The Masters Series Pain Edition

The Masters Series Pain Edition

Pain Edition 2023

We've all experienced physical pain, and we all know what the universal agony of grief, isolation, and shame is like.

Draining, paralyzing, and overwhelming, pain leaves us feeling powerless and unable to cope as new emotional and physical wounds open and aggravate historical injuries in a seemingly uncontrollable tailspin.

What can seem even harder is trying to help someone else in that state find hope, both in a professional and a personal context. But, armed with the right knowledge, it's possible and we can contribute to helping our friends, clients, and selves out of suffering.

In previous editions, we learned that unresolved trauma manifests in our bodies, but we haven't fully explored the impact that has on our present. The relationship between trauma, mental anguish, and chronic pain is well established. One in five of adults live with chronic pain, with traumatized individuals being twice as likely than the general population to experience this.

In The Master Series: Pain Edition, we will explore how pain connects with trauma and learn what we can do to address that relationship through our practice. Join us as we calculate the cost of pain on our mental health, consider the relationship between the pain we feel and the legacy of our past, and explore vital healing methods, techniques, and practices we can use to move towards a pain-free future.

Day 1

Transforming Pain into Power: Harnessing the Power of Neuroplasticity

Dr. Wayne Kampers

Learn about the science behind neuroplasticity and how it can be used to overcome chronic persistent pain. Drawing on his extensive knowledge and experience as a psychiatric consultant, Dr. Kampers will provide you with the tools you need to harness the power of neuroplasticity for healing.

Whether you are dealing with chronic pain yourself or working with clients who are, this workshop will provide you with the knowledge and skills you need to effectively use neuroplasticity as a powerful tool for healing.

Learning Objectives

  • Understand the science behind neuroplasticity and how it relates to chronic persistent pain.
  • Learn about the role of mindset in pain management and how it can be used to harness the power of neuroplasticity.
  • Develop effective strategies for using neuroplasticity to transform pain into empowerment.

Transcript of my presentation

Hi everyone.

Welcome and thank you so much for joining this fifth Masters Series edition, the Pain Edition

I will be one of your speakers for this edition and I'll also be the moderator for the other speakers. So, I want to thank you all for connecting with us wherever you are.

And it's really my hope and aim that after this edition that you will leave with a much great understanding of the profound and deep relationship and connection between trauma, addiction and chronic pain and how they relate it to shame and guilt and how in the process of that there is fracturing of the imagination.

I'd like to really thank the organizers for asking me to be part of this edition. I really am humbled and grateful for many reasons. I'm passionate about chronic pain myself and it's really fantastic to be given this opportunity. It's very interesting, I was talking to one of the organizers earlier and just telling them about six degrees of separation and a sliding door moment that happened with me as to how it came about that I was invited to take part in this Pain Edition.

Last September, I was asked to present at a trauma conference in London and I'd been asked earlier on in the year and I was under the assumption that I was going to be talking about pain at this trauma conference and I think it was about a week before it took place, they asked me for my slides and so I said to them, "I'll have them to you in a couple of days." And then they said, "And this is the topic that you're speaking on," and the topic was something completely different to what I was supposed to be speaking on.

It turned out I had to present on the pharmacology of PTSD. I had to talk for an hour on the pharmacology of PTSD. And for those of you who know anything about the pharmacology of PTSD, it's pretty hard to talk for an hour about it because the pharmacology of PTSD is not great. So, anyway, I almost thought of myself, I don't know if I want to do this. And that sliding door moment where I thought to myself do it. And so, I did it. I decided not to bail. And so, I went to this conference and presented on the pharmacology of PTSD and it was at that conference that one of the organizers of this conference, Araminta, approached me and asked me if I would be interested in talking. I said, "Of course I would. I'd love to."

Interesting at that same conference was another therapist who I hadn't seen for years because of COVID and I was speaking to her about this and so she's the one that me with Dr. Isaac Mathai who I contacted and he also agreed to be part of this. That same week, a patient of mine who is well, and I don't see her, probably see her every six months. She came to see me and she said to me, "I was visiting a friend of mine in LA and I mentioned to my friend your interest in pain and so she'd like to connect with you."

That is how I managed to end up connecting with Catherine Oxenberg. And obviously I'm interviewing Catherine later and Catherine's connected with Gita via her foundation and Gita's presenting later on today. And when I'm speaking to Catherine, she also talks a lot about the Curable App, which I'll mention later. And of course, Les Aria who's speaking tomorrow, he was in inextricably involved with the Curable App. So, it's strange how things happen and how it's all connected.

I just thought I'd share that story with you first. So, everything in life I believe is about relationships, about communication and about connection. And every human problem is related to problems in these areas including the relationship with pain. And I think could it be good just to reflect on the previous four editions that have happened before and how important they are leading up to us speaking about chronic pain today and how they really laid the foundation and mapped out the journey of the destination to talk about chronic pain today.

Let's back and look at the first edition, The Trauma Edition, and see how developmental trauma and attachment systems affect the processing of traumatic experiences, how it affects brain circuitry, in terms of social engagement systems, the social engagement system template that was presented by polyvagal theory and the link with sociality and autonomic regulation and dysregulation are that in terms of the fight, flight or freeze response really determines what happens in not only trauma but also in addiction. We introduced the concept of the amygdala hijack where the amygdala just really takes over and is running the show so that your prefrontal cortex and your smart part of your brain has to take a backseat. And the really importance as well of somatic experiencing and the trauma framework was introduced in that first edition as well, highlighting the real importance of the clinical tools that we need to develop to address these real fixed physiological states where both our minds and our bodies are stuck.

The Imagination Edition was really interesting because got to understand addiction and the source of addictions in early childhood environment, the neurobiology of the brain's reward pathways and the emotional patterns that lead to addiction and how they become wired into the unconscious brain. And we introduce them to the role of psychedelics and obviously later on today we're going to speak about psychedelics. And in that edition, it was really the neurochemical processes of addiction reflecting on ketamine, psilocybin, MDMA and there are so many trials going on with these medications.

In my clinical practice, I've successfully treated a lot of people with ketamine and that's the only one that's licensed in the UK at the moment. But on the horizon, psilocybin and MDMA are going to be very exciting. As part of my practice, I do pharmacogenetic testing and I was speaking to a geneticist yesterday who is based in America. She mentioned to me two new drugs that are actually being trialled in the states at the moment. But those are the first two new drugs I think that really have been manufactured in the last couple of decades. There has not been any new medications in psychiatry for a very, very long time, which is why I think the whole field of psychedelics and micro dosing are going to play an integral part in the treatment of many psychiatric conditions moving forward.

If we reflect really on The Connection Edition, there we really learned about the power of self-compassion and connection, what happens in disconnection, the role of trauma in addiction was highlighted again and we learned about the importance of the self and self-identity, interpersonal connection, interconnection and intraconnection, which will be addressed this weekend as well.

In The Shame Edition, the whole concept of generational shame and the collective legacy burdens that underpin race and class and gender and how it impacts us, not only individually but relationally and systemically, and internal family system techniques was introduced there, which is such a key part of looking at trauma and addiction and at chronic pain.

And also, really the importance of the healing power of intimacy from shame to connection and again the focus on the sensorimotor psychotherapy approach and the relational nature of shame and the role of the body in healing shame and how one needs to work somatically with parts of the self in terms of healing shame, which all leads us to what we are going to be talking about today, which is Chronic Pain

Let's talk about chronic pain. This is a global problem. It is estimated 20% of the world's population, that's one and a half billion people, suffering with chronic pain. Up to 50% of old adults, up to 10% of children, adolescents, those numbers are just absolutely staggering. There's no doubt that we are in the midst of a chronic pain epidemic. It is the single greatest leading cause of disability worldwide. It's a major contributor to healthcare costs in so many countries, major contributor to lost productivity, disability payments, and on an individual level the amount of suffering that it causes for individuals and their families.

Chronic back pain is probably the commonest chronic pain that people suffer with. It's deemed to be non-specific in up to 95% of cases. And there's still real uncertainty regarding what the most effective treatment for back pain is. Back pain is the single leading cause of disability worldwide.

I have myself suffered from and fortunately recovered from back pain. And I think that the reason my back pain was such a problem is because pretty much anybody who has X-ray from about the age of 18 or 19, is going to already start showing degenerative changes within their spines and bulging discs.

And my X-ray was not really a pretty sight. Degenerative changes. Various prolapsed herniated lumbar discs.

The analogy of as you get older and you get grey hair and you get wrinkles, that's exactly what's happening to your spine as well. It's also getting the equivalent of grey hairs and getting old, but that doesn't necessarily mean that it is the cause of your back pain.

Later on, I discuss the differentiating clues are of neuroplastic pain. I ticked all clues.

The huge consequence of chronic pain is the subsequent iatrogenic opioid addiction that the world is having to deal with. Iatrogenic obviously meaning that it's caused by the medical profession who are prescribing medications in order to try and help people with chronic severe pain.

Unfortunately, with chronic pain of this nature, neither interventions nor medications are helping. So, they end up on stronger and stronger and medication and eventually end up on opioids and become addicted to them.

Speaking from personal experience, I had reached the stage where my pain was that severe, I was one short of actually going onto opioids, onto a fentanyl patch. Thankfully that never happened. But it's not difficult to see how and why it happens and then the problems that one has.

Because now you're not only dealing with opioid addiction but worsening pain because the opioids are not actually helping their pain. And certainly, when one looks at pain recovery for somebody, you very often have to manage the opioid addiction concomitantly. And in my own experience with my own patients, there's often a very heavy investment in the opioids and not wanting to come off them; very often you have to address that as a separate entity.

And if we look back historically chronic pain conditions, it's been a real problem because there are such vague and ambiguous terms that have referred to chronic pain, nonspecific, somatoform, functional and all with real obscure aetiology and pathophysiology. And it's been a problem for so many decades. So, over the last couple of years there's been the working groups that have been really concentrating on this.

So chronic pain was reclassified in the ICD-11, which is the International Classification of Disease, it's the European equivalent of the DSM Diagnostic and Statistical Manual. I think it's DSMs fifth version now. So, the ICD-11 is the latest version of this and became effective in January of last year, of 2022. And this was a collective collaboration between the World Health Organization and the International Association for the Study of Pain, the IASP, who designated and reclassified all of these conditions into Chronic Primary Pain conditions and chronic secondary pain conditions.

In the chronic primary pain conditions, which is what we are going to be talking about this weekend, the pain itself is considered to really be the disease and distinguished systematically from chronic secondary pain conditions where pain is a symptom of another condition.

And certainly, this new definition of chronic primary pain has been an important step and has neutralized the misleading dichotomy that has existed for such a long time between somatic and mental disorders. It also includes important components to it of emotional distress and of functional disability.

So, in the new ICD-11, chronic pain is defined as primary if pain persists or recurs for more than three months or secondary to other causes. The whole concept of primary pain is it's a new concept and really has been informed by the latest public scientific and clinical evidence-based research. A lot of it has come from functional magnetic resonance imaging research and pain processing therapy research.

And Les Aria will talk about pain reprocessing therapy tomorrow and I'm hoping, which I'm assuming he will, he'll talk a little about the real advances in terms of the Boulder trial, which has been such a huge landmark in us understanding chronic primary pain conditions.

So fundamentally, chronic primary pain is where the primary pain is the problem as not secondary to any disease or pathology of the body. No structural abnormality is identified that can explain that pain. If you recall back to phantom limb pain, it's that type of pain really where the brain just continues to fire on pain pathways, even though there's no longer a limb there. And this pain basically becomes self-reinforcing, self-perpetuating. Virtually takes on a life of its own due to the changes in the brain pathways.

If we just look at the six major causes of the chronic secondary pain syndrome. So, we can understand the difference. This is pain that is related to an organic cause:

  • Secondary to cancer or its treatment
  • Post-surgical or post-traumatic pain
  • Neuropathic pain, which is really damage to the peripheral or central nervous system
  • Secondary headaches
  • Secondary visceral pains
    • An example there would be something like pancreatitis
  • Secondary musculoskeletal pains
    • Something like osteoarthritis.

When you look then at the Chronic Primary Pain categories, they really have differentiated these by organ systems all as a general category.

  • Chronic, widespread pain
    • That's where fibromyalgia fits and complex regional pain syndrome, CRPS.
    • These are two conditions that so many people suffer from and that's a category that they would fit into.

Then we literally go top down, okay?

  • Chronic primary headaches or a facial pain and those are people who present with chronic migraine, chronic tension type headaches and various other things in the head and neck.

Moving a bit further down, you have

  • Chronic visceral primary pain
    • Irritable Bowel Syndrome (IBS) would go into that category
    • As would chronic primary chest pain, chronic primary epigastric pain, abdominal pain, bladder pain, and the chronic pelvic pain that we see in both men and women, and obviously more commonly in women a problem.
  • Chronic pelvic pain in women without an identifiable cause is common.

And then we get down to the

  • Chronic primary musculoskeletal pain
    • This is really the back ache and chronic lower back pain, which is, as I mentioned earlier, the biggest problem and the poorest outcomes in terms of interventions for people who have got chronic primary lower back pain who go and see their doctors and it's identified as a disc or something that is seen on a scan and treated very often to surgery.
    • And we know from the results of surgeon Dr David Hanscom who is the expert on this area.
    • And when you hear what he says and when you read what he's written in terms of his path, it's amazing what happened to him and how he changed his career as a result of that.
    • And what enormous contribution he is now giving to the pain with all the fantastic work that he and many of his colleagues are doing.

The ICD 11 also details specifiers:

  • How severe, how bad,
  • How interfering with your activities of daily living
  • The course of it
  • The effects
  • How does it make you think?
  • How does it make you feel?
  • What does it make you do?
  • What does it make you not do?

All of these are just various ways of describing how negative and how devastating the pain is to a person's life.

In the medical world when anything is diagnosed as Primary, the other terms that are used in this category are

  • Idiopathic
  • Essential
  • Functional
  • Agnogenic

And these literally mean any disease with an unknown cause or mechanism that is apparently spontaneous in origin.

The Greek word for idiopathic, patho is suffering and literally translates into one's own suffering, a disease of its own kind

So even though this has been put in place by the ICD-11, it still leaves us with, well, these people have got Chronic Primary Pain often over years and years duration and we don't know what the cause is.

So, this whole series is about looking at this and we actually do know what the cause is. And are there things that we can look at to see how we can help these people out of chronic pain?

Many of us have been in our own chronic pain journeys ourselves and we have realized that there is a cause.

To further complicate matters, secondary pain is described as nociceptive pain, which means tissue damage or neuropathic pain, which is nervous system damage.

And then as far as primary pain goes, this is where it gets really messy.

So neuroplastic pain, neural pathway pain, nociplastic pain, chronic primary pain are all the same thing. And all underpinned really by another term,
central sensitization.

All of these are chronic primary pain, just not secondary. So not secondary to any cause.

And the ICD-11 really introduced this concept of nociplastic pain

I think that many people are still familiar with the word neuroplastic pain and certainly in Pain Reprocessing Therapy, that's the term that's used. For the purpose of the rest of our discussion, I'm just going to use the word neuroplastic pain so that everybody understands what I'm talking about.

This is the type of pain we are talking about. So, it's pretty much Chronic Primary Pain for which there's no identified structural cause

And the majority of chronic primary pain, chronic persistent pain, is neuroplastic pain

Neuroplastic pain, is in essence a maladaptive learned phenomenon, an unhelpful habit that the brain has learned.

The good thing is that because it's an unhelpful habit that has been learned, it's an unhelpful habit that can also be unlearned.

So neuroplastic pain really is a false alarm. It's pain that is caused by learned neural pathways in the brain and not due to ongoing structural damage or disease in the body and that's a very important point to make. The brain in essence is misinterpreting safe signals from the body as if they were dangerous. And as a result, produces neuroplastic pain or other medical unexplained symptoms.

There is a long list of medically unexplained symptoms that falls into this category. We're just going to be talking about pain today, but if you look at the PPDA website, which captures all of this very, very nicely, they describe a list of symptoms that literally it goes from tinnitus to visual stuff. I wouldn't be able to rattle off the list by myself, but neuroplastic symptoms can be anything. And any symptom that is medically unexplained that has been investigated by a doctor or doctors and they can't find a cause and that is persisting for more than three months, one really needs to consider whether or not this is a neuroplastic symptom.

So, let's just talk more about neuroplastic pain.

There are four main ways that neuroplastic pain can develop.

Firstly, a person can have an actual structural injury that is since healed and neuroplastic pain can actually follow a structural injury. What we do know about the body is everything the body heals. Everything has a healing time. And so, if you lacerate your finger, skin healing time is two to four weeks. If you damage a muscle, it's anywhere between one and six weeks. You break a bone, anywhere between four and 12 weeks. Tendons probably up to about 12 weeks. Ligaments a bit longer, possibly up to about 16 weeks. All things heal. The body heals them within that timeframe. There are some spinal discs that
maybe take a bit longer, possibly up to six months per se. But anything that's persisting after a period of six months, you really need to ask the question is why is this person still feeling this pain? And what we do know is that the single greatest factor that fuels pain is the fear factor. The fear factor that then becomes amplified and maintained well past healing time.

So, the second one is where there's actually no injury, but there's a perception that there's an injury or there's a perception that there's structurally something wrong with the body. And once that perception happens, the fear factor can fuel that and amplify it. And then that just gets maintained. And the
primary fear of all people in chronic pain is that there must be something structurally wrong with their body to be causing pain of the severity. And that's why so many visits to the doctor and so many investigations and so many different treatments.

And Catherine and I are going to talk about her experience and I think her experience, and I'll mirror my own experience in terms of the pathways, in terms of what happens when you do suffer with pain and you go and go to the doctor. So that's the second cause.

The third cause is chronic pain can be precipitated in childhood, in adolescence and in adulthood by any adverse or stressful or traumatic experience originating as early as childhood. And what we've learned is that it doesn't need to have been a major trauma. We are obviously familiar with the ACE studies and again, Catherine and I will talk about that, but I treat and see so many people who aren't able to identify a major single event trauma in their life, sometimes even aren't able to identify relational trauma that would constitute a diagnosis of complex PTSD. The difference between PTSD and complex PTSD, I'm not going to really discuss these in this meeting, but people don't have to have had those sorts of trauma and often people have had major traumas in their life and don't go on to develop pain. But that's just the point to make is I do see quite a few people in my own practice that when I do a very detailed trauma history on them, often we can't find any specific thing. But of course, that may be something in the subconscious that hasn't yet been accessed and I'll talk about that a bit later.

And so, then the fourth way that neuroplastic pain can develop is just an insidious onset. There's no definitive acute injury, no perceived injury and no obvious adverse, stressful or traumatic experience that one can identify and people develop pain. And in this group of the insidious development of neuroplastic pain, of course it can happen in all of the groups, but in this group personality traits may play a major role.

And I'll talk in more in detail of personality traits. But these are personality traits that people who are people pleasers, who are prone to self-criticism, who put enormous amount of pressure on themselves, people who have positive traits that end up being not so positive for themselves. Conscientious people, people pleasing, perfectionists might be prone to anxiety. Their brains are constantly on high alert feeling like they're emotionally in danger. And of course, when the brain does feel emotionally in danger, it can not only trigger, but it can also maintain pain.

So how do you know if somebody's pain is neuroplastic? There's certain neuroplastic clues in terms of just identifying neuroplastic pain. As I mentioned before, anything that is not related to an identifiable or a confirmed organ disease or structural damage, no organic cause. The whole medically unexplained symptoms or symptoms that really don't do well with treatment. They've been offered treatment and have only had partial or temporary relief. These are people that frequent visits the doctors and often be told after many, many investigations and many things that your symptoms are all about stress or your symptoms are all in your head.

And of course, that is the very, very last thing people want to hear because they're suffering. The pain is 100% real for them. And less understanding, the irony is that in fact the pain that they're experiencing is being generated from their brains, but to give the analogy, it's all in your head I suppose it's medical gaslighting if anything.

But those are the types of things that are presenting to doctors all the time. And I think for many doctors, possibly people with chronic medically unexplained symptoms become their heart sink patients because they want to help and their patients get subjected to enormous number of investigations and so much medication and the doctor doesn't feel like they're actually getting anywhere and the patient doesn't feel like they're getting anywhere. So, it ends up being a little bit of a catch-22 situation. So that group of people, medically unexplained symptoms. Symptoms that can begin with a physical precipitation, no actual obvious injury, no obvious trigger that's causing it. Symptoms that persist, as I said, much longer than the expected healing time. They can be symmetrical, both sides, or they can be asymmetrical but don't make anatomical sense.

So, one half of the body on one side, one half of the body on other side, that doesn't make anatomical sense in terms of where it'd be mapped in the brain. And certainly, when I talk about my own symptoms, the thing that was a key for me, I obviously had medical knowledge, but in terms of my pain, it didn't make anatomical sense. The pain I had didn't match the dermatome, the disc didn't match the dermatome. So that was something that always worried me is that why is this not making anatomical sense?

Pain that spreads over time to different areas of the body, that radiates to opposite side of the body or just that doesn't make sense. So that occurs in different body parts, multiple symptoms that have different qualities, that maybe associate with headache or bloating.

Qualities like tingling or electric shock or burning or numbness or hot or cold. All of these symptoms should really point a person towards, could this be neuroplastic pain? They're inconsistent. The pain migrates. Can be less intense, even within a day. Can occur upon awakening. Can occur while asleep. They can occur after exercise. Can occur when stress happens or even when people are thinking about stress. And tend to perhaps be at their minimum when they've got other distracting activities, okay? And symptoms that seem to be triggered. And the key really is that can be triggered by anything. They can be triggered by food smells, by sounds, by lights, by computer screens, menstrual periods, changes in the weather, anticipation of stress or actual stress. Even imagining engaging in a pain triggering activity such as bending over, if they believe they've got an injured back, turning the neck, sitting or standing. So many people will attribute the onset of their pain to something innocuous they did. I was just bending over, I was just picking up, and my back went and that's what actually caused the injury. When I speak to Catherine, I'll detail to you how a seemingly innocuous event, the same thing happened to me.

So those are really the things that you need to be looking at in terms of thinking it could this be neuroplastic pain? Always we need to have a look at does a person have a history of chronic stress or depression or anxiety or underlying untreated PTSD? Have a careful look to see if a person has a history of any adverse childhood experiences or childhood adversity. And these are all the sorts of things that will give you the clues.

Invariably there will be some form of trauma, psychologically emotional trauma that has resulted in what causes this chronic pain syndrome, which at the end of the day is basically corticolimbic system dysfunction. It's all about limbic system dysfunction. And I'll talk a little bit more about that.

Before we have a little bit of a break, I'd just like to just concentrate a little bit on people's personalities in terms of being able to recognize which people will develop neuroplastic pain. I mentioned a couple of personality traits earlier, but this is really key because very often people that have these personality traits are the types of people that maybe repress their emotions and it's the repressed emotions that invariably end up triggering neuroplastic pain.

Now, as I mentioned, things that are very positive in the workplace and very positive in terms of so many aspects of people's life. Perfectionists who are detail orientated, extremely organized, highly conscientious, try to accomplish too many things, very critical of themselves, hold themselves to
extremely sometimes impossibly high standards, overly responsible, overly conscientious, sometimes a little bit control orientated. Stoic people who just hold in their emotions, have difficulty opening up to people in expressing their emotions. They put the needs of other people before themselves and they
will routinely change their plans to satisfy the needs or schedule the needs of others, and try to be peacemakers in so many situations. Some of them might have quite legalistic tendencies, like to be right, my way or the highway approach. On the other hand, they might also be quite hypervigilant, anxious people, may have dependency traits, may have low self-esteem traits and may have some hostility or aggressive traits as well.

Fundamentally, these are people who ignore their own needs and repress their feelings, they repress their emotions. And so, over a long period of time their emotional and their physical needs often remain unmet. They never voice their real true feelings and that may be associated with deep-seated feelings of inadequacy or low self-worth, doesn't have to be, but all of these personality traits are negative to the self and these individuals can become quite harm avoidant. And this harm avoidance reflects a tendency to develop condition fear responses. And that explains the pain that they end up experiencing and just get caught in this vicious, vicious cycle of fear and avoidance, fear and avoidance and suffering. So certainly, in my clinical practice I do see a lot of very successful businessmen who reflect this exact profile in some form or other and are very successful in their jobs but end up being not successful in their lives because they get struck down by chronic pain.

So, pain is a survival technique, it's there in an attempt to protect us. We need to experience pain for survival. What most people don't probably realize is there's no such thing as pain receptors. All we have in our body are things called nociceptors, which pick up change. So, let's say for example, you're in the kitchen making dinner and you cut your finger with a knife. A signal gets sent immediately, so quickly up to your brain, and your brain sees blood, it processes all the information, it puts all the information together and it has to make a decision, what am I going to do?

So, it sends a pain signal straight back down to your finger and you experience the pain and you say, "I've got to do something about this." So, you put a pressure bandage on. If it's serious you go to A&E and you get it stitched and get stitched up. And once it's stitched up, unless there ends up being an infection or inflammation, the pain disappears or goes away because the brain now feels it's safe. And so no longer needs to send you that signal.

And then as we know skin healing times is two to four weeks later, that heals but the pain disappears the minute the brain perceives that it's safe. Imagine when people go on skiing trips and adults go skiing for the first time and have a fall on the ski slope and they sustain a fracture of their femur. Awful, awful injury, incredibly painful. And they get air ambulance out and end up having surgery and massive fractured femur, huge bone in the leg and they get it pinned and put together and immobilized. And can you just imagine they've got a broken shattered bone inside their leg but the minute it's surgically fixed, even though it's still very badly damaged, very badly broken inside, there's no longer any pain.

The legs immobilized because the brain says this is now safe. And the minute the brain deems that something is safe, it removes the pain. So, pain in acute injuries is there as a survival technique. And the type of pain we're talking about, chronic pain, the pain maps in our brains, they get damaged. And us warning signal, our fire alarms in our brain are just now firing off consistently, making us believe that there's a problem in our body when in fact it's just our brain, our pain system just continues firing long after the body has healed. It's almost like the acute pain that we had develops an afterlife that's in the case of injury or that your chronic pain develops a life without any acute injury. It's key to understand. And what I'm trying to say is that, and this is what people often don't realize is that all pain, whether it's due to an acute injury or whether it is current, all pain is determined is by the brain. And how much pain we feel is determined in significant parts in our brains by our past experience of pain, our psychology, how serious we think the injury is and what our whole perception of the pain experiences.

So, let's just talk a little bit now about what neuroplastic change is. Because neuroplastic change is key in terms of what happens in pain, what happens in the brain and also is key in terms of how we recover from chronic pain. So, neuroplasticity, we used to think that our brains were hardwired, what you were given was it and that you couldn't change your brain. But we now know that that's not true. Through quantum physics and functional imaging and advances in science, we know that the brain can change dynamically, it can change its structure, it can change chemically, it changes functionally.

And neuroplasticity represents that. It's the property of the brain that enables it to adapt and reorganize its own structure and functioning in responses to changes in the environment and in response to changes in mental experience as well. In response to thoughts, in response to emotions and in response to behaviours. And neuroplastic change really is responsible for all the habits we have, both good and bad, helpful ones and harmful ones. It's this flexible wiring capability of our brains that enables us to grow and to change and to heal or not. And when I say or not, there's a negative side to neuroplasticity as well. And the negative side of neuroplasticity is really if you look at addictions and harmful and addictive habits, be its substances or activities or toxic relationships, that can create a very negative neuroplastic change in the brain. And those can all become deeply ingrained habits. And if you think about addiction and being stuck in toxic relationships or having a process addiction or addiction to anything that is in any way destructive or harmful to yourself, you can be stuck in that position for years until you create the neuroplastic change.

Because for all intents and purposes, your brain may actually feel that that is a safe place to be and doesn't know better, doesn't know how to shift out of out of those deeply ingrained neural pathways. Positive neuroplasticity is where neuroplastic change can happen in our brain and you can have positive shifts and transformations on every level. And this is really, really the key in terms of how we address treating people who have chronic primary pain. We really need to rewire our neural networks chemically, electrically, behaviourally, psychologically, relationally. Every single aspect needs to be rewired. We need to create new neural networks in us brains.

On a day-to-day basis, 95% of our thoughts, of our beliefs, of our emotions, of our habits are all experienced and guided by our subconscious brains. Parts of our brains we are unaware of. 95% of that is guided by our subconscious brains. Our conscious brains, that 5%, is just constantly focused on creating the perceptual image of our reality. And it really is about understanding that and realizing that in order to change our habits, we have to understand what's going on in the subconscious brain, become aware of it and know how to access it, and what to do about it.

So neuroplastic change has to be a dynamic process, A dynamic process physiologically and physically. And it's really what we do and our interactions with ourselves and interactions with our environment that facilitates reorganizing of brain connections in response to what our changing needs are. Rewiring neural circuits are the only way that we can shift from being in chronic pain to not being in chronic pain. This whole concept is known as wiring and rewiring.

This is known as Hebb's Law. But interestingly, if you go back in history and look at the psychoanalysis of neuroplastic therapy as described by Hebb, neurons that wire together fire together. Actually, it was originally proposed by Freud back in 1888 I think it was. And what Freud stated is that when two neurons fire simultaneously, this firing facilitates their ongoing association. He called it the Law of Association by Simultaneity.
And that really forms a basis of what he did in psychoanalysis with free association, a patient would lie on the couch and Freud would be behind him.

In the slide presentation that I've prepared for all of the participants, you'll see quite a few slides towards the end, which shows that Freud, long before we had neuroimaging and long before we had advances in quantum physics and that, Freud was talking about so many of these things already and talking about what was going on in these subconscious and repressed emotions. And he was a huge contributor to psychiatry. And I think when you go back and see what he was actually talking about, information is actually, it's all there. I find that quite fascinating that we're in 2023 and Freud was talking about this hundreds of years ago.

So, the next question is, well, okay, we know all of this, so how do we do it? And this whole concept of neuroplasticity, which we know is essential for normal brain development and it helps create functional brain circuits that are required on basis of learning. It's how you learn new skills.

The greatest neuroplastic change is learning a new language, playing a musical instrument and interestingly traveling, creates this neuroplastic change.
Unfortunately just going on holiday doesn't create neuroplastic change. If only it did, we could all just pack up and go on holiday. I think it's more about new experiences and stimulating new pathways and possibly learning a lot of new things. So, it's that concept of traveling that I think is referred to.

The younger you are, the easier it is for neuroplastic change. Young brains are much better at learning and adaptation, but it doesn't negate the fact that it can't happen as you get older. There is still a huge amount of neuroplastic capability in adult age as well. But in order to achieve neuroplasticity, there are absolutely fundamental principles which underpin positive neuroplastic change in the brain. There has to be focused attention. So, you really have to be interested in what you're doing and there has to be consistent and repeated engagement with the same task. It has to be coupled with determination. It has to be coupled with hard work, with motivation and doing all of this maintaining brain health.

The best analogy I can give you is to think about if you wanted to make an enormous change in terms of sport or you wanted to run a marathon or you wanted to achieve lifting certain weights in the gym or you want to achieve anything in that. If you just think about focused attention, consistent and repeated engagement, determination, hard work, motivation and overall brain health, that's how you achieve it in that arena. It's no different. It's no different in this arena.

The opposite has exactly the same effect. If people are disengaged, inattentive, distracted, lazy, nothing happens. Okay? So, all of the previous things you would call neuroplastic on switches, all of those are what are called neuroplastic off switches. So, in terms of wanting to address where the problem is, everything is occurring in the limbic lobe. Okay? Limbic lobe dysfunction is what the result is in terms of what causes chronic pain.

And all of the interventions are focused really on resetting the limbic system, be it trauma, be it addiction, be it chronic pain, resetting the limbic system has to be the key component of that. And so, neuroplasticity is really an activity driven process, okay? It's something that has to be practiced on a daily basis in order for those neural pathways to be developed and to be strengthened.

So, this plasticity-based learning has to be consistent. There has to be consistent internal mental rehearsal. And because we know that every thought we have, every feeling and every action, we actually, are engaging and triggering thousands of neurons that join together, that form these neural
networks. And the more we engage in these, the greater chance we have of effecting change in a positive way.

In the same ways in a negative way, they've looked at scans of people who suffer with OCD and can see how the obsessional thoughts and obsessional thinking lights up certain parts of the brain. And to some extent, if you draw the analogy that what you're trying to do is you're trying to create new neural networks, you're not trying to correct old ones, trying to correct old ones just often reinforces those old ones, it's about creating new neural networks.

The analogy I give to my patients is an I'll talk about self-care routines because this is where it starts is if you've got a default setting neural pathway that's not serving you, be it a neural pathway, that is the pathway that drives anxiety, that drives addiction or that's driving chronic pain, you don't try and fix those pathways. You need to create new neural networks and new neural pathways and wire them together, almost create like a new neural super highway.

And give the analogy of saying think about a chandelier, all those bulbs on, okay? And every time you are creating a new neural pathway, you're switching a bulb on in that chandelier and you want to get that chandelier all the lights on, and that's the chandelier you want to be operating on. That becomes your new neural pathway, not your old default set pathway. You want to switch this on and switch it on all the time in terms of creating the change.

The reason why everything needs to be focused on the limbic system is because when you look at the whole concept of polyvagal theory that's been covered in previous editions, really in terms of the balance between the parasympathetic nervous system and the sympathetic nervous system. The sympathetic nervous system is your fight, flight, freeze, nervous system. You need that for survival and it kicks in when you need it. All right? And when you don't need it, you go into your parasympathetic state, which is connection, growth, sleep, recuperation.

Problem we have is this, we live in a dysregulated world. We live in a world that bombards us with so much negative information and so much negative energy that our limbic systems have become dysregulated. We have dysregulated limbic systems living in a dysregulated world, okay? It's quite hard to change a dysregulated world, but we can change our dysregulated nervous systems and that's where we have to focus on.

It would be great if we could change some aspects of our dysregulated world but for the purposes of dealing and helping people with chronic pain, you have to focus in on the limbic system. And so, your brain remembers. So, any learning driven neuroplastic changes that you are making, your brain will
remember your best efforts and it'll make that small change. And if you do that incrementally and consistently, slow progressive improvement will start.

I often say to people who are recovering from addiction, they might be working the 12 steps, but one of the things that is key in addiction is to attend 90 meetings in 90 days. And I often ask people, "What are you actually doing there? What does that mean? Why is it so important?" Because the recovery's always better in people who are able to attend those 90 meetings in the first 90 days. You think about it, really, they are reinforcing neuroplastic change and creating a new neural network and new habits in terms of that positivity. And I think often if people know why they're doing what they're doing, they're more likely to do it and especially if they're starting see results.

So neuroplastic change is really where things are at. And so, all self-care routines need to focus on switching on as many of the neuroplastic on switches as possible, specifically intended to calm down the nervous system and specifically intended to calm down the limbic system. Okay?

Neuroplasticity of thoughts is crucial as well. I think at one stage it was thought that we had something like 70,000 thoughts per day. When I last researched this, I think it's probably closer to 6,000 thoughts per day. But what the research does show is that of those 6,000 thoughts we have a day, probably 95% of them are repetitive and 80% are negative. So, in terms of neuroplastic change, you have to intentionally change your thoughts on a consistent basis in order to create stable new neural connections. You have to strengthen those neural connections so that you can actually create the change.

So, I'll talk to you a little bit about self-care routines because that's really in terms of where neuroplastic changes and how do you put neuroplastic change into action? I ask everybody the question when I'm talking about self-care routines. First of all, I'll ask people, do you have a self-care routine? And most people don't actually have a self-care routine.

I said to people, "What is the first thing that the vast majority of people do? The very first thing when they wake up in the morning?" Probably the whole planet or the majority of the planet, the first thing they do really is this, they're on their mobile phones. And of course, mobile phones in terms of wanting to create positive neuroplastic change in the brain, your self-care routine has to start with a digital detox. Not going on that phone for however long your self-care routine takes, half an hour, an hour. Because everything that you look at on that phone, it'll tend to be an email or a message or a WhatsApp or social media platform or the news. All of those sorts of things are not good in terms of calming a nervous system down. The aim is really to calm the nervous system down.

There has been research done in terms of seeing what are the things that really do promote longevity and people living a long life? And a key there is to have an anti-inflammatory approach to everything. Anti-inflammatory, positive neuroplastic approach to everything.

So, what do I mean by anti-inflammatory? What we now know is that anti-inflammatory doesn't just apply to inflammation of tissues and the bones, okay? In terms of what is inflammatory to the brain, the brain releases substances, sets off a cytokine system and that cytokine system is inflammatory to the brain even with things that you don't think that it is.

So, what I'm trying to get at is that your immune system can also get fired up by neuroplastic off switches, okay? Your immune system is there to protect you as well. So, when your immune system has to deal with an infection, it mobilizes all of its T-cells, it mobilizes cytokines and creates the inflammatory response so that it can deal with the threat, it can deal with the infection, it can deal with what it needs to deal with.

Turns out that any mental threats are also inflammatory processes that the same process can happen, except that with mental processes, those are far harder to escape in terms of the effect of your immune system and your cytokine system and you end up having a sustained inflammatory response and that can really form the basis of chronic pain and also of chronic mental and physical disease is all thought to be due to chronic inflammation of the cytokine system and the immune system.

And so, we really need to be thinking about an anti-inflammatory way of eating, an anti-inflammatory way of thinking, an anti-inflammatory way of being, okay? Anti-inflammatory way of eating, I'm not an expert nutritionist, but in its basics, anything that is mostly plant-based and not processed is anti-inflammatory way of a nutritional approach.

