In this transformative follow-up to Episode 4, psychotherapist John Gasienica guides patient David through a real-time therapy session—joined by mind-body medicine pioneer Dr. Howard Schubiner. Building on David’s recent neuroplastic pain diagnosis, this episode explores the emotional patterns and subconscious fear responses that keep chronic symptoms alive. As David confronts past trauma, guilt, and anxiety, you’ll hear powerful shifts unfold live—both physically and emotionally. Dr. Schubiner offers insight throughout, breaking down why these techniques work and how healing happens when the brain feels safe. Whether you're a practitioner or someone living with pain, this episode offers profound hope and practical tools for lasting change.
This is part two of our experimental two-part series following David, a patient living with chronic foot pain. In Episode 4, David received a neuroplastic pain diagnosis. In Episode 5, we go a step further—showing what happens when that diagnosis is explored through therapy.
What you’ll hear in this episode:
– A live, unscripted therapy session combining Pain Reprocessing Therapy (PRT), somatic tracking, and Emotional Awareness and Expression Therapy (EAET)
– Real-time reduction in pain as David rewires his brain’s fear response
– Exploration of childhood emotional patterns, perfectionism, and self-directed anger
– A somatic shift that helps David reclaim movement, safety, and strength
– Dr. Howard Schubiner’s expert commentary on the science behind each moment
This episode is about more than pain—it’s about the emotional undercurrents that shape how we experience our bodies, and the incredible transformation that can occur when we meet our pain with curiosity, compassion, and courage.
Bonus: Stay tuned to the end to hear Dr. Schubiner’s reflections on the future of healing—blending neuroscience, trauma-informed care, and emotional expression into one powerful therapeutic approach.
John: [00:00:00] Welcome back to another episode of the PRT Podcast where we teach actual patients how to heal from chronic symptoms and break down the tools they use. My name is John Gasienica. I'm a psychotherapist and the director of clinical research and Development at the Pain Psychology Center in Los Angeles.
Today's guest is an absolute trailblazer in the world of MINDBODY medicine and probably the most influential doctor in our field. Far too often us clinicians get stuck in our little fiefdoms of thought and clinging to our methods Rather than get curious about how others are healing, if there's one person who has taught me to buck this trend and find ways to consistently evolve and pick up better strategies, it's my guest on today's episode, Dr. Howard Schubiner.
Dr. Schubiner will share insights from this cutting-edge research and help me break down a therapy session. I conducted with a patient who received a neuroplastic diagnosis in our last episode. This episode is about not only breaking the cycle of chronic pain but also breaking the [00:01:00] patterns of trauma that keep us trapped.
The PRT Podcast is brought to you by the Pain Reprocessing Therapy Center, a training center where thousands of doctors, therapists, nurses, and coaches have learned how to treat and eliminate their patients' chronic conditions. If you'd like to become a certified PRT practitioner and support the podcast, use coupon code Heal 10.
To get 10% off certification training at painreprocessingtherapycenter.com. Now, before we get started, a brief disclaimer. This podcast is presented solely for general information and entertainment purposes and is not intended as a substitute for the advice of a physician, psychotherapist, or other professional healthcare service.
If you have specific medical concerns or questions, please contact your personal healthcare provider. Now, let's meet my guest for today's show.
So joining me today is Dr. Howard Schubiner. Dr. Schubiner is a world renowned physician with Gomeni Health, alongside Dr. STRs. He teaches medicine at Michigan State University, [00:02:00] and his research and clinical skills have helped countless patients get out of pain. He's authored over a hundred publications and scientific journals, as well as incredible books for both patients and clinicians such as Unlearn Your Pain. And his co-authorship of Hidden from View. There is even a Howard Schubiner award given out to residents in internal medicine and pediatrics for exemplary clinical care and compassion. Howard is built upon Dr. Sarno's legacy of MINDBODY Medicine more than anybody I know, and I'm absolutely honored to have him with me today.
Hi Howard. How are you
Howard: Hey, well you dug deep for that one, John.
John: There's a lot to sift
Howard: through you for. You forgot to say I'm a legend in my own mind.
John: You know, in some of the research I was doing on you to prepare for this, I saw a, an article you've written about Dr. Sarno, how much he influenced you, but rather than just sticking to patients like Dr. Sarno did, you've spent a substantial portion of your career doing clinical trials and, and research. Mm-hmm. What motivated you to take this different [00:03:00] strategy?
Howard: You know, um, I don't, I don't believe that everything happens for a reason necessarily, but there's opportunities that present in life and you kind of have to walk through the door.
And it just so happened that I spent the first 18 years of my career doing research. I. Before I was doing this work. Wow. Right. I was at Wayne State University and I, you know, rose the ranks in academia doing research on a variety of other fields. And so I had those kinds of skills and I'm writing a new book now.
What I write in the book about Dr. Sarno, that who's an amazing visionary and had incredible insights and clinical practice that, uh, really, uh, was revolutionary, but he didn't have the science. He didn't have access to some of the neuroscience that we have now.
John: Mm.
Howard: Because it wasn't, you know, out there yet, like predictive processing.
That's a big part of the way I see these, this world. But in addition to [00:04:00] that, we wasn't in a place and didn't have the backup and the skills to do clinical research very much. They did publish one study. David Schechter worked with him on a study that was, that was published with his patients, an outcome study.
But I'm just feel so fortunate to have been in a position where some of those research skills turned out, Hey, we that we need that. Absolutely. We need to do that. That's what, that's what one of the things that was missing in our movement, so to speak. And uh, it's still, you know, it's still in its infancy in a lot large degree, but we're making a lot of progress.
