Latest / The STA Clinician Podcast / Ep.304 'Therapy Show Speaker Spotlight' with guest Anna Maria Mazzieri, Director, The ST School

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Ep.304 'Therapy Show Speaker Spotlight' with guest Anna Maria Mazzieri, Director, The ST School · The STA Clinician Podcast

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You're listening to the STA Clinician Podcast, connecting clinicians across healthcare.
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Podcast, formerly known as the Sports Therapy Association Podcast.
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I'm your host, Matt Phillips, and as always, this episode is being recorded
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live on the Sports Therapy Association YouTube channel and Facebook page at
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eight o'clock UK time on a Tuesday.
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So just six weeks to go until Therapy Show, formerly known as Therapy Expo,
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the UK's largest multidisciplinary event for MSK Professionals,
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returns to the NEC in Birmingham, England this November on Wednesday, the 25th and the 26th.
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In these episodes leading up to therapy show, we'll be bringing you as guests,
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some of the speakers from the event.
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Last week, I had the pleasure of being joined by special guest,
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Mike James, the endurance physio, talking about his presentation and the debate
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session he's hosting, both happening on day two.
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You can check out that on all popular podcast apps and watch it on YouTube you
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prefer, and that's episode 303 of the STA Collision Podcast.
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But tonight, my guest coming up very shortly is the one, the only,
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Anna Maria Mazzieri, who many of you will already know is director of the ST
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School and creator of the super popular Hands-On Hub Theatre,
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which has been there in past years at Therapy Expo.
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What you may not know is Anna Maria is currently a PhD student in the Centre
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for Pain and Active Inference Research at Health Sciences University, HSE for short.
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HSU is a center dedicated to reimagining how we understand and treat pain,
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bringing together neuroscience, psychology, clinical science,
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and innovative technologies to explore how the brain body system perceives,
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interprets, and shapes pain.
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Seriously cool stuff. The geek in me is already just salivating at the prospect
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of this, and Anna-Maria is going to be here to tell us all about that and also
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what she's presenting at Therapy Show in November.
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So without further ado, let's bring up Anna Maria Matsieri.
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Hey, Anna-Marie, how are you doing? Good evening. I'm very well.
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Thank you. I don't know if I haven't seen you for a while, like physically,
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but you look really well. You look really well. Thank you, Matt.
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You look really healthy. The PhD is suiting you. Oh, loving it.
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I should have done it years ago, years ago. Absolutely loving it.
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Maybe ask my husband and son. Might not necessarily say the same, but yeah, I am loving it.
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Yeah, they knew what they were getting into. Yeah.
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Yeah, lovely to see you. Thank you so much. first of all for giving up your
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time to join us tonight i know you're a very busy person with a phd and running
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the st school and getting ready for therapy show i just remind you you need
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to get those slides ready so yeah thank you master.
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You were last uh on with us let's see march you were here in episode 276 we
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came on with the marvelous matt low to talk about the new lens physiothology,
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and then a month before that in episode 273 you came on with professor dave
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Newell, who's the head of the Center for Pale and Active Inference Research. My supervisor.
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I'm very lucky.
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I mean, since that episode, he and you just took me on a massive deep dive into
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it. I mean, nothing about it. It was wonderful.
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Fascinating. Well, it takes a little bit to make sense of it.
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Excuse the pun. But once an activist and an active inference start,
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you can manage to kind of contextualize it to one's on practice or whatever
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the practice is, it starts making sense.
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We don't, you know, we always repeat, it is not the absolute truth,
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but it's, there are frameworks that they are helping to,
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put things into perspective and to actually give a narrative,
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a structure to our thinking.
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In our behavior and it's evidence you know we we have evidence of especially
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computational evidence of some of those,
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theories yeah i noticed i meant to bring it up actually get a shot but i think
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i saw dave newell releasing
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news on a recent paper maybe with either some of his students showing connections
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now linking pain because that's always been the thing active inference
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and predictive processing is a fantastic framework and explains so much but
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i think the trickier thing is connecting it to pain isn't it and that's maybe
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where you're coming into it no,
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i mean there is there have been especially the especially there is a fabulous
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paper from mick tucker the embodied predictive processing paper which shows the links with pain so,
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he is still it's still quite still it's still theoretical and the other one
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to follow is eccleston you know christopher eccleston but I don't know,
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talking about evidence and talking about a little bit about this embodied and,
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how we can affect our own body through.
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There was a paper released from, I don't remember her name, she's in Israel. And.
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They used a pinprick to stimulate some inflammation.
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And what they did, the subjects, the participants, had to...
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Bring attention to the area. So what they found that when they brought attention
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to the area, the inflammatory markers decreased.
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There was changes in the inflammation. But even more, and this is what excites
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me, if the tactile input was part of the attention, i.e.
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Brought attention through the tight input, that showed even stronger effects.
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So, those are the type of empirical evidence that.
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We want to see more and more. That sounds very exciting. Yeah, but we have evidence.
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Evidence of predictive processing, evidence of active inference.
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It's evidence in interoceptive evidence.
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If our signals change in perception to something, our perception of interoception
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change. There is evidence on that.
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Kind of you know kind of makes us it gives us a little bit more of a of a strong,
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theory that we are predicting what is happening,
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and we are changing our our our body according to those predictions i want to
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try and break this down this is going to be challenging because i know it took me a few times
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for it actually to kind of fit in and make sense and then it's a beautiful it's
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like a door opens and i'm looking at the cat now and thinking wow that cat's
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updating its priors and all that prediction over the cat that's why it's trying
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to scratch me everything now is about prediction but,
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if we can strip it back to the basics where,
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with with prediction what we're saying like most people kind of think that the
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brain is waiting for to see stuff and hear stuff and then reacting to that and
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it's kind of just a computer in our head but can you explain what the whole
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predictive processing idea is
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and and yeah how it changes even more active Even more active inference, that's,
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the Fritzen concept.
