Tag Archives: brain science

Can School Heal Kids?

Can School Heal Children in Pain? – Guest Blog by “Paper Tigers” Director James Redford, original date June 3 (photo courtesy of Mr. Redford).

aredfordAfter learning about the overwhelming effects of childhood trauma, I decided to make a film about a school that’s adopted a “trauma-informed” lens.

Documentaries are no walk in the park. They take a lot of time and money; they have a way of making a mockery out of your narrative plans…

Why bother? It’s a good question. For me, I have one simple bar that all my films must clear: an “oh my God!” moment. If a story does not elicit that reaction from deep within my bones, I don’t do it. I count on that sense of awe, concern, wonder, and alarm to carry me through the long haul of making the film…

After three years of hard work and uphill battles, my latest documentary film, Paper Tigers, premiered last week [May 28] at the Seattle International Film Festival. And yet it seems like yesterday that I first encountered the explosive research that linked poor health to childhood trauma.

I didn’t know that adverse childhood experiences — like assault, emotional abuse, observing domestic violence — could fundamentally alter a child’s body and brain. These kids are at risk for every single major disease, including (but not limited to) cancer, diabetes, high blood pressure, and cardiovascular disease. That risk doesn’t include the increased likelihood of “self-soothing behaviors” like smoking, drinking, eating too much food, doing too many drugs, having too much sex.

Put that all together and you have the underpinnings for some of the greatest societal challenges we face. It quickly became clear that social support systems require a deeper understanding of adverse childhood experiences….

The good news is that there are schools, clinics, courts, and communities that are starting to adopt a “trauma-informed” lens.

Click to Read More…

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Kathy’s blogs and Guest Blogs explore the journey of recovery from childhood trauma by learning about Adult Attachment Disorder in teens and adults, Adult Attachment Theory, and the Adverse Childhood Experiences (ACE) Study.

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My Neurofeedback Journey – Dr. Tina Hahn

Tina Hahn, 30 monthsMy Neurofeedback Journey
by Tina Marie Hahn
as told to Kathy Brous

[Tina added on July 11:  I am experiencing major changes in my brain functioning so fast with neurofeedback, although as of this writing, I have only been doing it for three months. But in six months I seriously don’t think I will recognize myself anymore, and I say that after decades of struggle.  I truly recommend checking out neurofeedback, for anyone who has failed all the traditional approaches to trauma.]

I am Dr. Tina Marie Hahn, MD, advocate for Trauma-Informed Care and Communities, and survivor of actually ten Adverse Childhood Experiences (ACEs). As a pediatrician, I screen parents and children alike for childhood trauma. That’s me above at 30 months old and my background story is here: http://acestoohigh.com/2014/05…-her-ace-score-is-9/

I’ve been excited for some time to try neurofeedback, which I began on April 6, after listening to a talk given by Dr. Bessel van der Kolk and Sebern Fisher and reading Dr. van der Kolk’s latest book “The Body Keeps the Score” and a blog on Sebern Fisher’s work with neurofeedback here at http://attachmentdisorderhealing.com/neurofeedback/   I then read three books on neurofeedback, including Dr. Fisher’s book “Neurofeedback in the Treatment of Developmental Trauma: Calming the Fear-Driven Brain” and decided to research several electronic neurofeedback systems for home use.

I report as a user/patient, not as a doctor or expert, because my experience so far has been fairly stormy — I’m just starting out, so I don’t know where this will go and I am not an expert.  I feel I should warn readers: if you have experienced severe infant and childhood developmental trauma as I did, neurofeedback seems like a very rewarding method for healing — but it has intense risks if not done with care.

Please if possible, as Kathy’s book says: “Don’t Try This at Home.”  Neurofeedback is designed to be done in a trained practitioner’s office.  So for most people with trauma, probably it’s best not to do neurofeedback alone at home. Please try to do it with access to formal support, hopefully a good attachment-based psychotherapist who is very compassionate, so you can discuss what is happening and process these deeply brain stem based emotions with another human. If therapy is really impossible, maybe you could create a group of healing friends or at least have a friend come regularly to be with you while you do it or afterward. Some type of support would be key.

