Tag Archives: Stephen Porges

April-May 2015 “New Brain” Webinars

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

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

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

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

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

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

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

Webinar Schedule

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scary Parents

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

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

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

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

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

Soon after 1982, Main and Ainsworth agreed that 14-15% of babies actually belong in a new, fourth category: (D) Insecure Disorganized. Their mothers were so frightening that the babies couldn’t develop any consistent response at all. These infants “exhibited a diverse array of inexplicable or overtly conflicted behaviors in the parent’s presence” including “disorganization, disorientation, and confusion.” This includes crying loudly then suddenly freezing; ignoring the parent to rock on hands and knees; moving away; raising hand to mouth in fear; or even swiping at the parent’s face. They seemed vulnerable to dissociation.   [FN11, 8]

This finding that a whopping 15% of average U.S. babies are so insecure they’re almost incoherent was so shocking, it was checked for years and not used as a formal 4th category until after 1990 (the delay confused many scholars during 1982-1990). [FN12] But the number held. Worse, among children of American adolescent mothers the rate is over 31%, and is over 25% in many Third World nations. [FN13]

And: to remove the 14-15% of disorganized babies from Ainsworth’s original 69% Secure, reduced the Secure set to only 54-55%.  What was up with parents that 45-46% of their kids couldn’t manage secure attachment?  If so, Main would have  four categories: Avoidant 23%, Ambivalent 8%, Disorganized, 14-15%, Secure 54-55%.  [FN1, 11]

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

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

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

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

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

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

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

Astonishing Results You’ve Never Heard

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

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

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

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

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

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

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

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

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

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

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

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

Footnotes

FN1  NIH: Benoit, Diane, MD, FRCPC, “Infant-parent attachment: Definition, types, antecedents, measurement and outcome,” Paediatr Child Health, Oct 2004; 9(8) p. 541–545 at: www.ncbi.nlm.nih.gov/pmc/articles/PMC2724160/  4th subhead “Measurement” reports:
“The three ‘organized’ strategies (secure, avoidant and resistant) are assessed in the Strange Situation (SS), a 20-minute laboratory procedure where patterns of infant behaviour toward the caregiver following two brief separations are categorized… “Infants with secure attachment greet and/or approach the caregiver and may maintain contact but are able to return to play, which occurs in 55% of the general population… Infants with insecure-avoidant attachment fail to greet and/or approach, appear oblivious to their caregiver’s return… avoiding the caregiver, which occurs in 23% of the general population. Infants with insecure-resistant [ambivalent] attachment are extremely distressed by separations and cannot be soothed at reunions,  displaying much distress and angry resistance to interactions with the caregiver, which occurs in 8% of the general population.” [This NIH article earlier reports that the remaining “approximately 15% suffer insecure ‘disorganized’ attachment,” citing their own footnote which states “In normal, middle class families, about 15% of  infants develop disorganized attachment.” [23%+8%+15%  = 46% not securely attached.]

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

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

FN4  Porges, Stephen, PhD, “Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
–“The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
–“Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

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

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

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

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

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

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

FN11   (1999 van Ijzendoorn on Main’s nw Disorganized group; confirms Main’s 4 categories)
van IJzendoorn MH, Schuengel C, Bakermans-Kranenburg MJ, Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants and sequelae. Dev Psychopathol. 1999; 11:225–49. [PubMed] at https://openaccess.leidenuniv.nl/bitstream/handle/1887/1530/168_212.pdf?sequence=1

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

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

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

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

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

FN17  Main 1985; Main & Goldwyn 1984

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

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

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

Mary Main & Dan Siegel December-2010-UCLAOnly 55% of us have “secure attachment”– a number which would worry us all if we knew of it–according to research on over 6,280  infant-parent pairs during 1970-1999. [FN1, 11]  And, the attachment we get as infants continues all our lives in our relationships, say related studies of over 10,500 adults done 1982-2009. [FN18]

The math says the other 45% of us suffer “insecure attachment.”  That means 45% can’t handle a committed, stable relationship with anyone, from childhood to the rest of our lives, as of 1999.  We also pass this emotional pain to our children, who turn out similarly.  A National Institute of Health article summarizes the secure rate:  “Infants with secure attachment greet and/or approach the caregiver and maintain contact but are able to return to play, which occurs in 55% of the general population.” [FN1, 11]

This is the blockbuster result of Dr. Mary Ainsworth’s 1970-1978 “Strange Situation” study of babies, as completed by her student Mary Main.  Main’s research led to shocking conclusions. (Dr. Main & Dr. Daniel Siegel, above)

Main discovered so many upset babies, that she got concerned about the parents. So in 1982 she created the Adult Attachment Interview (AAI) to study the adults, releasing results 1984-96.  Her journey was so “Strange” and involved it was published in language hard to decipher (or even google) for most folks. The tale took me weeks to unravel (footnotes below).

