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17 Feb Befriending Your Nervous System at The Trauma Recovery Institute

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Polyvagal Informed Complex Trauma Recovery

At Trauma Recovery Institute we attempt to get to the root of your life challenging symptoms, discomfort, illness and maladaptive behaviours. This is not another talk therapy, we specialise in personality disorders & complex trauma and focus on the brain, body, mind, diet, lifestyle, relationships and most importantly the nervous system where trauma is held. The definition of trauma is experiences that overwhlem our capacity to cope. Trauma effects all areas of the brain and all bodily systems often manifesting as cancer, IBS and a host of other chronic illnesses and pain syndromes which can not be otherwise explained.
Trauma can be conceptualized as stemming from a failure of the natural physiological activation and hormonal secretions to organize an effective response to threat. Rather than producing a successful fight or flight response the organism becomes immobilized. Probably the best animal model for this phenomenon is that of ‘inescapable shock,” in which creatures are tortured without being unable to do anything to affect the outcome of events. The resulting failure to fight or flight, that is, the physical immobilization (the freeze response), becomes a conditioned behavioral response.
In his book, Affect Regulation and the Origin of the Self, Allen Schore has outlined in exquisite detail the psychobiology of early childhood development involving maturation of orbitofrontal and limbic structures based on reciprocal experiences with the caregiver. Dysfunctional associations in this dyadic relationship result in permanent physicochemical and anatomical changes, which have implications for personality development as well as for a wide variety of clinical manifestations. An intimate relationship may exist, with negative child/care giver interaction leading to a state of persisting hypertonicity of the sympathetic and parasympathetic systems that may profoundly affect the arousal state of the developing child. Sustained hyperarousal in these children may markedly affect behavioral and characterological development.
Many traumatized children and adults, confronted with chronically overwhelming emotions, lose their capacity to use emotions as guides for effective action. They often do not recognize what they are feeling and fail to mount an appropriate response. This phenomenon is called alexithymia, an inability to identify the meaning of physical sensations and muscle activation. Failure to recognize what is going on causes them to be out of touch with their needs, and, as a consequence, they are unable to take care of them. This inability to correctly identify sensations, emotions, and physical states often extends itself to having difficulty appreciating the emotional states and needs of those around them. Unable to gauge and modulate their own internal states they habitually collapse in the face of threat, or lash out in response to minor irritations. Dissociation and/or Futility become the hallmark of daily life.

“We use our minds not to discover facts but to hide them. One of things the screen hides most effectively is the body, our own body, by which I mean, the ins and outs of it, its interiors. Like a veil thrown over the skin to secure its modesty, the screen partially removes from the mind the inner states of the body, those that constitute the flow of life as it wanders in the journey of each day. The elusiveness of emotions and feelings is probably . . . an indication of how we cover to the presentation of our bodies, how much mental imagery masks the reality of the body” – Damasio

Part 1 of The New Traumatology & the Trauma Spectrum: A conversation between Dr. Robert Scaer and Anthony “Twig” Wheeler from Anthony Twig Wheeler on Vimeo.
Part 2 of The New Traumatology & the Trauma Spectrum: A conversation between Dr. Robert Scaer and Anthony “Twig” Wheeler from Anthony Twig Wheeler on Vimeo.

