Foundations of PRT: Messages of Safety and Self-Compassion
Video: Watch the full session here → https://www.youtube.com/watch?v=jPhQgvTteKE
Dr. John Stracks: Welcome, everyone. I'm Dr. John Stracks, a physician in the Chicago area and nationwide via telehealth, specializing in mind-body medicine. I'm joined again by Erica Walker, therapist and pain coach at Cormendi Health, who specializes in Pain Reprocessing Therapy — PRT. Erica has been doing outstanding work in this area for well over a decade and has treated thousands of patients with mind-body medicine disorders. This is our second conversation in an ongoing series on the fundamentals of PRT.
A quick note before we begin: Dr. Howard Schubiner, our colleague at Cormendi and a mentor of mine for many years, just released his new book Unlearn Your Pain — the culmination of two decades of work in mind-body medicine. It's available anywhere books are sold.
Erica Walker: Thank you so much for having me back. Always fun to talk about this with you.
A Brief Recap of Session One
Dr. Stracks: Last time we covered three foundational strategies you use right from the start with new clients. Can you quickly recap those?
Erica: Sure. The first is the evidence list — writing down and bullet-pointing all the reasons you believe your symptoms are mind-body rather than structural. Unremarkable test results, symptoms that appeared during high stress, pain that moves around or shows up in multiple places. The goal is to have something concrete you can return to when the anxiety chatter starts — but it could be structural, but something might have been missed — so you can look at the list and ground yourself rather than spiral.
The second is tracking your wins — deliberately keeping track of what's going well, because we're biologically wired to fixate on threat. We need no practice noticing what we don't like. We need a lot of practice noticing what's going right, even if it feels small. I tied my shoes without help for the first time in a year. I sat through a whole movie without getting up. Those are significant. I start every session by asking clients what went well since we last spoke.
The third is the Three C's — catch, compassion, carry on. Catch the looping scary thought without getting into battle with it. Offer yourself compassion — good, I caught that, I'm getting better at this — rather than attacking yourself for having the thought. And then carry on by returning to the breath. Shallow breath, faster heart rate, body tension are all part of the fight-or-flight response. Slowing the breath down brings the volume down on the nervous system.
Somatic Tracking and Interoceptive Exposure
Dr. Stracks: We also have a full video on somatic tracking — which we'll link in the comments — but can you give a brief overview of what it is and why it matters?
Erica: Somatic tracking is what's called interoceptive exposure — paying attention, on purpose and without judgment, to the physical sensations in the body that we find frightening. It sounds counterintuitive because the goal is for pain to go away, but in order to get there we have to get closer to it rather than away from it.
The fear-pain cycle is a loop: fear fuels the pain, pain fuels the fear. Somatic tracking interrupts that loop by helping us be with sensation without the judgment and fixation that usually accompanies it. When we can just notice a sensation — observe it moving, getting louder or quieter — without reacting, we teach the brain that this is safe.
Dr. Stracks: What if someone says, like many of my patients do — I don't want to feel it, I just want it gone?
Erica: The only way to reduce the fear around a sensation is to be with it. We've already tried avoiding it, and here we are. But we go slow. I'll often start with just three seconds. Not thirty minutes — three seconds. I've had clients come in saying they've been doing somatic tracking for thirty minutes every morning until they can't take it anymore. That's the same intensity and pressure, just shifted to the healing process itself. We don't want to somatic track our faces off.
When I work with clients individually, I'll sometimes be on a Zoom call with them as they walk, jog, or get on a stationary bike. If someone hasn't ridden their recumbent bike in a year, we don't just tell them to get on it and go. We describe the machine together. We breathe. We get on and just sit there for a moment. Then we start moving very slowly, and they raise a hand if anxiety starts to rise so we can pause and titrate. It makes a real difference to have someone with you, because people in chronic pain can't always explain to someone who's never experienced it just how frightening mild exercise can feel. Doing it together removes a layer of both fear and self-judgment.
Dr. Stracks: Pain isn't evidence of damage. It's evidence that the brain is sensing danger. The antidote to pain is safety — which is much easier said than done.
