the neurobiology of touch and trauma somatic experiencing from dysregulation to coherence

Neurobiology of Touch and Trauma…

RUNNING HEADER: Neurobiology of Touch and Trauma

The Neurobiology of Touch and Trauma

Somatic Experiencing from Dysregulation to Coherence

By: Mike Changaris, Psy.D.


Abstract

Touch plays a vital role in the building of the brain, the mind, and the self.

For the first years of life, touch is one of the main modes of communication

between infants and caregivers. The limbic-touch system can be accessed to

create effective safe treatments for trauma. Touch therapies including massage

have been shown to reduce cortisol, symptoms of depression, and anxiety as well

as increase dopamine, oxytocin (social bonding hormone), serotonin, parent infant

bonding, and relational satisfaction (Field, et al., 1997; Field, et. al., 2008;

Kurosawa, Lundeberg, Agren, Lund, & Uvnas-Moberg, 1995; Walach, Guthlin, &

Konig, 2003; Field, Seligman, Scafidi, & Schanberg, 1996;). This paper discusses

the neurobiology of trauma and touch systems offering an affect regulation based

approach to conceptualizing touch treatment. The field of psychology would

benefit from providing guidelines on the use of ethical touch so that clinicians can

develop treatment modalities and receive the necessary supervision to provide

safe effective touch interventions.


The Neurobiology of Touch and Trauma

Somatic Experiencing from Dysregulation to Coherence

From the rough and tumble play of five-year-old children to a mother’s

caresses, touch plays a vital role in the building of the brain, the mind, and the

self. The well-known studies on touch deprivation of infants in orphanages point

out that touch is as vital as food for human existence (Juhan, 1998). Dean Juhan

(1998) in his book Job’s Body states the skin is an extension of the brain. A child

learns about himself through the way he makes contact with the world. Our

earliest contact is through touch. For the first years of life, touch is one of the

main modes of communication between infants and caregivers.

Touch can either be damaging — for instance, abuse — or profoundly

loving, as in the skin-on-skin contact of an infant with his care providers. When

we touch one another we send a profound cascade of chemical reactions into

motion, such as the secretion of oxytocin, a hormone responsible for social

bonding, safety, and pain reduction. Touch can be a double-edged sword in

trauma treatment. It can simultaneously be a profound trigger of threat and be a

container creating safety.

Adults who experience traumatic events display fundamental adaptations

in their neurophysiology. Bowlby (1976) describes how as a child develops there

can be moments when his development veers of course. Shore (2002) noted that

these developmental interruptions can be seen as disruptions in brain function and

structure. But the disrupted brain development can be reformed and regulation

restored in proper therapeutic environment. According to affect regulation theory,


there are means to re-establish regulation in the brain, body, and self. Touch,

being a major communicator of affect, could play a large role in providing the

experience dependent maturation processes for the growth of brain functions

missed in development. Understanding the neurobiology of touch, trauma and

dysregulation could help the clinician creat effective touch based interventions.

Key Brain Regions in Affect Regulation

Hypothalamus Pituitary Adrenal-axis (HPA-axis). The HPA-axis is a cascade

of chemical events. The HPA-axis is made up of the hypothalamus, pituitary gland, and

adrenal cortex (which sits right above the kidney’s) (Zillmer, Spiers & Culbertson, 2008).

Its main task is to mobilize a powerful energetic defense when a person is threatened and

to return to rest when the threat is gone. It has been hypothesized that either functional or

structural changes in the HPA underlie the development of PTSD. A simplified

explanation of the HPA-axis activity is as follows: when a stress is recognized, the

hypothalamus secretes corticotrophin-releasing hormone (CRH). CRH then stimulates the

production of adrenocorticotropic hormone (ACTH) in the pituitary gland. ACTH makes

its way down to the adrenal cortex, where it triggers the production of cortisol

(Blumenfeld, 2002). Cortisol mobilizes a threat response. Cortisol then triggers the

hypothalamus to stop producing CRH and thus ends the production of cortisol. In systems

theory this is called a negative feedback loop. Touch based interventions could help

restore regulation to this system.

