PRT, TMS, Nervous System Regulation and Brain Retraining - are they all the same thing?
These days, mindbody approaches to chronic pain are getting more and more widespread. This reality comes with both advantages and disadvantages. The advantage is clear: an increasing number of people are being exposed to the idea that they can work with their brain and body to heal chronic conditions.
However, the most evident disadvantage is this: individuals are getting overwhelmed with the increasing number of mindbody approaches and modalities out there, and this may lead to feelings of confusion and helplessness, which is the very opposite of what one would hope to arrive at in trying to tackle chronic pain.
For this reason, in this post I shall discuss some of the most common approaches: Pain Reprocessing Therapy, Tension Myositis Syndrome (and the work behind this approach), Nervous System Regulation techniques and Brain Retraining in general.
Tension Myoneural Syndrome & Emotional Release
The main premise behind the concept of TMS is that repressed emotions can lead to psychosomatic symptoms, which can then become chronic.
Given that the origin is presumed to lie within the unconscious, TMS work today involves tools like journaling and self-awareness work so that the individual can identify negative emotions (namely rage and fear) that have led to both the onset and continuation of symptoms.
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This can lead the individual to experience a significant amount of relief, especially after realizing that his/her body is not in any way damaged or ill, but that symptoms are simply a result of what’s going on internally. It can also prompt the individual to engage in some shadow work [1] (working with the unconscious mind to get aware of repressed feelings or desires), and pursue growth and self-development in this way.
What’s more, by addressing psychological factors, the brain’s focus is taken away from the symptoms, and in some people, this decreased attention on the symptoms may lead to pain relief or even complete elimination.
That said, TMS work involves another component. As Dr Sarno recommends, the resumption of physical activity or normal day to day activities is also essential, in order to get over the belief that the body is injured or prone to damage. In a sense, this is the same as brain retraining.
The individual has to familiarize the brain with the idea that such activities are safe to resume, and lower the fear levels that usually accompany such activities. The elimination of fear and its replacement with confidence and other positive emotions is essential to TMS work, and to any sort of healing, for that matter.
Yet most people working on TMS take their healing even further, by addressing specific stressors or traumas that may have originally led to the pain, and often end up taking decisions to change their personal lives for the better and to reduce overall anxiety from their lives.
Pain Reprocessing Therapy, Curable and related approaches
Over the past couple of years, an approach known as Pain Reprocessing Therapy (PRT) has been developed to help individuals reprocesses the way they experience painful sensations.
The main aim of PRT is to teach the brain to interpret pain and associated activities as actually safe. To achieve this aim, the individual is prompted to let go of negative descriptors and adjectives used to describe pain, and to get more objective when describing or noticing painful sensations.
Tools like meditation and somatic tracking help in pain reprocessing, because such practises aid the individual in accepting any present sensations as they currently are, and to notice them without trying to change anything. Cultivating acceptance is key to lowering the fight or flight response that usually accompanies the experience of pain, and this simple concept is what many people actually struggle with.
The Curable app is probably the most popular tool that teaches this approach. It starts by educating individuals on the Science behind chronic pain (to dismiss certain beliefs and myths that get people stuck with pain). The app then guides them through various success stories, meditations and somatic tracking exercises so that they can practise pain reprocessing on their own.
Gradually, as in the case of TMS work, PRT helps substitute negative emotions like fear, frustration and helplessness towards painful sensations with better-feeling emotions like curiosity and acceptance.
Once we release our resistance to these symptoms, the brain will no longer receive the message that such symptoms are threatening, which in turn, may turn off the pain response (because chronic pain, in most cases, is generated as a response to a perceived threat).
So essentially, PRT is none other than brain retraining for chronic pain.
Breathwork, meditation and other forms of nervous system regulation (vagal regulation)
Before I proceed to make comparisons, I thought I might mention some other modalities that are being used to overcome chronic pain. There are several body-focused approaches that attempt to induce homeostasis (balance within) by promoting good eating and sleeping patterns, certain exercises and movements, as well as breathwork practises that get to calm down the nervous system.
I love experimenting with these approaches to see how they can boost my mental and physical wellbeing. Just like the mind can affect the body positively, the opposite is also true. To mention a simple example, specific sounds like the ‘voo’ sound promoted by Peter A. Levine in his Somatic Experiencing approach [2] (making a lenghty vooooo sound with your lips) can induce more calm and presence, whereas certain practises like hugging yourself and specific movements can promote relaxation and vagal regulation.
