Ep. 21: David Schechter, MD – Exploring the Mind-Body Syndrome and Neuroplastic Pain

Pain can be treated with many different approaches!

For most people, the go-to method for dealing with pain is taking pain medication. There’s nothing wrong with this approach and sometimes it’s very necessary to take some kind of medicine to ease the suffering.

I mean, I’m still very grateful for the morphine that I got after my ankle surgery where they put 2 screws into my talus bone back in 2012.

However, pain can be treated with many different approaches and before we automatically reach for painkillers it might be a good idea to consider other options as well.

In today’s episode, I talk to Dr. David Schechter, a family practice and sports medicine doctor who’s one of the pioneers in researching the Mind-Body Syndrome in medicine.

We go pretty deep into the process of how the brain and our psyche create not just our perception of pain, but pain itself and the research behind it. And because Dr. Dave is also the author of the Mind-Body Workbook, we also look at the ways that this knowledge can be used to treat the kind of pain that is likely to be neuroplastic (which is most chronic pain).

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Show notes & links

The show notes are written in chronological order.

  • Dr. David Schechter’s website: https://www.mindbodymedicine.com/
  • Dr. David Schechter’s books:
  • Biopsychosocial Model by Dr. George Engel [discover more here]
  • Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry. 1980;137(5):535-544 [read it here]
  • John Sarno, MD – Dr. Sarno was a pioneer in mind-body medicine. His books are helping many patients to become free of pain after “mainstream medicine” fail to help.
  • About Tension Myositis Syndrome (TMS) [discover more here]
  • Donnino MW, Thompson GS, Mehta S, et al. Psychophysiologic symptom relief therapy for chronic back pain: a pilot randomized controlled trial. Pain Rep. 2021;6(3):e959. Published 2021 Sep 23. [read it here]
  • Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23. [read it here]
  • ACE scores
  • Episode 18: Dr. Esly Carvalho – Exploring the EMDR Method for Healing Trauma [tune in here]
  • Smyth JM, Johnson JA, Auer BJ, Lehman E, Talamo G, Sciamanna CN. Online Positive Affect Journaling in the Improvement of Mental Distress and Well-Being in General Medical Patients With Elevated Anxiety Symptoms: A Preliminary Randomized Controlled Trial. JMIR Ment Health. 2018;5(4):e11290. Published 2018 Dec 10. [read it here]
  • Menda is an evidence-based, online Pain Psychology program. Pain Reprocessing Therapy has the highest effectiveness of pain treatments with no side effects or risky surgeries.
  • Episode 7: Les Aria, PhD – Neuroplasticity and Training Your Brain for Pain Recovery [tune in here] Dr. Les Aria is the co-founder of Menda Health and the Chief Scientific Officer for Menda. He specializes in treating psychophysiological disorders/persistent pain and functional neurological disorders, as well as, medically unexplained problems.

00:00 – excerpt from the episode
01:17 – intro (listen to discover a little more about your host. Martin will tell you a new lesser-known fact about Dr. Maya)

Dr. Maya Novak:
For most people the go-to method to dealing with pain is taking pain medication. There’s nothing wrong with this approach and sometimes it’s very necessary to take some kind of medicine to ease the suffering. I mean I’m still very grateful for the morphine that I got after my ankle surgery where they put 2 screws into my talus bone back in 2012. However, pain can be treated with many different approaches and before we automatically reach for pain medication it might be a good idea to consider other options as well. And that’s why I’m very excited about today’s guest. I’m joined by Dr. David Schechter who is a family practice and sports medicine doctor with a particular focus on non-surgical approaches. Most of his practice is chronic pain and he's one of the pioneers in looking at the mind-body syndrome in medicine. Dr. Schechter is the author of several books including The Mind-Body Workbook and Think Away Your Pain. Dr. Dave, thank you for being here.

Dr. David Schechter:
Thanks for having me.

Dr. Maya Novak:
I'm excited about today's conversation because I know that we're going to uncover many, many things and before we do that, I would like to know why did you decide to study medicine, but also, was the mind-body medicine something that you had been interested in since forever?

Dr. David Schechter:
Well I was a high school student who was very good at math and science and I began to think about my career and whether I would be happy in working in a laboratory or as a scientist or researcher, and I decided that practicing medicine and seeing patients would be something that I would enjoy a great deal more. And as a result of that I began to think about a medical career. When I was in college I studied a course in medical sociology to learn more about the profession and to learn more about what was happening in medicine at that particular point in time and I came across the concepts. Dr. George Engel, from the University of Rochester, coined the phrase "the biopsychosocial model." This model made a lot of sense to me because "bio" stands for biology, "psycho" for psychology, and I had studied both of these in college. Moreover, "social" refers to your social situation - the people you live with, interact with, and the society in general. All of these elements were clearly important to me, at least on a theoretical level. Then, I went to medical school at NYU. I found that the students and the faculty were very much oriented towards the biomedical aspects. They were not as interested in the psychosocial aspects. They were profoundly interested in the technical aspects of medicine, which I was as well. But, I was also interested in this broader perspective. Some of this interest might have come from the fact that I had a family doctor as a child. Growing up in Brooklyn, New York, I had a family physician who I transitioned to after I outgrew my pediatrician. I think he was quite aware and intuitive about stress and how it could affect your health. For example, I remember once going to him with an upset stomach. He asked me some questions and figured out that maybe I was nervous about going to a party. There were going to be girls there and stuff like that, and I was a bit shy at that point. [chuckles]

