Trauma affects nearly every area of a person’s brain.
Not only that, but trauma disrupts the connections in the brain. And when the brain isn’t integrated, it impacts the nervous system and the entire body.
So how can we work with clients to repair integration after trauma?
In the video clip below, Pat Ogden, PhD shares the approach she used to help a client integrate his brain and stay in the present.
Take a look – it’s just 4 minutes.
You can hear more from Pat, together with Bessel van der Kolk, MD; Dan Siegel, MD; Stephen Porges, PhD; and Ruth Lanius, MD, PhD in the Treating Trauma Master Series.
They’ll look at what happens to the brain during trauma, specifically how the hormonal response to trauma affects brain function, as well as how trauma affects gene expression.
How could you use these ideas in your work with clients? Please share your thoughts in the comment section below.
I am developing a trauma Informed approach to assist young people who are being chronically bullied. The approach I have developed has 7 underlying activities I suggest they do every day:
Keep your personal power – focus on powerful posture (presence – Cuddy) and think to themselves that they will not allow how someone treats them affect how they feel about themselves (rational emotive – Ellis).
Remain calm – practice mindfulness and identify personal strategies to deescalate.
Think things through – a specific strategy for problem solving.
Make positive connections – establish good friendships and connections with trusted adults.
Reach out to be kind – because being kind to others improves our well being and can increase peer acceptance.
Build your strengths – identify and build your personal character strengths (VIA Institute on Character).
Focus on the good – gratitude and focus on positive experiences (hardwiring happiness – Hanson).
I advise then that if someone is hurtful, they should stand tall, take a deep breath, and remind themselves to not let what someone else does affect how they feel. Find a way to remove themselves. Connect with a friend to think things through to decide what else may need to be done. Think/write 5 good things that have recently happened to them. Reach out to be kind to someone else so they can spread kindness in the world to counter the hurt.
Really good ideas. While I haven’t studied the research on trauma enough to know if this works I would say these techniques are healthy and good for everyone
I have had to do variation of Pat Ogden’s technique with my son, whose past traumas and current triggers often force him into huge states of anger & rage, from years of emotional abuse by his dad. He has been harassed in a subtle nuanced way for 5 yrs by a manager at the Y in Oakville, Ontario, Canada. Recently it has escalated to an unbearable point, & he was forced to leave his job (which meant everything to him) for personal emotional safety. The ensuing Labour Board complaint that he & I have made. has been fraught by ridiculous conflict of interest issues (legislation dictates that employer has to conduct an internal investigation, even if employer is the harasser!!!). For my son, it is a blatant re-enactment of his dad’s abuse (authority figure abuse again!!). I am training in trauma, so I talk him through freeze & explosive mode (as I am wearing my mum & trauma trainee hat at the same time; this may be perceived as conflict of interest too, but that is the only resource that I have right now). I am aware that even in freeze or explosive mode, he is listening to cues to let go of this frightening state of mind. So, in a way, it is a form of mindfulness, to engage his frontal lobes in a rational thought process and also be there for him, so he is not alone (social engagement). Would appreciate any feedback from fellow practitioners who may be dealing with similar issues on the home front. Nancy, your response does answer my queries. The challenges if for me as the mum to self-regulate when my son is dysregulated, as I have experienced the same abuse from his dad (my ex), so we also struggle with IGT (Intergenerational Trauma)
Thankyou for sharing the support you give your son..it helps me understand how my relationship with my daughter is since a very traumatic marriage breakup and the compulsary sharing of their children. The conflicts of beliefs and values are constant and sadly confusing to the children who are now in therapy. I share the emotional load of the grandchildren being as positive and encouraging peace and kindness to defuse the situations that arise. Mindfulness and talking through feelings briefly and moving on to replace the bad with the good is natural for a humble not threatening family up against one raised on pride and aggression and competitiveness. Sounds one sided but we have honestly tried to understand where the opposing “team” is coming from and trying to accomplish in a good way. These difficult episodes are hard to process afterward with so much emotion and I guess ..love for the children makes our”team” inherently protective. Your thoughts on how we can move forward are appreciated.
