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Holistic Practices That Promote
Neural Integration and Connection:
Using Somatosensory Techniques in
Counseling
Daryush Parvinbenam, M.Ed.,
M.A., LPCC-S
AMHCA conference 2009
2
Roots of Resiliency and Emotional
Wellness
 Emotional wellness is rooted in different layers of
connection and integration.
 These layers are interactive and multi-directional in
adults.
 These connections occur on
 Neurobiological system
 Intrapersonal/personality system
 Interpersonal/relational system
 Spiritual/system of meaning
3
This Presentation
 In this presentation we will focus on
 1. Somatosensory and sensorimotor
techniques that enhance the neurobiological
integration.
 2. Impact of neural integration on affect
regulation.
4
Somatosensory and Sensorimotor
Psychotherapy
 The Essence of Somatosensory and Sensorimotor
Psychotherapy are regulating affective and sensorimotor
states through the therapeutic relationship by teaching
the client to self-regulate.
 Self regulation occurs through mindfully contacting,
tracking and articulating somatosensory and
sensorimotor processes.
 It is a psychotherapeutic process that is not independent
of our current understandings of counseling process,
therefore it is not a set of techniques that can be applied
without consideration for importance of therapeutic
relationship, and counseling skills and procedures.
5
Impact of Affect Dysregulation
 Affect dysregulation
 1. Anxiety disorders
 2. Depression
 3. Affective Disorders
 4. Borderline and other personality disorders
 5. Alexthymia
 6. Impulsivity
 7. Anger
 8. PTSD
 9. Dissociative disorders
 10. Addiction
 Difficulties with attention and memory
 Inability to take effective actions
 Difficulties with interpersonal/relational complexities
 Difficulties with boundaries
6
7
Importance of Neural Integration
 Neural integration is the key component of
affect regulation.
 Counselors should consider how their
current case conceptualizations,
interventions and techniques enhance
neural integration among different regions
of the brain (cognitive, affective, and
somatosensory).
8
Neural Systems Development
 Healthy organization of neural networks
depends upon the pattern, frequency, and
timing of key experiences during
development.
9
Developmental Roots of Neural
Integration, and Resiliency
 Secure attachment, and its accompanying development
of neural integration acts as a barrier against stressors
which provides ability to self-soothe and effectively
regulate arousal.
 In “good-enough” biological and social conditions, most
people develop neurobiological integrities and secure
attachment.
 Secure attachment in childhood is the biggest predictor
of resiliency in adulthood in the face of traumatic events.
10
Impact of Neural Disintegration
 Insecure attachment and chronic relational
traumas tend to create neural disintegration
within different regions of the brain that leads to
numerous psychopathologies.
 Recent neuro-imaging techniques have given us
considerable evidence regarding neurobiological
consequences of chronic relational traumas and
maltreatments in early childhood.
11
12
Cortical, sub-Cortical,
Laterality, and Their
Structure and Function
(Targets of Integration)
13
Different regions of the brain
operate more like a symphony
orchestra than soloists. In other
words, different regions of the
brain have profound impact on the
functioning of each other.
14
15
Sub-Cortical Brain
 Sub-cortical part of the brain ( Limbic
Diencephalon, and Brain Stem) was first
developed from an evolutionary
perspective.
 Governs arousal, homeostasis of the
organism, reproductive drives, emotion,
memory, some social behavior, and
learning.
16
17
18
The Neocortex
 Last to develop phylogenetically.
 Enables cognitive information processing, such
as self-awareness and conscious thought.
 Includes large portions of the Corpus Callosum,
which bridges the right and left hemispheres of
the brain (MacLean, 1985).
 Helps consolidate information (Siegel, 1999).
19
Neurobiological system:
The Brain’s Hierarchical Organization
Levels Structures Understanding
of Environment
Functions
Cognitive
(Cortical)
Neocortex Concrete
Abstract
Declarative
Conscious
Thought
Info. Processing
Self-Awareness
Emotional
(Sub-Cortical)
Limbic Feelings
Procedural
Affiliation
Learning/ Memory
Emotional
Reactivity
Sensorimotor
Arousal
(Sub-Cortical)
Diencephalon
Brain stem
Instinctual
Tendencies
Survival
Sexual Behavior
Motor Regulation
Arousal &
Homeostasis
20
Mutuality and Independence of the
Levels
 Each of the three levels of the brain thus has its own
“understanding” of the environment and responds
accordingly.
 A particular level may become dominant and override
the others, depending on the internal and environmental
conditions.
 At the same time, these three levels are mutually dependent and
intertwined (Damasio, 1999; LeDoux, 1996; Schore, 1994),
functioning as a cohesive whole, with the degree of integration of
each level of processing affecting the efficacy of other levels.
21
Brain: Hierarchical Functioning
Lower Level Higher Level
Fixed Action Sequences Greater Plasticity
Reflexive Action Voluntary Control
Instinct Logic/ Planning
Unconscious Conscious
More Rapid Response Slower Response
Each level has its own understanding of the environment and
responds accordingly
Depending on circumstances, one level may dominate others
In daily adult life (except for emergencies), higher levels
generally override lower levels
22
Brain laterality (Right Hemisphere)
In the first 3 years of life (Attachment Formation)
the dominant brain hemisphere is the right
hemisphere.
The right hemisphere is more highly connected
with sensory and certain emotional aspects of
functioning.
Right hemisphere is holistic; involves non-verbal
signals, eye contact, facial expression, tone of
voice, posture, gesture, immediacy of response.
23
24
Brain Laterality (Left Hemisphere)
The Left hemisphere involves in linear,
linguistic, logical, and literal processing.
The left hemisphere is more closely
identified with organizational functioning,
and use of symbol system.