Dr. Maya Novak

Dr. David Schechter:
So, that experience helped me to be open to the idea that my own body could be affected by my feelings. And then in medical school I began to have, under the difficult conditions of the first year medical school, where you do a lot of memorization and all of that very hard work, I began to have knee pain and it was affecting me when I ran or played basketball, my two big reliefs from stress. So I did the conventional thing which is to go to the student health doctor and he couldn't fix me with anti-inflammatory medicine. They even referred me to an orthopedic doctor who was very well known because he would see the medical students for free, but he was like the New York Yankees team physician at that time. He didn't find an answer to my knee pain despite doing some tests, some of which were painful, and then I walked into Dr. John Sarno's office who was a rehabilitation professor that had lectured to us about anatomy of the leg and the back and all of this sort of thing, and I was not expecting anything more than maybe some high tech physical therapy. When I met with Dr. Sarno I explained to him that I was having this knee pain. It was really affecting my life and been going on for quite a few months at this point, and he looked at me asked me a couple questions and then said, “You know I don't know how you're going to take this,” but 90% of chronic pain in his opinion was psychosomatic. And I was shocked by that statement. Psychosomatic means mind-body. It means the psychology has to do with it as well as the soma - the body - so he said, “I see you're a little bit skeptical. Maybe a little surprised. I give a seminar to patients about this on Monday evenings. Why don't you come to that if you're interested and if it makes sense to you, I'd be happy to examine you the next week or something in a regular appointment to confirm that you have this diagnosis.” So I was at least open to the idea of going to the seminar where there were a lot of well-dressed people in the upper East side, upper West side at this conference room at the Rusk Institute of Rehabilitation Medicine, and little old me, 21 year old medical student and he laid out the concepts of what he called TMS (Tension Myoneural Syndrome), also known as the Mind-Body Syndrome. It has other names as well and it made sense to me. It made sense that I had the personality type, that I was a worrier, that I had the stresses of medical school. Social life wasn't going so well, and all these things combined to get me into a cycle of thinking and worrying and, if you will, obsessing about my pain, and this seminar gave me hope that there was another way to approach this and to perhaps get better. And the short answer to did I get better is yes. I got better over the next month or so, and I returned to basketball and running. And this so amazed me, and this so impressed me that I eventually spent more time with Dr. Sarno, doing research with him, and follow up studies and things we can talk about, and I saw that it helped other people as well. But what did the doctors and medical students at and NYU think about my amazing recovery? Not very much. They did not know how to integrate this into their biomedical, exclusively bio-mechanical biomedical approach to health and they probably just thought I was a little kooky or something like that.

Dr. Maya Novak:

Dr. David Schechter:
But I knew I wasn't. And I knew that the other patients that I called in this research study had also had amazing success with this approach. So that's what we're going to talk about today.

Dr. Maya Novak:
Absolutely. So yeah, that would be definitely my follow-up question. How did this affect your colleagues or schoolmates? Because I am also wondering - there are many physicians who don't believe in this “mind-body” stuff. So how do you approach this topic with them, or do you just let it, you know, slide away? Because I think that we are at that time when the medical system definitely needs to change, because there is so much evidence that the mind-body connection is very real. So how do you normally take these conversations with your colleagues other physicians?

Dr. David Schechter:
Now, let's fast forward through the decades since I was a medical student - it's been quite a while - and there has been more openness in society to looking at chronic pain and other conditions in a more integrative, biopsychosocial way. There's been more openness among patients, I think, to a psychophysiologic or a mind-body explanation for things, and there's actually been a lot more scientific research. So, when I talk to physicians now in 2023, I try to present this in a somewhat different way than I would have decades ago. I make them aware of the fact that there are studies - not just the outcome studies that have been done by colleagues of mine, or that I've done showing success with this approach, not just that. But there have also been some very good studies over the last few years published. Additionally, I explain to them some of the science because, as a result of a technology called functional MRI imaging that looks at the blood flow in the brain, not just the structures of the brain, we've learned that acute pain - the kind of pain you get when you bang your knee or sprain your ankle - is very different than chronic pain. Chronic pain, meaning it's persisting for more than three or six months, manifests differently in the brain in terms of blood flow. If you have acute pain, the part of the brain that seems to "light up," if you will, is the somatosensory cortex, where you'd expect it to be - the sensations going into the brain. But, the same patient with knee pain, back pain, or leg pain that persists for three to six months or more, that part of the brain has quieted down. Instead, a different part of the brain is illuminated in these studies, namely the amygdala and the prefrontal cortex. These are parts of the brain more closely linked to the emotional centers of the brain. So, acute pain, which is usually physical and mechanical, usually gets better in most cases and can be treated in one set of ways, including, in extreme cases, with morphine, as you mentioned, for post-surgical relief. However, chronic pain is not effectively treated unless you focus on the psychological aspects of recovery and why a person's stress, psychology, or other traumas from their present or past might be holding them back from healing. We now have that kind of scientific data. So, I try to speak to doctors more in those terms and try to steer away a little from some of the psychology concepts that my mentor, Dr. Sarno, emphasized in his books. He was very much a Freudian type of individual, despite being a physician. Freud is not so popular right now, and it's challenging to explain those concepts to medical doctors, especially. So, I explain it in other ways.