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That's what, to me, relates very much to us. So, if you think about,
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if I say the word homeostasis, we understand homeostasis quite well. Homeostasis is our body.
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Trying to go back to a state of balance, equilibrium.
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But that is very reactive because it means, homostasis, it means that you go
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back to a state of equilibrium after the equilibrium has been lost. Yeah?
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With predictive processing, what we are finding, and predictive processes is
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not new, by the way, what we are finding, what has been found is that the,
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system, the organism, I'm not going to break down body, and the organism as a whole,
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we actually don't react to a state that has changed.
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We predict in order for us to remain viable because this is our role is our
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system to remain viable in our environment so to live and to thrive,
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in order to do that we need not only to respond to the environment we need to predict,
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what's going to happen so that we are ready to then adapt to it.
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And that is a better system. That is called allostasis. So we are not responding,
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to input from the environment.
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We predict those inputs.
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Then what's happened, there is something called, so if I predict something,
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I predict that, for example, going out for a walk, I'm going to go out for a
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walk, and I predict that going out for a walk.
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My back will be painful. And then I go out for the walk, and my back is not painful.
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That mismatch between my prediction the reality of what's going to happen that
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creates an error that creates a mismatch it's called prediction error,
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and this is where and when we have a prediction error we have to update our
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prediction this is what learning is how do we learn
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in learning in education we always knew that we knew that you learn when there
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is a mismatch between what you know and what you thought you know but you actually
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don't so you feel a bit uncomfortable
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and only then you have to update your knowledge that's why you learn,
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so for us it's the same you know we have to learn that that prediction was not
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correct and this is where active inference come into place.
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What Fritzen, through his computational analysis, brought to us,
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and Fritzen is one of the most scientist neuroscientists with his free energy principle, he says that,
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he, and as I say, is computational, so it's been kind of evidenced.
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We want to lose as little energy, as little free energy as possible,
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because in order for our system to be viable and to thrive, we need to preserve,
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let's call it to preserve energy.
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Okay, so we need to be as efficient as possible.
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So predicting something, there's something not being what has been predicting.
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So when we sample reality, like going out for a walk, actually the back is not
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painful. So that is a mismatch.
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So that is called prediction error.
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In prediction error, when there is the error, there is loss of energy.
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And under Fritz and active inference, the loss of energy is something that the
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system wants to try to minimize.
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So actually, under active inference, we are not, again, just reactors of prediction.
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And if there is an error, we respond to that. Active inference,
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this is the active part, says that in very, you know, I will never do justice
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to the way it can be explained.
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But if I go out and I predict pain, my system will do everything to minimize the prediction error.
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And it has two options.
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One is to update the prediction.
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I, oh no, last time I was not, last time I didn't, I was not in pain.
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I didn't feel, I didn't sense pain. Therefore, my prediction changed.
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I can go out and not sense pain.
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Or I can change the way the system perceives the world What?
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So the prediction error is minimized. So the way I sense the world changes.
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We see that in chronic pain when we experience those sensations that sometimes,
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they are experienced much more acutely.
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Than we would expect.
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That is not only a subjective experience, that is actually a sensation that
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has changed because the system,
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wants to change the way the world is perceived to actually minimize the prediction error.
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And that is what sometimes might perpetuate the chronic pain.
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Because for a system that is so tired, that is so lacks capacity,
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actually re-updating those, when we say, oh, you know, go for the walk because,
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you know, that will make you feel better.
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Actually updating that prior, updating that original belief or that prediction,
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that requires so much work.
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So it's easier for the person to change the way they perceive the world so that...
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So that the perception is matched.
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So think about the other way is, remember when we
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first introduced a matter, you know, because it was those times when we started
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discussing about evidence-based practice in maniotherapy, there was people
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really went through cognitive dissonance there.
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And they really, some people really pushed themselves down and says,
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no, I'm absolutely sure that you're wrong because this, this and this,
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you know, this is what I see.
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So they actually felt, they read and they perceived their own arguments so strongly
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and they were right because this is how they perceived it.
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Because the system needed to protect, needed to lose.
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The least amount of free energy. We see that very often in trauma.
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So the system changes literally the way it samples the world so that there is not a mismatch.
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And that is then the prediction error is minimized and it's easier,
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even in that chronic pain,
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it's easier to match and leave that than actually change completely.
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Is it something that we do consciously? No. And this is where I come from.
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This is where my study is.
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It's about we are not the brain. We are not the body.
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We are unified. And this is what I love about active inference and activism.
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We are unified. We are a system that our body is not just a mere translator
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or conductor or conduit of information to brain.
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My body, the endocrine, neurological, immune system, they work in unison,
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hopefully, in order to both predict and respond to the prediction.
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So some of those things it's not a conscious level it's at embodied level,
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Very cool. Great explanation. And an Italian accent, which makes it even more interesting.
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It's fantastic. It's so hard to explain that. And I know people will listen
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to it and will have to listen to it maybe one or two times for it to sink in.
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But when it sinks in, it links so much of what we didn't have words for before
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when we were kind of trying to say, oh yeah, but you need the client's subjective experience.
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You need to think of their environment and the context around them and where
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they've come from, because this is what it's all about, isn't it?
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A person is not just them, it's about the environment.
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And this is where, bravissimo, Matt, and this is where not only active inference,
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because actually the theory of active inference, I'm quite critical.
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The core of it is quite brain-centric.
