Live Workshop 2

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    Thanks so much for being with us, Jessy.

    Many, many people will downplay their feelings and move away from dealing with them. One thing that may help is if you can help them see that talking about these feelings or exploring them will often create some tension in their body (like neck discomfort or stomach tension). Another thing to try is to give examples from your own life (or others) about how everyone has anger towards their own children at times. And when that anger is seen as being wrong or inappropriate, it gets suppressed, and pain can result. Again, tell stories about that, just like I did with getting fired from my job and laughing it off, and then getting back pain due to suppressed anger. I told you all that story, right?

    In a similar vein, one of the best ways to deal with skepticism about the diagnosis is to show people the connection, rather than telling them about it. So, I use provocative (or neural circuit) testing, as described in the Ovid app to demonstrate the relationship between the brain and the symptoms. You can also ask them to look for the FIT criteria occurring in their life between visits, such as triggered pain with weather, stress, simple movements, etc. OR pain that shifts or moves or spreads, etc. Over time, these findings will likely occur and then you have evidence for a mind-body cause for their symptoms.

    Does that help?
    Best, Howard


    Thanks for your questions, Jessy.

    It is very common for people to downplay their emotions; everyone does it to some degree. It’s a way to protect oneself and avoid dealing with painful emotions. Every parent has times of being very angry at their children. There is often no acceptable outlet for this anger, which is why we developed EAET! One way to show the connection between emotions and MBS symptoms is to tell stories from your own life or your patient’s lives; and another way is to talk about the emotions and see if some symptoms begin to emerge, such as neck or stomach tension. I had a patient who refused to believe that her rocky relationship with her daughter was one of the causes of her pain. One day, in a therapy session, her therapist forced her to face this issue and her pain got very high. Finally, she knew.

    The same process is useful for people who hang onto their diagnosis and a structural issue. You can use provocative testing and the FIT criteria to prove that it is MBS. And, you can investigate their symptoms over time by probing for times of pain getting better or worse and looking for evidence of pain that shifts, moves, turns on and off, is triggered by innocuous stimuli, etc. Usually it will become obvious.

    Best, Howard

    Jessy GlaubJessy Glaub

    Yes, that helps! Following up on the NCD provocative testing recommendation, how often do you find those test being positive? I have done these only a few times which were negative each time, I know they don’t need to be positive for an NCD to be present. After reading the articles shared with us about threat conditioning, I figure I should choose aggravating activities that have been more conditioned than general movements that cause pain as these are probably less conditioned, which would make sense and the app discusses the importance of doing that.


    I find that the provocative testing “works” about 70% of the time; and a recent research study appears to corroborate that! But I have also found that it is much less likely to “work” when the person is not buying into the mind-body concepts, interestingly!! 🙂
    Best, Howard


    It has been my experience that the single most powerful and indeed essential element in these interactions (and patient outcomes) is the “buy in” part, Howard. The engagement of the patient, where belief must enduringly trump skepticism and doubt, is the deal maker/breaker. After often years of disappointment and disillusionment, this can be a very tough sell! I think that the way you, in Unlearn Your Pain (and Alan Gordon, in “The Way Out”) emphasize how belief (ie Trust The Program), is the key, and you have both expressed that eloquently. Expectation of improvement or resolution leverages the placebo effect and sets the stage for neural circuit re-wiring. Expectation of improvement will also vanquish the nocebo effect. Because neural circuit disorder patients are often great skeptics, the pace of THEIR buy-in or acceptance of MBS (often by default, after nothing else would help) is often the rate limiting step in catalyzing and achieving lasting change.

    It is not surprising to me ie intuitively obvious that provocative testing outcomes are proportional to patient buy in. Please send along a reference to that article you mentioned above.

    I think it is very appropriate to offer up the list of hybrid diagnoses, beyond those that fit exclusively into the Mind or Body camps. Put another way, what chronic (and many acute) illness does not carry with it both mind and body components?

    I wanted to add that the screening forms (Body Map, Lifetime Stressors, Lifetime ROS, Personality Traits) from our first week’s class seem to be very potent ways to gently introduce some new thinking to a “negotiable” patient and provide a ton of clues (red flags) to an astute practitioner.I look forward to learning more about how to proceed in the treatment realm. Very exciting! Best regards, Murray


    Thanks so much for your own eloquent words, Murray. I agree with you wholeheartedly!
    I can’t reference that article as it hasn’t come out yet, so sorry about that.
    Sometimes, it takes time for people to realize that they actually have a mind-body condition. It can help to just wait and see; and observe the symptoms closely as they often will vary, change, shift, or become triggered by innocuous stimuli. Usually, the truth will emerge over time! 🙂
    Best, Howard


    Here is the requested syllabus for the year. I don’t see an upload function, so I’m just copying and pasting…
    OVID Dx Certification Course 2023

    The course begins the second Wednesday of every month, starting January 11, 2023 from 12-2pm CST, Jan. – Dec.

