Main Freedom from Pain: Discover Your Body’s Power to Overcome Physical Pain

Freedom from Pain: Discover Your Body’s Power to Overcome Physical Pain

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If you are suffering chronic pain-even after years of surgery, rehabilitation, and medication-only one question matters: How do I find lasting relief? With Freedom from Pain, two pioneers in the field of pain and trauma recovery address a crucial missing factor essential to long-term healing: addressing the unresolved emotional trauma held within the body.

Informed by their founding work in the Somatic Experiencing® process and unique insights gleaned from decades of clinical success, Drs. Levine and Phillips will show you how to:

  • Calm the body's overreactive "fight" response to pain
  • Release the fear, frustration, and depression intensified by prior traumas, and build inner resilience and self-regulation
  • Relieve pain caused by the aftermath of injuries, surgical procedures, joint and muscle conditions, migraines, and other challenges

Whether you're seeking to begin a self-care strategy or amplify your current treatment program, Freedom from Pain will provide you with proven tools to help you experience long-term relief.

"Brilliant, practical, and wise, this is an enormously helpful book. I cannot recommend this work highly enough."
-Jack Kornfield, author of A Path with Heart

"This book is for everyone who wants freedom from pain. I have read dozens of books on pain relief and the power of the mind for healing, and this is clearly the best to date."
-Steven Gurgevich, PHD, assistant clinical professor of medicine, Arizona Center for Integrative Medicine

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About Sounds True

SOUNDS TRUE IS A MULTIMEDIA PUBLISHER whose mission is to inspire and support personal transformation and spiritual awakening. Founded in 1985 and located in Boulder, Colorado, we work with many of the leading spiritual teachers, thinkers, healers, and visionary artists of our time. We strive with every title to preserve the essential “living wisdom” of the author or artist. It is our goal to create products that not only provide information to a reader or listener, but that also embody the quality of a wisdom transmission.

For those seeking genuine transformation, Sounds True is your trusted partner. At you will find a wealth of free resources to support your journey, including exclusive weekly audio interviews, free downloads, interactive learning tools, and other special savings on all our titles.

To listen to a podcast interview with Sounds True publisher Tami Simon and author Peter Levine and Maggie Phillips, visit

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About the Authors

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Peter A. Levine, PhD, holds doctorates in medical biophysics and psychology. He is the developer of Somatic Experiencing®, a body-based, naturalistic approach to healing trauma, which he has developed during the past forty years. He has received the Lifetime Achievement Award from the United States Association for Body Psychotherapy (USABP), in recognition of his original and pioneering work in trauma. He also received an honorary award as the Reiss-Davis Chair for his lifetime contributions to infant and child psychiatry.

Dr. Levine served as a stress consultant for NASA in the early space shuttle development. He has served on the APA (American Psychological Association) President’s Initiative and the International Psychologists for Social Responsibility Task Force for responding to large-scale disasters and ethno-political warfare.

He is the author of several bestselling books on trauma, including Waking the Tiger, Healing Trauma, published in twenty-four l; anguages, Trauma Through a Child’s Eyes, and Trauma-Proofing Your Kids: A Parent’s Guide for Instilling Confidence, Joy and Resilience. His most recent (“magnum opus”) book is In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. More information is available at and

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Maggie Phillips, PhD, lives and works as a licensed clinical psychologist in Oakland Hills above San Francisco Bay. As the author of three previous books and numerous papers, chapters, and articles on trauma, dissociation, pain, ego-state therapy, hypnosis, and mind-body healing, she specializes in the treatment of traumatic stress, dissociative, and pain disorders. She is a fellow of the American Society of Clinical Hypnosis and corecipient of its Crasilneck award for the best writing in the field of hypnosis. She is also a fellow of the International Society for the Study of Trauma and Dissociation, and corecipient of its Cornelia Wilbur award for her contributions to the treatment of dissociation. She has taught at major conferences and presented invited workshops on Somatic Experiencing, trauma, hypnosis, Ego-State Therapy, EMDR, behavioral medicine, and Energy Psychology in the US, the UK, Canada, Europe, South Africa, Australia, Scandinavia, Hong Kong, China, Malaysia, and Japan. Her most recent, best-selling book, Reversing Chronic Pain: A 10-Point All-Natural Plan for Lasting Relief, was released by North Atlantic Books in October 2007.

Dr. Phillips is the creator of a companion online pain self-help program and a pain CD coaching program available at She is also the creator and host of a popular monthly teleseminar and newsletter series (, which have featured several e-courses copresented with Peter Levine, including an audio series on somatic approaches to treating pain and trauma, which provided the genesis for their current joint book, Freedom from Pain. She has also recorded two pain CD programs, Hypnosis: The Pain Solution and Hypnosis: The Headache Solution, distributed by Her other books are Finding the Energy to Heal (W. W. Norton, 2000) and Healing the Divided Self (W. W. Norton, 1995), co-authored with Dr. Claire Frederick, MD. As an innovator in mind-body healing and in the treatment of persistent pain and trauma, Dr. Phillips is particularly interested in the interface of trauma, dissociation, and emotional and physical pain conditions.


From Peter A. Levine

I thank various colleagues, physical therapists, body workers, and a surgeon or two along the way, who have helped me maintain an effective level of functioning and a relatively pain-free life into my seventieth year.

Much appreciation for my parents and brothers who, in so many ways, have encouraged me to take the path that led me toward discovering the human spirit’s potent ability to transform suffering. Both my brothers have influenced my thinking about pain. Robert has helped me appreciate the functional route of pain control through his mastery of Traditional Chinese Medicine. Jon conducted the landmark study which revealed the existence of the placebo response mechanism and its role in the brain and body’s internal pain regulating system. His pioneering work has been an inspiration, opening a whole new arena of mind-body medicine.

Appreciation to the many animals, both wild and domestic, who have shared their vitality and pure joie de vivre with me and who have taught me lessons of self-regulation and resilience.

Finally, I wish to give my deepest recognition and appreciation to the thousands of individual clients I have seen over the past forty years. Their courage has been my greatest teacher and the inspiration for writing this book. Thanks to everyone who has used my books and learning programs, granting me the personal blessing of being able to make a difference in this world.

From Maggie Phillips

One of the greatest challenges we encounter in life is pain. At full force, pain is both indescribable and unmanageable, and isolates us unmercifully from the healing power of having a connection with one another.

I am grateful to the many clients who, during more than thirty-five years of clinical practice, have helped me expand my understanding of the contours of pain and how we best heal. Each of you has strengthened my faith in the unique power of the human spirit to transform even the most unimaginable suffering. I also acknowledge the many colleagues who have helped shape my work and who graciously add their own innovations to extend its effectiveness.

I have been blessed with many spiritual mentors, teachers, and companions—saints and sages from all traditions. I give an especially big, grateful hug to Brother David Steindl-Rast who has taught me so much about the power of divine healing and the art of spiritual life.

I express deep appreciation to my parents and brother who have guided many of the life steps that have led me to the discovery of bright light within the dark prisons of adversity. My thanks also to my extended family of loved ones and friends who have supported, held, inspired, and loved me throughout various life journeys. All of you have taught me well and contribute to all that I teach in the world.

Finally I want to honor Andrea Bryck whose loving patience and endless humor form the compass through each day’s complexity, and our dog Casey who tirelessly herds us home.

Together we all make a powerful difference in the world.


Why We Hurt and How We Suffer

It is life’s only true opponent.
Only Fear can defeat life.


THOSE OF US FORTUNATE ENOUGH to engage in a life fully lived will find it nearly impossible to escape from this world without experiencing moments of significant pain. According to the Buddha, “When touched with a feeling of pain, the ordinary person laments … becomes distraught … contracts and so … feels two pains … just as if they were to shoot a man with an arrow and, right afterward, were to shoot him with another so that he would feel the pain of [both] …”

The first arrow in this teaching represents necessary pain. The second one represents unnecessary suffering and trauma. It is our fear about pain that creates this second arrow, a fear that creates a fertile landscape for chronic pain, distress, and anguish. As pain sufferers, we become so frightened of pain that we recoil from feeling any bodily sensations. It is as though we believe that by feeling our bodies we will be destroyed or, at the very least, our conditions will worsen. Hence we remain stuck and so shoot ourselves with the second arrow.

In this volume, we hope to provide you with the skills necessary to begin to help take the fear and hurt out of your pain. This program provides you with the means to prevent chronic pain from developing in the aftermath of common life events such as accidents and surgeries, as well as to release unresolved pain that has been held in the body from past traumatic events.

It is our shared vision that, with the guidance of this program, you will start to free yourselves from unnecessary suffering. Our wish is to support your transformation of pain into an empowering energy that allows you to embrace your life fully, with purpose, and with freedom from pain.

If you are reading this book, we’re imagining that you’ve been struggling with pain or that you care about someone who is. More than likely, you have in mind important questions and concerns that you want to make sure are addressed in this program.

We want to assure you right from the beginning that our purpose is to introduce you to practical, effective strategies distilled from working successfully with many different pain problems over the years. Practice exercises sprinkled throughout our program, beginning with this first chapter, will help you understand the main principles and further evolve related techniques into integrated skills.

Some of the important questions we will answer include:

•   What does the latest research teach us about how to resolve pain and suffering?

•   How do I prioritize my many needs so that I stop feeling overwhelmed and can begin to reduce my pain right away?

•   Will this approach work with my specific type of pain?

•   How can I get the support I need from professionals who work with me, as well as from my loved ones?

•   How can I make decisions about medical interventions including medication and surgery?

We’ll begin now with a foundational question—what is pain, anyway?


