The Aspiring Psychologist Podcast - The Psychology Behind Chronic Pain, Fatigue & Nervous System Overload - Dr Sula Windgassen

Starting point is 00:00:00 I think I'm a pretty good judge of character and I love sharing tips and tricks with people which genuinely help them to run their clinical practices more efficiently. This episode is supported by WriteUp and they're a brand I've been using in my own clinical practice for over six years. I really do genuinely rate them and use the Write Up platform for each and every clinic session I book or conduct. That's why I'm so happy to be working with them. In case you don't know already, Write Up is an all in one practice. management platform built in the UK for UK clinicians. So that's your diary, your client records, your notes, your invoicing, your secure messaging, all in one place, all GDPR compliant,

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Starting point is 00:01:30 What's not to like. Now on with the show. When it comes to physical health, people are so often told your tests are normal. And of course, what they then hear is, so this is all in your head. But what if that's based on a complete misunderstanding for how the body and mind actually work together? In this episode, health psychologist Dr. Sula Wingasen and I explore pain, chronic illness, UTIs, adenomyosis and so much. more. We grapple with why feeling dismissed can be so psychologically devastating and how people can begin to take control once more.

Starting point is 00:02:07 Hi, welcome along to psychology actually. I'm Dr. Marianne Trent and I'm joined here today by Dr. Sula Wyngasen who is a health psychologist. Hi Sula. Hi, thanks for having me. Thank you for being here. You first took my attention because of thinking about I think some of your personal struggles with health. and perhaps why you got into kind of health psychology to begin with. Could you guide us through a little bit of that? Yeah, absolutely. So I started having problems when I was in my early 20s after graduating my psychology degree,

Starting point is 00:02:49 which started with recurrent urinary tract infections. They would come, they would kind of clear up with antibiotics, but then they'd come back and they evolved and changed and then started confusing people and doctors. I was in and out of different departments trying to get answers and not really getting any. And that whole experience made me incredibly depressed and hopeless. And I think being in that place for a relatively short period of time compared to, you know, what I know it can be like for lots of other people, just really shocked my system.

Starting point is 00:03:28 And when I started getting support and little rungs that gave me a little bit of hope, which allowed me to start changing things, when I got a bit of momentum with that and I started recovering, it solidified to me that I really had to understand why I was getting better. And a lot of that was to do with health psychology and these mind-body processes. So I went back to do a master's at King's College London in Health Psychology to explore that or more. But I think the thing that I come back to again and again, because I loved health psychology at undergrad, which was just one module that I was taught.

Starting point is 00:04:11 But I didn't know it was a career. And who knows what would have happened if I wouldn't have got ill, but it really, yeah, it really has given me the passion and undying interest in all of these processes. Yeah, I should just say for our audience, if anyone's interested in hearing more about the psychology kind of career for health psychology. There's another video on health psychology and it as a career, which I will link in the show notes. Okay, so, you know, the title of your book's very clever. Well done. Don't know if it's your idea or your publishers.

Starting point is 00:04:43 So it's all in your body, which of course is kind of a little tongue-in-cheek play around with that term that you probably perhaps did hear yourself like it's all in your mind. But what I really liked about this book is that it really kind of de-shames the person's experience. So I'm reading it as someone that has a physical health diagnosis themselves. We might cover that shortly. But also I'm reading it as a clinician and thinking about, oh, I've never actually thought about the impact of psoriasis and migraines and kind of recurrent, you know, urine retract infection. So I really liked it from kind of that perspective. But it's that, it's that pivot. It's a gentle, curious holding of the idea that maybe this isn't just about you and the way you're thinking about something that I

Starting point is 00:05:39 think is really powerful, Sula. Yeah. I mean, that phrase, it's all in your head is something that people do explicitly get told, but often they implicitly have it, you know, communicated to them, the tests came back normal. So therefore, this is a mental figment of your imagination, or this is a stress problem, or this is an anxiety problem. And what I explained in the book is that because we're socialized to think about the mind and body as very separate things, what that infers is A, this has got nothing to do with biological processes and B, this is all your fault then. Like it's your thinking error, it's your feeling error and you've got ultimate responsibility over that. But if we actually understand how interrelated our psychological experiences are