The hypothalamus is responsible for circadian rhythms, endocrine secretion, heart

rate (HR), breath rate, thirst, hunger, thermoregulation, and maintaining homeostasis. It

also controls aspects of growth hormone production, dopamine, vasopressin in men and


oxitocyn in women (Blumenfeld, 2002). Early experiences including maternal touch

sculpt HPA-axis reactivity and the rate of stress hormone secretion over a lifetime.

Therapeutic touch has been noted to reduce cortisol reaction, increase oxytocin

production and personal satisfaction with relationships between parents as well as with

children. Increased levels of oxytocin have been associated with social engagement and

maternal behaviors. Therapeutic touch has been shown to increase sleep, reduce over-

activation in cortisol, increase dopamine levels, and lead to a reduction of aggression.

Thalamus. The thalamus is a relay station for the brain (Blumenfeld, 2002). It

receives information and sends information to the entire brain. This is the first center of

the brain where information about touch is processed. It plays a large role in level of

arousal. A damaged thalamus can result in a coma. Recent theorists have postulated that

the thalamus may be the seat of human consciousness (Zillmer, Spiers & Culbertson,

2008). The thalamus in monkeys goes through a heightened maturation process between

birth and 30 weeks after gestation. The thalamus plays a role in brain activation and could

play a role in organizing the interaction between structures that are not physically

contiguous (Zillmer, Spiers & Culbertson, 2008). Sensory information from touch

reaches the cortex through connections in the thalamus.

Hippocampus. The hippocampus is found in the medial temporal lobe (Zillmer,

Spiers & Culbertson, 2008). There have been three major theories used to conceptualize

hippocampus functioning. These three theories are that the hippocampus is involved in:

behavioral inhibition, declarative memory consolidation, and sense of place. In

individuals diagnosed with PTSD, hippocampus declines have been noted to be more

significant in the posterior hippocampus region and bilaterally (Bremner, et al., 1995).


Significant Hippocampal decline was noted for those with Dissociative Identity Disorder

(DID), one study found a 26% decline compared with controls (Vermetten, Schmahl,

Lindner, Loewenstein, Bremner, 2006). No studies were found linking hippocampal

growth with touch therapies. However, touch reduces cortisol production and high levels

of cortisol production leads to loss of hippocampal volume that can be reversed in

Cushing’s syndrome with the re-regulation of cortisol (Starkmana, Giordanib, Gebarskic,

Berentb, Schorke, & Schteingartd, 1999). Increased levels of apoptosis (program cell

death) down regulators (protection) have been associated with levels of maternal touch in

certain mammals (Weaver, Grant, & Meaney, 2002).

Amygdala. Amygdala is often known as the fear center of the brain. Although it

could be better conceptualized as a smoke detector. It notices changes, but not

specifically danger. The amygdala becomes nearly fully developed by the age of one

year. Early in life it plays a role in the infant’s indiscriminant impulsive drive to social

interaction (Joseph, 1999). Touch has been shown to have strong links to the amygdala,

the insula, and other limbic structures (Friedman, Murray, O'Neill, & Mishkin, 2004).

The amygdala is involved in classical conditioning and emotional memory (Blumenfeld,

2002). Heightened arousal triggers stable memory formation. An fMRI study found no

volumetric differences between those who meet the criteria for PTSD and those who did

not (Bremner et al., 1995). An fMRI study found function changes (e.g., more activation)

in individuals who met the criteria for PTSD in the amygdala and the insular cortex

compared to controls. Individuals with a diagnosis of DID were found to have a 19.2%

reduction in AMY volume compared to controls (Vermetten, Schmahl, Lindner,

Loewenstein, & Bremner, 2006).


Insula. The insula is a part of the limbic cortex (Zillmer, Spiers & Culbertson,

2008). The limbic cortex is the higher cortical functioning area of the limbic circuitry.

The insula has been postulated to be involved in the felt-experience of introceptive cues

from the body, viscera, appetite, and addiction (Schore, 2002 ). The insula has been

found to play a role in the integration of body sensation of the primary emotions such as

anger, sadness, happiness, and disgust (Lamm, 2010; Schore, 2002). It also plays a role in

hunger. It has connections with the amygdala and the orbital frontal cortex through

connections with the thalamus (Blumenfeld, 2002). FMRI studies have found a strong

relationship between activation of the neurons in the insula and craving. Touch in

combination with the individual’s attention has been shown to activate the insula in fMRI

studies (Friedman, Murray, O'Neill, & Mishkin, 2004). The insula registers both painful

touch and pleasant touch (Francis, et al., 1999). In a study of individuals who survived a

fire, a reduction of gray matter was found in both the right and the left insula, the left

hippocampus, and left anterior cingulate gyrus.

