obyvatel
The Living Force
I recently finished "Trauma and the Body: A Sensorimotor Approach to Psychotherapy" by Pat Ogden, Clare Pain and Kekuni Minton. IMO this goes well with Peter Levine's "In An Unspoken Voice", Stephen Porges's "Polyvagal Theory" and Jaak Panksepp's work on Affective Neuroscience. I had posted an excerpt from Pat Ogden's writings in the Affective Neuroscience thread and that is what got me interested in her book. This book clarified and solidified certain concepts which were introduced in the above texts as well as other psychological books, and gave a good neuro and behavioral science based background on the mechanics of "running programs". It has a good balance of theory and practical case studies which help in understanding the theoretical concepts. Here are some excerpts.
Three levels of Information Processing
Those familiar with Peter Levine's "In An Unspoken Voice" would have encountered Maclean's triune brain model. Essentially
[quote author=Trauma and the Body: A Sensorimotor Approach to Psychotherapy]
The reptilian brain, first to develop from an evolutionary perspective, governs arousal, homeostasis of the organism, and reproductive drives, and loosely relates to the sensorimotor level of information processing, including sensation and programmed movement impulses.
Correlating with emotional processing, the “paleomammalian brain” or “limbic brain,” found in all mammals, surrounds the reptilian brain and mediates emotion, memory, some social behavior, and learning (Cozolino, 2002).
Last to develop phylogenetically is the neocortex, which enables cognitive information processing, such as self-awareness and conscious thought, and includes large portions of the corpus callosum, which bridges the right and left hemispheres of the brain (MacLean, 1985) and helps consolidate information (Siegel, 1999).
Thus the three levels of information processing— cognitive, emotional, and sensorimotor— can be thought of as roughly correlating with the three levels of brain architecture. Different kinds of knowledge originate from each of these brains.
The reptilian brain produces “Innate behavioral knowledge: Basic instinctual action tendencies and habits related to primitive survival issues” (Panksepp, 1998).
The limbic system provides “Affective knowledge: Subjective feelings and emotional responses to world events” (Panksepp, 1998).
The neocortex generates “Declarative knowledge… propositional information about world” (Panksepp, 1998).
Panksepp further clarified the behavioral and functional interface of these three “brains”: The inner most reptilian core of the brain elaborates basic instinctual action plans for primitive emotive processes such as exploration, feeding, aggressive dominance displays, and sexuality. The old-mammalian brain, or the limbic system, adds behavioral and psychological resolution to all of the emotions and specifically mediates the social emotions such as separation distress/ social bonding, playfulness, and maternal nurturance. The highly expanded neomammalian cortex generates higher cognitive functions, reasoning, and logical thought. Each of the three levels of the brain thus has its own “understanding” of the environment and responds accordingly. A particular level may become dominant and override the others, depending on the internal and environmental conditions. At the same time, these three levels are mutually dependent and intertwined.
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The brain functions as an integrated whole but is comprised of systems that are hierarchically organized. The “higher level” integrative functions evolved from and are dependent on the integrity of “lower-level” structures and on and optimal functioning of higher-level structures are thought to be dependent, in part, on the development and optimal functioning of lower-level structures. In many ways sensorimotor processing is foundational to other types of processing and includes the features of a simpler, more primitive form of information processing than do its more evolved counterparts. More directly associated with overall body processing, sensorimotor processing includes physical changes in response to sensory input; the fixed action patterns seen in defenses; changes in breathing and muscular tone; and autonomic nervous system activation. With its seat in the lower, older brain structures, sensorimotor processing relies on a relatively higher number of fixed sequences of steps in the way it works. Some of these fixed sequences are well known, such as the startle reflex and the fight/ flight response. The simplest sequences are involuntary reflexes (e.g., the knee-jerk reaction), which are the most rigidly fixed and determined. More complex are the motor patterns that we learn at young ages, such as walking and running, which then become automatic. In the more highly evolved cognitive and emotional realms, we find fewer and fewer fixed sequences of steps and more complexity and variability of response. Panksepp (1998) likened this variance in complexity to the operating systems of a computer: Higher functions are typically more open, while lower ones are more reflexive, stereotyped, and closed. For instance, the basic vital functions of the brain— those that regulate organic bodily functions such as respiration— are organized at very low levels. Higher levels provide increasingly flexible control over these lower functions….
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Cognitive processing refers to the capacity for conceptualizing, reasoning, meaning making, problem solving, and decision making. It encompasses the ability to observe and abstract from experience, weigh a range of possibilities for action, plan for the accomplishment of goals, and evaluate the outcome of actions. As adults, we can override emotional and sensory responses with voluntary cognitive processing - and this is referred to as "top-down processing".
However, there is evidence to indicate that cognitive processing is inextricably linked with our bodies. Bodily feelings, or “somatic markers,” influence cognitive decision making, logic, speed, and context of thought (Damasio, 1994, 1999). The background body sensations that arise during cognitive processing form a biasing substratum that influences the functioning of the individual in all decision-making processes and self-experiences. ( This is a component of Kahneman's System 1). If the body shapes reason and beliefs— and vice versa— then the capacity for insight and self-reflection— our ability to “know our own minds”— will be correspondingly limited by the body’s influence (Lakoff & Johnson, 1999). How, then, can we begin to know our own minds? If the patterns of the body’s movements and posture influence reason, cognitive self-reflection might not be the only or even the best way of bringing the workings of the mind to consciousness. Reflecting on, exploring, and changing the posture and movement of the body may be as valuable.
Emotions add motivational coloring to cognitive processing and act as signals that direct us to notice and attend to particular cues. Emotions help us take adaptive action by calling attention to significant environmental events and stimuli (Krystal, 1978; van der Kolk,McFarlane et al., 1996). The “emotional brain directs us toward experiences we seek and the cognitive brain tries to help us get there as intelligently as possible” (Servan-Schreiber, 2003). According to Llinas, “As with muscle tone that serves as the basic platform for the execution of our movements, emotions represent the premotor platform as either drives or deterrents for most of our actions” (2001).
Traumatized people characteristically lose the capacity to draw upon emotions as guides for action. They might suffer from alexithymia, a disturbance in the ability to recognize and find words for emotions (Sifneos, 1973, 1996; Taylor, Bagby, & Parker, 1997). They may be detached from their emotions, presenting with flat affect and complaining of a lack of interest and motivation in life and an inability to take action. Or their emotions may be experienced as urgent and immediate calls to action; the capacity to reflect on an emotion and allow it to be part of the data that guides action is lost and its expression becomes explosive and uncontrolled.
The term emotional processing refers to the capacity to experience, describe, express, and integrate affective states (Brewin, Dalgleish, & Joseph, 1996). Emotions usually follow a phasic pattern with a beginning, middle, and an end (Frijda, 1986). However, for many traumatized individuals, the end never arrives. Emotional responses to very strong stimuli, such as trauma, do not appear to extinguish (Frijda, 1986)— a phenomenon that has been demonstrated in animal research by LeDoux that emotional memory may be forever (LeDoux, 1996). Traumatized individuals are often fixated on trauma-related emotions of grief, fear, terror, or anger. There might be a variety of reasons for this fixation: denial or lack of awareness of the connection between current emotions and past trauma; attempts to avoid more painful emotions; the inability to “think clearly” (Leitenberg, Greenwald, & Cado, 1992); or the inability to distinguish emotions from bodily sensations (Ogden & Minton, 2000). Moreover, the emotions may relate to a variety of past events rather than only one (Frijda, 1986). All these elements contribute to a circular, apparently never-ending reexperiencing of trauma-related emotions.
