Repressed emotions can cause chronic pain and disease

A knot in your stomach; the blush of shame on your cheeks; a lump in your throat; butterflies in your stomach; a burden on your shoulders; or shaky knees. Emotions express themselves physically. Treatment for physical symptoms such as pain, is often not focussed on addressing repressed emotions that trigger and sustain symptoms and pain. This can lead to symptoms and pain to become chronic and provoke a range of other physical and mental health issues, as well as the use of ineffective treatment and overuse of pain medications.

Emotions express themselves physically. Such as a knot in your stomach; the blush of shame on your cheeks; a lump in your throat; butterflies in your stomach; a burden on your shoulders; or shaky knees. Treatment for physical symptoms such as pain, is often focussed on addressing the symptoms and fighting the physica lpain, but does not address repressed emotions that trigger and sustain symptoms and pain. This can lead to symptoms and pain to become chronic and provoke a range of other physical and mental health issues. It also increases the risk of ineffective treatments such as pain medications, while at the same time the patient experiences a declining quality of life. Adressing repressed emotions, obviously when applicable and relevant to the patient in question, can reduce and even cure long lasting symptoms and pain.

Persistent physical symptoms

About 40 percent of all physical symptoms that are reported to family doctors and medical specialists are somatically unexplained. In about 80 percent of cases, these symptoms become chronic. This can lead to feelings of frustration, helplessness, powerlessness and shame; or the fear of not being taken seriously or being seen as a ‘difficult case’.

Persistent physical symptoms can have far-reaching consequences including deterioration in lifestyle; reduction in overall physical and mental health; increased use of medication; loneliness and social isolation; deterioration in daily functioning; and reduced perceived quality of life. On a societal level, persistent physical symptoms are also relevant in relation to job loss, declining productivity, increased health care costs, and increasing pressure on health care.[i]

It is all in your head...

The term Medically (Insufficiently) Unexplained Physical Symptoms (in Dutch: somatisch onverklaarbare lichamelijke klachten, SOLK) used to be used: Physical symptoms that lasted longer than a few weeks and in which no somatic condition was found on adequate medical examination that could explains the symptoms. The patient then no longer would benefit from further somatic interventions.

The distinction that was made between symptoms resulting from a known illness, on the one hand, and medically uneplained physical symptoms, on the other, led to an overexposure to psychosocial influences in the case of medically uneplained physical symptoms (to put it bluntly: it is all in your head), and in the case of symptoms resulting from a known illness, those psychosocial influences were actually underexposed. While in both cases psychosocial influences can play an equally important role in disease progression and recovery.

SOLK has since been replaced by the concept of Persistent Physical symptoms (in Dutch: Aanhoudende Lichamelijke Klachten, ALK) in which the biopsychosocial model of health and illness is leading. In this model, biological, psychological and social factors are considered to influence health and illness. Thereby, the focus is not exclusively on the (physical) cause of symptoms, but also (or more) on the consequences of the symptoms in multiple areas and the biological, psychological and social mechanisms by which recovery can be promoted.

A multitude of biological and psychosocial (risk) factors and mechanisms influence the persistence of physical symptoms. Biological factors include chronic low-grade inflammation; genetic predisposition; immune, metabolic and microbiome dysregulation; and depression. Psychosocial factors include affective factors such as emotion regulation dysfunction; behavioral factors such as avoidance behaviors; cognitive factors such as body image and health worries; personal and interpersonal factors such as neuroticism and perfectionism; past experiences; psycho- pathological factors such as co-morbidity, Post Traumatic Stress Disorder (PTSD), depression and anxiety; and psycho- physiological factors such as stress reactions and symptom perception. [2]

It is indeed all in your head!

Negative emotions and thoughts open the pain gate in the brain

Persistent physical symptoms such as pain are not always a reflection of physical damage. For example, pain can also be felt in the absence of pain receptors, as in phantom pain. There is also a condition where pain is not felt because pain receptors in the body do not function.

Pain perception involves two processes in the body. The first process centers on opening the pain gate in the brain. The second process centers on closing it.

In the first process, the opening ofthe pain gate, sensory information from the location of the pain stimulus in the body, for example the hand, is directed to gates in the spinal cord. Within these, nerves conduct the information to pain centers in the brain. There are two types of nerves (norireceptors) that detect pain: The first type, the A- delta fibers, involves sharp pain, of short duration. Information is directed to the thalamus and to the cortex in the brain. This is the part of the brain focused on planning, decision making and action: we take immediate action and withdraw the hand from the fire.

