The Practice of Healing Trauma: 10 Ideas to cultivate restoration


The Practice of Healing Trauma: 10 Ideas to cultivate restoration

  1. Express your feelings:

The expression of feelings is vital to fulfilling human connection and well-being.  So many who struggle to communicate what they feel.  Toxic stress in childhood often constrains positive experiences of expression.  When we expressed feelings we were often met with constriction.  Do you have support in communicating your feelings?  The feeling of being understood by those you care about can have a profound impact on well-being.  

2. Nurture / cultivate desire:

Toxic levels of stress constrain self-exploration.  Freedom to creatively explore life is vital to the discovery of a healthy identity.  Unfortunately, we currently have a cultural structure that constrains this experience.  A family and culture overly focused on achievement vs. health development can make us highly sensitive to the goodwill and approval of others, rather than attuned to supporting our internal sense of desire, creativity, joy, and reward.  Notice what your emotional experience is as you think about and pursue pleasure and joy.  Does your nervous system have the capacity to support the experience?     

3. Expand awareness of autonomic sensory response to a stimulus:

Toxic childhood stress disrupts sensory awareness.  If children experience high levels of stress they normalize a high arousal state of being.  This can lead to a persistent physiologic state of high vigilance.  This highly vigilant results in high sensitivity to external factors to determine our own sense of safety and self (meaning we don’t have an internal sense of safety).  By increasing awareness of autonomic sensory patterns, we can identify and differentiate between the unwanted pattern, and cultivate an awareness of safety.  Identify the experiences that influenced high arousal? When did you get relief and safety from this? How did you cope? 

4. Expand compassion for yourself

Toxic stress affects executive functioning when we struggle with organization and coherence secondary adversity often occurs.  For example persistent relational conflict, that usually leaves you feeling responsible.  This is a toxic shame!  This equation goes something like this: Toxic Stress + Isolation = Shame.  The intolerable emotion of shame influences negative patterns associated with dysregulation.  Overall the experience constrains self-compassion which is vital for nervous system regulation.  

5. Survival Patterns and False Self

Autonomic regulation and safety create the basis for a connection to self.  When we are connected to self the essence of who we are can emerge.  (Some call it authenticity or the authentic nature of us / childlike expression of self).  Survival and/or adaptation strategies to survive developed to seek safety constrict our connection to the essence of self.  As a result, we develop and attached to survival strategies (FALSE SELF).  

    1. Polarized Thinking- Perceives stimulus in an extreme way. Black and white thinking, absolutizing leads to hopelessness,

    2. Catastrophizing - Your early development was seen as a burden on those around you. Parents fretted, worried, and hypnotized you with their endless stream of anxious reminders. You failed to experience consistent security by your caretakers and didn’t the experience of “I trust you to make a great life for yourself!”

    3. Universalizing - High sensory dysregulation when people “ask of you” obligations to be somewhere and/or meet a task. The type of trauma experienced maybe unprocessed grief and/or survivor remorse. The feeling like you should have done more to avoid the trauma experienced. Also, if you had a parent or caretaker who wasn’t dependable, frequently left you heartbroken you may experience dysregulation from the idea that you are responsible. We internalize trauma and project it into the world. This unmanageable regulatory pattern feels like all eyes are on you. You overcompensate and have a sensory experience of extreme dysregulation and ruminating thoughts.

    4. Mind-reading - If you heard messages that you were supposed to like and love by everyone, or if expressing unpleasant feelings caused so much high arousal and dysregulation to those connected to you, sometimes kids hold back expressing feelings as a means of avoiding perceived danger from the dysregulation experienced by those around their social environment. As a result negative thoughts and feelings are kept in, however, those feelings don’t just go away. They are often projected toward others and/or experiences. Was it safe to express and explore your feelings?

6. Practice Compassion and Cultivate Care

From birth, we are hardwired to connect with caregivers.  We come out of the womb seeking close connection.  Soon after birth, we begin storing how our needs are met by our caregivers.  These important interactions are stored in the limbic region of our brain. The response we receive from our caregivers establishes the primary structure of how our amygdala (threat response region of the brain) responds to threat, and we develop anticipation of the trustworthiness or mistrust of relationships.   If we experienced a high frequency of stress without calming reassurance from our caregivers, constriction in rest, restore, digestion occurs and we blame ourselves for what is causing the stress.  If the brain can’t resolve the problem the emotional system experiences arousal of the sympathetic nervous system and the acceleration of the parasympathetic nervous system at the same time.  It’s like having the gas and the break on at the same time.  Without relief, we internalize the emotion and blame ourselves.  Kids don’t have the capacity to realize that their parents or teachers often don’t know or have the skills to help meet kids' emotional needs.  This internalization is fuel for shame.  If we go for a prolonged period of time without calm reassurance from our caregivers our parasympathetic nervous system doesn’t calm down and consequently, we remain highly aroused and then if we can’t fight or flight we freeze, and the parasympathetic system does provide the relief it's designed to provide.  We call this toxic shame, and our ability to self-soothe through compassionate healthy experiences is replaced with compulsive patterns such as food, masturbation, pills, drugs, etc… 