This huge “insecure” figure is a predictor of broken homes and broken hearts for half the nation. It starts to explain why we’ve got a 50% divorce rate. If  (like me) you’ve tried over-40 dating after divorce, it won’t surprise you that science shows 50% of adults out there can’t carry on a secure, committed, loving relationship. Ouch, you’ve experienced it.

And if 45% of us were “insecurely attached” in 1999, what’s the percent in 2016?  In 1999 most of us hadn’t heard of the Internet. In almost 20 years since, email, texting, and so on have further trashed our ability to relate in person. Several psychotherapists interviewed for this blog said that a round number of “about 50%” is a  conservative estimate for how many Americans lack secure attachment today. Many believe it’s much higher.

It gets worse; check out another “about 50%” shocker.  The 1998 Adverse Childhood Experiences (ACE) Study showed that two-thirds (64-67%) of  17,421 middle class subjects had one or more types of childhood trauma, and 38-42% had two or more types.  In less privileged populations, these numbers are far higher. A national average of all economic groups would likely show 50% or more suffer severe trauma from ACEs.

The ACE Study lists physical and sexual abuse and 8 other types, including traumas that happen even to newborns like physical and emotional neglect. [FN2]  Such trauma by definition puts children into technical “fight-flight,” a chronic state biologically proven to shut down the organism’s capacity for feelings of attachment and love. Think soldier in a  battle ramped up in “fight-flight”– he can’t really feel much love for the other side. [FN3]

And it doesn’t go away. Continued fight-flight puts the nervous system into freeze: our vagus nerve starts shutting down bodily functions, Dr. Stephen Porges shows. [FN4] So ACEs create the conditions underlying the top 10 medical causes of death in the U.S.

Half of us are in serious emotional health and medical trouble – and don’t even know it.  Let’s get informed –then we can heal. If we didn’t get securely attached as kids, we can develop “earned secure attachment.”  “It’s possible to change attachment patterns,” as Main said in 2010. [FN5]

 Strange Situation  Experiment

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

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

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

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

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

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

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

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

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

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

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

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

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

Footnotes

FN1  NIH: Benoit, Diane , MD, FRCPC, “Infant-parent attachment: Definition, types, antecedents, measurement and outcome,” Paediatr Child Health, Oct 2004; 9(8) p. 541–545 at: www.ncbi.nlm.nih.gov/pmc/articles/PMC2724160/  4th subhead “Measurement” reports:
“The three ‘organized’ strategies (secure, avoidant and resistant) are assessed in the Strange Situation (SS), a 20-minute laboratory procedure where patterns of infant behaviour toward the caregiver following two brief separations are categorized… “Infants with secure attachment greet and/or approach the caregiver and may maintain contact but are able to return to play, which occurs in 55% of the general population… Infants with insecure-avoidant attachment fail to greet and/or approach, appear oblivious to their caregiver’s return… avoiding the caregiver, which occurs in 23% of the general population. Infants with insecure-resistant [ambivalent] attachment are extremely distressed by separations and cannot be soothed at reunions,  displaying much distress and angry resistance to interactions with the caregiver, which occurs in 8% of the general population.” [This NIH article earlier reports that the remaining “approximately 15% suffer insecure ‘disorganized’ attachment,” citing their own footnote which states “In normal, middle class families, about 15% of  infants develop disorganized attachment.” [23%+8%+15%  = 46% not securely attached.]

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

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

FN4  Porges, Stephen, PhD, “Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
–“The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
–“Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

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

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

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

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

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

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How to Use My Website

OLYMPUS DIGITAL CAMERAFor new readers signing up, bless you for your patience. I’m new to Attachment Disorder Healing, too — and it’s my website.  A note on “How to Use” AttachmentDisorder Healing.com is overdue.

I fell into all this entirely by accident, when attachment disorder hit me upside the head.  Just as the latest brain science on how it works and how to heal was flooding in.  So I’ve been going a bit ape (above), multiplying content here like rabbits — faster than I’ve been able to index it so you can find what you need. (Click on pics for clear shots; my software’s glitched.)