John: Well, one of the studies you recently just did last year, you showed that when doctors are trained to diagnose for neuroplastic pain or primary pain, as it's called in the study, yeah,
Howard: yeah.
John: They find that 88% of their patients have neuroplastic pain. I know you've been in this field a long time. Did did those results surprise you?
Howard: Well, this was with chronic back and neck pain, so you know, one of the things that I learned when I started this [00:05:00] work was that if you take regular medical literature and you just understand it through a lens of neuroplasticity if you take headaches, well, everyone knows. All neurologists know that 95 plus percent of people with chronic headaches are primary. In other words, not due to a structural problem. In other words, neuroplastic. So that's 95% there. Okay, let's take fibromyalgia. Chronic widespread pain. What percentage of that is neuroplastic or primary? Hmm, 95 to 99%. Let's take chronic stomach pain and irritable bowel syndrome. Same number. Let's take chronic pelvic pain.
When you look closely at that, the vast majority of people don't have structural damage to account for it. So you have all these different pain syndromes that are in the 90%. Being neuroplastic, let's take chronic back pain. So if you go to a regular doctor, the chance of you being diagnosed with a neuroplastic back pain is about 1% [00:06:00] because the chances are your MR MRI is gonna be abnormal and the MRI is viewed as causative as opposed to correlative. Mm-hmm. Anyway, so we did this study and this is, um. So happy we got to do this study with Bill Lowry in Lake Charles, uh, Louisiana, regular PM & doctor, seeing people coming in 222 people unselected. We didn't rule out, didn't rule out anybody, exclude anybody from the study and, you know, using the criteria.
And then we used the FIT criteria and just 98% of them had abnormal MRIs. Wow. Of the 222. So they all had abnormal rise, but they were normal findings, normal abnormalities that Dr. Sarner used to say, and it's still a great term, but if you use the fit criteria and you start looking for the pain that shifts and moves and is triggered by the weather and, and is spreading and is related to stress, et cetera, et cetera, that's what he did.
And he came up with his [00:07:00] 88%. The funny thing is he's, he was very conservative in that and he told me, he said, you know, if I did this study, gonna probably be higher than that even. So actually I wasn't surprised because of all the other data, why would chronic back pain be that different than all these other chronic pains?
But it is completely counterintuitive compared to what happens in the real world or the the world of traditional bio. Technological medicine.
John: Hmm. Well, we've talked a lot about your research skills, but I'm really more excited to get into your clinical skills today. I did a session with a patient named David, and you've inspired a lot of the tools I use in this, so I'm really excited to pick your brain just to give the listener a little background.
David's had chronic pain in his foot. Uh, in our last episode, he met with a good colleague of ours, Dr. Matt McClannahan, where he received a diagnosis for neuroplastic pain. So in this first clip, I check in to see how David's doing since [00:08:00] that session with Dr. Matt and since receiving the diagnosis.
So David, I know we were just talking before I hit record about, about your session with Dr. Matt. Tell me a little bit about it and, and some of the things that came up afterwards.
David: Yeah, so like I was saying that the session was, was brilliant and it eased my mind to a lot of the thoughts of was it neuroplastic or not, and then I felt after almost the symptoms flared up as if my body's way of saying, no, this is very, very real and it's not neuroplastic.
It's not contributed by the mind all the symptoms that were coming up, like levels of sensitivity. When I pressed down on my foot, it felt very like quote unquote real, which I, I guess could be evidence for neuroplasticity because it's, it sort of came up almost as retaliation for that. It was very much tied to like thoughts of anxiety and things out of like overthinking.
And in fact, I was overthinking a lot of the session with Matt even in so far as [00:09:00] like. I felt like I was very dismissive of all the doctors and stuff who had tried their best to help me and everything. But, um, yeah, I, it was that thing of being overly critical of everything I had said. It was great to have the recording back, but I was like, I, I fear watching it back.
'cause I'll be thinking, oh, was this exactly right? It was that. So it's, it was all very double aged, but I, I did take a lot outta it as well. Like, that was brilliant too. Do, do you feel like
John: this is a pattern that displays itself in other parts of your life?
David: Self-critical piece. Oh, a hundred percent. Yeah.
Yeah. I think in anything in work, in my studies, I've definitely seen that come up pretty much. Yeah. I would say most areas of life.
John: How long has that been going on for?
David: Probably since around 14. I would say. It's, it's hard to put into words. Even though you can probably notice the, the like hesitance, I, I'm like trying to pick the right thing to say and about we say such and such that could be mis [00:10:00] misconstrued or anything like that.
But yeah, around since 14 was definitely when I noticed it. That was when, um, depression and anxiety definitely like presented themselves like very physically in my body and rural Ireland. Age 14, like that many years ago, the. Depression wasn't a thing that was first of all really known about like, and second, definitely not really talked about.
Yeah. So it, it sort of manifested as like, everything I did was wrong or mm-hmm. I just, just hyper fixated on things. I do say how, how they would be interpreted. Uh, that has been, I would say, very. A persistent part of my life since then. Gosh,
John: it sounds incredibly lonely to be feeling that way at 14 and it also be labeled as something that's not appropriate or not dealt with or, or something that you kind of have to hide.
Did you feel like you had to hide it and and kind of put on a front? [00:11:00]
David: Yeah, and that also developed as I grew because it initially was like, I don't know what this is. That's happening to me. Yeah. It was isolating in so far as. And with chronic pain and depression, I was kinda like, well, most other people aren't feeling these things.
