SPEAKER_00: do you know which book has been mentioned as the most helpful for recovery in the one hundred and fifty five recovery interviews i've conducted so far if you've listened to even a few you can probably guess what book that is it's become such a phenomenon that there's even a term for it doctors call it book recoveries you read a book almost always this one specific book and you recover if you're new here welcome i'm raylan and don't worry in this video we're going to tell you what book that is each week here on the channel we dive deep into new recovery journeys from chronic conditions like chronic fatigue syndrome and long haul covid so we as a community can get inspired and learn from each other this famous book i mentioned changed everything for my guest today dr doug goufrida from the university of rochester after years of seemingly random unconnected health issues and unbearable back pain that he was told required surgery the information in this book didn't just help him avoid surgery and fully heal it also steered his career towards a whole new kind of research he now trains doctors to implement the same recovery strategies that have been so effective for him and so many others doug it was so great to have you here today thanks for doing this

SPEAKER_01: yeah thank you thank you for having me

SPEAKER_00: so you have had quite the journey with chronic pain and all of this so tell us about that

SPEAKER_01: yeah sure so like a lot of providers i got into this because of my own chronic pain i had back pain i had a herniated disc with you know shown on an mri couldn't sit down for a year it was extreme pain and was going to get surgery while i waited for surgery i found a book by a guy named john sono a lot of i think a lot of your readers or viewers are familiar with and read the book found a therapist to do some of the harder work and my back pain was gone within a few months went back to all my activities play basketball sports and not only that but a lot of the other health problems i had suffered with for years went away i had arthritic knee i had what nowadays would be called ibs i think that was probably before that diagnosis existed this was over twenty years ago shoulder pain

SPEAKER_01: headaches i mean you name it i had all kinds of stuff that you know one would go away and the other would come back i actually had heartburn so bad i had surgery for acid reflux which i wish i never had now because i clearly didn't need it causes problems for me now but yeah so everything went away i didn't do much with it as a practitioner i'm a counselor but i didn't do chronic pain counseling in fact we didn't talk about it much with anyone because back then you know you talk about it with people they think you were nuts to say that something physical could be cured something psychological and so i whisper to people in the shadows about you should try this book but didn't do much with it and then a few years ago i took an administrative role at my university and it was one that was a very stressful i wasn't enjoying it and my back pain came back and so i had a conversation with my supervisor at that point to say look i can't do this back hurting it's clearly bothering me for a while she had a hard time letting me out of the role and finally she said okay fine don't want to do this what do you want to do then and i said well i want to do chronic pain counseling and it wasn't my area i had been studying how to keep kids in college that was my college retention and she said well great we have a medical center here if you want to learn something new you can find someone i'll actually support you to do a fellowship and so she supported me i found the fellowship at the university who does this work with people with seizures bill watson who's a psychologist who works in the department of neurology he opened me up to the whole world of what we'll talk about later which is istp focused therapy bill uses this with seizure patients about forty percent of seizures are not epileptic meaning there's no chemical activity in the brain indicating any seizures and they're what's called psychogenic seizures and they use the same emotion focused approach i'll talk about to cure people of psychogenic seizures so i studied with bill i got to learn from a guy named howard schumer who some of your listeners are probably familiar with alan abbas is another big person in this field did a lot of my own work learning it engaging in it did what's called core training and istdp which is a pretty intensive

SPEAKER_01: three year training approach with a local expert named marvin scorman and then opened my whole private practice

SPEAKER_00: wow and just try even i'm still stuck on the point where they were telling you that you needed surgery because your chronic pain back pain and leg pain had been quite severe

SPEAKER_01: i couldn't sit down i couldn't move i would be locked up on the floor for you know sometimes hours at a time i got out of my car once at work and dropped to the ground couldn't get up for i don't know a couple hours in the parking lot i mean it was severe and you know there was visual evidence to indicate there was a structural problem now what we know now is that's all pretty much nonsense my back looked the same before it hurt it probably looks the same now you know there's quite a bit of research supporting the fact that back shoulders knees change as we age they look different just like hair turns gray our backs get narrow separate show little cracks they don't that doesn't cause pain just like gray hair doesn't hurt it's a psychological problem there's quite a bit of evidence now indicating there's really no very little relationship between observed structural changes back almost everybody you probably show herniated disc most people over the age of thirty show one of these things that would be diagnosable but don't have