Starting point is 00:06:35 with our biology, with what's happening biologically in our body, very physically, then that phrase, it's all in your head, becomes a nonsense because everything is all in our heads, bodies and wherever else it's being transmitted, you know, our thoughts are physical processes, our emotions of physical processes, and we just can't unentwine, you know, one thing from another. But the other thing is when we recognize that there is this ongoing interrelationship between these two things, but you also recognize that you can't dichotomize the cause like that, because, you know, even for somebody that's got an observable, injury, tissue damage or what have you. Yes, there's very biological, observable processes going on that

Starting point is 00:07:24 you could see, you know, if you were to open up the body or on a scan perhaps. But there's also additional processes, biological processes that we can't easily see that are massively impacted by how that person's feeling about that injury, how they're behaving around that injury, are they going back to try and work out too soon? Are they completely resting up so that they don't cause any injury about their perception of what that pain means, whether it means I'm healing or whether it means things are going to get worse. All of that has an effect physiologically in the body. And it's all of these multiple different elements that ultimately influence, you know, what happens with our physical experience as much as our psychological experience.

Starting point is 00:08:08 Yeah. And I think some of the trickier aspects of this is like you said, you know, when you become that head scratcher case that the medics are like, oh, I don't know then. Like, I don't know why this is happening. And when it comes to autoimmune conditions, you know, like inflammatory bowel disease or, you know, things like chronic fatigue syndrome or, you know, other conditions that people are like fibromyalgia, for example, that feels very judgy. It feels like it's about something that you've done before or you're using your thoughts incorrectly or your, you're somehow mismanaging your body and and then that's leading to that and because there's not always that treatment there isn't always the magic pill I think probably similar to me with I've got a

Starting point is 00:08:56 condition called adenomyosis you just get stuck with it holding it thinking well I just have to accept it and just put up with it however bad that gets it's so hard because one of the things that I try and straddle in the book is this heightened sense of responsibility and, you know, the knife edge of that being flipping over into self-blame or self-criticism because of precisely these wider social experiences of health. So if you went to the healthcare system and you were told, right, you've got inflammatory biol disease, this is what it is, this is what the treatment path looks like, this is what we're going to do to help you manage. But alongside that, we know that we know that. We know that stress physically affects the body. And so these are some things we can give you support with.

Starting point is 00:09:46 That is not at all stigmatizing. It's supportive. It's not being like, this is all on you to figure out. And so we can perhaps cope better and have more optimal outcomes in that scenario. But the problem is, again, people experience varying kinds of support with IBD. It tends to be better than if somebody gets condition diagnosed, I mean, yeah, like adenomyosis or endometriosis, often that's just put on the table as you've got this, we'll probably be able to manage it with hormones, maybe, or if you're lucky, or you get denied that you have anything for a long time until, you know, there's some kind of definitive thing that often is from you pushing for it. And the journey of that then implies this is not our problem as the medical system.

Starting point is 00:10:36 system, this is your problem, and it's all on you to figure that out. And when you finally do, yeah, if it's met with a lack of sense of, here's the appropriate treatment pathway, and by the way, this is probably being very stressful for you, and it's probably changed your life in lots of different ways. These are some things that we'd suggest, and these are some support services you can get to help you adjust to the life changes that you've had, that would be so much more destigmatizing and I don't think people would grapple so much with, oh, it's my fault then. It's this culture of, no, you don't have anything, no, you don't have anything, oh yeah, you do have something, and lack of continuity of care, which feeds this message of it's all on you.

Starting point is 00:11:21 So a big point that I make in the book is, yes, there are things that we can do to work with our bodies and to work with our psychological experience of the difficulties that arise when health, you know, is impacted. And that's super important because it has protective benefits and it helps us with healing and recovery, whatever that looks like in the various different forms. But we shouldn't be putting all the responsibility on ourselves. We do actually need social safety. And that looks like supportive friends, supportive partners, a healthcare system that actually can meet you and support you rather than, you know, leave you feeling like you're on your own with this to figure out. and unfortunately there are systemic issues that makes that hard to access a lot of the time.

