Contents
Summary 3
Chapter 1 4
Trauma and the loss of self 4
Numbing 4
Re-organisation of perception 4
Stuck in trauma 5
Chapter 2 Revolutions in understanding the mind and brain 5
Addicted to trauma, the pleasure of pain and the pain of pleasure 5
Soothing the brain 5
Chapter 3 Looking into the brain, the neuroscience revolution 6
Shifting to one side of the brain 6
Stuck in fight\flight 7
Chapter 4 Running for your life 7
The brain from bottom to top 7
Identifying danger 8
Disassociation and reliving 9
The thalamus shuts down 9
Depersonalisation split off from the self 10
Learning to live in the present 10
Chapter 5 Body Brain connections 10
Emotions 10
Nervous systems 10
Three levels of safety 10
Chapter 6 Losing your body, losing yourself. 11
Losing your body 12
Owning your life 12
Depersonalisation 13
Chapter 7 Getting on the Same Wavelength: Attachment and Attunement 14
Chapter 8 Trapped in relationships: the cost of abuse and neglect 15
Chapter 9 What’s love got to do with it 16
Chapter 10 : Developmental trauma, the hidden epidemic 16
Chapter 11 Uncovering secrets the problem of traumatic memory 17
Chapter 12 The unbearable heaviness of remembering 17
Chapter 13: Healing from trauma: owning yourself 18
The brain layers 18
Dealing with hyper arousal 18
No Mind without mindfulness 18
Relationships 19
Communal rhythms and synchrony 19
Getting in touch 19
Taking action 19
Exposure/Drugs 20
Wounds 20
Chapter 14 Language: Miracle and tyranny 20
The body is the bridge 20
Writing to yourself 21
Speaking trauma 21
Insula 21
Chapter 15 Letting go of the past: EMDR 21
Chapter 16 Learning to inhabit your body 22
Chapter 17 Putting all the pieces together: self-leadership 23
Chapter 18 Filling in the holes: creating structures 25
Chapter 19 Rewiring the brain: neurofeedback 25
Chapter 20 Finding your voice: communal rhythms and theatre 26
Summary
1.
3 ways to work with trauma
a.
Mind top down
b.
Drugs change symptoms
c.
Body bottom up
2.
Trauma as held in the body
3.
Trauma leaves the SNS stuck on
4.
Trauma produces learned helplessness, to
overcome this you need to let the body know it is safe
5.
Trauma and disassociation to emotions and body
feelings
6.
Trauma maintenance of current helplessness
Imagination and flashbacks
a.
Only feeling alive when in the trauma, as numb
otherwise
7.
Trauma in its extreme its pre-verbal, you can
howl like a baby, remember nothing consciously but you know it in your body, it
has a memory
8.
There is a public story for trauma and a private
one
9.
When words fail, images, nightmares and flashbacks
are in their place
10.
Left brain: facts and autobiography. Right brain
emotions
11.
Under heavy duress the executive functions, left
side diminishes, right side stores memory, right side memory activation gets a
sense of nowness
12.
Threat system stuck on tends to be reacting to
lower stimuli
13.
Old brain SNS, new brain executive
14.
Reptile brain: homeostatic systems
15.
Mammalian bran what is needed for survival,
emotions
16.
3 brains
a.
Brain
stem: basic housekeeping: homeostatic systems.
b.
Limbic
relates organism and environment, perception, emotional relevance
c.
PFC: imagination, symbolism, temporality
17.
Thalamus blends us perception into autobiographical
memory, when this happens time freezes, and things feel like they can go on for
ever
18.
Disassociation is the essence of the trauma when
the memory is split off and gets a mind of its own
19.
Working with trauma you either need to increase
the PFC to see that you are currently safe, this is a memory you survived, or
you work with the body through breath, touch and letting it know it is safe.
20.
3 levels of getting help
a.
asking
for it
b.
fight\flight\
c.
freeze
21.
VVS send out social signals
22.
Brain control 3 stages
a.
Stage 1 control by the Vasovagal system,
b.
Stage 2 by our mammalian brain and the SNS
c.
Stage 3 by our reptilian brain: shut down avoid
more damage
23.
3 stages of getting help
a.
You ask for help,
b.
You try to escape\fight,
c.
You shut down and dissociate to ride out the
pain
24.
Problem with trauma is either a shutdown
dissociation or fight\flight stuck on
25.
In trauma people disassociate from their
emotions and from their bodies, they turn off the systems that process terror,
however these are the same systems that are used to develop our sense of self,
this can reduce the sense of a sense of purpose, as the sense of self is
consciousness, desires, emotions
26.
To have a sense of agency and control in your
life, then you have to know how you feel about things, interoception as this
becomes your guide to what you want. If you have dissociated from your body
then you will feel out of control as you have turned down your ability to know
what you want.
Chapter 1
3 approaches to trauma
1.
Top down
a.
Understanding what’s going on with us,
reprocessing the memory
2.
Take medicine to shut down alarm reaction
3.
Bottom up
a.
Allow body to connect with the feelings of
helplessness and rage associated with the trauma
Reasons to keep trauma memory alive: loyalty to people.
Trauma and the loss of self
Trauma as the result of something that has been done to you
or something that you have done or possibly as a result of the trauma, i.e.
revenge.
Something unspeakable is within you, someone has done
something unspeakable to you, or you have done it. There is badness within you
and others. There is brutal violation, how can you have an intimate relation
again?
Trauma can also be the shame felt around what I did to
didn’t do.
Abused children often need their abusers for other reasons,
for looking after them, they feel intense shame for maintaining the connection,
then question where they victim or willing collaborator.
Numbing
One of the worst symptoms is emotionally number of trauma
victims to those around them. The emotional distance can also be towards
yourself, you live in frozen time apart from the outbursts of rage or
shame. People can keep busy, or use
drink\drugs to keep numb
Re-organisation of perception
Trauma changes imagination and perception. The trauma gets
superimposed onto everything. Their imagination is taken up by the trauma, so
much they perceive relates to the trauma. They are overloaded, overwhelmed as
the self was by the trauma.
Flashbacks: you never know when they will start or when they
will end
Imagination enables us to imagine new possibilities, to fantasises,
to give energy to action, but if its infused with trauma it will reduce
possibility and energy.
Imagination relieves boredom, enables goals, fires our
creativity and enriches our intimate relationships.
