Rumination—those endless loops of worry, symptom monitoring, and "what if" thinking—can make chronic pain worse by keeping the nervous system stuck in a state of high alert. In this episode, therapist John Gasienica works with Leslie, a new mom struggling with chronic pelvic pain and obsessive thoughts about her symptoms. John, alongside expert therapist Callie Klebanoff, breaks down the Pain Reprocessing Therapy (PRT) blueprint for disrupting rumination and retraining the brain to feel safe. They discuss: - Why rumination is one of the biggest roadblocks to pain recovery. - How overthinking reinforces pain pathways in the brain. - Practical strategies for shifting from fear-based thinking to self-compassion. - A real-time session where Leslie learns to calm her nervous system and reduce pain. If you’ve ever felt stuck in your thoughts about pain, this episode will give you the tools to break free from the cycle and start healing.
Rumination—constantly monitoring symptoms, worrying about pain, and overanalyzing every sensation—can make chronic pain worse by keeping the nervous system in a state of high alert. In this episode, therapist John Gasienica works with Leslie, a new mom struggling with chronic pelvic pain and obsessive symptom fixation. Alongside expert therapist Callie Klebanoff, they break down the Pain Reprocessing Therapy (PRT) blueprint for stopping rumination and retraining the brain to feel safe.
What You’ll Learn in This Episode:
Key Topics & Timestamps:
00:00:00 – Introduction: Why rumination fuels chronic pain
00:01:00 – The cycle of symptom fixation and its impact on daily life
00:02:00 – Meet Callie Klebanoff: Breaking the cycle of rumination
00:03:00 – The mental load of symptom monitoring and anxiety
00:04:00 – How overthinking affects the nervous system
00:06:00 – Leslie’s experience: A new mom stuck in the pain-rumination loop
00:07:00 – Constant symptom monitoring: How it worsens chronic pain
00:09:00 – Why the brain fixates on pain and discomfort
00:12:00 – Understanding intolerance of uncertainty and symptom anxiety
00:18:00 – The PRT approach: Moving from overthinking to feeling safe
00:23:00 – Emotional work: Addressing fear, grief, and self-doubt
00:31:00 – Practical strategies to stop overthinking and retrain the brain
00:39:00 – Final thoughts & next steps for listeners
John: [00:00:00] Welcome to the PRT podcast 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. My name is John Gasienica, and I'm the Director of Clinical Research and Development at the Pain Psychology Center in Los Angeles, where I team up with medical schools, health care companies, And government agencies to conduct research and improve the treatment of chronic conditions with psychology.
Today's episode is one that I'm really proud of. You'll hear a session I conducted with a patient named Leslie, who struggles with not only pelvic pain, but also consistent rumination about symptoms and motherhood. No matter what symptom you're dealing with, or what life stressor you tend to think too much about, I'm very confident you'll find her journey to recovery both relatable and instructive.
That's because this session focuses on breaking the cycle of rumination. I can't think of a more universal issue in the patients I see than a ruminative [00:01:00] fixation on symptoms and their impact on day to day life. It's something that can absolutely derail progress, and yet so many people struggle with it because the best tools are not really that intuitive and can contradict some common ways recovery is taught.
Luckily, I have a brilliant clinician, Callie Klebanoff, joining me today to help me break down the tools that help disrupt rumination from mild cases all the way to the most severe. We'll lay out the PRT blueprint for recovery. And even show you how to incorporate other modalities that get at some of the deeper issues behind fixation and rumination.
But 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 the professional healthcare service. If you have specific medical concerns or questions, please contact your personal healthcare provider.
And let's meet my guest for today's show. All right. So joining me today is Callie Klebanoff. Callie is an expert therapist, [00:02:00] specializing in both chronic pain and couples work. Before forming her private practice in Los Angeles, Callie was the executive director of the Pain Psychology Center. Callie became a mentor of mine when I was starting my therapy career, and I still consider her a mentor to this day, as do a bunch of really talented pain therapists in the field.
Callie, I'm so happy to have you today. How's it going?
Callie: Thank you for having me and for that generous introduction. You may be surprised to hear it. I don't think so, but you're also been a mentor to me as we started to work together and collaborate. And, you know, I feel so lucky that we. Share in this work and just get to do stuff like this together.
So thank you for having me.
John: I feel particularly lucky because I'm interrupting the tail end of your maternity leave right now. And there's some synchronicity with this episode because the patient I worked with is a new mom and she's dealing with not only rumination about her pelvic pain, uh, but rumination just about all the responsibilities that come with [00:03:00] bringing a person to this world and having a family.
