Tuesday, September 20, 2016

Flight, fight and freeze

Have you ever felt that you have spent the better part of your life in these states? Try tapping on this script and make sure to customise it for you and your unique experiences.

Even though I fight when/if (whatever else fits)... I completely accept my response

Even though I flee when/if ... this response used to/does help me in a bad situation but sometimes it makes things worse

Even though I freeze (shut down/numb etc) when/if ... I can become aware of my various different responses to stress, they're all trying to help me survive

Top of the head: It feels ... when I fight (take note of where you feel it in your body if you can)
Eyebrow: This tightness in stomach (for example, insert how fighting shows up for you)
Side of eye: This tension in my jaw
Under the eye: I want to punch something/someone (find something soft to punch to help you discharge the fight response)
Under the nose: I feel like screaming
Under the chin: I'm tired of having to fight
Collarbone: Why aren't things just ok?
Under the arm: I don't know how else to protect myself from harm

Top of the head: It feels ... when I flee (or feel the need to but can't)
Eyebrow: When I can go I feel ...
Side of eye: When I'm stuck and can't move that feels ...
Under the eye: When I'm too afraid to flee that feels ...
Under the nose: I'm noticing where this need to flee shows up in my body (my emotions, my mind)
Under the chin: And that feels ...
Collarbone: I'll notice as much as I can
Under the arm: I don't have to do this all at once

Top of the head: It feels ... when I freeze
Eyebrow: Freezing/shutting down/numbing helps me when ...
Side of eye: What is happening to my breath right now as I'm tapping on this?
Under the eye: I don't have to change my breath, I can just follow it and see where it goes
Under the nose: What do I see right in front me?
Under the chin: Can I describe it to myself out loud?
Collarbone: What do I hear? Can I describe the sounds out loud?
Under the arm: What can I feel/touch?

Top of the head: Becoming aware is the first step to changing
Eyebrow: I can take it as slowly as I need to in order to feel safe
Side of eye: I'm noticing my body's sensations more and more and that feels ...
Under the nose: I don't need to fight these sensations (It's ok if you feel you do need to fight/flee or freeze, tap on exactly how you feel, the truth really does set your system free)
Under the chin: These responses can be adaptive to stress
Collarbone: And sometimes, they're not, sometime they're caught in a feedback loop that goes nowhere
Under the arm: And that feels ...

Top of the head: I'm going to notice when I fight, flee or freeze
Eyebrow: And how they show up
Side of the eye: I'm going to breathe through how they show up as best as I can
Under the eye: And notice what's in front of me
Under the nose: Notice if my feet are flat on the ground and how I'm breathing
Under the chin: My instincts have saved my life
Collarbone: And I'm learning to appreciate them for that
Under the arm: And that makes me feel ...

Monday, September 12, 2016

Trauma: one of the biggest health problems in the world?

I believe trauma is one of the biggest public health problems in the world, if not the biggest. One of the most famous studies linking trauma to physical and mental health issues is the ACE study. Ischemic heart disease, cancer, liver disease, severe obesity, drug abuse and depression are just a few of the conditions linked to adverse childhood experiences (ACE), depending on how high an individual scores on a 10 item questionnaire. Questionnaires are not always accurate though, especially if you only have to tick yes or no or circle a number on a likert scale. So if a person only ticks one item, that doesn't mean that they're not traumatised. More in depth interviews are also needed to give an accurate diagnosis of trauma. Trauma is much more widespread than previously thought, a diagnosis of PTSD is not the only way trauma can manifest.

This comes as no surprise to many of us. So instead of getting bogged down and only treating symptoms, which is a never ending, but extremely profitable, merry-go-round, we should be looking for and treating the root cause of physical and mental dis-eases. And it’s obvious to a lot of us that the root cause in the vast majority of cases is trauma.