Creating Messages of Safety
Erica: This is where I spend a lot of time, especially early on. Some people do well with telling themselves I'm safe — they can buy into it and it works. Many people can't. And if you're telling yourself you're safe when you genuinely don't feel it, that's essentially gaslighting yourself. Your brain is too smart to believe something that isn't true.
So we look for alternatives. Some options that work well:
"I can tolerate this." This is the one I've been using most with clients lately, and I find it really effective because it's provably true. You're still here. You've been tolerating this. You didn't like it, you may hate it, but you've survived it. That's a true statement. And it starts building resiliency — we're moving away from catastrophic thinking and toward something the nervous system can actually believe.
"This is temporary." Simple, but meaningful.
"My body is fine. My brain will align." This came from a client recently — I asked permission to share it — and I love it. It frames the body and brain as getting back on the same team.
And sometimes none of those work, and that's okay. I worked with a client years ago who couldn't get on board with any standard safety message. So I asked: what are you good at? She thought for a moment and said, "I'm a good gardener. I grow beautiful tomatoes." And I said — that's your message of safety for now. I'm a good gardener. In that moment, she felt genuinely good. It bolstered her confidence. It felt true. And we can build from there toward something closer to I can tolerate this as trust develops.
Dr. Stracks: I think what ties this all together is that the people I see move forward most quickly are the ones who lose the fear — who find ways to create genuine safety where it didn't exist before.
Erica: Exactly. And when the standard messages don't work, we get creative. We look at what makes this specific person feel safe. A dog. A piece of rose quartz. A walk in the woods. Anything that anchors them in a felt sense of safety, even temporarily. In EMDR we call it outsourcing the resources — if we can't find safety inside the body right now, we borrow it from somewhere else until we can.
Self-touch is also powerful here. Placing a hand on the heart has been shown to elicit oxytocin — it mimics the physical experience of being held by someone who cares about you. It's simple and it works.
My own personal version came from a rescue horse my family took in when I was growing up. She'd been abused and was terrified. We had to move incredibly slowly with her. Once she let me touch her, I'd stroke her head and just say, easy girl — until her eyes softened. Now when I notice myself getting frantic or perfectionist, I'll stroke my arm and say easy girl to myself. It's nothing wildly profound, but it immediately brings me back. I'm talking to a sweet, scared animal — which is sometimes exactly what we need to do for ourselves.
Self-Compassion: The Often-Missing Piece
Dr. Stracks: We've been circling around self-compassion throughout this whole conversation. Let's address it directly. You and I both see people who are remarkably hard on themselves — and when we really unpack it, the internal voice is saying genuinely cruel things constantly.
Erica: I love the way you put this: we can be mean to ourselves or we can get better, but it's very hard to do both. Imagine someone walking just behind you all day saying out loud, Erica, you're not good at your job. You dropped that ball. You don't look great today. You'd feel terrible very quickly. But we do that to ourselves internally, and no one witnesses it, so it keeps running.
Here's the basic neuroscience: the amygdala — the part of the brain that triggers fight-or-flight — doesn't know who the critical messaging is coming from. It doesn't differentiate between an external threat and internal self-criticism. When we're constantly harsh with ourselves, we're lighting up the amygdala and pushing ourselves toward fight-or-flight. Self-compassion moves us in the opposite direction — toward safety, toward rest and digest, toward healing.
Most of us were not raised with self-compassion. The cultural message was pull yourself up by the bootstraps, no pain, no gain. And it's not that self-pressure has never worked — for a lot of us, it got us through school, into careers, to real achievements. But there's a point where the nervous system says: I cannot absorb any more pressure. Something has to shift. That's often when chronic symptoms appear.
Dr. Stracks: And the self-criticism doesn't have to be extreme to be damaging. It can just be background noise: I'll never get my to-do list done. I'm always behind. I should have handled that better. Constant and low-grade, but always running.
Erica: Always running. And that background noise is still driving the volume up on the nervous system. Every bit of it.
Dr. Stracks: I remember the moment self-compassion clicked for me personally. I was in training and had double-booked my clinic schedule on the day I was supposed to be away. My immediate instinct was to blame my staff, then to attack myself — how could you do this? Professionals don't make these mistakes, you're never going to be a successful physician. And then I caught myself and thought: we don't talk like that around here anymore. That interruption broke the cycle. I was able to see clearly what needed to happen, call patients directly, and every single one was gracious. Several said it was kind of me to call personally. None of it was the catastrophe I'd made it in my head.
