Blog

Every few weeks, I will post my thoughts from various books, articles, and discussions – as an extension of my desire to understand better the relationship between human behavioral health and counseling/psychotherapy. This blog is NOT intended to diagnose, treat, or replace person-to-person psychological, medical, or legal professional consultation.

Distressing Events, REM Sleep, & EMDR Therapy

Posted by on Sep 21, 2018 in Research | 0 comments

Distressing Events, REM Sleep, & EMDR Therapy

Several weeks ago, strolling through our local Barnes & Noble, a book title caught my eye. Why We Sleep; Unlocking the Power of Sleep and Dreams (2017) by Matthew Walker, PhD. Little did I know in that moment, it would become a most interesting and informative read. Dr. Walker is a professor of neuroscience and psychology at the University of California, Berkeley, and the director of the Center for Human Sleep Science. He is also a former professor of psychiatry at Harvard University. I was particularly interested in reading about the stage of REM (Rapid Eye Movement) sleep, and its possible implications for EMDR (Eye Movement Desensitization & Reprocessing) therapy – which I will say more about later.

In Chapter 10 called “Dreaming as Overnight Therapy, Dr. Walker writes:

“It is said that time heals all wounds. Several years ago I decided to scientifically test this age-old wisdom….Perhaps it was not time that heals all wounds, but rather time spent in dream sleep. I had been developing a theory based on the combined patterns of brain activity and brain neurochemistry of REM sleep, and from this theory came a specific prediction: REM-sleep dreaming offers a form of overnight therapy. That is, REM-sleep dreaming takes the painful sting out of the difficult, even traumatic, emotional episodes you have experienced during the day, offering emotional resolution when you awake the next morning.

At the heart of the theory was an astonishing change in the chemical cocktail of your brain that takes place during REM sleep. Concentrations of a key stress-related chemical called noradrenaline are completely shut off within your brain when you enter this dreaming sleep state. In fact, REM sleep is the only time during the twenty-four hour period when your brain is completely devoid of this anxiety-triggering molecule. Noradrenaline, also known as norepinephrine, is the brain equivalent to a body chemical you already know and have felt the effects of: adrenaline (epinephrine).

Previous MRI studies established that key emotion- and memory-related structures of the brain are all reactivated during REM sleep, as we dream….(N)ow we understood that this emotional memory reactivation was occurring in a brain free of a key stress chemical. I therefore wondered whether the brain during REM sleep was reprocessing upsetting memory experiences and themes in this neurochemically calm (low noradrenaline), ‘safe’ dreaming environment. Is the REM-sleep dreaming state a perfectly designed nocturnal soothing balm – one that removes the sharp edges of our daily lives? It seemed so from everything neurobiology and neurophysiology was telling us (me). If so, we should awake feeling better about distressing events of the day(s) prior.

This was the theory of overnight therapy….Think back to your childhood and try to recall some of the strongest memories you have. What you will notice is that almost all of them will be memories of an emotional nature: perhaps a particularly frightening experience of being separated from your parents, or almost being hit by a car on the street. Also notice, however, that your recall of these detailed memories is no longer accompanied by the same degree of emotion that was present at the time of the experience. You have not forgotten the memory, but you have cast off the emotional charge, or at least a significant amount of it. You can accurately relive the memory, but you do not regurgitate the same visceral reaction that was present and imprinted at the time of the episode.”

(Note: An exception to the soothing balm of REM sleep dreaming is the condition of post-traumatic stress disorder [PTSD], which Dr. Walker discusses later in the chapter. REM sleep dreaming is important to the reduction of PTSD symptoms, but additional factors are involved, which will not be addressed in this blog). 

Continuing this lengthy, but necessary excerpt, Dr. Walker writes:

“The theory argued that we have REM-sleep dreaming to thank for this palliative dissolving of emotion from experience. Through its therapeutic work at night, REM sleep performed the elegant trick of divorcing the bitter emotional rind from the information-rich fruit. We can therefore learn and usefully recall salient life events without being crippled by the emotional baggage that those painful experiences originally carried….That was the theory, those were the predictions; next came experimental test, the results of which would take a first step toward falsifying or supporting both.

We recruited a collection of healthy young adults and randomly assigned them to two groups. Each group viewed a set of emotional images while inside an MRI scanner as we measured their emotional brain reactivity. Then, twelve hours later, the participants were placed back inside the MRI scanner and we again presented those same emotional images…During these two exposure sessions, separated by twelve hours, participants also rated how emotional they felt in response to each image.

Importantly, however, half of the participants viewed the images in the morning and again in the evening, being awake between the two viewings. The other half of the participants viewed the images in the evening and again in the morning after a full night of sleep….

Those who slept in between the two sessions reported a significant decrease in how emotional they were feeling in response to seeing those images again. In addition, results of the MRI scans showed a large and significant reduction in reactivity in the amygdala, that emotional center of the brain that creates painful feelings. Moreover, there was a reengagement of the rational prefrontal cortex of the brain after sleep that was helping maintain a dampening brake influence on emotional reactions. In contrast, those who remained awake across the day without the chance to sleep and digest those experiences showed no such dissolving of emotional reactivity over time. Their deep emotional brain reactions were just as strong and negative, if not more so, at the second viewing compared with the first, and they reported a similarly powerful reexperiencing of painful feelings to boot….

As the theory predicted, it was the dreaming state of REM sleep–and specific patterns of electrical activity that reflected the drop in stress-related brain chemistry during the dream state–that determined the success of overnight therapy from one individual to the next. It was not time, therefore, time per se that healed all wounds, but instead it was time spent in dream sleep that was providing emotional convalescence.”

One, final important caveat. Citing the exquisite dream research of Dr. Rosalind Cartwright at Rush University in Chicago, Dr. Walker adds: “it (is) not enough to have REM sleep, or even generic dreaming, when it comes to resolving our emotional past….,but dreaming of a very specific kind: that which expressly (involves) dreaming about the emotional themes and sentiments of the waking trauma. It (is) only that content-specific form of dreaming that (allows movement) forward into a new emotional future, and not be enslaved by a traumatic past.”

So, what might be the possible implications of REM sleep dreaming, (if any) to Eye Movement Desensitization & Reprocessing (EMDR) therapy?

My website is replete with information about EMDR therapy; from a separate web page, to official websites, to specific blog posts. Borrowing an excerpt from my May 1, 2016 post:

“(EMDR therapy) was developed in the 1980s by psychologist Francine Shapiro, PhD. As with many discoveries, Dr. Shapiro made the chance observation that eye movements can reduce the intensity of disturbing thoughts, under certain conditions. This humble beginning launched years of experimental and clinical research, and has now evolved into one of the leading and most recognized treatments for trauma throughout the world. My succinct description of EMDR to clients goes something like this: ‘Research suggests that when distressing events are paired with bilateral stimulation—visual, tactile, and/or auditory—there is the potential that those events will be desensitized and reprocessed.’ Although no one knows how any form of psychotherapy works neurobiologically in the brain, EMDR appears to be similar to what occurs naturally during dream or REM (rapid eye movement) sleep. Therefore, EMDR therapy can be thought of as a physiologically based therapy that helps a person see disturbing material in a new and less disturbing way.”

