Presentation by Dr. Jesse Hanson, RP, PhD, Clinical Director and Co-Founder of Helix Healthcare Group. Dr. Hanson is a neuropsychologist; specializing in neuroscience, somatic (body-centered) psychology, trauma resolution, and holistic healing.
At Helix Healthcare Group, we address the brain, the body, and the belief system to create a healthy, happier and more balanced life. Unlike conventional treatments, our comprehensive approach creates lasting change by treating the root cause of the issue – not just its symptoms. Blending the best of Western and Eastern philosophies with cutting-edge neuroscience, we will empower you to create a better future, today. www.helixhealthcaregroup.com
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The Road Back From Trauma - Helix Healthcare Group
1. S
The Road Back
from Trauma
Jesse Hanson MA, PhD, RP
Clinical Director, Helix Healthcare Group
2. Overview
S Part 1: Redefining Trauma through neuroscience and
Objects-Relations Theory
S Part 2: Trauma and the Brain-Body: Understanding
Disassociation
S Part 3: Treatment of Trauma: Stabilization, Reprocessing
and Integration
3. S
Objectives – Part 1
• Redefining Trauma
• Window of Tolerance
• Exploring Trauma through the lens of
Neuroscience, Object-Relations, Interpersonal
Psychoneurobiology
5. What trauma can also look like
– The Little-T
S Little-T trauma or
development trauma
is just as damaging as
big trauma, especially
as it is repeated over
years of time; we
become conditioned
to it.
6. Attachment Trauma Versus
Acute Trauma
S Attachment trauma (Developmental Trauma) is trauma that is
created through relationships. It is “small t” trauma. This trauma
does not have to be overt; it can be negative verbal messages that
were shared, or alternatively the absence of positive messages
throughout childhood development. It is mentally/emotionally
based
S Acute Trauma (physical trauma) is “Big T” trauma. Acute trauma
is created through physical or sexual violence or physical
accidents and non abuse related injuries or experiences
7. Trauma is a
Phenomenon
Trauma is a
phenomenon that occurs
in relation to a person’s
window of tolerance; the
same event that one
person can cope with,
could create trauma and
PTSD in another
Trauma is not a noun
Trauma is a “verb”
9. The Lens of
Neuroscience
Trauma greatly effects how the neural
pathways in the brain are created and
regulated
Research shows the vast way that our
neural communication is affected once
trauma has occurred
Most human behavior is driven by
procedural memory – memory for
process and function – and is reflected
in habitual, automatic responses and
well-learned action patterns:
movements, postures, gestures,
autonomic arousal patterns, and
emotional and cognitive tendencies. --
Ogden (2006)
10. This research is showing us that it is our
relationship to what happened that
influences our outcome, not the event itself.
(1) chronic post-traumatic stress disorder
patients have gray matter structural damage
in the prefrontal lobe, occipital lobe, and
parietal lobe, (2) after post-traumatic stress
is reprocessed, the disorder symptoms are
improved and gray matter structural
damage is reduced --Weihui Li (2013)
11. The Lens of Object-relations
S Trauma that is created through early childhood relationships
will factor into how a person’s character structure is created
S Trauma creates a break down in how the mind-body
functions, which can lead to symptoms such as addiction
and disease
S Trauma will often have emotional associations that are
stored in the body
Understanding Attachment Trauma
13. Because most traumas (both attachment and acute) occur in
relationships, it is a healthy and safe relationship that can assist
in healing the symptoms of trauma and PTSD. The safety of
the relational container is of vital importance.
14. The Lens of Interpersonal
Psychoneurobiology
S Trauma creates separate parts that are not time-oriented-
parts of self.
