nothing. - Louder.
- Nothing.
- And how does that feel?
- That feels good.
- That feels good? - Yes.
- Is there any doubt about that?
- No, no. - No doubt.
So it's the truth.
- Yes. - Good.
So if you can tell yourself the truth,
that would be good, right?
- Yes. - Because we're telling,
who are we telling?
- The brain. - Exactly.
So what are we doing here?
We're trying to get a message through in humour,
in laughter, in joy.
We're trying to go around this fighting.
We're not fighting the brain.
We're talking with it,
we're calming it,
we're laughing with it, okay?
- Yes. - And I tell people,
I want you to take the quiz every day.
I want you to sing it, I want you to whisper it,
I want you to shout it,
I want you to say it in different languages, okay?
And every day you're just playing with your brain
and you're helping your brain understand
that there's absolutely nothing wrong and you're okay.
Alright? - Yes.
- [Howard] Can you do that?
- I will. - You will?
- Yes. - It'll be fun?
- Yes. - Good, I hope it's fun.
That's the whole point.
Okay, so that's the quiz.
I always start with that,
seems very silly.
And then I say, if you think that was silly,
this is even more silly, even more stupider.
That's American word, stupider,
is affirmations.
Okay, say I'm healthy and I'm strong.
- I'm healthy and I'm strong.
- There's absolutely nothing wrong with me.
- There is absolutely nothing wrong with me.
- I'm not afraid anymore.
- I'm in charge, I can do what I want.
- I'm safe. - I'm safe.
- I'm not in danger.
- And I'll be fine. - And I'll be fine.
- Great.
Can you do it in French?
(everyone laughs)
Can you do it in French?
- Yes, but I did the cheat code.
- I know, I was joking.
I was joking.
And what I tell people, as I said earlier,
affirmations change the brain.
They may seem silly, but if it's the truth,
are you lying to yourself?
- No. - Did anything is not true?
This is true
and we're asking you to tell yourself the truth.
And we're asking you to do this
just to keep in reminding the brain, talking the brain,
telling the brain you're safe.
And it's a mixture of fun and lightness,
and it's a mixture of calm and gentle,
and it's a mixture of empowerment.
And those are the characteristics,
the qualities that we wanna bring to this
calming and soothing the brain.
Okay? - Yes.
- Good.
Now having done that, now I will,
now I usually have a decision point.
The decision point is are there triggers
and or is there any discomfort right now in the moment?
So we've already worked on triggers this morning,
and I know you have a trigger with walking on stairs.
- Which obviously got away during lunch
because silly brain.
- What do you mean obviously?
- I feel as soon as I bring awareness to something,
then my body's happy.
And I'm like, oh, you're listening to me.
Great, then I don't need the pain anymore.
- [Howard] So tell 'em about the stairs.
- So I had knee pain since I was nine years old
up to last year
and can't remember anything when I was nine.
But I couldn't take stairs, I mean,
without pain and I couldn't cycle.
So it seemed quite specific.
I just stopped taking my bike, that was easy.
So it's been gone for one year,
but it got back like a few weeks.
And swimming and stairs has been painful again.
- And then what happened today?
- And then today, I had pain in the morning
and then I had less pain after the workshop in the morning.
And then we talked together at lunch.
And then when I went to the toilet, I thought,
oh, let's check that I still have pain,
otherwise it'll be annoying for the demonstration.
And obviously I didn't have pain anymore.
- So we talked and we talked about the knee pain
with walking up and down stairs.
And we said, "Well maybe we can do a demonstration
of that here with the knee pain
with walking up and down stairs."
And then you went to walk on the stairs.
And when you went to walk on the stairs,
what were you thinking at that moment?
- I hope the pain is still there so that I can demonstrate.
(everyone laughs)
- Exactly.
- Silly brain.
- But what happened then?
She was saying, I hope the pain is there.
And is that meaning, is that showing fear of the pain?
It's showing the opposite of fear of the pain,
hoping that it comes and then it doesn't come.
