Category Archives: Fight-Flight

Tapping (EFT) 2 of 2

Tapping Points 2015 Nick EBook diagramI’ve used Emotional Freedom Technique (EFT), aka tapping for years, as I wrote in Part 1 on  “what is tapping.”

Now for how to tap. “Focus on the negative emotion at hand: a fear or anxiety, a bad memory, an unresolved problem, or anything that’s bothering you,” says Nick Ortner, author of “The Tapping Solution.”

Then, “while maintaining your mental focus on this issue,  use your fingertips to tap 5-7 times each on 9 of the body’s meridian points.”  (Click on “Where to Tap” diagram above from TheTappingSolution.com)  [FN1]

“Tapping on these meridian points, while concentrating on fully feeling and accepting the negative emotion, will allow you to resolve and displace those learned, habitual reactions this feeling would ordinarily trigger,” he writes.

You said it, brother Nick. “Fully feeling and accepting the negative emotion” is an incredibly key point; see below.

But please: if you have severe trauma, do not tap alone!  Do it with a therapist or trained practitioner, or don’t tap.  “Your mileage may vary.”

Tapping starts with 3 “prep steps” which take 5-10 minutes once we get used to it.  Here we take the time to become fully Present with ourselves, our body, and our emotions.  Actual feelings, and relief of feelings, occurs only “in the Now.”  To do it, we’ve got to be Present in the Now.

1. Identify what’s troubling you. It can a specific feeling or situation, or just general anxiety or “I feel lousy.”  Try to figure out “what bugs me the most and how do I feel about it now?”  Try to put yesterday and tomorrow out of your mind.  Just ask this “now” question until you feel some sort of answer.

2. Write down the intensity of your feeling on a scale of 0 (doesn’t bug me) to 10 (makes me jump out of my skin).  This “Subjective Units of Discomfort Scale” (SUDS) is useful because often we feel so much better after tapping that we simply can not remember how bad it felt beforehand.

3. Create a one-sentence “set-up statement” which says: I’m going to accept myself and practice self-compassion. I’m deciding to fully accept me as I am, the emotions troubling me, even my worst feelings.  Because, as Dr. Tara Brach says, “it’s only when we accept ourselves completely exactly how we are, that we become free to change.

Anxiety

Let’s take as a sample, the feeling of general anxiety – we’ve all had it, and when it gets bad, it can cause panic and illness.  1: Think of something that makes you feel anxious.  2. Write down the intensity on a scale of 0 to 10.

3. Here are “set-up statements” about anxiety I’ve found most useful, from Nick Ortner’s e-book 2012 edition: “Your set up statement should acknowledge the problem you want to deal with, then follow it with an unconditional affirmation of yourself as a person,” he writes:

–“Even though I feel this anxiety, I deeply and completely accept myself.”
–“Even though I’m anxious about [__ situation], I deeply and completely accept myself.”
–“Even though I’m feeling anxiety about [__ person] I deeply and completely accept myself.”
–“Even though I panic when I think about [ __ ] I deeply and completely accept myself. ”

We only need one set-up sentence. Create one or try the samples above.

At the end of my set-up I often add  “and all my traumatized emotions.”  I’ll say, “Even though I feel anxious and panicky, I deeply and completely accept myself, and all my traumatized emotions.”  ( My therapist applauded this. If we accept that our “crazy” trauma is not crazy, but it’s to be expected, given the nasty experiences we’ve had, that really helps heal it.)

Start Tapping:  

tapping karate-chop-pointThe rest of the tapping should take about 10 minutes more, again, after we get used to it:

A.  Tap the Hand for Set-up and Self-Affirmation:  Start by tapping on the Karate Chop point, the outer edge of the dominant hand on the opposite side from the thumb, using the four fingertips of the other hand.  While tapping, repeat the one-sentence set-up statement three times aloud. (Photo from Patricia Hope, http://www.towards-happiness.com/natural-treatment-for-insomnia.html )

To me, the Karate Chop feels very steadying, and I’m glad this is where we repeat our self-affirmation. When I feel really bad, I might repeat my set-up affirmation while tapping three times on each hand, alternating hands.

B: Tap through all the other Acupressure Points:

–“Use a firm but gentle pressure, as if drumming on the side of your desk or testing a melon for ripeness,” says Nick Ortner.
–“You can use all four fingers, or just the first two (index and middle fingers). Four fingers are used on the top of the head, collarbone, under the arm… wider areas.  On sensitive areas, like around the eyes, use just two.
–“Tap with your fingertips, not your fingernails.”

I learned to start tapping the top of the head; Nick likes to start at the eyebrow and end at the top of the head.  They call him the Tapping King and he’s got a bestselling-book The Tapping Solution.  But I stick with what works for me.  It  doesn’t matter as long as we tap most or all the points.

Next, we just flat out say what hurts.   I tap on my head, then my eyebrow, then the side of my eye, going through all the 9 acupressure points.

At each spot, in the anxiety example, I’d say:  “I feel so anxious. I feel so anxious and panicky.  I feel anxious and panicky about living alone (for example).”  Say what you feel, keep it short, authentic, and blunt.

As many tapping youtube videos show, when we tap from one tapping point to the next, what we feel can start to morph.  If we don’t feel our feelings, they can stay frozen for decades, but once we start to feel them, emotions are by nature fluid;  they start to release and change. As we feel them, they begin to dissipate. Then the next feeling underneath may bubble up.

