TODAY'S GUEST: Alan Gordon, psychophysiologic psychotherapist and mind-body master

I'm extremely happy to welcome Alan Gordon to Hard Conversations!

Alan Gordon is a psychotherapist in Los Angeles, CA, specializing in the treatment of chronic pain and other physical symptoms. He developed Pain Reprocessing Therapy (PRT), a cutting-edge protocol for treating chronic pain, and completed a large neuroimaging study on the efficacy of PRT in conjunction with the University of Colorado Boulder. Alan was featured on CBS's The Doctors, where he conducted the first fMRI case study of a patient eliminating chronic pain. He is an adjunct assistant professor at USC and has presented on the topic of pain treatment at conferences and trainings throughout the country.

• WEBSITE:

  https://www.painpsychologycenter.com/

• Podcast:

• Tell Me About Your Pain

YOU'LL LEARN

• Chronic pain is all around us

• The impact of the brain on bodily sensations

• The similarities between working with chronic pain and erectile dysfunction

• How to notice “danger signals” in your body

• Metaphors for thinking about how overcoming bodily anxiety

• Insights on sexuality

• The impact of a bad experience on future experiences

• The importance of lowering the stakes and having fun

• About fIght or flight states

• From a role-play between Alan and Tim

• About dads

• And more!

THANK YOU FOR LISTENING to my male sexuality and sex therapy podcast!

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And lastly, if you have any questions (or would like answers to previously submitted voicemail questions!), head on over to Tim’s website.

About the Show

Introducing Hard Conversations, a podcast about male sexuality, and all things erectile, from the latest natural erectile dysfunction treatment to the best ed medical treatment. Therapist Tim Norton expands the conversation about male sexuality, adds context to why we struggle as a society to have hard conversations and breaks down how in a sex-positive environment there really is no room for taboos, judgment, or shame when it comes to penises.

YOUR online sex therapy and couple’s therapy HOST:

Tim Norton is a sex positive sex therapist working in private practice. He offers online therapy, online sex therapy, online sex coaching, and therapy and coaching for somatic symptom disorder.

Tim obtained his bachelor’s and master’s degrees from the University of Southern California. Tim is a proud member of American Association of Sex Counselors, Educators, and Therapists (AASECT), the Los Angeles Sexological Association, and works part-time with the Pain Psychology Center in Beverly Hills.

Hard Conversations Podcast Transcript

Tim Norton: Hello, and welcome to hard conversations. Really excited about my next guest today, Alan Gordon, who is a psychotherapist in Los Angeles, California, specializing in treatment of chronic pain. Alan is an assistant adjunct professor at the university of Southern California. You know what? I 

just, 

Alan Gordon: I don't believe it.   You're not selling it. I'm not - A little more enthusiasm.

Tim Norton: okay. All right. As a, as an adjunct professor at the university of Southern California has authored patients on the treatment of chronic pain and is presented on the topic of pain treatment at conferences and trainings. [00:01:00] Throughout the country. He served as the chair for the 2013 mind body conference at USC.

And co-created the treatment outline and trading protocol for the psycho. Wow. Look at that word for the psychophysiologic disorders association. Hi, Allen, and welcome to hard conversations, Tim. It doesn't say you were on the doctors in your, 

Alan Gordon: in your,  it's a,  an old bio. We haven't changed the website maybe like four years.

Tim Norton: Okay. Any other things you wanted to just brag about while, while talking about your, your intro and your bio? 

Alan Gordon:  we just did a really big, well, it's all pain related stuff, which isn't, it isn't necessarily. Linked to what we're going to be talking about. So lots of, lots of good pain stuff. That's a good pain step.

Yeah. 

Tim Norton: Well, and we are going to talk a little bit about pain because pain is your, your paradigm, but I feel like your paradigm gives you a really cool insight. Into treating erectile issues. When I, when I [00:02:00] texted you about this, you had a great, you had a great answer. You said the treatment for ed is similar to the treatment for TMS for, for psychogenic pain.

It's the fear and preoccupation around the symptom that perpetuates it. Outcome independence reduces the level of preoccupation. 

Alan Gordon: It's true. It's like a text. It's 

Tim Norton: a good text. And that could be the whole interview, right. That kind of sums it up, but why don't we break some of that down? Well, why don't we give a little bit more background for that?

So you, that this place, the pain psychologist center, where I work,  could you, how do you answer the question? What is it that you guys do there? 

Alan Gordon: We treat. Chronic pain.  studies have shown that the majority of chronic pain is actually caused by neural pathways in the brain, not structural problems in the body.

 and so, you know, people have chronic pain, you have chronic back pain, chronic neck pain, chronic pelvic [00:03:00] pain, and obviously the. Initial belief is like, Oh, there's something wrong with my body. And that could be reinforced by doctors or physical therapists, but more often than not, they find that many forms of chronic pain are actually caused by the brain misinterpreting safe messages from the body as if they're dangerous.

So what we do is we essentially help to rewire the brain to accurately interpret those messages, which deactivates the pain signal. Okay. 

Tim Norton: And I think the way that I started to think about you as a guest for this show is it's more than just back pain that ends up getting treated at your center. Right.  can you give us an idea of the array of symptoms that.

That get treated 

Alan Gordon: there. It's if it exists, we've treated it. I mean, mouth pain, tongue pain, eye pain,  stomach [00:04:00] pain, back pain, neck pain, foot pain.  you know, the brain is capable of generating any physical sensation in any part of the body. So there isn't something that can exist that the brain cannot create that isn't to say that all pains or even all chronic pains.

Are created by the brain, but they can be. 

