The Body Keeps the Score
The Body Keeps the Score

The Body Keeps the Score

Mithoefer and his colleagues were looking for a medication that would enhance the effectiveness of psychotherapy, and they became interested in MDMA because it decreases fear, defensiveness, and numbing, as well as helping to access inner experience.48 They thought MDMA might enable patients to stay within the window of tolerance so they could revisit their traumatic memories without suffering overwhelming physiological and emotional arousal. ... Two months later 83 percent of the patients who received MDMA plus psychotherapy were considered completely cured, compared with 25 percent of the placebo group. ... By being able to observe the trauma from the calm, mindful state that IFS calls Self (a term I’ll discuss further in chapter 17), mind and brain are in a position to integrate the trauma into the overall fabric of life. (Location 4002)

However, drugs cannot “cure” trauma; they can only dampen the expressions of a disturbed physiology. And they do not teach the lasting lessons of self-regulation. They can help to control feelings and behavior, but always at a price—because they work by blocking the chemical systems that regulate engagement, motivation, pain, and pleasure. ... EMDR proved to be a more effective antidepressant than Prozac. (Location 4027)

Medicines that target the autonomic nervous system, like propranolol or clonidine, can help to decrease hyperarousal and reactivity to stress.55 This family of drugs works by blocking the physical effects of adrenaline, the fuel of arousal, and thus reduces nightmares, insomnia, and reactivity to trauma triggers.56 Blocking adrenaline can help to keep the rational brain online and make choices possible: ... Traumatized patients tend to like tranquilizing drugs, benzodiazepines like Klonopin, Valium, Xanax, and Ativan. In many ways, they work like alcohol, in that they make people feel calm and keep them from worrying. (Casino owners love customers on benzodiazepines; they don’t get upset when they lose and keep gambling.) But also, like alcohol, benzos weaken inhibitions against saying hurtful things to people we love. ... A few studies have shown that anticonvulsants and mood stabilizers, such as lithium or valproate, can have mildly positive effects, taking the edge off hyperarousal and panic. ... But it’s important to keep in mind that these medications work by blocking the dopamine system, the brain’s reward system, which also functions as the engine of pleasure and motivation. (Location 4040)

“What can not be spoken to the [m]other cannot be told to the self.” (Location 4172)

Tags: favorite

Hiding your core feelings takes an enormous amount of energy, it saps your motivation to pursue worthwhile goals, and it leaves you feeling bored and shut down. Meanwhile, stress hormones keep flooding your body, leading to headaches, muscle aches, problems with your bowels or sexual functions—and irrational behaviors that may embarrass you and hurt the people around you. Only after you identify the source of these responses can you start using your feelings as signals of problems that require your urgent attention. (Location 4177)

Communicating fully is the opposite of being traumatized. (Location 4231)

Since then neuroscience research has shown that we possess two distinct forms of self-awareness: one that keeps track of the self across time and one that registers the self in the present moment. The first, our autobiographical self, creates connections among experiences and assembles them into a coherent story. This system is rooted in language. Our narratives change with the telling, as our perspective changes and as we incorporate new input. The other system, moment-to-moment self-awareness, is based primarily in physical sensations, but if we feel safe are not rushed, we can find words to communicate that experience as well. These two ways of knowing are localized in different parts of the brain that are largely disconnected from each other.10 Only the system devoted to self-awareness, which is based in the medial prefrontal cortex, can change the emotional brain. ... One system creates a story for public consumption, and if we tell that story often enough, we are likely to start believing that it contains the whole truth. But the other system registers a different truth: how we experience the situation deep inside. It is this second system that needs to be accessed, befriended, and reconciled. (Location 4239)

