Memory In Trauma

The old primitive brain is shown in blue and red: the limbic system, brain stem and cerebellum.
The old primitive brain is shown in blue and red: the limbic system, brain stem and cerebellum.

Some Thoughts On Memory

Where are memories stored? In order to heal trauma, how important is it to remember what happened? These are common questions that often come up working with clients and teaching on trauma.

There are folklore phrases such as ‘muscle memory’ and ‘cellular memory’ that can be very useful but need to be applied carefully. They speak to the importance of information stored in the body. However it is essential to understand that for the information to be available to our awareness, our brain needs to be involved in processing the patterns of information flow happening in the body. Where the information is processed – in the primitive brain (unconscious) or in the cortex (conscious) – determines whether or not the memory is explicit.

I have a favourite old pair of jeans right now, some holes are on the second round of stitching. The wrinkles and folds in the material are a memory of sorts, the jeans mould to my body like no other pair of trousers. The fascia researcher Gil Hedley (2005) talks about fascia as ‘fuzz’. The fuzz accumulates and represents time. A certain stickiness and alignment of the fibres in the tissues holds the joints in more habitual ways.

Imagine a small child being shouted out by her father. Her shoulders tense, her neck tightens and there is a surge of fear related hormones and activity in the body. If this happens continuously the pattern of ‘shoulders tense and neck tight’ becomes a deep ‘action pattern’ (Kozlowska et al 2015).

Now imagine 30 years later the adult is on your treatment table. With grounded presence and soft, safe, warm, hands you are holding her head and neck. The tissues in her neck begin to express long held contractions and tightness. A shape in her body emerges, similar to the pattern generated when she got shouted at. Your client begins to feel unease and may think about her father.

The ‘muscle memory’ is the tension and tone in the tensegrity of the neck (Ingber 2008). The ‘cellular memory’ is cellular membrane receptors on local and global cells that grew to be sensitive to the all the stress hormones, immune system signaling and inflammatory chemicals that used to be secreted in the fear response (Damasio and Carvalho 2013). The ‘action patterns’ are simple, default movement schemas held in the old primitive brain.

Sensory nerves signal the changes in tension and chemical milieu to the brain. Only with the brain involved do we have emotions, feelings and thoughts generated in awareness. They may or may not be fully integrated into cognition, but something is happening. A memory is being expressed.

Instead of explicit memories we can have implicit memories (I first heard this term from Babette Rothschild, 2000), here the activation is chiefly in the primitive brain (brain stem, cerebellum and limbic system). The client on the table becomes scared when you touch her neck and too much changes too soon, but she does not really know why she is getting upset.

As a therapist working with trauma it is important to note the surges and changes in the rhythmic activity of the body as implicit memories occur. There are some great early warning signals that something is happening.1

We can then help find the right pace of change for the individual so they can learn to self-regulate. The therapist’s skillful presence can lead to co-regulation such that the individual can learn to self-regulate (Ndefo 2015). The primitive brain does not do words and concepts very well, but will respond to safety, touch and presence.

Implicit memories are coded very simply in the primitive brain. Often they are without a timeline. The amygdala – an important part of our threat detection system (LeDoux 2015) – holds lots of symbolic representations of threat. The amygdala will trigger ‘fight-or-flight’ or ‘immobility’ responses (‘defense cascade’ Kozlowska et al 2015) if it senses danger in the incoming information stream.

If the cortex gets involved then we will have explicit memory – we can pull in associated events and a timeline to contextualise the activity in the body. Explicit memories usually only emerge into awareness after the body has changed. The hippocampus and prefrontal cortex should help us say ‘That happened 30 years ago’. The skill of the therapist here is to honor the memories and stories that appear but keep orienting the client to resources in the body and environment; ‘Its not happening now’, even if your body is screaming at you be scared.

Following Dr David Berceli (2008), founder of Trauma Releasing Exercises (TRE), I am fond of saying ‘You do not need to remember or do not need to understand to heal trauma’. The goal is to overwrite the symbols in the amygdala with present time information. The body is a great source of good news that can bring you into now.

Summary

Information is stored in the tissues and cells of the body.

The threat detection systems in the primitive brain can be activated as the body changes.

The primitive brain does not do words and concepts very well, but will respond to safety, touch and presence.

If we can support change in the body and down regulate arousal we can change memories with out needing to understand or remember the trauma event.

The goal is to uncouple the charge of the defense cascade from the sensations of the implicit memory.

Notes

1 Kozlowska et al (2015) list some early signs of arousal. For flight-or-fight (their preferred order of this phrase) they list; changes in breath, furrowing of the eyebrows, the tensing of the jaw, or the clenching of a fist, narrowing of the range of attention. For immobility states they list; visual blurring, sweating, nausea, warmth, light-headedness, and fatigue. 