Tim Norton: Okay. And obviously you've seen these symptoms reduce or get eliminated, right. And all of these parts of the body.  and at some point I am one of your, I attend Allen's case consultations and lectures, and it, at some point you did talk about erectile dysfunction as the kind of symptom that is along the lines of other things that you treat and you've, and you've treated it.

You are, you it's come up in sessions. And so tell me more about 

Alan Gordon: that. Well, I think that first off like pain is a dangerous signal, right? If you think about pain, it's a danger signal. If you put your hand on a hot [00:05:00] stove, the pain is letting you know, you got to move your hands. So you don't cause additional damage, but sometimes these dangerous signals can get activated.

And even in the absence of like an injury or structural damage or something. So the brain is actually interpreting danger where there is none. And I think. It's really similar with erectile dysfunction.  You, you actually asked me before the,  interview if I had any metaphors. And so I was, I was brainstorming.

And,  you grew up in Los Angeles. So you may remember this,  back in 1983, do you remember Steve sax on the Dodgers? Of course. So Steve sax was like this rookie phenom in 1983, he won rookie of the year. You know, he had this like amazing promising future and it was in his second year, he played second base and there was a ground ball hit to him and he threw it like 10 feet over the first baseman's head.

It's kind [00:06:00] of like a silly error people in the crowd, like, you know, or laughing or whatever, but it got in his head a little bit. So then. The next game, someone hit a ground ball and it was like a two hopper to first base. And it got even more in his head and it became this thing where every time there was a ground ball hit to him, you know, sometimes it would, you know, be in the dirt.

Sometimes he would literally throw it like 20 feet over the first baseman's head and it would fly into the stands and it became this whole thing. Like. At away games, people in the stands, it would like start wearing helmets is like a way to just like mock him, you know? And he made like 50 errors or something before the all-star break.

And so that's how it happens. Where at one point playing second base was fun. You know, he was confident, there was a ground ball hit to him and it was great. But then one time it didn't go well. And he started feeling all of this anxiety around it, and he started putting all of his pressure on himself around it.

[00:07:00] And obviously, you know, fielding a ground ball and throwing it to first base. It's like, you need to be loose. You need to be relaxed. And so when he was so tight, when he was feeling so much pressure, it injected him into a fight or flight state. He wasn't able to. Performs so to speak and he kept messing up.

And that's exactly what it is with erectile dysfunction, where, you know, for a lot of people, it was like, it didn't, it wasn't always like that, but they have, they have one incident where.  it doesn't go as they had hoped or as they planned, they felt really bad about it. They started feeling nervous about the future.

They started putting pressure on themselves. And now it's this thing where they're in this fight or flight state, right? Like you need to be in kind of like an easy, relaxed state,  to get an erection or maintain an erection. But because they were in this fight or flight state, There are sympathetic nervous system was activated.

They're putting so much pressure on themselves and they're [00:08:00] not able to do it. Well now it's like twice that that's happened now, is this going to become a thing I've read about it? Oh my God. I'm I have to spend the rest of my life on Viagra. Am I going to have to like start telling partners about this and advance they get in their head and it really becomes an issue.

And so it's this kind of like positive feedback loop where it happens. You feel terrible, nervous, freaked out that. You know,  compromises your ability to, to,  successfully perform in the future. So that a good metaphor. Yeah. That's a great metaphor. 

Tim Norton: And I wish the end of that story was Steve Sachs came to the pain psychology center and the problem went away and he, he won the world series with the Dodgers, but 

Alan Gordon: well, you know what, actually what happened is it was one of the first times this has ever happened.

Cause it's happened since then for baseball players, but. If they named it Steve sack syndrome, because it was like such a big deal. And it's happened, [00:09:00] you know,  with people in sports, at different levels. And almost no one is able to overcome it. Like it's the end of their career because it's just this downward spiral.

But Steve sacks. Was able to overcome it. And he went on to be a great player and like won the world series in 1988. He actually went to visit his dad and he was telling his dad all this stuff that was going on and his dad just kind of gave him a talk and it was like, Oh, you're putting so much pressure on yourself.

Like, what's the big deal. And it was like his ability to just kind of. Take the pressure off and relax into it. And you're just kind of like, ah, the worst case scenario was like, you know, I do something else or I, I N I try, I learned how to play first base or something. He took the pressure off, it took him out of a state of fight or flight, and he was able to do it again.

I think it's the same lesson, you know, if you could lower the stakes, if you could just start having fun with it again, that's the thing that could actually [00:10:00] pull you out of a fight or flight state. And allow you to overcome the issue. I 

Tim Norton: love the end of that story. Cause he's, you know, that's so psychodynamic, he's channeling his, his inner paternal object.

Right? His inner dad. Who's telling him everything's going to be okay, son. Yeah. And that that comes out in some of your methods. 

Alan Gordon: Doesn't it a little bit. Yeah. I'm actually thinking back now on what his dad, he kind of looked at his dad, he like pedestals, I, him so much, he's like this was, you know, a guy who had like a mind of steel and was so internally and externally strong.

And I think what his dad actually said to him is, Oh, I went through something like that when I played ball also. And he was like, Oh, like, This isn't the worst thing. And that if my dad could go through it, like this is fine, you know? So I think it allowed him to put less pressure on himself.  

Tim Norton: and, and that's really the name of the game, isn't it?

[00:11:00] Alan Gordon: And you know, it's, it's very similar with someone who has pain is there's so much fear around it. There's so much anxiety. There's so much pressure to get out of the pain and it just, it reinforces to your brain that that pain is dangerous. So it's a really about. You know, taking yourself out of this place of interpreting things as dangerous and into a place where you're able to interpret things as safe because,  You know, like we were talking about earlier, there's the sympathetic nervous system and the parasympathetic nervous system, right?