But stories also obscure a more important issue, namely, that trauma radically changes people: that in fact they no longer are “themselves.” It is excruciatingly difficult to put that feeling of no longer being yourself into words. Language evolved primarily to share “things out there,” not to communicate our inner feelings, our interiority. (Again, the language center of the brain is about as far removed from the center for experiencing one’s self as is geographically possible.) Most of us are better at describing someone else than we are at describing ourselves. ... We can get past the slipperiness of words by engaging the self-observing, body-based self system, which speaks through sensations, tone of voice, and body tensions. Being able to perceive visceral sensations is the very foundation of emotional awareness. ... There are other ways to access your inner world of feelings. One of the most effective is through writing. ... In the practice called free writing, you can use any object as your own personal Rorschach test for entering a stream of associations. Simply write the first thing that comes to your mind as you look at the object in front of you and then keep going without stopping, rereading, or crossing out. ... A wooden spoon on the counter may trigger memories of making tomato sauce with your grandmother—or of being beaten as a child. ... Soon an image will emerge, then a memory, and then a paragraph to record it. Whatever shows up on the paper will be a manifestation of associations that are uniquely yours. (Location 4271)

Those who allowed themselves to feel their emotions showed significant physiological changes, both immediate and long term. During their confessions blood pressure, heart rate, and other autonomic functions increased, but afterward their arousal fell to levels below where they had been at the start of the study. The drop in blood pressure could still be measured six weeks after the experiment ended. ... Again, those who wrote about personal traumas had fewer visits to the student health center, and their improved health correlated with improved immune function, as measured by the action of T lymphocytes (natural killer cells) and other immune markers in the blood. (Location 4328)

The real reason [that soldiers fall silent] is that soldiers have discovered that no one is very interested in the bad news they have to report. What listener wants to be torn and shaken when he doesn’t have to be? ... It is an enormous challenge to find safe places to express the pain of trauma, which is why survivor groups like Alcoholics Anonymous, Adult Children of Alcoholics, Narcotics Anonymous, and other support groups can be so critical. (Location 4380)

Note: The real reason trauma survivors fall silent as well

patients how to safely dip one toe in the water and then take it out again, thus approaching the truth gradually. We start by establishing inner “islands of safety” within the body.22 This means helping patients identify parts of the body, postures, or movements where they can ground themselves whenever they feel stuck, terrified, or enraged. These parts usually lie outside the reach of the vagus nerve, which carries the messages of panic to the chest, abdomen, and throat, and they can serve as allies in integrating the trauma. ... This sets the stage for trauma resolution: pendulating between states of exploration and safety, between language and body, between remembering the past and feeling alive in the present. (Location 4404)

Almost every brain-imaging study of trauma patients finds abnormal activation of the insula. This part of the brain integrates and interprets the input from the internal organs—including our muscles, joints, and balance (proprioceptive) system—to generate the sense of being embodied. The insula can transmit signals to the amygdala that trigger fight/fight responses. This does not require any cognitive input or any conscious recognition that something has gone awry—you just feel on edge and unable to focus or, at worst, have a sense of imminent doom. These powerful feelings are generated deep inside the brain and cannot be eliminated by reason or understanding. Being constantly assaulted by, but consciously cut off from, the origin of bodily sensations produces alexithymia: not being able to sense and communicate what is going on with you. Only by getting in touch with your body, by connecting viscerally with your self, can you regain a sense of who you are, your priorities and values. ... In order to overcome trauma, you need help to get back in touch with your body, with your Self. (Location 4448)

Memories evolve and change. Immediately after a memory is laid down, it undergoes a lengthy process of integration and reinterpretation—a process that automatically happens in the mind/brain without any input from the conscious self. When the process is complete, the experience is integrated with other life events and stops having a life of its own.4 As we have seen, in PTSD this process fails and the memory remains stuck—undigested and raw. ... posttraumatic stress is the result of a fundamental reorganization of the central nervous system based on having experienced an actual threat of annihilation, (or seeing someone else being annihilated), which reorganizes self experience (as helpless) and the interpretation of reality (the entire world is a dangerous place). (Location 4609)

Soon afterward an article appeared in the journal Dreaming suggesting that EMDR was related to rapid eye movement (REM) sleep—the phase of sleep in which dreaming occurs. ... Increasing our time in REM sleep reduces depression, while the less REM sleep we get, the more likely we are to become depressed. ... Today we know that both deep sleep and REM sleep play important roles in how memories change over time. The sleeping brain reshapes memory by increasing the imprint of emotionally relevant information while helping irrelevant material fade away. (Location 4699)

