In an Unspoken Voice by Peter Levine (Book)
In an Unspoken Voice by Peter Levine
Etiology of posttraumatic stress
Trauma occurs when we are intensely frightened and are either physically restrained or perceive we are trappedtraumatizedtheory’s
Trauma develops from intense fear and immobility.
Trauma is about wordless terror
People who lack solid early attachment are more vulnerable to being traumatize
The experience of trauma
The experience of paralysis and the critical self-judgment about weakness and helplessness are common components of trauma.
Polyvagal theory key elements
When one is threatened, we look first to others to share their faces and voices to communicate feelings to secure collective safety. These are attachment behaviors. Mammals deal with threats as a collective to avoid being picked off. We use prosocial behavior to initially try to resolve conflict
Fight or flight activated in danger. Immobility activated in doom.
Chronically traumatized people are dominated by immobilization, while acutely traumatized people are dominated by the fight or flight system.
Somatic symptoms of the shutdown include gastrointestinal problems, migraines, asthma, pain, chronic fatigue, and disengagement
A person whose social engagement system is suppressed has trouble reading positive emotions from other people’s faces and postures and has little capacity to feel their own nuanced positive affects
Fight or Flight
Arrest (increased vigilance, scanning), flight (try to escape first), flight (if the animal or person is prevented from escaping), freeze (fright - scared stiff), fold (collapse into helplessness)
We need to discharge or use up our fight or flight activation. We need to stay aware and track our spontaneous bodily reactions and feelings. We need the ability not to direct our escape; we feel fear because we are cunning from a source of threat.
Failure of the defense systems
Sensation-based feelings guide the adaptive response to valuations. Emotions occur when behavioral adaptions based on these valuations have failed. Fear is not what directs our escape bit do we feel fear because we are cunning from a source of threat. The person who can freely run away from threat does not feel fear.
Most organisms possess dispositions to large moving contours if not specific approach/avoidance responses. We are not conscious of it in the moment. We just respond to the pattern recognition.
·Preparation for defensive movement and image are fixed and registered together as the feeling of danger. This is not fear.
The urge to run (experienced as the feeling of danger) is followed by successful running (experienced as escape rather than fear of anxiety)
When our aggression is not thwarted but clearly directed, we don’t feel anger but instead experience the offensive attitude of protection, combativeness, and assertiveness. Anger is thwarted aggression. Healthy aggression is about getting what you need and protecting what you have
It is only when the normal orientation and defensive resources have failed to resolve a situation that non-directed flight, paralysis, or collapse come into play. Rage and terror panic add only the secondary emotional anxiety states that are evoked when orientation processes and preparation to flee or attack are not successful
The energy bound in inhibited responses is so powerful that it can cause extreme bracing. For example, when people jump from burning buildings to a trampoline net far below, the bones in their legs may fracture during the fall instead of on impact. This is because both the extensor and flexor muscles contract simultaneously
Freeze response
Tonic immobility: innate biological response for the body to shut down or freeze in response to overwhelming mortal danger
When freezing, your muscles stiffen against a mortal blow. Inertness tends to inhibit the predator’s aggression and reduce its urge to kill and eat. It may give the predator the illusion that the meat is old. The predator may think it’s dead and get its Cubs. It may distract the predator long enough for others to get away. It also numbs the body from extreme pain.
During shutdown and dissociation, traumatized individuals are unable to feel their odors, differentiate their emotions, or even know who they (or another person) are.
Dissociation makes the unbearable bearable.
