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February 22, 2018 by Julieta Benavides

Befriending The Body

 

My last post focused on the physiological feedback loops occurring in the body as a result of traumatic situations, as explained in Bessel Van Der Kolk, M.D.’s “The Body Keeps the Score.”  Essentially, he shows that the world is experienced through a different nervous system after a traumatic event (and this can be any event with lasting consequences; I would bet that every one of us has experienced at least one traumatic event in our lifetime).  We are often triggered into sympathetic nervous system activity, or “fight or flight”, by seemingly benign situations, unable to put what is happening into a historical context of past versus present.  Trauma sufferers never quite feel safe in the body, as the brain’s “alarm system” is always signaling danger through chronic stress hormone activity.  Van Der Kolk puts it best: “Trauma is much more than a story about something that happened long ago.  The emotions and physical sensations that were imprinted during the trauma are experienced not as memories but as disruptive physical reactions in the present.”   If every time we experience an emotional trigger, we get upset, our hearts race, our breathing becomes shallow and we can’t articulate our fears, it makes it very difficult to make good choices and behave in our own best interests.  The question then becomes: how can we pull ourselves out of this disruptive state and realize that we are safe in the present moment?

Over the last thirty years, psychiatry has relied more and more on medication to regulate the post-trauma brain’s activity.  Medication can greatly improve our quality of life, but the problem is that we have to keep taking it.  The symptoms reappear when we stop taking the medication; it does not actually solve the problem.  Talk therapy is another option. This treatment encourages us to name what happened to us, to trust another person enough to be vulnerable in front of them and to have our experiences and feelings recognized, all of which can be very powerful.  However, talk therapy alone won’t solve the problem, either, because, after trauma, the rational brain is always hijacked by the nervous system.  Nervous system activation ultimately trumps intellectual insight.  In order to fully heal from trauma, we need to incorporate our bodies, too.  We can befriend our bodies again and use them as a way into the nervous system.  We can accomplish this through mindful awareness of our subtle body sensations.  When we see that we can make little shifts to these sensations, we can remap our brains to better respond to the present moment.  Therapies such as EMDR (Eye Movement Desensitization and Reprocessing), Neurofeedback, Somatic Experiencing and TRE (Tension & Trauma Release Exercises) have consistently produced profound healing with lasting results.  My “personal” opinion is that these types of therapies are the best at resolving trauma (see below for resources).  Yoga is another excellent way to recalibrate the nervous system, as it encourages the development of interoception and the ability to approach the body with curiosity and acceptance rather than fear.  Studies have shown a permanent decrease of PTSD symptoms after only 10 yoga sessions.  I have an irrational and inexplicable resistance to doing yoga myself, but I DO recommend it to my clients, as it truly has so many benefits.  Ok, so now for my “professional” opinion: let’s talk about massage!

Massage alone will rarely heal trauma, but massage is a wonderful adjunctive therapy for it.  One of the most natural ways humans can calm distress is through touch.  There are definitely people who enjoy touch less than others, but a significant majority of us find comfort in a rhythmic back rub or in being gently rocked.  Skilled touch can affect us on an even deeper level.  A stressed person is on constant sensory overload, and one of the most well-documented benefits of massage is its calming effect on the nervous system.  Massage puts us into parasympathetic nervous system activity, or “rest and digest”.  Brainwave studies using electroencephalograph (EEG) technology show that massage decreases beta activity in the brain (the highest frequency and the most alert state) and increases theta and alpha activity (associated with states of peace and calm).  Another benefit of massage is that through nurturing touch, we establish a connection with another person, ameliorating the isolation that can accompany trauma.  A massage therapist can impart empathy and a sense of safety through touch, safety being one of the fundamental requirements of trauma healing.  As clients, we are in control, and we determine the boundaries of where, how and in which way we are touched.  Further, as we allow ourselves to receive touch, we bring awareness to the parts of the body being massaged.  In so doing, we are grounding ourselves in our bodies as well as in the present moment, another fundamental tenet of trauma healing.  An added benefit of this increase in body awareness is that it invites us to notice where we are holding tension and release it.  When emotions are bound up inside of us, the body is tense.  As we relax, it becomes more difficult to hold on to negative emotions.  In this way, too, we are recalibrating our nervous system.

