MBS

TREATMENT

Effective treatments for MBS are psychological in nature. They involve recognizing your symptoms as a false alarm, dealing with any stressors that could be tripping the alarm, and then recalibrating the alarm system to be less responsive. These treatments are largely free and self-administrated, but they aren’t a magic pill and they can require some serious introspection. While some people can use them to eliminate an MBS symptom quite quickly, it typically takes weeks or months to get there.

Below is my roadmap for treating MBS. It is a synthesis of the various strategies I used in my own recovery. As you will see, it draws heavily from the methods prescribed by Alan Gordon and Dr. Howard Schubiner, which have been shown to be highly effective (see This Shit Works), and it’s broken down into seven steps:

This shit works

A growing body of research is showing that the treatment methods put forth by Alan Gordon and Dr. Howard Schubiner really do work. For example, an early iteration of Schubiner’s treatment method that focuses on pain reattribution has been shown to significantly reduce pain severity in patients with fibromyalgia (Hsu, 2010) and chronic musculoskeletal pain (Burger, 2015). Schubiner has since developed a more comprehensive, emotion-focused method called emotional awareness and expression therapy (EAET), which has been shown to significantly reduce pain severity in patients with fibromyalgia (Lumley, 2017), irritable bowel syndrome (Thakur, 2017), headaches (Slavin-Spenny, 2013), and chronic urogenital pain (Carty, 2019). More recently, Alan Gordon’s treatment method, pain reprocessing therapy (PRT), produced jaw-dropping results in a randomized clinical trial in which 66% of chronic back pain patients treated with this method reported elimination or near-elimination of pain (Ashar, 2022).

Step 1: Educate yourself

The first step of MBS treatment is to simply learn about MBS. The aim here is to understand what’s happening to you so you can stop panicking about it.

You have some options when it comes to educational content. You can read books, listen to podcasts, watch YouTube videos or films. I urge you to try at least a few different resources. Each of the experts has their own style, and some will resonate with you more than others. Check out MBS Resources for specific recommendations.

In some miraculous cases, this first step of MBS treatment is all that’s required to eliminate a symptom. A good number of MBS-sufferers report that they were cured after simply reading about MBS. They call this “the book cure.” Schubiner estimates that the fix is this easy for a lucky 10-15% of people. But for the rest of us, there is more work to do.

Step 2: Build belief

It’s ok to be skeptical about this stuff initially, everyone is. We’ve been programmed to believe that pain is caused by a physical problem, and it’s hard to convince ourselves otherwise, especially when we have a scary diagnosis or test result from a doctor. However, research has shown that belief in MBS improves treatment outcomes. A recent study found that chronic back pain patients that believed that their pain was “in the brain” showed greater reductions in pain intensity following MBS treatment than their more skeptical counterparts (Ashar, 2023). Accordingly, the second step of MBS treatment is to build belief in your new diagnosis. Check out Two Ways to Build Belief for suggestions.

  • For this, I highly recommend Nicole Sach’s podcast The Cure for Chronic Pain, which offers an extensive archive of recovery stories. If you listen to a lot of these stories, you will come to understand that they are all fundamentally the same. But, for the purpose of building belief, see if you can find one in which your symptom plays a starring role. Additionally, I highly recommend watching the film This Might Hurt to see the dramatic effect that Schubiner’s treatment program had on the lives of three chronic pain patients. Of course, there are also plenty of recovery stories that you can read in books and online (e.g., at thankyoudrsarno.org).

  • Observe your symptom like a detective/scientist. Is it inconsistent or tied to stress? Does it fluctuate in severity and/or move around the body? Does it diminish when you are relaxed or engrossed in something enjoyable? All these observations are evidence that your symptom does not have a physical basis. Start a list of such observations and consider it in moments of doubt.

Two ways to build belief:

Step 3: Chill out

Before you can retrain your brain, you need to make it feel safe. After all, it’s hard to learn when your brain is busy feverishly scanning the world for danger. Thus, the third step of treatment is to chill-the-fuck-out. 

I understand all too well that this is easier said than done. For us MBS-personality types, chilling goes against our very nature. I’m not telling you that you need to spend your day picking daisies or lounging on a beach. (Ew.) I’m just suggesting that, to get the most out of treatment, you ought to find some ways to turn down the intensity. Check out Five Ways to Chill for suggestions.

  • While this sentiment can (and almost certainly should) be applied to many aspects of your life, the most critical one is MBS treatment. Being intense about MBS treatment backfires because putting too much pressure on yourself creates anxiety and thereby reinforces your brain’s belief that your symptom is dangerous. Try to take your time and focus on the process rather than the outcome. 

  • Our cushy modern lives are brimming with stressors. While most of them are mundane and harmless, our bodies still respond to them as if they could kill us (i.e., by triggering the flight-or-fight response). To get out of high alert mode, it helps to identify things that get you worked up and limit your exposure to them. The news and work emails are two biggies, but of course there’s also things like heavy metal, horror films, circus clowns, and group texts to consider. 

  • Lifestyle factors, such as diet, sleep, and exercise, significantly affect our mental health. To reduce anxiety, it can really help to do things like: prioritize sleep, exercise, eat a whole-food diet, limit sugar intake, and avoid caffeine and alcohol. I know that this might sound like a big ole bag of bummers, but I promise you that these practices won’t feel burdensome once you experience how much better they make you feel. 

  • Getting stuck in a negative thought loop can create mental tension and exacerbate pain. Use meditation and other mindfulness practices to learn to recognize negative thoughts for what they are (i.e., just thoughts) and not buy into them. 