Emotions are matters of the body - of the heart, the stomach, and intestines, of bodily activity and impulse.Whether we are aware of these internal sensations or not, they both contribute to, and are the result of, emotions. Butterflies in the stomach tell us we are excited, a heavy feeling in the chest speaks of grief, tension in the jaw informs us we are angry, an all-over tingling feeling indicates fear. Damasio stated that emotions have two features: first, the internal sensation, which is “inwardly directed and private,” and second, visible feature, which is “outwardly directed and public” (1999). Internal emotional states are thus experienced as subjective bodily sensations and are reflected in our outward presentation, giving signals to others around us about how we feel. Anger might be visible in the purse of the mouth, clenched fists, narrowed eyes, and general bodily tension. Fear may be communicated in hunched shoulders, held breath, and a pleading look in the eyes or in a bracing or moving away from the frightening stimulus. These bodily stances might be an immediate response to a current situation or a chronic, pervasive emotional state.
However, despite the inextricable involvement of emotions with the body and cognitions, when trauma-related emotions such as terror are coupled with body sensation, such as trembling, the client is encouraged to distinguish body sensations and movements from emotions. In these instances, we help clients differentiate emotional processing from sensorimotor processing. In our vernacular, emotional processing pertains to experiencing, articulating, and integrating emotions, whereas sensorimotor processing refers to experiencing, articulating, and integrating physical/ sensory perception, body sensation, physiological arousal, and motor functioning. This differentiation between these two levels of processing is important in trauma therapy because clients often fail to discriminate between body sensations of arousal or movement and emotional feeling, which can lead to the escalation of both. If body sensations (e.g., trembling, rapid heart rate) are interpreted as an emotion (e.g., panic), each level of experience— sensorimotor and emotional— inflates and compounds the other. Both the rapid heart rate and the panic are exacerbated when experienced simultaneously. If cognition in the form of a belief is then added, such as “I am not safe,” physical sensation and emotion will further intensify. In such a situation, arousal can escalate beyond the person’s tolerance, and integrative capacity will be compromised. Physiological arousal can be addressed, and often diminished, by uncoupling trauma-related emotion from body sensation through attending exclusively to the physical sensations of the arousal (without attributing meaning or emotion to them). Then, after the physiological arousal returns to a tolerable level, the client can look at the emotional contents of the traumatic experience and integrate both.
In the clinical practice of sensorimotor psychotherapy, we identify three general components of sensorimotor processing : inner-body sensation, five-sense perception, and movement.
The term inner-body sensation refers to the myriad of physical feelings that are continually created by movement of all sorts within the body. When a change occurs in the body, such as a hormonal shift or a muscular spasm, this change may be felt as an inner-body sensation. The contraction of the intestines, circulation of fluids, biochemical changes, the movements of breathing, or the movements of muscles, ligaments, or bones all cause inner-body sensations.
People with trauma-related disorders suffer from both “feeling too much” and “feeling too little” (van der Kolk, 1994). They often experience inner-body sensations as overwhelming and distressing. The “rush” of adreneline or the sensations of a rapid heartbeat or of bodily tension are felt acutely and become more disconcerting when interpreted as indicating current danger. Conversely, traumatized individuals commonly suffer from an inability to be aware of body sensation, or an inability to put words to sensation, known as alexisomia (Bakal, 1999; Ikemi & Ikemi, 1986). The absence of body sensation and the accompanying interpretation (e.g., “There is something wrong” “I can’t feel my body” “I feel dead”) can be just as distressing as experiencing too much sensation.
Five sense perception Sometimes called exteroception, the sensory nerves of our five senses receive and transmit information from stimuli in the external environment. The process of taking in information through the five senses can be thought of as having two components: the physical act of sensing and the individual’s perception of the sensory input (Cohen, 1993). Sensory perceptions may dominate traumatized individuals’ capacity to think rationally.
Because it is based on the comparison of sensory input with internal frames of reference, our perception— and thus our behavior— is self-referential (Damasio, 1994). Our beliefs and emotional reactions to previous similar sensory stimuli condition our relationship with current stimuli. Without the expectations that influence perceptual priming, each sensory experience would be novel, and we would be quickly overwhelmed. Instead, we fit sensory input into learned categories. Ratey pointed out that “we are constantly priming our perceptions, matching the world to what we expect to sense and thus making it what we perceive it to be” (2002). This priming function becomes maladaptive for traumatized individuals, who repeatedly notice and take in sensory cues that are reminiscent of past trauma, often failing to notice concomitant sensory cues indicating that current reality is not dangerous.
Movement is included in the sensorimotor level of information processing because of its obvious somatic component, although the frontal lobes of the cortex, rather than the subcortical areas of the brain, are home to the motor cortex and premotor cortex and are responsible for many forms of movement. The same areas of the brain that generate reason and help us solve problems are also involved in movement. Thus movement has shaped, and continues to shape, our minds (Janet, 1925), and vice versa, as articulated by Llinas: “The mind… is the product of evolutionary processes that have occurred in the brain as actively moving creatures developed from the primitive to the highly evolved” (2001). Movement is essential for the development of all brain functions: Only organisms that move from one location to another require a brain; organisms that are stationary do not (Ratey, 2002).
Todd (1959) taught that function precedes structure: The same movement made over and over again ultimately molds the body. For example, when the muscular contractions that prime defensive movements are repeated many times, these contractions turn into physical patterns that affect the body’s structure, which in turn, further affects function. Over a long period of time, this chronic tension interferes with the body’s natural alignment and movement, creates physical problems (most notably, back, neck, and shoulder pain), and even sustains corresponding emotions and cognitions. Kurtz and Prestera noted: “Such physical patterns become fixed by time, affecting growth and body structure, and characterizing not just the moment, but the person. Rather than simply a present disappointment, the crushed posture of hopelessness could be pointing to a lifetime of endless frustration, and bitter failure” (1976).
Repetitive movements and postures thus contribute to the maintenance of cognitive and emotional tendencies by creating a position from which only select emotions and physical actions are possible (Barlow, 1973). We often notice the posture of the startle response in traumatized clients: shoulders up, breath held, head pulled down and forward into the shoulder girdle, similar to a “deer in the headlights.” The action of the startle response disturbs the aligned balance between head and shoulders and is usually temporary, but if this normal response to a sudden novel stimulus becomes chronic, the physical organization itself may predispose the individual to experience emotions of fear and distrust and thoughts of impending danger on a chronic basis.
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COGNITIVE, EMOTIONAL, AND SENSORIMOTOR ACTION TENDENCIES
An action tendency is a propensity to implement or carry out a particular action. Action tendencies are formed on cognitive, emotional, and sensorimotor levels. Tendencies stem from procedural memory of processes and functions, reflected in habitual responses and conditioned behavior (Schacter, 1996). Procedural learning involves repeated iterations of movements, perceptions, cognitive and emotional processes, or combinations of these (Grigsby & Stevens, 2000). The original events from which these automatic personal processes and routines are learned have usually been forgotten. Actions that are procedurally learned “do not require conscious or unconscious mental representations, images, motivations or ideas to operate” (Grigsby & Stevens, 2000). Operating nonconsciously, procedural learning on all three levels of information processing turns into automatic action tendencies that become crucial organizers of behavior. Long after environmental conditions have changed, we remain in a state of readiness to perform the mental (cognitive and emotional) and sensorimotor actions that were adaptive in the past. For example, the child who learns that it is safer to back away from adults when either she or they are distressed, instead of seeking proximity, might develop action tendencies of avoidance-oriented postural adjustments (turned away, looking at the ground to avoid eye contact), movement impulses that lead to backing away, emotional responses such as fear, and cognitive belief systems such as “It’s not safe to seek comfort.”
These action tendencies “have the character of urges or impulses. They lie in waiting for signs that they can or may be executed; they, and their execution, tend to persist in the face of interruptions; they tend to interrupt other ongoing programs and actions; and they tend to preempt the information processing facilities” (Frijda, 1986). In broad terms, an action tendency is a readiness for specific behavior. This “readiness” means that the action tendency exists within the person in latent form and becomes activated in response to specific internal or external stimuli. Maladaptive actions tendencies conditioned from the past are triggered by internal and environmental reminders of the past and take precedence when other actions might prove more adaptive. Once procedures become automatic tendencies, we no longer use top-down processes to regulate them.