Dr. Maya Novak:
Yeah, so it's very much what you just described in regard to these studies and brain imaging when we're talking about chronic pain is that we actually absolutely have to talk about emotions, and what is happening emotionally with us. Not just what is happening physically with us... am I understanding this correctly?

Dr. David Schechter:
Absolutely we have to talk about - we want to ask about what you're feeling physically, but then we change the conversation or expand the conversation to understanding what you're going through as a person and what you're feeling emotionally, and what you felt right before the onset of your pain condition. And I even roll it back far enough to say what was your childhood like, because all of these things are relevant to chronic pain that has not been clearly explained by blood tests or imaging or something like that. And this refers to a lot - maybe not 90% as Dr. Sarno said - but a very high percentage of chronic pain is more related to the mind, brain and emotions, and how the brain is processing sensations and how the stresses and worries of our life cause us to overthink and over focus on sensations, than it necessarily is purely about the body and where it hurts. The pain is real. It's just that we have to approach it in a different way.

Dr. Maya Novak:
So here is the follow-up question: when we're talking about chronic pain and what you just described, is there a difference? Because I think that some listeners are going to be thinking about, “Well, is there a difference between pain that starts from “nowhere”, or pain that starts after an accident where a physical injury really happens?” Is this the same or not?

Dr. David Schechter:
That's a very good question. When you reach the point of chronicity, meaning three to six months or more, it doesn't even matter that much whether the pain started with an accident, an injury, or seemingly out of nowhere. Now, I'm not suggesting that every single person with chronic pain has a solution in the core program that we're going to discuss today, which is designed to activate the mind and body. Because, of course, I always review people's imaging and lab work.
There are indeed physical conditions that can cause pain - I don't deny that. Certainly, cancer metastasis can cause pain. There are many things that can cause pain. However, it turns out that a lot of people with chronic pain, even those diagnosed with a mild or nonspecific structural problem who haven't improved with conventional or alternative treatment for that problem, can respond effectively to this approach if they're open to it.
Part of my conversation with you today is to help more people become open to it. I would like them to at least consider this approach if they have not responded to other strategies for chronic pain and other chronic conditions, which we can discuss further on the show.

Dr. Maya Novak:
Yes, when we're talking about chronic pain or pain in general, does this include any kind of pain? For example, fibromyalgia that can be also treated by this approach or are there very specific pains that we can treat with this approach, but some other conditions that potentially might not respond well or not respond at all?

Dr. David Schechter:
Well, we've made a list of conditions that we've effectively treated with this approach, and the list is quite extensive. It includes conditions like fibromyalgia. I don't want to engage in a debate with those advocating differently in the ME/CFS community, but many patients with chronic myofascial pain, who've been diagnosed as having fibromyalgia, do respond well to this approach. Many people with legitimate migraine headaches, including in some cases those with a family history of migraines, thus indicating a genetic predisposition, have responded positively to this approach of examining stress and emotions. If you have an arthritic hip with a limited range of motion and severe arthritis, you're probably better off getting a hip replacement than trying to approach it psychologically. If you have a condition called ankylosing spondylitis with documented inflammation in the sacroiliac joint, this approach may not be the best for you. However, there are so many conditions for which this approach does work. There are also other conditions that it may not solve, but it can help. I hope those listening will keep an open mind as we discuss how we approach these problems and examine people with these different types of conditions.

Dr. Maya Novak:
Yes, absolutely. Now, what you said a few minutes ago about approach when you are talking with a patient, maybe for the first time, you ask many questions and then also do the physical examination. Why or how is childhood trauma or something that happened in childhood actually connected with chronic pain that we are experiencing now. Because perhaps people right now are thinking, “Well, I had an injury or I have this chronic pain. But what does my forty, fifty, sixty years-ago trauma have to do with what I'm experiencing right now?”

Dr. David Schechter:
Well, there's a term that people sometimes use in a derogatory sense - "It's all in my head." I never use that phrase, but what is in your head is your brain, and without your brain, you don't feel anything. For example, if you go under anesthetic for an operation, you're asleep and don't feel anything because your brain is asleep. All sensations, whether they be from a broken leg that hasn't healed well, an inflammatory condition in your back, a bulging disc, or a muscle spasm, which is a very common cause of chronic pain, are ultimately processed in the brain. In addition to processing sensations from the body, the brain, as a human organ, also processes emotions. These emotions can be those we're experiencing on a particular day - for instance, "I'm having a nice day," or "My boss screamed at me, I'm feeling really anxious right now." But the brain is also processing these emotions in the context of who you were at ages 2, 5, and 12. Those experiences seem to linger. There's been a lot of research on what's called Adverse Childhood Experiences, or ACEs. It turns out that people who have a high ACEs score, meaning they experienced more trauma (both "big T" and "little t" trauma, which we'll define later) as a child, are much more likely to experience a variety of illnesses in their 30s, 40s, 50s, and 60s - many decades later. This not only includes chronic pain, but even conditions like diabetes and high blood pressure are more common among those who experienced childhood traumas. These traumas can include things like divorce, a parent in jail, obviously various types of physical, psychological, and sexual abuse. But it can also include bullying, and other issues that are "small t" traumas, rather than “Big T”. We believe all these experiences affect how the brain works and responds to stimuli. You know how some people are more gung-ho, or go for it, for example to try a new sport or activity, while others are more timid or shy. Obviously, we all have different genetic makeups and personalities, but we also have different childhood experiences, which may make us more or less willing to try new things or to be open to new experiences. Those are just examples of how childhood experiences can affect us many years and decades later, and how they can also influence our experience of illness or pain.