I had to opt for a home-use neurofeedback system because I am in a rural backwater where everyone knows everyone so I don’t feel comfortable sharing incredibly strong emotions. I’ve also had prior bad experiences with psychiatry plus right now there aren’t good practitioners anywhere near where I live. In fact, I might be doing better if I had a well-trained therapist possessing extensive knowledge of developmental trauma.

As to the level of pain in my healing with neurofeedback so far: I have been working on this level of emotional pain for decades, so (thus far) it seems I have an ability to tolerate this intense experience. (I won’t know how much I can tolerate until I go further, who knows.)  But I did want to note that unless a person is willing to take chances and is pretty strong, they might get really shaken up.

The Fear-Driven Amygdala

I wanted to specifically treat my fear-driven amygdala that I have from being terrorized as an infant and child. I found one home system, which looked good, but it did not allow one to use different protocols to specifically calm down an overactive amygdala.

So I chose BrainPaint®, which did, and I was excited to get my BrainPaint® home neurofeedback system in the mail April 6.  BrainPaint® sent an excellent 47 minute video tutorial showing me how to set up the system and before the first session, I had an 1.5-hour phone tutorial. The system is very easy to set up and use. Also we get 45 minutes of assistance by phone every month we rent the system, and we can pay extra for more telephone help if we need it. I will be texting or calling my BrainPaint® “assistant” to help me as I become ready to change protocols based on symptom improvement.

BrainPaint® is not cheap but mental health and well-being? Priceless. The BrainPaint® set I got has a minimum two months rental at $675 per month for shipping and a deposit; I initially paid $1,875. The deposit comes back when you send the rental back.  Here is an introductory YouTube video: https://www.youtube.com/watch?v=7s0AFjRVfmk

I did my first session April 7; it starts with a symptom checklist. I had lots of symptoms checked. The protocol chosen initially was to calm my right amygdala— but because it looked like so many areas were out of whack, I did something called “non-linear on T3 and T4″ (right and left temporal) to get the brain hemispheres in synch.

My first session was 7 minutes….. It was interesting.. Looking at a screen with fractal patterns and auditory inputs. After the first 7 minutes, I fell asleep for 2 hours. For me that is amazing because I don’t take naps and don’t sleep well… I feel relatively calm and just completed a second session for 14 minutes. I am now pretty tired.

I don’t know the outcome of this process, but I have a strong feeling that neurofeedback is going to help rid me of my low self esteem, my rough edges and though I am really tired, I think this is going to really make some good changes. It already did something, as normally looking at a computer screen would never make me take a nap.

More Good Results

On April 8, I had more good results:  I did a few more BrainPaint® sessions throughout the day. Then last night I slept the best I have in months!

On April 20, I did an “Alpha-Theta” session on BrainPaint® and had a rather weird experience so here’s what happened:

I am stuck inside an ostrich shell. I am really stuck. I am little but grown. I am pushing on the shell. It doesn’t move and all around me is space …. lots of space.. me in a shell…
then I flash into the basement…. it is dark but there is a window a small window that is in the basement and I look outside trying to see the outside where it is light and bright and trees and leaves and I am stuck…

I don’t fight, I just flash back into the eggshell… then I think I cannot push this open… I will try to melt it away into infinity ..the infinity of equanimity ….. then it was done….

I suppose this is what we experience in the early sessions.

Major Trauma Release

On April 27, it had been about three weeks that I’ve been working with the BrainPaint® desktop home neurofeedback machine.  I’ve been doing about 1.5 hours of neurofeedback a day. That turned out to be a little too much for me as a beginner, so I gave myself a break the last two days.

After my second “Alpha-Theta” training April 19, I could not stop sobbing during the session, or after — for 4 hours straight. It was cathartic. During the session my body was shaking — like really shaking. It reminded me of Peter Levine’s discussions and the video he has of the polar bear shaking after he was attacked and then later came out of the trauma. It was incredible. I wasn’t just thinking this poison was coming out of my body — I was feeling it. I was shaking worse than if I had been locked for several hours in a deep freezer…..

