In An Unspoken Voice - Peter Levine

[gottathink]

I've been wondering about my daily shaking. It's been happening for years now, is distinctly uncomfortable and debilitating, and at times completely overwhelming. I've been using the Somatic Experiencing approach for a while now, and am improving my efficacy in it, but there is a question in my mind - how long do I have to do this? How much trauma is stored in me? How long do I have to be so disabled? I have heard that some people need 18 months and some 7 years in order to reach a state of cellular safety. Even then, some expierenced veterans in this approach still feel trauma release after 10 years. So I remind myself of all this when I get impatient and frustrated and feel like I don't want to live anymore. And of course, I make a practice of allowing the feelings, and surrounding them with love and all that.

But still, I wonder, sort of in line with Oxajil's question above, whether or not I am reinforcing neural circuitry - do the tremors originate from some form of physiological issue that is not associated with the trauma? I apparently have a genetic connective tissue disorder and my MRI showed brain lesions - can Levine's approach heal these? Neurons that fire together wire together. In chronic pain, focusing on the pain itself can sensitize the body and brain to the pain, which can cause it to be reinforced. Does sitting with the sensations in the way described by Lyon and Levine allow trauma to release in all cases? Does it sometimes 'wire in' the tremors or dystonia? Is there another therapeutic approach that could be used in conjunction with SE therapy to actively engage new circuitry in a more targeted way? Would this be a helpful addition to the somewhat more passive SE 'allowing/sensing' method?

On that note, I am reading a book by Dr. Jaoquin Farias and it may present a more active approach. Not sure, it's above my neuroscience knowledge to compare the two approaches. He writes the story of using what seems to be both a passive (sensing/feeling) and active (movement) approach in his recovery from major surgery - an approach that has helped many of his patients heal from their shaking using the neuroplasticity of movement. I also found it to be a clear and concise refresher regarding what happens in the brain during shock. It may also be helpful to read for anyone who is undergoing major surgery, or who will have a loved on doing so. His story begins with his response to his diagnosis of cancer:



So there's something different here than allowing the body to move - active engagement with the moving centre, or the motor centre in the prefrontal cortex to wire new connections. Not sure if I'm making too much of the passive/active distinction, but that's how it seems to me at this time. FWIW.

How about dance therapy? You are employing volitional movement but allows a level of freedom to work into any body part you feel it would benefit.

 

[gottathink]

Does sitting with the sensations in the way described by Lyon and Levine allow trauma to release in all cases? Does it sometimes 'wire in' the tremors or dystonia? Is there another therapeutic approach that could be used in conjunction with SE therapy to actively engage new circuitry in a more targeted way?

I have connected a few dots between SE, TRE, and movement therapy. These are things I was aware of but hadn’t be able to fully articulate in my mind. Yes I think there is a more targeted way to approach therapy through movement. I have a feeling about myself that my work and experience is inferior to others in this field. But I think I just didn’t see how it was situated with other therapies.

So the case above makes complete sense to me. In my clinical practice the steps I work through with clients is similar, the difference being I am helping them with the movements by triggering a non-volitional movement in limbs and or the head and neck by supporting fully the weight of that body part. With gentle pressure and cross fibre stretch the muscles that the brain has forgotten how to contract, start to contract again and it seems to wire the movement back into the brain.
At times when the movement pattern the body expresses just goes into a repetitive pattern (say 10minutes) I will change my hand pressures to direct it in a slightly different angle, this then allows the brain to break that particular stuck pattern and work in new movements. To get out of the “wired in” pattern.

Clients stay present and give me feedback, sometimes they observe their emotions, sometimes they see colours and/or shapes. Sometimes pain and I check if they are okay with it. It is a whole raft of combinations of muscle movement, pain, emotion, referred sensations, tremoring or shaking, heat, feelings of energy movement, deep relaxation. All sorts comes up, we work through the entire body always. Integrating or resolving the sensations that come up depending on what is being experienced.

I have had both medical doctors and a psychologist as clients who have benefited from the therapy. The psychologist who herself had experienced a sexual assault in her life and had related chronic pain issues felt the treatment was safe and effective for people who have experienced trauma.