My webmaster finally spanked me (metaphorically speaking, of course) and said “There’s too much good info on here, with no way to find it!  Re-index the place so that people can find your book, your Featured Topics, and your News Blogs of the Week.”  So here’s a new page to help you find stuff:

Book:  The first 30%  of my psychiatric autobio “Don’t Try This at Home” is posted on the New Book page here.  I’ve got 60% of it written, but all this trauma and brain science news has kept me tied up blogging, instead of “book-ing.”  I feel so much better now than I did during the events in the book, events which got me where I am.

Dr. Peter A. Levine talks about how prey like an impala, running in full fight-flight, will suddenly go into freeze, pass out and keel over — an instant before a predator such as a cheetah gets a claw in. Any mammal’s vagus nerve will deck us like that when the nerve “neurocepts” overwhelming danger in the environment  — no thinking involved.

Kathy w. Cheetah SignI used to feel like that impala; the world was a dangerous place and I’d go into freeze…  Not anymore!  So who wants to write about 2011 when all this great news is happening in 2014?  OK, ok, I’ll crack down and get the book onto Amazon soon.

Featured Topics (find info by topic):
Adult Attachment Disorder, Adult Attachment Interview (AAI)
Attachment Therapists Directory and Referrals
Brain Science
Developmental Trauma, Infant Development
Grief Recovery Handbook (GRH) and Method

Healing with Body Work, Rhythmic Regulation
Mammalian Attachment, Limbic Brain, “Fur”

Meditation, Being Present, Radical Acceptance
Music and Attachment, MP3 audios, Sheet Music

News Blogs: Click here for News Blogs; there are too many to list on this “How To” page, but here are the main themes:
Latest on the Brain
How We Develop
Did I Attach?
50% Suffer from Trauma
On Healing: Body Work
Being Present, Now
Watch Out for More Trauma

What is Addiction?

Resources: For Seminars, check now for the latest Brain Science of Trauma Webinar series live on line October 15 – November 19, at Now Live: Oct-Nov 2014 Trauma Webinars
Other resource tabs include:
Books & Reviews
Find a Support Group
Find a Therapist
Key Articles
Videos & Audios

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If you find the site useful, do remember:  I’m not a PhD studying “those people” with attachment disorder. I’m just a paramecium writing about how it feels to be a paramecium.

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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.

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Dr. Ruth’s Ultimate Trauma Solution

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Footnotes

FN1  This 2011 series is over, but a subscription to it for transcripts and recordings is still at http://www.nicabm.com/thebrain2011/

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Stephen Porges: Social Engagement Heals

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

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

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

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

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

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

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

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

Play and Mammalian Attachment

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

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

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

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

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

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

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

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

Heal Trauma by Acceptance – Not Stigma

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

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

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

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

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

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

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

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

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

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

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

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

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

Footnotes

FN Porges, Stephen, PhD, “The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
—“Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
—”Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

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

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Stephen Porges on Treating Trauma and Compassion

Stephen Porges magesDr. Stephen Porges discovered in 1994 that trauma in humans comes from our most ancient “reptilian” freeze reflex. He calls it the Polyvagal Theory, as I wrote last week. But Porges also says we can use our mammalian attachment system to heal this.

This week I have a few short (and two long) Porges
videos to share with you, which since Polyvagal is
pretty darn complex, are really wonderful to have.

I really like “The Science of Compassion,” his talk
at the Stanford University conference of the same
name.  Here they are:

“Polyvagal Theory: Trauma from a New Perspective” — Stephen Porges, PhD, inventor of the Polyvagal Theory, shares his insights with Dr. Ruth Buczynski of NICABM on the treatment of trauma. He explains how treating trauma or treating PTSD is not always straightforward;  4 minutes at https://www.youtube.com/watch?v=MKkDAOW2yd4

“The Science of Compassion,” by Stephen Porges, PhD,  at the Stanford University conference “Science of Compassion: Origins, Measures, and Interventions.” This was the first large-scale international conference of its kind dedicated to scientific inquiry into compassion; 25 minutes at https://www.youtube.com/watch?v=MYXa_BX2cE8

William Stranger interview Dr. Stephen Porges.
The Polyvagal Theory introduced a new perspective relating autonomic function to behavior that included an appreciation of autonomic nervous system as a “system,” the identification of neural circuits involved in the regulation of autonomic state, and an interpretation of autonomic reactivity as adaptive within the context of the phylogeny of the vertebrate autonomic nervous system; 40 minutes at https://www.youtube.com/watch?v=8tz146HQotY