My favourite signs to look out for are anything going too quick (thoughts, sensations or emotions that cannot be integrated into the present moment) and anything going too slow (spacey, floaty, absence, hard to make eye contact, numbness or tingling or loss of body awareness). 

Dry mouth, sense of small or far away feet, absent belly, cold hands and a sense of someone withdrawing are all good signs to put the brakes on, whatever process is being expressed. David Berceli teaches ‘Freezing, Flooding or Dissociation’ as signs that too much arousal is occurring.

Download as pdf: memory v3 2015-10-29

References

Berceli D (2008) The Revolutionary Trauma Release Process. Transcend Your Toughest Times. Vancouver: Namaste Publishing.

Damasio A and Carvalho GB (2013) The nature of feelings: evolutionary and neurobiological origins. Nature Reviews Neuroscience, Vol 14, February 2013, 143.

Hedley G (2005) The Integral Anatomy Series. 4 Vol DVD set. Integral Anatomy Productions, LLC, 430 Westwood Avenue, Westwood, NJ 07675, USA (or check ‘The Fuzz Speech’ on YouTube).

Ingber DE (2008) Tensegrity and mechanotransduction. Journal of Bodywork and Movement Therapies 12, 198–200.

Kozlowska K, Walker P, McLean L, and Carrive P (2015) Fear and the Defense Cascade: Clinical Implications and Management. Harv Rev Psychiatry. 2015 Jul; 23(4): 263–287.

LeDoux JE (2015) The Amygdala Is NOT the Brain’s Fear Center. psychologytoday.com http://bit.ly/ledoux-no-fear-center  Accessed 2015-09-01

Ndefo N (2015) Personal communication. www.trelosangeles.com ‘Sometimes we have to co-regulate before we can self-regulate’.

Rothschild B (2000) The Body Remembers – The Psychophysiology of Trauma and Trauma Treatment. London: W.W. Norton.

Rocking Review of ‘Pain Is Really Strange’ from a GP

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‘As a General Practitioner, faced with a patient with chronic pain and having less than ten minutes to ‘sort them out’, I know from experience it is very easy to reach for the prescription pad (or, latterly, the prescribing screen on the computer), rather than engage in lengthy discussion about perception, thinking habits and physical remedies. From now on, however, I may well recommend this great little book as part of my management of such difficult ‘cases’.

‘I learned new ideas from this book. Learning from graphic narratives is one thing, but finding a comic I would actually recommend to patients is a much rarer occurrence. I would definitely recommend this title to those suffering chronic pain or anyone with an interest in this fascinating area.’

For the full review see here:

http://www.graphicmedicine.org/comic-reviews/pain-is-really-strange/

Orienting To Your Body – Weight-Outline-Skin-Inside ‘WOSI’

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‘The findings presented here demonstrate that the subjective experience of pain can only be understood in a larger framework of body representations and peripersonal space.’

http://journal.frontiersin.org/article/10.3389/fnhum.2014.00369

See previous blog: https://painisreallystrange.wordpress.com/2015/04/18/altered-perceived-body-image-is-associated-with-chronic-pain/

Orienting to your body

An extremely useful skill is to learn to perceive the whole of your body. This is not a given. Close your eyes right now – how big or small do your feet feel? Are you sure they feel really clear and present?

Keep practicing your subjective experience of simple things such as the size, shape and weight. It may take a while until these qualities becomes easily available. Try to work through the Weight-Outline-Skin-Inside ‘WOSI’ sequence below.

Can you really inhabit the whole of your body space? The boundary of the skin helps differentiate who we are. Our skin is a transition place between me and not me. We can engage with the skin as an outpost of the nervous system. It is a very powerful to come into relationship with your skin and take up occupancy in the whole space of your body.

Frequently there will be bits missing in our awareness: ‘My feel feel really small and far away’, ‘One leg is heavier and bigger’, ‘My  abdomen feels absent and empty’, ‘I am floating’, ‘I think it feels ok’. 

The last one is always a challenge. You think you have a body? You are the expert on what it feels like to be you. Try to make definitive statements, generally simple descriptive words work best. What is the difference between knowing you have a body and thinking?

Commit to what you perceive, let yourself use metaphors (‘fluffy white rabbits’ was one memorable description) and swap the verb from thinking to feeling. Feeling is such a wonderful word in that it speaks of sensation but also emotional tone. Let both be present in your awareness. What is your response to feeling the nuances of your body? It can be intense, so go slowly, but do keep trying.

If your map of your body is inaccurate it will be very hard for your brain to control your body. This is the root of many pain conditions.

How is your brain mapping out your body? WOSI

Below are some sample questions that can help you draw out your sense of your body. Initially it can be useful to go through them as a sequence when lying down and using the mnemonic WOSI; Weight, Outline, Skin, Inside. With more experience you can be much more flexible. Often the simple question ‘how does x compare to y’ can open up a realisation of an incomplete mapping of the body.

