Chapter 24

Resolving Difficult
Emotions and Their
Physical Effects

Medicine’s Progress in Healing
the Mind-Body Split

“Is my chronic pain real or psychosomatic?”

The world of modern medicine has traditionally considered only two categories of symptoms. Only one type was thought to be real. Real symptoms are the physical ones you can verify by examining the body or running a test. These organic physical symptoms can be measured, quantified, and traced back to some bodily condition.

But if the reported symptoms do not show up on tests, or if they are out of proportion to the test results, then they must not be real. They aren’t caused by your body, so they must come from your mind. Such so-called psychological symptoms are often referred to as stress-related or psychosomatic symptoms. The connotations of these words haunt patients who report such symptoms. These words seem to blame them for a problem they didn’t cause. Because it’s “all in their head.”

Our natural healing capacities can bring clarity and restoration to these syndromes referred to as so-called psychosomatic illnesses. The common denominator of these disorders is that they are said to be caused strictly by unresolved emotional conflicts. I agree that emotional conflicts may play a contributing role, but they are not a sufficient cause by themselves. Rather, most often it starts with a physical vulnerability that is then worsened by emotional conflicts.

I have already mentioned that categorizing symptoms as psychosomatic is misleading, but it is part of a tradition that began four hundred years ago. Viewing illness with a sharp distinction between real physical symptoms and unreal psychological symptoms dates back to Descartes. He’s the French philosopher whose mechanistic theory of pain guided modern medicine’s treatment of pain until the 1960s. Descartes famously promoted the idea that the mind and the body are completely separate entities.

Descartes’s mind-body split suited the scientists in the emerging fields of medicine and physiology. They focused only on the body and its diseases. The mind had nothing to do with it. They were content to let others deal with the mind: philosophers, theologians, and eventually, psychologists and psychiatrists. Descartes drew a sharp line between the body and mind, and that line persists in the traditional medical paradigm. It is only now being changed.

In recent decades we have discovered that the mind connects with the body at the cellular level. Each emotion that we experience is born as an electrical nerve and hormone signal. Depending on the type of emotion, the nerve signals produce various chemical hormones made from protein. They are called neuropeptides. These chemicals are secreted into the bloodstream, where they serve as messenger molecules. They deliver their message to every cell in the body. Depending on the emotion, certain cells react to it—giving you a physiological response. This sequence explains how what goes on in the mind has a physical impact on the body.

Difficult or stressful emotions give rise to neuropeptides that can weaken your body’s immune system. That is why we are more likely to catch a cold or other infection during or directly after an emotionally difficult time. So when we feel upset, anxious, or stressed, our health can suffer. Today we know how thoughts and emotions concretely interact with behavior and physiology. There is no line between them.

The discovery of the mind-body connection was the culmination of a series of scientific breakthroughs throughout the twentieth century. These seminal discoveries—clustered around the immune system and nervous system—have revolutionized our understanding of mind-body connections: Dr. Hans Selye proving that stress plays an important role in physical illness. Dr. George Engel demonstrating that health and illness result from a combination of biological, psychological, and social factors. Dr. Robert Ader’s contribution that the immune system is influenced by the autonomic nervous system, and that the immune system can actually learn.

Dr. Ader’s research created the field known as psychoneuroimmunology: the study of how the mind and the stress response affect the ability of the immune system to maintain health and fight disease. We now know that emotions and behavioral reactions can influence physical illness or health through communication with the nervous system, hormonal system, and immune system. Science has evolved to demonstrate that emotions and thoughts can cause physiological changes in the body.

The traditional biomedical model excludes emotions and feelings as irrelevant in understanding “real” symptoms. That’s why it is so common for providers and patients alike to misunderstand the important interactions between emotions and chronic pain. Nevertheless, chronic pain sufferers are often told that their problem is an emotional one. Until you connect the dots of what this means, there is often defensiveness about the role of feelings. Patients are apt to say, “If you talk about my emotions, then you are implying that my chronic pain is all in my head and not real!”