Here are Nick’s names for the remaining tapping points,  to help read his diagram.   I tap on each of these  points and say several times at each point: “I feel anxious and panicky about living alone.”

–Top of Head (TH)  Crown of  head. Use four fingers.
–Eyebrow (EB)  Inner edges of the eyebrows near the bridge of the nose. Use two fingers.
–Side of eye (SE) The hard ridge between the corner of your eye and your temple. Use two fingers. Feel out this area gently; don’t poke your eye!
–Under eye (UE) The hard bone under the eye that merges with the cheekbone. Use two fingers, stay in line with the pupil.
–Under nose (UN)  between the bottom of the nose and the upper lip.
–Chin (CH)  centered between the bottom of the lower lip and the chin.
–Collarbone (CB)  Tap just below the hard ridge of your collarbone.
–Underarm (UA) On your side, about four inches beneath the armpit.

That’s it for Round 1.  Next: take a deep breath, and check if your SUDS number went down, because you might be finished.

But most of the time, I go through all the tapping points about three rounds.  For example, if after Round 1 you feel roughly the same and still feel bad, that’s normal; you’ll need a second or third round.  I need three, almost every time. In traumatic fear, I need four rounds or more.

If the number has risen or skyrocketed because we really “got in touch” with the feeling, that’s called spiking. *If you get overwhelmed, stop now.  Call a friend to help you calm down, breathe deeply, and drink some water.

I learned over time that spiking is a good result, as horrible as it feels in the moment – because in the next few rounds I can feel that nasty feeling so thoroughly that I pretty much get rid of it.

What very often happens to me is that I’ll do Round 1 and then Round 2, but I feel like nothing’s changing. It’s so boring that I start to feel like a jerk for wasting my time with this nonsense.  But I persevere.

Then sometime in Round 3 I’ll get a huge spike, and feel so horrible that I start bawling and must force myself to stay with it.  Then just as suddenly, the whole bad feeling is gone.  It simply disappears, to where I start thinking about my hairdo, or laugh and say “OK, done, what’s for breakfast?”

If I’m up at night anxious and I tap to get to sleep, very soon after the spike, my anxiety will evaporate and I’ll fall deeply asleep.

———————————

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  Nick Ortner’s website has a free e-book on tapping:  http://www.thetappingsolution.com/free_tapping_ebook.html I’m ever grateful to Nick and Jessica Ortner for popularizing tapping and making it so accessible to us, diagrams and all. But I’m troubled by how their site has grown so commercialized.  To me, any pitch to become rich, thin, famous, etc. feels bad; it says we’re not good enough as we are; got to get out there and perform harder and faster.  To me that’s a recipe for more cortisol, stress and panic.  I’d rather focus on being a human being, not a human doing (to paraphrase Jon Kabat-Zinn).

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Tapping (EFT) 1 of 2

tapping-points Color diagram PCOSDiva.comI’ve used Emotional Freedom Technique (EFT) aka  Tapping for four years and gotten major relief from severe fight-flight emotions like fear and anger (emotions I could feel).  I’ve also gotten relief from physical pain caused by “frozen” emotions I couldn’t feel.  Click on diagram for full graphic  “Where to Tap” by PCOSDiva.com.  [FN1]

Please note: if you have overwhelming trauma, do NOT tap alone! Use a therapist or trained practitioner, or don’t tap; it’s not safe.

Also note:  I’m making “I Statements,” not giving advice. These tools worked for me to heal traumatic feelings — but “your mileage may vary.”

What is tapping?  In 1980 psychotherapist Dr. Roger Callahan “was working with a patient, Mary, for an intense water phobia, “ reports Gary Craig, Callahan’s student and creator of tapping. “She suffered frequent headaches and terrifying nightmares related to her fear of water… Dr. Callahan tried conventional means for a year and a half.”   [FN2]

“Callahan had studied traditional Chinese medicine, which calls the body’s energy ‘ch’i’,” reports Nick Ortner, author of “The Tapping Solution.”   “The Chinese discovered 100 meridian points along the body. They learned that by stimulating them, they could manipulate the body’s ch’i to heal symptoms and diseases.”  Ortner’s website has a free e-book on tapping. [FN3]

One day with Mary in 1980, says Craig, “Callaghan… decided to tap with his fingertips under her eyes, an end point of the stomach meridian. This was prompted by her complaint of  stomach discomfort. To his astonishment, she announced that her disturbing thoughts about water were gone, raced to a nearby swimming pool and began throwing water in her face. No fear. No headaches. It all went away….and has never returned.”

Craig codified Callahan’s process into a sequence of acu-points to tap. “You tap near the end points of numerous energy meridians without knowing which of them may be disrupted,” says Craig. This set of meridians seems to cover what we need to calm most emotions.

Tapping aims to replicate Mary’s experience.  First, “focus on the negative emotion at hand: a fear or anxiety, a bad memory, an unresolved problem, or anything bothering you,” says Ortner, such as Mary did with her fear of water.  Next, “while maintaining your mental focus on this issue, use your fingertips to tap 5-7 times each on 9 of the body’s meridian points.”  These are nine spots on the hands, face, neck and upper torso easily accessible, even in public. (Diagram again  at top.)  It’s a non-invasive activation of some of the same spots targeted in acupuncture, but no needles.

