unlearn

your anxiety
& depression
A SELF-GUIDED PROCESS
TO REPROGRAM YOUR BRAIN

By Howard Schubiner, MD

MIND * BODY
PUBLISHING

2
Notes on Purchasing
Unlearn Your Anxiety & Depression
and Unlearn Your Pain
EACH OF MY TWO BOOKS, Unlearn Your Pain and
Unlearn Your Anxiety and Depression, is divided into two
parts: 1) an explanation of how these disorders develop
and why modern medical practice is often unable to solve
them, which is contained in the first five chapters of each
book; and 2) a complete self-guided workbook which
comprises the last seven chapters. The first five chapters of
each book are quite different, but the last seven chapters of
both books are essentially the same. Therefore, you will
not need both books in order to obtain the self-guided
recovery program. If you want to obtain both books and
the recovery program, you can order one eBook and the
other hard copy, which would be the least expensive
option. Below you will find the pricing information for
these two books if you buy them from
www.unlearnyourpain.com. Amazon.com does not allow
discounted pricing.
When you purchase the eBook of Unlearn Your
Anxiety and Depression, you are entitled to a $10 discount
off the $25 purchase price of the hard copy. This offer only
applies to purchases made on the website,
www.unlearnyourpain.com as mentioned above. If you
have purchased the eBook version of Unlearn Your
Anxiety and Depression, you can enter this code: 12gs484
when you order the hard copy in order to get the

3
discounted price.
The same discount offer applies to the purchase of
Unlearn Your Pain, i.e., if you buy the eBook version for
$10, you can order the complete hard copy for $15 instead
of the usual price of $25. The code for that offer is located
at the end of the eBook version of Unlearn Your Pain.
Therefore, if you order one of the eBooks and the other
hard copy, the total cost will be $35.
If you choose to buy hard copies of both books from
www.unlearnyourpain.com, you can receive a discount of
$10 so that the cost of both books will be $40 instead of
the usual $50.

Copyright 2014 by Mind Body Publishing, Pleasant

Ridge, MI

All rights reserved

Printed in the United States of America
Cover Photograph: Xi Xin Xing, ThinkStock
Author Photograph: Rob Vinson
Design and Layout: Eric Keller
Set in Trade Gothic and ITC Century.

Schubiner, Howard
Unlearn Your Anxiety & Depression: A Self-Guided
Process to Reprogram Your Brain
ISBN-10: 0984336737
ISBN-13: 978-0-9843367-3-9

Howard Schubiner, MD

4
www.unlearnyourpain.com

To my wonderful wife, Val Overholt, and amazing

children, Lindsay and Gabe

When I stand before thee

at the days end, thou shalt
see my scars and know that
I had my wounds and also
my healing.
Rabindranath Tagore

7


DISCLAIMER: Reading this book does not
establish a doctor-patient relationship with Dr. Schubiner,
nor does it offer diagnosis and/or treatment for any
medical condition. You should consult with your own
doctor(s) to make sure that your condition does not require
medical intervention and that an approach which includes
a consideration of the role that your mind plays in your
symptoms is appropriate for you. You should also make
sure that your doctor approves of any change in activities
that you plan to undertake.
This book does not offer specific recommendations
about the use of medications or about changing your use of
medications. You should decide, along with your
physician, if you should alter the dosage of or discontinue
any of your medications. Be aware that, stopping certain
medications can cause physical or psychological
symptoms if the withdrawal process is not carefully
managed.
This program suggests that you review stressful
events in your life and asks you to view them in relation to
how you are feeling, physically and psychologically. If
you are in counseling, you should consult with your
therapist or counselor to make sure that your participation
in this program is supported. If you develop emotional
difficulties during the course of following this program, it
is critical that you consult with your physician and/or
therapist. Many people have found that it is helpful (and
often necessary) to use this program with the aid of a
counselor or therapist.

8
 The personal stories used in this book are with the
consent of these patients, but the names and sometimes a
few details have been changed to protect their identities.

9
table of contents

PREFACE

ACKNOWLEDGMENTS

Chapter 1: WHAT IS ANXIETY & DEPRESSION?

Chapter 2: WHAT IS THE BIOLOGY OF ANXIETY &

DEPRESSION?

Chapter 3: HOW DOES ANXIETY & DEPRESSION

DEVELOP?

Chapter 4: DO YOU HAVE MIND BODY SYNDROME?

Chapter 5: WHAT CAN YOU DO ABOUT ANXIETY &

DEPRESSION?

10
 p reface

I saw a man who emerged from the

ocean proudly showing a conch shell he had just
recovered. He felt no pain until he noticed the extensive
injury to his legs, sustained from being cut on a coral reef.
A construction worker in Britain who accidentally impaled
his foot onto a large roofing nail had severe pain all the
way to the hospital and even required intravenous
painkillers. When his boot was removed, the nail had not
entered his skin, but instead sat between his toes. When the
man saw this, the pain immediately disappeared (Fisher, et.
al., 1995).
For the past decade, I have been treating individuals
with chronic painful conditions, such as back and neck
pain, fibromyalgia, and headaches. It has been an eye-
opening journey. My training as a medical doctor
established certain foundational principles in my mind, and
one of those was that pain is caused by a disease process in
the body. My training taught me that if there is pain, there
must be some sort of tissue damage. However, when I
learned about people who had severe, chronic pain that
was cured simply by changing how they thought about

11
their pain, I was fascinated by the potential for helping
people with seemingly incurable diseases and began to
study this process.

THE RELATIONSHIP
BETWEEN ANXIETY,
DEPRESSION, AND/OR
CHRONIC PAIN
After intensive study, I learned two things that I had
never been taught in medical school:
1) An injury can occur without the brain
registering pain, and
2) More surprisingly, pain can occur in the
absence of any injury to the body.
In both of these types of instances, the pain is real,
very real. It turns out that pain is a response by the
conscious part of the brain to some input from the
subconscious part. In other words, all pain actually occurs
in the brain. The brain activates neural impulses that create
pain following an injury to the body, but can also occur
following cues in the environment that are perceived as an
emotional injury or threat. Studies have shown that
physical injury and emotional injury activate the exact
same neural pathways in the brain, both of which create
pain (Kross, et. al., 2011; Eisenberger, et. al., 2003;
Eisenberger, et. al., 2006). These neural pathways
stimulate the flight or fight reaction, which is the innate

12
response to some significant threat involving danger and/or
fear. These neural pathways begin in the brain and are
connected to the rest of the body, where they produce very
real effects, such as painful changes in muscles, nerves,
and/or internal organs.
We develop learned neural pathways early in life
and these are responsible for many of our actions every
day. Examples of these pathways include walking, riding a
bicycle, signing our name, simple addition, and thousands
of other automatic actions that we take for granted. Once
these pathways are learned, they are activated
automatically in response to certain situations and the
more times they are activated, the more engrained they
become.
From my research, I learned that stress, particularly
stress occurring early in life, creates learned neural
pathways which produce the fear and danger response. A
child who is brought up in a stressful home learns a
powerful response to perceived danger as the neural
pathways are constructed by these experiences. This
response may be activated later in life under similar
stressful situations. When such a reactivation occurs, a
common response in the body is pain. This process has
been described as a psychophysiologic disorder (PPD) or
as Mind Body Syndrome (MBS).
Very few doctors think about pain in this way, yet
millions of people have chronic painful conditions for
which doctors do not have any evidence of a tissue injury
that could be responsible for causing the pain. I have found
that when someone with a PPD or MBS is treated as if
they have a bodily injury or disease with traditional

13
medical treatment (e.g., with narcotics, injections, or even
surgery), their pain often gets worse over time.
However, individuals with these conditions can
reverse the pain by:
changing how they understand the pain
processing the underlying emotions that have
created the pain
using the power of their mind to change the
neural pathways with a process similar to the
one used in changing a habit.
I studied with Dr. John Sarno, who pioneered this
work at New York University and has helped thousands of
people heal from psychophysiologic disorders. Over the
last decade, I have developed a program to guide people
through this process of healing. This program is fully
described in my book Unlearn Your Pain.
Over the many hours I have spent interviewing
patients to understand what stressful situations have
occurred in their lives, it has become crystal clear to me
that events that happened early in life, such as conflicts,
traumas, or other stressful situations are often re-activated
later in life. However, the observable manifestation of
these neural pathways is quite varied. A woman, who had
an aloof and unsupportive mother and a father who
frequently yelled and screamed at her, later developed
chronic headaches when her new boss began yelling at her.
A man who consulted me for neck pain, grew up with a
mother who was frequently suicidal and from whom he
had to remove a gun on several occasions. His neck pain

14
began later in life, after his father became depressed, and
the man went to his fathers house to remove the weapons.
As such stories emerged in the vast majority of
patients who I was treating for pain, I noted that the
outward manifestations of such underlying emotional
reactions were not limited to painful conditions. I saw
people who, instead of or in addition to pain, developed
diarrhea, urinary frequency, fatigue, insomnia, depression,
or anxiety. I found that these conditions responded with
improvement or resolution in a manner similar to painful
conditions.
Anxiety and depression are extremely common in
our society. One might expect most doctors to consider
stress and emotional reactions as major causes of anxiety
and depression. Instead, the notion that these disorders are
caused by a disease process in the brain is now the
dominant theory on which treatment plans are based.
People with anxiety and depression are often told that they
have a chemical imbalance that is likely caused by
genetics. They are, therefore, treated primarily with
medications designed to help them feel better.
However, as is often the situation with painful
psychophysiologic conditions, there is emerging evidence
that treating anxiety and depression as if they were
diseases can actually worsen the condition. Medications
for anxiety and depression can create side effects and/or
withdrawal symptoms that exacerbate the condition and,
even more devastatingly, can turn an intermittent disorder
into a chronic one. This book intends to promote the
understanding that anxiety and depression (as well as the
commonly associated symptoms of insomnia and chronic

15
fatigue) can often be effectively treated as
psychophysiologic disorders (PPDs) rather than as disease
states.

HOW TO USE THIS BOOK

It is important to recognize that not all painful
conditions are caused by a PPD. Of course, many
individuals have pain directly caused by tissue damage,
and traditional medical treatment is appropriate in these
cases. Similarly, some people with anxiety and depression
suffer from an underlying medical condition that requires
specific medical treatment. In addition, individuals with
schizophrenia, significant bipolar disorders, and severe
anxiety and depression usually need to be stabilized with
medications and sometimes more intensive treatments.
Individuals with severe symptoms of anxiety or depression
may need to be hospitalized. Unlearn Your Anxiety and
Depression is designed for those people who suffer from
anxiety and depression, but who have not been determined
to fit into this less common severe category. The
program described in Unlearn Your Anxiety and
Depression should not be viewed as replacing appropriate
medical or psychological treatment. The first five chapters
(which comprise the eBook version of Unlearn Your
Anxiety and Depression) explain the emerging research
that has advanced a new way of thinking about anxiety and
depression. They also offer a method of understanding
why you may have these disorders and a model for
reversing them. The following chapters provide a guided
model for unlearning anxiety and depression, as well as

16
other associated symptoms, such as chronic pain. Those
chapters are identical to chapters 6 through 12 of Unlearn
Your Pain, since the treatment of all of the
psychophysiologic disorders is the same. Therefore, if you
are reading the eBook, you will need to obtain the
complete version of Unlearn Your Pain or of Unlearn
Your Anxiety and Depression in order to begin the
program.
The majority of people suffering from anxiety or
depression, while able to function in the world, are plagued
by symptoms that make a substantial impact on their life
circumstances and their ability to enjoy life. People with
histories of stressful life events that have resulted in pain,
anxiety, and/or depression often appear to be beaten down.
They may feel that they are helpless, as the medical
treatment available to them has been unable to relieve their
symptoms or what lies under those symptoms.
The program in this book can be an antidote to these
helpless feelings. Individuals who recover from anxiety or
depression (or chronic pain) are those who can learn to
care enough about themselves to develop the power to take
control of their own health and life. They are people who
develop the courage to face the stressful events and
emotional processes that underlie anxiety and depression.
It is my hope that if you are one of these individuals, you
will find this book helpful. This combination of love and
strength is what everyone needs to be healthy and live a
long life. Even if you have had a long and difficult path,
such qualities can be developed and strengthened. The
possibility of recovering from anxiety and depression is
very real. It is my hope that you will take the time and

17
make the effort to do this work because you deserve to be
free of your anxiety, depression, and pain.

To your health,
Howard Schubiner, MD
June 2014

18
 ack n o wled g men ts

I am fortunate to have many people to

thank for their roles in making this book possible. I
became involved in this work by the chance occurrence of
learning about the work of Dr. John Sarno, of the Physical
Medicine Department of New York University. Dr. Sarno
has been a trailblazer in changing our view of many
individuals with chronic pain and he was gracious enough
to allow me to study with him. My chairman in the Internal
Medicine Department of Providence Hospital, Dr. Ernest
Yoder, readily agreed to my proposal to create a Mind
Body Medicine program. My colleagues at Providence
have been supportive of this program every step of the
way. I have the utmost gratitude for the patients who have
trusted me to help them in their process of recovery. They
have taught me a great deal and continue to inspire me
with their courage and perseverance.
I am grateful to several professional colleagues.
Mark Lumley, PhD, has been an invaluable asset in this
work. He is an perceptive clinician and excellent
researcher. He has contributed greatly to this work in
general and to this book in particular. Allan Abbass, MD,

19
has had a major impact on this work. His abilities as a
clinician and researcher are exceptional and I thank him
greatly for teaching me to work with patients on emotional
issues and for his comments on this book. Many of my
colleagues in the Psychophysiolgic Disorders Association
helped to hone the messages contained in this book and
made helpful comments on it. These include David Clarke,
MD, Eric Sherman, PsyD, Peter Zafrides, MD, Alan
Gordon, LMFT, and Rob Munger. John Stracks, MD, is a
great friend and advisor who has contributed greatly to this
book and to my work.
Maureen Dunphy is a gifted writer and was gracious
enough to help me edit this book. I am grateful to her for
taking these ideas and shaping them into a vastly improved
product. Eric Keller is an exceptional designer and I thank
him for the layout and covers. George Nolte is a dedicated
and talented proofreader to whom I am greatly in debt.
Rob Vinson is a skilled photographer and videographer
who I thank for the photographs and all his help over the
past few years.
I have listened very carefully to the stories of
hundreds of people who have chronic pain, anxiety or
depression. Their lives often consist of so many difficult
situations that are responsible for their symptoms. It is
very clear that their pain has been induced by events
outside of their control and that they have been very
unfortunate. This realization has made me all the more
grateful for my own family. My parents, Lorraine and
Elliot I. Schubiner brought me into a loving and supportive
home, where I learned the importance of work and family.
My wife, Valerie Overholt, has been an amazing life

20
partner and lover. My children, Lindsay and Gabriel, have
grown into wonderful adults. My siblings and extended
family have all been supportive. I have been so fortunate to
grow up in a family that creates resilience and confidence;
two factors that I wish for all of my patients to have.

Howard Schubiner, MD
June 2014

21
 ch ap ter 1

The Symptoms of
Anxiety and Depression
Anxietys like a rocking chair. It gives
you something to do, but it doesnt get
you very far. Jodi Picoult

Thats the thing about depression: A

human being can survive almost
anything, as long as she sees the end in
sight. But depression is so insidious, and
it compounds daily, that its impossible
to ever see the end. Elizabeth
Wurtzel

I have never been remotely ashamed of

having been depressed. Never. Whats to
be ashamed of? I went through a really
rough time and I am quite proud that I
got out of that. J. K. Rowling

22
 The Feelings of Anxiety
A young man named Gene suffered from a
generalized anxiety disorder. He first noticed that he was
anxious in high school. He just felt uncomfortable with
himself. There was nothing specific that had happened to
him as far as he could recall. He was doing relatively well
in school and had several good friends. He had good
parents who cared about him. Over time, he began to
notice that he was particularly anxious before tests. Then
he started being anxious when he was with his friends.
After a while, he was even anxious at home. These
feelings of anxiety began affecting his schoolwork, and by
the time he was ready for college, a part of him didnt want
to go.
He had been started on Celexa (citalopram, a
serotonin reuptake inhibitor) that helped for a while, but he
didnt like the side effects. Other medications, such as
Wellbutrin (bupropion, a drug that activates dopamine),
didnt have side effects, but didnt seem to help. One
doctor suggested a trial of Xanax (alprazolam, a drug that
stimulates gamma aminobutyric acid), but he didnt want
to use medications that could be addicting and difficult to
stop using. He had started counseling in high school with a
highly recommended therapist. Because the therapist
didnt know why he was so anxious, the techniques she
recommended only helped to a minor degree. He felt stuck
and unable to move forward with his life. What could have
caused these horrible sensations over which he felt no
control?
At its core, anxiety is fear. And fear can be

23
overwhelming. Fear can take your breath away. It can stop
you in your tracks and prevent you from leaving your
home. It can make you feel that you are dying. Fear can
dry up your mouth so that words will not emerge. It can
stop you from listening to a certain song or taking a certain
route or eating a certain food. Fear can keep you up at
night, night after night. It can make you think a certain
thought over and over so often that it becomes a constant
companion. Fear can make you create rituals that must be
followed, as if there is a powerful superstition residing
within you. Fear can cause you to relive traumatic events
and feel as if they are occurring right now.
Everyone has had moments in his or her life that
caused fear. We have all known the moment of being
scared by a sudden sound or a person playing a prank, the
shock of the terrifying moment in a thriller or horror
movie, the worry of not being able to reach a loved one
who is temporarily missing, or the distress of waiting to
get a medical test back not knowing if the answer will
mean that your life is forever changed. Those experiences
are often short-lived, sometimes so brief as to be easily
forgotten. But imagine living in that state of fear day after
day, week after week. Imagine feeling trapped inside a
bubble of fear that persists despite your best efforts to fight
it off. This is not anywhere you would want to be. This is
what anxiety feels like, and it is nothing anyone would
choose to feel.
Over time, living with anxiety ranges from being
difficult to virtually impossible. Some people do not suffer
from anxiety every day, but they are just a moment away
from a panic attack that can occur at any time. Others live

24
in the uncomfortable space of chronic anxiety and fear,
never feeling free.
There are many clinical syndromes that doctors have
given specific names to, such as panic disorder,
generalized anxiety disorder, social anxiety disorder,
obsessive-compulsive disorder, specific phobias (such as
fear of heights, snakes, or closed or open spaces), and post-
traumatic stress disorder (PTSD). Doctors pay careful
attention to which of these syndromes are present. But
these syndromes all stem from the primal fear reaction. A
reaction that every persons brain and body is capable of
producing and a reaction that becomes learned and
engrained by our experiences in life.
Many individuals with anxiety disorders began to
have symptoms in childhood. You may have noticed that it
felt scary when one or both of your parents left you or
when you had to go to school. You may have had
stomachaches or headaches in school. Or you may have
been worried about some of the kids at school who teased
you. Middle school and high school are filled with
situations that can cause fear. Worrying about succeeding
in school or artistic performances or athletics is a common
cause of anxiety.
It is perfectly normal to feel anxious in these
situations. Everyone tends to have feelings of fear and
anxiety when confronted with situations that cause us to
feel threatened in some way. This reaction is hard-wired
into our nervous system, i.e., we are born with the
capability to react in this way, and it is a system that is
very important for protecting ourselves, as we shall see.
No matter what situation triggers the anxiety in the

25
first place, it is very easy for the symptoms of anxiety to
become learned and therefore to occur more and more
frequently. In fact, the more the symptoms occur, the more
they become wired into the brain and body. Over time,
people may begin to notice that the symptoms of anxiety
occur even in situations that are not inherently fear-
provoking or stress-producing. This, of course, can create
more fear and worry. Then these kinds of thoughts tend to
arise: What is happening to me? Why is this happening in
my body? These feelings seem so random and
unpredictable. I cant control them. What can I do to stop
this? Once a person reaches this stage, the situation may
begin to escalate and spiral out of control. And other
symptoms often emerge, such as trouble sleeping or aches
and pains, which can prompt more anxiety, more doctors
visits and more medications.

