(attendants muttering indistinctly)
- Today, we're gonna talk about really important things,
really things that get to the heart
of who we are as human beings,
get to the heart of what our lives are about,
get to the heart of emotions
and emotional issues and trauma,
and in a lot of ways, get to the heart of healing.
A lot of times, people can use the PRT process
and the pain would go away
or the fatigue or the anxiety would go away.
But why did it start in the first place?
Usually, it started in the first place
because of some fears, because of some issues,
because of some things that happened in our lives
that caused the brain to turn on the danger signal.
And maybe it was just something small that passed
and it is not that important or not that critical.
But maybe it's a pattern of underlying things
that have gone on in our lives
and how we feel about ourselves
and how we treat ourselves
that might benefit from changing.
And so even if people have resolution of their pain,
or their irritable bowel, or their migraine,
or their anxiety, or their fatigue,
they still might wanna do some emotional processing work
because emotional processing work,
good for anybody. (chuckles)
'Cause we all have stuff in our lives
that might benefit from it.
So I think this part is very important
and can be very useful.
(attendee coughing)
And a lot of it boils down to self-care.
Yesterday, we talked a little bit
about inflammation and foods.
And last night, somebody sent me an email from Curable.
The Curable app is one of the apps that is a mind-body app
that's very good.
I've worked with these folks for a long time,
they're very excellent people.
And on the Curable app, it said,
"Oh, what do you think about foods?
Can foods affect pain?
Yes, there's research that shows that."
And the person who sent it to me said, "You said to me,
Howard, you gotta talk to Curable.
They shouldn't be saying this."
And so we talked yesterday about micro-inflammation
and how certain foods,
you know, there's no question that that can cause
some level of inflammation in the body.
But if you think about it
as I can't eat all these foods that I love
and would make me happy.
I can't eat 'em because I'm afraid I'm gonna get pain,
I would not advocate that.
I would not be happy with that message
'cause you're creating more fear in people.
And sometimes, they'll eat a food and then they'll get pain
and then it can become a conditioned response.
On the other hand, if you say,
"I wanna take care of myself and I wanna eat healthy,
and I wanna put good and healthy food in my body
as a measure of self-care and kindness and love to myself,"
I would say, "Absolutely, that's fantastic."
'Cause the most important thing is be kind to yourself.
The most important thing is be kind to yourself,
take care of yourself, do self-care.
And a lot of people who are in this situation
have not done self-care
or feel that they don't deserve it
or, you know, don't have enough agency,
which is what we're gonna talk about today.
So I just wanted to clarify
that I'm not against healthy diets. (chuckles)
I mean I am for myself, but for, (chuckles)
(attendants laughing)
for other people, it's fine. (chuckles)
There's an article
that I put in the article list on the Google Drive
on functional neurologic disorders.
It is a fantastic article. It's so well written by somebody.
And the person who wrote it does not put their name on it,
and I don't know why.
It's odd, I keep looking like,
"I wanna write this person and tell 'em
what a wonderful article it was."
But I can't find them.
- [Attendant] Tell 'em. - It's anonymous.
- [Attendant] A chat box.
I mean someone-
- Oh, you think chat box wrote it?
No, no, no, chat box did not write this.
(attendants laughing)
(Howard chuckling)
This is an incredible article
about a person who had all these symptoms
and could not find help
and kept going and going and going and going and going
and going everywhere, everywhere, everywhere,
on and on and on, and finally, they ended up
in Bethesda, Maryland at the National Institute of Health,
the premier research centre in the United States.
And the NIH has a little section called Rare Diseases.
And they probably get thousands of requests,
I don't know how many requests they get it,
but they decide, well, we'll see you or we'll see you.
And so then these people, and they'll come to them,
and they have this panel of really, really smart people
in genetics and infectious disease and all these fields
and they listen to their story and they say,
"Oh, let's do some testing.
Maybe you have this rare disease
or this rare disease, or this rare disease."
Well, this guy who wrote the article
got accepted to go to the centre at the NIH
and he went there
and they said, "You have
functional neurological disorder, FND."
He goes, "Well, what's that?" (chuckles)
Well, if you look at it,
the closer and closer you look at it and analyse it,
it's a conversion disorder.
It's a mind-body disorder.
And he's like, "What? (laughs)
That's what I've been suffering with all these years?
Is that an insult
or is that the key to my recovery?"
Interesting question, right?
If you take it as an insult,
there's nothing wrong with you.
It's your brain, it's your mind, it's your fault.
You're crazy, you're weak.
There's nothing wrong, you know? Get over it.
That's an insult.
If you take it as,
wow, there's a new science of the brain.
This new science of the brain tells us
that the brain can cause all these things
that are real and reversible, that's the key to a recovery,
that's how he went.
And he studied it and he went research
and he went back in time and researched
and he said, "You know what?
We've known about these disorders for hundreds of years
when you go back and look at it.
Hundreds of years, this is nothing new,
it's just science forgot about it, didn't care about it
or didn't understand it or whatever."
Anyway, it's a beautiful article. Very well written.
Okay,
should we start?
Okay, so EAET, Emotional Awareness and Expression Therapy.
We know that there's all these different symptoms
and syndromes that connect and intersect,
and many people have a lot of them.
But one of the ones that you see on here is PTSD.
And how is PTSD related to all these other?
And if you go to a regular doctor, say, well,
as we said yesterday, irritable bowel,
oh, it's a chronic disease like diabetes.
What does the irritable bowel have to do with PTSD?
In this doctor's mind, it would have nothing.
PTSD is a, you know, emotional disorder or mental disorder
that comes from trauma.
Irritable bowel is a physical disorder
that we don't know what causes it,
but it turns out all these are related.
They all go together
and they can switch interchangeably in the same people.
When I started this work, I began to work closely
with a lot of people with fybromialgia,
and at one point, it hit me, like,
"Oh, fybromialgia is just PTSD in the body."
Oh, of course, that's easy. That makes sense.
And so when we think about these central syndromes,
or mind-body syndromes,
we can see that a lot of people with PTSD have these,
a lot of people with these have PTSD.
A lot of people have PTSD without these,
so there's an overlap.
But is there something more?