Pseudoscience?  Energy Disrupt?  Amygdala Message?

Amygdala 2How to Tap is in Part 2, my next blog (or start with the links above).

As to what it is,  I was surprised that Wikipedia says  tapping “has no benefit beyond the placebo effect,” is “pseudoscience and has not garnered significant support in clinical psychology.”  [FN4]

“When she was experiencing fear, the energy flowing through her stomach meridian was disrupted,” Craig said of Mary. “That energy imbalance is what was causing her emotional intensity. Tapping under her eyes sent pulses through the meridian and fixed the disruption… It is accepted practice to ‘treat the memory’ and ask the client to repeatedly relive some emotionally painful event,” Craig says. “EFT, by contrast, respects the memory but addresses the true cause… a disruption in the body’s energy system.”

Books like “The Body Keeps the Score” by Bessel van der Kolk, and “Healing Trauma” by Peter Levine do say that healing traumatic emotions is about working with the body and the body-centered brain stem.  Talking with the thinking brain about the horrible details of past trauma is often re-traumatizing, van der Kolk, Levine, et. al. warn.  [FN 5]

When danger threatens or traumatic memories make our current situation “feel” dangerous, the brain’s amygdala sends out signals that stimulate cortisol, putting us into fight-flight.  When we are thus emotionally “triggered,” we often go into a painful fight-flight panic.

Clinical psychologist David Feinstein and his Harvard colleagues have published studies (dismissed by Wikipedia) saying that both ancient acupuncture and tapping on acupressure points signal the amygdala to calm down. Feinstein believes both methods stimulate hormones which tell the amygdala that we are safe, so the amygdala stops the cortisol flood.

Or Just Feel My Feelings?

One thing is clear: if there were a tiger about to leap at me, I wouldn’t be sitting around tapping my forehead.  Maybe tapping the forehead, under the nose, etc., is enough to tell the brain that our situation is safe.

To resolve trauma, says Dr. Dan Siegel, we must process traumatic emotions out of short-term memory where it feels like “this hurts now,”  into long-term memory so we can feel “that was in the past.” One brain area pivotal to that processing is the hippocampus. But in fight-flight, the amygdala turns off the hippocampus, to save all our energy for fighting and fleeing.  Maybe tapping keeps my hippocampus turned on?

Or maybe it’s simply this:

Tapping gives us license to do something for which our society has no room: sit with, accept, and fully feel through our feelings, which the yogis call self-compassion. Tapping actually trains us to do this, which usually allows our body to release these feelings;  then suddenly we don’t feel so bad.

I’ve spent 5 years reading grief letters about my childhood trauma, using the rigorous  Grief Recovery Handbook.  Maybe folks who haven’t done all that, might not be able to access childhood feelings as I do when I tap.

But one thing for sure: in tapping, we focus on a bad feeling, and feel it, and accept it – rather than trying to suppress it.

If while feeling, it helps me to tap on a few ancient acupuncture points, no harm. Maybe having this finger-drumming as a structure allows me to trust that these emotions won’t overwhelm me?  All I know is: when I tap,  I almost always feel through a feeling. Then it dissipates and I get relief.

Next Time:  Part 2:  How to Tap.

———————————

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 http://pcosdiva.com/2013/05/the-benefits-of-eft-for-pcos/

FN2  Gary Craig’s EFT Manual:  spiritual-web.comdownloadseftmanual.pdf.pdf

FN3  Nick Ortner’s website has a free e-book on tapping:  http://www.thetappingsolution.com/free_tapping_ebook.html

FN4  http://en.wikipedia.org/wiki/Emotional_Freedom_Techniques#cite_note-Feinstein-4

FN5  Dr. Bessel van der Kolk, Dr. Peter A. Levine, Dr. Bruce Perry and others say in books like “The Body Keeps the Score” and “Healing Trauma” that healing trauma requires body work.

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Is Our Medical System Traumatizing Us?

StethoscopeHey, it happens to us all. I’m healthy as a horse, but a body part was bugging me, so at my annual check up I asked to see a specialist.  I love my family doc, er I mean “primary care,” and I love this specialist.  They’re the best there is.  And they’re victims of the system as much as we.  I’m grateful they’re here just when I need them, with all their years of training and miraculous skills. I don’t want to cause them trouble, so let’s call it “body part X.”

It took months to get authorization for the specialist, thanks to insurance lunacy. Meanwhile X got worse, but still I expected just a routine new prescription.

The new doc walked in, took one look, and said, “You’ve got [deleted] here, and also there. You can go on like that for a while, and  I could just write you another prescription for Y [as it’s been handled before].  But you’ll be back in a year because it will get worse.  It’s not for me to tell you what to do, but we can replace [body part X] with an implant…

“Outpatient surgery takes 20 minutes, insurance pays for it all because it’s legally classified as  ‘medically necessary’ since otherwise you’re going to lose your Z [essential function]. Then you can forget about the problem, you’ll be done.”  (And no, it wasn’t prostate cancer.)

“Outpatient surgery”?  So professional.  Me?  I’ve just been told, “you’re getting a knife in a real scary place.”

The specialist (I do like him) told me later that at that first meeting, he then proceeded to outline my options for the different available types of inplants, and following surgery, what functional abilities each implant type would give me. I was with him less than 20 minutes. Next he sent me on to his medical assistant to be checked by one more machine, who sent me to their lady “surgery coordinator.”  By which time I was hit by a barrage of panic from my belly.