KEN WAS ON VACATION when some friends gave him

a drink that was laced with a potent drug. An hour later,
he noticed that his heart was racing, he was very sweaty,
and he had unusual sensations throughout his body. He
began to panic. He was taken to an emergency room, and
his condition required an overnight stay in a hospital.
Following this, he began to have panic attacks whenever
stressful situations occurred, and these progressed over
the years to the point where he had difficulty working.

SHERYL BEGAN TO HAVE DIFFICULTY SPEAKING

IN MEETINGS. She had a history of separation anxiety as
a child and had been teased by other kids at school. Just
before developing this form of social anxiety, she had a
conflict with one of her colleagues about a project they

26
were working on and had been criticized behind her back
by this colleague.

DIANNE, A COLLEGE STUDENT, SOUGHT CARE for

inability to fall asleep. As she lay in bed while attempting
to fall asleep, she noticed that her heart was pounding in
her chest and her thoughts were racing. She had never had
trouble sleeping before. Her grades began to slip and she
started to have difficulty concentrating on her homework.
Her parents wondered if she had attention deficit disorder
or if she simply needed a pill to help her sleep. Within
minutes of inquiry, she divulged that she was a rape
survivor, but had not confided this to anyone due to guilt
and embarrassment. The trouble sleeping started after the
rape, yet she had not considered that the two events were
linked.

Once your search for a cure for what ails you begins,
you may feel embarrassed by having these feelings or you
may worry that these feelings mean that you are not able to
handle your life or that you are weak or incompetent. If the
symptoms persist, you realize that you have to do
something. You may start by mentioning the anxiety
symptoms to a close friend. Hopefully, your friend will be
understanding, and often, they may have experienced
similar feelings themselves. Their advice may be: Talk to
your doctor about this. He or she can probably help.
Unfortunately for many people, this process often
becomes a journey down a path with no apparent light at
the end of the tunnel. Your doctor will likely tell you that
anxiety is a medical condition, and there is treatment for

27
it. He or she may ask if you know why you are anxious,
but it is likely that you will not know. It is difficult for
most people to look carefully at their lives and figure out
why the anxiety is there. Failing to identify or understand
the underlying causes of anxiety, your doctor may
prescribe medications. If these are effective, you will begin
to feel better for a while, but frequently, the anxiety will
rear its head again and again. If you decide to see a
psychiatrist, you will most likely be given even more
medications. More medications may result in a greater
likelihood of side effects.
If medications dont prove to be the answer,
counseling can be helpful. There are many different styles
of counseling and a wide variety of counselors and
therapists. Many of them are quite effective. There are a
variety of methods of coping with anxiety and much of the
therapeutic approach consists of learning coping strategies.
However, this approach may not lead to lasting cures.
Anxiety has a way of coming back, again and again,
particularly if you have not gotten to the bottom of it.
There are many other ways of trying to deal with
anxiety that you may have tried. Possibly someone
suggested a massage, which usually feels great and can
reduce anxiety for a while. Acupuncture is a popular
alternative practice as are herbal supplements such as
Valerian. Meditation is a very useful practice, but it may
not reach the underlying cause of anxiety. Alternative
doctors may have recommended special diets, vitamins, or
hormones. Despite all of these remedies, you remain with
these deep-seated feelings of fear, worry, and unease.

28
 The Feelings of Depression
JUSTIN, A TEENAGER, DEVELOPED LEG PAIN (in
the absence of an injury) and depression after his best
friend died in a car accident. Around the same time, his
father took a job that required him to be traveling much of
the time. Medical testing did not reveal any cause for the
pain, and medication didnt help. His family then moved to
another state where he felt more alone. As the pain
continued, he began to feel depressed. Depression led to
increased pain, which led to decreased activities,
withdrawal, and isolation, which led, not surprisingly to
more depression. Justin was treated with anti-depressants
and pain medications, but neither was effective in breaking
this cycle. He became less active and eventually couldnt
go out much or even attend school.

In addition to an increase in the prevalence of

anxiety, more people have been diagnosed with
depression. At its core, depression is sadness. However, it
is not just normal sadness that abates after a few hours or
days. It is a deep sadness that is very hard to shake. It takes
a horrible toll as it weighs on your every waking moment,
day after day after day. Depression affects just about every
aspect of life. It becomes difficult to enjoy things that
normally make you happy. You are tired all of the time,
even after youve slept for more than eight or 10 hours.
You move more slowly, and even find it hard to think
clearly. Friends and family cant console you and dont
know how to help. Eventually they tend to stop trying and
as a result, you may feel more and more isolated. It may

29
take almost all of your energy to get out of bed and face
the day. Your ability to function in school or at work
suffers. You struggle to keep going, but it begins to feel
that this will never end, and it may seem like its not worth
it to keep trying.
Depression feels like its coming from deep inside of
your bones or soul. There is often no explanation for it, as
it covers you with a thick blanket of fog. Sure there may
have been some sad things that have happened to you, but
dont sad things happen to everyone? In the past, you
bounced back from loss or rejection, but this time is
different. This time, the sadness is not abating and there
seems to be no way to overcome it. Friends may tell you to
take a vacation or get out more often, but you dont seem
to have the energy, or when you manage to do these things,
theyre just not as much fun as they used to be. In addition
to sadness, there are often feelings of failure, guilt,
loneliness and eventually helplessness. You may also feel
continually tired and that can lead to testing for the
symptoms of chronic fatigue syndrome.
Your doctor may have recommended medication,
and you started on a serotonin reuptake inhibitor, which
worked for a while, but when you stopped it, the
depression returned. When you restarted that medication, it
didnt help as much. Then your doctor tried a different
one, but you just didnt feel right on it. Maybe you were
referred to a psychiatrist, who explained that you have a
chemical imbalance that you were born with. He tried two
different anti-depressants (such as Prozac and Lexapro)
and even an anti-psychotic medication (such as Abilify),
but you just felt drugged. Over time, you began to feel

30
anxious as well, as if there was something inside of you
that just needed to come out. You saw three different
counselors, each of whom was initially optimistic that they
could help you. However, your feelings of depression
didnt dissipate. You began to feel like you were cursed,
on the one hand, and that this was somehow your fault, on
the other. Herbal remedies such as St. Johns wort or S-
Adenosyl methionine (SAM) didnt help, nor did a full-
spectrum lighting system.
Over time, you may have developed back pain, or
headaches, or total body pain that was diagnosed as
fibromyalgia. That began another journey of pain
medications, chiropractors, pain doctors, and injections. It
seemed like the more depressed you got, the more pain you
had, and vice versa. You noticed that you were more
forgetful; you couldnt remember things on a simple
grocery list or which errands you wanted to run.
Sometimes you felt really dizzy as if the world were
spinning around you or you felt light-headed as if you
were going to faint. These feelings, on top of everything
else, made you stay home most of the time. This made you
more isolated and more depressed. There may have been
this overwhelming sense of fatigue. You began to have
less contact with friends and family. When you did get out
or have company, there was less and less to talk about. It
seemed like there was a huge chasm that you had fallen
into. And there was no obvious way out. Its easier to
surrender than fight when you dont know who the enemy
is or where the enemy lies in wait. When the depression is
especially deep or the pain is crushing, it may seem that
the best course is to give up, and you may even start

31
noticing that you are having thoughts of wishing that you
were dead.

CLAIRE FELL INTO A DEEP DEPRESSION after the

death of her son. He was only six years old, but he had a
chronic medical condition. One morning, he felt ill and
although she wanted to take him to the doctors office, her
husband convinced her that he would be fine. By the time
she returned from work, her son was quite sick and they
rushed him to the hospital. Sadly, he died later that
evening. Claire has been blaming herself for his death ever
since. As her depression deepened, she began to entertain
thoughts of suicide. Her sense of responsibility for her
other two children prevented her from acting on those
thoughts, but the depression continued despite counseling
and medication.

Anxiety and depression are powerful symptoms,

symptoms that can take over your life and resist every
remedy that you try. When nothing works, you begin to
feel totally out of control, as if your body had a mind of its
own.
But there is hope, even if you have tried every single
treatment known to man, including any or all of those
mentioned above. This book offers you a different
approach to ending your anxiety and depression, by
helping you to understand your anxiety and depression,
figure out what caused it, and use powerful tools to resolve
the symptoms.
This approach is truly different because it is based
upon cutting-edge science that will help you truly

32
understand why you are feeling this way and give you a
clear path to recovery. Hundreds of people like you who
have followed this program have recovered. And while this
approach takes hard work, it is straightforward and easy to
understand. This treatment program does not rely on
medications or injections. It relies on the healing powers of
the mind to change neural pathways that have been
learned. The same neural pathways that have been learned
in response to your life events can be unlearned.If you
are open to a different approach a mind-body approach
recovery is within your reach.

33
 ch ap ter 2

What Is the Biology of

Anxiety and Depression?
Every trial endured and weathered in the
right spirit makes a soul nobler and
stronger than it was before. James
Buckham

Let me not pray to be sheltered from

dangers, but to be fearless in facing
them. Let me not beg for the stilling of
my pain, but for the heart to conquer it.
Rabindranath Tagore

The Acute Anxiety Response

As mentioned in Chapter 1, modern psychiatry
divides anxiety disorders into several types, such as
generalized anxiety disorder, social phobia, PTSD, panic
disorder, obsessive-compulsive disorder, and specific
phobias, such as fear of heights or snakes. Over the last

34
several decades, a significant amount of scientific research
has been devoted to figuring out how each of these
disorders is different from the others and what specific
processes in the brain are responsible for them. While
these efforts have helped us learn more about the brain,
they have not led to any breakthrough treatments.
Therefore, I will review what is known about these
disorders from a medical point of view and describe why
the medical approach has not led to more effective
treatments.
Chronic or recurring anxiety can be caused by
specific medical conditions, such as hyperthyroidism
(over-activity of the thyroid gland), carcinoid syndrome (a
rare condition caused by a tumor in the intestine),
pheochromocytoma (a rare tumor of the adrenal gland),
certain neurological disorders, or by medications or drugs
that can cause anxiety, such as cocaine, methamphetamine,
and excessive caffeine intake. Once these conditions are
ruled out, which is possible in the case of the vast majority
of people with anxiety disorders, we are left with the
condition we simply call anxiety a condition that is now
epidemic among people in the 21st century (Whitaker,
2010).
What do we know about anxiety that is not caused
by a medical condition? We know where this disorder
originates; it originates in the brain. We know when this
disorder occurs; it occurs when we are subjected to a
sudden scare, such as a near-miss car accident or
something that worries us, for example, when preparing
for an important presentation or test. We know how this
disorder occurs; it occurs as our brains activate the

35
amygdala and associated networks in the limbic system.
These areas of the brain are part of the fight or flight
response system that is hard-wired into each of our brains.
This system exists to protect us in times of extreme danger.
As you are probably aware, when the fight or flight
reaction is activated, acute changes occur in our bodies.
Our bodies react powerfully to acutely stressful or
dangerous situations with sweaty palms, a racing heart,
muscle activation, dilated pupils, and a variety of other
reactions, which may include shaking, hyperventilation,
gastro-intestinal upset, urinary frequency, turning red, or
feeling very warm or cold. Most people have experienced
reactions such as these in stressful situations. These
physical reactions help us respond appropriately during
times of acute stress. Once the situation changes, these
physical reactions usually get turned off within a few
minutes to a few hours after the event that prompted the
response, and counter-regulatory mechanisms in the brain
are activated. As the biologist Robert Sapolsky points out,
animals activate specific parts of the brain to calm the
body after acutely stressful situations (Sapolsky, 2004.)
Individuals with chronic or recurring anxiety
experience a heightened activation of the amygdala to
situations that trigger anxiety, even to triggers that would
not trigger the fight or flight response in other people
(Keeton, et. al., 2009). This heightened activation of the
amygdala can be caused either by a reduced activation
threshold or by hyper-responsiveness of the amygdala
(Martinez, et. al., 2007). We will explore the underlying
reasons for this heightened activation of the amygdala, as
understanding why it occurs is of critical importance in

36
resolving the disorder we call anxiety.

Modern Medicines Theories of

Anxiety
If you see a psychiatrist for an anxiety disorder, it is
likely that you will be given one or both of these
explanations as the cause of your condition: anxiety
disorders are genetic and/or they are caused by chemical
imbalances in the brain. With regard to genetics, we do
know that some of us are born with a higher likelihood for
being fearful. Studies have shown that rats can be bred to
be more or less fearful from birth (Kloke, et. al, 2013;
Ramos, et. al., 2003).
Large studies of children have demonstrated that
each of us is more or less likely to be fearful, shy, or
sensitive (Kagan and Snidman, 1991). This is obvious to
parents who often see significant differences between
siblings in what we generally refer to as temperament.
However, studies that track people over time have shown
that despite the fact that these personality traits tend to
persist to some degree into adulthood, many children grow
out of these traits, and one cannot predict who will or will
not develop anxiety disorders (Prior, et. al., 2000; Kagan
and Snidman, 1999; Kagan, 2002).
In fact, many children who develop anxiety will not
have an anxiety disorder later in life (Pine, et. al, 1998;
Schwartz, et. al., 2003). The anxiety disorder that has the
strongest research support for genetic influence is
obsessive-compulsive disorder (OCD). Yet, even in OCD,

37
the degree to which the disorder can be linked to inherited
factors is only 27-47% (van Grootheest, et. al., 2005).
However, a predisposition to certain traits does not
necessarily determine our fate. Interestingly, we have
recently learned that inherited genes are activated by
environmental influences. This relatively new field of
research is known as epigenetics. In fact, epigenetic
studies have led us to understand that environment plays
an even more crucial role in the development of anxiety
and depression than do simple genetics. The truth is that
environment plays a very large role, in fact, the dominant
role, in the development of anxiety disorders (Tambs, et.
al., 2009).
The second medical theory of anxiety is that anxiety
is caused by an imbalance of brain chemicals known as
neurotransmitters. This theory has not turned out to be
accurate. As I will discuss in more detail below, scientists
have not been able to demonstrate that anxiety (or
depression) is actually associated with abnormalities in
serotonin or other neurotransmitters. As we shall see,
however, neurotransmitter levels do change in people who
are treated with medications for anxiety or depression
(Kirsch, 2010). We shall see how this change in
neurotransmitter levels may complicate the recovery
process and can turn a limited process into a chronic
disorder.

A Brief History of Anxiety

Disorders

38
 In Anatomy of an Epidemic, Robert Whitaker
documents the history of anxiety and depression over the
last 60 or 70 years (Whitaker, 2010). Whitaker notes that
Sigmund Freud first described anxiety neurosis in 1895.
He believed anxiety was caused by unconscious responses
to stressful life experiences, rather than being a condition
of tired nerves as had been thought to be the case up to
this point in time. While individuals diagnosed with
anxiety neurosis often had troublesome symptoms, they
rarely became completely disabled. In fact, Whitaker
documents the relative lack of severe disability or inability
to work seen in those with anxiety prior to the modern era
when medications began to be used for anxiety and
depression.
In the 1950s and 1960s, medications such as
Miltown, and later Librium and Valium began to be used
for anxiety disorders (Whitaker, 2010). Since then, these
medications have been largely replaced with Klonopin,
Ativan, and Xanax. Even though the newer drugs have
been touted as being more effective and less dangerous,
there are no studies showing that this group of medications
(benzodiazepines) is effective for the long-term treatment
of any of the anxiety conditions (Committee on the Review
of Medicines, 1980; Kendall, et. al., 2011).
While these medications can reduce the symptoms
of anxiety quickly (and for many, this effect is very
welcome), over time, the dangers of these medications rise
and the beneficial effects diminish. Because the
benzodiazepines alter gamma-aminobutyric acid (GABA)
receptors in the brain, the brain adapts to this dramatic
change by decreasing receptor availability. This in turn,

39
causes the person taking the drug to become relatively
dependent on the medication. When the dosage is reduced
or stopped, withdrawal symptoms develop, and these can
be severe (Mugunthan, et. al., 2011; Ashton, 1991).
Although not all people have trouble withdrawing
from these medications, many people will tell you that it
can be difficult. And the symptoms that can emerge from
reducing or stopping benzodiazepines, such as irritability,
nervousness, fatigue, dizziness tremor, and/or sweating,
are very similar to the symptoms of an anxiety disorder.
Hence, a vicious cycle is created: while the medications
used to treat anxiety may stabilize the symptoms of anxiety
in the short run, they can make people dependent on the
medications and cause the symptoms of anxiety to worsen
in the long run.