The second type, polymodal C-fibers, involves dull throbbing pain, of longer duration.  Information is directed to the limbic system of the brain, including the hypothalamus and the amygdala. The limbic system is a set of brain structures involved in emotion regulation, emotional memory, pleasure and motivation. The hypothalamus is responsible for the production of endorphins, which cause the pain to be experienced less severe.  

->  Negative feelings and emotions lead to lower production of endorphins, and thus to more intense pain experience.

The second process centers on pain gate closure. So-called A- beta fibers compete with the norireceptors that open the gate. These A- beta fibers become active when the painful area is rubbed for example, resulting in a less severe perception of pain.

The intensity of pain perception depends on the degree to which both processes of opening and closing the gate are activated. Activation of sensory nerves open the gate, while activation of A- beta fibers can close the gate again.

-> Negative thoughts and emotions can also open the pain gate, while calming and positive thoughts and emotions can close the gate.

In addition, negative thoughts (and behaviors) can cause not only the pain gate to open, but they can also cause symptoms to be perceived as more severe. Such as the thought of triggering pain with certain activities. When symptoms are experienced as more severe, more negative thoughts and behaviors arise: a vicious circle.

The erratic nature of persistent physical symptoms also plays an important role. This capriciousness leads to patients maintaining negative thoughts and being constantly preoccupied with their symptoms; doing a lot to prevent symptoms; and continuing to search for a (physical) causes or diagnosis. This is particularly seen in patients with central sensitization.Thisis a persistently high activity state of the nervous system in which the central nervous system responds to little stimuli as if there has been a highlevel of painful stimuli. Overtime, patients become hypersensitive to pain, and centralized pain is associated with memory loss and worsening anxiety.[3]

The effect of repressed emotions on persistent physical symptoms

Emotions arise from activations of certain parts of the brain, including the amygdala. Feelings are conscious, emotional experiences of these activations that contribute to neuronal networks that mediate thoughts, language, and behavior. This increases the ability to predict, learn, and reappraise stimuli and situations in the environment, based on previous experiences.

Amygdala

The amygdala plays an important role in emotion regulation and in anxiety and stress. It connects emotions to other functions of the brain such as memory, learning and the senses. The amygdala is constantly evaluating and integrating sensory information from the environment and assigning values of emotional dimensions. It plays a role in how we unconsciously assess a given situation and instinctively behave in response.

A dysfunctional amygdala can lead to mental health issues such as anxiety, mood or panic disorders; PTSD; phobias and personality disorders. Symptoms of a dysfunctional amygdala include activation of the sympathetic nervous system with increased heart rate, heavy breathing and sweating.

Example

An example of a dysfunctional amygdala is burnout: During short-term stress, stress hormones rise in the body and the sympathetic nervous system becomes active so that energy is released to achieve the goal, such as meeting the deadline at work. After the stressful event ends, stress hormones drop back to their baseline and the body and mind return to rest.

With prolonged stress, stress hormones do not drop back to their baseline, but remain slightly elevated. This happens again after each stressful event, causing the baseline to rise ever so slightly and the body and mind fail to calm down. The sympathetic nervous system remains overactive and people feel agitated and exhausted. Breathing becomes shallower, reducing oxygen to the blood and reducing energy and recovery. The functioning of the prefrontal cortex in the brain, responsible for planning, decision making and emotion regulation, diminishes, making people more sensitive to stimuli andhaving more difficulty concentrating. The stress load persists. Sleep disturbances occur (Sleep, CrossFit and Health), making recovery difficult. With poor sleep, the amygdala becomes more active, while the prefrontal cortex that inhibits the amygdala functions less well. It feels like a constant fight or fly. An overactive amygdala leads to impaired emotion regulation and chronic stress and burnout.

-> Repressed emotions can negatively affect the functioning of the amygdala.

Repressed emotions
Repressed emotions are emotions that are unconsciously avoided, ignored or blocked. It is an unconscious defense/ self-protection mechanism against unpleasant feelings that seem too intense or shameful, for example. Repressed emotions can also be a result of not having learned to recognize and express emotions.

