Neuroscience for Effective Clinical Practice: How ...

Neuroscience for Effective Clinical Practice: How understanding the way our brain works can help us become better practitioners. Synchronicity Therapy – Maggi McAllister-MacGregor

Neuroception

Safe VVC - Social Engagement

Environment Behaviours

SNS – Play

DVC Loving/nurturing Behaviours

© Synchronicity Therapy

Brain – Body Connection

Brain

Body State Internal Environment Body State

Brain

Sense Organs

External Environment


Exercise

• Body posture and state


Safety

Our body reacts in the way that is most likely to keep us alive! Stephen Porges


Neuroception

• Not ‘below’ the level of conscious mind, but different to conscious mind

• Provides an adaptive reaction to the environment that serves to keep us alive

• However, this can be problematic


Neuroception

• Intimacy and trust require the ‘newer’ vagal circuits (VVC) to be available

• The cues that cause defensive reactions are not voluntary – they are reflexive

• Nervous system is hierarchically organised


What Is Safety?

• What makes us safe?

• How do we know when we are safe?

• Brain – body connection


Brain – Body Connection

Brain

Body State Internal Environment Body State

Brain

Sense Organs

External Environment


Safety

• If the neuroception is one of trust and safety this is incompatible with being defensive

• Defensive states – what happens when defence is the ‘normal’ physiological state?


Safety

• Self-soothing: part of the SES. Not something we necessarily do on our own! We rely on others for emotional regulation; this is part of being a social animal.

• Increasingly, in the West especially, individuality and independence are valued as important qualities. Dependence is seen as a weakness.

• Interactions are increasingly being mediated by ‘objects’: text messages, facebook, twitter etc.

• ‘face-to-face’ interactions serve a very necessary function (at least from the NS’s perspective).

• Why has therapy developed ‘behind closed doors’?


Safety in Therapy

• ‘to provide sufficient safety so that the patient can make it back from the edge of the abyss and be aware of having done so…….the optimal treatment context requires that the patient feels ‘safe but not too safe’. Bromberg, P. M. (2006). Awakening the dreamer: clinical journeys. P189, Mahwah, NJ. Analytic Press.

• ‘is always a dance of safety, uncertainty and risky challenge’ Ogden, P. in press.

• ‘Human beings have a need for safety, rest and deep relaxation, which requires co-opting the dorsal vagal system for immobilising states, without the fear that accompanies dorsal vagal shutdown. But we also have a need for novelty. Which is risky and unpredictable and requires that we are able to mobilse sympathetic arousal without the extreme fear associated with hyperaroused states. (italics added). Fisher, J., Ogden, P. (2014). Sensorimotor Psychotherapy: interventions for trauma and attachment. New York, Norton & Co.


Questions

• Do we offer a safe environment for our clients?

• What signs may the client show that indicates lack of safety?

• What about the therapist?

• How do we increase the chances that our clients will feel safe and therefore be able to engage in therapy?


Brain Body Connection

S – R


Safety Cues

• Facial expression, especially of the upper part of the face

• Prosody of voice

• Gesture


Why is Safety Important?• "Trauma is not what happens to us, but what

we hold inside in the absence of an empathetic witness.”― Peter A. Levine


Window of Tolerance

• The area or amount of ANS regulation available to a person in any given situation

• Can change in size depending on several factors

• The extremes could be envisaged as an arrow slit window in a Castle Wall or as a Panoramic window in a room wall.


Recognising PNS states

• VVC of PNS – SES = WOT = regulation

• SNS – mobilisation: F or F (defence) play (safety) = hyperarousal

• DVC of PNS – immobilisation: freeze/shutdown (defence) intimacy/nurturing (safety) = hypoarousal


Window of Tolerance

• When in the WOT we are emotionally regulated, social, have the ability to make decisions, problem solve, think logically and regulate ourselves emotionally – SES – PNS VVC activation

• When we become over-aroused, we move into SNS activation –Mobilisation. We experience anxiety, fear, suspicion, hypervigilance, aggression, rage, anger, distrust, distance, flight

• When we become under-aroused we move into PNS DVC activation –Immobilisation. We become shut down, depressed, terrified, phobic, passive, dissociated, desperate, needy


Coping Mechanisms and Trauma

• “Childhood abuse necessitates self-alienation: we must disown thehumiliating ‘bad child’ and work harder to be the ‘good child’, acceptableto our attachment figures. In the end, we survive trauma at the cost ofdisowning and dissociating from our most wounded selves. While longingto feel safe and welcome, traumatized individuals find themselves inconflict: alternating between clinging and pushing others away,experiencing self-hatred or hostility toward others, yearning to be seenyet yearning to be invisible. Years later, these clients present in therapywith symptoms of anxiety, depression, low self-esteem, diagnoses ofbipolar and borderline personality disorder, and a distorted or absent senseof identity”.

Janina Fisher. Healing the Fragmented Selves of Trauma Survivors: Overcoming Self-Alienation.


Coping Mechanisms Fisher.J. (2017) Healing the fragmented selves of trauma survivors: Overcoming internal self- alienation. Routledge, New York

Defence Response Action BehaviourFight Vigilance Angry, judgemental, mistrustful, self-

destructive, controlling, suicidal

Flight Escape Distance, ambivalent, cannot

commit, addictive behaviour, eating

disordered

Freeze Fear Frozen, terrified, wary, phobic of

being seen (trying to be ‘invisible),

agoraphobic, reports panic attacks

Submit Shame Depressed, ashamed, filled with self-

hatred, passive, ‘good girl’,

caretaking, self-sacrificing, people-

pleasing

Cry for Help Attach Desperate, craves rescue and

connection, sweet, innocent, wants

someone to depend on, jealous,

needy, clingy© Synchronicity Therapy

Safety and Threat

• Feeling safe involves activation of the SES, which is mediated through the ventral-vagal complex, with the pre-frontal cortex online

• In threat, the limbic system is activated, particularly the amygdala, producing the Fight or Flight response mediated through the SNS

• In life threat, or when the F or F response is ineffective, the dorsal-vagal complex in the brainstem is activated producing the Freeze response mediated through the PNS


Safety and Threat

• When we feel safe, we have access to the ‘social’ area of our brain, the pre-frontal cortex, which allows us to think clearly, make good decisions, problem solve, plan, to interact with people in pro-social, relational ways

• When we feel threatened we move into acting in more pro-self ways as opposed to the pro-relational ways when we feel safe

• This is why when we are in conflict, which is often threatening, it is often difficult to see the others point of view, to empathise, to work out ways to find solutions, because the pre-frontal cortex has lost it’s ability to inhibit the activity within the limbic system and brainstem, and communication between the pre-frontal cortex and the lower brain areas is disrupted, moving us from a pro-relational to a pro-self stance, which makes us less able to remain open to the other


Looking Forward

• In WS 4:• We will look at the role of the PFC in safety and the SES

• We will look at neuroceptive triggers

• We will look at ways to strengthen our capacity to be more often in our SES, and therefore less ‘reactive’

• We will look at burnout – empathy vs compassion


Suggested Reading

• ‘The Body Keeps The Score’ Bessel an Der Kolk, Penguin

• ‘Trauma and the Body’ Pat Ogden, Kekuni Minton, Clare Pain, Norton

• ‘Sensorimotor Psychotherapy’ Pat Ogden, Janina Fisher, Norton

• ‘The Polyvagal Theory’ Stephen Porges, Norton

• ‘The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions’ Jaak Panksepp, Norton

• Healing the Fragmented Selves of Trauma Survivors: Overcoming Self-Alienation. Janina Fisher, Routledge


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