Rethinking Trauma - Amazon S3 · 2019. 1. 2. · rather than the negative, as we are inspired to do by the experience of having been traumatized? Dr. Borysenko: When you're used to

How to Work with the Traumatized Brain Bessel van der Kolk, MD - Next Week - pg. 1

Rethinking Trauma

How to Work with the Traumatized Brain

a Next Week in Your Practice Session with

Joan Borysenko, PhD; Bill O’Hanlon, LMFT; and Ruth Buczynski, PhD


Table of Contents

(click to go to a page)

What Stood Out Most ........................................................................................... 3

An Exercise to Bring Clients Into the ‘Here and Now’ ............................................ 4

How to Help Traumatized Clients Regain Their Sense of Aliveness ........................ 5

One Strategy to Increase Mindfulness and Embrace Positive Experiences ............ 6

Two Techniques to Calm the Thalamus ................................................................. 7

The Importance of Working with the Senses to Re-Engage with the Present ........ 9

About the Speakers ............................................................................................... 13

A Next Week in Your Practice Session: How to Work with the Traumatized Brain

with Ruth Buczynski, PhD; Joan Borysenko, PhD; and Bill O’Hanlon, LMFT


Dr. Buczynski: Hello, everyone, and welcome. I'm Dr. Ruth Buczynski, a licensed psychologist in the state of

Connecticut and the president of the National Institute for the Clinical Application of Behavioral Medicine.

I'm joined by Dr. Joan Borysenko and Bill O’Hanlon.

Joan is a licensed psychologist as well as a cell biologist, and she's the author of The Plant Plus Diet Solution:

Personalized Nutrition For Life.

Bill is a licensed marriage and family therapist and a speaker who has spoken all over the world, and has

prolifically written books, including Quick Steps to Resolving Trauma.

Both of you, thanks for being here. Let's jump right in – What stood out to you most as I was talking with

Bessel van der Kolk?

What Stood Out Most

Dr. Borysenko: A number of things stood out. First of all, I think he gives us such a good framework for

looking at what has actually happened to the brain and trauma that we're waiting for the next shoe to drop.

That part of the brain that's watchful is definitely triggered, and at the same time, the part of the brain that's

dealing with what's really relevant to the here and now is not working well. So we're not in the here and

now.

I realized that a very important part of that is his notion that if you can't get into the here and now, you can't

become aware of the subtle kinds of perceptions that are coming

from your own body in your own experience. And without doing

that, it's hard to change anything.

I think I have a quote from him here, or it might have just been

my note here – it's really hard to change irrational organic

“If you can't get into the here

and now, you can't become

aware of the perceptions that

are coming from your own

body in your own experience.”

with Ruth Buczynski, PhD; Joan Borysenko, PhD; and Bill O’Hanlon, LMFT

A Next Week in Your Practice Session: How to Work with the Traumatized Brain


responses that are coming from the body. They're below the level of consciousness, except, by developing

this very fine attunement to your inner world, and that's something we don't hear much about.

I hadn't heard much about it, except in eastern philosophies, where they tell you to pay very fine attention to

a difficult emotion, and not to try to escape from it; to notice it, to be curious, to observe the subtleties.

In the actual work of doing that, activating what Bessel calls the watchtower, the difficult sensations begin to

disappear, and you get back to a more peaceful part of yourself.

I found that very, very interesting that they kept coming back to what it is to develop self-observation; I really

haven't heard that before from a more modern scientist.

Dr. Buczynski: How about you, Bill? What stood out to you in that session with Bessel?

Mr. O’Hanlon: I've followed Bessel’s work for a long time, and every time you talk to him, and every time I

hear him, he seems to have gone to a new place.

Number one, he'd probably taken in the latest research; but number two – my life partner is a psychiatrist,

and I don't mean to dis psychiatrists, but – you don't hear many psychiatrists talking about yoga as part of

treatment. They don't bring in the body. They’re focused a lot on neurology, which is appropriate – but he

seems to branch out a lot and say, “You've got to bring this in. You could bring this in.”

And he brought us neurofeedback. He seems really interested in, how can we bring in as many affective

modalities that affect the neurology, the emotions, the body, the physiology, and he seems quite open to

these new things.

That just stood out for me in the whole conversation; I kept thinking, wow, he's interested in this, and he's

brought this in, and he's brought this in.

He’s very eclectic while still having a clear point of view. That was what stood out for me.

An Exercise to Bring Clients Into the ‘Here and Now’

Dr. Buczynski: Bessel’s got a lot of government NIH grants and studies a lot of this whether it's studying

EMDR or yoga, or now he's studying neurofeedback. We've talked a lot about staying in the present and how


important that is. What are some exercises or take-home homework that people watching the webinar can

use with their patients?

