top of page

It’s NOT all in Your Mind – Exploring Somatic Therapy for Chronic Pain & Anxiety

Updated: May 14

6 May 2024


A hand appearing out of a dark ocean against a grey sky.

Science is catching up with what many holistic therapists have known for years – that we simply cannot separate body and mind when it comes to our physical, emotional and mental wellbeing.


Nowhere is this more evident than in the fields of chronic pain management and in the treatment of anxiety. Whilst these two issues can be experienced separately – i.e not everyone who suffers with anxiety has chronic pain – the numbers in both the UK and the US show strong links between the prevalence of anxiety and depression for those living with chronic pain.


In the US, 55.6% of adults reporting chronic pain also have unremitting anxiety and depression symptoms whilst in the UK a 2017 nationwide survey found that 65% of those with Chronic Pain were also suffering with Anxiety or depression.


There's more and more evidence to show that a Somatic approach - one that addresses the mind-body connection - is effective not just for alleviating symptoms but for getting to the root causes of both anxiety and chronic Pain.


In a recent interview*, Dr. Howard Shubiner, Director of the Mind-Body Medicine Centre in Michigan and author of Unlearn Your Pain, explored the links between chronic pain, our emotions and the brain's processing mechanisms. He explained the often-misunderstood nature of chronic pain, emphasising that in many cases, the brain creates neural pathways that perpetuate pain signals, even in the absence of structural damage.


The example he cited was that of a medically ‘famous’ case – first reported in the British Medical Journal in 1995 - of a builder in the UK who saw a 15cm nail drive through into his foot on a building site. This man was rushed to hospital in agony and sedated on opiates before his boot was removed… revealing that the nail had, in fact, gone between his toes and not through his foot at all.


Whether this man was totally unharmed or not, the injury was clearly much less than his brain was telling him. The truth was that the expectation of pain on seeing the nail through his foot had created the reality of pain. There was no injury to his body but the pain was real.


Neuroscience research shows that emotions and stress activate the exact same parts of the brain as a physical injury. So the pain that occurs because of a fracture is exactly the same as the pain that occurs due to a stressful situation happening in our life.


This parallels the experience of anxiety, which is actually an umbrella term for explaining what happens where the brain's response to perceived threat amplifies feelings of distress and tension. The information being sent from the body to the brain is that of alarm – a fight or flight stress response; the brain creates the appropriate thought to match the distress signals and sends information back to the body which then serves to amplify and confirm the threat. This increases the multiple felt symptoms of shortness of breath, tightness in the chest, shaking or trembling, dramatic changes in temperature and raised heart rate.


Stress can and does cause both anxiety and severe pain. A fight-flight response to threat causes anxious thoughts. It’s NOT all in our heads. The fact is that stress causes real, debilitating conditions in the body even where there is no physical injury.


Everyone has had situations in which stress has caused a physical response in the body no matter what they tried to do to think their way out of the situation. If you’ve ever felt nervous before an interview or starting a new job, running a race or speaking on stage, you’ve no doubt had a physical response to stress – perhaps you’ve had clammy hands, an accelerated heart-rate or an over-active or underactive digestive system causing diarrhoea or constipation.


Trauma, or ‘stored stress’ is not caused by events themselves but by the body’s response to the events.


A Very Personal Experience of Chronic Pain


When my mother died almost 5 years ago I was living in Denmark and was doing my best to support my elderly father who was in the UK. He was in shock and grieving and when I was with him I had to put aside my own needs and feelings because he wasn’t coping so well on his own. I also had a young son and step-children and was under a lot of pressure financially because I was a self-employed massage therapist and coach and didn’t ethically (or emotionally) feel able to work because I simply couldn’t hold the safe container needed to take care of my clients.

 

Then, just a few short months later, the Pandemic began and Denmark went into lock-down, followed by the rest of the world. Now, I was isolated at home with no close friends nearby, taking care of a young family in one country and whilst trying to support my father in another, but no longer able to visit. On top of this, I now had to sell my UK home in order to secure a home in Denmark because of a legal battle with the landlord of our rental property which we’d lost.


Over three short months, I home-schooled my son, sold a house in one country and bought a house in another. All whilst in lock-down. Then, about 3 months after we moved house my husband began working for long periods away from home.