And so I'm jumping a little bit here,
but one of the techniques we use often later,
at the beginning, maybe not so much
'cause people are afraid,
but Viktor Frankl, psychiatrist in,
was in Auschwitz from Vienna after the war
and all his amazing work and book,
but one of the things, he became a therapist
and he developed this thing called paradoxical intention.
So paradoxical intention is basically reverse psychology
is like how you treat a kid.
If you want your kid to clean up the room,
you don't say clean up the room.
You say, God, I love that messy room.
So great.
And that's how we treat our brain sometimes.
So I had a patient who was in my office
and he had a like back pain.
He had a level five back pain.
And I explained to this, this to him.
And if there's a bully in the school yard,
the bully says to the kid, you're stupid, you're ugly,
and the kid runs and hides
and then the bully does it more and more.
But if the kid says, oh, I'm stupid, I'm ugly,
that's a good one.
What else do you wanna call me?
Call me anything you want, bring it on.
So I call this the Pat Benatar model of treatment.
"Hit Me With Your Best Shot".
Pat Benatar, anyone?
Yeah.
Fire away.
So this guy has a level five back pain
and I say to him, "Well, tell your brain, gimme more."
Come on, bring it.
I want more pain, not less
'cause I'm not afraid of it.
What's the worst thing that could happen?
So I have more pain.
I've had more pain before.
I can handle it, I can tolerate, I'm not afraid.
So make it a five, make it a six, make it a seven,
make it an eight.
So the pain goes up a little bit.
He goes, good.
I want more, make it a 10.
Make it a 20.
What's a 20? I don't know.
And so we laugh, oh, a 20?
That's a good one, good one.
And then the pain goes down.
He says, why are you going down?
I want more, I want more.
Just more, I'm not afraid of it.
Hit me, go ahead.
And then it goes down and then it goes away.
And he goes, oh.
And that's exactly what you did.
- That's good, then I don't need you,
(audience laughs)
- That's my goal.
- Obviously that's the joke.
- That's the whole point of this work
is to empower people to do this for themselves.
So now we don't have to do the stairs.
- There's no point I think, yeah.
- There's no point in that.
It'll come back on the stairs sometimes.
- But I know that I just have to wish for the pain.
- You just have to say, I don't care.
I'm happy either way.
- Yeah.
- Come, make pain when I walk upstairs,
don't make pain when I walk upstairs.
Doesn't matter, I'm gonna be fine either way.
I'm going to enjoy walking upstairs no matter what.
- [Ludmilla] Yeah, that's nice.
- That's called outcome independence.
I'm gonna be happy, I'm gonna enjoy my activities.
I'm gonna enjoy my life.
I'm gonna do my life whether I have pain or not,
whether I have fatigue or not.
And that's teaching the brain that it's okay,
you're safe, you're not in danger.
You're gonna keep doing it.
The guy, he had no pain with the McDonald's
and he had pain, severe pain with McDonald's.
Then he did it again, then he did it again.
And he kept showing the brain, I'm gonna do it.
Good, so now that's the decision point.
We're not gonna go toward the trigger in this case.
We're gonna go toward sensations.
So do you have any sensations in your body right now?
- I still have one thing.
So that's useful if something here in the junction.
- You have a sensation there right now?
- Yeah. - Okay, nowhere else?
- A bit in the ankle, same idea here.
That's about it. - Okay, there and there.
What about the other ones you had earlier today?
- Well if you mentioned it,
they come back, they're nice,
(Howard chuckles)
- But you don't have them right now.
- Maybe here. - But if we look for 'em,
we can find them. - Yeah, that's it.
- How about here? Is it work?
Is it bothering you here? - Yeah.
- How about right there?
Yeah, how about right there?
- No. - No, how about right there?
- No. - Are you sure?
- Yes.
- We're just playing, right? - Yes.
- We're just playing with your brain
because we're not afraid of it, right?
You don't have to be afraid of this one or this one
or that one or that one
'cause they're all being caused by your brain.
And you're okay and you're gonna be okay.