So I think the case ‘iamthis’ posted above emulates the process I work through with my clients but differs as it is self guided. It is also similar to how I work on myself. I use movement, some tremoring, some specific exercises, some visualisation and moving energy through my tissues where I feel blocks. Some yoga and stretching, some breathing practice etc.

I don’t think it’s enough to just release trauma, it needs to be replaced with movements of your own volition that give you the grounding in how you want to be in the world.

 

[gottathink]

I will add, the objective of these treatment sessions are to help a person move again. So move out of stuck patterns or fear/freeze responses. I then give them simple exercises to practice to consolidate the treatment gains. Often muscles have atrophied through disuse as well as distorted their posture so that joints are no longer seated correctly. With this the joints are not moving from a neutral position which causes additional strain on the tissues surrounding the joints. There is alot that needs correcting but we just start the process and aim for better not worse. Do that for long enough and literally miracles happen. Each session we build on the last and evolve the exercises they do at home.

I might be able to provide some useful guidance.

 

[Gaby]

do the tremors originate from some form of physiological issue that is not associated with the trauma? I apparently have a genetic connective tissue disorder and my MRI showed brain lesions - can Levine's approach heal these?

There's no question in my mind that those can be a result of genetic issues that are NOT associated with the trauma.

Stay open-minded to the fact that you don't have to reach an idealized resolution either, whether with Levine's method or another. That in and of itself - resolution as measured by some sort of trembling index - sets you up for failure. Enjoy moving, let it flow, but don't think the trembling has to completely go away before you "qualify as ok".

 

[iamthatis]

Thanks gottathink - your work reminds me of what I've read in Kathy Kain's book, who was one of Irene Lyon's first teachers. She wrote about therapeutic touch specifically as being really effective for release, and all the various positives and negatives around transference of 'stuff' between caregiver and patient, the benefits of practicioners being trauma-informed, etc. In a similar vein, Farias mentions that in his clinical practice, when someone is dystonic, the caregiver can sort of 'lend' their nervous system and its regulation to the patient. He does this through dancing, and also eating together, going up and down stairs hand in hand, and all kinds of other daily life situations where there's an opportunity for the overlay of the dystonic by the tonic nervous system.

I was considering going to dance classes actually, and looking up studios yesterday. For a while, I was going to Tai Chi for a while, but it was beyond my capacity. Even just the basic joints warm-up had me approaching a shaking meltdown. When I do it in the mornings at home, this continues to happen - my legs lock and I have a full-body tremor for 30 seconds or so. I haven't felt like I'm going to fall over, but it's still overwhelming for my system. IIRC, Irene Lyon suggests that in cases of overwhelm, dial back wha you're doing and titrate, or just do as much as one can prior to overwhelm. My therapist gave this as general advice as well. I also built a standing work station to try to survive our cramped era of passive sitting, but I can't stand for more than 20 minutes without my legs starting to shake like mad, discomfort with breathing and in the abdomen. Not sure how to strike a balance between pushing it and not going too far - I suppose that's part of 'learning the new language' of 'dancing with the nervous system' that Lyon talks about.

All of this has me wondering about the wisdom of Gurdjieff, who described himself as 'just a dancing teacher' later in his life. Although he didn't use the modern neuroscience terms as fas as I know, he knew the importance of using will and intent from cortical systems to overcode the subcortical reflex responses (which we all do as infants). The motor cortex, emotional regulation, and mental clarity are all wired together. Or, the three centres in man, moving, emotional, and intellectual, alll affect each other, and work in one centre can generalize to create benefits in the others.

For now, relieving the pressure of gravity on the spine and anti-gravity muscles and improving my basic bodily awareness through Feldenkrais lessons on the floor has been the most helpful. After reading Feldenkrais' general theory in Awareness Through Movement, I was also struck by how similar his approach and language was to what I remember from Gurdjieff - though with a more explicit focus on going slow, creative play with movement, and ease. All of these, especially the slowness, are apparently necessary for the cortex to recognize imbalance, and neuromodulate towards a different organization of the body.