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This is where, to me, the inactive interpretation of active inference,
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and there is all those big words, and people say, oh, do we need...
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Well, Well actually somewhere we need to start giving a name to the philosophy
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we follow in our healthcare.
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So, inactivism for me, inactivism or the inactivist kind of translation of active
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inference for me really works.
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It's a good framework to spend because like you absolutely mentioned,
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Spoton, is I don't respond, me as an organism, I do not respond to my environment.
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I create my environment the way it is and my environment that creates me the way I am.
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So an activism sees the organism, the person, as emerging from this ongoing,
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coupling with the environment.
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That coupling, you cannot separate that. And this is why I love it, because,
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it's an ecological approach, it's an ecological way of seeing the person.
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But to me, it's so clinically relevant.
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When we speak to people that they're in pain, that have been in pain a long
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time, think about the fibromyalgia patient.
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Think about nothing can help. I mean, there is obviously there are many other
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reasons, but for a moment, just look at it underneath this lens.
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They're creating an environment for them to survive the way they do.
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Changing that environment too much, providing them the exposure that is not
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graded, is too much of an error there.
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Sometimes also, let's change a little bit of the environment before we actually change them.
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And also what an activist says, and to me that is even more,
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It says that us as a unified system,
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we are not only embedded into our environment so that we live,
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we are actually enacting it.
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We are actually part of that environment, but also we're part of that environment to make sense,
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the sense-making to what we do and the way we sense the world.
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So when I say sense in the world, it's not just a passive, oh, I'm picking up touch.
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It's about making sense that this is touch.
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So pain, we can have control, we can live well with chronic pain when we have control over it.
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But how can we have control over it if we cannot make sense?
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How can the person that comes to you that says, I've got pain all over my arm,
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they do not know where it comes from, or the pain, they cannot control it.
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They cannot make sense. If they, well, instead what we can do,
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and this is again, this is where my study is. My study is about touch.
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How can touch help people become coherent?
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So the embodied self being coherent means my hypothesis is, which some of it,
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there is already some evidence.
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My hypothesis is that actually people in chronic pain lack of coherence between
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themselves and in this case, some of the body parts.
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And my hypothesis is that touch in this unique sensory, because it's multisensory.
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There is proprioception, interoception, seroception, all in one.
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But plus it's also affective and relational.
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So it's an integration, everything. Through that, we can help the person make sense.
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What does that mean? It means if somebody I work there on a shoulder that they
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don't feel theirs, there is connection to the area through the touch.
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But not only through the touch because the nervous system picks up the message.
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Because the touch to the person at the time, momentum to momentum,
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means connection with the person.
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And we then apply consciousness, being conscious about it.
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So what does that feel like, even if it feels a bit painful,
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but the person can connect feeling a little bit of discomfort with that part
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of the body. That is already sense making.
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And once there is sense-making, so it's not only about lived experience, I feel that.
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It's also I feel that and that match what I feel with what the reality of the sampling is.
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And that, all of a sudden, once you make sense, you're in control.
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You start from a very strong base of coherence and control takes place.
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You still have chronic pain? Yes.
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But you are a strong base to then move forward with it.
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And to then, that's where the option for healing starts.
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Very cool. I'm interested because obviously this is going to sound complex to
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therapists out there, but it does kind of provide.
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I think it was Paul Ingram who once said, if you know how something works,
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you can make it work better.
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And the more I read into this is we are getting closer to understanding how touch can help.
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And once we start going down that road, we can start making what we do even better but,
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like for somebody who is in charge with delivering courses to level five and level three,
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and upgrades at what point do you think some of what you're doing in your phd
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can be introduced to learners is it just a level five thing or is there kind of no no no of course not,
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you can you can no no matt because it's any level so of course i will not i
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talked about the sense with some of my level 5 students that are gone now because.
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They enjoyed and they asked.
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So I might not go to that because it's not relating to what they introduced.
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You cannot teach, but certainly you can deliver about the difference,
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about predictive processing, active inference, very clinically speaking, at any level.
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So you can deliver anything at any level, Matt. It's just the complexity of
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it. that you're scaffolding.
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So I can still deliver about an anthem at level three or level five.
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It's not the topic, it's the scaffolding of the knowledge that you put on top of it.
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So obviously at level five, I can go a little bit more in depth.
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And level five is not what I teach, it's what the students then do with what I teach.
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So it's them listening, learning, evaluating, and analyzing,
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evaluating, synthesizing, and coming up with the plan through it.
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While at level three, I might actually say, you know, I very much apply predictive
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processing for, for example, on room preparation. So if somebody says, Anna, what it is that.
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A clinical application of what you're discussing, well, it's the prep of the room.
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So what does the person expect? In the moment in which they already come in
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and calling for a massage, yeah, what are they expecting? Massage therapy.
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I'm not expecting that the whole one hour will be or needs to be massage therapy,
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but I'm certainly expecting that the person expects massage.
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So you're not providing massage on the day. What does that create?
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Unless they've been told, created a mismatch.
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So if your treatment or anything you provide or the way you explain that,
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this is why it's really important to explain the treatment of what is going to happen because,
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you are not breaking the boundary of the expectations.
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So then when the expectation is met, and this is where.
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I don't want to keep the person into chronic pain. So I'm not always going to match the processing.
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What I'm going to do, I'm going to create a safe enough space where then.
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Prediction error can occur so that the mismatch, the error we together with
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me and the client can actually then find,
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re-update the priors.
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And that's how we apply active inference.
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But if it's a level three, I would say prepare the room in the way in which
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your client would expect the room to be prepared in order for them to relax.
