Category Archives: Dissociation

Neurofeedback works: Van der Kolk

Bessel website pix vanderKolkportrait1Psychiatrist and trauma expert Dr. Bessel van der Kolk, MD posted a neurofeedback webinar August 9 that changes the map on trauma healing: http://neurofeedback2015.kajabi.com/fe/79711-rewiring-the-brain-free-ce-seminar . [Or try this link to a 5 min intro. His  72-min seminar is below at “Click Here to Begin Your Free One Hour:” http://neurofeedback2015.kajabi.com/fe/80095-support-neurofeedback-research-2015]

Please forward this to your lists of therapists, colleagues, anyone interested in healing. Dr. van der Kolk has promoted EMDR, yoga, and body work for decades.  Now folks with early trauma can check out neurofeedback.

I’ve so far done 10 months of neurofeedback and the healing is enormous. But it’s not known enough or funded. Getting word out could stop suffering.

At minute 20, van der Kolk shows graphics on how Sebern Fisher introduced him to neurofeedback. “She showed me drawings that traumatized kids did of their families (stick figures), then how they developed after 20 weeks of neurofeedback (real people), after 40 weeks (an attached group), and I was blown away by their development,” he said.

“There’s nothing I know that can do that,” he said. “When you see something like that, you pay attention. Can my psychoanalysis do that?  Can my acceptance and commitment therapy do that?  Can my friends who do EMDR or Somatic Experiencing do that?  No.  Nothing I know of can do THAT.  Time to learn new things.”

Don’t hire just any provider. A neurofeedback practitioner with 1. Five-ten years’ neurofeedback; 2. A certificate from EEGSpectrum.com or EEGInfo.com; and 3. Familiarity with attachment issues, is a good place to start.  A good neurofeedback therapist won’t do “one size fits all.”  Ask to be sure that they carefully adjust it to each individual and keep re-adjusting.

My blog on neurofeedback with links to Sebern Fisher interviews is here: http://attachmentdisorderhealing.com/neurofeedback/

Find a Neurofeedback Practitioner Online Directories are here:
1. EEG Spectrum International: http://www.esiaffiliatesforum.com/providers  2. EEG Institute Directory: http://directory.eeginfo.com/
Sebern Fisher says both are fine. Only #2 had a provider near me; he’s great. He’s got all 3 features above.  My insurance covers it for a $35 copay.

Am I In Tune — Or Not?

Neurofeedback Before & After mirasol.netAs for me, I feel calmer, more centered, less frightened, and less easily triggered every day. It works on long-term issues.

Still, I felt shocked as van der Kolk described “ways of being” which I have in spades, but never knew are symptoms of brain disorganization. This knocked me for a loop:

“Our brain is shaped by human interactions, by the way that people respond to us, to rhythms, voices, touch, sounds, how we make music together,” he said. “We are rhythmic machines; I talk to you and move my hands, my face, and I image you responding in kind.

“But if you talk to your partner and they freeze their face, your mind goes blank — because we need feedback… If the world does not respond to you, if people do not smile at you, if as a little kid  when you come home people say, “Oh, you again”?  You miss the experience of being in tune with people. It goes to the very core of our central nervous system.”

At this point (6 minutes in) I had to lay down and sob for 10 minutes. Feeling what he said totaled me.  I had no attunement experiences until I was 4  1/2 and my sister was born. No responses, no rhythm.

“If you have many attunement experiences,” he said, ” when you get scared, someone’s there so the feeling gets repaired; someone gets mad but soon they repair it, then you get a sense of flow with other people. You know we can do things together, we can work things out. You know I can have a voice because my voice has an impact on you. You can have a voice because your voice has an impact on me.”

Again I was sobbing.  What is he talking about?  Have a voice, what’s that?  I never had an impact. Work things out?  Unheard of.  I’m terrified at mis-attunement.  I have no experience that what I feel matters.

In abuse or neglect, he said, “these neural rhythms get broken. The most important parts of the brain to grow in first years of life get you in tune with people, tell you what to be scared of, when to feel safe, how to connect, how to be in synch.”  I was never in synch.

At minute 15:30 he shows astonishing brain scans (click on graphic above). When normal people hear a strange sound (“eeek”), he says, they need to figure out what it means, “so all the different parts of the brain synchronize to focus on that. They’ve developed an N-200 filtering wave that says ‘ignore your phone, your hunger… just pay attention to this sound.’

“But traumatized people have enormous problems filtering out irrelevant information. They are hyper-stimulated by sounds, sights, images, body sensation, have a terrible time filtering them out. As you see here, traumatized people have very different wave forms. Different parts of the brain are not in synch… which explains why they have such a hard time learning from new experiences… taking new information into the brain, paying attention, taking in life as it comes, learning from it.”

That’s me. I’m hyper-stimulated by sounds, sights, images, body sensation. Half the time I can’t filter them out.  This last point really concerns me.  I had no idea that most people can filter out these things.

I just called my neurofeedback therapist and told him that I need a lot more help. “I’m afraid both of us under-estimate how disorganized my brain is,” I said. “You may want to try other areas of my brain for your sensors and/or other procedures” during neurofeedback.

Thank Heaven for neurofeedback and fighters like Dr. van der Kolk.

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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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Comments are encouraged, with the usual exceptions; rants, political speeches, off-color language, etc. are unlikely to post.  Starting 8-22-16, software will limit comments to 1030 characters (2 long paragraphs) a while, until we get new software to take longer comments again.

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My First Podcast 2 of 2

Part 2 “How to Heal” of my 11-6-15 podcast with therapist Jeff Friedman:

Allan Schore 2What books and resources would you recommend for trauma?
I really recommend Dr. Allan Schore’s Sept 2014 Oslo speech video “The Most Important Years;” on my Resources tab, see the subtab on Audios & Videos.  Dr. Schore (left) explains that babies are born screaming in pain because we’re designed for an adult’s emotional brain to show us “Someone cares, I can relax.”  Mom’s love actually creates the neural networks in a baby’s brain needed to calm down, Schore wrote in the’ 90s. Now, in the last 5 years, brain scans have proven him correct. But with infant developmental trauma and attachment disorder, no adult showed us how to calm, so we never did. Infant emotions are still crying painfully deep inside us, says Schore. We’re unaware of it, but that is the cause of our anxiety, fear, anger, and misery.

Several healing tools are really helping me now. Links to all these below are on my Resources tab, sub-tab Healing Tools.  I’m sorry to keep mentioning my website but I was forced to build it when I couldn’t find all this centralized anywhere else. My home page has almost 40,000 hits; my book tab over 12,000 hits and there are 4 more tabs. It gets hits because there’s a large amount of content on my pages.  Here are the healing tools:

Neurofeedback is a computer program which therapists use to train clients to calm brain waves. We with early neglect and abuse have disorganized brains and fear circuits dominate.  Neurofeedback can calm this by growing new neural networks, the way a mother grows a baby’s neural networks. I was moved to tears by Sebern Fisher’s recent interview “Neurofeedback in the Treatment of Developmental Trauma” on ShrinkRap radio, as she described how necessary love and attachment are to the creation of a human brain.

EMDR can resolve trauma using bilateral eye motion, bilateral sounds, or even tapping on either foot. When a therapist moves a finger from side to side before the patient’s eyes, it guides the eyes to move naturally as in rapid eye dreaming. That’s where we process most trauma. That means, we move traumatic memories out of short-term memory banks where it feels like a terrifying flash happening “right now,” into long-term memory banks where we feel it’s past, and we’re “over it.

Tapping: For years I’ve used tapping, aka Emotional Freedom Technique (EFT). We use fingertips to tap a few times on 9 of the body’s acupuncture points. It’s a fantastic aid in calming down, or even just getting to sleep at 2 am.  I used it again just this morning to release a pile of anger.

Meditation: Meditation is where we ultimately need to go to fully heal, but it can be terrifying for us with infant trauma. To get started, we can work with our therapist on it, and meditate in groups. Please check Dr. Tara Brach’s “Basic Elements of Meditation Practice” videos on youtube; it’s also on my Resources tab, sub tab Audio & Video.

Books:  on my Resources tab, look for the subtab on Books:
–“The Grief Recovery Handbook”  by John James & Russell Friedman
–“A General Theory of Love”,  Thomas Lewis, Richard Lannon et al; 2000.
–“Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body,” Peter A Levine
–“Changes that Heal,” Dr. Henry Cloud
–“The Body Keeps the Score” Dr. Bessel van der Kolk, MD

Didn’t you say recently that there’s a lot of trauma in high places?
Yes, in part because emotional abuse is really hard to spot.  Emotional abuse alone can be just as damaging as overt abuse, but I didn’t know I had trauma the whole time I was a high-functioning business gal with a math degree, working with rocket scientists.  When I found out I had trauma, I used to say, “Nobody beat me or raped me.  What’s wrong with me!?”

What’s wrong was, I had a huge left thinking brain, but an infant’s right emotional brain that took a lot of damage.  As Allan Schore says, when the mom doesn’t grow the infant’s right brain, the child’s left brain often over-develops in an effort to control the emotional chaos.  My mom didn’t hold me as an infant or show me “it’s safe out here so you can stop crying,” to grow my right brain. So it remained an infant right brain.  Instead, I learned that “it’s dangerous as heck out here, the world is scary.”  I probably didn’t stop crying until my left brain grew myelin and began to think at 2 1/2 and I realized, cognitively, that if I didn’t shut up, they’d swat me.

