2021 Conference Presentations
Psychophysiologic Disorders: The Impact & Science
Definition and Scope of Psychophysiologic Disorders (PPD)
David Clarke, MD - 30 minutes
A review of the definition, history, clinical impact and cost of Psychophysiologic Disorders (PPD) and the changes to incorrect assumptions in medical thinking that are needed to elevate the standard of care.
Objectives:
Describe the definition of PPD
Describe how PPD has been managed historically
Describe the magnitude of PPD's impact on the healthcare system today
Describe the shift in thinking needed to achieve the best outcome for PPD patients
Patient Perspectives & Physician Responses: Using the Clues
Case #1: Jessica Shahinian & David Clarke, MD - 20 minutes
Case #2: Rob Munger, MA, MS & John Stracks, MD - 20 minutes
Case #3: Lee Canter, MSW & David Schechter, MD - 20 minutes
One in six adults and 30-40% of primary care patients suffer from pain symptoms and chronic conditions that are “medically unexplained.” So, where do these symptoms come from? Listen to three patients describe their experience with and recovery from Psychophysiologic Disorders and three physicians respond to their cases, providing insight you can use.
Objectives:
Describe the primary symptoms that Jessica, Rob and Lee experienced
Describe clues from these three cases that indicate a diagnosis for Psychophysiologic Disorders (PPD)
Describe several ways physicians can talk with their patients about PPD while reducing the chance of pushback
Describe the importance of patient buy-in with the PPD diagnosis and its effect on patient recovery
Communicating and Making the Paradigm Shift: What Follows
David Schechter, MD - 30 minutes
Learn why the patient's paradigm and narrative are crucial. Also, techniques in the art of listening to and changing the patient's perspective on their condition. This is perhaps the most crucial step in the whole process.
Objectives:
Definitions and understanding of patient paradigm and narrative
How can the clinician guide the patient toward a new perspective and approach (i.e. PPD's)
Sheila Swadell Memorial Lecture: The Neuroscience and Evidence for PPD
Howard Schubiner, MD - 30 minutes
How does the brain work? Why does it cause pain? How does it cause pain? Can pain occur in the complete absence of any abnormalities in the body? Why does it cause so many other symptoms, such as fatigue, insomnia, anxiety, tingling, or muscle spasms? Are all of these symptoms due to PPD? How does the brain choose which symptom to produce? Why do some symptoms last for a long time, while others are just transient? Dr. Schubiner will review a new model for brain functioning known as predictive coding and attempt to answer all of these common questions about PPD.
Objectives:
Describe the neuroscience of predictive coding
Describe how acute pain turns into chronic pain
Describe the factors that make chronic pain persistent
What the Science Shows: University of Colorado Back Pain Study & Beyond
Yoni K. Ashar, PhD - 30 minutes
Dr. Ashar will present results from the University of Colorado Back Pain Study, the first randomized, controlled trial of Pain Reprocessing Therapy (PRT). Results demonstrate that chronic back pain patients can experience substantial relief following psychological treatments targeting fear and other emotions linked to pain. Dr. Ashar will also comment on future directions for research in this field.
Objectives:
Describe the principles and therapeutic techniques of Pain Reprocessing Therapy, in the context of other psychological treatments
Describe the results of University of Colorado Back Pain Study
Describe future directions for research into psychological treatments for chronic pain
Q&A Panel #1 - recorded Thursday October 28, 2021
Jessica Shahinian (Host) & Day 1 Speakers: David Clarke, Rob Munger, John Stracks, Lee Canter, David Schechter, Howard Schubiner and Yoni Ashar
Fundamentals of Diagnosis & Treatment
Diagnosis of PPD
John Stracks, MD - 30 minutes
Psychophysiologic Disorders (PPD) show up frequently in medical offices, psychology clinics, and physical therapy practices. Patients benefit significantly from clinicians who are both astute enough to make the diagnosis of PPD and also knowledgeable enough to explain the concept and direct patients to effective treatment options. Research is showing that all pain and chronic symptoms have nonphysical aspects to them; often times those symptoms are entirely driven by nonphysical aspects of patients’ lives. PPD-literate practitioners can learn to spot these situations quickly and take appropriate action, including directing patients to effective treatment options. This 30-minute session will help clinicians comfortably make the diagnosis of PPD in preparation for effectively explaining the condition and making the appropriate referrals when necessary.
