Trauma and the Brain

The human body has the  ability to grow, develop, and change. There are three main aspects to the human form: physical, emotional, and psychological. Within each of these aspects, adaptation occurs depending on genetics and environmental influences. When subjecting the human form to different stressors, our minds and bodies are wired toward health, wellness, and survival. For example, if someone is training for a marathon. The person will push his/her body to its limitations. Exercising and exhausting muscles in order to repair and strengthen the body. This amount of stress on the body is challenging, but over time the body adapts and is fortified because of the stress. Or think back to your first relationship-the concept of being “lovesick” is real. You can’t eat or sleep. Your whole mind is consumed. Your brain is being flooded with chemicals like dopamine and norepinephrine. These hormones narrow your focus, constricting your blood vessels, dilating your pupils. The body only has so many ways of responding. So the very chemicals that aid in falling in love, are also some of the same hormones that are secreted when we endure a trauma.

So what exactly is going on when we experience trauma, and more importantly, is it possible to recover? The connection between memory and traumatic stress response is strong. This is why one of the main features of Post Traumatic Stress Disorder is flashbacks to the event. Trauma can (loosely) be divided into two categories. One time big T trauma; and developmental/complex trauma. Big T trauma is something that occurs one time-like getting in a car accident or witnessing 9/11. Developmental or complex trauma is multiple or chronic adverse experiences that occur during development; usually of interpersonal nature. There are many types of developmental trauma including physical, sexual, emotional abuse; community violence and neglect.

During a time of traumatic stress the mind goes into self preservation mode. The sympathetic part of our nervous system clicks ‘on’ and activates the release of norepinephrine, or adrenaline. When the sympathetic nervous system is activated, normal bodily functions shut down in order to preserve energy to defend the perceived threat. This means digestions shuts down, our hearts begin to beat faster-we become focused on what’s in front of us, and we have motivations to fight, flight, freeze, fawn or withdraw. This is the body’s natural defense system; it is healthy and survivalistic. Without this sophisticated system, human life would probably exist.

Here’s the thing though; after the traumatic event occurs and we are out of the environment- our bodies and minds have to process through what just happened. And this is where things can get tricky. We are perceptive creatures, so our realities are a constant calculation of different factors and variables to help us ward off threat. And things we remember from our past, can have physiological bodily responses in the present time.

A memory is “something you remember from the past, a recollection.” Memory can be recalled through external stimuli, like driving past the house you grew up in, or internal stimuli, a familiar scent that takes you to a time in your past. Memories are more than just images, they are feelings and states of mind. And the brain is a highly complex electrical system that works with the other parts of the body, and the environment around you-so information is constantly being taken in a processed.

When working with clients, I like to use the library metaphor to describe how memories are stored in our brain. This is a loose representation of memory, and it is far more complex than how I’m describing; but it will help illustrate my point.  When you go into a library, each book is itemized and has its ‘place’, so in the off chance you need to retrieve that memory, you know how to find it. Like when you meet up with old friends and someone brings up high school graduation. You can easily go into your library of memories, and appropriately bring up the feelings, the images, and the thoughts associated with high school graduation. You can talk about the event, reminisce with your friends, then when you’re done with the conversation-your brain returns the memory to its rightful place in your library of memories. You will not continue to think about this event, until another trigger will tap into that memory web. Now imagine that certain memories (feelings, thoughts, states of mind)  are not chronicled, and these books (memories) are thrown around random places in your mind. So you may be going about your day, and BOOM all of a sudden you’re thinking about that one time in the 3rd grade you did not get picked for softball. A cascade of events go through your mind- you’re feeling rejected and hurt, the same way you did all those years ago. You’re having a response in the present, to a past event. These unprocessed memories are like books thrown around a library. And you may bump into them randomly-and go right back into that traumatic physiological response.

These are unprocessed memories. Ones that have not found their rightful place in the library-thus it’s very difficult for the individual to retrieve them appropriately. So inappropriate retrieval happens, and actually can retraumatize the person. So, there may be a new memory in the present moment, being triggered by the past-that is traumatically stressful again. Did that all make sense? Basically, every moment is an opportunity to heal past trauma, to stay stuck, or to be retraumatized again.

So, how do we process through terrible events in life? No two people are identical; and certainly some personalities are more resilient (this is a topic for another post). It’s also important to keep in mind that one time trauma is different than pervasive developmental trauma. There are more memories and belief systems created when we have lived with interpersonal violence, neglect, and abuse. Nonetheless, healing involves three main components: authentic affect, meaning making, and time. Authentic affect is feeling all the feelings in a supportive and loving environment. One cannot go around the feelings, one must go through the feelings and allow for the transformation to occur. The second part of healing involves meaning making. We are conscious creatures, who use stories to help understand the world around us. And we too, tell ourselves stories about our lives. The good and the bad. So, looking at the meaning of this trauma, and helping making a more complete life narrative. Lastly is time. Giving yourself the gift of time to understand and heal your mind and body. Understanding this will be an ongoing process in life, and seeing this as an opportunity rather than a nuisance.