John: Mm-hmm.
David: And then it became that thing of I couldn't enjoy happiness without benchmarking it against other people. It was like, they don't feel as, as kind of low or as like mood swingy as I do. And then I suppose chronic pain became a part of that, whereas anytime I'd be enjoying something or happy, it's like, oh.
You know, another person would experience this without pain.
Howard: Wow. It was really nice how you kind of tuned into his feeling of being alone, lonely, isolated through way you did that was just precise. It was really nice.
John: You know, [00:12:00] you could hear how its origins were from when he grew up. They weren't negative emotions. Yeah. Weren't accepted. What were negative emotions treated like when you were a kid?
Howard: Oh, we didn't have negative emotions in those days, John. We just ignored our emotions and, um, yeah. It's funny. Um, you know, it's funny, I just wanna say one thing, like I had a funny neuroplasticity moment when you first started that recording. Because I'm thinking like, I can't understand this guy. What's he saying?
And then, but I'm listening and I'm thinking like, is he, is he British? Is he Spanish? Is he, oh, he's Irish. And as soon as I clicked in that this was Irish, then I could understand exactly what he is saying.
Wow.
Howard: Because I love, I've been to Iron and I love the Irish and I love the Irish accent. And it was just so funny that.
How your brain, like when you categorize things, it allows your [00:13:00] brain to to tune into these neural circuits that have been formed. 'cause I'm used to hearing people speak in that Irish dialect, but I didn't click in until I named it. Isn't that interesting?
John: It's so interesting.
Howard: Yeah. And it's the same with, you know, it's the same with our symptoms too.
It's a categorization and that's one of the predictive processing concepts they call rec categorization. Right, and it was just simply, what do you categorize it as? You know, do you categorize these feelings? Are they loneliness or is there something wrong with me? Do we categorize these, these symptoms as neuroplastic or not?
Do we categorize these thoughts? He was talking about these kind of what I would call scary thoughts, and this thoughts were triggering his, uh, sensations. Painful sensation. We see that of course all the time. A lot of times people have symptoms since physical sensations that are neuroplastic coming from the danger alarm mechanism in their brain.
But they don't also realize that their danger alarm [00:14:00] mechanism is also giving them the all these scary thoughts. Mm. As another way of alarming them or messaging them, or some would say tormenting them. So
John: as Dr. Shipner was saying, we can see how some of these mental patterns keep David in a cycle of pain.
And these are things that we want to address. But before we get into the heavy lifting of addressing these patterns, I often like to check in with the client to see what kind of strengths or protective factors they have. These are often some of the avenues that can help build confidence and get early wins in the therapy process.
So let's take a listen.
It sounds like you've been able to counteract. Some of those feelings with some of your activities like boxing and surfing?
David: Yeah, boxing is a massive one. I was actually just thinking about it as you were talking there, because you'd think being in there sparring with someone, you would feel oversensitive and, and things like that.
That part of my brain just switches off. In fact, most, most of my brain completely switches [00:15:00] off, and you're just focused completely in the moment and it's actually one of the rare times where I'll feel. No sensation in my foot because it's just, you're thinking, I'm moving this way, I'm moving that way.
You know, what combination am I gonna put together next? You make a mistake, you get hit and it's fine. You move on. You know? And, um, drumming is another one. They're the two, two things. Music and boxing are the only, like two things in my life I would say I've gotten into that flow state that people talk about.
That's amazing.
John: So we have great evidence. Your brain is able to feel safe enough to not have this hypersensitivity, not have this low threshold for danger. What we just want to do is teach your brain to be in that state when you're not boxing and when you're not drumming. 'cause it almost seems like when those activities end, your brain just goes back into the default mode of feeling fragile and, and kind of behind the eight ball.
Does that feel
David: consistent? Yeah, in fact, like sensitivity will increase after [00:16:00] those exercises. Sometimes it's almost as if. As if it's because of that. So
John: yeah, and you can see how our brains just have this cause and effect mechanism where you say, okay, I boxed and now it's sensitive. So certainly the boxing causes sensitivity.
What we're realizing is it's not the boxing that's causing the sensitivity. In fact, the boxing's helping. It's going back to the default mode that you have after boxing, which is causing the sensitivity. And we can work on that today.
Howard, how do you do in the boxing ring? What's, what's your boxing career been like?
Howard: I have no fights. I've never, I. Been in a physical fight in my life. On the other hand, I do body combat at the Y and it is so much fun
John: Wow.
Howard: To, you know, do my jabs and hooks and upper cuts and kicks and it's just fantastic.
John: Uh, you know, it's funny, I was talking to [00:17:00] Dr. McLennan last week and he's. Doing a, a similar strategy. Maybe it's a, a trend in mind-body medicine.
Howard: Well, if you have aggressions, it's one good way to get 'em out.
John: Why do you think activities like that help to decrease pain activities that you really enjoy? I.
Howard: Well, you know, I mean, as we know, it's basically about the danger signal or the safety signal, where the brain is coming from, from dangers, safety. And, you know, when he's, when he is boxing, he's, he's feeling in a, as he said, he is in a zone, he's in a safe place. He's in a happy place. You know, the, the brain has these mechanisms of turning on and turning off danger versus safety.
And as soon as he stops boxing, all of a sudden he goes. Back to, as you were saying, back to the default mechanism of the danger mode that he's been living in. But I think in addition to that, there's also a mechanism that after exercise, when the danger signals turned off and the symptoms are less, there can often be a [00:18:00] shooting up.