Cingulate gyrus. The cingulate gyrus is often referred to as the limbic cortex

(Zillmer, Spiers & Culbertson, 2008). It is the area directly above the corpus coliseum. It

develops between three to nine months (Joseph, 1999). At three to nine months of

development, the infant grows the ability to modulate social engagement through

immobility and withdrawing (noradrenalin) and active protection through fight/flight

(dopamine-excitatory system) (Schore, 2002). It is organized in to three main areas: the

anterior, medial, and the posterior region. The anterior is discussed here and is related to

autonomic homeostasis, reward anticipation; heart rate, decision-making, emotions, and

modeling the emotions of others (Blumenfeld, 2002). It plays a central role in integration


of bottom up and top down neural processes. The cingulate gyrus is involved in the

limbic touch circuit (Friedman, Murray, O'Neill, & Mishkin, 2004). It mediates both

pleasant and unpleasant (painful) touch (Rolls, O’Doherty, Kringelbach, Francis,

Bowtell, & McGlone, 2003). These areas are separate and can act independently. Current

theory of the ACC postulates that it monitors internal and external behavior, attends to

mistakes, and seeks to make the behavioral outcome more successful. Damage to the

ACC results in inability to self-monitor, behavioral impulsivity, and inattention. In some,

stimulation of the ACC relieved depression.

Orbital frontal cortex. The orbital frontal cortex (OFC) is the “emotion and

reward” area of the prefrontal cortex. This is likely the most abstract area of emotional

processing (Zillmer, Spiers & Culbertson, 2008). It is also the last to mature. It reaches

full maturity in the early twenties. It is involved in decision making and expectation.

Posterior OFC regulates sensory experiences such as touch (Blumenfeld, 2002). Anterior

regions monitor abstract categories such as status or money. The medial portions were

found to monitor and regulate positive experiences. The lateral portions regulate and

attend to noxious stimulus or punishment (Zillmer, Spiers & Culbertson, 2008). Some

studies have found the OFC plays a role in intuition or holistic processing (Schore, 2002).

The medial portion also plays a large role in self-monitoring. Damage to the OFC can

lead to hypersexuality, increased addictive behaviors, poor social skills, disinhibition, and

lack of empathy (Zillmer, Spiers & Culbertson, 2008). The OFC is one of the areas of the

brain that changes most over a lifetime. Long time mediators have more cells in the OFC

than controls. Pleasant touch increases activation in the OFC and thus likely increases the


regulation of more uncomfortable interceptive events (Friedman, Murray, O'Neill, &

Mishkin, 2004; Rolls, O’Doherty, Kringelbach, Francis, Bowtell, & McGlone, 2003).

Basal Ganglia (BG). The basal ganglia plays several key roles in the brain and

behavior. These are modulation of movement, emotional set, anticipation of movement,

eye movement, motivation, and reward (Zillmer, Spiers & Culbertson, 2008). Largely the

basal ganglion exerts an inhibitory control on other systems (Blumenfeld, 2002). If it

releases that inhibition, then the body moves. The BG contains a topographic map of the

entire brain. The organization of this map is still unclear because the basal ganglia is

likely organized in three-dimensional space, while the brain is organized in layers. The

main neurotransmitters in the basal ganglia are GABA, dopamine, and acetylcholine.

GABA is the main inhibitory transmitter in the brain. Dopamine modulates salience,

reward, motivation, and movement. Acetylcholine is a central modulator of

neuroplasticity and attention. The ventral tegmental area plays a role in the reward system

of the brain mediating motivation or the appetitive aspects of behavior. If this system is

damaged in a mouse’s brain, it will not eat food if it is beside it, but will eat it if placed

in its mouth. Overactive appetitive functions have been implicated in multiple addictions,

ranging from gambling to cocaine addition (Zillmer, Spiers & Culbertson, 2008). The BG

is also involved in force selection, planning of motor movements, initiation of motor

plans, and the extrapyramidal (modulating fine motor control) motor system

(Blumenfeld, 2002; Vaillancourta, Yua, Maykab, & Corcosa, 2007). Physical touch

increases neurotransmitter production key for basal ganglia functioning.

