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What Is Happening in the Brain of Someone With Unresolved Trauma Ruth Lanius, MD, PhD - TalkBack - pg. 1

Frontiers in the

Treatment of Trauma

The Neurobiology of Trauma - What Is Happening

in the Brain of Someone With Unresolved Trauma

a TalkBack Session with

Ruth Lanius, MD, PhD; Ron Siegel, PsyD; and Ruth Buczynski, PhD


Table of Contents

(click to go to a page)

What Stood Out Most ........................................................................................... 3

How to Repair Impaired Attachment ...................................................................... 6

The Importance of Psychoeducation ...................................................................... 8

How to Use Mindfulness with Trauma.................................................................... 9

Using Epigenetics to Help Patients Heal ................................................................. 10

About the Speakers ............................................................................................... 13

with Ruth Buczynski, PhD; Joan Borysenko, PhD; and Ron Siegel, PsyD

A TalkBack Session: What Is Happening in the Brain of Someone With Unresolved Trauma


A TalkBack Session: What Is Happening in the Brain of Someone With Unresolved Trauma

with Ruth Buczynski, PhD; Joan Borysenko, PhD; and Ron Siegel, PsyD

Dr. Buczynski: Wow! I loved talking with Ruth Lanius. She was right there with the research – right there

with an explanation of how trauma so severely affects people – and yet with such hope. I loved it.

I’m now going to our TalkBack session with my good friends Joan and Ron.

They’re both licensed psychologists. Ron is assistant clinical professor of psychology at Harvard Medical

School; he is also in private practice and the author of many, many books, one of which, Backsense, he co-

authored.

Joan is from Colorado now, but we know her for all of the work she did in Boston; she was a pioneer there in

mind-body medicine and one of the first to develop a mind-body medicine clinic.

She’s the author of many, many books including Fried: Why You Burn Out and How to Revive.

What Stood Out Most

Dr. Buczynski: So, I’m eager to hear – what did you think and what struck you most in the session? Let’s start

with you, Ron.

Dr. Siegel: I thought that Dr. Lanius did a wonderful job of outlining just how adverse experiences early on in

our lives can really set the stage for a lifelong course of psychological

difficulties.

This is particularly the case if we don't have a secure base – if we’ve

had adverse experiences early on.

She puts together very nicely what those mean in terms of not having some kind of organized attachment

pattern that can make us feel that other people are safe, and through feeling that other people are safe, to

feel that living in our own bodies and minds is going to be a safe experience.

When we don't have that as a secure base and then bad or challenging things happen during the course of

“Adverse experiences early

on in our lives really set the

stage for a lifelong course of

psychological difficulties.”


our life, she shows how difficult it is to respond to them in a resilient way –

to be able to experience them but move forward and get beyond them.

She did a marvelous job of integrating in both the neurobiology – what

we’re beginning to learn about how that works – as well as the

phenomenology – in terms of how it affects our behavior, particularly how a

secure base affects our ability to care for our own kids or people that we’re interacting with, and how this

creates these chains over the generations of difficult life experience begetting difficult life experience,

begetting difficult life experience.

When we can understand this, it gives us a perspective that allows us to work with an individual who is

struggling this way. It both allows us to be compassionate toward that individual and also helps that

individual to be compassionate toward him or herself.

They can start to see that what they’re experiencing is simply the natural unfolding of being in this long

intergenerational sequence and occupying a particular place in it at this moment.

Dr. Buczynski: How about you, Joan – what stood out or struck

you in this webinar?

Dr. Borysenko: I think Ruth is a very important part of the whole

lineage of understanding how mental health affects physical

health.

Back in the eighties, APA had a monograph with so many papers – I can’t remember but, hundreds of papers

– that looked at effective mental health on physical health and still it was a hard sell. Society, in general,

didn’t get it.

Then, along came another person in this lineage – Vincent Felitti – and Robert Anda, two physicians who

developed what are called the ACE Studies – ACE stands for “adverse child experiences.”

That was very, very interesting. Felitti is a compassionate, mindful guy and he was a physician at Kaiser

Permanente in San Diego where they take good early histories of their clients – and not only of early

traumas, but histories of abuse and neglect – those kinds of specific childhood experience.

Felitti and Anda have nine categories: abuse, neglect, a parent absent from the home – all the types of abuse

“When we don’t have

a secure base, she

shows how difficult it

is to respond in a

resilient way.”

“What they’re experiencing is

simply the natural unfolding

of being in this long

intergenerational sequence

and occupying a particular

place in it at this moment.”


that you can imagine. Plus they were looking at the effect of trauma later in life.

What was fascinating about the ACE Studies was that Felitti came to understand, for example, that being

obese is not the problem – it’s the symptom of an underlying problem, which is emotional pain.