In terms of what is toxic to the nervous system. If you just think about social media, inflammatory things to our limbic system are the use of too many mobile phones for watching the news, violent games, violent movies, all of these sorts of things are actually inflammatory to our brain. And so, in the process of recovering, all of these things need to be addressed as well.

So, let's just go back to self-care routines. So, self-care routine has to start each day in the same way away from your mobile phone. Digital detox is the way to start it and then is to try and switch on as many neuroplastic on switches as possible. And a lot of people will be talking about this over the weekend. That daily morning routine is the calm before the storm of life, the calm before our dysregulated world that we are going into. You have to have a system and an approach that calms your nervous system, starting with a digital detox from your phone, not watching the news, not watching violent shows, not overstimulating your brain through that.

Then it's really about what other ways can we look at in terms of calming nervous system? And all of the medicines and breathing exercises, all of the mindfulness meditations, all of the things that calm down the nervous system, affirmations and gratitude. There's a list of so many things that you can do and you have to bespoke those to yourself. If you look at The Miracle Morning by Hal Elrod, it gives you a template of what you can do in order to start with a neuroplastic on switch routine every day.

There's one last thing I just want to talk about in terms of neuroplasticity. And this is the real concept of things that in terms of all of the pain patients that I have, is the concept of something called expressive writing. Expressive writing, I think is an absolutely wonderful tool, and there's been a lot of research into expressive writing.

Pennebaker is the cornerstone of this, and he's done extensive research on this. John Sarno, who was a huge contributor to what we understand now about chronic pain, in his book called The Divided Mind, he talks about something called the reservoir of rage. And the reservoir of rage, it's like being in a prison with lots of unsavoury characters trying to break out. These are in our internal reservoir of rage.

These are people that they're too dangerous to enter from the subconscious mind into the conscious minds. They just remain. They remain repressed in our subconscious unconscious mind.

And they remain there because we repress so many of our emotions. Because if we express them or show them, you could almost think of yourself as losing it with a loved person or someone close to you. And so, we repress these because we are not only safeguarding ourselves, but also safeguarding other people from hurting them by saying something that we want to say that is deeply unkind or unpleasant.

And that may be socially acceptable in any situation. So, what we do is we just repress, we repress, repress all of these emotions into our reservoir of rage, almost like a pressure cooker. And these really are unconscious, repressed emotions. Could be viewed in a way even they're stored trauma. And we need to release these repressed emotions in order to heal, in order to deal with our pain, in order to move from our chronic pain state.

Because the reservoir of rage tries to inform our conscious minds of just how scared and stuck, we are. And our conscious mind just keeps on pushing them back. So, our subconscious minds then says, "Well, no. What messages can I send to you that you're going to take notice of?" And of course,
pain is the message they can send and everybody responds to pain. Nobody ignores pain. And particularly when it's pain that's that severe.

And that neuroplastic pain that we are experiencing really diverts us from experiencing our internal emotional world, our emotional pain. And this is why expressive writing is so important. Expressive writing is about accessing our subconscious mind and being able to dive deep into our thoughts, our opinions, our emotions rooted in memories and trauma.

There may not be major trauma, that major trauma might have been dealt with via therapy, but expressive writing is certainly a way to process those feelings that are deep in the unconscious, that our brains won't allow to come into the conscious thing because of the reason that we might deeply offend people or it might be socially unacceptable the thing that we do. So expensive writing, here's how it works. You don't tend to prepare for this. There's a guide as to lists you can use, but there's no real thinking ahead. It's something that you just sit down and you do.

It needs to be spontaneous and all the writing that you do is completely confidential. There's no sharing of the content of the writing. And you really do write in a stream of consciousness, free flow writing, coming from your gut and from your heart. You shouldn't edit your thoughts; you shouldn't edit your feelings.

You really, really want to go deep and explore your deepest emotions and thoughts, those darkest secrets that you don't want any other person to know or that you don't want to discuss with anybody. They can be about anger, shame, guilt, past or present, about anyone or about anything. They can go back to your childhood. They can be about adult experiences. They can be in the here and now. They can be about anything. It literally is that you are diving really deep and getting all of those deep-seated emotions out.

Consistency is the key. 20 minutes every day, but here's the real key. The minute the 20 minutes is up, you do not read what you have written down, okay? You are not examining your thoughts. You tear that piece of paper up immediately and you destroy that piece of paper immediately. It's not for you to read and it's not for anybody else to read. This is not journaling. This is not keeping a diary. This is not examining a thought dialogue.

This is about separating your repressed thoughts and emotions that are trapped in your unconscious mind because fundamentally you are not your thoughts. And by doing this, one can start the healing process. You are accessing so many of those deep-seated repressed emotions that are fuelling your pain.

You want to access that raw, unfiltered truth about how you feel. You don't want to sense yourself. Things that are shameful, that are scary, that are ugly. Imagine yourself as a kid almost having a tantrum, getting it all out. Okay. Often been described as a word vomit onto a page. Another description I've heard, which is quite graphic, is you've got a bad cold, you literally are blowing your nose into that handkerchief or that tissue. You're not going to go and look at it afterwards. You literally are just going to get rid of it. You don't even want to be associated with it, you're taking all of those real deep-seated things and you're getting an art into your conscious mind.

And gradually what will happen is your brain will start to learn that it's okay to have these feelings. Your brain will start to learn that it's okay to feel these things. You're accessing deep-seated emotions and repressed emotions and very often straight after doing the expressive writing, people might want to engage in some self-compassion meditation just to calm their nervous system down or might want to do some guided visualization.

It's such a key part of recovery and the regular practice of this is a huge neuroplastic on switch. So, all of the things that are I've spoken about really are the neuroplastic on switches. And any person that is going to be recovering from chronic pain has to start their day with the self-care routine that focuses in on calming down the limbic system, calming down the nervous system that has become dysregulated and that it's in a dysregulated world.

And finally, the last thing I really want to say about neuroplastic change is all of these things that are spoken about, all the neural networks that wire together and fire together to create the new neural super highway in your brain, the new chandelier, the thing that is the most important though is the neuroplastic change that has to happen with your thinking.

That is the thing that is the game changer. That people who are able to change the way that they think, not only about their pain but the way they think about life in general, are the ones that can make progress. That is not a passive process either. One has to go from an unintentional way of thinking.

An unintentional way of thinking is starting your day every day with somebody else telling you what you must think, your mobile phone, to an intentional way of thinking. That you are intentionally starting your day every day in a way that is self-serving.

The principles of so many religions, Buddhism and Christianity and other religions is you can't serve others until you've served yourself. And self-care routines are all about serving yourself and getting yourself emotionally regulated and getting yourself into a good head space so you can deal with the dysregulated world. The world outside is going to carry on in its dysregulated way. And the only way that people can recover from their pain is to very first start calming down their nervous system is absolutely crucial. And obviously as part of the neuroplastic change in thought processes, the thing that holds people strongest in their pain is really their belief. Their belief about what their pain is.

And the education side of getting people to understand the concept of neuroplastic pain is that their brain's made a mistake and is giving them a false alarm and that actually there's nothing wrong with their bodies is absolutely crucial. Because by doing that, people can say, "There's nothing wrong with my body. I can start exercising again." And that's encouraged. That's another neuroplastic on switch, movement and exercising. So, all of these things in terms of self-care routines, and I only just touched on them, there's so much we could talk about in terms of self-care routines that are anti-inflammatory, neuroplastic on switches. That in itself it's a little mini conference on its own.

So, I've been talking for a long time now and I hope that everybody that's watching has got an understanding really of what neuroplastic pain is and what chronic pain is, and that you all have an understanding of why this has happened. Our brains have made a mistake. Our brains have become super sensitized. Our brains are sending us the wrong message. They're trying to protect us. Our brains are doing their best to protect us.

And those people who do suffer with chronic pain have nothing structurally wrong with their bodies. And that is such a positive thing. That gives people hope. Everybody who suffers with chronic pain really wants hope. And there is hope when they know there's not anything structurally wrong with their


Interview with Catherine Oxenberg


Hello, Wayne.

Dr. Wayne Kampers
Oh, it's so to see you. And I'm so grateful and I'm so pleased that you agreed to do this. I think that you
have an unbelievably fascinating story and I think that your journey is a journey that needs to be shared.
I think people need to hear about your journey because, first of all, of how positive the outcome is, and
also how it's created a platform for you to be able to give back. And I think that for so many people who
have experienced chronic pain or any other devastating medically unexplained symptom and recovered,
part of that ongoing journey and part of connection is about giving back. So it's a real pleasure to be able
to speak to you, and a real honor to be part of this process.

Catherine Oxenberg

Thank you very much. Well, it was an honor to listen to you before, so thank you for inviting me to
Dr. Wayne Kampers (00:01:21):
And it's really serendipitous, I think some of those people are just destined to meet. And I think that our
journeys and our paths, I think they were meant to cross, and this is the reason why.
Catherine Oxenberg (00:01:38):
Through one of my dearest childhood friends, Cosmo.
Dr. Wayne Kampers (00:01:41):
I know. Unbelievable. I did thank her when I last spoke to her. So Catherine, I just want to hear your
story like, I think, everybody else does.
Catherine Oxenberg (00:01:59):
Okay. And feel free to interject. And if I miss anything just...
Dr. Wayne Kampers (00:02:03):
Sure. Just go at your pace and let's hear your story.
Catherine Oxenberg (00:02:12):
Okay. So let's go back to January of 2020 where really I had a massive health crisis. And in a period of
about two weeks, I went from an active healthy woman to being an absolute bedridden cripple. And it
was terrifying. I literally woke up one morning and my hands were swollen with massive nerve pain,
tingling, numbness, everywhere I lay on my body was aching and sore. I felt like I had fire in my spine
and in my head. I was literally overrun with excruciating pain and it kept building. And it was my wrists
and it was like stabbing nerve pains in my feet and I couldn't walk, and I was terrified. And so before I

get to the litany of doctors, I'm going to cut back a little bit to what preceded this, which took me a
while to figure out, we had some connection.
I had been come out of a seven-year battle to rescue my eldest daughter from a very dangerous cult
where she was being trafficked along with 100s of other young women. And it took all of me to fight for
her. And it was a very public battle, and I was very involved in getting the government involved, in
getting the media involved, and bringing the government proof of crimes. And eventually, to make a
long story short, the head of the cult was captured and he is now in jail for 120 years, along with five
other cohorts. So I would say his crimes were significant.
Dr. Wayne Kampers (00:03:53):
And that formed the basis of your book, Captive, isn't it?
Catherine Oxenberg (00:03:56):
Yes. About what it took to rescue her and take this cult down ostensibly. So subsequent to getting India,
that's my daughter's name, back, I had bought this beautiful post-divorce property in Malibu. And we
were going to be reunited with my other two daughters and build this beautiful compound there where
I was going to probably end my days with chickens and so forth. Five days after her being back,
everything is burnt, the whole property is burnt down in the Woolsey Fire. So what, 1500 properties
were destroyed in Malibu back in November of 2018? And we were left homeless. In a weird way from
having been polarized by trauma, the whole family, now we were trauma bonded, which was very
strangely ironic. From there, I think between the acute trauma, the chronic trauma, just the stress to my
nervous system, it wasn't until this man, the cult leader, was put away that my health fell apart.
And that makes sense. It's like, a person holds it together for the fight, and then when everything is
okay, then you stop producing so much cortisol, and because the cortisol is actually boosting your
nervous system, all of a sudden then you fall apart. I went to my GP and he did blood work and my

blood work showed fine, and it just didn't make any sense. And I sat there feeling like a-
Dr. Wayne Kampers (00:05:35):

So virtually, your whole body was pretty much shut down and your blood work was completely normal.
Catherine Oxenberg (00:05:43):

Completely normal. And so you start to feel-
Dr. Wayne Kampers (00:05:45):

What did you think? That must be like, "What's going on here?"
Catherine Oxenberg (00:05:50):
Well, when this middle-aged doctor looked at me like I'm another crazy hysterical woman complaining
about non-existent symptoms, it's embarrassing. It's like, "I know there's something wrong with me
because I'm in excruciating pain." And so he said, "It looks like fibromyalgia." That was the first
diagnosis. And that made sense to me. I'd had about a fibromyalgia a few years ago, but this was way
worse. And now I think about it, you would traditionally call what I had a major flare, that's what the
medical community would call it. And I'm like, "I need medication. I can't function like this." And so

basically I was desperate for a diagnosis to make sense of what I didn't understand had taken over my
body so quickly. And I wanted medicine, I wanted immediate relief. And I'm like, "Just give me
whatever." And he started to give me medicines and they made me feel worse, horrendous.
Literally I had about 20 different meds by the end of seeing all these different doctors. I think this first
one was gabapentin, and I thought I was going to lose my mind. So all these drugs suck and they
definitely do not work for what I have.
Dr. Wayne Kampers (00:07:09):
And then of course they wouldn't work for something where there's not a structural problem.
Catherine Oxenberg (00:07:15):
Precisely. But I didn't know that then.
Dr. Wayne Kampers (00:07:17):
No, of course you didn't.
Catherine Oxenberg (00:07:18):
So then he starts to send me to a bunch of specialists, and the first specialist I see is a rheumatologist.
And I can't move my hands, all of a sudden I need my kids to open jars for me and bottles. I can barely
hold a fork. I'm thinking I have MS or some or something really terrifying. And so the second doctor, he
says, "Well, it looks like peripheral neuropathy." And he gave me medicine. And then every doctor that I
went to just piled on another diagnosis and gave me more medicines. And the point at which I was really
terrified, because I thought this was the end of the road, was when one of the doctors said that this
becomes chronic pain when the pain is at a three-month marker. Because once you hit three months,
then your brain is wired for pain and you cannot undo those circuits.
And I'm thinking to myself, this is at the two and a half month mark. I've got two weeks before I'm
condemned. And it's a terrifying thing when you have an authority figure who basically says that what
you have is incurable. It might as well be a cancer diagnosis. And they don't give you any way out. It
really is terrifying, that's all I can tell you. And there was a moment where I started Googling euthanasia
clinics, because I'm thinking to myself, I can't live like this. I can't walk, I can't play tennis, I can't work,
there's no comfort for me lying down, I can't sleep, I can't lie in front of the television. And suddenly it's
like my whole identity is consumed with being in pain. And my life got very small very fast because I
didn't want to do anything.
I couldn't do anything. And the shame that accompanies somebody who suddenly becomes a pain
sufferer... Because you feel you've been marginalized. Basically you've been rejected by the medical
community because they can't help you, which is very, very scary. And look, these are great healers, but
I think that the training and understanding of how to treat pain needs to catch up a little bit as far as
traditional treatment. So I would say around the three-month mark, I made a decision. I'm like, "I can't
live like this. There has to be a better way." And I think that's my personality. And that's the same
mindset that I had when I was fighting this very dangerous cult is, there has to be a way, there just has
to be a better way. And the best that I could do at that point, because I couldn't move very much, is I

would go and I would lie in the gym and I would do what you would call maybe yin yoga or deep
And I would just lie on the floor and listen to meditations and just stretch and feel the excruciating pain
in my body, and just pray for an answer. And about three months later I went to see another
rheumatologist and she actually was the first doctor to ask me a little bit about my history. And she did
the ACE test with me. And I scored about seven on the ACE test. And I had never heard of the ACE test
before. And she said, "Somebody with your history is a poster child to develop pain in later life." And it
was the first time that a doctor actually made me feel validated that it wasn't because I was a failure at
life that I was in excruciating pain, that there was some reason, there was some sense to it. And then I'm
like, "Well, what's the solution?" And she offered me another medicine. And at that.
Dr. Wayne Kampers (00:11:23):
Catherine, why did she do an ACE on you?
Catherine Oxenberg (00:11:26):

Because she stopped-
Dr. Wayne Kampers (00:11:28):

Just for the listeners, ACE is, it's a list of adverse childhood experiences and they're all predictive of
trauma and predictive of healing and predictive of probably addiction and chronic pain. And the higher
the ACE score that you have, the more vulnerable you are to developing these chronic... But because
ordinarily I wouldn't have expected a rheumatologist do an ACE score on somebody, so I'm interested in
Catherine Oxenberg (00:12:00):
Well, I was too. I think her approach was more towards where we're headed, which is to spend time
with the patient and ask them about their history. Ask them about what had happened to them. So it
was less symptom oriented and more person focused. That's the reason. And she was the first doctor
who treated me. We had an hour session on Zoom because it was during the time of COVID. But she
spent time with me to understand who I was, and that made a difference. Now, the disappointment is
that she didn't have anything to give me beyond validating why I had symptoms. So cut to another three
months and I come across a clinic in Northern California called Biorecept, and I flew up there. And it was
not a ketamine clinic, and I want to be very specific about this, because the experience that I had was
the beginning of seeing light at the end of the tunnel, it was really important.
I think it's a functional integrative medicine. Dr. Matthew Cook is an anesthesiologist. And what he told
me, he did tests, he says that from stress, my immune system had really imploded and that it couldn't
fight anymore. And that made a lot of sense to me. And so he started to give me IV supplementation of
minerals and vitamins and NAD+ and he spent a lot of time with me. And what he was really doing
without me realizing is he was setting an intention for me. And the intention that he was setting, he was
going to give me a ketamine IV, was that I was going to heal, and that I was already healing. And when I
got on the table, and the reason that I say that I had a hybrid experience is because he's not a
psychiatrist, I had an IV infusion, but it was a very therapeutic experience with a ton of time spent with a
medical professional who was preparing me for a mindset shift.

And he was also supplementing my brain so that when the ketamine hit my nervous system, I was able
to hold a charge. And it really did maintain. And I think that's critical. So I was given low dose. I think low
dose ketamine for chronic pain is going to be an absolute game changer because it for me. It was
literally like I was being airlifted out of combat, and it gave me a relief from myself. And what I
understand is it gave me a relief from my default neural network and my brain got to reset and my
nervous system, it was like I was out of pain for the first time. And I was also registering that I was out of
fight and flight, maybe for the first time in my life. I was experiencing what it was like to be regulated.
And immediately I got in touch with a part of myself that was intact, that was vaster than any traumas I
had ever incurred.
And this part of me knew how to heal, and also recognized that healing was an inside job. Everything
changed from that first session. I cannot tell you, I am such an advocate for ketamine therapy properly
done, it changed my life. It was truly the light at the end of the tunnel. And from there, from that one
recalibration, that one realignment, I started to find solutions. And the first solution that I found was
Curable, this app. And if you don't have a lot of resources and you can only do one thing and you're in
chronic pain, go to Curable, because what I got there was knowledge therapy. And I have read

everything, I've done every exercise. I have listened to every expert on that site. It was like my 24/7 go-
to. And I learned that you have to treat the mind and the body as one system.

I got to learn about the difference between non-structural pain and structural pain, so what we call
neuroplastic and structural pain, and that there was a difference. And that one of the key identifiers of
neuroplastic pain is that it moves, that it changes, that it morphs. And that made so much sense to me.
If I had truly broken a bone, it would hurt in the same place. It wouldn't one day my left hand, and the
next day my right hand, it would switch around. It was confounding the way the pain would come, it
would go, I just couldn't make any sense of it. And the more I understood the science of pain and what
was really going on with my brain, the less afraid I became. And that was the thing I think that shifted for
me so much. I was the one who was wiring my brain for pain because I was in so much fear and the pain
just perpetuated this cycle of fear.
And when I realized, "Oh my god, I have so much control over my symptoms!" And I started to
understand how to communicate with my subconscious and that I started to understand that my
symptoms were both a distraction from my subconscious trying to protect me from feeling a more
intense emotion that it considered more threatening to me, but also was a form of communication. And
in one of the curable exercises, I think it's called identifying emotions, you really ask your subconscious
to reveal to you what it is it's trying to communicate. And I started to get answers. And I started to
realize I am a person who expresses emotion through my body. I may always, but I'm not afraid of that.
In fact, it's become my greatest gift because I have now access to such an authentic communication
from the deepest part of myself. It's miraculous to have a clear communication to your subconscious,
which as you said is 90% of who we are.
The fact I learned the brain is so neuroplastic as opposed to what I was told that I was wired at three
months is revolutionary. And the fact that psychedelics are such a key component in increasing the
neuroplastic potential of the brain, and my ability to learn new behaviors is incredibly exciting. I think it
took me a long time to be able to unravel pain from fear and that I could. And a lot of it had to do with

an internal dialogue. So let's say I had some pain that came back, I was able to say to myself, "I know this
is uncomfortable, but you're not in any danger. There's nothing bad happening right now. You're
completely safe." So I started to teach my brain to down-regulate even if I was being symptomatic. And I
learned how my language contributed, that I was scaring myself all the time.
So when I talked about being in pain, and then I realized, well, I could talk about my symptoms, because
that's less alarmist than using the word pain. And then down-regulating even more, I could say, "Well, I
have sensations," because sensations is even less alarmist in terms of language, and how key the words
that I was using were impacting my nervous system. So that was actually really important. And there
was something else. Well, when I started to understand that my pain had an emotional component, and
you talk about the reservoir of rage that John Sauna talks about, I talk about volcanic unexpressed rage.
And I swear I didn't think ever I was an angry person. I had a lot of pain. And I think I want to go back
afterwards because when I started to do the chronology of my life, I realized that I have been a pain
sufferer my whole life.
I just didn't realize that this revolving door of symptoms, and what I thought was bad health, was
actually me suppressing emotions. And when I started to be honest about, oh wow, what if all this pain
is rage that I'm not in touch with and that I somatize so quickly that I don't even identify as rage because
I just sympathized so fast. And I slowed down the whole process, and I just went from sort of reverse
engineering. So right now, if I have a load of pain, what am I so angry about? And I just started to ask
that question. And I started to realize I was angry about absolutely everything. And it took a year of
really learning to integrate what I would call, it's like the good, bad and the ugly or Freud's id, that part
of ourselves that, especially women, were so conditioned not to express that ugliness, that anger. And I
learned fast to suppress. And I didn't find any other way to process emotionally as a child, so I just used
sickness and symptoms.
And as soon as I started to find ways to express that wouldn't harm anybody, because I grew up with a
dad who was bipolar. So I was really afraid of anger. The first thing that I did was get in my car and I did
a lot of yelling in my car. I yelled and yelled and yelled about everything. And then I did a lot of
expressive writing, what I called rage on the page. And I did something a little bit different than you
sometimes, is because if I was raging about something and it took me on a journey. And I realized what I
was really raging about specifically was identifying a need that wasn't getting met. And then I would flip
the statement and create a prescription for myself to give myself the thing that I was terrified that I
wasn't getting. And sometimes that was me not giving it to myself.
So let's just say I did a terrible interview and I was beating myself up for being such a loser and so
incompetent in everything. And then I realized, okay, what is it that I'm not giving myself? I'm not giving
myself the message that I'm enough, that I'm good enough. And so that sometimes is my wrap-up when
I do my writing is I put my hand on my shoulder and, "I got this girl, you're good enough." And that
actually has helped. And then to refine the rage process, I now do a lot of internal raging. So I could be
very politely having a conversation and something could me off and I could just blow somebody up in
my head. And I can do what I want in my head and it's business. And it's a good thing in my head
because it would be a terrifying place for people to be.

But I don't have pain anymore. So I think understanding what it means to be a human being doesn't
mean that you transcend all of these human feelings. The power of me, and what has come from being
honest about my anger and even telling my kids I have an anger problem or my boyfriend, I would never
admit that normally, is that it has birthed an authenticity and access to a voice where I assert myself in a
very clear, direct way that I couldn't do before because I was so conflict avoidant and I was so terrified
of disappointing people. So for me, getting in touch with my rage and not being afraid of it and finding
ways to integrate it in a way that's very empowering and ultimately it has given me my energy back. And
I feel like I am so grateful to be out of excruciating pain that all I want to do is share this information.
And I've mentioned that 50 million people in the United States alone suffer from chronic pain. And if this
information was more mainstream, and it is evidence based and it's not hokey, and if more people knew

that they could go down this road to recovery and that so much power to reduce symptoms-
Dr. Wayne Kampers (00:24:12):

Catherine Oxenberg (00:24:12):
In their own hands...
Dr. Wayne Kampers (00:24:36):
So you just said some really key stuff we just want to focus in on. So obviously it's, first of all, amazing
that you've recovered from this. That's fantastic. And it's awful to think about the journey that you had
to go on to get there, but you are where you right now and you're in a very good place and are
continuing to continue your journey. It's interesting because I think that on the one hand, I think that
the Curable app is fantastic. It's accessible to everybody. So everybody who has chronic pain can
obviously can access Curable. But on the other hand, you also had transformative results with ketamine,
which is not readily available to everybody. So there's this middle group, and probably for the
foreseeable future, we've got a huge population that are still in pain.
[NEW_PARAGRAPH]They all have access to the Curable app. And I have a lot of people of my own
patients who've used the Curable app with success, and some they, need something more, et cetera.
And I think the real focus is what you are saying, and that is it is about people really, first of all,
education and understanding what their chronic pain is about. That is absolutely key because in your
situation from what you said is that the greatest thing that drives people's pain is a fear that there's
something wrong with them. And of course the thing that happened with you is what does happen with
so many people is that they do go to doctors, doctors are in the caring profession and they don't want
their patients to be in pain, but they also want to know the cause. And I remember you and I having a
conversation earlier, I asked you the question, "Do you know how long it takes for a doctor, a family
physician, let's say that's got a short consulta... How long it takes for them to interrupt their patient
when they come in and see them?
And it's so short. I think it's 15 or 20 seconds or something like that. And that's why I was so interested
in the third doctor that you saw that actually spends time just getting to understand what was really
going on with you. I used to be a GP before I became a psychiatrist in rural Canada. I was a young doctor
there who was running a practice in rural Canada. And I had 10 minutes per patient and often 60,
sometimes 80 people a day that I would see. And it's obviously an enormous amount of people to see.

And what I very quickly realized is that the best way for me to actually differentiate between what a
good GP needs to differentiate between that is the worried well and somebody that actually has an
illness or that they've got symptoms that you really understand. And it's amazing, 10 minutes, if you just
let the person speak. You let a person speak for five minutes uninterrupted about themselves and about
this, there's an enormous amount that you can learn.
I think that is really a skill that doctors should employ is to be listeners and to be listeners at source. And
obviously the person, if they feel they need to direct them in a certain direction, then by all means. But
just by listening very often the person will tell you what's going on in their lives, and very often by them
telling you what's going in their lives there may then come the clues for the symptoms that they then
describes to you rather than go straight to, "Okay, well, I've got to do investigation, I've got this whole..."
Clearly excluding underlying organic pathology is always necessary. But if somebody's tests like yours
come back completely normal, then it's be... And as I said to you when you and I had that conversation
the other day, I think there are a couple of blind spots in medicine. And medically unexplained
symptoms and chronic pain is definitely a blind spot.
I think that perimenopausal symptoms is a blind spot. And I think that sometimes mental health issues
that end up being either undiagnosed or untreated, ADHD or ADD is another blind spot. But the only
way around that is to always say, could this be? And I think as a doctor, if you just ask that question,
could this be chronic primary pain? The minute you ask that question, and of course if you know then
what to look for, if you know what to listen for. But that's the key. And as you said, quite rightly, the
education system needs to change in the terms of the way doctors are taught. I think the same applies
to if I go back to my own medical school is a long time ago, but even what doctors are taught in terms of
nutrition. It's absolutely crucial. And mind body, and eastern philosophy and all of these sorts of things.
I think if we look at how big the problems are in our world in this arena and I think Western has become
so focused and very good at organ systems and surgery and investigating and testing, but are missing a
bigger picture.
Catherine Oxenberg (00:31:10):
I agree. My experience is that my pain was a cry for help, but from a deeper place of my consciousness.
And looking for some form of resolution, and I think if we understood pain as a form of communication
and to look for what that communication could be. And unfortunately I think a lot of it does come from
unresolved trauma, I really do, that the pain is a trauma response. But it's identifying probably a lifetime
pattern that was born from a trauma response, which is you couldn't freely express intense emotions in

a way that was-
Dr. Wayne Kampers (00:31:56):

And as you said, it was really not being able to express how you were feeling from a young age. I think
that is very, very common in terms of children who, they don't necessarily have to go through
particularly traumatic experiences at that age, but not being able to articulate what they are feeling or
not being able to communicate their internal experiences means that they don't have a skill set to do
that and then they repress it. And as you say, that came out in sickness and physical stuff.
Catherine Oxenberg (00:32:46):

Well, it makes me think about the concept of how an infant learns to regulate. And if you are a
dysregulated infant, which happens, you get put on your mother's chest and you immediately learn to
co-regulate. But if you have a dysregulated parent or you're left alone crying in a crib by yourself to cry
yourself to sleep, you don't learn how to self-regulate through co-regulation. And I wish more people
would know. I don't think I knew that when I was a parent. I think I had a sense, I didn't really
understand the concept. But as far as a lot of pain possibly coming from attachment issues, this idea of if
you don't learn how to co-regulate with a parent... And possibly because the parent is very
dysregulated, and I'm sure all of us who are traumatized come from parents who are traumatized. And
that's just like, that's how trauma gets passed down. But I think it's key because what I'm having to do
now is learn how to regulate myself through... But I don't think I did learn that naturally through my

caretakers. I just-
Dr. Wayne Kampers (00:34:02):

No, you're absolutely spot on in terms of when you look at trauma, it invariably goes right back to
attachment theory. And what happened at that stage of a life where the attachment is ruptured in
terms of even the preverbal part of a toddler's life, pre three years old, is that what we know is that the
most traumatic thing for all children is the relationship they have with their parents and the safety that
they feel in that relationship. And if there is a secure attachment and a nurturing attachment, those
children don't tend to go on and suffer from a trauma. But if that traumatic attachment is not there or
fractured at a very, very, very young age, then all the problems do stem from there, almost in the way
that the child's brain develops.
So if they don't have a secure attachment and they're unable to articulate their what's going on inside
them, then their amygdala pretty much senses that things are dangerous and their amygdala tends to
take over. And if a child doesn't know how to express how they're feeling, they don't learn to develop
that skill either. And so they have an inability to articulate how they're feeling. There's a medical
terminology called Alexithymia, and that's exactly what that... They can't articulate what they're feeling.
It's absolutely crucial to be able to, because if you can't articulate what you're feeling, then you don't
understand what you're feeling. And then that leads on, as your brain starts to develop it starts to have
a domino effect.
Catherine Oxenberg (00:36:36):
Well, I would say I definitely had the term that you just expressed, the inability to express, articulate
feelings, for sure. And I first heard that term when I read The Body Keeps the Score, and I'd always had a
sense that at a cellular level you remember everything, even pre-verbal. And that book really confirmed
it for me.
Dr. Wayne Kampers (00:36:57):
And that's Bessel van der Kolk book, it's so descriptive and so well written in terms of detailing to us
exactly what happens in the developing brain from the amygdala to the ventral prefrontal cortex and
how crucial the time is in terms of going right back to [inaudible 00:37:25]. And the thing is, it doesn't
actually need to actually be anything major at that stage. I think you had said to me the very first time I
met you that I think we grew up in the Dr. Spock era sort of thing where children were unseen and
Catherine Oxenberg (00:37:49):

Well, yes, and were put to sleep, and were expected to fall asleep crying. But I think that was what Dr.
Spock recommended. That's a whole generation of kids.
Dr. Wayne Kampers (00:38:03):
And the thing is, I suppose that generation as well... And I think at all stages, fortunately we live in a very
informed society now, but I always think at every stage, very often parents are doing the best that they
can at the time. You're a parent and I'm a parent as well, and parents, they're doing their best at the
time. Sometimes they aren't, obviously they're not good parents, but most parents are doing the best
that they can based on the information they have available to them. And I do think in all arenas it's
about educating yourself and about gathering information. And this is no different. And as you said, an
absolutely crucial part about people who are suffering from pain's journeys to recovery is educating
themselves as well about the pain. And of course, as you mentioned, Curable, that does create a great
platform for that. Or any way that a person... for myself, John Sauna's books were absolutely
groundbreaking for me because that's what I had at the time that I struggled with pain.
And in the slides show that I've put together for all the participants, I just put a selection of all of the
books that I've read and there's just a few of them and there's so much art that people can educate
themselves with.
Catherine Oxenberg (00:39:54):
I've definitely read all the books because that helped me tremendously. And through Curable, I also read
Nicole Sachs' book, the Meaning of Truth, and I love her write her writing exercise, her journal speaker is
fantastic. And then I loved Crushing Doubt by Dr. Dan Ratner. And it's to the point that I reached a
plateau with my symptoms and I was really frustrated and I did his workshop and it completely broke
me through the plateau. So what I love is that different teachers offer different perspectives. And one of
the things that he said that was unique was, every time you have an uptick of a symptom, your
symptoms mean something. So everything comes from somewhere. And that was really helpful for me.
It's like, there is so much intelligence in the nervous system that everything is a specific form of
Now, I may not have time to unpack everything because there's a lot going on. And there was a while
where I was having a lot of symptoms and were more, it was almost as if the pattern was having its last
hurrah, and it did get worse before it got better. And it was just one thing morphing into another thing
and it was frustrating. And at that point I also did one-on-one therapy, I did pain reprocessing therapy
with Vanessa Blackstone, who I think is one of the directors at the clinic. And there was so much trauma
coming up for me, I needed one-on-one support for sure. So for me this has been a three-year process
of healing. And I'm at the other end. And I really am interested in figuring out how can one make this
accessible to people who might not be able to take two years off to heal themselves or who might not
have the resources.
How does one democratize this process? Because ultimately it's not that costly because you're doing
most of the work yourself. And I think the hardest thing I found is because I know so many people in my
life who have pain. My mom has sciatica and I browbeat her with mind body stuff. But it's like, you
either get it or you don't want to abandon the old model. And...