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I think that's really nice as well because i think i've been because i'm,
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studying inclusion i'm really using active inference and predictive error and
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everything to explain how different cognitive profiles with different precision weights
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and different expectations and different ability to filter out and reduce precision and that
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are going to react and i'm really interested in how this explains maybe generalizing
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but the autistic brain inverted yes or the adhd brain and there's so many parallels
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it's so fascinating but i think even on a level three,
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course you can use this to explain why you might think that,
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your room looks perfect for massage but your client might not like the bright
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light or they might not like the smell of the joss stick or they might not like
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the whale music you know so you've got to
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and it sounds obvious doesn't it give the client what they want but we often
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forget this this explains why you need to give the client what they want Yes. Which is beautiful.
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Mark, this is, so then the treatment outcomes is not anymore giving the client what they want.
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The treatment, giving the client what they want, what they expect is to create,
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is to create safety at the beginning.
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Because then into the safety, eventually we need to, especially I'm talking
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about chronic pain, but even in education, yeah, I cannot, I need the students.
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To face the uncertainty that they do not know,
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because unless they face that there is no transformation in learning this is
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one of the things in in phd that literally it breaks you down,
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to the core to crying for how,
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you know challenging that the intellectual depth you have to go to because once
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you're there you then come out as transformation so I say to my students,
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the middle of the course, you always go through this deep in education.
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You got so much inside your brain that all of a sudden you do not know what
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to do. And you think, oh my God, I would never.
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Only through that, then you come out as a transformation, transformed person.
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And this is where the prediction error in this case, we keep calling prediction
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error, but they need to be challenged, those prayers need to be challenged,
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those beliefs need to be challenged.
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But we need to do them in a way and at the time where the system feels safe.
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Because if the system does not feel safe, cognitive or body-wise,
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now you will find other things. It will change its environment to confirm the prediction.
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Exactly. Because that's the other thing, isn't it? If you can't update the prior,
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if you can't kind of re-evaluate your expectations, then the other option is
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just do one and run and get out of there, isn't it? Correct.
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Yeah, because what you... Avoid the movement.
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Yeah. Esattamente. The same, you know, when you say to, again,
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the fibromyalgia patient, you know, going for the walk, if 10 minutes is too
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much, go for five minutes. They go for five minutes and say,
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oh, but I was still in pain.
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Why? Because actually it's for the system is so much more valuable and they
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preserve so much more to actually experience.
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It's not that they're lying to you, that literally the pain is real,
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that inflammation is real, that hypersensitization is real, because the system
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has created, you've got the endocrine, the neuro, and the
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immune system, that they're working together,
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to preempt.
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And this is the beauty of the, it's Curvus, I never can pronounce,
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well, I cannot pronounce it. It was Mick Thacker in 2022 with Curvus Stern.
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And they wrote embodied predictive processing, the theory, pain in embodied
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predictive processing.
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So we know that. And the paper, what I really like, because it's actually a
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bit of a, rightfully so, a criticism, because one of the things,
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and again, on my study as well.
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I will criticize that we are old enough, me, you and Gary, to remember,
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you know, the changes from biomechanical to biopsychosocial and so on.
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And for us, you know, in holistic therapy, we always understood that holistic, holism.
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Anyway, we moved from, you know, biomechanical, wanting to be so away from biomechanical,
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reasoning or biological reasoning, that actually we've gone to,
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you know, brain-centric.
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We change one system for another. So now everything is to do with neuroscience
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or everything is to do with the brain.
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And actually, no, not everything is to do with psychology, not everything is
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to do with the brain, not everything is to do only with the body.
31:43
Even the biopsychosocial is so compartmentalized. This is why I love in activism,
31:49
because you cannot extrapolate your biological from your psychological, from your social.
31:55
You know, we are one system. The only thing that put us all together...
32:02
In clinical practice that we can rely on is what we call phenomenology,
32:07
is the experience, the sense-making of the person.
32:11
And this is why, again, I'm very excited about my study because out of the empirical
32:17
studies, what I put in there also is to the person, what does it feel like to be coherent,
32:26
and what it feels like not to be coherent.
32:29
That is the only thing that puts everything to what we call first or third person
32:34
science third person yeah first is that we are the subject
32:39
third person is more about brain works and so on very exciting,
32:46
okay we've geeked off for 35 minutes fantastic we thought we'd like a little
32:50
intro if you are listening to that i'm really wary of people who are going what
32:54
the hell don't start thinking oh my god this is what,
32:57
don't start doubting yourself i know you look a lot like the more you put hands
33:00
on someone the more you doubt your ability but this is stuff which i would encourage
33:03
you we'll put some nice links in the show notes for you to have a little look through,
33:09
but it's a really,
33:11
i don't know i say it's entertaining but that's my reality once you get into
33:15
it it's it explains so much it joins the bits together in a wonderful beautiful
33:19
way of Yeah, but Matt, I am one of those.
33:21
This is why I like speaking about it, because I'm one of the listeners.
33:27
I am not an academic, I was not, you know, came to be an academic,
33:32
or I am a clinician, I am a therapist, I'm a very proud massage therapist and
33:39
sports therapist, but I'm not academic.
33:43
I became an academic because, actually,
33:47
because of thanks to some, you know, Roger Carey and Chad Cook,
33:52
I must say, and Laura Case that involved me in some of the studies and made
33:57
me realize, oh, actually, do you know what?
33:59
I quite like that, but never thought I did. So it's not, it's only difficult when we push them away.
34:06
And this is, I think, we need more and more a lower level, you know,
34:11
a lower educational level to start introducing those terminology now.
34:16
Because, of course, my students, even at level five, they will not go out and
34:19
just talking about predictive processing as a matter of fact.
34:23
But what they're going to do when they hear it, they're starting already,
34:29
you know, appreciating that.
