This week I share some concepts that I blend into my pain recovery program which I call cognitive-somatic mapping. I discussed the experience of The Felt Sense in last week's episode.

Cognitive Fusion is a concept from Acceptance and Commitment Therapy that helps people see that their thoughts are just sentences in their mind.

Hey! That's the same concept I work with in regards to using "the model" a life coaching tool I learned from Kara Lowentheil from Unf*ck Your Brain and the main life coaching methods from The Life Coach School. BTW, I'm starting my certification there next month! Cannot wait! Totally terrified! Fuck yeah feelings!

Here's the links to these three resources:
https://www.habitsforwellbeing.com/what-is-cognitive-fusion/

http://eightfoldcounseling.com/wordpress/wp-content/uploads/Cognitive-Fusion-Explained.pdf

http://unfuckyourbrain.com/

And my website - debmalkin.com
To book a curiosity call - https://calendly.com/paincoachdeb

Transcript

Welcome to Move With Deb. I'm Deb your friendly neuroplastician. And this is a podcast that explores the relationship between the body and the mind from a health at every size, judgment, free perspective. I teach you how developing a new internal conversation based on curiosity, self friendship and simple neuro-plasticity techniques can rewire your bodymind out of pain and emotional overwhelm to help you build the rich full life that you want to live. Disclaimer, this is not a replacement for medical care.

[00:00:50] Hi everyone. It's Deb with Move With Deb the podcast. Thank you for joining me here today. I'm going to talk a little bit about this concept from psychology, from acceptance and commitment therapy, called cognitive fusion and the opposite, which is cognitive defusion. So I want to share some ideas around this because when we're talking about changing our experience with pain, oftentimes what we are talking about is it tending to the sensations in our body, through the lens of safety to borrow a line from Alan Gordon, from the Pain Psychology Center.

[00:01:36] So to do that, we have to start to understand and untangle some of our thinking, because thoughts create a sensation in our body. Thoughts and feelings are inputs into our safety system. Just as much as sensations from the body and all of our other senses. So looking at cognitive fusion is a great way to begin to explore the thinking input into our body mind system.

[00:02:12] So I'm going to read from this article, from a website called eightfoldcounseling.com and it's just a very handy primer on cognitive fusion. "So it refers to the human tendency to become entangled with thoughts as a result of a strong belief in their literal content. In other words, we listen to and believe what our minds tell us. Of course, buying into thoughts isn't always problematic. When your mind tells you how to balance your checkbook or drive your car safely, listening may be adaptive. What happens when your mind says that you are boring or unattractive? Fusion with these kinds of thoughts will probably result in attempts to avoid experiences you associate with these thoughts.

[00:03:00] For instance, you might avoid social or romantic interactions, even if being close with others is very important to you. In this way cognitive fusion pulls us away from living in alignment with our values." So I'm going to pause here and jump into, say cognitive fusion includes thoughts that are not ours.

[00:03:25] The thoughts that we think are oftentimes words that are handed to us from the culture, including predominantly white heterosexual, patriarchal, Christian, diet culture, weight stigma, medical providers, right? So, oftentimes our choices of what we think are not thoughts that we would even choose to think.

[00:03:54] So there's a lot of being able to look at and demystify and disentangle ourselves from you can call it propaganda. You can call it bias. So part of the work that we do is explore how some of these thoughts become entangled in our beliefs. Especially if we have marginalized bodies, especially if we have had to grow through a process of resistance to dominant culture.

[00:04:28] I think it becomes very important to be able to explore our relationship, to the thoughts that we think about our bodies, about ourselves, about our worth and value. Now I'm just reading this article. I am not an acceptance and commitment therapist. My work involves a lot of cognitive and somatic mapping.

[00:04:53] We begin to language and separate their experiences between our thoughts and our sensations in our bodies. So this work is an important foundational piece, from both doctors and therapists who are working in the TMS field. I find my tools from The Life Coach School to overlap this very well so I like to share this from this point of view.

[00:05:19] I am not saying this is the one way, but what I like about this as it helps give you some framework for exploring the idea that our thoughts are just sentences in our head. "Cognitive fusion is most likely to arise across six cognitive domains, rules, reasons, judgments past, future, and self rules. Rule govern thinking often consists of should, must, ought and if then language. If you think if I'm in therapy, then it must mean I'm crazy. I should be more normal. If people know how messed up I really am, then they will never accept me. Fusion with rule govern thinking, equates to inflexibility, which inevitably results in suffering.

