rachelmanija (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
rachelmanija) wrote2012-02-12 07:18 pm
rachelmanija) wrote2012-02-12 07:18 pm
Entry tags:
Trauma and PTSD Reading and Excerpts
If I get through all this tonight, I will go eat dinner and watch some Flashpoint. Really dense material below - but interesting.
Summary:
- PTSD is largely a matter of conditioned physiological changes, which are very hard to change via insight and introspection alone.
- Many people face trauma, but not all develop PTSD. People are wired to respond to fear with action (fight/flight.) If they are immobilized and helpless, literally or metaphorically, during a trauma, they are likely to develop PTSD. This may have a biological basis. If they could take action - complete the fight/flight response - they may be able to decondition some of their PTSD reflexes.
- Traumatized people often freak out when meditating due to its internal focus's tendency to send them straight into traumatic memories. But meditation or mindfulness would probably be helpful if they could manage it. Wonder if movement-based meditative practices are less likely to cause freak-outs? If so, that would explain why so many survivors find movement practices helpful. Maybe the movement provides a balance between interior feelings (scary/bad) and external focus (move left arm to block), thus decreasing interior focus and making it more tolerable.
If the trauma is partly caused by the interruption of the fight/flight response and people being forced, physically or by circumstance, into helplessness or inaction, then maybe movement lets them work through the fight/flight (action) response they needed, thus rewiring conditioned responses.
Lots of detail below cut.
"Clinical Implications of Neuroscience Research in PTSD," BESSEL A. VAN DER KOLK
ABSTRACT: The research showing how exposure to extreme stress affects brain function is making important contributions to understanding the nature of traumatic stress. This includes the notion that traumatized individuals are vulnerable to react to sensory information with subcortically initiated responses that are irrelevant, and often harmful, in the present. Reminders of traumatic experiences activate brain regions that support intense emotions, and decrease activation in the central nervous system (CNS) regions involved in (a) the integration of sensory input with motor output, (b) the modulation of physiological arousal, and (c) the capacity to communicate experience in words. Failures of attention and memory in posttraumatic stress disorder (PTSD) interfere with the capacity to engage in the present: traumatized individuals “lose their way in the world.” This article discusses the implications of this research by suggesting that effective treatment needs to involve (a) learning to tolerate feelings and sensations by increasing the capacity for interoception [Rachel: interoception -sensitivity to stimuli originating inside of the body], (b) learning to modulate arousal, and (c) learning that after confrontation with physical helplessness it is essential to engage in taking effective action.
"The fact that reminders of the past automatically activate certain neurobiological responses explains why trauma survivors are vulnerable to react with irrational—subcortically initiate—responses that are irrelevant, and even harmful, in the present. Traumatized individuals may blow up in response to minor provocations; freeze when frustrated, or become helpless in the face of trivial challenges."
People with PTSD have their Broca's areas partially deactivated when exposed to traumatic stimuli. ("the expressive speech center in the brain, the area necessary to communicate what one is thinking and feeling.") Hence, very very hard to answer the question, "How are you feeling?"
"Since at least 1889 it has been noted that traumatized individuals are prone to respond to reminders of the past by automatically engaging in physical actions that must have been appropriate at the time of the trauma, but that are no longer relevant. In “The Traumatic Neuroses of War” Kardiner described how WWI veterans riding on the New York subway were prone to duck in fear and behave as if they were back in the trenches when the train entered a tunnel."
"Many traumatized children and adults, confronted with chronically overwhelming emotions, lose their capacity to use emotions as guides for effective action. They often do not recognize what they are feeling and fail to mount an appropriate response. This phenomenon is called “alexithymia,” an inability to identify the meaning of physical sensations and muscle activation. Failure to recognize what is going on causes them to be out of touch with their needs, and, as a consequence, they are unable to take care of them. This inability to correctly identify sensations, emotions, and physical states often extends itself to having difficulty appreciating the emotional states and needs of those around them. Unable to gauge and modulate their own internal states they habitually collapse in the face of threat, or lash out in response to minor irritations."
