Host Daniel Lyman is joined by Dr. Mark Lumley, founder of Emotional Awareness and Expression Therapy (EAET), and Christie Uipi, psychotherapist and co-developer of Pain Reprocessing Therapy, to discuss three real patient cases: vestibular migraine and dizziness, chronic back pain with nighttime flare-ups, and migraine with uncertainty about neuroplastic diagnosis. Together they explore how emotions, conditioning, and the nervous system intersect — and what treatment might actually look like for each person.
In this episode, Daniel Lyman is joined by two of the leading minds in mind-body medicine — Dr. Mark Lumley and Christie Uipi — for a candid, collaborative case discussion unlike anything we've done before.
Dr. Mark Lumley is a distinguished professor of psychology at Wayne State University, co-developer of Emotional Awareness and Expression Therapy (EAET), and one of the world's leading researchers on mind-body therapies for chronic pain. Christie Uipi is a psychotherapist, Executive Director of the Better Mind Center, a key contributor to the development of PRT, and a chronic pain overcomer herself.
Together, the three work through three real cases submitted by listeners:
Jill from Canada has lived with vestibular migraine and Persistent Postural-Perceptual Dizziness (PPPD) for six years after a lifetime of people-pleasing, boundary struggles, and pushing through stress. The group explores dizziness as an "escalation symptom" — what happens when the body has been ignored for too long — and how unexpressed emotions may be driving the nervous system's loudest signals.
Ben from Edinburgh has had chronic lower back and hip pain for 30 years. His herniated discs have largely resolved, but the pain remains — and it's worst in the middle of the night. The group digs into conditioned pain responses, the psychology of sleep and pain, and why rigidity in daily routines might be keeping the nervous system stuck.
Katerina has suffered from migraines since age 20 and is now dealing with up to 20 migraine days a month. She wants to know: is migraine actually neuroplastic? Can you treat it like neuroplastic pain if there's an underlying disease process? Dr. Lumley shares findings from a recent randomized controlled trial showing a 40% reduction in migraine frequency with group EAET, and the group unpacks the tension between traditional migraine management and a neuroplastic approach.
This episode is a masterclass in collaborative clinical thinking — and a reminder that no matter how long you've been suffering, there are still doors worth opening.
Neuroplasticity Case Discussion: Dizziness and Migraine
Host Daniel Lyman_1: [00:00:00] Okay. I am so [00:01:00] excited today to be joined by Dr. Mark Lumley and Christie Uipi. And as I've discussed, we are going to be talking through some case examples and, giving you our perspectives on the different ways that we would treat each of these patients. But before we do that first let me introduce them.
I'll start off with Dr. Mark Lumley. He is a clinical psychologist who comes to us from the academic world. He's a distinguished professor in the psychology department at Wayne State University in Detroit, Michigan. Mark is one of the world's leading researchers of mind body therapies for chronic. Pain.
And along with Howard Shubner, Mark developed emotional awareness and expression therapy and uh, has shown its effectiveness in many clinical trials. He also has been a key player in the testing of PRT and pain reprocessing therapy. And Mark also does a lot of teaching, including training doctoral psychology students in psychotherapy and training health professionals in EAET.
And I will also add, I think Mark might be the nicest man in the business here. So I'm so glad to have you here, mark, thank you so much for taking time to do this.
Mark Lumley_1: My pleasure to be here. Thanks,
Daniel
Host Daniel Lyman_1: Awesome. Okay, and next up we have [00:02:00] Christie Uipi, who is the executive director of the Better Mind Center, and she is a psychotherapist specializing in the treatment of chronic pain, anxiety, and depression.
Christie has also recovered chronic pain patient herself and the healing process so profoundly transformed her quality of life that she decided to dedicate her entire career to supporting others through their recoveries. Uh, Christi is a key contributor, was a key contributor to development of PRT, and Christi continues to shape its e evolution through ongoing research.
She lectures nationally on PRT and other psychotherapeutic interventions to treat chronic pain and is committed to cross-disciplinary collaboration between mental health and physical medicine. Christy also hosts the like mind like body podcast on Curable. And also I will add, Christie is a dear friend that I've worked with for a long time now.
Christie Uipi: So happy to be here with you both. Thank
you Daniel
Host Daniel Lyman_1: Thanks for taking Thanks for taking time outta your day to do this. I'm really excited. as I said to you before, what we're gonna do is I'm gonna read this first case and then we're gonna spitball. We're gonna throw out all the different ideas, all the different things that come to mind from reading this case about the ways that we would [00:03:00] treat it.
And I'm really stoked to have, we have people, two people here that are the founding members of different therapeutic modalities.
Host Daniel Lyman_1: Now, this is the PRT podcast, so it's great that we've got Christie here
Host Daniel Lyman_1: who is one of the founding members of PRT.
We have what I consider like a close cousin or even a brother or a sister, treatment, emotional awareness and expression treatment.
Host Daniel Lyman_1: We've got Mark here who was the founder of that. So between these two modalities, we can put our heads together and think of what are the best things that, what are the best ways that we can treat our patients? And that's that. Of course, all of us are trained in other stuff too, so we throw out ideas from other modalities as well.
Host Daniel Lyman_1: Alright, any questions before we get going?
Christie Uipi: Excited.
Host Daniel Lyman_1: Okay. Excited Mark's giving me the thumbs up. Are we nervous? I hope we disagree. What if we disagree? Won't that be exciting?
Christie Uipi: Great. even better.
Host Daniel Lyman_1: Great. Okay, so just as a reminder, these are cases that people have emailed into me saying that they are open to having them on the podcast.
The names have been changed when they were asked to change. Um, but let's go ahead and dive in here. So this is Jill from Canada who's dealing with [00:04:00] vestibular Migraine slash Triple
pd, Here's what
she wrote in, I have been diagnosed with vestibular migraine and Triple PD.
When I was 55 years old, I woke up with the sensations and have now been living with them for over six years, and I've been able to work since the onset. So the main sensations include persistent dizziness, head and neck pain, light and sound, and screen sensitivity. I see a neuropsychologist monthly. I've read the Way Out.
Joined the Curable app, have tried all sorts of traditional and non-traditional treatments, including acupuncture, injections. Botox she wrote, sadly not for wrinkles. I have trialed over 16 medications, seen seven neurologists, ENT, and over 10 and 10 other types of medical professionals. I have been told.
We don't know what to do with you and you may never recover and just go cuddle with your grandchildren and you'll be fine.
I live in Canada, but was able to see a neurologist in the US virtually who specializes in vestibular and migraine disorders, and he made the diagnosis just a few months ago. It has been a very long journey with lots of tears.