Trauma Treatment

Effective treatment needs to involve (1) learning to tolerate feelings and sensations by increasing the capacity for interoception, (2) learning to modulate arousal, and (3) learning that after confrontation with physical helplessness it is essential to engage in taking effective action. Introception is the process of embodied mindfulness, and in neuroscientific terms it is becoming aware of visceral afferent information (bodily sensations)
Being traumatized is continuing to organize your life as if the trauma was still going on unchanged and every new encounter or event is contaminated by the past. After trauma the world is experienced with a different nervous system, a survivor’s energy now becomes about suppressing inner chaos at the expense of spontaneous involvement in life. These attempts to maintain control of these unbearable physiological reactions can result in a whole a range of physical symptoms such as autoimmune diseases, this is why it is important in trauma treatment to engage the entire organism, body, mind and brain. Deactivation of the left hemisphere of the brain has a direct impact on the capacity to organize experience into logical sequences and to translate our shifting feelings and perceptions into words. Without sequencing we cannot identify cause and effect, grasp the long-term effects of our actions or create coherent plans for the future.
When something reminds traumatized people of the past, their right brain reacts as if the trauma were happening in the present but because their left brain may not be working very well, they may not be aware that they are re-experiencing and reenacting the past, they are just furious, terrified, enraged, shamed or frozen. After the emotional storm passes, they may look for something or somebody to blame for it, for their behaviour, they may say,
“I acted this way because you looked at me like that or because you were late”. This is called being stuck in fight or flight.
In trauma recovery where the left hemisphere is activated through speaking of the traumatic past and making sense of what happened within a safe environment, the left brain can talk the right brain out of reacting by saying that was then and this is now. This can only happen when safety is establish through attunement with a therapist where the amygdala is down regulated, this can often take some time for traumatized people as the amygdala tends to stay in a heightened state of arousal ready for fight or flight even years after then traumatic event or experience. Even the slightest detection of a threat can cause extreme arousal of this system. Minor stimuli will illicit major responses.
This is why it is important to engage the left and right-brain in trauma recovery, whilst body based interventions are absolutely imperative and ofcourse right brain to right brain affect reglation is critical for rewiring the nervous system contributing to long term character change and critical for trauma recovery, these interventions may be undermined should they exclude left-brain based activities. Body based interventions such as dance; massage and yoga are a fantastic adjunct to psychodynamic psychotherapy. Lazar’s study lends support to the notion that treatment of traumatic stress may need to include becoming mindful: that is, learning to become a careful observer of the ebb and flow of internal experience, and noticing whatever thoughts, feelings, body sensations, and impulses emerge. In order to deal with the past, it is helpful for traumatized people to learn to activate their capacity for introspection and develop a deep curiosity about their internal experience. This is necessary in order to identify their physical sensations and to translate their emotions and sensations into communicable language—understandable, most of all, to themselves.
Traumatized individuals need to learn that it is safe to have feelings and sensations. If they learn to attend to inner experience they will become aware that bodily experience never remains static. Unlike at the moment of a trauma, when everything seems to freeze in time, physical sensations and emotions are in a constant state of flux. They need to learn to tell the difference between a sensation and an emotion (How do you know you are angry/afraid? Where do you feel that in your body? Do you notice any impulses in your body to move in some way right now?). Once they realize that their internal sensations continuously shift and change, particularly if they learn to develop a certain degree of control over their physiological states by breathing, and movement, they will viscerally discover that remembering the past does not inevitably result in overwhelming emotions.
After having been traumatized people often lose the effective use of fight or flight defenses and respond to perceived threat with immobilization. Attention to inner experience can help them to reorient themselves to the present by learning to attend to non-traumatic stimuli. This can open them up to attending to new, non-traumatic experiences and learning from them, rather than reliving the past over and over again, without modification by subsequent information. Once they learn to reorient themselves to the present they can experiment with reactivating their lost capacities to physically defend and protect themselves.

Trauma and the Nervous System

Exposure to extreme threat, particularly early in life, combined with a lack of adequate caregiving responses significantly affect the long-term capacity of the human organism to modulate the response of the sympathetic and parasympathetic nervous systems in response to subsequent stress. The sympathetic nervous system (SNS) is primarily geared to mobilization by preparing the body for action by increasing cardiac output, stimulating sweat glands, and by inhibiting the gastrointestinal tract. Since the SNS has long been associated with emotion, a great deal of work on the role of the SNS has been collected to identify autonomic “signatures” of specific affective states. Overall, increased adrenergic activity is found in about two-thirds of traumatized children and adults. The parasympathetic branch of the ANS not only influences HR independently of the sympathetic branch, but makes a greater contribution to HR, including resting HR. Vagal fibers originating in the brainstem affect emotional and behavioral responses to stress by inhibiting sympathetic influence to the sinoatrial node and promoting rapid decreases in metabolic output that enable almost instantaneous shifts in behavioral state. The parasympathetic system consists of two branches: the ventral vagal complex (VVC) and the dorsal vagal complex (DVC) systems. The DVC is primarily associated with digestive, taste, and hypoxic responses in mammals. The DVC contributes to pathophysiological conditions including the formation of ulcers via excess gastric secretion and colitis. In contrast, the VVC has the primary control of supradiaphragmatic visceral organs including the larynx, pharynx, bronchi, esophagus, and heart. The VVC inhibits the mobilization of the SNS, enabling rapid engagement and disengagement in the environment.

