Tag Archives: Rhythmic Regulation

Music Therapy and Child Trauma

Vienna Boys ChoirWant to heal developmental trauma in kids?  Create children’s choirs, I wrote last week.   Dr. Bruce Perry says “patterned, repetitive, rhythmic regulation” is what regulates the brain stem, and when it’s not regulated, we can’t truly reach the rest of a child’s brain.

The brain science studies have been done on yoga, meditation, EMDR and so on — not on Bach.  But is that only because those scientists were never given the chance to sing Bach?  Chalk it up to the decline of education.  What if Bessel van der Kolk had sung in the Vienna Boys’ Choir?  (Ok, so he’s from Holland…)  Or haven’t I seen the brain science studies on choirs?  Please leave me a comment!

Plus: there’s a lot of science that shows music helps shape babies in the womb — and keeps them alive when they need it.  Science shows this “medical music therapy” helps people of all ages.  Put this with the fact that children’s choirs have been a keystone of civilization since at least 700BC  [FNO] and we start to see a pattern.

The Music in Your Cells

What we do know is that everybody loves music because every body loves music.  Music is literally built into the human cells, especially brain cells from the hour of conception.  Our bodies physically need it. Infants and children know that instinctively.  “The first music encoded deep within your memory are the earliest vibrations that made you – the rhythms and tempos of your first cells,” writes Galina Mindlin, MD, Columbia University Professor of Psychiatry. [FN1]

“As your cells began to develop with the comforting rhythms of your mother’s heartbeat and the whooshing low frequency sounds vibrating through her placenta and your umbilical cord, these first musical scores began entrainment (two or more rhythms synchronizing into one) in your brain and orchestrating the essence of music for your entire being.  So from your first spark of life, your brain was already establishing the relationship for how music affects you today…

“Newborns can almost immediately show some memory of sounds they encountered in the womb… Before any of us is capable of speaking words, we can recognize changes in notes and rhythmic patterns… Throughout all this development, lyrical and comforting ‘motherese,’ the singsong way in which parents speak to their children, plays a significant role in instilling feelings of calm, safety, and love…

“By only their 14th week, children can distinguish their mother’s footsteps from anyone else’s, and discriminate between their mother’s voice and a stranger’s… At the beach on any given day, we can see a man or woman lying in the sand… listening to the whoosh of waves and the easy hush of wind, smiling like a baby…”

“Music in its most primodial form links our brain to vibrations we experienced as babies that have both long- and short-term effect on our brains’ circuitry.  The core characteristics of music – rhythm, harmony, synchrony, resonance, and dissonance – can affect frequencies in our brain and extend their influence on our hormones, neurotransmitters, and essential enzymes, and can ultimately affect our focus, feelings, moods, motivation” and more. [FN2]

Music Therapy Saves Preemies

Joanne Loewy Sings to BabyDr. Joanne Loewy, Director of the Louis Armstrong Center for Music and Medicine at New York’s Beth Israel Hospital, saves lives of premature babies (and other patients) using music to replicate the auditory environment in the womb. I haven’t asked Dr. Loewy about choirs, but to me this work says worlds about what singing can do to regulate the physiology and thus the brains of kids.   Dr. Loewy sings to a newborn, above. [FN 3]

I first met Dr. Loewy by email shortly after the Beth Israel team she heads published a major study on medical music therapy for preemies  on  April 15, 2013.  First off, I was blown away to learn there exists a Louis Armstrong Center for Music and Medicine  at the top hospital in New York City.  It’s official: music is essential to humans!  [FN4]

I was also delighted when she invited me to see her for music therapy to heal my pre-concious anxieties from being an unwanted pregnancy.  Gosh, she trains music therapists worldwide and teaches  at the Albert Einstein College of Medicine. It was too long a commute from California.  But I started music therapy anyway and it sure works for me.

“By re-creating a womb-like environment through sound and music, music therapy has been shown to deepen infant sleep-state, support infant self-regulation, assist in the stabilization of breathing and heart rates, enhance parent/infant bonding, sooth irritability, re-enforce feeding/sucking rhythms and weight gain, and promote a sense of safety during painful procedures” faced by many preemies,” she wrote.

“Historically, we thought premature infants were best left alone in a quiet, closed incubator with no stimulation,” she told the press when the study came out. “But more recently, we’re seeing that the right kind of stimulation — particularly live, interactive music — can enhance babies’ neurological function and increase their quiet-alert state. . . . the more we can regulate the sound environment, the better they’re going to fare.”  [FN 5]

Dr. Loewy’s team studied  272 infants in 11 hospital neonatal intensive care units (NICUs). They found that live music matched to babies’ breathing and heart rates enhanced feeding and sleeping patterns. Parent-selected lullabies also seemed to promote bonding between parents and babies, easing the stress of the chaotic NICU environment.

