When the Past is Always Present Part 15

This article brings together the ideas of Scaer and Sarno. Here, pain coencoded with traumatized defensive rage and fear is the cause of complex psychogenic pain. This provides an opportunity to cure the painful conditions by havening the traumatic encoding moment.

Karen, R. (1998). Becoming attached: First relations.h.i.+ps and how they shape our capacity to love. New York, NY: Oxford University Press.

Attachment provides meaning to an experience. Being detached from an experience prevents the expression of emotion and traumatization. How does attachment occur and what can go wrong? Karen's book is essential to understanding this process.

Karen takes us on a psychohistorical journey from the beginnings of attachment theory to its current incarnation. He discusses the work of Bowlby and Ainsworth on the mother-child relations.h.i.+p. His book takes you to the first discussions of how sick children were treated (mostly by isolation) to the current views of the critical role of parental involvement. Experiencing abandonment at a youthful age is at the core of many psychological disorders that manifest in adulthood. He describes the difficulty experienced when children cannot form attachments that make them feel secure and safe. Karen has put together the historical and research discoveries that have made us aware of the truth; as Wordsworth said, "The child is father to the man." In it we can clearly see clues to the origin of why an individual may be susceptible to traumatization.

It is agreeably written, and the brilliant organization of the material is truly a private guide through a mountain of material.

Stratheaern, L., Jian, L., Fongay, P., & Montague, P. R. (2008). What's in a smile? Maternal responses to infant facial cues. Pediatrics 122:4051.

Key dopamine-a.s.sociated reward processing regions of the brain were activated when mothers viewed their own infant's face compared with an unknown infant's face. These included ventral tegmental area/substantia nigra regions (reward areas of the brain), the striatum, and frontal lobe regions involved with emotion processing (medial prefrontal, anterior cingulated, and insula cortex), cognition (dorsolateral prefrontal cortex), and motor behavioral outputs (motivation to action areas of the brain). Happy, but not neutral or sad, infant faces activated nigrostriatal brain regions interconnected by dopaminergic neurons, including the substantia nigra and dorsal putamen. These data support the rewarding and motivating power of an infant's smile.

Field, T. (2002). Infants' need for touch. Hum. Dev. 45:100103.

In the extremes of touch, significant effects on growth, development, and emotional well-being were clearly evident. Extreme cases can be seen in the Romanian orphanages where children achieved half their expected height due to touch deprivation. Their cognitive and emotional development had also been significantly delayed by the lack of physical stimulation. On the other hand, using ma.s.sage therapy with preterm infants can facilitate growth. Ma.s.sage enhances weight gain and development, and with normal infants, facilitates sleep, reduces irritability, and enhances performance. (See also Trauma touch therapy, www.csha.net.) Chemtob, C. M., Nomura, Y., & Abramovitz, R. A. (2008). Impact of conjoined exposure to the World Trade Center attacks and to other traumatic events on the behavioral problems of preschool children. Arch. Pediatr. Adolesc. Med. 162:126133.

Preschoolers who witnessed the September 11 attack on the World Trade Center or saw its victims were at high risk for developing lingering emotional and behavioral problems if-and only if-they had had a previous frightening experience. These authors conclude that the additive effects of trauma exposure are consistent with the hypothesis of kindling. They recommend a more vigorous outreach to trauma-exposed preschool children.

Chapter 7: Disrupting a Traumatization.

Monfils, M-H., Cowansage, K. K., Klann, E., LeDoux, J. E. (2009). Extinction-reconsolidation roundaries: Key to persistent attenuation of fear memories. Science. 324: 951955.

Two paradigms (blockade of reconsolidation and extinction) have been used in the laboratory to reduce acquired fear. Unfortunately, their clinical efficiency is limited: reconsolidation blockade requires potentially toxic drugs and extinction is not permanent. In this experiment, extinction training (the rapid repet.i.tion of the CS without the UFS) was applied within the reconsolidation window (after the memory is rendered unstable by presenting an isolated retrieval trial). This procedure permanently attenuated the fear memory in a way completely different than normal extinction training. This article is consistent with the hypothesis suggested in this book.