    Program Overview

    Clients and patients often present with chronic symptoms for which there is no clear medical explanation. These syndromes include chronic pain, anxiety, depression, fatigue and insomnia. High rates of lifetime trauma and unresolved emotional experiences often underlie these conditions. New research and clinical practices have been shown to be effective for these individuals. This training offers the clinician the opportunity to gain advanced knowledge and skills that will be immediately applicable to their practices. The program is delivered via a year-long workshop series of 12 live, virtual 2-hour monthly training sessions lead by Drs. Howard Schubiner and Alicia Batson.

    CME/CE Offered:
    2 credits per 2 hour LIVE-only workshop (up to 24 credits for LIVE-only certification course) for physicians, nurses, psychologists and social workers

    Program Objectives

    Attendees will be able to:
    Describe the role of the brain in neural circuit disorders
    Describe which disorders are clearly caused by neural circuit disorders
    Determine which patients have neural circuit disorders and which have structural disorders
    Perform neural circuit testing in the assessment of neural circuit disorders
    Explain neural circuit disorders in a clear and compassionate manner
    Refer patients to appropriate resources in the treatment of neural circuit disorders
    Initiate treatment using pain reprocessing therapy and emotional awareness and expression therapy

    The curriculum will consist of the following exercises:

    12 sessions which consist of the following components:

    1. Didactic material as described below for each month (45 minutes)
    2. Case presentations demonstrating how to use the mind-body approach with
    individual clients (30 minutes)
    3. Presentation of new research findings from the literature (15 minutes)
    4. Question and answer component (30 minutes)

    Course Content:

    Workshop I: Common mind-body conditions
    Participants will describe which conditions are almost always mind-body
    Participants will describe which conditions are rarely mind-body conditions
    Participants will describe which conditions are typically hybrid conditions with
    elements of both structural and mind-body conditions

    Workshop II: Predictive coding/how the brain works
    Participants will describe predictive coding
    Participants will give examples of predictive coding
    Participants will describe how predictive coding affects one’s experience of somatic, cognitive and sensory experiences.

    Participants will describe how pain develops and what makes pain become.
    Participants will describe what reinforces chronic pain
    All pain is real/validation/offering hope
    Participants will describe three myths about chronic pain (injuries heal, scars
    don’t hurt, MRIs are always abnormal)
    Participants will be able to communicate to clients that all pain is real and that it
    comes from brain neural circuitry

    Part IV: Assessments Part One—body map, ROS, ACEs, fear, personality traits
    Participants will be able to use these instruments to assess clients for mind-body
    Participants will be able to use these instruments to predict likelihood of mind-
    body conditions

    Part V: Assessment Part Two—FIT criteria and Evidence Sheet
    Participants will be able to use these instruments to assess clients for mind-body
    Participants will be able to use these instruments to educate clients about mind-
    body conditions

    Part VI: Assessment Part Three—Provocative testing
    Participants will be able to use these instruments to assess clients for mind-body
    Participants will be able to use these instruments to educate clients about mind-
    body conditions

    Part VII: Putting it all together and beginning the program
    Participants will be able to confidently make a diagnosis of a mind-body
    condition when appropriate
    Participants will be explain their reasoning to the client and assess client’s
    readiness to engage in a mind-body treatment program
    Participants will be able to use a simple quiz as a bridge between assessment and
    Participants will be able to describe the correct attitudes for treatment, including
    puppy training, scared and fallen child analogies and avoiding the six Fs

    Part VIII: Affirmations, during the day exercise, somatic tracking (with IFS) and other techniques
    Participants will be able to help clients use affirmations for recovery
    Participants will be able to use the during the day exercise for recovery  
    Participants will be able to use somatic tracking, with IFS components for
    Participants will be able to use the bring it on method to help clients in recovery
    Participants will be able to use positive affect to help clients in recovery
    Participants will be able to use compassion and self-compassion techniques to
    help clients in recovery

    Part IX: Expressive writing exercises
    Participants will be able to use the 25-minute jog writing technique to help clients
    in recovery
    Participants will be able to use the unsent letters writing technique to help clients
    in recovery
    Participants will be able to use the dialogue writing technique to help clients in
    Participants will be able to use the barriers to recovery writing technique to help
    clients in recovery
    Participants will be able to use the gratitude and forgiveness writing techniques to
    help clients in recovery
    Participants will be able to use the “new you” writing technique to help clients in

    Part X: Emotional processing work–Emotional awarenEss and expression therapy (EAET), Internal Family Systems (IFS)
    Participants will be able to describe the elements of EAET and IFS therapies 
    Participants will be able to initiate treatments using EAET and IFS components of
    therapy to help clients in recovery
    Participants will be able to use the Time Traveler visualization techniques to help
    clients in recovery

    Part XI: Personality traits
    Participants will be able to describe the key personality traits that are present in
    clients with mind-body conditions
    Participants will be able to help clients recognize and modify these personality

    Part XII: Life changes, meaning and purpose, and the “external journey”
    Participants will be able to describe the importance of the “external journey” in
    recovery from mind-body conditions
    Participants will be able to help clients address these issues to help them recove


    Dr. Graue,

    Regarding your question about the care of your patient…an “82 yo F with Parkinson’s, depression, cognitive decline, vasculitis, hypertension and hyponatremia, who was referred to me for post-herpetic neuralgia”…

    First of all, I think you deserve kudos for so patiently sticking with it and with her. I would think that even though you may not feel you are making progress, her time with you improves her quality of life. It sounds like she has had some great sadnesses and disappointments in life. You are giving her some reprieve from that and reminding her brain and soul that she is worthy of kindness and compassion.