The Current State of Affairs

In the modern era of medication treatment for
anxiety disorders, the rates of disability and inability to
function have skyrocketed. Anxiety disorders now
represent the most common type of emotional disorder in
the U.S. Approximately 40 million adults in the country
(18% of the population) have been diagnosed with an
anxiety disorder. The resulting economic burden is greater
than $42 billion a year (Anxiety and Depression
Association of America, 2014; Regier, et. al., 1998;
Greenberg, et.al., 1998), which represents almost one-third
of the total national mental health cost and this figure does
not even consider the additional costs of lost productivity.
Individuals who experience stressful or fearful

40
situations are more likely to develop anxiety as a normal
response to those circumstances. What they dont need is
to be told that they have a chemical imbalance or that they
are destined to feel this way because of their genetic
inheritance. The great majority doesnt need to be placed
on benzodiazepines chronically (although some people
may benefit from a very short course), and unfortunately,
the newer anti-anxiety medications arent much better as
we shall see. What individuals experiencing anxiety do
need is to understand exactly what is happening to them
and their brain in order to reverse their symptoms and
move beyond them. This process will be described in
detail in Chapter 3.

The Disorder Known as

Depression
While the state of depression or melancholia has
always existed in human societies, the disorder we call
depression has dramatically increased in the last few
decades. We know that, as with anxiety, there are certain
medical disorders that can cause depression. Disorders
such as low thyroid function, low testosterone levels, low
pituitary or adrenal levels, anemia and a few other
conditions can cause low energy, fatigue, and lack of
interest in activities. These disorders should be addressed
by traditional medical treatments. Side effects of certain
medications, including the benzodiazepines, certain
hormones such as birth control pills, and some blood
pressure medications, can also cause depression. However,

41
the vast majority of people who are diagnosed as being
depressed do not have any of these conditions, nor are they
being treated with any of these medications.
There is an epidemic of depression in our modern
world. Prior to the last few decades, depression was seen
primarily in middle-aged and older adults and did not
frequently persist or recur (Whitaker, 2010). As Robert
Whitaker documents, the disorder of depression was not
nearly as common as what we are seeing in modern times.
In the 1930s and 1940s, there were less than one in 1,000
adults diagnosed with depression (Silverman, 1968).
Depression was not regarded as a significant public health
problem that resulted in disability or loss of function.
Currently, depression is the most common cause of
disability in the U.S. among those from 15 to 44 years of
age. There are about 14.8 million American adults 6.7
percent of the U.S. population who suffer from
depression (Anxiety and Depression Association of
America, 2014). What has changed?

The Medical Model of

Depression
As is the case with anxiety disorders, people
suffering from depression who seek medical advice will
likely be told that their problem is due to genetics and/or a
chemical imbalance. In fact, several genes have been
identified as having a relationship with depression. Some
of these genes are linked to the serotonin neurotransmitter
system. For example, a serotonin transporter gene known

42
as 5-HTTLPR has been found to be associated with
depression in those who inherit the short-short variation
of these genes, as opposed to those who inherit the short-
long or the long-long gene pairs. A close examination
of these data shows that these associations are only present
for those people who have major stresses in their lives. For
individuals who do not have major stressors in their lives,
there is no higher risk for those who have the so-called
high-risk genes (the short-short pair) (Caspi, et. al., 2003).
In addition, other studies have shown that those with the
short-short genes are only at higher risk for depression if
they have significantly adverse conditions, such as abuse,
neglect, or separation in their family of origin. Those
people with short-short genes are actually at lower risk for
depression if they grow up in a nurturing and supportive
family (Taylor, 2010).
While it is obvious that there have been no major
shifts in our genetic makeup over the last 50 years, there is
probably some degree of genetic predisposition for
depression in some people. As the above studies have
demonstrated, it is highly likely that this predisposition
will only be triggered if there are significant stressful life
events. As mentioned in the anxiety section above, we now
understand that many genes that we inherit are only
activated or expressed in the presence of environmental
cues or situations. More importantly, for our purposes,
these gene activations can also be de-activated that is,
these genes can be turned off with changes in the
environment (Lipton, 2008).
The other reason most commonly given by the
medical profession for depression is that depression is

43
caused by a chemical imbalance in the brain. This has
become so widely accepted that many lay people can tell
you that low serotonin causes depression. This is why the
medications that are supposedly so effective for depression
are called serotonin reuptake inhibitors (SRIs), i.e., their
purpose is to increase serotonin levels in the brain.
Following that line of reasoning, low serotonin must
be at the root of depression. It is fascinating that this
concept is so widely held because it has not been
demonstrated to be scientifically correct. This theory
developed because medications that caused increases in
serotonin were found to improve depressive symptoms in
short-term trials. However, all scientific efforts to
document the supposed decreased serotonin levels have
been futile (Maas, 1984; Cowen, 2002; Kendler, 2005).
LaCasse and Leo have summarized this issue:
Contemporary neuroscience research has failed to
confirm any serotonergic lesion in any mental disorder,
and has in fact provided significant counterevidence to the
explanation of a simple neurotransmitter deficiency
(LaCasse and Leo, 2005). One piece of counterevidence to
the serotonin theory of depression is the fact that there is a
new medication that decreases serotonin in the brain,
which has also been shown to improve depression
(Wagstaff, et. al., 2001).

The Effects of Anti-Depressants

Even though the serotonin theory of depression has
been disproven, there were 171 million prescriptions for
serotonin reuptake inhibitors anti-depressants in 2011

44
(Lindsley, 2012). Why are SRIs and other newer anti-
depressantssuch as Effexor and Wellbutrin, which are
combined serotonin and norepinephrine reuptake inhibitors
prescribed so frequently? They must work, right?
Lets take a closer look. Data have emerged over the
past few years that are shocking. Irving Kirsch (2010) is a
psychologist who was interested in studying the placebo
effect. He chose to study the efficacy of anti-depressants
and conducted a series of well-designed studies confirmed
by several other similar studies, which showed that the
overall effect of all of the modern anti-depressants is
minimal.
This doesnt mean that people who take these
medications dont see improvements. In fact, they usually
do, at least in the short term. About 75% of people who
take an anti-depressant experience an improvement in
terms of symptom relief. That is a much higher rate of
response than what is typically seen in people who get no
treatment for depression. What is fascinating about
Kirschs studies is that they showed that a similar amount
of people who take a placebo pill for their depression also
see improvements. In other words, the majority of people
can experience relief from their depression without any
medication treatment. Simply the idea that they are taking
medication that they have the hope of getting better
is what makes them better. Why not bottle this kind of
hope? That is a significant component of this book, as
we shall see.
The British agency NICE (National Institute for
Health and Clinical Excellence, 2004) has developed
guidelines for assessing the efficacy of medical treatments.

45
These guidelines require the identification of a certain
level of efficacy below which the treatment is deemed to
not be effectual. In the case of anti-depressants, this level
of efficacy is calculated by the difference between the
effects of anti-depressants and those of the placebo pills.
Several large studies of anti-depressants for people
with mild to moderate depression have shown that the
effect of anti-depressants is less than the minimum
standard established by NICE, which is defined as an
effect size lower than 0.3 (Kirsch, 2010; Fournier, et. al.,
2010). People with severe depression (about 11% of those
diagnosed with depression; Zimmerman, 2002), however,
do benefit from anti-depressants (to a significantly greater
degree than in those with mild to moderate depression,
over and above the placebo effect).

A Darker Side of Anti-

Depressants
Even more alarming than the ineffectiveness
(compared to placebo treatment) of anti-depressants for
people with mild to moderate depression is the possibility
of the harm they may cause. Unlike the benzodiazepines
(or alcohol or narcotic medications), anti-depressants do
not cause a physical addiction. They can certainly cause
side effects, such as headaches, insomnia, rashes, muscle
aches, gastrointestinal symptoms, sexual problems, and,
surprisingly, anti-depressants can even cause depression
and suicidal thoughts. If you have ever watched a
television advertisement for an anti-depressant, you will be

46
familiar with this list, which the FDA requires
pharmaceutical companies to include.
We have already established that there is no
evidence of abnormal neurotransmitters in the brain due to
a state of depression. However, once treatment with anti-
depressants has begun, there is now an alteration of
neurotransmitters, and the brain adapts to that state
(Jacobs, 1991; Hyman, 1996). As one such adaption, the
increase in serotonin leads to a decrease in receptors for
serotonin creating a new steady state in the brain.
However, when the medication is stopped, the drop in
serotonin level that the brain perceives is exaggerated. A
relative serotonin deficiency is now very real.
Consequently, withdrawal from anti-depressants can be
difficult. In fact, studies have shown that withdrawal from
anti-depressants can cause depression and the subsequent
need for restarting the medication.
This withdrawal mechanism is most likely
responsible for the emergence of depression as a chronic
and relapsing disorder, as opposed to the relatively benign
natural history of depression of 50 years ago. One startling
study randomized individuals with depression to treatment
with either anti-depressants or exercise, or both. Each
group initially had similar rates of improvement in
depression. However, the rates of recurrence of depression
were much different after the treatment (medication or
exercise or both) was stopped several weeks later. The
group who took anti-depressants had a relapse rate of 38%,
the exercise group had only an 8% relapse rate, and the
group who took medications and exercised had a relapse
rate of 31% (Babyak, et. al., 2000).

47
 Another study found that the relapse rate for
individuals treated with anti-depressants was 76% in
comparison to a 31% relapse rate in those treated with
psychotherapy (Hollon, et. al., 2005). Other large
naturalistic studies (studies where researchers assess
outcomes based upon what treatment the individuals
receive, but where a particular treatment is not mandated,
i.e., they can get whatever treatment they want, rather than
being assigned randomly to one group or another) show
that depressed adults who are treated with anti-depressants
and maintained on them actually have worse outcomes
overall such as inability to work and function in society
than those who were never treated with anti-depressants
or who stayed on anti-depressants for a short time only
(Ronalds, 1997; Weel-Baumgarten, 2000; Patten, 2004).
While these naturalistic studies are not as conclusive as
randomized trials, the results are nevertheless suggestive
of a worrisome trend.

The Newest Theory: A Brain

Disease
In that last decade, biomedical researchers have
identified changes in the brain that are associated with
anxiety and depression. There is evidence of inflammation
and other structural changes in specific brain regions when
either disorder is present. In patients with so-called major
depressive disorder (MDD), regional blood flow studies of
the brain suggest hyperactivity in the ventromedial
prefrontal cortex and the lateral orbital prefrontal cortex as

48
well as hypoactivity in the dorsolateral prefrontal cortex,
when compared with people who are not depressed
(Drevets, 1998). The hypothalamic pituitary adrenal
(HPA) axis, which turns on the fight or flight reaction
during times of stress, has also been shown to be altered in
people with depression (de Kloet, 2007).
A study that compared the brains of those who
committed suicide and who had been abused as children to
those who had committed suicide and who had not been
abused as children revealed that the glucocorticoid
receptors in the brain were altered in those with childhood
abuse leading to an increased fight or flight stress response
(McGowan, et. al., 2009). Thus, the abnormality in the
brain of those with depression was not due to the
depression itself, but due to the childhood abusive
experiences. It had been learned rather than being
inherited. In addition, increases in pro-inflammatory
cytokines have been demonstrated in depression. Pro-
inflammatory cytokines are chemicals that can activate
inflammatory responses in the body, which may have
consequences for health over many years (Raison, 2006).
However, it is well known that stressful life situations
increase such pro-inflammatory cytokines and this process
can be reversed when stress is reduced (Salim, et. al.,
2012; Zunszain, et. al., 2011).
These studies could be interpreted as evidence that
anxiety and depression are brain diseases that require
treatment with medications. While it is true that there are
changes in the brain in those with anxiety and depression,
this does not prove that these changes are responsible for
these states of mind. It seems equally likely that these

49
changes in the brain are caused by being anxious or
depressed, rather than the reverse, i.e., anxiety or
depression being caused by changes in the brain that have
resulted from genetics or a chemical imbalance.
The brain and nervous system are shaped by a
process known as neuroplasticity, which is the ability of
the brain and nervous system to change in response to
shifts in their environment. All experiences that we have
change the brain. For example, the brain shows changes
when we learn to play the piano or ride a bicycle or speak
a foreign language. Similarly, anxiety and depression
cause changes in the brain. Just as the brain can change
when one learns something, it will also change when one
unlearns something. In fact, there is a research study that
shows changes in the structure of the brain when
individuals unlearn the fear of spiders (Paquette, et. al.,
2003). Prefrontal-limbic activation abnormalities have
been shown to reverse with a clinical response to either
psychologic or pharmacologic interventions (Viinamaki,
et. al., 1998; Soili, et. al., 2008; Saarinen, et. al., 2005).
For many people, the medication approach to
anxiety and depression does not help them recover in the
long run. Treating these disorders as diseases that require
medical treatment actually can make matters worse over
time, resulting in the epidemic we are currently facing.
Anxiety and depression should be viewed as temporary
mental states that are a result of stressful life events. This
model suggests that if chronic medical treatment is
avoided and effective psychological treatment begun, the
vast majority of individuals will recover. This simple and
proven fact, that we can reverse anxiety or depression,

50
even after it has developed, is the basis for this book:
anxiety and depression can be unlearned, and if you suffer
from either condition, your brain will definitely change
for the better by completing the process described in the
following chapters.

51
 chapter 3
How Does Anxiety
and/or Depression
Occur?
While we may not be able to control all
that happens to us, we can control what
happens inside us. Benjamin Franklin

When asked what single event was most

helpful in developing the Theory of
Relativity, Albert Einstein replied,
Figuring out how to think about the
problem.. W. Edwards Deming

All glory comes from daring to begin.

William Shakespeare

In Unlearn Your Pain, I explain that there are
two major causes of pain or any other medical symptom:
some kind of tissue damage or learned neural pathways. In
individuals with acute pain, tissue damage problems, such

52
as kidney stones, infections, fractures, and other injuries
are very common. On the other hand, chronic pain is much
more likely to be due to learned neural pathways, and
fortunately, the pain from learned neural pathways can be
reversed.

Learning the Response of

Anxiety or Depression
In the case of anxiety, learned neural pathways are
created in a way similar to those that result in chronic pain.
Acute anxiety is frequently caused by a reaction to some
event, such as being threatened by a bully or being lost in a
forest. However, chronic anxiety (in the absence of the
medical conditions listed earlier) is caused by neural
pathways that have been learned and become engrained in
the brain after a series of stressful events.
The dynamics of depression are similar. Acute
symptoms of depression can be caused by a temporary
situation, such as a loss or other occurrence that causes
sadness. As with situations that cause fear, worry, and/or
anxiety, our brains are designed to bounce back and
recover from depression caused by a discrete event. And,
as with anxiety, repeated stressful events can cause chronic
depression, which is also caused by learned neural
pathways that have become engrained over time.

The Neural Pathways of Anxiety

In order to understand how acute anxiety or

53
depression is produced, it is helpful to understand a bit
about how the brain works. Everything that happens to us
in our lives, including our lives in utero, is imprinted on
our brain. Through what happens to us in our lives, we
learn a vast amount of lessons, especially in childhood. In
fact, our childhood experiences have a profound effect on
how we respond to the events we encounter in our adult
lives.
This imprinting of experience has been shown in
very simple animal models. The Nobel Prize winner, Dr.
Eric Kandel, demonstrated that the Aplysia organism (a
small marine organism with relatively few brain cells)
learns to withdraw from a stimulus that causes pain
(Carew, et. al., 1979; Walters, et. al., 1979). This is an
example of what is known as Hebbian learning and is
the basis for our modern understanding of brain
functioning. Donald Hebb was a Canadian psychologist
who first explained how neural pathways develop. The
essence of Hebbs Law is that brain cells that fire
together become wired together (Simpkins and
Simpkins, 2013). And we now refer to this process as
neuroplasticity.
Children who are brought up in environments where
they feel safe and protected have brain wiring that reflects
this environment. They learn to be trusting and resilient.
However, children who are raised in environments that are
harsh, learn something much different. Their brains
become wired to respond to new situations with distrust
and fear. When a child is mistreated, such as in cases of
verbal abuse, physical abuse, or sexual abuse, the childs
brain becomes wired to respond with the automatic fight or

54
flight reaction.
The fight or flight response is necessary, but only
necessary for our survival in dangerous situations.
However, when this response is repeatedly activated in
childhood, it creates learned neural pathways the activation
of which, in the future, will act as an alarm, warning of
danger. In other words, the brain becomes sensitized to
respond with fear to new situations, especially those that
are similar to the stressful situations the individual has
previously experienced. These pathways are remembered;
they become part of the brain wiring of these individuals
and create profound changes in both their brains and
bodies.
As described in Chapter 2, the fight or flight reaction
triggers a wide array of physical reactions in the body, as
well as a great deal of mental and emotional responses.
Studies have documented how this process alters certain
brain regions and leads to excessive cortisol the stress
hormone production (Carpenter, et. al., 2009). An
example of how this process works can be demonstrated
by the experience of someone who has been bitten by a
vicious dog. He or she may immediately learn to be afraid
of barking dogs or may even feel fear upon seeing a dog
approach. The more someone is exposed to such
occurrences of fear, the more the neural pathways learned
from this fear become sensitized. Furthermore, they can
easily become generalized (Lissek, 2012). The neural
pathways that were specific to dog-related anxiety can
begin to occur in response to other non-dog-related events,
resulting in the person experiencing fear in many other
situations.

55
 Anxiety is fear expressed in the mind and body.
Once the neural pathways of fear are created, over time
they can become engrained. These fear pathways which
produce our experience of anxiety become a default
mechanism for how we respond. The danger signal
becomes activated by situations that would not cause fear
in people who did not have such adverse childhood
experiences. People with harsh childhoods easily feel
threatened. For example, a young woman who grows up
with an emotionally controlling parent is likely to feel
extremely threatened in high school by social interactions
that threaten her sense of security, such as a social
rejection by other girls or a jealous boyfriend or a strict
teacher. In such a situation, it is easy to see how anxiety
might develop.
There are very few situations where someone
develops anxiety (in the absence of a medical condition)
that cannot be understood as being caused by this simple
learned mechanism. All it takes to determine the cause of
the anxiety is the careful process of searching for such a
pattern.
As you may suspect, anxiety is not the only outlet
for this powerful alarm system in the brain. As described
in Unlearn Your Pain, it is equally likely that someone in
this situation (that is, a stressful childhood coupled with
threatening situations later in life) will develop a painful
condition, such as headaches or migraine, back or neck
pain, abdominal pain or irritable bowel syndrome. It is not
unusual for these same individuals to experience multiple
such conditions. For instance, at one point in life, a person
may be held hostage by migraines; while at other times,

56
they may suffer from back pain or be a victim of anxiety.
There are much more severe, as well as much
milder, situations than those described above. Some very
unfortunate people are subjected to horrible abuse. Many
people with chronic anxiety or depression have been
sexually abused. They may be ashamed that they have
never informed anyone, keeping the source of their shame
a secret. One of the worst outcomes of such a situation
occurs when the child or adolescent finds the courage to
speak of the abuse, and the adults in his or her life do not
believe the victim and therefore, take no action to protect
her or him. Sometimes the victim is made to feel guilty for
the abuse happening and continues to carry this shame,
which of course magnifies the emotional pain they carry
through life.