I’ve never had more than a tooth pulled in my life, and OK, I’ve always been a “fraidy cat.” And all I could think of was “Surgery. Surgery? Surgery — there?

From the first mention of “surgery,” clearly I was in trauma. But why did this occur to no one, with so many professionals there?  They seemed so oblivious that anything upsetting could possibly have occured, I was afraid to show it.

“We’ve discovered in our work in trauma that going to the gynecologist, pediatrician, social worker at school, any of the helping professions, can be traumatic,” says trauma expert Dr. Mary Jo Barrett (below right). “People with prior trauma, especially, experience their attempts to get help from the medical system as traumatic – because they experience it as a threat to their bodies.”  [FN1]

Mary Jo BarrettAnd according to the ACE Study, roughly 50% of us suffer one or more types of Adverse Childhood Experience (ACE) trauma. That means half of us are going to experience such a medical issue as trauma.  Including clearly me.

But in fact any human who’s a mammal will experience something like this as trauma, science is just starting to show.  And even the most well-meaning, kindly medical personnel have never gotten the memo on what is trauma and how their system contributes to it.

Not to mention the legions of pretty much heartless medical personnel who have had their humanity forcibly ripped out of them by their training. Psychiatric expert Dr. Daniel Siegel, MD, says he almost quit med school when he realized he was being deliberately trained to destroy his emotions and view patients as machinery to be fixed, in the name of better performance.

No Time to Think – Let Alone Feel

Not to mention the insurance companies who now force doctors to stay glued to a stop-watch while seeing patients. Docs are forced to spend no more than X (pardon the pun) minutes per patient, no matter what, or they won’t be paid, can’t pay their staff or their astronomical malpractise insurance premiums, and must close their doors.

Upset?  Shove it.  Suddenly there I was with the “surgery coordinator,” and I had no time to panic, feel any emotion, or even to think. Wham, she hit me with a barrage of wildly complex surgery insurance questions involving a five-way tangle between my HMO, the specialist, the primary doc, the doctors’ “medical group,” and the hospital– made more complex by the fact that my insurance was about to change radically in three months. Worse, she was the type who quickly rattles off a list of in-house acronyms that only an insurance exec could understand, then says “OK?”

No, it was most definitely not ok.  In fact with all my experience handling insurance companies over many years, 15 years experience interviewing engineers about rocket science, a BS in Math and 3 foreign languages — I still couldn’t understand a word she said.  Surely she’s good at what she does, but her ability to explain what she does to another human being was sub zero.

As I began to drown under her spiel, that internal voice just got louder: “Surgery. Surgery? Surgery — there?

On she went with questions about my meds, vitamins, lifestyle, and complicated instructions about new meds they were going to give me before surgery, and when to take what in a detailed month-long schedule. The level of detail would have overwhelmed anyone who’d just been given good news. By the time she was done rattling, the office was about to close at 5 pm and I was ushered out.

No more than two minutes of the entire two hour ordeal had been allowed for discussion of, or even for me to think about, the real Square One decision at hand:  Surgery? Go for surgery, or not?

“Surgery. Surgery? Surgery — there?”  It seemed like a nightmare from which I’d soon wake up. As it turned out, that feeling lasted about ten days.  I kept thinking, “Oh, this is just a bad dream. I’ll wake up any minute.”  No such luck. Somehow I made it through an evening of appointments straight until 9 pm, drove home and collapsed at 11 pm.

Involuntary Reaction to Survival Threat

Stephen Porges mages“Medical procedures send many of the cues to the nervous system that physical abuse has,” warns Dr. Stephen Porges (left). “We need to be very careful about how we deal with people and whether or not even medical practices trigger some of the features of PTSD…

“Our clothing is taken away. They remove your glasses. We’re left in a public place and all predictability is gone. Many of the features that our nervous system uses to regulate and feel safe are disrupted,” says Porges. [FN2]

“And one of the most potent triggers of neuroception un-safety, is low-frequency sounds which the neurological system interprets as ‘predator.’ In ‘Peter and the Wolf,’  friendly characters are always the violins, flute, and oboe. Predator is always conveyed via lower frequency sounds. Medical environments are dominated by low frequency sounds of ventilation systems and equipment. Our nervous system responds, without our awareness, to these acoustic features and shifts physiological state.”

Medical pronouncements about what’s going to happen to our bodies, and medical environments generally “trigger ‘neuroception’,” Porges explains, “the neural circuits regulating the autonomic nervous system” tell our bodies that we are under threat. The news goes straight to our brain stem which takes action, without ever involving our thinking brain. Something entirely involuntary happens.

“Neuroception is not perception. It does not require an awareness of what’s going on,” says Porges. “Throw away the word ‘perception.’  Neuroception is detection without awareness.  It is a neural circuit that evaluates risk in the environment from a variety of cues. When our mammalian social engagement system is working and down-regulating defenses, we feel calm, we hug people, we look at them and we feel good.  But in response to danger, our sympathetic nervous system takes control and supports metabolic motor activity for fight/flight.  But next, if that doesn’t get us to safety, the ancient unmyelinated vagal circuit shuts us down,” says Porges, literally describing shock.