#090: Adam Carolla and Dr. Stephen Porges September 30, 2013  Podcast – Dr. Stephen Porges returns to The Dr. Drew Podcast and this time we are also joined by special guest Adam Carolla.  Dr. Porges and Dr. Drew attempt to investigate Adam’s behavior and identify some patterns; 57 minutes at http://drdrew.com/090-adam-carolla-and-dr-stephen-porges/

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

Footnotes

FN  Porges, Stephen, PhD, “The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
—“Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
—”Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

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Polyvagal Theory: Trauma as Reptilian Freeze

Polyvagal Theory Book Amazon1Neuroscientist Dr. Stephen Porges appeared in my last few blogs; let’s explore his 1994 discovery of the Polyvagal Theory.  Dr. Porges runs brain-body research at top psychiatry departments (University of Chicago and University of North Carolina Chapel Hill).

And he always says he wasn’t looking for a polyvagal theory. He was just researching ways to measure the vagus nerve, the 10th cranial nerve running between the brain stem and most of the body.

Until 1994, textbooks said there are two parts to the autonomous nervous system (ANS).  First, the sympathetic system mobilizes us for fight and flight, but is harmful if it stays on too long, making us tense, anxious and prone to disease. Second, the parasympathetic inhibits mobilization, so it was believed to be calming and healthy. Textbooks taught that “the net result was a balance between a pair of two antagonistic systems,” Porges says. The vagus nerve makes up a chunk of the parasympathetic; “it functions like a brake on the heart’s pacemaker.” [FN]

This two-part model broke down “as I was conducting research with human newborns to measure heart rate, assuming vagal activity was protective,” Porges says. “If newborns had good clinical outcomes, they had a lot of vagal heart rate going up and down with breathing. Babies with flat heart rates were at risk.  So I wrote a paper in the journal Pediatrics to educate neonatologists.

“Following publication, I received a letter from a neonatologist who noted that… the vagus could kill you, and that perhaps too much of a good thing was bad. His comments startled and motivated me to challenge our understanding of the nervous system.

“I immediately understood what the neonatologist meant. From his perspective, the vagus can kill, since it is capable of life threatening bradycardia and apnea — massive slowing of heart rate and cessation of breathing. For many pre-term infants, bradycardia and apnea are life threatening.  I now framed the ‘vagal paradox.’  How could the vagus be both protective and lethal? For months I carried the neonatologist’s letter in my briefcase.”

Poly Faces of Vagus

Polyvagal Anatomy Diagram

Porges went back to the evolution of anatomy, and saw that in fact there are two different vagus circuits — a total of three ANS circuits, not just a pair.  The two circuits “come from two different areas of the brain stem, and they evolved sequentially,” one far earlier.

“This motivated me to develop the polyvagal theory, which uncovered the anatomy and function of two vagal systems, one potentially lethal, and the other protective,” he says.

“Immobilization, bradycardia, and apnea are components of a very old, reptilian defense system, ” Porges says. “If you look at reptiles, you don’t see much behavior — because immobilization is the primary defense system for reptiles… it’s an ancient vagus nerve.”  This pre-historic nerve has no myelin, a nerve coating of  protective protein and fat.

Porges found mammals have this unmyelinated vagus, on the dorsal (top) side of the nerve, which immobilizes us, too —  “and that immobilization reaction, adaptive for reptiles, is potentially lethal for mammals.”

Porges also saw that among the “firsts” which began with mammals, a new vagus with myelin develops on the ventral underside of the nerve.  “So mammals have two vagal circuits,” he found. ” The myelinated circuits provide more rapid and tightly organized responses. The new mammalian vagus is linked to brain stem areas that regulates the muscles of the face and head. Every intuitive clinician knows that if they look at people’s faces and listen to voices,  controlled by muscles of the face and head, they know the physiological state of their client.”

Neuroception:  It’s Just Not Cognitive

Porges adds that our more primitive neural circuits operate by “neuroception” — totally involuntarily.  “Neuroception is not perception,” he says. “Neuroception does not require an awareness of things going on.  It is detection without awareness. It is a neural circuit that evaluates risk in the environment… When confronted in certain situations, some people experience autonomic responses such as an increase in heart rate and sweating hands. These responses are involuntary. It is not like they want to do this.”

The polyvagal theory emphasizes that our nervous system has more than one defense strategy – and whether we use mobilized flight/flight or  immobilization shutdown, is not a voluntary decision.  Outside the realm of our conscious awareness, our nervous system is continuously evaluating risk in the environment, making judgments, and prioritizing behaviors that are not cognitive.

