Monthly Archives: September 2014

Stephen Porges on Treating Trauma and Compassion

Stephen Porges magesDr. Stephen Porges discovered in 1994 that trauma in humans comes from our most ancient “reptilian” freeze reflex. He calls it the Polyvagal Theory, as I wrote last week. But Porges also says we can use our mammalian attachment system to heal this.

This week I have a few short (and two long) Porges
videos to share with you, which since Polyvagal is
pretty darn complex, are really wonderful to have.

I really like “The Science of Compassion,” his talk
at the Stanford University conference of the same
name.  Here they are:

“Polyvagal Theory: Trauma from a New Perspective” — Stephen Porges, PhD, inventor of the Polyvagal Theory, shares his insights with Dr. Ruth Buczynski of NICABM on the treatment of trauma. He explains how treating trauma or treating PTSD is not always straightforward;  4 minutes at https://www.youtube.com/watch?v=MKkDAOW2yd4

“The Science of Compassion,” by Stephen Porges, PhD,  at the Stanford University conference “Science of Compassion: Origins, Measures, and Interventions.” This was the first large-scale international conference of its kind dedicated to scientific inquiry into compassion; 25 minutes at https://www.youtube.com/watch?v=MYXa_BX2cE8

William Stranger interview Dr. Stephen Porges.
The Polyvagal Theory introduced a new perspective relating autonomic function to behavior that included an appreciation of autonomic nervous system as a “system,” the identification of neural circuits involved in the regulation of autonomic state, and an interpretation of autonomic reactivity as adaptive within the context of the phylogeny of the vertebrate autonomic nervous system; 40 minutes at https://www.youtube.com/watch?v=8tz146HQotY

#090: Adam Carolla and Dr. Stephen Porges September 30, 2013  Podcast – Dr. Stephen Porges returns to The Dr. Drew Podcast and this time we are also joined by special guest Adam Carolla.  Dr. Porges and Dr. Drew attempt to investigate Adam’s behavior and identify some patterns; 57 minutes at http://drdrew.com/090-adam-carolla-and-dr-stephen-porges/

——————

Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN  Porges, Stephen, PhD, “The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
—“Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
—”Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

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Polyvagal Theory: Trauma as Reptilian Freeze

Polyvagal Theory Book Amazon1Neuroscientist Dr. Stephen Porges appeared in my last few blogs; let’s explore his 1994 discovery of the Polyvagal Theory.  Dr. Porges runs brain-body research at top psychiatry departments (University of Chicago and University of North Carolina Chapel Hill).

And he always says he wasn’t looking for a polyvagal theory. He was just researching ways to measure the vagus nerve, the 10th cranial nerve running between the brain stem and most of the body.

Until 1994, textbooks said there are two parts to the autonomous nervous system (ANS).  First, the sympathetic system mobilizes us for fight and flight, but is harmful if it stays on too long, making us tense, anxious and prone to disease. Second, the parasympathetic inhibits mobilization, so it was believed to be calming and healthy. Textbooks taught that “the net result was a balance between a pair of two antagonistic systems,” Porges says. The vagus nerve makes up a chunk of the parasympathetic; “it functions like a brake on the heart’s pacemaker.” [FN]

This two-part model broke down “as I was conducting research with human newborns to measure heart rate, assuming vagal activity was protective,” Porges says. “If newborns had good clinical outcomes, they had a lot of vagal heart rate going up and down with breathing. Babies with flat heart rates were at risk.  So I wrote a paper in the journal Pediatrics to educate neonatologists.

“Following publication, I received a letter from a neonatologist who noted that… the vagus could kill you, and that perhaps too much of a good thing was bad. His comments startled and motivated me to challenge our understanding of the nervous system.

“I immediately understood what the neonatologist meant. From his perspective, the vagus can kill, since it is capable of life threatening bradycardia and apnea — massive slowing of heart rate and cessation of breathing. For many pre-term infants, bradycardia and apnea are life threatening.  I now framed the ‘vagal paradox.’  How could the vagus be both protective and lethal? For months I carried the neonatologist’s letter in my briefcase.”

Poly Faces of Vagus

Polyvagal Anatomy Diagram

Porges went back to the evolution of anatomy, and saw that in fact there are two different vagus circuits — a total of three ANS circuits, not just a pair.  The two circuits “come from two different areas of the brain stem, and they evolved sequentially,” one far earlier.

“This motivated me to develop the polyvagal theory, which uncovered the anatomy and function of two vagal systems, one potentially lethal, and the other protective,” he says.