I’ve been told: “Most people with what you have take it to the grave because they’re so intelligent, no one imagines anything’s wrong.”  One thing motivating me to finish this book is: I’m betting that 20 to 40% of smart people in high places have infant or child trauma hiding inside where no one can tell, just as I did. Maybe my book can help them wake up.

That’s why our corporations, governments and so forth make a lot of un-compassionate decisions.  No one showed them how to do compassion as kids.  That’s why wee spend over $80 billion a year to drug school kids into being quiet, but there’s no funding for serious therapy for children.

Maybe my book will help people see reality. Allan Schore said in his Oslo video that UNICEF put out a report in 2013 saying society needs a massive shift of resources toward making sure at least the child, from conception to age 3 at least, and families with young children, get major public support to try to stop child trauma at the source.  $80 billion would sure help.

Any closing thoughts?
Sebern Fisher hit it on the nose: the real answer to trauma is love.  Babies need our mothers to love us, to even just have the brain cells for emotional well-being. “We need to know that the Big Person who’s taking care of us, loves us,” says Dr. Henry Cloud, and then gradually a baby learns to grow “love inside” he says.

Or Not.  What if I didn’t get love as an infant?   Then emotional chunks of me are an infant’s emotions, and I need to find out about that.  Then I need to go where I can get that part of me loved!  Not to new parents, but I do need to feel the kind of love a good parent gives. And not to romance; we don’t want an infant or toddler on Match.com.  Instead, I need to learn that I can receive platonic love from a really fine therapist, and that I can love them back.  I need to learn that I can do deep platonic love with my Grief Partners and platonic friends at church or in small groups or yoga or meditation groups. I need to feel and give unconditional platonic love.

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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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Comments are encouraged with the usual exceptions; rants, political speeches, off-color language, etc. are unlikely to post.  Starting 8-22-16, software will limit comments to 1030 characters (2 long paragraphs) a while, until we get new software to take longer comments again.

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How EMDR Helped My Early Trauma

Guest Blog by Amelia
[Amelia is the pen name of an EMDR therapy client of Dr. Sandra Paulsen, pioneer of new EMDR protocols for developmental trauma/early trauma (ET). [FN] Amelia is now with Paulsen colleague D. Michael Coy, MA, LCSW.  She graciously provided this blog to inspire others to seek healing. –kb]

Sandra Paulsen BookIn 2013 I began working with Sandra Paulsen, PhD. I am very grateful for the early childhood trauma (ET) work we did.   It was a stunning process that gave me understanding and resolution of significant traumas.  I learned to understand “ego states” and gained a view of the numerous parts of me that acted as protectors throughout my life.   The use of “the conference room” was difficult and surprising at first, but with Dr. Paulsen’s encouragement and compassion for “the little one” inside me, it quickly became easier for me to imagine a conference room in which I could see “parts of my self” sitting around a table.

We worked intensively in long sessions often using EMDR therapy.   The tappers were scary sometimes, but became easier for me to tolerate; they create a mild, alternating bilateral vibration and can be held.  [EMDR therapy for ET may tap on alternate feet or other areas away from the face, rather than moving a finger before the eyes as in Francine Shapiro’s original EMDR therapy. -kb]

Initially, I learned to ground myself in the present where I felt safe.   Within a short time, I was able recognize parts of self in the conference room, an imaginal place in my mind’s eye where different aspects, or parts, of myself could come to help us understand and access trauma memories.   The process revealed difficult memories that enabled me to understand “the why” of my lifelong struggle with confusing fear, along with the “why” I felt a need to isolate myself from family and friends.

At the end of each session. the content of our work was consciously set aside in an imaginal “vault” in the conference room until next time.  I envisioned my memories and feelings floating down a stream into a large container that held them tightly (the vault).  After most sessions, despite my recall of terrifying memories, anger, and tears, I felt relief.  Thinking of those sessions now, I’m amazed by the sense of safety I felt with Dr. Paulsen.

Developing Confidence, Deep Body Memories

Paulsen Sandra PhotoI developed confidence in the process and believed that one day my “whole self” would be healed.  I realized too that I was becoming valuable to myself for the first time. [Sandra Paulsen, right]

I remembered more than I could have imagined.  Often my body felt memories first.  These somatic memories led me through a long trail of abuse and abandonment by family members.  Remembering specific parts of the abuse was a surprise at times.  I attribute the lack of memory to my amnesia barrier and am grateful that my brain was able to develop the barrier.  I sometimes recall those surprising memories and marvel at the function of our brains.

I’m also grateful that Dr. Paulsen took time to help me build boundaries that I could use then and later to further process my memories.  My new boundaries were a great help in painful relationships, which could have destroyed my fragile but growing sense of self.

When visualizing my childhood “parts of self” with Dr. Paulsen, I began to appreciate each part and welcomed the knowledge we recovered together.  My parts worked together to accept the reality I could not manage to be aware of in childhood.  I love knowing that my unconscious mind protected the conscious me and built a complex support system.  My understanding and knowledge of my parts is pivotal to release, resolution and healing of my fragmented self.

I am learning to accept all of me rather than just “the parts” my family wanted.  The good and bad parts held me together in the midst of chaos.  I’ve decided the difference between some of the “good and bad” parts of self were those behaviors or beliefs that were acceptable or not.

My experience taught me that I was never safe in my family because attitudes could change in a moment.  I lived in fear of the unexpected changes and surprise attacks.  Sometimes it’s difficult to like certain parts because I viewed them as causing the pain of disapproval and abandonment.  In reality, my unacceptable parts were protecting me.

After working with Dr. Paulsen, I understand the functions each had in helping me stay alive.  For instance, I have a split sense of God.  I’ve hated the bad God part (judgment) and love the good God part (compassion).  I understand now that  “bad God” part protected me from my family because “bad God” taught me to act the “right” way.  To understand it now is valuable, but the judgment led to self-loathing.  It’s amazing that hating myself made me safer within my family.  All I could expect was abandonment and a family that used me rather than caring for me.

My feelings about my family are still confusing, but I’m learning to view them from a distance.  My mother and father are not bad.  There were reasons for their behavior.  I am aware that I see them as the bad parts who inflicted pain.  I expect that resolution can be reached in time.

I developed the ability to talk with my parts.  We have safe spaces to talk, reflect and empathize with ourselves.  I’ve found this essential.  The spaces are in nature…a forest, the beach or a quiet space for meditation.   Walking in a peaceful place is important to clearly see our existence together and care about our efforts toward wellness.

Anger, Move to Chicago

D. Michael CoyOn the opposite side of the peaceful place is the angry place.  It’s very difficult for me to acknowledge anger at others because it is dangerous to do so.  Working with Dr. Paulsen, I could acknowledge the anger.  My acknowledgment of angry feelings was hard because I was not able to express it in childhood or even in adulthood.  For me anger is the most dangerous feeling.  Others could be angry with me, but I could not express anger toward them.  Our work helped release some of my angry feelings, but it’s still difficult to feel safe enough to express angry feelings appropriately.  I recognize the angry parts of self.  I think we’re still waiting to feel safe and valuable enough to own those feelings.  I continue to work in my messy angry part of self.

In April 2014, I met D. Michael Coy, MA, LCSW [above], to whom I was referred by Dr. Paulsen before I returned to live in the Chicago area.   As it was with Dr. Paulsen, our work together has focused on my dissociated “parts of self,” but now using EMDR and other therapies to focus on the later memories of traumatic experience that I continue to struggle to get past.

Looking back over my time since I began working with Dr. Paulsen, then with Michael Coy, I’ve watched myself grow. I care for the many dissociated “parts of self.”  Visualizing my “parts of self,” I understand how each developed and the job each part did to prevent damage throughout my life.   I love knowing that my unconscious mind always protected me.  My understanding and knowledge of my parts is pivotal to release of trauma on every level.  I expect to function in the months ahead as the “whole person” I am.

In summary… there is so much more to know and say about living with (and healing from) complex trauma.  It’s a relief to know that my symptoms are real and not made up.  I cannot express my relief in light of my work in the therapeutic process called the EMDR early trauma approach, which Dr. Paulsen has so skillfully developed further to work with people like me, who struggle with complex traumatic experience.  I can honestly say that I’ve never been more hopeful in my life.

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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, “Neurobiology and Treatment of Traumatic Dissociation: Toward an Embodied Self,” by Lanius, Paulsen, and Corrigan, 2014, http://www.amazon.com/Neurobiology-Treatment-Traumatic-Dissociation-Embodied/dp/0826106315
See also especially Dr. Paulsen’s website: http://www.bainbridgepsychology.com/EarlyTraumaOShea.html

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What is EMDR – and Why is it So Effective?

Francine ShapiroDuring REM sleep, the brain is attempting to process survival information until it’s resolved.

Eye Motion Desensitization and Reprocessing (EMDR) is a potent trauma treatment developed by Dr. Francine Shapiro (left), a literature professor who was diagnosed with cancer.  The shock of suddenly finding her survival was under threat, affected her so strongly that Dr. Shapiro mindfully paid attention to how her body was reacting.

She discovered by accident that when the survival fear got intense, her eyes would sometimes move back and forth diagonally or from side to side, as if in dreaming – following which she felt less upset, much to her surprise.

So Dr. Shapiro began to study mind-body programs for trauma and PTSD – and went back to school for a PhD in trauma psychology.  EMDR, the treatment she developed,  is now used by the Departments of Defense and Veteran’s Affairs, the World Health Organization, and many others.  Dr. Vincent Felitti, co-director of the Adverse Childhood Experiences (ACE) Study, recommends EMDR as “highly effective” for the healing of trauma.