Dr. Maya Novak:
Thank you for explaining this. I think that it's very important that we acknowledge and really talk about that “big T” trauma may not necessarily have more effect on what we're experiencing now than “small t” trauma, because sometimes people are like, “Well, you know what, my childhood wasn't so bad. I mean, I didn't experience anything so bad. So why am I suffering right now?” But it might be something that for one person is a small thing can be a very big thing for our own psychology. Would you agree?

Dr. David Schechter:
Absolutely. And you know, there are experiences in childhood that pull you down, and there are also experiences that can pull you up. So for example, there's people who have unfortunately not great parents or not attentive parents. But maybe there's a grandparent, or there's an uncle, or there's a teacher or coach who gives them that help and that mentoring and that self-esteem that they really need growing up. So not everyone is blessed with the best circumstances, but you can you can move beyond that. Especially with the help of other people, or if you get to adulthood with the help of trauma work and psychotherapy and EMDR and other techniques that are used to help you work through those things. But the key thing, the key lesson from the standpoint of my talk or my experience is that these things are relevant to your health when I talk to you about them in the office today. Not just relevant ten years ago, or twenty years ago - they're really important now.

Dr. Maya Novak:
Yes. Now, before you slightly touched.. well, slightly - you talked about emotions quite a bit. But can we go a bit deeper into what is actually emotional pain. How is emotional pain processed and also how is it creating these physical sensations?

Dr. David Schechter:
Okay, well those are those are very good questions. Let me let me start with what we call the Type T Personality. The Type T personality is characterized by traits that many individuals suffering from chronic pain or the mind-body syndrome, TMS, which we're discussing today, often exhibit. For example, these individuals are often hard on themselves, perfectionistic, people-pleasers, sensitive to how others perceive them, and highly responsible for others - sometimes to the point of neglecting their own self-care. Some people are "goodists," meaning they have an overwhelming desire to fix a broken world, a task that can be draining when you're just one person. Having one or more of these characteristics, we believe, leads to increased pressure and tension. Now, these aren't necessarily bad characteristics to have. You'd probably want a friend or a partner who is responsible, for instance, and being a "goodist" isn't so bad. However, these traits can put a lot of pressure on individuals, potentially making their autonomic nervous system, the fight-or-flight response, more active. This fight-or-flight response is a biological mechanism designed to protect us, such as when an animal chases us with the intent to eat us. It allows us to either run away or confront the threat. This response is encoded in our DNA, but in the modern world, we don't often face these types of physical threats. Therefore, our fight-or-flight response should be less active most of the time. Unfortunately, the stimuli of social media and the rush-rush-rush of our environment impact us and interact with our personality and our responses, creating a hyper aroused autonomic nervous system. We believe this contributes to the physiology of chronic pain.
And that's why lowering the fear of what's wrong with you is one of the things that I work on with patients - reducing the fear associated with their condition. Often, this fear is not correct, it’s a false fear – for example, the fear that they'll end up in a wheelchair, or that they'll suffer from chronic pain for the rest of their life, or that they'll have to stay on medication forever. If I can help a patient let go of these fears and worries, and if I can get them to moderate their Type T personality traits - not change them completely, just tone them down a bit - we often see tremendous progress in their physical sensations and overall wellbeing. I hope that answers your question to some degree.

Dr. Maya Novak:
Yes, oh absolutely it answers it. So in general, how many of your patients would you say need this kind of approach. Is this like 90 or 100%, or are we talking about, here and there, or 50% - what is your experience?

Dr. David Schechter:
People require this approach to varying degrees. For instance, when I have a patient who has suffered from chronic back pain for 10 years, and no one has been able to help them, preventing them from walking, playing tennis, or jogging, they need a comprehensive consultation that lasts 45 minutes to an hour. They need to focus on the whole program, which we'll discuss shortly. On the other hand, if someone comes in mentioning that they're not sleeping well due to stress at work, they may need just a bit of this approach. If another person mentions that their previously manageable headaches are becoming more frequent, I have to explore what's happening in their life a little more, implying they need slightly more attention. Different people need different amounts of attention. Studies have shown that 40 to 60% of patients visiting a primary care physician, such as an internist or a family practice physician, come in with some type of mental health-related issue that they might not even be aware of. Their symptoms might manifest as headaches, chest pain, arm pain, fatigue, or insomnia, but the underlying cause is often stress, emotions, or a mind-body issue. In my opinion, most doctors barely scratch the surface with even 10% of these people. When it comes to chronic pain, probably around 70 to 90% need to work with this type of approach. However, in terms of ordinary medicine and life, people need bits and pieces of this approach. Some people need to meditate a little, some need to breathe more often and more relaxedly, and some need more sleep or exercise. People need different things, but not everyone needs the entire program that we use, which includes education and journaling among other things, and we'll discuss this further shortly.

Dr. Maya Novak:
Yes, absolutely, it's really figuring out what works for that person. So it's not like, “Here’s 10 steps and you have to do everything.” And then maybe you don't even have time to go to work right? Because you have so many things, and meditation, and journaling in the morning and evening. So it's really about what works for that individual.

Dr. David Schechter:
Yeah. Yeah, individualizing the approaches is very important.

