Foundations of PRT: What is Pain Reprocessing Therapy?
Video: Watch the full session here → https://youtu.be/zfnkIyc_Li0?si=yVVZl3Cut5ZL2Nf3
Dr. John Stracks: Good afternoon, everyone. I'm Dr. John Stracks, a physician in the Chicago area and nationally via telehealth, specializing in mind-body medicine. I'm joined today by Erica Walker, psychotherapist and pain coach at Cormendi Health.
Erica is a world-renowned Pain Reprocessing Therapy — or PRT — practitioner. She's been with us at Cormendi for about four years and was previously the Clinical Director at the Pain Psychology Center in Los Angeles. Given her expertise and extraordinary results helping clients heal from physical symptoms, I've asked her to help me create this primer on what PRT is and how it works. There's a lot of both interest and confusion around PRT, and I'm so glad to have her here to help unpack it.
Erica Walker: That introduction made me sound like a superstar. I'll take it.
How Erica Became the Therapist She Is
Dr. Stracks: Can you tell us a bit more about your background and how you came to this work?
Erica: I'll start from the beginning. I had two undergraduate degrees — pre-med and psychology — and during that time, I had the remarkable privilege of dissecting two human cadavers, which sparked a deep fascination with anatomy and physiology. That led me to massage therapy school at the Institute of Psycho-Structural Balancing — literally mind-body balancing. So I started my mind-body career on the body side, but with a deep focus on how we hold emotion in the body.
My adulthood began with the understanding that mind and body are not separate entities. They affect each other constantly.
Dr. Stracks: Did you see that in action while working as a massage therapist?
Erica: Two moments have stayed with me. The first was a young man who came in the day before his wedding — visibly nervous, enormous tension in his body. I did an energy hold, hand on his head and hand on his heart — it mimics being held by someone who cares about you. Without a word being spoken, he started weeping profoundly. Huge emotional release, tension flooding out of his body.
The second was a cellist for the LA Philharmonic — high-achieving, high-performing. When I worked on her forearms and hands, she would laugh, this wild, profound laughter until she cried, and feel extraordinary afterward. Being part of those experiences was deeply touching.
Dr. Stracks: Those are remarkable examples of the body influencing the mind. And I think what's unique about you is that you're completely fearless when it comes to talking about people's bodies and physical symptoms.
Erica: You cannot freak me out. I'm not intimidated. Tell me exactly what's going on in your body — I want to know. A lot of psychotherapists learn that their domain is the mind and the physician's domain is the body, with no overlap. That's never been my world.
Arriving at PRT
Dr. Stracks: At some point, you made your way to the Pain Psychology Center, where you were first introduced to PRT.
Erica: It was a really special time. It was still very small — we were meeting in Alan Gordon's apartment, a small group of therapists: me, Christie Uripiece, and others. It was a think tank, case consultation, and real-time learning. I was learning PRT from Alan Gordon, Christie Derecs, Ed Walton, as the Boulder Back Pain Study was underway, as Alan was writing The Way Out. I was on the ground floor.
It wasn't a one-off training. PRT was my entire world. I was learning not just PRT as a modality, but how to adapt it for each individual client — constantly assessing what strategy or tool might be most meaningful for this particular person right now.
Dr. Stracks: What made you feel like this was your calling?
Erica: I like results. I want to see what works and lean hard into it. And at this point in my career, what I have seen work — over and over — is this.
What PRT Is — and Isn't
Dr. Stracks: There's a lot of confusion about what PRT actually is. Many people found mind-body medicine through Dr. Sarno, whose approach was rooted in psychoanalysis — read the book, and if that's not enough, go to an analyst for years of deep work. PRT is not that.
Erica: Right. I think of psychoanalysis as more of a bottom-up process. PRT is more structured and strategy-oriented. And by the time clients get to me, they've been through dozens of doctors, physical therapists, medications — things I've sometimes never even heard of. They're exhausted, frustrated, overwhelmed, scared. They need someone to tell them what to do and how to do it. They can't keep talking about their childhood indefinitely and hope it shifts what's happening in their body.
When I think of PRT, I think of one core concept: danger versus safety. Everything we do is in service of bringing the volume down on the nervous system — creating opportunities for the brain to register: I am safe right now. It's not necessary to continue sending pain signals through the same old neural circuitry.
The First Session: Building an Evidence List
Dr. Stracks: If I came to you as a new client — back pain, migraines, fibromyalgia, chronic fatigue, anything — what happens?