Ramping up. So the pain is even, we're not just back to default, but oftentimes it can be way worse. You know, one way of thinking of that is a condition response. The exercise is producing a condition response. Another way to think of it is the brain is just punishing you and say, what did you do? You know, you can't be doing that stuff.
I'll let you do it now. Um, we don't know why the brain doesn't, what does what it does. In essence, it's a subconscious structure. But one of the things I think about with this is also a lot of times people say, well, I didn't have pain 'cause I was distracted. You know, at that time I was distracted, so there was something else distracting me, but the pain was still there.
I just didn't feel it or notice it. And I think that's an incorrect way of thinking about it. And I think as you alluded to when you were talking with him, I think it's a better way, more accurate way to think about it, was the. When you're not noticing it, it's not actually there because if it is constructed by the brain, it's not like it's there all the time.
It is turning on and off, and when people can see that [00:19:00] it's turning on and off, obviously, and hopefully that gives them more evidence and more hope and more confidence that. They can take the extra steps to turn it off more of the time.
John: This, it's a perfect segue into our next clip because we know we can't be in this positive emotional flow state all the time, but I wanna show the client that he's capable of getting into this place where his pain can change and it can turn off even when he's not boxing.
And so let's take a listen.
And so I want you to just close your eyes, and I want you to just think back to a time in your life where you felt free, you felt like you were at play. There was no strings attached. You were just kind of experiencing what comes to mind.
David: I, I hope you'll believe me, and that it was a few years ago, one of my first sparring sessions.
John: Amazing. And I want you to just use [00:20:00] your memory to bring back some of the sensory information. So remember what the mat smelled like. The room smelled like even the squeak of your shoes, the light in the room, the temperature, and just go back to that place and just remember what that felt like being alive.
And how does that feel to remember that memory?
David: Powerful. I can, I can feel the heat almost. It was, it was in the middle of summer and it was. Complete opposite of today, a very warm, very warm day.
John: And so what I want to see if you can try to do is get in the brain of that guy who's just flowing. And now I want you to see if you could bring your awareness down to your foot and almost watch it.
Like that guy would watch it. And what do you notice when you watch it like this?
David: I notice from that perspective it's, it's hard to put a. A label on the sensations I'm feeling, I could usually [00:21:00] quickly label it as, as pain or pulling, but it, it now just feels more like a general sensation. So good
John: and really just take that confident approach. At the same time, when you were sparring and you're just kind of throwing punches, why don't you just kind of push your foot into the ground, play around with it. Just watch it through the lens of that guy who's just feeling free and feeling at peace. We're teaching your brain how to view this sensation.
We want it to view it through a lens of confidence and relaxation. And how does that feel as you even dig into it? Get like even a little bit more aggressive with it? Yeah.
David: It feels like I can put more pressure than I usually could. Good. And I'm not really, yeah. I'm not really feeling anything coming back.
John: And here's what I want you to do is just feel like you don't have any restrictions on that foot. Stop protecting it. Bounce it around as if it's your [00:22:00] other foot. Kind of get that giddy confidence back of like, I'm gonna be fine. This is nothing. And if you feel any fear come up, you feel any hesitancy or resistance coming up, just go back to that guy in the ring.
Feel that heat of boxing in the summer. Bring your brain back to some of the smells in that room, the sounds, and just remind your brain, this is a lens that I can use. And how does that feel?
David: It's almost, uh, God, it's, it's hard to describe. It's almost, it's almost gone. It's almost as if there's no negative sensation there at all.
Very empowering, I would say.
John: So keep going. And what I want you to do is feel the strength in that foot. Let yourself know I'm, I'm gonna be okay. Not only am I okay, but I'm strong. Think about that feeling after you get like a good punch in when you're sparring and move your [00:23:00] awareness away from your foot.
Now just up through your leg and through the rest of your body, I want you to feel that strength you fl in your foot and the rest of your body and just kind of move around and how's that feel?
David: It feels really good. I was worried I was gonna punch the screen because I felt I was back in that place. I was like, yeah, you know, my hands were about to go up in the defensive posture.
Oh, that felt, yeah, that felt very good. I noticed my left leg, I can usually feel all the muscles engaging when I'm walking around, but I, I do walk quite gingerly on my right leg where the injury is. Mm-hmm. I noticed during that my, I was. The muscles in the right leg. Were starting to engage that. That usually don't, you know, just even to move the foot around.
I thought that was very interesting. That had never happened really before.
John: So Howard, when you hear a patient say that, that not only is it the foot [00:24:00] that's been changed, but the rest of their leg, you can feel muscles that aren't engaging or bracing. Why does that happen? Where the rest of the body also has issues, uh, alongside the pain?
Howard: Yeah, there's, um, I. Kind of the way the brain is organized, it's organized in very discreet units, like, um, some kind of micro level, tiny units.
The toe, this part of the toe, that part of the toe goes to this part of the brain. But there's also, that's called the specificity theory of pain. But there's also. There's more generalization there. There's networks and the brain really works in networks. And so there's a lot of like small networks that include regions of the body.
Mm.
Howard: And so that's why frequently people will have pain that spreads. It starts in when ear and starts spreading and, and also mirror images where the brain is, you know, you see his right hand. It goes to the left hand. People who have, um. CRPS can have a injury to their knee and all of a sudden [00:25:00] their foot is starting to have all these symptoms.