Now, 30 years later, independent sleep studies—like Matthew Walker–offer support for Shapiro’s ideas: that directed eye movements can stimulate the same processes that occur in REM sleep. Dr. Shapiro (2018) writes:

“Despite this evidence that REM can support forms of memory and emotional processing critical for trauma recovery, there is currently no direct evidence that EMDR induces similar processing during the waking state. However, Strickgold (2002) has posited direct neurobiological correlates between EMDR- and REM-state functions and has also posited appropriate tests of this hypothesis….Strickgold (2002) proposed that the repetitive redirection of attention in EMDR processing induces changes in regional brain activation and neuromodulation similar to those produced during REM sleep. Activation of these systems may simultaneously shift the brain into a memory-processing mode similar to that of REM sleep, facilitating the integration of traumatic memories into associative cortical networks.”

Robert Strickgold, PhD (cited above) is not only Professor of Psychology at Harvard Medical School, and Director of the Center for Sleep and Cognition in Boston, Massachusetts, he is also Matthew Walker’s “mentor…longtime collaborator and friend” at Harvard Medical School.

Conclusion? Independent sleep research suggests that the most common form of bilateral stimulation used in EMDR therapy—side-to-side eye movements—can stimulate the same processes that occur in REM sleep.

Bill Bray, Colorado Springs, CO

Feeling Our Feelings: Revisited

Posted by on Apr 29, 2018 in Research | 0 comments

Feeling Our Feelings: Revisited

A year ago, March, I posted a blog called “Feeling My Feelings” (3/5/17), occasioned by the decision to put our beloved 14-year-old dog, “Mia,” a Papillon, to sleep. My wife and I agonized for weeks over Mia’s failing condition. I said in that blog that my intent was “not to subvert the purpose of the blog, or even memorialize our ‘furry, quirky, little dog,'” as my wife called her, but to…emphasize the importance of ‘feeling our feelings.'” Even now as I write this, I feel that same, old familiar ache in my stomach. Five months later, my wife declared that she was ready for another dog; but, I was not ready. She revealed that she had been researching a very different dog. Different breed. Different size.  Different background. And, because I was not interested, I reluctantly agreed to go with her to a rescue shelter. Not asking my wife, nor caring about another dog, you can imagine my shock when in trots a large, white and tan-coated – greyhound; a six-year-old racer from the Midwest. I’m sure my stunned silence and demeanor spoke volumes. I’ll spare you the details of the next few hours and days, but a week later, we loaded this large (but very beautiful) dog in our vehicle and took her home. Identified only by a number tattooed in her ear, and not liking the temporary name given her by the shelter, we renamed her “Lilly.” Simply put, I’ve had to recant all my negative thoughts and resistance. Lilly has turned out to be the sweetest dog I could ever imagine. Although my heart still aches when I think about Mia, my “sad” has become “glad” when I think about Lilly.

The reason I’m revisiting the theme of “feelings” in this blog is largely due to an article in the current edition (May/June 2018) of “Psychology Today” magazine. Written by a psychologist and professor at James Madison University, Gregg Henriques, PhD addresses the “neurotic feedback loop of negative reactions to negative feelings.” He begins the article by telling about Hannah (name changed), a college junior he had been counseling for depression and anxiety. Of particular clinical interest to Dr. Henriques was Hannah’s closing statement in one session: “I need to stop acting like a (expletive) child, cut these feelings off, and just grow up.” He writes:

“I guided her to take a moment to locate the root of this feeling. ‘Take a deep breath. Close your eyes. Do you recall a time when you felt vulnerable or needy and then hated yourself for that?'” Tears welling up, she did remember a time: ‘I was about 10. I liked drawing horses and dogs and stuff like that. I always shared them with my dad. One day, I brought a new drawing to him, asking if he would put it with the other drawings I’d given him. He said, in his usual calm, matter-of-fact tone, that he had thrown them out because I could draw so much better now. I knew my dad loved me and did not mean to hurt me, so I didn’t say anything. But I started to feel all those sensitive feelings I would always have. I ran to my room to cry. I remember thinking, ‘What is wrong with me? I am such a freak! My dad loves me. What can’t I have normal reactions like everyone else?’

I pointed out that she was punishing herself for her negative feelings so that she could stay close to her dad. This process of turning against oneself is the root of much pain in life. Yet there are alternative ways of relating to negative feelings….(T)he root of much long-term suffering takes hold when individuals battle with themselves by developing negative reactions to their negative feelings….(T)his  secondary reaction to the original negative feelings often creates a vicious cycle that results in major depression and generalized anxiety disorder….Many cases of depression and anxiety have their root in negative reactions to negative feelings. It is hard to overstate the importance of this fact. Depression and anxiety disorders are the biggest drivers of mental illness, and they get continually worse in modern society. This increase may be occurring because people are taught that they should be afraid of their negative feelings, or that they should not have to feel them, or that they are ‘disease states’….Instead we too often seem to reinforce the idea that negative emotions are, well, negative. This is a mistake because all emotions are essential to human living.

Early on, Hannah developed the idea that she felt things she should not feel. She learned from her mother, who coped with her own distress through avoidance, that she should put on a happy face. She learned from her father, who was kind but also analytical and not as attuned to her feelings as he could have been, that her sensitivity was a weakness. She learned as a child that she ought not to have strong negative feelings, that such feelings were a problem and she should control herself by whatever means necessary to crush them. By doing this, Hannah could imagine maintaining a justifiable image of herself in the eyes of her parents. Unfortunately, she ended up turning against herself.”

Henriques’ discussion, thus far, reminds me of reading about “an early Buddhist teaching…parable of a person pierced by two arrows in rapid succession….The first arrow  is the objective pain and distress felt when encountering an adversary, trauma, or loss. The second is the extent to which the pain challenges tightly held, albeit inaccurate, expectations, needs, worldviews, resulting in resistance, avoidance,…suffering” (Briere, 2015). Neuropsychologist Rick Hanson, PhD (2009) similarly writes: “(I)nescapable physical or mental discomfort is the ‘first dart’ of existence. As long as you live and love, some of those darts will come your way. First darts are unpleasant to be sure. But then we add our reactions to them. These reactions are ‘second darts’ – the ones we throw at ourselves. Most of our suffering comes from second darts.”

Basically, Hannah’s negative reactions to her negative feelings is a classic example of first and second arrows, or darts. Hannah’s negative reactions (second dart) only exacerbated and complicated her negative feelings (first dart).

So, how does Hannah–how do we–close this neurotic loop? Henriques writes:

“Attempting to regulate our feelings does make good sense. However, the crucial point is how that regulation is achieved. If a person uses a critical, controlling voice, he can set in motion a downward spiral of feelings that get harder to control. As he grows increasingly frustrated with his own negative feelings, he can become conflicted and vulnerable. The criticism leads to more and more negative emotions, which leads to more and more frustration and harsher and harsher attacks from the inner critic….What we need to do, both intrapsychically and interpersonally, is create a different kind of attitude toward bad feelings. Rather than seeking to avoid them or control them or engage in self-attack, we should listen to what our feelings are telling us and to learn how to use them to guide us toward long-term valued states of being.” Did you catch that?

“What we need to do . . . . is create a different kind of attitude toward bad feelings.”

Henriques concludes: “Over time, Hannah learned….a different way of being….Eventually she learned to become curious about what her feelings mean, to accept them for what they are, and to use them to inform herself about who she wants to be going forward. By breaking the loop created by her negative feelings, she set herself on a path to a much freer and more fulfilling way of being.”

