Monthly Archives: November 2014

Neurofeedback: Healing the Fear-Driven Brain

Sebern FisherPsychotherapist Sebern Fisher gave a great webcast on October 22, 2014 in the NICABM series, about neurofeedback (biofeedback to the brain), which gives us access to our brain function frequencies.

Neurofeedback, she said, is a computer program therapists use in their office, training clients on it to get them in touch with their own brain waves, learn what’s good for the brain, and calm their thoughts.

The brain is organized from the womb in oscillatory patterns, Ms. Fisher says, so we with developmental trauma, early neglect and abuse, have disorganized and dysregulated brains.  Our fear circuits dominate.  Neurofeedback can calm these erupting circuits and even grow neural connectivity, which helps us create a more coherent sense of self, so we feel safer and more centered. [FN1]

Folks with difficult parents often grow up with a “fear-driven brain” as I did — and it’s a huge relief to find out we’re not freaks — we’re a chunk of the mainstream.  In fact, maybe 50% of Americans have some degree of this “attachment disorder” due to parents who were too scary to attach to. Of course it’s not their fault either; odds are, our grandparents were too scary for our parents to attach to, and so on back, inter-generationally.

I was particularly struck watching Ms. Fisher’s NICABM video as she repeated again and again how many people are walking around with a “fear-driven brain.”  Her 2010 radio interview “Attachment Disorder, Developmental Trauma and Neurofeedback” says she spent decades trying to heal kids with early attachment wounds, but found we can’t talk to the parts of the brain formed from conception to 36 months; those parts have no speech. So she made no progress until she tried neurofeedback in 1996. It can talk to those parts: http://www.futurehealth.org/Podcast/Sebern-Fisher-Attachment-by-Rob-Kall-100516-497.html

I’d bet maybe 20% of us have “developmental trauma” like that, as I do, which means that life was one continuous trauma “since the sperm hit the egg.” For what it looks like when Mom is too scary for her child to attach, check http://attachmentdisorderhealing.com/developmental-trauma-2/

I was moved to tears by Ms. Fisher’s more recent interview “Neurofeedback in the Treatment of Developmental Trauma,” as she described how deeply necessary love and attachment are to the creation of a human brain. It’s because we crave the regulation of our nervous system which love can bring, that our brains respond to neurofeedback signals which feel calmer and even loved: http://shrinkrapradio.com/452-neurofeedback-in-the-treatment-of-developmental-trauma-with-sebern-fisher-m-a/

And: here’s an amazing blog by Dr. Tina Hahn MD, “My Neurofeedback Journey,” on the BrainPaint® home neurofeedback system she’s using.

Find a Neurofeedback Practitioner: Online Directories:
1. EEG Spectrum International [Ms. Fisher’s husband John Fisher was president of this co.] Directory: http://www.esiaffiliatesforum.com/providers
2. EEG Institute Provider Directory: http://directory.eeginfo.com/

Trauma, Up Front and Personal

Ms. Fisher got into therapy and attachment work in the first place because she herself had developmental trauma.  She also had a lot of head injury and traumatic brain injury.  One of the first things to be healed when Ms Fisher began neurofeedback herself were her terrible migraines, which have never returned.  She still uses neurofeedback because, she says, “I have had a lot of head injuries so I am at a greater risk of Alzheimer’s than other people, but all of the signs of head injury and traumatic brain injury that I had are all gone.”

Here are some salient quotes from Ms. Fisher’s  NICABM interview:

“Neurofeedback is biofeedback to the neuronal activity of the brain. It is a computer interface where you pick up the firing of the brain in the EEG (electro-encephalogram) in real-time, scrolling for a therapist and client to look at together. By challenging their brain through feedback, we can see that the EEG is changing,” she starts.

“And obviously the change that I am most concerned about is change in levels of fear. Mostly what I am concerned about is quieting fear, so let’s take that situation. We know that the fear circuits are in the temporal lobe and that survival’s fear circuit, the survival amygdala, is in the right hemisphere. We’re trying to say to the brain – not to the person– “Stop practicing that fear-driven over-arousal. Chill. Get quiet!”