The Dorsal Vagal State and manifestation of 
autoimmune disorders 

People who are in the dorsal vagal state a lot which is the state when the amygdala is activated due to a detection of a slight threat in the environment consciously or unconsciously through neuroception and the traumatized person goes into a state of learned helplessness or what is called dissociation or freeze response which is an unconscious conditioned fear response, the body’s reflex to an internal or external stimuli from a cue of an original trauma. This will activate all the viscera, your heart, your lungs, your colon, your stomach, all of these are run unconsciously by the dorsal vagal nucleus and if you have syndromes where you are in the freeze response a lot, the dorsal vagal nucleus will be hyperactive and you will get syndromes of hyperactivity within the viscera and that can be characterized by Irritable bowel disease, colitis and other autoimmune diseases.
These are cyclical diseases which means they oscillate between sympathetic and parasympathetic nervous system meaning the symptoms come and go which is why the medical profession very often can not diagnose the problem or refer to it as psychosomatic meaning it is a condition of the mind when in fact it is actually emotionally driven physiological conditions of the gut and the brain. Problems with the gut are common with people who have had trauma, it is the physiology of trauma that drives these conditions and so if you heal the trauma you can heal the disease. These conditions are also referred to as neurosomatic, which means they are brain based conditions, physical conditions caused by abnormal function of the brain.
“An Excerpt from world expert neurophysiologist Dr. Robert Scaer”
The Amygdala is the agent of fear conditioning, it stores emotionally based memory positive and negative, it is also the gate keeper for responding to threat by activating the fight or flight response, when the fight or flight response is not successful, such as you can not escape the traumatic event, the body goes into a freeze response. The freeze response is predicated by the effects of early childhood experiences, the freeze response is also called dissociation. When dissociation happens you are dysregulated, Dissociation is based a lot on what happened in childhood that allowed you to develop the brain in a way to prevent that from happening too easy. This has to do with Allan Schore’s work on attunement, the part of the brain that controls this regulation of autonomic nervous system and emotional system, which is the orbital frontal cortex. This develops in a healthy attuned infant and shrinks in a neglected infant. We need a developed orbital frontal cortex to regulate us over our lifetime and prevent us from going into freeze states and dysregulation. Helplessness is the essential ingredient for the freeze response.
The freeze response is a motor action, which perpetuates the escape behaviour in a way that erases all the procedural (Implicit) memory of that trauma. If you have a threat and don’t discharge the freeze response, you are conditioned thereafter to any body cues related to that traumatic event.