- Yes.
- Yeah.
So now what we can do
when we have a discomfort in a certain area,
we can do mindfulness or somatic tracking.
Mindfulness is paying attention
to the sensations in your body
without fear, without worry.
And as Lakshmi, we were talking about with curiosity,
to just watch them and see what happens, right?
Standard mindfulness 101.
Why do we do mindfulness?
'Cause it does work.
It doesn't work when you have a categorization
of the pain being damaging,
but if it's categorization the pain being a thought,
being a neural circuit, then it works fantastically well
or it can.
So you wanna do that, a little meditation?
- Yes. - Okay.
You can have a seat.
You'd be more comfortable.
Okay.
So before I do somatic tracking
or mindful awareness, what I like to do
is I like to do this little experiment
that I learned from internal family systems,
Dick Schwartz work.
So some of you're probably familiar with Dick Schwartz.
He's a buddy of mine, he's a great guy.
Brilliant, brilliant model that he has.
And so what we're gonna do is I'm gonna ask you,
when you have these sensations in your body, right?
They're kind of troubling, annoying,
how would you describe them?
- Maybe my first objective
that comes in mind is informative.
It's mostly like, hey,
please pay attention to something you're doing.
Something I don't like.
- Something like calling out. - Yeah.
- Like telling you something's important.
- Yeah. - Like a message or something.
Okay, that makes sense.
That's brilliant on your part to think of it that way.
Do you have any feeling toward the pain when it comes?
Feelings such as fear or resentment
or annoyance or anything like that?
- Depends mostly on the kind of fears.
The kind of pain. - Pain, yeah.
- So if the pain is new,
it's mostly, it's like surprise and I'm like, oh, funny.
Please don't annoy me too long.
If it's something that I've already had
and that got worse over time, then I'm afraid
because I know it might pass and that,
but I'm not sure it will pass.
I like, I'm- - Yeah, so there's some fear.
- Yes.
- And is there also sometimes some resentment or annoyance
that it's coming back or that it's there?
Do you have that sometimes?
- I would say no.
- Not really?
Okay, great.
So let's just do an experiment before we do this,
the mindful awareness or the somatic tracking,
what I like to do is I like to deal with that.
Usually it's fear or anger,
resentment toward the sensations, okay?
So just close your eyes for a moment.
And what I want you to do, if you don't mind,
is look inside of yourself
to see if you see that fear.
Okay, see if you can find that fearful part of you
inside of yourself.
Maybe you can find it as a sensation,
just a feeling of fear.
Maybe you can find it as an image
or a visual you have of it.
Maybe it's a certain place, you notice it in your chest
or your stomach or somewhere.
Maybe it's a little person.
It could be anything.
Or maybe it's just the word.
But see if you can notice that fear or worry
or concern about it.
Can you do that?
- Yes.
- How do you notice it?
What, does it have a shape or a feeling
or a colour or what is it?
- Should I answer? - Yeah, please.
- For me, it's mostly sensations.
- The sensation? - Yeah,
I have different places.
- [Howard] Again.
- At different places.
- [Howard] Different places, sensation of fear
in different places.
- Yes. - Yeah.
And where are those places?
- The first one is mostly the sternum.
- [Howard] Yeah.
- And then I would say clenching of the teeth.
So tension here, trapeze, and then hip.
- Gotcha, okay.
So now what we wanna do is just close your eyes,
we'll just do a little experiment with this.
And if you don't mind, what we'd like to do
before we do the exercise, the meditation exercise,
if you could just gently reach inside of yourself,
metaphorically, just gently reaching inside
and see if you can take this fear,
this fear reaction that you feel
and just gently see if it'd be okay
if you set it on the table here next to you,
just for a moment.
You don't have to get rid of fear forever,
but just gently reaching inside.
And if it's okay with you, gently taking that fear
and just set it on the table for a moment.
You can always bring it back, but set it aside.
Can you do that?
- Not completely.
- [Howard] Okay, can you do it a little bit?
