I always end my sessions by asking my clients, “Based on what we discussed today, what are you going to work on for homework?” At the end of a recent session with a client who has the tendency to avoid her feelings and thoughts of her past trauma, when I asked this question, she responded, “Dr. B I am going to work on feeling my feelings and making friends with them.” I could not be happier! She got it. She was trying so hard to push the feelings away that it was exhausting her. We worked on the idea of thinking of her symptoms not as something that had to be pushed away, and gotten rid of, but as a part of her that needed to be reintegrated. In his book The Body Keeps The Score: Brain, mind and body in the healing of trauma, Bessel Van Der Kolk, M.D. talks about “Befriending the Emotional Brain.” Since I am not going to go into the specific treatments for PTSD, as it can vary from person to person, I want to summarize what Van Der Kolk shares as a place for you to start in terms of beginning the journey of recovery from trauma. Dealing with Hyperarousal The vagus nerve connects the brain with many of the internal organs. Eighty percent of the fibers of the vagus nerve run from the body to the brain. This gives us the ability to influence our arousal via our breath, movements, and vocalizations. Being able to use the breathe to achieve a state of physical relaxation while visiting painful memories is required in order to recover from traumatic experiences. Taking a few deep breathes you can notice the parasympathetic nervous system damper your arousal. The more you focus on your exhale until the very end and then pause before your inhale the more you will turn on your parasympathetic nervous system. Continue to breath and notice the air moving in and out of your lungs thinking about how the oxygen nourishes and energizes the cells of your body helping you feel connected and alive. Mindfulness Self-awareness is at the center of recovery. Being able to notice our irritation or anxiety allows us to change our point of view and see other options besides our usual habitual reactions. Mindfulness allows us to see the transitory nature of our feelings and perceptions. When we tune in with focused attention to our bodily sensations we can feel the ebb and flow of our emotions and with that we can increase our ability to have control over them. The first task is focusing your mind on your sensations and noticing how the sensations are transient and shift in response to changes in body position, breathing, and thinking. Next start to label what is happening, i.e. “When I feel sad I feel a prickly knot in my stomach.” Focus on the sensation and notice how it changes when you take a deep breath and focus on the exhale, or allow yourself to cry. Being self-aware, or practicing mindfulness calms down the sympathetic nervous system so that you are less likely to be catapulted into fight or flight. Gaining the skill of observing and tolerating physical sensations is essential for safely revisiting the traumatic memories. Mindfulness decreases activity of the amygdala and thus decreases reactivity to potential triggers. Relationships Repeated research studies have shown that having a good support system is the single most powerful protection against developing PTSD. Our brains are wired to be in-tune with others. Remember those mirror neurons?? Recovery involves connecting with others. When trauma occurs within trusted relationships it can be more difficult to treat due to the fear of being re-traumatized within a relationship. This can take a toll on other relationships as the fear of getting hurt can prevent the formation of the required healing relationships. Communal Rhythms and Synchrony When we are able to play with others we feel attuned and experience a sense of connection and joy. Drum circles are a wonderful example of this feeling in tune with and connected to others. Getting in Touch The most natural way we as humans are soothed is by being hugged, touched, or rocked. Think of an infant, how we rock, and hold them in order to sooth their distress. This desire to be held and comforted in times of stress stays with us forever as a means of helping us calm. Taking Action The purpose of stress hormones are to give us strength and endurance so that we can respond and act in traumatic situations. People who take action during a traumatic situation use their stress hormones for their proper purpose and thus are less likely to develop PTSD. Feelings of helplessness and not being able to take action prevent the use of the stress hormones as they are meant to be used. This results in the stress hormones and activation that was meant to fuel coping with the stress, to be turned back against the organism. This results in the continuing of misplaced fight, flight, or freeze responses. When these responses to extreme stress get stuck, treatment moves to explore physical sensations and identifying the location and shape of how the trauma left its mark on the body. As mentioned in a previous post, Peter Levine developed Somatic Experiencing which focuses on guiding clients in gently moving in and out of feeling the imprints of the traumatic memory left on the body in a process he calls pendulation. Moving in and out of the traumatic sensations helps clients build their tolerance to such sensations. As clients become more aware and build tolerance to their trauma based sensations they are likely to recognize physical energy such as hitting, running or pushing that they wanted to do during the trauma but were unable to in order to maintain their safety. These impulses come out in subtle bodily movements. Working to fully feel and express these movements in different ways can help bring the trauma to a close. Somatic Experiencing helps the client free themselves from the trauma by feeling that it is safe to move in the present. They literally move to free that pent up energy that got stuck during the trauma. In a training on Somatic Experiencing that I completed, Peter Levine treated a man who, as an infant, was in a holocaust orphanage. Peter Levine helped the client lean into his sensations and exaggerate what his body wanted to do. He ended up making these grand movements as if he was flapping his wings flying away. Just incredibly interesting stuff. The desire of the body to escape being acted out and released years later. In Somatic experiencing when the clients can feel what it would of felt like to take effective action, it can give them a sense of control. When clients can experience what it would of been like to expel that energy and fight or flee, their bodies can begin to relax and feel at peace. So this is where I am going to end my blog series on PTSD. I hope it gave you enough information and understanding of what PTSD is, what it looks like, and how it impacts the brain and body. Like I said when I started this topic, trauma is a broad, heavy topic but one I felt compelled to address as so many people are not living fully due to their PTSD. I hope this information gives you a place to start if you or someone you love is suffering from PTSD. With great care and compassion. Until next time… Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books.