25
26
How Emotions are primarily Processed
LEFT
Positive Emotion
RIGHT
Negative Emotion
27
Neuroplasticity of the Brain
(Neurogenesis, and
Synaptogenesis)
28
Neuroplasticity of the Brain
 Neuro-Plasticity:
 Ability of the nervous system to change.
 Recent research suggests that new neurons are
generated in different areas of primate and human
brains.
 The generation of new neurons occurs especially in
regions involved with ongoing learning, such as the
hippocampus, the amygdala, and the frontal and
temporal lobes.
29
Neuroplasticity of the Brain
 Neural networks change in a “use-dependent”
fashion. In order for impoverished neurons,
synapses, and neural pathways to recover, they
must be activated.
 Hebb’s principle-Neurons that fire together, wire
together.
 Patterned, repetitive activity changes the brain.
30
Birth Six years old 14 years old
Synaptic Density
31
32
Expansion of Affect Regulation
Through Interventions That Lead
to Neural Pathway Connections
33
Window of Tolerance/Arousal
 Working with clients’ window of tolerance, is the
key issue in improving neural integration.
 In order for clients to improve affect regulation,
counselors must create a therapeutic arena that
is safe, but not too safe.
 In return, as clients’ neural integration improves,
so does their affect regulation (feedback loop)
34
Window of Arousal and
Regulating Arousal
 Freeze:
“The deer in the headlights”
Mute, Physically immobilized
Frozen defensive responses
↑
↓
Sympathetic Hyperarousal
_______________________________________________________________
_____________________________________________________________
“Window of Tolerance”
Optimal Arousal Zone
Parasympathetic Hypoarousal
Hypoarousal:
Collapsed, weak, no energy, defeated flat affect,
numb, “empty” or “dead” Cognitively dissociated,
unable to think
Helpless and hopeless
Hyperarousal:
Hypervigilant, action-oriented, impulsive
Emotionally flooded, reactive, defensive
Flashbacks, nightmares, racing thoughts
Suicidal, self-destructive
35
Window of Tolerance/Arousal
 The counselor acts as an auxiliary ego for the
clients, to help them to process and integrate
negative emotions and affects without getting
overwhelmed.
 Clients are not able to integrate information
when they are not within their optimal arousal
zone.
 Hyper or hypoarousal states are counter
integrative, and tend to delay client’s progress.
36
Window of Tolerance
High Arousal- Dissociation
Low Arousal- Dissociation
_________________________________________________________
High Arousal- Re-experiencing,
Hyperarousal
_________________________________________________________
Apn: “the surface of consciousness”
_________________________________________________________
Low Arousal – Emotional Numbing,
Depression
________________________________________________________
Full or partial
Intrusion of EPs
EP Activity
ANP Narrow
Window
of tolerance
EP Activity
Full or partial
Intrusion of
EPs
37
The Role of the Body in
Counseling, and Historical Lack of
Engagement of Body in
Counseling
38
In the animal self-help section
39
Introduction
 The body, for a host of reasons, has been left out of the
“talking cure.”
 Somatosensory and Sensorimotor psychotherapy builds
upon traditional psychotherapeutic understanding, but
approaches the body as central in the therapeutic field of
awareness.
 Theoretical principles and treatment approaches from
both the mental health and body psychotherapy
traditions are integrated in this approach.
40
Lane and Schwartz Model
 Authors present a cognitive-developmental
theory of emotional awareness.
 Their primary thesis is that emotional
awareness is a type of cognitive
processing which undergoes five levels of
transformation along a cognitive-
developmental continuum.
41
Lane and Schwartz Model
 The five levels of transformation are:
 No emotional awareness
 Awareness of bodily sensations
 The body in action (Awareness of behaviors)
 Individual feelings
 Differentiated Emotional awareness
 Blends of feelings
42
Lane and Schwartz Model
 No Emotional Awareness:
 At this level, a person has no idea what they are
feeling or experiencing an emotion. For example, a
person may say that they "feel like a loser." However,
this is not really an emotional state, but instead, an
evaluation or judgment.
 Awareness of Bodily Sensations:
 a person has some awareness of their emotions.
However, they may only be aware of bodily sensations
that they are experiencing, such as increased heart
rate or muscle tension.
43
Lane and Schwartz Model
 Awareness of Behaviors/actions:
 At this level of emotional awareness, a person is only aware of
how they would like to act as a result of having some kind of
emotion. For example, a person may say that they feel like they
would like to get away (which may be an indication of fear or
anxiety).
 Awareness that an Emotional State Is Present:
 At this stage, a person is aware that an emotion is present;
however, they may have a hard time figuring out exactly what
emotion is there. For instance, a person may have enough
awareness to know that they feel "bad" or "overwhelmed" but
nothing more specific than that. This is sometimes referred to as
an undifferentiated emotional state.
44
Lane and Schwartz Model
 Differentiated Emotional Awareness:
 At this level, a person is aware of discrete emotions
that are present. A person is able to identify the
emotion that they are experiencing at any given point
in time, such as sadness, anger, fear, anxiety,
happiness, joy, or excitement.
 Blended Emotional Awareness:
 This is the top level of emotional awareness. At this
level, a person is aware of multiple emotions that are
present at the same time, including emotions that
may on the surface appear to be in opposition to one
another (for example, someone could feel hate and
anger toward someone at the same time.
45
Top Down Vs Bottom up
Approach to Counseling
46
Background
 Traditional therapeutic models are based primarily on the
idea that change occurs through a process of narrative
expression and formulation in a “top-down” manner.
 Improving ego functioning, clarifying meaning,
formulating a narrative, and working with emotional
experience are fundamentally helpful interventions that
accomplish real gains for the client.
 The addition of “bottom-up” interventions will address
physical sensations, movement inhibitions, and
somatosensory intrusions that disrupts top-down process
(talk therapy).
47
The Interface
 Top-down processing alone may manage
sensorimotor reactions but may not enable their full
assimilation.