'Cause PTSD is very specific, it's got these categories
and you have to have a certain level of X, Y, or Z.
But if you can think about it more broadly,
think about the human experience more broadly,
you can see that there's psychological conflict or stress
and the routine everyday traumas
that may not rise to the level of diagnosis of PTSD,
but the everyday traumas that many, many people experience.
And when you think of it that way, it's a much bigger chunk.
And the reason I'd like to think of it this way
is because what we're trying to do
is de-pathologize, in my view,
de-medicalize all of these disorders as much as possible
to make them part of the normal human experience
as opposed to, you know,
you're sick, you're broken, you're damaged,
there's something wrong with you.
Like, you know, your bones stick out too much.
You know, Ehlers-Danlos,
your ligaments are too flexible.
What's the other one?
You know, your histamine, mast cell activation,
your histamine is off,
or your fatigued, your ATP's not working.
Or all these theories that are really just speculation.
With PTSD, I've had people come in and they say,
"Well, I've got CPTSD," are you familiar with that?
Complex PT, I don't just have PTSD. (laughs)
My PTSD is complex. (laughs)
I mean I shouldn't be, you know, it's not funny,
but it's kind of like, "It's mine, you know?"
Like I'm holding on to the gem of my PTSD in a way.
But that's what people have been told.
I've seen people who've been told
oh, you have a history of physical abuse,
or you have a history of sexual abuse.
Well, we can do therapy. We can do therapy for that.
It'll take at least 10 years.
I don't know, that just seems wrong to me.
And maybe in some theories
or some types of therapy, it will take 10 years,
but I don't think so.
We can do amazing things with the work that we're,
and what we do, EAET,
we made it as simple as possible, (chuckles) as you'll see.
And the hurts and the traumas come from so many places,
from society, from our lives,
from our parents' lives, our grandparents' lives,
from what we experience in the world.
And then we ended up writing this article,
just got published this year,
just trying to point out
that when people feel uncomfortable or attacked,
even in small ways, over a long period of time,
that can be the driver of pain.
It can be causing it.
So a lot of pain psychology
doesn't target the emotional issues.
They're working more on the physical issues,
they're working on more the pain itself.
So we're trying to look at the underlying problems.
And a lot of times, people who do
kind of the standard talk therapy,
their view of emotions is emotions are kind of bad
or they need to be regulated, you know?
Let's just regulate, oh, you're angry?
Yeah, let's regulate that.
And in our work, in EAET, oh, you're angry? Good. (laughs)
There's probably a reason you're angry.
We can help you express that
in a safe and positive and healthy way.
It's a total different road or view.
If you're feeling guilty,
there's a reason for that, we can help you.
If you're feeling sad, there's a reason for that.
Emotions are a call to action, they're guides,
they're really important.
You know, if you're angry, it means what do you wanna do?
What is anger?
Why do we have anger? What is that useful for?
To bring to action, to protect ourselves,
to stand up for ourselves.
When you need anger, if someone's attacking you,
if you don't get angry, you'll die.
What is sadness calling us to do when you're sad?
To care, to love, to be compassionate to yourself,
to reach out to others
and connect in human experience.
Sadness is good.
This is Mark Lumley, my brilliant friend,
who helped me develop this.
He was saying like,
"Well, all therapies draw on other therapies.
There's nothing new under the sun."
You know, we drew a lot
from intensive psychodynamic therapy,
I'll talk about that in a minute.
Cognitive behaviour exposures,
experiential therapies like Gestalt, psychodrama,
written exposure where you're writing, James Pennebaker,
assertiveness training, rescripting training.
We'll talk about that where you go back in time
and change something.
It's amazing process that we love to do.
And we just drew as best we could from those.
And when we think about this work,
we're thinking about as assessment, education about pain,
PRT, and then EAET,
so the two main pillars of the way we think about it.
So the pain reprocessing
is more about these types of things,
which are more cognitive,
and the emotional awareness is about more emotional work.
So they're different in my view.
There's a lot of treatments for PTSD,
exposure treatments, prolonged exposure.
That's in the States, in the veterans hospital system,
they have this model of exposure therapy.
So exposing people back to the trauma
over and over and over again until eventually,
the trauma becomes normalised or they stop fearing it.
But to expose yourself to relive a trauma,
from my point of view, it seems cruel,
and you can get worse by keeping exposing to the trauma.
And we'll talk more about memories as well.
So here is some of the other theoretical models
that led us to think about this.
People who tend not to feel any emotions at all
have higher rates of mind-body disorders,
people who are avoiding things.
If you had a traumatic experience in a certain town,
I know a person who had,
he would drive from here to here,
and if he had to go through this town,
he would get a headache
because something happened in this town
so he would just drive around.
Well, you can drive around,
but you're avoiding dealing with the issue.
So people suppress thoughts. We talked about that.
Don't think about the pink elephant in the room.
People who hold onto secrets,
especially if it's a shameful secret,
can really, really cause a lot of internal stress.
So if you're in therapy,
this is a standard question for therapists.
You go to therapy, what's the biggest thing
that causes people to have a good outcome in therapy?
The most important characteristic
between the therapist and the patient.
- A good relationship. - A good relationship.
So it's true where they've done lots of studies
and the client-therapist relationship,
the quality of the relationship
is the highest predictor of success,
more important than the type of therapy.
This doesn't matter which therapy you're doing,
it has more to do with the actual connection,
the communication, the caring, et cetera.
All that stuff is the strongest predictor
of good outcomes in therapy,
except for one thing.
There's one thing that's more powerful than that.
Anyone wanna guess what that is?
So in this study, big study of thousands
of people, 30,000 people,
they found that this alliance, the connection,
had a effect size of 0.57, really high effect size.
But there's one that had eight, five,
and that is emotional expression. (chuckles)
Isn't that interesting?
And when there's emotional expression
within the therapy encounters, expression of emotions.
When tears happen, when anger happens,
when emotions come out, that predicts good outcomes.
So Mark Lumley and I,
we're doing our work and mind-body work.
And then somebody sent us an article from Allan Abbass.
So Allan Abbass is the professor
at Dalhousie University in Halifax, Nova Scotia, Canada.
And he's been doing this work for decades.