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As we know, roots of most action tendencies lie in early childhood experiences. Bowlby's attachment theory gives a framework to look at such patterns. Secure attachments give a child a stable foundation to embark on the life journey. Insecure attachment patterns give rise to certain deficits which continue to affect lives as adults.
[quote author=Trauma And the Body]
INSECURE-AVOIDANT ATTACHMENT
Mothers of insecure-avoidant infants actively thwart or block proximity-seeking behavior of the infant, responding instead by withdrawing or even pushing the child away (Ainsworth et al., 1978; Schore, 2003a). These mothers appear to have a general distaste for physical contact except on their terms and may respond to the infant’s overtures with wincing, arching away, or avoiding mutual gaze (Cassidy & Shaver, 1999; Schore, 2003a; Siegel, 1999). The child adapts to this affectively laden somatic communication of unavailability by expressing little need for proximity, and apparently little interest in adult overtures for contact. And, when contact is made, the avoidant child does not sustain it, focusing instead on toys and objects rather than on the mother. He generally avoids eye contact with her and shows few visible signs of distress upon separation, although some researchers (Fox & Card, 1999; Main, 1995) have found evidence of autonomic arousal in these toddlers even when they appear behaviorally indifferent to the mother. Upon reunion, they actively ignore or even avoid the mother by moving or leaning away when picked up (Main & Morgan, 1996). They generally do not seek proximity with caregivers and are reserved emotionally.
Children with insecure-avoidant attachment patterns are described as having a dismissive stance towards the importance of attachment in adulthood. They often distance themselves from others, undervalue interpersonal relationships, become self-reliant, and tend to view emotions with cynicism. Clients with insecure-avoidant attachment histories tend to withdraw under stress and avoid seeking emotional support from others. With a compromised social engagement system and limited access to internal states, these clients typically minimize their attachment needs. Preferring autoregulation to interactive, they may find dependence frightening or unpleasant and avoid situations that stimulate attachment needs.
The body tendencies vary; through muscular tonicity or rigidity these clients might show that they are more comfortable with defensive movements than with reaching out or moving toward. For example, one adult client found it unfamiliar and uncomfortable to reach out with her arms and did so awkwardly and stiffly, saying that it was easier to push away than to reach out for contact when no one had ever responded. As they are approached, these clients may pull back or become more armored. Others withdraw through a demeanor of passivity, often reflected in low muscular tonicity, and lack of response to relational overtures. Many clients demonstrate mixed tone: high tone in certain areas of the body, and low tone in other areas, as in the client who was strong and muscular through her legs but weak and flaccid through her arms. A lack of emotional expression and eye contact and a lower level of overall arousal are also correlated with this attachment group (Cozolino, 2002).
In a sensorimotor approach, somatic interventions that strengthen interactive regulation and social engagement (reaching out, seeking proximity, eye contact) provide effective avenues of exploration. Children with insecure-avoidant attachment histories have a more complicated balance to attain between their need for caregiver proximity and their tolerance of anxiety; this adaptation may be subsequently reflected in a disjunction or disconnection between their interior needs and their external behavior. These incongruent patterns are apparent in our adult clients, too. For instance, the client who sits on the couch, visibly uncomfortable, may respond to the question “How are you doing?” or “How are you feeling in your body” with a smile and “Fine.” This client’s disconnection between her physical or emotional discomfort and her reported psychological state demonstrates an incongruence or mismatch between her inner psychological and somatic states, of which she is frequently genuinely unaware. Treatment for these clients includes becoming aware of internal states and practicing physical movements that accurately correspond to these states.
INSECURE-AMBIVALENT ATTACHMENT
The mother of the infant who develops insecure-ambivalent attachment patterns is inconsistent and unpredictable in her response to the infant. She may either over-arouse the infant or fail to help the infant engage. Because her interactions are often a response to her own emotional needs and moods rather than the infant’s, this caregiver might stimulate the infant into high arousal even when the infant is attempting to down-regulate by gaze aversion. Thus, when the mother’s own emotional need for engagement overrides the infant’s need, her behavior intrudes on the infant causing dysregulation of the infant’s arousal. Because the car giver is inconsistent in her availability, sometimes allowing and encouraging proximity and sometimes not, the child is unsure of the reliability of the caregiver’s response to his or her somatic and affective communications (Belsky, Rosenberg, & Crnic, 1995; Carlson, Armstrong, Lowenstein, & Roth, 1998; Main, 1995). This uncertainty results in infants who appear cautious, distraught, angry, distressed, and preoccupied throughout both separation from, and reunion with, the mother. Upon reunion, they typically fail to be comforted by the caregiver’s presence or soothing (Main & Morgan, 1996), often continuing to cry. These infants characteristically appear irritable, have difficulty recovering from stress, show poor impulse control, fear abandonment, and engage in acting-out behavior (Allen, 2001). One example of the ambivalence such infants show with the unpredictable parent is to alternate between angry, rejecting behaviors and contact-seeking behaviors upon reunion with the mother after separation.
Children with insecure-ambivalent patterns have a “difficult temperament” with “tendencies to intense expressiveness and negative mood responses, slow adaptability to change, and irregularity of biological functions” (Schore, 2003a). Children with insecure-ambivalent insecure-ambivalent attachment histories are described as having a preoccupied stance toward attachment in adulthood. They are preoccupied with attachment needs, overly dependent on others, and might have a tendency toward enmeshment and intensity in interpersonal relationships, with a preference for proximity. They focus excessively on internal distress, often pursuing relief frantically (Cassidy & Shaver, 1999). With a compromised social engagement system, these clients are often unable to recognize safety within the relationship. Preoccupied with the availability of attachment figures (including the therapist), they frequently experience increased affect and bodily agitation and increase or loss of muscular tone at the prospect of separation.
A sensorimotor approach would facilitate autoregulatory capabilities through a development of grounding, boundaries, and core internal support as well as promote adaptive interactive regulatory abilities (see Chapter 10). Children with insecure-ambivalent attachment patterns may demonstrate more congruency between internal states and external physical movement than insecure-avoidant children, but their behavior is often dysregulated. Their physical movement may be uncontained, geared more toward discharge of high arousal than toward the purposeful achievement of a specific goal. For example, a child may frantically cry and flail when the attachment system is aroused, rather than execute directional, purposeful movement toward the caregiver. The movement may take the form of agitation that does not translate into a tempered, purposeful movement that accomplishes a particular goal. In a sensorimotor approach with adult clients with insecure ambivalent attachment histories, learning to tolerate high emotional and physiological arousal and execute thoughtful, purposeful action rather than dysregulated, non-directional movement is essential.
Disorganized/ Disoriented Attachment
Main and her colleagues (Main, 1995; Main & Hesse, 1990; Main & Solomon, 1990) observed a group of children who had puzzling and contradictory sets of responses to their mothers upon reunion after separation. The researchers also observed the mothers, whose behavior they evaluated as “frightening” (e.g., looming behaviors, sudden movements, sudden invasion, attack postures) or “frightened” (e.g., backing away, exaggerated startle response, retraction in reaction to the infant, a fearful voice or facial expression) (Main & Hesse, 1990). In addition, these mothers may exhibit role confusion (e.g., eliciting reassurance from the child), disorientation( e.g., trance-like expression, aimless wandering in response to the infant’s cries), intrusive behavior (e.g., pulling the child by the wrist, mocking and teasing, withholding a toy) or withdrawal (e.g., not greeting the infant, not interacting verbally, gaze avoidance) (Lyons-Ruth, 2001). These caregivers often provoked sudden state switches without providing interactive repair. Sometimes the caregivers (usually the mother) of these children may be abusive or neglectful or both. Such a caregiver induces traumatic states of enduring negative affect. Because her attachment is weak, she provides little protection against other potential abusers of the infant…. This caregiver is inaccessible and reacts to her infant’s expressions of emotion and stress inappropriately and/ or rejectingly, and shows minimal or unpredictable participation in the various types of arousal-regulating processes. Instead of modulating, she induces extreme levels of stimulation and arousal, either too high in abuse or too low in neglect, and because she provides no interactive repair, the infant’s intense negative emotional states last for long periods of time. (Schore, submitted) Because this misattuned caregiver shows little or no attempt to recognize or repair breaches in relatedness, the infant is left in hyper-or hypoaroused zones for extended periods of time. Main and Solomon (1986, 1990) named the attachment pattern that developed from such caregiving the disorganized/ disoriented style and identified seven categories of behavior indicative of this style:
1) Sequential contradictory behavior; for example, proximity seeking followed by freezing, withdrawal, or dazed behavior.