Pain, first and foremost, is a signal to let us know that we have been injured or are ill. Pain can also arise from tension and discomfort caused by how we respond to stress and threat. When we are threatened physically, emotionally, mentally, and spiritually, our nervous systems automatically react to ensure that we are protected from harm or injury.

In its purest form, pain is an essential part of our natural survival system, warning us that something is wrong and motivating us to give our body urgent attention. Pain signals are sent from nerves in the part of the body that has been injured to the brain. No pain is felt until the brain has interpreted the information it has received.

Many parts of the brain, as we shall see, collaborate in turning on pain as a survival response, including areas that govern past memories, emotions, and mood, as well as future intentions. Meaning and importance of the pain are also part of the pain picture. For instance, the same hand injury might mean something very different to a professional pianist than it does to an amateur volleyball player; therefore, both individuals may have drastically different pain experiences. That is why each person’s struggle with pain will be unique, and why we actively encourage you to find the exercises and concepts in this program that work best for you.

We will be studying three types of pain in this program: physical, emotional, and posttraumatic. Physical pain is due to actual injury and tissue damage. Emotionally based pain is formed by strong, unresolved emotions that we have “stored” in the body instead of healthfully expressing them. Finally, posttraumatic pain is generated from much stronger reactions to overwhelming, terrifying, or devastating events.

These three types of pain are categorized according to their root causes, which also often correspond to how they appear or present themselves. For example, following an accident or injury, your primary concern will almost always be the localized physical pain you experience. When you suffer the loss of someone you love, as expected, you will struggle with emotional distress that might include sadness, grief, fear, anger, rage, despair, or some combination of these feelings. And, after being assaulted, threatened with rape, or surviving a fire, flood, or tornado that results in the loss of all your belongings and perhaps even family members, you more than likely will be overwhelmed by posttraumatic reactions that might include insomnia, panic attacks, sensory flashbacks, or systemic or stress-related pain such as migraines, depression, helplessness, and hopelessness.

Although these three classifications have obvious distinctions, one of the keys to treating pain successfully is the recognition that these three basic types overlap each other. Pain then is multi-dimensional. For example, many physical pain conditions include emotional reactions and interactions with past trauma. Most emotional pain conditions will also feature somatic symptoms such as physical pain and links to past traumatic events. And posttraumatic conditions involve a complex combination of all three types of pain responses.

So in addition to presenting ways to help you achieve freedom from these three types of pain, we will also help you understand some of the complexity that may be driving your pain and preventing you from healing. Because most pain complexity is linked to trauma, we continue our opening discussion with important perspectives on trauma.


There are many theories about what trauma is. However, most definitions emphasize that the traumatized person has been exposed to one or more life events involving actual (or perceived) threats to survival or physical wholeness, and where the individual’s reactions included intense negative emotions like fear, helplessness, loss of control, and/ or terror. Traumatic events are basically of two types—a single incident (such as an accident or injury), or multiple, ongoing events like those involved in repeated childhood emotional, physical, or sexual abuse, and/or neglect.

Studies of animal responses to threat have helped us better understand how these kinds of responses are resolved and released. Animals in the wild encounter numerous incidents of threat to their survival each day, yet generally seem to display no residual signs of trauma. From what we know, animals in their wild habitats are only concerned with what is happening right now. They do not worry or dream about the future. They do not regret or pine for the past. They are always “in the moment,” so to speak. After the threat has passed, they give themselves time to “discharge” or release the energy generated by the threat, and allow themselves time to settle. This is what we will be teaching you to do in this program: to become aware of your heightened physiological responses, to learn and practice a variety of techniques to discharge energies related to high-threat arousal, and strategies to give yourself time to settle from this activation and return to equilibrium.

The main difference between wild animals and human ones in terms of trauma is that animals complete fight and flight responses that allow them to fight back against what threatens them or to flee and escape the source of threat. Then they spontaneously shake off any residual stress effects through a series of shaking movements. It is after these involuntary trembling movements reach their natural conclusion that animals are able to become fully mobile and return to life as usual. They are also freed from the aftereffects of traumatic stress.

We human animals, however, often cannot escape or fight back, and have been conditioned not to allow our bodies time to “shake off” the aftermath of threat. We then often shift into the freeze response. Remnants of the fight, flight, or freeze response, when not released from the body, leave us in these heightened and inhibited physiological states. In order to try to integrate back into society (where we often receive the message to “just get over it”), we try to suppress these urges to fight back or flee. This avoidance can create more physiological constriction and psychological dissociation, the foundation for many pain conditions.

During this program, you will learn more about the somatic reactions that set the stage for the evolution of stress and pain disorders as well as ways to free your body of their effects. The unique contribution of the Somatic Experiencing model to the treatment of pain and trauma is the understanding that trauma exists in the nervous system and the body, not in the content of the traumatizing event.

The Freedom from Pain process emphasizes “bottom-up” approaches, or healing from the body level up to intervene in related thoughts, feelings, and perceptions. To accomplish this, you will learn a series of skills related to first identifying and then regulating your pain sensations. This will allow you to gradually break free of the pain trap that may be blocking your recovery, and eventually release the intense energies trapped in the nervous system so that they can be transformed into resilience and flow.


In order to recruit your body as your ally in securing freedom from pain, the first step is to learn how to communicate with your body so that you can create a healing, collaborative partnership. In other words, you will need to figure out how to shift your body from painful enemy to invaluable resource.

Although it’s obvious that the body is important to the healing process, many people in pain have trained themselves to disconnect from their body experience in a defensive attempt to avoid feeling more pain. Yet leaving body experience out of your healing equation will greatly limit your healing possibilities.

During this program, we will teach you to develop the language of sensation so that you can recognize the wisdom of your body in terms of the important information and feedback it provides. The felt sense paradigm of Focusing, developed by philosopher, psychologist, and researcher Eugene Gendlin, provides a map for learning this new language.1

The felt sense utilizes the language of body-mind communication and serves as a kind of radar or navigation system, letting us know instantly about elements of our internal and external environments and how they are affecting us in the current moment. Understandings from Somatic Experiencing and our Freedom from Pain program will prepare you to listen to and interpret this language as guidance, relayed to you immediately through your felt-sense radar.

You can learn, step-by-step, to decode the power of the unspoken voice of the sensate communications your body transmits. This will enable you to follow your body’s primitive, nonverbal pathways to discover actions that you can take to release the shock of trauma and pain. Tracking these kinds of sensory, nonverbal clues can also lead you to resources of expansion that can relieve your suffering and help reset your nervous system to support balance and new awareness.

First Steps

As part of your Freedom from Pain program, we recommend, if you aren’t already, engaging in gentle movement, such as stretching, qi gong, tai chi, or a gentle, restorative yoga class for people with injuries or disabilities.

Receiving gentle massage can also be helpful.2 As you explore your body experience with the help of an experienced masseuse, you can begin to realize numerous important pain connections. For example, you may recognize that the pain in your shoulder or neck may actually start down in your hips and back. The pain in your back could also originate from constriction in your ankles and knees. Massage can help you relax and also become aware of how various types of tension in your body create the pain.

In movement classes, you can practice the same principles, by moving slowly, and beginning to become aware of the tense muscles in the center of your body, and then the muscles at the periphery. Also note any images or feelings that you may have as you slowly allow yourself to release the tension through the gentle movements you are experiencing.

Our caveat is that massage and movement practice should never be painful (or that the pain should dissipate quickly and you should feel less pain afterwards). You must take care never to let your massage or movement practices become so intense that you have to ignore or push through the pain.

The first stepping stones on this journey are often ones of invitation and permission for simple exploration, using little more than innate curiosity and focused attention. This first exercise will help you begin to reconnect with and re-inhabit your body, which you may have abandoned to the ravages of pain and trauma. Although this may sound like a major undertaking, our message is that there are simple practices that can help you befriend your body and its unique resources.

EXERCISE: Re-Inhabiting Your Body

Let’s start with a part of your body that is not painful. It’s important to note that no matter how long you have been in pain, there is always a place in your body that is relatively pain-free. Granted, this part of your body may be small and off the beaten path, so to speak, like the inside of your forearm or the palm of your hand. Wherever it is, find and feel the lack of pain, the pleasure or comfort, or at least the neutrality of sensation.

Now allow yourself to feel an area where your body hurts. Take this at your own pace, and if it’s too intense, find an area that is less painful, and one that you can stay with more comfortably. Gently sense the contours of this area by breathing into it, and then see if you can let go of pain or tension as you exhale. Some of the sensations you may find are tingling, burning, warmth or heat, coldness, sharpness, stabbing, or aching.3 Whatever sensations you discover, just notice how they change with your awareness and breath.

Next, return to the pain-free area you identified before, sensing into it as you breathe in, and then letting go of what you sense there as you breathe out. Repeat this several times. What are you finding now in this area of the body that you did not find before?

Using your breath, shift back and forth, visiting several of the more painful places in your body, and then the more pleasant or pain-free places. Pause at each, sending your breath to re-inhabit it, and letting go of all effort as you exhale.

Record your responses to this exercise in your pain notebook.[image: Image]


Bill discovered the tools of invitation and permission in his first consultation session, which he had scheduled to evaluate the persistent nerve pain just below his right scapula following a serious bicycle accident.

Bill was pacing, his face guarded as he waited to find out how this appointment would be different from the numerous sessions with the acupuncturists, physiatrists, orthopedists, osteopaths, physical therapists, kinesiologists, surgeons, and medical doctors he had already experienced during the seven years following his bicycle accident.

