Therapy

Mindfulness & Trauma - an old, new hope.

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Psychological ‘treatments’ for trauma are predominantly cognitive based and due to the high drop-out rate for these treatments, researchers are considering “non-traditional” treatments for trauma (Frewen, Rogers et al. 2015.Pg.1323). Frewen, Rogers et. al (2015) ‘proof of concept’ study showed that mindfulness was “considered potentially helpful… in the context of treatment for trauma… as well as more broadly for persons seeking to improve their self-regulation” (Pg.1331).

TRAUMA

When an event occurs that is beyond our normal realm of experiencing, it can have a damaging effect on our self-structure as a response (Turner, 2012.Pg.31). Trauma is a threat (or perceived threat) to the survival of the Self, and the effects of such an event are that the assimilation of the information from the traumatic experience isn’t initially integrated with the existing self-concept - “it is frighteningly outside normal experience” (Turner, 2012.Pg.33). Trauma throws into question everything a person understands, or believes they understand, about themselves and themselves in the world (Turner, 2012.Pg.31).

 

In our brain, we have an area called the amygdala which is key in the detection of threat. Once threat is detected (either real or perceived), the sympathetic nervous system (SNS) is activated and our body responds by ensuring we’ve sufficient resources for “fight-or-flight” (Joseph, 2013. Pg.52) to ensure our survival. When a person is presented with sounds or images relating to their original trauma, adrenaline surges occur that initiate the physiological response to the trauma memory, “increase blood pressure, heart rate and oxygen intake” (Van Der Kolk, 2014.Pg.42) and mirrors the same responses that would have happened at the point of the original trauma (Van Der Kolk, 2014. Pg.45). Conversely, when ‘fight-or-flight’ responses aren’t available, the body enters “tonic immobility”(Joseph, 2013.Pg.56) due to an initiation of the parasympathetic nervous system (PNS), where “heart rate and respiration decrease, blood pressure lowers” ”(Joseph, 2013.Pg.53).

 

The hippocampus, in conjunction with the amygdala, form the limbic system with the hippocampus responsible for creation and storing of memory. When the amygdala is activated, the hippocampus area is deactivated, which means that initially it’s unlikely a person has a coherent narrative surrounding their trauma. Through neural imaging, Van Der Kolk (2014) discovered there’s a reduction in the Broca’s region of a traumatised brain - an area of the brain responsible for speech, “without a functioning  Broca’s area, you cannot put your thoughts and feelings into words” (Pg.43). This highlights why talking therapies are necessary in the ‘treatment’ of trauma.

 

A consequence of trauma is the impact on affect regulation which means a person may not be able to regulate their emotions or responses. However, “enhancing affect regulation competences can be considered as a core therapeutic goal with client’s with complex trauma histories” (Ford, 2013. Pg.58) and  “to rediscover the personal goals, choices, and abilities”, ”validate strengths” and “engage clients in a constructive self-directed examination” (Ford & Russo, 2006.Pg.343). In order for a person with a trauma history to undertake a therapeutic endeavour, “learning to observe and tolerate your physical reactions is a prerequisite for safely revisiting the past” (Van Der Kolk, 2014.Pg.209) and adults with a trauma history “may respond best to therapy if affect regulation problems are directly addressed” (Ford, 2013. Pg.62). That’s where mindfulness steps in…

MINDFULNESS & SELF-REGULATION

“Emotion regulation is vital to creating a sense of safety” (Kalmanowitz & Ho, 2016.Pg.60)

Understanding that affect regulation is impacted by trauma, I want to explore how I can facilitate a client’s self-regulation. Mindfulness is based on Buddhist introspective principles that have been adapted for Western culture (Jooste, Kruger et al., 2015.Pg.555) and defined as ‘”paying attention in a particular way: on purpose, in the present, and nonjudgmentally” (Kabat-Zinn, 1994. Pg.4 as cited in Jooste, Kruger et al., 2015.Pg.555). Mindfulness is a particular type of meditation and is sometimes described as breathwork and can involve visualisation and guided ‘body scans’.

Van Der Kolk (2014) proposes that through focussing on sensations within the body, and becoming curious of the effects that breathwork has on a particular sensation, a person may find that there’s a memory attached to that sensation.(Pg.209). Within the therapeutic setting, the practitioner is there to ensure that a persons’ threat detector (amygdala) isn’t instigated.