Dr. Borysenko: I think one of clearest exercises was John Kabat-Zinn about his MBSR, the Mindfulness Based

Stress Reduction Program, which was called Full Catastrophe Living, a line from Zorba the Greek. Johnny's

exercise is so simple, and it's that raisin exercise.

I bet a lot of you practitioners who are listening already know about that, where you take something that you

take for granted, a raisin, and you usually pop a pile of them in your mouth at once and you have to develop

a deep and intimate relationship with one raisin: looking at it; feeling it: the texture, the stem end, the

blossom end; smelling it, involving all your senses; finally putting it in your mouth without popping it;

watching the body responses; finally, sticking maybe your one tooth through the raisin and it releases the

flavor—and you watch all these things.

It definitely brings you into the moment, because actually the flavor of the raisin is much more arresting and

piquant than you might have thought.

I think that is such a simple exercise for coming to the moment that it's easy then to generalize, how do you

come into the moment when you're eating a piece of chocolate cake? Or, when you're doing something like

that.

Or, how do you come into the moment when you're making love, so that you're not rerunning your grocery

list in your mind instead of focusing on the sensations? Since there's such a blunting of sensations of pain and

pleasure that accompanies trauma, I find it very interesting how Bessel

focuses on, okay, we have to bring people into the here and now.

So, I would say something like the raisin exercise because it's easy. Start with what's easy.

How to Help Traumatized Clients Regain Their Sense of Aliveness

Dr. Buczynski: Bessel talks about traumatized patients being attracted to dangerous situations because it

feels more alive. Now, while extensive treatment is necessary, what activities or interventions could

practitioners offer in the interim to keep patients out of danger while they are healing?

“Start with what's easy.”


Mr. O’Hanlon: Years ago, the reality therapist, William Glasser talked

about positive addictions and negative addictions.

I think a positive thing that you can do, or encourage people to do, is

something that would be very frightening for people and feel

dangerous, but not actually physically dangerous.

I've always found this the place that I'm most alive where I have a longing to do something and it scares the

heck out of me.

The first time I wrote a book, it's like I'm not sure I can do that. That's beyond me.

Doing public speaking was terrifying to me. But I had this longing in me to do it.

So, I would probably steer my clients to a place where they had

longed to do something, but it seemed beyond them, or it seemed

really intimidating; and I’d say, “That's the place where you can

get your thrills. You can get this frightening, alive sensation, but it

will do you so good to go in this direction, rather than go out to a

dark street wearing a short miniskirt. Not a good idea. That's a

dangerous thing that could get you killed. This, it may make you

anxious and you may think you are inadequate for it, but if you pull it off, or even if you don't, nothing

terrible is going to happen.”

One Strategy to Increase Mindfulness and Embrace Positive Experiences

Dr. Buczynski: How can we train perception to take in more of the positive, or at least take in the neutral,

rather than the negative, as we are inspired to do by the experience of having been traumatized?

Dr. Borysenko: When you're used to dwelling on the negative, usually that piece of the brain that's looking

for trouble is always activated. And I think sometimes we work hard on trying to deactivate a system that's

already in place like that.

Another way of looking at it is, how do we activate another part of the brain and another part of perception,

“I'm most alive where I

have a longing to do

something and it scares

the heck out of me.”

“I would steer my clients to a

place where they had longed

to do something, but it

seemed beyond them, and I’d

say, that’s the place where

you can get your thrills.”


so that it starts to take up more and more of the consciousness? Then the old stuff just gradually fades away

because it's got less space.

There's one simple exercise that I've used for almost thirty years, and I've used it with clients, and I think I

mention it in almost every public talk I give. It's a gratitude exercise; I happen to have learned it thirty years

ago from Brother David Steindl-Rast, who's a Cistercian monk and was one of the first of those people from a

particular religious tradition who took up an eastern study. He became a Zen teacher. So Christian, monk, Zen

teacher.

And he said, "Every day make a deal with yourself that just before bed, you will think of one thing to be

grateful that you've never felt grateful for before" – so it can't be some stock thing like, I'm grateful to have a

roof over my head or that I have a job or that somebody loves me, which are all wonderful; but it actually has

to be something that happened that day that you related to very intimately, that you could feel in your body

– one of these subtle ‘here and now’ perceptions that Bessel really is talking about.

So, for example, probably when I go to bed tonight, I've had such a good time with you and Bill, and it feels so

good in my body – the sense of safety, the sense of friendship, the fun of talking about things that we're all

passionate about together – I can locate that easily within my body; I'm like a cat, blissed out, purring, and

tonight when I go to bed, I'll bring back this particular gratitude.