Nancy, your statement “Find a way to remove themselves.” is key. What others do is not about you. Notice that with bullying, it’s not about making someone else feel something, it’s about the bully wanting to feel something (power, control, superior, dominant, etc.) I still get bullied by an older sibling and remain unaffected because I see her fear and inability to feel good feelings (kindness, gratitude, genuine appreciation, humbleness.) I just reply to her with empathic concern and remain unphased. Her heart is armoured. Bullies are very unhappy inside. They have self-confidence, but not self-compassion. Life gives everyone what they need and I have yet to meet a content, kind, peaceful bully.
I was being carried in a war. Along with two more years of being ‘shocked awake’, by these same sirens. I live in ear plugs, funny ;it just dawned on me somethings wrong about that. I might still have some kind of unresolved early trauma & shock going on! l have good access to my feelings, but this one has caused me insomnia all my life.
The greatest challenge for me today as a marriage and family therapist is to integrate my EMDR training with my sensorimotor training to help my clients desensitize and reprocess their trauma, both the big Ts and little ts; to fully feel their negative cognitions in their bodies, reprocess and clear them and achieve true acts of triumph. The best book I’ve found to date that helps me is EMDR Therapy and Somatic Psychology by Ariel Schwartz and Barb Maiberger, especially chapter 4: Interventions to Enhance Embodiment in Trauma Treatment.
I am dealing with my own trauma which I had worked through some years ago with help nut which has raised its head again after further emotional trauma. Thanks for the tips you give.
Dissociation is the most important part of Time Line Therapy (a form of NLP). In TLT we ask client to float above their Time Line (which we have established with them) and to have their unconscious mind lead them back to the first event of the trauma. Being above the event will keep them dissociated from it. Which makes being there much more comfortable then experiencing the event. Then we ask them to go even further back in time (still above their TL) and when we ask them what do you feel now, what do you experience now, where is your emotion now? The often start laughing and say it’s gone. To check if the emotions are really gone we ask them to descent into the event and ask “and now where is this emotion this trauma now” they say “gone”.
I feel this is the most humane way to tackle emotional events. I think there is no need to experience the trauma, emotion completely. (as in flooding)
My sense is Trauma happens during early childhood repression of powerful surges of emotion where cultural parental, educational conditioning is repressive and judgemental of not supportive of social emotional learning, self-care and compassion.
So the overall task of education and personal growth for prevention of adult trauma is to teach mindfulness of feeling, body sensation, changing emotional moods, acceptance of all experience without over thinking judgement/separation with presence, recognition, curiosity and detachment. As a mindfulness teacher, I feel the best time to teach mindful-awareness of breath-body-feelings-proper verbal expression is in elementary grades by parents, teachers and adults.
I am dealing with my own trauma. Thank you for the tips.
Love to do work with clients that focus on brain work. They seem to make leaps of progress when they receive knowledge of the brain.
Yes, good ideas! But I would like to now what do you think about EMDR therapy?
Hi Laurinda,
I have had both EMDR therapy, which I don’t know helped the trauma that I myself experienced, but also have utilized EFT therapy. I have found the EFT therapy the least expensive (you can do this at home) and has worked for me to “rewire” the intensity of the reaction to that trauma.
Where did you learn to do the EFT at home?
What particular EFT actions/Motions have helped you?
This ‘keeping the social brain online’ while going through the feelings, is that the same thing Dr. Levine calls pendulation? Or what is the difference if there is one?
This combination of moment to moment awareness, engaging the body/ sensations as well as the capacity to think and speak – right a the moment of being triggered – this is very familiar in psychodrama psychotherapy. By changing the client’s perspective physically, from being ‘in’ the scene to being outside the scene looking in (using the technique of the mirror) we are able to moderate the intensity of the experience, develop the observing ego, give a sense of mastery and begin to integrate traumatic experience and memory.
