ASSESSING THE EFFICACY OF SOMATIC EXPERIENCING FOR REDUCING SYMPTOMS OF ANXIETY AND DEPRESSSION
Assessing the efficacy ofSomatic Experiencing forreducing symptomsof PTSD
Is Trauma: Pathology or aninterruption on the path toResilience? QuickTimeª and a TIFF (Uncompressed) decompressor are needed to see this picture.
“Nature has instilled in all animals, including humans, a nervous system capable of restoring equilibrium. When self- regulating function isblocked or disturbed, trauma symptoms develop...” Peter Levine (Foundation for Human Enrichment, 2007)
Recovery, Resilience, and Chronic Symptoms QuickTimeª and a TIFF (Uncompressed) decompressor are needed to see this picture.
Some evidence for innate resilience… 60% of Dominant culture Americans experience a traumatic event. 8% of Dominant culture Americans meet the criteria for PTSD. In a cohort of 911 survivors number of number of positive emotions inversely correlated to the development of PTSD (Fredrickson, 2001). Resilient individuals have habits that increase resilience (Bonnano, 2004).
In this slide show we willaddress these four questions… • Why this study? • Why this study now? • How will the study be conducted? • What this study could show?
Why this study? Most theories used for psychological treatment start with the question, “How does pathology develop?” Somatic Experiencing starts from the questions: “What makes people resilient? Why don’t more people develop PTSD, trauma or other mental illness?”
Why this study? Cont... Paradigm Shift…3 levels: Resilience / affect regulation, deterministic chaos,. Bodymind Over the last ten years there has been a growing body of literature on resilience. Much of this literature matches the assumptions underling Somatic Experiencing theory. Preliminary studies show indications of SE being a short term effective treatment.
SE Studies: TFA (Trauma First Aid) Care Providers with Catholic Charities Post Katrina were given between one and two sessions. (N= 142) (Leitch, 2006). Significant increase in resilience was found (Leitch, 2006). Significantly less severe symptoms then control (Leitch, 2006). Both control and experimental had an increase of symptoms at follow up (Leitch, 2006). Tsunami Study: A few days after the session, 90% of participants showed complete or partial improvement in reported symptoms (Leitch, 2007). A few days after the session, 84% of participants exhibited complete or partial improvement in therapist observed symptoms (Leitch, 2007). All of the results should be interpreted with caution given the small sample size and lack of an equivalent comparison group (Leitch, 2007).
Why this study now? There is a growing interest in clinician driven research. Initial studies of the SE model have indicated that even one session can significantly reduce the development of symptoms of PTSD. The full SE treatment modality has not yet been studied. SE is a short-term treatment and thus would fit the current managed care model. The SE modality works with an individuals cultural, personal and familial contexts to increase psychological health.
Trauma affects the whole person: Body-Mind-Relationships-Context… “All neurosis is are in essence Men who committedMiddle class physioneurosis.” (Kardinair, intimate abuseindividuals who 1941) “Veterans…(diagnosed with experienced more “The four “The body PTSD)…experiencepsychophysiological changeskeeps the score.” chronic traumaadverse posttraumatic moredisorder are symptoms than performed poorly than the in childhood stress (Kolk, McFarlane, & Weisaeth, both extensive andsample on a measure of verbal comparison enduring.”events are 250%PTSD (Herman, 1997) 1996).Bessal van der Kolk (1996) nonabusive controls. effects the whole significant describes three exhibiting affects changes 2005) (Dutton, Post-Traumatic Stress Disorder learning,extreme stressless proficient in stressmore likely to to “Exposure person: mind,physical psychobiological is a“normal” brain, body, cumulative acquisition across repeated reactivitySmoke. 4600% self, history of childhoodlife… reaction to and an extraordinary people at many a relationships–Chronic physiological Women with levels of exposures, greater sensitivity to proactivemore like to exhibited increased(Kolk, McFarlane, & event pituitary- functioning: Somatic, emotional, autonomic arousal, abuse use interference, andWeisaeth, – Heightened response to cognitive,and autonomic responses adrenal 1996). more perseverativeI.V. drugs. (Fallite,charicterlogical” behavioral,Al, 2000) (Heim et and1999) errors.” (Uddo, Vasterling, Brailey & reminders of the traumatic event and (Kolk, McFarlane, & Weisaeth, Sutker, 1993) 1996). –Hyperarousal in reaction to intense but neutral events.
Key concepts in SE Model… “Trauma is a natural normal part of life, not a mistake, a disease or aberration.” “Bodymind designed to heal intense experiences” “Works within clients, ‘range of resilience’” “Verbal / cognitive content is used to track activation not to access memories.” “SE model works with: Felt experience, physical sensation, motor patterns, and cognitive processes.” (Foundation for Human Enrichment, 2007)
Somatic Experiencing Model Tools for Evoking Innate Righting Response Titration: Using the Pendulation: smallest amount of Inherent oscillation activation possible to between Sympathetic shift the system in a and Parasympathetic contained way. activation. Resource: Evocation Discharge: Release of relaxation response, of high amounts of empowerment, or arousal to return to self-mastery. baseline resting state. (Foundation for Human Enrichment, 2007)
Affect Regulation Affect Regulation: The ability to tolerate mange and return to homeostasis after a range of intensity of different emotional states. Self Regulation: The use of an affect regulation tool to manage high levels of affect. Auto Regulation: Well established, automatic or implicit regulation of affect. Co-Regulation: Regulation of affect through relationship or inter-subjective relatedness (Schore, 2008).