- Yes. - Okay, close your eyes
and see if you can do it a little bit.
See if you can just set that fear aside
for a little bit, okay?
Or a half of it, or whatever amount, doesn't matter.
But whatever you can do, what we wanna do for this exercise,
see if we can just lower that fear for a little bit
because you actually are okay, okay?
You actually are okay.
And guess what, there's nothing wrong with you.
And what are you feeling right now?
How does it?
- A bit of fear, but that's it.
- A little bit of fear? - Yeah.
- Same as before or a little different?
More, less, or the same?
- Less, yeah. - Less fear.
How does it feel to just let go of a little bit of fear?
How does that feel to let go of a little bit of fear?
- Very good.
- Good, that's okay? - Yeah.
- Good, you're gonna practise that.
That would be good for you to practise letting go of fear.
And now that you're letting go of that
and you can just take some nice deep breaths, okay?
Just breathing in a little bit of kindness for yourself.
And everyone can do this.
Just breathing in a little kindness for yourself
and just watching your breath.
Just watching your breath as you breathe in
and as you breathe out, just noticing your breath.
Watching the breath, your breath is perfectly fine.
You can just notice that you're breathing in
and notice that you're breathing out.
Did you ever watch clouds in the sky when you were young?
- Yes. - Yeah.
Let's pretend for a moment
that you're watching clouds in the sky.
Okay, would that be all right?
- Yes. - Just imagine
you're lying back looking at the sky on a nice day
and the clouds are just passing across the sky
and you're just watching them.
You don't have to change the clouds
or do anything with the clouds,
you're just watching the clouds as they move and they shift
and you're just trying to enjoy the clouds.
And you don't have to change them.
You can't change the clouds.
They're just there, right?
You can just observe them.
And it doesn't matter what shape the clouds form into,
if they form into a bunny rabbit or a dinosaur, right?
Or french fries, anything.
You can just watch the clouds, it's okay.
You're okay, you're safe.
You're okay, just watching the clouds
as they come and as they go.
And how does that feel for you
to just be able to kinda lie back and watch the clouds?
- Feels good.
- Just being interested and curious
about what the shape the clouds will be in just for fun.
And so this attitude, this watching, this curiosity,
this interest and not trying to change anything
is what you're gonna do now is you just notice
the sensations in your body.
The sensations in your body are like clouds in the sky.
They may shift, they may move,
they may come, they may go,
but they're just sensations
and you don't have to try to change them,
you don't have to fight them,
you don't have to worry about them.
They're just sensations your brain is creating
and you can just watch and see what happens.
They may shift, they may move, they may come, they may go,
they may get better, they may get worse, they may go away,
but it doesn't matter, you're just watching.
Are you with me? - Yes.
- [Howard] Just watching, just noticing whatever happens
and whatever happens is fine
'cause it doesn't matter.
You're not afraid.
It doesn't matter.
And as you do this, what do you notice?
What's happening in your body as you just watch
with interest and curiosity?
With no fear, no worries.
What are you noticing?
Is there any changes or shifts or what's happening?
- I feel it's hard to stay focused.
Like to stay present.
Yeah.
- [Howard] And what are you noticing in your body?
- I struggle to stay in my body.
- [Howard] You don't wanna pay attention to your body.
You'd rather pay attention to clouds.
(Howard laughs)
I don't blame you.
Because your body has been fearful,
you've been fearful of your body,
is that what's happening?
- Yeah. - Yeah.
Right and it brings up some emotion, doesn't it?
- Yeah. - Yeah.
Because it's been hard.
And again, maybe just putting your hand over your heart,
if you don't mind.
Just to allow the compassion.
Just breathe in compassion for yourself.
You can learn to be okay being in your body,
Ludmilla, all right?
Just like you can learn to love your brain,
you can learn to love your body.
Sometimes people feel like their body has betrayed them.
You know, do you feel that way sometimes?
- Yes.
- Or that your brain is betraying you?
- I don't know.
More like the body.
- The body has been betraying you,
but it's the brain that's causing the body
to react that way. - Yes.