Dr. Maya Novak:
Yes, so when we're talking about chronic pain. very often we think that you have pain every single day, all the time, or maybe in the morning, or maybe in the evening. But what is your experience with pain that comes and goes, where potentially people are not even thinking about it as chronic pain because they have it for a week, let's say, and then it's fine for a few weeks, and then it comes back. Or maybe it resurfaces in another part of the body. What would you say to those people or what kind of approach is good for this kind of situation?

Dr. David Schechter:
So you'd be talking about episodic chronic pain rather than constant chronic pain. Constant chronic pain is pretty much every day that somebody's affected by their pain condition, and episodic pain can vary in terms of how often it happens, but it might be somebody who seems to throw their back out twice a year, or once every two years or something like that, often with no clear reason why their back is thrown out. But as you start probing, you find that those episodes seem to occur after conflict at work, or conflict at home, or issues with the teenage children or whatever it is. You find something that is the relevant psychological trigger. It depends on the person's motivation. I can't help anyone who's not open to being helped in this way. I can write a prescription for medication, but I can't get them to... I can't fix their mind-body biopsychosocially, unless they're open to it. I can be more reassuring than some doctors. I can be more calming than other doctors. But I really need the patient to be involved. That's an exciting part of my work and it's also I guess a challenge, because not everyone is initially open to this. I find that sometimes I plant a seed with regard to the mind-body approach and that patients will later come back and say, “You know that thing you mentioned to me,” or “That website you told me about. I looked at it after a couple of months and boy it really makes a lot of sense to me, can we make an appointment and talk more about that’” So sometimes people are not ready for change right away but they become ready down the line.

Dr. Maya Novak:
Yes, it's really about planting the seed and at the same time, we have to know that when we have pain for a very long period of time it becomes a part of our identity. So even though we would love to get rid of this pain, who are we without this? Who am I if I don't have this crippling sensation? Who am I if all of a sudden I can do so many things?

Dr. David Schechter:
Right, I mean that's a very important point that chronic symptoms can become part of a person's identity. Not necessarily in a positive way, but there can be almost an attachment. I had one patient who very eloquently said that pain had become his friend. Now it wasn't a friend that he liked. But it was a relationship that he had and it was kind of learning to give up that relationship, to give up that connection. Seems ok, right? Who wouldn't want to give up that friend and kick him out of the door? But he realized that there was a connection there, as you mentioned.

Dr. Maya Novak:
That's a really great insight, because potentially many people are not aware that they actually have a relationship with something that causes pain, or pain itself. So it’s very necessary that we slowly disengage these relationships so we can then say, “Bye-bye. It was nice meeting you, but now it's time to move on.” And I think that during this whole process it is very important to have self-compassion as well. The know how to take care of ourselves, right?

Dr. David Schechter:
Yes, very much so.

Dr. Maya Novak:
Please can you can you explain what is self-care for you, or what do you tell your patients about self-care?

Dr. David Schechter:
Well, we find that a lot of people with chronic pain are very good at taking care of other people and not as good at taking care of themselves. They're kind of not putting themselves on the list of those people they take care of. They're not focusing enough on doing things that they enjoy which is a great solution for pain. For example, playing golf, playing tennis, dancing, other things that you would associate with being free or being childlike. Playing can be very therapeutic. Self-care is different for different people. For some people, it's going into a jacuzzi once in a while. For other people, it's getting a massage. For other people, it's getting your nails done. It can be different for different people. But it's important to think about ourselves in terms of caring, just like we care for other people.

Dr. Maya Novak:
Yes, well you have a really amazing Mind-body workbook and it would be amazing if we can go through a bit of this. We talked in advance that we can go through a few exercises so that people can take what we are talking about, this theory, and put it into practice. Could you explain what we're going to be doing right now, and what would be a really good thing for people to do.

Dr. David Schechter:
Yeah, well I want to put this in context. So I see a patient and I diagnose them with what I call TMS or the Mind-Body Syndrome, or Tension Myoneural Syndrome, also called Neuroplastic Pain. It has a lot of names. Now I diagnosed them with this ah condition and I say to them that there's a treatment program. So the treatment program is education, which involves reading a book, listening to a podcast, perhaps like this or a podcast very focused on the treatment, and journaling. Journaling is one of the things that I advocate as a treatment approach for a lot of conditions, including chronic pain. Journaling or expressive writing is sitting down, as I'm advising now those who are listening to play this part of the show either now or later when you can sit down, ideally at a table or a desk, and you can write. It's ideal to write with a pen or pencil and paper. If that's not possible for you, you can type on a computer. What we don't recommend is to just think about the answers. It turns out that's not effective. They've actually done research on this. So writing is effective, typing is pretty good, although not as good as writing and even recording the answers on your phone or on a recording device is effective. So you've got to do something with the answers, right? So if you're in your car, either park or do this later. If you're at home you could potentially do it now, and I'm going to in a moment read a question, and then give you some time to answer it. Now because of we want to show the flow I'm going to read the questions sequentially, but you will take 2 to 4 minutes for each question to write about it. We usually say ten or fifteen minutes a day and there's about 4 questions a day in this section. So whatever it takes you - 1 minute, 2 minutes 4 minutes per question - take your time to write it out. Don't rush. Then restart the podcast with the next question. You can do it later if you don't have time now, but thinking the answers is not as effective as writing them, and we call this the Mind-Body Workbook. So I'm gonna be working directly out of that today.

