Trauma & Attachment Therapy

Social Anxiety Treatment

(Dear readers, I'm deep into writing Trauma Treatment Handbook and have been neglecting my blog. Here's an email exchange that the correspondent has graciously given me permission to post.)

From the asker: I just came across your site while researching heart rate coherence.  I have Servan Shreiber's book(s) and actually had forgotten about heart rate coherence until it recently came up again while doing research for my father's heart disease/stress.

I was hoping you might be able to help me navigate in terms of finding the right tools to help myself with what seems to be social phobia (as it's outer manifestation anyway). I have come to realize that I avoid going out and being around others and have managed to avoid talking on the phone although it is a source of stress for me.  If you met me, you probably wouldn't know this(well maybe YOU would) most people don't but I sense people do notice my discomfort when  I have it.  I feel as if I'm never in my own skin and i don't really feel truly in the moment very often.  When I look back...i believe this has been the case for decades but I just wasn't conscious of it.  I don't feel joy very often and I have a hard time remembering things from the past....as if I wasn't even there.

If I have given you the impression that I am suicidal or depressed i assure you I am not:)  I have really been taking care of myself in many ways and I'm trying not to make this into a "problem".  I eat well, I recently gave up smoking...again.  I go to acupuncture, I excersise every day as always and take my supplements(incuding the 7:1 epa:dha which is new).  It's as if the more conscious I am of the issues, the better i am taking care of myself but the worse I feel.  Maybe this is just part of the process.  But still, the anxiety/fear gives me constant problems in my every day life and I'm concerned that they will not be resolved .  Case in point-my boyfreind of 7 years just mentioned his brother and nephew want to come for a visit again(they were here recently).  I found myself making all of these excuses as to why it wouldn't work right now but the truth is It takes my all to pull it off even when it's my own family.  I put a great game face on but it's as if it's a performance and it sucks every last bit of life from me and I feel like I can't keep it up the way I used to.  Bottome line.....I'm tired of feeling like this!

 I keep wondering if there's something internal that isn't being dealt with.   I'm not sure I believe therapy is what is best for me.  I was in therapy on and off for years and iscovered I had a better understanding of how I felt but in the end I still felt like crap. I am, however, intrigued by what I read about EMDR in Servan Shreiber's book.  My fear is it won't be helpful to me and I will humiliate myself in the process........I tend to freeze/go blank when the focus is on me which becomes yet another source of anxiety.

Any ideas on what I may be able to try by myself .  Do you think the heart rate coherence is enough based on your experience.   Any thoughts about the EMDR or any other therapy I might consider?  I'm in a fairly rural area but I'm near a large town and discovered that there are 5 or 6 therapist trained in EMDR.  I know it's near impossible to give any suggestions for someone you've never met.

I have never done this before but you struck me as the right person to ask.  I would be most grateful for anything you may have to offer.  Thanks for your time Robin!!

My Reply: In my opinion and in other people's research there are a clan of people who feel anxiety more strongly. Research shows that social anxiety can be predicted by a 3-week-old baby's reaction to a puff of air in their face. The bad news is, you're anxious.  The good news is, even though your body may be more aware of its anxiety response than some other people's bodies are, there's a lot you can do to manage it.
 
EMDR can be a great way to clear out the trauma part of your sensitivity and give you internal practice at dealing with social situations. And do exercise, take O 3's and D's and learn how to calm your body.
 
Read: Elaine Aron's The Highly Sensitive Person. If it's a fit for you, it's like a care and feeding manual for anxious people.
 
I'm married to an HSP, who used to have social anxiety. He's still high strung, but he no longer lets it stop him from doing anything. Through therapy he's learned to ask for what he wants, say no when he needs to, and accept that he's never going to love crowded places. He's even doing some public talks, now and then. Years ago, he wouldn't knock on neighbors' doors to talk to them about the block party. He doesn't think twice about it now, in fact he's been the Block Captain. And he's still very sensitive to his anxiety, still predicts the worst outcome for everything (he's the designated worrier in the marriage and I'm the designated pooh-pooher), still thinks that we'll be late, and there will be a disaster. (Then we're not late and he has a better time than I do.)
 