I understand that my nervous system plays a role in this, and I'm starting to talk to myself about being safe and practicing self-compassion. Before the [00:05:00] onset, I led a very full and busy life Working part-time. Though I never set boundaries because I was trying to prove I could meet every deadline. I was bullied at work.
Yes. At 55 years old, I had just hosted two daughters weddings over two consecutive summers. It was super stressful, but the fun part was dancing at the weddings. And still had one adult son living at home, the youngest child, always cooking huge meals for family gatherings. Was a people pleaser, but I didn't recognize it at the time and was very physically active, running, doing Pilates and attending Orange Theory regularly.
I didn't know how to rest or take time for myself. I am also married to what, uh, what I call a workaholic, but my husband doesn't like that label. All right, that is Jill's summary. What are your first impressions here, Christie? I'm gonna, I'm gonna ask you to go first, if you don't mind. What are your first impressions?
Just reading this again, no wrong answers. What do you, what do you what? What stood out to you?
Christie Uipi: First, I speak broadly to dizziness and its associated sensations and experience. I don't know if there's any research on this. Specifically, maybe Mark would know, but I consider dizziness a, an [00:06:00] escalation symptom. I've that a lot with my patients, and by that I mean they've probably had a number of other attempts.
Their body has likely made a number of other attempts to slow them down or get their attention or ask them to ease up and due to their, um, perfectionistic tendencies or the pressure that they put on themselves or the expectations that they have on themselves. They've overridden those initial signals and then dizziness steps in as an escalation symptom to say this one, you're not going to be able to work through.
It's different from a lot of the other symptoms that we work with.
Host Daniel Lyman_1: Yeah.
Christie Uipi: Pain and other sensations are awful. Do not get me wrong. And a lot of our clients do find a way to quote unquote push through. They can still drive. They can still work with accommodations. Not everyone, but a lot of people don't think that's the case.
Most of the time with dizziness, I think causes a. Full or close to full life. Pause, stop, reorientation moment. So that's the first thing that stood out to [00:07:00] me is, is this, is this an escalation symptom? Did we miss some signs along the way? And what are we grappling with at this point? If that's the case.
Host Daniel Lyman_1: So maybe what you're saying is before the dizziness came on, Jill might have been dealing with, uh, high anxiety, or maybe she had panic attacks or maybe she had, um, back pain or something like that. Uh, but those were those signs or those symptoms were ignored and then things escalated and got worse to dizziness.
Host Daniel Lyman_1: Is that what you're saying?
Christie Uipi: That's what I'm curious about, especially since she mentioned she has some awareness that she tends towards workaholism. She knows she struggles with boundaries, so maybe she had some indications that her stress levels were high.
Host Daniel Lyman_1: Yeah. totally. I love that. Mark, what are your thoughts? Initial impressions here?
Mark Lumley_1: So my initial thoughts were, um, I had a little pause when I saw vestibular migraine and this triple pd. Uh, I thought, okay, is this any sort of unusual, special, uh, you know, medical type of symptom that we need
Mark Lumley_1: to be careful with? But she's been worked up like crazy by all sorts of physicians. So I felt quite comfortable saying, what's going on here is neuroplastic.
Host Daniel Lyman_1: Yes.
I
Mark Lumley_1: was, Christie's Comment about the, the purpose of a symptom, like dizziness. Um, you know, all these [00:08:00] symptoms tend to, uh, get a person's attention and pull them away from something active. Pain. Does that, dizziness, does that fatigue, does that it sort of impairs their ability to engage fully with life or with their emotions and relationships.
And I love what you're saying, Christie, which is, it seems like the, her dizziness serves a purpose to, uh, to a strong message from her brain to stop, to pause. You can't do all these things. Um. Which leads me to the question, what is it that she ought to be doing? She has a long list of OTs here. Uh,
she has a
list and you know, her list of things that she's been doing in the past half, you know, half decade or so.
The work, alcoholism, the planning, these weddings, the, you know, uh, people pleasing all over the place. The doing all the active running and Pilates and doing everything else. Um, it's, you know, there's a, there's clearly a part, I suspect, a part of her that is, uh, saying, how do I stop doing this? How do I say no?
I, um, pull back and if what I didn't hear in her, in her statement was any sense of assertion or anger or a part of her that wants to say, I object to all this stuff I'm supposed to be doing, I [00:09:00] ought to be doing. And, uh, as Christie's hinting at here, the notion of, uh, if she's not gonna say it with her words or her behavior, her symptoms will do it for her.
Host Daniel Lyman_1: Yeah. So what you're hypothesizing here is that she's got some strong feelings about all the things she ought to do or the circumstances in her life, and maybe she's not fully allowing herself to feel them. Is that what you're saying?
Mark Lumley_1: Feel and express. I there's a sense of passivity. She's going along with all these things in her life. I'm supposed to, uh, you know, even. I, I had to host two daughters weddings over two consecutive summers. It was super stressful. Stress is such a vague term. Um, but the fun part was dancing at the weddings.
She quickly moves away from whatever the stress was about having to host all of these weddings to, it was nice to dance.
Um
I'd wanna take back, say, tell me about the stress and what was the feelings behind that and what did you wanna say and do you know?
Host Daniel Lyman_1: I love, I love that comment and I, I'm really glad you brought that up because even when I was reading this initial email, I thought, oh, it sounds like she's trying to, people please me reading this by like, making me smile at her, like laugh or dancing at the wedding. And, you know, talking about how what she like, like fun she has with her family and how much she loves her family.
Or even jokes about her husband not loving the term workaholic. Um, it just felt like she was trying to soften the blow to me. [00:10:00] When, what I would love for her to do is to own how those strong feelings she might be having around what's going on with her. We know people pleasing and perfectionism, those tendencies are not always there, but they're oftentimes there.
So I, I felt like I read, read those in the emails. I'm glad you brought that up. Mark. Um, Christy, do you have experience working with P Triple PD yourself?
Christie Uipi: Yeah. Yes. And I have experience with dizziness
Host Daniel Lyman_1: I thought you might say that.
Christie Uipi: yeah. As Peggy speaks to that as a patient. Yes. We see it a lot in our practice. I see it, my colleagues see it. I think it's a really. A A common experience that can be neuroplastic in nature. And it was my last symptom, last symptom before I found the right path to treatment.
It. When I had chronic symptoms, I had many of them, lots of pain that I pushed through, lots of anxiety that I pushed through, but the dizziness and the migraines were the one, they were the thing that got me to stop, didn't have a choice. And I'll also say there's a unique invitation into feeling with the dizziness.
Speaking from my own experience. I think there's a lot of talk in our space around we wanna get away from feeling [00:11:00] about the symptom because you'll just be feeling more scared, you'll be feeling more frustrated. You're revving the engine of the symptom fear cycle. But our friend, Callie Klebanoff, who's another psychotherapist, speaks to this really wisely.