Erica: First, I want to know the client's working knowledge of neuroplastic pain. What have they read? What's informing them? And why do they think this applies to them? Most Corendi clients have already read something. But I want to solidify: what does this mean to you, and how do you fit into this?
From there, we build what's called an evidence list — the pieces of evidence that suggest this is mind-body rather than structural. On the physical side, that might include: MRI came back relatively unremarkable, blood work didn't show much, medication hasn't helped significantly, and physical therapy hasn't been as effective as expected. The symptom moves around. Multiple symptoms. Maybe a childhood history of frequent stomachaches or earaches.
Then there's the psychological evidence: Did this symptom show up during a period of high stress? Does it flare after an argument with your partner, or when an estranged family member reaches out unexpectedly?
Dr. Stracks: Is this a conversation, or an actual written list?
Erica: We're writing it down right away — bullet-pointing together. I'll ask: do you find yourself perfectionistic? People-pleasing? Any history of anxiety? And I want to unpack anxiety for a moment because people often say they've never had anxiety — but anxiety is just the clinical word for what most of us experience as worry, obsessive thoughts, catastrophic thinking, rumination, tension in the body, fear. A lot of people say "I don't have anxiety, but I've had a lot of stress" — stress is anxiety. They're the same thing.
We also look at the quality of the anxiety. Is it more monitoring — is it there, is it gone, is it worse? Is it more worry — what if this happens? Is it more catastrophic — I'm the one who will never figure this out, this is the rest of my life?
Dr. Stracks: That last one — "I understand it might work for others, but it won't work for me" — is that the most common fear you hear?
Erica: Probably the most common, yes.
Why These Personality Traits Matter
Erica: Sarno referred to perfectionism and people-pleasing together as "being the goodest" — I still like that term. When we're thinking about people-pleasing, we're talking about boundaries. Saying yes when you'd rather say no. We're biologically hardwired to want to stay in the group — group is safety. So we navigate our lives in many ways to keep people from disliking us. That often means weaker boundaries than we'd like. That's not a character flaw. It's usually learned behavior. And it's a genuinely good quality — it means you're kind and generous. We don't want to abolish it. We want to ask: to what degree are we taking care of ourselves within our relationships?
These strategies — perfectionism, people-pleasing — are usually developed very early. If a child grew up in a chaotic or unpredictable household, they learn quickly that there's no space for their feelings. So they stuff those feelings down and navigate by staying invisible, getting good grades, staying out of trouble. That keeps them safe. The downside is that we can't stuff everything down forever. Emotions need somewhere to go. And when emotions become associated with danger, the body will produce physical symptoms to manage them.
Dr. Stracks: Until we learn otherwise, we just assume physical symptoms come from physical problems. But the research doesn't actually support that. You can have significant physical findings on an MRI with no pain, or severe pain with no physical damage at all. Pain is about the sense of danger — not damage.
Erica: Exactly. And for many of us, that threat-sensing strategy is so well-established from childhood that as adults we're still running on it automatically — even when it no longer serves us.
Tracking Wins
Erica: In the first session, I always want a client to leave with something concrete they can use. The evidence list rolls directly into the next strategy: track your wins.
We're survival-oriented beings — profoundly skilled at cataloguing what we don't like, even amplifying it. I stubbed my toe this morning; the whole day is ruined. So we deliberately build the practice of noticing what's going well. A win can be as simple as: I went to a restaurant with hard chairs, and I was nervous, but I went anyway. I bent over and tied my shoes. I went to Target even though it was loud and crowded. I attended a family event and got genuinely absorbed in the moment and forgot to monitor my body — that's not just a win, that's also evidence: when I experience joy, I stop noticing sensation. That's not structural.
I push hard in this direction because we naturally go the other way. I want clients mining for wins — even the smallest ones. I ate a cupcake, and it was delicious. That counts.
Dr. Stracks: I had a patient who had suffered from severe foot pain, used a wheelchair, did remarkable work, and recovered. She took her young daughter to Disney World for a week and called me afterward — walked the whole park, sat down for about ten minutes on one day. She was thrilled. A few weeks later she told me the trip had been terrible because of how much pain she'd had. She'd sat for ten minutes out of an entire week and rewritten the whole experience as a failure.
Erica: Yes. That's why we go so hard in the other direction. Because left to our own devices, we will find the threat. So we mine for what's going well — relentlessly.
The Three C's: Catch, Compassion, Carry On
Erica: In the first session, I also decide whether to start with something more cognitive or with somatic tracking. If the level of fear is quite high, we start cognitive. The tool I use is something I developed specifically for this population — I call it the Three C's: catch, compassion, carry on.
