Tell us a little about your backstory. How did you end up working as a psychotherapist and pain coach at the Better Mind Center?

I also experienced chronic pain. I’ve been diagnosed with chronic migraines and I would experience low back pain as well as some other sensations. At that point in my life, I never even acknowledged the mind-body connection. I thought it was something medical or physical. Then I had an opportunity to get a position at the Better Mind Center. Alan Gordon was my professor in graduate school so I was already aware of pain psychology, but I wasn’t really sure that it applied to me.

Flash forward two or three years ago and there’s an opening at the Better Mind Center. I interviewed with Christy Uipi (executive director of the Better Mind Center) and she shared all this information with me about the mind-body connection and pain reprocessing therapy. I started putting two and two together and I was like, “Oh mg god, this is me. You’re literally describing me”. I went on my own journey to find support for myself and I started implementing these techniques. When I saw the benefit of actually eliminating my pain and recognizing that my body communicates these danger signals to me in a way that shows up in pain it was transformational. That’s how I came into it and now I really incorporate pain psychology and the mind-body connection with so many of my clients.

Did you go through the process of pain reprocessing therapy and use techniques such as mindfulness and somatic tracking? And did you find a significant reduction in your pain because of these techniques?

Yes, for sure, 100%. Somatic tracking was tremendously helpful. At first, I was really hesitant and skeptical at first. Once I started implementing the techniques and being guided by my therapist, it was really helpful. She really helped guide me into understanding that we have all of this evidence of how I was experiencing stressors and how my body was showing up for me too. It’s the body literally saying, “This feels dangerous”. Once I started implementing mindfulness and somatic tracking, it really helped me reframe how I was viewing my body. It wasn’t the enemy anymore. I realized that this is information that I can use for myself and that my body was just trying to communicate something to me.

Why do you think pain reprocessing therapy is such a successful form of treatment compared to other therapies and treatments?

I think a lot of it has to do with fear. Pain reprocessing therapy is really about honing in on how we’re so fearful of our pain and also recognizing the other fears that we are dealing with. It’s understanding that we can retrain our brains into relating differently to those pain signals and relating differently to the way our body is communicating things to us. We start to recognize how we’re relating to external stressors. Pain reprocessing therapy takes into account all of those dynamics.

We start to recognize that we have these neural pathways that really contribute to a preferred way of thinking. Now we can integrate a different way of reframing our thoughts and create new neural pathways. It’s really beneficial and it’s so different from other modalities.

What exactly is the Better Mind Center offering to chronic pain patients and what differentiates it from other organizations that treat chronic pain?

One of the biggest things that separates us from other organizations is that we are implementing pain reprocessing therapy, but we’re also incorporating a lot of compassion as well. The way we talk to ourselves when we’re experiencing pain or when we’re feeling stressed out is often mean and hostile. There is so much aggressiveness and intensity. We’re really trying to look at it from a compassionate lens and to incorporate elements of caring for ourselves. Let’s incorporate ways of being kind and slowing down and being able to say, “I need to pause right now because the way that I am speaking to myself is intensifying the pain”.

We work on that fear-pain loop and utilize other techniques to create a tailored approach to the client. We let them know that even if they don’t align with the word yet, they are safe and as we do mindfulness exercises, we don’t put so much pressure around that specific word. Let’s create a different language for ourselves that resonates with the dynamic that we are creating in the session with our clients. Maybe that’s going to be about feeling calm or feeling neutral and recognizing that feeling safe is not at reach for many clients. That doesn’t mean that there are shortcomings for them, but that’s something we can work on. We want to give the client the ability to breathe outside of the pain and acknowledge other areas of who they are as a person.

When it comes to you personally treating people with chronic pain in your one-on-one sessions, what is your personal process and starting point?

That looks different based on the client that is in front of me. There are a lot of times I see clients who do not have a lot of knowledge about pain reprocessing therapy or they just don’t understand the way pain functions. My approach for clients who don’t have a lot of awareness is providing education, but making the education really tailored specifically to the client’s experiences. I help them make a connection to understanding how their body feels when they’re experiencing stressors. I help them understand that they are in their thoughts so much about what they’re experiencing physically and somatically.

Sometimes I’ll have clients who are really well-versed and have immersed themselves in the mind-body community. Then it’s more about starting where they’re at and utilizing their knowledge of their pain instead of starting from Ground 0. My initial phase involves assessing where they are in their healing journey.

You mentioned that you have experience working with people who have eating disorders and chronic pain. Can you tell us about the relationship between eating disorders and chronic pain?

I have had a lot of clients who have a history of an eating disorder. I have had clients who have been diagnosed with anorexia or bulimia or some form of a diagnosis that they had experienced at one point. A lot of these clients had gone through a recovery process and they still use those recovery tools. Their eating disorder was their way of controlling their emotional pain and the stressors they had been experiencing. They were able to recover from the way they related to food and then they noticed that their body was still communicating things to them.

One of the biggest things with people who experience eating disorders is that when they experience distress or strong emotions they feel dysregulated. They turn to behaviors that allow them to control other aspects of themselves, like the way they eat.

When that dynamic shifts for them after recovery, they start experiencing pain. Then we have to identify what other things have been left unsaid or what are other things that still feel like they’re out of control. Are we looking at emotions as binary, as good or bad? Instead of saying this emotion is dangerous, this emotion is bad, let’s just recognize that we’re experiencing that emotion. Let’s practice compassion techniques and recognize that the body is sending signals to us.

When you’re working with people who have these eating disorders, how do you treat that while treating chronic pain?

A lot of the time my clients have done a lot of the work with their eating disorder, so now we have to deal with the remaining barriers. Our attention is still heavily focused around the pain itself, but now we can recognize what stressors and emotions we’re fearful of and how that relationship has set off certain things in our body.