So I want to name her. That was my first opportunity to feel compassion for myself To Mark's point. It was my first opportunity to say, this sucks. Like why am I sitting here in a grad school class taking anti-nausea medication for the vertigo medication with these braces on my wrist to type through my wrist?
Pain? Pain? I was like, this sucks. I feel bad for myself. And that was a great invitation into feeling for me.
Host Daniel Lyman_1: Yeah. Into self-compassion.
Christie Uipi: Yeah.
Host Daniel Lyman_1: Self-compassion can oftentimes start that way. It's just recognizing that things suck, just observing the reality of it, so you're not denying yourself what you're actually feeling. Yeah. So, so Mark, from an EAET perspective, which does mirror, you know, has some similarities to PRT in terms of wanting to get to the, the emotional aspect of these things.
Host Daniel Lyman_1: [00:12:00] From an EAET perspective though, how would you treat this patient? Or what would you wanna work on specifically?
Mark Lumley_1: I would go after, um, helping her access her, her needs, uh, her, her feelings about these various life situations. And they're a mixed bag, right? She gets some gratitude, some, uh, some satisfaction outta doing these things. But there are tremendous, appears to be a tremendous pressure on her, and I would help her to find her voice, the part of her, the part of her, not the full aspect of her, but the part of her that wants to say no, that wants to say, stop, that, wants to say somebody else do it, that wants to tell her husband, help me out here quit being such a workaholic and rubs off on me, and all these other things.
And my guess is that she would find it difficult to, um, to find that assertive, stronger voice. So in session, I would have her really go strong with that and activate that part of her that's actually, uh, quite angry about some of these things and work up, support her to work up to the capacity to, uh, to be strong and to imagine, for example, some situation dealing with somebody in her life who's, uh, who's taken advantage of her.
And to find her voice to be able to say, no, stop. I'm not gonna do it. My answer's no. actually one of the things we found is that the body needs to be involved. And [00:13:00] so it's not just words, but actually en encouraging the person to use to imagine using their body in some way. And this could be, uh, very commonly for a person like this, it's feeling bigger and stronger than the other.
So I would actually invite her to stand up and to look down and to maybe use her hands to imagine maybe pushing the other person down. So they'd have to listen to her so she's like taller and more powerful than the other. Because I think in her life, she feels probably less tall and less powerful than the other.
And so getting the body involved, many patients will say, this is new. It's one thing to talk about it, but when my arms and my legs and my torso, uh, and my chest puff up and my face looks stronger, my voice gets louder. Those things I think can be really, uh, really brain changers. So I'd probably help her do that work and then take a look at what she might need to do in her actual life with her
Mark Lumley_1: relationships
Host Daniel Lyman_1: Hmm
Mark Lumley_1: it's more than just in session. Many people, most people need to transfer it somehow into their own lives, so they start saying, you know, start setting better B, better boundaries, for example.
Host Daniel Lyman_1: I love that because you're talking about the step one is just helping her recognize these feelings. Step two would be [00:14:00] expressing them, finding positive ways to express them, and then step three might potentially involve making changes in her life. To actually assert boundaries or, or, you know, figure out new relationship dynamics.
And I think, uh, I've seen that a lot with patients where they're like, well, I'm feeling this feeling and I understand it, but they don't wanna make the changes in their life so that they are not continually staying in that, in that cycle or in that loop. And that's a tricky thing. That's a challenging thing to us to say, oh, we may actually have to do the scariest possible thing, which is set a boundary with my partner, with my kids, with my parents, whatever.
Host Daniel Lyman_1: That's really scary for people.
Mark Lumley_1: Yeah, well, scary things you, the way I like to think about it's to work up the hierarchy of fear. Something we can borrow from the classic behavioral therapy of exposure for phobias something when something seems too tough, like I can't do that. Look for something that seems less tough,
Host Daniel Lyman_1: Yes.
Mark Lumley_1: you know, if the, the spouse is gonna be too tough to have that conversation.
There might be the neighbor or the coworker or somebody else that it's easier to practice on
Host Daniel Lyman_1: I
love
Mark Lumley_1: the capacity to do that.
Host Daniel Lyman_1: I, I am constantly working on boundaries, so I have to look for the easier ones first before I can build up to ones. You know, you're talking about in terms of, the expression and needing to [00:15:00] be in somebody's body to express those feelings. It just reminds me of like my I-S-T-D-P training in terms of moving from smooth muscle and striated muscle and trying to get the subconscious expression into the conscious.
Bodily space so that we can do something with it. Because it's really hard to do something with the physical expression of something that isn't smooth muscle. So like dizziness is hard to do something. Whereas if we actually feel tension in our body, we can do something with it. We can push against something, we can throw a pillow, we can be embodied more easily.
So it reminds me of that as well, and that's what I would encourage of her, as well as getting into her body more, lessen her head more in her body in many
Mark Lumley_1: I think about it as what scares the person. And for many people it scares them to use their body in a new way, in some strong way. And so it's all right. Let's face this fear of getting out of your seat, of raising up, becoming strong. I had worked with a woman the other day who's, um, pretty bad IBS and she was reflecting on some experience of, uh, being ridiculed and punished by a teacher back in elementary school.
And I actually had her get up out of her chair and imagine physically pushing the teacher back outta the classroom, and she said it was that part of the exercise actually throwing her hands [00:16:00] forward and seeing herself physically pushing, not just seeing herself, but physically with her body, pushing somebody out of the room.
That was very changing for her. It wasn't talking about it or just using her voice.
Host Daniel Lyman_1: I love that. That's awesome. Chris, did you, have you ever done that for your own symptoms?
I've
Christie Uipi: like done it with Mark.
Mark
have some very satisfying life experiences being led through these exercises with
Mark Lumley_1: Was that satisfying or traumatizing there?
Christie
I'm wondering
Host Daniel Lyman_1: Maybe column A and column B, who knows, you know,
uh, any, anything else before we move on? Actually, I wanna just quickly mention that you know, Jill, uh, Christie mentioned this. Mark mentioned it, and I, I'll mentioned it as well. We worked with triple PD before, this is a common symptom, so it may, it sounds like it took you a bit to kind of find the, uh, the neuroplastic treatment space, but you're in the right space now, so know that this is a common symptom we treat at my center, we honestly treated hundreds and hundreds of people that are dealing with dizzy symptoms.
It's same as with Christie Center. I'm sure Marcus treated a lot as well. It's not, uh, it's not uncommon symptom. In spite of all the stuff you've gone through, you're in the right place. All right, let's move on to the next case. And for this case, we are [00:17:00] lucky enough to have the patient reading their story themselves.