Dr. Wayne Kampers (00:42:19):
I think that's true. And I think that education has to come from so many different levels. I think generally
as well, people are generally quite skeptical of accepting that pain can be generated from the mind. And
I think once people actually are able to accept that all pain is in fact generated from the mind in terms of
the way it works. And not until they're in pain or in their chronic pain and it's become a vicious cycle,
most people don't think about these things, but it's those people who are in chronic pain that are not
getting better. I think the medical profession, hopefully with the new definitions of pain, hopefully it'll
start improving. I think there's a long way to go though.
Catherine Oxenberg (00:43:24):
Well, I think if some of it is that people really don't want to get in touch with their repressed rage, that
might be one of the reasons. They would rather go get a cortisone shot. I'll tell you this, it upset things in
my life. I wasn't responding the way people were used to me responding. I was much more assertive. I
was much more holding my boundaries. And I do want to mention this, for me, my whole lifetime, my
body has been a problem. My body has been my adversary, it's always been symptomatic and I've
always resented it. I've really had a hate relationship with my body. It's always giving me problems and
I'm always sick. And now I understand my body as my chief advocate and champion. And there's a book

Dr. Wayne Kampers (00:44:17):

It was talking to you.
Catherine Oxenberg (00:44:20):
It's always talking to me. And it's always upholding boundaries for me where I'm too weak and haven't
learnt to assert myself in a way that is for my best good. My body speaks for my best good. It's my voice.
It speaks for what it wants for me only, it doesn't consider anybody else. And when I really see the value
of that and how my health has improved, but also how my life and my relationships have improved,
even though they went through a rocky patch of people going, who is this person? Now I have so much
more respect in my life, and I feel more potent in everything that I do. So there's so much value in this
process. And when I tell people they have to do the work, not everybody wants to do the work. And you
have to do the work, you have to get to underneath the physical symptom to really understand the root.
And I am all about getting to the root cause. I don't want to be putting out fires, putting out symptoms
for my whole life because it is a lifelong distraction.
And I see it as people age, it's like their lives become their ailments and that's a terrible way to live. And
a lot of people just accept that that's part of the aging process.
Dr. Wayne Kampers (00:45:37):
And I think it's so medicalized as well, isn't it? It's so medicalized, that as you get older that it's part of
life, just that pain will creep in. And unless you've got some degenerative organic condition, that's not
Catherine Oxenberg (00:45:58):
Look, I think you may have mentioned, but one of the studies where they take MRIs of everybody's
spine, one of the arguments I think either by Sarno or somebody was, "Hey, if degeneration meant pain,

then wouldn't every 90-year-old be in excruciating pain?" And light bulbs went off. I'm like, that makes
so much sense, that it has nothing to do with the bulging disc that it has to do... There's something else
going on that is not representative in the body's anomalies. And so it's incredibly hopeful, it's incredibly
mysterious, but it's extraordinary. It really is that...
Dr. Wayne Kampers (00:46:52):
Yeah. And I that you are where you are at on your journey, but it is a lifelong journey. I think that for
anybody that has struggled with chronic pain, one always recognize that there's never room for
complacency. Because if one allows your nervous system to become dysregulated again, then the pain
can come back. And as I said in my talk, we live in a disregulated world. So anybody that suffers with
pain or addiction or has got trauma that needs to be dealt with or has been dealt with that still has
symptoms, there has to be a consistent paying attention to regulating your limbic system. It's an
ongoing process.
Catherine Oxenberg (00:47:58):
The ongoing process is the dialogue between me and my subconscious. If I ignore myself or abandon
myself in some way, my body's going to start to scream. So my responsibility to have a loving
relationship with myself is to be in conversation with myself.
Dr. Wayne Kampers (00:48:14):
So how do you do that on a day-to-day basis?
Catherine Oxenberg (00:48:18):
Well, number one, I have an intentional morning. I think if the whole point of this is to reprogram the
operating system is I need to set my mind a certain way. And I have a series of prayers that I have put
together. And before I get out of bed, I do what I call my prayers, which to me, it's intentional speaking.
And, really makes the difference. And then I'll do some form of meditation and then I'll do some form of
exercise because my body is craving it. And even in the early days when my feet hurt so much, it hurt, I
would be hobbling. I would be having to tell myself, "There's nothing wrong with you, you're not in any
danger. You're not hurting your body by moving." And I built up to three miles a day. I built back my
confidence that I was okay and there was nothing wrong with my body.
So it really has been a process of not buying into the pain. And that's an extraordinary shift. And then
one of the things that I'm not great at, but that I need to do more is these five-minute check-ins because
my personality is I like to power through my day and get everything done, and then I overtax myself and
then I'm exhausted. But if I give myself check-ins once an hour and just connect and do breath work for
about five minutes, it makes a difference. Learning to pace myself as a way to regulate my nervous
system is actually probably one of the most powerful things that I need to do more.
Dr. Wayne Kampers (00:50:03):
Catherine, I'm so glad you said it because the absolute key to what you have said is, as I said in my talk,
the most important thing, the greatest thing, the most powerful thing that one does in terms of
recovery is to be in control of your thoughts. And starting your day off with intentional thinking is singly
the greatest power that you give yourself because you're in charge, you're in control of the way you
think. And most people start their day in an unintentional thinking way by going on their mobile phones

or watching the news and then think about what that does to an already dysregulated nervous system.
And so intentional is exactly the way it has to be. So everything has to be done intentionally, and it's
intentionally putting your prefrontal cortex, your smart thinking, logical, rational brain in charge, running
the show.
And the only way you do that is by intentional thinking. If you think about the principles of CBT,
cognitive behavioral therapy, where people have distorted thinking, cognitive distortions and those
cognitive distortions are what are running their anxiety and how they behave. So CBT is based on
cognitive restructuring, which is looking at those cognitive distortions and doing a process called
cognitive restructuring, which is great. The problem is people do not practice CBT in day-to-day life. Why
would they? On day-to-day basis, people, if they have an argument with their partner, with their kids,
they don't go into other room and think, okay, what's cognitive distortion was that I need to address? Et
cetera. It's not human nature to do that. People don't generally use CBT principles on a day-to-day basis.
But intentional thinking is in fact a very powerful thing to do because what you're actually doing is you
are deciding what you think, you are putting your own thoughts in charge.
And intentional thinking is thinking you can control, with unintentional thinking is thinking that you can't
control. And of course, unintentional thinking leads to the emotions that one expresses and the
behavior that results as those emotions. Whereas intentional thinking has a really positive way of
deciding exactly how you start the day. So that is probably singly the most powerful thing that you are
doing. You are intentionally starting your day in a way that then will govern your beliefs and govern your
habits and govern your patterns of thinking. And your patterns of thinking are so positive about yourself
and so positive about keeping the momentum going. So intentional thinking is fantastic.
Catherine Oxenberg (00:53:27):
Well, I'll say a couple other things too is that I think I was so terrified of intense negative emotions
before that if anything escalated to a certain amount, I would dissociate, I would literally go offline and I
would lose access to my prefrontal cortex because I was so afraid. I think parts of my brain shut down.
And now that I'm more fluent with my anger, especially, I stay present in situations that before I might
have shut down. That's a huge change in personality. So when you talk about, couldn't even use CBT
before because there was nothing in my prefrontal cortex I had access to, was all limbic and all
amygdala. I had just gone into severe flight and parts of me shut down. So I think also tuning in and
being really honest about how things really affect me and learning to recognize my anger immediately,
whether it's clenching my jaw, whether it's suddenly I find myself clenching my fist.
It's like how my body... And how fast I go to anger because that child was really wounded and that child
is very protective. And the more that I'm honest about how angry things make me without it making me
a dangerous person or a bad person. The more humor I have about myself. Like, I'm really human, I'm a
really angry human. There is a five-year old raging tantruming child inside me. And that's part of being a
human being, and not thinking that part of me doesn't dominate my life. But as long as I'm honest that
she's there and it's about integrating her for me in a loving way where I don't censor her, for me, I don't
vomit her all over the place, I don't have as many symptoms. That's really key for me. The more I admit
how things really impact.
Dr. Wayne Kampers (00:55:38):

And I think as part of that process, what you are saying is that you've taught yourself how to sit with
uncomfortable emotions, because I think we also live in a dopamine driven society where there's a drive
just to feel good and everything is about pleasure and everything is about feeling great, et cetera. And I
think people, as a society, we don't like to feel bad, we don't like uncomfortable feelings. And life is full
of uncomfortable situations and uncomfortable emotions and uncomfortable feelings, which are
normal. Feelings are normal and you should be able to experience every feeling. It's really about
whether or not that feeling is proportionate and relevant to the situation. But all feelings are actually
normal. So one has to learn to sit with uncomfortable feelings otherwise one will not be able to process
emotions. And processing of emotions is very, very important. And same ways as you went through the
pain reprocessing therapy, processing emotions is a very key part of anybody's recovery from pain.
Catherine Oxenberg (00:57:06):
I'll tell you this, accessing the anger, which is like a volcano, I found that there was a debris field of
trauma that I needed to blast through in order for things to start to make sense. And when something
would trigger me, I would literally ask myself, okay, when's the first time I remember feeling this? And
that's very intensive therapy I was doing all the time with myself and not everybody has to go there. But
it really helped me because there was always a memory of a similar situation that my nervous system
was on high alert because this was too familiar and it felt it needed to protect me. And the minute that I
resolved the original situation as a child and showed up as the adult, my future self, for that part of me
that was frozen through trauma, then that was another way of integrating those lost parts of my own
psyche. And that's been incredibly powerful. It's time-consuming, but it's been worthwhile.
Dr. Wayne Kampers (00:58:02):
So it's been an incredible journey for you so far. And how's India?
Catherine Oxenberg (00:58:14):
Well, India is really in an extraordinary place. And for her PTSD, because she had quite a lot, ketamine
therapy is key for her as far as helping regulate her. And she's going to be part... My nonprofit is hosting
and sponsoring the first pilot program for ketamine assisted psychotherapy with a group of clinicians.
And it's a 10-day residential experience that we are customizing for sexual assault survivors. And India is

going to-
Dr. Wayne Kampers (00:58:52):

Oh, that's good. That'll give so many people hope and treatment. That's amazing. Now, on a day-to-day
basis, we were talking about your self-care routine, do you still use Curable? What other things do you
use to calm and regulate your nervous system?
Catherine Oxenberg (00:59:20):
Movement. I do some form of exercise every day. Yoga is very, very helpful. I know that Bessel van der
Kolk talks about a concept called interception, which is amazing, the ability to just connect deeply within
and be still. Just aside, I remember in the moment of great pain, lying on the floor feeling like I was going
through a metamorphosis from cocoon. Because I really did feel like I was dying. And when you're in
that much pain, and I don't know if other pain sufferers feel like that, you really feel like you're going
through a death. And there was a moment where I was meditating, when I was like, I could feel a blue
crystalline center. And I'm like, "Oh my god, there's the butterfly!" So I know it's a little bit metaphysical,
but I really did have that. It was almost as if the pain took me through dying to one way of living into

being born into a different way of life, which is more the butterfly. But as far as my daily practice I read, I
find that reading material that reinforces the truth of my beliefs is really great.
Dr. Wayne Kampers (01:00:39):
And what about a nutritional approach?
Catherine Oxenberg (01:00:43):
So I was bulimic for 20 years. I really believe that one can completely recover from an eating disorder.
Beyond 12 steps I really do not have any issues with food at all. I do believe that your concept of having
an anti-inflammatory diet, as long as I'm having a histamine reaction, it means that my immune system
is still being overstimulated because I still have some trauma. Ultimately, I think I would get to the place
where I could eat no matter what and it wouldn't trigger me. So maybe gluten still triggers me a little
bit. I'm very clean with my eating. I do that because I feel better. So very little refined sugar. I don't drink
coffee, but I drink green tea, barely any alcohol.
Dr. Wayne Kampers (01:01:39):
So all of these things really are actually your neuroplastic chandelier is shining bright right now.
Catherine Oxenberg (01:01:48):

But I will tell you this-
Dr. Wayne Kampers (01:01:53):

I'm so sorry to interrupt you. I just want to say, while I'm thinking about it, it's interesting what you said
about bulimia because I think another thing that I think is always really, really important to ask the
question, and that is when anybody is in the context of, or has had trauma, if anybody has chronic pain,
just by reframing the eating and saying, could this be disordered eating as a result of...? Rather than
saying this is an eating disorder. Because so often actually the eating is a behavior. In some ways, very
often the addiction is a behavior. You need to think, why is this disorder...? Try and find the emotion.
Let's detect it and go look for the emotional pain. So I think disordered eating, I think a lot of people do
get diagnosed eating disorders and in fact have disordered eating where the trauma hasn't been
identified and processed.
Catherine Oxenberg (01:02:50):
I think you're 100% correct and I would think anybody who would need to vomit is trying to purge rage,
because it's such a violent act, it is such a cry for help and it is the body acting out of trauma on a daily
basis for me. So I have a lot of compassion for myself. It was a really very, very painful experience to be
locked into for 20 years from the age of 16.
Dr. Wayne Kampers (01:03:21):
It sounds like as part of your journey is that it's almost like your body, it almost had to shut down in
order to reboot itself. It reached a point where I think your whole system just dissociated from itself and
just went into complete shutdown in order to be able to reboot and reset itself.
Catherine Oxenberg (01:03:50):

I agree. And I just was distracted because I noticed my button was open and I'm hoping that I haven't

been flashing everybody the entire-
Dr. Wayne Kampers (01:03:56):

No, you can't. Well, I can't see anything, so...
Catherine Oxenberg (01:04:00):
I'm like... Sorry.
Dr. Wayne Kampers (01:04:05):
Yeah. Well, hearing your story and seeing how all of the neuroplastic clues, every single one of them was
there. What about your personality? If you think about neuroplastic personality traits, where would you
be on that?
Catherine Oxenberg (01:04:32):
Poster child. When I read Sauna's book and he goes, A type personality, goodist, perfectionist, which
perfectionism is a trauma response. It's like I have so much compassion for the perfectionist part of me.
It's like I'm terrified of getting anything wrong because I'm terrified of being punished. So, people
pleaser, every box, I check, conscientious, all the things. And now, to be able to actually benefit from all
the good qualities of my personality without the violent, critical, all of the negative sides too, very, very
hard on myself, every single one.
Dr. Wayne Kampers (01:05:16):
And sometimes, in my experience of treating people for pain, it is the very deeply ingrained personality
characteristics that can sometimes be a little bit of a hindrance to their recovery, if they are that
ingrained that they're hard to shift. And sometimes people's recovery from pain can be limited by them
not identifying and acknowledge and accepting that it's not that you have to change your personality,
it's that one has to identify and recognize that some of the personality characteristics are not serving
you well and that you need to just change the way that you think in that respect. Because those can very
often be barriers to people recovering, combined with, and obviously just listening to the way you talk
have this in abundance, is where people sometimes don't have cognitive flexibility. Having cognitive
flexibility is absolutely important, is crucial as well.
If a person does have a very rigid approach to things and doesn't have that cognitive flexibility and they
have such deeply ingrained personality characteristics that it's very hard for them to accept change or
accept that things could be different or that there's such an enormous investment in their pain being
structured. It's often said, I've heard people say, as long as you have a little bit of belief that you're going
to get better, it's enough. I often think sometimes I have to ask people to completely suspend their
disbelief because by completely suspending their disbelief, you sometimes feel there's possibly a better
chance of them recovering. Because often it's the belief in structural causes because doctors have
reinforced that and because of the investigations. And very often I see it with back pain because a scan
has been put up and people have been shown your back's a mess and, et cetera. That's what happened
when my MRI was put up.

The look on the doctor's face was like, then they put it up and say, "This is bad!" There's some things you
don't want to hear from a doctor. You don't want to hear a surgeon say, "Oops!" And you don't want to
hear a doctor put up something and say, "This is bad! Or in your case, "It's incurable!"
Catherine Oxenberg (01:08:04):
But it's harder for you to then come back from the doctor's prognosis. It's like you have to climb Everest.
Once a doctor's established a baseline of reality, to fight against, that takes a lot of fortitude. It just
does. And generally you're beaten down by your own pain. And I think pain for me beat me down to the
point where I had to be willing to change no matter what because I didn't want to live like that. So pain
can bring you to your knees for sure and make you willing. And that some of the rigidity that you're
talking about comes from trauma having locked you into certain circuits that you then can't get out of.
And I certainly know what it's like to be in one of those rigid ruts. And I think whatever we can do,
whether it's psychedelics, anything to encourage moving out of the default mode network to give

yourself some more flexibility mentally that you can make new neural connections is part of-
Dr. Wayne Kampers (01:09:04):

And sometimes people do need to be able to access parts of their brains that are shut down or that they
are disconnected from. And we do see that in some of the psychedelic treatments of PTSD certainly is
that people are able to connect with their trauma. And it's hopefully something that will be more
available and be more accessible to the world, given how many people worldwide are suffering with
chronic pain, and what is available at the moment in order to help them. But there are certain things
that everybody can access. But I think the greatest thing that people can access is knowledge and
understanding of why people have chronic pain in the first place. And then this kind of conference
wouldn't have been happening years ago.
I mean, I think I attended my first painting conference, and then probably going on before there, but the
first pain conference in the UK probably back in about 2015. And now, if you see what's going on just in
the psychiatric world in terms of trauma conferences and pain conferences and addiction conferences,
mind, body and East meets West, I think that people are certainly showing a whole lot more interest in
the connection between the mind and the body. And one could argue even that there shouldn't even be
this disconnection, that it's all just one you're one organism, and the fact that we're even talking about a
mind body connection or disconnection in and of itself is, well, you just... It's interesting.
Catherine Oxenberg (01:11:11):
I agree.
Dr. Wayne Kampers (01:11:18):
What advice would you give to somebody who was in chronic pain that didn't immediately have access
to having ketamine treatment? Because ketamine was obviously transformational for you, but all of the
other stuff that you've done as well, I think is transformational as well. And your intentional thinking,
how you look after your inner child, how you know how to access your subconscious mind, you have an
anti-inflammatory approach to your lifestyle and to your nutrition, to exercise. What advice would you
give to somebody who was struggling that didn't have access to psychedelics, but they had access to
everything else? What would your advice be in terms of a starting point for people like that?

Catherine Oxenberg (01:12:30):
Well, I'll give you a little story that happened yesterday. I went to get a facial and I was thinking about
this talk today. And I put my hand on my heart and actually, I was feeling the pain of the 50 million
chronic pain sufferers in this country. And my facialist said, "Are you okay?" And I said, "Yes, I'm very
okay. I'm just feeling something I'm going to talk about." And she asked me what it was and I said I'm
going to be talking about chronic pain. She said, "Well, does migraine qualify as chronic pain?" And I
said, "Yes, it does." She said, "I suffer terribly from migraines." And I said, "There could be an emotional
component to your migraine, somebody that you might be very angry at." And she said, "Well, my
mother." It was so immediate that she immediately knew that her mom was her migraines. And I
immediately sent her to Curable, because to me it's the most simple. It's where she's going to get all the
knowledge, from there basically all the expert... That's, to me, one-stop shop.
Dr. Wayne Kampers (01:13:39):
No, I think that it's a really good recommendation. And that's exactly what I say to people as well is
always access what you can in the first instance, because it may well be that that is transformational or
even if this other stuff you need and you can build on from that. So I do think that is an excellent
resource for people to access. Absolutely. Well, I think we're almost there, aren't we?
Catherine Oxenberg (01:14:15):
I think we are.
Dr. Wayne Kampers (01:14:16):
Is there anything that you you'd like to ask me?
Catherine Oxenberg (01:14:21):
Oh gosh. Well, what's it looking like in your part of the world as far as what you teach becoming more
Dr. Wayne Kampers (01:14:37):
It's interesting because most of my work colleagues who are all psychiatrists, when I told them that I
was doing this and I was going to be talking about chronic pain, many of them said, "Oh, it's so nice to
know somebody who's an expert on chronic pain." And I said to them that everybody should be, and all
doctors should be an expert on chronic pain. I only became informed and have educated myself about
chronic pain because of my own journey. But everybody should be an expert on it or at least educate
themselves about it and not have to say, "Oh, we send the pain guide to Wayne." Any doctor I think
should have this on their radars. I still think there's a lot of education and a lot of work that needs to be
done, but there is a very proactive conscience in this country about mind body, about pain, and it's
getting better. It's nowhere near what it could be, and it's nowhere near what it is in the states.
But certainly I think having opportunities like this certainly do create that platform to be able to share
ideas and to share and to share knowledge. And I think nowadays as well, I think we learned this from
COVID, is that with Zoom and with platforms like this, the world can communicate.
Catherine Oxenberg (01:16:32):

Yeah, it's really extraordinary. Well, I hope that there's more of a convergence between the ketamine
psychedelic world and the mind body world so that these therapeutics can function together.
Dr. Wayne Kampers (01:16:45):
I think so. I think they will. I think that if you see the way psychiatry is going and in terms of just in my
own practice, and I mentioned this in my talk in terms of the fact that new medications are not being
made, and so the world is looking now towards psychedelics. And I think that'll be a very key part of
things moving forward, as will micro-dosing. But I think on a practical level, in terms of the vast measure
of people, without a doubt, the key starts with education and in getting informed about, this is what's
going on, this is what's going on in your body, this is why this is happening. Rather than the end game
where people are absolutely crippled by their pain or by these symptoms. It'll be so much better if there
was more education to prevent a lot of this happening. But that's huge, huge task of its own. But it's
always a good place to start.
Catherine Oxenberg (01:18:00):
Well, my wish is absolutely to end needless suffering and there is too much needless suffering and

Dr. Wayne Kampers (01:18:09):

No, that is true. And of course, we're also faced with a big opioid problem as well, and all of the trouble
that causes in people's lives and all of the difficulties they experience from that, it's a global problem in
some countries much worse than others in terms of their opioid problems.
Catherine Oxenberg (01:18:33):
I want to add to that, that I just recently read that in the United States, supposedly in hospitals, they're
only going to prescribe opioids for 48 hours and then they're going to give patients ketamine as a
substitute. And I actually think that until we find something better, that's a really good, safe alternative.
Dr. Wayne Kampers (01:18:51):
Yeah, that's very interesting. So I think the psychiatric world is very much opening their minds to the fact
that we need to explore what previously has been uncharted territory in terms of helping people and
getting people better, because certainly with respect to chronic pain, we haven't been doing very well.
Catherine Oxenberg (01:19:22):
I agree.
Dr. Wayne Kampers (01:19:23):
No, have not been. Catherine, it's been an absolute pleasure to have you interviewed. And so thank you
so much for being so open, so honest. I think that anybody that is watching this would've learned so
much about everything that you've said, and very, very enlightening. But for me, the most important
thing is it's just so wonderful to see that you're in such a good place after having been in what must have
been... You can't even begin to imagine what that must have been like.
Catherine Oxenberg (01:20:02):
Thank you. I feel very blessed.

Dr. Wayne Kampers (01:20:05):
Yeah. Okay, great. Thank you so much.
Catherine Oxenberg (01:20:08):
Dr. Wayne Kampers (01:20:08):

Dr. Wayne Kampers (00:00:00):
So it's really, really a great pleasure to welcome both Gita and Licia, who are going to talk us really
through the journey of ketamine treatment. I think that it's going to be really fascinating to hear what
they have to say about this really in the treatment of what they do in the terms of how ketamine helps
their patients from a clinical perspective, and really how these guided journeys for pain relief are
facilitated via this. I myself am fascinated to hear about their use and experience of ketamine. So I'm
going to hand over to both of you and thank you both so much for sharing your knowledge with me and
with the audience.
Licia Sky (00:01:00):
Thanks so much, Dr. Wayne Kampers. Hi, Gita.
Gita Vaid (00:01:03):
Hi, Licia. It's a pleasure to be here in conversation with you.
Licia Sky (00:01:07):
I'm so delighted to be with you too. So I guess I'll introduce myself a little bit and hope you'll introduce
yourself a little bit too. I come from the bodywork world. I've been a bodyworker for, oh, 35 plus years,
and I'm a singer/songwriter. I've learned over time that incorporating vocalizing work with touch and
breath was very, very helpful in helping people release physical pain. So there's always a way that, and
in vocalizing to release pain, I found that there was always an emotional release that happen with
vocalizing and that made me understand the connection between emotional pain and physical pain.
I came to do ketamine training to learn how to be a guide or a sitter for people who are having ketamine
journeys, and Gita was one of my first teachers in this regard, and she remains one of the most brilliant
people that I work with. I have great respect and gratitude for my work with you. So Gita, please.
Gita Vaid (00:02:27):
Well, thank you, Licia. I love that you think of me as your teacher because I feel you are practically the
most creative individual I've met who walks the planet. I definitely hold in such high regard because you
are my teacher. My background is quite, I think, in some ways complimentary. I'm a psychiatrist and a
psychoanalyst in training. I've been in practice for about 30 years, and about 10 years ago became
interested in the world of psychedelic psychotherapy and was so surprised at the access that one can
have with psychedelic medicines that I really dove in very quickly to explore how it can be utilized for
I'm an expert in ketamine-assisted psychotherapy, which is where our paths crossed. I would say the
biggest thing that has shifted in my work with psychedelic medicines and specifically ketamine, I think, is
how my whole career was thinking about mental suffering and mental pain and anguish states held in
the mind, but as also I've gotten older, I have recognized in my practice that the mind and the body are
not separate and the disease state that we all manifest as we get older, there's such a poetry. It's almost
like the somatic equivalent of what is being held in the mind.

Certainly, ketamine and other medicines allowed me and allow all of us, I think, to almost peep behind
the scenes of how on a structural level the mind and the body and the emotional body and the nervous
system are actually all one, which, of course, gets into the train and systems that Licia has already
known and recognized for decades.
Licia Sky (00:04:08):
Thank you. So we work well together. Someone mentioned when we were prepping that in the United
Kingdom, there's a reputation of ketamine as being a party drug, and so people don't know how it can
be used therapeutically and how to trust it in that regard. You being a psychiatrist and an analyst
bringing this to the world, I wonder if you would speak a little to that.
Gita Vaid (00:04:44):
I'd love to talk about it because I do think ketamine has a bad reputation even within psychedelic
medicines. I think it's seen as the, in a way, the inferior psychedelic, the one that's the standard until the
good ones come around. I think in some parts of the world, it also has the further stigma of being
associated with addiction or party drug. I think even a particularly toxic party drug is its reputation
because when people are using it at music festivals or in a party scene, it's a very unfavorable
presentation. Having people slumped over on the floor, it looks kind of very unappealing. It doesn't
really showcase its beauty as a medicine. So it does have a bad reputation. People also associate it as a
horse tranquilizer.
I feel like there's a lot of fear and misinformation about ketamine, but ketamine actually is an incredibly
safe medicine. It's been around for a really long time. It was developed as an anesthetic. Interestingly, it
was developed as an alternative to PCP, which had a lot of side effects. Ketamine was developed initially
as an anesthetic. It was found to be really effective because it didn't cause respiratory depression or
cardiac symptoms, which basically meant it was super safe, and that even soldiers could use it on the
battlefield because you didn't need all of that monitoring.
So it's been around for a really long time, but it's also a dissociative anesthetic in that you actually can
have really a lot of access to not only dissociating from different parts of the psyche, but a lot of access
to different states of consciousness, which was initially considered an emergent delirium is what they
called it, but psychonauts get very interested in this as a way of exploring consciousness.
It's really only since the 2000s that it was recognized by the Yale group to have a very rapid
antidepressant effect. So it came into psychiatry's attention because it's a fast-acting antidepressant
with a very different way of working compared to all the medicines we have available in psychiatry. It's
also very rapidly anti-suicidal. So that started a whole other research and applications.
I think the most important part from what we're talking about today is as a psychedelic agent for
psychedelic assisted psychotherapy, when dosed correctly, and I think the dosing is key here, it can
really actually open us into different states of consciousness and non-ordinary state where one has a
chance to both have the mind and the brain primed for really deep healing work.
Licia Sky (00:07:24):

Yeah. I have so many questions there, but I will say that because set and setting is such an important
part of how I learned to sit with people who are receiving ketamine is in medicine, I can't imagine doing
it without great care. I can't imagine doing it in a public place with people who weren't aware of what
was happening for you as a person who is receiving. Also, to set and setting, I know there are clinics,
especially in the United States, where people receive it IV, supposedly, for antidepressant, but they're
left alone. There's no preparation and there's no integration afterwards, and that's been of great
concern to me because you call it, you say it has an anti-suicidal effect, and yet I know that there are
people who've received high doses without any preparation, without any integration who actually did
not do well at all, and there are suicides that I've heard of with ketamine as well.
Depression is such a massive thing to take on, and it is so profoundly painful that I think, and you're such
a master in dosing, and I know some people think just blast them with a higher dose and that's going to
help things.
Gita Vaid (00:08:59):
I'd love to pause and maybe dive into a little bit about what you said, Licia, because the concept of set
and setting is such an interesting one, isn't it? I mean, I think that you're absolutely right. It's a powerful
antidepressant, but what's unique about psychedelic medicines, and I think ketamine, it falls into that
family, is that the mindset entering into the experience, what you're holding in your mind ahead of time
or what your preparation is or what your fantasies about, what it's going to provide for you both
positive and negative can affect the subjective experience as well as the context.
That's radical because if I prescribe any other antidepressant, it doesn't matter where someone is taking
Prozac, it's going to affect the person in very much the same way regardless of what they feel about it or
regardless of if they're in nature or if they're in a locked ward, and that's not true of ketamine. So could
you say a little bit more about that because I think you are bringing up such valuable points in terms of
what that means?
Licia Sky (00:10:02):
Well, the trainings that I learned in, there was great care taken about set and setting, about being in a
calm, safe place, knowing the people around you, great care to establish a relationship, a listening
relationship with the person you're sitting with and setting intentions, asking the person, "Well, how
often, if ever, have you had a psychedelic experience? What are your things that you're anticipating?
What are you having reservations about?" There's a real intake process that I think is a very, very
important part of even beginning to set the stage for what you're going to experience, and as much
physical comfort as possible, and an experience of settling and listening, which I don't think happens in a
medicalized setting. I don't think there's enough time, and I don't think there's often the interest in that.
Gita Vaid (00:11:15):
I completely agree with you, and I think what you're illustrating so beautifully in your description, Licia,
is how ketamine can be so beautiful to open up a process, a neuroplastic state in the mind and the
motions so that it sets a field that can be really leveraged, and then the field isn't the medicine itself, it's
the whole context, the situation, even the atmosphere of the environment and room, the container
where the treatment is going to happen, the container within the self, how one is prepared in their mind
and body entering into the experience, the container in the relationship, the person who's working with
you, their attitude, their mindset, their invitation. These are all different elements, the music in the

room, the chaos in the room or the calm in the room or the beauty in the room. All of these elements
suddenly become healing agents, which are not just ketamine as a molecule or a drug of action.
Licia Sky (00:12:14):
I think that whoever is being present to guide the experience, the attitude really has to be one of
preparing a person to meet what's inside themselves. In medicine, it's like you take the pill and you're
going to escape whatever your symptoms are. They're going to magically dissolve or you're going to be
liberated somehow. That mindset is almost like trying to bypass something that you have to be present
One thing that I noticed in the first training where I was being taught was how many people seemed to
need extremely high doses in order to even notice what was happening. As somebody who practice this
somatic awareness, I needed just a tiny, tiny bit in order to have a very, very huge expansive psychedelic
experience with this medicine as part of the training, learning to experience the effects and being able
to know what someone else might expect to have, but my tiny, tiny dose me going, "Oh, my gosh! How
could anybody possibly need more?" Then guiding embodied awareness and having somebody come up
to me who'd had a dose that was 10 times what I had taken saying, "Maybe I don't need a higher dose.
Maybe I need what you were doing," was what moved me to say, "Hey, maybe I can add this to the
Gita Vaid (00:14:03):
I would say the trainings that we're talking about at the Ketamine Training Center, and it's a really

wonderful experiential way of learning about how to work with ketamine and become a ketamine-
assisted psychotherapist. Licia participated in this, and I'd love for her to share, if she's comfortable, a

bit about her personal subjective experience when she did touch on it but go a bit deeper into it. I think
we were very quickly able to see how much we needed Licia to come join the trainings because as you're
pointing out.
When you enter into this whole relationship with yourself, sometimes none of us have actually
experienced tools with which to listen, tools with which to actually receive the medicine or become
curious. So if that's not there, there is a natural tendency, perhaps even for both the prescriber and the
patient to say, "Well, why don't I give myself more?" or, "Why don't I take more?" Then of course, you
get swept away with the medicine, perhaps even beyond yourself to have a very big experience, but of
course, big is not always better. Also, to have a big experience beyond yourself can be quite powerful,
but actually, you've left yourself behind.
So we very quickly invited Licia to join the faculty, and I'd love for you to share about your own
experience, but also about what you bring to the trainings because it's so invaluable. I think it's really
allowed people to have such richer, fuller experiences on lower doses, not on higher doses.
Licia Sky (00:15:31):
Thank you so much. I'll say that what I found for myself with a lower dose, and I'm so sensitive that I
could only do lower doses, was that I experienced a heightened awareness of my physical sensations,
heightened awareness of how my muscles felt, how my nervous system felt going through my whole
body, heightened awareness of my breath and my voice and my ability to vocalize and a sense of the

vibrational effect of my voice on my body, and the vibrational effect of the voice of the person who sat
with me.
So somatic sensations, even without medicine, are the thing that I focus on. I do it because the people
that I work with, most of them have severe trauma experiences in their life, especially early in their life.
We all develop ways of pushing our feelings down and being in our heads and focusing forward. You
have to do that to get by in life in some ways, but when there are really big feelings that are being
locked down, they're very hard to access.
Even though they're hard to access with our conscious awareness, they're still having a huge impact on
us physically. They have a huge impact on what we orient towards, what we are attracted to, what we
move away from, what we get upset about, and generally how we see the world. When people are living
with the effects of severe stress and severe trauma, accessing what's in our subconscious, accessing
what's locked off on a regular basis to us is where all the gold is. That's where the healing work happens.
What I've found with psychedelics is that it does make it possible to lift the lid off and access more, but
if you blast too far out there, you don't have a way to bring back the insights that you might have from
opening that box.
So what I try and front load in the trainings that we do is expanded awareness without the medicine first
because that can almost be like a psychedelic journey. Then when you take a smaller dose, a smaller
dose than normal, you might actually find that you can stay in a place where you can notice your body
differently. Our emotions are a big part of our physical experience. Our emotions are a big part of telling
us how safe we are, telling us what we can relate to with each other, telling us who and how we can
relate, and telling us how we can have a relationship with ourselves, which many people who've been
traumatized, that's the thing they lack most is a relationship with their own self. Does that explain
enough? Maybe that's a good jumping off point.
Gita Vaid (00:19:12):
I think you explained beautifully, and I think that you capture twofold how you'll develop really a
person's interest in developing a vocabulary with being able to access themselves and tools with which
to listen to themselves. Actually, the beginning training when Licia does this work, sometimes it's the
most challenging and the most growthful aspect of the whole training, which actually sets people up to
have really ways of accessing this state and navigating the experience.
The other thing you touch on so beautifully with ketamine, and I think this is one of the things that I
really value about ketamine, which is unique to it, is that it really allows people to drop into, at the right
doses, into almost a place of safety in the mind, in the body, in the nervous system. So you actually can
almost, to me, I've had people say it's dissociative, but I almost feel it allows you to distill out the
different components so you can have an awareness and can watch the chatter of your mind. You can
watch the feelings that are coming up for you. You can even notice any physical sensations that are
happening, and I think there's something so unique.

Of course, you can't see that even if it's happening unless you have lenses with which to know how to
look. So that's where the medicine and the dosing is really important, but also having a way of actually
even knowing how to see, which I think Licia provides so beautifully in exercises. I'd love for people to
hear what the exercises are because I'd never experienced such a thing. When I was doing them, I was
just really surprised, and they were so playful and also challenging and interesting and really actually not
only helped me develop some of the tools, but also had a huge impact on creating the group field.
Licia Sky (00:21:04):
Yeah. It's really starting with an invitation to be curious and an intention to go much, much slower than
normal in paying attention to things. So if we're trying to notice what's happening under the surface of
things, finding our way into our subconscious awareness, then it's important to go slow enough that
what might pass by fleeting in a few seconds, we can stay with for moments and minutes and listen and
ask, "What's happening for me now?"
I try and start with physiological things. It's a question of, "How does your bum feel in the chair? What
kind of balance do you have? What's happening in your body when you've noticed this sensation of
contact? Are you able to notice the sensation of your bum in the chair of being held and supported and
having the weight of your body and the gravity that your body feels? How does that feel? Are you able
to find a way to tell yourself what you're feeling, note for yourself what you're feeling?"
So that's the invitation is, how do you listen to your own body? How do you listen to the experience of
breathing, say? I always use my own body as the map. I couldn't read off a menu and say, "It wouldn't
be the same thing. It's actually doing it myself in realtime with you." So if I'm inviting you to pay
attention to your breath, then I'm listening to my own breath. The questions that I ask will be from my
experience of, "Well, am I breathing shallowly? Am I breathing deeply? How are you breathing now? Is
there anything that you could do with your posture to shift how you're breathing? Would you like to
take a deeper breath? What would that be like? Can you feel your ribs expanding? Can you feel your
diaphragm expanding and contracting? Can you hear the sound of your breath as it moves through your
sinuses in the back of your throat?"
So there are many, many delicate, delicate, nuanced moments of questioning about your body's
experience. It's a practice for me, and many people who are experienced in mindfulness meditation will
find it familiar, but people who aren't practiced in meditation, especially people who've had a lot of
trauma, can have a lot of difficulty with staying present in that way with their bodies. A lot of agitation
can come up, a lot of irritation or frustration or boredom, it can be labeled boredom, but that
discomfort, being able to stay comfortable and curious even if something doesn't feel comfortable is a
really important place to start from. Especially with a psychedelic experience, there can be great
discomfort in letting go of the known and trusting that you're going to be okay moving into another
state of mind. So going there slowly without the medicine first, it's almost like training wheels. It's like
being able to feel the wind under your wings before you take off.
Gita Vaid (00:24:50):
Absolutely. I love that you focus on almost developing these capacities because so much I feel about
healing that one can access in psychedelic space is almost growing our containers to hold the pain, not
necessarily working it out or resolving it, processing. Maybe that'll happen as an epiphenomena, but I

think the main thing is actually us being able to grow ourselves to regulate better, to have a capacity, to
hold feeling states that perhaps were too dangerous or too overwhelming for an immature mind but
early life stages or how much effort is spent suppressing feelings or not being able to roll through the
ups and downs of life and to be able to expand ourselves to hold and not have to work so hard to be in a
management state.
The other thing that I think you really touch on is when I started working with psychedelic medicines, I
was just amazed at how, I mean, I knew already from my work about the poetry of the mind, but I had
no idea how all that poetry is mapped out in our bodies in the most extraordinary way. I think this gets
into pain as well. You really have such knowledge in such a way of inviting people to listen and stand in
awe of how much of that poetry lives in a very active state in our bodies all the time, and is therefore
the appreciation if one can just tap into it even without medicines, even to notice one exercise,
closeness, distance. It's so beautiful. I'd love to hear you share that with our audience.
Licia Sky (00:26:33):
About closeness and proximity and orientation?
Gita Vaid (00:26:36):
Yes, absolutely.
Licia Sky (00:26:39):
Yeah. So we start with paying attention to our bodies in an inward state, and then we start to listen to
the environment that we're in and then invite our sight in. So it's multisensory. It's auditory, it's visual,
it's contact, weight, balance. As we orient and see around us, we're noticing what we're attracted to,
noticing what we find attractive and noticing what we are repelled from or don't like, and noticing what
it's like to come closer to objects that we like, and then noticing what our body responses are. What
does my breath do if I'm uncomfortable?
I bring in a lot of theater exercises. So the first theater exercise is what we call milling and seeding.
Milling is wandering about, milling about, wandering the space, and even if it's a space that you've lived
in all your life, when you wander about with new eyes, you can see things differently. You can see what
you take for granted and habitually disregard. You can take in the familiar things, maybe even beautiful
things that you haven't had the time to notice and spend time with in a meaningful way that affect you
positively, that you haven't had the psychic room to take in and allow to affect you in a positive way
overall. You might notice the dust balls in the corner that you habitually avoid.
So it's noticing our habits of attention, but then also in milling about in a group of people, it's noticing,
"What does it feel like in my body, this body that I've already been paying attention to in stillness and
paying attention to inwardly, what does my body feel like when I'm in a room with other people, people
that I may know or people who are strangers? How close or far away am I from those people, and how
does my body respond with closeness or distance? How does my body respond? How does my breath
respond with closeness or distance or with eye contact or not eye contact?"

