In this episode, John Gasienica sits down with Dr. David Clarke to explore the hidden stressors beneath chronic pain and trauma. Together, they walk patient Rachel through practical tools to unlearn pain, build self-compassion, and find healing.
In this episode of the PRT Podcast, host John Gasienica, LCSW, is joined by Dr. David Clarke, a board-certified physician in internal medicine and gastroenterology and co-founder of the Association for the Treatment of Neuroplastic Symptoms.
John and Dr. Clarke discuss how trauma and adverse childhood experiences (ACEs) can shape chronic pain and stress, and why traditional tools don’t always work for those with PTSD. Together, they guide patient Rachel through techniques to face emotions of grief, fear, and anger, while learning to see physical symptoms as expressions of emotions rather than signs of damage.
Key topics include:
Understanding trauma as a driver of chronic pain
The three major consequences of childhood trauma (triggers, suppressed emotions, and people-pleasing)
Why stillness and compassion can feel unsafe for trauma survivors
How to use the physiological sigh and mindfulness tools for regulation
Steps to build self-esteem, self-compassion, and sustainable healing
Featured Guests:
Dr. David Clarke – Physician, author of They Can’t Find Anything Wrong, expert in neuroplastic pain, co-author of Psychophysiological Disorders
Rachel – Patient guest sharing her journey with trauma, PTSD, and recovery
Click here to access the free meditations mentioned by John in the podcast!
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 therapist and the director of clinical research and Development at the Pain Psychology Center in Los Angeles. I'm going to be talking about healing from trauma today, and before you decide that this word does not apply to you, I promise that if you are dealing with a chronic condition.
You are dealing with a trauma. Trauma has become a buzzword over the last decade with a lot of associations to it. So let's start with the simplest definition. Trauma is a lasting, physical, or emotional effect from a distressing event or a series of events. That's it. That's all it is. If you've been feeling anxiety for months or your back's been hurting for years, that is a trauma that, in the very least, subtly, changes the way you view your life or go about your day.
Now, for some people, healing [00:01:00] from this trauma simply means reading a book or doing a few meditations to help your brain realize that you are in fact not broken. For others, trauma is a little bit more complex. Maybe you carry multiple wounds from multiple events, which interact in destabilizing ways.
Maybe you're experiencing burnout or your trauma comes in the form of involuntary doubt, disbelief, or agitation. Whenever it's suggested that things will be okay. Pain, distressing emotion, negative thoughts. These are all the faces of trauma. And as you will see with the patient I treat today, the traumatized brain can use any or all of these faces to strongly resist the idea that you can be healed.
But this is a story with a happy ending, and this episode is about learning how to break through that resistance. And I have one of the most qualified doctors in the country. Dr. David Clark here today to help give guidance on how to get your brain back to believing that you are healthy and capable of thriving.
As always, the [00:02:00] PRT podcast is brought to you by the Pain We Processing 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 PRT practitioner and support the podcast, use coupon code Heal 10 to get 10% off training.
At pain reprocessing therapy.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, psychotherapists, 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.
All right, so joining me today is Dr. David Clark. He is a board certified physician in internal medicine and gastroenterology, and an expert in Neuroplastic pain. He's a president and co-founder of the Association for the Treatment of [00:03:00] Neuroplastic Symptoms, which is having a conference this September, and as the author of the wonderful book, they can't Find Anything Wrong, as well as the co-author of the Landmark Text Psychophysiological Disorders.
He's a rare combination of knowledge and warmth and kindness whose work has inspired thousands of clinicians like myself to better understand how to treat trauma, stress, and pain. Dr. Clark, it's truly an honor to have you here today.
David: Great to be with you and uh, thank you for helping us get the word out there. I really appreciate it.
Sure thing.
John: Well, one of the reasons, you know, I started this podcast is to help people find some of the hidden stressors beneath their pain. And it's something you've been doing for a huge part of your career is finding those hidden stressors. In your book, you break down these stresses into five categories.
Can can you tell me about some of the categories of stress that you help people find?
David: Yeah, it's all part of what I call a stress evaluation that I do with any patient who either doesn't have a definite organ disease or [00:04:00] structural damage to explain their symptoms or where I'm highly suspicious that that's going to be the case for, uh, any of a variety of reasons.
Uh, which, uh, my colleague Dr. Schumann calls the FIT criteria. I use those as well, and. What I look for is first, you know, stress in your life, uh, at the moment. Is anything going on right now? Uh, does it have any, uh, chronological links or connections with, uh, what's been going on? And if it does, you know, especially like if there was a big event or trauma that, uh, happened right around the time the symptoms started, that's a strong clue that we're looking at a neuroplastic uh, condition.
And the next area I'm looking at is, um. Whether a person went through experiences as a kid that we call ACEs, adverse childhood experiences, which can be the usual bad things that everybody thinks about, uh, physical, sexual abuse and so on, but it also can be more subtle than that. Many of my patients have come from [00:05:00] environments that they feel we're supportive and, and, uh, kind and not stressful.
But it turns out that, uh, even well-meaning parents can sometimes create, uh, very high levels of pressure on their kids without, um, really intending to, and that can play out, uh, over many years. Create consequences for adults that are similar to those that are suffered by, uh, kids who went through, uh, abuse or trauma or those more obvious kinds of, uh, difficulties.
And then the, the last three areas are. Pretty much garden variety, mental health conditions, depression, anxiety disorders, post-traumatic stress. Um, but it turns out that probably a majority of people with those conditions who present themselves to the healthcare system are. Presenting with a physical manifestation rather than a [00:06:00] mental health issue.
