According to Peter Levine, “Trauma is perhaps the most avoided, ignored, belittled,
denied, misunderstood, and untreated cause of human suffering. Although it is the source
of tremendous distress and dysfunction, it is not an ailment or a disease, but the
byproduct of an instinctively instigated, altered state of consciousness. We enter this
altered state – let us call it “survival mode” – when we perceive that out lives are being
threatened. If we are overwhelmed by the threat and are unable to successfully defend
ourselves, we can become stuck in survival mode. This highly aroused state is designed
solely to enable short-term defensive actions; but left untreated over time, it begins to
form the symptoms of trauma. These symptoms can invade every aspect of our live.
Trauma is a basic rupture- loss of connection – to ourselves, our families, and the world.
The loss, although enormous, is difficult to appreciate because it happens gradually. We
adjust to these slight changes, sometimes without taking notice of them at all. Contrary to
the view of psychiatric medicine- that trauma is basically untreatable and only marginally
controllable by drugs, - when treated thoroughly healing can lead not only to symptom
reduction, but long-term transformation.” (Levine, 1999)
Simple post-traumatic stress disorder (PTSD) develops after a terrifying ordeal that
involved physical harm or the threat of physical harm. The person who develops PTSD
may have been the one who was harmed, the harm may have happened to a loved one, or
the person may have witnessed a harmful event that happened to loved ones or strangers.
PTSD was first brought to public attention in relation to war veterans, but it can result
from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or
held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural
disasters such as floods or earthquakes. People with PTSD may startle easily, become
emotionally numb (especially in relation to people with whom they used to be close), lose
interest in things they used to enjoy, have trouble feeling affectionate, be irritable,
become more aggressive, or even become violent. They avoid situations that remind
them of the original incident, and anniversaries of the incident are often very difficult.
PTSD symptoms seem to be worse if the event that triggered them was deliberately
initiated by another person, as in a mugging or a kidnapping. Most people with PTSD
repeatedly relive the trauma in their thoughts during the day and in nightmares when they
sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or
feelings, and are often triggered by ordinary occurrences, such as a door slamming or a
car backfiring on the street.
- A person having a flashback may lose touch with reality and believe that the traumatic
incident is happening all over again. Not every traumatized person develops full-blown
or even minor
PTSD.
- A person having a flashback may lose touch with reality and believe that the
traumatic incident is happening all over again. Not every traumatized person
develops full-blown or even minor
PTSD.
- Symptoms usually begin within 3 months of the incident but occasionally emerge
years afterward.
- They must last more than a month
to be considered PTSD.
- The course of the illness varies. Some people recover within 6 months, while others
have symptoms that last
much longer.
- In some people, the condition becomes chronic.
Chronic PTSD vs. Complex PTSD
According to Judith Hermann, “Even the diagnosis of “post-traumatic stress disorder,” as
it is presently defined, does not fit. The existing diagnostic criteria for this disorder are
derived mainly from survivors of circumscribed traumatic events. They are based on the
prototypes of combat, disaster, and rape….In survivors of prolonged, repeated trauma,
the symptom picture is often far more complex. Survivors of prolonged abuse develop
characteristic personality changes, including deformations of relatedness and identity.
Survivors of abuse in childhood develop similar problems with relationships and identity;
in addition, they are particularly vulnerable to repeated harm, both self-inflicted and at
the hands of others. The current formulation of post-traumatic stress disorder fails to
capture either the protean symptomatic manifestations of prolonged, repeated trauma or
the profound deformations of personality that occur in captivity. The syndrome that
follows upon prolonged repeated trauma needs its own name. I propose to call it
“complex post-traumatic stress disorder. The responses to trauma are best understood as a
spectrum of conditions rather than as a single disorder. They range from a brief stress
reaction that gets better by itself and never qualifies for a diagnosis, to classic or simple
post-traumatic stress disorder, to the complex syndrome of prolonged, repeated trauma.
As the concept of a complex traumatic syndrome has gained wider recognition, it has
been given several additional names. The working group for the diagnostic manual of the
American Psychiatric Association has chosen the designation Disorder of Extreme Stress
not Otherwise Specified
Diagnostic Criteria for Complex Post-Traumatic Stress Disorder
A history of subjection to totalitarian control over a prolonged period (months to years).