34:31
We need to have more and more of those conversations, no less and less of them.
34:35
I agree. And we've got to make philosophy a common word as well,
34:39
because a lot of it is philosophy, isn't it?
34:40
Thank you very much indeed, Dan. We get scared about philosophy, but a lot of it.
34:45
The more you delve into philosophy and start looking at the long words,
34:49
we're realizing what it means, like epistemology or something,
34:52
looking at what the knowledge is, depending on who's giving you that knowledge
34:55
and how that changes everything.
34:57
And like you said, phenomenology and ontology and all these ology things and isms.
35:01
It just becomes a beautiful thing. It's beautiful because it is,
35:06
it builds up your identity.
35:09
I, you know, we had to do the philosophy of science, philosophy,
35:13
sorry, our research for the PhD because the whole PhD has to have a philosophy.
35:17
Each of those members here that they're listening or non-members,
35:22
you all have your own philosophy.
35:25
The difference is you probably never talk about it with anybody.
35:28
And this is, I am, I am very critical of university that we're putting less
35:33
and less value on certain topics. I know, it's sick, isn't it?
35:37
And this is why departments are closing.
35:39
While we need to be comforted to have those discussions, even if we don't know
35:43
the big words, and we should not be afraid of that.
35:47
We always want everything clinically applicable. But what is more clinically
35:50
applicable than the philosophy of healthcare? If you all sit down,
35:54
and I know that Gary always says, you know, what is your, what do you call it?
35:58
What is your, oh my God, avatar? What's your client avatar?
36:02
You know, even that is thinking about your own identity.
36:05
And then you go deeper into what do you think about your health journey?
36:09
What do you think about a client, you know, the healthcare in general?
36:13
These are things, those are, you know, concepts that we need to be discussing more and not less.
36:21
Very cool. right i want to have a little look at i don't know if jess is still
36:25
saying this but she did say it 30 minutes ago i find this so exciting is that
36:29
still the case jesse still with this that's great it is exciting but if you're
36:32
not getting it yet you will,
36:34
but it does open up a lot of doors and explains things and it sounds really
36:39
complex but once you start just thinking in a slightly different tangent suddenly
36:42
it just opens these doors which are really exciting
36:44
and nikki mansfield has said here let's read this out for the podcast listener
36:48
chronic pain sufferers eds fibro already have limited energy,
36:51
how can we best remap the prediction quickly?
36:54
Is it a case of keep gathering real feedback of, in this case,
36:57
pain-free walks? Question.
37:00
I love that. I love what Nikki says, that she always, super,
37:03
super contributions actually gives,
37:06
Yes, it's a little bit exposure, exposure, exposure. Said that, there is exposure.
37:17
That's not mean that necessarily you are going to come out of fibro or going
37:21
to come out of EDS and not all the EDS.
37:24
But what it means is that you can be more in control, potentially,
37:32
of the pain you have. So as we know, fibro especially is complex.
37:36
So it's a neuroinflammation.
37:40
Immunoresponses. So some of it potentially, you know, looking at some of the
37:47
evidence coming out recently, it could be, you know, helped.
37:51
And certainly pharmacology can help.
37:54
But where I think active inference and predictive processing have their role, it's.
38:03
On helping the person to be more coherent and be adapting themselves better.
38:12
Because ultimately what happens, we lose adaptation.
38:16
You know, we become less and less adaptable to the world around.
38:21
So as the world changes we cannot respond to it quickly enough so by by becoming
38:27
more adaptable we are becoming more resilient and potentially you know coping better with what we have,
38:35
because we have to be very careful that when we discuss about predictive processing
38:39
and active inference and all this,
38:41
that we do not think that this is a cognitive process people do not,
38:48
think. It's not people's fault to be in chronic pain.
38:53
So we need to be very careful because a client says, oh, do you think that I
38:58
should update my beliefs in order to be, if I even update them now,
39:02
does it mean that it's my fault or I'm not able to update them? No, no.
39:07
This is beyond cognition at the level that we know it.
39:11
This is about the, this is what I say, You know, cognition is more.
39:18
Than just, you know, thinking. And this is, again, where the embodied self,
39:23
the embodied self is the sense of self, what we call it, the minimal sense of
39:27
self, where there is no need of thought.
39:30
The body is embedded and enacted into the environment and acts and responds and act and responds.
39:43
So predict and reflect without the thought process.
39:50
And this is where I do think that's why some people choose massage therapy or choose hands-on.
40:01
Because they make sense not by thinking, not by cognition. They make sense about,
40:08
the pain, the world, by touch.
40:13
I personally make sometimes sense of the,
40:16
when I touch the person, not because I touch an area over another,
40:20
literally touch, tactile stimulus helps my brain organize my thoughts about the person.
40:30
And to me, that's where.
40:33
Let's have a little read. This is going back to expectations and prediction errors and things.
40:38
Gary says, we advocate a what to expect video or what session looks like on your platforms.
40:44
That's cool in the beginning. Again, when we're going back to creating an environment
40:47
that's not going to create initially some kind of massive prediction error or
40:51
mismatch with them. Yeah, but I used to see my, yeah, yeah. Really cool.
40:55
Immy here, excuse me, the one for Immy, has said, not just relational,
40:59
but inter-rational to different degrees depending on context.
41:02
Very good. Yeah, very much. You like that as well? Very much, yeah.
41:05
And then Sarah, oh, you've got your fan clubber in it tonight,
41:08
Sarah. Wonderful Sarah Jones also adds here, I'm so sorry to the party.
41:12
Blame uni work, which I blame on Anna and Nimri. There we go.
41:14
That's very true as well.
41:17
Gary comes back again. Thank you for contributing. Everybody's joining us live.
