Coming into connection; the neurobiology of trauma repair. Silvana Izzo Somatic Experiencing Practitioner Occupational Therapist and Educator

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1 Coming into connection; the neurobiology of trauma repair Silvana Izzo Somatic Experiencing Practitioner Occupational Therapist and Educator

2 We are wired for connection

3 Between the stimulus and the response exists potential..

4 How do we know what we know about ourselves?

7 We use our minds not to discover facts but to hide them. One of the things the screen hides most effectively is the body, our own body, by which I mean, the ins and outs of it, its interiors. Like a veil thrown over the skin to secure its modesty, the screen partially removes from the mind the inner states of the body (p.28) Antonio R. Damasio, The Feeling of What Happens: Body and Emotion in the Making of Consciousness

8 Body - Mind Central NS Peripheral NS Sensory Motor NS Autonomic NS Sympathetic Parasympathetic

9 The triune brain Paul D. MacLean Three distinct Languages Neocortex Thinking Brain - Words I make meaning here Limbic System - Social Brain - Feelings I feel emotions here Sensations - Instinctual Survival brain - Sensations My experience enters here

10 The Amygdala the smoke detector on guard"

11 The Autonomic Nervous System

A resilient nervous system Waves https://www.youtube.com/watch?

13 A resilient nervous system Waves Pendulum Rhythm

14 Below conscious awareness Below conscious awareness Reach - Fight Flight - Freeze Collapse Response to manage the threat Sensing danger in the nervous system (Entroception) Sensory Information Automatic Amygdala & ANS Self protective Survival focus Lower (sensation) brain circuits Sensory Information

15 What then is trauma

16 Stress Response Thinking Danger Feeling Danger Sensing danger Internal or External Trigger

17 Prolonged stress response

22 Primed to sense for danger..

24 What is trauma A disruption in the nervous system creating many other symptoms Being stuck in past survival modes after the danger is over, making it difficult to feel safe and focus in present time Incomplete self protective and defensive responses Sensations of constriction, hyper-arousal, overwhelm and disconnection/dissociation Feelings of hopelessness, helplessness, rage,shame

25 Trauma is encoded in the brain stem, the thalamus, the limbic system and the hypothalamus and the language of that part of the brain is bodily sensation Peter Levine Founder Somatic Experiencing

Trauma Physiology is meant to be heard is an alarm system still identifying danger has hijacked ones ability to be in the here and now and identify signals of safety (and actual threat) reinforces

26 Trauma Physiology is meant to be heard is an alarm system still identifying danger has hijacked ones ability to be in the here and now and identify signals of safety (and actual threat) reinforces trauma patterns impacts on awareness/witness primed - stimulus response - compresses time and choice Neuroception (Porges) a subconscious system for detecting threats and safety - a feeling of what is (and is not) AM I NOT SAFE -THERE IS A THREAT

27 Top Down Sensing Embodiment 80% Afferent Thinking Talking Bottom Up

28 Expectation Sensory Input from Environment Previous Experience How dangerous is this really? Meaning Making Cultural Factors Social Environment Expectations about consequences Beliefs, Knowledge, Logic Outputs to Protect ANS Motor Endocrine Immune Pain

29 (Reach)*- Fight - Flight - Freeze - Collapse Some traits may only be evident in some states - state dependent traits e.g. in fight state have traits of aggression, rigidity, decrease - flexibility, playfulness, curiosity and social engagement Trauma when beyond window of tolerance - constant stress and/or threat beyond perception of what system can cope with - move towards trauma Trauma becomes locked in this threat-survival response pattern of our nervous systems - stored in our bodies and influences our experience of ourselves the sense of us in the here and now Can trigger confusion, shame, frustration, sense of hopelessness and helplessness (to responses) Moving towards greater ease and sense of safety is achieved not via words but rather via sensations noticing, mindfulness, sensing, embodiment, grounding, rhythm, connection

32 (Reach)*- Fight - Flight Response Person is sensing a threat in nervous system (lower brain structures) Wired for survival functional (self) protective response to threat Below conscious (thinking) level of awareness it is a biological response with a survival focus Interpretation of sensory information both internal and external (via amygdala) am I safe or is there a threat Neuroception (Porges) Individual s response is influenced by life experience (biology and biography) use dependent patterns & state dependent traits Can become stuck in a response pattern to sensing threat/danger that is no longer helpful; ongoing after threat has gone or not adaptive to the current situation i.e. sensing danger terrified activation fight mode