Examples include hostages, prisoners of war, concentration-camp survivors,
and survivors of some religious cults. Examples also include those subjected to
totalitarian systems in sexual and domestic life, including survivors of domestic
battering, childhood physical or sexual abuse, and organized sexual exploitation
Alterations in consciousness, including:
· Amnesia or hypermnesia for traumatic events
· Transient dissociative episodes
· Depersonalization/derealization
· Reliving experiences, either in the form of intrusive post-traumatic stress disorder
symptoms or in the form of ruminative preoccupation
Alterations in self-perception, including:
· Sense of helplessness or paralysis of initiative
· Shame, guilt, and self-blame
· Sense of defilement or stigma
· Sense of complete difference from others (may include sense of specialness, utter
aloneness, belief no other person can understand, or non-human identity)
Alterations in perception of perpetrator, including:
· Preoccupation with relationship with perpetrator
(includes preoccupation with revenge)
· Unrealistic attribution of total power to perpetrator
(victim’s assessment of power realities may be more realistic than clinician’s)
· Idealization or paradoxical gratitude
· Sense of special or supernatural relationship
· Acceptance of belief system or rationalizations of perpetrator
Alterations in relations with others, including:
· Isolation and withdrawal
· Disruption in intimate relationships
· Repeated search for rescuer (may alternate with isolation and withdrawal)
· Persistent distrust
· Repeated failures of self-protection
Alterations in systems of meaning:
· Loss of sustaining faith
· Sense of hopelessness and despair
Naming the syndrome of complex post-traumatic stress disorder represents an essential
step toward granting those who have endured prolonged exploitation a measure of the
recognition they deserve. It is an attempt to find a language that is at once faithful to the
traditions of accurate psychological observation and to the moral demands of traumatized
people. It is an attempt to learn from survivors, who understand, more profoundly than
any investigator, the effects of captivity.” (Judith Herman Trauma and Recovery, 1992)
View Conversations with History: Judith Herman
Dr. Judith Lewis Herman, professor of Clinical Psychiatry at Harvard University Medical
School, and a pioneer in the study of post-traumatic stress disorder and the sexual abuse
of women and children, joins UC Berkeley's Harry Kreisler on this edition of
Conversations with History
In his work, Healing Trauma, Levine writes, "Human responses to threat are primarily
instinctive and biological, and secondarily psychological and cognitive. They comprise
three innate action plans: fight, flight, and freeze-common to all mammals. When we
sense threat, our bodies and minds enter the first stage of what is called the ‘arousal
cycle’. Our muscles tense, and we begin to search for the source of possible danger. If
we locate this source and perceive it to be a real threat, then we enter the second stage.
Mobilized, our bodies and minds begin to produce adrenaline and cortisol, the two
primary chemicals that energize us to fight or flee. In the third stage, we discharge this
energy by completing the appropriate defensive actions (namely, fighting or fleeing).
The fourth and final stage ensues when the nervous system, no longer aroused, returns
to a state of equilibrium. If are overwhelmed by a threat and are unable to fight or flee,
we instinctively employ the third action plan, the "freezing response”. This defensive
maneuver serves two purposes:
· It may fool the attacker into losing interest, allowing us a chance to escape.
· We will not suffer any pain if we are injured or killed while in this state, because in
immobility, consciousness seems to leave the body (dissociation)
Here’s the Problem:
Even though we are immobilized, our nervous system is still highly aroused. Since we
have been unable to discharge any of the fight-or-flight energy that our body has
mobilized, we are left us in a state like that of a car whose accelerator and brakes are
being floored at the same time. It is impossible to complete the arousal cycle if one can't
move! Animals who survive an attack by using the freezing response simply allow for the
biological discharge of excess energy and completion of the arousal cycle.
•They shake
•They rattle
•They roll around
•They tremble
Instinctively, animals tremble in a way that restores spontaneous breathing and allows the
nervous system to regain its balance.
You’ve seen dogs shake and heard the coach say “shake it off”, right? Unfortunately, we
humans have a much harder time actually “shaking it off.”
This for difficult for human beings because 1.) The intensity of survival energy frightens
us, and 2.) We are not comfortable giving in to involuntary (unconscious) sensations.
Unfortunately, our rational brains often override this physiological completion process.
When this happens, the nervous system remains in a state of arousal. Even if the threat is
gone, the brain and body continue responding- spewing out the fight-or-flight chemicals.
Clusters of Trauma Symptoms in Chronological Order (more or less)
· Hypervigilance
· Extreme sensitivity to light and sound
· Restlessness, agitation
· Heightened startle reactions
· Insomnia
· Increased Physiological Arousal, i.e. increased heart rate, difficulty breathing, cold
sweats, tingling, increased muscular tension
· Intrusive imagery or flashbacks
· Nightmares and night terrors
· Affect dysregulation: abrupt mood swings
· Reduced ability to deal with stress
· Racing thoughts and worry
Followed by…
· Panic attacks
· Agitation
· Anxiety
· Avoiding certain circumstances that remind us of previous traumas
· Exaggerated or diminished sexual activity
· Abrupt mood swings
· Dissociation
· Frequent anger or crying
· Attraction to dangerous situations
· Amnesia
· Fear of dying or having a shortened life
· Feelings of helplessness
· Avoidance of loved ones
· Isolation
And Finally…
· Chronic fatigue, very low physical energy
· Immune system and certain endocrine problems
· Thyroid dysfunction
· Psychosomatic Illnesses
· Headaches
· Neck and back problems
· Asthma
· Irritable bowel syndrome
· Spastic colon
· Severe PMS
· Eating disorders
· Excessive shyness
· Blunted emotional responses
· Depression
· Feelings of impending doom (waiting for the other shoe to drop)
· Inability to make commitments
· Disconnection from others (feeling different, not like other people)
· Feelings of detachment and alienation
· Spiritual disconnection
“Failure to approach trauma related material gradually is likely to lead to intensification
of posttraumatic symptomatology, leading to increased somatic, visual or behavioral re-
experiences. Once the traumatic experiences have been located in time and place, a
person can start making distinctions between current life stresses and past trauma, and
decrease the impact of the trauma on present experience. Talking about the trauma is not
enough: trauma survivors need to take some action that symbolizes triumph over
helplessness and despair.” (van der Kolk, van der Hart, Burbridge, 1995)
Why Trauma Treatment is
Tricky?