Starting point is 00:12:08 Yeah, absolutely. And I think because we are all so different, but we, I think can sometimes struggle with kind of that theory of mind in thinking that anyone else has had a different experience to us. And, you know, when it comes to things like periods, you know, I think I just always thought, even from my teenage years, that everybody else had really awful, painful periods.

Starting point is 00:12:30 So even when I was a teenager, I spoke to one of my childhood friends about this recently. I was like, do you remember on the first day of every period, I'd be ill from school because I'd be being sick. I'd be being physically vomiting. She's like, yeah, like you really struggled, didn't you? But I just thought everyone did. And then, yeah, like really painful periods.

Starting point is 00:12:52 But in the end, I stopped taking kind of even any painkillers. So I just thought, well, this is just something I've got to put up with and deal with and learn and accept. And I think they haven't always been super heavy. They've got much heavier as I've got older. And I don't know if it's because I've had two cesarean sections as well, and that hasn't helped matters. But what I also didn't realize until I googled even last, I think it was last month,

Starting point is 00:13:16 that adenomyosis is probably one of the reasons why I'm never going to have a flat stomach, at least while I'm still menstruating, because actually you're more likely to have, you know, to look about four and a half months pregnant, which I do. And which kindly a young child did say to me. recently. Are you seeing a baby? And it's like, oh, no, I'm not, I'm not that judgment and that blame and that kind of internal. I go, I go to the gym, like a, you know, few times a week. And why have I not got a flat stomach? Because I work hard and I, you know, I eat reasonably well.

Starting point is 00:13:47 And yeah, like, for me, learning, well, that's, that's, that's likely why has been useful. But I was never, I wasn't told that at the point that I was diagnosed. I was literally just told the name and that's probably that's it then there you go it's terrible really isn't it because it's such a big diagnosis to get and to receive it without any information any checking out you know what what care needs might you need from this or what your options might be again it all feeds into that sense of also you know if anything's to change it's all on me it's a reality at that point because nobody's doing anything for you, no one's saying, let me help you understand this.

Starting point is 00:14:33 And also the interesting thing there, Marianne, when you're talking about assuming it's normal, we have so much of that, again, natural disposition, you know, we're like lobsters in a pot, slowly being boiled alive, we don't realize, you know, we get big tolerance to these things and assume, well, this is just the way it is, especially if we're not having conversations, like no one's having conversations with us about what's normal, what's not normal, what requires or deserves extra looking into.

Starting point is 00:15:06 And as children, as teenagers, we're the least well equipped to advocate for ourselves potentially because we just don't have any point of reference. And so unfortunately, this is, you know, such a common story for conditions like adenomyiosis and endometriosis because there's the gender issue as well of like women's suffering is normal. you know, it's just periods. That's just what it is. You just have to get on with it. And women are so socialised not to make a fuss and be a burden. So we, yeah, we internalise. And that's made more difficult because then often when people have gone to the doctor, even early on in their, in their journey in adolescence or what have you, a lot of the time, the same message comes back of like, I will, you know, at best we'll put you on the pill, but there's no, like, let's explore this a little bit more. And so the theme that comes up again and again, which I talk about in the book and

Starting point is 00:16:05 which comes up again and again in my clinic is, you know, this sense of insignificance and not really important. Like, whatever you're dealing with isn't that important to anyone else. It's just, and if you're having an issue with it, well, that's your thing and you just need to work that out on your own, which is such a threatening experience. And I talk about how when we think about trauma, we think about, you know, the being in amongst all of the physical suffering maybe. But I hypothesize and we're doing some research, my colleagues and I at Kings at the moment, to explore this a little bit more. I hypothesize that actually one of the things that kind of embeds the traumatic nature of this in the brain is the fact of there's suffering plus the message surrounding the brain. that of you're not going to be helped so you're stuck with this and that's truly you know