The sympathetic nervous system is, you know, when you're in a state of high alert, if you think of like a zebra and a jungle, surrounded by lions, like you're in a state of high alert because you need to be able to like run like first notice parasympathetic nervous system is when you're safe, when you're relaxed.

When you're out of danger, it's I feel like whenever I'm talking about that, there's like a siren or motorcycle in the background, just sub communicating the opposite of what [00:12:00] I'm saying, but, you know, and that's when you're able to like go to sleep and relax and you need to be in a parasympathetic state to like, get an erection to maintain an erection.

So the irony is the anxiety and the fear and the preoccupation and the pressure. Around getting an erection and maintaining an erection is the very thing that brings you out of that sympathetic state. I'm sorry, out of that parasympathetic state that you need to get it in the first place. It's like a catch 22.

So what do we do?

What do you think? 

Tim Norton: So. You know, I I've, I've worked with you guys for, for some time now and the approach lately and the approach for, for a significant period of time, that's been really effective that you guys are applying and your study and everything has to do with,  [00:13:00] tracking with approaching this pain and, and tracking pains, various paints.

And I'm wondering if. You know, giving that attention to a non-interactive panus and, and tracking it and, and trying to eliminate the fear of the symptom would also probably be okay. 

Alan Gordon: Effective. I don't think it would work. You don't think so? No. I think that it would just lead to even more pressure and hypervigilance around it for something like that.

Okay. Can we role play? Yeah. Okay. Absolutely. You be someone who. It is like, has ed okay. Is freaked out about it and,  you know how, however it manifests, maybe you're not able to get an erection. Maybe it's premature ejaculation. Okay. No, so, 

Tim Norton: yeah. So,  for the last,  three months, Like three months ago, I was on vacation with my [00:14:00] girlfriend.

We were in,  we were in San Francisco and we got a really nice hotel. It was a Friday night and everything was, was great. And it came to time to, to have sex and nothing, nothing just, and ever since then, like at best, I'll have an erection, I'll run into the bedroom and try to have sex with then I'll lose it.

And. And it, I just can't. I can masturbate fine. Yeah. 

Alan Gordon:  you're all, you're able to get an erection when you masturbated master. 

Tim Norton: Yeah. And you're I went to a urologist. He said my everything's okay. Testosterone levels are fine.  I even got an erection during the exam that was kind of embarrassing and every, literally 

Alan Gordon: owning this role, 

Tim Norton: I've never actually heard somebody say that.

 yeah. It's so soon. So what do I 

do? 

Alan Gordon: Something funny? Steve Sachs was able to make the throw to first base every time during practice. Right? So [00:15:00] you're able to get the erection when you master Bay, right? Because there's no pressure because the stakes are low, but as soon as you're in the game, there's so much pressure.

And it sounds like having sex is a really fun anymore. It's like, you're trying to do it successfully to overcome this problem, to beat this thing. It's like a job. It's like a chore. You know, when I was in high school, I read the book catch 22. Cause I had to, for school, you need to read three chapters a week.

You know, you need to like write a paragraph on character development. And I hated it because of the situation that I was at, like forced to read it, you know, needed to kind of gather all of this data. And then I read it when I was like 25. And I said, this is the best book I've ever read. Yeah. And the reason why is because the first time it was a chore, it was a job.

It was a responsibility, but the second time it was fun. I could [00:16:00] do it at my own pace. It was enjoyable. And I think that, you know, what you're telling me is that, you know, sex a thing that used to be fun. I'm assuming is no longer fun. Now it's like a test. You're taking a test and if you pass, you're going to feel okay about yourself.

And if you fail, you're going to feel awful about yourself. And the irony is that makes it almost impossible to pass because of the pressure around taking a test is literally going to pull you out of the state that you need to be in when you have sex, you know, no one, I don't care. You know who you are.

No one would be able to get an erection under gunpoint. Literally, you know, like it would be impossible if someone's holding a gun to your head to get an erection because you're not in the right. Your nervous system is not capable of it. So if you think about the [00:17:00] pressure that you feel. To need to get an erection and those moments it's like, you're holding yourself at gunpoint.

So we just need to lower the stakes. What was going on?  you know, do you have any ideas or theories why you didn't get the erection the first time? I feel like people are going to be joining at this point in the, in the podcast. And they're not going to realize this is a role-play they're like, wow.

Tim's are really making themselves vulnerable. 

Tim Norton: Yeah. Yeah.  so the question again is, do I, do I remember what was going 

Alan Gordon: on? Yeah. You may have not gotten an erection that first night in San Francisco on vacation in the really nice hotel. You know, 

Tim Norton: I have no idea.  we, we decided to drive. It was, it was a long drive.

 they had the wrong room for us and we had to wait and we actually had to kind of yell the manager and then like,  we were hungry. We went out to eat and then like, I ended up at this restaurant [00:18:00] that was really expensive and like the food was kinda kind of shit and got home. And it just had been an awful day, but she had gotten new lingerie for the night and, and we even had like,  just some sex toys and it was, it was, it was, this was a big night cause we hadn't been having much sex.

 and it was like this vacation. It was all like, okay, this is going to be our weekend. 

Alan Gordon: You bet you guys really planned for it. We did. But it sounds like the day was so heavy and stressful and frustrating that it's like, Ah, you weren't really in that parasympathetic state that we were talking about, you weren't really in that relaxed state where you were able to, which is fine, that happens.

And so it makes sense that under, you know, I understand why you weren't able to have sex that first night, but the next time you tried having sex. You know, it probably wasn't as awful of a day, but the new fear, the new preoccupation was, am I going to be able to have [00:19:00] sex? So it started because you were in this state of anxiety and preoccupation about other stuff, but then after it happened one time, it was like, The sex itself became the new stressor.