It really was amazing…. I let go of a lot of stuff. I saw that my mother did the best she could. I could see myself letting go of the residual anger.

Then, the anger was replaced with a tremendous well of grief and loss. I realized that I was full of so much grief over what could have been and how my life might have been different if this had not happened to me — how my mother’s life would have been different if she had been able to feel love from her children instead of being so stressed that she allowed the most horrific things to happen to her kids.

I thought about how my brother wouldn’t be psychotic if he hadn’t been hurt so much…. How he could know happiness instead of his constant fear…..

And please know: it might not be good for most people to do this alone, as the title of your book says, “Don’t Try This at Home.”  For me, I’ve been working on confronting my childhood for decades, so I have an ability to tolerate this intense experience.  But for most people, unless you are willing to take chances and you’re pretty strong, a person might get really shaken up. It would probably be good to have a therapist to discuss what is happening and to process those deeply brain stem based emotions — or a group of healing friends. To have someone with you to support you would be helpful.

I might be doing better if I had a therapist too, but like Kathy I’ve had bad experiences with therapy so my confidence in it is low and anyway I’m in a rural area without much available.  But I think many people with severe childhood trauma like me who are considering neurofeedback might want to use it with formal support such as therapy or a support group.

For me, I wasn’t re-traumatized. That is all I want to say for now except I think this is a powerful tool!

Getting More Relaxed

By May 6, I found that we need to give the neurofeedback some time to settle into our brain, let the brain settle into new patterns. That’s why I’m not posting as much: I just don’t feel the need to reflectively respond to everything, and that means everything in general.  For someone with trauma, that’s progress.

I have been able to work through my anxiety and though it seems strange, send the emails and make the telephone calls that I need to make but generally procrastinate on. I have been cleaning and organizing. Usually I am so disorganized I am not good at this.

Now I am less reactive. I am certain of it.  When talking to others and they say something that would generally trigger me – I might still become triggered but there is more of a second or two to contemplate first.

I stopped doing several hours of neurofeedback per day. I think so much was making it very confusing for me to determine what was going on in my brain.  While I think generally it has all been effective, I like the general stabilizing non-linear protocol I began with.  I have done several more sessions of the “Alpha-Theta.” That is the type that has the capability to take us into the deep meditative state.

I haven’t had anymore of those really emotional spells during the “Alpha-Theta,” but my dreams have been more colorful. Actually last night I had the first dream in color and it was sad, but more positive.  Usually my dreams have always about big mean things trying to kill me.  So that is great, too.

I feel like I am better able to sit back, take in others point of view, back off from feeling like I have to do everything myself. I really feel this is great.  I also attribute it to the neurofeedback.  I feel like I could talk to people much easier now and have a great interactive conversation without feeling strange and out of place inside.  This is all awesome to me.

And I am feeling like moving into other areas of healing like meditation which I am not good at because of a “way too busy mind that is always quadruple tasking”.  I actually sat down and did about 15 minutes of sitting meditation yesterday and that was good.  So I think all in all this has been a very positive process for me.

I have also been taking others suggestions or at least listening and then making I think more informed decisions based on information from others. To me this is the start of trying to connect.

Also, though I don’t use Facebook much, I have been posting on Facebook more recently and will see people I know. Before, I would be afraid to send a friend request — I would be too afraid because I’m a bad person, that person wouldn’t want to be my friend.  But now, I have been taking chances, sending friend requests and guess what – people have been accepting.  I just find this totally weird for me.  I don’t look out of control outside but now, I am starting to feel more competent instead of “out of control inside.”  By that I mean that strange anxiety when you feel like you don’t belong, like you are an alien to a foreign species.  But now I’m starting to feel I do belong more, I’m feeling more human.

A Breakthrough or Epiphany?