“Now, if people could do this on their own, they wouldn’t need the game or the neurofeedback. [So she’s never harsh on the person; she just re-trains their brain.] We have to find the frequency that works for that particular individual – it’s going to be different for everyone. They tell me two or three days later that, on the whole, they have been calm, they have been sleeping, they are less reactive, and/or they are making easier eye contact. That is what I mean by works….

“I had a young woman, who had been adopted from a third-world country. She had been in an orphanage after having been delivered in a shoebox from a police station. They fed her with an eyedropper, not ever expecting that she was going to live. She had every possible level of disorganization: she couldn’t read; she bumped into doorjambs; she had a very difficult time negotiating through life.

“I was now meeting her out of a mental hospital, and she was in her twenties. [After neurofeedback training] she comes in and tells me this story. She was always the last one chosen for any sports team, as you can imagine, when she was a kid, and now she’s stabilized enough to be dating. She is out with a guy, they are waiting to go to a movie, and they go to a batting cage – she hits 90% of the balls. Therapy could never get somebody from bumping into walls to being able to hit 90% of the balls! Her boyfriend was very impressed…

“Neurofeedback is deeply organizing to the nervous system. This goes deep into the nervous system; neurofeedback is healing deep into the CNS, the central nervous system, and through the brain.

“I had one patient who was given the diagnosis of Borderline Personality Disorder and had been hospitalized multiple times. She very much wanted to do neurofeedback training because she felt like she had gone as far as she could with psychotherapy, and she still wanted to drive off a bridge every day!  We used two different protocols: the eyes-open protocol – it doesn’t matter what the specifics were for her – but she got stabilized in 20 sessions, and then we did the alpha-theta protocol. She did 30 or 40 sessions. All together, she had about 60 sessions, then it was over. She did not meet any criteria for Borderline Personality and she no longer wanted to jump off a bridge.

“She actually got married and had a baby, and went on to advance her career. I saw her once after that ending, and it was when a pet that had been her primary object of attachment, was killed in a freak accident. She came back in and she was very distressed. An additional trauma can also throw the brain back into its known pattern of firing. So we trained about four times, to address the state she was in, and she very quickly reorganized and was off again.

Repair of Attachment with Neurofeedback

(Interviewer Dr. Buczynski): “How do you think of attachment and repairing of attachment in regard to neurofeedback?

Fisher: “Oh, that’s a wonderful question, and it is somewhat amazing that this happens. In my experience, what I have seen is that people always seem to want relational connection.

“Things can get in the way – if you are having something akin to a seizure and you’re constantly living in fear; it is very difficult to imagine relationship as a primary part of your life. But we are social creatures; we are meant to relate to one another. That is our safety; that is our harbor, as my patient said, and when you find a way to quiet the fear-driven brain, what emerges quite spontaneously are the attachment circuits.

“I had one patient who was self-abusing and dissociative when she came into sessions. She had not seen her mother nor talked about her mother – so this wasn’t a result of conversation – but her mother had not behaved ideally. She came in one day [after neurofeedback treatment] and said, “I think you might be interested in this: I called my mother last night.” It was spontaneous, and now we could talk about the reality of her mother’s trauma.

“Now, this had been presented to her multiple times, and it even occurred to her, but the dysregulation and high arousal of her nervous system made it pretty meaningless. I see that happening a lot. I see spontaneous family reunion that I have nothing to do with orchestrating, and often, without even talking about it, I see it happen with people who train their brains.”

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Kathy’s 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 “Neurofeedback: Soothe the Fear of a Traumatized Brain: How a New Intervention Is Changing Trauma Treatment,” Sebern Fisher, MA, BCN, Psychotherapist and Neurofeedback practitioner, Private Practice, Northampton, MA;  10-22-14 Webinar interview by Dr. Ruth Buczynski, National Institute for the Clinical Application of Behavioral Medicine (NICABM), http://www.nicabm.com/treatingtrauma2014/post-info/

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California ACEs Summit

CA ACEs Summit Nov.2014At California’s first ACEs summit November 5-7, “Children Can Thrive,” over 200 health professionals, policy leaders and advocates gathered in San Francisco. They created a national model for a statewide dialogue on the biggest public health problem facing California today: Adverse Childhood Experiences (ACEs).  They focused on programs in health, education, juvenile justice and child welfare at the local and state levels, and how national policies can support those efforts.