It’s paramount to find a supportive environment to heal. Perhaps it is a yoga class, a church group, or talking with your mom on the phone everyday. The more you create supportive networks around you to facilitate processing, the faster you will heal. That being said, if you don’t know where to begin, or feel you need a more concentrated space of healing, I recommend finding a trusted therapist to talk with. There are many kinds of therapies designed to help heal trauma including, Eye Movement Desensitization and Reprocessing (EMDR). It is a specific type of therapy to help the brain heal itself from the suffering of its past.

PTSD is an going problem in our country and many people (veterans and others) go lifetimes without help. If you or someone you know is suffering please reach out for help. You are not alone.

I’m grateful to all the men and women who bravely gave of themselves to protect our country. I wish everyone a safe and healing Veterans Day.

In Times of Trouble

It seems we can’t turn on the news, check social media, or even listen to music without some tragic and emotional event shaking us to our core. Whether it is the political climate, the climate, or the devastating vastness of sexual abuse and harassment- so much of our efforts are directed at how to help, and make a difference in what can feel like a bleak situation.

            Here are some small ways to make a difference in what feels like a time of perpetual trouble.

1) Give of your most valuable commodity.

             I’m not speaking monetarily. Most of us don’t have limitless financial resources. I’m talking about the small things that can make an impact on an individual level, right now. While relief efforts are needed with the earthquakes, fires, and flooding; give of your time. After all, it is the most valuable resource. There are troubles all around us, lend an ear, and give your time to a worthy cause or person. Not only is there research to support that it cultivates good feelings within us; but you may just pay it forward and brighten someone else’s day, who will go on and do the same.

2) Find the heroes.

            The negative is plastered in our faces; most of the time-but there is uplifting news out there. Here are a couple stories I found today. “NFL Eagles player Chris Long donating the rest of his salary to charity.” “ICU grandpa snuggles newborns when their parents can’t be at the hospital.” And “Military vets volunteer to rebuild homes destroyed by Hurricane Harvey.” Now, these stories are not front-page news, but they are happening! Go; seek out the heroes in the world. Even if that means googling “positive news today.”

3) Express gratitude.

            There are many ways to give thanks, on an individual to a societal, to a cosmic level. Start small, tomorrow morning when you wake up, and feel heavy with thoughts in your head-check your pulse. You’re alive today…and that’s something. When you’re eating a chicken salad for the fourth day in a row, give thanks for the food in front of you and a full belly. When you accidentally cut someone off on 405 today; wave to the person who didn’t honk their horn at you (and to the person who did). When you come home to the people who love you, after a long day of work-remember that you are safe, and express gratitude. These things add up.

4) Gain some perspective.

I find there is a really quick and easy way to gain some objectivity. Find a 5 year old and an 85 year old to chat with for 5 minutes. The five year old may remind of you the innocence and curiosity in the world. How things can feel new and passionate. The 85 year old, may remind you how the things that are consuming your thoughts and feelings, are ultimately not that important, and can help you prioritize what’s most important in life. Sometimes we just need a reminder of innocence and wisdom, to gain some insight.

And finally…

5) Self Care.

            Never neglect yourself. I can’t emphasize this enough. Now, you may be thinking… “I don’t have time for self care. I have a family, children, a partner, work, meetings, and other demands that are taking up my time…also, what is self care?!” Please review bullet point 1. You are also, worthy of your time. Perhaps you can’t take the week long vacation to Hawaii, but you can do small things for yourself. Here is a list that works for me, I’d love for you to comment and let me know what works for you.

* Listening to soulful music on my drive to work (Nina Simone is a favorite)

* Sitting and having a cup of coffee, alone

* Breathing for 5 deep breaths

* Taking a walk (on my lunch break)

* Calling a friend and reminiscing on a good memory

* Setting aside a time in my calendar to grab dinner with loved ones

* Waking up 15 minutes early (or sleeping in 15 minutes later)

These are small, tiny, itty bitty, differences in my day-but they add up. It all adds up. So, when we are flooded with stress, negative news, and bad days; keep in mind these five things. And perhaps, you can pay it forward too.

Power of Denial

Father of Psychoanalysis, Sigmund Freud, identified three main parts of the human psyche: id, ego, and superego. The id is our wishes and desires, the ego is the mediator, and the superego is our disciplinarian. Here is an example of how the personality structure can work:

Id-“I want ice cream”

Ego- “You can have one scoop of butter pecan”

Superego- “You’re on a diet, put that spoon down!”