The music also lowered parental stress, the study found — which is key, because anxious, fearful, clueless parents produce developmental trauma in their kids.  Parent-preferred melodies and entrained live rhythm and breath sounds enhanced quiet alert and sleep states, suck response, and oxygen saturation in premature infants and also  significantly reduce fear and anxiety perception in parents, they found.

Over two weeks, the 272 premature babies underwent several sessions of two instruments, singing and no music at all.  The instruments and lullaby singing style were intended to approximate womb sounds, said Dr. Loewy.  Two-tone heartbeat rhythms were played on a “gato box,” a rectangular wooden drum.  [Bruce Perry and Bessel van der Kolk speak  extensively on the primacy of the mother’s heart rate in determining fetal brain development. Dr. van der Kolk strongly recommends heart-rate variability regulating therapies for trauma. -kb]

Whooshing sounds [like those in the womb referenced by Dr. Mindlin and I suspect by numerous researchers] were produced by an “ocean disc,” a cylinder containing shifting metal beads.

For melody, parents were asked for a favorite song.  If it wasn’t a lullaby (one chose “I Heard It Through the Grapevine”; another, “Pick Up the Pieces”), therapists slowed it, changed meters to lullaby-like waltzes and adjusted lyrics.

“Lots of times you see parents bopping the baby up and down on their lap, and there’s no purpose to it,” Dr. Loewy said. “You don’t feel the music intention as much as if you have a song that a parent has chosen.”  If parents did not specify, researchers used “Twinkle, Twinkle, Little Star.”  Tempos were coordinated with babies’ vital signs, indicated not only by monitors but also by baby  eye movements and its chest’s rise and fall.

Researchers found that the heart beat gato box, the whooshing ocean disc and the  singing, all slowed a baby’s heart rate, though singing seemed most effective.  Singing also increased the time babies stayed quietly alert.  Sucking behavior improved most with the gato box. Breathing rate slowed most and sleeping was best with the ocean disc. Babies hearing songs their parents chose had better feeding behavior and gained more calories than those who heard “Twinkle, Twinkle, Little Star.” But the “Twinkle” babies had slightly more oxygen saturation in their blood.

“Many NICUs are noisy, or people put on random lullabies that are recorded,” Loewy said. “But it’s not just any recorded lullaby, it’s the power of the parent’s voice synchronized therapeutically . . . and the other two sounds can have a therapeutic benefit.”

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

Footnotes

FNO  Chorus members in Greek theater were trained in childhood from around 700 BC.  Greek theater always included a chorus, whose members also danced and spoke, but also sang: http://en.wikipedia.org/wiki/Greek_chorus   Both boys and girls were trained to sing: http://www.amazon.com/Choruses-Young-Women-Ancient-Greece/dp/0742515249
Greece and Rome founded many children’s singing schools: http://www.boychoirs.org/library/history/hist014.html
The Schola Cantorum in Rome was formed in the seventh century to train boys in reading and singing.

FN1  Galina Mindlin, M.D., Ph.D is Assistant Clinical Professor of Psychiatry at Columbia University College of Physicians and Surgeons, and Supervising Attending Physician at the Department of Psychiatry in St. Luke’s Roosevelt Hospital Center.  She is Board Certified in psychiatry and neurology.  See also: www.nicabm.com/nicabmblog/what-healthy-brains-sound-like-how-brain-music-therapy-is-helping-first-responders/

FN2  Mindlin, Galina MD, PhD, “Your Playlist Can Change Your Life: 10 Proven Ways Your Favorite Music Can Revolutionize Your Health, Memory, Organization, Alertness,”  Sourcebooks, Inc., Naperville, IL, 2012

FN3  Joanne V. Loewy, DA, LCAT, MT-BC,  is Director,
Louis Armstrong Center for Music & Medicine,
Beth Israel Medical Center, New York, NY  Websites:
http://www.musicandmedicine.org/ and http://www.facebook.com/ArmstrongMusicandMedicine
She is also Co-Editor-in-Chief, “Music and Medicine” www.sagepub.com/journals/Journal201929

FN4  “The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants,” Joanne Loewy,  Kristen Stewart, Ann-Marie Dassler,  Aimee Telsey,  Peter Homel
Online April 15, 2013; hard copy in May 2013 Pediatrics.
Abstract: http://pediatrics.aappublications.org/content/early/2013/04/10/peds.2012-1367.abstract
Full Text in PDF: http://pediatrics.aappublications.org/content/131/5/902.full.pdf+html
SUMMARY:
What’s Known on This Subject:
Recorded music, parent voices, and sung lullabies have been shown to increase oxygen saturation, nonnutritive sucking, and weight gain in premature infants.
What This Study Adds:
Parent-preferred melodies and entrained live rhythm and breath sounds can enhance quiet alert and sleep states, suck response, and oxygen saturation in premature infants and significantly reduce fear and anxiety perception in parents.

