Tag Archives: Emotional pain

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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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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A Pastor’s Battle with Childhood Trauma

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“General Theory of Love” on Mammals

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Footnotes

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

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Pediatricians Screen for Child Trauma

To prevent childhood trauma, pediatricians screen children and their parents…and sometimes, just parents…for childhood trauma”
guest blog by Jane Ellen Stevens, Editor, ACEsTooHigh.com and ACEsConnection.com

Tabitha Lawson & kidsWhen parents bring their four-month-olds to a well-baby checkup at the Children’s Clinic in Portland, OR, Drs. Teri Petersen, R.J. Gillespie and their 15 other partners ask the parents about their adverse childhood experiences (ACEs).  [Tabitha Lawson of Portland, OR with her two children, who greatly benefited from the new program; more below]

When parents bring a child who’s bouncing off the walls and having nightmares to the Bayview Child Health Center in San Francisco, Dr. Nadine Burke Harris doesn’t ask: “What’s wrong with this child?” Instead, she asks, “What happened to this child?” and calculates the child’s ACE score.

In rural northern Michigan, a teacher tells a parent that her “problem” child has ADHD and needs drugs. The parent brings the child to see Dr. Tina Marie Hahn, who experienced more childhood trauma than most people. Instead of writing a prescription, Hahn has a heart-to-heart conversation with the parent and the child about what’s happening in their lives that might be leading to the behavior, and figures out the child’s ACE score.

What’s an ACE score? Think of it as a cholesterol score for childhood trauma.

Why is it important? Because childhood trauma can cause the adult onset of chronic disease (including cancer, heart disease and diabetes), mental illness, violence, becoming a victim of violence, divorce, broken bones, obesity, teen and unwanted pregnancies, and work absences.

The CDC’s Adverse Childhood Experiences Study (ACE Study) measured 10 types of childhood adversity: sexual, physical and verbal abuse, and physical and emotional neglect; and five types of family dysfunction – witnessing a mother being abused, a household member who’s an alcoholic or drug user, who’s been imprisoned, or diagnosed with mental illness, or loss of a parent through separation or divorce.  (There are, of course, other types of trauma, but those were not measured in this study. Other ACE surveys are beginning to include other types of trauma.)

Each type of trauma — not the number of incidents of each trauma — was given an ACE score of 1. So, a person who has been emotionally abused, physically neglected and grew up with an alcoholic father who beat up his wife would have an ACE score of 4.

The ACE Study found that childhood trauma was very common — two-thirds of the 17,000 mostly white, middle-class, college-educated participants (all had jobs and great health care because they were members of Kaiser Permanene) experienced at least one type of severe childhood trauma. Most had suffered two or more.

The more types of childhood trauma a person has, the higher the risk of medical, mental and social problems as an adult (Got Your ACE Score?). Compared with people who have zero ACEs, people with an ACEs score of 4 are twice as likely to be smokers, 12 times more likely to attempt suicide, seven times more likely to be alcoholic, and 10 times more likely to inject street drugs. Compared to people with zero ACEs, people with an ACE score of 6 have a shorter lifespan – by 20 years.

Twenty-two states and Washington, D.C., have done their own ACE surveys, with similar results.

The ACE Study is part of a perfect storm of research emerging over the last 20 years that is revolutionizing our understanding of human development. Brain research shows how the toxic stress of trauma damages the structure and function of children’s brains, which can explain their hyperactivity, inattentiveness, angry outbursts and other behavior. This affects their ability to learn in school, and leads them to use drugs, alcohol, thrill sports, food and/or work as coping mechanisms.

Biomedical researchers discovered that toxic stress experienced as a child can linger in the body to cause chronic inflammation as an adult, resulting in heart and auto-immune diseases, such as arthritis. And epigenetic research shows that the social and emotional environment can turn genes on and off, and childhood trauma can be passed from parent to child to grandchild.

Let’s put this another way: A huge chunk of the billions upon billions of dollars that Americans spend on health care, emergency services, social services and criminal justice boils down to what happens – or doesn’t happen — to children in their families and communities.

acemagnituteofsolution

The pediatricians mentioned in this article know that, and they also know that if they intervene early enough to stop or prevent childhood trauma by building resilience factors in children and families, children won’t suffer, and they’ll have happier, healthier lives as adults.

Pediatricians aren’t just about sore throats and ear infections anymore, says Gillespie. “This is a culture shift. We’re here to support families.”