[00:06:11] Reasons. Reason, govern thinking typically consists of excuses for why change is impossible. You might have thoughts such as I don't have the willpower to change. I'm not smart enough. Strong enough, capable enough. I'm too lazy, ill, unlucky. Or my craving, anxiety, depression, et cetera, is too strong to battle. Fusion with reason govern thinking holds you back from making meaningful changes, even when those changes are in line with important values

[00:06:45] Judgments. Usually with judgments can pose a problem whether evaluations are negative, like I'm so ugly or this anxiety is unbearable. Or positive, for example, consider someone who puts friends, colleagues, family members, or helping professionals up on a pedestal and is chronically disappointed when they do not live up to expectations.

[00:07:10] Past and future. Fusion with the past or future can involve both unpleasant and pleasant content. Fusion would negative memories wishing to recapture positive experiences from the past, getting hooked by fears about the future or wishing for bright ahead. All of these forms of fusion pull you out of the present moment.

[00:07:31] Sometimes this process serves as a cognitive form of avoiding experience. Although this may produce mild temporary relief in the longterm. It only results in suffering. Ultimately like all types of fusion. It tends to pull you away from the things that are most important to you. If, for example, you're getting hooked by thoughts, like the last time I interviewed for a job, it was a total disaster. The next time is bound to be the same. You are likely to avoid a future job interview even if career development is a meaningful life pursuit for you.

[00:08:06] And Self. Thoughts about the self are stories that you tell that make up your sense of identity. They typically begin with, I am. And in ACT they are referred to as the conceptualized self, this type of fusion leads you to be driven by stories you have about and yourself. Example, I am the kind of person who's guarded rather than by your values. I want to be an open and vulnerable partner.

[00:08:33] So cognitive defusion is the process by which you change the relationship with your thoughts by stepping back and simply witnessing their presence."

[00:08:43] So this is Deb talking about that. So changing the relationship with your thoughts, stepping back and simply witnessing their presence is one of the main things we do when we're starting to approach our pain, anxiety, and emotional overwhelm, the responses of our body, to the various inputs that are coming into our nervous system.

[00:09:08] That's why I created the lazy detective tool. We want some place to go while we're having these thoughts. Now we have a character in our mind who is holding that space of stepping back and simply witnessing their presence. We are practicing with our mind, the ability to witness without judgment and without a sense of danger. And maybe with some flare and theatricality.

[00:09:37] "So when you diffuse, you disentangle from your self-talk and observed cognitions as entities separate from yourself as just words. This allows you to look at your thoughts rather than from them."

[00:09:51] So you want to observe your thoughts. You don't want to live inside of them because if you have. This is me talking. If you have 60- 80,000 thoughts a day, um, first off, you're only really noticing the ones that are like pinging your threat attention, or really captivating, or maybe kind of bizarre, like you're not actually paying attention to all of those thoughts. So let's be real our body mind system is like not really delivering us an equal playing field of all the thoughts that we can think about ourselves.

[00:10:26] So if we have a hundred thoughts a day about how we're a dirt bag and how nobody loves us. But we have 10 thoughts a day about like, oh my God, my hair looks awesome. I'm kind of, yeah, great person. I'm really good at my job. Like you're not paying attention to those thoughts. You're really paying attention to these terrible thoughts that we think about ourselves. And then when we take those thoughts seriously, then we train our brain to pay attention, even more to them.

[00:10:59] Going back to the article. "For instance, if you have the thought presenting at a professional conference is too scary, my colleagues will think I'm an incompetent fraud. Then you can probably see that fusion with this thought is likely to result in avoidance of professional presentations.

[00:11:17] While this avoidance would certainly reduce anxiety in the short term, it would also mean missing out on an important professional opportunity and the anxiety would persist in the longterm. What if instead, you simply witness what the mind says in much the same way you would watch a screen saver scroll across your computer.