Dear Ruth and Pat, thank you for this short video which gives valuable information. You probably know art therapy. May I introduce you here to our family foundation which focusses on bringing art therapy for children and families mainly in natural disasters, conflict areas, and long-term hospitalisations. Kindly visit Red Pencil (new revamped website available this coming week) I would so much appreciate to involve your important knowledge into the work that we are doing if you would be willing and have the time to connect. Thank you and best wishes.
Hello, I have used a technique similar to Pat Ogden’s. I work through Hakomi, so mindfulness is an essential part of my work with clients. Doing little experiments like that slows the process down so the client can experience things safely, stay in communication with me, feel present to what is happening and re-frame a current response. Most importantly they feel accepted and loved in a process that can be very threatening and painful.
Has anyone had much experience in using Transcranial magnetic stimulation (TMS) for the management of trauma? If so what have been your results? Thanks
We use sound and light to reset the nervous system / allow the body to realize trauma. It’s a great way to help clients get out of the flight or fight and get the parasympathetic nervous system engaged again.
Hello there,
I tend to work with therapeutic hypnosis, and ego states\parts (depending on the extent of compartmentalization and impermeability in the intra-psychic system) within a safe hypnotic space . What Pat describes often happens in very controlled, titrated, and careful trance work – the client finds herself in need of making gestures, movements, and take/feel bodily stances that might have been impossible at the time of the early trauma (because of the danger and rage of the perpetrator(s) and the adaptive shame/freeze-catatonia response, for example).
Being able to complete the “idea” of a movement within a safe, interrelational space does indeed advance healing and non-re-traumatizing work – especially – as Pat illustrates so beautifully – when the therapeutic alliance is well established.
Thanks,
Thank you very much. I use Somatic Experience techniques which seem to be similar, but reminders how the brain becomes integrated while giving attention to what happens at the moment itself, within a social engagement, helps me to re-focus and to give the work that extra value that is needed from time to time.
Thanks for the reminder – already use observe and describe with clients. Also add the stability ball at times to engage the brain through the stabilizing muscles.
Social engagement is a new concept for me, so will be mindful of this in the future.
In the past, i worked with the management of aggression in the work-place (residential workers), and it was tricky to work with that ‘welling up’ and still contain the prospect of re-triggering destructive actions.
Finding objects such as pillows could help some people as it offered a controlled release. Another useful practice was a high level of physical activity in the outdoors.
This was not so feasible later in my career when working in the consulting room. Guided visualisation could go a surprising long distance for some but ‘just noticing’ worked well as clients were able to see, in actual practice, that levels of high emotion go up and down. Holding on long enough to see the ‘down’ helped as long as the client felt contained for the time being. In this case, ‘just notice’ had to be preceded by stepping back and, again, visualisation was able to facilitate that sometimes.
Superb, concise, natural presentation as always by the wonderful Pat Ogden. The piece that was new for me, and very helpful in conceptualizing what’s actually happening when we dissociate, was her phrase “dissociating into the subcortical brain.” I’ve not studied dissociation in depth, but what I often read or hear is that someone is spacing out or “leaving (their) body.”
This for sure conveys the subjective experience. Just pointing to the subcortex, though, somehow makes a positive resolution feel more accessible. It seems to remove the daunting prospect of coming, or bringing someone else, back into a body while it’s still flooded and overwhelmed with negative sensation and affect.
This is probably where the value of social engagement comes in. It seems that part of what makes trauma continue to hurt over time is when nobody is in there with you with compassion. If trauma was caused by a human perpetrator, that person was usually at the very least not fully empathically engaged with you at that moment — and might even have been enjoying your pain — or they wouldn’t have done it. With an accident or natural disaster, human presence (outer or inner/remembered) was missing.