The profession is moving away from looking solely at healing a child, to healing a family and a community. For the last several years, the American Academy of Pediatrics has been helping pediatricians create medical homes where all needs of children and their families are met, including “specialty care, educational services, out-of-home care, family support, and other public and private community services that are important for the overall health of the child and family.”

Two years ago, the AAP encouraged pediatricians to also address adverse childhood experiences and toxic stress in early childhood. Last month, AAP President Dr. James Perrin launched a new initiative, the Center on Healthy Resilient Children, to “coordinate the academy’s response to the issue of adverse childhood experiences, the promotion of healthy development, and the prevention of toxic stress.”

Feeling overwhelmed…and someone to turn to

When Tabitha Lawson brought her four-month-old son in to the Children’s Clinic in Portland, OR, they both were having a hard time. Unlike her 6-year-old daughter, he wasn’t an easy baby. He had colic, and Tabitha and her husband were under stress from his long bouts of crying.

“I was feeling overwhelmed,” she recalls. “I had no breaks. I work full time. From my job to my house is five minutes, where I’d go into my other life mode, and every evening, the scream-outs.”

She filled out a survey with 10 questions about her adverse childhood experiences (ACEs)…  click here to READ MORE…

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Allan Schore: What is the “Self”?

Allan Schore 2In March 2013, I was standing unknown in a crowd of professors and therapists at a UCLA conference, and noticed a quiet gentleman on my right.  I’d seen his photo online.  “Dr. Schore?” I asked.  “Yes,” said Allan Schore, turning calm eyes on me.

“I’m so grateful for all you’ve done to show that babies can’t control emotions, that’s the mother’s job to model, and emotions are ok,” I blurted,  suddenly in tears. “I’m writing a book on what it feels like on the inside, when we don’t get that as an infant.”

Dr. Schore didn’t flinch; his eyes grew wide with empathy. He got it.  He got a total stranger, right by the conference stage, got that I had walked through a hell of emotional pain to study this. He got that I was feeling love for him because he’s shown there’s a scientific reason for the pain.  He got that “emotions are ok” and only emotions from a caring other can heal this, so he gave me emotions: presence and compassion. On the spot. “We see it every day,” he said.

Just sayin’: he walks the walk.

UCLA professor Allan Schore is a world leader in Attachment Theory. He’s known as “the American Bowlby” after British psychiatrist John Bowlby who first wrote about attachment in the 1950s. [FN1]  Schore was among the first to put together the latest brain science on how an infant’s brain forms biologically (“developmental neuroscience”), with the early psychology of the infant mind (“developmental psychoanalysis”).

Dr. Schore’s 9-28-14 Oslo speech “The Most Important Years…the Right Brain and Its Importance” is a must-see to understand infant developmental trauma. He calls it  “trauma in the first 1000 days, conception to age two.”  Schore reviews how the theories he’s published since the 1990s are being proven to be hard science by today’s brain scan technologies (content starts minute 8): https://www.youtube.com/watch?v=KW-S4cyEFCc

Schore is known for documenting the “origin of the self”– what, scientifically, is the “Self”?  What is it that makes me, Me?

He calls it “the origin of the early forming subjective implicit self.” It’s entirely subjective; each infant has a different experience.  It’s “implicit memory” because the self forms in infancy when memory is only subconcious. It all happens years before we have thought and conscious “explicit memory” at age two or three.

This isn’t mere geek-speak; the mental, emotional, and physical health of all humans depends on it. We can’t remember what happened before age 3 when our self was formed, but the experience had massive impact. It’s all still “down there,” driving our feelings and behavior big time for the rest of our lives.

When the self is damaged during formation in early infant and childhood, a person can feel miserable all their life. The ACE Study shows this often leads to biological disease and premature death.

The Self and Emotions : Secure Attachment

brousblog4c Claire+MosesBabies are born with a massive level of emotions. Schore reports that they are  overwhelmingly dependent on the mother to show them how to handle it all. An infant’s brain doubles in size “from the last trimester of pregnancy through the second year,” he says. “At birth, there are hardly any cortical (conscious thinking brain) areas that are myelinated and online… so it’s impossible for the baby to regulate its own emotions…

The mother is the regulator of that baby,” he says, and this shapes the development of its entire brain. “Over the first year… the mother’s interactions are shaping the very wiring of those higher regulatory centers… Attachment communications which are emotional are forging the connections in the early developing right brain… The right brain literally is imprinted by these attachment relationships while it is being created…”  FN2