How did you motivate yourself to? Get away from those patterns of ruminating, constant problem solving to start taking care of yourself better when you knew that these old patterns had brought you so much success in the past,
Callie: I didn't abandon them. I don't think it's about abandoning them and changing your personal.
I don't really think it's possible. I think it's about being aware of them. I think that that is the ultimate superpower, actually, because with awareness, I We have the option to make different choices and we have options to figure out what we might need or strategies that might help us to pause and say, how do I relate to this differently?
This is now turning into something that doesn't serve me where I'm just cycling through anxiety and I'm putting all this pressure on myself and I'm in that familiar place of not feeling good [00:04:00] enough. And what do I need to actually feel safer in this moment? And that answer changes all the time. So I think a lot of people who struggle with chronic pain, you know, they want this kind of cheat sheet of answers of how to respond in this perfect way.
And so much of this work is challenging because it is actually about deepening your relationship with yourself to be able to find those answers. You hold them. But how do you actually kind of developing the listening ear for them?
John: This deepened awareness that you have that you've built that you work on is probably one of the things I look up to you most about.
I actually, I don't know if you remember this, but when I was an intern, you told this story about you were with a group of friends and you were telling a story at like a dinner party or something. And halfway through the story, you just started feeling really tired. You had like a little bit of a headache and you pause the story and you were just like, you know what? I'm too tired to finish the story. I don't really want to finish the [00:05:00] story. And you just stop telling the story. And I remember thinking to myself, like, either this is an absolute genius that I'm talking to, or, like, I need to steer clear of this person. And luckily it was a former.
Callie: Yeah, was I being, maybe I was being rude, I don't know.
John: But I think it's just like an example of When you're in chronic pain, you have this idea of like, I want to actually not feel these things, but actually building the awareness in your body so you can take care of them early before they escalate to these huge alarms. Seems like the most important part.
I'm really excited to hear your reaction to this client because I think that's part of the journey we go through is helping her build awareness. So why don't we check out the first clip?
The Conversation
Tell me a little bit about what this has been like for you.
Leslie: No, it's been really hard. It's been five years of, you know, on and off, but like really basically always on pain and, you know, [00:06:00] looking for answers and like going down rabbit holes and appointments and all of that, and then having some progress and then having setbacks and just the overall feeling of like. Think about how much better things could be like in my life if I didn't have this like issue, right? Which is obviously not a very productive way to think, but it's hard not to like go there.
John: What is an average day like what's today feel like to you?
Leslie: Well, a day for me, I had a baby a little over a month ago. So. My days, these days are like a routine of taking care of her, but I am constantly monitoring my symptoms. Um, and so that does not, like, I pretty much never have that off my mind completely. So, like, right now, you know, I'm sitting here talking to you, but in the back of my mind, I'm thinking about, like, okay, like, how is my pain level right now?
Or like, how is my discomfort and whatnot? [00:07:00] And that is pretty much constant and then so that what that does is also just it creates a bit of worry that I carry with me every day. Right about that. And is it going to get better? And is it going to be like this forever? And is it my postpartum recovery or is it my chronic symptoms or is it a mix of both?
So. And it kind of goes up and down. Like I'll have like hours where I'm like, you know what, I'm going to heal. And I'm actually, you know, I'm doing great with this mind body stuff and I'm going to get better. And then I have, you know, hours usually later in the day when my tiredness sets in, my anxiety kicks up and then I'm just like in despair and I like try and use my tools to get out of it, but it's hard.
John: So Callie, what's your first impression of Leslie in this clip?
Callie: Oh, I think she's so. Relatable. Truthfully, I think that what kind of speaks to me is this constant monitoring of her symptoms and the background of what she's doing while caring for her baby, like this kind of overwhelming cognitive [00:08:00] multitasking, and she's already at baseline because she's postpartum exhausted, and so I feel for her in that, and she's also taking care of this baby, which is all very new, and she's It's probably trying to figure out how to best do that at the same time.
John: What does the brain get so fixated on danger and discomfort and make you focus on that stuff? Um, whereas there's so much good going on around you.
Callie: Well, I do think that our brain has a negative bias. The brain is oriented towards survival. And discomfort can, can be a danger signal. It can be something that's telling us that we are threatened, that we have some kind of physical threat internally in our body, right?
So she's postpartum and she's like, Is this normal? Is this normal? The amount of times where, that I, you know, wondered whether something was normal that I was feeling, I can't even tell you. And so what can start to happen is [00:09:00] that we're actually having a trauma response. with our pain itself. How we're relating to it.
You've had pelvic pain, let's say, and then you feel something, just something subtle in your body and your panic can come up because you've had this pain in the past. All of those questions of is it going to get worse? Why is it here? What happened? Is it this? Is it that you may start to engage in pain? A lot of those kind of PTSD responses of kind of avoidant behaviors, preoccupation, anxiety, depression, and get swallowed into that hole.