Septal Nucleus. Plays a role in pleasure, relaxation and rest. It has an inhibitory

effect of cortisol. It has been shown to have a role in the antidepressant effects of


progesterone through the inhibitory neurotransmitter GABA. The septal nucleus is

involved in sexuality (direct stimulation creates penile or clitoral erection). The septal

nucleus develops later than the amygdala and the cingulate gyrus at about three years of

age (Joseph, 1999). In early development, the amygdala pushes the infant toward

indiscriminant social contact. As the child develops, the septal nucleus provides

regulation for amygdalar impulses. Stressful touch to rats increased the septal nucleus

secretion of dopamine and activation of the hypothalamic circuits (Albert, & Chew,

2004). This regulatory function is lost if the septal nucleus is damaged. In rat pups, a

damaged septal nucleus leads to increased aggression and loss of maternal behaviors.

Neurobiology of Touch

There are four major classes of touch pathways to the brain (Blumenfeld,

2002). Two of these pathways are wide and myelinated, which makes them able

to deliver their signals to the brain quickly. These pathways deliver sensations of

deep pressure, light touch, joint position, muscle tension, vibration, hair

movement, and proprioception. Two of these pathways are unmyelinated, have a

narrow diameter of the axon, and deliver their messages slowly, conveying

information about pain and temperature. The pain pathways can be overridden by

the wider myelinated pathways of deep touch, vibration, proprioception, and so on

(Blumenfeld, 2002).

There are three major sensory motor tracts going from the periphery to the

brain (Blumenfeld, 2002). These are the lateral cortical spinal tract, which is

primarily a motor pathway from the brain to the body; the posterior columns,


which are a sensory pathway conveying joint position, vibration, and fine

discriminatory touch; and the anterior columns, which are also primarily a sensory

pathway conveying pain temperature and crude touch. These nerve pathways all

have a rough somatotropic organization (e.g., certain areas relate to certain body

parts).

The anterior columns also break into three major sensory tracts that each

play a critical role in pain and sense of self (Blumenfeld, 2002). The

spinoreticular track is the philogentically oldest of these pathways. It goes from

the spine to the reticular activating system. This system is a major body regulator

of level of conscious arousal. This pathway mediates the emotional arousal

aspects of pain and the motivation to stop the pain. When a person stubs her toe,

this information is read by the brain as, “ouch.” The spinothalamic tract goes from

the spine and to the thalamus. It conveys information to the brain about specific

areas of pain, sensation, and temperature. This area can localize the pain to a

given region. This area is the one that makes a person say, “I stubbed my toe!”

The third area is the spinomesencephalic tract. This tract, through communication,

is responsible for modulating and reducing the pain response mediated by

serotonin and opiates produced endogenously. When this area comes on line, one

might state, “My toe feels better.”

Once the information gets into the cortex, it moves to the primary sensory motor

strip. This area is organized somatotropically (e.g., one brain area is related to one part of

the body) (Blumenfeld, 2002). The brain typically has three areas of sensory processing.

The first receives raw sensation, the second integrates sensation with previous


experience, and the third forms higher abstract concepts related to the sensory input

(Zillmer, Spiers & Culbertson, 2008). Stimulating the primary sensory-motor strip causes

sensation or movement of a particular area. If the primary sensory motor strip is

damaged, muscles contract in a spasm. Damage to the secondary motor area leads to loss

of: a. the urge to move (basal ganglia), b. organized patterns of movement, and c.

emotional drives for movement. Damage to the secondary sensory area can lead to a.

difficulty localizing and integrating sensory input and b. losing propreaceptive input,

such that the person feels lost in space. If the tertiary area is damaged, higher order

sensory integration is lost (Zillmer, Spiers & Culbertson, 2008). It is important to note

that the human experience of sensation is an integrated one. The sensation of touch does

not happen in a vacuum. The felt experience of touch includes vision of the touch, sound,

smells and temperature. If the touch is traumatic it can include activation of the figh,

flight or freeze system. According to Somatic Experiencing theory disruptions in the

integration of sensory modalities occurs in trauma. A key region for this integration for

touch with other senses is in the superior temporal sulcus (Beauchampa, Yasara, Fryec,

& Rod, 2008).