This is information gathering for people who are going to be guides to understand the level of a
attunement, non-verbal attunement. Most people who are journeying don't have many words. So how
do you pay attention? How do you listen to an experience that someone else is having, and how does
your body cue you in to what's happening between the two of you at the same time? That's before we
take any medicine.
Gita Vaid (00:29:42):
I feel like you are such a psychedelic molecule yourself because you really have this incredible gift of
inviting people to almost appreciate in this very nuanced way experientially how they're constructing
their inner world or the world they live in, and also how they create their outer world in what they see.
It's so powerful in a group to have that experience where you can actually have a realtime experience of
how different the world we all create in a group is and how unique our own nervous systems are and
sensory access we have. Some people are preferentially very visual and other people barely notice the
room. So it's really beautiful to start off with those exercises to open up that whole discourse, really. Of
course, so important to learn how to be a facilitator, but navigation tips of how to even notice where
you start off at baseline, let alone when you start authoring that. It's profound.
Licia Sky (00:30:47):
It's very important to notice your emotional state. Alexithymia is a real thing. I think that we even
practice it. That's that dissociative state where you don't really know how you feel, and if you don't
really know how you feel, I don't think that's a great place to take off from. We all have these internal
maps of how we're relating to the world, and these experiences, it's opening and unfolding the map
before the journey starts. It doesn't even have to do with where you're ultimately going to go, but it sets
a landscape for you.
Gita Vaid (00:31:33):
Absolutely, and so much, I think, actually has to do with how disconnected we are to start off with. I
mean, I think we have such a loneliness pandemic, and so much of our emotional dysregulation and our
emotional pain as well as physical pain stems from these disconnections. I was just reading this study,
which is this Harvard study on happiness and how much the main indicator that they felt mattered for
happiness was connection or how much loneliness. Many talk about loneliness, "Well, let's just have you
be around more people," because some of the loneliest people, they comment in this article in the
study, are people who live within families. It's so much an interior experience. So of course, being alone
in the world versus even being in a family may not actually tell you much about how lonely or
disconnected a person is. Of course, I think how can we connect with another person if we're all
disconnected ourselves?
Licia Sky (00:32:32):
So often we have a sense of social obligation or cultural obligation to always appear as if we are fine, the
obligatory, "I'm fine, I'm fine, I'm fine.," and a smile and a joke and whatever gayness you feel obliged to
put forward to the world no matter how badly you feel. The thing about trauma is that people
remember things differently. They remember things at different times and your body might be
remembering before your mind remembers. You might be feeling physically the pain of a depression
before you really understand why. You might be feeling desolation inside that you don't feel it socially
appropriate to present to the world in any way. You might feel an obligation to buck up and smile even
when you feel devastated inside. Having the safety and space to be met with somebody who's going to

greet you like a midwife in the throes of your labor and help you birth yourself, that's the framework
that I have when people have tremendous pain.
Gita Vaid (00:33:59):
So beautiful. It's so holistic. I love that. You see people so holistically, and it's really been helpful to me
that when someone comes to my office and they talk about what's happening, and then they also
mention, "This happened yesterday as an aside, and then I have all this stuff going on in my neck and I
just had an epidural," I'm like, "Why did you have an epidural?" There's so much tightness or pain or
nonspecific medical problems that people may not bring into a session with psychiatrist, but really
appreciate, well, what's really happening here? This is a much bigger presentation and expression from
the person's mind and body. So I love that you think about this as a birthing.
Licia Sky (00:34:42):
Well, we have patterns of holding in our bodies. We learn we're socialized to physically suppress the
expressions of our emotional feelings. So children are taught sometimes often in very, very harsh ways
not to cry, not to shout. There are physical impulses that are very powerful. They're as powerful as a
sneeze or a yawn or a cry. It takes tremendous physical effort to lock those feelings down.
There are ways that we have to use the muscles of our gut and the muscles of our back. There are ways
that we learn to force ourselves to be still when everything in us feels like moving. So fight or flight is a
response that's a huge response in our body. It makes us shout. A shout is a vocal way of signaling that
you need distance from something that's dangerous. There are all these ways that we silence those
impulses and stifle the physical impulses that go along with that. Those physical patterns become the
places that we hold the hardest and experience physical pain. So yeah, go on, go on.
Gita Vaid (00:36:16):
I was going to say, what I see with ketamine, which is so beautiful, is when you add a small dose,
sometimes you can disconnect back from your mind to your body, and that can sometimes be a painful
state because you almost access why you needed to disconnect in the first place. So sometimes it's
actually the working through, not alone, but with the therapeutic relationship of almost remembering.
When I say that not only remembering mentally, but actually having a remembering of the disconnect
and a working through and processing of all of what was disconnected from and the trauma that's held
in the body to actually expand one's capacity to be in relationship with oneself and have a deeper
I feel like you, Licia, are like an artist of giving us different tools to really, as facilitators, accompany the
patient while they're working in this state to not be alone either through vocalization or contact or even
breath, how there's different ways to either attune to, I mean, I've seen people now who when you
connect with their bodies, they start going into shock almost. So that's not necessarily a bad thing. It
might have been something previously I would say, "Well, let's go to a higher dose because they're in
some fight and flight, dysregulated, painful state."
Now, I might do that, but I have a choice to say, "Well, can I breathe with them through it? Can I
regulate with them?" So you have this incredible gift of offering different techniques, and I'd love for
you to talk about a few of the different ... Really, you're like an artist with this whole different palette to

really use your artistry in the moment, meet the person and find ways to contact them. It's like magic or,
actually, a mother with a baby when you can actually breathe together, how the person's body, even if
their mind doesn't care for it, the body responds in such a powerful way. It just opens up a whole
different way of thinking and working.
Licia Sky (00:38:18):
So I want to say a couple things. One is that our minds, just as we train ourselves to not cry, to not laugh,
to not express, it's possible to turn off a psychedelic experience, especially at a lower dose. I've seen
people go from the throes of a big emotional experience and they hear something drop across the hall
and suddenly they're done, they're out of it, they've pushed to draw back down again. So having that
capacity to stay present, that's the thing about holding a lower dose experience or even a higher dose
experience. People can snap out of it because we're so trained to push that back down.
So when we're building a container for the experience, I think the first thing I want to say is that my
capacity to meet a person who's in an uncomfortable state has to do with how familiar I have been with
those states myself. There's a tremendous amount of shame involved with emotional expression,
especially people who've had a lot of trauma can often have tremendous shaming that forced them into
silence, forced them into not crying, not expressing.
So being able to meet them with respect for those experiences that are emerging, being able to be
comfortable myself with what's emerging because my comfort level as the person who's sitting and
being able to say, "Yes, I'm here with you with this big uncomfortable experience that you're having," is I
think the most important thing. It's to be absolutely respectful, absolutely accepting and unafraid myself
to meet what this person is meeting.
We're like Virgil going through the gates of hell sometimes. It's like we're the companion that's going to
stay present, that's not going to run away, that's not going to judge, that's not going to shame, but be
curious with and confident that this experience, whatever it is the person is going to emerge with and be
able to bring back something useful from this journey.
Gita Vaid (00:40:53):
I think one of the tenets of this work when it's done as skillfully as Licia is describing is not only the
corrective experience of having someone where you can really take in that experience in this unique
field at psychedelic support of almost having a reparenting good enough mother or parent, and that's
corrective element, but also how generous it is when you have a facilitator who has done their own
work to be able to actually offer their whole presence and nervous system to support very much like an
infant who comes into the world with all of us with a completely dysregulated nervous system and
hopefully has a caregiver who can lend their own nervous system to help regulate. Actually, I think none
of us get that because it takes a village to really have that.
So there's just so much potential for repair when you can have someone who can meet you in that way.
It's so powerful. Of course, if you get to higher doses, you miss all of that. Even if there is a therapist
sitting there next to you who is as skillful as Licia, they're in another realm or not even in the room,
which is a phrase that people use in psychedelic space as opposed to the richness of being in this real
conversation with themselves, their body, their emotional life, and another person who's there to hold

them and meet them in all of those very deeply attuned ways. It's so powerful. Of course, in that way
you can see the medicine is all of those different elements.
Licia Sky (00:42:21):
There's an element of wonder in all of it. I hope it's okay to self-disclose, and I've learned so much also
from my higher journeys with somebody who was really skilled, who was delighted and curious when I

was afraid-
Gita Vaid (00:42:42):

How beautiful.
Licia Sky (00:42:43):
... and whose hand I was holding very tightly just as a silver thread back because I had gone out so far. I
remember very, very slowly saying, "I think I'm afraid," and the person was able to say to me, "Wow!
What are you afraid of?" with such delight and such curiosity and such confidence that I was safe while
they were saying that that it allowed me to be really present with myself even in that very deep state. I
think even when we go far, far out, my sense is that even though it's called a dissociative, it might be
that you're not relating to the outer world, but you're very, very connected to inside.
Gita Vaid (00:43:40):
Absolutely. I love what you said. I haven't had the same experiences. To me, the field is so important
and, for sure, my teachers and my facilitators, their presence connect with myself, but certainly in the
more out there journeys, just the whole field being held and feeling like, "This person has me," allows
me to just let go and almost swim in the deep seas because I feel like, "I'm not going to drown or I'm not
going to get lost. I'll find my way back. They have me and their knowledge and their capacity and
experience generally is what I trust." It's such a felt experience, I feel. It's so interesting how you can
really feel that in such a somatic way.
Licia Sky (00:44:25):
So can you talk more about the differences between the kinds of journeys that you started off when you
were first learning about ketamine and how you got into the nuance of dosing a little bit more? I'd love
to hear some of the cases that you've worked with.
Gita Vaid (00:44:41):
Thank you. I would love to. Actually, I do think funnily enough. Part of the reason why I start, I mean, I
think my tendency in general is less is more because I do love the experience of exploring the self. I was
never quite buying into what had become popular when I first started getting involved with psychedelic
work, which was the mystical states, which to me seemed incredible and these big experiences, but I
didn't quite know how do you bring them back into yourself. What I was hearing was a lot of behavioral
stuff of how do you anchor it, how do you remember it, how do you develop practices, how do you
remind yourself. Of course, being a psychoanalyst, I sniffed behavioralism, an application, which never
sits well with me because it lacks spontaneity. So I feel like it's nice to have those practices as a last
resort, but that's not really true change. That's getting into your mind again of trying to talk yourself into
behaving correctly.

So that was a little bit of a question in my own experience of, "How do I work with this? How do I use
this?" but I did have an experience in my training when I was first working because in our trainings, we
do low doses and high doses. So in my high dose experience, turns out I'm very sensitive. I didn't know
that at the time. I went so far out. It was the wildest experience, and even though I was very proud of
myself for surviving it afterwards, it was so extreme. I didn't feel inclined to want to do it again. I did feel
like, "This is a really valuable experience." I felt like I was, just to share a little bit of what that was, I felt
like I was in a whole different universe almost, a whole different level of experience, which had so much
content and even different colors, but nothing I recognized.
I think my sitter was talking to me, I couldn't hear them. I lost connection with anything in this universe.
I think it lasted about 40 minutes, although I was tired for quite a long time afterwards because it was
quite a high dose and took a bit of a toll on my body, but in that 40 minutes, it felt like it was an eternity.
So it was powerful coming back because actually I felt really high, high on life. I was like, "Oh, my God!
What a gift to have a body. What a gift to breathe."
So on that sense, it was beautiful because I felt, "Who gets to reincarnate into their body?" I did see the
application for seriously sick individuals with suicidality, who really need almost a rebooting and an
on/off switch. So I thought, "That's really good to know that, that this exists."
Personally, I didn't find myself compelled to try that again. Actually, the teacher who I was working with
said to me, "I think you might be a bit traumatized from that." I said, "Well, that's interesting. Maybe,
but I just don't feel a need to do that again," and he was insistent, "I really think you should because you
are nervous about it and I see you don't want to administer to people in that way."
Anyway, we played around with different doses, and with his coaxing, I did start to experiment with
different doses and it really allowed me to really understand how important it was to be so careful with
dosing and the experience and thoughtful of where do you want to get a person in their own platform of
experience. Once I explored all of those ranges in myself, I knew what was available and I knew more
and more what the applications were.
So now when I see someone, I like to experiment with their sensitivity and know how sensitive they are.
So I don't want to assume anything, and then I like to actually make a decision based on that person
themselves. So if you drop into a tiny place and they're able to work with it, how beautiful or if they get
stuck in some place where they need higher, at least there's a rationale behind it, but more and more,
what I do is I try and have someone drop into a state so there's an unfolding process. It doesn't have to
be what I want for them or what their mind wants from them.
Just to your metaphor about a birthing, there is a real intelligence that happens that if I can get my mind
out of the way and can really attune to the person and just listen from my being, I can see when
something's unfolding. My job, I feel like, is just to notice that and try and translate it enough so I can
know how can I support it. What is the dosing? Has it done enough work for today that there's a
completion? I do think there's a real sense. I've realized that if I can attune myself sometimes even a
small dose, it can be such a powerful experience. It feels complete and it almost feels like disrespectful
to give someone more and to really listen to that because it really feels like it's like watching a flower

grow in front of you, that there's a real blossoming that happens and that when you have that unfolding
process, and then if you have several session, to see how session four can never have happened without
three and two.
I feel like the awe and the reverence I have for that process, it feels like a spiritual doulaship. If I can
offer that kind of support, there is nothing more magical for me or gratifying. So it's been a shift. I think
that captures a little bit about how I think about dosing or even my own personal experiences that lent
themselves the benefits, as well as the mishaps that helped me actually understand more, even a little
bit of getting beaten up or traumatized a bit was so helpful to educate me on what could happen.
Licia Sky (00:50:09):
It also speaks to how, unlike medicine where there are standardized dosing, this one size fits all of if you
have depression, this is the dose we're going to give you. Even dosing, the way you're talking about it is
very individual, very specific to the person. I think that there's something that happens in the presence
of somebody who's that attuned to you, that's that caring from moment to moment, listening to your
experience. That does not happen when something gets sent to you in the mail or when you get an IV
put in your arm and you're left alone in a room or you're given an inhaler and sent off by yourself.
There's so many nuances to this experience that I think people need that guidance for and need more
information about than they're often given.
Gita Vaid (00:51:24):
I think it's such a different way of working the way you and I enjoy working, Licia. You're so right. It's not
just using these medicines as a rapid acting antidepressant, which for that application, it can be really
valuable and powerful too. It's not what I'm particularly interested in, but I do think this whole
complicated dance between the field or the group or even the music, I mean, I have so much reverence
for the whole process. I do think this process of being a witness, I feel like I'm so in awe of how we
construct ourselves through the eyes of another person, how I only know myself because of the way in
which you see me or how I missee myself in the way in which I've been misseen, and how there's such
an opportunity in that field to repair and correct our identities and sense of self.
That's really humbling and such an honor to be able to bring your best to a situation with an individual
to help sometimes repair what has been deeply held, unfortunately, from a past story or a past
Licia Sky (00:52:31):
Right, and the relationship that we have with the person who's sitting with us or the therapist, you as
the analyst, I can't help but think that we are teaching people to have that relationship with themselves
that maybe they never learned to have developmentally or they lost somehow along the way, that this
reconnection and reconnection to self-respect, reconnection to be able to listen to the interior, to know
what these feelings mean and how to practice self-care because it's a practice. It's not a one-off. It's not,
"Oh, I took this pill and that was how I cared for myself and I'm done now." It's an ongoing relationship
that hopefully keeps growing for the rest of your life.
Gita Vaid (00:53:33):

Absolutely. I completely concur with you. I have to say, talking about pain, working with ketamine has
really alerted me to the mysteries of pain and the mind-body field in which we really are focused on in
this work. I remember one of the first cases I worked with was a woman who had tremendous back
pain, had just gotten an appointment for the week after. It was a long wait list to have a back surgery. So
she was really happy and she'd gotten clearance that she could do the ketamine for her depression
Then after the session, the pain resolved. So she was in a tailspin of, "Do I do the surgery? It's been
going on for so long, this chronic pain, and it was so hard to get in with this surgeon, but now it's not
there," and I, of course, was like, "Why would you have a surgery when you don't have pain?" but she
was like, "You don't understand what I've been through," but how much of the pain was. The surgeon
actually she went and spoke to did not do the surgery, but he did say he really wanted to have a
conversation because he said, "This is not the first time this has happened with ketamine sessions, not
necessarily with me, with other colleagues, where it's resolved," and he was getting really curious about
pain and our relationship to it and how you can unlock it perhaps surgically, but also through other less
invasive interventions when there is the right space.
Certainly, in working with you, Licia, and I was talking before about a case I'd love us to share about how
sometimes the pain is trapped in the muscles and trapped in the body, and it's hard for the person to
access even with ketamine and other skills are needed to help the person liberate it. The results are so
magnificent, not only on a somatic level, but I know in the one case I'd love for us to share more with
the person we were working with in a group. Everyone commented on the person's physical appearance
looked so different. It's not just did they have pain or did they not or were they ... It was just their
demeanor, their presence, their sense of themselves, how they held themselves, the confidence.
Everyone was in shock of it. I'd love to go into a little bit more detail of the exercise because this was a
group that we did together with low dose ketamine, with Licia facilitating. I'd love for you to talk about

that case, if you can recall it, because it was masterful. It was just a moment-
Licia Sky (00:55:57):

It was a person who was having great difficulty expressing his anger towards his father. He was one of
those very, very soft spoken, worked extremely hard to always have a gentle decorum, and was
speaking in what to me seemed like as unexpressive a way as possible talking about the experience of
being deeply humiliated and was defenseless against that humiliating onslaught.
It was a very low dose. I think it was five milligrams, right? This person was sitting very upright, speaking
very softly, and not having any outward expression of frustration or hurt or anger. I think I don't even
know if we had him stand up or not. I just remember inviting him to vocalize with me. So often with
people who have been silenced or shamed, there's a tremendous amount of shame around any vocal
So in my bodywork practice, I learned that if they weren't responding to physical manipulation, if they
weren't responding to breathwork and release, that if I made a sound that I intuited their body needed
to make, that could often be the breakthrough that allowed something physical to happen to change. So
I invited this person to make a sound that for me expressed frustration and anger not in an explosive
way, but just in a way that a body might make a sound when it was frustrated.

So it was a real growling sound like ... and me making that sound without holding shame around it and
inviting him to make his sound inside my louder sound was the beginning of physical safety in making a
sound that he probably hadn't made in years and years. It was the beginning of physical release,
physiological release that was connected to an emotional holding. Is that where you saw him?
Gita Vaid (00:58:43):
Absolutely, and it was so powerful to watch you work because, of course, you can hear, I think, the
creativity and the generosity of the invitation. I think with this fellow, I think he had been invited to
stand up and he was talking about the feelings and it was very flat. Then when you actually started
engaging in this, suddenly you could feel it. You could feel the energetic shifts. You could feel the
emotion come up. I think his actually face changed color, and the affect shifted. He was really getting
into it in such a creative way, which I can confidently say couldn't have happened from these other
domains because they were tried getting up, trying to stand up, trying to maneuver in these different
somatic domains, but then that was just so powerful to witness. I think the whole group was just in awe
of what was unfolding and the beauty of how this was held inside him, and how you managed to unlock
it in such a creative, delicate, attuned way. It was slightly playful, but in the moment, it was such a
sincere earnestness in the endeavor. It wasn't frivolous at all.
Licia Sky (00:59:47):
No, no, and the thing is that it can be really scary to do that. There is a physical effort that comes with
unlocking a sound that you're going to make. When we make a sound, we are signaling that attention is
going to come our way, that eyes are going to be on us differently. It can feel extremely vulnerable, even
if you're making a sound that's meant to say, "Back off." The fear of judgment, the fear of more harm,
more humiliation can be there.
So being able to help that person stay present and grounded, and those sounds need to come from the
core of our body, from the center of our body. They're very connected to our breath. There's a real
sense of tuning in differently to your body, engaging your core muscles and your breath differently. To
make a sound like that is a very big thing. Having the courage to trust your vulnerability in that moment
and do something big in that way, making that sound, holding the space for that sound is huge.
So that's another instance of even with the medicine of ketamine at a low dose helping you access that
feeling, it's the guidance to stay present with that feeling and find a way to move through it. For me in
my work, it's always a somatic way of moving through that. What's the physical contact that might help
a person to be supported? What does it mean to unlock your knees and tune into your sense of gravity if
you're standing up, and what happens to your diaphragm? How do you breathe to make a sound like
that, and how do you hold the space? I've been in situations where if it's in a group, we all make the
sound with that person. We all make the sound so that it's a collective experience that's holding a
person with even less exposure as an individual and more support as a group holding you.
Gita Vaid (01:02:17):
One of the things I love about ketamine is that it is an anti-pain medicine. So it is actually used for pain
treatment anyway, but what can be really nice if someone has an area of pain is sometimes what I've
found is not only do they have a bit of a break from the pain, which can be really welcome if you have

some aches or pains in your body for the duration of the session. It doesn't last forever, but sometimes
if you can bring your awareness to that area, it is incredible what can unpack, and some of that I think is
not always the organic cause, which is emotional. Sometimes it might be or somehow when we have
pain, that becomes almost a nidus for pain, emotional pain to also be deposited.
I've had some beautiful sessions, and I'm sure you have, where when one of the sessions that happened
recently is a fellow I worked with brought his awareness to knee pain that he'd had for several years.
When he was thinking about later on, I had no idea what was going on, but he explained to me the pain
lifted and how much of that pain had been about a dispute he'd had with a mentor of his, this was a
fellow in finance, and how what he felt was almost betrayed his mentor in a deal. It was the right
business decision, but it was at the cost of a lot of money to this mentor.
He had a lot of feelings around that, about betraying his mentor or was that okay and how this person
was like father figure to him, and shame and guilt. All of which was stuffed away in that knee. Actually,
when it came through, it wasn't just a feeling of ... It was almost unpacking it and reviewing it as a film,
and it's all an the imagery of what had happened and had a lot of questions about his own integrity and
guilt and humanity, which, of course, had he been in touch with it, might have made it much more
conflictual, if not impossible, to execute as he had, even wondering if he make amends as he always
does an apology.
The bigger part, regardless of how he acted afterwards, was that the knee pain and the processing of a
lot of that stuff did allow for the pain, subsequent to the session, it's been a few months, not necessarily
to go 100% away, but significantly diminished in a way that has been sustained. It's just remarkable to
see how we think of pain. It certainly has been comforting.
Licia Sky (01:04:43):
It sounds as if he was able to face a moral injury.
Gita Vaid (01:04:48):
Absolutely. I love the way you describe it. Absolutely.
Licia Sky (01:04:53):
Yeah, and this brings to mind another question that I have about how ketamine is administered because
the recommendations in a standardized thinking are, "Oh, you come once a week for six weeks, and
bop, bop, bop, you're done." I think often when these kinds of openings happen, when this much is
being processed, that just as we can be open-minded and tailoring a dose for each session, the spacing
that we have for integration between each session, especially when it's very, very old, very, very deep
pain, I think great care has to happen because a journey can reverberate for months after it happens,
and respecting the space that we need to fully retrieve whatever wisdom and insight we have from a
journey is really important.
I think often, and maybe this has to do with the party culture that we started talking about in the
beginning, there's almost a way that you go, "Oh, it's a throwaway experience," but these are profound

experiences and it can take time to understand fully what we've seen, what we've heard, what insight
we have.
The people that I work with, I never rush when the next session is going to happen. I don't even rush
how long we're going to process after a journey has taken place where some people say, "Oh, you're in
and out in two hours," or whatever. I try and allow a lot of space afterwards to reflect, remember,
ground, maybe even eat something, and really come fully into your body, and then, "What are your
dreams like in the days and weeks after? What are your journal writing like in the days and weeks after,
and how do you feel?" People often meet parts of themselves that they didn't know they could have a
relationship with. So what are the unfolding relationships you have with the parts of yourself that you
meet in a journey?
Gita Vaid (01:07:28):
I think this really you capture so beautifully what is thrown around a lot, this concept of holding space
because people talk about that and oftentimes it's unclear just sitting in the room and watching
someone, but I think, Licia, you really talk about what that is for you in that description of how much
that richness of inquiry and your interest and your enthusiasm really promotes this really deep,
sometimes for the first time, interest in a person because there are these secret neglects that
sometimes go unnoticed because it's not the atmosphere that one has grown up with.
It brings to mind a session I did with a woman who had this remarkable session with so much beautiful
imagery, but the more important part for her at the end she said was she said she was so dismissive of
it. She was just like, "Oh, it's all derivative. This is just all Van Gogh stuff and Monet. None of this is my
productions." She just threw it away, and I was shocked at how callous it was and how, I mean, the
beauty of her sessions were just extraordinary.
She did actually say to me the most powerful aspect was she was shocked at how in awe of her journey I
was. She was shocked. I told her, "I'm shocked equally of how dismissive you are of what's happening. I
can't believe how brutal your attitude is when I'm feeling like I'm walking through the Museum of
Modern Art and you are saying, 'But I'm not the artist. It's derivative.'" I'm like, "Your mind is the
Museum of Modern Art." My jaw was on the ground.
Even that exchange of her attitudes was probably the most valuable part because she did have such an
experience of, "Wow! Why am I so harsh?" So I think in your way of working, there's such respect and
it's so genuine, the curiosity, that sometimes that piece, the invitation to perhaps for the first time learn
that or try it on is so remarkable, so beautiful, such a healing.
Licia Sky (01:09:24):
It is a healing. Bringing it back to developing relationship with ourself, so she's learning to value an
aspect of her capacity to imagine that she didn't value before. Value through your eyes first, but
hopefully develops a capacity to appreciate that there's something worth carrying on instead of
throwing away because we are opening the door to ourself. If throw ourself away, we throw out whom
we meet inside ourselves, we're missing the point of that point of journey for me.
Gita Vaid (01:10:12):

So much of that is reflective with such impoverishment in early life. Oftentimes I feel like this work really
allows, the way in which I think you and I practice is almost like infrastructure development, building an
inner world or enhancing the capacity of our inner dream furniture almost or our psyche's furniture,
which just allows for such an enrichment for capacities that perhaps either have been shut down or
disconnected from or not really adequately supported.
It's really, I think, deep healing instead of just trying to employ medicines to cope or manage or to
numb, which can also cause shifts away from pain, but not really getting to the underpinnings of why
are we in pain or where does this stem from, this painful state which can be held in the mind or the
body or oftentimes both.
Licia Sky (01:11:08):
Yeah, and I've actually found that once you have some of these log jam breaking sessions, enough is
opened up that you could continue for a few more sessions just unpacking what you opened up. I had
one person meet parts of themselves that they said, "Oh, now that I know these parts are here, I feel
like I need their permission to have another journey with medicine because this relationship is so new
and I'm hearing something from this part of myself that I didn't know is there before it." There's so many
ways that these experiences can keep playing on through us for quite some time. So pacing and spacing
as you meet these different aspects of yourself I think is also really important.
Gita Vaid (01:12:16):
I love that. I love the way it's so respectful the way you describe described that, and I agree. I think that
just running to more and more sessions can almost be this. I like to use the metaphor of almost like
going to a really great meal where people have a great meal and they're like, "Wow! I want to come
back and have this again," which, of course, one can, but you have to finish the meal and digest the meal
and actually get hungry again. Otherwise, you're actually undermining. If you just order the entree again
when you haven't even finished the first one, you're not really going to be able to take it in in a way that
it's nourishing.
Licia Sky (01:12:51):
Right, and savoring is a huge part of that. I don't think savoring is a big part of Western culture, the way
we move in such a speedy way through life thinking we have to get it all done at once. Even insurance
culture is 10 sessions and you're done. Human beings and human bodies aren't really like that. There's
so much nuance there.
Gita Vaid (01:13:21):
I love your use of the word savoring. That's such a beautiful image that you capture. I mean, more and
more, I do feel like how much of our attachments doing this work, I feel how much of our attachment,
how much of this work I do reveals an attachment with people I work with as well as myself to suffer
versus how much pleasure can you tolerate in loosening some of these habits that we have cultivated? I
think that's a really interesting aspect of the work.
I just did this session yesterday for the first time, and the person was a little bit questioning, "It's just so
pleasurable being in this space. Shouldn't I be talking about painful things that happened to me?" and I
said, "Well, but you're always in so much pain. Perhaps you're opening into discover what is it like for

you to be safe and not in pain?" There's almost like this confusion of, "Am I allowed? I thought this was
going to have to be a painful treatment to get to the core wounds I've had. Am I not doing my work if
I'm not suffering and struggling in stride?"
Licia Sky (01:14:23):
So wonder is a great big piece of all of this. It looks like questions are starting to come in. Do you mind if
I share this one?"
Gita Vaid (01:14:23):
Please. So nice.
Licia Sky (01:14:34):
I apologize if I may have missed this answer. How much of ketamine therapy couples with IFS? I'd rather
speak out loud to that. I do have some IFS training and Dick Schwartz has come in to the ketamine
training programs that we've been doing. Parts work is a part of what I do with every session. I'm open
to meeting with different parts that are emerging, and because we're dealing with feelings and
awareness that's locked down, if you know the language of IFS, we're dealing with the exiles that are
locked away, that are managed and protected by protectors and managers. We're opening ourselves to
meet those entities within us, those aspects of ourselves that are most unknown, that are most
rejected, that we're most afraid of, that we're most afraid of having the world see. They're the parts of
ourselves that hold the greatest pain that needs to be healed.
So holding space to meet those rejected parts, those exiled parts with as much respect and care and
curiosity and compassion is possible. That's always an intention that I'm setting for myself with every
session that we're doing. It's a big part of building the container and helping the person who's
journeying to meet these aspects of themselves.
So I won't say to them that I'm bringing them into IFS, but so often spontaneously, parts is what comes
up and they spontaneously start to speak in parts language. I find it enormously useful, especially when
we're dealing with our bodies and knowing how we feel. It's a very helpful frame to be able to hold an
integrated journey.
Dr. Wayne Kampers (01:16:46):
Can I just interrupt you guys? I cannot believe how quickly the last hour and a half has gone. It's been
absolutely riveting listening to both of you and your passion for your subjects and how it comes across.
You can almost feel how it must be to be one of your patients. So that just comes across in such
abundance, and it's just been really unbelievably fascinating to listen to both of you.
I'm wondering if I could ask. We had wanted to do just a grounding practice to close. So I think that
would be so useful for people to see. Thank you. Thank you both so much. To hear you talk about these
experiences and your expertise is, really, it's unbelievable. So thank you.
Gita Vaid (01:17:45):
Thank you for having me. It's been a pleasure to be in conversation.

Licia Sky (01:17:51):
So I'm just going to reground myself then. I invite you to take a soften gaze if that's comfortable for you
or closed eyes if you're comfortable doing that, but I invite you to just take a snapshot for just a moment
of how you're feeling in your body right now after all that talk, that talk about journeying and ketamine
and whatever else it brought up for you and is swirling around. I invite you to just take a snapshot of
your body in this moment right now of where you feel tension, where you feel relaxed. I invite you to
notice internally your sense of your breath. I wonder if you can feel the expansion and contraction of
your belly and your diaphragm with each inhale and exhale.
I invite you to try placing a hand on your belly. I invite you to notice what does your hand feel as your
hand holds your belly. It's an invitation. If it's not right for you, what does it feel like to even hear that
invitation? If you're able to place your hand on your belly, what does your hand feel? Does it feel the
texture of your clothing, the softness or firmness of your belly, the movement as your belly expands and
contracts with each breath? I invite you to notice what you feel in your body, what you feel in your
With the next breath in and out, I invite you to place a hand on your heart or your chest, and this is an
invitation. So I invite you to notice what that invitation feels like for you. Is that one that you feel
comfortable trying? What comes up for you with the invitation of placing your hand on your heart or
your chest? Again, I invite you to notice what you feel in your hand. It might be the texture of your
clothing. It might be the firmness or softness of your chest. You might notice the rise and fall of your
chest with each breath.
I invite you to notice what your chest and heart feel with this contact, the firmness or softness of your
hand, the pressure and temperature of your hand. I invite you to notice how far inside your body are
you able to notice the sensations of this contact. I invite you to notice how your breath responds to this
I invite you to notice how your nervous system responds to this contact. Does this animate you? Does
this calm you? I invite you to listen to the sensations of your body internally. I invite you to notice the
sensations of your bum in your chair and perhaps the contact of your foot with the floor, your feet with
the floor. I invite you to notice your sense of balance. I invite you to notice perhaps that you are holding
someone. This contact with your heart and your belly is a way of holding, and what's it like to hold the
person that you're holding? I invite you to hold an intention of respect and kindness as much as you are
able. How do you regard this person who you are holding? How much respect and kindness can you
With the next breath in and out, I invite you to allow your attention to notice the sensation of being
held, and how does it feel to be held by this person who is doing their best in this moment, holding an
intention in this moment of respect and kindness? How much trust are you able to give to this person?
How much respect and kindness are you able to receive in this moment from this person who's holding

This is the beginning of a relationship with yourself. This is the beginning of a relationship that a
psychedelic experience might expand, but I invite you to just notice how does it feel in this moment to
have this conversation, this wordless self-holding conversation with the person who's holding you, with
the person you are holding with all the parts that might emerge to listen in and feel this moment of
grounding. You might push your feet into the floor. What would it take to take a deeper breath? What
does it feel like to just land here in this moment just now?

Is that enough, Wayne? I don't know how long I have, but-
Dr. Wayne Kampers (01:24:10):

Licia, we could spend all night listening to you. I wish I could capture your spirit in a bottle and just keep
it. You've got such an amazing way about you and I thank you so much for sharing this with us. It's been
fantastic. Thank you. Thank so much.
To the rest of the audience, we'll be regrouping tomorrow again at 10:00 Eastern time. We've got three
very exciting speakers, Dr. Isaac Mathai, who's from the Soukya Retreat, talk to us about Ayurvedic,
practices and Ayurvedic medicine, and then Dr. Christine Wolf and Les Aria, who are going to further
expand in terms of their knowledge on chronic pain. So I'm looking forward to tomorrow and thank you
all very, very much for tonight. It's been amazing.
Licia Sky (01:25:12):
Thanks so much, and it was lovely, especially to have an opportunity to talk with Gita, one of my
Dr. Wayne Kampers (01:25:19):
The two of you just flowed so nicely. I just loved the way you did it because it really was you could
almost feel what it was like to be both of your patients, and I think that that came across in abundance.
It was the connection between the two of you is palpable.
Licia Sky (01:25:42):
Thank you. Thank you so much, everyone.
Dr. Wayne Kampers (01:25:42):
Yeah, thank you.

Dr. Wayne Kampers (00:00:00):
Hi, good afternoon everybody and welcome back to day two of our Master Series in Pain. I'm very
excited about today and about our speakers. So I'm very excited to welcome Dr. Issac Mathai to the Pain
Edition of this series. His credentials really do speak for themselves. He's a medical doctor and a
homeopathic physician who has a master's in homeopathic medicine from London. He's also studied a
Chinese pulse diagnosis and he is an expert on mind-body medicine, having trained at Harvard Medical
School and he is one of the leaders in the field of holistic medicine and he is the medical director and
chairman of the renowned holistic health treatment center in India called Soukya.
Dr. Wayne Kampers (00:00:55):
So he really does understand and know Eastern philosophy and Western medicine and so we are
privileged to have him today impart his expertise and knowledge with a focus on mind-body medicine
and chronic pain from his perspective. As I outlined yesterday how important it is to focus on limbic
system dysfunction as part of the treatment approach, I'm looking forward today to understanding his
approach to releasing emotions through the ancient systems of Ayurveda and yoga principles and his
anti-inflammatory nutritional approach.
Dr. Issac Mathai (00:01:31):
Thank you. Thank you Dr. Kampers for the good introduction and I felt that for the participants to listen
to our way of treating, it is not a philosophy, this is what we do on a day-to-day basis because we have
patients from all over the world coming over and my conversation with you earlier and I also believe and
experience that the deep pain and the trauma and deeper in their mind and subconscious mind, even in
the spirit, that's a root cause. Unless we remove that, the condition or the health is not going to be
regained. So I'm doing that presentation on this holistic healing and concept, all that. Maybe some of
your participants are very well aware about it, but I want to bring it into the yoga expert to talk about
yogic philosophy beyond just yoga as an exercise, much deeper into the psychological and spiritual
connection of yoga.
Dr. Issac Mathai (00:02:28):
And also the Ayurveda rather than Ayurveda as just also a physical treatment. It is much deeper in your
subconscious mind and the spirit. So some of that presentation subject may be little bit too complex and
difficult to understand, but let us run it and I'm with you to answer questions. Plus in between, if I have

to come in and I'm with this presentation. So I'll just run it and-
Dr. Wayne Kampers (00:02:50):

That's great.
Dr. Issac Mathai (00:02:50):
... I can stop it and then have, ask some questions for us, people to discuss something and then continue
that. Thank you so much for this opportunity and thank you.
Dr. Wayne Kampers (00:03:02):
And thank you for joining us.
Dr. Issac Mathai (00:03:05):

Good evening. I'm Dr. Isaac Mathai, founder of Soukya International Holistic Center based in Bangalore,
India. I'm practicing holistic medicine, mind-body medicine for the last 35 years in India, in Europe and in
USA. My experience dealing with the chronic diseases, it is more and more evident that in any chronic
disease with a pain or otherwise has its own mental component as well as the component from the
spirit. I can explain that on my presentation, how that is affecting somebody's health and wellbeing, as
well as looking at how the different tools we use in the ancient Indian medical systems of Ayurveda and
naturopathic and yogic treatments and homeopathy, helping in such cases to resolve the traumas and
the deeper level of pain, as well as the chronic diseases reversing.
Dr. Issac Mathai (00:04:08):
As we have more than 180 nationalities coming to Soukya for treatment and stay from two weeks to few
months, we get amazing results by understanding the person as a whole with the mind-body-spirit
connection and we spend hours on understanding their emotional state and the traumas and the impact
on their health and wellbeing. And the treatment protocols are designed along with the counseling and
other emotional and mental modification treatment, yoga, meditation, Ayurvedic treatments,
homeopathic medicines and being in a healing sanctuary of organic farm will make a huge impact on
people's health and wellbeing. So I will explain to you the understanding of holistic health and healing
and see that we could do amazing results by holistic healing for the patient, those who are suffering.
Dr. Issac Mathai (00:05:09):
When you talk about holistic health and healing, we have to look at the mind-body connection, I would
say more than that into a mind-body-spirit connection. The World Health Organization explained holistic
health or health as a state of complete physical, mental and social wellbeing and not merely the absence
of disease. When you look at that perspective, the definition of health from the WHO perspective and
holistic health perspective is not a major difference. But when you look at the holistic perspective, it is
always as harmonious state of mind-body-spirit with respect to the physiological, psychological,
sociological, environmental, nutritional and emotional state as well as the spiritual wellbeing.
Dr. Issac Mathai (00:06:05):
Today, the medical world, whether in the East or the West, is disconnected from the physical diseases to
the mental or to the psychological or deeper in your subconscious or in the spirit. So patients are divided
between a physically treating doctor or a surgeon to a psychologist or a psychiatrist as well as with the
other methodology or treatment or a yoga, therapeutic yoga person or other mindful practices. So our
aim is to bring that all together, that way we could treat the person in a very holistic way as well as
incorporate all their different mental and physical and their traumas and their sufferings all together
into one perspective and put that person in a holistic perspective of the connection with the
sociological, environmental and nutritional, emotional, all these aspects together. This is the idea behind
the holistic health approach.
Dr. Issac Mathai (00:07:13):
Holistic medicine, again, focus on the person as a whole with mind-body-spirit. So that is in the present
Western medical model. It is not that easy for a normally trained surgeon or a person to deal with that. I
believe that more and more doctors should come forward to deal with that as well as more
psychologists and psychotherapists should work with a person in connection with the mind, body and
spirit. That is make them, anyone of them, as a best holistic healer or a holistic physician or a holistic
health provider.