Next, he says, “humans and other mammals, as fight/flight machines, only work if they can move and do things. But if we are confined, if we are placed into isolation, or if we are strapped down, our nervous system reads those cues and functionally wants to immobilize.  I can give you two interesting examples: one is a news clip I saw on CNN and the second  from my own personal experience.

“I saw a CNN news broadcast with a video clip of a plane whose wings were tipping up and down as the plane was tossed by the wind. The plane did land safely and the reporter went to interview the people. He asked one of the passengers how it felt to be in a plane that looked like it would crash. Her response left the reporter speechless. She said, “Feel? I passed out.” For this woman, the cues of a life threat triggered the ancient vagal circuit. We don’t have control over this circuit.

“Many people who report abuse especially sexual abuse, experience being held down or physically abused. These abused clients often describe a psychological experience of not being there. They dissociate or pass out. The abusive event  triggered an adaptive response, to enable them not to experience the traumatic event.”

Porges’ second example, noted in my Aug. 22 blog, was his own attempt to have an MRI – in which his body flat out overruled his powerful thinking brain. “I wanted the MRI.  But something happened to my body when I entered the MRI that triggered my nervous system into…wanting me to mobilize to get out of there.” So the nurses let him out.

Porges was asked by one interviewer, “What would have happened if you called to be let out — but no one came?”

“Now we’re talking!,” said Dr. P. “So now I am stuck in there, I can’t get out; I am in this confined area. That would be totally like being physically abused, being held down, going through all these same things.” Like the plane passenger who defaulted back in evolution to her most primitive system, he might have dissociated or passed out.

“The problem, of course, is how do you get people back out of that?” Porges asks. ” If a life threat puts a human into this state, it may be very difficult to reorganize to become ‘normal’ again.”

Friday Sept. 26:  Videos and audios on Polyvagal Theory

Friday Oct. 3: Dr. Porges on how to “get people back out of” the reptilian freeze of trauma.

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

Footnotes

FN Porges, Stephen, PhD, “The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
—“Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
—”Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

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Mammalian Attachment System Heals Trauma

Stephen Porges magesDr. Stephen Porges writes in his groundbreaking “Polyvagal Theory” that mammals like us aren’t made for trauma.  We’re made primarily to attach to other mammals, which makes us feel safe, secure and good.  When that fails, we’re also made to go into a secondary fall-back option of fight/flight; we get aggressive or at least defensive. And it feels bad; we know something’s wrong.

But we’re not made to be in fight/flight for a long time, so when we’re caught in fight/flight and can’t get out, mammals are forced back into a third, even more primitive system: reptilian freeze, aka immobilization or dissociation.

“If you go to a pet store and look at the reptiles, you don’t see much behavior, because immobilization is the primary defense system for reptiles,” says Porges. “But if you look at the small mammals, hamsters and mice, they are running around. They are socializing.”

“Some reptiles can shut down and go underwater for several hours and be fine. The shut-down system works well if you are a reptile, because reptiles don’t need much oxygen and don’t need to support a big brain…

“But this immobilization reaction… is potentially lethal for mammals. If a life threat triggers a biobehavioral response that puts a human into this state, it may be very difficult to reorganize to become ‘normal’ again,”  he warns. [FN]

I talked about that kind of trauma last blog.  I was suddenly thrust into a medical system that ignored all these mammalian basics.  No matter to whom I turned for communication and  information, nobody saw me, nobody heard my questions, nobody seemed to care what happened. No mammalian response.

So instead of being about to simply sit and be “Present” with the sudden survival threat of a surgical knife coming at me, I had to take all the perfectly normal fight/flight feelings which that causes, and “stuff  it.”  Because I had to push myself into hunting and gathering all that info alone. Which threw me into reptilian freeze, just as my body was designed by the Manufacturer to do.  That’s trauma.

Mammals Should Be Seen – And Heard

Cats Bad Day, I fix itBut, good news: I got out of that trauma in under a week, thanks to Dr. Porges’ primary state: mammalian attachment.

The first thing that happened was I took a step myself, to get myself “seen” and “heard” – I wrote that blog.  It went out to almost a thousand readers, and the response was terrific.  In particular, lots of nice warm mammals in my Life Team support system started to call and write to me, and wow did that feel good.

“Dearest Kathy,” wrote one reader, “I just read your latest blog post, and it sounds rough.  I hope things are calming down and straightening out, and I wish I could be there to help. Do call if you want. – A big, warm, long hug….”