[00:11:40] Imagine how your behavior might be different. If you choose to see this thought as simply some words that may or may not be true. Defusion creates a little wiggle room to make value choices. For example, if buying into the thought about presenting at a professional conference causes you to avoid professional presentations, then simply observing the thought gives you the space to make a different choice. Importantly, this does not mean that thought disappears. It simply means that you are making the choice not to be driven by its content. Thus, you are free to continue moving in directions that are important to you. Perhaps, for example, disseminating your expert knowledge to your colleagues. Defusion exercises fall into two broad categories, stepping back and observing the content of the mind and showing language for what it is. A verbal production of sounds and syllables."

[00:12:36] In this other article on a website called habits for wellbeing, they quote from Dr. Harris's book ACT Made Simple, in which he says, "in a state of cognitive fusion we're Velcroed, fused, or attached to the thoughts and or beliefs we can be so caught up in them, like on automatic pilot that we forget we're just thinking a bit like in the movie Groundhog day. Harris indicates in a state of fusion of thought can seem like the absolute truth, a command you have to obey or a rule you have to follow. Something that's happening right here and now, even though it's about the past or the future, something very important that requires all of your attention, something you won't let go of, even if it worsens your life and a threat you need to get rid of as soon as possible."

[00:13:31]I wanted to share those ideas because from a danger threat, embodiment viewpoint, all of those thoughts create a reaction in the body. When you have a thought that your system is reacting to like a threat you need to get rid of as soon as possible, your threat system will become activated. Those hormones will course through your body. Cortisol, adrenaline, your fight and flight system will come online, but it's because of a thought. Oftentimes when we're looking at pain, we build a lot of cognitive fusion around the pain itself. We also create a lot of commands or rules for us to follow for our bodies to feel okay. So I see people creating a sense of physical okayness in having an ever increasing limited availability of movement.

[00:14:43] Like I can only sit in a certain chair or I can't sit for a long period of time or I can't walk for more than five minutes. And those are real physical events happening in your body, but they're happening because you are having a thought about the fear of the pain, which then becomes a trigger for the brain to turn up the volume on what can be some very neutral nociception.

[00:15:18] So the fear creates the pain that you were afraid of experiencing. And there's lots of ways that the work that we do together can go about helping you see what is cognitive fusion. What's fear based thinking. What is your nervous system's misinterpretation of nociceptive input, and then delivering that to you as the nociceptive projection, as the brain's projection of what it's expecting to experience, and then you experienced the pain.

[00:15:56] That is oftentimes what's happening when we're feeling pain. It's not actually a true story about the state of your tissues or any tissue damage happening on the inside of your body. Especially if this is years after an injury, we can begin to believe that the tissues have healed. What is not healed is the neural pathway delivering the brain's expectation of a certain nociceptive experience.

[00:16:32] And with this work, we go through the cognitive fusion. We start to diffuse them. We start to make thoughts themselves, be less dangerous to think. And certainly if you're living in a marginalized body, if you are living with pain and disability, there are threats from the culture to your body. Let's say you were told by a doctor 10 years ago, that if you didn't lose weight, you would end up in a wheelchair or you would lose your ability to walk.

[00:17:08] That's an input into your nervous system. That can become a thought that you become cognitively fused with, a threat that you need to get rid of as soon as possible, because if you think that thought your belief is that it will come true or that it is true, especially if it's delivered to you by a medical professional.

[00:17:31] So a lot of times I have clients tell me, I can't think this. It is unbearable to feel this. And we're not even talking about the pain that they're experiencing. Oftentimes we're talking about the fear of a thought, the fear of a belief. And I think the most important thing to understand in this work is that a thought is just a sentence in your mind, it is not a belief. And no matter who delivers you a thought about your body, it does not mean that it's one that you need to just take into yourself and believe. I certainly had thoughts that were delivered to me about my body from my own family and took me a very long time to learn how to not believe something.

[00:18:24] And when you're doing the work of not believing or disbelieving, that also can have its own level of threat, it's own sense of being unsafe. When you receive a message or a belief from another human being, especially one that you either rely on or care about. It can be very distressing to have a different belief about yourself and your brain might want to spend a lot of time arguing. I called it with a client, going to debate club.