There is a mountain of research showing the ill effects of unresolved trauma. It’s important to note that we can go through something traumatic and not develop trauma. Trauma occurs when our coping mechanisms are overwhelmed and we dissociate. Dissociation is an ingenious survival mechanism that allows us to freeze any experience(s) we find unbearable. We do this on both a psychological and somatic level. And we all dissociate to a greater or lesser degree, we are all somewhere on the dissociation continuum.

Not surprisingly, dissociation happens more often with babies and children (in utero and beyond), as their capacity to process difficult experiences is limited and very much dependent on the attachment and support they have from their caregivers. If their caregivers are the harbingers of trauma, deep betrayal occurs. How can a baby or young child process that? They can’t. They need their caregivers for their very survival, so they’ll do whatever they can do to survive the situation. And that usually means dissociating from the pain and the fact that their parents are the abusers so that they can go on.

But dissociation has a high price. While it’s a brilliant short term solution, long term it can cause havoc. Seemingly unexplained symptoms start to show up in our lives from about the age of 30 onwards, of course, sometimes that can happen a lot earlier. We might wonder what’s happening and go on a long and difficult journey of trying to find out what’s wrong which can lead to frustration and which is very often retraumatising. When trauma is the root cause of our ill health, it is our dysregulated nervous systems that need attention and treatment.

This is why I believe that talk therapy is not effective on its own, we need to include the body in trauma therapy. It is almost criminal not to in my opinion as it is leaving out a crucial part of the healing equation. Whatever therapy you choose though, make sure you find a responsive and attuned practitioner with whom you feel safe. In my experience, these are the most important ingredients to get right. If our nervous system doesn’t feel safe, we will remain frozen. Our bodies can’t and won’t lie, they are a fantastic guidance system when we (re)learn to trust and feel safe in them.

Tuesday, August 30, 2016

The importance of ethics

Sometimes common sense isn’t so common and despite all the talk about ethics, it isn’t as common as it should be either.

I’ve been to see 4 practitioners in the last 18 months or so who have messed me around. One practitioner gave me a different treatment than the one I had booked. After the treatment, I asked them for the treatment I had booked and they told me that my “energy would be all over the place” and it therefore wasn’t possible. I concluded that they had obviously done this on purpose to at least guarantee I’d be back for one more session so they’d make more money. (This dragging out of sessions and prolonging intakes goes on far too often for my liking). As one practitioner said to me when I mentioned this, your energy should be in a more coherent state after a treatment and therefore the treatment that I had requested would give a more accurate reading. I emailed this person stating that I felt totally disrespected and not listened to and not surprisingly didn’t hear anything back. What good is any tool/technique/therapy if there aren’t the basics of safety, respect and trust? Needless to say, I didn’t go back so their unethical and unprofessional behaviour didn’t guarantee them what they thought it would: a returning paying customer.

Another practitioner was obviously triggered by me or by issues that I was bringing up, this is called countertransference in psychotherapy. And again, they abdicated themselves of all responsibility. From my point of view they had zero insight into their own behaviour. That’s worrying, we all have blind spots, but we’re supposed to discuss cases with peers or supervisors so that we can see things more clearly and act accordingly. That certainly did not happen in this case. I am being ethical by not mentioning any identifying details about these practitioners, because there are, or ought to be, the proper channels to deal with these matters. I’m not going to drag anyone’s name through the mud as that would be unethical and unprofessional of me.

You can be the best marketer in the world but if you don’t deliver what you promise, what does it matter? We’re drenched in marketing and we fall for it time and time again but how many times does it actually deliver even 50% of what it promises? There has to be something in any relationship to the benefit of both (or more) parties. I’m always of wary of practitioners who talk about their success rates. The success rate of any treatment doesn’t depend solely on the practitioner, it also depends on the readiness and willingness of the client. It is a two way street and I’d be wary of any practitioner that promises anything. Any progress and healing is down to both partners working together and for that you need the absolute basics of any good therapeutic relationship: safety, trust and respect.