Something happens, and if you haven't learned the emotional skills to

deal with what happened, it’s only human and natural to want to

make yourself feel better. He tracked obesity back to early-childhood

experiences, at least, in some cases.

He also looked at, for example, the effect on addiction. A male with an ACE score of six out of nine or more is

almost five thousand times more likely than others to be an IV drug abuser, for example.

This is a wonderful body of studies that have been done with adverse childhood experience, and what Ruth

has done is to go all the way to their molecular underpinnings to find out: What happens?

What happens with our ability to become aware of our emotions? What happens to our ability to suss out

self-relevance in situations and to drop back and have awareness and some control over our emotional

response?

I thought her going through the pathways through which emotions become futile to us and we turn them off

was absolutely brilliant.

I just thought this was an extraordinary session, Ruth.

I also want to comment that you’re an extraordinary interviewer who really brought these ideas out so that

we could get the full scope of what Dr. Lanius was saying.

Dr. Buczynski: Thank you, Joan.

Going into memory lane, it also made me think of Robert Ader’s work – the early work that came out – the

monograph with APA. Here we’re talking about the American

Psychological Association and Robert Ader was considered the father

of psychoneuroimmunology, looking at how all of that comes

together and affects us on an immunological level – our immune

system is affected by our emotions.

“Being obese is not the

problem – it’s the symptom

of an underlying problem,

which is emotional pain.”

“A male with an ACE score

of six out of nine or more is

almost five thousand times

more likely than others to

be an IV drug abuser.”


How to Repair Impaired Attachment

Dr. Buczynski: Moving on, Ron, and going back to you – Ruth reminded us a lot about the parent/child

attachment and how key that is to both emotional awareness as well as self-regulation.

How can we help patients divert some of the damage that is caused by impaired attachment?

Dr. Siegel: There have been a number of studies, specifically developing interventions to work with folks

who have impaired attachment histories and who are in danger of creating impaired attachment histories for

their kids.

I had the privilege of teaching for many years at Cambridge Hospital with a

developmental psychologist named Karlen Lyons-Ruth, who is an attachment

researcher. She had worked with Mary Ainsworth and Mary Main and the

people who had developed these different categories of attachment which

Dr. Lanius alluded to.

There are – and I’m going to take a moment and outline what they are because it then makes more sense –

basically, different ways in which adults offer emotional regulation to kids, and particularly to little kids.

There is secure attention, which is when the child is distressed and the adult goes to comfort the child, and

the child molds right into the adult and feels comforted. It works quite nicely and easily.

But that’s only with a limited percentage of the population and it’s different in different cultures how big that

population is – but it’s never more than a modest majority.

Then there are the other strategies that come up.

There are the kids who are anxious in their attachment and who flail about and do things to try to get more

attention from the parent when the parent isn’t able to provide that kind of attention.

Or there are the avoidant kids who pull back and won’t mold in and they act as though they are not

distressed if the parent is not there –“I’m cool – I don't need anybody.”

There are the disorganized attachment kids who flit from one style to another style desperately trying to find

something that will work.

“There are different

ways in which adults

offer emotional

regulation to kids.”


Researchers found over the years – and this is striking, almost

tragically striking – is that, by giving an adult attachment interview

and asking questions of the mother, prenatally, before she has her

child, they could determine the likely attachment pattern that was

going to be seen when these kids were being brought up.

Karlen was very deeply involved in this research and said, “We can screen these people in advance. Let’s pour

in services at the very beginning, even before the baby is born, to, in essence, help the parents integrate their

past trauma and then show them how to do things that for a non-traumatized person come naturally.” For

example, “When the baby cries, try picking him/her up like this. When the baby is angry, try responding in

this way.”

They’ve followed these kids now for thirty years, so they have seen them through all sorts of developmental

stages, and they discovered that you could tell from the prenatal interview which kids were going to be in the

principal’s office by the time they were in first grade and which kids

were going to be in jail later on.

This was from prenatal interviews. But they also discovered that if you

try to teach people these skills early on, it is mitigating, and the

parents are actually able to learn how to provide these basic

resources for their kids. So some of it is systemic; some of it is programmed to do this.

The other way we do this is simply in the corrective emotional experience of the therapeutic relationship.

Whether we’re doing healthcare generally or we’re in psychotherapy, if we’re aware of the person’s

attachment style, we can begin to think about, “What was this person’s attachment experience? How are

they having difficulty allowing me to help them in their emotion regulation?”

Simply being aware of attachment style helps us to figure out how to pick up and hold our patient – I don't

mean literally now, but figuratively – in a way so that they can find it

soothing, and then they can pass that on to others.

Dr. Buczynski: Thanks for describing that work, Ron.