- 'Cause there's not actually anything wrong
with your body, you know?
And sometimes you may have some feelings about that.
Is there any resentment that comes up
that your body's betraying you?
Or is it more sadness?
- It's mostly fear and then sadness.
- Fear and sadness, right. - Yeah.
So what we're gonna do is we're gonna help you
to rebuild trust in yourself, trust in your body.
And we're gonna do it by having you walk
up and down the stairs.
(chuckles)
- Fine. - Yeah?
- Yeah.
- Having you bicycle, having you swim
and regaining the joy
and the trust in your body that you're okay.
- Yes.
- And we'll do this gradually, like training a puppy.
Okay? - Yeah.
- Gentleness and kindness.
Makes sense?
- Yes.
- Okay, good.
Do you have any questions?
- No. - No.
Does this make sense?
- Yes, it just puts a lot of pieces of puzzles
that I had in my life altogether.
So for me it's quite obvious.
It just tiring.
- Tiring? - Yes.
- Yeah, yeah 'cause you're working hard.
And so what we wanna do
is instead of making this a struggle,
as much as we want to make it a game.
More of a fun, more of a joyfulness,
as opposed to trying to fight against,
fight against the pain.
Trying to push through the pain
or fight against it to try to fix it
'cause you don't,
there's a saying we have in the states,
if it ain't, this is southern.
If it ain't broke, don't fix it.
- Yes.
- And that's the attitude that we want you to have.
- Thank you. - Okay?
- Yes. - Okay.
Thank you.
(audience applause)
So like with anything, we're just taking clues,
we're just going wherever, wherever she goes.
She's going toward emotions,
we go toward emotions.
If she's not, we go in the other directions.
And so what we're doing here is we have the quiz,
we have the affirmations, we have the provocative testing
and working on the triggers.
And we have the somatic tracking or the mindful awareness.
And before the mindful awareness,
we're looking for reactions to the sensations
to decrease fear or resentment
or anger towards the sensations.
Mindful awareness.
We had a demonstration of that.
And there's a recording of the mindful awareness
on my website under meditations,
it's called Mindful Awareness Exercise.
You can access it, anyone you want can access it.
There's a password to get into the meditations.
And the password is meditations,
which is all lowercase and plural.
And when you were doing the mindful awareness,
this didn't happen to Ludmilla,
but frequently what happens is the pains will start shifting
or changing or the quality will shift or change
and we're just paying attention to it
with interest and curiosity
and taking away the fear and worry about it.
And as the sensations start to shift or change in the body,
you can say, oh, we see the brain working.
So it's more demonstration
of the neural circuits in the brain.
And then Alan Gordon is really good at this.
And here's some ways to access his materials.
And then we're doing graded exposure.
So one of the things I would say to Ludmilla is,
graded exposure with stairs, with cycling,
with any physical activities,
we're gonna ask her to do this in three steps
or let's say three steps.
First step, before you're gonna go cycling
or before you're walking the stairs,
just imagine it.
Just take a second and imagine doing this activity,
the stairs or the cycling or the running,
imagine doing it with freedom, with joy, with peace,
with affirmations, with whatever,
whatever you can do to calm the brain, soothe the brain,
and imagine doing it with joy and passion and love.
And then do the activity with joy and passion and love
to a small degree.
Don't start, the first day is don't run a marathon.
It's too much.
Maybe too much for the body,
but it's definitely too much for the brain.
So we wanna teach the brain gradually with graded exposure
for these activities by imagining
and then doing them to a low level,
small degree with the same positive mental attitude.
And then the next day or the next, do that for a week,
whatever you want.
Then the next week you bring it up to another level
and the next week up to another level
and you get to get back to where you wanna be.
So what else do I tell people?
I say, well there's a during the day exercise,
during the day exercise is simply
as you're going through your day and you notice
a sensation in your arm
or you notice a sensation in your knee,
or you notice some anxiety
or you notice a scary thought,
you're gonna say, that's interesting.
That's my brain.