Best teacher, researcher, clinician, and ISTDP,
intensive short-term dynamic psychotherapy.
So somebody sends us this article,
and the article has a transcript of somebody,
a therapist talking to a client,
and the therapist is talking to the client,
and all of a sudden,
there's a bunch of anger that emerges in the room.
And the patient is getting angry at their father,
I think it was.
And he's starting to express imaginary anger
toward his father.
His father's not there, of course.
And all of a sudden, he's like yelling at him,
he's beating him up in his mind,
he's stabbing him, he's killing him.
And we're like, "What is this?
This is the craziest thing I've ever seen."
And then, at the end,
the father's like dead on the floor or whatever,
unconscious or whatever,
and the therapist says, "Look in his eyes."
Oh no, I'm sorry, what it was,
he's stabbing and killing the therapist.
He's getting mad at the therapist.
He says, "I hate you." (mutters)
What do you wanna do to me?
Oh, I'm gonna punch you. Good, keep punching me. (chuckles)
What else do you wanna do? I wanna stab you.
Great, stab me. (chuckles)
Okay, you're dead. Good.
Now, look in my eyes, whose eyes are though?
And he goes, "Oh, they're my father's eyes."
And we're like, "What? (laughs)
This is the weirdest thing I have ever heard of."
So as I'm talking to Mark Lumley going,
"What is this? Is this real?"
And so we go, "Well, let's find out."
So we take a trip up to Halifax
and Allan Abbass is having a seminar
and we go to the seminar
and he presents these things that are incredible.
I mean unbelievable. Talk about magic.
And he's got research, you know, he's got research
showing that ISTDP in a single visit
in emergency room setting
leads to decrease in future visits.
He's got research that's showing long term.
If you take people with mind-body type problems
and you do ISTDP therapy,
over years, they have dramatic reductions in cost
in how much they're utilising medical care, it's amazing.
Pseudoseizures, that's the epilepsy
that's due to a mind-body epilepsy,
not due to electrical discharge in the brain.
Amazing results they've got for chronic pain.
They've got amazing results even for multiple sclerosis,
which autoimmune disorder, they're showing big results.
And so we go to this meeting, four days,
and at the end, I say to Allan Abbass,
I said, "Allan, should I be doing this?"
And he goes like me, "Howard, you can't not do it."
I'm like, "Okay."
Number one, I'm not a therapist. (chuckles)
Number two, this is a four-day training.
And do you know how long it takes to learn ISTDP? Years.
So I'm saying.
And so he's like, "Yeah, you should do this."
I'm like, "Okay, whatever."
So I go back to Detroit.
The next day, the very next day, I'm in my office,
and the first patient I see is this woman
who has a conversion disorder.
She's in a wheelchair, she can't walk,
her legs are paralysed.
But there's nothing wrong with her legs physically,
this is a conversion disorder.
And she speaks in this dialect
that sounds like kind of a childlike dialect.
I've never heard her speak any other way.
And she comes in, and I've been working with her
for the last month or so
and everything I've tried, nothing has helped.
And I said to her, "You know, I was just up in Halifax
and we learned some stuff, do you wanna try it?"
And she goes, "Sure, what have I got to lose?"
So I go, "Okay."
So I ask her, "When you look back at your childhood,
what feelings do you have about it?"
And she says, "Well, my father was gone a lot
and he was kind of aloof, he really wasn't there for me.
And my mother was really harsh,
really kind of abusive to me.
And my brother was abusive to me
and my sister was abusive to me."
And I said, "Well, how do you feel about that?"
And she said, "I'm angry about that.
I'm angry for that little girl."
And I said, "Well, what does the anger
want to do about that?"
And so I have to warn you, okay? (laughs)
It's a little bit gory, so I apologise,
but this is what happens.
And she says, "Well, what my anger wants to do
is it wants to take my mother and put her up on the wall
and nail her to the wall,"
which is kind of religious, right?
Christ and all that.
I go, "Okay. (laughs)
Anything else?"
She says, "Yeah, and I see it
and I see the blood running down."
Okay, okay, (chuckles) gulp.
(attendants laughing)
Anything else? (chuckles)
Yes, I wanna take my brother
and I wanna do the same to him,
and my sister, and I wanna do the same to her.
And I'm going like, "Okay."
(attendant chuckling)
And I'm thinking, what have I done, right?
Have I just made someone psychotic,
or, you know, what's gonna happen to this poor woman?
But I didn't do anything. It is all coming from her, right?
I just asked the simple questions.
And she says, "The blood and their bodies
turned to dust and ashes."
I think that's from the Bible, isn't it?
Anyway, their bodies turn to dust and ashes.
And I go, "And how do you feel
about that little girl who was you?"
She says, "Oh, I see her. Her dress is torn and dirty.
Her hair is matted and uncombed."
And I said, "How do you feel toward her,
to that little girl?"
She says, "Well, I'm sad for her, you know?"
And I said, "Can you imagine showing love
and compassion to her, that little girl?"
Yeah, I can do that.
And this takes 20 minutes.
Okay, so she comes outta this scene and we talk
and she goes home in her wheelchair.
And I call her the next day
because I think she's gonna be admitted
to a psychiatric ward or something.
And she answers the phone and her voice is normal,
no dialect, no childlike tone.
She hasn't been in a wheelchair since that day.
And I was astounded, shocked and hooked. (laughs)
You know, when you see magic, let's see if it's repeatable.
Maybe this was a one time thing that could only exist.
But they have all this data, you know,
they've shown that this works.
And I could help somebody, it just happened to be somebody
who obviously was very ripe and easy for that or whatever.
But with very little training even,
it seemed like I could help somebody.
That was amazing.
And so at the same time,
Mark Lumley and I, we were part of a,
we were starting a research study funded by the NIH
'cause Mark Lumley is so smart, he could write this grant
and get funding, $3 million, from the NIH
to do a study on fybromialgia.
And now, we had extra methods.
So we did this study, it was published a couple years ago,
five years ago now,
and we compared it to a standard CBT,
cognitive behavioural therapy and an education group,
just education about fybromialgia.
It was done in Detroit, in Ann Arbour.
We had 230 people, mostly women,
eight sessions in group settings.