Conclusion

Interoceptive, body-oriented therapies can directly confront a core clinical issue in PTSD: traumatized individuals are prone to experience the present with physical sensations and emotions associated with the past. This, in turn, informs how they react to events in the present. For therapy to be effective it might be useful to focus on the patient’s physical self-experience and increase their self- awareness, rather than focusing exclusively on the meaning that people make of their experience—their narrative of the past. If past experience is embodied in current physiological states and action tendencies and the trauma is reenacted in breath, gestures, sensory perceptions, movement, emotion and thought, therapy may be most effective if it facilitates self-awareness and self-regulation. Once patients become aware of their sensations and action tendencies they can set about discovering new ways of orienting themselves to their surroundings and exploring novel ways of engaging with potential sources of mastery and pleasure.
Working with traumatized individuals entails several major obstacles. One is that, while human contact and attunement are cardinal elements of physiological self-regulation, interpersonal trauma often results in a fear of intimacy. The promise of closeness and attunement for many traumatized individuals automatically evokes implicit memories of hurt, betrayal, and abandonment. As a result, feeling seen and understood, which ordinarily helps people to feel a greater sense of calm and in control, may precipitate a reliving of the trauma in individuals who have been victimized in intimate relationships. This means that, as trust is established it is critical to help create a physical sense of control by working on the establishment of physical boundaries, exploring ways of regulating physiological arousal, in which using breath and body movement can be extremely useful, and focusing on regaining a physical sense of being able to defend and protect oneself. It is particularly useful to explore previous experiences of safety and competency and to activate memories of what it feels like to experience pleasure, enjoyment, focus, power, and effectiveness, before activating trauma-related sensations and emotions. Working with trauma is as much about remembering how one survived as it is about what is broken.
Drawing on his work with patients who have survived a variety of traumatic experiences — from plane crashes to rape to torture — Van der Kolk considers the great challenge of those of us living with trauma:In response to the trauma itself, and in coping with the dread that persisted long afterward, these patients had learned to shut down the brain areas that transmit the visceral feelings and emotions that accompany and define terror. Yet in everyday life, those same brain areas are responsible for registering the entire range of emotions and sensations that form the foundation of our self-awareness, our sense of who we are. What we witnessed here was a tragic adaptation: In an effort to shut off terrifying sensations, they also deadened their capacity to feel fully alive.
While this dissociation from the body is an adaptive response to trauma, the troublesome day-to-day anguish comes from the retriggering of this remembered response by stimuli that don’t remotely warrant it. Van der Kolk examines the interior machinery at play: The elementary self system in the brain stem and limbic system is massively activated when people are faced with the threat of annihilation, which results in an overwhelming sense of fear and terror accompanied by intense physiological arousal. To people who are reliving a trauma, nothing makes sense; they are trapped in a life-or-death situation, a state of paralyzing fear or blind rage. Mind and body are constantly aroused, as if they are in imminent danger. They startle in response to the slightest noises and are frustrated by small irritations. Their sleep is chronically disturbed, and food often loses its sensual pleasures. This in turn can trigger desperate attempts to shut those feelings down by freezing and dissociation.
In a passage that calls to mind philosopher Martha Nussbaum’s excellent subsequent writings on the nuanced relationship between agency and victimhood, Van der Kolk adds: Agency starts with what scientists call interoception, our awareness of our subtle sensory, body-based feelings: the greater that awareness, the greater our potential to control our lives. Knowing what we feel is the first step to knowing why we feel that way. If we are aware of the constant changes in our inner and outer environment, we can mobilize to manage them. But one of the most pernicious effects of trauma, Van der Kolk notes, is that it disrupts our ability to know what we feel — that is, to trust our gut feelings — and this mistrust makes us misperceive threat where there is none. This, in turn, creates an antagonistic relationship with our own bodies. He explains:
If you have a comfortable connection with your inner sensations — if you can trust them to give you accurate information — you will feel in charge of your body, your feelings, and your self. However, traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from their selves. The more people try to push away and ignore internal warning signs, the more likely they are to take over and leave them bewildered, confused, and ashamed. People who cannot comfortably notice what is going on inside become vulnerable to respond to any sensory shift either by shutting down or by going into a panic — they develop a fear of fear itself.
The experience of fear derives from primitive responses to threat where escape is thwarted in some way. People’s lives will be held hostage to fear until that visceral experience changes… Self-regulation depends on having a friendly relationship with your body. Without it you have to rely on external regulation — from medication, drugs like alcohol, constant reassurance, or compulsive compliance with the wishes of others. In its extreme, this lack of internal regulation leads to retraumatizing experiences: Because traumatized people often have trouble sensing what is going on in their bodies, they lack a nuanced response to frustration. They either react to stress by becoming “spaced out” or with excessive anger. Whatever their response, they often can’t tell what is upsetting them. This failure to be in touch with their bodies contributes to their well-documented lack of self-protection and high rates of revictimization and also to their remarkable difficulties feeling pleasure, sensuality, and having a sense of meaning.

One step further down on the ladder to self-oblivion is depersonalization — losing your sense of yourself.

What, then, can we do to regain agency in our very selves? Pointing to decades of research with trauma survivors, Van der Kolk argues that it begins with befriending our bodies and their sensory interiority: Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies. Being frightened means that you live in a body that is always on guard. Angry people live in angry bodies. The bodies of child-abuse victims are tense and defensive until they find a way to relax and feel safe. In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past. In a sentiment that calls to mind Schopenhauer’s porcupine dilemma, Van der Kolk writes: The most natural way for human beings to calm themselves when they are upset is by clinging to another person. This means that patients who have been physically or sexually violated face a dilemma: They desperately crave touch while simultaneously being terrified of body contact. The mind needs to be reeducated to feel physical sensations, and the body needs to be helped to tolerate and enjoy the comforts of touch. Individuals who lack emotional awareness are able, with practice, to connect their physical sensations to psychological events. Then they can slowly reconnect with themselves. How we respond to trauma, Van der Kolk asserts, is to a large extent conditioned by our formative relationships with our caretakers, whose task is to help us establish a secure base. Essential to this is the notion of attunement between parent and child, mediated by the body — those subtlest of physical interactions in which the caretaker mirrors and meets the baby’s needs, making the infant feel attended to and understood.

Attunement is the foundation of secure attachment, which is in turn the scaffolding of psychoemotional health later in life.