So you didn't even need to be stressed out about anything else. So this is kind of like the cycle, you know, for pain, we call it the pain fear cycle. I think that, you know, for the sake of this condition, it would be like the erection fear cycle,  where it's like, you know, you weren't able to get an erection the first time because you were in a state of anxiety about something else, but then it was the fear of not being able to get an erection.

Itself that prevented you from being able to get an erection. Then the second time you weren't able to have sex, I'm sure. Now you're like, Oh my God, once it was a fluke, now this is like a thing. Yeah. Tell me about that. 

Tim Norton: Yeah, no, you're right. You're right. And now, now I think about it at work. [00:20:00] I think about it, you know, all day long when she's nowhere near me, where there's no, no sign of sex anywhere and get.

Totally worked up about it,  to the point where yeah, I feel like I need to drink more or I've looked at like getting gone anxiety medication just it's. Yeah. It's, it's kind of 

Alan Gordon: maddening desperation. Yeah. And is she feeling a sense of powerlessness over it? Is she feeling bad about it? You know, does she, not really.

Is she like. Well, we're going to work this out together. How she feeling about it? The first 

Tim Norton: couple of times she was like that. She was like, okay. Yeah. You know, it's, it's no, it's fine. Don't worry about it. Yeah. But I think sometimes when I get really anxious about it, like she just, she's starting to get impatient.

Like she just wants me to. To 

Alan Gordon: handle it. It almost doesn't even sound like she's like mad at you for not satisfying her. It's almost like now there's just so much [00:21:00] anxiety you're out about having sex. She's like, let's just, let's figure this out. You know, like it's time to get past this. It sounds like sex.

Isn't fun for either of you guys anymore. That's true. Hm. Well, you know, we talked about how. Being in the state of anxiety, having this fear, having this preoccupation is the thing that can bring you out of that parasympathetic state that you need to be. And, you know, because you're in a state of anxiety, she's in a state of anxiety and has it become like a central thing in your guys's relationship?

Has it hurt your relationship chip? Yeah. Yeah. I 

Tim Norton: feel I'm scared. She wants to leave 

Alan Gordon: me. 

Tim Norton: We fight, we bicker. Yeah. 

Alan Gordon: Mm. And it kind of seems like, you know, the anxiety around this or the stress around this is like spilling over into like different areas of your relationship. Yeah. [00:22:00] Do you feel like she's on your team?

Like, do you feel like if you had a solution or a new approach that she would be like in to try it with you or do you feel like she's just so frustrated with you at this point? She's like, you just figure it out. You know, or do you feel like there's like some support from her. 

Tim Norton: I feel like if I handled it better and I presented it to her that, yeah, she would be a 

Alan Gordon: team player.

You do? I do. So if we had her here and I explained to her the whole erection fear cycle, it happened that first time it got in his head, the more pressure he puts on himself. You know, the harder it is for him to get an erection, the harder it is for him to get an erection, the more pressure he puts on himself.

And now, you know, it's this thing where he's not able to be in the right state. And she understood that. Then you think that, you know, if we put together like a plan or something like that, that she would be on board, she'd be like, okay, we're a team we're going to address this. Yes. Okay. That's that's important [00:23:00] because if she was like, Putting extra pressure on you and not willing to work with you through it.

Well, how are you not supposed to feel pressure if someone else is putting pressure on you? You know,  but if we had her here and we were able to kind of talk about it together, okay, this is what's going on with the primitive part of, you know, Tim's brain is blah, blah, blah. This is happening to his autonomic nervous system.

I have a plan. Here's what I want you guys to do. She would be like, all right, let's try this thing. Great. So here's the plan. Okay. All right. I'm taking notes. All right. So what we want you to do is just make sex fun. Again, it doesn't even matter if you get an erection, you know, you're there, you have so much outcome dependence around whether or not you get interaction.

 outcome independence is one of the most important components of overcoming. [00:24:00] Erectile dysfunction. My favorite example of outcome independence is have you ever seen the movie dead poet society? I have. So there's this scene where there's this kid and he has this huge crush on a girl from a school across town, but he's always too scared to ask her out.

So one time he just like goes to a party across town to ask her out and he comes back and his friends see him walking back and he has. A big smile on his face and he has a black eye and they're like, what happened? And he's like, I asked her out. And they're like, and she said, yes. And he's like, no, she said no.

And her boyfriend punched me in the face and they said, well, why are you so happy? And he said, because I asked that's outcome independence where you know, where you no longer defend, defined success as whether or not you're able to achieve the outcome. But you define it as your attitude around independent outcome independence.

Right? Right. [00:25:00] So that's where that term comes from.  So I think that for you, you're very outcome dependent right now. If you're able to get an erection, you pass the test, you get an a, if you don't get an erection, you fail the test, you get an F right. We want you to really work on outcome independence and start looking at the definition of success as.

Was I able to enjoy myself, was I able to enjoy the experience independent of the outcome? So the goal is for you and your girlfriend to engage in sexual activity and really just enjoy it. Be light about it, you know, reconnect with each other, reconnect with each other's bodies, you know, and, and if you're able to be in that state of joy, it doesn't matter if you're able to get an erection or not.

That's a win, right. You've developed an association where sex is now [00:26:00] dangerous. We want to create a new association or sex is fun. Is safe, is exciting. Does that make sense? It does. 

Tim Norton: It does. What I'm worried about though, is that I'll just be too nervous going into the bedroom. Like, is there anything I can do to just settle my nerves?

Like I, all I'm thinking about is my penis. Isn't hard and it's never going to get hard. And then she's going to. Be obsessed. She's going to give me a look. I'm going to get scared. Like it's just a lot. 