ALEXANDRA, WAS SEXUALLY ABUSED by her
grandfather. When the family became aware of the abuse,
it stopped. However, no one spoke about it again,
Alexandra was never allowed to express any feelings, nor
did she ever receive counseling. Her grandfather
continued to be invited to family functions, where she was
expected to pretend that nothing had ever happened and
that everything was fine. When Alexandra was taken
advantage of later in life, she developed symptoms of pain
and anxiety.

PETER, A YOUNG MAN WITH CHRONIC ANXIETY,
did not have a history of serious traumatic events in his
life. He had loving and kind parents who had always done

57
their best in caring for him and his sister. My patients
younger sister was autistic and consequently required a
tremendous amount of attention from his parents. Being
raised by kind, caring parents, the brother was also kind
and caring. The fact that his younger sister had a disability
weighed on the whole family, and the brother did his part
to help out as much as he could. However, by the time he
became a teenager, he began to resent his sister and had
no outlet for those powerful feelings. This resentment was
turned inward as he felt he must be a selfish, uncaring
person to harbor these feelings. He felt guilty about having
anger towards his disabled sister and this inner conflict
consisting of feelings of anger and guilt resulted in
anxiety. Over time, as these feelings persisted, his brain
learned to be anxious much of the time and these patterns
became engrained and chronic.

The Brain and Depression

The response to the danger signal is hard-wired into
us as part of our birthright. We are all born with the innate
ability to respond in very powerful ways to danger.
Activation of this fight or flight reaction is at the core of
learned anxiety disorders. However, there are two other
responses to the danger signal that are also inborn: the
freeze response and the submit response. These responses
are well known in the animal kingdom. We see the freeze
response when a rabbit stops and remains motionless in
response to a sound. We recognize the submit response
when a possum plays dead when attacked. Humans are
also capable of employing the freeze and submit responses.

58
Either of these two responses in people is often triggered
by life events that are overwhelming. The freeze and
submit responses in people are manifest by the clinical
symptoms of fatigue and depression.

GAIL RECALLS BEING DEPRESSED as early as
middle school. Her feelings of depression began when her
family moved to another city and she was separated from
her best friend. Her father worked long hours and was
rarely home. Her mother also worked and depended on
Gail to help with the housework and in caring for her two
younger brothers. Gail found few friends at her new
school, and she felt alone most of the time. Her mother was
energetic and domineering. Gail felt that her mother
expected her to be this perfect kind of person, and Gail
struggled to live up to those expectations, yet felt unable to
do so much of the time. This resulted in a lack of self-
esteem that exacerbated her feelings of depression. She
often felt that she didnt have the energy to even try to
succeed.
Gail was able to graduate from nursing school, and
she married and had two children. However, the marriage
was not ideal. Her husband was unhappy, very stressed,
and had little time or inclination to give attention to her or
her needs. Their communication worsened over the years,
and she fell into a deep depression. In addition to her
marital problems, she had a series of demanding and
overbearing bosses. Despite great efforts to save her
marriage, she divorced and viewed this as another failure.
She was treated with almost every anti-depressant

59
including Cymbalta, Wellbutrin, Zoloft, Celexa, and Elavil.
Unfortunately, each of these caused a significant
uncomfortable side effect, including, in turn: rash,
headache, fatigue, increased heart rate, and weight gain.
She also spent a lot of money and time in psychotherapy,
which while helping her cope better on a day-to-day basis,
didnt help her shake her underlying feelings of sadness
and despair.
In the Mind Body Syndrome program, she was able
to connect the dots and see how her depression had
been learned and reinforced during the course of her life.
She accepted the idea that she could actively change these
feelings and reclaim her life without the use of
medications.
Gail learned to express her deeply held emotions
concerning her parents, the move, her husband, and her
bosses. She learned to recognize self-critical thoughts and
to appreciate herself and what she has accomplished. She
is practicing mindfulness, exercising, engaging in yoga,
and eating better. She has found a job she likes that
challenges her and in which she is appreciated. Her
children are doing well and she has been able to forgive
her ex-husband and develop a civil relationship with him.
Gail has noticed that she reverts to depressed feelings at
times, but because she understands how these feelings
were learned, she looks for why they might have re-arisen,
and she is more able to release them and get back to
enjoying her life.

Unraveling Anxiety and

60
 Depression
You can discover the reasons for your anxiety or
depression (or insomnia, fatigue, or chronic non-structural
pain) by a careful review of your life story if you know
what to look for. There are typically three components that
create these conditions: priming events, triggering
events, and your specific personality traits.
How do priming events contribute to conditions
where anxiety or depression (or insomnia, fatigue, or
chronic non-structural pain) is manifested? As we know,
humans are born with a great deal of neural pathways,
including the pathways which make us capable of
responding to our lifes events with the fight or flight
reaction. We are also born with varying degrees of
sensitivity or fearfulness. Some people are more likely to
be sensitive to stress and more likely to be responsive to
other peoples needs. In addition, we are all born helpless.
We are dependent on a tremendous amount of caring to
meet our needs as infants and we are not independent for
many years. When our childhood consists of love and
kindness, gentle touch, adequate food and water, and
safety, our brains become wired to expect love and safety
in our future. These individuals are less likely to respond
to life events with the fight, flight, freeze, or submit
responses.
Conversely, children who have the unfortunate
situation of having experienced parental divorce, hunger,
death in the family, sickness or disability, powerful sibling
rivalries, emotional, physical or sexual abuse or any other
negative events are primed to expect negative experiences

61
in their lives. Their brains learn to react with fear, and the
neural pathways that fire the danger signal become
deeply engrained due to these priming events. Everyone
has some negative occurrences in their childhood, but
those children who have repeated episodes are most likely
to develop learned neural pathways of fear and danger.
The more such pathways are reinforced, the more easily
they can be aroused or activated later in life.
The pathways that are learned are often quite
specific to particular emotional hurts, such as loss or
abandonment, being controlled emotionally, being
physically or sexually attacked, or other such specific
situations. In some people, the early childhood stressors
are so overwhelming or the individual is so sensitive to
those stressors that symptoms, such as anxiety,
stomachaches or headaches begin in childhood. However,
most people dont develop the manifestations of anxiety,
depression, or pain until later in life.
Triggering events are life circumstances that activate
the neural pathways created by priming events. These
events are often eerily similar to the priming events.
Helen, a woman whose mother was overly critical
and judgmental, developed anxiety in college after
becoming involved with a boyfriend who was
verbally abusive.
Terry, a man whose father left the state after his
parents got divorced when he was a child, became
depressed when his wife divorced him and he had
to move away from his children.
In both cases, triggering events, occurring later in

62
life, activated the specific established fear and danger
pathways in the brain that were created by priming events,
thus producing powerful reactions in the body that trigger
anxiety or depression (or pain, insomnia, fatigue or a
variety of other symptoms).
While triggering events are often very similar to the
priming events, individuals who have had many priming
events in their lives often become susceptible to non-
specific triggering events. Someone who was abused as a
child may develop clinical symptoms of chronic non-
structural pain, anxiety or depression after a car accident or
surgery. A brain that is sensitized to trauma can easily
interpret such unrelated situations as being traumatic.
This will be particularly true when there are emotionally
charged situations that occur at the same time as the
physical injury. For example, a victim of a car accident is
much more likely to develop chronic symptoms if the
person who hit them has no remorse and just walks away
without so much as an apology. Similarly, surgery is more
likely to be interpreted as an assault by the subconscious
mind if the doctors are uncaring or harsh.
Women are more likely than men to have anxiety
and depression (Gater, et. al., 1998). As described in
Unlearn Your Pain, migraine headaches, irritable bowel
syndrome, and fibromyalgia are also much more common
in women (Lipton, et. al., 2007; Neumann and Buskila,
2003; Saito, et. al., 2002). The reason has eluded
explanation for many years. If one understands how MBS
develops, it appears that there may be several potential
explanations. First, women are more likely to be socialized
to be deferential and take care of the needs of others before

63
attending to their own needs. They are also more likely to
be the victims of abuse. In addition, women are more often
in employment positions that are subservient. They are
expected to be physically attractive while managing most
of the duties in the home. They are also more likely to be
in situations where they are caring for children, for aging
parents, and/or for grandparents.
Women are more likely to be oriented toward
wanting to please others and feel like they should be better
or do more, and they are less likely to assert themselves.
Men are more likely to be assertive and blame others for
problems in their lives. In fact, two very large studies of
men and women from around the world showed that
women are more likely to be conscientious and agreeable,
and to be more prone to worry. Surprisingly, these
differences are greater in North America and Europe than
in countries with more traditional cultures (Costa, et. al.,
2001; Schmitt, et. al., 2008). Obviously, men also
experience anxiety and depression, as well as pain and
other symptoms caused by learned neural pathways. Many
men have endured childhood hurts and have had life
stressors that have triggered anxiety or depression as
responses.
Whether male or female, people who have had
significant early life stressors are more likely to develop a
variety of specific personality traits such as perfectionism,
low self-esteem, feeling excessive guilt, being overly
responsible and/or self-critical, and needing to be good or
liked. People with these traits tend to hold emotions in and
put extra pressure on themselves. In addition, many
individuals are born with genetic traits of being highly

64
sensitive (Aron, 1996). Then when stressful life events
occur, these personality and genetic traits contribute to the
activation of learned neural pathways that result in
symptoms such as anxiety, depression, insomnia, fatigue,
and chronic non-structural pain.
In fact, each of our bodies is a barometer of what is
going on in our environment and how we react to it. The
events in our early life condition us. If weve been hurt on
a regular basis, two typical adaptive reactions would be to
either learn to try to please others in order to gain favor or
to learn to avoid others to prevent getting hurt. But we
often pay a price for these reactions.
When we experience stressful events that trigger the
deep emotions of suppressed anger, guilt, fear, or sadness,
our bodies will often warn us of the situation by producing
anxiety, depression, pain, insomnia, or fatigue. One thing
that I often tell people is that the reason that they have
developed these learned neural pathways is not that they
are weak or crazy or incompetent; it is because they are
human. Because of how we are constructed, the interaction
between the mind and body frequently causes powerful
physical reactions to stressful events, thoughts, and
feelings.
All of these reactions are mediated by the
subconscious part of our brain, that is, the part of our brain
that is automatic and the part of which we are not aware.
Surprisingly, the majority of our brains functioning occurs
at a subconscious level. On a moment-by-moment basis,
our senses are taking in millions of bits of information that
includes sounds, sights, and other sensations that are
constantly changing. Our brains process all of these. In

65
addition, there are millions of inputs to our brains from our
bodies as we constantly monitor our heart rate, respiratory
rate, temperature, balance, and the functioning of all of our
organs (such as the intestines and bladder), muscles and
joints. On top of all this, we are consciously aware of what
is going on around us, while we walk, drive, work, and
play. We are also aware of many of our thoughts and
feelings, which provide additional input to our brains.
However, it is shocking to realize that we are not
consciously aware of the majority of our thoughts and
feelings as they are being generated by our subconscious
(Wilson, 2002).
Our brains are designed to protect us. The
subconscious is constantly reviewing all of the incoming
data to determine if there is anything dangerous in our
environment, including any dangerous thoughts or
feelings. This particular screening system is in place so
that we can respond instantly in case of physical danger. If
we are suddenly threatened (for example, by a close call
while driving, by someone who attacks us, or by an
encounter with a threatening wild animal), our brains will
recognize that threat to our safety immediately and activate
the fight or flight response in our bodies to protect us. All
of this happens on a sub-conscious level; we are not aware
of the process, as it happens in milliseconds (LeDoux,
1996).
Recent research studies have shown that the brain
responds to emotional dangers in exactly the same way
that it responds to physical dangers (Kross, et. al., 2011).
In other words, the fight or flight response can be activated
by a controlling boss, an argumentative sibling, a son who

66
gets arrested for underage drinking, or a parent who is
demanding or critical. In these situations, our bodies will
frequently react with anxiety, depression, or pain, even if
were not consciously aware that those situations are
affecting us.
In fact, this mind-body reaction system is so
sensitive that simply having thoughts about any of these
life stressors is often enough to trigger these physical
reactions, even when we are NOT consciously aware of
thinking about them. Events that occurred a long time ago
are frequently the cause of anxiety or depression because
our minds are capable of recalling and reacting to these
past events in the present. In fact, there is research
suggesting that prior traumatic events are likely to be
stored in a part of the brain that is easily accessible.
Certain research techniques allow respondents to answer
questions based on the part of their brain with primarily
factual memories (left brain) versus the part of the brain
with primarily emotional memories (right brain). For
example, one research participant was asked about the
bullying he endured as a child. When the experiment
forced him to use his left brain to respond, he indicated
that the bullying occurred a long time ago and really didnt
bother him much anymore. However, his right brain
responses indicated that it was still very much on his mind,
in a way as if the bullying was occurring in the present
(Schiffer, 1993). We have learned that emotional memory
is timeless, which is why events from many years in the
past (if they are not processed emotionally) can continue to
cause reactions due to learned neural pathways. This is
particularly true at times of stress when these subconscious

67
emotional reactions can trigger powerful responses, such
as anxiety, depression or pain.
In addition, humans are uniquely able to anticipate
to worry about events that might happen in the
future, such as job loss, illness, marital infidelities,
delinquent children, and death. Of course, if negative
events occurred in the past, that will tend to create worry
about a replication of the event. For example, pregnant
women who had complicated deliveries in the past were
more likely to worry about a future pregnancy (Sjogren,
1997). Prior fearful experiences also predicted increased
fear of dying.
All of these thoughts and emotions are normal.
Everyone has worrisome thoughts and feelings, and these
occur on a regular and, oftentimes, frequent basis.
However, we can train ourselves to be more resilient and
to learn new skills to respond to what life brings us and to
be less negatively affected by the thoughts and feelings
those events generate. The MBS Program is designed to
help you learn to recognize how these subconscious
mechanisms work and to prevent them from triggering
symptoms. It is effective in the treatment of anxiety,
depression, fatigue, insomnia, and chronic pain because it
teaches you how to retrain your brain by changing the
neural pathways that are responsible for the symptoms.

JEANETTE, A 37-YEAR-OLD WOMAN, HAD
SUFFERED with both generalized anxiety and burning
sensations in her abdomen for about six months. The
results of the GI tests were normal, as were tests for lupus
and a number of other disorders. However, she felt very

68
uneasy all the time, even when she was simply resting. Her
doctor started her on the anti-depressant Celexa, but she
wasnt sure she wanted to take it and stopped taking it
after a couple of weeks. She tried some supplements and
vitamins after consulting with an alternative doctor, but
this approach didnt help. She saw a doctor who
specialized in Lyme Disease, but the tests were
inconclusive. She had never had symptoms like this before,
and she didnt know where to turn.
When we met, I listened to her life story. Her parents
were loving, but had high moral standards and very high
expectations for her. She had always done well in school
and had become a professor at a university. However, she
realized that she was a perfectionist, was never willing to
say no, and that she was often taken advantage of by co-
workers. Jeanette found it difficult to stand up for herself
and keep her own best interests in mind. Six months
earlier, someone who worked for her had done something
that she felt was unethical and had involved her in the
situation. She had not been given all the facts about the
situation and she felt used. However, she had not taken
any action to change the situation, and she kept her
feelings to herself. She attempted to ignore the problem
and had tried to continue to be nice to this individual. She
even bought a birthday present for him. The anxiety and
GI symptoms had begun just after she had delivered the
present.
When I first saw her, Jeanette was very afraid that
there was something seriously wrong with her physically.
It took some time and a lot of discussion to help her see
that there was nothing physically wrong with her, but that

69
her symptoms were manifest due to her suppressed anger
at her employee and her guilt at not having spoken up. She
learned to express her feelings of anger, and she acted to
clear her name from the situation. Her fear of the
symptoms decreased, and she stopped dwelling on them.
Jeanette started feeling that she could release her anxiety
and found that she could quell her discomfort. The
symptoms disappeared and she was able to return to work.
Jeanettes work involves constant stresses, and
sometimes she feels these stresses build. When this
happens, she sometimes gets symptoms of anxiety and
abdominal discomfort. She has learned to remind herself
that these symptoms are not the result of a significant
medical condition, but instead, that these symptoms are
warning signs and messages from her brain telling her
that she is stressed and that she needs to act to take care of
herself. She has learned to take time for herself and has
started practicing yoga. She feels better about herself, has
taken steps to process her emotions, and understands
herself much better.

70
chapter 4
Is My Anxiety and/or
Depression Caused
by Mind Body
Syndrome?
Fears are educated into us and can, if we
wish, be educated out. Karl A.
Menninger

You gain strength, courage and

confidence by every experience in which
you really stop to look fear in the face.
You must do the thing which you think
you cannot do. Anna Eleanor
Roosevelt

The golden opportunity you are seeking

is in yourself. It is not in your
environment; it is not in luck or chance,
or the help of others; it is in yourself
alone. Orison Swett Marden

71
 Im not afraid of storms for Im learning
how to sail my ship. Louisa May
Alcott

How do you know if your symptoms of
anxiety or depression are the result of a psychophysiologic
disorder, or what I term Mind Body Syndrome (MBS)? As
mentioned in Chapter 2, there are several medical
conditions that can cause these symptoms, and your doctor
should rule these out. Doctors are trained to take medical
histories, conduct physical exams and order simple
laboratory tests to determine if you have a disorder such as
hyperthyroidism, pheochromocytoma, sleep disorders,
heart disorders or other relatively rare conditions that can
cause anxiety. Your doctor can also check for low
testosterone levels (in men), adrenal insufficiency, or other
disorders that can cause depression. Since these conditions
have a pathological basis in the body, a doctor will
recommend specific medical treatments. However, it is
rare to have testosterone or adrenal hormone levels that are
low enough to cause depression. Borderline tests results
are now commonly being treated as low T or adrenal
fatigue but these conditions are unlikely to be the cause of
depression. It is also important to recognize that a variety
of medications can cause anxiety or depression, including
amphetamines, beta-blockers, alcohol, marijuana, and
cocaine, as can withdrawal from many medications,
including the medications used to treat anxiety or
depression.