Repressed emotions do not equal supressed emotions. Suppressing emotions is a conscious process where a person avoids or ignores their emotions, such as at work.
In repressed emotions, the person is unaware of having and avoiding these emotions. For example, the person cannot remember how they felt during or after an unpleasant event. Repressed emotions manifest themselves in a different way, often in the form of aggression or anger, while the person is actually grieving for example.

Negative consequences of repressed emotions
Repressed emotions do not disappear on their own and can have long-term negative physical, mental and emotional consequences:

- Chronic stress
Repressed emotions require energy to remain repressed, and that energy causes chronic activation of the amygdala and sympathetic nervous system, and thus chronic stress. That increases the risk of chronic disease and musculoskeletal complaints such as low back pain.

- Pain symptoms, chronic diseases and phobias
Repressed emotions can cause a person to get stuck in a negative emotion, so to speak, while the true emotion remains hidden. Aggression and anger, common with repressed emotions, increase the risk of negative health effects such as pain symptoms and cardiovascular risk. Repressed emotions are also related to the development of phobias. Repressed emotions in the unconscious part of the brain can also trigger pain symptoms.

Moreover, repressed emotions make it more difficult to express and feel positive emotions, making the pain gate less likely to close. Negative childhood experiences and trauma play a role in this. Childhood experiences and learned beliefs and behaviors from the past, such as how to deal with (or ignore) emotions also play a role. Traumatic life events especially in childhood, can lead to a higher risk of persistent physical symptoms. A combination of childhood trauma and intense life events later in life increase the risk of a more severe course of persistent physical symptoms. For example, it appears that adults with PTSD who were also abused in childhood have a higher risk of developing pain symptoms later in life.

- Misunderstood disproportionate behaviors and defense mechanisms
People with repressed emotions may have feelings and exhibit behaviors that are inappropriate or disproportionate to a situation, such as reacting excessively angry, or being very tense, without being aware or understanding their own reaction. Sometimes repressed emotions may be accompanied by other defensive behaviors to avoid unwanted feelings and emotions and maintain the situation. Such as denying or downplaying an unpleasant situation (it wasn't that bad). Dissociation also occurs, where feelings or thoughts are disconnected from the situation and people seem to completely shut themselves off from reality, as in PTSD. Sometimes they cannot remember a violent event or believe it was just a dream. Dissociation can be accompanied by permanent partial amnesia. Other defense mechanisms include addiction to drugs, alcohol or food; and intellectualization in which a person avoids with logic and rationality, emotions and feelings of self and others.[4]

Effective treatment of persistent physical symptoms

Many treatments of persistent physical symptoms are aimed at tackling the symptoms, such as the treatment with pain medication or with cognitive behavioral therapy. Repressed emotions that can play an important role around the start of the symptoms are often not or hardly addressed, as a result of which symptoms can persist.

Therapies such as Emotional Awareness and Expression Therapy [EAET] and Psycho physiological Symptom Relief Therapy (PSRT) seem to be more effective in treating persistent physical symptoms such as chronic pain, than traditional treatments such as disease education alone; pain medication; cognitive therapy; or Acceptance and Commitment Therapy. These therapies aim to help patients deal with their negative thoughts and behaviors; negative childhood experiences and traumas; and repressed emotions, by becoming more aware of their feelings and emotions, and expressing and dealing with them in an effective and helpful way. Breaking patterns starts with learning how to deal with the symptoms rather than the endless search for causes or a diagnosis. [5]

Emotional Awareness and Expression Therapy

Emotional Awareness and Expression Therapy (EAET) is a treatment that combines techniques from various therapies with the goal of addressing (early life) stressors underlying symptoms. The premise of EAET is that stress, repressed emotions and dysfunctional emotion regulation can cause changes in brain structures and functions of the brain that can lead to (chronic) pain.

-> Revealing repressed emotions, and expressing and processing them; and developing more helpful behaviors in relation to the self andothers, can have a positive effect on brain structures involved in pain and emotions.

EAET focuses on issues that arise particularly in people with central sensitization, which is strongly influenced by the central nervous system and specifically the brain structures involved in thoughts, feelings, emotions and relationships.

-> This involves conditions such as fibromyalgia, headaches, irritable bowel syndrome, back pain and pelvic pain, where it is known that repressed and negative emotions can exacerbate symptoms.