On June 8, I wrote that I haven’t posted on my use of the BrainPaint® neurofeedback system for a month for a few reasons.

Good reasons: I felt so much better due to neurofeedback that I got too busy!  I’ve been out a lot, creating and attending meetings about the ACE Study and regional trauma-informed schools, and I’m writing several articles.  I’ve begun working on key things I used to procrastinate on, that’s also getting better with neurofeedback…  I can feel a real improvement in my impulse control and affect regulation (my ability to regulate my emotions is growing nicely.)

I still feel neurofeedback benefiting me in daily activities, for example if I want to write something that makes a point, I do it so that it’s not impulsive, and is worth reading.  My new ability to do that is part of the neurofeedback.

But I also missed a lot of BrainPaint® sessions. On the one hand, we do need time for the neurofeedback changes to settle into our brain. But I got 2-3 weeks behind so let me note: For anyone who decides to do home neurofeedback, it is important to follow the BrainPaint® policy to rate your goals and answer the assessment questions before each session, and also be careful to keep up with the updates they issue to their computer system.

I got behind on that because my cursor wasn’t working properly, I was blaming myself, so I missed a lot of sessions. Finally I called my BrainPaint® home neurofeedback coach and we learned it wasn’t my fault — the program needed an update, so it was updated on Friday [June 5].

Then we reviewed and updated the BrainPaint® assessment together that calculated new protocols and she told me to stop trying to do everything on my own, to please call for help. I promised to follow the directions and did so over the weekend and — wow, did my brain move with the new protocols the system created!

In fact, as I was doing my session with the directed protocols, I came to what I have to call an epiphany.  Something has happened to me which feels weird, in fact it feels absolutely crazy (compared to how I used to feel).

I want to report it because it must be the neurofeedback which is really helping me. OK:

I’m often scared to take my dogs to the vet because the office is on a main highway, and the dogs jump out of the car as soon as a door is opened. I’ve been afraid one would jump out and get hit by a car. I have to put them in the back of the RAV4 when driving or I get a 60 or 45 pound dog in my lap, but I couldn’t get them out the back door due to trouble with the auto-lift gate.

Now yesterday while I was doing neurofeedback, for the first time in my life it hit me: Hey, I could go inside the vet’s office and simply ask a front desk person to help me so my dogs don’t jump out and get hurt. This sounds so stupid but it isn’t — it means for the first time in my life I considered asking another person for reasonable help!

That means believing people are supposed to help each other and that some people can be approached for help.

That’s a first step in trust. Amazing.
So I began to weep, really weep.
Let me explain why this feels so weird and crazy and amazing to me.

As many of us with a high Adverse Childhood Experiences (ACE) score, people have horribly hurt me. I’ve come to feel, I want no part of mammalian attachment to people (you call that “fur”) — even if it is the only way to heal. Trusting people is horribly scary for me for reasons like this:
When I was 7 or 8, I was with my dad in the car about an hour away from our trailer.  I never asked my dad for anything because he was incredibly mean. My dad smoked in the car with us kids inside.  But on this winter day, I had a cold, and as he is smoking, I suddenly couldn’t breath.  I am scared to death because I cannot breath. I timidly ask him “Dad could you please stop smoking? I cannot breathe.”  His response was “If you don’t like it, I can drop you off here right now and you can walk home!”  A very typical response. I don’t know how I managed to escape with my life in that small car for an hour as he puffed away while I was close to respiratory arrest… but I never forgot the incident or the horrible insensitivity.

From that time forward, I could not ask for anything reasonable – I could not ask for something reasonable to save my life.

To others, asking for assistance may seem like a no-brainer. But for me, tremendously hurt by my parents for years starting at a young age — to consider in the middle of today’s neurofeedback session that I could ask the vet for reasonable help — it made me weep.

And I’m going to try to no longer react immediately, even to such epiphanies, as I want to be more reflective going forward — another amazing plus of neurofeedback.  But wow, I have experienced an amazing movement of my brain that I don’t think could have occurred any other way.

