Experiential Self-Regulation in Trauma Therapy
Feelings, Emotions, and Affect Regulation*
Affect regulation (self-regulation) is the ability to manage extreme emotions (positive or negative affect). Self-regulation is essential to trauma therapy, for virtually all survivors deal with on-going emotional reactions to things that remind them of the past (triggers and secondary alerts) and with the increased vulnerability to stress that usually follows trauma. These reactions can be so strong that survivors experience a kind of regression into Withdrawal, an early stage in trauma recovery (see diagram of the stages in the Expressive Trauma Integration model as a means of coping.
Last blog post, I wrote about self-regulation in the context of attachment and developmental trauma. This post addresses self-regulation in the context of trauma and PTSD.
Invisible Volcano Within
After trauma, survivors suffer from strong stress reactions and sensations that are unpredictable and disordered. They feel that life is “out of control” and something bad is about to happen. This can lead to chronic stress for trauma survivors.
Self-regulation is a challenge, of course, for every human being. Post trauma stress makes the challenge even harder. For trauma survivors self-regulation is a monumental task.
Trauma shocks all systems. These include: (1) Cognitive – trauma affects ability to process thoughts and make good judgments; (2) Physical – it affects our muscles, joins, metabolism, temperature, sleep, immune system etc.; (3) Spiritual – trauma affects our worldview, our understanding and meaning of life, society, and the world; and (4) Social – trauma affects relationships with spouses, family, friends, colleagues and strangers.
Trauma brings fear and a sense of anxious unpredictability into our experience of all these systems. The result is that many survivors feel chronically “on edge” and overwhelmed, with all their inner resources consumed in the struggle to cope with the sense of constant vulnerability they carry.
An individual’s self-regulation system after trauma plays out in two opposite ways. Some survivors are prone to hyperarousal, which is like carrying an invisible volcano inside, stoked with easily triggered anger, panic, or anxiety. Other survivors are prone to the opposite, hypoarousal, characterized by numbness and withdrawal.
There are survivors who struggle with hyperarousal for a time and then, overwhelmed and exhausted, shift into hypoarousal. Such difficulties are temporary for some survivors and prolonged for others.
During a traumatic event, stress responses trigger fight/flight/freeze response (Event stage in the ETI roadmap). When the traumatic Event is over, triggers remain. That is, the individual is easily triggered to feel that danger has returned, by things that look, sound, smell, or feel like the experience at the time of trauma. These perceived threat responses often activate what I call a Withdrawal response (stage three in the ETI roadmap).
The moment that trauma takes place an unusual amount of life resources emerge to help you survive. These resources continue after the traumatic event ends, and into the next stage, Withdrawal.
As soon as the traumatic Event is past, a powerful urge to Withdraw to safety and rest sets in. In the immediate aftermath of trauma, Withdrawal is a useful, life-preserving response that reduces vulnerability to further injury. However, at some point this life preserving response can easily create a cycle of misery.
In withdrawal, survivors remove themselves from active engagement with life and other people. They cycle through intense emotions typically associated with the immediate aftermath of trauma, such as fear, anger, shame, guilt, and a sense of moral injury. Often they are gripped by endless rumination (“shoulda’/coulda’/woulda’”).
Some survivors are able to move beyond this stage before long. Many more have a hard time moving beyond it and remain trapped in a sense of Withdrawal for a long time, some for a lifetime.
Awareness as Exit From Withdrawal
Two types of awareness are needed to move beyond withdrawal (Awareness is stage four in the ETI roadmap). The first one is through experiential psychoeducation. The second one is through practice of Awareness as being in the present. In the context of trauma therapy, addressing body-awareness is central for moving towards integration.
The Body – Both Source of Pain and Resource
To understand why work with the body is so important, let’s review what happens in trauma. When trauma takes place, automatic survival mechanisms pave a kind of emergency highway in the brain. This highway is managed by the instinctual part of the brain and coordinates the fight/flight/freeze mechanisms we are wired to use in emergencies. The instinctual part of the brain control this highway and assumes broad control of all brain and body functions when we are on it.
Once created, an emergency highway doesn’t go away. It remains as a neural pathway with a variety of quick entry ramps, all of them from the body. The instinctual brain can be easily triggered to re-enter it by any signals from the senses, perceived or real, that remind of the original threat. These could be a smell, a taste, a sound, a sight, a body motion or sensation, anything that we associate with the trauma.
The body is like a sponge for stress sensations. Following trauma, the body remembers the sensations experienced in response to the traumatic event/s. Sensations experienced during the traumatic event create a neural pathway, with a deep imprint in the body and brain, which I refer to above as an emergency highway. This emergency highway system is easily triggered. With repeated triggering events, it moves the body into a state of constant high alert. Over time, the stress has damaging affects on the body, in the form of disturbed metabolism, compromised immune system, difficulties with sleeping, and more.
