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TMS & Treatment FAQs

TMS and Treatment: Text

What is Tension Myositis Syndrome (TMS)?

TMS is a physical pain disorder due to conscious and unconscious emotional conflicts such as rage, guilt, anxiety and shame. TMS patients struggle with chronic pain such as chronic back, neck, shoulder, elbow and leg pain. TMS pain may manifest itself intermittently and occur coincidentally with life stressors. Patients often experience repeated failed medical treatments.

Dr. Sarno also wrote of other TMS equivalents such as migraine headaches, stomach ulcers, fibromyalgia, irritable bowel syndrome, and eczema that are also strongly suspected to be a part of TMS as well.

What causes TMS?

TMS is caused by a combination of alexithymia, unconscious repression of painful pasts and unacceptable emotional conflicts. Alexithymia is the inability to recognize, identify, and express emotions. It is often the culprit in repressing unpleasant negative emotions.

TMS is the translation of negative emotions into the development or worsening of physical problems or complaints (see Presentation on alexithymia). Dr. Sarno also identifies a multitude of TMS Personality traits that are common among TMS patients.

What are TMS Personality Traits?

Low Self-Esteem- most people harbor feelings of self-judgment and inadequacy.

Perfectionism-need to be perfect in order to prove self-worth, self-critical people who set high standards for themselves. The inner sense of inadequacies fuel the perfectionism.

Goodism-the need to be good, to the point of sacrificing their own need for others which leads to unconscious anger towards self.

Hostility/aggression-irritability and short-tempered towards others as a result of repressed rage.

Guilt- more self-criticism of not being or doing enough to please or placate others.

Dependency-deep inner desire to be taken cared of but when that falls short, it generates unconscious anger to the one we depend on.

How can it be treated?

TMS must first be diagnosed and screened by a TMS trained physician (visit Dr. Paul Gwozdz' website The physician then checks previous medical history and prior workups. After attending a TMS lecture provided by the physician, the patient is then referred to a TMS trained clinical psychologist.

What kind of psychotherapy is involved?

The psychotherapy portion of TMS is treated via short-term psychodynamic therapy (see Resources). It is a time-limited approach that focused on the patient’s wishes, fears and defense mechanism. The goal is to identify pain triggers and decrease the phobia of experiencing one’s emotions while increasing honest expression of emotions in order to get one’s needs meet

What will I expect at the first meeting with the psychologist?

Treatment will start with 90 to 120 minutes of a Diagnostic Interview Exam. An Intake Form as well as additional questionnaires will be mailed to you prior to the first meeting. After the initial interview, the patient and therapist mutually decide if the TMS treatment is a good fit. If so, then weekly sessions are scheduled and individual treatment goals are set.

What are the stages of treatment?

Initial Stage:
• Symptoms Management
• Increase acknowledgement the psychological basis for the pain
• Consciously thinking and experiencing the psychological triggers for the pain rather than structural/physical reasons for the pain
• Psychoeducation for the basis of one’s pain

Middle Stage:
• Walking the walk - putting TMS principles into practice
• Resuming physical activity with less fear
• Working through resistance
• Work through heightened emotional pain in order to decrease physical pain

Termination Stage
• No fear of the pain coming back
• Maintenance strategies
• Summary of what was learned in therapy

TMS and Treatment: FAQ
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