Toxic shame experienced in childhood impacts the hippocampus (brain responsible for consolidating memory). Our hippocampus consolidate how we should respond to situations where we feel uncomfortable or uncertain.  If we were mistreated, our hippocampus internalize negative messages about ourselves and what we can expect from others.  The effect is that later in life when we encounter uncomfortable situations our hippocampus takes over and we feel shame.  This triggered response sends us spiraling into a complicated dance of arousal and fear that adversely affects how we form new relationships with others.  

Where in life do you struggle to set limits?  When there is a scarcity of attunement over a long period of time during development we experience scarcity and deprivation.  If we cannot find the words to alert our caretakers of this distress we self-blame/shame for the social problems experienced.  If you were deprived of safety and attunement you may have felt deprivation or a persistent autonomic sense of high regulation without relief, the compassion necessary to set a limit may have been constrained.  

7. Connect to your Trauma

Try to understand how your developmental experiences are influencing your current unwanted behavior.  Undifferentiated sensory patterns vs. a differentiated sense of self is the path to building capacity.  If we can identify mistakes and autonomic patterns that were essential for survival during our developmental years we can seek to modify and alter our response.  The autonomic patterns may not change but our response and experiences can.  The brain’s development is experience-dependent, but we must recognize the implicit autonomic pattern we seek to alter first.  Seek understanding and resolution.  Undifferentiated sensory-motor experiences are just underdeveloped parts of self that need our attention and care.   Practice the serenity, compassion, and care to allow your system to attune to these aspects of self.  

8. Take responsibility

Cultivate a healthy sense of shame and understand patterns connected to toxic shame.  Healthy shame allows you to make mistakes, which are integral to development.  Permission to make mistakes allows you to connect to desire and fulfillment and open the door to repairing constraints to development. If you function in a rigid or disorganized manner this will constrain mobility, creativity, and exploration.  You may fail to seek guidance and constrain opportunities for growth, intimacy, and connection.  

9. Structure your Support so you can sustain it

Develop a structure that facilitates continued growth, self-awareness, personal growth, feedback, supports desire, and intimate connections.  Survival strategies will always kick in, especially as we grow and expand capacity.  So develop some structural guidelines that ensure you must remain committed to personal growth.  

10. Expand your capacity by resolving conflict

Establish a strategy and rules for resolving conflict.  By cultivating sensory awareness, and expression of feelings we can put this into action by working to resolve the conflict associated with dysregulation.  This may mean we need to exercise grace for ourselves and others for mistakes.  What problems are you struggling to resolve, and what part can you identify as a change you need to make. 

Polyvagal Theory

Polyvagal theory is the tenths cranial nerve and responsible for coordination of signals between the brain to the organs, and under threat it functions as the break to high arousal. For anyone who’s experienced dissociation or depersonalized experiences its the vegas nerve that coordinates this response. The vegas nerve is also responsible for coordination of calm restorative experiences. In essence the vegas nerve is the processor for threat response between the brain and body.

Why Polyvagal? The vegas nerve has three key functions in relation to our autonomic nervous system: 1. Sympathetic arousal, 2. Ventra Vegal, 3. Dorsal Vegal.

The sympathetic nervous system (SNS) prepares us to take action with the options of fight or flight, using movement to protect.  This system protects us to mobilize in the search for safety. In our evolutionary history, being alone, not part of a tribe was dangerous, and the sympathetic nervous system activates us to engage and seek safety. If we are under threat the middle ear shifts away from listening to human voice toward listening for low-frequency sounds of predators or high frequency sounds of distress to tune into detecting danger.  Also tunes into reading facial expressions however in a heightens state we often misread cues.

 Children who experience frequent and ongoing sympathetic activation stay on high alert and release of cortisol that makes it hard to sit still. This may be a factor when diagnosing ADHD and other alternative learning styles.  

The ventral vagal is considered the compassion branch of the vagas nerve. This coordinates the body to engage in to care/intimacy/connections, and supports compassionate interactions.  It’s the state that slows our heart rate, softens our eyes, brings a kind tone to our voice, and moves us to reach out to others.  It is the same energy that support self-compassion.  Ventral vagal activity restorative and good for us.