We took these young psychologists
and we trained them to do this work,
even though we didn't really know how to do it ourselves.
But we figured it out and we did it. (chuckles)
And we did follow up for six months.
And we compared, this is Dave Williams.
He was the top best person in cognitive behavioural therapy
for fybromialgia pain in the country.
He was on our team. He developed that.
And it turned out that the EAET had better results
than the other two groups for pain.
This was the first randomised controlled trial
to show that one psychological therapy was actually superior
to another psychological therapy for pain.
Remember the other studies I told you at the first day,
CBT versus ACT versus mindfulness, all the same,
small level of benefits and no difference between them?
Well, we did better.
And if you look at the amount of 50% pain reduction,
it was much higher in the EAET group
compared to the other groups
and the same with much improved pain.
And the people who didn't meet the criteria
for fybromialgia anymore was much higher in the EAET group
than the other groups.
So they were actually better, not everybody.
And then so we've been writing about this since then,
and now, it's accepted
in the United States Health and Human Services
as one of the acceptable,
you know, approaches to chronic pain.
The federal government said, "Hey, that's good.
We'll add it to our list."
And Brandon Yarn, I don't know why I don't have this study,
but Brandon Yarns, our colleague in Los Angeles,
has done another study on EAET versus CBT
for pain in veterans, US military veterans,
with chronic pain showing dramatic difference.
EAET was much better than the CBT.
So dealing with emotions,
look, it actually helps people, that's exciting.
And so what are we doing with this?
What do we do with emotions?
Do we wanna regulate them or do we wanna activate them?
Well, regulation, the way you regulate emotions
or you distract from 'em, don't think about that anger.
You know, do breathing, exercise, do relaxation,
down-regulate your emotions.
Think about something pleasant.
It sounds silly when I say it. (chuckles)
I must be saying in a silly way. (chuckles)
Reappraise your emotions, down-regulation techniques.
But there's some
that are up-regulation techniques, the opposite,
such as imagining something, imagine the situation.
You can imagine having a feelings in a situation.
You can express the feelings to someone else.
You can express the feelings to yourself.
You can write the feelings in expressing them.
You can reenact something.
You can have like the empty chair where here's somebody
and you can talk to 'em.
You can say what you wanna say
or you can actually do it in real life.
So we'll talk about all that.
Where does mindfulness come in?
Well, it's kind of in the middle.
Mindfulness can be more emotional, obviously,
but it can also be more calming, it can be both.
So what do we need as people?
We need agency and we need connection.
Agency, we need who we are.
We need to have ourself, we need to be autonomous.
We need to make decisions for ourself.
We need to be able to stand up for ourselves.
We need to be able to protect ourselves.
Connection, relatedness,
we need vulnerability, we need trust,
we need caring, we need connection.
These are two basic needs that everybody has.
So power, dominance, assertion, vulnerability, trust,
intimacy, emotions of sadness, emotions of love,
emotions of anger, pride.
And where's your comfort zone?
Do you know some people who are all the way over here?
They do everything for everyone else.
They never wanna risk any disruption
in their connection to others
because risking disruption in their connection to others
makes them feel very uncomfortable.
Because if they move just a little bit
toward the agency autonomy side,
they're feeling very uncomfortable
when they stand up for themselves or they say,
"No, I don't think I can do that."
Do you know what I'm talking about?
Do you know anybody like that?
Why are you smiling? (laughs)
And on the other hand, do you know people
who are totally on this side
who don't care about other people,
don't care what anybody says?
They only care about themselves.
They're always thinking only about themselves.
And it doesn't matter,
they don't care about the connection to others.
It's not healthy.
What we're trying to do,
and we can see that you can get anxiety
if you go too far in one direction or the other.
You can be uncomfortable if you go too far
in one direction or the other
and cause tension, stress, fatigue, pain.
And what we wanna do is expand the comfort zone.
We wanna help people to feel comfortable,
allowing themselves to assert themselves,
allowing themselves to be angry when necessary.
Allowing themselves to be vulnerable
and trusting and cry when necessary.
That's the full range of the human experience.
And look at that, we can go all the way. (laughs)
And so when we avoid the feeling, avoid the situation,
we're avoiding the emotions.
When we're afraid of the emotions,
we're avoiding them by inhibiting,
holding down the emotions,
distracting ourselves, not thinking about 'em,
which can cause anxiety, which can cause pain, et cetera.
So what we wanna do is we wanna help people
to realise they don't have to avoid the emotions,
it's healthy and safe.
There's ways to feel the emotions
and then the symptoms get better.
So the basic components of EAET,
we have a different explanatory model of what is health
and that emotions are normal and healthy.
We wanna facilitate emotional exposure,
engage in experiential enactments,
and encourage honest and direct communication in your life.
So you're leading to experiencing and expressing emotions
in safe and healthy ways,
and then figuring out how to work in life,
how to deal with your life
so that you can have better relationships,
more honest and open relationships.
We can be assertive when necessary.
You can be vulnerable and intimate when necessary,
and you can do both.
Emotional exposure, writings,
in my books, you'll see a lot of writing exercises.
That's a simple way to do it. Anybody can do this.
There's simple instructions for it.
You don't need a therapist
to do expressive, emotional writing.
There's lots of different exercises on how to do that.
So here's the model that I like to use
where stress and hurts cause fear.
And the fear can build up and build up
and lead to pain, fatigue, anxiety, depression.
But if you get hurt, you're likely to be angry.
If you hold the anger in,
likely to have more pain and symptoms.
If you feel guilt about being angry
or you're feeling a lot of guilt
that somehow you think you've done something wrong,
most of the time when people feel guilt about something,
they haven't actually done anything wrong,
but they're feeling guilty
'cause that's how they were trained.
And holding guilt in leads to more symptoms.
Sadness occurs because of all of this.
The stress and the hurts cause sadness
and sadness held in,
so we want to help people express the sadness,
move the sadness to love that we talked about yesterday
with Ludmilla a little bit, right?
We wanna help people understand their guilt
and express their anger in private and directed ways.
We're not encouraging anger in public
like 'cause you can go to jail if you do violence.
We're not encouraging violence in the world.
Healthy anger is different than violence.
