By Tyler Orr, LPC/MHSP
A member of Team PTI

EMDR is based on a theoretical model called the adaptive information processing model, or AIP model. The AIP model states that most pathologies are derived from earlier life experiences that are maladaptively stored in the nervous system. As a mental health professional, especially one who holds to the AIP model, I see things like panic attacks, depression, and intrusive thoughts as symptoms—not the problem. The same is true for chronic pain. For example, if you catch a cold, it’s likely you won’t mistake your runny nose as the source of your ailment. Rather, you understand that the runny nose is a symptom and indicator of something deeper that is going on in your system. It’s easy to see this with a cold, but we are conditioned to believe very differently about pain.

The current medical model holds firmly that pain is the result of tissue damage in the body, but this is often not the case. Most medical professionals are hesitant to look for a deeper cause of pain because the medical paradigm for understanding pain, as well as that of our culture at large, is incomplete.

Lorimer Moseley, an Australian physiotherapist and pain neuroscientist, recently improved upon older definitions of pain by stating, “Pain is produced by the brain after a person’s [nervous system] has been activated and concluded the body is in danger and action is required.” It is important to note from Moseley’s description that pain doesn’t come from the body. It comes from the brain. When the brain detects that an area of the body needs special attention, a neural network is activated between the brain and body where a danger message is detected and the experience of pain is localized to that part of the body. However, sometimes the brain gets it wrong. It can mistakenly localize pain to areas that need no special attention. Another important thing to note from Moseley’s definition is that all pain is a matter of perception—how the person’s nervous system perceives what is happening—and sometimes the perception can be incorrect, causing pain to persist beyond the necessary time for damaged tissue to heal, and/or exist even in the absence of detectable damage or potential for damage.

I’m especially interested in pain where there is no detectable tissue damage or reliable medical reason for the pain because this type of pain can be viewed a symptom of something deeper. What I’ve consistently found is those with early attachment disruptions—those who were abused, neglected, separated, or pressured—are especially susceptible to this type of pain. My hope for this blog is to bring awareness to how early childhood experiences can influence the experience of pain later in adulthood—how the past impacts the present physically, mentally, and emotionally.

Attachment Styles and Character Traits

Imagine yourself around age three or four. You’re standing in front of a large banquet table, and on the table is every possible defense strategy or character trait imaginable. These defenses and traits are what you turn to to feel safe and connected when you’re in a stressful situation. They are tools available to help you survive in your world. The problem is you’re too young and haven’t figured out which ones are most useful for your unique home environment. Let’s say you are faced with a stressful or abusive situation and you reach for the defense of standing up for yourself, but that doesn’t work out so well. Let’s say you’re punished or shamed. Your situation becomes worse somehow, and as a result you don’t feel safer or more connected to your caregivers. Because of this you put that strategy back on the table and you don’t touch it again the next time you experience a stressful situation. In fact, you now shy away from it altogether thinking that it might not be safe to use.

Now imagine you’re in another stressful or abusive situation and this time you reach for the defense strategy of something like submitting. You don’t resist, and as a result, you feel safer than you did before. Or let’s say you try the strategy of putting your caregivers’ needs before your own, and as a result you get special attention and feel more connected to them. Whichever the case, you don’t want to put that strategy back on the table because it worked. You keep it and hold it close. So that next time you face a stressor, you don’t have to fool with finding something on the table because you have something that has already proven itself effective. So you use it and it works again. In future times of stress, you use it and it keeps working. As long as it keeps working you keep it close until eventually it sort of becomes hardwired into your system. You don’t have to decide to use it. The strategy automatically arises when your system deems necessary. It becomes part of your personality. It becomes one of your personality traits. This adaptation to life becomes your “Answer”.

The “Answer” is a concept PTI uses to help simplify attachment theory in order to apply it more easily in therapy. We use this concept along with character types to predict blocks and integrate dysfunctionally stored memories more effectively. Your Answer is anything you overdeveloped early in life to help you make it in your world—to feel safer and more connected.

The Answer and Personality

There’s a pattern that is common among those with persistent pain. They have self-defeating “Answers”. Let’s take a look at the common defense strategies and character traits:

Low self-esteem
Perfectionism
High expectations of self
Wanting to be good or liked
Guilt
Dependence on others
Conscientiousness
Being hard on yourself
Overly responsible
Taking on responsibility of others
Excessive worry
Indecisiveness
Powerlessness/helplessness
Rule following
Difficulty letting go
Being cautious, shy, or reserved
Repressing thoughts and feelings
Lack of safety/hypervigilance
Harboring rage or resentment
Not standing up for yourself

There is a commonality to all of these character traits. From what I’ve seen, powerlessness is the source of the “runny nose.” It’s the source of persistent pain. If your natural fight or flight responses where repeatedly thwarted, a sense of powerlessness would become overdeveloped and hardwired into your system. As a result, personal power and personal needs would be repressed. If you have chronic pain, my guess is you can relate to several of these traits. Those with pain are the nice guys, the caregivers, the ones who focus more on the needs of others, the ones who hold on to the past, and worry excessively about the future or other peoples’ problems. They exert lots of energy outside of themselves, taking care of other people’s feelings while not attending to their own. These are the “Answers” that repress personal needs, desires, and feelings. Repression becomes overdeveloped. Personal feelings get pushed into the unconscious only to seep out as symptoms like panic attacks, obsessive thoughts, or pain.

