Getting the most out of Pain Reprocessing Therapy (PRT)
What is Pain Reprocessing Therapy (PRT)?
Pain Reprocessing Therapy, or PRT, is a type of psychotherapy that addresses chronic, neuroplastic pain. It is described in detail in the book The Way Out and in the podcast Tell Me About Your Pain.
PRT is built around the theory that for many chronic pain sufferers, pain happens when the mind misinterprets safe bodily sensations as dangerous. This happens for a variety of reasons, such as having a tendency to worry or catastrophize, having early life experiences that cause ongoing feelings of unsafety, or simply having a human brain that is designed by nature to detect threats in an attempt to protect us from harm.
The good news about neuroplastic pain is that because it involves learned associations between sensations and interpretations, we can unlearn these associations over time, thereby reducing or eliminating our experience of chronic pain. PRT produced promising results in the first clinical trial on its use for people with chronic back pain. In the study, 66% of people who completed PRT had little to no pain by the end of the 4-week treatment, compared to 20% who received a placebo injection and 10% who received usual care.
What do you do in Pain Reprocessing Therapy (PRT)?
It can be helpful to make a distinction between the techniques used in PRT and the psychological changes that the techniques are designed to elicit.
The techniques include things like:
Building a list of evidence for why your chronic pain can’t be fully explained by physical damage to your body, or, said another way, the ways in which your pain has a strong psychological component (remember that this does not need to be an all-or-nothing thing!)
Somatic tracking, a mindfulness-based exercise that involves noticing pain with lightness and curiosity (vs. fear)
Connecting to positive feelings in your body (also known as “getting good at feeling good”)
Reducing behaviors that keep your mind and body on high alert
When practiced over time, these techniques can result in significant mindset shifts, including:
Viewing pain sensations with curiosity and openness, rather than fear and dread
Worrying and catastrophizing less, and becoming more flexible in your thinking
Putting less pressure on yourself and treating yourself more gently
Letting go, lightening up, and slowing down
What prevents people from benefiting from PRT?
According to the theory on which PRT is based, it is these mindset shifts that help us change our relationship to pain and reduce or resolve our chronic pain.
This distinction is important because it is possible (and not uncommon) for people to use the techniques, but somehow never quite get the benefit of the mindset shifts.
In fact, a very common thing that I hear from folks before they start working with me is: “I’ve read the book, I’m totally convinced, I’ve been doing somatic tracking, but my pain hasn’t gotten better.”
When we start our work and dig a little deeper, we will often encounter a few common sticking points that pose a barrier to reaping the benefits of PRT.
Barrier #1: “This has to work.” (The Desperation Trap)
Many people take a psychological approach to pain only when they feel like they have exhausted all other treatment options. They’ve already been through many cycles of hope and disappointment in their attempts to heal. They believe that PRT is their last chance to get better. They feel hopeful about it, but also carry a nagging worry of “What if this doesn’t work?”
These fears and worries are so, so understandable. And they create an environment of pressure, intensity, and fear around the work that is in direct conflict with the spirit of PRT.
That doesn’t mean that you have to resolve all of these concerns before you start PRT. It does, however, mean that it’s helpful to be aware that these fears may be lurking in the background, ready to jump out and scare you at any moment. It helps to hold them lightly, to remind yourself to trust the process, and to send yourself some loving-kindness for all of the suffering that you have endured that led your mind to think this way.
Barrier #2: “This isn’t working.” (The Attachment Trap)
Getting out of pain is understandably the top priority in the lives of most people with chronic pain. Of course you want this treatment to work. Why else would you be doing it?
Yet, being attached to a particular outcome–getting rid of pain–can create an internal environment of vigilance to pain sensations, which perpetuates the fear of pain.
PRT focuses on creating an internal environment of safety as a pathway to resolving pain. That means it is helpful to shift your attention away from fear-producing thoughts like “this isn’t working” and toward safety-promoting thoughts like “let’s see what happens,” “I’m learning something new,” or “this is another chance to practice letting go.” This is not to suggest that you can just replace one thought with another (and attempting to do this can result in the initial thought getting stronger). Rather, this is about shifting your stance from one of fearfully drawing conclusions to one of openness and curiosity.
Barrier #3: “This won’t work.” (The Hopelessness Trap)
When I hear variations on this theme from clients (“This is stupid.” “How could this possibly help me?”), I hear their history of being disappointed by pain treatments that once felt promising. I hear a fearfulness about this new treatment, covered up by a self-protective readiness for disappointment.
Skepticism about a new treatment can be very helpful when it cultivates a sense of curiosity and inspires productive action toward educating oneself. Sometimes it can cross over into a darker place, however, and cause people to draw conclusions that cut them off from giving a new approach a chance to work for them.
Learning to name the feelings that underlie a conclusion that PRT is “stupid” or “won’t work” can be powerful. Acknowledging “I’m scared that this won’t work for me” or “I’m afraid to let go of control” is a radically different place from which to start treatment, and one that will lead in a much more fruitful direction over the long-term.
PRT is about more than technique
As you can see, engaging in PRT can entail making radical shifts in how you think, feel, and relate to your body. The work can often be very subtle, as it requires a careful examination of insidious belief systems that are so ingrained that they don’t even feel like beliefs, but like facts. If you’ve tried PRT, either on your own or with a certified provider, I’d love to hear from you about where you have gotten stuck and what helped you work through it. Send me a message here.
Want to work through your own sticking points? Check out my group coaching program for chronic pain and request to join today.
The content shared here is for informational purposes only and is not intended as a substitute for professional medical advice, diagnoses, or treatment. Always seek advice from your physician or other qualified healthcare provider before making changes to your health regimen.