Get therapy. Get EMDR from the best person in town. If you don't like them, try someone else. Tell them to read my chapter about anxiety if they haven't done it. And if you had some deficits in your childhood and are not an HSP, they can nail it completely and clear the anxiety, unlike my genetically nervous husband.

Asker: You're a sweet heart!  I don't feel like a freak after reading this.  I think my judgement of what I'm experiencing makes it much worse.
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Bainbridge Book-Signing Party

Book Signing Party!

On Beautiful Bainbridge Island

June 14, 2-5PM

 

Sandra Paulsen, Ph.D & Robin Shapiro, MSW, LCSW will be there to sign and read excerpts of their 2009 books. We may have a special guest reader, Yaak Panksepp.
Bring your checkbook if you want to buy a book. Save shipping costs!

Location: 9054 Battle Point Dr. NE, Bainbridge, Island, WA 98110
At the log house in the woods of Sandra Paulsen, Ph. D and Tim Iistowanohpataakiiwa, MA. Weather permitting, there will be a campfire in the pasture with the horses.

From Seattle: Take the Bainbridge Ferry to wy 305, turn left at the third light--Sportsman's Road--and an immediate right on New Brooklyn. The next light is Miller Road, turn right, go two blocks, then left on Battle Point Drive. Follow the S curve to the very top of the hill. Turn tight at the big cedar mailbox at 9065 Battle Point Dr., and veer right at the fork in the driveway. If you pass Bainbridge Gardens on the left you have gone too far.

From Poulsbo: Take Hwy 305 across Agate Pass Bridge to the first light. Turn right on Miller Road and veer left. Go straight for several miles. Turn right just past Bainbridge Gardens, onto Battle Point Drive. Follow the S curve to the very top of the hill. Turn tight at the big cedar mailbox at 9065 Battle Point Dr., and veer right at the fork in the driveway.

Presented by Sandra Paulsen, Ph. D. and the Bainbridge Institute for Integrative Psychology.

For more information:
206-855-1133
sandra@paulsenphd.com
www.bainbridgepsychology.com

"Mental" Is Terrible

There's a new fantasy show on Fox: Mental. It's supposed to take place in an inpatient psych unit.

So, first, the new head of psychiatry strips down in a room full of clients to connect with a psychotic guy who has pulled his clothes off. Later, he breaks into a woman's house in order to check out his hunch that her schizophrenic brother is an artist. And he thinks it's a good idea for his patients to go cold turkey off their antipsychotic medications. And he doesn't lose his contract, immediately.

All the psychiatrists are cute. All the patients are reasonable. The families just don't understand. And the residents and other psychiatrists have endless time to spend with their clients. Oh, and they invented a radical new idea: intensive outpatient day treatment.

I saw bad treatment, silly ideas, and a romanticization of extreme mental illness. I saw nearly every 1960's cliche possible. It's really bad. Except that all the psychiatrists are cute. And the new head of psychiatry looks to be about 32. That would happen, too.

 

Spirituality and Neuroscience

There was a great series on National Public Radio this week about the neuroscience of spirituality. I'm going to post links to all 5 days. You can read about it and then play the pieces if you want. They're by Barbara Bradley Haggerty and each is 7 to 9 minutes.

1. Is there a God chemical?                     http://www.npr.org/templates/story/story.php?storyId=104240746

2. Are Spiritual Encounters All in Your Head? http://www.npr.org/templates/story/story.php?storyId=104291534

3. Prayer May Reshape Your Brain, and your Reality: http://www.npr.org/templates/story/story.php?storyId=104310443

4. Can Positive Thoughts Heal Another Person: http://www.npr.org/templates/story/story.php?storyId=104351710

5. Decoding the Mystery of Near Death Experiences: http://www.npr.org/templates/story/story.php?storyId=104397005

Daphne Merkin on Her Chronic Depression

Daphne Merkin, a New York Times writer, articulately recounts her history and hospitalization for Depression:

http://www.nytimes.com/2009/05/10/magazine/10Depression-t.html?pagewanted=all

Connie Sidles Interview: Grief, meaning, presence and bliss

Connie Sidles is a famous Seattle birder. Here is this week's KUOW radio interview with her about why she spends so many hours at the Montlake Fill. Connie gives a cogent discussion of dealing with grief, how to create/have meaning in life, how to get present, and why birding creates bliss in its more conscious adherents. Hear her here: http://kuow.org/program.php?id=17451