One final word. In addition to Henriques’ focus on depression and anxiety, Robert Weiss, MSW, LCSW, CSAT-S (2015) adds the addictive consequence of inhibiting feelings. He writes: “In the world of addiction treatment, there are two main areas of concern – addiction to substances, and addiction to patterns of behavior….So whatever the addictive substance or behavior, the drive is the same – addicts want to feel better, which usually means feeling less, and they know their addiction is the easiest way to (temporarily) disconnect, numb out, and not have to experience the difficulties of life….This is a sure sign of addiction.” Reminds me of one of my professors who similarly observed: “Addiction is the inability to feel.” To repeat the sage admonition of Dr. Henriques:

“What we need to do . . . . is create a different kind of attitude toward bad feelings.”

Bill Bray, Colorado Springs, CO

Relationship Conflict and the Transformative Power of Feeling Safe

Posted by on Jan 28, 2018 in Research | 0 comments

Relationship Conflict and the Transformative Power of Feeling Safe

Emotional flooding. Psychologist John Gottman, PhD, explains what it means:

“(Your body mobilizes) so that it can effectively cope with emergencies that might injure you. The way this works is that in situations you perceive as ‘dangerous’…a series of things happen in your body. It can even happen without your awareness.

For example, suppose you are driving down the highway at night and suddenly see headlights in your lane coming right at you. You swerve onto the shoulder and narrowly avert a collision. If we were to examine your physiology at the moment, we would find your heart was beating fast and contracting hard, that your blood pressure was up, that you were secreting adrenaline, that blood flow had shut down to ‘nonessential services’ (your gut and kidney), that your liver had changed some of its supply of glycogen to glucose (sugar) in your blood, that the reninangiotensin system was conserving blood volume in anticipation of hemorrhage, and that you were sweating, particularly on your palms and the soles of your feet. You would be in a state of high alertness and arousal as well, a state psychologists call ‘tunnel vision.’ Your limbic system…would have been activated. Your blood pressure would be up, and blood would have been drawn in from your arms and legs into your trunk.

We call this state ‘diffuse physiological arousal’ (DPA) because many systems are simultaneously activated….You would feel what we call ‘flooded’….

The amazing thing is that all these things can, and do, happen during relationship conflict. But whereas the DPA response can be adaptive in dealing with emergencies, in relationship conflict it has consequences that are quite negative. With DPA there is a reduced ability to process information. It is harder to attend to what your partner is saying. Peripheral vision and hearing may actually be compromised. As much as you want to listen, you just cannot do it….Fight and flight routines become more accessible. The sad result for relationship conflict is that creative problem-solving, active listening, empathy, and your sense of humor go out the window” (2011).

Gottman adds: “We also know that men become more flooded during conflict than women. That’s just an empirical fact.”

Gottman’s discussion of emotional flooding (during couple conflict) meshes with another emotionally-focused psychologist, Susan Johnson, PhD. In her emotion-focused couple therapy (EFT), Johnson uses attachment theory to help couples deal with what she calls “attachment injuries.” Attachment theory broadly defines attachment in terms of secure and insecure. Johnson writes: “Attachment theory is essentially a theory of trauma, (where) distressed partners tend to adopt stances of fight, flight, or freeze that characterize responses to traumatic stress” (2004).

Which brings me to my primary reading interest of 2017; the research of Stephen W. Porges, PhD, and his “polyvagal theory.” Dr. Porges is Distinguished University Scientist at Indiana University where he directs the Trauma Research Center within the Kinsey Institute. Having plowed through his initial, groundbreaking book in 2011, I was delighted to learn he had published a more user-friendly Pocket Guide to the Polyvagal Theory in 2017. This book now ranks among my top five most “marked up, written in, and highlighted” books – ever. I could never sell it back to someone else; or, even loan it for someone else to read. Heck, I can barely read it now because of my notations. Let’s just say that I earnestly tried to digest its contents.

Specifically, Porges’ research targets the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). While the SNS mobilizes us to take action, for example when threatened (“fight or flight”), the PNS calms us down; one being the accelerator, the other being the brake, so to speak. Both systems are part of the autonomic nervous system (ANS) which operates, as the name suggest, more automatically or involuntarily. Whereas the traditional view has been twofold (SNS and PNS), Porges’ research has subdivided the PNS to make three subsystems. This subdivision of the PNS focuses on the vagus nerve, which is the tenth cranial nerve, and the largest nerve in our body. This nerve with its many (poly) fibers sends and receives messages between the brain and the rest of the body. The ventral vagal nerve generates and interprets positive responses (called the “social engagement system). The body perceives safety, as when someones smiles at us, calming us down in a positive way. The dorsal vagal nerve does the opposite, and is considered a second “defense” system along with the SNS (“fight or “flight”). When one cannot handle a perceived threat by addressing it, or getting away from it (namely, “helplessness”), then there is an “immobilzation” or “freeze” response. This numbs the pain associated with the threat. Porges coined  the term “neuroception” to mean that the nervous system evaluates threat apart from conscious awareness. In other words, our nervous system is already defending us before we’re even aware of it. Porges writes:

“When people are defensive–feeling bad about themselves, feeling angry at someone else–they are recruiting (these) neural structures. There is an overlap between defensive responses and responses to evaluation… Whenever we are evaluated, we are already recruiting the physiology of defense….These feelings of danger would produce a chronic state of defense that would negatively bias perception of others.” This “neuroception” is not always accurate; for example, the body might detect risk when there is no risk. Nevertheless, one’s physiology is already on the defensive. Is it any wonder why Porges subtitles his 2017 book “The Transformative Power of Feeling Safe.” Secure attachment is all about safety.

Now, let’s connect this back to “emotional flooding” and relationship conflict. Couples who are genuinely and earnestly intent on improving their relationship need to change their interactional patterns (versus overpowering each other with “fire and fury,” even logic). We can change interactions during conflict by mindfully respecting physiology! We can work with the nervous system, not against it. We can do this by helping ourselves and each other feel “safe.” In other words, “I’m here for you. I’m not going anywhere. Talk to me. I will do my best to listen, affirm, apologize, and validate your feelings – even if we don’t agree. You can trust me.”

In that 2011 book I cited earlier, The Science of Trust; Emotional Attunement for Couples, Gottman makes an admission and correction to his Seven Principles for Making Marriage Work (1999; 2015). Read for yourself:

“(The) implicit suggestion…was that by following (the) seven principles, any two people in the world could create a stable, happy relationship. We had misgivings about those implications….(So) as we worked with couples in therapy, we found that indeed something might have been missing in the seven principles conceptualization….I therefore began searching for the missing ingredient for these couples….The answer came during the course of building a program for lower-income couples expecting a baby. What we found was that all the couples talked about the importance of ‘trust.’ (Many) told us that the central missing ingredient was the ability to build and maintain trust with each other. Many distressed couples complained that their partners simply couldn’t be counted on to ‘be there’ for them when they needed them most. Over time, they said, the emotional injuries they sustained from a lack of trust built a huge gulf of emotional distance between them, leading to eventual  betrayal or the quiet whimper of the demise of love….So it appeared that the missing ingredients…were all about trust and betrayal. After all, trust and safety in a relationship are the theoretical pillars of…attachment theory.”

While “trust” may not be synonymous with “safety,” the two are definitely related. Trust creates safety. And, feeling safe is transformative.