"the rational, executive brain, the mind, the part that needs to be functional in order to engage in the process of psychotherapy, has very limited capacity to squelch sensations, control emotional arousal, or change fixed action patterns."
Need mind-body integrative practices. Many types of these were born in Asia (meditation, martial arts, yoga, etc); in Europe and the US, some were also created but were considered more "fringe." (Many mentioned, including Pesso-Boyden psychotherapy, Rubenfeld synergy, Hakomi. Never heard of them - talk about fringe.)
"one of the most critical factors that renders a situation traumatic is the experience of physical helplessness—the realization that no action can be taken to stave off the inevitable. Trauma can be conceptualized as stemming from a failure of the natural physiological activation and hormonal secretions to organize an effective response to threat. Rather than producing a successful fight or flight response the organism becomes immobilized. Probably the best animal model for this phenomenon is that of ‘inescapable shock,” in which creatures are tortured without being unable to do anything to affect the outcome of events. The resulting failure to fight or escape, that is, the physical immobilization, becomes a conditioned behavioral response."
BINGO. No wonder being tied up and abused was so traumatic - I mean, apart from the obvious. But in general, "captivity" - kidnapping, political imprisonment, being tied up - is extremely, extremely prone to producing PTSD.
"LeDoux and his colleagues showed that, in rats, it is possible to redirect the fear conditioned pathway that is responsible for initiating autonomic and endocrine reactions and behavioral immobilization. When rats are given the option of physically escaping from the stimulus they lose their conditioning, even after a conditioned fear response is well established."
Give people a chance to "escape" (or fight, presumably) and they can rewire themselves? Apparently so:
"In our clinic and laboratory we have taken the findings from neuroscience about the rerouting of conditioned responses by taking effective action very seriously. Neuroscience research provides the theoretical underpinning of our work with action-oriented programs with traumatized adolescents and adults, involving improvisational theater, “model mugging” (in which women who have been raped are taught self-defense and learn to actively fight of a simulated attack by a potential rapist), and other interventions that involve physical
action."
Here they do an experiment with people with PTSD: one group does yoga, one group does talk therapy (DBT). Mild improvement of somatic symptoms for yoga group, though (if I'm understanding the very technical report correctly) the PTSD groups had such disturbed somatic baselines (like heart rate) that they couldn't even get accurate measurements for a number of them. Subjective reports from the yoga group were extremely positive.
"Most traumas occur in the context of interpersonal relationships, which involve boundary violations, loss of autonomous action, and loss of self regulation. When people lack sources of support and sustenance, such as is common with abused children, women trapped in domestic violence, and incarcerated men, they are likely to learn to respond to abuse and threat with
mechanistic compliance or resigned submission. Particularly if the brutalization has been repetitive and unrelenting, they are vulnerable to continue to become physiologically dysregulated and go into states of extreme hypo- and hyperarousal, accompanied by physical immobilization. Often, these responses become habitual, and, as a result, many victims develop chronic problems initiating effective, independent action, even in situations where, rationally, they could be expected to be able to stand up for themselves and take care of things."
"Clinical experience shows that traumatized individuals, as a rule, have great difficulty attending to their inner sensations and perceptions—when asked to focus on internal sensations they tend to feel overwhelmed, or deny having an inner sense of themselves. When they try to meditate they often report becoming overwhelmed by being confronted with residues of trauma-related perceptions, sensations, and emotions: they report of feeling disgusted with themselves, helpless, panicked, or experiencing trauma-related images and physical sensations. Trauma victims tend to have a negative body image— as far as they are concerned, the less attention they pay to their bodies, and thereby, their internal sensations, the better. Yet, one cannot learn to take care of oneself without being in touch with the demands and requirements of one’s physical self."
"Traumatized individuals need to learn that it is safe to have feelings and sensations. If they learn to attend to inner experience they will become aware that bodily experience never remains static. Unlike at the moment of a trauma, when everything seems to freeze in time, physical sensations and emotions are in a constant state of flux."