In EMDR a therapist moves a finger or two from side to side (or diagonally) before the patient’s eyes.  This guides the eyes to move as they do during the Rapid Eye Movement (REM) phase of sleep in which we do most active dreaming. Dreaming can “process” a lot of trauma, move it from short-term memory banks where it feels like a terrifying flash happening “right now,” to long-term memory banks where we feel it’s past and we’re “over it.”

I use EMDR to calm myself at home, sitting with eyes closed and moving my eyes back and forth while focusing on the upsetting thought until it dissipates.  This works with upsetting incidents in the present, such as arguments.  I also use EMDR to heal grief over specific past incidents such as hurtful acts by others. But long-term healing needs a therapist.

It had been thought that EMDR is best for “incident trauma” due to one or any finite number of incidents, such as battlefield traumas, car accidents, rape, threats such as Dr. Shapiro’s cancer, or incidents like mine above.

EMDR  had been considered iffy for developmental trauma which starts with fetal stress and continues while the infant brain is developing. As Dr. Bessel van der Kolk notes, it’s a continuum of panic until we become a “frightened organism.” Drs. Shapiro and van der Kolk have said that in developmental trauma, EMDR may bring up infant feelings so overwhelming as to be re-traumatizing. [FN1]

More recently, however, Dr. Sandra Paulsen and colleague Katie O’Shea  have had success using new EMDR methods they’ve created specifically to address developmental trauma, documented in  “Neurobiology and Treatment of Traumatic Dissociation.” [FN2] Here’s a summary: http://attachmentdisorderhealing.com/emdr-sandra-paulsen-developmental-trauma/

“EMDR is effective and well-supported by research evidence for treating children with symptoms accompanying post-traumatic stress (PTSD), attachment issues, dissociation, and self-regulation,” GoodTherapy.org also recently reported: http://www.goodtherapy.org/blog/emdr-for-children-how-safe-and-effective-is-it-0430155

Dr. Paulsen’s collaborator Dr. D. Michael Coy details how he keeps patients safe while going deep into infancy with EMDR on his website:  https://www.dmcoy.com/main/my_practice/emdr-therapy/emdr-pre-verbal-trauma/.  See also Dr. Coy’s comments below, including a link to the EMDR International Association’s EMDR therapist finder directory: http://www.emdria.org/search/custom.asp?id=2337

I still say, as in my book title, “Don’t Try This at Home.”  Please do not “do it yourself.”  Get a highly-trained attachment-based psychotherapist and/or EMDR specialist with a lot of specific training in your type of trauma.

When Nightmares are Real

Until you’ve been beside a man/ You don’t know what he wants
You don’t know if he cries at night/ You don’t know if he don’t
When nothin’ comes easy/ Old nightmares are real
Until you’ve been beside a man/ You don’t know how he feels
Bob Seeger

Francine Shapiro Getting_Past_Your_Past_smallDr. Shapiro gave a terrific webinar on EMDR which even explained what nightmares are, how they work in trauma, and how we can leverage this to heal traumatic feelings.  It was Dr. Ruth Buczynski’s April 17, 2013 interview for the National Institute for the Clinical Application of Behavioral Medicine (NICABM) “Trauma 2013” series.  [FN3]  Her book is seen above (please click on the graphic to see it best; my software’s not behaving well…)

“Disrupted REM (Rapid Eye Movement ) sleep is often a marker of PTSD,” Shapiro said. “The earlier memory in PTSD, the trauma, is being held unprocessed with the emotions as physical sensations.  The brain continues to try to process it; sleep researchers say that during REM sleep, the brain is attempting to process survival information until it’s resolved.  That’s why we’ve all had the experience of being disturbed at something, going to sleep, and feeling better about it, with a better understanding of what to do next.

“The brain has done what it’s supposed to do: it’s processed the information, and now it’s guiding us appropriately into the future.  But if a trauma has disrupted that process, although the brain may be again trying to process this (survival information) in dreams, the person continues to wake up in the middle of a nightmare (ie., stop the processing prematurely), because it’s too disturbing.”

“When people are jarred from sleep because of a nightmare, the disturbing images can be difficult to shake,” Dr. Buczynski said on her blog April 12, 2013.  “Even though they’re ‘just dreams,’ nightmares can be very upsetting and can sometimes haunt us long after we’ve awoken. But believe it or not, there may be a good reason for them. Nightmares are part of the brain’s attempt to help us resolve traumatic experiences. But when they wake us up too soon, a key process for healing gets interrupted. So how can we finish what the brain is trying to start?”

“In EMDR,” Dr. Shapiro then explained, “we look for what are the nightmare images that a person can recall. One person would continually wake up from a nightmare of being chased by a monster through a cave.  So (in the EMDR session) we target that dream image, so she’s holding in mind being chased through a cave by the monster.  Then we start the EMDR processing – and it’s like a veil gets peeled back, and the individual sees what the actual experience was, and she reports, ‘OMG, that’s the person who molested me, chasing me through my childhood home!’

“The EMDR processing moves the past memory to resolution, and now the person no longer has that dream, because once it’s processed, it’s integrated with larger memory networks and arrives at adaptive resolution, so that dream image does not come back. So with EMDR you don’t have to try to change their mind about it or talk about it. It’s simply identifying the image and their thoughts that go with it, and then processing it (by EMDR) to complete resolution.”  Check out her video: http://www.nicabm.com/nicabmblog/the-brains-attempt-to-help-us-heal-from-trauma/

Dr. Shapiro reports fantastic results especially with rape victims and war veterans.  “These past traumatic experiences get locked into the brain until they can get processed… We try to process how the earlier traumatic memories created the problem, then we process their current situations that are disturbing, and then what might disturb them in time in future.  If they can’t identify the past memories, we talk about what is currently disturbing them.  That often automatically takes them back to the past experience — and in those instances where it (the past traumatic experience) hasn’t fully be stored (in  long-term memory,) we can see that it shifts (from short-term to long-term memory) and ultimately they’re no longer disturbed…

“My PhD dissertation on rape victims was published in the Journal of Traumatic Stress back when PTSD was viewed as intractable, but I was getting results in a single session,” Shapiro said. “So the controversy was: ‘how could anything be that rapid, and how could eye movements have any effect?’  There were 20 randomized controlled trials introducing EMDR. One done with rape victims was by a very experienced cognitive behavioral researcher viewed as extremely credible; she reported that 90% of the rape victims no longer had PTSD after three EMDR sessions.

“That corresponded to another study at the time published in the Journal of Clinical Psychology which showed the same with a mixed trauma group, that after three EMDR sessions, 84% no longer had PTSD.  We’ve continued to see that… a rule of thumb is, a single trauma can be processed by three 90-minute EMDR sessions.  A study by Kaiser Permanente that used 50-minute sessions found… that an average of 6 EMDR sessions, found 100% of single-trauma victims no longer had PTSD and 76% of multiple trauma victims no longer had PTSD.”

Here’s an ABC News clip by the CalSouthern School of Behavioral Sciences featuring Dr. Shapiro. Again it notes that EMDR is best done with a therapist, which is why they don’t post “How To” on the internet.  It also notes that in Shapiro’s original discovery, her eyes “flickered,” and therapists continue to have patients move eyes fast, “like watching tennis,” as one rape victim (who got huge relief) reports: https://www.youtube.com/watch?v=GTLLfdcJE0Q

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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  Francine Shapiro, PhD, “The Power of EMDR to Treat Trauma,” April 17, 2013 and Bessel van der Kolk, MD, “Expanding the Perspective on Trauma,” April 24, 2013, webinars by the National Institute for Clinical Application of Behavioral Medicine (NICABM): http://www.nicabm.com/trauma2013/trauma2013-post/

FN2  “Neurobiology and Treatment of Traumatic Dissociation: Toward an Embodied Self,” by Lanius, Paulsen, and Corrigan, 2014, http://www.amazon.com/Neurobiology-Treatment-Traumatic-Dissociation-Embodied/dp/0826106315

FN3  Transcripts and recordings of this and five related webinars again at  http://www.nicabm.com/trauma2013/trauma2013-post/

More reading:

Shapiro, Francine, PhD, “Getting Past Your Past: Take Control of Your Life with EMDR Therapy.”

Shapiro, Francine, PhD, “The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences,” Permanente Journal, Perm J. 2014 Winter; 18(1): 71–77   A substantial body of research shows that adverse life experiences contribute to both psychological and biomedical pathology. Eye movement desensitization and reprocessing (EMDR) therapy is an empirically validated treatment for trauma, including such negative life experiences as commonly present in medical practice. The positive therapeutic outcomes rapidly achieved without homework or detailed description of the disturbing event offer the medical community an efficient treatment approach with a wide range of applications. Methods: All randomized studies and significant clinical reports related to EMDR therapy for treating the experiential basis of both psychological and somatic disorders are reviewed. Also reviewed are the recent studies evaluating the eye movement component of the therapy, which has been posited to contribute to the rapid improvement attributable to EMDR treatment.  Results:  Twenty-four randomized controlled trials support the positive effects of EMDR therapy in the treatment of emotional trauma and other adverse life experiences relevant to clinical practice. Seven of 10 studies reported EMDR therapy to be more rapid and/or more effective than trauma-focused cognitive behavioral therapy. Twelve randomized studies of the eye movement component noted rapid decreases in negative emotions and/or vividness of disturbing images, with an additional 8 reporting a variety of other memory effects. Numerous other evaluations document that EMDR therapy provides relief from a variety of somatic complaints: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951033/

