Journaling for protracted psychiatric drug withdrawal

One way to reduce the emotional danger at perhaps the heart of the syndrome

Introduction

So today I want to talk about journaling and how writing can be part of a mindbody approach that can ultimately resolve protracted withdrawal sensations. Now I’m not a medical professional or researcher but it is my experience that this can happen because protracted withdrawal sensations aren’t necessarily literal withdrawal or an injury or coming from slowly tapering. Instead withdrawal sensations can be learned by the nervous system over a period of time. This happens when withdrawal brain pathways just fire again and again to the point that they can get wired into the brain’s circuitry. It’s just a form of learning. And now both research studies and clinical trials are showing that people can learn chronic pain, Long COVID without tissue damage, chronic fatigue, and so on. It is my experience and some others as well that people can also learn withdrawal.

Why Journal About This?

So why would we journal about this? Well what seems to help facilitate the brain to learn syndromes like withdrawal sensations that go on and on is an internal danger signal that keeps the sensations alive. In other words our sense of danger is directly involved in the brain’s processing of withdrawal itself by keeping withdrawal pathways firing again and again until they’re a conditioned response that just becomes a part of our everyday reality. Now some of this danger comes from our fear and preoccupation with the sensations themselves or if we think we’re damaged or something’s physically wrong with us. But neuroscientific research also demonstrates that deeper emotional processing—maybe about things we’re upset about—can also drive the learning of pain syndromes. So what’s kind of weird about this is that despite this deeper emotional activity taking place inside us, we tend to feel physical sensations instead or really vague emotions like terror or panic. So the emotional-danger processing then about something bothering us and feeding these withdrawal sensations is a mostly unconscious process. It’s emotions beneath the surface, that we might only feel the tip of that might ultimately be driving the syndrome. 

Now all this might sound kind of crazy but what’s been found in practice and now clinical trials, such as a pair of Harvard studies on psychophysiologic symptom relief therapy on chronic pain and Long Covid without tissue damage (linked above), is that by addressing emotional threats people are highly likely to resolve chronic pain or perhaps other syndromes they were experiencing. This was once thought impossible and still often denied and yet it’s happening. And one technique people are using to do this is journaling.

How Does Journaling Help?

So because protracted withdrawal sensations can feel so terrible these experiences basically preoccupy our entire consciousness. The focus is on: oh my God I’m physically damaged or my nervous system is ruined or sometimes you just want to cry for help. But if the root of these neuroplastic sensations—not permanent but neuroplastic (learned)—if their root is emotional danger, if that’s what’s feeding into this withdrawal processing, then we’re kind of looking in the “wrong” place if we’re framing this as an exclusively physical syndrome. In fact thinking this may actually perpetuate the syndrome by increasing the danger driving all this.

Now according to John Sarno who pioneered a successful mindbody approach to pain that had decades of success before later research and clinical trials further proved the validity of his approach, well, according to Sarno the purpose of painful or mysterious sensations especially when they turn into syndromes is to distract or protect someone from threatening emotions. The emotions, he says, maybe rage or sadness, are just too painful to deal with. So the mind prefers to repress our emotions and possibly redirect our attention onto the body or some other sensation instead. I mean most people do this every day when they use their phones to distract themselves or they drink to stop themselves from feeling. Now whether this particular detail of Sarno’s theory is true or not, we are probably distracted from the deeper emotional processing driving the syndrome if our focus is on sensations of “protracted withdrawal syndrome” and thinking we have a purely physical syndrome.

But what can help shift our perspective though is journaling. Because journaling can help us go beneath the withdrawal sensations and start to acknowledge their actual source: the emotions, the stressors or pressures in life that caused these threatening emotions to arise in the first place. We can then begin to reprocess our experiences by realizing that despite what’s happened in our lives that’s caused us to feel scared, upset, or angry, we’re now emotionally safe. Or we’re upset with things we’ve done we begin to show ourselves compassion. When we reaffirm this over and over again with, say, journaling, we can begin to reduce or cut off this danger signal that’s feeding the withdrawal sensations and they can start to go away and eventually disappear. 