[00:19:05] And even going to debate club can become an activity, a cognitive activity that looks like we're taking care of ourselves. But when it becomes a conditioned response of where our brain goes, where we train our system to go ,that kind of leaves our body. That then drives up the threat level, even though we're doing it because we're trying to defend ourselves because we're trying to believe something that other people is telling us is not true about our own immutable worth and value as a human being in the body that you're in, but that need to fight and defend yourself reinforces the fear, the pain, the distress signal that is happening on the inside of your body, that's being detected by your safety system. So what if we just decided that we were valuable, that that was an unshakable truth about us?

[00:20:08] What if we just decided that some things are not up for discussion and that other people are entitled to their opinion. Those are their thoughts in their head creating sensations in their body, and that we are allowed to believe what we want to believe about ourselves. Now, I know it's easy to say that, but that is the good first place to start begin to observe our cognitive fusion and begin the process of cognitive defusion and it doesn't have to be painful.

[00:20:40] We don't have to have other people be wrong for us to be right. We don't have to have other people agree with us, for us to believe something new and different. Every day I thank being queer for this understanding of looking at how we have brought a broader understanding of love, of gender, of the full and richness of human diversity.

[00:21:12] And there are still people who don't agree that there are more than two genders, don't agree that people of the same gender should be allowed to get married. And somebody else's belief or opinion, certainly can structurally have a lot of effect on you, but also we can decide that we have immutable worth and value that we don't actually need to go to debate club all the time.

[00:21:41] We can begin our own process of cognitive defusion. We can begin our own process of de-escalating, the threat level of our own thoughts and feelings and other inputs into our body. That part of our work in creating safety in ourselves is finding our own wholeness, finding the unshakeable belief in our own beauty and magnificence in our own exquisite humanity.

[00:22:15] Recognizing that being fully human requires us to feel things that are pleasant, neutral, and unpleasant. Those are the outputs of our nervous system, of our body mind system. We take in all of these inputs, thoughts, feelings, sensations, nociceptive input, inputs from information on the inside of our body, the outside of our body, all gets processed by the nervous system. And evaluated, gets matched with experiences of the past because biologically that's metabolically conservative. It's kind of how the brain works because otherwise it would take a lot of fuel for the brain to be like actually analyzing things in real time.

[00:23:10]So sometimes we'll match a sensation or a thought that you have today to something that happened when you were in seventh grade and your body's going to respond to that. Right? Maybe we call that a trigger. It's a trigger only because the brain has not replaced that predictive code with something else.

[00:23:33] When we replace that predictive code with new nociceptive experience, with new information, with a new neural pathway to travel down, that becomes the new prediction. So when we experience the sensation of fear or panic arise in us, we do not need to believe that we are in danger in this moment. We can set up a system by which we're actually then able to feel that sensation of fear and panic, and then say, am I in danger, not as a way of telling yourself that you're wrong for having that experience, but it's your check engine light. It's saying this sensation matches this other sensation that I had back at a time where I was very scared, that I was very upset. Our body is doing some time travel, but we don't have to time travel to take that moment of, oh, I'm having a thought and feeling the sensation in my body, that's telling me that something is dangerous.

[00:24:48] We can say, what is my checklist for danger? And look at what's happening around us right now. Not believe the thought or the feeling, just believe in cognitive fusion. It's just the brain matching an experience, cause that's what the brain does, cause that's how the body mind system operates and maintains allostasis.

[00:25:16]We want to understand biologically what is happening for our own benefit. We don't want to think that the car is going to drive off the road, every time we take a turn on a corner where we can't see the road, right? We don't want to slam on the brakes every single time we have an experience that matches an experience that we did not like, that was from the past. But that's just the brain trying to help us. That's just the body mind system operating as designed. So we can begin to build a new conditioned response based on our current observations and our values.

[00:26:00] And we can begin to recode our body's experience by accurately evaluating our own physical capability. So when we look at pain and tissue damage, if you're having pain that moves around, if your knee pain comes and goes, if there's enough holes poked into the theory of your pain, let's also just look at the possibility that this pain is being driven by neural circuits being fired, because that's what the brain does.

[00:26:33] I will leave you with a little story. I was having terrible knee pain on my left knee, which is the knee that I had arthroscopic surgery on to repair my meniscus 10 years ago. So that meniscus is gone, at least in that one part. And I was getting on my balance board and I've been doing some swimming. I got on my balance board and it's purposefully unstable, it's a balanced board. There's a lot of random movement that I have to contend with and it is a little scary. And this little one part of my knee would light up when I would get on the balance board. Now it didn't hurt before the balance board, it would hurt on the balance board.