S The parts that are not time-oriented “live” in the right brain
S Through the lens of interpersonal psychoneurobiology we
begin to see the benefits of re-integration
15. Dan Siegel, MD
An “interpersonal neurobiology” of human development enables us
to understand that the structure and function of the mind and brain
are shaped by experiences, especially those involving emotional
relationships -- Siegel (1999)
Through the linkage of differentiated components of a system,
integration is viewed as the core mechanism in the cultivation of
well-being. In an individual’s mind, integration involves the linkage
of separate aspects of mental processes to each other, such as thought
with feeling, bodily sensation with logic. In a relationship, integration
entails each person’s being respected for his or her autonomy and
differentiated self while at the same time being linked to others in
empathic communication. -- Siegel (1999)
17. S
Objective – Part 2
• Deepening our Understanding of how Trauma is Stored
• Right Versus Left Brain
• Structural Dissociation
• Trauma and the Body
18. Trauma and the Brain
S Traumatic experiences overwhelm a person integrative capacities
S The person is flooded by somatosensoryinformation that cannot
be fully processed and integrated
S This results in a split, the apparently normal part that is in time,
resides in the left brain and helps “normalize” the event
S The unhealed, hurt or emotional part(s) becomes stuck in
“trauma- time” and are stored in the right brain
19. The Healthy
System
S We all have two action systems: The Daily Living Action System and the
Defensive Action System
S Daily Living Action System deals with all mental and behavioral actions dealing
with daily life
S Defensive Action Systems come into play when the individual perceives danger
and activates defensive instincts (limbic brain)
S These systems work together to assimilate, process and integrate experiences as
they occur in our daily life.
S Trauma occurs when an event can’t be fully processed. The defensive system has
to hold onto and store the traumatic event so daily living can appear normal in
day to day life. If integration still does not happen once the system can rest then
the two systems are no longer working in harmony.
Daily
Living
Defensive
-- Martin (2015)
20. This breakdown of communication between
these systems stops them from being able to
fully communicate and ends in dissociation
across the personality
21. Structural Dissociation
S Once a trauma has led to ongoing dissociation there will be the apparently normal part
(ANP) and a second (rather limited and rudimentary) emotional part (EP)
S PRIMARY
S Simple PTSD
S Simple DissociativeDisorders (DSM-IV, ICD-10)
S SECONDARY
S Chronic, complex PTSD
S Bi-Polar, Borderline Personality, DDNOS
S TERTIARY
S DID
-- Van der Hart, O., Nijenhuis, E., & Solomon, R. (2010)
22. The ANP and the
EP’s
S Once the breakdown of the Daily Action and Defensive Systems
becomes too great, due to the unprocessed material stored in the
defensive system, we see two new systems that are phobic to one
another appear.
S The apparently Normal Part of the Personality (ANP) is the part that
shows up in daily life and try’s to keep the appearance of normalcy. It
will try to avoid the trauma through different numbing and coping
skills but is still plagued by information from the defensive system
S The Emotional Part of the Personality (EP) encodes and stores the
trauma. It relives the trauma; it is not time-oriented; lives in ‘trauma
time.’
S Both of these parts contribute to the dissociation
Apparently
Normal
Part of the
Personality
Emotional
Part of the
Personality
-- Martin (2015)
24. A look into Structural Dissociation -- Kathleen (2015)
EP: submit
ANP
2
ANP 1
EP: fight
EP: flight
EP: child
attachment cry
EP: 5 yr
old
EP: Freeze
25. Trauma and the Body
S Disease is often the body's way of saying "no" to what the
mind cannot or will not acknowledge -- Gabor Maté (2003)
S The body holds and stores the trauma that the EP’s are
holding which eventually can lead to disease, illness and
chronic pain
S Once trauma is fully processed the body experiences a
freedom of energy and movement
29. Being curious about our own
past experiences
On a scale of 1-10, where 1 equals little to no disturbance; and a 10
equals extreme disturbance (going to pull my hair out, or can’t breath);
Choose a past experience from your life that registers at about a 2 or 3
(either an acute or developmental trauma)
Discuss with a partner. Practice integrating the new awareness and
language as you discuss the traumatic event
Your partner will offer reflections about how this impacts them.
This is not a therapy session, just a chance to learn through sharing and
offering compassion.
30. S
Objectives - Part 3
• Stabilizing
• Importance of Mindfulness
• Treating Trauma: Phase 1, phase 2 and phase 3
• How not to grow the phobia
31. Stabilizing
• Stabilization is the first
priority.
• A client must have the
capacity to sustain calm and
relaxation.
• The system that is stuck in
Hyper-vigilance has a lower
capacity to deal with stress
and can’t process new
situations, which leads to
higher probability of creating
new trauma.
• Stabilization requires
mindfulness to help integrate
mind and body in present
moment experiences.