And yet it is well-known that chronic pain affects your emotions, and your emotions affect your pain. Negative emotions add to your suffering when pain makes you angry, sad, anxious or stressed. Positive emotions, however, can have a beneficial effect. Sometimes you forget all about the pain in your back when you are engaged in doing fun things—such as attending a live concert, or playing with your grandchildren. When you are enjoying yourself and feeling happy, you hardly notice your pain. The ways that your mind modulates thoughts and emotions affect the ways that your body controls pain.

To add to your suffering, pain and the fear of pain can cause you to avoid physical and social activities that you normally enjoy. This sort of reclusive withdrawal can weaken your relationships, reduce your mobility, and then contribute to the vicious cycle of more chronic pain. Pain can cause depression and anxiety, and conversely the presence of depression or anxiety can make your existing pain worse. The result is that depression and anxiety are very common among people living with chronic pain.

The connection between chronic pain and difficult emotions is not just a coincidence. From a neurological perspective, we can see that both emotions and pain are processed by the same structures in the brain. The areas of our brain that are associated with sensory pain perception overlap with the areas of the brain that process emotions. That means in order to heal from chronic pain, we must first understand what happens in the normal functioning of emotions. And then we must face the challenge of processing difficult emotions.

Emotions are a naturally occurring phenomenon in all mammals. We are hardwired to experience emotions, both positive ones and negative ones. Positive emotions include excitement, happiness, and tenderness, while negative emotions refer to such feelings as sadness, anger, and fear. Emotions each have their own life cycle. When you can allow yourself to experience the feeling in your body, the emotion is eventually discharged, and you can move on. You’ve gotten over it. However, when you can’t or won’t allow yourself to experience the emotion, it often becomes stuck. There are lots of reasons why we sometimes resist experiencing feelings of sadness or anxiety. Perhaps we avoid them because they make us feel uncomfortable. Maybe we instinctively fear that the emotion will weaken us, or that we will sink into a bottomless well of grief.

One thing is for sure. When you fight the feeling, problems ensue. For example, when you chronically fight or deny the experience of anger or sadness in your body, it may eventually manifest in the form of depression.

There is no better illustration of this than looking at an infant. One moment the baby is angry and screaming, and then before you know it she is laughing with delight. They don’t hold anything back. They fully express each bout of sadness and happiness. But we almost never see a depressed infant! This is because the infant has not yet learned to suppress feelings of anger or sadness. That allows the ongoing flow of whatever feeling surfaces! Babies possess the natural ability to go with the flow of their emotions. Somehow, we learn to fight that natural ability as we grow older.

What happens to us physically when we don’t effectively process our emotions? One of the best lessons I have learned on this topic comes from a presentation by Dr. Robert Scaer, a neurologist who studies the effects of post-traumatic stress. At a conference where we were teaching together, Dr. Scaer showed a video that powerfully conveys the effects of trauma on behavior in the animal kingdom. He began his program with a question. Why don’t wild animals exhibit the symptoms of PTSD? After all, their lives are filled with life-threatening trauma—they struggle to survive as both predator and prey.

His video was a documentary on researchers in the Arctic who were investigating the effects of a traumatic stimulus on polar bears. The scientists aboard a helicopter sighted a group of polar bears. The noise of the helicopter frightened them, and they ran away. They flew low enough to shoot one of the fleeing bears with a tranquilizer dart. They landed and approached the tranquilized polar bear, who lay motionless on the ground. Later, after they had conducted their examination, the tranquilizer gradually wore off. The bear opened his eyes and became alert, but remained motionless. Dr. Scaer likens this to a post-traumatic “freeze response.” A short time later, the bear started trembling uncontrollably. The shaking lasted for nearly an hour. All of a sudden, the bear got up on all four legs and walked away as if nothing had ever happened!

Scaer interprets this bizarre scene as depicting a crucial distinction between humans and wild animals. Animals in the wild have never learned to hide or suppress negative emotions or physiological reactions such as the uncontrollable trembling. The frenzied shaking is a way to discharge the nervous system, releasing the psychophysiological effects of trauma.

It is one of the great contradictions of civilized human culture that we have learned to suppress our emotional reactions even though it is bad for our health. It is simply not socially acceptable to go around crying or trembling with fear. What would people think? As a result, our nervous systems don’t have the opportunity to discharge the trauma. That leads to unresolved tension, nightmares, and feelings of dread that accompany both PTSD and chronic anxiety. I tell my patients this story to show the importance of allowing physical expressions of emotions when they arise—whether it’s crying, blushing, or even trembling with anxiety. I tell them that crying is just as important a nervous system discharge as trembling is for that polar bear!

