One of the biggest discoveries that someone with chronic pain or symptoms can make is to happen upon Dr John Sarno’s books, or any other good books on TMS - Tension Myoneural Syndrome, today known by its more scientifically-grounded term, neuroplastic symptoms.
It certainly was the case for me and thousands of others. By some stroke of good luck, we came upon the mindbody connection — often at a time when we had almost exhausted all hope of recoverying fully — only to realize that maybe, just maybe, our symptoms were just TMS: real, physical symptoms generated by a brain that feels unsafe.
There are some individuals who read one of the books on TMS and recover. They literally witness their symptoms melt away within a few days or weeks. However, others continue to struggle. They somehow know that their symptoms have a mindbody dimension, but feel at a loss on what to do.
In this post, I’d like to address this category of people and the very common question: I’ve read the TMS books and watched so many videos, but what do I do to actually overcome my symptoms?
The answers are in the books - but the application is up to you
Granted, this might sound a bit disappointing. The answers are already in Sarno’s books, in particular his Healing Back Pain and The MindBody Prescription. The process is made even clearer in some additional books written by other mindbody specialists and practitioners, including my own book The Pain Secret: Unlocking the MindBody Connection to Overcome Chronic Pain and Symptoms.
At the end of The MindBody Prescription, Dr Sarno outlines a therapeutic program. He also lists his popular 12 Daily Reminders for People with TMS in Healing Back Pain.
But only around 10% of readers really know how to implement these action steps (this is my own estimate - excuse my arrogance for quoting the figure, but it’s based on my own experience of 10 years as a TMS Coach in this field). Moreover, although other authors have gone to great lengths to explain parts of the process more deeply, still the majority of readers remain clueless on how to embody the healing.
So I’ll make one attempt in this post to guide you through some of the most important steps. Who knows, it might be what finally leads to your ‘aha moment’!
1. Understand what TMS really is
TMS or neuroplastic symptoms typically have multiple underlying factors - and those factors are never due to injury or structural abnormality (otherwise, it wouldn’t be TMS). It’s not just ‘stress’ that causes symptoms - in fact, stress as we typically understand it is hardly ever the culprit!
Yes, symptoms can flare up or appear due to repressed rage, guilt or shame. The core of these emotions is unacknowledged, which means that people with TMS don’t even realize how angry, resentful or scared they are. Very often, there would be deep sadness or guilt behind the anger.
Step one follows on from this aspect — because in some way, we have to get more aware of our internal landscape.
However, there are other layers to neuroplastic symptoms. As we start fearing the symptoms and our anxiety about them increases, we actually start wiring the brain to get better at generating those symptoms. Habits like negative assumptions and avoidance of activity to accommodate symptoms actually reinforce the pain pathways, because they are fear-based.
Basically, any action that we take due to fear of symptoms wires the brain for more symptoms. Even if that action may provide temporary relief.
To give a simple example, if we use an ice pack to bring about temporary relief, especially before we attempt a physical activity, like a walk, this very action is being done in anticipation of pain. The brain understands that we are afraid of the activity, and because the activity is deemed to be potentially unsafe, we are more likely to get symptoms either during or after that activity.
Photo of myself still climbing 10 years after I resolved my pains, even though I still have a detached ligament in my shoulder that was never operated!
2. Think Psychological at ALL times
Dr Sarno’s famous adage to think psychological still applies, yet many ignore it. When we get symptoms, we often start wondering why. Did we overdo it with activity? Are we still injured? What if that bulge on our MRI is the culprit? What if Covid made us weaker? What if it’s genetic?
You get the gist of it. All of the above questions are not only fear-based, they are based on the idea that our symptoms may be due to physical damage. This belief keeps the brain stuck in ‘danger mode’ and prevents us from really getting to the root of our distress: the personal issues that we’re dealing with, the anger, the resentment, the uncertainty. It’s these emotions that need to be voiced, validated and addressed.
So what if you still doubt whether your symptoms are TMS? I suggest you carefully re-read the indicators, which you’ll find in so many of the books and Neuroplastic symptom tests online. If the doubt persists despite having multiple indicators, then your doubtful thought patterns are a habit you have to decide to break.
Yes, your decisions play a huge part in all of this. It’s not about what others think, and it’s not even about what your doctor or PT thinks. It’s about what makes sense to you based on your personal situation and the new insight you’ve gained when you learnt about TMS. Which brings me to the next step…
3. Decide to address symptoms as TMS
Many of us are still in a position to choose to be healthy and pain free. This means that we don’t have any illnesses that are irreversible, and so it’s within our power to train our brain and nervous system to break the negative patterns that are detrimental to our health.