 

[gottathink]

Thanks gottathink - your work reminds me of what I've read in Kathy Kain's book, who was one of Irene Lyon's first teachers. She wrote about therapeutic touch specifically as being really effective for release, and all the various positives and negatives around transference of 'stuff' between caregiver and patient, the benefits of practicioners being trauma-informed, etc. In a similar vein, Farias mentions that in his clinical practice, when someone is dystonic, the caregiver can sort of 'lend' their nervous system and its regulation to the patient. He does this through dancing, and also eating together, going up and down stairs hand in hand, and all kinds of other daily life situations where there's an opportunity for the overlay of the dystonic by the tonic nervous system.

Thank you for this feedback and information, more reading for me! When clients have given me feedback on the value they experience of my input into the therapy sessions I have dismissed it and say that it’s actually all them. This is not actually correct, I think it seems it’s okay to recognise my therapist role in this process. Lack of maturity on my part.

It makes sense, when I work with clients I am very aware of my own nervous system and the calm intent and focus that I need to maintain in order for transformation in the clients body to occur. This in some way provides the person with a feedback system to figure out what regulated actually is. It similar to how we need objective feedback on our joint position and posture to find neutral, without that outside pair of eyes our neutral just floats around with no knowledge of where the balance point is. It’s like the nervous system is the same.

 

[Oxajil]

I'd like to address your question as a real-life case, not a theoretical one, so it would be helpful to know if this is something that happens to you or someone else. It would also be helpful to know a little about the circumstances in which it occurs.

Apologies for the late reply, just saw your post! It happened to a client who would shake and hide in a corner whenever he heard people arguing, whether in the street or next door.

After giving information as to why he might react this way, we set up an exposure experiment to test his worst fear: "I’ll be attacked (if I hear an argument)." His homework was to listen to videos of people arguing, and then we'd review whether something had happened to him afterward (e.g. were you attacked?).

At some point, he told me there was an angry customer at the job he works at, there was an argument between the customer and a colleague and he actually felt less afraid than before. The exercise seemed to have helped him recognize that hearing conflict or loud voices doesn't necessarily mean danger.

His instinct to hide also appeared subtly in our sessions. Whenever we talked about traumatic memories, he would pull his knees up and hold them close, curling into a ball. He told me it made him feel safe. I gently asked him to try putting his feet on the floor and to rest his hands on his lap for a few seconds, just to see what it's like. He said he actually felt a bit of relief.

He'd automatically revert back to his protective posture, and that's okay, it's part of his process. He could benefit from somatic exercises and he was offered treatment by a psychomotor therapist, but he refused. There's unfortunately a lot of fear involved and he's going to need a more slow and gentle approach (and longer treatment).

But yeah, his bodily reaction to triggers prompted my question.

There's no question in my mind that those can be a result of genetic issues that are NOT associated with the trauma.

Stay open-minded to the fact that you don't have to reach an idealized resolution either, whether with Levine's method or another. That in and of itself - resolution as measured by some sort of trembling index - sets you up for failure. Enjoy moving, let it flow, but don't think the trembling has to completely go away before you "qualify as ok".

Yeah, I agree.

There are people who are diagnosed with functional neurological symptom disorder or conversion disorder and I have a colleague who has a lot of experience treating that who's shared that people who reported to have lost all feeling in one leg for example were able to walk again after treatment. The treatment consists of hypnotherapy and behavioral therapy (it's a specific protocol), which you could maybe try at some point, but I think your shaking-symptoms might be more due to genetic and/or neurological causes.

In case you're interested, here's a translated article on that type of therapy:

Limited research has been conducted on conversion disorder, and a taboo still surrounds it. That needs to change, say Marleen Tibben, healthcare psychologist and manager of the HSK Expertise Centers for Conversion and Tics, and Ingeborg Visser, clinical psychologist/psychotherapist for children and youth.

A conversion disorder involves disruptions in motor and/or sensory functions that cannot be explained by a neurological defect. Examples include paralysis, tremors, or epileptic-like seizures. The absence of a neurological explanation is essential for diagnosing a conversion disorder. Marleen: “The chance that, after careful neurological examination, a neurological cause is still found for a condition diagnosed as conversion is about 4 percent.”