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Another possible response to experiencing trauma is the person going into denial. Their bodies register the trauma, but their mind goes on as if nothing happened. Even though their mind may learn to ignore the signals from the emotional brain, the alarm messages and stress hormones do not stop firing. The continuous firing from the emotional brain and secretion of stress hormones keep the body in a state ready for action or immobilize for collapse. These physical effects on the organs go on until they ultimately result in illness.
A person with PTSD has a malfunctioning thalamus that is not filtering incoming information properly. This results in a state of constant sensory overload. To cope with this state of sensory overload, the person may attempt to shut down, which unfortunately could also lead to cutting out the experiences of pleasure and joy. Traumatized people feel unsafe in their bodies due to the chronic discomfort of their visceral distress signals. In an effort to function, they become skilled at ignoring their bodily sensations. The more people try to ignore their bodily sensations, the more apt these sensations are to take over. When an individual cannot recognize what is happening inside their bodies he or she can end up responding in extreme ways by either shutting down or panicking in response to even the slightest trigger. The cost of ignoring bodily sensations is not being able to truly recognize what is dangerous and harmful, or what is safe and nourishing. Our sense of self is housed down the midline of the brain. Severe early life trauma effects this area of the brain in a profound way. On brain scans of people with early trauma and chronic PTSD, it has been found that there is nearly no activation along the midline of the brain. What this indicates is that the person learned to shut down the brain areas that process the visceral feelings and emotions that come along with terror. In doing so, however, they also shut down the ability to feel the full range of emotions and sensations that form the foundation of self awareness. As an attempt to avoid the terrifying sensations, they also lost the ability to feel fully alive. This lack of activation down the midline of the brain could explain why many traumatized people lose their sense of purpose and direction. The core of our self-awareness is housed in the physical sensations that communicate the inner states of our body. Remembering emotional experiences from the past cause us to feel in the present the visceral sensations that were felt during the original incident. The more we are aware of our sensory body-based feelings, the more able we are to control our lives. Knowing what we feel is the first clue in figuring out why we feel that way. Our gut feelings tell us what is safe or threatening, and help us figure out what is going on around us. If you are connected to your inner sensations, you can trust them to guide and provide you a sense of control. Brain scans of traumatized people who freeze completely when revisiting their trauma show a marked decrease in activity across the whole brain, and report feeling nothing. This is referred to as depersonalization. The bottom-up approach is essential when working with someone who presents with depersonalization. The goal is to change the person’s relationship to their bodily sensations. Help them notice body sensations by tapping acupressure points or engaging them in rhythmic interactions such as passing a beach ball, drumming, or bouncing. A main challenge of treating individuals with PTSD is helping them to learn to live in the present. Self-regulation only happens when one has a good relationship with his or her body. People who have a difficult time knowing and describing their physical sensations tend to register their emotions as physical problems. They may experience being angry or sad as muscle pain or irregular bowels. Recovery from trauma requires becoming familiar with and accepting the bodily sensations. It requires developing awareness of their sensations and the ways their bodies respond to their environment. Physical self-awareness is the first step in letting go of the trauma. What I have found in working with client’s with PTSD is that there is often a sense of urgency to get rid of the troubling symptoms, to get past it, to get away from it. This instinct, however, does not jive with truly addressing the trauma and how it is impacting the body. To push it away or ignore it, as we have read, only makes it push in more or seep out, as my old supervisor would say, sideways. When working with a client I want to look at how they think about their symptoms. Do they hate their symptoms or see them as evidence of them being faulty or damaged? Are the symptoms something you can truly ignore or push away, and if so, at what cost?? We can see there are major costs physically. Over time, the ignoring of the sensations can lead to deteriorations in health. So I invite you to think differently about the sensations and how to approach them. In my next post we will talk more about this and the idea of making friends with your sensations. With great care and compassion. Until next time… -Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. What is it like to live with PTSD? Hard.