People with chronic pain tend to be hard on themselves. They've also often absorbed the message that they're not supposed to have negative thoughts. So a scary thought arrives, and rather than just noticing it, they attack themselves for having it — see, something is uniquely wrong with me, that's why I keep thinking this way, that's why I'll never get better. The Buddhists call this the second arrow. You're kicking yourself while you're already down.
The Three C's addresses this directly.
Catch — simply notice that you're in a looping thought. You might be 45 minutes down a rabbit hole before you realize it. That's okay. We're not replacing the thought with a positive one — that just creates a debate: yes it will, no it won't — now anxiety is higher. We're just noticing: oh, there's that thought.
Compassion — this is the hardest one, and the one I add that's specific to our clients. Once you've caught the thought, the response isn't self-criticism. It's: good, I'm getting better at this. I've had clients give themselves an actual thumbs up, which I love — it's goofy and light-hearted and it moves in the right direction. The mind will keep trying to pull back into threat-orientation. That's not a failure. It's just a habit. Catch it again. Good. Getting better at this. Even if it happens 400 times in an hour.
Carry on — check in with the breath. After marinating in a scary thought, your breath is likely shallow, your heart rate slightly elevated, your body a little tense. Put your hand on your belly and just breathe into it. Nothing fancy unless you already have a technique you love. Just slow things down.
The whole sequence is: aha — good, I'm getting better at this — what's happening with my breath.
Dr. Stracks: And people generally find this usable?
Erica: Right out of the gate, most people find it useful. Some with high anxiety will immediately worry about whether they're doing it correctly — and that's just another fear-oriented thought. Back to the Three C's.
The How Matters More Than the What
Erica: I want to name something important. We don't want to attack our healing process with intensity. Clients will sometimes try to somatic track obsessively, re-read every book, and consume every piece of content. The how we do these things is going to be a bigger shift than the what we're doing. If I do this technique perfectly, then I'll be out of pain — that's the same pressure that's been driving the nervous system all along. Finding gentleness in the process is part of the process.
What's Coming Next
Dr. Stracks: Erica and I will be back in about six weeks to continue this conversation. Can you give a brief preview of what we'll cover?
Erica: Self-compassion. How does self-compassion fit into chronic pain? I often tell people: we can be mean to ourselves or we can get better, but it's very hard to do both. The belief that we can motivate ourselves through harshness — keep putting pressure on, keep pushing — may have worked in other areas of life. But the nervous system can only handle so much pressure before something has to shift.
Q&A Highlights
Q: Once people really understand what's driving their symptoms, can they see dramatic, rapid improvement?
Erica: Yes, quite often. When people are able to identify what's happening under the surface, symptoms can shift quickly — sometimes immediately.
Q: What about longer-term work on personality traits like perfectionism and people-pleasing?
Erica: A quote I come back to often is from author Prentis Hemphill: "Boundaries are the distance at which I can love you and me simultaneously." That framing has been really useful for me when thinking about whether I'd rather say no. For self-compassion specifically — it deserves its own full session. The starting point is simply: can I notice myself through a lens of kindness? The somatic tracking video on our YouTube channel is a good place to begin, because gentleness is woven into the whole approach.
Q: I have a diagnosed inflammatory condition with elevated markers. How is PRT relevant when there's something physiologically happening?
Dr. Stracks: This is such an important question. When we talk about the immune system and the nervous system as separate entities, that's a framework our brains use to understand what's happening microscopically. From the body's perspective, there are no separate systems — it's all one. When we calm the nervous system, the entire system begins to calm, including the immune system. We had a client with inflammatory arthritis who did six months of psychological work here at Corendi. Her inflammatory markers dropped by half.
Erica: I think of inflammation as volume up — the immune system pitched toward danger. When we bring the nervous system into greater safety and calm, inflammation follows.
Q: How do I manage the urge to obsessively research, re-read, or try to figure out what's triggering my symptoms?
Erica: We can actually use the Three C's for that. Notice the obsessive impulse — aha. Catch it. Have compassion for it. Check in with your breath. You don't need to somatic track your face off or consume every resource available. Notice the impulse to attack the healing process with intensity, and bring some of that same gentleness to it.
Dr. John Stracks practices mind-body medicine via telehealth nationally and internationally. Erica Walker is a psychotherapist and pain coach at Cormendi Health, certified in Pain Reprocessing Therapy and EMDR. To access handouts from this session, contact the team at info@cormendihealth.com or visit cormendihealth.com. The somatic tracking video referenced in this session is available on the Cormendi Health YouTube channel.