Learning to Brake Before
Accelerating:
Using Emotional Regulation
When Treating Individuals
With Trauma
J. Barry Mascari, Ed.D., LPC, LCADC Jane Webber, Ph.D., LPC, ACS
Kean University
As mental health practitioners, much of what we were taught to help clients release their distress was harmful to individuals with trauma.
We will explain how the neurophysiological loop strengthens and reinforces traumatic memory with emotional dysregulation.
Video clips of expert therapists will be shown to illustrate their experiences with treating client with trauma, often ineffectively.
We will demonstrate how somatic techniques are
essential to regulate emotions (brake) before telling the trauma story (accelerate).
You will practice simple, easy-to-remember techniques to help children and adults regulate emotionally before
SESSION PURPOSE
Understand how the neurophysiological loop
strengthens & reinforces traumatic memory
Use of the SUD to determine when to “brake”
Help clients to be aware of their own
emotional dysregulation
Implement at least 3 new somatic techniques
FOR THE NEXT HOUR…
Forget everything you know about
“theories” or “approaches”
Agree that most of what we do to help
clients resolve traumatic experiences
cannot be resolved by talk alone
Be open to somatic (physical/body)
The Body Remembers
The body speaks what
the mind cannot. The purpose of hitting the brakes and dropping the level of arousal is not just to give a pause and a
sense of safety. It also… enables the therapy to
proceed at a reduced level of arousal. Without
hitting the brakes, arousal will just build and build. (p. 115).
Some form of trauma experience is nearly universal
in individuals, and thus in people seeking counseling.
Being able to regulate emotional and somatic
reactions is essential before telling their story.
Multi-sensory approaches jump start the trauma
story without words, provide access to traumatic memories and facilitate the integration of
traumatic memory in the brain
Clients can reduce traumatic symptoms without
telling their story verbally.
Clients should not be retraumatized by talk therapy
Sitting Like a Frog
The Spaghetti Test* Sitting Like a Frog*
Attention to the Breath
The Pause Button*
First Aid for Unpleasant Feelings
A Safe Place
A Conveyor Belt of Worries*
The Secret of the Heart Chamber
CONCEPTS TO KNOW
The autonomic nervous systems’ role in the “fight, flight or
freeze” response
Sympathetic
Parasympathetic
Emotional hijacking
Vasal-vagal response
“Big T/little t”
SUD
Somatic techniques
Bilateral stimulation & its impact on relaxation
ASSESSING YOURSELF
SUD= 0 – 10
Subjective Units of
Distress
How Do I Feel
Thermometer (tired, exhausted …..well, relaxed)
Weather report… (tornado,
stormy....downpour...light rain, sunny)
Does the feeling remain throughout the day?
Does it change?
What do I notice about my body? How do I feel?
BIG TRAUMA
and
little trauma
BIG T
Major traumatic event
with imminent danger and harm, overwhelming,
immobilizing: sex assault, rape, abuse, tsunami,
Earthquake, car crash, Fire
Little t
Needed For
Emotional Regulation
5 empirically supported elements
(Hobfoll, et al. (2007):
1. Sense of safety
2. Calming
3. Sense of self-& community efficacy
4. Connectedness
Somatic Regulation
…
These sensations just produce intense
emotions without being able to
modulate them…
our therapy needs to
consist of helping people to stay in
their bodies and to understand these
bodily sensations.
And that is certainly
not something any of the traditional
psychotherapies, which we have all been
taught, help people do very well.
The brain will
self-heal
if the
circumstances
are set properly
Fernyhough, C. (2013).
Sympathetic Dominance
• Compromised Cognitive and
Motor Functioning • Reactive
• Repeating Same Mistakes
• Coercive or Hesitant Leader
Parasympathetic Dominance
• Maximal Cognitive & Motor
Functioning • Intentional
• Creative Problem Solving
P
ERCEIVED
T
HREAT
Physiological Brain Mechanics Other Effects ▲Heart Rate ▲ Basal Ganglia &
Thalamic Fx ▲Obsession ▲ Breathing Rate ▼ Neo-cortical Fx ▲Compulsion
▼ Breathing Volume ▼Frontal Lobe activity
▼Executive Fx
▼Fine motor control
▼Emotional regulation
▼ Speed & Agility
Centralized Circulation
▲ Muscle Tension ▼Temporal Lobe Activity
▼Language (Werneke’s)
▼Speech (Broca’s)
▼ Strength
▲ Energy ▼ Anterior Cingulate Constricted thoughts &
behaviors
▲ DIS-EASE Fatigue
The Psychophysiology of
Traumatic Memory
Amygdala – keeps us safe, alert to danger & triggers the fight or flight alarm
Cortex – stores information
Hippocampus – “librarian”, tags memories with
information, time,
sometimes stores info in wrong places
Snooze Alarm
(Mascari, 2014)
The brain’s inability to resolve and properly file the trauma
narrative results in
flashbacks & intrusive thoughts
Like the alarm clock, even when you snooze the issue (suppress the memory) the alarm
Blocking Formation of
Traumatic Memory
Together the amygdala, hippocampus, and cortex help form &
reinforce a loop that ties traumatic memory to physiological arousal.
Further recollection of the event (naturally or in debriefing, etc.)
may elevate arousal & further reinforce this loop.
Disrupting the loop by lowering physiological arousal can reduce
the likelihood of PTSD & other emotional consequences.
Using propranolol (beta-blocker) ”disrupting” the formation of
traumatic memories.