Also exciting, Google.org announced a $3 million grant November 3 to the Center for Youth Wellness (CYW), the clinic started by Dr. Nadine Burke Harris, organizer of the CA ACEs Summit.  The grant is specifically aimed to get enough scientific documentation that childhood trauma causes adult onset diseases, to actually make toxic stress a diagnosis code billable for insurance: http://www.sfgate.com/bayarea/article/Google-gives-3-million-to-Nadine-Burke-Harris-5865372.php

Dr. Harris’ clinic “focuses on what is known as adverse childhood experiences and toxic stress — issues like neglect, abuse, exposure to violence and household dysfunction that can damage a child’s developing brain and body.  Burke Harris said that 1 in 10 of the children she sees has experienced not just one of those traumas, but four or more,” the San Francisco Chronicle reported November 3. “Even though Burke Harris’ work has been lauded by former Secretary of State Hillary Rodham Clinton — who featured the doctor in a video for her Too Small to Fail philanthropic campaign last year — it has been a challenge raising enough money….

“/’This grant is built on science,’ said Google’s Justin Steele. “If they prove it works in Bayview, we’d love to see it scale up across the country.’  …Burke Harris said the grant will enable her team to develop a clinical protocol to address toxic stress. That will be key to making the issue into something that insurance companies can understand — and cover. Now, insurers don’t.”

Summit on Adverse Childhood Experiences
by Jane Stevens and Staff of ACEsConnection.com
ACEs are traumatic experiences, such as abuse, neglect and household dysfunction, which can result in toxic stress and have a profound effect on a child’s developing brain and body. Research shows that nearly two-thirds of Californians have reported at least one adverse childhood experience.The Center for Youth Wellness videoed the main conference sessions November 5-7, and will post those videos, including a presentation about ACEs by Burke Harris, a conversation between her and Dr. Vincent Felitti, one of the co-founders of the ACE Study, and Jamie Redford showing the trailer from  “Paper Tigers”, a documentary about Lincoln High, a trauma-informed school in Walla Walla, WA.

ACASkids-1The ACEs Connection Network team participated and reported on the breakout sessions, which weren’t videoed. On the first day, Elizabeth Prewitt covered health (CA ACEs Summit: Overall health depends on much more than healthcare, pediatricians and other public health specialists agree).

Joanna Weill covered juvenile justice (CA ACEs Summit: Juvenile Justice Panel), and the discussion that occurred during the panel that covered ACEs from a national perspective.

In that session, Sylvia Paull was inspired by Esta Soler, founder of Futures Without Violence, and, in the education panel, by the pioneers transforming cultures of public schools from punishment to compassion. Elizabeth Prewitt covered the state panel (CA ACEs Summit: Building the ACEs movement in 3 states).

Alicia St. Andrews of ACEsConnection.com shares reports on the panel at the CA ACEs Summit on how local groups are getting organized to stop the trauma and spread compassion and healing instead, here:  CA ACEs Summit Building the Foundation to Help Children Thrive: Strategies to address the impact of ACEs
ACEs 101 FAQs – What are ACEs?
by Jane Stevens, founder, ACEsConnection.com

ACEs are adverse childhood experiences that harm children’s developing brains so profoundly that the effects show up decades later; they cause much of chronic disease, most mental illness, and are at the root of most violence.   Read more: http://www.acesconnection.com/blog/aces-101-faqs

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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.