And actually, it has caused me to be mindful. Steindl-Rast said “Look, if

you do gratitude exercises like this it trains mindfulness, whether you sit

in meditation or not, you're looking for something during the day. You're

searching for the inner sensations. They're linked to something and it

causes you to pay more attention and be in the here and now.

I think that one gratitude exercise is extremely transforming for people. It takes no extra time, you're living

anyhow. It's really unexpectedly powerful.

Two Techniques to Calm the Thalamus

Dr. Buczynski: I thought it was interesting when Bessel was talking about the cook, which was his way of

describing the function of the thalamus. What exercises might work best in calming the cook or the

“Whether you sit in

meditation or not,

you’re searching for the

inner sensations.”


thalamus?

Mr. O’Hanlon: He talked about this kind of disassociated, disowned parts of people where it's so frightening

for them to connect with these parts. And that’s why he’s trying to calm down the thalamus to do it.

Because I've worked with trauma for so many years, I learned this when I learned hypnosis; I do a very

permissive, kind of gentle hypnosis, and all of a sudden my clients were starting to tell me, “Forget the rest of

hypnosis – what you do at the very beginning is calming me down so much; that's the treatment. Forget

hypnosis, just do that part.”

I started to call this inclusive therapy.

They had excluded some feelings, some memories, or some part of their body that was so traumatizing and

unacceptable they couldn't bring it in. And I would say, “It's okay to be numb. It's okay not to remember. You

can remember, and you don't have to.”

So, I use two techniques of permission inclusion.

One is permission to be where they were. Numb, if they were numb. Agitated, if they were agitated.

Frightened, if they were frightened. And forgetting if they were forgetting, or repressing if they were.

Permission for being, permission to do something, and then permission not to do something.

You don't have to remember. You don't have to feel anything right now. You don't have to be in your body

right now –that’s permission to be where they were.

It melted that hardness that they had in them to keep that stuff away, and all of a sudden, the not-numbness

would come in. They were fully in that numbness, and gave permission.

The second thing was to feel opposite at the same moment.

I was talking with a client one time and she had said “You know, how come I forgot all this trauma that

happened to me for so many years?”

She had all sorts of psychological and relational and physical symptoms.

And I said, “Well, I think you knew and you didn't know at the same time.”

And she immediately said, “I know what you mean. My mind forgot but the cells in my body always knew.”


And so I said, “So you can know and not know. You can remember and not remember.”

I just kept repeating some variations on these opposites, because usually they want to take one side – I have

to remember, or I have to forget. And I say, you can remember and forget.

Milton Erickson was a big influence. He used to say these things

which he called the apposition of opposites. You can remember to

forget certain things, and forget to remember other things. It's

important to remember to remember and to remember to forget.

People would just sort of relax into the idea, there's nothing they can do wrong.

I think that's a way to calm down that thalamus and bring in the missing pieces.

The Importance of Working with the Senses to Re-Engage with the Present

Dr. Buczynski: Could you both give some thoughts or suggestions on how best to activate the traumatized

brain so as to keep the brain and the body in the present?

Dr. Borysenko: Bessel talked about the vagus nerve as it connects the

brain to the body. And then you've got those two evolutionary branches

of the vagus – the part left over from our reptilian development that is

affecting a part of the body below the diaphragm, the digestion and all

of that; and then you have the newer mammalian part of the vagus

that's affecting the heart, the face, and that system.

I think it really depends what system is being really activated by trauma for an individual person. And we're

different that way.

I want to give you an example –

A number of years ago, I was at a meeting in New York. My friend and I were sitting on a park bench,

opposite the place where the conference was happening, and a mugger came up.

There we were, sitting there with our suitcases like two little sitting ducks in high heels and little business

“You can remember to forget

certain things, and forget to

remember other things.”

“It really depends what

system is being really

activated by trauma for

an individual person.

We're different that


suits. She had a history of trauma, and I had a history of trauma – so, both of us.

So, the guy came over – hand in his pocket, or a gun, how were we to know?

The idea is our reaction to trauma is not rational. There is nothing rational in it. It's coming directly from the

vagus, and from the brain and from these pathways, and so we responded in two very different ways.

It was her reptilian vagus that was getting stimulated and she froze. She absolutely froze.

I, on the other hand, had my fight or flight system stimulated, and I got up, kneed the guy in the crotch and

started to scream bloody murder. Then I started to chase him through Central Park, holding my luggage and

my handbags so that they wouldn't get stolen. I must have been quite a scene, like – who is that crazy lady in

heels?