And if you want to see my husband's book of photographs of the Montlake Fill, go here: http://issuu.com/dougplummer/docs/at_the_fill . You don't have to buy the book to see the pictures. Click on the book then on the pages below. You can listen to Connie on one Explorer and look at the book on the other. Connie wrote the intro to the book.

Addiction, a form of dissociation, II

Ulrich Lanius, a clincial psychologist, researcher, therapist, and writer in Vancouver sent me this:

"The connection between dissocation, depression and addiction is a fascinating one and more likely than not  related to attachment. An article written by Bessel van der Kolk some insight into this:

http://www.cirp.org/library/psych/vanderkolk/

For more intensive reading, Alan Schore describes the effect between attachment and infant trauma and how they lead to traumatic stress syndromes:

http://www.trauma-pages.com/a/schore-2001b.php

There is little doubt that dissociation is in part mediated by an excessive release of endogenous opiates/endorphins. Animal studies that mimic neglect also suggest that animals that have experienced lack of caregiving have fewer opiate receptors. This likely  leads to lack of pleasure and sometimes intolerance of positive emotions, a common phenomenon in human beings that have experienced attachment trauma and who suffer from depression.

Addictions can be seen as an attempt by the addict to make up for impaired functioning of their own opiate system. Except that the pleasure derived is short lasting and commonly leads to negative outcomes in the long run, health or otherwise.

Another exciting development in the research on opiates are the effects of opiate antagonists on immmune system disorders but also potentially positive effects on depression. A review paper can be found here:

www.ldn4cancer.com/techpapers/ldn_for_disease_prevention_quality_of_life.pdf  "

Thanks Ulrich!

Mindfulness Through Pleasure

Mindfulness is a major goal of psychotherapy. We want our clients to be able to savor the moment free of intrusive memories or worries about the future: Right Now. There are many ways to bring a client to the present moment: teaching mindfulness meditation, body awareness, or playing what do you notice? ("Name 3 things in the room that are red, 3 things you hear, 3 sensations.")

Some of my more anxious clients find that their obsessiveness scuttles attempts to meditate ("Am I doing it right? This is stupid? What am I supposed to be focusing on? I can't do it!). Body awareness reminds them of what could go wrong with their bodies. ("What if I stop breathing?!) I'm teaching these folks to make state changes through noticing pleasure. Here's how it works:

"Look around the office. Look out the window. Notice what catches your eye. Notice what's fun to look at or that you enjoy seeing. Stay with whatever it is, as long as it's interesting or pleasurable. (Usually they start to smile and to relax at this point.) When you're ready, and only when you're ready, look around for something else that pleases you. Stay with that object or view until you feel like moving on. Stay with it as long as you like. Great!" (We usually do 3 objects or views. I say that my eye can be pleased by looking at the angles on a molding, or 3 planes coming together in the corner of the room. I only have art that I like and little objects scattered about to look at. I tell them how much I like to look at the big tree across the street. This kind of pleasure can be a new experience for some, and quite profound. For others, it's not new, but consciously using it for mindfulness or self-soothing might be new.) "Now notice how you're sitting on the couch. Could you do anything to make that more comfortable? Try sinking into those cushions. How's that? Try sitting straighter or sticking this pillow behind your back. What feels the best? What fabric feels the best under your fingers? How about your hair on your hand? Do you like that texture?" (Crew cuts win this one!) Hang with what feels the best. Can you imagine the next time you take a shower, totally feeling that hot water, and enjoying it? Can you imagine being worried about something that you don't have power over, and finding something pleasing to look at or feel or smell or do? Think of something that might happen at work, and soothing yourself with something you enjoy. Think of something that happens at home, and coming back to yourself and this moment with something pleasing. If you commute, think of the irritating drivers and the waiting, and how you can shift your body in the car for your best comfort, and look at something interesting, a cool car, the view, a cloud, a bumper sticker, and while still paying attention to driving, have a little pleasure vacation."