Weight

‘How does the weight of your body feel?’

‘Do your shoulder blades, hips, knees and ankles feel even?’

Outline

‘Can you feel the outline of your body, the silhouette it makes?’

‘Does the outline feel the same from the inside with your eyes closed as it would if you were looking at your body or touching it?’

‘How close or far away are your hands and feet. Check they are not too big too small or too close or too far away?’

Skin

‘Can you feel your skin as a clear boundary between the inside and the outside?’

‘Does your skin feel sharply defined and easy to contact or is it a bit blurry or amorphous?’

Inside

‘How does the inside of your body feel?’

‘Does the inside of your body feel full, flowing, alive or are there bits that feel empty, fixed, numb or hard to contact?’

prs body map v1

A revolution in understanding pain – interview with the author of ‘Pain is Really Strange’

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In this interview Steve Haines, author of Pain is Really Strange, discusses the topic of pain, he explains the reasons behind his choice to write a book about it using the graphic medium and tells us what people can do to manage pain.

Read the edited interview here:

Why do a book on pain?

There’s an awful lot of pain around. There was a huge survey done in Europe: 1 in 5 people experience chronic pain. They have persistent or severe pain for more than six months. For many of them, the median time was a number of years.

People manage large amounts of pain. Pain is a universal human experience; everybody knows what pain is.

The really exciting news is that there is a revolution in how we understand pain. The goal of the book is to try and explain that. How pain works is actually a little bit counterintuitive, a little bit strange. Some of the things that people think cause pain actually turn out to be not quite as central as folklore would have it.

Why do a graphic book on pain?

Education is a central tool in changing pain. The goal of using images it to make it light and really accessible. A good image can communicate an argument and idea very quickly. The book emerged from lots of lectures and talks I’ve given over the years. I have been endlessly trying to find creative ways of explaining how pain works to my clients and students.

I was incredibly lucky to meet Sophie Standing. I have really enjoyed how she’s visualized the work. She surprised me sometimes about how she took an idea that I’d been familiar with for a number of years and just showed it in a very different way.

I think that graphic novels can be very powerful tools. Pain Is Really Strange is short and sweet, 36 pages, but there’s an awful lot of information packed into the book. The images try and really crystallize ideas into something simple.

 Who is the book aimed at?

The book is for everybody. Everybody experiences pain, and I think everybody can learn from the new science. The current research can really help us change our idea and experience of what pain is, even really difficult chronic pain.

I would offer that everybody should be able to stand, walk, sit, and sleep, without issues. You might not be able to run a marathon anymore, and you might not have the best tennis serve that you had when you were in your 20s, but ordinary movements of sitting, standing, walking, lifting your shopping; it’s actually often possible to get people to a place where they can do those everyday functions with ease reasonably quickly. That makes a huge change in happiness and vitality

What is the central message of the book?

There is something that you can do to change your pain experience. There’s always a change in behaviour, a change in how you think, feel, move that can be used to creatively stimulate your brain to do something different.

The really central message is: think of pain as a bad habit or an alarm system that has gone wrong. Short-term it was very useful, but long-term chronic pain serves very little purpose. We can unlearn the pain habit. We can train our nervous system to respond differently to the information that’s coming in.

What is the hardest thing to explain about pain?

By saying: “Pain involves the brain,” people often feel that you’re saying that it’s their fault. That’s really not what I am saying. I like to talk about the mind, the brain, and the body. The mind is our consciousness, our awareness, our sense of self. The brain is in between the mind and the body. Pain is an output from the nervous system, not an input.

The brain can make mistakes. It gets into habits or reflexes. Evolution has taught us to respond to the threat of danger very, very quickly, and sometimes in those quick responses, we go down fixed, hard-wired, old patterns that are hard to break out of. But, and this is the important bit, reflexes and habits are responsive to new learning; we can learn to respond differently.

There’s no one answer to pain. For me that’s very exciting, but it can feel overwhelming and confusing. It implies that creativity, learning to do things differently, is possible. A complex nervous system will benefit from a multitude of responses. Culture, society, family, stress, how we eat, emotion and metabolic activity in our body are all deeply relevant to the pain experience.

What can people do to manage pain?

Mostly, it’s about being creative. Do something different. Whatever you’ve been doing, if you’re still in pain, it’s not working. Try a new approach. We can move differently, understand differently, feel differently, describe ourselves differently. The book explores some simple hints about how we might do those things, but the essence is change and creativity in response to the danger signal, and not going down fixed, hard-wired responses.

Understand that reflexes that were useful when you really needed to protect the tissues as they repaired are no longer useful after the tissues have repaired. Tissue repair takes no more than a few months. In chronic pain the nervous system needs recalibrating.