What Happens Physically When
We Suppress an Emotion?

Let’s imagine once again that you are in a social situation where you want to hide your emotions. Although you are on the verge of tears, you must attend a social function at work. As you enter the room where your coworkers have gathered, you don’t want them to know that you feel like crying. How would you guard against that? The customary strategy is to “grit your teeth and bear it” or “keep a stiff upper lip.” Physically speaking, donning a facial mask to hide your feelings is a matter of tightening your muscles of expression—e.g. the muscles and tissues of your face, neck, and upper chest. You would want to tighten the muscles around your jaw and mouth, so others don’t see your lips trembling. To avoid crying, you’d tighten the muscles around your eyes, temples, and forehead. Your breathing would shift to shallow upper chest breaths, since we instinctively know that deep belly breaths are more likely to bring those deeper emotions up to the surface.

But what if you must keep up this ruse for a long time? When you chronically control the expression of difficult emotions, you have to keep all those muscles in a constant state of tense readiness. Each morning you brace yourself for another exhausting day of tight muscles and restricted breathing. Imagine how, over time, this could contribute to continued symptoms of chronic pain and fatigue.

Suppressing your emotions is a double-edged sword. When you successfully block out your negative emotions, it also keeps the positive feelings from coming through. I saw a good example of this in a patient who had chronic arm pain. In response to the pain, she developed chronic depression and hopelessness. The stronger her pain, the more hopelessness she felt. Over time she learned to suppress that emotional response. She hated feeling helpless, so she denied her feelings to the point where she became emotionally dulled. But then she couldn’t feel any emotion—good or bad. Because of this, whenever she encountered any improvement, she was unable to feel good about it. She had no sense of hope, relief, or encouragement, and these feelings are necessary to cope with the ongoing rehabilitation from chronic pain. She had developed what I call “prudent pessimism.” Or, as the lyric from the rock song goes, “Things don’t seem as dark when you’re already dressed in black.”

When it comes to the somber duet of emotional problems and chronic pain, it does not matter which comes first. Sometimes emotional problems predate the onset of chronic pain. A person could suffer from chronic depression for years and then develop chronic migraine headaches. Or someone could get injured at work and go on Workers’ Compensation for years with low back pain, only to develop chronic irritability and anxiety after being confined to his home for several months. Whether the chronic pain or the emotional difficulties developed first doesn’t really matter. Both are normal, common reactions.

The Healing Power of Tears

The list of unpleasant emotions one can experience from chronic pain is long indeed. They include anger, frustration, inadequacy, fear, guilt, shame, anxiety, and overwhelm, to name just a few.

And yet, the most difficult emotion for most people that I have seen over the years is sadness. This feeling, along with its variants—grief, loss, emptiness—seem to be the one that causes the biggest problems and generates the most resistance.

There are many reasons for this. Anger and anxiety are activating emotions. These feelings are associated with arousal, elevated heart rate, and muscle tension. These emotions help mobilize the fight-flight response in the body. They are part of our innate trauma response that prepares us to do battle or to escape as quickly as possible. By contrast, sadness and loss are associated with the opposite response—a deep sense of emptiness, grief, isolation, and weakness. Rather than stimulating a mobilization response, sadness and loss often feel as if the bottom has dropped out. Sadness, therefore, can feel far more vulnerable than other emotions.

Psychodynamic theorists have written about this phenomenon for years. Alexander Lowen, a psychiatrist, developed the field of analysis known as bioenergetics. This approach asserted that emotional problems arose from chronic muscular bracing and guarding in the body due to excessive stress. Understanding the mind-body connection was central to his approach, and his treatment focused on how difficult emotions are stored in the body.

In particular, Lowen stressed that we grow up being taught to inhibit crying, because it conveys weakness, or immaturity. As someone learns to guard against crying, they also learn to guard against the letting-go that happens with experiencing pleasure. In effect, we learn to hold ourselves rigidly, including tight, rigid muscles. Lowen said that we maintain this physical rigidity as a way to block out painful sensations as well as painful emotions.