Finally, Stickgold suggests a clear link between EMDR and memory processing in dreams: “If the bilateral stimulation of EMDR can alter brain states in a manner similar to that seen during REM sleep then there is now good evidence that EMDR should be able to take advantage of sleep-dependent processes, which may be blocked or ineffective in PTSD sufferers, to allow effective memory processing and trauma resolution.”18 The basic EMDR instruction, “Hold that image in your mind and just watch my fingers moving back and forth,” may very well reproduce what happens in the dreaming brain. (Location 4725)

The lives of many trauma survivors come to revolve around bracing against and neutralizing unwanted sensory experiences, and most people I see in my practice have become experts in such self-numbing. They may become serially obese or anorexic or addicted to exercise or work. At least half of all traumatized people try to dull their intolerable inner world with drugs or alcohol. The flip side of numbing is sensation seeking. Many people cut themselves to make the numbing go away, while others try bungee jumping or high-risk activities like prostitution and gambling. Any of these methods can give them a false and paradoxical feeling of control. ... When people are chronically angry or scared, constant muscle tension ultimately leads to spasms, back pain, migraine headaches, fibromyalgia, and other forms of chronic pain. ... Their diagnosis will come to define their reality without ever being identified as a symptom of their attempt to cope with trauma. (Location 4796)

Note: Dulling of sensory experience leads to seeking that experience via other means.

Why is HRV important? When our autonomic nervous system is well balanced, we have a reasonable degree of control over our response to minor frustrations and disappointments, enabling us to calmly assess what is going on when we feel insulted or left out. Effective arousal modulation gives us control over our impulses and emotions: As long as we manage to stay calm, we can choose how we want to respond. Individuals with poorly modulated autonomic nervous systems are easily thrown off balance, both mentally and physically. ... After we’d tested about sixty subjects, it became clear that people with PTSD have unusually low HRV. ... We confirmed that yet another brain regulatory system was not functioning as it should.4 Failure to keep this system in balance is one explanation why traumatized people like Annie are so vulnerable to overrespond to relatively minor stresses: (Location 4819)

Tags: favorite

Yoga and the Quest for the True Self (Location 4914)

A good yoga teacher will encourage you to just notice any tension while timing what you feel with the flow of your breath: “We’ll be holding this position for ten breaths.” This helps you anticipate the end of discomfort and strengthens your capacity to deal with physical and emotional distress. Awareness that all experience is transitory changes your perspective on yourself. (Location 4952)

Every major school of psychology recognizes that people have subpersonalities and gives them different names.2 In 1890 William James wrote: “[I]t must be admitted that … the total possible consciousness may be split into parts which coexist, but mutually ignore each other, and share the objects of knowledge between them.”3 Carl Jung wrote: “The psyche is a self-regulating system that maintains its equilibrium just as the body does,”4 “The natural state of the human psyche consists in a jostling together of its components and in their contradictory behavior,”5 and “The reconciliation of these opposites is a major problem. Thus, the adversary is none other than ‘the other in me.’” (Location 5057)

Tags: favorite

The IFS model helped me realize that dissociation occurs on a continuum. In trauma the self-system breaks down, and parts of the self become polarized and go to war with one another. Self-loathing coexists (and fights) with grandiosity; loving care with hatred; numbing and passivity with rage and aggression. These extreme parts bear the burden of the trauma. ... For example, we all have parts that are childlike and fun. When we are abused, these are the parts that are hurt the most, and they become frozen, carrying the pain, terror, and betrayal of abuse. This burden makes them toxic—parts of ourselves that we need to deny at all costs. Because they are locked away inside, IFS calls them the exiles. ... Critical and perfectionistic managers can make sure we never get close to anyone or drive us to be relentlessly productive. Another group of protectors, which IFS calls firefighters, are emergency responders, acting impulsively whenever an experience triggers an exiled emotion. (Location 5082)