Bill Bray, Colorado Springs, CO

Vicarious Traumatization (VT)

Posted by on Nov 22, 2017 in Research | 0 comments

Vicarious Traumatization (VT)

On November 6, 2017, CNN reported that of the 30 deadliest shootings in the US dating back to 1949, 18 have occurred in the last 10 years. Two of the five deadliest have taken place in just the last 35 days.

On Sunday, November 5, 2017, a gunman opened fire inside a small community church in Sutherland Springs, Texas, killing 26 people; the fifth-deadliest shooting in modern US history.

On October 1, 2017, a gunman opened fire from the 32nd floor of the Mandalay Bay Resort and Casino on a crowd of more than 20,000 gathered on the Las Vegas Strip for a music festival. He kills 58 people and injures more than 500; the deadliest shooting in modern US history.

The Las Vegas attack was 10 years removed from the 2007 Virginia Tech massacre (32 killed), and a year removed from the second-deadliest shooting in modern US history–the Orlando nightclub shooting, where 49 were killed and more than 50 injured.

Then, there’s the December 14, 2012 Sandy Hook Elementary School shooting in Newton, Connecticut, where 20 children (ages 6-7) and six adults were gunned down.

Etcetera. Etcetera.

I’ve been thinking a lot lately about the trauma survivors of these horrific events; the lives of their loved ones tragically and swiftly snuffed out. I remember watching a television interview with the bereaved family of the Sandy Hook Elementary Principal, Dawn Hochsprung. One of the daughters was asked the awkward question what she might say to her mom, if she could. The daughter tearfully replied: “Come back”; the precise sentiments of trauma survivors who’ve lost loved ones.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines the three main symptom clusters of posttraumatic stress disorder (PTSD) as: a re-experiencing of the event (for example, intrusive imagery or flashbacks), avoidance of event-related cues, and hyperarousal. While posttraumatic stress (PTS) most certainly threatens the health of trauma survivors, I’m thinking that the ubiquitous and real-time nature of social media exposes every person to a kind of secondary traumatic stress (STS); also known as vicarious traumatization (VT).

Secondary Traumatic Stress/Disorder (STS/D)—a.k.a. Vicarious Traumatization (VT)–is the emotional duress that results from seeing/hearing about the firsthand trauma experiences of others. As such, it primarily targets helping professionals, like myself, who work directly with trauma survivors. Its symptoms mimic those of posttraumatic stress disorder (PTSD). In her book, SecondaryTraumatic Stress; Self Care Issues for Clinicians, Researchers, & Educators (1999), Beth Hudnall Stamm, PhD, now retired research psychologist at Idaho State University, writes:

“Here we define secondary traumatic stress as the natural, consequent behaviors and emotions resulting from knowledge about a traumatizing event….It is the stress resulting from helping or wanting to help a traumatized or suffering person.

There is a fundamental difference between the sequela or pattern of response during and following a traumatic event, for people exposed to primary stressors and those exposed to secondary stressors. Moreover, not only are family and friends of people exposed to primary stressors (i.e., ‘victims’) vulnerable to secondary traumatic stress and stress disorders, so are mental health professionals and other helpers.

Therefore, STSD is a syndrome of symptoms nearly identical to PTSD except that the response to a traumatizing event experienced by one person becomes a traumatizing event for the second person….At the same time, we suggest that perhaps PTSD should stand for Primary Traumatic Stress Disorder, rather than Post Traumatic Stress Disorder, since every stress reaction is ‘post’ by definition.”

Dr. Stamm contrasts the symptoms of PTSD with the symptoms of STSD around the same threefold symptom cluster of: re-experiencing the traumatic event, avoidance and numbing of event-related reminders, and persistent arousal (mentioned above). The only difference between the two is the “vicarious” nature of STS/D; that is, hearing what happened to the “primary” trauma survivor.

Stamm observes that a “disrupted frame of reference” is the “hallmark of vicarious traumatization.” By “frame of reference,” she means one’s identity, worldview, and spirituality. While writing primarily to helping professionals, the disruptive nature of trauma on everyone is hard to miss:

“As a result of…trauma, (one) is likely to experience disruptions in their sense of identity (sense of oneself as man/woman, as helper, as mother/father, or one’s customary feeling states), worldview (moral principles, ideas about causality, life philosophy), and spirituality (meaning and hope, sense of connection with something beyond oneself, awareness of all aspects of life, and the sense of the non-material.”

Think about it. Can anyone honestly deny that their “frame of reference” (identity, worldview, spirituality) has been challenged–yet again–by the random violence of the last few days?

Stamm continues: “The other parts of the self impacted by VT are psychological need areas: safety, trust, esteem, intimacy, and control. Everyone possesses all the five needs, but specific areas are more important or central for each individual. One’s most important need areas are those most likely to be disrupted.”

Survey that fivefold list for a moment. Which “need area” has not been “disrupted”–yet again–by the random, violent acts of the past few days? Which “need area” do you personally feel most vulnerable? Safety? Trust? Social connectedness? What about control, or predictability? The Stanford University professor of biology and neurology, Robert Sapolsky, PhD (2004) talks about many of these same psychological variables needed—to some degree–to withstand the stressors of life; especially social connectedness, control, and predictability (See my October 8, 2012 blog).

Given the primary and secondary helplessness of traumatic events, Stamm asks if there’s anything we can do. “What antidotes can we create to these ‘disruptions’?” Citing research where trauma therapists were asked to identify self-care strategies, some of the activities mentioned include: travel, social activities, collegial support, pleasure reading, workday breaks, emotional support from family and friends, time spent with children, listening to music, time spent in nature, physical exercise, community involvement, rest and relaxation, gardening, spiritual life and practice, artistic expression, hobbies, to name just a few.

Perhaps some of these suggestions will prompt you to generate your own “antidotes” to a “disrupted frame of reference.”

This is the second time in six months that the expression, “frame of reference,” has surfaced in one of my blogs. On May 26, I posted thoughts from Irvin Yalom’s book, The Gift of Therapy (2002). The emeritus professor of psychiatry at Stanford University talks about his interpersonal and existential “frame of reference;” which strikes me as particularly apropos for thinking about “antidotes” to vicarious traumatization. Yalom discusses the need for developing and sustaining gratifying relationships (interpersonal frame of reference), as well as the “givens” of human existence (existential frame of reference); especially: death, isolation, meaning in life, and freedom. Yalom’s existentialist orientation reminds me–in the face of random violence and traumatization–that there is no such thing as absolute control or predictability in life. The shootings of the past 35+ days have reminded us of that. Rather, we are confronted with the inexorable “givens” of existence – and, how we choose to live life. There is no freedom to do otherwise.

One last thought. Several months ago, one of my colleagues brought a plaque to our office suite. I found myself mouthing the words on the plaque every time I saw it; a saying attributed to the renowned French painter Claude Monet: “For one’s health, it is necessary to walk in the garden and see the flowers growing.” In a world of primary and vicarious traumatization, that sounds like good advice.

