When the Past is Always Present Part 13

Appendix E:

Suggestions for Treatment*

An infinite number of different behaviors, physical ailments, and emotional states can be stored during a traumatization. For the six psychological problems described in the text we have had excellent results. When there is an obsessive comorbid disorder we find that havening is not as effective.

Get a good history of onset, surrounding events, and previous emotional events. Try to find the emotional origin of the symptom. For physical complaints, I ask clients if there is any unresolved anger or if they were ever in a motor vehicle accident or suffered any accident. Seek out traumatized rage or unresolved fear and its a.s.sociated components. In cases of neck and back pain I seek unresolved anger. There are often several people at whom the anger may be directed. For example, in cases of unresolved anger toward an abusing parent, anger can be directed at the spouse for allowing it to persist or a significant other who dismisses your experience and feelings. Sometimes the symptoms are encoded with unexpressed rage.

Try to get the individual with panic disorder to activate the last time he or she experienced a panic attack and haven the fear of the physical feelings (such as rapid heartbeat, difficulty breathing). Ask what about the physical feelings make him or her frightened. For physical ailments, especially chronic pain, ask if an organic disease has been ruled out. If it has not, suggest that the client returns after a workup has been completed.

A family history of substance abuse should alert you to underlying psychological problems, both inherent and as a consequence of living in a household where this occurs. The need for continued history taking if the problem does not resolve after havening the putative emotional event is seen in the story below.

I was asked to see a physician who had just experienced a debilitating stroke. The circ.u.mstances surrounding the stroke were terrifying to him. The stroke occurred on a night when he was sleeping in the on-call room. He was awakened by the event and realized that he was in trouble. He tried to rise, but his paralyzed left side prevented him from standing and he fell to the floor. He started screaming "Help me! I don't want to die here" over and over. After a while his shouts were heard and he was brought to the ER. Treatment began, but it was too late to reverse the damage. After a short stay in the hospital, he was moved to a rehabilitation facility. A week or so after arrival there, he would awaken about 90 minutes after falling asleep with the most excruciating pain, unresponsive to narcotic painkillers, in his paralyzed foot. By the time I had been asked to see him he had had this pain for several months.

Initially, the frightening memory of his lying on the floor screaming was havened. While he could no longer retrieve the cognitive or emotional components of that memory, his foot pain remained. On further detailed questioning about previous injuries he recalled an event 50 years prior when he was playing tennis and severely twisted that ankle, causing him to fall to the ground in pain. That position on the ground was similar to that which occurred during the stroke. I asked him to recreate the memory and he developed a subjective unit of distress (SUD) score of 7 (out of 10). After 50 years! This was havened and he slept through the next night without pain. He has remained pain-free since.

An interesting question arises as to why he developed pain many weeks after the original stroke. Ninety minutes after falling asleep corresponds to the first onset of REM sleep. Here both norepinephrine and serotonin levels drop dramatically and acetyl choline rises. One can postulate that during dreaming he subconsciously a.s.sociated the earlier traumatized tennis accident due to overlap of the physical position on the ground. The traumatically encoded pain a.s.sociated with that event, in the absence of norepinephrine, produced the severe pain. The lack of responsiveness to narcotics was because the pain did not arise from the periphery; rather, it was encoded centrally during the traumatization and did not involve an opioid- dependent pathway.

There are also times when the person has a great sense of shame or embarra.s.sment about an event. Do no press this discussion, as it is not necessary for the therapist to understand the problem, only that the individual can bring the event and its emotional component to conscious awareness.

After getting a history that provides what you believe is the origin of the problem, have the client activate the emotional state.

Many aspects of a traumatized event and its sequelae need to be havened. One should haven the accident, fear of reinjury, fear of movement, fear of being permanently disabled, and other fears that the client relates. Modulate your voice in cadence and tone, and speak in an unhurried way. Self-havening can be useful for people with difficulties with being touched.

1. Learn from clues that reveal themselves as one disrupts the memory. Patients will often have an insight after a round of havening.

2. Consider using affirmations as well: "Even though I have this pain, this feeling, etc., I know I will be fine." (See Gary Craig's approach at www.eftuniverse.com) 3. Be persistent and aware. When clients get stuck and the SUD score cannot be lowered to 0, look elsewhere or earlier in the history for clues.

4. Abreactions in which the patient starts losing emotional control require the therapist to make a judgment whether to continue. These abreactions include crying, shaking, anger, fear, and other strong reactions to the imaginal event evoked by the client. I have found that using a firm voice and saying "Stay with me and focus on my what I need you to do," while simultaneously applying havening touch, can often disrupt these abreactions.