Levine, P. (1997). Waking the tiger. Healing trauma. Berkeley, CA: North Atlantic Books.

Levine believes that traumatic memories are not caused by the event itself, but rather from the frozen residue of energy that has not been resolved and discharged. For him, a traumatized human must discharge all the energy mobilized to deal with the threat or he or she will become a victim of trauma. How this is accomplished is described in Levine's book. He demonstrates how his method, somatic experiencing, can be used to heal traumatization.

Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York, NY: W.W. Norton & Co.

Trauma is trapped not only in the mind, but also in the body. Ogden and coworkers demonstrate that a traumatic memory can be activated just by the use of body sensations. The book's main thesis is that by accessing the body-centered experience of the trauma, we can explore without fear and hopefully free our minds from the seemingly permanently encoded moment. It is an extremely well-thought-out and organized book and is offered as another tool for therapists of all orientations.

Baddeley, A. (1998). Recent developments in working memory. Curr. Opin. Neurobiol. 8:234238.

The Baddeley and Hitch model a.s.sumes an attentional control system, a central executive, which operates in conjunction with two subsidiary systems, the phonological loop and the visual-spatial sketchpad. Functional imaging studies suggest that encoding occurs on the left side of the brain and retrieval on the right side of the brain. Recall that the right amygdala is involved with traumatization. This article is the basis for the distraction processes used to disrupt working memory. Thus, we need to divert attention and disrupt the visual and auditory cues attending a traumatic event.

A question arises as to whether all information brought into working memory becomes available to conscious awareness. In the model described in this book, it is speculated that retrieval of subconscious stimuli enters working memory en route to the amygdala, but does not reach awareness. Nonetheless, the information activates glutamate pathways in the amygdala that tie it to other components. See also working memory in Wikipedia (http://en.wikipedia.org/wiki/working_memory) for a discussion of its location, executive function, and other details.

Aston-Jones, G., Akaoka, H., Charlety, P., & Chouvet, G. (1991). Serotonin selectively attenuates glutamate-evoked activation of noradrenergic locus coeruleus neurons. J. Neurosci. 11:760769.

The nucleus of the locus coeruleus receives a dense innervation of serotonergic fibers. Serotonin (5HT2A) receptors appear to selectively inhibit excitatory neurons via action on GABA-releasing neurons. Thus, serotonin inhibits those neurons that are activated by glutamate from releasing norepinephrine.

Lake, D. (2008). Acceptance tapping-A powerful EFT treatment for severe compulsive disorders and bulimia. Retrieved from www.eftuniverse.com This article describes the use of self-tapping during activation of a compulsive act. We would term this self-havening. The idea is to have the brain experience havening each and every time the compulsive drive is present. Over time, it is postulated that this drive can be extinguished. However, like addictive behaviors, where stopping a specific substance from being abused is s.h.i.+fted to another substance, compulsive behaviors may also be s.h.i.+fted to another act. The key is to downregulate the brain so that all compulsive activities cease. If the distress that motivates this behavior is due to a trauma, havening the traumatization may have beneficial effects.

Spoont, M. (1992). Modulatory role of serotonin in neural information processing: Implications for human psychopathology. Psychol. Bull. 112:330350.

This article describes the anatomy and physiology of the serotonin system in humans and explores the role of serotonin as a modulator of dopamine activity. In the case of the amygdala, the same argument can be made for the interaction of serotonin, norepinephrine, and dopamine. In the appet.i.tive system, serotonin abolishes dopamaine-driven foodseeking behavior. No learning is necessary to stop the food-seeking behavior, just the rise of serotonin accomplished by consuming food. In the aversive system, the elevated levels of serotonin diminish salience and vigilance.

