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Neurobiology of Touch and Trauma…
RUNNING HEADER: Neurobiology of Touch and Trauma
The Neurobiology of Touch and Trauma
So...
Neurobiology of Touch and Trauma…
Abstract
Touch plays a vital role in the building of the brain, the mind, and the self.
...
Neurobiology of Touch and Trauma…
The Neurobiology of Touch and Trauma
Somatic Experiencing from Dysregulation to Coherenc...
Neurobiology of Touch and Trauma…
there are means to re-establish regulation in the brain, body, and self. Touch,
being a ...
Neurobiology of Touch and Trauma…
oxitocyn in women (Blumenfeld, 2002). Early experiences including maternal touch
sculpt ...
Neurobiology of Touch and Trauma…
Significant Hippocampal decline was noted for those with Dissociative Identity Disorder
...
Neurobiology of Touch and Trauma…
Insula. The insula is a part of the limbic cortex (Zillmer, Spiers & Culbertson,
2008). ...
Neurobiology of Touch and Trauma…
of bottom up and top down neural processes. The cingulate gyrus is involved in the
limbi...
Neurobiology of Touch and Trauma…
Mishkin, 2004; Rolls, O’Doherty, Kringelbach, Francis, Bowtell, & McGlone, 2003).
Basal ...
Neurobiology of Touch and Trauma…
involved in sexuality (direct stimulation creates penile or clitoral erection). The sept...
Neurobiology of Touch and Trauma…
discriminatory touch; and the anterior columns, which are also primarily a sensory
pathw...
Neurobiology of Touch and Trauma…
(Zillmer, Spiers & Culbertson, 2008). Stimulating the primary sensory-motor strip causes...
Neurobiology of Touch and Trauma…
2009). Several studies have shown that people can identify multiple emotions through
phy...
Neurobiology of Touch and Trauma…
tendency to socialize indiscriminately, and the cortical structures that myelinated afte...
Neurobiology of Touch and Trauma…
the hypoarousal reaction is related to the numbing and avoidance cluster.
Another model ...
Neurobiology of Touch and Trauma…
nervous system. Some indications of social engagement are the inner ear tuning to the
ra...
Neurobiology of Touch and Trauma…
Touch is as vital as food and can affect multiple neurobiological systems that are
targe...
Neurobiology of Touch and Trauma…
regulation centers in the brain.
There are three main types of affect regulation. These ...
Neurobiology of Touch and Trauma…
Through the process of contained activation, the cortical structures responsible for
emo...
Neurobiology of Touch and Trauma…
Conclusion
Touch is as vital as food, not simply to children but also adults (Juhan, 199...
Neurobiology of Touch and Trauma…
of attack and defense in the rat. Behavioral and Neurobiology, 30(4), 357-388.
Bremner, ...
Neurobiology of Touch and Trauma…
(1996). Massage therapy for infants of depressed mothers. Infant Behavior and
Developmen...
Neurobiology of Touch and Trauma…
communication of emotion via touch. Emotion, 9, 566-573.
Joseph, R. (1999). Environmenta...
Neurobiology of Touch and Trauma…
corticothalamic perfusion ratios during a PTSD flashback. Depression and
Anxiety, 4(3), ...
Neurobiology of Touch and Trauma…
treatment of Cushing’s disease. Biological Psychiatry, 46(12), 1595-1602.
Vaillancourta,...
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The Neurobiology of Touch and Trauma Somatic Experiencing from Dysregulation to Coherence

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This paper explores the role of touch in treatment. It explores the neurobiological impact of touch with a focus on the main neurological systems activated in touch. The paper attempts to outline tools to reduce symptoms of trauma through touch.

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The Neurobiology of Touch and Trauma Somatic Experiencing from Dysregulation to Coherence

  1. 1. Neurobiology of Touch and Trauma… RUNNING HEADER: Neurobiology of Touch and Trauma The Neurobiology of Touch and Trauma Somatic Experiencing from Dysregulation to Coherence By: Mike Changaris, Psy.D.