And so they're coming to the medical clinicians, they're having some kind of physical symptom, often one that's not particularly well-defined. Uh, and when you ask them, do you feel depressed? Do you feel anxious? Many of them will say no. And you have to dig a little deeper into what's been going on.
John: One of the things that's helped me a.
Help patients understand some of the more hidden stressors. You know, I know you have one question that I use all the time to help people see if their childhoods had stress in them, even if they didn't have trauma. Can you share one of the questions you ask people?
David: Yeah. Especially when people are, uh, skeptical about.
How much they went through as kids when they are telling you, uh, it wasn't that bad, or other people have been through worse, or, I think I'm over it now, and so I'm asking them, well, how would you feel if a child of your own or any child that you care about was going through [00:07:00] exactly the same experiences that you did while you had to watch?
In fact, on our, uh, screening questionnaire, 12 questions that we have on Symptomatic Me the nonprofit website, that's question number 12. Um, if you learned that a child you care about was growing up exactly as you did, would it make you feel sad or angry? Many people who are denying up and down that their childhood was all that, uh, difficult for them once they think about a kid going through the same stuff.
It's a completely different perspective and it also therapeutically, it helps them connect, uh, with emotions that may have been repressed about all.
John: Well, I'm really excited to have you listen to the session that I'm gonna present today and get your insights on this patient's condition. 'cause she has significant trauma, significant PTSD and her PTSD symptoms are getting in the way of her using some of the more traditional tools for pain.
So let's [00:08:00] take a listen.
So, Rachel, can you just gimme a, a brief background on what your pain's been like, say like the last year or so?
Rachel: Yeah. Um, I had suffered a couple of injuries. I'm a runner. Um, and they were doing really stressful things that I was going through and I noticed with each in injury I was getting like this nerve pain and I kept going to the doctor and they said, you know, you're in really good shape.
And it kind of seemed like the pain levels weren't lining up with what they were saying. The injury was. I had a sprained ankle and a nerve impingement in my knee. Mm-hmm. And it was nerve pain going all the way up to my hip and nobody could really figure out why the entire leg was being affected.
John: And tell me about the effect on running.
I know we talked in our console call about how important [00:09:00] running was to you.
Rachel: Yeah. Um, I was under, like, in the middle of a really stressful situation when these all happened. So, um, I felt like my mental health really took a hit because running was, you know, I have two dogs. I was always out with them.
That was not only my stress release, but my way of spending time with them too. So it, it really took a lot away from me.
John: And tell me about some of the traumas you've been through that you feel might affect your current mental state or your current pain.
Rachel: Um, I had a lot of childhood trauma. Um. Verbal abuse, physical, all that stuff.
Um, but I was also misdiagnosed for about 20 years. Um, I was told that I had bipolar disorder, so I was trying all sorts of medications. And it wasn't until about three years ago I was told that I don't have bipolar disorder. And it was PTSD. Wow. Yeah, so [00:10:00] finding that out was pretty, pretty much a shock, right?
It made sense once they explained it to me, but I'm like, I've been being treated for the wrong thing this whole time. Um, and once I really started to dive into that, I noticed that even sometimes in social interactions, they can be micro traumatic because of my other experiences and everything I've been through.
So it's a lot sometimes.
John: Yeah. And tell me about what are some of the ramifications of your PTSD? How does that show up for you? On a, on a daily basis,
Rachel: I'd say more, mostly like mood swings. I can get irritable sometimes and it take, like I can communicate that and say like I'm upset about something, but I don't always understand why I am upset or yeah, what I need to do about it.
Like I just. Instantly my brain goes into this mode and, um, it's, it's like I'm not, it's, I'm not here. Something else is happening. [00:11:00] Um, so it makes, it makes some relationships really difficult because if there's a boundary being pushed and I start to get uncomfortable, I tend to shut down so that I can figure it out and communicate it.
I can't, I can't do that as quickly as I'd like yet.
John: And I can imagine doing any pain work during those periods where you feel like you're offline and you don't really realize why you're in these type of moods can be very difficult. What's that experience been like trying some of the pain tools while you're fluctuating like that?
Rachel: It's really hard because I get frustrated so easily. Right? Like, why is this still here? Why is this working? Is this even the problem? Um, and you know, I, I know it's the partially the way I'm going at it, it's really hard, especially doing like. The tracking on my own to get myself in a different mindset.
'cause I'm so like frustrated with everything going on.
John: So, Dr. Clark, when you hear a patient like this, [00:12:00] what are some of your first reactions or what are some of the things you're thinking about?
David: Well, there is a, a tremendous amount to unpack, um, just in that. Short segment there. Um, first of all, with the symptoms, uh, that they were clearly not biologically mediated.
Um, you know, she's got a problem in her knee and a problem in her ankle, and yet the pain is going all the way up to the hip. It's kind of going backwards. You know, if you've got a pinched nerve, uh, in your, uh, lumbar spine, for example, the, the pain from that pinched nerve goes downward, uh, into the leg starting up at the, uh, the lumbar area.
So for somebody to have an injury, um, lower down in the nervous system and have. Come back up and cause pain in the, in the thigh and the hip is, um, huge red flag for it being neuroplastic. Um, and then, uh, obviously you, you start talking to [00:13:00] people about, you know, what they're going through, uh, and as their current stress.
And she mentions that, uh, she is having stress, uh, at the moment, uh, in her life. And she talks about the verbal and physical abuse, the people whose progress. With, uh, pain reprocessing therapy may stall, uh, often are the ones who are the most profoundly affected by, uh, childhood trauma. The consequences of childhood trauma or adverse childhood experiences in general tend to fall into three, uh, major categories.