Stuck in trauma
The trauma memory creating a break with the present, only
fully alive when recounting the trauma.
The mind needs to make the trauma meaningful, to integrate
it as a not overwhelming memory. The body needs to live in the present and
realise the trauma has passed.
Chapter 2 Revolutions in understanding the mind and
brain
Learned helplessness of inescapable shock as part of trauma,
terrifying, inescapable harm has been done, resulting in extreme agitation or
collapse.
IN trauma the sympathetic system is left on.
To teach animals to overcome learned helplessness you have
to get their body to experience that they are not helpless.
Scared animals return home, even if home isn’t safe.
Addicted to trauma, the pleasure of pain and the
pain of pleasure
Trauma victims can come alive when talking of their trauma, it’s
an identity, it’s powerful cognitively and emotionally, it makes you special,
gives you some powerful meaning.
After a trauma, some trauma victims are attracted to other
“traumatic” situations.
Re-enactments of painful events can be an unconscious
attempt to gain control over it (Freud).
Our bodies recalibrate to certain activities, we start
running it’s hard, then we get endorphins, then we can start to feel really
good only when we push ourselves to the limit.
Endorphins are released in response to stress and stress has
an excitement, so it can be attractive to have stress and with pain and trauma?
Well strong emotions can block other pains. When you are involved in something
painful the body will release endorphins to counteract this.
Soothing the brain
Serotonin is related to fear response, less serotonin, more
reactive fear response. Or it could be
that not feeling good, produce less serotonin, not feeling good, don’t feel as
able to look after self, so fear response greater.
Placebo effect is strong in PTSD as if you’ve plucked up the
courage to attend trial you are motivated to get better. If people ask you
questions about your trauma, pay interest to you then this can work to soothe
and to understand you, much like mother and her attention and her kisses.
Amygdala the part of the brain that deals with fast
emotional response like threat.
If SSRI cure depression, then we shouldn’t have any
depression now
RCT use manualised treatments but then this doesn’t allow
them to be adapted to specific clients.
Pharmacology uses a brain disease model, there is a disease
in a brain that produces a chemical imbalance that we can cure with a
drug. The brain disease model though ignores that
what we do and believe affects our physiology. What we do and believe is also
affect by the environment we live in.
Chapter 3 Looking into the brain, the neuroscience
revolution
Trauma isn’t re-experienced as the whole film play, rather
than fragments.
The limbic area being the area responsible for emotion, the
amygdala is within his limbic areas. Amygdala warns us of danger.
Talking about a previous trauma can activate the amygdala as
if it’s happening again. The same responses are evoked.
During reliving trauma also, the broke area is affected,
which is the same place affected by strokes which inhibits your ability to
speak.
All trauma is preverbal. Under extreme trauma you can lose
the ability to speak, howl like a baby, call for your mother etc.
People cannot say exactly what happened to them in trauma,
but their bodies react as if it’s happening again.
Most trauma victims have a cover story that is for public
consumption that makes the trauma explainable but is different from the inner
story they have for themselves.
Trauma can’t by its intrinsic nature as being so awful,
cannot be entirely described in words. When words fail, images, nightmares and
flashbacks come in its place.
Reliving trauma also lights up the Broadman area, in the
visual cortex that deals with image when it first enters the brain.
Shifting to one side of the brain
During flashback the right-side light, up the left
deactivates
Left side language and logic
Right side emotions, visual, spatial, tactile
Left brain remembers facts, right brain remembers sensation.
Right side memory seems to tell us how things are, left side what we think
about things, which is more debatable.
Normally both sides work together.
People who are said to lose their minds under heavy duress
lose the executive functioning that comes from the left side of the brain, as
with flashback, where the sense of newness indicates the dominance of the right
side of the brain.
Stuck in fight\flight
Trauma people are much more sensitive to their sympathetic nervous
system response, as after their stress hormones have been produced a lot they
react to lower stimuli. Also, they get irritable, memory problems and sleep
problems.
The other response to constant stress is denial, the alarm
system goes one, but then is denied via drink or drugs.
One difficulty with reliving is that the rational brain can’t
talk the emotional brain out of its reality.
It is much easier for trauma victims to tell what has been
done to them, than about their internal experience.
Chapter 4 Running for your life
The traumatized remain stuck in the trauma, they use much
energy in dealing with the inner chaos, which in turn has knock on physical
problems.
In PTSD the body responds to a threat from the past as if it
is present.
Old brain, sympathetic nervous system, connects directly to
the body. New brain is the executive and consciousness.
Sympathetic system fires, but if the standard response is
inhibited, i.e. fight\flight then the system keeps on firing. It can keep
firing long after the incident happened.
Being able to move and do something to protect yourself is
vital to avoid long lasting scars.
The brain from bottom to top
The most important job our brain can do is to survive,
everything else is secondary
To survive the brain needs to:
1.
Signal our needs
2.
Establish where our needs can be met
3.
Generate energy to meet our needs
4.
Signal any danger to our needs getting met
5.
Adjust our actions depend on current needs,
dangers and environment
Rational and cognitive brain the youngest part of the brain
and is 30% of our brain.
Rational brain is concerned with the world outside us and
figuring out how to satisfy our needs. There are two evolutionarily older brains
that look after our physiology and identifying our feelings (comfort, safety,
pleasure, pain, safety, threat).
The ancient animal brain, the reptilian brain is located at
the point the spine enters the head. This is responsible for all the things the
baby can do, eat, feel hunger, warmth etc., operate the body. It’s the brain
stem and hypothalamus. This controls the homeostatic systems, eating,
breathing, sleeping etc.
Right above the reptilian brain is the mammalian brain, the
limbic system. This is the seat of emotions, memory and decides what is
important for survival. The limbic system is shaped by experience, what fires
together wires together.
Reptilian brain plus limbic brain=emotional brain=looks
after your welfare (para and sympathetic nervous system), i.e. directs you to
the good stuff and away from the bad stuff, via hormones, that result in
emotions, fear, excitement.
The emotional brain is far simpler than the rational brain,
and relates broad similarities, as opposed to the rational brain being more
subtle.
The neocortex is the top layer of the brain and allows us to
imagine, to empathise, to plan, to symbolise, to abstract etc. It contains the
frontal lobes.
Mirror neurones fire the same neurones when you watch
someone as if you were doing it yourself.
Mirror neurones allow people to be close, to be in tune and
in sync. This can be good on good days but not so on the bad days.
