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The Road Back from Trauma

Jesse Hanson MA, PhD, RPClinical Director, Helix Healthcare Group

Overview

S Part 1: Redefining Trauma through neuroscience and Objects-Relations Theory

S Part 2: Trauma and the Brain-Body: Understanding Disassociation

S Part 3: Treatment of Trauma: Stabilization, Reprocessing and Integration

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Objectives – Part 1

• Redefining Trauma• Window of Tolerance• Exploring Trauma through the lens of

Neuroscience, Object-Relations, Interpersonal Psychoneurobiology

What you might think trauma looks like – The Big-T

What trauma can also look like – The Little-T

S Little-T trauma or development trauma is just as damaging as big trauma, especially as it is repeated over years of time; we become conditioned to it.

Attachment Trauma Versus Acute Trauma

S Attachment trauma (Developmental Trauma) is trauma that is created through relationships. It is “small t” trauma. This trauma does not have to be overt; it can be negative verbal messages that were shared, or alternatively the absence of positive messages throughout childhood development. It is mentally/emotionally based

S Acute Trauma (physical trauma) is “Big T” trauma. Acute trauma is created through physical or sexual violence or physical accidents and non abuse related injuries or experiences

Trauma is a Phenomenon

Trauma is a phenomenon that occurs in relation to a person’s

window of tolerance; the same event that one

person can cope with, could create trauma and

PTSD in another

Trauma is not a noun

Trauma is a “verb”

Window of Tolerance

Hyper-arousal

Hypo-arousal

-- Martin (2015)

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The Lens of NeuroscienceTrauma greatly effects how the neural pathways in the brain are created and regulated

Research shows the vast way that our neural communication is affected once trauma has occurred

Most human behavior is driven by procedural memory – memory for process and function – and is reflected in habitual, automatic responses and well-learned action patterns: movements, postures, gestures, autonomic arousal patterns, and emotional and cognitive tendencies. --Ogden (2006)

This research is showing us that it is our relationship to what happened that influences our outcome, not the event itself.

(1) chronic post-traumatic stress disorder patients have gray matter structural damage in the prefrontal lobe, occipital lobe, and parietal lobe, (2) after post-traumatic stress is reprocessed, the disorder symptoms are improved and gray matter structural damage is reduced --Weihui Li (2013)

The Lens of Object-relations

S Trauma that is created through early childhood relationships will factor into how a person’s character structure is created

S Trauma creates a break down in how the mind-body functions, which can lead to symptoms such as addiction and disease

S Trauma will often have emotional associations that are stored in the body

Understanding Attachment Trauma

What’s Your Reaction?

Because most traumas (both attachment and acute) occur in relationships, it is a healthy and safe relationship that can assist in healing the symptoms of trauma and PTSD. The safety of the relational container is of vital importance.

The Lens of Interpersonal Psychoneurobiology

S Trauma creates separate parts that are not time-oriented-parts of self.

S The parts that are not time-oriented “live” in the right brain

S Through the lens of interpersonal psychoneurobiology we begin to see the benefits of re-integration

Dan Siegel, MD

An “interpersonal neurobiology” of human development enables us to understand that the structure and function of the mind and brain are shaped by experiences, especially those involving emotional relationships -- Siegel (1999)

Through the linkage of differentiated components of a system, integration is viewed as the core mechanism in the cultivation of well-being. In an individual’s mind, integration involves the linkage of separate aspects of mental processes to each other, such as thought with feeling, bodily sensation with logic. In a relationship, integration entails each person’s being respected for his or her autonomy and differentiated self while at the same time being linked to others in empathic communication. -- Siegel (1999)

Interpersonal Psychoneurobiology In Action

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Objective – Part 2• Deepening our Understanding of how Trauma is Stored• Right Versus Left Brain• Structural Dissociation• Trauma and the Body

Trauma and the Brain

S Traumatic experiences overwhelm a person integrative capacities

S The person is flooded by somatosensory information that cannot be fully processed and integrated

S This results in a split, the apparently normal part that is in time, resides in the left brain and helps “normalize” the event

S The unhealed, hurt or emotional part(s) becomes stuck in“trauma- time” and are stored in the right brain

The Healthy System

S We all have two action systems: The Daily Living Action System and the Defensive Action System

S Daily Living Action System deals with all mental and behavioral actions dealing with daily life

S Defensive Action Systems come into play when the individual perceives danger and activates defensive instincts (limbic brain)

S These systems work together to assimilate, process and integrate experiences as they occur in our daily life.