Category number one that she mentions is emotional outbursts. That are triggered by, as she described it, less than you would think would normally be required to trigger an emotional reaction like that. And that's very common in. Space survivors is that they have, uh, repressed [00:14:00] emotions. Uh, I often describe them as being like dormant volcanoes on the outside with boiling magma on the inside.
And sometimes the boiling magma comes, you know, bursting out. And the, the treatment for that is clearly to help people understand, you know, where this is coming from and to connect. With the magma, uh, and to begin converting it, uh, into verbal expression instead of outburst expression and somatic bodily expression in the form of symptoms.
Um, the second consequence, uh, in the adult years of ACEs are triggers, you know, that situations, people, or events that are happening in the present day, uh, that are. Highly stressful for the patient because they are in some way connected, uh, to the past. They have a lot of, um, mental health consequences from that that, uh, can be [00:15:00] misdiagnosed.
And so, uh, another common misdiagnosis is, uh, a DD or a DHD that people who are, you know, who are trying to deal with the emotional consequences of, uh, ACEs, um. May naturally find it difficult to stay focused. And then the third area that, uh, she hasn't really talked about yet, that's a consequence of ACEs, um, are the personality traits.
People who are, you know, kids who are trying to survive a challenging childhood environment, don't have that many options, uh, for trying to deal with it all. You know, it's not like they can just. Walk away. They're dependent on the people who are causing the problems. So what do they do? Patients who wind up in my office try to make things better and they work really hard to make things better, and they become very focused on the needs of the others in the household.
And so they become people pleasers and they try to [00:16:00] be perfect. Uh, and if doing their best fails to solve the problems, they can feel second rate or worthless. Um. Or like they're not measuring up in some way. And so they are very harshly, self-critical. Um, as a result of that, they are much appreciated in the workplace because of their reliability, um, their attention to detail, their compassion for others that their hardworking.
Um, but all of those qualities that get them so much appreciation in the workplace can be taken too far and. End up being, uh, highly stressful for people and nobody can do that indefinitely. Um, sooner or later the body is gonna protest and it's gonna force you. To stop doing that lifestyle and to take care of yourself.
Chronic fatigue is a common one. It just, you know, I've seen it where it just flattens people. They can barely get outta bed [00:17:00] and the mind won't let you get outta bed until you have figured out that you need to do some self-care. You need to take some time for your own joy. If you, if you can add. To your practice, all of the things that I was just describing, uh, it will give you a whole other dimension for a patient like this, um, beyond, uh, pain reprocessing therapy.
John: Well, this is a perfect transition because in the next clip you'll hear I'll. Share with Rachel these ramifications of childhood stress and just see if she identifies with them. So let's take a listen.
So with these three kind of ramifications that. People experience after childhood trauma. One is being more easily triggered. So as you were saying, like your emotions can kind of pop up outta nowhere and it feels overwhelming. The second [00:18:00] thing is actually the tendency to suppress emotion because when you get these emotions coming up, you do want to get rid of them.
You do kind of wanna move through things. And the third is moving away from enjoyable activities. Taking on more responsibility. Taking on responsibility for others. Do you relate to, to any of these things that I've brought up?
Rachel: Yeah, all of the above. Anything to not pay attention to whatever is going on in there.
John: Totally. What PTSD does to your. Neuroplasticity is, it makes it very difficult for your brain to learn that you're safe and to learn this new idea that your environment has changed. You're no longer in these traumatic experiences as you've been recognizing the brain can play a lot of tricks that kind of hold you in this pattern of shut down and in this pattern of just survival, does it feel like you've just been surviving?
Rachel: More often than not, it does feel like survival. Um, like I've never experienced burnout before and I feel like every few months I actually take a week off work. [00:19:00] 'cause I can feel when it's coming.
John: And even when you say that this idea of like. How much this has affected your life and how much this has affected your work?
What emotion comes up just as we're talking about this?
Rachel: Um, grief, right? Sadness. Yeah. Because I keep trying to put myself in a position to reach these goals that I have with running, and I'm watching my friends do it, and I'm like, what's, you know, it makes me feel like what's wrong with me?
John: What I want to help you with today is even when this grief comes up, or even when the frustration comes up, learn how to.
React in a different way that helps actually break this cycle rather than keep it going.
So Rachel really identified with some of these stressors and the ramifications. It might not be curative, but why is it a necessary step for the patient to understand where these stressors are coming from, understand kind of the picture of why they're feeling the way they are?
David: Well, as, uh, my colleague Howard Schu puts it, you wanna [00:20:00] unlearn your pain and if you can understand the sequence of events that has.
Led you to where you are today. I think it's easier to unlearn them, uh, you know, the, uh, understanding of what you learned about yourself as a child. That is not true. Facilitates, uh, replacing those false concepts with more accurate ones. Um, you know, so if you learned that, uh, you're a second rate human being, that it's your job in life to take care of the needs of everybody else, that it is not appropriate for you, uh, to have strong negative emotions, uh, that it's not appropriate for you to take time.
For your own joy because you've got other things to do that are more important. Now, these are all ideas that people from [00:21:00] ace environments acquire. They become fundamental assumptions about themselves. It's like learning that two plus two equals five when you're really young and learning it over and over again until it becomes a a basic assumption.
Uh, and you're gonna make some mistakes as an adult if you think that two plus two equals five. Um, you know, including choosing, uh, you know, not so good or even narcissistic relationship partners. Um, so if we can unlearn the two plus two equals five and replace it with, uh, more accurate information, um, that changes everything.