Hello, Daniel. This is Ben from Edinburgh in Scotland. I've got constant chronic pain and I've had it for 30 years now. It affects my lower back and hips and often extends into the back of my rib cage and shoulders too. I long thought that the reason for the pain was because of two herniated discs in the lower back, but in recent times, I've read a huge amount on neuroplastic pain and I don't think that's the whole story.
Now, the pain started in 1995 and it's been with me 24 7 since then. I first noticed it when doing lateral pull downs at the gym, and it never went away. I expelled every conventional and alternative therapy I could find, and after a long 16 years, I finally got an MRI scan, which showed a pronounced herniation.
Another two further MRIs in subsequent years showed the herniation had reduced to almost nothing but the pain remained. I am convinced now that the pain is entirely neuroplastic. In the 30 years I've had the pain, I've [00:18:00] learned to manage it by swimming, doing yoga very regularly, and avoiding long periods of sitting.
I use a sit stand workstation when I'm working, and since learning about PRT, I've used methods to calm my brain, like meditation, breathing techniques, and TRE.
Usually the pain's about three or four outta 10, but it rises to six halfway through the night. I'm always aware of the discomfort while I'm sleeping, and as the pain level rises, I wake at about 4:00 AM.
I then try to make myself sleep for the remainder of the night, but I just tend to doze constantly trying to find a comfortable position, but I can't find one. So I've dabbled occasionally with getting up for a couple of hours at the 4:00 AM point before returning to sleep. The second sleep phase is always more comfortable and my mood is better afterwards.
So I've recently started a a pattern of regular biphasic sleep with a second sleep of about 90 minutes so that I have a full sleep cycle. What I'd like to ask you is why when I'm almost definite that [00:19:00] my pain is neuroplastic. Should it increase while I'm sleeping? And why should it be worse in the middle of the night?
I would've thought that my brain was calmer at night, but that's when the pain's the worst. Do you have any advice on what I could do to help myself when it's so bad in the middle of the night? Many thanks for your time. Love the podcast.
Host Daniel Lyman_1: Thank you so much, Ben. I really appreciate you taking the time to record that for us. Um, this is a really common question. Uh, sleep comes up a lot and pain around sleep. Let's go ahead and start with you, Mark. What are your first impressions or thoughts?
Mark Lumley_1: I will confess that the, the nighttime thing is an interesting mystery to me. I've heard people say, if you get pain at night, it must be neuroplastic. I'm not sure where that statement comes from. Um, you know, I've seen people. Linking it to, well, is it something about a dream they're having? They're unconscious of it, but the dream is activating some process in the brain that might be activating the symptoms.
Is it something about who they're sleeping with or what they're sleeping, you know, where they're sleeping or the meaning of sleep, or the meaning of being in bed? Um. [00:20:00] So I, I'm not sure that I am confident that just because it happens during sleep or gets worse during sleep, that it's neuroplastic.
Host Daniel Lyman_1: Yeah. Fair.
Mark Lumley_1: it requires some more exploration from my end of things
Host Daniel Lyman_1: Absolutely. I appreciate that. And in terms of the rest of the history that he gave, does it give you any clues towards neuroplasticity there that give you any confidence? Or is it, uh, a big question mark. I
Mark Lumley_1: now. I think that, uh, it certainly feels like it has his story that, uh, you know, they found a couple of bad herniated discs. Of course one can find that on MRIs all over the place. Um, and he got it after he had his pain and subsequently the herniated discs resolved as they often do, and he knows, okay, I still have the pain.
So it looks like there's clearly a strong learned component of his pain there.
Host Daniel Lyman_1: Totally. Absolutely. Christie, thoughts, impressions?
Christie Uipi: My mind goes towards classic conditioned responses, we see a lot. I see a lot linking to sleep. It's hard. I won't undersell that. I think conditioned responses that wake you up are tricky because you're not at your best in the middle of the night to be able to apply the
interventions
Host Daniel Lyman_1: I am actually, that's what I [00:21:00] am at my best, sorry to hear you are Christie, but
Christie Uipi: I am
not not. That's where my mind goes. Did his brain at some point link pain to sleep? And I wanna mention this 'cause I, I think it's important the first time a conditioned response is established, meaning the very first time you have pain while sleeping or pain while doing any other activity. It could be completely random.
Like we may never know exactly why that happened. Were you more activated the day before? Was there something that you were dreaming about that was stressful? Did you have something coming up the next day that you were pre? I have no idea. And at a certain point, once a condition, response links, meaning your brain has learned to link these things, every time I go to sleep, I expect to have pain, and then I have pain due to the expectation.
Once that happens, the impetus for the condition response to me fades away, and now we're just dealing with the mechanics of a condition response. So that's where my brain goes to with this
Host Daniel Lyman_1: Gr Great. Can you break that down even further? The mechanics of the conditioned response. What, what does that mean?
Christie Uipi: So he sounds like he has a lot of. [00:22:00] Expectations of the pain coming on. And he has responded in kind with a set of, uh, with a protocol to deal with those expectations. One thing I thought was interesting, he said, I now, um, the second sleep phase is always more comfortable. So he now is like a, there's a condition response within the condition response where he expects pain.
While sleeping and the expectation of pain can bring pain on in and of itself, but now he has this other expectation that the second part of sleep will be more comfortable. I don't think that either of those, uh, pain experiences is linked to anything to sleep itself the second phase of sleep, meaning the physical act of sleeping.
I don't think it's linked to anything about his bed or his sleep positioning or the time of night. It just sounds like his brain is prone to making these links and association, so now he has two of them. One part of sleep is more uncomfortable and one is less
comfortable
Host Daniel Lyman_1: Yeah, I, I'm gonna, I'm gonna agree with you here, Christie. My, what stood out to me is he's performing, uh, like a science experiment every single [00:23:00] night and getting different results. So he goes to sleep, and then he wakes up and has pain, and then he goes to sleep and wakes up and feels good, meaning he doesn't wake up with the pain.
He now, he says he has pain most of the time, but he is not waking up from that second phase of sleep, uh, in the same level or the same distress that he is the first time. So he's getting two different responses here. He's probably sleeping in similar positions both times, right? He's probably not changing beds or changing a, a variety of things, uh, but different responses, which again leads me into thinking condition response as well.
That first sleep, he's expecting pain. Um, I remember there's a period in my, uh, in my life where I would expect to wake up at 2:00 AM with a headache, and lo and behold, I. I did, and it was, I'd be up for half hour, I'd put on a podcast and I would eventually go back to sleep and I'd wake up again without the headache.