2) Simultaneous contradictory behavior, such as avoidance combined with proximity seeking.
3) Incomplete, interrupted, or undirected behavior and expressions, such as distress accompanied by moving away from the attachment figure.
4) Mistimed, stereotypical, or asymmetrical movements,and strange, anamolous behavior, such as stumbling when the mother is present and there is no clear reason to stumble.
5) Movements and expressions indicative of freezing, stilling, and “underwater” actions.
6) Postures that indicate apprehension of the caregiver, such as fearful expressions or hunched shoulders.
7) Behavior that indicates disorganization or disorientation, such as aimless wandering around, labile affect, or dazed, confused expressions.
Main and Solomon observed that these infants’ “approach movements were continually being inhibited and held back through simultaneous activation of avoidant tendencies. In most cases, however, proximity-seeking sufficiently ‘over-rode’ avoidance to permit the increase in physical proximity. Thus, contradictory patterns were activated but were not mutually inhibited” (1986). Versions of these incongruent behaviors are observed in traumatized adults, especially in the context of discussing past relational trauma or past or current attachment relationships, including the relationship with the therapist. In clinical contexts, therapists often are confused by what seem like paradoxical responses to contact and apparent relational discontinuity. For example, Lisa frequently complained that “no one is there for me” and begged her therapist for more contact: to sit closer, to hold her hand if she cried, to call to see how she felt during the week. Yet, in sessions, Lisa consistently seated herself in such a way that she was facing away from the therapist and orienting toward the floor and sofa, and her body stiffened when the therapist moved her chair closer (at Lisa’s request). Proximity seeking emerged in her verbal communication, whereas avoidance was communicated physically: her body held back the approach, avoiding even eye contact. The often confusing incongruent and contradictory behavior observed in these infants, and in clients such as Lisa, can be understood as the result of simultaneous or alternating stimulation of two opposing psychobiological systems: attachment and defense (Liotti, 1999a; Lyons-Ruth & Jacobvitz, 1999; Main & Morgan, 1996; Ogawa, Sroufe, Weinfield, Carlson, & Egeland, 1997; Van der Hart et al., 2004). An infant predictably seeks proximity to the caregiver when distressed, but if the caregiver further distresses the infant instead of providing comfort and safety, an irresolvable paradox ensues (Main & Solomon, 1986). The infant cannot satisfactorily approach, flee, or reorient his or her attention. When the attachment system is aroused, proximity-seeking behaviors are mobilized. But when the defensive system is aroused, flight, fight, freeze, or hypoarousal/ feigned death responses are mobilized. The disorganized/ disoriented infant experiences the alternating or simultaneous stimulation of these two opposing psychobiological systems. Steele, Van der Hart, and Nijenhuis (2001) have challenged the notion that this attachment paradigm is, in fact, “disorganized” (see also Jaffe et al., 2001). They have proposed that, in the context of frightened and/ or frightening caregiving, disorganized/ disoriented attachment is actually an organized, logical response caused by the concurrent activation of both the defensive and attachment systems: the social engagement system and the sympathetic and dorsal vagal systems are thought to be simultaneously or alternately stimulated. In childhood trauma and neglect, disorganized/ disorientated attachment as a strategy is a logical outcome. The ongoing threat of frightened and frightening caregiving evokes the action tendencies of both proximity seeking and defense. This attachment behavior has been demonstrated in 80% of maltreated infants (Carlson et al., 1998) and is a statistically significant predictor of both dissociative disorders (Carlson et al., 1998; Liotti, 1992) and aggressive behavior (Lyons-Ruth & Jacobvitz, 1999).
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Each attachment pattern show some distinctive features of emotional self- regulation. In auto-regulation, the person relies on him/herself while in interactive regulation, others are sought via the social engagement system. For securely attached individuals, both auto and interactive regulatory abilities are developed and applied appropriately.
[quote author=Trauma and the Body]
The child with an insecure-avoidant history may depend upon autoregulation and parasympathetic (dorsal vagal) dominance (Cozolino, 2002;Schore, 2003a) to self-regulate, most likely experiencing increased dorsal vagal tone characterized, in the extreme, by feelings of helplessness and lower levels of activity (i.e., a state of conservation and withdrawal) (Schore, 2003a). With a tendency to curtail the expression of emotion (Cassidy & Shaver, 1999), this “overregulation” indicates a reduced capacity to experience either positive or negative affect and may contribute to a low threshold of arousal in socioemotional contexts and to modulation imbalances( i.e., difficulty shifting out of low arousal states and moderating high arousal). This child, in the relative absence of an available caregiver, is robbed of the opportunity for satisfying social engagement and typically develops a preference for autoregulatory tendencies that do not depend on another’s presence. He or she may learn to modulate arousal in solitude, turning inward through reading, daydreaming, and worlds of fantasy. Although generally compliant, the child may express frustration in peer relationships where avoidant attachment behaviors are sometimes associated with hostility, aggressiveness, and conduct problems (Allen, 2001; Crittenden, 1995; Sroufe, 1997; Weinfield, Stroufe, Egeland, & Carlson, 1999). Interactive regulatory and social engagement abilities necessary for resolving interpersonal conflicts are often underdeveloped in such individuals.
On the other hand, children with insecure-ambivalent attachment patterns tend to have a sympathetically dominant nervous system (Cozolino, 2002; Schore, 2003a) with a low threshold of arousal and concurrent difficulty maintaining arousal within a window of tolerance. The inconsistent responsiveness of the primary caregiver has taught the child to increase signaling for attention, escalating distress in order to solicit caregiving (Allen, 2001). These children are biased toward undercontrolled high-arousal states, with increased emotional reactivity combined with an inability to modulate distress, leaving them vulnerable to underregulatory disturbances (Schore, 2003a). Less able to autoregulate, as adults these individuals find isolation stressful: Because they have trouble tolerating solitude, they cling to relational contact, becoming overly dependent on interactive regulation but simultaneously experiencing a lack of ability to be easily calmed and soothed in a relationship. Although social engagement is sought, the person remains biased toward hyperarousal, in part due to hypervigilence developed from previous experience of intrusive behavior by the primary attachment figure.
Disorganized-Disoriented Attachment and Regulation: Hyper-and hypoarousal are both involved in the infant’s psychobiological response to frightened or frightening caregivers, with whom the social engagement system is functionally off-line for much of the time. Disorganized/ disoriented attachment patterns in children has been associated with elevated heart rates, intense alarm reactions, higher cortisol levels, and behavior that may indicate increased dorsal vagal tone, such as stilling, going into a brief trance, unresponsiveness, and shutting down (Schore, 2001). In the initial stage of threat, infants demonstrate sympathetic activation accompanied by startle reactions, elevated heart rate, respiration, and blood pressure, and usually crying or screaming (Schore, submitted). However, when sympathetic arousal cannot be regulated, a quick shift to hypoarousal may occur. The body undergoes “the sudden and rapid transition from an unsuccessful strategy of struggling requiring massive sympathetic activation to the metabolically conservative immobilized state mimicking death associated with the dorsal vagal complex” (Porges, 2001a). Thus sympathetically mediated responses quickly change “from interactive regulatory modes into long-enduring less complex autoregulatory modes” (Schore, submitted). During these hypoaroused conditions, observed in newborns (Bergman, Linley, & Fawcus, 2004; Spitz, 1946), the infant is unresponsive to interactive regulation (Schore, submitted). Early relational trauma generates prolonged negative affective and physiological states in the infant, which, in turn, “generate immature and inefficient orbitofrontal systems, thereby precluding higher complex forms of affect regulation” (Schore, submitted). These negative states also leave the child with a compromised social engagement system. .....underdeveloped or ineffective interactive regulatory abilities, as well as impaired autoregulatory capacities; they remain in, or alternate between, hyper-or hypoarousal zones for extended periods of time.
