All Kinds of News for September 14, 2016
In recent years there has been a growing awareness of the importance of body-based therapies as a necessary part of effective trauma treatment (Levine, 2010; Rothschild, 2000; Van der Kolk,2014;). There has also been a significant broadening of the understanding of the range and types of trauma that exist and their far-reaching effects on development, psychological functioning and general well-being (Heller and LaPerrier, 2012; Van der Kolk, 2014). The study of post traumatic stress disorder in the veteran population has led to an increased awareness of these symptoms in the general population as well. The term “complex trauma” is now used to describe the profound effects that repeated traumatic events (typically interpersonal events) during early development can have on the individual (Emerson & Hopper, 2011).
What is trauma?
It has become increasingly clear that, from a psychological standpoint, the critical factor in what constitutes a traumatic event for an individual is related much more to the meaning the event has for that individual and the perceived threat that event constitutes for safety and well-being than any objective measure of the event’s magnitude or threat (Heller and LaPerrier, 2012; Rothschild, 2000; Van der Kolk, 2014). If an individual perceives an event as seriously threatening to her personal welfare or the welfare of someone close to her, that event is likely to be, at some level, traumatic. The critical element long-term is often what the person takes this event to mean --- about herself, about the world she lives in and the people she lives with (Rothschild, 2000). This generally results in strongly held unconscious beliefs about the nature of the world and the self that are typically felt by the individual at an emotional and even physiological level, rather than something that is held in conscious awareness (Rothschild, 2000; Van der Kolk, 2014).
At Greenbrier Academy we work to access these unconscious beliefs to allow them to become conscious and therefore corrected when necessary. At the same time that we recognize the important cognitive elements and their contribution to the aftermath of the trauma, we also recognize the physiological aspect of the reaction to a traumatic event and how these are inextricably linked (Levine,2012). Advances in neuroscience in recent decades have given us a much more detailed understanding of the role that the body plays in the response to and recovery from traumatic events. Because the trauma response takes place on a physiological level, as well as a psychological level, the treatment of trauma symptoms also must involve the body to be truly effective. Understanding the psychophysiology of the trauma response is helpful in understanding why this is so.
The psychophysiology of trauma
What happens physiologically in a traumatic situation can be understood as the organism’s survival response. When a person feels seriously threatened --- and this doesn’t have to be a physiological threat --- signals are sent from the amygdala triggering this survival response. The brain itself is a first responder to this message, mostly shutting down the reasoning centers of the pre-frontal cortex in favor of the more instinctual/reactive brain stem (Van der Kolk, 2014). This allows for instantaneous action, which may be needed for survival. It also stimulates the release of hormones readying all systems for a fight, flight, freeze or submit response. In a situation where fleeing or fighting is perceived to be helpful, the sympathetic nervous system will be activated, flooding the body with adrenaline and noradrenaline. This readies us for instant action, sending blood to large muscles, increasing the heart rate and blood pressure. At the same time it efficiently shuts down those systems that are not needed for the immediate response (such as digestion and reproduction). In situations where the subject is not sure what the best response to the threat may be, the response will often be to “freeze.” In this state, both the parasympathetic and sympathetic systems appear to be activated---the sympathetic system preparing all systems for action, but the parasympathetic system putting action on “hold” until information can be gathered to take action (Van Der Kolk, 2014). If the threat is perceived by the subject as one where there is little hope of surviving, a parasympathetic state will become dominant with the individual “shutting-down.” This dissociative mode is protective as it avoids further aggravating an aggressor and limits the sensations of pain felt by the victim (Emerson & Hopper, 2012). These physiological survival responses clearly can be helpful in many situations. The primary difficulty for the person who has experienced trauma is that the triggered survival response continues long after it was useful and may become a set of symptoms that create additional suffering. It also appears that the more often an individual experiences a traumatizing situation of terror and an inability to take effective action, the more easily activated the nervous system becomes and the more difficult it becomes for the nervous system to return to the normal baseline (Van der Kolk, 2014). With repeated trauma, the nervous system may become highly sensitized and basically “stuck” in a highly activated or dissociated state. Being stuck in a highly aroused state means being in a place of nervous agitation, anxiety or panic attacks. Sleep may be difficult, digestion may not work well and seemingly minor things may trigger extreme reactions. Being stuck in a dissociative state means being unable to feel, unable to care, feeling disconnected from oneself and others. Any of these situations leads to increasingly difficult symptoms.
Those who have suffered from trauma often do not have a clear conscious narrative of the traumatic events. This is now understood to be related to the fact that the hippocampus area of the brain, which stores sequential memory and gives us the clear indication of events being “in the past,” is inhibited during the body’s survival response (Rothschild, 2000). However, it is well known by trauma specialists that sensations from the traumatic event (emotions and somatic memories) are actually stored in the body and can be accessed through the body ( Levine, 2010; Rothschild, 2000; Van der Kolk, 2014). This is why working with the body, as well as the mind is so critical in healing from trauma.