Steps to work through trauma
Establish an environment of relative safety. The therapist must create a refuge, hope, and possibility. We must be careful of creating dependence
Support initial exploration and acceptance of sensation. Work on touching in with positive sensations and body experiences first
Establish pendulation and containment: the innate power of rhythm. Work on noticing positive sensations during the session. Notice that sensations are time-limited
Use titration to create increasing stability, resilience, and organization. Titration is about carefully touching the smallest drop of survival-based arousal and other difficult sensations to prevent re-traumatization
Provide a corrective experience by supplanting the passive responses of collapse and helplessness with active, empowered, defensive responses. When one's primary response of fight or flight is executed freely, one does not necessarily experience fear but rather the pure and powerful primary sensations of fighting or fleeing. When the response fault, it defaults to freezing or being “scared stiff” or collapsing helplessly
Separate or uncouple the conditioned association of fear and helplessness from the normally time-limited but now maladaptive biological immobility response. What is frightening is our resistance to feeling paralyzed or enraged. When exiting immobility states, people may feel tingly sensations all over their body
Resolve hyperarousal states by gently guiding the discharge and redistribution of the vast survival energy mobilized for life-preserving action while freeing that energy to support higher-level brain functioning
Engage self-regulation to restore dynamic equilibrium and relaxed alertness
Orient to the here and now, contact the environment, and reestablish the capacity for social engagement
Bottom-up processing
When the brain is injured or stressed, it reverts to a less refined, evolutionarily more primitive level of functioning. Higher-order functions are inhibited. It can be reversed to more refined functions through bottom-up processing
Bottom-up processing: sensation, image, behavior, affect, meaning
Sensation channel: physical sensations that arise from within the body. The interoceptive channel.
Kinesthetic: signals the state of tension of our muscles using stretch receptors.
proprioceptive: position information about our joints. It tells the position of all the parts of the body with respect to gravity. Combined with kinesthetic, it tells us where we are in space.
vestibular: derived from hairs embedded within the inner ear’s semicircular canals. When we move, fluid in these canals “slosh” over the hairs, bending them. Information from this sense lets us know our position with respect to gravity and changes in velocity
visceral (deepest level): derived from viscera and blood vessels. The opening and construction of blood vessels. Receptors in the gut that are integrated by the enteric nervous system
Image refers to the traditional five senses. Stimuli that arise from outside the body.
The sense of sound and touch are similar. The inner ear vibrates from sound, stimulating hair receptors and sending impulses to the brain, similar to how the hair on our skin functions. Dead individuals can “hear” through their skin
Behavioral domain
Voluntary gestures
Facial expressions that convey emotion
Posture: rigidity, retraction, poised preparation for a fight, twisting and collapse, and openness and expansion
Autonomic shift signals
Breathing that is shallow, or full and free.
Carotid pulse of the neck
Skin color to identify the tonus of the blood vessels
Vasoconstriction: cold fingers will appear blue/whitish. Fingers are pinkish when blood vessels are open, relaxed, and dilated
Capillary vessels dilate, leading to a flushed face and neck.
Pupil size: wide is associated with sympathetic arousal; small can be indicative of immobility and dissociation
Visceral behavior is with the gut
Sequence must be understood with context. These indicators are not standalone
The affect channel: emotions and contours of feeling (felt sense)
When the client’s body’s behavior becomes conscious in the safety of the present moment, the thwarted movements come to an intrinsic resolution or corrective experience. This resolution leads to a discharge of energy, leading to a new affect that brings new options or meanings. If the client is unaware of behavior or sensation, the fixed image generally leads to fixed affects and thoughts that were troubling the client to begin with. When a fixed behavior is not completed in a new way, the result is habitual or over-coupled affect. Because behavior reflects preparatory, protective, and defensive orienting responses, assisting clients in following their sensorimotor impulses to completion as they come out of the freeze is key.
Role of the Trauma Therapist
The sound, intonation, and rhythm of the human voice (prosody) have a calming effect
The therapist’s vocals can have a soothing effect.
The key to healing trauma is to uncouple and separate the fear from the immobility
The therapist aids the client to gradually uncouple the fear from the paralysis. The client experiences the physical sensations of immobility in the absence of fear, and equilibrium is restored
·Therapists guide clients out of immobilization by helping them become aware of their physiological paralysis, shift toward sympathetic mobilization, guide them through the sudden defensive/self-protective activation, and back to equilibrium
The therapist must contain the intense arousal without the client becoming too aroused.