And one of the. For me, the, the most fundamental, uh, changes is in your own self-esteem. How you think about, uh, who you are as a person and. The analogy I, I use to understand that your early [00:22:00] life was analogous to parachuting into a dangerous jungle or into the Himalayas, uh, as a toddler and somehow being able to find your way out, uh, that you know that what this emphasizes is that through no fault of your own, you found yourself in this highly difficult environment, an environment that because of this.
Imagining a kid, you care about exercise, you are now getting a more accurate sense of just how difficult it really was, and once you see how difficult it really was, you can start to give yourself some credit for having made it through. My patients are like Olympic weightlifters who've been asked to carry 50 pounds more than the world record, uh, for their weight class, uh, in the form of stress.
And anybody who's trying to carry that kind of burden around, uh, their body is gonna break down and they're gonna feel weak and they're, they're gonna feel like they can't cope [00:23:00] and they're gonna wonder, you know. As she put it, why I'm not like my friends. Uh, well, you know, if your friends were carrying 50 pounds more than the world record around on their shoulders, they would find it difficult to run too.
And once you can flip your self image 180 degrees from negative to positive. It gives you a foundation for making lots of other changes. What I recommend to people is that they take time for themselves every week, um, several hours in a block if they possibly can just for activity with no purpose but their own joy.
You have to have a, a sense of your own value to feel like you're worthy of doing that. Uh, it takes quite a bit of trial and error to find activities that are joyful for somebody who's never done that before. It can take months to learn how to do this, but it is absolutely an essential human skill, uh, to be able to take [00:24:00] this time for yourself.
I often tell people I used to play soccer on up to three different. Uh, recreational teams at a time for over 20 years after being compassionate with my patients all week, I would get to go out and kick something, um, just what I needed. Plus, you know, we'd go out for a beer with the team afterwards. I mean, it was my own personal stress reduction, absolutely essential to my, uh, healthy functioning, um, and every, every human being, uh, needs that needs to learn that.
John: Some of these concepts you're talking about of going toward self-esteem, building self-compassion, building leisure. One of the things I've noticed with patients is if they're so overwhelmed by emotion or if they have an intolerance of things quieting down or things getting relaxing, it's very difficult for them to move in that direction.
So you could hear in this last clip that Rachel had some emotion coming up. Usually at this stage, I'll typically lead the patient through a meditation to help them feel [00:25:00] safer with this emotion that's coming up. As I led Rachel through some of the breathing techniques to help her feel more grounded, the opposite happened.
Turning inward and trying to regulate her system actually made her feel more uncomfortable. And this is a very common reaction, especially for people dealing with PTSD. So I wanna fast forward a lit little bit to hear Rachel's reaction to trying to settle our system down. Just so people can get an idea of how to overcome this challenge.
I want you to take one or two more breaths and then when you're ready, just slowly open your eyes and come back to the screen. How did that feel?
Rachel: Um, I could feel my body physically calming down. But my brain doesn't like the stillness.
John: How do you know that? What did your brain do?
Rachel: It's like, I don't know how to describe it, but it's like clawing at the walls, right?
Like, like it's still some like the calm before the storm, right? Like, something's gonna happen if [00:26:00] I sit in this stillness.
John: So this is what we wanna work on today, because your brain has learned this fear of stillness and peace, because in this. Survival mode. It's in. When you're complacent, when you're still, when you're not moving, it feels like you're very vulnerable.
That's why a lot of people have a hard time sleeping. It's why a lot of people have a hard time getting away from their phone because it's going toward the stillness that the brain's terrified of. And so no wonder it's been so hard for you to do some of the pain tools.
Rachel: Yeah, I'm a, I'm a certified forest therapy guide too, and part of it is like just sitting in the woods in silence and without fail, even though I know it's happening, the first 10, 15 minutes are excruciating.
So yeah. This, this makes sense.
John: If you had to describe that feeling of your brain not liking what you just went through, is it physical? Is. Thoughts coming through? How would you describe it? It's,
Rachel: it's more like primal, like not necessarily words, but it's mostly [00:27:00] mental and it just feels like my brain turns into static.
I don't, I don't know, like you think of you're picking up a cat and it's like just clawing around everywhere 'cause it's scared. Like that's kind of what it feels like in my head.
John: So Dr. Clark, I know you mentioned A DHD before and people getting misdiagnosed, this kind of static feeling, this feeling like a rapid firing brain. Have you seen that in patients before who have been through stressors? This feeling like it's difficult to quiet down, it's difficult to relax. They have so much activity going on.
David: Yeah, absolutely. So many of my patients, their early environment resembled a minefield and it could be perfectly okay, uh, one day. Um, it could be perfectly okay for a week or 10 days, and then something happens. Um, a patient that. I interviewed, uh, a couple of months ago. It took a long time to identify what was [00:28:00] traumatic about her childhood experience.
I mean, she had some very powerful symptoms in the present day. She had some very strong, uh, post ace personality traits. Uh, so that. It was clear that something, you know, had happened. People are not born this way, but eventually, um, she began telling me that her parents used to fight with each other and she was clearly not feeling like it was a big deal.
Um, but, uh, the more we talked about it, it turned out that the, the fights were, they were not physical. They were only verbal and emotional. Uh, but. As I've learned, uh, that can be every bit as bad as, um, more physical altercations, and they were so bad that at the end of the fights that dad would leave the house, uh, go sleep somewhere else and threaten not to come back.