Hypnosis
In treating conversion disorders, Marleen Tibben and Ingeborg Visser use hypnotherapy combined with behavioral therapy. Marleen: “The beauty of hypnosis is that a patient relaxes through hypnosis. At the same time, under hypnosis, you can alter perception. For a patient with a tremor in the arm, for example, you can make that arm feel very heavy under hypnosis. This causes the tremor to disappear. By practicing this often, you eventually achieve cue-conditioning. The tremor disappears by thinking about making the arm heavy.”

Associative Connections
According to Marleen, hypnosis works because it creates a kind of bypass in movement control. “The starting point for the treatment is Kihlström's dissociation theory. This theory assumes a break between implicit and explicit information processes. Problems are experienced particularly in explicit control, while indirect information processes remain intact. You see the same thing, for example, when you can't recall a familiar person's name due to fatigue, stress, or lack of sleep. Even though you know the name well, it just won't come to mind. Continuing to think about that name often helps little. It's more useful to use a different search strategy, such as asking yourself where you know this person from or what they do in daily life. These search strategies use other implicit, associative connections and are often successful in solving the problem. The effect of hypnosis seems based on this; it establishes alternative, implicit associative connections.”

Poor Reputation
Marleen regularly trains professionals and sees an increase in the number of rehabilitation centers and institutions working with hypnosis and behavioral therapy. Nevertheless, hypnosis still has a poor reputation. “For many outsiders, it still feels too vague. But treating conversion disorders is essentially a behavioral therapeutic treatment. What matters is that within that treatment, you seek an incompatible response. You then teach this incompatible response through hypnosis. Eventually, a patient can evoke that incompatible feeling even without formal hypnosis. The rest of the treatment consists of shaping techniques.”

Research
Currently, there is hardly any research available on the effectiveness of treatments for conversion disorder. Marleen: “For pseudo-epileptic seizures, a good RCT has been done showing that cognitive behavioral therapy is effective. Other studies are limited or of moderate quality. Moreover, the absence of suitable measurement instruments makes research difficult.” The HSK Expertise Center for Conversion Disorders has started a pilot study on the effectiveness of hypnosis and behavioral therapy. “So far, the results look very promising. As many as 73 percent of patients fully recover. In the remaining patients, there is often a severe conversion or involvement of neurological complaints as well.”

Faker
In addition to research on effective treatments, more attention is needed for conversion disorders to normalize them. Ingeborg: “Monique van der Vorst is a well-known athlete who spent a long time in a wheelchair. In the media, she was nearly torn apart for supposedly being a faker. That's very harmful.” Patients with unexplained somatic complaints often feel not taken seriously. If there's no diagnosis, nothing is wrong. Ingeborg: “But there is something wrong. You don't imagine something you can't see.” Yet the diagnosis can also be challenging. Marleen: “The neurologist can be important for accepting the diagnosis. If they say, ‘I have good news for you, it's nothing neurological,’ that can help patients.”

Collaboration
Although the treatment is purely psychological, the HSK Expertise Center for Conversion Disorders collaborates extensively with neurologists. Marleen: “Every month, we hold intervision sessions where we discuss all patients whose progress is slower. A neurologist is always present. Besides discussing treatment progress, this collaboration with neurologists is also based on the scientific world. ‘Historically, research on conversion disorders has mainly been neurological. Psychological research is only available to a limited extent.’” Unfortunately, not all neurologists are equally well-informed about conversion disorders. Marleen: “There are still neurologists who tell patients: it's all in your head. Or worse: you have to learn to live with this. How terrible is that when we see patients improve in ten sessions?”

I think what might help is learning to accept the current situation and to think more in terms of "what can I do?" rather than "what can't I do?", and how you can build up tolerance a little bit every time (if that's something you'd want to do). For example, once you've recognized a pattern, you can maybe do 5 min of Tai Chi or dancing or another activity, do something else, then maybe the next day or next week see if you can stretch it a little bit and do 6 min, all the while taking a bit of a happy-go-lucky attitude. It doesn't have to be that precise of course. Keeping a positive journal might also help, where you write down three things each day that you managed to do and are proud of. Just my 2 small cents. I think you're doing great with gaining knowledge and trying things out. Also, thank you for sharing that excerpt from the book, very interesting!