A Word of Caution

Now as I’m about to get into some specific journal techniques I will say that journaling does involve reviewing stressful events in our lives, so if you feel emotionally ready for that then proceed at your own pace, but if you think this might be too much for you at this time then maybe you don’t want to do this, which is totally fine. There are other ways of acknowledging the emotional basis of withdrawal sensations outside of journaling. Journaling is just one way and no one has to journal to resolve withdrawal sensations but it can be helpful so with that let’s get into journaling.

What Do I Write About?

The framework of journaling that I’ll outline here is based on the work of John Sarno and his former group, with some of Howard Schubiner’s adaptions that can be found in his book Unlearn Your Pain; a great book that offers structure to this journaling process. And structure to the journaling process can be really important otherwise you might be journaling randomly and not know when to start or end or when to do it or how to do it—so it can be helpful to have some structure. 

So the first thing we can do is make a list of things that may be contributing to these threatening emotions inside of us and that we can journal about. And to do that we can create three categories: the first category is stressful events from our childhood or our more distant past. These might be longstanding sources of anger, hurt, or emotional pain. Examples might include our parents, a “traumatic event”, school, or religion, basically anything that made us feel unsafe growing up in some way. I think emotions are timeless, they can still affect us long after an event has passed. We can recall an emotion when we think of a long-passed difficult event. Or emotions can be also repressed so we might not feel emotions about a past event but at least we can think of events that might have upset us in some way. So we can make a list of those things.

Now the second category is personality traits or things about ourselves that might put pressure on us. So most people who experience this mindbody stuff—I mean everyone experiences some mindbody stuff, it’s part of the human condition—but for those who might get it worse than others we often have certain personality traits that can generate internal pressures that can help drive this danger signal. This is not to say there’s anything with our personalities—there isn’t—but if you’re like me and tend to be perfectionistic or goodist or people pleasing or very self-critical or have feelings of inferiority or really driven in some way, you always have to be on, all these traits can be explored as generating internal danger that can maintain sensations. Basically how we feel about ourselves can affect how we feel within ourselves. 

Finally the third category is about present pressures in our lives. Whatever’s bothering us right now. I’m not talking about the withdrawal sensations themselves, that’s the surface level, I’m talking about the current stressors that might be causing them. For me, my rage toward psychiatry was a big one. Certain people in our lives also might be great sources of stress. So can finances, lost time and so on, whatever you whatever you can think of.

Now after you create these three categories you can then circle three or four of these things from each one that you think might be most contributing to your situation. Now you have the start of your journaling material.

Journaling Techniques

There are three parts to this particular journaling process and it takes about 25 minutes to complete. The first part is to pick something on your list that you circled and write that item down in the middle of a page or type it out. Then set a timer for five minutes and kind of branch off that central idea and free associate some secondary ideas. In other words write down some things that you associate with this central idea, in a few words ideally, and do it quickly without really thinking about it. Now circle whatever you came up with and connect it back to the main subject. 

After the five minutes pass, your timer goes off, you can pick a topic to actually write about, maybe the central one, or maybe one of its satellite ideas but hopefully you now have some thoughts percolating. You can then open a blank document or with a pen and paper you can start by writing the following sentence: My feelings about me and (your chosen topic) include . . . and then set a timer and write for ten minutes. And free write this; that is, just write as fast as you can and don’t care about grammar or logic or anything, just let the emotions fly and let them come straight from your depths. 

When I did this I was very surprised about the depth of my feelings, the intensity of them, and the things I would write tended to come from my shadow side, things I would never say to anyone or do to anyone, but on the page, you can do or anything. Your mind knows this and it might just take off. So get whatever you can out.

Now when the ten minutes is up, you can set your timer for another ten minutes for one more writing session and that can start with the following sentence: My understanding of me and (your chosen topic) includes . . . Now this is kind of the part where we can process the emotions a bit. I mean still free write and write whatever comes to mind, but maybe aim our writing toward understanding on how these events has affected us. How our minds might be protecting from these emotions. How this might have kept a danger signal going. Also you can ask: were any lessons learned, what actions can we take to protect ourselves in the future. If we’re writing about ourselves can we see that we just did the best we could at the time, with the knowledge that we had, and learn to develop at least some momentary compassion for ourselves. Whatever comes to mind in terms of understanding. 