In our culture, children are commonly taught to restrain their emotions. Above all, they are not supposed to cry. Many children can remember being teased in elementary school for crying when they got hurt. Some parents threaten their children with the admonition, “Stop crying or I’ll give you something to cry about.” Many people grow up believing that crying is a sign of weakness. Such tearful behavior also places a burden on people close to them. The phrase “boys don’t cry” is widely understood and was even the title of a major motion picture. The prohibition against crying, however, is widely upheld by both sexes.

Paradoxically, even though crying is often discouraged in our culture, the value of a good cry for feeling better is widely understood. The significance of releasing deeply stored grief and loss has been recognized not only in psychological circles, but in pop culture as well. You might remember the chart-topping group Tears For Fears and their number-one hit single “Everybody Wants to Rule the World.” The co-leaders of the group explained in interviews that they chose their name based on their experiences in psychotherapy. They learned that by accepting their anxiety instead of fighting it, they could let go and cry to resolve their underlying sadness. By accepting their tears, they reduced their fears.

Chronic Pain, Sadness, and Loss

The sense of loss is obvious after the death of a loved one, but that feeling of loss is also common with chronic pain. The fear of being incapacitated by pain can feel like the fear of death itself. Patients with chronic pain experience profound losses because of the multiple impacts it has on their lives. After all, chronic pain can cause a loss of abilities and roles, job-related losses, and financial losses. One can even suffer a loss of identity—feeling changed as a person and misunderstood by others.

Why Do We Cry?

Crying emotional tears has the potential of multiple health benefits. We are not speaking of reflex tears, which occur when you get something in your eye, or the continuous tears that keep your eyes lubricated. Emotional tears are released at times of strong emotion, particularly sadness or joy. These tears help self-soothing, but they are also important for biological homeostasis. Such tears prompt the release of beneficial neurohormones such as oxytocin, serotonin (mood-enhancing), and endorphins (natural painkillers). Crying emotional tears also helps balance the activating and calming branches of our autonomic nervous system. Research has revealed that crying may also serve more complex communication and social bonding functions.

Release and Balance: The Emotional
and Physiological Value of Crying

Crying is a hardwired automatic process for self-regulation and biological homeostasis.

We are all born with the capacity to experience a wide variety of emotional states. These include positive emotions such as happiness, excitement, and joy, and negative emotions such as sadness, anger, and fear. As I mentioned earlier, when you notice an emotion surface and allow it to be there without struggle, the feeling eventually passes.

Consider sadness—a normal response to grief or loss. When we let the feelings and sensations of sadness be experienced without avoidance or struggle, eventually the sadness passes. But if you were to chronically suppress feelings of sadness, it would eventually morph into clinical depression. Instead of a transitory sadness, you become immersed in a constellation of despair, exhaustion, insomnia, appetite disturbance, and hopelessness. That is often treated with psychotherapy and antidepressant medication.

Just as Dr. Scaer’s polar bear taught us, physical expression of difficult emotions allows for nervous system regulation. Such a release is essential for healing from the trauma of chronic pain.

Irene is a ninety-year-old woman who has been suffering from chronic low back pain for several years. She is very bright intellectually, but has had difficulty identifying anything more than the most basic emotions, with anxiety being the most common one she suffered from. In the course of her treatment with me, she worked diligently to pay more attention to the sensations and emotions of her body, making significant progress. As our work together progressed, she became more aware of feelings of deep grief and loss about all she has missed out on because of being so limited due to back pain.

I introduced the concept of the healing power of tears to Irene. At first, she was skeptical about this. “Of course I know I’m sad about this—what good will it do to cry over spilled milk?” She reluctantly agreed to do this exercise with me. I encouraged her to start with a brief 4-4-8 breathing technique. Then I guided her to take slow, steady breaths as she let herself acknowledge all that she has missed out on due to her back pain. After a minute or so, her lower lip started to quiver, and soon she was crying. I encouraged her not to have to “understand why” and instead just allow this natural bodily reaction to occur. This went on for about one or two minutes. The crying naturally ended. Then what followed was very surprising to Irene. She said: “I never would have believed it—my anxiety is gone, and the back pain is less than half of what it was when I began the exercise!”