These three parts interact and can create internal conflicts. As humans, we do not like to feel pain, especially psychic pain; so Freud uncovered and identified different mechanisms to combat the conflict that ensues when our psychological structure is at odds. Denial is a powerful defense mechanism employed by people to avoid percieved pain.

Denial noun

            the action of declaring something to be untrue

            synonyms: contradiction, refusal, refutation, repudiation, lie

It can be hard to believe the capacity for the human psyche to engage with this powerful defense mechanism, but it happens all the time. On an individual level, denial helps us avoid potentially distressing truths about ourselves. It can be healthy, we have all engaged in denial at one point or another. (I did need to buy another pair of shoes that look exactly like the ones I’m wearing) Denial gets us through the day, and helps create consistency in distressing situations.

But what happens when denial becomes our status quo when going through life? People can live in denial for days, weeks, months, years, and even lifetimes. And depending on the depth, denial creates psychological dysfunction like depression, anxiety, dissociation, personality disorders, and can lead to premature death.

So this leads me to my next point, what happens when there is denial on a greater scale, like in a community or even a nation? Where the contradictions of facts or deception, on a national scale from governments, can lead to mass confusion and apathy, at best. Long-term denial of the reasons why a country may go to war, commit genocide, ignore famine and illness is bewildering to the individuals who are subjects in these atrocities or to those who bear witness to them. So what happens? Over time, people become enraged. This is different than day-to-day anger, and typically the longer the denial, the more intense the rage and desire for retribution.

Essentially, entire populations can experience symptoms of Post Traumatic Stress Disorder; including but not limited to: flashbacks, emotional numbness, persistent and exaggerated negative beliefs or expectations about oneself, others, or the world, persistent feelings of fear, horror, guilt, shame, and extreme irritability.

When discussing how entire races can be effected by governmental decisions, people can be more divisive, less tolerant of other, fearful and distrusting, and vengeful. As individuals, we [frequently] lie to ourselves about a multitude of things in order to protect ourselves from painful truths.

Systemic invalidation of a population or race’s historical experience breeds rage, distrust, and intolerance. None of which promote health. Acknowledgement is the antidote to invalidation. People and populations need to feel heard, seen, and understood. And only through the un-denial can there be a hope for peace of mind or peace of nation.

 

Love, what is it good for?

 

There is a strong relationship between love and health. Not only does love make you feel more connected to those around you, but love can actually make you live longer.

Back in the 1990’s there was a large study done on the relationship between marriage and mortality. There were some, perhaps, more obvious conclusions like; married people reported feeling more supported and financially stable. But, there was an emotional conclusion too, more married couples reported feeling less isolated. Loneliness has been linked to “all cause mortality-dying for any reason.” Marriage seems to protect against loneliness, and thus-death.

Long, stable, committed relationships seem to have a lasting, positive effect on our lives.  When we are around people we love, we feel less anxious, less depressed. Humans are social creatures. We crave bonding and attachment with others. Our brains are wired to connect. When we cuddle, have sex, engage in social interactions (just to name a few,) our brains release a chemical called oxytocin. Oxytocin is long known as the “love hormone.” It helps our brain create connections with others; and once we bond with someone, we want more because it feels good.

Love has been associated with less doctor visits. When we have strong family connections and ties to those around us, we have people who are more encouraging of healthier lifestyles. No one wants to see their loved one sick, and over time these small encouragements can add up to a healthier lifestyle.

Love helps control pain. There have been studies done where subjects have undergone electric shock. The study found that people, who were holding the hand of their partner, showed less activation in the area of the brain that processes pain and stress. Pain and stress management are a growing concern in this day and age. The closer we are to our partners, the more supported we feel. Feeling supported helps us cope with life’s stresses more efficiently.

The greatest, most obvious benefit of love is happiness. We have all heard “you can’t buy happiness” and it’s true. The correlation between love and happiness is greater than the correlation between happiness and a high income. Basically, connections and feelings of support aid in our overall wellbeing, in a way that money (or anything else) can’t.

So, if on this Valentine's Day, you're feeling like the love is lacking, here are a few tips that you can do right now to foster those loving feelings:

·      Say “I love you.”

·      Give a hug and kiss

·      Hold hands

·      Celebrate success with your loved one

·      Make eye contact and smile

·      Express gratitude

So, love-what is it good for?

Everything.

 

Paradox of Tolerance

Tolerance, by definition, is the range of conditions an organism can withstand. Depending on the context, tolerance can illustrate a biological, ecological, mathematical, and a variety of other “-ical” ways of adapting to a state.

When studying human behavior, the idea of tolerance has to do with the capacity of a person to withstand certain conditions and it varies from individual to individual. Behavioral psychology is not predictable like hard sciences. Simply said, people don’t follow equations. There is human error, free choice - and with this, the intentional or unintentional decision to be a walking paradox.