Describing the site of the pain, he commented, “It’s hard for me to believe I still have this. No one can find a reason for this pain.” As with so many pain sufferers, nothing had shown up on any of the X-rays, CAT scans, and MRIs. The only finding had resulted from a nerve conduction test indicating that an auxiliary nerve had been compressed. “But I’ll tell you,” he added, “it’s very real to me. I feel like I died that day I went off my bike. I don’t remember it, but I know it happened, and in that moment, everything in my life changed.”

With some reassurance and encouragement, Bill told the story he had told countless times before. Instead of passively accepting his narration—which is what Bill had experienced in all his previous medical visits—I began to probe for the impact that the story was having on Bill’s body, and, at the same time, initiating the process of resolution.

Bill explained that at the time of his accident, he had been trying out a new racing bike. Hunched over the handlebars, head down, Bill failed to see a telephone repair truck parked in the bike lane (later he found out that there was no orange cone marking its presence), sailed over the handlebars, and crashed headfirst into the left side of the truck’s bumper. Twelve hours later, he woke up in the hospital with no memory of what had happened. After his release, the officers who had been called to the scene told Bill and his family that he had answered all of their questions accurately with the exception of giving them an inaccurate phone number.

When I asked Bill to show me how he believed the impact occurred, Bill got up from his chair and began making movements related to losing control of the bicycle. Knowing that, to be effective, any movements needed to go very slowly to aid in regulation and integration, I suggested that he continue the movements as if in “slow motion.”

After several sequences of movement, Bill commented, “That’s interesting. This is the first time I’ve realized how I must have landed on my right shoulder. I didn’t hit on the top of my shoulder, as I’ve been thinking all this time. It has to be that my body twisted to the left to try to avoid hitting the truck, so that’s why the force of the impact was really right under my scapula where the pain still is.”

Because Bill was helped to connect with his felt sense of what had happened, allowing his body to take the lead, he was able to regain a valuable clue about the site of his pain. Instead of the scapula pain being an indirect, mysterious result of his collision with the truck, he discovered that the area of chronic, lingering pain was likely one of the epicenters of the impact. This connection helped him to make sense of his body’s story.

We also spent time exploring other accidents and injuries seemingly unrelated to the injuries from his bike accident. Bill’s initial response to this inquiry was: “I’ve never really hurt my shoulder before.” However, after a series of probing questions about surgery, accidents, and injuries, Bill realized he had had several related accidents. These included an earlier head injury sustained during his short history as a high school football player, a bad fall where his right hip and right upper body landed on a set of concrete steps, as well as an even earlier accident in first grade when he fell down a flight of steps and landed on his left hip.

The second clue Bill discovered in his history was the presence of shock and dissociation that protected him from immediate pain after both hip injuries. After both of those falls, Bill reported that he had continued activity as if nothing had happened, until finally others suggested he get medical attention. X-rays revealed that his left hip had been cracked by the fall in first grade, and that his body later was misaligned in his cervical spine and pelvis. During the second fall on his right hip, the same side of his body as the bike collision, he felt “stunned,” but got up and continued to play ball, though he sought medical attention later.

This ability to “push through the pain” was echoed in his revelations of two other severe accidents sustained as a young man. In the first of these, he and his (now) wife had just announced their engagement to her parents and they were all enjoying time on the family boat when it was hit from behind by a bigger boat, slamming all four adults into the water. Bill reported that his right arm was “frozen” holding his fiancé tight to protect her from harm from the time they hit the water until rescue.

As soon as they fell in the water, he felt something moving across his back from right to left, and immediately recognized that it was the side of the other boat that had hit them. He recalled, “All I could think was that I had to push us away from the propeller. So I was holding on to Millie with my right arm and pushing away as hard as I could with my left leg and my left arm.” As he swiveled to show me what had happened, he noticed that his body had attempted to brace to protect his fiancé on his right side while bracing against the threat of the boat and its propeller on his left side.

When I asked what it was like for him to feel those movements, Bill said, “I realize now that the other boat went right across the area where my scapula pain is from my bike accident. Do you think the two accidents are connected somehow?” He also recognized that his body was divided between holding on to Millie, who was clutching her engagement ring, and desperately trying to flee from the boat’s invasion on the other side.

Bill’s story illustrates the fact that although he was not practiced in connecting with his body experience, with guidance he discovered during his first sensate journey several important links between traumatic events and his current physical pain. He also began to realize that some of the movements his body made to protect him had also played an important part in his pain story. These discoveries activated his curiosity, which helped him to begin trusting the wisdom of his body and continued to be an invaluable tool in resolving his pain. In later sessions, learning to use the language of sensation allowed him to feel more deeply the connections between the various somatic responses to these traumatic events, and to begin to shift the pain itself in a positive direction.

Bill’s story is also a good example of the fusion of the three types of pain we mentioned earlier. In addition to the physical scapula pain and the posttraumatic pain related to the series of earlier injuries and the boating accident, Bill later realized that unconscious emotional feelings of fear and loss contributed to his pain reactions as well as to his challenges in resolving them.


An important aspect of trauma is the threat response. The threat of danger mobilizes our call to action, an all-hands-on-deck response, and turns on the classic fight-or-flight system that we have mentioned before, and which you are probably familiar with. Certain nervous-system networks (the sympathetic adrenal system, in particular) are engaged to prepare vital organs and muscles for these protective responses. Like little batteries, our nerve cells charge up so they can fire off commands to the body to preserve life, whether it is for that extra burst of speed or one more good punch.

When the threat is perceived potentially fatal or as inescapable, the third natural response to threat, the freeze response, is evoked. Here, we lie immobile waiting for the threat to pass. This collapse response is often referred to as dissociation. When we become stuck in this state, we feel frozen in life, unable to move forward.

Our protective responses would be ideal in situations where we can actively defend ourselves. When fight-or-flight responses are impossible—when the animal (human or otherwise) cannot fight back against the threat or escape it—then like turtles, our heads retract into our shoulders and we bring our shoulders up toward our ears. Our bodies, particularly our musculoskeletal systems, tighten and brace. We may freeze in a kind of paralysis or collapse into helplessness, despair, and dissociation.

It may seem odd that dissociating or disconnecting from the body can become part of a pain problem. Dissociation, however, doesn’t turn off the fear or pain but protectively walls it off so we don’t feel it. This diminishes our capacity to feel pleasure and to think clearly. Dissociation prevents us from being in the here-and-now.

Frank had had more than twenty surgical procedures on his knee, including three full knee replacements. For most of the procedures and surgeries, he was dissociated from his body and so had manageable pain afterwards. When he approached the final surgery that ultimately brought him to treatment, however, he was scared for the first time, scared of the pain and scared of what the effects of the procedure would be.

When he woke up from this surgery in the hospital, he was in excruciating pain and asked for more medication. When the nurse explained that the doctor had not left orders for more medication than she had given him, Frank announced that if she did not find a way to give him the medication, he would tear apart the ICU. When Frank’s dissociative barrier was breached, he was overcome with terror and by the terrible pain that had been managed by the walls of dissociation his nervous system had constructed. As he began to feel these feelings again, his brain turned on the fight response to protect him from these perceived threats.

Another issue is that many different situations can activate the threat response. Some situations, like assault, actually are life threatening, yet others are based more on our perceptions that something appears to be life threatening. For example, the boss at work may be unsatisfied with an employee’s work on a project. The employee may be called into the office for a meeting. Suddenly, a spike in the employee’s heart rate and respiration may signal preparation for life-saving action because of the perception that if the job is in jeopardy, the employee’s chances of survival are lost too. Therefore, the situation is perceived as a threat to life itself rather than just a situation that needs to be attended to.

In other cases, such as the dangerous threat of an automobile accident, since there is no human or animal to fight back against or to flee from, the fight and flight reactions become internal ones. These protective reactions not only are dysfunctional, they become habitual and can contribute to many health problems, including pain.


As mentioned previously, if the roots of our responses to threat are directly related to the pain we experience, then we can learn a lot about how to complete these survival responses and release the energy engendered by threat by studying animals in the wild. This is because animals in their natural habitats don’t become traumatized in the same ways, or as easily, as people, pets, or animals in captivity.

Imagine a rabbit in a small glen, munching on some green grass. A sound comes from the bushes. The rabbit’s ears, followed by its head, perk up and turn toward the sound to locate its source and whether it is a threat to life. From out of the foliage, a coyote sprints into view. The chase is on: the rabbit’s muscles engage and dig into the ground Why We Hurt and How We Suffer as it sets off, hoping to escape through several daring twists and turns. Ultimately the rabbit uses its resources of speed and agility (and a bit of good luck) to escape and then hides in a log or down inside a hole. Finally safe, the rabbit takes a series of deep breaths and shakes off its encounter with threat.

Rabbits, like most other animals, are equipped to utilize flight, fight, or freeze responses to survive the threats they encounter. So the wild animal that may encounter these types of life-threatening situations multiple times a day must be equipped so that it doesn’t carry residual stress. Otherwise, it would lose its capacity to fight back or flee.

The question is: what’s the difference between the reactions of a human being and those of an animal in terms of trauma? This is an important concern, because if an animal became traumatized as readily as a human being, the animal and its entire species might not survive. In fact, precisely because it can release the stress of threat and learn new escape moves, the animal may actually become more effective in evading threat each time it’s challenged.

After a threatening encounter, as mentioned earlier in this chapter, animal bodies tend to shake and tremble for a relatively short period as part of moving out of a shock reaction. This is illustrated in the behavior of the opossum. If attacked by a predator, the opossum freezes, or “plays possum.” This is not “playing,” but is actually a response to threat defined by a profound physiological shut down: this is often its only option since the opossum can’t run away because it’s very slow, and is unable to fight back because it lacks sharp teeth and claws.