Dr. Issac Mathai (00:07:52):
Here, a very important component in holistic healing is the usage of different methodology, not only the
Western medical methodologies or a mind-body medicine, but other aspects also you can incorporate.
That is including the therapeutic yoga which is widely used in the Western medical world nowadays
after so many studies in the Harvard and other thousands of research findings are there, which is always
explaining about the impact of that on the mind and the subconscious mind and the neurochemicals and
all that.
Dr. Issac Mathai (00:08:38):
So usage of yoga and different other milder methodology of treatments like reflexology or acupuncture,
all that things are very beneficial along with the other treatment. Even massage therapy is also very
good for releasing tension in the muscles and some of the Ayurvedic special treatments are very
effective in removing even psychological and toxins in the spirit in a deeper level of our mind and the
Dr. Issac Mathai (00:09:10):
So I will talk about the integrative medicine is equally important in a holistic approach because a
treatment cannot be done only based on the physical model and only based on the Western medical
approaches. So the ancient medicines like Ayurveda, which goes back to thousands of years, and it is
widely practiced in India in a lot of physical medical conditions to psychological conditions and
neurological diseases like that, which is very effective in incorporating in a holistic approach. The same
way about homeopathy medicine, which is started in Germany and it is widely practiced in India now
and very beneficial even for mental diseases and psychological issues, mild anxieties and a lot of physical
diseases in acute gastroenteritis and to chronic liver cirrhosis, that type of conditions.
Dr. Issac Mathai (00:10:07):
In my practice in the last 35 years with homeopathy and mind-body medicine and incorporating
integrative medicine in our day-to-day practical patients, and we have seen amazing results happening
with all sectors of society. We have our clinics for the poorest of the poor in India, which we provide free
treatment where we teach yoga, meditation also along with Ayurveda and Western medicine and taking
care of more than 150,000 people free of charge. And also our international center, Soukya, where we
incorporate in a global standard with the medical involvement as well as the good facility and organic
farm, which shows that a healing environment with the mind-body connection and treatment which can
help in your deeper level of your psychological and your level of your consciousness, which also can
change a lot in health and healing and in the healing process.
Dr. Issac Mathai (00:11:13):
When you talk about a holistic physician and the holistic physician's involvement is to have a promotion
of health, not only disease treatment and early intervention and prevention of diseases. Interestingly,
ancient medicines like Ayurveda give us a lot of insight into 7 to 10 years before somebody develop a
biochemical changes in the system and develop a disease like metabolic disorder like diabetes or a
neurological disorder like Parkinson's also or a balance issue or arthritis. 7 to 10 years in advance, you'll
be able to see the impact of that in the person by observing and analyzing, based on the body nature, so
that a good doctor, holistic physician can with the knowledge of Ayurveda, with the knowledge of yoga
and homeopathy, can easily diagnose a person that which direction the person is developing towards
their chronic diseases.

Dr. Issac Mathai (00:12:16):
So that can be treated much in advance so that that person will never develop that and the anti-aging
effect of this treatment and also the agenda, idea of treatment is having a positive effect in the
inflammatory changes. At last, enhancing their body's immune system and the continuously encouraging
the person to understand that whatever you do, whatever you think, whatever you act, whatever you
eat, it all has its own effect on your health and wellbeing. So collection of all this, very important and the
most important thing for a holistic physician with a psychologist or a psychiatrist or a healthcare
provider should have a listening to the patient, which a psychologist and psychiatrist does it all the time.
So that listening to the patient itself is a huge healing effect. Normal doctors won't do that. So a normal
doctor or a holistic physician, spending time to understand the person and listen to the person and that
is also a very important tool in healing process.
Dr. Issac Mathai (00:13:23):
When you talk about the holistic understanding about healing to educate many dimensions, the true
healing of holistic, I would say the true healing is a holistic healing. So that when you look at the body,
we can see that in the nature of the healing of the body, which is always very visible, the pain is going
away, a deformity is getting changed and that need in my opinion, very limited participation of the
person, limited effect or maybe a little bit of diet and rest. These are the things changed, whether it's
intestinal problems or any ache and pains or anything like that.
Dr. Issac Mathai (00:14:05):
But like a lot of physical body aches and everything in the same time, I would say have a deeper impact
on their mind, but chronic disease I'm talking about, not the acute one, impact on their subconscious
mind and deeper level of trauma in their life. So that's why the listening and understanding and learning
about their life, even if somebody come only with a pure body pain or chronic fatigue syndrome or any
neurological disorders. We have to look back into what happened in their life, that'll give us a much
deeper understanding about what is going on in their system.
Dr. Issac Mathai (00:14:48):
Second point is when you look at the healing of the mind and it is not visible, maybe the person will feel
that. And also a lot of cases which I experience with several of the people are, they're not aware about
they're going through it or they have that emotional or traumas in the subconscious level. That is
required in opening of the person. So I sometimes give three or five days or even if seven days and
different interaction for the person to open up, even person himself to understand that what happened
in the childhood.
Dr. Issac Mathai (00:15:29):
The last week I was dealing a person with some medical issues and I felt that this person is having some
history of childhood trauma. But I mentioned to the person who's in the 50s, lady, she was reluctant to
talk about it because she didn't look at me as a psychologist or somebody, she looked at me as a normal
doctor. But then again the second visit, second sitting, I told her that I need to know more about what
had now happened in your life. And Sheva said that, "Oh, let me think about it," but no news. And after
a few days I had another session with her to explain that, "Until you open up, either you don't know,
then you have to think because you are in a healing environment, you have time to think about it, reflect
on yourself, go deep into your life and see what happened in your childhood or later stages, your
situations in your life. If you share that, I'll be able to help you more."

Dr. Issac Mathai (00:16:31):
And it was actually, it took two weeks for the person to open up and then shared with me her horrible
experiences with sexual abuse in her childhood from the age of 6 to 14 by her stepfather and how that is
affected. And before six years old, her mother and father was in a very bad relationship and abusive
environment, toxic environment at home. Then the father left and then the abandonment of the feeling
by this little girl from the father. Then the mother have a new husband, that husband is sexually abusing
her. That trauma. And after 14 years she could share that with the mother and that created her to go
away from their home and stay with the grandmother and then rest of the life, so many things
Dr. Issac Mathai (00:17:25):
Unless in other ways we clear and complete that healing of what happened in the childhood, it'll be very
difficult in her life, her suffering, whether it's a chronic headache or a neck pain or other fibromyalgia
symptoms or whatever it is, will not go away. So my tool is to use internal homeopathic medicine that
will change that suppressed emotions or Ayurvedic treatment which will remove the toxic deep effect,
yogic protocols that'll help with the regaining mindfulness, will change the neurochemical changes. So
this kind of multiple use or multiple healing techniques is going to transform that person into a
completely whole person. That is the way we handle that. And when you talk about the spirit in the
same person also, some of the incidents, things happened in her childhood has a deep impact on her
spirit. I would say trauma in the spirit. Even she doesn't know in my conversation what is happening in
her sexually because she was not knowing about what is this, but she always felt in her deeper sense
that this is not right. What this man, my stepfather, is doing is not right.
Dr. Issac Mathai (00:18:44):
That created so much of a tightness in her body, in the mind and a deep wound in her spirit. So when I
talked further about this person in the later stage when she married and she's 18 years of marriage,
she's saying that she could never enjoy sex and she was like a mechanical person who's participating in
the sex with the husband, but she could never experience a bliss or a freedom or a free spirit feeling
when she engage in the beautiful act of sex. So that also should be corrected by a methodology of
treatment. So I do ask her to come back for another three weeks of treatment protocol which will be
able to correct a lot of this deeper level of traumas to transform her from that state to a better state.
Dr. Issac Mathai (00:19:36):
So when you again look at it, the mind-body-spirit concept, the body is easy, visible, and mind is not
visible, but people can feel. But there are effect on that in every chronic or a disease state. Not only
mental diseases or emotional imbalances, all the other cases also will see a change or a deeper effect in
the mind. And lot of these kinds of cases where impact happened, not only in the sexual abuse, there
are major trust issue, major things happen in the business or life or divorces or war. And personally, I
have several people from the Ukraine and Europe coming over. The impact of the war in their personal
life has so much of a deep effect on their spirit. So we have to understand this impact in many world, in
many ways. It is not only the effect by the financial losses or anything, but the uncertainties, the issues
about the safety of the family members and how that, all the economic situation, how that affecting.
Dr. Issac Mathai (00:20:45):
Fear about the future, apprehensive [inaudible 00:20:48] to day life or collapsing your multinational
businesses and you not only losing money, losing your own built up business in the last 30 or 40 years,

all this have a huge impact in the spirit. So I have seen people from Middle East and the Iraq war and
other war happened in the previous years or Lebanon with the blast, such patients also. So anything
happening surrounding us, that is a blast. Whether it's a war, whether it's a fire, whether it's a financial
loss, whether it's a business failure. All these things have its own effect on people's deeper level, not
only in the mind, not only in subconscious mind, in their spirit. That's where holistic healing treatment
and methodology can help to heal that aspects also, for that the person can be liberated from this kind
of traumas.
Dr. Issac Mathai (00:21:42):
So the state of being, a person, whether they're a newborn baby or a adult, the body system is always
our mind, body and the spirit always try to be in a balanced state. And when the other external factors
or internal factors or our mental state recreating certain imbalances, again, that stage also, our system is
capable of trying to balance that imbalance into a balanced state. That constantly, that balancing act is
happening in our system, whether you are exposed to a virus or a bacteria or a dust or a weather change
or anything like that, but then that situation changes, you'll get into a balanced state. But over a period
of time, whether it's because your mental situation or because of eating habits, because of external
factor like a virus or anything like that, constantly you are dealing with that, then that will become a ill
health. In my opinion, majority of the people will get that feeling of the ill health only when they get
some symptoms, which is continuing for a period of time and majority of the people will ignore it, try to
do some self-help methodology.

PART 1 OF 4 ENDS [00:23:04]

Dr. Issac Mathai (00:23:03):
So, people will ignore it, try to do some self-help methodology and try to settle that in some cases or
most of the cases, when you remove the causative factor for ill health, either by food habits, or
environmental factors, or emotional factors or anything like that, this will get better. But then, if that is
not happening, then, the person get into a disease stage.
Dr. Issac Mathai (00:23:24):
Majority of the people go to a doctor, or a hospital, or any help they seek for only when they get into a
disease stage. So, a role of a physician is to reverse that disease stage into a imbalanced stage into a
balanced stage. That balanced stage of the mind, body, spirit actually make a person truly healthy. This
can be applicable even for a cardiac issue, even for neurological disorders.
Dr. Issac Mathai (00:23:53):
In so many disease conditions, we cannot disconnect our mind from your physical disease. Even a
cardiac issue, when they have a diagnosis, the anxiety about that, perhaps simple blood pressure, they
imagine about the patient, about people, those who died out of cardiac issue or a blood issues or
anything like that.
Dr. Issac Mathai (00:24:14):
Recently, I met with somebody with a very mild intestinal issue, is afraid and fear of cancer in the
intestine, and is going around to hospital to hospital, prove that he has a cancer in the intestine. That
fear, how we are going to remove the fear? Only by counseling alone is not possible. So, there are
specific medicines and treatment to remove such imaginative fear. Or even the cases of hallucinations,

even the cases of anxiety-related diseases, apprehension, depression, all these things can be reversed by
a proper methodology of treatment with a natural treatment, along with maybe some cases of
advanced cases, they may need psychotic medicines, all sorts.
Dr. Issac Mathai (00:24:53):
So, our aim is to remove the person from ill health or disease to a balance state where western medical
intervention and western medicines, as well as along with that, natural methodologies and self-help
methodologies, all very effective to do that.
Dr. Issac Mathai (00:25:15):
So, you know that a lot of reasons for ill health, I would say, nowadays people are not like getting
enough sleep and too much of stress and have eating habits. These are the type of things, lack of
exercise, and these are the things more than communicable diseases or a bacteria or the diseases in
today's world. So, changing the lifestyle is very, very important for a person to improve the health and
prevent diseases.
Dr. Issac Mathai (00:25:44):
Then, you look at the healing of an individual. The person should accept that he has a problem. You may
see that a lot of people, they deny their issue. They don't want to accept that they have a problem,
whether it's a physical or a emotional state. And they have to identify that and always try to get help,
because if people doesn't want to seek help, then, nobody will be able to help. If the family want to
help, that's not good enough.
Dr. Issac Mathai (00:26:15):
And also, the persons within feel that, no, you need to create a need to within to heal and seeking for
healing. That's very, very important. Their participation is very important for the healing process. And
their belief in that healing process, whether it's doing a yoga or a change your diet or other practices,
they should have a belief in that. And they have to have active participation in that process, and
participation, as well as they have to make proper changes and have a positive attitude towards that
change. That is only going to make them a better person or a healed person.
Dr. Issac Mathai (00:26:59):
And the body, when there's a lot of body... There are a lot of cases we know that the accumulation of
toxins are creating a situation. And their working environment or environment they're living, that has a
lot of toxicity. So, we had to understand that and correct that to have an optimum health or a balanced
health. And functioning of the body systems, that's very, very important to improve health and
Dr. Issac Mathai (00:27:26):
And lot of cases, as I mentioned earlier, prevention of illness by understanding and releasing in advance,
much in advance with the health of a professional or your own observation and do the corrections, that
will make a huge impact on the healing of the body. And doing exercises, diet changes, lifestyle changes
and stopping abusing your system by your practices, unhealthy practices, and focusing that every act
you do to improve your health and wellbeing, that make a big difference in the healing of the body.
Dr. Issac Mathai (00:28:01):

And the healing of the mind, people need to get into our practices of breathing is an amazing thing. In a
different kind of yoga, breathing, my colleague Dr. Ragur is going to explain in later stage, that is having
own huge impact. And there's enough and more research is conducted around the world in best
universities about the effect of pranayama or breathing exercises on your neurochemicals, changing a
mood, effect on your depression and all that.
Dr. Issac Mathai (00:28:29):
So, all this condition, along with the western medical interventions or psychological interventions or
therapeutic interventions or psychological counseling, you could use the breathing technique as one of
the best way of influencing the mind and balancing of the mind. And self-awareness is also very, very
important for somebody's health and wellbeing. That self-awareness can be done very much with
mindfulness, as well as self dialogue and that required time. When I say control of emotion, it's more
than control. It is balance of emotions.
Dr. Issac Mathai (00:29:06):
So, when you do activity to balance your emotions, in a healthy stage or unhealthy state, that is very,
very important for the performance of your mind in the most optimum level. And the spiritual healing, if
I am a great believer of power of prayer, that is one of my prescription to my patients, whether you
believe in God or a particular religious background. The power of prayer, power of intention and the
power of meditation, these things has a huge impact on the deeper level in our spirit.
Dr. Issac Mathai (00:29:42):
And along with that one, the time for silence. In all the traditions around the world, in any religious
background, they always focused a lot in the time to silence. That silence will give a lot of reflections, a
lot of emotional cleansing and cleansing of the spirit. So that self dialogue and time to silence to which
we focus a lot in Soukya when people stay here, connecting with the nature is also healing.
Dr. Issac Mathai (00:30:14):
Connecting with the nature, time for self dialogue, and time for silence, that'll give a deeper level of
insight into what you are, who you are, and to reorganize your life and reorganize your purpose in life,
by understanding what is your aim and what you want to achieve, what you want to have, what is a
peace and bliss you would like to have in your day-to-day life. That is by these practices. Definitely, this
can be achieved.
Dr. Issac Mathai (00:30:46):
So, integrated medicine, when you talk about it, integrating modern medicine with the traditional
systems of medicine like either homeopathy, naturopathy, sadhana, typical medicine, Chinese medicine
and all that. And there is a hundreds of different therapeutic methodologies, complemented therapies
from yoga to acupuncture to reflexology to acupressure and a lot of hydro therapies, these are all have
its own impact on your system to improve your health and wellbeing.
Dr. Issac Mathai (00:31:16):
So, using along with the western medicine, if necessary, with the traditional systems of medicine like
Ayurveda, which we are talking more about that later by our senior physician, Dr. Naranan [inaudible
00:31:28] into the essence of Ayurveda and how that is going to affect our mind and overall health and
wellbeing will be done in my later presentation.

Dr. Issac Mathai (00:31:37):
So, the homeopathic medicine also have a huge impact on your mind as well as your physical diseases.
Other systems of medicines are used in India, so which is also very beneficial for the health and
Dr. Issac Mathai (00:31:50):
So, Ayurveda, what I mentioned earlier is that our doctor is going to talk a little bit more about the
essense of Ayurveda in a much deeper level in later part of my presentation. But this is a 5,000-year old
Indian herbal medicine. Ayurveda's concept is very holistic, and it is very much connected with the mind,
body, spirit aspect, hence, Ayurvedic treatments are used for a lot of chronic diseases and all that.
Dr. Issac Mathai (00:32:20):
But some of the treatment with the hundreds of herbs infused in oil and utilized by rubbing on your
body or pouring on your body and pouring on your forehead and that type of... There are hundreds and
hundreds of different methodology. There are thousands of herbal decorations are used for treatment
by internally and externally.
Dr. Issac Mathai (00:32:41):
This one, when you do properly, it has a very huge impact on so many chronic diseases which is not
curable or treatable by the western medical approach. So, we believe that along with the western
medicine usage for lot of chronic diseases, neurological diseases, Ayurveda has as amazing result, even
in mental conditions also, Ayurveda is very, very effective.
Dr. Issac Mathai (00:33:04):
So, there are the most important Asia's biggest neuroscience and mental hospital based in Bangalore.
They have a department of integrative medicine, and thus, 30 years, they are using Ayurveda part of
mental disorders, even some of the complex mental diseases also, Ayurveda is used. So, it is a very
effective treatment methodology. And Panchakarma is particular methodology in Ayurveda which is for
rejuvenation and anti-aging, as well as detoxification.
Dr. Issac Mathai (00:33:36):
The concept of Ayurveda and in naturopathy, is a lot of toxicity, accumulation of toxicity in the body
create a huge impact on your system, and that is creating a sort of unhealthy system, unhealthy
situation in your system. That is helped by a course of Panchakarma treatment that is a complete pure
cleansing treatment, rejuvenative treatment which will take about 21 days to execute.
Dr. Issac Mathai (00:34:06):
And I have seen amazing change in people's, not only mind, the physical body, and the antiaging effect.
And people in their 80s are losing their hearing, and neurological coordination is coming back and they
having a much better healthy state by doing Panchakarma on a yearly basis. This is a very much need to
be done under a medical supervision. It cannot be done in a resort, or a hot lodge, somewhere like that.
It is a very serious work, which has a unbelievable effect on aging process and anti-aging process.
Dr. Issac Mathai (00:34:41):

But we are doing a research on this one at the moment, because some of our treatment, when we do a
combination of treatment by 21 days, same. Even the toxins are attached to the DNA indicating
released, this which we have noticed and tested properly by our international patients, and we have
seen that happening.
Dr. Issac Mathai (00:35:01):
So now, in the Soukya, we are undertaking a new research project where two weeks to three weeks of
treatment, how much that is effective in anti-aging effect by measuring the genome in your DNA. What
are the aging factors which can be measurable. And we are undertaking a project like that at the
Dr. Issac Mathai (00:35:25):
Homeopathic medicine, which is started in Germany 200 years ago, widely practiced in India.
Homeopathy also has a huge impact and very, very effective in so many psychological issues,
psychological condition, along with other chronic diseases. We use that widely for simple anxiety to
schizophrenia and traumatic situations where trauma happened few years or decades ago. That can be
cleared. It depends on what kind of trauma and what was the response of the person.
Dr. Issac Mathai (00:35:57):
An amazing result we get from homeopathic medicine treatment. There are several yogic meditation
practices later, we're going to talk about that, explain about that in a deeper level by other doctors.
There are several impact by small meditation and pranayama and different asanas and nose washing
techniques or other cleansing techniques can have a huge impact on your health and wellbeing.
Dr. Issac Mathai (00:36:25):
And I have done two books on fun and holistic healing, one is on woman's health, and anybody's
interested approaching us through, you'll be able to get that books. And our entire aim of
our holistic healing and holistic methodology dealing with your mind and your body and your life and
your spirit is about your life imbalance to life in balance. So, this will make us very comprehensively
understand that the entire imbalance to balance is our aim, and our system with the God-given
mechanisms are doing it all the time.
Dr. Issac Mathai (00:37:07):
But by participating in that, by good practices, as well as doing some herbal and holistic treatments, we
can get to the optimum health. That is what a person would like, and also, it'll prevent diseases, chronic
diseases, and help in so many different ways. Thank you.
Isaac (00:37:37):
Good morning, everybody. Today, we are discussing about yoga for mind, body, spirit. So, we'll discuss
about the definition of yoga. The yoga is mentioned in Rigveda, the collection of ancient texts that yoga
is a Sanskrit word, a huge... Which means the union, to join. Yoga [foreign language 00:38:13].
Controlling of your mind is yoga.
Isaac (00:38:21):

Yoga literally means union of mind, body, and soul. The parts of yoga, the philosophy of yoga says
connecting the mind, body, spirit. Each branch represents different focuses and sets of characteristics.
Totally, we have a six branches, Haṭha yoga, Raja yoga, Karma yoga, Bhakti yoga, Jnana yoga, Tantra
yoga. Hatha yoga is a physical and mental branch that aims to prime a body, mind, connection of body,
mind. Raja yoga, a series of disciplinary steps, the eight limbs of yoga, Yama, Niyama, Asana, Pranayama,
Pratyahara, Dharana, and Dhyana. I will explain in the next slides.
Isaac (00:39:36):
Karma yoga is a part of service, aims to create a future free from negativity, selfishness. Bhakti yoga, the
branch of yoga about wisdom, devotion, and acceptance and tolerance. Jnana yoga is a knowledge, yoga
of knowledge. The path of scholar and developing the intellectual thoughts through study. Tantra yoga is
a part of ritual ceremony and relationship. Kosha theory. Our bodies surrounded by different sheets, or
mind is surrounded by different file layers of casing. Annamaya kosha, the physical body. Pranamaya
kosha with the vital force. Manomaya kosha, mind and thoughts. Vijnanamaya kosha, intellect, wisdom,
balance. Anandamaya kosha, a bliss, harmony, expanded awareness. Annamaya kosha is a food, sheet.
Pranamaya kosha, energy sheet. Manomaya kosha mind sheet. Vijnanama kosha is a knowledge sheet.
Anandamaya kosha, a bliss sheet.
Isaac (00:41:39):
These are the five sheets, layers of your body surrounded with your soul. The practice and philosophy
application of yoga in day-to-day life brings body, breath, mind, wisdom and spirit control into the
harmony. It balances all the levels of your mind, body, spirit.
Isaac (00:42:16):
Ashtanga yoga. Ashtanga yoga literally means eight limbs. Ashtamis eight. The father of yoga, Sage

Patanjali formulated the Ashtanga yoga. According to the Patanjali, for internal purification and self-
consciousness, we need to practice Ashtanga yoga, the eight steps of yoga, Yama, Niyama, Asana,

Pranayama, Pratyahara, Dharana, Dhyana, Samadhi. Yama, the moral codes. Niyama, the self
purification and study. Asana, pushes, standing pushes, sitting pushes supine and form pushes.
Pranayama, the breathing technique, the breath control. Pratyahara, sense control. Dharana, the
concentration. Dhyana, meditation. Samadhi, the oneness.
Isaac (00:43:54):
The eight limbs of yoga is a very basic principles of yoga to attain the higher self consciousness of mind,
body, spirit. Pranayama. The word pranayama comes from two separate words. Prana, the breathing,
ayama, the expansion. By practicing Pranayama, improves the lung function, improves the oxygen level
in your cells, tissues, organs. It helps to remove all the toxins, the carbon dioxide from your body.
Mainly, the cognitive function, improves the auditory and sensor motor skills, improves the coordination
in your mind, body. It regulates the stress and emotional levels.
Isaac (00:45:04):
Study says it reduces the levels of stress molecules in the body by practicing Pranayama. We have a
different types of breathing technique. Four faces of breath. The purakada, inhalation, rechaka,
exhalation, antara kumbhaka, retention of the breath, bahya kumbhaka, retention after exhalation.
These are the technique we practice in Pranayama. Very slowly, very systematically, you need to inhale
and exhale. As you inhale, the cool air is going in. While exhalation-

PART 2 OF 4 ENDS [00:46:04]

Isaac (00:46:03):
Going in while exhalation is coming out. As you inhale, it is passing through your nostrils, trachea and
lungs, while exhalation, it is coming back from your lungs, trachea and nostrils. Breathe in and breathe
out. As you inhale in, your abdominal muscles are expanding, your chest is expanding, your clavicle
bones are moving upwards, along with the shoulder joint. While exhalation, your clavicle bones are
moving downwards, chest is constricting, abdominal muscles are moving in. Try to synchronize your
breathing movements with abdominal, chest, clavicle movement. It is called full yogic breathing.
Isaac (00:47:14):
If you practice 10 rounds in a day, slow and deep inhalation and exhalation, it has got a tremendous
effect on your body. The benefits of [inaudible 00:47:29], it clears your mind, improves the mindfulness,
it strengthens your lungs, improves the quality of the sleep, improves cardiovascular function. It reduces
the high blood pressure, hypertension. It activates your brain cells, activates your central nervous
system, reduces the depression, helps on weight loss. It helps to detoxify your body, it strengthens the
immune system, reduces all the congestion of your upper, middle, and lower respiratory track. Good for
skin health. Yoga can be a great vehicle for postural, physical and mental transformation. Yoga allows
one to find wholeness, awareness of the body, it stimulates the different chakras in the body by
practicing asanas [inaudible 00:48:53] meditation, relaxation technique. Chakra meditation, we have
seven chakras. The root chakra is called, "Muladhara." The second, "Svadhisthana chakra." The solar
plexus, "Manipura Chakra," situated at the level of your naval. The heart, the, "Anahata Chakra." Throat,
"Vishuddha Chakra." The third eye, "Ajna Chakra," between the two eyebrows in the center of the
forehead. And crown, "Sahastrara," in the top of the head. The energy will be freely flowing in all the
seven chakras due to imbalances. Bad lifestyle, mental anxiety, stress, leads to imbalance of flow of
chakras and energies. The blockages in the chakras may happen leads to various diseases. The research
have clearly reported, by practicing yoga, asana [inaudible 00:50:35] meditation relaxation technique,
decreases the activities, it reduces the mind graph, the ample of changes in gene expression, and boost
your immune system. By practicing slow and systematic yoga, improves the life quality, reduces the
stress, it boosts your immune system. It promotes overall wellbeing and improves the self
consciousness, which is very important. By practicing yoga [inaudible 00:51:39] systematically, regularly,
improves the mindfulness, regulates the emotional balances. It brings the full awareness of the body,
different body parts, and even the thinking process also will change, improves the positive thinking. The
benefits of yoga, the research suggests that the fostering the mindfulness technique relaxes your mind,
reduces the anxiety and stress. The faster wavelength at your mind will slowly reduces. It strengthens
the physical, mental and moral balances. By practicing regularly yoga, it helps to control the anxiety.
Activates your central nervous system, improves the confidence and self-esteem.
Isaac (00:53:10):
The physical benefits of yoga. By practicing yoga, it [inaudible 00:53:17] improves the body flexibility, it
strengthens the muscles, it tones up the muscles, improves the elasticity of your muscles, which is very
important. Improves the respiratory function, improves the oxygen level to your cells, tissues, organs. It
regulates the metabolic activity, balances the metabolic function, helps in weight reduction. Very good
exercise for cardiovascular health. It protects the joints, reduces the injuries, it strengthens the
ligaments, tendons, lubricates all the joints.
Isaac (00:54:13):

The mental benefits, reduces the stress, anxiety, depression. You will have a mental clarity and
calmness. It improves the body awareness. In all the practices of yoga, we close our eyes and practice so
that you will have your own body awareness movements. It improves the happiness, peace of mind, it
releases the endorphin. By practicing yoga, breathing, relaxation technique, boost your immune system,
boost your happiness, boost your activities. Throughout the day, you'll be active, energetic, improves
overall quality of life.
Isaac (00:55:19):
Yoga is combined with meditation, which helps in thought process. Mind over matter. If the mind is
relaxed, entire body will relax. Organs will function normally, the blood circulation will be equal to all the
body parts. The healing process also improves and you will have a complete mental clarity. The focusing
the inward body helps to calm your mind. It helps to releases the anxiety, stress, at any level of your
body. It relaxes your muscles, release the stiffness of your muscles and ease the body moment. You'll be
able to calm your mind body completely.
Isaac (00:56:41):
So we practice yoga [inaudible 00:56:44]. It's an internal purification. We use a pot filled with salt,
lukewarm water, [inaudible 00:57:00] any nostril and when the water flows fully, it loose the
congestions that your upper respiratory tract so that the free flow of air takes place to the nostrils,
trachea, bronchials, bronchi, alveoli. The eye cups, we fill the herbal water and we immerse the eye cups

into the eyeball, and we do eye exercises, up and down, left and right, rotation, clockwise, anti-
clockwise. Removes all the dust from the eyes, it strengthens the eye muscles. It's a cooling effect for

your eyes, reduces the eye strain. Trataka is a flame meditation. We are focusing on the lamp, focusing
on the light continuously. In the beginning, you will have a lot of thoughts, negative thoughts, in your
mind when you are focusing the light. After some time, all the thoughts will slowly reduces. You'll be
focusing only to the flame, and by closing off your eyes, you'll be able to visualize the same light for
longer period. It improves your concentration and it's the first step for meditation. The Harvard Health
publishing yoga for mental health. A journal, "Aging and Mental Health," by practicing relaxation
technique, it helps in depression, anxiety in older adults, and the effect is long-lasting. In a study
published in Oxidative Medicine and Cellular Longevity, researchers found that 12 weeks of yoga slowed
cellular aging. [Inaudible 01:00:20] in 2017. Conclusion, yoga, which is never born by any faith, religion,
one of the India's greatest gift to the world to attain the mind, body, spirit health.
Isaac (01:00:52):
Any age person can practice, these are very safe, medically proven exercises, postures, breathing
technique. In most of the diseases we could practice, depending on the body flexibility, one can practice
yoga. By practicing, it calms down your mind, it calms down your thoughts, it relaxes your muscles. It
helps for complete relaxation, improves the sleep quality. It's a tool to accomplish the higher purpose
and absolute freedom from the negative thoughts, from the diseases. The yogic and meditative practice
prove to be an immense importance for overall wellbeing and any [inaudible 01:02:17]. Thank you.
Speaker 1 (01:02:49):
Today, we are going to practice three important breathing technique pranayamas. We'll start with left
nostril breathing, Chandra Nadi Pranayama. We use the last two finger and thumb finger. Close your
right nostril with the help of thumb, inhalation through the left nostril, slow and deep inhalation.

Maximum amount of air we are inhaling in the final stage. Exhale through the right nostril, exhale out
completely, empty your lungs. That completes one round.
Speaker 1 (01:03:59):
Second round again, inhalation through the left nostril. As you inhale, your abdominal muscles are
bulging out, chest is expanding, your clavicle bones are moving upwards. Exhale through the right
nostril, exhale out completely. After full breathing technique, slowly bring down your right hand to the
normal position. Relax for a while, normal breathing. Chandra Nadi Pranayama, it gives cooling effect to
our mind, improves very quickly oxygen to your cells, tissues, organs.
Speaker 1 (01:05:11):
We'll go for Anuloma Viloma Pranayama, or Nadi Suddhi Pranayama. Alternative breathing, last two
finger and thumb finger. Close your right nostril, inhalation through the left nostril. After full inhalation,
close your left nostril, exhale through the right nostril. Exhale out completely. After full exhalation,
again, inhale through the same right nostril. Exhale through the left nostril. That completes the first
Speaker 1 (01:06:24):
Second round, we'll start from the opposite side. Close your left nostril, inhalation through the right
nostril. Slow and deep inhalation, you should not hear your own breath sounds. Exhale through the left
nostril. After full exhalation, again, inhale through the same left nostril. Exhale through the right nostril.
After full exhalation, slowly bring down your right hand to the normal position. Relax for a while, normal
breathing. Anuloma Viloma Pranayama, or alternative breathing, it stimulates the right and left
hemisphere of the brain. Very good exercise for your upper, middle and lower respiratory muscles,
clears up all the congestions that your airways.
Speaker 1 (01:07:56):
The third one, we are going to practice Bhramari Pranayama, making a humming sound like a female
honeybee by closing off your lips. We need to close our ears with the help of index finger, inhalation
through both the nostrils slowly. Take a deep inhalation. After full inhalation, bend your head and neck
forward. Lock your chin. Make a humming sound. Normal breathing.
Speaker 1 (01:08:55):
Second round, again, inhalation through both the nostrils, bend your head and neck.