John: So with pain repressing therapy, we want the client to feel safe. And as Callie was explaining, it's very difficult to, when you get into these cycles to find safety, find. Positive feelings, even find neutral sensations. So our first line of defense is to encourage the client to give themselves messages of safety and calm their system.
But a ruminative brain can sabotage this. So I usually like to check in with the client to see what happens [00:10:00] when they try to calm themselves down or when they try to focus on good things and let's hear what happens.
Some of the doubts that flood in when you try to give yourself messages of safety.
Leslie: Oh my God. Like that's all that comes in. It's like, no, you're not like, it just, I mean, with the pain, it's like, There's something wrong. Like you have this syndrome, this syndrome that can happen in pregnancy or like it's your mind body, which is absolutely screwed now because you're a mom and you're not getting enough sleep and you're so anxious about being a mom that is fueling the fear cycle and now you're never going to get out of it.
The list goes on and then pain aside about other things. Yeah. It's just like, well, how is it ever going to be normal again? Or it's going to be so long before you feel any sort of like normalcy again. Or a big thing for me too is like, is like, how am I going to survive the time until I get there? I know it sounds like dramatic, but like [00:11:00] my, you know, you see a doctor at six weeks postpartum, which for me at my appointments in like a couple of weeks, two and a half weeks.
And I feel like at that time I will not only be feeling better. My logical brain knows I will be feeling better. And also that I'll be seeing a doctor who can like, check me out and just make sure everything's okay. And so my logical brain is like, that's soon. But then when I'm like doubting, I'm like, I can't, I can't last two and a half weeks.
How, how am I going to do that? Like think about these days and just how monotonous they are and like, what, and then, and then it's panic. So yeah. So that's what, that's what comes in when I try to self soothe sometimes.
John: So this is exactly what we want you to pivot to now, because the last thing we want you to do is just get stuck in the weeds.Cause you're going to give yourself messages of safety and your brain's just going to go bat them down. This is rumination.
Leslie: Yeah.
John: And so once you've noticed, okay, I've gone one round, I've tried to get myself safety and now my brain's fighting back. Okay. The game's over.
Leslie: Yeah.
John: And this is what we call getting out of the weeds.
Leslie: Okay.
John: [00:12:00] Acknowledging that what you're worrying about is not the issue. This is just uncertainty. It's just an intolerance of uncertainty. Everything you listed is your brain bumping up against some question that can't answer and making you feel very unwell. And what you want to do is you want to find the answers right there, right?
Like you want to schedule the appointment to bring it up, or you want to think about all the ways that you could raise your daughter and try to problem solve ways to make sure that there's no problems ever. Yep. As long as you're doing that, you're feeding into the compulsion because you're telling your brain, you're right.
We can't survive on uncertainty. We need certainty right now.
Leslie: Yeah. That's so true. That's like why I Google stuff. Yes. Even stuff I know the answer to because I need to see it written somewhere. You know? Yeah. That's really resonating. Wow.
John: Callie, how much time did you spend Googling when you were a new mom?
Callie: Lot of time. [00:13:00] A lot. Um, you know, this is the thing that's so hard, specifically pertaining to kind of pregnancy and babies, is that you look something up and it can range from like meaning nothing and being absolutely normal to literally being something that kills you.
And you're tasked with deciphering where you stand and how you feel on that extreme spectrum, which is very challenging and emotionally chaotic. And I actually think this is the hardest part is I'm in this rogue state of anxiety where I can't reason with myself to then becoming aware and grounding and feeling safe. And oftentimes I find before we can decide to not give into that compulsion, it requires a slowing down and validating the fears and connecting to what we actually need in that moment.
John: I'm so glad you brought this up because I think this is maybe the single most confusing thing. In mind, body therapies is that we're constantly asking clients to seek safety and seek a sensation that they're going to be [00:14:00] okay, but when it does cross the threshold and rumination, where it does become compulsive or when it does really show an intolerance of uncertainty, we actually kind of want to go the other way, right?
This is why some of the OCD therapists call these methods paradoxical. You would think that you just want to get as much safety as possible, but as we all know, when we Google things for three hours, sometimes we come away from it feeling even more jittery than we went into it. What I hear you saying is it's not just seeking safety.
It's also questioning what's going on in your body at the moment and figuring out what do I need emotionally on top of what do I need logically? Is that fair to say?
Callie: Yeah. And I think actually what you're, what you're touching on, which I think is important is that when you actually stop and validate that question, you know, you have an opportunity to start to notice what am I feeling in my body outside of just the yell of the pain or [00:15:00] that specific symptom. Usually that, that really strong symptom is secondary and there are actually more subtle symptoms, sensations underneath of anxiety. And I think you're absolutely right. We want to go towards those.
