Healing Trauma

     Most talk therapy places emphasis on the capacity of the cognitive rational brain to conquer our irrational survival brain. Neuroscience has helped us understand that you can’t talk yourself out of being in love, or being angry, or disliking particular people, because these are not rational processes, and reason has a limited capacity to override these more primitive survival issues. Instead of relying on reason, we need to rely on connection to our body, mastery of our body, safety of our body, and finding peace in our body.

     Dr. Bessel Van der Kolk, an expert on post-traumatic stress disorder (PTSD) explains the benefits of a yoga practice for PTSD survivors. “Trauma is an experience that overwhelms your capacity to cope. People feel helpless, overwhelmed, scared, horrified; at the core of trauma is horror.”

     Dr. Van der Kolk’s research found that “Yoga was more effective than any medication… medication can be quite nice to sort of dampen some of the symptoms. But in the end, people need to own their bodies, they need to own their physical experiences. And, in order to overcome your trauma, it needs to be safe to go inside and to experience yourself.”

     Nobody can “treat” a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on body, mind, and soul: the crushing sensations in your chest that you may label as anxiety or depression; the fear of losing control; always being on alert for danger or rejection; the self-loathing; the nightmares and flashbacks; the fog that keeps you from staying on task and from engaging fully in what you are doing; being unable to fully open your heart to another human being.

     Trauma robs you of the feeling that you are in charge of yourself. The challenge of recovery is to reestablish ownership of your body and your mind—of yourself. This means feeling free to know what you know and to feel what you feel without becoming overwhelmed, enraged, ashamed, or collapsed. For most people this involves (1) finding a way to become calm and focused, (2) learning to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind you of the past, (3) finding a way to be fully alive in the present and engaged with the people around you, (4) not having to keep secrets from yourself, including secrets about the ways that you have managed to survive.
These goals are not steps to be achieved, one by one, in some fixed sequence. They overlap, and some may be more difficult than others, depending on individual circumstances.

Our Focus for Recovery

     When we talk about trauma, we often start with a story or a question: “What happened during the war?” “Were you ever molested?” “Let me tell you about that accident or that rape,” or “Was anybody in your family a problem drinker?” However, trauma is much more than a story about something that happened long ago. The emotions and physical sensations that were imprinted during the trauma are experienced not as memories but as disruptive physical reactions in the present. In order to regain control over yourself, you need to revisit the trauma. Sooner or later you need to confront what has happened to you, but only after you feel safe and will not be re-traumatized by it. The first order of business is to find ways to cope with feeling overwhelmed by the sensations and emotions associated with the past.

     The engines of post-traumatic reactions are located in the emotional brain. In contrast with the rational brain, which expresses itself in thoughts, the emotional brain manifests itself in physical reactions: gut- wrenching sensations, heart pounding, breathing becoming fast and shallow, feelings of heartbreak, speaking with an uptight and reedy voice, and the characteristic body movements that signify collapse, rigidity, rage, or defensiveness.

     Why can’t we just be reasonable? And can understanding help? The rational, executive brain is good at helping us understand where feelings come from (as in: “I get scared when I get close to a guy because my father molested me” or “I have trouble expressing my love toward my son because I feel guilty about having killed a child in Iraq”). However, the rational brain cannot abolish emotions, sensations, or thoughts (such as living with a low- level sense of threat or feeling that you are fundamentally a terrible person, even though you rationally know that you are not to blame for having been raped).

     Understanding why you feel a certain way does not change how you feel. But it can keep you from surrendering to intense reactions (for example, assaulting a boss who reminds you of a perpetrator, breaking up with a lover at your first disagreement, or jumping into the arms of a stranger). However, the more frazzled we are, the more our rational brains take a backseat to our emotions.

     Limbic System TherapyThe fundamental issue in resolving traumatic stress is to restore the proper balance between the rational and emotional brains, so that you can feel in charge of how you react and how you conduct your life. When we’re triggered into states of hyper-or hypoarousal, we are pushed outside our “window of tolerance”— the range of optimal functioning. We become reactive and disorganized; our filters stop working—sounds and lights bother us, unwanted images from the past intrude on our minds, and we panic or fly into rages. If we’re shut down, we feel numb in body and mind; our thinking becomes sluggish and we have trouble getting out of our chairs.

     As long as people are either hyperaroused or shut down, they cannot learn from experience. Even if they manage to stay in control, they become so uptight that they are inflexible, stubborn, and depressed. Recovery from trauma involves the restoration of executive functioning and, with it, self- confidence and the capacity for playfulness and creativity.

     If we want to change posttraumatic reactions, we have to access the emotional brain and do “limbic system therapy”: repairing faulty alarm systems and restoring the emotional brain to its ordinary job of being a quiet background presence that takes care of the housekeeping of the body, ensuring that you eat, sleep, connect with intimate partners, protect your children, and defend against danger.

     The neuroscientist Joseph LeDoux and his colleagues have shown that the only way we can consciously access the emotional brain is through self awareness, i.e. by activating the medial prefrontal cortex, the part of the brain that notices what is going on inside us and thus allows us to feel what we’re feeling. (The technical term for this is “interoception”— Latin for “looking inside.”)

     Most of our conscious brain is dedicated to focusing on the outside world: getting along with others and making plans for the future. However, that does not help us manage ourselves. Neuroscience research shows that the only way we can change the way we feel is by becoming aware of our inner experience and learning to befriend what is going inside ourselves.

Befriending the emotional brain
Dealing with Hyperarousal  

     Over the past few decades mainstream psychiatry has focused on using drugs to change the way we feel, and this has become the accepted way to deal with hyper/hypoarousal. However, we have a host of built-in skills to keep us on an even keel. Some 80 percent of the fibers of the vagus nerve (which connects the brain with many internal organs) are afferent; that is, they run from the body into the brain.