He gives an example: himself.  “I had to get an MRI. Many of my colleagues conduct research using the MRI, and I thought, ‘This will be a very interesting experience.’  You have to lay down flat on a platform and the platform is  moved into the magnet. I enthusiastically lay down on the platform for this new experience. I felt really good. I was not anxious…

“Slowly the platform moved into a very small opening of the MRI magnet. When it got up to my forehead, I said, “Could I get a glass of water?” They pushed me out and I took my glass of water.  I lay down again and it moved until my nose was in the magnetic.  I said, ‘I can’t do this.’  I could not deal with the confined space; it basically was putting me into a panic attack…  And an MRI produces massive amounts of low-frequency sounds…

“My perceptions, my cognitions, were not compatible with my body’s response.  I wanted to have the MRI.  It wasn’t dangerous. But, something happened to my body when I entered the MRI. There were certain cues that my nervous system was detecting and those cues triggered a defensive of wanting to mobilize to get out of there. And I couldn’t do anything about it. I couldn’t think my way out of it. I couldn’t even close my eyes and visualize my way out of it. I had to get out of there! Now when I have a MRI, I take medication.”

I could go on.  I could tell you how I dealt with the question “should I have this surgery” the very next day, by getting a second opinion in my area, and was told “Yes, and soon.”

I could tell you how after a few days, I realized that the next looming question was what type of implant to choose, how long it would take each type of implant to get approved through the insurance maze, and where each type would leave my body functions after surgery.  So I put out queries to the second specialist, and to three personal friends in Maryland, New York, and Illinois who are doctors, who all polled their colleague specialists in body part X.   All of them came back with conflicting advice.

I didn’t ask my first specialist because I’d been told by the surgery coordinator to wait for a packet by mail, believing it would tell me how to select implants.  But when it came a week later, it didn’t mention implants.

As noted, the specialist said later that at our first meeting, he did outline my options for the different types of implants. I was with him less than 20 minutes, half of which was a physical exam with a lot of machines.

Perhaps he gave a good briefing, but I was in “Surgery!?!” trauma, and my brain was out to lunch — like Dr. Porges in the MRI.  If so, didn’t he realize I might be too preoccupied by the word “Surgery” to hear all those critical complex details immediately?

Perhaps he just read me an incomprehensible list in under a minute.  I’ll never know; I simply can not remember even a single mention that first day of this issue, which is still tying up many of my waking hours at this writing.

Because now, nine days later, I have his read-out, and read-outs from the other four specialists – and none of them agree on the implants.  Some of them even imply that the type my specialist is recommending could be a health hazard long term.  And none of them have the remotest idea there might be a bit of trauma after all this at my end.

It’s 1 am and time to post this blog — so I can get up tomorrow and try to get this straightened out in time to select the correct implants, in time to get them authorized by insurance, in time for —  surgery.

——————

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 Barrett, Mary Jo, MSW, “Addressing PTSD: How to Treat the Patient without Further Trauma,”
NICABM Webinar, June 29, 2011. Dr. Barrett’s latest book is “Treating Complex Trauma: A Relational Blueprint for Collaboration and Change,” orders are here:  http://goo.gl/SEiWVD  and http://www.centerforcontextualchange.org/publishedworks.html

FN2 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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What Trauma-Informed Care Means to Me

IMAG3258 James, kid, bike“Rider for Change” James Encinas arrived by mountain bike at San Diego’s Cherokee Point Elementary May 2 to the delight of some hundred students, and visitors from around southern California. James, a career LA school teacher, is riding 3,000 miles from Sacramento to Philadelphia. He’ll take the southern route through Texas and Louisiana, then follow the Underground Railway by which African Americans escaping slavery crossed north to freedom.

James is riding to draw national attention to the need for “trauma-informed schools,” key to the movement for “Trauma-Informed Care (TIC)” in education, health, and all public systems. But what is Trauma-Informed Care, and what’s a trauma-informed school ?  (Hint: all the pix in this blog are from Cherokee Point).

“In medicine, a patient is sent to hospice when all medical procedures have failed, and they’re going to die. That says: we give care and comfort only when nothing else works,”notes Dr. Christopher Germer, psychology prof at Harvard Medical School and co-editor of Mindfulness and Psychotherapy.  Pretty crazy right there, if you consider. Been in a hospital lately? Often you’re a widget; they take your clothes away, don’t tell you what’s happening, and so on. [FN1]

IMAG3250 James, Dana Mom w. FoodBut when treating the real human being, “Care Equals Cure,” says Dr. Germer. If a therapist doesn’t care, he’s not going to cure his client. But it’s also true in any dealings with humans. “Care IS the practice of non-resistance to suffering which dismantles emotional suffering,” says Germer. “It means opening to emotional pain more fully, instead of trying to bypass it. Compassion opens the heart, reveals inner suffering, and makes the suffering available for transformation.” (Above: James and activists carry food donated for kids.)

“So the message is:  Stop fixing,and start caring,” Dr. Germer concludes. In fact, it’s brain science. Comfort, care, compassion reduce so much of a human’s fight-flight reflex, even in major medical pain, that this has been shown to heal surgeries faster. Pain and bodily trauma create enough fight-flight that the brain stem often shuts down the immune system, for one.  Compassion helps it come back online. “Let a wounded soldier talk to his mom and he’ll require 50% less pain meds,” says Dr. Bruce Perry, MD.

But could it be necessary or work well in schools?