PART 3 OF 4 ENDS [01:09:04]

Speaker 1 (01:09:03):
Bend your head and neck, lock your chin, make a humming sound. Bring down both the [foreign
language 01:09:31], making a humming sound. Release all the conditions at your throat, it relaxes your
facial muscles. Very good types of illnesses [foreign language 01:13:00] for anxiety, fear, depression. You
could feel the resonance throughout your body. With breathing exercises, very quickly oxygen improves
to the cells, tissues, organs, relieves conditions at your upper, middle and lower respiratory tract,
improves the diaphragmatic moment so that lungs can expand completely, constrict completely. You
could feel the free flow of the air in all the parts of the lobes. Normal breathing, and thank you very

Dr. Narran (01:11:07):
Hi. I'm Dr. Narran from Soul Care in Bangalore, India. I am a qualified Ayurveda practitioner, practicing
Ayurveda medicine for the last 30 years. Ayurveda is a collection of information on health management.
Before I go to Ayurveda, let me say a little bit about its origin. According to Indian tradition, we have
four Vedas called Rigveda, Yajurveda, Samaveda and Atharvaveda. Ayurveda is understood to be a
subsect of the fourth Veda that is Atharvaveda. Vedas are basically the treasure troves of information
for a happy and healthy living, and thereby attain the purpose of human life on earth. Ayurveda is,
again, a set of information for health management and treat diseases if at all one falls sick.
Dr. Narran (01:12:14):
It is to be noted that the very purpose or the primary purpose of Ayurveda is to preserve the good
health and attain the full lifespan of 120 years disease free. And secondarily, to treat the diseases
whenever or if at all, anyone falls sick. The definition of illness in Ayurveda is very unique. It says, "Any
unfavorable feeling is called an illness." And Ayurveda says there are three types of illnesses. One is
[inaudible 01:13:00]. [foreign language 01:13:00] is the physical diseases. [foreign language 01:13:08] is
the mental diseases or psychological disorders. And [foreign language 01:13:13] is the spiritual diseases
or shortcomings where we need some correction. So in short, the diseases are classified as physical,
mental or psychological and spiritual.
Dr. Narran (01:13:34):
Because the diseases are are classified that way, the management for them are also threefold. We have
physical illness management through procedures, detox procedures, what we call as Panchakarma. And
psychological or mental disease management through various procedures likes [foreign language
01:13:59] internal medications, and spiritual disease management through various kinds of meditation,
mantra meditation, prayers, spiritual practices in walking, divine blessings. Spirituality does not
necessarily mean religion or religious practice, it's end of the day the one self connecting with the
nature. So a healthy mind can only live in a healthy body and vice-versa. And for the mind and body to
remain in harmony, a spiritual health is very important. That's why any disease we treat, it has to be
treated from all three angles of spiritual, mental, and physical. That's why the World Health
Organization has come up with a new definition of health called health is a state of complete physical,
mental and spiritual sense of wellbeing.
Dr. Narran (01:15:11):
The role of inflammation in the formation of most of the diseases is now found to be very important
topic for discussion and research and studies. Even depression is now believed to be secondary to an
inflammation. If you look at the Ayurveda therapies, most of the therapies be it Panchakarma or other
treatment for psychological problems, they are all found to be anti-inflammatory in nature and helps in
improving the immune system in the body. In Ayurveda, apart from the detailed description about
physical disorders like autoimmune conditions, neurodegenerative, inflammatory disorders, Ayurveda
also talks about different psychological or mental conditions as well like different stages of psychosis,
hallucinations, split personality, bipolar effective disorders, and the management for them.
Dr. Narran (01:16:17):
When it comes to the management of it, whether it is a psychological disorder or a physical problem,
the primary requisite is to do a physical detox procedure using a Panchakarma procedure, because both
are complimenting each other. There is no treatment for the mind alone leaving the physical body aside

or the other way. And to overcome at the end of the whole process, there is a spiritual treatment also in
order to ensure that there is no relapse of the same happening. In most cases, we have seen that a
physical problem having a psychological base and a psychological problem having a physical base.
Dr. Narran (01:17:05):
The only occasion where it does not apply or the exception is the physical injury caused by an accident
or a fall or a trauma. But even in that case, a physical injury over a period of time can cause anxiety and
depression and other psychological problems. There can be certain situations where physically a person
is healthy, mentally no diseases, yet the person complains that I don't feel well, I don't feel positive.
That's where we need to start treating for the spirit.
Dr. Narran (01:17:46):
Ayurveda looks at human body as a single unit, and not one organ is different from the other or isolated
from the other. Similarly, when we treat holistically through Ayurveda, the treatment is not just for the
physical body, it goes beyond to treat mind and the spirit. In Ayurveda we have a concept of vata, pitta
and kapha which are basically certain qualities. When certain qualities increases in the body, then we
call vata has increased, vata has decreased, or pitta increased or decreased. When we talk about the
psychological problems or mental disorders, we can see certain qualities going up or going down. When
water is going up, it results in certain conditions what we call as anxiety, depression, et cetera. And
when the pitta is in derangement or it goes up, then we see diseases like hyperactivity disorders,
obsessive compulsion disorder and so on.
Dr. Narran (01:19:01):
Needless to mention, these psychological problems leave a mark on the physical body calling for some
physical management. And that's how in Soul Care we are able to achieve this complete health with a
perfect combination of Ayurveda, yoga, naturopathy, homeopathy and spiritual practices as well.
Ayurveda talks about two kinds of management. One is that when you treat a disease, that subsides at
the same time it gives rise to another problem. That is considered as improper treatment. The right
treatment is that you treat a disease and that gives a total relief from that, and it does not give rise to
any other problem.
Dr. Narran (01:19:54):
According to Ayurveda, a disease is formed in six stages Sanchaya, Prakopa, Prasara, Sthana Samshraya,
Vyakti and Bheda. And it's only in the stage five of Vyakti where the actual symptoms start surfacing. At
the same time, book says that you are to start treating a disease in the stage one. So obviously, one can
ask when in the absence of any symptoms, how do we start treating? This is called preemptive
management. When something goes wrong in terms of your lifestyle, your eating habits, your lack of
exercise or over exercise or whatever it is, anything that goes out of the way, that gives the first scratch
to the formation of a disease. So it says a real time correction is required. So if you feel anything has
gone off the track in your lifestyle, do a real time correction not leading to or not allowing it to
accumulate and result in or moving to the stage two. And stage two, in the absence of any symptoms we
again tend to ignore, it moves to stage three, stage four, and then the symptom starts developing.
Dr. Narran (01:21:20):
So Ayurveda always stands for a preventive care and wellness management. So that is why it insists on
treating any disease in the stage one. The bible of Ayurveda we call it [foreign language 01:21:42]. It

starts with a line saying [foreign language 01:21:47], that means the diseases of mind starting with
anger, jealous, greed, unhealthy competition, competitive mind. So Ayurveda say is any disease is
starting with a problem in the mind, and the treatment has to be started for that first. The basic concept
or approach of Ayurveda management is that the theory that the human body is the only machine which
can heal itself provided a right environment is given for that to happen. Ayurveda therapies or the
medicines are basically something that helps the body to heal itself, and not something that an external
agent that comes and challenges the system in correcting it.
Dr. Narran (01:22:51):
So to sum it up, I believe Ayurveda is the future of medicine, which is a holistic treatment for the body,
mind and spirit. And it is the right treatment, treats the system in the most appropriate manner, giving
rise to or leading to a perfect health. Thank you for patiently listening. I wish you all good health.
Dr. Wayne Kampers (01:23:25):
I think one of the things that came up for me is just how... And I think that it is certainly in terms of... I
think any work that needs to be done with people who are in chronic pain as the example is that it has
to be such an intentional approach, and there has to be a structure to people recovering. In terms of the
daily routine and the self-care routine that I promote is very intentional, because I think that without the
intentionality from the client or patient's perspective, there's not going to be that belief. There has to be
an act of participation. And I think that with all programs, I think that must certainly be a cornerstone, is
just how intentional it needs to be that people need to have a really compelling reason to take part. And
I think that chronic severe pain is probably a compelling reason enough for anybody to want to become
pain free, but that is not just going to happen without the real intentional aspect from their part.
Dr. Wayne Kampers (01:24:47):
We talked yesterday about the importance to have a digital detox in terms of that, but somatic detox,
environmental detox, all of the things that we've been seeing today, it literally is a detox from every
angle, nutritional detox, all with the real purpose of realigning and rebalancing a dysfunctional limbic
system in essence. And I think that to me is what comes across in abundance today. It's how much of
what you do and how many of the techniques and how many of the approaches you use are really
focused in on limbic system... A reset. And on really getting that balance back that is probably the root
cause of the problem in the first place.
Isaac (01:25:54):
Yeah, you're absolutely right. And that is true holistic engagement with whether you call a patient or a
client or a person, another person, another human being, going into all these aspects and helping them
to come out of it, transform them and liberate them from the chronic pain to incorporate what you said
to all these different points are very, very important.
Dr. Wayne Kampers (01:26:21):
I have a question that I'm interested in, is how one differentiates on a practical basis in terms of your
approach the difference really between all of the aspects of the mind and the spirit? In terms of all of
the work that you do, because in a sense, when one is looking at all of the aspects of the mind or looking
particularly at the complexities of the prefrontal cortex, and [inaudible 01:26:58] I'm very interested to
understand the difference in terms of how you address. I understand the concept between mind and
spirit, but how it addresses because is it part of not really focusing on the mind, does that not lead to

the spirits I think? Yesterday we saw some fascinating stuff in terms of the expansion of the mind with
psychedelics, which I suppose goes into other realms and spirits, and into parts of the external mind. I
just wanted to share from your perspective what your view is on that.
Isaac (01:27:37):
Yeah. What I felt is as I am not a trained psychiatrist or psychologist, being a holistic physician, I look at
always the totality of people's experiences. And yes, definitely in the mind we can much more easier to
identify and specifically understand the feelings and emotions and depressions, and all that things we
can easily get out of the mind. But what I felt is a lot of people, especially when you talk about the pain
management of chronic diseases, any chronic disease, I said, your mind is not just on the brain, your
every cell of your body has your mind or the spirit. So when you deal with that, you cannot deal only
with the mind, you have to go into every cell. To do that, then practices should be impact on every cell
of your body because your mind and the spirit is in every cell.
Isaac (01:28:32):
So whether it's a cancer treatment... For example, a lot of cancer treatment, I would sometimes say that
patient is suffering more from the fear and anxieties and everything than the cancer. So how do you
disconnect or link both and help them in the both process or healing of the cancer or healing of the
physical disease as a cancer, along with that all the mental complex situations and their fear, anxieties
and all kind of imaginations also? So it's truly interconnected.
Isaac (01:29:03):
So with my experience, I won't try to dissect and find out where is what. I would say that everything is
equally mixed together in their life. And when you go, one thing is connected with something else. And
always I notice because nowadays, I'm convinced that any chronic diseases you have to go to a deeper
level. Being a psychotherapist or psychologist, you may have a different wording for that but I'll say a
deeper level you have to go and bring it out. And when they identify... And not necessarily the physical,
medical treatment, as soon as they identify itself there's a lot of change happened to them and things
start to clear, which I noticed. [inaudible 01:29:51]
Dr. Wayne Kampers (01:29:51):
No, I think that what you say...
Isaac (01:29:55):
[inaudible 01:29:56]
Dr. Wayne Kampers (01:29:55):
Yeah. I think that what you said is absolutely spot on, because in terms of... There's an author, Candace
Pert, and she writes beautifully about the molecules of emotion. And really when you look at things
down really at a cellular level in terms of that... Yeah, our cells or our molecules of emotion, so
everything is absolutely inextricably linked. And in a way, we mentioned this yesterday, sometimes it
almost pay to not to even see the delineation between mind, body, spirit, soul is because they're
actually all just one collective being. And it's about we cannot address any part of a collective being
without addressing the collectiveness of the whole being. So for me, this has been... And I hope
everybody else is the same. For me, this has been an absolutely fascinating insight especially into yoga
and especially into meditation and just into the complexities of how many different types there are. And

I look forward to watching all of this stuff on the Ayurvedic stuff, because again, I think virtually the anti-
inflammatory nutritional approach which I think Ayurvedic nutrition offers is a key part as well of this

Dr. Wayne Kampers (01:31:20):
So I'm mindful of the time. Thank you so much, Isaac. It's been a wonderful experience having this and
I'm deeply grateful to you for sharing your knowledge and your expertise, and the other people who are
on the show as well. I'm very thankful. So we'll take a break for 15 minutes and then we'll reconvene.
Thank you.
Isaac (01:31:46):
Thank you. Thank you so much. Thank you. Thank you for inviting me. Thank you.
Dr. Wayne Kampers (01:31:49):
Thank you.
Dr. Wayne Kampers (00:00:00):
I am absolutely delighted to welcome Dr. Christiane Wolf. And before I go any further, today is her
birthday. So I just would like from all of us to wish her a very, very happy birthday.
Dr. Christiane Wolf (00:00:14):
Thank you.
Dr. Wayne Kampers (00:00:16):
So a little bit more about Dr. Wolf. She is a medical doctor and a board certified OB-GYN, who also has a
PhD in psychosomatic medicine. She's a renowned mindfulness and Insights and Vipassana meditation
teacher, who is also the lead consultant for teacher training at the National Mindfulness Facilitator
Training at the US Department of Veterans Affairs. That was a bit of a mouthful. Okay. She's also author
of a very, very good book, which I've thoroughly enjoyed, called Outsmart Your Pain: Mindfulness and
Self-Compassion to Help You Leave Chronic Pain Behind. And she's also the co-author of the classic
training manual for mindfulness teachers, A Clinician's Guide to Teaching Mindfulness.
I'm really looking forward to her knowledge on key areas in the recovery from chronic pain. I focused
mostly yesterday on the definition of chronic primary pain, but I think it's crucial to reinforce the
differences between acute and chronic pain. And so Dr. Wolf will impart her knowledge on this and also
her knowledge on mindfulness meditation and describe the key research about the influence of
mindfulness on pain. She will examine the three layers on how mindfulness reduces pain and describe
the role of interoception in processing of chronic pain. So Dr. Wolf, I'm really, really, grateful that you
have joined us. And over to you.
Dr. Christiane Wolf (00:01:59):
Thank you so much. Thank you so much. Very, very happy to be here. I just want to say that, for me, it
makes always such a big difference whether we're practicing in community or we're practicing by
ourselves. And I have to say, so before the pandemic started, I would not have thought that we can even
create community in the same way online. And I had to learn otherwise. And I've taught many retreats
since then online. And I think it's just really lovely to feel the connection. So even if you're in front of
your screen, just knowing that, at least at this point right now, there's other people here at the same
time. And I think that is just wonderful that we are together.
And so I just want to invite us to feel into our interconnectedness. And so actually, as I was sitting more
with the topic of this talk, so I know that the speaker who will come after me, Les Aria, he actually,
there's a lot of overlay or overlap with my theme. And one thing that I think we haven't really
mentioned and I haven't put that into the writeup is actually the role of self-compassion in chronic pain.
And I think that is really crucial and is often overlooked. So I will create some time today also to bring
that in.
So if you have questions, I actually really love to answer questions. So you can write them down, you can
email them to me or you can email them to the organizers here and then they will pass them onto me
and I will make sure your questions get answered. All right. Actually, I would like to have us all start with
a short grounding meditation. I find that is really helpful to do at the beginning of a presentation so that
we really become present. So just for a couple of minutes, just inviting you to just starting from the

outside. So from hearing, from seeing, being here with that presentation, to just bring the awareness
inside and become aware of the body in this moment. And if you like, you can close your eyes. You don't
have to do that.
And starting to just bring the awareness to your feet, your seat, just noticing where the body has contact
right now with the chair or whatever you're sitting on. And if the breath is a good anchor for you, just
inviting you to start noticing the sensations of the breath in this moment. Maybe just lengthening and
deepen the breath just for a little bit. Really sensing the breath so that the breath is not an idea, we're
not thinking about the breath, but actually feeling the breath. And then, in a moment, I'll be ringing a
bell here and that will be the end of our short practice. Let me just...
All right. So I hope you feel a little bit more present. I definitely do. Okay. So let's dive into the slides
here. So this is something that is something that many of us in the field deal with, that if there was an
easy solution to getting rid of pain, we would do that. And it often feels like we actually give over our
power to the healthcare system. And I often have that people will come and say, "Fix me. Do this for
me." And of course, we're very grateful for the advances of western medicine and also of eastern
medicine. But lifestyle changes are actually quite hard. And a lot of people, it takes a while for them to
actually embrace lifestyle changes.
So I really want to start really in on a very basic level. So this man here, his name is Dr. Jon Kabat-Zinn,
and he is really instrumental of bringing mindfulness to the west. The mindfulness is not new. It comes
from the Buddhist tradition, so it's over 2,500 years old. But Jon Kabat-Zinn really had this insight in the
late seventies that if we would just take all the vernacular and the religion out of yoga and out of
Buddhism and would just used terms in plain English, that would be so much more helpful for many
And he founded a program that's called Mindfulness-Based Stress Reduction, which is the gold standard

for mindfulness classes. So if you're hearing about research in mindfulness and you hear about an eight-
week class, that usually is an MBSR class. So his definition is really, mindfulness is awareness that arises

by paying attention. So it's a very particular way that we're paying attention on purpose. It's just the
present moment and it's non-judgmentally, and it's in the service of self-understanding and wisdom.
And what are we doing when we do mindfulness meditation is, so we choose an anchor in the census,
for example, the breath. So that's what we just did. Doesn't have to be the breath. If we use the breath,
we actually don't manipulate it. So it's not like yoga breath where we have... and I invited us actually to
breathe a little bit longer and deeper, but that's not the point. It's just the way that we can really
connect with the breath in a felt sense, and then we let go and we just pay attention. Because what we
want to do is we want to pay attention to what is actually here, compared to what our mind is telling us
in that moment. And because, where does the mind go when we're not present? The mind goes either
into the past or goes into the future. We call that rehashing or rehearsing.

So we direct the attention to the anchor, we sense the anchor with an attitude of curiosity and non-
reactivity, that's really core. Yeah. So we're just saying like, "Oh, what is here?" And this is really crucial

as we're later looking into how do we work with pain. So we notice when the mind has wandered off,

basically when it's not on the anchor anymore and there's no blaming, the mind will wander, we know
this, lots of studies about that. We also know the wandering mind is not a happy mind. And then we
bring it back. We redirect it. So very basic. So here, gone, here, gone.
And the mindfulness actually has two parts. It has a aiming part. I can aim it onto something that I want.
And then a sustaining part. Aiming part is usually easy. So if I want to feel my breath, I can do it.
Sustaining, staying there, not that easy. So that's the basic. So this is something what's very interesting.
So relaxation is actually not the main goal of mindfulness. We get very confused with that right now
because we have all these really very helpful and wonderful apps, and there's a lot of really relaxation.
So I see a lot of teachers teaching something that's like, "Oh, you need to relax the body." The problem
is we can't make ourselves relax the body. Have you tried relaxing? And then you're just like, "Oh, I can't
relax." And then you feel like, "I'm doing it wrong. I can't do. What's wrong with me?"
In particular when we have pain, really hard to relax because it's really hard to be in the body. Period. So
actually awakening or wisdom is the main goal of mindfulness. And the paradox is, when we're relaxed,
it's a lot easier to be mindful. So when we're in pain, it's actually quite hard. When we are tense, it's
really hard. When the mind is going like a 100 miles an hour, it's really hard to be mindful. So what we
do is what we call the paradox of relaxation. So we give ourselves permission to not relax, but just to be
aware of what it feels like to not be relaxed. It's like, what does it feel like to not be relaxed? With
curiosity and non-reactivity.
And then, as often, what happens is, you know how that goes, you know you can't force yourself to fall
asleep. So the process is very similar. So we set the conditions and then we need to let go. And that is
not easy in itself. And then that is something we can train. So I actually want to do a little exercise with
you. And so just because what we want to talk here about is, how are we relating to our pain within
ourselves? So this is really what I want to be our core message of my talk today.
So what I want you to do is, I want you to make a fist. And so let's say this is the pain or this is the
tension that you have. And then you are in yourself. You want to get rid of that pain. So you really,
really, really don't want to have that pain. And so this is the part that really, really doesn't want to have
the pain. So what do you normally do? So you have all these fingers and you want to get rid of this. So
let's do this. So try to make that hand open and relaxed. And this hand doesn't want to open and relax.
So try to [inaudible 00:13:19] fingers open and just see what that feels like and what it feels like for both
hands. And get a good sense. I think I got a good sense just like that. Yeah.
All right. So let's shake that out. All right. And now, do it again. Here's the pain. There's a tension. And
now what I want to do is I want to relate to this pain in a different way. And the way that I want to relate
to that is, do this, make a cradle and rest your hand, the pain hand, the tension hand, the stress hand in
it. And then just take a moment and just feel again into both hands. Do you notice a difference? Yeah. Of
course, that would be a great moment to check in with you and hear about what that was like. Often
what I hear, and definitely my own experience is, is this is a fight. Yeah. This is frustrating. I can't make
this. This feels even tighter when I try to do this. When I do this, this is a lot less work. And often what I
hear is people say like, "Oh, now the hand wants to open. It's really hard to stay really tense and keep
fighting when I am in this warm, soft holding environment."

And I want you to keep that in mind. I think that is just such a great reminder around how are we
relating to ourselves with the pain that we're having. All right. So from here, I want to go a little bit into
a equation that I find super helpful. It's a little bit provocative. And so I want you to come along with me
here. So suffering equals pain times resistance. I did not come up with this. This is from the wonderful
meditation teacher, Shinzen Young, who's also a mathematician. So no wonder he comes up with an
equation. And when he put this into an equation... And basically what we're doing here is we're
separating pain from suffering. And this is really important.
So usually, we use the words pain and suffering interchangeably. And what we want to do here is we
want to say, "Well, pain is a part of life." So we have to have pain. Our bodies, it's really important that
we are able to feel pain. If we can't feel pain, there's a genetic condition where people can feel pain,
they get hurt all the time because their danger protecting system doesn't work. So we really want to be
able to feel pain. So we say pain is a constant. And now I want to ask you, in your own experience, life
experience... So we could say resistance, or we can also say worry. So if you have pain and you really
don't like the pain, you're pushing against it, you so badly want to get rid of it, or you worry really badly
about the pain, what happens to suffering? Goes up, doesn't it? The more we don't like it, the more we
fight against it, the more it goes up.
So now think about, again, same pain, for whatever reason, you just don't resist it so much, you don't
fight against it so much, what happens to suffering? Suffering goes down, doesn't it? And now, let's just
play with this a little bit more. Since this is an equation, so imagine there's pain and you have zero
resistance against it. What happens to suffering? Zero suffering. No? Do you believe that? You're
probably, "No, I'm not sure." Let me give you an example. So actually I had somebody, I was just the
That last week, I did a podcast with somebody and she said, "Oh, I have a tattoo." And she lift it up her
arm and she had a tattoo on her forearm and she said, "You know what? I totally get it. If I would have
the sensations that I had while getting the tattoo without any context, I would be really upset. I would
really think there's something wrong, that shouldn't happen. But because this..." She had, I can't actually
remember what it was, but something that was really meaningful to her to the point that she wants to
have it visible all the time. And for her, there was pain. Yes, getting a tattoo on the sensitive skin of your
forearm is painful. She said, "No suffering."
And often when I ask people, give me other examples, people say like, during childbirth, for example, or
doing a hard workout. So if you're doing a hard workout and the next day you're really sore, if you
wouldn't have done that workout, you would go like, "Oh my gosh, there's something wrong with me."
But now you could say, "Yes, I worked out. Actually, I earned feeling this pain." So that is really
important to keep in mind. So what is pain? Very simplified. And I know you've heard lots about pain,
lots of different definitions. So I just want to give you a brief version here.
So basically, really important, the pain is the body's way to tell the brain, "Pay attention." Very simple.
Yeah. And what we know is, and a lot of people actually don't know that yet, is there are actually no
pain receptors, but danger receptors. So what we call nociceptors, which we usually translate as pain

receptors, what it actually means? Noci means danger. And it means danger, basically body saying, "Hey
brain, something might be dangerous. Let's pay attention to this." And it's up to the brain to decide if
this is painful and how much.
So a student recently told me in a class, she said, "Oh, now I understand. I understand that between my
body and my pain is my brain. So it gets filtered through that." And your brain's main job is to keep you
safe. And so here's something from pain research, which again, it feels very counterintuitive. So I find it's
very important that we know this. So when we have acute pain... So let's say you step on a thorn or
something. Yeah. That hurts. What you do is you pull your foot off. And basically, your brain has done
that job. It has protected you from getting further injured.
And then there's another element to it. So in acute pain, there's a direct correlation between the
amount of tissue damage and the amount of pain. So if we're like, let's say you get a paper cut, little
injury, that hurts. Yeah. But it's not that bad. If you cut yourself cutting vegetables, you got to like deep
cut, that hurts a lot. Yeah. So direct correlation. Really important. That is also not happening anymore
when we have chronic pain. So in chronic pain, that link is broken. So we're saying acute pain is
protective, chronic pain is overprotective. And this is really our brain tries to get better at detecting pain.
So, you've heard a lot about neuroplasticity. So neuroplasticity is always on. And since your brain's main
job is to keep you safe, it is trying to get better and better at getting you safe. And so the signal is really
dialed up in chronic pain to a point where we see in research that people with chronic pain or the brain
of people with chronic pain makes something into pain that is not painful for somebody who doesn't
have chronic pain, which I find really interesting. So sensations, even just like stroking, for example, can
be seen as painful for the brain in a way that, again, if you don't have that, that is not painful. And so a
lot of this training is really around down dialing, basically letting your brain know this is not dangerous,
this is not dangerous.
So we know chronic pain triggers can be about anything. So everything can make the pain worse, can
trigger the pain. Sometimes it does, sometimes it doesn't. Can be quite unpredictable. The good thing
really is that we can work with this. Neuroplasticity works both ways. So if the brain basically trains itself
to become more and more sensitive to pain, we can also dial that back. Yeah. So this is something... I
was actually at neuroscience and mindfulness conference in San Diego last week, and just some take
home points around how mindfulness works with chronic pain. So one thing that we do is attention
control over automaticity.
[NEW_PARAGRAPH]And what that means is we are breaking the autopilot. So your brain, again, just
tries to keep you safe. And then it starts to have a pattern around physical sensations. And what we are
doing here is we're... Right? So autopilot, we're very grateful for autopilot in general. So we need
autopilot for habits. For example, remember when you learned how to drive, you're probably very glad,
I am very glad that I don't have to think about which is the gas and which is the break anymore. So that's
on autopilot. Great. But here, we want to interrupt that, and we want to interrupt that actually also
when we're living our everyday life because autopilot takes over in situations where we don't want to be
on autopilot.

For example, how many of you have ever hugged a loved one on autopilot? Guilty. Right? I'm guilty. And
we don't want to do that. And have you ever been hugged on autopilot. Right? I have. And it just doesn't
feel good. And so, these are the things when we practice mindfully on a regular basis, so we're not just
practicing it in order to work with our pain but we actually want to be mindful, more generally mindful
in everyday life so that we can really be more present for these things. So what we do here is, again,
instead of going into contraction avoidance, that is what we do usually around pain, we do this exactly
what mindfulness does is we become curious and we turn towards, which is very counterintuitive. I
don't want to feel it, I want to pretend it's not there. And I will show you some of the, actually,
outcomes of what happens when we do that.
So we want to shift from effective to sensory processing. And what that means is, instead of saying,
"This is bad, this is killing me, I need to get rid of it," which is, that is all what we say effective, we want
to be able to come back to actually sense it in this moment. And one of the reasons why we don't want
to sense it in this moment is because we go like, "Oh, this will go on. This will not stop." But when we're
looking into this, what actually happens is we are now caught in a thought about the future. The future
isn't here yet. And so in this moment, as I'm feeling the sensations of pain, I can really break that down
and say like, "Okay, let me just stay with the sensations and become more aware of what is actually the
story, what is an emotion, and then what is the sensation in this moment?" And that is really important.
So I will share an example with you with one student that I had years ago, but that so stuck with me, and
a patient with IBS, so inflammatory bowel syndrome, which is very, very painful. And so, one day, she
came in and she was just like, her face was like, you could just see like, okay, something was going on.
She looked really sad. She looked hopeless. And then we meditated together and she softened a little
bit. And then afterwards, I asked her and I said like, "Okay. So there's something going on in your body."
She said Yes. And then I said, "So if somebody who had never had these sensations before that you're
feeling right now, what would they think?" Then she went inside and felt into her stomach, into her
guts. And then she said... And that was really a moment, she got very teary-eyed about that. And she
said, "They would think they have an upset stomach."
And for her, that was really an aha moment because, in that moment, she noticed it was not the
sensations that were so upsetting. I mean, nobody wants to have an upset stomach. But what happened
for her in the morning was, it started and her brain went into, "Oh my god, the last time I had this, I had
to miss work. Again, I'll lose my job, I will not be employable, I can't pay my bills. And I had to go to the
hospital and I got these medications, I had such bad side effects and was so terrible. And what's going to
happen with me?" That was what was happening for her in that present moment.
And so when we're able to really see what is here, then we can manage it more. Because of course,
sometimes the pain itself, the sensations are really, really terrible. But very often, the physical
sensations are not that bad when we're actually checking in with them and when we're separating,
again, the emotions and the thoughts out. And there are practices, mindfulness practices that can work
with both these parts. So this is a really important part too. So what we are doing is... And then this is
pretty much what I already said.
So one term in neuroscience that's definitely something to keep in mind is the default mode network.
And what the default mode network is, there's several areas in the brain that they found, the

neuroscience found, when we are not doing something specifically aimed, so basically we are left with
our phone and just thinking about whatever, our brain will think about basically things and how it
relates to me. So it's like the I, me or mine story that is happening in that moment.
And what we do with mindfulness and they've shown that with meditators, we interrupt that. We
interrupt that and we can, in this moment, we are shifting to this is what it feels like in this moment. And
you see that I'm not even saying this is what is happening to me in this moment, but what we're learning
is we're learning to relate to sensations, it's like, "Oh, there's pressure here or there's tightness here or
there's heat here," which is different than saying, "This is my pain, my pain story, past, future, and I can't
get away from it." So that's the identification piece.
So this is a very interesting piece here. You don't have to go into the weeds with that. So you get all the
information without looking in detail here. But what they found was that... So they did MRI studies and
looked at people when they first came in with lower back pain. And then they did it again after a year.
And what they could see that for the people who weren't able to resolve the lower back pain, some
areas in their brain started to shrink because they weren't used anymore. Very fascinating. And what
that was is, this is really important, was so in chronic pain or when pain becomes chronic, we stopped to
actually feel the sensations. The sensations of pain.
And here's the bummer, if we stop sensing the body because it's so painful... Again, makes total sense,
we don't want to feel it. So we try to get as far away from the body as possible, living all the way up in
our head. That only works to some extent, but it works to the point that we can measure the shrinking
in our brain. When we can't feel the pain, we also can't feel pleasure. And that is something that I often
hear from people with chronic pain is that they say also it's really hard to feel joy and to feel pleasure
because that is also something that we feel in the body.
And so, the parts of the brain that are shrinking, so what I want to pay attention to is in particular what
is called the interoception. And interoception is... So exteroception is everything from the outside. So
environment, or comes in through our senses. So people probably know that term. Less people know
the term interoception. And what it is, is, it is the sensation from inside the body. So from the GI tract,
proprioceptions, we know where our limbs are in space all the time and it's the felt sense of the body.
And this is a really hot topic in neuroscience research because there's a lot of, in general, good stuff
happening with interoception. But first where we need to go is, so very often is, we can't feel the body
at all. So it's kind of numb.
So often when we start practicing mindfulness, people feel into the body, and go, "I don't really feel that
much. No." Right now, if you feel into your lower legs, you might go like, "I guess I have lower legs. Let
me check." Yes, they're there, but we can't feel them. So that's very normal. Or it's too intense. So if you
have chronic pain, it's too intense. If you suffer from anxiety, it's too intense. There are certain
conditions where it's just like, "No, I can't be with this." And in particular, if we are working with trauma
in our nervous system, trauma is a sign of overwhelm and it is really hard to be with. And I know other
speakers are addressing that part more. But really it's hard to be present.

But what we want is actually we want to be present in a body that it feels good. So the MAIA score, I
thought I just put that in here in case folks are interested in that. It's called the multidimensional
inventory of interceptive awareness. It's been developed through UC San Francisco, and you can get it
there, do the test. And it's statements of different areas because we can be in the body in a different
way. It's something that we call embodiment. Yeah. So if we say somebody is really embodied and really
feels at home in their body. And the MAIA score is trying to figure what that is actually to make it
measurable. And it has these different statements. And you can see body trusting.
So this is like, "Oh, I could trust my body." Attention regulation, emotional awareness, all of this happens
in the body. So very, very fascinating. And so mindfulness practice and compassion practice, I should
actually add that here, compassion practice, self-compassion practice, increases the good kind of
interoception in the body, which is like, "I'm feeling good, I'm feeling safe, and I'm feeling at home in my
body." That is, I think, what we all want eventually. And there was one statement on this conference
that I really liked. One of the researcher put that there. So your body wants to tell you something, you
just have to listen and to be able to trust what it is telling you. And you might right now go like, "Oh
yeah, that's a hard one." I've learned, and I know a lot of people with chronic illness, chronic pain, it's
just really hard to trust the body.
And I think it is often when I ask people, "So when did that start? Did that start with a chronic pain or
the chronic illness?" Often I hear like, "No, it was hard before. I didn't have the best of relationships with
my body before." For many, many different reasons. And we also, I think, have to say we live in a culture
where, with all the... I mean, body positivity is totally new, really. Yeah. But we come from a culture
where there's a lot of like the body is sinful, shameful, dirty, especially women's bodies, over the
century. So I think we are carrying a lot in here that makes it really hard to relate to our bodies and to
feel really at home in our bodies.
So this is just a slide, just an example so you get a sense of what kind of questions, what the MAIA score
looks like. So yeah. Again, if you're interested, you can put MAIA score also into Google and you'll find it.
So self-compassion is a concept that, over the last maybe 15 years, a clinical researcher, clinical
psychologist, her name is Kristin Neff, came up with. I mean, self-compassion is obviously also nothing
new, but it was new to really bring it into the research field, to bring it into the therapeutic field, and to
bring it into the general population. So they, Kristin Neff and she teamed up with Christopher Germer, a

wonderful Dharma Buddhist teacher as well, and they developed also an eight-week class on self-
compassion, which is called Mindful Self-Compassion.

I also teach that and I can really recommend that. It's a wonderful class, especially for those of us who
have a hard time being a good friend to ourselves. And she came up with these three components of
self-compassion. And so she said the first one is self-kindness versus self-judgment. Yeah. So usually,
we're really hard on ourselves. And what we want to do here is we want to basically treat ourself the
way we treat a good friend. So we have an exercise where we have asked people, "So something, a good
friend comes to you and says like, "Oh, I messed up. I did this thing. I feel so bad, I feel so ashamed. I'm
like, 'what's wrong with me?'" How would you talk to that friend? Or how would you treat that friend?"
And usually we go like, "Oh my God. I'm so sorry. This is not who you are. We make mistakes or bad
things happen." And we might hug them. We might be really kind and compassionate to them. And then

we'd say like, "Okay, now imagine you're the person who made that mistake. So how are you talking to
yourself? And what are you saying to yourself? What are you believing about yourself? What's your tone
of voice with yourself?" And it's quite a stark difference. So it's often like, "Oh my gosh. Wow. I would
never say out loud to a friend what I'm saying to myself. And when I make a mistake, I think there's
something wrong with me at the core." Yeah. There's something, like, "What's wrong with me?" Instead
of saying like, "Yeah, we make mistakes and this has nothing to do with how I am as a person." So, it can
be very powerful.
And then what is really is... And this is why I started actually my talk saying like, let's remember we are
here together. Let's just actually take a moment and just feel into, we are here together. Even if we can't
see each other, we are here together in this moment. And we are sharing something, we share this
human experience. And many of you have pain, many of you suffer from pain and you are not alone in
that. And we know that that is one of the core pains that is added to chronic pain is that it makes us
often feel so lonely and isolated. And often we don't know another person who has this particular pain.
And the self-compassion practice reminds us that no matter what you have, there are so many other
people who experience this at the same time. And this is not to say your pain is... right? That others
have it worse. That's what I heard as a child. Like, "Oh, what do you have to complain about?" That
wasn't helpful. So to say like, "Oh yeah. I'm not alone in this." And we all know this wonderful feeling
to... Or I make assumptions, but I think a lot of people know this. So if you're just holding something
that's really hard, and then finally you share with somebody that you trust and they look at you and they
go like, "You know, me too. I have that too. Or I did that too."
And just the immense release that we can have in that moment of just like, "Oh, thank you. Thank you
for saying that." Yeah. That's why support groups work so well. Yeah. That's one of the core... Yeah.
That's the shared humanity. It's not just me. And there's something really weird, right? Because nothing
has really changed about the pain, and yet we feel more buoyant. We can handle things maybe a little
bit better because we know we're not alone.
And the third one here is actually the mindfulness. It's just like, yeah. We can say, "Yeah, this is painful."
Right? Instead of the turning away and to pray, "Oh no, I'm fine, I'm fine, I'm fine." Just like, "No, I'm not
fine. And this hurts." And to be curious, turn towards it and say, "This is what's happening in this
moment." So what I'll do then is, I'll actually guide us through a practice. And what I'll do is I will weave
in the self-compassion. Because basically, there is, in my book... So these are the official three steps of
mindful self-compassion. And there is, in my book, fourth one, for basically all of us, but particular for
those of us who have chronic pain, which is supportive touch.
So again, most of us know the experience that if we're in pain and we have a loved one there who can
hold our hand or who can hug us, just the physical contact is really helpful. And as a human species, we
are hardwired for supportive touch. We know that babies can't survive if they don't have a minimal
amount of really being held. We actually have fibers in our skin that respond to a particular pressure and
frequency, which we could call stroking, of course, only if that works in a good context. So if, I don't
know, a family member does that or loved one. This just go like, "Oh, this is wonderful."

If the person on the bus next to you does this, different thing, sensations. So that comes back to, the
brain actually will tell you what is the context. Okay. All right. And then what I want to do, so I want to
just practice a little bit of self-compassion, and then I want to teach you practice to, which I call zooming
in and zooming out that works really well with chronic pain and is about physical sensations and staying
with the interoception of the body in that moment. All right. So let's practice.
So we'll practice about, let's say, 10 minutes. Okay. So actually what I would like to do then is to tease
that out. So instead of just lumping it together into one practice, and we actually have the time to do
two shorter practices, so you can really put it into practice and we do this together. So then let's start
with the self-compassion practice. And this is self-compassion for pain practice. So first of all, I want to
invite you to get as comfortable as possible. So if you're in a chair or in a position that works for you,
that's great. If you want to stand up... So sometimes, actually sitting in a chair doesn't make the pain any
better. So you can stand up. If you want to lie down for this, this can also be really nice.
And actually, just asking yourself the question, "So what's the right body position right now?" So that is
already right on the track because your body will let you know. Not your head goes like, oh, that we
should be doing this, but check in with your body. And if your body says like, "Oh, lying down would be
really nice," then go for that. Yeah. Okay. So what we are starting with is supportive touch. So just
before we go in, it's, I said, really helpful with other people, but we can give that, at least to some
extent, the same supportive touch to ourselves. And I think we often do that automatically. So for
example, when we get bad news, we often will do like, we will cup our face with our hands or we do
this, we go like... Right? So we are holding ourselves.
And so this can be different ways. Some people might like to hold their face. If you've been around the
meditation communities for a while, you've probably been invited to put a hand on your heart. Yoga
class is hand on the heart, hand on the belly, something like that. Again, there's no right or wrong way to
do it. It's just like, ask your body. So really like, what does your body respond to? Stealth. Supportive
touch is holding your own hand. So I often do that when I'm giving a public talk in-person and I'm really
nervous before. So I sit there holding my own hand. People just think I'm just sitting there, just having
my hands in my lap and I do a little squeeze and internal self talk, saying like, "You got this, you can do
And what we want to do when we have pain is to use the supportive touch on the place where the pain
is. So it could be your neck. Or if you reach it, you can put it on your lower back or you can put it on your
belly or you can hold your... Right? Really. But the idea is really, can you touch yourself with care? Yeah.
So it's really about this gesture of presence and of care. So yeah, just inviting you to just experiment
with that a little bit. And feeling that support of you using the touch. So just letting yourself feel that
there's actually a supportive hand.
Your hand might be cold or warm. And just really sensing that there is a hand with this intention of
presence and friendliness. And this is really, if you remember back to the exercise we did in the
beginning, just making a nest, making a holding environment for your pain. Just like, "Ugh. Yeah." And so
coming back to the three parts of self-compassion, so maybe we just start with just acknowledging that
there's pain. Yes. Instead of turning away, we're turning towards and we say, "Yes, this hurts. This is a
moment of pain, this is a moment of struggle." And just letting that sink into. You're acknowledging that.