This seems to be part of Puerto Rico’s current pain over not-attuned federal response since Hurricane Maria. As a psychotherapist in a Workers Comp practice a few years ago, I also heard many people injured on the job say, with tears, that even severe physical injuries were not as bad as their employers’ (and fellow employees’) indifference, shunning, or active hostility and attempts to force them out of the workplace if they were still working after the injury.
Very helpful reminder how to keep our clients engaged while they share the “live” experience of their sensations and feelings and through the reporting and constant engagement the client is able to be acknowledged, be in the present moment in a supported safe container.
I can easily go into fight or flight and thought I was being mindful as I watched my legs wildly make running movements, my arms circle, my mouth bite, or whatever. Then my body worker and I would try to figure out what I was even doing. This approach is better as it slows it down way more (maybe just the beginning of a movement) and also uses social engagement during the reactivation.
Good for you! I was pleased to see you use the key word “mindful.” It’s what we emphasize in Trauma-Management Yoga… mindfulness of the somatic, visceral, and kinesthetic sensations in the body as you hold the postures or move slowly from one form (posture) to another.
I am used to DBT Core Mindfulness skill but the added dimension of using it in situ with social engagement is a new thought to me. I look forward to using this.
Brilliant. I will try and work on the mindfulness aspect and the observational,part of the brain and encourage and work with clients to learn and use mindfulness as a first step.
Thanks for the example. I will talk to the workers I train who work with traumatised kids and young people about this as we explore the brain, and triggers and how to keep children and young people safe as they feel these powerful feelings by staying socially connected.
i very strongly encourage all my patients to go to yoga that FOCUSES ON Breathing techniques, mindful moment to moment awareness of body sensations ( muscle memory through Kinesthesis ) and Visceral memory through Intero – ception .
Stephen Porgess’ Poly vagal theory explains it very well.Charles Darwin showed this connection among all mammals.
The Physiology changes and i wonder if Pitocin/oxytocin are the chemical hormones get squirted also due to the social engagement with the therapist !
Well done……also leads into a followup at appropriate time; have you had these feelings before in your life?
I wonder how Pat would deal with the grief about the interpersonal carnage, after the rage is gone.
thanks i did this with my male client and his rage changed to tears and resolved over the session- beautiful work.
In my Stress Management & Prevention Center I use Mindfulness Practices and Trauma-Management Yoga, modeled on the Trauma-Sensitive Yoga of David Emerson and Bessel Van Der Kolk to get the client to regain visceral, somatic, and kinesthetic sensation numbed by the traumatic events. I have witnessed that once the sensations are regained, the client begins to recover. My work is done in a “triad” — the client, his/her therapist, and I.
In my Stress Management & Prevention Center I use Trauma-Management Yoga (based on the Trauma-Sensitive Yoga of David Emerson and Bessel Van Der Kolk) to get the client to get in touch with the visceral, somatic, and kinesthetic sensations in the body that were numbed by the traumatic experience.
I encourage all my patients to join Yoga that emphasizes conscious awareness of Breath,body sensations, /muscle memory and movement and moment to moment awareness of the viscera (interoception)
No comment yet
It struck me that I always try to get the client to stop raging, sending some messages. This actually encoutages clients to welcome the rage as a helper. Interesting.
Most clients do not know what the pre-frontal cortex is. Rather than conduct a training session, I try to get them to accept that they have a ‘cognitive’ brain and an ’emotional’ brain, both of which they are entitled to. I then do the best I can to get them to appropriately engage those, in the best interests of them and their significant ohers.
Thanks, Ruth. A helpful tool. I especially appreciate Pat Ogden’s way of sustaining pre-frontal cortex and social engagement side by side … often a missing connection especially in developmental trauma. In addition, providing the felt experience of mindfulness side by side rage potentially can open the space for mindful observer to assist and support in future trauma triggers.