And this was happening [00:29:00] three times a month for her entire childhood. This is exactly the, the minefield that I was talking about. You know, nine days, everything's fine. Day number 10, massive blow up. Dad storms out of the house. Um, you know, the minefield is blowing up and she, you know. Basically lived, uh, in fear with constant attention, uh, toward trying to prevent those episodes.
And of course, constant failure to prevent those episodes. Um. When you are trying to be silent, uh, and at peace and regulate yourself, you are not fixing the minefield. Uh, another possibility, um, somehow striking me as less likely for her, but still possible is that the, uh, the magma in the dormant volcano, um.
Comes closer to erupting when she's trying to regulate. Well, you've,
John: you've hit both nails on the head here. Um, and as you'll see in the [00:30:00] next couple clips, what I work on with Rachel is just helping her begin to tolerate stillness and quiet, not just to help her brain calm down and relax, but to also start to notice what is causing so much activity.
What is causing so much fear when I start to quiet down. So in this next clip, what I usually start with when I'm doing a meditation is a breathing technique called the physiological sigh. And that's a breathing technique that's been scientifically proven. It's one of the most effective ways to just start the process of helping your nervous system start to calm down.
It's a great tool, but if you haven't tried it before, I would just sitting down when you try it for the first few times. So if you're in your car right now, I would suggest waiting till you get home. So let's take a lesson.
And so what we're gonna do is get you in a nice breathing cycle. This is called the physiological sigh. And so what this involves is just taking a nice inhale through your nose till you're about 90% full. [00:31:00] Another sharp inhale through the nose at the top, almost past capacity, and then a nice slow exhale through the mouth.
And so see if you can just replicate this cycle on your own 90% in through the nose.
Inhale the top, and then exhale. And what we're doing here is actually changing the makeup of carbon dioxide in your system. If you've ever noticed with your dog, it gives like a big huff when they sit on the couch. This is them regulating their system. And I want you to think of this breathing pattern as almost like a safety base to go back to.
So I'll pause you a few times. We'll talk a little bit. Whenever you go back and close your eyes, I want you to just return to this breathing pattern. We want your brain to start associating this pattern with safety. 'cause we'll have you use it when you're with friends or with people, and you feel those emotions come on strong.
And as you're breathing like this, what do you notice [00:32:00] physically? What makes you feel like your brain is really rejecting this silence?
Rachel: Um, it's almost like I, like I start thinking like, how much longer am I doing this? Is this over? Like,
John: yeah,
Rachel: good. Like, it's not comfortable to continue without knowing like, what's gonna happen next.
John: So what your brain's gonna want to do is just kind of like, escape this. Get away. And what we want to do is actually show your brain that this is totally safe and go toward the thing that's making you the most uncomfortable. So I actually want you to go toward that feeling that's coming up that's saying, get me outta here.
I wanna be done with this. When is this gonna be over? And just ask your unconscious brain, what are you afraid of right now? What are you nervous about? And if any information comes up, just speak it out loud.
Rachel: I'm trying to think of how to describe it. It's like there's nothing, like if I'm constantly scanning for a threat and it's silent, there's like.[00:33:00]
There's nothing to solve
John: good, and so just validate your brain. Let it know. I know this is new for you. I know it's strange for you to not have a problem to solve. And see if you can just empathize with this piece of you that's very worried about this new experience and just let it know. I get it, and I can almost see some emotion coming up.
What do you feel? Kind of makes me sad. Good. These are all the layers that come up that block you from a feeling of peace. Don't be afraid of the sadness. Just keep that nice breath going. It's your safety blanket. You're perfectly safe to process these feelings and just ask your brain what's making you sad right now?
And not in an accusatory way. In a very kind way. What feels sad?
Rachel: Well, even me trying to reassure it, it doesn't feel safe because 'cause people aren't generally safe. Yeah. To
John: me. And can you [00:34:00] relate with that feeling of not trusting safety? Yeah. And to have that conversation with your brain, say, I know, I know your guard is up.
I know this is scary. I know it seems. Inauthentic, and I get it. You don't have to change your mind. I just wanna let you know I'm here with you who better than you to understand this emotional piece of your brain and its experiences. And I almost just feel like you have this long lost sibling almost. So you're holding and saying, gosh, I know exactly what you're going through.
And just encourage that sadness to come up. And let your brain know. If you need to feel sad about this, I'm here for you. 'cause I understand why it's so sad. And just use that breath to help your brain process this. And just know that each moment that goes by your brain's getting a little bit more comfortable with these emotions, with this silence.
And how does that feel? I
Rachel: can feel it fighting it.
John: So this is the last part we want to go into. Why don't you ask your brain what are you [00:35:00] angry about? What makes you wanna fight right now? What makes you frustrated And what comes up?
Rachel: It's not fair. Yeah.
John: Injustice good. And so let just encourage your brain to get really angry about that.
Don't shut it down and let it know. Of course you're angry about that and ask it. What specifically about injustice are you angry about?
Rachel: Especially relating to trauma and stuff, um, that people can do these things and there's no consequences. But I feel like I'm paying for something,
John: of course, and just let it know this is unbelievably unfair.
And let it get angry at the perpetrators. Let it get angry at the universe for allowing this to happen. Who better than you to empathize with this piece of your brain that's really upset? And as you feel this intensity come up, just keep using your breath. It's almost like a safety blanket that's helping your brain process this in a safe way and feel that physical sensation of [00:36:00] anger.
What does the anger feel like right now? Physically?
Rachel: Actually, the nerve pain.