van der Kolk, Bessel A, MD, “Restoring the Body: Yoga, EMDR, and Treating Trauma , July 11, 2013 interview by  Krista Tippett of OnBeing.Org.  Human memory is a sensory experience says psychiatrist Bessel van der Kolk. Through long research and innovation in trauma treatment, he’s learning how bodywork like yoga or eye movement therapy can restore a sense of goodness and safety: http://www.onbeing.org/program/restoring-the-body-bessel-van-der-kolk-on-yoga-emdr-and-treating-trauma/5801

van der Kolk Bessel A, MD, Spinazzola J, Blaustein ME, Hopper JW, Hopper EK, Korn DL, Simpson WB,  “A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance, J Clin Psychiatry. 2007 Jan; 68(1):37-46. Abstract: The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for posttraumatic stress disorder (PTSD). This study compared the efficacy of a selective serotonin reup-take inhibitor (SSRI), fluoxetine, with a psychotherapeutic treatment, eye movement desensitization and reprocessing (EMDR), and pill placebo and measured maintenance of treatment gains at 6-month follow-up. METHOD: Eighty-eight PTSD subjects diagnosed according to DSM-IV criteria were randomly assigned to EMDR, fluoxetine, or pill placebo. They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up. The primary outcome measure was the Clinician-Administered PTSD Scale, DSM-IV version, and the secondary outcome measure was the Beck Depression Inventory-II. The study ran from July 2000 through July 2003.RESULTS: The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms, but this benefit accrued primarily for adult-onset trauma survivors. At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. For most childhood-onset trauma patients, neither treatment produced complete symptom remission. CONCLUSIONS: This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma. It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma. Future research should assess the impact of lengthier intervention, combination treatments, and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma: http://www.ncbi.nlm.nih.gov/pubmed/17284128

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The Adult Attachment Interview (AAI) (Pt.2 of 2): Mary Main’s Scary Parent Study

Scary Parents

Mary Main BerkeleyPart 1 of this blog Jan. 23 concluded that by 1978, Dr. Mary Ainsworth’s estimate for U.S. babies was that (A) 23% were Avoidant insecure (avoid parents); (B) only 69-70% were Securely Attached; and (C) 8% were Ambivalent insecure (unhappy and indecisive).  [FN1, 11]

By 1988, her Strange Situation study had been done with 2,000 infant-parent pairs in 32 studies in 8 countries. By 1999 it  had been done globally with 6,282 infant-parent pairs. Some countries varied, but worldwide results averaged out the same as Ainsworth’s 1978 original. [FN1, 9, 11]

In 1973 Mary Main [above] became Ainsworth’s grad student at Johns Hopkins in Baltimore, working on the Strange Situation experiments from the start. After her doctorate, Main moved to Berkeley, to see if Ainsworth’s Kampala and Baltimore findings would replicate.[FN8]  In 1978 she ran a Strange Situation study of 189 Bay Area infant-parent pairs and made the same findings. [FN10]

But by 1979 Dr. Main was making her own discoveries—out of concern about the parents. “In none of Ainsworth’s original observations was the possibility considered that some mothers… could also be frightening,” Main notes. “For my dissertation at Johns Hopkins, I watched 50 children in the Strange Situation… Using Ainsworth’s three-part classification (secure, avoidant and ambivalent), I found at least five infants could not be classified.”  Ainsworth was concerned, too; in fact, she’d left some babies in her Secure set only since they didn’t fit her other two sets. [FN8]

By 1982, Main decided to “extend attachment theory to include the import of infant exposure to anomalous fear-arousing parental behaviors… The mother is the haven of safety that must be approached in times of danger. However, when the infant’s biological haven of safety has simultaneously become a source of fright, the infant is placed in an irresolvable and disorganizing approach-flight paradox,” she said.  [FN8]

Soon after 1982, Main and Ainsworth agreed that some 15% of babies actually formed a new, fourth group: (D) Insecure Disorganized. Their mothers were so frightening that the babies couldn’t develop any consistent response at all. These infants “exhibited a diverse array of inexplicable or overtly conflicted behaviors in the parent’s presence” including “disorganization, disorientation, and confusion.” This includes crying loudly then suddenly freezing; ignoring the parent to rock on hands and knees; moving away; raising hand to mouth in fear; or even swiping at the parent’s face. They seemed vulnerable to dissociation.   [FN8, 11]

This finding that a whopping 15% of average U.S. babies are so insecure they’re almost incoherent was so shocking it was checked for years. [FN11, 12] But the number held. Worse, among children of American adolescent mothers the rate is over 31%, and is over 25% in many Third World nations. [FN13]

To remove the 15% of disorganized babies from Ainsworth’s original 69-70% Secure, reduced the Secure set to only 54-55%.  What was up with parents that 45-46% of their kids couldn’t manage secure attachment?  If so, Main would have  four categories: Avoidant 23%, Ambivalent 8%, Disorganized, 15%, Secure 55%.  [FN1, 11]

That was how researchers, including Dr. Benoit in footnote 1, read Main’s documents for 20 years 1990-2010. See also footnote 11.

In numerous writings, Main and colleagues called the disorganized group a new “fourth category,” a category in addition to Ainworth’s original three, and added that most disorganized subjects had been classed “secure” under Ainworth’s original three categories, but in fact belonged elsewhere.
FN12 Main M, & Solomon J (1986): ” …the majority of these…disorganized-disoriented infants would have been identified as secure… had we forced them into the standard classification system.
FN11 vanIjz1999, p.226 :  “the limits of the traditional Ainsworth et al. (1978) coding system became apparent because many children with an established background of abuse or neglect nevertheless had to be forced into the secure categoryDisorganization of attachment is usually considered a type of insecure attachment...”

Dr. Ainsworth herself, co-authoring a volume with Dr. Main in 1990, writes on page 480:  “… it is acceptable to consider adding…the fourth D category that Main identified as disorganized… Now that so much careful work has been done to explore the ramifications of this new category, it may be accepted as a valuable extension of the Strange Situation classificatory system.”

Recently, however, there has apparently been over-use and abuse of the term “disorganized” by social services and courts, such that Dr. Main’s group began around 2011 to criticize the “reification” of disorganized as a category:

“Main, Hesse, and Hesse (2011, p.441) have criticized the “widespread” and “dangerous” presumption that infants can be divided into four categories of comparable status… Solomon expresses particular concern:
“\’ The reification of our work from its context—and a lack of awareness of the grounding of our ideas in the behavioral and theoretical contributions of Bowlby and Ainsworth—has lead readers to treat D as a category equivalent in kind to ABC, rather than recognizing it as a phenomenon that runs orthogonal to the basic Ainsworth patterns. (personal communication, April 2013) ‘/ ”
from: “The Emergence of the Disorganized/Disoriented (D) Attachment Classification, 1979–1982,” by Robbie Duschinsky, Hist Psychol. 2015 Feb; 18(1): 32–46.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321742/
Cited within which: “Attachment theory and research: Overview with suggested applications to child custody,” Family Court Review, 49, 426–463, Main M., Hesse E., & Hesse S. (2011).

The Adult Attachment Interview (AAI)

Mary Main '09 Bowlby-Ainsworth award(Inge Bretherton,Everett Waters)Either way, by 1982 Main had seen enough to begin developing the Adult Attachment Interview (AAI).  She’d seen plenty of disorganized babies – that meant a lot of scary parents. She needed a way to document the behavior of parents. [FN14] (Right: Dr. Main receives the Bowlby-Ainsworth Attachment Award, 2009.)

The AAI was designed to document the level of secure, loving attachment the parents had, during their own childhoods with the babies’ grandparents. Parents were asked “both to described their attachment-related childhood experiences – especially their early relations with parents – and to evaluate the influence of these experiences on their development and current functioning.”

Parents were studied not just on facts they gave, but on how coherent a narrative they could produce quickly. That’s easy for folks who had a secure childhood, but difficult for folks who did not. The AAI questions are designed to “surprise the unconscious” to yield information about the “state of mind with regard to attachment” that might not otherwise show up. Each AAI was taped and transcribed verbatim. Then transcripts were classified by specific patterns by independent trained specialists. [FN15, 10]

In 1983 Main also created the “Berkeley Longitudinal Study” to take the Bay Area infant-parent pairs in her 1978 Strange Situation, and study them for a generation. In 1978, the babies were 12-18 months old; Main and her team re-studied these pairs when the kids reached age 6 in 1983, and studied the kids again when they reached 19 in 1996.  [FN8].   In 1983 Main and her team gave three completely different tests to the Bay Area pairs:

— 1. The six year olds were again studied with their parents in the Strange Situation (as in 1978 when they were infants).

— 2. The “sixes” were also individually (without parents) given a new Separation Anxiety Test (SAT): they were shown pictures of children being separated from their parents, then asked how they felt. This was taped, transcribed and sorted by Main’s student Nancy Kaplan into Ainsworth’s three sets: secure, avoidant and ambivalent. [FN16, 8]

— 3. The parents were given the AAI (without their kids). Responses were sorted into three set of adult attachment matching Ainsworth’s three 1978 categories of infant attachment: Secure-autonomous (matching infant Secure), Dismissing (infant Avoidant)  and Preoccupied (infant Ambivalent). (Main’s new 4th category wasn’t in use until after 1990.) [FN 17, 8, 10]

Astonishing Results You’ve Never Heard

Mary Main, Erik Hesse '09 Bolwby-Ainsworth AwardDr Main’s first 1983 results were so astonishing that attachment researchers have been buzzing ever since.  (Dr. Main and Dr. Erik Hesse, right.) Her results were also so important that it’s outrageous that your doctor never learned this in medical school; your therapist (and mine) never heard of this; you’ve never heard of it; and so you have to read about it here, since the media doesn’t report it. It’s hard to even find this story on the internet; I had to sleuth it out.  Her results were:

First: the six year olds’ 1983 responses with parents in the Strange Situation correlated strongly to their 1978 responses in the Strange Situation as infants five years earlier. In 1978 the infants were Securely attached 69%;  Avoidant 23%, and Ambivalent 8%. In 1983 the same kids at six were the same as they had been as infants, in the same percents. [FN7]

Second: the six year olds’ 1983 solo responses to the SAT photos also produced the same results and percentages.