Months later, my check-in with Irene revealed that her daily practice of allowing tears is paying big dividends. “I allow myself to have tears every morning for just a few minutes. I can feel how much calmer my mind and body feel afterwards. If I happen to miss a day of practice, I notice because my back pain gets ornery again! I hope you are teaching this to all of your patients!”

How to Regain the Capacity
to Shed Emotional Tears

Now that you know the health benefits of crying, how can you allow yourself to do it, especially if you are not used to allowing tears?

Happily, there are several strategies available to regain this inborn ability.

Start by taking a short walk—even three to five minutes walking will help by releasing some of the chronic muscular guarding that prevents crying. Follow this with one of the following strategies:

•Listen to emotionally evocative music.

•Watch movies that have made you cry in the past. If you need more choices, do a Google search for “the best sad movies.” One recent online search revealed “Seventy-Seven Best Sad Movies to Cry To.”

•Think of your saddest memories: the death of a loved one, or a time when you felt hurt by someone close to you. You may feel hesitant to do this, but the resulting release will make you feel better.

•Think about what you are grateful for.

Do Emotions Occur in Your
Head—or in Your Body?

People often talk as if emotions occur in their head, as if they are some sort of mental activity. A physician who can’t find a physical cause for your symptoms might say, “It’s all in your head.” A derogatory way to refer to someone with emotional problems is to call them a “head case.” People accused of being emotionally unstable may hear, “You ought to have your head examined!”

Aside from being offensive, these expressions are not grounded in scientific fact. The truth is that the only place that you can experience emotion is in your body. That holds for any emotional experience you can imagine. Emotions may be triggered in your brain, but they are not felt in your brain.

When an emotion happens, the brain sends a series of messenger molecules throughout your body. The chemical composition of these molecules varies depending on the emotion, but each message contains a program that causes physiological changes that ready us for action. We can sense these changes physically by paying attention to our bodies. For example, you know you’re in love from the warm feeling in your heart, and the smile that just won’t quit. You know you’re anxious by feeling your heart racing, your mouth becoming dry, your skin turning pale, and your muscles contracting. When you feel sad, your body feels heavy, or you can sense an aching emptiness in your chest. Feeling emotions is a matter of reading the body.

An interesting example of this misconception about emotions involves the neurotransmitter serotonin. It is a widely known mood-enhancer that improves the experiences of depression and anxiety. Some antidepressant medications work in part by adjusting the amount of serotonin between nerves. Many people naturally think that most receptors for serotonin are in the brain. Perhaps it will surprise you to know that over 95 percent of all serotonin receptors are located in the gut! This is just one of many examples of how emotions are intertwined with the body.

A jumble of difficult emotions can become associated with chronic pain. Some feel deep sadness and grief at their sorry state. A strong desire for relief may cause feelings of intense anxiety and impatience. You might feel angry and resentful when you see everyone happily going about their day, oblivious to your burden of chronic pain. It might be feelings of shame and embarrassment. Some feel jealous toward all the others who doesn’t have to struggle so much.

Regardless of which emotion becomes commingled with your chronic pain, the result is greater suffering. Think of the physical changes in your body if you had a deep, aching chronic pain in your lower back. You may get occasional tingling or burning down one leg. Just the effort of cautiously moving your sore body around all day leaves your muscles feeling stiff and tired. Add the physical manifestations of sadness, anxiety, and frustration that are so common with chronic pain. The net effect is often an experience of overwhelm and despair.

Knowing how to work effectively with these difficult emotions can ease the intensity of suffering in chronic pain. The place to begin is by understanding that your emotions are embodied.

Now that you know something about how difficult emotions can negatively affect chronic pain, we will explore what recent research tells us about how past emotional difficulties can affect your pain.

Adverse Childhood Experiences
and Chronic Pain

Some of my new patients are a bit puzzled when I ask them whether they had experienced any sort of childhood trauma. They wonder to themselves, “What in the world does childhood trauma have to do with my chronic pain problem?” It can have a lot to do with it. Many studies indicate that someone who has experienced adverse childhood experiences (ACEs) are two to three times more likely to develop chronic pain as an adult. That’s why I ask about their childhoods. It can be a significant factor in chronic pain, and it affects a lot of people. Once we know about such things, however, we can address them in treatment.