 Top-down management (insight and understanding)
and bottom-up processing (sensations, arousal,
movement, and emotions) must be thoughtfully
balanced.
48
Somatosensory and Sensorimotor
Techniques
49
Impacts of Somatosensory and
Sensorimotor Techniques
 Somatosensory/sensorymotor techniques :
 A. Promotes neural integration through bottom up
pathways.
 B. Creates moment-to-moment connection, and client
experiences a sense of empathy by the counselor.
 C. Generates movement toward completion of arousal
cycle.
 D. Accelerates surfacing of unconscious implicit
memory/dynamic process.
50
Somatosensory and Sensorimotor
Techniques
 1. Self-soothing and grounding techniques
 2. Somatosensory, Focusing, and Mindfulness techniques
 Arousal and activation of natural defenses techniques
 3. Sensorymotor techniques (Ogden, 2006)-Pushing
action, Grounding, Breath work, Alignment, Reaching
out, Elaborating somatic resources the client is already
using
51
Somatosensory and Sensorimotor
Techniques
 4. Bilateral stimulation
 5. Alternative/complementary approaches
(Yoga, Vipassana, Tai Chi)
52
Soothing and Grounding
Techniques (Breath-Work)
 Counselor’s voice, and guiding the client through
this exercise is extremely important (this is
especially true for clients with trauma history).
 Many clients tend to hold their breath, and
maintain a shallow breathing pattern in order to
stay disconnected from their bodily experience.
This “natural” tendency for holding their breath
could be used to create somatic engagement,
and self observation.
53
Soothing and Grounding
Techniques (Breath-Work)
 Technique: Guide the client to take a deep and
slow breath, through their nostril and hold
his/her breath for a few second, and then slowly
exhale.
 Initially this intervention should take place only
in the therapist office, and with the instruction of
the therapist. After a few sessions clients will be
able to do it at home on their own.
 The client can be instructed to observe the
muscular tension that is experienced in different
parts of their body (back, shoulder, neck, etc)
while they are holding their breath.
54
Soothing and Grounding
Techniques (Breath-Work)
 It is possible to isolate the focus of the breath to certain
parts of the body in order to develop deeper somatic
connection and awareness, but client is still able to
become mindful of their breath and body.
 Technique: Client will take a breath, and become observant of
the breath within their nostril or other parts of the body (chest,
abdomen, etc). Initially they may not notice anything, but this is
completely acceptable and understandable. It is important to
remind them to maintain a non-judgmental attitude, and when
their mind wanders off, to bring their attention back to their
nostril without judgment.
 This technique can also help clients to access blocked and
repressed emotions.
 Mindful observation is the key in this exercise.
55
Soothing and Grounding
Techniques (Somatosensory
Visualization)
 This technique is designed to help clients to use their
past positive and life giving experiences for their current
therapeutic process.
 Technique: Ask the client to remember a safe person or
place that felt relaxed/comfortable to be around when
they were growing up. As they recall the memories, ask
them to remember what their bodily experience was in
that situation/environment.
 This process will be repeated over time in the sessions,
so the client can easily access/recall bodily experiences
related to their past positive experience.
56
Soothing and Grounding
Techniques (Tapping)
 Many trauma clients struggle with psychological
dissociation symptoms including: Dissociative
Amnesia, Depersonalization, and Dissociative
Identity Disorder.
 Tapping has been a very useful tool to help
clients move out of dissociative states prior to
full switch, but first these clients must develop
effective “awareness” skills so that they
recognize precursor bodily experiences prior to
the manifestation of symptoms.
57
Soothing and Grounding
Techniques (Tapping)
 Suggested Pressure/Tapping points:
 Forehead
 Outer corner of eyes
 Below the eye orbit
 Above the upper lip
 Below the lower lip
 Area where thumb joins fingers
 Side of the hand
 Between the ribs
 Below collar bone
58
Mindfulness Awareness, and Its
Role in Somatosensory Techniques
 Mindfulness awareness is the cornerstone
of somatosensory and sensorimotor
strategies and techniques.
59
Positive Effects of Long-Term
Mindfulness Practices
 fMRI study of one monk:
 Significant difference in left prefrontal cortex
activation compared to right prefrontal cortex.
 Difference as high as 3 standard deviations
above the “norm”. There is a strong relation
between increased activity of left prefrontal
cortex and positive affects such as joy and
compassion.
60
Body Awareness and Completion of
Arousal Cycle Techniques
 Counselors need to help clients practice
expanding their orienting process beyond
discussion by adding the sensorimotor
interventions.
 Counselors will help clients to slow down and
become mindful of their orienting and
attentional processes in order to increase
awareness of their bodily sensations and affects,
and the way they respond to them.
61
Body Awareness and Completion of
Arousal Cycle Techniques
 In many of the mindfulness practices, we
are focusing on an aspect of body
experience. This engages prefrontal
cortical, paralimbic, limbic, and
somatosensory structures which clearly
play an important role in neural
integration.
62
Mindfulness and Arousal
Modulation
Mindfulness body oriented practices tend
to expand window of arousal tolerance.
This is done by:
1- tracking internal sensations, and allowing
oneself to experience one’s internal process,
that is, establishing an intrapersonal
relationship. This relationship may become a
neurobiological substitute for deficits in
earlier attachments.
63
Mindfulness and Arousal
Modulation
2- Gaining awareness of the transitory
nature of all sensory experience.
These key issues have been the main focus of
many ancient spiritual practices such as:
Zen Buddhism
Vipassana (school of Buddhism)
Many schools of yoga
Sufism (dances and chants)
Tai Chi/Chi Kung , etc
64
Body Awareness and Completion of
Arousal Cycle Techniques
 Therapist will ask the client to recall an incident that is somewhat
stressful and arousal-evoking (this could be part of client’s trauma
history).