“Immobilization, bradycardia, and apnea are components of a very old, reptilian defense system, ” Porges says. “If you look at reptiles, you don’t see much behavior — because immobilization is the primary defense system for reptiles… it’s an ancient vagus nerve.”  This pre-historic nerve has no myelin, a nerve coating of  protective protein and fat.

Porges found mammals have this unmyelinated vagus, on the dorsal (top) side of the nerve, which immobilizes us, too —  “and that immobilization reaction, adaptive for reptiles, is potentially lethal for mammals.”

Porges also saw that among the “firsts” which began with mammals, a new vagus with myelin develops on the ventral underside of the nerve.  “So mammals have two vagal circuits,” he found. ” The myelinated circuits provide more rapid and tightly organized responses. The new mammalian vagus is linked to brain stem areas that regulates the muscles of the face and head. Every intuitive clinician knows that if they look at people’s faces and listen to voices,  controlled by muscles of the face and head, they know the physiological state of their client.”

Neuroception:  It’s Just Not Cognitive

Porges adds that our more primitive neural circuits operate by “neuroception” — totally involuntarily.  “Neuroception is not perception,” he says. “Neuroception does not require an awareness of things going on.  It is detection without awareness. It is a neural circuit that evaluates risk in the environment… When confronted in certain situations, some people experience autonomic responses such as an increase in heart rate and sweating hands. These responses are involuntary. It is not like they want to do this.”

The polyvagal theory emphasizes that our nervous system has more than one defense strategy – and whether we use mobilized flight/flight or  immobilization shutdown, is not a voluntary decision.  Outside the realm of our conscious awareness, our nervous system is continuously evaluating risk in the environment, making judgments, and prioritizing behaviors that are not cognitive.

Next, he says, “humans and other mammals, as fight/flight machines, only work if they can move and do things. But if we are confined, if we are placed into isolation, or if we are strapped down, our nervous system reads those cues and functionally wants to immobilize.  I can give you two interesting examples: one is a news clip I saw on CNN and the second  from my own personal experience.

“I saw a CNN news broadcast with a video clip of a plane whose wings were tipping up and down as the plane was tossed by the wind. The plane did land safely and the reporter went to interview the people. He asked one of the passengers how it felt to be in a plane that looked like it would crash. Her response left the reporter speechless. She said, “Feel? I passed out.” For this woman, the cues of a life threat triggered the ancient vagal circuit. We don’t have control over this circuit.

“Many people who report abuse especially sexual abuse, experience being held down or physically abused. These abused clients often describe a psychological experience of not being there. They dissociate or pass out. The abusive event  triggered an adaptive response, to enable them not to experience the traumatic event.”

Porges’ second example, noted in my Aug. 22 blog, was his own attempt to have an MRI – in which his body flat out overruled his powerful thinking brain. “I wanted the MRI.  But something happened to my body when I entered the MRI that triggered my nervous system into…wanting me to mobilize to get out of there.” So the nurses let him out.

Porges was asked by one interviewer, “What would have happened if you called to be let out — but no one came?”

“Now we’re talking!,” said Dr. P. “So now I am stuck in there, I can’t get out; I am in this confined area. That would be totally like being physically abused, being held down, going through all these same things.” Like the plane passenger who defaulted back in evolution to her most primitive system, he might have dissociated or passed out.

“The problem, of course, is how do you get people back out of that?” Porges asks. ” If a life threat puts a human into this state, it may be very difficult to reorganize to become ‘normal’ again.”

Friday Sept. 26:  Videos and audios on Polyvagal Theory

Friday Oct. 3: Dr. Porges on how to “get people back out of” the reptilian freeze of trauma.

——————

Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN Porges, Stephen, PhD, “The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
—“Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
—”Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

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“General Theory of Love” on Mammals

BrousBlog6c General Theory“A General Theory of Love”  by Thomas Lewis MD,  Fari Amini, MD, and Richard Lannon, MD, is all about why it’s so important that we are mammals.  They say it’s vital that we value our mammalian attachment system and stay close to other mammals.   Here are  quotes and some great MP3 audio clips from “General Theory,” to follow up on Dr. Stephen Porges’ writings on our mammalian attachment system last week.

“A body animated only by the reptilian brain stem is no more human than a severed toe.  Reptiles don’t have an emotional life,” says General Theory.  “The advent of the mammalian limbic lobe, uniquely, allows mammals to care for their own, have emotions, and risk and lose life for another.”