"it is critical to help create a physical sense of control by working on the establishment of physical boundaries, exploring ways of regulating physiological arousal, in which using breath and body movement can be extremely useful, and focusing on regaining a physical sense of being able to defend and protect oneself. It is particularly useful to explore previous experiences of safety and competency and to activate memories of what it feels like to experience pleasure, enjoyment, focus, power, and effectiveness, before activating trauma-related sensations and emotions. Working with trauma is as much about remembering how one survived as it is about what is broken."
Summary:
- PTSD is largely a matter of conditioned physiological changes, which are very hard to change via insight and introspection alone.
- Many people face trauma, but not all develop PTSD. People are wired to respond to fear with action (fight/flight.) If they are immobilized and helpless, literally or metaphorically, during a trauma, they are likely to develop PTSD. This may have a biological basis. If they could take action - complete the fight/flight response - they may be able to decondition some of their PTSD reflexes.
- Traumatized people often freak out when meditating due to its internal focus's tendency to send them straight into traumatic memories. But meditation or mindfulness would probably be helpful if they could manage it. Wonder if movement-based meditative practices are less likely to cause freak-outs? If so, that would explain why so many survivors find movement practices helpful. Maybe the movement provides a balance between interior feelings (scary/bad) and external focus (move left arm to block), thus decreasing interior focus and making it more tolerable.
If the trauma is partly caused by the interruption of the fight/flight response and people being forced, physically or by circumstance, into helplessness or inaction, then maybe movement lets them work through the fight/flight (action) response they needed, thus rewiring conditioned responses.
Lots of detail below cut.
"Clinical Implications of Neuroscience Research in PTSD," BESSEL A. VAN DER KOLK
ABSTRACT: The research showing how exposure to extreme stress affects brain function is making important contributions to understanding the nature of traumatic stress. This includes the notion that traumatized individuals are vulnerable to react to sensory information with subcortically initiated responses that are irrelevant, and often harmful, in the present. Reminders of traumatic experiences activate brain regions that support intense emotions, and decrease activation in the central nervous system (CNS) regions involved in (a) the integration of sensory input with motor output, (b) the modulation of physiological arousal, and (c) the capacity to communicate experience in words. Failures of attention and memory in posttraumatic stress disorder (PTSD) interfere with the capacity to engage in the present: traumatized individuals “lose their way in the world.” This article discusses the implications of this research by suggesting that effective treatment needs to involve (a) learning to tolerate feelings and sensations by increasing the capacity for interoception [Rachel: interoception -sensitivity to stimuli originating inside of the body], (b) learning to modulate arousal, and (c) learning that after confrontation with physical helplessness it is essential to engage in taking effective action.
"The fact that reminders of the past automatically activate certain neurobiological responses explains why trauma survivors are vulnerable to react with irrational—subcortically initiate—responses that are irrelevant, and even harmful, in the present. Traumatized individuals may blow up in response to minor provocations; freeze when frustrated, or become helpless in the face of trivial challenges."
People with PTSD have their Broca's areas partially deactivated when exposed to traumatic stimuli. ("the expressive speech center in the brain, the area necessary to communicate what one is thinking and feeling.") Hence, very very hard to answer the question, "How are you feeling?"
"Since at least 1889 it has been noted that traumatized individuals are prone to respond to reminders of the past by automatically engaging in physical actions that must have been appropriate at the time of the trauma, but that are no longer relevant. In “The Traumatic Neuroses of War” Kardiner described how WWI veterans riding on the New York subway were prone to duck in fear and behave as if they were back in the trenches when the train entered a tunnel."