FN5  Pam Belluck, “Live Music’s Charms, Soothing Premature Hearts – Preemies and Sound,” New York Times, April 15, 2013, www.nytimes.com/2013/04/15/health/live-music-soothes-premature-babies-a-new-study-finds.html?_r=0
Maureen Salamon,  “Lullabies Soothe Preemies, Parents Alike,” Philadelphia Inquirer, April 15, 2013 [webpage removed]

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Bruce Perry and Children’s Choirs

Cantoria1 Youths larger della_robbia_02I’ve reported Dr. Bruce Perry’s in Washington May 4 to talk on healing trauma at the National Council.

What’s that got to do with this sculpture of children singing in the Cathedral of Florence in 1436 to kick off the Renaissance?  Everything!

Dr. Perry says it’s brain science to regulate the brain stem with “patterned, repetitive, rhythmic regulation,” featuring yoga, meditation, deep breathing, and singing, principles so fundamental they go back to the dawn of man. [FN1]

Who can imagine life without singing?  In every culture, long before writing, the only way to pass down an idea was to sing it. Aryans have sung Vedas since 5,000 BC or before. Hebrews sang Psalms as far back as 2,500 BC, long before they were written down ca. 1400 BC. [FN2  ]

Want to regulate kids? Teach them to sing! Gathering children to sing in choirs was the core of the Greek educational system since at least 700 BC, and there were choir schools for kids in Europe at least since the 900s AD. [FN3]  Singing in choirs brings kids into organized personal connection with other living, regularly-breathing human beings.  Being connected and in harmony with other humans is what best regulates human beings – today brain scientists call it “limbic resonance.” [FN4]

Amira Willighagen 1Singing gives kids a voice!  Children have been known to sing gloriously even today. Watch 9-year old Amira Willighagen sing in Amsterdam last year.

She did it without any training.  Amira just went on the internet looking for songs, found this Italian aria, and learned it by imitating.  Clearly she found a terrific adult soprano – we can hear the inflections of a highly-experienced adult in Amira’s voice. [FN5]

St Thomas Choir1AOr take the St. Thomas Boys Choir of Leipzig. When J.S. Bach became music director in 1723, the choir school was already 511 years old. Click here for the boys singing a Bach “Gloria.”    [FN6]


Born to Sing

Cantoria2 Boys10-12 & Teens della_robbia22If a child can speak, he can sing; most kids can sing before they can speak. Training children to sing as young as possible is a principle of civilization. Electronic culture has forgotten it to our peril as our kids whack out on machine-made noise. We need a revolutionary approach as old as the hills.  We need children’s choirs on a mass scale.

These children singing on the “Cantoria” by Lucca della Robbia, sculpted 1431-36, were placed in the Cathedral as public ads, to urge parents to bring in their kids for training. This is the level of culture and education which later produced Bach, Haydn, Schubert and Beethoven. Was their genius just magic?  Why don’t we have composers today, who produce music on such a scale (and they did it all without electronic equipment) ?

Answer: Bach & co. were trained as children to sing harmonic, complex polyphony (4-6 different musical lines at once).  So complex, harmonic music was what they heard in their heads as little kids. They were bilingual; music was their second mother tongue.  To them, it was simple: as soon as they could hold a pen, they would just start to write down their musical ideas. That tradition continued in Europe until the end of the 19th Century.

And there’s another reason everybody loves music: it’s because every body loves music. Music is literally built into kids’ bodies from the hour of conception.  Our bodies physically need it. And kids know that instinctively, from infancy.

“The first music encoded deep within your memory are the earliest vibrations that made you – the rhythms and tempos of your first cells,” writes Galina Mindlin, MD and music therapist.

“As your cells began to develop with the rhythms of your mother’s heartbeat and the whooshing sounds vibrating through her placenta and your umbilical cord, these first musical scores began entraining (two or more rhythms synchronizing into one) in your brain… your brain was already establishing the relationship for how music affects you today…   Newborns can almost immediately show some memory of sounds they encountered in the womb… Before any of us is capable of speaking words, we can recognize changes in notes and rhythmic patterns…” [FN7]

The Mother of All  Trauma

Cantoria3 Boys 10-11 playing stringsWhat about trauma healing?  Consider this: from 1348-1350, the Black Death, the mother of all trauma, killed half the population of Asia and Europe. In Italy, Florence’s population was reduced from 120,000 in 1338 to 50,000 in 1351. Many thought civilization was finished. [FN8]

Then a handful of intellectuals devised the idea of a re-birth or “Renaissance,” a project to unite a new economics to feed the population, with the science, philosophy, and arts to uplift them.  Florence had a famous problem whose solution could inspire people with hope. At the city’s center lay the massive Cathedral of Florence, begun 1296 — but no one had any idea how a dome could be built large enough to cover such a space without collapsing. Work was also delayed by waves of plague for decades. The roof lay open for over a century as people prayed in the rain.