The top level of the brain is also known as the pre-frontal cortex
Brain stem: basic housekeeping: homeostatic systems.
Limbic relates organism and environment, perception,
emotional relevance
PFC: imagination, symbolism, temporality
Brain stem is developed in the womb:
Limbic brain develops during first 6 years and from there is
use dependent
Thalamus processes perceptual information
PFC from 7 onwards and from there is use dependent.
The more the intense input from the emotional brain, the greater
the dampener is put on the rational brain.
Identifying danger
Perception information collects in the thalamus in the
limbic system then is pushed to both the amygdala in the limbic system and the
PFC.
Processing by the thalamus can break down, sensual
information is isolated, encoded by the memory in isolated fragments, time freezes,
and the sensation feels like it could go on forever.
The amygdala is the smoke alarm, if it detects a threat it
sends signals to the hypothalamus to invoke a whole-body response.
Information first collects on the thalamus, then it is sent
to the amygdala for emotional significance. If a threat is discovered them a
message is sent to the hypothalamus to activate a whole-body response, i.e.
fight\flight. This happens before we are conscious of the threat. The second
pathway is via the hippocampus to the PFC, although this is slower.
The amygdala can generate the smoke alarm, and release
stress\adrenaline. The PFC is like a manager, the house owner that can look
down over what is happening and rationalise the situation and see that this is
a false alarm and turn the alarm off.
When the PFC doesn’t work we automatically go into fight or
flight mode, so if something is evaluated as a threat by the amygdala then we
always respond.
The amygdala can be changed top down or bottom up, i.e. from
messages from the PFC, or messages from the reptilian brain, which is affected
by breathing, touch and the like.
Top down means strengthening the executive function, the Pre-frontal
Cortex to establish we have no threat, so it means monitoring the bodies
sensations to see if there is a threat response, then to establish it as a
false alarm if it is.
Bottom up means affecting the automatic nervous system. This
can be done by breath, touch or movement.
Emotions assign value to experience and are the foundation
of experience. There’s the rational brain and the emotional brain, much like a
rider and an unruly horse. Under good conditions all is well, and the rider
rides the horse easily. But when there is a threat to survival then the rider
isn’t listened to, when another horse spooks your horse again the rider isn’t
listened to.
When emotional and rational brain are in conflict then
misery ensues, physical and psychological.
Disassociation and reliving
Disassociation is the essence of trauma. The overwhelming
experience is split off and gets a mind of its own.
To gain control over the experiences, people can go the gym
to get strong, or drink, or show they can control things so do dangerous sports.
The more flashbacks, the more stress hormones, the more
those memories are engraved, the more powerful the memory, the less powerful
the present, the more the attraction of the past
Trauma victims can respond by overreacting to small
incidents, as their PFC is desensitised, or by being numb to things that should
provoke their emotions. They shut down as to feel any emotions is better than
to feel the continued unpleasant emotion of flashback.
The key to recovery is not coming to terms with per se, but
rather naming and managing the internal reactions of your body.
You need an efficient smoke detector not one that thinks there’s
a raging fire every time it smells smoke.
In flashback, it’s more imaginary, the right side of the
brain lights up not the left.
The dorsolateral PFC deals with time.
Being anchored, grounded in the present whilst revisiting
the past can help support the notion that the event has ended, and you are
accessing a memory.
The thalamus shuts down
The thalamus is the cook that unifies experience to enable
autobiographical memory. Trauma is remembered as fragments not as a narrative
due to the breakdown of the thalamus. Thalamus also helps you to focus and
determine relevant and irrelevant information.
The thalamus is in the limbic system.
The thalamus isn’t working in flashback or the original
trauma, to attempt to shut down their attention then they use drink or drugs or
hyper focus. However, this closes out both the trauma and the world.
Depersonalisation split off from the self
Disassociation is to split an experience from yourself, you
don’t engage with what is happening. Depersonalisation is the effect of
disassociation, where people have a blank stare, or are unengaged with powerful
events. Talking therapy when this
happens is virtually useless.
Dissociation is where you blank your mind out, stop your
brain working if you like.
People can start with explosive flashback then numb out
later.
Learning to live in the present
The challenge of trauma is to both deal with the past and return
to the present.
Chapter 5 Body Brain connections
Emotions
Emotions: means to move out. It gives values to thoughts,
ideas, experiences, and are expressed by our body and face.
Sadness I need comfort. Fear I am helpless. Anger: back off.
There is a social element to emotions, that we share with some animals
Nervous systems
If you’re stuck in fight or flight mode, there is no space
for self-nurturing activities.
The sympathetic nervous system is sympathetic with the
emotions, when I am afraid it kicks in, when I am angry it kicks in, when they
subside it subsides.
Breathing in deeply can activate the SNS, breathing out
slowly the PNS.
The SNS is the accelerator, the PNS is the brake.
We can notice the emotions of others by small changes in
their body, we can then empathise via mirror neurones.
Our brains are built to work with us as members of a tribe,
we are always engaging within others even if by ourselves.
Almost all mental distress is either trouble building
relationships or difficulty regulating arousal.
Three levels of safety
When threatened we have three levels of response
1.
Social engagement, via the VVC
a.
We call out for help
2.
Fight/Flight
3.
Freeze: the body signals retreat and withdraws
The ventral vagal system allows us to send out social signals,
we smile when others smile, we nod our head when we agree, we frown when
another tells us they are unhappy.
Any threat to our safety, or to our ability to be safe, i.e.
social connection, will fire the VVC
The VVC triggers changes in our body, how we display to
others, how our heart beat and breathing works (hmm thought this was ANS)
Stage 1. The VVC triggers external bodily changes and
internal ones, to ask for social help, by signalling sadness. No joy on to
Stage 2: SNS (mammalian brain) kicks in…still no joy
Stage 3: DVC (reptilian brain) kicks in reduces, heart rate
plunges, we can faint, our guts stop working and empty. Reason being play dead,
fighting would be futile and lead to greater damage.
Sometimes activating fight or flight is better than the
collapse as at least its energising.
The polyvagal nerve is a two-way street between brain, major
organs and others. On one hand input comes in that there is a threat, and the
polyvagal will transmit facial expressions, breathing effects which can signal
to other people anger, sadness etc. Likewise, soothing comfort, acknowledgement
from others can calm via the same mechanisms.