SPEAKER_00: yeah it's interesting our understanding of chronic pain now because we used to think not so long ago well if there's no structural damage maybe this is a psychogenic thing but now we're seeing that there's very little correlation between the level of structural damage and the pain that you're experiencing or that the pain being an indication of a level of structural damage they just really aren't

SPEAKER_01: radiologists can't tell from looking at images who has pain which should be pretty clear cut but it's not

SPEAKER_00: so when you read dr john sarno's book what was it from the book that was resonating for you and making you think okay this might be what's happening for me

SPEAKER_01: well the symptoms right the fact that i had always had something really since i was a kid stomach problems headaches digestive problems you know sleep problems it was always something one would go away and the other one so you just find this carousel specialists that are just looking at one particular body part that really resonated the personality characteristics i don't know if you're familiar with some of the things sorrow talked about but they're they're so true for me most of my clients that i see really highly motivated ambitious hardworking but also really uncomfortable with strong emotions we're the people that run around trying to make everyone feel better we don't like it when people get upset you know we can have a party and everybody has a great time but if one person is unhappy we're really upset about that those kinds of things

SPEAKER_00: i know a lot of people watching will be familiar with the book and have heard about it but many won't have read it so the approach to treating this what does that look like from that perspective

SPEAKER_01: well sorrow said that a lot of people could get better just by reading the book and i know you mentioned in one of your interviews with the fact folks talk to you about that too just the idea that it resonates with it this isn't a structural problem there's nothing wrong with physically i just have to get in touch with my emotions you know learn to not be afraid of things and engage in things in more gradual persistent way he said about eighty percent of his patients got better just doing that i wasn't one of them and a number of us the people that i see usually are you know they have read it they're familiar with it that's why they find me but they're still struggling and so what we engage with now is a process called tensive short term dynamic psychotherapy i do some of the other things that i think your viewers are probably familiar with brain reprocessing pain neuroscience education i think those are some of the buzzwords that i definitely use those tools but for me the core of the intervention is this emotion focused approach the idea is all emotions are healthy we're born emotional human beings with this whole range of really intense feelings that need to be there for us to transition

SPEAKER_01: even things that we consider negative emotions grief loss intense anger and rage you know those things are all helpful to us to mobilize us to advocate ourselves but we learn early on often from our caregivers that some emotions are okay healthy and some emotions are really problematic and even dangerous and so we develop strategies sometimes even before we even can talk to adapt to our environment to protect ourselves and others from these emotions that we learn are not okay so we are born the most helpless creatures on the planet right if you watch a horse born you know they jump up and run away right babies are completely helpless our human babies are our entire existence depends upon between us and our caregiver and so we learn to adapt ourselves to fit in that environment to get the care sometimes this can happen where parents are ragers angry painful see all this fighting can come because of abuse but more often than not it can come because really good parents just are really uncomfortable with the fits that a kid throws or the range of emotions that a kid might show probably a lot of people have seen the disease movie inside out it's just a beautiful depiction of really good parents and teach a kid that where's my happy girl and you can't be upset put a smile on that kind of thing and so we learn to disconnect from these emotions to sit with the needs of our environment and we develop strategies to ward off these uncomfortable or dangerous emotions one of the strategies can be varied but for chronic pain patients it tends to be physical pain parents who might not be adapted handling their anger their rage fits become very mobilized when they have a stomach ache or a headache or hurt themselves and they learn this and so subconsciously we're able to transform this physical or these emotions into physical form there's actually quite a bit of mri research that supports this process which is really quite amazing that we're sort of supporting the things from you know the eighteen hundreds now mri research with people chronic pain versus acute pain looks very very different acute pain which they'll put someone in an mri kind of apply heat to their finger in a way that doesn't hurt the finger but hurts a lot you see the brain lights up there's not one pain center like there is an emotional visual cortex or auditory cortex it sort of lights up all over across the brain but you put people with back pain for example

SPEAKER_01: their brains light up one little teeny place called

SPEAKER_01: you might guess what the amygdala does if you're not familiar it's part of us responsible for emotions anger rage

SPEAKER_01: it looks very different so science is actually backing up the idea emotions can be transformed physical form

SPEAKER_00: and we know all this now and we can have these conversations but with your experience because he said you know back then you couldn't even need kind of whisper this in the shadows what's your experience now with people knowing and understanding and accepting this