nTalk therapy is inadequate (but, we’re so good at it)
nClinicians are not accustomed to paying attention to the client’s body-where the trauma
is stored-because we want “the story”.
nWhen our clients remember the trauma, their arousal levels go up.
nWhen arousal levels go up, the hippocampus goes off-line, leaving the client with NO
executive functioning ability, therefore no more information can be processed.
nThe client is left un-resourced, i.e. (s)he has the very same resources available to
him/her at the time of the original trauma, which were obviously inadequate, as the client
was psychologically overwhelmed, as evidenced by the fact that (s)he is now in your
office, presenting with PTSD symptoms.
Long Term Goals from The Complete Adult Psychotherapy Treatment Planner
1. Reduce the negative impact that the traumatic event has had on many aspects of life
and return to pre-trauma level of functioning.
2. Develop and implement effective coping skills to carry out normal responsibilities and
participate constructively in relationships.
3. Recall the traumatic event without becoming overwhelmed with negative emotions.
4.Terminate the destructive behaviors that serve to maintain escape and denial while
implementing behaviors that promote healing, acceptance of the past events, and
responsible living.
Ok. How do we do that?
"One of the first things you need to ask is, ‘how did you survive this? This is amazing
that you’re still here. It’s amazing that you still have the guts to go on with your life.
What is allowing you to function? What are you good at? What gives you comfort?’"
- Arousal Reduction
- Affect Regulation
- Self Soothing
(based on Traditional Chinese Medicine and Michael Gach’s Acupressure for Emotional Healing)
Press CV 17
When fearful memories surface, you
may feel overwhelmed or in like you
are in danger. Anxiety and panic can paralyze breathing or trigger
hyperventilation. If this occurs, press the Sea of Tranquility point, which
is located four finger-widths above the base of the breastbone, at the level
of the heart. Press into the indentations with your middle three finders,
breathing deeply through the nose. Try to relax as you focus on taking
slow, deep breaths, through the nose, for two minutes. Breathing slowly
and deeply through the nose counteracts hyperventilation. Acupressure on this emotional
balancing point can open the chest, enhance respiration, and calm a panic or anxiety attack.
Rub St 36
Make two fists. Place your right fist on the outside of your right leg.
Place your left fist on the outside of your left leg. Briskly rub your fist
up and down beside the shinbone for one minute, breathing deeply
into the lower abdomen. Focus on deep exhalations to discharge
emotional residue. This acupressure technique helps counteract
post-trauma dizziness, anxiety, and dissociation.
Letting Go (Lu 1)
These two emotional healing points are located on the outer
sides of the chest, four finger-widths up from the armpit
crease and one finger-width inward. To activate these points,
cross your arms over the chest center. Place your fingertips
firmly on both sides of your outer chest. Breathe deeply and
hold these points for up to two minutes. Activation of these
healing points helps relieve difficult breathing, trauma, stress,
fatigue, confusion, emotional repression, choking, and asthma.
Gates of Consciousness (GB 20)
These two points are located
about three inches apart. Place
the thumbs just below the base of
the skull, in the hollow between
the two large neck muscles.
With your thumbs, press underneath the base of the skull into the indentations on both sides.
Close your eyes and slowly tilt your head back. Visualize this mental balancing point relieving
your panic and anxiety as you gently press up underneath your skull for one to two minutes.
Take slow, deep breaths. These points help relieve headaches, neck stiffness and pain, trauma,
shock hypertension, and irritability.
Wind Mansion (GV 16)
This point is located at the base of the skull, in the large
center hollow. To activate this point, place your two middle
fingers on the center point. Close your eyes and slowly tilt
your head back. Breathe deeply and press firmly into the
hollow area for one minute. Activation of this point helps
with headaches, pain, insomnia, shock, trauma, stiff neck,
head congestion, and mental stress.
Third Eye (GV 24.5)
This point is between the eyebrows, in the indentation between
the nose bridge and the forehead. To activate this point,
sit up with a straight back. Close your eyes and tilt your chin
down slightly. Bring your palms together and up to your forehead.
Lightly touch the Third Eye point with the tips of your middle and
index fingers. Breathe slowly and deeply for one minute as you
visualize yourself in a calm, safe, restful place where you can
take steps to heal your trauma. Activating this point relieves pain,headaches, dizziness,
emotional instability, irritability, and confusion.
Clear Mind (GB 14)
These emotional balancing points are located one finger-
width above the eyebrows, in line with the center
of the iris. Place the thumb above one eye and the
third finger above the other eye. This will give gentle
stimulation to GB 14 on both sides. These two points require the lightest possible touch.