 Then invites the client to stay present with the bodily sensation and
experiences that are aroused. The therapist might ask:
 What are you experiencing in your body right now?
 Where in your body are you having these experiences?
 If this experience had a shape what would it be?
 If this experience had a color what would it be ?
 If this experience had a texture what it would be?
 What does your body want to do right now?
 What is about this situation that makes you so ______________
65
Arousal and Activation of Primal
Natural Defensive Responses
 Fight or flight response are the most primitive
and ingrained defenses against threat and
danger.
 For many clients these defenses were forbidden
or were proven ineffectual in the face of
disturbing, threatening or dangerous situations.
 Counselors can use these responses to counter
past traumatic situation, and awaken clients’
natural responses, and create affect regulation
and neural integration.
66
Arousal and Activation of Primal
Natural Defensive Responses
 Technique: These technique can include
moving your leg as if you are running, or
ask the client to walk/jog in place while
describing their bodily experience.
 Clients could also visualize doing these
techniques if they are not willing or it is
not appropriate to do it (screaming) in the
office.
67
Bilateral Stimulation
 Enhances lateral neural integration.
 EMDR uses Bi-Lateral stimulation in order to
enhance processing of traumatic memories.
 It involves patterned, repetitive activation of left
and right hemispheres.
 Many of the ancient cultures have integrated this
technique in their spiritual/cultural practices.
68
Child Soldiers in Africa
War Dance
69
70
71
72
73
74
75
76
Halveti Darvishes
77
Sensorimotor Techniques
 Pushing action
 Grounding
 Alignment
 Reaching out
 Elaborating somatic resources the client is
already using
78
Alternative/Complementary
Approaches (Yoga, Vipassana, Tai
Chi, etc)
79
Studies on Meditation and Yoga
 Lazar’s studies examined the thickness of
cortex of meditators vs. non-meditators (fMRI).
 Results: subjects who meditated and practiced Yoga had
larger medial prefrontal cortex and insular connections
than non-meditators.
 These brain region are associated with attention and
sensory processing, and the modulation of outside stimuli
(affect /arousal tolerance) and the connection of
emotional and cognitive processing.
80
References and Recommended
Readings
Bensimon, M., Amir, D., & Wolf, Y. (2008). Drumming
through trauma: Music therapy with post-traumatic
soldiers. The Arts in Psychotherapy, 35, 34-48.
Corrigall, J., Wilkinson, H. (2003). Revolutionary
connections: Psychotherapy and neuroscience. London:
H. Karmac (Books) Ltd.
Damasio, A. (1999). The feeling of what happens. New
York: Harcourt, Brace.
Edmondson, L. (2005). Marketing trauma and the Theatre
of War in northern Uganda. Theatre Journal, 57, 451-
474.
Folensbee, R. (2007). Neuroscience of psychological
therapies. New York: Cambridge University press.
81
References and Recommended
Readings
Gendlin, E. (1978). Focusing. New York: Bantam Books.
Goleman, D., with Dalai Lama, et al. (2004). Destructive
emotions: How can we overcome them? New York:
Bantam Books / Random House.
Gray, A. (2001). The body remembers: Dance/Movement
therapy with an adult survivor of torture. American
Journal of Dance Therapy, 23(1), 29-43. Herman, J. L.
(1992). Trauma and recovery; The aftermath of violence
– from domestic abuse to political terror. New York:
Basic Books.
LeDoux, J. (1996). The emotional brain. New York: Simon
and Schuster.
Levine, P.A. (1997). Waking the tiger: Healing trauma.
Berkeley, CA: North Atlantic Books.
82
References and Recommended
Readings
Lisak, D. (June, 2008). The neurobiology of trauma (2005
ppt presentation).
Mills, L. J., & Daniluk, J. C. (2002). Her body speaks: The
experience of dance therapy for women survivors of
child sexual abuse. Journal of Counseling & Human
Development, 80, 77-85.
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the
body: A sensorimotor approach to psychotherapy. New
York: Norton.
Perry, B.D. (2006). Applying principles of
neurodevelopment to clinical work with maltreated and
traumatized children. In N.B. Webb (ed.), Working with
traumatized youth in child welfare (pp 27-52), New York:
Guilford.
83
References and Recommended
Readings
Ratey, J.J. (2001). A user’s guide to the brain: Perception,
attention, and the four theaters of the brain. New York:
Vintage Books.
Rothschild, B. (2000). The body remembers: The
psychophysiology of trauma and trauma treatment. New
York: Norton.
Siegel, D. J. (2007). The mindful brain: Reflection &
attunement in the cultivation of well-being. New York:
Norton.
84
References and Recommended
Readings
Solomon, E. P. & Heide, K.M. (2005). The biology of
trauma: Implications for treatment. Journal of
Interpersonal Violence, 20 (1), 51-60.
Van der Kolk, B. A. (1994). The body keeps score: Memory
and the evolving psychobiology of posttraumatic stress.
Harvard Review of Psychiatry, 1, 253-265. Van der Kolk,
B. A. (2001). The assessment and treatment of complex
PTSD. In R. Yehuda (ed.), Traumatic Stress (Chap. 7).
Washington, D. C.: Am. Psychiatric Press.
Van der Kolk, B. A., & Fisler, R. (1995). Dissociation and
the fragmentary nature of traumatic memories:
Overview and exploratory study. Download:
http//www.trauma-pages.com/vanderk2.htm
85
References and Recommended
Readings
Van der Kolk, B. A.. McFarlane, A. C., & Weisaeth, L. (Eds.).
(1996). Traumatic Stress: The effects of overwhelming
experience on mind, body and society. New York:
Guilford.
Van der Kolk, B. A. (2002). Beyond the talking cure:
Somatic experience and subcortical imprints in the
treatment of trauma. In Shapiro, F., EMDR as an
integrative psychotherapy approach (pp 57-83).
