One of the more complex aspects of working with trauma is helping clients reintegrate the brain.
Without this crucial step, many of the interventions we try may fail – and clients can remain stuck in their trauma experience.
So in the video below, Jennifer Sweeton, PsyD shares how we can more effectively work with the brain to help clients process trauma.
She’ll lay out several key areas of the brain to focus on, the order in which we should target them, and interventions that can help regulate each one.
Have a look.
A goal that goes along with that, that aligns actually really nicely, is we need to get the insula online. If the insula is offline – and the insula is the area of the brain that allows you to feel into internal experiences – if it’s offline, you’re probably working with someone pretty dissociative. You can think of it like the body and the brain have been ripped apart. They’re disconnected. And you’re trying to put the brain back on the body so that we understand and can feel into what the body is doing and what the body can tell us. And the way you do that is really through somatic techniques, which if you think about it, are pretty much the same techniques that you’re going to be using to down-regulate the amygdala. So, the really cool thing, I think, about the way our brains are designed is that you don’t have to go brain area by brain area by brain area.
If you’re doing the amygdala reduction techniques, if you’re doing the deep breathing and the somatic techniques, those are the exact techniques that have been shown to be associated with insula activation. So, you’re going to actually start what we call bottom-up, working through the body. Sensorimotor skills. You’re going to be doing more classic somatic techniques, breathing techniques, mindfulness techniques, but focused on the body. When you get a sense that the client is able to practice these techniques and can feel some level of success with them, it’s okay if the insula’s not completely on all the time. It’s okay if the amygdala’s not completely down-regulated. It’s not going to be, but they’ve been working on these techniques and they feel a little bit more of a sense of regulation, they might also say they feel a little more clearheaded, then you might move into work focusing a little bit more on thoughts, memories.
So, memory reconsolidation techniques are going to be great for the hippocampus, to strengthen and rebuild the hippocampus and to reconsolidate or shift traumatic memories in a way that doesn’t erase them, but that makes them feel more tolerable. That’s what your EMDR is going to be for. That’s what your prolonged exposure is going to be for. To some extent, cognitive processing therapy, a narrative exposure therapy, any sort of exposure therapy where you’re focusing on the trauma is going to fall into this category and has been associated with amazing gains in terms of hippocampal volume going up and activation going up. Along with the memory techniques are, of course, are the cognitive techniques. Because you’re using your mind as you’re talking about memories or thinking about memories. It’s a good time then also to move maybe into some of that traditional cognitive work. So, it might be cognitive processing therapy where you’re considering the ways that the trauma has impacted your life in different domains and how maybe it’s compromised your ability to trust people.
So, maybe you’re working on that through these cognitive techniques. Maybe it’s more classic cognitive restructuring and ABC sheets. It might also be narrative therapy, putting the trauma back in the context, the broader context of your life, and coming up with some sort of meaning. So, working on meaning-making and storytelling, which is very cognitive. So, now we’ve moved from bottom-up working with the body to shift the brain to top-down where we’re working with our mind or our thoughts or our memories to change the brain. But starting with the somatic techniques and then moving into memory and thoughts is the order of operations that we need to move with healthy brain change instead of against it.
So, what it’s going to be associated with is, reduced amygdala activation so you’re calmer. Increased insula activation so you’re more in your body. Increased hippocampal activation so memories feel less distressing and overwhelming. And more cingulate and prefrontal cortex activation, so you feel more in control of yourself. You’re more clear-headed. You can focus better. You have better self-awareness and stronger relationships. All of those things together really are what make trauma treatment most effective.
For more strategies on working with the traumatized brain, have a look at this short course with the masters in the field, including Dan Siegel, MD; Bessel van der Kolk, MD; Pat Ogden, PhD; Stephen Porges, PhD; and Ruth Lanius, MD, PhD.
Now we’d like to hear your thoughts. How might you apply Jennifer’s approach with your clients? Please let us know in the comments below.
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