And I managed it all – I honestly felt there was no choice.


Soon after I eventually went back to work, I started to get shooting pain through my left hand and wrist whilst putting pressure down through my arm. Not great for a body therapist. I tried acupuncture and massage without any success and went to the doctor when the pain reached my shoulder. They told me they couldn’t find anything structurally wrong but prescribed pain killers and physiotherapy. Because of my background in working with the body, I instinctively knew it was related to the events of the past year but couldn’t seem to fix my shoulder. Over the next six months, I had ultra-sound, physical therapy and increasing excruciating pain. And the doctors kept insisting there was nothing wrong.

Eventually, my shoulder froze.  Now there was far less pain, but there was also no movement at all.


The fact is that unprocessed emotions that get stored inside of us and can generate very real pain or other physical symptoms. And this is true whether the symptoms arrive all at once, as in the builder story, or over time as they did with my frozen shoulder.


For our builder, the perceived injury caused the pain. In my case, the issue was that I had no real opportunity, support or space in which to properly feel and grieve the loss of my mum and was holding a huge amount of responsibility. And nobody was asking about that. Not the doctors; not even me. And I’d thought I was managing.


A Framework for Understanding Chronic Pain


Dr Shubiner offers a framework of 6 Fs to explain what happens when we begin to experience pain; I’ll use and elaborate on it here as it’s something that can help us understand the process -


1.  Fear of the pain

Most of us don’t know how to really feel our emotions. We’re not taught how to do this. It may not consciously even be fear that causes the pain, but a lack of awareness of what we’re not feeling. It might simply be too much to experience, or too soon to allow it and this is how trauma, or stored stress, occurs. There’s simply not enough space, time or SAFETY to process what’s happening, so we don’t.


2. Focus on the pain  - paying attention, monitoring all the time. And of course, this is where anxiety starts to arise and the questions about how long this will go on for and what it means; for me there was huge anxiety about the loss of livelihood and identity when I began to experience this pain.


3. Frustration - we feel angry or upset, trying to work out how to stop the pain happening. And how to stop feeling anxious.


4. Fighting – of course, we’re fighting the pain itself and we might also have very critical or self-blaming thoughts or hate the parts of us that feel anxious or are in pain, wanting to push them away. I really struggled with the fact that I was a yoga teacher and body therapist – in pain. I felt as though I’d failed somehow; that I should have been able to avoid a situation like this.


5. Figuring out – trying to work out what to do differently; how to manage or adapt to the pain and wanting desperately to understand what’s happening. I tried going to talking therapy, but discussing the loss, frustrations and situation simply left me feeling exhausted. And after a while I couldn’t stand listening to myself; it simply felt like being on a hamster wheel, going round and around… talking, crying and “complaining” (my judgement at the time).


6. Fix -  I visited a number of holistic practitioners to try and fix the problem; fix the pain.  


The problem is that the harder we do all these things, the more it gives the brain the message that there's a problem. And it makes it worse. So we get a vicious-cycle feedback loop of pain, anxious or frustrated thoughts and more symptoms.


How Anxiety Works


Even without physical pain – anxiety works in much the same way as chronic pain. "Anxiety" can be thought of as an umbrella term for a collection of thoughts, sensations and emotions that are being experienced in the body and mind. And we end up so focussed on the symptoms and ways to avoid them, that we don’t notice that the symptoms are there because of what we’re not feeling; what there hasn’t been space or safety to feel.


Shubiner’s  6 steps show us how we’re focussing on the symptoms, rather than turning our attention to the root causes of the pain. It’s the same with anxiety – we tend to focus on the discomfort, the triggers for the discomfort and how to manage it, rather than taking our attention to what the anxiety is caused by.


hands touching, one on top of the other

A Somatic approach adds two more ‘Fs’: (be)-Friending & Feeling


Chronic Pain without structural damage and Anxiety are messages from our body signalling that something is wrong. They are symptoms, not the problem.


(Be)Friend – We need to lower the fear reaction and the fight-flight response to symptoms and understand that the pain or anxiety is not the enemy - it's the message. If you have a child lying in bed who’s scared of a monster in the cupboard, you're not going to get angry with them. You'll open the cupboard door say “look, there's no monster, you're okay”. You’ll lie down with them and tell them you love them. Maybe you’ll read them a story and get them to laugh. You'll create connection with them and that in turn means they feel safe enough to sleep.


