Hello, readers. Thanks for following along on my blog. I hope you have a restful and relaxing holiday season. A reminder that my weekly blog articles can be found on Psych Central The Savvy Shrink. In addition, I have a podcast, also entitled The Savvy Shrink on MHNR Network. In other news, I have been working away on EMDR certification while also contributing to and creating other projects that will be unveiled in the new year. WIshing you and your's a wonderful and restorative holiday season. Perhaps think about constructing a Vision Board for the new year. Here's to a wonderful 2019...see you then on my blog here and other publications.
"Someone who has experienced trauma also has gifts to offer all of us- in their depth, in their knowledge of our universal vulnerability, and their experience of the power of compassion."- Sharon Salzberg
What a week. You'd have to be living under a rock if you haven't at all tuned in to the tumultuous news cycle in the US. Those that are survivors of trauma (specifically sexual assault and other forms of abuse) are incredibly triggered, and those that provide psychotherapy for trauma survivors are, well, ..busy (understatement). It is a time of tremendous shifts, it's a time of political divisiveness and upheaval, some say greater than that of the era of the Civil War. I don't doubt that. And it is through adversity that profound transformation and transcendence can and does occur (cue in silver linings here).
Politics aside, we must collectively focus on how to heal the traumatized brain. In the latter three posts, I wrote extensively about the brain mechanics of trauma. I shared information about our wonderful amydalas, hippocampi, prefrontal cortex, and hypothalamus, among other miraculous brain components. We know how the brain scatters traumatic material in different parts of our grey matter, rendering a cohesive narrative approaching impossible for the healing individual. Brain-wise interventions, including EMDR (Eye Movement Desensitization and Reprocessing), help the traumatized survivor to develop an adaptive resolution to their trauma in which the "held charge" of the trauma (hyperarousal, hypervigilance, intrusive flashbacks, freezing, numbness, etc), can be desensitized and reprocessed in a cohesive manner (van der Kolk, 2015).
Let us know turn our attention to how we can help our precious craniums heal in the aftermath of trauma. Follow along with me as I discuss five ways to help the traumatized brain heal:
1) See a psychotherapist who is strengths-focused (not victim-shaming/blaming), trauma-informed (has had extensive advanced training in evidence-based modalities to heal conditions like PTSD, C-PTSD), and who is competent and compassionate. It is imperative to work with a mental health professional who is not only licensed in their field (psychology, social work, counseling) but also has advanced clinical training in trauma recovery. Treating conditions like PTSD, C-PTSD, depression and anxiety fall under the category of clinical intervention. Therefore, you need to work with a licensed mental health professional who has the training to address these conditions. Life coaches, although helpful, are not trained to address clinical conditions. It is unethical for a life coach to attempt to treat any of these clinical conditions, as it is out of their scope. Life coaches can provide psychoeducation, coping skills, and resources. Psychotherapists ( PhD, PsyD, LCSW, LMFT, LPCC), do the clinical interventions addressing the delicate nuances of trauma. You would not see a vitamin consultant to deal with a cardiac bypass condition. Within those qualifications, the practitioner must also be strengths-focused, client-centered, and empowering for their client.
2) Physiological release is vital. Those of us in the field of trauma recovery are intimately acquainted with the seminal writings of Bessel van der Kolk (2015) and Francine Shapiro (1992), as well as others including Lenore Terr, Judith Herman, Peter Levine, Pat Ogden, Cathy Malchiodi, among many more. When humans experience trauma, the event is "held" in a somatic (physical) part of the brain that is not accessible to verbal (higher order) understanding or meaning-making of the event. Therefore, interventions often need to begin with "bottom-up" processing (van der Kolk, 2015) where physiological release can safely take place, and after which the verbal/cognitive parts of the brain can then make sense of what happened. Some interventions can include trauma-informed yoga, somatic experiencing psychotherapy, EMDR therapy, exercise in a safe place (i.e. nature/hiking, with safe others), ,mindfulness based practices, deep breathing and progressive muscle relaxation, expressive arts utilizing major muscle groups, music and dance therapy, and other trauma-informed modalities.