  • Learn to be nicer to yourself. Work to forgive yourself and others. Practice acceptance and gratitude. Do things that make you happy or that feel meaningful to you. Make time to connect with your fellow humans. If you're like me, these corny things may make you want to puke, but research has shown that they really matter. 

Five ways to chill:

Step 4: Lose the fear

Once you understand that your brain is responsible for your symptom and you’ve done what you can to get it off round-the-clock patrol duty, you’re ready to work on ditching the fear that’s fueling your symptom. I see this as a three-step process.

Step 1: Foster a sense of safety. Use affirmations, such as “my body is not damaged” and “this pain is a false alarm,” to remind yourself that you are safe.

Step 2: Tell your symptom off. Tell it that you know what it is and that the jig is up, that it’s services are no longer needed, or simply to fuck off. You can also laugh at it, ignore it, talk some shit (e.g., “is that all you got?”), or refer to it using a fun pejorative nickname. Do whatever helps you to take it less seriously.

Step 3: Teach your brain that your symptom isn’t dangerous. This can be accomplished by observing your symptom mindfully, i.e., with curiosity and lightness rather than fear and judgment. While any form of meditation that helps you to practice non-judgmental awareness of your symptom can be used here, I recommend that you try out an MBS-tailored approach, such as “somatic tracking” or the guided meditations that accompany Schubiner’s book Unlearn Your Pain.

Somatic tracking

“Somatic tracking” is a brain-reprogramming method that was developed by Alan Gordon for use in Pain Reprocessing Therapy. In this method, you observe your symptom while fostering a sense of safety to try to create a corrective experience. You remind yourself that your symptom is not dangerous, and you ask yourself questions about what it feels like and how it might be moving or changing. You can learn more about somatic tracking by reading AG’s book The Way Out or listening to this episode of his podcast Tell Me About Your Pain. 

Step 5: Feel your feelings

For those of us who have unresolved trauma or tend to stuff down our emotions, accessing and expressing these emotions may be necessary to make our brains feel safe. This can be accomplished via emotional disclosure exercises that prompt you to write or talk about your stressors and feelings. The goal of these exercises is to convince our brains that our emotions are safe and that we no longer need symptoms to warn us about them or distract us from them. 

Nichole Sachs prescribes a trademarked form of expressive writing called JournalSpeak™ for this. JournalSpeak™ is beautifully simple: it’s vomiting out your feelings onto a page for twenty minutes each day and then meditating to soothe yourself. If you want a more structured approach, check out Dr. Howard Schubiner’s Unlearn Your Pain workbook, which provides a large variety of guided writing exercises. 

Our minds can use powerful defense mechanisms (e.g., denial, rationalization, minimization) to avoid dealing with “unacceptable” emotions. Thus, while most people can work on emotional processing on their own or with a nonprofessional confidant, it may be helpful for some people to work with a psychotherapist to overcome these defenses.

Whether or not we’ve experienced a major trauma, we’ve all experienced stressors that have left us lugging around emotional baggage. Even ordinary experiences, like feeling like we didn’t fit in as a child, can leave a lasting mark on our bodies (see The Body Keeps the Score). It’s important to be aware that emotions connected to these experiences can be unexpectedly stirred up later in life, and that they can trigger or exacerbate our symptoms.

“Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways.”
— Sigmund Freud

The Body Keeps the Score

If these ideas feel familiar to you, it may be because you’ve read psychiatrist Bessel van der Kolk’s bestseller The Body Keeps the Score. This book suggests that trauma is a special type of memory that is seared into the nervous system and that causes the body to remain hypervigilant to a threat long after it’s gone. van der Kolk’s prescribed treatment for trauma victims includes helping them to unlock their bodies from perpetual fight-or-flight mode and to process their feelings.

Step 6: Challenge your triggers

MBS sufferers often report that they have certain “triggers” that cause their symptoms to flare up. For example, people with irritable bowel syndrome (IBS) often cite certain foods as triggers, and people with chronic back pain often cite certain movements or positions. Schubiner argues that triggers are innocuous stimuli that we start having symptoms in response to as a result of conditioning. (Think of Pavlov’s dogs, who learned to salivate in response to a ringing bell after coming to associate it with dinner time.) In other words, our brains learn to associate triggers with our symptoms simply because they’ve happened to coincide with them. 

The goal of the next MBS treatment step is to unlearn these associations. This can be accomplished by challenging our belief that a trigger will cause symptoms via exposure to it. This type of exposure therapy has been shown to increase function and reduce pain intensity in people with chronic back pain (Boersma, 2004). 

Schubiner suggests that we start with a small exposure to a trigger (e.g., just a bite of a food, just a few seconds of a movement) and then gradually get bolder as we gain confidence. Initially, exposure to the trigger will continue to produce symptoms because conditioning is powerful (check out this bonkers example: Goebel, 2002). As symptoms come up, we can use them as an opportunity to work on breaking the symptom-fear cycle via mindfulness, as described in Step 4.

Step 7: Prepare for substitutes

Often, as people overcome their fear of their symptoms and work through their psychological issues, their primary symptom will resolve only to be replaced by a new one. Some people even experience a climactic extension burst in which they are shelled with various symptoms as their brain desperately tries to maintain its reign of terror. This phenomenon is referred to as “getting it on the run.” While it can be maddening to feel like you are playing Whac-A-Mole with your symptoms, it’s a clear indication of progress, so try your best to see it as a milestone rather than a cause for despair.  

Remember that your brain creates MBS symptoms to try to warn you about something that it perceives to be dangerous. (It’s just trying to keep you safe!) So instead of panicking and running to your doctor when a new symptom pops up, try checking in with yourself to see if you can root out a stressor or emotion that may have tripped the ole alarm system.