Bill Bray, Colorado Springs, CO

The Value of Negative Experiences

Posted by on Sep 17, 2017 in Research | 0 comments

The Value of Negative Experiences

February 5 was NOT a good day for me. In the words of the popular children’s writer and psychoanalyst Judith Viorst, it was a “Terrible, Horrible, No Good, Very Bad Day.” My car was broken into while jogging, involving the theft of my wallet, credit cards, and checkbook. I remember the sick feeling in my stomach as I spotted the shattered back window from a distance. Looking immediately into the console of my car–where these items were kept–only confirmed my fears. Everything was gone. Those of you having experienced identity theft know the feeling all too well. Exacerbating my loss was the knowledge that I had no one to blame but myself. Frankly, I had grown complacent; having jogged at this particular park many times, and leaving such valuable information in a securely locked car (or so I thought). Had it not been for locating a police officer who took my report and provided telephone numbers to call, the situation would have been much worse. Quite simply, I was traumatized. 

The financial and emotional fallout from that experience is better now in these 6+ months since, but the trauma still lingers. I still go (force myself to go?) to that same location to jog, but with some definite changes. I no longer leave such valuable information in my car, and my complacency has been replaced with a vigilance; even hypervigilance at times. Call it the school of hard knocks. 

In his book Buddha’s Brain (2009), neuropsychologist Rick Hanson, PhD writes about the value of negative experiences:

“When an event is flagged as negative, the (brain) makes sure it’s stored carefully for future reference. Once burned, twice shy. Your brain is like Velcro for negative experiences and Teflon for positive ones – even though most of your experiences are probably neutral or positive.” I’ve thought of Hanson’s Velcro/Teflon simile often since February 5, and have used it frequently with clients in therapy. Hear it again:

“Your brain is like Velcro for negative experiences,

and Teflon for positive ones.”

This is not to minimize or idealize the negative effects of pain, or to promote suffering. Hanson quickly adds that “emotional pain with no benefit to yourself or others is pointless suffering.” Nevertheless, he underscores what he calls the “negativity bias of memory.” Why? What possible value could there be from negative experiences? In a word? Survival. Hanson continues:

“(The) brain is built more for avoiding than for approaching. That’s because it’s the negative experiences, not the positive ones, that have generally had the most impact on survival….(L)oss open the heart, remorse provides a moral compass, anxiety alerts you to threats, and anger spotlights wrongs that should be righted.” Obviously “survival” means more than the avoidance of human extinction; it enhances quality of life. Hanson continues:

“The remedy is not to suppress negative experiences; when they happen, they happen. Rather, it is to foster positive experiences….Positive experiences can be used to replace negative ones. When two things are held in mind at the same time, they start to connect with each other. That’s one reason why talking about hard things with someone who’s supportive can be so healing; painful feelings and memories get infused with the comfort, encouragement, and closeness you experience with the other person. These mental minglings draw on the neural machinery of memory. When a memory–whether implicit or explicit–is made, only its key features are stored, not every single detail….When your brain retrieves a memory, it does not do it like a computer does, which calls up a complete record of what’s on its hard drive (e.g., document, picture, song). Your brain rebuilds implicit and explicit memories from their key features, drawing on its stimulating capacities to fill in missing details.”

Hanson echos the research of others, including UCLA psychiatrist Dan Siegel, M.D., whose research I’ve referenced extensively throughout my blogs. Basically, writes Siegel, “Memory is not a static thing, but an active set of processes…Remembering is not merely the reactivation of an old (experience); it is the construction of a new (understanding) with features…from other experiences…and present state of mind” (The Developing Mind, 2012). 

Summary. The brain has a bias toward negativity. There is value in negative experiences. Negative experiences need not be the final verdict. Positive experiences can begin to modify negative experiences in the brain. All this I have been reminded of since February 5. I still go to that same park to jog. I still have residual memories of that “terrible, horrible, no good, very bad day.” But, other experiences since are attaching themselves to the old memory. Just the other day, I finished my run and leaned against my car. I watched children playing. I noticed a new dog owner training his chocolate lab puppy. And I wasn’t thinking about February 5 at all. 

Bill Bray, Colorado Springs, CO

Internal Family Systems (IFS)

Posted by on Jul 23, 2017 in Research | 0 comments

Internal Family Systems (IFS)

Last month, I took a day off from seeing clients to attend an Internal Family Systems Therapy (IFS) seminar. The seminar was led by Frank G. Anderson, M.D. Dr. Anderson completed his residency in Psychiatry at Harvard Medical School, and was a clinical instructor at Harvard. He is currently the chairman of the Foundation for Self Leadership, which is the organization for Internal Family Systems Therapy (IFS). Dr. Anderson maintains a private practice in Concord, Massachusetts, and has maintained a long affiliation with Bessel van der Kolk’s Trauma Center at the Justice Resource Center in Boston. The seminar was well worth the time and money spent.

I have been aware of IFS therapy for several years, as my March 4, 2012 blog post will attest. That post, more than five years old now, reads as follows:

———————————————

It is not uncommon to describe ourselves in “parts.” For example, “A part of me loves him, and a part of me doesn’t even like him.” Or, “A part of me is mad, and a part of me is sad.” Such is the language of ambivalence that often characterizes human awareness. There is even a biblical reference to such ambivalent “parts”: “I do not understand my own actions. For I do not do what I want, but I do the very thing I hate” (Romans 7:15; NRSV), and vice versa. So “parts” is often how we describe our internal conflicts. Just as families consist of individuals (Mom, Dad, child[ren]), each person contains an internal family of personalities (or, subpersonalities).

In his book, Internal Family Systems Therapy (1995), Richard C. Schwartz, PhD (Northwestern University) organizes these internal “parts” into three groups: Exiles, Managers, and Firefighters. Basically, “exiles”–the most sensitive members of the group–represent internal conflicts (for example, painful memories, feelings, behaviors). “Managers” represent the internal control of exiles, mostly through preventative measures. And, “firefighters” represent our remedial actions when the exiles seriously threaten escape.

Here’s how Schwartz describes each group:

“Commonly, children are taught to fear and hide their pain or terror….They become the exiles, closeted away and enshrouded with burdens of unlovability, shame, or guilt. Like any oppressed group, these exiles become increasingly extreme and desperate, looking for opportunities to break out of their prison and tell their stories….Like abandoned children, many of the exiles desperately want to be cared for and loved. They constantly look for someone who might rescue and redeem them….(Managers) live in fear of the escape of exiles. They try to avoid any interactions or situations that might activate an exile’s attempts to break out or leak feelings, sensations, or memories into consciousness. Different managers adopt different strategies (for example, Controller, Perfectionist, Dependent One, Caretaker, Etc.)….The point (and) primary purpose of all mangers is to keep the exiles exiled….That is, the goal is to keep the feared feelings and thoughts from spilling over the inner walls, so that the system remains safe and the person is able to function in life….(Common managerial manifestations) include: obsessions, compulsions…passivity, emotional detachment…panic attacks, somatic complaints, depressive episodes, hyperalertness, and nightmares….(Sometimes) despite the best efforts of the managers, the exiles are activated and threaten to break out and take over. When this happens, another group of parts leaps into action to try to contain or extinguish the feelings, sensations, or images. I call this group the ‘firefighters’ because they react automatically whenever an exiled part is activated. It is as if an alarm goes off and they frantically mobilize to put out the fire of feelings. They do whatever they believe necessary to help the person (separate from) or douse dreaded exiled feelings, with little regard for the consequences of their methods. The techniques of firefighters often include numbing activities such as self-mutilation, binge eating, drug or alcohol abuse…or promiscuity. When activated, a firefighter will try to take control of the person so thoroughly that he or she feels nothing but an urgent compulsion to engage in (an avoidance behavior) or self-soothing activity….Although firefighters have the same basic goal as managers – to keep the exiles exiled – their roles and strategies are quite different….Managers strive to prevent the activation of exiles by keeping the person in control at all times….Firefighters …usually react after the activation of exiles has occurred.” 