And displacing the anger is not a great thing either.
So if I'm mad at my boss
and I come home and I kick my dog, that's not good.
Punch my fist in the wall, that's not good.
I mean there's therapies for this.
Bioenergetics is a type of therapy
where you're getting all the anger
out at a inanimate object, that can be helpful.
But what we're doing is helping people express their anger
directed to where it's supposed to be directed
and in a private and safe and healthy way.
So let me give you a couple examples of that.
And I want to take you
all through a personal experience of this
in our imaginations in a few moments.
I just wanna see how you're reacting to that. (chuckles)
Anybody getting anxious or anything?
It's all just imaginal.
But I wanna normalise these experiences for you.
Normalise this type of activity,
normalise feeling and expressing emotions
in safe and healthy ways.
So let me give you two examples, three examples.
Number one, several years ago in the hospital I work at,
I'm a head of a committee.
And the committee made a decision that this one person,
other doctor, didn't like.
And this doctor is very, very powerful,
very, very influential in the hospital
and a real asshole. (chuckles)
And he came to one of our meetings with the express purpose
of screaming at me for 20 minutes in public,
which he proceeded to do.
And I just listened.
And finally, he left.
It was the most unprofessional thing I'd ever seen
in the hospital, any hospital I've ever worked in.
And I wanted to slash his tyres,
(attendants laughing)
but I didn't. (laughs)
It's probably a good move in retrospect.
I think it might have escalated things.
But I was really angry and hurt
and shaking like fearful, right?
I don't do well with that. (chuckles)
So I'm going back to my,
oh, I go back to my office
and I realised I calm down with the fear.
You know, I'm okay, I'm in my office.
But I'm so angry and I don't know what to do.
But what I come up with in my mind is I imagine
taking his head and smashing it into the desk
over and over and over again until his nose is bleeding
and his teeth are falling out.
(attendant chuckling)
And I did that for about like one minute, maybe 90 seconds,
I don't know, maybe two minutes, I don't know.
It wasn't that long.
Bam, bam, bam, and then I literally laughed out loud.
(attendants chuckling)
I literally laughed out loud at the release.
(sighs) That was fun. (laughs)
That felt good.
And I imagine him walking around the hospital
with bandages on his face
(attendants laughing)
being humiliated in the same way he humiliated me.
People think revenge is the bad thing.
And revenge in violence is really a bad thing
because it escalates.
But revenge in your mind, that's what people want.
People want someone else who hurt them
to feel what they felt.
I've seen that over and over and over again,
and that's what I wanted.
And I couldn't get it in real life, but I can't,
but I can get it in my mind,
and that was enough, I laughed out loud.
And then I had to move. Did I feel guilty?
Did I do something wrong? No.
I didn't have any guilt about it.
I didn't have to deal with that.
Was I sad? Yeah, I was sad and I was sad for myself.
And I had to help myself be,
I had to just go to kindness for myself and help myself.
And then did I have any sadness for him?
Or do I just wanna walk away and never see him again?
In some situations, if you are abused by somebody,
you just wanna walk away and forget about it.
Don't let that person take up any space in your brain.
I write in my book, I was a therapist
in that I know really wonderful, wonderful woman
who in college, a long time earlier,
had been assaulted, sexually assaulted by some guy,
like a date rape.
And she always thought it was her fault
and it troubled her
and she did therapy and she worked through it.
And she was done with it, she let it go.
And she went to a college reunion 20 years later
and she saw this person who was there and he comes up to her
and he says, "Hey, remember me?"
And she goes, "No, I don't think so."
Walks away, she'd resolved it.
She didn't need to arrest him,
she didn't need to kick him in the balls.
She was done with it. She just walked away.
For this guy, this doctor,
I actually felt pity for him, he's a real jerk.
Everyone knows he's a real jerk. Who would wanna be him?
And that helped me to move on and let it go.
You can do this all the time in simple ways.
My wife is a wonderful person.
And a couple years ago, she calls me
on the way home from work in my car.
I'm driving home, I had a long day
and she says, "Hey honey,
would you mind stopping at the grocery store,
the cleaners and the pharmacy?"
Okay, (chuckles) I'll send you a list.
Okay honey, bye. (chuckles)
And so what am I feeling?
(attendant muttering indistinctly)
What?
- [Attendant] Overload.
- I was overwhelmed, like it's enough.
Like so what do I do?
I either do the chores or I don't.
If I don't do the chores, what's that gonna cause?
Conflict at home. That's not good, I don't want that.
I'm a good boy, I always do the right thing.
So I'm gonna do the chores,
the question is, am I gonna do the chores with resentment
or am I gonna do the chores out of love?
Well, I have the resentment.
So how can I do the chores out of love
when I'm feeling resentful?
Simple, I hang up the phone, I start screaming at her,
you this, you that,
who do you think you are asking me to do this?
I worked all day, blah, blah, blah, blah, blah, right?
And I'm feeling self-righteous.
And I yell and I scream and I get it all out
and then I go, "Ah, that felt good." (chuckles)
And then I let it go.
And then I moved to the next step.
Do I feel guilty about being angry with her? I do.
She does most of the work, you know?
And so then I didn't have to be angry anymore.
My anger was just me being angry and I could let it go.
And then I do the chores with love, you know?
And I come home and I say,
"Hey honey, I did all the chores, you know?
You wanna have sex? No, I'm just."
(attendants laughing) (Howard chuckling)
But see, then the relationship, right?
The relationship is repaired rather than broken.
Okay, the relationship is repaired rather than broken.
And the relationship with the guy who yelled at me
is realigned in my mind
'cause he has all power over me and that is not good.
So I had to realign the relationship in a power sense,
dominant sense, at least in my mind.
Okay, does that make sense?
One more.
(attendant coughing)
In November, oh yeah.
- [Attendee] I get like the yelling and the screaming part
and the being angry part and I do it
and the letting go part afterwards doesn't happen.
It feels like it accumulates
and the cloud of that thought
gets bigger and bigger and bigger.
- Yeah. - [Attendee] Without
the letting go. - Yeah.
- [Attendee] And I wonder what you do when,
you know, in that case.
- Yeah.