Washington, D.C.: APA Press.
Wilbarger, P. & Wilbarger, J. (1997). Sensory defensiveness
and related social/emotional and neurological problems.
Van Nuys, CA: Wilbarger. (May be obtained from Avanti
Education Program, 14547 Titus St., Suite 109, Van
Nuys, CA, 91402).

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Holistic Practices That Promote Neural Integration and Connection

  • 1. 1 Holistic Practices That Promote Neural Integration and Connection: Using Somatosensory Techniques in Counseling Daryush Parvinbenam, M.Ed., M.A., LPCC-S AMHCA conference 2009
  • 2. 2 Roots of Resiliency and Emotional Wellness  Emotional wellness is rooted in different layers of connection and integration.  These layers are interactive and multi-directional in adults.  These connections occur on  Neurobiological system  Intrapersonal/personality system  Interpersonal/relational system  Spiritual/system of meaning
  • 3. 3 This Presentation  In this presentation we will focus on  1. Somatosensory and sensorimotor techniques that enhance the neurobiological integration.  2. Impact of neural integration on affect regulation.
  • 4. 4 Somatosensory and Sensorimotor Psychotherapy  The Essence of Somatosensory and Sensorimotor Psychotherapy are regulating affective and sensorimotor states through the therapeutic relationship by teaching the client to self-regulate.  Self regulation occurs through mindfully contacting, tracking and articulating somatosensory and sensorimotor processes.  It is a psychotherapeutic process that is not independent of our current understandings of counseling process, therefore it is not a set of techniques that can be applied without consideration for importance of therapeutic relationship, and counseling skills and procedures.
  • 5. 5 Impact of Affect Dysregulation  Affect dysregulation  1. Anxiety disorders  2. Depression  3. Affective Disorders  4. Borderline and other personality disorders  5. Alexthymia  6. Impulsivity  7. Anger  8. PTSD  9. Dissociative disorders  10. Addiction  Difficulties with attention and memory  Inability to take effective actions  Difficulties with interpersonal/relational complexities  Difficulties with boundaries
  • 6. 6
  • 7. 7 Importance of Neural Integration  Neural integration is the key component of affect regulation.  Counselors should consider how their current case conceptualizations, interventions and techniques enhance neural integration among different regions of the brain (cognitive, affective, and somatosensory).
  • 8. 8 Neural Systems Development  Healthy organization of neural networks depends upon the pattern, frequency, and timing of key experiences during development.
  • 9. 9 Developmental Roots of Neural Integration, and Resiliency  Secure attachment, and its accompanying development of neural integration acts as a barrier against stressors which provides ability to self-soothe and effectively regulate arousal.  In “good-enough” biological and social conditions, most people develop neurobiological integrities and secure attachment.  Secure attachment in childhood is the biggest predictor of resiliency in adulthood in the face of traumatic events.
  • 10. 10 Impact of Neural Disintegration  Insecure attachment and chronic relational traumas tend to create neural disintegration within different regions of the brain that leads to numerous psychopathologies.  Recent neuro-imaging techniques have given us considerable evidence regarding neurobiological consequences of chronic relational traumas and maltreatments in early childhood.
  • 11. 11
  • 12. 12 Cortical, sub-Cortical, Laterality, and Their Structure and Function (Targets of Integration)
  • 13. 13 Different regions of the brain operate more like a symphony orchestra than soloists. In other words, different regions of the brain have profound impact on the functioning of each other.
  • 14. 14
  • 15. 15 Sub-Cortical Brain  Sub-cortical part of the brain ( Limbic Diencephalon, and Brain Stem) was first developed from an evolutionary perspective.  Governs arousal, homeostasis of the organism, reproductive drives, emotion, memory, some social behavior, and learning.
  • 16. 16
  • 17. 17
  • 18. 18 The Neocortex  Last to develop phylogenetically.  Enables cognitive information processing, such as self-awareness and conscious thought.  Includes large portions of the Corpus Callosum, which bridges the right and left hemispheres of the brain (MacLean, 1985).  Helps consolidate information (Siegel, 1999).
  • 19. 19 Neurobiological system: The Brain’s Hierarchical Organization Levels Structures Understanding of Environment Functions Cognitive (Cortical) Neocortex Concrete Abstract Declarative Conscious Thought Info. Processing Self-Awareness Emotional (Sub-Cortical) Limbic Feelings Procedural Affiliation Learning/ Memory Emotional Reactivity Sensorimotor Arousal (Sub-Cortical) Diencephalon Brain stem Instinctual Tendencies Survival Sexual Behavior Motor Regulation Arousal & Homeostasis
  • 20. 20 Mutuality and Independence of the Levels  Each of the three levels of the brain thus has its own “understanding” of the environment and responds accordingly.  A particular level may become dominant and override the others, depending on the internal and environmental conditions.  At the same time, these three levels are mutually dependent and intertwined (Damasio, 1999; LeDoux, 1996; Schore, 1994), functioning as a cohesive whole, with the degree of integration of each level of processing affecting the efficacy of other levels.
  • 21. 21 Brain: Hierarchical Functioning Lower Level Higher Level Fixed Action Sequences Greater Plasticity Reflexive Action Voluntary Control Instinct Logic/ Planning Unconscious Conscious More Rapid Response Slower Response Each level has its own understanding of the environment and responds accordingly Depending on circumstances, one level may dominate others In daily adult life (except for emergencies), higher levels generally override lower levels
  • 22. 22 Brain laterality (Right Hemisphere) In the first 3 years of life (Attachment Formation) the dominant brain hemisphere is the right hemisphere. The right hemisphere is more highly connected with sensory and certain emotional aspects of functioning. Right hemisphere is holistic; involves non-verbal signals, eye contact, facial expression, tone of voice, posture, gesture, immediacy of response.
