Tag: behavioural response

Trauma Treatment: Understanding the Complexity of Trauma

The complexity of trauma is explained both scientifically and by case histories by Bessel Van Der Kolk in his book, The Body Keeps the Score: Mind, brain and body in the transformation of trauma.  As I mentioned in an earlier post, psychologists agree that trauma is not the “life-threatening”, precipitating event but the ongoing impact on a person’s mind, brain and body.  In his book, Bessel discusses the evolution of trauma treatment methodologies (and his roles in this evolution), the complex impact of trauma on individuals, the differential behavioural responses to trauma by individuals and the common responses that lead to addiction.

Evolution of trauma treatments

Bessel explains that in his early training and working days, he experienced different treatment modes for trauma such as “talk therapy” and the pharmacological approach.  He explained that talk therapy involved having an individual recount the trauma event in detail so that they had to confront the reality of the event.  Unfortunately, this often lead to the person experiencing a traumatic episode as a result of the stimulus of recall.  In the pharmacological approach, reliance was placed on drugs to treat the trauma patient.  Unfortunately, these were often administered in isolation without the support of therapy and contributed to ongoing psychological problems such as prescription drug addiction and depression.

The most heartless approach that Bessel describes is electrical shock treatment designed to desensitise individuals to precipitating stimuli.  Sometimes the treatment itself created a trauma response because of the effect of the stimulus (e.g. touch) and the inhuman nature of the treatment, e.g. for someone who had been sexually abused.  Bessel highlighted the lack of understanding of trauma and the absence of an adequate framework for treatment modalities illustrated in these early methodologies. The pursuit of a more holistic and scientific approach to trauma treatment underpinned his life’s work in helping trauma sufferers, especially those suffering from P.T.S.D. (post-traumatic stress disorder).

Result of visceral overload of precipitating event

Bessel was at pains to explain the complexity of trauma and its impact on individuals.  In his book, he explains the different regions of the brain, how they interact normally and the dysfunctionality caused by trauma.  He stated, for example, that a traumatic event can leave a “visceral imprint” on the lower region of the brain, the amygdala (the source of our fight/flight/freeze response). Thus a particular sensation (a smell, sound, sight, touch or taste) can create a “flashback” and trigger a trauma response in an individual.  This traumatic experience of discrete sensations illustrates the ever-present challenge for a traumatised person of “misreading signals” and seeing danger where it does not exist.  This inability to control the stress response is in part due to what Bessel describes as the ”visceral overload” at the time of the trauma-precipitating event.  He also makes the point that therapists are often misguided by their own belief systems, including the belief that the interaction of the mind and body is top-down only.  However, his own experience of trauma patients and recent neuroscience research shows clearly that the body/brain influence is bidirectional.

Same event – different behavioural responses

Different people respond differently to the sensory overload precipitated by a traumatic event.  Bessel tells the story of Stan and Ute who were involved in a major pile-up on a Canadian motorway in 1999 involving 87 cars.  They were travelling in the same car and met a wall of fog and were part of the continuous crashing of cars and trucks.  They feared for their lives and witnessed people being killed by the intensity of the crash and associated fires.  Stan’s reaction to subsequent stimuli was one of aggression and anger (fight response) whereas Ute was numb, a condition involving “massive dissociation” (the freeze response).  Bessel suggested that Ute’s freeze response was a learned behaviour precipitated by her upbringing by a mother who continuously “yelled” at her.  Through Bessel’s caring therapy, they were able to progressively restore their lives, regaining emotional control.  Ute benefited from the bottom-up approach of the Trauma Center where the focus was on physiological monitoring to enable the patient on change their “relationship to bodily sensations”.  Bessel subsequently established the Trauma Research Foundation after he had been unfairly dismissed from the Center, experiencing trauma in his own professional life.

Common responses to trauma

Trauma and its incessant re-activation through discrete sensory stimulation along with flashbacks and nightmares, create a life situation of continuous pain.  Many people attempt to numb the pain by resorting to drugs or excessive alcohol to block out the painful memories. This can eventually lead to addiction, associated mental illnesses and censorious misunderstanding by family and friends.

Reflection

Trauma is a very complex phenomenon precipitated by a great variety of events, experienced in differential ways by individuals and leading to individualised responses.  Added to these diverse events, impacts and responses are the variety of initiating stimuli that can trigger a seemingly unrelated trauma response in everyday life.

Bessel argues that one of the problems for traumatised individuals is that they spend so much time and energy in the past.  They become unaware of, and insensitive to, the present.  He maintains that mindfulness practices can help to restore top-down, emotional regulation and that bottom-up approaches such as “breath, movement, touch” can help to restore physical equilibrium and calmness.  The widespread use of somatic meditation for trauma management  is consistent with his view.