Now this gal and I go way back decades, though she’s on the east coast where I haven’t seen her since 2009. But we were attached mammals for so long, that in 2011 I woke up one morning dreaming I’d been singing Handel’s  Messiah, things went terribly wrong – but suddenly there at the foot of the stage, she appeared – to give me a big hug. “Oh!  It’s her!  She knows me. She sees me — the real me, the me who really is.”

And about three hours later that same day in 2011, my cell phone rang and…. it was her.  Across 3,000 miles.

“The evolution of the nervous system starts with the un-myelinated vagus nerve, which does immobilization. Reptiles have this oldest defensive system,“ says Porges.

“With mammals, a newer circuit, a uniquely mammalian vagus which is myelinated, comes online.  So mammals have two vagal circuits, which originate in different areas of the brain stem. The new mammalian vagus is linked in the brain stem to areas that regulates the muscles of the face and head.  Every clinician knows that if they look at people’s faces and listen to their voices, which are controlled by muscles of the face and head, they will know the physiological state of their client.

“If we are protected with the newer mammalian vagal circuit, we do fine. When our mammalian social engagement system is working, we feel calm, we hug people, we look at them and we feel good.

“These mammalian part of our  nervous system  enables social interactions to calm our physiology and to support health, growth, and restoration.  When a person is facially expressive, has vocal intonation, has an expressive face and whose eyes are open when we talk to them,”  then we feel seen, heard, and connected.

“Thank you for actually ‘seeing’ me and knowing me,” I wrote back to my gal pal last week after she saw my blog. “It’s got everything to do with plain old simple mammalian attachment, in which we  just ‘be with’ each other, and feel safe.

“And just this morning, it hit me: Oh, Mom again. I was under survival threat as an infant because I was raised in a glass box, which is interpreted by the infant brain stem as a survival threat. Google ‘Still Face Experiment’  – it shows how infants go nuts when nobody sees them, nobody hears them – nobody responds.

“So today, survival threat  (surgical knife) will cause me to over-react.  ‘Of course’ says my wonderful attachment therapist,  ‘it’s baked into your brain stem.  Give yourself some grace, have your reaction, and then do the reality check.’   So when the doctors exhibit the same reptilian behavior as Mom: nobody hears me, nobody sees me, nobody responds?   ‘Of course’ — bam, it  triggers the whole infant deep neurological experience.

“The minute I put that together, I had a good cry, then started to feel absolutely fantastic.  Because suddenly I knew: it’s not about the doctors or the surgery — it’s about my mammalian attachment system.  No matter what happens with the surgery or the doctors, it won’t matter – as long as I get with mammals.  And what a relief.

“Because now I do have mammalian attachment to my friends, my therapist, and a few other important people – like God – now I do have “Safe People.”

“So suddenly now the surgery is no big deal because the doctors will do a great technical job like well-trained reptiles, and back to what really counts, my mammalian support system is taking care of my mammal needs big time.  Which brought me an enormous relief of tension, and feeling of support.”

And no sooner did I figure this out, than my email dings –  and it’s her again.

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

Footnotes

FN  Porges, Stephen, PhD, “The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
—“Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
—”Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

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Is Our Medical System Traumatizing Us?

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

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

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

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

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

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

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

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

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

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

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

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

No Time to Think – Let Alone Feel

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

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

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

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

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

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

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

Involuntary Reaction to Survival Threat

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

——————

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

Footnotes

FN1 Barrett, Mary Jo, MSW, “Addressing PTSD: How to Treat the Patient without Further Trauma,”
NICABM Webinar, June 29, 2011. Dr. Barrett’s latest book is “Treating Complex Trauma: A Relational Blueprint for Collaboration and Change,” orders are here:  http://goo.gl/SEiWVD  and http://www.centerforcontextualchange.org/publishedworks.html

FN2 Porges, Stephen, PhD, “The Polyvagal Theory for Treating Trauma,” 2011, http://stephenporges.com/images/stephen%20porges%20interview%20nicabm.pdf
—“Body, Brain, Behavior: How Polyvagal Theory Expands Our Healing Paradigm,” 2013, http://stephenporges.com/images/NICABM%202013.pdf
“Beyond the Brain: Vagal System Holds the Secret to Treating Trauma,” 2013, http://stephenporges.com/images/nicabm2.pdf
—”Polyvagal theory: phylogenetic substrates of a social nervous system,” International Journal of Psycho-physiology 42, 2001,  Dept. of Psychiatry, Univ. Illinois Chicago, www.wisebrain.org/Polyvagal_Theory.pdf

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