The individual still had vivid recall of the event, but the medication broke the
Sympathetic Dominance
• Fight/flight
• Compromised Cognitive and
Motor Functioning • Reactive
• Repeating Same Mistakes
• Coercive or Hesitant Leader
• Hypervigilance
Parasympathetic Dominance
• Maximal Cognitive & Motor
Functioning • Intentional
• Creative Problem Solving
• Transformative Leader
Herman’s Tri-Phasic
Recovery Model
Safety and stabilization
Remembrance and mourning
(Telling the story)
Reconnection
Building & Maintaining
THERAPEUTIC RELATIONSHIP Relaxation/
Self-Regulation
Constructing & Sharing
NARRATIVES
Smoke Alarm:
Amygdala
•
Signals danger & provides early
warning
•
Sometimes produces a false
positive
•
Misreads situations as
BASIC-Ph
Belief: Spiritual or religious meaning, rituals, rites
Affect: Feelings expressed, identified, affirmed, and emotionally regulated
Social: Therapist, family, friends ,classmates,
teammates, communal traditions, rituals, connections
Imagination: Puppets, music, drawing, play, sand tray, journaling, drama
Cognitive: Thoughts, misperceptions, faulty thinking, recurring thoughts, clearing mind, attention
Physiological: Body (emotion and mind) regulation meditation, yoga, relaxation, breathing, bilateral stimulation, play dough, music, core ball
Box Breathing
Visualize going
around each side of
a square garden:
breathe in 2…3…4…
hold 2…3…4..
breatheout
2…3… 4…Breathing
Inhale: “My
body is filling
with calm”
Exhale: “My
body is
releasing
tension” while
exhaling.
Visualize your
body like a
balloon
Breathe in to fill
the balloon up
Breathe out to
slowly letting the
air out of the
Bubbles
Bubble falls: blow
bubbles floating down slowly to calming music (Goodyear-Brown).
Relax and slow breathing
while watching the bubbles.
Blow out large bubbles
slowly and focus on an distant point to control their breathing.
Pinwheels
Practice breathing with
the pinwheel close to your mouth with light breaths.
Move the pinwheel out –
use deep breaths (Goodyear-Brown).
Glow-in-the-dark paper
Grounding
Helps individuals reorient themselves when they
appear to be losing touch with their environment.
Begin to orient the individual by describing the
grounding process.
After a frightening experience, you can be very upset or
GROUNDING EXERCISE
1. Sit in a comfortable position with your legs and arms uncrossed
a. Breathe in and out slowly three times
b. Look around you and name 5 non-distressing simple objects that you can
see. For example, you might say “I see the floor, a shoe, a table, a chair, my friend”.
c. Breathe in and out slowly three times
d. Name 5 non-distressing sounds you hear. For example, you might say “I
hear a teacher talking, myself breathing, kids playing, a cell phone ringing.
e. Breathe in and out slowly three times
2. Name 5 non-distressing things you can feel. For example, you might
say “I can feel the pen in my hand, toes inside my shoes, back
pressing against the chair…”. Breathe in and out slowly three times
(For younger children—colors of things they see.)
TECHNIQUES
•
Tongue touch
•
Stress ball squeezing (2
hands)
•
Steam irons
•
Tapping (thigh, foot, shoulders)
Breathing is the single most effective
somatic and emotion regulation tool
Exhalation is more important than
inhalation
Vagus nerve is activated
Somatic Experiencing – Aware of &
manage stress in body
Discharge energy in body from trauma
Parasympathetic Nervous System
returns
Bilateral Hemisphere
Integration
Somatic Experiencing
Bilaterial Stimulation
Walking
Cross crawl
Tapping
Sharing the story (play therapy, drama, sandtray)
Eye Movement Treatments
EMDR
Bilateral Stimulation
•
Thigh tapping
•
Foot tapping
•
Hug yourself…
•
Tap your shoulders
•
Someone else taps your shoulders
•
Windshield wipers
Neurobiology of Meditation
to Gyrification
Increased-cerebral cortex folding,
Process information faster,
Improved processing memory &
attention
Increased cortical thickness
Reduced sensitivity to pain
Increased gray matter density in brain
stem, hippocampus and frontal area
Improved breathing & heart rate
Reduced age effects on gray matter
Reduced cognitive decline
Reduced depression
Different brain metabolite expression
Decreased default mode network
activity and connectivity in ADHD and anxiety & with Alzheimer's-beta
amyloid plaques
Increased Theta and Alpha EEG
activity with relaxed attention and wakefulness, contemplative thought
Reduced cortisol levels, improve
multitasking
Reduced feelings of stress in stressful
event by prior meditating
Increased sustained voluntary
Yoga
Alertness
Brain functioning
Gene expression
Physical flexibility
Mental Flexibility
Balance
Reduce anxiety
Decrease stress
level
Lower blood
pressure
Lower weight
My Safe Place
Visualize the place
where you can feel
safe.
Draw your safe place
or make a collage.
Practice sensory
Safety of the Container
Relationship
Play room
Sand tray
Tent under the table
Play house
A trusted friend, dog, pet
Adam Sandler in the
Safety and Comfort
Guided imagery
Progressive relaxation
Tai chi
Walking, running
Scanning your body
Self-soothing blankets
Music/earphones
Breath work
Paint, play dough
Post Crisis Tools: Color My Heart
The child chooses a color to match 4 feelings (e.g.
happy, sad, mad, scared). Make a key or legend.
“What’s another feeling word you know”…“What’s
another feeling people feel”… “What’s another feeling you feel a lot”)
“Color how much of the feeling you have in your
heart until your heart is full. Try to use every color on your key.”
Can be used with colored sand in a bottle or a
Color Your Feelings
Identify feelings about
other people with the colors you add to
gingerbread figures including perpetrators (Gil, 2006.)
Color your feelings and
pain on your body cut-out.
Color your feelings in
Resources
Dougy Center: http://www.dougy.org/
Sesame Street: https://www. about our kids.org
(death, disaster, trauma)