————————————————-

One additional observation not included in the original blog post. These “parts,” sometimes called “ego states,” are most often formed when we do something over and over again. This repetitive learning, this over and over again learning, creates a literal, physical neural pathway (circuitry) in the brain. In other words, a “part” or “ego state,” is a physical part of the brain – with its own experiences, emotions, and behaviors. It is to say, in the oft quoted words of Canadian psychologist Donald Hebb: “Neurons (nerve cells) that fire together, wire together.”  And the more they fire, the more they wire. And the more they fire, the more they wire. And the more they . . . .

By the way . . . . The brain can make changes.

Bill Bray, Colorado Springs, CO

The Gift of Therapy: Reasonable Happiness

Posted by on May 26, 2017 in Research | 0 comments

The Gift of Therapy: Reasonable Happiness

The other day I finally purchased a book I had passed by multiple times; each time thinking “I should read that book.” The book is The Gift of Therapy; An Open Letter to a New Generation of Therapists and their Patients (2002). The author is the emeritus professor of psychiatry at Stanford University, Irvin Yalom, M.D. Obviously written to and about a professional reading audience, Yalom calls the book a “nuts-and-bolts collection of favorite interventions or statements…long on technique and short on theory.”

Although Yalom urges therapists to work from a variety of approaches, he writes:

“Still, for the most part, I work from an interpersonal and existential frame of reference. Hence, the bulk of the advice that follows issues from one or the other of these two perspectives. Since first entering the field of psychiatry, I have had two abiding interests: group therapy and existential therapy. These are parallel but separate interests….The two modes are different not only because of the format (group versus individual), but in their fundamental frame of reference. When (I’m in a group setting), I work from an interpersonal frame of reference and make the assumption that (people) fall into despair because of their inability to develop and sustain gratifying interpersonal relationships.”

“(W)hen I operate from an existential frame of reference, I make a very different assumption: (people) fall into despair as a result of a confrontation with harsh facts of the human condition – the ‘givens’ of existence.”

These two frames of reference reminded me that I should have purchased the book much earlier than I did. Indeed, whatever else urges us to talk with a counselor-type, the challenge of relationships, and the inexorable conditions of life are among the primary influences.

 

Yalom’s first frame of reference: the difficulty of developing and sustaining gratifying relationships.

For all the value of gathering information about a person’s history in therapy, Yalom emphasizes the “here-and-now” importance of the “therapy relationship”; the importance of interpersonal relationships, and the idea of therapy as a social microcosm. This is to say that sometimes the interpersonal problems a person has with others (spouse, partner, parent, friend, coworker) will manifest itself in the “here-and-now” of the therapy relationship. This emphasizes something I’ve written about in earlier blogs; that what we do not or cannot communicate directly, we evoke or (re)enact with others. It’s basically the nonconscious, nonverbal behaviors we communicate unawares.

Yalom tells of a client, Albert, who was “suffused with anger but could find no way to express it.” In one of their sessions, Albert described a frustrating encounter with a girlfriend who, in his view, was “jerking him around,” yet he was afraid to confront her. Yalom writes: “The session felt repetitious to me; we had spent considerable time in many sessions discussing the same material and I always felt I had offered him little help. I could sense his frustration with me…. (So) I tried to speak for him:

‘Albert, let me see if I can guess at what you might be experiencing in this session. You travel an hour to see me and you pay me a good deal of money. Yet we seem to be repeating ourselves. You feel I don’t give you much of value. I say the same things as your friends, who give it to you free. You have got to be disappointed in me, even feeling ripped off and angry at me for giving you so little.’

(Albert) gave a thin smile and acknowledged that my assessment was fairly accurate. I was pretty close. I asked him to repeat it in his own words. He did that with some trepidation, and I responded that, though I couldn’t be happy with not having given him what he wanted, I liked very much his stating these things directly to me. It felt better to be straighter with each other, and he had been indirectly conveying these sentiments anyway. The whole interchange proved useful to Albert. His feelings toward me were an analog of his feelings toward his girlfriend.”

Rather than talk objectively about Albert’s frustration with his girlfriend, Yalom used the therapy relationship to talk directly about Albert’s difficulty with expressing feelings.

 

Yalom’s second frame of reference: our confrontation with the “givens” of existence.

Yalom writes: “The existential psychotherapy approach posits that the inner conflict bedeviling us issues not only from our struggle with suppressed instinctual strivings or internalized significant adults or shards of forgotten traumatic memories, but also from our confrontation with the ‘givens’ of existence.

And what are these ‘givens’ of existence? If we permit ourselves to screen out…the everyday concerns of life and reflect deeply upon our situation in the world, we inevitably arrive at the deep structures of existence (the ‘ultimate concerns,’ to use theologian Paul Tillich’s term). Four ultimate concerns, to my view, are highly salient to psychotherapy: death, isolation, meaning in life, and freedom.”

That fourth “ultimate concern,” or “given”—freedom—implies responsibility; choice. Hoffman (2007) writes: “The attempt to be free without being responsible is, by nature, pathological, and arguably, immoral. The process of psychotherapy helps people embrace and enhance their freedom (by becoming more responsible).” Freedom, responsibility, and choice – all go together. They are irrevocably linked. Corey (2001) cites the existentialist philosopher Jean-Paul Sartre (1971) in speaking about “bad faith.” Examples of Sartre’s bad faith are: ‘Since that’s the way I’m made, I couldn’t help what I did’ or ‘Naturally I’m this way, because I grew up in an alcoholic family.’ Sartre claims we are constantly confronted with the choice of what kind of person we are becoming, and to exist is never to be finished with this kind of choosing.”

Hoffman (2007) again writes: “This is one of the great paradoxes of existential theory; that people are both necessarily limited in their freedom and at the same time condemned to be free. It is not possible to escape the influences of biology, genetics, and the past. Furthermore, individuals can never become fully aware of the influences lurking in their unconscious. This is what (German philosopher) Heidegger refers to as thrownness. Everyone is thrown into a particular life situation with a particular genetic makeup, with parents they have not chosen, and into a time and culture they are not able to control.”

This second frame of reference—the “givens” of existence—reminds me of theologian Reinhold Niebuhr’s “Serenity Prayer,” (1926) – but not the part you might think. The more familiar part of the prayer begins: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” A later line in the prayer seems to emphasize the inexorable “givens” of human existence. The petition reads: “That I may be reasonably happy in this life…”

“Reasonable happiness.” Sometimes I read the claims of therapies and therapists and think, “Wow! ‘Banish anxiety forever!’ ‘Live the stress-free life you’ve always dreamed of!'” Obviously, I’m being both facetious and satirical. There’s no question about the potential efficacy of therapy, but “absolute happiness?” No way. We know better.

Thus, the prayerful and realistic petition: “That I may be reasonably happy in this life.” That’s what we’re after. It’s one of the gifts of therapy.