We actually want to use the awareness of, Oh, I'm in panic mode. Okay. I have the options to handle this however I want. I actually have control here, but first where am I at and how do I find that in my body to even start to see this connection between this cognitive process? That's. That may be creating anxiety and the anxiety we feel a big part is intellectually understanding how that rumination might be negatively affecting you, but also then actually having the experience of seeing and feeling the impact of that rumination on your body, [00:16:00] because Again, we're in that rogue state.
We're all just we're just feeling bad, right? But when we can start to see the connection between our mind and our body in these moments, it can really intrinsically motivate someone to say, Oh, I see this connection. I don't want to do that anymore. I see how bad this makes me feel. I can feel it.
John: Uh, it really sets us up for this next step, but before we get too far ahead of ourselves, I just want to explain in that last clip, step one was resisting the urge to solve all the problems in the moment and simply admit I'm very intolerant of uncertainty right now.
And the reason we do this is we break our obsession with these logical details. As Callie says, like we get out of this rogue state. This idea of intolerance of uncertainty comes from therapies like ERPS and other obsessive compulsive disorder therapies. So if you have OCD, this is very compatible with your treatment.
And so what pain reprocessing therapy tells us is the next step is to bring our brain out of our thoughts and into our [00:17:00] physical body. As Callie was explaining deep in this understanding of how much discomfort this rumination is causing us. So let's see how that works.
And so a lot of OCD therapists call this taking a level up of abstraction, and it's just a complicated way of saying getting out of the weeds and realizing this is about uncertainty. This is not about what I'm thinking of. And your brain's not going to like this. It's going to be like, no, this is the most important thing in the world right now, and you need to solve it. And so you can just take a moment and say, okay, this is about uncertainty. And now we want to get very, very curious. And so this is the exposure element of it. This is the uncomfortable part of this type of work. Is when those doubts are coming in, taking a moment, just feeling them in your body like right now, we've been talking about some of these uncertainties.
Where do you know that you feel on? Well, right now, where do you know that you feel anxiety? If you just do a little scan of your body,
Leslie: like my chest and my a [00:18:00] little bit of my stomach. Good. If it's something really intense that I'm worried about. Like my stomach will drop in that moment when the worry comes in and then usually like as I ruminate, it's like just kind of a tightness in my chest.
John: so I wanted to pause the clip there because we see the client find the sensation in her body and. Typically at this point where, okay, you've successfully gotten the client out of their thoughts and into their body, you have them anchored into their sensation so that they're no longer thinking. Where do you take the client at this point?
Callie: Well, I think that she's, she's somebody who has great language and awareness of her body, actually. Like, she is somebody where one, you just asked her to kind of pivot her attention. She was really able to do it, um, which is really helpful. And sometimes individuals [00:19:00] have a harder time getting there, right?
And so if they're having, if they're struggling a little bit more, I get them to start breathing, first of all. And what I actually start to ask them questions around where the breath feels most enjoyable, where does it feel neutral? And when do they feel like they want to rush through it that can start to give even just a little bit of language to how they're experiencing their body as they're grounded and still just breathing, right? In her situation where she's already connecting to some of those feelings, our goal would be to have her be able to experience these feelings without feeling like she needs to run from them.
John: Mm.
Callie: To experience them as being safe, and I would have her start to kind of do some light somatic tracking, breathe into these sensations that she's noticing, notice if her brain is trying to pull her away to [00:20:00] cognitive processes, come back whenever she's aware of it, and Just notice what happens with me there with her where she can feel a little bit safe that she's not alone in it She's not gonna get swallowed up and where I can help her notice what happens When she is sitting in these really subtle sensations of her anxiety and then she can start to see this ruminating process You know probably take hold I remember that used to happen to me when I started to really practice mindfulness is that when I would start to Calm down when I would notice this like very pleasant hum From just being with the sensations of anxiety and not running from them.
I would be like, I should write this down. What just happened here? You know, and something would come up where, where I was just like, Oh, okay. And then I would feel that, you know, a little bit of that butterfly in my stomach. This anxiety churning a little bit to kind of bring me back to this familiar state of [00:21:00] rumination.
John: So what Callie's describing is somatic tracking. It's one of the foundational tenants of pain repressing therapy. And this is where we eventually want our clients to get to. I do this all the time. This is literally building their skills of tolerating uncertainty. You're bringing them to the. Discomfort in their body and you're teaching them.
Oh, I don't have to run from this. And so to just recap what we've done so far, step two, which you heard in that clip is to find the sensation of anxiety you get from uncertainty in your body. If you find with mild rumination that you're able to use somatic tracking or positive messages to help this sensation relax and dissipate, or just become tolerable and fantastic.