As we grow in mindfulness, we gain increased insight into our “inner landscape”, our behavioural responses and the options we have to behave differently.  We come to understand better the impact of past events on our present-day triggers and responses.  This can help us to achieve clarity, calmness and compassion towards others experiencing their own physical and emotional challenges.

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Image by Gerd Altmann from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group, and the resources to support the blog.

Barriers to Overcoming the Anxiety Habit Loop

In previous posts I have discussed Judson Brewer’s concept of the habit loop underpinning anxiety, addiction and craving and his mindfulness processes for overcoming anxiety.  Central to his process for overcoming anxiety, is understanding the trigger-behaviour-reward process, the need to honestly and openly explore the realised rewards and costs of a particular behaviour and the willingness to update the reward value in our mind in the light of this learning.  In this post on barriers to using Judson’s process to overcome anxiety, I will explore further some of the ideas presented in his book, Unwinding Anxiety: Train Your Brain to Heal Your Mind.  I will also link this discussion to other ideas on barriers to mindfulness that I have written about earlier. 

Barriers to overcoming the anxiety habit loop

Below are some of the barriers I have identified in reading Judson’s book but supplemented by my earlier discussions:

  • Obsession with the news – we can feast on the news as if our lives depended on it.  At every opportunity, we might be seen accessing our mobile phones to find out the latest news.   We can do this while waiting, instead of using this down-time to build our awareness.   The problem is that the news is typically dominated by adverse events and people’s suffering as well as portents of disaster.  It is often unnerving, adds to anxiety and causes disquiet.  If we become obsessed with the news, we are not creating the space for stillness and calm that would enable us to be mindful about our habituated behaviour and its real rewards (outcomes). 
  • Closed worldview – pursuing the news is what Judson describes as “deprivation curiosity” where our motivation is to address a deficit in our knowledge where the reward is discovery of the up-to-date information.  However, this process constitutes a closed system because closure is achieved once the void (missing information) is filled.  We can also adopt a closed worldview by trying to protect ourselves from disconcerting or uncomfortable information, and related feelings, about our habituated behaviour and its impact on our wellbeing and the welfare of others.  Judson argues that what we need to pursue is “interest curiosity” where the process of curiosity is reward in itself because it is open-ended, never dries up and exposes us to the rewards of joy, wonder and awe.  He suggests that interest curiosity feels better when we compare it to “the scratchy, closed-down itch of deprivation”.
  • Review and regret approach – this habituated behaviour constitutes another closed circuit in that it leads us to self-flagellation and negative self-appraisal whenever we revert to our bad habit or make a mistake.   Judson suggests that what is needed here is “forgiveness and moving on and up”.  This reflective approach opens the way to real learning and sustained habit change.  We can beat up on ourself for mistakes but this only feeds the anxiety habit cycle and contributes to depression.  In contrast, If we adopt a growth mindset, we can see each experience, and attempt to overcome our anxiety habit loop, as an opportunity to learn and grow.  Our actions serve to give us feedback about outcomes, both intended and unintended – and this is the way we learn.
  • Lacking persistence – in this era of the desire for immediate satisfaction, it is easy to lose heart and give up before our goal is realised, even if we have made some progress along the way to reducing our anxiety level.  We can overlook the fact that our habituated behaviour has been developed over many years and, in some instances, has resulted from a traumatic event or adverse childhood experience.  It will take a concerted effort over an extended period of time to overcome an anxiety habit loop.   Judson suggests that it will take “short moments, many times” and a willingness to persist with the process of “kind curiosity” to unearth our anxiety habit loop and the underpinning reward system. 
  • Unchanged reward value – we can mindlessly accept the existing reward value that keeps our anxiety habit loop locked in thus creating a barrier to change.  Alternatively, we can actively seek to update our reward value with disenchanting information (which we typically ignore).  We tend to see only the positive aspects of a habituated behaviour (e.g. avoidance of discomfort, pain, embarrassment  or hurtful self-disclosure).  Judson likens this barrier to a “chocolate experiment” where people failed to realise when eating more and more chocolate turned an otherwise pleasurable experience into one that caused displeasure.  We can either not notice or ignore the “turning point” and fail to develop a real updated, assessment of a reward value.   This often occurs with people whose underlying anxiety drives a habit of procrastination.
  • Focus on reasoning rather than feeling – Judson argues that thinking and rationalisation will only go so far in terms of sustainable habit change.  While as humans we need thinking to problem solve, be creative and plan, rational argument has little impact on entrenched habits.  A more holistic approach of sustained personal inquiry is required to unearth not only our thoughts but emotions and bodily sensations that inform us about what is happening in the moment when we resort to our habituated responses. Focusing on our feelings in the moment gives us a way to understand the drivers behind habit formation and maintenance, and enables us to develop the requisite insight to update our “reward value” of the habituated behaviour.