During 1402–1404, Filippo Brunelleschi and his friend Donatello visited Rome to study the ancient ruins and the Pantheon on which the Cathedral was modeled. They returned to build the first “classical” buildings in Florence. In 1420, Florentine banker Cosimo de’ Medici (1389-1464) bankrolled Brunelleschi to work  16 years to complete the first octagonal dome in history to be built without a wooden supporting frame. [FN9]

What did they do in that Cathedral? They brought in the children of the city and taught them to sing, to show there was hope for the future, that  the children could be saved from the jaws of death. These sculptures just above show that by the age of 9-11, kids were singing (and playing) complex four and six part polyphony.

Note the rounded mouths in all the sculptures (and in the St. Thomas boys). Vocal scholars can tell you what note they’re singing by how large of an egg-shaped mouth they’re making.

The dome was ready in time for the Council of Florence which opened in the Cathedral on March 25, 1436, the date often cited as the start of the Renaissance. Inside were featured these sculptures of children singing in the choir loft by Lucca della Robbia.  Flemish composer Guillaume Dufay and many of his colleagues were brought to Italy to teach advanced musical composition.  Dufay’s advanced motet Nuper rosarum flores was composed for the 1436 opening and sung from della Robbia’s choir loft by kids like these in the sculptures.

Cosimo de’ Medici and his grandson Lorenzo de’ Medici (1449-1492) also backed philosophers Marsilio Ficino and Pico della Mirandola. Pico’s 1486 “Oration on the Dignity of Man” stated the Renaissance Idea: each individual human soul is a divine spark of God, not a beast of burden as under feudalism.

Cantoria4 Boys 5-10 Sing-Dance1A webThese sculptures show that in Florence, the Dignity of Man began with the dignity of the children.  These kids have been taught to sing even younger, at 5 to 8 years.  Della Robbia did several sculptures of toddlers singing as well (more than I have space to show!).

Cantoria5 Infant singingEven infants sang, singing with their families perhaps while they learned to speak.This child is not much older than 2.  Kids who started this early acquired the experience it took to produce genius in many fields.

San Diego Trauma-Informed Renaissance?

I’ve seen this kind of singing of fine music in choirs make traumatized children happy.  Musicians who run children’s choirs will tell you that.

San Diego Childrens Choir1 earlyyears_collageThe San Diego Children’s Choir (right), founded 1990, now has 5 branches with  over 250 participants. It also has a neighborhood outreach program that spans many low-income areas full of traumatized children including City Heights and other areas.

City Heights is also where Principal Godwin Higa has been turning Cherokee Point Elementary into an advanced trauma-infomed school since 2008. Three professors at San Diego State and community organizers Dana Brown and Dorothy Zirkle worked with the City Heights community to develop a two-year $684,094 pilot project at Cherokee Point, the Wellness and Restorative Practice Partnership (WRPP), funded by the California Endowment.

I can’t be with Bruce Perry in Washington May 4, but I will be in San Diego May 2, talking to  my friend Dana Brown and other members of the San Diego Trauma-Informed Guide Team (SD-TIGT) about Bruce Perry, Bessel van der Kolk, and the brain science of trauma.  SD-TIGT is leading the way among county health and welfare institutions to implement trauma-prevention and trauma-healing practices in schools, medical, and social facilities.

If Principal Higa and Dana haven’t met the folks at the San Diego Children’s Choir yet, maybe I’ll be able to provoke something.  Even if they’ve met, maybe we can expand their forces. As a result of the economic crisis, San Diego just lost its opera company, the San Diego Opera.  The city must be full of struggling singers, school music teachers and private voice teachers who would jump at the chance to teach every child at Cherokee El to sing Bach.

Next step: find our Cosimo de’ Medici to pay these already financially-pressed musicians and educators, so they can put in the hours necessary every week at Cherokee El. Then stand back.

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

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Footnotes

FN1  Lucca della Robbia, Cantoria (Choir Loft), shows children singing, dancing,and  making music to “praise the Lord” in the words of Psalm 150. Photos  at http://commons.wikimedia.org/wiki/File:Cantoria_di_luca_della_robbia_11.jpg

FN2  http://en.wikipedia.org/wiki/The_Arctic_Home_in_the_Vedas

FN3  Chorus members in Greek theater were trained in childhood from around 700 BC.  Greek theater always included a chorus, whose members also danced and spoke, but also sang. [http://en.wikipedia.org/wiki/Greek_chorus ]  Both boys and girls were trained to sing.  [http://www.amazon.com/Choruses-Young-Women-Ancient-Greece/dp/0742515249 ]  Greece and Rome founded many children’s singing schools [ http://www.boychoirs.org/library/history/hist014.html ] The Schola Cantorum in Rome was formed in the seventh century to train boys in reading and singing.
The Vienna Boys Choir, formalized in a 1498 letter by Maximilian I Habsburg, goes back to the year 957 when Bishop Wolfgang of Regensburg created his cathedral choir [ http://www.boychoirs.org/library/history/hist014.html  and http://en.wikipedia.org/wiki/Vienna_Boys%27_Choir ] The first choir school was founded at  St. Paul’s Cathedral, London in 1127, the second at St. Thomas’ Church, Leipzig in 1212. A boarding school for choristers at the Kreuzkirche in Dresden is mentioned in 1300, a choir known now as the Dresdner Kreuzchor. The Vienna Boys Choir received a solid musical education, many went on to become professional musicians such as Franz Schubert.
[ http://en.wikipedia.org/wiki/Choir ].