Touch and Emotions

Touch is one of the most understudied senses, yet it can be a profound

communicator of emotion. In human relationship there is a dance of meaning driven by

the synchrony of non-verbal emotional communication. Paul Eckman, the pioneer in the

study of emotions, discovered that facial expressions of emotion were universal across

cultures, wired into the emotional systems and follow regular patterns. Recent studies


have found the same is true with touch (Hertenstein, Holmes, McCullough, & Keltner,

2009). Several studies have shown that people can identify multiple emotions through

physical touch such as anger, fear, disgust, love, gratitude, and sympathy via touch with a

high degree of accuracy. Other studies have shown that people can decode emotional

information communicated by touch by simply watching touch on a film (Hertenstein,

Holmes, McCullough, & Keltner, 2009; Keysers, Wicker, Gazzola, Anton, Fogassi &

Gallese, 2004).

Neurobiology of Dysregulation

The body and mind are full of rhythms, from the daily rhythm of sleep to waking,

to the diurnal pattern of cortisol secretion. Dysregulation occurs when the normal

coherent relationship between these patterns is disrupted in such a way that the brain or

mind has difficulty returning to its normal homeostatic range (Liberzon, Taylor, Fig, &

Koeppe, 1998). In Post-traumatic stress disorder (PTSD), there is an upregulation of the

threat system such that it triggers a dissociative shutdown, it over-produces stress

hormones, reacts too intensely to triggers, or it is triggered too easily to produce stress

hormones (Levine & Fredrick, 1998).

There are two major forms of psychological dysregulation. These are

developmental dysregulation and event-based dysregulation. Developmental

dysregulation occurs when there are either disruptions in the developmental environment

or physical systems of the brain leading to altered growth in the cortical structures,

hormones, neurotransmitters, or the relationship between structures (De Bellis et al.,

2002; Penza, Heim, & Nemeroff, 2003; Schore, 2002). If a child misses the processes


that lead to the maturation of the septal nucleus, that child could display impulsivity and

tendency to socialize indiscriminately, and the cortical structures that myelinated after the

development of the septal nucleus could display disruptions functioning as well.

Although, there has been a call for the diagnosis of developmental trauma by Bessel Van

Der Kolk and others, it is yet to be included in the DSM-V.

The second main form of dysregulation happens in a catalyzing event, through

which the brain and self undergo fundamental functional alterations. There are two major

types of dysregulation in the event based PTSD literature; over-activation and under-

activation. Over-activation reflects an upregulation of stress hormone production and an

under-activation of cortical structures, which regulate stress. In the hyperarousal/re-

experiencing type of dysregulation in an fMRI study Lanius (2008) found over activation

in the insula (bringing extreme amounts of information from the body’s interceptive

cues), an under-activation of the anterior cingulate cortex (ACC) and medial prefrontal

cortex (mPFC) (areas needed to regulate the body sensations brought up from the insula).

In essence, the hyperaroused individual floods with information from the body and has

less capacity to regulate the intense sensation. The hypoarousal/ avoidant type on the

other hand, displays flattening of physical sensations from the insula and increased

activation in the ACC and mPFC. In the hypoarousal type, only a small amount of

interceptive cues get into the limbic cortex and are quickly squelched by cortical

structures, leaving the individual feeling disconnected, emotionally flat, and dissociated.

A study assessing two tendencies found that 70% of individuals with PTSD displayed

heightened stress hormone secretion to a trauma script. This same study found that 30%

of individuals sampled had a reduction in their stress hormone secretion. The


hyperarousal reaction to trauma is related to the re-experiencing symptom cluster, while

the hypoarousal reaction is related to the numbing and avoidance cluster.

Another model of dysregulation was proposed by Dr. Porges, and called the

polyvagal theory (Porges, Doussard-Roosevelt, & Maiti, 1994; Porges, 1995). In the

traditional model of the autonomic nervous system there are two branches, sympathetic

(fight/flight reactivity) and parasympathetic (resting state). When looking at the

autonomic nervous system, Porges noted that there were two types of neurons in the

parasympathetic branch, one that is myelinated, fast-acting and evolutionarily newer

(Ventral Vagal, VVC), the other unmyeolinated, slow-acting and evolutionarily older

(dorsal motor nucleus or DMNX). He proposed that the older system, present in lizards,

leads to a defensive response called freezing. According to his theory, mammals are

dependant on their parents during childhood and need to remain at rest when safe.