Erica: That's such a perfect example. The self-criticism doesn't solve the problem — it just amplifies the danger signal and makes it harder to think clearly.
Building the Self-Compassion Skill
Dr. Stracks: How do you actually start working with people on this?
Erica: The resource I recommend to almost every client is the Mindful Self-Compassion Workbook by Kristin Neff and Christopher Germer. It's extremely user-friendly. I'll ask clients to read just the first two chapters — about eight pages — to start. We go slowly, because there's usually real resistance to being kinder to yourself. There's a fear that if you ease up on the pressure, you'll stop achieving. We have to examine that.
Self-compassion is a skill. It has 13 meditations and 38 exercises in that book. It's learnable. It takes practice. And the Three C's we talked about — the compassion in the middle is always the hardest step. People will say, I caught the thought, and then I went back to my breath. And I'll say: what happened in between? That's where the self-compassion lives. We can't skip it.
Q&A Highlights
Q: During high-intensity intervals, I noticed that the pain in my calf became less in the second and third intervals when I focused on my opposite leg or the runner ahead of me. Is that interoceptive exposure?
Erica: Yes, that sounds great. You're doing a couple of things at once — oscillating your attention between what doesn't feel comfortable and what does, rather than fixating only on the painful sensation. That's exactly the kind of titrating we talk about in somatic tracking, and it's working.
Q: How do you maintain a sense of safety when the world itself feels unsafe — violence, environmental threats, viruses, political chaos?
Erica: This is such an important question. We are living through the highest levels of collective anxiety I've seen in my lifetime. Two things I'd say: first, limit content consumption. Stop Googling your symptoms. And extend that to news and media — it's not that we're burying our heads in the sand, but the algorithms are designed to escalate fear, not inform. I think of it as capacity versus capability. I'm capable of being on the news thread all day. Do I have the capacity for it right now?
Dr. Stracks: There's an interesting parallel here. Humans evolved during times when information was scarce — anything we could learn about potential danger helped us survive. Now, information is essentially unlimited, but our biology still says to consume as much as possible. Just like food becoming abundant required us to develop new strategies to stay healthy, information abundance requires us to develop new strategies, too. Unlimited consumption is no longer adaptive.
Gratitude practices also matter here. Multiple studies support the benefit of deliberately focusing on what's positive in our lives and world — even briefly, each day. It's a counterweight to the threat-oriented default.
Q: If my brain has been causing muscle tightness and compensation patterns for over a year, is that considered structural or neuroplastic? Can I still get out of it?
Dr. Stracks: This is a place where I encourage people to shift away from physical-based thinking entirely, even when the framing is "stress causes muscle tension." That's still thinking structurally. The more useful question is: what's going on psychologically? What's the stress? What's the history? The body doesn't have a tensometer — we can't measure how tight a muscle actually is. And plenty of people have significant muscle tension with no pain at all. When we focus on the physical explanation, we miss the psychological one that's actually driving things.
Erica: And when we turn ourselves into an equation we're trying to solve, that problem-solving energy becomes part of the pressure. You are not a problem to be solved.
Q: I'm self-employed and can never fully clock out. The to-do list never ends. How do you make peace with that?
Erica: Honestly, you kind of have to accept that it won't end and build rules around it anyway. I have a rule: once I leave my office, I don't think about work. If a work thought comes in while I'm at home, I have to go back into my office — which is deliberately my least comfortable room — to think about it. It trains me to want to be out of work mode.
Dr. Stracks: Boundaries are a huge part of PRT that we haven't fully unpacked yet, but this is a good example. There's actually a study from the early days of the internet where two identical consultant websites were tested — one said "contact me here," the other said, "contact me between 9 a.m. and 5 p.m. or by appointment." The one with limits got more clicks. People respect and admire limits. Setting these signals professionalism, filters out clients with unrealistic expectations, and most importantly, protects your own nervous system. None of us are designed to be available 24 hours a day, and that availability doesn't serve our mental or physical health.
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.