  2. 2. Neurobiology of Touch and Trauma… Abstract Touch plays a vital role in the building of the brain, the mind, and the self. For the first years of life, touch is one of the main modes of communication between infants and caregivers. The limbic-touch system can be accessed to create effective safe treatments for trauma. Touch therapies including massage have been shown to reduce cortisol, symptoms of depression, and anxiety as well as increase dopamine, oxytocin (social bonding hormone), serotonin, parent infant bonding, and relational satisfaction (Field, et al., 1997; Field, et. al., 2008; Kurosawa, Lundeberg, Agren, Lund, & Uvnas-Moberg, 1995; Walach, Guthlin, & Konig, 2003; Field, Seligman, Scafidi, & Schanberg, 1996;). This paper discusses the neurobiology of trauma and touch systems offering an affect regulation based approach to conceptualizing touch treatment. The field of psychology would benefit from providing guidelines on the use of ethical touch so that clinicians can develop treatment modalities and receive the necessary supervision to provide safe effective touch interventions.
  3. 3. Neurobiology of Touch and Trauma… The Neurobiology of Touch and Trauma Somatic Experiencing from Dysregulation to Coherence From the rough and tumble play of five-year-old children to a mother’s caresses, touch plays a vital role in the building of the brain, the mind, and the self. The well-known studies on touch deprivation of infants in orphanages point out that touch is as vital as food for human existence (Juhan, 1998). Dean Juhan (1998) in his book Job’s Body states the skin is an extension of the brain. A child learns about himself through the way he makes contact with the world. Our earliest contact is through touch. For the first years of life, touch is one of the main modes of communication between infants and caregivers. Touch can either be damaging — for instance, abuse — or profoundly loving, as in the skin-on-skin contact of an infant with his care providers. When we touch one another we send a profound cascade of chemical reactions into motion, such as the secretion of oxytocin, a hormone responsible for social bonding, safety, and pain reduction. Touch can be a double-edged sword in trauma treatment. It can simultaneously be a profound trigger of threat and be a container creating safety. Adults who experience traumatic events display fundamental adaptations in their neurophysiology. Bowlby (1976) describes how as a child develops there can be moments when his development veers of course. Shore (2002) noted that these developmental interruptions can be seen as disruptions in brain function and structure. But the disrupted brain development can be reformed and regulation restored in proper therapeutic environment. According to affect regulation theory,
  4. 4. Neurobiology of Touch and Trauma… there are means to re-establish regulation in the brain, body, and self. Touch, being a major communicator of affect, could play a large role in providing the experience dependent maturation processes for the growth of brain functions missed in development. Understanding the neurobiology of touch, trauma and dysregulation could help the clinician creat effective touch based interventions. Key Brain Regions in Affect Regulation Hypothalamus Pituitary Adrenal-axis (HPA-axis). The HPA-axis is a cascade of chemical events. The HPA-axis is made up of the hypothalamus, pituitary gland, and adrenal cortex (which sits right above the kidney’s) (Zillmer, Spiers & Culbertson, 2008). Its main task is to mobilize a powerful energetic defense when a person is threatened and to return to rest when the threat is gone. It has been hypothesized that either functional or structural changes in the HPA underlie the development of PTSD. A simplified explanation of the HPA-axis activity is as follows: when a stress is recognized, the hypothalamus secretes corticotrophin-releasing hormone (CRH). CRH then stimulates the production of adrenocorticotropic hormone (ACTH) in the pituitary gland. ACTH makes its way down to the adrenal cortex, where it triggers the production of cortisol (Blumenfeld, 2002). Cortisol mobilizes a threat response. Cortisol then triggers the hypothalamus to stop producing CRH and thus ends the production of cortisol. In systems theory this is called a negative feedback loop. Touch based interventions could help restore regulation to this system. The hypothalamus is responsible for circadian rhythms, endocrine secretion, heart rate (HR), breath rate, thirst, hunger, thermoregulation, and maintaining homeostasis. It also controls aspects of growth hormone production, dopamine, vasopressin in men and