Starting point is 00:16:58 horrifying how you know you can suffer and be like well at least i know that i've got this care and that's so relieving but if the message coming back again and again is it's all on you and nobody else is going to save you that's that's really really scary and causes extreme stress and we know that the brain kind of changes how it processes things when when under extreme stress and that's such a repeated and common experience unfortunately yeah And I only went to the doctors about this when I was 43, I think. And that's because I thought I was having some symptoms that indicated the perimenopause. But I probably started my periods when I was 13 or 14.

Starting point is 00:17:40 So that's, you know, 30 years that I just chugged on with it. And, you know, maybe there was treatment. Maybe there wasn't treatment. I guess I perhaps thought, well, maybe the treatment would be removed my uterus. and I don't want that because I want children. But, yeah, like, people aren't asking you generally, how are your periods? Like, that's just not something that we ask each other even as women, I don't think. No, it's not.

Starting point is 00:18:08 Yeah, there's such a role for increasing awareness and having these conversations. But it's tricky because, in fact, I presented something recently to the pelvic pain network. and I think to a conference as well, where we've got this interesting thing at the moment of a disparity between the increasing awareness of some of these issues, including gender health inequality, but we are not seeing any change to systems or policy or care. And that actually creates more problems because you have higher threat anticipation. I'm not going to be helped. and then you have that actual experience. So we do need systemic things to start shifting.

Starting point is 00:18:58 We do. And I think growing up and even, you know, if you watch a few TikToks or Instagram wheels, it's thought that a really good partner is the sort of partner that when you're having a period, we'll go out to the corner shop and buy you some chocolate and make sure you've got a hot water bottle and, you know, get your favourite sweets

Starting point is 00:19:18 and, you know, give you the remote control. And one of the things that really struck me about your book is maybe when it comes to periods, some of that might actually make it worse. Can I ask you to explain a little bit about what I mean, Sula? Yeah, let me give some context. So in the book, I talk about this process of psychobiological loops. So what I mean by that is we have, let's say, changed physiology because of something like hormonal fluctuations at different points. parts of our cycle. And as a result, we'll then have changes to our psychology. That will be like our preferences, what we're seeking. It will be, you know, our emotions, of course. Like most women,

Starting point is 00:20:04 I would imagine, can have that reference point of coming on their period and having some kind of mood change. For me, it was like extreme rage and then being like, oh, I don't know, a few days later when it all cleared being like, hmm, I don't know why that made me so angry. So we have these changes that are influenced by changes in our physiology, but the changes to our psychology can then also impact our physiology. So, you know, that's a good example of hormonal fluctuations might increase anger or sadness. You then naturally can react on that basis. So maybe that's having a big argument or snapping at your partner or it might be, you know, being very tearful. And some of that's absolutely fine, but some of it might actually then cause difficulty.

Starting point is 00:20:54 So let's say like interpersonally, if you have argument with your partner and they're not particularly understanding and, you know, having a bad time themselves, then that will create tension. That adds stress. That then feeds into our physiology. And so we then, you know, have this like building snowball effect of different factors feeding into, you know, just the baseline changes in physiology. And then one of the points that I make in the book is that sometimes these, you know, changes in our physiology that we've got no real control over just is the way it happens, end up steering us down roots that aren't particularly helpful for us. So in regards to menstruation, I think I give the example of like that might make us create for sugar more,

Starting point is 00:21:46 but then having that extra sugar can then actually have an impact on our hormone levels and have an impact on our body and how it's processing different things, which actually can have impacts on our mood and make our mood worse. And even, I think, exacerbate pain depending on, yeah, obviously it's different for different people. But so a lot of the time what's happening below the surface are processes that we're being steered towards because of our physiology in ways that actually don't serve us and when we understand some of the mechanisms and we can identify that we can choose different options which isn't always easy often it's not easy at all but it actually can interrupt some of these psychobiological loops yeah it can and i was being a little