So instead of freaking out, you're saying,
oh, that's interesting.
That's my brain.
You're just saying what this is,
this is just a sensation or this is just a thought,
not important right now, it will pass.
I'm okay, take a breath and move on.
Or you can just say, I'm okay.
Or you can just say, that's my brain
or just a sensation or just a thought.
And you're just, over the course of the day,
when you're noticing things come up,
you're just saying, that's my brain, I'm okay.
Just little by little persistent,
consistent messages that you're okay.
Extremely simple, but over time it's very powerful
'cause you're changing.
Every time you do this,
every time you say to yourself, that's my brain,
what you're doing is investing
in lowering the danger signal.
Even if nothing changes, you're not expecting
things to change.
You're not saying this to lower the pain
or lower the anxiety.
You're saying it to lower the fear
and worry about the pain or the anxiety, right?
So you're investing and over time,
that will pay benefits.
And then there's three more things.
One is leaning into the sensations,
second is opportunity, and third is bring it on.
We already talked about bring it on
'cause you brought it up in terms of the stairs.
But leaning in is trying to make
the sensations less unpleasant.
And so, do you like coffee?
You don't?
Most people here seem to like it.
Do you like strong coffee?
Do you like bitter coffee?
Do you like wine? Do you like beer?
All these are unpleasant tastes.
They're not pleasant.
No child liked them the first time they tried them.
But we have learned, we have taught ourself
to like these tastes.
Do you like a Sona, Sona?
Do you like lemon?
None of these are pleasant.
Cigarettes and so we have the capacity
as human beings to take something that's unpleasant
and make it into being either neutral or even pleasant.
And we do it all the time.
And so what we're asking people to do
as a way of not fearing the sensation,
we're asking them to see if they can find
something interesting in the sensation itself
to make it less unpleasant.
Maybe instead of calling it pain,
we wanna call it a sensation or we going to energy
or tingling or some sensation
that's some way of thinking about it
and experiencing it as less unpleasant.
Is that easy to do?
Not really.
It can be quite hard to do,
but if you can do that, it's helpful.
Is that something you've,
Ludmilla, have you ever,
has this concept ever...
Has anyone told you about that?
This concept I'm talking about now?
The leaning into the sensation or no?
- If I'm being honest,
I would say no one really tried to help me
apart from hands-on physio. - Yeah.
- So that's not really inpouring.
- And what do you think about this idea
of leaning into the sensation,
trying to make it less unpleasant?
Trying to think of it as energy or movement or something.
- Yeah, I like that.
I think that's also what we do in Feldenkrais, so.
- Really? Oh, awesome.
You were saying something about,
you said it's not that hard or?
- Yeah, I have a lot of experience of that
with respect to trauma.
So what I notice for myself
is that the natural response for me with trauma
is to be frightened of all sorts of things.
Memories, in fact, so frightened it didn't even have them.
- Sure. - But over time,
actually approaching them and being with them
and not running away
has taken away so much of the sort of the energy
of actually very severe trauma.
So I've been able through practises to recover memory,
violently shake at the memory,
stop at the edge of the threshold,
sit with it, then approach it all inside.
And when I did that,
three more memories that were all blocked came.
All of that was within 15 minutes.
Unbelievable. - Yeah, amazing.
- But I know for myself that my automatic reaction to trauma
was to stay the hell out of there.
- [Howard] Yeah.
- And it was the opposite
that really was the way forward.
- Exactly, that's amazing.
Amazing what you did and what you're doing.
It requires courage, does it not?
- Last time I did that,
I was actually in a practise session of something,
doesn't matter what it was.
And the other person who sort of saw me go in
'cause this going in was all inside,
is what you've just been talking about there.
And all he said was, "I'm here, you know,
if you wanna go back in and try it, I'm here."
And that was enough for me to go back.
And as soon as I said, as soon as I went back in,
I could get to a certain point of closeness to the memory.
It may not be obvious what that even means,
and the violent shaking stood.
But because I had this person who was,
and the value of the person was their presence,
they didn't have to say anything.