  5. 5. Neurobiology of Touch and Trauma… oxitocyn in women (Blumenfeld, 2002). Early experiences including maternal touch sculpt HPA-axis reactivity and the rate of stress hormone secretion over a lifetime. Therapeutic touch has been noted to reduce cortisol reaction, increase oxytocin production and personal satisfaction with relationships between parents as well as with children. Increased levels of oxytocin have been associated with social engagement and maternal behaviors. Therapeutic touch has been shown to increase sleep, reduce over- activation in cortisol, increase dopamine levels, and lead to a reduction of aggression. Thalamus. The thalamus is a relay station for the brain (Blumenfeld, 2002). It receives information and sends information to the entire brain. This is the first center of the brain where information about touch is processed. It plays a large role in level of arousal. A damaged thalamus can result in a coma. Recent theorists have postulated that the thalamus may be the seat of human consciousness (Zillmer, Spiers & Culbertson, 2008). The thalamus in monkeys goes through a heightened maturation process between birth and 30 weeks after gestation. The thalamus plays a role in brain activation and could play a role in organizing the interaction between structures that are not physically contiguous (Zillmer, Spiers & Culbertson, 2008). Sensory information from touch reaches the cortex through connections in the thalamus. Hippocampus. The hippocampus is found in the medial temporal lobe (Zillmer, Spiers & Culbertson, 2008). There have been three major theories used to conceptualize hippocampus functioning. These three theories are that the hippocampus is involved in: behavioral inhibition, declarative memory consolidation, and sense of place. In individuals diagnosed with PTSD, hippocampus declines have been noted to be more significant in the posterior hippocampus region and bilaterally (Bremner, et al., 1995).
  6. 6. Neurobiology of Touch and Trauma… Significant Hippocampal decline was noted for those with Dissociative Identity Disorder (DID), one study found a 26% decline compared with controls (Vermetten, Schmahl, Lindner, Loewenstein, Bremner, 2006). No studies were found linking hippocampal growth with touch therapies. However, touch reduces cortisol production and high levels of cortisol production leads to loss of hippocampal volume that can be reversed in Cushing’s syndrome with the re-regulation of cortisol (Starkmana, Giordanib, Gebarskic, Berentb, Schorke, & Schteingartd, 1999). Increased levels of apoptosis (program cell death) down regulators (protection) have been associated with levels of maternal touch in certain mammals (Weaver, Grant, & Meaney, 2002). Amygdala. Amygdala is often known as the fear center of the brain. Although it could be better conceptualized as a smoke detector. It notices changes, but not specifically danger. The amygdala becomes nearly fully developed by the age of one year. Early in life it plays a role in the infant’s indiscriminant impulsive drive to social interaction (Joseph, 1999). Touch has been shown to have strong links to the amygdala, the insula, and other limbic structures (Friedman, Murray, O'Neill, & Mishkin, 2004). The amygdala is involved in classical conditioning and emotional memory (Blumenfeld, 2002). Heightened arousal triggers stable memory formation. An fMRI study found no volumetric differences between those who meet the criteria for PTSD and those who did not (Bremner et al., 1995). An fMRI study found function changes (e.g., more activation) in individuals who met the criteria for PTSD in the amygdala and the insular cortex compared to controls. Individuals with a diagnosis of DID were found to have a 19.2% reduction in AMY volume compared to controls (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006).
