Is it all in my head?

by Brian on June 23, 2019

in Cancer,Health,Mindfulness

If you were to have told me a year and a half ago that my chronic stomach pain was all in my head, I would have picked up the nearest stick and shown you what “all in your head” really feels like.

OK, so not exactly. But I have long resisted entertaining the thought that in some way I helped cause my own pain. It’s a message I internalized when I first got sick with Crohn’s disease as a teenager – you’re not responsible for bringing on what ails you.

That’s why I nearly fell off my chair when my gastro doctor suggested I try medical hypnotherapy.

I’d been through every possible test to locate the source of the pain that had led to the discovery of my cancer but that ultimately doesn’t seem connected to it. I’d had tubes stuck down my throat, I’d pooped on a stick and swallowed a video capsule. Everything came back normal.

“I don’t think we’re going to find an organic reason for your pain,” my doctor said. “It’s not the Crohn’s. I think you could really benefit from hypnosis. I know just the guy. He did his internship here in the gastro department.”

I had nothing to lose, except maybe my obstinacy. So I made an appointment.

Udi started by addressing the elephant in the room. “You didn’t cause your pain,” he reassured me. The interaction between brain and body is complex. “Think of it as the 3 Ps.”

Usually there’s some “predisposition” – in my case a long-standing relationship to pain as a result of the Crohn’s disease.

Then there’s a “precipitating” factor. It could be a physical accident, a viral infection or psychological stress from a life event.

“What were you doing when the pain started?” Udi asked.

“Well, I was just about to start an extensive publicity tour for my book. I was pretty overwhelmed. Wait…do you think there’s a connection?”

Udi smiled as the message sank in.

This combination of predisposition and precipitation generates real pain, not imaginary I-want-to-stay-home-from-school complaining. But it’s the third P – “perpetuation” – that causes the real damage.

As anxiety about the pain kicks in, the sympathetic nervous system, which is responsible for activating the “fight or flight” response, is aroused.

The body starts pumping out cortisol and other chemicals, and the unconscious interplay between pain, anxiety, a focus on worrisome symptoms, and chemical overload winds up sensitizing the amygdala to pay extra attention to even the smallest signs of pain. (The amygdala is the part of the brain that plays a key role in processing and responding to emotions.)

All of that eventually triggers a negative feedback loop. “The associations you make in your mind lead to the pain persisting even when the physical reason has passed,” Udi explained. “Medical hypnotherapy tries to break the connections and pause the loop.”

“Stopping the amygdala’s hyper-reactions allows…the body’s own healing mechanisms [to] bring it back to balance and homeostasis,” writes Ashok Gupta, a psychotherapist who developed a methodology called “Amygdala Retraining.” 

First, we had to see if I was hypnotizable.

Udi tried two brief techniques on me. One checked to see if I could paint a picture in my mind based on verbal input from him. (I could.) 

In the other, Udi asked me to clasp my hands together and hold out both my pointer fingers. Udi then guided me through a visualization in which my fingers were getting closer and closer together. And by golly if my fingers didn’t start to move. I tried to stop them but couldn’t.

But when Udi tried a full 30-minute relaxation exercise the following week, I was resistant. Udi urged my hands, but unlike the previous time, they stayed firmly in place.

I left the session discouraged. I had been so excited to think that this could help me.

“Take the week and just try to be mindful whenever the pain arises,” Udi said as I was walking out the door.

Did he say something about mindfulness? Well, I can do that! I’ve been going to meditation retreats for years and, even though I don’t practice daily, I’m very familiar with what it feels like to tamp down, if only temporarily, my ever-animated thoughts.

for years and, even though I don’t practice daily, I’m very familiar with what it feels like to tamp down, if only temporarily, my ever-animated thoughts.

? Well, I can do that! I’ve been going to meditation retreats for years and, even though I don’t practice daily, I’m very familiar with what it feels like to tamp down, if only temporarily, my ever-animated thoughts.

I did what Udi prescribed: when pain began to arise, instead of jumping into crisis mode (which is what my amygdala had been conditioned to do), I let my body relax. I acknowledged the pain and softened into it

“The sensations are unpleasant, but they’re not dangerous,” I repeated, employing a mantra Udi had shared.

And then, for a moment, the pain passed.

And I thought: “What the…?”

I tried it each time the pain arose. The pain didn’t go away, but it couldn’t seem to grab me in the same way. It didn’t take over.

In our next session, Udi shared with me some additional techniques from the field of “mindfulness for pain.” (Yes, that’s a thing – Google it.)

Then my mood darkened.

“Are you telling me that I had the tools to break this cycle of pain a year ago and I just didn’t know I could go there?” I quietly raged.

“Maybe you weren’t ready then,” Udi said gently.

It’s been a few weeks and I’m still able to abate much of my pain. I don’t want to get too excited, though – I’ve seen this pain pass before only to come back full-force.

In the end, was I actually hypnotized? Probably not.

Does it matter? Not at all.

I first wrote about medical hypnotherapy in The Jerusalem Post.

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