And so there's a lot of connections in the brain. The brain is super complex and there's just a lot of connections there. And, uh, it's also also kind of why we have phantom limb syndrome in a sense, whereas parts of the brain are being activated that are no longer there. So. I think on a neurologic level it's fairly complex, but there's just so much interaction and that's why I just think of them as circuits and, uh, I don't even use the word pathways anymore.
Pathways imply too specific, so I'm thinking more circuits or networks even within the brain. But what's really nice, what you were doing was, you know, you were, you were really using this. Simplest neuroscience model, neurons that fire together while you're together. 'cause when people are having pain, when they walk, they're appearing a a, a motion walking with pain, with a negative experience and with fear, and it becomes that vicious cycle.[00:26:00]
But when you start pairing movement or walking this case movement with this incredible positive experience, now the brain is learning that this movement of his leg or part of his leg, or the feeling of his leg or whatever is actually quite positive. So really powerful and straightforward way of changing neural circuits.
John: What I love so much about your books is that you do. Talk about this straightforward method and getting people wins like that. And for some people this is all the work is. Mm-hmm. But then you also go into the deeper parts of this work, and that's where we're gonna be headed with David next is we know that he has a hard time maintaining this positive outlook consistently.
And so if you're like David, where your brain quickly returns to an intensely fearful state. It might be hard to make feeling safe, consistent, and sustainable. So this is where we pivot to in the PRT world, uh, our focus on decreasing fear in the other non-pain aspects of your life.[00:27:00]
So there's gonna be a time where your brain says, all right, that was comfortable and warm there, but now this is kind of the cold, cruel world. We have to get back to being afraid and get back to being careful. I want you to prepare for that other side of the coin. So what are some of the things that come up for you on a daily basis where you feel overwhelmed or you feel sad, or you feel anxious?
David: It can be as simple as one word that links to, you know, uh, a painful memory of the past, and then it will be hyper fixating on, you know, whatever that word is, has linked my mind to. I actually notice, I try and avoid, you know, certain topics in case one of these words is, is, is brought up,
John: how would it feel to go towards some of these things and just teach your brain a different way of dealing with them so that they don't feel [00:28:00] so scary.
Yeah. I want you to just close your eyes and the first thing I want you to do is just commit to this idea of voluntary discomfort. I'm going toward this to teach my brain that I can tolerate it. This is a choice I'm making. And see if you can even feel esteem from the idea of like, I'm going into the pit myself.
'cause I'm choosing to not 'cause my brain's bringing me back there just 'cause I hear a word. I almost feel like that boxer in that ring of getting, stepping in with a guy who's, who's pretty big and saying like, I'm going in there to face this guy. This is my choice. I want you to see if you can bring your brain back to a time where you do feel wounded, particularly a time that you feel like you'd be judged for and what comes up for you.
David: I can sort of [00:29:00] feel the head space that I was in around that time and the time that came up was the time. I was having sort of a cluster of panic attacks. Mm-hmm. Um, yeah. Everything's kind of coming through then of, of this is gonna seem almost as if I'm saying this on purpose, but I'm really not. What's really coming up for me is the time I first felt this, the thick lump in my foot.
Mm-hmm. And it was going for a run during this time of, of these, of these panics and, and feeling. I guess the feeling that I, you know, everyone was kind of against me or everyone. Yeah, yeah. Everyone would hate me or, or, or something like
John: that. And I think I remember from our console call you were going through a breakup at this time too.
Is that true?
David: That's right. Yeah. Yeah. Um, it would've been, breakup was actually just, yeah, just prior to this.
John: And did, did that play into it as well?
David: For sure. [00:30:00] Um, yeah. You know, I've had a, you know, I've, I've experienced normal breakups throughout my life and things like this, but it definitely just left me very devastated at.
John: And so just as accessible as that memory was of you in the ring and that feeling of empowerment, this is probably even more powerful 'cause trauma memories get stored in a different part of the brain. Can you feel the intensity of this?
David: Yeah. I was just the, to get to the ring took, took a little while.
This was just instantly and I was kind of there. I could feel, you know, everything I felt around that time.
John: There's a reason for this. When you have a trauma memory, it doesn't get timestamped in your brain. The same way normal memories do. So when you think about it, your brain doesn't have this concept of that was then, and this is now.
Your brain thinks this is absolutely happening to me right now. And so you can feel that I can even see it in your face. And so what I want you to [00:31:00] do is just learn how to handle these memories when they come up because this is the thing that's gonna put your brain. In vigilance mode. 'cause it thinks these things are happening to me right now and I need to stay alert and I need to stay aware.
And so I want you to just notice what you're feeling in your body. What changes did you feel when you came back to this memory?
David: The pain for sure spiked and it, it wasn't even conscious. I've, I've only noticed, uh, that I'm looking for, for changes and I do feel very. Tense. I've noticed my shoulders have kind of tightened up and uh, really I just feel like I'm, I, I can picture vividly exactly where I was when I, at this time, and how everything felt in my body.
Everything felt a bit just at odds, a little bit wrong, I think. And yeah, I'm sort of mimicking that now. [00:32:00] Um, not just subconsciously, I.
John: So Howard, what I was doing in this clip was very much inspired by a tool or a method you created called Provocative testing, where you use the patient's imagination to bring on a chronic symptom to show how closely linked they are. Can you tell me how you developed this tool and, and how it helps the patient
Howard: when we.
Do something. Uh, the brain has certain activities, certain memories, certain every millions of stuff associated with it. And it turns out when you imagine doing something, it's kind of the same. There's a bunch of research that shows that people who imagine practicing free throws are better at free throw shooting.