What I found is that many times
what we do is we kind of hold on to this.
We have the anger and we keep getting stuck in it.
You know, and it's like this low-level anger
and it keeps coming around
and coming around and coming around.
The idea of this work is to go to high-level anger,
to take it to a level which is way
like smashing the head into the thing.
Well, I would never do that, right?
But then I laughed.
That allows the release when you take it to this level
that is unprecedented, unfathomable, you know,
way over the top in your imagination, like yelling.
And I would never yell at my wife. I've never done that.
But in my mind, doing that allowed me to let it go,
allowed that release.
So that's one thing that I've found for that situation.
Sometimes, people really kinda want to hang onto the anger
'cause they feel like their anger
is somehow hurting the other person.
That's holding a grudge,
and holding a grudge,
people hold their grudge like sometimes,
it's kinda like a gem, you know? (chuckles)
But holding a grudge is what?
It's like swallowing poison
and hoping the other person dies.
(attendants laughing)
It's not gonna work.
(attendants chuckling)
So then in November,
so my wife, Val, wants me,
I was working five days a week for all my career,
and then last four years or so, working three days a week
and then doing other teaching and research,
it's a nice balance.
But I turned 70 this past June, so she's saying,
"Well, maybe you can cut back a little more."
And I wanna expand my mind-body programme at my hospital.
So I'm looking for a young doctor
who can come with me and I find somebody,
I think he could help and the hospital could hire him,
take the money from me and send it to him
and we could grow and make this programme long lasting.
I thought it was a good idea.
So I have a meeting with the bosses of the practise.
In November, they come in to see me
and I think they're gonna tell me how we're gonna do this.
They don't tell me that, they tell me,
"Your contract is over at the end of December,
we want you out."
You want me out? (chuckles)
You're getting rid of me, you're letting me go? Yeah.
Oh, but you can work one month longer if you want,
one month longer, but then you're out.
Okay, I spent my whole life,
40 years of whatever it is, being a doctor,
working so hard as I can possibly work
to become the best doctor I can possibly be.
And I feel like I'm doing a pretty good job.
I feel like I've been helping a lot of people.
And they say, "Yeah, well the hospitals
has a lot of cutbacks.
There's a lot of budget cuts.
You know, we just have to find ways to cut budget.
It's not personal.
(attendants chuckling)
(chuckles) Don't take it personally." (chuckles)
(attendants chuckling)
And oh God, like getting kicked in the stomach.
And then, you know, I finish the day and I go home
and I talk to Val and I talk to a couple friends
and then I start telling people the hospital fired me.
It's not technically correct that they fired me,
they're just letting me go
or they're not renewing my contract,
but it feels like they fired me, whatever.
So I say, "Oh, the hospital fired me. (chuckles)
Isn't that funny?"
That's what I say.
And then I tell my other friend,
"Hey, the hospital got rid of me.
They let me go. Isn't that hilarious?
Me, huh? Who knew?
Isn't that funny? Ha ha ha."
And then my back starts to hurt.
You think that's a coincidence? (chuckles)
My back starts to hurt and it's tight
and I'm walking like this
and my wife is osteopath,
so she's like working on my back, it's not helping.
And so what do I do?
I say, "Okay, it's my brain. There's nothing wrong with me.
You're okay, Howard brain, you're okay.
It's fine. Don't worry."
Hobbling, hobbling, hobbling. (chuckles)
It's fine, it's fine.
Bring it on, give me more. I can handle it.
I'm not afraid. It's not going away.
So I finally decide that, you know, when I'm telling people
that the hospital let me go and I'm laughing,
I finally decide, you know what?
It's not funny. It's not funny.
I'm fucking angry, okay?
And so, I'm driving in my car.
It's been about two weeks after that,
my back is still hurting, I'm driving in my car,
and I start swearing and yelling out loud,
screaming at the top of my lungs,
"Fuck you, fuck the hospital.
Fuck the insurance companies, they're not paying for me.
Why aren't they not firing the doctors doing back surgery?
'Cause they make money on unnecessary surgery.
What about the injection doctors? What about this?
Fuck the insurance, fuck the hospital, fuck the system.
I'm so upset I can't take it."
This whole thing is so messed up,
and I'm angry, I'm furious, I'm in a rage
and I imagine taking,
you know, in a cartoon
where they have the plunger with the TNT
and it blows up something?
(attendants laughing)
(Howard laughing)
I'm not joking, I imagine going like this
and the whole hospital just
(Howard booming)
(attendees laughing)
blows up.
I mean I wouldn't do that,
(attendees laughing)
but I wanted to, right?
That's the point, I wanted to.
There's a part of me that wants to do that.
And I can honour that part because it's righteous anger.
Is my anger justified? Damn right.
And that really helped, that was a release.
I did all that and I just start calming down.
And then I started to feel the hurt and the sadness.
And it was just hurtful and sad
to be kicked aside, you know?
I knew I'd be okay, you know?
It wasn't like my finances were in ruin or anything,
but it just felt being kicked aside,
it's hurtful and it's sad.
And then it took me back to remembering other sad things
that happened in my life.
Like when I was young, my father one time,
only once, but it made an impression.
He hit me with a belt, you know? Whack, whack, whack.
And I remembered that.
And I remembered a time when I was on my basketball team
and my coach demoted me, which made me cry.
I mean it's not a big deal in retrospect,
but I was crying at that, you know?
That was my life playing basketball.
And I remember other times that happened
that were hurt or were painful, hurtful and sad in my life
and I just allow that all to come just to allow the sadness.
'cause sadness is about self-care and connection
and compassion and reaching out.
And then I was talking to a friend of mine,
another mind-body doctor from Tennessee,
wonderful young doctor.
And he was just so nice.
He said, "Oh, Howard, you know, they're idiots.
They don't know what they're doing.
I'm so sorry, you didn't deserve that.
You know, I'm so sorry."
And I said, "I know, I know. I'm gonna be okay."
And then I came home from that day
with the anger up and out and release and the sadness,
allowing the feeling
and moving the sadness to compassion.
I walked in the door to my house and my back was fine.
Just totally went away.
It was amazing. (sighs)
Does everyone have those kinds of experiences
in their lives?