Active somatic tracking allows us to expose ourselves to fears so that we get into a place of acceptance. We start to think, “Okay, this is my current state, but I am hopeful that I’ll be able to regain 100% back of my body or that I am going to eliminate this pain”. A lot of that is really intertwined with eating because you get to a point where you reclaim your body and you gain this sense of strength instead of blaming your body and using it as a weapon. 

How often do you encounter people who have a disordered relationship with food that started because of chronic pain?

That’s also very common. Especially for my clients who experience GI issues or have been diagnosed with IBS. They’ve done a lot of these ruling-out procedures where they try a specific diet to see if it will alleviate the symptoms. When that doesn’t work, they try a different diet, and they keep trying different diets until they have created so much fear around so many foods. We become so restrictive and rigid with our diet and what we can and can’t have. We get stuck with very particular food options because we’re so fearful of how our bodies will react to other foods. Food becomes another source of fear.

I read that you’re trained in emotional awareness and expression therapy as well as dialectical behavioral therapy. Can you define these therapies and how they work?

Emotional awareness and expression therapy is really about allowing ourselves to express any emotion in a healthy manner. Most often it’s how we express anger in a healthy way. Some people will say no and that they don’t want to experience anger because anger feels dangerous. It’s about releasing some of that in a way that feels healthy and not destructive, but it’s also about being able to let go of some of these things and being able to tap into other emotions. There’s a need for connection or a need to tap into sadness or a different emotion that we’re not giving light to because anger is just sitting there. It allows us to release some of the tension around some of these emotions. It really helps clients release emotions that they’re holding really tensely inside or that we haven’t given a voice to and just saying that it is okay to do this here. If they want to yell it out, they can yell it out. We create a safe space where no one is judging them.

Anger can contribute to our somatic experiences. It can feel like tension in our shoulders or maybe a headache. We want to release the energy that’s causing these symptoms.

For dialectical behavioral therapy, we incorporate ways of destressing moments and recognizing that there can be two things going on at the same time and how do we find some balance? How do we cope with dysregulation in our emotions? From there we tap into their values and what gives them purpose.

I think these therapies blend really well with clients who experience chronic pain.

How would you recommend someone to release anger in a healthy way?

I like to tell my clients to practice giving themselves a moment of privacy and to give themselves space in a place where they feel comfortable. I tell them to let things flow through them for a moment and allow five minutes to just stay there. Just say whatever it is that’s coming to you almost like you’re opening a vent. You’re just allowing yourself to release things. A lot of people try to suppress the emotion, but it’s like “No, let that emotion out”. After that, let’s just see what part of you feels relief. Does any part of you feel calmer now that you got to say those things? A lot of times my clients say that they feel better and that the intensity has decreased. 

We are off when we’re feeling anger, frustration, or resentment, but we don’t get to say these things to the person or thing that you’re feeling these emotions towards. Being able to say, “It’s okay if this person doesn’t hear it, but I’m going to give myself the opportunity to say it anyway. I don’t have to sit with it. I don’t have to bottle it up and have it become internalized within me.

There’s a lot of nervousness around anger because people are fearful of how they or others will react if they’re angry. We close ourselves off to that experience. Validating and acknowledging what’s occurring for us is so helpful.

What advice do you have for someone who is struggling with an eating disorder and chronic pain?

I want them to start with having compassion for themselves and their experiences. I want them to take a step back from saying, “My body is doing this to me again”. This is your body trying to say, “I’m with you. Don’t abandon me. Don’t just try to fix me away”. Let’s utilize that as information that we can work with and use the tools we have to ground ourselves. We have the tools to help bring calmness into our bodies and rebuild trust in our bodies.

Can you share any success stories that you have had with previous clients?

I have this one client in mind. This client was seeing me for both eating disorder struggles and chronic pain. It was a bit of a journey to rebuild that trust in her body, but she was able to do that for herself eventually. She was able to relate to her body differently when her emotions were intense. Before, when her emotions were intense, she wanted to choose very specific foods and portions. She wanted an element of control because that pain was out of control.

She went through what we called the “cocoon phase” where she was isolating herself from a lot of her relationships. She was fearful of saying no and then recognized that when she started setting boundaries for herself and making decisions that she wanted for herself, she was able to step away from that cocoon phase. She was ready to use her voice.

She recently reached out to me and said, “There are still moments that are like valleys. In every valley, there is some flow of water. I’m thinking of my pain and my concerns around food as that body of water that’s just flowing through and I’m no longer trying to change anything about it. It’s present, but I recognize that it will flow through me”. That made me so happy. I was so excited when I got this message.

For my final question, do you have any resources that you would like to recommend for people who have chronic pain?

The Curable app is a wonderful place to start. A book called “The Way Out” by Alan Gordon is a great resource. Nichole Sachs and Dr. Yumi Arthur (specific to dizziness and migraines) are amazing resources. There are practitioners and providers out there who have a lot of information for specific symptoms and sensations.

Takeaways

• Having self-compassion for ourselves and our experiences is part of the healing process.

• Pain reprocessing therapy allows us to recognize the fear we experience with chronic pain and we can train our brains to respond differently to pain.

• How we interpret our emotions matters. Instead of labeling them as good or bad, let’s take a moment to recognize that we’re experiencing them.

• Anger is an emotion that all people experience and there are healthy ways to release anger rather than suppress it.

Thank you so much to Bernice Hurtado for taking the time to do this interview with me. She is so knowledgeable on chronic pain and how it can be successfully treated. I learned so much from her in this interview and she is an amazing resource to those struggling with both chronic pain and eating disorders.