Fight the Brain or Change the Brain

Recent research in neuroscience tells us what we had thought impossible is now possible. Early traumatic implicit (non-verbal bodily held) learning – the kind of learning that drives most forms of psychological distress, can actually be erased without touching the explicit (verbal – story) memory it was associated with. First let’s take a look at what this means.

Implicit learning is laid down in the nervous system – it is emotional and non-verbal. Here are some common examples:

I am inherently bad/dirty/stupid/ugly…etc.

Love is dangerous/painful/violent/exploitive and it’s best to avoid all risk or to expect all relationships to be like that

To love is to be mistreated/to mistreat

If I try I will fail, so best not to try

Dependence is wrong – it’s best not to have any needs

These kinds of “beliefs,” or “scripts” can drive large areas of life. They are usually laid down due to early (as in childhood) repetitive emotionally charged or even traumatic experiences and so tend to be immune to logical questions or arguments. 

This is because they are actually held in the body and nervous system rather than in the “thinking brain” and are faster and more automatic than logical thinking because they were originally somehow tied in to perceptions around survival (the messages may have originally been communicated by needed childhood caregivers, for example).

Fighting the Brain

Since most forms of psychotherapy are verbal, we have believed up until now that the only way to cope with this kind of dysfunctional learning was to challenge the logic of such beliefs and set up competing neural pathways that would eventually, through a great deal of practice, become available as the “preferred” neural pathway.  This is the foundation of much of cognitive and behavioural psychology.

Nevertheless, competing new beliefs learned logically in adulthood can never completely replace implicitly held beliefs laid down and reinforced in childhood, and so relapse must be constantly guarded against, especially when something associated with the earlier learning reappears in the current environment (e.g. a boss or spouse implying the same message).

The most common way set up competing beliefs is via Cognitive Behavioural Therapy, whereby the dysfunctional beliefs are deliberately challenged with new thoughts and learnings which are then rehearsed in new behaviours repeatedly until the old beliefs lose their original power. Psychoanalytic or psychodynamic interpersonal therapies also challenge old implicit learning via the therapeutic relationship itself, whereby repetitive experiences of (hopefully!) non-exploitive, consistent, secure attachment with the therapist replace the old beliefs that were based on exploitive, inconsistent, insecure early attachments.  

Example:

CBT: Old implicit learning: “If I try I will fail, so best not to try” as applied to job hunting (for example). CBT points out the illogic of the assumptions and encourages rehearsing new alternate thoughts such as “if I try, even if I fail, I can still learn something of value – and sometimes I will succeed.”  Behavioural rehearsal might involve the assignment of applying for xyz jobs and keeping track of any learnings or successes to challenge the old learning. Through  repetitive practice the new learning creates a new available pathway that offers an alternative to the older learning – however it doesn't replace it, and confirmations of the old learning (such as failures that don’t result in positive learnings) can always send the person back to the old learning.  I call this approach “fighting the brain.”

Changing the Brain

In their recent book, Ecker, Ticic and Hulley (2012) present the basic components necessary to erase dysfunctional implicit learning, and then examine numerous contemporary forms of psychotherapy to determine which types incorporate these components. Not surprisingly, most do. However, some forms of therapy are more efficient, systematic, and deliberate in their use of these components than others, making for a considerable difference in the likelihood of success and the length of time it takes to get there. The components are as follows:

1.       Identify and access the memories of the original experiences that laid down the implicit dysfunctional beliefs

2.       Retrieve the accompanying  learning simultaneously with the memories:  both emotional and  schematic

3.      At the same time as the feelings, memories and beliefs are retrieved, provide repeated experiential disconfirmation of the dysfunctional learning

a.      Disconfirmation must “make sense” emotionally

b.      Original learning plus disconfirmation must be repeatedly paired within a 5 hour window

c.       After 5 hours a built-in mechanism re-locks the synapses

Each of these steps correspond precisely to phases 4 through 7 desensitisation stage of the standard 8 phase EMDR protocol, even though EMDR was developed 20 years prior to the current confirming discoveries in neuroscience.

My main concern here is that this “new” approach, if applied systematically, will probably have similar limitations and cause similar results to those that have emerged from years of research and practice in EMDR. It will seem miraculous when applied to dysfunctional learning caused by a single –incident trauma; but it won’t be so simple when dealing with the many ego states that develop in response to repeated developmental trauma and dysfunctional implicit learning.

When ego states are split off by trauma, they are sometimes unable to “share” information from one state to another. This is what enables many survivors to function at a much higher level than they might otherwise if the full impact of the traumas were experienced by all parts of self equally. This also means that it is essential, when applying the above steps, to make sure that the ego states that hold the implicit dysfunctional learning are the same ego states that are exposed to the disconfirmation of that learning.

I think we will find, as we did with EMDR, that more complex forms of traumatic implicit learning are most effectively addressed with a combination of trauma processing (or Implicit memory “erasure”), somatic mindfulness, and ego state work.

