obyvatel
The Living Force
This is brief review of the very interesting book "In An Unspoken Voice - How the body releases trauma and restores goodness" by Peter Levine, PhD. Much of the information presented in the book has strong correlation to aspects of the Work and recommended psychology books like "Myth Of Sanity", "Trapped in the Mirror" etc. Levine takes a body centric sensation based approach to the understanding and healing of trauma and does a great job in providing a review of relevant neuroscience as well as behavioral studies that tie in to his approach.
Trauma and Disembodiment
[quote author=In An Unspoken Voice]
When we perceive (consciously or unconsciously) that we are in danger, specific defensive postures necessary to protect ourselves are mobilized in the body. (These are automatic and controlled by the sympathetic-adrenal component of the autonomic nervous system). The specific innate bodily responses are powerfully energized to meet extreme situations. These survival energies are organized in the brain and specifically expressed as patterned states of muscular tension in readiness for action. However, when we are activated to this level and then prevented from completing the course of action - as in fighting or fleeing - then the system moves into freeze or collapse, (controlled by the oldest phylogenetic component of the autonomic nervous system - the unmyelinated dorsal vagal complex) and the energized tension remains stuck in the muscles. In turn, these unused or partially used muscular tensions set up a stream of nerve impulses ascending the spinal cord to the thalamus (a central relay station for sensations) and then to other parts of the brain (particularly the amygdala) signaling continued presence of danger and threat. Said simply, if our muscles and guts are set to respond to danger, then our mind will tell us that we have something to fear. .............
Where the distress is generated internally (by muscles and viscera), one experiences an obsessive pressure to locate the source of threat or when that's not possible, manufacture one as a way of explaining to oneself that there is an identifiable source of threat.
Highly traumatized and chronically neglected or abused individuals are dominated by the immobilization/shutdown system. On the other hand, acutely traumatized people (often by a single recent event and without a history of repeated trauma, neglect or abuse) are generally dominated by the sympathetic fight/flight system. They tend to suffer from flashbacks and racing hearts, while the chronically traumatized individuals generally show no change or even a decrease in heart rate. These sufferers seem to be plagued with dissociative symptoms, including frequent spacyness, unreality, depersonalization and various somatic and health complaints.
...........................
Traumatized individuals are disembodied and "disemboweled" (since the gut reactions are so overwhelming that they are shut down). They are either overwhelmed by their bodily sensations or massively shut down against them. In either case, they are unable to differentiate between various sensations as well as unable to determine appropriate actions.
The degree to which we cannot deeply feel our body's interior is the degree to which we crave excessive external stimulation.
[/quote]
Acutely traumatized individuals are likely to fall in the "equivalent" and "paradoxical" states in Pavlov's famous experiments while the chronically traumatized ones exhibit "transmarginal inhibition".
For trauma therapy, Levine has his own method which he illustrates with multiple case studies. Operating from the premise that the frozen state of trauma is often a result of conflicting biological impulses, Levine guides his patients to sense the trapped energy and gently dissolve the same through focused awareness and micro-movements to re-enact and complete the unfinished, instinctual protective actions. He gives the following steps as a guide to therapy
[quote author=In An Unspoken Voice]
1. Establish an environment of relative safety - through a calm, compassionate and soothing presence.
2. Support initial exploration and acceptance of sensation - this requires the therapist to be aware of non-verbal signals given by the patient to indicate proper timing when exploration of sensations can proceed without overwhelming the patient.
3. Establish pendulation and containment - involves engaging the body's innate restorative rhythm of expansion and contraction when dealing with difficult sensations and feelings.
4. Use titration to create increasing stability, resilience and organization - by carefully touching into the smallest "drop" of survival based arousal, and other difficult sensations to prevent retraumatization
5. Provide a corrective experience by supplanting the passive responses of collapse and helplessness with active empowered defensive responses.
6. Separate or uncouple the conditioned association of fear and helplessness from the normally time limited but now maladaptive biological immobility response
7. Resolve hyper-arousal states by gently guiding the discharge and redistribution of the vast survival energy mobilized for life preserving action while freeing that energy to support higher level brain functioning - the discharge of the energies is generally achieved through involuntary shaking and trembling.