People with chronic pain appear to have more frequent experiences of psychosocial trauma and intra- or interpersonal conflict. Addressing these risk factors creates opportunities to reduce pain. For example, research among patients with fybromyalgia, a form of rheumatoid arthritis (Rheumatism and CrossFit), shows that treatment with EAET has significantly more positive effects on pain symptoms, mental health and quality of life, compared to treatment with disease education alone or with cognitive behavioral therapy. A study among military veterans with musculoskeletal complaints including low back pain, shows that EAET can lead to significantly less pain symptoms and anxiety compared to cognitive behavioral therapy. A study of patients with irritated bowel syndrome shows that these patients often have more trauma, stress and relational conflicts and exhibited emotion-avoiding behaviors, and EAET significantly reduced symptoms.

Unlike cognitive behavioral therapy, the premise in EAET is that symptoms do not necessarily have to remain chronic, provided the patient is able to change their emotions and relationships that are not helpful. EAET can then result in significant reduction of symptoms or even their disappearance, and improvements in daily functioning, mood and relationships.

EAET has four components

1. The first part is education about, among other things, the relationship between stress, emotions, and chronic pain; about chronic pain in relation to changes in brain structures resulting from negative experiences and repressed emotions; and about opportunities to turn those changes for the better by working with emotions.

2. The second part guides patients to recognize and express traumas and psychological conflicts in their lives that appear to drive their pain, by talking and writing.

3. In the third part, patients are guided to express the emotions that they have been avoiding or blocking. In particular, it deals with three types of emotions: anger toward sources of hurt; vulnerability and intimacy toward sources of attachment; and compassion and forgiveness toward themselves.

4. The fourth section guides patients to communicate more effectively and helpfully with their relationships and express their emotions and feelings.

Possible risks

‍Although EAET seems more effective in treating persistent physical symptoms, it is not necessarily appropriate for everyone. EAET is associated with greater risk than other psychological treatments for chronic pain. Sometimes patients become more upset or experience an increase in symptoms as they begin to address emotions and feelings that have been avoided for years. EAET may not be appropriate for people who have difficulty regulating their emotions, who dissociate or who tend to hurt themselves or others when memories or feelings are activated.[6]

Psychophysiological Symptom Relief Therapy

Psychophysiological Symptom Relief Therapy (PSRT) is a treatment for pain symptoms similar to Emotional Awareness and Expression Therapy (EAET).
The premise of PSRT is that pain need not be chronic, but can diminish or disappear when underlying stressors and avoidance behaviors are addressed. This is in contrast to many other treatment methods and therapies that assume that chronic pain is untreatable, and focus on learning how to cope.

In PSRT, the patient is educated that it is mostly emotional processes that cause the pain symptoms, rather than that the pain has (exclusively) a physiological/physical cause. Chronic stress and avoidance of negative emotions and feelings are important factors underlying the symptoms. Patients learn that the brain can reduce pain experiences but can also amplify or worsen them; that pain can be maintained through fear and avoidance; and that it is possible to retrain the brain to reduce pain. In addition, patients work on emotional awareness and expression, and exposure to fearful situations, among other things.

Pain-related anxiety

The main theme of PSRT is pain-related anxiety. Pain-related anxiety can result in hypervigilance to bodily sensations, making a person more aware of painful sensations. They experience pain as more severe and actively avoid potentially painful stimuli. This process paradoxically leads to more pain, discomfort and disability. By addressing pain anxiety through neuroscience education and experiential exercises, PSRT aims to reverse this process.

Research shows that PSRT is more effective in treating low back pain (Low back pain) than treatments with Mindfulness Based Stress Reduction alone, or traditional treatments such as with pain medication.[7]

Concluding: not just spiritual garbage

Emotions express themselves physically, this is not just spiritual garbage. There is convincing scientific evidence for the influence of the brain, thoughts and emotions on a multitude of (chronic) physical symptoms. Approaching health and illness from biopsychosocial perspectives makes it possible to combine traditional evidence based medical treatments with psychosocial insights and treatments, as best of both worlds. Acknowledging the influence of psychosocial factors and emotions and placing as much value on them as on biological factors can help reduce and prevent disease burden. The patient can be offered an integral approach. After all, humans are an integral whole of body and mind in the context in which they live, and treatment should match up with that.

‍

References

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