History of Trauma-Informed Care (TIC)

IMAG3253 Dana w. Youth LeadersTIC goes back to 1994 when the federal Substance Abuse and Mental Health Services Administration (SAMHSA) began to study the remarkably high rate of women in the mental health system with histories of physical and sexual abuse trauma. It became clear that, since such clients came in already pre-traumatized, providers should be mindful lest their own practices and policies put the women in danger, physically or emotionally, or lead to re-traumatization. (Activist Dana Brown with youth leaders.)

These and related studies next showed high rates of earlier life trauma in clients seeking services for substance abuse, domestic violence, child welfare and many other areas. In 2005 SAMSHA created the National Center for Trauma-Informed Care (NCTIC) to assist all public programs to implement Trauma-Informed Care, not only in mental health, but in all services including criminal justice and the education system. [FN 2]

“NCTIC seeks to change the paradigm from one that asks, “What’s wrong with you?” to one that asks, “What has happened to you?” says SAMHSA. “Trauma includes physical, sexual and institutional abuse, neglect, inter-generational trauma, and disasters that induce powerlessness, fear, hopelessness, and a constant state of alert…often resulting in recurring feelings of shame, guilt, rage, isolation, and disconnection.”

It’s impossible to successfully  treat human beings in that condition without recognizing this and at least following the principle of “Do No Harm.”  “When a program becomes trauma-informed, every part of its organization and service delivery system is assessed… to include a basic understanding of how trauma affects the life of an individual,”  SAMHSA notes.

IMAG3271 Kids Raise HandsSchools are key, since all Americans are supposed to spend 13 years there. “If fixing school discipline were a political campaign, the slogan would be ‘It’s the Adults, Stupid!’,” says Jane Stevens, founder of ACEsConnection;  “More than three million kids are suspended or expelled each year” in the U.S., 3.4  million in 2006 according to the National Center for Education.  “But punishment doesn’t change behavior; it just drops hundreds of thousands of  kids into a school to prison pipeline.” (Above: Kids ask James questions.)

“Instead of waiting for kids to behave badly then punishing them,  trauma-informed schools are creating environments in which kids can succeed,” she says. It’s about re-training the adults to drop their fears and assume that kids are basically good, but something traumatized them, so they act out. Bad behavior isn’t accepted and it is corrected – by a dialog with kids to hear what’s hurting inside, and show them how to address it. “Focus on altering behavior of teachers and administrators, and kids stop fighting and acting out in class. They’re more interested in school, they’re happier and feel safer,” Stevens says. [FN3]

See the Grade or see the Person?

As SAMHSA began trauma studies in 1994, the Adverse Childhood Experiences (ACE) Study (1994-98) documented a shocker:  about 50% of Americans have significant child trauma. The 17,421 HMO clients studied were privileged to be mostly college-educated, have jobs and good health care. Yet more than half had two of ten types of childhood trauma: physical abuse; sexual abuse; alcoholic or drug addict parent; family member in jail; battered mother; parent with mental illness; loss of a parent; physical neglect, emotional neglect;  or verbal/emotional abuse.

The ACE Study compared their childhoods, to whether they later developed life-threatening physical conditions and/or addictions.  “It found that those 10 types of severe and chronic childhood traumas up the risk of adult onset of major diseases. But it also  increases the chances of being violent, a victim of violence and becoming chronically depressed,” Stevens reports in a terrific post on  Cherokee Point El.  “Brain research revealed one reason: the toxic stress of trauma damages the structure and function of a child’s brain. Kids get anxious and can’t sit still; get depressed and withdraw; get angry and fight; can’t focus and stop learning. They cope with anxiety, depression, anger by drinking, smoking, drugs, fighting, stealing, overeating,  and/or becoming overachievers on their way to being workaholics.”

What about not-so-privileged kids?  Child trauma and its mortal results must affect a far higher percentage of kids in low-income areas with less access to nutrition, health care, and on and on.  A huge percentage of American children suffer trauma, bigger than 50% if we knew the real national average.

IMAG3293 Big GroupMeanwhile many of us privileged middle class kids grow up to be teachers,  administrators, and so on. If we’re traumatized ourselves, we can’t feel our feelings– so we believe that considering “feelings” is idiotic.  Instead, we set up schools as a place to tell kids things.  Because adults talked at us, we think it’s adult to talk at kids. We tell kids they are there to listen to information and repeat it back as we want it, ie. “get the grade,” or face trouble. Enough to put anyone into fight-flight. (James Encinas, left, with students, Principal Godwin Higa, activists.)

I’m from that privileged middle class. I often say, “Nobody beat me or raped me; what’s wrong with me?”

IMAG3306 Higa & Crane AOn Feb. 25 this year, I heard Ruth Beaglehole, founder of Echo Parenting and Education, address Echo’s annual Los Angeles meeting. Urging the 150 professionals present to get passionate about raising awareness of child trauma, she said,  “Kids have to live in the real world? Make the real world non-violent and trauma-sensitive!  What about creating places where children can seek safety, where children can come home to people who open their arms, attune to them, and say ‘Tell me what happened today’. ” (Above: Principal Higa helps Cherokee students make origami cranes for charity.)

“Some people define that as a report card and demand, ‘I want to see your grades.’  Enough of these bloody grades!” Ruth said, to audience laughter, including mine. “Why do we accept this?  Why do we accept that that’s the definition of a person — their grades?”