8. Engage self regulation to restore dynamic equilibrium and relaxed alertness
9. Orient to here and now, contact the environment and reestablish the capacity for social engagement - thus engaging the phylogenetically recent myelinated vagal component of the autonomic nervous system.
[/quote]
Trauma and Disembodiment
[quote author=In An Unspoken Voice]
When we perceive (consciously or unconsciously) that we are in danger, specific defensive postures necessary to protect ourselves are mobilized in the body. (These are automatic and controlled by the sympathetic-adrenal component of the autonomic nervous system). The specific innate bodily responses are powerfully energized to meet extreme situations. These survival energies are organized in the brain and specifically expressed as patterned states of muscular tension in readiness for action. However, when we are activated to this level and then prevented from completing the course of action - as in fighting or fleeing - then the system moves into freeze or collapse, (controlled by the oldest phylogenetic component of the autonomic nervous system - the unmyelinated dorsal vagal complex) and the energized tension remains stuck in the muscles. In turn, these unused or partially used muscular tensions set up a stream of nerve impulses ascending the spinal cord to the thalamus (a central relay station for sensations) and then to other parts of the brain (particularly the amygdala) signaling continued presence of danger and threat. Said simply, if our muscles and guts are set to respond to danger, then our mind will tell us that we have something to fear. .............
Where the distress is generated internally (by muscles and viscera), one experiences an obsessive pressure to locate the source of threat or when that's not possible, manufacture one as a way of explaining to oneself that there is an identifiable source of threat.
Highly traumatized and chronically neglected or abused individuals are dominated by the immobilization/shutdown system. On the other hand, acutely traumatized people (often by a single recent event and without a history of repeated trauma, neglect or abuse) are generally dominated by the sympathetic fight/flight system. They tend to suffer from flashbacks and racing hearts, while the chronically traumatized individuals generally show no change or even a decrease in heart rate. These sufferers seem to be plagued with dissociative symptoms, including frequent spacyness, unreality, depersonalization and various somatic and health complaints.
...........................
Traumatized individuals are disembodied and "disemboweled" (since the gut reactions are so overwhelming that they are shut down). They are either overwhelmed by their bodily sensations or massively shut down against them. In either case, they are unable to differentiate between various sensations as well as unable to determine appropriate actions.
The degree to which we cannot deeply feel our body's interior is the degree to which we crave excessive external stimulation.
[/quote]
Acutely traumatized individuals are likely to fall in the "equivalent" and "paradoxical" states in Pavlov's famous experiments while the chronically traumatized ones exhibit "transmarginal inhibition".
For trauma therapy, Levine has his own method which he illustrates with multiple case studies. Operating from the premise that the frozen state of trauma is often a result of conflicting biological impulses, Levine guides his patients to sense the trapped energy and gently dissolve the same through focused awareness and micro-movements to re-enact and complete the unfinished, instinctual protective actions. He gives the following steps as a guide to therapy
[quote author=In An Unspoken Voice]
1. Establish an environment of relative safety - through a calm, compassionate and soothing presence.
2. Support initial exploration and acceptance of sensation - this requires the therapist to be aware of non-verbal signals given by the patient to indicate proper timing when exploration of sensations can proceed without overwhelming the patient.
3. Establish pendulation and containment - involves engaging the body's innate restorative rhythm of expansion and contraction when dealing with difficult sensations and feelings.
4. Use titration to create increasing stability, resilience and organization - by carefully touching into the smallest "drop" of survival based arousal, and other difficult sensations to prevent retraumatization
5. Provide a corrective experience by supplanting the passive responses of collapse and helplessness with active empowered defensive responses.
6. Separate or uncouple the conditioned association of fear and helplessness from the normally time limited but now maladaptive biological immobility response
7. Resolve hyper-arousal states by gently guiding the discharge and redistribution of the vast survival energy mobilized for life preserving action while freeing that energy to support higher level brain functioning - the discharge of the energies is generally achieved through involuntary shaking and trembling.
8. Engage self regulation to restore dynamic equilibrium and relaxed alertness
9. Orient to here and now, contact the environment and reestablish the capacity for social engagement - thus engaging the phylogenetically recent myelinated vagal component of the autonomic nervous system.
[/quote]