“When mammals showed up on the planet, their method of reproduction was different. Unlike reptiles, they gave birth to live helpless young that had to be nurtured or wouldn’t survive,” said co-author Dr. Tom Lewis in a 2008 interview.   “The parent had to monitor the physiology of the baby.

“This lead to the development of a part of the brain called the Limbic Lobe, which we share with all mammals.  Infants’ physiology is incomplete on its own; babies can’t get to sleep on their own, they need to be lulled to sleep; they can’t soothe themselves, instead they seek out someone who can soothe them.

“Just as infants need the regulating presence of the external contact figure, all of us are like infants, only bigger, and we also need the regulatory influence… Most people think their body is self contained, that sugar levels are monitored internally and so on, oxygen, hormones.  It’s very surprising that this not true – there are physiological parameters regulated by other people outside own body.

“In our culture we construe loneliness as weakness, as a character defect… But it’s based on brain evolution; there’s no choice about it. Just as when you’re hungry, or low on water and feel thirst, loneliness is a real physiological feeling telling you you need something vital.  It hurts so much because it’s important to your health.”

Love is the glue that keeps people and societies together, says Dr. Richard Lannon in a terrific series of mp3 clips of  interviews by radio host Paula Gordon.  He explains fundamental human biology which makes our connections to others fundamental.

He relates the mammalian brain’s limbic system to being alive, to parenting, to being happy, to appreciating beauty and explains why we cannot “think our way” to fulfillment:   http://www.paulagordon.com/shows/lannon/mp3/RLannonConv2.mp3

Dr. Lannon says it is good mothering which leads to secure attachment and explains the profound implications of the importance of optimally tuning in to a child. He describes how the ideas in General Theory of Love expand on (as well as part company from) traditional psychotherapy.

He reviews the profound, central importance of long-term, sustaining support networks for humans.  He notes that most social forces currently work in the opposite direction:
http://www.paulagordon.com/shows/lannon/mp3/RLannonConv3.mp3

Dr. Lannon explains why self-help books usually are no help. He distinguishes General Theory of Love from that genre, explaining why we cannot intellectually (neocortex) control our emotions (in the limbic brain.) He argues for integration of the different ways of knowing – thinking neocortex and emotional limbic – urging us to give the limbic system its due – while pointing to the terrible social price we are paying for not doing so.

He describes what happens when people do not attach, personally and in society.  http://www.paulagordon.com/shows/lannon/mp3/RLannonConv4.mp3

Humans have been given the gift of being a social animal, says Dr. Lannon, who urges us to be more of what we are. He reminds us that emotions are innate and that we all have them and must “tune” them, comparing this to tuning an instrument.

He describes humans as open-loop systems, deeply affected by our relationships with other and NOT independent of each other. He expands on, “We create each other.” He assures us that we can change, but only with the help of other people. He reminds us of the tremendous power social interactions have to heal, reminding us of research which shows that brains continue to grow into old age. http://www.paulagordon.com/shows/lannon/mp3/RLannonConv5.mp3

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME:  The Silent Epidemic of Attachment Disorder How I accidentally regressed myself back to infancy and healed it all.”  Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  Lewis, Thomas, MD; Amini, Fari, MD; Lannon, Richard, MD; “A General Theory of Love”,  Random House, New York, 2000.  See Dr. Lannon interviews at: www.paulagordon.com/shows/lannon/
Preface excerpts at:  www.nytimes.com/books/first/l/lewis-love.html
On therapy:  www.goodreads.com/author/quotes/1503539.Thomas_Lewis

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Mammalian Attachment System Heals Trauma

Stephen Porges magesDr. Stephen Porges writes in his groundbreaking “Polyvagal Theory” that mammals like us aren’t made for trauma.  We’re made primarily to attach to other mammals, which makes us feel safe, secure and good.  When that fails, we’re also made to go into a secondary fall-back option of fight/flight; we get aggressive or at least defensive. And it feels bad; we know something’s wrong.

But we’re not made to be in fight/flight for a long time, so when we’re caught in fight/flight and can’t get out, mammals are forced back into a third, even more primitive system: reptilian freeze, aka immobilization or dissociation.

“If you go to a pet store and look at the reptiles, you don’t see much behavior, because immobilization is the primary defense system for reptiles,” says Porges. “But if you look at the small mammals, hamsters and mice, they are running around. They are socializing.”