People do this homework. And it works, even with the most anxious. And it doesn't feel like work. And they learn both mindfulness and painless state change. It doesn't clear underlying trauma. It doesn't take away an anxiety disorder. But it's a nice, easy habit to take on.

Is addiction a form of dissociation?

I read an article about how naltrexone, an opiate suppressant, curbs the urge to engage in kleptomania. I've had dissociative clients who have successfully used naloxone and naltraxone to vanquish their endogenous (internal) opiates, in order to be able to stay present and process traumatic events, instead of switching or spacing out completely. (See EMDR Processing w/ Dissociative Clients: Adjunctive Use of Opioid Antagonists by Ulrich Lanius, in EMDR Solutions: Pathways to Healing, 2005). I've also had success using ego state work with addicts, alcoholics, and people with compulsive/addictive behaviors. Here's my theory: Opiate Antagonists work on dissociation because much of dissociation is run by endogenous opiates. When addicts think of their drug or behavior of choice, they begin to enjoy their endogenous opiates. When they engage in their drug or behavior it gives them an even better high. The neural pathways to the repetitive addictive behavior become wide and strong, until they become ego states. When people in recovery talk about "my addict", they refer to this strong ego state. Integrate the ego state and help heal the addiction.

So how does this work? Have clients bring up the last time they were frantic to use, or the last time they did use. "Where do you feel that inside? What's the feeling? Float back to the first time you had that feeling. How old is that? What was happening then? Can you bring your adult back to that time/that kid? What do you need to tell that child? You're with her. You can fly her up to the present time. She's with you all the time, now, and you're with her. Can you tell her that now, as a competent adult, you can tolerate those enormous feelings? Can you show her how you have learned to soothe yourself without that drug/behavior? How's that kid doing now? (Do whatever it takes to calm her down.) And are you ready to hug her into you now and forever?"

There is usually a frantic little child and often an angry/protective teenage part. Sometimes there are several "parts" involved in different pieces of the addiction. It has worked on several clients.

A.J. Popky and Jim Knipe have protocols that seem to fit my opiate theory. Popky developed the Level of Urge to Use. Knipe spun off the Level of Urge to Avoid. In both of these you have the person imagine whatever triggers them to use a drug or to avoid a task and to feel how good it would feel to use or avoid. Then you do eye movements and watch the good feeling start to fade away. (DeTUR, an Urge Reduction Protocol for Addictions and Dysfunctional Behaviors by Popky, and Targeting Positive Affect to Clear the Pain of Unrequited Love, Codependence, Avoidance, and Procrastination-- both in EMDR Solutions: Pathways to Healing, 2005, Norton.) You target inappropriate positive affect in both cases. When the positive affect (the good endogenous drugs) fade, you target the distressing affect underneath, and the trigger stops being a trigger. I've done this many times, for many addicts. It works amazingly well.

I've watched clients and people in my private life turn into unrecognizable demons, sociopaths, and screaming or pleading children while in thrall to their addictions. The dissociation/opiate theory explains these behavioral shifts. Please comment and give me your opinion about this theory.

Book Signing Parties!

 

 

Book Parties

EMDR Solutions II for Depression, Eating Disorders,

Performance & More

Robin Shapiro, Editor

&

Looking Through the Eyes of Trauma and Dissociation:

An Illustrated Guide for EMDR Clinicians and Clients

by Sandra Paulsen

Meet both authors at each party.

 2: 00, April 19th, 2009

at 6203 28th Ave NE, Seattle, WA

&

2:00 June 14

at Sandra's log house on Bainbridge Island

Readings, Signing, Snacks, Socializing.

If you are a therapist or friend who wants to celebrate with us, please attend. Bring your books for signing or buy them from us, or just show up for the party.

Please RSVP, if possible, or get more information,

for the Seattle party: Robin 

or the Bainbridge party: Sandra