Stimulating these points relieves pain, shock, and trauma, while clearing the mind
Inner Gate (P6)
This point is three finger-widths away from the center of the crease inside the wrist.
Place the right thumb on the point on the left arm. Wrap your fingertips around the
outside of the arm and place them directly behind your thumb. Firmly grasp the arm for
one minute. Breathe deeply. Switch wrists and hold for another minute. This point can
relieve nervousness, shock, trauma, nausea, insomnia, palpitations, and wrist pain.
Activating this point also calms emotional upset and balances the inner world.
Outer Gate (TW 5)
This point is three finger-widths
away from the outer wrist crease, between
the two forearm bones. To activate, place
the middle three fingertips on this point and
place the thumb on P6. Firmly grasp both
points for one minute. Breathe deeply.
Switch wrists and hold for another minute.
Sea of Tranquility (CV 17)
This point is on the center of the breastbone, four finger-widths
up from the base of the sternum. Gently press this point with the
middle three fingertips. At the same time, concentrate as you
take deep, slow breaths into your heart for three minutes. This is
an emotional balancing point, which opens the chest for deep
breathing, activates the thymus gland, and is very effective anxiety remedy.
Center of the Person (GV 26)
This point is in the middle of the upper lip, two-thirds of the way
up towards the nose. To activate, use your index or middle
fingertip to press firmly on GV 26. Place your finger so that you
angle some pressure into the upper gum. Breathe deeply and
hold for two minutes. This point reduces emotional shock,
restores consciousness, calms the spirit and improves memory and concentration.
It also relieves dizziness, nosebleeds, muscle cramps, and pain.
The Neurovascular Hold
The response to stress is primarily physical, and secondarily psychological. We all
experience the feedback loop at one time or another. The stress of daily life causes the
primitive brain centers to go into survival mode. When this happens, up to 80 percent of
the blood may leave the more evolved forebrain; stress chemicals flood the bloodstream;
primitive emotions engulf the body; perceptions are distorted and the capacity to respond
creatively or even appropriately is completely compromised. Just understanding the
dynamics of this reaction should produce some compassion for self and others.
Seems we need some modern tools to cope with this primitive system. The Neurovascular
Hold is that tool. Unlike the EFT Basic Recipe-where tapping sends signals to the
amygdala, interrupting the stress response- the Neurovascular Hold works directly with
the blood flow to the brain.
Neurovascular points are specific spots on the head that activate blood flow. Thinking
about a particular stressor while touching the neurovascular points seems to suspend the
stress reaction by preventing the blood from leaving the forebrain. By interrupting a key
component of the fight-or-flight response, the Neurovascular Hold allows us to think
more clearly and cope more effectively with stress.
How to:First, sit or lie down and then focus on a stress you already feel or on a stressful
thought, memory, or situation. Next, place the palm of one hand on your forehead and
the palm of the other hand on the back of your head. Hold softly for up to three minutes,
breathing deeply. On the inhalation, raise your head up. On the exhalation tuck your chin
to your chest.
The Theory
According to the principles of energy medicine, a “skeleton” of energy supports the
physical flesh and bones. The body’s physical structure is built upon and animated by the
energy body’s structure of meridian pathways, chakra centers, aura and other discrete
energy systems. The energy structure is not just one big electromagnetic field. The
variety of components in the energy “skeleton” mirrors the complexity of the physical
body.
Anatomy of the Energy Body:The Meridians and Acupuncture Points
The anatomical descriptions
of the energy body are supported by electromagnetic measurements.
They also correlate with
descriptions of energy structures found throughout the world. Each
culture has its own
understanding and concepts related to the energy body.
A meridian carries energy in
the same way that an artery transports blood.
The meridian system
functions as the body’s
energy bloodstream. It brings vitality
and balance, removes blockages,
adjusts metabolism, and
determines the speed and form of cellular change. The meridian
pathway’s energy flow is as
critical to the body as the flow of blood.
There is no life without
energy. Meridians affect all the organs and the
physiological systems, including the immune,
nervous, endocrine,
circulatory, respiratory, digestive, skeletal, muscular, and lymphatic
systems.
Each system is fed by at
least one meridian. Blocked or
unregulated energy flow through a
meridian will have a negative
effect on the system that the meridian feeds.
The meridians include
fourteen channels that
transport energy into and throughout the body.
The meridian pathways
also link hundreds of tiny, discrete reservoirs of
heat and electromagnetic energy along the
surface of the skin.
The reservoirs are acupuncture
points. When these points are stimulated
with needles or physical pressure,
energy is released and redistributed along the meridian
pathway.
According to van der Kolk, et al (1996), effective treatment requires exposure to, without
total re-experiencing of, the traumatic material; too much arousal precludes assimilation
of any new information. It may be that the tapping protocol in TFT and EFT provides a
concrete physical stimulus drawing attention back to the here and now, anchoring clients
in the present.