72
 This chapter has been written for people suffering
from anxiety, depression, and other disorders likely to be
caused by MBS, such as tension headaches, migraine
headaches, neck pain, back pain, whiplash, fibromyalgia,
irritable bowel syndrome, chronic fatigue syndrome,
interstitial cystitis, insomnia, tinnitus, and chronic
abdominal or pelvic pain. For such people, the Unlearn
Your Anxiety and Depression program can offer the
opportunity for a cure or a remission of symptoms.

Common Patterns in the

Development of Anxiety or
Depression
To prepare you for the kind of self-evaluation you
will be doing, here are cases I have encountered that
illustrate common patterns seen in the development of
anxiety or depression.

LENORE, A 35-YEAR-OLD WOMAN, SOUGHT CARE
FOR ANXIETY, which had been present since her
childhood. She was an only child and she developed the
sensation of anxiety around the age of 5 when her father
was diagnosed with cancer. She was very close to him and
the fear of his illness and death was overwhelming. As her
mother was self-centered, not particularly nurturing to
Lenore, and consumed with her husbands illness, Lenore
felt abandoned and afraid. She responded by trying to be
the perfect child, excelling in school and being on her best

73
behavior at home. When Lenore was 23, her fathers
cancer recurred, and he died. Her mother was not
particularly supportive to her, and Lenore developed
significant anxiety symptoms, which persisted.
She married and had three children, yet Lenore
continued to experience anxiety, and over time, she began
to develop depression as well. Her husband was caring,
but left the housework and child rearing to her, and her
mother remained self-centered and unavailable,
emotionally and physically. Lenore was not interested in
taking medications for her symptoms and sought help from
the Mind Body Syndrome program.
A careful review of Lenores life identified the key
issues of loss, abandonment, lack of nurturing and
support, and fear of being alone, which were the cause of
her anxiety and depression. For the first time in her life,
she understood why she had these. She did some emotional
work to express grief in response to her losses, to express
anger towards her mother and husband, and to express
love for herself. She was able to speak more openly with
her husband and express her feelings and needs. She was
able to let go of unrealistic expectations she had of her
mother, who, Lenore realized, was never going to be able
to give her the kind of love and support she had craved.
She is now less critical of herself and takes time to meet
some of her own needs.
Lenore stated, Your story doesnt have to define
you for the rest of your life.Yes, it stinks that I lost my dad,
but I had a great relationship with him, one that many
people didnt have. And I can appreciate my life and
myself much better now. We actually are in control. We

74
dont need to be medicated for anxiety and depression. We
just need to identify where its coming from.

PHILIP SOUGHT RELIEF AT AGE 72 FOR A LIFE-
LONG HISTORY OF ANXIETY. He had separation
anxiety as a child, which gradually increased over time.
His parents were very busy and self-centered. They had
little time for him and left him feeling alone, isolated and
not loved. His father was prone to fits of anger. The closest
person to him was a nanny, and one day without warning,
she was fired and he never saw her again. As a teenager,
he began to have symptoms of anxiety. He would avoid
groups of people, he wouldnt sit in the middle of a row in
a theater, and over time, he developed many other
phobias. The anxiety became so severe that he dropped out
of high school for a year, as he was simply unable to
attend. Through sheer force of will, he made himself return
to school and eventually graduated and went to college.
He has been successful in business and with his family, but
has carried his fears along with him. He has always felt on
the edge of being unable to conduct his daily life due to
anxiety.
In addition, he began to develop a variety of
physical symptoms, such as nausea and abdominal pain
that were not caused by any specific medical malady. In
the MBS Program, he learned that his physical issues were
connected to anxiety. He found it encouraging that other
people in the program who dealt with their problems could
get better. He began to believe that he could get better too.
He learned that he was a good person who had difficulties
in life that had resulted in his symptoms. He learned that

75
he didnt need to be perfect, and, instead, worked toward
accepting himself as he was.
He learned that his anxiety was learned rather than
genetically determined and inalterable. Through
mindfulness and cognitive therapy, he has learned to take
control over the anxiety. More importantly, Philip realized
that there has been a lot of anger and other negative
emotions lurking underneath his anxiety, and he has
learned that he can express these emotions and let them
go. He has been able to overcome many of his phobias by
facing them rather than avoiding them. Philip is also much
better at handling the major issues in his life, such as
illness, death, and dying. Yes, I have anxiety like
everyone else, but I dont dread living each day and can
enjoy my life.

TERESA, A 40-YEAR-OLD WOMAN, SOUGHT A
CONSULTATION about three years ago for anxiety and
OCD symptoms. She was constantly checking herself for
lumps that might indicate cancer. She made frequent visits
to the doctor looking for reassurance that she was not
dying. A few years earlier, the husband of a close friend
had developed a lump on his back that was initially
diagnosed as benign and was just observed for several
months. Sadly, it turned out to be a malignant sarcoma,
and he passed away in less than a year.
As a child, Teresa had several experiences that laid
the foundation for excessive worrying. A neighbors dog
was electrocuted during a storm, she had a puppy that was
hit by a car when Teresa was six, and at age 10, her kitten

76
developed a lump, which turned out to be cancer, and the
kitten was put to sleep during its initial visit to the
veterinarian. She never had another pet and her family
never discussed this loss. Around this time, Teresa
developed trouble sleeping.
At age 21, Teresa developed back pain during a
stressful time in a job where she felt that she wasnt
performing up to her standards. When she was 29, she had
some joint and muscle pains and got some medical testing,
which showed a positive result for lupus. Fortunately, the
test was a false positive, and she did not actually have
lupus. Nevertheless, she worried about it. A couple of
years later, her father died of a heart attack, which led her
to experience more fears. When she noticed a lump in her
neck a couple of years ago, she became incapacitated.
Despite testing that showed no evidence of cancer, she was
unable to shake her fears. She began having panic attacks
as well as an increasingly difficult time leaving her house.
Upon undertaking the Mind Body Syndrome
program, she was able to understand why she was so
anxious, that is, how the cumulative events in her life had
created learned neural pathways of anxiety. Teresa began
viewing her anxiety from a different perspective, as
something she could unlearn. She started reminding
herself that she was okay and not damaged, that her
feelings of worry would not harm her and would pass. She
learned techniques to calm herself and she began to feel
better.
If she got a headache after reading a story about
someone having a brain tumor, she learned to relax, and
she was able to make the headache go away. She joined a

77
Bible study class, which helped her gain more perspective.
She also learned to recognize other sources of stress in her
life, such as annoyance and resentments related to her
relationships with family members or friends and began to
deal with those. Teresa has gradually overcome her
anxiety and is able to live her life with less fear; she can
now even get medical testing without becoming
incapacitated.

RONALD SOUGHT HELP FOR DEPRESSION AND
ANXIETY AT AGE 54. His childhood was marked by
emotional and physical abuse from his mother. As a child
he was socially insecure and felt that he never fit in. He
had trouble sleeping and developed anxiety before
examinations. After high school he went away to college
but felt that it was too much for him to handle. He couldnt
find the motivation to study, developed fatigue, and fell
into a depressed state. Ronald dropped out of college
during his first year and worked at construction jobs. He
continued to be depressed and also developed anxiety,
which was diagnosed as generalized anxiety disorder and
PTSD (as a result of the abuse). He was treated with
Prozac and Paxil for a while, but developed side effects to
both of these, including abdominal pain and problems with
sexual functioning. In his twenties, he had a bad case of
the flu and this exacerbated his fatigue and depression. He
was in therapy for many years, but continued to carry the
weight of his abusive childhood. He managed to improve
enough to attend and graduate from nursing school. When
I saw him, he was working as a nurse, but suffered with

78
depression and anxiety regarding his job performance.
Some of the doctors he worked with could be critical and
demanding, which triggered feelings of insecurity and
worthlessness.
In the Mind Body Syndrome program, he learned
that the original source of his depression and anxiety was
his mothers treatment of him, which caused him to feel
devalued and therefore to devalue himself. He learned that
his symptoms of anxiety were present because of the hurts
he had suffered and the subsequent patterns that his brain
had learned. Most importantly, he learned that he could
change these patterns by doing the difficultbut very
rewardingwork of facing the issues in his life and
making changes in order to take control of his life.
Expressing long-held feelings toward his mother and
others (including his bosses), who had treated him poorly,
in the safety of a therapeutic setting, helped him to feel
much better.
He took those lessons back out into the real world,
and he learned to stand up for himself. He began to feel
powerful and act more assertively in relation to his
symptoms, to his mother and to his bosses. Ronald learned
that he had value and that he could care for himself, love
himself, and protect himself. He still gets anxious at times,
especially when he is in a new situation, but he has
learned that he can handle new situations, and he uses a
variety of affirmations and self-talk to process the feelings
that emerge.

A Warning Regarding Severe

79
 Symptoms
Individuals can become completely overwhelmed by
anxiety disorders. For example, panic disorder typically
consists of episodes of severe panic during which the
person feels as if they are dying. Symptoms of chest pain,
shortness of breath, and severe anxiety often lead to
emergency department visits. If an individual is plagued
with frequent panic attacks, they may require medication
and even hospitalization to quell the acute symptoms.
Once this has been accomplished, they may be able to
undertake the work of unlearning the panic. Similarly,
those with PTSD can be afflicted with severe anxiety
symptoms, including nightmares, flashbacks, violent
responses to benign events, and feelings of dread. Those
with severe symptoms may also require medications and
even hospitalization as steps forward in their healing
process. Ultimately, such individuals can unlearn PTSD by
understanding it, processing the underlying emotions that
caused it, and by ultimately taking control over it.
As with any biological measure, symptoms of
depression can vary from mild to severe. It may well be
that severe depression is a much different disorder than
mild to moderate depression. Fortunately, mild and
moderate depression is much more common than severe
depression and everyone has had days or even weeks when
they feel somewhat down or blue. There is some
research evidence that mild depression may even have
some benefit. Researchers have found that people who are
mildly depressed are able to think and focus more clearly
on their problems (Andrews, et. al., 2009). Being down at

80
times is part of being human and the experience may give
us some space to ponder our situation, whether were
going through the break up of a relationship or considering
the existential questions of life and death. Treating this
type of depression with medications seems to make
relatively little sense, as the vast majority of individuals
will recover and may well be better off for the episode,
which may well help them develop inner strength, wisdom,
and confidence.
Severe depression on the other hand may be a
different biological entity. Anti-depressants have been
shown to have a positive benefit for those with severe
depression (in contradistinction to the lack of significant
clinical benefit for anti-depressants over a placebo for
those with mild to moderate depression) (Kirsch, 2010).
Individuals who are severely depressed are less likely to be
able to pull themselves out of it without significant
therapeutic help. They are also more likely to be at risk for
suicide and therefore are usually in need of careful
monitoring and close connections to family, friends, and
counselors. In addition, they are less likely to be able to
use the program in this book without significant help. Most
people with severe depression will require individual
psychotherapy and often medication in order to get them to
a place where this program will prove accessible to them.
Bipolar disorder is an enigmatic problem that can
also vary widely in severity, from mild to severe. The
same cautions mentioned above regarding depression
apply to this disorder. Severe bipolar disorder is likely to
be biologically determined and usually requires treatment
with medications known as mood stabilizers, along with

81
psychotherapy. Over the past few decades, the field of
psychiatry has gradually relaxed the criteria for the
diagnosis of bipolar disorder. Bipolar disorder type I
requires evidence of both significant depressive episodes
and manic episodes. Yet bipolar disorder type II only
requires evidence of irritability or angry outbursts for
shorter amounts of time as evidence of mania. This shift
has led to millions more children and adults being
diagnosed with this milder form of bipolar disorder. It is
not clear that this designation is helpful or if medications
are truly effective in these cases. It seems more likely that
people with milder symptoms of depression and irritability
or angry outbursts are suffering from the reactions to
stressful life events that can be managed by the program
described in this book. It is common for individuals with
stressful life events to have both anxiety and depression.
This makes sense because of the ways in which the
autonomic nervous system can respond. Over-activation of
the fight or flight reaction creates the symptoms of anxiety,
while over-activation of the freeze or submit reaction
causes depression. These two reactions are often triggered
in a sequential fashion so that individuals can feel anxious
or irritable one minute and then depressed the next.
There is a great overlap between anxiety, depression,
chronic pain (as I have described in Unlearn Your Pain),
and other symptoms that can be caused by Mind Body
Syndrome (MBS). For example, there is a significant
overlap between PTSD and chronic pain; people with
PTSD have high rates of chronic pain, and people with
chronic pain syndromes such as fibromyalgia, neck and/or
back pain, headaches, and abdominal and/or pelvic pain,

82
have high rates of PTSD (Amir, et. al., 1997; Beckham, et.
al., 1997; Sherman, et. al., 2000). This overlap occurs
because stressful life events create learned neural pathways
that can cause virtually any symptom to occur. In our
society, the symptoms that commonly occur in response to
powerful unresolved emotions are anxiety, depression,
chronic fatigue, insomnia, irritable bowel and bladder
syndromes, and the many different types of chronic pain
syndromes. I frequently get inquiries from individuals who
wonder if a specific chronic pain syndrome they are
experiencing could be caused by MBS. For example,
people with foot or ankle pain, genital or rectal pain,
tailbone pain, facial pain, tooth or jaw pain, or chest pain
can certainly be suffering from MBS, assuming that
medical testing has not uncovered a specific and clear
physical reason for the pain. You may be like most people
reading this book about anxiety and depression who have
suffered from one of the chronic pain syndromes at some
point in your life. It is important to carefully consider and
understand MBS as a possible cause. I have found that the
people who are convinced that they have MBS and that
they can fix the problem are much more likely to get better
faster.
The following list provides some of the more
common manifestations of MBS.

Chronic Pain Syndromes

Tension headaches
Migraine headaches
Back pain

83
Neck pain
Whiplash
Fibromyalgia
Temporomandibular joint (TMJ) syndrome
Chronic abdominal/pelvic pain syndromes
Chronic tendonitis
Vulvodynia
Piriformis syndrome
Sciatic pain syndrome

Autonomic Nervous System Related

Disorders
Irritable Bowel Syndrome (IBS)
Interstitial cystitis (Irritable bladder syndrome)
Postural orthostatic tachycardia syndrome (POTS)
Inappropriate sinus tachycardia
Reflex sympathetic dystrophy (Chronic regional pain
syndrome)
Functional dyspepsia

Other Syndromes
Insomnia
Chronic fatigue syndrome
Paresthesias (numbness, tingling, burning)
Tinnitus
Dizziness

84
Spasmodic dysphonia
Chronic hives
Anxiety
Depression
Obsessive-compulsive disorder
Post-traumatic stress disorder (PTSD)
NOTE: Many of the symptoms or syndromes in this table
can be caused by physical disorders that do require
medical treatment. Consult your doctor or a specialist in
Mind-Body Medicine (see the Appendix for resources) to
determine if you are able to participate in this program.

Mind Body Syndrome Self-

Diagnosis
You can easily get started determining whether or
not you have Mind-Body Syndrome, as well as seeing
what issues in your life may have contributed and/or be
contributing to this disorder by completing the worksheets
below. These worksheets will help you understand
yourself better, and this understanding is the key to ridding
yourself of your symptoms. The process you will follow
using the worksheets is based upon the detailed interview I
use with my patients.

STEP 1: IDENTIFY YOUR MBS

SYMPTOMS
The following list of symptoms and diagnoses are

85
likely to be caused by Mind Body Syndrome The more of
these symptoms/diagnoses you have had during your
lifetime, the more likely it is that you have MBS. People
with several of these conditions have usually seen many
doctors and been given multiple diagnoses, but their
doctors have not considered MBS. This is because our
Western biotechnological medical practice tends to look at
each body system in isolation. You may have seen a
neurologist, orthopedic surgeon or neurosurgeon,
gastroenterologist, rheumatologist, or others, but in most
cases no one doctor is considering you as a whole person.
MBS occurs in people not in body parts and we can
only understand it by evaluating the whole person: the
body and the mind. This is particularly critical if you have
been experiencing anxiety and/or depression. You can
begin to see how these mental symptoms are often part
of a body of symptoms that are all connected.
It is common for MBS symptoms to start in
childhood or adolescence. Many people develop
headaches, stomachaches, dizziness, fatigue, anxiety, or
other symptoms while they are young and then later in life
develop back or neck pain, fibromyalgia, irritable bowel
syndrome, or other conditions.

CHECK EACH ITEM ON THIS LIST that you have
ever experienced, and write down at what age you were
when each set of symptoms first appeared in your life.

Symptom:
Date of onset:

86
1. Heartburn, acid reflux ___________________
2. Abdominal pains ________________________
3. Irritable bowel syndrome _________________
4. Tension headaches ______________________
5. Migraine headaches _____________________
6. Unexplained rashes _____________________
7. Anxiety and/or panic attacks _______________
8. Depression _____________________________
9. Obsessive-compulsive thought patterns
______________________________________
10. Specific phobias _______________________
11. Eating disorders _______________________
11. Insomnia or trouble sleeping _____________
12. Fibromyalgia _________________________
13. Back pain ____________________________
14. Neck pain ____________________________
15. Shoulder pain _________________________
16. Repetitive stress injury _________________
17. Carpal tunnel syndrome ________________
18. Reflex sympathetic dystrophy (RSD)
______________________________________
19. Temporomandibular joint disorder (TMJ)
_____________________________________
20. Chronic tendonitis _____________________
21. Facial pain ____________________________
22. Numbness, tingling sensations ___________

87
23. Fatigue or chronic fatigue syndrome
____________________________________
24. Palpitations ___________________________
25. Chest pain ____________________________
26. Hyperventilation _______________________
27. Interstitial cystitis/spastic bladder/ Irritable bladder
syndrome _____________________
28. Pelvic pain ____________________________
29. Muscle tenderness _____________________
30. Postural orthostatic tachycardia syndrome (POTS)
______________________________
31. Tinnitus ______________________________
32. Dizziness _____________________________
33. PTSD ________________________________

STEP 2: INVESTIGATE YOUR

CHILDHOOD FOR LIFE
STRESSES
Now consider the following questions and write
brief answers to as many of them as seem important to
you.