Immobilization is characterised by the reptilian brain and
is characteristic of trauma. The mammalian brain seeks comfort, fight or flight
from others, the reptilian brain, goes into freeze.
Danger turns off our social sensors, so we can’t hear voices
as well and increases the sound of danger.
When fight\flight doesn’t work we freeze, it’s the last
resort.
Polyvagal=DVC brain to organs
Ventral vagal complex=moderates fight\flight in service of
social situations.
The VVC controls facial expressions and the larynx so we can
socially express our emotions as opposed to either fight or flight. The VVC
allows us to be attuned to people in quite subtle ways, that we can see in
mother baby, choral music and basketball.
Trauma is a failure of the VVC, you plead for your life the
assailant ignores you. When the freeze response comes, you dissociate then
faint.
Trauma can affect normal life as either your danger signals
are on overload or you are numb.
Deep intimacy, sex, or sleeping with someone means that you
can immobilize without fear. But if immobilisation meant sheer terror in trauma
then you are unlikely to want to do this.
Traumatised people get stuck in a chronic fight\flight or in
a shut down. To attend to this, you need to re-engage social engagement,
re-engage the DVC/VVC. This can get the social message in that you are safe.
Chapter 6 Losing your body, losing yourself.
Chronic emotional abuse as bad as sexual. Not being seen,
not being known having nowhere that is safe is very bad for young children
trying to find their place in the world.
Emotional regulation by asking for help, or doing something
with your body, exercise, soothing stuff. If you have never experienced this,
then you may go to other things, drink drugs, food, etc.
Losing your body
Post trauma people can access senses from various parts of
their bodies. Standard sensations are received in pieces and then integrated
into a whole, a unified sensation. People with PTSD have difficulty in
integrating, in putting the picture together.
DSN=Default state network, when weren’t not thinking of anything. When your brain is idling it activates the
areas of your brain that are responsible for creating your sense of self.
With trauma victims in their DSN they don’t activate these
areas that are responsible for creating your sense of self. These areas that
are responsible for sense of self are also related to the areas that enable
emotions.
So, the trauma victim shuts down their emotions and visceral
processing at a cost of shutting down the system that helps them create their
sense of self as it dampens emotional awareness and lessens the bodily
sensati9ons that form emotions.
You need to be able to understand signals from your body and
your emotions, to understand what is happening and therefore what you want. The
physical and emotional get shut down by trauma.
Under strong emotions the brain stem is affected, which
affects basic bodily functions: which makes sense of you make my skin crawl, my
heart sank, an icy shard went through me.
If there is a constant sense of danger, then the smallest
event will provoke a startle the smallest irritation produce anger.
So, the theory goes, there are triggers to the trauma,
creates powerful emotions, the more powerful emotions are created the more the
fight\flight system can get stuck on. As this happens this provokes bodily
changes which as with the emotions are unpleasant. So, the response to this can
be a shutdown of the emotions generally and the limbic system that notices
physical sensations, this is a fundamental aspect of our sense of self, so can
help us understand why trauma people lose their sense of purpose
Owning your life
Agency is the term where you feel in charge/can influence
something, it’s the opposite of feeling out of control.
Agency starts with interoception, knowing what you feel, can
then allow you to ask why you feel it and what you need. The MPFC is the rational conductor that takes
information form the amygdala, the thalamus and works out what to do, if it
isn’t handed good information it can’t respond effectively and that’s why
mindfulness, i.e. paying attention is the corner stone of trauma recover as it
allows you to notice what is happening in your body, which is the opposite of
disassociation.
Ogden and Levine:
1.
Connect with sensory information frozen and
blocked by trauma
2.
Help befriend the energies released by that
inner experience
3.
To complete self-preserving actions that were
missed out in the trauma
We have gut feelings: interoception and VVC for self and
others, that allow us to navigate very subtle signals. Trauma people feel unsafe in their bodies,
they are bombarded by warning signals, via memory and therefore shutdown
listening to them, but in so doing this they find it harder to navigate the
world. They don’t know what they want, what others are doing.
If you can’t comfortably notice what’s going on in yourself
you can either shut down or go into panic, you develop a fear of fear.
So, the idea is that I suppress my emotions as they are too
much as they come back with the memory of when I was overwhelmed, so there is
both the memory and the association between the two. I then feel fear, and I become
panicked or shut down as I am afraid of this emotion as it spells being overwhelmed
Without being able to rely on your body, you have to rely on
constant reassurance from others, numbing activity, or being compliant with
others.
Some people do this by instead of feeling stress, get a
headache instead.
You can suppress the inner cries but not the production of stress
hormones.
Alexithymia: not having feelings
Alexithymics substitute behaviour for emotions: how would
you feel, I would act like this. They register emotions as physical problems,
aches and pains, rather than something that merits attention.
Depersonalisation
One further step down the route of self-oblivion is
depersonalisation. Having a sense of
agency during the trauma helps reduce PTSD after. Depersonalisation helps you
deal with overwhelming pain be it physically or emotionally. Full depersonalisation means you become a stranger
to yourself and the world, which seems strange and distant.
You can get to the extent where you can feel you are
standing behind yourself, or outside yourself or are looking down (reminds me
of the false self from Laing)
Physical self-awareness is the first step to becoming freed
from the tyranny of the past, as it allows you to connect your body with what
is currently going on, to learn to listen to its signals, which then can give
you trust about what is currently going on.
Exploring the inner world of emotions, this can provoke
trauma memories and emotions, which will need containing
1.
Notice physical feelings
2.
Identify the changes made with
a.
pleasure or relaxation
b.
unpleasant emotions
3.
When people need calming the most natural way is to cling to
another person. If someone has been abused they are then left in an impossible
dilemma. They crave touch, yet they are afraid of it.
The sense of self gets built when the brain is idling
In heavy trauma people can avoid eye contact as they feel
disgusting and can’t stand seeing me thinking how despicable they are, it’s
like hearing it again for the first time.
Periaqueductal Grey, which generates startle,
hypervigilance, cowering, and other self-protective behaviours.
Chapter 7 Getting on the Same Wavelength:
Attachment and Attunement
Pierre Janet: “Every life is a piece of art, put together
with all means available.”
Infant care seeking behaviour will be assuaged with touch.
Our first lessons in self-care are the way that we are cared
for.
Mastering the skills of self-regulation are dependent then
on how well our parents, and how our parents did it, although of course it can
be changed.
