Moskowitz uses the MIRROR acronym to describe six qualities of a successful neuroplastic intervention.
Here is a brief run down of what these letters stand for:
M — motivation. The motivation part refers to being motivated to change the pain pattern. Active visualisation, an active role in our own treatment, in the face of inevitable setbacks.
I — intention. The intention is to not necessarily to remove pain (which is not the experience for the first week or so). The intention is “focus the mind to rewire the brain”. More on this below.
R — relentlessness. Again, more on this below. Briefly: we must be utterly ruthless with our visualisation and be more relentless than the pain.
R — reliability. Cultivating a reminder that the brain is not an enemy, and it is doing something it has evolved over millions of years to do. In most cases, the very mechanism at play in chronic pain is the same mechanism that we can use to unwind it.
O — opportunity. Somewhat pathologically optimistic this one, but it’s good to get in the habit of trying to see each pain spike not as a threatening event but an opportunity to learn new ways to untangle ourselves from these eruptions. Mentally re-framing our experience like this reduces the panic of each spike onset.
R — restoration. We are not trying to mask the pain but to restore normal brain function.
Today I’m a bit confused about two of these qualities — ‘I’ for Intention and ‘R’ for Relentlessness. So what are these concepts all about anyway?
The Intention aspect is a reminder of why we are doing the technique. Surprisingly, this “is not to get rid of pain — it is to focus the mind”. By focusing on the visualisation, we are engaging a part of our brain that would otherwise be processing pain and encouraging it (Relentlessly) to process visual imagery. If we instead focus on pain, or on getting rid of it, we engage other thinking regions of our brain that are not involved in the pain cycle, and so the results will be different.
Relentlessness is all about intensity of focus. Any pain “intruding into consciousness is the signal to push back. When the pain is just beginning to act up, (we) may think perhaps it will be enough to tolerate the pain or distract (ourselves) … casual distraction must be resisted, because it allows the pain to run unopposed … Relentlessness means, every time pain is detected, push back, with full focus and the Intention to rewire the brain back to what it was before the chronic pain began. No exceptions. No negotiations with pain.”
My question is, what about long-running stubborn pain, i.e., that lingers for minutes or hours even with visualisation? These two aspects seem to be in conflict then.
Say I drive to the supermarket nearby. Halfway there I feel a spreading pain and tightness from the base of my head into my shoulders and down my arms. This is a classic repeat symptom for me, so I pull over and run through the pain maps in my mind. No relief. All good, I’ll run through it again. No relief.
According to Doidge, a helpful internal dialogue at this point would go “I got a pain attack and used it as an opportunity to exercise mental effort and develop new connections in my brain, which will help me in the long run.”
But that runs counter to the aspect of Relentlessness, which says to push back every time pain “intrudes on consciousness”.
Until I learn otherwise, I’ve set myself an arbitrary maximum of three times through the visualisation. That way I’m not falling short of strong focus (after all, Three Is a Magic Number). But in keeping with the Intention, I am also not trying to calculate whether the pain has relinquished its hold. If the pain melts away in less than three iterations, then I will smilingly carry on my way to the supie. Freedom is its own reward, to paraphrase Ghandi.
 Doidge, Norman. The Brain’s Way of Healing, Penguin Books. pp19-20.
Also published on Medium.