It also appears that the physical, rhythmic stimulation has a calming and soothing effect
on agitated clients. This is most likely produced by the reciprocal inhibitory relaxation
response of the parasympathetic nervous system’s reducing the effects of the
hyperactivated sympathetic nervous system. (Carbonell and Figley,
1995)
Developed by psychologist Roger Callahan, Thought Field Therapy (TFT) can be
described as psychological acupressure. It builds upon a foundation of elements from
EMDR and introduces a new technique, tapping. The client taps on specific acupressure
points while focusing on the traumatic material. The tapping technique is inspired by
concepts of Chinese energy medicine that are widely accepted in holistic health circles.
Within this conceptual framework, physical and emotional problems result when the
body’s energy is blocked. In TFT, the therapist directs the client to tap gently on critical
acupressure points along the body’s energy meridians. This tapping helps the body’s
energy to flow and rebalance.
EFT is a less expensive variation of TFT. It too has been described a needleless
acupuncture for the emotions. In addition to the simpler, all-purpose tapping protocol,
EFT also instructs people to speak affirmations and engage in unusual, yet seemingly
effective behaviors, including tapping, eye movements,
humming, and counting.
Craig, a student of Roger Callahan, developed EFT, by combining EMDR’s eye
movements and emphasis on shifting underlying cognitive belief systems with a more
generalized acupressure point tapping, based on TFT. One cycle of EFT takes only a few
minutes, generates little distress and it can be effective even if the client does not believe
that it would be.
There have been no formal research studies done to empirically prove efficacy of these
acupressure techniques. However, clinicians and clients alike seem impressed with the
results that they’ve been getting (author included). According to van der Kolk, et al
(1996), effective treatment requires exposure to, without total re-experiencing of, the
traumatic material; too much arousal precludes assimilation of any new information. It
may be that the tapping protocol in TFT and EFT provides a concrete physical stimulus
drawing attention back to the here and now, anchoring clients in the present. It also
appears that the physical, rhythmic stimulation has a calming and soothing effect on
agitated clients. This is most likely produced by the reciprocal inhibitory relaxation
response of the parasympathetic nervous system’s reducing the effects of the
hyperactivated sympathetic nervous system. (Carbonell and Figley, 1995)
In EFT, you tap gently on certain acupuncture meridians on the face and the body as you
tune into the problem you want to resolve. The tapping process, combined with your
focused attention on the issue you want to resolve, can reduce physical and emotional
pains, end cravings/habits, and relieve anxiety, fears and phobias, sometimes with
remarkable speed and often with long-lasting positive effects.
To find out more about all the various issues that EFT has been used for and to download
the free EFT Manual, visit:
Gary Craig's official EFT website
Click to view an Introduction to EFT with Judy Byrne, EFT Master
Eye Movement Desensitization and Reprocessing (EMDR) is a complex, highly
specialized therapy used to overcome the effects of traumatic
or upsetting experiences.
Psychologist Francine Shapiro developed EMDR, after she noticed her own stress
reactions diminishing when her eyes swept back and forth as she walked through a park.
EMDR combines several therapeutic methods—psychodynamic, cognitive, behavioral,
etc.—with eye movements or other forms of rhythmical stimulation, such as hand taps or
sounds. It involves recalling a stressful past event and “reprogramming” the memory in
the light of a positive, self-chosen belief. On the EMDR Institute’s website, Shapiro uses
the example of rape to illustrate how we can get stuck in trauma. “A rape survivor may
‘know’ that rapists are responsible for their crimes, but this information does not connect
with her feeling that she is to blame for the attack. The memory is then dysfunctionally
stored without appropriate associative connections and with many elements still
unprocessed. When the individual thinks about the trauma, or when the memory is
triggered by similar situations, the person may feel like she is reliving it, or may
experience strong emotions and physical sensations. EMDR links the memory of trauma
with present-oriented, adaptive information. Though the exact mechanism is unknown, it
appears that the eye movements relieve the anxiety associated with the trauma so that the
original event can be examined from a more detached perspective, somewhat like
watching a movie of what happened. In this way cognitive reorganizing takes place,
leading to spontaneous emotional and behavioral life changes.
The Theory
In
his work, the Mindful Brain, Daniel
Siegel explains how consciousness plays a
direct
role in the harnessing of neural plasticity (the brain’s ability to alter
automatic
modes of neural firing which enables new patterns of neural firing to
occur.)
He writes, “The basic steps linking consciousness with neural plasticity
are
as follows: Where attention goes, neural firing occurs. And where neurons
fire,
new connections can be made. In this
manner, learning a new way to pay
attention
within the integration of consciousness enables an open receptive mind
within
therapy to catalyze the integration of new combinations of previously
isolated
segments of our mental reality.” One way to practice this “new way of
paying
attention within the integration of consciousness” is through a mindful
practice.
While other clinicians are discovering the
benefits and have begun to incorporate
mindfulness
into their own clinical work, some pioneer clinicians have been doing
it
for years - most notably, Kabat Zinn’s work, Mindfulness-Based Stress
Reduction;
Brach’s Radical Acceptance and Linehan’s Dialectical Behavior
Therapy.