Field, T., Hernandez-Reif, M., Diego, M., Schanberg, S., & Kuhn, C. (2005). Cortisol decreases and serotonin and dopamine increase following ma.s.sage therapy. Int. J. Neurosci. 115:13971413.

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

To date, it has been shown that stimulating pressure receptors under the skin increases the tone of the vagus nerve and causes a decrease in heart rate, and a change in voice and facial expression of depressed individuals. Vagal nerve stimulation has been shown to help with depression and with the prevention of seizures. Serotonin and dopamine levels are increased and cortisol levels decreased during ma.s.sage.

Chapter 8: Havening.

Dietrich, A. M., Baranowsky, A. B., Devich-Navarro, M., Gentry, J. E., Harris, J., & Figley, C. R. (2000). A review of alternative approaches to the treatment of post-traumatic sequelae. Traumatology 6:251271.

This landmark but sometimes criticized paper describes and compares different alternative approaches to the treatment of PTSD. These methods included Trauma Recovery Inst.i.tute method, trauma incident reduction, visual/kinesthetic disa.s.sociation, and Thought Field Therapy (TFT). All these methods, except TFT, have been validated. The authors concluded that alternative therapies must withstand careful scrutiny, and we should discard or revise those that fail to maintain the standards of efficacy and safety.

Callahan, R., & Callahan, J. (2000). Stop the nightmares of trauma. Chapel Hill, NC: Professional Press.

Callahan, R., & Trubo, R. (2002). Tapping the healer within. Using Thought Field Therapy to instantly conquer your fears, anxieties and emotional distress. New York, NY: McGraw-Hill.

While CT-TFT has been seriously criticized on both a theoretical and methodological basis, it does work. In his book Thought Field Therapy, Roger Callahan correctly states that most of human suffering, certainly in first world countries, is due to emotional traumatization. According to Callahan, a thought field is the energy generated when you think of a traumatic event from your life. It is perturbed due to blockages in the flow of energy along meridians. This a.n.a.lysis relies on traditional Chinese medicine, which views the body as infused with energy flowing along pathways called meridians.

These meridians have points along their path called acupoints where traditional Chinese physicians place needles to encourage a healthier flow of energy. Thought Field Therapy consists of bringing the memory of the event to mind and then, depending on the problem that presents, tapping on specific but different acupoints. As peculiar as this seems, it is extremely successful in relieving a host of problems that are the consequences of traumatization, such as phobias, PTSD, pathological emotions, and others. It is to Dr. Callahan's credit, despite many criticisms of this approach, that he has persevered and helped many live without the distress. One major concern about his methods involves his costly advanced training course, called Voice Technology (see Pignotti, M. (2004). Callahan fails to meet the burden of proof for Thought Field Therapy claims. J. Clin. Psychol. 61:251255, and http://www.integrativeclearing.com.au/tft_split.html).

Church, D. (2010). The treatment of combat trauma using EFT (Emotional Freedom Techniques): A pilot protocol. Traumatology, 16(1): 5565.

A pilot program using 11 veterans and family members who were a.s.sessed for PTSD and treated with a brief (five days) EFT. EFT is an exposure therapy using mild sensory input. One-year follow-up on seven of the partic.i.p.ants showed they no longer met criteria for PTSD. This suggests that EFT can be an effective postdeployment intervention.

Craig, G. www.eftuniverse.com This Web site offers a free download of Gary Craig's approach to psychological problems. While he also ascribes the healing power of tapping to meridians and energy fields, his ideas are grounded in a sophisticated clinical approach. This web site should be read by anyone wis.h.i.+ng to do this form of therapy. In addition, Gary has a free newsletter providing tips and case studies to help those who practice what he calls Emotional Freedom Techniques (EFT). This model differs from TFT in several ways. (See http://www.integrative-clearing.com.au/eft/eft_and_tft.html for a detailed a.n.a.lysis.) In EFT, the problem is activated by a setup phrase that incorporates a component of the event, and he has one set of tapping points.

The theoretical model described in our book does not provide an explanation for many of the case studies that are described in his newsletters. Indeed, some are downright astonis.h.i.+ng.