Third: The parents’ 1983 solo responses to the Adult Attachment Interview correlated strongly with just how their own kids had behaved as infants, five full years earlier.  The parents also turned out to be Secure-autonomous (matching infant “Secure”) 69%;  Dismissing (matching infant “Avoidant”) 23%;  and Preoccupied (matching infant “Ambivalent”) 8%.

Fourth:  The match of the parents’1983 AAI security with how securely their babies behaved five years back in 1978, was at an unheard-of level. It correlated more than 70% of the time, in a field where a 20% correlation is highly significant. “A marked relation between a parent’s discussion of his/her own attachment history (AAI), and the offspring’s Strange Situation behavior 5 years previously, had been uncovered.”  [FN8, 10]

Fifth: When the 1978 infants reached age 19 in 1996, they too were given the Adult Attachment Interview. Again results correlated strongly: the 19 year olds’ responses in the AAI in 1996, correlated precisely to their infant behavior in the Strange Situation in 1978, their behavior at six in 1983, and to their parents’ 1983 AAI responses.

That means the Strange Situation predicts an infant’s behavior for life, and the AAI proves it.  [FN8, 10]

Sixth: When after 1990 Mary Main’s four categories were used, the results of all the tests were just as strongly correlated across Main’s four categories, as when data were sorted into only three sets. Main’s four categories did become Avoidant 23%, Ambivalent 8%, Disorganized, 14-15%, and Secure 54-55%.  Whenever responses to the Strange Situation, SAT, and AAI were sorted into these four sets,  the same percents were found. [FN1, 11]

By 2009, over 10,500 subjects globally had been given the AAI and the results continued to average out the same.  [FN18]

“Researchers worldwide have replicated the relation originally uncovered in the Bay Area study between a parent’s status in the Adult Attachment Interview and an infant’s Strange Situation response to that same parent… The same average parent-to-child, secure/insecure match of 75% holds even when the interview is conducted before birth of the first child…

“Describing the strength of this relation across studies conducted several years ago, van I Jzendoorn (1995) calculated that it would take 1,087 further attempted replications, every one yielding insignificant results, to reduce the present relation between adult and infant attachment status to insignificance,” Main concluded. [FN7, p.1091]

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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  NIH: Benoit, Diane, MD, FRCPC, “Infant-parent attachment: Definition, types, antecedents, measurement and outcome,” Paediatr Child Health, Oct 2004; 9(8) p. 541–545 at: www.ncbi.nlm.nih.gov/pmc/articles/PMC2724160/  4th subhead “Measurement” reports:
“The three ‘organized’ strategies (secure, avoidant and resistant) are assessed in the Strange Situation (SS), a 20-minute laboratory procedure where patterns of infant behaviour toward the caregiver following two brief separations are categorized… “Infants with secure attachment greet and/or approach the caregiver and may maintain contact but are able to return to play, which occurs in 55% of the general population… Infants with insecure-avoidant attachment fail to greet and/or approach, appear oblivious to their caregiver’s return… avoiding the caregiver, which occurs in 23% of the general population. Infants with insecure-resistant [ambivalent] attachment are extremely distressed by separations and cannot be soothed at reunions,  displaying much distress and angry resistance to interactions with the caregiver, which occurs in 8% of the general population.” [This NIH article earlier reports that the remaining “approximately 15% suffer insecure ‘disorganized’ attachment,” citing their own footnote which states “In normal, middle class families, about 15% of  infants develop disorganized attachment.” [23%+8%+15%  = 46% not securely attached.]

FN2  Felitti VJ, MD; Anda RF, MD, et. al, 1998, “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 1998;14:245–258.  Detailed article on the ACE Study: http://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/

FN3  Karr-Morse, Robin, Wiley, Meredith,  “Scared Sick,”  Penguin Basic Books, 2012

FN4  Porges, Stephen, PhD, “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
–“The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.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

FN5   Earned secure attachment occurs when we experience harmful parenting, so we start with insecure attachment, but find ways to “rise above” childhood trauma and “are now securely attached… What’s more important than what happened to us, is how we’ve made sense of our own childhood,” Dr. Dan Siegel says. “When we make sense of our past… we become free to construct a new future for ourselves and for how we parent our children. Research is clear: If we make sense of our lives, we free ourselves from the prison of the past.”  (Source: video by Dr. Mary Main, Dr. Erik Hesse, Dr. Daniel J. Siegel, Dr. Marion Solomon: https://www.youtube.com/watch?v=YJTGbVc7EJY )
The question is: what ways?  How do we “rise above” and “make sense” of our childhood trauma?
“Mindfulness has been shown to be effective in healing insecure attachment,” say Siegel’s recent writings. “The purpose of both psychotherapy and mindfulness practice is to provide this internalized secure base. Attunement, whether it is internal in mindfulness, or interpersonal in attachment, is what leads to a sense of secure base.” (The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration, W.W. Norton, 2010;   Mindsight: The New Science of Personal Transformation,  Random House, 2010).
“The regular exercise of mindful awareness seems to promote the same benefits–bodily and affective self-regulation, attuned communication with others, insight, empathy, and the like–that research has found to be associated with childhood histories of secure attachment,” Siegel wrote earlier. “ Mindfulness and secure attachment alike are capable of generating… the same invaluable psychological resource: an internalized secure base.” (Siegel, 2007, Wallin, 2007, p. 5-6).
In his 1999 book “The Developing Mind: How Relationships and the Brain interact to shape who we are,” (Guilford Press),  Siegel defined “earned secure/autonomous attachment” as a pattern noticed by therapists doing the Adult Attachment Interview:  “individuals whose experiences of childhood… [were] likely to produce insecure attachment (avoidant, ambivalent, or disorganized),” but their AAI interview responses instead show “a fluidity in their narratives and a flexibility in their reflective capacity, such that their present state of mind with respect to attachment is rated as secure/autonomous. These individuals often appear… to have had a significant emotional relationship with a close friend, romantic partner, or therapist, which allowed them to develop out of  insecure…into a secure/autonomous AAI status.”

FN6  Bowlby, John, “The Nature of a Child’s Tie to His Mother,” British Psychoanalytical Society, London, 1958; “Attachment and Loss,” New York, Basic Books, 1969

FN7  Main, Mary,  2000, “The Adult Attachment Interview: Fear, attention, safety and discourse processes;” also titled “The Organized Categories of Infant, Child, and Adult Attachment: Flexible vs. Inflexible Attention Under Attachment-Related Stress,” Jour of Amer Psychoanalytic Assoc, 48:1055-1095; 2000.  *p.1091: “The same average parent-to-child, secure/insecure match of 75% holds even when the interview is conducted before birth of the first child…” Lifespanlearn.org/documents/Main.pdf

FN8  Main, Mary, 2005, with Hesse, Erik & Kaplan, Nancy, “Predictability of Attachment Behavior and Representational Processes at 1, 6, and 19 Years of Age – The Berkeley Longitudinal Study,” Chapter 10 of “Attachment from Infancy to Adulthood: The Major Longitudinal Studies,” edited by Klaus E. Grossmann, Karin Grossmann, and Everett Waters, pp. 245–304, New York: Guilford Press. Main refers to it as “Regensburg.”
https://lifespanlearn.org/documents/5.Main Regensburg 2005 .pdf
–Main’s summary of the Strange Situation in this document:
“Ainsworth structured the Strange Situation procedure to include three of Bowlby’s ‘natural clues to danger’ in eight episodes:  1. Introduction to the room.  2. Mother and infant are left alone in a toy-filled environment whose unfamiliarity supplies the first natural clue to danger.  However, the mother’s presence is expected to provide the infant with security sufficient for exploration and/or play.  3. Providing a second clue to danger, a stranger joins the mother and infant.  4. The mother leaves the infant with the stranger, providing two combined clues to increased danger. 5. The mother returns, and the stranger departs…. Many infants initially seek proximity but then, reassured of their mothers’ nearness, resume play. 6.  The mother leaves, and the infant remains entirely alone in the unfamiliar setting. Infant distress can be strong at this point, and this episode is often terminated rapidly. 7. The stranger, rather than the mother, enters the room. 8. The mother returns… By now, most infants are expected to be crying, and actively not only seeking proximity to mothers, but also… indicating a strong desire to be held… Nonetheless, they are expected to settle and renew interest in exploration and play by the end of this 3-minute period…
“Somewhat surprisingly, Ainsworth found that infant responses to separation and reunion in this procedure fell into three distinct, coherently organized patterns of attachment (“secure,” “insecure-avoidant,” and “insecure-ambivalent” (Ainsworth, Blehar, Waters, & Wall, 1978). … Given the length and complexity of this chapter, we suggest individuals divide reading to its three central parts (secure attachment, pp. 261–273; avoidant attachment, pp. 273–279; and disorganized attachment pp. 279–288).”