For further information on these pioneers and their work the reader
should
visit the websites and refer to the literature below:
During trauma, dissociation provides a psychological escape when physical escape is not
an option. Quite a gift, really. Another gift for the survivor would be a practice that
provided a means for the development of a healthier escape-a conscious detachment and
dis-identification from trauma’s sequelae. Mindfulness and mindfulness meditation is
such a practice.
In meditation, the survivor detaches and observes his/her internal process, as he or she is
experiencing it. Detachment from feelings, sensations and thoughts, allows emotional
and physical pain to become more distant, therefore more manageable. Only when the
survivor no longer identifies with the suffering, can (s)he transcend or transform it.
Mindfulness is a technique which cultivates an intentional awareness of the present
moment. It helps clients experience life non-judgmentally, as it unfolds moment by
moment, with curiosity, attention, and compassion for self and others. Engaging in life
mindfully helps clients to develop more skillful and creative responses to life – to live
with greater balance and ease; to cope with life’s stressors and challenges; to accept the
human condition; and to develop an awareness of, and appreciation for, the only time we
have: the now. As previously stated, mindfulness is attracting increasing interest among
western psychiatrists as a non-pharmacological means of dealing with anxiety and
depressive mood states.
Meditation affects the body in exactly the opposite ways that traumatic symptoms do.
When practicing meditation, heart rate and breathing slow down; blood pressure
normalizes; oxygen is used more efficiently; adrenal glands produce less cortisol,
adrenaline and noradrenaline; positive hormone production increases; and immune
function improves. In addition, the mind gains clarity and creativity increases. People
who meditate find it easier to give up former coping mechanisms, i.e., life-damaging
habits like smoking, drinking, binging, purging, self injury and drugs. Meditation restores
the body to a calm state, helps the body to physically repair itself, and prevents new
damage caused by the physical effects of every day stress.
According to Thich Nhat Hanh- Buddhist monk, poet, scholar, peace activist and one of
the best known teachers of mindfulness today- “Awareness of breathing and of our steps
is our anchor in the present moment. It enables us to nourish peace, joy, love and
understanding in our individual and collective consciousness, and to avoid losing
ourselves in regrets about the past, worries about the future, or craving, anger, or
jealousy in the present.” Hanh offers a practice of mindfulness that seems to appeal
to Western sensibilities. His contribution permeates the work of Jon Cabot Zinn,
Tara Brach, Jack Kornfield and Marsha Linehan.
Sharon Salzberg, cofounder of the Insight Meditation Society, writes “The entire purpose
of meditation practice is to learn how to harness, refine, and sensitize this quite incredible
power of awareness”. According to Hahn, “The miracle is not to walk on water. The
miracle is to walk on the green earth in the present moment, to appreciate the peace and
beauty that are available now.”
· Buddha Mind, Buddha Body: Walking Towards Enlightenment
· No Death, No Fear: Comforting Wisdom for Life
· Touching Peace
Hanh’s teachings are very simple and easy to instruct others in the practice. Below are
examples of his mindfulness breathing techniques from Touching Peace, Parallax Press,
1992, p. 1.
Conscious Breathing
Meditation 1
As you inhale, say to yourself,
“Breathing in, I know that I am breathing in.”
or simply “In.”
As you exhale, say to yourself, “Breathing out, I know that I am breathing out.”
or simply “Out.”
With this exercise you recognize your in-breath as an in-breath and your out-breath as an
out-breath. This technique can help keep the mind on the breath. The mind becomes
peaceful and gentle along with the breath. It takes but a few minutes to experience the
benefits of this meditation. It is important and enjoyable to breathe in and out. The breath
links the body to the mind. When the mind is thinking one thing and the body is doing
another, mind and body are disconnected. By concentrating on breathing “In” and “Out,”
we reconnect mind and body and become integrated and whole again.
Meditation 2
Recite these four lines silently as you breathe in and out:
1. “Breathing in, I calm my body.” Recite this line and feel the coolness permeate your
body, just like a cool drink on a hot day. When you breathe in and recite this line, you
can feel the breath calming the body and mind.
2. “Breathing out, I smile.”
A smile can relax hundreds of facial muscles. Smiling shows that you are master of
yourself.
3. “Dwelling in the present moment”
“Dwelling in the present moment.” With this phrase you can sit. You don’t need to
think of anything else. You know exactly where you are.
4. “I know this is a wonderful moment.” It is wonderful to sit, stable and at ease. It is a
joy to return to your breath, to smile, and to know your true nature. Our appointment
with life is in the present moment. If you do not have peace and joy right now, when will
you have it? What prevents you from being happy right now? Follow your breath and
say, simply, “Calming, Smiling, Present moment, Wonderful moment.”
According to Sharon Salzberg, mindfulness is one of the main pillars of
meditation. “…that means being aware of what is going on as it actually arises –
not being lost in our conclusions or judgments about it; our fantasies of what it
means; our hopes; our fears; our aversions. Rather, mindfulness helps us to see
nakedly and directly; “this is what is happening right now.” Through mindfulness,
we pay attention to our pleasant experiences, our painful experiences, and our
neutral experiences – the sum to total of what life brings us.”