According to polyvagal theory, the newer myelinated branch (VVC) of the

parasympathetic branch mediates the sense of safety in social engagement. In a stressful

event, the normal social engagement system disengages and the sympathetic system leads

to fight/flight activation, but over time the system returns to rest. In a traumatic event,

according to Porges, the social engagement system disengages, fight/flight activation

occurs, and the older parasympathetic system (DMNX) shuts down the system, inducing

tonic immobility (freeze response). According to somatic experiencing theory, if the

nervous system is given time to complete the freeze response and the mobilized defensive

response (fight/flight) the individual will not develop symptoms of PTSD (Levine, &

Frederick, 1997). If however, these factors do not complete, the high arousal continues

and the individual begins to adapt to the dysregulation by displaying symptoms of PTSD.


In SE theory, the return of social engagement behavior can indicate a re-regulation of the

nervous system. Some indications of social engagement are the inner ear tuning to the

range of the human voice, breathing becoming slow and smooth, orienting towards the

therapist, and the individual growing curious about his or her environment (Foundation

for Human Enrichment, 2007).

Touch in Therapy

Just as touch plays a profound role in the development of the child, it can play a

profound role in the regulation of the nervous system. Therapeutic touch has been shown

to decrease cortisol production, substance P (mediating pain responses), increase

dopamine, serotonin, and oxytocin production (known to mediate maternal behaviors,

attachment and partner boding) (Field, et al., 1997; Field, et. al., 2008; Field, Seligman,

Scafidi, & Schanberg, 1996; Kurosawa, Lundeberg, Agren, Lund, & Uvnas-Moberg,

1995; Walach, Guthlin, & Konig, 2003). In infants it has been shown to increase birth

weight, cortical development, length of the infant, reduce asymmetry between frontal

lobes (associated with depression), increase the ability to self-soothe, and re-regulate

cardiac vagal tone (an indication or autonomic regulation) (Ferber, Laudon, Kuint,

Weller, & Zisapel, 2002; Field, et al., 1997; Field et. al., 1998; Matthiesen, Ransjo-

Arvidson, Nissen, & Uvnas-Moberg, 2001). In parents, it has been shown to increase the

quality of their relationship, infant-parent synchrony, perception of partner support,

reduce frontal lobe asymmetry, and reduce the effects of post-partum depression (Cullen,

Field, Escalona, & Hartshorn, 2000; Field, et. al., 1996; Latifses, Estroff, Field, & Bush,


2005). Massage has been shown to reduce symptoms of depression, state anxiety, and

PTSD (Field, Seligman, Scafidi, & Schanberg, 1996; Field, et al., 1997).

Touch is as vital as food and can affect multiple neurobiological systems that are

targets of anti-depressants, anxiolytic medications. Having one positive emotion after a

stressful event or the experience of a triggering event can speed the reduction of cortisol

levels, and reduce physiological indicators of stress. Soothing, safe touch can be an

effective means to provide an experience of safety, evoke the relaxation response and for

some positive emotions (Fredrickson, Mancuso, Branigan, & Tugade, 2000).

Through the visuotactile mirroring mechanism, people model each other’s

emotions and experiences by integrating touch and vision (Ebisch, Perrucci, Ferretti, Del

Gratta, Romani, & Gallese, 2008). The touch-vision integration system includes, the

secondary somatosensory cortex bilaterally, “left inferior parietal lobule , supramarginal

gyrus, bilateral temporal-occipital junction, and left precentral gyrus. Interestingly the

sight of intentional touch correlated directly with the… left primary somatosensory

cortex (Ebisch, Perrucci, Ferretti, Del Gratta, Romani, & Gallese, 2008).” Researchers

hypothesized that the intentional touch system mediates the experience of resonating with

another and the non-intentional mediates contact with objects.