"Many traumatized children and adults, confronted with chronically overwhelming emotions, lose their capacity to use emotions as guides for effective action. They often do not recognize what they are feeling and fail to mount an appropriate response. This phenomenon is called “alexithymia,” an inability to identify the meaning of physical sensations and muscle activation. Failure to recognize what is going on causes them to be out of touch with their needs, and, as a consequence, they are unable to take care of them. This inability to correctly identify sensations, emotions, and physical states often extends itself to having difficulty appreciating the emotional states and needs of those around them. Unable to gauge and modulate their own internal states they habitually collapse in the face of threat, or lash out in response to minor irritations."
"the rational, executive brain, the mind, the part that needs to be functional in order to engage in the process of psychotherapy, has very limited capacity to squelch sensations, control emotional arousal, or change fixed action patterns."
Need mind-body integrative practices. Many types of these were born in Asia (meditation, martial arts, yoga, etc); in Europe and the US, some were also created but were considered more "fringe." (Many mentioned, including Pesso-Boyden psychotherapy, Rubenfeld synergy, Hakomi. Never heard of them - talk about fringe.)
"one of the most critical factors that renders a situation traumatic is the experience of physical helplessness—the realization that no action can be taken to stave off the inevitable. Trauma can be conceptualized as stemming from a failure of the natural physiological activation and hormonal secretions to organize an effective response to threat. Rather than producing a successful fight or flight response the organism becomes immobilized. Probably the best animal model for this phenomenon is that of ‘inescapable shock,” in which creatures are tortured without being unable to do anything to affect the outcome of events. The resulting failure to fight or escape, that is, the physical immobilization, becomes a conditioned behavioral response."
BINGO. No wonder being tied up and abused was so traumatic - I mean, apart from the obvious. But in general, "captivity" - kidnapping, political imprisonment, being tied up - is extremely, extremely prone to producing PTSD.
"LeDoux and his colleagues showed that, in rats, it is possible to redirect the fear conditioned pathway that is responsible for initiating autonomic and endocrine reactions and behavioral immobilization. When rats are given the option of physically escaping from the stimulus they lose their conditioning, even after a conditioned fear response is well established."
Give people a chance to "escape" (or fight, presumably) and they can rewire themselves? Apparently so:
"In our clinic and laboratory we have taken the findings from neuroscience about the rerouting of conditioned responses by taking effective action very seriously. Neuroscience research provides the theoretical underpinning of our work with action-oriented programs with traumatized adolescents and adults, involving improvisational theater, “model mugging” (in which women who have been raped are taught self-defense and learn to actively fight of a simulated attack by a potential rapist), and other interventions that involve physical
action."
Here they do an experiment with people with PTSD: one group does yoga, one group does talk therapy (DBT). Mild improvement of somatic symptoms for yoga group, though (if I'm understanding the very technical report correctly) the PTSD groups had such disturbed somatic baselines (like heart rate) that they couldn't even get accurate measurements for a number of them. Subjective reports from the yoga group were extremely positive.
"Most traumas occur in the context of interpersonal relationships, which involve boundary violations, loss of autonomous action, and loss of self regulation. When people lack sources of support and sustenance, such as is common with abused children, women trapped in domestic violence, and incarcerated men, they are likely to learn to respond to abuse and threat with
mechanistic compliance or resigned submission. Particularly if the brutalization has been repetitive and unrelenting, they are vulnerable to continue to become physiologically dysregulated and go into states of extreme hypo- and hyperarousal, accompanied by physical immobilization. Often, these responses become habitual, and, as a result, many victims develop chronic problems initiating effective, independent action, even in situations where, rationally, they could be expected to be able to stand up for themselves and take care of things."
"Clinical experience shows that traumatized individuals, as a rule, have great difficulty attending to their inner sensations and perceptions—when asked to focus on internal sensations they tend to feel overwhelmed, or deny having an inner sense of themselves. When they try to meditate they often report becoming overwhelmed by being confronted with residues of trauma-related perceptions, sensations, and emotions: they report of feeling disgusted with themselves, helpless, panicked, or experiencing trauma-related images and physical sensations. Trauma victims tend to have a negative body image— as far as they are concerned, the less attention they pay to their bodies, and thereby, their internal sensations, the better. Yet, one cannot learn to take care of oneself without being in touch with the demands and requirements of one’s physical self."