You'll notice that you've sued these sensations and your brain slows down. And you're able to get back to your day. If it works like that, fantastic. There's no more need for complication. And this really is most of the work that people do. But over time, if you feel that the sensation in your body does not want to relax, it [00:22:00] doesn't feel tolerable, or you jump right back into overthinking, it often means there might be some emotions that are keeping your brain on edge.
The strategy now is to explore what emotion might be lingering below the surface. That's keeping you in this. Agitated state. Pain reprocessing therapy is an amazing blueprint because it sets the track, but it also allows you to get creative and pull in some other compatible therapies during these steps to get at the deeper issues.
You'll hear in the next clip, I pull in some emotional expression work from Howard Shubner and Mark Lumley and a therapy called EAET. And I also use some Jungian shadow work to just help attack this rumination at a deeper level. It's actually a lot less complicated than it sounds. And I'll break down the steps in the next section.
Good. So we're going to take you out of your thinking brain right now and just close your eyes and go right into that sensation in your chest. Okay. And the first couple moments here are going to be uncomfortable, but all I want you [00:23:00] to do is just work on slowing your breath down. Imagine like you can push this sensation out in front of you.
Not to get rid of it, you can't do that, but just get a little separation from it. This anxiety is not me. This is just a piece of me. It's very afraid of uncertainty. And I want you to look at that anxiety in front of you and given an image that looks like you, what's an embodiment of an anxiety that looks like you?
What does she look like?
Leslie: Well, I actually just like picturing myself as I am right now, looking like, but like, With this, like, existential crisis look on her face.
John: Perfect. And I want you to look at her and just ask her, what are you afraid of? Just see what she says.
Leslie: Um, your pelvic pain lasting forever and thus like ruining your life. All the things that can come up with like raising a baby and how every day there could be a new challenge and nothing's ever guaranteed or certain in the moment. Like it could change. At the [00:24:00] drop of that, um, all the worries that come with just like then parenting, like from a baby onward and how that might like impact your life and your ability to like reclaim what you had before you were pregnant.
And also when I haven't brought up yet, but I just thought of is sometimes I will ruminate on things that have already happened. So events that have occurred that have been ruined because of my pelvic pain, let's say, or how hard my pregnancy was and just ruminating on that and wishing it were different, are the things that are top of mind for her.
John: What's been ruined by your pelvic pain?
Leslie: Some vacations, um, and, or like special events, um, even like silly things like weekend dinners and things like that. But. Um, and just like in, in general, like, I mean, I've been able to live through it and have a very full life, but it has kind of been a cloud over a lot of things, you know, when you're managing pain. So there is a certain amount of like grief that I [00:25:00] feel.
John: Ask her to tell her, tell you about the grief.
Leslie: It just feels like kind of like a nausea almost. Just like It's kind of like when you really regret something or, or you feel like you missed out on something. Like it's actually kind of like the feeling when you're like running to catch a bus or something and you miss it or like just miss buying concert tickets or something. It's like that times like a million thinking about the things that are like a vacation or whatever that pelvic pain is like gotten in the way of. Is, is how that manifests
John: and do you feel sadness coming up? Do you feel any sadness?
Leslie: Oh yeah. Yeah. There's, yeah. It's a lot of sadness surrounds that for sure.
John: Ask that piece of you to express how sad she feels. What's this been like for her? I can imagine it's been exhausting.
Leslie: Yeah. It's been really, really exhausting. Really isolating. Really, really, really hard.
John: Yeah. [00:26:00] And just let this piece of you who's feeling very, very sad right now. Know that of course she feels sad, that you get it.
I want you to imagine just putting your arm around her and letting her know, of course this has been horrible. I can imagine it's been so lonely. I'm going to ask her, what does the loneliness felt like?
Leslie: Just kind of like hollow sometimes and like empty.
John: And I want you to just see if all the energy that you put into fixing things and googling things and figuring things out, if you can just pour that into her right now, and let her know I'm so sorry there wasn't somebody there to take care of you in the way that you needed to be taken care of. And that's not an indictment on anybody else, and just let her know. Instead of trying to fix the external world, I'm going to turn inward toward you going forward. You are my priority even more than my daughter as crazy as that is to sound and how does that feel? It feels nice [00:27:00] Yeah, it's supportive And I want you to ask her to see if is there anything that I can tell you Anything you need to hear from me that would make you feel better right now.
Leslie: I think like having like hope that That like the support will be there moving forward. You know what I mean? Like we're leaving that She will get that support that she needs like.