 Our dorsal vagal system is considered the oldest part of the autonomic nervous system and part of the parasympathetic nervous system. This nerve is responsible for regulating digestion. It helps us with conservation of energy when we experience high levels of stress. It protects us from both physical and psychological pain. In the most extreme circumstances it’s responsible for freeze response, in less extreme circumstances it will tune our distractions that cause persistent stress. For example veterans who are consistently under threat for more than three consecutive months will report they were able to tune out the sound of bombs, and threat to life experiences. It’s the dorsal vagal system that coordinates this response to protect us from remaining in high arousal.

Specifically for children with alternative learning styles who experience high levels of threat because they are not learning like the others experience dorsal vagal response, and will tune out teachers and others due to the stress its cause in the past.  

The dorsal vagal system influences persistent patterns of coping with high sympathetic arousal when we don’t feel like we have options.  If an emotional obstacle feels too big to deal with a dorsal vagal response will kick in. If you frequently feel like you don’t matter, are unimportant, criticized or over critical of self, feel like you don’t belong or don’t matter a dorsal vagal behavior pattern will serve to sooth the impact of this unbearable emotional state. 

Organizing Principles:

1.     Hierarchy: The autonomic nervous system response to sensations in the body and signals from the environment.  These pathways work in specific order to respond to challenges in predictable ways.  The three pathways are the dorsal vagus (immobilization) the sympathetic nervous system (mobilization), the ventral vagus (social engagement and connection).

2.     Neuroception: This is a term to describe the ways our autonomic nervous system response to cues of safety, danger, and life-threat from within our bodies, in the world around us and in our connections to others.  Different from perception, this is “detection with-out awareness.”

3.     Co-Regulation: Polyvagal Theory identifies co-regulation as a biological imperative: It is through reciprocal regulation of our autonomic states that we feel safe to move into connection and create trusting relationships.

The Why Behind the What – Adverse Childhood Events

“As practitioners, we need to be able to explain or at least seek to explain the why behind the what.”

This statement, recently made by a colleague of mine, immediately resonated, especially for therapy related to adverse childhood events (ACE). A vast body of data indicates an increased risk of health issues for children exposed to ACEs.  To understand the “why” of this elevated risk, you need to understand the limbic brain, which is common to all mammal species.

The limbic region of the brain takes in basic information from the five senses and relays it to our central nervous system (CNS) for processing.  The CNS then helps the endocrine system deliver neurons that trigger an appropriate response from our body. Over time, this chemical response process establishes a pattern in our brain that shapes future reactions to similar experiences. This ability of the brain to form and organize synaptic connections in response to experiences is known as neuroplasticity, and it is formed primarily in early childhood, potentially impacting the way we experience relationships as adults.

The way our brain processes early childhood experiences also determines immune system function by gauging the frequency of being in an aroused state vs. a resting or restorative state. This response is also known as the hypothalamus pituitary adrenal (HPA) axis, which acts as a thermostat for our endocrine system. Certain stimuli require necessary responses – to take action, relax, rest, digest or restore.  Adults who’ve experienced a higher frequency of stress in childhood have a more sensitive HPA axis/thermostat response, delivering a much higher ratio of hormones to the body adversely affecting immune function and response. 

Even more significant than immune system response is the impact of heightened arousal on the opioid peptide beta-endorphin. What is an opioid peptide beta-endorphin? In short, the effects of these peptides vary, but they all resemble those of opiates. Brain opioid peptide systems are known to play an important role in motivationemotionattachment behavior, stress and pain response and the control of food intake. Essentially it is the endorphin released when we feel safe and connected with those we love. Many schools of thought tie human longevity to sustained engagement in deep, close and safe relationships that directly increase opioid peptide endorphins which in turn enhance immune system function. Those who have experienced ACEs often lack safe, intimate relationships.

We are on the cusp of treatment models that will enhance therapy practices and influence education, public policy and the organization of family systems. This post is just a brief overview of the “why” behind the importance of therapy for those who have experienced ACEs. If you are interested in more information on this topic, check out the additional resources listed below:

 “Affect Regulation and the Origin of the Self, the Neurobiology of Emotional Development.” Allan N. Shore.

“Adverse Childhood Experiences (ACEs) - Ace Study.” CDC.gov.

The Impact and History of Children & Stimulant Medications

The Impact and History of Children & Stimulant Medications

As indicated by numerous studies, medicating children with stimulants provides short-term improvement of classroom concentration and a reduction in disturbances. However, short-term gains may come at the long-term price of negative impact on child brain development. 