Doesn't everyone have experiences in their lives
where there's hurt or pain
or feeling attacked or neglected or abused
or just treated unfairly,
sometimes in small ways, at the grocery store,
when you're driving, a neighbour, whatever?
Or a mean word
or somebody who says something that's hurtful
and they're a caring person, you love them,
but they said something that's hurtful.
Doesn't everybody have those things?
Doesn't everybody have times when they have anger
about something that happened
or they have guilt about something
or they have sadness about something, right?
Doesn't everybody have those?
Do you?
- [Attendant] Yes.
- Why?
(guest mutters indistinctly) (attendee chuckling)
It's life, we're human. We're human and that's life.
So what I'd like to do now, with your permission,
and you don't have to participate,
but I'd like to take 10 minutes
and lead you through an exercise
of what I was just describing for myself.
Would that be okay?
The best way to do this work is to experience it.
So what I'd like you to do, if you wanna participate,
and you don't have to, obviously, it's not compulsory,
but I'd like to just have whoever wants to participate
think of something.
Don't necessarily think of the biggest, most traumatic,
hurtful thing in your life, okay?
'Cause this is short and this is not individual,
we can't really process it.
But maybe think of something smaller,
something more current,
or something that's happened in the last few days
or months or year.
Something that is more, you know,
bite-sized (chuckles) if you can.
Does that make sense? Okay.
So think about that just for a moment.
Think about what you wanna work on
and I'll give you a minute just to think about it
and then we'll start in just a minute.
And if you don't wanna participate in this,
that's perfectly fine.
You can use the time to breathe
and calming or relaxing or, you know,
deciding what kind of sauce you're gonna have
on your mussels tonight.
Okay, so
what you wanna do is you wanna allow yourself
to go to the situation in your mind
to see what feelings come up.
You wanna allow yourself
to go to the situation in your mind,
not to relive it so much,
but to go to that to see what feelings come up,
to see if you can access some feelings for yourself.
See if there's any fear.
See if there's any hurt or sadness.
See if there's any resentment, annoyance or anger.
See if there's any guilt.
So just see, just explore
what feelings might come up for you
as you go to the situation
that was troublesome or bothersome in your mind
as you go to that experience.
And if fear comes up, fear and tension and anxiety,
realise that the fear and the anxiety and the tension
is your brain's reaction to the situation,
your brain's reaction.
And part of that reaction is your brain is saying,
"Oh, these emotions are too dangerous.
Don't go to anger, don't go to guilt, don't go to sadness."
But that's okay, you can say to your brain,
"Yeah, I know this is fearful.
I know it makes me anxious,
but I wanna look deeper now,
I wanna look deeper at the underlying emotions of it
'cause I'm not afraid of feeling emotions.
I know emotions aren't harmful, emotions aren't dangerous.
I'll be okay."
And just breathe gently
and see if you can let any fear, anxiety just calm,
if you can just set it aside for the moment
to allow yourself to feel other feelings
like resentment, anger, like guilt,
and like sadness.
So first, we're setting the fear aside, okay?
If you can do that.
And then the question is, what comes next?
What feeling comes next?
Let's say there's hurt and sadness.
If you're noticing hurt and sadness,
it's because, you know, it's real.
You're hurt.
It was sad, it was unfair, shouldn't have been done.
It feels bad. It feels bad to be hurt.
It feels bad to be neglected or hurt or abused
or dismissed or not paid attention to or judged
or whatever the situation was or yelled at.
And if there's sadness, if there's hurt,
just see if you can allow yourself
to feel the sadness without blocking it.
It's okay to feel sad.
'Cause sadness has a function.
Sadness is alerting you
and telling you that you need to care for yourself.
Sadness is there for you to care for yourself
and act on your behalf.
Sadness is there for you to reach out to others
for connection and caring.
And the person you want to reach out to
right now for connection and caring is yourself.
So imagine breathing in
caring and compassion for yourself right now.
Imagine giving yourself a little bit of a hug
or a warm touch on the shoulder
or a pat on the back saying,
"It's okay, you're gonna be okay.
I know it hurts.
You're gonna be okay. You didn't do anything wrong.
You can care for yourself."
And turn that sadness and hurt into compassion and caring
and connecting to yourself, treating yourself
in the way that a warm, loving parent would treat you.
We all have to be the warm and loving parent,
mom or dad, to ourselves
and I'm asking you to do that right now.
And see if you can allow feelings of compassion and caring
to wash over you for a moment.
And if you can do that, then you can also explore,
is there resentment?
Is there anger here? Did you deserve to be treated that way?
Did you deserve to be hurt or neglected or abused
or dismissed or judged or yelled at?
Did you deserve that?
I don't think so. I know you didn't.
You can allow yourself to feel any resentment or annoyance
or anger or fury or rage about this.
You can allow yourself to be angry, to be righteously angry.
'Cause your anger is justified.
You're not going to do anything violent,
but you're going to allow yourself to feel anger
'cause anger is healthy and normal and protective.
You're gonna allow yourself to stand up for yourself.
And you can ask yourself, what would that anger wanna say?
What would that anger wanna say
if it could speak with no holds barred,
without holding anything back,
what would that anger wanna say in the situation?
And imagine saying it.
Imagine speaking firmly or strongly or yelling or screaming.
Imagine that anger coming out of you.
Not that you would or could say that in real life,
but what would the anger wanna say?
What's the urge? What's the impulse?
And picture doing that, allow it all to come out.
Don't hold anything back.
And you can also ask the anger, what would it wanna do?
What would the anger wanna do?
Not what you could do or would do or should do,
but what would the anger wanna do?
What's the urge? What's the impulse?
Would the anger wanna push or shove or yell or scream or hit
or throw something?
Allow that to happen if that's there,
and there's no right or wrong,
it's just whatever the anger wants to do,
what are the impulses?
Let it out, feel free to let that anger out
in a safe and healthy way in your imagination.
Let it all out. Let it just flow out.
And take your time.
Don't hold anything back. Let it all out.
And at some point, you're gonna be ready to walk away.
You're gonna be ready to wipe your hands.
You've done, you've said everything you wanted to say,
you've done anything you wanted to do.