John: Moving forward. So see if you can make that commitment. This is going to be my priority. And let her know. I know that I'm not going to be able to prove to you that I'm going to be there until I just start doing it, but I want you to know that you're my priority going forward and that you're allowed to be here through all of this.
You're allowed to show up at night and feel scared. You're allowed to doubt. You're allowed to feel sad. You're allowed to feel isolated. And I'm going to bring you along this journey with me. And how does she feel to hear [00:28:00] that?
Leslie: It feels nice to, to say allow. Cause I think so often she's met with like, no, don't like, no, this shouldn't be happening.
I need to like fight against her, you know? Which doesn't work. It's not helpful. And so I think saying like, no, actually, like you can be around and you can express all of these things whenever you want really is, is kind of takes the pressure off a
John: bit. And isn't that how you'd like to be? Parented.
Leslie: Yeah.
John: Definitely.
Callie, one time you told me that having children is devastating, but in like the most beautiful way possible, and it completely upends your life. It's amazing. But all these changes that go on is just like pure, beautiful devastation. How do you make sure that you're connecting to what you [00:29:00] need and what your emotions need while confronted with a devastation like that?
Callie: Well, sometimes you can't. You know, I think that our goal should be to course correct, you know, I think that a lot of times people feel very anxious just about the idea of kind of perfect attunement with themselves. And I think to take that pressure off and to lower the standard a little bit, you're not always going to perfectly.
Balance yourself. But our goal is to move from that state of hypervigilance around feeling things in our body to just a real sensitivity towards ourselves. And being able to kind of find these more subtle cues because again, pain and those symptoms are often much, they're often secondary to more subtle cues in our body [00:30:00] that can tell us that we're, we're off kilter. And so if we can become sensitive and start to pivot based on what's going on, right. And be able to say, okay, um, maybe I need to ask for my husband's support a little bit more tonight because I'm. I'm moving towards empty in my tank or I would really love if we just ordered in dinner and I didn't cook a perfect meal for my family and we can do these really subtle things.
It doesn't need to be this kind of grand spa day of self care. It can really just be something small that starts to move you a little closer to giving your nervous system a break. And what I even ask people when I bring this up is, did you just feel anxious when I said that? When I, when you started to think about how you might need to either call on other people or lower what feels like a standard of [00:31:00] care in whatever you're doing towards somebody else, um, did you start to feel your anxiety start to To turn.
John: I've really like what you're getting at here because I remember the last time we talked about rumination. You made some comment about how like we can't talk about rumination or even parenting without the sense of guilt. Like when you have patients start being kinder to themselves and actually not cook that meal and order in or ask their partner for help.
How do you handle the guilt that comes up from them? The other piece of your brain that says like, no, this isn't how a great mother does it, or this isn't how a perfect mother does it.
Callie: Pause because I'm, I still struggle with this sometimes, truthfully. I'm like, I'm like, how do I do this? Um. It's kind of the classic, you know, put the oxygen mask over yourself before you put it over somebody else. Like that is what's going to help you be able to show up in the way that you want to. And in these little moments where you're unsure because you took a little bit of time for yourself or [00:32:00] you weren't able to do it perfectly, a lot of this is about reckoning with living within your capacity.
So much of this work is about people are living by these kind of idealized value systems that they're trying to live up to. And there can be a huge grieving process of realizing like, what is my capacity? How can, how do I thrive, right? We first need to just get really honest about that. And then dealing with the emotional counterpart of maybe disappointment, or is that enough, or what does that mean about me, and the feelings of shame that can come up.
A lot of the work that you are just doing with this client is really helpful to support for that. It really starts with being able to care for what our capacity is, and be able to trust. That it is enough and to build some exposure around that and to build some compassion around that you can [00:33:00] see When she pivoted she had this beautiful Natural ability to be there for herself and she could tune in to how supported she felt by herself To the extent of saying I just don't want this to go away You know, I I just want to always feel this supported but it was by her own skill set It was inside of her.
And if she's able to do that with herself, she sure as hell giving that to her child.
John: 100 percent and just to run through the steps of this last clip, step four in this process is to visualize this sensation of discomfort as a version of you and ask it, what is it afraid of? Get really curious. Ask follow up questions. What are you sad about? What are you angry about? Step five is to provide comfort to this emotional piece of you as your brain emotes. Give it all your love. Imagine giving all the energy you give to fixing your problems. Instead, giving it to the piece of your brain that's in [00:34:00] pain. And then the final step is just to keep repeating these steps.
Keep repeating steps four and five. Keep asking your emotional brain to emote. Keep providing that comfort and companionship. Not only will you feel comfort, but your top, your brain will tire out. You'll feel that spinning motor of rumination begin to slow on its own. And usually at this point, I'll check in with the symptoms that the patient is presenting with Leslie.