"Traumatized individuals need to learn that it is safe to have feelings and sensations. If they learn to attend to inner experience they will become aware that bodily experience never remains static. Unlike at the moment of a trauma, when everything seems to freeze in time, physical sensations and emotions are in a constant state of flux."
"it is critical to help create a physical sense of control by working on the establishment of physical boundaries, exploring ways of regulating physiological arousal, in which using breath and body movement can be extremely useful, and focusing on regaining a physical sense of being able to defend and protect oneself. It is particularly useful to explore previous experiences of safety and competency and to activate memories of what it feels like to experience pleasure, enjoyment, focus, power, and effectiveness, before activating trauma-related sensations and emotions. Working with trauma is as much about remembering how one survived as it is about what is broken."
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This article sounds like it really connects with what we're doing right now so i wrote the article name in my book to take along the next time I go see my psychiatrist.
I really identify with the troubles associated around contemplative meditation. I arm myself with books and an mp3 player and knitting because I must never be (mentally) idle. It's amazing - if I try to just sit with nothing to read or listen to or do it doesn't take long for my mood to plummet and stress to rise. It's overwhelming and frightening so I avoid it.
I have issues around sleep for this very reason - I have to drug myself to sleep, or else I'm up reading until the book tumbles out of my hand as I fall asleep midsentence. If I'm forced to remain in a dark room with no drug assistance to sleep, I will wind up hiding in the closet with horrible panic attacks. I often hid in confined spaces, often spaces that people would think were too small for me to fit into. But I fold up very well.
But I love Hatha Yoga and I had an extremely positive experience with indoor rock climbing and I have repeatedly praised cycling as a "mood miracle" and it's helped to change that rejection of the body talked about here too. other physical activities are too intimidating, but I've gotten more comfortable with increased heart rate with cycling, so maybe my activites will expand.
One other thing - I have often been encouraged to join self defense classes or martial arts classes. I can't do it. I just shut down around the idea of physically fighting my way out of a problem - it was actually hard to write that sentence. It has to do with the consequences I faced if I showed any resistance, i understand that, but the day i enroll in a course like that is a day for champagne and celebration. I doubt it will ever happen.
Me, me, me! -- Me too!
ARE YOU ME? Because yeah, I ALWAYS have a book, multiple books, _and_ a notebook and music and whatever with me. Being idle = bad things mentally. That's one reason I found it difficult to shower when depressed, because that's practically like a meditative mindfulness exercise in and of itself. When I was younger and bored I would just sort of automatically get in trouble, if I didn't have a book. Reading was so obviously my self-soothing mechanism (and escape, and entertainment, and how I learned things, &c &c) if I were a kid now I think adults might not try so hard to take it away. Or at least, it's pretty to think so.
I have issues around sleep for this very reason - I have to drug myself to sleep, or else I'm up reading until the book tumbles out of my hand as I fall asleep midsentence. If I'm forced to remain in a dark room with no drug assistance to sleep, I will wind up hiding in the closet with horrible panic attacks.
DUDE
YES
OMFG, even up til when I started living with T, I would have the lights on, the radio or music on, and reading a book, and I would read right up til the book fell out of my hand. That's still the best way for me to get to sleep. Otherwise, I lie there, and I tense up, and freak out, and it doesn't take long for me to tip right over into an anxiety attack, especially if everything is dark and quiet. UGH. Situations other people find soothing tend to make me really agitated.
OTOH there's what Alice Sebold (yeah) calls "trauma Zen" in her memoir (much better than her awful first novel), where if you're waiting in a stressful situation you can just kind of space out and dissociate and not flip out. I do this so frequently in hospitals, it's not even funny. I can actually feel my emotions just sort of shut off.
I often hid in confined spaces, often spaces that people would think were too small for me to fit into. But I fold up very well.