Whatever the anger wanted to say,
whatever the anger wanted to do,
you've done, you've said it.
You can take some deep breaths
and you can just let it go.
Let it go, just picture wiping your hands,
picture walking away.
It's okay, you're done.
You said what needed to be said,
you did what needed to be done, you can let it go.
Just take deep breaths and let the anger go now.
Just let it go. Let it go.
With each breath as you breathe out, letting it go,
your anger is justified.
You don't have to feel guilty about being angry
'cause anger is justified,
anger is necessary, anger's important.
If you do feel guilty
about having that amount of anger towards somebody,
then it shows that's a good thing
'cause it shows you're not a psychopath.
You care, you know you don't wanna harm anybody, obviously,
but did you really do something wrong in this situation?
If you really did something wrong
and you're feeling guilty about that, then you can atone.
You can apologise. You can repair a relationship.
But chances are you didn't really do anything wrong.
And if you didn't do anything wrong, you can say,
"My anger is justified.
I don't have guilt about being angry.
And now, I choose to let the anger go."
And as you're letting the anger go,
as you're letting any guilt go,
you can come back to compassion and caring.
Come back to speaking to yourself in a kind and caring way.
You're okay. You did the best you can do.
You're gonna be all right.
I care for you. I love you.
I'm here for you. I'm here for you.
I'm here for myself.
And maybe there's some kind things
that you wanna say to the other person
or there's some caring or pity
or whatever you have toward the other person
that maybe if you let the anger go,
you're able to connect in some way.
Or maybe you don't wanna connect
or don't need to connect or would not be the right thing
in this situation, that's completely up to you.
Maybe you just need to walk away and let it go
and realise that this situation
doesn't have to take up space in your brain anymore.
You don't need to hold a grudge. You can be free.
And see how that feels to just breathe
and to just practise letting go and moving on.
And you can do this exercise several times.
Sometimes, it takes doing this exercise several times,
not just once, to go through this range of emotions,
but eventually, you will realise that the emotions are fine,
they're safe, they're healthy,
and you don't have to keep coming back to it.
And whenever you're ready, just opening your eyes
and coming back here to this room.
What did you notice?
Any comments, any questions?
It's a pretty simple model
and as you know from my experience,
I use it whenever necessary. (chuckles)
- [Attendant] Very liberating.
- Very what?
- [Attendant] Liberating.
- Okay, that's nice.
That was it?
Why? What was liberating about it?
- [Attendant] It feels like you presented me at least,
I don't know about the others,
with a piece of the puzzle that was still missing.
- [Howard] A piece of what puzzle?
- The puzzle of resolving.
- A situation.
- [Attendant] Things that were still lingering.
Yeah. - Yeah, yeah.
- So great, thank you.
- Yeah, I was at a meeting one time
and this person I really looked up to
and I wanted him to really understand our work.
I started telling him about our work
and he just got really mad
and started yelling at me like,
"That's the worst thing you can do."
I was like, "Oh," and I just felt,
and I replayed that scene a million times in my mind.
I should have said this, I could have said that,
I could have done this,
but I didn't do anything, I just like frozen
and I've gone over it so many times,
and finally, it's like I'm saying to myself,
"Okay, it's enough.
I mean (chuckles) I've said all the things
I could have said, would've said,
should have said in my mind."
And, you know, there'll be other times.
But it's hard sometimes to really get through something.
But usually, this is like exposure therapy
with repeated exposures.
Eventually, you're going like, "Yeah, I'm okay."
Other comments or questions?
- It's a little bit strange for me
because actually, I was aware of the fact
that I was angry at one situation.
And when you started, you talked about the fear.
- [Howard] Yeah. - And I had the feeling
to have no fear, I was just angry.
Then you went on and on
and it went far too fast for me.
And in the middle of the process,
I realised that actually, I have some fear,
but I didn't know that.
Okay, and my question would be as well,
you said sometimes, it's better to walk away, you know?
And I'm just wondering,
walking away could be also an avoidance.
- Avoiding. - [Attendee] Yeah,
avoiding people.
- Well, there's what we do in our mind
and then what we do in real life,
there are two separate things.
Walking away in our mind,
letting go of emotions is one thing.
Deciding whether to avoid the person
or deal with the situation in real life is a separate thing.
And that has to come later after doing this work.
After doing this work, then we decide what's the best way
to deal in real life.
Is there someone we can talk to or we can't?
Is this someone we should avoid or someone we can't avoid
and we need to engage with?
Those are decisions to make in real life.
- [Attendant] Okay.
- [Participant] Firstly, thank you for the exercise.
Anger is something that I've sort of grown up
deeply believing I shouldn't have.
- [Howard] Yeah. - And it's been a long term
sort of trying to come with it,
but I've come, like connect to it
and I still struggle, I really still struggle.
And on this occasion, it was sort of funny
because I chose something
that is a bit of a common thing for me
and it's to do with drivers
and so in different situations.
And so a part of me sort of thinks it's so funny
that I get so pissed off with in certain situations,
like if a driver invades my space in some way.
- Sure. - Anyway,
so I decided to choose one of those.
And firstly, I had a very clear idea
of what I wanted to do to them.
And I'm not even me to go through that,
but I was surprised at how clear something in me was.
- [Howard] Yeah. - And then
I sort of got stuck,
like, you know, you were sort of bringing us back
and I got stuck and then you said,
"And what would you wanna say to them?"
And when I did that, then the tears just came.
But not only did the tears come,
but I also got a sense of what it was really about.
And it's not about the drivers,
it's just that this happens to be a situation in real life
where someone invades my space
and I don't have control over,
and it's bringing me back to something that's much younger.
- [Howard] Right.
- And then it sort of fell into place, if you like.
The tears came and-
- Right, so the beauty of this work is that emotions,
like as I was saying, the hurt I felt
brought me back to other hurts in my life.
The anger that you felt
brought you back to other situations, important situations,
real situations in your life.
So it opens the door to understanding
and then we can use this process
to go to that other situation as well at a later time
or even right away, whenever.
And so we're always looking for that in this work,
we're always looking to make those connections
because the feelings that you feel about one little thing
are often the same feelings you would feel
about other things in your life that are important and big.
This is really, really important.