I came back and I found my friend, and the first really unfortunate part is that she felt deeply ashamed that

she hadn't responded differently.

There is nothing to be ashamed of. That's just the way our nervous

system has adapted to deal with trauma. So the answer to your question,

how do we help people's nervous system stay in the here and now,

depends on what their dominant system is.

Do they tend to freeze numb out? Do they tend to get like over-stimulated and go into fight or flight? How do

they do this? And so I’d give a different answer, depending on where people were.

I know that for people who tend to freeze, one of the things that I have found particularly useful is inviting

them to do an exercise of sensing themselves several times a day. And by sensing, that is to say, “Okay. Sense

your legs. What do you notice?”

Often people notice exactly noting.

“Sense. Was there a feeling of aliveness in there? What can you sense? Sense your arms. Sense your arms.

Sense your legs. Sense your genitals. There's often, there's more sensation down there. I mean you're sitting

on your genitals. If you tune in, there's going to be something there.”

Just the thing of sense thing is very good.

For somebody who tends to just be overstimulated and on the lookout for danger, and alert to fight or flight

“How we help people's

nervous system stay in

the here and now,

depends on what their

dominant system is.”


all the time, I might do something very, very different from them. I might choose a breathing exercise that's

coming down some of that autonomic activity, and maybe stimulating heart rate variability through the

vagus. So, it depends.

Mr. O’Hanlon: I usually do it through the senses, and I'll give you three examples.

Years ago – and I probably wouldn't do this now, because we're litigious society, but – I had a client who

would come in, start talking about her trauma, and she would immediately be back; she would be four years

old and inarticulate.

She couldn't even say a word. She would just be lost in the trauma. She was being raped again by her father.

It would be useless session. There was no conversation, no interaction, no change.

And she said, “This is frustrating. I got to work on this and I got to talk about it, but I disappear as soon as we

start talking about it.”

And so she came up with a solution and she said, "I just have to remember I'm in a therapist's office while I'm

here." And she said "How about if I put out my little finger, my pinkie, you grab on to my pinkie, and I'll

remember I'm here, while I'm there."

And again, touching people is shaky these days because of all the legal stuff, but it worked for her. She was

able to stay enough present because there was enough physical connection to the present, while she

collapsed into the old stuff; she could remember I'm in a therapist's

office and I'm moving through this, rather than I'm here being raped

in this moment.

Related to that – this wasn't my case, but it was a case I supervised in

my clinic – we had a couple that came in and the wife had been

sexually traumatized. She had fine sex with her husband, but every once and a while, she would go right back

into, this is my abuser molesting me.

And that would be quite disturbing for him, because they loved each other.

Usually they had a pretty good sex life. And we figured out what the variable was – it was when the lights

were off at night. Sometimes they had sex during the day. Sometimes earlier in the evening, and she could

see him. But when she couldn't see him, it was easy to project that it was my old molester.

“She was able to stay

enough present because

there was enough physical

connection to the present.”


So, we just had them turn the lights on.

I think what those two things have in common is, some sort of sensory input that tells you it's the present

rather than the past. It's the raisin in the mouth. It's something that brings you into the present.

One more example – We had another couple again that had pretty good sex and every once and while she

would get triggered. It turned out that when he would reach form behind her and grab her breasts, she

would go right back into her old trauma.

So, to stop doing that was number one. Two, was if she turned around

and looked at him, she would realize that it was her husband, not the

abuser.

And so again, this sensory input in the present, mixed with sometimes your old trauma reaction, can help

keep you a little more present.

Dr. Buczynski: Great. Thank you very, very much.

“Sensory input in the

present can help keep you

a little more present.”


About the Speakers . . .

Joan Borysenko, PhD has been described as a

respected scientist, gifted therapist, and unabashed

mystic. Trained at Harvard Medical School, she was an

instructor in medicine until 1988.

Currently the President of Mind/Body Health Sciences,

Inc., she is an internationally known speaker and

consultant in women’s health and spirituality, integrative

medicine, and the mind/body connection. Joan has also

a regular 2 to 3 page column she writes in Prevention

every month. She is author of nine books, including New

York Times bestsellers.

Bill O’Hanlon, LMFT is a psychotherapist,

author, and speaker. He co-developed Solution-

Oriented Therapy, a form of Solution focused

brief therapy, and has authored or co-authored

over 30 books, including Out of the Blue: Six Non

-Medication Ways to Relieve Depression.

He is also a musician who plays guitar and

writes songs.

Documents

Rethinking Trauma - Amazon S3 · 2019. 1. 2. · rather than the negative, as we are inspired to do by the experience of having been traumatized? Dr. Borysenko: When you're used to