     This means that we can directly train our arousal system by the way we breathe, chant, and move, a principle that has been utilized since time immemorial in places like China and India, and in every religious practice that I know of, but that is suspiciously eyed as “alternative” in mainstream culture.

     In research supported by the National Institutes of Health, Bessel Van Der Kolk and colleagues have shown that ten weeks of yoga practice markedly reduced the PTSD symptoms of patients who had failed to respond to any medication or to any other treatment. Neurofeedback can also be particularly effective for children and adults who are so hyperaroused or shut down that they have trouble focusing and prioritizing.

Learning how to breathe calmly and remaining in a state of relative physical relaxation, even while accessing painful and horrifying memories, is an essential tool for recovery.

     When you deliberately take a few slow, deep breaths, you will notice the effects of the parasympathetic brake on your arousal. The more you stay focused on your breathing, the more you will benefit, particularly if you pay attention until the very end of the out breath and then wait a moment before you inhale again. As you continue to breathe and notice the air moving in and out of your lungs you may think about the role that oxygen plays in nourishing your body and bathing your tissues with the energy you need to feel alive and engaged.

     Mainstream Western psychiatric and psychological healing traditions have paid scant attention to self- management. In contrast to the Western reliance on drugs and verbal therapies, other traditions from around the world rely on mindfulness, movement, rhythms, and action. Yoga in India, tai chi and qigong in China, and rhythmical drumming throughout Africa are just a few examples. The cultures of Japan and the Korean peninsula have spawned martial arts, which focus on the cultivation of purposeful movement and being centered in the present, abilities that are damaged in traumatized individuals. Aikido, judo, tae kwon do, kendo, and jujitsu, as well as capoeira from Brazil, are examples. These techniques all involve physical movement, breathing, and meditation. Aside from yoga, few of these popular non-Western healing traditions have been systematically studied for the treatment of PTSD.

No Mind Without Mindfulness.

     At the core of recovery is self-awareness. The most important phrases in trauma therapy are “Notice that” and “What happens next?” Traumatized people live with seemingly unbearable sensations: They feel heartbroken and suffer from intolerable sensations in the pit of their stomach or tightness in their chest. Yet avoiding feeling these sensations in our bodies increases our vulnerability to being overwhelmed by them. Body awareness puts us in touch with our inner world, the landscape of our organism.

     Simply noticing our annoyance, nervousness, or anxiety immediately helps us shift our perspective and opens up new options other than our automatic, habitual reactions. Mindfulness puts us in touch with the transitory nature of our feelings and perceptions. When we pay focused attention to our bodily sensations, we can recognize the ebb and flow of our emotions and, with that, increase our control over them.

     Experiencing trauma causes the body to become afraid of feeling. It is not so much the perpetrators (who, hopefully, are no longer around to hurt them) but our own physical sensations that now are the enemy. Apprehension about being hijacked by uncomfortable sensations keeps the body frozen and the mind shut. Even though the trauma is a thing of the past, the emotional brain keeps generating sensations that make the sufferer feel scared and helpless. It’s not surprising that so many trauma survivors are compulsive eaters and drinkers, shun making love, and avoid many social activities: Their sensory world is largely off limits.

     In order to change you need to open yourself to your inner experience. The first step is to allow your mind to focus on your sensations and notice how, in contrast to the timeless, ever-present experience of trauma, physical sensations are transient and respond to slight shifts in body position, changes in breathing, and shifts in thinking. Once you pay attention to your physical sensations, the next step is to label them, as in “When I feel anxious, I feel a crushing sensation in my chest.” And you can begin to notice how these sensations constantly shift and change.

     Practicing mindfulness calms down the sympathetic nervous system, so that you are less likely to be thrown into fight‑or‑flight. Learning to observe and tolerate your physical reactions is a prerequisite for safely revisiting the past. If you cannot tolerate what you are feeling right now, opening up the past will only compound the misery and re-traumatize you further.

     Once we are fully aware that the commotions in our bodies are in a constant state of flux we can tolerate whatever discomfort comes up. One moment your chest tightens, but after you take a deep breath and exhale, that feeling softens and you may observe something else, perhaps a tension in your shoulder. Now you can start exploring what happens when you take a deeper breath and notice how your rib cage expands. Once you feel calmer and more curious, you can go back to that sensation in your shoulder. You should not be surprised if a memory spontaneously arises in which that shoulder was somehow involved.

     A further step is to observe the interplay between your thoughts and your physical sensations. How are particular thoughts registered in your body? (Do thoughts like “My father loves me” or “my girlfriend dumped me” produce different sensations?) Becoming aware of how your body organizes particular emotions or memories opens up the possibility of releasing sensations and impulses that you may have learned to block in order to survive.               
-Adapted from Bessel Van der Kolk’s book, “The Body Keeps The Score: Brain, Mind and Body in the Healing of Trauma

​Body Oriented Techniques:
When the body has been hijacked by trauma, it is helpful to have some tools that can help restore a sense of safety between sessions. These body oriented techniques can help restore the sense of safety.

1. Place the right hand under the left armpit (as if cupping the side of your chest). Place the left hand on the right upper arm just below the shoulder. The arms are now crossed as if you are hugging yourself. Holding the body in this way helps us become aware of our container. The body is the container of all of our sensations and feelings. When you can feel the container the sensations and emotions don’t feel so overwhelming.
2. Place one hand on forehead and one on heart. Feel what goes on between the hands. You may feel an energy flow or a change in temperature or a feeling. Once you feel some kind of a shift, take the upper hand that is on the forehead and move it to the belly. Pay attention to the feeling between the hands. ​