Letting that sink into your body, into your system. Is this being heard and acknowledged? Maybe just
ouch, ouch.
And you can already see that we can already weave in the self-kindness into how we talk to ourselves. If
it doesn't feel like too hokey, even say like, "Oh sweetheart, I'm so sorry, this really hurts. This is a
moment of pain." And then, the next step is really the shared humanity. And so, first of all, just to... I
mean, we can do it in a more generalized way. We can say pain is part of life. I mean, if I say there's
nothing wrong with you, I know you have immediately parts that go like, "No, I do have something
wrong." So I do want to respect that. But it's not a mistake that we are in a human body and we have a
human heart and we feel pain. That's what I want to convey.
And you can also just be very specific with your pain actually. And you could see how does that feel to
say this is what it feels like for, and then you fill in your specifics to feel this. Also, you could say, "This is
what it feels like for somebody to struggle with migraines." Or if you're working mainly with emotional
pain, you could really just be very specific and say like, "This is what it feels like for a mom to know her
child is struggling." So it can be that specific. And again, just letting that resonate in your body or see if
that is possible, inviting that to resonate.
And if you like, you can, in your mind's eye, call to mind all the other people who are also struggling with
what you are struggling with. And sometimes, you can imagine sitting in a circle with them. Or I like to
imagining them at my back, reaching back, it's just like, ugh, yeah, there's so many people who know
exactly what this feels like. And letting yourself feel that you're, whether you like it or not, you're a part
of that community and you're not alone. That's the key message. You're not alone.
And then the third part is just, again, you can just... Maybe you're already doing that by infusing your
words with kindness, with softness, or you can add another phrase or word, just like, "May I be kind to
myself? May I not abandon myself or parts of myself?" And then just for this last minute or so, bringing
your awareness back to either your breath or another area in the body that is not in pain and that
doesn't feel overwhelming. Just using that as an anchor that is still in the senses.
Okay. And then, coming out of that. Again, I would love to hear from some of you, but that's
unfortunately not the format that we have today for this. But if you want to share, again, feel free to
reach out. And honestly, sometimes the pain can be so bad that we can't be mindful. We can't practice
mindfulness, but we can practice self-compassion. And two things really important. First of all, we can
learn self-compassion, we can learn compassion. And it's something that's trainable. So if you feel like,
"Oh, I really can't, I never did it, it can be really hard." Actually, for a lot of people, it's really hard to do
that. So it's trainable, it's teachable.
And the other thing is that we can't, just like, coming back to relaxation, coming back to sleep, we can't
make ourselves feel compassion. We can invite it in. And this is where people often get confused
because, as I said earlier, we have agency over where we place our attention. So the aiming and
sustaining part of mindfulness doesn't work the same way with compassion. And then that's often,
again, why people think like, "Oh, I can't. I'm bad. I'm not made for this." It's just like, no, no, no. What
we do with compassion is, it's an innate capacity that we have. And the fact that you're probably very

compassionate to other people says like, okay, the compassion muscle totally works. We just have not
learned to address it to ourselves. And that is learnable.
And just doing these exercises, actually that will teach you how to be compassionate. So even if you
didn't feel anything right now, totally fine. You just keep doing it. Yeah. That's the beautiful thing, again,
about neuroplasticity and repetitions. Repetitions work. Repetitions do work. Okay. Let me see. Are you
all up for doing the other practice right to the back of this, and then I'll sum it up with a little bit... I have
a couple more slides about the zooming in and zooming out, and then we can wrap it up.
So if you're in your meditation posture, great, stay there. And we'll go right into the next meditation. I'll
just grab my water bottle here. I'll be right back. And actually, I was thinking if the self-compassion
practice was helpful for you and you could soften into it, and it might have even been a sense of
relaxation. Again, I know not for everyone, but I'm sure for some of you, because I've done this often
enough to know that. That actually will probably make it easier for you to do the next exercise. So I'm
actually really glad we're doing it in this order, which I hadn't planned. I had planned to do it the other
way around.
All right. So this next practice. So let's just go right back into body awareness. So again, really important.
Exteroception is always there for you. So you can be mindful with exteroception. You can see, you can
hear. And what we do here.. So the attitude that we want to do is actually, it's receptive. So you can see.
You could say like, "Oh, I see the light, I see the door, I see the window." Or you can really become
aware that seeing is happening. Now just maybe do that for a moment. So instead of looking at
something, let seeing happening. So the moment you open your eyes, seeing is happening. You're not
doing that. So just to bring that kind of receptiveness into the meditation.
So if it's too hard to be in the body with your eyes closed, with the interoception, start with the
exteroception. Totally fine. But if it's okay to close your eyes... And remember, you can always just open
your eyes, look around, come back to the breath, reorient yourself, stop the meditation. That is all really
important for you so that you are in charge. Yeah. So it's not like one right way. But the question for you
to ask yourself is always, what helps you to stay present? And it's different for different people, and it's
different at different times. Yeah.
All right. So what we want to do now is, as you are inviting the awareness inside the body, maybe let's
just start with connecting with the breath, if that feels okay for you, and the whole body in this moment.
And then what we're doing now is we do what I call zooming in. So what we do... And again, if it's too
much, you just come out. Zooming in is now turning your awareness to where it hurts. And you don't
have to go right to the core. You can hover at the edges of the pain, if there are, like borders, which
most pain actually have borders, and bringing this curious, non-reactive attitude towards it. Maybe
checking your attitude first.
And often when we start turning towards the pain, what we find first is resistance and fear. And so
sometimes, just naming that can be helpful. Say like, "Oh yeah, there's resistance," or, "Oh, there's
fear." Yeah, of course. So your system has learned to fear or to resist those sensations. And then see if
you can actually, what we call this a sensory tracking, if you can track the sensations, the actual

sensations of what you call pain, in this moment, just in this moment. Don't even call it pain. And see
what kind of qualities are here. Let's start with the size. So what's the size of the discomfort?
And if you don't have pain right now, you can just play along so you get an idea. So what's the size? And
then noticing the shape. And you can just sense it, feel it, or you can label it. So you could say like, "Oh,
it has the size of, whatever, golf ball or quarter or an orange." And then what's the texture? Does it have
a texture? It's like rough or smooth. [inaudible 01:04:17] temperature. Is it tight or loose? Is it solid or
liquid? Anything else? Does it have a color? What else can you notice about this sensation or this
conglomerate of sensations? And then notice, do these sensations stay the same? Yeah. Do they
change? Are they solid? Do some of them change?
And now, inviting you from the zoom in state, which is very detailed, very detailed, to now zoom out.
Zooming out. So making it bigger, going beyond the borders of where there's still pain. Noticing if you
can exactly feel where there is still pain and then when the pain is gone. And then making your lens...
We're staying with the zoom and the lens, your camera lens, making it so wide that it includes the whole
body in this moment. And then seeing if it is possible for you to be aware at the same time of the pain
and the not pain in the body. Maybe there are other areas in the body that feel challenging or
unpleasant, but maybe the rest of your body is pain free. Can you feel that? Can you feel that?
So we're not saying the pain isn't there, but we say, yes there's pain, and there are all these areas that
are not in pain. The mind has a tendency to collapse around the pain, which makes us feel that there's
only pain. So we have to retrain the mind, retrain the brain that actually there are areas that are not in
pain. And then some people like to go even out beyond the boundaries of the body and just being aware
of the room or even further. That can be a very sweet practice in itself. All right. And now we're, again,
at the end of this practice. So maybe if you want to take a few longer, deeper breaths again, or just start
to move the body a little as I ring my bell.
All right. So this is zooming in, zooming out. So zooming in, we just did that. Be very specific. Pay
attentions to the borders. Yeah, are these borders fixed? So one thing we really want to pay attention to
is that sensations change. And very often, this is really important... I keep saying this is really important.
Noticing that. So when we are not mindful, then we are only forced to pay attention when the pain is
bad. Yeah. So it feels like every time I check in, the pain is bad. What I'm losing in those moments is I'm
not checking in when the pain is not there or the pain is little.
So I have often heard that people say the pain is always there and it's always at the same level. And then
they go home and they do this exercise and they come back and say, "That was actually not true. The
pain is not always there and it's not at the same level." Because we are not giving our brain this new
information of what is actually here in this moment. Because pain, like sensations, they're never exactly
the same because that's how the body works. It's not static. And so we want to inform our body to say
like, "How about now? How about now? How about now?" And be particular, keep feeding this back of
when there's actually less pain or no pain.
Breath can be very helpful as a handrail. So breathing into the pain, breathing, like creating space if the
breath is a good anchor for you. And then zooming out is bring awareness to the entire body, including

areas of pain. And just like what we did, be aware there can be pain and no pain at the same time. And
just be aware how much of your body... So our mind clumps around the pain and that's it. Yeah. So what
we want to do is we want to say, yes there's a pain, and can I also feel no pain at the same time?
So last piece I want to share with you is actually also really important. Research is finding out great
things about that. And that is the role of savoring. Remember when I said earlier that we noticed that
with people with chronic pain, certain areas in the brain shrink. And one part, and I said, if we want to
feel the joy and the pleasure, we also need to be able to feel, sense, that's what I mean, sense the pain.
Yeah. So we want to sense the joy, we want to sense the pleasure. Again, also something that a lot of us
have not learned growing up. That was not a focus, definitely not in my upbringing, I have to say that.
Excuse me. So savoring.
And some cultures actually are great with savoring, it feels like. So sometimes when I go to, I don't
know, at least in Spain. So people have their meals, they can definitely savor food in a way that we,
Germans, we cannot. So here are a few things about savoring and then we'll wrap it up with that. Okay.
So what is savoring? What does that actually mean? So it's attending, appreciating and enhancing
positive experience that occur in one's life. And what we do is... So actually coming back to MBSR.
MBSR, Jon Kabat-Zinn's class that I started my whole talk with is, in the first class in MBSR, what we do is
we eat a raisin mindfully.
So you might have done that in other contexts, other classes, but that is where that was made popular
in the MBSR class. So what do we do? We take a raisin and we use all of our senses. We look at it, we
touch it. We basically play with our food, what we all have learned to not do. We smell it, we listen to
the raisin. And then we taste it. And we use our full attention on that raisin. And people will often say
afterwards, "Well, that was the best raisin I've ever had." And then we go like, "Oh, isn't that
interesting?" So what is that? Right? Because that was not the first raisin. And we use something that is
very ordinary, but what we do is we bring all of our attention to it, but we do it in a playful way, in an
open way. And we do it as a group in a class, and then we have a lot of fun doing that.
And what happens is, something that feels so ordinary can become extraordinary. That is savoring. Yeah.
So it's not like the grand moments in life, which of course they're great to savor too, but what we
actually want is to say like, "My sweater feels nice. I love the way my tea or my coffee smells." And
those are usually things that we're not paying attention to, particular when we're in pain. Because our
brain is so focused on the pain. So yeah. Can be external or internal. The so exteroception,
And it is the positive emotions that is derived from that experience. And it needs mindfulness, as I just
said. And so if you want to Google this, Rick Hanson, my colleague has made that very popular called the
thought taking in the good. And what we do is, and this is really important, we have to become aware
that something feels good, feels pleasant. Notice where you feel that. How do you know it's pleasant? Is
that taste? Do you have some lightness? Does it have tea-leaf, sensations? Whatever that is. And then
you need to stay with it for a little bit. Yeah.

Because we know that's negativity bias of the brain. We know this. You don't have to remember to
remember something painful. That is right there. No problem with that. Different with something
positive, especially with these small moments. So gratitude, enjoyment, connection. So we need to stay
with it a little bit, give it a little bit more screen time. And then, it makes it more likely that we are able
to remember it. And what it also does, it actually goes into what we call our implicit memory. So explicit
memory are the things that we can actually remember, but we have an implicit memory about how life
is, what life feels like. And if life feels like there is not a lot of joy, there's not a lot of fun, this is actually
one way how we can influence our implicit memory.
So I think that was summary. So the non-identification. I'm not my pain. These are sensations that are
here in this moment. I want to sense, instead of think about the pain, self-compassion, supportive
touch, and the role of savoring.

Dr. Wayne Kampers (00:00:01):
Hi, everybody. So welcome back for our final session, which I'm very excited about. And we are very,
very privileged and very lucky to have Les Aria here who is very well known in the mind and body
community as an exceptional pain psychologist, and Les is also the chief science officer and co-founder
of Menda Health, which focuses on a knowledge-based therapeutic approach to pain, followed by pain
reprocessing therapy. And it is my understanding that the word Menda means reversing pain, so it's very
succinct in terms of that. Les also a board member for the Curable app, which obviously we mentioned
quite a lot yesterday, designed to help people with chronic pain, which Catherine Oxenberg referenced
on many occasions yesterday. So we are really privileged to have Les here to share his knowledge and
expertise on pain and on pain science, and on the evidence-based research that pain reprocessing
therapy is based on. So welcome, Les, and thank you very much. And so over to you.
Les Aria (00:01:16):
Fantastic. Thank you for the warm welcome, and good morning and good afternoon wherever you are,
or maybe even good evening, wherever you are in the world. I'm Les, and I'm hoping that, before we get
started, if it's okay with everyone, I like our nervous systems to be on board together perhaps. And even
though we're at a distance, and I might not be able to see everyone all at once, I'm pretty sure our
nervous systems can actually co-regulate real easily by this simple practice. This practice we're about to
engage in, hopefully you find it fun, something new, something different, it's called Genshin Jiu Jitsu, or
if that's difficult to pronounce, I call it the finger squeeze. So let me give you the instructions, and then
we'll do this together. But when we do any mind-body practices, it's not up here. Any mind-body
practices is about coming home, it's about coming back to your body. So with that said, let me give you
the instructions.
So I'm going to raise my hand so you can see it, but what I'd like you to do is put your hands down where
it's comfortable, rest in it your lap or your desk, or even turn it sideways. But just for visibility, I'm going
to have your hands placed up so you can see my hands. So the instructions are really simple, is go ahead
and grab your thumb. And when you breathe in, do it with me, when you breathe in, squeeze and hold.
And as you breathe out through your softly-pursed lips, feel that sinking, melting, letting go, releasing
breath. Now, let's do it again, but this time, I want you to not just focus on the squeezing and release,
but I want you to take your mind's eye and place it right in the middle of your body. I want you to notice
what happens when you squeeze, and then when you release. And for those of you who have back pain,
neck pain, any kind of pain, what I want you to do is focus on that sensation.
For example, if you have back pain or you're feeling like you've got neck pain 'cause you've been leaning
down and watching this video, or you've been busy at the desk, what I want you to do is pay attention to
where you feel the emotional charge or tension in your body, okay? So let's go ahead and we'll walk
through this. So I don't like to rush through this, so let's enjoy this. So just focus, you can close your eyes
if you feel comfortable or have it half-closed with a soft gaze in front of you. Here we go. Grab your
thumb, and go at your own pace, please. So you don't have to rush your breath in or out. Whenever
you're ready, take a breath in, squeeze, and as you breathe out, feel that sinking, melting, letting go,
releasing breath. Beautiful. At your own pace, breath in, squeeze and hold. Feel that sinking, melting,
letting go, releasing breath. Beautiful. At your own pace, breath in, squeeze and hold. Feel that sinking,
melting, letting go, releasing breath. Now, we're going to continue this three breaths for each other

Let's do it together. Breathing in, squeeze, and feel that sinking, melting, letting go, releasing breath.
Again, at your own pace, breathing in, squeeze. Feel that sinking melting, letting go, releasing breath. Do
not forget to focus on your body. Breath in, squeeze, and hold. Feel that sinking, melting, letting go
releasing breath. Beautiful. Almost done. Middle finger, breath in, squeeze, and feel that sinking,
melting, letting go, releasing breath. Doing a great job. Breath in, squeeze, feel that sinking, melting,
letting go, releasing breath, focusing on your body. Squeeze. Feel that sinking melting, letting go,
releasing breath. Good. Ring finger, breath in, squeeze and hold. Feel that sinking, melting, letting go,
releasing breath. Good. Breath in, squeeze. Feel that sinking, melting, letting go, releasing breath. Really
focusing on where you feel that tension in your body. Breath in, squeeze. Feel that sinking, melting,
letting go, releasing breath. Almost done here, last one. Breath in, squeeze, and hold. Feel that sinking,
melting, letting go, releasing breath.
It's okay to breathe in faster if you wish. Squeeze, breath in, squeeze, and feel that sinking, melting,
letting go, releasing breath. Again, breath in, squeeze, and hold. Feel that sinking, melting, letting go,
releasing breath. Let's do this last one. Really focus on the body, notice what happens when you breathe
in, squeeze, and hold. Really focus on your body. Now, feel that sinking, melting, letting go breath, all
that no longer serve you. All right, there you go. Loosen up that finger. Hopefully it was something fun
and different. And I'm going to go ahead and get my slides up. As I start my slides, I want you to check in
with your body because it's always good, when you do a meditation, breath work, to notice like what's
shifted. Maybe nothing's shifted, and that's okay because we've got a few other things that we'll do
throughout this presentation, hopefully you'll enjoy it. So let me get my slides up and then we'll get
going here.
So let's go ahead and review the title of this. It was difficult to come up with a title because there's so
many things I'd like to say. And one of the things this title really emphasizes is that pain recovery is
possible. And you're going to hear this throughout the presentation, that we really need to have a
different paradigm and a different way of treating persistent pain, much like we've learned to treat
trauma differently. Well, we need to actually treat trauma in chronic pain from a different perspective,
not so much from a cognitive and thinking perspective, but in an embodied practice. And my big
message to everyone, regardless of what is said or not said, the ultimate goal in the end result here is to
be able to reduce the time that you [inaudible 00:08:39] physiology. And I'll explain that a little bit more
as we get going. A couple of disclosures here, as it was nicely said, and the co-founder of Menda Health
and also the chief science officer, I oversee the clinical findings of our company.
Let's get into this. So I really wanted to briefly mention to you there's a huge difference, the paradigm
between old science and modern pain science. And I'm hoping that through some examples I'll be able
to clearly explain to you there is a huge difference, so huge that it's difference between the world being
flat, that's the old science, and the world being round, that's the new science. That's how much of a
difference it is. And I'm hoping to also help you understand, and maybe play around with a different
definition of chronic pain that maybe you learned in medical school or residency, or when you attended
grad school, or for those of you who have read things on Google. Let's take a look at a different way to
understand chronic pain using modern pain neuroscience. And the part I'm really, really excited about is
I love talking about this, called How to Actually Explain Chronic Pain. How do we develop chronic pain? If
you use the old science way, it's really doesn't quite make sense. And I want you to understand this.

A lot of practitioners, along with physical therapy to pain physicians, to psychologists, to therapists, to
body workers, we have some understanding about chronic pain and how it develops. But I wanted to lay
out a step-by-step process that the brain actually is in service of protecting us. So you're going to see
this in four phases, and I'm hoping you're just as excited about this as I am, as I love talking about this.
And of course, the end-all, be-all here is the pain reprocessing therapy. What is this? And I'm hoping to
be able to give you this clear explanation, and perhaps even towards the end, show you what they did in
the seminal study they did, which was published, in JAMA, Journal of the American Medical Association,
on their randomized control studies that they did. And so I'm hoping that you'll enjoy that. Before we

begin any further, it is very, very important that we get clarity here. Pain reprocessing therapy, mind-
body practices, really a helpful for a very specific kind of chronic pain. And I'm hoping that you'll lend me

your ear on this.
Now, when I say chronic pain, I actually differentiate between chronic primary pain and chronic
secondary pain. Let me explain. So we're used to putting things together. Now, if there are any
physicians out there, I'd like you to ask yourself this question; do you treat all cancer the same? And for
those clinicians out there; do you treat all kinds of depression the same way, when someone has a
situational stressor versus grief versus major depression, recurrent? Probably not. So why do we treat
chronic pain with a one-shot deal? The World Health Organization is very clear on this premise, that
chronic primary pain responds very well to mind-body practices. And here are some examples. And I
work with a lot of war veterans and people with trauma, developmental trauma, that means childhood
experience, difficulties, chronic life stresses and car accidents, just a variety of them. And this is not a
complete list offered by the World Health Organization, but this is just a sample of what we might see in
our office, or someone that we might know has this chronic primary pain.
Now, if this is chronic primary pain, then what is chronic secondary pain? Well, I'm glad you asked that
question. So that is anything that's very medically based, meaning like cancer, I treat a lot of cancer
patients. And so one of my colleagues said, "Well, I thought that's not a mind-body syndrome, that's not
a nervous system issue." Well, yes and no. Let me explain that as we go through. But pain reprocessing
therapy, I want to be clear, treats chronic primary pain. Now, it can be used for chronic secondary pain.
And these are just some of the things. And I often treat people who have had multiple surgeries and the
surgeon says, "I don't understand why you still hurt." And they kind of tuck the hands underneath the
armpits and go, "I don't know what to do with you." And so with that said, sometimes gaslighting can be
a problem, but the message here is this; chronic primary pain is really a dysregulated autonomic nervous
system. That's what it is.
[NEW_PARAGRAPH]And I hope to use this hypothesis to unfold it as I explain to you what chronic
primary pain as in the treatment of pain reprocessing therapy. Now, I want you to really get a clear
definition, again, emphasizing chronic primary pain. I keep saying this because I want you not to lump

everything into one bin. Many of my colleagues, including myself, we sometimes use the word mind-
body syndromes. Now, sometimes that might be offensive and it's not meant to offend anyone by all

means. Often, I say it's a dysregulated nervous system, and specifically it's your autonomic nervous
system. According to the World Health Organization, I'm going to read this out on purpose, I usually
don't read word for word, but this is really important so I want us to pause, the World Health
Organization says this, so pay attention to the red words, that chronic primary pain is defined by
persistent pain. Yep, got that. We understand that, we've heard that throughout the presentations. And,
and, not but, and is associated with significant emotional distress. Wow.

The World Health Organization is saying that you have chronic primary pain because there's something
inside of you that's exploding, something that's overwhelming, and you don't know how to deal with it.
And work, for that matter, impacts your functional disability. So chronic primary pain has a strong
emotional component, that's self-distress, and, check this out, cannot be better explained by another
condition or a medical condition. What a wonderful gift to the world, that these experts around the
world got together and helped us understand this. But the problem with this is, across the United
Kingdom and Europe and including the United States, we still lump chronic pain as one. That's a
problem. Again, physicians, do you treat chronic cancer pain or cancer pain with the same treatment?
I'd like to shift gears and maybe hit a theme of hopefulness. I love this quote, I love this quote because it
says, "It always seems impossible until it's done." This is often attributed to Nelson Mandela, but Henry
Ford also mentioned this.
But the message here is this, is I've been told for the past 20 years that it's nearly impossible to get
people out of chronic pain, and I'm here to say that's a lie. That's like telling me the world is flat and I
have to disagree with you on that. But what I'm hoping that you'll agree with me on this presentation is
this is lend me your ear and open your heart. But those of you who actually treat patients with chronic
pain to actually take a different paradigm, because this is very distressing when you have no hope. This
is rhetoric. So does anyone know who Roger Bannister is? Well, he's a British fella. Well, this guy, in the
1950s, broke the world record. And by the way, he wasn't a great runner, he trained to be a great
runner. Keep that in mind. He broke the world record and everyone in his realm said he could not, no
one could run a mile under four minutes. Many have tried, decades and years, but he was the first man
in the world to break this 3 minutes and 59.
So he ran a mile under three minutes. So what's this guy, what's Roger got to do with chronic pain, or
even trauma for that matter? Well, it's always impossible until it's done. Many people will heckle, poke
fun, ridicule, call it what you will, because we often mock what we do not understand. So for those of us
who treat patients, through understanding, will have greater sense of compassion. And the more you
understand your nervous system, you'll understand that its ability is amazing. Here's an important
question for us to ask. What does the body need to heal? Think about it. I want you to really maybe
write down maybe three things that you think that what does the body need to heal? And what the
body does need to heal from, the old science says, "Well, we need to fix something. If you're a car, let's
change your spark plugs. If you're a car, let's change something and fix it and remove it." Old science
says the reason you have pain is because it's often a better account by structural nerves and/or tissue
damage. Well, guess what?
Many of my patients often come to see me after, after, they have attempted all medical conservative
and invasive treatments. Well, old science cannot explain why you continue to hurt even after an
epidural injection. I don't understand why you're flaring up, it's supposed to help you. I don't understand
why the fusion I put into you is creating more pain in the opposite leg. Maybe it was a lumbar fusion. I
do not know why the trigger point injections resulted in your arm swelling and now you have a new
diagnosis called complex regional pain syndrome. Old science, they're scratching the hood, but we keep
using old science to treat the majority of people with persistent pain. That's insanity. Maybe I'm the only
person on this island that thinks that way, and I'm hoping I'm not. But this Master Series brings us all
together to understand that we need to look at things differently. Old science, old science cannot
explain why medical treatment fails.

And the danger in that is, very often, this is not every single physician or allied health professional,
including therapists and psychologists, it's not to say that they knowingly gaslight someone. That's
basically to say as well, "My treatment worked. I don't know what's the matter with you." Modern
science says, "Stop the shame and blame game," because for you to heal, it requires you to shift into
physiological states of safety. For those of you familiar with the polyvagal theory, you'll probably get a
whiff of this, that this means being in ventral vagal. And more times than not, being in ventral vagal and
dorsal vagal, which is a sense of stillness, which is a sense of meditativeness, which is a sense of peace
and letting go when we fall asleep. In simple English, what I'm trying to say to everyone is this; the body
really can heal. And I'm here to give you and everyone, just to reaffirm everything that we've heard
these past few speakers and the panelists, that the ultimate goal is, in summary, whether we use some
fancy medications or fancy techniques of breath, it's moving towards one state, a state of safety.
Keep that in mind because that's really what PRT's all about. But let's unfold it a little bit more. I'm
hoping that you'll consider this, I'm hoping. And please, if someone is reading this and saying is, "Wait a
minute, wait a minute. You're telling me that chronic pain is not about structural nerves or tissue
damage and simplicity?" I'd like you to really just digest this. Chronic pain or persistent pain is a software
problem, not a hardware problem. I really want you to digest this. It's a software problem. That means
the nervous system, the brain and the body and all its 45 miles of nerves, it communicates intricately
messages from the brain to the body and the body to the brain. It's not unilateral, it's bidirectional. It's
bidirectional. The brain needs the body and the body needs the brain. So in essence, I'm speaking that
the nervous system is the problem. We'll talk about this as we go through the slides here to educate you
that we really need to understand; why is this nervous system doing what it's doing?
There's several explanations for it. Well, perhaps you don't like the definition of this and that's okay, but
maybe let me use a different way of expressing it. Perhaps for those of you who are more
neurobiologically inclined or want different words, think of chronic pain as an emotional brain
circuitries, emotional brain circuitries that interferes with your motor and sensory processing circuitries.
That's what I'm trying to say. I'm trying to say that the reason that we have leg weakness, even after
they find some fancy things on their MRIs, such as hernia...
PART 1 OF 4 ENDS [00:23:04]

Les Aria (00:23:00):
... should they find some fancy things there on their MRIs, such as hernia, disc, annular tears, or they
throw a very, very difficult diagnosis like complex regional pain syndrome, CRPS, myofascial pain,
spondylolisthesis, on and on and on. Those diagnoses are great nomenclatures for billing and
communication. It does not, does not communicate why you still hurt.
So if you should go with this new definition, you're really going to grasp the fact that why you hurt is
because my nervous system says, "Me no safe."
Emotional brain circuitries. That means there's something emotionally interrupting it, whether it's
trauma, whether it's fear of moving, there's something interrupting this so profoundly that it has the
propensity to paralyze your leg, the propensity to create pain even when you're sleeping and to get you
out of it, jarring you out of your sleep.

The emotional brain circuitries, as some of us might have heard through the talks here, is that the limbic
system is key and so is the brainstem. They're like cousins. They hang out with each other. They're
Why do people hurt? Well, the simple explanation may be that it's because your nervous system is
constantly doing this. Your nervous system is constantly asking, "Safe or not? Am I safe or not? Am I safe
or not?" That's the one question your nervous system will ask. And by the way, for those of you who
don't quite understand that, is the nervous system is constantly using our five senses and including our
thoughts to assess whether we're safe within ourselves, outside ourselves, the environment and/or
whomever or whoever is in front of you, whatever. Let me repeat that again. Your nervous system every
few milliseconds, milliseconds, not seconds, every few milliseconds is asking this one question, "Am I
safe inside?" So if you don't have skills to deal with negative thoughts, strong raw emotions, and
punishing painful physical sensations, your nervous system will say, "Me no safe."
And guess what? The cascade of cytokines, inflammation, [inaudible 00:25:31] nerves, tightening up
muscles, the sympathetic nervous system becomes activated. The nervous system is scanning for danger
messages in me, outside of me. Is your environment overstimulated? Have you constantly had the TV
on? There's always someone that's yelling and talking. The constant computer that's on. Is there
overstimulation of noise? Inside, outside and whomever or whatever is in front of me.
Notice that sometimes people with chronic pain cannot heal because of something dangerous at home.
Now, this is a funny, but I'm being serious. It often might be the partner who's dismissive, invalidating,
which is activating of the nervous system saying, "Me no safe." So with that said, I want you to truly,
truly understand that how this all works is to be able to recognize that your nervous system is constantly
asking, "Am I safe inside, outside, or whomever is in-between."
And by the way, for those of you who can hear my chocolate Lab bark, it's a perfect timing. I think I must
have paid him with a good cookie. Because when my dog barks, like my nervous system, it's barking
because it senses danger somewhere close to it. And it's using its sound, its sight, its scent, no different
than our brain. So thank you, Bentley, for weaving into this presentation.
Before we move on any further, I'm hoping that you folks will maybe write down three things that is
new to you, three pieces of information. I'm hoping that you'll write down maybe two questions you
might have or you wish to ask towards the end of this presentation. I'm also hoping that maybe you'll
ask yourself, "What is one piece of skill or information I'm going to use within 24 hours. Or the next time
I see a patient. Or with myself?"
So let's kind of continue this presentation in addressing how does chronic pain really develop, using the
modern pain neuroscience explanation. So let's go. I always start with this because it's really important
for us to understand this, that our nervous system doesn't just get hijacked. We don't just develop
chronic pain because that's what happened. Maybe you had a car accident or something difficult
occurred in you. I want you to pause here for a second and reflect on all the patients you might have

seen or maybe yourself, personally. Now, without getting too much into it, I'll just kind of whip through
a few of these factors. This is not the whole list, but I'd like to take complex things and making it simple.
Believe it or not, people with chronic pain and including trauma actually have a couple of the
dispositions. One of the factors is the ACE and those of you who know about the adverse childhood
experiences, that's what ACE stands for. Let me repeat that again. ACE stands for adverse childhood
experiences. Done by Dr. Felitti in Southern California through Kaiser Permanente Medical Group and
accidentally discovered factors that people who had serious medical problems including cancer,
depression, suicide, and a variety of other body medical conditions, including smoking by the way, he
could predict that why they were actually having that.
Now, mind you, I want you to be clear, this study talks about not correlation, causation. When they
statistically ran it and they assessed it, it was causation. So what am I saying? I'm saying in simplicity that
a lot of trauma and chronic pain already have a primed nervous system. I'm going to talk a little bit more
about this in the slide so I can unfold it for you. So keep in mind, ACE is a very important factor in
priming. When I say priming, you'll see the next slide.
Priming basically means amping up the vigilance of the brain and the body of me-no-safe personality.
We know several people who have chronic pain. We know ourselves, we know patients. We've heard in
stories, movie stars, athletes. People who tend to have chronic pain often have very unique
personalities. By the way, on a side note, did you know that people who are most conscientious, loving,
compassionate, and sometimes don't have boundaries, tend to actually be more dispositioned to
chronic pain?
A little side note here. Accidentally, at Stanford they were doing a study and they found out that one
group of people actually did not tend to have more chronic pain than the average human being or the
public. It's people with personality disorders. They actually accidentally discovered that when they ran
personality assessments and brain scans and they found out that personality really is predictive. Now,
you can draw upon or extrapolate from cardiac studies, studies that looked at psychological factors that
results in heart attacks. You know what I'm talking about. The Type A personality, the personality that's
always perfectionistic, a personality that's always bountifully giving and selling their soul so they can be
loved and accepted and wanted, or good enough. Those are the personality styles that tend to be
dispositioned and actually have a primed nervous system.
One more time. When I say primed nervous system, I'm referring to the nervous system that's already
hijacked and sensitized towards vigilance of me no safe. Now you pepper it and salt with life, called
chronic life stressors, and what you have here is a recipe for a primed nervous system to be
dispositioned towards chronic pain, regardless of whether it's a car accident, a slip and fall, a surgery
that goes wrong, or one day you wake up and you realize insidiously your pain has dominated you and
now has reached its apex. So take a look at the timeline here as you see those little silly dots there. Take
a look at your childhood. Now, when I sit and work with a patient, and especially pre-pandemic, one of
the things I do is I grab a blank sheet of paper as I do my intake and I ask them questions, and I draw a
big line just like you see there. And then I make little asterisks or markings and I ask them a little bit
about what was going on in their childhood. Mind you, I specialize in treating doctors, so they often they
ask me, "What's my childhood got to do with that? Are you being Freud?" And I usually chuckle and tell

them, "No, actually I'm doing my assessment because I'd like to know what your nervous system was
going through when you were a child."
And very often I ask this question as, "When you were a child, who comforted you the most? Who was
aloof?" And very often people tell me, "Oh, I had a great childhood." And I often ask this question, many
clinicians will hear me loudly on this one, is I often ask, "Tell me who in your family, including your son
or daughter when they were a child or a grandchild, who's the most sensitive, and would you like that
child to go through your life?" And very often I get a knee-jerk reaction of saying, "Nope, I don't want
that." But, I thought you just said a few seconds ago that you had a great childhood?
My point here is this is our adverse childhood experiences does not have to be about sexual abuse or
physical abuse. It can be a parent who we never feel good enough. It can be a place where you realize
that if I'm good in academics or sports or actually I bow down and listen to everything Mom and Dad
says, or whomever raised you, then I will be loved. And they often talk about me and what a wonderful
kid I am, then I'll be the golden child. That's still an ACE.
As you build through life, you realize that in your adulthood you are having this perfectionistic and not
good enough personality or this need to prove how smart you are or whatever it is that you need to do.
And finally, one day something happens and it goes something like this. As you go through your days, as
you go through your days, maybe you have a few stressors as you go through childhood and adulthood.
And finally, as you get into your thirties and forties, whatever age group, finally one day you slip and fall
or you get into a minor fender bender and something unleashes in you. What I'm saying to you is this is
your lived experiences is really a learned habit in the brain called the nervous system. What I'm really,
really telling you that every single experience like a rope has a knot on it. Some bigger, some larger,
depending on the adversity and the pressures you've been under.
The brain does not have a delete button. Did you know that? Well, our computer has one. But guess
what? Our nervous system, our brain does not have a delete button. And so what I'm saying to you is
your nervous system encodes your lived experiences. And these three factors actually raise precedence
for the priming of your nervous system for that moment when you wake up one day, the car accident,
the slip and fall, the surgery that goes awry, or the dentist that actually sticks novocaine into your gums
and accidentally hits a nerve root and thereby creating tinnitus.
So let's go through this. So before we move on here, I want you to maybe write a question or two that
you might want to ask when we actually have the question and answer session, is maybe you want some
greater clarity here. But keep in mind that the message here is this is everything we experience is a lived
experience and it's encoded in the nervous system, the brain and the body, and I call it learned neural
So let's really get into the stuff so we can actually explain this to our patients, ourselves, and those we
love. That how does chronic pain really develop. Well, chronic pain develops in many different ways, but
this work comes out of Apkarian at Northwestern University School. His lab and his colleagues have
discovered a very clear process of identifying it. So let me walk you through it. So this credit goes to Dr.
Vania Apkarian at Northwestern University. I'm going to walk you through four distinct phases. So please