Bill Bray, Colorado Springs, CO

Feeling My Feelings

Posted by on Mar 5, 2017 in Research | 0 comments

Feeling My Feelings

I write this blog with a heavy heart. Yesterday, my wife and I made the painful decision to put our beloved 14-year-old dog, “Mia”, a Papillon, to sleep.  I realize that “put down,” “put to sleep,” “put out of their misery,” and “euthanized” are all euphemisms for ending life when deemed necessary. Having worked as a psychotherapist with animal shelter technicians, assigned to euthanize animals on a regular basis, I have listened to their pain and observed their tears regarding the often traumatizing effects of their work. So, I do not wish to debate the ethics of euthanasia except to say that my wife and I agonized for weeks over our beloved Mia’s failing condition.

Papillon “derives its name from its characteristic butterfly-like look of the long and fringed hair on the ears, the French word for ‘butterfly’ being ‘papillon’….The long tail is set high…over the body, and covered with long, fine hair.” While Mia’s ears lacked some of the height and frill of some papillons, her tail did indeed curve up and over part of her back. As you can see from her picture in this blog, she was a beautiful brown and white dog. Hardly a walk we took together that someone didn’t comment, “What a pretty dog! What is s/he?”

As best we know, from reading and consulting with our wonderful veterinarian, Mia suffered from a degenerative condition clinically known as “canine cognitive dysfunction;” basically dementia in senior dogs, characterized by confusion and disorientation. Some call it dogzheimers. According to Vetsteet.com (2012), “Just like humans, dogs can suffer from many of the same symptoms: sleep-wake cycle disturbances, generalized anxiety, lower threshold for aggression, decreased activity levels, inappropriate vocalization (howling, barking, or whining), repetitive behaviors (pacing), elimination disorders, staring at walls, fewer social interactions, (and) disorientation (getting ‘lost’ in the house). In the last year of her life, Mia manifested and suffered from all of these symptoms, with increasing frequency and severity.

My intent in the above information is not to subvert the purpose of this blog, or even to memorialize our “furry, quirky, little dog,” as my wife called her, but to remember some reasons why we did what we did, and to emphasize the importance of “feeling our feelings.”

It’s a well-known fact (joke?) that  counselor types are forever asking people “How do you feel?” Truth is, there’s a reason for this. Emotions or feelings (often used synonymously, though distinguished in the literature) tell us things. For example, “mad” (anger) often implies we’re not getting something we want or need. So, as a therapist, I’m wondering what a person wants or needs? “Sad” (depression, grief) implies actual or perceived loss. So, as a therapist, I’m wondering what loss(es) a person has experienced? (By the way, “grief” differs from “depression” as the “normal, necessary response” to loss.) “Scared” (anxiety, fear) implies actual or perceived threat. So, as a therapist, I’m wondering about the nature of this threat?

Writing about the subject of “Post Traumatic Stress”, psychologists Resick, Monson, and Rizvi (2008) give the example of a therapist describing to a client the differences between “natural” and “manufactured” emotions:

“The therapist first describe(s) ‘natural’ emotions as those feelings that occur in response to events that are normal or that occur naturally. For example, if we perceive that someone has wronged us, it is natural to to feel anger. If we encounter a threatening situation, it is natural to feel fear. Natural emotions have a self-limited and diminishing course. If we allow ourselves to feel these natural emotions, they will naturally dissipate. The therapist use(s) the analogy of energy contained in a bottle of carbonated soda to illustrate the concept. If the top of the bottle is removed, the pressure initially comes out with some force, but that force subsides and eventually has no energy forthcoming. On the other hand, there are ‘manufactured’ emotions, or emotions that a person has a role in making. Our thoughts contribute to the nature and course of these emotions. The more that we fuel these emotions with our self-statements, the more we can increase the ‘pressure’ of these emotions.”

I would also like to include “avoidance” to the above genre of “manufactured” emotions; where “suppression” is generally understood as the conscious avoidance of emotions, and “repression” generally understood as the unconscious avoidance of emotions. I  remember a psychology professor of mine making the observation in class that “addiction (compulsivity) is the inability to feel.” Makes sense, doesn’t it? Whatever prevents us from feeling becomes a drug, eroding our willingness and ability to feel. The antidote? Permission to feel our feelings – even the bad ones – to let them run their course. Admittedly hard to do, but important to consider.

Steven C. Hayes, PhD and developer of Acceptance and Commitment Therapy (ACT), writing about the acceptance and willingness “to feel” says: “In our context, the words willingness and acceptance mean to respond actively to your feelings by feeling them, literally, much as you might reach out and literally feel the texture of a cashmere sweater….The goal of willingness is not to feel better….Said another way, the goal of willingness is to feel all of the feelings that come up for you more completely, even – or especially – the bad feelings so that you can live your life more completely. In essence, instead of trying to feel better, willingness involves learning how to feel better” (2005). Did you get that? The point is not necessarily to feel better, but to feel.

Which brings me back to the loss of our beloved “Mia”. I end this blog the way I began. I write with a heavy heart. I miss our “furry, quirky, little dog” terribly. I’m trying to practice what I preach to clients. I’m trying to “feel my feelings” and let them run their natural course. I decided this several weeks ago, seeing the end approaching. In his book, On God and Dogs (1998), theologian Stephen H. Webb writes: “Mourning for the death of a pet is a display of excessive grief for which many feel ashamed.” Stephen Webb disagrees with that notion – and so do I.

Bill Bray, Colorado Springs, CO

Cyclical Maladaptive Pattern (CMP)

Posted by on Jan 22, 2017 in Research | 0 comments

Cyclical Maladaptive Pattern (CMP)

Cyclical Malaptive Pattern (CMP) describes “the cycles or patterns people get into that involve inflexible,…self-defeating expectations, and negative self-appraisals – that lead to dysfunctional  and maladaptive interactions with others”, so writes clinical psychologist Hanna Levenson, PhD, in her book Brief Dynamic Therapy (2010).

Dr. Levenson is perhaps best known for her work in what’s known as Time Limited Dynamic, Psychotherapy, or TLDP.  Often when we hear the term “psychodynamic” we think of Freud, psychoanalysis, and long-term therapy. So, “time-limited dynamic therapy” might sound like an oxymoron. But, TLDP was developed and empirically tested by Hans Strupp, PhD and associates at Vanderbilt University in the 1980s. Reflecting on TLDP, Levenson writes: “The major objective of TLDP as originally conceived was to examine recurrent, maladaptive themes as evident in the client’s interactions with others, (even) with his or her therapist.”

Several assumptions, or themes, permeate the rationale and practice of TLDP. Some of those themes include the following:

1. People are innately motivated to search for and maintain human relatedness. This means, as attachment theory tells us, we are hardwired for human connectedness. In other words, we really do need each other.

2. Maladaptive relationship patterns are acquired early in life, and underlie many presenting complaints. For example, let’s say a man had parents who treated him harshly and in an authoritarian manner. As a boy, the man learned to be overly placating and deferential to avoid his parents’ anger. He did so to stay close to them. His learned expectation? Be compliant or get hurt. While such thinking serves an adaptive purpose in childhood, it easily becomes obsolete and counterproductive if rigidly practiced in adulthood.

3. Relationship patterns persist because they are maintained in current relationships. Acquiescence becomes a problem when assertiveness is needed in adult situations. For example, the man above consistently acts in passive, even subservient ways as an adult. This invites others (spouse, friends, coworkers, strangers) to relate to him in more authoritarian and domineering ways. While emotionally and relationally stressful for the man, it feels strangely familiar.