The Psychological and Physiological Effects
of Adverse Childhood Experiences (ACEs)

The idea that childhood trauma can have long-lasting psychological effects is as old as Freud. The updated version is that ACEs can have physiological effects as well.

In 1997, the Centers for Disease Control (CDC) teamed up with healthcare conglomerate Kaiser Permanente for a groundbreaking study of the effects of childhood abuse, neglect, and dysfunctional homes. They sorted these various problems into a list of ten adverse childhood experiences, or ACEs. They were looking for things that affected a child anywhere from birth to their eighteenth birthday.

They found that ACEs are quite common. About 61 percent of adults surveyed across twenty-five states reported experiencing at least one type of ACE and nearly 17 percent reported that they had at least four ACEs. The CDC-Kaiser Permanente study found that ACEs create a major negative impact on general mental and physical health conditions in adulthood. Resulting maladies such as heart disease and depression have enormous social and economic costs for families, communities, and society.

Examples of ACEs include:

•Witnessing violence in the home or community

•Experiencing violence, abuse, or emotional neglect

•Having a family member attempt or die by suicide

•Growing up in a problematic home with

•Substance abuse

•Mental health problems

•Parental separation or divorce

•Household members in jail or prison

How Do ACEs Contribute to Chronic Pain?

ACEs create a complex mix of psychological changes and physiological changes in the brain and nervous system that add to the risk of developing or worsening chronic pain. These changes fit within our previous discussion of stress, and how too much stress can damage the function of our central stress-response system, the HPA axis.

When someone experiences chronic traumatic events such as ACEs, the HPA system may be chronically activated and dysregulated, leading to increased wear and tear on the body and mind. Over time, this dysregulation can negatively affect learning, behavior, and emotional regulation—all of which can lead to heightened vulnerability to developing chronic pain.

Over time, ACEs can affect parts of the brain that we refer to as the pain network. This can cause parts of our limbic brain to become overly sensitive to threats. Our alarm system can be set off by a stimulus that is ordinarily too weak to evoke a response. At the same time, ACEs can weaken the ability of your rational brain (frontal cortex) to calm down the faulty alarm. The systemic weakening of these brain functions can lead to problems later in life—inflammation in the body, increased pain sensitivity, and greater severity of pain.

In addition to having these physical effects on the brain, ACEs also have psychological consequences. These can also contribute to chronic pain. ACEs can lead to catastrophizing, feeling powerless, feeling generally unwell physically, and feeling lonely. More broadly, ACEs are linked to a greater prevalence of depression and anxiety. People with those conditions are twice as likely to develop chronic pain.

What Can Be Done for the Chronic Pain
Sufferer with a History of Aces?

There are many ways to heal both the psychological and neurophysiological changes that result from ACEs. Many of the treatment strategies for ACEs overlap with our other tools for addressing chronic pain, the ABC method.

The general goal for those with a history of ACEs is to increase resilience, the ability to cope with the ongoing daily stresses of life. Greater resilience can be achieved by improving physical, emotional, and social health. This requires developing problem-solving skills and self-regulation abilities.

Here is a list of treatment areas to keep in mind:

•Bodily self-care: Obtaining appropriate sleep, nutrition, exercise

•Emotional self-care: Developing coping skills for dealing with difficult emotions:

•Identifying when you are numb

•Overcoming sensory dissociation

•Nurturing self-compassion—so that you feel entitled to self-care

•Practicing self-soothing and self-regulation skills

•Cognitive self-care: Recognizing and reflecting on problematic beliefs—especially those that are self-limiting, self-critical, and self-sabotaging

•Socialization: Developing interpersonal skills that foster productive relationships, including communication skills and setting boundaries

Here are some useful tools for improving self-care:

•Journal writing: A way to identify and deal with negative emotions

•Mindfulness meditation: Promotes generalized calming, aids emotional regulation, enables “big picture” perspective

•Clinical hypnosis: Improves mood and cognitive clarity, reduces hypervigilance and impulsivity, increases capacity for self-soothing and self-regulation

What to Do About Negative Emotions

Now that you know the importance of dealing with negative emotions for your chronic pain, what do you do about it? There are a lot of myths and misconceptions about this. A common misconception is the “pressure cooker” metaphor. According to this model, your suppressed feelings build up more and more pressure until they finally explode—in the form of a tantrum or emotional breakdown. The only way to prevent such a blowout is to release the pressure or blow off some steam by yelling, screaming, beating on a pillow, or confronting someone head-on. The pressure-cooker model is ineffective because it doesn’t accurately depict how emotions work.