The second pillar is concentration or “…the development of stability of mind, a
gathering in and focusing of our normal scattered energy. The state of
concentration that we develop in meditative practice is tranquil, at ease, relaxed,
open, yielding, gentle, and soft. We let things be; we don’t try to hold on to
experiences. This state is also alert - it’s not about getting so tranquil that we just
fall asleep. It’s awake, present, and deeply connected with what is going on. This
is the balance that we work with in developing concentration.”
The Practice
Below is a written copy of a Basic Breath Meditation based on Sharon Salzberg and
Joseph Goldstein’s Insight Meditation.
Therapist should read and record script. Give client a copy of the CD. Have the
client play and follow meditation twice daily. (For people with a history of sexual
abuse please begin to practice in five minute intervals – increasing the duration as
the client becomes more comfortable with the procedure.)
Client should begin by finding a quiet space where he/she will be undisturbed for
the duration of the meditation. Take a comfortable posture-sitting on a chair with
your back supported and your feet comfortably on the floor. Play script:
“Close your eyes or find a spot a few feet in front of you to place your gaze.
Begin to relax. Allow your mind to be spacious. Don’t try to make anything
happen, just begin to become aware of what is. Slowly bring your attention to the
breath. Take a few deep breaths and release. Now allow your breath to return to
normal-no need to control or change it in any way. Just notice the natural rhythm
of the breath. Wherever you notice the breath most distinctly whether it be at the
nostrils, the chest, or the abdomen, allow your attention to rest there.
As you feel the breath, you might silently label it – “in/out or rising and falling”.
As you feel the breath enter, noting “in” and as it leaves the body, “out”.
Notice the cycle of the breath as it is appearing right now. Allow yourself to
sustain attention through a full cycle. The beginning of the in breath-the end of
the in breath, the pause, the beginning of the out breath through to the end of the
out breath. Allow yourself to pay attention throughout an entire cycle.
You may find your mind wandering. That’s fine. Our minds have been trained to
be distracted. It doesn’t matter. Each time you notice that you’ve lost touch with
the breath simply notice and very gently bring your attention back… come back
to the feeling of the breath in this very moment.
You may discover that there’s a pause between the in breath and the out breath or
between the out breath and the next breath. If you notice a pause just allow your
attention to settle there. Simply noticing what is; allowing the next breath to come
naturally. There’s nothing you need to do about it. There’s no need to alter it or
perfect it. Simply notice the breath as it arises.
Many distractions will appear-the mind will wander. It doesn’t matter. When you
practice you’ll need to begin again and again. When you recognize that you’ve
lost touch with an awareness of the breath… simply and lovingly return your
attention to the breath as it is appearing right now. You can end this session by
bringing your attention to your hands and feet. Slowly and gently opening your
eyes.
The Practice Recommendations:
- Having the therapist’s voice on the client’s CD allows for soothing in addition to
serving as a transition object for client.
- To induce meditative state and enhance the experience add alpha wave meditation
music as background for the script.
- “… Insight Meditation makes it simple to start meditating in the Buddhist tradition. This elegant
gift-boxed set includes two exclusive compact discs with authentic guided meditations,
complemented by study cards and a special instruction book with the beginner in mind.”
Alpha Wave Meditation see: Brainwave Suite by Jeffrey Thompson
“Brainwave Suite blends subtle pulses of sound into the musical soundtrack, to stimulate your brain to
produce waves with a pattern that matches the state you want to experience.
Using three-dimensional recording techniques, Brainwave Suite combines synthesizers, shakuhachi flutes,
Tibetan bells and acoustic guitar with actual sounds of nature to produce soothing, relaxing music which
enhances the effect”.
The Theory
According to Belleruth Naparstek, Guided imagery is intentional, directed daydreaming-
blending one’s imagination with words and phrases that evoke sensory fantasy and
memory. Guided imagery creates a deeply receptive mind, body, psyche and spirit state
during which change becomes possible. For most of us, imagery is an accessible form of
meditation yielding immediate empirically proven benefits including a wide variety of
physical and psychological outcomes. The ones of interest to this population include:
- Reduction of anxiety and depression
- Decrease in blood pressure
- Strengthening of immune function
- Reduction of pain
- Reduction of bingeing and purging in those with bulimia
- Improvement in attention and concentration
Imagery is effective because it basically bypasses rational thought and logical
assumptions - delivering healing messages directly to the hypervigilant primitive brain.
Once received, imagery disperses gentle reminders of health, strength, meaning and hope
that affect unconscious assumptions and self-defeating concepts.
Because it is processed through the right brain’s primitive, sensory, and emotion-based
channels, it is an ideal intervention for post-traumatic stress. Imagery works on the
right-brain the home of feeling, sensing, and perceiving, rather than the thinking, judging,
analyzing and deciding functions of the left brain. Since it does not depend on the brain’s
logical and analytic centers, it circumvents psychological resistance, fear, hopelessness,
worry, and doubt, and goes directly to attitude and self-esteem, without interference from
the rather obstinate, literal mind.
