New Moves in Trauma Treatment

NEED ANOTHER reason to take up yoga or try a bodywork program like Feldenkrais  (an exercise therapy that uses gentle movements  to reorient mind-body connections)?

Turns out that, besides working on the physical body,  movement programs can also balance and strengthen one’s mental state.

Brain imaging in recent years has discovered that trauma, including that from childhood, is lodged in primitive parts of the brain—brainstem, hypothalamus and limbic systems.  A deeply distressing or disturbing experience might be beyond the scope of traditional treatments like psychotherapy or Cognitive Behavioral Therapy (see MyLittleBird post Confronting Anxiety) because these address higher-level brain functions, such as language.

“When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it,” writes Boston psychiatrist Bessel van der Kolk, author of the 2014 book The Body Keeps Score. That’s also the name of his all-day workshop, subtitled “When Talk Isn’t Enough,” at the recent Psychotherapy Networker Symposium.

“All trauma is pre-verbal,” van der Kolk writes.  “When something reminds traumatized people of the past, the right brain reacts as if trauma is happening in the present…they are just furious, terrified, enraged, ashamed or frozen.”

One recent imaging technique—the “functional MRI” (fMRI), which traces changes in blood flow—shows decreased neural activity in almost every area of trauma sufferers’ brains.  The fMRI also shows neuroplasticity—ongoing changes that occur in response to the environment or therapy—in “lower” parts of the brain, previously believed to be impossible.

At Boston’s Trauma Center, founded by van der Kolk, therapeutic yoga positively affected both arousal levels and PTSD symptoms in a small group of subjects, while those in a program of Dialectical Behavior Therapy (incorporating mindfulness) did not improve.  Van der Kolk cites evidence that yoga’s combination of breathing practices with postures and meditation helps balance the central nervous system.

Also recent is the understanding that trauma can occur even in childhoods where basic needs—food, clothing and shelter—are met.  In How Children Succeed, Paul Tough describes categories of “adverse childhood experiences” (ACEs) that can be chronic and ongoing.  Besides abuse, ACEs include growing up in a “seriously dysfunctional household,” which extends to parents with substance-abuse problems, often with underlying mental illnesses, and those who divorce.  The third category is “neglect,” which can occur when parents are present but disengaged, creating what’s called “chronic understimulation.”

Mild, early trauma can cause a lifetime of physical ills: heart disease, liver disease, emphysema or chronic bronchitis and many symptoms of immune system dysfunction such as chronic fatigue.  (Van der Kolk talks about the effect on the immune system of incest, which can provoke an immune reaction to the person’s own body as if faced with ongoing danger.) Early trauma has also been linked to difficulties in learning and behavior that include attention regulation, cognition and language development.

“We found that lots of clients who usually intellectualized their way through talk therapy responded well to guided imagery, sensate body focusing…” writes UCLA psychiatrist Daniel Siegal (author of the recent Mind: A Journey to the Heart of Being Human) in a blog for Psychotherapy Networker.

During the 1990s—named the “Decade of the Brain” by President George Bush—Siegal writes, “We began to look at how therapy can catalyze neural growth to create long-lasting change…to optimize self-regulation, the coordinated flow of energy and information through the major systems of the brain—brain stem, limbic circuits…”

Van der Kolk believes the essence of trauma is dissociation—a feeling of numbness or a lack of connection to the body, or self-numbing with food, work, drugs, alcohol.  For many people, ongoing stress makes them feel stuck and unable to trust others.

To help overcome trauma, van der Kolk uses a kind of role-playing therapy that involves both the physical body and other people—whenever he has a “small group and a willing volunteer,” according to Jeneen Interlandi in the New York Times.  Interlandi describes van der Kolk’s “four decades studying and trying to treat the effects of the worst atrocities we inflict on each other: war, rape, incest, torture and physical and mental abuse,” and writing some 100 peer-reviewed papers on psychological trauma.

“In so many cases, it was patients’ bodies that had been grossly violated, and it was their bodies that had failed them—legs had not run quickly enough…voices had not screamed loudly enough to evade disaster,” Interlandi explains.  She quotes van der Kolk: “The single most important issue for traumatized people is to find a sense of safety in their own bodies.”

Van der Kolk’s therapy exercise, called a “structure,” is based on psychomotor therapy developed by a dancer.  One of van der Kolk’s therapy groups focused on a soldier suffering from PTSD after shooting a man who appeared threatening but turned out to be unarmed, and then watching the man’s mother discover his body.  As different group members were assigned roles of people involved in the incident, they moved to sit very close to the soldier and, as he told the story, to touch and hold him. Van der Kolk considers touch a source of physical comfort that’s “about how we collectively care for each other.”

Van der Kolk’s critics, such as New York neuroscientist Joseph Le Doux, contend that the rational and emotional brains are already well integrated and communicate regularly, and that van der Kolk’s scans showing otherwise are not reliable.  Critics also point to the dearth of controlled studies supporting the use of psychomotor therapy, yoga, massage or acupuncture for trauma.

Data on more than 10,000 September 11 survivors, however, show that the most popular therapy requested was acupuncture, along with massage and yoga.  Yoga is about regulating the body, says van der Kolk, and therapies such as craniosacral and Feldenkrais involve touch.

He also points out that there was very little PTSD as a result of 9/11 because no one blamed New Yorkers and—in contrast to the child who has no one coming to their aid—the world “poured caring and love into New York City.”

—Mary Carpenter
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