People who imagine. Practicing piano scales get better at, at playing piano. There's one study that showed that people who imagine weightlifting actually were stronger. 'cause the, when you're, when you're imagining doing something, the brain reacts as if you're [00:33:00] actually doing
it.
Howard: Mm-hmm. And so that scientific concept is pretty clear and tested and shown.
What I was looking for is a way to expose people in a very small dose because when people. Get overwhelmed with their symptom, it's harder for them to respond to it with curiosity and compassion. It's harder for them to respond to it. With indifference, it's harder for them to extinguish it using somatic tracking.
So what I wanted to do was expose people to a way of getting a low level of symptom that they could easily see that could easily extinguish, but at the same time, they can also see that it's actually not there. Body doing it. So if you have somebody imagine bending over and they get pain in their back, they're like, well, what happened?
You know, it's, it takes away the idea that it's actually a structural problem when you see that, and it's a really light bulb [00:34:00] moment for many people. And he got a tension reaction. You know, you can see that anxiety, fear, reaction coming up. And uh, so I've had many times where that's the symptom.
Mm-hmm.
But it
Howard: still indicates the fear that the brain has of that movement. And obviously in him, the fear that his brain has of that situation and that time in his life that was so scary, lonely. Feeling discarded, feeling not cared about, and was fascinated about that also is I think that he's starting to get, he was panic, panic, panic.
And then it's like, oh, pain. And frequently the brain will do that. You know, it's panic. Anxiety is so uncomfortable that after a while the anxiety has become so uncomfortable in the brain, it'll turn on a different symptom to help get you out of the panic. The panic will be less. But then there's the pain that you have to deal with, and then of course you think you hurt your foot, but you didn't.[00:35:00]
John: I'm so glad you bring that up. I've had so many patients who, when they've gotten out of pain. Now they face the anxiety and they say, gosh, I didn't realize how much more I dislike the anxiety than the pain. Yeah. It's almost a, a scarier thing for people to face. Have you seen that?
Howard: Yeah. Yeah, totally. Many times.
And that's what I, when I first started doing this work, I was just seeing pain and all of a sudden I was seeing these connections between anxiety, depression, and fatigue, and all these other symptoms began to enlarge. My concepts of, of what neuroplastic symptoms were. And you know, some people kind of divide, they say, oh, well you have anxiety or depression, or you have pain.
Like, they're different. I don't, I don't really see them as different, I don't see treating them differently, frankly, which, you know, it, it's, it's worked out pretty well. I.
John: So in the PRT process, we use exposure exercises to teach our brain that negative emotions don't have to be labeled as dangerous. This helps our brain feel a more consistent sense of safety.
There are many ways to do that. One of the main ways is [00:36:00] somatic tracking, but another method that leans more into the active expression comes from a therapy called emotional Awareness and expression therapy, or EAET as Howard had a hand in creating alongside his colleague Mark Lumley. Let's take a listen and.
As I use some PRT tools and fold in some EAET strategies,
we'll worry about the pain a little bit later. Right now, I want you to just feel that sadness that's coming up, that anxiety, that fear, that real feeling like you're being judged, and I want you to see if you can almost push it in front of you like it's a cloud, you're not gonna be able to get rid of it.
We wanna push it in front of you to just remind your brain, this is just a piece of you. This is not all of you. We can't have all parties in the life raft panicking, but we can have one and we can take care of that person. And so push that guy in front of you and give it a visual [00:37:00] that looks like you be a concerned version or a scared version, and look at them.
Look at that guy running during COVID after a breakup, feeling this pain and just ask him, what are you feeling right now? What's wrong? What are you afraid of? Just see what he says.
David: I suppose. Hard for the course with with panic. It, it just is panic and. It's almost as if that version is talking, you know, a mile a minute, and it just, it can't narrow down to one thing.
It's just all these hypothetical, what could go wrong. You know, what, what, what will go wrong?
John: This is the tornado and I want you to jump into it, and as those hypotheticals come out, just just verbalize them. What is he afraid of? And ask him, be like, I really wanna know and just let him speak. What are some of these things?
And just speak 'em out. Even if they [00:38:00] come rapid fire
David: direction and, and life is a big, big one that's coming up.
John: Good. And what's he say about direction and life? What is he afraid of?
David: It feels like so many things come. It's like. He doesn't know which way he wants to go, if he's on the right path, or you know, if, if I go after what I want, what if I fail? You know, the consequences of that.
John: Of course, you're afraid. Don't quiet him down. Say This is terrifying human existence. Going after things you want is freaking hard.
It's exhausting. All that energy you feel of trying to resist these panic attacks, I actually want you to transfer that into him with compassion. Let him know. Of course you're terrified. [00:39:00] The world shut down. You're out of a relationship. Your foot is hurting like hell. No wonder you're so scared. I want you to ask him, is he angry about anything?
On top of that fear, what is he angry about?
David: Two, two prominent things are, are coming up and it's, it's mistakes that I've made, but also seeing almost everything that I've done as mistakes that might have been, you know, learning opportunities.
John: Yeah, a lot. Just, just be frustrated with that. Let him know. Of course. It's so frustrating. There's been nobody here to teach you how to deal.
Mistakes and teach you how to view them as constructive, and it's really hard to figure this out on your own and let 'em just get angry at the universe, like God, whatever it is, just for making this so difficult. The only important thing is we want this anger to be outward, and I want you to test that. I want you to ask them, [00:40:00] what happens when I criticize you, when I tell you that you should have been doing this differently?