41:21
This is what separates great educators from those who think the industry is a side hustle cash cow.
41:25
Thank you, Gary. Thank you very much.
41:29
Thank you. Fantastic. Look, I'm conscious of the time. So, yeah,
41:32
thank you so much. It's so interesting, your PhD.
41:34
How long have you got left? Because you've been doing it, what,
41:36
a year now, is it? Yeah, yeah, yeah.
41:37
It's three and a half years. I'm a bit behind because I got to do a,
41:40
I'm in the middle of a Scorpion review. By the way, if there is anybody out
41:44
there that are doing their own review and they want to share paper reading,
41:48
because I've got 1,000 papers to screen now. Yeah, yeah, yeah.
41:53
Okay, let's have a chat about the therapy show. We're back. We're going back.
41:57
We're going to see each other in the flesh again. Fantastic. In six weeks now.
42:01
So I want to bring up here what you're going to be talking about this year.
42:05
So let's have a little look in some detail. Well, not too much detail, but...
42:09
I've gone mad. Yeah, I've gone... I'm excited here. Well, the first one,
42:13
let's have a look. So if you've got your pen and paper ready, people...
42:16
Oh, no, they've still got the title up. That's not the title.
42:19
Is that not the title? What can psychedelic research teach us about pain?
42:22
Yeah, yeah. Is that it? It is. It is.
42:24
What can we learn from psychedelic research for... Oh.
42:30
It is. It's similar. No, I thought it's similar. Yes, it's similar.
42:35
If you like, email me and I'll get to change it. Yes, the psychedelic research.
42:39
What are we talking about, Maria? Are we talking about illegals or what?
42:42
No, no, we're talking properly about illegals.
42:44
So what we're going to be talking about, what I'm going to be talking about,
42:48
because it's all linked to predictive processing, to the human experience.
42:56
And I'm also very, very interested in psychedelic research, especially because
43:03
in Exeter here we have a very big center.
43:05
And actually, what we found in psychedelic research about the way the brain,
43:12
crosses and the brain changes is something that we need to take note in science.
43:21
I'm not discussing about psychedelics
43:25
for chronic pain, but the way psychedelics, science and research,
43:31
has shown us of how we think,
43:37
and how we change the patterns.
43:42
Of thinking is something that we need to take definitely note.
43:48
And also the way they're researching it. So I'm not going to say too much here
43:52
because this is something quite a big part of the talk.
43:57
So from the psychedelic perspective, we're looking at what is called entropy.
44:07
And actually there is a paper that came out yesterday that I need to research
44:10
it because that says completely the opposite. Anyways, but especially in Robin
44:14
Carr-Harris' lab, they have found the psilocybin...
44:20
There are dramatic changes in actually a biomarker's level in the brain.
44:29
But what they found is that in order for this transformation,
44:33
this immense transformation, so first of all, for those of you who are not aware,
44:38
the use of psychedelics like psilocybin or magic mushrooms, what we call magic
44:44
mushroom LSD, MDMA, Well, MDMA is not strictly a psychedelic,
44:50
but it's still part of that.
44:55
And Ibogaine, which comes from Ghana, I've been shown to MDMT,
45:04
plus others, sorry, there are quite a few.
45:06
I've been shown dramatic benefit for certain mental health, addiction, PTSD.
45:17
We're talking about changes, that important changes that is like when,
45:24
for example, it's been compared to when antibiotics have been discovered.
45:30
Yeah, it's one of the biggest things that happened in the last 50 years in psychiatry.
45:34
And what they found is that unlike antidepressant they do not,
45:40
change the brain in terms of suppressing ideas or feelings actually what it does what they do they,
45:49
open different they make the brain much more instead of being convergent much
45:56
more divergent so there is this highly neural,
46:01
changes peace.
46:04
The person after, and we're talking about one medical dose.
46:11
So what I'm discussing here, nothing is done without the research study.
46:17
So I'm not talking about recreational psychedelics. So we're talking about.
46:25
Medically supported use of psychedelics with also integration with psychotherapy.
46:33
But they found that there is a dramatic change in the way the person then after,
46:40
they feel about that experience.
46:44
And there are different hypotheses and there are different research.
46:51
And I'm going to put it all together because we need to learn from it.
46:55
Because it's telling us about it's relating to prediction, it's related to embodiment,
47:01
and it's telling us a lot about how we should be researching about pain.
47:09
And my feeling is that because psychedelics,
47:17
some of the academics in psychedelics are also people that,
47:21
come less from an academic background, And because there is this tremendous
47:26
amount of respect for the naturalistic and indigenous knowledge,
47:33
they are using this pluralistic view of the world and health.
47:39
Which we do not care.
47:45
We are actually, you imagine, you know, having an academic high-level pain scientist
47:52
going and chat to a massage therapist. Yeah.
47:55
Yeah. But, because actually there is a lot of snobism in, there's quite a lot of snobism in academia.
48:01
Yeah. Well, instead, you have these amazing academics on psychedelics said at
48:08
the conference, they say,
48:12
first thing first, let's give our respect to the shamans, to those indigenous
48:19
cultures, and they're actually eager to learn from them.
48:26
That's, yeah, that is knowledge, huh? That is knowledge.
48:30
Right, good hook. So that's Theatre A, Theatre A, check you out Theatre A 9.30am.
48:38
On day one on Wednesday Nobody's going to come to that I said Yeah they will
48:42
No no 9.30 Who's come on the first day at 9.30 I will Yes of course because
48:47
I'll make you come Oliver will I'll make you come Is Oliver going?