It’s all subconscious. With “secure attachment,” when a baby cries, the mother “attunes” to it. An “attuned” mother doesn’t say “think” or “ought to.”  She feels a strong, emotional urge to comfort her baby; she subconsciously intuits whether her baby cries because it’s hungry, wet, or tired. “The mother is able to pick up the baby’s communications,” Schore says. “She is not doing this by language, there is no thinking or language before age two.  She is picking up bodily-based nonverbal communications:  facial gestures, auditory tone of voice, and tactile expressions.  The attachment communication is more than between the mother and the infant’s minds; it’s between their bodies…

“She is psychobiologically attuning to the internal rhythms… of the baby’s autonomic nervous system and central system arousal…  It’s an attunement of mind and body. In doing so, she is regulating the baby’s rhythms and allowing the baby to create different emotional states that are associated with these different rhythms. This is not a matching of behavior; it is more of an intuitive matching of the internal rhythms of the baby.

“The baby is expressing these internal rhythms through the emotional communications it is sending back to the mother, in the prosody of the baby’s voice, or in the cry, or in the expression on the baby’s face, or in the gesture.  They are matching each other’s subjective state. Now, when two people match their subjective states, there is a sense of empathy, there is a sense of a bond; a sense that ‘someone’s body is exactly resonating with my body.’  When that occurs there is an amplification of arousal, and this amplification of arousal leads to things like joy states.”

Infants also have no sense of self.  Instead, Schore adds, there’s a “mother-baby continuum” for at least the first six months of life where the “dyad” (mother and child) often don’t know (and don’t care) where one person ends and the other begins.

We begin life as a sea of emotions, and then mom models for us again and again, that she can comfort our wild emotions. Unconsciously we pick up that skill. After we cry and mom comforts us for the millionth time, one day we feel our way to stop crying because we’ve “internalized” mom’s comfort. We subconsciously learn to manage emotions, to both enjoy good emotions, and also–very important–to tolerate and be able to fully feel negative emotions. Without fearing or repressing them.

This is also called “Emotional Object Constancy.”  Mom was an external object, but now we’ve taken her image inside us, so we feel loved and emotionally secure 24×7, even when we’re alone.

Our “self” begins when we first start to “regulate” our own emotions (“affect”) this way. When we realize we can feel our emotions and also modulate them, without screaming for someone else to do it for us? That’s when we first realize that we are not merely part of mom. We’ve got some independent “self.” “Essentially, one’s self-concept is focused around a positive sense of emotionality in the self,” says Schore.

Insecure Attachment and Trauma

Still Face Experiment 2Or not.

Back to how all babies are born with a massive level of emotions. We’re all supposed to receive all that attuning above, then we’re fine.

Or not.

What if we’re an “Or Not” baby?  What if we cry but no one comes?  Or what if someone comes, but they don’t have the neural equipment to attune, or they’re too distressed to attune?  “That baby learns that there is no comfort, that emotions are terrifying, and the world is a scary place,” Dr. Schore says. His colleague Dr. Ed Tronick shows this graphically in the “Still Face Experiment”– click for video.  [FN3]

That baby often does not develop much of a self.  To the extent no one showed it how to manage emotions, the day could not come when it could “regulate like mom.” It can’t regulate, so it can’t individuate.

That is really uncomfortable; it’s what’s behind the feeling that “I have a hole in me.”

All the above leave deep damage, even just passively.

Plus, on top of that: what if we cry, someone comes, and then there’s active aggression; we’re yelled at or physically maltreated?

A whole lot can and does go wrong for a baby. I call that a lot of Adverse Infant Experiences (AIE). “Aaiiee!” Double ouch.

Schore says this is the root of developmental trauma.  “In trauma there is an intense negative state about the sense of self,” he says, with “extremely high states and low states of arousal, an inability to internally regulate their state or to use other people to help them regulate their state and bring them into a sense of comfort.”

With insecure attachment, he says, “there are problems that the caregiver is having emotionally…  There is anxious insecure attachment, where the mother is preoccupied or unpredictable… There is also avoidant insecure attachment, where the mother is mostly cold…

“And there is ‘mind blindness,’ so to speak. There are some mothers who cannot read the tone of the baby… depressive mothers have problems reading facial expressions, especially the facial expressions and gestures of the baby. You see inter-generational transmission of these deficits…”

Schore first showed this scientifically in his three blockbuster books Affect Regulation and the Origin of the Self (1994), Affect Dysregulation and Disorders of the Self, and Affect Regulation and the Repair of the Self.  FN4

“Affect regulation” means we can freely feel our emotions without being emotionally blocked, we can enjoy our emotions–yet also be “on top”of our emotions, so they don’t feel overwhelming, painful or frightening.  If not, we suffer “affect dysregulation ” i.e., some level of painful emotional chaos.