It takes a lot to reach out and ask for help, there are many vulnerable people who might even be suicidal and I don’t think that enough practitioners are taking their responsibilities seriously enough. And this is true for seasoned therapists belonging to professional organisations being supervised. Too many people just don't get the help that they need. There are guidelines you can follow in choosing someone, but also trust your gut and if you do meet some duds, don’t blame yourself. That’s the thing that really gets me, clients nearly always think it’s their fault and practitioners, by being defensive and maybe even fearful of legal liability, are loathe to own their shit as Elizabeth Gilbert would say.

Friday, August 05, 2016

Avoiding your pain only prolongs it

In my experience avoiding my pain only prolongs it. The simple, but certainly not easy, act of feeling pain helps you through it. But the problem is we often fear that if we felt our pain, it would never end and/or it might swallow us up, and so we run. We run in many different ways and in many different directions. But the ways and the directions don’t matter, they only serve as a smokescreen as to what’s really going on.

Self-regulation is the ability to handle all of our emotions. But self regulation doesn’t happen in a vacuum, we need to have been taught and shown how to regulate our emotions, particularly difficult emotions, or what might be termed negative emotions. Our care givers are our most important and influential teachers in this regard. They show us how they handle their emotions and we learn from them. If they can handle their emotions, they can then provide a safe container for us to feel our emotions, that is, they co-regulate us. We learn self regulation from co-regulation.

Of course this is the ideal situation and many of us didn’t have that, not only for reasons of abuse and neglect but also because very few of our parents were taught how to self regulate by their parents. We’re mostly living in an emotionally illiterate world where we divide emotions into positive and negative and so most of us are emotionally constipated, our barrels are full of unprocessed stuff which makes us feel like crap.

The important thing is that you find a way through, not under, over or any other way except through. The way for each of us will be different, find what path feels true and right for you.

Tuesday, July 26, 2016

When it's hard to take

There are some things in this life which are just hard to take. A really simple way to tap on this is to say as you go through the pointsI find it hard to take this … in” or use whatever words feel right for you. Living a healthy life is all about good digestion both physically and psychologically. And at the risk of sounding like a broken record, it’s why I like Ivor Browne’s definition of trauma: unexperienced experience. It’s not frightening, stigmatising, complicated or marginalising. It’s just beautifully simple and inclusive because I’d bet we can ALL identify with it. It also defines trauma as an experience, not an event. A crucially important distinction that gives weight and credibility to the individual’s experience.

Developmental trauma can be especially difficult to overcome. We are social animals and we suffer tremendously when we don’t have at least one person on whom we can depend. Love is not optional, it is essential for our physical and mental wellbeing at every stage of our life, but particularly so when we are infants. Babies who are securely attached have a solid foundation and if they are traumatised later in life, can usually get through it with the help of family and friends. They have learned that they are fundamentally okay, lovable and acceptable and that anything that happens is not because they’re innately bad or unworthy.

Tuesday, July 05, 2016

Here but not present

You might wonder what dissociation has to do with trauma. Both terms can seem scary and stigmatising until we learn what they mean and how many of us have experienced them (all of us?). One of the simplest definitions of trauma is ‘unexperienced experience’, by Irish psychiatrist Ivor Browne. What I really like about this definition, besides its simplicity, is it explains how trauma comes about.

It is dissociation, both psychological and somatic, which prevents an experience from being experienced, and consequently, integrated. Dissociation is a mental and physical process that results in a lack of connection and integration between thoughts, emotions, memories and our sense of identity.  We can experience a traumatic event and not develop trauma. Trauma only develops when we persistently dissociate. And while dissociation is a brilliant short term defence strategy for survival, long term, it can cause havoc with our mental and physical health.

Nijenhuis, E. R. S. and van der Hart, O. (2011). Dissociation in trauma: A new definition and comparison with previous formulations, Journal of Trauma & Dissociation 12(4): 416-445.