S Trauma occurs when an event can’t be fully processed. The defensive system has to hold onto and store the traumatic event so daily living can appear normal in day to day life. If integration still does not happen once the system can rest then the two systems are no longer working in harmony.

Daily Living

Defensive

-- Martin (2015)

This breakdown of communication between these systems stops them from being able to fully communicate and ends in dissociation

across the personality

Structural Dissociation

S Once a trauma has led to ongoing dissociation there will be the apparently normal part (ANP) and a second (rather limited and rudimentary) emotional part (EP)

S PRIMARY S Simple PTSDS Simple Dissociative Disorders (DSM-IV, ICD-10)

S SECONDARYS Chronic, complex PTSDS Bi-Polar, Borderline Personality, DDNOS

S TERTIARYS DID

-- Van der Hart, O., Nijenhuis, E., & Solomon, R. (2010)

The ANP and the EP’s

S Once the breakdown of the Daily Action and Defensive Systems becomes too great, due to the unprocessed material stored in the defensive system, we see two new systems that are phobic to one another appear.

S The apparently Normal Part of the Personality (ANP) is the part that shows up in daily life and try’s to keep the appearance of normalcy. It will try to avoid the trauma through different numbing and coping skills but is still plagued by information from the defensive system

S The Emotional Part of the Personality (EP) encodes and stores the trauma. It relives the trauma; it is not time-oriented; lives in ‘trauma time.’

S Both of these parts contribute to the dissociation

ApparentlyNormal

Part of thePersonality

Emotional Part of the Personality

-- Martin (2015)

These parts become Phobic of each other and can no longer communicate

A look into Structural Dissociation -- Kathleen (2015)

EP: submit

ANP 2

ANP 1EP: fight

EP: flight

EP: child attachment cry

EP: 5 yr old

EP: Freeze

Trauma and the Body

S Disease is often the body's way of saying "no" to what the mind cannot or will not acknowledge -- Gabor Maté (2003)

S The body holds and stores the trauma that the EP’s are holding which eventually can lead to disease, illness and chronic pain

S Once trauma is fully processed the body experiences a freedom of energy and movement

Case Study

Creator and star of Bipolarized Ross McKenzie

Healing from bipolar disorder – One man rethinks his mental illness

https://youtu.be/Z7lXVAunXJg

Personal Exercise

Being curious about our own past experiences

On a scale of 1-10, where 1 equals little to no disturbance; and a 10 equals extreme disturbance (going to pull my hair out, or can’t breath); Choose a past experience from your life that registers at about a 2 or 3 (either an acute or developmental trauma)

Discuss with a partner. Practice integrating the new awareness and language as you discuss the traumatic event

Your partner will offer reflections about how this impacts them.

This is not a therapy session, just a chance to learn through sharing and offering compassion.

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Objectives - Part 3• Stabilizing• Importance of Mindfulness• Treating Trauma: Phase 1, phase 2 and phase 3• How not to grow the phobia

Stabilizing• Stabilization is the first

priority.• A client must have the

capacity to sustain calm and relaxation.

• The system that is stuck in Hyper-vigilance has a lower capacity to deal with stress and can’t process new situations, which leads to higher probability of creating new trauma.

• Stabilization requires mindfulness to help integrate mind and body in present moment experiences.

Importance of Mindfulness

S In every day lifeS Significant reduction in psychological and physiological responses

to daily hassles -- Williams (2001)

S Greater capacity for self regulation of emotional and dispositional states correlating with improvements in affective experience and declines in mood disturbances -- Brown (2003)

S In times of crisisS Significant improvement in ability to cope with traumatic life

events, including reductions in anxiety, depression and PTSD symptoms -- Kvillemo (2011)

Navigating Trauma

Phase 1

S Stabilization: Reducing the ANP’s phobia to the EPs and the traumatic material by increasing the ANP’s ability to deactivate arousal in the defensive system

S Affect tolerance and regulation skills

-increasing the positive affect tolerance of calm in particular

• Decrease phobias to internal experience

• Decrease phobias to emotional parts

• Develop co-consciousness and compassion by the ANP toward the EPs

• ANP’s development of skills to deactivate EP arousal

• Time orientation skills and other stabilization skills

ANP’s exposure to the traumatic material in this phase is not effective because it grows the ANP’s phobia.