37 Freeze - Collapse Response Unable to fight or flee person freezes into shutdown Not a conscious choice but a nervous system (automatic and below consciousness) level response to perception that situation is inescapable System is overwhelmed; physiological state stores great bound energy May increase or decrease chance of survival Can move from here to collapse (tonic immobility) vaso vagal Linked to shame response

Impacts of trauma Takes you out of your senses Takes you out of your body Takes you out of engagement Takes you out of connection Ruptures relationships Shatters safety and

42 Impacts of trauma Takes you out of your senses Takes you out of your body Takes you out of engagement Takes you out of connection Ruptures relationships Shatters safety and trust Creates incoherence affects concepts of time and space Affects memory and perception Stored at implicit levels Provides opportunities for resilience and post traumatic growth

44 Identity Individual and collective

45 Trauma Developmental Trauma Situational - Episode Trauma Medical Trauma Complex Trauma Intergenerational Trauma Ancestral Trauma Collective Trauma Cultural Trauma

46 How can we restore* a sense of safety?

48 Heart Brain Connection Creating Safety

49 The Poly Vagal Theory Dorsal Safety and Ventral Ventral Social Engagement Safety, empathy, attachment and attunement Neuroception and the Social Engagement System Soothing the alarm state threat response

50 Porges Polyvagal theory The Ventral Vagal the smart vagus (part of the parasympathetic nervous system) An invitation to: social engagement attunement attachment co regulation The vagus is functionally an inhibitory nerve that slows our heart up and enables us to calm down. BUT...there is a very primitive defensive system still embedded within our mammalian nervous system... The Dorsal Vagal System

52 Mammals have two vagal circuits, an unmyelinated...and a uniquely Mammalian circuit that is myelinated.

54 "Trauma is much more than a story about the past that explains why people are frightened, angry or out of control. Trauma is re-experienced in the present, not as a story, but as profoundly disturbing physical sensations and emotions that may not be consciously associated with memories of past trauma. Terror, rage and helplessness are manifested as bodily reactions, like a pounding heart, nausea, gutwrenching sensations and characteristic body movements that signify collapse, rigidity or rage. The challenge in recovering from trauma is to learn to tolerate feeling what you feel and knowing what you know without becoming overwhelmed. There are many ways to achieve this, but all involve establishing a sense of safety and the regulation of physiological arousal. Bessel van der Kolk

55 Trauma and Memory: One of the key functions of nervous tissue is to store information Body memory implicit procedural memory of trauma trauma locked in the body There is a mistaken notion that trauma is primarily about memory the story of what has happened. Bessel van der Kolk

56 We are not meant to go it alone where does attachment fit?

58 The roots of resilience are to be found in the sense of being understood by and existing in the mind and heart of a loving, attuned and self possessed other Bowlby

59 We learn to self regulate by co regulation

60 Creating Connected Safety Social engagement prosody of voice, posture, (soft) eye contact, contained touch* Relationship within window of tolerance Creating time and choice Creating (connected) space Rhythm and movement Voice, humming, chanting Breath and embodiment

63 Co regulation - a shared process Safety, protection, containment and escape paths Noticing internal and external environment - sensory goggles on Slowing it down - stretching time - taking a pause Attunement and attachment within window of tolerance Building in choice Scaffolding for success Vertical integration soothing the amygdala

67 What else helps from the frontiers of neuroscience

68 Melodic Voice Prosody Singing

69 Dance and Movement

70 Music Rhythm

71 Connection Contact

72 (safe)touch*

73 Play (sensory motor)

74 Mindfulness

75 Yoga

76 Embodying Nature

78 Self and collective care for trauma informed practice

80 Rituals and belonging

81 River of life

82 A sense of coherence

83 Connectedness

84 Reflection Being

86 .to make our heartbeat match the beat of the universe Joseph Campbell

This is Your Brain on Trauma: Bessel Van Der Kolk s Version

This is Your Brain on Trauma: Bessel Van Der Kolk s Version Lois A. Ehrmann PhD, LPC, NCC Certified EMDR Consultant; Certified IFS Clinician Certified Attachment Focused Family Therapist Certified in Clinical