Affect Dysregulation Over Activated Sympathetic… Physical: Increase heart rate, difficulty breathing, cold sweats, tingling, muscular tension, exaggerated startle response, difficulty with sleeping Mental/Emotional: Anxiety attacks, rage outbursts, hyper vigilance, racing thoughts, worry (Foundation for Human Enrichment, 2007)
Affect Dysregulation Over Activated Parasympathetic… Physical: Low energy, exaughstion, numbness, low muscle tone, poor digestion, low heart rate, blood pressure, poor immune function Mental/Emotional: Depression, dissociation, apathy, disconnection in relationship, under responsive (Foundation for Human Enrichment, 2007)
How will this study be conducted? Between groups pre-test post-test matched control group design. Minimum N = 18 in each group ( N > 68 needed for optimum power.) Population: A convenience sample of adults who are currently living at COTS shelter. Matching Criteria: Years homeless, age, gender. Symptoms of depression operationalized as score on the Beck Depression Inventory. Symptoms of anxiety is operationalized as score on STAI
How will this study be conducted? Cont.Statistical Analysis: Repeated Measures Multivariate Profile Analisys will be used to asses all hypothesis. Descriminant Analysis will be used to assess all hypothesis.
How will this study be conducted? Cont. Some questions that remain: Administering surveys two possibilities: A) senior participant at COTS shelter receives stipend, B) Find research assistants (undergrad volunteers). Incentives for control group: A) Weekly raffle, B) $5 per week per control group member.
What could this study show? Whether and to what degree Somatic Experiencing is an effective modality for reducing symptoms of trauma. The effects of interactions of other therapeutic modalities such as: psychotherapy, case management, parenting classes, mindfulness based programs etc. The number of sessions that creates optimal change from Somatic Experiencing The type of Somatic Experiencing interventions that correlate the best with change in symptoms.
References cont. pg 1 of 3Duttot, D. (2005). Trauma symptoms and PTSD-like profiles in perpetrators of intimate abuse Traumatic StressEisenberg, N., Guthrie, K., Fabes, R., Reiser, M., Murphy, B., Holgren, R. Masak, P., Losoya, S. (1997). The relations of regulation and emotionality to resiliency and competent social functioning in elementary school children. Child development, 68, 295-311Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, et al JS. (1998). The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine. 14, 245-258.Fredrickson, B., Mancuso, R., Branigan, C., Tugade, M., (2000).The Undoing Effect of Positive Emotions Motivation and Emotion, 24Fredrickson, B., Tugade, M., Waugh, C., Larkin, G. (2001). What good are positive emotions in crisis? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, Journal of Personality and Social Psychology. 84(2), 365-376Foundation for Human Enrichment (2007) Somatic Experiencing: Healing Trauma, Training ManuelHerman, J. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. Basic Books.Heim, Newport, Heit, Graham, Wilcox, Bonsall, Miller, Nemeroff, (2000). Pituitary-Adrenal and Autonomic Responses to Stress in Women After Sexual and Physical Abuse in Childhood JAMA. 284, 592-597.
References cont. pg 2 of 3Hulnick, M. (1996).Victim-to-perpetrator process: Effect of trauma on incarcerated adult male sex offenders, Boston CollegeKolk. B., McFarlane, A., Weisaeth, L., (1996). Traumatic stress, Guilford Press, Ny: New YorkLeitch, L. (2007). Somatic Experiencing Treatment With Tsunami Survivors in Thailand: Broadening the Scope of Early Intervention. Journal of Traumatology,13(4) 11-20. JLeitch, L. (2006). Hurricane Katrina Projects: Findings Foundation for Human Enrichment. Manuscript submitted for publicationLuthar, S.(2003). Resilience and Vulnerability: Adaptation in the Context of Childhood Adversities, Cambridge University PressPorges, S.W., Doussard-Roosevelt, J.A., & Maiti, A. K. (1994). Vagal tone and the physiological regulation of emotion. In N.A. Fox (ed). Emotion Regulation: Behavioral and Biological Considerations. Monograph of the Society for Research in Child Development, 59 (2-3, Serial No. 240), 167- 186.Porges, S. (2002). Neuroception: A subconscious system for detecting threats,Zero to 3 Schore, A. (2003). Affect Regulation and repair of the self, Norton & Company
References cont. pg 3 of 3Tugade, M., Fredrickson, B., & Barrett. L., (2004). Psychological Resilience and Positive Emotional Granularity: Examining the Benefits of Positive Emotions on Coping and Volume 72 Issue 6 p. 1161-1190. Journal Personality.Uddo, M., Vasterling, J., Braily, K., & Sutker, P. (1993). Memory and attention in combat-related post-traumatic stress disorder (PTSD). Journal of Psychopathology and Behavioral AssessmentValentine, L., Feinauer, L.(1993). Resilience factors associated with female survivors of childhood sexual abuse, The American Journal of Family Therapy.Schore, A. (2002) Dysregulation of the right brain: a fundamental mechanism of traumatic attachment and the psychopathogenesis of post traumatic stress disorder (36: 9-30) Australian and New Zealand journal of psychiatrySchore, A. (2008). Quarterly study group on attachment theory. Alta Bates Hospital, Berkeley: CAStern, D. (2006) The interpersonal world of the infant, Basic BooksSelvam, R. (2008) Somatic therapy treatments effects with tsunami survivors 14 (3), 103-119