Great article, Todd! In my experience, the main difference between prt and some of the other treatments you listed is the form of exposure. Combining mindfulness, safety reappraisal and positive affect induction maximizes the chance of giving the patient a corrective experience. Once the patient experiences the position or activity with no pain, it often eradicated the illusion that the pain is an accurate reflection of tissue damage. And allows the patient to over the fear of the pain. Here’s an example of the technique in action:
Thanks Todd. I think another distinction is that during the exposure process, we use avoidance behaviors as a tool (as a function of pain intensity), to help patients maximize corrective experiences and minimize retraumatizations. (This is outlined more in ch 6 of The Way Out). My understanding is that most other exposure-based therapies don’t incorporate avoidance behaviors as part of the treatment.
Thanks for writing about this study and engaging with the ideas! I'm a former chronic pain patient and I made a film that explores this new treatment approach through filming with one of the study's authors, Dr. Howard Schubiner, and a few of his patients. He was in charge of examining and "re-diagnosing" the people in this PRT study, and you can see more about how he does it in our film, This Might Hurt.
A key part of the process is ruling out a tissue damage process (herniated discs, pinched nerves) which so many patients have become so scared of — that their backs are damaged. And then educating people that in the absence of tissue damage, brain-induced pain is 100% reversible. Then learning so many things held in common by practitioners of CFT, MBSR, or PRT etc., which can have a more powerful effect (60% in this study who were assigned to PRT became nearly pain-free). Some of the specific techniques used in PRT like somatic tracking are really helpful in reducing fear of pain, and wearing away the belief that the body is damaged, and that pain is always a sign of damage.
The group of practitioners who authored this study is having a large conference and training in two weeks. They train a lot of physical therapists to do this work. Might be worth checking out! https://ppdassociation.org/
The keys for transformative healing in this model including the new diagnosis that explains to the patient that the problem is real, but benign, and not permanent, structural, or biochemical. The educational piece is key, changing beliefs and attitudes. The psychological component starts with the premise that the problem can go away, not just be managed. The expression of emotions not previously understood to be related to the pain is highly therapeutic. In all, a very successful model. David Schechter, M.D.
Great article, Todd! In my experience, the main difference between prt and some of the other treatments you listed is the form of exposure. Combining mindfulness, safety reappraisal and positive affect induction maximizes the chance of giving the patient a corrective experience. Once the patient experiences the position or activity with no pain, it often eradicated the illusion that the pain is an accurate reflection of tissue damage. And allows the patient to over the fear of the pain. Here’s an example of the technique in action:
https://m.soundcloud.com/alantgordon/ep4-v8-mixdown-0001
Alan
Hi Alan,
Thanks very much for the information, and congrats on the study. I will share this information in an upcoming post soon.
Thanks Todd. I think another distinction is that during the exposure process, we use avoidance behaviors as a tool (as a function of pain intensity), to help patients maximize corrective experiences and minimize retraumatizations. (This is outlined more in ch 6 of The Way Out). My understanding is that most other exposure-based therapies don’t incorporate avoidance behaviors as part of the treatment.
Hello Todd,
Thanks for writing about this study and engaging with the ideas! I'm a former chronic pain patient and I made a film that explores this new treatment approach through filming with one of the study's authors, Dr. Howard Schubiner, and a few of his patients. He was in charge of examining and "re-diagnosing" the people in this PRT study, and you can see more about how he does it in our film, This Might Hurt.
A key part of the process is ruling out a tissue damage process (herniated discs, pinched nerves) which so many patients have become so scared of — that their backs are damaged. And then educating people that in the absence of tissue damage, brain-induced pain is 100% reversible. Then learning so many things held in common by practitioners of CFT, MBSR, or PRT etc., which can have a more powerful effect (60% in this study who were assigned to PRT became nearly pain-free). Some of the specific techniques used in PRT like somatic tracking are really helpful in reducing fear of pain, and wearing away the belief that the body is damaged, and that pain is always a sign of damage.
The group of practitioners who authored this study is having a large conference and training in two weeks. They train a lot of physical therapists to do this work. Might be worth checking out! https://ppdassociation.org/
Thanks for the information Kent, very interesting.
Great summary Todd - well thought through and very useful overview IMO :)
Thanks Kjartan!
The keys for transformative healing in this model including the new diagnosis that explains to the patient that the problem is real, but benign, and not permanent, structural, or biochemical. The educational piece is key, changing beliefs and attitudes. The psychological component starts with the premise that the problem can go away, not just be managed. The expression of emotions not previously understood to be related to the pain is highly therapeutic. In all, a very successful model. David Schechter, M.D.
Briliant!
Sounds a little Sarno-ish in terms of the optimism.
Yes, inspired by Sarno, updated with more scientific explanations.