Objectives:
Understand the need to rule out dangerous, physical issues before making the diagnosis of PPD.
Learn to listen for the timing of onset of symptoms in relation to past and present stressors in patients’ lives.
Understand the correlation between common mental health disorders and the onset and continuation of PPD symptoms.
Know Pain, Know Gain: How Physical Therapists Can be The Future of Pain Care
Charlie Merrill, PT - 30 minutes
Physical therapists have the potential to be at the leading edge of pain care. However, to make this transition from biomedical to biopsychosocial clinician, there are some critical hurdles to overcome that go beyond pain neuroscience education (PNE) skills. PTs have an opportunity to expand clinical practice and improve outcomes using PPD concepts for chronic and acute symptoms. This session will discuss current best practice in the PT field relative to the PPDA’s model to reconcile their differences. We’ll explore the role of therapeutic alliance skills and other ways PTs can reduce fear and improve outcomes. We’ll discuss the barriers and opportunities PTs have to go beyond PNE. Lastly, we’ll vision a new path forward in a way that maximizes fidelity in the treatment of both the body and the mind.
Objectives:
Understand current PNE+ best practice relative to PPD best practice
Learn about the role of therapeutic alliance and listening as therapeutic interventions
Understand what PTs need to unlearn to do this work and why this is an opportunity
Learn about the PTs role in prevention by using PPD concepts to treat pain acutely
PPD and Specific Syndromes: Spine, Skin & Pelvis
PPD and the Spine
David Hanscom, MD - 10 minutes
Degenerative discs are not a disease and are NOT a cause of chronic low back pain. Yet we are spending over 15 billion dollars a year performing spine fusion on normally aging spine. Successful outcomes occur less than 30% of the time and the chance of making the patient worse is between 40-60%. Chronic non-structural pain in any part of the body is a neurological problem. This is why structurally-based interventions cannot and have not worked.
Objectives:
Surgical success depends on clearly identifying an anatomical abnormality that has matching symptoms.
Chronic low back pain with no evidence of nerve damage is rarely due to a structural issue.
Degenerative discs are not a disease. They are correctly designated as consistent with a “normally aging spine.”
PPD and the Skin
Roy Seidenberg, MD - 10 minutes
The mind and body are connected, and the mind can initiate real physical disease. The skin is no exception. This talk will discuss the most common cutaneous disorders that have a psychosomatic component, and review some of the related articles in the mainstream dermatology literature.
Objectives:
Describe the most common cutaneous PPD symptoms
Describe some of the related dermatologic literature
PPD and the Pelvis
Terri Nishimoto, PT, CLT, PRPC - 10 minutes
Persistent pelvic pain diagnoses are commonly associated with PPD. Yet, it is still a topic that is shrouded with embarrassment, guilt and shame. Terri Nishimoto will talk about common pelvic health issues and the evolving role of the pelvic health physical therapist.
Objectives:
Describe the importance of a biopsychosocial approach in pelvic health
Identify different approaches to the treatment of persistent pelvic pain beyond neuroscience education
A Psychodynamic Perspective
Arlene Feinblatt, PhD - 30 minutes
Dr. Feinblatt was the Chief Psychologist who worked with John E. Sarno, MD - mindbody medicine icon and New York Times Best Seller. Interviewed by Jessica Shahinian, Dr. Feinblatt will share how she developed a mindbody approach with Dr Sarno at NYU Langone’s Rusk Institute.
Objectives:
Describe the psychology programs Dr. Feinblatt created with Dr. Sarno and why she chose to work using psychodynamic psychotherapy within the Intensive Short Term Dynamic Psychotherapy (ISTDP) framework.
Describe the significance of Dr. Feinblatt’s first interactions with PPD patients including the first psychotherapy session.
What to Know for Therapists New to PPD
Jessica Oifer Stelle, MA, MBA, LMFT - 30 minutes
This 30-minute presentation will help psychotherapists who are new to working with PPD clients begin to build or enhance their foundation for treating these clients. Therapists will learn how to think about and conceptualize clients who present with psychophysiologic disorders. They will gain a topline look at treatment methods and interventions, as well as learn about common questions and challenges, and other key tenets for working with PPD clients. Additionally, attendees will learn to recognize and be aware of some common pitfalls or assumptions that can get in the way. This presentation will help prepare attendees for the rest of the conference, where they will have more in depth exposure to specific treatment modalities.