Dr. Maya Novak:
This is very interesting that thinking about the answers is not enough. But if you are saying things out loud and recording yourself, it is actually working. If perhaps someone doesn't... you know, there are some people who perhaps right now in this moment they don't have the capability of writing because perhaps they have injured arms, but there are some other things that they can do. So don't just stay in your mind. Do something with that.

Dr. David Schechter:
Yes, exactly do something with the answers. Writing if you can. Typing on a keyboard or recording the answers, and obviously you want to have some privacy for this. So it's best to be in a room quietly by yourself, without your children, without your significant other, and just do the writing. It can mean a nice daily thing. You don't have to do it every day. You can do it a few days a week - it's a nice emotional release. Makes you aware of some things, and when you start writing, sometimes things come out that you didn't even realize you were thinking about. They come out from deeper inside of us. So can I start with the first question?

Dr. Maya Novak:

We'll continue in just a moment. I wanted to quickly jump in for two things. First, thank you for tuning in. And second, I’m sure you have at least one friend, colleague, or family member who would very much appreciate this episode. So share it with them and help us spread the word – I’m thanking you in advance. Now let’s continue…

Dr. David Schechter:
And remember after each question I'm going to pause briefly but you should stop the podcast and then write your answer for a couple minutes and then restart the podcast. We resume the podcast at that point so I'm reading to you from Week Four, Day One of the Mind-Body Workbook Volume 2, which is the most recent one that was just published recently. And this week we will focus on an area of life that's often neglected and it's very important for healing and for ongoing flourishing. So the question number 1 in this this week; sometimes people believe self-criticism helps them succeed or do well in life. What are the pros and cons of being highly self-critical? So that's the question to answer you can pause..... Welcome back. Question 2: describe an incident when you have been highly self-critical in your life. How did you feel about this and how did you or might you get out of this cycle? Pause and do the writing..... Welcome back. Question 3: What are the benefits of being self-compassionionate, self-nurturing or self-soothing? Have you had any experiences with this? To discuss, write your answer for that question.... Welcome Back. Can you see a connection between your approach to criticism and self-compassion and how it relates to your childhood experience? Please elaborate.
So you're writing your answer and that was a whole day's worth of questions for you, so consider that to be 10 to 15 minutes of writing..... Welcome back. Now if you want to do another day, we're going on to Week Four, Day 2 in this workbook which has a total of 30, or 32 days of journaling. So I'm giving you the second day now. Question 1: self-criticism and criticism of others are highly associated with each other. Identify 3 people or situations in which you can be more kind and compassionate. So now you're going to write for several minutes about this, pausing the podcast..... Welcome back. The question number 2 for Day 2: in what ways are you self-critical in relation to the healing of your pain. For example, do you beat yourself up for not having healed quickly enough? And you're writing your answer.....
Welcome back. Question 3: do you hold constantly high expectations for yourself? Elaborate: is this innate to you or does this reflect your upbringing, or both? And again, write your answer or record it or type it, pause the podcast and then come back..... And now for the fourth question on Day 2 of the Mind-Body Workbook Volume 2 that we're journaling about today. What feelings, thoughts, or parts of yourself are you most critical of? How might you be kinder to yourself about these issues? So write your answer and then when you come back I also wanted to mention I have an affirmation that we've written each day for the workbook. Affirmations are positive statements that you can repeat to yourself. Sort of reset your brain and break up some of the negative chatter. I forgot to read the affirmation for Day 22, but Day 23 which is the one we just did, the affirmation is “I am courageous for committing to heal from TMS and chronic pain. I am courageous for committing to heal.” So that's something you want to repeat to yourself to erase some of the negative chatter.
The affirmation for the previous day which you've already written the journaling about is: “I can be kind to myself, self-loving, and still be successful. I can be kind to myself, self-loving, and still be successful.” So the exercise is basically writing every day or most days of the week. The workbook gives you these 4 questions - every day different questions, written by me and a clinical psychologist based on our experience working with chronic pain and other conditions, and then we wrote a particular affirmation for each day of the workbook that was connected to the day's theme. And by journaling every day, either in a blank notebook without the workbook. The reason I wrote the workbook is that the prompts can help you to find things to write about. Because sometimes if you write just in a blank notebook after a few days you run out of things to say, and I've been working in this area for a long time and I also wrote the book with a clinical psychologist, Dr. Barker, and so together we're able to craft questions that help you to look at different parts of your life. If we were working on a different week we might be talking about your family, your childhood, your work... We might be talking about gratitude.
I'll give you a one more very brief exercise from Week 3, Day 4; it's a gratitude day. So once a week we have a gratitude day in the journaling. 3 things you were thankful for this week, or in your life. Take the time to do this, pause the podcast, and come back when you think of 1 of the 3 things that you were grateful for...... How does it make you feel when you reflect upon that item or person or thing? And again, pause and write about this for a few minutes...... and the third question on Day 4 of Week 3 is to write about this item or one of the other 2 things you were thankful for in more detail. The more detail you use, the more grateful you feel, so it's just a chance to elaborate more upon that. The affirmation we came up for that day - and you can pause the podcast to write about that some more - but the affirmation was: “I learned to appreciate all the bounties in my life. I learned to appreciate all the bounties in my life.” So that's an example of three different days; two days on self-compassion, one day on gratitude.
Now I can bet that most people in the audience have never had a doctor tell them to journal, or never had a doctor tell them to write about things they're thankful for, but there's scientific research - like a lot of scientific research that journaling is therapeutic for a variety of physical and mental health conditions. And that gratitude journaling specifically helps with depression, anxiety, low self-esteem... a lot of things. The reason why nobody's telling you to do this is there's no pharmaceutical companies profiting off of journaling. And last time I checked the places you can buy a notebook for $2 a blank notebook are not advertising that to doctors, right? They're not making a lot of money off buying a notebook at your particular retail store or online store that you use. And even the workbook which doesn't cost that much more than that is not as well-known, although over 35000 people have used the original Mind- Body Workbook. Over the years it has accumulated a lot of users, and the new workbook I think is even better, the Volume 2. It’s a great exercise That's my major take-home message for you: that you can help a lot of your conditions by journaling, and I've given you very specific examples and questions on how to do it today. So Maya, thank you for that.