Gary states that we should try this approach on every problem encountered, as we have nothing to lose and potentially a cure to be gained. Gary has a disclaimer about not "going where you don't belong," meaning that seriously ill individuals should be treated by professional health care providers.

Kim, J., Lee, S, Park, K, Hong, I.,Song, B., Son, G., Park, H., Kim,W. R., Park, E, Choe, H. K, Kim, H., Lee, C., Sun, W., Kim, K, s.h.i.+n, KS. & Choi, S. (2007). Amygdala depotentiation and fear extinction. Proceed. Nat. Acad. Sci. 104(52): 2095520960.

This paper is of critical importance in understanding the effect of havening on encoded memories. It shows that application of low frequency pulses to an in vitro preparation of rat amygdala, wherein the rat had been conditioned to an auditory stimulus, produced depotentiation of AMPA receptors in the thalamo-amygdala pathway. This depotentiation caused the AMPA receptor to become internalized within the post-synaptic amygdala neuron preventing further downstream activation.

Chapter 9: A Brief Introduction to Psychosensory Therapy.

Fellows, D., Barnes, K., & Wilkinson, S. (2004). Aromatherapy and ma.s.sage for symptom relief in patients with cancer. Cochrane Database Syst. Rev. 2:CD00287.

The most consistently found effect of ma.s.sage or aromatherapy was on anxiety. Four trials (207 patients) measuring anxiety detected a reduction in postinterventions, with benefits of 19 to 32% reported.

Cottingham, J. T. (1985). Healing through touch. A history and review of the physiological evidence. Boulder, CO: Rolf Inst.i.tute.

The term somatic (body) techniques is used to describe a range of techniques that involve touching the body. Healing through touch goes back more than the 5,000 years of recorded history. Prehistoric cave paintings portray the laying on of hands for the sick and injured. It is intended for the curious reader and serious student who would like to understand the historical and Cottingham's view of the theoretical basis of these therapies.

Eden, D., with D. Feinstein. (1998). Energy medicine. New York, NY: Tarcher/ The Penguin Group USA.

Donna Eden sees the world in an extraordinary way. She is able to visualize energy fields that surround people. Guided by her senses, she performs healing that would be considered just this side of miraculous. For her, the body is suffused with visible energy. The energy must flow unimpeded for the body to function normally. The healing system she describes is internally consistent, albeit invisible to most, untouchable, and unknowable, except for a few well-tuned individuals. This book describes many approaches to alter energy for health, including breathing, posture, movement, ma.s.sage, and nontouch healing. All involve the interaction of different energy systems within our bodies. In the final a.n.a.lysis, this is a book about subtle energy, the rhythms that impact on our lives (such as the seasons), and how we can open our awareness to these energies. Donna Eden knows to the depth of her soul that all things in the universe are connected.

Feinstein, D., Eden, D., & Craig, G. (2005). The promise of energy psychology. New York, NY: Jeremy P. Tarcher/The Penguin Group USA.

This book phenomenally outlines current thinking in the field of energy psychology for those who appreciate and feel comfortable with the Eastern model.

a.s.sociation for Comprehensive Energy Psychology (ACEP). www. EnergyPsych.org ACEP is an international nonprofit organization of licensed mental health professionals and allied energy health pract.i.tioners dedicated to developing and applying energy psychology methods for the treatment of those suffering from emotional challenges such as addictions, compulsions, anxiety, depression, limiting beliefs, personality disorders, phobias, stress, and trauma. Energy psychology interventions address the human vibrational matrix of three major interacting systems: Energy pathways-meridians and related acupoints Energy centers-chakras Energy systems-the human biofield that envelops the body ACEP seeks to establish the credibility and effectiveness of energy psychology through its programs of certification, education, ethics, humanitarian aid, and research.