  • 23. 23
  • 24. 24 Brain Laterality (Left Hemisphere) The Left hemisphere involves in linear, linguistic, logical, and literal processing. The left hemisphere is more closely identified with organizational functioning, and use of symbol system.
  • 25. 25
  • 26. 26 How Emotions are primarily Processed LEFT Positive Emotion RIGHT Negative Emotion
  • 27. 27 Neuroplasticity of the Brain (Neurogenesis, and Synaptogenesis)
  • 28. 28 Neuroplasticity of the Brain  Neuro-Plasticity:  Ability of the nervous system to change.  Recent research suggests that new neurons are generated in different areas of primate and human brains.  The generation of new neurons occurs especially in regions involved with ongoing learning, such as the hippocampus, the amygdala, and the frontal and temporal lobes.
  • 29. 29 Neuroplasticity of the Brain  Neural networks change in a “use-dependent” fashion. In order for impoverished neurons, synapses, and neural pathways to recover, they must be activated.  Hebb’s principle-Neurons that fire together, wire together.  Patterned, repetitive activity changes the brain.
  • 30. 30 Birth Six years old 14 years old Synaptic Density
  • 31. 31
  • 32. 32 Expansion of Affect Regulation Through Interventions That Lead to Neural Pathway Connections
  • 33. 33 Window of Tolerance/Arousal  Working with clients’ window of tolerance, is the key issue in improving neural integration.  In order for clients to improve affect regulation, counselors must create a therapeutic arena that is safe, but not too safe.  In return, as clients’ neural integration improves, so does their affect regulation (feedback loop)
  • 34. 34 Window of Arousal and Regulating Arousal  Freeze: “The deer in the headlights” Mute, Physically immobilized Frozen defensive responses ↑ ↓ Sympathetic Hyperarousal _______________________________________________________________ _____________________________________________________________ “Window of Tolerance” Optimal Arousal Zone Parasympathetic Hypoarousal Hypoarousal: Collapsed, weak, no energy, defeated flat affect, numb, “empty” or “dead” Cognitively dissociated, unable to think Helpless and hopeless Hyperarousal: Hypervigilant, action-oriented, impulsive Emotionally flooded, reactive, defensive Flashbacks, nightmares, racing thoughts Suicidal, self-destructive
  • 35. 35 Window of Tolerance/Arousal  The counselor acts as an auxiliary ego for the clients, to help them to process and integrate negative emotions and affects without getting overwhelmed.  Clients are not able to integrate information when they are not within their optimal arousal zone.  Hyper or hypoarousal states are counter integrative, and tend to delay client’s progress.
  • 36. 36 Window of Tolerance High Arousal- Dissociation Low Arousal- Dissociation _________________________________________________________ High Arousal- Re-experiencing, Hyperarousal _________________________________________________________ Apn: “the surface of consciousness” _________________________________________________________ Low Arousal – Emotional Numbing, Depression ________________________________________________________ Full or partial Intrusion of EPs EP Activity ANP Narrow Window of tolerance EP Activity Full or partial Intrusion of EPs
  • 37. 37 The Role of the Body in Counseling, and Historical Lack of Engagement of Body in Counseling
  • 38. 38 In the animal self-help section
  • 39. 39 Introduction  The body, for a host of reasons, has been left out of the “talking cure.”  Somatosensory and Sensorimotor psychotherapy builds upon traditional psychotherapeutic understanding, but approaches the body as central in the therapeutic field of awareness.  Theoretical principles and treatment approaches from both the mental health and body psychotherapy traditions are integrated in this approach.
  • 40. 40 Lane and Schwartz Model  Authors present a cognitive-developmental theory of emotional awareness.  Their primary thesis is that emotional awareness is a type of cognitive processing which undergoes five levels of transformation along a cognitive- developmental continuum.
  • 41. 41 Lane and Schwartz Model  The five levels of transformation are:  No emotional awareness  Awareness of bodily sensations  The body in action (Awareness of behaviors)  Individual feelings  Differentiated Emotional awareness  Blends of feelings
  • 42. 42 Lane and Schwartz Model  No Emotional Awareness:  At this level, a person has no idea what they are feeling or experiencing an emotion. For example, a person may say that they "feel like a loser." However, this is not really an emotional state, but instead, an evaluation or judgment.  Awareness of Bodily Sensations:  a person has some awareness of their emotions. However, they may only be aware of bodily sensations that they are experiencing, such as increased heart rate or muscle tension.
  • 43. 43 Lane and Schwartz Model  Awareness of Behaviors/actions:  At this level of emotional awareness, a person is only aware of how they would like to act as a result of having some kind of emotion. For example, a person may say that they feel like they would like to get away (which may be an indication of fear or anxiety).  Awareness that an Emotional State Is Present:  At this stage, a person is aware that an emotion is present; however, they may have a hard time figuring out exactly what emotion is there. For instance, a person may have enough awareness to know that they feel "bad" or "overwhelmed" but nothing more specific than that. This is sometimes referred to as an undifferentiated emotional state.
  • 44. 44 Lane and Schwartz Model  Differentiated Emotional Awareness:  At this level, a person is aware of discrete emotions that are present. A person is able to identify the emotion that they are experiencing at any given point in time, such as sadness, anger, fear, anxiety, happiness, joy, or excitement.  Blended Emotional Awareness:  This is the top level of emotional awareness. At this level, a person is aware of multiple emotions that are present at the same time, including emotions that may on the surface appear to be in opposition to one another (for example, someone could feel hate and anger toward someone at the same time.