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The Body Keeps the Score – Bessel van der Kolk

Bessel Book bodykeepsscore “The Body Keeps the Score” by Bessel van der Kolk, MD, will “permanently change how psychologists and psychiatrists think about trauma and recovery,” as trauma scholar Dr. Ruth Lanius writes.  She was the first to call developmental trauma a “hidden epidemic,” source of my book’s subtitle “Silent Epidemic.” Dr. van der Kolk repeats this in his new book.  [FN1]

And it is about the body. “Infants are psycho-biological beings, as much of the body as of the brain,” writes Prof. Ed Tronick, author of the Still Face Experiment. “Without language or symbols, infants use every one of their biological systems to make meaning of their self in relation to the world.  Van der Kolk shows that those same systems continue to operate at every age, and that traumatic experiences, especially chronic toxic experience during early development, produce psychic devastation.”

I reported van der Kolk’s work on developmental trauma and on getting the military to recognize PTSD in March 2014.  When the New York Times damned van der Kolk’s insistence on body work in June 2014, I roasted them.  In this book, van der Kolk makes his case much better than anyone else could.

I’m having trouble reading the book; I keep starting to sob. That started on page 3 where Dr. van der Kolk describes his heart-breaking childhood experience in bombed-out post-war Holland, with his father prone to violent rages, and his mother acting out her childhood trauma on him. I could feel that little boy, what he’s been going through all these years, and see the depths of what he has accomplished by giving his life so passionately to heal himself and all the rest of us.

These are “good sobs;” they feel good, because once again van der Kolk has told the truth about reality where few dare. Half the human race has had significant childhood trauma, and most of them are in complete denial and live in a state of dissociation, aka freeze or numbness. People in trauma, he writes, feel “numb” to most of life. One patient felt “emotionally distant from everybody, as though his heart were frozen and he was living behind a glass wall. He could not feel anything except his momentary rages, and his shame.”

Dr. Stephen Porges calls van der Kolk’s book a “courageous journey into the parallel dissociative worlds of trauma victims and the medical and psychological disciplines.” As van der Kolk and Porges have said before, medical and psychological experts have been just as much in denial and dissociated regarding the serious nature of trauma as are the traumatees.  “As our minds desperately try to leave trauma behind, our bodies keep us trapped in the past with wordless emotions and feelings,” Porges says. “Van der Kolk offers hope by describing treatments and strategies that have.. helped his patients reconnect their thoughts with their bodies.”

Why all the denial?  “We don’t really want to know what soldiers go through in combat,” writes van der Kolk. “We do not really want to know howe many children are being molested and abused in our own society and how many couples – almost a third –engage in violence at some point…. We want to think… of our own country as enlightened civilized people. We prefer to believe that cruelty occurs only in faraway places like Dafur…”

Solutions for Recovery

Bessel van der KolkLet’s get right to what everyone wants to know.  Here are Dr. van der Kolk’s “Paths to Recovery,” which I think of as  “body solutions” :

— Healing starts with owning our “self,” 100% total acceptance of our self, exactly as we are today, no guilt, no self condemnation. It means developing pride in who we are; only by accepting ourselves as we are now, do we become free to change. We must respect our body for putting us into trauma freeze; it was the only way to defend us, as Stephen Porges says at the end of my blog last week.

– Recognize that language is a “miracle and tyranny,” van der Kolk says. “Telling the story doesn’t necessarily alter the automatic physical and hormonal responses of bodies that remain hypervigilant, prepared to be assaulted, or violated at any time. For real change, the body needs to learn that the danger has passed.” At some point we must let go of all the verbiage as yackety-yack largely in the conscious frontal cortex and logical left brain.

Instead, we must grasp that there is something more fundamental underneath all that, lead by our body sensations, non-verbal subconscious, and non-logical right brain. The body literally needs to have many, often thousands, of new, good physical experiences, such as being taught to physically move or defend itself, just where it could not during the original trauma. Only these can create a “visceral” certainty of safety, to race the old experiences of danger.