  7. 7. Neurobiology of Touch and Trauma… Insula. The insula is a part of the limbic cortex (Zillmer, Spiers & Culbertson, 2008). The limbic cortex is the higher cortical functioning area of the limbic circuitry. The insula has been postulated to be involved in the felt-experience of introceptive cues from the body, viscera, appetite, and addiction (Schore, 2002 ). The insula has been found to play a role in the integration of body sensation of the primary emotions such as anger, sadness, happiness, and disgust (Lamm, 2010; Schore, 2002). It also plays a role in hunger. It has connections with the amygdala and the orbital frontal cortex through connections with the thalamus (Blumenfeld, 2002). FMRI studies have found a strong relationship between activation of the neurons in the insula and craving. Touch in combination with the individual’s attention has been shown to activate the insula in fMRI studies (Friedman, Murray, O'Neill, & Mishkin, 2004). The insula registers both painful touch and pleasant touch (Francis, et al., 1999). In a study of individuals who survived a fire, a reduction of gray matter was found in both the right and the left insula, the left hippocampus, and left anterior cingulate gyrus. Cingulate gyrus. The cingulate gyrus is often referred to as the limbic cortex (Zillmer, Spiers & Culbertson, 2008). It is the area directly above the corpus coliseum. It develops between three to nine months (Joseph, 1999). At three to nine months of development, the infant grows the ability to modulate social engagement through immobility and withdrawing (noradrenalin) and active protection through fight/flight (dopamine-excitatory system) (Schore, 2002). It is organized in to three main areas: the anterior, medial, and the posterior region. The anterior is discussed here and is related to autonomic homeostasis, reward anticipation; heart rate, decision-making, emotions, and modeling the emotions of others (Blumenfeld, 2002). It plays a central role in integration
  8. 8. Neurobiology of Touch and Trauma… of bottom up and top down neural processes. The cingulate gyrus is involved in the limbic touch circuit (Friedman, Murray, O'Neill, & Mishkin, 2004). It mediates both pleasant and unpleasant (painful) touch (Rolls, O’Doherty, Kringelbach, Francis, Bowtell, & McGlone, 2003). These areas are separate and can act independently. Current theory of the ACC postulates that it monitors internal and external behavior, attends to mistakes, and seeks to make the behavioral outcome more successful. Damage to the ACC results in inability to self-monitor, behavioral impulsivity, and inattention. In some, stimulation of the ACC relieved depression. Orbital frontal cortex. The orbital frontal cortex (OFC) is the “emotion and reward” area of the prefrontal cortex. This is likely the most abstract area of emotional processing (Zillmer, Spiers & Culbertson, 2008). It is also the last to mature. It reaches full maturity in the early twenties. It is involved in decision making and expectation. Posterior OFC regulates sensory experiences such as touch (Blumenfeld, 2002). Anterior regions monitor abstract categories such as status or money. The medial portions were found to monitor and regulate positive experiences. The lateral portions regulate and attend to noxious stimulus or punishment (Zillmer, Spiers & Culbertson, 2008). Some studies have found the OFC plays a role in intuition or holistic processing (Schore, 2002). The medial portion also plays a large role in self-monitoring. Damage to the OFC can lead to hypersexuality, increased addictive behaviors, poor social skills, disinhibition, and lack of empathy (Zillmer, Spiers & Culbertson, 2008). The OFC is one of the areas of the brain that changes most over a lifetime. Long time mediators have more cells in the OFC than controls. Pleasant touch increases activation in the OFC and thus likely increases the regulation of more uncomfortable interceptive events (Friedman, Murray, O'Neill, &
  9. 9. Neurobiology of Touch and Trauma… Mishkin, 2004; Rolls, O’Doherty, Kringelbach, Francis, Bowtell, & McGlone, 2003). Basal Ganglia (BG). The basal ganglia plays several key roles in the brain and behavior. These are modulation of movement, emotional set, anticipation of movement, eye movement, motivation, and reward (Zillmer, Spiers & Culbertson, 2008). Largely the basal ganglion exerts an inhibitory control on other systems (Blumenfeld, 2002). If it releases that inhibition, then the body moves. The BG contains a topographic map of the entire brain. The organization of this map is still unclear because the basal ganglia is likely organized in three-dimensional space, while the brain is organized in layers. The main neurotransmitters in the basal ganglia are GABA, dopamine, and acetylcholine. GABA is the main inhibitory transmitter in the brain. Dopamine modulates salience, reward, motivation, and movement. Acetylcholine is a central modulator of neuroplasticity and attention. The ventral tegmental area plays a role in the reward system of the brain mediating motivation or the appetitive aspects of