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Three levels of Information Processing
Those familiar with Peter Levine's "In An Unspoken Voice" would have encountered Maclean's triune brain model. Essentially
[quote author=Trauma and the Body: A Sensorimotor Approach to Psychotherapy]
The reptilian brain, first to develop from an evolutionary perspective, governs arousal, homeostasis of the organism, and reproductive drives, and loosely relates to the sensorimotor level of information processing, including sensation and programmed movement impulses.
Correlating with emotional processing, the “paleomammalian brain” or “limbic brain,” found in all mammals, surrounds the reptilian brain and mediates emotion, memory, some social behavior, and learning (Cozolino, 2002).
Last to develop phylogenetically is the neocortex, which enables cognitive information processing, such as self-awareness and conscious thought, and includes large portions of the corpus callosum, which bridges the right and left hemispheres of the brain (MacLean, 1985) and helps consolidate information (Siegel, 1999).
Thus the three levels of information processing— cognitive, emotional, and sensorimotor— can be thought of as roughly correlating with the three levels of brain architecture. Different kinds of knowledge originate from each of these brains.
The reptilian brain produces “Innate behavioral knowledge: Basic instinctual action tendencies and habits related to primitive survival issues” (Panksepp, 1998).
The limbic system provides “Affective knowledge: Subjective feelings and emotional responses to world events” (Panksepp, 1998).
The neocortex generates “Declarative knowledge… propositional information about world” (Panksepp, 1998).
Panksepp further clarified the behavioral and functional interface of these three “brains”: The inner most reptilian core of the brain elaborates basic instinctual action plans for primitive emotive processes such as exploration, feeding, aggressive dominance displays, and sexuality. The old-mammalian brain, or the limbic system, adds behavioral and psychological resolution to all of the emotions and specifically mediates the social emotions such as separation distress/ social bonding, playfulness, and maternal nurturance. The highly expanded neomammalian cortex generates higher cognitive functions, reasoning, and logical thought. Each of the three levels of the brain thus has its own “understanding” of the environment and responds accordingly. A particular level may become dominant and override the others, depending on the internal and environmental conditions. At the same time, these three levels are mutually dependent and intertwined.
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The brain functions as an integrated whole but is comprised of systems that are hierarchically organized. The “higher level” integrative functions evolved from and are dependent on the integrity of “lower-level” structures and on and optimal functioning of higher-level structures are thought to be dependent, in part, on the development and optimal functioning of lower-level structures. In many ways sensorimotor processing is foundational to other types of processing and includes the features of a simpler, more primitive form of information processing than do its more evolved counterparts. More directly associated with overall body processing, sensorimotor processing includes physical changes in response to sensory input; the fixed action patterns seen in defenses; changes in breathing and muscular tone; and autonomic nervous system activation. With its seat in the lower, older brain structures, sensorimotor processing relies on a relatively higher number of fixed sequences of steps in the way it works. Some of these fixed sequences are well known, such as the startle reflex and the fight/ flight response. The simplest sequences are involuntary reflexes (e.g., the knee-jerk reaction), which are the most rigidly fixed and determined. More complex are the motor patterns that we learn at young ages, such as walking and running, which then become automatic. In the more highly evolved cognitive and emotional realms, we find fewer and fewer fixed sequences of steps and more complexity and variability of response. Panksepp (1998) likened this variance in complexity to the operating systems of a computer: Higher functions are typically more open, while lower ones are more reflexive, stereotyped, and closed. For instance, the basic vital functions of the brain— those that regulate organic bodily functions such as respiration— are organized at very low levels. Higher levels provide increasingly flexible control over these lower functions….
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Cognitive processing refers to the capacity for conceptualizing, reasoning, meaning making, problem solving, and decision making. It encompasses the ability to observe and abstract from experience, weigh a range of possibilities for action, plan for the accomplishment of goals, and evaluate the outcome of actions. As adults, we can override emotional and sensory responses with voluntary cognitive processing - and this is referred to as "top-down processing".
However, there is evidence to indicate that cognitive processing is inextricably linked with our bodies. Bodily feelings, or “somatic markers,” influence cognitive decision making, logic, speed, and context of thought (Damasio, 1994, 1999). The background body sensations that arise during cognitive processing form a biasing substratum that influences the functioning of the individual in all decision-making processes and self-experiences. ( This is a component of Kahneman's System 1). If the body shapes reason and beliefs— and vice versa— then the capacity for insight and self-reflection— our ability to “know our own minds”— will be correspondingly limited by the body’s influence (Lakoff & Johnson, 1999). How, then, can we begin to know our own minds? If the patterns of the body’s movements and posture influence reason, cognitive self-reflection might not be the only or even the best way of bringing the workings of the mind to consciousness. Reflecting on, exploring, and changing the posture and movement of the body may be as valuable.
Emotions add motivational coloring to cognitive processing and act as signals that direct us to notice and attend to particular cues. Emotions help us take adaptive action by calling attention to significant environmental events and stimuli (Krystal, 1978; van der Kolk,McFarlane et al., 1996). The “emotional brain directs us toward experiences we seek and the cognitive brain tries to help us get there as intelligently as possible” (Servan-Schreiber, 2003). According to Llinas, “As with muscle tone that serves as the basic platform for the execution of our movements, emotions represent the premotor platform as either drives or deterrents for most of our actions” (2001).
Traumatized people characteristically lose the capacity to draw upon emotions as guides for action. They might suffer from alexithymia, a disturbance in the ability to recognize and find words for emotions (Sifneos, 1973, 1996; Taylor, Bagby, & Parker, 1997). They may be detached from their emotions, presenting with flat affect and complaining of a lack of interest and motivation in life and an inability to take action. Or their emotions may be experienced as urgent and immediate calls to action; the capacity to reflect on an emotion and allow it to be part of the data that guides action is lost and its expression becomes explosive and uncontrolled.
The term emotional processing refers to the capacity to experience, describe, express, and integrate affective states (Brewin, Dalgleish, & Joseph, 1996). Emotions usually follow a phasic pattern with a beginning, middle, and an end (Frijda, 1986). However, for many traumatized individuals, the end never arrives. Emotional responses to very strong stimuli, such as trauma, do not appear to extinguish (Frijda, 1986)— a phenomenon that has been demonstrated in animal research by LeDoux that emotional memory may be forever (LeDoux, 1996). Traumatized individuals are often fixated on trauma-related emotions of grief, fear, terror, or anger. There might be a variety of reasons for this fixation: denial or lack of awareness of the connection between current emotions and past trauma; attempts to avoid more painful emotions; the inability to “think clearly” (Leitenberg, Greenwald, & Cado, 1992); or the inability to distinguish emotions from bodily sensations (Ogden & Minton, 2000). Moreover, the emotions may relate to a variety of past events rather than only one (Frijda, 1986). All these elements contribute to a circular, apparently never-ending reexperiencing of trauma-related emotions.
Emotions are matters of the body - of the heart, the stomach, and intestines, of bodily activity and impulse.Whether we are aware of these internal sensations or not, they both contribute to, and are the result of, emotions. Butterflies in the stomach tell us we are excited, a heavy feeling in the chest speaks of grief, tension in the jaw informs us we are angry, an all-over tingling feeling indicates fear. Damasio stated that emotions have two features: first, the internal sensation, which is “inwardly directed and private,” and second, visible feature, which is “outwardly directed and public” (1999). Internal emotional states are thus experienced as subjective bodily sensations and are reflected in our outward presentation, giving signals to others around us about how we feel. Anger might be visible in the purse of the mouth, clenched fists, narrowed eyes, and general bodily tension. Fear may be communicated in hunched shoulders, held breath, and a pleading look in the eyes or in a bracing or moving away from the frightening stimulus. These bodily stances might be an immediate response to a current situation or a chronic, pervasive emotional state.
