The key toward healing when exposure to long term stress or aversive events and chronic pain co-exist?
There are numerous models that seek to explain why some individuals experience chronic pain while others do not, each offering valuable insights but none fully explaining every instance of pain. This is because a universal explanation does not exist. To comprehend the underlying causes of someone's pain, it is essential to consider their personal history, coping mechanisms, significant life experiences, and their responses to bodily sensations before attempting to interpret the reasons for their pain through any single perspective.
One perspective that often receives insufficient attention in exploring potential contributors to chronic pain is the learned helplessness model, typically used to understand trauma. Yet, this model proves particularly useful in addressing chronic pain, especially when trauma or burnout and pain coexist.
The learnt helplessness model
Learnt helplessness is described by the American Psychological Association as a phenomenon in which repeated exposure to uncontrollable stressors results in individuals failing to use any control options that may later become available.
This phenomenon often arises from repeated adverse experiences that are perceived as unavoidable or inescapable. It commonly results from exposure to chronic stress, trauma, or persistent pain, leading to feelings of helplessness and loss of motivation, even when the opportunity to change one’s circumstances arises.
The concept behind the learned helplessness model originates from experiments on various mammals where initially, these animals were subjected to inescapable shocks, followed by the same shocks in scenarios where escape was possible. As the animals did not escape even when given the opportunity to do so, it was believed that uncontrollable events led animals to perceive their actions as irrelevant to outcomes. Early research suggested that organisms start by expecting control and learn helplessness when stressors are inescapable. However, modern neuroscience challenges this view.
Modern neuroscience suggests that passivity is the brain's automatic, default reflex to prolonged stress, and control is what must be actively learned.
Learnt helplessness or a hardwired reflex?
The perceived sense of control that an organism has over a stressor has been observed to have a modulatory role in the stressor’s impact, with uncontrollable stressors producing numerous outcomes that do not occur if the stressor is controllable. Modern neuroscience has broken down this phenomenon that early researchers were able to observe in animals and thought to be a learnt behavior into the interaction between two major brain regions.
When an organism experiences any severe or prolonged stressor, the Dorsal Raphe Nucleus (DRN) automatically activates. This activation directly triggers the default behavioral defense freeze responses: passivity, social withdrawal, and heightened anxiety.The key difference between an organism that keeps trying and one that gives up is linked to the Ventromedial Prefrontal Cortex (vmPFC). This brain area manages executive function and planning. When individuals recognize they can change their situation, the vmPFC activates, inhibiting the DRN and acting as a "brake" on the brainstem and shutting down the automated freeze-and-passive reflex. True learning therefore involves grasping control over helplessness, as the brain must learn that its actions have significance to overcome an instinctual passive defense state.
So seems that what was thought to be a learnt behavior, turns out to be a hardwired reflex to an uncontrollable stressor without any learning required for this passivity to occur. So what is actually learned is not helplessness, but the sense of control. The brain must actively learn that the individual’s actions matter and lead into a positive outcome in order to override its hardwired, passive defense state.
Healing from pain that the brain believes to be uncontrollable and inescapable requires experiences that contradict this brain-induced default state of passivity
When chronic stress and chronic pain coexist, they form a self-reinforcing loop that deepens over time. The brain comes to interpret persistent, unrelenting pain as an inescapable threat, which often triggers a default state of passivity, fear, and pain catastrophizing. To heal from chronic pain that the brain perceives as uncontrollable, therapeutic interventions must intentionally and directly disrupt this ingrained neural loop with experiences where one’s actions lead to a positive outcome to help offset this default brain state that is now known to be reflexive when a stressor is perceived to be one that the individual can no longer overcome.
Whereas it is still common to see passive treatments being prescribed, such as long sick leaves or reduction of activity level, it is crucial to understand that while they might be valid and needed in some instances, in others these same treatments might be detrimental to an individual’s actual needs. True recovery requires providing the nervous system with repeated, tangible experiences—emotional, physical, and behavioral—that clearly contradict the brain's learned prediction of inevitable pain and helplessness, with the goal of helping it to relearn safety and possibility where one’s actions have an effect on the outcome of the situation.
Learn more about my coaching package that integrates this modern perspective into the treatment of chronic pain especially when exposure to chronic stress or aversive events and pain coexist: https://app.paperbell.com/checkout/packages/233838
-Ansku
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