After the threat passes, however, the opossum doesn’t immediately jump up and run away and go about the business of hunting for grubs or engaging in a complex mating ritual. After several minutes (or up to several hours), the opossum slowly begins to move, though it’s still unstable. It shakes and trembles a little bit, and then seems to regain its grounding, and off it goes. Animals that are slow or unequipped relative to their predators often default automatically into this freeze or immobility strategy. This is often times the case with humans, particularly children. For example, if children who are abused try to fight back, this will often make the situation worse. The only option that children have is to collapse, which is why they’re so vulnerable to trauma, particularly when they are not guided toward recovery time, and encouraged to shake and tremble, and to finally fall back into a deep settling in themselves and their environment.

The innate biological responses of animals help them literally shake off the result of their traumatic encounters and then they automatically return to equilibrium, since equilibrium and balance are the patterns most established in nature. Animals go on to another experience or a new day. Because humans frequently block these recovery reactions, this benefit of shaking off the impact of threat and trauma may escape us. That is, until we are guided to recover the wisdom of nature.


Our program will teach you to learn to identify and accept, or at least not interfere with, your own innate healing responses so that you can move into truer alignment with your hard-wired animal heritage. This type of learning will teach you to become curious about and then begin to explore the dynamics that underlie your pain and help restore your animal nature.

Much of this program is designed to teach you how to discover and befriend the body sensations that are connected to trauma and, more importantly, with resilience. We’ve found that acceptance of the full range of those somatic responses is what prompts the nervous system to restore balance automatically.

To practice this kind of awareness at this moment, read aloud the words “fear,” “anger,” “paralysis,” and “freeze.” Read them now more slowly, one at a time, pausing to check your inner body reactions. What happens in your body when you say each of them? What images, body gestures, or responses do you become aware of? How does your posture change, even in subtle ways? You might like to note your results for this mini-practice exercise on the power of words in your pain journal.

In the next chapter, we will build on your connection with your body experience to explore the pain trap that is created by responses to threats of danger that are not released from the body. Since most people in pain are caught in this trap at some point, it’s helpful to discover how you may get stuck in it and how to move beyond it.


The Pain Trap

THE BRAIN RESPONDS to threat by activating certain primitive brain structures, including the brain stem and amygdala, which are involved in maintaining survival. The amygdala, which has been called the smoke detector, or alarm center, of the brain, is central to these reactions. If there is the perception of danger that poses a threat to survival, the amygdala responds by turning on the fear response.

Once the fear response is activated, the body begins to brace to protect itself against threat. For example, our arms may instinctively rise up to protect our heads. Bracing can trigger chronic constriction if it is not released. And if this constriction persists, it creates pain.

Eventually we brace against the pain itself, which creates further constriction and more pain. As this cascade continues, we may also collapse into the helplessness of the freeze response. This vicious cycle or “pain trap” can be self-reinforcing and often difficult to break.

The pain trap deepens in its complexity because the amygdala also shuts down other areas of the brain, such as the frontal lobes, which are essential to our powers of observation, language, and perspective. Because our powers to notice, distance ourselves, and gain perspective from our sensations are diminished when we are in pain that results from fear and other reactions to threat, we begin to believe and experience that we are the pain, and we then become the pain. Our brains activate this belief, and our experience confirms this because we have no way to process a different reality.


To summarize, the pain trap begins when we activate our natural responses in reaction to threats to our survival. These responses are accompanied by the fear response that is turned on by the amygdala, which then activates bracing reactions through the body. First, we brace against the threat that caused the pain and eventually against the internal threat of pain itself. If this cycle of threat → fear → brace → constrict → pain → collapse → threat of pain is not interrupted, many serious problems, including chronic pain, can occur.

To escape this trap, we must shift from “I am the pain” to “I am experiencing the pain” to “I am experiencing the sensations that are underneath the pain.” Once we complete these shifts, then we can begin to resolve the pain. We need to regain the ability to observe and to disidentify from the pain, in order to prevent being overpowered and engulfed so completely by our discomfort. To do so, we need to find ways to develop our curiosity and explore the sensations that underlie the pain.

One important intervention is to use the power of curiosity to help interrupt the fear that often marks the first downward slide into the pain trap. As we learn to sustain a playful and mindful focus on the sensations of our bodies, we stop waiting for our worst fears to be fulfilled, and instead begin to discover how our somatic experiences feed into each other and keep the patterns related to threat alive in the present moment.

EXERCISE: Exploring the Felt Sense

The simplest way to explore the felt sense of your body is to start with this moment, whether you’re sitting, lying down, or even standing up.

First, get a sense of your feet and how they seem to be (or not be) connected to the earth. For example, are they pressed into the floor, resting on top of a couch or bed, or somehow floating in space? How do you know? Now gently shift your weight from foot to foot. How does this change your awareness?

Next, explore how the rest of your lower body, your calves and thighs, feel connected to your feet. Are there differences between the right and left legs? If so, how would you describe the difference?

Allow your attention to shift to any other part of your body that seems to draw your awareness. What do you notice? What language can help you describe any specific sensations you find? Are you aware instead of a more global sense? How might you describe that?

Once your exploration of a body area seems or feels complete, allow your attention to be drawn to the next part of your body, and so on. For each area, pause to notice your felt sense and then identify the language that might describe how it feels or seems to you.

As you continue, practice using the language of sensation to describe your experience of each area. Examples include: tight, loose, blocked, congested, flowing, tingly, heavy, floating, empty, cold, or warm. Challenge yourself to shift away from thoughts and beliefs. If you notice that you use one sensation word repeatedly, are there other words that can be used more accurately?

If you feel stuck at any time, you can ask yourself: “What kinds of sensations are associated with being stuck? What is this part of my body touching? How does that feel? What smells or tastes am I aware of? Are there any sounds or vibrations I can hear or sense here?”

Is your overall sense of your body right now comfortable, uncomfortable, or neutral? How do you know? How might your felt sense of your body guide you further into types of activity or rest? For example, are you feeling more energized? If so, would you like to take a walk or do some other activity? If you’re feeling quiet and calm, can you take more time to explore this resting state? Take a few minutes to record your reactions in your pain notebook.[image: Image]


Many people are resistant to the idea that their current pain is related to past trauma. We have found that it’s very important to communicate this information in ways that each person can accept and work with. Often, we start with a more practical, simplified explanation of the fear-bracing-pain cycle and work with that. Once this basic pattern is resolved, or at least manageable, we often find that images or clues related to past traumatic experiences where the body responded by bracing sometimes begin to surface.

There is a risk of becoming overwhelmed by the perspective that it is necessary to reexamine all the threatening experiences of the past in order to manage pain. We find it’s better to work with the basic patterns of pain in present time, and to trust the organism to reveal, through its innate wisdom, the additional somatic sensations and patterns we need to explore for lasting relief.

It is common for people who have significant trauma to become stuck in one or more of the fight, flight, or freeze response patterns, which then determines the types of difficulties that will ensue. For example, many of the soldiers who are coming back from Iraq and other battlefields display symptoms of rage, indicating that they may be stuck in the fight response. Similarly, other returning soldiers exhibit symptoms more related to intense fear, which can stem from incomplete flight responses. With other kinds of trauma, particularly with rape, molestation, and other forms of sexual abuse, particularly if they occur in early childhood, immobilization or freeze may be the main difficulty. Children who have been threatened and molested over time, for example, can present with helplessness, hopelessness, or other depressive symptoms related to the freeze response. Because they could not fight back or escape, they tend to collapse. Often this is associated with feelings of shame and self-blame. This is where a dose of self-compassion can be invaluable.

When first working with chronic pain, it can be useful to focus on the interaction of trauma with pain in two main ways. One is to address the trauma that may have begun the pain problem to start with, like an accident or injury, assault, or disease. The other important focus is to realize that pain in and of itself becomes traumatizing.

There is often significant trauma related to the beginning of a pain condition, whether or not there is conscious awareness of this. One of the most dreaded things in the human experience is pain, and the fear that it will become endless and unrelenting. Many older people, for example, have a universal fear, not of dying, but of being in pain. So remember, this is the second arrow in the pain cycle: the recoiling from our sensations that can become a root cause of unnecessary suffering.

Regardless of the nature of the trauma that may be connected to your pain, the principles and practices you will learn in our program will help you unlock its mystery. What we have learned over and over again in working with numerous types of pain is that whenever chronic pain is not resolving even when reasonable treatment has been used, inevitably trauma is the missing link. Once unreleased trauma is identified and liberated from the body, most conditions will then begin to resolve. During the rest of this program, you will learn ways of tracking, working with, and releasing the elements of trauma that may be blocking your progress.


As we’ve suggested earlier in this chapter, it is also important to recognize that working with trauma linked to pain always involves healing both emotional and physical aspects. In fact, it may surprise you to discover that emotional and physical pain operate identically in the brain. With injuries, pain signals often originate from the periphery of the body, but also from parts of the brain related to emotion. Functional brain scans (fMRIs ), which measure activity in the brain, have shown that once pain signals reach the brain, three specific areas light up simultaneously: the limbic system (the emotional center), the sensory cortex (which governs sensation), and the cerebral cortex (which organizes thoughts and beliefs).1

To summarize, any kind of pain that is ongoing will contain an emotional component, some sensation or physical pain, and various thoughts and beliefs that can block recovery, and which often contribute to pain. In order to resolve any pain condition successfully, it is necessary to work always with the emotional pain aspects, as well as with the physical sensations and the thinking mind’s limiting beliefs.


In our experience, the primary antidote for people who struggle with pain and trauma is to learn how to regulate emotional and sensory experiences, and to calm themselves so the limbic fear and rage systems in the amygdala deactivate. Although the regulatory process is quite complex, we can actually help to restore it with simple awareness practices, such as circle breathing, which we will describe in this next exercise.