Alan Gordon: Well, it's sounds like you've really kind of developed in association with even any kind of sexual activity is just like, I mean, the first thing we want to do is just kind of like, take it off the table.

The first time you guys do this, you're not going to get an erection. That's not even an option. That's not something that's going to be on the table. You know, that's not the goal. The [00:27:00] goal is for you guys to have fun and you know what. If the bedroom has, if you've developed this association where you're like super nervous to even go in the bedroom, take it somewhere else, get a hotel, go to her place, you know, hang out in the living room.

We want to kind of create an environment where we're not adding more obstacles or barriers than there needs to be. And I could give you techniques for anxiety regulation and things like that. But, you know, the point is. You need to get back to just, you know, lowering the stakes and enjoying being with her in a sexual way, knowing that that's off the table right now in the early stages, if we're able to get back to just enjoying ourselves eventually, you know, Your body will be able to be in a parasympathetic situation while engaging with her in the sexual way [00:28:00] and it will follow.

Okay. Yeah. Any questions about that? 

Tim Norton: Nope. No, I think that was,  I think that was really helpful. 

Alan Gordon: I'll let you know how that goes. There was,  I think that this is really a great analogy. I had a friend who got a rescue dog, right? This dog that was treated really poorly the first couple of years of its life, Rocky, the rescue dog.

And so my friend got this rescue dog and, you know, because it was treated so poorly by its previous owners, it had developed a specific association people. Equals dangerous. Right? So every time anyone of us would come over, we ring the doorbell. We knock on the door dog, Sprint's behind the couch. It's terrified.

But of course, every time we came over, we would treat the dog really nicely. So after a week or two knock on the door, dog is still behind the couch, but he's like poking his head out. A couple weeks after [00:29:00] that, dog's like halfway between the couch and the door a couple weeks after that you knock on the door, the dog is like pieing at the door.

He can't wait to get to you. After enough corrective experiences, the dog developed a new association. People equals safe. That's what we want to do. With you in that situation is we want to create a new association where sex your girlfriend in general sexual activity is safe, and we want to help you get some corrective experiences by just enjoying the experience of being with her in a sexual way.

And just taking sex off the table, reconnecting with the joy, getting some of those corrective experiences. So we could teach that rescue dog in your brain, a new associate. 

Tim Norton: I like that. And kind of where I'm at right now is 

Alan Gordon: I don't. Are we still in the role-play still in the role-play [00:30:00] overall 

Tim Norton: or are we sometimes like my, my girlfriend, my real life, non role-play girlfriend listens every episode.

Alan Gordon: Hi. 

Tim Norton: And so, yeah, that would be, that'd be kind of fun. Yeah.  so no, no, no. In my role play with this, like in the dog situation, I don't even want to call my girlfriend. I I'm, I'm avoiding, hanging out with her. 

Alan Gordon: Lately the association has grown, you know, it started with,  And this happens for a lot of people who have pain also, right?

Like maybe you have back pain, it starts to have back pain every time you walk, but then it spreads and you have a back pain every time you stand and then you have back pain. Every time you sit and now you even have back pain when you're lying down. So a lot of times these associations spread. So I think at first the association was sex equals dangerous, but then it's [00:31:00] spread.

It's like a contagious. And then it was like, My girlfriend equals dangerous and now it's spread. Even beyond that, or even thoughts about your girlfriend are dangerous and it's like, there's probably a part of you that one sort of break up with you just so you can be free. Of all that danger, but so that's what we want to do.

We want to start creating new associations, right? So when you find your mind going to a fear about it, right, just kind of like check in, bring your attention to the physical sensation of anxiety that comes up, let your brain know it's okay. You're safe right now. We're going to take care of this. What would 

Tim Norton: a physical sensation of anxiety be?

Alan Gordon: Good question. I'm taking too much for granted these listeners.  so, right, so let's say you're in the middle of work. And, you know, you know, you're hanging out with her girlfriend that night, you guys are going to dinner and you're like, Oh, we're probably going to have to have sex later. Right. And all of a sudden you feel this like, feeling of tightness in your chest or your stomach or your throat or something [00:32:00] like that.

And your mind goes to, okay, let's see, dinner is going to end at this time. You know, maybe if we order enough alcohol she's, he'll pass out. And she won't, you know, you start kind of going through all of these things to kind of. Regulate your anxiety. So that's a moment where it's like, this is an opportunity to start promoting messages of safety instead of danger to your own brain.

Right? So, you know, you have that thought of great, we're going to dinner. I'm probably gonna, you know, are going to have to have sex afterwards. I'm going to feel bad about myself. She's going to be disappointed in me. Right then as an opportunity, that is a moment. Check in. See if you could identify where you're feeling anxiety in your body.

Is it in your chest as in your stomach? Is it in your throat? And let's say that, you know, for instance, there's a feeling of tightness in your chest. All you need to do is just bring your attention to that physical sensation of anxiety. This is that tracking thing [00:33:00] that you were talking about earlier, right?

Yes. So just lean into the anxiety. Bring your attention to it and just breathe into it for a second. Right? So now instead of, you know, running away from the sensation to all of these terrifying thoughts, you're leaning into it. Right. So that's a way of, of, you know, kind of trying to create a new association with the fear thoughts around it.

But that's what we want to do. We want to start creating new associations first with, you know, the fear thoughts around it, then just with your girlfriend in general, and then with like sex with your girlfriend. Okay. 

Tim Norton: So I'm visualizing all these things or having all these thoughts and noticing the sensations in my body.

Right. And then am I literally trying to make the chest pain 

Alan Gordon: go away? Good question. Remember, you know, this chest pain, this anxiety is just another [00:34:00] thing that, you know, it's a physical sensation in your body and. We want to teach your brain that all of these physical sensations are safe as opposed to dangerous.