FN4  Lewis, Thomas, MD; Amini, Fari, MD; Lannon, Richard, MD; “A General Theory of Love”, Random House, New York, 2000.  Lannon interviews : www.paulagordon.com/shows/lannon/

FN5  Amira Willighagen video: http://news.distractify.com/default-category/a-shy-9-year-old-girl-takes-the-stage-these-people-will-never-forget-what-follows/

FN6  St.Thomas Choir video:  https://www.youtube.com/watch?v=A-apSehviiQ&list=PL517BEEF15EA64268

FN7  Mindlin, Galina, MD, PhD, “Your Playlist Can Change Your Life,” Sourcebooks, Inc., Naperville, IL, 2012  More here:
www.nicabm.com/nicabmblog/what-healthy-brains-sound-like-how-brain-music-therapy-is-helping-first-responders/

FN8  The Black Death was one of the most devastating pandemics in human history, peaking in Europe between 1348 and 1350 with 30–60 percent of Europe’s population killed. It reduced world population from an estimated 450 million to between 350 and 375 million in the 14th century. http://en.wikipedia.org/wiki/Consequences_of_the_Black_Death

FN9  Walker, Paul Robert, “The Feud That Sparked the Renaissance: How Brunelleschi and Ghiberti Changed the Art World,” Harper Collins, 2003

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Perry: Rhythm Regulates the Brain

Perry another headshotDr. Bruce Perry, MD is taking his healing for trauma to Washington in a May 4 program for the National Council for Behavioral Health.

And the doc’s got rhythm.  In fact, he and other trauma experts are reporting revolutionary success with treatments using yoga, meditation, deep breathing, singing, dancing, drumming and more.

These principles are so fundamental to our brains they go back to the dawn of man; the Vedas were sung before 5,000 BC (likely with yoga and meditation.)  My book describes how yogic chant and meditation saved my life in 2010, before I ever read a word about brain science.

One California county is trying to cancel such programs, insisting on Cognitive Behavioral Therapy (CBT) which relies on the thinking brain.  But Perry and many experts say talk therapy alone can re-traumatize trauma survivors.

Perry says we need “patterned, repetitive, rhythmic somatosensory activity,” literally,  bodily sensing exercises. Developmental trauma happens in the body, where pre-conscious “implicit memory” was laid down in the primitive brain stem (survival brain) and viscera. Long before we had a thinking frontal cortex or “explicit memory” function. [FN1]

The list of repetitive, rhythmic regulations used for trauma by Dr. Perry, Dr. Bessel van der Kolk, Dr. Pat Ogden and others is remarkable. It includes singing, dancing, drumming, and most musical activities.  It also relies on meditation, yoga, Tai Chi, and Qi Gong, along with theater groups, walking, running, swinging, trampoline work, massage, equine grooming and other animal-assisted therapy…. even skateboarding. Click here for Perry’s web page on interventions.

“I am asked how hip hop and skateboarding can help a child with depression or ADHD,” reports Dr. Sarah MacArthur of the San Diego Center for Children. “Yet 70% of the children showed improvement in symptoms of depression, anxiety, and PTSD.” [FN2]

The Brain Stem Rules

Perry simpler 4 brain from web“The brain organizes from bottom to top, with the lower parts of the brain (brain stem/diencephalon aka “survival brain”) developing earliest, the cortical areas (thinking brain) much later,” Perry says. “The majority of brain organization takes place in the first four years.

“Because this is the time when the brain makes the majority of its “primary” associations… early developmental trauma and neglect have disproportionate influence on brain organization and later brain functioning… When a child has experienced chronic threats, the brain exists in a persisting state of fear… and the lower parts of the brain house maladaptive, influential, and terrifying pre-conscious memories… ”  [FN3]

“People with 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,” says Perry. “First the stress chemicals shut down their frontal cortex (thinking brain).  Now they physically can not think. Ask them to think and you only make them more anxious.

“Next the emotional brain (limbic brain) shuts down. They have attachment trauma, so people per se seem threatening; they don’t get reward from emotional or relational interaction.

“The only part of the brain left functioning is the most primitive: the brain stem and diencephalon cerebellum. If you want a person to use relational reward, or cortical thought – first those 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.