But there's no reason biologically for me to wake up at two in the morning with a headache. There's no difference there between when I'm, you know, I'd go to sleep at various times, but I'd always wake up right at that time with a headache. Um, so that's condition response stood out to me there. And, and Mark, I agree with you that there's no, uh, undisputed science that says.
Pain while sleeping equals neuroplastic? Um, there's no, I haven't, I haven't read that. If there is the signs out there, I'd love to read that. Um, [00:24:00] but I'm also looking for, like, Christie, I'm looking for signs that this might be more conditioning and seeing how, how he's behaving in the face of conditioning.
Mark Lumley_1: I think you're both onto something here. Great job that that hypothesis there, Christie? Um. I'm convinced as well, and it of, it reminds me of what we're seeing just in insomnia, which this, uh, many people end up having kind of fragmented sleep, a strong belief they must sleep and they start to do things like try to force themselves to sleep.
They're lying in bed, ruminating about it. And one of the most effective treatments for insomnia is, um, sleep restriction therapy. Where you actually tell people, quit trying to go to
sleep,
stay up longer, consolidate those scattered hours of sleep into one four hour period, or one, you know, three or five hour period.
Um, and it, this, you know, one of the things I'm reading through Ben's story here is this real pressure. I need to, And if we can take some of that out and say, let's, uh, quit trying to go to sleep so much. And I wonder if, I wonder if. A treatment for insomnia, like sleep restriction therapy might do something for his pain as well because it is, it shifts people's, not only their, their sleep rhythms, but it also shifts the drive or the need to have
to Mm-hmm
Host Daniel Lyman_1: that's the most important thing is like when there's some sort of. Change that we're forced to have with the relationship. And that's what's happened to me is in the past when I've [00:25:00] been forced to change my relationship with sleep, where someone's like, well, tonight you can only get three hours because you have to get up for this thing.
Um, I will be upset that I can't sleep that much, but I'm grateful if I can plan for it, then I'm like, great, three hours will be fine. I will plan for that and I'll make it work. Whereas on a normal night, if something like that happened, I'd be like, distraught and in distress. So it's changing my relationship with the sleep there.
And I think that, I think you're onto something here, mark, is that. There might be too rigid of a structure around sleep or the relationship to sleep, and we wanna mix that up a bit. Um. Yeah, I think that's a really great point. The, for me, when I read that somebody's had symptoms for 20 plus years or however long he's had there a very long time, uh, it leads me to wonder like how much pressure or how much rigidity there is in his life, because no fluctuation whatsoever says to me that things aren't.
You know, we would expect a natural fluctuation with neuroplastic symptoms based on changes in somebody's life, but maybe there haven't been many changes because of the rigidity or the pressure that he puts on himself. keeping himself very, you know, he said he did this while he was at the gym, that things hurt.
Oftentimes, gym injuries happen when we're really. I'm guilty of this. We're really like neurotic about being at the gym and [00:26:00] really focused on like, I have to do this. No matter what my body's telling me, I need to work out like this. So again, I'd be curious about changing the relationship, not just to sleep, but to a lot of activities in his life.
What if we shake them all up and see how he feels in that space? Behavioral changes. F
Mark Lumley_1: I'm, I'm struck, um, by one other thing about Ben's story. In contrast to Jill from Canada.
Host Daniel Lyman_1: Uh huh.
Mark Lumley_1: Ben doesn't mention other people or stressors or emotional stuff at all,
Host Daniel Lyman_1: know. Thank you for bringing that up.
Mark Lumley_1: I, I thought this could be a gender thing. I think we're probably more likely to see sometimes with, with guys, they stay away from that topic and they just stick with just to the facts of my problem in my sleep or something, my environment.
Host Daniel Lyman_1: Yes.
Mark Lumley_1: but I'd be very curious what his life is like. His relationships are, like his emotional life is like, and do some exploring there.
Host Daniel Lyman_1: am so glad you brought that up because that really stuck out to me too. I thought that was so interesting that it wasn't mentioned at all. Um, and so that also leads me to want to encourage him to pay more attention to his emotional
health
How does your, you know, oftentimes when people say My symptom is exactly the same a hundred percent of the time, um.
Quite honestly what that system is, oftentimes, maybe we're not paying close enough attention to the small variations, because when we [00:27:00] feel better, oftentimes our symptom is slightly lower. It can be just a little bit better. Um, and so maybe we're not even tuned into our emotional health enough to recognize when those symptoms might be changing or the, we just feel lightness in our body or heaviness in our body, depending upon what we're feeling.
Christie Uipi: I wanna underscore that, if that's okay. I have. I think it can be really hard for someone who's in the active suffering phase, like this individual to recognize the containing element of preoccupying around pain and the containing element of preoccupying over pain treatment and pain recovery, which might feel like, well, of course I'm thinking about my recovery.
I care about getting out of pain. What's bad about that? I'm troubleshooting, I'm planning, I'm working on myself. I am not saying that Ben enjoys thinking about pain and pain recovery all day. I'm sure he doesn't. And if he had the choice to think about something else and free up his brain space, he might hit that easy button.
And it is a containing force to say, instead of thinking about all the things in your life that, again, that did not show up here, [00:28:00] instead of feeling about any of the other things in your life, what if we just draw a box around your mental wanderings for the day and we'll just have you think about these things.
Including the protocols of which he has many, some of which were super adaptive and helpful, and at this point I think they've become a bit rigid to Daniel's point and tricky for him.
Host Daniel Lyman_1: The rigidity in this case, or the rigidity that I'm perceiving in this email, which again, I could be wrong because it's just an email, but the rigidity that I'm perceiving makes me want to assess for obsessive or compulsive tendencies, um, because the, to your point, Christie, that can keep us stuck in this particular way of thinking or behaving and not mixing up the relationships or the patterns to help free us of this, uh, very specific way of thinking that our brain or our body is broken and that we need to focus on that in order to fix it.
So I would want to assess for OCD. That would be something that I would do. What? Any other thoughts or questions or any other things you might do, um, to treat Ben here?
Christie Uipi: One thing that just came to mind especially is. He directly asked, does he have any advice on what I could to do? We've been talking about that up this point. I do think there's a daytime opportunity that I
Host Daniel Lyman_1: Ooh, tell us more. Yes.
Christie Uipi: So if I'm working [00:29:00] with someone who has any sort of issue in the nighttime, particularly a condition response, I will either do this in session with them or I will record a version of it for them to practice in between sessions where it's essentially a, um, imagined exposure to the fear-inducing stimuli.
That they're during, during the day. So I'll take them through a 10 minute meditation where they imagine themselves in bed, unable to sleep if it's an insomnia patient, or imagine themselves in bed awoken by the pain, and then watch their bodily response during the daytime meditation to that imagined exposure.