FN9  (1988 van Ijzendoorn: on global proof of Ainsworth’s 3 categories; written before Main’s 4 category put in use)
van IJzendoorn, Marinus H.; Kroonenberg, Pieter M.  “Cross-Cultural Patterns of Attachment: A Meta-Analysis of the Strange Situation,” Child Development,Vol 59 No 1, Feb 1988, p.147–56.   Abstract: http://www.jstor.org/discover/10.2307/1130396?uid=3739560&uid=2&uid=4&uid=3739256&sid=21103831443011

FN10   Hesse, E., (2008) “The Adult Attachment Interview: Protocol, Method of Analysis, and Empirical Studies,” Chap. 25 of Cassidy, Jude &  Shaver, Phillip R. (Eds), “Handbook of Attachment: Theory, research, and clinical applications,” 2nd edition, 2008, p. 552-598, New York, Guilford Press. It was online (I downloaded it Aug. 2014) but was taken down or has web issues; try here: http://icpla.edu/wp-content/uploads/2012/10/Hesse-E.-Adult-Attachment-Int-Protocol-Method-ch.-25.pdf   [His 1999 version in Cassidy & Shaver’s 1st edition, Chap. 19,  “The Adult Attachment Interview: Historical and current perspectives,” p. 395-433 wasn’t online.]

FN11  van IJzendoorn MH, Schuengel C, Bakermans-Kranenburg MJ, Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants and sequelae. Dev Psychopathol. 1999; 11:225–49. [PubMed] at https://openaccess.leidenuniv.nl/bitstream/handle/1887/1530/168_212.pdf?sequence=1

FN12  Main, Mary, & Solomon, Judith, (1986), “Discovery of an insecure disoriented attachment pattern: procedures, findings and implications for the classification of behavior,” in Brazelton T, Youngman M. Affective Development in Infancy, Ablex, Norwood, NJ
Main, M., & Solomon, J. (1990). “Procedures for identifying infants as disorganized/disoriented during the Ainsworth strange situation,” in Greenberg, M. T., Cicchetti, D., & Cummings, M. (Eds.),. Attachment in the preschool years: Theory, research, and intervention (pp. 121-160), University of Chicago Press

FN13  “Among children of American adolescent mothers, the rate is over 31% (Broussard 1995). Disorganized attachment is also common among the Dogon of Mali (~25%, True et al 2001), infants living on the outskirts of Cape Town, South Africa (~26%, Tomlinson et al 2005) and undernourished children in Chile (Waters and Valenzuela 1999),” reports NIH [op cit FN1; NIH cites v. Ijzendoorn 1999 and the other authors just mentioned]

FN14  George, Carol, Kaplan, Nancy, & Main, Mary, “Adult Attachment Interview,” Unpublished MS, Department of Psychology, University of California at Berkeley, third ed. 1996.  Original 74-page MS dated 1984, 1985, 1996.  Described in FN10 op cit Hesse 2008. ( I have it, but it was removed from the web during 2014.)

FN15  Main, Mary B., “Adult Attachment Interview Protocol,” 11 pgs, 20 questions, no date or publisher. Dr. Main requires intensive training for use of the AAI. The questions per se, marked “Do not reproduce this material without permission of the author,”  are here:  http://www.psychology.sunysb.edu/attachment/measures/content/aai_interview.pdf   UCLA’s Lifespan Learning Institute in Los Angeles holds AAI workshops and has an extensive CD  lectures on the AAI at www.lifespanlearn.org

FN16  Kaplan, Nancy, (1987), Separation Anxiety Test (SAT): “Individual differences in six-year-olds’ thoughts about separation: Predicted to actual experiences of separation,”  Unpublished doctoral dissertation, University of California, Berkeley.
Kaplan, N. (2003, April), “The development of attachment in the Bay Area study: One year, six years, nineteen years of age.” Paper at the biennial meeting of the Society for Research in Child Development, Tampa, FL.

FN17  Main 1985; Main & Goldwyn 1984

FN18  Bakermans-Kranenburg MJ, van IJzendoorn MH, “The first 10,000 Adult Attachment Interviews,” Attach Hum Dev. 2009 May; 11(3): 223-63. doi: 10.1080/14616730902814762 at http://www.ncbi.nlm.nih.gov/pubmed/19455453

More by Mary Main on the AAI:
Main, Mary, PhD, “Introduction to the special section on attachment and psychopathology: 2. Overview of the field of attachment,” Journal of Consulting and Clinical Psychology, 64, 237-243, 1996
Steele, Howard and Miriam, Editors, “Clinical Applications of the Adult Attachment Interview,” The Guilford Press,  New York, 2008

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The Adult Attachment Interview (AAI) (Pt.1 of 2): Mary Ainsworth’s Strange Situation

Mary Main & Dan Siegel December-2010-UCLAOnly 55% of us had “secure attachment” as infants, according to research on 6,281 infant-parent pairs done during 1970-1999. [FN1, 2]  This would worry us all if we knew what it meant, because the other 45% of us suffer “insecure attachment.”  That means 45% of us have trouble with committed relationships.

It’s worrisome because the attachment we had as kids continues all our lives in our relationships, say related studies of over 10,500 adults done during 1982-2009. [FN3]  Plus, we pass our “insecurity” on to our own children.

These are the “quiet blockbuster” results of, first, Dr. Mary Ainsworth’s 1970-1978 “Strange Situation” study of babies, as extended by her assistant Dr. Mary Main. (Dr. Main & Dr. Daniel J. Siegel, above)

Second, Dr. Main discovered enough upset babies to become concerned about the parents. She created the Adult Attachment Interview (AAI) to study the adults in 1982. Her results, released 1984-96, showed 42-45% of adults were not securely attached, analogous to the infants above.

This 45% “insecure” figure starts to explain why we’ve got a 50% divorce rate, If  (like me) you’ve tried dating after divorce, it won’t surprise you that science shows almost half the adults out there can’t manage a secure, committed, relationship. Ouch, you’ve experienced it.

And if 45% of us were “insecurely attached” in 1999, what’s the percent in 2017?  In 1999 most of us hadn’t heard of the internet. In almost 20 years since, email, texting, and so on have further trashed our ability to relate in person. Several psychotherapists interviewed for this blog said that a round number of “about 50%” is a  conservative estimate for how many Americans lack secure attachment today. Many believe it’s much higher.

Here’s more “about 50%” data.  The 1998 Adverse Childhood Experiences (ACE) Study showed that 64-67% of  17,421 middle class subjects had one or more types of childhood trauma, and 38-42% had two or more types.  In less privileged populations, these numbers are far higher. A national average of all economic groups would likely show 50% or more suffer ACE trauma.

The ACE Study lists physical and sexual abuse and 8 other types, including traumas that happen to newborns like physical and emotional neglect. Such trauma puts children into “fight-flight,” a chronic state proven to shut down the organism’s capacity for feelings of attachment and love. Think soldier in a battle, ramped up in “fight-flight”– he’s not into love. [FN4]

Half of us are in serious emotional health and medical trouble,  and don’t even know it.  Let’s get informed; then we can heal. If we didn’t get securely attached as kids, we can develop “earned secure attachment.”  “It’s possible to change attachment patterns,” as Main’s colleagues Dr. Dan Siegel and Dr. Marion Solomon say. [FN5]

 Strange Situation  Experiment

bowlby-johnAttachment Theory isn’t new, it just gets too little air time. British psychiatrist John Bowlby (left) developed it in the 1950s while dealing with the post-WWII crisis of dislocated orphans. [FN6]  Bowlby believed that all infants would seek to stay close to parents, since “proximity-seeking behavior” is best for survival. In 1952 he published a study of toddlers’ responses to separation from parents. It showed that “when toddlers were placed in unfamiliar surroundings that provided no stable caregivers, they underwent three… stages of response to separation: protest, despair, and finally detachment,” writes Mary Main. [FN7]

Mary Ainsworth ca 1990Dr. Mary Ainsworth studied with Bowlby in London 1950-54, then studied this same “proximity-seeking behavior” (attachment) in infant-mother pairs in homes in Kampala, Uganda, published as “Infancy in Uganda” (1967).  Next, she “found astonishing similarities”  in Baltimore, MD pairs. [FN7]

So Ainsworth created the Strange Situation in the early 1970s, as a science experiment at Johns Hopkins in Baltimore to document this infant behavior. “Ainsworth deliberately structured the Strange Situation to include three of Bowlby’s ‘natural clues to danger’… to arouse babies to seek proximity” to the parent, Main says. Researchers watch and video-tape through one-way glass, as infant-mother pairs react to apparent danger.  First the babies respond to the strange lab room; then to two entrances of a stranger; then separation from mother at two different times. [FN8]

All or most babies were expected to stay close to parents as Bowlby thought.  Such babies “that Ainsworth termed ‘secure,’ play and explore happily prior to separation; show signs of missing the parent during separation, such as crying and calling; seek proximity immediately upon the parent’s return; and then return to play and exploration, ‘secure’ once again in the parent’s presence,” said Main. [FN8]

But 30% of babies did not act secure — they avoided mom.  Given a choice, they show no preference between mom and the stranger.  “While a majority of infants behaved as expected and were termed secure, to Ainsworth’s amazement six showed little or no distress at being left alone in the unfamiliar environment, and then avoided and ignored the mother upon her return.”  [FN7]

Ainsworth decided to categorize these babies separately, as “avoidant” of mother, so now she had two types: (A) Insecure Avoidant, and (B) Secure. She concluded that their mom didn’t respond to them, or respond with enough sensitivity to understand their actual need, so the infants felt “insecure.”  [FN8]

Still later Ainsworth saw that of the insecure babies, some had yet a third reaction: actually, they were “ambivalent” about mom. They were very distressed when mom left, but on her return, they alternated between avoiding and frantic clinging–plus, they never calmed down. Research showed that ambivalent attachment results from moms who are sometimes available, sometimes not, so babies learn they can’t depend on mom to be there when they need her.