We all know people who either can’t or won’t access their emotions, or others whose emotions go out of control to where they and those around them feel miserable.  Others  swing to both extremes, but never simply enjoy their emotions without freaking out or hurting people.

The good news is: there is repair, as Dr. Schore’s third book lays out in detail. At a support group, Al Anon meeting, therapist’s office, or with friends, repair means we find other humans to do exactly what Schore did for me on the floor of that conference: be present emotionally with another emotionally-attuned human being.

If we can sit for an hour and attune to another human willing to share our emotion state and help us learn to gradually shift and modulate it, we learn to “regulate.”  Brain scans now show that we can literally repair the neural circuits which remained painfully out of tune when we didn’t receive human attunement as kids.

It takes time, perseverance, courage, and real human beings like Allan Schore.  I’ve met them–they’re out there.  Find them.

——————-

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  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

FN2  Schore, Allan N., PhD, “Affect Regulation and Mind- Brain-Body Healing of Trauma,”   National Institute for the Clinical Application of Behavioral Medicine (NICABM), June 15, 2011
Schore, Allan N., “The right brain implicit self lies at the core of psychoanalysis,” Psychoanalytic Dialogues  21:75–100, 2011 www.lifespanlearn.org/documents/2011Handouts/Schore/Schore%20Psych%20Dialogues%2011.pdf
Interview with Allan Schore – ‘the American Bowlby,’  by Roz Carroll, UK ;  The Psychotherapist, Autumn 2001, www.thinkbody.co.uk/papers/interview-with-allan-s.htm

FN3  Dr. Ed Tronick of the U Mass Boston’s Infant-Parent Mental Health Program did his first “Still Face Experiment” work in 1975; his 2007 video  has over 1.3 million hits.  First a mother and child play in a responsive, attuned way, so the baby learns to interact with the world. Then she suddenly stops attuning. Video at: www.youtube.com/watch?v=apzXGEbZht0&feature=youtu.be

FN4  Norton Textbook Series on Interpersonal Neurobiology:
Schore, Allan N., “The Science of the Art of Psychotherapy,” April 2012; 480 pages
Schore, Allan N., “Affect Regulation and the Origin of the Self,” Norton textbook May 2003; first edition 1994; 432 pages

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The Hole in Half of Us

Brousblog1a Perry brains X-secThe Adult Attachment Interview (AAI) study since 1994 shows that  50% of Americans have some degree of failed attachment in childhood.  These are rigorous psychiatric studies of the general public which have nothing to do with “addicts.”  It’s not just about “them.”  [FN1]

It’s about “the hole in me” inside half of us.  Secure attachment is necessary for the neurons in a baby’s brain to develop. “The hole” is caused by any problematic bonding with the mother.  That means “parts of my brain are dark” — the neurons just don’t fire. (Above left: normal 3 year old. Right: major attachment disorder)

No coincidence, 50% of Americans also abuse not only alcohol and drugs (including prescriptions) but also tobacco, food, gambling, internet porn, sex…  Those of us who’d never “use” anything, often become work-aholics.  All these, abused, often cause premature death.

Until we treat the underlying childhood trauma, says Dr. Vincent J. Felitti, nothing will change and people will keep dying early. That’s the point of his 2003 “The Origins of Addiction: Evidence from the Adverse Childhood Experiences (ACE) Study,” published here last week:  click here.  [FN2]

“My point is that there is a Public Health Paradox,” Dr. Felitti wrote in transmitting his article, “wherein some of our most difficult public health problems are actually unconsciously attempted solutions, at the individual patient level, to problems that are unrecognized because they are lost in time and then protected by shame, by secrecy, and by major social taboos against exploring certain realms of human experience…

“Needless to say, vacuous cautionary advice doesn’t do much, coming from people who have no idea what has gone on.  Thus, ‘Obesity is bad for you,’ but it’s sexually protective; ‘Smoking is bad for you,’ but nicotine has been known for almost a century to have potent anti-anxiety, anti-depressant, appetite suppressant, and anger suppressant activity.  Moreover, those occur within 15-20 seconds of inhalation, whereas the risks, which are certainly real, occur in 15-20 years.”

“The current public health approach of repeated cautionary warnings has demonstrated its limitations,” as Dr. Felitti put it in his 2003 piece, “perhaps because the cautions do not respect the individual when they exhort change without understanding.”