You should have figured this out. How does he feel when you tell him that?
David: Definitely. Hurts. And you know, it's easy in hindsight to, to know what I should have done.
Mm-hmm.
David: But at that time, you know, whatever I did seemed like the right decision. Yeah.
John: So tell 'em
David: that
John: you were basing your decisions on imperfect information, which is always gonna be the case, and you made a decision based on the information you had at the time.
Yeah, I'm pissed at the outcome too, but I support you for the decision you made, and I want you to feel that bond with this emotional piece of you. Put your arm around him, give him a hug. Let him know. I'm so sorry. There hasn't been somebody to do this for you, but I'm gonna be there for you now.
David: How does that feel?
Supportive? [00:41:00] It feels, it feels like there is support, I suppose. I've. I've went through a lot of life feeling that I couldn't ask for help or support.
John: Yeah. When you think about you've gone through so much of life without support, what emotion comes up?
David: I'm not sure about emotion. I, I can't word. It's just I feel more empathy towards myself really.
Mm-hmm. It seems a strange thing to say, but I can just. Yeah, empathize a bit more with what was going on at the, at those times.
John: And so just stick with that empathy feeling
and not bring your awareness down to your foot with this new lens. And how does that feel? I,
David: I don't, it's a very tough one to word. The, the pain feels [00:42:00] less a part of me. It feels, oh, it, yeah, the, the pain feels more emotional than phy physical. Now it's very odd to like experience, but yeah, so invite that in.
John: That sensation now feels emotional. It doesn't feel physical. And just ask it. What are you feeling right now? What do you need and what comes it up?
David: The, the word safety comes up with that.
John: So let it know you're gonna be safe.
David: And how's that feel? I can actually believe for the first time in a long time that I will be safe and, okay.
Good.
John: So Howard, I, I know this wasn't textbook EAT, but it had some elements particularly [00:43:00] emphasizing acceptance and expression of emotions. Can you tell me why these help neutralize fear of emotions?
Howard: Well, what was really, really great about it is that when I think about EAT, I think about layers. And you have the pain layer and the panic layer, and then you said, well, what's under that?
It was fear. So you allowed him, you helped him to see that fear, and then you were like, well, what's underneath that? So underneath that, you were asking about anger and he went to anger towards self guilt. So what, what we're typically doing with the at is we're opening the door, as you did to feel different emotions and see what comes up.
Is that anger toward others? Is it guilt or anger towards self? Is it sadness and hurt and betrayal? And so whatever comes up, we have ways of dealing with, in this case it was guilt and then [00:44:00] the question is, well, is it deserved guilt or undeserved guilt? You know, did he actually do something wrong or not?
And so we never. We never condone anger towards self because anger towards self is not healthy. But we wanna explore a couple things. One, where's the guilt coming from? Who taught you to feel so guilty? Mm-hmm. So that's an avenue that, you know, we could go in, where does this come from? Where did this voice, this guilty voice?
Is that your voice? Or is it something you learn from other people? So that's one direction. But when someone does feel guilt, they either have to. I realize that they actually did something wrong, in which case they have to apologize, atone, and forgive themselves, or they didn't do anything wrong, and they have to deflect the guilt and not take it on.
And in either of those cases, it calls for compassion is what you led him to, because [00:45:00] guilt calls for compassion, sadness, calls for compassion, both of those. And so with the compassion and forgiveness, then he was able to move more towards safety. Another way that it, he almost went to, and you almost went there, and if you had more time, you probably would've, but he almost went to like, now that I'm feeling compassion for myself, but who was there?
I. You know where were other people. And that leads to back around to saying, yeah, who was there? Who was supposed to be there? Yeah. And that leads, and that will lead typically to resentment for things that he didn't get, didn't have, and that were missing from his life. Which is why, as I said before, he tends to.
Feel guilt, he tends to take on guilt because something things happened in his earlier life that we're missing, uh, in terms of support and caring.
John: It's really helpful hearing you talk about that [00:46:00] self-directed anger. 'cause I think it's probably the thing I see the most in patients with chronic pain is there's some sort of self-directed anger there.
That guilt that you talk about and it's, it's. Great to hear these two pathways that you lead them down.
Howard: Most of the time they're taking on guilt that they didn't really do anything wrong, but they've been trained and learned to, you know, feel bad about themselves or feel they're at fault. I mean, it's so pernicious.
I mean it. Parents get divorced and the kid feels like it's their fault. Like, how insane is that? But it's, you know, if that happens, you can imagine how people who've been hurt or people pleasing, perfectionistic, uh, you know, didn't get love, caring attention, et cetera. When something goes wrong, how common is it for them to blame themselves?
John: So now David feels more comfortable with some of these emotions and some of these. More deeper understandings now that he's feeling in a more regulated state. I wanna show him how much easier some of the PRT tools are [00:47:00] used when he has this new baseline feeling of safety.
Yeah, there's a saying that the journey from the head to the hearts a thousand miles. So right now, drill that in. Really play around with your foot. Feel that strength. I'm gonna be okay and kind of recklessly, just play with it on the ground. I just bring this from a logical thought to really feel it emotionally, feel that confidence coming back.
Then what do you notice when you do that?
David: I notice I'm moving that leg like my as if it was never injured. Perfect.
John: As I
David: just enjoy
John: that for a few moments. And let yourself know. And this is the predictive coding piece of it. This is what the feeling is gonna be going forward. And just visualize yourself walking around with this sensation.