Starting point is 00:22:34 bit cheeky because obviously a supportive partner is always what we would want for someone but it was yeah, the kind of reaction of sugar and estrogen and that interaction that can actually potentially make things worse that I hadn't actually realized. And you also talk about another concept called biology balancing behaviour. How might, what does that look like? How might that show up for us? So this relates to a concept that I talk about in the book called Allostatic Lode. So Alastatic Lod is this cumulative physiological buildup of stress in the body. And that can happen across lots of different biomarkers. So changes to cortisol, not always in one direction. It can be a buildup of cortisol. It can be a reduction in cortisol.

Starting point is 00:23:22 It can be changed in our heart rate variability, our blood pressure, our cholesterol, lots of different biomarkers of allostatic load. And essentially, alistatic load can happen because we have too much stress, which is one that's quite intuitive for us to think about without adequate reprieve or moments of restoration and replenishment, and that builds and builds. But allostatic load can also happen because we get insufficient stress. So our kind of systems aren't worked out enough. Essentially, what we're aiming for is flexibility across lots of different systems, not just our nervous system, but our different regulatory systems like our cardiovascular system, our metabolic system, neuroendocrine system, immune system, we want it to be nice and responsive, which means kind of

Starting point is 00:24:10 like activating and deactivating and what have you. And so when it comes to, you know, behaviours that serve our body to balance things across these regulatory systems, we need to be thinking about this principle of consistent little and often, rather than these big overhauls. So So society we're not really socialized to this because if you think about how holidays work, even in school periods, you have like a big wedge of term time and then you get two weeks off. And then you have a big wedge of term time and then you get a week off and so on and so forth. And then at some point you get six weeks off. So it's very much just like condensed, kill it, learn, get assessed.

Starting point is 00:25:00 Then you can have two weeks off. Then you're back into it. So what we would call like a boom-bust pattern, also the working day, the way, you know, we're socialized to have it is you get up, you then do like a big wedge of work throughout the day and then theoretically you can have the evening off, although many people don't have the evening off. And then same pattern throughout the week. Throughout the week, you do all your work and then on the weekend theoretically you can relax. And because we live in this kind of capitalist society, it's very much about, you know, cramming productivity and output. and earn your rest. So what this means is for biology balance behavior, we're not very good at balancing different behaviors and habits. We tend to, you know, have these big condensed periods

Starting point is 00:25:48 of doing different things that are completely disparate. So it's do something towards productivity and then rest. If we think about how that then kind of feeds into what we're thinking about is important to replenish our bodies, we don't necessarily think about the habits that need to be sprinkled throughout our days, throughout our weeks, consistently. That includes things like restorative rest, not just a lack of doing anything, which for most people now, that means they are still doing something, they're picking up their phones and they're scrolling or they're watching TV because they're so zoned out because their brain's overtaxed. So the principles of biology balance behavior are really simple.

Starting point is 00:26:34 There are things that everybody knows about. You know, it's eating regularly, eating, you know, healthily, having some movement, socially connecting, getting outside in nature, doing things for pleasure, all of those cornerstones that we can readily think of. But it's about actually trying to apply them. in our lives in a way that is consistent and more regular rather than I'm going to do all of this stuff that accumulates this allostatic load potentially and then, you know, then I can do that. So it's not groundbreaking stuff in terms of what it is, but it's more in our approach of how we

Starting point is 00:27:17 allow ourselves to engage in it. I'm with you. So my youngest son, who's nine, he gets migraines. And so this kind of gives me some evidence that actually my approach only allowing a half an hour fluctuation in his bedtime, even on holidays, really, unless we're a way away, because that means we're less likely to get migraines. So that builds up that evidence base for why I'm doing that then. Absolutely. It's so key that, you know, yeah, sleep is a big one. And especially when you have something like migraine or chronic headache, circadian rhythm plays a massive role. And having that regular kind of sleep window wake time just really, really helps a foundation. Obviously, it's not the whole picture. But without it, then everything else is a bit more different.