SPEAKER_01: yeah most of the folks that i work with come to me because they know and understand and accept this but it's it's and some folks can work through the process very quickly and istdp we call those low resistance patients they come in ready to go all these defenses have been lowered they understand what they need to do they trust me they trust the process and you can just see this transformation pretty quickly these are some of the more remarkable recovery stories you might see or very quickly we're able to like work through the little bit of defenses point them out they notice them we work together to kind of you know work through them and then these emotions can kind of come up other people it's more complicated and it's harder i was one of the people that's more complicated i still am to this day very guarded and defended i still am in therapy and i have a lot of challenges getting in a lot of the core issues and emotions but i'll tell you a little bit more about what the process looks like i guess what gets in the way so we might start talking about something it's not a big deal

SPEAKER_01: in istdp we're always checking what do you notice in your body as you talk about this person

SPEAKER_01: often our anger comes in and when we check into the body body doesn't lie brain will lie they'll say i'm angry i'm so mad

SPEAKER_01: but we check in the body and often in the beginning you'll see tension

SPEAKER_01: right what do you notice my stomach's tight i feel constriction

SPEAKER_01: my shoulders you know those are the different places and that's anxiety they don't know they're anxious subconscious what they're anxious about are these feelings that ward off tense rage anger and actually underneath all of that guilt and so once they get to notice that they realize they're not really angry at all they know they should be but their bodies are really afraid about this feeling and so and usually the pain will start like in groups it's it's really quite funny to watch when i run through someone get activated you'll see the other people oh my god this chair you know to stand up adjust or you know they just get activated by other people's emotion and so we teach them that you know they might have to get up and go to the bathroom people with ip style coffee i gotta go to the bathroom that's a way to ward off the feelings another way is what we call cognitive disruption they lose their train of thought happens all the time or just talking about what did you ask i can't remember what you said that's that's a defense and so we'll point these out intellectualization well i need to just forgive them she had a hard life we get there istp gets tremendous forgiveness but you can't short circuit it with defensive behavior so once they are able to work through those real the somatic experience of anger and rage is often allowed to come through that's very different it's a looseness it's it's a warmth it wants to move and push up and out of the person we'll see them sign

SPEAKER_01: that's an activation we'll notice hands moving clenching sometimes grabbing we watch the leg movement when you see activation and they talk about a warm loose feeling that's a somatic experience of grabbing

SPEAKER_01: and sometimes we'll ask them they'll have visions you know quick images i have this picture person sometimes it's not even a person start to talk about it quickly go to primary caregivers people who use them it's called unlocking it comes out in its fullest form it is the most dramatic part of the healing process it doesn't happen in all cases but when it does it usually leads to some pretty dramatic improvements

SPEAKER_00: what sorts of conditions or symptoms are people coming in to address with this

SPEAKER_01: back pain knee pain shoulder pain headaches fibromyalgia so i didn't get into this you know i got in it more for the those kinds of issues my first two clients i saw both had fibromyalgia i didn't know much about it at the time this is going back about ten years but i had read some of schumer and lumbley's work that they had effectively so i started using it with them with an understanding to say hey you're the first people i've seen with this i can't really promise you know what will happen i just know that other people and they both got better very very quickly in fact went back to their doctors and told them they were cured the doctor called me to say what what happened

SPEAKER_01: this happened and as you can imagine after that my practice really picked up quickly so i have been working more with folks with fibromyalgia i take them readily because i do believe that it's the only thing that i've learned that really can cure it at least you know keep in mind the people i see have been through everything else i'm never the first stop usually the last so you know they'll come with all these other things that they've done and tried a lot of frustration about it i started to work with people with long covid and me those were not on my initial list but

SPEAKER_01: with long covid i was very hesitant because i didn't know what it was or what was going on last thing i wanted to say that this could be helpful there was no evidence out there and i had never seen anyone but there is starting to be some research showing that emotion focused therapy and helpful so i have started to see people with long covid and me and have been having some success with that as well

SPEAKER_00: are you seeing a shift in the professional community in terms of accepting this sort of therapy and treatment

