“It was at a five, but I can barely notice it now—I'd say it's a one out of ten. I didn't think it was possible.”
Bill learned to observe his gut on his own, and when he returned for the second appointment ten days later, he was very pleased to report that the frequency and intensity of the pain in his gut was noticeably reduced. His third appointment became his last, because the symptoms hardly bothered him at all anymore.
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Not all patients find relief from their symptoms as quickly as Bill did. But practically all of our patients do experience relief and an improved sense of control over their symptoms by learning to notice and observe the sensations in this passive way. Ironically, they're learning to control their symptoms more by not trying to control their symptoms at all.
As a little experiment, just take a minute or two right now to focus on a sensation somewhere in your stomach or abdomen. Just imagine that you're going to pull a chair up to it and simply observe it. Don't try to change it, fight it, or make it relax. Just let that sensation in your abdomen be there exactly the way it is. If it stays the same, that's fine. If it moves, changes location or intensity, that's fine, too. Just be curious to notice what happens without you trying to change it in any way. Afterward, jot down on a piece of paper what you observed.
As you practice this skill and gain experience with it, your brain and nervous system will learn that these sensations are not threats. You will begin to feel the sensations diminish in intensity. What's more, you'll find that the anxiety, dread, and muscle tension associated with those sensations will also diminish. You will feel better and calmer, and you can then begin the process of actually listening to what the sensations are trying to convey.
You may be put off by this whole idea. You might be thinking, Why on earth would I want to make room for and accept sensations that I hate so much? I want to fight that sensation with everything I've got! This is a common reaction to something that seems counterintuitive. Skepticism is normal. As one of our patients said at this stage, “No offense, Doc, but are you crazy? This pain in my gut has taken over my life in every way. The last thing I want to do is pay any more attention to it. I'd rather stick my finger in an electric socket.”
We are biologically predisposed to be alarmed when we feel something painful or unusual in our body, especially when it's new. This is meant to protect us from harm. If you accidentally put your hand over a flame, that natural alarm activates a signal in your brain to pull your hand away as quickly as possible. You don't just watch it. If you suddenly notice pain or pressure in your chest with pain radiating down your left arm, you should not simply make room for that sensation. Instead, start calling 911! Similarly, if you experience new abdominal symptoms of pain, pressure, bloating, and diarrhea and have not seen a physician, you should definitely call now for an appointment.
However, if your symptoms have become chronic—and you have already been medically examined and tested—then the alarm function is not needed. It's a false alarm. The mix-up is that your more primitive, reflex-level limbic brain never got the memo. Unfortunately, most people still react with alarm, anxiety, or panic when they feel that all too familiar discomfort in their gut. Calmly observing those sensations helps to short-circuit the primitive brain.
At first, it may feel awkward or scary to observe your gut symptoms with a sense of passive curiosity. But we want to assure you that it is perfectly safe. We will be with you through this process, step-by-step, to help you master these new empowering skills. Over time, it will help you feel relief and gain more control over your symptoms.
Why Fighting Symptoms Doesn't Work
When you go on the offensive and try to fight your symptoms, it only makes them stronger. Try this: whatever you do, do not think of an elephant. What happens? The harder you try not to think of it, the elephant's image becomes even more prominent.
That's exactly what happens when you try the same game with a more emotionally charged topic: whatever you do, do not think of your gut distress. Instead of not thinking about your gut, your reactions become all the more amplified and disturbing. The harder you try to not think about the symptom, the more powerful the image. And the more powerful the image, the more likely you are to assign emotional value to it. Your body then responds automatically, unleashing multiple reactions, including the release of stress hormones and other factors that perpetuate or worsen gastrointestinal distress.
Say you get a burning pain in your upper abdomen every time you eat pizza. It's nothing new—a chronic problem. You've seen your doctor to rule out physical pathology. As you feel that all too frequent sensation, your body sends out a cascade of emotional and physiological processes in response.
First, your sympathetic nervous system shouts out for the release of stress hormones such as adrenaline (also called epinephrine) and cortisol as your primitive limbic brain mistakenly encodes the pain as a threat. Because emotions often express themselves in physical ways, when you then try to not feel this unwanted burning pain, you instinctively tighten the muscles and other tissue in the area where it hurts—and other areas of your body as well, perhaps far removed from the source of the pain. All of this makes the pain worse, sometimes even spreading to other parts of the body.
At the same time, conditioned learning occurs in your limbic brain; the next time you eat pizza and get that familiar burning pain, you're just a little more likely to automatically react with anxiety, anger, frustration, or despair. It's a difficult cycle, one that increases your suffering.
Avoidance Increases Anxiety
In your body's understanding, the twinge of pain in your gut has taken on a whole new meaning. Instead of merely being useful information, this sensation has become mislabeled as a serious danger to be avoided. Yet this false threat has the power to take away simple everyday pleasures like pizza parties.
Tensing and resisting actually make distress worse.
Susan was learning how to go spelunking in a practice cave with narrow, hard-to-navigate crawl spaces. At one point, she got stuck in a particularly narrow space and panicked. “Oh my God, I'm stuck,” she shrieked. “No, you're not,” called back her instructor. “Just relax, Susan. You are never stuck. If you tense up, your body will naturally get bigger and you'll be even more stuck. If you relax, your muscles will go loose and your body will naturally find a way out.” Tensing and resisting actually make distress worse—in spelunking and in your gut! Likewise, learning to relax your gut helps to activate your body's natural healing powers.
Learning to Listen
Let's do a simple exercise to prepare you for listening to your gut. At this stage, don't worry about interpreting symptoms. In this exercise, you are going to observe your gut sensation and not judge or fight it.
The next time you notice a gastric symptom (gas, bloating, constipation, gurgling, churning, and so on), take one slow breath every three seconds. Allow your breathing to become easy, relaxed, and calm. Then mentally scan your gut.
Ask yourself:
When I get this sensation, what is the thought I become aware of?
What is the emotion I begin to feel?
What is the sense I have of myself at this moment?
As you learn how to notice and respond