3) Expressing the "held emotion" of the event(s) allows the processing and release of traumatic loss to unfold. Behind every traumatic event is a loss of some kind (whether literally to death, to abandonment, separation, a dream, safety, control , self-efficacy)...allowing the client to go to expression of loss, grieving the loss(es) inherent in the traumatic circumstances, is essential to healing. A "safe, holding environment (Winnicott, 1992) allows this expression to unfold, which may come about in expressive arts, journaling, narration of story, music/drama therapy, EMDR, somatic experiencing, and other trauma-informed modalities.
4) When a survivor can release trauma physiologically and emotionally, then they can access their higher order reasoning and understanding of the traumatic event(s). At this point, the survivor can "narrate" their story, either verbally, in written form, or in a visual journal. By cognitively connecting the dots in a solid, cohesive understanding of the chronology of events, the client is able to store the traumatic material in a more adaptive fashion that does not activate the amygdala but instead allows the hippocampus to appropriately file away past events and current triggers. EMDR therapy is magnificent for this type of reprocessing and transcending trauma (Shapiro, 2017).
5) Spirituality helps make meaning of the nonsensical. And I don't necessarily mean a religious institution. A mindfulness based practice of meditation, connection with nature and safe others, meditation, creativity, prayer, all allow a survivor to transcend and make meaning out of adversity (Malchiodi, 2018). Survivors may also connect with safe others along the healing journey who are concurrently healing and evolving through trauma-informed modalities (psychotherapy, meditation, expressive arts, etc) that allow a connection and a decrease of isolation. In turn, communion with safe others allows healing to occur (i.e. support groups, individual psychotherapy). That which is witnessed and validated ceases to exert dominion over the well-being of the individual.
Retrieved from https://www.trauma-informedpractice.com/
Shapiro, Francine (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures, 3rd Edition, The Guilford Press.
van der Kolk, Bessel (2015). The body keeps the score: Brain, mind and body in the healing of trauma, Penguin Books.
Winnicott, D.W. (1992). The child, the family and the outside world (classics in child development), Perseus Publishing.
"Although the world is full of suffering, it is also full of the overcoming of it." - Helen Keller
**This article is Part 3 of 4 in a series entitled The Nuts and Bolts of the Traumatized Brain - See Part 1 here, Part 2 here**
Continuing the discussion of the human brain and the subsequent impact of trauma exposure, today's article will focus upon five additional tidbits of information. Prior articles (see above) have addressed the role of the amygdala and hippocampus in trauma and trauma recovery. Moving forward in learning about the neurobiology of our miraculous cerebrums, we know that the body interprets trauma as a life-threatening event(s). Therefore, different parts of the brain fire up to respond to the perceived threat (real or imagined).
11) The HPA Axis is a hormonal/nervous system connection in the brain that lights up when the saber-toothed tiger is attacking (i.e. a present day trigger or perceived/real threat like a car accident, rape, abuse, reminder of prior trauma, etc.). The aforementioned HPA Axis is activated by stress and trauma and consists of the hypothalamus, the pituitary gland, and the adrenal glands.
12) The hypothalamus acts as a Command Center of the brain, communicating with the pituitary gland to release hormones, which in turn activate the adrenal glands to release hormones. These hormones include cortisol, opiates, oxytocin, and catecholamines, and they are released in varying amounts to ready the body to respond to trauma in "fight, flight, or freeze" response. Cortisol works to ready the body to have the energy to respond to the perceived threat; opiates reduce physical pain; and oxytocin reduces psychological pain.
13) As mentioned in the prior articles in this series, the hippocampus and amygala work together to process the trauma. However, with the HPA Axis producing the "neurological soup" described above, encoding, processing and storing information goes haywire during a traumatic event. The amygdala remains activated while the hippocampus goes "offline" and stores traumatic material in scattered "file cabinets" of the brain, rendering processing of the traumatic event, at best, difficult and memory consolidation impaired.
14) The area of the brain associated with language in the left frontal region, Broca's Area, gets shut down during trauma. A flashback or trigger shuts down this part of the brain, rendering the survivor incapable or at minimum, very impaired, with their ability to assign words to the experience of trauma (van der Kolk, 2015). Brain-wise psychotherapeutic interventions (like EMDR) help the brain to synthesize and organize the traumatic material in such a way that the brain is able to store the traumatic material in an adaptive fashion, whereby the "charge" of the limbic system lowers. In turn, the higher order executive functioning skills of language, focus and concentration go back "online" to assist the survivor with narration of the story and thereby mastering the traumatic experience (Herman, 1992).