Thus it was that “surprisingly, Ainsworth found that infant responses to separation and reunion fell into three distinct, coherently organized patterns of attachment,” and added a third category: (C) Insecure Ambivalent, Main reports. [FN8-9]

By 1978, Ainsworth’s estimate for U.S. babies was (B) Securely attached 69%; (A) Avoidant 23%, (C) Ambivalent 8%.

By 1988, her Strange Situation study had been done with 2,000 infant-parent pairs in 32 studies in 8 countries. By 1999 it  had been done globally with 6,282 infant-parent pairs. Some countries varied, but the worldwide results averaged out the same as Ainsworth’s 1970s studies. Amazing, but it makes sense considering the U.S. is a global melting pot. [FN1, 9, 11]

But stay tuned for my next blog Feb. 6, when Ainsworth’s grad student Mary Main gets into the act big time.  Main found that Ainsworth’s concept of Securely Attached had flaws that made necessary a whole new fourth category of attachment failure.  And a whole lot fewer than 69% turned out to be “secure.”

If you can’t wait for Part 2 on Feb. 6, the whole article is here: http://attachmentdisorderhealing.com/adult-attachment-interview-aai-mary-main/

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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  NIH: Benoit, Diane , MD, FRCPC, “Infant-parent attachment: Definition, types, antecedents, measurement and outcome,” Paediatr Child Health, Oct 2004; 9(8) p. 541–545 at: www.ncbi.nlm.nih.gov/pmc/articles/PMC2724160/  4th subhead “Measurement” reports:
“The three ‘organized’ strategies (secure, avoidant and resistant) are assessed in the Strange Situation (SS), a 20-minute laboratory procedure where patterns of infant behaviour toward the caregiver following two brief separations are categorized… “Infants with secure attachment greet and/or approach the caregiver and may maintain contact but are able to return to play, which occurs in 55% of the general population… Infants with insecure-avoidant attachment fail to greet and/or approach, appear oblivious to their caregiver’s return… avoiding the caregiver, which occurs in 23% of the general population. Infants with insecure-resistant [ambivalent] attachment are extremely distressed by separations and cannot be soothed at reunions,  displaying much distress and angry resistance to interactions with the caregiver, which occurs in 8% of the general population.” [This NIH article earlier reports that the remaining “approximately 15% suffer insecure ‘disorganized’ attachment,” citing their own footnote which states “In normal, middle class families, about 15% of  infants develop disorganized attachment.” [23%+8%+15%  = 46% not securely attached.]

FN2  Felitti VJ, Anda RF, et. al, 1998, “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 1998;14:245–258.  Detailed article on the ACE Study: http://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/

FN3  Karr-Morse, Robin, Wiley, Meredith,  “Scared Sick,”  Penguin Basic Books, 2012

FN4  Porges, Stephen, PhD, “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
–“The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.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

FN5   Earned secure attachment occurs when we experience harmful parenting, so we start with insecure attachment, but find ways to “rise above” childhood trauma and “are now securely attached… What’s more important than what happened to us, is how we’ve made sense of our own childhood,” Dr. Dan Siegel says. “When we make sense of our past… we become free to construct a new future for ourselves and for how we parent our children. Research is clear: If we make sense of our lives, we free ourselves from the prison of the past.”  (Source: video by Dr. Mary Main, Dr. Erik Hesse, Dr. Daniel J. Siegel, Dr. Marion Solomon: https://www.youtube.com/watch?v=YJTGbVc7EJY )
The question is: what ways?  How do we “rise above” and “make sense” of our childhood trauma?
“Mindfulness has been shown to be effective in healing insecure attachment,” say Siegel’s recent writings. “The purpose of both psychotherapy and mindfulness practice is to provide this internalized secure base. Attunement, whether it is internal in mindfulness, or interpersonal in attachment, is what leads to a sense of secure base.” (The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration, W.W. Norton, 2010;   Mindsight: The New Science of Personal Transformation,  Random House, 2010).
“The regular exercise of mindful awareness seems to promote the same benefits–bodily and affective self-regulation, attuned communication with others, insight, empathy, and the like–that research has found to be associated with childhood histories of secure attachment,” Siegel wrote earlier. “ Mindfulness and secure attachment alike are capable of generating… the same invaluable psychological resource: an internalized secure base.” (Siegel, 2007, Wallin, 2007, p. 5-6).
In his 1999 book “The Developing Mind: How Relationships and the Brain interact to shape who we are,” (Guilford Press),  Siegel defined “earned secure/autonomous attachment” as a pattern noticed by therapists doing the Adult Attachment Interview:  “individuals whose experiences of childhood… [were] likely to produce insecure attachment (avoidant, ambivalent, or disorganized),” but their AAI interview responses instead show “a fluidity in their narratives and a flexibility in their reflective capacity, such that their present state of mind with respect to attachment is rated as secure/autonomous. These individuals often appear… to have had a significant emotional relationship with a close friend, romantic partner, or therapist, which allowed them to develop out of  insecure…into a secure/autonomous AAI status.”

FN6  Bowlby, John, “The Nature of a Child’s Tie to His Mother,” British Psychoanalytical Society, London, 1958; “Attachment and Loss,” New York, Basic Books, 1969

FN7  Main, Mary,  2000, “The Adult Attachment Interview: Fear, attention, safety and discourse processes;” also titled “The Organized Categories of Infant, Child, and Adult Attachment: Flexible vs. Inflexible Attention Under Attachment-Related Stress,” Jour of Amer Psychoanalytic Assoc, 48:1055-1095; 2000.  *p.1091: “The same average parent-to-child, secure/insecure match of 75% holds even when the interview is conducted before birth of the first child…” Lifespanlearn.org/documents/Main.pdf

FN8  Main, Mary, 2005, with Hesse, Erik & Kaplan, Nancy, “Predictability of Attachment Behavior and Representational Processes at 1, 6, and 19 Years of Age – The Berkeley Longitudinal Study,” Chapter 10 of “Attachment from Infancy to Adulthood: The Major Longitudinal Studies,” edited by Klaus E. Grossmann, Karin Grossmann, and Everett Waters, pp. 245–304, New York: Guilford Press. Main refers to it as “Regensburg.”
https://lifespanlearn.org/documents/5.Main Regensburg 2005 .pdf
–Main’s summary of the Strange Situation in this document:
“Ainsworth structured the Strange Situation procedure to include three of Bowlby’s ‘natural clues to danger’ in eight episodes:  1. Introduction to the room.  2. Mother and infant are left alone in a toy-filled environment whose unfamiliarity supplies the first natural clue to danger.  However, the mother’s presence is expected to provide the infant with security sufficient for exploration and/or play.  3. Providing a second clue to danger, a stranger joins the mother and infant.  4. The mother leaves the infant with the stranger, providing two combined clues to increased danger. 5. The mother returns, and the stranger departs…. Many infants initially seek proximity but then, reassured of their mothers’ nearness, resume play. 6.  The mother leaves, and the infant remains entirely alone in the unfamiliar setting. Infant distress can be strong at this point, and this episode is often terminated rapidly. 7. The stranger, rather than the mother, enters the room. 8. The mother returns… By now, most infants are expected to be crying, and actively not only seeking proximity to mothers, but also… indicating a strong desire to be held… Nonetheless, they are expected to settle and renew interest in exploration and play by the end of this 3-minute period…
“Somewhat surprisingly, Ainsworth found that infant responses to separation and reunion in this procedure fell into three distinct, coherently organized patterns of attachment (“secure,” “insecure-avoidant,” and “insecure-ambivalent” (Ainsworth, Blehar, Waters, & Wall, 1978). … Given the length and complexity of this chapter, we suggest individuals divide reading to its three central parts (secure attachment, pp. 261–273; avoidant attachment, pp. 273–279; and disorganized attachment pp. 279–288).”

FN9  (1988 van Ijzendoorn: on global proof of Ainsworth’s 3 categories; written before Main’s 4 category put in use)
van IJzendoorn, Marinus H.; Kroonenberg, Pieter M.  “Cross-Cultural Patterns of Attachment: A Meta-Analysis of the Strange Situation,” Child Development,Vol 59 No 1, Feb 1988, p.147–56.   Abstract: http://www.jstor.org/discover/10.2307/1130396?uid=3739560&uid=2&uid=4&uid=3739256&sid=21103831443011

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Dr. Ruth’s Ultimate Trauma Solution

Ruth Bz blog pic… Dr. Ruth Buczynski, that is (so, relax…that’s her at left).  A peek inside the minds of cutting-edge psychotherapists on how to really heal trauma is in her latest blog; click here: “Rethinking Trauma: The Third Wave.” http://www.nicabm.com/nicabmblog/rethinking-trauma-the-third-wave-of-trauma-treatment/

She says the latest “Aha” is that “talk therapy” can’t always cut it — we need body work and other alternative “somatic” therapies such as Dr. Bessel van der Kolk, Dr. Peter Levine, Dr. Dan Siegel, Dr. Stephen Porges, and Dr. Bruce Perry are delivering, as I’ve written for months.

Ruth is starting a new series October 15 by interviewing Steve Porges live, and yes there is a fee to subscribe if you’d like transcripts and recordings to keep.  And yes there’s also a free version of the series (detailed links at bottom).

And no, I’m not getting a cent for posting this. No one asked me to; I just wanted to “pay it forward.”