International scope of ACEP. ACEP members come from more than 50 countries around the globe, including the western hemisphere, Europe, Africa, the Middle East, Australia, and the Pacific Rim. Twenty-two countries were represented at the 2008 annual international conference in Albuquerque, New Mexico.

ACEP certification program. ACEP sponsors a two-track certification program aimed at helping pract.i.tioners to amplify their credibility, upgrade their energy psychology skills, and rise to their peak potential. The tracks are: * DCEP (Diplomat, Comprehensive Energy Psychology) for licensed mental health professionals, or the international equivalent.

* CEHP (Certified Energy Health Pract.i.tioner) for allied health and human service pract.i.tioners and nonlicensed mental health professionals and academics. Candidates must complete home study modules available online, partic.i.p.ate in workshops focused on technical and ethical competence, and demonstrate treatment proficiency under the guidance of an ACEP certification consultant.

This organization holds conferences and exposes those interested to vendors who offer a variety of systems and techniques to modify these energy fields. I have attended two conferences and found the individuals open to exploration of the ideas found in traditional Chinese medicine.

Benson, H. (1976). The relaxation response. New York, NY: HarperTorch.

This landmark book describes the effects of relaxation on several physiological parameters. For an up-to-date review of this research go to www.RelaxationResponse.org.

Appendix J:

Glossary

afferents: Axons that enter an area of the brain from elsewhere. See efferents.

AMPA receptor: A cla.s.s of glutamate receptor involved in memory and learning. See http://en.Wikipedia.org/wiki/ Glutamate_Receptor.

amygdala: A paired group of nuclei in the temporal lobes of the brain affecting various aspects of memory (e.g., storage, retrieval, and a.s.sociations), especially memory that is involved with emotional states.

BLC: The basolateral complex (BLC) of the amygdala. It is the location where affective memory is mediated, but it is not the location of memory. It is made up of the lateral nucleus, basolateral nucleus (BLA), and accessory basal nucleus, whose efferents activate the central nucleus and other brain areas, including the hippocampus and the medial prefrontal cortex.

central executive: The part of the brain that decides what we attend to.

complex content: A combination of unimodal sensory input and other related aspects of the event, which can include color, size, speed, visceral sensations, and pain.

conditioned response: The learned response to a neutral stimulus when it is paired with an unconditioned stimulus.

conscious: Information of which we are self-aware.

context: The surroundings unrelated to content, e.g. the place the event occurs.

cortisol: A hormone secreted by the adrenal gland. It influences the immune system, the body's electrolytes, glucose levels, and the ability to learn and remember, and has a diurnal variation, peaking around 6.00 a.m. and bottoming out around 4.00 p.m. It appears to be necessary for the traumatic encoding of emotional events.

declarative memory: Knowledge to which we have conscious access, such as events in our lives and facts we have learned.

defensive rage: A response to fear when fighting or fleeing is not an option. It involves a clenched jaw, tight neck muscles, flared nostrils, dilated pupils, and an arched back.

depotentiation: The removal of a receptor after activation during memory recall. In the case of activated glutamate receptor, low-frequency electrical (1 to 5 Hz) stimulation accomplishes this.

dissociation: The process by which a component of memory is stored such that its accessibility by conscious thought is prevented.

distraction: The use of cognitive, visual, and auditory input to displace the current content of working memory.

dopamine: Transmitted by efferents from the ventral tegmental area, this substance affects salience and vigilance, and motivates and drives motoric action.

dorsal striatum: Infracortical elements that include the caudate, putamen, and the fundus.

dysregulation: A medical term for disordered regulation of a homeostatic process leading to disease.

efferents: Axons that leave an area of the brain and are connected to another area. See afferents.

EFT: Emotional Freedom Techniques (see www.eftuniverse.com). A psychosensory therapy useful for a wide range of problems. It involves exposure to a psychological or physical problem followed by mild sensory stimulation.

encoding: The process of consolidating a memory in the brain and all the experiences occurring with that event.

extrasensory response: An unbidden, hardwired, or learned response to sensory input that has meaning to the individual.