behavior. If this system is damaged in a mouse’s brain, it will not eat food if it is beside it, but will eat it if placed in its mouth. Overactive appetitive functions have been implicated in multiple addictions, ranging from gambling to cocaine addition (Zillmer, Spiers & Culbertson, 2008). The BG is also involved in force selection, planning of motor movements, initiation of motor plans, and the extrapyramidal (modulating fine motor control) motor system (Blumenfeld, 2002; Vaillancourta, Yua, Maykab, & Corcosa, 2007). Physical touch increases neurotransmitter production key for basal ganglia functioning. Septal Nucleus. Plays a role in pleasure, relaxation and rest. It has an inhibitory effect of cortisol. It has been shown to have a role in the antidepressant effects of progesterone through the inhibitory neurotransmitter GABA. The septal nucleus is
  10. 10. Neurobiology of Touch and Trauma… involved in sexuality (direct stimulation creates penile or clitoral erection). The septal nucleus develops later than the amygdala and the cingulate gyrus at about three years of age (Joseph, 1999). In early development, the amygdala pushes the infant toward indiscriminant social contact. As the child develops, the septal nucleus provides regulation for amygdalar impulses. Stressful touch to rats increased the septal nucleus secretion of dopamine and activation of the hypothalamic circuits (Albert, & Chew, 2004). This regulatory function is lost if the septal nucleus is damaged. In rat pups, a damaged septal nucleus leads to increased aggression and loss of maternal behaviors. Neurobiology of Touch There are four major classes of touch pathways to the brain (Blumenfeld, 2002). Two of these pathways are wide and myelinated, which makes them able to deliver their signals to the brain quickly. These pathways deliver sensations of deep pressure, light touch, joint position, muscle tension, vibration, hair movement, and proprioception. Two of these pathways are unmyelinated, have a narrow diameter of the axon, and deliver their messages slowly, conveying information about pain and temperature. The pain pathways can be overridden by the wider myelinated pathways of deep touch, vibration, proprioception, and so on (Blumenfeld, 2002). There are three major sensory motor tracts going from the periphery to the brain (Blumenfeld, 2002). These are the lateral cortical spinal tract, which is primarily a motor pathway from the brain to the body; the posterior columns, which are a sensory pathway conveying joint position, vibration, and fine
  11. 11. Neurobiology of Touch and Trauma… discriminatory touch; and the anterior columns, which are also primarily a sensory pathway conveying pain temperature and crude touch. These nerve pathways all have a rough somatotropic organization (e.g., certain areas relate to certain body parts). The anterior columns also break into three major sensory tracts that each play a critical role in pain and sense of self (Blumenfeld, 2002). The spinoreticular track is the philogentically oldest of these pathways. It goes from the spine to the reticular activating system. This system is a major body regulator of level of conscious arousal. This pathway mediates the emotional arousal aspects of pain and the motivation to stop the pain. When a person stubs her toe, this information is read by the brain as, “ouch.” The spinothalamic tract goes from the spine and to the thalamus. It conveys information to the brain about specific areas of pain, sensation, and temperature. This area can localize the pain to a given region. This area is the one that makes a person say, “I stubbed my toe!” The third area is the spinomesencephalic tract. This tract, through communication, is responsible for modulating and reducing the pain response mediated by serotonin and opiates produced endogenously. When this area comes on line, one might state, “My toe feels better.” Once the information gets into the cortex, it moves to the primary sensory motor strip. This area is organized somatotropically (e.g., one brain area is related to one part of the body) (Blumenfeld, 2002). The brain typically has three areas of sensory processing. The first receives raw sensation, the second integrates sensation with previous experience, and the third forms higher abstract concepts related to the sensory input