Humans are highly complex organisms who are in constant flux; from moment to moment we have a range of thoughts, feelings, and behaviors that affect each other and may not always be sensical. (Have you ever had a feeling about a feeling, or a thought about a thought?) Therefore, the relative nature of tolerance is subject to the ever-changing environment in an unpredictable way.

The effect emotions have on tolerance can invoke the primal feeling of fear; it is during this time when we as humans can become the exact thing we are defending. This is called the paradox of tolerance, when a tolerant person holds antagonistic views towards intolerance, and hence is intolerant of it. This is a sophisticated complex that we have all engaged in at some point, due to our amorphic perception of reality. We try to make sense of things that don’t make sense

So, what can we do?

It’s ironic how the most complex problems can have the simplest solutions.

1.     Listen

2.     Aim for understanding-try simply repeating another person’s statement, verbatim, then ask them…is this what you said?

3.     Be emotionally honest- “I feel angry.” (that’s it) Chances are you have more in common than you think…you are probably both angry.

4.     Don’t blame- we all respond differently to our experiences and environment

The mind of man is capable of anything…

       

 

 

Who's the right fit?

So you've made the decision to start therapy. Its a brave choice and will likely pay off in a positive way. But now what? How do you go about finding a therapist? Maybe you ask around to your friends or family. Perhaps you get a few, "Oh, my lady is GREAAT!…here's her number, I think you'll really like her." So you wait a day or so, think about it...check out her website, and decide to make the call. You set up an appointment to meet for a first session. What should you be looking for? Many people may not realize that finding a therapist is about finding the right therapist for you. In Los Angeles, we are living in a plethora of therapists, so taking the time to figure the best fit, is well within your right and will improve your chance of benefiting from treatment. 

Therapy works because of three basic concepts: 

1. The therapeutic frame

2. Therapeutic alliance

3. Empathic attunement

The frame is the boundaries/limitations set by the therapist with the patient. Think of the frame like an empty picture frame. The contents of the therapy will exist within the space where the picture would go. These parameters are there for your protection and the protection of the therapy.  This is everything from the day and time you meet, to how many times a week/month you meet, to how often the therapist allows contact during off hours, to how much each session costs and when you pay. As the patient, it's not your job, wholly, to know or understand all aspects of the frame. Your therapist will explain all of these boundaries along the way. Some may be more obvious than others…the most important thing is to ask

The structure of the frame begins with the first phone call/email/text. However, the structure continues to be created from session to session. The frame involves different variables like: the theoretical orientation of the therapist, personal style, needs of a particular patient, and/or particular protocol if the therapist works at a clinic or hospital vs. private practice. Any deviation from the established frame is considered a break down of the frame. And this may happen, but it's important to remember, we are all human and therefore imperfect. 

 There may be times where there is a deconstruction of the frame, or the limits are tested. During these times, it's the reconstruction of the frame that can greatly benefit the therapy. The beauty about starting therapy is, the frame is not fully formed, so we don't know exactly how it will all work, we simply wait and see how the relationship unfolds (at least if we are the patient.)

As the therapist, much thought goes into creating a frame that is specific to the patient and the orientation of the therapist. So when there is a change or something unexpected (restructuring of the frame) it's extremely important for the therapist to  talk the patient through the transition. 

This brings me to point number two, the therapeutic alliance. This is the working relationship between patient and therapist. Essentially, how you feel working with your therapist. Do you like her style, do you feel heard, understood, do you trust her? This is important. The individual style of the therapist can come into play. The things you struggle with that you discuss in therapy are not always pleasant or easy; there may be times when you feel sadness, rage, or surprise. And working with a therapist with whom you have a strong alliance, will give you the strength and understanding to overcome difficult times. 

And lastly, empathic attunement is going to be a great indicator for you to create a positive therapeutic alliance. This refers to the therapist's ability to be able to understand your emotional state and speak to it. Now, this does not mean she is a mind reader and will know what you're thinking and feeling every moment. Empathic attunement means that you and your therapist share a trusted connection where she is able to sense your underlying emotion. It can feel as powerful as magic. 

Keeping all of this in mind, it's important to be honest with yourself.  If you ever feel like the fit is off, the first step is to bring it up with your current therapist. Talk about your experience working with her. Be as open as you can about your expectations and goals for the work. Remember, no two therapists are exactly the same. If you decided that you're not fitting the way you'd like, you may switch therapists. Your current therapist may be able to provide referrals to others in the area, that will better fit your needs.  

Thoughts

I will be using this space to discuss different topics related to therapy and psychology. I hope you find the posts helpful in your understanding of the way therapy works and the benefits of therapy. Feel free to let me know if there is a topic you would like me to write about. However, please note- this space will be used for general educational purposes only. If you have a specific question regarding your therapeutic needs, please reach out to me directly.