Like that's the paradigm with everything. Our goal is to teach our brain that something that is learned to interpret as dangerous is actually safe. Right. Whether it's the prospect of getting an erection, whether you're a rescue dog, living with a new family, or whether you're sitting at work and a feeling of anxiety comes up, we want to promote messages of safety.

So if there's a feeling in your chest of anxiety, if you want to get rid of it, if you try to get away from it, You're just reinforcing to your brain, that it's dangerous. Why would you want to get rid of something that's safe? So instead, instead of trying to get rid of it or change it in any way, all you need to do is lean into it, explore it.

So even right now, see if you could just bring your attention to the physical sensations in your body. Okay. All right. And what are you aware of feeling right [00:35:00] now in this moment in your stomach or your chest or your throat? Is there any tightness? Is there any warmth? Is there any tingling or burning feelings?

Yeah, 

Tim Norton: there's in the front of my chest, like in the middle of my chest plate. There's like a, 

Alan Gordon: like a, an ache. Good. That's great. So even just the fact that you're able to identify it as fantastic, because oftentimes people are feeling anxiety and they're so distracted that it's beneath the radar. They're not even connected with it.

So just the fact that we're even aware of it and. This is a real nut role, right? I do have a little bit. Okay. That's good. Cause we all have physical sensations at different times.  so I want you to see if you could just bring your attention to that achy feeling. And sometimes it can be like a little challenging to attend to something that is kind of unpleasant or, you know, a little sharp, but that's okay.

As long as you can tolerate it. See if you could just bring your attention to that physical [00:36:00] sensation. We don't even need to label it. Right. Maybe it's pain, maybe anxiety, maybe it's an emotion, but let's just call it a physical sensation. That's a little achy. Kay. So the first thing that I want you to do is just describe it for me, right?

Like. Is it widespread or is it localized? It's localized. Good. And is it pleasant? Is it unpleasant? Is it neutral? Is it slightly unpleasant? How would you describe it? Slightly unpleasant. Great. So again, even just the fact that you're able to identify that you're really paying attention to it. So how would you describe the quality of activity tightness?

Is it a stabby feeling? Is it a sharp sensation? Is it Tingley? Fluttery? What do you think? 

Tim Norton: It's vague. It's. It's mild. It's like a, it's a dull pain. 

Alan Gordon: Okay. So it's a dull, it's dull. Is it tight? Is it pick about it? [00:37:00] Just bring your attention to it for even like five or 10 seconds and just kind of explore it.

You don't need to jump to any assessments, really. Just kind of like give yourself the time to attend to it and assess like why, what is the sensation? What's the quality of this sensation? Well, it's, it's kind 

Tim Norton: of disappearing, 

Alan Gordon: right? So, so bring 

Tim Norton: your attention to it. 

Alan Gordon: Okay. But let's just call it a delay.

Okay. All right. So it's this localized, slightly unpleasant delay, and I want you to lean into it and you don't need to get rid of it. You don't need to change it in any way. All you're doing is attending to this sensation. And just watching, you know, if you've ever been like scuba diving or snorkeling and you see a really interesting looking fish, you're not doing anything to it.

You're not chasing after it. You're just watching it, noticing it. Exploring how the patterns on his body in the way that it swim. That's the same thing. You're just paying attention to the [00:38:00] slightly unpleasant, localized, dull, achy sensation. We know it isn't dangerous. It's just a sensation. And see if you could just watch what happens to it really kind of like Explorer.

Does it expand? Does it contract, does it intensify? Does it subside? Does it. Change in quality. How would you describe it? What's what do you notice happening that 

Tim Norton: sometimes on an exhale it's like it sinks down and disappears. And then it's gone for like two breaths and then on an inhale, it kind of 

Alan Gordon: comes back.

So this is an awesome opportunity to practice outcome independence. We don't want, we don't want to be excited when it's gone and bummed when it's back, we just want you, we want you to be okay either way and really just kind of like a Marvel at the fact that your brain is powerful enough to like actually [00:39:00] cause these.

You know, ebbing and flowing sensations in your body and see if you could just watch it and you don't need to change it. And again, you're not necessarily watching it with any intensity or scrutiny, almost kind of like if you're like lying back in the field, watching clouds pass by over a hat or a beautiful sunset, you're just kind of watching.

And then this like easy, effortless kind of way, knowing that whatever happens to it is okay. And again, it's just ebbing and flowing. It's like a few of her, I don't know, been to a symphony or something like that. And it's like, sometimes the violins come in and the tempo increases and then the tubas come along and like it slows down.

Are there tubas in a symphony? Yeah. Okay. I need to research my analogies more. So see if you can just like lean into it and enjoy it. Just enjoy the show. We know it's safe and if it intensifies that's okay. If it flutters, that's fine. And what do you [00:40:00] notice happening?

Tim Norton: It was, you know, was really absent for the majority of when you were talking to them. Right. When you started to finish it kind of flared up again. Cool. 

Alan Gordon: And is it still there? Is it still unpleasant? Yeah. Good. Barely. But yeah. Great. So yeah, just the fact that you're able to pay attention to it, this physical sensation that came up in your chest without trying to run away from it without trying to get rid of it.

You were literally communicating to your brain, this physical sensation that my brain has been interpreting as dangerous as actually safe. That's what we want to do. We want to teach your brain to reinterpret something that is looking at as dangerous as if it's safe. That makes sense. It does. Do you know about that?

Lorimer Moseley study with sadomasochist?  remind me, so Lorimer Moseley did a study with [00:41:00] like sadomasochist, like people who, you know, go to dominatrixes dominatrices dominate dominator seas dominate as soon as you knew that a little bit quickly.  and,  this is a show that's all about 

Tim Norton: sexuality. We actually almost had a dominatrix.

