Why I don't talk about brain retraining programs
It's not my role
I recently received a question on my Ask Dr. Talia form about why I don’t use my platform to talk about neuroplastic pain and Pain Reprocessing Therapy (a manualized therapeutic brain retraining approach) in order to provide hope for people. I thought deeply about this question, and this is my response.
Everyone with chronic pain or illness has worried that it’s all in their head.
Then bring in the plethora of research showing that the brain does in fact impact our pain and illness symptoms, and things can feel dicey.
The idea behind brain retraining and pain reprocessing therapy is that some chronic pain pathologies are “psychophysiologic processes that can be reversed” and “result from the brain misinterpreting safe messages from the body as if they were dangerous” (quotes from the links above). For many, this includes addressing central sensitization, where the nervous system remains in a high state of reactivity, leading to more pain signals.
Despite the cause of the pain originating in the brain, this framework still stresses that the pain is very, very real.
My own perspective
I’ll start by saying that I believe in the power of brain retraining, neuroplasticity, and working with central sensitization. I have used brain retraining programs like Curable to success in the reduction of some of my symptoms some of the time. There is promising data that some people go into remission through these programs. This is great news! Amazing! And while I don’t call it brain retraining, I do use some of the same frameworks in my work with coaching clients.
But here’s the nuance: brain retraining programs weren’t helpful for me seven years ago, and what they did instead was induce shame around my body. Seven years ago, I was focused on finding help for symptoms that had no explanation, and I wasn’t in a place where connecting pain to my thoughts would have made sense. Brain retraining would only have (and it did) heighten my emotional anguish.
For pain reprocessing therapy to be effective, an individual needs to be in the right place. They need to feel safe enough in their body that approaching the brain as a contributor to pain can make a meaningful difference.
And the truth is that even if someone is ready for it, pain reprocessing therapy and brain retraining Programs, while proven effective for some (including myself, mildly), do NOT work for everyone. And more importantly—and I really want to stress this—do not work for everyone at every given time.
The cost I see for people who have engaged with brain retraining
What I see regularly is that brain retraining programs and clinicians practicing pain reprocessing often do a great job teaching the skill—and for many, reducing pain—but not at instilling self-trust or connection to the body, which I believe is the key ingredient to living well with a chronic condition.
So we need to admit that for some people engaging with some brain retraining programs or working with some clinicians, the drop in pain isn’t worth the self-distrust these programs can breed.
I’ve worked with clients who have so deeply internalized the messages of brain retraining that they lose contact with what they need, what they believe, what actually works for them.
And more concerning, the belief that they are to blame for their pain—because it originates in their head—can become so deeply embedded that it creates a harmful feedback loop:
Pain
→ “gotta change my thoughts!”
→ temporary relief
→ distrust and dislike of thoughts
→ disconnection from the body
→ inability to sense what will be painful
→ pain
→ “gotta change my thoughts!”
Quick Announcement Break — Podcast Appearance!
I’m featured on The Accrescent Podcast with Leigh Ann Lindsay! We had such a rich conversation discussing grief, acceptance, hypervigilance, and self-trust when living with chronic illness.
We also provide some actionable tools. I’d love to know what you thought if you listen.
Listen here.
What’s missing in research on neuroplastic pain
The major measured outcome in research on neuroplastic pain is pain reduction. Duh. Of course this matters to people living with chronic pain, and multiple studies show sustained reductions even one year out.
That said, I have yet to see a study measuring connection to the body or self-trust—outcomes that I would argue have a profound impact on long-term success, and that are my primary drivers when working with clients.
My role
When do I believe it’s relevant to speak about neuroplastic pain?
If I were a therapist advertising Pain Reprocessing Therapy as one of my specialties and a patient sought me out? Totally fine!
If I were leading a group program on brain retraining and people opted in? Gucci!
If I were writing a newsletter about how to treat chronic pain? Love it! Show that data!
But I am an acceptance-based coach who helps people trust themselves. Telling people what is right for their bodies is antithetical to my mission. And if I started doing that within the spirit of my strength- and acceptance-based framework, it would induce shame in more people than I care to count.