EXERCISE: Circle Breathing

Now that you are beginning to understand the wisdom of your felt sense by completing the previous exercise, you can go further to use your breath to open up pathways of movement and flow in your body. These can begin to counteract the constriction of fight, flight, and freeze.

Take a few moments to connect with the overall sense of your body. How would you describe your felt sense of the right side of your body compared to your left? Is there one side of your body that is significantly less comfortable than the other? Pause briefly and use the language of sensation to describe the felt sense of each side of your body. You may find sensations such as heavy, light, tight, burning, loose, and aching, among others.

Now imagine that you can breathe in through the more comfortable side of your body, starting with your foot and lower leg on that side, and progressing up to the area where it feels like your breathing connects with the core of your body (usually through your belly in the center of your body). Then sense your breath as it crosses your belly or diaphragm to the other side of your body. As you exhale, imagine that your breath moves down and through the other leg and foot and out into the earth. Repeat this three to four times, noticing your felt sense of what is different in your body each time.

Next, imagine that your breath is a magnet that can pick up the more comfortable sensations (name them as you breathe) so that as you breathe in, up the more comfortable side of your body, your breath picks up these sensations and shifts them over through your belly, and then down and through the less comfortable side of your body, and through your leg and foot into the earth. Again, pause and notice what is different now in the felt sense of your body experience. For example, do you feel lighter, more energized, more calm, less tense or tight, or do you experience some other kind of change? What is it?

If this exercise does not seem to be helping you shift in the direction of flow and ease, imagine breathing up the more uncomfortable side of the body this time, letting your breath cross over through your belly. Then imagine breathing down and out through the more comfortable side of the body. What difference does this make? What is your felt sense now of your lower body? Of your upper body? Of your body as a whole?

If both sides of your body feel equally comfortable or uncomfortable, or you want to try another variation of circle breathing, practice breathing up the middle (midline) of your body, imagining that your inhale starts at the base of your pelvis and rises up to your nose and face. Then imagine you can breathe out, down, and through both sides of your body, through both your shoulders, arms, and hands, and down through both your legs and out through your feet. Repeat this process for three to four breath cycles. What is this like for you?

Finally, if your problem area is in your cervical, thoracic, or lumbar spine, or you want more practice with this technique, imagine that you can breathe up the middle front of your body to the top of your head. As you breathe out, sense your breath moving down the back of your head, neck, mid-back, and through your lower back and out through your tailbone; finally, imagine it cascading down both of your legs. Repeat this several times. What are the effects? How are they different from the first three steps of practicing circle breathing?2

Remember to record your observations from this exercise in your pain journal.[image: Image]

Equally important to regulating the emotional and sensory elements of body experience is to focus on strengthening social engagement and building a support system to help with self-regulation. This should include a secure relationship with treatment professionals. Throughout the rest of this program, we will explore many of the specific self-regulation tools we have found most useful, along with tips for building collaborative and supportive relationships with yourself and others.

In addition to learning to use social support, you will also learn specific tools to deactivate and counteract some of the common factors that often bridge from normal acute pain into the downward spiral of chronic pain. This process, explained in our next chapter, will help you begin to free yourself from the pain trap and lead you forward on the path of ultimate freedom from pain.


Neutralizing the Factors That Cause Chronic Pain

IN CHAPTER 2, we explored the concept that if our natural reactions to threats are not completed and released from the body, the accumulation of ongoing bracing and defensive reactions related to fight, flight, and freeze can generate continued pain, resulting in a pain trap.

This chapter will discuss how the shift occurs from normal, necessary pain to more chronic pain that persists after the initial cause of the pain has resolved. Self-regulation can fail for all of the “big three” trauma reactions—fight, flight, and freeze—through the mechanisms of:

•   dissociation

•   anxiety, fear, and panic

•   helplessness and hopelessness

•   anger, rage, and irritability

We will discuss each of these, and offer you a toolbox for working with them and breaking free of pain entrapment.


The first type of shift we’ll explore occurs through the defense of dissociation, which is connected to the freeze response. Dissociation is the most primitive element of our natural response to pain, as well as to threat and trauma. It’s a kind of automatic disconnection from the environment as a whole. It allows us to deal with overwhelming anxiety and fear by minimizing movement and the expenditure of energy as well as by numbing so that we do not feel pain.

If you’ve ever been in even a minor vehicular accident, you know firsthand how this works. You can be driving along in the flow of traffic, listening to music, registering the scenery flashing by, aware of your own thoughts, daydreams, and memories. In the next moment you can be plunged into the darkness of fear and uncertainty, as well as the disorienting aftereffects of a punishing impact with another vehicle. You may be able to check your body for obvious injury, get out of the car, check with the other driver, and retrieve and exchange information. You may possibly even be able to tell your story to a police officer or paramedic called to the scene (as Bill was able to do, even with a head trauma).

At some point in this process, however, you may notice that you do not actually feel your body, so, in fact, you cannot be a fully reliable witness of your own injuries. This numbing is due to the shock response and the protective activation of chemicals, such as endorphins, turned on by various centers of the brain. These chemicals are designed to minimize pain so that appropriate defensive action can take place. Dissociation is actually a vital survival skill. When dissociation becomes habitual, however, the dissociated person gets lost in this condition and cannot find the way back to a more connected state.

The Way Back

If you are significantly dissociated from your body, including its pain responses, the first step to coming out of shock (whether recent or longstanding) is to begin to sense when and how you’re dissociated, and then learn to gradually reconnect with your body. As you reconnect, you will discover and build various types of resources that will help you to resolve your body’s stress and pain responses. We call this self-regulation. The ability to achieve successful self-regulation of your body’s stress responses will lead to less reliance on dissociation, faster resolution of pain, and a greater sense of empowerment and strength.

Shifting Dissociation

There are many tools that can help you begin to decrease your dissociation, so that you can reconnect with and begin to explore your body experience (including your pain) in a safe, productive way. In this part of the chapter, we will introduce you to several necessary skills and tools, while also giving you opportunities to practice them.

One starting place is to find out what you experience in the dissociated state. Sometimes this can be the kind of classic dissociation, where you perceive that, “I’m outside my body; I’m looking down at the room; I see you; I see me.” If you are aware of detaching, it’s important to notice how you’re detaching, by expanding the experience of it. For example, if the detachment begins to feel like a floating sensation, an expansion of this experience might lead to the question: “Do I feel like I’m floating more to the right or more to the left, or in some other direction?” Then, can you describe what you see from that place?

Next, after expanding the experience from outside your body, try to describe what you are aware of in your body—even if this is very tenuous. Within a few moments, you may have the astonishing experience of coming back into your body and returning to yourself, with your anxiety and fear significantly reduced. The key is always to follow your felt sense, as best as you can, through the dissociation. This is something that has to be a slow, gentle, stepwise process so that you experience a “return home” to the knowledge that it’s OK to come back into your body.

As you read this, you might react to this suggestion with a comment like, “But I don’t feel anything. I’m just numb.” Whether you’re aware of it or not, there has to be a part of your body that feels less numb than any other part. In this situation, you can use a body scan,1 focusing methodically from the top of the head to the bottom of the feet to track your body experience more carefully. This way you will find differences, even if they are small or subtle ones.

To perform and experience a body scan, take a few minutes right now to focus on your body experience. Begin either at the top of your head or with the bottom of your feet. Gently “sense in” to the area you have chosen, becoming aware of various types of sensations. If you “don’t feel anything,” ask yourself what it’s like to feel nothing, and note your response.

Then move on to the next area that you sense. From the top of your head, you might move down into your face, jaw, and the sides of your head. If you started at the bottom of your feet, consider what it’s like to find and focus on the tops of your feet and on your lower legs. What sensations do you find here?

Continue to flow through various areas of your body somewhat systematically, finding a rhythm with how and where you move from place to place. When the experience feels complete, what feels different in your relationship with your body as compared with when you started this practice? (For more extensive information and practice about body scans, please refer the resource section).

Toolbox for Shifting Dissociation

If you are experienced in working with your body, you may wonder if the tools in this section are too basic for you. We ask that you experiment with them, even though you might think you know what will happen. Both of us regularly use these tools ourselves, and consistently make important discoveries that add to our body resources, sometimes in unexpected and creative ways.


A primary self-help skill that will support your reconnection to your body is to develop mindfulness in order to become a better observer of your body experience. One important way of engaging mindfulness is to develop awareness of a relatively neutral or comfortable place in your body that is reliable across time. In other words, whenever you become upset, over-activated, or disconnected, it’s very helpful to find the place in your body that brings you a consistent sense of connection and a relative sense of security and safety. Finding even a neutral somatic experience that evokes feelings of security, no matter what is going on inside you or around you, is often very effective.

The following exercise will encourage you to develop the resource of rest in your body by finding a place (or a series of places) that can serve as a refuge for you from pain and discomfort.

EXERCISE: Securing a Resting Place in Your Body

Starting at your head or feet (whichever you prefer), gradually journey to areas where you find some degree of “OK-ness” in your body—not necessarily positive sensations, but not painful ones either. Then, pay attention to the parts of your body that you cannot feel—those that are numb or blank. These may be areas from which you consistently disconnect, such as your feet and legs, hands and fingers, chest or pelvis. Notice whether they seem connected with past injury or areas of habitual stress.

Take a few moments to use your breath and sense your way into one of the numb or disconnected locations you have chosen. Breathing in, feel that part of your body; while breathing out, feel that part of your body again. After three to four breath cycles, ask yourself, “What am I sensing in that area now? Does this part of my body feel more connected? Less connected? Is my sense of it shifting in a positive direction?”