References:

Ecker. B, Ticic , R, & Hulley, L. (2012). Unlocking the Emotional Brain. New York: Routelege

Shapiro, F, & Forrest, MS, (2004) EMDR: The Breakthrough Therapy for Anxiety, Stress and Trauma. New York: BasicBooks

Tronson, N. C.; Taylor, J. R. (2007). Molecular mechanisms of memory reconsolidation. Nature Reviews Neuroscience 8 (4): 262–275

Healing from Childhood Abuse, Trauma and Neglect (Part 1)

When searching for counselling and therapy to heal the wounds of trauma, childhood abuse, and/or childhood neglect one can be faced with an overwhelming myriad of choices.   Most treatment techniques (both  medical and psychological) that are studied scientifically take into  account that a significant percentage (actual numbers vary based on condition or treatment being studied) of those being studied get better spontaneously simply because they believe they are being given a  (called the placebo effect).

A number of new approaches that take into account the recent discoveries of neuroscience, made possible by modern brain imaging techniques, have been shown either scientifically (in placebo controlled randomised blind or double-blind studies) or anecdotally (based on empirical observations and patient/client reports) to be highly effective in a shorter period of time than conventional "talking only" therapy. All of these approaches, of course, need to be integrated by a skilled and experienced clinician, into an overall treatment style and plan that will include talking therapy as well as a healthy respect for the power of the therapeutic relationship and the need for the therapist to earn the client's trust by creating safety.

Below I list some of the approaches that have been shown to be effective  with survivors of adult trauma and childhood physical, sexual, and emotional or psychological abuse, plus a link to another blog entry I wrote on effective  approaches for those suffering from the effects of "poor affect regulation",  commonly caused by emotional neglect or the unavailability of reliable  soothing in early childhood.  I only list those methods that I have personally learned and tried and observed to be effective, and the reasons (if known) that they work. 

Affect regulation treatment approaches are also useful with survivors of trauma and/or childhood abuse. The basis for this is  described in a separate blog entry (Learning to Comfort and Soothe) as they are more generic therapy approaches used for a broader range of problems and causes.  Since writing that entry, I have been learning about "memory reconsolidation" which claims that rather than going through the painstaking process of learning to "regulate" out of control feelings, one can "re-write" the implicit memory itself so that feelings become self-regulating, as they would have been if the original "dysfunctional implicit memory" hadn't been laid down in the first place. I will explore this in depth in another blog entry (coming as soon as I finish writing it).

I mention anecdotal or scientific (placebo-controlled) in brackets next to the name of each approach to identify the type of documentation of  effectiveness. I include approaches that have primarily anecdotal evidence because it is extremely difficult to measure approaches to complex trauma and dissociation in a laboratory setting. In my opinion, there are too many uncontrollable variables once you try to measure treatment effects with this population, especially since it isn't ethical to in any way limit access to anything that might help simply because it could confound the scientific evidence of your study.  The DNMS, Sensorimotor Psychotherapy,  and Ego State Work, for example, have ample anecdotal evidence presented in scientific journals as controlled case studies, and are based upon modern scientific insights into the brain,  but that is not the same as evidence based on rigorously controlled scientific studies.

Ego State Therapy (anecdotal)

Founders: John and Helen Watkins

The concept of segmentation of personality into discreet parts of self has been around for many years, but has only recently been validated scientifically by new brain scanning technologies. These technologies, by measuring blood flow patterns in the brain, demonstrate how ego states are formed by neural clusters repeatedly firing together (and therefore "wiring together"). 

Such neural nets form the basis for most implicit learning - such as learning how to ride a bicycle - a skill that improves and eventually "clicks" as the neurons, which fire together in the same pattern whenever riding is practised, form a network with a particular skill set. When such a neural net forms in the context of a relationship, it will develop a unique point of view and way of behaving.

Ego states exist as a collection of perceptions, cognitions and emotions in organised clusters. An ego state may be defined as an organized system of behaviour and experience, whose elements are bound together by a common principle. Ego states may also vary in volume. A larger ego state may include all the various behaviours activated in one's occupation, whereas a smaller ego state might be formed around a simple action, such as using a mobile phone. They may encompass current modes of behaviour and experiences or include many memories, postures, feelings, etc., that were learned at an earlier age.

The human mind is a collective "family of self" within a single individual. How well these "family" members get along, and how effectively they cooperate can vary considerably from individual to individual. 

This segmentation has been called many names over the years, depending upon which psychological theory is being used. In Freudian language we are all divided into Ego, Id and Superego; Jungians refer to "complexes" which are described almost identically to ego states; Transactional Analysts talk about the internal Parent, Adult and Child; and Psychosynthesis refers to "sub-personalities." Ego states exist on a continuum of separateness, with the most extreme dividedness being caused by the most extreme early relational trauma.

Although everyone has ego states, those states formed in response to loving supportive experiences do not tend to require psychotherapeutic intervention. When ego states are more split off and engage in internal battles, Ego State Therapy can be employed to help resolve some of these conflicts, often using techniques found in conflict resolution, group or family therapy, to enable a kind of internal diplomacy. This approach has demonstrated that complex psychodynamic problems can often be resolved in a much shorter period than with analytic therapies. 

PLEASE NOTE: The techniques described here have been integrated into PSI^TM (PsychoSomatic Integration), an overall approach I teach for working with trauma and abuse survivors. PSI^TM is described here in more detail.  

More approaches to come....to be continued