48:49
Yeah you Oh I have to ask Oliver you know now he's So he comes along Yeah Anyway
48:55
then at 10.30 on the same day afterwards you've got I don't want to say too
48:58
much about this but it'll be very interesting to hear an updated view of it
49:02
hands-on-hands-off debate.
49:04
Do you know who's going to be in that debate? Yes, so it's going to be me,
49:07
a couple of me, Rishi, Anthony. There are two on the MSK Theatre.
49:13
And it's, we have to change the title again for that. Okay. And we're looking
49:19
at touch and modern health care. Touch and modern health care.
49:23
You know, it's moving on from the hands-on-hands-off debate.
49:27
The two physiotherapists, the primary...
49:31
Well, I don't remember the title. An updated version of that would be cool because
49:36
some people on social media are still, I think Roger once just said,
49:40
can we just stop pretending there is this kind of, should it be hands on or hands off?
49:43
It's like, he said it about five
49:45
years ago. There's still people making a living out of it, aren't they?
49:49
Talking about my lovely... No, no, save that. I've got a little thing for that later on.
49:54
Day two, what can touch teach us about chronic pain, which I imagine is what
49:58
we've kind of been trying to talk about.
49:59
Which, this is what I was going to say, that thanks to Roger,
50:03
so I actually, the second one, the practical, is exactly in response to some
50:10
of Roger's posts recently.
50:12
Oh, really? Yeah, yeah, yeah, yeah, that's why, you know, that's what I was
50:16
going to, where there is a lot of confusion about people says,
50:20
oh, you know, do not use massage or do not use, and I say, well,
50:23
actually, it's only the way you.
50:27
It's your definition of what massage is.
50:30
It's people's definition of what manual therapy is. So I'm going to bring the
50:36
concept of touch in its broadest forms,
50:40
and how it can be applied in clinical practice, especially in those practices
50:46
where, let's say, they want to be less hands-on in terms of manual therapy and massage.
50:52
And to show that actually maybe manual therapy and massage can be a very good
50:57
tool in order to achieve what their outcome will be.
51:01
Very cool. Should be good. I mean, there's three there, which are,
51:04
I mean, there's so much going on at Therapy Show this year, but there's definitely
51:09
three there. And the good news is that I don't think...
51:13
Yeah, you're free at 9.30 on day two to see Dr. Laura Mimosa.
51:17
Yes, yes. Well, to see the live stream anyway. Yes, I am very excited.
51:21
That should be quite cool.
51:24
It'll be like the first time I'm going to see Coldplay or something.
51:26
It should be quite good, except it'll be a recording. I've seen him a couple
51:28
of times. Yeah, he's got...
51:32
That's the good news. You'll be able to watch Roger Carey. The bad news is you do clash with...
51:37
Okay, not with Dr. Laura Mimosa, but you do clash with Matt Phillips. No!
51:41
Yeah, on day two. Yeah, yeah, yeah. Oh my God. When you're doing a day two thing.
51:45
I will make, I will make. Why have they done this?
51:48
I will make a cardboard picture of me.
51:52
It's very cruel. I cannot believe that.
51:54
I'm sorry you're going to be forced to choose these people, but honestly,
51:57
you've got, you've got this debate between the hands on hands of debate,
52:01
or you've got changing the room, not the person, which kind of links to the
52:05
whole ecological psychology. And that's me on 1030. Are we clashing on both?
52:09
No, just one of them. Just the 1030 one. Yeah. sad oh my god the change in the
52:14
room not the person no don't know i'm gonna have mine change i'm gonna find
52:17
somebody who changes well anyway,
52:18
the good news if you're listening and thinking oh my god what do i do i'm gonna
52:21
have to rip my body in half so half me can go and see ann marie and half me
52:23
can go and see matt no no don't worry because there is for 20 pound extra.
52:28
You can get the recording okay for 20 pound this year at 30 you can get the
52:31
recording so please don't mutilate yourself or try and divide yourself anyway,
52:36
right so you mentioned roger I wanted to bring Roger up because I've just,
52:39
I mean, I know you've got, you've got an extreme fun place in your life.
52:44
But it's exciting. Roger's going to be speaking this year at the therapy show,
52:48
which will be wonderful. I don't think he's been the same person before,
52:50
but we're going to have Neck and Headaches, where clinical reasoning meets real
52:53
world practice, which will be in Theatre B.
52:55
And that's on Thursday after my talk, people. So I have a little cup of coffee
52:59
and then come and see Roger or after Anna Maria's if you've chosen that one.
53:02
But yeah, Thursday 26th, day two Roger is worth it to listen to. He's a top, top.
53:11
Person, is very inclusive. It just makes sense.
53:15
Just makes sense, yeah. It should be really cool. There's some good people coming
53:19
this year, I'm not going to lie. They've got some interesting people.
53:23
Right, look, time is getting better from us. Thank you so much,
53:25
Anne-Maria, for joining us, giving you some time. Really cool.
53:28
I'm always humbled to be asked.
53:30
Is there anyone else offhand? I mean, we mentioned Roger now.
53:33
Is there anyone else at therapy show this year who you know is going,
53:36
who you think you want to shout out for?
53:39
Oh my God, don't put me on the spot, La Dama. No, I know. That was very cool.
53:42
I just wondered. There might not be because there's so many people there.
53:45
Yeah, I am so out of the loop with everything a little bit because of,
53:51
you know, obvious reasons.
53:53
But there's a lot there. I just wondered because sometimes someone comes up.
53:56
Obviously, you'll be getting your dose of Mike James, won't you? Oh, yes. Obviously.
54:02
And Mike's free for one of the days as well. He's not showing on one day.
54:04
So he'll be free. Oh, really? Oh my God.
54:07
That's a treat for him yeah yeah yeah that's a treat.