“The only way to move from these super-high anxiety states, to calmer more cognitive states, is rhythm,” he says. “Patterned, repetitive rhythmic activity: walking, running, dancing, singing, repetitive meditative breathing – you use brain stem-related somatosensory networks which make your brain accessible to relational (limbic brain) reward and cortical thinking.

“Cognitive behavioral therapy (CBT) is great if you have a developed frontal cortex – but we’re talking about a five year old kid who’s so scared to death most of the time that it’s shut down his frontal cortex ’cause he just saw his mother get shot,” Perry told an audience of therapists. “You’re going to do 20 sessions of CBT and expect change? That’s a fantasy.”  [FN4]

6 R’s for Healing Trauma

Perry NMT Bar Chart from webDr. Perry does separate developmental “maps” of each person (left) using his “Neurosequential Model of Therapeutics” (NMT). Each individual is so unique that using NMT needs training;  this blog is meant only to point you toward it. For an overview of NMT, click here for Perry, B.D. and Hambrick, E. (2008), “Neurosequential Model of Therapeutics.  Click here for training in NMT and Somatosensory Regulation.

Trauma healing, says Perry, requires 6 R’s; it must be:
Relational (safe)
Relevant (developmentally-matched to the individual)
Repetitive (patterned)
Rewarding (pleasurable)
Rhythmic (resonant with neural patterns)
Respectful (of the child, family, and culture)

“To change any neural network in the brain, we need to provide patterned, repetitive input to reach poorly organized neural networks involved in the stress response. Any neural network that is activated in a repetitive way will change,” Perry explains.

“The rhythm of these experiences matter. The brain stem and diencephalon contain powerful associations to rhythmic somatosensory activity created in utero and reinforced in early in life. The brain makes associations between patterns of neural activity that co-occur.

“One of the most powerful sets of associations created in utero is the association between patterned repetitive rhythmic activity from maternal heart rate, and all the neural patterns of activity associated with not being hungry, not been thirsty, and feeling ‘safe’ (in the womb).

“Patterned, repetitive, rhythmic somatosensory activity… elicits a sensation of safety.  Rhythm is regulating.  All cultures have some form of patterned, repetitive rhythmic activity as part of their healing and mourning rituals — dancing, drumming, and swaying.

“EMDR and bilateral tapping are variations of this patterned, repetitive rhythmic, somatosensory activity… We believe that they are regulating in part because they are tapping into the deeply ingrained, powerful permeating associations created in utero.”  [FN5]

For each child, the NMT develops a unique, personalized “map” (see above) of what the specific neurological damage has been, how far development has come (or not), and where the child needs to go. Next it creates “a unique sequence of developmentally-appropriate interventions,” says Perry. “While many deficits may be present, the sequence in which these are addressed is important. The more the therapeutic process can replicate the normal sequential process of development, the more effective…

“The first step in therapeutic success is brain stem regulation… Start with the lowest undeveloped/ abnormally functioning set of problems and move sequentially up the brain as improvements are seen…

“An example of a repetitive intervention is positive, nurturing interactions with trustworthy peers, teachers, and caregiver… using patterned, repetitive somatosensory activities such as dance, music, movement, yoga,  drumming or therapeutic massage…  This is true especially for children whose persisting fear state is so overwhelming that they cannot improve via increased positive relationships, or even therapeutic relationships, until their brain stem is regulated by safe, predictable, repetitive sensory input.” [FN6]

Sound like your family doctor saying “Go calm down in the gym” ?  I thought so – until I tried it.  It works, big time.  My story is here: “Dr. Perry: Music Makes Your Case.”

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

Footnotes

FN1  Perry, Bruce D., MD,  “Born for Love: The Effects of Empathy on the Developing Brain,” Annual Interpersonal Neurobiology Conference “How People Change: Relationship & Neuroplasticity in Psychotherapy,” UCLA, Los Angeles, March 8, 2013 (unpublished).
Library of articles on interventions, trauma, brain development: https://childtrauma.org/cta-library/
Training in NMT Method and Somatosensory Regulation, Power of Rhythm — Individual and Site Training Certification Programs, DVD/streaming training, and online training: http://www.ctaproducts.org
Dr. Perry’s latest research and key slides: “Helping Children Recover from Trauma,” National Council LIVE, National Council on Behavioral Health, Sept. 5, 2013 at www.thenationalcouncil.org/events-and-training/webinars/webinar-archive/  (scroll down to Sept. 2013.)
Dr. Perry’s YouTube channel with educational videos in depth: https://www.youtube.com/channel/UCf4ZUgIXyxRcUNLuhimA5mA?feature=watch

FN2  MacArthur, Sarah,PhD., “Wellness Innovations Transform Children,” San Diego Center for Children, June 2013, http://www.centerforchildren.org/live-blog/87-wellness-innovations-transform-children/