John: And where is that right now?
Rachel: Um, in my lower leg, it twitches starts.
John: So here's what I want you to do, is I want you to bring your awareness down to that twitching and just keep breathing in this way and just watch it and just see if you can see it for what it is. Just an emotion being somaticize in your leg and see if you can feel the sensation, not with fear that your body's broken, but with empathy for this piece of you that just has a lot to say and has been through a lot.
Rachel: I haven't been listening to it either.
John: Tell me about that. What do you feel when you say that? Oh,
Rachel: like I feel like it's been trying to get my attention, um, with all the pain, but it's not, you know, intentionally [00:37:00] ignoring that it's happening, but it's not like understanding the way it communicates.
John: Amazing how much it open your, open your eyes for a second.
So we see there's a lot of emotion, uh, kind of lingering beneath the surface. And then at the end of the clip there, what gets me excited is that the patient starts to see, but this physical symptom is actually just an expression of my emotion. Why can it be helpful for patients to see these sensations as emotions or expressions of emotions rather than some physical damage to their body?
David: Well, you know, you. Moved her through that exercise though just beautifully and, you know, step by step helped her to get deeper and deeper, uh, appreciation for what was happening, uh, mentally and physically and. The reason why symptoms manifest physically is because [00:38:00] people are not consciously aware, uh, of the sources.
They're not consciously aware of the emotions, um, and the emotions need some way to express themselves. Uh, and so they do. I mean, there, there are, there is a school of thought that the physical symptoms are a distraction, uh, from the emotions. And personally, I, I always found that. A difficult analogy to, uh, support.
Um, I like a different metaphor. It's not necessarily any better, but, uh, I prefer to think about the emotions just simply getting expressed physically. Um. You know, all emotions have a physical component to them. You know, when we're, uh, afraid if we are dumb enough to go to a horror movie and, um, we get afraid watching the horror movie, uh, you know, there's gonna be a, a physical, uh, reaction, uh, to that.
And what happens in neuroplastic patients is that they have the [00:39:00] physical reaction without the conscious awareness, um, of the emotion. And you were able to, uh, step by step, uh, uh, move her, uh, conscious awareness to recognizing that. For me, that's the highest level of recovery from neuroplastic symptoms is when you can understand that when a symptom happens, it is your mind trying to communicate with you.
It's trying to tell you something. And many people who reach a, uh, very successful outcome with their neuroplastic symptoms. Reach a state of appreciating when they have them because it's, um, a form of communication about what's happening in their life, um, that, um, many other people simply don't have and they can take advantage of it.
Um, make changes, uh, have deeper insight into what's happening in their life, um, because they've learned to read, [00:40:00] uh, the bodily signals. And, you know, in that. Clip there. You, you helped her take a huge step toward, uh, that level of understanding. The only other comment that I would make is that, um, many of my patients, when they first begin experiencing the buried emotions that repressed emotions they have, um, in essence.
Mutated one emotion into another, and she did that. Um, her initial, uh, sense of what she was feeling was sadness. And, uh, it, as the conversation, uh, in the clip, uh, evolved, uh, I think we can see that, uh, it was rage about what she had been forced to go through that was getting, um. Mutated into a more acceptable form, uh, of feeling sadness.
Um, but, uh, [00:41:00] you helped her to, uh, move past that and see it for what it really was.
John: So now the patient has this awareness. She sees that her body's trying to communicate with her as Dr. Clark was talking about. And so this next clip I wanna show you what to do once you start hearing what your body's trying to tell you.
How do you start reacting in a way that's actually gonna. Help your body feel a sense of ease and and a sense of relaxation,
and I want you to bring your awareness down to that tightness in your leg. And what do you feel now?
Rachel: It's kind of burning
John: Good. So just watch that sensation and almost like that feeling of like, you wanna just open your eyes when silence happens. The feeling is you're gonna wanna run from this, but I want you to just stay with the burning for a second and just use your breaths, create this feeling of safety, and just watch that burning.
And as you can watch it, I want you to just ask. That sensation. What are you afraid of?
Rachel: Just [00:42:00] afraid of getting hurt again.
John: And so just empathize with it. You don't have to change its mind. Let it know. Of course, I understand why you're afraid and just see if you can slip in a message of safety. Let it know.
I know you're scared, but we're gonna be okay. And how do you emotionally react to that feeling of we're gonna be okay? What comes up?
Rachel: Um, it's like a mix of sadness and fear. Good.
John: And so this is what's blocking your brain from feeling safety. And suggest accept the sadness and fear again. Stick with that feeling of consoling.
Let it know. I know. It's so scary to let your guard down and get your hopes up and to think that you're gonna be safe and just give your brain the space until it feels comfortable enough here in this message. And just every once in a while I'll say, I know this is scary, but I promise you we're gonna be okay.
And any wave of sadness or fear that comes up, just let it come on. Like a wave. And as you breathe like this, you're helping your brain stick with this journey [00:43:00] of breaking free instead of just getting stuck. And as you keep going, you'll notice that this message sinks in a little bit more and a little bit more.
And try it again. Let yourself know we're gonna be okay. And just see what you feel Selfly fear. Good. And ask it again. What are you afraid of?
Rachel: Uh, the failing. Good.
John: And can you relate to that fear of failure? Yeah. Good. And let it know, of course you're afraid of failure. I just feel like you're getting to the bottom of these fears and what comes up for you.
Rachel: Um, something that was going on. So my mom is a big source of, you know, my childhood trauma and, um, the stressful situation I was in when my knee got hurt, had a little bit to do with her. Um, and that's where a lot of that like fear and judgment is coming from. That's, I think that's when it all started.