[00:27:20] It would go through this process of hurting. I would use my somatic tracking tools, my other mind body tools, and I would keep balance boarding through the pain because I knew that I wasn't doing anything that was damaging the tissue. And on occasion, the pain was very intense and then it would always calm down.

[00:27:43]What I observed was I didn't have this pain afterwards. I didn't have the pain ongoing at different times during the day. I had it pretty much when I got on the balance board. And then also I would get it when it got in the pool and I would do like a frog kick. So it, this similar kind of bending movement, there was something about bending my knees in this particular way that, that triggered my brain to make this pain.

[00:28:13] It was the identical pain that I had when I was recovering from surgery. While I was swimming, I would also use these same somatic tracking tools, leaning into pleasant sensations, telling my brain that I was well and that nothing was being damaged. I knew that I was swimming very gently. There was really nothing to be concerned about. And I also just decided, I decided that I was okay and it took a while and I actually ended up talking to Dr. Stracks about it briefly. And he confirmed that this was mind body pain. This was just a pain that was being kicked up. I have some thoughts about roller skating, have some reoccurring fears that like the activities that I do, I hurt myself.

[00:29:09] There's this anticipatory experience in my brain, like waiting for the next pain to arise that then I will have to deal with. And then I will have to like take care of myself and stop moving. That's a whole nother thing about a walk that I went on. I think I told that story in a previous podcast. So my brain has a lot of thoughts.

[00:29:34] And once I really just decided that this pain, did not mean anything, that it was just an old neurocircuit being fired and that I was fine and I took a two day break from the balance board. I just decided like, I'm not going to be high stakes about it. I'm going to be relaxed about it. The next time I get on it, I'm just going to have fun and know that like, this is safe for me. This is a safe activity for me to do. And next time I got on it. Did not have that pain. The next time I went swimming didn't have that pain. I haven't had it since. And maybe it will come back and that's okay. I'm going to just treat it the same way and know that I'm fine. I had that pain for a very long time.

[00:30:22] And so sure there's an old neurocircuit that goes from my nervous system to that spot in my knee and whatever it was, which is like, oh, it's our time. Let's just, uh, Light up. But I had enough evidence and I had enough experience and I watched the pain be really different. Watch it, show up at certain moments and go away. And I was not having swelling. Like there was a whole long list of evidence for how nothing was happening. Nothing was wrong with my body. The mind, and the body can create any sensation. Especially if it's something that you've felt before in the past.

[00:31:06] So this process of cognitive fusion and defusion is an important one. And so that's the kind of psychology term. I like to use the idea of Buddhism and mindfulness, thinking about a watcher. And because I enjoy theatricality and the process of kind of shaking up your brain with, unique and novel language, I like to create characters like our lazy detective, somebody that we can set off and start to build that practice of neutral observation without danger with friendliness and warmth.

[00:31:48]We want to build the road that we want to be traveling down, that we want to take our whole body mind system with us. And we begin that work now. That doesn't happen in the future. We make the future with what we do now. That becomes the new predictive code, that becomes the new interpretation of inputs and threats.

[00:32:13] Sometimes that work you can do on your own once you understand this. And sometimes that work, you need a guide and sometimes that work you might need, somebody to help you through the darkest times and the deepest waters, and maybe that would be a therapist. There's lots of different ways to start to begin this process of exploring and examining your cognitive and somatic experiences with friendliness and love and compassion.

[00:32:46] That's it for me today. I hope that some of this has been helpful. And I will see you next week. And just to remind you, if you are interested in exploring further with my eight week pain recovery program would like to get out of curiosity, call with me. You can find that on my website, debmalkin.com. Or on my Instagram movewithdeb there is a link to my calendar. You can hop on a curiosity call with me and I'll explain the program, how we explore all of these tools together to help you change your pain experience. Pain and anxiety and emotional overwhelm. They're all interrelated. You can have surprising levels of healing that you were not even expecting to happen.

[00:33:39] So I look forward to speaking with you. Bye.