Today we will go a little deeper in trauma. Dr. Stephen Porges developed Polyvagal theory to expand our understanding of how the nervous system responds to threat and trauma.
In our last post we briefly talked about the nervous system and it's role in trauma. Dr. Porges added a third factor: the vagus nerve. The vagal nerve plays a role in regulating the heart, face, stomach, and breath. The nerve also communicates with the brain. When talking about the nervous system, we will need to use some anatomical terms to orient ourselves:
Ventral: towards the front of the torso. The navel (belly button) is on the ventral or anterior part of the body.
Dorsal: towards the back of the torso. For example, the shoulder blades are dorsal or posterior to the ribs.
The vagus nerve, or more specifically the ventral branch of the vagus nerve, controls the muscles of the face. The face, heart, and lungs are all used when we interact with others (e.g. smiling or making eye contact, feeling our heart beating faster, using our lungs to speak and breathe). This is what Dr. Porges calls "social engagement". In other words, it is through our face, heart, and brain connection that we learn to respond to interpersonal threats and challenges. Let's use a worst-case scenario as an example of how this works. Imagine this: you are walking down a dark alley alone and you see a dark shadow in the distance approaching you. Your face (eyes, nose, and ears) capture the image, hear the footsteps, and smell any scents or aromas in the air. Your brain takes in all the information your sensory organs are sending and tries to make sense of the shadowy figure. As this takes place, your heart begins pumping a lot harder to disperse blood flow to your muscles just in case you need to fight or make a run for it (flee/flight) from this unfamiliar and potentially dangerous shadowy figure. So what just happened? Your vagal nerve was working in overdrive, working hard as gatekeeper of your body's responses to the environment, moderating a conversation between your brain and body during a moment of possible danger. Another branch of the vagus, the dorsal vagus, regulates organs below the diaphragm (e.g. stomach, intestines). The dorsal vagus activates what we call "shutting down" during overwhelming trauma.
Polyvagal theory emphasizes that our nervous system has more than one defense strategy and whether we use fight-or-fight or shut down, is not a decision we actively decide to use. But if we are trapped, or feel unsafe, our nervous system reads those cues and makes a decision from there. I should note these responses were adaptive to the environment or situation that an event or trauma occurred at a moment in time. This is where Somatic and Attachment-focused EMDR (Eye Movement Desensitization Reprocessing) can really help clients identify these patterns and work WITH the vagal responses to process painful memories and heal. Somatic and Attachment-Focused EMDR or SAFE EMDR model is compatible in treating most psychiatric diagnoses including but not limited to PTSD, trauma, anxiety, and depression.
This concludes our discussion about the neurobiology of trauma. If you or a loved one have any questions, would like further information on EMDR, or would like to set up an appointment. Please feel free to give me a call at 904.404.1763.
Trauma can leave you feeling overwhelmed, anxious, or possibly shut down and it is incredibly beneficial to develop an understanding of where these feelings and responses are coming from inside the body.
You may be familiar with the body's acute stress response: fight-or-flight.. If you are not familiar with the terms, fight-or-flight are features of the body's built in protection mechanism that surface in the presence of something that is terrifying, either mentally or physically. There is an additional response to perceived threat to safety: Immobilization/Freeze/Submit. This occurs when fight-or-flight do not restore safety and can appear in various forms such as a high alert stillness, freezing, or dissociation.
You can probably think of a time when you experienced the fight-or-flight response. In the face of something that may have been frightening; perhaps encountering a growling dog during a walk or preparing to give a big presentation at school or work, your heartbeat began beating much faster, you could feel yourself breathing faster, and your entire body became tense. Maybe you felt a lump in your throat, felt dizzy, tired, you could feel your hands trembling, or felt serious urgency to use the restroom. Essentially, the physical symptoms you experienced were indicating that your body was gearing up to either fight or flee the threat (real or perceived). Your brain, and more specifically your nervous system, sent the signals to your body, preparing you to fight or flee, making it more likely that you would survive the danger. Cool, huh? Let's take a minute to discuss where and what this whole nervous system thing is about before going deeper into trauma.
Your Nervous System 101
A basic way to describe the very intricate and delicate nervous system is to point out the two components of the nervous system. One that is conscious (e.g. actively thinking to move your fingers) and another that functions without awareness (e.g. regulating body temperature). The main actor in the human nervous system that functions without conscious awareness is the autonomic nervous system (ANS). The ANS regulates organ functions such as heart rate, digestion and also responds to trauma or threat.
Also, the ANS either deploys energy (e.g. cortisol) or conserves energy through two primary systems: the sympathetic nervous system and parasympathetic nervous system. Why is this important? Our autonomic nervous system plays a significant role in our emotional and physiological responses to stress (trauma included!). The sympathetic nervous system releases a stress chemical (cortisol) in the body (fight-or-flight). The parasympathetic nervous system pumps the breaks on the sympathetic nervous system and instead allows the body to shift towards relaxation, digestion, and recovery. When things are going well and you are feeling great, chances are your sympathetic and parasympathetic nervous systems are working in harmony and you would be less likely to have issues with digestion, sleep, and feeling "run down". This is where trauma comes back into the story...