The same benefits can be derived from breathwork, as it grounds you in the present moment and can switch off the stress response. On the other hand, exercise and practises like yoga can increase feel-good hormones like dopamine (with one caveat: if you approach any sort of exercise with dread, for fear that it will cause you pain, the results may be disastrous).
That said, certain somatically-focused modalities sometimes fail to get to the root of why pain has come up in the first place. If there are significant unaddressed emotions that are fuelling the pain, these modalities can provide temporary relief at best.
In the worst of cases, they may create overwhelm, as the individual tries one technique after another in a desperate search for a cure, and is left wondering if there’s some other technique that he’s missing out on.
Which is better, TMS or PRT, or a combination of mindbody tools?
TMS work includes elements of PRT, especially when it comes to challenging one’s limitations, changing the way you talk about pain and eliminating avoidance behaviours.
Yet TMS, like shadow work, does prompt the individual to look deeper within, which is something that not everyone is comfortable with. The idea of pain reprocessing or simple nervous system regulation might sound more appealing to individuals who are not yet ready to face specific emotional issues or to dig unpleasant emotions up.
That said, if strong negative emotions are still present within, PRT or body-focused approaches on their own may not be as effective as one hopes. They may indeed prove effective in eliminating a specific symptom (as the danger signal is deactivated in relation to that symptom), but in some cases this only leads to the emergence of alternative symptoms or even other health problems.
This is because the unconscious still feels threatened on some level, and if this threat is negated or repressed, the body is bound to express such unconscious emotions in some other way, which may result in more life-threatening illnesses like autoimmune disorders or cancer. Dr Sarno makes this concept very clear in his later book, The Divided Mind [3], and today is reinforced by prominent thought leaders like Gabor Mate [4] and Inna Segal [5].
The same can be said for breathwork, meditations and other ways of vagal regulation if these are practised in isolation and fail to get to the root of what’s causing symptoms in the first place. It can be compared to trying to throw water at a large forest fire that’s continuously burning from the edge of the forest, without quenching the source of that fire that’s found at the heart of that forest. The fire may recede, but eventually it will spread again.
This is why I always recommend a certain degree of introspection and emotional release work when one embarks on a healing journey. This advice is backed up by the fact that so many individuals that I see have had or are having significant emotional distress such as instances of abuse, relationship problems, issues of low self-worth, deep-rooted fears of rejection, grief, and so on. In such cases, treating the symptoms in isolation may not have the desired long-term effect.
That said, mindbody tools that promote relaxation certainly contribute to recovery. My favourites are somatic tracking (a PRT technique) and mindfulness meditation, because both can help the individual release resistance towards symptoms, and both promote a certain degree of awareness of one’s dominant thoughts and emotions.
Healing IS a mindset shift
Ultimately, as I always like to say, healing is a mindset shift. It’s about gradually substituting those negative emotions for better-feeling ones, both in one’s personal life as well as in relation to the symptoms themselves (one’s perception and view of the symptoms). Anything that helps in this process will prove beneficial.
That said, overwhelm can be a detrimental factor in today’s information-saturated world. There are indeed too many mindbody modalities and approaches that go by different names, but ultimately, if these are serving to achieve the same goals, our task is not to get lost in too many details.
Really and truly, it’s all about identifying possible underlying causes (too often, strong repressed / semi-repressed negative emotions and/or expectations / beliefs) behind chronic symptoms, and then working by inducing the relaxation response and lowering one’s level of fear, rage and resistance. It really is as simple as that, and I believe that the TMS approach, in the manner it has evolved today, ticks all these boxes.
For more inspiration, watch my videos below or check out my comprehensive TMS recovery program, which includes elements of pain reprocessing, emotional release work, as well as bonus meditations and other mindbody techniques to help you along the way.
References
[1] Tonya Russell, Exploring Your Dark Side Through Shadow Work, Shape, 2021.
[2] Peter A. Levine, PhD, The Unspoken Voice: How the Body Releases Trauma and Restores Goodness, North Atlantic Books, 2010.
[3] Dr John E. Sarno, M.D., The Divided Mind: The Epidemic of MindBody Disorders, HarperCollins (2007)
[4] Gabor Mate, When the Body Says No: The Cost of Hidden Stress, Vermilion, 2019.
[5] Inna Segal, The Secret Language of Your Body: The Essential Guide to Health and Wellness, Beyond Worlds Publishing, 2010.