Come back to this exercise again either later on in the same day or another day. Has your sense of this part of your body changed? In what ways does it feel neutral? Does it offer more comfort over time? How does your connection with this place in your body change your pain?

Note your experience with this and the other exercises in your pain journal to maximize your results.[image: Image]


Another simple resource to help you shift out of dissociation is grounding through your feet and legs. This next exercise will help you learn to feel grounded as a way of staying centered in relation to pain.

Grounding is one of the foundational skills in learning to connect with your body. Grounding generally involves balancing the energy in your body by connecting with the gravitational forces that hold us securely on the earth. Grounding exercises, such as the one we’ve recorded on track 4, will help you link with physical and spiritual, mental and emotional energies, bringing them into alignment, and making it safe for you to inhabit your body.

In a way, grounding is similar to electrical grounding, which connects electrical circuits to the earth, allowing energy to move safely into the earth and preventing mechanical damage, fire, or other negative effects. Lightning rods, for example, are grounding devices that allow the electricity of lightning to pass safely from the air into the earth without damaging humans or property.

Grounding processes, like the one we are guiding you through in this exercise, allow you to connect fully with your body without stressing or overwhelming your energy circuits. They will also help you engage with your legs and feet so as to provide a solid foundation for exploring the rest of your body.

EXERCISE: Grounding

First, begin by gently shifting your weight from foot to foot. Perhaps imagine that they are like the suction cups on a frog’s foot connecting you firmly, but flexibly, to the ground.

Next, while breathing in, press gently, through one or both legs, into the floor. While breathing out, let go of the tension in your body. Experiment with how much tension you can release while still being able to hold yourself up in a stable way. Now try the reverse. Breathe in and feel the flow of breath coming into your body, then while breathing out, press gently into the floor through one or both legs.

How do the sensations of pressing down, alternating with letting go, help you feel more connected with your body? Experiment with decreasing or increasing the pressure through your feet and legs until you feel a positive sense of connection. How does grounding affect your sense of well-being?

Don’t forget to note your experience with this exercise in your pain journal.[image: Image]


Another resource to shift out of disconnection and dissociation is to keep a sustained focus on breathing. Rather than trying to control or change how you breathe, our goal is to teach you awareness of the actual experience of breathing. Often, just taking this simple step results in a shift of tension and pain. If nothing else, your awareness of breathing will usually result in a feeling of greater connectedness to yourself and to others.

EXERCISE: Just One Breath

Without consciously trying to change your breathing, simply follow the sense of your breath as it moves in and through your body, and again as your breath moves out, just like waves lapping on the beach flow in and out. What changes in your body during that one inhale/ exhale cycle? What changes in your pain?

If this is helpful, follow the pathway of a second breath as it moves through your body, as it comes in, and then as it goes out, again sensing it like the tides of the ocean that ebb and flow. What changes in your body this time? What further changes in your pain do you notice?

Feel free to come back to this exercise again and again.2 Use it whenever you are aware of anxiety, stress, or discomfort.

One important distinction we emphasize is that the focus of the breathing practice is not as much on inhaling, but on exhaling. In other words, it is essential to learn to allow a full exhalation rather than to focus on creating a full inhalation. The next exercise will help you practice extending your out-breath.

Tibetan and other spiritually guided chants have been used successfully for thousands of years to facilitate healing and open the doors of perception. We borrowed this exercise, with certain modifications, from these chants. The “voo” sound will open, expand, and vibrate the organs in the belly. This vibration, in turn, may stimulate the vagus nerve (the largest nerve in the body after the spinal cord) and will provide new signals that can help a shutdown or overstimulated nervous system to rebalance. This simple exercise can make a real difference in your relationship to pain, sometimes shifting your pain dramatically, and other times creating a more gradual shift.

EXERCISE: Voo Breathing

Begin the exercise by finding a comfortable place to sit. Slowly inhale a full breath, then pause momentarily. On your out-breath, gently vibrate the sound “voo,” as though the sound were coming from your belly. Sustain this sound throughout the whole exhalation. Let the breath go all the way out, and then pause, waiting for the next breath to come in on its own. If you like, repeat this several times. Then feel your body, particularly your fingers, hands, and feet, as well as any other parts of your body that feel enlivened or reduced in pain.

You can do this exercise as many times a day as you want. We suggest doing it at least three times a day, especially when you begin to feel stress or when your pain starts to increase. You can also use this at the end of the day when you’re lying in bed and about to go to sleep—and then in the morning (along with a cat-like stretch) to greet the new day.

Record your experience with this exercise in your pain journal, noting how you feel after you use it in a variety of circumstances.[image: Image]

Positive Regulation of Your Breathing

For some people, over-focusing on breathing can be a problem if they attempt to control their breathing. Controlled breathing is generally only helpful for a breath or two; for example, if you’re in a state of panic or intense anxiety and you want to calm yourself just for the moment, you might take a few deep, easy breaths—accenting the out-breath. Try this next exercise to help you find a different kind of spontaneous regulation of your breathing.

EXERCISE: Modified Diaphragmatic Breathing

Place one hand on top of the other just above your belly button. While inhaling, press down gently with both hands, and then while exhaling, let all the muscles in your belly relax or loosen, including those in the hands.

You may want to experiment with reversing this breathing practice. To do this, keep one hand over the other on your diaphragm and press down gently while you exhale, letting all muscles relax when you breathe in. Continue for several breath cycles. What differences do you find in the results between the two approaches?

Some people also find it helpful to add grounding through the feet or legs to this practice. If you’d like to try this, press gently through your feet and legs at the same time you are pressing down gently with your hands on your diaphragm (either during the inhale or exhale, whichever you prefer). Notice how this feels.

What do you discover as you do this exercise? Within a few seconds, many people discover that those feelings of connection with their breathing and their bodies increase. As always, if the exercise does not feel helpful, please discontinue it for the time being.

Please note your experience with this exercise in your pain journal.[image:  ]

An important caveat is that, for some people, just focusing on their breathing can lead to more anxiety, especially if the breathing practice is unguided. If this occurs for you, circle breathing (see exercise, track 2) can be a better alternative. This is because the focus is more on the periphery of the body and not on the diaphragm, belly, or core. Remember, it is always a matter of what works best for you. It’s essential to feel full permission to experiment, and if a technique or practice isn’t working, let it go and move on. There are many other techniques that may be more appropriate, more timely, and more effective for you.


Another of the most common sets of reactions to trauma and pain consists of anxiety. Generalized anxiety is diagnosed when there is chronic, exaggerated worry and tension. And even though there’s seemingly nothing that provokes it (or alternatively, everything provokes it), there can be very clear symptoms.

One set of symptoms is related to the sympathetic branch of the central nervous system and includes restlessness, feeling keyed up, or on edge. Other symptoms include feeling easily fatigued, especially as the situation becomes more and more chronic. Also, there can be difficulty with concentration, disturbance of thoughts or awareness, or problems associated with blanking out mentally. General irritability, muscle tension, and sleep disturbance constitute yet another set of difficulties. The latter category can include difficulty falling asleep or staying asleep. Panic, in contrast, is usually associated with strong somatic sensations such as a racing, pounding heart, difficulty breathing, shortness of breath, or a queasy twisted gut.

What we can conclude from neurobiological research is that panic and fear are triggered by the amygdala, our “all-points bulletin” natural alarm center. Trauma disrupts our alarm system through the mechanism of memory. Past traumatic events are stored in procedural or implicit memory as though they were ongoing and still happening at the present time.3

The result is an alarm system that seems to be randomly firing, but is actually firing due to unconscious cues from the past. We end up with a perpetual warning that something is wrong, that we’re always in danger. So we can have nearly constant activation from fragmentary emotional memories that impair our thinking brains. That is why we can’t intervene very well when we are having an anxiety or panic response.

In addition, pain can intensify greatly when the nervous system, over-activated by fear, goes rogue. Nerves begin to send out false alarms due to the development of pain hypersensitivity. This hypersensitivity can cause even benign sensory experiences, such as the touch of cloth on skin, to be triggering and painful. When this happens, pain ceases to be adaptive and becomes an illness in and of itself, creating persistent, unceasing torment.

Some individuals with unresolved trauma seem to experience more of a terror or fear response first thing in the morning, while others report this surge in the evening. Although we don’t know exactly what causes this phenomenon, we suspect that it’s due to fluctuating cortisol levels. It’s been widely accepted that people suffering from chronic PTSD have low cortisol levels, due to its depletion over time from heightened amygdala response.4

A research study of individuals involved in self-harm cutting5 indicated that cortisol levels were very, very low on the first day, then increased gradually, until on the seventh day the subjects exhibited relatively high cortisol levels. At the high point of the cycle, participants tended to cut themselves. What seemed to help them was to ask that they not get out of bed immediately to avoid their anxiety, but begin to make small stretching movements instead.

Toolbox for Shifting Anxiety, Fear, and Panic

Moving Just a Little Bit

When most people wake up in an anxious state, they tend either to stay in that state or they try to jump up and occupy themselves with something else. If you tend to wake up with high anxiety, try moving just a little bit. You might practice some of the breathing exercises that have already worked for you in this program. Then, slowly get out of bed and begin to mobilize more gradually by doing your regular morning activities at a relatively slow pace. Periodically, you may want to sit for a little while and evaluate how the anxiety feels and how you feel in general. This kind of self-paced approach seems to result in more stabilized cortisol levels and less fear.

Islands of Safety

Many people in pain are aware that as soon as their pain levels increase, they fall into states of anguish and anxiety. This reflects the intimate relationship that exists between pain and anxiety. In this program, we present a number of tools that work effectively with anxiety related to pain, and with pain related to anxiety. The key is to find what works best at a given time. Sometimes even an hour or perhaps a day later, the solution may change.