SPEAKER_01: yeah that's been the most amazing thing as someone who you know went through his own process over twenty years ago and kind of as i said hid in the shadows with this it's it's really been incredible to watch the change in fact right after this i'm going to switch to another zoom meeting and i'm training doctors here in our local hospital on this as part of a community of us that's been doing this work so yes i get calls from doctors a lot now not just for you know training or teach me about this but can you see my patients because you know there's a growing recognition even in medical school now they're starting to get some there was no pain curriculum medical school and they're starting to have one now and starting to look to scientifically supported approaches back pain is not scientifically supported or back surgery the evidence shows that most people with back pain only twenty to thirty percent of them get better and most of them have long term problems after one of the biggest diagnoses now is failed back surgery syndrome just doesn't work in most cases and our approaches have much higher success rates that research is really supportive

SPEAKER_00: so what do you think about the people out there that are maybe a bit resistant to this idea or reluctant to go into therapy because it's going to be a really painful thing to endure but yet they're still struggling with their health what do you think what do you think's happening there

SPEAKER_01: yeah that's that's a good question dealing with emotions is never easy it is some of the hardest work that we'll ever do istdp is incredibly difficult approach it's incredibly supportive of people but it's different and i do liken it to you know some different therapies that people go to that they found helpful but don't cure them which i used to do cognitive behavioral therapy person centered therapy those were my approaches prior to

SPEAKER_01: they were helpful but i liken them more to like a walk like walking is really good for it's great for your health right everybody should go for a walk and walk a lot and it's easy and it doesn't cause istdp is more like crossfit right if you really want to change your body going for a twenty minute walk every day is not going to do it you got to get in the gym and put the more severe work and that's what i like

SPEAKER_01: a really supportive crossfit coach because the goal for us we have this threshold that we're working at right this emotional capacity that people have for these difficulties and most people with chronic pain or emotional thresholds very low and so what we want to do is increase the threshold gradually and our therapy should get people to the emotion that they can tolerate deal with without going over because it will have setbacks without staying too low because then we won't see progress just like good fitness right just take off and run a marathon after just walking ten minutes you would build up to it to your maximum capacity so that's the goal with istp so we do look to take people you know a little bit further every time without going too far that's difficult

SPEAKER_00: and i suspect one of the biggest barriers for people is even before this because most of us think of our you know mental health and our physical health and those are two separate things and if you're going through major physical health problems addressing your mental health stuff is a nice to have when i was really sick i started going into therapy and counseling but it wasn't to make myself get better that wasn't my motivation it was just to help me cope with the sickness and keep me going until i found my physical cure so it's it's such a change in mindset and our understanding of what's happening to even get people to the place where they see this as a part of their path to getting better

SPEAKER_01: yeah my clients will say that all the time people

SPEAKER_01: say this looks different why didn't i find this my answer is always the same you find this when the time's right and not everyone's ready for this at this point in their lives and you know probably about seventy to eighty percent of my people get better but twenty to thirty percent it's not the right time for them and we'll decide together that it's not and one of the things i published a study on a group that i ran we were actually looking at data and one of the things we do notice is that people get better generally have a setback at some point as things start to get more difficult emotionally these defenses get really activated and their symptoms will flare up or new things will happen and that's the time that's the make or break time people who really believe in it and know that a setback is part of the progress we'll stick with it and work through it and get better and people that aren't so sure about this will say well this is just bringing up all kinds of stuff you know i'm already sick you know now i got to deal with all these emotions too and they might be the ones that decide this isn't the right time for them people get better in my study were the ones that believed in it so much at the start that they worked through the setbacks and were able to make a lot of progress after that

SPEAKER_00: well doug this is just incredible i just my head explodes every time i have a conversation with someone like yourself it's so amazing to have professionals out there who are aware of this and out there and available and helping people because

SPEAKER_00: it's not the case just a very short time ago so i really appreciate you taking the time today to walk us through this and to show us you know the science behind it this is real this is helpful and it is that message that it is coming into mainstream conventional practices is really encouraging to hear as well so yeah thank you so much for this

SPEAKER_01: you're welcome thank you for talking to me i appreciate it

SPEAKER_00: yeah i'm curious from the viewers what questions you have love to see it and what's your experience been with all of this what's your take and also want to send a shout out to channel member yousef david thank you so much you said for the support and joining the channel sending big hugs to you i really appreciate it and for people watching i know this is a lot to take in if you're not already on my mailing list i do send out a weekly newsletter that summarizes and bullet points kind of the key takeaways from the interviews if you're not able to capture them all so there's a link for that in the video description as well so yeah thank you again doug thank you to those of you watching sending you massive hugs i hope you enjoyed this video i hope you got a lot out of it and i hope to see you in this next one