 

In Shapiro et. Al (2006) they propose that the ‘mechanism of mindfulness’, is composed of three axioms, “Intention, attitude & attention” (Pg.374). Shapiro et. al (2006) discuss the importance of intention, “why one is practicing” (pg.376), as not only is it missing from previous mindfulness teachings but also because their findings support that “outcomes correlated with intentions” (Pg.376). Within the therapeutic setting, if the client and therapist openly discuss the intention behind introducing mindfulness (attaining a more balanced affect regulation), I’d anticipate the client experiencing growth.

“mindfulness increases the ability of the individual to handle the emotions they have, as opposed to trying to escape them” (Kalmanowitz & Ho, 2016.Pg.58)

With the second axiom, attention, Shapiro et. al (2006) describe the phenomenological view of experiencing the experience (pg.376) and through this attentiveness there’s an attainment of presence. The third axiom in Shapiro et.al (2006) paper, attitude, refers to the “qualities one brings to attention” (Pg.376) in a balance of heart and mind, nonjudgment and acceptance (Shapiro et.al, 2006. Pg.377).

Shapiro et. al (2006) remarks that “self-regulation is based on feedback loops” (pg.380):

“intention - attention - connection - regulation - order - health” Fig. 2. (Shapiro et. al, 2006. Pg.380)

The same principle could apply to the therapeutic work of a person with a trauma history; restoring the feedback loops, creating regulation and order by assimilation into their adapted self-structure.

The effect of mindfulness on the brain is incredible, Kabat-Zinn states when “resting in awareness—they exhibit an oscillation in the brain that we call y oscillations… These y oscillations are high frequency oscillations of about 40 cycles per second that have been implicated in basic mechanisms of synaptic plasticity” (Paulson et.al, 2013.Pg.92). Purely stated, mindfulness changes the brains plasticity and causes new neural pathways to be forged. And potentially, the same principle could be applied to the mechanisms of anxiety. With the effects of trauma, such as a heightened state of arousal, rewiring the brain through mindfulness allows a new arousal baseline to be set. With that new baseline, a person can begin to self-regulate more effectively, and/or understand their triggers, which frees them to focus on other aspects of their therapeutic endeavour.

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References

Ford, J.D., (2013) Enhancing emotional regulation with complex trauma survivors. In: Murphy, D. & Joseph, S. (Ed.)(2013) Trauma and the therapeutic relationship: approaches to process and practice. Basingstoke: Palgrave MacMillan. Ch.5.

Ford, J.D. & Russo, E. (2006) Trauma-Focused, Present-Centered, Emotional Self-Regulation Approach to Integrated Treatment for Posttraumatic Stress and Addiction: Trauma Adaptive Recovery Group Education and Therapy (TARGET). American Journal of Psychotherapy. Vol.60(4). pp.335-355.

Frewen, P., Rogers, N., Flodrowski, L. & Lanius, R. (2015) Mindfulness and Metta-based Trauma Therapy (MMTT): Initial Development and Proof-of-Concept of an Internet Resource. Mindfulness Vol 6. Pp.1322-1334.

Jooste, J., Kruger, A., Steyn. B.J.M., & Edwards, D.J. (2015) Mindfulness: A foothold for Roger’s humanistic person-centred approach. Journal of Psychology in Africa. Vol 25(6). pp554-559.

Joseph, S. (2013) What doesn’t kill us. A guide to overcoming adversity and moving forward. Piatkus: London.

Kalmanowitz, D. & Ho, R.T.H. (2016) Out of our mind. Art therapy and mindfulness with refugees, political violence and trauma. The Arts in Psychotherapy. Vol.49. pp.57-65.

Paulson, S., Davidson, R., Jha, A. & Kabat-Zinn, J. (2013) Becoming conscious: the science of mindfulness. Annals of the New York Academy of Sciences. Vol 1303. pp.87-104.

Shapiro, S. L., Carlson, L.E., Astin, J. A., & Freedman, B. (2006) Mechanisms of Mindfulness. Journal of Clinical Psychology. Vol. 62(3). pp.373-386.

 Turner, A. (2012). Person-Centred approaches to trauma, critical incidents and post-traumatic stress disorder in: Tolan, J. & Wilkins, P.(Ed.) Person Issues in Counselling & Psychotherapy. Sage: London. Pp.30-46.