  • 45. 45 Top Down Vs Bottom up Approach to Counseling
  • 46. 46 Background  Traditional therapeutic models are based primarily on the idea that change occurs through a process of narrative expression and formulation in a “top-down” manner.  Improving ego functioning, clarifying meaning, formulating a narrative, and working with emotional experience are fundamentally helpful interventions that accomplish real gains for the client.  The addition of “bottom-up” interventions will address physical sensations, movement inhibitions, and somatosensory intrusions that disrupts top-down process (talk therapy).
  • 47. 47 The Interface  Top-down processing alone may manage sensorimotor reactions but may not enable their full assimilation.  Top-down management (insight and understanding) and bottom-up processing (sensations, arousal, movement, and emotions) must be thoughtfully balanced.
  • 49. 49 Impacts of Somatosensory and Sensorimotor Techniques  Somatosensory/sensorymotor techniques :  A. Promotes neural integration through bottom up pathways.  B. Creates moment-to-moment connection, and client experiences a sense of empathy by the counselor.  C. Generates movement toward completion of arousal cycle.  D. Accelerates surfacing of unconscious implicit memory/dynamic process.
  • 50. 50 Somatosensory and Sensorimotor Techniques  1. Self-soothing and grounding techniques  2. Somatosensory, Focusing, and Mindfulness techniques  Arousal and activation of natural defenses techniques  3. Sensorymotor techniques (Ogden, 2006)-Pushing action, Grounding, Breath work, Alignment, Reaching out, Elaborating somatic resources the client is already using
  • 51. 51 Somatosensory and Sensorimotor Techniques  4. Bilateral stimulation  5. Alternative/complementary approaches (Yoga, Vipassana, Tai Chi)
  • 52. 52 Soothing and Grounding Techniques (Breath-Work)  Counselor’s voice, and guiding the client through this exercise is extremely important (this is especially true for clients with trauma history).  Many clients tend to hold their breath, and maintain a shallow breathing pattern in order to stay disconnected from their bodily experience. This “natural” tendency for holding their breath could be used to create somatic engagement, and self observation.
  • 53. 53 Soothing and Grounding Techniques (Breath-Work)  Technique: Guide the client to take a deep and slow breath, through their nostril and hold his/her breath for a few second, and then slowly exhale.  Initially this intervention should take place only in the therapist office, and with the instruction of the therapist. After a few sessions clients will be able to do it at home on their own.  The client can be instructed to observe the muscular tension that is experienced in different parts of their body (back, shoulder, neck, etc) while they are holding their breath.
  • 54. 54 Soothing and Grounding Techniques (Breath-Work)  It is possible to isolate the focus of the breath to certain parts of the body in order to develop deeper somatic connection and awareness, but client is still able to become mindful of their breath and body.  Technique: Client will take a breath, and become observant of the breath within their nostril or other parts of the body (chest, abdomen, etc). Initially they may not notice anything, but this is completely acceptable and understandable. It is important to remind them to maintain a non-judgmental attitude, and when their mind wanders off, to bring their attention back to their nostril without judgment.  This technique can also help clients to access blocked and repressed emotions.  Mindful observation is the key in this exercise.
  • 55. 55 Soothing and Grounding Techniques (Somatosensory Visualization)  This technique is designed to help clients to use their past positive and life giving experiences for their current therapeutic process.  Technique: Ask the client to remember a safe person or place that felt relaxed/comfortable to be around when they were growing up. As they recall the memories, ask them to remember what their bodily experience was in that situation/environment.  This process will be repeated over time in the sessions, so the client can easily access/recall bodily experiences related to their past positive experience.
  • 56. 56 Soothing and Grounding Techniques (Tapping)  Many trauma clients struggle with psychological dissociation symptoms including: Dissociative Amnesia, Depersonalization, and Dissociative Identity Disorder.  Tapping has been a very useful tool to help clients move out of dissociative states prior to full switch, but first these clients must develop effective “awareness” skills so that they recognize precursor bodily experiences prior to the manifestation of symptoms.
  • 57. 57 Soothing and Grounding Techniques (Tapping)  Suggested Pressure/Tapping points:  Forehead  Outer corner of eyes  Below the eye orbit  Above the upper lip  Below the lower lip  Area where thumb joins fingers  Side of the hand  Between the ribs  Below collar bone
  • 58. 58 Mindfulness Awareness, and Its Role in Somatosensory Techniques  Mindfulness awareness is the cornerstone of somatosensory and sensorimotor strategies and techniques.
  • 59. 59 Positive Effects of Long-Term Mindfulness Practices  fMRI study of one monk:  Significant difference in left prefrontal cortex activation compared to right prefrontal cortex.  Difference as high as 3 standard deviations above the “norm”. There is a strong relation between increased activity of left prefrontal cortex and positive affects such as joy and compassion.
  • 60. 60 Body Awareness and Completion of Arousal Cycle Techniques  Counselors need to help clients practice expanding their orienting process beyond discussion by adding the sensorimotor interventions.  Counselors will help clients to slow down and become mindful of their orienting and attentional processes in order to increase awareness of their bodily sensations and affects, and the way they respond to them.
  • 61. 61 Body Awareness and Completion of Arousal Cycle Techniques  In many of the mindfulness practices, we are focusing on an aspect of body experience. This engages prefrontal cortical, paralimbic, limbic, and somatosensory structures which clearly play an important role in neural integration.
  • 62. 62 Mindfulness and Arousal Modulation Mindfulness body oriented practices tend to expand window of arousal tolerance. This is done by: 1- tracking internal sensations, and allowing oneself to experience one’s internal process, that is, establishing an intrapersonal relationship. This relationship may become a neurobiological substitute for deficits in earlier attachments.