It made me think of the teachers who are watching this. Very often we

have educators and people in our school systems, and that might be important for them to think about as

“By giving an adult attachment

interview and asking questions

of the mother, prenatally, they

could determine the likely

attachment pattern.”

“If you teach people these

skills early on, it is

mitigating, and the parents

learn how to provide basic

resources for their kids.”

“Being aware of

attachment style helps us

to figure out how to pick

up and hold our patient.”


they’re dealing with a child who might be disruptive and interrupting their ability to get much done in the

classroom.

I was wishing we had politicians watching – no one admits to being a politician, so perhaps we do have some

– but if we could start getting ahead of things and fund that kind of work, maybe we could make a difference

later in life.

The Importance of Psychoeducation

Dr. Buczynski: Joan, Ruth talked a lot and we’ve talked a lot about different brain regions that are involved

when it comes to someone experiencing trauma. Is there a way that we could use that information to aid or

expedite the healing process?

Dr. Borysenko: I definitely think so, Ruth. I’ve been a great believer all

my career in a psychoeducational model.

Yes, you need the experiential part, but it’s amazing how people

simply brighten up when things are broken down.

Even explaining to somebody the difference between the fight or flight response and the relaxation response,

suddenly there’s a framework and they understand what they’re working toward.

With Ruth Lanius’s framework, people are beginning to understand what the prefrontal cortex does; just

seeing a diagram, they’ll say, “Oh, there’s the dorsal medial prefrontal cortex. I need to do things that

activate it more because that’s going to calm down my amygdala. I’m going to be able to activate the upper

and lower parts of my brain.”

Or they might say, “Oh, my goodness – I’m traumatized!” or “I’m a vet from the war in Afghanistan and every

time I see the color green, I panic.”

And then, they realize, “There’s nothing wrong with me – it’s just that my brain can’t pick out the difference

between what is relevant to me and what is not relevant to me. So the fact that I see green outside my

therapist’s window doesn’t mean that there is an IED in the bushes and I am about to blow up.”

When people realize – and I’m going to use the word “nutcase” here because that’s how they think of

“They realize, ‘There’s

nothing wrong with me –

it’s just that my brain can’t

pick out the difference

between what is and what

is not relevant to me.’”


themselves – that they’re not a “nutcase” and that there’s not something radically wrong with them, they

can detach themselves from the sense of self-blame.

They can recognize what needs to be done, get in alignment with the programs and practices that can help

them, and, most importantly, feel a tremendous amount of hope.

That is always so important in a psychoeducational program – that you place the meaning of the trauma in a

place of hopefulness and transformation. So, knowing the neural anatomy is just fabulous.

How to Use Mindfulness with Trauma

Dr. Buczynski: Ron, Ruth and I talked about the healing effects that mindfulness can have in the cases of

trauma and I know that is a big area of expertise for you. How do you work, in particular with people who

have experienced trauma – how do you use mindfulness?

Dr. Siegel: It’s a wonderful question and one that comes up quite a bit.

Ruth put it very nicely when she started talking about the different ways in which she uses mindfulness, and

particularly the issue of assessing whether somebody in this moment

needs more safety and more holding, which, in the trauma field, is

often called grounding – or whether they’re ready to do the work of

moving toward reintegrating or re-understanding or reconnecting with that which has been traumatic or has

been pushed out of awareness.

So, the first task is diagnostic. We sense that based on the person’s resources: What is the strength of the

therapy relationship? Are they able to feel that we’re able to hold them through what might be turbulent

waters if they get close to the traumatic memories?

What is their external situation like? Are they living in a safe environment where they don't have to worry

about getting enough to eat or not being beaten by somebody?

What is their willingness? Do they have a psychoeducational framework like Joan was talking about – a way

to understand that, “Oh, okay – I’ve blocked these things out because they were too intense and now I’m

going to begin to let them come back in and I’m doing this intentionally?”

“What is the strength of

the therapy relationship?”


When that is not in place, then there are mindfulness practices that help to develop safety, and Ruth alluded

to some of these. She talked about developing “safe places.”

I think of them as falling into two categories. One is simply to

bring our attention to the safety of the external world: to look at

a tree, to feel our feet planted on the ground, to taste an orange.

This simply means to notice that – even if we’re feeling the inner turmoil of some kind of memory that has

been very painful – the outer world is safe and we can take refuge in this present moment.

The other set which she alluded to involves conjuring up images that are comforting to us – images that are

soothing to us, such as a place we’ve been to that was safe.

This might be doing something like the mountain meditation that Jon Kabat-Zinn helped to make widely

known, in which one imagines oneself as a mountain, even as all these seasonal changes are happening.

The key for us is to differentiate which they need. Do they need more safety or are they ready to do this

reintegrating work?

Then, we have to choose methods either that make them feel safer or that

help them start to reintegrate this material.