  12. 12. Neurobiology of Touch and Trauma… (Zillmer, Spiers & Culbertson, 2008). Stimulating the primary sensory-motor strip causes sensation or movement of a particular area. If the primary sensory motor strip is damaged, muscles contract in a spasm. Damage to the secondary motor area leads to loss of: a. the urge to move (basal ganglia), b. organized patterns of movement, and c. emotional drives for movement. Damage to the secondary sensory area can lead to a. difficulty localizing and integrating sensory input and b. losing propreaceptive input, such that the person feels lost in space. If the tertiary area is damaged, higher order sensory integration is lost (Zillmer, Spiers & Culbertson, 2008). It is important to note that the human experience of sensation is an integrated one. The sensation of touch does not happen in a vacuum. The felt experience of touch includes vision of the touch, sound, smells and temperature. If the touch is traumatic it can include activation of the figh, flight or freeze system. According to Somatic Experiencing theory disruptions in the integration of sensory modalities occurs in trauma. A key region for this integration for touch with other senses is in the superior temporal sulcus (Beauchampa, Yasara, Fryec, & Rod, 2008). Touch and Emotions Touch is one of the most understudied senses, yet it can be a profound communicator of emotion. In human relationship there is a dance of meaning driven by the synchrony of non-verbal emotional communication. Paul Eckman, the pioneer in the study of emotions, discovered that facial expressions of emotion were universal across cultures, wired into the emotional systems and follow regular patterns. Recent studies have found the same is true with touch (Hertenstein, Holmes, McCullough, & Keltner,
  13. 13. Neurobiology of Touch and Trauma… 2009). Several studies have shown that people can identify multiple emotions through physical touch such as anger, fear, disgust, love, gratitude, and sympathy via touch with a high degree of accuracy. Other studies have shown that people can decode emotional information communicated by touch by simply watching touch on a film (Hertenstein, Holmes, McCullough, & Keltner, 2009; Keysers, Wicker, Gazzola, Anton, Fogassi & Gallese, 2004). Neurobiology of Dysregulation The body and mind are full of rhythms, from the daily rhythm of sleep to waking, to the diurnal pattern of cortisol secretion. Dysregulation occurs when the normal coherent relationship between these patterns is disrupted in such a way that the brain or mind has difficulty returning to its normal homeostatic range (Liberzon, Taylor, Fig, & Koeppe, 1998). In Post-traumatic stress disorder (PTSD), there is an upregulation of the threat system such that it triggers a dissociative shutdown, it over-produces stress hormones, reacts too intensely to triggers, or it is triggered too easily to produce stress hormones (Levine & Fredrick, 1998). There are two major forms of psychological dysregulation. These are developmental dysregulation and event-based dysregulation. Developmental dysregulation occurs when there are either disruptions in the developmental environment or physical systems of the brain leading to altered growth in the cortical structures, hormones, neurotransmitters, or the relationship between structures (De Bellis et al., 2002; Penza, Heim, & Nemeroff, 2003; Schore, 2002). If a child misses the processes that lead to the maturation of the septal nucleus, that child could display impulsivity and
  14. 14. Neurobiology of Touch and Trauma… tendency to socialize indiscriminately, and the cortical structures that myelinated after the development of the septal nucleus could display disruptions functioning as well. Although, there has been a call for the diagnosis of developmental trauma by Bessel Van Der Kolk and others, it is yet to be included in the DSM-V. The second main form of dysregulation happens in a catalyzing event, through which the brain and self undergo fundamental functional alterations. There are two major types of dysregulation in the event based PTSD literature; over-activation and under- activation. Over-activation reflects an upregulation of stress hormone production and an under-activation of cortical structures, which regulate stress. In the hyperarousal/re- experiencing type of dysregulation in an fMRI study Lanius (2008) found over activation in the insula (bringing extreme amounts of information from the body’s interceptive cues), an under-activation of the anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) (areas needed to regulate the body sensations brought up from the insula). In essence, the hyperaroused individual floods with information from the body and has less capacity to regulate the intense sensation. The hypoarousal/ avoidant type on the other hand, displays flattening of physical sensations from the insula and increased activation in the ACC and mPFC. In the hypoarousal type, only a small amount of interceptive cues get into the limbic cortex and are quickly squelched by cortical structures, leaving the individual feeling disconnected, emotionally flat, and dissociated. A study assessing two tendencies found that 70% of individuals with PTSD displayed heightened stress hormone secretion to a trauma script. This same study found that 30% of individuals sampled had a reduction in their stress hormone secretion. The hyperarousal reaction to trauma is related to the re-experiencing symptom cluster, while