As I wrote in my earlier book, Trust Your Gut, the way to resolve the effects of negative emotions is to call on the power of your self-awareness skills. The key is to first recognize negative feelings, and then express them. These two steps sound surprisingly simple, but are very effective when applied regularly:

Two-Step System for Resolving
Negative Emotions

1.Recognize: Acknowledge the emotion to yourself and feel it physically in your body

2.Express: Choose from a wide continuum of possible constructive actions to resolve the suppressed emotion

Let’s take a closer look at each of these steps.

Step One: Recognize

Recognizing an emotion means identifying the feeling in your body and acknowledging to yourself that the feeling is there. It may be a suppressed emotion or an unmet need from the past. If you continue to ignore it, it may become a major trigger for future pain flare-ups. But when you allow yourself to feel these difficult emotions, then you can resolve them and promote healing. Recognizing the emotion is the first step in this process.

How do you do this? Start by asking this question: “What do I feel?” It may take a while for the answer to emerge, so be patient and allow some time for it to come to awareness. Observe the thoughts that pop up as well as the sensations that you notice in your body. Don’t judge—just watch, listen, and feel.

Don’t Ask Why

When you are trying to recognize a difficult emotion, do not ask why the feeling is there. Asking that question activates different parts of the brain than the ones you are using to recognize the feeling. As you stay with the experience without judging, the reasons why the feeling is there will soon become clearer.

Methods to Help Recognize Your Emotions

Emotions are important because they are reliable indicators of your inner state. The goal is to find methods for recognizing your emotions that best fit your personality. Some people need to be around trusted others to get in touch with this, while others do better through solitude.

These strategies will help you recognize what you are feeling:

•Limbic Retraining: The same powerful method for reducing the distress of chronic pain also works very well for recognizing your emotions. The first step is to stop and recognize that you may be feeling something. It may start as a hunch or inkling that something is stirred up. Once you recognize a little feeling of sadness, anxiety, or anger, then scan your body and notice where you can tangibly sense the feeling. Using Limbic Retraining is a good reminder that feeling refers to both emotion and bodily sensations. Find the part of your body where you most notice the trace of this feeling, whether a rumbling in your abdomen or a tightness in your arms or chest. Focus on the sensation without trying to change it. Stay with it as it moves and changes. Refer to the section on Limbic Retraining in this book (Chapter 22) for more tips on using this method.

•Pay attention to your thoughts and daydreams. This will reveal a lot to you about your life, your relationships, your loves and hates. Write down these snippets of daydreams and thoughts because writing them down will bring a greater level of awareness of patterns and clues about your emotional experience.

•Identify the minor hurts that may seem little and unimportant. Many people routinely brush off these hurts, saying, “It doesn’t matter” or, “It’s not important.” That’s a mistake, because big pieces of hurt emotion are buried within them, so these minor hurts do matter. Men in particular are socialized to frequently downplay what bothers them. These buried emotions can create difficulties with your health by triggering imbalances in your nervous system that can worsen your pain. Identifying these hurts will reveal much to you about unrecognized difficult feelings.

•Write in a journal. Keep an ongoing record of any noticeable emotions. (Refer to the section in this book on journal writing in Chapter 11). Research tells us that briefly writing down the emotion—without regard to why you are feeling it—can make you feel better and reduce a potential pain trigger.

•Notice memories that recur and don’t go away. If you repeatedly remember situations or hurts that happened long ago, you are guaranteed to have unresolved emotions toward the person or situation. Document these awarenesses carefully as they are likely contributing to increased physical pain.