It's her pelvic pain. And I'll see if they're still present and help the patient use some of the tools now that they're feeling more relaxed and at ease. But as you'll see, sometimes we don't even have to go into that process.
What I want you to do is see if you can just bring your awareness down to wherever you're feeling discomfort before and just see what you're feeling.
Leslie: I actually feel okay right now.
John: And how does that feel?
Leslie: Really nice. Create a, you know, a little bit of in the back of [00:35:00] my mind, or I guess with her, there's like always a little bit of panic or uncertainty of like perfect when the last or whatever, but I'm trying to allow that to exist while also, you know, being able to feel okay in the moment.
John: So this is the pattern that's going to continue for a little while when you feel good like you do right now, there's going to be this. Oh, God, is the other shoe going to drop feeling. I want you to notice where you feel that in your body. Where do you feel that little anxiety of Oh, my gosh, I hope this lasts?
Leslie: Like in my chest.
John: So go back there. Go to your chest, push that sensation in front of you, give it a visual that looks like you. Maybe it's a nervous version of you this time and just ask her, what are you afraid of right now?
Leslie: I'm afraid of not doing this correctly and messing it up for myself when, when I hold the ability to make myself better. And I know that I do, but I mess it up and I can't get there. [00:36:00]
John: And let her know, of course you feel that way. It's so natural to doubt yourself like that and just let her feel scared for a moment. This is not all of you. It's just a piece of you. This is the basis of imposter syndrome for anything. Yeah. And let her know it's okay to feel that way and relate to her and be like, I know how this feels.
Have there been times in your life where you felt like an imposter that you, you weren't good enough?
Leslie: Yeah, totally. I mean, professionally, I feel like that's something that a lot of people struggle with, myself included. Right. Yeah. So I can definitely understand that.
John: And again, just feel yourself every instinct you want to just fix this right now, just or all that energy of love into this piece of you, but your arm around her and say, it's okay to be scared. And when you're scared, I'm going to take care of you. And now you don't have to be this, like, incredibly optimistic, almost toxically positive person to get out of pain. You can just take care of these fears.
Leslie: Yeah. And how does that feel? [00:37:00] It feels really nice. Like I said, it
John: keeps the pressure off. Yeah. And so just spend a few moments, just breathe into your chest now.
Notice how it feels when this emotional piece of you is catered to, and just see if you can enjoy it, this communion between you and this other piece of you. It's no longer this antagonistic relationship. This is integration. And you string a few days like this in a row, a few weeks like this in a row, and your nervous system calms down just like that.
Why do you think pain can go away by simply dealing with rumination like this or by simply feeling comfort? How does that process work in your brain?
Callie: Well, she is soothing her nervous system and pain is a danger signal. So she's feeling less threatened. You know, she is. [00:38:00] Connecting to her emotional self, she's providing herself comfort, she is feeling very heard and validated, and that she's in trusted hands also, both within herself and with you, and so it's really a barometer of how safe she feels.
John: The pain will come back when they've had chronic pain for so long, the brain doesn't give up the fight that easily, but when you start stringing Moments like this together all of a sudden that predictive coding mechanism kicks in where your brain starts predicting Oh wait, I can exist in my environment without pain And in fact, that's what I'm gonna start predicting and that's when people don't really have to work on the tools anymore Because their brain starts predicting when I'm in this environment I feel safe and I'm gonna be okay
Callie: Absolutely, and something that I say to Clients all the time is, you know, I used to struggle from migraines and headaches and amongst some other things too. But [00:39:00] have I never gotten a headache again after I started to get better? No, I get them once in a while. But this brings me back to that kind of course correction.
Now, instead of going into that place of like, oh, now is this going to start happening every day again? I've built enough trust that I'm going to show up for myself. My brain doesn't feel as panicked when I'm off kilter and I am running at a million miles per hour and I'm putting other people's needs before myself when I'm not attuning to myself.
And when I start to feel certain signals of discomfort or that my system is kind of run down or I get a headache. I kind of know intuitively at this point, what do I need? And this prescription can be different for everybody to start to find and rebalance again. And I'm going to give that to myself. And that builds this trust that you are safe.
Even when you are thrown off, it's not a failure. This happens to everybody. How do I get back on course?
John: I [00:40:00] love that. What you just said, because in this clip with Leslie, we didn't solve any of her problems. We didn't prove to her that her daughter is going to grow up healthy. We didn't change anything in her external world, but she learned that she could feel safe even when there was problems all around her. And I can't think of anything better to give to a client than that sense of I'm going to be okay even before I have the answer. Absolutely. And so let's see how Leslie plots her strategy going forward.