I may even be able to move to where attaching to people becomes okay.
Oh and as I had this epiphany – my dogs ate my dinner and I didn’t get mad!

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Kathy’s blogs and Guest Blogs explore the journey of recovery from childhood trauma by learning about Adult Attachment Disorder in teens and adults, Adult Attachment Theory, and the Adverse Childhood Experiences (ACE) Study.

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‘Paper Tigers’ Film: ACE Trauma Can Be Healed

“Resilience practices overcome students’ ACEs in trauma-informed high school, say the data” — Guest Blog by Jane Stevens, Founder of ACEsConnection.com

Paper Tigers Cast Crew Seattle Premier 5-28-15Three years ago, the story about how Lincoln High School in Walla Walla, WA, tried a new approach to school discipline and saw suspensions drop 85% struck a nerve. It went viral – twice — with more than 700,000 page views. Paper Tigers, a documentary that filmmaker James Redford did about the school, premiered last Thursday night [May 28] to a sold-out crowd at the Seattle International Film Festival. Hundreds of communities around the country are clamoring for screenings. [Cast and crew of Paper Tigers after Seattle screening; photo by Jane Stevens]

After four years of implementing the new approach, Lincoln’s results were even more astounding: suspensions dropped 90%, there were no expulsions, and kids grades, test scores and graduation rates surged.

But many educators aren’t convinced. They ask: Can the teachers and staff at Lincoln explain what they did differently? Did it really help the kids who had the most problems – the most adverse experiences? Or is what happened at Lincoln just a fluke? Can it be replicated in other schools?

Last year, Dr. Dario Longhi, a sociology researcher with long experience in measuring the effects of resilience-building practices in communities, set about answering those questions.

The results? Yes. Yes. No. And yes.

In 2010, Jim Sporleder, then-principal of Lincoln High, learned about the CDC-Kaiser Adverse Childhood Experiences (ACE) Study and the neurobiology of toxic stress at a workshop in Spokane, WA. The ACE Study showed a link between 10 types of childhood trauma and the adult onset of chronic disease, mental illness, violence and being a victim of violence…

Here’s what Sporleder learned:

Severe and chronic trauma (such as living with an alcoholic parent, or watching in terror as your mom gets beat up) causes toxic stress in kids. Toxic stress damages kid’s brains. When trauma launches kids into flight, fight or fright mode, they cannot learn. It is physiologically impossible.

They can also act out (fight) or withdraw (flight or fright) in school; they often have trouble trusting adults or getting along with their peers. They start coping with anxiety, depression, anger and frustration by drinking or doing other drugs, having dangerous sex, over-eating, engaging in violence or thrill sports, and even over-achieving.

Sporleder said he realized that he’d been doing “everything wrong” in disciplining kids, and decided to turn Lincoln High into a trauma-informed school.

With the help of Natalie Turner, assistant director of the Washington State University Area Health Education Center in Spokane, WA, Sporleder and his staff implemented three basic changes that essentially shifted their approach to student behavior from “What’s wrong with you?” to “What happened to you?”

Click to Read More…

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Kathy’s blogs and Guest Blogs explore the journey of recovery from childhood trauma by learning about Adult Attachment Disorder in teens and adults, Adult Attachment Theory, and the Adverse Childhood Experiences (ACE) Study.

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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.

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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  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.

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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 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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April-May 2015 “New Brain” Webinars

James ReeseDr. Daniel J. Siegel gave a webinar April 8 to kick off the 2015 “New Brain Series” of weekly webinars by the National Institute for the Clinical Application of Behavioral Medicine (NICABM).  The series is airing Wednesdays April 8 – May 13, 2015, at 5 pm Eastern Time, repeated at 6:30 pm Eastern.

NICABM head Dr. Ruth Buczynski ran a terrific “Rethinking Trauma” series last year, pointing out that “talk therapy” can’t always cut it — we need body work and other alternative “somatic” therapies, as I’d written for months.  It’s still available; click here: http://attachmentdisorderhealing.com/Ruth-trauma2014/

Ruth’s April-May 2015 “New Brain Series” weekly schedule is below, and what a great lineup.