We need to be attached to people, to groups, we need
strokes, if we can’t get them through family and friendships we get them
through feuds and illness
If there is a consistent pattern of care, children can adapt
to this, resulting in secure, anxious or avoidant. In anxious there is a loud
noise as part of care seeking behaviour but there is no settling down when
mother comes, there is feeling not dealing, and angry and sulky attention to
mother when they could be playing. Avoidant is dealing not feeling, getting on
with, being self-reliant, but not acknowledging any feelings of missing, or
wanting or needing.
Most people who present in psychiatric settings had their
primary care giver as the source of distress.
This creates an impossible dilemma, the PCG is both necessary for
survival and a source of fear.
Disorganised attachment: child may approach PCG then turn
away, may develop intense bonds with stranger or trust no-one. Occasional
breaks in attunement, lead the child to managing disappointment and frustration
and that the broken attachment bond can be repaired.
Disorganised infants lead to spaced out, aggressive, or
disengaged toddlers who have higher physiological reactions than their peers,
this physical response doesn’t change through their life.
Chronically failing to calm a child down, the mother may
feel like a failure then stop trying to comfort him.
If you have no internal sense of safety it is difficult to
tell the difference between danger and security.
If you feel numb, dangerous situations may make you feel
alive.
When bad things happen to you as a child, you may conclude
this is because you are a bad person you may also conclude there is nothing you
can do about it. So, you have a combination of I deserve bad things to happen
and am helpless in the face of them
Disorganised attachment can show up in two ways
1.
Hostile rejecting mother expects child to react
to their needs
a.
History of physical abuse
2.
Helpless and fearful, wanting their child to
comfort them. They weren’t the adult in the relationship
a.
History of sexual abuse, or loss, but not
physical abuse
How do you get abuse?
Misattunement, child gets more sullen, angry, mother more
defeated helpless sees child as disconnected stranger…
Children with seriously disrupted emotional communication,
grew up with an unstable sense of self, and reckless behaviour, impulsivity,
high anger and suicidality (BPD)
Disassociation: lost, overwhelmed, abandoned and
disconnected from the world, feeling unloved, empty and trapped. Disassociating means knowing and not knowing.
If you can’t tolerate what you know or feel, then you deny
or disassociate. In turning away from your emotions then you don’t feel real,
you feel empty and you may do intense things merely to feel again.
Disassociation is an inability to know how to feel safe.
This would be predicated by not feeling safe with the PCG, that then leads to
excessive clinging, or self-damaging behaviour.
Not feeling safe leads to disassociation and lack of self-regulation.
When we are small if we associate intense sensation, e.g.
hungry, with satisfaction, then we learn that you can manage strong emotions
and you are fundamentally safe. If you don’t then you don’t know how to regulate
your emotions, you don’t know what to do with them, and you have a fear that
these strong emotions also indicate that you are not safe, which then provokes
even stronger emotions.
Early attachment patterns develop what we might expect from
the other, and what pleasure\pain we can experience with them.
Chapter 8 Trapped in relationships: the cost of
abuse and neglect
Therapy as connecting with the unowned and denied parts of
yourself, that might start with an inexplicable behaviour, that takes time to
sit with so that it can show itself as opposed to rushing in and trying to fix
it.
Conversion reaction where clients’ express conflicts by
losing control of parts of their body
How do we learn what’s inside, outside, what’s safe, what’s
not.
As children we are egocentric, and if we are told we are the
cutest we believe that, or that we are idiots we believe that too, then if the
wold doesn’t accord, it’s a problem with the world, not with us.
We can act on this believe it as our inner map, even though
we think its irrational. To try to restructure this is to ally with the
irrationality and not to ally with the inner map.
As much as our inner maps of the world from childhood may be
malign we can change them by our experiences with love and intimacy etc. Likewise,
our childhood maps being benign they can be changed by traumatic events. Our
maps of the world are encoded on our emotional brain, not the PFC
So, if we have the old emotional brain and the current
rational brain, then the latter can override the former. The art of change is
firstly to notice the difference between the two, then secondly to tolerate the
emotions coming from the emotional brain without acting as if they are true.
If children are abused by their parents, they have no
authority to turn to, their parents are the authority, they can’t move out, so
they move out of their experience, their thoughts, their feelings, their
emotions.
Terror increases a desire for safety so ironically children
can want to be around their abuser as they feel safe with them. You can then feel helpless, your abuser is
your safety, you can’t feel or think then the rage you feel gets turned inwards
as a displacement activity as you can’t turn it outwards.
Chapter 9 What’s love got to do with it
When children disown their own powerful senses then they
tend to distrust their own senses.
Self-harm correlates with sexual abuse. If you have not felt
safe before, then the receptors that can respond to human kindness can fail to
develop, then how can you calm yourself when you feel distressed
PTSD is remembered trauma, but childhood trauma can play out
in the same way but disassociated from so there will be no memory.
3 groups for trauma
1.
CSA
2.
DV
3.
People who suffered from “natural” disaster
Being overweight can protect women form being seen sexually
and men from being seen sexually or as a small guy and therefore weak. Eating
and substance abuse may be the only place they feel safe. The problem may be a
solution to something you don’t see.
Sometimes the problem is just a marker for the real problem
which is buried in shame, dissociation and secrecy.
Chapter 10 : Developmental trauma, the hidden
epidemic
Effect of chronic stress is you numb out, when you do this,
people don’t see you are upset and don’t care for you. If you don’t acknowledge
your upset, you don’t care for yourself either.
Sexual abuse as a child leads to early onset puberty and
higher sexual desire.
Chapter 11 Uncovering secrets the problem of traumatic
memory
Memory as autobiographical, the stories we tell ourselves,
our take on experience. We remembered
based on how meaningful an event is and how much our level of arousal is. The mind operates to schemes and maps and
events that fall outside of that are unlikely to register.
Adrenaline that we secrete when afraid helps us to remember
that event. When something terrifying happens, this leads to an accurate and long-term
memory. The more adrenaline the more
precise the memory up to a point when it breaks down.
Under normal situations the emotional and rational brain
work together to encode within a narrative the meaningful events. When that
breaks the emotional brain takes over, emotions can’t be put into word,
location is lost, sense of time is lost. The PFC, the front lobe, the thalamus
shut down, there is no unity of perception.