I used to hide in the closet as a kid, or under the bed, or one of my favourite places ever was under my mother's piano, while she practiced. I LOVED folding up under stuff. I can't do it much anymore (too fat and too stiff), but I'll still retreat to the bathroom if I'm having a bad anxiety attack. It just feels more....manageable.
Re: Me, me, me! -- Me too!
Re: Me, me, me! -- Me too!
Did you hear the whole saga of how my New Awesome GP looked at me and was all, "Have you ever been tested for ADHD?" and I was like "....no?" and she gave me this book called Women with ADD and asked me to tell her if it rang any bells and oh, God, it was like a carillon (sp). And apparently ADD can increase your risk for PTSD? And ADD already increases the risk of depression and anxiety disorders and mood disorders and all kindsa shit. WHOO. I seriously so fit every single symptom of 'ADHD predominantly inattentive,' it was almost scary. - Weirdly enough, my mother also has a lot of the same symptoms, especially when she was younger -- inattention, dreaminess, ability to just escape inside her head, &c &c, except she was school valedictorian at 16 and I was a dropout. But we also both have that whack-ass extreme distractibility COMBINED WITH the ability to hyperfocus thing going on.
....oh dear, I thought this post was locked, HAHA WHOOPS. Oh well, it's not like I conceal this stuff on the internet anyway.
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I don't think the type of movement matters, only that it's something that feels good to you. If you can't do it, it's useless. Personal triumphs over fears are great, but I'm not a fan of "do it because it feels bad and scary."
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Heh
heh
heh
yep
"Corpse position" in yoga? YEAH NO. I would start freaking out. Then I would start distracting myself by reciting poetry in my head or reciting prime numbers or whatever. Then I would feel guilty because this isn't meditation, apparently. Whoops.
Wonder if movement-based meditative practices are less likely to cause freak-outs? If so, that would explain why so many survivors find movement practices helpful. Maybe the movement provides a balance between interior feelings (scary/bad) and external focus (move left arm to block), thus decreasing interior focus and making it more tolerable.
Tai chi, and the non-meditative parts of yoga, were always SO much more helpful to me than meditation. Didn't you say you had essentially treated most of your own PTSD with karate training? It seems like that would work on both a physical and psychological level -- helping the fight/flight impulse, in actually _doing_ something, as well as establishing boundaries and being able to defend yourself, while working off the physical stuff.
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I would say that this, without fail, has been the hardest for people (usually family) in my life to understand, even including some therapists. If you're depressed, why don't you work on feeling better? If you're feeling bad, why not go to therapy? &c &c. It just really does feel like you go blank. The way I described it to countless doctors was that it's like my spark plug is broken, or the engine doesn't turn over, or something. It's like the kick just isn't there. It's SO FRUSTRATING. The Vyvanse has helped a lot with that, and surprisingly, also with the emotional bluntness (the mood stabilizers tend to take care of the wild mood swings, but also blunt me a bit). It's like the most fucking frustrating thing ever.
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Is that old hat now?
I like the idea of teaching martial arts to survivors.
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Question: Bullying and PTSD
Would it be possible for simple schoolyard bullying to add up to cause PTSD?
Re: Question: Bullying and PTSD
Re: Question: Bullying and PTSD
That being said, PTSD is a fairly specific mental illness. A person can be significantly affected, traumatized, or harmed without having that particular set of symptoms which make up the phenomena.
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This reminded me of something I came across while reading about serial killers. More than one of them commented (after-the-fact) about how some victims had opportunities to escape, but didn't take them. There was one in particular that has stuck with me a long time: one of them picked up his victims in a car that he had modified to disable the passenger-side window and door latch. He would leave the victims in the car and run an errand and the victims would stay in the car instead of taking the opportunity to try the other windows and doors in an attempt to escape.
That has always stuck with me as a curious type of response on the part of the victims, but I think I understand it a bit better now.
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That's common among long-term victims of kidnapping, by the way.
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---L.
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