How to Integrate the Brain and Prevent Dissociation After Trauma

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, PhDTreating Trauma Master Series.

They get into the neurobiology of treating trauma, as well as what’s happening in the brain during trauma.

How could you use these ideas in your work with clients? Please share your thoughts in the comment section below.

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44 Comments

  1. Has anyone had much experience in using Transcranial magnetic stimulation (TMS) for the management of trauma? If so what have been your results? Thanks

  2. Gail says:

    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.

  3. 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,

  4. Eva-Lena Kost Fehlmann says:

    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.

  5. Tina says:

    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.

  6. 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.

  7. 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.

  8. Karen says:

    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.

  9. Rachel Garst says:

    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.

  10. Joanne Nemecek, LMSW says:

    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.

  11. Ann L says:

    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.

  12. Terry says:

    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.

  13. srisht says:

    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 .

  14. srisht says:

    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 !

  15. smfields says:

    Well done……also leads into a followup at appropriate time; have you had these feelings before in your life?

  16. Elaine Dolan says:

    I wonder how Pat would deal with the grief about the interpersonal carnage, after the rage is gone.

  17. thanks i did this with my male client and his rage changed to tears and resolved over the session- beautiful work.

  18. 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.

  19. 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.

    • srisht says:

      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)

  20. Barbara Harris says:

    No comment yet

  21. Kathy Farrell says:

    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.

  22. Dr John Morrissey says:

    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.

  23. Day Piercy says:

    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.

  24. Mike Thomas says:

    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!

  25. Ginger Ingalls says:

    This understandin could help in working with the homeless, especially. Thank you.

  26. Ellen Jaffe says:

    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.

  27. 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.

  28. 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.

  29. 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.

  30. srisht says:

    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.

  31. Therese M Bertsch says:

    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.

  32. Patty Olwell says:

    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.

  33. Rachel says:

    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”.

    • srisht says:

      couldn’t agree more with you.
      Well said

  34. Debbie Davis says:

    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.

  35. Peter Scheer says:

    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

  36. 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.

  37. Marion houghton says:

    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.

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