Anxiety is NOT just in your head
As a mental health expert specializing in working with elite and professional athletes, playing a sport won't "solve" or "cure" issues related to mental health.
What I generally observe is a disconnect occurring between the mind and body, affecting performance, and ultimately affecting emotional safety and health. This cycle circulates in one big loop, or what I love to phrase as a "pattern".
At the same time, it is also important to recognize that an athlete is still a human being under the helmet or uniform he or she wears.
Just because a person can compartmentalize and carry pain well does not mean it is not heavy for that person.
With Eye Movement Desensitization Reprocessing (EMDR) therapy becoming popularized as a mental health treatment, I would like to spend some time with you today talking about the various mechanisms of trauma and how it affects our brain and its functioning.
A primary question I often receive centers on the question of "what is dissociation" and "will I dissociate during EMDR?". Dissociation is a survival oriented process. Dissociation is the way the brain has the ability to take something that is so overwhelming when a patient cannot escape a stressful event and/or is caught in the freeze response.
So for example, there might be a child being hurt by a caregiver. Children are often too small to run away or fight back. They are the victim of the grown up. What the brain does during this type of scenario is that it allows the child to be there and not be there at the same time. In other words, the dissociative process of the brain is protecting the child so they can survive the experience.
EMDR therapy helps patients move through the dissociative process, which is inherent in any kind of trauma. EMDR helps the patient move through the experience with a much reduced rate of emotional arousal.
For the previous thirty years when trauma and Post Traumatic Stress Disorder (PTSD) were added to the Diagnostic Statistical Manual (DSM), it only categorized trauma as specifically large or “Big T” events. However, adverse life experiences or “little traumas” can also have a major impact on social, emotional, psychological, and physiological functioning.
I personally choose not to define trauma by “little” or “big” events. What is significant to me in my professional opinion is how the smaller, more repetitive patterns of events become recorded in the nervous system and because of its repetition, these experiences gradually accumulate in the brain.
Where in the brain does this all get stored? Please allow me to introduce to you, if you have not already learned about the amygdala. The amygdala is within the right hemisphere of the brain, known for responding to a heightened sense of arousal. The amygdala translates information that it receives from the other parts of the brain into an emotional response. This type of response can manifest in a variety of ways within the body (e.g. heightened blood pressure, more rapid breathing, blood moving from the central part of the body to the peripheral, and the release of adrenaline).
In my next post, I will continue to discuss two key symptom behaviors that are congruent with trauma: avoidance and rumination. Stay tuned!
Let's Talk Trauma: Polyvagal Theory
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.
It can be an uncomfortable feeling not knowing how to show you care and support a friend or loved one when he or she is in a dark place, whether it be depression, PTSD, anxiety, or anything else.
It's important to point out that support can look different for everyone. However, sometimes support is simply listening and validating feelings. Telling someone what they feel isn't real or isn't important may help you feel like you're doing due diligence encouraging someone to keep going but spoiler alert: it doesn't.
Validating feelings, whether or not you understand them, is SO important. Let compassion, kindness, and awareness be your guide to responding.
Remember: being present is sometimes the greatest present you can give.
Amy Pope-Latham, LCSW is a board certified mental health professional in Ponte Vedra Beach, FL.