Ways to overcome the barriers to unwinding anxiety

In his Unwinding Anxiety book, Judson discusses a one-week silent retreat that he and a colleague provided for members of the US women’s Olympic water-polo team (who were back to back gold medal winners).  He explained that a real breakthrough for members of the team in developing holistic, interest curiosity was achieved by having participants repeat the sound “hmm” as a mantra.   This sound when repeated tends to engender openness, wonder and awe while clearing the mind of its tendency to engage in worry and negative self-judgment.  Judson suggests that this practice can be employed whenever we become stuck in our meditation attempts, experience panic or encounter internal barriers to overcoming our anxiety habit loop.  It enables us to tap into bodily sensations, thoughts and emotions.

Judson also provides a process for experiencing a closed versus an open mindset.  This entails recalling in full colour and richness an anxious event followed by recalling a joyful event.  He explains that this process of observing bodily sensations generated by the different events forms part of the first day of his Unwinding Anxiety app.

Another source of encouragement to maintain persistence and adopt an open, learning mindset is provided by Lulu & Mischka in their mantra meditation, Metamorphosis.  The words of this mantra effectively describe the process of the sustained effort and open mindset required to achieve transformative change and encourages us to “not give up” but “trust the process” and be open to breaking with our old ways.  If we sing the mantra along with Lulu & Mischka, we can reinforce our desire to persist until we overcome our anxiety habit.

Reflection

Clearly the unwinding anxiety process proposed by Judson has application in many arenas, including in sports.   This got me thinking about an issue I am having with my tennis game when playing social tennis.   I have played tennis since I was about 12 years old (and probably earlier but I can’t think back that far).  I have used a single-handed backhand all my life but as I get older, my wrists and arms are becoming weaker (despite my occasional efforts to strengthen them with exercises).  So, for my 75th birthday, I requested three tennis lessons from a coach to learn how to do a double-handed backhand.  By the end of the third half hour lesson, I could manage a rally with the coach using my newly “acquired” double-handed backhand.  The problem is that I am experiencing an emotional blockage that is stopping me from using the new stroke at social tennis – I keep reverting to my single-handed backhand.

When I read about the habit loop and the need to change/update the reward value (in my mind) attributed to a particular behaviour in order to change the habit, I realised that what was keeping my old habit (single-handed backhand) in place was the failure to update the reward value of this behaviour.  I still seemed to be assuming that it was a reliable stroke preventing me from making mistakes and enabling me to keep the ball in play or win a rally.  The reality is that my single-handed backhand is no longer reliable and I do make lots of mistakes with it.  So I need to update the reward value that I attribute to this stroke and accept that in the earlier stages of a changeover to the new double-handed stroke, I will probably make more mistakes.  However, the bigger, better offer (BBO) is a stronger, double-handed stroke capable of winning a rally.  By being unwilling to use my double-handed backhand, I am adopting a closed mindset and depriving myself of the opportunity to learn through doing and reflecting on the outcomes.

As we grow in mindfulness through reflection, kind curiosity and mantra meditations, we can develop the persistence and courage to explore our anxiety habit loop and its reward value.  With a sustained concerted effort, we can begin to overcome our anxiety habit loop as we update our reward value and develop substitute rewards that are bigger and better than what we currently rely on, consciously or unconsciously.

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Image by Rudy and Peter Skitterians from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group, and the resources to support the blog.

Developing Awareness to Overcome Anxiety

Judson Brewer, world-renowned clinical psychologist and neuroscientist, maintains that mindfulness through a three-geared awareness process can break the anxiety habit loop.  His latest book,  Unwinding Anxiety: Train Your Brain to Heal Your Mind, provides a guide on how to develop the requisite awareness.  His clinical practice and scientific research in relation to cravings and addictions, the focus of his first book The Craving Mind, led naturally to his understanding of anxiety and how the anxiety habit is formed and overcome.

Judson argues that anxiety hides in our habits.  Underpinning cravings, addiction and anxiety is the fundamental habit loop which develops through operant conditioning – reinforcement of a behaviour through a rewards system.  We experience some kind of trigger which leads to a habituated response that brings a personalised reward.  For example, if you experience a stressful event/day (trigger), you might come home and have a drink of alcohol (behaviour) which enables you to deaden your distress and distracts you from it (reward).  In the process, you are setting up a habit loop which becomes increasingly entrenched because your behavioural response (drinking alcohol) becomes habituated and you progressively need more and more alcohol to deaden the pain and achieve the necessary level of distraction.     