Firefighters will do anything to make emotional pain go away. Aside from sharing the task of keeping the exiles locked up, they are the opposite of managers: Managers are all about staying in control, while firefighters will destroy the house in order to extinguish the fire. The struggle between uptight managers and out-of-control firefighters will continue until the exiles, which carry the burden of the trauma, are allowed to come home and be cared for. (Location 5221)

Like most incest survivors, Joan hated her exiles, particularly the little girl who had responded to her abuser’s sexual demands and the terrified child who whimpered alone in her bed. When exiles overwhelm managers, they take us over—we are nothing but that rejected, weak, unloved, and abandoned child. The Self becomes “blended” with the exiles, and every possible alternative for our life is eclipsed. Then, as Schwartz points out, “We see ourselves, and the world, through their eyes and believe it is ‘the’ world. In this state it won’t occur to us that we have been hijacked.” (Location 5236)

Individual IFS therapy helped patients apply the language of parts to daily issues. For example, one woman felt trapped by conflicts at her job, where a manager part insisted the only way out was to overwork until her RA flared up. With the therapist’s help she realized that she could care for her needs without making herself sick. (Location 5292)

The research that Judy Herman, Chris Perry, and I had done (see chapter 9) showed that people who felt unwanted as children, and those who did not remember feeling safe with anyone while growing up, did not fully benefit from conventional psychotherapy, presumably because they could not activate old traces of feeling cared for. (Location 5379)

Sandy McFarlane’s study reminded me of what Pierre Janet had said back in 1889: “Traumatic stress is an illness of not being able to be fully alive in the present.” Years later, when I saw the movie The Hurt Locker, which dealt with the experiences of soldiers in Iraq, I immediately recalled Sandy’s study: As long as they were coping with extreme stress, these men performed with pinpoint focus; but back in civilian life they were overwhelmed having to make simple choices in a supermarket. (Location 5665)

Theta frequencies (5–8 Hz) predominate at the edge of sleep, as in the floating “hypnopompic” state I described in chapter 15 on EMDR; they are also characteristic of hypnotic trance states. Theta waves create a frame of mind unconstrained by logic or by the ordinary demands of life and thus open the potential for making novel connections and associations. One of the most promising EEG neurofeedback treatments for PTSD, alpha/theta training, makes use of that quality to loosen frozen associations and facilitate new learning. On the downside, theta frequencies also occur when we’re “out of it” or depressed. ... Alpha waves (8–12 Hz) are accompanied by a sense of peace and calm.13 They are familiar to anyone who has learned mindfulness meditation. ... time of this writing the results are not yet available. Beta waves are the fastest frequencies (13–20 Hz). When they dominate, the brain is oriented to the outside world. Beta enables us to engage in focused attention while performing a task. However, high beta (over 20 Hz) is associated with agitation, anxiety, and body tenseness—in effect, we are constantly scanning the environment for danger. (Location 5839)

In our neurofeedback lab we see individuals with long histories of traumatic stress who have only partially responded to existing treatments. Their qEEGs show a variety of different patterns. Often there is excessive activity in the right temporal lobe, the fear center of the brain, combined with too much frontal slow-wave activity. This means that their hyperaroused emotional brains dominate their mental life. Our research showed that calming the fear center decreases trauma-based problems and improves executive functioning. This is reflected not only in a significant decrease in patients’ PTSD scores but also in improved mental clarity and an increased ability to regulate how upset they become in response to relatively minor provocations. (Location 5888)

As long as we feel safely held in the hearts and minds of the people who love us, we will climb mountains and cross deserts and stay up all night to finish projects. Children and adults will do anything for people they trust and whose opinion they value. (Location 6404)

calming down enough to take charge of ourselves requires activating the brain areas that notice our inner sensations, the self-observing watchtower discussed in chapter 4 (Location 6464)

We also strengthen the brain’s watchtower by teaching them to recognize and name their physical sensations. For example, when their chest tightens, that probably means that they are nervous; their breathing becomes shallow and they feel uptight. What does anger feel like, and what can they do to change that sensation in their body? What happens if they take a deep breath or take time out to jump rope or hit a punching bag? Does tapping acupressure points help? We try to provide children, teachers, and other care providers with a toolbox of ways to take charge of their emotional reactions. (Location 6482)