  15. 15. Neurobiology of Touch and Trauma… the hypoarousal reaction is related to the numbing and avoidance cluster. Another model of dysregulation was proposed by Dr. Porges, and called the polyvagal theory (Porges, Doussard-Roosevelt, & Maiti, 1994; Porges, 1995). In the traditional model of the autonomic nervous system there are two branches, sympathetic (fight/flight reactivity) and parasympathetic (resting state). When looking at the autonomic nervous system, Porges noted that there were two types of neurons in the parasympathetic branch, one that is myelinated, fast-acting and evolutionarily newer (Ventral Vagal, VVC), the other unmyeolinated, slow-acting and evolutionarily older (dorsal motor nucleus or DMNX). He proposed that the older system, present in lizards, leads to a defensive response called freezing. According to his theory, mammals are dependant on their parents during childhood and need to remain at rest when safe. According to polyvagal theory, the newer myelinated branch (VVC) of the parasympathetic branch mediates the sense of safety in social engagement. In a stressful event, the normal social engagement system disengages and the sympathetic system leads to fight/flight activation, but over time the system returns to rest. In a traumatic event, according to Porges, the social engagement system disengages, fight/flight activation occurs, and the older parasympathetic system (DMNX) shuts down the system, inducing tonic immobility (freeze response). According to somatic experiencing theory, if the nervous system is given time to complete the freeze response and the mobilized defensive response (fight/flight) the individual will not develop symptoms of PTSD (Levine, & Frederick, 1997). If however, these factors do not complete, the high arousal continues and the individual begins to adapt to the dysregulation by displaying symptoms of PTSD. In SE theory, the return of social engagement behavior can indicate a re-regulation of the
  16. 16. Neurobiology of Touch and Trauma… nervous system. Some indications of social engagement are the inner ear tuning to the range of the human voice, breathing becoming slow and smooth, orienting towards the therapist, and the individual growing curious about his or her environment (Foundation for Human Enrichment, 2007). Touch in Therapy Just as touch plays a profound role in the development of the child, it can play a profound role in the regulation of the nervous system. Therapeutic touch has been shown to decrease cortisol production, substance P (mediating pain responses), increase dopamine, serotonin, and oxytocin production (known to mediate maternal behaviors, attachment and partner boding) (Field, et al., 1997; Field, et. al., 2008; Field, Seligman, Scafidi, & Schanberg, 1996; Kurosawa, Lundeberg, Agren, Lund, & Uvnas-Moberg, 1995; Walach, Guthlin, & Konig, 2003). In infants it has been shown to increase birth weight, cortical development, length of the infant, reduce asymmetry between frontal lobes (associated with depression), increase the ability to self-soothe, and re-regulate cardiac vagal tone (an indication or autonomic regulation) (Ferber, Laudon, Kuint, Weller, & Zisapel, 2002; Field, et al., 1997; Field et. al., 1998; Matthiesen, Ransjo- Arvidson, Nissen, & Uvnas-Moberg, 2001). In parents, it has been shown to increase the quality of their relationship, infant-parent synchrony, perception of partner support, reduce frontal lobe asymmetry, and reduce the effects of post-partum depression (Cullen, Field, Escalona, & Hartshorn, 2000; Field, et. al., 1996; Latifses, Estroff, Field, & Bush, 2005). Massage has been shown to reduce symptoms of depression, state anxiety, and PTSD (Field, Seligman, Scafidi, & Schanberg, 1996; Field, et al., 1997).
  17. 17. Neurobiology of Touch and Trauma… Touch is as vital as food and can affect multiple neurobiological systems that are targets of anti-depressants, anxiolytic medications. Having one positive emotion after a stressful event or the experience of a triggering event can speed the reduction of cortisol levels, and reduce physiological indicators of stress. Soothing, safe touch can be an effective means to provide an experience of safety, evoke the relaxation response and for some positive emotions (Fredrickson, Mancuso, Branigan, & Tugade, 2000). Through the visuotactile mirroring mechanism, people model each other’s emotions and experiences by integrating touch and vision (Ebisch, Perrucci, Ferretti, Del Gratta, Romani, & Gallese, 2008). The touch-vision integration system includes, the secondary somatosensory cortex bilaterally, “left inferior parietal lobule , supramarginal gyrus, bilateral temporal-occipital junction, and left precentral gyrus. Interestingly the sight of intentional touch correlated directly with the… left primary somatosensory cortex (Ebisch, Perrucci, Ferretti, Del Gratta, Romani, & Gallese, 2008).” Researchers hypothesized that the intentional touch system mediates the experience of resonating with another and the non-intentional mediates contact with objects. Neurobiological Model of a Touch Intervention for Trauma Touch can be used in several ways to reduce the symptoms of trauma (Francis, et al., 1999; Friedman, Murray, O'Neill, & Mishkin, 2004; Rolls, Bilderbeck, & McGlone, 2008; Rolls, O’Doherty, Kringelbach, Francis, Bowtell, & McGlone, 2003). These are: a. to re-establish the regulation of the autonomic nervous system, b. to desensitize individuals to trauma triggers, c. to increase the ability to attend to interceptive cues from the body, d. to reduce fight/flight activation, and d. support the growth of emotion