We've had a couple porn stars. Oh wow. Sex surrogate. So yeah. BDSM comes up. Oh, 

Alan Gordon: okay. Well, there was an explanation for that.  okay. So anyway, he did this study with, you know, sadomasochists and it was this really fascinating thing where they put like a hot, a really hot probe on their leg. And they were taking an FMRI of their brain kind of scanning the activity of their brain.

And,  they were all listening to a recording. And the scientist was talking and he was just narrating. What was happening? There's a hot probe on your leg. It's this many degrees. This is the chemical reaction that's happening on your skin. And the person [00:42:00] was processing it as pain, which is what you would expect.

Now. Everything stays exactly the same, except the recording changes. And it's no longer the scientists talking anymore. It's a dominatrix. She's actually following the exact same script. This is what's happening on your leg. This is how it feels. This is what's happening on your skin. And the subject went from processing it as painful to processing it as pleasure.

Pleasure. Exactly. Wow. So nothing changes except the interpretation, right? So when there's a physical sensation of anxiety in your body, You don't need to get rid of it. Cause there's nothing to get rid of. It's just your brain brain interpreting this, these little bits of sensory input as dangerous and as being processed as unpleasant, but by leaning into it, by tracking it, by exploring it in that kind of like objective mindful, curious way by reminding your brain that it's safe by enjoying the [00:43:00] experience, you're developing new neural pathways to interpret that sensation as safe.

Okay. 

Tim Norton: So. Now I'm doing that just when I'm trying to lower my anxiety. Would I also do that with my non erect penis? 

Alan Gordon: I don't know why that was such a funny question at that moment. You know, what's so funny is I've been, I've talked about. This so many times somatic tracking, reinforcing to the brain that it's safe.

And for a sec, I forgot that I was on a podcast about erectile dysfunction. So all of a sudden take what I do know with a nonresident felt totally out of the blue though. It isn't. That was amazing. Never gotten that question before, not at that point in the explanation. Okay.  you know, I think that. Your guts telling, you know, my gut is telling me no.

And the reason [00:44:00] why is because I don't think you're going to feel the anxiety in your penis. I think you're going to feel either your anxiety in different parts of your body, you know, and I think it would be hard to pay attention to your penis and be outcome independent. I think it would be hard to be like, Oh, that's interesting.

You know what I mean? You'd be like annoyed or frustrated that it was in that state. Yeah. 

Tim Norton: But that task of otherwise lowering the anxiety symptoms in every other part of your body is 

Alan Gordon: pretty important. Well, it sets the stage for being in a parasympathetic state, you know, like when you're able to regulate your anxiety.

Then your body, you know, this is, this is what insomnia is. It's people being on able to get into a parasympathetic state because they're in such a state of anxiety throughout the day. So it's, it's kind of globally important, but generally speaking, that was a really big statement. 

Tim Norton: Oh, what's that? That's what 

Alan Gordon: insomnia is.

That's what [00:45:00] insomnia is. Okay. I like that. Yeah. Okay. When you start your insomnia podcast, we'll have the same conversation with a different application, right? 

Tim Norton: No, I've, I've broken it down as such before, too. Like, it's hard to imagine someone getting out of that sympathetic state,  when it's just been so long, your body doesn't, doesn't quite shut down that quick.

Yeah. Zebras bodies do. 

Alan Gordon: Yes, we don't. Yeah, it's complicated.  But just to kind of give some context to the different things. We've talked about, the anxiety that you carry all throughout the day, you know, is it going to just like prime you to be in that state of, you know, your sympathetic nervous system being activated, you being in that kind of like high alert state.

And so being able to kind of practice regulating your anxiety throughout the day is. Can I is it's going to help you lower the stakes. It's going to make it [00:46:00] easier for your body to be in that parasympathetic state necessary in order to get the erection. So I know we've been talking about different parts of this, and I don't want any of the listeners to be confused as like.

Ah, do I do the somatic tracking thing? Do I like enjoy the sex? Like these are all different parts of it. You know, you want to lower the stakes in general. You want to promote messages of safety to your brain. You want to kind of teach your brain that these anxious sensations that it's interpreting as dangerous are actually safe.

You want to, you know, reconnect with your girlfriend or boyfriend and, and get them on board and try to create some new associations where it's enjoyable and light and easy and effortless again. Hmm. That's, that's 

Tim Norton: really eloquent and succinct. I like that. And it actually corroborates. Did I say that word right?

That was perfect.  an earlier guest who, who we weren't role-playing who was telling an actual story that had happened to him. And he was talking about his issues [00:47:00] with erectile issues. 

Alan Gordon: When you said an earlier guest, you said that like they do on shows when someone's about to come out and like join. And here he is like, wait, but we're in my place.

Tim Norton: He's not, he's not here.  and his solution was he developed an intense meditation practice, like over an hour to two hours a day. Yeah. And just really, I mean, obviously kicked up that parasympathetic state 

Alan Gordon: tremendously that it's a little intense to me. Yeah. Because you know, I've actually, you know, worked with like meditation experts and gurus before,  Who meditated way more than me, but, you know, they still had pain and it was almost kind of like they were meditating with a sense of intensity, you know, because meditation is all about just being easy and effortless and enjoying the moment.

And [00:48:00] sometimes even like, You know, you could take up something like meditation, but do it with an energy that's intense and not to kind of, you know, whoever that previous guest was. It sounds like it worked for them. But I think a lot of people, they feel like they need to work so hard to overcome this problem.

