TMS and RCTs: The Conversation Continues

The conversation between Dr. Frances Sommer Anderson and Bronwyn Thompson continues (renamed, per Dr. Anderson’s request, TMS and RCTs).  For the first part of the dialogue, go here.

From Dr. Anderson:

Bronwyn,

First, I want to clarify: I have the keenest respect for RCTs. I was trained as a rigorous experimental psychologist before I switched to clinical psychology and psychoanalysis. I advocate research on the clinical reports made by medical, mental health, allied health care professional professionals, and people who have found relief from “TMS” pain. That research has already begun, in a study of fibromyalgia using RCTs (Howard Schubiner, personal communication February 2010) submitted for publication in a peer-reviewed medical journal. An application for research support from NIH has been submitted to expand this research.

I hope that the current and succeeding generations of pain professionals and concerned lay people will promote RCTs to evaluate the methods we have found to be effective, case by case, in our clinical practices for 40 years. We all recognize that in order for TMS to be included in the DSM, there will need to be substantive documentation that it is a “syndrome.” Pushing toward that goal, along with the aim of educating the public about TMS, the TMS EDUCATIONAL WORKING GROUP, a non-profit corporation, has just been formed by a coalition of people who have been successfully treated for TMS and health care professionals experienced in treating TMS, many of whom will be contributing to LA Mindbody Conference in March 27-28, 2010.

I would now like to invite you, Bronwyn, to comment on a section of my original response to your response: I recommend reading about the theoretical and empirical foundation for my treatment technique in my chapter in Relational Perspectives on the Body (www.francessommeranderson.com). I provide a detailed case presentation of my treatment of a patient with TMS pain, illustrating how overwhelming emotions were related to her long history of back pain and how she was relieved of this pain as she worked with disavowed affects. I ground my “technique” in the publications of psychoanalyst researchers such as Henry Krystal (Michigan State University), his son John Krystal (Yale University), and Graeme Taylor (University of Toronto) and his colleagues in Canada. These clinician-researchers have focused on the role of emotions/affects in health and illness. In particular, their findings document the value of recognizing what we’re feeling, and developing the capacity to tolerate and regulate both positive and negative emotions.

Feelings/emotions/affects become problematic when we need to avoid experiencing them because they may be overwhelming. Intolerance and avoidance of emotions can be associated with physical as well as psychological illness, as documented by these and other researchers. Researchers are increasingly focusing on the significant role of emotions, e.g., in the neurobiology of fear (Joseph LeDoux) and the neurobiology of trauma, e.g., Bessel van der Kolk and his colleagues. How these dysregulated emotions are related to health and illness should concern all practitioners.

My treatment approach is also influenced by the field of contemporary neuroscience, which the author values as a model in explaining chronic pain syndromes. I want to emphasize that I am not at odds with the identification of a neurobiological substrate for pain and other disorders. I am in favor, however, of an integrative approach rather than one that values biology or psychology over the other: Unfortunately, valuing neurobiology over psychology is once again a manifestation of the dichotomous mind vs. body philosophy that still informs much of Western medicine. My point is made most convincingly by a number of current clinicians and researchers. Allan Schore’s (http://www.allanschore.com/) integration of data from the psychoanalytic theory of development, neurobiology of attachment, and the neuroscience of emotional regulation demonstrates the value of an integrative synthesis of knowledge from the domains of psychoanalysis, psychology, and neurobiology. Daniel J. Siegel (http://drdansiegel.com), a psychiatrist who has studied mindfulness meditation and neuroscience, uses the term “interpersonal neurobiology” to capture the complexity of the interpenetration of the psychological and the neurobiological realms of theorizing (The Mindful Brain). A psychologist, Wilma Bucci (http://www.referentialprocess.org/), is a cognitive science researcher (Chapter in Bodies in Treatment, FSA Editor; www.referentialprocess.org) who has developed a “multiple code theory,” arguing for a “congruence” between psychological and neurobiological models of emotional and cognitive processing. Candace Pert’s substantive research (http://www.candacepert.com/), offered for a general audience in Molecules of Emotion, demonstrates how “emotions” are stored in every area of the body, including in the molecules.