This is how we need to treat a brain and body that are stuck in a fear response. The brain is worried and having worried thoughts and sends signals that cause these symptoms. Or the body is still remembering a time when there really was a "monster" and is still reacting as though it’s here, in the cupboard and sending distress signals to the brain. There's a part that's protecting you and it needs to know that it can stand down...that it's OK now. It's safe.


We slowly take our focus towards something that IS okay – whether that’s noticing even a very small part of the body where there’s no pain or remembering an experience in which you had no anxiety.


A client of mine with long-term global chronic pain was able to find just the tip of one finger in her first session; it was just enough to begin to understand that it was possible for a place in her body to feel okay. And we expanded from there.


Sometimes we need to begin outside the body in an imagined or remembered experience or space and notice what happens when we can take our attention to something that’s okay. When we begin by offering an experience that feels safer and more connected and then we work slowly to begin to support, befriend and feel those parts of us that are in distress, disconnected or disassociated.


Feel – when we can create a safe enough container in the present moment we can slowly begin to feel what has got stuck from the past. When we no longer need to protect ourselves, we can begin to feel and let go. We can stop bracing, holding or, in my case, freezing because now there’s enough time, care and support to allow the emotions to be felt.


Another client had crippling fibromyalgia with severe pain and cramps. She’d spent many months as an infant in a cast, in order to reset the bones and joints of her legs; she hadn’t been able to move and was too young to understand what was happening. This experience had been stored in the body and was contributing to her current symptoms. When we created enough safety here and now she was able to allow her body to move and feel what she hadn’t been able to express which resulted in a dramatic lessening of cramping and pain.


My body began to come out of a chronic state of freeze when I had space, time and opportunity to listen to what was stuck there. For me, this was largely during my Somatic Experiencing training and individual therapeutic sessions, which offered a safe, contained space to slowly turn my attention to the deep grief I’d experienced on my mother’s death, which was in turn linked to numerous previous losses I’d also never had time or opportunity to heal. It was this gentle somatic process, combined with the gentle listening touch of Myofascial Release Therapy that allowed me to feel what had not been felt and release what had got stuck. It was enough safety and connection that allowed me to heal.


When we work somatically, we give ourselves the opportunity to do the following:



magnified illustration of neurons in the brain


Change Neural Pathways:

Both chronic pain and anxiety involve the brain's creation and reinforcement of neural pathways. When we work somatically, we interrupt learned pathways that are signalling threat and support people to rewire the brain's response to pain and anxiety triggers. Somatic therapy allows us to break free from negative thought patterns, beliefs and behaviours.


Embrace Body AND Mind: Unlike traditional approaches that often focus solely on physical symptoms OR on talking therapy, a Somatic approach recognises the interconnectedness of mind and body. By addressing emotional triggers and stressors and listening to the story of the body – which is often very different to our conscious story - we promote holistic healing and long-term symptom relief.

 

Gain Education and Understanding: Central to Somatic therapy is psycho-education about the mind-body connection and the role emotions have in our symptoms and behaviours.

 

Feel Empowered: Somatic therapy empowers us to take an active role in our healing journey. By creating and noticing more safety and connection, we create space for all our experience to be felt. We  cultivate a resilience and flexibility which allows us to manage the stressors of life without having to shut down or brace. Life doesn’t stop happening, but we gain tools to navigate life with greater ease and creativity.  

 

In essence, working somatically offers a paradigm shift in the treatment of chronic pain and anxiety. So whether you're living struggling or coping one or both these conditions, exploring this therapeutic approach may be the key to unlocking your journey towards greater health, ease and self-leadership.


If you’re curious about how Somatic therapy and body therapy, including MFR, can help you, contact me through my website or socials and we can have a conversation about the way forward that would work best for you.


*interviewed by Dr Rangan Chatterjee on his podcast Feel Better Live More

 

Find me on Instagram - @fionabodywisdom


For more information about Somatic Experiencing and an holistic approach to healing trauma, visit https://www.fionalsmith.com/somatic-experiencing and https://go.fionalsmith.com/reset-thrive


Read more blogs here



15 views0 comments

Comments


bottom of page