Starting point is 00:28:08 So yeah, absolutely. Yeah. And there can be so many decisions to make when you're just living a modern life, but also when you've got health conditions or diagnoses, more and more decisions. And I think it's said that women carry more of the mental load and make more decisions about household things day-to-day. If you are not a woman and you're listening to all this watching this, feel free to disagree. But that's, I think, generally said to be understood.

Starting point is 00:28:39 But I really like something in the book where you talk about glutamate, which is not something I've ever heard of or considered. Tell us about glutamate. Yeah, so glutamate is this, I think it's a protein that gets released as we're, well, from a lot of things, but when we're making decisions, we have this buildup of glutamate. And the more decisions we make, the more that's produced. And the relationship is, the more glutamate build up, the more we require sleep to clear it. And then we start again and we were theoretically back at our kind of baseline and so on and so forth.

Starting point is 00:29:23 And what people don't really know is that relationship between those cognitive processes of decision making, every new decision then, you know, is a metabolic toll essentially and influences this buildup of glutamate. And like you say, in our modern day lives, there's so many micro, mini decisions. So that's all influencing this very physical process. And then if you add on top of that things that we do to try and zone out, like phone use, that actually brings in more micro decisions. Do I want to watch this? Do I want to press like? Do I comment do I want to make? Do I want to go to the next one? What does this mean about this? Oh, that makes sense. On to the next one. So even our ways of kind of zoning out actually go the opposite direction in terms of like what they do to us physically.

Starting point is 00:30:18 Rather than restore, they actually deplete. And then if we add into the mixed chronic illness and decisions about health and decisions about your body and trying to home into what a particular sensation means, you can see how that quickly escalates how many different micro decisions and thinking processes you have to engage in and how that then direct. can correspond to fatigue. Yeah, absolutely. Should we be then trying to down tools a bit more often and have no decisions? You know, would reading a book still cause glutamate to be released

Starting point is 00:30:56 or not so much? Not so much because we're being led along and we're reading. And yes, we might have other little thought processes, but we're engaged in something more akin to like a flow state of our imagination kind of going with the book. But I think I talk about this in the book as well. I'm pretty sure I must talk about this in the book somewhere. There's something called the default mode network, which is like a network of different brain regions that work together.

Starting point is 00:31:30 And essentially, when we're engaged in goal directed thinking, the default mode network is not active. So we're engaged in, you know, the cognitive processes that would lead to this buildup of glutamate, and that's quite metabolically heavy. When we're allowing ourselves just to freethink and we're not trying to analyze or problem solve or, you know, do all of those things that we're so readily doing by just our kind of automatic pilot. So that might be like having a daydream or just, you know, sitting there allowing the thoughts

Starting point is 00:32:05 to go, which not many of us have time for, prioritise, that's when our default mode network activates. And the default mode network activates in that cognitive state of like free flowing thought, not goal directed. And the benefits of that default mode network activating is that it allows us to emotionally regulate. It allows our brain to be more creative. It actually ends up helping us problem solve. It might not be right in that exact moment, but I think about it as like there's pieces of the puzzle line all the way around your different kind of brain regions and networks. And when you're kind of engaging goal directed thinking, sometimes that can be really strategic and be like this bit, this bit, this bit, okay, brilliant. But often we're just like, oh my God, I've got no time.

Starting point is 00:32:54 And is that, is it that bit? Is it that bit? Whereas when we're allowing our default mode network to activate regularly, our brain's kind of like slowly turning over and it's pulling that bit. It's in that bit and they're getting a little bit closer and then before you know it like days passed or some hours have passed and then you can suddenly see it more clearly and people will have experienced that when they're like really trying to figure something out then they go for a walk and they come back and they're like you know what let me try this and it works you know that's that's the default mode network in in action so there's so many different benefits of that default mode network activation, but it involves us doing something that's now quite counterintuitive,

Starting point is 00:33:34 especially because we don't have that downtime if we're using a lot of digital technology when we're not engaged in our tasks and our obligations. So one of the things that I kind of expand on in the book is it is really important to have just many moments of allowing your brain to be free-flowing. And that can actually be very threatening to a lot of people when there's a lot of difficult emotions, a lot of difficult thought processes. So you can set it up so that it feels safer. That might be like listening to music that stimulates a particular mood or it might be just watching the birds out of the window. So, you know, you've got a benevolent kind of focus and then your brain can do its thing in the background.