One effective strategy is to build “islands of safety.” When you find yourself in a raging sea of trauma, anxiety, fear, or pain, you may find a tiny island where you can settle, if only for a moment’s rest. One idea is to find the resting place in your body that you discovered in the first exercise in this chapter, Securing a Resting Place in Your Body. Repeat the exercise now and find a resting place or refuge from pain or discomfort. From there you can search for another tiny island. Then perhaps, you can create a bridge between these islands. As you continue along, you can begin to assemble a real landmass, a large solid island, which may have hills and an interior.

The key to working with these very difficult states of fear, of anguish, of helplessness, is to learn tools that can change your experience even a little bit. The nervous system really can’t change too much at once, particularly in chronic situations. But if you can achieve one small shift here, and then another there, eventually you discover that you’re on stable ground, and that the raging sea of pain and stress is going on around you, but you’re not in the middle of it anymore; you’re settled on the safety of an island instead.

Pause, Take One Breath, and Choose

Another idea is to find relief from anxiety through a simple three-step model. When you become aware of an increase in pain or anxiety, the first and most important step is to pause. Really get a sense of pausing and slowing everything down.

The next step is to take one breath with full awareness (see the Just One Breath exercise, track 5). Notice what happens in your body as you take only one full breath.

After that one breath—and you may want or need to take several more—you will then be in a position where you can make choices. You can choose to explore the possibility of islands of safety, of gentle stretching and movement, or use other tools based on breathing, mindfulness, or energy psychology, or any of the other techniques presented in this program. Just taking that one breath may set you in motion beyond fear, pain, and trauma.

Resolving More Lasting States of Anxiety, Fear, and Panic

Focus on resolving anxiety and fear states needs to take place throughout treatment of pain. We believe that all chronic pain conditions are also anxiety conditions—that is, pain is intimately related to the experience of dysregulated fear, when fear causes the body to constrict or brace against the pain. This causes the organism to experience more pain, which then triggers more fear and anxiety, and so forth.

One important way to work with fear is through mindful observation. When we are able to stand at a distance from fear, observe it, and take it apart as physical sensation along with its related thoughts and images, the fear often dissolves and transforms.

To get a sense of how this works, imagine that you are able to flee the source of your pain. If there’s an incident that started your pain, like an accident or injury, imagine that you can run away from that scene.

Joe, for example, imagined that he could sense the impact that caused the motorcycle accident that left him with chronic back pain before it actually happened. He envisioned revving up his engine and directing his bike safely in a different direction, then feeling the sense of successful escape in his body.

If there is a scene for you that is connected to the onset of your pain, imagine that you can use your legs to run away, or jump and roll out of harm’s way, or otherwise execute a planned escape. What do you feel in your body as you imagine this? How do you experience the flight response? What effect does this have on your memory of the incident? What effect does it have on your pain now? You might want to note your reactions to this mini-exercise in your pain journal.[image: Image]


 Helplessness comes from being overwhelmed by anxiety and fear. If you’re not overwhelmed, you may be able to experience fear, or even terror, without a long-lasting effect, because you know somehow that you’re going to be able to move through it. But when people don’t have this experience of knowing that they will be able to move through anxiety, chaos, and fear, this can lead to sensations, feelings, and postures of helplessness and of hopelessness.

Much of the research on helplessness has been done by psychologist Dr. Marty Seligman, who developed the term “learned helplessness”6 to refer to a situation where we perceive that we have no choices, or no control, over the outcome of very difficult, in some cases, life-threatening circumstances. Robert Scaer has suggested in his book The Trauma Spectrum that helplessness and hopelessness may be related to an unresolved freeze response.7

Toolbox for Shifting Helplessness and Hopelessness

We invite you to experience a series of tools to help you resolve helplessness and collapse. Take your time to explore these possibilities, working with one or more that seem to resonate for you. If none of them appeal to you, or if they feel overwhelming in any way, feel free to leave them for now and return at another time.

Working with the Posture of Helplessness

Helplessness and resignation are embodied as a collapsed posture—the shoulders slumped forward, the chest caved in, a folding around the area of the diaphragm (midriff). The posture is one of giving up. So in helping people begin to become aware of those postures, we often work with them in a standing position. When you’re standing up, your muscles have to deal with gravity, and can’t completely collapse. If they are sitting down, collapse can occur far more easily. Here’s an exercise you can use to find out how to explore the sensations and feelings of helplessness.

EXERCISE: Shifting the Posture of Helplessness and Collapse

While standing up, notice the parts of your body that feel strong in some way. Maybe you notice strength in your ankles, legs, thighs, arms, elbows, or shoulders. Pay attention to sensations in those areas that are even a little bit different from helplessness and collapse. Spend a little time exploring the sense of strength throughout your body, mapping and affirming those areas of improvement using the language of sensation. In your pain journal, note your experience of discovering your strengths.

Another important step is to notice in daily life whenever you start to experience the feeling or sense of helplessness. This might be related to your pain or some other challenge. If possible, go to a mirror and notice your posture. See if you can recognize specific places where your posture seems or feels collapsed, and then continue by practicing a few simple movements to begin to shift it. Remember to record your experience with the posture of helplessness in your pain journal.[image: Image]

Connecting with Conflict-Free Experience

Another way of working with this type of collapse into helplessness can be accomplished by connecting with conflict-free experience8 in your body. This technique refers to finding areas where you don’t experience helplessness, pain, or self-blame reactions.

EXERCISE: Connecting with Conflict-Free Experience

A simple way to find conflict-free experience is to ask yourself, “When, in the last day or so, have I felt least anxious or least in pain, and most like the self I hope to embody most of the time?” You may not be completely free of pain in this kind of moment, but there are always moments when you feel a little less pain, for example when you are laughing with a friend, taking a walk, or during other times of simple, pleasant engagement.

When you find that moment, see if you can represent that experience in your mind’s eye—as an image or a thought. Then shift back and forth between that image (or thought) and your body sensations. As you do this, notice how your body may be containing or holding the experience that is free of conflict, anxiety, pain, or helplessness. Then use your attention to go back and forth between your image or memory of the experience, and whatever sense of it you have in your body.

Repeat these steps two or three times, and then think of another time a week or two ago that was relatively conflict free. What do you notice? How can you describe the sensations in your body that result from this practice? Now think of another moment when you felt less pain and more freedom. Explore the felt sense of this moment. What happens to your pain as you practice? Note your experience with this tool in your pain journal.[image: Image]

Techniques to Reduce Negative Feelings before Searching Out Conflict-Free Moments

Another strategy is to use various techniques to lower anxiety, panic, or helplessness before finding a conflict-free moment. One example of how to do this is to use a technique (derived from applied kinesiology) often used in the practice of Energy Psychology called the “over-energy correction” or Cook’s Hookup.9 From this point of view, panic, fear, and anxiety all involve a situation in which too much energy is trying to flow through your energy pathways or meridians. There’s a lack of containment and a lack of flow.

If you’ve never encountered this type of approach before, be forewarned that it can seem a little strange and unfamiliar. Yet many people have good results with it in terms of reducing anxiety or fear—so if you’re ready for an “out of your usual box” experience, give it a try.

EXERCISE: Over-Energy Correction

To practice this technique, while sitting or lying down, cross your left ankle over your right if you are right-handed (reverse the directions if you’re left-handed). Then stretch your arms in front of you so that they’re parallel to the floor (if you are lying down, just reach toward the ceiling), with the backs of your two hands touching each other. Next, cross your right hand over your left and clasp your fingers together, fold your hands and arms, drawing your fingers down and back toward you, eventually pointing your fingers toward your face. Rest your hands and elbows on your chest. If you are at all uncomfortable in your wrists or your arms, modify this position by just crossing your arms over your chest with your right arm over your left (See more specifics including a diagram under “Energy Approaches,”, in the resources section).

Then place your tongue at the back of your upper front teeth, on the palate. Close your mouth and eyes, and just breathe for a few moments. Usually within the first ten seconds there begins to be a shift. Notice what happens for you, and continue for as long as your response is positive.

Many people report a deep settling into their bodies with a sense of calm. If this works for you, you can use this approach before you go to bed at night or if you wake up and are not able to return easily to sleep. You can also use it to manage many kinds of anxiety-fear responses including panic.

Note your experience with this exercise in your pain journal.[image: Image]

As with any technique, pay attention to your experience so that you can make nurturing choices in selecting those tools that have positive or neutral effects. As we have said before, this program includes many alternative possibilities so that you can find and choose the methods that are most effective for you.


Every day we have stresses that frustrate us and trigger anger. A driver pulls sharply in front of us without warning and we slam on the brakes, narrowly avoiding a collision, and the papers we had on the front seat are thrown all over the floor. Later in the day, a coworker repeats a mistake for the fifth time in a row, even after promising to resolve the issue. That evening, we learn that our spouse or partner has forgotten, once again, to complete a promised financial transaction, missing a deadline and incurring late fees.

Whether we want to or not, we have predictable reactions to these kinds of situations: elevated heartbeat, flushing, or the feeling that an internal volcano is about to erupt.

Anger is a normal reaction and can stimulate us to take action in adverse situations. It is related to the third of the “big three” reactions to pain and threat—the unreleased fight response. Like flight and freeze, fight reactions are important survival options when we are threatened with danger. When the fight mode is turned on through our body’s alarm system, powerful chemicals are released to give us more energy to persist in the face of obstacles, to ward off attacks, and even to counterattack.