People who don’t resonate with pain reprocessing therapy shouldn’t seek out a therapist who uses it. People who don’t resonate with my acceptance-based approach shouldn’t work with me. I’m not placing a moral judgment on the types of support professionals provide; I’m simply stating that not everyone needs to subscribe to the same hypothesis about what will be most effective. Clients get to seek out the care that feels relevant to them.
When people subscribe to my newsletter, they have not consented to receive recommendations for their treatment. They have consented to learn about, and think about, the emotional realities of living with a chronic condition. With some points for reflection sprinkled in.
The big takeaway!
Chronic pain and chronic illness are too complex to hold a simplistic view of treatment, especially when it comes to emotional and brain-related approaches. The real power—for those of us who work 1:1 with individuals—is recognizing where someone is on their healing journey and flexibly using the skills that fit their situation.
That’s why I don’t use my platform to speak about brain retraining programs or pain reprocessing therapy. My goal isn’t to tell people what will or won’t work for their body; it’s to empower them to believe themselves and trust themselves to take the next step forward.
——
I am happy that there are others who specialize in brain retraining and who speak about it as expert.
I choose to not be an expert that tells individuals what to do for their bodies.
I’m the expert who helps people understand what they want to do. How they can best support themselves. How they can reconnect with their innate self-trust. And how they can hear their intuition over the loud noise of healing expectations.
That’s my role.
To provide a space that leaves room for growth and wellbeing, without “should”ing or offering recommendations like I know your body and what it’s been through.
Because I don’t.
So brain retraining and pain reprocessing therapy might be exactly what you need at this moment in your healing journey. And it also might not be.
I’m not one to guess.
Sending lots of love for joy and healing always <3,
Dr. Talia
If you’re looking for next steps:
🌻 1:1 Coaching — A space to be supported in moving from fixing yourself toward acceptance, self-trust, and body safety while living with chronic illness.
🌻 My guide, “What I Wish Your Therapist Knew About Chronic Illness” — A resource for purchase that bridges lived experience and clinical care.
You can also find me on Instagram, guiding meditations on Aura Health, and at my website
Some previous posts you may enjoy:
Acceptance isn’t a performance; “I don’t trust my body” they say;
5 ways mistrusting your body shows up in your life
You just explained why brain training programs made me feel worse when I was super sick and without a diagnosis.
I felt I’d failed, and that failure further alienated me from my brain and body.
I was hoping brain retraining was the panacea and cure. It never could be for me.
Now that I have the diagnosis of an incurable disease, revisiting brain retraining could be helpful for the limited relief it might provide.
Thank you, as always, for diving into these topics in an accessible and compassionate way.
As a neuroscientist who’s been through chronic pain, I find this perspective genuinely fascinating and eye-opening.
That sentence you wrote about "despite pain coming from the brain, it still being real" is particularly perplexing to me - it’s like saying, despite inhaling and exhaling, you are still breathing.
In general my impression is that for a lot of people, if they can link something to the brain, it makes it more real to them - I suspect this is why there is so much (often nonsensical) neurolingo out there in the online wellness space. So for you to say that it can be the opposite - just another version of "it’s just in your head", as if it was just a fragment of imagination, is not what I would have expected.
At the same time, it doesn’t surprise me that (some) clinicians have managed to boil brain training down to that & breed the opposite of what we know we need, even though that’s a misrepresentation of what brain science actually says.
Just because something happens in the brain doesn’t mean that thoughts can change it - even if yes, thoughts are something the brain does too.
The neural networks involved in conscious thinking are just a fraction of what the brain does, and the idea that we can control what the brain does is an illusion. The vast majority of what the brain does is not under our direct control - and that includes pain. Yes, we can attempt to modulate it, but how well that works is going to depend on a whole host of things - and not just on "how hard" someone is trying. And to not take all the factors you mentioned into account when doing brain training… is going to undermine what it might otherwise be able to achieve. And notice that I said might - intentionally, cause even if "everything aligns perfectly" there is no guarantee it will work cause brains are complex.
I’m working on a book - and planning on launching another Substack - as well as teaching an in-person “yoga meets neuroscience" course where I go into the neuroscience of chronic pain; I’ll keep this perspective in mind so I can hopefully try to communicate the science in a way that feels supportive rather than invalidating… cause just another version of "it’s just in your head", or "adjusting your thoughts is all it takes" is the last thing I’d want people to take away from that.