What words would you use to describe your father?

(Substitute another caregiver if you didnt grow up with
your father.)
________________________________________________________
________________________________________________________

88
________________________________________________________
What kind of work did your father do? Was he successful
in his career?
________________________________________________________
Was your father loving? Did he hug you or tell you he
loved you? Was he supportive?
________________________________________________________
Were you particularly close to your father? Did he confide
in you?
________________________________________________________
Was his love conditional?
________________________________________________________
Did your father have high expectations of you?
________________________________________________________
Was he critical or judgmental?
________________________________________________________
Was he a perfectionist?
________________________________________________________
Did he yell at you?
________________________________________________________
Did he hit or punish you?
________________________________________________________
Were you afraid of him?
________________________________________________________
Was your father aloof, neglectful, or self-centered?
________________________________________________________

89
Were some children given preferential treatment or treated
more harshly than others? If so, how did that make you
feel? How did that affect the relationship between you and
any of your siblings?
________________________________________________________
________________________________________________________
Did your father drink or use drugs? If so, how did that
affect him, the family, and you?
________________________________________________________
Did your father have any mental health issues?
________________________________________________________
Was he anxious, worried, or insecure?
________________________________________________________
How did your father treat your mother?
________________________________________________________
Did you identify with your father?
________________________________________________________
Did you attempt to be like him or to be different from him?
________________________________________________________

What words would you use to describe your mother?

(Substitute another caregiver if you didnt grow up with
your mother.)
________________________________________________________
________________________________________________________
________________________________________________________
What kind of work did your mother do?

90
________________________________________________________
Was she successful in her career?
________________________________________________________
Was your mother loving? Did she hug you or tell you she
loved you? Was she supportive?
________________________________________________________
________________________________________________________
Were you particularly close to your mother? Did she
confide in you?
________________________________________________________
Was her love conditional?
________________________________________________________
Did your mother have high expectations of you?
________________________________________________________
Was she critical or judgmental?
________________________________________________________
Was she a perfectionist?
________________________________________________________
Did she yell at you?
________________________________________________________
Did she hit or punish you?
________________________________________________________
Were you afraid of her?
________________________________________________________
Was your mother aloof, neglectful, or self-centered?
________________________________________________________

91
Were some children given preferential treatment or treated
more harshly than others? If so, how did that make you
feel? How did that affect the relationship between you and
any of your siblings?
________________________________________________________
Did your mother drink or use drugs? If so, how did that
affect her, the family, and you?
________________________________________________________
Did your mother have any mental health issues?
________________________________________________________
Was she anxious, worried, or insecure?
________________________________________________________
Did you identify with your mother?
________________________________________________________
Did you attempt to be like her or to be different from her?
________________________________________________________
How did your mother treat your father?
________________________________________________________
Who was in charge of the house?
________________________________________________________
Who handled disciplinary issues?
________________________________________________________
Did your parents argue?
________________________________________________________

Did anyone other than your mother and father have

responsibility for you or care for you as a child? If so,

92
who?
________________________________________________________
Repeat the same questions above for these individuals if
they had significant roles in your upbringing. Use a
separate piece of paper for these questions.
________________________________________________________

Now, considering the relationships you had with your

siblings while you were growing up:
Were there resentments or jealousies?
________________________________________________________
________________________________________________________
________________________________________________________
Was there any cruelty, meanness, or abuse?
________________________________________________________
Did any of your siblings have any illnesses, psychological
problems, or drug abuse problems?
________________________________________________________
Did any of your siblings rebel, act out, or behave in ways
that were upsetting to your parents or to you?
________________________________________________________
How did you react to these situations?
________________________________________________________
________________________________________________________

Considering your familys relationship with money:

________________________________________________________
How was money handled in your family?

93
________________________________________________________
Did you feel that money was a scarce resource?
________________________________________________________
Did your parents use money as a controlling agent?
________________________________________________________
Were they generous with money or not?
________________________________________________________
Did you work as a child or teenager?
________________________________________________________

Finally, consider if there were any particularly stressful

or traumatic events in your childhood.
Describe any of the following: deaths, moves, bullying,
taunting, teasing, emotional or physical abuse, changes in
school situations, conflicts with teachers, or changes in
family situations?
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________

94
________________________________________________________
________________________________________________________
Have you ever been subjected to any episodes of unwanted
sexual activity or sexual abuse?
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________

Childhood experiences create very powerful

reactions in our minds that remain for the rest of our lives.
Emotions that are generated when we are young can very
easily get triggered later in life, and, when they are
triggered, can cause the start of any form of Mind Body
Syndrome, such as anxiety, depression, pain, insomnia, or
fatigue. It is usually relatively easy to identify the
childhood issues that people with MBS have grown up
with. It is well known that a large percentage of the people
with irritable bowel syndrome, fibromyalgia, TMJ
syndrome, and other MBS symptoms have been neglected
or abused sexually, emotionally, or physically as
children or adolescents. People who have suffered from
severe childhood abuse are most likely to have
experienced many forms of MBS, particularly anxiety and
depression. Studies by Anda and colleagues have shown
that childhood trauma is linked to a wide variety of
illnesses in adults (Anda, et. al., 2006).
Sometimes these situations are severe:
FRANCES WAS A 34 YEAR-OLD WOMAN WHOSE
MOTHER had been addicted to cocaine. Her father had

95
an addiction to multiple drugs and he had been both
physically and sexually abusive to her. As an adolescent,
she became addicted to cocaine and lived on the streets.
She eventually went to jail, and after a great deal of hard
work, broke her addiction to drugs, and was able to both
raise a daughter and find a job. The lasting effects of all
those years of traumatic experiences led to the
development of fibromyalgia, migraine headaches,
irritable bowel syndrome, TMJ disorder, chronic fatigue,
back pain, insomnia, anxiety, depression, and several
other MBS disorders.

Not everyone with MBS has had severe childhood
trauma. For many people, the childhood issues that
generate strong emotions are normal childhood
experiences. How many of us have felt jealous of a sibling
or ostracized by friends in middle school or picked on by a
bully in elementary school? These common childhood
experiences, especially for someone who is sensitive and
embodies the personality traits described in Chapter 3, can
alone generate enough emotions to cause an MBS
symptom to appear, either at the time of the events or,
more commonly, later in life.

I TREATED ANNE, a woman who grew up with loving
parents and a stable home environment. She had a difficult
relationship with her younger sister. Her sister was
constantly in trouble and she frequently lied to avoid
responsibilities. Even though she resented her sister for

96
her irresponsible behaviors, Anne frequently covered up
for her and often did both of their chores to avoid conflict.
When Anne was thirty-three years old, she was leading a
team at work on an important project. One woman on the
team avoided her share of the work and lied to cover up
her lack of effort. Anne was trapped in a situation eerily
similar to that of dealing with her younger sister and had
to double her own effort to get the project completed.
During that time, she developed anxiety and back pain as
the situation at work triggered the stored emotional
reactions from her youth.
Several years later, Anne developed headaches
every time she drove all the way across town to visit her
father who was in a nursing home. Her sister had chosen
that particular nursing home since it was more convenient
for her, disregarding how far it was for Anne. Yet Anne
was the daughter who visited every day, while her sister
visited once a week or less. After learning my patients life
story, it became clear that her resentment of her sister was
the underlying trigger for the anxiety, back pain and
headaches.

STEP 3: DETERMINE YOUR

CORE ISSUES
Once you have carefully and honestly reviewed the
stresses in your life, you will likely begin to see patterns.
You will be able to identify your core issues, those
issues that have been stored in your subconscious mind
and are most likely to trigger the onset of physical and
psychological symptoms.

97

Indicate which of the following patterns apply to
you, or describe any other patterns that apply to you.

1. Loss and abandonment (losing a parent or sibling,
divorce, moving) ________
2. Childhood abuse (physical, sexual, and/or emotional)
or neglect (never feeling loved or cared for)
________
3. Not fitting in or feeling ostracized (being shy and
reserved, not being athletic or popular, being teased
or picked on) ________
4. Feeling pressure to succeed or be perfect (from parents,
other family members, church or religious
organizations, or self) ________
5. Feeling inferior to siblings or other relatives (not as
attractive, funny, athletic, interesting, accomplished)
________
6. Never feeling good enough (having to earn love from
parents, feeling criticized much of the time)
________
7. Resentment and/or anger towards family members,
neighbors and/or religious leaders, ________
8. Identifying with one or several family members and
trying to emulate them (trying to be different from
one or several family members) ________
9. Learning to be anxious, worried, or insecure ________
10. Other patterns

98
 ____________________________________________________
_______________________________________________________
_______________________________________________________

STEP 4: INVENTORY YOUR

PERSONALITY TRAITS
These personality traits are commonly seen in people with
anxiety, depression, and other symptoms of MBS.
Check those that apply to you.

Would you describe yourself as:

1. Having low self-esteem ________
2. Being a perfectionist ________
3. Having high expectations of yourself ________
4. Wanting to be good and/or be liked ________
5. Frequently feeling guilt ________
6. Feeling dependent on others ________
7. Being conscientious ________
8. Being hard on yourself ________
9. Being overly responsible ________
10. Taking on responsibility for others ________
11. Often worrying ________
12. Having difficulty making decisions ________
13. Following rules strictly ________
14. Having difficulty letting go ________

99
 15. Feeling cautious, shy, or reserved ________
16. Tending to hold thoughts and feelings in (as opposed
to expressing them) ________
17. Tending to harbor rage or resentment________
18. Not standing up for yourself________

Conflict in ones mind is a very important part of the
mechanism that creates and perpetuates MBS. The traits
above are aspects of the conscience they are things that
we feel obligated to do or ways we feel obligated to be.
Having a strong conscience (sometimes called an internal
parent) is almost universally found in people with
anxiety, depression, and other forms of MBS. People like
this are less likely to be narcissistic and self-centered.
Selfish people tend to blame others and externalize their
emotions by getting angry with others in public displays of
violence or aggression.
Most people with MBS are people who try hard,
who care what others think of them, who want to be good
and want to be liked. They tend to be conscientious,
responsible, and hard on themselves. These personality
traits are generally found in people who are kind and
sensitive, the very kind of people most people would like
to know and be friends with. The problem is that people
like this put extra pressure on themselves. They tend to get
down on themselves and beat themselves up for their
failings. In addition, they tend to not stand up for
themselves and to also suppress their anger. When external
events and stressors occur, the conflict between what one
needs to do to protect oneself and what a person believes

100
he/she needs to do for others can create a great deal of
internal conflict. It is this internal conflict that eventually
results in the development of MBS.

STEP 5: FINDING
CONNECTIONS BETWEEN
CORE ISSUES, LIFE STRESSES,
AND THE ONSET OF MBS
SYMPTOMS
Once you have identified your core issues, review
the list of potential MBS symptoms listed under Step 1. On
the next page, list the times in your life when you
developed any of the MBS manifestations in chronological
order. Think carefully about what events occurred just
prior to or during the onset of symptoms. You will
typically find that the symptoms began at the time or
shortly after you experienced something which was
stressful and that reminded you of your core issues
triggering your emotional speed dial and causing you to
feel trapped in that situation. List each MBS symptom.
Then write down the possible events or situations that may
have triggered the symptom, and finally take a look at
what emotions and/or core issues caused the symptoms to
occur.
Once youve lined up the symptoms that have
occurred and the diagnoses youve received next to your
life stressors, see what patterns emerge and what
connections you can make. This is a critical step in

101
figuring out why you have MBS. Do this for each of your
MBS symptoms. For each symptom, think carefully about
what was going on in your life at the time this symptom
began. What events had occurred that bothered you? What
emotions did you feel? How were these events or emotions
similar to those you experienced in childhood? What core
issues might have been triggered? Did you feel trapped in
some way, either physically or verbally?
Be as open and honest as you can in this process.
Often, it is very obvious that stressful life events in
childhood have created the emotional memories of hurt,
loss, fear, guilt, or anger, and it is equally obvious that
certain stressors later in life have triggered MBS
symptoms. However, sometimes it takes a fair amount of
introspection and searching to find the connections.
It is common for a mild stressor in adult life to
trigger significant symptoms if the stressor is related to an
earlier stressor, particularly one from childhood. Neglect
or lack of love by a parent can create a childhood hurt that
may get triggered later in life by a seemingly mild
interaction. Such a pattern occurs because emotional
memory is permanent and early childhood hurts create a
reservoir of emotional pain. During the course of our lives,
this emotional pain may build over time when new
emotional hurts occur, especially those that are similar in
nature to the earlier ones. Later in life, our bodies can
easily react to a seemingly small emotional stressor, such
as not getting a particular position, conflict with a
colleague or boss, having a child, or getting married, since
that current stressor is linked in our subconscious mind to
all of our earlier emotional issues. This process explains

102
why a large emotional hurt in childhood may not produce
any symptoms while a small stressor later in life can
produce severe anxiety, depression or pain.
While completing the table below, consider which of
the following emotions were triggered: anger or
resentment, fear, guilt, shame, sadness or loss.

Making the Connections

103
 Making Your Decision
For many people, doing these exercises makes it
clear that Mind Body Syndrome is the cause of symptoms
of their anxiety, depression, or other symptoms. If you can
see the connections between your life experiences and
your symptoms, your chances of curing your anxiety,
depression, and/or pain are very good. You are now ready

104
to begin the powerful program contained in the rest of this
book.

RACHEL HAD EXPERIENCED SEVERE CHILDHOOD
TRAUMAS and consequently had developed a very long
list of disorders, including irritable bowel syndrome,
anxiety, depression, neck pain, TMJ disorder, and
fibromyalgia. She had been treated unsuccessfully for
many years and was convinced that achieving emotional
and physical health was a hopeless quest. After reviewing
the clear connections between her life events and the onset
of her MBS symptoms, she suddenly looked up at me and
said, I have Mind Body Syndrome. The certainty and
confidence in her voice were striking as she realized at
that moment that she could take control of her life and
shed these disorders that moments before had seemed
incurable to her.
If youre not sure if you have MBS, or that your life
experiences are actually the cause of your symptoms of
anxiety or depression, consider these steps:
Make sure you have seen a doctor who has
provided you with enough medical testing to rule
out a purely physical cause for your symptoms.
Discuss these issues with a counselor, relative, or
good friend to help uncover the connections
between the stressors in your life and your
symptoms.
Do further reading on the subject of Mind Body
Syndrome. I recommend reading one of Dr. John
Sarnos landmark books, such as The Mindbody

105
 Prescription or The Divided Mind. Dr. Sarno is a
pioneer in this field, and his books have excellent
descriptions of MBS (his term for this condition is
Tension Myositis Syndrome). A number of other
useful books are listed in the Appendix of this
book, such as David Clarkes They Cant Find
Anything Wrong, Nancy Selfridges Freedom
From Fibromyalgia, David Hanscoms Back In
Control, and Steve Ozanichs The Great Pain
Deception.
See a doctor or mental health provider who
specializes in MBS. There is a list of such
professionals in the Appendix. The PPD/TMS Peer
Network (tmswiki.org) is an excellent patient-run
website with up-to-date information on MBS. It
also includes a list of MBS practitioners. If you
would like to make an appointment with me,
please contact me on my website:
www.unlearnyourpain.com.
Once you have the correct diagnosis, and you can
say to yourself, I have Mind Body Syndrome, you are
ready to use the MBS workbook to heal yourself. If you
participate in this program, it is very likely that you will
reduce or eliminate your symptoms of anxiety and/or
depression, as well as any other MBS symptoms you may
have. You will also increase your understanding of
yourself, and learn how to gain control and mastery over
your mind and body. In fact, the program has been so
helpful to many participants that they recommend it to
others they know, including those who do not have

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symptoms of MBS.

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 chapter 5
What Can You Do
About Your Anxiety
and Depression?
Although the world is full of suffering, it
is also full of the overcoming of it.
Helen Keller

Courage doesnt always roar. Sometimes

courage is the quiet voice at the end of
the day saying, I will try again tomorrow.
Mary Anne Radmacher Hershey

He has not learned the lesson of life who

does not every day surmount a fear.
Gaius Julius Caesar

How can someone unlearn anxiety or
depression? You may ask: Can I possibly change these
feelings that seem so powerful and over which I have been
unable to exert control? What if I have had anxiety or

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depression for many years? Doesnt that mean that my
nerve pathways are so completely engrained that they will
be virtually impossible to change? What if I have tried
medications, talk therapy, herbal supplements, acupuncture
and other treatments?
Everyone asks these questions, and my answer may
sound too good to be true. The simple answer is this: You
can unlearn anxiety and depression just as you can unlearn
chronic pain. The processes that have been so successful
when applied to pain (as we have described in Unlearn
Your Pain) are equally successful in meeting the challenge
of unlearning anxiety or depression. The four steps that are
outlined below are fairly simple and clear. However, these
steps are not always easy. You will need to devote a
certain amount of commitment, energy, and work toward
your goal, but you can succeed. You do not need to use
medications for this program to work, and if you are
currently taking medications, you do not need to stop
them. However, it is certainly possible, and even likely,
that you will be able to wean yourself off of your
medications for anxiety or depression, which I recommend
you do in consultation with your physician.

STEP 1: UNDERSTAND THAT

MBS IS THE CAUSE OF YOUR
SYMPTOMS
The very first step in the process is understanding
that MBS is the cause of your symptoms. It is critical that
you realize that MBS can cause all of the anxiety and

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depressive symptoms that you have suffered from.
Understanding this will allow you to recover fully.
However, it is also important that you recognize any other
symptoms that may be also caused by MBS. These may
include chronic neck or back pain, tension or migraine
headaches, fibromyalgia, irritable bowel or bladder
syndrome, chronic fatigue, insomnia and other symptoms.
For more information about these, see my book Unlearn
Your Pain.
In order to conquer anxiety or depression, you must
understand that these symptoms have been learned by your
brain and body in response to the stressful events that have
occurred in your life. If you harbor a belief that your
symptoms are caused by genes over which you have no
control or are diseases of the brain, or that your symptoms
are too entrenched to change, you will not have the belief
that you can recover.
Recovering from MBS is a matter of mind over
brain. It is critical for you to believe that you can get
better. This belief acts as a powerful trigger in the brain
that activates the dorsolateral prefrontal cortex (DLPFC)
and causes positive changes in the brain, changes that
reverse anxiety and depression. In addition, it is necessary
to develop the confidence that you can take the necessary
steps to heal. Therefore, you need to understand that you
have MBS and not a disease. You need to believe that you
can recover, and you need to build the confidence to know
that you can do this for yourself.
It may be difficult to even imagine that you can get
better, especially if you have tried many different
treatments and have not been successful. If you can at least

110
entertain the possibility that you can recover, it will help
you as you begin this program. It is very likely that you
will start to see changes in your symptoms as you delve
into this work. As this happens, you can allow yourself to
have hope; and this hope will give you courage to continue
on your path to recovery.