15) "Bottom-up" processing of the trauma(s) involves helping the brain move into the action of recovery and getting unstuck from looping back to the state of being viscerally frozen in trauma (van der Kolk, 2015). Such interventions are designed to soothe and calm the limbic system and can include EMDR, sensori-motor therapy (i.e. somatic experiencing), expressive arts, music, meditation, trauma-informed yoga, prayer and mindfulness based practices, among others. Talk therapy (which requires a functioning prefrontal cortex that is back "online") comes only after addressing the somatic components of trauma recovery.
The last article in this four part series will address interventions that help with healing the traumatized brain.
Retrieved from : https://sapac.umich.edu/article/neurobiology-trauma September 25, 2018
Herman, Judith (1992). Trauma and recovery: The aftermath of violence from domestic abuse to political terror; Basic Books.
van der Kolk, Bessel (2015). The body keeps the score: The brain, mind and body in the healing of trauma, Penguin Books.
"Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies. Being frightened means that you live in a body that is always on guard...." Bessel van der Kolk
"The paradox of trauma is that it has both the power to destroy and the power to transform and resurrect." - Peter A. Levine
Hello and Happy September...
Hello folks. I hope your summer is going well. July brought a blazing heatwave in So Cal, but hopefully temps are starting to level out to more tolerable levels now...In any case, thanks for following along with me on my blog. Here's the latest:
* I continue to see clients in my practice in San Dimas (and also in telemental health) for trauma-informed services ranging from recovery from toxic relationships to maternal mental health. I also see men! Men are often overlooked and are in need of support as well! I enjoy helping people move through challenging circumstances, and I consider it a true honor to bear witness to this transformation in my clients.
*I am Basic Trained in EMDR (Eye Movement Desensitization and Reprocessing), which involved a tremendous amount of training last year. AND, I am currently working on the next level, certification...I love using EMDR with my clients when appropriate, and I continue to see the benefit of this incredible modality that is based in brain science. Consultation and learning is ongoing, and I enjoy being a life-long student as a clinician. EMDR is an art and science -- there is a lot of evidence-based protocol, blended with clinical intuition...it's really cool! If you want to learn more about it or might be considering this trauma-informed modality for you or someone you love, feel free to contact me through my website here.
*I continue to write weekly blogs for Psych Central under my own blog The Savvy Shrink. As well, I am podcasting for MHNR Network under the same title, The Savvy Shrink.
*Other projects that are in process: more written work available to clinicians and clients alike coming up...and soon, some online courses which I am currently in the works of formulating. Stay tuned!!
Happy Summer, and thanks for following my work here!!! Namaste, Andrea
My new office address will be: 448 E Foothill Blvd., Suite 205 San Dimas, CA 91773 ...Effective 5/7/18....
I look forward to assisting you with your counseling needs at my new location very shortly!
Boy, it's been a while since I have blogged on my own blog -- I've been keeping busy writing for Psych Central, doing my podcast, and also, of course, seeing clients! It's been busy. In any case, I am going to share a link to my most recent article for Psych Central on Psychological Spring Cleaning...enjoy! Here it is. Happy Spring!
**Author's note: If you are not inclined to read about breasts, fibrocystic breasts, and those of this author, then you are forewarned to read no further. Selective self-disclosure was chosen by the author to help those in similar situations.**
This blog entry is dedicated to women everywhere, women who are battling breast cancer, both those who have won and lost the battle, and most especially for my colleague, Anise Ojeda Smith, who is battling fiercely as a metastatic breast cancer suvivor, or metavivor.
I wasn't expecting to start breast cancer screening in my 30s, but due to fibrocystic breasts, it was recommended by my physician to start mammography earlier than the generally recommended age 40. Fibrocystic breasts are normal. They are just really dense breasts with lots of tissue in them (ducts, lymph nodes, and lobes). And when a woman goes through pregnancy, childbirth, breast-feeding and then perimenopause, the breasts go through changes. 60% of women have fibrocystic breasts, and with that comes tissue changes as hormones, aging, and reproductive life events impact the density of the breast tissue (webmd.com, 2018). Women with fibrocystic breasts are not at greater risk of breast cancer, but they do have a higher rate of false positive mammograms and call-back mammograms.