However, despite the inextricable involvement of emotions with the body and cognitions, when trauma-related emotions such as terror are coupled with body sensation, such as trembling, the client is encouraged to distinguish body sensations and movements from emotions. In these instances, we help clients differentiate emotional processing from sensorimotor processing. In our vernacular, emotional processing pertains to experiencing, articulating, and integrating emotions, whereas sensorimotor processing refers to experiencing, articulating, and integrating physical/ sensory perception, body sensation, physiological arousal, and motor functioning. This differentiation between these two levels of processing is important in trauma therapy because clients often fail to discriminate between body sensations of arousal or movement and emotional feeling, which can lead to the escalation of both. If body sensations (e.g., trembling, rapid heart rate) are interpreted as an emotion (e.g., panic), each level of experience— sensorimotor and emotional— inflates and compounds the other. Both the rapid heart rate and the panic are exacerbated when experienced simultaneously. If cognition in the form of a belief is then added, such as “I am not safe,” physical sensation and emotion will further intensify. In such a situation, arousal can escalate beyond the person’s tolerance, and integrative capacity will be compromised. Physiological arousal can be addressed, and often diminished, by uncoupling trauma-related emotion from body sensation through attending exclusively to the physical sensations of the arousal (without attributing meaning or emotion to them). Then, after the physiological arousal returns to a tolerable level, the client can look at the emotional contents of the traumatic experience and integrate both.
In the clinical practice of sensorimotor psychotherapy, we identify three general components of sensorimotor processing : inner-body sensation, five-sense perception, and movement.
The term inner-body sensation refers to the myriad of physical feelings that are continually created by movement of all sorts within the body. When a change occurs in the body, such as a hormonal shift or a muscular spasm, this change may be felt as an inner-body sensation. The contraction of the intestines, circulation of fluids, biochemical changes, the movements of breathing, or the movements of muscles, ligaments, or bones all cause inner-body sensations.
People with trauma-related disorders suffer from both “feeling too much” and “feeling too little” (van der Kolk, 1994). They often experience inner-body sensations as overwhelming and distressing. The “rush” of adreneline or the sensations of a rapid heartbeat or of bodily tension are felt acutely and become more disconcerting when interpreted as indicating current danger. Conversely, traumatized individuals commonly suffer from an inability to be aware of body sensation, or an inability to put words to sensation, known as alexisomia (Bakal, 1999; Ikemi & Ikemi, 1986). The absence of body sensation and the accompanying interpretation (e.g., “There is something wrong” “I can’t feel my body” “I feel dead”) can be just as distressing as experiencing too much sensation.
Five sense perception Sometimes called exteroception, the sensory nerves of our five senses receive and transmit information from stimuli in the external environment. The process of taking in information through the five senses can be thought of as having two components: the physical act of sensing and the individual’s perception of the sensory input (Cohen, 1993). Sensory perceptions may dominate traumatized individuals’ capacity to think rationally.
Because it is based on the comparison of sensory input with internal frames of reference, our perception— and thus our behavior— is self-referential (Damasio, 1994). Our beliefs and emotional reactions to previous similar sensory stimuli condition our relationship with current stimuli. Without the expectations that influence perceptual priming, each sensory experience would be novel, and we would be quickly overwhelmed. Instead, we fit sensory input into learned categories. Ratey pointed out that “we are constantly priming our perceptions, matching the world to what we expect to sense and thus making it what we perceive it to be” (2002). This priming function becomes maladaptive for traumatized individuals, who repeatedly notice and take in sensory cues that are reminiscent of past trauma, often failing to notice concomitant sensory cues indicating that current reality is not dangerous.
Movement is included in the sensorimotor level of information processing because of its obvious somatic component, although the frontal lobes of the cortex, rather than the subcortical areas of the brain, are home to the motor cortex and premotor cortex and are responsible for many forms of movement. The same areas of the brain that generate reason and help us solve problems are also involved in movement. Thus movement has shaped, and continues to shape, our minds (Janet, 1925), and vice versa, as articulated by Llinas: “The mind… is the product of evolutionary processes that have occurred in the brain as actively moving creatures developed from the primitive to the highly evolved” (2001). Movement is essential for the development of all brain functions: Only organisms that move from one location to another require a brain; organisms that are stationary do not (Ratey, 2002).
Todd (1959) taught that function precedes structure: The same movement made over and over again ultimately molds the body. For example, when the muscular contractions that prime defensive movements are repeated many times, these contractions turn into physical patterns that affect the body’s structure, which in turn, further affects function. Over a long period of time, this chronic tension interferes with the body’s natural alignment and movement, creates physical problems (most notably, back, neck, and shoulder pain), and even sustains corresponding emotions and cognitions. Kurtz and Prestera noted: “Such physical patterns become fixed by time, affecting growth and body structure, and characterizing not just the moment, but the person. Rather than simply a present disappointment, the crushed posture of hopelessness could be pointing to a lifetime of endless frustration, and bitter failure” (1976).
Repetitive movements and postures thus contribute to the maintenance of cognitive and emotional tendencies by creating a position from which only select emotions and physical actions are possible (Barlow, 1973). We often notice the posture of the startle response in traumatized clients: shoulders up, breath held, head pulled down and forward into the shoulder girdle, similar to a “deer in the headlights.” The action of the startle response disturbs the aligned balance between head and shoulders and is usually temporary, but if this normal response to a sudden novel stimulus becomes chronic, the physical organization itself may predispose the individual to experience emotions of fear and distrust and thoughts of impending danger on a chronic basis.
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COGNITIVE, EMOTIONAL, AND SENSORIMOTOR ACTION TENDENCIES
An action tendency is a propensity to implement or carry out a particular action. Action tendencies are formed on cognitive, emotional, and sensorimotor levels. Tendencies stem from procedural memory of processes and functions, reflected in habitual responses and conditioned behavior (Schacter, 1996). Procedural learning involves repeated iterations of movements, perceptions, cognitive and emotional processes, or combinations of these (Grigsby & Stevens, 2000). The original events from which these automatic personal processes and routines are learned have usually been forgotten. Actions that are procedurally learned “do not require conscious or unconscious mental representations, images, motivations or ideas to operate” (Grigsby & Stevens, 2000). Operating nonconsciously, procedural learning on all three levels of information processing turns into automatic action tendencies that become crucial organizers of behavior. Long after environmental conditions have changed, we remain in a state of readiness to perform the mental (cognitive and emotional) and sensorimotor actions that were adaptive in the past. For example, the child who learns that it is safer to back away from adults when either she or they are distressed, instead of seeking proximity, might develop action tendencies of avoidance-oriented postural adjustments (turned away, looking at the ground to avoid eye contact), movement impulses that lead to backing away, emotional responses such as fear, and cognitive belief systems such as “It’s not safe to seek comfort.”
These action tendencies “have the character of urges or impulses. They lie in waiting for signs that they can or may be executed; they, and their execution, tend to persist in the face of interruptions; they tend to interrupt other ongoing programs and actions; and they tend to preempt the information processing facilities” (Frijda, 1986). In broad terms, an action tendency is a readiness for specific behavior. This “readiness” means that the action tendency exists within the person in latent form and becomes activated in response to specific internal or external stimuli. Maladaptive actions tendencies conditioned from the past are triggered by internal and environmental reminders of the past and take precedence when other actions might prove more adaptive. Once procedures become automatic tendencies, we no longer use top-down processes to regulate them.
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As we know, roots of most action tendencies lie in early childhood experiences. Bowlby's attachment theory gives a framework to look at such patterns. Secure attachments give a child a stable foundation to embark on the life journey. Insecure attachment patterns give rise to certain deficits which continue to affect lives as adults.