When individuals with PTSD are stuck in survivor mode, it is difficult to tend to their relationships, or to focus on anything else. Their relationships and overall functioning suffer. Intense emotions impact the brain, gut, and heart via the pneunogastic nerve. This is why we feel strong emotions in the visceral areas of our stomach, and chest. These visceral sensations are so jarring that most people will do anything to make them stop. Individuals who experience flashbacks tend to shape their lives in a way as to avoid the flashback. The more the traumatic memory is replayed, the more the stress hormones carve those memories more deeply into the mind. When people shut down they may not feel any changes; however, when they are medically monitored, racing hearts and the presence of stress hormones are detected. This shutting down generalizes to other parts of their lives in which they would normally feel joy and connection to others. This lack of connection often leads to the feeling of shame. At the core of PTSD is that, as a result of the trauma, the person’s threat perception system has changed, and now their reactions are dictated by the past. The trauma from their past is played out in their bodies in the present, often without a conscious understanding of what is happening. A traumatized person will shape and behave in their life as if the trauma is still going on. Every new experience they have is jaded by the past. After trauma, the person experiences the world with a different nervous system. Their energy becomes focused on pushing down their inner chaos, which interferes with their ability to truly engage in life. The effort to control these internal physiological reactions can lead to further physical symptoms, including fibromyalgia, chronic fatigue, and other autoimmune diseases. When the brain’s alarm system is activated, and we know that in PTSD it is activated more readily due to the elevated stress hormones, it automatically initiates preprogrammed physical escape plans from the oldest parts of the brain. Remember how our brains form? The older parts of our brain take over when our alarm system sounds. Not unlike other animals, the nerves and chemicals that comprise our basic brain structures have a direct link to our bodies. When the old brain is activated, it takes over and partially shuts down the higher brain centers, including our conscious mind, and forces the body to run, hide, fight, or possibly freeze. We might not be fully aware of our situation until we are already on the move. If the fight, flight, freeze response is successful and we escape the threat, then we return to our equilibrium and move on. If a response is blocked, or unsuccessful, the brain keeps releasing stress chemicals and the brain’s electrical systems continue to fire. Being able to take action and protect oneself is a critical piece in whether or not the experience will leave lasting effects. Immobilization at the time of the trauma is at the root of most cases of PTSD. According to Peter Levine, the immobilization or inability to act successfully during a traumatic event leads to sensations getting stuck in the body. Levine developed a treatment approach called Somatic Experiencing. In Somatic Experiencing, the client is gently guided in moving in and out of feeling the imprints of the traumatic memory left on the body. Moving in and out of the traumatic sensations helps clients build their tolerance to such sensations, as well as start to release some of the physical impulses stuck in the body. If you look up videos of Levine his work it appears almost magic. Without many words he works with the client to feel into their sensations, move into them, and release them. A more famous case study of Levine’s was on a Marine named Ray who was blown up with two IED’s. Ray presents with a stiff posture and what appears to be Tourettes-type tics. In the video recordings of Levine’s work with Ray you can see Ray’s body physically release what is purported to be the trauma imprint impulses as he moves into his sensations. Really amazing stuff! In a sense, Levine’s work serves to close the loop that was opened during the traumatic event but was not closed at the time due to the person’s response being blocked, or immobilized. The tuning into those visceral sensations is critical. The road to recover is not necessarily learning to accept what has happened but rather to gain control over one’s internal sensations and emotions. Tuning in, naming, and identifying what is occurring in the body is the first task. Recovery from trauma can occur only when the brain structures that were turned off during the original experience are turned back on. Bringing attention to the past trauma should only occur while people are feeling grounded, safe, and calm in the present. Helping a person get rooted in the present while thinking about the past trauma presents the opportunity of recognizing that the traumatic event exists in the past. In order to do this, the frontal lobe and the limbic system need to be on and working together, otherwise the person will continue to be pulled into the past. The driving force of PTSD comes from the emotional brain, which means that it shows up in physical sensations, gut wrenching, heart-breaking physical sensations. The only way to change how we feel is by tuning-in to what is going on inside our bodies, and learning to befriend our bodily sensations. More on this later. With great care, and compassion. Until next time… Dr. B References Heck, S. (2013). Healthing and Resilience After Trauma. Home Study. heiselandassoc.com. Levine, P. (2015). Peter Levine Ph.D. on Trauma: How the body releases trauma and restores goodness. Online Training. catalog.pesi.com Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. New York, NY: Penguin Books. |
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