 Van Der Kolk, B. (2014) The body keeps score. Mind, brain and Body in the Transformation of Trauma. Penguin: UK

PART 1. Motherhood... My Anger and Me.

Photo by  Zach Lucero  on  Unsplash

Photo by Zach Lucero on Unsplash

PLEASE NOTE: THIS POST IS A PERSONAL ACCOUNT OF POSTNATAL DEPRESSION & ANXIETY

“So if you are to subdue & suppress women… to think human connection frail & unreliable – you must target the vagina”

(Wolf. 2012, Pg. 114)

Anger is the unspoken dimension of Motherhood that, in my experience, society seems unwilling to acknowledge. Anger flies in the face of the attributes women are assigned in their gender role as mothers: caregiver, nurturer and calmness personified. Held up as having the virtues of a Goddess, “she is of even temperament, always in control of her emotions. She loves her children completely and unambivalently” (Viorst, 2002. Pg.214), society places guilt at our door as mothers for expressing anger towards our new roles, “So strong are societal prohibitions against female anger that the angry woman may be condemned” (Lerner, 1996 Pg. 52). We ‘should’ be happy our kids are alive and healthy, we ‘should’ be content that they’re feeding so much through the night as it means they’re growing and we ‘should’ be thankful we’ve a partner to support us where others parent alone. My internalised comparison of the ‘good mother’ society urged me to be and the ‘bad mother’ I felt when I failed at those expectations, left me feeling suffocated and invalidated. The taboo of expressing my own losses at the hands of Motherhood, led to my depression and its aftermath.

I’ve reflected on the losses I experienced as I became a Mother and my reticence at writing this blog has only served to demonstrate to myself how emotionally charged this change still is. Kübler-Ross (2014) suggests that in grief we have several stages that allow us to fully process our loss, sometimes progressing from one stage to another and repeating others. Whilst primarily the focus of Kübler-Ross theory (2014) is bereavement, it resonated with my transition into motherhood as I had experienced several of the stages (Denial/Isolation, Anger, Bargaining, Depression and Acceptance). Some stages featured more prominently than others, but through acknowledging that I did lose my own sense of identity in motherhood, it’s made me feel less ashamed that I felt the way I did. That ‘mother’ is just one ‘configuration of self’ that serves a purpose to nourish and protect my children, where my own mother failed to do so for me. In the words of Judith Viorst (2002) “Parenthood can be a constructive developmental phase in which we heal some of the wounds of our own childhood” (Pg. 230) Maybe I’ve created in myself the mother I needed as a child?

Being raised without a stable, mentally healthy and loving mother figure didn’t ease my transition into being a parent which is no surprise as evidenced by Fuchs, Resch & Kaess (2015), “children who grew up without an acceptable role model of parenting might have difficulties in adopting this role themselves” (Pg. 179). The early stages of parenthood threw up all the anger and rejection I felt towards my mother at my own loss of childhood. Having watched this body physically change in pregnancy, being monitored and tested by medical professionals, my body felt invaded by them and by the baby.

 

“The myth of the feminine woman as devoid of anger and aggressiveness could not have so vigorously survived over the ages unless both sexes shared deep intrapsychic fears of female anger”

(Lerner, 1996 Pg. 53)

 

Anger was one of the primary drivers for my entry into personal counselling. I’m aware that my initial anger in motherhood was towards the medical professionals, as I felt violated and as if they’d ripped my baby from my womb whilst I was unconscious. Consequently, I’d missed my opportunity to experience the home birth I’d planned and so my expectations of birth versus the reality became my source of anger. My anger towards the medics subsided, rational Jo engaged ‘I was alive and so was my baby’. The fact that I didn’t birth ‘naturally’ cast me as an anomaly to the ‘natural parenting’ community in Brighton, which pushed me even further into my eventual depression.

 

The first aspect of myself I felt I lost was my identity. I’d been a relatively independent woman prior to birth, at work people knew who I was due to my reputation of being able to deliver on projects and my foresight to identify risks to the business. Now I’d failed to deliver a baby and hadn’t foreseen the risky business of birth. In the hospital, I was referred to as the lady ‘In Bay 3’ and then latterly as ‘Star’s Mum’. It was the first occasion I had been identified with my role and responsibility instead of my name (and the awareness that I feel my name as an important part of my identity). I couldn’t fathom why nobody explained to me that ‘Jo’ had died in the operating theatre so that ‘Star’s Mum’ could be given life. There was an element of confusion for me around this time as I grappled with being thrust into this new self.