For me, the book is a very hopeful book; there is something you can do to change your pain experience. Pain isn’t about tissues. It’s about an alarm system in the nervous system that’s exaggerated and is no longer accurate about the state of the tissues.

Steve Haines, June 2015

Or listen to the full interview here. Linda from Singing Dragon asked Steve Haines some questions…

(reblogged from the weblink above)

 

What People Are Saying About ‘Pain Is Really Strange’

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Only a few weeks to go before publication on 21 June and officially getting excited. Here are some comments from people who have seen the pdf version:

‘The wisdom and knowledge in this seemingly simple book sneaks up on the reader. Initially one would not think that such a depth of insight could be infused in a picture book. However, it can be likened to a printed version of a TED Talk. It engages the reader more and more with each page until in the end the reader realizes they want to read it again because it contains so much useful information in such an easily accessible manner.’

David Berceli, Ph.D. Creator of Tension & Trauma Releasing Exercises (TRE). Author of The Revolutionary Trauma Release Process

 

‘Steve and Sophie have done an extraordinary thing: they have managed to make pain beautiful and interesting. If you want to really understand your relationship with pain and be thoroughly entertained at the same time then this is the book for you.’

Fred Deakin, Professor of Interactive Digital Arts at University of the Arts London, half of the band Lemon Jelly, and founder and director of Airside design agency

 

‘This seemingly innocuous picture book on pain is so much more. Steve Haines has compiled a brilliant little volume of insights. Its colorful images evoke in us the playful and open response we need to unlearn long-held beliefs, while the rich scientific information dissembles, piece by piece, the way we’ve come to think about pain as a culture. Haines takes the next step, too; he doesn’t leave us wondering what to do next, but offers practical tools we can use to rewire the mind-body circuits that experience and respond to pain. This tiny book packs a powerful punch.’

Bo Forbes, Psy.D., Psychologist, Yoga Teacher, and Author of Yoga for Emotional Balance

 

‘Pain Is Really Strange is a revelation. I have been actively managing multiple health conditions for over 20 years. In his book, Steve unpacks information about our brains, nerves, and body memories, sketching out a framework, which has presented me with a new, insightful perspective on my pain/health/medical issues. He differentiates different types of pain and eloquently articulates bits of information I have encountered over the years but not been able to join up. I shall re-read it often as a touchstone. Brilliant!’

Craig Givens, Someone who manages more pain than he likes.

Altered perceived body image is associated with chronic pain

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Our ability to accurately map out our body is an essential feature of health. The brain needs accurate information about the body to be able to control the body. In my clinical practice, people reporting distorted body images are very common. Helping people be safe enough and skilled enough to feel the slow background tone of the body is often the first thing I work on in helping people change their pain experience.

Feet are often hard to feel and the belly is frequently absent. Simple things like the weight, outline, skin and inside feel of the body are surprisingly hard to orient to.

The article by Nishigami 2015 explores the above model. He highlights research that states ‘Altered perceived body image is associated with chronic pain.’ and ‘Many studies have shown that somatosensory cortex reorganization might contribute to pain…… Poor sensory function and distorted image are likely to contribute to discrepancies between sensory and motor performance. Therefore, sensorimotor incongruence may be associated with distorted perceived image of the low back in chronic low back pain patients.’

(Nishigami discusses a study he performed on 42 people with chronic low back pain. He find thats the 57% of the patients had expanded or shrunken perceived body image. Though it should be noted that in his study, ‘differences in perceived body image were not associated with clinical symptoms’.)

References

Nishigami T (2015) Relationship between tactile acuity, clinical symptoms and perceived body image in patients with chronic low back pain. Body In Mind http://www.bodyinmind.org/tactile-acuity-clinical-symptoms-body-image-clbp/ accessed 2015-04-18

Emotion influences the intensity of pain: www.npr.org

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Follow this link to a really nice 4 min clip on pain and emotion. A little bit of the text is copied below.

http://www.npr.org/blogs/health/2015/02/18/387211563/pain-really-is-all-in-your-head-emotion-controls-intensity

‘”Soldiers in the heat of the moment don’t recognize the pain that’s happening,” Linden says. But once that moment is over, those same soldiers may feel a lot of pain from something minor, like a hypodermic needle, he says.

The brain also determines the emotion we attach to each painful experience, Linden says. That’s possible, he explains, because the brain uses two different systems to process pain information coming from our nerve endings.

One system determines the pain’s location, intensity and characteristics: stabbing, aching, burning, etc.

“And then,” Linden says, “there is a completely separate system for the emotional aspect of pain — the part that makes us go, ‘Ow! This is terrible.’ ”

Linden says positive emotions — like feeling calm and safe and connected to others — can minimize pain. But negative emotions tend to have the opposite effect. Torturers have exploited that aspect for centuries.’