Why? Hey, that story I always tell of how I clicked the wrong link in a friend’s email, and ended up on a brain science website that saved my life?  That was Dr. Buczynski’s March 2011 webinar, “The New Brain Science Series – Barrier-Breaking Interviews with the Experts.” [FN1]

And she, and they, did save my life, and I do hope you check this out.

Here’s a clip of Dr. Porges’ interview airing October 15: http://www.nicabm.com/nicabmblog/reframing-a-patients-response-to-trauma-so-they-can-heal/

Dr. Porges even brings in Bach, Beethoven and music in general as the most powerful healing there is — after live in-person human support, of course.

Ruth adds:  “What trauma therapy owes to Beethoven and Bach…  According to Stephen Porges, PhD, classical composers knew something hundreds of years ago that could be so helpful in trauma therapy . . .  in today’s webinar, he outlines how playing and listening to music, and even the design of the rooms where we deliver services, can shift the physiology of our patients. Stephen also goes into how to work with neuroception, the “personal risk detector” in the nervous system, as well as powerful, concrete suggestions for incorporating Polyvagal Theory into clinical work.”

We can watch or listen free in real time (schedule below). These free broadcasts reach many more than can afford subscription (to me, an insanely reasonable fee, considering what I got out of it).  Transcripts, video, mp3s of  all speakers, and more extras come with subscription.

 Schedule: Wednesdays at 5pm EST & 6:30pm EST

Wed Oct 15th: Stephen Porges, PhD:  Beyond the Brain: Using Polyvagal Theory to Help Patients “Reset” the Nervous System After Trauma

Wed, Oct 22nd:  Sebern Fisher, MA: Neurofeedback: Soothe the Fear of a Traumatized Brain: How a New Intervention Is Changing Trauma Treatment

Wed, Oct 29th: Bessel van der Kolk, MD: How to Help Patients Rewire a Traumatized Brain – Applying the Latest Strategies to Speed Healing and Reduce Symptoms for Even the Most Traumatized Clients

Wed, Nov 5th: Pat Ogden, PhD: Why A Body-Oriented Approach Is Key for Treating Traumatized Patients (and What It Looks Like in Practice)

Wed, Nov 12th: Daniel Siegel, MD: The Neurobiology of Trauma Treatment: How Brain Science Can Lead to More Targeted Interventions for Patients Healing from Trauma

Wed, Nov 19th: Peter Levine, PhD: Getting to the Root of Trauma: Why It’s Critical to Understand the Role of Memory in Trauma Therapy

Here’s the link to see Ruth’s full promo with important details on each of the speakers and what they’ll cover:
http://www.nicabm.com/treatingtrauma2014/info/?del=10.11.14blog

Register here to watch or listen free at time of broadcast: http://www.nicabm.com/treatingtrauma2014/freesignup/

Register here for a subscription Gold Membership ($197) with all items noted above: https://www.nicabm.com/treatingtrauma2014/register/

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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  This 2011 series is over, but a subscription to it for transcripts and recordings is still at http://www.nicabm.com/thebrain2011/

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Stephen Porges: Social Engagement Heals

Neuroscientist Dr. Stephen Porges explained in my Sept.19 blog that when a survival threat pushes humans back into the ancient reptilian mechanism of freeze, that’s how trauma happens.  The autonomic nervous system (ANS in diagram below) just does this automatically; we don’t have a say;  it’s not cognitive.  Porges says that for humans to be out of trauma, mammalian attachment must happen.

Polyvagal Autonomic Nervous System
For that, Dr. Porges says, we need what he calls “the social engagement system… in which we listen to intonation in voice and use facial engagement.  When a person has vocal intonation, an expressive face and eyes open when we talk to them, this expressive individual is also contracting middle ear muscles that facilitate the extraction of human voice from background sounds,” he says. [FN]

“When people are smiling and looking at us, they are better able to pull out human voice from back ground sounds.

“We also use ingestive behaviors; the baby nurses. Adults use the same systems. We go to lunch or we go for a drink, as a way of socializing. Ingestive behaviors use the same neural mechanisms we use for social behavior.  We use ingestive behaviors to calm and to develop social engagement. And when that is done, the physical distance between people can be modulated and we can come close…

“Safety modulates our ability to develop secure attachments. Whether an individual feels safe with people during early development might modulate individual differences in vulnerability to trauma.”

Dr. Porges’ 1994 “Polyvagal Theory” says the autonomic nervous system is not a balance of two circuits, but instead “a hierarchical system” of three circuits, “in which newer circuits inhibit older circuits. And when we get challenged, those systems  degrade to older and older circuits, in an attempt to survive.”  We mammals start out trying to use our “social engagement system” to look at each other and resolve things warmly; that’s our first, myelinated vagus parasympathtic circuit.

If that fails, we devolve into more primitive fight/flight animals, where our sympathetic circuits take over and juice up our adrenalin.

And if that fails, our ancient reptilian unmyelinated vagus circuit takes over and knocks us out into immobilization, called dissociation in humans.

Play and Mammalian Attachment

Mammal Play dogs2One way to get people back out of dissociation, aka freeze — aka trauma — says Porges, is to surround them with friendly mammals, and stimulate their mammalian social engagement systems to come back on line.  He gives the fascinating example of play.

“Real play, is not playing with a ‘Game Boy’ or computer; it is not solitary,” Porges says. “Play requires social interaction  using face-to-face. ”  Notice how the two dogs above are looking each other in the eye.

“Play requires an ability to mobilize with the sympathetic nervous system and then to down-regulate the sympathetic excitation, using face-to-face social interaction and the social engagement system.  I have two little dogs; they chase each other, and nip. Then one will turn around to look at the other, a face-to-face interaction to ensure that biting was play and not aggression.”

In play, he says, we practice using our fight/flight systems properly – but we also practice to “diffuse them with social engagement.  So play requires face-to-face interactions. We see this in virtually all mammals.”

“I use video clips of Dr. J. and Larry Bird, a clip in which they are friends.doing an advertisement for sneakers,” Porges notes. “Then I show them playing basketball, bumping and hitting each other. Dr. J. hits Larry Bird in the face, knocks him to the ground and walks away. By walking away, he didn’t diffuse the mobilization behaviors from fight/flight.  So Bird goes after him and they have a fight.

“When we play, we mobilize physiological state changes that support fight/flight behaviors, but then we down-regulate defensive reactions by looking at each other – so that we learn to repair  If we hit each other by mistake, we say ‘I’m sorry.’

“Other forms of adult play have similar features – such as dancing. Most forms of team sports involve face-to-face interactions that include communication via eye contact.

“Play is actually a neural exercise of using the social engagement system, a uniquely mammalian system, to regulate our fight/flight behaviors, to be able to down-regulate this older defensive system.  Note that individuals with a variety of clinical pathologies often have difficulty playing.”

Heal Trauma by Acceptance – Not Stigma

Radical Acceptance Tara BrachSo when we don’t receive attachment — which allows us to use our mammalian myelinated vagus parasympathetic — then, we feel endangered. Then our bodies are triggered to devolve into our second, more primitive fight/flight response (mobilizing our sympathetic system).

Further, if we are overwhelmed and fight/flight doesn’t get us to safety, our neurological system hijacks us and forces us back into our third, most primitive response: freeze, aka immobilization or dissociation (using the reptilian unmyelinated vagal system).

Almost all trauma occurs when we are overpowered just like that, by dangerous environments or people.

Polyvagal Theory also shows that our nervous system just does these things – trauma is simply not a voluntary decision.  “Outside the realm of our conscious awareness, our nervous system is continuously evaluating risk in the environment,” and shoving us into bodily actions that are just not subject to thought, Porges shows.

So Dr. Porges is asking doctors and therapists to realize that tramatized people can best be healed if everyone accepts and respects what their bodies have done – instead of stigmatizing them for it.

“Try something different with clients,” Porges tells clinicians. “Tell clients who were traumatized that they should celebrate their body’s responses, even if the profound physiological and behavioral states they experienced in past, are now limiting their ability to function in current social situations. Those bodily responses enable them to survive under the trauma, often as children. It reduced some of the injury. If they were oppositional during an aggressive traumatic event such as rape, they could have been killed.

“So tell them to celebrate how their body responded — instead of making them feel guilty that their body is failing them when they want to be social –and see what happens.

“Therapies often convey to the client that their body is not behaving adequately. The clients are told they need to be different. They need to change.  That kind of therapy in itself is too judging of these individuals. And once we are evaluated, we are in defensive states. We are not in safe states.

“Mindfulness requires feeling safe because if we don’t feel safe, we are, in a sense, neuro-physiologically evaluative of our setting which means we can’t be safe, and we can’t engage.  We can’t recruit the wonderful neural circuits that enable us to express the wonderful aspects of being human.  So if we are able to create safe environments,” starting with clinicians who make us feel respected and safe, “we have access to neural circuits that enable us to be social, to learn, and to feel good.”

Once the professionals accept reality, next traumatees can start to respect themselves, and stop judging and evaluating themselves negatively – usually for the first time since the trauma hit them.

That creates a “mammal to mammal” social engagement state inside the traumatized person, where their internal voices are kind and compassionate to them, rather than self-condemning as is the norm in traumatees.

“There is no such thing as a ‘bad’ response; there are only adaptive responses,” says Porges. “The primary point is that our nervous system is trying to do the right thing — and we need to respect what it has done. And when we respect its responses, then we move out of this evaluative state and we become more respectful to ourselves — and we functionally do a lot of self-healing.”

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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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Comments are encouraged with the usual exceptions; rants, political speeches, off-color language, etc. are unlikely to post.  Starting 8-22-16, software will limit comments to 1030 characters (2 long paragraphs) a while, until we get new software to take longer comments again.

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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/

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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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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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