Very often they say even during the meditation like this, yeah, my body is, is. Stressing out. Even just imagine being woken up by the pain. You can get a ton of practice there where you are more awake. When you are more awake.
Mark Lumley_1: Hmm.
Host Daniel Lyman_1: Christie, I love that. I, one of my favorite things to do is to, uh, because I work virtually with a lot of people, is to have them take their computer or phone or whatever to the spot of the, where the relationship so that I can see how they're responding. Because oftentimes, bed is such a triggering place for people for so many different reasons.
So I can watch them like, okay, it's gonna be [00:30:00] weird. I'm gonna talk to you on your phone and you're gonna lay down in bed and I can watch them get really tense. Just laying down in bed because that's the scene of the crime, right? That's the space where they are already stressed out. So we want to change the relationship, even with that physical space to make it a little more playful, a little bit less heavy.
So I love that Christie Imaginal exposure. Any anything we can do to change that relationship is so beneficial. I.
Christie Uipi: true
Host Daniel Lyman_1: Yeah, mark, from an EAET perspective, you brought up the fact that he didn't bring up, uh, emotional triggers, uh, any relationships in his life. But from an EAET perspective, is there anything that specifically stands out to you that you'd wanna focus on?
Mark Lumley_1: This is hard to know where to start because he is not having any openings.
Um
Host Daniel Lyman_1: Yeah, definitely.
Mark Lumley_1: I'd
probably start by doing a bit of
a um a
a, a survey of his life experiences and his somatic symptoms. What happened in your life, you know, what's going on when you were a child, good or bad things, but especially stressful things.
And see what stories he shares,
Host Daniel Lyman_1: Yeah.
Mark Lumley_1: so that we'd take him out of just the pain in my back and my sleep, um, and try to put it into a larger life context. I'd like to learn about his life, you
Host Daniel Lyman_1: Yes. Getting get him to think more psychologically, more [00:31:00] emotionally. Put it in the context. I love that. That's great. Okay, let's move on here to our third and final one. Christi, would you mind reading Katarina?
Christie Uipi: I'd be happy to Caterina. I am a woman in my early forties who has suffered from migraines and concurrent neck pain since I was around 20 In the past, I used to have maybe one or two attacks per month, but it has gotten worse with time, especially during the last few years. In the fall of 2024, I finished my PhD, moved back.
To my home country and started a new job. I was happy to move home, but felt pretty much constantly overwhelmed with everything. I think I was worn down by the big life changes and my constant battle with anxiety and depression, which is something I have struggled with for many years. I think the stress of mental illness has always contributed strongly to my pain.
In any case, the depression as well as the migraine started escalating completely out of control during the summer of 2025. With around 20 migraine days per month, despite being on sick leave and trying various preventative migraine medications since September, 2025, there is no consistent [00:32:00] decrease in my migraine days.
The pain intensity is typically lower than it used to be, but I am not sure to what extent that is due to the meds because I noticed a few years ago that while the frequency and duration went up, the intensity went down except for the occasional really bad attack. I first stumbled onto the concept of neuroplastic pain back in 2022 when I was desperately trying to get out of several years of debilitating foot pain.
After understanding that my feet were, in fact not broken, daring to walk and run again, and trying some exercises, including somatic tracking, I was 95% pain free all within a few months. So I know for a fact that this approach can work extremely well. But I find it much harder to apply to the migraine. I have started doing somatic tracking daily, but I have a hard time understanding if migraine should really be viewed as a fully neuroplastic thing.
When it came to my foot pain, it was a really obvious case. I could basically tick all the boxes suggesting that the pain was neuroplastic and there was no evidence whatsoever. To the contrary, the migraine in contrast, is a diagnosed chronic [00:33:00] illness, although I certainly think that my fear and avoidance of potential migraine.
Excuse me, triggers are making the symptoms worse. I find it hard to accept the idea that my migraine symptoms are just my brain misinterpreting safe signals from the body. After all, there is this underlying disease that messes around with the nervous system, blood vessels, neuropeptides, et cetera, causing pain, at least in accordance to what I have. What would you say that migraine is? Fully neuroplastic? Can it be both? Can you have migraine on the one hand and then neuroplastic symptoms mimicking the migraine on top of that? Or is it rather all migraine with the whole associated chaos of neurological, vascular and chemical stuff happening? But at some point the trigger for that migraine is the Learned Threat Association rather than sunlight, physical exercise or whatever trigger it seems to be.
I think it will be necessary for my healing to understand this better, partly because the uncertainty in itself adds further stress, but also because it seems that the strategies and concepts are pretty much the opposite in traditional [00:34:00] migraine care versus PRT, avoiding potential triggers versus graded exposure, and there is nothing wrong with you.
Uh, and there's nothing wrong with you versus you have a chronic illness. Specifically, I would really like to know whether or not to avoid potential triggers and if there is a risk of exacerbating the migraine. If I treat it as neuroplastic and it turns out it's not, I would be very grateful from some guidance.
I'm sure I'm not the only migraine. Suffer, suffer, or who struggles with this.
Host Daniel Lyman_1: Thank you, Christie. Yeah, that's a, a longer one, but there's a lot of good information there. So as you can hear, uh. What Katerina is struggling with is the idea of whether or not migraine is neuroplastic or not, and that's a key step in PRT as we know, is kind of getting a certain level of confidence about whether the symptom that we're dealing with is neuroplastic.
Um, when I first read her email, I actually read it wrong. Uh, I kind of read it quickly, and then I responded to her because I, I had read it wrong and I just said, oh, you mentioned underlying disease. And for some reason I thought she was referencing. Something else because my bias is that I don't think of migraines as disease.
So when I saw that word, I responded to her. I was like, oh, can you let me know what the underlying disease is? And she responded. She said, well, it's [00:35:00] migraines. That's what I'm talking about. And of course that was so illuminating for me, both my mistake in reading the email and her bias, and assuming that, uh, migraines are disease, which that word she used chronic illness.
And she uses the word disease a fair number of times in this, and that stands out to me. I could talk more about that in a bit, but, uh, mark, would you like to start us off with your impressions?
Mark Lumley_1: This one really, uh, attracted my attention in part because I just published a randomized controlled trial my colleague Dr. Dan Kaufman the University of Utah.
Host Daniel Lyman_1: That's partially why I chose this one too. Yeah.
Mark Lumley_1: Yeah. Um, applying EAAT to people with, with migraine. Um, and there's another paper that came out simultaneously testing group EAT. Uh, this is in the Canadian Journal of Neuroscience from or at Zamer and colleagues including Brandon Yarns, um, where they also found a similar nice improvement, nice reduction in migraine frequency.