In 1956 Ritalin was introduced to the market as a Narcolepsy treatment, touted as a safe alternative to amphetamines. In 1970 Ritalin usage increased, primarily among state mental hospitals, to treat children suffering from severe emotional disturbances.

Fast forward to 1991 when Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), an organization focused on addressing problems of adults and children suffering from Attention-Deficit/Hyperactivity Disorder (ADHD), successfully lobbied Congress to include ADHD as a disability covered under the Americans with Disabilities Act (ADA). This made children diagnosed with ADHD eligible for special services – special services funded with federal money. As a result, diagnosis-related use of stimulant medication spiked to over one million throughout the 1990s.

ADHD is identified as a brain disease, but the etiology remains unknown along with many other medicated pediatric mental diagnoses. CHADD describes ADHD as a chemical imbalance characterized by underactive dopamine, a position which has increased medicated diagnoses. What CHADD does not provide information on is the failure of medication to normalize or repair brain activity, with research indicating a more detrimental effect. 

Today over 3.5 million individuals are diagnosed and prescribed stimulant-based medication. According to the Harvard Review of Psychiatry (2009), diagnosis of ADHD primarily arises from teacher complaints, with a small minority displaying symptoms during a physician visit. 

Efficacy studies consistently demonstrate an improvement in classroom functioning and a reduction of classroom disturbances with the use of stimulant medications. What efficacy studies fail to demonstrate is a drug treatment that benefits overall development. In fact, a contrary outcome is frequently documented.

A University of Texas study shows that stimulant medication leads to negative child development outcomes – specifically in the area of social development. The child abandons sense of and trust in self, relying instead on medication.

The psychotropic impact of the Methylphenidate drug classification (Ritalin and Adderall) includes:

·       Blockage of 70% of transporter neurons that remove dopamine from synaptic cleft – having a negative effect on the pleasure and reward structure of the brain.

·       A slower brain clearing time than cocaine, thus blocking dopamine reuptake for hours. This is the opposite of cocaine, which is fast and brief, and the reason cocaine is more addictive.

Additionally, in response to Ritalin a compensatory adaption occurs:

·       Dopamine remains in synaptic cleft too long, so the child’s brain dials down its dopamine machinery.

·       Density of dopamine receptors in postsynaptic neurons decline.

·       Dopamine receptors are altered affecting homeostasis – specifically one’s organization to pleasure and reward neuropathways.

In conclusion, the tradeoff for improved classroom performance and behavior does not translate into long-term success. Brain development in the areas of reasoning, problem-solving, and emotional coordination is not improved and in fact, may suffer long-term negative impacts. 

Emotion Coaching

Emotion Coaching

John Gottman a Ph.D research based psychologist has evaluated thousands of parent-child interaction and reports there four styles of parenting: 1. Dismissing, 2. Disapproving, 3. Laissez-fare, 4. The emotional coach.  I encourage parents to examine these four parenting characteristics and identify what yours.  As we become more conscious of our own behavior we can begin to shift. 

1.     Dismissing parent (constrains connection)

a.     Treats child feelings as unimportant, trivial

b.     Disengages from or ignores the child’s feelings

c.     Wants child’s negative emotions to disappear quickly

d.     Characteristically uses distraction to shut down child’s emotions

2.     The disapproving parent (constrains autonomy)

a.     Displays many of the dismissing parent behaviors but in a more negative way

b.     Judges and criticizes the child’s emotional expression

c.     Is unaware of the need to set limits on the child

d.     Emphasizes conformity to good standards or behavior reprimands, disciplines, or punishes the child for emotional expression, whether the child is misbehaving or not.

3.     The Laissez-Faire Parent (constrains safety)

a.     Freely accepts all emotional expression from a child

b.     Offers little comfort to a child experiencing negative feelings

c.     Offers little guidance on behavior

d.     Does not teach child about emotions

4.     The emotion coach (maintains connection, safety, and autonomy)

a.     Values the child’s negative emotions as an opportunity for intimacy

b.     Can tolerate spending time with a sad, angry, or fearful child; does not become impatient with the emotion

c.     Is aware of and values his or her own emotions

d.     Sees the world of negative emotions as an important area for parenting. 

e.     Does not say how the child should feel

f.      Does not feel he or she has to fix every problem for the child uses emotional momentum as a time to:

  • Listen to the child 
  • Empathize with soothing words and affection
  • Help the child label the emotion
  • Offer’s guidance on regulating emotions
  • Sets limits and teaches acceptable expression of emotions
  • Teaches problem-solving skills.