John: And where was that fear coming [00:44:00] from back then? What was causing you fear?
Rachel: Um, I was under contract on a house I was buying and I had asked her for advice 'cause I wanted to make the right decision. And, uh, she told me the house was really crappy and like, didn't support it at all and went to help. Uh, so I ended up having to call a friend, um, because I wanted to go ahead, but I was afraid I was going to like, make big mistake.
Because I didn't, it was my first time and I didn't know what I was doing,
John: and so let that sensation, you're like, no, I know what it feels like to be afraid of failure, and see if you can talk to that sensation the same way you talk to that younger version of you who's trying to buy the house and let her know you're doing the best you can with the information you have, and just let her know, I'm gonna care for you and love you no matter what happens.
With this house and it's the same feeling with your leg. Let it know I'm gonna care for you and love you no matter what [00:45:00] failures or injuries or pain we go through. And then just feed it with the message of we're gonna be okay. You're no longer alone and just take care of that emotional piece of you that wanted help.
And how does that feel?
Rachel: It's kind of like you're in charge, though.
Like your track record's not that great either.
John: You know, not all of this is defended. You can let it know you're right. I am fallible. I make mistakes, and even the fact that you can laugh at that is so beautiful.
Rachel: It feels like it's starting to warm up a little bit because it can call me out good.
John: Even having the conversation, the back and forward is just so helpful.
It shows me that you're not in this deep, deeply frozen state. You've done enough work to where your emotional self worth willing to engage. It's not completely shut down and just enjoy the idea of just having this conversation and rebuilding this relationship. You know, what you said [00:46:00] about injustice before is completely true.
It's bullshit that you have to do this work, but you're capable of doing it. And you don't need to rely on anybody else to do it 'cause you can take care of this piece of you
Rachel: likes that.
John: How do you know it likes it? What do you feel when you get a message?
Rachel: It was like, well that was empowering.
John: Let's to see if you can just enjoy that empowerment for a little bit. That feeling of I can do this.
In some of the research studies I've been a part of, we deal with a lot of patients with a tremendous amount of trauma, and I see this pattern all over. Whereas as a clinician, you want to feed them lines of self-compassion and feeling like they're gonna be safe, and you can just see the resistance come up.
Their body feels afraid with compassion, it feels fear or anger toward compassion or ideas of safety. Why do you think the. Brain that's been through trauma and PTSD rejects feelings of compassion [00:47:00] or rejects feelings of safety?
David: Well, there are, I think a lot of theories about that. Um, my own, uh, is based on what someone has learned, uh, about themselves, uh, from their environment.
You know, we. Humans are learning creatures. Um, we are distinguished from other living things on the planet by our capacity for learning. And the single most important thing we learn about is ourselves. Um, who are we, what are we good at? What are we not good at? And um, you know, if we have learned that we live in a minefield, uh, if we have learned that.
We are a second rate human being who doesn't measure up to the quality of others. Um, then it's [00:48:00] hard to believe that. You can be, uh, in a state of safety and if you have a, a kind therapist who is trying to bring you to that state, um, you know, you're looking around and it's like, Hey, I'm still in the minefield.
You know, it, uh, I may be safe just standing right here, but over there there's probably a mine. Um, and. Yeah, my, my kind therapist is telling me to be compassionate toward myself, but, um, I know deep down, uh, that I am a second rate human being. Um, and so it's gonna be hard for me to be compassionate to myself.
Um, under those circumstances.
John: One of the things you'll hear in the next clip as I'm just helping Rachel. Commit to the idea that if she works on this and continues her relationship with herself, she can learn how to handle these emotions and how to learn how to be more compassionate to herself.
Rachel: I [00:49:00] think that's what I struggle with the most, um, is I, I feel like I have a habit of doing things for a little while, and then once it feels better, I just kind of stop and then it's a problem again. For sure.
John: How does it feel to you? How has it felt in your life when you've reached out to people and you've been abandoned or you've been treated improperly?
Rachel: It hurts. Um, but I also try to be there as much as I can for other people when they need me. And so it's kind of like, well, why am I not able to get that back?
John: This is exactly how the emotional piece of U feels. When it's abandoned, you know how much that hurts of when you give effort and you're putting energy into it and you're not getting anything reciprocated.
I want you to use that as motivation of, I don't wanna do that to myself. I know you wouldn't do that to other people. Just from our brief conversations, I could tell you're not a person who abandons other people or who flippantly [00:50:00] ignores their issues. We end up doing to ourselves, the thing we would never wanna do to other people.
And I want you to just remind yourself of that. I need to care about myself as much as I care about other people, if I wanna break out of this. Does that feel motivating to you? Yeah.
Rachel: Yeah, it actually popped into my head yesterday too. Like I had somebody who, you know, I have multiple people who like come, people come to me with with things, and it dawned on me like I've had a really bad week and I was trying to help other people.
And I'm like, why don't you like, who's helping you?
John: Yes.
Rachel: It was a really eye-opening thought to have. Um, 'cause I was like, well, nobody else is helping me. You know, and not necessarily for negative reasons. Like I have very busy, like very good friends who are very busy. But, um, it was kind of eyeopening, like, oh, okay, like I have to be the one to do this now.
John: On one hand it's haunting 'cause there's nobody else there that can do this for you. And it feels [00:51:00] terribly lonely and scary. But it's also tremendously motivating and empowering of like, I can do this for me. And if you can get into that mindset of I have to stop waiting for somebody else to heal this trauma for me, or give me an indication that I'm worthy, if you can do it for yourself, all those other relationships are like icing on the cake.