- Yeah, yeah. - It was just that they
were there, but that meant everything.
- [Howard] Right.
- So, yeah. - Yeah.
- But for me, it's actually the fundamental aspect
of moving forward with anything
Is to turn towards it.
but with gentleness, compassion, and love.
- You can't move toward it unless you have the courage.
Unless you have the connection, the compassion,
the caring, the willingness,
and to see that it's what you need to do.
'Cause you have to overcome the fear of it
and that's exactly what this is all about.
Tomorrow we're gonna talk about emotions and trauma more,
and it's the same process.
We're making the emotions less dangerous.
We're making the trauma less dangerous
by moving toward it in a way which recategorizes it,
reshapes it, remembers it, changes it actually.
So that's amazing.
- [Attendee] And what it doesn't do is retraumatize.
- Exactly. - That's really important.
It's very different from telling a therapist
what happened to you.
- No, no, to relive it is the worst thing you can do.
Why would you wanna relive trauma?
That's cruel. Cruel.
- I had a client who was a doctor and a CEO,
but it just came up that she took it
in a whole different direction
'cause she was into BDSM.
Bondage and sadomasochism.
And she said, "When I have that, I feel totally zen."
- [Howard] Yeah.
- And it's like, well, I wasn't opposing that,
but a traumatic childhood
where she took that emotional pain into, I have this.
Any comments on that?
- Well, I'm usually not,
I'm usually saying that I want people to be able
to experience the sensations with less fear
and more interest and curiosity to make the unpleasant
neutral or even pleasant.
And then I usually say,
I'm not trying to turn you into sadomasochism.
I usually say that there's an interesting study,
Lorimer Moseley did an interesting study with that
where he took men, I think, who were sadomasochists.
And he had himself, he read a statement,
now you're gonna close your eyes.
Now you're taking a hot metal
and now you're putting the fire
and now you're touching it to yourself or whatever.
And then they would feel pain,
and then they would have a dominatrix
read the exact same script
and then they didn't feel pain when she read it.
And it was an interesting study.
So leaning into the sensation is one thing you can do.
The second thing you can do is the opportunity.
So the patient I was saying earlier
where she was having all these symptoms at night,
she would lie down at night
and her body would light up like a Christmas tree.
So every night, what's happening, she's dreading it.
Most people who have pain or fatigue or anxiety
or whatever, wake up in the morning and say,
I hope I don't have that today.
I hope it doesn't come.
Who wouldn't? Of course you don't want it to come.
But when you say, I hope it doesn't come,
what are you saying?
What message are you giving to your brain?
I'm afraid of it, I can't handle it.
And so we want to give the opposite message.
So what's the opposite message?
I hope I get a lot of pain today.
And it sounds silly, but it's true.
I hope I get a lot of anxiety today, why?
Because it'll give me an opportunity to practise.
It's an opportunity.
Every time the symptoms come, it's an opportunity
to practise calming my brain.
It's an opportunity to say, I'm okay.
It's an opportunity to invest in myself.
It's an opportunity to empower myself
and say, I can handle this.
I'm gonna be okay.
I'm strong, I'm healthy.
I'm gonna keep going.
It's an empowerment, it's a message of empowerment
and it's a message of no fear.
And so what I'm gonna say to this woman is saying,
well, I hate to tell you this,
but I want you to look forward to the evening
because every evening you're gonna have the opportunity
to practise and you're gonna get better.
This will work.
So we're giving them the pushing and the support
and the idea that this is for a reason,
that you have to meet.
You have to meet the fear.
So it's the leaning in, it's the opportunity,
and then finally it's the bring it on, okay?
And what you're saying to your brain is, yeah, gimme more.
I can handle it. I'll be okay.
So these are hard, these last three are hard
for people to hear, hard to imagine, hard to do,
lean in, look forward to it.
Say bring it on, gimme more.
But those are the most powerful ways to turn off the fear
and danger mechanism.
And that is pain reprocessing therapy in a nutshell.