We actually found eight sessions of group EAT led to a 40% reduction in migraine frequency.
Host Daniel Lyman_1: It's amazing.
Mark Lumley_1: Yeah, and the control condition just had a small reduction. Um, and some of these patients were basically migraine free, but on average there was a lot of improvement. The three patients who didn't, out of the [00:36:00] 15 who got the therapy, the three patients who didn't benefit, um, were the ones who were only partially committed, didn't do the homework, missed some sessions.
But the patients who went through it all, um, got some nice results. So, um, you know, one of my thoughts was the great battle over. How could this problem be, you organic? Could it be structural disease based? Um, you know, there is this world of psychophysiological disorders where there is both, uh, symptom presentations driven by psychosocial factors and physiological changes.
Um, so the asthmas and the, you know, the bowel, bowel issues and a whole bunch of other things. Sure there's things going on in the body, but they can be triggered by, uh, by psychosocial processes. Um. But you know, the notion that migraines have been recognized as a quote psychosomatic or let's say a neuroplastic illness for a long time.
The fact that she's got, had this other foot pain that was clearly neuroplastic, the more of those symptoms you see in a person, the more you go, they hang together due to the brain, due to, due to the psycho, the psychosocial neuroplastic aspect. Um, but the other thought I had was instead of debating could this be like biological and I'm stuck with it and it's just the way it is, my, my genetics are driving this.
Is you do the therapy and you'll see what happens.
Host Daniel Lyman_1: [00:37:00] Hmm,
Mark Lumley_1: Um, most of the cases of migraine, I, I'll go with most, maybe not all, but most cases, are gonna be responsive to psychosocial processes. And, uh, it might be the best way to start there and see what changes. And if you give that your best shot and nothing changes, then you might be thinking a different process.
But my guess is most people will have, as Christie was sharing earlier on this, on this session, uh, your own recovery from migraines. Most people will have some nice benefit if they do the work.
Host Daniel Lyman_1: Absolutely. Christie, what are your impressions?
Christie Uipi: I love how this person is thinking about her symptoms. I, I as a probably ATM ser speaking to another TM ser, I feel like she's, she's speaking my language in terms of the way she's breaking down her questions. Um, I, I love this where she says, um, there's all of this conflict between traditional migraine care versus PRT and they're directly at odd.
So if I do one. What is that like? Am I doing harm to myself by fully leaning into PRT? Is there any chance that I'm harming myself? With this disease process, so I wanna name or validate for her or anyone like this. There is a part of the treatment process where we are looking to get [00:38:00] actual certainty.
Like there's so much talk in, at least in psychotherapy, the psychotherapeutic side of the neuroplastic world around we wanna help our patients tolerate uncertainty. We don't always want to give them a certain answer that's so much of life is recognizing there's a lot that's outside of our control. And at the front part of treatment for neuroplastic symptoms, if you genuinely do not know what is going on in your body and feel like treating your pain as if it were neuroplastic, could be harming your body, of course you're not feeling safe in the presence of your symptoms.
Of course, telling yourself when you're having a migraine. This is actually a safe sensation. My body is completely fine. Of course, it's falling flat. You have this underlying very valid doubt and concern, like, am I causing myself harm right this moment by trying to enforce this? So I wanna call her out for having, I think, as a very valid, certainty seeking moment that I think she deserved clarification on.
Host Daniel Lyman_1: And if she gets that clarification from your perspective, Christie, [00:39:00] think what? What do you think that will do for her?
Christie Uipi: Well, I think that can go one of two ways.
I think
I think for some people that certainty is all they need, meaning once they really fully commit to the path of this is neuroplastic, I answered all, I got, all of my questions genuinely answered. Sure, I might need some reassurance in the face of my symptoms, but more or less I am here.
My feet are fully planted in the neuroplastic recovery realm. I think that happens a lot of times. The other way it could go is it might uncover. A whole slew of other uncertainties that she's having difficulty tolerating. It might be like, okay, okay, okay, okay, I get it. This is neuroplastic. I won't ask you any more questions about that.
But now I'm really worried about X thing that I'm certainty seeking around. So what might unveil a pattern of certainty seeking that is more obsessive compulsive in nature? But my guess with how she's thinking about this is she really just needs to know what's going on in her body. She has this an understanding based question, like a conceptual concern.
Host Daniel Lyman_1: Here. Here's what I love about the two different perspectives we're getting right now, is that both EAET and PRT are. [00:40:00] Working to help people find safety in the body. Uh, it is safety through emotional expression. Uh, what what Christie's talking about is like safety through cognitive awareness and understanding.
Uh, and so, and I'm a firm believer that the more safety we find in the body, the better we're going to feel regardless how, how we do it. I think both answers are absolutely correct here. You could go into, let's say, EAET therapy. And, and, and try and let go of whether or not the, you know, what, what's going on exactly with the migraines and see what comes up for you.
And you'll probably feel better and. Going into PRT where there's this very high, high level focus on trying to make sure we understand exactly what is happening to us and confirming that it's neuroplastic. Of course, that will help her reduce some of the anxiety or the question asking here, which will reduce some fear and increase safety.
So both are correct here. That's what I love about this, and they're both actually coming at this from the same perspective. It's let's just make people feel safer in their bodies here. There's just two different ways of doing it.
Christie Uipi: Totally.
Host Daniel Lyman_1: I appreciate what she's asking here as well, and she asks it multiple times, which, which stands out to me that this isn't just a, Hey, what do you think?
It's, there's a high [00:41:00] level of concern about what's going on here. Um, and so it's clearly very distressing to her about whether or not these migraines are neuroplastic or not. She ask it in a few different ways. Um, so that stands out to me in terms of like, okay, the hypervigilant. Is there, and we'd want to find ways to soothe the hypervigilance, whether that be through getting confirmation that this is neuroplastic or helping her find some sort of emotional or somatic safety some other way.
Um, migraines are something I dealt with when I was working a job that I really couldn't stand it just like I would get to work and then I would just have a terrible migraine and not be able to work. Um, for me, what had really helped me in that moment was recognizing the amount of pr, uh, pressure and hypervigilance I had around that job, which was torturing me and my body was screaming at me that I needed to step away from that job.
Host Daniel Lyman_1: So anyway, what other thoughts do we have in terms of treatment? What would you tangibly have her do?
Christie Uipi: Mm. I'm also, I'm noticing her wondering about triggers, like how much challenge those. Um, well, which I think in her case requires a, a higher degree of confidence that as neuroplastic in nature. So it circles back to the conceptualization
Host Daniel Lyman_1: Yep. Because we can't do, we can't, just to speak on that, we can't do triggers If we think we're really causing damage to ourselves and we go [00:42:00] out and try and expose ourselves to those triggers, it can be, we can re-traumatize ourselves. Uh, it's a step back, not a step forward. So having confidence that there's some nothing wrong, like, okay, my brain's not gonna explode if I look at the sun.