54:11
For him if people want to follow you Anna Maria now again you're posting on
54:15
LinkedIn yes I do actually I do post on LinkedIn,
54:19
a little bit not as much because to write a post it takes me three days because
54:24
of that terrible imposter syndrome but it will get better I'm also teaching
54:30
next week in the lower limb master class with,
54:34
Physiomatters because I am going to present there, which is quite different.
54:39
I've been working for a while on neuropathy. Fantastic.
54:44
Touch and neuropathy. Because actually it's one of those things that people,
54:50
come to us all the time with.
54:54
Often say, oh, there is nothing that we can do. Of course, there's nothing we
54:57
can do to the neuropathy, but there is so much we can do with touch to the person
55:02
suffering with neuropathy.
55:04
So, that I'm looking forward to.
55:07
I think that, you know, oh yes, then at HSU there is a mini conference in November,
55:14
so I'm going to be talking that, but that is, but yeah, that's me, really. Fantastic.
55:19
So yeah, on LinkedIn, possibly the best.
55:22
Six weeks. That's where we'll all be. And also, of course, at the ST School,
55:26
we've still got one of the best level five upgrades. Bless you.
55:33
It's true, though, isn't it? There's a couple. I could count on my hand other
55:36
people I might recommend, but obviously it depends on you and what your needs are.
55:40
You know, the beautiful thing is, Matt, that I just assessed some students at
55:45
the weekend and at the exam a few weeks ago for another group.
55:50
I see things that changed in terms of, some of them for the worst,
55:55
but the level of people that come through the door, the level of what they want
56:01
and the way they engage and they live so enthusiastic.
56:07
I haven't experienced that. So in the last few years,
56:11
there might be less people coming through the doors, but the ones that come
56:14
through the doors, oh my God, they are at a level that some conversation that
56:19
I have, They are really, really deep and I get, I get so excited.
56:25
I'm in Scotland this weekend. There's another class. I'm in Scotland up there
56:28
and oh my God, you know, some of them is just amazing. Amazing.
56:33
So, you know, from one perspective, the future is bright.
56:39
From one perspective. Let's not say the other perspective. From that perspective,
56:42
it's bright. From one perspective, the future is very bright.
56:46
Right. Fantastic. So yes, follow Anna Maria on LinkedIn, follow the ST School
56:50
for everything you need to know about modern interpretation of touch and massage
56:53
and soft tissue therapy. That's at the ST School across all social media.
56:58
Before I forget, thank everyone who's joined us. I think there's a record tonight
57:02
in these days, people who joined us. So there we go. Big up to Anna Maria.
57:05
And thanks everyone who joined us. If you've got any comments, you're watching this,
57:09
I always say it, but just go to YouTube and leave some comments.
57:11
If you do a little bit of homework now, if you start looking up active inference,
57:14
if you're interested in reading about Carl Friston and the crossover between
57:18
ecological psychology and activism and all that kind of stuff, then.
57:25
Put it on YouTube. Let's see what this talk has sparked.
57:28
We'd love to see what you found because you will. You will find some really
57:31
fascinating stuff and you'll open the philosophy door, which can be really exciting
57:36
for you. and it will help your clients, your family, and you, and your life. Bravo.
57:41
Philosophy is clinically applicable. Bravissimo. And I think if it was Roger
57:44
first, he would probably turn me on to philosophy because he's very much into
57:47
his philosophical. Oh, yes.
57:49
Yeah. So I'm really excited to probably find him and tie him up for about half
57:53
an hour somewhere. Can you help me with that?
57:55
Can you tie up, Roger? Yeah, we'll tie him up somewhere and just ask him questions.
57:58
I would love that. Yeah, we'll do that. Love that.
58:00
And yeah, so yeah, brilliant. Thanks everyone who joined us live and asked the great questions.
58:04
We really appreciate you guys giving it our time. to join us live also people
58:07
who've listened to the podcast if you're listening now and you've enjoyed it
58:10
then thank you very much for reaching the end
58:11
we do ask if you can just leave a rating and a review on the podcast just a
58:15
few words five stars be fine it just helps us reach more people we hit this
58:20
kind of two to three thousand we can't get any higher
58:23
the only way we can reach new people is by you sharing it we've done as much
58:26
as we can we put the information out there
58:28
if we want to reach four or five thousand people then we need you a month and
58:32
we need you to actually share it now we've we've reached our peak we've peaked,
58:36
so please if you can just leave a rating leave a review share it on your stream
58:40
i never ever see anybody on social media sharing an episode of the podcast so
58:43
prove me wrong do it today if you've enjoyed this episode,
58:46
We're going to be next week and we continue our therapy show speaker spotlight
58:50
with the amazing pelvic health physio Gronia Donnelly is going to be with us,
58:53
who's also speaking at therapy show for the first time.
58:55
Oh, yes, of course, Gronia. Yeah, yeah. Gronia's going to be there,
58:58
you know. Of course. All these people have been on this podcast and are finally
59:01
getting to therapy show. So thank you, advisory board, for going through my
59:05
episodes and just picking people from it.
59:08
I'm glad I helped you all. A bunch of physios. How lazy. Honestly,
59:11
a bunch of physios go to the STA podcast to see who should be on this. There we go.
59:15
I'm glad to be of support to you but there we go that'll be next week the amazing
59:18
Gwani Donnelly again if you can join us live everything anything you need to
59:22
know about pelvic health particularly female athletic pelvic health that'll
59:25
be Gwani Donnelly absolute physio that'd be amazing
59:28
so that's where we are until then thank you once again Anne-Marie Matsieri thank
59:32
you everybody else take care of
59:33
yourselves and as always take care of each other we'll speak to you soon.