Therefore, it is essential to address the body and the way in which trauma affects it, as well as how the body in time comes to affect the mind. “The price for ignoring or distorting the body’s messages is being unable to detect what is truly dangerous or harmful for you and, just as bad, what is safe and nourishing,” (van der Kolk, 2014, p. 97).
Learning to detect and trace what is happening in the body, what sensations are associated with particular emotion, which day-to-day routines bring relaxation and comfort, and which bring stress – all are important ways to maintain self-regulation.
What about Internal Secondary Alerts (ISA)?
In working on body awareness, it helps to understand and address Internal Secondary Alerts. These are responses of the body experienced during episodes of remembering trauma. Repeated episodes of being reminded about the past by triggers of any kind, and reacting with anxiety and fear over and over again, can cause a survivor’s physical responses to themselves become triggers.
When survivors are triggered by something that reminds them of the original trauma, they typically experience reactions like high pulse, dizziness, headache, sweating (hot/cold), dry-mouth, nausea, feeling hot/cold, etc. Multiple experiences of this can result in these reactions becoming associated with trauma, to such an extent that they become triggers themselves, capable of bringing back memories of trauma with the same intensity as triggers “out there”.
When this happens, something as simple as shivering in cold weather or nausea from morning sickness in pregnancy can set off a trauma response. Internal secondary alerts also need to be addressed in trauma therapy just as carefully as the more obvious primary trauma triggers.
The Midway Zone
The Window of Tolerance is a term coined by Siegel (2010) to describe a balanced zone of stress response. When within his or her Window of Tolerance, a trauma survivor can process thoughts and emotions, make proper judgment calls, and gain new learnings without instinctually reacting to stress (slipping into hyperarousal or hypoarousal).
“Personal change, both in therapy and in life,” wrote Siegel, “often depends on widening…a window of tolerance” (Siegel, 2010). The goal is for clients to be able to expand their ability to respond to their high and low triggers in a way that makes these sensations tolerable without throwing them off-balance (hyperarousal or hypoarousal).
Porges (2011) added an important additional concept to the Window of Tolerance, social engagement. Interaction with others is difficult in either a hyper or hypo state. In the Midway Zone, survivors can gain new skills and experience a full range of emotions while maintaining a sense of control. Porges emphasized face-to-face interaction as key to maintaining social engagement.
Playful social engagement regulates stress responses and enables survivors to expand their midzone. From the standpoint of Porge’s polyvagal theory, trauma survivors lack spontaneity (ability to be playful) in social engagement.
Consequently, trauma therapy interventions should rely on modalities that facilitate creativity, spontaneity and playfulness.
Staying in the present may sound simple, but for trauma survivors stuck in withdrawal, rumination and defensive reactions, being in the present seems like an impossible task. Survivors who are hypoaroused need assistance to be uplifted from a state of frozenness, and survivors who are hyperaroused need support to be calmed.
To assist this process, grounding activities are a good entry point for trauma intervention. Grounding is a form of body-awareness. Grounding activities help survivors become aware of the present moment, while paying attention to the sensations that arise in that process. Grounding activities cross-over the emergency highway, and connect the survivor to higher parts of brain functioning.
Various tools can be used to achieve grounding. As a trauma survivor and later as a therapist, I have found that incorporating experiential aspects into the practice of being in the present (grounding) assists in increasing body-awareness and foster self-regulation**.
Learn more about the experiential grounding and application of it in the upcoming Expressive Trauma Integration third workshop Series I: Emotional Regulation and Experiential Grounding . February 4, 2018 in Silver Spring MD.
*“Affect is a is a non-conscious experience of intensity…Affect plays an important role in determining the relationship between our bodies, our environment, and others, and the subjective experience that we feel/think as affect dissolves into experience.”
“A feeling is a sensation that has been checked against previous experiences and labelled.”
“An emotion is the projection/display of a feeling. Unlike feelings, the display of emotion can be either genuine or feigned.” (Shouse, 2005).
** Whether using experiential grounding or other approaches, for survivors, staying in the moment may also mean allowing themselves to experience emotions, sensations, and feelings that are terrifying, unbearable, or that seem life threatening. For this reason, establishing a sense of safety first is required.
Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation (Norton Series on Interpersonal Neurobiology). WW Norton & Company.
Shouse, E. (Dec. 2005) “Feeling, Emotion, Affect,” M/C Journal, 8(6). Retrieved from <http://journal.media-culture.org.au/0512/03-shouse.php>.
Siegel, D. J. (2010). Mindsight: The new science of personal transformation. Bantam.
Van der Kolk, B. (2014). The body keeps the score. New York: Viking.
Gertel Kraybill, O. (2018). Experiential Self-Regulation in Trauma Therapy. Psych Central. Retrieved on February 21, 2018, from https://pro.psychcentral.com/experiential-self-regulation-in-trauma-therapy/