There’s a huge difference between entertaining the idea that your symptoms may be TMS and actually choosing to address them as such. The first doesn’t work, because typically there will be conflicting thoughts and behaviours that will override the dominant belief you want your brain to download: the belief that symptoms are neuroplastic, therefore fuelled by emotional distress.
You can choose to address symptoms as TMS safely, even if you still have some doubt. This involves thinking about the possible psychological reasons why you have them, and challenging fear-based thinking when this thinking is not leading to any beneficial action. Embodying the belief that your symptoms are neuroplastic is crucial for recovery, and this is what will spur you to take up more helpful habits, including:
1. moving more naturally, with less fear and hesitation if you have pain
2. doing certain activities that you would usually avoid altogether due to fear of pain, even though you are definitely allowed to be gentle at first.
3. responding to symptoms with more curiosity and acceptance (this is where somatic tracking and pain reprocessing techniques can help you).
4. negating that catastrophic self-talk and that voice in your head that is panicking about symptoms possibly being ‘something else’. If you’ve already visited dozens of doctors without getting a solution that worked, then it probably isn’t anything else but TMS.
5. Not buying into the idea or belief that you are broken. Your pain is real but you’re not broken - it’s just an alarm signal that’s too loud, because neurologically your brain has been primed to make it loud.
4. Address your Emotions
You likely know what causes ongoing rage, fear, dissatisfaction or resentment in your life. If you don’t, a couple of weeks of journalspeak or expressive writing will give you a very good idea. You may find that you’re writing things that you deemed to be unspeakable - this is a great start!
If your writing sounds to nice and proper, you’re likely not getting to the bottom of it. Be brave and allow that little child in you to really speak!
Being able to validate your emotions - including those that you may not want to be experiencing - is crucial to addressing the build-up of tension that’s within. Do NOT expect to resolve every problem in your life - this is not what the practice is for. But DO think of ways in which you can:
1. Express emotions in a healthier way - for instance, by opening up with your friend, partner or boss instead of keeping things buried deep within to avoid conflict or judgement. Good communication does wonders in releasing tension that’s being held in the body.
2. Take action or adjust your routine so you’re happier in your day to day life - this means incorporating more moments of fun and play, and possibly, looking for opportunities that bring you more happiness. Sometimes — but not always — this involves looking for a different job, changing your environment, or starting to hang out with a different group of people.
With some honest reflection, you’ll know what needs to change. And once you take that bold action towards change, your nervous system will thank you for it, because your inner self will finally feel heard. The tension will release, which will make the rest of the healing process way easier.
5. Live from the belief that you are going to be fine.
Your assumptions and expectations will dictate how you feel. If you assume that an activity will hurt, it will. But what if you start to mimic the behaviour of someone who doesn’t have all these thoughts and worries about the body? What if you went about your day while moving a bit more naturally, not alway second-guessing your movements, not always stopping at the first hint of pain? What if you just accepted that dinner invitation without entertaining a thousand negative thoughts about what could go wrong?
This is how the most powerful brain-rewiring takes place. By approaching movements and activities with more confidence, the brain learns that they are safe to engage in. And here’s the most important part:
you cannot wait for your symptoms to get better before you re-engage in activity. You cannot keep telling yourself that you’re going to do ‘X’ or ‘Y’ only when your symptoms are gone.
If you keep avoiding, the brain will still be led by fear. But if you re-engage with self-compassion, with less rigid expectations, with more acceptance of your current pain levels - then you teach it that the pain isn’t that scary or dangerous after all. You teach it that the activities you’re engaging in are actually harmless. The more diverse the activities, the better.
When I was recovering, I restarted with some short walks (even when I had pain). I took up some swimming, I went out and met friends. After 5 weeks into the process, I restarted some easy rock climbing even though I still feared it might hurt. But I kept telling myself that it was all TMS. So even if there was pain, I was not in danger. Eventually the pain turned into a curiosity. I could smile in amusement when I felt it.
And then it dissolved shortly after. Because if you can start to respond to pain with curiosity and amusement, the brain learns once and for all that it isn’t dangerous.
A wonderfully simple yet committing process of neuroplastic healing.
And that is what you have to do after you read Sarno’s books. Don’t get lost in too many ‘tools’ and techniques. Only use techniques if they serve to help you with one of the above-mentioned steps. Otherwise, live your life knowing you’re not broken. Validate negative emotions as they come up. Let go of rigid expectations about how you want your body to behave.
If you follow the above guidance, I' can bet you’ll get there.
Just think about this: how lucky we are to have access to this information today. How many people before us, including our own ancestors, believed they were ill and broken, just because they were never taught the secret? For me, this is enough motivation to get me going whenever I experience a TMS symptom. And I trust that it will be so for you too.