    I have found it to be a challenge working with elderly when there is cognitive decline already present. They may tend to forget the information and recovery methods you imparted and even what it felt like to experience compassion or love.

    Late stage aging can be so terrifying – the failing body, the humiliations and vulnerabilities, the constant reminders of what you can no longer do or shouldn’t do…and then there is death looming which for some can be the most terrifying.

    I think that sometimes while our goals for our chronic pain patients may be no more pain, it may be wiser (and even more compassionate) to just meet them where they are, be with them in the way they want to be and just listen and support. Humor is always a good tool when all else fails.

    When my patients are exhibiting a lot of resistance, I interpret that to mean they just aren’t ready for the work and need more time to learn to relax in their bodies, feel calmness and safety, decrease general anxiety.

    Hope something in this message helps.



    Dr. Graue,
    Those are great papers on POTS and fear conditioning. Thank you for sharing. I was not previously aware of them.


    Hi Jessi Glaub !!

    Regarding your subset of patients who “tend to express some emotions about their pain experience and life stressors related to the onset of those symptoms, but immediately follow it up with a justification for why they shouldn’t feel that way or will same something along the lines of “but I am blessed for…”…..

    Emotions are repressed for a reason – patients have learned that they are very painful to feel or very dangerous to feel. They are repressing in order to survive – this is what they learned either in childhood or adulthood. But as adults, we have to start acknowledging, accepting and feeling these difficult emotions, if we are to heal. When my patients are exhibiting discomfort with anger/rage/sadness, I often explain to them that it is ok to feel both anger/rage/sadness and love/support/compassion at the same time !!! It is not either/or – it is both/and. They need to hear that it does not make them a bad person, a bad mother, a bad sister, a bad daughter, etc. to have these feelings. They will feel guilt and shame for having negative emotions towards people they believe they are only supposed to love !!! It is the guilt and shame that is suppressing the anger and causing the pain – not the anger itself. The anger is the normal emotion that is just trying to be felt and then, released from the body. Help them to let go of the guilt and shame for feeling these other emotions and they will be able to feel the anger, then it passes and then the pain goes with it.

    Alicia Batson MD


    Jesse Glaub,
    Regarding your patients who are unable to except the diagnosis…
    I would help them to build an evidence sheet (we will talk more about this).
    Teach them that DOUBT (in the mind-body diagnosis) = FEAR (because the opposite belief is you are broken) = PAIN (because fear is the fuel for the pain).
    Suggest to them that in trying this new approach, they “have nothing to lose but you pain” – no side effects, no risks (like meds and surgery). What do they have to lose by trying it? They don’t have to believe fully right away, but if you can get them to invest enough to begin to see a little improvement, it can give them confidence, then that gives hope, which begins to turn off the danger signal, which improves the pain and pretty soon, you have an uphill snowball rolling !
    Alicia Batson MD


    Hi Everyone!
    Grace will soon be posting the requested recovery program checklist that I use for each patient to help me remember which aspects/tools/techniques of recovery we have already gone over in session. It definitely doesn’t mean you won’t need to or want to go over them several times because when a patient’s brain is under threat, they will have difficulty remembering the concepts – they must be repeated over and over. I use the form to help remind me what the important tools to recovery are and as patients get better, it reinforces and keeps a record of which tools were most helpful for them as individuals. Also, if you have already gone over one tool of recovery 5 times and they aren’t better, maybe that means I’m on the wrong track and need to look under the rocks/drivers of their danger signal.


    Hi Alicia,
    Nothing like the humility and the learning that comes in helping you see (by keeping decent records and honest appraisals of how things are going with each pt) what works and what isn’t working! Having a checklist of options, but more importantly the skill and confidence to use each effectively, to organize and guide the choices of “what approach for what patient”, will be huge asset to us. The Western reductionist medical model can be paraphrased as, “when you have just a hammer, everything (and everyone!) looks like a nail!” The art in this business is in the capacity to individualize and customize our approach to each patient ie put the hammer away when the nail is not going in.


    Yes, Murray! Agree!

    Lilia Graue, MDLilia Graue, MD

    Alicia, thank you so much for your kind and wise words about the care of my patient, the challenges in working with the elderly when there is cognitive decline, how to best offer loving and compassionate presence to folks facing the pain and fear that come with late stage aging, and how to approach resistance, it’s very helpful and supportive. And yes, humor is such a great tool.

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