Trauma memory can be expressed physically, the paralysed leg
of the man who thought his legs would be crushed. Trauma memory is fragmented.
Narrative memory needs rationality and emotions
Trauma memory is run by the emotions
When one aspect of traumatic memory is triggered then other
aspects come, traumatic memory is not condensed so what can be remembered can
come out over hours but can have actually taken minutes.
Narrative memory is flexible and serves a social purpose, we
can tell a story, make a point, draw different parts of it.
Traumatic memory is fixed, serves no purpose.
Flashbacks are always frozen in time and serve no useful
purpose.
When you can’t integrate historical experience, it’s as if
the personality gets frozen in time, unable to integrate any new experience.
Disassociation keeps trauma memory frozen, unable to produce
an ever-changing narrative memory. The
brain can’t think that was then, and this is now with disassociated memory.
Memory that doesn’t have a verbal memory is acted out, it is
the client’s way of remembering. He
doesn’t realise it is a memory. Bringing the memory back with affect and
putting words to it, reduces the symptoms, remembering without affect doesn’t.
Chapter 12 The unbearable heaviness of remembering
Women you are younger and abused by a relative are more
likely to forget their abuse.
A memory unremembered is frozen, in telling it, it changes
Traumatic memories are disorganised, some fragments are very
powerful, much detail is missing.
Merely remembering and articulating trauma doesn’t alleviate
it.
Sometimes having a dual existence is the only way, the
trauma self and the post trauma self each with their independent existence.
Chapter 13: Healing from trauma: owning yourself
Trauma “recovery”
1.
Find a way to be calm and focussed
2.
Learn to remain calm in response to images from
the past
3.
Find a way to be fully alive and engaged with
those around you
4.
Not to have to keep secrets from yourself about
what you did to survive
The emotional brain controls physical reaction.
Understanding why I feel the way I do, does not stop me feeling it, but it can
reduce how much I act on it. When we’re
under stress our emotional responses are more prominent.
If people are hyper or hypo aroused then they can’t learn
from experience, they can become rigidly in control, white knuckle sobriety,
which leads them to being depressed and inflexible.
The medial PFC deals with interoception and self-awareness.
The PFC rational thinking and executive function. Amygdala threat system. The
PFC doesn’t deal directly with the emotional brain, the limbic system but the
mPFC does.
The brain layers
Reptilian brain, brain stem, responsible for all the things
babies can do, eat, breathe, feel pain, pleasure, hunger, wake, cry
Brain stem and hypothalamus: control heart lung, and immune
and endocrine systems, keeps us homeostatically balanced
Above this is the limbic system, or mammalian brain as all
mammals have one. Seat of emotions, judges what’s important for survival and
helps us within complex societies. The
limbic system is moulded by experience and built on genetics and “personality”.
Emotional brain=limbic system and reptilian brain
Interoception, perceiving internal sensation generated
internally: muscle tension, adrenaline
Exteroception, perceiving internal sensation generated
externally: light sound
Dealing with hyper arousal
Most organ connections to the brain via the vagus nerves are
afferent, i.e. run into the brain, which means we can directly control our
arousal by the way that we breathe.
Learning how to be relaxed and to breathe calmly in the face of
troubling memories is essential to recovery.
No Mind without mindfulness
Noticing the emotional state in our bodies can add to our
control over them, can notice their ebb and flow. If we try not to feel these
feelings we can be overwhelmed by them.
As we notice our emotions we come out of automatic pilot and take a
different perspective. Traumatised
people fear their own physical sensations.
To reduce the fear that you have of your inner experience
then: Label it, the emotion, the physical feeling and notice how it changes as
you breathe deeply out. In some ways
what you are noticing is how the emotion changes and isn’t stuck in a timeless
present. Learning to observe your physical feelings, so that they don’t feel
overwhelming is a prerequisite for re-living, so you don’t get re-traumatised
by it.
Noticing how the body changes can be done by
1.
When you have an emotion then noticing your
breathe, and breathe out deeply
2.
Having different thoughts and notice how the body
changes
Relationships
Terror and safety are incompatible, so a reassuring word or
hug will give you a feeling of safety that there is someone bigger than you who
can take care of the problem.
After an acute trauma then a person needs to feel safe. Familiar
people, places, foods etc.
Recovery from trauma happens via relationships, therapist,
friends, organisations, where there can be a feeling of safety, or not being judged,
of being understood and supported.
Trauma that happens in relationship DV, CSA, is the hardest
to treat as these are the relationships that are supposed to keep yourself safe
from trauma.
People who were brutalised by their parents often do not
feel safe. It can be useful to ask the question who they felt safe with when
they were growing up. This can be the seed of learning to re-engage.
Communal rhythms and synchrony
Our relationships are embodied we give and receive facial
expressions, in trauma we lose our physical attunement.
Physical communal activity helps you tune back into people,
dancing, improv, sport, karate. It helps you get in touch with your body and
that of the other.
Getting in touch
The most natural way to be calmed, is to be rocked, hugged,
or touched. Its what mama did. Doing some body work is going to be therapeutic.
Taking action
In trauma cortisol is released to help you take action.
People who do are much less likely to develop PTSD, people who don’t have a build-up
of cortisol that causes problems for them. The fight and flight that was used
to deal with an external situation is turned back internally.
Whilst a client may have frozen and felt helpless at the
time, their stress hormone had built up and was prepared to act, but this was
thwarted by the frozenness. Therefore, when you relive you can re-access some
of the bodily desire, to hit, protect, duck etc. These might be shown in
smaller body movements, and arching of the back whilst talking. IN extreme
fear, your executive functions go off line and you can freeze.
Exposure/Drugs
Exposure works so you get more used a response, you dampen
it, so you feel anxiety regularly enough you dampen your response to it, it’s
not such a big deal but what can happen is that you dampen your responses to
other emotions. Your emotional life
becomes more muted, the same is true with drugs that dampen your physiological
responses. Drugs as we aren’t sure how
they work, can have different effects for different people. Some can find a
muting of all emotions some less so. However, there is another way to go, to
associate and integrate so the overwhelming trauma becomes part of you, an
unpleasant memory that happened some time ago.
Wounds
The idea with wounds, be they physical or mental is to
integrate them into our lives, to not over identify with them or to label
ourselves on the basis of them. Some bad
things happened to me, but I am not a bad person, I have some weakness, but it
does not mean I’m a weak person.