Suddenly out of nowhere I began violently sobbing at my table full of therapists, about 20 feet from the podium.  “I see you,” Ruth said, looking straight at me. “You don’t have to hold it back.” She saw the real person I am, she didn’t need me to fake anything. She was willing to simply be with me in the pain, as Chris Germer said: “Stop fixing, start caring.” Boy did that feel good. [FN4]

I knew I always hated having to go out and get that grade, and it better be above 90 “or else.”  So I did it, but I lived in fear.  They didn’t see me.  I was a widget who had to produce results or there’d be trouble.

Back story? On Feb. 8, 2011, I’d just heard I might have a thing called “attachment disorder.” Late one night I dragged myself to the sink to wash, listening to a CD by Dr. Henry Cloud. He joked about a lady who didn’t like her husband to go bowling: “She’s not old enough to be dropped off at school.”  But it wasn’t funny.  [FN5]

“That’s it: I wasn’t old enough to be dropped off at school,” I journaled, “I was just dumped off.”  Terrified, I slumped in a heap sobbing, clutching a stuffed dog and a soggy toothbrush.  Rising an hour later, I couldn’t even brush my teeth without holding the dog. “I’m really frightened because I don’t know if this hole under my feet ever ends,” I muttered into my pocket recorder.

I didn’t know last February but read later that Ruth was born in New Zealand to prestigious academic parents who didn’t see Ruth, either.  “I baby-sat since age 12, trying to give to vulnerable children what I didn’t get,” she says.  So she took a BA in early childhood ed, moved to LA, got a Masters in family therapy, and grew Echo Parenting into an agency of 23 staff that trains 100 professionals a year in service.

IMAG3308 Trauma SignWhat if Ruth’s right? What if a school’s whole mission were to look at each child and say “I see you”?  “I see you as a human being, I care how you’re feeling today, and I care what feelings and fears you’re bringing in the door.  I care if you feel threatened even before you walk in the door.  I want to get to know you, the real you who is.  That way we can make you feel safe to be here in school.  And then, you’ll really want to learn!”  (One of many posters students did for James Encinas.)

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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  Christopher Germer, PhD, “Open Heart, Open Eyes: Self-Compassion,” speech to 20th Annual Conference on Psychology of Health, Immunity and Disease, National Institute for the Clinical Application of Behavioral Medicine (NICABM), Hilton Head SC, Dec.2008
Dr. Germer [http://www.mindfulselfcompassion.org/ and http://www.centerformsc.org/ ] is a founding member of the Institute for Meditation and Psychotherapy, a clinical instructor in psychology at Harvard Medical School, author of The Mindful Path to Self-Compassion, and co-editor of Mindfulness and Psychotherapy. His meditation MP3 are here: http://www.mindfulselfcompassion.org/meditations_downloads.php   “Why Self-Compassion is Becoming a Psychotherapist’s Best Between-Sessions Tool,” Dr. Chris Germer interview by  Dr. Ruth Buczynski, Sept 13, 2009 is at http://www.nicabm.com/nicabmblog/can-self-compassion-become-a-portable-between-session-tool/

FN2  The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. Websites on TIC:  http://www.samhsa.gov/nctic/ ; http://www.samhsa.gov/nctic/trauma.asp

FN3  Jane Stevens, ACEsConnection.com and ACEsTooHigh.com:  http://blogs.psychcentral.com/organizations/2014/04/5-reasons-we-struggle-to-be-trauma-responsive-and-why-the-struggle-should-continue/
http://acestoohigh.com/2012/05/31/massachusetts-washington-state-lead-u-s-trauma-sensitive-school-movement/
http://acestoohigh.com/2013/03/20/secret-to-fixing-school-discipline/

FN4 Ruth Beaglehole, founder of Echo Parenting and Education, address to Echo’s annual Los Angeles meeting “Developmental Trauma: Changing the Paradigm,” Feb. 25, 2014

FN5  Dr. Henry Cloud, PhD, “Character Discernment for Dummies, Part 2,” CD, Dec. 6, 2010, www.CloudTownsendResources.com

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This Is Gonna Hurt – It’ll Be Worth It

#2 in my ongoing book series; original post July 26, 2013

brousblog2a Mordor w.Frodo“Don’t Try This At Home” takes you along on the journey to the center of my brain, tripping down what felt like my old New York City apartment building’s incinerator shoot, blind and alone, after the first professionals I saw called the wrong shots. I discovered, with no desire to do any of this, the realities of Attachment Disorder in a world half sick with it – unbeknownst to all but a few of the 3.5 billion folks involved.

Some 50% of Americans have some form of Attachment Disorder, also the average worldwide. This story is meant not to depress you, but to inspire the 50% of us in this reality to recognize it, respect ourselves and our injuries, and seek serious healing – because it can happen. This mess can even turn out to be a blessing; but you won’t believe such an ending could come about until much, much later.

So bad news first, then good.

The bad news is way bad: this is really gonna hurt.  Healing is impossible without feeling the boatload of emotional pain hiding frozen inside us.

Attachment Disorder often involves “developmental” injury to the brain stem in the womb or before age 5, which no one involved ever knew happened. We just walk around all our lives feeling hyper-sensitive to feelings. I couldn’t believe how bad it hurt when I first got in touch with this “baby pain.” When I say pain in my chest or gut, we’re talking knife-stabbing level pain. Some days it felt like crawling across Mordor, except on my belly, butt naked.  Frodo at least had clothes.

