Perception, Threat, Pain, and Purple

A brief thought/memory on perception of threat, the brain, and pain… Back in the mid 90’s I worked in Florida for a bit and met Chris who was another PT at a beach party. He was heavily tattooed, had spiky hair, and multiple earrings in each ear. In talking to some co-workers who knew him pretty well, they mentioned that this PT was “really out there.” Based on his appearance and first impression, I was leaning toward agreement.

Our conversation included the design of his PT clinic which he said was quite unique. I was doing some rotations at multiple locations as part of my intro to the company and had the opportunity to work at Chris’ clinic for a day.

When I arrived at the clinic, my initial response was that I was apparently lost as this did not look like any clinic I had ever been in before.  It reminded me of someone’s home.  Not at all what I expected.  Chris greeted me and began to show me around.  By the way, his hair was perfectly combed, his tattoos were covered, and his earrings were nowhere to be seen, so I almost didn’t recognize him.

The carpet was lush, and the lighting was not the typical harsh florescent overhead light but rather provided by lamps and decorative lighting.  The things that struck me the most were the colors, the sounds, and the smells.  Yes, the smells.

The walls, curtains, and trim were all various hues of purple.

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At first it reminded me of a teenage girl’s room and fully expected to see posters of the Backstreet Boys on the walls (it was the 90’s after all).  No posters to be found.  Just tasteful artwork that matched the purples.

As Chris talked, I noticed the soft music playing throughout the clinic in the background.  Not your typical local radio station or Muzak.  This was a bit “new agey” but not annoying or offensive.

“What am I smelling,” I asked Chris.

“Oh, that’s lavender oil.  It’s nice, isn’t it?”

“Sure,” I said leaning harder toward my first impression from the beach.

I left that day not really sure what to think of Chris or his clinic design.  I didn’t understand how all the minute details could really have an effect on a treatment outcome.  If you’re a good therapist, that’s all that matters… I thought.

Fast forward to the present.

My more mature prefrontal cortex with an expanded understanding of the patient experience thinks Chris was brilliant.  Whether he knew it or not, Chris was well ahead of the curve back in the 90’s based on our current understanding of perception and pain science.  He created a massive “home field advantage” in working with people in pain.

All perceptions matter.  Not just sights, sounds, and smells of the room, but our appearance, the tone of our voice, our handshake, or our facial expressions (smile!) are all perceived by our clients and can contribute to either a more comfortable or more threatening experience.

Neuroception according to Porges, takes place below conscious awareness in the more primitive areas of the brain and determines whether an environment is safe or dangerous.  A higher perception of threat increases the sympathetic tone of the nervous system in preparation of flight, fight, or freeze.  This will increase the sensitivity of already damaged nerves and inflamed tissues and potentially makes pain perception worse no matter how good a therapist or coach you think you are.

While our clients may present with knee pain, shoulder pain, or back pain, we are always treating “the system.”

Rather than go on about the patient interaction, I’m going to refer you to my favorite article from 2013 by my buddy, Zac Cupples.  Zac is a master at understanding the therapist to patient interaction.  While he doesn’t wear earrings, sport any tattoos, or wear purple, he does an amazing job of creating a powerful “home field advantage.”  Read The Interaction Here.

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