STEP2: REVERSE YOUR

BRAINS REACTIONS TO
STRESSFUL LIFE EVENTS
The second step in the process is to reverse the
brains reactions to stressful life events. By now it should
be obvious that there are powerful links between emotions
and MBS symptoms. The same areas of the brain are
activated by both physical injuries and emotional injuries.
Emotional memories and emotional hurts that occurred in
the past do not simply disappear over time. When one
looks very carefully at the life stories of people with MBS,
the patterns that cause MBS are clear. Lessons learned
early in life create pathways that are stored in the
amygdala and other areas of the brain. If there are severe
early life stressors, MBS symptoms may begin
immediately and may persist for many years.
Early life stressors may not cause the immediate
development of MBS symptoms, but they do create the
neural pathways, which set up the architecture for the
danger and fear responses. Once these neural pathways
have been created, stressful events that occur later in life
may trigger these stored emotional hurts causing MBS

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symptoms to develop. This is particularly common when
the situation later in life is quite similar in an emotional
sense to the earlier life situations, but may also occur with
any kind of traumatic event, an event that is either
emotionally traumatic or physically traumatic. The
emotions that are most commonly held in such emotional
memories are fear, anger, guilt or shame, and sadness or
grief.
Typically, individuals are most aware of fear, as this
represents the usual response to being hurt, especially by
those who are closest to us. Holding onto fear eventually
leads to the anxiety disorders of Obsessive-Compulsive
Disorder (OCD), Post-Traumatic Stress Disorder (PTSD),
social anxiety disorder (social phobia), and panic
disorders. When we become overwhelmed with fear,
depression and fatigue are common reactions.
The second common response to emotional injury is
anger and resentment. Anger is a much healthier response
to being hurt than is fear. When one feels trapped and
powerless, fear is manifest and anger is usually
suppressed. However if one is or can become
powerful, it is possible to express anger and to overcome
someone who is causing us harm. Most children who are
hurt emotionally are powerless and, unable to express their
anger, they learn to hold anger in. As a result of this simple
and understandable dynamic, a more complex life-long
pattern of feeling afraid and being unable to express anger
or assert oneself may develop. This dynamic is the basic
building block for MBS. Learning to overcome that pattern
of holding anger in and learning to be more assertive are
critical components in unlearning anxiety or depression.

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 The other set of emotions that often promotes the
development of MBS are guilt and shame. There are two
forms of guilt: deserved guilt and undeserved guilt.
Deserved guilt is the result of recognizing that one has
made actual mistakes.
Many people with MBS tend to feel guilty for many
things they have done. They have a difficult time letting go
of that guilt or forgiving themselves for mistakes, even
though they would easily forgive others for similar actions.
Undeserved guilt may also be present in someone
experiencing MBS symptoms. For example, many women
carry undeserved guilt for having been sexually assaulted,
as if this event was their fault, and many children assume
undeserved guilt for their parents divorce. It is easy to see
that this form of guilt is harmful and needs to be
abandoned.
There is another form of undeserved guilt that is
important to recognize and overcome: the guilt one feels
for the resentment and anger he/she holds toward others,
even though this resentment and anger is completely
justified. Generally this form of guilt is most commonly
felt in relation to those closest to us, such as our parents,
siblings, spouses, and children. As you shall see, accessing
this particular type of guilt is often critical in order to
process and resolve anger, move through it toward love
and acceptance of yourself and, in many cases, toward love
and acceptance of the other people involved.
Finally, shame is a powerful blocker of healing. At
its core, shame is the belief that one isnt a good person,
isnt worthy of being loved, or doesnt deserve to be
happy. People who were not fully loved or accepted in

113
their childhood or who were frequently told that they
werent good enough, or smart enough, or good-looking
enough tend to develop shame. Guilt and shame are both
forms of anger being turned inward upon oneself. They are
destructive emotions, and consciously dealing with them
will allow you to reverse MBS.
Stressful situations, either in childhood or later in
life, often involve loss, such as the loss of the physical
presence or affection from an important person in our
lives. It is only natural that these losses will cause sadness
and grief. As with the other major emotions, sadness and
grief need to be experienced, expressed, and released,
instead of being suppressed, in order to fully heal from
Mind Body Syndrome and banish your anxiety or
depression.
The emotion that everyone longs to experience is
love. When we are able to truly experience love, caring,
and kindness toward ourselves and toward others, healing
on a deep level occurs, and MBS symptoms melt away. It
is not difficult to see that holding onto anger and
resentment toward others blocks the ability to love them
fully. It is also obvious that turning anger toward ourselves
by holding onto guilt, being unable to forgive ourselves,
and/or living with shame will block your ability to love
yourself. Many people with MBS are unable to say that
they are a good person or that they love themselves.
The exercises in this book are designed to help you
release your suppressed anger, let go of your guilt and
shame, allow yourself to experience your grief, and then
allow you to move toward loving relationships with
yourself and the important people in your life. When you

114
are able to do this, anxieties and fears from your past do
not weigh upon you, and the normal stresses of everyday
life become more easily manageable. This path is
surprisingly simple to travel, although it takes courage to
recognize the deep emotions that you have long held in
and then allow yourself to feel them and express them.
However, it is well worth the effort as it is a path that is
truly healing, both in mind and body. You will find a
complete description of this type of emotional work in the
full version of Unlearn Your Pain or in the full version of
this book.

STEP 3: TAKE CONTROL OF

ANXIETY AND DEPRESSION
The third step in the process of unlearning anxiety
and depression is to take control of your anxiety and/or
depression, and there are two components to this step.

Change Your Response to Your Symptoms
The first part of taking control of your anxiety and
depression is to change your behaviors in relation to your
symptoms. There are several aspects to the behavioral
work component of the MBS program. Once you truly
know that you can stop these symptoms, and youve done
the emotional work in order to release yourself from their
underlying cause, you can proceed to simply taking control
over them.
Since anxiety and depression are caused by
subconscious processes in the brain, it is necessary to
override them by using your conscious brain. First, you

115
need to stop being afraid of the symptoms. If you are
fearful of being anxious or depressed, you will lose the
battle to overcome these feelings. The more you are afraid
of these symptoms (or of chronic pain symptoms due to
MBS), the more power those symptoms have over you.
And the more fear you harbor, the worse the anxiety or
depression will be. In fact, panic attacks are caused by
having so much fear of being anxious that a powerful
vicious cycle is created a cycle of fear begetting more
fear, anxiety creating more anxiety. Therefore,
remembering that these feelings cant actually harm you,
you must constantly remind yourself not to fear anxiety
and depression and continually vow to yourself that you
are going to stop them in their tracks. When you see these
symptoms for what they really aresimply learned neural
pathwaysyou can stop fearing them and just relax in the
knowledge that you are not only okay, you are actually
healthy and strong; you are going to be fine.
When you are able to shift your beliefs and accept
this point of view in place of your fear, you can then exert
power over the symptoms. You can use your conscious
brain to stop anxiety or depression. Consider the parallel
situation at work here. In the emotional work described
above, you learn to take power over those who have hurt
you. This is accomplished by unleashing and processing
the powerful force of anger as an antidote to fear,
powerlessness, and victimization. You also learn to move
through the hurts to express guilt, grief, and love before
learning to let go of them.
Taking control over symptoms of anxiety and/or
depression requires you to stand up to the symptoms and

116
forcefully tell them to go away. Although this may seem
silly, when combined with the emotional work, it is
amazingly effective. If you are confident that you can
make the symptoms go away, then you can be assured that
you actually will make them go away. The power of our
brains to overcome anxiety and depression is vast and
deep. Taking advantage of this power can free you from
the prison of your MBS symptoms and let you get on with
living and enjoying your life. Quite simply, the more often
you take the time to be assertive in overriding symptoms
(and this includes not only anxiety and depression, but
pain and other MBS symptoms), like anything else
requiring practice, the better you will get at it. You can
simply and firmly say to your symptoms, No more. Im
not putting up with this anymore. Youre through. Or you
can yell and scream at them. Or you can simply train
yourself to relax and stop worrying about the anxiety or
depression knowing that it will be getting better soon.
When you take these steps, you are preventing the
symptoms from controlling you and you can move on.

Challenge the Specific Triggers of Your
Symptoms
In addition, you will want to challenge any specific
triggers of your symptoms. In this context, a trigger
refers to an event that precipitates your symptoms on a
regular basis. For example, anxiety can be triggered by
certain places, situations, sounds, smells or memories.
Many people become anxious when in closed spaces, in
tall buildings, going over bridges, and the like. These are
learned or conditioned responses created by the association

117
of anxiety with these situations. A common trigger for
depression is the decreased amount of daylight in the
winter, known as Seasonal Affective Disorder (SAD).
However, it seems likely that the association of depression
with winter is also a learned response in many people and
can be unlearned. A common reaction to a trigger is to
simply avoid it, thus sparing yourself from having to deal
with your response. However, this strategy only serves to
give these triggers more power over you and makes you
feel more helpless. In order to overcome anxiety or
depression, you must challenge such triggers. It is critical
to learn to encounter your triggers without reacting to them
with responses of anxiety, depression, or pain. The best
way to do this is to purposefully go into any triggering
events with a new and confident attitude.

DURING A VERY TRYING TIME IN HIS MARRIAGE,

Don developed severe anxiety when he was driving over
bridges. Although the marital difficulties were resolved, he
continued being anxious about crossing bridges. In the
MBS Program, Don learned to overcome this anxiety by
affirming his control over the symptom while driving over
bridges.

As you encounter such triggers, you need to
consciously work to change your feeling about them and
modify your reactions to them. Instead of being worried or
fearful about what might happen to you, as you begin
exercising or start crossing a bridge, or bite into a certain
food, or encounter a certain weather pattern or quality of
light, you will be more confident that this trigger wont

118
hurt you or harm you. You can talk to yourself and to your
mind and body, saying something like this: I am healthy
and strong. There is nothing wrong with me. I can do this
and I will do this without it causing anxiety, depression, or
pain.

STEP 4: MAKE CHANGES IN

YOUR LIFE
The fourth step in the process is to make any
changes in your life that are necessary, important, or
healthy. It is quite obvious that life events and situations,
particularly stressful ones, can affect us in powerful ways.
Although you will be able to make great strides in
alleviating anxiety and/or depression (and/or pain) by
following the steps detailed above, there are certain
situations in the real world that can undermine your
recovery if they are not addressed.

ONE OF MY PATIENTS, KATHRYN, IS A YOUNG
WOMAN who suffered from disabling pelvic pain after
being raped. She was so disabled that she was unable to
continue working or going to school. Using the steps
outlined above, she was able to completely eliminate her
pain over the course of several weeks. However, she began
to have significant anxiety and panic attacks. She knew
that these symptoms were part of the process of MBS that
her mind and body were experiencing, so she was
confident that she could heal herself by taking steps to deal
with emotional issues in her life and take control over the
anxiety. In fact, she soon learned to stop the anxiety

119
symptoms in their tracks when they did arise.
However, the symptoms kept arising, prompting us
to explore other areas of her life to search for underlying
issues that might be driving the anxiety symptoms. It soon
became clear that her parents were a major source of
anxiety in her life. They were over-protective, controlling,
and unsupportive of her attempts to return to school and
work. Although she now felt perfectly capable of resuming
her life and moving forward, they constantly undermined
her confidence and suggested that she would fail.
Closer examination revealed that her parents
needed her to remain living at home and being
dependent on them. Her parents had significant marital
problems. When Katherine was home, her presence was
helping her parents with their emotional needs. However,
this is not what their daughter needed to move on with her
life, and she felt both angry with them and guilty for
wanting to abandon them. Dealing with this problem in
her life was a necessary step in her recovery.

Anger is a normal and healthy emotion to be able to
express. However, it is not generally healthy to publicly
express anger. Acts of violence are never healthy or
productive. They typically cause many more problems
than they solve. That is why this program encourages
powerful expressions of anger in a safe and private setting,
for instance, when one is alone or working with a close
friend or therapist. Such work reduces anger by releasing it
and allows you to be free of anger that has been carried
into your current life from the hurtful events in your past.
As a result of this safe release, your actions out in the real

120
world can be undertaken with much less anger toward
everyday events and toward the people who may have hurt
you in the past.

A WOMAN, ELAINE, WHO WAS DATE-RAPED in her
college days completed this type of emotional expression
work and has released her anger toward the rapist. By
doing this, she has been able to move on with her life and
realize that this person has absolutely no power over her
anymore. Many years after she completed the emotional
work, she saw the rapist at a college reunion. When he
approached her, rather than allowing his presence to
trigger fear or anger, she looked at him, and asked Do I
know you? and simply walked away. She felt incredibly
powerful and free from any residual reactions to the hurt
from many years ago.

Often it is important to both speak to people in our
lives and take action about troubling situations. For
example, one woman needed to tell her sister that she
would not put up with the sisters frequent renditions of
Mom always liked you best, and another woman found
that she needed to place certain boundaries on how often
and where she saw her parents who continued to denigrate
her publicly.
As a result of your experience with MBS, you may
find there are several other areas in your life in which you
need to make changes. Anxiety and depression or other
MBS symptoms may have derailed your life to the extent
that you have been unable to work, leave the house, go out
with friends, see family members or participate in sports.

121
You may have become socially isolated, lost romantic
relationships, or been unable to be intimate with lovers. In
order to heal, you will need to face many of these
situations and overcome them. Remember, these types of
auxiliary symptoms were only an attempt by your brain to
protect you from what it perceived as dangers in the
world. But the unintended result has been isolation and
disability. It takes a great deal of courage to return to work
when that environment has been difficult, to start
exercising again, or to begin a new romantic relationship.
Yet, if these hurdles are not faced, there is a tendency to
fall back into anxiety, depression, and/or chronic pain.
Some people fall into patterns of using alcohol,
marijuana, or narcotic painkillers to help them cope with
anxiety or depression and the underlying emotional pain of
the stressful life events prompting their MBS symptoms.
Getting out of these unhealthy and unhelpful patterns, or at
least reducing their use to a minimum, is essential as part
of healing. For those with chemical dependencies,
addressing this issue is often one of the first steps in the
recovery process. There are many resources, such as
Alcoholics Anonymous and Narcotics Anonymous, to help
in this process.
A question that is often asked of me by a new patient
has to do with getting off of anxiety, depression, or pain
medications. The people who do the best in this program
are those who do ultimately wean themselves off of these
medications. However, one should only do this under the
care of a physician who can monitor the process. Some
people exhibit additional symptoms withdrawing from
these medications, but it is definitely worth the effort of

122
getting off such drugs to take responsibility for your own
health and be in charge of your life. In order to reduce and
ultimately discontinue these medications, it is necessary to
have completed the above steps of the educational,
behavioral, and emotional work in the process of
unlearning your anxiety or depression, and it is necessary
to be completely confident that you have beaten MBS and
dont need the medications anymore. On the other hand,
some people find that these medications are helpful and
necessary to use in conjunction with the MBS program.
I have found that people who have difficulties in
reversing the symptoms of anxiety or depression usually
have a problem in one of the four major areas of the
program, i.e., understanding how and believing that neural
pathways are the cause of their symptoms, doing the
emotional work required to free them of deep-seated
emotional hurts, making the behavioral changes necessary
to overcome the symptoms through willpower and
conscious effort, or making the changes in their lives that
are required. If you are able to make progress in all of
these areas, you have a very high likelihood of beating
anxiety and depression, as well as chronic pain, fatigue,
insomnia, or any other symptoms that may be caused by
Mind Body Syndrome.