Uh, then we can actually have these corrective experiences where looking, 'cause looking at the sun was one of my triggers. Uh, but like we can look at the sun again and not feel like our brain is gonna explode and we can have confidence in that.
Christie Uipi: yeah.
Yes. I'm glad you slowed me down on that. I would love to see her challenging the traditional migraine triggers. I don't think that her body is, uh, allergic in any way to things like sunlight or drinking a little bit less water or being in front of a computer screen. I think her brain has habituated to being more sensitive to those things, and it's turning the volume up on those experiences, so to speak. And easy does it Maybe like, I don't think we have to challenge avoidance in one fell swoop. Some people like that push me into the deep end, it feels really empowering. I'm gonna go stare directly at the sun
until
Host Daniel Lyman_1: to be clear, when I said that, I didn't mean like actually stare at the sun. What I meant was be outside in the sun.
Christie Uipi: I'm just
playing with you.
She
Mark Lumley_1: Christie. I, I'm thinking, Christie, as you were saying about the, uh, the provocative testing, the imaginal
[00:43:00] exposure
Christie Uipi: yeah.
Mark Lumley_1: you use that, would you use that, uh, with her, with these triggers imaginable rather than
Christie Uipi: Totally. It's a great idea. That's a great way to ease into it in a safe way. Definitely a safe way.
Host Daniel Lyman_1: And that can actually help build confidence and buy-in of neuroplasticity. So if we have her imagine that she's stepping outside into the sunlight and all of a sudden a migraine comes along, well that doesn't make sense from any sort of bio, uh, biomechanical or biophysical perspective that is about the stress, the anxiety, the emotional impact of being in sunlight would cause her to have this reaction.
Host Daniel Lyman_1: So that can help build confidence.
Mark Lumley_1: Joel Fishbein published a few papers, uh, published a paper on a few case reports of people getting kind of classic PRT, not, not involving emotional work, just classic PRT and showing these cases had nice improvements in migraines and, and part of that, I think the active ingredient was, uh, somatic tracking of when the symptoms start to come on to stop trying to push them away or fight against them to allow them to be.
And just start to notice them. And I was struck by these patients who seemed to recover a lot from their migraines by doing this work. And I think the active ingredient was the shift from, oh crap, here comes a migraine. [00:44:00] Oh, here's the aura. Oh no. To allow it to be. And you know, I think that might've been a key part of it.
In our work, we have been, uh uh, I watched lots of patients go through this therapy and the key thing I think was their capacity, their ability to. Start to tackle some relationship stuff, the emotional work, especially assertion and anger that had been blocked. And so as I read her story, I see by the way, this looks like it started during her college years age 20.
Not surprise. is a hard driving PhD oriented, uh, woman who, uh, you know, and she moved back home to her home country and they got a lot worse. Um, so I'm very curious about the pressures that she experiences that she ends up experiencing from others and putting on herself. And again, I was reading the text going, where is the person who's, you know, needing to address some of the relational issues, the emotions that go with 'em?
Um, I think she probably feels quite stuck in whatever place she is, uh, psychologically, emotionally, interpersonally. And I'd love to help her, um, find her voice again. That was the number one thing we saw in the patients who overcame their migraines, was finding their assertion ability and, and often tackling it in real, [00:45:00] in real relationships with the parent or the spouse or the partner
or coworker or somebody
Host Daniel Lyman_1: I love that you're bringing that up because when I was doing my I-S-T-D-P training, I remember the, the, the guy who was training me is an excellent clinician at one point said to me, Daniel, we're not doing assertiveness training here. And I was like, okay, but I also think that's what this patient needs.
was like, it's like you're, you, you might be right. And I really firmly believe that assertiveness training is gonna help this
person
Mark Lumley_1: Yeah. Yeah.
Host Daniel Lyman_1: I, I really see that as beneficial.
Mark Lumley_1: It, it really is. Assertiveness training is one of those things that was classically done in, in a, in effective behavior therapies for a wide range of problems, and it sort of disappeared off the radar of clinical therapies, but it's actually a really good technique.
Host Daniel Lyman_1: Totally.
Mark Lumley_1: You know, I would add to it two little twists.
Uh, assertiveness training starts by saying, don't get aggressive. be assertive. And I would argue that being aggressive in the privacy, the sanctity of a session, can be helpful.
Host Daniel Lyman_1: yes, yes. Get
Mark Lumley_1: thing
is that assertiveness training misses, misses the need for connection. And the fact that you often wanna, they have mixed feelings towards relationships.
It's not just assertion, it's also love me or be with me or care about me, and I'm unhappy about this.
Host Daniel Lyman_1: absolutely. We can hold space. We can hold those in both, in both of those things in ourselves. Yeah. Any other comments or [00:46:00] thoughts before we wrap up on this case? Awesome. Thank you both so much. This was amazing. This was super fun. I love hearing your perspectives. Um, you're both people that I admire very much in this field, so it's really fun to hear your clinical insight on all of these cases.
Thank you so much for being here, and hopefully we can have you back sometime.
Mark Lumley_1: This has certainly been my pleasure. I have learned a ton from you. I mean, I, I will confess, uh, you, I'm sitting here in the room with two super clinicians and I don't do nearly as much. Clinical work. I'm more of the research teach kind of guy, so I love learning from the both of you. Thanks for having me with you today.
Host Daniel Lyman_1: We have a lot to learn from the academics in our life. I'm so grateful your, for your work. Mark, you've, you've changed, you've changed this world quite a lot.
Christie Uipi: Yes. Thank you so much to both of you, and I wanna say thank you to the people who are writing in and being so vulnerable to allow discuss the cases. And the three of us chatted about this before we were on air, but it's okay. I just wanna say it out loud. There's no co-creation with that individual here.
There's no dialogue between us and the patient. Like we were not, we were con, we were con, we were talking about things. Based on our initial impression. So for anyone listening who has any sort of res like response to what we [00:47:00] shared, even these three people like, oh, that didn't really jive with me, or That wasn't how I meant it, or that's not how I experienced it.
Take care of yourself through all of our ideas. These are just initial impressions and that, that the vulnerability from these people is just beautiful. I really appreciate it.
Host Daniel Lyman_1: I really appreciate you saying that, Christie, we're, you know, the three of us, we, we may be people that have done this for a long time, but we can also all be wrong about things, especially based on initial
impressions So
thank you people that I'm the first person to say I could be wrong about things, especially based on an email somebody sends.
So thanks again so much. I really appreciate you both being here.
[00:48:00]