And the irony is. All that extra work is just more pressure, you know, and more intensity and more tension, which contributes to the very problem in the first place. Was that, was that earlier to no, no, 

Tim Norton: no, no, no, no. You, the way you described that story, I actually have been talking to somebody recently who heard another story that you had told and another.

 place, I don't know where, where you talked about your dedication to symptom reduction and how you, you kind of took it,  where you were doing, like all the things. So you have a little 

Alan Gordon: experience. I remember, cause I [00:49:00] kind of have that personality where it's like, I have a tendency to put a lot of pressure on myself.

And I remember when I was in grad school, I used to. Highlight like three fourths of every page. And I remember one of my friends was like, you know, it actually be more efficient to highlight the stuff you thought wasn't important. Right.  and I remember when I had really bad pain, you know, I, I, at one point I had really bad head pain and I.

Knew all the things I was supposed to do. I was attending to my internal state. I was doing the somatic tracking. I was paying attention to my emotions. I was, you know, meditating, and this is on a Sunday and I spent a lot seven straight hours doing all these things that you're supposed to do. And at the end of that 11 hour stretch, I was in even more pain.

And instantly I was just like, I'm never going to beat this. I don't care. I'm done trying, I'm going to have this for the rest of my life. I'm just like surrendering and the weirdest thing. Within [00:50:00] five minutes, it was 50% better. And I was like, Oh, on the surface, I was doing all of the right things. But when you're doing anything with an energy of pressure and intensity, it can turn a tool into a weapon.

So that's why I'm kind of hesitant to be like, yes, an hour of meditation a day will solve this problem two hours. Well, it's less about the behavior and more about the energy. Beneath that behavior. Hmm. No, that's really good. All right. 

Tim Norton: Well, I think we covered a lot. 

Alan Gordon: Is it, has that been 

Tim Norton: an hour? It's it's been 50 

Alan Gordon: minutes.

Wow. It was relief, like flu. That was really fun. Yeah. 

Tim Norton: Good.  so any, any other tips that you'd like to give to all the guys out there about 

Alan Gordon: their,  

Tim Norton: They're non erect penises in there. They're eggs about it.  how does it usually show up? I was [00:51:00] wondering, do you, do you work with somebody on back pain?

And then they're like, okay, there's something else that's going on? Like, 

Alan Gordon: it could just be related a lot of patients that I've seen. Don't even know that I do the pain thing. Cause they're like referred from like one of my friends or a friend of a patient. And so, yeah.  I, it's probably the only like 50, 50 now.

I mean, I'm only saying like four patients right now, so that doesn't say anything, but historically I've seen a lot of like non-paying patients, but yeah, generally speaking people who have pain are more likely to have anxiety also because it's just a different way of the brain interpreting danger. And people who have pain or anxiety might be more likely to have EDD because likewise it's like brain just interpreting danger.

So I think, you know, the most important thing I can say is you want to just kind of like lower the stakes. I know it's hard because you're like, this is so important. How could I lower the stakes? But the irony is like when the stakes [00:52:00] are really high, It just, it makes it hard to be successful. And when you're, when you're able to get back to that joy, that lightness, that ease, that effortlessness that you used to have, you know, that's when your body and your brain are able to be in that state, that primes you for success.

And then once you start getting those corrective experiences, Oh, I actually enjoyed this experience, you know, and. At a certain point. It like, there's less fear. There's less preoccupation. There's less hopelessness. You see the light at the end of the tunnel. And from there, it's just kind of like an upward spiral.

Okay. Yeah. Well, 

Tim Norton: thank you so much. You're welcome. What's going on for Alan Gordon and the pain psychologist 

Alan Gordon: center.  well, we just finished this huge pain study out in Boulder,  chronic back pain where, you know, we did this treatment versus a control group and everyone got FMRIs rise of their brains before and [00:53:00] after.

And that should be coming out sometime in the next year. And we're going to be writing a book, talking about all of this treatment and everything. That's going to be specific on pain. We're still trying to come up with a title for the book and,  One of our,  one of my coauthors friends wrote a book on depression called the upward spiral, and I was like, ah, that's the best name for a Vogue ever.

So where, if you have any ideas for the name of a book about. Ouch. We, we want to focus on the solution of the problem. Okay. That's good though. I like that, right. That is definitely like,  attention grabbing. Right.  so we're writing that book and you know, all of this stuff should be coming out at the early part of 2020, and we're really excited about it.

Yeah, 

Tim Norton: it's really exciting. And we find you at pain, psychology center.com 

Alan Gordon: pain, psychology 

Tim Norton: center.com. Yeah. Okay. And any, any other social media plugs or anything [00:54:00] like that, or 

Alan Gordon: that's pretty much the website. Yes. There are other social media things, but I never check them. So I don't even know what their handles are.

Yeah. Okay. 

Tim Norton: And there's a big presence on,  this, this bland called TMS Wiki. 

Alan Gordon: Yes, we have a pain recovery program,  on TMS T like Tom M like Mary S like Samantha Wiki,  that is like a 21 day program on how to overcome pain. And I bet a lot of that stuff 

Tim Norton: I haven't looked at in a minute, but a lot of that 

Alan Gordon: stuff would apply to this.

It really does. I mean, the Steve sack story is on there. The Rocky, the rescue dog story on there. I really borrowed a lot. All right. All right. I'm gonna recover it for him, but it's all the same application it's like lowering the stakes. Regulating your anxiety, getting corrective experiences, things like that.

Okay. 

Tim Norton: Sounds 

Alan Gordon: good. Well, thank you so much, Alan. Yeah, that was fun.

Tim Norton: Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, and other fellow sex, podcasters, sex surrogates, academics, sexual health, medical community, sex workers. The [00:56:00] tantric community and everybody else involved with having hard conversations. .