You can use mindfulness for both; you can use mindfulness practices for

reintegrating the hard things, by simply noticing, as you come up with the memory, how it feels in the body.

What is happening now – the kinds of practices that we were discussing when reviewing Peter Levine’s talk.

Using Epigenetics to Help Patients Heal

Dr. Buczynski: Joan, you know, I found it fascinating talking with Ruth about gene expression and epigenetics,

and how that comes into play when someone has experienced trauma.

I bet you found it interesting, too, coming from your roots as a cell biologist. How can we use that to help our

patients heal?

Dr. Borysenko: This is absolutely a crucial idea, Ruth. For those listeners who may not really understand

“Even if we’re feeling the inner

turmoil – the outer world is

safe and we can take refuge in

this present moment.”

“Do they need more

safety or are they

ready to do this

reintegrating work?”


what epigenetics is: the word “epi” means “above and beyond,” and “genetics” means “the genes.”

So, epigenetics is the study of what is even above the genes, in terms of how they actually function. It turns

out that the tissue-culture medium in which our cells live contains hormones, which are put out from fear.

Every emotion has its own hormonal fingerprint, you might say, and

the beliefs that we have affect the chemistry of the blood.

The base pairs of the genes don't change, but what does change is that little groups called histone groups or

methyl groups are added, and the DNA folds differently.

When the DNA folds differently, different genes are exposed and other ones are hidden. So, not only can this

completely change the way that your body functions but obviously it affects the mind.

Then, here’s another interesting aspect. There’s a constellation of genes, for example, that have to do with

how serotonin is metabolized and can be changed epigenetically.

Now, as you know, there’s a whole study of, “Do people with poor impulse control who get angry and

murder have problems in these certain genes?” The answer is, “Yes – it does seem like there’s a correlation.”

We were talking a little bit about attachment off-air, and Ron was saying that attachment definitely is very,

very important, but it’s not the whole picture – and temperament is important, too.

What controls temperament, in part, is epigenetics, because here is the big punch line: remember going to

high school and studying Lamarckian evolution?

It was the idea where, if you cut off the tail of the mouse, will the next generation of mice come without

tails? The answer was, “No, that’s ridiculous.”

But epigenetics does follow Lamarckian inheritance. We know that stress and trauma create epigenetic

changes that can last for three to four generations.

So, now, I’ll make this personal: I always felt, but not anymore, “Why

do I personally have trouble?”

I have spent a life learning to be emotionally literate – but for many,

many years, I was really a hyper-reactor – always on edge. That’s, in part, why I got interested in this field.

“We know that stress and

trauma create epigenetic

changes that can last for

three to four generations.”

“Every emotion has its own

hormonal fingerprint.”


A relative, five years ago, sent me a picture of my own family – thirteen people, and, honest to God, I looked

at them and I burst into tears. They looked exactly like me – little

kids all the way up to a great-uncle – and they had all perished in

Auschwitz.

Then I realized, “Why did my family come here?” They came in the

late 1800s – all except for this branch of the family.

Because of pogroms, they had lived with trauma and they had lived with fear – for generation after

generation after generation.

As clinicians, this is what we often miss. We say, “Well, this person wasn’t in a concentration camp or doesn’t

have any background of trauma. Why are they behaving like a person who’s traumatized?”

If you look into their family history, probably they have the same changes that are there because of

epigenetics.

We have to be so aware culturally of people’s lineage – what they’ve been predisposed to – and this is a

neglected part of practice and it’s very good for us all to bear that in mind.

Dr. Buczynski: Thank you. That is an important point to make.

“We have to be so aware

culturally of people’s lineage

– what they’ve been

predisposed to – and this is a

neglected part of practice.”


About the speakers . . .

Joan Borysenko, PhD has been described as a

respected scientist, gifted therapist, and unabashed

mystic. Trained at Harvard Medical School, she was an

instructor in medicine until 1988.

Currently the President of Mind/Body Health

Sciences, Inc., she is an internationally known speaker

and consultant in women’s health and spirituality,

integrative medicine and the mind/body connection.

Joan also has a regular 2 to 3 page column she writes

in Prevention every month. She is the author of nine

books, including New York Times bestsellers.

Ron Siegel, PsyD is an Assistant Clinical

Professor of Psychology at Harvard Medical School,

where he has taught for over 20 years. He is a long

time student of mindfulness mediation and serves

on the Board of Directors and faculty for the

Institute for Medication and Therapy.

Dr. Siegel teachers nationally about mindfulness and

psychotherapy and mind/body treatment, while

maintaining a private practice in Lincoln, MA.

He is co-editor of Mindfulness and Psychotherapy

and co-author of Back Sense: A Revolutionary

Approach to Halting the Cycle of Chronic Back Pain.

frontiers in the treatment of trauma - amazon s3 · psychological association and robert ader was...

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