Finally, to return to the two pathways for perceptive input from my prior post, massage addresses both options for trauma recovery.  According to Van Der Kolk, treatment can be based on recalibrating the nervous system or strengthening our mindfulness surrounding body awareness.  Massage can provide a powerful support to primary therapies utilizing either treatment protocol, as I have illustrated above.  Even if we are not in trauma therapy, many of us have emotional triggers from a past experience and the basics of trauma healing can apply to us:  reestablishing ownership of body and mind, having experiences that restore a sense of physical safety and calming physical tensions in the body.  These are all benefits of massage therapy!

 

RESOURCES:

EMDR:  Leslie Larson, LPC  leslielarsontherapist.com

Somatic Experiencing:  Miranda Jane, mirandajanecounseling.com

 

 

 

Filed Under: Mindfulness

February 9, 2018 by Julieta Benavides

Trauma: Your Issues Really ARE In Your Tissues

My last few blog posts have focused on the relationship between body and mind.  Most massage therapists are very interested in how one informs the other.  In keeping with that theme, I recently read a fascinating book about Post Traumatic Stress Disorder, “The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel Van Der Kolk, M.D.  In it, Van Der Kolk explores the physiological changes in the body and minds of people who have experienced traumatic situations, essentially providing a more scientific explanation for the visceral and very physical reactions to emotional triggers exhibited by sufferers of trauma.  These reactions in the body can keep us trapped in a feedback loop of defensive or non-productive behavior, hindering our capacity to heal emotionally.  Van Der Kolk convincingly argues that since the nervous system after trauma is altered, we can utilize the nervous system in order to remap the brain and heal from past experience.  In very simplified terms, we can use the body to reprogram our minds.

Van Der Kolk bases much of his book on his work with war veterans and survivors of childhood abuse.  These extreme definitions of trauma provide very vivid examples of how the body and mind can react to shocking and stressful situations.  However, for my purposes I would like to expand the breadth of how we talk about trauma.  Fear or hurt in reaction to almost anything can leave dramatic marks on our psyches, resulting in traumatic effects. A “traumatic incident” can encompass a wide spectrum, from a car accident to a teacher’s harsh reprimand.  Shame around sexual desire or sexual rejection can cause trauma.  Even a tired father absentmindedly refusing a hug during childhood can leave a scar.  A situation that appears benign to one participant can leave a painful impression for a lifetime on another participant, if not dealt with.

Multiple studies show that trauma produces physiological changes in the brain (please refer to the aforementioned book for specifics – it is dense and full of research articles and case studies).  Trauma activates the right-brain, which is responsible for emotion and creativity, and deactivates the left-brain, which governs rational thought, language and historical sequencing.  This shutting down of the left-brain activity explains why when faced with an emotional trigger, we may not be able to put into words what we are feeling or experiencing.  Rational thought escapes us, the lines between past and present become blurred and we are incapable of understanding that we are not in actual danger in the present moment, as we were back when we initially suffered the traumatic event.  There is an accompanying increase in stress hormone activity, or a recalibration of the brain’s “alarm system”, which becomes chronic, keeping us in a constant state of sympathetic nervous system activity, or “fight or flight”.  Here is a basic idea of how this works:  the thalamus in the brain combines our perceptive input into a coherent picture of what is actually happening.  This can take two pathways in the brain.  The first is what neuroscientist Joseph LeDoux calls “the low road”, down to the amygdala in the limbic brain.  Van Der Kolk refers to the amygdala as our smoke detector, as one of its main functions is to determine whether input is relevant for our survival or not.  This function is quick and automatic, and if danger is sensed, the amygdala can instantly trigger the release of the stress hormones cortisol and adrenaline and recruit the nervous system to produce a whole-body response.  The second pathway, “the high road”, is much slower than the first.  The input here is directed up to the frontal cortex, for a conscious interpretation of the situation.  We can then judge whether the threat is real through conscious assessment: we observe what is happening, predict what might happen in various scenarios and then make a choice to act.  The problem is that the low road gets first dibs on interpreting the incoming information, so we can ostensibly get into nervous system activation before we can consciously assess whether there is real danger or not.  Trauma increases the risk of misinterpreting the signals and thalamus processing can break down, so those with PTSD have a much harder time making sense of the input, often over-reacting to innocuous comments or facial expressions.  In addition, the medial prefrontal cortex of trauma victims is often shut down.  This affects our sense of being fully alive and the sense of who we are.  For this reason, trauma sufferers often feel “dead inside” or feel like they “are not themselves” after the trauma.