[quote author=Trauma And the Body]
INSECURE-AVOIDANT ATTACHMENT
Mothers of insecure-avoidant infants actively thwart or block proximity-seeking behavior of the infant, responding instead by withdrawing or even pushing the child away (Ainsworth et al., 1978; Schore, 2003a). These mothers appear to have a general distaste for physical contact except on their terms and may respond to the infant’s overtures with wincing, arching away, or avoiding mutual gaze (Cassidy & Shaver, 1999; Schore, 2003a; Siegel, 1999). The child adapts to this affectively laden somatic communication of unavailability by expressing little need for proximity, and apparently little interest in adult overtures for contact. And, when contact is made, the avoidant child does not sustain it, focusing instead on toys and objects rather than on the mother. He generally avoids eye contact with her and shows few visible signs of distress upon separation, although some researchers (Fox & Card, 1999; Main, 1995) have found evidence of autonomic arousal in these toddlers even when they appear behaviorally indifferent to the mother. Upon reunion, they actively ignore or even avoid the mother by moving or leaning away when picked up (Main & Morgan, 1996). They generally do not seek proximity with caregivers and are reserved emotionally.
Children with insecure-avoidant attachment patterns are described as having a dismissive stance towards the importance of attachment in adulthood. They often distance themselves from others, undervalue interpersonal relationships, become self-reliant, and tend to view emotions with cynicism. Clients with insecure-avoidant attachment histories tend to withdraw under stress and avoid seeking emotional support from others. With a compromised social engagement system and limited access to internal states, these clients typically minimize their attachment needs. Preferring autoregulation to interactive, they may find dependence frightening or unpleasant and avoid situations that stimulate attachment needs.
The body tendencies vary; through muscular tonicity or rigidity these clients might show that they are more comfortable with defensive movements than with reaching out or moving toward. For example, one adult client found it unfamiliar and uncomfortable to reach out with her arms and did so awkwardly and stiffly, saying that it was easier to push away than to reach out for contact when no one had ever responded. As they are approached, these clients may pull back or become more armored. Others withdraw through a demeanor of passivity, often reflected in low muscular tonicity, and lack of response to relational overtures. Many clients demonstrate mixed tone: high tone in certain areas of the body, and low tone in other areas, as in the client who was strong and muscular through her legs but weak and flaccid through her arms. A lack of emotional expression and eye contact and a lower level of overall arousal are also correlated with this attachment group (Cozolino, 2002).
In a sensorimotor approach, somatic interventions that strengthen interactive regulation and social engagement (reaching out, seeking proximity, eye contact) provide effective avenues of exploration. Children with insecure-avoidant attachment histories have a more complicated balance to attain between their need for caregiver proximity and their tolerance of anxiety; this adaptation may be subsequently reflected in a disjunction or disconnection between their interior needs and their external behavior. These incongruent patterns are apparent in our adult clients, too. For instance, the client who sits on the couch, visibly uncomfortable, may respond to the question “How are you doing?” or “How are you feeling in your body” with a smile and “Fine.” This client’s disconnection between her physical or emotional discomfort and her reported psychological state demonstrates an incongruence or mismatch between her inner psychological and somatic states, of which she is frequently genuinely unaware. Treatment for these clients includes becoming aware of internal states and practicing physical movements that accurately correspond to these states.
INSECURE-AMBIVALENT ATTACHMENT
The mother of the infant who develops insecure-ambivalent attachment patterns is inconsistent and unpredictable in her response to the infant. She may either over-arouse the infant or fail to help the infant engage. Because her interactions are often a response to her own emotional needs and moods rather than the infant’s, this caregiver might stimulate the infant into high arousal even when the infant is attempting to down-regulate by gaze aversion. Thus, when the mother’s own emotional need for engagement overrides the infant’s need, her behavior intrudes on the infant causing dysregulation of the infant’s arousal. Because the car giver is inconsistent in her availability, sometimes allowing and encouraging proximity and sometimes not, the child is unsure of the reliability of the caregiver’s response to his or her somatic and affective communications (Belsky, Rosenberg, & Crnic, 1995; Carlson, Armstrong, Lowenstein, & Roth, 1998; Main, 1995). This uncertainty results in infants who appear cautious, distraught, angry, distressed, and preoccupied throughout both separation from, and reunion with, the mother. Upon reunion, they typically fail to be comforted by the caregiver’s presence or soothing (Main & Morgan, 1996), often continuing to cry. These infants characteristically appear irritable, have difficulty recovering from stress, show poor impulse control, fear abandonment, and engage in acting-out behavior (Allen, 2001). One example of the ambivalence such infants show with the unpredictable parent is to alternate between angry, rejecting behaviors and contact-seeking behaviors upon reunion with the mother after separation.
Children with insecure-ambivalent patterns have a “difficult temperament” with “tendencies to intense expressiveness and negative mood responses, slow adaptability to change, and irregularity of biological functions” (Schore, 2003a). Children with insecure-ambivalent insecure-ambivalent attachment histories are described as having a preoccupied stance toward attachment in adulthood. They are preoccupied with attachment needs, overly dependent on others, and might have a tendency toward enmeshment and intensity in interpersonal relationships, with a preference for proximity. They focus excessively on internal distress, often pursuing relief frantically (Cassidy & Shaver, 1999). With a compromised social engagement system, these clients are often unable to recognize safety within the relationship. Preoccupied with the availability of attachment figures (including the therapist), they frequently experience increased affect and bodily agitation and increase or loss of muscular tone at the prospect of separation.
A sensorimotor approach would facilitate autoregulatory capabilities through a development of grounding, boundaries, and core internal support as well as promote adaptive interactive regulatory abilities (see Chapter 10). Children with insecure-ambivalent attachment patterns may demonstrate more congruency between internal states and external physical movement than insecure-avoidant children, but their behavior is often dysregulated. Their physical movement may be uncontained, geared more toward discharge of high arousal than toward the purposeful achievement of a specific goal. For example, a child may frantically cry and flail when the attachment system is aroused, rather than execute directional, purposeful movement toward the caregiver. The movement may take the form of agitation that does not translate into a tempered, purposeful movement that accomplishes a particular goal. In a sensorimotor approach with adult clients with insecure ambivalent attachment histories, learning to tolerate high emotional and physiological arousal and execute thoughtful, purposeful action rather than dysregulated, non-directional movement is essential.
Disorganized/ Disoriented Attachment
Main and her colleagues (Main, 1995; Main & Hesse, 1990; Main & Solomon, 1990) observed a group of children who had puzzling and contradictory sets of responses to their mothers upon reunion after separation. The researchers also observed the mothers, whose behavior they evaluated as “frightening” (e.g., looming behaviors, sudden movements, sudden invasion, attack postures) or “frightened” (e.g., backing away, exaggerated startle response, retraction in reaction to the infant, a fearful voice or facial expression) (Main & Hesse, 1990). In addition, these mothers may exhibit role confusion (e.g., eliciting reassurance from the child), disorientation( e.g., trance-like expression, aimless wandering in response to the infant’s cries), intrusive behavior (e.g., pulling the child by the wrist, mocking and teasing, withholding a toy) or withdrawal (e.g., not greeting the infant, not interacting verbally, gaze avoidance) (Lyons-Ruth, 2001). These caregivers often provoked sudden state switches without providing interactive repair. Sometimes the caregivers (usually the mother) of these children may be abusive or neglectful or both. Such a caregiver induces traumatic states of enduring negative affect. Because her attachment is weak, she provides little protection against other potential abusers of the infant…. This caregiver is inaccessible and reacts to her infant’s expressions of emotion and stress inappropriately and/ or rejectingly, and shows minimal or unpredictable participation in the various types of arousal-regulating processes. Instead of modulating, she induces extreme levels of stimulation and arousal, either too high in abuse or too low in neglect, and because she provides no interactive repair, the infant’s intense negative emotional states last for long periods of time. (Schore, submitted) Because this misattuned caregiver shows little or no attempt to recognize or repair breaches in relatedness, the infant is left in hyper-or hypoaroused zones for extended periods of time. Main and Solomon (1986, 1990) named the attachment pattern that developed from such caregiving the disorganized/ disoriented style and identified seven categories of behavior indicative of this style:
1) Sequential contradictory behavior; for example, proximity seeking followed by freezing, withdrawal, or dazed behavior.