-- Martin (2015)

• Develop internal communication between the ANP and EPs and among the EPs

• Help all parts to understand that their “jobs” were created by their “one brain” to manage the overwhelming events in times of danger. This helps to create the necessary compassion to reduce the phobias among the parts

Phase 2Reprocessing the traumatic material: carefully titratingmemory-reprocessing work with stabilization skills helps prevent re-traumatization and/or re-dissociation

Understanding the CORE organizers

1. Cognitive

2. Emotional

3. Movement

4. 5 Senses

5. Inner-body sensations

-- Ogden (2006)

Modalities for Phase 2

• EMDR

• Sensorimotor Psychotherapy

• Relational Somatic Psychotherapy

• Equine Assisted Therapy

• Dance/Movement Therapy

Phase 3Enhancing Daily Living: Integration of the personality, overcoming phobia of intimate attachment, and learning to live life without dissociation

Growing the Trauma

S No integration can occur when the emotional part or part that is holding the trauma is outside the window of tolerance

S Reliving is outside the window of tolerance. Reliving implies re-dissociation/re-traumatization

S Phobia grows if it is activated without integration

S As Phobia’s grow client has less ability to de-activate (to calm and time orient)

S Avoidant/Addictive behaviors increase

Treating the Phobia

S Stabilization: increasing the person’s level of functioning and window of tolerance

S As the persons level of functioning and tolerance increases, he or she will feel more in control of the internal experience

S Therefore, reducing the ANP’s phobia reverses the post traumatic decline and decreases/eliminates negative symptoms of trauma

Self-Awareness as a Professional

We can only take our clients down the path as far as we have traveled on our own.

If we truly want to help our clients heal from their traumas, we have to examine and reprocess our own.

The Outcome• Individuals who process

trauma to conclusion can begin to experience daily life freer, healthier and with greater success

• Addictions can be let go of with no substitute addiction to pop up in place of current addiction

• Individuals “earn” more influence to make higher quality choices that help them create a higher quality of life.

• Earning the ability to Respond rather than React

416.921.2273 (CARE)www.helixhealthcaregroup.com

References

S Dr. Dan Siegel. Interpersonal neurobiology. The Developing Mind, 1999; The Norton Series on Interpersonal Neurobiology.

S Gabor Mate MD. When the Body Says No, The costs of hidden stress: 2003;S Pat Ogden. (2006) Trauma and the BodyS Department of Child and Adolescent Psychiatry, The National Hospital, Psychiatry. Dissociation in children

and adolescents as reaction to trauma--an overview of conceptual issues and neurobiological factors. Nord J Psychiatry2005;59(2):79-91.

S Weihui Li. Xiangya Hospital, Central South University, China (2013) Neural Regeneration Research; 8(26):2405-2414.

S Kirk Warren Brown, Richard M Ryan (2003) The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, Vol. 84, No. 4, Apr 2003, 822-848

S Pia Kvillemo, et al. (2011) A Randomized Study of the Ef fects of Mindfulness Training on Psychological Well-being and Symptoms of Stress in Patients Treated for Cancer at 6-month Follow-up. International Journal of Behavioral Medicine: December 2012, Vol. 19, No. 4, pp. 535-542

S Kimberly A. Williams, Maria M. Kolar, Bill E. Reger, and John C. Pearson (2001) Evaluation of a Wellness-based Mindfulness Stress Reduction Intervention: A Controlled Trial. American Journal of Health Promotion: July/August 2001, Vol. 15, No. 6, pp. 422-432

S Kathleen Martin, LCSW. (2015) Treating Complex Trauma with EMDR and Structural Dissociation Theory; A Practical Approach; slides 34, 39, 42, 48

S Van der Hart, O., Nijenhuis, E., & Solomon, R. (2010) Dissociation of the personality in Complex Trauma-Related Disorders and EMDR: Theoretical Considerations. Journal of EMDR Practice and Research. 4(2), 76-92