Ruth Lanius, MD, PhD

Ruth Lanius, MD, PhD, is a researcher and professor of psychiatry at the University of Western Ontario, and a leading expert on post-traumatic stress disorder.

Her groundbreaking trauma research focuses on treatment outcomes for both pharmacological and psychotherapeutic approaches, which has led to the development of effective strategies for managing dissociation and processing traumatic memory.

Ruth is also the author and editor of over one hundred publications, including books such as Healing the Traumatized Self.^[1]

Here are some of her contributions to the field of trauma treatment . . .

How Trauma Impacts Three Key Brain Networks

Much of Ruth’s research has looked at how trauma impacts certain regions of the brain.

Specifically, she and her colleagues have found that traumatic stress affects three key brain networks:

• The default mode network
• The central executive network
• The salience network

First, let’s look at the default mode network . . .

The default mode network describes the regions of the brain that are active when a person is “at wakeful rest” – like when looking out the window while riding a bus to work, or waiting in line for a morning coffee.

These brain structures allow us to:

• Have a sense of self
• Know what we’re feeling inside
• Process memories and think about the future

Based on Ruth’s research, all three of these functions can be impaired in clients who’ve experienced trauma.

In a 2011 study,^[2] Ruth and her colleagues found that in adults who’d experienced chronic childhood trauma, their default mode networks resembled those of a 7 – 9 year old.

And if we think about what we know about trauma patients, this makes sense – these patients often have a fragmented sense of self, trouble remembering, and feel disembodied.

Next, let’s turn to the central executive network.

This network is responsible for:

• Thinking
• Planning
• Concentrating

Here too, Ruth has pointed out that in trauma patients, many of these functions are severely impaired. For instance, some patients might dissociate after trauma, which can keep them from concentrating on a task at hand.

Lastly, we have the salience network, which helps us figure out what in our environment is most important to respond to.

When a person experiences trauma, it sends their threat perception system – this salience network – into overdrive. Meaning, these patients will detect threat even when there is none. Not only that, but for these patients, even small threats can seem overwhelming.

While experts are still learning about the brain and trauma, within the past few years, much of Ruth’s research has provided us with neurobiological explanations for many of the symptoms and behaviors that we often see in trauma patients.

And in recent years, not only has Ruth’s research brought us closer to understanding the after-effects of trauma, but her work has also helped shed light on how the nervous system responds during a traumatic event.

How Does the Nervous System Respond to Trauma?

According to Ruth, when a person is faced with threat, their nervous system responds based on a particular hierarchy – known as the Defense Cascade Model.

What this means is, if an initial defensive strategy doesn’t successfully mitigate the threat, the nervous system will adapt further and turn to a different response.

For instance . . .

“Fight and flight activation is really adaptive for escapable stress. But if we move into situations of inescapable stress where we can’t leave the situation, then the nervous system needs to adapt further.”

– Ruth Lanius, MD, PhD, Advanced Master Program on the Treatment of Trauma

According to Ruth, the model progresses as follows:

1. Orienting freeze – This is the state a person might go into when they’re first faced with a threat and simply trying to detect it. Once the threat is located, a person might then shift into . . .
2. Fight/Flight – Sometimes, a person will be able to manage a threat by fighting it, or by running away from it. But if fight and flight aren’t feasible strategies, the next response that might take over is . . .
3. Freeze, or tonic immobility – If a client is motionless, has wide eyes, and tense muscles, there’s a good chance they’ve gone into freeze. From an evolutionary standpoint, freezing can keep an animal safe by camouflaging them from a predator. Keep in mind, though, that some experts use “freeze” to describe a different nervous system response than the one we’re referencing here. To differentiate this type of freeze from the orienting freeze mentioned earlier, Ruth often refers to this response as “tonic immobility freeze.” The term “tonic immobility” references the rigidity of specific muscles that occurs when a person is in this state.
4. Collapse/shutdown – In cases where trauma and abuse are chronic, like childhood trauma, a person’s nervous system might have to adapt further to protect itself from this near-constant pain. We might see a person show a collapse/submit response, where they disengage from the world. They might even dissociate, which can save them from feeling the pain they’re enduring.

Now, this progression of responses isn’t strictly linear – each person’s nervous system is unique. And so, a client’s body might resort to different responses depending on the type of threat, or just a predisposition to rely on one response more than another. And of course, there are other nervous system responses besides these four – like please and appease and attach/cry-for-help.

That said, the model can still be a useful way for your clients to conceptualize how and why their nervous system might respond to trauma.

Now of all the ways a client might respond to trauma, much of Ruth’s research has focused on one particular response – that is, dissociation.

How to Help Clients Re-Regulate When They’re Dissociating

Ruth has worked extensively with clients who struggle with dissociation and dissociative identity disorder, or DID.

According to Ruth, these are some key signs that a client is dissociating:

• Zoned-out gaze
• Quick eye movements
• Shallow breath
• Lack of responsiveness

Now, there are a number of different ways that experts conceptualize dissociation, and several ways that it can manifest. But here’s how Ruth understands it. . .

Trauma can fragment a person’s sense of self, to the point where they might have a number of different “self-states.”

Now this is something that we all experience. For example, when we’re at our jobs, we’re in our professional state. When we go home, we might be in our parenting state. And when we’re out with our significant other, we might be in our partner state.

When a person is healthy, they’re able to regulate those states and acknowledge that they all exist simultaneously – in other words, their many states can co-exist. Ruth calls this being “co-conscious” of them.

But if a person has experienced abuse or neglect, they might have states that come from that trauma. And being aware of those states can be overwhelming and painful.

So, it’s often adaptive for a client’s different states to split, says Ruth. This is how patients can end up with a fragmented sense of self.

When this fragmentation gets even more severe, might be experiencing an even more severe form of dissociation: Dissociative Identity Disorder.

But how might you distinguish between dissociation and DID? Here are three questions Ruth asks her clients:

1. Do you lose chunks of time? – If a client finds that they often have no memory of minutes, hours, or even days, Ruth says this might indicate that the client has Dissociative Identity Disorder.
2. Do you ever feel detached from your body? – Specifically, if a client indicates their body often doesn’t feel like it belongs to them, this can also be a sign of DID.
3. Do you hear voices? – However, it’s important to know that hearing voices is a symptom of other mental health conditions, like schizophrenia. But according to Ruth, the number, age, and onset of voices for each condition vary greatly. Specifically, voices associated with DID tend to come up soon after trauma, whereas symptoms of schizophrenia don’t usually appear until a client is in their late 20s/ early 30s. Number of voices is also relevant; if a client reports hearing more than 3 voices, this is also a stronger sign of DID. And finally, child voices are far more associated with DID than schizophrenia.

So how does Ruth work with clients who have a tendency to dissociate? One strategy she uses is to ask this simple question: “How much of you is here right now?”

In Ruth’s experience, even if a client is severely dissociated, they’ll still be able to answer that question.

She’ll then follow up by asking them what she can do to help them feel safe enough for all of them to come back online. Then, she’ll work with her client to implement some grounding strategies – like standing up and walking, or straightening their posture.

Another strategy Ruth often uses is positive imagery and containement imagery.

Whichever strategy you may use with a client, the goal is to help them re-regulate so that they’re within their window of tolerance.

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References

1. Healing the Traumatized Self: Consciousness, Neuroscience, Treatment
2. Default mode alterations in posttraumatic stress disorder related to early-life trauma: a developmental perspective

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