Treat ACES  vs Early Death

BrousBlog7a ACE pyramidDr. Felitti is elegant and to the point: unless we treat Adverse Childhood Experiences per se, people will find something, somehow, anyhow, to numb the emotional pain of childhood trauma.  Details on the ACE pyramid. [FN3]

“People with attachment-based developmental trauma can start to feel so threatened that they get into a fight-flight alarm state, and the higher parts of the brain shut down first,” neuroscientist Dr. Bruce Perry, MD told a 2013 UCLA conference.

“First the stress chemicals shut down their cortex (thinking brain).  It’s instinct; they can’t control it.  Now they physically can not think. Ask them to think and you only make them more anxious.

“Next the more primitive emotional brain (limbic brain) goes. They have attachment trauma so people seem threatening; they don’t get reward from emotional or relational interaction. Their own emotions feel like a threat to them.

“Now the only part of the brain left functioning is the most primitive: the brain stem and diencephalon cerebellum (reptilian brain).  Here they can get rewards, but only from sweet/salty/fatty foods, drugs, sex — only the strongest sources of opiates can sooth these lower brain parts.

“They know cognitively it’s wrong to steal from Grandma, they may even love Grandma, but the brain is state-dependent.  At that moment, cognitive thinking or emotional-relational consequences, just can’t relieve their anxiety.  They are in such distress in the lower parts of the brain that they need the food, drugs, etc.  too badly.

“You can get to the point where you can’t even reach the lower part of the brain.  If you’re so ramped up and anxious, the only thing you want is to relieve the distress, and the only thing that can do it is to drink.  Alcohol will reduce anxiety, and make us more vulnerable to other unhealthy forms of reward pleasure.”

The problem is that the emotional pain from ACE is buried inaccessibly deep in our neural structures since our brains first developed, so we don’t even know it’s there.

“If you want a person to use relational reward, or cortical thought -– first the lowest parts of the brain have got to be regulated,” Perry concludes.  “We must regulate people, before we can possibly persuade them with a cognitive argument or compel them with an emotional affect.”

Perry has proven in thousands of clinical trials that the only way to do this is to treat the underlying childhood issues. [FN4]

—————————–
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  George, C., Kaplan, N., Main, Mary, “An Adult Attachment Interview,” Unpublished MS, University of California at Berkeley, 1994;  and Ainsworth, Mary D.S., Blehar, M.C., et al, “Patterns of attachment: A psychological study of the  Strange Situation,” Erlbaum, Hillsdale, NJ, 1978

FN2  Felitti, Vincent J. , MD, “The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study,” English version of the article published in Germany as:
Felitti VJ, “Ursprünge des Suchtverhaltens – Evidenzen aus einer Studie zu belastenden Kindheitserfahrungen,” Praxis der Kinderpsychologie und Kinderpsychiatrie, 2003; 52:547-559.

FN3 ACE Study Pyramid, www.cdc.gov/ace/pyramid.htm; and “Adverse Childhood Experiences by Vince Felitti, MD,” 13 min video, Academy on Violence and Abuse, 2006: www.youtube.com/watch?v=GQwJCWPG478

FN4  Perry, Bruce D., MD, PhD, “Born for Love: The Effects of Empathy on the Developing Brain,” Annual Interpersonal Neurobiology Conference “How People Change,” UCLA, Los Angeles, March 8, 2013 (unpublished).  See also Perry, B.D. and Hambrick, E. (2008) The Neurosequential Model of Therapeutics. Reclaiming Children and Youth, 17 (3) 38-43, at: http://childtrauma.org/nmt-model/references/

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Dr. Vincent Felitti: “The Origins of Addiction”

Felitti ACE DVD 3-min Preview screenshotAfter I heard Russell Brand say that what compels addicts is the “hole in me,” I wrote Feb. 14 that this means:  “parts of my brain are dark.”  And it’s so painful, we just medicate.  Ten % of us use hard drugs and alcohol.  Another 40% abuse tobacco, food, gambling, internet porn, sex, sports and more.

All these, abused, cause premature death.  Huge numbers of us are in pain so bad, we’d rather die than live with it.

In response, Dr. Vincent J. Felitti with great patience sent me his 2003 article, “The Origins of Addiction: Evidence from the Adverse Childhood Experiences (ACE) Study.”  It reported these facts 10+ years ago in hard statistics — and more.

Until we treat the underlying ACE trauma, Dr. Felitti says, nothing will change and a high percent of people will continue to die early.  These abuses create the top ten causes of death in the U.S.

This week I’m writing to send you Dr. Felitti’s article and make it your Friday read.  [ FN1]   Click here for the English pdf.