4. In TLDP, clients are viewed as stuck, not sick. As Levenson observes, “The viewpoint of TLDP is that clients are in a rut for the same reason soldiers dig foxholes in war – for self-protection. The goal of therapy is to help them get out of that hole and put down their rifles – to give themselves the opportunity to see what would happen. Perhaps peace would break out.”

 

Which brings us back to the concept of “Cyclical Maladaptive Pattern” (CMP). The CMP is composed of four categories or stages:

1. Acts of The Self Toward Others – which includes our thoughts, feelings, motives, perceptions, behaviors – in relationship to other people. For example, a girl is afraid (a feeling) to go to a dance.

2. Expectations of Others’ Reactions – which include how we “imagine” (expect) others will react to us. For example, the girl thinks: “If I go the dance, no one will ask me to dance.” So, she distances herself from the group and sits off in the corner. (NOTICE how this girl’s “expectation” has now become “solicitation”! She’s actually soliciting her expections [self-fulfilling prophecy?] – to not be asked to dance. Attachment theorist and clinical psychologist David Wallin, PhD, observes: “That which we cannot verbalize, we tend to enact with others, (and/or) evoke in others…” (2007) . This is exactly what we’re seeing in the girl at the dance. She’s enacting/evoking (I call it “soliciting”) her expectations. By distancing herself from the others and sitting off in the corner, she actually saying: “Don’t ask me to dance!” Sometimes these actions are conscious, but oftentimes these actions are unconscious; outside our awareness.

3. Acts of Others Toward The Self – which involves our “interpretations” of others’ actions. For example, let’s say that the girl is asked to dance, numerous times. The girl thinks to herself (interprets): “When I got to the dance, guys asked me to dance, but only because they felt sorry for me.” The girl’s interpretation corroborates (strengthens) her expectation/solicitation.

4. Acts of the The Self Toward One’s Self – which involve all the thoughts, feelings, and behaviors we internalize (introject) about ourselves. Basically, it’s how we treat ourselves. So, the girl at the dance concluded that guys felt sorry for her–therefore asking her to dance–because she’s “fat, ugly, and unlovable,” prompting her to pour herself a drink.

To summarize, the CMP consists of four categories or stages:

Acts….Expectation/Solicitation….Interpretation….Internalization

To quote Hanna Levenson again from a 2007 interview: “I act, think, feel in a certain way and expect other people will treat me in such and such a way. In fact, they treat me in this way, and all of this leaves me feeling ??? about myself, which causes me to act, feel, think; and then what we have is a cyclical maladaptive pattern. It’s cyclical; it feeds on itself. It’s maladaptive because it doesn’t work well for the person, and it’s a pattern because it occurs over time, over place, over people.”

Despite our complaints and protestations to the contrary, CMP tells us we could be getting what we’re asking for.

Bill Bray, Colorado Springs, CO

The Trauma of Secrecy

Posted by on Sep 26, 2016 in Research | 0 comments

The Trauma of Secrecy

Two months ago I based my July blog on Dr. Brene’ Brown’s book Daring Greatly (2012). As is often the case, the authors I read become referral sources for who and what I should be reading professionally, next. That’s exactly what happened when I read Brene’s following paragraph:

“Shame thrives on secret keeping, and when it comes to secrets, there’s some serious science behind the twelve-step program saying, ‘You’re only as sick as your secrets.’ In a pioneering study, psychologist and University of Texas professor James Pennebaker and his colleagues studied what happened when trauma survivors–specifically rape and incest survivors–kept their experiences secret. The research team found that the act of not discussing a traumatic event or confiding it to another person could be more damaging than the actual event. Conversely, when people shared their stories and experiences, their physical health improved, their doctor’s visits decreased, and they showed significant decreases in their stress hormones.”

Note to self: Add James Pennebaker, PhD, Professor of Psychology at the University of Texas at Austin – to reading list. 

I did read Brene’s next paragraph about Dr. Pennebaker’s research before picking up the iPhone to order his book on Amazon:

“Since his early work on the effects of secret keeping, Pennebaker has focused much of his research on the healing power of expressive writing. In his book Writing to Heal (2004), Pennebaker writes, ‘Since the mid-1980s an increasing number of studies have focused on the value of expressive writing as a way to bring about healing. The evidence is mounting that the act of writing about traumatic experience for as little as fifteen or twenty minutes a day for three or four days can produce measurable changes in physical and mental health. Emotional writing can also people’s sleep habits, work efficiency, and how they connect with others.'”

Brene’ adds: “Shame resilience is a practice and like Pennebaker,  I think writing about our shame experiences is an incredibly powerful component of the practice.”

The only–but extremely important–caveat, I would add (with Drs. Pennebaker and Brown’s professional blessings, I’m sure) is that some trauma processing should ONLY be done with a mental health professional. As one reviewer put it: “We have defenses such as repression for good reasons.”

So, I placed my order. Expressive Writing; Words that Heal (2014) is the updated and revised version of Pennebaker’s 2004 edition; co-authored with John Evans, Ed.D. In the preface, Dr. Pennebaker, a “research psychologist” tells how he:

“accidentally discovered the power of writing in an experiment…conducted in the mid-1980s. In the study, people were asked to write for four consecutive days, fifteen minutes per day, about either a traumatic experience or a superficial event. To my surprise, those who wrote about traumas went to the doctor less often in the following months, and many said their writing changed their lives. Ever since then, I’ve been devoted to understanding the mysteries off emotional writing.”

While “emotional writing”(or its oft-used research term, “expressive writing”) is obviously the purport of the research, and Pennebacker’s book, I became intrigued by the additional traumatic impact of secrecy cited earlier by Brene’ Brown. Pennebaker writes:

“When my students and I studied the aftereffects of traumas, we observed the same things (the Adverse Childhood Experiences [ACE] ) researchers did.” (Note: See my July 5, 2015 blog regarding the ACE Study.) Pennebaker continues:

“But we also found something more striking. Having a traumatic experience was certainly bad for people in many ways, but people who had a trauma and kept that traumatic experience secret were much worse off. Not talking to others about a trauma, we learned, placed people at even higher risk for major and minor illness compared to people who did talk about their traumas.

The dangers of keeping secrets were most apparent for major life traumas. In a series of surveys, several hundred college students and people who worked at a large corporation were asked to complete a brief questionnaire about traumas that had occurred earlier in their lives. The respondents were asked if prior to the age of seventeen they had experienced the death of a family member, the divorce of parents, a sexual trauma, physical abuse, or some other event that had ‘changed their personality.’ For each  item, they were also queried as to whether they had talked to anyone in detail about this experience.

First, over half of the people we surveyed reported having experienced a major trauma in their life prior to the age of seventeen (Keep in mind that these were generally middle and upper-middle class students and adults.) Second, the people who had had any kind of major trauma before the age of seventeen went to physicians for illness at twice the rate of people who had not had a trauma. Finally, among those who had traumas, those who kept their traumas secret went to physicians almost forty percent more often than those who openly talked about their traumas.

Later research projects from multiple labs confirmed these results….Not talking about important issues in your life poses a significant health risk.”

Huh. “Not talking about important issues in your life poses a significant health risk.” My brother would agree that we had loving parents. We never doubted our parents’ love for us. Although I can’t speak for my brother, I don’t remember really talking to anyone about the negative effects Mom and Dad’s troubled marriage was having on me. What I do remember, vividly, is being taken to the doctor for what seemed like an inordinate amount of times –  for stomach aches.

Bill Bray, Colorado Springs, CO