Sometimes we dissociate just before or during an upsetting experience (peritraumatic dissociation), but afterwards we find the resources; e.g. solid childhood foundation, supportive network of family and friends etc, to help us digest and move through the difficult experience. When we’re continually overwhelmed however, it can be very difficult to process painful experiences and this is particularly true of children. If a child suffers from continuous abuse and neglect and has no one to turn to on top of the abuse—what is termed betrayal trauma—they are very prone to dissociating because it really is the only relief they can find in horrible circumstances. A good example of this is author Carolyn Spring who developed Dissociative Identity Disorder (DID) after suffering horrific continuous ritual abuse during her childhood.

The degree to which we dissociate is the degree to which we have been hurt and that is subjective. Trauma cannot be defined objectively. Of course there are horrific experiences that some people go through, but when it comes to trauma, or more precisely showing the signs of being traumatised, comparisons are odious. All they do is minimise or maximise someone’s pain instead of taking each individual’s experience seriously.

Most people know that amnesia, derealisation and depersonalisation are examples of dissociative behaviour but did you know that flashbacks and intrusive emotions and sensations etc., are also dissociative behaviours? The former are termed negative symptoms as they denote a loss of some kind (hypoarousal) and the latter are called positive as they intermittently intrude on the self and other parts (hyperarousal).

We tend to think of dissociation as something that remains hidden, in the shadows, and therefore something to be feared. We also tend to think of it as a purely psychological or mental process, however, the freeze response (or tonic immobility) is an example of physical or somatic dissociation. It is the reason that rape victims often can’t move or call out for help. They are physically paralysed with fright and shock. This is often mistakenly perceived as being compliant, or not putting up a fight and as a result, many perpetrators are not bought to justice.

In Karla McLaren’s book, The Language of Emotions, she talks of panic and terror as being signs that we’re ready to move into phase three of trauma healing (the final phase). Could flashbacks and intrusions, that often go along with terror, be an attempt of the dissociated parts to integrate and to experience what hasn’t been fully experienced? is this why they're termed positive dissociative symptoms? I think knowledge is power and when we know what’s happening to us has a reason, it brings some relief, or even a lot of relief. I think unresolved trauma is one of the greatest health issues that we all face, as stress is responsible for over 80% of physical diseases.

Monday, June 27, 2016

Stress becomes anxiety

Stress becomes anxiety when we don’t release it. Anxiety is compacted built up stress, sometimes decades of years old, that usually manifests itself as excruciatingly uncomfortable physical sensations and of course anxious thoughts that can spiral out of control.

The thing with anxiety is to keep it as simple as possible so you don’t become even more overwhelmed. Pare back what you expose yourself to and give yourself as much of a break as you possibly can.

A book that I have found extremely helpful is The Dare Response (I have no affiliation to the author). The information in it is not new, as the author Barry McDonagh states, but the way he presents it is. It is beautifully simple and extremely practical which is exactly what someone suffering from anxiety needs. I cannot recommend the book highly enough.

Being human beings we try and move towards pleasure and away from pain but with anxiety, this doesn’t work. In fact, it makes it much worse. The old cliche of what you resist persists. If the truth be told, when I have felt anxious, I have often tapped to get rid of it just because it feels so awful. But EFT never works when our intention is to get rid of something, which of course frustrates us even more until we realise what’s going on. Tapping to help us through a difficult experience is completely different and does work, and tapping works wonderfully well when putting the steps in this book into practise.

As McDonagh explains in his book, you need to stop resisting your anxiety so your nervous system can discharge it. It is only by doing this that it can be discharged by your nervous system, By not resisting your anxiety (which he explains how to do in simple practical details), you are teaching your system to recognise imminent threat. If there were an impending threat, you would have to deal with it there and then as best as you could. With anxiety, the threat feels ever present, even when you are safe (being safe and feeling safe are not the same). This is because your nervous system has not discharged the flight/fight response, or responses (there are many many undischarged experiences with chronic anxiety), so it is on hyper alert all the time. 

One of the things I have found with anxiety is the feeling of being on a merry-go-round or living groundhog day over and over again. The trauma loop in other words. Living with anxiety often becomes more traumatising than the original traumatic experiences that weren’t resolved. But you can really can learn to heal anxiety.