The topic of trauma is incredibly complex and I have obviously simplified things for the purposes of this blog.  The vagus nerve plays an important role, and that will be the subject of another post.  However, I hope I have begun to make clear that trauma sufferers often repeat behaviors not out of a lack of willpower but due to actual changes in the brain.  This is why talk therapy alone is often not enough to resolve the problem.  If the emotional brain is wreaking havoc on the nervous system, no amount of insight and understanding will silence our “danger signals”.  Naming a trauma and connecting with another person can be an important part of healing the sense of isolation often felt by victims. However, adjunctive therapies are almost always necessary.  Trauma involves constant sensory overload and makes us feel chronically unsafe in our own bodies.  In order to recover we need to become familiar with and befriend our bodily sensations again; we need to feel IN our bodies and in the present moment.  Developing our sense of interoception, the awareness of our subtle body-based feelings, can help us change our relationship to our bodily sensations and learn to identify past versus present.  Van Der Kolk suggests going about this in two ways:  recalibrating both the low and high roads.  We can regulate the nervous system activation through breath, movement and touch.  We can also strengthen the capacity of the frontal lobes to monitor body sensations through mindfulness meditation or yoga.  Our perceptual and emotional map is nurtured and shaped by our experiences.  In other words, “neurons that fire together, wire together”; this is the neuroplasticity of the brain.  We can use the concept of neuroplasticity to remap our brains and regain our agency after traumatic experiences.

In summary, after trauma we experience the world through a different nervous system.  However, we can rewire our brains in order to regain a sense of normalcy.  In the next post, I will elaborate on some effective ways to accomplish this, including how massage therapy comes into play.  Massage therapy by itself will not resolve trauma, nor is it the most effective adjunctive therapy for all conditions.  However, it can be an incredibly powerful tool to develop body awareness, ground us in the present moment and reestablish boundaries and a sense of safety in touch.

 

Filed Under: Massage

February 7, 2018 by Julieta Benavides

Best of 2017

 

Thank you for all of your feedback and support over the past year!  I have a few new people on my newsletter, so I thought it would be a good time to revisit some of the most popular posts of 2017.  Many of these contain self-care tips you can use at home!  Even if you have been with me since the beginning, you might find re-reading a couple of your old favorite posts over your morning coffee helpful.  Truthfully, I write many of these as reminders to myself as well as to my readers, so …. this is what I did this morning over MY morning cup.   (PS. I  switched to mushroom coffee a few months ago – if anyone finds coffee anxiety-producing, my vote is give this a try.  I actually like the milder flavor now.)  Thank you, as always, for reading!

Sleep:

Allowing yourself ample time and creating a good environment for sleep is probably the most restorative thing you can do for yourself.  Your body cannot function properly without enough sleep.

sleep positions

sleep hygiene

artificial light and sleep

 

Movement:

Most of us do not get enough movement throughout our days, as we generally spend too many hours sitting at desks, in the car, on the sofa or at the kitchen table.  The old saying “Motion is Lotion” is true:  constant, varied, gentle motion spread out throughout the course of the day keeps muscles and joints limber and prevents repetitive stress injuries.

the case for movement

alternatives to chair sitting

feet mobilization and shoes

how to walk better

 

Anatomy:

They are all important but these were the most shared posts about the body.

joint pain

psoas

eyes and effects of staring at screens

 

The Lymphatic System:

This critical system never gets enough attention in the medical literature, in my opinion.  Here are some basics.

lymphatic system overview

manual lymphatic drainage

DIY lymphatic drainage

 

Owning Your Healing:

the doctor within

advocating for yourself

 

 

Filed Under: Updates

December 12, 2017 by Julieta Benavides

Why You Still Need A Doula Even If You Have A Midwife And Partner

Midwives and doulas have become slightly more mainstream in the U.S. over the past few decades, but there is still much confusion as to what exactly their roles are.  Women often ask why they need a doula if they are planning to have a midwife. Another common question is why they would need a doula if their romantic partner is planning to be the birth companion during labor.  The truth is that each of these people have a specific and important role to inhabit during the birthing process and these roles are very different.