5. Use suggestions during the distracting part of havening; for example, as you walk up the flight of stairs, each step causes you to become calmer.

6. A traumatization should cause you to seek out previous traumatizing episodes. In this way we might prevent future events from being traumatizing. Indeed, searching for earlier clues may require going back to the earliest parts of our young life, when our memories are not readily available because the part of the brain that stores narrative has not developed. Asking the client to ask his or her parents may provide important clues. While this is not easy, we must actively seek out these feelings because, although hidden, they affect how we respond to the present moment.

In the final a.n.a.lysis, if we disrupt the linkage between the emotion and the cognitive component of the event, the other components also lose their ability to be reactivated. I think that it is useful to consider havening as providing a sense of safety that allows us to de-traumatize the event. For an excellent book on futher ideas and approaches, see Wells, S., & Lake, D. (2010) Enjoy Emotional Freedom. Wollambi, Australia: Exisle Publis.h.i.+ng Limited.

Appendix F:

Transduction, Depotentiation, and the Electrochemical Brain*

The model presented in this book is an electrochemical one. The key chemical players are those neurochemicals that "landscape" the brain and are a.s.sociated with vigilance, salience, and a feeling of safety. Touch stimuli (as well as other sensory stimuli) enter the brain and are transduced (converted) into both electrical and chemical signals. The duality of this signal is similar to the particle-wave nature of light. What we measure is what we observe.

Thus, when we study the electrical brain with an electroencephalogram (EEG), we are measuring the electrical components of firing neurons. These electrical components are measured as waves. EEGs can be modified by the use of chemicals injected into the brain. We can use specific chemical substances such as GABA agonists (an agonist acts as if it were the substance itself) to alter the EEG. GABA agonists and acetyl choline (a neurochemical also involved with learning) have been shown to increase a specific waveform a.s.sociated with 1 to 2 Hz called a delta wave.

Suffice it to say that there is no electrical activity without neurochemicals and no neurochemical release without electrical activity.

Rasolkhani-Kalhorn and Harper1 speculate that synapses mediating traumatic memories found in the BLC have a larger than usual number of specific glutamate receptors. They are in agreement with other research showing that exposure therapies open these glutamate receptors, thus making these memory traces labile and subject to disruption. Memories, they suggest, are extinguished by the depotentiation and elimination of these glutamate receptors by a 1- to 2-Hz signal generated directly as a result of touch, tapping, and eye movement. They provide evidence from EEG studies of subjects undergoing eye movement desensitization and reprocessing (EMDR) that eye movements or tapping (nonspecific brain stimulation) enhances a preexisting 1.5-Hz neuronal firing frequency of princ.i.p.al neurons in the areas of activated pathways.

According to Harper and colleagues,2 traumatic memory is reactivated by an overpotentiated glutamate receptor called alpha-amino3-hydroxy-5-methyl-4-isoxazolproprioninc (AMPA). We suggest that EMDR, EFT, TFT-CT, and havening increase the amplitude of a depotentiating wave by raising GABA. Depotentiation occurs through the internalization of the activated glutamate receptors. This permanently removes activated AMPA receptors, preventing the neuron from propagating the traumatic memory and its components.

This electrical model has simplicity and experimental evidence to provide us with a good idea as to how havening disrupts the traumatic memory. The chemical model helps us understand how we feel after havening.

References

1. Rasolkhani-Kalhorn, T., & Harper, M. L. (2006). EMDR and low frequency stimulation of the brain. Traumatology 12:924.

2. Harper, M. L., Rasolkhani-Kalhorn, T., & Drozd, J. F. (2009). On the neural basis of EMDR therapy: Insights from qEEG studies. Traumatology 15:8195.

Appendix G:

Havening Touch: Clinical Guidelines*

Even though touch is used in many therapeutic situations, its use in the practice of psychotherapy has been essentially forbidden. While nail salon workers, ma.s.sage therapists, physical therapists, dentists, and doctors touch their clients, trained talk therapists do not.

Freud set the stage for our current-day situation by describing touch between the therapist and client as having the potential for erotic misinterpretation. As a consequence, the practice of psychoa.n.a.lysis and other talk psychotherapies became touch averse. In the setting of havening therapy I have found that a simple explanation that the purpose of havening touch is to provide a sense of safety removes the act from the s.e.xual arena and places it in a therapeutic context. During the last six years, I have never had havening touch experienced in any way other than therapeutic.