Brain development studies have shown that a traumatized brain is no longer able to focus
on language or verbal content. Instead, it spends all its time processing nonverbal
danger cues—body movements, facial expressions, and tone of voice—as it searches for
information about danger and threat. The primitive brain in effect co-opts cognition and
behavior in the service of safety and survival. Unfortunately this causes a distinct loss in
ability to think abstractly, process language, and attend to ideas or word meanings. These
functions are higher cortical functions- gray matter issues- which can only be attended to
once the primitive brain is sufficiently calmed. It seems clear that interventions that rely
on cognitive, problem-solving activities do not, and more importantly, cannot have much
impact on these clients or their terror-driven behavior.
With the advancement of technology, neuroscience has shown us that traumatic changes
appear in Broca’s area of the brain, where personal experience gets translated into
language. It appears that survivors can see, hear, smell, taste and feel parts of the
traumatic event, yet struggle unsuccessfully to translate these sensory elements into
language. In addition to this “speechless terror”, some long-term trauma survivors
experience an additional obstacle in their analytic ability. Due to persistently high
elevation of stress hormones, causing a reduction in the size of the hippocampus,
survivors are often less able to put things in context and/or make critical distinctions
about what is and what is not threatening in the present. Without this necessary
discernment, survivors become more and more impulsive and less and less inhibited. In
effect, what survivors are left with is a constantly hyper-aroused autonomic nervous
system; an inability to distinguish past from present threat – necessarily producing a state
of constant hypervigalence; a speechless terror accompanied by painful and traumatic
sensory and body memories; and a marked inability to access any their own cognitive
resources.
Quite a predicament.
What should be resoundingly apparent to the reader is that talking “about trauma”- which
requires participation from the language/ logic portion of the left brain- is inadequate,
oftentimes triggering, and very likely re-traumatizing to the client. A better option for
therapists would be to target the client’s highly sensitive, hyper-acute right hemisphere
with its over-functioning visual, sensory, and emotional channels. By accessing the
limbic system and the right hemisphere of the brain, survivors are able to process the
images, body sensations and feelings, attach some sort of meaning to them, and
eventually move toward a more helpful and adaptive resolution of the traumatic material.
Imagery seems to offer a viable solution. Using a calming tone of voice, music and
symbolic representations of safety, imagery quiets the hypervigilant primitive brain,
creating an environment where the higher brain can once again function in the service of
the survivor.
Naparstek posits that guided imagery provides a cushion of evocative, multisensory
protective images and built-in emotional safety. Appealing memories and lush fantasies
require little energy or discipline to evoke. They provide distraction from pain; carry
clients beyond worry, fear and anguish she goes on to report that guided imagery has the
ability to avoid the direct traps of language and literalism. A powerful healing tool, that
provides a kinder, gentler and more effective route to tending to wounds of the inner self.
Naparstek explains that the imaginary world developed through imagery is a generous
place where clients can gain distance by locking pain away in a safe, floating it away on
the wind, or erasing it from an imaginary blackboard. In this world, clients can summon
protection and support from magical allies, remembered friends, favorite animals,
powerful ancestors, guardian angels and other divine helpers. They can create as many
layers of distance between the traumatic event and themselves as needed. All the while
surrounding themselves with loving, powerful protectors. The following link is to
For further information about Belleruth’s work or to order CD’s, please visit:
The Practice
Recommendations
Therapist should read and record script. There are plenty of guided visualization scripts;
this author’s favorites come from (Invisible Heroes: Survivors of Trauma and How They
Heal (UK), 2006.) Give client a copy of the cd. Have the client play and follow muscle
relaxation in the evening. It is very important that the client and therapist experiment with
this exercise in session, and then decide whether this practice is appropriate. (Some
clients begin to experience intense anxiety with this exercise-truly not what the creators
had in mind in the way of outcomes)
- Having the therapist’s voice on the client’s cd allows for soothing in addition to
serving as a transition object for client.
- To induce meditative state and enhance the experience add alpha wave meditation
music as background for the script.
For information on Alpha Wave Meditation see: Brainwave Suite by Jeffrey Thompson
Brainwave Suite blends subtle pulses of sound into the musical soundtrack, to stimulate
your brain to produce waves with a pattern that matches the state you want to experience.
Using three-dimensional recording techniques, Brainwave Suite combines synthesizers,
shakuhachi flutes, Tibetan bells and acoustic guitar with actual sounds of nature to
produce soothing, relaxing music which enhances the effect.
Model Mugging is based on muscle memory (operant conditioning). Students learn how
to deal with the emotions of fear. In actual attacks, the initial reaction of victims is
surprise. They freeze (as in the original traumatic event) in fear while falling into
immobility. Immobility is where the mind goes blank and the student quickly becomes
overwhelmed by the violence. Because being scared is natural, the Model Mugging
System, through operant conditioning, teaches women how to recondition the “Freeze
Response” thought many repetitions of being placed in the precise moment of an attack.
In Model Mugging, women learn how to defend themselves in realistic scenarios and use
“real” fear to their advantage by transforming it into positive fighting energy. They learn
how to fight their way out of immobility. They also learn to deal with other feelings such as
lack of confidence, helplessness, and anger.