A midwife is a medical professional, much like an OB/GYN solely in terms of her ROLE in pregnancy and labor.  A midwife is trained through years of schooling to provide any necessary medical care during pregnancy and her license authorizes her to catch the baby when it comes time for labor.  (Not to be weird, but I don’t like using the expression “deliver the baby” because the mother is the one delivering the baby … not the doctor or midwife.  Even through the language we use, I think the power should stay where it belongs, with the mom.)   Certified nurse-midwives can do many of the same things as doctors, meaning they can perform gynecological exams, provide prenatal care, administer pain medications, give labor-inducing drugs, monitor the fetus using electronic equipment and perform an episiotomy and stitch tears. Here is where the similarities with modern obstetrics end, however.  Midwifery, in contrast to the medicalized model of birth, is woman-centered.  It produces birth professionals with expertise and skills in supporting women to maintain healthy pregnancies, have optimal births and have the most favorable recoveries during the postpartum period. Here is a statement from the Midwives Alliance North America:

“The Midwives Model of Care™ is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics. Midwifery care is uniquely nurturing, hands-on care before, during, and after birth. Midwives are health care professionals specializing in pregnancy and childbirth who develop a trusting relationship with their clients, which results in confident, supported labor and birth. While there are different types of midwives practicing in various settings, all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns. The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:

  • monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
  • providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • minimizing technological interventions and
  • identifying and referring women who require obstetrical attention.

The application of this model has been proven to reduce the incidence of birth injury, trauma, and cesarean section.”

In contrast to a midwife, a doula is not a medical professional, but her role is just as important.  A birth doula is basically a birth coach, trained in all sorts of non-medical techniques to help a laboring mom feel safe and empowered throughout the experience.  Doulas provide continual, uninterrupted support during the length of the labor, responding to mom’s physical, mental and emotional needs as they arise.  A doula is always asking herself “What is going on for mom at this stage of her labor and how can I best support her?”  This can come in the form of physical support:  providing comfort measures for pain management, such as massage, hot packs, ice packs, or breathing exercises, and even reminding mom that she might need to eat, use the bathroom or simply rest.  One of the most important ways in which a doula can provide physical support is by suggesting position changes based on where the baby is in the pelvis or if a position is not producing any progress.  The majority of unplanned cesareans are performed due to “failure to progress,” which means the baby essentially gets temporarily stuck in the pelvis, and the doctor either doesn’t have the time or doesn’t know how to help mom and baby get into a more favorable position for descent.  If mom is encouraged to move, squat, perform a lunge, allow an “abdominal lift” or a side-lying release for a few contractions, it often provides just that extra little bit of space so baby can wiggle his or her way down further in the pelvis.  This provides a feeling of accomplishment for mom and less birth trauma for baby.

Mental support from a doula might involve coaching mom through visualization exercises, or explaining what could be happening at any given time so mom or her partner can better advocate for themselves.  Preserving the memory of the birth is another way in which a doula provides mental support, as she can often fill in fuzzy details for the new parents later during the postpartum visit.  Finally, a doula provides emotional support through constant reassurance and encouragement. She takes charge when mom loses her rhythm until mom can get it back.  If mom loses faith in herself for a moment, a doula is there to remind her that she is strong enough to deliver her baby.  Often what is needed is some sort of change, whether it be positional or environmental, and a doula can provide knowledgeable guidance.  After birth, postpartum doulas help a new mother as she recovers from the birthing process. This includes caring for the infant and guiding a mother through the breast-feeding process.

Benefits of having a doula:

 

A birth partner (husband, wife, partner, etc) has a large supportive role during labor, but unlike a doula, lacks the specific training to help mom with position changes and pain management techniques.  A doula will often coach the partner in how to better support the laboring mom, so rather than the doula being the focus, the focus can be on the bond between mom and her partner.  As the partner has a very personal investment in the birth process, s/he might get anxious or overwhelmed and be unable to help mom effectively.  A doula has the professionalism and experience to handle emotional situations with a sense of calm, and can often step in to provide the necessary support until the partner can once again participate.  A doula can be helpful for the partner as well as for the birthing mom.

The childbirth year is a time of a woman’s life during which she should have an abundance of  support.  A doula, in addition to a midwife and labor partner, can play an integral part in helping a laboring mom to feel as empowered as possible and to have a more positive birth experience.

 

RESOURCES:

DONA International

Midwives Alliance North America

 

 

Filed Under: Best Practices

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