A friend and colleague of mine, Dr. Matt McClanahan likes to say that the jerks of the world don’t have pain. That’s because they don’t repress their personal needs and wants. They are overdeveloped in expressing personal power in any way they want. As a result, they usually have no pain.

Procedural Learning

We remember the past not only as cognitive memories that include images and stories. We also remember the past through chronic habits of tension, movement, and posture. Our bodies continually respond to what we experience in our environments and how we feel inside. If you felt safe when you were a child, your body at the time would have relaxed. You would have cuddled, run, jumped, or played, but if you felt afraid, your body would have tightened and braced. You likely would have cried for a caregiver to soothe you. If no one was available to comfort you, your natural response would be to suppress that tension by shutting down emotionally or cutting off from your body. On the contrary, maybe your system became hypervigilant and overly sensitized to your environment in an attempt to find safety. If we are scared or neglected long enough, the tension, suppression, or hypervigilance can turn into enduring physical habits. Over time, the body’s repeated responses and reactions become automatic, persistent patterns. These patterns now arise in your body as a “memory” of the past that your mind may have forgotten or repressed.

When we learn something through repetitive physical experience, we call that procedural learning. An example is learning to ride a bike. Initially, it took tremendous conscious effort to stay balanced through correct posture, movement, and muscle tension, but after repetitive experience of staying on the bike, it became habitual. There is now an automatic knowing of how to ride that requires no conscious thinking. The same is true for stressful childhood experiences. If a child finds herself in a stressful situation of any kind, her body will respond accordingly. For example, certain situations may call for her body to shrink into a protective posture. And if this same type of situation occurs repeatedly, then the same protective posture will also repeat if it was used successfully in previous stressful events. These repetitive tension patterns, gestures, postures, and movements become the blueprints for the way she learns to move and hold her body throughout life. They become procedurally learned habits that endure into adulthood.

The patterns we display were formed because they were initially adaptive. However, later in life, when conditions have changed, the procedural learning remains in operation even if they are no longer appropriate responses to your current reality. For example, even if when you know intellectually that you are now safe, your procedural learning, which is now an unconscious automatic habit, can repeatedly warn you that painful past experiences are happening again and will continue to happen. All pain is a matter of perception—how your nervous system perceives what is happening. If your system still sees the world as dangerous or deems certain body sensations as dangerous, it will respond as if something dangerous is happening. Additionally, if in childhood you had to repeatedly constrict your body to repress your fight or flight responses so you could put the needs of others before your own, that same tension will now habitually show up to hold feelings of fear, anger, and sadness at bay, making it difficult for you to connect with those emotions in your present life.

One of the more popular theories in mindbody pain literature is that pain is a protective distraction that prevents you from experiencing repressed emotional pain like anger and sadness. Oftentimes pain is a result of unconscious tension, movements, postures, and gestures that happen unconsciously in an effort to protect you from feeling repressed emotions that your system perceives as too overwhelming. Basically, your system will create one type of pain to prevent you from contacting another kind of pain that was determined in your childhood to be much worse. But in my experience as a therapist, the repressed emotions aren’t too much to handle. With proper preparation and a pace that feels safe to the client, we can learn to bring these unconscious feelings into conscious awareness where they can be experienced in safety, reprocessed, and released. And when this happens, the body can begin to relearn. It can learn to release tension the same way that it learned to hold tension—though repetitive experience.

They all have a sense of powerlessness at their root.

I taught my dog, Marty, to go to the bathroom outside when he was a puppy, and I didn’t do it by giving him a ten-point lecture on the benefits of being housebroken. It’s important to note that your nervous system is the same as Marty’s from your eyebrows down. That part of your nervous system learns the same way—procedurally. My dog learned through repetitive experiences where he was scolded when he went inside and praised when he went outside. This is why talk therapy doesn’t usually bring relief to pain, because talking only speaks to the part of your nervous system that understands words and the words are largely lost on the part of your system that unconsciously produces the pain. And this is why EMDR is such an effective treatment for pain, because it encourages the deeper parts of your system—your inner Marty—to reprocess those past experiences that are at the root.

To summarize, theorizing that pain is always due to damage in the body is like saying that your nose must be defective if it is running. Just like a runny nose is a symptom of a virus in the system, chronic pain is often a symptom of deeper emotional pain that is rooted in adverse childhood experiences. If our theory is correct and pain can exist in the presence of no tissue damage, that’s good news for us all. It means there is hope for pain reduction because, for example, your back pain may not be rooted in the tissue of your back after all. Rather, it may be rooted in emotional pain from early life experiences that are presently and maladaptively stored in your system. And that can be treated.