"I just can't seem to stop my mind," Linda told me. "I try to relax, but after a few moments, my brain starts to buzz again with a jumble of thoughts and feelings. I can't seem to turn them off." As she spoke to me during our second visit, she was visibly distressed. She had the pinched face and hunched shoulders of someone who felt at once threatened and helpless.
"Lots of times, it's the same old thing, just the same old negative thoughts and worries and blaming myself," Linda went on. "Sometimes I try to head them off by going out for a run, but they come back later. When they really get ahold of me, I get kind of shaky, dizzy, and sick to my stomach. If they go on long enough, I actually get a stiff neck, and eventually a headache."
A client's negative, intrusive thoughts are a therapist's stock and trade. Ditto the accompanying roster of bodily complaints, from stomach pains and neck tightness to headaches and back problems. In my 20 years as medical director of a multidisciplinary chronic-pain program, I've found these body-mind intrusions to be a sort of generic marker for significant emotional disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and adjustment disorder.
But if Linda's distress seems familiar, it isn't just because we see this kind of client so frequently in our offices. It's also because her complaint rings true for "healthy" people like ourselves. All of us ruminate, bringing up the cud of old memories and unresolved problems, in the process experiencing a sinking feeling in the stomach or perhaps a tightening in the throat. As we well know, these experiences usually arise unbidden and often at inopportune times, such as when we're reading a book, eating a meal, or even, God forbid, making love! And when we're interrupted in this way, we basically lose it: we forget why we went into the bedroom, we lose track of our place in the book, and, if the intrusion is upsetting enough, we may even lose the wherewithal to continue with what's going on right now. We've experienced that most insidious of insults to our mind--the corruption of the present moment by emotion-linked memory.
When we catch ourselves in this state of nonpresence, we're likely to chalk it up to "mind chatter." When a client reports these repetitive intrusions, we may wonder about a tendency toward obsessiveness or the possibility of depression and/or anxiety. While all of these interpretations may have some validity, I believe that much more is at stake. I propose that in many of these moments of body-mind intrusion, our brain is trying to protect us from mortal danger arising from memories of old, unresolved threats. In short, we're in survival mode.
To understand the meaning of these everyday emergency responses, and to transform them into opportunities for healing, we first need to rethink our fundamental assumptions about trauma. I propose that the sources of trauma are far more complex than the standard Diagnostic and Statistical Manual (DSM) definitions. Under Criterion A, the DSM-IV defines trauma as the result of having "experienced, witnessed or been confronted with . . . actual or threatened death or serious injury . . . to self or others" and responding to that event with "intense fear, helplessness or horror."
This definition isn't wrong, but it's woefully incomplete. In fact, any negative life event occurring in a state of relative helplessness--a car accident, the sudden death of a loved one, a frightening medical procedure, a significant experience of rejection--can produce the same neurophysiological changes in the brain as do combat, rape, or abuse. What makes a negative life event traumatizing isn't the life-threatening nature of the event, but rather the degree of helplessness it engenders and one's history of prior trauma.
All of us, clients and professionals alike, will continue to set ourselves up to be retraumatized until we recognize that many of our negative intrusive thoughts and sensations are, in fact, symptoms of trauma. They may not be identified as such in the DSM-IV, but these more commonplace body-mind invasions assume the same meaning, if not the intensity, as the trauma-related thoughts and flashbacks of full-fledged PTSD. In both PTSD and what we might call "ordinary" trauma, conscious and unconscious memories brutally intrude upon and corrupt the present moment. Not everyone suffers from PTSD, but each of us has sustained many of these smaller traumas, setting us up for being continually shoved out of the present moment into a frightening, helpless past.
Who Cares about the Present?
In psychiatrist Daniel Stern's model, the "present moment" is a brief period--lasting perhaps 1 to 10 seconds--that represents our conscious experience of the here and now. Only in the present moment can we fully live. If our "nows" are perpetually interrupted by intrusive memories, we're essentially stuck in a time warp formed by those stored perceptions. We can't problem-solve, we can't experience a daffodil or a sunset, we can't relate to other people, resolve old conflicts, or form new attachments. Only in the here and now can we directly experience, and move ahead with, our lives. The present is indeed a precious commodity.
Yet we repeatedly squander it. Therapists most readily witness this dissipation of the present moment with certain clients, the ones who focus obsessively on ancient complaints and worries to the exclusion of creative or productive ideas that might help them move forward. Many of these clients also complain of various aches and pains, most commonly gut symptoms, such as acid reflux or irritable bowel, or chronic pain in the head, neck, or back.