Objectives:
Build a therapy roadmap for working with PPD clients, including key principles and strategies of treatment
Address common questions and concerns that arise in therapy
Help increase awareness of your own relationship with stress-induced symptoms
The Benefits of Writing Therapy
Nicole Sachs, LCSW - 30 minutes
We each have within us a reservoir of unconscious repressed emotions. This is not pathological. It is the natural result of living a human life. The problem is that when this reservoir reaches maximum density, and threatens to spill over and inform our conscious minds of how scared, stuck, shameful, rageful, and despairing we are deep down, the mind/body system enacts a protective mechanism that sends pain signals to different muscle groups and bodily systems. This diverts us from experiencing this emotional world that it deems "more dangerous" than the physical pain, syndrome, symptom, condition, or diagnosis. Writing Therapy, or "JournalSpeak" as I call it in my practice, is a vehicle by which we can put a ladle into this reservoir and spill it out, little by little, one day at a time. Once the brain becomes informed that it is safe and beneficial to feel these feelings (and they won't kill you!) the pain signals stop firing. In my over 20 years of private practice and global teaching, I have seen myriad stunning transformations as a result of utilizing a JournalSpeak practice, as well as my own healing which began 25 years ago when I became acquainted with the work of Dr. John Sarno.
Objectives:
Develop an understanding of the mind/body connection as it pertains to pain, and the ways in which emotional stimuli can cause physical reactions.
Recognize the timeless nature of repressed emotions and stored trauma, and the importance of actively releasing them for pain relief.
Understand why a JournalSpeak Practice is an excellent and effective vehicle to reduce emotional repression.
Learn how to JournalSpeak properly for optimal results.
Q&A Panel #2 - recorded Friday October 29, 2021
Jessica Shahinian & David Clarke (Hosts) & Day 2 Speakers: John Stracks, Charlie Merrill, Roy Seidenberg, Terri Nishimoto, Jessica Oifer Stelle and Nicole Sachs
Specialized Treatment Approaches
& Improving Access to Care
Three Different Questions with the Same Answer
David Clarke, MD - 30 minutes
Why do some acute injuries evolve to become a chronic Psychophysiologic Disorder (PPD)? Why do so many PPD patients share similar personality characteristics? Why do some PPD patients who have recovered suffer relapses? Exploring the links between PPD and Adverse Childhood Experiences (ACEs).
Participants will be able to describe the connection between ACEs and:
Development of chronic PPD after acute injury
Development of personality characteristics that are common in PPD patients
Symptom relapses after recovery
Practical Tools from a UK Practitioners Association
Georgie Oldfield, MCSP - 30 minutes
The SIRPA approach is an educational, self-empowering programme aimed at helping individuals living with chronic pain (and other persistent health problems) relieve their symptoms and regain their lives. In this talk Georgie Oldfield MCSP, UK Physiotherapist and Founder of SIRPA, will explain some of the self-help strategies she feels are important for individuals to learn and utilize as they progress on what she believes is more of a personal development journey than just an approach to resolve symptoms. In order to reinforce and expand upon what she will be talking about, alongside the talk Georgie will include links to additional information and experiential resources.
Objectives:
Describe tips and strategies to help boost resilience and to more easily deal with triggers and self-induced stress
Describe how to make use of the brain’s neuroplastic capacity to calm conditioned pain pathways
Describe strategies to help build emotional awareness and address unresolved emotions, plus fears related to the pain/symptoms
Practical Tools from Psychotherapy and Psychoanalysis
Frances Sommer Anderson, PhD, SEP - 30 minutes
During 42 years of working with people in chronic pain, I learned that those who experienced early life adversities often need special techniques to help them recognize, tolerate, and learn to use emotions related to those experiences. Research has shown that these unacknowledged emotions contribute to somatic symptoms later in life.
Today I will illustrate how I use the theoretical and technical contributions of contemporary trauma theory to treat my client, Jill, who experienced chronic adversity in childhood and developed chronic musculoskeletal pain and other somatic symptoms early in life. I will show how I integrated a relational psychoanalytic treatment approach with the skills I learned from Somatic Experiencing ™ and how these interventions helped relieve her physical symptoms.