Methamphetamine 1943 AdDr. Felitti also sent this fascinating photo, a full page ad in a 1943 American medical journal for the successful new antidepressant of that day, Methamphetamine.  “Does it mean anything that in impure form and unknown dose the same chemical is sold as the street drug known as crystal meth?” he wrote.  “Like maybe, ‘My kid is buying antidepressants on the street’ ? ”

If anyone says Dr. Felitti “wants to hand out drugs,” I’d love to see them in libel court.  Nope, his message is short and sweet.

Unless we treat ACE trauma, traumatized people will find something, anything, somehow, to numb the horrific emotional pain of ACE trauma.  They’d rather be dead than live with it un-numbed.  And what they find will kill most of them prematurely.  Period.

“Our findings… imply that the basic causes of addiction lie within us and the way we treat each other, not in drug dealers or dangerous chemicals,” Dr. Felitti states.  “They suggest that billions of dollars have been spent everywhere except where the answer is to be found…

“Because cause and effect usually lie within a family, it is understandably more comforting to demonize a chemical than to look within,” he concludes.

—————————–
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.

——————————
FN1  Felitti, Vincent J. , MD, “The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study,”
English version of the article published in Germany as:
Felitti VJ, “Ursprünge des Suchtverhaltens – Evidenzen aus einer Studie zu belastenden
Kindheitserfahrungen,” Praxis der Kinderpsychologie und Kinderpsychiatrie, 2003; 52:547-559. http://attachmentdisorderhealing.com/resources/key-articles/

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The Hole in Me

Philip Seymour Hoffman“Philip Seymour Hoffman is another victim of extremely stupid drug laws,” writes Russell Brand in The Guardian on Feb. 6 at www.theguardian.com/ commentisfree/2014/feb/06/russell-brand-philip-seymour-hoffman-drug-laws   I posted this Feb. 7 in the comments of his article:

What causes that “pain” which drives us to use?  Russell calls it “the hole in me,”  “the gutter within,”  “the unfulfillable void,” his “private hell.”  What causes “the hole in my soul,” as William Moyers dubs it in “Broken,” in the first place?

It’s all about “the hole in me.”  Hardly anyone speaks of it – but “the hole” is the real problem. Hardly anyone speaks of it because 50% of the population in most OECD countries suffers some degree of it and it scares the heck out of us all.

Russell Brand says 10% have this pain so severely, they use hard drugs and alcohol.  OECD statistics show upwards of 30% of us have it so bad we abuse food and are overweight to obese, which kills too.  I’ve not seen statistics on child abuse, gambling, or  “respectable business folk” like me or my ex husband who are work-aholics or addicted to sports, political power, abusive romance, internet porn, sex, and so on. That’s at least another 10% (if not far higher).

In fact, the Adverse Childhood Experience (ACE) Study of over 17,400 college-educated employed Americans done by top medical doctors shows that over 50% of Americans have some form of childhood trauma and of these, a significant percent suffer from food, alcohol, or other addictions.

Plus, it showed that we die prematurely of both these “hard” and “soft” addictions — the stress eats away our body parts. It shows ACEs are the primary causes in the first place of heart disease, lung disease, diabetes, and the other top ten causes of death in the U.S.

Hole Under My Feet

Loss That Is Forever Maxine HarrisI discovered “the hole in me” by accident. I never heard of it, either, after 50+ years of extensive education. After my divorce in 2008 I just starting saying “I have a hole in my heart” because I literally felt it in my chest.

In 2009 I got Dr. Robin Norwood’s “Women Who Love Too Much” which says that if we simply sit quietly, we can “feel the wind blowing through the empty place where our heart should be.”  I could feel the hole in my chest.  She notes that this is why we never sit quietly (without which cure is impossible). [FN1]

In 2010 I got “Motherless Daughters” by Hope Edelman, case studies of people who were little when their moms died, and a similar book by Dr. Maxine Harris. My Mom died in 2008; why read such books?  It fell into my hands “by accident.” Yet time and again the case study subjects spoke of growing up feeling as though they had a “hole under their feet” or a “hole in the heart.”  [FN2]

I started to bawl as it hit me that I’d felt as if I had a “hole under my feet’ all my conscious life.  I just alternated between denial and praying my parents wouldn’t notice my terror.  My first memory of TV was a documentary about open heart surgery on a “blue baby” with cardiac perforation. As the camera showed a scalpel probing a gap in bloody tissue, the announcer intoned, “Here is the hole in Julie’s heart.”  I could never forget his voice.