The emotional pain is so bad, that the brain stem actually knocked us out into oblivion whenever it was first experienced, to protect us from feeling it as a helpless kid in the first place. It’s the same biological mechanism that takes charge when we see a mouse pass out as the cat picks it up, often called “freeze,” or technically, “dissociation.”

brousblog2b PterydactylIt’s a raw instinct of fight or flight, and when that’s impossible, freeze, which goes back to the advent of bony fish. The fish doesn’t have time to debate “should I freeze now?”  It just passes out.

Trick is, we’ve got to un-freeze the frozen pain from those early months and years, and feel it – to release or “discharge” the stored-up stress energy deep in our muscles and viscera. And feeling our feelings, I learned, bad as they felt, can never kill us. It doesn’t even harm us in the slightest. In fact, afterward we feel better, though it might take a while.

It’s when we refuse to feel this stuff that it silently eats at us from the inside, first emotionally, then by generating enough stress chemicals to physically destroy body parts. That’s what actually kills many of us.

Attachment Disorder stems from any disruption to an infant’s attachment to the mother, and unfortunately, babies are very easy to damage. It can start as soon as the sperm hits the egg, or at any time in the next 45 months, since a baby requires solid, calm attachment from conception to 36 months, for the brain to develop in a healthy way. Any stress to a mother carrying a baby is a warning sign. Recent studies show it is prevalent in underprivileged areas, orphanages, alcoholic homes, or any home where mom is under existential stress. Neuroscientists in a recent book call it the “hidden epidemic.” [FN3]

But Attachment Disorder also occurs “in the nicest families” due to factors as simple as a mom smoking while pregnant as did moms of many baby boomers. Unwanted pregnancies (however wealthy the home) are at high risk. Neonatal incubation and adoption deeply damage attachment; only recently have remedial treatments been introduced. Infant or childhood surgeries or any medical trauma are a red flag. Mothers who as kids had little air time with their own mom and thus are tone deaf to others’ emotional state, unwittingly pass the damage on to their infants.

Many health professionals today did not adequately study attachment during training, if at all. It goes unnoticed in schools, medical systems, and houses of worship, all the places where hurting people go for help.

This makes a chunk of our population an emotional health time bomb. It may account for much of our 50% divorce rate and the work productivity crisis draining our economy. The top trauma specialist for the Pentagon says it’s one reason Congress can’t seem to function. [FN4]

brousblog2c Death Valley Lots of RocksNo, I’m not sitting on the brink of Mordor  – but it is Death Valley.

The good news, however, is so good: healing is worth the fight.

As I move further into my own healing, I feel so much better than I ever have in my life. This may be difficult to believe until you experience it.

I sure didn’t feel this way when I first started contemplating all those layers of pain — but I got through it.

You will never trade how you lived before for how you’re going to be able to live now, the fullness of feeling everything wonderful you haven’t been able to feel all your life, freedom from all that raging anxiety deep inside, which kept you as frozen up as that conked-out mouse or fish.

Trauma specialists compare recovery from AD to a religious experience of God or a metaphysical awakening to enlightenment, the relief is that profound. [FN5]

Whatever the words, it’s a transformation which can make us feel so loved and full of life and relief that weeping for joy can become a bad habit. The feelings of sheer gratitude have put me on a first name basis with God, and He’s a really nice Man.

Since most of this book is going to tell you in graphic detail how bad it feels when we first discover Attachment Disorder and walk through the necessary early stages of pain and healing, there’s no reason not to believe me about the happy ending.

And I’ve even got clinical proof.  Never in my wildest imagination (and that’s saying something) did it occur to me to even address the various medical issues “we all develop” after 40. Just by addressing my emotional pain, feeling it, and finally releasing it, the oddest results began to materialize in my body.

During the first 18 months of this purely emotional program, my cholesterol dropped 35 points, my kidney disease numbers dropped way back into the “lots better than normal” range, a nearly crippled foot simply healed itself, and the list goes on. Just wait, it’s all in Chapter 14.

These days, my family doctor looks at my annual check-up lab results and asks “Do you plan to live forever?”

Meanwhile, my friends have to put up with hearing me repeatedly blurt out, wherever we go: “I can’t believe how much better I feel than the last time we were here!”

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This is from the Preface of Kathy’s forthcoming 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 of excerpts from the rest of her book 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
3. Lanius, Ruth A., MD, Vermetten, Eric, Pain, Claire, Editors, “The Impact of Early Life Trauma on  Health and Disease: The Hidden Epidemic,” Cambridge University Press, 2010.  “Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician,” American Academy of Pediatrics,  2012 (New York Times 1-7-12), and many more.
4. van der Kolk, Bessel, MD, “What Neuroscience Teaches Us About the Treatment of Trauma,”  June 6, 2012 webcast, National Institute for the Clinical Application of Behavioral Medicine  (NICABM). Dr. van der Kolk said the US Congress is “dissociated,” or they’d feel the simple human compassion to know that sending youth to war brings back a flood of PTSD suicides.  (To me that means more than 50% of Congress has attachment problems, which is why they made a career of trying to control others. )  See footnote 9 in http://attachmentdisorderhealing.com/developmental-trauma/
5. Levine, Peter A., “Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body,” ‘Sounds True, Inc.,’ Boulder CO, 2005; ISBN 1-159179-247-9

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