Pat_Ogden AmazonI want to especially recommend two speakers I haven’t covered yet:  Dr. Pat Odgen (right) on “Why the Body Matters When Working with Brain Science,” and  Dr. Rick Hanson on “Why Ancestral Survival Skills Trip Us Up Today,” (otherwise known as the negativity bias of the brain, and how we can overcome it.)

RickHanson AmazonTheir past webinars have helped me enormously. (Rick Hanson, left)

I’ve done a series of blogs on Dr. Stephen Porges  and another series on Dr. Dan Siegel, who both were pivotal to my healing.

You can sign up to watch Ruth’s April-May 2015 “New Brain Series” free at the time of broadcast, or support the series by purchasing it and be able to watch, get audio mp3s, and transcripts any time. Here’s the link to watch live: http://www.nicabm.com/brain2015/freeconfirmed/?wemail=
Here’s the link to buy and download anytime: http://www.nicabm.com/brain2015/lay/info/

Webinar Schedule

The Brain In Two Places: Inside Your Head,  Embedded in the World  –  Dan Siegel, MD     Wednesday, April 8th    5:00 PM EDT & 6:30 PM EDT

Transforming the Brain through Good Experiences –  Rick Hanson, PhD  Wednesday, April 15th     5:00 PM EDT & 6:30 PM EDT

The Neuroscience of Willpower – Kelly McGonigal, PhD  Wednesday, April 22nd  5:00 PM EDT & 6:30 PM EDT

Unlocking The Enormous Potential of Neuroplasticity –  Norman Doidge, MD   Wednesday, April 29th    5:00 PM EDT & 6:30 PM EDT

How Neurobiology Changed the Way We View Trauma Treatment   –  Pat Ogden, PhD   Wednesday, May 6th    5:00 PM EDT & 6:30 PM EDT

Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm  –   Stephen Porges, PhD    Wednesday, May 13th   5:00 PM EDT & 6:30 PM EDT

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NICABM 2011-2014 Series Library on Trauma and the Brain: http://www.nicabm.com/programs/trauma/

Rethinking Trauma 2014 Webinar Series http://www.nicabm.com/treatingtrauma2014/post-info/
Peter Levine, PhD
Bessel van der Kolk, MD
Stephen Porges, PhD
Pat Ogden, PhD
Daniel Siegel, MD
Sebern Fisher, MA
Ruth Lanius MD, PhD
Laurel Parnell, PhD
Richard Schwartz, PhD
David Grand, PhD

New Treatments for Trauma 2013 Therapy Program http://www.nicabm.com/trauma2013/trauma2013-post/
Peter Levine, PhD
Bessel van der Kolk, MD
Pat Ogden, PhD
Stephen Porges, PhD
Francine Shapiro, PhD
Ruth Lanius, MD, PhD

New Treatments for Trauma 2012 Training Program http://www.nicabm.com/trauma-2012-new/
Bessel van der Kolk, MD
Pat Ogden, PhD
Stephen Porges, PhD
Belleruth Naparstek, LISW
Ruth Lanius, MD, PhD
Sue Johnson, EdD

New Treatments for Trauma 2011 teleseminar series http://www.nicabm.com/treating-trauma/?del=programspage
Peter Levine, PhD
Pat Ogden, PhD
Stephen Porges, PhD
Matthew Friedman, MD, PhD
Mary Jo Barrett, MSW
Allan Schore, PhD
Christine A. Courtois, PhD
Carol Look, LCSW

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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.

Tags: Adult Attachment Disorder, Adult Attachment Theory, Neuroplasticity, Polyvagal Theory, Sensorimotor Therapy, Brain Science, Brain Stem, Limbic Brain, Fight-flight, Pat Ogden, Dan Siegel, Stephen Porges, Rick Hanson

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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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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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A Pastor’s Battle with Childhood Trauma

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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]

———————————
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/

———————————
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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