5 Key Steps to emotion coaching:

1.     Be aware of child’s emotions

2.     Recognize emotions as opportunity for intimacy and teaching

3.     Listening empathetically and validating child’s feelings

4.     Helping child verbally label emotions

5.     Setting limits while helping child problem solve

Extras:

  • Avoid excessive criticism, humiliation, or mocking
  • Create mental maps of child’s daily life
  • Think about your child’s experiences in terms of similar adult situations
  • Don’t try to impose your solutions on your child’s problems
  • Empower your child by giving choices, respecting wishes
  • Share in your child’s dreams and fantasies
  • Be honest with your child
  • Read children’s literature together
  • Be patient with the process
  • Understand your base of power as a parent
  • Believe in the positive nature of human development

 

Supporting Adolescent Development

Supporting Adolescent Development

The Adolescent Brain:

In a book titled “The Neuroscience of Human Relationships.  The author describes the teenage brain and explains why they display behavior that leaves parents confused.  First point reminds us that the transition from child to adult is rapid and abrupt.  Just when children establish predictability in their social environment by the end of 5 and 6th grade, their bodies and brains begin to shift.  The way we interact socially changes as well.  Children become more conscious of social connection, and identity formation is in full swing.  They also become more likely to engage in risky behavior.  The author describes the brain development of adolescent development as: 

Natural development milestones and life challenges coincide with sensitive periods of neural development and enhanced plasticity.  The kinds of changes discovered in the adolescent brain show a loss of the overall number of neurons (gray matter) with an increase in the number of myelinated fibers (white matter) connecting functional neural networks.  The author says these changes represent a process of selection and reorganization of neural networks with a goal of faster and more efficient information processing.  Enhanced speed of communication among cortical areas between cortical and subcortical structures ultimately leads to increased integration of brain functions located in diverse regions of the central nervous system. 

Could it be that nature's design is to increase tolerance for risky behavior, and increase our motivation to differentiate from family and develop a sense of identity, so we are prepared to launch from family?  

The key to supporting this stage of development is:

  • Encourage the natural motivation to be exploratory in an individualized manner. 
  • Support a sense of safety in exploration without judgment.
  • Foster autonomy toward the adolescent doing their own exploration; provide a safe foundation to develop a sense of identity. 
  • Encourage an inside out vs. outside approach, by supporting self discovery and exploration of emotions. 

Emotions are essential for exploration, so encourage the integration of emotions, and healthy self-discovery.  Try to support identity formation, and allows neural connections to develop. Intense emotions are opportunities to help a child grow.  Try to coach the movement through emotions, and be cautious of the impulse to protect children from experiencing strong emotions.  The changes in the brain's reward circuitry required for new attachments during adolescence can also lead to confusion, disorientation, and depression.  These biological and behavioral shifts are connected to the impending life transitions that lie ahead. 

The specific life stage tasks for adolescence and early adulthood are:

1.       Moving away from the family of origin

2.       Establishing an identity and connection with peer groups

3.       The creation of new family. 

Adolescents set the stage for us to achieve these life stage tasks.  Our goal as parents is to help children integrate all three tasks into a complex set of attachment relationships.  Essentially it is important to model, and provide children opportunities make deep meaningful relationships with peers, teachers, coaches, and family members.    

Parent Task: is to establish balance of supportive affection and discipline as we simultaneously try to encourage teenager’s enthusiasm while reining in their impulsive brains.  

 

 Stress Response

Stress Response

The way we respond to life stress and threat is managed by a region of the brain called the Amygdala.  The Amygdala can be thought of as our first responder. It is important to note that stress response is bodily based. Meaning our bodies are activated about 5 seconds before our mind can recognize what's going on.  The key to stress response is; factors in our social environment influence the manner we respond to stress, and how is this response influencing my current ability to manage relationships, make decisions, and cope with everyday life.  

The Autonomic Nervous System is the biological systems that regulates arousal and rest.  This system is not fully formed at birth.  Therefore, stress factors in throughout development have significant impact on how we cope with stress throughout our life.   Further the manner we respond to challenges is predominately a non-cognitive function.  

The good news is; it's a malleable system, and we can forever change the way we respond to perceived threat.  Somatic experiencing therapy is a practice of therapy that provides individuals the awareness to become an observer of their threat response, and provides opportunities to change and give us a new operating system for how we respond to stress in our social environment, that leads to experimental change.  Experiential change is when an unwanted response to stress not longer presents the same level of charge.  

So much of life's restrictions are consumed in a rigid response to stress.  Somatic Experiencing therapy helps create more flexibility, allowing us to increase connection to our true self.