Rachel: I'm just thinking like, you know, all the times, like you try to go to these different providers.
And I kind of feel like giving up lately. 'cause I, I do feel like the, the key is inside me. So I appreciate that insight because I'm like, nobody can really tell you how to do that. I feel like that, like part of me is like, oh, you finally listen. Thank you. Like I can stop screaming now.
John: How does that feel?
Like, how does that feel internally?
Rachel: It is, it's a relief. That's exhausting.
John: So. After the session, I [00:52:00] left Rachel with two meditations to practice on her own, and we'll put them in the show notes so that people have access to them. And what I wanted to help her practice was not just to give herself messages of safety, but also understand what to do when her emotions came up and when her emotions said that you are not safe.
And a few weeks later, Rachel reached out and told me she was doing great. She was feeling regulated and going on longer, more frequent walks with her dog. And was a little shocked with the changes she was feeling. I spoke to her briefly just to hear what her process had felt like. We'll play the full recording in a future podcast, but I wanted to share a few moments from that second call just so people can hear what changes are possible when you stick to this work.
How's everything been? How have you been feeling?
Rachel: Um, calm, you know, like my friends ask me like, how are you doing? And I'm like, good. Like, like kind of skeptical, right? Like, this is [00:53:00] weird. I don't generally feel this good consistently. Um, which has been really cool. I've had a couple people say, I seem more peaceful.
It's been a fascinating journey because I've always, I've really always looked up to the people that could be, you know, like more calm and kind of peaceful. Um. And I firmly believe that we admire that in other people. We have it in ourselves, but I thought I was do, I'm gonna cry. I thought I was doomed to be this like angry, intense, aggressive person.
And for people to be like, you've been shifting in the last couple of weeks. It's just incredible to me. And it's because I'm allowing myself the space to slow down, which seemed terrifying before.
John: Oh, that's so good to hear. I'm so glad you reached back out and do you have any questions or any thoughts going forward?
Rachel: I some reassurance would be nice. I think one of the most mind boggling [00:54:00] things to me is trying to believe that this is sustainable, right? Mm-hmm. Like is it really like potentially if I keep up with this work a new way of life to be, because it's such a stark contrast to the way I felt before. I think one of my fears is.
I'm gonna lose this.
John: So, Dr. Clark, you hear Rachel feeling so much better, but also feeling this question of, is this, is this change possible to sustain? I know, I know you've seen 7,000 people in your career with neuroplastic pain get better and, and improve. Can you talk about some of the ups and downs of recovery and, and whether this change is possible long term?
David: Yes. Um, I, first, I wanted to go back to just a moment to the clip before last where she's talking about being the kind of person that others rely on. And as we discussed earlier, uh, that's [00:55:00] very common in people that grew up, uh, taking care of others in their household, and, um, also being in multiple relationships with people who are needy or.
Have to have support or have issues or problems or are toxic. Um, the, uh, it's a huge source of reducing stress if you're able to, um, internalize a belief in yourself that you deserve better than that. You tend to start attracting people into your orbit, uh, that want to give to you as much as you are giving to them, but it, it only starts happening.
Um. When there's been an internal shift in how you think about yourself, um, with respect to the, the long-term outcome of this, um, one analogy that I make goes back to the Olympic weightlifter who's carrying 50 pounds more than the world record for their weight class. That [00:56:00] this process of treatment is analogous to teaching the patient how to take that weight and put it down.
And once they put it down, uh, number one, they start to realize how strong they have been all along. Uh, that there wasn't any of their fault that they felt weak or in pain or inadequate. It was this weight, um, which. They couldn't initially see the magnitude of, because they've been carrying it around for their entire lives, but once they put it down, um, they're not gonna pick it back up again.
And yes, you know, life being what it is, it's gonna throw stresses at us from time to time and our brain is wired, uh, to carry those stresses, uh, and express them somatically. Um, but. She's already learning how to use that information, uh, to her benefit. When the symptoms flare up, it means that there's an issue that [00:57:00] she should be, uh, addressing in her life.
So she's, um, using it for, uh, for good, the, the physical symptoms. And so, yes, the, the benefit of this is lifelong.
John: I so appreciate you coming today. I wanna give you an opportunity if you have any final messages for people who are listening, uh, and going through their own journey or their own struggle.
David: Well, first of all, there's tremendous hope. Um, exactly. The ideas that you and I have been discussing today have been validated by research studies across North America, and there are more research studies, uh, underway that'll be published in the next couple of years, and I'm confident they will validate this as well.
That when they do, there's gonna be a critical mass of, uh, science out there that is going to change medical practice, uh, for the first time since these symptoms, uh, [00:58:00] were written down, uh, in 1800 bc.
John: Thank you so much, Dr. Clark.
David: Thank you.
John: Thank you for listening to the PRT Podcast, brought to you by the Pain Processing Therapy Center. I wanna thank our guest, Dr. David Clark for joining me today. You can find his nonprofit, the Association for the Treatment of Neuroplastic symptoms@thewebsitesymptomatic.me and on instagram@symptomatic.me.
Finally, I wanna give a special thank you to Rachel for allowing us to broadcast a piece of your journey. If you'd like to access the meditations that Rachel used to get better, you can find them@johngtherapy.com or in the show notes for this podcast. If you'd like to partake in a session for the podcast, message me on Instagram at John g therapy or answer questions and provide information on the tools we cover in the episodes.
Thanks again for [00:59:00] listening.