Starting point is 00:34:20 But it's really crucial that we make that a safe activity to do regularly. Yeah, it feels like it's a very important user manual for the brain, all of this stuff, really. And sometimes we can be our own worst enemy, can't we? And it's that idea of the mind and the body, which you described in the book, when you're communicating fearfully but also reactively. Could you give us a little example, perhaps using, you know, recurrent UTI infections, to give us an idea of how that might play out? Yes, so I can use my own example, really.

Starting point is 00:34:56 So I think the first thing to recognize as well, going back to the point that we made at the beginning, we will so quickly assume self-blame and like we're doing something wrong if we're having particular thoughts or feelings. We'll claim that as like a fault of our own. And we have to recognize it's not. It's natural. Just like the physical sensation is something that we can't control at the outset. It's just there. So is the natural thought processing that comes with it. what's important is we know that we can interrupt things going forward, maybe not acutely in that very moment, but when we become aware of it, we already start changing things and then when we start to practice relating to it in a different way, we can start changing things. But the default

Starting point is 00:35:43 isn't a character flaw, it's just natural physiological reactions to something threatening. So for me, when I was getting these horrible symptoms, which are very threatening in their own right and very disruptive and feel awful. So let's say that kind of burning sensation and I feel like I can't get off the toilet. I will get that panic in my chest, in my stomach even. I will then automatically be focusing on this sensation. Oh my gosh, it's terrible. I can't move like this. My brain then skisks. ahead, you need to be at work in 45 minutes, how are you going to get to work if you're feeling like this? Oh my gosh, you'll have to take another sick day. They're going to be really angry with you. What if this doesn't clear up by tomorrow? What if this keeps happening? So on and so forth. And you can see, just even me describing those thoughts, they're fair enough thoughts. You know, I need money to survive. I need to keep my bosses happy to keep my job. So like, it's not like any of this is unfair cognitive processing and the panic is just natural.

Starting point is 00:36:51 But the problem is what all of that surmounts to is the attention remains fixated on two focuses of threat. The thoughts of projecting what the threats might be in the future and the physical threat in the moment. And then you're not really getting an opportunity for any alternative to bring in safety in that moment. You're trapped between a rock and a hard place, your thoughts and your physical sensations. So one of the foundational things that I have people practice when we first start working together is trying to get out of the habit of sinking in those moments of acute panic and physical discomfort and often counterintuitively to a lot of people starting to get into the feelings and the body to then soothe and calm the system down because when we're in that autonomic,

Starting point is 00:37:46 sympathetic nervous system zone, it's just going to feed those fearful brain processes and we're just going to get trapped in all of the understandable cognitive spirals. So, you know, there's so many different ways that we can physiologically soothe, but we know one staple is just changing the breath, trying to extend the exhale. So it's longer than the inhale, slowing everything down. That directly feeds back into this sympathetic nervous system and starts to balance things. But it also gives a different attentional point of focus. So it doesn't have to be on the thought stream or the physical sensations in the bladder. And when there's a little bit of space there and it's not quite so frantic, then we can step into options, you know, and the options

Starting point is 00:38:31 in that moment of acute panic or acute crisis, we want to ring fence so that they're very much in the present. They're not projecting forward. We can get to that stage, but we give ourselves permission of like, what's the thing now that's going to serve me? Shall I stay on the toilet for a little bit longer and see how this goes. Shall I get a sashay? You know, that might soothe my bladder. Shall I go, you know, get somebody to bring me some water? So we can think about the here and now a little bit more. And then, and then from there, you know, we can add in different things to help. But I think one of the expectations that people have is my intervention that I have in this moment has to switch everything right around. Otherwise, it's failed and it's not worth it. And that