Chapter 14 Language: Miracle and tyranny
Traumatic events can lack words, can be so bad they are
indescribable and can only exist n image and sensory fragments. To not label
our trauma, to keep it hidden from ourselves and others keeps us in isolation.
As we keep secrets from ourselves as we suppress memories
then it takes up our energy and vitality. As the horrible thing isn’t
integrated into you as a thing that happened then it’s still active and current
and it can be triggered
When you describe your experience you leave it, you can feel
your experiences your memories or you can articulate it to another
There are two senses of self, one that is autobiographical
and exists through time and is expressed in the coherence of language, one that
exists in present and experiences and is experienced in physical sensations.
One system can produce a story for public consumption that
can be at odds with our felt sense, our present experience of wat this means to
us deep inside. Treatment is to reconcile these two aspects the public story
and the inner sensation.
The body is the bridge
Blaming helps you feel better whilst feeling bad, the trauma
story is who we can blame for how you feel. However, there’s is a sense where trauma
changes you and that’s hard to put into words. Words describe external things,
harder to describe internal world also harder to describe our own internal
world. When you follow the interoceptive
experience of trauma things begin to change.
Writing to yourself
Writing letters, you don’t send to people that have hurt you
can be helpful, you can listen to your own thoughts, allow them their flow. If
we talk to someone about this our guard is up, by writing this doesn’t happen.
Free writing: take an object and write whatever comes into
your head without correction.
Speaking trauma
Trauma can be overwhelming and hard to put into words,
dipping in and out of it can be helpful to show how to stay safe. Start by identifying a safe island in the body
outside the reach of the vagus nerves, e.g. hands or feet. Focus on them notice
how they are feeling pre-trauma, talk trauma for a little bit then come back to
the hands\feet., moving them if necessary to ground in the present. Likewise
feeling weight in chair can be helpful, or if patient slipping into chair ask
them to sit up straight.
To understand trauma, pendulate, swing between safety and
exploration. Find somewhere safe in your body, explore the trauma and return.
Move between language and the body, between the present and the trauma.
People with PTSD have problems with attention and learning
new words.
Trauma enters our body like a foreign object, and like a
splinter it is the bodies reaction to it that is the problem, the
disassociation of the body\emotions, the emotions, the avoidance.
Insula
Brain imaging shows PTSD people having abnormal activity in
the insula. This is what amalgamates internal sensation to give an embodies
sense of self. The insula can transmit
directly to the amygdala, so you get a sense of threat\doom without cognition.
As much as the insula can transmit warning signals to the amygdala
and you dissociate, then you are under a barrage of information but shut down
from it, this can lead to alexithymia, where you can’t sense what is going on
with you. Trauma can make you feel like
no body or somebody else, and to treat this you must get in touch with your
body, to establish a sense of self and priorities.
Chapter 15 Letting go of the past: EMDR
There is a public story of trauma and the story that is acted
on.
People can recover from trauma without talking about it.
EMDR integrates traumatic material
Without integration a memory has a life of its own,
undigested and raw.
The trauma also reorganises the self as helpless and the
world as threatening.
Exposing to trauma can bring scores down but it doesn’t restore
vitality.
EMDR allows the client to integrate a memory via associations,
and imagination into their autobiographical memory, it’s what our standard REM
sleep processing does for us.
Rem sleep reduces depression
In sleep we reshape and integrate memories,
Conscious: recollection
NREM: reflection
REM: integration
In rem sleep distant associations are made between ideas and
memories.
EMDR allows novel connections to be made which allow the
trauma memory to be integrated, creativity is the art of making novel
connections and this is what EMDR does.
The basic EMDR instruction is to hold that image in mind and
watch my finger go back and forth.
Drugs can blunt the trauma memory but not integrate it.
There is no clear indication how EMDR works, but it does.
The same is too for serotonin and talking to a friend.
Chapter 16 Learning to inhabit your body
The amygdala is your threat system that controls the
fight\flight\freeze response. If it is malfunctioning and interpreting
threatening scenarios that aren’t you can’t start to doubt your perceptions.
Small children are very good at compartmentalising, so the
fear of your father would be held in one part of consciousness, your love of
him in another.
The feeling of helplessness is stored in the affected body
areas as tension or a feeling of disintegration.
Trauma victims’ life is spent trying to ward of unwanted
physical/sensory feelings. So, they become experts at bracing and numbing. They
can do this through substance, food, work or exercise addictions
As much as they might numb themselves to manage their
intolerable and painful world then they also do things to get some feeling
back, and they use powerful things, DSH, adrenaline sports, risky behaviour,
drugs\sex\crime.
Chronically angry or scared leads to muscle tension, leads
to physical problems.
Sensations become more tolerable when you realise they have
a beginning, middle and end. When you numb yourself, you support the idea that
they will never end, which increase their power.
SNS Sympathetic nervous system, uses adrenaline to help us
take action in the face of threat
PNS: parasympathetic nervous system, uses acetylcholine to
regulate, digestion, sleep, wound healing and dream cycles
Inhaling stimulates the SNS: which increases the heart rate
Exhaling stimulates the PNS: which decrease the heart rate
If the heart rate is a steady rhythmic fluctuation, then the
systems are in balance.
PTSD peoples SNS and PNS are out of sync, showing they
aren’t calm, showing that they will find it hard to manage emotions.
HRV in PTSD. Breathing is rapid and shallow. Heart rate is
slow and out of synch with the breath. This is a typical pattern of a shut-down
person with chronic PTSD.
Changing how you breathe can alleviate aspect of mental and
physical distress.
The aim is to have cardiac coherence to match the heart rate
with breathing pattern.
To have a sense of self we have a vital connection with our
body, we feel and interpret physical sensations to know what we do and don’t
want. If we numb ourselves from our
feeling we numb ourselves from our body, it can help us navigate pain but at
the cost of losing ourselves and being alive.
Numbing muffles, the everyday sensual pleasures of life that
imbue life with meaning.
The two most important phrases in therapy and yoga are
notice that and what happens next.
If you feel safe in your body, you can learn to communicate
the terrifying things that have happened to you.
Chapter 17 Putting all the pieces together: self-leadership
When we are humiliated we do whatever we can to protect ourselves.
We suppress our feelings, we plot revenge, we may decide to become so powerful
that no one can ever hurt us again.
For children it can be easier to blame themselves for their
distress as opposed to be angry or run away from their parents who they depend
on for support.