But if we're honest, we also recognize this corruption of the present in our own lives. How often do we find ourselves ruminating about this or that familiar resentment or well-worn worry? How often do we truly notice where we are, whom we're with, or what's actually happening--that is, experience our own precious moments? It's as though some dark, implacable entity invades our minds and bodies and fills them to the brim, leaving little space for pleasure in our aliveness, much less for growth or healing. That entity, I believe, is the total body-mind experience of a past trauma.
Treatment: Mere Words Aren't Enough
Trauma healing, in essence, is the recovery of the purity of the present moment. This concept has vital implications for trauma therapy (which, from here on in, should encompass treatment for "ordinary" as well as extraordinary trauma). The bottom line: therapy must adequately address the body-based procedural memories that form a large part of the trauma structure.
So, how do we get from here to there? The royal road to the present moment, I believe, is through the emotional brain. We know that the limbic nucleus, the right amygdala, evaluates the emotional content of incoming sensory stimuli. If we can find a way to shut down the right amygdala while a client is exposed to the contents of the dissociative capsule, we should be able to extinguish its contents. With the amygdala "off-line," the traumatic memory would no longer be associated with the somatic cues of arousal--the tight chest, the pounding heart, the constricted throat. These symptoms would no longer intrude on the present moment. Procedural memories of the trauma--both bodily sensations and emotionally linked memories--would no longer convey threat in the here and now, because they'd accurately be perceived as old memories. We'd find ourselves restored to the present moment, in all of its richness and possibility.
Retraining the Brain
What therapeutic processes might convince the amygdala to "down-regulate?" I'm not touting any specific approach. But what we know about the neurophysiology of trauma suggests that some of the so-called somatic and energy therapies, such as Somatic Experiencing, EMDR, Emotionally Focused Therapy (EFT), and Thought Field Therapy (TFT), may be particularly well equipped to escort a traumatized person from the past back to the present. Let's look at how these approaches might fulfill some fundamental needs of trauma healing.
Ritual. This is often part of the healing process in non-Western and especially indigenous societies, where it's often practiced by tribal healers or shamans. Rituals often involve repetitive behaviors, such as drumming, dancing, or singing, and frequently induce hypnotic trance states. The use of hypnosis in healing trauma may have its roots in this process. In addition, social rituals may activate the anterior cingulate, the part of the cortex that's known to inhibit the amygdala. We know that the anterior cingulate plays an important role in mother-infant and social bonding, a state that may be replicated by social ritual. The potency of ritual also may explain the impact of the eye movements of EMDR, the tapping procedures of EFT and TFT, and the repetitive affirmative statements of the latter two approaches.
Empowerment. This is the ultimate goal of all trauma therapy. To heal, an individual must recover from the state of helplessness that defines the trauma experience. During a traumatic event, a person experiences physical helplessness and effectively freezes into that state, leading to all manner of pain and illness. To recover, one needs a way to thaw out the body.
This "melting" process is at the heart of Somatic Experiencing, a body-based therapy in which one accesses the felt sense of the trauma and allows the failed motor defense to emerge in the form of a "freeze discharge," wherein the individual moves out of immobility into an effective fight or flight response. This ability to achieve discharge can be facilitated via a number of other somatic approaches, including dance, balance, equestrian therapy, and art therapies. What these approaches have in common is their capacity to access the freeze discharge and extinguish somatic procedural memories through completion of the bodily act of defense or escape. This completion at once permits and celebrates reempowerment.
Making meaning. Talk does play an important role in trauma therapy, but not as the first order of business. Once the contents of the dissociative capsule are extinguished, client-therapist conversations can help to provide the client with conscious, cognitive meaning and perspective. Talk can empower a client with the knowledge that the occasional recurrence of residual somatic symptoms--a sudden bout of nausea, a strangled feeling in the throat--actually represent an event from the past, and not an imminent threat that wipes out the here and now.
We can make enormous strides in discharging the contents of our trauma capsules, especially via approaches that address our body-based memories. But as we make our vital journeys back to the present, we'd do well to cultivate an attitude of gentle acceptance. For it's quite possible that all the body-based therapy in the world, plus regular infusions of meditation, running, yoga, and other mindfulness practices, won't be enough to keep us permanently anchored in the here and now. It seems we just aren't wired to live there full time. But we can make extended visits. And when we do, we can explore the lush landscape of the present moment with more wonder, wisdom, and pleasure than ever before.
This blog is excerpted from "The Precarious Present," by Robert Scaer. The full version is available in the November/December 2006 issue, The Present Moment: How Can We Get There and How Can We Stay?
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