Visualize yourself boxing, [00:48:00] even doing chores around the house with your leg feeling like this. And just take one or two more breaths, and when you're ready, just slowly open your eyes.
David: How did that feel? Good. I, the weirdest thing, uh, it's very dark here, but it felt a lot brighter when my eyes were closed.
Like, it's a very odd thing, but it felt very, it felt very real. And then I always have this part of me pulling back, being like, whatever I try, you know, this will work that. But it feels like a, I feel confident that it, you know. This will help going forward.
John: Howard, why do you think that? By going towards some of these negative feelings, these negative thoughts, and then I. Coming out the other end relatively unscathed. Why does that help the client get this sensation of safety or this optimism going forward?
Howard: Well, there's three things that people [00:49:00] need, and this is how Mark and I think about EAT.
One is agency. They need to be able to. Stand up for themselves and speak up for themselves and have the ability to state their needs and desires and get those needs and desires. Met agencies like toddlers when they say no, they're showing agency, um, and then they need connection. I. And they need connection to themselves.
This relationship that people have with themselves needs to be repaired oftentimes because it has broken down over the years in terms of these ways of being self-critical, et cetera, and then relationships with others where they can be able to, um, I. Be vulnerable with people they trust. And then the third thing is the self-care and self-compassion piece.
So when you put those three together, you're meeting people's needs. You're helping them go through the feelings of anger and sadness and moving towards compassion. You know, when they [00:50:00] do anger, they're doing agency saying, I'm strong, I'm powerful. You can't do that to me. Uh, when they're doing compassion, when they're doing sadness, they're connecting to themselves.
When they're doing compassion, they're connecting to themselves and developing self-compassion and self-care, and then they often connect to others. Part of EAT is to repair relationships and find the, find the. Goodness that in other people and find the parts of other people that they can connect to and that they do appreciate.
So when you're doing all those things, that creates the needs that people, that human beings need. Mm-hmm. And when you do that, their brain goes to safety. And when their brain goes to safety, their symptoms will typically turn off or lessen dramatically. And what you were doing, which was really nice, once you got to that point where he felt safe in his brain through some of these emotional processes, you were then linking it, going back to the neurons that fired together, wired together.
Adage you were linking that to movement with his foot to [00:51:00] help him once he's in that place to help him link that. Mental space with his foot and foot movement. So that was a really, I think, a great way to reinforce that and help his brain learn that his foot was fine. Basically.
John: In that theme of kind of molding these modalities together and bringing in different tools, I know you've done that your whole career.
I know you've been a huge proponent of PRT and the blueprint that it lays out and all as well as these other emotional therapies. Where do you see the future? Of treating people with these disorders, going in terms of, uh, combining these skills or taking tools from different places.
Howard: It's just gonna all be psychedelics, John.
That's it. We don't have to do any of this anywhere. Just give people drugs. Now I'm just teasing. Uh, I can't resist the joke, but I mean, you know, it's true that [00:52:00] some people have. More needs. We see people who don't get better right away or don't get better in a long time, and it's hard for them to do PRT.
It's hard for them to do, or they've done it and they've done the at and they're still, and maybe they really need to make changes in their life. I. And maybe they need to, to do something in their, in their real life, in their world to, uh, help them break out of the internal stuff that they feel, uh, stuck into.
And, and that's one of the reasons why, uh, ketamine and psychedelic treatments have been found to be effective and will play a role. I think for some people, I don't think it's gonna be the standard, but for some people, because it does open up neural circuits, it, it changes the default mode network. So if you want the scientific.
I it does that, but, um, but we're always learning, you know, and, and in one sense there's, I, I think of our work as nothing new under the sun.
Mm-hmm.
Howard: When you come, you think you've come up with this new therapy and then you actually go in the history [00:53:00] of science and psychology. Oh. So and so was doing that in 1910.
So and so was doing this in 1950. You know, it's amazing. So I really think we're standing on the shoulders of giants whenever we do something. You know, mark and I can't say, well, we created something brand new EAT. No one ever heard of that before. That's, that's absurd. You know, we took from so many, so many different places and I think that's, that's the beauty of our work and just doing this podcast, of talking about different ways of coming to the same place and different models and.
And I think that's obviously gonna continue. I think we have a long, long way to go.
John: Well, it's been just absolutely wonderful chatting with you. I always get so much out of these conversations. Do you have any final parting words you'd like to leave people with?
Howard: I think the main thing that I think about when working with folks is, is being kind.
Is being kind and [00:54:00] patient and it's hard. You know, it's hard. A lot of the stuff they've been through is hard and a lot of stuff they're going through is hard. And, you know, certainly not to give up hope, uh, 'cause I've seen a lot of people find, find things. If they keep trying different things and they keep exposing themselves to different things and they find something that really makes a big difference for them and they just need a little change.
Sometimes you just need a little change to start a spiral that can lead to.
John: You
Howard: know, better stuff.
John: Amazing. Well, thank you so much, Howard.
Howard: Thank you, John. I love being here. Appreciate you so much.
John: Thank you for listening to the PRT podcast, brought to you by the pain rep processing therapy center. I wanna thank our guest, Dr. S Schubiner for joining me today. You can find his website@unlearnyourpain.com, or you'll find a link to have your recovery story be included in his upcoming book. [00:55:00] Finally, I wanna give a special thank you to David for allowing us to broadcast a piece of your journey.
Be sure to subscribe to our show, and if you'd like to partake in a session for the podcast, message me on Instagram at John g Therapy where I answer questions and provide information on the tools we cover in the episodes. Thanks again for listening.