“Some reptiles can shut down and go underwater for several hours and be fine. The shut-down system works well if you are a reptile, because reptiles don’t need much oxygen and don’t need to support a big brain…

“But this immobilization reaction… is potentially lethal for mammals. If a life threat triggers a biobehavioral response that puts a human into this state, it may be very difficult to reorganize to become ‘normal’ again,”  he warns. [FN]

I talked about that kind of trauma last blog.  I was suddenly thrust into a medical system that ignored all these mammalian basics.  No matter to whom I turned for communication and  information, nobody saw me, nobody heard my questions, nobody seemed to care what happened. No mammalian response.

So instead of being about to simply sit and be “Present” with the sudden survival threat of a surgical knife coming at me, I had to take all the perfectly normal fight/flight feelings which that causes, and “stuff  it.”  Because I had to push myself into hunting and gathering all that info alone. Which threw me into reptilian freeze, just as my body was designed by the Manufacturer to do.  That’s trauma.

Mammals Should Be Seen – And Heard

Cats Bad Day, I fix itBut, good news: I got out of that trauma in under a week, thanks to Dr. Porges’ primary state: mammalian attachment.

The first thing that happened was I took a step myself, to get myself “seen” and “heard” – I wrote that blog.  It went out to almost a thousand readers, and the response was terrific.  In particular, lots of nice warm mammals in my Life Team support system started to call and write to me, and wow did that feel good.

“Dearest Kathy,” wrote one reader, “I just read your latest blog post, and it sounds rough.  I hope things are calming down and straightening out, and I wish I could be there to help. Do call if you want. – A big, warm, long hug….”

Now this gal and I go way back decades, though she’s on the east coast where I haven’t seen her since 2009. But we were attached mammals for so long, that in 2011 I woke up one morning dreaming I’d been singing Handel’s  Messiah, things went terribly wrong – but suddenly there at the foot of the stage, she appeared – to give me a big hug. “Oh!  It’s her!  She knows me. She sees me — the real me, the me who really is.”

And about three hours later that same day in 2011, my cell phone rang and…. it was her.  Across 3,000 miles.

“The evolution of the nervous system starts with the un-myelinated vagus nerve, which does immobilization. Reptiles have this oldest defensive system,“ says Porges.

“With mammals, a newer circuit, a uniquely mammalian vagus which is myelinated, comes online.  So mammals have two vagal circuits, which originate in different areas of the brain stem. The new mammalian vagus is linked in the brain stem to areas that regulates the muscles of the face and head.  Every clinician knows that if they look at people’s faces and listen to their voices, which are controlled by muscles of the face and head, they will know the physiological state of their client.

“If we are protected with the newer mammalian vagal circuit, we do fine. When our mammalian social engagement system is working, we feel calm, we hug people, we look at them and we feel good.

“These mammalian part of our  nervous system  enables social interactions to calm our physiology and to support health, growth, and restoration.  When a person is facially expressive, has vocal intonation, has an expressive face and whose eyes are open when we talk to them,”  then we feel seen, heard, and connected.

“Thank you for actually ‘seeing’ me and knowing me,” I wrote back to my gal pal last week after she saw my blog. “It’s got everything to do with plain old simple mammalian attachment, in which we  just ‘be with’ each other, and feel safe.

“And just this morning, it hit me: Oh, Mom again. I was under survival threat as an infant because I was raised in a glass box, which is interpreted by the infant brain stem as a survival threat. Google ‘Still Face Experiment’  – it shows how infants go nuts when nobody sees them, nobody hears them – nobody responds.

“So today, survival threat  (surgical knife) will cause me to over-react.  ‘Of course’ says my wonderful attachment-based psychotherapist,  ‘it’s baked into your brain stem.  Give yourself some grace, have your reaction, and then do the reality check.’   So when the doctors exhibit the same reptilian behavior as Mom: nobody hears me, nobody sees me, nobody responds?   ‘Of course’ — bam, it  triggers the whole infant deep neurological experience.

“The minute I put that together, I had a good cry, then started to feel absolutely fantastic.  Because suddenly I knew: it’s not about the doctors or the surgery — it’s about my mammalian attachment system.  No matter what happens with the surgery or the doctors, it won’t matter – as long as I get with mammals.  And what a relief.

“Because now I do have mammalian attachment to my friends, my therapist, and a few other important people – like God – now I do have “Safe People.”

“So suddenly now the surgery is no big deal because the doctors will do a great technical job like well-trained reptiles, and back to what really counts, my mammalian support system is taking care of my mammal needs big time.  Which brought me an enormous relief of tension, and feeling of support.”

And no sooner did I figure this out, than my email dings –  and it’s her again.

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN  Porges, Stephen, PhD, “The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
—“Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
—”Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

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