Feeling anger can serve an enlivening function, empowering us to stay strong instead of collapsing into helplessness. It’s also a normal reaction when we lose basic trust in other people, because this is yet another type of threat to our sense of safety and security. Like the other survival responses, however, problems occur when the fight response is continually activated in the present moment due to reminders of past threats. When the energy of the fight response is not completed or released in appropriate action or discharge, it can create intense muscle tension, inflammation, and other systemic reactions that contribute significantly to pain. When feelings of anger or rage go unmanaged, they can trigger fierce reactions that are out of proportion to current realities, creating fear at the power of our angry reactions, whether provoked or not.

The problem here is not anger. The problem is that we often don’t know how to cope with, or express, feelings of anger in a fruitful way. We are also confused by other companion feelings such as resentment, hurt, frustration, disappointment, jealousy, and shame. Anger is simply a natural instinctive response to obstacles in our path and to many different circumstances where we feel powerless or victimized.

However, the habitual ways we express angry feelings and the energy of the fight response may be counterproductive. If we are unable to express our anger effectively, our automatic “short fuse” reactions may trigger us to react with full activation as if our circumstances were actually life threatening, causing problems in our work and family relationships. Continually angry individuals may actually provoke others to react aggressively and with hostility toward them, because of the inflexible ways they attempt to control their environments. This can set up a self-fulfilling prophecy associated with trauma-related beliefs like “I can’t trust anyone,” or “After all I’ve been through, I deserve to be treated better than this,” or “Why didn’t so-and-so prepare me for what could happen?”

Any effective treatment of pain should include awareness that fight responses are always present, as are freeze and flight reactions, whether or not they are being expressed. And as with any persistent discomfort, pain itself can activate arousal of the fight response since we can become angry at the events that created the pain to begin with, angry that our pain is unmanageable, angry that no one can protect us from the suffering that pain provokes. Additionally, if we have been significantly threatened or abused at a young age, we may not have learned flexible, effective ways to respond to conflict.

Somatic Contours of Emotional Anger

As emphasized in chapter 1, all pain conditions have sensate, emotional, and cognitive components. Discussion of anger, and the fight response, gives us the ideal opportunity to examine the wedding between emotion and sensation. Similar interfaces exist between fear reactions and the flight response, and between helplessness and collapse related to the freeze response.

We have said that the pain trap is created by the vicious cycle of bracing against the threat of danger, possible injury, or further pain; which leads, in turn, to constriction and more pain and fear, and so on. We can also become trapped by anger responses that become too compulsive, rigid, easily triggered, or explosive.

The primary intervention to prevent imprisonment in any of these traps is through the use of body awareness to process the emotional component of a threat response just as it is in the body. If we experience anger in its purest form in any given moment, free from mental analysis and judgment, we can begin to “dismantle” our habitual responses and enter into new, and energizing, somatic experience. In other words, when we access our feelings through carefully paced body awareness, rather than through rapid cathartic emotional release, we are able to create the lasting change in emotional patterns that we desire.

Toolbox for Regulating Anger, Rage, and Irritability
There are numerous tools that can help you effectively regulate your anger and fight responses. Try one or more of the following options and, as always, enter into an attitude of curious exploration so that you can move on if you aren’t satisfied with the results.

Shifting Habitual Anger Patterns

Learning how we deal with and resolve prolonged states of anger and rage has enormous impact on our abilities to transition to a pain-free life. Since these emotions trigger terror of our own aggression, we often turn these feelings in on ourselves because we are too afraid of expressing—or even feeling—them. The exercises that follow will teach you how to track, contain, and safely express these powerful emotions and their related sensations.

EXERCISE: Free Yourself from Habitual Anger and Rage

Tracking Bodily Sensations. The first step in shifting destructive emotional patterns is to track the bodily sensations that underlie the anger. Take a moment to think of a situation that frequently triggers anger, irritability, or frustration for you. Notice what happens in your body. You may become distracted by negative thoughts related to the anger response, but don’t be distracted by their content or your analysis. Instead return to and stay with the sensations in your body.

At first this may be confusing or distressing because it’s so different from your usual focus. However, as you hold these sensations in your awareness, without trying to change anything, feeling them just as they are, eventually your body experience will seem more spacious and settled. This is because as the underlying sensations of anger become uncoupled or separated from the emotion and then unhooked from related thoughts or beliefs, and even from images or memory, the felt sense becomes more fluid, moving toward subtler, freer “contours” of feeling.

What happens right now as you stay with the sensations of your anger? Note your experience in your pain journal. What part of your body wants to
express anger when you think of the anger trigger you selected a moment ago? What part seems afraid of the anger and wants to hold it back? Remember, the feeling of anger evolves from the fight response of wanting to strike out and attack. This holding back accumulates in our bodies as muscle tension and pain, and prevents the expression of healthy aggression.

Containing Powerful Feelings. To befriend your anger, you will also need to learn how to contain, or hold within you, powerful feelings. When we give into our usual ways of dealing with anger (which is either to stuff or suppress it or mindlessly express it), we are often trying to release the tension and feel relief from the powerful emotional charge. However, this may make no lasting change in our capacity to tap into the positive, life-affirming energy of anger.

To feel what healthy aggression is like, take a really crisp apple and take a big bite out of it. Now chew it with great vigor. Then take another big bite, enjoying the crunch and the power of your teeth biting down and destroying the apple by pulverizing it. Finally,
take in the juicy nourishment of the fruit. This is what pure healthy aggression feels like.

Examine Your Reactions in the Past. Think of a time in the past when you actually expressed your full anger at another person. Maybe you shook your fist, raised your voice, exploded into swear words, shoved him or her, or pointed your finger.

What was the effect of your behavior on the other person and on yourself? Notice as you explore the answer to this question whether you become more connected with anger or less connected.

What did you learn? What do you think might happen the next time you encounter a similar situation? [image: Image]

Explore The Roots of the Fight Response

To continue your study of the fight response, it can be useful to feel the animal roots of this powerful response to threat.

EXERCISE: Exploring the Roots of the Fight Response

Imagine that you are your favorite wild animal—strong, powerful, and quick—whatever appeals to you at the moment you are reading this. Feel the sense of your strength and power in your animal body. What sensations do you notice? Now stand up and begin to walk around the room. Let your eyes narrow so that you can get a sense of deliberate movement as you, more and more, “step into” the body of this animal. How do you experience your strength, power, and forcefulness?

Now imagine that another animal is approaching. You know, instinctively, that this animal is also strong and powerful; it is a force to reckon with, just as you are. You also sense that this animal wants to attack you. What do you begin to feel in your body? If you sense that you are going to collapse or shrink back, remember that this is your territory and that you have a right to defend it. What are the sensations that signal your determination to protect what is yours? Pay particular attention to sensations of determination and strength in your head, neck, shoulders, face, and jaw. What movements and tensions do you feel? What emotions are you aware of? Feel the strength in your shoulders, arms, legs, and feet.

Finally, prepare to take action toward the animal that is trying to invade your space and usurp what is yours. Notice what happens as you prepare to fight back and to protect your vital interests. Follow those sensations and movements, staying grounded in your body’s felt sense of your own animal power and strength. Feel how your shoulders, arms, and neck tense as you prepare to strike out. Does the energy related to fight begin to shift? If so, how? Continue to stay with these sensations until you sense completion. What does completion feel like? What happens to your pain?

Become Aware of the Feelings of Healthy Aggression

The following exercise can help you process anger about an event in the past as well as work with current anger reactions.

EXERCISE: Working with Healthy Aggression

First, constrict your hand into a fist and clench it tight. This act can represent being locked up in anger. You might even want to name the resentments, irritations, and anger that you’re aware of, and sense your fist clenching tighter and tighter to hold onto the anger.

Now gradually open your hand and extend your fingers so that they’re mostly straight but also form a bit of a cup. Where did the anger go? The lesson is that if you can learn to let go of anger in your body, it will tend to dissolve, or even “disappear,” because its energy is transformed in the letting go.

Now make your hand into a fist again, and again gradually allow it to open. What sensations are you aware of as your hand continues to open? Name all the ones you are experiencing. What do you notice as you practice using the language of sensation to describe your experience?

Explore the Sensations Underneath Anger

Often when we surrender to the urge to get angry, we simply let off steam like a pressure cooker. This does not allow us, however, to find ways of turning down the heat so that we can regulate the underlying buildup of anger (or steam). This next exercise teaches you how to feel the underlying sensations.

EXERCISE: Feeling the Sensations Underneath Anger

Start with a feeling of anger toward someone in your life. Feel and name the sensations as you track each one from its starting point to a sense of completion, change, or stuckness. Resist the temptation to detour by getting into your thought process.

If you feel stuck, just track your breathing as you focus on the anger. Feel the rhythm of the rise and release of your chest, the wave of energy and where and how it moves through your upper body. Stay with the sense of movement, the feel of muscles expanding and then letting go.

As you sense your somatic experience beginning to shift, return your attention to the anger you began to explore. What is different now? If you envision the next time you’re likely to experience the same kind of irritability, frustration, or anger, can you imagine shifting your attention to your sensations and breathing whenever you feel blocked or stuck, and then returning and expressing your anger with words meant to connect rather than to distance?

Jot down your experiences in your pain journal, then return to this exercise at a later time when you are feeling triggered by anger. What happens over time as you practice this approach?[image: Image]

The next chapter will help you continue on the journey from uncontrollable or unmanageable emotional or physical pain, which can result from insufficient self-regulation, back to the place of stable functioning. As in the current chapter, you will encounter additional practice exercises to help you develop specific skills in self-regulation that lead to further wholeness, balance, and stability. Our message will continue to show you how your unresolved stress reactions to threat and trauma can serve as the pathway to transforming your pain condition through the use of simple tools we present.


The Journey Back