Starting point is 00:39:18 And that's one thing that then ends up keeping us stuck because often we don't have a route for that in the moment. But if we have a route for calming the system down a little bit, that opens a little option over here, which then can open a little option over here and so on and so forth. And all of these things take practice for them to work quicker and more enduringly. Yeah. And you've really wonderfully described how you can take what feels like something that's outside of your control and then be able to pull on the threads that you actually do have

Starting point is 00:39:52 some control about that then really make you feel better about the whole thing. And then you can get those moments of deep exhale, which then actually are going to make you feel ultimately better anyway, because your system isn't so stressed and aggravated. Yeah, absolutely. And people really surprised themselves of how much influence they have over their state, even when they're at very heightened levels of panic or physical discomfort. And often when I'm working with people, we're doing it together to begin with. And I'm even surprised at how quickly their state changes. And when they've had that experience once, whether it's in company or on their own,

Starting point is 00:40:33 you know, their brain and their body has a point of reference of like, I've been there once, I can get there again. And even that creates a little bit of hope and curiosity in a moment that otherwise is full of despair and feeling trapped. Yeah, I think for me, you know, reading your book, it really is a really nice manual of hope for people that might be feeling despair. So yeah, if people want to grab a copy, check it out. Is there an audio book as well? Is there an e-book?

Starting point is 00:41:02 Yes, there's an e-book, everything. All of them are available. And it's called It's All in Your Body, a practical roadmap to healing through mind-body connection by Dr. Sula. Wengasson. Where can people learn more about you and your work? Are you on Instagram, Sula? I'm on Instagram. My handle is at the underscore health underscore psychologist underscore. I have a YouTube channel which is at the health psychologist and it's got a lot of episodes of a podcast of mine that's just come out which is called How We Really Feel, which is a deep dive particularly into bladder and pelvic. conditions but it's very relevant to people navigating chronic illness generally as well

Starting point is 00:41:50 and then there's my website which has got lots of free resources which is healthpsychologist.co. com. Amazing. I will make sure that all of that is linked in the show notes. Thank you so much for your time and for illuminating our audience on this really, really important area. Thank you so much for having me. You're so welcome. Thank you so much again to my guest. Please do check out her book. It's all in your body if you think that might be useful for you. And a little plea, as an author myself, if you ever read a book that you really like, please do leave a Good Reads Review, an Amazon review, something that helps people know it's a genuinely helpful resource. If you've got ideas for future episodes that you'd like

Starting point is 00:42:33 to see me hosting psychology, actually, I would love to hear from you. I'm Dr. Marianne Trent, wherever you are on social media, or you can just pop a comment on any of my YouTube videos. If you are interested about the experiences of people on their way to becoming qualified psychologists, I think you will like the Clinical Psychologist Collective, which despite the title doesn't just feature stories of clinical psychologists. We have another couple of different psychology disciplines in there as well. You can get that from Amazon and please, like I said, if you do like the book, I love it if you'd rate and review it.

Starting point is 00:43:15 If you've enjoyed health psychology, I think you'll really like this video that I did hear with Nicola O'Donnell, who was at the time a trainee health psychologist, but is now fully qualified as a health psychologist. If you're a fan of the podcast and you'd like early access, please do consider subscribing to the podcast,

Starting point is 00:43:35 which you can do on Captivate, on Patreon, on YouTube, and on Apple Podcasts. I think I'm a pretty good judge of character and I love sharing tips and tricks with people which genuinely help them to run their clinical practices more efficiently. This episode is supported by write-up and they're a brand I've been using in my own clinical practice for over six years. I really do genuinely rate them and use the write-up platform for each and every clinic session I book or conduct. That's why I'm so happy to be working with them. In case you don't know already, write-up is an all-in-one practice management

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The Aspiring Psychologist Podcast - The Psychology Behind Chronic Pain, Fatigue & Nervous System Overload - Dr Sula Windgassen

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