Clients learn to trust that moderate activation unwinds on its own when one doesn’t avoid and recoil from it
·Restore the full spectrum of the disparate parts of the image for trauma resolution
Exercises
Re-establish awareness of body boundaries through awakening skin sensations
Take a pulsing shower and move through each body part. As you make contact, say, “This is my arm, this is my neck, etc.”
grasp parts of your body with your opposite hand. Be mindful of how your muscles feel from the inside as they are being squeezed
Also explore tai chi, aikido, chi gong, martial arts to restore connection to the body
Balancing in an exercise ball or standing requires proprioceptive and kinesthetic integration
Awareness of running exercise. Page 119. Stop and focus on the running exercise when bringing up traumatic material. This allows the muscles to discharge latent energy
When you open up and chant or sign in, feel resonant lower belly tones, you also open up your chest, mouth, and throat and stimulate serpentine branches of the vagus nerve
Voo chant: soft “ooo” as you imagine a foghorn guiding you safely home at a foggy bay. Vibrate the sound as it is coming from your belly. Pause at the end of the exhale and wait for your body to be ready to inhale
Exercise: notice the difference between opening and closing your fist while looking at it and while feeling it with eyes closed
Gastrointestinal relationship with trauma
Embedded within the lining of the gastrointestinal wall is a massive plexus of nerves, sensory, motor, and interneurons, and integrate digestive and eliminative organs so they function coherently. It is the enteric system and is the oldest brain, and 95% of serotonin is produced there
About 90% of the vagus nerve that connects our guts and brains is sensory
When we are mortally threatened, or when the threat is internal, our survival response is to vomit or to expel the contents of our intestines with diarrhea and then to lie still and conserve energy
Instinctual drives
The conscious decision to act comes after the action itself. People decide to act only after their brain unconsciously prepares them to do so
Our most compelling feelings of badness (avoidance) and goodness (approach) derive from visceral sensations such as nausea or belly warmth
Most of the time, we have solely our thoughts as meager substitutes for our instinctual drives
Embodiment: we are guided by instincts while simultaneously having the opportunity to be self-aware of that guidance
Consciousness and awareness
We think because we are rather than existing because we think
I sense, I act, I feel, I perceive, I reflect, I think, and I reason; therefore, I know I am
Consciousness unfolds through the development of body awareness, of learning to understand the nuances and the meaning of our internal physical sensations and our emotional feelings
Consciousness is a strategy, an evolutionary intention that allows an animal to predict better its trajectory in relation to potential sources of food, shelter, and threat.
Any animal that can modify its behaviors in response to changes in its situation is imbued with some sort of consciousness
=Most resilient people and with the most peace in their lives have learned to tolerate extreme sensations while gaining the capacity for reflective self-awareness
We need to notice which elements of the SIBAM are old, conditioned patterns, or missing entirely because they are unconsciously hidden.
Neurology of trauma healing
Triune brain: integration of all parts of the brain
The nervous system comprises two neural systems that allow us to move in a smooth, coordinated way. We have a combination of excitatory and inhibitory nerve cells
A negative feedback system allows us to regulate. A positive feedback loop is dysregulation
The limbus system is related to posture, locomotion, and external expression of internal visceral states
The cortex is an outgrowth of the limbus system, which allows for control, perception, symbolization, language, and manipulation of the external environment
The brain is a gadget evolved by the stomach to serve its purpose of securing food. The stomach is a device invented by the brain to provide it with the energy and raw materials it needs to function and stay alive
About half a second of continuing activity of stimulation in the sensory cortex Is needed for a person to become aware of a sensory stimulus
The uncoupling of sensation from image and thought is what diffuses the highly charged emotions and allows them to transform fluidly into sensation-based gradations of feelings
The medial prefrontal cortex can modify the response of the limbo system, particularly the amygdala. The medial prefrontal cortex (insula cingulate cortex in particular) receives direct input from muscles, joints, and visceral organs and registers them into consciousness
Curious exploration, pleasure, and trauma cannot coexist in the nervous system
Attending to the body
Body work is about doing something to keep the insula, cingulate cortex, and Broca’s area online
The body is a mandala. If you look inside, it is an endless source of revelation
I am body through and through, nothing more, and the soil is just a word for something in the body
Work on focusing attention on a movement and doing so slowly
Feelings accessed through body awareness rather than emotional release bring is the change we desire
“Death, meditation, sex, and trauma are portals to transformation and toward spiritual awakening.”