  • 63. 63 Mindfulness and Arousal Modulation 2- Gaining awareness of the transitory nature of all sensory experience. These key issues have been the main focus of many ancient spiritual practices such as: Zen Buddhism Vipassana (school of Buddhism) Many schools of yoga Sufism (dances and chants) Tai Chi/Chi Kung , etc
  • 64. 64 Body Awareness and Completion of Arousal Cycle Techniques  Therapist will ask the client to recall an incident that is somewhat stressful and arousal-evoking (this could be part of client’s trauma history).  Then invites the client to stay present with the bodily sensation and experiences that are aroused. The therapist might ask:  What are you experiencing in your body right now?  Where in your body are you having these experiences?  If this experience had a shape what would it be?  If this experience had a color what would it be ?  If this experience had a texture what it would be?  What does your body want to do right now?  What is about this situation that makes you so ______________
  • 65. 65 Arousal and Activation of Primal Natural Defensive Responses  Fight or flight response are the most primitive and ingrained defenses against threat and danger.  For many clients these defenses were forbidden or were proven ineffectual in the face of disturbing, threatening or dangerous situations.  Counselors can use these responses to counter past traumatic situation, and awaken clients’ natural responses, and create affect regulation and neural integration.
  • 66. 66 Arousal and Activation of Primal Natural Defensive Responses  Technique: These technique can include moving your leg as if you are running, or ask the client to walk/jog in place while describing their bodily experience.  Clients could also visualize doing these techniques if they are not willing or it is not appropriate to do it (screaming) in the office.
  • 67. 67 Bilateral Stimulation  Enhances lateral neural integration.  EMDR uses Bi-Lateral stimulation in order to enhance processing of traumatic memories.  It involves patterned, repetitive activation of left and right hemispheres.  Many of the ancient cultures have integrated this technique in their spiritual/cultural practices.
  • 68. 68 Child Soldiers in Africa War Dance
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  • 77. 77 Sensorimotor Techniques  Pushing action  Grounding  Alignment  Reaching out  Elaborating somatic resources the client is already using
  • 79. 79 Studies on Meditation and Yoga  Lazar’s studies examined the thickness of cortex of meditators vs. non-meditators (fMRI).  Results: subjects who meditated and practiced Yoga had larger medial prefrontal cortex and insular connections than non-meditators.  These brain region are associated with attention and sensory processing, and the modulation of outside stimuli (affect /arousal tolerance) and the connection of emotional and cognitive processing.
  • 80. 80 References and Recommended Readings Bensimon, M., Amir, D., & Wolf, Y. (2008). Drumming through trauma: Music therapy with post-traumatic soldiers. The Arts in Psychotherapy, 35, 34-48. Corrigall, J., Wilkinson, H. (2003). Revolutionary connections: Psychotherapy and neuroscience. London: H. Karmac (Books) Ltd. Damasio, A. (1999). The feeling of what happens. New York: Harcourt, Brace. Edmondson, L. (2005). Marketing trauma and the Theatre of War in northern Uganda. Theatre Journal, 57, 451- 474. Folensbee, R. (2007). Neuroscience of psychological therapies. New York: Cambridge University press.
  • 81. 81 References and Recommended Readings Gendlin, E. (1978). Focusing. New York: Bantam Books. Goleman, D., with Dalai Lama, et al. (2004). Destructive emotions: How can we overcome them? New York: Bantam Books / Random House. Gray, A. (2001). The body remembers: Dance/Movement therapy with an adult survivor of torture. American Journal of Dance Therapy, 23(1), 29-43. Herman, J. L. (1992). Trauma and recovery; The aftermath of violence – from domestic abuse to political terror. New York: Basic Books. LeDoux, J. (1996). The emotional brain. New York: Simon and Schuster. Levine, P.A. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.
  • 82. 82 References and Recommended Readings Lisak, D. (June, 2008). The neurobiology of trauma (2005 ppt presentation). Mills, L. J., & Daniluk, J. C. (2002). Her body speaks: The experience of dance therapy for women survivors of child sexual abuse. Journal of Counseling & Human Development, 80, 77-85. Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: Norton. Perry, B.D. (2006). Applying principles of neurodevelopment to clinical work with maltreated and traumatized children. In N.B. Webb (ed.), Working with traumatized youth in child welfare (pp 27-52), New York: Guilford.
  • 83. 83 References and Recommended Readings Ratey, J.J. (2001). A user’s guide to the brain: Perception, attention, and the four theaters of the brain. New York: Vintage Books. Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. New York: Norton. Siegel, D. J. (2007). The mindful brain: Reflection & attunement in the cultivation of well-being. New York: Norton.
  • 84. 84 References and Recommended Readings Solomon, E. P. & Heide, K.M. (2005). The biology of trauma: Implications for treatment. Journal of Interpersonal Violence, 20 (1), 51-60. Van der Kolk, B. A. (1994). The body keeps score: Memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry, 1, 253-265. Van der Kolk, B. A. (2001). The assessment and treatment of complex PTSD. In R. Yehuda (ed.), Traumatic Stress (Chap. 7). Washington, D. C.: Am. Psychiatric Press. Van der Kolk, B. A., & Fisler, R. (1995). Dissociation and the fragmentary nature of traumatic memories: Overview and exploratory study. Download: http//www.trauma-pages.com/vanderk2.htm
  • 85. 85 References and Recommended Readings Van der Kolk, B. A.. McFarlane, A. C., & Weisaeth, L. (Eds.). (1996). Traumatic Stress: The effects of overwhelming experience on mind, body and society. New York: Guilford. Van der Kolk, B. A. (2002). Beyond the talking cure: Somatic experience and subcortical imprints in the treatment of trauma. In Shapiro, F., EMDR as an integrative psychotherapy approach (pp 57-83). Washington, D.C.: APA Press. Wilbarger, P. & Wilbarger, J. (1997). Sensory defensiveness and related social/emotional and neurological problems. Van Nuys, CA: Wilbarger. (May be obtained from Avanti Education Program, 14547 Titus St., Suite 109, Van Nuys, CA, 91402).