listen up. We just talked about the risk factors, didn't we? Again, those are just three major factors that I
see most commonly in my patients.
But the first one I want you to recognize is the nervous system is already primed. And when the nervous
system is primed, which is waiting for that shoe because we're already at the edge of the cliff. You've
heard of the saying it's the straw that broke the camel's back. It didn't say the boulder that dropped on
the camel's back. What is the straw in your patient that actually resulted to step away from the fancy
nomenclatures of the medical diagnoses of what you have and lend your ear and paradigm to a new way
of looking at chronic pain? The risk factors prime your nervous system and some day, on that one given
day, maybe you wake up a slip and fall, just as I've been mentioning, is your nervous system becomes
extremely protective. Now I'm going to pause here for a second. But those of you who are saying, "I
don't have chronic pain, but I have trauma and yeah, I have some aches and pains and I have flashbacks
and I have body tension, hypervigilance," stop for a moment. The reality is the brain does not
discriminate. We discriminate short, black, tall, fat, white, beautiful, ugly. The brain does not
discriminate. The brain does not discriminate when it comes to emotional and physical pain.
Did you know that when you have a heartache, a breakup, it is as if it's processed as if it's physical.
Naomi Eisenberger's study discovered that when someone has a breakup and a picture is shown, in the
MRI they can actually notice what circuitries are fired up and wired up in the brain. And guess what?
You're going to be blown away with this, at least I was, that you can actually look at it and they could not
differentiate between someone who had physical pain.
So what I'm saying to you is we discriminate. That's what we humans do, but the brain does not because
we're more alike than different. And so when we have an injury, a slip or fall, a car accident, a dental
work that goes awry or surgery, or one day you just wake up because your life is just so dissatisfying or
lack of purpose, or you feel empty because you feel not good enough, that's second to that injury, the
emotional physical injury, that's what shifts your nervous system into a heightened state of vigilance
which then often sets you on the path towards subacute pain.
So we can look at number two, the second phase, as the instant the mechanical disposition that occurs,
whether emotional or physical, and that's the start of it. That's within two to four weeks. And as we shift
into the fourth and eight week, we're in subacute pain. And guess what? This is really, really, really
important, I think we're treating chronic pain incorrectly. I know this might be a terrible thing to say, but
I think we're waiting too dang long to treat it. We need to treat chronic pain the moment we recognize
it. And the prescriptions should be mind-body practices, not towards the end, as well it's fourth down
with punting, it's a football analogy. Well, I guess let's just do that. Let's just throw in the breath work
and the yoga and the tai chi and the qi gong.
We've got this wrong. Modern pain science says we need to do this sooner and better. We need to do
this within the two to eight week period, not past three to six months plus years.
So in the transition period, this is where we need to, this is the period between two to four weeks. It
goes from acute to subacute. This is when the inflammation is really intense, the nerves are really
sensitive. This is the part that what you do in this period, how you think about your pain, how you

actually are dealing with life is very, very important. Because what really shifts you from subacute, from
acute number two to subacute number three, the transition, the brain is gearing up. So if you have a lot
of stress during this time period and you're just trying to use medications as the sole thing and you're
not taking a look at your lifestyle, you're not taking a look at what in my life is hurting that's not allowing
my body to heal.
Remember the word safety in the beginning? What is it? Guess what? They discovered it by accident.
Apkarian's lab discovered that when you fear pain in this period and avoid moving while the doc says,
"All right, your ankle is healing, let's get it moving. Let's mobilize it. Let's kind of get you moving. Let's
get to PT." And you're like, "I can't doc, because it's so painful. You don't understand. Could I get an
increase in the opioids and the Norco and a glazed donut to go, please?" So if we change the medical
system's paradigm and how we actually treat this, we'll have less people with disability, less people with
depression and anxiety. And perhaps, perhaps, perhaps we could solve the opioid crisis once for all.
But the fear and avoidance is key because Apkarian discovered that when someone has fear and
avoidance, this is what shifts the brain. You're going to love this part. The brain, where it processes pain,
physical pain, where the brain processes physical pain, for those of you neurobiologically inclined in
somatosensory 1 and 2, or S1 and S2, which is right above your ear, it processes it there.
But however, when the pain starts to shift between eight weeks and 12 weeks, check this out. In phase
four, with the marination of fear and avoidance, the brain relocates its real estate on processing pain
into the limbic system. So if you were paying attention here, just imagine where your ears are, if you
place your hand, your palm right above the ear, maybe about a good five or six inches above, you'll run
into that area, both sides left and right side of the brain hemisphere. And what I want you to know is
this is the brain goes from uptown to downtown into the limbic system. Now the question that no one
can quite answer, including myself but we can hypothesize, is this is why does the brain shift the way it
processes physical pain from a physical way of noticing where the homunculus area where it notices the
motor and sensory processing strips, wherever pain is processed physically in the brain, why does it shift
it into the limbic system, the emotional brain?
Well, one rationality or hypothesis is that the brain is all about conserving energy. Think about this. If
you had to wake up every morning to learn how to make coffee or tea, boy, that'd be a terrible thing,
right, for most of us. Can you imagine you forgot actually how to tie your shoelace. Well, guess what, in
the limbic system, that's where all habits are created, and we're just about to talk about the pain habit
because this is what learned neural pathway is.
We go from phase one to two, the nervous system becomes jacked up with greater sensitivity. The brain
is trying to heal and the body is trying to heal, but then we add our suffering and avoidance. The very
thing that you're using to protect yourself is the very thing that will keep you from living life. Fear and
avoidance, and chronic pain, is the worst nightmare someone can have without properly getting the
education of why you hurt.
And when the pain in the brain shifts into the fourth phase it's already past three months. Yep. Medical
diagnosis you heard from who basically says is that when pain is greater than three months, this is when

it shifts, and we have signs now it shows that once it hits the fourth stage it is now called persistent pain
or chronic pain. But in my world, I call it learned neural pathways and that is a mouthful, but let me
simplify it if you don't like that lengthy word.
Pain habits, the brain has now developed a habit just like making coffee, just like tying your shoelace.
Think about someone who has a stroke. They have to relearn it. Think about someone who has chronic
pain. Now your brain says, "Me no safe, and from hereafter I'm going to protect you."
This is a lot in a simple slide, but I'm hoping that you'll ask a few questions for clarification or contribute
to yep, I get what you mean by this, towards the end.
The big take-home message is what we do, we become better at. What are you practicing. If we're
teaching our patients and we're buying into the old signs that you shouldn't move even after things have
healed, you know, I'm feeling pain. Pain is not a good sign to assess whether you actually have healed,
because pain is a protector.

PART 2 OF 4 ENDS [00:46:04]

Les Aria (00:46:00):
...healed because pain is a protector. The question you need to ask and beg is, what is it protecting you
from? Look into your life. Now, this might be an easier slide to understand versus that silly slide that we
had previously, but I'm hoping that you'll be able to kind of take a look at this. This is the same
mechanism how chronic pain develops in four phases. You have risk factors, right? You've got the risk
factors here. And when you have risk factors or childhood adversive experiences, it sensitizes your
nervous system. So, basically your nervous system is already recalibrated to be vigilant. Why?
Psychologically my response is because it's an adaptive quality of survival. Think about it. You had to be
perfect, you had to speak properly, you had to get good grades, you had to shut your pie hole so no one
could actually get mad at you so you can actually get love, right? So, we had to shut up so we could
actually suppress our feelings and so we can please those who raised this. That's a survival mechanism.
In phase two, when the injury occurs, take a look at the threshold. Your threshold now is raised. It's
when you're going to be very sensitive. And as we move into phase three, that's the subacute brain. The
brain starts to change. And what we do in that two to eight, two to four weeks is very, very important.
What we do in that eight weeks, as we get to that eight weeks before we hit into the chronic phase, it's
really important is what we do and how we relate.
Listen to these words. How we relate to what shows up is very important. You're not responsible for
what shows up, but you are responsible to how you show up to what showed up. And if we don't show
up with a sense of compassion, understanding and ultimately safety physiology with different mind body
practices and skills and lifestyle changes, we develop chronic pain. So, in essence, if someone asks you
like, "Why do I still hurt, Doc? Why do I still hurt?" You hurt because your nervous system is sensitized
and it's there trying to protect you. Like, "Then what do we do, Doc?" Well, the solution would be as

you'll go through the slides here with me, is to be able to create physiological states of safety. For those
of you pretty apt in polyvagal theory or the nervous system, this will be very easy to understand. For
those of you not, I'll be, I'll just explain it a little bit more. Hopefully you'll enjoy this, that I look at
chronic pain not as structural nerves of tissue. I look at chronic pain as the nervous system stuck, stuck
in states of stress and shutdown. Me, no safe, how do I protect myself? Me, no safe, how do I protect
myself away from everyone? And this is the vicious cycle.
Now, for those of you not well versed in this, let me kind of walk you through. There's another phase in
between which I've not put on the slide. When we feel sympathetic, that's a fight of flight, also known as
stress. When we cannot fight or flee from our life, from things inside of us, outside of us and or
whomever or whatever's in between us, including our work, our taxes, our computers, our finances.
When we cannot escape our stressful life or emotions, our trauma, when we cannot fight or flee, that's
the sympathetic, we go into freeze. And when we cannot, and when the brain cannot protect us from
the freeze response, which means standing there like a deer in headlights does not help you. And often
people with chronic pain, this is when they tend to start to feel a flare up. Their body becomes most
sensitized. They tell you they feel inflamed, they tell you that, and they hurt when different places now.
Everything is magnifying because they're in this scared straight phase known as freeze.
And when we cannot fight a flee or freeze from whatever is dangerous, then the brain actually does
something called a biological imperative of shutting you down into dorsal vagal. And this is when people
are debilitated. And some of my patients are so debilitated that they cannot actually get out of bed
because they believe they're damaged, because they were told they were damaged. You're not
damaged, you're just stuck. It's really important for us to pause here and reflect what we just did there.
We just walk through the who, organization about what chronic primary pain is. We talked about the
definition, a new definition. We slid into the four phases. And now we're talking about how avoidance of
pain, emotional and physical, do not discriminate folks. We may have a biases, but this is one thing you
don't want to discriminate because the brain does not discriminate. And here is the message whenever
our nervous system is constantly in threat physiology and how do we create threat physiology, let me
show you. Just like when I learned how to ski, I had to learn how to fall down first before I could actually
hit the slopes.
And so in the same sense you need to understand that you're falling down is what are we doing
personally? What are we doing our lifestyles? What are we doing to create and keep threat physiology?
In simple English, what are we doing to avoid our difficult thoughts, emotions and physical sensations?
What are we doing and avoidance, mental control of what shows up? How do I get rid of that thought?
How do I get rid of this pain? You're going to find out very quickly in pain reprocessing therapy and
trauma. Evidence-based trauma therapy is you have to lean into the discomfort, in micro doses. That's
the key part.
So, let's talk a little bit about danger in me messages because that's the threat physiology. This is taken
from Lorimer Mosley, world renowned physiotherapist, love his work and this is also taken and bridged
with Judson Brewer, brilliant neuropsychiatrist now at Brown University and really uses mindfulness and
smoking gestation. But I've taken this and adapted this and so I want to explain how the pain habit loop.
If you didn't like the four phases and all the other stuff, maybe this will appease to your mind. It is that
when we actually have chronic pain, we actually have developed a pain habit loop.

Let me walk you through this gently. Just imagine that and now it's 4 months, 6 months, 8 months, 12
months, 10 years, 20 years. When we have difficult thoughts, emotions and physical sensations, not just
physical sensations folks. When you have a difficult life, when something triggers you, a thought and
emotion and or physical sensations or maybe a bill or a breakup, a death, whatever triggers us, check
this out. Biologically imperatively, we don't have a say. Your brain automatically engages us into
avoidance. You don't believe me? Ever touch a hot stove? Yep. Why do you pull back? Try convincing
yourself to leave your hands there. No, because it's a biological imperative and this is the key message.
You're not responsible for what shows up, but you are responsible to how you show up to what showed
So, in this slide I want you to grasp a new way of looking at things is, there's something triggering our
patients, our clients, ourselves, and we biologically imperatively engage. Your brain, your nervous
system is just trying to protect you. And guess what? When you avoid, just like in phase three to four, as
you heard previously, when we engage in avoidance, it takes us away from living life and the
opportunity to heal from chronic pain including trauma. Because every time you reward yourself by
avoiding something difficult, you just got to reprimand hit. Let me repeat that again. Maybe you didn't
get that. Every time you have a difficult thought, emotion and or physical sensation, you activate a part
of your brain system, the limbic system, the brainstem, you activate a fear of avoidance behavior that's
biologically imperative in there for you to be alive to protect you. But what we do is we allow the
autonomic nervous system to control us and to dictate our lives, but as it activates our stress response,
we actually have that space within us.
Victor Frankl said beautifully, and Dr. Wolf and several others have mentioned here is this, "That
between the trigger and the reaction, there's a space and that's the space we human beings can actually
fill to mitigate, to influence the nervous system's output." So, let me talk a little bit more about that
because when we avoid, we actually get a dopamine hit. So, what about the dopamine hit? I don't
understand. Well, dopamine is highly associated with emotional learning. Remember the previous
slides, the four phases. Between stage three and four, there was emotional learning of avoidance and
fear. Avoidance and fear were identified in a current study. It's functional MRI study. They discovered it.
They looked at the brain functions, and every time the nucleus incumbents gets rewarded, whenever
you engage or don't engage in something, whenever you avoid or don't want to deal with something,
you just learned and taught your part, you're part of your brain. Just on a side note, University of Basel a
couple of months ago discovered by accident that emotional learning does not only occur in the
emotional brain, it also occurs, drum roll, in the brainstem, automatically. So, once we learn something,
it becomes emotionally learned. And guess what? What we practice is the drive changer of the nervous
What are you practicing? You want to heal from trauma and chronic pain, but what are you practicing?
We ought to be practicing safety in me messages. This is where pain recovery falls in a simplistic manner
to a complex problem. It's that whenever you have difficult thoughts, emotions, and physical sensations,
we are to use helpful attitudes and values such as curiosity because curiosity triggers dopamine. Wait a
minute, whoa, whoa, whoa, whoa, wait. Let's back this up a little bit. You're telling me whenever I avoid
something and don't want to deal with it, I get a dopamine hit and I emotionally learn that habit and I'm
likely to repeat that? Ah-huh. So, wait a minute. So, now you're telling me that whenever I create safety
physiology, do my breath work, do mindful movement, tap myself, do something, massage, squeeze,

play, laugh, hug. Whenever I do that or whenever something difficult shows up, I bring a sense of
curiosity and other helpful attitudes or value-based choices, actions. You mean, when I get curious and
say, "Huh? Ain't that something?" When I'm feeling the tension and burning sensation, you mean when I
bring curiosity, I get a dopamine hit and I also learn emotional stuff and I get it reinforced in my
brainstem and limbic system? Ah-huh. You know why? Because practice is the drive changer of the
nervous system. Creating a felt sense of safety is the route to healing.
One of the things I want to do here also is really, really break down pain reprocessing therapy. Now,
what you may not have realized, what I've been doing with you is I've been actually telling you about
pain reprocessing therapy except I've not been using it so much. Everything I've spoken about thus far is
pain reprocessing therapy, but let's get our sleeves rolled up and let's really get into pain reprocessing
therapy and what is this really. Sounds like emotional freedom tapping or something like that. Well, in
some sense you're going to find that there's a commonality.
If you've not read this journal, I highly recommend you do this in Dr. Google as that's what I call Google
now, is that if you Google pain reprocessing therapy and JAMA, J-A-M-A, you'll get this wonderful article.
And guess what? It's one of the first studies in the world to show that mind-body practices actually
shifts, shifts brain networks into a state of safety physiology. Wow. Right? I was so excited. I thought I
wanted to pin this article up and make it a poster so my patients can see it. But no matter how much
data I show my patients, they don't seem to quite believe it because they've been hypnotized by the
medical system.
Now mind you, the medical system is phenomenal for acute issues and maybe for chronic secondary
pain, but it's terrible for chronic primary pain. This article really speaks to what pain reprocessing
therapy is and how they did it. And I'm hoping that we'll get a chance towards the end to be able to
practice the very skill they taught besides some of the things we'll be talking about. So, pain
reprocessing therapy, really what is it? It's psychological technique. So, what about it, Les? Well, it's
there to show you how to reinterpret sensations in your body as me safe versus me no safe. That's what
it is. That's nothing more than that. Whether you have trauma, whether you have depression, whether
you have anxiety, whether you have chronic pain, it's the same brain. If you'd like further explanations
on this, I'll be happy to take this during into the question and answer sessions. It's not everyone will be
below first in something called bottom up processing and top down processing. But if you are, let me
just say, mention this to you. So, very often, psychological therapies, and forgive me if I offend anyone,
but talk therapy does not work. Talk therapy does not change the nervous system. It's helpful to feel
loved and supported and validated and to get some different perspective, but it does not change the
nervous system and it does not change chronic pain and it does not change trauma. What changes
trauma and chronic pain and depression and anxiety and all the nervous system issues are basically
using bottom up processing, which means body. Teach patients to find their thoughts and emotions and
pain sensations and to lean into it in micro doses and then use the top down processing of, okay, I'm
safe. I'm safe. And that's the talk you use. But the bottom up processing needs to be is, can I feel safe
with the sensations and sensations include thoughts, emotions, and physical sensations.
So, what is pain reprocessing therapy? Unless I'm still, I kind of get it, but I don't, so you're telling me
about something about safe. I think that's what you're telling me. Well, pain reprocessing therapy in
clear definition is to break your pain-fear cycle. That's what this is all about. It's if you actually replaced

pain with trauma because when someone has trauma, they don't know what it feels like to feel safe
because it's safer to feel unsafe because we gravitate towards what we're most familiar with. And two,
so PRT, Pain Reprocessing Therapy is very big on breaking the pain cycle, and I'll be unpackaging this in a
five step process. So, ultimately when you learn to no longer fear, fear itself, desensitization occurs in
the brain, the nucleus incumbents, the part of the brain that rewards us with the emotional learning
gets reset and you start to notice that the pain that shows up inside of you is nothing more than a
sensory input of the brain saying, "Hey mom, hey dad, me no safe." And your job is to counsel that
thought, emotion and physical sensation.
If you can actually do that, learn to come back home to the body. You'll actually start to change things.
Keep in mind, put parentheses somewhere in your notes, Microdosing is key because when you move
too fast, you'll have what we call a paradoxical effect. It's kind of like when you start to feel too relaxed,
your brain may produce a panic attack in you because it says last time you relax too much, you let things
go, and therefore me no safe, I have to produce a panic attack or I have to produce a flare up in you.
Time and time again, all I've been mentioning is the reason we actually have chronic pain is because it's
a dysregulated nervous system and specifically autonomic nervous system. It's not about past injuries. It
really is not. Yes, it is. I have some really important things my doctor told me about and I actually have
this and I have that and this is what I really have.
Well, one of the things I kindly say to my patients and doctors, and I treat lots of doctors and specialists,
including orthopedic surgeons, when I treat them, they often say, "Yes, you don't quite understand the
body." And I say, "Well, you might be right." I get that, I get that. And therefore it sounds like I may not
be the practitioner for you, and I'm hoping that the person you'd believe in with those fancy diagnosis
can get you the life that you want because the reality is it's not about past injuries, it's not about
structural issues, it's not about tissue damage. It's about the nervous system stuck in a state, of states of
survival. It's stuck between the sympathetic, the freeze and the dorsal vagal. This oscillation keeps us
trapped from feeling tense muscles to amplified sensations in our body, and then when that does not
work, our brain imperatively will shut us down and weaken our body where we cannot move our limbs
to the point where medication and emergency room interventions do not work unless they knock you
This is going to be a busy slide. So, forgive me, I did my very best to try to explain this in simplicity
because it's a complex process and I've just reduced this and I'm hoping that people can ask questions
and we can go forward there. What I'd like you to do is just take a look at this step, but I'm going to
emphasize one thing again, pain reprocessing therapy is really about how do can I get my body and mind
into physiological states of safety? How can I actually befriend my sensations? As you've heard with
mindful practitioner and panelists here is that it's about that mindfulness. It's about being able to shift
our nervous systems and that influence it in that sense.
So, let's walk through the five process of PRT, okay? So, totally it was a busy slide. So, what I'd like you to
know is this is, let's start at the step one. I'm going to pause you for a second because I want you to
really hear this message. I really, really want you to hear this message. I love mindfulness and that is my
go-to. If you were spying on me at 4:00 in the morning, I'd be meditating. Yep. It's when no one,
including the world in text messages, no one needs me at that point, including my dog, my chocolate lab
who likes to play the moment I wake up. What am I talking about? I'm saying is this is a lot of

psychotherapies, a lot of treatments, including mindfulness is very, very helpful to chronic pain.
However, they did a study and a couple of studies on this and Lorimer Mosley's team in Australia
pointed this out too very beautifully, that while cognitive-behavioral therapy and mindfulness and
several others, they really are profound and I'm so grateful to the practitioners who continue to do this.
However, what's missing is neuro-informed information about chronic pain that is in simple English, we
have to first, no matter what the intervention is. If you're doing mindfulness and you neglect to talk
about that pain is in your brain or in the nervous system much like trauma, and you neglect to actually
emphasize that pain in the brain can be retrained, then we're doing a disservice and people leave feeling
better, but they still believe they're damaged.
Step One of PRT emphasizes over and over again that pain education is key to getting patients to
recognize that this has become a pain habit. That's the language I use and it's really important to
understand that pain comes from the brain. I use different examples. For example, when someone says,
"No, my pain is in the back, it's not in the head." So, you're telling me I'm a nutcase? You're telling me
it's all in my head.? No, actually not quite. I'm telling you that pain comes in the brain, it can be
retrained. And they continue to go, "No, I still disagree. My back hurts because I have an L4-L5 herniated
disc and I have a spondylolisthesis and a glazed donut to go.
So, people often get hung up on their medical diagnosis and here's my message. Pain comes from the
brain. You know how I know it? Because what I often tell my patients and the doctors I work with is pop
your head off and let me talk to your body or your back. If you cannot pop your head off, then my first
point of argument is this is because it's synergistic. It is part and parcel. You cannot separate brain from
body because that's old science and that's Descartes who is a French philosopher and we're all medical
schools and systems get their read. It's as if something is broken, fixed them. That's what it is.
So, PRT says is, "Pain is in the brain and you've basically caught up in a pain habit. That fear-pain cycle
needs to be broken, but you need to understand that you're not damaged, wounded, everything in you
is healed, chronic primary pain, and this is where we are, it starts with education. Pain is in the brain, it's
the nervous system that's stuck. You're not damaged and you can get better. In Step Two, gathering the

PART 3 OF 4 ENDS [01:09:04]

Les Aria (01:09:02):
In step two of gathering the information, Cheryl Combs is basically... Listen, about 20 years ago, I tried
convincing my patients and I realized the more I try to convince them, the more they fight me. I guess I
got a little bit more white hair and a little bit more wisdom I guess, and figured out that let me help
them figure out their own data.
Basically send people away asking them to collect and be Sherlock Holmes. As you know, Sherlock
Holmes often was looking for clues, so whenever they notice they're stressed out, I ask them to pay
attention to their body. Whenever they notice they're with the computers, are they holding their breath
and do they notice that the cervical pain is becoming magnified? Have they noticed that when they are

laughing and laughing at a funny movie or playing with your family pet or hugging someone or feeling
loved by something or someone or taking a walk and tree bathing? Have you noticed what it feels like
that the symptoms are less? That's called data gathering. You don't try to convince them. Your goal is to
send them away to become Sherlock Holmes to gather information when they notice the pain is up or
There's a special form for all of this, and then the lens of safety. This is where the sauce is. I don't know
about you but I like some sauce in my salmon and my Brussels sprouts. Yeah, so what is the sauce? The
sauce is somatic tracking, and for those of you with trauma therapy background, you'll know what this
Somatic tracking is like pendulation that Peter Levine came up with, is where you kind of gently lean into
the sensations, but somatic tracking adds cognitive behavioral therapy stuff to it, and it adds
mindfulness stuff to it, and then it adds positive sensations to it. I'm hoping to get to practice this with
you. I'll check in here with the timeline here so I'm not falling behind.
The fourth phase, and I'm going to get down to the slide now. I'm going to check in to see where I'm as
far as time. But let me talk about the fourth and fifth and I'll check in with the time. It's the fourth phase
here, I want to slow down here. Pain reprocessing therapy is very effective and people in that study that
I showed you previously in the JAMA article, 67% had pain. The pain was no longer dominant and/or
pain free. 67 better than gold standard medical treatment that is expensive, lack of accessibility.
I want to mention because one of your panelists talked a lot about ketamine and psychedelics. Listen,
that is effective, absolutely, folks. Wait a minute, Les, what about the PRT then? Let's pause here for a
second. PRT is very effective for chronic primary pain. Now, when I'm working with someone and PRT
says, when you have other emotional issues such as things such as trauma, such as OCD, such as
domestic violence at home, you have severe, severe financial issues, you are going to lose your home.
You've got three kids who are autistic and you don't know who to get help from. You are a mom or a
dad and you're working three jobs.
Those issues increase the threat physiology, which reduces your chances of getting into pain recovery.
This is where often when I run into a problem, I turn to my colleagues who are trauma-based to use
evidence-based treatments such as EMDR, brain spotting, somatic experiencing. These are very, very
effective, and sometimes certain kinds of medications, and this is when your previous panelist talked
about psychedelics. Absolutely, folks. Different strokes for different folks, but you need to know where
the person is stuck, and this is the boulder that seems to get in my way. Depression, anxiety, chronic
pain, OCD, domestic violence, financial stress. These are the factors that stop you from healing because
it increases the threat physiology of the nervous system.
As we pause here for a second, and do a time check, is I want you to understand is the ultimate goal is if
you work these steps, you move your nervous system towards a state of safety and you start to feel a
difference in it.
Dr. Wayne Kampers (01:13:09):

I mean, to me, what you've done here is just fantastic. You are such a brilliant storyteller, and I think this
paradigm shift story of yours, shifting from old science to new science. We know when we look at
paradigm shifts, you need to change a set of assumptions, you need to change concepts, you need to
change values, and you need to change practices, all with a view to, and it constitutes a new way of
viewing reality.
You have talked us through that story beautifully in terms of it's so understandable. When I started
yesterday morning where you started off in terms of really showing what the ICD-10 did in terms of
chronic primary pain versus chronic secondary pain. You've just taken that and then said, okay, let's talk
about chronic primary pain. This is what it is and we need to change everything. Our paradigm shift story
needs to happen.
I mean, I have not yet heard somebody tell that story as beautifully as you have. It's so understandable
the way you explain it and it's so relatable in terms of the way that you explained and I just think that
that is, it's remarkable in the way that you've done it. You have such a deep understanding of this, but
you are able to translate that into practical understanding, which is just wonderful.
Les Aria (01:14:38):
Well, that's great and thank you for that because it's taken me a few white hairs, about 48,000 patients
to be able to come up with that. But I will tell you this, as my mentors told me, that books have not
taught me this, my patients have. That's what it is about.
I'm going to have a look at another slide or two, and then I'd love to take question and answers. I would
love then to be able to close out with the somatic tracking intervention. We'll close out.
Dr. Wayne Kampers (01:15:10):
I've got a question here that's come from somebody, is that is the brain habit that you're talking about
the same as procedural memory as part of implicit memory?
Les Aria (01:15:19):
I love that. Someone knows their stuff. Yes. Procedural memory, often known as implicit memory,
known as habit. I just call it habit. Yes, that's exactly it. I do not differentiate between trauma and
chronic pain because it's the same brain area, different shelf. Today, when you pull out your plates for
dinner or lunch, take a look and see if they have different shelves because the brain has different
shelves, but same compartment.
Dr. Wayne Kampers (01:15:45):
Great answer. Another question, which I think is a very good question. Does neurofeedback fit in as a
technique for pain reprocessing? And what is your feeling about client's self-directing these techniques
versus working with a caring clinician provider?
Les Aria (01:16:05):
I love that. Such beautiful questions by the way. Neurofeedback. Yes, yes, yes. Why? One of the things
when I do neurofeedback or my colleagues do neurofeedback is I have them do open space. There are

different protocols where you might take anywhere between 20 to 24 sessions, they're different
protocols. But what I like to do is what I know about science.
One of the things that I tend to do or recommend if it's neurofeedback to do open space meditation,
and most people may not know what that, is and let me just walk through it. This was discovered
accidentally in neurofeedback, is that when you're actually on a walk and you look at a branch. There's a
space, a gap, or you see one tree to the next tree, that space. Place your mind's attention on it, and
what happens is your brain waves, your breath rate, your heart rate like three horses will become
synchronized in that open space. Your feedback is great to get people into that state of relaxation
without even trying. Yes, very helpful.
Dr. Wayne Kampers (01:17:05):
And the last...
Les Aria (01:17:07):
What was the other question?
Dr. Wayne Kampers (01:17:07):
The last aspect to that was is there a.... I've got one more question after this. Is the relational aspect of
healing important?
Les Aria (01:17:19):
Yes, absolutely, in short. We can go into it a lot, but the answer, the short answer is absolutely.
Dr. Wayne Kampers (01:17:27):
Then this is a really interesting question. Would PRT work for fibromyalgia? Because is fibromyalgia
mostly insecure attachment complex, PTSD? Would PRT work without trauma therapy to regulate the
nervous system for fibromyalgia patients?
Les Aria (01:17:46):
Yeah, great question, complex question, but simple answer here is yes, PRT will work. However, look at
step four. If you have stuff you've not dealt with and you don't have a peaceful life, think of all chronic
primary pain as nervous system dysregulation. The answer to that is yes, it does work, and very often
when I'm giggling and laughing and teasing my patients as we do the work, they tell me, my body feels
relaxed. I say, "No, duh" in my head because that's safety physiology. It's a felt sense of safety with
another human being. The answer is PRT does work. However, in other emotional threats, as long as
they're minimized.
Dr. Wayne Kampers (01:18:26):
I think it's really great that you did point out that all of the things that we've spoken about this weekend
have their place in treating chronic primary pain, but there is no one size fits all. Some people will do
very well with one particular treatment modality, another treatment modality. But the core, I think at
the core, what we've focused on this weekend really is about focusing on, we live in a dysregulated
world with dysregulated nervous systems.

I've said yesterday, we can't change the dysregulated world, so we have to focus in on treating our
dysregulated nervous system, and the whole description of threat physiology and how we are trying to
get that into safety physiology, understanding the polyvagal ladder and looking at what I've described as
all of the neuroplastic on switches to switch you from threat physiology to safety physiology. There is an
abundance of stuff that you can do, but that it has to be intentional. Everything has to be intentional.
As you said, you start your own morning with an intentional self-care routine because you're actually
putting yourself into safety physiology, and not starting your morning in threat physiology state. I think
so many people do by first looking at their mobile phones. That's just a simple step to start. I mean we
talked about with the Ira [inaudible 01:20:03] stuff today, we talked about not only a digital detox, but
it's an environmental detox. It's a nutritional detox. Mostly, it's also about a thought detox because it's
not about fixing old neural pathways, it's about creating new neural pathways, and new neural
pathways that are our default setting, that actually become... That run on safety physiology.
Les Aria (01:20:29):
Yeah, so beautifully said. I mean, what a great summary of this, and that's really the take home message
of this is all things work differently for different folks. It's not one super, it's not the PRT and that's the
goal. The reason we call it the golden standard, it's one of the most effective things. If you run into it,
you can kind of switch it up.
But I think if we take a higher level view, just as you said, take a look at your life. In the presentation I
said this, and very often I get like, what did he just say? "What is your pain protecting you from?" It's not
a conscious thing, it's an unconscious part of your brain. Not Freud unconscious, but brainstem and
limbic system. It's there to protect you.
Dr. Wayne Kampers (01:21:12):
Les Aria (01:21:12):
When we have a panic attack, it's protecting you. When I have a panic attack, let me tell you personally,
when I have a panic attack, it's my unconscious brain is trying to protect me from anger.
Dr. Wayne Kampers (01:21:23):
It's often been, the analogy's often been drawn that the two things that are probably the most difficult
for any human being to cope with is relentless anxiety and chronic persistent pain. Actually, if you look
at the threat physiology, they're identical.
Les Aria (01:21:38):
Dr. Wayne Kampers (01:21:38):
They really are. They are absolutely identical in terms of the inflammations, the cytokines that are being
released and affecting our immune system, and the approach should be the same as well.

Les Aria (01:21:50):
Yeah, beautiful.
Dr. Wayne Kampers (01:21:52):
Les, it's been an absolute pleasure. You are a wonderful, wonderful storyteller. You obviously make a
huge difference to your patients, and you've a great contributor to the community that are helping
people in chronic pain. Thank you so much.
Les Aria (01:22:11):
My pleasure.
Dr. Wayne Kampers (01:22:12):
So over to you for the last five minutes.
Les Aria (01:22:15):
Absolutely. I would like to actually, I think just the way you summarized everything so beautifully, if it'd
be okay. I'd like to walk you through the practice of somatic tracking in PRT, that was step three. It's
really simple, it's just like pendulation. What I'd like to do is have everyone, you don't have to have your

eyes closed, but if you feel comfortable, I'd like to just take the next few minutes to help just down-
regulate your nervous system.

If you want to have a goofy face to look at, just look at mine because I'm often smiling for whatever
reason, feeling safe, I guess. Go ahead and find your position, and once you find your position, whether
it's lying down, seated, that's absolutely, just let it be. Now, just like any meditation, again if you feel like
you want to close your eyes or have your eyes half-closed, with a soft gaze about three or four feet in
front of you.
Now, go ahead and drop into your breath and just notice where you feel the breath in the body. Perhaps
you know the breath at the nose, and if you do, then gently use these soft mental notes as you breathe
and say in, as you breathe out and say out. In, out. Or maybe you notice the breath of the belly in. If so,
then use these soft mental notes as you breathe and say, belly rising, belly falling, belly rising, belly
Just let your mind rest in one of these places, whether it's the nose or the belly, laced with those soft,
gentle notes, in, out, or belly rising and belly falling. Just let your body settle back down here, letting
your mind come back into your body and let your body be in this present moment.
As you continue to allow your mind to come back into your body, just scan your body and notice where
you might be holding an emotional charge or a sensation you might be feeling in your body that's calling
your attention. For example, we carry a lot of our stress and tension, maybe around our neck, around
our shoulders, our backs.

Or if you have a condition that's chronic, go ahead and focus on it. May that be your belly, your arms,
doesn't matter. Just go ahead and focus on it. As we continue this practice, we're just going to track and
notice what happens. The first thing I want you to do is go to now as you continue to connect with your
breath and releasing those soft mental notes to simply connect with your breath and then locate where
you feel that tension in your body, that discomfort, the emotional charge, call it what you will.
As you locate that sensation in your body that's calling out to you, notice the size, shape, and even the
color of it. Maybe it's circular, maybe it's a ribbon, maybe it's jaggered. What color is it, and what quality
is it? Stabbing, aching? Just describe it. Once you've noticed that, I want you to get real close to it as if
you're just hovering above that sensation.
For example, if you were experiencing some back pain there, just notice the size, shape, color, quality of
it, and just imagine you were just hovering just right above that sensation. Just right above it, you're
hovering, or you could imagine sitting just really close to it, looking, nudging up to it like a child.
In step two, now notice what the emotion might be that's connected to that sensation. If you don't
know what it feels like to have that sensation, maybe you simply think, [inaudible 01:26:27] or tense.
You're just noticing at this point. Now, here's what I want you to do. Go ahead and leave it for a few
seconds. Now come back to where you feel the breath from the body and connect with those soft
mental notes. Leave where you are focusing on and come back to where you feel the breath in the body,
the nose or the belly. Just go and connect with those breaths. If you wish, you can add the soft mental
notes again in, out to belly rising, belly falling.
Just for another breath of two. Ease over effort. There's no need to force your breath. Now, direct your
spotlight of attention to the spot, going back to where you felt that sensation in your body. We're just
going to watch over it, hover over it, nudge up to it, sit by it like a child. We're going to just sit next to it.
As you continue to notice your breath as it comes and goes, as you're watching that sensation, so use
your breath as you connect with that sensation, just for a few more breaths. I want you to notice and
maybe even speak to that sensation that it's okay, we're safe. It's okay, it's okay, it's okay, it's okay.
If you wish, you could even do this right now. If you're comfortable with it, you can just grab your hands.
Your eyes are still closed. You could just gently rub your chest or just tap your chest. I sometimes like to
add a gentle rock. I'm tapping, I'm breathing and I'm just focusing on the sensation, that area that I
noticed, and I'm watching it. As I'm breathing, as I'm tapping or maybe rubbing, if you like to do that.
You're paying attention to the sensation.
Now speak to it, we're safe. We are safe. Feel your breath, feel your body connect with that sensation.
Now, go and leave what you were doing, coming back to where you feel the breath in the body, noticing
where you feel the breath in the body. It's okay for you to use those soft mental notes. In, out, of belly
rising, belly falling.

Before we end this practice, I always like to do this, and this is just a modified version. Let's place one
hand over your heart. You can tap or rub and simply speak to that sensation. I'm here for you. I'm here
with you. I am here. Repeat again. I'm here for you. I'm here with you. Don't just say it, feel it. I am here.
One more time before we wrap up. Hear my words. Embed that into your body because your pain is like
a child that needs your comfort and counsel. So repeat after me and feel these words. I'm here for you.
I'm here with you. I am here. Placing your hands down, connecting with your breath, feeling the whole
body in the present moment, taking a breath in, pausing. As you breathe, now gently opening your eyes.
This ends the meditation. There you go. Hopefully, everyone enjoyed it and everyone is back online.
Dr. Wayne Kampers (01:30:40):
Thank you very much, Les. Thank you.

PART 4 OF 4 ENDS [01:30:47]