EMDR (Eye Movement Desensitization and Reprocessing) is van der Kolk’s next step, to integrate the right and left sides of the brain. In trauma often neural pathways between them have been frozen; in developmental trauma from infancy, these pathways may not have developed well and must be developed now.  By moving the eyes back and forth, we simulate Rapid Eye Motion (REM) sleep, which the brain uses to take events of “now” (today) out of short-term memory, where feelings like fight-flight and trauma reside, and put them into long-term memory.  Instead of feeling as if our trauma is happening again now, it begins to feel like an old story that loses its sting.

Yoga then teaches us how to inhabit our bodies right here, right now; that’s why it’s been used as a path to enlightenment for thousands of years.  Easy to say, but the challenge is to actually practice it rigorously and regularly; only then comes the benefit.

Neurofeedback programs done by trained neurofeedback specialists really help.  Dr. van der Kolk also recommends the computer (and smart phone) -based electronic feedback system EmWave by HeartMath, which trains users to synchronize breathing and heart rates, known as heart rate variability (HRV). In good HRV, heartrate speeds up when we breathe in and slows when we breathe out.  But in trauma we lose HRV coherence; breathing is very rapid and shallow, and heart rate de-synchronizes from the breath, also hazardous to physical health.

Finding Your Voice:  As Bruce Perry says, “Patterned, repeated rhythmic activity”  can re-tune a traumatized brain stem.   Dr. van der Kolk likes  “communal rhythms” such as drum circles and dance.  He particularly likes theater work because it gives the players a substantial voice and a character they can use to express all their feelings in a way everyone can accept.

Trauma Experts Praise “Body Keeps the Score”

“This is an absolutely fascinating and clearly written book by one of the nation’s most experienced physicians in the field of emotional trauma. Equally suitable for primary care doctors and psychotherapists wishing to broaden their range of helpfulness, or for those trapped in their memories, ‘The Body Keeps the Score’  helps us understand how life experiences play out in the function and the malfunction of our bodies, years later.
– Vincent J. Felitti, MD
Chief of Preventative Medicine Emeritus, Kaiser Permanente San Diego;  Co-Principal Investigator, ACE study

“Breathtaking in its scope and breadth, ‘The Body Keeps the Score’ is a seminal work by one of the preeminent pioneers in trauma research and treatment. This essential book unites the evolving neuroscience of trauma research with an emergent wave of body-oriented therapies and traditional mind/body practices. These new approaches and ancient disciplines build resilience and enhance the capacity to have new empowered bodily (interoceptive) experiences that contradict the previous traumatic ones of fear, overwhelm and helplessness. They go beyond symptom relief, and connect us with our vital energy and here-and-now presence. A must read for all therapists and for those interested in a scholarly, thoughtful, tome about the powerful forces that affect us as human beings in meeting the many challenges of life including accidents, loss and abuse.
– Peter A. Levine, PhD, Author, In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness.

“This book is a tour de force. Its deeply empathic, insightful, and compassionate perspective promises to further humanize the treatment of trauma victims, dramatically expand their repertoire of self-regulatory healing practices and therapeutic options, and also stimulate greater creative thinking and research on trauma and its effective treatment. The body does keep the score, and Van der Kolk’s ability to demonstrate this through compelling descriptions of the work of others, his own pioneering trajectory and experience as the field evolved and him along with it, and above all, his discovery of ways to work skillfully with people by bringing mindfulness to the body (as well as to their thoughts and emotions) through yoga, movement, and theater are a wonderful and welcome breath of fresh air and possibility in the therapy world.”
– Jon Kabat-Zinn, Professor of Medicine emeritus, UMass Medical School, Author of “Full Catastrophe Living.”

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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  Van der Kolk, Bessel, MD., “The Body keeps the Score: Brain, Mind, and Body in the Healing of Trauma,” Peguin Press Viking, New York, 2014  http://www.amazon.com/The-Body-Keeps-Score-Healing/dp/0670785938#reader_0670785938

Bessel van der Kolk, M.D. is the founder and medical director of the Trauma Center in Brookline, Massachusetts. He is also Professor of Psychiatry at Boston University School of Medicine and Director of the National Complex Trauma Treatment Network. When he is not teaching around the world, Dr. van der Kolk works and lives Boston, Massachusetts.

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