FN3  Perry, B.D. and Hambrick, E. (2008), “The Neurosequential Model of Therapeutics (NMT),” Reclaiming Children and Youth, 17 (3) 38-43;  and
Dobson, C. & Perry, B.D. (2010), “The role of healthy relational interactions in buffering the impact of childhood trauma in “Working with Children to Heal Interpersonal Trauma: The Power of Play,” (E. Gil, Ed.), The Guilford Press, New York, pp. 26-43
Both at: http://childtrauma.org/nmt-model/references/

FN4  Perry, Bruce D., “Born for Love,” op. cit. FN1

FN5  MacKinnon, L. (2012), “Neurosequential Model of Therapeutics: Interview with Bruce Perry,” The Australian & New Zealand Journal of Family Therapy, 33:3 pp 210-218, http://childtrauma.org/cta-library/interventions/

FN6  Perry & Hambrick, op. cit. FN3

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Dr. Perry: Music Makes Your Case

BrousBlog9a Perry head shotIn last week’s blog, I was surprised by sudden overwhelming feelings of being loved which could only be described as physical.  I’ve had these odd explosive physical experiences before.  I had one with music so striking at the end of last year, that I wrote to brain scientist Dr. Bruce Perry (left) about it.  Why?  He’s got rhythm!

My blog on Perry last Sept. 13 “How Your Brain Works 101” notes the three broad areas of the brain: the brain stem aka reptilian survival brain, a knob atop the spinal cord that reptiles have too, which regulates raw survival functions;  the limbic brain, first developed in mammals, which wraps around the brain stem and regulates emotions; and the cortex or thinking brain, which wraps around all the rest.

Next I quoted  Perry on how the apparently primitive brain stem is the key to the whole shebang:

“Because the brain is organized in a hierarchical fashion, with symptoms of fear first arising in the brain stem and then moving all the way to the cortex, the first step is brain stem regulation,” Perry said.  This, he revealed, requires “patterned, repetitive rhythmic activity.”  Examples are “dance, music, or massage, especially for children whose persisting fear state is so overwhelming that they cannot improve via increased positive relationships, or even therapeutic relationships, until their brain stem is regulated by safe, predictable, repetitive sensory input…

“The only way you can move from these super-high anxiety states, to calmer more cognitive states,” Perry said, “is rhythmic regulation: Patterned, repetitive rhythmic activity: walking, running, dancing, singing, repetitive meditative breathing – you use brain stem-related somato-sensory networks which make your brain accessible to relational [limbic] reward and cortical thinking. If you want a person to use relational reward, or cortical thought – they’ve got to be emotionally regulated first!”

Two months after that  Sept. 13, 2013 blog, I had a musical experience so intense that I wrote this letter :

Dear Dr. Perry,

I just had an explosive physiological experience which demonstrates your thesis that “We must regulate people with patterned, repetitive, rhythmical activity, before we can persuade them with a cognitive argument, or compel them with an emotional affect.”

Pink & Nate Ruess1 Just give me a reasonIt involved the attached song.  Ever consider using music in your presentations? One audio example can pack quite an emotional punch to get audiences to see how deep your ideas actually are.   [I sent the audio MP3 but here’s the whole video: www.youtube.com/watch?v=p_sDwUFQkt4]   And the healing has to go ‘way far deep to tune up some of us who have seriously jangled cells.

I’ve sung and conducted operatic music for 25 years; Mozart, Bach, Beethoven.  Not your average rocker.   So this  train of events is pretty unusual, which also kinda proves your case. Here’s what happened:

Today I was feeling some fear and anger triggered by a friend who occasionally flips out and disconnects emotionally when the holidays approach (a rough emotional time for us all).  I began to dissociate a bit from the disconnect, and boy do I hate that frozen feeling; the pain is terrible.

Suddenly the attached recording by P!nk popped up on my MP3 player earphones while I was doing a chore.

Within five seconds I had pretty much involuntarily dropped everything and found myself dancing violently around the condo – and I do mean violently.  I had to take off my socks since without skin traction against the carpet I’d have slipped and broken my neck.  I was dancing that hard.  I was banging my hands against the walls at certainly points.  My body also went into the usual full-body infant sobbing, just thrashing away.

Then it hit me: as usual, the real problem wasn’t with “the person in my present” at all.  My real problem was that my present experience of emotional disconnect, had brought up “the pain from my past.”  There was actually deeply buried grief coming up, from the way my husband of 27 years, and before him, my mother, used to disconnect as a way of life – repeatedly and continuously disconnecting and pushing me away emotionally over decades.

The present-day incident was only a trigger, and an opportunity.  I’ve learned to use “incidents in my present” as a “pull-tag” – to pull up the more important buried pain from my past and grieve that in order to get rid of it!  So I did.

Just thump and bang

The first thing according to your formula, was to just thump around a lot dancing.  My body more or less did that without asking me. This P!nk song is a great example; it has intense patterned, very reliably repetitive, highly rhythmical activity.  To be blunt: it bangs.   Think “native drum circle.”  My brain stem says: “I feel angry –  ok, I can bang!”