Dr. Maya Novak:
Yes, well, thank you for sharing this, because this is so extremely helpful, and these questions are questions that people don't just randomly think about: “Oh, what should I be journaling?” They're very specific and they're guiding you how to do this and what to do with this. So I am so grateful to you and I encourage all listeners to look into this workbook and purchase it because it's definitely... oh my goodness, I know that I want to start journaling in that workbook because it's so helpful. So thank you for sharing this.

Dr. David Schechter:
You're very welcome. Thanks for having me on the podcast to talk about this and to and to share this particular actual practical activity that people can do to feel better that you don't hear as much about. You hear something about journaling, but you don't hear quite as much about journaling as you might do with meditation and yoga and other things that are also very helpful, but it's really not easy to do right. Sitting down and writing about your feelings, writing about your past, writing about your gratitude, writing about your anger is not that easy to do. But it's worth It. You get something out of it. You really do and the cost is very limited, very, very minimal compared to anything else you could do in this area.

Dr. Maya Novak:
Yes. So what do you suggest when the person is done with journaling for that day. Do you suggest for people to keep the answers, or do you prefer for people to tear it apart. You know, in a way to let it go. What is your approach, what do you advise?

Dr. David Schechter:
That's a very good question and like many things, I do try to individualize it, and I recommend people individualize it. If you're having an angry outburst kind of a day, sitting down writing angry dark stuff, looking at it and then ripping it up can be very helpful. The expressive writing or the journaling that we do in the workbook I think is good to keep, because at the end of the thirty days, or thirty two days, or whatever is in the workbooks, you can go back and you can look back on day one, and day five, and you can see how you've grown in the course of the thirty days of writing. You can even look back six months later and see how you've changed. So I think there's a value to keeping it, especially if you can do so in a private place where nobody's going to read the things that you wrote. If you don't have privacy, then rip it up or shred it if you feel like you want that release, then maybe some days rip it up. But I generally say keep it and you can refer back to it later.

Dr. Maya Novak:
This is a great point because it sometimes is very difficult to acknowledge how much work or how much growth we've actually done, so having something that we can look back and see; “Oh. 2020 or 2023 I was here ,but now I am here. So wow, how much I've changed!” So I think it's very important for people to have that opportunity to actually see that yes, they are changing, they are growing, things are changing. So that it's not like as it was in high school, for example, right? So that we are all growing and evolving. So this is a really great point.

Dr. David Schechter:
I've talked to people who have journals throughout their life that they've kept, and you know some people want to pass it on to other people. Other people want to destroy it before they get really old. But whatever you decide to do with it, whether you keep it for a day, a week, a month, ten years or forever, I think there's a value in doing it. A value in writing, a value in sitting down and just letting your feelings out and trying to kind of connect them to childhood experiences and other things in your life.

Dr. Maya Novak:
Yes, there are some listeners I'm sure who are right now saying, “Dr. Dave, I've been doing this type of work for such a long time. Yes, I'm going to get your workbook, but what can you tell me about how can I approach this? Because I've been doing this for such a long time and I cannot think away my pain. So do you have any suggestions? Because right now I feel very defeated - am I doing something wrong? Is it something wrong with me?”

Dr. David Schechter:
I think that I would first recommend that they try to see a physician who utilizes this approach and whereas there are not thousands of them, there are dozens of them. And not just the United States, but other countries as well. I have a list on my website, on Mindbodymedicine.com, of physicians practicing in different states. Obviously I practice in California and during the pandemic I was able to do a lot more telemedicine, but now the restrictions are coming back. As life gets better unfortunately telemedicine gets worse. So I recommend you see a physician, if you can, who's an expert on this in or near your state or location. If you're interested in coming to California or you live in California I'd be happy to see you in California. So getting a physician diagnosis can often provide an extra step forward in accepting and in reducing doubt. The second thing I would do is make a list of what progress you've made and what struggles you've had, and make a list of why you believe you have a mind-body condition, and why you struggle to accept that, because I think that can provide you some clarity as to whether doubt is holding you back, your own doubts. And another thing - after you've had a diagnosis from a physician and you've worked - if you said you've worked on your own for a while - maybe finding a psychotherapist. Again, list on my website or other places. There's PPD association which is psychophysiologicdisorders.org that has listings as well that it's a nonprofit that I'm involved with, so finding a good psychotherapist that can help you with looking at some of these issues might help you to think away your pain, think away your other conditions or understand your mind-body connection better. There is help out there. In other words, putting together the right team might be beneficial. There's some great apps now that are out there. I'm affiliated as a consultant with an app called Menda. They do online groups in many states virtually, so that's another resource now that these couple of companies have come up with apps and done online programs. So these are some ideas I have for you. I hope that this helps those people who feel stuck or who feel like they're not making the progress. I tell people to sometimes take a break from it all. Let's see, you've been doing mind-body work for a while - take a couple weeks off and just do other things. And then maybe you come back to it with a fresh perspective. Maybe some of the things I've said today will give you a fresh perspective or fresh excitement about approaching it this way, and as I mentioned, putting together the right team virtually or in person can be very, very helpful, and groups can be helpful as well. So there's some online groups done virtually through some of these apps, or my office if you're a patient of mine. So there's lots of different ways to get the help you need.