Neurobiological Model of a Touch Intervention for Trauma

Touch can be used in several ways to reduce the symptoms of trauma (Francis, et

al., 1999; Friedman, Murray, O'Neill, & Mishkin, 2004; Rolls, Bilderbeck, & McGlone,

2008; Rolls, O’Doherty, Kringelbach, Francis, Bowtell, & McGlone, 2003). These are: a.

to re-establish the regulation of the autonomic nervous system, b. to desensitize


individuals to trauma triggers, c. to increase the ability to attend to interceptive cues from

the body, d. to reduce fight/flight activation, and d. support the growth of emotion

regulation centers in the brain.

There are three main types of affect regulation. These are: a. cognitive regulation

(deciding to use an affect regulation skill), b. co-regulation (regulation through the

interaction with another person or animal), and c. auto-regulation (internalized regulation

or automatic regulation processes). When the cortical structures used in affect regulation

are stable enough to manage current levels of activation of the limbic structures there is a

natural smooth transition from arousal to rest. It is this last that is the focus of clinical

treatment. Touch can play a large role in each of these types of regulation.

Touch can be used in cognitive regulation by the clinician teaching a skill and the

client practicing the skill. A skill might be to use self-touch to reduce activation. The

client might evoke the orienting response and parasympathetic rest through placing his

hand on his heart and noticing the sensations. Other tools could be to stand in a warm

shower and notice the comfort, massaging one’s feet, pressing feet into the ground, or

placing the hands over the eyes. In this type of regulation individuals choose to use a

conscious skill to move their sub-cortical systems.

Co-regulation falls into two categories. The first is regulation through indirect

mirroring, such as from mirror neuron system or the ACC’s modeling of the emotions of

others and second is the regulation provided through direct therapeutic intervention.

Touch can play a role in both. When the clinician’s ability to read emotions through

touch is good and her body can respond supplely to her client’s emotions, physical

contact can be an excellent way of mirroring or providing attunement. When the client’s


activation goes up, the contact with the therapist can provide a regulatory boundary

helping the stress levels to reduce to within the client’s ability to tolerate the activation.

Through the process of contained activation, the cortical structures responsible for

emotion regulation grow (Schore, 2008). As the client’s mind replays emotional ruptures

from the past, touch can provide an experiential repair and a restructuring of the event.

Touch has been shown to reduce cortisol levels, increase activation in pleasure centers of

the insula, and increase activation in the orbital medial prefrontal cortex (Friedman,

Murray, O'Neill, & Mishkin, 2004; Rolls, O’Doherty, Kringelbach, Francis, Bowtell, &

McGlone, 2003).

Auto-regulation is the current innate capacity of an individual to regulate his

levels of limbic and autonomic activation (Schore, 2002). Through the internalization of

the therapist as a safe mentalized regulator of affect by changing the ACC and its ability

to model and play back emotional events, the client builds new regulatory possibilities.

The interaction patterns between a therapist providing safe, contained model of self-

regulation and the client reduces for the client the number of conflicts their ACC needs to

monitors through its conflict monitoring function and the number of number of emotional

exchanges with a successful outcomes. Neurons that fire together wire together. As the

therapist coaxes the client’s orbital frontal cortex online through safe touch and emotional

mirroring through touch, these areas likely are strengthened. The safe contact with the

therapist could allow for increased ability of the client to tolerate his interceptive

responses to events and thus allows him to be available to a wider range affect with out

dysregulating and be an active participant in a wider range of life experiences. As a new-

felt experience of contact with one’s physical form and physical contact with a self–


regulating other is internalized, the individual has the ability to auto-regulate through

touch.

Conclusion

Touch is as vital as food, not simply to children but also adults (Juhan, 1998).

Touch has been shown to be an excellent communicator of emotions, lead to improved

parenting relationships, reduce cortisol production, physical pain, symptoms of

depression, PTSD and anxiety (Field, et al., 1997; Francis, et al., 1999; Friedman,

Murray, O'Neill, & Mishkin, 2004; Rolls, Bilderbeck, & McGlone, 2008; Rolls,

O’Doherty, Kringelbach, Francis, Bowtell, & McGlone, 2003). Touch can be an effective

intervention in clinical practice that leads to profound changes not simply in

psychological processing, but the physical structures of the brain. The field of psychology

would benefit from providing guidelines on the use of ethical touch so that clinicians can

develop treatment modalities and receive the necessary supervision to provide safe

effective touch interventions.


References

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