A child may well split off large parts of reality, external
and internal. So, when you work with someone with trauma, then there may well
be a frozen child living inside of them.
Pushing away feelings maybe adaptive in the short term to
enable you to do certain things, however in the longer term you are emotionally
shut down to the world and yourself, you also have a memory that is fragmented
rather than integrated and can be reactivated although you don’t know why.
Treatment involves being able to engage with memories from
the past without getting overwhelmed by hem. It is also about being able to
reconfigure your mind\body that have learnt to cope with the worst.
The mind is a mosaic, there are many different
personalities.
How we get along is how well our internal leadership works,
listening to all the parts, caring for them and making sure they don’t sabotage
each other
Parts often come across as absolutes when they only actually
represent one part of the mosaic. That
can be due to context or intensity, but they can overshadow the other aspects
that soften the absolute.
The self is a community of selves, sub personality, every
modality sees that. They can jostle along, contradicts each other, but in
trauma parts get so polarised that they go to war.
IFS internal family system recognises the systemic nature of
the self and looks to see change to one part will necessarily have changes to
all the other.
All systems need to be well led, all parts of it need to be
validated, cared for. IFS argues that childhood trauma lose this leadership and
operate on beliefs from that period.
When this isn’t the case IFS argues that there is blending, i.e.
identification with a part.
So, with IFS the model is that there is a self that is
confident, calm and curious but that has gone to the background whilst various
protectors keep the self-safe, once these protectors know that it’s safe again
the self can continue to do its job.
Naming the various parts can be helpful in terms of reducing
their power. Likewise, when the self is pushed to the background identification
can happen with one of the parts. You can ask the protectors to stand back to
see what its protecting.
You might ask a client how they feel, and what part of them
feels like that, is there an image related to it. Then ask how you feel towards that part of
you. If you get a strong response, I hate it, then ask the part that hates it
to step back and ask how you feel towards that part now. In some ways the idea
is to get to know the parts, to see the relationships between the parts, and as
you do you are implicitly strengthening the sovereign self.
Again, what do you say to that part, what feels right for it
now can be helpful to make sense of the part. You can get to know it as well
its origins, its worldview.
You might think of the parts in terms of function
1.
Manager: deals with problems, stay in control
2.
Firefighter: deals with crisis, get rid of
emotional pain, can destroy the house to put out the fire.
3.
Exiles: those bits that managers try to get rid
of
The struggle between the uptight manager and the out of
control fireman will continue until the exiles who carry the burden of trauma
are allowed home and can be cared for.
Chapter 18 Filling in the holes: creating
structures
Physically and spatially representing your inner world can
allow you to engage and access it in ways you may not have before. You can use
people or objects to do this.
Psychomotor therapy allows you to feel what you felt back in
a scene and allow you to be the director of your memory.
With a tableau you can become an active participant in your
memory\story, done within a group you can feel both safe and experience
validation.
Tableaus don’t erase the memory of fix it like EMDR does but
what they do is to add an alternative memory in which your needs are met.
Creating tableaus create trance like states where past and
present can co-exist, feel the feelings as a child with the perspective of the
adult. In the tableau you can have the
actual characters and the ideal characters.
Re-scripting takes place via the ideal characters
Feeling safe
In our bodies
In our homes
In our relationship
In the groups we belong to
Expectation bad things can happen, formed on a basis of
experience, creates fear and isolation and leads to a reluctance to try new
things which could challenge their basic world view.
Rescripting enables you to see a different past, the power
of this is in so far as it liberates you from the past, things could have been different,
and they can be different now.
Trauma causes you to remain stuck in interpreting the
present in the light of an unchanging past. Re-scripting loosens that past, so
you can interpret the present differently.
With re-scripting you are playing out what you wanted, in
some ways coming to terms with that person, what you wanted and what you got.
In some ways that can then form the gestalt and there isn’t unfinished business
with them, that you then use to define other people and hence your present.
Re-scripting can form an antidote to a painful memory. Re-scripting
can help the process of weaving memories into other parts of life by
association. It’s what dreaming does
Chapter 19 Rewiring the brain: neurofeedback
Used to be understood that the brain worked via chemicals
and electricity, but when pharmacology dominated interest in electricity waned.
Traumatic stress is about not being able to be fully alive
in the present.
In trauma there is pin point focus, out of trauma there is
difficulty focussing, amygdala stuck on PFC not working, ADHD response, can’t
filter out noise.
Neurofeedback is an EEG on a computer, and exercises that
enable certain types of brain wave to be encouraged. So useful with trauma as
it can calm down the fear response brainwaves to allow the brain to focus on
other things and therefore have better attention.
Whilst you still feel afraid, you’re still in it, it’s
difficult to build relationships. It’s
difficult to explore the world as you are scared.
Too many delta waves whilst awake=foggy thinking. Delta
waves most often seen whilst asleep
Theta waves are seen on the edge of sleep and creates a mind
unconstrained by logic, so creative
Theta waves are also seen when depressed.
Alpha waves are accompanied by peace and calm
Beta waves enable focussed attention, fast beta waves are
related to anxiety, agitation and restlessness.
When theta waves predominate there can be a hypnotic feeling
When alpha waves can be a bridge from internal to external
world
PTSD treatment is about getting the person to experience
novel experience, so the present isn’t a continual reliving of the past.
Trance states enable new associations to be made and breaks
the traditional relation between stimulus and response.
To stimulate alpha\theta waves and relive can produce fresh
associations.
VDK uses neurofeedback for developmental trauma.
Chapter 20 Finding your voice: communal rhythms and
theatre
Acting is about learning to be someone, accessing the inner
part of your character that is that person, it’s about becoming that person in
your body.
Music binds people together who individually may be
terrified but collectively become powerful.
Traumatized people are afraid to access their emotions as
they could lose control Theatre is about giving voice to emotions, to your
emotions, and have an audience feel them.
There is a commonality in theatre, you’re are part of a troupe performing
for an audience, you are part of a larger body.
Traumatized people are afraid of conflict, afraid of landing
on the wrong side again.
Trauma is about trying to hide how scared, or helpless you
felt, in the face of conflict. Drama is about trying to develop the truths
within conflict.
Mirroring helps loosen people’s preoccupation with what the
other thinks and gets them to attune viscerally.
Therapy and theatre are about intuition, what makes therapy
effective is the deep subjective resonance that lives in the body.