Dr. Maya Novak:
This is very helpful. Great insight, and it's very important that people know that they are not alone, because when people are in chronic pain, they feel very isolated. And they feel that no one really understands them. So it's hard to then also reach out because if you feel that you are alone - where to look? But right now you just told us so many places where people can look to get the solution, because solutions are out there and not just out there but inside of us as well, right?

Dr. David Schechter:
The ultimate solution is inside, but it can be helpful to have, as you said, to feel like there's a community helping you. Other people with chronic pain that you can talk to in these various groups and things.
I'm not I'm not a huge fan of support groups in genera. I'm a fan of healing groups. A support group often requires you to continue to be sick to be part of the group I'm looking for more of a therapeutic group like the one that I lead from my office, or that Menda leads, or there's other companies that have apps that do that. Because that has a goal of getting you to eventually be independent of the group, not to be a permanent member of a pain society, so to speak.

Dr. Maya Novak:
Thank you! Yes, because support groups very often are kind of for people to feel that they are accepted and they belong. But it’s exactly what you said; usually there is no goal, or the goal potentially is not positive. So it's just about talking about pain, talking about this difficulty or that difficulty, and there is no solution. So yes, I completely agree. Now before we finish this very helpful and interesting conversation, I have one question that is out of the box. Very fun question, and this is, if you were stuck on a desert island with an injury and you could bring only one thing with you that would help you heal amazingly, what would that be and why?

Dr. David Schechter:
Okay, okay. So I'm stuck in a desert Island and it’s not that I have chronic pain. It's not that I have a psychophysiological disorder I have an injury and I can only bring one thing?

Dr. Maya Novak:
Well pain is also kind of an injury, or physical trauma, right? So you can choose whatever kind of injury you would like to, absolutely.

Dr. David Schechter:
Well, if I had or I if I thought that I would have a stress related condition, I would bring my book or my mentor's book, or one of the books in this area. If I was going to bring one thing on a desert island I think I would bring a foam roller because I think that it's a nice thing to be able to sort of stretch your hamstrings and your calves and other things while I'm climbing up to get those pineapples or those fruits from the trees on the island to survive. I'm thinking of the Tom Hanks movie of course from years ago I've got to have something to keep my body and shape. So maybe I would get like a hard foam roller. Not the softie ones, but the ones that are hollow and have a hard plastic core. That's what I would bring with me.

Dr. Maya Novak:
That's great. Dr. Dave, where can people find out more about you, your work, and how to get in touch?

Dr. David Schechter:
Well, the website mindbodymedicine.com tells you about the work that I do, has contact information, and also has connections to my books as well, so that's probably the best way. I'm in Los Angeles, specifically Culver City, California, but you don't have to look me up that way. Just go to mindbodymedicine.com - it's all one long string of words.

Dr. Maya Novak:
Dr. Dave this was amazing. Such invaluable information that you shared today and I know that it's gonna give so many insights to listeners. Especially after they do the whole journaling exercise, everything that you shared, and then also get your workbook so that they can continue this. And may I ask you what is your experience? Because potentially people are curious how fast will they see results when they are doing these exercises in your workbook?

Dr. David Schechter:
Well, that's a common question that I get asked and my ultimate answer to that is everyone's different. Every situation is different. I mean, I had a school teacher who called me one morning and she said, “I'm just feeling so lousy and so much pressure, and I think I'm gonna have to take the day off of work.” So I said, “Why don't you just take ten or fifteen minutes and just journal about everything you just told me right now?” And she called me back in half an hour and said, “I just want to let you know I'm getting in the car and I'm driving to work. I feel better.” So that's an extreme example of somebody who was having just like an acute problem and spilled it onto paper and felt a lot better after that. I don't want to predict how long it takes to get better from chronic conditions because it really is so individualized. It doesn't matter how smart you are, you still got to do the work. It still takes time. It doesn't matter how clever you are or you think you are, it’s just really very different from person to person. So you just have to go through the process.

Dr. Maya Novak:
Yes. Dr. Dave thank you so much for this. I really enjoyed our conversation and I'm very grateful for your knowledge and for everything that you shared with us today.

Dr. David Schechter:
Thank you so much for having me.

Dr. Maya Novak:
This wraps up today’s Mindful Injury Recovery Talk with Dr. David Schechter. If you haven’t done it yet, subscribe to the podcast on whatever platform you’re using to tune in, and share it with your loved ones. As you know: sharing is caring. To learn more about The Mindful Injury Recovery Method visit my website mayanovak.com and find my book Heal Beyond Expectations on Amazon. Until next time – keep evolving, blooming, and healing.

Love and gratitude xx
Dr. Maya

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