Trauma interferes with the harmonious dance between the sympathetic and parasympathetic nervous systems. I should also point out that the parasympathetic nervous system is not only associated with recovery functions but is involved with dissociation and immobilization (freeze).
Dissociation is a biological protective mechanism deployed by the body when there is a perceived threat or danger. Dissociation separates you from conscious awareness particularly when frightening feelings or memories surface. I'm going to normalize dissociation here by saying we all do it or have done it at some point in our own lives. What does dissociation look like? Dissociation can appear in a variety of symptoms however, most frequently they may manifest as relatively mild sensations of fogginess, sleepiness, nauseous, or difficulty concentrating to feeling numb or cut off. In some of my more complex trauma cases, I have worked with clients who have reported experiences lapses of memory or feeling "lost in time".
When a trauma occurs and goes unanswered, a survival mechanism, either fight-or-flight will become conditioned into the nervous system. So if a traumatic event, death, abuse, accident, rejection, abandonment, chronic illness, sports injury, and so forth occurred in childhood, chances are a triggering event may produce anxiety and high arousal if there was a missing experience during and after the event. This I feel to be especially true if that person experienced a pain that was unanswered with love, connection, or attachment, particularly when he or she needed it most.
With just a slight shift in the lens of therapy, it's become apparent that a lot of the psychopathologies I treat as a therapist have at some point or another functioned as adaptive coping mechanisms for my clients, and that they were most likely developed as a response to a significant change (e.g. threat, loss, trauma, etc.). Whatever it is that they needed to do to allow him or her to thrive also became a symptom and limitation keeping him or her stuck. But you don't have to stay stuck if you don't want to! We will get to more on that in a future post ;) Stay tuned.
When telling people about the counseling services I offer I am often asked if I accept health insurance as a means of payment for my services. The response I tend to get when I say "No" is the question, "You don't take insurance?"
It's true, I do no not take insurance. Why?
There are a number of reasons for which I do not directly accept and bill insurance. When a mental health provider directly bills your insurance for counseling or psychotherapy services, your insurance requires a lot of personal information about you to ensure that you have a "medical necessity" which requires the need for mental health and counseling services.
"Medical necessity" means that you have a mental health diagnosis that is severe enough to be impacting your daily functioning, meaning your ability to get your day to day things done (eg. work, school, social interactions, activities of daily living such as bathing, eating, etc.). This means that a therapist directly billing your insurance needs to make a strong justification what your diagnosis is and how it impairs you from being a functional individual. Also, most insurance companies require treatment plans which itemize the issues we are working on in therapy and the goals we have set to help you resolve the issues you are working on in therapy. Some insurance carriers only authorize a certain number of visits and require reauthorization by asking the therapist to share more of your personal information with the health insurance provider each time you need more sessions.
Sound complicated and intrusive enough yet? It is.
One primary reason I don't accept insurance is due to my desire to protect my clients' privacy as much as possible. A second reason is because my clients are not so sick that their day to day functioning is impaired in a significant way. Most of my clients are educated, high functioning, successful people who are simply having a hard time right now and just need a caring, neutral, third-party to meet with to discuss their thoughts and feelings, and with whom to uncover other underlying hidden strengths.
However, I know that using insurance can really help the financial aspect of any type of treatment. Therefore, most therapists, myself included, offer a monthly Super Bill to their clients who request them for reimbursement purposes.
A Super Bill itemizes the services rendered, how much you paid for your services, and a diagnosis that is sufficient enough for the insurance carrier to pay you back a portion of the fees you paid for your services. As an "Out of Network" provider, I am outside of your insurance company's preferred provider network, meaning that some of the fees for mental health services might be reimbursable to you through your insurance provider.
If you are considering counseling services, don't let the cost of the services scare you away. Insurance is a great resource to have, and can be helpful, but in reality, investing in our overall wellbeing is a more cost effective way of managing our health. A part of that wellbeing includes investing in a really good therapist with whom you connect who can help you on your current journey through life.
Above all, if you are interested in counseling services and would like to use a preferred "In Network" therapist, I encourage you to lean on that. You could ask your insurance carrier to refer you to someone who is covered by your insurance plan, but remember, that therapist will have to share a lot of personal information about you to justify your need for counseling services. Keep in mind, sometimes paying more out of pocket for someone who you really connect with that is outside of your network can really make a big difference in how the therapeutic process works for you.
So, find out what your benefits are, crunch the numbers, and then, go out and pick that really amazing therapist with whom you really connect and let your healing process begin.
If you have any questions or would like to schedule an appointment, give me a call for a free phone consultation: 904.404.1763
Take just one moment of your day to look around and intentionally look at each object in your surroundings. As you focus on one object at a time, see if you can just notice the shape, the color, the size, the texture, maybe even sound.
This is the fun part: as you look at each object individually ask yourself "how would I describe this object to a toddler or to a visitor from a foreign country who does not speak or understand my language?"
Amy Pope-Latham, LCSW is a clinical psychotherapist in Ponte Vedra Beach, FL.