Too often I’ve seen mindfulness used as a hidden therapeutic agenda to suppress and shame women’s rage. Unfortunately, the traditional ideal role of women’s surrender to “docile” behavior is still an active pattern in psychology, though often unconscious.
Pat Ogden’s use of mindfulness demonstrates an alternative: support of personal strength and power development. My bias and belief — we need more of that in these challenging times!
I’m looking forward to the new trauma series.
Live this comment!! Thank you for posting.
Sorry, love comment. Tsk.
I agree – fantastic moment, and very much appreciated.
I’m very excited and refreshed to be reminded of the neurological implications of Mindful awareness of the senses and socially engaging them in the present moment when trauma symptoms surface. I see that clearly requests my and prompting my clients to report back their body sand sensations in detail with encourage an integration of the PFC, which is the area damaged most significantly in trauma. Great info! Simple, concise, and easy to apply. Gratitude for the work you are all doing to heal our world, one client at a time.
Cheers!
A few typos in there above…
This understandin could help in working with the homeless, especially. Thank you.
This talk showed how important it is not to ask the client to DENY or shut down the feeling of rage (creating shame, hopelessness, and feeling alone), but instead to acknowledge it by having him talk about and remain mindful and socially engaged.
I’m a first-hand survivor of a TBI. In my recovery-process, I’ve seen that the lest way to reintegrate a survivor back into society would be to show the victim ßuccess stories of other people who’ve had vicarious experiences. This will allow the new victim to think: “Maybe I can recover as well.”
This idea came originally from Viktor Frankl in his founding of Logotherapy.
This emphasizes how important teaching mindfulness is in building resources to begin reintegration. Alert, relaxed observer’s mind is no small skill! I find it sets my clients up to make healthy strides in many areas of the work we do together. It is one of the best self-care tools we have.
Interesting….years ago we used to encourage emotional release of trauma but have moved away from that into keeping eye contact (“keep looking”) with the client and encouraging dialogue as the traumatic memories are surfacing that has proved to effect much less dissociation more lasting integration.
That is the hardest part of trauma therapy since Dissociation is so instant and automatic ,particularly when betrayal happened by the person of trust at a very young age like incest.
The exercise demonstrated how “mindfulness” works in keeping the client engaged socially in their interaction with me, as well as helping the client to use their thinking and cognition while expressing their strong and conflicting feelings, without flooding and disassociating.
Ruth, love what you offer our community. This video gives us one wonderful example of how Pat works with trauma. What I find so rich about NCIABM is that you aren’t stuck in one perspective or theory. You offer different theoretical lenses to examine the same issue. Thanks.
Hello all, I first experienced this approach from a Cranio Sacral Therapist back in 2004. As a “mind” but not body trained therapist I realised how wrong C20th &21st psychoanalysis was to have completely forgotten the body. Thankfully they are catching up now. Freud actually had an integrated mind body approach. These schools have truly abused his teaching with their dogmae. The other thing they had done was to pathologise homosexuality, something Freud had no prejudice against. He knew we are all on a spectrum of “sexualities”.
couldn’t agree more with you.
Well said
Thank you for this nugget of information, as this is a crucial part of healing for people who experience dissociation. I have used some of this, but will use more of this strategy in my therapy with these clients.
Has anyone used drumming to integrate the brain for trauma patients?? This video seems to explain some of my reading about drumming being a method to bring mindfulness and brain integration. When done in a group setting, it promotes social engagement as well… So far I have a research paper by Bensimon, et al about drumming and its therapeutic effect on PTSD soldiers
Thank you NICABM. Such great morsels of information to remind of the mind body connection and the importance of integration for our clients. As an EMDR therapist working with military and veterans, this is a crucial component to their healing.
I very much like the idea that we need to bring the different levels of brain activity into the present moment together while using social engagement. It sounds like acknowledging the role of the myelinated vagus in Stephen Porges’ work.