Last month, I finally heard a specialist identify “the hole” as that which must be cured or nothing works. It was therapist Dr. Tara Brach in her talk “Reacting Wisely to Desire” (Aug.10, 2011) min 24: www.youtube.com/watch?v=hka8c4OteYA

She quotes William Moyers, an alcoholic activist, speaking at a scientific conference. “I was born with a ‘hole in my soul,’ a pain that came from the reality that I just wasn’t good enough, that I wasn’t deserving enough, that you weren’t paying attention to me, that you didn’t like me,” he said. “For us addicts, recovery is more than a pill or a shot. Recovery is about dealing with that hole in the soul.”

“Drugs and alcohol are not my problem — reality is my problem. Drugs and alcohol are my solution,” as Russell Brand told The Spectator March 9, 2013: www.spectator.co.uk/features/8857821/fixing-a-hole/

Parts of My Brain Are Dark

But what is this “reality” of so many human beings?  What causes the “hole” and “private hell of pain” in the first place?

Brousblog1a Perry brains X-secThe cause of “the hole in my soul” is Attachment Disorder, a mental and physiological condition both, which results from injury to an infant or child’s brain stem while the brain is still developing.

Science has only recently demonstrated that unless kids (and other mammals) are given solid emotional connection and eye contact (“attachment”) from birth by parents or others, infant neurological systems just don’t develop well. The infant brain literally requires programming by an adult’s eyes and facial expressions to begin to program its own neurons, dubbed “Limbic Resonance” and documented in “A General Theory of Love.” [FN3]

When a mother doesn’t respond to her baby this way (she’s being battered, stress at work, is unable to attune to others), the infant’s brain stem reads that as a survival threat.  This floods its bloodstream with fight/flight stress chemicals.  If an adult doesn’t make the baby feel safe, stress chemicals overwhelm its brain and within 45 minutes the baby goes into shock (dissociation). [FN4]

What began as emotional stress ends in physical brain damage. We can now do brain scans showing that whole chunks of neurons in some brain regions don’t fire; I felt this as “parts of my brain are dark.” There is literally a “hole in me.” You can see the dark holes in the brain scans above; the left side is a normal 3-year old, and the right side a 3-year-old with attachment disorder. [FN5] The pain we feel is immense; more in:  http://attachmentdisorderhealing.com/ the-silent-epidemic-of-attachment-disorder/

That’s why an “attachment wound” made when a lover (for example) rejects us sends us running to our drug, as Russell almost did in March (see his Spectator piece). It touches the original wound, an infant or childhood wound buried deep and not accessible to consciousness.

“As a baby’s precarious neurophysiology falls under the steadying spell of his mother… he is modulating his emotions via an external source… an attuned parent can sooth him; he cannot sooth himself,” as “General Theory” reports. “As a consequence of thousands of these interactions, a child learns to self-quiet… The child of emotionally balanced parents will be resilient to life’s minor shocks…

“Those who miss out… find that in adulthood, their emotional footing pitches beneath them like the deck of a boat in rough waters. They are incomparably reactive to the loss of their anchoring attachments — without assistance,they are thrown back on threadbare resources. The end of a relationship is then not mere poignant, but incapacitating.” [FN3 op.cit., p.156-8]

That’s what Russell Brand said drove him off the edge and halfway down the freeway to a Santa Monica crack house just last year — his woman broke the attachment bond (see his March 2013 Guardian piece).

I’ve felt doubled over in just that way by romance so many times. Now I know why and I know what drove my addictions.

Alcoholics Anonymous Works

That’s why the “attachment wound” responds to the compassionate sound of a friend’s voice when Russell calls from LA to London; the pain eases for a day.

Addiction as Attachment Disorder Philip FloresThat’s why the “Anonymous” programs work: we have a wound made when we didn’t get the simple human acceptance and compassion that a child’s very brain needs to grow. When we walk into a room of co-sufferers and we receive that human acceptance, and compassion, it literally fires up some of those dark neurons in our brain, and the pain eases. With regular attendance, this can work for decades.

See “Addiction as an Attachment Disorder” by therapist Philip J. Flores. [FN6] See also numerous related studies in “Does Science Show What 12 Steps Know?,” Aug. 2013: http://news.nationalgeographic.com/news/2013/08/130809-addiction-twelve-steps-alcoholics-anonymous-science-neurotheology-psychotherapy-dopamine/

But why do people like Philip Seymour Hersh or Russell Brand relapse after twenty or thirty years?  Why do I still feel the occasional twinge from my old addictions, after four years clean and nearly 24 x 7 study of all this?  (Hope it’s not my new addiction…)  Blame genes if you like but I don’t buy it.