The reward value concept

Judson explains in his latest book that the reward experienced after a habituated behaviour is not a single element creating the habit.  According to him, the way the brain works is that it establishes a reward value for a particular behavioural response that not only involves the present moment reward but also the recollection of the accumulated rewards associated with prior occurrences of that behavioural response.   So, the reward value attributed by the brain to a behavioural response (such as drinking alcohol after a stress trigger) is an accumulation of prior experiences that were deemed positive (such as drinking alcohol in good company in a stunning location) – all of which can distort the real value of the reward and further entrench the behaviour.

Breaking the habit loop or anxiety cycle

Judson points out that the way to break the habit loop or anxiety cycle involves fundamentally developing awareness of the habit loop and establishing a realistic and holistic assessment of the “reward” in the present moment.  For example, if our to-do list acts as an anxiety trigger leading to procrastination (behaviour) which provides the reward of avoidance, we can in-the-moment recall that the procrastination behaviour itself has adverse effects such as leading to criticism for delays and/or intensifying the level of experienced anxiety.   This heightened awareness may also be developed “reflexively” (reflecting on the trigger-behaviour-reward loop after the event) if the experience is relatively recent and the recall is rich in content.  These options of present moment awareness or reflexivity relate to what we have discussed previously as reflection-in-action and reflection-on-action. 

Developing holistic awareness

The fundamental problem with a habit loop is that our recall is often biased and defective.  We tend to overlook the adverse effects of a behavioural response and focus only on the positive, immediate effects (such as deadening or distraction).  In developing awareness of a habit loop or chronic anxiety, we need to adopt a more holistic and balanced approach – we need to become aware of the impacts of a behavioural response on our bodily sensations, thoughts and feelings as well as broader impacts such as on our work, our relationships and our environment.  Just providing an intellectual rationalisation for the desired changed behaviour is normally not enough to create the behaviour we desire – it ignores the power of emotions embedded in bodily sensations.  Judson points out that our survival needs (manifested through difficult emotions and bodily sensations) are more powerful than our need to overcome “cognitive dissonance” (where our rationalisations of a behavioural response conflict with our evidence-based experience).

Kind curiosity

Judson encourages the pursuit of “kind curiosity” to enable us to develop a more holistic and realistic assessment of the personally assigned “reward value” of a behavioural response.  Curiosity is a natural habit (evident in children and somewhat deadened in adults because of “mass distraction”) that can be encouraged and cultivated.  Unfettered curiosity can lead to unearthing disconcerting facts that may disarm, disillusion or distress us – it can challenge our self-concept in relation to our sense wholeness and genuine goodness.  Judson points out the importance of accompanying this heightened curiosity with forgiveness and loving kindness towards ourself – hence, the concept of kind curiosity.  Interestingly, Jon Kabat-Zinn’s definition of mindfulness includes the concept of purposefully paying attention in the present moment and doing so “non-judgmentally”.

Reflection

Once-off awareness raising is most likely to be ineffective in changing a habit and is definitely not going to overcome chronic anxiety.  We cannot expect to overcome habits that are entrenched and developed over many years (often since childhood). What is required is sustained kind curiosity and ongoing awareness raising.  Through sustained effort, we can substitute a more realistic reward value for the one that we have developed in our mind over time – which is why Judson suggests that we can unwind our anxiety by training our brain, through awareness training, to heal our mind.  Over time, too, we can develop what he calls a “bigger, better offer” (BBO) to offset the current reward value driving the existing anxiety habit loop.  He suggests that mindfulness might “fit the bill” here as it provides a wide range of benefits, without the adverse effect of substituting one bad habit for another (e.g. substituting lollies for alcohol).

As we grow in mindfulness, we can become aware of our triggers, our habituated behavioural responses and gain insight into the reward value that we attribute to our responses.  We can also learn to substitute more rewarding responses that will encourage the development of changed habits that have positive outcomes.  If we revert to old habits in times of extreme stress, it is important to avoid negative self-talk and self-denigrations and we can do this by extending forgiveness to ourself.

Throughout his book on anxiety, Judson draws on illustrations and validation from users of hist three  apps focused on cravings (e.g. over-eating), addiction (e.g. to smoking) and anxiety.  What these app-based programs provide is a readily accessible way to monitor yourself throughout the day and progressively substitute holistic rewards for those that are currently entrenching unhealthy habits.

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Image by Rudy and Peter Skitterians from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group, and the resources to support the blog.