  18. 18. Neurobiology of Touch and Trauma… regulation centers in the brain. There are three main types of affect regulation. These are: a. cognitive regulation (deciding to use an affect regulation skill), b. co-regulation (regulation through the interaction with another person or animal), and c. auto-regulation (internalized regulation or automatic regulation processes). When the cortical structures used in affect regulation are stable enough to manage current levels of activation of the limbic structures there is a natural smooth transition from arousal to rest. It is this last that is the focus of clinical treatment. Touch can play a large role in each of these types of regulation. Touch can be used in cognitive regulation by the clinician teaching a skill and the client practicing the skill. A skill might be to use self-touch to reduce activation. The client might evoke the orienting response and parasympathetic rest through placing his hand on his heart and noticing the sensations. Other tools could be to stand in a warm shower and notice the comfort, massaging one’s feet, pressing feet into the ground, or placing the hands over the eyes. In this type of regulation individuals choose to use a conscious skill to move their sub-cortical systems. Co-regulation falls into two categories. The first is regulation through indirect mirroring, such as from mirror neuron system or the ACC’s modeling of the emotions of others and second is the regulation provided through direct therapeutic intervention. Touch can play a role in both. When the clinician’s ability to read emotions through touch is good and her body can respond supplely to her client’s emotions, physical contact can be an excellent way of mirroring or providing attunement. When the client’s activation goes up, the contact with the therapist can provide a regulatory boundary helping the stress levels to reduce to within the client’s ability to tolerate the activation.
  19. 19. Neurobiology of Touch and Trauma… Through the process of contained activation, the cortical structures responsible for emotion regulation grow (Schore, 2008). As the client’s mind replays emotional ruptures from the past, touch can provide an experiential repair and a restructuring of the event. Touch has been shown to reduce cortisol levels, increase activation in pleasure centers of the insula, and increase activation in the orbital medial prefrontal cortex (Friedman, Murray, O'Neill, & Mishkin, 2004; Rolls, O’Doherty, Kringelbach, Francis, Bowtell, & McGlone, 2003). Auto-regulation is the current innate capacity of an individual to regulate his levels of limbic and autonomic activation (Schore, 2002). Through the internalization of the therapist as a safe mentalized regulator of affect by changing the ACC and its ability to model and play back emotional events, the client builds new regulatory possibilities. The interaction patterns between a therapist providing safe, contained model of self- regulation and the client reduces for the client the number of conflicts their ACC needs to monitors through its conflict monitoring function and the number of number of emotional exchanges with a successful outcomes. Neurons that fire together wire together. As the therapist coaxes the client’s orbital frontal cortex online through safe touch and emotional mirroring through touch, these areas likely are strengthened. The safe contact with the therapist could allow for increased ability of the client to tolerate his interceptive responses to events and thus allows him to be available to a wider range affect with out dysregulating and be an active participant in a wider range of life experiences. As a new- felt experience of contact with one’s physical form and physical contact with a self– regulating other is internalized, the individual has the ability to auto-regulate through touch.
  20. 20. Neurobiology of Touch and Trauma… Conclusion Touch is as vital as food, not simply to children but also adults (Juhan, 1998). Touch has been shown to be an excellent communicator of emotions, lead to improved parenting relationships, reduce cortisol production, physical pain, symptoms of depression, PTSD and anxiety (Field, et al., 1997; Francis, et al., 1999; Friedman, Murray, O'Neill, & Mishkin, 2004; Rolls, Bilderbeck, & McGlone, 2008; Rolls, O’Doherty, Kringelbach, Francis, Bowtell, & McGlone, 2003). Touch can be an effective intervention in clinical practice that leads to profound changes not simply in psychological processing, but the physical structures of the brain. The field of psychology would benefit from providing guidelines on the use of ethical touch so that clinicians can develop treatment modalities and receive the necessary supervision to provide safe effective touch interventions. References Albert, D. J., & Chew, G. L. (2004). The septal forebrain and the inhibitory modulation
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