 

Angry because my breasts were now for nourishing children rather than for sexual pleasure. And coupled within that, I was lackluster in my connection with my sexual self and the remainder due to my lack of self-confidence. My womb hadn’t done what it was supposed to so how could I trust my vagina to please my partner?! I hadn’t realized how my sense of self was tied up in my sexual pleasure. Without feeling fully ‘womanly’ in that respect, I couldn’t fathom why my partner still found me sexually attractive when I had no drive or inclination to be intimate with them, “impossible expectations, unmet needs and unmeshed needs are continuing sources of marital tension & strife” (Viorst, 2002. Pg.195). That for me, sex and intimacy went hand in hand...  

This is Part One in a 3 part series of my personal experience of postnatal depression.

References:

Fuchs, A., Resch, F. & Kaess, M. (2015) Impact of a maternal history of childhood abuse on the development of mother-infant interaction during the first year of life. Child abuse & neglect (48): pp 179-189

Kübler-Ross, E. (2014) On death & dying: What the dying have to teach doctors, nurses, clergy & their own families. Scribner: New York

Lerner, H. (1989) Women in therapy. Harper Collins: New York

Viorst, J. (2002) Necessary Losses. The Free Press: New York

Wolf, N. (2012) Vagina. A new biography. Virago: Great Britain

3 Inspirational Books For Living an Authentic Life

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3 Inspirational books for living an authentic life!

Let’s face it, the world is full of amazing books with some really great resources and authors! So many books and so little time.

As a therapist, I ensure I read for pleasure and personal development. It can be a heady mix to find the right balance - challenging and engaging enough without being too repetitive, not too aimed at an academic readership or where the general narrative is pretty dry. I dislike feeling like a book is a slog! It’s my form of self-care where I always want something that sparks a resonance or an insight for me. I know… I have quite a list of requirements for my reading.

I also enjoy reading around topics that my clients bring to me or that I feel may help them in their therapeutic journey. Psycho-education leads to a greater understand of Self and the world around us. I don’t believe that therapy should be a mystical process and through sharing books or useful material, I can help de-mystify the therapeutic process. I feel my role is to empower a client to lead their best possible life with the resources they have available to them.

Resources for your self-development toolkit

Here’s my top 3 books for authentic living!

  1. Authentic by Dr. Stephen Joseph.

  2. Daring Greatly by Brené Brown

  3. Flow. The Psychology of Happiness by Mihaly Csikszentmihalyi

First up is the book Authentic, which does exactly what it says on the tin! Dr Stephen Joseph weaves his personal narrative with thought provoking and motivational exercises, resulting in an exploration through psycho-educational tools to find out what you need to fulfil a sense of living authentically. It’s a book you can either devour, dip in and out of or pace yourself through the exercises to allow time to process what may come up for you. I’d highly recommend to anyone thinking of entering, or already in, therapy or as a handbook for life!

Daring Greatly is yet another awesome book by the delightful Brené Brown (Would recommend all of her books and most are now on Audible too!). I was inspired to attend her Daring Way workshops after reading this book, I can honestly say that this book offered me insight into what my personal motivations are and what has previously prevented me from achieving my dreams. Brené’s easy to digest style and wholehearted approach to others was a delight to read. The legacy of this book has meant I feel I can firmly stand in my chosen arena and slay any dragons that come between me and my vision.

And finally, Flow: The Psychology of Happiness is the cumulation of decades of research by the author as to ‘states in which people report feelings of concentration and deep enjoyment’. It’s a journey through the question of what makes a meaningful and purposeful life, and at what points do we feel truly alive? It covers a diverse range of topics from philosophy, consciousness, sex, music, solitude and chaos. Sounds like an average weekend in Brighton… About a sixth of the book is the author’s notes and references, it’s truly a comprehensive book that requires commitment. But what a pay-off!

I hope you consider reading some of the books listed above and would love to hear of any other suggestions you may have. Most of the books are also available on Audible, so there’s really no excuse! Happy reading!