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Holistic Practices That Promote Neural Integration and Connection

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Holistic Practices That Promote Neural Integration and Connection

  1. 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. 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. 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. 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. 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
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  7. 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. 8 Neural Systems Development  Healthy organization of neural networks depends upon the pattern, frequency, and timing of key experiences during development.
  9. 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. 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.
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  12. 12. 12 Cortical, sub-Cortical, Laterality, and Their Structure and Function (Targets of Integration)
  13. 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.
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  15. 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.
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  18. 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. 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. 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. 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. 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.
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  24. 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.
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  26. 26. 26 How Emotions are primarily Processed LEFT Positive Emotion RIGHT Negative Emotion
  27. 27. 27 Neuroplasticity of the Brain (Neurogenesis, and Synaptogenesis)
  28. 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. 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. 30 Birth Six years old 14 years old Synaptic Density
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  32. 32. 32 Expansion of Affect Regulation Through Interventions That Lead to Neural Pathway Connections
  33. 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. 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. 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. 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. 37 The Role of the Body in Counseling, and Historical Lack of Engagement of Body in Counseling
  38. 38. 38 In the animal self-help section
  39. 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. 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. 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. 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. 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. 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. 45 Top Down Vs Bottom up Approach to Counseling
  46. 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. 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. 48. 48 Somatosensory and Sensorimotor Techniques
  49. 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. 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. 51 Somatosensory and Sensorimotor Techniques  4. Bilateral stimulation  5. Alternative/complementary approaches (Yoga, Vipassana, Tai Chi)
  52. 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. 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. 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. 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. 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. 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. 58 Mindfulness Awareness, and Its Role in Somatosensory Techniques  Mindfulness awareness is the cornerstone of somatosensory and sensorimotor strategies and techniques.
  59. 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. 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. 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. 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. 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. 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. 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. 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. 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. 68 Child Soldiers in Africa War Dance
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  73. 73. 73
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  75. 75. 75
  76. 76. 76 Halveti Darvishes
  77. 77. 77 Sensorimotor Techniques  Pushing action  Grounding  Alignment  Reaching out  Elaborating somatic resources the client is already using
  78. 78. 78 Alternative/Complementary Approaches (Yoga, Vipassana, Tai Chi, etc)
  79. 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. 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. 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. 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. 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. 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. 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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