Touch is arguably the most powerful form of communication. The extrasensory response to touch can alleviate pain, produce a sense of belonging, and provide for feelings of acceptance and trust. Touch is particularly important for the elderly, who are often untouched and lonely. Most of us are probably touch deprived.

What areas of the body produce a sense of safety? We believe, and as has been shown by Field1, it is the areas that come in regular contact with the parent. These areas are the face and head, the arms and hands. The simple act of holding hands has powerful extrasensory effects.

While the research has yet to be done, common sense suggests that the extrasensory components of touch are more powerful when applied by another. Tickling is an example. Nonetheless, self-touching is powerful in and of itself. A client can self-haven with the image of someone who the client wishes to perform the havening in mind. From the theoretical model described in this book, I was teaching a woman who had several phobias and chronic fatigue how to self-haven. I told her to cross her arms and gently rub the upper arm on the other side. She suddenly stopped, gasped, and started to release tears. She said that she just recalled and experienced how wonderful and comforting it was when her father did that to her.

If havening is applied outside the psychotherapeutic setting, such as an internist's practice, no problems should arise. However, if it is used as part of a psychotherapeutic treatment, careful deliberation should precede its use. This may be a moot problem, however, because if a therapist feels uncertain in any way, self-havening touch can be taught to the client and self-applied.

Durana provides six guidelines to help the therapist when it is determined that touch is appropriate:2 1. The therapist must learn about the client's readiness for touch.

2. Before touching, the therapist must determine the appropriateness of potential contact and advise the client as to areas of touch.

3. The therapist must be aware of how the client interprets the contact.

4. The therapist must be aware of his or her own feelings.

5. The client's family may misconstrue physical contact, and education of the family may be necessary.

6. Decision to touch should be based solely on the client's needs.

When used in this manner, havening touch, distraction, and other mild brain stimulation are powerful agents for change. It is sad that the mental health profession ignores such powerful tools, as they often lead to a deeper understanding of the client's problems and resolve issues that are not accessible simply by talk therapy.

References

1. Field, T., Diego, M. & Hernandez-Reif, M. (2005). Ma.s.sage therapy research. Dev. Rev. 27: 7589.

2. Durana, C. (1998). The use of touch in psychotherapy: Ethical and clinical guidelines. Psychotherapy 35:269280. For more information, see www.zurinst.i.tute.com/touchintherapy.html#guidelines and www.zurinst.i.tute.com/touchstandardofcare.pdf

Appendix H:

The Downside of Removing a Traumatic Memory*

Removing a distressful memory would seem to have only benefits, but there are circ.u.mstances when this is not the case. Attachment is strong in a traumatized memory, and the emotion it arouses keeps our connections alive. This is particularly true when you have lost a loved one. People are motivated by emotions, and a traumatizing event can be the driving force for someone's life work. Before treatment it is wise to ask the client whether he or she wishes to have the emotional component of the memory erased, and possibly the ability to visualize it altogether. It is important that we respect others' feelings, and not try to always make life less painful. Be aware that you will be changing how the individual perceives the world. For the most part, this is a good thing.

There is a medical joke that goes as follows: Sadie, who is 85 years old, calls her friend and screams to her, "I'm dead! I'm dead!" Her friend, alarmed by the statement, asks, "How do you know?" Sadie answers, "Nothing hurts."

Appendix I:

Notes and Additional References

This section provides an annotated review of selected articles and books useful for understanding traumatization and havening therapy.

Chapter 1: A Third Pillar.

Chapter 1 introduces the reader to traumatization and this will be called havening. Among the crucial issues facing modern medicine is that most health care providers do not recognize traumatization as a cause of symptoms. A few researchers and clinicians have attempted to bring this to the attention of mainstream medicine.

Tallis, F. (2002). Hidden minds. A history of the unconscious. New York, NY: Arcade Publis.h.i.+ng.

This beautifully written book explores how the unconscious can affect our lives. Tallis describes the ideas and efforts of the early researchers, Charcot, Janet, Freud, Breuer, Jung, and other great scientists and thinkers, as they explore the unconscious. He comments on the intellectual searches, jealousies, battles, and disappointments these brilliant men experienced as they undertook to find pa.s.sages into the hidden mind. Hidden minds will alter the way you think about the unconscious. See also Tallis's book Changing Minds.

Kirmayer, L. J., Lemelson, R., & Barad, M. (Eds.). (2007). Understanding trauma. Integrating biological, clinical and cultural perspectives. New York, NY: Cambridge University Press.