123
 ap p en d ix :
ad d itio n al
res o u rces
Books for Understanding and
Healing MBS
MEDICAL BOOKS:

The Adaptive Unconscious Timothy Wilson, PhD

Back in Control David Hanscom, MD

Back Sense Ronald Siegel, PsyD, Michael Urdang,

Douglas Johnson, MD

The Biology of Belief Bruce Lipton, PhD

Brain Lock Jeffrey Schwartz, MD

The Brain that Changes Itself Norman Doidge, MD

Co-Creating Change: Effective Dynamic Therapy

124
Techniques Jon Frederickson, MSW

The Divided Mind John Sarno, MD

The Emotional Brain Joseph LeDoux, PhD

Emotions Revealed Paul Ekman, PhD

Freedom From Fibromyalgia Nancy Selfridge, MD

From Paralysis to Fatigue: A History of Psychosomatic

Medicine Edward Shorter, PhD

The Illusion of Conscious Will Daniel Wegner, PhD

Lives Transformed: A Revolutionary Method of Dynamic

Psychotherapy David Malan, MD and Patricia Coughlin
Della Selva, PhD

The Mindbody Prescription John Sarno, MD

The Mindful Brain Daniel Siegel, MD

Overtreated Shannon Brownlee

Snake Oil Science R. Barker Bausell, PhD

Stabbed in the Back Nortin Hadler, MD

Stumbling onto Happiness Daniel Gilbert, PhD

125
They Cant Find Anything Wrong David Clarke, MD

Train Your Mind, Change Your Brain Sharon Begley

Unlocking the Unconscious Habib Davanloo, MD

SELF HELP BOOKS:

The Beggar King and the Secret of Happiness Joel ben

Izzy

Chronic Pain: Your Key to Recovery Georgina Oldfield

Facing the Fire John Lee

Forgive for Good: A Proven Prescription for Health and

Happiness Fred Luskin, PhD

Full Catastrophe Living Jon Kabat-Zinn, PhD

The Gifts of Imperfection: Let Go of Who You Think

Youre Supposed to Be and Embrace Who You Are Bren
Brown, PhD

The Great Pain Deception Steve Ozanich

The Journey: A Practical Guide to Healing Your Life and

Setting Yourself Free Brandon Bays

The Love Response Eva Selhub, MD

126
Loving What Is Byron Katie

The Mindfulness Path to Self-Compassion Christopher

Germer, PhD

The Mindfulness Solution Ronald Siegel, PsyD

The Places that Scare You Pema Chodron

The Power of Now Eckhart Tolle

The Presence Process Michael Brown

Sanity, Insanity, and Common Sense Enrique Suarez

The Secret Code of Success Noah St. John

Self-Compassion: Stop Beating Yourself Up and Leave

Insecurity Behind Kristin Neff, PhD

Slowing Down to the Speed of Life Joe Bailey

The Spirituality of Imperfection: Storytelling and the

Search for Meaning Ernest Kurtz and Katherine
Ketcham

Waking the Tiger: Healing Trauma Peter Levine

What to Say When You Talk to Yourself Shad Helmstetter

You Can Be Happy No Matter What Richard Carlson

127
Health Professionals
USA, BY STATE:

CALIFORNIA
Susan Basset, MSW, LCSW
18319 Linnet
Tarzana, CA 91356
(818) 345-0260

Will Baum, LCSW

437 S. Robertson Blvd., Suite B
Beverly Hills, CA 90211
www.willbaum.com
(323) 610-0112

Bruce Eisendorf, MD
2025 Soquel Avenue
Santa Cruz, CA 95062
www.scruzmedical.com
(831) 458-5524

Alan Gordon, LCSW

Pain Psychology Center
9777 Wilshire Blvd., Suite 1007
Beverly Hills, CA 90212
(310) 853-2049

Michelle Gottlieb, Psy.D., MFT

305 N. Harbor Blvd., Suite 202

128
Fullerton, CA 92831
(714) 879-5868 x5
www.michellegottlieb.com

Helene G. Green, LCSW

19710 Ventura Blvd., Suite 203
Woodland Hills, CA 91364
(818) 999-9664

Philip S. Green, PhD

19710 Ventura Blvd., Suite 203
Woodland Hills, CA 91364
(818) 999-9663

Susan Mendenhall, MSW, PsyD

10111 McConnell Place
Los Angeles, CA 90064
(310) 558-8091

Colleen Perry, MFT

1247 7th Street #300
Santa Monica, CA 90401
(310) 259-8970
www.colleenperry.com

David Schechter, MD
8530 Wilshire Boulevard, Suite 250
Beverly Hills, CA 90211
(310) 657-0366 and
3855 Hughes Avenue, Suite 200
Culver City, CA 90232

129
(310) 838-2225
www.mindbodymedicine.com

Clive M Segil, MD
2080 Century Park East, Suite 500
Los Angeles, CA 90067
(310) 203-5490

Nancy Sokolow, LCSW

530 Wilshire Blvd., Suite 310
Santa Monica, CA 90401
(310) 393-2020

Jill Solomon, MFT

8240 Beverly Blvd., Suite 8
Los Angeles, CA 90048
(323) 692-3759

Patti D. Thomas, LCSW

Peaceful Sea Counseling
920 Samoa Blvd., Suite 209
Arcata, CA 95521
(707) 822-0370
pdthomas@reninet.com

CONNECTICUT
Leslie Reis, LCSW
75 Kings Highway Cutoff
Fairfield, CT 06824
(203) 333-1133

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Dario M. Zagar, MD
Associated Neurologists of
Southern Connecticut
75 Kings Highway Cutoff
Fairfield, CT 06824
(203) 333-1133
www.anscneuro.com

COLORADO
Pam Benison, MA
1625 Larimer St. #2704
Denver, CO 80202
(303) 809-2162
integratedwellness@hotmail.com

Evana Henri, PhD

Clinical/Health Psychologist
2101 Ken Pratt Blvd. Suite 200
Longmont, CO 80501
(720) 771-9248
evanahenri@accessyoureverest.com
www.accessyoureverest.com

DISTRICT OF COLUMBIA
Andrea Leonard-Segal, MD
George Washington University Center
for Integrative Medicine, Suite 200
908 New Hampshire Avenue, N.W.
Washington, D.C. 20037
(202) 833-5055

131
GEORGIA
David Lipsig, MD
12 Piedmont Center, Suite 410
Atlanta, GA 30305
(404) 495-5900
Fax (404) 495-5901
www.atlantapsychiatry.com

Ed Glauser, Licensed Professional

Counselor
1 Huntington Road, Suite 205
Athens, GA 30606
(706) 202-3590
www.edglausercounseling.com

Leonard J. Weiss, MD
3188 Atlanta Road
Smyrna, GA 30080
(770) 319-6000

ILLINOIS
John Stracks, MD
Northwestern Memorial Physicians
Group Center for Integrative Medicine
and Wellness
1100 E. Huron Street, Suite 1100
Chicago, IL 60611
(312) 926-DOCS (3627)

MARYLAND
Harold Goodman, DO

132
8609 Second Avenue, Suite 405-B
Silver Spring, Maryland 20910
(301) 565-2494
hrpharold@gmail.com

MASSACHUSETTS
Eugenio Martinez, MD
Greater Boston Orthopedic Center
200 Providence Highway
Dedham, MA 02026
(781) 461-4543
Fax (781) 326-2030.

Jay E. Rosenfeld, MD
311 Service Road
East Sandwich, MA 02537
(508) 833-4000
jrosenfeld@adelphia.net

Ronald D. Siegel, PsyD

20 Long Meadow Road
Lincoln, MA 01773
(781) 259-3434
www.backsense.org

MICHIGAN
Roger Gietzen, MD
1460 Walton Boulevard, Suite 200
Rochester Hills, MI 48309
(248) 650-1800
Fax (248) 650-1856

133
Howard Schubiner, MD
Providence Hospital
Department of Internal Medicine
16001 W. Nine Mile Road
Southfield, MI 48075
(248) 849-4728
hschubiner@gmail.com
www.unlearnyourpain.com

MINNESOTA
Douglas Hoffman, MD
St. Marys / Duluth Clinic Health System
400 E. Third St.
Duluth, MN 55805
(218) 786-3520

NEW HAMPSHIRE
Marc Sopher, MD.
27 Hampton Road
Exeter, NH 03833
(603) 772-5684
Fax (603) 772-5256
mdsophermd@comcast.net
www.themindbodysyndrome.com

NEW JERSEY
Robert Paul Evans, PhD
163 Engle Street
Englewood, N. J. 07631
(201) 569-3328

134
Paul Gwozdz, MD
710 Easton Avenue, Suite 1A
Somerset, NJ 08873
(732) 545-4100
www.GwozdzMD.com

Thomas Nordstrom, M.D.

The Center for Orthopedic Care
215 Union Avenue
Bridgewater, New Jersey 08807
(908) 685-8500
Fax (908) 685-8009
www.tcfoc.com

NEW YORK
Frances Sommer Anderson, PhD
140 East 40th Street #12A
New York, New York 10016
(212) 661-7588
Ira Rashbaum, MD
Rusk Institute of Rehabilitation
Medicine
400 East 34th Street
New York, NY 10016
(212) 263-6328

Eric Sherman, PsyD

19 West 34th Street, Suite PH-13
New York, New York 10001
(212) 947-7111 x227

135
Roy Stern, MD
Dermatologist
800A Fifth Avenue, Suite 403
New York, NY 10021
(212) 421-SKIN (7546)

NORTH CAROLINA
Bruce Hill, MD
Crossroads Arthritis Center
300 Billingsley Road
Charlotte, NC 28211-1075
(704) 333-1400

OHIO
John Nadas, MD
1330 Mercy Dr NW, Suite 320
Canton, OH 44708
(330) 489-1495

Peter Zafirides, M.D. Psychiatry

5151 Reed Rd., Suite 128C
Columbus, OH 43220
(614) 538-8300
and
Southeast Mental Health
16 W. Long Street
Columbus, OH 43215
(614) 225-0985

PENNSYLVANIA
Randy A. Cohen, DO

136
Pain Medicine and Rehabilitation
Specialists
160 North Pointe Boulevard, Suite 115
Lancaster, PA 17601
(717) 560-4480
Fax (717) 560-4485
rcohen@painstoppers.org

SOUTH CAROLINA
Jim Moran, LISW-CP
Middle Path Therapy Center
125 The Parkway, Suite 104
Greenville, SC 29615
(864) 908-9061
middlepaththerapycenter@gmail.com

TENNESSEE
Christopher Vinsant, MD
501 16th Street, Suite 606
Knoxville, TN 37916

TEXAS
Jonna Lee Barta, PhD
101 W. McDermott Street, Suite 109
Allen, Texas 75013
Jonna.barta@att.net
(214) 629-6986

MaryAnn Schaffer, PhD

One Killeen Center
Executive Suite 108-7

137
Killeen, TX 76541
schaffer@clearwire.net
(254) 718-2952

John Sklar, MD
2500 West Freeway, Suite 400
Fort Worth, TX 76102
(817) 870-1868

WASHINGTON
David Hanscom, MD
Spine Program, Swedish Hospital
550 17th Avenue, Suite 500
Seattle, WA 98122
206-320-2225

Joel Konikow, MD
Swedish Pain Center
1101 Madison St., Suite 200
Seattle, WA 98104
206-386-2013

Mark G Strom, MD
1370 Stewart Street, Suite 202
Seattle, WA 98109
(425) 922-7576
Fax (425) 669-7500
www.integrativehealthmd.com
mark@integrativehealthmd.com

UNITED KINGDOM:

138
Georgina Oldfield, MCSP
Chartered Physiotherapist
Pain Relief Centre, West Yorkshire, UK
00(44)1484 452500
info@tmsrecovery.com
www.tmsrecovery.com

Dr Nicholas Straiton FRCS, DM-S

Med, MLCOM
1 Glovers Yard, 121 Havelock Road
Brighton, BN1 6GN, UK
01273 540303
Fax 01273 540092
nicstraiton@btinternet.com

Life Coaches
Monte Hueftle:
www.runningpain.com

Steve Ozanich
www.paindeception.com

Art Smith, PhD:

drsmith@noetichealth.com

Abigail Steidley:
www.thehealthylifecoach.com

Websites and Blogs:

139
Dave Clarke, MD
www.stressillness.coml

David Hanscom, MD
www.drdavidhanscom.com

ISTDP Institute
www.istdpinstitute.com

International Experiential Dynamic

Therapy Association
www.iedta.net

PPD/TMS Peer Network

www.tmswiki.org

Psychophysiologic Disorders
Association
www.ppdassociation.org

Howard Schubiner, MD
www.unlearnyourpain.com

Marc Sopher, MD
www.tms-mindbodymedicine.com

David Schechter, MD
www.mindbodymedicine.com

TMS Help Forum

http://www.tmshelp.com/

140
141
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151
 index

5-HTTLPR 14
abandonment 25, 33, 48
abdominal pain 21, 33-34
Abilify 6
abuse 14, 18, 20, 22, 25-26, 34, 45-46, 48
acupuncture 5, 53
adrenal gland 9, 13, 17, 31-32
alcohol 16, 32, 63
alprazolam 2
Amir, M 34
amygdala 10, 57
Anda, R 47
Andrews, P 34
anemia 13
anti-depressants 5-6, 15-16, 17, 23, 29, 34
anxiety 1-5, 7, 9-19, 21-29, 31-34, 40, 46-49, 51-53, 55-
64

152
Anxiety and Depression Association of America 13-14
Aron, E 26
Ashton, H 12
ativan 12
Babyak, M 16
Back in Control 53
back pain 6, 22, 32, 34, 47-48, 56
Beckham, J 34
benzodiazepines 12-13, 16
bipolar disorder 34
birth control pills 13
blood pressure medications 13
bupropion 2
Buskila, D 2 6
caffeine 9
Carew, T 20
Carpenter, L 21
Caspi, A 14
Celexa 1, 23, 29
chemical imbalance 6, 10, 13-14, 18
citalopram 1
cocaine 9, 32, 47
Committee on the Review of Medicines 12
cortisol 21
Costa, P 26
Cowen, P 15

153
Cymbalta 23
cytokines 18
Clarke, D 53
de Kloet, E 17
depression 1, 5-7, 11-18, 20, 22-28, 31-34, 40, 46-47,
49, 51-53, 55-64
disability 12-13, 22, 24, 63
Divided Mind, The 53
dopamine 2
dorsolateral prefrontal cortex 17, 56
Drevets, W 17
economic 12
Effexor 15
Eisenberger, N xi
Elavil 23
epigenetic 11
exercise 16
failure 6, 23
fatigue 6, 12-13, 23-28, 32, 34, 40-41, 46-47, 56-57, 64
fear 2-3, 5, 9, 18, 20-21, 25, 27-29, 31-34, 50-51, 55, 57,
59-60, 63
fibromyalgia 6, 26, 32, 34, 40, 46-47, 52, 56
fight or flight 10, 17-18, 20-21, 23-24, 27, 34
Fisher, J xi
Fournier, J 16
Freedom From Fibromyalgia 53

154
freeze response 23-24, 34
Freud, S 11
full-spectrum lighting 6
gamma-aminobutyric acid (GABA) 2, 12
Gater, R 26
generalized anxiety disorder 2, 9, 34
Great Pain Deception, The 53
genetics 10-11, 14, 18
Greenberg, P 13
guilt 4, 6, 22, 26-27, 29, 49-51, 57-60, 62
Hanscom, D 53
headaches 3, 6, 16, 21, 25-26, 32, 34, 40, 47-48, 56
Hebb, D 20
helplessness 6
Hollon, S 17
Hyman, S 16
hyperthyroidism 9, 31
inflammation 17
insomnia 16, 24-28, 32, 34, 46-47, 56, 64
interstitial cystitis 32
irritable bowel syndrome 21, 26, 32, 40, 46-47, 52
Jacobs, B 16
Kagan, J 11
Kandel, E 20
Keeton, C 10
Kendall, T 12

155
Kendler, K 15
Kirsch, I 11, 15-16, 34
Kloke, V 11
Klonopin 12
Kross, E 27
LaCasse, J 15
LeDoux, J 27
left brain 28
Leo, J 15
Lexapro 6
Librium 12
limbic system 10
Lindsley, C 15
Lipton, B 14
Lipton, RB 26
Lissek, S 21
loneliness 6
loss 6, 13, 20, 25, 28, 33-34, 50-51, 58
Maas, J 15
marijuana 32, 63
Martinez, R 10
McGowan, P 18
meditation 5
methamphetamine 9
migraine 21, 26, 32, 47, 56
Miltown 12

156
Mindbody Prescription, The 53
Mind Body Syndrome (MBS) 24, 26, 28, 31-34, 39-40,
46-47, 49-53, 56-64
Mugunthan, K 12
National Institute for Health and Clinical
Excellence (NICE) 16
neck pain 21, 32, 40, 52
neglect 14, 48
Neumann, L 26
neuroplasticity 18, 20
neurotransmitters 1 1, 16
obsessive-compulsive disorder (OCD) 2, 9, 11, 34, 57
Oldfield, G 53
Ozanich, S 53
pain medication 5, 6, 63
panic disorder 2, 9, 34
Patten, S 17
Paxil 34
perfectionism 26
personality traits 11, 24, 26, 47, 49, 50
pheochromocytoma 9, 31
phobias 2, 9, 33, 34, 40
Pine, D 11
pituitary 13, 17
post-traumatic stress disorder (PTSD) 2, 9, 34, 41, 57
PPD/TMS Peer Network 53

157
Prior, M 11
Prozac 6, 34
psychotherapy 17, 23, 34
Raison, C 18
Ramos, A 11
Regier, D 13
rejection 6, 21
right brain 28
Ronalds, C 17
Saarinen, P 18
S-Adenosyl methionine 6
sadness 5-6, 20, 24, 27, 51, 57-58
Saito, Y 26
Salim, S 18
Sapolsky, R 10
Sarno, J 53
Schiffer, F 28
Schmitt, D 26
Schwartz, C 11
seasonal affective disorder 61
Selfridge, N 53
separation anxiety 3, 33
serotonin 1, 6, 11, 14-16
serotonin reuptake inhibitor (SRI) 1, 6, 14-15
serotonin transporter gene 14
sexual abuse 20, 46

158
shame 22, 51, 57-59
Sherman, J 34
side effects 1, 4
Silverman, C 13
Simpkins, C 20
Sjogren, B 28
sleep 4, 31, 34
Snidman, N 11
social anxiety disorder 2, 57
Soili, M 18
St. Johns wort 6
subconscious 25, 27-28, 48, 51, 59
submit 23-24, 34
suicide 7, 17, 34
Tambs, K 11
Taylor, S 14
testosterone 13, 31, 32
They Cant Find Anything Wrong 53
thyroid 9, 13
tinnitus 32
tmswiki.org 53
trauma 2, 22, 25, 28, 34, 46-47, 57
triggers 10, 25-27, 48, 50, 56-57, 60-61, 63
unconscious 11
Unlearn Your Pain 19, 21, 26, 34, 55-56, 59
Valium 12

159
van Grootheest, D 11
victim 22, 25
victimization 60
Viinamaki, H 18
Wagstaff, A 15
Walters, E 20
Weel-Baumgarten, E 17
Wellbutrin 2, 15, 23
Whitaker, R 10-13
Wilson, T 27
women 26, 28, 58
Xanax 2, 12
Zimmerman, M 16
Zoloft 23
Zunszain, P 18

160
 about the
author

Dr. Howard Schubiner is board certified in

pediatrics and internal medicine and is the director of the
Mind Body Medicine Center at Providence Hospital in

161
Southfield, MI. He is a Clinical Professor at Wayne State
University School of Medicine and is a fellow in the
American College of Physicians, the American Academy
of Pediatrics. He has authored more than sixty publications
in scientific journals and books and has given more than
250 lectures to scientific audiences regionally, nationally,
and internationally. Dr. Schubiner has consulted for the
American Medical Association, the National Institute on
Drug Abuse, and the National Institute on Mental Health.
He is also a senior teacher of mindfulness meditation. He
has been included on the list of the Best Doctors in
America since 2003. Dr. Schubiner lives in the Detroit area
with his wife of 30 years and has two adult children.

162
163
164
Table of Contents
Title Page 2
Copyright 3
Table of Contents 10
Preface 11
Acknowledgments 19
Chapter 1: The Symptoms of Anxiety and
22
Depression
Chapter 2: What Is the Biology of
34
Anxiety and Depression?
Chapter 3: How Does Anxiety and/or
52
Depression Occur?
Chapter 4: Is My Anxiety and/or
Depression Caused by Mind Body 71
Syndrome?
Chapter 5: What Can You Do About
108
Your Anxiety and Depression?
Appendix: Additional Resources 124
References 142
Index 152
Back Cover 163

165
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