Medical guidelines these days encourage women to begin mammography at age 40 ( komen.org, 2018). For those with a family history of breast cancer or other risk factors, mammography can begin earlier. For women with fibrocystic (or dense) breasts, often times it is recommended to begin screenings before age 40 (mayoclinic.org, 2018).
So when I had my routine mammogram, I was not expecting to get a call-back on my voicemail. The strained voice on the message stated, "The doctor would like to get some additional pictures with a diagnostic mammogram. Please call our office right away to schedule that appointment..." My first thought was this is the third call-back mammogram I have had in the last two decades, and both times before, there was no malignancy. I am sure this is just a precaution, and because they are being thorough, if there is anything there, they will catch it before it gets any more problematic and then blast it into oblivion. I was pleased I could do some cognitive restructuring voodoo on myself, like I help my clients. Then distraction and a walk with the dog.
Then, my mind went into "what if "scenarios. And suddenly, I went from 0 to 10, sky-rocketing in anxiety. What if I was one of those small percentages of women whose cancer is not detected in a mammogram and it's more like inflammatory breast cancer that's already metastasized? What if I leave my children motherless before they are able to launch to independence? What if my husband is widowed unexpectedly and left to raise our sons alone? Suddenly, my brain catastrophized, and I was not doing well containing my anxiety.
Fast forward a week and a half later (and what seemed like a light-years time), I went in for my diagnostic mammogram, and by divine intervention, many warm wishes and prayers, I had a benign reading. There was just a folded tissue on the original mammogram that looked like "asymmetrical density" on one side. The diagnostic mammogram found nothing abnormal. The word "benign" was music to my ears.
So why do I write about something so personal? Because half of the people on this planet have breasts. It's not "just" a personal story about breasts. It's about self-care, managing anxiety, and supporting women who live with the unknowns of health outcomes on a daily basis.
I realize I am fortunate for many reasons. I am fortunate to have health care, and good health care where screenings are taken seriously even if a false positive happens. I know the doctors work very hard for preventative medicine in all possible scenarios. I also do not have a family history of aggressive breast cancer. I have a very strong support network of compassionate family and friends. And I do have internal resources to manage anxiety, even when it's through the roof. Above all, I am fortunate to be cancer free. I know not all are so lucky. And I know and love some of them.
Without a shadow of a doubt, this adverse experience was speaking with me to look at things differently, if only to remind me of what's important. Here's what I got:
1) Don't sweat the small stuff. How many times have I told this to clients and now to myself? Too many to count. And it's true. If you have your health, you have everything.
2) Continue to build and lean into your social support network, near and far. These individuals get it, will listen, pray for you, send you well wishes when you need it, and help you through life's ups and downs. When we have strong social supports, we are less likely to get long term depression or anxiety, and we are more likely to live longer.
3) Place your self-care as number one. Always. Good nutrition, good sleep, exercise (preferable in nature). Say no to things that don't serve you well and yes to experiences and people who are health-enhancing.
4) Be grateful for what is going well in your life. There is always something to be grateful for, and often we don't realize how very lucky we really are until the threat of losing what's importance smacks us in the face.
5) Connect with your spirituality. It could be prayer, meditation, a Higher Power, nature, whatever connects you with a divine source and meaning for being on the planet. Allow those who share your spirituality to embrace you in comfort.
6) Take care of your ta-tas. Get them screened as often as your doctor recommends (most are yearly after age 40).
7) For medical professionals: Consider a diagnostic mammogram yearly for women with fibrocystic breasts so that false positive mammograms don't send women into anxiety unnecessarily.
8) Manage anxiety. Life will always present unknowns. When faced with an exam result that is ambiguous, anxiety inevitably skyrockets. Practice cognitive restructuring, mindfulness meditation, distraction, deep breathing, massage, aromatherapy, positive social supports, yoga, and exercise in nature.
By sharing my experience, I hope this blog is helpful to others in similar situations. You are absolutely not alone. Healing wishes to all. Namaste.
Retrieved from the web, February 9, 2018:
Andrea Schneider, MSW, LCSW