Objectives:
Identify the kinds of early life adversities that can result in chronic pain and other somatic symptoms later in life
Recognize the significance of the client’s relationship with the therapist, in that the therapist helps the client learn slowly and safely to identify and express feelings that have not been safe to acknowledge
Learn how acknowledging, tolerating, and learning to use emotions led to relief of somatic pain symptoms
Key Elements of Pain Reprocessing Therapy
Alan Gordon, LCSW & Alon Ziv - 30 minutes
This presentation shows a treatment session with a patient who is experiencing pain. Key elements of Pain Reprocessing Therapy are taught to the patient (and explained in more detail for the viewer) resulting in a significant improvement in her symptoms.
Objectives:
Learn to assess a patient for a neuroplastic origin of pain
Understand some of the key elements of Pain Reprocessing Therapy including reducing fear and somatic tracking
Understanding Emotional Awareness and Expression Therapy
Mark A. Lumley, PhD & Howard Schubiner, MD - 30 minutes
This presentation introduces the rationale, clinical indication, techniques, and clinical trial outcomes of Emotional Awareness and Expression Therapy (EAET). Many people with chronic pain and other Psychophysiologic Disorders have experienced psychosocial trauma, childhood or adulthood adversities, relationship problems, or psychological conflicts. The failure to resolve or overcome such issues drives pain, other somatic, and psychological symptoms, but the leading psychological interventions do not address these problems. Informed by pain neuroscience as well as psychodynamic, emotion-focused, and exposure-based therapies, we developed EAET for such patients. Core to EAET is the premise that overcoming fears of one’s emotional processes (awareness, disclosure, and expression) reduces pain via changes in pain neural circuitry. We and others have tested EAET in a number of uncontrolled and controlled clinical trials, finding it to be effective for many patients, and quite healing for some. Two trials provide evidence of superiority to cognitive-behavioral therapy for fibromyalgia and musculoskeletal pain. Many clinicians are applying EAET to people with chronic pain and unresolved trauma histories, such as military veterans, reporting it to be highly effective.
Objectives:
Describe the model guiding Emotional Awareness and Expression Therapy and supporting research.
Describe specific techniques used by EAET to help patients process trauma or conflict and reduce or eliminate their chronic pain.
Achieving the Quadruple Aim: UnitedHealth Group’s Model Pain Clinics
Howard Schubiner MD, Christie Uipi LCSW and Scott Shimotsu PhD MPH - 30 minutes
Speakers to discuss their work launching and running the model pain clinics with UnitedHealth Group. They will discuss the process flow of the pain clinic and its multidisciplinary providers, demographics of the patient population involved, initial outcomes, barriers encountered, and implications for future endeavours.
Objectives:
Describe the intent of the UnitedHealth Group Las Vegas project
Describe the population and outcomes from the project
Describe difficulties of incorporating mindbody therapies in a real world clinical setting
Describe lessons and opportunities for future projects
Q&A Panel #3 - recorded Saturday October 30, 2021
Jessica Shahinian (Host) & Day 3 Speakers: David Clarke, Georgie Oldfield, Frances Sommer Anderson, Mark Lumley, Howard Schubiner and Christie Uipi
Bonus
Introduction to Psychophysiologic Disorders (in Spanish)
Introducción a los Desordenes Psicofisiológicos en Español
Encarna Espunya, PT - 30 minutes
Mi presentación será como una muestra o introducción a los temas más importantes que tienen que ver con los Desórdenes Psicofisiológicos para las personas de habla hispana. Los temas que cubrirá serán:
Definición: El Desorden psicofisiológico como una condición causada por redes neuronales en el cerebro.
En qué consiste.
Elementos clave en su tratamiento: La educación y como esto reduce el miedo a que el cuerpo esté dañado. Ir retomando y aumentando la actividad física. Y muy importante aumentar la conciencia emocional.
La incidencia de los Desordenes Psicofisiológicos en la sociedad, y la evidencia científica que sostiene a los Desordenes Psicofisiológicos.
Recursos para pacientes y profesionales dentro del marco de la PPDA
Recursos para las personas de habla hispana.