32. Importance of Mindfulness
S In every day life
S Significant reduction in psychological and physiological responses
to daily hassles -- Williams (2001)
S Greater capacity for self regulation of emotional and dispositional
states correlating with improvements in affective experience and
declines in mood disturbances -- Brown (2003)
S In times of crisis
S Significant improvement in ability to cope with traumatic life
events, including reductions in anxiety, depression and PTSD
symptoms -- Kvillemo (2011)
35. Phase 1
S Stabilization: Reducing the ANP’s phobia to the EPs and the traumatic
material by increasing the ANP’s ability to deactivate arousal in the defensive
system
S Affect tolerance and regulation skills
-increasing the positive affect tolerance of calm in particular
• Decrease phobias to internal experience
• Decrease phobias to emotional parts
• Develop co-consciousness and compassion by the ANP toward the EPs
• ANP’s development of skills to deactivate EP arousal
• Time orientation skills and other stabilization skills
ANP’s exposure to the traumatic material
in this phase is not effective because it
grows the ANP’s phobia.
-- Martin (2015)
36. • Develop internal
communicationbetween the
ANP and EPs and among
the EPs
• Help all parts to understand
that their “jobs” were
created by their “one brain”
to manage the overwhelming
events in times of danger.
This helps to create the
necessary compassionto
reduce the phobias among
the parts
37. Phase 2
Reprocessing the traumatic
material: carefully titrating
memory-reprocessing work with
stabilizationskills helps
prevent re-traumatization and/or
re-dissociation
40. Phase 3
Enhancing Daily Living:
Integration of the personality,
overcoming phobia of intimate
attachment, and learning to live
life without dissociation
42. Growing the Trauma
S No integration can occur when the emotional part or part that is
holding the trauma is outside the window of tolerance
S Reliving is outside the window of tolerance. Reliving implies re-
dissociation/re-traumatization
S Phobia grows if it is activated without integration
S As Phobia’s grow client has less ability to de-activate (to calm and
time orient)
S Avoidant/Addictive behaviors increase
43. Treating the Phobia
S Stabilization: increasing the person’s level of
functioning and window of tolerance
S As the persons level of functioning and tolerance
increases, he or she will feel more in control of the
internal experience
S Therefore, reducing the ANP’s phobia reverses the post
traumatic decline and decreases/eliminates negative
symptoms of trauma
44. Self-Awareness
as a Professional
We can only take our
clients down the path as
far as we have traveled on
our own.
If we truly want to help
our clients heal from their
traumas, we have to
examine and reprocess our
own.
45. The Outcome
• Individuals who process
trauma to conclusion can
begin to experience daily life
freer, healthier and with
greater success
• Addictions can be let go of
with no substitute addiction
to pop up in place of current
addiction
• Individuals “earn” more
influence to make higher
quality choices that help
them create a higher quality
of life.
• Earning the ability to
Respond rather than React
47. References
S Dr. Dan Siegel. Interpersonal neurobiology. The Developing Mind, 1999; The Norton Series on Interpersonal
Neurobiology.
S Gabor Mate MD. When the Body Says No, The costs of hidden stress: 2003;
S Pat Ogden. (2006) Trauma and the Body
S Department of Child and Adolescent Psychiatry, The National Hospital, Psychiatry. Dissociationinchildren
and adolescents as reactionto trauma--anoverviewof conceptual issues and neurobiological factors. Nord J Psychiatry
2005;59(2):79-91.
S Weihui Li. Xiangya Hospital, Central South University, China (2013)Neural RegenerationResearch;
8(26):2405-2414.
S Kirk Warren Brown, Richard M Ryan (2003)The benefits of being present: Mindfulness and its role in
psychological well-being. Journal of Personality and Social Psychology, Vol. 84, No. 4, Apr 2003, 822-848
S Pia Kvillemo, et al. (2011) A Randomized Study of the Effects of MindfulnessTraining on Psychological
Well-being and Symptoms of Stress in Patients Treated for Cancer at 6-month Follow-up. International Journal
of Behavioral Medicine: December 2012, Vol. 19, No. 4, pp. 535-542
S Kimberly A. Williams, Maria M. Kolar, Bill E. Reger, and John C. Pearson (2001) Evaluation of a
Wellness-based Mindfulness Stress Reduction Intervention: A ControlledTrial. American Journal of Health
Promotion: July/August 2001, Vol. 15, No. 6, pp. 422-432
S Kathleen Martin, LCSW. (2015) Treating Complex Traumawith EMDR andStructural Dissociation Theory;A
Practical Approach;slides 34, 39, 42, 48
S Van der Hart, O., Nijenhuis, E., & Solomon, R. (2010) Dissociation of the personality in Complex Trauma-
Related Disorders and EMDR:TheoreticalConsiderations.Journal of EMDRPractice and Research. 4(2), 76-92