The “Anonymous” programs are as indispensable as food or water; without their “people support” we can’t even make a start. Yet they can’t possibly provide enough support or go deep enough to heal the original wound.

When will we see that “so many broken people” must be caused by society’s ignorance, and not by the individual user’s screw-up?  Why is the true cause of all this pain never addressed?   Society is militantly oblivious and illiterate about it.  And why?

Some 50% of the population in most OECD countries suffers some degree of the childhood emotional pain of Attachment Disorder. There’s an Adult Attachment Interview which has been used by psychologists in enough studies to prove it since 1994. [FN7]  The ACE Study backs this up with 17,400+ hard medical exam statistics.

The number is so high that the very existence of Attachment Disorder and of its symptoms are literally incomprehensible to most who suffer from it.  Sufferers include large percentages of “high achievers” in business and government.  Denial is rampant to the point of arrogance.

Our entire society is virtually structured for, and dedicated to, the precise purpose of providing these distractions from the “hole within.”  Such distractions give us temporary bursts of endorphins to ease the pain.  But since they can’t heal the real pain, we require more and more of our addictions until the stress kills us.

Fact is, 50% of us have some degree of “hole within,” and 40% are in denial.  The other 50% are uneducated.

Until the “hole in the brain” from Adult Attachment Disorder, and the causes of Adult Attachment Disorder are addressed, the 40% who don’t use hard-core drugs or booze, will go on wagging their fingers at the 10% who do use – blaming the wounded for the wound.  These superior folks have the same wound killing them, only more slowly.

We need mass education to publicize the cause of the “hole in the soul” so that people know not to walk around all their lives thinking they are the only one on earth who feels it.  We need publicity to wake up the many who don’t feel the hole because their hyperactivity and addictions numb them – especially those in high places.

Congressmen check their cholesterol, but Adverse Childhood Experiences are the real cause of heart disease as the ACE Study shows.  If they knew the truth, wouldn’t they get an ACE score and an Adult Attachment Interview (AAI) check-up?

People need to know to go for help – and to know that if they go for help, they won’t be stigmatized, as they are today, but supported. We need more publicly-supported programs modeled on the Anonymous groups for healing hearts and minds.  We need those groups in every flavor, for every addiction, in every city and town. We need them to be publicly supported so that large numbers of people know that it’s ok to go for help.

We need a referral system so that people in enough pain after doing all – like Russell and me – get referred to therapy.  We need a real mental health system in which therapy has insurance which makes it feasible, not a pipe dream as it is today for 99.99% of Americans.

“General Theory of Love” also demonstrates in depth that a huge percent of therapists haven’t healed their own “hole inside me” and so are tone deaf and clueless about how to heal.  We need a serious overhaul of our therapy training programs and remedial re-education programs for therapists now in practice.

Why the big deal? Huge numbers of our population are in pain so bad they’d rather die than live with it.

——————-
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  Norwood, Robin, PhD, “Women Who Love Too Much,” Pocket Books, New York, 1985

FN2  Edelman, Hope, “Motherless Daughters: The Legacy of Loss,” Da Capo Press, 2006.  See also: Harris, Maxine, PhD, “The Loss That Is Forever: The Lifelong Impact of the Early Death of a Mother or Father,” Penguin Books, New York, 1996

FN3 Lewis, Thomas, MD; Amini, Fari, MD; Lannon, Richard, MD; “A General Theory of Love”, Random House, New York, 2000. Dr. Lannon interviews at: www.paulagordon.com/shows/lannon/

FN4  Herman, Judith, PhD, “Trauma and Recovery,” Basic Books, New York, 1992

FN5  Perry, Bruce, MD, “Overview of Neuro-sequential Model of Therapeutics (NMT),” www.childtrauma.org, 2010

FN6  Flores, Philip J., PhD, “Addiction as an Attachment Disorder,” Jason Aronson, Inc., 2004:  “Addiction is a disorder in self-regulation. Individuals who become dependent on addictive substances cannot regulate their emotions, self-care, self-esteem, and relationships.”

FN7  Ainsworth, Mary D.S., Blehar, M.C., et al, “Patterns of attachment: A psychological study of the Strange Situation,” Erlbaum, Hillsdale, NJ, 1978.  See also: George, C., Kaplan, N., Main, Mary, “An Adult Attachment Interview,” Unpublished MS, University of California at Berkeley, 1994

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