You’re right: it’s important for the brain stem that the body be able to simply bang – over and over and over.  For me, and I’d bet a lot of folks, it’s a form of “infant protest” against the developmental trauma of being disconnected.

Second, we need “love and acceptance” (limbic brain) when we come out of the closet and just simply bang.  We need to bang, protest, beat the drums in a social (limbic) context.  As you’ve noted, that’s why native cultures do drum circles all over the world.  That’s why Vietnam vets do drum circles on beaches all over California.

Third, the words (thinking brain) are very intense and “relevant” –  and you keep emphasizing, “It’s got to be relevant” to the trauma at hand.

The song is a duet between P!nk (soprano) and Nate Ruess  (tenor). The soprano is paranoid that the tenor doesn’t love her anymore, he’s talking in his sleep, he must have someone else.  Her words are all about the trauma of emotional disconnect – which often gets us caught in arguments fatal to relationships.

But the tenor doesn’t get caught. Instead, he responds: “You’ve been having real bad dreams” (no doubt due to her childhood trauma), but “your head is running wild again, my dear, we still have everything!”  I’m here for you now and I really do love you.  “I’ll fix it for us – our love’s enough,” he sings.  He’s saying he loves her enough to put in real work on it, our love is that important.

Mis-Attune – Repair

AllanSchore-57246_222x180I was completely overwhelmed by the feeling the tenor models of REPAIR.  “My God, he loves her enough to do REPAIR,” I kept thinking, as if witnessing some impossible miracle which had never before occurred on planet Earth.

Attachment Theory leader Dr. Allan Schore (above) writes about “attune – mis-attune – repair.” That means learning that getting out of tune with another is not the end of the world, as we in trauma often experience it to be in childhood.  Gosh I certainly had!  But Schore says that instead, getting out of tune, if handled well, can be a temporary and very useful learning experience.

When we get out of tune, instead of slamming the door on each other, we can learn to take it as a signal that we both need a time out.  We can learn to sit down, take deep breaths, get back in touch with ourselves  – and then talk it out in a collaborative way.  We can express our fear and hurt and anger in reasoned words, only – instead of acting out with doors or verbal abuse.  After we each feel that we’ve been seen and heard, we’ll often feel better.  Doing this we also get to know each other better, so we grow closer for the whole experience.  Tricky but potentially invaluable.

The more I brought the word “repair” into consciousness – the harder my legs and arms wanted to bang on the floor and the walls, stretching out to the four corners of the globe. And then I knew it wasn’t even about my 27-year marriage coming up. My body was telling me it went a whole lot deeper.

Repair, was what my mother never could do.  If anything went wrong, if anything didn’t go so as to satisfy her (which was pretty difficult) – she would fly off the handle and disconnect.  The cold shoulder often went on for weeks at a time, why not?  She was mad.

Repair?  “Repair?  ‘Let’s make up? ‘  Are you out of your mind?”  I can hear mom saying.  I had sinned terribly somehow and it was out of the question for her to talk to me or look at me nicely; I didn’t deserve it.

The very concept of repair, the idea that human beings ever did any such thing, in fact, had never crossed my mind as a possibility in human relations – until I read about it in Allan Schore in 2011.

So yeah, “He loves her enough to do REPAIR!” was enough to make me barf up, process, and release some really deep grief. Like from kindergarten.  Like about my Mom, not anyone in my present.

Afterward, as usual when I can manage to feel the childhood pain, bang it out and be done with it, I felt absolutely fantastic.  That’s what music can do with patterned, repetitive, rhythmical activity.

The Back Story

Kathy in Zion Market 9-23-15 812404440_2874571766_0Also fun is the “back story” as to how this “rock bit” got onto my MP3 player.

About six months ago, shortly after I heard your March 8 UCLA talk, I was out food shopping.  Suddenly this P!nk duet came blasting out of the grocery store sound system; it seemed everyone knew it but me. I’d never heard it before – I had no idea what in heck it was.

But suddenly  I was dancing around the Korean vegetable store, stomping my feet and raising my arms to the ceiling in a peal of pure unadulterated joy –  much to my own shock and to the surprise and delight of the onlooking shoppers (Koreans adore music).  And I’m a pretty good dancer, which figures.  I guess that’s why so many abused women end up becoming dancers of some sort, ballet or pole.  Check out ballerina Gelsey Kirkland’s book  “Dancing on My Grave.”  No Polish jokes, please, I’m Polish.

So yeah, we get release when we do “patterned, repeated, rhythmical activity” – at the oddest times.  Then the creativity flows.  Later I downloaded the audio of the P!ink duet and filed it away on my MP3 player, where it popped up conveniently six months later as the subject of this letter.

Using music in your presentations?  I wonder how many of your clinical audiences have ever had a personal experience of this?  Could have a massive impact.  So if you ever want a musical trauma consultant, I’m your gal.

You rock, Doc!

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

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