•Be specific: As you learn to recognize your emotions, you might get stuck by using terms that are too general. For example, consider depression. What you are calling depression may be more accurately described as sadness, loneliness, boredom, a lack of creativity in your life, abandonment, or suppressed anger. The more specifically you can identify and label your feeling, the easier it will be to resolve it.

•Be aware of excessive or compulsive behaviors. This is especially important if this pattern has emerged in recent weeks or months. Overeating, overworking, drinking daily, or compulsive sex or gambling are examples. You may be acting this way because you are avoiding unpleasant feelings that emerge when you stop the behavior. Noticing this can help in recognizing the underlying feeling.

•Expand your emotional vocabulary. Examples of feeling words include angry, sad, scared, happy, excited, tender, ashamed, amused, terrified, impatient, rageful, giddy, appreciative, grateful, calm, agitated, joyful, weary. This is not, of course, an all-inclusive list, but may serve as a useful starting point for identifying your emotional experience. To exercise your “emotion muscles,” start a daily practice of writing briefly in a journal on “What am I feeling right now?” With practice, you will more readily find terms that fit your experience.

•Notice your positive emotions. These may include love, compassion, excitement, tenderness, and joy. The way that our emotions are hardwired, you cannot suppress just one emotion without suppressing all of them. By recognizing the positive emotions that you experience, you will help to open the pathways to recognizing negative emotions as well.

Step Two: Express

Once you have recognized the emotion you are feeling, the next step is to decide what type of action (if any) is needed to express the emotion. Resolving negative emotions requires having a solid repertoire of methods for expressing emotions.

Why is this important? Because effective expression of emotions supports a more balanced autonomic nervous system, healthier immune functioning, and improved physical health. Simply put, you reduce the likelihood of a pain flare when you recognize and express strong negative feelings such as anger, dread, or anxiety.

For example, picture yourself feeling angry at a friend for saying something unkind to you at a party. Imagine a continuum of possible levels of emotional expression. At one end of the continuum would be recognizing the feeling but otherwise doing or saying nothing. At the other end of the continuum would be confronting the friend directly and angrily about what she said. In between are several possible responses. These options give you the flexibility to respond more appropriately to the unique details of the situation.

Here are some ways to express your emotions:

•Talk to a different friend or confidant about the incident and the feelings.

•Walk and talk. Getting up and moving your body can help to dislodge challenging and stuck feelings. Or go for a walk with a voice recorder so you can talk spontaneously on your stroll.

•Write in a journal. Notice that I list this both under the recognize and express sections here, as it can help with both functions. Ensure that you use short, simple phrases and include feeling words. Example: “When I heard you tell Frank at the party that I’ve been missing work so much lately, it made me feel angry and betrayed.”

•Write an unsent letter. Since you will not be sending the letter, you can feel free and uninhibited to fully express the extent of all the embarrassment, hurt, and anger you might be feeling. This technique can also be used when you have strong negative emotions toward someone who is deceased.

•Use the empty chair technique. As a variation on the unsent letter, sit down and face an empty chair while imagining that the person you want to address is sitting in it. Then fully express your feelings toward the “person” in the empty chair. You will still get the benefits because you will have succeeded in the necessary steps of recognizing and then expressing the tough feelings.

•Confront the person directly. Sometimes nothing substitutes for talking directly to the person you feel bothered by. If you talk to the person you feel upset by, you might consider writing an unsent letter to crystallize your emotions before speaking to them.

Concluding Thoughts on the
Two-Step Model for Resolving
Difficult Emotions

Remember that calm, clear identification and expression of your difficult emotions is more effective than yelling and accusations. That’s why the pressure-cooker model is obsolete. Stay with the format of using “I feel” statements. Rather than saying, “You’re so mean and thoughtless for what you said,” it’s far more effective to say, “I felt angry and hurt when you talked about my headaches with others like you did with Suzy.” Keep in mind that resolution of difficult emotions can be achieved without necessarily talking directly to the person you’re upset with.

These are just a few of many possible strategies for expressing and resolving negative emotions. Experiment with several of these methods and see which ones work best for you. Effective management of difficult emotions is one of the best medicines you can use for reducing pain flare-ups and improving your long-term health.