Helping the whole person to heal
Mind/body practices can be integrated into therapy in many ways. Yoga offers an ancient tradition of mind/body practices that are easily integrated for therapeutic benefit (Emerson & Hopper, 2012). At Greenbrier, we do this both with group practices and by integrating specific practices into individual therapy sessions. One way that trauma-sensitive yoga can help is to gently begin to assist the overly aroused or shut down nervous system to begin to self-regulate again. This is done through simple exercises of movement and breathing with attention. Engaging in this sort of breath and movement with awareness has been shown to stimulate the body’s ability to begin to self-regulate the nervous system. This is measurable as an increase in heart rate variability (HRV), which is one of the simplest ways to show the body’s ability to move between the activated state of sympathetic dominance to one of parasympathetic dominance (Van der Kolk, 2014). As they experience this shift, individuals who have been stuck in a hyper-vigilant state --- where a feeling of constant anxiety has become normal --- can begin to relax. Those individuals who have been in a dissociated state --- one where they are not actually aware of feelings and sensation in their bodies --- can begin to access bodily sensation and experience a sense of coming back into their body. They may have increased energy as a result. The challenge in the beginning stages of these practices is that many with trauma may find them very difficult to start with (Emerson & Hopper, 2012). The key is a very slow and incremental approach to the practices that gives the individual as much control and freedom as possible. This is the trauma-sensitive approach --- taking very small steps and allowing the individual to control the pace at which the practice proceeds. At Greenbrier, we are able to do this by offering individual sessions that combine the trauma-sensitive yoga practices with other therapies in way that allows individuals to guide the progress into difficult areas at a rate that is appropriate for them. Groups are helpful to many by offering a supportive environment with others where full permission is given to individuals to participate in the way that works for them individually. Group classes offered at Greenbrier have focused on practices for helping to reduce anxiety, connecting positively with the body, improving body image and finding a healthy mood balance.
The goal of integrating these mind/body practices is to enable the whole person to heal. The mind/body practices focus on simple movements and postures that are done with attention, breath awareness and brief mindful meditation. All these practices work toward present moment awareness by staying with the sensations noticed in the body --- integrating mental awareness with somatic (bodily) sensation. Each of these practices has multiple helpful results. Breathing tends to become deeper and more relaxed as it self-regulates under meditative awareness. This triggers the body’s relaxation response allowing the individual to begin to experience body sensations in different way. As they are ready, participants are guided to try different ways of breathing that may help them to access that relaxed state more quickly, such as slowing the breath and diaphragmatic breathing.
The ability to increase interoceptive awareness (our ability to perceive our own internal sensory experience) is another benefit of these practices. For those who have become dissociated from their emotions and the bodily sensations related to them, this is an important first step in being able to live more fully again (Emerson & Hopper, 2012). They can begin to increase their ability to notice these sensations incrementally and in a safe environment where there is adequate support if difficult past experience is triggered. Dissociated individuals feel disconnected from their bodies and the world around them. This is often experienced as a lack of synchrony or flowing connection (Emerson & Hopper, 2012; Van der Kolk, 2014). Rhythmic movement is helpful for increasing this felt sense of connection and synchrony with the world around them and is frequently incorporated into therapeutic sessions.
As individuals are able to access a place of greater emotional and physiological stability and are able to experience greater interoceptive awareness, many forms of more cognitively-focused therapy become more accessible and more effective. This is true both for individuals suffering from dissociative symptoms and depressed states, and for those suffering from hyper arousal and anxiety. In the case of those with dissociative symptoms, their ability to access somatic cues (the messages their body is sending them about how they feel) related to emotions may be very limited. This means that these individuals’ ability to engage in therapies will also be limited. Therefore finding a way to increase the area of comfort where they can connect again with emotions and somatic (bodily) sensations is extremely helpful. On the other hand, if a person is struggling with a very over-activated nervous system, losing stability while doing therapeutic work is also a very real danger (Rothschild, 2000). The ability to use the practices of yoga to ground the individual in the here and now of the moment and access those resources in the body can be extremely helpful as a basis for other trauma work (Van der Kolk, 2014). What may be revealed through a somatic (body) intervention can be worked with in cognitive ways --- but the body can also be used as a powerful resource for stability in practices that help with grounding, centering, regulating affect and being able to once again feel connected with one’s own self and the rest of the world.
Greenbrier Academy, a therapeutic boarding school located in Pence Springs, WV, aspires to heal the whole person by integrating cognitively-based therapies with somatically-based therapies within our relational model. By acknowledging the powerful and silent reality of the body as a repository of past experiences and its relationship to the mind, we are able to use a whole array of tools to help assist in a more complete healing process. Integrating mind/body practices facilitates a profound transformation of the individual by enabling the integration of insight and new identity with a new felt experience of the self. This experience of the self is not a self in isolation, but a part of a network of interrelated relationships that are able to grow and heal as well. Thus each one of our students who moves toward greater wholeness will also be facilitating greater wholeness in her whole community ---r adiating healing into her world as she grows.
Emerson, D. & Hopper, E. (2011) Overcoming Trauma through Yoga: Reclaiming Your Body. Berkeley, CA: North Atlantic Books.
Heller, L. & LaPierre, A. (2012) Healing Developmental Trauma: How Early Trauma affects Self-Regulation, Self-Image and the Capacity for Relationship. Berkeley, CA: North Atlantic Books.
Levine, P. (2010) In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, CA: North Atlantic Books.
Van Der Kolk, B. (2014) The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma. New York, NY: Viking Penguin.
Rothschild, B. (2000) The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. New York, NY: W.W. Norton & company, Inc.