2) Simultaneous contradictory behavior, such as avoidance combined with proximity seeking.
3) Incomplete, interrupted, or undirected behavior and expressions, such as distress accompanied by moving away from the attachment figure.
4) Mistimed, stereotypical, or asymmetrical movements,and strange, anamolous behavior, such as stumbling when the mother is present and there is no clear reason to stumble.
5) Movements and expressions indicative of freezing, stilling, and “underwater” actions.
6) Postures that indicate apprehension of the caregiver, such as fearful expressions or hunched shoulders.
7) Behavior that indicates disorganization or disorientation, such as aimless wandering around, labile affect, or dazed, confused expressions.
Main and Solomon observed that these infants’ “approach movements were continually being inhibited and held back through simultaneous activation of avoidant tendencies. In most cases, however, proximity-seeking sufficiently ‘over-rode’ avoidance to permit the increase in physical proximity. Thus, contradictory patterns were activated but were not mutually inhibited” (1986). Versions of these incongruent behaviors are observed in traumatized adults, especially in the context of discussing past relational trauma or past or current attachment relationships, including the relationship with the therapist. In clinical contexts, therapists often are confused by what seem like paradoxical responses to contact and apparent relational discontinuity. For example, Lisa frequently complained that “no one is there for me” and begged her therapist for more contact: to sit closer, to hold her hand if she cried, to call to see how she felt during the week. Yet, in sessions, Lisa consistently seated herself in such a way that she was facing away from the therapist and orienting toward the floor and sofa, and her body stiffened when the therapist moved her chair closer (at Lisa’s request). Proximity seeking emerged in her verbal communication, whereas avoidance was communicated physically: her body held back the approach, avoiding even eye contact. The often confusing incongruent and contradictory behavior observed in these infants, and in clients such as Lisa, can be understood as the result of simultaneous or alternating stimulation of two opposing psychobiological systems: attachment and defense (Liotti, 1999a; Lyons-Ruth & Jacobvitz, 1999; Main & Morgan, 1996; Ogawa, Sroufe, Weinfield, Carlson, & Egeland, 1997; Van der Hart et al., 2004). An infant predictably seeks proximity to the caregiver when distressed, but if the caregiver further distresses the infant instead of providing comfort and safety, an irresolvable paradox ensues (Main & Solomon, 1986). The infant cannot satisfactorily approach, flee, or reorient his or her attention. When the attachment system is aroused, proximity-seeking behaviors are mobilized. But when the defensive system is aroused, flight, fight, freeze, or hypoarousal/ feigned death responses are mobilized. The disorganized/ disoriented infant experiences the alternating or simultaneous stimulation of these two opposing psychobiological systems. Steele, Van der Hart, and Nijenhuis (2001) have challenged the notion that this attachment paradigm is, in fact, “disorganized” (see also Jaffe et al., 2001). They have proposed that, in the context of frightened and/ or frightening caregiving, disorganized/ disoriented attachment is actually an organized, logical response caused by the concurrent activation of both the defensive and attachment systems: the social engagement system and the sympathetic and dorsal vagal systems are thought to be simultaneously or alternately stimulated. In childhood trauma and neglect, disorganized/ disorientated attachment as a strategy is a logical outcome. The ongoing threat of frightened and frightening caregiving evokes the action tendencies of both proximity seeking and defense. This attachment behavior has been demonstrated in 80% of maltreated infants (Carlson et al., 1998) and is a statistically significant predictor of both dissociative disorders (Carlson et al., 1998; Liotti, 1992) and aggressive behavior (Lyons-Ruth & Jacobvitz, 1999).
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Each attachment pattern show some distinctive features of emotional self- regulation. In auto-regulation, the person relies on him/herself while in interactive regulation, others are sought via the social engagement system. For securely attached individuals, both auto and interactive regulatory abilities are developed and applied appropriately.
[quote author=Trauma and the Body]
The child with an insecure-avoidant history may depend upon autoregulation and parasympathetic (dorsal vagal) dominance (Cozolino, 2002;Schore, 2003a) to self-regulate, most likely experiencing increased dorsal vagal tone characterized, in the extreme, by feelings of helplessness and lower levels of activity (i.e., a state of conservation and withdrawal) (Schore, 2003a). With a tendency to curtail the expression of emotion (Cassidy & Shaver, 1999), this “overregulation” indicates a reduced capacity to experience either positive or negative affect and may contribute to a low threshold of arousal in socioemotional contexts and to modulation imbalances( i.e., difficulty shifting out of low arousal states and moderating high arousal). This child, in the relative absence of an available caregiver, is robbed of the opportunity for satisfying social engagement and typically develops a preference for autoregulatory tendencies that do not depend on another’s presence. He or she may learn to modulate arousal in solitude, turning inward through reading, daydreaming, and worlds of fantasy. Although generally compliant, the child may express frustration in peer relationships where avoidant attachment behaviors are sometimes associated with hostility, aggressiveness, and conduct problems (Allen, 2001; Crittenden, 1995; Sroufe, 1997; Weinfield, Stroufe, Egeland, & Carlson, 1999). Interactive regulatory and social engagement abilities necessary for resolving interpersonal conflicts are often underdeveloped in such individuals.
On the other hand, children with insecure-ambivalent attachment patterns tend to have a sympathetically dominant nervous system (Cozolino, 2002; Schore, 2003a) with a low threshold of arousal and concurrent difficulty maintaining arousal within a window of tolerance. The inconsistent responsiveness of the primary caregiver has taught the child to increase signaling for attention, escalating distress in order to solicit caregiving (Allen, 2001). These children are biased toward undercontrolled high-arousal states, with increased emotional reactivity combined with an inability to modulate distress, leaving them vulnerable to underregulatory disturbances (Schore, 2003a). Less able to autoregulate, as adults these individuals find isolation stressful: Because they have trouble tolerating solitude, they cling to relational contact, becoming overly dependent on interactive regulation but simultaneously experiencing a lack of ability to be easily calmed and soothed in a relationship. Although social engagement is sought, the person remains biased toward hyperarousal, in part due to hypervigilence developed from previous experience of intrusive behavior by the primary attachment figure.
Disorganized-Disoriented Attachment and Regulation: Hyper-and hypoarousal are both involved in the infant’s psychobiological response to frightened or frightening caregivers, with whom the social engagement system is functionally off-line for much of the time. Disorganized/ disoriented attachment patterns in children has been associated with elevated heart rates, intense alarm reactions, higher cortisol levels, and behavior that may indicate increased dorsal vagal tone, such as stilling, going into a brief trance, unresponsiveness, and shutting down (Schore, 2001). In the initial stage of threat, infants demonstrate sympathetic activation accompanied by startle reactions, elevated heart rate, respiration, and blood pressure, and usually crying or screaming (Schore, submitted). However, when sympathetic arousal cannot be regulated, a quick shift to hypoarousal may occur. The body undergoes “the sudden and rapid transition from an unsuccessful strategy of struggling requiring massive sympathetic activation to the metabolically conservative immobilized state mimicking death associated with the dorsal vagal complex” (Porges, 2001a). Thus sympathetically mediated responses quickly change “from interactive regulatory modes into long-enduring less complex autoregulatory modes” (Schore, submitted). During these hypoaroused conditions, observed in newborns (Bergman, Linley, & Fawcus, 2004; Spitz, 1946), the infant is unresponsive to interactive regulation (Schore, submitted). Early relational trauma generates prolonged negative affective and physiological states in the infant, which, in turn, “generate immature and inefficient orbitofrontal systems, thereby precluding higher complex forms of affect regulation” (Schore, submitted). These negative states also leave the child with a compromised social engagement system. .....underdeveloped or ineffective interactive regulatory abilities, as well as impaired autoregulatory capacities; they remain in, or alternate between, hyper-or hypoarousal zones for extended periods of time.
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