Leslie: I guess like my question for you is like in the moment throughout the day, right? When these thoughts are in rumination cycles are coming up, you know, you're not gonna sit and have that moment of visualization, right? So like, what's the shortcut, like what, I guess, what should I do to get this feeling that I [00:41:00] just had? You know what I mean? Without you, without this, like, you know, this moment that we have or this hour, um, how can I get there on my own?
John: I think in the beginning it's carving out time for yourself. So I, I'll leave you a meditation where you can be guided through this.
Leslie: Amazing.
John: so that you can get on a more consistent basis of your brain getting to the, like the depths of actually what's wrong, what I don't want you to do is feel like you have to kind of be constantly be doing these exposures because they're exhausting. Like, even after we're done today, you're going to be tired, right? So when you have time to do them, do them with intensity.
And when you don't have time to do them, just live your life the same way you've been living your life. Yeah, because I don't want you just thinking about this constantly just because it becomes another source of rumination where it's like, am I doing this enough or am I doing this well enough? If that makes sense.
Leslie: Totally. No, it does. You're right. It's like with. With any tactic with like, mind, body medicine, I feel like that [00:42:00] is actually is another thing I probably should have brought up. That is part of my rumination, right? About like, you could be doing all these things and I ended up doing none of them because it's like, you should be journaling.
You should be doing this somatic. Tracking and breathing and your vagus nerve or, you know, and I'm just like, open my Instagram and it's like, um, so it's really, I'm happy to hear you say that, like, I don't actually need to be worried about it like regularly. I can just live my life and then dedicate time aside to this work.
John: What I would suggest is when you're in a, uh. Mental state you are like you are right now where you're thinking clearly and you feel relaxed set a number say like I'm going to do this four or five times a day or I'm going to do this five or six times a day and then actually mark it down on a piece of paper. Oh, I hit these. Five times, and now I'm done now. I can go cook food or hang out and not worry about this stuff. Um, and it just provides you a little bit of structure that [00:43:00] that makes your brain feel safe. How does that feel?
Leslie: That makes sense. And I, I love a checklist.
John: How do you give out homework to your clients, particularly those clients who you feel like might over ruminate or might overdo it with homework?
Callie: I think really simplifying it. So one, I'll maybe give one thing for that. Person to focus on that week, right? If I'm seeing them consistently based on what our session was, I might just really simplify it.
So depending on how much they're taking in from what we have done, I might say, I really just want you to really notice. And become aware that you're ruminating, then just kind of check in with your body when you become aware. And I want you just to feel really proud of yourself for your ability to have kind of gotten out of that rogue state and become [00:44:00] aware.
So I might really start super small actually and give them one task and then build on it and be able to say, Hey, if you can, if you can remember to maybe then move to another task of. Checking in on how you feel doing a little bit of somatic tracking and I'll give them something really, really simple of just find your anxiety, breathe into it.
Maybe then I ask another question, just ask yourself what you need, you know, just really simplify it and then notice how you feel. And then really helping them to feel safe that they're really investing in a process of recovery. They're investing in individual therapy. They can come every week and feel like they get a really good work out of this visualization of taking care of themselves, of sending the message to their brain that they're safe when they're exposing them to their symptoms, to their cognitive processes that create anxiety. They're going to start to internalize that and start doing it automatically [00:45:00] without even thinking about it so much by simply being in therapy. So I want them to start to build that trust.
John: You've given so much good insight tonight. And I just want to check in if there's any final thoughts you have to the listeners who are dealing with this type of issue or any chronic issue.
Callie: I think what I want to reiterate, which I've probably already said is that when you are a caretaker or a parent in pain, we are conditioned to believe that.
Each choice that we make or are forced to make has this domino effect on our life, our children, on how we're going to feel. And that's a lot to hold. And so just throughout this process, just connecting with how challenging that is and how much that is to hold and feeling like you have enough space to give some compassion your way of just that you're navigating it the best you can is going to take you a long way.
And then all this other stuff or extra details that you can add into it, which is really important to do, [00:46:00] but really stopping for a moment to see how much you're holding and how tremendous it is while you're going through this huge life change. And while you are really doing this extra work of caring for somebody else, it's pretty incredible. And so trust that you are just by thinking about these things, probably on the right path.
John: Well, thanks so much for your time today, Callie.
Callie: Thank you for having me. This was fun.
John: Thank you for listening to the PRT podcast brought to you by the pain reprocessing therapy center. I want to thank our guest Callie Klebanoff for joining me today. You can find her website at Callieklebanoff. com Finally, I want to give a special thank you to Leslie 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 johng. therapy, where I answer questions and provide information on the tools we cover in the episodes. Thanks again for [00:47:00] listening.