After ten minutes the timer will go off and you can write the following three times: Understanding these subjects will help me feel better. Understanding these subjects will help me feel better. Understanding these subjects will help me feel better. Now we do this to reinforce the mindbody connection, that the reason we’re journaling here is to acknowledge that this threat of emotional danger is contributing to the withdrawal sensations themselves. And yet this actual emotional danger has passed and we can tell our minds that we don’t need to be protected from our emotions anymore because it’s okay to have emotions. Emotions are safe. We’re safe. And, again, when we’re doing this we’re acknowledging the root of the sensations so making this mindbody connection is essential to the process. And that’s the end of the journaling session. It’s a pretty quick 25 minutes. You can now delete the document you wrote or shred the paper or whatever. It’s not meant to be saved. It’s over now.

Variations

Now there are variations on journaling. For instance if there’s a topic you want to explore further on another day instead of journaling in this straightforward way, you could write an unsent letter to someone explaining how you really feel and acknowledge your feelings toward that person without actually upsetting them or lashing out at them. Or you could write a letter to yourself or your own mind directly, maybe about a personality trait, how a personality trait may have developed, or something you were hard on yourself about and you can develop some compassion for yourself and give yourself the comfort you would give someone else but maybe you’re not giving to yourself. Or finally you could write dialogues between you and someone else if you wish you’d expressed something to someone. Maybe this is a fictional dialogue to change the past a bit in your mind or maybe get closure on something by having a made-up future conversation. I did this for psychiatry for instance. Sometimes it just feels better and gets it out better if we get it on the page rather just going over it again and again in our minds.

Writing Frequency and Limitations

So I journaled I think once a day for about three, maybe four weeks. Personally I wouldn’t do it much longer than that. So it’s not that big of a commitment. There are some other TMS groups that I think make journaling more long-term and might in some ways overemphasize its importance. There are some cautions to consider. For instance some people journal for like months and months and get stuck in the past or they’re frustrated searching for some event or emotions that are the root cause of all this, but we don’t need to hit on one definitive thing, we don’t need some ultimate closure. It’s acknowledging the collection of our experiences that it’s important. 

Also if you journal too much it might just be overwhelming and I remember Dan from Pain Free You, which is a great YouTube channel you might want to check out, he journaled for six months and basically journaled himself into despair. So maybe don’t journal about the same thing over and over again or indefinitely. As I said for myself I moved on after about four weeks. And at the end of those four weeks did everything feel resolved from my past and my current life? No. But I acknowledged my past, my current rage and sadness and validated myself and honoured my experiences,  that’s what’s important. Did I change my personality? No. I just acknowledged how it was affecting me. For me, the biggest thing was making that mindbody connection by realizing just how upset I was and how this was affecting my nervous system and, you know, no wonder I felt as physically badly as I did considering I was so internally enraged and upset. So I had to learn to tell myself that it’s okay, it’s okay that I feel this way; I can be aware of emotions, my feelings, and bring them into the light because it’s safe to have emotions. And if you don’t feel a lot emotions doing this, that’s okay too, a lot of our most powerful emotions are repressed so we won’t feel them, it’s just acknowledging that’s the most important. 

So that’s the journaling approach that I used. Now if you want more information about doing this type of journaling, again, it’s explained in this book Unlearn Your Pain by Howard Schubiner and if you have trouble getting this book, just let me know. 

Journaling Aftermath

Now when I finished journaling did all the withdrawal sensations and chronic pain go away? No. It didn’t happen just like that. For some people it seems to, for others there is more to understand. And this approach is all about understanding this mindbody connection. And journaling can help with that. And it helped me. But I was still afraid to participate in life. To go out. I was too scared to even go to a grocery store. To make a meal even. I almost had no social connections. I had to get back to life to prove to my mind that I’m okay, I’m safe. And so I continued to listen to TMS materials to gain confidence in the process, to deepen my understanding and worked my way back into doing things that I was previously scared to do. I went fairly slowly but once I got into the swing of things, I went a lot faster than I expected to. And as I was getting back to life my understanding that I was okay became more complete and the sensations started going away and disappeared completely. 

Today I  don’t journal much anymore. Really rarely. If I’m really upset about something, maybe. But even then I might not. Because I’m more absorbed in living life and doing the things I feel inclined to do. But back then, when I was in the thick of things, it was really important for me. Anyway good luck with the journaling if you end up trying that out. Take care.